Journal of Exercise, Sports & Orthopedics

Number 3, 2014

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Rheumatoid Arthritis and Total Ankle Joint Replacement

Authors: Chaudary B, Mathavan G, Jamal B* and Pillai

Abstract

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Number of views: 498

Rheumatoid arthritis is a systemic autoimmune condition of unknown etiology which may present to the orthopedic surgeon with multi joint involvement. Rheumatoid arthritis can involve the ankle, hindfoot and forefoot. We review the historical surgical treatments for the rheumatoid ankle. We also discuss the results of the varying generations of total ankle replacement in rheumatoid arthritis. We conclude the results of the latest generation of ankle arthroplasties are limited in the rheumatoid population. This demands a frank discussion between patients and surgeons prior to embarking on surgery. Keywords: Rheumatoid; Arthritis; Ankle; Arthroplasty

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A Preliminary Investigation to Establish the Criterion Validity of a Qualitative Scoring System of Limb Alignment during Single Leg Squat and Landing

Authors: Lee Herrington* and Allan Munro

Abstract

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Number of views: 533

Objective: The present study aimed to investigate the criterion validity of a novel qualitative assessment scheme to assess limb alignment during single leg loading activities. Design and setting: Observational laboratory study Main outcome measures: Performance of 5 participant’s single leg squat and hop landing was assessed using 3-D motion capture and the findings of this compared to the qualitative scoring scheme. Results: The range of percentage of agreement between the qualitative and 3-D score was for all subjects across both tasks 95.6- 100%. The kappa measure of agreement was k = 0.9 for hop landing and k = 0.97 for single leg squat. Conclusion: The scores generated by the qualitative scoring scheme used showed excellent association with the corresponding data from 3-D motion capture, implying the measurement tool shows criterion validity. Keywords: Assessment; Lower limb; Movement

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N-Terminal Pro-Brain Natriuretic Peptide, Cardiac and Vascular Function in Patients with Type 1 Diabetes Mellitus during the Ascent of Mt. Kilimanjaro

Authors: Suzanna T. de Vries*, Pieter de Mol, Bert D. Dikkeschei, Marion J. Fokkert, Hans G. Krabbe, Eelco JP. de Koning, Rijk OB. Gans and Henk JG. Bilo

Abstract

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Number of views: 558

Aim: Hypobaric hypoxia during high altitude mountaineering and trekking triggers physiological changes in the cardiovascular and pulmonary systems that optimize the delivery of oxygen to tissues. As Type 1 Diabetes Mellitus (T1DM) is associated with increased cardiovascular risk, our goal was to investigate any disproportionately adverse effects of hypobaric hypoxia on cardiac and vascular parameters in patients with T1DM during an expedition to the summit of Mt. Kilimanjaro. Methods: Sixteen well-trained subjects, 8 with T1DM and 8 nondiabetic controls, climbed Mt Kilimanjaro (5,895 m) over a 7-day period. Cardiac function was evaluated by echocardiography and measurement of NTproBNP levels both at Sea Level (SL) and at 4000 m. Vascular measurements were performed at 1300 m and 4000 m, and included assessment of blood pressure (Dinamap), derived central aortic systolic pressure (B-PRO) and pulse wave velocity (VICORDER). Oxygen saturation (SatO2 ) was assessed at 4000 m. The Lake Louise Acute Mountain Sickness (AMS) score was obtained daily. Results: All participants reached the summit. At 4000 m SatO2 was reduced in both groups. NTproBNP levels were significantly higher in the total group at 4,000 m compared to SL. Left ventricular function and right ventricular diameter did not change. However, tricuspid annular plane systolic excursion decreased significantly. High altitude increased both systolic and diastolic peripheral Blood Pressure (BP) in the total group (SBP: 116.4 ± 8.9 vs. 121.4 ± 10.5, p < 0.05; DBP: 70.7 ± 6.3 vs 74.7 ± 8.2, p < 0.05), but not the pulse wave velocity. AMS scores remained modest except for a significantly higher score on the summit day. No significant differences were observed between T1DM subjects and controls in all parameters measured. Conclusion: Well-trained subjects with T1DM showed similar adaptation of the cardiopulmonary system compared to non-diabetic controls, with increased NTproBNP levels and peripheral blood pressure at high altitude up to 4,000 m in both groups. Keywords: NTproBNP; RV function; Pulse wave velocity; Diabetes; High altitude

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Dynamic Gene Expression Profile Changes in Synovial Fluid Following Meniscal Injury; Osteoarthritis (OA) Markers Found

Authors: Danica D. Vance*, Liyong Wang, Evadnie Rampersaud, Bryson P. Lesniak, Jeffery M. Vance, Margaret A. Pericak-Vance and Lee D. Kaplan

Abstract

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Number of views: 492

Purpose: We hypothesize that molecular changes leading to Osteoarthritis (OA) occur soon after a meniscal tear and long before the manifestation of OA. We sought to characterize the gene expression profile in synovial fluid at different time points following a meniscal tear with a focused examination on inflammatory and arthritis related genetic markers. Methods: Synovial fluid was collected from 8 male patients (24~48yrs old) with evidence of meniscal injury on Magnetic Resonance Imaging (MRI). Illumina humanht-12 microarray and RNA-Seq were used to characterize gene expression profile in cell pellets and supernatant, respectively. Unsupervised clustering analysis was performed to identify patterns of gene expression profile among samples. Metacore was utilized to perform pathway analysis. T-tests with False Discovery Rate (FDR) corrections were used to compare subset of genes among individuals. Results: Individuals with short injury duration (< 2 months) had distinct expression signatures than the rest, in both cell pellet and supernatant analyses. In the cell pellets, among genes previously linked to inflammatory or arthritic conditions, IL 1B, IL1RN, ILF2, NFKB1, IL10RB, IL18BP, ILF3, IL13RA, BMP2K and IL10RB were significantly upregulated (adjusted p < 0.05) in individuals with long duration compared to individuals with shorter injury duration in the microarray analysis. In the cell-free supernatant, 764 RNA species were identified and 65 RNA species were down-regulated and 78 RNA species were up-regulated (FDR < 0.05) in individuals with short compared to individuals with long injury duration. The most differentially expressed gene in the supernatant is SLC2A9 (P = 1.2x10-13; FDR = 9.6x10-11). In the cell pellet, the top 5% expressed genes are enriched for inflammatory and cytoskeleton remodeling pathways. Among them LAIR 1, TMSB4X, CCR6, IL18 and IL10; all have been implicated in arthritic conditions. Conclusions: Molecular changes contributing to OA development occur earlier than previously described and potentially evolve or change over time. Clinical Relevance: Our data suggest the potential for early interventions to halt detrimental molecular changes following meniscal injury, thereby reducing the susceptibility of patients to OA following a meniscal tear. Keywords: Meniscus; Meniscal tear; Gene expression; Synovial fluid; Microarray; Osteoarthritis

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The Relationship between Quadriceps Muscle Volume and Patellar Cartilage Morphology in Patients with Knee Osteoarthritis

Authors: Michael J. Berger*, Dean Inglis, Charles A. McKenzie, Kendra L. Derry, Aashish Goela, and Timothy J. Doherty

Abstract

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Number of views: 545

The purpose of this study was to determine whether quadriceps strength and whole muscle volume or distal vastii muscle volumes (Vastus Medialis: VM, Vastus Lateralis: VL) are associated with Magnetic Resonance Imaging (MRI)-derived measures of patellar cartilage morphology in patients with knee Osteoarthritis (OA). Twenty (13 female) community dwelling participants with knee OA completed isometric maximal voluntary knee extensor contractions for determination of maximal torque. MRI using 3D multi-echo spoiled gradient echo imaging sequences and a multi-point fat-water separation method were used to acquire images of the quadriceps and the PF joint. The determinants of cartilage volume, mean cartilage thickness and maximum cartilage thickness were obtained from stepwise multiple linear regression models. A stepwise model including distal VM volume (β = 0.54) and isometric torque (β = 0.40) predicted the greatest proportion of variance in cartilage volume (adjusted r2 = 0.75, p < 0.001. The variance in mean and maximum thickness was explained partially by distal VM volume only (predicted 31% of the variance in mean thickness and 32% of the variance in maximum thickness, p < 0.05). These results provide support for further investigation of distal quadriceps function in patients with knee OA, as distal VM volume is an important predictor of patellar cartilage morphology. Reduced distal VM volume could indicate focal weakness in this portion of the muscle that may not be evident with knee extensor strength or whole muscle volume measurement. Keywords: Patellofemoral osteoarthritis; Cartilage morphology; Quadriceps strength; Magnetic resonance imaging

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The Impact of Exercising on Bone Mineral Density in Women Exercising on Bone Mineral Density

Authors: Nilza Aparecida de Almeida Carvalho*, Simoni Bittar, Bruna Eriko Matsuda Marangoni and Cláudio Santili

Abstract

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Number of views: 616

The reduction in Bone Mineral Density is important during the ageing process because it can be a potential manifestation of osteoporosis. Aim: The objective was to assess the impact of exercise on bone mineral density in women. Materials and Methods: This research was conducted under the supervision of a physical therapist focused on the bone mineral density of ageing women. One hundred women, 60 years of age or older, were included in the study and underwent bone mineral density evaluation before and after administering two types of exercise. Results: Only 58.8% of the participants had undergone bone mineral density evaluation at some time before the study, and 74.4% were sedentary. No significant difference was found between vertebral and femoral bone mineral density before and after the intervention in both groups. No correlation was found between the evolution of bone mineral density and the age of menarche. Conclusion: Exercise, with or without supervision, also helped to maintain bone mineral density in postmenopausal women, who would have a natural tendency to experience bone mineral density loss. Keywords: Osteoporosis; Motor activity; Bone mineral density; Exercise; Muscle stretching exercises; Resistance training