Degrees Of Flexion Research Articles

Immediate Effects of Whole Body Vibration on Proprioception and Upper Extremity Reaction Speed in Young Adult Students.

There is limited information on the immediate effects of whole-body vibration (WBV) on the upper limb. This study aims to determine the immediate effects of WBV on reaction speed and proprioception in young adult students' upper extremities. In total, 62 students participated in the study. WBV was applied to the participants, and its immediate effects on proprioception and upper extremity reaction speed were examined. Participants' proprioception and perception of joint position at 30-60 degrees of shoulder flexion, shoulder abduction, and elbow flexion angles were measured with absolute error degrees. Reaction rates were evaluated with the Ruler-Drop Test and the mobile application SWAY. A decrease was observed in the absolute error level of the participants' joint position perception at 30-60 elbow and shoulder position degrees, measured after immediate WBV application (p <0.05). After the RDT application, a decrease in the length of catching the target was observed (p <0.05). The SWAY test determined that they moved the smartphone in a shorter time (p <0.05). Right and left RDT scores showed that the distance to catch the ruler was significantly lower in male individuals before the application. In comparison, the distance to catch the ruler was lower after the application (right/left p<0.05). The study found that applying WBV improved upper extremity proprioception perception and reaction speed in young adults. This information can guide clinicians in applying WBV to healthy individuals and those with symptoms.

Comparison between Warm-Up Protocols in Post-Activation Potentiation Enhancement (PAPE) of Sprint and Vertical Jump Performance in a Female Futsal Team

ABSTRACT The aim of this study was to examine the influence of three warm-up protocols, with and without post-activation performance enhancement (PAPE), on sprint and vertical jump performance in female athletes. Twenty-five university futsal athletes were randomly assigned to three protocols: i) Traditional Warm-Up (TWU), involving cardiovascular, coordination exercises, and dynamic stretching; ii) Drop Jump Warm-Up (DJWU), consisting of drop jumps from heights of 30 and 40 cm; and iii) Maximum Isometric Warm-Up (MIWU), with high-intensity isometric contractions held for 10 seconds in a squat position at approximately 130–135 degrees of knee flexion. Tests included the countermovement vertical jump (CMVJ) and a 20-meter sprint (S20). The CMVJ showed a significant increase across all three groups (F(1,72) = 125.312; p < .0001; ηp2 = 0.635), while S20 displayed a significant time reduction only for MIWU (p = .002). Although no significant differences were found between groups, individual analysis revealed significant CMVJ differences for TWU, DJWU, and MIWU (p < .0001). We conclude that PAPE effectiveness varies according to protocol and individual athlete characteristics; however, maximum isometric exercises appear to have a more pronounced effect on PAPE production in sprint performance.

An In-Vitro Biomechanical Comparison of Annular Ligament Repair and Reconstructions to Restore Radial Head Stability in Anterior Monteggia Fractures

BackgroundPersistent or recurrent instability of the radial head (RH) remains a challenge in treating anterior Monteggia fractures despite anatomic restoration of the ulna. RH instability may be caused by the pull of the biceps muscle with rupture of the annular ligament and other soft tissue stabilizers of the proximal radius. Currently, the optimal method to stabilize the proximal radius is unknown. The purpose of this study was to compare annular ligament repair with three different ligament reconstructions in restoring anterior RH stability. MethodsEight cadaveric upper extremities were mounted on an elbow simulator in 90 degrees of flexion with the forearm in neutral rotation. Simulated sequential biceps loading was applied in 10N increments up to a maximum biceps load of 150N to generate an anteriorly directed force to the RH. Testing was first conducted in the native state with all soft tissue intact, followed by sectioning the central interosseous membrane, the proximal interosseous membrane, annular and quadrate ligaments. This was followed by the randomized evaluation of an annular ligament repair and three different ligament reconstructions, including a Bell Tawse reconstruction with triceps fascia (Bell Tawse reconstruction), a free tendon annular ligament reconstruction (Itadera reconstruction), and a free tendon anatomic annular ligament reconstruction (anatomic reconstruction). An optical tracking system was used to determine RH kinematics relative to the humerus. For all test states, the anterior translation of the RH relative to the capitellum was quantified as a measure of subluxation. ResultsSectioning the soft tissue stabilizers of the proximal radius produced a significant increase in anterior RH subluxation relative to the intact state (P<0.001). The annular ligament repair was most effective at reducing anterior radial subluxation (p=1.000). The Itadera reconstruction was the next most effective procedure at reducing anterior RH subluxation (p=1.000) and was followed by the anatomic reconstruction (p=0.192) and the Bell Tawse reconstructions (p=0.015) respectively. ConclusionsAnnular ligament repair was most effective in restoring normal RH stability, however, repair of this structure may not always be feasible as the tissues are often compromised by the injury and may not be reparable. The Itadera reconstruction was the most effective reconstruction technique at restoring RH stability and should be considered over alternative procedures when annular ligament repair is not feasible. These data also suggest that careful rehabilitation will be important postoperatively as residual RH instability can occur even with an anatomic reduction of the ulna and annular ligament repair or reconstruction.

Giant Cell Tumor of Capitate with Secondary Aneurysmal Bone Cyst: A Case Report

Abstract Background Giant cell tumors (GCTs) of the carpal bones are rare. GCTs of the hand tend to be aggressive, could result in multifocal presentation, and have a high rate of recurrence. Case Description We report a rare case of GCT of the capitate with secondary aneurysmal bone cyst (ABC) in a 40-year-old man. The patient presented with complaints of pain and swelling over his right wrist since 6 months. Radiographs showed the presence of a lytic lesion in the capitate. Magnetic resonance imaging scanning revealed a well-defined, lobulated, multiseptate lytic lesion involving the entire capitate, extending into its subarticular regions. Fine-needle aspiration revealed findings suggestive of a GCT. He underwent en-bloc excision of the capitate, bone grafting of the defect using an appropriately sized bicortical iliac crest autograft, and third carpometacarpal and midcarpal fusion. Histopathological examination of the lesion confirmed the presence of a GCT, with a secondary ABC. At 3 years following surgery, he was asymptomatic with no signs of tumor recurrence, radiocarpal arthritis, or instability. He was able to perform 45 and 60 degrees of wrist extension and flexion, respectively. Literature Review To our knowledge, there are no prior reported cases of GCT of the capitate with a secondary ABC. Clinical Relevance GCTs of the hand in general have a high rate of recurrence. The presence of a super-added ABC could further increase this risk. In the authors' opinion, en-bloc excision of the affected bone, reconstruction of the defect, and appropriate fusion is the optimal mode of management of these cases.

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using the Rectus Femoris Tendon: Surgical Technique

Objectives: Present a combined ACL and anterolateral ligament (ALL) reconstruction technique using a rectus femoris tendon graft harvested in a minimally invasive approach without specialized instruments. Methods: The graft is harvested from the lateral portion of the rectus femoris tendon. The distal end is detached from the patella, and dissection is extended proximally by 8 cm, ensuring preservation of the intermediate and deep layers of the quadriceps tendon (QT). A closed tendon stripper is carefully pushed with the knee at 20 degrees of flexion. The graft is folded asymmetrically, with the distal portion forming a double or triple graft for the ACL, and the proximal portion remaining unfolded for the ALL. The femoral tunnel is made using an outside-in technique, replicating both the ACL and ALL footprints. Results: The graft length typically ranges from 28 to 35 cm, and the ACL portion diameter ranges from 8 to 10 mm. The technique showed a low rate of complications and provided adequate control of pivot shift. Advantages include predictable graft diameter, use of standard instruments, and preservation of hamstring strength. Disadvantages include potential quadriceps strength reduction, risk of hematoma, an additional incision, and the need for an extra screw for ligament fixation. Conclusion: To our knowledge, this is the first report of a combined ACL and ALL reconstruction technique using a QT graft. The minimally invasive rectus femoris graft approach offers a viable alternative for combined ACL and ALL reconstruction in both primary and revision surgeries.

Anterior Cruciate and Anterior Oblique Ligament Reconstruction Using Hamstrings and Peroneus Longus’ Anterior Half Grafts

Objective: To describe the surgical technique for anterior cruciate ligament (ACL) and anterior oblique ligament (AOL) reconstruction using hamstring tendons and the anterior half of the peroneus longus tendon. Methods: The surgical technique involves the following key steps: 1. Tendon Harvesting: The semitendinosus and gracilis (STG) tendons are harvested from the injured limb or the contralateral limb in cases of prior ACL reconstruction. Additionally, a 3 cm longitudinal incision is made in the posterolateral region of the fibula to harvest the anterior half of the peroneus longus (PL) tendon, ensuring the fibular nerve is not injured. The harvested tendons form a quintuple graft, with the STG folded four times and the PL used as a fifth component. 2. Graft Preparation: The STG graft is folded to create a quadruple graft, and the PL is integrated into this without folding, forming a quintuple graft proximally. The distal portion remains single, extending the PL length. 3. Tunnel Positioning for ACL: The reconstruction involves precise anatomic positioning of the femoral and tibial tunnels. The femoral tunnel is created in the Anatomical Functional Position, as described by Jorge et al., using an outside-in technique with the Acufex Pinpoint guide (Smith &amp; Nephew). The tibial tunnel is positioned on the anteromedial surface of the tibia, ensuring optimal alignment with the femoral tunnel. 4. Femoral Tunnel for AOL: The femoral tunnel for the AOL is positioned at the medial epicondyle. Fluoroscopy is used to identify the medial epicondyle in the lateral view. A guidewire is passed through the anterior portion of the medial epicondyle, creating a tunnel under radiographic visualization to ensure correct anatomical placement of the AOL. 5. Graft Passage and Fixation: The graft is passed through the tibial and femoral tunnels using a No. 5.0 Ethibond suture. The quintuple graft occupies both tunnels, and the single PL portion remains outside the tibial tunnel until fixation. Femoral fixation is achieved with an interference screw (Biosure; Smith &amp; Nephew). After pretensioning, tibial fixation is completed with the knee in full extension. The remaining PL is passed subcutaneously on the medial side and fixed in the AOL tunnel with the knee in neutral rotation and 45 degrees of flexion. This technique ensures optimal biomechanical restoration and stability in the anterolateral and anteromedial knee compartments. Results: This technique aims to improve knee stability by addressing anterolateral and anteromedial instability, which is critical in some instances of ACL injury. Using the anterior half of the peroneus longus tendon in conjunction with hamstring tendons provides a viable, biomechanically sound option for reconstruction. Conclusion: Combined ACL and AOL reconstruction using hamstring and peroneus longus tendons is a promising technique for improving knee stability in patients with ACL injuries, particularly those with anteromedial instability. This approach may be a valuable alternative to exclusive anterolateral reinforcement in select cases.

Is it necessary to use a sling or abduction pillow sling after superior rotator cuff repair? A preliminary report

Objectives: The study aimed to evaluate the effects of the use of a shoulder sling, shoulder sling with a pillow, or not using a sling on the shoulder functional score and pain levels following arthroscopic rotator cuff tear repair. Patients and methods: This randomized prospective study was performed with 90 patients (49 males, 41 females; mean age: 56.2±12.2 year; range, 33 to 77 years) with a small-to-mid, full-thickness rotator cuff tear between July 2020 and October 2022. All patients underwent arthroscopic double-row repair. The nonsling group wore no sling, the sling group wore a sling, and the abduction pillow sling group wore a sling with an abduction pillow. The same rehabilitation program was performed. The Visual Analog Scale (VAS) score, Constant-Murley scores, and degrees of flexion and abduction were recorded preoperatively, on the 15th and 45th days, and at three months, six months, and one year. Results: On the 15th postoperative day, the VAS score was found to be significantly lower in the nonsling group. On the 45th day, the Constant-Murley score was found to be significantly higher in the abduction pillow sling group. There was no significant difference between the groups regarding the Constant-Murley scores at three weeks, six months, and one year. The shoulder forward flexion angle was significantly lower in the nonsling group on the 45th day. There was no significant difference between the three groups in respect of the shoulder forward flexion at three months, six months, and one year. Conclusion: No difference was determined between the groups at the six-month and one-year functional results. Not using a sling bandage can be recommended by reducing pain in the early postoperative period.

Spinal cord stimulation combined with exercise in patients diagnosed with persistent spinal pain syndrome. Study protocol for a randomized control trial.

Administration of spinal cord stimulation to individuals with PSPS-T1/2 may induce supraspinal descending activation. Similarly, exercise is recognized as a fundamental aspect of spinal pain management. Studies have demonstrated its impact on neurophysiological factors, including the release of spinal and supraspinal beta-endorphins, which activate μ-opioid receptors. Therefore, the purpose of this study will be to examine the effect of SCS in combination with lumbo-pelvic stability core training on perceived low back pain, quality of life and disability in PSPS-T2 patients. A double-blind randomized clinical trial (RCT) has been designed. All participants will be randomized from a pre-set sequence. The intervention design has been elaborated from the CONSORT guidelines. This study has been registered at Clinicaltrial.gov (NCT06272539). Sample size was calculated using G Power® Sample size software (University of Düsseldorf). The calculation was based on a moderate effect size of 0.7 (partial η2 = 0.70, α = .05, power = 0.95), resulting in a total of 40 patients. Assuming a 30% dropout rate, 52 participants will be recruited in total. Two sessions per week will be scheduled for 8 weeks with a total of 16 sessions. Each work session will have a duration of 60 minutes. The exercise will be adapted according to the phases based on the results already published, limiting in each phase the degrees of flexion and extension of the spine to avoid the risk of electrode migration. Primary outcomes will be functionality, satisfaction, strength, psychosocial variables, quality of life and pain perception.

Comparative analysis of hand dynamometer measurements across different arm positions: implications for rehabilitation and functional assessment

Background and Study Aim. Grip strength is a crucial measure of human physical capability, affecting activities from daily tasks to athletic performance. Variations in arm position during grip strength measurement may influence the results, which has significant implications for both rehabilitation and functional assessment. This study explores the impact of different arm positions on grip strength to enhance understanding of human biomechanics and inform rehabilitation and sports training practices. Material and Methods. Forty right-handed male volunteers (mean age 18.27 ± 0.90 years) participated in the study. Grip strength was measured using a CAMRY Model: EH101 hand dynamometer. Measurements were taken across four arm positions: seated with elbow extension, 90-degree elbow flexion, 90-degree elbow flexion with pronation, and 90-degree elbow flexion with supination. Each position was tested three times. The highest recorded value for each position was used for analysis. Results. The dominant right hand exhibited higher grip strength across all positions compared to the non-dominant left hand. Significant differences were noted, with the greatest grip strength in the extension position. Statistical analysis using paired t-tests indicated significant differences (p &lt; 0.001) between the right and left hands across all positions. Pearson correlation coefficients highlighted strong relationships between different arm positions. Multiple linear regression analysis showed significant predictors of grip strength variability based on arm position, age, and BMI. Conclusions. Arm position significantly influences grip strength performance, underscoring the importance of standardized positioning in ergonomics. Standardizing arm position can optimize performance and mitigate injury risks in activities requiring robust grip strength. These findings have practical implications for rehabilitation protocols, sports training programs, and ergonomic assessments. The results emphasize the need for consistency in grip strength evaluations to ensure accurate and reliable results.

Cretaceous bird from Brazil informs the evolution of the avian skull and brain

A dearth of Mesozoic-aged, three-dimensional fossils hinders understanding of the origin of the distinctive skull and brain of modern (crown) birds1. Here we report Navaornis hestiae gen. et sp. nov., an exquisitely preserved fossil species from the Late Cretaceous of Brazil. The skull of Navaornis is toothless and large-eyed, with a vaulted cranium closely resembling the condition in crown birds; however, phylogenetic analyses recover Navaornis in Enantiornithes, a highly diverse clade of Mesozoic stem birds. Despite an overall geometry quantitatively indistinguishable from crown birds, the skull of Navaornis retains numerous plesiomorphies including a maxilla-dominated rostrum, an akinetic palate, a diapsid temporal configuration, a small cerebellum and a weakly expanded telencephalon. These archaic neurocranial traits are combined with a crown bird-like degree of brain flexion and a bony labyrinth comparable in shape to those of many crown birds but substantially larger. Altogether, the emergent cranial geometry of Navaornis shows an unprecedented degree of similarity between crown birds and enantiornithines, groups last sharing a common ancestor more than 130 million years ago2. Navaornis provides long-sought insight into the detailed cranial and endocranial morphology of stem birds phylogenetically crownward of Archaeopteryx, clarifying the pattern and timing by which the distinctive neuroanatomy of living birds was assembled.

Outcome of mini open anterolateral rotator cuff repair by suture anchor

Background: Rotator cuff tears are a prevalent cause of shoulder pain and dysfunction, necessitating effective surgical interventions to restore function and alleviate symptoms. The mini open anterolateral rotator cuff repair technique using suture anchors has emerged as a promising approach, combining the advantages of arthroscopic and open surgery. This study aimed to evaluate the outcomes of mini open anterolateral rotator cuff repair with suture anchors, focusing on pain relief, range of motion, functional outcomes, complications, and radiographic assessments. Methods: A retrospective analysis was conducted on 30 patients who underwent mini open anterolateral rotator cuff repair. Patient demographics, surgical details, postoperative outcomes, complications, and radiographic findings were evaluated. Results: The average pain score significantly decreased from 7.8 (SD=1.2) preoperatively to 2.3 (SD=0.8) postoperatively (p&lt;0.001). Range of motion improved with an average increase from 60 to 150 degrees of abduction and from 50 to 140 degrees of flexion (p&lt;0.001). Functional outcomes, assessed by the American Shoulder and Elbow Surgeons (ASES) score, increased from 45 to 85 points (p&lt;0.001). Complications, including joint stiffness, pain, and re-tears, were effectively managed. Radiographic assessments demonstrated satisfactory healing and alignment in the majority of patients. Conclusions: Mini open anterolateral rotator cuff repair with suture anchors is an effective and safe surgical approach for managing rotator cuff injuries, leading to improved clinical outcomes and favorable radiographic findings. Further research is warranted to validate these findings and optimize treatment strategies.

Results of distraction and ligamentotaxis in thoracolumbar fractures without decompression

Background: Thoracolumbar fractures are common spinal injuries often requiring surgical intervention. Traditionally, decompression surgery has been used to relieve neural pressure. This study evaluates the effectiveness of ligamentotaxis with pedicular screw fixation, which minimizes the need for decompression, in treating thoracolumbar fractures. Methods: A retrospective cohort study was conducted at a Government Medical College, Aurangabad involving 30 patients aged 18 and older with thoracolumbar fractures treated with ligamentotaxis and pedicular screw fixation. Clinical outcomes were assessed using the visual analog scale (VAS) for pain, the American spinal injury association (ASIA) impairment scale for neurological function, and forward flexion degrees for spinal mobility. Patients were followed up for 12 months post-operatively. Results: Significant pain reduction was observed, with VAS scores decreasing from 8.5 pre-operatively to 2.5 at 12 months (p&lt;0.001). Neurological function improved, with many patients advancing from ASIA category A pre-operatively to category D by 12 months (p&lt;0.001). Spinal mobility showed considerable recovery, with forward flexion increasing from 0 degrees pre-operatively to 80 degrees at 12 months (p&lt;0.001). Conclusion: Ligamentotaxis with pedicular screw fixation is an effective treatment for thoracolumbar fractures, providing substantial pain relief, neurological improvement, and restored spinal function. While outcomes are generally positive, patient selection remains critical to avoid poor neurological results. Further research is needed to refine indications and optimize treatment protocols.

Static Stability of Elbow Interposition Arthroplasty Stabilized With Novel Ligament Reconstruction.

Outcomes of interposition arthroplasty for treatment of elbow arthritis are highly dependent on elbow stability. The purpose of this study was to determine whether interposition arthroplasty with a novel bidirectional ligament reconstruction technique could adequately restore the static stability of the native elbow. Static varus and valgus elbow stability was tested in 7 cadaver elbows with intact ligaments and capsule at 5 flexion angles (0°, 30°, 60°, 90°, and 120°). At each angle, the distance between fixed reference points across the elbow was measured both medially and laterally. The elbows were then destabilized and an interposition arthroplasty with ligament reconstruction was performed. Static elbow stability was reassessed by comparing postoperative deflection measurements with those of the native state. Graft slippage or loosening was visually assessed following testing. Interposition arthroplasty was performed in 7 cadaver specimens. Following ligament reconstruction, specimens reproduced the flexion angle-dependent static stability of native elbows to both varus and valgus stress. The greatest deflection changes between native elbows and elbows after interposition arthroplasty were 2.7% (P = .13) medially and 2.3% (P = .42) laterally, which were not significant. There was no loosening or slippage of either the interposition graft or the ligament reconstruction grafts. Cadaveric elbow specimens underwent interposition arthroplasty with a novel technique for bidirectional ligament reconstruction. Static stability was maintained at varying degrees of elbow flexion, comparable to that of the native elbow. Interposition and ligament reconstruction grafts maintained secure fixation following static biomechanical testing.

Effectiveness of Retraction 30 over Gross Stretch For Relieving Pectoralis Minor Tightness Among College Students

Background: The Pectoralis minor muscle originates from different 3 ribs and converges into one attachment point. Pectoralis minor shortening can contribute to many syndromes and impairments, especially at the shoulder. Some of them are impingement of the soft tissues, adhesive capsulitis etc. The prevalence of pectoralis minor tightness is very high in college-going students. The gross stretch is the stretching procedure that increases the length of the pectoralis minor muscle. This shoulder position produces tension in the muscle insertion in a posterior direction in conjunction with the scapular motion that is performed at flexion and elevation in the scapular plane, thereby lengthening the muscle. Retraction 30 is stretching with scapular retraction at 30 degrees of shoulder flexion; the flexion angle at 30 degrees can lengthen the muscle along the muscle fiber direction in the coronal plane. 30 degrees of flexion is considered to be more comfortable than a higher angle of flexion, as well as the angle is closest to the line of force Objectives of the study: To compare the effectiveness of gross stretch and retraction 30 in relieving pectoralis minor muscle tightness which can be co-operated in further treatment protocols. Study Design: Comparative Study Methodology: Two group pre–test–post–test design was used with purposive sampling. Selected subjects were allocated to two groups. Fourty subjects (20 males and 20 females) who fulfilled inclusion and exclusion criteria were recruited for the study. The independent variables are gross stretch and retraction 30 whereas the dependent variables were PMI (pectoralis minor index), pectoralis minor length test and Cervical Curvature. Result: This study results imply that retraction 30 is better when compared to gross stretch for correcting pectoralis minor tightness. Hence should be included as an inevitable part of stretching treatment. Practicing clinicians should continue to use evidence-based decisions when treating pectoralis minor tightness.

Effects of 60 degrees of flexion and perioperative use of tranexamic acid on recovery after knee replacement

Abstract OBJECTIVE To explore the effect of 60 knee flexion combined with multiple tranexamic acid application on postoperative recovery of knee replacement patients. METHODS Knee replacement patients admitted to our hospital from October 2020 to September 2022 were selected as the study subjects, and randomly divided into two groups. Postoperative D-dimer, prothrombin time and partial thrombin time were recorded in the two groups, and the differences between the two groups were compared. Erythrocyte, hemoglobin and erythrocyte volume were recorded before, 1 day and 3 days after surgery and the affected limb circumference were also assessed. RESULTS On the 1st and 3rd day after surgery, the red blood cells, hemoglobin, and hematocrit levels in the experimental group were higher than those in the control group, and the differences were statistically significant(P&amp;lt;0.05). The difference in VAS score and circumference between the two groups on the 1st day and 3rd day after surgery was compared, and the difference was statistically significant. The difference in VAS score and circumference was lower in the control group(P&amp;lt;0.05). After surgical treatment, knee joint function recovered, knee joint mobility and HSS score improved, and the difference between the experimental groups was statistically significant (P&amp;lt;0.05). CONCLUSION Perioperative 60-degree flexion combined with multiple tranexamic acids can significantly reduce blood loss in patients undergoing knee replacement surgery, increase red blood cells, hemoglobin levels and red blood cell volume on postoperative days 1 and 3, and reduce postoperative swelling of the affected limb.

Understanding gait alterations: trunk flexion and its effects on walking neuromechanics.

Evolutionary and functional adaptations of morphology and postural tone of the spine and trunk are intrinsically shaped by the field of gravity in which humans move. Gravity also significantly impacts the timing and levels of neuromuscular activation, particularly in foot-support interactions. During step-to-step transitions, the centre of mass velocity must be redirected from downwards to upwards. When walking upright, this redirection is initiated by the trailing leg, propelling the body forward and upward before foot contact of the leading leg, defined as an anticipated transition. In this study, we investigated the neuromechanical adjustments when walking with a bent posture. Twenty adults walked on an instrumented treadmill at 4 km h-1 under normal (upright) conditions and with varying degrees of anterior trunk flexion (10, 20, 30 and 40deg). We recorded lower-limb kinematics, ground reaction forces under each foot, and the electromyography activity of five lower-limb muscles. Our findings indicate that with increasing trunk flexion, there is a lack of these anticipatory step-to-step transitions, and the leading limb performs the redirection after the ground collision. Surprisingly, attenuating distal extensor muscle activity at the end of stance is one of the main impacts of trunk flexion. Our observations may help us to understand the physiological mechanisms and biomechanical regulations underlying our tendency towards an upright posture, as well as possible motor control disturbances in some diseases associated with trunk orientation problems.

Reliability and concurrent validity of the bubble inclinometer for visual estimation of straight leg raise in asymptomatic individuals

IntroductionThe straight leg raise (SLR) test is commonly used to investigate neurodynamic problems or hamstring muscle length. Visual estimation can be used to identify the degrees of hip flexion during the SLR test. However, intra-tester and inter-tester reliability, as well as concurrent validity, await formal investigation.MethodsThis study was an experimental study. Two testers, a novice and an experienced physical therapist, measured hip flexion angles during the SLR test using visual estimation for two sessions and the bubble inclinometer method during the first session in 31 asymptomatic participants, in random order. Intra-tester reliability (intraclass correlation coefficient, ICC&lt;sub&gt;3,3&lt;/sub&gt;), inter-tester reliability (ICC&lt;sub&gt;2,3&lt;/sub&gt;), concurrent validity (Pearson correlation with bubble inclinometer), and measurement error was represented as standard error of measurement (SEM) and minimal detectable change (MDC), were calculated.ResultsThe concurrent validity and intra-tester reliability of visual estimation for both testers were good (ICC&lt;sub&gt;3,3&lt;/sub&gt; = 0.885 with 95% confidence interval = 0.775–0.943, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and excellent (ICC&lt;sub&gt;3,3&lt;/sub&gt; = 0.904 with 95% confidence interval = 0.810–0.952, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), respectively. Inter-tester reliability of visual estimation was poor (ICC&lt;sub&gt;2,3&lt;/sub&gt; = 0.373 with 95% confidence interval = 0.027–0.639, &lt;i&gt;p&lt;/i&gt; = 0.018).ConclusionsAlthough the concurrent validity of visual estimation with the bubble inclinometer was good, and intra-tester reliability was excellent, the inter-tester reliability was poor. Therefore, caution should be exercised if more than one tester is involved in visual estimation.

Ankle Fractures Treated With Locked Fibular Intramedullary Nailing: Description and Outcomes of a Minimally Invasive Open Technique.

To describe and report outcomes of a minimally invasive open fibular intramedullary (IM) nailing technique for fixation of ankle fractures. Case Series. Urban Level 1 trauma center. Adult patients with ankle fractures (OTA 44A-C) treated with locked fibular IM nailing through a minimally invasive open technique for fracture and syndesmotic reduction between 2021 and 2024. Quality of reduction, complications, and patient-reported outcomes. A total of 150 consecutive patients operated by a single surgeon were included. Mean age was 53.3 (17-97) years, and mean body mass index was 30.6 ± 7.4 kg/m 2 . Ninety-three (62%) patients were female, and 78 (52%) patients were White. Seventy-two (48%) patients were obese, 40 (27.7%) patients were current/former smokers, 39 (26%) patients had diabetes, and 23 (15.3%) patients had open fractures. Thirty-seven (24.7%) patients had isolated lateral malleolus fractures, 48 (32%) had bimalleolar fractures, and 65 (43.3%) had trimalleolar fractures. One hundred and twenty-three (82%) patients had 2 syndesmotic screws placed, 26 patients (17.3%) had 1 screw, and 1 patient (0.7%) had none. Quality of reduction was good for 98%, fair for 2%, and poor for none per McLennan criteria. One hundred thirteen patients (75.3%) were followed until clinical and radiographic union for a mean of 7.6 months (range 3-22) months. One hundred and ten patients (97.3%) went on to successful clinical and radiographic union after the index procedure. No patient had a superficial surgical-site infection, and 3 (2.6%) had deep surgical-site infections. Three patients had a loss of reduction, and 6 patients had implant failure (5 broken syndesmotic screws, and 1 medial malleolus screw). Nine (8%) patients had unplanned reoperations (3 for debridement, 2 for loss of reduction, and 4 for removal of symptomatic implants). Mean ankle range of motion at final follow-up visit was 12.9 degrees (0-40) of dorsiflexion, 39.6 degrees (10-70) of plantar flexion, 23.5 degrees (5-40) of inversion, and 18.2 degrees (5-50) of eversion. Mean PROs at final follow-up visit were Global Physical Health: 42.4 (23.5-67.6), Global Mental Health: 47.5 (21-67.6), Physical Function: 37.5 (14.7-57.8), Pain: 54.9 (22-72), and Mobility: 36.9 (16-65.3). Minimally invasive open fibular IM nailing allowed for excellent reduction and results in union with low rates of complications and good patient-reported outcomes. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Total knee replacement with an accelerometer-based, hand-held navigation system improves knee alignment: reliable in all patients.

Achieving adequate alignment has traditionally been an important goal in total knee arthroplasty to achieve long-term implant survival. While accelerometer-based hand-held navigation systems (ABN) has been introduced as a way to achieve alignment, there is a limited body of evidence on its accuracy, especially in patients under 65 years with differing etiologies for knee arthritis. This study aimed to assess the precision of a specific ABN system in restoring the mechanical axis and report surgical variables and complications, with particular attention to younger patients. We conducted a retrospective review of 310 primary TKA performed with ABN from May 2016 to February 2021. The mean patient age was 67.4 (SD 8.9) years, with 43% under 65 years and mean body mass index of 33.2 (SD 6.8). The average surgical time was 96.8min (57-171) and the average follow-up was 3.3 years (1.9-6.7). Data regarding length of stay, pain, range of motion (ROM), complications, and reinterventions were collected from the institutional joint arthroplasty registry and the medical records. Preoperative mechanical axis measurements and postoperative radiological data, including mechanical axis, component alignment and mechanical alignment outliers were analyzed. The mean preoperative mechanical axis was 175.4° (SD 7.6), with 248 knees (80%) in preoperative varus. The mean postoperative mechanical axis was 179.5° (SD 1.96) with 98% of knees falling within ± 3° of the neutral mechanical axis. Only 6 knees (2 varus, 4 valgus) fell outside the ± 3° range. And 3 knees (1 varus, 2 valgus) fell outside the ± 5° range. In the sagittal plane, 296 knees (95.5%) knees were within ± 3° of goal of 3 degrees of femoral flexion and 302 (97.4%) knees were within ± 2° of goal 1° of slope for tibial component. Far outliers (alignment outside ± 5° of targeted position) were found in 3 knees. Factors such as posttraumatic arthrosis, previous surgery, presence of retained hardware, and age below 65 years were not associated with increase in alignment outliers and far outliers. No complications related to the navigation system were observed. There were 22 complications and 20 reoperations, including 2 revisions for periprosthetic joint infection and 1 revision for flexion instability. Patients that required knee manipulation achieved an ultimate flexion of 110° (SD 14.1). The ABN system proved to be user-friendly and accurate in reducing alignment outliers in both coronal and sagittal planes in all patient populations. It offers a straightforward navigation solution while preserving surgeon autonomy and the use of traditional surgical tools. These findings advocate for the integration of this navigation system as a valuable tool to enhance the precision of TKA surgery in all patient groups.

A finite element analysis of patellofemoral joint biomechanics: Exploring potential causes of postoperative anterior knee pain following unicompartmental knee arthroplasty

PurposeAnterior knee pain is a common complication following unicompartmental knee arthroplasty (UKA). This study aimed to elucidate the mechanism of anterior knee pain after UKA by examining the biomechanical characteristics of the patellofemoral joint. MethodsThis study employs the finite element analysis method. A healthy model of the right lower limb was created using CT scans of an intact right lower limb from a healthy woman. Based on this model, a preoperative pathological model was generated by removing the meniscus and part of the articular cartilage. The UKA prosthesis was then applied to this model with five different bearing thicknesses: 5 mm, 7 mm, 10 mm, 11 mm, and 13 mm. To simulate various degrees of knee joint flexion, the femur was rotated relative to the knee joint's rotational axis, producing lower limb models at flexion angles of 0°, 30°, 60°, 90°, and 120°. We applied a constant force from the center of the femoral head to the center of the ankle joint to simulate lower limb loading during squatting. The simulations were conducted using Ansys 17.0. ResultsBoth overstuffing and understuffing increased the peak stress on the patellar cartilage, with overstuffing having a more pronounced effect. Compared to healthy and balanced models, overstuffed and understuffed models exhibited abnormal stress distribution and stress concentration in the patellar cartilage during knee flexion. ConclusionOverstuffing and understuffing lead to residual varus or valgus deformities after UKA, causing mechanical abnormalities in the patellofemoral joint. These abnormalities, characterized by irregular stress distribution and excessive stress, result in cartilage damage, exacerbate wear in the patellofemoral joint and consequently lead to the occurrence of anterior knee pain.