Active Range Of Motion Research Articles

Effect of glenosphere diameter and lateralization in primary reverse shoulder arthroplasty: a randomized clinical trial

BackgroundWithin reverse total shoulder arthroplasty (RSA), prior studies have suggested that smaller glenosphere diameters may result in higher rates of scapular notching and polyethylene wear, while lateralized glenospheres may allow for better range of motion (ROM); however, supportive data remains limited. Therefore, the purpose of this study was to report the outcomes of a prospective randomized clinical trial comparing 4 different glenosphere configurations based on diameter and lateral offset. MethodsBetween 2016 and 2020, 113 primary RSAs with a diagnosis of either rotator cuff tear arthropathy (n = 48, 42%), irreparable rotator cuff tears (n = 22, 19%), or primary glenohumeral osteoarthritis with subluxation or glenoid bone loss (n = 43, 38%) were enrolled into a blinded prospective randomized clinical trial. The mean age of the patients included in the study was 73 ± 7 (range, 50-89) years, and 58 (51.3%) were males. All procedures were performed by two surgeons utilizing the ReUnion RSA system (Stryker, Mahwah, NJ, USA). Patients were randomized into four possible groups based on the diameter and lateral offset of the glenosphere implanted: 36 mm diameter with 2 mm (n = 34, 30.1%) or 6 mm (n = 28, 24.8%) of lateralization and 40 mm diameter with 2 mm (n = 29, 25.7%) or 6 mm (n = 22, 19.5%) of lateralization. Outcomes collected included pain, active ROM, strength, satisfaction, patient-reported outcome measures (PROMs), complications, reoperations, and revisions. PROMs included the Oxford Shoulder Score, the American Shoulder and Elbow Surgeons, and the quick Disabilities of the Arm, Shoulder and Hand questionnaire. All patients were followed for a minimum of 2 years. ResultsWith the numbers available, glenosphere diameter and lateralization resulted in no differences in pain, ROM, strength, satisfaction, and PROMs at 1 year, 2 years, or final follow-up (All P > .05). However, all 3 complications (10.7% vs. 0% vs. 0% vs. 0%; P = .025) and 2 revision surgeries (7.1% vs. 0% vs. 0% vs. 0%; P = .103) occurred in males, with the 36 + 6 cohort. ConclusionsUsing this particular RSA design, implantation of glenospheres with 36 mm or 40 mm of diameter and 2 mm or 6 mm of sphere lateralization did not translate into significant differences when primary RSA was performed in shoulders with rotator cuff tear arthropathy, irreparable cuff tears, or primary glenohumeral osteoarthritis. However, all observed complications occurred in males with the smallest diameter and lateralized glenosphere.

Multimodal sensorimotor assessment of hand and forearm asymmetries: a reliability and correlational study.

Effective rehabilitation of upper limb musculoskeletal disorders requires multimodal assessment to guide clinicians' decision-making. Furthermore, a comprehensive assessment must include reliable tests. Nevertheless, the interrelationship among various upper limb tests remains unclear. This study aimed to evaluate the reliability of easily applicable upper extremity assessments, including absolute values and asymmetries of muscle mechanical properties, pressure pain threshold, active range of motion, maximal isometric strength, and manual dexterity. A secondary aim was to explore correlations between different assessment procedures to determine their interrelationship. Thirty healthy subjects participated in two experimental sessions with 1 week between sessions. Measurements involved using a digital myotonometer, algometer, inclinometer, dynamometer, and the Nine-Hole Peg test. Intraclass correlation coefficients, standard error of the mean, and minimum detectable change were calculated as reliability indicators. Pearson's correlation was used to assess the interrelationship between tests. For the absolute values of the dominant and nondominant sides, reliability was 'good' to 'excellent' for muscle mechanical properties, pressure pain thresholds, active range of motion, maximal isometric strength, and manual dexterity. Similarly, the reliability for asymmetries ranged from 'moderate' to 'excellent' across the same parameters. Faster performance in the second session was consistently found for the Nine-Hole Peg test. No systematic inter-session errors were identified for the values of the asymmetries. No significant correlations were found between tests, indicating test independence. These findings indicate that the sensorimotor battery of tests is reliable, while monitoring asymmetry changes may offer a more conservative approach to effectively tracking recovery of upper extremity injuries.

Effect of hamstring flexibility on cervical range of motion and deep neck flexor endurance in healthy young adults: A study to explore myofascial tensegrity network

IntroductionAccording to the concept of biotensegrity, the whole body consists of fascial lines. The relationship between muscles and fascia is important to ensure full and proper range of motion. This study investigated the effect of hamstring flexibility on cervical range of motion and deep neck flexor muscle endurance. The aim was to explore the relationship between the hamstring muscles and neck region in the myofascial tensegrity network. MethodSixty healthy participants with a median age of 22.0 years (24 male, 36 female) were included. Hamstring flexibility was categorized as “normal (n = 31)” or “limited (n = 29)” according to hip flexion angle (HFA) using the passive straight leg raise (PSLR) test. Active cervical range of motion was measured by the Clinometer smartphone application, and the following movements were recorded: flexion, extension and lateral flexion. The craniocervical flexion test was performed to evaluate deep neck flexor endurance using performance index and highest-pressure score. The Mann-Whitney U test was used for statistical analysis. ResultsNo significant differences in cervical range of motion were observed between the groups (p > 0.05). Participants with limited hamstring flexibility presented lower deep neck flexor muscle endurance scores (performance index and highest-pressure score) than participants with normal hamstring flexibility (p = 0.002, and p = 0.012, respectively). ConclusionThe results suggest that hamstring flexibility can influence deep neck flexor muscle endurance in healthy young adults. This preliminary clinical finding supports the hypothesis of a myofascial network between the hamstring muscles and neck region.

Understanding tightened muscle in knee osteoarthritis and the impacts of Fu's subcutaneous needling: A pilot trial with shear-wave elastography and near-infrared spectroscopy.

Given the scarce reports on the interplay between Fu's subcutaneous needling (FSN), tightened muscle, and therapeutic effects, we developed a clinical research protocol to synchronously collect data on clinical efficacy and muscle characteristics in patients with knee osteoarthritis, exploring the mechanism of FSN action. The primary aim was to assess the feasibility and safety of this protocol, guiding future trials and their sample size calculations. In this prospective, single-blind, self-controlled study, 19 patients with early to mid-stage unilateral knee osteoarthritis underwent FSN therapy on both knees over 1 week (4 sessions, every other day). We measured local elastic modulus, muscle thickness, blood flow volume, and oxygen consumption rate of bilateral vastus lateralis muscles using shear-wave elastography and near-infrared spectroscopy (NIRS) before and after the first and fourth treatments. Additionally, real-time NIRS indicators (oxygenated hemoglobin [O2Hb], deoxyhemoglobin [HHb], total hemoglobin [THb], and tissue saturation index [TSI]) were recorded during these treatments. Pain intensity (visual analogue scale [VAS]), functional status (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and active range of motion were evaluated before these treatments. All 19 participants completed the trial without serious adverse events. After 3 FSN treatments, significant changes were observed in VAS and WOMAC scores (VAS: P < .001; WOMAC: P < .001), and knee flexion (P < .001) and external rotation (P = .02), except for internal rotation. No meaningful significant differences were observed in muscle characteristics at baseline or between pre- and post-treatment periods. NIRS results during treatments indicated significant increases in local O2Hb and THb post-FSN therapy (First treatment: O2Hb: P = .005; THb: P = .006. Fourth treatment: O2Hb: P = .002; THb: P = .004); however, no significant increases were observed for HHb (First treatment: P = .06; Fourth treatment: P = .28). No linear correlation was found between therapeutic effects and changes in tightened muscle indices. FSN reduces pain and improves joint function in knee osteoarthritis, while also enhancing blood flow and oxygenation in the vastus lateralis muscle of the affected side. Further revisions of this protocol are warranted based on our insights.

EFFECTIVENESS OF THE PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION METHOD APPLICATION ON UPPER LIMB FUNCTIONS IN PATIENTS AFTER STROKE: A SYSTEMATIC REVIEW OF LITERATURE

The brain damage caused by a stroke can lead to severe and long-lasting physical and mental health problems, which can have a significant impact on human quality of life. Although restoring gait parameters in stroke patients is one of the most important rehabilitation goals, currently around 80% of stroke survivors have some degree of upper limb motor impairment. Several authors have shown that restoration of upper limb function is often more difficult to achieve and requires a longer rehabilitation period. Proprioceptive neuromuscular facilitation (PNF) is thought to be one of the most common neurophysiological techniques used by physiotherapists in post-stroke rehabilitation. The aim is to evaluate the effectiveness of proprioceptive neuromuscular facilitation (PNF) in improving upper limb function in patients after stroke through a systematic literature review. The research inquiry was performed by searching through various online databases until February 2023. Following the PRISMA 2020 guidelines, studies were selected using the PICO model and its elements, and based on the inclusion and exclusion criteria. The quality of the selected studies was assessed using the PEDro scale. The review examined five studies on PNF effects in 210 stroke patients, all scoring six or more on the high-quality PEDro scale. Patients were, on average, 52 to 63 years old. Four of the five studies, using the Arm Motor Ability Test and Fugl-Meyer assessment, showed statistically significant improvements in upper limb motor ability and function post-PNF intervention. One study assessing self-care functional ability revealed significant improvements in the Barthel index for both experimental and control groups. Spasticity assessment with the Ashford scale in one study indicated a statistically significant reduction in upper limb spasticity in both groups. Yeole et al. found significant improvements in active range of motion using a manual goniometer in shoulder and elbow joints and wrist joint flexion, extension, and radial deviation for PNF-applied participants.

Evaluating the effects of two different kinesiology taping techniques on shoulder range of motion and proprioception in patients with hypermobile Ehlers-Danlos syndrome: a randomized controlled trial.

Ehlers-Danlos syndrome (EDS) is a common group of inherited connective tissue disorders with a prevalence as high as 0.75%-2% of the population. Physical manifestations include pain and decreased proprioception, especially in more mobile joints, such as the shoulder. The kinesiology tape (K-Tape) is often used to treat patients with shoulder dysfunction. The effectiveness of the K-Tape is uncertain, and there is a lack of studies specifically studying the K-Tape in an EDS population. The purpose of this study was to compare the short-term effects of two different K-Tape procedures on shoulder active joint reposition (AJR) and active range of motion (AROM) in patients with hypermobile EDS (hEDS) and shoulder pain. All participants were recruited from the EDS support groups and presented with shoulder pain. Baseline demographic information was obtained for each participant, after which AROM and AJR were assessed. The participants were randomized to receive one of two K-Tape procedures. Testing was repeated immediately post-taping and 48 h post-taping. Significant improvements in shoulder external (F = 10.917, p < 0.001) and internal (F = 11.736, p < 0.001) rotations were seen from baseline to immediately post-taping and baseline to 48 h post-taping in the experimental K-Tape group. There were no significant differences in the shoulder rotation in the control K-Tape group and no significant differences in either group for shoulder flexion or AJR at any time point (p > 0.05). K-Tape may offer short-term improvements in shoulder rotation AROM in patients with hEDS and shoulder pain.

Humeral Component Version Has No Effect on Outcomes Following Reverse Total Shoulder Arthroplasty: A Prospective, Double-Blinded, Randomized Controlled Trial.

Controversy exists regarding the ideal humeral component version to optimize humeral rotation and patient outcomes in reverse total shoulder arthroplasty (rTSA). Patients undergoing primary rTSA for rotator cuff tear arthropathy, a massive rotator cuff tear, or primary osteoarthritis with a rotator cuff tear were randomized to placement of the humeral component in neutral version or 30° of retroversion. Shoulder active range of motion and strength and visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES), and Patient-Reported Outcomes Measurement Information System Global 10 (PROMIS-10) scores were collected up to 2 years postoperatively. The goal of the study was to determine whether humeral external rotation and internal rotation are affected by humeral component version following rTSA at 2 years postoperatively. Sixty-six patients were included in the analysis. The median follow-up was 26 months for the neutral and 27 months for the 30° retroversion group. No differences between the groups were observed with respect to the primary diagnosis, sex, age, body mass index, or American Society of Anesthesiologists (ASA) class. The 2 groups did not differ significantly in terms of improvement at 2 years in active shoulder abduction (p = 0.969), forward elevation (p = 1.000), internal rotation measured as the highest spinal level reached (p = 1.000), internal rotation with the arm abducted 90° (p = 0.451), external rotation (p = 0.362), or muscle strength in forward elevation (p = 1.000), abduction (p = 1.000), external rotation (p = 0.617), or internal rotation (p = 1.000). The 2 groups did not differ significantly in terms of improvement in postoperative ASES (p = 1.000), PROMIS-10 physical (p = 1.000), or VAS pain scores (p = 0.718) at the time of final follow-up. In the neutral version group, 1 patient underwent revision for instability and 1 for stiffness. One acromial stress fracture occurred in the 30° humeral retroversion group. Scapular notching was observed in 7 (21.2%) of the patients in neutral version group and 5 (15.2%) of the patients in the 30° retroversion group (p = 0.750). Securing the humeral component at neutral version or 30° of retroversion in rTSA resulted in similar active shoulder external rotation, internal rotation, forward elevation, abduction, and strength measurements, complication rates, and VAS pain, PROMIS-10 physical, and ASES scores at 2 years postoperatively. Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Investigation of the Relationship Between Exercise Barriers, Quality of Life, Physical Performance, and Range of Motion in Patients with Total Hip Arthroplasty

Aim: This study aimed to demonstrate the relationship between exercise barriers-benefits with joint range of motion (ROM), quality of life, and physical performance in individuals with total hip arthroplasty (THA). Material and Method: A cross-sectional observational study was conducted with fifty older individuals with THA. Patients were evaluated with the 5-Times Sit and Stand Test (5TSTS), Exercise Benefits and Barriers Scale (EBBS), and EuroQol (EQ-5D-5L) Quality of Life Scale. In addition, the patient's active ROM was measured with a universal goniometer. Results: There was a significant low correlation between body mass index (BMI) and EBBS-Benefits sub-score (r=-0.286 p

Effectiveness of Kirschner wire fixation for proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of flexor digitorum tendon

To explore the mechanism, surgical method, and effectiveness of proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of the flexor digitorum tendon. A retrospective analysis was conducted on the clinical data of 4 patients with proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of flexor digitorum tendon admitted between May 2018 and September 2022. The patients were all male, the age ranged from 26 to 52 years, with an average of 33 years. The injured fingers included 1 case of middle finger and 3 cases of ring finger. The causes of injury were rock climbing of 2 cases and carrying heavy objects of 2 cases. Preoperative anteroposterior and lateral X-ray films and CT examination of the fingers showed a lateral avulsion fracture of the proximal phalanx, with a fracture block length of 15-22 mm and a width of 3-5 mm. The total active range of motion (TAM) of the injured finger before operation was (148.75±10.11)°. The grip strength of the middle and ring fingers was (15.50±2.88) kg, which was significantly lower than that of the healthy side (50.50±7.93) kg ( t=-8.280, P<0.001). The time from injury to operation was 2-7 days, with an average of 3.5 days. One Kirschner wire with a diameter of 1.0 mm was used for direct fixation through the fracture block, while two Kirschner wires with a diameter of 1.0 mm were used for compression fixation against the fracture block. The fracture healing was observed, and the TAM of the injured finger and the grip strength of the middle and ring fingers were measured. The finger function was evaluated according to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society. The incisions all healed by first intention after operation. All patients were followed up 6-28 months, with an average of 19 months. X-ray films showed that all avulsion fractures of proximal phalanx reached bony union, and the healing time ranged from 4 to 8 weeks, with an average of 4.6 weeks. At last follow-up, the grip strength of the middle and ring fingers was (50.50±7.76) kg, which significantly improved when compared with preoperative one ( t=-8.440, P<0.001). The TAM of the injured finger reached (265.50±2.08)°, and there was a significant difference when compared with preoperative one ( t=-21.235, P<0.001). According to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society, the finger function was all evaluated as excellent in 4 cases. Using Kirschner wire fixation through bone blocks and external compression fixation of bone blocks for treating proximal phalangeal bone avulsion fracture caused by A2 circular trochlear injury of the flexor digitorum tendon can achieve good effectiveness.

Pins and Rubbers Traction System for Treatment of Intraarticular Fractures of Distal Interphalangeal Joint.

Background: The pins and rubber traction system (PRTS) has proven effective in managing intra-articular fractures of the proximal interphalangeal joint. However, there is scant evidence in the literature regarding its efficacy in treating distal interphalangeal joint (DIPJ). This study aims to investigate the outcomes of PRTS in the treatment of comminuted intra-articular fractures of the DIPJ. Methods: We conducted a retrospective review of patients with comminuted intra-articular fractures of the DIPJ treated with PRTS between 2017 and 2021. At the final follow-up, we measured and compared the active range of motion (ROM) in both affected and non-injured contralateral fingers. The subjective evaluation utilised the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and the Visual Analogue Scale (VAS). Results: Ten patients with a mean follow-up of 13.2 months (range: 12-17) were included in the study. Fracture locations included the base of the distal phalanx in two patients, the condyle of the middle phalanx in seven and both in one patient. At the final follow-up, the average VAS score was 0.5 (range: 0-2). The average active motion of the DIPJ was 61° (range: 50°-70°) for the injured side and 76° (range: 75°-80°) for the opposite side. The mean range of DIPJ movement was 80% (range: 68%-87%) of the non-injured side. Extension deficits were observed in five patients, with a median deficit value of 10° (range: 5°-10°). The average Quick-DASH score was 2.9 (range: 0-11.3). Conclusions: The PRTS can be considered as an effective surgical technique in managing comminuted intra-articular fractures of the DIPJ. Level of Evidence: Level IV (Therapeutic).

Clinical Outcomes and Failure Rate of Triangular Fibrocartilage Complex Foveal Repair Were Comparable between Arthroscopic and Open Techniques.

Background: This study compared clinical outcomes between arthroscopic and open repair of triangular fibrocartilage complex (TFCC) foveal tears in chronic distal radioulnar joint (DRUJ) instability patients. Methods: A total of 79 patients who had gone through foveal repair of TFCC using arthroscopic technique (n = 35) or open technique (n = 44) between 2016 and 2020 were retrospectively analyzed. The visual analog scale (VAS) score for pain, active range of motion (ROM), grip strength, Mayo Modified Wrist Score (MMWS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, and Patient-Rated Wrist Evaluation (PRWE) score at 2-4-6-12-24 months postoperatively were compared between two groups. Results: Two years after the operation, clinical parameters (VAS, MMWS, DASH, and PRWE), grip strength, and ROM showed significant advancement in the two groups in comparison to their values measured preoperatively (p < 0.001). Nonetheless, we could not identify any statistically significant differences in the above clinical factors between the two groups. The arthroscopic group showed a better flexion-extension arc at 2 months and supination-pronation arc at 2 and 4 months than the open group (p < 0.001). There were no significant differences between the two groups at 2 years postoperatively. Ten patients (12.6%) had recurrent instability (three in the arthroscopic group and seven in the open group, p = 0.499). Similarly, both groups showed no significant difference in the return to work period. Conclusions: Arthroscopic foveal repair of TFCC provided similarly favorable outcomes and early recovery of pain and ROM compared to open repair.

SURGICAL TECHNIQUE FOR ANATOMICAL RE-CONSTRUCTION OF THE DISTAL RADIOULNAR LIGAMENTS IN CHRONIC TRAUMATIC INJURY OF THE TRIANGULAR FIBROCARTILAGE COMPLEX

Abstract-Injury to the triangular fibrocartilage complex (TFCC) can lead to instability of the distal radioulnar joint (DRUJ). In this article, we have presented a treatment method for patients with chronic traumatic TFCC injury. The surgical technique described here demonstrates anatomical reconstruction of the volar and dorsal distal radioulnar ligament using an autologous palmaris longus tendon graft.In the period 2014-2023, 22 patients with chronic traumatic injury to the triangular fibrocartilage complex, leading to instability of the DRUJ, were operated on in our clinic. The main parameters studied pre- and post-operatively were: degree of pain during active movements in the wrist joint and prono-supination of the forearm,range of active movements in the same joints, stability of DRUJ and grip strength relative to the contralateral limb.All 22 patients reported pain reduction with active wrist movements and forearm prono-supination. This surgical technique with anatomically based reconstruction of the distal volar and dorsal radioulnar ligament provides restoration of stability of the distal radioulnar joint and reduction of pain in patients with chronic injury to the triangular fibrocartilage complex.

Efficiency of pulsed electromagnetic field and neuromuscular electrical stimulation on painful shoulder following stroke

Efficiency of pulsed electromagnetic field and neuromuscular electrical stimulation on painful shoulder following stroke

Rehabilitation Protocols in Elbow Medial Ulnar Collateral Ligament Injuries: A Systematic Review of Articles Published in the Last 20 Years.

Elbow medial ulnar collateral ligament (UCL) injuries have become increasingly common in athletes. Despite this, rehabilitation protocols appear to vary drastically, which may explain the clinical equipoise regarding optimal management. This systematic review reports rehabilitation characteristics reported after UCL injuries and compares reported outcomes based on early versus delayed rehabilitation. Our search utilized PubMed/MEDLINE, Embase, Web of Science, and Cochrane to identify all articles on UCL rehabilitation published between January 1, 2002 and October 1, 2022. Studies in English with ≥5 patients that reported rehabilitation protocols for UCL injuries were evaluated. Systematic review. Level 4. Data included sample characteristics, time to achieve physical therapy milestones, outcome scores, and return-to-play (RTP) rate and timing. Our review included 105 articles with a total of 15,928 elbows (98% male; weighted mean age, 23 years; follow-up, 47 months), with 15,077 treated operatively and 851 treated nonoperatively. The weighted mean time patients spent adhering to nonweightbearing status was 42 days. The mean time until patients were given clearance for active range of motion (ROM) 15 days, full ROM 40 days, and elbow strengthening exercises 32 days. The mean time until all restrictions were lifted was 309 days. The mean time to begin a throwing program was 120 days. Across all rehabilitation characteristics, protocols for patients undergoing nonoperative management started patients on rehabilitation earlier. After UCL reconstruction, earlier active ROM (≤14 days), elbow strengthening (≤30 days), no restrictions (≤180 days), and throwing (≤120 days) postoperatively led to earlier RTP without a negative effect on functional outcome scores. Current literature provides a spectrum of protocols for elbow UCL rehabilitation, regardless of management. Nonoperative patients began ROM activities, strengthening, and throwing programs sooner than operative patients, and earlier milestones led to earlier RTP.

Rotator Cuff Rehabilitation: A Survey of Practice in India

Background- Rotator cuff related shoulder pain (RcRSp) and Rotator cuff (RC) tears constitute a significant amount of the caseload of shoulder disorders. Rehabilitation following surgical repair of the cuff is designed according to the stage of healing and has been widely studied with varying opinions on its progression.The present study aimed to describe the practice of rehabilitation following RC repair in India. Study Design - Cross-sectional descriptive survey study Methods- A content validated questionnaire to describe the rehabilitation practice following RC repair was developed and converted into an online survey. Results- We analysed 125 responses from physiotherapists. Majority of the participants commenced passive range of motion (ROM) and scapular exercises in the first week, active ROM in 4-6 weeks. Wide variability exists in commencing glenohumeral strengthening exercises. Conclusion-Rehabilitation practices show variability, with certain similarities to practice in other countries and non-uniform concordance to existing guidelines.

Reverse shoulder arthroplasty with an inverted-bearing prosthesis as revision procedure for failed anatomic and reverse shoulder arthroplasty: a long-term multicenter study

BackgroundDespite the increasing popularity of revision total shoulder arthroplasty (RTSA), studies directly comparing revision RTSA performed for different failed index procedures are limited. We therefore compared the results of revision RTSA between patients with a failed primary anatomic arthroplasty (total shoulder arthroplasty and hemiarthroplasty) and those with a failed primary RTSA to explore revision of which index procedure resulted in better long-term clinical outcomes. MethodsIn this prospective, multicenter, observational study, patients underwent revision RTSA using an inverted-bearing prosthesis. We recorded clinical scores, active range of motion, pain, satisfaction, and the rate of scapular notching. Complications and prosthesis survival were also noted. ResultsWe included 45 patients (45 shoulders) with revision RTSA for failed primary anatomic shoulder arthroplasty (30 patients) and RTSA (15 patients). Clinical and radiographic outcomes were recorded from 36 patients at a median follow-up of 101.6 months, and prosthesis survival was assessed from all 45 patients. At final follow-up, clinical scores (P < 0.05), abduction (P = 0.032), re-revision rate (P = 0.018), and prosthesis survival (P = 0.015) were significantly better in patients revised from failed primary anatomic shoulder arthroplasty than those from RTSA. However, pain, satisfaction, and overall complication rates were similar in both groups (P > 0.05). ConclusionsWe found better long-term clinical scores, abduction, and prosthesis survival rates after failed primary anatomic shoulder arthroplasty than after RTSA. Pain reduction and complication rates were comparable in both groups. Thus, anatomic shoulder arthroplasty remains an attractive option for primary arthroplasty in selected cases.

A Comparative Study of the Efficacy of Ultrasound Therapy against Intra-articular Corticosteroid Injection in Adhesive Capsulitis: A Randomised Open-label Study

Abstract Introduction: Adhesive capsulitis is idiopathic, progressive, painful, and restricted active and passive shoulder range of motion in patients with normal radiographs. Adhesive capsulitis can be effectively treated by ultrasound therapy, exercise, and intra-articular steroids. Objective: To see the efficacy of ultrasound therapy and intraarticular corticosteroid injection in adhesive capsulitis. And compare the efficacy of ultrasound therapy and intra-articular corticosteroid injection. Materials and Methods: Study Design: A comparative study. Setting: Tertiary care center. Time period:from October 2019 to September 2020. Participants: 80 patients who attended the Physical Medicine and Rehabilitation department during the study period, met the inclusion criteria. Intervention: Patients were randomly assigned to the intra-articular corticosteroid injection (Group A) and ultrasound therapy treatment (Group B). Main Outcome Measures: Parameters such as the Visual Analogue Scale (VAS), Shoulder Pain and Disability Index (SPADI) and range of motion with goniometry. The examination was performed at the 1st visit (0 week) and then 4th, 8th and 12th weeks. Results: At the end of the study, a statistically significant improvement was obtained in all clinical parameters: VAS (P &lt; 0.001), SPADI (P &lt; 0.001) and goniometry (P &lt; 0.001) in both Group A (the intra-articular corticosteroid injection) and Group B (ultrasound therapy treatment). While in combination with therapeutic exercises, the greatest pain improvement was seen in the local corticosteroid injection group, the ultrasound therapy group also showed significant and comparable improvement. Conclusions: Both intra-articular corticosteroid injection and ultrasound therapy were effective in adhesive capsulitis treatment. Thus, ultrasound therapy can be an alternative treatment for adhesive capsulitis, particularly in patients who do not accept injections.

Outcomes of V-Y Quadricepsplasty for the Management of Genu Recurvatum Deformity in Congenital Dislocation Knee

Abstract Background: Congenital dislocation knee (CDK) is a rare congenital anomaly clinically presented with genu recurvatum deformity. In early reported cases, conservative management with manipulation and serial casting once a week for up to 4 weeks can be successful. Surgical methods of deformity correction include percutaneous quadriceps recession, Z-plasty, V-Y quadricepsplasty (VYQ), and Achilles tendon reconstruction for the reconstruction of the quadriceps tendon. Very few studies are reported in Indian literature describing the outcomes of surgical intervention in such an uncommon congenital deformity. The purpose of this study is to evaluate the outcomes of VYQ in CDK. Materials and Methods: Ten children with CDK with a mean age of 44.4 months, who met the inclusion criteria, were included in the study. All the children had undergone VYQ as described by Curtis and Fisher and subsequently modified by Tercier and Shah. Outcome measures such as active and passive knee range of motion, quadriceps power, and modified knee functional scoring system were assessed at the final follow-up. Results: Most of the children in the current study achieved knee flexion of &gt;90° with an average flexion of 90.5° + 21.73 (standard deviation), and 50% of them achieved quadriceps power Grade 4 or more (median 3.5). Modified knee function score was good in 60% of cases, fair in 20%, and excellent function in 10% of cases. Conclusion: Adequate knee flexion without quadriceps weakness and good knee function can be achieved by VYQ in CDK. This is a simple surgical procedure that can be easily learned with a flat learning curve.

Double-pulley, V-shaped fixation technique for arthroscopic repair of ideberg type IA glenoid fracture.

Different techniques have been described for glenoid fractures, there is still a need for safe and effective agents to promote outcomes. From January 2016 to April 2021, the clinical data of 17 patients with pulley type IA fractures treated by the V-shaped fixation technique under shoulder arthroscopy were retrospectively analyzed. Preoperative X-ray, CT, and MRI examinations were completed. The functional score of the shoulder joint, such as the visual analog scale (VAS), Constant score, and Modified Rowe score, was used to evaluate the preoperative and final follow-up clinical outcomes. The active shoulder range of motion (ROM) was also collected preoperatively and at the final postoperative follow-up. Accordingly, intraoperative and postoperative complications were also observed. The mean follow-up was 49.52 months (16-79months). The patients' follow-up exams showed that shoulder joint flexion, abduction, external rotation, internal rotation, and pain were not significantly different from those of the contralateral side (p > .05). The mean Constant score was 83.52 (58-98), and the average Modified Rowe score was 94.29 (70-100). X-ray and CT films of all cases showed good healing without articular depression or steps. Three patients had traumatic arthritis, with VAS <3 pain. No postoperative complications, such as infections, nerve or vessel damage, or suture anchor problems occurred during the follow-up period. Using the Double-pull, V-shaped fixation technique can stabilize the reduction of glenoid fractures while reducing the possibility of bone destruction. It is a good solution and provides an opportunity to treat rotator cuff tears associated with the procedure.

Open Approach for Repair of Tibial PCL Avulsion

Background: Tibial avulsion of the posterior cruciate ligament (PCL) often requires operative fixation, which frequently results in successful outcomes if identified acutely. Open or arthroscopic techniques are most commonly used. Indications: Primary surgical indications for open fixation include acute tibial avulsion of the PCL. Secondary indications include grade 2 to grade 3 posterior drawer test and radiographic posterior subluxation of the tibia. Ideally, the joint space and articular cartilage should be well preserved. Technique Description: In the simplified approach initially described by Burks and Schaffer, the patient is placed prone, and an inverted L-shaped incision is made over the posteromedial corner of the knee. A plane is developed between the medial head of the gastrocnemius and the semimembranosus down to the knee joint capsule. The gastrocnemius is retracted laterally to protect neurovascular structures and a vertical capsulotomy is performed. The tibial attachment of the PCL is reduced and held with K (Kirschner) wires and then fixated with screw and washer. Results: Six months post operation, our patient achieved full active and passive range of motion with a stable posterior drawer test. He returned to work without difficulty. Multiple studies have shown success with open PCL fixation and decreased rates of arthrofibrosis when compared with arthroscopic approach. In this case, the patient did not develop arthrofibrosis. Discussion/Conclusion: PCL tibial avulsions can be safely treated with an open approach. Contrary to other ligaments that favor reconstruction over repair, PCL avulsions may be better treated with early repair, so it is important to avoid delay in intervention. The most common complication in both open and arthroscopic approaches is arthrofibrosis, which is less common in the open approach. Early range of motion is encouraged to prevent arthrofibrosis. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.