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Bonsel JM, Reijman M, Verhaar JAN, van Steenbergen LN, Janssen MF, Bonsel GJ. Socioeconomic inequalities in patient-reported outcome measures of Dutch primary hip and knee arthroplasty patients for osteoarthritis. Osteoarthritis Cartilage 2024; 32:200-209. [PMID: 37482250 DOI: 10.1016/j.joca.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To study socio-economic inequalities in patient-reported outcomes in primary hip and knee arthroplasty (THA/TKA) patients for osteoarthritis, using two analytical techniques. METHODS We obtained data from 44,732 THA and 30,756 TKA patients with preoperative and 12-month follow-up PROMs between 2014 and 2020 from the Dutch Arthroplasty Registry. A deprivation indicator based on neighborhood income, unemployment rate, and education level was linked and categorized into quintiles. The primary outcome measures were the EQ-5D-3L index and Oxford Hip/Knee Score (OHS/OKS) preoperative, at 12-month follow-up, and the calculated change score between these measurements. We contrasted the most and least deprived quintiles using multivariable linear regression, adjusting for patient characteristics. Concurrently, we calculated concentration indices as a non-arbitrary tool to quantify inequalities. RESULTS Compared to the least deprived, the most deprived THA patients had poorer preoperative (EQ-5D -0.03 (95%CI -0.02, -0.04), OHS -1.26 (-0.99, -1.52)) and 12-month follow-up health (EQ-5D -0.02 (-0.01, -0.02), OHS -0.42 (-0.19, -0.65)), yet higher mean change (EQ-5D 0.02 (0.01, 0.03), OHS 0.84 (0.52, 1.16)). The most deprived TKA patients had similar results. The higher mean change among the deprived resulted from lower preoperative health in this group (confounding). After accounting for this, the most deprived patients had a lower mean change. The concentration indices showed similar inequality effects and provided information on the magnitude of inequalities over the entire socio-economic range. CONCLUSION The most deprived THA and TKA patients have worse preoperative health, which persisted after surgery. The concentration indices allow comparison of inequalities across different outcomes (e.g., revision risk).
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Affiliation(s)
- Joshua M Bonsel
- Department of Orthopaedics and Sports Medicine, Erasmus MC, the Netherlands.
| | - Max Reijman
- Department of Orthopaedics and Sports Medicine, Erasmus MC, the Netherlands.
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC, the Netherlands.
| | - Liza N van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), the Netherlands.
| | - Mathieu F Janssen
- Department of Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, the Netherlands.
| | - Gouke J Bonsel
- EuroQol Research Foundation, Rotterdam, the Netherlands.
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Becker ML, Hurkmans HLP, Verhaar JAN, Bussmann JBJ. Validation of the Activ8 Activity Monitor for Monitoring Postures, Motions, Transfers, and Steps of Hospitalized Patients. Sensors (Basel) 2023; 24:180. [PMID: 38203041 PMCID: PMC10781347 DOI: 10.3390/s24010180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/13/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024]
Abstract
Sedentary behaviors and low physical activity among hospitalized patients have detrimental effects on health and recovery. Wearable activity monitors are a promising tool to promote mobilization and physical activity. However, existing devices have limitations in terms of their outcomes and validity. The Activ8 device was optimized for the hospital setting. This study assessed the concurrent validity of the modified Activ8. Hospital patients performed an activity protocol that included basic (e.g., walking) and functional activities (e.g., room activities), with video recordings serving as the criterion method. The assessed outcomes were time spent walking, standing, upright, sedentary, and newly added elements of steps and transfers. Absolute and relative time differences were calculated, and Wilcoxon and Bland-Altman analyses were conducted. Overall, the observed relative time differences were lower than 2.9% for the basic protocol and 9.6% for the functional protocol. Statistically significant differences were detected in specific categories, including basic standing (p < 0.05), upright time (p < 0.01), and sedentary time (p < 0.01), but they did not exceed the predetermined 10% acceptable threshold. The modified Activ8 device is a valid tool for assessing body postures, motions, steps, and transfer counts in hospitalized patients. This study highlights the potential of wearable activity monitors to accurately monitor and promote PA among hospital patients.
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Affiliation(s)
- Marlissa L. Becker
- Physical Therapy, Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Henri L. P. Hurkmans
- Physical Therapy, Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Jan A. N. Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Johannes B. J. Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
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Mulder CFL, van der Vlist AC, van Middelkoop M, van Oosterom RF, van Veldhoven PLJ, Weir A, Verhaar JAN, de Vos RJ. Do physical tests have a prognostic value in chronic midportion Achilles tendinopathy? J Sci Med Sport 2023; 26:421-428. [PMID: 37482492 DOI: 10.1016/j.jsams.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/18/2023] [Accepted: 06/28/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES To determine whether baseline physical tests have a prognostic value on patient-reported outcomes in Achilles tendinopathy. DESIGN Prospective cohort study, secondary analysis of data from a randomized trial. METHODS Patients with chronic midportion Achilles tendinopathy performed a progressive calf muscle exercise program. At baseline and after 2, 6, 12 and 24 weeks, patients completed the Victorian Institute of Sports Assessment-Achilles questionnaire and performed the following physical tests: ankle dorsiflexion range of motion with a bent knee or an extended knee, calf muscle strength, jumping height and pain on palpation (Visual Analogue Scale; 0-100) and after 10 hops (Visual Analogue Scale-10-hops). Associations between baseline test results and improvement (Victorian Institute of Sports Assessment-Achilles scores) were determined using a Mixed Linear Model. RESULTS 80 patients were included. The mean Victorian Institute of Sports Assessment-Achilles score improved 20 points (95 % confidence interval, 16-25, P < .001) after 24 weeks. There were significant associations between the baseline ankle dorsiflexion range of motion with a bent knee (β 0.2, 95 % confidence interval 0.001 to 0.3, P = .049), the baseline pain provocation tests (Visual Analogue Scale palpation: β -0.2; 95 % confidence interval: -0.4 to -0.1; P < .001, Visual Analogue Scale-10-hops: β -0.3; 95 % confidence interval: -0.4 to -0.2; P < .001) and the change in the Victorian Institute of Sports Assessment-Achilles score. CONCLUSIONS In patients with chronic midportion Achilles tendinopathy, easy-to-perform pain provocation tests have a clinically relevant prognostic value on patient-reported improvement. Patients with less pain during pain provocation tests at baseline have a better improvement in pain, function and activities after 24 weeks than patients with high baseline pain scores.
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Affiliation(s)
- Céline F L Mulder
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, the Netherlands
| | - Arco C van der Vlist
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, the Netherlands; Department of General Practice, Erasmus MC University Medical Center, the Netherlands
| | | | | | | | - Adam Weir
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, the Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, the Netherlands.
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Koper MC, Spek RWA, Reijman M, van Es EM, Baart SJ, Verhaar JAN, Bos PK. Are serum cobalt and chromium levels predictors for patient-reported outcome measures in the ASR hip resurfacing arthroplasty? Bone Joint J 2023; 105-B:775-782. [PMID: 37394959 DOI: 10.1302/0301-620x.105b7.bjj-2022-1359.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Aims The aims of this study were to determine if an increasing serum cobalt (Co) and/or chromium (Cr) concentration is correlated with a decreasing Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) in patients who received the Articular Surface Replacement (ASR) hip resurfacing arthroplasty (HRA), and to evaluate the ten-year revision rate and show if sex, inclination angle, and Co level influenced the revision rate. Methods A total of 62 patients with an ASR-HRA were included and monitored yearly postoperatively. At follow-up, serum Co and Cr levels were measured and the HHS and the HOOS were scored. In addition, preoperative patient and implant variables and the need for revision surgery were recorded. We used a linear mixed model to relate the serum Co and Cr levels to different patient-reported outcome measures (PROMs). For the survival analyses we used the Kaplan-Meier and Cox regression model. Results We found that an increase of one part per billion (ppb) in serum Co and Cr levels correlated significantly with worsening of the HHS in the following year. This significant correlation was also true for the HOOS-Pain and HOOS-quality of life sub scores. The overall ten-year survival rate in our cohort was 65% (95% confidence interval (CI) 52.5 to 77.6). Cox regression analysis showed a significant hazard ratio (HR) of 1.08 (95% CI 1.01 to 1.15; p = 0.028) for serum Co level. No significance was found with sex or inclination angle. Conclusion This study shows that increasing serum Co and Cr levels measured in patients with an ASR-HRA are predictive for deterioration in HHS and HOOS subscales in the following year. Increasing serum Co and Cr should forewarn both surgeon and patient that there is a heightened risk of failure. Continued and regular review of patients with an ASR-HRA implant by measurement of serum Co/Cr levels and PROMs remains essential.
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Affiliation(s)
- Maarten C Koper
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Reinier W A Spek
- Department of Trauma and Orthopedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Max Reijman
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Eline M van Es
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - P K Bos
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, the Netherlands
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Beddows TPA, Weir A, Agricola R, Tak IJR, Piscaer TM, Verhaar JAN, Klij PV. Hip and groin pain in male field hockey players: Prevalence, incidence and associations with patient reported outcome scores and hip muscle strength. Phys Ther Sport 2023; 61:66-72. [PMID: 36933477 DOI: 10.1016/j.ptsp.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES Investigate point prevalence (second half season 2018-2019) and incidence (season 2017-2018 and first half season 2018-2019) of non-time-loss and time-loss hip/groin pain in male field hockey players. Secondary aims were to study associations between: current/previous hip/groin pain and hip muscle strength, patient reported outcome measures (PROM) and hip muscle strength, and previous hip/groin pain and PROMs. Additionally we studied normal values for the PROMs (Hip and Groin Outcome Score (HAGOS)). DESIGN Cross-sectional study. SETTING Testing at field hockey clubs. PARTICIPANTS 100 male field hockey players (elite, sub-elite and amateur). MAIN OUTCOME MEASURES Point prevalence and incidence of hip/groin pain, strength: eccentric adduction and abduction, adductor squeeze, HAGOS. RESULTS Hip/groin pain point prevalence was 17% (time-loss: 6%) and incidence was 36% (time-loss: 12%). Presence of current or previous hip/groin and lower HAGOS-values were not associated with lower hip muscle strength. Previous hip/groin pain was associated with a significant lower HAGOS-values in all domains, except for the 'participation in physical activities' domain. CONCLUSIONS Hip/groin pain is common in field hockey. One fifth of players have hip/groin pain and one third had pain in the previous season. Previous hip/groin pain was associated with worse ongoing patient reported outcomes in most domains.
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Affiliation(s)
- T P A Beddows
- Afdeling Orthopedie & Sportgeneeskunde, Erasmus Medisch Centrum, Rotterdam, the Netherlands.
| | - A Weir
- Afdeling Orthopedie & Sportgeneeskunde, Erasmus Medisch Centrum, Rotterdam, the Netherlands; Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - R Agricola
- Afdeling Orthopedie & Sportgeneeskunde, Erasmus Medisch Centrum, Rotterdam, the Netherlands; Afdeling Orthopedische Chirurgie, Sport & Orthopedie Eindhoven, St. Anna Ziekenhuis, the Netherlands
| | - I J R Tak
- Fysiotherapie Utrecht Oost, Utrecht, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS) / IOC Research Center of Excellence, Amsterdam, the Netherlands
| | - T M Piscaer
- Afdeling Orthopedie & Sportgeneeskunde, Erasmus Medisch Centrum, Rotterdam, the Netherlands
| | - J A N Verhaar
- Afdeling Orthopedie & Sportgeneeskunde, Erasmus Medisch Centrum, Rotterdam, the Netherlands
| | - P van Klij
- Afdeling Orthopedie & Sportgeneeskunde, Erasmus Medisch Centrum, Rotterdam, the Netherlands; Afdeling Sportgeneeskunde, Isala Ziekenhuis, Zwolle, the Netherlands
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Lagas IF, Tol JL, Weir A, de Jonge S, van Veldhoven PLJ, Bierma-Zeinstra SMA, Verhaar JAN, de Vos RJ. One fifth of patients with Achilles tendinopathy have symptoms after 10 years: A prospective cohort study. J Sports Sci 2023; 40:2475-2483. [PMID: 36617848 DOI: 10.1080/02640414.2022.2163537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Patients with midportion Achilles tendinopathy (AT) are thought to experience a gradual symptomatic improvement over time. The aim of this study was to prospectively investigate if patients with midportion AT have symptoms at 10-year follow-up. Patients withmidportion AT were invited to complete an online questionnaire 10 years after inclusion in an intervention trial. The primary outcomewas the presence of AT symptoms. Secondary outcomes were: the Victorian Institute of Sports Assessment-Achilles tendinopathy (VISA-A, 0-100) score and sports activity level. Of the 54 patientsincluded, 43 (80%) completed the questionnaire at an average follow-up of 10.4 years. Persisting symptoms were reported by 19%. The mean (standard deviation-SD) VISA-A score improved from 52 (17) at baseline to 79 (21) at 10-years follow-up with a mean change of 27 points (95% confidence interval: 21; 35, p < 0.001). Of the 38 active patients, 16 (42%) returned to their pre-injury level sports,of whom 14 (37%) performed them pain free. One-fifth of patients with conservatively treated midportion AT still have symptoms after 10years. One-third of patients were able to perform sports pain-free atpre-injury level. Patients should be adequately counselled to giverealistic expectations. Trial registration number: clinicaltrials.gov (identifier: NCT00761423).
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Affiliation(s)
- Iris F Lagas
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johannes L Tol
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Amsterdam University Medical Center, Academic Medical Center, Amsterdam Movement Sciences, Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Adam Weir
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Medicine and Exercise Clinic Haarlem (SBK), IJsbaanlaan 4B, 2024 AV Haarlem, The Netherlands
| | - Suzan de Jonge
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Sita M A Bierma-Zeinstra
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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van der Graaff SJA, Reijman M, van Es EM, Bierma-Zeinstra SMA, Verhaar JAN, Meuffels DE. Meniscal procedures are not increased with delayed ACL reconstruction and rehabilitation: results from a randomised controlled trial. Br J Sports Med 2023; 57:78-82. [PMID: 36137731 DOI: 10.1136/bjsports-2021-105235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess whether initial non-operative treatment of anterior cruciate ligament (ACL) ruptures with optional delayed ACL reconstruction leads to more meniscal procedures compared with early ACL reconstruction during the 2-year follow-up. METHODS We compared the number of meniscal procedures of 167 patients with an ACL rupture, who either received early ACL reconstruction (n=85) or rehabilitation therapy plus optional delayed ACL reconstruction (n=82), participating in the Conservative vs Operative Methods for Patients with ACL Rupture Evaluation trial. Patients were aged 18 to 65 years (mean 31.3, SD 10.5), 60% male sex (n=100). We evaluated the presence and location of meniscal tears by baseline MRI. We analysed and compared how many patients per randomisation group had a meniscal procedure during follow-up in the ACL injured knee, adjusted for sex, body mass index, age group and orthopaedic surgeon. RESULTS At baseline, 41% of the entire study population (69/167 patients) had a meniscal tear on MRI. During the 2-year follow-up, 25 patients randomised to early ACL reconstruction (29%, 25/85 patients) had a meniscal procedure, compared with 17 patients randomised to rehabilitation plus optional delayed reconstruction (21%, 17/82 patients) (risk ratio 0.67 with 95% CI 0.40 to 1.12, p=0.12). Of these patients who received early ACL reconstruction (n=82) and patients that received delayed ACL reconstruction (n=41), 5% of the patients had an additional isolated meniscal procedure after ACL reconstruction. In patients who received no ACL reconstruction (n=41), 10% (n=4) had an isolated surgical procedure for a meniscal tear during the 2-year follow-up period. CONCLUSION Initial non-surgical treatment of ACL ruptures followed by optional delayed ACL reconstruction does not lead to a higher number of meniscal procedures compared with early ACL reconstruction over a 2-year follow-up period. TRIAL REGISTRATION NUMBER NL 2618.
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Affiliation(s)
| | - Max Reijman
- Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Eline M van Es
- Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Duncan E Meuffels
- Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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van Buuren MMA, Heerey JJ, Smith A, Crossley KM, Kemp JL, Scholes MJ, Lawrenson PR, King MG, Gielis WP, Weinans H, Lindner C, Souza RB, Verhaar JAN, Agricola R. The association between statistical shape modeling-defined hip morphology and features of early hip osteoarthritis in young adult football players: Data from the femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study. Osteoarthr Cartil Open 2022; 4:100275. [PMID: 36474944 PMCID: PMC9718108 DOI: 10.1016/j.ocarto.2022.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To explore the relationship between radiographic hip shape and features of early hip osteoarthritis (OA) on magnetic resonance imaging (MRI) in young male and female football players without radiographic hip OA. Design We used baseline data from a cohort of symptomatic and asymptomatic football players aged 18-50 years. Hip shape was assessed on anteroposterior radiographs with statistical shape modeling (SSM) for men and women separately. Cartilage defects and labral tears were graded using the Scoring Hip Osteoarthritis with MRI (SHOMRI) system. We used logistic regression with generalized estimating equations to estimate associations between each hip shape variant, called shape modes, and cartilage defects or labral tears. Results We included 229 participants (446 hips, 77.4% male). For each sex, 15 shape modes were analyzed. In men, three shape modes were associated with cartilage defects: adjusted odds ratios (aOR) 0.75 (95%CI 0.58-0.97) per standard deviation (SD) for mode 1; 1.34 (95%CI 1.05-1.69) per SD for mode 12; and 0.61 (95%CI 0.48-0.78) per SD for mode 15; and one also with labral tears: aOR 1.30 (95%CI 1.01-1.69) per SD for mode 12. These modes generally represented variations in the femoral neck and subtypes of cam morphology, with and without pincer morphology. For women, there was no evidence for associations with the outcomes. Conclusions Several hip shape variants were associated with cartilage defects on MRI in young male football players. Specifically, one subtype of cam morphology was associated with both cartilage defects and labral tears. Hip shape was not associated with early OA features in women.
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Affiliation(s)
- M M A van Buuren
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - A Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - K M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - J L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - M J Scholes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - P R Lawrenson
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - M G King
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - W P Gielis
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H Weinans
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - C Lindner
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - R B Souza
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, USA
| | - J A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R Agricola
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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van der Graaff SJA, Eijgenraam SM, Meuffels DE, van Es EM, Verhaar JAN, Hofstee DJ, Auw Yang KG, Noorduyn JCA, van Arkel ERA, van den Brand ICJB, Janssen RPA, Liu WY, Bierma-Zeinstra SMA, Reijman M. Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial. Br J Sports Med 2022; 56:bjsports-2021-105059. [PMID: 35676079 PMCID: PMC9304087 DOI: 10.1136/bjsports-2021-105059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To compare outcomes from arthroscopic partial meniscectomy versus physical therapy in young patients with traumatic meniscal tears. METHODS We conducted a multicentre, open-labelled, randomised controlled trial in patients aged 18-45 years, with a recent onset, traumatic, MRI-verified, isolated meniscal tear without knee osteoarthritis. Patients were randomised to arthroscopic partial meniscectomy or standardised physical therapy with an optional delayed arthroscopic partial meniscectomy after 3-month follow-up. The primary outcome was the International Knee Documentation Committee (IKDC) score (best 100, worst 0) at 24 months, which measures patients' perception of symptoms, knee function and ability to participate in sports activities. RESULTS Between 2014 and 2018, 100 patients were included (mean age 35.1 (SD 8.1), 76% male, 34 competitive or elite athletes). Forty-nine were randomised to arthroscopic partial meniscectomy and 51 to physical therapy. In the physical therapy group, 21 patients (41%) received delayed arthroscopic partial meniscectomy during the follow-up period. In both groups, improvement in IKDC scores was clinically relevant during follow-up compared with baseline scores. At 24 months mean (95% CI) IKDC scores were 78 (71 to 84) out of 100 points in the arthroscopic partial meniscectomy group and 78 (71 to 84) in the physical therapy group with a between group difference of 0.1 (95% CI -7.6 to 7.7) points out of 100. CONCLUSIONS In this trial involving young patients with isolated traumatic meniscal tears, early arthroscopic partial meniscectomy was not superior to a strategy of physical therapy with optional delayed arthroscopic partial meniscectomy at 24-month follow-up. TRIAL REGISTRATION https://www.trialregister.nl/trials.
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Affiliation(s)
| | - Susanne M Eijgenraam
- Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Duncan E Meuffels
- Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Eline M van Es
- Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Dirk Jan Hofstee
- Orthopaedics, Noordwest Hospital Group, Alkmaar, The Netherlands
| | | | | | | | | | - Rob P A Janssen
- Orthopaedic Surgery, Maxima Medical Centre, Eindhoven, The Netherlands
- Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Wai-Yan Liu
- Orthopaedic Surgery, Maxima Medical Centre, Eindhoven, The Netherlands
- Orthopaedic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Max Reijman
- Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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van der Graaff SJA, Meuffels DE, Bierma-Zeinstra SMA, van Es EM, Verhaar JAN, Eggerding V, Reijman M. Why, When, and in Which Patients Nonoperative Treatment of Anterior Cruciate Ligament Injury Fails: An Exploratory Analysis of the COMPARE Trial. Am J Sports Med 2022; 50:645-651. [PMID: 35048733 DOI: 10.1177/03635465211068532] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimal treatment strategy for patients with an anterior cruciate ligament (ACL) rupture is still under debate. Different determinants of the need for a reconstruction have not been thoroughly investigated before. PURPOSE To investigate why, when, and which patients with an ACL rupture who initially started with rehabilitation therapy required reconstructive surgery. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS In the Conservative versus Operative Methods for Patients with ACL Rupture Evaluation (COMPARE) trial, 167 patients with an ACL rupture were randomized to early ACL reconstruction or rehabilitation therapy plus optional delayed ACL reconstruction. We conducted an exploratory analysis of a subgroup of 82 patients from this trial who were randomized to rehabilitation therapy plus optional delayed ACL reconstruction. The reasons for surgery were registered for the patients who underwent a delayed ACL reconstruction. For these patients, we used the International Knee Documentation Committee (IKDC) subjective knee form, Numeric Rating Scale for pain, and instability question from the Lysholm questionnaire before surgery. To determine between-group differences between the nonoperative treatment and delayed ACL reconstruction group, IKDC and pain scores during follow-up were determined using mixed models and adjusted for sex, age, and body mass index. RESULTS During the 2-year follow-up of the trial, 41 of the 82 patients received a delayed ACL reconstruction after a median time of 6.4 months after inclusion (interquartile range, 3.9-10.3 months). Most reconstructions occurred between 3 and 6 months after inclusion (n = 17; 41.5%). Ninety percent of the patients (n = 37) reported knee instability concerns as a reason for surgery at the moment of planning surgery. Of these patients, 18 had an IKDC score ≤60, 29 had a pain score of ≥3, and 33 patients had knee instability concerns according to the Lysholm questionnaire before surgery. During follow-up, IKDC scores were lower and pain scores were higher in the delayed reconstruction group compared with the nonoperative treatment group. Patients in the delayed reconstruction group had a significantly younger age (27.4 vs 35.3 years; P = .001) and higher preinjury activity level compared with patients in the nonoperative treatment group. CONCLUSION Patients who experienced instability concerns, had pain during activity, and had a low perception of their knee function had unsuccessful nonoperative treatment. Most patients received a delayed ACL reconstruction after 3 to 6 months of rehabilitation therapy. At baseline, patients who required reconstructive surgery had a younger age and higher preinjury activity level compared with patients who did not undergo reconstruction.
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Affiliation(s)
- Sabine J A van der Graaff
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Eline M van Es
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Vincent Eggerding
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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11
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Cloosterman KLA, Fokkema T, de Vos RJ, Visser E, Krastman P, IJzerman J, Koes BW, Verhaar JAN, Bierma-Zeinstra SMA, van Middelkoop M. Educational online prevention programme (the SPRINT study) has no effect on the number of running-related injuries in recreational runners: a randomised-controlled trial. Br J Sports Med 2022; 56:676-682. [PMID: 35197248 PMCID: PMC9163714 DOI: 10.1136/bjsports-2021-104539] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of this study was to examine the effectiveness of an enhanced online injury prevention programme on the number of running-related injuries (RRIs) in recreational runners. METHODS We conducted a randomised-controlled trial in runners who registered for running events (distances: 10-42.195 km) in the Netherlands. Adult runners who provided informed consent were randomised into the intervention or control group. Participants in the intervention group received access to the online prevention programme, which included items to prevent RRIs. Participants in the control group followed their regular preparation for the running event. The primary outcome measure was the number of new RRIs from baseline to 1 month after the running event. To determine differences between injury proportions, univariate and multivariate logistic regression analyses were performed. RESULTS This study included 4050 recreational runners (63.5% males; mean (SD) age: 42.3 (12.1) years) for analyses. During follow-up, 35.5% (95% CI: 33.5 to 37.6) of the participants in the intervention group sustained a new RRI compared with 35.4% (95% CI: 33.3 to 37.5) of the participants in the control group, with no between-group difference (OR: 1.03; 95% CI: 0.90 to 1.17). There was a positive association between the number of items followed in the injury prevention programme and the number of RRIs (OR: 1.05; 95% CI: 1.00 to 1.11). CONCLUSION The enhanced online injury prevention programme had no effect on the number of RRIs in recreational runners, and being compliant with the programme paradoxically was associated with a slightly higher injury rate. Future studies should focus on individual targeted prevention with emphasis on the timing and application of preventive measures. TRIAL REGISTRATION NUMBER NL7694.
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Affiliation(s)
- Kyra L A Cloosterman
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Tryntsje Fokkema
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Edwin Visser
- Department of Physical Therapy, Sportgeneeskunde Rotterdam, Rotterdam, The Netherlands
| | - Patrick Krastman
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rotterdam Marathon Study Group, Rotterdam, The Netherlands
| | | | - Bart W Koes
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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12
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Herfkens J, van Buuren MMA, Riedstra NS, Verhaar JAN, Mascarenhas VV, Agricola R. Adding false-profile radiographs improves detection of developmental dysplasia of the hip, data from the CHECK cohort. J Hip Preserv Surg 2022; 9:3-9. [PMID: 35651710 PMCID: PMC9142192 DOI: 10.1093/jhps/hnac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/09/2021] [Accepted: 01/06/2022] [Indexed: 11/14/2022] Open
Abstract
The aim of this study was to determine the additional value of the false-profile (FP) view radiograph in the diagnosis of developmental dysplasia of the hip (DDH), as compared with an anteroposterior (AP) pelvic radiograph only, and evaluate the correlation between the Wiberg-lateral center edge angle (W-LCEA) and Wiberg-anterior center edge angle (W-ACEA). We used baseline data from a nationwide prospective cohort study (Cohort Hip and Cohort Knee). DDH was quantified on AP pelvic and FP hip radiographs using semi-automatic measurements of the W-LCEA and W-ACEA. A threshold of <20° was used to determine DDH for both the W-LCEA and the W-ACEA. The proportion of DDH only present on the FP view determined the FP view additional value. The correlation between the W-LCEA and W-ACEA was determined. In total 720 participants (1391 hips) were included. DDH was present in 74 hips (5.3%), of which 32 were only present on the FP view radiograph (43.2%). The Pearson correlation coefficient between W-LCEA and W-ACEA of all included hips was 0.547 (95% confidence interval: 0.503–0.591) and 0.441 (95% confidence interval: 0.231–0.652) in hips with DDH. A mean difference of 9.4° (SD 8.09) was present between the W-LCEA and the W-ACEA in the hips with DDH. There is a strong additional value of the FP radiograph in the diagnosis of DDH. Over 4 out of 10 (43.2%) individuals’ DDH will be missed when only using the AP radiograph. In hips with DDH a moderate correlation between W-LCEA and W-ACEA was calculated indicating that joints with normal acetabular coverage on the AP view can still be undercovered on the FP view.
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Affiliation(s)
- Julie Herfkens
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Michiel M A van Buuren
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Noortje S Riedstra
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Vasco V Mascarenhas
- MSK Imaging Unit (UIME), Imaging Center, Hospital da Luz, Lisbon, Indiana, Portugal
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13
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Abstract
Closed treatment of paediatric diaphyseal forearm fractures carries the risk of re-displacement, which can lead to symptomatic malunions. This is because growth will not correct angulation deformity as it does in metaphyseal fractures. The purpose of this prospective cohort study was to evaluate the outcomes after 3-D-planned corrective osteotomy with patient-specific surgical guides for paediatric malunited forearm fractures causing impaired pro-supination. Our primary outcome measure was the gain in pro-supination at 12 months follow-up. Fifteen patients with a mean age at trauma of 9.6 years and time until osteotomy of 5.9 years were included. Preoperatively, patients displayed a mean pro-supination of 67° corresponding to 44% of the contralateral forearm. At final follow-up, this improved to 128°, achieving 85% of the contralateral side. Multivariate linear regression analysis revealed that predictors of greater functional gain after 3-D corrective osteotomy are severe preoperative impairment in pro-supination, shorter interval until 3-D corrective osteotomy and greater angulation of the radius.Level of evidence: III.
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Affiliation(s)
- Kasper C. Roth
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands,Kasper C. Roth, Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - Eline M. van Es
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gerald A. Kraan
- Department of Orthopaedics, Reinier HAGA Orthopaedic Centre, Zoetermeer, The Netherlands
| | - Jan A. N. Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Joost W. Colaris
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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14
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Sleeswijk Visser TSO, van Es EM, Meuffels DE, Verhaar JAN, de Vos RJ. Standardized pain mapping for diagnosing Achilles tendinopathy. J Sci Med Sport 2021; 25:204-208. [PMID: 34753666 DOI: 10.1016/j.jsams.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/19/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the level of agreement between patient-reported pain using a standardized pain map and the physician-determined clinical diagnosis of Achilles tendinopathy. DESIGN Cross-sectional study. METHODS Eligible patients were adults visiting a sports physician for symptoms in the Achilles tendon region. Patients completed a digital questionnaire and indicated one location on a pain map where they experienced their pain. The primary outcome measure was level of agreement (% and Kappa coefficient) between patient-reported pain on the pain map and the physician-determined clinical diagnosis (defined as localized pain associated with tendon-loading activities and pain on palpation with or without tendon thickening). The secondary outcome measure was the agreement between the location on the pain map (midportion/insertional region) with the clinical diagnosis of midportion/insertional Achilles tendinopathy. RESULTS 110 patients (mean (SD) age 48 (13), 61% men) with pain in the Achilles region were included. In 102 (93%, Kappa = 0.86, CI 0.78-0.95) patients who indicated pain in the Achilles tendon region on the pain map, the clinical diagnosis of Achilles tendinopathy was made by the sports physician. 82% of the patients had the clinical diagnosis of tendinopathy in the specific region of the tendon they marked on the pain map (Kappa = 0.67, CI 0.54-0.79). CONCLUSIONS There is almost perfect agreement between patient-reported pain on a pain map and a physician-established clinical diagnosis of Achilles tendinopathy. There was substantial agreement between the localization of the pain that was selected by the patient and the diagnosis of insertional/midportion Achilles tendinopathy by the physician. This tool could potentially aid in adequate triage for specialized care and for researchers performing large epidemiological studies.
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Affiliation(s)
- Tjerk S O Sleeswijk Visser
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, the Netherlands; Leiden University Medical Center, the Netherlands
| | - Eline M van Es
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, the Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, the Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, the Netherlands.
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15
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Utomo L, Fahy N, Kops N, van Tiel ST, Waarsing J, Verhaar JAN, Leenen PJM, van Osch GJVM, Bastiaansen‐Jenniskens YM. Macrophage phenotypes and monocyte subsets after destabilization of the medial meniscus in mice. J Orthop Res 2021; 39:2270-2280. [PMID: 33336820 PMCID: PMC8518591 DOI: 10.1002/jor.24958] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/10/2020] [Accepted: 12/14/2020] [Indexed: 02/04/2023]
Abstract
Macrophages play an important role in the development and progression of osteoarthritis (OA). The aim of this study was to identify macrophage phenotypes in synovium and monocyte subsets in peripheral blood in C57BL/6 mice by destabilizing the medial meniscus (DMM), and the association of macrophage subsets with OA features. DMM, sham, and non-operated knees were histologically assessed between 1 and 56 days for macrophage polarization states by immunohistochemistry (IHC), cartilage damage, synovial thickening, and osteophytes (n = 9 per timepoint). Naive knees (n = 6) were used as controls. Monocyte and polarized synovial macrophage subsets were evaluated by flow cytometry. CD64 and CD206 levels on IHC were higher at early timepoints in DMM and sham knees compared to naive knees. iNOS labeling intensity was higher in DMM and sham knees than in naive knees from d3 onwards. CD163 expression was unaltered at all timepoints. Even though macrophage polarization profiles were similar in DMM and sham knees, only in DMM knees the presence of iNOS and CD206 associated with synovial thickness, and CD163 staining inversely correlated with osteophyte presence. At day 14, monocyte subset distribution was different in peripheral blood of DMM mice compared with sham mice. In conclusion, monocyte subsets in blood and synovial macrophage phenotypes vary after joint surgery. High levels of iNOS+ , CD163+ , and CD206+ cells are found in both destabilized and sham-operated knees, and coexistence with joint instability may be a requirement to initiate and exacerbate OA progression.
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Affiliation(s)
- Lizette Utomo
- Department of Orthopaedics, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands,Present address:
L. Utomo, Department of Oral and Maxillofacial Surgery & Special Dental Care, University Medical Center Utrecht, Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Niamh Fahy
- Department of Orthopaedics, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands,Department of Oral and Maxillofacial Surgery, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Nicole Kops
- Department of Orthopaedics, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Sandra T. van Tiel
- Department of Radiology and Nuclear Medicine, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Jan Waarsing
- Department of Orthopaedics, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Jan A. N. Verhaar
- Department of Orthopaedics, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Pieter J. M. Leenen
- Department of Immunology, Erasmus MCUniversity Medical Center RotterdamThe Netherlands
| | - Gerjo J. V. M. van Osch
- Department of Orthopaedics, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands,Department of Otorhinolaryngology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
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16
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van der Ende B, van Oldenrijk J, Reijman M, Croughs PD, van Steenbergen LN, Verhaar JAN, Bos PK. Timing of debridement, antibiotics, and implant retention (DAIR) for early post-surgical hip and knee prosthetic joint infection (PJI) does not affect 1-year re-revision rates: data from the Dutch Arthroplasty Register. J Bone Jt Infect 2021; 6:329-336. [PMID: 34513570 PMCID: PMC8428083 DOI: 10.5194/jbji-6-329-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/16/2021] [Indexed: 11/11/2022] Open
Abstract
Debridement, antibiotics, and implant retention (DAIR) is a procedure to treat a periprosthetic joint infection (PJI) after total hip arthroplasty (THA) or total knee arthroplasty (TKA). The timing between the primary procedure and the DAIR is likely a determinant for its successful outcome. However, the optimal timing of a DAIR and the chance of success still remain unclear. We aimed to assess the risk of re-revision within 1 year after a DAIR procedure and to evaluate the timing of the DAIR in primary THA and TKA. We used data from the Dutch Arthroplasty Register (LROI) and selected all primary THA and TKA in the period 2007-2016 which underwent a DAIR within 12 weeks after primary procedure. A DAIR was defined as a revision for infection in which only modular parts were exchanged. A DAIR was defined as successful if not followed by a re-revision within 1 year after DAIR; 207 DAIRs were performed < 4 weeks after THA, of which 16 (8 %) received a complete revision within 1 year. DAIR procedures performed between 4 and 12 weeks ( n = 98 ) had a failure rate of 9 % ( n = 9 ). After TKA 126 DAIRs were performed in less than 4 weeks, of which 11 (9 %) received a complete revision within 1 year; 83 DAIRs were performed between 4 and 12 weeks, of which 14 (17 %) were revised. There was no significant difference in 1-year re-revision rate after a DAIR procedure by timing of the DAIR procedure for total hip and knee arthroplasty based on Dutch registry data.
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Affiliation(s)
- Barry van der Ende
- Department of Orthopaedic Surgery and Sport Medicine, Erasmus University Medical Center, Rotterdam, 3000 CA, the Netherlands
| | - Jakob van Oldenrijk
- Department of Orthopaedic Surgery and Sport Medicine, Erasmus University Medical Center, Rotterdam, 3000 CA, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery and Sport Medicine, Erasmus University Medical Center, Rotterdam, 3000 CA, the Netherlands
| | - Peter D Croughs
- Department of Microbiology, Erasmus University Medical Center, Rotterdam, 3000 CA, the Netherlands
| | - Liza N van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), 's Hertogenbosch, 5232 AD, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery and Sport Medicine, Erasmus University Medical Center, Rotterdam, 3000 CA, the Netherlands
| | - P Koen Bos
- Department of Orthopaedic Surgery and Sport Medicine, Erasmus University Medical Center, Rotterdam, 3000 CA, the Netherlands
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17
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Lagas IF, Meuffels DE, Visser E, Groot FP, Reijman M, Verhaar JAN, de Vos RJ. Effects of eccentric exercises on improving ankle dorsiflexion in soccer players. BMC Musculoskelet Disord 2021; 22:485. [PMID: 34039331 PMCID: PMC8157442 DOI: 10.1186/s12891-021-04337-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/06/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose The purpose of this study was to determine the effect of targeted eccentric calf muscle exercises compared to regular training on ankle dorsiflexion in healthy adolescent soccer players with a decreased ankle dorsiflexion. Methods Male adolescent players (aged 14–21 years) from two professional soccer clubs were evaluated with the Weight Bearing Dorsiflexion Lunge Test (WBDLT) at baseline and after 12 weeks of this prospective controlled study. One club served as the control group and the other as the intervention group. Players with decreased ankle dorsiflexion (WBDLT) ≤ 10 cm) performed stretching and eccentric calf muscle exercises three times per week next to regular training in the intervention group, and performed only regular training in the control group. Primary outcome was the between-group difference in change in WBDLT between baseline and 12 weeks. Results Of 107 eligible players, 47(44 %) had a decreased ankle dorsiflexion. The WBDLT (± standard deviation) increased in the intervention group from 7.1 (± 1.8) to 7.4 (± 2.4) cm (95 % Confidence Interval (CI)[-0.493 to 1.108], p = 0.381) and in the control group from 6.1 (± 2.4) to 8.2 (± 2.9) cm (95 % CI [1.313 to 2.659], p < 0.001). The difference in change of WBDLT between both groups was statistically significant (95 % CI [-2.742 to -0.510], p = 0.005). Conclusions Targeted eccentric calf muscle exercises do not increase ankle dorsiflexion in healthy adolescent soccer players. Compared to regular training, eccentric exercises even resulted in a decreased calf muscle flexibility. Trial registration This trial was registered retrospectively on the 7th of September 2016 in The Netherlands Trial Register (ID number: 6044).
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Affiliation(s)
- Iris Femmigje Lagas
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Duncan E Meuffels
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Edwin Visser
- Department of Physiotherapy, Sportgeneeskunde Rotterdam, Rotterdam, The Netherlands
| | - Floor P Groot
- Department of Sports Medicine, FIFA Medical Centre of Excellence, Royal Netherlands Football Association (KNVB), Zeist, The Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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18
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van Buuren MMA, Arden NK, Bierma-Zeinstra SMA, Bramer WM, Casartelli NC, Felson DT, Jones G, Lane NE, Lindner C, Maffiuletti NA, van Meurs JBJ, Nelson AE, Nevitt MC, Valenzuela PL, Verhaar JAN, Weinans H, Agricola R. Statistical shape modeling of the hip and the association with hip osteoarthritis: a systematic review. Osteoarthritis Cartilage 2021; 29:607-618. [PMID: 33338641 DOI: 10.1016/j.joca.2020.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/30/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize available evidence on the association between hip shape as quantified by statistical shape modeling (SSM) and the incidence or progression of hip osteoarthritis. DESIGN We conducted a systematic search of five electronic databases, based on a registered protocol (available: PROSPERO CRD42020145411). Articles presenting original data on the longitudinal relationship between radiographic hip shape (quantified by SSM) and hip OA were eligible. Quantitative meta-analysis was precluded because of the use of different SSM models across studies. We used the Newcastle-Ottawa Scale (NOS) for risk of bias assessment. RESULTS Nine studies (6,483 hips analyzed with SSM) were included in this review. The SSM models used to describe hip shape ranged from 16 points on the femoral head to 85 points on the proximal femur and hemipelvis. Multiple hip shape features and combinations thereof were associated with incident or progressive hip OA. Shape variants that seemed to be consistently associated with hip OA across studies were acetabular dysplasia, cam morphology, and deviations in acetabular version (either excessive anteversion or retroversion). CONCLUSIONS Various radiographic, SSM-defined hip shape features are associated with hip OA. Some hip shape features only seem to increase the risk for hip OA when combined together. The heterogeneity of the used SSM models across studies precludes the estimation of pooled effect sizes. Further studies using the same SSM model and definition of hip OA are needed to allow for the comparison of outcomes across studies, and to validate the found associations.
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Affiliation(s)
- M M A van Buuren
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - N K Arden
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; NIHR Musculoskeletal Biomedical Research Unit, Arthritis Research UK Centre for Sport, Exercise, and Osteoarthritis, University of Oxford, Oxford, UK
| | - S M A Bierma-Zeinstra
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of General Practice and Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - N C Casartelli
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland; Laboratory of Exercise and Health, ETH Zürich, Schwerzenbach, Switzerland
| | - D T Felson
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - N E Lane
- Department of Medicine, University of California, Davis, CA, USA
| | - C Lindner
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - N A Maffiuletti
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - J B J van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A E Nelson
- Thurston Arthritis Research Center and Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - P L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain
| | - J A N Verhaar
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - H Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - R Agricola
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Barvelink B, Reijman M, Schep NWL, Brown V, Kraan GA, Gosens T, Polinder S, Ista E, Verhaar JAN, Colaris JW. The CAST study protocol: a cluster randomized trial assessing the effect of circumferential casting versus plaster splinting on fracture redisplacement in reduced distal radius fractures in adults. BMC Musculoskelet Disord 2021; 22:370. [PMID: 33879131 PMCID: PMC8059188 DOI: 10.1186/s12891-021-04238-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is no consensus concerning the optimal casting technique for displaced distal radius fractures (DRFs) following closed reduction. This study evaluates whether a splint or a circumferential cast is most optimal to prevent fracture redisplacement in adult patients with a reduced DRF. Additionally, the cost-effectiveness of both cast types will be calculated. METHODS/DESIGN This multicenter cluster randomized controlled trial will compare initial immobilization with a circumferential below-elbow cast versus a below-elbow plaster splint in reduced DRFs. Randomization will take place on hospital-level (cluster, n = 10) with a cross-over point halfway the inclusion of the needed number of patients per hospital. Inclusion criteria comprise adult patients (≥ 18 years) with a primary displaced DRF which is treated conservatively after closed reduction. Multiple trauma patients (Injury Severity Score ≥ 16), concomitant ulnar fractures (except styloid process fractures) and patients with concomitant injury on the ipsilateral arm or inability to complete study forms will be excluded. Primary study outcome is fracture redisplacement of the initial reduced DRF. Secondary outcomes are patient-reported outcomes assessed with the Disability Arm Shoulder Hand score (DASH) and Patient-Rated Wrist Evaluation score (PRWE), comfort of the cast, quality of life assessed with the EQ-5D-5L questionnaire, analgesics use, cost-effectiveness and (serious) adverse events occurence. In total, 560 patients will be included and followed for 1 year. The estimated time required for inclusion will be 18 months. DISCUSSION The CAST study will provide evidence whether the type of cast immobilization is of influence on fracture redisplacement in distal radius fractures. Extensive follow-up during one year concerning radiographic, functional and patient reported outcomes will give a broad view on DRF recovery. TRIAL REGISTRATION Registered in the Dutch Trial Registry on January 14th 2020. Registration number: NL8311 .
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Affiliation(s)
- Britt Barvelink
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.
| | - Max Reijman
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Niels W L Schep
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Vanessa Brown
- Department of Emergency Medicine, Franciscus Hospital, Rotterdam, The Netherlands
| | - Gerald A Kraan
- Department of Orthopedic Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Taco Gosens
- Department of Orthopedic Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine - Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Joost W Colaris
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
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20
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Sleeswijk Visser TSO, van der Vlist AC, van Oosterom RF, van Veldhoven P, Verhaar JAN, de Vos RJ. Impact of chronic Achilles tendinopathy on health-related quality of life, work performance, healthcare utilisation and costs. BMJ Open Sport Exerc Med 2021; 7:e001023. [PMID: 33868707 PMCID: PMC8006822 DOI: 10.1136/bmjsem-2020-001023] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives To evaluate the impact of Achilles tendinopathy (AT) on quality of life (QoL), work performance, healthcare utilisation and costs in adults with conservatively treated chronic midportion AT. Methods This cross-sectional survey-based study included 80 patients and took place in a sports medicine department of a large regional hospital in the Netherlands. Data were collected before any intervention was given. Primary outcome was the EuroQol questionnaire (EQ-5D). The EQ-5D expresses the percentage of moderate/major problems on the domains self-care, anxiety/depression, mobility, usual activities and pain/discomfort. Secondary outcomes were the number of previous healthcare visits, work performance during the period of symptoms and estimated annual direct medical and indirect costs per patient as a result of AT. Results All 80 patients completed the questionnaires. The EQ-5D scores were low for the domains self-care (1%) and anxiety/depression (20%), and high for the domains mobility (66%), usual activities (50%) and pain/discomfort (89%). Patients with AT mainly reported an impact on work productivity (38%). Work absenteeism due to AT was present in 9%. The total median (IQR) number of annual healthcare visits was 9 (3-11). The total mean (SD) estimated annual costs were €840 (1420) per patient with AT (mean (SD) US$991 (1675)). Conclusions This study shows the large impact of AT on QoL and work productivity. This study also provides new information about the socioeconomic impact of AT, which emphasises that this common and longstanding disease causes substantial costs. These findings stress the need for optimised treatment and improved preventive interventions for AT. Trial registration number NCT02996409.
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Affiliation(s)
- Tjerk S O Sleeswijk Visser
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands.,Department of Orthopedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Arco C van der Vlist
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Robert F van Oosterom
- Department of Sports Medicine, Haaglanden Medical Centre, Leidschendam, The Netherlands
| | - Peter van Veldhoven
- Department of Sports Medicine, Haaglanden Medical Centre, Leidschendam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Robert-Jan de Vos
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands
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21
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van der Vlist AC, Winters M, Weir A, Ardern CL, Welton NJ, Caldwell DM, Verhaar JAN, de Vos RJ. Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials. Br J Sports Med 2021; 55:249-256. [PMID: 32522732 PMCID: PMC7907558 DOI: 10.1136/bjsports-2019-101872] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To provide a consistently updated overview of the comparative effectiveness of treatments for Achilles tendinopathy. DESIGN Living systematic review and network meta-analysis. DATA SOURCES Multiple databases including grey literature sources were searched up to February 2019. STUDY ELIGIBILITY CRITERIA Randomised controlled trials examining the effectiveness of any treatment in patients with both insertional and/or midportion Achilles tendinopathy. We excluded trials with 10 or fewer participants per treatment arm or trials investigating tendon ruptures. DATA EXTRACTION AND SYNTHESIS Reviewers independently extracted data and assessed the risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation to appraise the certainty of evidence. PRIMARY OUTCOME MEASURE The validated patient-reported Victorian Institute of Sport Assessment-Achilles questionnaire. RESULTS 29 trials investigating 42 different treatments were included. 22 trials (76%) were at high risk of bias and 7 (24%) had some concerns. Most trials included patients with midportion tendinopathy (86%). Any treatment class seemed superior to wait-and-see for midportion Achilles tendinopathy at 3 months (very low to low certainty of evidence). At 12 months, exercise therapy, exercise+injection therapy and exercise+night splint therapy were all comparable with injection therapy for midportion tendinopathy (very low to low certainty). No network meta-analysis could be performed for insertional Achilles tendinopathy. SUMMARY/CONCLUSION In our living network meta-analysis no trials were at low risk of bias and there was large uncertainty in the comparative estimates. For midportion Achilles tendinopathy, wait-and-see is not recommended as all active treatments seemed superior at 3-month follow-up. There seems to be no clinically relevant difference in effectiveness between different active treatments at either 3-month or 12-month follow-up. As exercise therapy is easy to prescribe, can be of low cost and has few harms, clinicians could consider starting treatment with a calf-muscle exercise programme. PROSPERO REGISTRATION NUMBER CRD42018086467.
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Affiliation(s)
- Arco C van der Vlist
- Department of Orthopaedics and Sports Medicine, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Marinus Winters
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Adam Weir
- Department of Orthopaedics and Sports Medicine, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Aspetar Sports Groin Pain Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Clare L Ardern
- Division of Physiotherapy, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
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22
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Visser D, Verhaar JAN. [A male with black cartilage]. Ned Tijdschr Geneeskd 2021; 165:D5661. [PMID: 33651519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 52-year-old men suffered from osteoarthritis of the knee. During knee replacement surgery, the remaining cartilage appeared black. This discoloration and early degeneration of the cartilage is characteristic for the metabolic disorder alkaptonuria in which homogentisic acid accumulates in the body.
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Affiliation(s)
- David Visser
- Erasmus MC, afd. Orthopedie, Rotterdam
- Contact: David Visser
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van Klij P, Heijboer MP, Ginai AZ, Verhaar JAN, Waarsing JH, Agricola R. Correction to: Clinical and radiological hip parameters do not precede, but develop simultaneously with cam morphology: a 5-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2021; 29:1411-1412. [PMID: 33544159 PMCID: PMC8182847 DOI: 10.1007/s00167-020-06374-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- P van Klij
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - M P Heijboer
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A Z Ginai
- Department of Radiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J A N Verhaar
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - J H Waarsing
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - R Agricola
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Cohen A, Reijman M, Kraan GA, Mathijssen NMC, Koopmanschap MA, Verhaar JAN, Mol S, Colaris JW. Clinically SUspected ScaPhoid fracturE: treatment with supportive bandage or CasT? 'Study protocol of a multicenter randomized controlled trial' (SUSPECT study). BMJ Open 2020; 10:e036998. [PMID: 32994236 PMCID: PMC7526317 DOI: 10.1136/bmjopen-2020-036998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Some scaphoid fractures become visible on radiographs weeks after a trauma which makes normal radiographs directly after trauma unreliable. Untreated scaphoid fractures can lead to scaphoid non-union progressing to osteoarthritis. Therefore, the general treatment for patients with a clinically suspected scaphoid fracture and normal initial radiographs is immobilisation with below-elbow cast for 2 weeks. However, most of these patients are treated unnecessarily because eventually less than 10% of them are diagnosed with an occult scaphoid fracture. To reduce overtreatment and costs as a result of unnecessary cast treatment in patients with a clinically suspected scaphoid fracture and normal initial radiographs, we designed a study to compare below-elbow cast treatment with supportive bandage treatment. We hypothesise that the functional outcome after 3 months is not inferior in patients treated with supportive bandage compared to patients treated with below-elbow cast, but with lower costs in the supportive bandage group. METHODS AND ANALYSIS The SUSPECT study is an open-labelled multicentre randomised controlled trial with non-inferiority design. A total of 180 adult patients with a clinically suspected scaphoid fracture and normal initial radiographs are randomised between two groups: 3 days of supportive bandage or 2 weeks of below-elbow cast. We aim to evaluate the functional outcome and cost-effectiveness of both treatments. The primary outcome is the functional outcome after 3 months, assessed with the Quick Disability of the Arm, Shoulder and Hand score. Secondary outcomes include functional outcome, recovery of function, pain, patient satisfaction, quality of life and cost-effectiveness measured by medical consumption, absence from work or decreased productivity. ETHICS AND DISSEMINATION The Medical Ethics Committee of the Erasmus MC Medical Centre, Rotterdam, approved the study protocol (MEC-2017-504). We plan to present the results after completion of the study at (inter)national conferences and publish in general peer-reviewed journals. TRIAL REGISTRATION NUMBER NL6976.
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Affiliation(s)
- Abigael Cohen
- Department of Orthopaedics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Max Reijman
- Department of Orthopaedics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Gerald A Kraan
- Department of Orthopaedics, Reinier de Graaf Hospital, Delft, Zuid-Holland, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedics, Reinier de Graaf Hospital, Delft, Zuid-Holland, The Netherlands
| | - Marc A Koopmanschap
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Sander Mol
- Department of Emergency Medicine, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, The Netherlands
| | - Joost W Colaris
- Department of Orthopaedics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
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van der Vlist AC, van Oosterom RF, van Veldhoven PLJ, Bierma-Zeinstra SMA, Waarsing JH, Verhaar JAN, de Vos RJ. Effectiveness of a high volume injection as treatment for chronic Achilles tendinopathy: randomised controlled trial. BMJ 2020; 370:m3027. [PMID: 33315586 PMCID: PMC7479639 DOI: 10.1136/bmj.m3027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To study whether a high volume injection without corticosteroids improves clinical outcome in addition to usual care for adults with chronic midportion Achilles tendinopathy. DESIGN Patient and assessor blinded, placebo controlled randomised clinical trial. SETTING Sports medicine department of a large district general hospital, the Netherlands. PARTICIPANTS 80 adults (aged 18-70 years) with clinically diagnosed chronic midportion Achilles tendinopathy and neovascularisation on ultrasonography. 39 were randomised to a high volume injection without corticosteroids and 41 to placebo. INTERVENTIONS Participants were instructed to perform an exercise programme for 24 weeks (usual care) combined with one 50 mL high volume injection of saline and lidocaine (intervention group) or one 2 mL placebo injection of saline and lidocaine (placebo group) at baseline. MAIN OUTCOME MEASURES Primary outcome was pain and function assessed using the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire at 24 weeks (analysed using a generalised estimation equations model). Secondary outcomes were patient satisfaction, return to sport, degree of ultrasonographic Doppler flow, visual analogue scale on 10 hop test, power and flexibility of the gastrocnemius and soleus muscles, pain detect questionnaire for neuropathic pain, and pain coping inventory. Participants were evaluated at baseline and at 2, 6, 12, and 24 weeks. RESULTS Only one participant (1%) was lost to follow-up. The estimated mean VISA-A score improved significantly, from 40.4 (95% confidence interval 32.0 to 48.7) at baseline to 59.1 (50.4 to 67.8) at 24 weeks in the high volume injection group and from 36.9 (27.1 to 46.8) to 58.5 (47.9 to 69.1) in the placebo group. The VISA-A score over time did not differ between the groups (adjusted between group difference at 24 weeks 0.5 points, 95% confidence interval -17.8 to 18.8). No significant between group differences were found for patient satisfaction (21/37 (57%) v 19/39 (49%) patients, P=0.50) and return to desired sport (15/29 (52%) v 19/31 (61%) patients active in sports, P=0.65) at 24 weeks. None of the other secondary outcomes differed between the two groups. CONCLUSIONS A high volume injection without corticosteroids in addition to usual care is not effective for symptom reduction in patients with chronic midportion Achilles tendinopathy. On the basis of our findings, we cannot recommend the use of a high volume injection in this patient group. TRIAL REGISTRATION ClinicalTrials.gov NCT02996409.
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Affiliation(s)
- Arco C van der Vlist
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, Netherlands
| | - Robert F van Oosterom
- Department of Sports Medicine, Haaglanden Medical Centre, 2262 BA Leidschendam, Netherlands
| | | | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Centre, 3000 CA Rotterdam, Netherlands
| | - Jan H Waarsing
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, Netherlands
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van Klij P, Reiman MP, Waarsing JH, Reijman M, Bramer WM, Verhaar JAN, Agricola R. Classifying Cam Morphology by the Alpha Angle: A Systematic Review on Threshold Values. Orthop J Sports Med 2020; 8:2325967120938312. [PMID: 32844100 PMCID: PMC7418265 DOI: 10.1177/2325967120938312] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The alpha angle is the most often used measure to classify cam morphology. There is currently no agreement on which alpha angle threshold value to use. Purpose To systematically investigate the different alpha angle threshold values used for defining cam morphology in studies aiming to identify this threshold and to determine whether data are consistent enough to suggest an alpha angle threshold to classify cam morphology. Study Design Systematic review; Level of evidence, 3. Methods The Embase, Medline (Ovid), Web of Science, Cochrane Central, and Google Scholar databases were searched from database inception to February 28, 2019. Studies aiming at identifying an alpha angle threshold to classify cam morphology were eligible for inclusion. Results We included 4 case-control studies, 10 cohort studies, and 1 finite-element study from 2437 identified publications. Studies (n = 3) using receiver operating characteristic (ROC) curve analysis to distinguish asymptomatic people from patients with femoroacetabular impingement syndrome consistently observed alpha angle thresholds between 57° and 60°. A 60° threshold was also found to best discriminate between hips with and without cam morphology in a large cohort study based on a bimodal distribution of the alpha angle. Studies (n = 8) using the upper limit of the 95% reference interval as threshold proposed a wide overall threshold range between 58° and 93°. When stratified by sex, thresholds between 63° and 93° in male patients and between 58° and 94° in female patients were reported. Conclusion Based on the available evidence, mostly based on studies using ROC curve analysis, an alpha angle threshold of ≥60° is currently the most appropriate to classify cam morphology. Further research is required to fully validate this threshold.
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Affiliation(s)
- Pim van Klij
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Michael P Reiman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jan H Waarsing
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
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Lagas IF, Fokkema T, Bierma-Zeinstra SMA, Verhaar JAN, van Middelkoop M, de Vos RJ. How many runners with new-onset Achilles tendinopathy develop persisting symptoms? A large prospective cohort study. Scand J Med Sci Sports 2020; 30:1939-1948. [PMID: 32615645 PMCID: PMC7540273 DOI: 10.1111/sms.13760] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Achilles tendinopathy (AT) occurs in half of the elite runners. AT is a difficult-to-treat tendon disease, which may progress from new onset to a chronic state. It is unknown how many runners with new-onset AT develop persisting symptoms and which prognostic factors are associated with this course. OBJECTIVE To describe how many runners develop persisting symptoms 1 year after onset of reactive AT. STUDY DESIGN Prospective cohort study. METHODS Runners registering for a Dutch running event (5-42.2 km) were eligible for inclusion. Runners reporting new-onset AT between registration for the running event and 1 month after received a 1-year follow-up questionnaire. The 1-year follow-up questionnaire inquired about persisting symptoms (yes/no), running activity, and metabolic disorders. We calculated the percentage of runners with persisting symptoms and performed a multivariable logistic regression analysis to study the association between potential prognostic factors and persisting symptoms. RESULTS Of 1929 participants, 100 runners (5%) reported new-onset AT. A total of 62 runners (62%) filled in the 1-year follow-up questionnaire. Persisting symptoms were reported by 20 runners (32%). A higher running distance per week before new-onset AT was associated with a lower risk of developing persisting symptoms (odds ratio (OR): 0.9, 95% confidence interval (CI): [0.9;1.0]). There was a positive trend toward an association between metabolic disorders and persisting symptoms (OR: 5.7, 95% CI: [0.9;36.2]). CONCLUSION One third of runners develop persisting symptoms 1 year after new-onset AT. Interestingly, a higher running distance per week before new-onset AT potentially lowers the risk of developing persisting symptoms.
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Affiliation(s)
- Iris F Lagas
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Zuid-Holland, The Netherlands
| | - Tryntsje Fokkema
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Zuid-Holland, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Zuid-Holland, The Netherlands.,Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Zuid-Holland, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Zuid-Holland, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Zuid-Holland, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Zuid-Holland, The Netherlands
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Fokkema T, de Vos RJ, Visser E, Krastman P, IJzerman J, Koes BW, Verhaar JAN, Bierma-Zeinstra SMA, van Middelkoop M. Enhanced injury prevention programme for recreational runners (the SPRINT study): design of a randomised controlled trial. BMJ Open Sport Exerc Med 2020; 6:e000780. [PMID: 32577303 PMCID: PMC7299036 DOI: 10.1136/bmjsem-2020-000780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Running-related injuries (RRIs) are frequent, but no effective injury prevention measures have been identified yet. Therefore, we have set up the INSPIRE trial in 2017, in which the effectiveness of an online injury prevention programme was tested. Although this programme was not effective in reducing the number of RRIs, we gained new insights from this study, which we used to design an enhanced, online multidisciplinary injury prevention programme. The aim of this study is to test the effectiveness of this enhanced injury prevention programme in a group of recreational runners. Methods and analysis For this randomised controlled trial, we aim to include 3394 recreational runners aged 18 years or older who register for a running event (distances 10 to 42.2 km). During the preparation for the running event, runners in the intervention group get access to the enhanced online injury prevention programme. This online programme consists of 10 steps, all covering separate items of RRI prevention. Runners in the control group will follow their regular preparation. With three follow-up questionnaires (1 month before, 1 week before and 1 month after the running event), the proportions of self-reported RRIs in the intervention group and the control group are compared. Ethics and dissemination An exemption for a comprehensive application has been obtained by the Medical Ethical Committee of the Erasmus MC University Medical Center, Rotterdam, the Netherlands. The results of the study will be disseminated among the running population, published in peer-reviewed international journals and presented on international conferences. Trial registration number NL7694
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Affiliation(s)
- Tryntsje Fokkema
- Department of General Practice, Erasmus MC Medical University Center, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics, Erasmus MC Medical University Center, Rotterdam, The Netherlands
| | - Edwin Visser
- Department of Physiotherapy, Sport Medical Center 'Sportgeneeskunde Rotterdam', Rotterdam, The Netherlands
| | - Patrick Krastman
- Department of General Practice, Erasmus MC Medical University Center, Rotterdam, The Netherlands.,Rotterdam Marathon Study Group, Rotterdam, The Netherlands
| | | | - Bart W Koes
- Department of General Practice, Erasmus MC Medical University Center, Rotterdam, The Netherlands.,Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Jan A N Verhaar
- Department of Orthopaedics, Erasmus MC Medical University Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC Medical University Center, Rotterdam, The Netherlands.,Department of Orthopaedics, Erasmus MC Medical University Center, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC Medical University Center, Rotterdam, The Netherlands
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van der Vlist AC, van Veldhoven PLJ, van Oosterom RF, Verhaar JAN, de Vos RJ. Isometric exercises do not provide immediate pain relief in Achilles tendinopathy: A quasi-randomized clinical trial. Scand J Med Sci Sports 2020; 30:1712-1721. [PMID: 32474979 PMCID: PMC7496962 DOI: 10.1111/sms.13728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/24/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022]
Abstract
Background Isometric exercises may provide an immediate analgesic effect in patients with lower‐limb tendinopathy and have been proposed as initial treatment and for immediate pain relief. Current evidence is conflicting, and previous studies were small. Objective To study whether isometric exercises result in an immediate analgesic effect in patients with chronic midportion Achilles tendinopathy. Methods Patients with clinically diagnosed chronic midportion Achilles tendinopathy were quasi‐randomized to one of four arms: isometric calf‐muscle exercises (tiptoes), isometric calf‐muscle exercises (dorsiflexed ankle position), isotonic calf‐muscle exercises, or rest. The primary outcome was pain measured on a visual analogue scale (VAS) score (0‐100) during a functional task (10 unilateral hops) both before and after the intervention. Between‐group differences were analyzed using a generalized estimation equations model. Results We included 91 patients. There was no significant reduction in pain on the 10 hop test after performing any of the four interventions: isometric (tiptoes) group 0.2, 95%CI −11.2 to 11.5; isometric (dorsiflexed) group −1.9, 95%CI −13.6 to 9.7; isotonic group 1.4, 95%CI −8.3 to 11.1; and rest group 7.2, 95%CI −2.4 to 16.7. There were also no between‐group differences after the interventions. Conclusion The isometric exercises investigated in this study did not result in immediate analgesic benefit in patients with chronic midportion Achilles tendinopathy. We do not recommend isometric exercises if the aim is providing immediate pain relief. Future research should focus on the use of isometric or isotonic exercise therapy as initial treatment as all exercise protocols used in this study were well‐tolerated.
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Affiliation(s)
- Arco C van der Vlist
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Robert F van Oosterom
- Department of Sports Medicine, Haaglanden Medical Center, The Hague, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Robert-Jan de Vos
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Khatab S, Leijs MJ, van Buul G, Haeck J, Kops N, Nieboer M, Bos PK, Verhaar JAN, Bernsen M, van Osch GJVM. MSC encapsulation in alginate microcapsules prolongs survival after intra-articular injection, a longitudinal in vivo cell and bead integrity tracking study. Cell Biol Toxicol 2020; 36:553-570. [PMID: 32474743 PMCID: PMC7661423 DOI: 10.1007/s10565-020-09532-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/29/2020] [Indexed: 02/06/2023]
Abstract
Mesenchymal stem cells (MSC) are promising candidates for use as a biological therapeutic. Since locally injected MSC disappear within a few weeks, we hypothesize that efficacy of MSC can be enhanced by prolonging their presence. Previously, encapsulation in alginate was suggested as a suitable approach for this purpose. We found no differences between the two alginate types, alginate high in mannuronic acid (High M) and alginate high in guluronic acid (High G), regarding MSC viability, MSC immunomodulatory capability, or retention of capsule integrity after subcutaneous implantation in immune competent rats. High G proved to be more suitable for production of injectable beads. Firefly luciferase-expressing rat MSC were used to track MSC viability. Encapsulation in high G alginate prolonged the presence of metabolically active allogenic MSC in immune competent rats with monoiodoacetate-induced osteoarthritis for at least 8 weeks. Encapsulation of human MSC for local treatment by intra-articular injection did not significantly influence the effect on pain, synovial inflammation, or cartilage damage in this disease model. MSC encapsulation in alginate allows for an injectable approach which prolongs the presence of viable cells subcutaneously or in an osteoarthritic joint. Further fine tuning of alginate formulation and effective dosage for might be required in order to improve therapeutic efficacy depending on the target disease. Graphical Abstract ![]()
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Affiliation(s)
- Sohrab Khatab
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands
| | - Maarten J Leijs
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands
| | - Gerben van Buul
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands
| | - Joost Haeck
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands
| | - Nicole Kops
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands
| | - Michael Nieboer
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands
| | - P Koen Bos
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands
| | - Monique Bernsen
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands
| | - Gerjo J V M van Osch
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
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31
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van der Vlist AC, Veen JM, van Oosterom RF, van Veldhoven PLJ, Verhaar JAN, de Vos R. Ultrasound Doppler Flow in Patients With Chronic Midportion Achilles Tendinopathy: Is Surface Area Quantification a Reliable Method? J Ultrasound Med 2020; 39:731-739. [PMID: 31724758 PMCID: PMC7154669 DOI: 10.1002/jum.15152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/05/2019] [Accepted: 09/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Ultrasound assessments of patients with chronic midportion Achilles tendinopathy include determining the degree of neovascularization using Doppler flow. A frequently used measure to quantify neovascularization is the modified Öhberg score. It is unknown whether the semiquantitative modified Öhberg score (0-4+) has higher reliability than a quantified measure of Doppler flow (0-100%). The purpose of this cross-sectional study was to evaluate the interobserver reliability of the modified Öhberg score and a surface area quantification (SAQ) method for Doppler flow in patients with chronic midportion Achilles tendinopathy. METHODS Two observers examined the degree of Doppler flow independently using SAQ and the modified Öhberg score during a single consultation. The intraclass correlation coefficient, standard error of measurement, and minimal detectable difference were determined to evaluate the reliability and measurement properties of the SAQ method and the modified Öhberg score. RESULTS In total, 28 consecutive patients with chronic midportion Achilles tendinopathy participated. The intraclass correlation coefficient for interobserver reliability of the SAQ method was 0.81 (95% confidence interval, 0.58-0.91), compared to 0.64 (95% confidence interval, 0.45-0.81) for the modified Öhberg score. The standard error of measurement and minimal detectable difference values for the SAQ method were 2.9% and 8.0%, respectively, and for the modified Öhberg score, they were 0.55 and 1.53 points. CONCLUSIONS The SAQ method shows good reliability to evaluate the degree of Doppler flow in patients with chronic midportion Achilles tendinopathy, and it overcomes the ceiling effect of the modified Öhberg score. Future research should focus on the relationship between the SAQ method and clinical outcomes and use this method to monitor treatment responses.
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Affiliation(s)
- Arco C. van der Vlist
- Department of Orthopedic Surgery and Sports MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - Jasper M. Veen
- Department of Orthopedic Surgery and Sports MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - Robert F. van Oosterom
- Department of Sports MedicineThe Hague Medical Center AntoniushoveLeidschendamthe Netherlands
| | | | - Jan A. N. Verhaar
- Department of Orthopedic Surgery and Sports MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - Robert‐Jan de Vos
- Department of Orthopedic Surgery and Sports MedicineErasmus University Medical CenterRotterdamthe Netherlands
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32
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van Klij P, Ginai AZ, Heijboer MP, Verhaar JAN, Waarsing JH, Agricola R. The relationship between cam morphology and hip and groin symptoms and signs in young male football players. Scand J Med Sci Sports 2020; 30:1221-1231. [PMID: 32201993 PMCID: PMC7317829 DOI: 10.1111/sms.13660] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
Abstract
Background Conflicting and limited high‐quality prospective data are available on the associations between cam morphology and hip and groin symptoms and range of motion (ROM). Objectives This cross‐sectional cohort study investigated associations between cam morphology presence, size and duration and symptoms and ROM. Methods Academy male football players (n = 49, 17‐24 years) were included. Standardized antero‐posterior pelvic and frog‐leg lateral radiographs were obtained at baseline, 2.5‐ and 5‐year follow‐up. The femoral head‐neck junction was quantified by:
Visual score. Cam morphology (flattening or prominence), large cam (prominence). Alpha angle. Cam morphology (≥60°), large cam (≥78°).
Cam morphology duration was defined as long (first present at baseline) or short (only from 2.5‐ to 5‐year follow‐up). Current symptoms at 5‐year follow‐up were assessed using a hip and groin pain question and by the “Hip and Groin Outcome Score” (HAGOS). HAGOS scores were categorized into: most symptoms (≥2 domains in lowest interquartile range [IQR]), least symptoms (≥2 domains in highest IQR). Hip ROM was measured by goniometry at 5‐year follow‐up. Results Large cam morphology based on visual score was associated with hip and groin pain (23.8% vs. 7.1%, OR: 3.17, CI: [1.15‐8.70], P = .026), but not with HAGOS scores. Cam morphology presence, size, and duration were associated with limited flexion of around 6° and/or 3° to 6° for internal rotation. Conclusion Cam morphology presence, size, and duration were associated with limited hip flexion and/or internal rotation, but differences might not exceed the minimal clinical important difference. Whether cam morphology results in symptoms is uncertain.
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Affiliation(s)
- Pim van Klij
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Abida Z Ginai
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marinus P Heijboer
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jan H Waarsing
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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33
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van Egmond JC, Hunfeld NGM, Rijnders BJA, Verhaar JAN. Persistent candida arthritis successfully treated with micafungin instillation and surgery. A case report. Med Mycol Case Rep 2020; 27:29-31. [PMID: 32123657 PMCID: PMC7036544 DOI: 10.1016/j.mmcr.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/09/2019] [Accepted: 12/16/2019] [Indexed: 11/28/2022] Open
Abstract
We report a rare case of C. krusei knee arthritis treated with instillation of micafungin and arthroscopy. A 49-year-old man hospitalized for treatment of Acute Myeloid Leukemia developed knee arthritis with C. krusei. He was treated with a combination of arthroscopic debridement, intravenous as well as intra-articular micafungin. Serum and intra-articular concentrations of micafungin were determined. After instillation of micafungin in the knee and arthroscopic debridement, the patient completely recovered.
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Affiliation(s)
- Jeroen C van Egmond
- Department of Orthopaedics, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Nicole G M Hunfeld
- Department of Pharmacy, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Intensive Care, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Bart J A Rijnders
- Department of Infectious Diseases, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
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34
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Sivasubramaniyan K, Koevoet WJLM, Hakimiyan AA, Sande M, Farrell E, Hoogduijn MJ, Verhaar JAN, Chubinskaya S, Bühring HJ, van Osch GJVM. Cell-surface markers identify tissue resident multipotential stem/stromal cell subsets in synovial intimal and sub-intimal compartments with distinct chondrogenic properties. Osteoarthritis Cartilage 2019; 27:1831-1840. [PMID: 31536814 DOI: 10.1016/j.joca.2019.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/24/2019] [Accepted: 08/29/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Synovium contains multipotent progenitor/stromal cells (MPCs) with potential to participate in cartilage repair. Understanding the identity of these MPCs will allow their therapeutic potential to be fully exploited. Hence this study aimed to identify primary synovial MPCs and characterize them in the context of cartilage regeneration. METHODS Primary MPC/MPC-subset specific markers in synovium were identified by FACS analysis of uncultured cells. MPC-subsets from human synovium obtained from patients undergoing total knee arthroplasty were FACS sorted, cultured, immunophenotyped and chondrogenically differentiated. The anatomical localization of MPCs in synovium was examined using immunohistochemistry. Finally, the presence of these MPC subsets in healthy synovium obtained from human organ donors was examined. RESULTS A combination of CD45, CD31, CD73 and CD90 can isolate two distinct MPC-subsets in synovium. These MPC-subsets, freshly isolated from synovium, did not express CD45 or CD31, but expressed CD73. Additionally, a sub-population of CD73+ cells also expressed CD90. CD45-CD31-CD73+CD90- cells were significantly more chondrogenic than CD45-CD31-CD73+CD90+ cells in the presence of TGFβ1. Interestingly, reduced chondrogenic ability of CD73+CD90+ cells could be reversed by the addition of BMP2, showing discrete chondrogenic factor requirements by distinct cell-subsets. In addition, these MPCs had distinct anatomical localization; CD73 was expressed both in intimal and sub-intimal region while CD90 was enriched in the sub-intimal region. We further demonstrated that these subsets are also present in healthy synovium. CONCLUSIONS We provide indications that primary MPCs in synovial intima and sub-intima are phenotypically and functionally distinct with different chondrogenic properties.
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Affiliation(s)
- K Sivasubramaniyan
- Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - W J L M Koevoet
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - A A Hakimiyan
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | - M Sande
- Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - E Farrell
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M J Hoogduijn
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - J A N Verhaar
- Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - S Chubinskaya
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | - H-J Bühring
- Department of Internal Medicine II, Division of Hematology, University Clinic of Tübingen, Tübingen, Germany
| | - G J V M van Osch
- Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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35
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Koper MC, Reijman M, van Es EM, Waarsing JH, Koot HWJ, Keizer SB, Jansen I, van Biezen FC, Verhaar JAN, Bos PK. No added value for Computer-Assisted surgery to improve femoral component positioning and Patient Reported Outcomes in Hip Resurfacing Arthroplasty; a multi-center randomized controlled trial. BMC Musculoskelet Disord 2019; 20:473. [PMID: 31651318 PMCID: PMC6814023 DOI: 10.1186/s12891-019-2883-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022] Open
Abstract
Background Computer Assisted Surgery (CAS) has proven to improve the accuracy in several orthopedic procedures. Therefore we used this technique to evaluate femoral component positioning in Hip Resurfacing Arthroplasty (HRA). The aim of this study was to evaluate imageless CAS compared to manually implanted femoral components and subsequently evaluates Patient Related Outcome Measures (PROMs). We hypothesized that the use of CAS optimizes the position of the femoral component and improves PROMs. Methods This is a multicenter, single-blinded, randomized, controlled trial of two groups. In the CAS group guiding of the femoral component was done with imageless navigation. In the Conventional (control) group the femoral component was placed manually according to the preplanned position. The primary outcome measure consists of a maximum of 3 degrees difference between the postoperative Stem Shaft Angle (SSA) and preplanned SSA. Secondary outcome measures consist of the Hip disability and Osteoarthritis Outcome Scale (HOOS), the Harris Hip Score (HHS) and Visual Analogue Scale (VAS) pain score. Results A total of 122 patients were randomized, 61 in the CAS group and 61 in the conventional group. There was no significant differences in accuracy of femoral implant position. The mean difference between the postoperative- and preplanned SSA was − 2.26 and − 1.75 degrees (more varus) respectively in the CAS and Conventional group. After surgery both groups show significant improvement in all PROMs compared to the baseline measurements, with no significant differences between the groups. Conclusion Our cohort indicates no benefit for the use of CAS in accuracy of placement of the femoral component in HRA compared to manual implantation. There are no clinical differences in PROMs after 1 year follow up. This study showed no added value and no justification for the use of CAS in femoral component positioning in HRA. Trial registration This trial is registered at ClinicalTrails.gov (https://clinicaltrials.gov/) on the 25th of October 2006: NCT00391937. Level of incidence Level IIb, multicenter randomized controlled trial.
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Affiliation(s)
- M C Koper
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands.
| | - M Reijman
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - E M van Es
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - J H Waarsing
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - H W J Koot
- Department of Orthopedics, Maxima Medical Center, Eindhoven, The Netherlands
| | - S B Keizer
- Department of Orthopedics, Medical Center Haaglanden, Den Haag, The Netherlands
| | - I Jansen
- Department of Orthopedics, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - F C van Biezen
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - J A N Verhaar
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - P K Bos
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
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Muggen AF, de Jong M, Wolvers-Tettero ILM, Kallemeijn MJ, Teodósio C, Darzentas N, Stadhouders R, IJspeert H, van der Burg M, van IJcken WF, Verhaar JAN, Abdulahad WH, Brouwer E, Boots AMH, Hendriks RW, van Dongen JJM, Langerak AW. The presence of CLL-associated stereotypic B cell receptors in the normal BCR repertoire from healthy individuals increases with age. Immun Ageing 2019; 16:22. [PMID: 31485252 PMCID: PMC6714092 DOI: 10.1186/s12979-019-0163-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/21/2019] [Indexed: 01/10/2023]
Abstract
Background Aging is known to induce immunosenescence, resulting in alterations in both the innate and adaptive immune system. Here we evaluated the effects of aging on B cell subsets in peripheral blood of 155 immunologically healthy individuals in four age categories (range 20-95y) via multi-parameter flow cytometry. Furthermore, we studied the naive and antigen-experienced B cell receptor (BCR) repertoire of different age groups and compared it to the clonal BCR repertoire of chronic lymphocytic leukemia (CLL), a disease typically presenting in elderly individuals. Results Total numbers and relative frequencies of B cells were found to decline upon aging, with reductions in transitional B cells, memory cell types, and plasma blasts in the 70 + y group. The BCR repertoire of naive mature B cells and antigen-experienced B cells did not clearly alter until age 70y. Clear changes in IGHV gene usage were observed in naive mature B cells of 70 + y individuals, with a transitional pattern in the 50-70y group. IGHV gene usage of naive mature B cells of the 50-70y, but not the 70 + y, age group resembled that of both younger (50-70y) and older (70 + y) CLL patients. Additionally, CLL-associated stereotypic BCR were found as part of the healthy control BCR repertoire, with an age-associated increase in frequency of several stereotypic BCR (particularly subsets #2 and #5). Conclusion Composition of the peripheral B cell compartment changes with ageing, with clear reductions in non-switched and CD27 + IgG+ switched memory B cells and plasma blasts in especially the 70 + y group. The BCR repertoire is relatively stable until 70y, whereafter differences in IGHV gene usage are seen. Upon ageing, an increasing trend in the occurrence of particular CLL-associated stereotypic BCR is observed. Electronic supplementary material The online version of this article (10.1186/s12979-019-0163-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alice F Muggen
- 1Department Immunology, Laboratory Medical Immunology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Madelon de Jong
- 1Department Immunology, Laboratory Medical Immunology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Ingrid L M Wolvers-Tettero
- 1Department Immunology, Laboratory Medical Immunology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Martine J Kallemeijn
- 1Department Immunology, Laboratory Medical Immunology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Cristina Teodósio
- 1Department Immunology, Laboratory Medical Immunology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,2Present Address: Department Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Nikos Darzentas
- 3Central European Institute of Technology, Masaryk University, Brno, Czech Republic.,4Department Internal Medicine, University Schleswig-Holstein, Kiel, Germany
| | - Ralph Stadhouders
- 5Department Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Hanna IJspeert
- 1Department Immunology, Laboratory Medical Immunology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Mirjam van der Burg
- 1Department Immunology, Laboratory Medical Immunology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,6Present Address: Department Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jan A N Verhaar
- 8Department Orthopedics, Erasmus MC, Rotterdam, The Netherlands
| | - Wayel H Abdulahad
- 9Department Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth Brouwer
- 9Department Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Annemieke M H Boots
- 9Department Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Rudi W Hendriks
- 5Department Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jacques J M van Dongen
- 1Department Immunology, Laboratory Medical Immunology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,2Present Address: Department Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Anton W Langerak
- 1Department Immunology, Laboratory Medical Immunology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Hermans J, Bierma-Zeinstra SMA, Bos PK, Niesten DD, Verhaar JAN, Reijman M. The effectiveness of high molecular weight hyaluronic acid for knee osteoarthritis in patients in the working age: a randomised controlled trial. BMC Musculoskelet Disord 2019; 20:196. [PMID: 31064359 PMCID: PMC6503549 DOI: 10.1186/s12891-019-2546-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/28/2019] [Indexed: 01/27/2023] Open
Abstract
Background High molecular weight (HMW) hyaluronic acid (HA) is a treatment option for knee osteoarthritis (OA). The efficacy of HMW-HA in knee OA is investigated extensively, but the effectiveness in patients in the working age is unknown. Nevertheless, the number knee OA patients in the working age is increasing. Surgical treatment options are less eligible in these patients and productivity losses are high. In this study the effectiveness of intra-articular HMW-HA added to regular non-surgical usual care in everyday clinical practice (UC) compared to UC over 52 weeks in symptomatic knee OA patients in the working age was investigated. Methods In this open labelled randomized controlled trial, subjects aged between 18 and 65 years with symptomatic knee OA (Kellgren and Lawrence I-III) were enrolled and randomized to UC + 3 weekly injections with HMW-HA (intervention) or UC only (control). The primary outcome was the between group difference in responders to therapy according to OMERACT-OARSI criteria after 52 weeks. These criteria include the domains pain, knee related function and patient’s global assessment (PGA). Function was evaluated with the KOOS questionnaire. Pain was assessed with the Numeric Rating Scale. Secondary outcome comprised the between group difference on the individual responder domains, as analysed with a random effects model. Odds Ratios (OR) were calculated by logistic regression analysis. Sensitivity analyses were performed. Results In total, 156 subjects were included (intervention group 77, control group 79). Subjects in the intervention group (HMW-HA + UC) were more often responder compared to the controls (UC). Depending on whether pain during rest or pain during activity was included in the responder domains, 57.1% versus 34.2% (p = 0.006) and 54.5% versus 34.2% (p = 0.015) was responder to therapy respectively. The results of the secondary outcome analyses show that scores on individual responder domains over all follow-up moments were statistically significant in favour of the intervention group in the domains pain during rest (δ 0.8, 95%CI 0.2; 1.4, p = 0.010), knee related function (δ − 6.8, 95%CI -11.9; − 1.7, p = 0.010) and PGA (δ − 0.7, 95%CI -0.9; − 0.4, p < 0.0001). Conclusions Intra-articular HMW-HA added to usual care is effective for knee OA in patients in the working age. Trial registration www.trialregister.nl, NTR1651, registered 2009-3-3. Electronic supplementary material The online version of this article (10.1186/s12891-019-2546-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Job Hermans
- Department of Orthopaedic Surgery, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Sita M A Bierma-Zeinstra
- Department of Orthopaedic Surgery, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of General Practice, Erasmus University Medical Centre, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Pieter K Bos
- Department of Orthopaedic Surgery, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Dieu Donne Niesten
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, PO Box 5011 2600, GA, Delft, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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Fokkema T, de Vos RJ, van Ochten JM, Verhaar JAN, Davis IS, Bindels PJE, Bierma-Zeinstra SMA, van Middelkoop M. Online multifactorial prevention programme has no effect on the number of running-related injuries: a randomised controlled trial. Br J Sports Med 2019; 53:1479-1485. [PMID: 30954948 PMCID: PMC6900232 DOI: 10.1136/bjsports-2018-099744] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/23/2019] [Accepted: 03/19/2019] [Indexed: 12/01/2022]
Abstract
Objective To examine the effect of a multifactorial, online injury prevention programme on the number of running-related injuries (RRIs) in recreational runners. Methods Adult recreational runners who registered for a running event (distances 5 km up to 42.195 km) were randomised into the intervention group or control group. Participants in the intervention group were given access to the online injury prevention programme, which consisted of information on evidence-based risk factors and advices to reduce the injury risk. Participants in the control group followed their regular preparation for the running event. The primary outcome measure was the number of self-reported RRIs in the time frame between registration for a running event and 1 month after the running event. Results This trial included 2378 recreational runners (1252 men; mean [SD] age 41.2 [11.9] years), of which 1196 were allocated to the intervention group and 1182 to the control group. Of the participants in the intervention group 37.5% (95% CI 34.8 to 40.4) sustained a new RRI during follow-up, compared with 36.7% (95% CI 34.0 to 39.6) in the control group. Univariate logistic regression analysis showed no significant difference between the intervention and control group (OR 1.08; 95% CI 0.90 to 1.30). Furthermore, the prevention programme seemed to have a negative impact on the occurrence of new RRIs in the subgroup of runners with no injuries in the 12 months preceding the trial (OR 1.30; 95% CI 0.99 to 1.70). Conclusion A multifactorial, online injury prevention programme did not decrease the total number of RRIs in recreational runners. Trial registration number NTR5998.
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Affiliation(s)
- Tryntsje Fokkema
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - John M van Ochten
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Irene S Davis
- Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Abstract
Background Achilles tendinopathy is a common problem, but its exact aetiology remains unclear. Objective To evaluate the association between potential clinical risk factors and Achilles tendinopathy. Design Systematic review. Data sources The databases Embase, MEDLINE Ovid, Web of Science, Cochrane Library and Google Scholar were searched up to February 2018. Eligibility criteria To answer our research question, cohort studies investigating risk factors for Achilles tendinopathy in humans were included. We restricted our search to potential clinical risk factors (imaging studies were excluded). Results We included 10 cohort studies, all with a high risk of bias, from 5111 publications identified. There is limited evidence for nine risk factors: (1) prior lower limb tendinopathy or fracture, (2) use of ofloxacin (quinolone) antibiotics, (3) an increased time between heart transplantation and initiation of quinolone treatment for infectious disease, (4) moderate alcohol use, (5) training during cold weather, (6) decreased isokinetic plantar flexor strength, (7) abnormal gait pattern with decreased forward progression of propulsion, (8) more lateral foot roll-over at the forefoot flat phase and (9) creatinine clearance of <60 mL/min in heart transplant patients. Twenty-six other putative risk factors were not associated with Achilles tendinopathy, including being overweight, static foot posture and physical activity level. Conclusion From an ocean of studies with high levels of bias, we extracted nine clinical risk factors that may increase a person’s risk of Achilles tendinopathy. Clinicians may consider ofloxacin use, alcohol consumption and a reduced plantar flexor strength as modifiable risk factors when treating patients with Achilles tendinopathy. Trial registration number CRD42017053258.
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Affiliation(s)
- Arco C van der Vlist
- Department of Orthopedic Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Stephan J Breda
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopedic Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Wiegers EJA, Sewalt CA, Venema E, Schep NWL, Verhaar JAN, Lingsma HF, Den Hartog D. The volume-outcome relationship for hip fractures: a systematic review and meta-analysis of 2,023,469 patients. Acta Orthop 2019; 90:26-32. [PMID: 30712501 PMCID: PMC6366538 DOI: 10.1080/17453674.2018.1545383] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - It has been hypothesized that hospitals and surgeons with high caseloads of hip fracture patients have better outcomes, but empirical studies have reported contradictory results. This systematic review and meta-analysis evaluates the volume-outcome relationship among patients with hip fracture patients. Methods - A search of different databases was performed up to February 2018. Selection of relevant studies, data extraction, and critical appraisal of the methodological quality was performed by 2 independent reviewers. A random-effects meta-analysis using studies with comparative cut-offs was performed to estimate the effect of hospital and surgeon volume on outcome, defined as in-hospital mortality and postoperative complications. Results - 24 studies comprising 2,023,469 patients were included. Overall, the quality was reasonable. 11 studies reported better health outcomes in high-volume centers and 2 studies reported better health outcomes in low-volume centers. In the meta-analysis of 11 studies there was a statistically non-significant association between higher hospital volume and both lower in-hospital mortality (adjusted odds ratio (aOR) 0.87, 95% confidence interval (CI) 0.73-1.04) and fewer postoperative complications (aOR 0.87, CI 0.75-1.02). Four studies on surgeon volume were included in the meta-analysis and showed a minor association between higher surgeon volume and in-hospital mortality (aOR 0.92, CI 0.76-1.12). Interpretation - This systematic review and meta-analysis did not find an evident effect of hospital or surgeon volume on health outcomes. Future research without volume cut-offs is needed to examine whether a true volume-outcome relationship exists.
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Affiliation(s)
- Eveline J A Wiegers
- Department of Public Health, Erasmus University Medical Center, Rotterdam; ,Correspondence:
| | - Charlie A Sewalt
- Department of Public Health, Erasmus University Medical Center, Rotterdam;
| | - Esmee Venema
- Department of Public Health, Erasmus University Medical Center, Rotterdam; ,Department of Neurology, Erasmus University Medical Center, Rotterdam;
| | | | - Jan A N Verhaar
- Department of Orthopaedics, Erasmus University Medical Center, Rotterdam;
| | - Hester F Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam;
| | - Dennis Den Hartog
- Department of Surgery-Traumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Fahmy-Garcia S, Mumcuoglu D, de Miguel L, Dieleman V, Witte-Bouma J, van der Eerden BCJ, van Driel M, Eglin D, Verhaar JAN, Kluijtmans SGJM, van Osch GJVM, Farrell E. Novel In Situ Gelling Hydrogels Loaded with Recombinant Collagen Peptide Microspheres as a Slow-Release System Induce Ectopic Bone Formation. Adv Healthc Mater 2018; 7:e1801496. [PMID: 30565901 DOI: 10.1002/adhm.201801496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fahmy-Garcia S, Mumcuoglu D, de Miguel L, Dieleman V, Witte-Bouma J, van der Eerden BCJ, van Driel M, Eglin D, Verhaar JAN, Kluijtmans SGJM, van Osch GJVM, Farrell E. Novel In Situ Gelling Hydrogels Loaded with Recombinant Collagen Peptide Microspheres as a Slow-Release System Induce Ectopic Bone Formation. Adv Healthc Mater 2018; 7:e1800507. [PMID: 30230271 DOI: 10.1002/adhm.201800507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Indexed: 01/06/2023]
Abstract
New solutions for large bone defect repair are needed. Here, in situ gelling slow release systems for bone induction are assessed. Collagen-I based Recombinant Peptide (RCP) microspheres (MSs) are produced and used as a carrier for bone morphogenetic protein 2 (BMP-2). The RCP-MSs are dispersed in three hydrogels: high mannuronate (SLM) alginate, high guluronate (SLG) alginate, and thermoresponsive hyaluronan derivative (HApN). HApN+RCP-MS forms a gel structure at 32 ºC or above, while SLM+RCP-MS and SLG+RCP-MS respond to shear stress displaying thixotropic behavior. Alginate formulations show sustained release of BMP-2, while there is minimal release from HApN. These formulations are injected subcutaneously in rats. SLM+RCP-MS and SLG+RCP-MS loaded with BMP-2 induce ectopic bone formation as revealed by X-ray tomography and histology, whereas HApN+RCP-MS do not. Vascularization occurs within all the formulations studied and is significantly higher in SLG+MS and HApN+RCP-MS than in SLM+RCP-MS. Inflammation (based on macrophage subset staining) decreases over time in both alginate groups, but increases in the HApN+RCP-MS condition. It is shown that a balance between inflammatory cell infiltration, BMP-2 release, and vascularization, achieved in the SLG+RCP-MS alginate condition, is optimal for the induction of de novo bone formation.
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Affiliation(s)
- Shorouk Fahmy-Garcia
- Department of Orthopedics; Erasmus MC; Wytemaweg 80 3015CN Rotterdam The Netherlands
- Department of Internal Medicine; Erasmus MC; Wytemaweg 80 3015CN Rotterdam The Netherlands
| | - Didem Mumcuoglu
- Department of Orthopedics; Erasmus MC; Wytemaweg 80 3015CN Rotterdam The Netherlands
- Fujifilm Manufacturing Europe B.V.; Oudenstaart 1 5047TK Tilburg The Netherlands
| | - Laura de Miguel
- Fujifilm Manufacturing Europe B.V.; Oudenstaart 1 5047TK Tilburg The Netherlands
| | - Veerle Dieleman
- Department of Oral and Maxillofacial Surgery; Special Dental Care and Orthodontics; Erasmus MC; Wytemaweg 80 3015CN Rotterdam The Netherlands
| | - Janneke Witte-Bouma
- Department of Oral and Maxillofacial Surgery; Special Dental Care and Orthodontics; Erasmus MC; Wytemaweg 80 3015CN Rotterdam The Netherlands
| | | | - Marjolein van Driel
- Department of Internal Medicine; Erasmus MC; Wytemaweg 80 3015CN Rotterdam The Netherlands
| | - David Eglin
- AO Research Institute Davos; Clavadelerstrasse 8 7270 Davos Switzerland
| | - Jan A. N. Verhaar
- Department of Orthopedics; Erasmus MC; Wytemaweg 80 3015CN Rotterdam The Netherlands
| | | | - Gerjo J. V. M. van Osch
- Department of Orthopedics; Erasmus MC; Wytemaweg 80 3015CN Rotterdam The Netherlands
- Department of Otorhinolaryngology; Head and Neck Surgery; Erasmus MC; Wytemaweg 80 3015CN Rotterdam The Netherlands
| | - Eric Farrell
- Department of Oral and Maxillofacial Surgery; Special Dental Care and Orthodontics; Erasmus MC; Wytemaweg 80 3015CN Rotterdam The Netherlands
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van Klij P, Heijboer MP, Ginai AZ, Verhaar JAN, Waarsing JH, Agricola R. Cam morphology in young male football players mostly develops before proximal femoral growth plate closure: a prospective study with 5-yearfollow-up. Br J Sports Med 2018; 53:532-538. [PMID: 30323059 DOI: 10.1136/bjsports-2018-099328] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Cam morphology is not completely understood. The aim of this study was threefold: (1) to investigate if cam morphology development is associated with growth plate status; (2) to examine whether cam morphology continues to develop after growth plate closure; and (3) to qualitatively describe cam morphology development over 5-year follow-up. METHODS Academy male football players (n=49) participated in this prospective 5-year follow-up study (baseline 12-19 years old). Anteroposterior and frog-leg lateral views were obtained at baseline (142 hips), 2.5-year (126 hips) and 5-year follow-up (98 hips). Cam morphology on these time points was defined as: (A) visual scores of the anterior head-neck junction, classified as: (1) normal, (2) flattening, and (3) prominence; and (B) alpha angle ≥60°. Proximal femoral growth plates were classified as open or closed. Cam morphology development was defined as every increase in visual score and/or increase in alpha angle from <60° to ≥60°, between two time points. This resulted in 224 measurements for cam morphology development analysis. RESULTS Cam morphology development was significantly associated with open growth plates based on visual score (OR: 10.03, 95% CI 3.49 to 28.84, p<0.001) and alpha angle (OR: 2.85, 95% CI 1.18 to 6.88, p=0.020). With both definitions combined, cam developed in 104 of 142 hips during follow-up. Of these 104 hips, cam developed in 86 hips (82.7%) with open growth plate and in 18 hips (17.3%) with a closed growth plate. Cam morphology developed from 12 to 13 years of age until growth plate closure around 18 years. CONCLUSION Cam morphology of the hip is more likely to develop with an open growth plate.
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Affiliation(s)
- Pim van Klij
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Marinus P Heijboer
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Abida Z Ginai
- Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jan H Waarsing
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Rintje Agricola
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands
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Lagas IF, Meuffels DE, Visser E, Groot FP, Reijman M, Verhaar JAN, de Vos RJ. High knee loading in male adolescent pre-professional football players: Effects of a targeted training programme. J Sci Med Sport 2018; 22:164-168. [PMID: 30031748 DOI: 10.1016/j.jsams.2018.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/30/2018] [Accepted: 06/27/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess whether targeted neuromuscular exercises can decrease knee loading of adolescent pre-professional footballers with high knee loading as identified with the field-based Drop Vertical Jump Test (DVJT). DESIGN Prospective controlled trial, conducted between August and November 2016 at Erasmus Medical Centre, The Netherlands. METHODS Pre-professional football players (aged 14-21years) were evaluated at baseline and after 12weeks follow-up with the field-based DVJT. The field-based DVJT is a standardised test in which a player drops from a box and jumps up immediately after landing; knee load is calculated based on five parameters. Players with high knee load (probability≥0.75) from one club performed regular training(control group), and players with high knee load from another other club performed targeted neuromuscular exercises for 12weeks (intervention group). The difference of change in knee load between both groups after 12weeks was the primary outcome measure. RESULTS Of 107 eligible players, 75 had a high knee loading. Knee loading decreased in both groups after 12weeks of training, but change in probability of high knee load was not significantly different between both groups (95% Confidence Interval [-0.012-0.082], p=0.139). CONCLUSION Targeted neuromuscular exercises had no additional effect in decreasing knee loading of adolescent male pre-professional football players compared to regular training. TRIAL REGISTRATION NUMBER The Netherlands Trial Register (ID number: 6044).
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Affiliation(s)
- Iris F Lagas
- Department of Orthopaedic Surgery, Erasmus University Medical Center Rotterdam, The Netherlands.
| | - Duncan E Meuffels
- Department of Orthopaedic Surgery, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Edwin Visser
- Department of Physiotherapy, Sportmedical Center "Nieuw Rotterdams Peil",The Netherlands
| | - Floor P Groot
- Department of Sports Medicine, FIFA Medical Centre of Excellence, Royal Netherlands Football Association (KNVB), The Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedic Surgery, Erasmus University Medical Center Rotterdam, The Netherlands
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van Outeren MV, Waarsing JH, Verhaar JAN, Reijman M, Brouwer RW, Bierma-Zeinstra SMA. Response to the Letter to the Editor: 'Is a high tibial osteotomy superior to non-surgical treatment in patients with varus malaligned medial knee osteoarthritis?'. Osteoarthritis Cartilage 2018; 26:e3-e4. [PMID: 29627445 DOI: 10.1016/j.joca.2018.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/27/2018] [Indexed: 02/02/2023]
Affiliation(s)
- M V van Outeren
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J H Waarsing
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - J A N Verhaar
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - M Reijman
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - R W Brouwer
- Department of Orthopaedics, Martini Hospital, Groningen, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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van der Heijden RA, Poot DHJ, Ekinci M, Kotek G, van Veldhoven PLJ, Klein S, Verhaar JAN, Krestin GP, Bierma-Zeinstra SMA, van Middelkoop M, Oei EHG. Blood perfusion of patellar bone measured by dynamic contrast-enhanced MRI in patients with patellofemoral pain: A case-control study. J Magn Reson Imaging 2018; 48:1344-1350. [PMID: 29734499 PMCID: PMC6221059 DOI: 10.1002/jmri.26174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/16/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Altered perfusion might play an important role in the pathophysiology of patellofemoral pain (PFP), a common knee complaint with unclear pathophysiology. PURPOSE To investigate differences in dynamic contrast-enhanced (DCE)-MRI perfusion parameters between patients with PFP and healthy control subjects. POPULATION/SUBJECTS/PHANTOM/SPECIMEN/ANIMAL MODEL Thirty-five adult patients with PFP and 44 healthy adult control subjects. FIELD STRENGTH/SEQUENCE 3T DCE-MRI consisting of a sagittal, anterior-posterior, frequency-encoded, fat-suppressed 3D spoiled gradient-echo sequence with intravenous contrast administration. ASSESSMENT Patellar bone volumes of interest (VOIs) were delineated by a blinded observer. Quantitative perfusion parameters (kep and ktrans ) were calculated from motion-compensated DCE-MRI data by fitting Tofts' model. Weighted mean and unweighted median values of kep and ktrans were computed within the patellar bone VOIs. STATISTICAL TESTS Differences in patellar bone perfusion parameters were compared between groups by linear regression analyses, adjusted for confounders. RESULTS Mean differences of weighted mean and unweighted median were 0.0039 (95% confidence interval [CI] -0.0013; 0.0091) and 0.0052 (95% CI -0.0078; 0.018) for ktrans , and 0.046 (95% CI -0.021; 0.11) and 0.069 (95% CI -0.017; 0.15) for kep , respectively. All perfusion parameters were not significantly different between groups (P-values: 0.32; 0.47 for ktrans , and 0.24; 0.15) for kep . However, a significant difference in variance between populations was observed for ktrans (P-value 0.007). DATA CONCLUSION Higher patellar bone perfusion parameters were found in patients with PFP when compared to healthy control subjects, but these differences were not statistically significant. This result, and the observed significant difference in ktrans variance, warrant further research. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1344-1350.
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Affiliation(s)
- Rianne A van der Heijden
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dirk H J Poot
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, The Netherlands.,Quantitative Imaging, Department of Imaging Physics, TU Delft, Delft, The Netherlands
| | - Melek Ekinci
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Gyula Kotek
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics & Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopedics Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Orthopedics Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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van Oudenaarde K, Swart NM, Bloem JL, Bierma-Zeinstra SMA, Algra PR, Bindels PJE, Koes BW, Nelissen RGHH, Verhaar JAN, Luijsterburg PAJ, Reijnierse M, van den Hout WB. General Practitioners Referring Adults to MR Imaging for Knee Pain: A Randomized Controlled Trial to Assess Cost-effectiveness. Radiology 2018; 288:170-176. [PMID: 29664339 DOI: 10.1148/radiol.2018171383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To determine the cost-effectiveness of early referral by the general practitioner for magnetic resonance (MR) imaging compared with usual care alone in patients aged 18-45 years with traumatic knee symptoms. Materials and Methods Cost-utility analysis was performed parallel to a prospective multicenter randomized controlled trial in Dutch general practice. A total of 356 patients with traumatic knee symptoms were included from November 2012 to December 2015 (mean age, 33 years ± 8 [standard deviation]; 222 men [62%]). Patients were randomly assigned to usual care (n = 177; MR imaging was not performed, but patients were referred to an orthopedic surgeon when conservative treatment was unsatisfactory) or MR imaging (n = 179) within 2 weeks after injury. Main outcome measures were quality-adjusted life years (QALYs) and costs from a healthcare and societal perspective. Multiple imputation was used for missing data. The Student t test was used to assess differences in mean QALYs, costs, and net benefits. Results Mean QALYs were 0.888 in the MR imaging group and 0.899 in the usual care group (P = .255). Healthcare costs per patient were higher in the MR imaging group (€1109) than in the usual care group (€837) (P = .050), mainly due to higher costs for MR imaging, with no reduction in the number of referrals to an orthopedic surgeon in the MR imaging group. Conclusion MR imaging referral by the general practitioner was not cost-effective in patients with traumatic knee symptoms; in fact, MR imaging led to more healthcare costs, without an improvement in health outcomes.
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Affiliation(s)
- Kim van Oudenaarde
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Nynke M Swart
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Johan L Bloem
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Sita M A Bierma-Zeinstra
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Paul R Algra
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Patrick J E Bindels
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Bart W Koes
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Rob G H H Nelissen
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Jan A N Verhaar
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Pim A J Luijsterburg
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Monique Reijnierse
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Wilbert B van den Hout
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
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48
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Verschueren J, Meuffels DE, Bron EE, Klein S, Kleinrensink GJ, Verhaar JAN, Bierma-Zeinstra SMA, Krestin GP, Wielopolski PA, Reijman M, Oei EHG. Possibility of quantitative T2-mapping MRI of cartilage near metal in high tibial osteotomy: A human cadaver study. J Orthop Res 2018; 36:1206-1212. [PMID: 28892256 DOI: 10.1002/jor.23729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/06/2017] [Indexed: 02/04/2023]
Abstract
T2-mapping is a widely used quantitative MRI technique in osteoarthritis research. An important challenge for its application in the context of high tibial osteotomy (HTO) is the presence of metallic fixation devices. In this study, we evaluated the possibility of performing T2-mapping after a HTO, by assessing the extent of magnetic susceptibility artifacts and the influence on T2 relaxation times caused by two commonly used fixation devices. T2-mapping with a 3D fast spin-echo sequence at three Tesla was performed on 11 human cadaveric knee joints before and after implantation of a titanium plate and screws (n = 5) or cobalt chrome staples (n = 6). Mean T2 relaxation times were calculated in six cartilage regions, located in the distal and posterior cartilage of femoral condyles and the cartilage of tibial plateaus, both medially and laterally. T2 relaxation times before and after the implantation were compared with paired t-tests and Wilcoxon rank tests. Due to the extent of the magnetic susceptibility artifact, it was not possible to segment the knee cartilage and thus calculate T2 relaxation times in the lateral weight-bearing femoral and tibial cartilage regions only in the cobalt chrome group. In all cartilage regions of the titanium implanted knees and those unaffected by artifacts due to cobalt chrome implants, T2 relaxation times did not significantly differ between the two scans. Our results suggest that accurate T2-mapping after a HTO procedure is possible in all areas after implantation of a titanium fixation device and in most areas after implantation of a cobalt chrome fixation device. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1206-1212, 2018.
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Affiliation(s)
- Joost Verschueren
- Department of Orthopedic Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Gravendijkwal, Rotterdam, The Netherlands
| | - Duncan E Meuffels
- Department of Orthopedic Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther E Bron
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Gravendijkwal, Rotterdam, The Netherlands.,Department of Medical Informatics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Stefan Klein
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Gravendijkwal, Rotterdam, The Netherlands.,Department of Medical Informatics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gert-Jan Kleinrensink
- Department of Anatomy, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of Orthopedic Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Gravendijkwal, Rotterdam, The Netherlands
| | - Piotr A Wielopolski
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Gravendijkwal, Rotterdam, The Netherlands
| | - Max Reijman
- Department of Orthopedic Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Gravendijkwal, Rotterdam, The Netherlands
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49
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Dorleijn DMJ, Luijsterburg PAJ, Reijman M, Kloppenburg M, Verhaar JAN, Bindels PJE, Bos PK, Bierma-Zeinstra SMA. Intramuscular glucocorticoid injection versus placebo injection in hip osteoarthritis: a 12-week blinded randomised controlled trial. Ann Rheum Dis 2018. [PMID: 29514801 DOI: 10.1136/annrheumdis-2017-212628] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Guidelines recommend intra-articular glucocorticoid injection in patients with painful hip osteoarthritis. However, intra-articular hip injection is an invasive procedure. The efficacy of systemic glucocorticoid treatment for pain reduction in hip osteoarthritis is unknown. This randomised, double-blind, trial assessed effectiveness in hip pain reduction of an intramuscular glucocorticoid injection compared with a placebo injection in patients with hip osteoarthritis. METHODS Patients with painful hip osteoarthritis were randomised to either 40 mg triamcinolone acetate or placebo with an intramuscular injection into the gluteus muscle. The primary outcomes were severity of hip pain at rest, during walking (0-10) and WOMAC pain at 2-week postinjection. We used linear mixed models for repeated measurements at 2, 4, 6 and 12 weeks for the intention-to-treat data analysis. RESULTS Of the 107 patients randomised, 106 could be analysed (52 in the glucocorticoid group, 54 in the placebo group). At 2-week follow-up, compared with placebo injection, the intramuscular glucocorticoid injection showed a significant and clinically relevant difference in hip pain reduction at rest (difference -1.3, 95% CI -2.3 to -0.3). This effect persisted for the entire 12-week follow-up. For hip pain during walking, the effect was present at 4-week, 6-week and 12-week follow-ups, and for WOMAC pain the effect was present at 6-week and 12-week follow-up. CONCLUSIONS An intramuscular glucocorticoid injection showed effectiveness in patients with hip osteoarthritis on one of the three primary outcomes at 2-week postinjection. All primary outcomes showed effectiveness from 4 to 6 weeks, up to a 12-week follow-up. TRIAL REGISTRATION NUMBER NTR2966.
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Affiliation(s)
- Desirée M J Dorleijn
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pim A J Luijsterburg
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Max Reijman
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pieter Koen Bos
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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50
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van Outeren MV, Waarsing JH, Brouwer RW, Verhaar JAN, Reijman M, Bierma-Zeinstra SMA. Is a high tibial osteotomy (HTO) superior to non-surgical treatment in patients with varus malaligned medial knee osteoarthritis (OA)? A propensity matched study using 2 randomized controlled trial (RCT) datasets. Osteoarthritis Cartilage 2017; 25:1988-1993. [PMID: 28903017 DOI: 10.1016/j.joca.2017.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 08/31/2017] [Accepted: 09/04/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE No randomized controlled trial (RCT) has compared the high tibial osteotomy (HTO) with non-surgical treatment in patients with medial knee osteoarthritis (OA) and varus malalignment. The aim was to compare the effectiveness of an unloader brace treatment or a usual care program to the HTO regarding pain severity and knee function. DESIGN Surgical treatment (HTO) to two non-surgical options was compared by combining the data of two RCTs. One RCT (n = 117) compared an unloader brace to usual care treatment; the other RCT (n = 92) compared closing to opening wedge HTO. One-to-many propensity score matching was used to equalize patient characteristics. We compared clinical outcome at 1 year follow-up (VAS pain (0-10) and knee function (HSS, 0-100)) with mixed model analysis. RESULTS Propensity score matching resulted in a comparison of 30 brace patient with 83 HTO patients, and of 28 usual care patients with 71 HTO patients. Pain at 1 year after HTO (VAS 3.8) was lower than after valgus bracing (VAS 5.0) with a mean difference of -1.1 (95% CI -2.2; -0.1). Function showed a nonsignificant mean difference of 2.1 [95% CI -3.1; 7.3]. Comparing HTO to usual care a difference was seen in pain (-1.7 [95% CI -2.8; -0.6]) and function (6.6 [95% CI 0.2; 13.1]), in favor of the HTO. CONCLUSIONS Our data suggest that HTO was more effective in pain reduction compared to both non-surgical treatments. Function improved only when HTO was compared to usual care treatment. These small differences question the benefits of surgical treatment over the brace treatment.
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Affiliation(s)
- M V van Outeren
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J H Waarsing
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - R W Brouwer
- Department of Orthopaedics, Martini Hospital, Groningen, The Netherlands
| | - J A N Verhaar
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - M Reijman
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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