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BACKGROUND: Pelvic organ prolapse is common, but the underlying etiologies are poorly understood, which limits our current prevention and treatment options. OBJECTIVE: Our primary objective was to compare the uterosacral ligament histologic features in women with and without prolapse using the novel pelvic organ prolapse histologic quantification system. Our secondary aim was to determine whether composite histologic findings in uterosacral ligaments are associated with prolapse risk factors. STUDY DESIGN: This was a prospective cohort study in which paracervical uterosacral ligament biopsies were performed at the time of hysterectomy for primary prolapse or other benign gynecologic indications and processed for histologic evaluation. The pelvic organ prolapse quantification system was used to determine the prolapse stage. In this study, 9 prominent histologic features were semiquantitatively scored using the pelvic organ prolapse histologic quantification system in a blinded fashion and compared between prolapse and control groups. Unbiased principal component analysis of these scores was independently performed to identify potential relationships between histologic measures and prolapse risk factors. RESULTS: The histologic scores of 81 prolapse and 33 control ligaments were analyzed. Compared with the control group, women in the prolapse group were significantly older and more likely to be in the menopausal phase. There was no difference in the number of vaginal deliveries, body mass index, hormone use, or smoking status between the groups. To control for baseline differences, patients were also stratified by age over 40 years and menopausal status. Compared with the control group, the prolapse ligaments in the premenopausal group had significantly more loss of smooth muscle fibers within the fascicles (P<.001), increased inflammatory infiltrates of neutrophils within the tissue and perineural inflammatory cells (P<.01 and P=.04, respectively), and reduced neointimal hyperplasia (P=.02). Prolapse ligaments in the postmenopausal group exhibited elevated adipose content compared with that of the control group (P=.05). Amount of fibrillar collagen, total nonvascular smooth muscle, and muscle fiber vesicles of prolapse ligaments did not differ in either the premenopausal or postmenopausal group compared with that of the control group. Unbiased principal component analysis of the histologic scores separated the prolapse ligaments into 3 phenotypes: (1) increased adipose accumulation, (2) increased inflammation, and (3) abnormal vasculature, with variable overlap with controls. Posthoc analysis of these subgroups demonstrated a positive correlation between increasing number of vaginal deliveries and body mass index with increasing adipose content in the adipocyte accumulation and inflammatory phenotype and increasing neointimal hyperplasia in the vascular phenotype. However, only the relationship between vaginal delivery and adipocytes was significant in the adipose phenotype (R2=0.13; P=.04). CONCLUSION: Histologic phenotypes exist in pelvic support ligaments that can be distinguished using the pelvic organ prolapse histologic quantification system and principle component analysis. Vaginal delivery is associated with aberrant adipose accumulation in uterosacral ligaments. Our findings support a multifactorial etiology for pelvic organ prolapse contributing to altered smooth muscle, vasculature, and connective tissue content in crucial pelvic support structures. To confirm these associations and evaluate the biomechanical properties of histologic phenotypes of prolapse, larger studies are warranted. Closing this gap in knowledge will help optimize personalized medicine and help identify targets for prevention and treatment of this complex condition.

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SUMMARY Generalized ligamentous hyperlaxity (GLH) has been shown to predispose an individual to a number of orthopaedic conditions. Little is known about how GLH affects people' foot health-related quality of life. This study analyses a sample of people with GLH and people without GLH with normalised reference values of the scores collected with regard to using the Foot Health Status Questionnaire (FSHQ). A total of 100 respondents with mean age of 22.69 ± 3.78 years old, who attended a health centre were classified as GLH (n = 50) or non-GLH (n = 50). The GLH was determined of the patients with and without GLH using assessment with Beighton tool and the scores on the FHSQ were compared. The control group recorded higher scores in the First Section for foot pain, foot function and general foot health, and lower scores in footwear. In the Second Section, they obtained higher scores in social capacity and lower scores in physical activity, vigour and general health. Differences between the two groups were evaluated through a t-test for independent samples, showing statistical significance (P<0.001). This study has detected measurable differences of association between GLH (Beighton score ≥4) with impaired quality of life related to foot health.

RESUMO A hiperlaxia ligamentosa generalizada (HLG) demonstrou predispor um indivíduo a várias condições ortopédicas. Pouco se sabe sobre como a HLG afeta a qualidade de vida relacionada à saúde do pé das pessoas. Este estudo analisa uma amostra de pessoas com HLG e pessoas sem HLG com valores de referência normalizados das pontuações coletadas no que diz respeito ao Foot Health Status Questionnaire (FSHQ). Um total de 100 informantes com média de idade de 22,69 ± 3,78 anos que eram atendidos em um centro de saúde foi classificado como HLG (n = 50) ou não HLG (n = 50). A HLG foi determinada com os pacientes com e sem HLG usando a ferramenta Beighton e os escores na FHSQ foram comparados. O grupo de controle registrou pontuações mais altas na primeira seção para a dor no pé, função do pé e saúde geral do pé, e menores pontuações no calçado. Na segunda seção obtiveram maiores escores em capacidade social e menores escores em atividade física, vigor e saúde geral. As diferenças entre os dois grupos foram avaliadas por meio de um teste t para amostras independentes, mostrando significância estatística (P<0,001). Este estudo detectou diferenças mensuráveis de associação entre HLG (pontuação de Beighton≥4) com deterioração da qualidade de vida relacionada à saúde dos pés.

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Generalized ligamentous hyperlaxity (GLH) has been shown to predispose an individual to a number of orthopaedic conditions. Little is known about how GLH affects people' foot health-related quality of life. This study analyses a sample of people with GLH and people without GLH with normalised reference values of the scores collected with regard to using the Foot Health Status Questionnaire (FSHQ). A total of 100 respondents with mean age of 22.69 ± 3.78 years old, who attended a health centre were classified as GLH (n = 50) or non-GLH (n = 50). The GLH was determined of the patients with and without GLH using assessment with Beighton tool and the scores on the FHSQ were compared. The control group recorded higher scores in the First Section for foot pain, foot function and general foot health, and lower scores in footwear. In the Second Section, they obtained higher scores in social capacity and lower scores in physical activity, vigour and general health. Differences between the two groups were evaluated through a t-test for independent samples, showing statistical significance (P<0.001). This study has detected measurable differences of association between GLH (Beighton score ≥4) with impaired quality of life related to foot health.

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The aim of this study was to compare the knee kinematics of anterior cruciate ligament reconstructed (ACL-R) and healthy subjects (CG) during gait and classify the status of normality. Ten healthy and six ACL-R subjects had their gait analyzed at 60 fps. 3D knee angles were calculated and inserted into three separate matrices used to perform the principal component (PC) analysis. The scores of PCs retained in each analysis were used to calculate the standard distances (SD) of each participant in relation to the center of the CG. The PC scores of the three planes were used in a logistic regression to define normality. In the sagittal plane there was no difference between groups. In the frontal and transverse planes ACL-R subjects showed higher SD values than CG. PCs identified that ACL-R subjects showed increased adduction, internal and external rotation. All these subjects had their gait classified as abnormal by logistic regression. Therefore, in the studied ACL-R subjects the gait pattern did not return to normal levels after surgery. This may lead to degenerative injuries, as osteoarthritis, in the future.

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Introducción y Objetivo: La elongación y/o osificación del ligamento estilohioideo es una patologíapoco conocida, con un diagnóstico difícil de establecer. El propósito del presente estudio fuerealizar un análisis retrospectivo de exámenes para evaluar la presencia de variaciones en la longitud del ligamento estilohiodeo, según edad y género, mediante un Sistema de tomografía de alta resolución Cone Beam debido a su gran confiabilidad dimensional. Materiales y Métodos: La muestra consistió en 82 exámenes imagenológicos, los cuales fueron obtenidos con fines de estudios Ortodóncicos, de Implantología o de Diagnóstico general, durante el año 2008-2009. Se realizó el análisis retrospectivo de la muestra, y se clasificó según edad, género, y se individualizó el análisis cuantitativo tridimensional de los procesos estilohioideos. Resultados: El análisis realizado no mostró diferencias significativas en las variables relacionadas con el género, sin embargo en los pacientes mayores de 50 años, hubo un incremento importante en la longitud del ligamento estilohioideo. Conclusión: Los resultados obtenidos difieren con los resultados de trabajos anteriores analizados mediante ortopantomografía. Esto se explicaría por la gran sensibilidad diagnóstica del método utilizado.

Introduction and Objetive: This paper analyzes the existence of variations in the length of the stylohyoid ligament, according to age a genre, by using the high resolution Cone Beam System. Materials and Methods: The research was based in a sample of 82 imagenology examinations taken during the period 2008-2009 for routine studies in orthodontics, implantology and general diagnosis. The sample was examined with 3D measurements of the styloid process considering aprevious classification by age a genre, to establish if there is difference through these variables. Results: We found no significant difference in the length of the stylohyoid ligament by genre. However, there is evidence of an increase of the lengths of the ligament in patients over 50 years old. Conclusion: Our findings differ from previous documentation by using less accurate systems like orthopantomography.

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Se presenta el caso de una paciente femenina de 41 años con osoficación de los ligamentos estilohioideos (síndrome de Eagle), que simulaba dolor en la articulación témporo-mandibular. Esta es una patología que se presenta entre el 1 - 4 por ciento de la población en general, pero solo un número muy pequeño de estos se llegan a reconoer, ya que puede ser asintomáticos o presentar diversas manifestaciones clínicas. Se hace una revisión del tema

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Chronic renal insufficiency gives rise to osteoarticular and tendinous alterations, with tendinous rupture reaching 3.6% among patients receiving hemodialysis. To evaluate potential tendinous and ligamentous alterations, 39 consecutive patients receiving longterm hemodialysis (mean dialysis time 33 months) were studied prospectively by clinicoradiological methods. Of the 39 cases, atlantoaxial subluxation was found in 3 (7.7%). Tendinous or ligamentous hyperlaxity was present in 29 (74%) with patellar tendon elongation in 19 (49%), articular hypermobility in 20 (51%) and both in 10. Differences were significant (p less than 0.05) in patients with articular hypermobility with over 36 months' dialysis, and even more so (p less than 0.01) in those with over 48 months. Atlantoaxial subluxation was more frequent after 48 months' dialysis. Therefore, patients receiving longterm hemodialysis are prone to present tendinous or ligamentous hyperlaxity with atlantoaxial subluxation as well.

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