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Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (31 July 2021) | Viewed by 37699

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Prof. Dr. Francesco Oliva

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Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy
Interests: arthroplasty; shoulder; hip; knee; ankle and foot surgery; tendinopathies
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Nicola Maffulli

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Laboratory of Translational Medicine, Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy
Interests: sports trauma injury, joint replacement, hand & rheumatoid surgery, & adult & paediatric orthopaedics; surgical techniques in the field of knee, foot and ankle, and sports surgery; soft tissues problems
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Musculoskeletal problems impose a heavy burden worldwide in terms of lost working days or absence from competitive activity. This Special Issue provides a detailed examination and discussion regarding epidemiology, risk factors, orevalence, and incidence of musculoskeletal disorders (MSD) among athletes, from amateur to elite, and physically active individuals, with particular references to gender medicine and interdisciplinary/translational medicine. In this way, we should be able to better understand how to prevent such ailments, when to perform surgery, and how to plan rehabilitation for optimal results. In this context, new studies which have the potential to produce major improvements in the current state-of-the-art are needed. Thus, authors are encouraged to submit systematic reviews and meta-analyses and original research. Research conducted in populations that so far have received little attention is also of particular interest for this Special Issue. Controversial works that may lead to a potential paradigm shift will receive our highest priority.

Prof. Dr. Francesco Oliva
Prof. Dr. Nicola Maffulli
Guest Editors

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Keywords

Epidemiology
Risk factors
Sport traumatology
Gender medicine

Published Papers (11 papers)

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Research

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13 pages, 963 KiB

Open AccessArticle

Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions

by Thomas Fuchs, Josef Stolberg-Stolberg, Philipp A. Michel, Patric Garcia, Susanne Amler, Dirk Wähnert and Michael J. Raschke

J. Clin. Med. 2021, 10(19), 4597; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10194597 - 06 Oct 2021

Cited by 10 | Viewed by 2195

Abstract

Background: Delayed fracture healing continues to cause significant patient morbidity and an economic burden to society. Biological stimulation of non-unions includes application of recombinant bone morphogenetic protein-2 (rhBMP-2). However, rhBMP-2 use continues to be a matter of controversy as literature shows scarce evidence for treatment effectiveness. Questions: The objective of this study was to evaluate the effectiveness of rhBMP-2 treatment on long bone non-unions measuring union rate and time to union. Furthermore, we assess risk factors for treatment failure. Methods and patients: A total of 91 patients with non-unions of long bones were treated with rhBMP-2 (n = 72) or standard care without BMP (n = 19) at our institution. Patient characteristics, comorbidities, nicotine consumption, and complications were recorded. Bone healing was assessed by plane X-rays and clinical examination. Patients were followed up with for 24 months. Results: Overall, there was significantly faster bone healing after rhBMP-2 application compared to the no-BMP group (p < 0.001; HR = 2.78; 95% CI 1.4–5.6). Union rates differed significantly between rhBMP-2 compared to the no-BMP group (89% vs. 47%; p < 0.001). At the humerus, there was neither a significantly higher union rate in the rhBMP-2 (83%) compared to the no-BMP group (50%) (p = 0.26; n = 12) nor a faster bone healing with a median time of 9 months in both groups (HR = 2.01; 95% CI 0.49–8.61; p = 0.315). The 33 femora treated using rhBMP-2 healed significantly faster than 9 femora in the no-BMP group (HR = 2.93; 95% CI 1.00–8.4; p = 0.023) with significant differences in union rate with 85% and 44%, respectively (p = 0.022). Regarding tibia non-unions, 25 out of 27 (93%) healed with a median of 9 months after rhBMP-2 application with no significant difference in the no-BMP group (33%) in time to union (p = 0.097) but a significantly higher union rate (p = 0.039). There was no effect of comorbidities, age, sex, soft tissue damage, or nicotine use on time to union, union rate, or secondary interventions. Conclusion: Consistent with the literature, overall, significantly higher union rates with reduced time to union were achieved after rhBMP-2 application. Femoral and tibial non-unions in particular seem to profit from rhBMP-2 application. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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11 pages, 1219 KiB

Open AccessArticle

Prevalence and Incidence of Osteoarthritis: A Population-Based Retrospective Cohort Study

by Rola Hamood, Matanya Tirosh, Noga Fallach, Gabriel Chodick, Elon Eisenberg and Omri Lubovsky

J. Clin. Med. 2021, 10(18), 4282; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10184282 - 21 Sep 2021

Cited by 25 | Viewed by 6222

Abstract

While trends data of osteoarthritis (OA) are accumulating, primarily from Western Europe and the US, a gap persists in the knowledge of OA epidemiology in Middle Eastern populations. This study aimed to explore the prevalence, incidence, correlations, and temporal trends of OA in Israel during 2013–2018, using a nationally representative primary care database. On 31 December 2018, a total of 180,126 OA patients were identified, representing a point prevalence of 115.3 per 1000 persons (95% CI, 114.8–115.8 per 1000 persons). Geographically, OA prevalence was not uniformly distributed, with the Southern and Northern peripheral districts having a higher prevalence than the rest of the Israeli regions. OA incidence increased over time from 7.36 per 1000 persons (95% CI 6.21–7.50 per 1000 persons) in 2013 to 8.23 per 1000 persons (95% CI 8.09–8.38 per 1000 persons) in 2017 (p-value for trend = 0.02). The incidence was lowest in patients under 60 years (in both sexes) and peaked at 60–70 years. In older ages, the incidence leveled off in men and declined in women. The growing risk of OA warrants a greater attention to timely preventive and therapeutic interventions. Further population-based studies in the Middle East are needed to identify modifiable risk factors for timely preventive and therapeutic interventions. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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9 pages, 2889 KiB

Open AccessArticle

Differences in the Prevalence of Clinical Adjacent Segment Pathology among Continents after Anterior Cervical Fusion: Meta-Analysis of Randomized Controlled Trials

by Young-Woo Chung, Sung-Kyu Kim and Yong-Jin Park

J. Clin. Med. 2021, 10(18), 4125; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10184125 - 13 Sep 2021

Cited by 2 | Viewed by 1269

Abstract

Development of adjacent segment pathology leading to secondary operation is a matter of concern after anterior cervical discectomy and fusion (ACDF). Some studies have reported anatomic difference between races, but no epidemiological data on prevalence of clinical adjacent segment pathology (cASP) among races or continents has been published. The purpose of this study was to compare the prevalence of cASP that underwent surgery after monosegmental ACDF among continents by meta-analysis. MEDLINE, EMBASE, and Cochrane Library with manual searching in key journals, reference lists, and the National Technical Information Service were searched from inception to December 2018. Twenty studies with a total of 2009 patients were included in the meta-analysis. We extracted the publication details, sample size, and prevalence of cASP that underwent surgery. A total of 15 papers from North America, three from Europe, and two from Asia met the inclusion criteria. A total number of 2009 patients underwent monosegmental ACDF, and 113 patients (5.62%) among them had cASP that underwent surgery. The rate of cASP that underwent surgery was 4.99% in the North America, 3.65% in the Europe, 6.34% in the Asia, and there were no statistically significant differences (p = 0.63). The current study using the method of meta-analysis revealed that there were no significant differences in the rate of cASP that underwent surgery after ACDF among the continents. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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8 pages, 672 KiB

Open AccessArticle

Electric Scooter-Related Injuries: A New Epidemic in Orthopedics

by Alexandre Coelho, Pablo Feito, Laura Corominas, Juan Francisco Sánchez-Soler, Daniel Pérez-Prieto, Santos Martínez-Diaz, Albert Alier and Joan Carles Monllau

J. Clin. Med. 2021, 10(15), 3283; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10153283 - 25 Jul 2021

Cited by 24 | Viewed by 3502

Abstract

Background: The use of electric scooters has increased considerably as they are an accessible means of transportation. The number of injuries from falls and collisions has risen significantly. Therefore, the aim of the study was to describe demographics injury patterns of electric scooter accidents produced over one year. Methods: A prospective observational study of electric scooter- related injuries presented in the emergency room from May 2019 until May 2020. The inclusion criteria was based on the direct cause of injury produced while an electric scooter was in use. Demographic data, the use of a helmet or the lack thereof, accident mechanism, injury time, type of injury produced, and the treatment applied were collected. Results: Over the study period, 397 patients were identified with a total of 422 injuries. The mean age was 30.8 years, with 12.6% of patients being minors. The patients mainly presented in evening hours and in summertime at the emergency department. Of the total injuries seen, 46.9% were fractures. Some 25% of the total cases required surgery. Only 19% of the riders wore a helmet at the time of the accident. Most of the fractures were to the upper limbs (62.6%). There was a greater incidence of radius fractures. Conclusion: Injuries incurred while using electric scooters are an emerging phenomenon, despite existing regulations. In this study, most injuries occurred in young men and were due to falls from the vehicle. Nearly half of those injuries were fractures to the upper limbs. Surprisingly, 50% of the fractures required surgery. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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8 pages, 856 KiB

Open AccessArticle

Ulnar Nerve Dislocation and Subluxation from the Cubital Tunnel Are Common in College Athletes

by Keisuke Tsukada, Youichi Yasui, Jun Sasahara, Yasuaki Okawa, Takumi Nakagawa, Hirotaka Kawano and Wataru Miyamoto

J. Clin. Med. 2021, 10(14), 3131; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10143131 - 15 Jul 2021

Cited by 7 | Viewed by 6105

Abstract

Background: Hypermobility of the ulnar nerve from the cubital tunnel reportedly occurs in healthy people without symptoms of ulnar neuropathy. However, the occurrence rate in athletes is unknown. We examined the occurrence rate of ulnar nerve hypermobility using ultrasonography, symptoms, and physical findings in athletes and compared the results of four types of sports. Methods: Medical charts of college athletes competing in baseball, rugby, soccer, and long-distance running between March and November 2018 were retrospectively examined. Dynamic evaluation of the ulnar nerve was performed using ultrasonography and categorized as Types N, S, and D respectively, indicating normal position, subluxation, and dislocation. Subjective and objective findings were evaluated. Results: The present study included 246 male athletes (mean age, 19.7 years; 492 elbows) including 46% Type D, 29.8% Type S, and 24.2% Type N. Subjective findings showed pain and dysesthesia in 9% and 4.5% of participants, respectively, whereas objective findings showed Tinel sign in 6%, nerve tension test in 1.3%, Froment’s sign in 0.5%, and weakness of strength of opponens digiti minimi muscle in 8% of patients with Types D and S. Conclusions: There was a high-frequency hypermobility of the ulnar nerve from the cubital tunnel with or without subjective and objective findings in college athletes. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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13 pages, 1359 KiB

Open AccessArticle

Male Sex Is Associated with Higher Mortality and Increased Risk for Complications after Surgical Treatment of Proximal Humeral Fractures

by Jeanette Koeppe, J. Christoph Katthagen, Robert Rischen, Moritz Freistuehler, Andreas Faldum, Michael J. Raschke and Josef Stolberg-Stolberg

J. Clin. Med. 2021, 10(11), 2500; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10112500 - 05 Jun 2021

Cited by 9 | Viewed by 2239

Abstract

Aims: The best surgical treatment of multi-fragmentary proximal humeral fractures in the elderly is a highly controversial topic. The aim of this study is to assess for sex-related differences regarding mortality and complications after reverse total shoulder arthroplasty (RTSA) and locking plate fixation (LPF). Patients and Methods: All patients from the largest German healthcare insurance (26.5 million policy holders) above the age of 65 years that were treated with LPF or RTSA after a multi-fragmentary proximal humerus fracture between January 2010 and September 2018 were included. Multivariable Cox regression models were used to assess the association of sex with overall survival, major adverse events and surgical complications. Results: A total of 8264 (15%) men and 45,707 (85%) women were followed up for a median time of 52 months. After 8 years, male patients showed significantly higher rates for death (65.8%; 95% CI 63.9–67.5% vs. 51.1%; 95% CI 50.3–51.9%; p < 0.001) and major adverse events (75.5%; 95% CI 73.8–77.1% vs. 61.7%; 95% CI 60.9–62.5%; p < 0.001). With regard to surgical complications, after adjustment of patient risk profiles, there were no differences between females and males after LPF (p > 0.05), whereas men showed a significantly increased risk after RTSA (HR 1.86; 95% CI 1.56–2.22; p < 0.001) with more revision surgeries performed (HR 1.76, 95% CI 1.46–2.12; p < 0.001) compared to women. Conclusion: The male sex is an independent risk factor for death and major adverse events after both LPF and RTSA. An increased risk for surgical complications after RTSA suggests that male patients benefit more from LPF. Sex should be considered before making treatment decisions. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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10 pages, 1467 KiB

Open AccessArticle

Impact of the 1st and 2nd Wave of the COVID-19 Pandemic on Primary or Revision Total Hip and Knee Arthroplasty—A Cross-Sectional Single Center Study

by Sebastian Simon, Bernhard J.H. Frank, Alexander Aichmair, Philip P. Manolopoulos, Martin Dominkus, Eva S. Schernhammer and Jochen G. Hofstaetter

J. Clin. Med. 2021, 10(6), 1260; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10061260 - 18 Mar 2021

Cited by 10 | Viewed by 2193

Abstract

The aim of this study was to evaluate the number of primary and revision total joint arthroplasties (TJA/rTJA) in 2020 compared to 2019. Specifically, the first and the second waves of the COVID-19 pandemic were evaluated as well as the pre-operative COVID-19 test. A cross-sectional single-center study of our prospectively maintained institutional arthroplasty registry was performed. The first COVID-19 wave and the second COVID-19 wave led to a socioeconomic lockdown in 2020. Performed surgeries, cause of revision, age, gender, and American Society of Anesthesiologists-level were analyzed. Preoperative COVID-19 testing was evaluated and nationwide COVID-19 data were compared to other countries. In 2020, there was a decrease by 16.2% in primary and revision TJAs of the hip and knee compared to 2019. We observed a reduction of 15.8% in primary TJAs and a reduction of 18.6% on rTJAs in 2020 compared to 2019. There is an incline in total hip arthroplasties (THAs) and a decline in total knee arthroplasties (TKAs) comparing 2019 to 2020. During the first wave, there was a reduction in performed primary TJAs of 86%. During the second wave, no changes were observed. This is the first study quantifying the impact of the COVID-19 pandemic on primary and revision TJAs regarding the first and second wave. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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16 pages, 1304 KiB

Open AccessArticle

The Role of Hip Joint Clearance Discrepancy as Other Clinical Predictor of Reinjury and Injury Severity in Hamstring Tears in Elite Athletes

by Jesus Seco-Calvo, Martin Palavicini, Vicente Rodríguez-Pérez, Sergio Sánchez-Herráez, Luis Carlos Abecia-Inchaurregui and Juan Mielgo-Ayuso

J. Clin. Med. 2021, 10(5), 1050; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10051050 - 04 Mar 2021

Cited by 2 | Viewed by 2108

Abstract

Hamstring tear injuries (HTI) are the most prevalent injuries in athletes, with high reinjury rates. To prevent reinjury and reduce the severity of injuries, it is essential to identify potential risk factors. Hip characteristics are fundamental to optimal hamstring function. We sought to investigate the role of hip joint clearance discrepancy (JCD) as a risk factor for HTI and a clinical predictor of risk of reinjury and injury severity. A cross-sectional, retrospective study was performed with elite athletes (n = 100) who did (n = 50) and did not (n = 50) have a history of injury. X-rays were taken to assess JCD. We reviewed muscular lesions historial, and health records for the previous 5 years. Significant differences were found in injury severity (p = 0.026; ŋ²p = 0.105) and a number of injuries (p = 0.003; ŋ²p = 0.172). The multivariate analysis data indicated that JCD was significantly associated with the number of injuries and their severity (p < 0.05). In the stepwise regression model, JCD variability explained 60.1% of the number of injuries (R² 0.601) and 10.5% of injury severity (R² 0.0105). These results suggest that JCD could play an important role as a risk factor for HTI and also as a clinical predictor of reinjury and injury severity. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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8 pages, 606 KiB

Open AccessArticle

Injuries Associated with the Practice of Calm Water Kayaking in the Canoeing Modality

by Manuel Isorna-Folgar, Raquel Leirós-Rodríguez, Rubén Paz-Dobarro and Jose Luis García-Soidán

J. Clin. Med. 2021, 10(5), 902; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10050902 - 25 Feb 2021

Cited by 3 | Viewed by 2178

Abstract

Knowing the most frequent injuries in canoeists is important, considering the consequences for the athlete’s sports career, health, and labour, social and economic life. Therefore, the aim of this study was to describe the most frequent injuries among high-level canoeists and the intrinsic variables of the sport’s practice (years of practice, number of training sessions per week, and stretching habit) that can influence the appearance of such injuries. An observational, transversal, and retrospective epidemiological study was carried out with 122 canoeists that completed a sport injuries questionnaire (number, body area, type, and severity of injuries). The ratio of injuries per participant was 1.1 injuries/year in men; and 1.5 injuries/year in women. Shoulder injuries were the most frequent, followed by knee injuries (in women) and lower back (in men), and the other segments of the upper limbs. In men, injuries occurred more frequently in the central period of training sessions and in women during the last 15 min of training sessions. Then, there is a common profile of injuries in canoeists: Being a female, having more years of sports practice, and never executing stretching exercises are associated with predisposing factors to injuries. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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Review

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11 pages, 1530 KiB

Open AccessReview

Autologous Bone Grafting in Trauma and Orthopaedic Surgery: An Evidence-Based Narrative Review

by Filippo Migliorini, Francesco Cuozzo, Ernesto Torsiello, Filippo Spiezia, Francesco Oliva and Nicola Maffulli

J. Clin. Med. 2021, 10(19), 4347; https://doi.org/10.3390/jcm10194347 - 24 Sep 2021

Cited by 14 | Viewed by 3381

Abstract

Autologous bone grafting is common in trauma and orthopaedic surgery. Both the Reamer Irrigator Aspirator (RIA) and Iliac Crest Bone Graft (ICBG) aim to obtain autologous bone graft. Although the process of harvesting a bone graft is considered simple, complications may occur. This study examined morbidity and pain at the donor site, blood loss, and iatrogenic fractures, comparing RIA and ICBG. The source of the autologous bone graft, the alternative graft sites, and the storage modalities of the harvested bone marrow were also evaluated. In May 2021, PubMed, Embase, Scopus, and Google Scholar were accessed, with no time constraints. RIA may produce greater blood loss, but with less morbidity and complications, making it a potential alternative source of bone grafting. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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22 pages, 506 KiB

Open AccessReview

by Daniel Gould, Michelle M Dowsey, Tim Spelman, Olivia Jo, Wassif Kabir, Jason Trieu, James Bailey, Samantha Bunzli and Peter Choong

J. Clin. Med. 2021, 10(1), 134; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10010134 - 02 Jan 2021

Cited by 15 | Viewed by 5154

Abstract

Total knee arthroplasty (TKA) is a highly effective procedure for advanced osteoarthritis of the knee. Thirty-day hospital readmission is an adverse outcome related to complications, which can be mitigated by identifying associated risk factors. We aimed to identify patient-related characteristics associated with unplanned 30-day readmission following TKA, and to determine the effect size of the association between these risk factors and unplanned 30-day readmission. We searched MEDLINE and EMBASE from inception to 8 September 2020 for English language articles. Reference lists of included articles were searched for additional literature. Patients of interest were TKA recipients (primary and revision) compared for 30-day readmission to any institution, due to any cause, based on patient risk factors; case series were excluded. Two reviewers independently extracted data and carried out critical appraisal. In-hospital complications during the index admission were the strongest risk factors for 30-day readmission in both primary and revision TKA patients, suggesting discharge planning to include closer post-discharge monitoring to prevent avoidable readmission may be warranted. Further research could determine whether closer monitoring post-discharge would prevent unplanned but avoidable readmissions. Increased comorbidity burden correlated with increased risk, as did specific comorbidities. Body mass index was not strongly correlated with readmission risk. Demographic risk factors included low socioeconomic status, but the impact of age on readmission risk was less clear. These risk factors can also be included in predictive models for 30-day readmission in TKA patients to identify high-risk patients as part of risk reduction programs. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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