Contralateral Lower Extremity Research Articles

Factors Determining Risk of Contralateral Lower Limb Amputations in Unilateral Dysvascular Transfemoral and Transtibial Amputees

Abstract Background: This study deals with the factors influencing contralateral lower limb amputations among unilateral dysvascular transfemoral and transtibial amputees. Aim: (1) Early identification of risk factors responsible for amputations in contralateral lower limb. (2) To determine the preventive measures of the concerned risk factors. (3) The aim of this study was to determine the risk factors associated with, contralateral amputation in patients with chronic limb threatening ischaemia (CLTI). Study Design: Cross-sectional study, 45 patients with unilateral transfemoral and transtibial amputees due to diabetes and peripheral arterial disease (PAD) were recruited for this study. Materials and Methods: Analysis of risk factors by ankle-brachial index (ABI), Claudication Pain Scale. Results: Unilateral transfemoral and transtibial amputees due to diabetic foot syndrome and PAD are at 2–4 times increased risk for contralateral lower-limb amputations. Conclusions: Risk of anticipated contralateral limb amputation is high based on ABI and Claudication Pain Scale. All patients, but particularly those at increased risk, should undergo close surveillance and counselling to help prevent subsequent amputations in their contralateral lower extremity.

Biofeedback training for the analysis of gait stereotypes in patients with gonarthrosis

BACKGROUND: The justification of the treatment techniques for patients with gonarthrosis requires the use of modern methods for assessing walking stereotypes.
 AIM: This study aimed to evaluate the biomechanical and podometric gait parameters of patients with gonarthrosis using the C-Mill multifunctional complex with biofeedback.
 MATERIALS AND METHODS: The study included 55 patients who were divided into the following groups: main group (n=35) of patients who had gait disturbances, diagnosed with stage III–IV primary gonarthrosis with varus deformation of the limb axis according to ICD-10, and underwent total knee replacement and control group (n=20) of patients diagnosed with stage I primary gonarthrosis. The average age of patients was 58.7 years in the main group and 47.5 years in the control group.
 RESULTS: In the main group, the decrease in average walking speed was accompanied by decreases in stride length and step frequency (р 0.05). In the stance phase, which is characterized by the contact of the foot of the affected and contralateral lower extremities with the platform surface, the durations of the double stance phase of both extremities in the main group were longer than those in the control group (p 0.05), indicating gait asymmetry and redistribution of excess load on the contralateral lower extremity, which is clinically manifested by lameness. In the main group, gait was characterized by a decrease in voluntary speed, step frequency, and gait pattern changes in various planes, confirming severe clinical and functional disorders in the lower limbs.
 CONCLUSION: The study of the walking stereotype in patients using the C-Mill multifunctional complex with biofeedback can be used to substantiate treatment techniques, followed by drawing up an individual medical rehabilitation plan to restore lower limb functions in the postoperative period, fully monitor treatment dynamics, prevent falls, and improve the quality of life of patients.

Effect of transtibial prosthesis weight on the contralateral knee joint in relation to the risk of osteoarthritis.

Individuals with transtibial amputation place more load on the contralateral lower extremity. A higher adduction moment at the knee joint has been shown to have an effect on the risk of osteoarthritis. The aim of this study was to investigate the effect of weight-bearing of lower-limb prosthesis on the biomechanical parameters associated with the risk of contralateral knee osteoarthritis. Cross-sectional. The experimental group of 14 subjects with unilateral transtibial amputation (13 males). The mean age was 52.7 ± 14.2 years, height 175.6 ± 6.3 cm, weight 82.3 ± 12.5 kg, and duration of prosthesis use 16.5 ± 9.1 years. The control group consisted of 14 healthy subjects with identical anthropometric parameters. Dual emission X-ray absorptiometry was used to determine the weight of the amputated limb. For gait analysis, 10 Qualisys infrared cameras and a motion sensing system on 3 Kistler force platforms were used. Gait was analyzed with the original, lighter, commonly used prosthesis, as well as the prosthesis loaded to the original limb weight. The gait cycle and kinetic parameters of the amputated and healthy limbs were more similar to those of the control group when using the weighted prosthesis. We recommend further research to more accurately specify the weight of the lower-limb prosthesis with respect to the prosthesis design and duration of use of the heavier prosthesis during the day.

The influence of passive extensibility of the posterior oblique sling’s upper portion on contralateral knee extension

IntroductionThe posterior oblique sling (POS) serves to improve stability by transferring the force and load during an active movement in muscle contraction. The purpose of this study was to investigate the influence of pelvic positions on the knee extension range of motion (KE ROM) and the influence of trunk positions on the mobility of the lower extremity.MethodsSixteen subjects (age 21.0 ± 1.9 years, height 165.3 ± 7.6 cm, weight 59.56 ± 7.9 kg) participated in this study. The therapist measured the active KE ROM of the dominant leg at three different pelvic positions (neutral position, maximal anterior, and posterior pelvic tilt) and at two different trunk positions (trunk flexion and trunk rotation) using a Bluetooth embed inertial measurement unit sensor. A 10-minute rest was taken between positions. During trunk flexion and trunk rotation, the pelvis was maintained in a neutral position to prevent the change in length of the hamstring muscles. Statistical significance was set at <i>p</i> < 0.05.ResultsIn comparison to the neutral position, the anterior and posterior pelvic tilt significantly decreased (<i>p</i> < 0.001) and increased the KE ROM (<i>p</i> < 0.001). In addition, the trunk rotation significantly decreased the KE ROM (<i>p</i> = 0.002). However, the trunk flexion did not significantly change the KE ROM.ConclusionsThe findings in this study indicate that the changes in the length of the POS significantly influenced the functional mobility in the lower extremity. In clinical practice, the flexibility of POS must be considered during reciprocal movements involving the upper body and contralateral lower extremities.

The incidence, risk factors, characteristics, and prognosis of recurrent deep venous thrombosis in the contralateral lower extremity

BackgroundRecurrent events after a first symptomatic deep venous thrombosis (DVT) are relatively frequent, but little is known about contralateral recurrent DVT (RDVT). MethodsWe retrospectively reviewed the medical records of patients with a first symptomatic lower extremity DVT between January 2017 and April 2021. The incidence, demographics, risk factors, and prognosis of RDVT were analyzed, with differences compared between patients with contralateral RDVT and those with ipsilateral RDVT. ResultsIn 570 consecutive patients with DVT, 28 patients (4.91%) developed contralateral RDVT, and 49 patients (8.60%) developed ipsilateral RDVT during a mean follow-up of 27.62 ± 14.84 months. Contralateral RDVT was more frequently found in the right lower extremity, whereas ipsilateral RDVT had more left lower extremity involvement. The median follow-up was 12 months until ipsilateral RDVT and 26.5 months until contralateral RDVT. In multivariate Cox analysis, inherited thrombophilia, stent extension with 50% to 100% coverage, autoimmune disease and anticoagulation noncompliance were identified as risk factors for contralateral RDVT. During follow-up, 5 patients (17.86%) with contralateral RDVT and 10 patients (20.41%) with ipsilateral RDVT died (P > .05), with 12 of 15 dying of an underlying malignancy. ConclusionsThe incidence of contralateral RDVT after a first symptomatic DVT is relatively low, and contralateral DVT is strongly associated with stent extension with 50% to 100% coverage, autoimmune disease, anticoagulation noncompliance, and inherited thrombophilia. Compared with ipsilateral RDVT, contralateral RDVT occurs later and is more often in the right lower extremity. Survival following contralateral RDVT is similar to survival following ipsilateral RDVT, with underlying malignancy being the leading cause of death.

Restoration of Native Leg Length After Opening-Wedge High Tibial Osteotomy: An Intraindividual Analysis.

Background:Opening-wedge high tibial osteotomy (OWHTO) has been shown to significantly increase leg length, especially in patients with large varus deformity. Thus, the current literature recommends closing-wedge high tibial osteotomy to correct malalignment in these patients to prevent postoperative leg length discrepancy. However, potential preoperative leg length discrepancy has not been considered yet.Hypothesis:It was hypothesized that patients have a decreased preoperative length of the involved leg compared with the contralateral side and that OWHTO would subsequently restore native leg length.Study Design:Case series; Level of evidence, 4.Methods:Included were 67 patients who underwent OWHTO for unilateral medial compartment knee osteoarthritis and who received full leg length assessment pre- and postoperatively. Patients with varus or valgus deformity (>3°) of the contralateral side were excluded. A musculoskeletal radiologist assessed imaging for the mechanical axis, full leg length, and tibial length of the involved and contralateral lower extremity. Statistical analysis determined the pre- and postoperative leg length discrepancy and the influence of the mechanical axis.Results:Most patients (62.7%) had a decreased length of the involved leg, with a mean preoperative mechanical axis of 5.0° ± 2.9°. Length discrepancy averaged –2.2 ± 5.8 mm, indicating a shortened involved extremity (P = .003). OWHTO significantly increased the mean lengths of the tibia and lower limb by 3.6 ± 2.9 and 4.4 ± 4.7 mm (P < .001), leading to a postoperative tibial and full leg length discrepancy of 2.8 ± 4.3 mm and 2.2 ± 7.3 mm (P < .001 and P = .017, respectively). Preoperative leg length discrepancy was significantly correlated with the preoperative mechanical axis of the involved limb (r = 0.292; P = .016), and the amount of correction was significantly associated with leg lengthening after OWHTO (r = 0.319; P = .009). Patients with a varus deformity of ≥6.5° (n = 14) had a preoperative length discrepancy of –4.5 ± 1.6 mm (P < .001) that was reduced to 1.8 ± 3.5 mm (P = .08).Conclusion:Patients undergoing OWHTO have a preoperative leg length discrepancy that is directly associated with the varus deformity of the involved extremity. As OWHTO significantly increases leg length, restoration of native leg length can be achieved particularly in patients with large varus deformity.

Factors Affecting Contralateral Extremity Following Lower-Extremity Major Amputation

Objective: Lower-extremity amputation is performed in patients who are at risk due to acute limb ischemia (ALI), chronic limb-threatening ischemia (CLTI), and diabetic foot infections, yet the proportion of patients who progress to amputation of their contralateral extremity following major amputation is not well defined. This study determines the rate of subsequent minor or major amputation of a contralateral extremity. Methods: We conducted a retrospective review of patients undergoing lower-extremity major amputation at JIVAS from 2011 to 2015. Outcomes included the proportion of patients who underwent minor or major amputation of contralateral extremity for a follow-up of 3 years. Results: From 2011 to 2015 period, 113 patients underwent major lower-extremity amputation. The mean age of patients was 59.5 years. Seventy-five percent were male, 88% were diabetic, 69% were hypertensive, 19% had renal insufficiency, 35% had coronary artery disease, 15% were smokers, 31% presented with diabetic foot infections, 20% presented with ALI (four patients underwent contralateral major amputation within the same admission), and 48% presented with CLTI who underwent an initial major amputation. After ipsilateral major amputation, 54% had normal contralateral extremity (four patients had ALI and six patients had CLTI and underwent revascularization), 14% underwent contralateral minor amputation (toe/transmetatarsal), 4% underwent contralateral major amputation (below/above the knee), 6% lost to follow-up, and 19% were dead at follow-up for 3 years. In this study, there is no significant difference between factors (gender and comorbidities) affecting contralateral limb amputation in patients who underwent major amputation. Conclusions: Preexisting comorbidities and gender might not affect contralateral limb amputations in patients with major amputation. Good control of comorbidities in the follow-up and diligent foot care probably play a role in predicting contralateral limb amputations. Vascular surgeons should be alert, and close surveillance and counseling of patients should be followed to prevent subsequent amputation in their contralateral lower extremity.

Tensile Force Transmission from the Upper Trunk to the Contralateral Lower Leg throughout the Posterior Oblique Sling System

Although recent studies have confirmed that muscles of the upper body are obliquely linked with the muscles of the contralateral lower extremity through posterior oblique sling (POS) system, the upper portion of the POS connected to the lower leg below the hamstring is yet to be determined. In the supine position, the active maximum dorsiflexion (DF) angles of the right and left legs were randomly measured. During passive trunk rotation performed by the therapist, the active maximum DF angles of the right leg (contralateral side) and left leg (ipsilateral side) were measured. In a long sitting position with and without trunk rotation, the active maximum DF angles in both legs were measured. The left upper body was made to rotate rightward in trunk rotation. In the contralateral lower extremity, the DF ROM in the sitting position with trunk rotation was significantly different compared with those in the sitting position without trunk rotation, and in the supine position with trunk rotation. In the comparison between the ipsilateral and contralateral lower extremity, significant differences were found in the DF ROM in the sitting position with trunk rotation. This study indicates that the tensile force generated by trunk rotation is transmitted to the contralateral terminal end by examining changes in DF ROM. Since the upper portion of the POS is connected all the way down to the contralateral calf, the POS must be considered during the clinical treatment of patients with restricted DF mobility.

Whole-body morphological asymmetries in high-level female tennis players: A cross‑sectional study

ABSTRACT This cross-sectional study aimed to examine the degree of whole-body morphological asymmetries in female tennis players. Data were collected in 19 high-level female tennis players (21.3 ± 3.4 years). Based on anthropometric measurements (upper arm, lower arm, wrist, upper leg and lower leg circumferences as well as elbow and knee widths) and dual x-ray absorptiometry research scans (bone mineral density (BMD), bone mineral content (BMC), lean mass (LM), fat mass (FM) as well as humerus, radio-ulnar, femur and tibia bone lengths), within-subject morphological asymmetries for both upper (dominant vs. non-dominant) and lower (contralateral vs. ipsilateral) extremities were examined. Upper arm (p = 0.015), lower arm (p < 0.001) and wrist circumferences (p < 0.001), elbow width (p = 0.049), BMD (p < 0.001), BMC (p < 0.001), LM (p = 0.001), humerus (p = 0.003) and radio-ulnar bone length (p < 0.001) were all greater in the dominant upper extremity. BMC (p < 0.001) and LM (p < 0.001) were greater in the contralateral lower extremity, whereas FM (p = 0.028) was greater in the ipsilateral lower extremity. This is the first study to report significant side-to-side differences in both upper and lower extremities in high-level female tennis players.

Gait biometrics in children with cerebral palsy before and after robotic mechanotherapy

Background. The improvement in existing methods and the development of new principles for treating children with cerebral palsy necessitates a quantitative assessment of the parameters of motor activity. However, because of the explicit and complex abnormalities in motor skills in patients with severe forms of cerebral palsy, an evaluation of their locomotor function dynamics using instrumental diagnostic methods remains a serious problem.&#x0D; Aim. This work aimed to study the walking function in patients with cerebral palsy before and after motor rehabilitation using a biomechanical method with biometric sensors.&#x0D; Materials and methods. We examined 14 patients with cerebral palsy aged 8 to 13 years with III level of restriction of motor activity according to the gross motor function classification system (GMFCS). All patients underwent rehabilitation in the Lokomat robotic simulator for three weeks. The course consisted of 15 sessions of 45 min each. The temporal and dynamic parameters of walking were studied in 14 patients with cerebral palsy before and after a course of locomotor training. The biometry of the step cycle was studied using the STEDIS hardware-software complex, including the Neurosens set of wireless biometric sensors. The temporal characteristics of the step cycle and the force interaction of the lower extremities with the supporting surface during walking were recorded. For comparison, we conducted a biomechanical examination of 18 healthy children of the same age who did not have signs of orthopedic disorders.&#x0D; Results. Although after a course of mechanotherapy, the indices of the support phases in biometry in children with cerebral palsy did not reach the level of healthy individuals, a physiological tendency to roll foot was observed in the phase of pushing and accelerating the foot. Active braking of the lower limb increased. The studied time parameters showed a relative improvement in the step structure because of the emerging tendency to normalize the ratio of the periods of the double support of the contralateral lower extremities.&#x0D; Conclusion. Robotic mechanotherapy helps to change the biomechanical pattern of walking of a child with a severe degree of cerebral palsy. An instrumental analysis of walking using wireless biometric sensors allows you to evaluate the results and effectiveness of rehabilitation measures in patients with severe motor impairment objectively.

Chronic musculoskeletal pain, phantom sensation, phantom and stump pain in veterans with unilateral below-knee amputation.

Many individuals with lower limb loss report concerns about other musculoskeletal symptoms resulting from amputation. The objective of this study was to assess chronic musculoskeletal pain in Iranian veterans with unilateral below-knee amputation. The participants agreed to take part in a health needs assessment and were interviewed face-to-face by trained interviewers. The assessment consisted of demographic information, wearing a prosthesis, pain locations in extremities, stump complications, severity of pains related to amputation and low back pain. Of 247 unilateral below knee amputees, 97.9% wore a prosthetic limb and times walking or standing with the prosthesis were 12.47 ± 3.84 and 4.22 ± 3.53 h a day, respectively. Low soft tissue coverage of the stump (15.4%) and symptomatic osteoarthritis in the contralateral lower extremity (40.1%) were the most common complications. The prevalence of stump pain, phantom sensations, phantom pain, low back pain, and knee pain was 84.2%, 77.3%, 73.7%, 78.1%, and 54.7% respectively. The odds ratio of stump pain in amputees with phantom pain was 2.22 times higher than those who did not experience phantom pain [OR = 2.22 (CI: 1.19-4.17); p = 0.012] and the odds ratio of low back pain was higher in amputees with stump pain [OR = 3.06 (CI: 1.50-6.21); p = 0.002]. This research enhances our understanding of comorbid musculoskeletal problems in below-knee amputees which can help health providers to identify rehabilitation needs and emphasizes the importance of regular assessments. These findings underline the importance of paying closer attention to different dimensions and aspects of musculoskeletal complications in veterans with unilateral below-knee amputation.

Dorsal root entry zone ablation for lower limb pain after thoracolumbar spine fracture

Objective To evaluate the efficacy and safety of dorsal root entry zone (DREZ) ablation surgery in the treatment of lower limb pain after thoracolumbar fracture, and to analyze the underlying mechanism of lower limb pain. Methods From October 2011 to December 2016, a total of 20 patients with lower limb pain after thoracolumbar fracture were treated with DREZ ablation in the spinal cord segment corresponding to the dermatome of the pain territory at Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University. The relationship between the segments of the spinal cord injury, sensory level, and area of pain was analyzed retrospectively. The efficacy (overall VAS score improvement more than 50%, no more analgesics needed) and safety of the operation were evaluated according to the postoperative pain relief and complications. Results The segments of spine injuries were T12-L3, and the pain territory was distributed at T11-S2, which lied 2-6 segments higher than that of the injured spinal cord segment. Spinal cord and nerve root were severely injured at the fractured vertebra level. The corresponding spinal cord segments of the pain territory dermatome were moderately atrophied and in 12 cases the corresponding nerve roots were avulsed from the spinal cord. Eighteen patients was pain free right after the operation, 2 cases with pain relieve rate less than 50%. 1 case developed pain recurrence after 3 months. The effective rate on time interval with immediate, 3months and 1 year after operation was 18/20, 17/20, 17/20 respectively. Seven patients had developed transient stabbing pain within the upper boundary of the ablated segment. Two patients who underwent unilateral DREZ lesion developed irritant pain in the contralateral lower extremity area after the operation. Conclusions Chronic neuropathic pain of the lower limb due to thoracolumbar fracture seems more likely to be caused by nerve root injury instead of spinal cord injury. DREZ ablation is safe and effective for those patterns of pain. Key words: Spinal fractures; Spinal cord injuries; Neurosurgical procedures; Neuropathic pain; Dorsal root entry zone

Dorsal Root Entry Zone Lesion for Neuropathic Pain Due to Thoracolumbar Spine Fracture: Long-Term Result

To retrospectively evaluate long-term efficacy and safety of dorsal root entry zone (DREZ) lesion for treatment of neuropathic pain within the lower extremities and perineal region after thoracolumbar spine fracture. Forty-two patients were treated with posterior laminectomy under general anesthesia. The DREZ regions of the spinal cord segments were ablated under a microscope. Data regarding pain relief, pain variation over time, and postoperative complications were collected. The relationship between injured spinal column segment, spinal cord, nerve root, and pain territory were analyzed retrospectively. Spinal column injury segments were located between T12 and L4. Pain territories were distributed between the T11 and S5 dermatomes with varying ranges, at an average of 2-6 segments higher than the spinal cord injury segments. Pain relief rate was 100% in 21 patients (50.0%) and was over 50% in 14 patients (33.3%). Eighteen patients (42.9%) developed temporary tingling in the upper edge of the spinal cord lesion segment after surgery. Of the 4 patients with unilateral lower extremity pain, 2 developed postoperative persistent pain in the contralateral lower extremity. For patients with neuropathic pain of the lower extremities and/or the perineal region after thoracolumbar spine fracture, pain within the lower extremities was mostly because of nerve root injury. Pain in the perineal region caused by L1 fracture was attributed to spinal cord injury segmental pain. Nerve root injury pain had a good prognosis after DREZ lesion; the effect of DREZ lesion for spinal cord injury segmental pain may be uncertain.

Differentiation in an inclusive trauma system: allocation of lower extremity fractures

BackgroundImplementation of an inclusive trauma system leads to reduced mortality rates, specifically in polytrauma patients. Field triage is essential in this mortality reduction. Triage systems are developed to identify patients with life-threatening injuries, and trauma mechanisms are important for triaging. Although complex extremity fractures are mostly non-lethal, these injuries are frequently the result of a high-energy trauma mechanism. The aim of this study is to compare injury and patient characteristics, as well as resource demands, of lower extremity fractures between a level (L)1 and level (L)2 trauma centre in a mature inclusive trauma system.MethodsThis is a retrospective cohort study. Patients with below-the-knee joint fractures diagnosed in a L1 or L2 trauma centre between July 2013 and June 2015 were included. Main outcome parameters were patient demographics, trauma mechanism, fracture pattern, and resource demands.ResultsOne thousand two hundred sixty-seven patients with 1517 lower extremity fractures were included. Most patients were treated in the L2 centre (L1 = 417; L2 = 859). Complex fractures were more frequently triaged to the L1 centre. Patients in the L1 centre had more concomitant injuries to other body regions and ipsi- or contralateral lower extremity. Patients in the L1 centre were more resource demanding: more surgeries (> 1 surgery; 24.9% L1 vs 1.4% L2), higher immediate admission rates (70.1% L1 vs 37.6% L2), and longer length of stay (mean 13.4 days L1 vs 3.1 days L2).ConclusionThe majority of patients were treated in the L2 trauma centre, whereas complex lower extremity injuries were mostly treated in the L1 centre, which placed higher demand on resources and labour per patient. This change in allocation is the next step in centralization of low-volume high complex care and high-volume low complex care.

Ligament Strain Response Between Lower Extremity Contralateral Pairs During In Vitro Landing Simulation.

Background:Limb asymmetries, as determined through in vivo biomechanical measures, are known risk factors for anterior cruciate ligament (ACL) injury. Previous cadaveric studies have shown a lack of significant differences in ligament strain between contralateral lower extremities when identical kinematics were simulated on specimens. Recent methodological developments have applied in vivo knee kinetics to exert landing forces on cadaveric lower extremities to mimic ACL injury events, but it is unknown whether contralateral limbs fail in a consistent manner during impact simulator testing.Hypothesis:It was hypothesized that contralateral lower extremities would not exhibit side-to-side differences in ligament strains. Furthermore, it was hypothesized that failure loads and failure locations would be independent of limb dominance.Study Design:Controlled laboratory study.Methods:Fourteen pairs of cadaveric lower extremities were obtained from an anatomic donations program (8 female, 6 male; mean ± SD: age, 41.7 ± 8.1 years; mass, 86.8 ± 27.0 kg; body mass index, 29.4 ± 9.0 kg/m2). A mechanical impact simulator was used to re-create the impulse ground-reaction force generated during an in vivo landing task. Ligament strains were recorded by differential variable force transducers implanted on the ACL and medial collateral ligament (MCL).Results:No significant differences were observed in peak ACL or peak MCL strain for 5 loading conditions. Fisher exact tests of independence revealed that limb dominance was independent of both load at failure and failure location.Conclusion:There were no significant differences in ACL and MCL strain values between limb sides during in vitro impact simulation testing. This finding indicates that limb dominance does not influence the failure threshold of the ACL, since there was no significant difference in failure strains. The functional mechanics of the ACL are comparable between contralateral pairs from the same healthy specimen.Clinical Relevance:Injury mechanisms and intra-articular mechanics cannot be ethically studied in an in vivo setting. The current study provides additional insight into limb asymmetry that is observed among athletes in clinical sports medicine settings.

Directing clinical care using lower extremity biomechanics in patients with ankle osteoarthritis and ankle arthroplasty.

Ankle osteoarthritis is a debilitating disease with approximately 50,000 new cases per year leading to skeletal deformity, severe and recurrent pain, cartilage breakdown, and gait dysfunction limiting patient mobility and well-being. Although many treatments (total ankle arthroplasty [TAA], ankle fusion [arthrodesis], and ankle distraction arthroplasty) relieve pain, it is not clear that these procedures significantly improve patient mobility. The goal of the research presented here is to summarize what is presently known about lower extremity gait mechanics and outcomes and to quantify the impact of ankle osteoarthritis and TAA have on these measures using an explicitly holistic and mechanistic approach. Our recent studies have explored physical performance and energy recovery and revealed unexpected patterns and sequelae to treatment including incomplete restoration of gait function. These studies demonstrated for the first time the extreme levels and range of gait and balance dysfunction present in ankle osteoarthritis patients as well as quantifying the ways in which the affected joint alters movement and loading patterns not just in the painful joint, but throughout both the ipsilateral and contralateral lower extremity. Through this work, we determined that relieving pain alone through TAA is not enough to restore normal walking mechanics and balance due to underlying causes including limited ankle range of motion and balance deficits leading to long-term disability despite treatment. The results indicate the need to consider additional therapeutic interventions aimed at restoring balance, ankle range of motion, and movement symmetry in order to improve long-term health and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2345-2355, 2017.

The Comprehensive High-level Activity Mobility Predictor-Sport (CHAMP-S)

The Comprehensive High-level Activity Mobility Predictor (CHAMP) is a reliable and valid outcome measure that assesses high-level mobility in Service Members (SM) with traumatic lower limb loss. The CHAMP has the potential to be used to assess current high-level mobility capabilities in healthy, athletic individuals, to determine those athletes that may be at risk for injury, can be administered throughout rehabilitation process, and can assist with return to play decision making for collegiate athletes that suffer lower limb injuries. PURPOSE: To develop the reliability and validity of the Comprehensive-High-Level Activity Mobility Predictor-Sport (CHAMP-S) in Division I Collegiate Football Players. METHOD: 206 student athletes participated in the study. 97 were tested at one time by three testers (two using the paper format and one using a mobile device application) to determine CHAMP-S interrater reliability. 115 had completed CHAMP-S, anthropometric measures, upper and lower limb power, speed, and agility measures and underwent correlation analysis. 206 underwent ANOVA followed by post hoc analysis to determine differences between CHAMP-S scores between different football positions. Twenty athletes who underwent season ending injury were administered the CHAMP-S every 4-5 weeks throughout rehabilitation to assess change in high-level mobility and determine return to sport. RESULTS: The ICC’s for the CHAMP-S items ranged from 0.90 (95% Confidence Interval, CI: [0.85, 0.93]) to 0.98 (95% Confidence interval, CI: [0.97-0.99]) for Single Limb Stance, Four-meter side step test, L-Test, and Illinois Agility Test. The CHAMP-S was significantly correlated with BMI, % Body Fat, Vertical Jump, Broad Jump, 40-yard dash, and shuttle run. The CHAMP-S demonstrated differences between linemen and skilled position players in all planes of movement. All 20 athletes returned to play safely and have not suffered re-injury to the ipsilateral or contralateral lower extremity. The athletes achieved 103% ± 5% (95-109%) of their baseline CHAMP-S score (p = 0.09). CONCLUSION: The CHAMP-S is a reliable and valid measure of high-level mobility in Division I Collegiate Football Players that can help determine differences by position and assist return to sport following lower limb injury.

Abstract 88: Increased Incidence of Symptomatic Deep Venous Thrombosis Following Lower Extremity Flap Harvest for Abdominal and Perineal Reconstruction: A Case for Extended Surveillance

BACKGROUND: Postsurgical venous thromboembolism (VTE) remains a leading cause of hospital morbidity and data to support VTE prophylaxis guidelines in lower extremity flap surgery are currently lacking. The purpose of this study was to identify the incidence of symptomatic VTE in patients undergoing harvest of lower extremity flaps who received standard chemoprophylaxis while hospitalized to identify factors which could change postoperative prophylaxis guidelines. METHODS: One hundred twenty-seven consecutive patients undergoing unilateral lower extremity flap harvest from June 2011 to December 2015 were retrospectively evaluated for the development of VTE. Each patient had a flap harvested from the lower extremity and inset into the abdomen or perineum and not the ipsilateral leg/foot/ankle. All patients with symptomatic leg pain received bilateral ultrasonographic evaluation for VTE formation. The contralateral, non-operative leg served as an internal control. Sixty comorbidity-matched patients who underwent perineal tumor extirpation without reconstruction provided an external control. RESULTS: Sixty patients were male (47%) with mean age of 52 years. Mean follow-up was 339 days. All patients underwent flap reconstruction for an oncologic defect of the abdomen or perineum with 79% undergoing perineal reconstruction. Most patients underwent anterolateral thigh (41%) or gracilis flap (40%) harvest. Eleven patients developed VTEs in either leg (9%), for a total of 15 episodes of VTE. Of these, 10 were donor site (66%) and 5 were contralateral leg (33%). There was a non-significant trend towards increased odds for the formation of donor-site VTE when compared with contralateral lower extremity (OR:1.7;CI:0.80–3.4;p=0.15). Patients who underwent flap harvest had a 9 times higher odds of VTE formation when compared with their comorbidity matched controls who did not undergo flap reconstruction (OR:9.08;CI:1–82.6;p<0.05). CONCLUSIONS: The rate of VTE is higher than previously appreciated for reconstructive procedures of the perineum that utilize lower extremity flaps. Routine surveillance or extended prophylaxis may be warranted.

Effect of tensioner neural mobilization on the flexibility of contralateral lower extremity

Effect of tensioner neural mobilization on the flexibility of contralateral lower extremity

Ipsilateral Tibiotalar Joint Osteoarthritis Transferred to the Contralateral Tibiotalar Joint.

Classically, it is thought that pain or disability in one leg can stress the contralateral leg, leading to similar symptoms. The mechanism of action for subsequent dysfunction in the healthy limb is thought to involve compensatory changes that are used as a means to reduce stance phase time on the injured limb. This is believed to increase the forces distributed across the healthy limb, ultimately leading to injury. This belief has been challenged, as supportive literature is sparse. The goal of this study was to determine whether an association between tibiotalar (TT) osteoarthritis (OA) in the right vs left lower extremity exists, and whether injury to one lower extremity leads to degeneration in the contralateral lower extremity. The authors evaluated 704 TT joints to determine the presence of OA. A multiple linear regression was performed using a standard P value cutoff (P<.05) and 95% confidence interval. The absolute value of the difference between right and left TT OA was compared for specimens in each decade of life. Multiple regression analysis revealed a positive correlation between right and left TT OA, after correcting for age, sex, and race. Right TT vs left TT had a slope of 0.489 with a P value approaching 0. Findings indicated the absolute value of the difference between right and left TT OA was not zero, and this difference remains significant throughout life. Based on these findings, OA in one ankle does not appear to lead to accelerated OA in the contralateral ankle. [Orthopedics. 2016; 39(4):e664-e667.].