Changes In Range Of Motion Research Articles

Treatment of Concomitant SLAP Lesion in Patients Aged 45 and Above Who Underwent Arthroscopic Rotator Cuff Repair: Tenotomy versus Labral Repair?

Background: The current study aimed to compare the clinical and functional outcomes of the long-head biceps tendon (LHBT) tenotomy or labrum repair for the biceps-labral complex in the presence of superior labrum anterior-posterior (SLAP) lesion accompanying Goutallier type 0-I-II rotator cuff injury in patients aged 45 and above who underwent arthroscopic repair. Method: A retrospective analysis was conducted on 1148 patients who underwent arthroscopic shoulder surgery. A total of 223 patients, who underwent arthroscopic repair for Goutallier type 0, I, and II rotator cuff tears (RCT) and received simultaneous treatment for SLAP lesions through either LHBT tenotomy or labral repair, were included in the study. Patients were divided into two groups according to the treatment of SLAP lesions such as tenotomy (n=78) and repair (n=145). Demographic data, pre-operative, post-operative 3-month, and 12-month range of motion, visual analog scale (VAS), and Constant Murley Scale (CMS) were compared. Results: Flexion and external rotation were significantly higher in the tenotomy group, and internal rotation in the repair group (p<0.001, <0.001, 0.005, respectively). Although the VAS score was significantly lower in the tenotomy group compared to the repair group in the 3rd-month postoperative control (p<0.001), the difference between the two groups disappeared in the 12th-month control (p=0.081). The CMS score was low in the tenotomy group preoperatively (p=0.015), by the 12-month follow-up, although there was a severe increase in both groups, there was no statistically significant difference between them (p=0.071). Conclusion: The study determined that both LHBT tenotomy and labral repair treatments for SLAP lesions, performed in conjunction with arthroscopic rotator cuff repair, are successful methods in terms of function, pain, and range of motion changes. It was observed that flexion and external rotation outcomes were better in tenotomy patients, while internal rotation was more favorable in patients undergoing labral repair.

Preoperative and Postoperative Segmental and Overall Range of Motion in Patients Undergoing Lumbar Spinal Fusion Using HA-Infused PEEK and HA-Treated Titanium Alloy Interbody Cages.

Retrospective observational radiographic analysis. Determine how single level lumbar interbody fusion (LIF) alters segmental range of motion (ROM) at adjacent levels and decreases overall ROM. This study included 54 patients who underwent single-level anterior (ALIF, 39%), thoraco-LIF (TLIF, 26%), posterior LIF (PLIF, 22%), or lateral LIF (LLIF, 13%) (L2-3/L3-4/L4-5/L5-S1: 4%/13%/35%/48%). Segmental ROM from L1-2 to L5-S1 and the overall lumbar ROM (L1-S1) were assessed from preoperative and postoperative flexion-extension radiographs. K-means cluster analysis was used to identify ROM subgroups. The overall L1-S1 ROM decreased 14% (25.5 ± 20.4° to 22.0 ± 17.2°, P = .104) postoperatively. ROM at the fusion level decreased 77% (4.8 ± 5.0° to 1.1 ± 1.1°, P < .001). Caudal adjacent segment ROM decreased 12% (5.2 ± 5.7° to 4.6 ± 4.4°, P = .345) and cranially ROM increased 34% (4.3 ± 5.0° to 5.7 ± 5.7°, P = .05). K-cluster analysis identified 3 distinct clusters (P < .05). Cluster 1 lost more ROM and had less improvement in patient-reported outcomes measures (PROMs) than average. Cluster 2 had less ROM loss than average with worse PROMs improvement. Cluster 3 did not have changes in ROM and better improvement in PROMs than average. Successful fusion was verified in 96% of all instrumented segments with >6months follow-up (ROM <4°). Following single-level L IF, patients should expect a loss of 3.3°, or 14% of overall lumbar motion with increases in ROM of the cranial segment. However, specific clusters of patients exist that experience different relative changes in ROM and PROMs.

Manipulation Under Anesthesia is Safe and Effective for Management of Early Postoperative Knee Arthrofibrosis in Adolescent Patients.

Management of postoperative knee arthrofibrosis can be challenging and the preferred time for intervention remains controversial. The purpose of this study is to evaluate the safety and efficacy of early (<3mo postoperatively) manipulation under anesthesia (MUA) for the treatment of knee arthrofibrosis in adolescent patients. We hypothesized that early MUA could restore normal knee motion with a low complication rate and without the need for more invasive intervention. In a retrospective review, 57 patients who underwent MUA for postoperative knee arthrofibrosis were identified. The time between the index surgery and MUA as well as changes in range of motion (ROM) before and after MUA were analyzed. Descriptive statistics with median and interquartile range were used to analyze this non-parametric study cohort. Repeated measures ANOVA was performed to assess improvement in ROM over time. A P value <0.05 denoted statistical significance. The median age of the cohort at time of MUA was 14.5 years [interquartile range (IQR) 12.9 to 17.6)]. 54.4% were male. Median time to MUA was 64 days (IQR 52 to 79) after index surgery. ROM before MUA was 90.0 degrees (IQR 75 to 100), which improved to 130 degrees (120 to 135) after MUA. At final median follow-up of 8.9 months (IQR 5.1 to 16.1), mean ROM was 133 degrees (130 to 140). There were no iatrogenic fractures or physeal separations associated with MUA. 12.3% (n=7/57) failed MUA either due to the need for subsequent repeat MUA (n=2), need for lysis of adhesions (n=3) or need for surgery after MUA (n=2). Those who failed early MUA and required subsequent procedures had ROM >120 degrees at final follow-up. Postoperative knee arthrofibrosis can be safely and effectively treated with early (<3mo postoperative) MUA. There were no iatrogenic fractures or physeal separations during MUA. Patients who had recurrence of motion deficits after early MUA and required further intervention, regained satisfactory knee motion at final follow-up. Although further research is warranted to better characterize risk factors for knee arthrofibrosis in adolescent patients, early recognition and MUA is a safe and effective treatment for arthrofibrosis to help patients regain full ROM without invasive intervention. Therapeutic Study - Level IV.

Wide-Awake Local Anesthesia No Tourniquet Surgery for Zone VII Extensor Tendon Reconstruction: Stages in Active Range of Motion From Intraoperative to Final Recovery

We investigated chronological changes in active range of motion (ROM) of the metacarpophalangeal (MCP) joint after zone VII extensor tendon reconstruction with wide-awake local anesthesia no tourniquet (WALANT) surgery. Reconstruction of the extensor tendons ruptured in zone VII of 82 fingers in 40 patients was performed using WALANT techniques. The mean patient age was 71.3 years. During surgery, we evaluated passive stretch distance and active contraction distance of the ruptured musculocutaneous unit. The sum of passive stretch distance and active contraction distance was defined as total excursion. In cases with total excursion ≥30 mm, we selected bridge tendon grafting for tendon reconstruction. In cases with total excursion <30 mm, end-to-side tendon transfer was performed. Active ROM of the MCP joint was measured before surgery; during surgery; 1, 3, and 5 months after surgery, and at the final follow-up. Extension lag of the MCP joint was 49.2° before surgery, improving to 2.9° during surgery, deteriorating to 18.7° at 1-month, and improving again to 15.6° at 3-months, 13.6° at 5-months, and 10.5° at the final follow-up. Meanwhile, the active flexion angle of the MCP was 87.9° before surgery, 87.3° during surgery, 67.6° at 1-month, 76.0° at 3-months, 79.7° at 5-months, and 81.0° at the final follow-up. Extension and flexion angles at each time point remained nearly constant regardless of whether tendon grafting or tendon transfer was used. Extensor tendon reconstruction using WALANT surgery allowed intraoperative measurement of active ROM, confirming near-complete extension and flexion after reconstruction. The changes in ROM of the MCP joint during follow-up are an approximate indication of the progression of postoperative recovery. Therapeutic Ⅳ.

Assessing changes in range of motion in adolescent patients undergoing myoActivation® for chronic pain related to myofascial dysfunction: a feasibility study

IntroductionmyoActivation® assessment utilizes systemized movement tests to assess for pain and limitations in motion secondary to myofascial dysfunction. myoActivation needling therapy resolves the myofascial components of pain and is associated with immediately observed changes in pain, flexibility, and range of motion. The principal aim of this feasibility study was to objectively characterize the kinematic metrics of upper and lower body motion before and after myoActivation movement tests and therapy.MethodsFive consecutive eligible adolescent participants considered appropriate for myoActivation were consented to receive their myoActivation intervention in a motion laboratory. Clinical motion analysis was used to measure the changes in maximum range of motion (maxROM) and maximum angular speed to maximum ROM (speedROM) of movement tests predicted to change. Metrics were analyzed to assess changes over specified time intervals - i) baseline to after initial myoActivation session, and ii) baseline to after complete myoActivation course. Each participant served as their own control.ResultsWe demonstrated objective evidence of improved maxROM and/or speedROM in 63% of the movement tests predicted to change after just one session of myoActivation and in 77% of movement tests predicted to change over the complete course of treatment. The myoActivation clinician observed positive change in 11/19 of movement tests across all patients, that were predicted to change after the initial myoActivation session; 81% of these positive changes were confirmed by the kinematic data.DiscussionClinical motion analysis provides objective support to clinicians evaluating, treating, and teaching myofascial release. A larger, prospective clinical trial is warranted to explore the impact of myoActivation on movement. Refinement of observation techniques and outcome measures established in this feasibility study will strengthen future clinical motion analysis of the myoActivation process.

Meta-analysis of clinical efficacy of ankle arthrodesis and total ankle arthroplasty in the treatment of end-stage ankle arthritis

To systematically review the clinical efficacy of total ankle arthroplasty (TAA) and ankle arthrodesis (AA) in the treatment of end-stage ankle arthritis. The PubMed, EMBASE and Cochrane Library databases were searched for articles published in the treatment of end-stage ankle arthritis with AA or TAA from the establishment of the database to June 2021. Bias risk tool was used to evaluate the quality of the literature. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale(AOFAS), visual analog scale (VAS), ankle osteoarthritis scale(AOS), gait analysis (pace, frequency, stride), range of motion (ROM), satisfaction, complications and reoperation rate were analyzed by meta-analysis between AA and TAA groups by RevMan 5.3 software. A total of 12 articles were included, including 1 050 patients in the AA group and 3 760 patients in the TAA group, totaling 4 810 patients. Meta-analysis showed that the total score of AOFAS[MD=-3.12, 95%CI(-9.02, 2.96), P=0.31], pain score [MD=1.60, 95%CI(-1.35, 4.54), P=0.29], alignmentl score[MD=-0.04, 95%CI(-0.52, 0.44), P=0.88], VAS[MD=0.10, 95%CI(-0.49, 0.68), P=0.74], and AOS total score [MD=-4.01, 95%CI(-8.28, 0.25), P=0.06], the difference was not statistically significant (P>0.05). The score of AOFAS functional in TAA group was significantly higher than that in TAA group[MD=44.22, 95%CI(-8.01, -0.43), P=0.03]. There was no significant difference in gait analysis between the two groups (P>0.05). Postoperative ROM [MD=-4.93, 95%CI(-6.35, -3.52), P<0.000 01] and change in ROM from preoperative to follow-up[MD=-5.74, 95%CI(-8.88, -2.61), P=0.0003] between two groups, the difference was statistically significant. There was no significant difference in satisfaction between the two groups [OR=1.011, 95%CI(0.46, 2.23), P=0.98]. Complications [OR=1.61, 95%CI(1.26, 2.06), P=0.0002] and non-revision reoperation [OR=1.61, 95%CI(1.17, 2.21), P=0.003] were significantly lower in the TAA group than in the AA group. There was no significant difference in the rate of revision and reoperation(P>0.05) between the two groups [OR=1.02, 95%CI(0.37, 2.78), P=0.97]. The clinical efficacy of AA is similar to that of TAA, but the non revision reoperation rate and main surgical complications of TAA are significantly reduced. Therefore, further high-quality methodological research and long-term follow-up are needed to confirm this conclusion.

Association of Changes in Hip and Knee Kinematics During a Single-Leg Squat With Changes in Patient-Reported Outcomes at 6 Months and 1 Year After Hip Arthroscopy

Background: Previous studies have demonstrated alterations in squat kinematics in patients with femoroacetabular impingement syndrome (FAIS). Little is known about the effects of arthroscopic hip surgery on biomechanics during a single-leg squat (SLS) in these patients. Purpose/Hypothesis: The purpose of this study was to determine if (1) lower extremity dynamic range of motion (ROM) during an SLS task improves after hip arthroscopy for FAIS and (2) correlations exist between changes in patient-reported outcomes (PROs) and changes in lower extremity dynamic ROM during an SLS after hip arthroscopy for FAIS. It was hypothesized that dynamic hip ROM would improve after hip arthroscopy and that hip dynamic ROM would be associated with changes in PRO scores at both 6 months and 1 year. Study Design: Descriptive laboratory study. Methods: Patients with FAIS performed 3 SLSs that were analyzed using a 20-camera motion capture system. Dynamic ROMs were calculated in 3 planes for the hip, knee, ankle, and pelvic segments. Squat depth was calculated as the change in vertical center of mass during the squat cycle. PROs including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports (HOS–Sports), International Hip Outcome Tool–12, and visual analog scale for pain scores were collected preoperatively and at the time of postoperative testing. Paired-samples t tests were used to compare kinematic variables pre- and postoperatively. Correlations were used to compare changes in PROs with changes in kinematics. All statistical analysis was performed using SPSS Version 26. Results: Fifteen patients were tested preoperatively and at a mean of 9 months postoperatively. All PRO measures improved postoperatively at 6 months and 1 year. Squat depth and sagittal plane hip and knee dynamic ROMs were significantly improved postoperatively. Positive correlations existed between changes in (1) hip ROM with the 6-month HOS-ADL score (r = 0.665) and (2) knee ROM with the 6 month (r = 0.590) and 1-year (r = 0.565) HOS–Sports scores. Conclusion: Dynamic sagittal plane hip and knee ROMs improve after hip arthroscopy for FAIS. These improvements demonstrate strong correlations with improvements in some but not all postoperative PROs. Clinical Relevance: The current study sought to better understand the role of dynamic movement in the diagnosis and treatment of FAIS. These findings indicate that dynamic ROM and squat depth can, similarly to PROs, serve as biomarkers for patient function both before and after hip arthroscopic surgery.

Altered Gait in Charcot Neuropathic Mice: A Kinematic Analysis

Category: Diabetes; Hindfoot Introduction/Purpose: Charcot arthropathy is known to cause neurodegenerative as well as physical skeletal changes that can affect gait. A verified model of inducing Charcot arthropathy in mouse hindlegs exists, but clinical data has yet to be gathered from this model. This is a pilot study with the purpose of gathering clinical data on mouse gait and joint reactive forces that occur over time as a result of Charcot arthropathy utilizing MatLab software. Methods: Eleven wild-type 25-week-old C57BL/6J were included in this study. Group A (n= 6) was fed a high-fat 60% kcal diet starting at the age of 6 weeks and underwent a verified running protocol to induce microtrauma leading to hind-paw Charcot-type arthropathy. Sensory testing and fasting blood glucose levels confirmed the presence of hyperglycemia and neuropathy in Group A. Group B (n= 5) was fed a normal diet and did not complete a running protocol. At week 0 and week 16 of the study, brightly colored dots were placed on mice hindlimbs to mark the hip, knee, ankle, and tarsal joints. The mice were placed on the treadmill at a constant speed of 10 m/sec and were recorded in slow motion for 2-3 full gait cycles. MATLAB was used to measure gait angles and coordinates in space by following the corresponding colored dot for each joint on the mouse (Figure 1). Results: The control mice did not have significant changes in range of motion of the knee, ankle, or midfoot while walking between weeks 0 and 16. In contrast, the mice fed a high-fat diet had statistically significant differences in ankle range of motion (p=0.0275), nearly significant differences in knee range of motion (p=0.0991), and insignificant differences in midfoot range of motion between weeks 0 and 16. In addition, the differences between range of motion of the knee of the control vs. C57BL/6J mice were significantly different between groups at both weeks 0 (p=0.0016) and 16 (p=0.0201). In the ankle, the difference was statistically significant at week 0 (p=0.0275) but not week 16 (p=0.7066), presumably due to a large standard deviation in ankle range of motion. Conclusion: Results of this gait analysis indicate that mice with Charcot-like arthropathic changes demonstrated gait differences that affected the range of motion of the knees and ankles of the mice, but not the midfoot. These changes could be due to the neuropathic abnormalities induced in mouse feet that would cause gait changes. Future studies will include a larger sample size of mice with gait analysis done at intermediate time points to further quantify how gait changes over time with Charcot arthropathy.

The Importance of Timing of Physical Therapy in Relation to Radiation Therapy during Multimodality Breast Cancer Treatment to Maximize Shoulder Range of Motion

Physical therapy (PT) is an effective tool for improving range of motion (ROM) for breast cancer patients to reduce long-term impairment. There is a paucity of data surrounding when PT should be initiated to optimally reduce upper limb disability. We hypothesized that patients who initiated PT early after surgery and before radiation therapy (RT), would experience greater gains in functionality compared to PT during/after RT. Demographic/clinical variables were assessed via retrospective chart review for patients referred to outpatient PT and receiving multimodality treatment for breast cancer between January 2015 and August 2021. Three distinct cohorts were established: patients who received PT and no RT, PT initiated before radiation therapy (pre-RT), and PT initiated during/after RT (d/a RT). The primary endpoint was percent change of total ROM of the ipsilateral shoulder between the first and last PT visits. Secondary endpoints included absolute change in degrees of total ROM of the ipsilateral shoulder between first and last PT visits. Associations between ROM across PT groups and baseline characteristics were evaluated with analysis of variance (ANOVA) testing. Thirty-seven patients were identified, median age 47 years (range 28-76). Higher tumor stage and axillary lymph node dissection were associated with the receipt of RT (p = 0.023, p = 0.003 respectively). Baseline ROM was associated with both percent and absolute improvement in ROM (p = 0.007). Patients receiving no RT demonstrated the greatest mean percent improvement in ROM with PT (84%), compared to the pre-RT and d/a RT cohorts, which demonstrated a 63% and 40% improvement, respectively. In pairwise comparisons, patients in the no RT group and those in the PT pre-RT group both demonstrated a statistically greater improvement in percent change in ROM compared to patients receiving PT d/a RT (no RT 74% vs d/a RT 20%, p = 0.006; pre-RT 59% vs d/a RT 20%, p = 0.045). There was no difference in percent change in ROM between the no RT and pre-RT groups (p = 0.528). On univariate analysis, baseline worse ROM was associated with statistically worse percent change in ROM after PT (p = 0.008), no other baseline characteristics were associated with ROM after PT. When adjusting for baseline ROM, the no RT cohort continued to be associated with improvement in ROM compared to the PT d/a RT group (p = 0.024), while there was no difference in percent change in ROM between patients who received physical therapy pre-RT compared to no RT (p = 0.829). Physical therapy is helpful in improving shoulder ROM at all stages of multimodality breast cancer treatment, however early initiation of PT prior to the start of RT may help maximize range of motion gains.

Noninvasive magnetic resonance-guided focused ultrasound for tendon disruption: an in vivo Animal study

Purpose Surgical resection of the tendon is an effective treatment for severe contracture. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is a non-invasive ultrasonic therapy which produces a focal increase in temperature, subsequent tissue ablation and disruption. We evaluated MRgFUS as a clinically translatable treatment modality to non-invasively disrupt in vivo porcine tendons. Material and methods In vivo Achilles tendons (n = 28) from 15–20kg Yorkshire pigs (n = 16) were randomly assigned to 4 treatment groups of 600, 900, 1200 and 1500 J. Pretreatment range of motion (ROM) of the ankle joint was measured with the animal under general anesthesia. Following MRgFUS treatment, success of tendon rupture, ROM increase, temperature, thermal dosage, skin burn, and histology analyses were performed. Results Rupture success was found to be 29%, 86%, 100% and 100% for treatment energies of 600, 900, 1200 and 1500 J respectfully. ROM difference at 90° flexion showed a statistically significant change in ROM between 900 J and 1200 J from 16° to 27°. There was no statistical significance between other groups, but there was an increase in ROM as more energy was delivered in the treatment. For each of the respective treatment groups, the maximal temperatures were 58.4 °C, 63.3 °C, 67.6 °C, and 69.9 °C. The average areas of thermal dose measured were 24.3mm2, 53.2mm2, 77.8mm2 and 91.6mm2. The average areas of skin necrosis were 5.4mm2, 21.8mm2, 37.2mm2, and 91.4mm2. Histologic analysis confirmed tissue ablation and structural collagen fiber disruption. Conclusions This study demonstrated that MRgFUS is able to disrupt porcine tendons in vivo without skin incisions.

Effect of Different Foam Rolling Sensitivities on the Amount of Change in Range of Motion: A Randomized Controlled Trial

Foam rolling (FR) is an easy-to-perform self-care activity to improve the range of motion in patients with injuries. However, even if FR is performed at the same intensity, the feeling differs depending on the patient. In addition, FR affects the contralateral side. This phenomenon is called cross education. Therefore, the main purpose of this study was to examine the relationship between FR sensitivities and FR efficacy. The secondary purpose was to determine how FR intensity perception influences cross education. In this study, FR sensitivity was calculated using the Visual Analogue Scale (VAS). The difference in the effect of FR sensitivity was evaluated using the correlation between the amount of change in PRE-test to POST- test ROM and VAS. The experimental procedure in this study first measures ankle dorsiflexion range of motion (ROM) on the left and right leg. Immediately after measurement, 3sets of FR were performed on one random leg. Participants wrote the VAS of FR for each set during the rest period of each FR intervention set. Immediately after 3 sets of FR, the ROM was measured in the left and right legs. Statistical analysis performed Two-way repeated measures ANOVA in group comparison. As a result, two-way ANOVA did not show a significant effect of group (F = 0.003, P = 0.95) or interaction effect (F = 2.28, P = 0.14). In contract, time had a significant effect (F = 39.65, P = 0.001). Post hoc result in [Dominant leg] PRE: 19.7 ± 7.6° POST: 22.2 ± 7.3° P = 0.001 Δ = 0.33. [Non-dominant leg] PRE: 20.0 ± 7.8° POST: 21.6 ± 7.8° P = 0.01, Δ = 0.21). On the other hand, Pearson’s correlation coefficient was used for the correlation between the amount of change in ROM and VAS. As a result, a dominant leg significant negative correlation was observed between the 3dr set of FR VAS score and the amount of change in ROM (r = -0.38, P = 0.04). Non-dominant leg significant correlations were observed third set of FR VAS score and amount of change in ROM (r = 0.41, P = 0.03). The result of this study suggested that it is necessary to perform FR with a comfortable stimulus on the dominant leg to maximize the effect of FR.

Clinical outcomes of modified versus traditional expansive open-door laminoplasty for cervical spondylotic myelopathy: A single-institution experience.

To compare the surgical outcomes of modified expansive open-door laminoplasty (EOL) (C4-C6) and traditional EOL (C3-C7) in patients with cervical spondylotic myelopathy (CSM). One hundred and two CSM patients were retrospectively recruited from Fujian Medical University Union Hospital between March 2012 and December 2019. Seventy-one patients with CSM underwent modified EOL, and 31 patients underwent traditional EOL. The primary endpoint was axial symptoms. Patients who underwent modified EOL had a significantly lower incidence of axial symptoms (odds ratio: 0.273; 95% confidence interval: 0.184-0.691; p = .002). The length of hospital stay (p = .263), and intraoperative blood loss (p = .402) were not significantly different between the groups. Significantly more postoperative drainage was observed in patients who underwent modified EOL (p < .001), while the cost of hospitalization in patients treated with traditional EOL was higher (p = .011). There were significant differences between modified and traditional EOL for the changes in range of motion (p < .001), modified Japanese Orthopaedic Association score (p = .001), and the Nurick grade (p = .014), while the changes of visual analogue scale (p = .250), and the neck disability index (p = .134) were not significantly different between the groups. This study found modified EOL may decrease the incidence of axial symptoms in patients with CSM compared to traditional EOL.

Shoulder Strength And Range Of Motion Changes Following 8-Week Dynamic Warm-Up Intervention For Collegiate Swimmers

Shoulder Strength And Range Of Motion Changes Following 8-Week Dynamic Warm-Up Intervention For Collegiate Swimmers

Short-term clinical outcomes of primary total knee arthroplasty with a new-type kinematic retaining implant: A comparison with preexisting cruciate retaining prosthesis.

Despite the success of total knee arthroplasty (TKA), current implant designs could not consistently restore the physiological knee kinematics, especially in cruciate-retaining (CR) implants. This study aimed to investigate the short-term clinical outcomes, particularly patient satisfaction, of primary TKA employing a new-type kinematic retaining (KR) implant. We analyzed 149 cases applied the KR implant at our institutions during June 2017 to May 2019. The effectiveness of this implant design was compared with another CR one (171 cases). Both groups underwent primary TKA in the same period and all patients completed 2 years of follow-up. Perioperative changes in range of motion (ROM), Knee Score, function score, and patient satisfaction by Forgotten Joint Score-12 (FJS-12) method were evaluated. Postoperative ROM, Knee Score, and function score were significantly improved at 1 year after surgeries and maintained for another year in both KR and CR groups. The improvement rate of ROM in KR group (108.1%) was substantially higher than that in CR (104.5%), even 4% increase could have affected patients' satisfaction in a real-world setting. Regarding the patient satisfaction, such 4 items as climbing stairs, walking on a bumpy road, doing housework or gardening, and taking a walk or hiking were significantly enhanced in KR cases compared to CR. There were no loosening or revision cases and the short-term survivorships of both implants were 100%. In addition, there has been no case of obvious complications in both groups during and after surgeries. The results of the present study suggest that this novel KR prosthesis can reproduce physiological knee kinematics, recover its functions, and contribute to pain relief after TKA. TKA procedure using the KR implant should be a good surgical option to improve postoperative outcomes.

Factor VIII Level in the Potential Female Carrier Mothers of Patients with Hemophilia A and Its Impact on Joint Health

Background Hemophilia A is an X-linked bleeding disorder. The characteristic bleeding phenotype in patients with severe hemophilia is recurrent spontaneous hemarthrosis with development of hemophilic arthropathy. Heterozygous female carriers with factor VIII (FVIII) activity level lower than 40% may be at risk for bleeding that is usually comparable to that seen in males with mild hemophilia. Aim of the Work To assess factor VIII level in mothers of known patients of hemophilia A correlating it with the frequency of clinically and radiologically documented arthropathy. Patients and Methods A cross sectional study included 40 mothers of patient with hemophilia A during the period from September 2020 to September 2021. Studied participants were subjected to detailed analysis of bleeding history, six major joints range of motion (ROM) examination, functional independence score in hemophilia (FISH), FVIII level one stage assessment and magnetic resonant imaging (MRI) of the reported affected joints. Results Mean age of mothers is 42.25 ± 7.74 years. Eleven mothers (27.5%) had no bleeding symptoms, 16 (40%) had one bleeding symptoms and 13 (32.5%) had two or more bleeding symptoms. As regard joint pain, 13 (32.5%) had severe pain, 3 (7.5%) had ankle pain and 2 (5%) had elbow pain with a mean pain score of 2.55±3.32, and 7 (17.5%) had bilateral pain. Mean FVIII activity was 43.33 IU (± 22.79), ranging from FVIII (0 &amp;lt; 30 IU) in 13 (32.5%), FVIII (30 &amp;lt;60) in 18 (45.0%) and FVIII ≥ 60 IU in 9 (22.5%) among the studied participants. Knees were the most affected joints with decreased mean ROM (±SD) in right and left knees of (123.25 (±12.06) and 120.00 (±15.81)) respectively. The median MRI scores were studied was 5 (2.6%) with median osteochondral changes of 4 (2.5%) and median soft tissue changes of 1 (0-1), their median FISH score of 8 (8-9). By comparing groups at the level of factor VIII, there was no significant difference according to anthropometric bleeding parameters, pain, and MRI score. None of participants needed hospital admission, factor VIII replacement or packed red cells replacement. Conclusion Potential female hemophilia A carriers are at risk of spontaneous bleeding which may entail bleeding in the joints, causing early joint damage. They showed reduced overall joint ROM and structural osteochondral changes in MRI joint examination which mandates further studies about early detection of potential female hemophilia carriers for the possible need of early medical intervention.

Comparison of telerehabilitation methods for patients with systemic sclerosis in the COVID-19 Era: A randomized controlled study

Study DesignThis was a single-blinded randomized clinical trial. IntroductionSystemic sclerosis (SSc) is an autoimmune connective tissue disease that progresses with fibrosis. Patients with SSc need to be protected against epidemic diseases and provided for in terms of rehabilitation needs. Purpose of the StudyTo compare the effects of real-time telerehabilitation (RTT) and asynchronous telerehabilitation (AT) on individuals with SSc. MethodsForty-two participants with SSc with a mean age of 44.17 ± 11.05 years were included in the study. The patients were randomly divided into three groups, RTT (n = 16), AT (n = 16), and control (n = 16) groups. A structured rehabilitation program was performed in real-time (RTT group) and asynchronously (AT group) for 40 minutes per day, in three sessions per week for 8 weeks. The participants' finger and wrist joint range of motion (ROM), upper extremity functions, grip strength, superficial sense of touch, activities of daily living (ADL), and general health status were assessed at baseline and after treatment. ResultsAfter 8 weeks, there were improvements in finger ROM (effect size [ES] = 0.23 to 0.60), wrist ROM (ES = 0.45 to 0.83), upper extremity functions (ES = 0.61 to 1.00), and ADL parameters (ES = 0.74) in the RTT group (p < 0.05). Also, there were improvements in finger ROM (ES = 0.16 to 0.45) and hand functions (ES = 0.54 to 0.55) in the AT group (p < 0.05). The RTT and AT groups had better hand functions and finger ROM than the control group in (p < 0.05). In addition, the RTT group had better wrist ROM than the control group (p = 0.008). RTT was superior to AT only in lateral pinch strength (p = 0.025). DiscussionExperimental groups achieved a statistically significant change in ROM, upper extremity functions and ADL over time in concordance with prior investigations. Changes in grip strength, superficial sense of touch, and general health status scores differed from previous investigations and the between-group comparison was not statistically significant. ConclusionsBoth RTT and AT may be effective in individuals with SSc, and RTT has additional benefits.

Poster 195: Retrospective Outcomes of Primary Rotator Cuff Repairs Involving Two or More Tendons

Poster 195: Retrospective Outcomes of Primary Rotator Cuff Repairs Involving Two or More Tendons

Poster 214: The Effect of Femoral Retroversion on Hip Range of Motion – A 3D Computational Analysis

Objectives: A subset of patients undergoing hip arthroscopy suffers from persistent pain and dysfunction which can be secondary to a number of factors. Femoral rotational deformities are often overlooked and/or providers are unsure when to address femoral deformities. Currently, there is limited to no data guiding surgeons when to consider a femoral osteotomy at the time of hip arthroscopy for FAI. Through previously validated computer-assisted 3D modeling software, this study sought to answer two questions: 1) How much femoral retroversion is too much to render cam femoroplasty ineffective in improving range of motion (ROM)? 2) In the setting of an osteotomy, what degree of femoral version correction would be sufficient to improve impingement free ROM? Methods: Ten patients were selected with symptomatic focal cam impingement lesions who underwent hip arthroscopy and had pre- and post-operative computed tomography (CT) scans. These patients were screened for normal acetabular morphology and demonstrated no radiographic signs of osteoarthritis. Pre- and post-operative 3D modeling of the involved hip was performed and subsequently dynamized with the femoral version set at (15, 5, -5 and -15 degrees) to define the impingement free ROM and location of impingement with maximum hip flexion and maximum hip internal rotation (IR) at 90 degrees of hip flexion. Results: Mean alpha angle pre and post cam resection were 66°±7.6 ° and 44°±4.9° respectively and were significantly different (p=0.003). Location of impingement shifted during hip flexion from the medial to anterior femoral neck with decreasing femoral version while the IR impingement location remained on the anterior femoral neck and was unaffected by femoral version. Kruskal-Wallis testing demonstrated decreasing femoral version significantly decreased hip flexion and IR ROM in both the pre and post cam resection groups (p&lt;0.0003). Impingement free ROM, as defined by hip flexion and IR greater than 90° and 10° respectively, was only identified in the 5 and 15 degree femoral anteversion models irrespective of whether cam femoroplasty had been performed. In the post cam resection group, hip IR ROM was significantly less with any level of decreasing femoral version (p&lt;0.002) while hip flexion ROM was significantly less with any level of decreased femoral version when compared to 15 degrees of anteversion (p&lt;0.04). When assessing the degree of change in ROM between the pre and post cam resection groups, femoral version had contrasting effects on hip ROM with decreasing femoral version showing less improvement with hip IR ROM while the femoral retroversion models had significantly greater improvements in hip flexion ROM when compared to the 15 degree anteversion model (p=0.02). Conclusions: Decreasing femoral version demonstrates significantly decreased hip flexion and IR both in the presence and absence of a CAM lesion. After cam femoroplasty, any level of decreased femoral version has a significant effect on hip ROM when compared to normal femoral anteversion. Femoral version seems to be the predominant factor in determining the amount of hip IR ROM in flexion and to a certain extent hip flexion ROM irrespective of the cam FAI. Impingement free ROM was only identified within the femoral anteversion models even after cam femoroplasty suggesting that recurrent mechanical collision and intra-articular damage seen with FAI may still be present with any level of true femoral retroversion. This study provides insight into the changes in hip flexion and IR that can be expected following both cam resection and simulated femoral osteotomy. [Table: see text]

Comparison of Changes in Range of Motion of the Trunk and Pressure Pain Threshold When Extracorporeal Shock Wave and Pulsed-ultrasound Are Applied to the Thoracolumbar Fascia

Comparison of Changes in Range of Motion of the Trunk and Pressure Pain Threshold When Extracorporeal Shock Wave and Pulsed-ultrasound Are Applied to the Thoracolumbar Fascia

Effects of combined taping of quadriceps and hamstring muscles on pain and disability in patients with knee osteoarthritis: Randomized assessor-blinded controlled study

BackgroundThe ability of patients suffering from knee osteoarthritis to carry on routine daily activities is a significantly valuable target. ObjectivesThis study aimed to assess the effect of quadriceps and hamstring taping using kinesio tape on knee pain, function and range of motion (ROM) in patients suffering from knee osteoarthritis. MethodsTwenty-four patients, ages ranging between 50 and 70 years, diagnosed with chronic knee osteoarthritis were randomly allocated into two equal groups. Group (A) received kinesio tape on quadriceps and hamstring muscles in addition to conventional exercises while, group (B) received solely conventional exercises. Pain, knee flexion ROM and function were assessed using the visual analogue scale (VAS), the universal goniometer and Western Ontario and McMaster Universities Osteoarthritis Scale (WOMAC) respectively. Both groups were assessed before and after four weeks of treatment. ResultsMixed Design Multivariate Analysis of Variance (MANOVA) revealed non-significant differences between groups in pain, ROM and WOMAC (P > 0.05) post-treatment. Additionally, pairwise tests revealed significant reduction of VAS and WOMAC with significant increase in ROM (P < 0.05) for group (A) post-treatment. While group (B) showed significant reduction of VAS and WOMAC (P < 0.05) with non-significant change in ROM (P = 0.109) post-treatment. ConclusionQuadriceps and hamstring taping in addition to conventional exercises has no more effect than conventional exercises alone for decreasing pain and disability and increasing ROM in patients suffering from chronic knee osteoarthritis.