Journal of Medical Implants & Surgery
Open Access

Musculoskeletal tumors; Biopsy; Soft tissue tumors; Precision medicine; Surgical margin; Bone tumors; Translation research; Sarcoma.

Introduction

As one of the main causes of disability worldwide, musculoskeletal conditions includes traumatic injury, osteoporosis, and osteoarthritis are essential components of public health. It has been demonstrated that biomechanics is crucial to the pathophysiology, treatment, and rehabilitation of the musculoskeletal system. The development of sequelae and the metabolic activity of cells may be influenced by biomechanical forces. The development of biomechanical theory, methodology, and practise may also encourage the construction of better surgical, rehabilitative, and protective equipment [1]. The evolution of computational biomechanics was even aided by advances in computational technology. This special issue focuses on cutting-edge biomechanics theory and application to comprehend musculoskeletal pathology and enhance treatment and rehabilitation methods. For biomechanical researchers, rehabilitation therapists, protective device designers, and orthopaedic surgeons, this special issue can provide a platform.

Particularly in orthopaedic surgery, finite element (FE) analysis is a potent tool for biomechanical investigations. Two different threedimensional FE models of the lumbar spine were built, one by each of two separate research groups from the School of Medicine at Tongji University (L3-L5) [2]. Examined the stability of extraforaminal lumbar interbody fusion and conventional transformative lumbar interbody fusion under various internal fixations, and studied the biomechanical effects of varying grades of facetectomy. Tianjin University of Technology researchers also carried out a FE modelling investigation. To compare the biomechanical stability following two different types of plate fixations, they created and validated a refined FE model of the middle femoral commented fracture. They also created microscopic models of chondrocytes and articular cartilage to study the biomechanical response to cyclic compressive loading. Furthermore, they expounded on the biomechanical mechanism of pectus excavatum in pectus excavatum patients with scoliosis and conducted a thorough analysis of the effect of pectus excavatum on scoliosis. Investigated how well the laparoscopically aided plate performed biomechanically [3].

Another subject covered in this special issue is the mechanism and prevention of sports injuries. Two publications by a researcher from Shanghai University of Sports examined how fatigue affected the impact forces and sagittal plane kinematics of recreational athletes’ lower extremities during a drop-landing activity. Additionally, they investigated the relationship between lower extremity joint torque and mechanical power and hamstring strain during sprint running. Shenyang Sport University researchers identified the contact force loading related to various walking speeds [4]. In recent years, biomechanics has gained a lot of popularity in rehabilitation. The effects of overweight and obesity on total knee arthroplasty (TKA) were examined in an article written by authors from Taiyuan University of Technology, University of Sussex, and University of Southampton. They looked at early spatiotemporal patterns and knee kinematics during level walking in patients after TKA. Y.-P. Huang and colleagues assessed the compensatory response of the muscle activity of seventeen major muscle groups in the spinal region, intradiscal forces of the five lumbar motion segment units, and the effect of arch support insoles on uphill and downhill walking of patients with flatfoot [5].

Along with other subjects, this special issue covered cell biomechanics. By measuring the repair of femur fractures in both fat-1 transgenic mice and WT mice, authors from Sichuan University proposed a strain feedback compensation method based on digital image correlation to achieve the accurate strain control of the membrane during stretching. They also looked at the effects of various propolis extracts and flavonoid components on platelet aggregation. Overall, a wide spectrum of biomechanics in musculoskeletal health is covered in this special issue. To develop the subject of biomechanics, further study is required to look at computer modelling in bones, sports injury prevention, rehabilitation, and cellular level. German writers first referred to granular cell tumour as granular cell myoblastoma in 1926. According to current thinking, the tumour has a neurological genesis [6].

These tumours are uncommon clinically and make up about 0.5% of all soft tissue tumours. The majority of documented experience comes from a few limited series and thinly described case reports. Granular cell tumours typically exhibit benign behaviour, but they do have a propensity to come back. They could show as multifocal. Anywhere in the body, usually in the dermis and sub cutis, along mucosal surfaces, and infrequently in skeletal muscle, they can develop. Rarely, they can metastasize, especially if they develop deep to the fascia or are larger than 4 cm in diameter. Although uncommon, malignant transformation is well known [7].

Materials and Methods

We conducted a review of our database in the past. The study covered every patient with a granular cell tumour diagnosis. We looked at data from 2002 to 2008. Preoperative MRI scanning was performed on all patients. Patients were either given an excision biopsy or a core needle biopsy followed by a large local excision. In the beginning, a retrospective review of the medical and imaging records of 74 patients who received MR imaging for the evaluation of bone or soft-tissue malignancies in our institution between May 2014 and January 2017 was conducted. 43 patients were omitted because they had tumours other than sarcoma or because they had their tumours surgically removed more than three months following the MR imaging [8].

31 patients with a histopathological confirmed sarcoma who underwent curative surgical excision fewer than three months following MR imaging made up the study cohort. With a mean age of 34.9 24.4 (standard deviation [SD] years), there were 18 men and 13 women (range: 6–87 years). Nine patients had natural tumours that had not yet been treated when they had MR imaging, 18 patients were receiving chemotherapy, and four patients had already undergone radiotherapy. The institutional review board granted exemption as a result of the retrospective data analysis. A pathologist who specialises in musculoskeletal tumours examined the surgical samples of all tumours. In accordance with worldwide norms, at least one section per centimetre in the plane of the biggest tumour diameter was conducted. Surgical margins were also sampled [9]. The bone sarcomas were graded using Broder’s approach, whereas soft-tissue tumours were graded using the French system of the Cancer Centers (Federation National des Centres de Lutte contre le Cancer [FNCLCC]) [10].

Discussion

Musculoskeletal tumours are extremely complicated diseases that frequently present challenging diagnostic challenges. 11 Only an accurate histological diagnosis to inform the medical team can lead to appropriate treatment. 2 The biopsy is the gold standard for diagnosing any tissue abnormality, but it must be carried out carefully because a bad biopsy can lead to a lot of difficulties.

Effort to discover the best way to handle these cases, we looked back at the care of NDBs in musculoskeletal tumour patients that were referred to our specialised unit over a 6-year period. A 4.8% NDB rate was detected. Based on our observations and analysis of the literature we present the therapeutic method in the rare occurrence of a nondiagnostic biopsy [11]. We have discovered that semi-quantitative MR perfusion parameters can tell us how much tumour necrosis there is. Furthermore, we discovered that MR perfusion parameters have remarkable interobserver repeatability (ICC > 0.84). Compared to tumours with low necrosis ratios, the AUC and maximum slope values were significantly lower in tumours with high necrosis ratios. The most variable perfusion parameter was the AUC, which is a reliable, accessible, and repeatable perfusion parameter. When tumours with high grades of histologic necrosis were contrasted with tumours with low grade necrosis, the INI was significantly higher. INI provided a reasonable ICC but tended to overestimate necrosis in terms of histology. This discovery is most likely due to the fact that cellular necrosis can be directly measured histologically, whereas tumour perfusion is an indirect sign of necrosis. Non-invasive tumour necrosis with INI and AUC measurement is simple to implement in daily practise and may be helpful in assessing the efficacy of adjuvant therapy in patients [12].

Conclusion

Due to a number of technical, patient-related, and lesion-related issues, image-guided CNB of musculoskeletal lesions may be difficult. To ensure a safe and effective process, pre-procedural planning should be optimised with potential complicating factors taken into account.

The diagnosis of paediatric patients with non-tumor musculoskeletal involvement depends heavily on radionuclide images. With its high sensitivity for detecting osteogenic involvement, three phase BS is the cornerstone of imaging in skeletal nuclear medicine. It can be used as a screening tool to rule out infection as well as to provide a more precise diagnosis based on clinical manifestations and patterns of uptake in the acquired images.

Conflict of interest

None

Acknowledgment

None

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