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  • 1
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    Return to sport following low-risk and high-risk bone stress injuries: a systematic review and meta-analysis
    BMJ ; 2023
    In:  British Journal of Sports Medicine Vol. 57, No. 7 ( 2023-04), p. 427-432
    Details
    In: British Journal of Sports Medicine, BMJ, Vol. 57, No. 7 ( 2023-04), p. 427-432
    Abstract: Bone stress injuries (BSIs) are classified in clinical practice as being at low- or high-risk for complication based on the injury location. However, this dichotomous approach has not been sufficiently validated. The purpose of this systematic review was to examine the prognostic role of injury location on return-to-sport (RTS) and treatment complications after BSI of the lower extremity and pelvis. Design Systematic review and meta-analysis. Data sources PubMed, Web of Science, Cochrane CENTRAL and Google Scholar databases were searched from database inception to December 2021. Eligibility criteria for selecting studies Peer-reviewed studies that reported site-specific RTS of BSIs in athletes. Results Seventy-six studies reporting on 2974 BSIs were included. Sixteen studies compared multiple injury sites, and most of these studies (n=11) described the anatomical site of injury as being prognostic for RTS or the rate of treatment complication. Pooled data revealed the longest time to RTS for BSIs of the tarsal navicular (127 days; 95% CI 102 to 151 days) and femoral neck (107 days; 95% CI 79 to 135 days) and shortest duration of time for BSIs of the posteromedial tibial shaft (44 days, 95% CI 27 to 61 days) and fibula (56 days; 95% CI 13 to 100 days). Overall, more than 90% of athletes successfully returned to sport. Treatment complication rate was highest in BSIs of the femoral neck, tarsal navicular, anterior tibial shaft and fifth metatarsal; and lowest in the fibula, pubic bone and posteromedial tibial shaft. Conclusion This systematic review supports that the anatomical site of BSIs influences RTS timelines and the risk of complication. BSIs of the femoral neck, anterior tibial shaft and tarsal navicular are associated with increased rates of complications and more challenging RTS. PROSPERO registration number CRD42021232351.
    Type of Medium: Online Resource
    ISSN: 0306-3674 , 1473-0480
    URL: Article
    DOI: 10.1136/bjsports-2022-106328
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2003204-3
    SSG: 31
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  • 2
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    Impaired bone quality in the superolateral femoral neck occurs independent of hip geometry and bone mineral density
    Elsevier BV ; 2022
    In:  Acta Biomaterialia Vol. 141 ( 2022-03), p. 233-243
    Details
    In: Acta Biomaterialia, Elsevier BV, Vol. 141 ( 2022-03), p. 233-243
    Type of Medium: Online Resource
    ISSN: 1742-7061
    URL: Article
    DOI: 10.1016/j.actbio.2022.01.002
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2173841-5
    SSG: 12
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  • 3
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    Characterization of tissue-specific subchondral quality in hip osteoarthritis reveals stage- and region-dependent nanomechanical interface disruption
    Elsevier BV ; 2022
    In:  Bone Reports Vol. 16 ( 2022-05), p. 101278-
    Details
    In: Bone Reports, Elsevier BV, Vol. 16 ( 2022-05), p. 101278-
    Type of Medium: Online Resource
    ISSN: 2352-1872
    URL: Article
    DOI: 10.1016/j.bonr.2022.101278
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2821774-3
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  • 4
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    Tumor localization and treatment of tumor-induced osteomalacia
    Springer Science and Business Media LLC ; 2022
    In:  Zeitschrift für Rheumatologie Vol. 81, No. 3 ( 2022-04), p. 182-188
    Details
    In: Zeitschrift für Rheumatologie, Springer Science and Business Media LLC, Vol. 81, No. 3 ( 2022-04), p. 182-188
    Type of Medium: Online Resource
    ISSN: 0340-1855 , 1435-1250
    URL: Article
    DOI: 10.1007/s00393-022-01160-1
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1463308-5
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  • 5
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    Allograft Chip Incorporation in Acetabular Reconstruction : Multiscale Characterization Revealing Osteoconductive Capacity
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of Bone and Joint Surgery Vol. 103, No. 21 ( 2021-11-3), p. 1996-2005
    Details
    In: Journal of Bone and Joint Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 103, No. 21 ( 2021-11-3), p. 1996-2005
    Abstract: Impacted bone-grafting with morselized allograft chips is commonly used to reconstruct acetabular bone defects in revision total hip arthroplasty (THA). While the overall clinical outcome of this procedure is described to be excellent, the microstructural basis and histological determinants of allograft incorporation remained to be further elucidated. Methods: The acetabula of 23 individuals with documented previous use of allograft chips during revision THA were explanted post mortem. The time that the allografts were in situ averaged 10.3 ± 4.5 years (range, 1.2 to 19.8 years). The host bone (HB)-allograft bone (AB) interface was characterized using a suite of high-resolution (HR) imaging techniques including HR-peripheral quantitative computed tomography (HR-pQCT), histological analysis, cellular histomorphometry, and scanning electron microscopy. Results: AB could be identified in 16 of the 23 cases. The HB and AB showed overlap (i.e., ingrowth) in 91.3% of the total interface. The mean ingrowth was 2.2 ± 1.0 mm with a maximum of 4.7 ± 2.1 mm. The periphery of the AB showed a tight interconnection with the HB associated with increased bone remodeling indices and increased trabecular thickness. While no association between the time in situ and the ingrowth was observed, the bone defect area was positively associated with the thickness of a fibrosis layer separating the ingrowth zone from the AB. Conclusions: Allograft chips in revision THA form an adequate osseous foundation with successful incorporation through ingrowth of the HB (i.e., osteoconduction). While complete remodeling was not observed, larger defects were associated with fibrosis formation, which may compromise stability. Clinical Relevance: Our study provides the first systematic, multiscale long-term evaluation of chip allograft incorporation in revision THA to underscore its successful clinical use. As larger defects were associated with fibrous ingrowth, structural allografts may be superior for larger defects in terms of long-term outcomes.
    Type of Medium: Online Resource
    ISSN: 0021-9355 , 1535-1386
    URL: Article
    DOI: 10.2106/JBJS.20.01943
    RVK:
    XA 52200.A
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 6
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    Genetic Diagnostics in Routine Osteological Assessment of Adult Low Bone Mass Disorders
    The Endocrine Society ; 2022
    In:  The Journal of Clinical Endocrinology & Metabolism Vol. 107, No. 7 ( 2022-06-16), p. e3048-e3057
    Details
    In: The Journal of Clinical Endocrinology & Metabolism, The Endocrine Society, Vol. 107, No. 7 ( 2022-06-16), p. e3048-e3057
    Abstract: Many different inherited and acquired conditions can result in premature bone fragility/low bone mass disorders (LBMDs). Objective We aimed to elucidate the impact of genetic testing on differential diagnosis of adult LBMDs and at defining clinical criteria for predicting monogenic forms. Methods Four clinical centers broadly recruited a cohort of 394 unrelated adult women before menopause and men younger than 55 years with a bone mineral density (BMD) Z-score  & lt; -2.0 and/or pathological fractures. After exclusion of secondary causes or unequivocal clinical/biochemical hallmarks of monogenic LBMDs, all participants were genotyped by targeted next-generation sequencing. Results In total, 20.8% of the participants carried rare disease-causing variants (DCVs) in genes known to cause osteogenesis imperfecta (COL1A1, COL1A2), hypophosphatasia (ALPL), and early-onset osteoporosis (LRP5, PLS3, and WNT1). In addition, we identified rare DCVs in ENPP1, LMNA, NOTCH2, and ZNF469. Three individuals had autosomal recessive, 75 autosomal dominant, and 4 X-linked disorders. A total of 9.7% of the participants harbored variants of unknown significance. A regression analysis revealed that the likelihood of detecting a DCV correlated with a positive family history of osteoporosis, peripheral fractures ( & gt; 2), and a high normal body mass index (BMI). In contrast, mutation frequencies did not correlate with age, prevalent vertebral fractures, BMD, or biochemical parameters. In individuals without monogenic disease-causing rare variants, common variants predisposing for low BMD (eg, in LRP5) were overrepresented. Conclusion The overlapping spectra of monogenic adult LBMD can be easily disentangled by genetic testing and the proposed clinical criteria can help to maximize the diagnostic yield.
    Type of Medium: Online Resource
    ISSN: 0021-972X , 1945-7197
    URL: Article
    DOI: 10.1210/clinem/dgac147
    RVK:
    XA 10000
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2022
    detail.hit.zdb_id: 2026217-6
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  • 7
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    Compartment‐specific effects of muscle strength on bone microarchitecture in women at high risk of osteoporosis
    Wiley ; 2022
    In:  Journal of Cachexia, Sarcopenia and Muscle Vol. 13, No. 5 ( 2022-10), p. 2310-2321
    Details
    In: Journal of Cachexia, Sarcopenia and Muscle, Wiley, Vol. 13, No. 5 ( 2022-10), p. 2310-2321
    Abstract: It is well known that skeletal integrity is influenced by the musculature. Poor muscle strength (i.e. sarcopenia) is considered a major predictor of fragility fractures. While this observation appears particularly relevant for older women with increased risk of osteoporosis, there has been no comprehensive investigation to determine the influence of muscle performance on compartment‐specific bone microarchitecture in multiple body regions. Methods We retrospectively analysed data from different muscle performance and bone microarchitecture assessments in 230 women (aged 21 to 87 years) at high risk of osteoporosis. Muscle performance tests included grip strength and chair rising test (CRT) combined with mechanography. Balance was determined by Romberg posturography. Areal bone mineral density (BMD) was measured by dual‐energy X‐ray absorptiometry (DXA) at the hip and lumbar spine. Compartment‐specific volumetric BMD, microarchitecture, and geometry were assessed by second‐generation high‐resolution peripheral quantitative computed tomography (HR‐pQCT) at multiple skeletal sites (distal radius, tibia, and fibula). Regression models were applied to test for interactions between muscle and bone parameters. Subgroups were defined to compare women with osteoporosis and osteosarcopenia regarding BMD and microarchitecture. Results While osteoporosis was diagnosed in 115/230 (50.0%) women, sarcopenia was detected in 38/230 (16.5%). Positive associations of both grip strength and CRT maximum force with cortical geometric and microarchitectural parameters were detected at all measured sites, with the strongest effect applying to CRT maximum force and tibial parameters (e.g. tibial cortical area R 2  = 0.36, P   〈  0.0001, and tibial cortical thickness R 2  = 0.26, P   〈  0.0001). Balance parameters showed much weaker or no associations with HR‐pQCT parameters. Major associations between muscle strength and trabecular parameters could not be confirmed. Age and body mass index were confirmed as negative and positive predictors for several microarchitectural parameters, respectively. An independent predictive value of grip strength on radial, tibial, and fibular (all P   〈  0.01) cortical area and of CRT maximum relative force on cortical thickness (all P   〈  0.05) was revealed. Women with osteosarcopenia showed significantly reduced cortical HR‐pQCT parameters but no differences in DXA values compared with women with osteoporosis but no sarcopenia. Stratification by fracture and treatment status revealed that vertebral fractures and denosumab treatment altered the muscle–bone interaction. Conclusions A systemic interaction between muscle strength and bone microarchitecture was demonstrated, and this interaction appears to be primarily with the cortical bone compartment. The value of muscle assessments in fracture risk evaluation may be partly mediated by their effects on bone microarchitecture.
    Type of Medium: Online Resource
    ISSN: 2190-5991 , 2190-6009
    URL: Issue
    URL: Article
    DOI: 10.1002/jcsm.v13.5
    DOI: 10.1002/jcsm.13044
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2586864-0
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  • 8
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    Superior Bone Microarchitecture in Anatomic Versus Nonanatomic Fibular Drill Tunnels for Reconstruction of the Posterolateral Corner of the Knee
    SAGE Publications ; 2022
    In:  Orthopaedic Journal of Sports Medicine Vol. 10, No. 9 ( 2022-09-01), p. 232596712211264-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 9 ( 2022-09-01), p. 232596712211264-
    Abstract: Several fibula-based reconstruction techniques have been introduced to address ligamentous injuries of the posterolateral corner of the knee. These techniques involve a drill tunnel with auto- or allograft placement through the proximal fibula. Purpose: To determine the skeletal microarchitecture of the proximal fibula and its association with age and to compare the microarchitecture within the regions of different drill tunnel techniques for reconstruction of the posterolateral corner. Study Design: Descriptive laboratory study. Methods: A total of 30 human fibulae were analyzed in this cadaveric imaging study. High-resolution peripheral quantitative computed tomography measurements were performed in a 4.5 cm–long volume of interest at the proximal fibula. Three-dimensional microarchitectural data sets of cortical and trabecular compartments were evaluated using customized scripts. The quadrants representing the entry and exit drill tunnel positions corresponding to anatomic techniques (LaPrade/Arciero) and the Larson technique were analyzed. Linear regression models and group comparisons were applied. Results: Trabecular microarchitecture parameters declined significantly with age in women but not men. Analysis of subregions with respect to height revealed stable cortical and decreasing trabecular values from proximal to distal in both sexes. Along with a structural variability in axial slices, superior values were found for the densitometric and microarchitectural parameters corresponding to the fibular drill tunnels in the anatomic versus Larson technique (mean ± SD; bone volume to tissue volume at the entry position, 0.273 ± 0.079 vs 0.175 ± 0.063; P 〈 .0001; cortical thickness at the entry position, 0.501 ± 0.138 vs 0.353 ± 0.081 mm; P 〈 .0001). Conclusion: Age represented a relevant risk factor for impaired skeletal microarchitecture in the proximal fibula in women but not men. The region of drill tunnels according to anatomic techniques showed superior bone microarchitecture versus that according to the Larson technique.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671221126475
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 9
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    Musculoskeletal laboratory diagnostics in competitive sport
    Springer Science and Business Media LLC ; 2021
    In:  Der Orthopäde Vol. 50, No. 9 ( 2021-09), p. 700-712
    Details
    In: Der Orthopäde, Springer Science and Business Media LLC, Vol. 50, No. 9 ( 2021-09), p. 700-712
    Abstract: Laboratory diagnostics represent a valuable tool for the optimization and assessment of the performance and regeneration ability in professional athletes. Blood parameters play an important role in the prevention, diagnosis and rehabilitation of injuries and physical overload. Objectives The aim of this article is to present an overview of musculoskeletal laboratory parameters and to provide relevant information for the medical care of competitive athletes. Methods Literature search and narrative review. Results The laboratory assessment of bone metabolism includes vitamin D, calcium and bone turnover and aims to provide a preventive benefit with respect to skeletal complications (e.g., to minimize the risk of bone stress injuries). In addition, muscular serum markers, such as lactate dehydrogenase (LDH), creatine kinase (CK), myoglobin and aspartate aminotransferase (AST) can be used to monitor metabolic adaptation to physical exercise and to obtain information about the muscular workload and potential damage. The energy availability can be estimated and optimized by appropriate balancing and laboratory determination of macro- and micronutrients. Conclusions Laboratory diagnostics have a clinical relevance across different sport disciplines. They are intended to support athletes and medical staff on their way to the highest possible performance and help to ensure the optimal prevention of bone and muscle injuries. Parameters with deficiency results (e.g., vitamin D) should be adequately compensated. A periodization of the laboratory tests, with at least two tests per year, and the establishment of individual variability and reference ranges can improve the assessment.
    Type of Medium: Online Resource
    ISSN: 0085-4530 , 1433-0431
    URL: Article
    DOI: 10.1007/s00132-021-04072-1
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 3122958-X
    detail.hit.zdb_id: 1462973-2
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  • 10
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    Investigation of distal femur microarchitecture and factors influencing its deterioration: An ex vivo high‐resolution peripheral quantitative computed tomography study
    Wiley ; 2022
    In:  Journal of Orthopaedic Research Vol. 40, No. 9 ( 2022-09), p. 2057-2064
    Details
    In: Journal of Orthopaedic Research, Wiley, Vol. 40, No. 9 ( 2022-09), p. 2057-2064
    Abstract: While fractures of the distal femur are often considered as fragility fractures, detailed knowledge of the bone microarchitecture at this skeletal site is largely unavailable. Initial evaluation of a patient cohort with distal femur fractures showed a markedly increased occurrence in elderly women. The purpose of this study was to determine the extent to which demographic characteristics of distal femur fractures are reflected by general age‐ and sex‐specific variations in local microarchitectural parameters. Fifty cadaveric femora were collected from 25 subjects (12 females, 13 males, age 25–97 years). A volume of interest within 3 cm proximal to the condyles was analyzed using high‐resolution peripheral quantitative computed tomography (HR‐pQCT), which revealed impaired trabecular and cortical bone microarchitecture in women compared to men as well as in osteoporotic compared to normal or osteopenic subjects, as classified by dual‐energy X‐ray absorptiometry (DXA) T‐score. Linear regression analyzes showed negative associations between age and HR‐pQCT parameters in women (e.g., cortical thickness −14 µm/year, 95% CI: −21 to −7 µm/year), but not in men (e.g., cortical thickness 1 µm/year, 95% CI: −12 to 14 µm/year). HR‐pQCT parameters showed strong positive associations with areal bone mineral density (aBMD) determined by DXA at the hip in both sexes. Taken together, our findings suggest that female sex, advanced age, and low aBMD represent major risk factors for impaired microarchitecture at the distal femur. Both the diagnostic value of DXA for predicting distal femur fractures and the efficacy of bone‐specific agents on fracture risk reduction should be investigated in the future.
    Type of Medium: Online Resource
    ISSN: 0736-0266 , 1554-527X
    URL: Issue
    URL: Article
    DOI: 10.1002/jor.v40.9
    DOI: 10.1002/jor.25246
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2050452-4
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