Active Knee Range Of Motion Research Articles

Influences of mechanical decompression using different forces on knee joint space, range of motion, and hamstring flexibility in asymptomatic subjects

INTRODUCTION: Knee joint decompression is one of the promising methods for the treatment of osteoarthritis. Yet, the most appropriate decompression force is not conclusive. OBJECTIVES: To compare the effect of different distraction force magnitudes on knee joint space, active range of motion (ROM), hamstring flexibility, and self-reported discomfort in asymptomatic subjects. METHODS AND MATERIALS: Twenty-five asymptomatic participants were recruited in this study. The dominant knee was distracted for 30 minutes in a 30° flexion position using three force magnitudes (10%, 20%, and 30% body weight (BW)). The traction forces were randomized with one week in between knee distractions. Joint space, range of motion (ROM), and hamstring flexibility were assessed before, immediately after, and 30 minutes after the distraction. The self-reported discomfort was assessed immediately after the distraction only. RESULTS: Medial joint space, ROM, and discomfort showed a significant difference between different force magnitudes post-distraction. The 20% and 30% BW force magnitudes significantly, but equally, increased joint space and ROM post distraction. The discomfort level was directly related to distraction force magnitude and the least comforting was the 30% BW force. Follow-up data was not significantly different than that for post-distraction. Hamstring muscle flexibility showed a significant. Yet, small increase after the 30% BW distraction force. CONCLUSION: Continued mechanical distraction of the knee joint using force magnitudes of 20% and 30% of body weight was effective in increasing medial joint space, active knee ROM, and hamstring flexibility in asymptomatic individuals. 20% force magnitude was more comfortable than the 30% percent.

Poster 227: Prospective Clinical and Radiological Follow-Up Beyond 10 Years in Patients Undergoing Matrix-Induced Autologous Chondrocyte Implantation (MACI) in the Patellofemoral Joint

Objectives: Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging outcomes in the treatment of knee cartilage defects, though limited research is available on its longer-term (≥10 years) sustainability in the patellofemoral joint. This prospective study sought to present and report the clinical and radiological outcome beyond 10 years in a prospectively recruited cohort of patients undergoing MACI in the patellofemoral knee joint. Methods: The current study included 82 patients (patella = 41, trochlea = 41) assessed at ≥10 years following patellofemoral MACI. Patients were assessed preoperatively and at 2, 5 and ≥10 years via the Knee Injury and Osteoarthritis Outcome score (KOOS), the 36-item Short Form Health Survey (SF-36), the frequency (VAS-F) and severity (VAS-S) of knee pain, patient satisfaction, active knee range of motion (ROM) and peak isokinetic knee extensor and flexor torque. High-resolution magnetic resonance imaging (MRI) assessed pertinent measures of graft outcome as per the magnetic resonance observation of cartilage repair tissue (MOCART) system, as well as an overall MRI composite score. Results were analyzed according to the graft location (patella or trochlea). Results: While no statistically significant differences (p>0.05) were observed between those undergoing patella or trochlea MACI across the majority of demographic (age, weight, BMI), injury history (duration of symptoms) or surgery (defect size, prior procedures, requirement for concomitant patellofemoral re-alignment) variables, a significantly higher (p=0.013) proportion of males was seen in the trochlea MACI group. All patient-reported outcome measures significantly improved (p<0.05), with no differences observed between those undergoing patella or trochlea MACI. No group differences (p>0.05) were observed in active knee flexion or extension ROM between groups, though those undergoing patella (versus trochlea) MACI demonstrated significantly greater postoperative quadriceps (Figure 1) and hamstring strength limb symmetry indices. No statistically significant decline (p>0.05) was seen from 2 years to final follow-up in any MRI-based measure, with no MRI-based differences observed between patella (Figure 2) and trochlea (Figure 3) grafts. In the cohort assessed at ≥10 years post-surgery, 4 patients (patella n=2, trochlea n=2) demonstrated graft failure on MRI, though a further 3 patients (all trochlea) were omitted from ≥10-year review that had already progressed toward total knee arthroplasty. Conclusions: Good clinical scores, high levels of patient satisfaction and adequate graft survivorship were observed at ≥10 years following MACI to the patella or trochlea.

Comparative Effects of Isometric Quadriceps Training, Glucosamine and Chondroitin Sulphate Iontophoresis on Pain Intensity and Physical Functions of Patients with Knee Osteoarthritis

This study was with a view to comparing the effective means of alleviating pain and improving physical functions in patients with knee osteoarthritis using quadriceps strengthening exercises, glucosamine and chondroitin sulphate iontophoresis. Seventy-eight participants with grade II knee OA were purposively selected and randomly assigned to three groups using fish bowl technique. Group one participants received 1g of glucosamine sulphate (GS) through iontophoresis while group two received 1g of chondroitin sulphate (CS) iontophoresis (40mA- min as dosage) using trans-arthral electrode placement technique twice a week, for 12 weeks. Group three participants had intervention in the form of quadriceps muscle strengthening exercise (1RM, 10 reps and 3 sets), which was a baseline treatment for all the groups. Pain intensity, active knee range of motion and physical function were assessed. Descriptive statistics, ANOVA and Kruskal-wallis test were used to analyze the data. Alpha level was set at p ≤ 0.05. The three modes of interventions significantly alleviated pain (p = 0.001), improved the Functional Activity Level and active ranges of motion (p = 0.001) in the groups after 12 weeks. Although, the administration of Quadriceps strengthening exercise alone, significantly improved the Functional Activity Level than Chondroitin sulphate iontophoresis and Glucosamine sulphate (H = 19.89, p = 0.001). However; there was no significant difference in the active range of motion across the 3 groups. In conclusion, Quadriceps strengthening exercise, Glucosamine and Chondroitin sulphate iontophoresis were effective in alleviating pain, enhancing range of motions and improving physical functions. However, Quadriceps strengthening exercise showed higher efficacy compared to others.

Ab. No. 89 Reproducibility of a Smartphone-Based Application for Assessing Knee Range of Motion

Introduction: Smartphone applications using in-built gyroscope chips are attractive options that can facilitate self-assessment of knee range of motion without having to wear a sensor-based device. Methods: A cross-sectional study was conducted to compare this smartphone-based app with universal goniometer (UG) in assessing active knee range of motion in sitting and lying position. Consecutive patients with knee osteoarthritis or those who had knee replacement or the healthy accompanier and hospital staff above 18 years of age and consenting to volunteer were approached for the study at a tertiary care academic hospital in India. The comparisons were repeated measurements with UG and test-app under same conditions, UG versus test-app, physiotherapist versus patient’s accompanier with test-app in the same phone, in different phones, and a physiotherapist measuring on different stool heights using test-app. We report mean difference between two measurements with 95% limits of agreement and intraclass correlation coefficient (ICC) calculated using one-way random effects. Result: The 95% LoA between the UG and test-app in supine flexion was -7.5° to +4.5° and extension was ±4°. The test retest 95% LoA of the test-app in supine flexion and sitting flexion across all scenarios was within ± 8.5°. The test-retest 95% limits of agreement of extension in sitting and supine position across all scenarios was within ±6.5°. Test-retest reliability (ICC) of knee flexion ranged between 0.70 to 0.99 and extension between 0.16 to 0.97 across all scenarios. Conclusion: The smartphone-based app is reliable to differentiate between various ranges of motion of knee with measurement errors no greater than universal goniometer. This app has the potential to measure changes in ROM that are above 8° of flexion and above 7° in extension.This app can enhance the ability to remotely measure and monitor knee ROM of pathologic knee.

A comparison between hypertonic dextrose prolotherapy and conventional physiotherapy in patients with knee osteoarthritis.

The aim of the present study was to compare the efficacy of hypertonic dextrose prolotherapy (HDP) with conventional physiotherapy (CPT) in improving symptoms in females with knee osteoarthritis (OA). The present study included 60 patients with a diagnosis of knee OA. The patients were randomly assigned to the HDP (n=30) and CPT (n=30) groups. The patients in the HDP group were treated with a dextrose injection into the knee joint (25% dextrose) and around the knee (15% dextrose) in two sessions for 1 month, while those in the CPT group received a hot pack, transcutaneous electrical nerve stimulation and therapeutic ultrasound in five sessions a week for 4 weeks. Prior to commencing the treatment, and at 1 and 3 months post-treatment, all the patients were evaluated using the visual analog scale (VAS), Western Ontario and McMaster Osteoarthritis Index (WOMAC), the goniometric measurement of active knee range of motion (ROM), a 50-m walking test and isokinetic knee muscle strength measurements. There were no statistically significant differences between the two groups as regards the demographic characteristics at pre-treatment (P>0.05). However, at 1 and 3 months post-treatment, the scores of all the outcome parameters were significantly improved in the HDP group compared with the CPT group (P<0.05 for all). In both groups, a significant improvement was observed in the VAS scores, WOMAC total values and ROM following the treatments, with the greatest improvement observed in the HDP group (P<0.001). The isokinetic quadriceps peak torque measurements were increased in both groups following treatment. All the scores exhibited a statistically significant improvement in the HDP group at both 1 and 3 months post-treatment. On the whole, the results of the present study demonstrate that both HDP and CPT are effective treatment modalities to relieve pain, and increase functionality and strength in patients with knee OA. However, greater improvements in pain and functionality can be achieved with prolotherapy.

Early application of extracorporeal shock wave therapy improves pain control and functional scores in patients undergoing total knee arthroplasty: a randomized controlled trial.

The use of biophysical stimuli produced by extracorporeal shock wave therapy (ESWT) can improve the rehabilitation treatment of patients undergoing total knee arthroplasty (TKA). The aim of our study is to evaluate the short-term efficacy of early postoperative ESWT in combination with physiotherapy in terms of pain reduction and motor function recovery of patients undergoing TKA and compare it with conventional physiotherapy treatment. Fifty-six patients undergoing TKA were enrolled in the study from January 2019 to February 2020. Patients received two sessions of physiotherapy daily, with (experimental group) or without (control group) four sessions of ESWT within sevendays after surgery. Patients were prospectively evaluated at baseline and at post-operative day two and seven. Assessment included active knee range of motion (aROM), timed up and go (TUG)test, visual analogue scale (VAS) for pain, and Borg scale. Fifty patients completed the study. Both treatments proved to be effective in reducing pain and improving the knee range of motion and functional scores at sevendays after surgery: the aROM in the ESWT group was 36.8 ± 11.0 grades (p < 0.001), while in control group was 19.8 ± 7.8 grades (p < 0.001). TUG, VAS, and BORG scores showed a similar trend. Comparative analysis revealed superior clinical results for the experimental group in all the outcomes, in particular aROM (96.0 ± 5.40 vs. 81.20 ± 11.01, p < 0.001) and TUG test (17.4 ± 5.61 vs. 21.24 ± 5.88, p < 0.001), at day seven after surgery. Early application of ESWT in addition to physiotherapy can positively influence the rehabilitation process after TKA. The treatment proved to be well tolerated and safe. Preliminary results demonstrated better pain control and functional scores compared to physiotherapy alone.

Effect of Thermotherapies Associated with Hamstring Stretching in Peak Torque: Randomized Clinical Trial

Background: Stretching is an effective strategy used mainly to reduce muscle stiffness, and increase both flexibility and Range of Motion. Aim: To compare the effects of different thermotherapy modalities associated with static stretching on peak torque (PT) of knee flexor muscles. Methods: This study compared a sample of 34 healthy men, aged between 20 and 30 years, with active knee range of motion (ROM) ≤160 degrees. They were subjected to three sessions of static stretching of the hamstrings, either with or without a thermotherapy modality. The order of interventions was randomized for one of the groups: isolated stretching (IS), stretching with heat (SH), and stretching with cold (SC). The concentric and eccentric PTs were assessed pre and post-intervention. Results: In the comparison of PT among different measures, there was a significant decrease in eccentric and concentric PT of knee flexor muscles in IS, in eccentric PT of knee flexor muscles in SH, and in eccentric and concentric PT of knee flexors in SC groups. Conclusion: Regardless of the use of thermotherapy, one single session of static stretching resulted in decreased PT of knee flexor muscles. This is probably due to the effects of stretching, such as the immediate change of the elastic component of the muscle-tendon unit, which leads to a deficit in acute force production.

Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in young athlete: An uncommon injury

Introduction: Patellar tendon rupture is a rare entity, accounting for 3% of all knee extension system injuries. In some cases, the tear is accompanied with avulsed tibial tubercle. Such concurrent fracture is extremely rare, and only a few previously cases have been described in the literature. We reported a 13-year-old male with combined avulsion fracture of the tibial tubercule and patellar tendon rupture. Case Report: A 13-year-old male junior basketball athlete presenting with left knee pain since 2 days before admission. The patient had previously fell to the ground with his left knee hitting the ground while playing basketball. Physical examination demonstrated swollen left knee. Radiographic examination suggested tibial tubercle avulsion, and magnetic resonance imaging demonstrated partial rupture of distal patellar tendon. The patient then underwent open reduction and internal fixation using single cannulated screw for the avulsed tibial tubercle, and patellar tendon reconstruction using suture anchor with ultra high molecular weight polyethylene fibers. Postoperatively, the patient was placed in a locked straight leg brace. One week after surgery, the patient began range of motion exercises and progression of weight bearing with physical therapy. At 4 months of follow-up, the patient can already weightbear, and he had regained active knee range of motion. Discussion: Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in young athlete is an extremely rare case. As such, there is no guideline regarding the best treatment. In this report, we chose open surgery for anatomical reduction of the tuberosity fragment because we consider the growth plate and direct visualization of the patellar tendon. Rigorous physical therapy is of utmost importance in this patient for return to sport, as he is a young athlete. Conclusions: Open reduction and internal fixation using single cannulated screw, and patellar tendon reconstruction suture anchor might be a treatment of choice for those with combined avulsion fracture of the tibial tubercle and patellar tendon rupture in young patients.

One-Stage Arthroscopic Multiple Ligament Reconstruction for Schenck IV Knee Dislocation.

Schenck IV knee dislocation patients have dissatisfactory knee function and return-to-sport rate with the existing treatment methods. The purpose of this study was to illustrate a one-stage arthroscopic multiple ligament reconstruction method for treating Schenck IV knee dislocations. A retrospective case series study was performed. All patients with a history of Schenck IV knee dislocation who underwent one-stage arthroscopic multi-ligament reconstruction from 2010 to 2018 were followed for 24months. The outcomes, including general patient data, Lysholm scores, International Knee Documentation Committee (IKDC) scores, visual analog scale (VAS) pain scores, knee active range of motion, and complications, were reviewed. The data was analyzed with paired-samples t-test. A total of 12 patients, comprising nine males and three females, were followed up and reviewed. The mean age at the time of the surgical procedure was 40.3 ± 9.0 (22-57) years. The mean body mass index (BMI) was 24.6 ± 4.9 (15.2-32.5) kg/m2 . The mean IKDC score and Lysholm score before surgery were 30.4 ± 6.1 (21-42) and 28.2 ± 6.2 (22-39), respectively. The average operation time was 121.8 minutes. The mean IKDC score and Lysholm score at the 24-month follow-up were 80.6 ± 6.5 (68-92) and 82.0 ± 7.5 (72-95), respectively. There were significant differences in the IKDC and Lysholm scores between the preoperative and 24-month postoperative time points (p < 0.01). The mean knee range of motion was 124.6° ± 6.6° (115°-135°) at the 24-month follow-up. No major complications occurred. The results of this retrospective study suggest that the new arthroscopic one-stage multi-ligament reconstruction technique is an effective way to treat Schenck IV knee dislocation with satisfactory postoperative knee function.

Single-stage procedures for treatment of traumatic patellar osteomyelitis: A retrospective study of 21 patients

IntroductionWe herein report on a series of 21 patients with traumatic patellar osteomyelitis treated by single-stage surgery, and discuss the specific application of single-stage procedures for traumatic patellar osteomyelitis. MethodsWe retrospectively reviewed the medical records of 21 patients with traumatic patellar osteomyelitis treated in our hospital from January 2010 to April 2018. In a single-stage surgery, aggressive debridement was performed together with application of a tissue flap, especially a gastrocnemius flap (for repair of skin/soft tissue defects and treatment of extensor mechanism defects), and internal refixation of the patellar fracture. The knee joint was exercised early after surgery. Long-term follow-up was performed to evaluate the recurrence of osteomyelitis according to clinical and laboratory signs of infection and to measure the active knee range of motion (ROM). ResultsSingle-stage wound treatment was successful in 20 of 21 patients. Treatments included radical debridement together with tissue flap for repair of soft tissue and extensor mechanism defects, and internal refixation of patellar fractures. 14 patients were treated with gastrocnemius flaps. One patient developed recurrent wound infection, which healed after reoperation. At a mean follow-up of 8 ± 2.63 years (range, 3.2–11.4 years), none had developed recurrence. Six patients had nearly full knee ROM (0°–105° to 0°–146°), whereas 11 patients had impaired knee mobility (ROM, 0°–90° to 0°–65°), 3 patients had knee joint stiffness with a ROM of 0°, and 1 patient had knee flexion contracture with a ROM of 78°–130° ConclusionsSingle-stage surgical treatment consisting of various surgical techniques was an acceptable treatment for traumatic patellar osteomyelitis, allowing early exercise of the knee joint. The osteomyelitis did not recur, and most patients’ knee ROM was restored to a certain extent, excluding patients with severe damage to the patellar articular surface and inactive functional exercise.

Effects of acupuncture at acupoints with lower versus higher pain threshold for knee osteoarthritis: a multicenter randomized controlled trial.

BackgroundThe acupoint selections impact the effects of acupuncture, and preliminary evidence showed potential connection between pain threshold (PT) and acupuncture response. This study examined whether acupuncture at acupoints with lower PT versus higher PT would yield different effects in patients with knee osteoarthritis (KOA).MethodsIn this multicenter randomized clinical trial, patients were randomly assigned (1:1:1) to receive acupuncture at acupoints with lower PT (LPT group), acupuncture at acupoints with higher PT (HPT group), and no acupuncture (waiting-list group). PT was measured with electronic von Frey detector. The primary outcome was the change in WOMAC total score from baseline to 16 weeks, and the secondary outcomes were SF-12 score, and active knee range of motion (ROM). Intention-to-treat analysis was conducted with linear mixed-effect model.ResultsAmong 666 randomized patients, 625 (93.84%) completed the study. From baseline to 16 weeks, patients in the LPT group versus HPT group had similar effects in reducing WOMAC total score (adjusted mean difference (MD) 2.21, 95% confidence interval (CI) −2.51 to 6.92, P = 0.36), while a greater reduction in WOMAC total score was observed in LPT group (−9.77, 95% CI −14.47 to −5.07, P < 0.001) and HPT group (−11.97, 95% CI −16.71 to −7.24, P < 0.001) compared with waiting-list group. There were no differences in SF-12 score and knee ROM between LPT versus HPT groups.ConclusionOur findings found that the effects of acupuncture at acupoints with lower versus higher PT were similar, both were effective for patients with KOA.Trial registration: ClinicalTrials.gov identifier: NCT03299439. Registered 3 October 2017, https://clinicaltrials.gov/ct2/show/NCT03299439Supplementary InformationThe online version contains supplementary material available at 10.1186/s13020-022-00626-3.

Effect of an Endoprosthetic Reconstruction Tube and Medial Gastrocnemius Flap on Extensor Mechanism Function After Oncologic Prosthesis Reconstruction of the Proximal Tibia

BackgroundExtensor mechanism reconstruction after the proximal tibial resection and implantation of a megaprosthesis is challenging. In this study, we evaluated the effectiveness of the Trevira tube and medial gastrocnemius flap in restoring extensor mechanism following the resection of proximal tibial tumor and implantation of megaprosthesis. MethodsForty patients who underwent endoprosthetic implantation following the resection of proximal tibial tumor and patellar tendon reconstruction with the Trevira tube and medial gastrocnemius flap were included. The outcome measures were knee range of motion, extensor mechanism function, patellar position, and limb function subjectively evaluated through Toronto Extremity Salvage Score and objectively through Musculoskeletal Tumor Society score. The mean follow-up of the patients was 6.1 years. ResultsThe patellar position was normal in 28 (70%) patients, patella baja in 3 (7.5%) patients, and patella alta in 9 (22.5%) patients. The mean active knee range of motion was 98.9 ± 17° (range: 85°-125°). Extension lag was present in 7 (17.5%) patients (range: 5°-20°). The mean Toronto Extremity Salvage Score of patients was 92.1 ± 6.9% (range: 85-100). The mean Musculoskeletal Tumor Society score of the patients was 87.7 ± 13 (range: 73.3-100). Postoperative complications included aseptic wound dehiscence (2 patients), aseptic loosening of the tibial component (1 patient), periprosthetic fracture in the femur (2 patients), and wound infection (1 patient). ConclusionTrevira tube combined with gastrocnemius flap augmentation is a suitable procedure for restoring extensor mechanism after proximal tibial resection and megaprosthesis implantation.

Effect of Mobilization with Movement and Kinesio Taping on Knee Function and Pain in Gonarthrosis

Background. Gonarthrosis is one of the most common diseases of the musculoskeletal system. As the disease progresses, the patient’s social and physical activities change. Reliable and effective therapies that slow the progression of gonarthrosis have not yet been found. There is a lack of evidence that a short course of physiotherapy and exercise-based treatment is effective or of how mobilization with movement and kinesio taping affects knee function and pain. We believe that in patients with knee gonarthrosis, the positive effects of physiotherapy combined with mobilization with movement and kinesio taping on knee functions and pain will be better than in those subjects who received only traditional physiotherapy.&#x0D; Aim. To determine the effect of mobilization with movement and kinesio taping on knee function parameters and pain in gonarthrosis.&#x0D; Methods. The study included 22 people diagnosed with gonarthrosis. For the experimental group (n=11), physiotherapy exercise, mobilization with movement and kinesiotape were applied, whereas the control group (n=11) used only physiotherapy exercise procedures. Subjects were evaluated for pain intensity, active knee range of motion, dynamic knee joint stability and evaluation of thigh muscle strength.&#x0D; Results. In the experimental group, there was a significant decrease in pain after 7 days and a significant difference with control group. Significant knee flexion results were recorded in the experimental group and significant knee extension results were recorded in the control group. In the experimental group, the dynamic knee joint stabilization significantly increased after 14 days. The strength of the thigh muscles was significantly increased in the experimental group after 14 days.&#x0D; Conclusion. The effect of mobilization with movement and kinesio taping of knee function, dynamic stability pain improving functional performance of dynamic stability was more significant than an exercise program lasting two weeks in subjects with knee gonarthrosis.&#x0D; Keywords: gonarthrosis, mobilization with movement, kinesio taping.

Modified Pulvertaft on Weave Technique Restores Full Active Knee Extension in Patients With Large Chronic Quadriceps Tendon Rupture: A Case Series

We aimed to investigate the clinical and functional outcomes, including maximal and explosive strength, after chronic quadriceps tendon rupture repair with Modified Pulvertaft on Weave (MPW) technique METHODS: Knee joint range of motion (ROM), patella height, thigh circumference, and Lysholm and International Knee Documentation Committee (IKDC) scores were assessed preoperatively and postoperatively. The knee extensors maximal (isokinetic peak torque and isometric maximal voluntary contraction (MVC) torque) and explosive strength-rate of torque development (RTD) early [RTD50 and RTD100] and late [RTD250]-were performed. We assessed the thigh circumference and vastus lateralis muscle thickness (MT) as indicators of quadriceps muscle mass, and the voluntary quadriceps activation using surface electromyography (EMG50). Nine patients (mean age: 53 ± 11 years) took part in the study. We observed a significant increase in the knee active ROM and a decreased extension deficit (both, P < .001), but not for pain (P= .07), IKDC (P= .07), and Lysholm (P= .21) after the surgery. We did not observe a difference between involved (n= 8) and uninvolved (n= 10) limbs for ROM, thigh circumference, and MT. We observed differences for extensors peak torque, MVC torque, and late RTD (all, P < .05). However, we did not observe differences for early RTD and EMG50. Significant positive correlations were observed for RTD50 (ρ= .80) and RTD100 (ρ= .81) vs EMG50. Both the IKDC and Lysholm were better correlated with the early than with later RTD. The MPW reestablished the active knee extension. The same level of quadriceps muscle mass was observed in both limbs, suggesting a lack of hypotrophy due to the injury. Although the involved limb had demonstrated lower knee extensors maximal strength, they demonstrate an equivalent early RTD when compared to the uninvolved limb. The early RTD seems to be better correlated with the patient's functionality than the later RTD and maximal strength. IV, case series.

Correlation between hamstring tightness and time duration of disease in knee osteoarthritis: an observational cross-sectional study.

Background: Osteoarthritis (OA) is gradually developing articular diseases that originate in the cartilage and affects the underlying bone, soft tissues as well as synovial fluid. OA usually occurs late in life and mainly it affects the hand and large weight-bearing joints such as the knee and hip. The knee joint is largely affected due to its weight-bearing nature. In many studies, this functional loss is related to muscular weakness caused by OA in particular the quadriceps and hamstring muscles. Flexibility is the ability of a muscle to lengthen and allow one joint [or more than one joint in a series] to move through a range of motion. The hamstring muscle group have tendency to shorten and the tightening results in increased patello-femoral compressive force, which may eventually lead to patello-femoral syndrome often associated with osteoarthritis. Method: Seventeen patients with knee osteoarthritis matched with the inclusion criteria were included in the study. Sit and Reach test was used to evaluate the hamstring tightness. Goniometer was used to evaluate knee active range of motion Spearman’s correlation was used to determine the relationship between hamstring tightness and duration of disease in knee osteoarthritis. Result: The present study found significant inverse correlation (r = -0.07) between hamstring tightness and duration of disease such that the hamstring flexibility decreases with increase in the duration of knee osteoarthritis. However, the correlation between duration of disease and knee active range of motion was negligible (r = 0.25). Conclusion: The results states that hamstring tightness and duration of the disease in knee osteoarthritis are correlated. Further research is indicated with a larger sample size. Keywords: Knee osteoarthritis, hamstring tightness, osteoarthritis.

Surgical treatment outcome of painful traumatic neuroma of the infrapatellar branch of the saphenous nerve during total knee arthroplasty.

BACKGROUNDDevelopment of infrapatellar saphenous neuroma (ISN) is a well-recognized reason for knee pain following total knee arthroplasty (TKA). So far, very few studies have addressed the development of painful ISN after TKA and its impact on functional outcome and patient satisfaction.AIMTo present the results of surgical treatment for ISN after primary TKA, the level of pain relief, and the improvement of knee motion and function.METHODSFifteen patients (13 women, 2 men) with persistent medial pain for more than six months after primary TKA, due to osteoarthritis, underwent surgical excision of ISN. ISN diagnosis was confirmed with the presence of Tinel’s sign along the course of the infrapatellar branch of the saphenous nerve and with pain relief after selective nerve block using local anesthetic. Component loosening, malalignment, instability and infection were excluded systematically in all patients as a source of pain. Pain relief in terms of visual analog scale (VAS), active knee range of motion (ROM), and the Knee Society Score (KSS) for pain and function were evaluated preoperatively and at least six months postoperatively.RESULTSThe mean patients’ age was 71.3 ± 5.4 years old. The mean interval between TKA and neuroma excision was 10 mo (range, 6 to 14 mo), while the mean follow-up was 8 mo (range: 6 to 11 mo). All 15 patients experienced almost complete immediate pain relief and resolution of allodynia and hyperesthesia after surgery. Pain on the VAS scale improved from 8.6 ± 1.3 preoperatively to 0.8 ± 0.9 at the final follow-up (P = 0.001). KSS pain and function scores were improved from 49.3 ± 5.9 and 62.7 ± 12.8 before surgery to 91.8 ± 4.2 and 75.3 ± 11.3 after surgery, respectively (P = 0.001 and P = 0.015). Active knee ROM was also increased postoperatively from 96 ± 4 to 105 ± 6 degrees (P = 0.001). There were no complications and no further operations required.CONCLUSIONISN should be considered a potential cause of persistent pain following TKA. Neuroma excision not only provides immediate pain relief and resolution of symptoms but may also improve the knee range of motion.

Free Functional Latissimus Dorsi Reconstruction of the Quadriceps and Hamstrings following Oncologic Resection of Soft Tissue Sarcomas of the Thigh

Background Limb-salvage surgery combined with radiotherapy has become the primary treatment for soft tissue sarcomas of the extremity. Free functional latissimus flaps (FFLF) are an option to restore function in the setting of volumetric muscle loss. The purpose of the current study was to examine the use of FFLF in patients undergoing resection of thigh sarcoma. Methods Twelve patients with a sarcoma involving the hamstring (n = 6), quadriceps (n = 5), or combined (n = 1) defects which included multiple muscle groups were reviewed. This included 9 males and 3 females with a mean age and body mass index of 56 ± 12 years and 31.3 ± 5.7 kg/m2. Results The mean defect volume and operative time was 3,689 ± 2,314 cm3 and 587 ± 73 minutes. Following reconstruction, the mean knee range of motion (ROM), MSTS93 score, and muscle strength was 89 ± 24°, 90 ± 15%, and 4 ± 1; with 75% of patients ambulating without gait aids. Seven (58%) patients sustained a complication, namely, delayed wound healing (n = 2). Conclusion Although there was a high incidence of complications, FFLF can restore active knee ROM and function, with most patients ambulating without gait aids following reconstruction of large oncologic defects in the thigh.

The Effect of Preoperative Behavioral Intervention on Pain, Anxiety, Opioid Use, and Function in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Study.

To evaluate the efficacy of preoperative cognitive-behavioral psychoeducation (CBE) for improved pain, anxiety, opioid use, and postoperative function in total knee arthroplasty (TKA) patients. A randomized controlled trial was conducted among 36 military health system beneficiaries attending preoperative education for TKA. The standard of care (SOC) group (n = 18) received information on home safety, rehabilitation, postoperative precautions, and pain management. In addition, the occupational therapy led CBE group (n = 16) received information on principles of holistic wellness (healing process, effects of stress on healing, heart-rate control through diaphragmatic breathing, anti-inflammatory nutrition, goal setting, and mental imagery). Outcomes of interest: knee active range of motion, pain (Defense and Veterans Pain Rating Scale), opioid medication use, heart-rate coherence (emwave2), anxiety (Generalized Anxiety Disorder Scale), and function (Knee Outcome Survey Activities of Daily Living [KOS-ADL], modified Functional Independence Measure, and Global Rate of Change). The CBE group demonstrated significantly greater decline in pain overall, with activity, and during sleep in relation to the SOC group when comparing visit 1 to visit 5. Opioid medication use was significantly lower for CBE versus SOC. Postoperative General Anxiety Disorder-7 scores decreased significantly among CBE participants with similar increase in high heart rate coherence. Function significantly improved postoperatively based on KOS-ADL and Global Rate of Change scores. Twice as many CBE participants had same-day discharge compared to SOC participants and most CBE participants continued with healthy lifestyle recommendations at the 3-month follow-up. A cognitive-behavioral approach to preoperative education may improve postoperative pain, anxiety, and function while decreasing opioid use among TKA patients. Findings from this pilot study support further research to examine similar interventions among distinct surgical populations and encourage further evaluation on the effects of CBE to enhance health and healthcare delivery.

Reappraisal of Limited Duration Tourniquet in Total Knee Arthroplasty: A Double-Blinded RCT.

The majority of arthroplasty surgeons use a full duration of tourniquet while doing total knee arthroplasty. Recent literature suggests clinical dilemma about superior function with limited duration use of a tourniquet. The purpose of this study is to evaluate the time-dependent effects and clinical outcome of tourniquet in patients undergoing total knee arthroplasty (TKA) and to assess the incidence of adverse vascular events of the limb in TKA. This study is the first of its kind to evaluate all the serious vascular events prospectively. Sixty participants who underwent TKA in the duration of 1.5years at a large single tertiary care centre were recruited and randomly allocated in two groups: Full duration tourniquet (n = 30) and tourniquet only during cementation (n = 30). All patients underwent preoperative and postoperative arterial and venous Doppler to evaluate the presence of thrombosis. The operative duration, blood loss, and clinical outcome (visual analogue scale, active knee range of motion, Knee Society score, and duration of stay) were recorded. The incidence of vascular complications was not statistically significant in either group (P = 0.99). Tourniquet during cementation only group exhibited decreased postoperative pain on days 1, 2, and 3 (P < 0.01). But postoperative knee active range of motion was the same between the two groups with no significant postoperative complications. Tourniquet use only during cementation could result in faster recovery and less pain during the early rehabilitation period with no influence over the incidence of serious vascular events. AIIMS/IEC/2018/475. This study was approved by the Research Ethics Committee at All India Institute of Medical Sciences, Jodhpur and was carried out at AIIMS (Jodhpur), India.

Chronic Quadriceps Tendon Rupture Reconstruction with Sartorius Muscle Transfer: A Report of Five Cases.

Summary:Disruption of the knee extensor mechanism is an unfavorable situation because efficient mobilization requires a functioning knee extensor apparatus. The purpose of this retrospective study was to report our technique of sartorius muscle transfer for restoration of extension mechanism function and the outcomes of five patients. Patients with ruptured knee extensor mechanism secondary to trauma or knee arthroplasty-related issues were studied retrospectively. In all patients, sartorius muscle was transferred to restore the quadriceps tension deficit. Increase in the knee active range of motion, increase in the extensor mechanism power by one grade on Medical Research Council scale, and improvement in the extension lag were observed in all patients. The sartorius muscle transfer can be a reliable option to restore the knee extensor mechanism in chronic quadriceps tendon injuries. Our initial results are promising and showed improvement of the extensor mechanism muscle power, increased knee active range of motion, and decreased knee extension lag. The complications we observed did not impair the successful outcome of the sartorius transfer and were anticipated given the complexity of the studied cases. We encourage additional studies of sartorius muscle transfer to treat chronic quadriceps tendon injuries.