OBJECTIVE. The aim of this study was to determine the usefulness of sonography for detecting elbow injuries among young baseball players.SUBJECTS AND METHODS. One hundred fifty-three volunteers ranging in age from 9 to 12 years and belonging to youth baseball teams participated. Sonography of the elbow was performed in the field when baseball exercises were being conducted. We analyzed the relationship between elbow pain and sonographic abnormalities and the relationship between pitchers and sonographic abnormalities.RESULTS. Sonography showed that 33 subjects had medial epicondylar fragmentation and two had early-stage osteochondritis dissecans of the capitellum. In 25 subjects who agreed to further examination and treatment, radiography confirmed the sonographic findings. All of the 23 subjects with medial epicondylar fragmentation, who stopped throwing, obtained union of the bone and returned to baseball. The two subjects with osteochondritis dissecans of the capitellum underwent surgery before the ost...

https://www.ajronline.org/doi/pdf/10.2214/AJR.05.1086

Using Sonography for the Early Detection of Elbow Injuries Among Young Baseball Players

Purpose
There is ongoing debate about the management of medial epicondyle fractures in the pediatric population. This systematic review evaluated non-operative versus operative treatment of medial epicondyle fractures in pediatric and adolescent patients over the last six decades.

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Operative versus non-operative management of pediatric medial epicondyle fractures: a systematic review

Objective: To report and assess the usefulness of ultrasound (US) findings foroccult fractures of growing bones.Materials and Methods: For six years, US scans were performed in childrenyounger than 15 years who were referred with trauma-related local pain andswelling of the extremities. As a routine US examination, the soft tissue, bones,and adjacent joints were examined in the area of discomfort, in addition to theasymptomatic contralateral extremity for comparison. Twenty-five occult fracturesin 25 children (age range, five months -15 years; average age, 7.7 years) wereconfirmed by initial and follow-up radiograms, additional imaging studies, andclinical observation longer than three weeks. Results: The most common site of occult fractures was the elbow (n = 9, 36%),followed by the knee (n = 7, 28%), ischium (n = 4, 16%), distal fibula (n = 3, 12%),proximal femur (n = 1, 4%), and humeral shaft (n = 1, 4%). On the retrogradereview of the routine radiographs, 13 out of the 25 cases showed no bone abnor-malities except for various soft tissue swelling. For the US findings, cortical discon-tinuity (direct sign of a fracture) was clearly visualized in 23 cases (92%) and wasquestionable in two (8%). As auxiliary US findings (indirect signs of a fracture),step-off deformities, tiny avulsed bone fragments, double-line appearance of corti-cal margins, and diffuse irregularity of the bone surfaces were identified. Conclusion: Performing US for soft tissue and bone surfaces with pain andswelling, with or without trauma history in the extremities, is important for diag-nosing occult or missed fractures of immature bones in pediatric-aged children. o diagnose occult fractures in skeletally immature children, radiographyis often insufficient because a subtle fracture is obscured by overlappingstructures and by non-perpendicular X-ray beams to the fracture line.Also, it is difficult to interpret radiographs as to whether a fracture is present or not;especially in the joint regions where growing bones are composed of unmineralizedphysis and cartilaginous ossification centers (1-4). Fractures account for 71% of thedelayed diagnoses in pediatric trauma, with the extremities having the most commoninvolvement (5). In contrast to trauma in adults, the evaluation of a pediatric patient isoften confounded by the patient’s inability to participate in the history and physicalexamination (1-3, 5). In these situations, performing ultrasound (US) is helpful for theearly diagnosis of both soft tissue and bone injuries, resulting in appropriate and timelymanagement. The high reflectivity of US at the interface between the cortical boneand peri-osseous soft tissues can delineate the bone cortical outline and adjacent softtissue changes at a fractured site (4, 6). US can be performed in young childrenwithout sedation, which is frequently required for MRI to prevent a motion artifact.Kil-Ho Cho, MD

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Ultrasound Diagnosis of Either an Occult or Missed Fracture of an Extremity in Pediatric-Aged Children

The scope of clinical applications of emergency ultrasonography continues to expand. Bedside ultrasound has been typically described as an "extension of the palpating hand" and a "visual stethoscope" during physical examination. One of the relatively newer applications is its use in the detection of rib fractures. The author discusses the technique, applicability, limitations, and role of emergency ultrasound in the diagnosis of rib fractures.

Emergency bedside ultrasound for the diagnosis of rib fractures

The elbow is an important synovial hinge joint of the upper extremity. This joint represents a common site of musculoskeletal symptomatology, affecting all age groups. The advantages of ultrasound imaging of the elbow include easy availability, multiplanar capability and the ability to assess structures dynamically. Patient symptomatology and site of maximal tenderness can be directly correlated with imaging findings. Comparison is easily made with the contralateral side. Particular strengths include the ability to assess para-articular structures, such as regional tendons and ligaments, in addition to assessment of joint effusions, loose bodies and regional bursae. With operator experience and excellent technique, ultrasound is a valuable imaging tool for assessment of disorders of the elbow joint.

Ultrasound of the elbow.

Using sonography to diagnose an unossified medial epicondyle avulsion in a child

(1) Background: Conclusions of meta-analyses of clinical studies may substantially influence opinions of prospective patients and stakeholders in healthcare. Nineteen meta-analyses of clinical studies on the management of primary knee osteoarthritis (pkOA) with stem cells, published between January 2020 and July 2021, came to inconsistent conclusions regarding the efficacy of this treatment modality. It is possible that a separate meta-analysis based on an independent, systematic assessment of clinical studies on the management of pkOA with stem cells may reach a different conclusion. (2) Methods: PubMed, Web of Science, and the Cochrane Library were systematically searched for clinical studies and meta-analyses of clinical studies on the management of pkOA with stem cells. All clinical studies and meta-analyses identified were evaluated in detail, as were all sub-analyses included in the meta-analyses. (3) Results: The inconsistent conclusions regarding the efficacy of treating pkOA with stem cells in the 19 assessed meta-analyses were most probably based on substantial differences in literature search strategies among different authors, misconceptions about meta-analyses themselves, and misconceptions about the comparability of different types of stem cells with regard to their safety and regenerative potential. An independent, systematic review of the literature yielded a total of 183 studies, of which 33 were randomized clinical trials, including a total of 6860 patients with pkOA. However, it was not possible to perform a scientifically sound meta-analysis. (4) Conclusions: Clinicians should interpret the results of the 19 assessed meta-analyses of clinical studies on the management of pkOA with stem cells with caution and should be cautious of the conclusions drawn therein. Clinicians and researchers should strive to participate in FDA and/or EMA reviewed and approved clinical trials to provide clinically and statistically valid efficacy.

/pdf/methodological-flaws-in-meta-analyses-of-clinical-studies-on-1yefma81.pdf

Methodological Flaws in Meta-Analyses of Clinical Studies on the Management of Knee Osteoarthritis with Stem Cells: A Systematic Review

Uncultured, unmodified, autologous, adipose-derived regenerative cells (UA-ADRCs) are a safe and effective treatment option for various musculoskeletal pathologies. However, it is unknown whether the composition of the final cell suspension systematically varies with the subject’s individual age, sex, body mass index and ethnicity. UA-ADRCs were isolated from lipoaspirate from n = 232 subjects undergoing elective lipoplasty using the Transpose RT system (InGeneron, Inc.; Houston, TX, USA). The UA-ADRCs were assessed for the number of nucleated cells, cell viability and the number of viable nucleated cells per gram of adipose tissue harvested. Cells from n = 37 subjects were further characterized using four-channel flow cytometry. The present study shows, for the first time, that key characteristics of UA-ADRCs can be independent of the subject’s age, sex, BMI and ethnicity. This result has important implications for the general applicability of UA-ADRCs in regeneration of musculoskeletal tissue. Future studies must determine whether the independence of key characteristics of UA-ADRCs of the subject’s individual age, sex, BMI and ethnicity only applies to the system used in the present study, or also to others of the more than 25 different experimental methods and commercially available systems used to isolate UA-ADRCs from lipoaspirate that have been described in the literature.

/pdf/the-composition-of-adipose-derived-regenerative-cells-1qi5fbwq.pdf

The Composition of Adipose-Derived Regenerative Cells Isolated from Lipoaspirate Using a Point of Care System Does Not Depend on the Subject’s Individual Age, Sex, Body Mass Index and Ethnicity

Objective: Symptomatic, partial-thickness rotator cuff tears (sPTRCT) are problematic. Management of sPTRCT with fresh, uncultured, unmodified, autologous, adipose-derived regenerative cells (UA-ADRCs) isolated from lipoaspirate at the point of care is safe and leads to improved shoulder function without adverse effects. This study tested the hypothesis that management of sPTRCT with injection of UA-ADRCs is safe and more effective than injection of corticosteroid even in the long run. Methods: Subjects who had completed a former randomized controlled trial were enrolled in the present study. At baseline these subjects had not responded to physical therapy treatments for at least six weeks, and were randomly assigned to receive respectively a single injection of an average 11.4 x 10^6 UA-ADRCs (n = 11) or a single injection of 80 mg of methylprednisolone (n = 5). Safety was assessed by rigorously documenting and evaluating treatment emergent adverse events. Efficacy was assessed using the ASES Total score, pain visual analogue scale (VAS) and RAND Short Form-36 Health Survey at 33.2 {+/-} 1.0 (mean {+/-} standard deviation) and 40.6 {+/-} 1.9 months post-treatment. Proton density, fat-saturated, T2-weighted (PD FS T2), magnetic resonance imaging (MRI) of the index shoulder was performed at both study visits. Results: There were no greater risks connected with injection of UA-ADRCs than those connected with injection of corticosteroid. The subjects in the UA-ADRCs group showed statistically significantly higher mean ASES Total scores than the subjects in the corticosteroid group. Treatment outcome could not be assessed using measurements of tear volume on MRI scans. On the other hand, PD FS T2 MRI scans at six months post-treatment allowed to "watch the UA-ADRCs at work". There was no relationship between treatment outcome and baseline data, including those data characterizing UA-ADRCs that can be collected with a clinical test. Conclusions: The present study further supports treatment of sPTRCT with injection of UA-ADRCs. Trial registration: Clinicaltrials.gov NCT04077190 (September 4, 2019).

Long-term safety and efficacy of treating symptomatic, partial-thickness rotator cuff tears with fresh, uncultured, unmodified, autologous, adipose-derived regenerative cells isolated at the point of care: 40 months follow-up of a prospective, randomized, controlled, first-in-human clinical trial

David A. Pearce

Papers

Using sonography to diagnose an unossified medial epicondyle avulsion in a child

Methodological Flaws in Meta-Analyses of Clinical Studies on the Management of Knee Osteoarthritis with Stem Cells: A Systematic Review

The Composition of Adipose-Derived Regenerative Cells Isolated from Lipoaspirate Using a Point of Care System Does Not Depend on the Subject’s Individual Age, Sex, Body Mass Index and Ethnicity

Long-term safety and efficacy of treating symptomatic, partial-thickness rotator cuff tears with fresh, uncultured, unmodified, autologous, adipose-derived regenerative cells isolated at the point of care: 40 months follow-up of a prospective, randomized, controlled, first-in-human clinical trial