Active Flexion-extension Research Articles

СРАВНИТЕЛЬНЫЙ АНАЛИЗ РЕЗУЛЬТАТОВ ЛЕЧЕНИЯ ОСТЕОХОНДРАЛЬНЫХ ДЕФЕКТОВ СУСТАВНОЙ ПОВЕРХНОСТИ КОЛЕННОГО СУСТАВА, АССОЦИИРОВАННЫХ С ПОВРЕЖДЕНИЕМ ПЕРЕДНЕЙ КРЕСТООБРАЗНОЙ СВЯЗКИ

Purpose of work: to perform a comparative analysis of the results of treatment of patients with osteochondral defects of the articular surface associated with damage of the anterior cruciate ligament of the knee joint. Materials and Methods. Between 2015 and 2023 inclusive, 72 patients with anterior cruciate ligament injury accompanied by osteochondral defects of femoral condyles were treated. All patients were randomly divided into three groups: the first group - simultaneous ACL reconstruction and abrasive chondroplasty (ACh-ACL group) (n=24); the second group - ACL reconstruction and microfracturing (MF-ACL group) (n=24); the third group - ACL reconstruction and mosaic autochondroplasty (OAT-ACL group) (n=24). For the purpose of independent evaluation, a control group - anterior cruciate ligament reconstruction with intact articular cartilage (IAC-ACL group) (n=24) was introduced for comparison. Results and Discussion. Having analyzed the results of IKDC-2000 and Lysholm + Tegner questionnaires at 3, 6 and 12 months after the operation we noted the greatest positive dynamics in the early postoperative period (3 months) in all groups. From 6 to 12 months the dynamics changed its tendency and more pronouncedly passed into a "plateau" in groups 1 and 2, which was clinically determined by the restoration of passive movements with insufficient volume of active flexion-extension movements in the knee joint, as well as by the persistence of pain syndrome during loading. Conclusions. Simultaneous reconstruction of osteochondral lesions of the articular surface of the knee joint and reconstruction of the anterior cruciate ligament is the basis for full restoration of the function and bearing capacity of the knee joint. In this case, the use of organ-reconstructive methods of surgical intervention (bone-cartilage autochondroplasty and anterior cruciate ligament reconstruction (OAT-ACL)) allows achieving better clinical results compared to "mesenchymal stimulation" of the defect area, showing full functional recovery of the knee joint.

Examining the Efficacy of Arthroscopic Scaphocapitate Arthrodesis for Advanced Kienbock's Disease: Clinical and Radiological Outcomes.

Altering wrist biomechanics, Kienbock's disease leads to progressive carpal collapse that results in early arthritis and degenerative changes. By shifting the loading axis toward the radioscaphoid joint, scaphocapitate arthrodesis (SCA) has been reported as a salvage procedure effective in treating symptomatic patients with advanced Kienbock's disease. In this study, we aimed to evaluate the clinical and radiological outcomes of arthroscopic SCA in symptomatic patients with advanced stages of Kienbock's disease. Between March 2010 and February 2021, we included 15 patients with symptomatic stage IIIA (n=2) and stage IIIB (n=13) Kienbock's disease who were followed up for a minimum of 24 months after arthroscopic SCA with or without lunate excision. The lunate was excised in 6 patients and retained in 9. Visual analog scale (VAS) pain score, grip strength, range of motion (ROM), active flexion-extension arc, and modified Mayo wrist score (MMWS) were measured preoperatively and at each follow-up examination after surgery. Operation-related complications and radiographic changes were also assessed. There were 13 women and 2 men, with a mean age of 57.6 years (range, 21-74 years) at the time of undergoing arthroscopic SCA. Follow-up ranged from 24 to 116 months, with an average of 56.9 ± 32.3 months. Bony union was achieved in all patients. At preoperative examination, wrist ROM (67%) and grip strength (48%) significantly decreased, compared to the contralateral wrist. At the final follow-up, there were significant improvements in VAS, grip strength, and MMWS, whereas the active wrist ROM showed no significant change. Radioscaphoid angle recovered after surgery, while radiographic carpal collapse and ulnar translation of the carpus occurred. In subgroup analysis according to excision of the lunate, there were no significant differences in VAS, MMWS, grip strength, or total ROM. However, increased ulnar translation and decreased radial deviation were noted in the lunate excision group. Arthroscopic SCA achieved significant improvements in pain and wrist function in patients with advanced Kienbock's disease without any complications. Excision of the lunate when performing arthroscopic SCA seemed to induce progressive carpal ulnar translation, with no apparent clinical benefits over retaining it.

Case Study: The Application of Extracorporeal Shockwave Therapy (ESWT) and Active Finger Blocking Exercise on Movement and Function of Fingers Disorders Caused by Trigger the 4th Finger Dextra

Background: Trigger finger also referred to as stenosing tenosynovitis. It is a traumatic condition that involves the formation of nodules in the tendons of flexor digitorium muscle due to a combination of repetitive finger movements or local trauma and impaired healing, as a result of which the affected finger is locked in either a flexed or extended position thereby impeding movement. Objective: This case study was aimed to determine the effect of extracorporeal shockwave therapy, and active finger blocking exercise in one women patient, aged 47 years old with diagnosed of trigger the 4th finger dextra. Methods: This case studies have been carried out 6 times for 2 weeks in one women patient, by evaluating the degree of pain by using the Visual Analogue Scale (VAS), Joint Range of Motion (RoM) by using a goniometer and functional activity ability hands with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Results: There was a decrease in the motion pain degree from VAS 7 to VAS 4, and the degree of tenderness pain from VAS 5 to VAS 2. There was an increase active flexion-extension movement of the 4th finger dextra from (S)=25°-0°-50° to (S)=40°-0°-75°, while passive movement from (S)=30°-0 °-60° to (S)=40°-0°-75°. There was a decrease in the value of hand disabilities based on the results of the DASH questionnaire from 24% to 21%. Conclusion: The application of extracorporeal shockwave therapy and active finger blocking exercise can reduce the pain, increase the range of motion and functional abilities patient diagnosed Trigger the 4th Finger condition.

Radiolunate arthrodesis and scaphoidectomy combined to Sauvé-Kapandji procedure as treatment of wrist osteoarthritis: Clinical and radiological results

ObjectiveThe aim of this study was to analyze clinical and radiological results for 1-stage radiolunate arthrodesis and scaphoidectomy associated to the Sauvé-Kapandji procedure, to alleviate pain and conserve wrist motion. MethodsSeven patients (8 wrists) with symptomatic osteoarthritis of the radiolunate and distal radioulnar joints were treated from 1999 to 2016. Mean age at surgery was 49 years and M/F sex ratio was 6/1. Etiologies were distal radial intra-articular malunion for 6 patients and bilateral gouty arthritis for 1. The procedure was performed by a dorsal approach in a single step. Pain was assessed on visual analogue scale (VAS). Pre- and post-operative active flexion-extension and pronation-supination were compared. The secondary endpoint was onset of postoperative complications. ResultsAt a mean 71 months’ follow-up (range, 30–168 months), there was significant reduction in pain (VAS, 0.5/10; p < 0.0001). Motion results were satisfactory, with 32° flexion, 39° extension, for a non-significant decrease of 11° and 5° respectively; pronation and supination were significantly increased, by a mean 23° and 30° respectively. Three wrists (37.5%) required a second surgery. There were no cases of surgical site infection or non-union. ConclusionRadiolunate arthrodesis and scaphoidectomy combined to Sauvé-Kapandji procedure was an effective solution for the treatment of symptomatic radiolunate and distal radioulnar osteoarthritis. Level of evidenceIV.

Modified Lemaire Tenodesis Forces in Cadaveric Specimens Are Not Affected by Random Small-Scale Variations in the Femoral Insertion Point During Active Knee Joint Flexion-Extension

PurposeTo directly measure lateral extra-articular tenodesis (LET) forces supporting anterior cruciate ligament reconstruction (ACLR) during dynamic flexion-extension cycles induced by simulated active muscle forces, to investigate the influence of random surgical variation in the femoral LET insertion point around the target insertion position, and to determine potential changes to the extension behavior of the knee joint in a cadaveric model.MethodsAfter iatrogenic anterior cruciate ligament deficiency and simulated anterolateral rotatory instability, 7 fresh-frozen cadaveric knee joints were treated with isolated ACLR followed by combined ACLR-LET. The specimens were tested on a knee joint test bench during active dynamic flexion-extension with simulated muscle forces. LET forces and the degree of knee joint extension were measured. Random variation in the LET insertion point around the target insertion position was postoperatively quantified by computed tomography.ResultsIn extension, the median LET force increased to 39 ± 2 N (95% confidence interval [CI], 36 to 40 N). In flexion over 70°, the LET was offloaded (2 ± 1 N; 95% CI, 0 to 2 N). In this study, small-scale surgical variation in the femoral LET insertion point around the target position had a negligible effect on the graft forces measured. We detected no difference in the degree of knee joint extension after combined ACLR-LET (median, 1.0° ± 3.0°; 95% CI, −6.2° to 5.2°) in comparison with isolated ACLR (median, 1.1° ± 3.3°; 95% CI, −6.7° to 6.1°; P = .62).ConclusionsLET forces in combined ACLR-LET increased to a limited extent during active knee joint flexion-extension independent of small-scale variation around 1 specific target insertion point. Combined ACLR-LET did not change knee joint extension in comparison with isolated ACLR under the testing conditions used in this biomechanical study.Clinical RelevanceLow LET forces can be expected during flexion-extension of the knee joint. Small-scale deviations in the femoral LET insertion point around the target insertion position in the modified Lemaire technique might have a minor effect on graft forces during active flexion-extension. To directly measure lateral extra-articular tenodesis (LET) forces supporting anterior cruciate ligament reconstruction (ACLR) during dynamic flexion-extension cycles induced by simulated active muscle forces, to investigate the influence of random surgical variation in the femoral LET insertion point around the target insertion position, and to determine potential changes to the extension behavior of the knee joint in a cadaveric model. After iatrogenic anterior cruciate ligament deficiency and simulated anterolateral rotatory instability, 7 fresh-frozen cadaveric knee joints were treated with isolated ACLR followed by combined ACLR-LET. The specimens were tested on a knee joint test bench during active dynamic flexion-extension with simulated muscle forces. LET forces and the degree of knee joint extension were measured. Random variation in the LET insertion point around the target insertion position was postoperatively quantified by computed tomography. In extension, the median LET force increased to 39 ± 2 N (95% confidence interval [CI], 36 to 40 N). In flexion over 70°, the LET was offloaded (2 ± 1 N; 95% CI, 0 to 2 N). In this study, small-scale surgical variation in the femoral LET insertion point around the target position had a negligible effect on the graft forces measured. We detected no difference in the degree of knee joint extension after combined ACLR-LET (median, 1.0° ± 3.0°; 95% CI, −6.2° to 5.2°) in comparison with isolated ACLR (median, 1.1° ± 3.3°; 95% CI, −6.7° to 6.1°; P = .62). LET forces in combined ACLR-LET increased to a limited extent during active knee joint flexion-extension independent of small-scale variation around 1 specific target insertion point. Combined ACLR-LET did not change knee joint extension in comparison with isolated ACLR under the testing conditions used in this biomechanical study.

Effectiveness of lyophilized growth factors injection for subacromial impingement syndrome: a prospective randomized double-blind placebo-controlled study

BackgroundPlatelet-derived lyophilized growth factors (L-GFs) use a standardized number of allogenic pathogen-free platelets instead of autologous platelets used in PRP as a source of growth factors. This study aimed to evaluate the efficacy of L-GF injection versus placebo in subacromial impingement (SIS) treatment.MethodsThe current randomized double-blind placebo-controlled study included sixty patients (40 females and 20 males, aged between 24 and 75 years) diagnosed with SIS (both clinically and sonographically). Patients were randomly assigned to two equal groups. Under ultrasound guidance, group 1 received subacromial saline injection, and group 2 received L-GF injection. Clinical examination, pain visual analogue scale (VAS), shoulder pain and disability index (SPADI) and shoulder ultrasound were performed before and at the 8th week after injection.ResultsFollow-up assessment showed statistically significant improvement in the L-GF group regarding active flexion, active and passive internal rotation and extension, SPADI-disability scale, VAS and thickness of the supraspinatus tendon by US. Regression analysis showed that group 1 was approximately 30 times more likely than the L-GF group to experience painful arc at follow-up. Both groups showed statistically significant improvement in SPADI-pain scale and SPADI-total, flexion and abduction (still the mean value of abduction was significantly higher in the L-GF group).ConclusionsL-GF injection resulted in clinically significant reductions in pain and functional disability outcomes in patients with SIS. An objective significant reduction in the thickness of the supraspinatus tendon, measured by ultrasound, in the L-GF group hopefully encourages proper healing and functioning in SIS.Trial registration: The identification number is NCT04330027, date of first registration (01/04/2020). Unique on 21/11/2019, Protocol ID: 0106178.

Patellar tendon ruptures repaired through a simple modified reconstruction using hamstrings tendon graft in obese patient: surgical technique and case report

Background: Patellar tendon ruptures are uncommon, severe, and are complex cases that require early surgical intervention. Loss of function of the extensor mechanism of the knee joint might cause severe disability and inability to hold a standing position. Case Presentation: A 34-year-old Saudi male, known to have morbid obesity (class 1), came to the emergency room complaining of severe pain in the left knee after experiencing a fall on a flexed knee while playing soccer. The patient had no other significant past medical history. In this case, the injury occurred due to a minor sports accident, and there were no predisposing factors. Thus, it was decided to do patellar tendon augmented reconstruction using a pedicled hamstring tendon, involving primary repair. After the surgery, a cast was applied on the patient&amp;apos;s knee and retained for 3 weeks, allowing only active knee flexion and passive extension. Then, active assisted knee extension was allowed through physiotherapy for 2 months, until 75%-80% of active extension was achieved. Patient was moved to out-patient department after 3 months for further assessment. Conclusion: Patellar tendon ruptures from the tibial tuberosity are quite uncommon. When the patient has morbid obesity, acute repair of the patellar tendon through reconstruction using hamstring tendons could give a positive result with good outcome in the joint&amp;apos;s movement.

Long-term results of trans-scaphoid perilunate fracture dislocations treated by open reduction and internal fixation

PurposeThe paper holds the research purpose of confirming the long-term results of trans-scaphoid perilunate fracture dislocations (TSPFD) under the treatment of open reduction and internal fixation.MethodsAnteroposterial-lateral radiographs of the patient's wrist were taken before and after surgery. We use a dorsal approach for all cases. Postoperative clinical and radiographic assessments were performed routinely. The scapholunate angle (SLA), estradiol angle (RLA), as well as lunotriquetral distance (LTD) assisted in the radiographic assessment. Clinical assessment was performed using the Krimmer score, modified Mayo wrist score (MWS), active flexion extension arc (FEA), radial deviation and ulnar deviation arc (RUDA) and grip strength. A visual analog scale (VAS) assisted in the pain evaluation, the VAS score ranges from 0 to 10.ResultsTwenty-two TSPFD patients due to the wrist trauma received operative treatment and we retrospectively analyzed the surgical results, together with evaluating their clinical and radiological follow-up. These patients held a mean age of 30 years old. Herzberg’s perilunate fracture-dislocation classification was taken into account to find that 19 males and 3 females suffered dorsal dislocation. The fellow-up time lasted 98.3 months on average. All cases obtained sufficient union after open reduction and internal fixation. The last follow-up found the median of grip strength was 20.00 (interquartile range, 20.00–21.25), which was 84.5% of the normal side. The modified Mayo wrist score evaluation scale considered 12 cases as excellent, and 10 good. The median of VAS and Krimmer scores at the final follow-up were 1.50 (interquartile range, 0.75–2.00) and 100.00 (interquartile range, 100.00–100.00), respectively, higher relative to the pre-operation (P < 0.001). No patients showed nerve damage preoperatively or postoperatively, or pin tract infection in any of the patient.ConclusionsIt is necessary to diagnose such complicated biomechanical damage in early stage and adopt the open reduction and stable fixation for treatment; appropriate treatment can contribute to a functionally adequate and anatomically integrated wrist.

EFFECT OF REHABILITATION TRAINING ON CRUCIATE LIGAMENT INJURY

ABSTRACT Introduction: Sports injuries in the anterior cruciate ligament of the knee are common and serious in the field of sports and rehabilitation medicine. Objective: To observe the effect of early comprehensive rehabilitation training on knee function recovery after anterior cruciate ligament reconstruction. Methods: 40 patients were randomly divided into observation group (n = 19) and control group (n = 21). The control group received routine rehabilitation training and the observation group had water exercise added to their intervention. The active knee flexion range, extension range, and Lysholm score were observed before and 3 months after rehabilitation training. Results: 3 months after training, the active knee flexion range and extension range in the observation group were better than those in the control group (p&lt; 0.05). Lysholm score in the observation group (91.2 ± 5.6) was higher than that in the control group (78.3 ± 4.8), and the difference was statistically significant (p&lt; 0.05). Conclusions: Early systematic rehabilitation training can reduce pain and swelling and improve the function of the knee joint after operation. Level of evidence II; Therapeutic studies - investigation of treatment results.

The dynamic rotation axis of ulnohumeral joint during active flexion-extension: an in vivo 4-dimensional computed tomography analysis

BackgroundAs the collateral ligament reconstruction becomes more common to perform, the knowledge between the collateral ligament reconstruction and the elbow rotation axis is still ambiguous. The purpose of this study was to investigate the location of the intersections between the elbow rotation axis and medial and lateral aspect of the humerus.MethodsFour-dimensional computed tomography (4D CT) scan was designed to obtain the images from 8 participants. The instantaneous rotation axis was created according to the trochlea notch of the ulna in the Rapidform XO software. Then the intersections between the instantaneous rotation axis and the medial and lateral aspect of the humerus were identified in the Geomagic Wrap software. Landmark coordinate systems of the distal humerus was created.ResultThe intersections in the medial aspect of the humerus were mostly located in the superior and posterior quadrant and showed the trend from anterior-superior to posterior-superior with the increment of the elbow flexion. The intersections in the lateral aspect of the humerus were mostly located in the middle half of the anterior quadrant and showed the trend from posterior-inferior to anterior-superior with the increment of the elbow flexion.ConclusionThere’s no isometric point for medial collateral ligament (MCL) and lateral ulnar collateral ligament (LUCL) reconstruction. The isometric area for MCL reconstruction should be considered at the superior and posterior quadrant of the medial aspect of the humerus. The isometric area for LUCL reconstruction should be considered at the middle half of the anterior quadrant of the lateral aspect of the humerus.Trial registrationThis work was supported by the National Natural Science Foundation of China [No.81911540488] in 07/01/2019.

Closed-reduction Intramedullary Screw in Fractures of the Proximal Phalanges of the Digits of the Hand: A Series of Three Cases.

The most frequent skeletal injuries are hand fractures, which constitute around 20% of all fractures. Fractures of the phalanx are usual, comprising 6% of all fractures. Proximal phalanx fractures arise more often. The main goals of the care are to repair the anatomy, reduce the damage to soft tissue, and mobilize the damaged fingers as soon as stabilization of the fracture allows it. The present report is intended to examine the clinical and radiation effects of proximal phalanx fractures in patients treated with intramedullary screw fixation who underwent closed reduction. We report three consecutive cases of proximal phalanx fracture: two basal fractures and one simple shaft fracture. They were treated surgically with closed reduction with intramedullary headless compression screws. The preoperative magnitude of the angulation of the proximal phalanx averaged 30.3° (range: 13° to 42°). Two patients presented rotational deformity. The clinical findings were measured using the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire, and the range of motion and functional results were assessed. Complications were observed over a span of at least 3 months. The patients displayed complete active flexion-extension proximal interphalangeal joint and flexion-extension metacarpophalangeal joint without rotative deformity. The scores on the QuickDASH were satisfactory (mean: 2.3; range: 0 to 4.5). No secondary surgeries were performed, and complications were not observed. Intramedullary fixation of proximal phalanx fractures with cannulated tension screws has been shown to be a safe operation, resulting in outstanding functional performance and an early recovery. The fracture is minimized and properly consolidated by the patients.

Four-dimensional CT analysis of carpal kinematics: An explorative study on the effect of sex and hand-dominance

Wrist pathology is often diagnosed by using the contralateral wrist as a comparison of baseline motion and strength. However, recent range of motion studies suggest that females have different carpal motion patterns compared to males and that the dominant carpal bones have different motion patterns. The purpose of this study is to evaluate the effect of sex and hand dominance on in vivo kinematics of the scaphoid, lunate and capitate using four-dimensional computed tomography (4D-CT) analysis in healthy uninjured volunteers. In this prospective study, both wrist of 20 uninjured Caucasian volunteers (11 men and 9 women) were assessed using 4D-CT during active flexion–extension and radial-ulnar deviation. A linear mixed model was used to compare the carpal motion patterns. Sex had no influence on carpal kinematics. Hand-dominance in males did have a significant effect on carpal kinematics. During flexion–extension of the male wrist, more radial-ulnar deviation of the lunate, scaphoid and capitate of the non-dominant hand was seen. During radial-ulnar deviation of the male wrist, radial-ulnar deviation and pro-supination of the lunate was more in the dominant hand.This study provides a better understanding of carpal kinematics and the effect of sex and hand-dominance on the scaphoid, lunate and capitate in uninjured wrists.

Management of Acute Distal Radioulnar Joint Instability Following a Distal Radius Fracture: A Systematic Review and Meta-Analysis

PurposeWe sought to review the clinical outcomes of conservative and operative treatment options for acute distal radioulnar joint (DRUJ) instability associated with distal radius fractures in adult patients.MethodsA systematic search of PubMed, MEDLINE, and EMBASE for articles published between 1990 and 2020 involving DRUJ instability associated with distal radius fractures was performed. The primary outcomes analyzed included clinical grip strength; range of motion; the disability of the arm, shoulder and hand (DASH) score; and the modified Mayo wrist score (MMWS).ResultsOf the 531 articles identified in the literature search, 8 met our defined criteria and were included in the final analysis. The cumulative sample size was 258 patients at a mean follow-up of 11.1 months (range, 3–16.9 months). Treatment groups included cast immobilization in supination, K-wire stabilization, and triangular fibrocartilage complex (TFCC) repair. Statistical analysis revealed no difference across groups in active flexion-extension or DASH scores. A significant decrease in grip strength was found in patients who underwent TFCC repair compared with that in those who underwent both cast immobilization (P = .04) and K-wire stabilization (P = .02). Furthermore, we found a significant decrease in active pronation-supination between patients who underwent TFCC repair and those who underwent cast immobilization (P = .03). Patients who underwent TFCC repair were also found to exhibit decreased MMWS as compared with those who underwent K-wire stabilization (P = .05). Overall, persistent DRUJ instability was only found in 4 patients (1.5%), without a significant difference between treatment groups.ConclusionsThis study suggests functional advantages of certain treatment modalities over others, with the range of motion being highest in patients who underwent cast immobilization and grip strength being highest in patients who underwent K-wire stabilization. However, the mean DASH scores showed no difference across all groups, calling into question the clinical need to pursue operative treatment via K-wire stabilization or TFCC repair over conservative treatment via cast immobilization. This study will hopefully serve as a foundation for future prospective studies to help improve and standardize treatment algorithms in patients with DRUJ instability and distal radius fractures.Type of study/level of evidence: Therapeutic II.

Morphological and functional assessment of the flexor carpi radialis brevis using conventional ultrasound and elastography.

The flexor carpi radialis brevis (FCRB) is a supernumerary musculotendinous structure of the wrist that has been the focus of some interest in the last decade. While its anatomy is well known, its in vivo function remains unknown as it has never been studied. Eleven cases of FCRB underwent a multimodal ultrasound consisting of B-mode, color Doppler and shear wave elastography. A pennate shape was observed in all cases and the mean value of the cross-sectional area was 0.8cm2 (SD 0.3cm2). Young's modulus was significantly (p < 0.01) different between the resting position and active flexion or passive extension. Our study demonstrates that the FCRB shows biomechanics of a typical skeletal muscle and is voluntarily controlled by flexing the wrist. Absent in other vertebrate taxa, the FCRB probably plays a role in active stability of the wrist in Human.

Chronic Tear of the Distal Triceps Tendon Treated With Suture Anchors and Fascia Lata Allograft: Case Report, Surgical Technique and Literature Review

Chronic tears of the distal triceps tendon are extremely uncommon lesions. Surgical therapy can be performed with a direct reattachment of the 2 sides of the lesion or—in case of significant tendon retraction—using grafts to fill the resulting gap. Herein, we report a case of a torn distal triceps tendon that occurred in a 33-year-old patient suffering from paraplegia. The resulting functional impairment of the elbow impeded her to use a wheelchair, causing a substantial limitation to her mobility and autonomy. Preoperative clinical evaluation, x-rays, muscle-tendon ultrasound, and magnetic resonance imagingwas been performed. In consideration of a 6 cm retraction at the surgery, we reconstructed the tendon using a combination of suture anchors (5 mm Super Reevo ConMed) and a cadaver fascia lata allograft. After surgery, the elbow was immobilized in extension inside a brachio-metacarpal cast for 30 days. In the following month, the cast was replaced with a hinged elbow brace and progressive mobilization was permitted. Five months postoperatively, the patient regained her previous active flexion-extension articular ROM and was able to use her wheelchair again. No complication occurred.

Quantifying in vivo scaphoid, lunate, and capitate kinematics using four-dimensional computed tomography

ObjectiveWe aimed to establish a quantitative description of motion patterns and establish test-retest reliability of the four-dimensional CT when quantifying in vivo kinematics of the scaphoid, lunate, and capitate.Materials and methodsWe assessed in vivo kinematics of both wrists of 20 healthy volunteers (11 men and 9 women) between the ages of 20 and 40 years. All volunteers performed active flexion-extension and radial-ulnar deviation with both wrists. To test for reliability, one motion cycle was rescanned for both wrists approximately 15 min after the first scan. The coefficient of multiple correlation was used to analyze reliability. When two motion patterns are similar, the coefficient of multiple correlation tends towards 1, whereas in dissimilar motion patterns, it tends towards 0. The root mean square deviation was used to analyze the total motion patterns variability between the two scans.ResultsOverall, mean or median coefficient of multiple correlations were higher than 0.86. The root mean square deviations were low and ranged from 1.17° to 4.29°.ConclusionThis innovative non-invasive imaging technique can reliably describe in vivo carpal kinematics of uninjured wrists in healthy individuals. It provides us with a better understanding and reference values of carpal kinematics of the scaphoid, lunate, and capitate.

Cervical kinematics estimated by finite helical axis behaviour differs in patients with neck related problems as compared to healthy controls.

584 subjects were recruited from private and ambulatory institutional physiotherapy practices. Among these 171 patients with neck related problems were selected based on referral diagnosis by primary care general practitioners. Cervical kinematics were compared based on minimal convex hull, path length and mean angle of the Finite Helical Axis distribution as well as on the helical angle. Three active planar motions were registered: flexion-extension, axial rotation and lateral bending. Patients demonstrated a significantly reduced and less variable behaviour of the Finite Helical Axis during active flexion-extension and axial rotation motions as compared to healthy individualsand lateral bending. Patients with neck related problems demonstrate a more restricted motion behaviour with less variability in Finite Helical Axis distribution and orientation during active planar motions. At present it is not clear whether these kinematic differences are the result or the cause of dysfunction. These slides can be retrieved under Electronic Supplementary Material.

No differences in knee kinematics between active and passive flexion-extension movement: an intra-operative kinematic analysis performed during total knee arthroplasty

PurposeThe objective of the present study was to acquire and compare by the use of a navigation system the intra-operative flexion-extension movement of the knee performed actively by the patient and passively by the surgeon before and after a total knee arthroplasty (TKA) implantation.MethodsA cohort of 31 patients with primary knee osteoarthritis (OA), candidate for TKA underwent intra-operative kinematics assessment with a commercial navigation system before and after the definitive implant positioning of a Cruciate Retaining (CR) Mobile Bearing (MB) prostheses. The kinematical data were acquired while surgeon performed the flexion-extension movement (passive ROM - pROM), and while the patient performed it (active ROM - aROM). Differences between pre- and post- implantation and between active and passive motions, were statistically analyzed using paired Student t-tests (p = 0.05).ResultsNo statistically significant difference were found between aROM and pROM with paired Student t-test regarding internal-external rotation and anterior-posterior translation of the femoral component with respect to the tibia during flexion-extension movement before and after TKA implant (p > 0.05).ConclusionsActive muscle contraction seems to not significantly affect TKA kinematics. The ROM performed by the surgeon during operation resemble the movement actively performed by the patient.The clinical relevance of this study further supports the use of CAS system in performing intra-operative analysis concerning knee biomechanics.

Patellofemoral Pain in Adolescents: Understanding Patellofemoral Morphology and Its Relationship to Maltracking

Background: Developing bone is highly adaptable and, as such, is susceptible to pathological shape deformation. Thus, it is imperative to quantify if changes in patellofemoral morphology are associated with adolescent-onset patellofemoral pain, as a pathway to improve our understanding of this pain’s etiology. Purpose: To quantify and compare patellofemoral morphology in adolescent patients with patellofemoral pain with matched healthy adolescent controls and determine if a relationship exists between patellofemoral shape and kinematics (measured during active flexion-extension). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Using 3-dimensional static magnetic resonance images acquired during a previous study, we measured patellar, trochlear, and lateral patellar width; trochlear and patellar depth; Wiberg index; patellar-height ratio; lateral trochlear inclination; cartilage length; and lateral femoral shaft length. Student t test was used to compare shape parameters between adolescents with patellofemoral pain and controls. Pearson correlations and stepwise linear regression models were used to explore the relationship among morphology, kinematics (medial-lateral shift/tilt), and pain. Results: Relative to controls, adolescents with patellofemoral pain had larger sulci (mean ± SD, 6.6 ± 0.7 vs 6.0 ± 1.1 mm; 95% CI, 0.6 mm; P = .043; d = 0.66), lateral patellar width (23.1 ± 2.4 vs 21.4 ± 2.6 mm; 95% CI, 1.6 mm; P = .033; d = 0.70), and patella-trochlear width ratio (1.2 ± 0.1 vs 1.1 ± 0.1; 95% CI, 0.1; P < .001; d = 1.26). Shape correlated with kinematics in both cohorts and in the entire population. In the patellofemoral pain group, lateral shaft length (r = 0.518; P = .019), Wiberg index (r = 0.477; P = .033), and patellar-height ratio (r = −0.582; P = .007) were correlated with medial shift. A moderate correlation existed between patellar-height ratio and lateral patellar tilt (r = 0.527; P = .017). Half of the variation in patellar shift in the patellofemoral pain cohort was explained by the patellar-height ratio and Wiberg index (R2 = 0.487; P = .003). Linear correlations with pain were not found. Conclusion: This study provides direct evidence that patellofemoral morphology is altered and influences maltracking in adolescents with patellofemoral pain, highlighting the multifactorial etiology of this pain. Neither morphology nor kinematics (measured during active flexion-extension) correlated with pain. Both increases and decreases in these parameters likely lead to pain, negating a direct linear correlation.

Multiparametric ultrasound imaging of the flexor carpi radialis brevis

Flexor carpi radialis brevis (FCRB) is a supernumerary musculo-tendinous structure of the wrist, often discovered incidentally during imaging, surgical procedure, or cadaveric dissection. Five cases (three patients) with FCRB were reported and underwent a multimodal ultrasound consisting of B-mode US, Doppler US and Shear Wave Elastography. Examinations were conducted on a dedicated ultrasound system (AixplorerTM, Supersonic Imagine, Aix-en-Provence, France). A high-resolution linear 18 MHz transducer (SuperLinearTM SL18-5, Supersonic Imagine, Aix-en-Provence, France) with 256 elements and a bandwidth from 5 to 18 Mhz was used. A penniform shaped FCRB was found in all of our cases and the mean value of its cross sectional area was 0.77 ± 0.21 cm2. Arterial supply to the FCRB was via branches of the radial artery in all cases. Young modulus (kPa) of the FCRB was significantly (P < 0.02) different from resting position to active flexion or passive extension. Our study demonstrates that the FCRB shares similar biomechanics with a normal skeletal muscle and acts as an accessory wrist flexor. The authors will retrace the evolution of FCRB in the vertebrate phylum and discuss the rarity of this muscle in humans and its clinical application.