Tiit Haviko

Treatment of children with Osteogenesis imperfecta in Estonia

Aim: To analyse the changes in fracture rate, bone density and histology in children with Osteogenesis imperfecta receiving treatment with alendronate (oral bisphosphonate) and calcitriol. Methods: Children treated at Tartu University Hospital from 1995 to 2001 were examined for Osteogenesis imperfecta. Radiographs and bone density measurements were obtained for all patients at the beginning of the study. Four patients also had bone biopsies prior to and one year after beginning treatment. The children were then given alendronate in weight‐dependent dosages and also calcitriol. The number of fractures during the treatment period was recorded and follow‐up bone density measurements were made. Results: Fifteen patients were treated during the 6‐y period; mean follow‐up approximately 3 y. It was found that the number of bone fractures had decreased significantly (p < 0.0001). Bone density improved in all 15 patients. Histologic studies revealed an increased number of osteoblasts and thickness of bone trabeculae as well as a more regular bone lamellar structure at the time of the second operation.

Quadriceps femoris muscle voluntary isometric force production and relaxation characteristics before and 6 months after unilateral total knee arthroplasty in women

The purpose of the present prospective intervention study was to evaluate voluntary isometric force production, relaxation and activation capacity of the quadriceps femoris (QF) muscle before and 6xa0months after unilateral total knee arthroplasty (TKA). TKA was performed in ten women with primary knee osteoarthritis (OA) using the condular endoprostheses. Isometric maximal voluntary contraction (MVC) force, rate of force development at 50% of MVC (RFD50) and their ratio to body mass, half-relaxation time (HRT) and voluntary activation (VA) of the QF muscle were recorded in patients for operated and non-operated leg before and 6xa0months after TKA. Established characteristics were compared with data on the dominant leg of ten age- and gender-matched controls. The clinical examination was performed using the Knee Society System (KSS) scores and pain intensity was assessed by visual analogue scale. MVC force in operated leg was lower (Pxa0<xa00.05) before and 6xa0months after TKA as compared with the non-operated leg (31 and 32%, respectively) and controls (48 and 44%, respectively). Patients had lower (Pxa0<xa00.05) VA of the QF muscle in operated leg 6xa0months after TKA as compared to controls. Significant increase (Pxa0<xa00.05) of KSS clinical scores and the tendency for the increasing of explosive force production of QF muscle in the operated leg were observed 6xa0months after TKA (RFD50 was 60% lower before TKA and 40% lower 6xa0months after surgery as compared to controls). When compared with the preoperative value, HRT prolongation (Pxa0<xa00.05) was noted 6xa0months after TKA in QF muscle of both legs in patients. Therefore, the present study confirmed that patients with knee OA had reduced force generation ability of QF muscle before TKA and the improvement of explosive force was noted 6xa0months after surgery.

Heterotopic ossification after total hip arthroplasty

Abstract. We studied 178 patients undergoing total hip arthroplasty (66 men and 112 women) retrospectively, with regard to the incidence and severity of heterotopic ossification and the significance of postoperative prophylaxis with non-steroid anti-inflammatory drugs. The overall incidence of heterotopic ossification was 32% 1xa0year after surgery. The factors increasing the incidence were male gender, previous arthroplasty of the contralateral hip joint, previous surgery on the hip, absence of preoperative treatment with non-steroidal anti-inflammatory drugs and an operating time of more than 100xa0min. The incidence of heterotopic ossification was lower in the patients of 0 blood group.Résumé. Nous avons étudié la fréquence et la sévérité dossification hétérotopique dans 178 cas darthroplastie totale de la hanche avec une prophylaxie postopératoire par AINS. Une année après la chirurgie la fréquence totale était de 32%. Les facteurs qui augmentent le risque étaient le sexe masculin, une arthroplastie de la hanche contrelaterale, des antécédents chirurgicaux sur hanche, labsence de traitement préopératoire par AINS et une durée opératoire de plus de 100xa0min. La fréquence dossification hétérotopique était inférieure chez les patients du groupe sanguin 0.

The anterior glenohumeral joint capsule: macroscopic and MRI anatomy of the fasciculus obliquus or so-called ligamentum glenohumerale spirale

The purpose of this study was to demonstrate the macroscopic and MRI anatomy of the fasciculus obliquus, otherwise known as the ligamentum glenohumerale spirale or spiral GHL of the anterior shoulder joint capsule. Conventional and MR arthrography (1.5-T device Somatom Symphony, Siemens with shoulder coil) images in standard planes were compared with gross anatomic dissection findings in six fresh shoulder specimens from three cadavers. The MR imaging protocol included T1, PD and DESS 3D WI sequences. The macroscopically recognisable band—the spiral GHL—was identified by anatomic dissection and MRI in all the specimens. It was best visualised by MR arthrography on axial and oblique sagittal planes (T1; PD WI) and appeared as a low signal intensity stripe within the superficial layer of the anterior joint capsule. The absence of the variable middle glenohumeral ligament did not influence the anatomic properties and the MR imaging of the spiral GHL. Diagnostic visualisation of the normal anatomic structures is a prerequisite to distinguish between normal and pathologic conditions. Anatomy of the spiral GHL can be used by radiologists for more detailed interpretation of the anterior shoulder joint capsule ligaments on MR images.

Inter-observer reliability in the assessment of heterotopic ossification: proposal of a combined classification

We applied four published classifications for assessment of heterotopic ossification after total hip arthroplasty (Arcq, Brooker, DeLee and Della Valle [1, 2, 5, 6]. The average incidence of heterotopic ossification varied from 19.8% to 27.7%. The inter-observer reliability of the various classifications was determined by Cohen’s Kappa statistic. Kappa values ranged from 0.897 for Arcq’s to 0.814 for Brooker’s classification. In order to increase the reliability and consistency, we propose a new classification system combining Brooker’s and Della Valle’s classifications. This new classification preserves the high reliability of Della Valle’s system and is comparable to previous publications since it includes Brooker’s criteria.RésuméNous avons utilisé quatre classifications publiées pour l’estimation des ossifications hétérotopiques après arthroplastie total de la hanche (Arcq, Brooker, DeLee and Della Valle [1, 2, 5, 6]. La fréquence moyenne de ces ossifications variait de 19,8 à 27,7%. La précision inter-observateurs des classifications a été déterminée par le kappa statistique de Cohen. Les valeurs Kappa ont varié de 0.897 pour Arcq à 0.814 pours la classification de Brooker. Pour augmenter la précision et la cohérence, nous proposons un nouveau système qui combine les classifications de Brooker et de Della Valles. Cette nouvelle classification conserve la haute précision du système de Della Valle et est comparable aux publications antérieures puisque elle inclut les critères de Brooker.

The Spiral Glenohumeral Ligament: An Open and Arthroscopic Anatomy Study

PURPOSEnThe purpose of this study was to visualize arthroscopically and to describe the micro- and macroscopic anatomy of the poorly known ligament of the anterior capsule of the glenohumeral joint: the so-called ligamentum glenohumerale spirale (spiral GHL).nnnMETHODSnTwenty-two fresh shoulder joints were dissected, and the anatomy of the anterior capsular structures (the spiral GHL, the middle glenohumeral ligament [MGHL], and the anterior band as well as the axillary part of the inferior glenohumeral ligament [AIGHL and AxIGHL, respectively]) was investigated. For arthroscopic visualization, 30 prospective arthroscopic clinical cases and 19 retrospective video clips of the patients who had an arthroscopic shoulder procedure with a normal subscapularis tendon, labrum, and anterior joint capsule were evaluated.nnnRESULTSnThe spiral GHL and the AxIGHL were present in all 22 shoulder specimens. The AIGHL was not recognizable on the extra-articular side of the joint capsule. The MGHL was absent in 3 shoulder specimens (13.6%). Arthroscopically, the spiral GHL was found in 22 (44.9%), the MGHL in 43 (87.8%), and the AIGHL in 46 (93.9%) of the cases. The spiral GHL arose from the infraglenoid tubercle and the triceps tendon and inserted together with subscapularis tendon onto the lesser tubercle of the humerus.nnnCONCLUSIONSnOur results suggest that extra-articular structure of the spiral GHL is consistently recognizable, the upper part of which can be arthroscopically identified.nnnCLINICAL RELEVANCEnAdvanced anatomic knowledge of the spiral GHL helps the clinician better understand the normal anatomy of the shoulder joint and also helps to differentiate it from pathologic findings of the patient. The biomechanical importance of the spiral GHL and its connection with shoulder pathology remains to be determined in further studies.

Bone status in healthy Estonian women assessed with quantitative ultrasonometry.

We assessed age-related changes of bone status in healthy Estonian women in various age groups with quantitative ultrasonometry. The speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index (SI) of the calcaneus were measured in 288 women. BUA and SI values peaked at 30-39 years of age while SOS peaked at 20-29 years and decreased thereafter. We detected no statistically significant changes between the age groups of 20-29, 30-39 and 40-49 years. The total age-related decrease was 18% for BUA, 3% for SOS and 29% for SI. Wefound a statistically significant correlation between bone status and calcium intake, as well as physical activity in the age group over 40 years.

40 years of tissue banking in Estonia

A survey is given of the development of tissue banking in Estonia during40 years, in which we address methods of tissue preservation, application ofpreserved skeletal tissues in orthopaedics as well as issues of clinical andexperimental research in this area. Preparation and use of demineralized andmorselized bone allografts has been significant during the last ten years.Progress of endoprosthetic joint surgery has essentially increased the need forbone transplantation in orthopaedics.

Postural control in total knee arthroplasty patients with patellofemoral pain syndrome before and six months after re-operation

Background Although excellent long-term clinical results have been reported for the total knee arthroplasty (TKA), 37% of patients have limited functional improvement one year after the surgery [1]. Patients with a clinical presentation of anterior knee pain could be diagnosed with patellofemoral pain syndrome (PFPS). Modified clinical classification of PFPS patients includes two main groups: with malalignment and with muscular dysfunction [2]. The aim of the study was to compare postural stability characteristics in TKA patients with PFPS before and six months after re-operation.