Introduction. Trigger points can be the source of radiating pain and may interfere with normal muscle function. The aim of this study is to investigate the neck muscle’s sense of force in subjects with trigger points of the upper trapezius muscle compared with healthy subjects. Materials and methods. In a cross-sectional analytical study, in 40 young subjects with hidden trigger points of the upper trapezius muscle and 40 healthy young subjects, constant, absolute and variable error of sense of force of cervical muscles, range of motion of neck and pressure pain threshold of upper trapezius muscles in both groups were measured. Results. The absolute and variable error of sense of force in the extensor and lateral flexor muscles of the neck were significantly different between two groups, and the subjects with hidden trigger points had higher errors. The pain threshold of both sides in subjects with hidden trigger points was significantly lower than healthy subjects. The range of motion wasn’t significantly different between the two groups. Discussion and conclusions. This study showed that the sense of force error was higher in subjects with trigger points. Also, the pressure pain threshold in subjects with trigger points were lower than healthy subjects. As a result, In the evaluation of neck pain patients, it is important to pay attention to sense of force error.

Background. The ankle joint is a frequent site of injury and bone remodeling, and often requires cartilage repair. Studies have shown that growth factors and bioactive compounds have regenerative properties capable of promoting cartilage restoration. Hyaluronic acid (HA) and orthobiologics like platelet-rich plasma (PRP) and adult stem cells (ASCs) are particularly interesting as therapeutic solutions for ankle cartilage repair and have received considerable attention over the years. Methods. We performed a literature review to summarize the clinical uses and outcomes of HA, PRP and ASCs as reparative interventions in osteochondral lesions (OCL) and osteoarthritis (OA) of the ankle, when used alone and post-surgically. Results. In total, 50 studies were eligible and included in this review. HA was shown to be a safe treatment option with a low rate of adverse effects and overall clinical improvement for talar OCL when used alone and post-surgically. PRP was found to be superior to HA for talar OCL in non-surgical and post-surgical patients. Studies evaluating HA injections for ankle OA noted a general improvement in pain and function post-injection with minimal adverse reactions, though there is mixed data regarding the efficacy of PRP injections for ankle OA. High-level randomized controlled trials are lacking for the evaluation of ASCs in talar OCL and ankle OA, though limited research has found them to be safe and efficacious. Conclusions. HA and orthobiologics can be considered for use as a pre-surgical treatment in ankle OCL and OA, or as a second-line treatment for patients who remain symptomatic after surgery. The safety profile and subjective improvement in clinical outcomes following orthobiologic treatments is promising, though requires additional investigation.

Introduction: Recently, Cromeens proposed a new interpretation of the deltoid ligament (DL) using its attachment sites to define individual components. The aim of this cadaveric study was to evaluate the reproducibility of this new classification and investigate anatomical variations of the ligament to contribute to reaching an evidencebased consensus regarding its ligamentous constituent bands, their origins and insertions. Methods: The classification was applied to study only four components of the DL: the tibiocalcaneonavicular (TCN), the superficial posterior tibiotalar (sPTT), the deep anterior tibiotalar (dATT) and the deep posterior tibiotalar (dPTT) ligaments. Fifteen fresh frozen ankles were dissected and the deltoid ligament components defined by their attachment sites and measured on the three axes. Results: The TCN, sPTT and dPTT ligaments were identified in all of the specimens. The TCN was the widest and longest ligament with variable thickness. The sPTT ligament was the second thicker and longer. The dATT ligament, the smaller and thinner, was not identified in 3 specimens. The dPTT ligament was the second wider, which in 3 cadavers presented an accessory bundle, the deep intermedial tibiotalar ligament (dITT ligament). Conclusions: Cromeens's attachment-based classification was proved to be simple, rational and reproducible in allowing the methodological description of the different bands of the DL. Our findings showed that the dITT ligament must be considered a secondary bundle of the dPTT ligament, which was not always identified in all specimens.