Differences In Range Of Motion Research Articles

Total knee arthroplasty: does ultra-early physical therapy improve functional outcomes and reduce length of stay? A retrospective cohort study

BackgroundThe Enhanced Recovery After Surgery (ERAS) Society recommends that after total knee arthroplasty (TKA), patients should be mobilized early. However, there is no consensus on how early physical therapy should be commenced. We aim to investigate whether ultra-early physical therapy (< 12 h postoperatively) leads to better outcomes.MethodsThis is a retrospective cohort study of 569 patients who underwent primary TKA from August 2017 to December 2019 at our institution. We compared patients who had undergone physical therapy either within 24 h or 24–48 h after TKA. Further subgroup analysis was performed on the < 24 h group, comparing those who had undergone PT within 12 h and within 12–24 h. The outcomes analyzed include the Oxford Knee Scoring System score, Knee Society Scores, range of motion (ROM), length of stay (LOS) and ambulatory distance on discharge. A student’s t test, chi-squared test or Fisher’s exact test was used where appropriate, to determine statistical significance of our findings.ResultsLOS in the < 24 h group was shorter compared to the 24–48 h group (4.87 vs. 5.34 days, p = 0.002). Subgroup analysis showed that LOS was shorter in the ultra-early PT (< 12 h) group compared to the early PT (12–24 h) group (4.75 vs. 4.96 days, p = 0.009). At 3 months postoperatively, there was no significant difference in ROM, ambulatory distance or functional scores between the < 24 h group and 24–48 h group, or on subgroup analysis of the < 24 h group.ConclusionPatients who underwent physical therapy within 24 h had a shorter length of stay compared to the 24–48 h group. On subgroup analysis, ultra-early (< 12 h) physical therapy correlated with a shorter length of stay compared to the 12–24 h group (4.75 vs. 4.96 days, p = 0.009) - however, the difference is small and unlikely to be clinically significant. Ultra-early (< 12 h) physical therapy does not confer additional benefit in terms of functional scores, ROM or ambulatory distance. These findings reinforce the importance of early physical therapy after TKA in facilitating earlier patient discharge.

Open Bankart repair plus inferior capsular shift versus isolated arthroscopic Bankart repair in collision athletes with recurrent anterior shoulder instability. A prospective study

BackgroundOpen Bankart repair plus inferior capsular shift and isolated arthroscopic Bankart repair have never been prospectively compared under the concept of glenoid track in collision athletes with recurrent anterior shoulder instability. The aim of this study was to compare the functional outcomes, range of motion and recurrence rate between these two surgical techniques. We hypothesized that open Bankart repair plus inferior capsular shift would provide similar functional outcomes to isolated arthroscopic Bankart repair but with a lower recurrence rate. MethodsA prospective cohort study was conducted with 86 collision athletes divided into two groups of 43 patients each. All patients had a subcritical glenoid bone loss ≤ 13.5% and an on-track Hill Sachs lesion. The average follow-up was 66 (60-93) months for the open group and 68 (60-97) months for the arthroscopic group. The primary functional outcomes of each group were evaluated at baseline, 6 months, 1 year and for a minimum of 5 years after surgery. The functional outcomes were also compared between the two groups. The assessment tools included the WOSI and ASES scores. In addition, recurrent instability and range of motion were also evaluated. ResultsIn each group, there were significant differences in WOSI and ASES scores between the pre and postoperative periods. There were no differences between the groups at the end of follow-up (P = 0.47 and 0.22). Three dislocations (6.9%) in the open group and 10 dislocations (23.2%) in the arthroscopic group were reported showing significant differences (P = .012). In addition, there were no differences in range of motion between pre and postoperative periods for each group as well as between them. ConclusionWe found no differences in functional outcomes and range of motion between the two groups. The recurrence rate was significantly higher in the arthroscopic group. We recommend performing open Bankart repair plus inferior capsular shift as a treatment alternative in collision athletes with recurrent anterior shoulder instability.

Temporal Variability in Stride Kinematics during the Application of TENS: A Machine Learning Analysis.

The purpose of our report was to use a Random Forest classification approach to predict the association between transcutaneous electrical nerve stimulation (TENS) and walking kinematics at the stride level when middle-aged and older adults performed the 6-min test of walking endurance. Data from 41 participants (aged 64.6 ± 9.7 years) acquired in two previously published studies were analyzed with a Random Forest algorithm that focused on upper and lower limb, lumbar, and trunk kinematics. The four most predictive kinematic features were identified and utilized in separate models to distinguish between three walking conditions: burst TENS, continuous TENS, and control. SHAP analysis and linear mixed models were used to characterize the differences among these conditions. Modulation of four key kinematic features - toe-out angle, toe-off angle, and lumbar range of motion (ROM) in coronal and sagittal planes - accurately predicted walking conditions for the burst (82% accuracy) and continuous (77% accuracy) TENS conditions compared with control. Linear mixed models detected a significant difference in lumbar sagittal ROM between the TENS conditions. SHAP analysis revealed that burst TENS was positively associated with greater lumbar coronal ROM, smaller toe-off angle, and less lumbar sagittal ROM. Conversely, continuous TENS was associated with less lumbar coronal ROM and greater lumbar sagittal ROM. Our approach identified four kinematic features at the stride level that could distinguish between the three walking conditions. These distinctions were not evident in average values across strides.

Immediate effects of a vibrating foam roller on dorsiflexion rom, balance, and gait in stroke patients: a randomized controlled trial.

The purpose of this study was to investigate the immediate effects of vibration foam rolling on dorsiflexion range of motion (ROM), balance, and gait in stroke patients. Thirty stroke patients volunteered to participate and were randomly assigned to the vibrating foam roller group (n=15) and the foam roller group (n=15). The vibrating foam roller group performed a 30-min foam roller exercise program, with participants subjected to vibration at 28 Hz. The foam roller group performed the same exercise program as the vibrating foam roller group, but without vibration. Dorsiflexion lunge test, limits of stability, and Timed Up and Go were used to evaluate dorsiflexion ROM, balance, and gait before and after each intervention. The results revealed that the vibration foam roller group showed significant differences in dorsiflexion ROM and gait after the intervention, while the foam roller group exhibited a significant difference only in dorsiflexion ROM (P<0.05). In comparisons between the vibration foam roller group and the foam roller group, significant differences were observed in dorsiflexion ROM and gait (P<0.05). However, there were no significant differences in balance, both before and after the intervention, as well as in the comparisons between the two groups (P>0.05). This study confirmed that a single-session vibrating foam roller exercise program improves dorsiflexion ROM and gait in stroke patients. Further studies with extended exercise program durations are needed to address limitations and explore long-term effects.

Does the coronoid fracture in terrible triad injury always need to be fixed?

BackgroundThe ideal treatment of terrble triad injuries and whether fixation of coronoid process fractures is needed or not are still debated. Therefore, we aimed to investigate if terrible triad injuries necessitate coronoid fracture fixation and evaluate if non-fixation treatments have similar efficacies and outcomes as fixation-treatments in cases of terrible triad injuries.MethodsFrom August 2011 to July 2020, 23 patients with acute terrible triad injuries without involvement of the anteromedial facet of the coronoid process were included to evaluate the postoperative clinical and radiological outcomes (minimum follow-up of 20 months). According to the preoperative height loss evaluation of the coronoid process and an intraoperative elbow stability test, seven patients underwent coronoid fracture fixation, and the other eight patients were treated conservatively. The elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), and modified Broberg-Morrey score were evaluated at the last follow-up. In addition, plain radiographs were reviewed to evaluate joint congruency, fracture union, heterotopic ossification, and the development of arthritic changes.ResultsAt the last follow-up, the mean arcs of flexion-extension and supination-pronation values were 118.2° and 146.8° in the fixation group and 122.5° and 151.3° in the non-fixation group, respectively. The mean MEPSs were 96.4 in the fixation group (excellent, nine cases; good, tow cases) and 96.7 in the non-fixation group (excellent, ten cases; good, two cases). The mean modified Broberg-Morrey scores were 94.0 in the fixation group (excellent, sevev cases; good, four cases) and 94.0 in the non-fixation group (excellent, ten cases; good, tow cases). No statistically significant differences in clinical scores and ROM were identified between the two groups. However, the non-fixation group showed a significantly lower height loss of the coronoid process than the fixation group (36.3% versus 54.5%).ConclusionsThere were no significant differences in clinical outcomes between the fixation and non-fixation groups in terrible triad injuries.

Biomechanical Comparison of Anterior Cervical Plate Fixation Versus Integrated Fixation Cage for Anterior Cervical Discectomy and Fusion.

Cadaveric, biomechanic study. To compare the range of motion profiles of the cervical spine following one-level anterior cervical discectomy and fusion (ACDF) constructs instrumented with either an interbody cage and anterior plate or integrated fixation cage in a cadaveric model. While anterior plates with interbody cages are the most common construct of fixation in ACDF, newer integrated cage-plate devices seek to provide similar stability with a decreased implant profile. However, differences in postoperative cervical range of motion between the 2 constructs remain unclear. Six cadaveric spines were segmented into 2 functional spine units (FSUs): C2-C5 and C6-T2. Each FSU was nondestructively bent in flexion-extension (FE), right-left lateral bending (LB), and right-left axial rotation (AR) at a rate of 0.5°/s under a constant axial load until a limit of 2-Nm was reached to evaluate baseline range of motion (ROM). Matched pairs were then randomly assigned to undergo instrumentation with either the standard anterior cage and plate (CP) or the integrated fixation cage (IF). Following instrumentation, ROM was then remeasured as previously described. For CP fixation, ROM increased by 61.2±31.7% for FE, 36.3±20.4% for LB, and 31.7±19.1% for AR. For IF fixation, ROM increased by 64.2±15.5% for FE, 56.7±39.8% for LB, and 94.5±65.1% for AR. There was no significant difference in motion between each group across FE, LB, and AR. This biomechanical study demonstrated increased motion in both the CP and IF groups relative to the intact, un-instrumented state. However, our model showed no differences in ROM between CP and IF constructs in any direction of motion. These results suggest that either method of instrumentation is a suitable option for ACDF with respect to constructing stiffness at time zero.

Are Lower Passive Anterior Elevation and External Rotation at 6 Weeks Postoperatively Associated With Healing of Isolated Arthroscopic Supraspinatus Repairs?

Background: Despite advancements in surgical technique, failure of tendon healing remains a common problem after arthroscopic rotator cuff repair (ARCR). Purpose/Hypothesis: The purpose of this study was to examine the relationship between range of motion (ROM) recovery and healing after ARCR. It was hypothesized that an early loss of ROM would be associated with tendon healing. Study design: Case-control study; Level of evidence, 3. Methods: This was a retrospective comparative study of primary ARCR of isolated full-thickness supraspinatus (SSN) tendon tears. Cases were retrieved from a prospective rotator cuff repair database and divided into 2 groups based on healing (healed/nonhealed). A standardized clinical evaluation was performed before and at 6 weeks, 3 months, and 6 months after surgery. Collected data included passive and active ROM, visual analog scale for pain, and Constant score. Healing was assessed by ultrasound at 6 months. Results: Of 1397 eligible ARCRs, 1207 were included. The healing rate was 86.7%. Age was higher in the nonhealed group (57.8 ± 7.9 years vs 61.6 ± 8.8 years; P < .001). Patients with healed repairs had a larger decrease in passive anterior elevation (AE) from the preoperative to the 6-week postoperative visit (–31°± 28° vs −18°± 26°; P < .001), followed by a more substantial increase throughout the remaining follow-up period (32°± 23° vs 18°± 21°; P < .001). At 6 months postoperatively, there was no difference in AE between groups (159°± 17° vs 161°± 14°; P > .999). External rotation elbow at side (ER1) and internal rotation hand in the back (IR1) followed similar courses of recovery. Passive and active ROM had a strong positive correlation at each follow-up. Age (odds ratio [OR], 1.79; 95% CI, 1.45-2.23; P < .001) and 6-week passive AE (OR, 1.33; 95% CI, 1.20-1.48; P < .001) and ER1 (OR, 1.15; 95% CI, 1.03-1.29; P = .017) were predictors for nonhealing. Conclusion: Lower passive AE and ER1 at 6 weeks postoperatively and younger age are associated with healing after ARCR of isolated SSN tendon tears. At 6 months postoperatively, there were no differences in ROM, regardless of tendon healing.

Immediate Effects of Instrument-Assisted Soft-Tissue Mobilization Versus Dry Needling on Trigger Point Pain and Tightness of Calf Muscles in Long-Distance Runners.

Introduction Muscle tightness is frequently identified as a potential precursor to muscle injuries. Reclaiming flexibility and enhancing range of motion (ROM) is crucial for preventing injuries and achieving improvements in performance.The present study examines the immediate effects of instrument-assisted soft-tissue mobilization (IASTM) and dry needling (DN) in reducing trigger point pain and calf tightness in long-distance runners. Methodology A total of 40 long-distance runners were recruited in the study (30 males and 10 females). The procedure was performed under the author's surveillance at the sports complex. These recruited players were placed into two groups: the IASTM (n=20) and the DN (n=20) group.The outcome measures used were the pressure algometer for assessing pain pressure threshold and the lunge test. An iPhone Measure app (Measure app, Apple App Store 2023) is used to assess ankle dorsiflexion ROM. The evaluation took place both prior to and immediately following the interventionand 48 hours after the intervention. Result The analysis within each group revealed a significant alteration in pain pressure threshold for both the IASTM and DN groups (p≤0.05), along with a relative enhancement in ankle dorsiflexion ROMobserved in the IASTM group (p≤0.05). Between-group analysis revealed a notable difference with an effect size difference of Cohen's d=1.06 (large difference) in pain pressure threshold, d=0.21 (small difference) in lunge test, and d=0.57 (medium difference) in ankle dorsiflexion ROM. Conclusion The present study concludes that both groups, IASTM and DN, showed significant effects in improving pain pressure threshold in long-distance runners. However, DN showed better results. IASTM showed significant results in enhancing the ankle dorsiflexion ROM immediately. This implies thatit can be used in conjunction with stretching to decrease pain and enhance flexibility, hence improving performance and preventing injuries.

Neck stiffness and range of motion for young males and females

Well characterised mechanical response of the normal head-neck complex during passive motion is important to inform and verify physical surrogate and computational models of the human neck, and to inform normal baseline for clinical assessments. For 10 male and 10 female participants aged 20 to 29, the range of motion (ROM) of the neck about three anatomical axes was evaluated in active-seated, passive-lying and active-lying configurations, and the neck stiffness was evaluated in passive-lying. Electromyographic signals from the agonist muscles, normalised to maximum voluntary contractions, were used to provide feedback during passive motions. The effect of sex and configuration on ROM, and the effect of sex on linear estimates of stiffness in three regions of the moment–angle curve, were assessed with linear mixed models and generalised linear models. There were no differences in male and female ROM across all motion directions and configurations. Flexion and axial rotation ROM were configuration dependent. The passive-lying moment–angle relationship was typically non-linear, with higher stiffness (slope) closer to end of ROM. When normalising the passive moment–angle curve to active lying ROM, passive stiffness was sex dependent only for lateral bending region 1 and 2. Aggregate moment–angle corridors were similar for males and females in flexion and extension, but exhibited a higher degree of variation in applied moment for males in lateral bending and axial rotation. These data provide the passive response of the neck to low rate bending and axial rotation angular displacement, which may be useful for computational and surrogate modelling of the human neck.

Sex-Related and Performance Differences in Contractile Properties, ROM, Strength, and Dynamometry Performance of World-Class Flatwater Canoeists

The inclusion of women canoe in the Olympic Games reflects the growth and development that women have ahead of them in this modality. Therefore, the aim of this study was to explore sex and performance level differences in muscle contractile properties through Tensiomyography (TMG), range of motion (ROM), strength, and canoe-specific functional electromechanical dynamometry (FEMD) performance and establish performance differences between international medalists and non-medalists. Twelve male and nine female canoeists from the Spanish and Portuguese national canoe teams were assessed through TMG, ROM, strength, and canoe-specific isometric and incremental FEMD tests. Few sex and performance level differences were found in TMG and ROM; however, significant sex differences were found in the strength and FEMD tests. Male canoeists had a greater Fmax in Leg Press, Pm and Pmax in canoe position cable row, 1RM bench press and bench pull, Fm and Fpeak canoe-specific isometric FEMD test and number of strokes, and Fpeak and Pmax on the incremental FEMD test than females. International medalists showed a lower time until reaching Vmax and Pmax in Leg Press on both sides and a greater number of strokes and Fpeak in the maximal incremental FEMD test than non-medalists. This study reinforces the utility of the use of TMG and FEMD for assessing and monitoring world-class athletes.

Clinical Evaluation of Patients Over the Age of 75 Receiving Either Anatomic or Reverse Total Shoulder Arthroplasty: A Single Institution Retrospective Analysis

BackgroundAnatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) are proven surgical treatment options for both traumatic and degenerative conditions of the shoulder. Our objective is to report both clinical and patient reported outcomes (PROs) of patients over the age of 75 at the time of arthroplasty. We hypothesize no functional difference in outcomes between patient groups. MethodsPatients over the age of 75 at the time of surgery who received primary aTSA or rTSA between 2009 and 2020 with a minimum of two-year follow-up were selected. A retrospective chart review was performed. Patients 60-75 were included as a control group. 2:1 propensity matching using sex, CCI, preoperative forward elevation, and external rotation was used in selecting a comparison cohort of patients 60-75. Statistical analysis included t-test, Wilcoxon signed-rank test, and Chi-squared test. ResultsFor aTSA, 25 patients older than 75 years fit inclusion criteria. Mean follow-up time was 4.2 (2.0-12.0) years. ATSA patients over the age of 75 had significant improvements in forward elevation (FE) 111 to 141 degrees (p=0.007), external rotation (ER) 28 to 44 degrees (p<0.001), internal rotation (IR) Sacrum to L4 (p=0.002). There were also improvements in forward elevation strength (FES) 4+/5 to 5/5 (p=0.0303) and internal rotation strength (IRS) but not external rotation strength (ERS) from 4+/5 to 5/5 (p=0.097). There was no significant difference in range of motion (ROM), strength, or PROs between age groups (>75 years vs 60-74 years). For rTSA, 47 patients older than 75 years fit inclusion criteria. Average clinical follow-up was 3.5 (2.0-10.6) years. Patients demonstrated ROM improvements in ER (31 to 40 degrees, p=0.0413), FE (96 to 138 degrees, p= <0.001) but not IR (L5 to L4, p=0.3509). There were significant improvements in post operative strength in FES (4-/5 to 4+/5, p=<0.001), ERS (4-/5 to 4+/5, p=<0.001), and IRS (4/5 to 5/5, p=<0.001). The only significant difference between propensity matched age groups was postoperative IR (L4 to L5, p=0.013). There were no significant differences in PROs between different age groups. ConclusionsATSA and RTSA provide significant improvements in ER, FE ROM, ERS, FES, and IRS in patients over the age of 75 with no significant difference in outcomes compared to a younger cohort.

Development and in vivo biomechanics of goat mobile artificial lumbar spine complex

Mobile artificial lumbar complex (MALC) which suitable for reconstruction after subtotal lumbar resection in goats was developed,and to test stability of the complex and postoperative lumbar segmental motor function. Eighteen male boer goats aged from 1 to 2 years old (weighted from 35 to 45 kg) were selected and divided into control group,fusion group and non-fusion group,with 6 goats in each group. According to preoperative CT scans and MRI examinations of lumbar,the goat MALC was designed and performed by 3D printed for non-fusion group. Operation was performed on three groups respectively,and only vertebral body and disc were exposed in control group. In fusion group,L4 part of vertebral body and the upper and lower complete disc tissues were removed,and the lumbar spine bone plate fixation was performed with titanium mesh bone grafting. In non-fusion group,vertebral body and disc were removed in the same way,and MALC was implanted. AP and lateral X-rays of lumbar vertebrae in goat were taken at 6 months after surgery,in order to understand whether the plant was dislocated,displaced and fractured. Biomechanical tests were performed on the specimens by mechanical instrument to measure range of motion (ROM) of L2,3,L3,4,L4,5 intervertebral space and the overall ROM of L2-5 lumbar vertebrae. MALC of lumbar vertebra was designed by 3D printing,and its component artificial vertebrae and upper and lower artificial end plates were manufactured. The semi-spherical structure was fabricated by precision lathe using high-crosslinked polyethylene material,and the prosthesis was assembled. Postoperative AP and lateral X-rays of lumbar vertebra at 6 months showed the implant position of implant and MALC were good without displacement and dislocation. In vitro biomechanical test of lumbar vertebrae specimens:(1) There were no statistical significance in ROM of lumbar intervertebral space flexion and extension,lateral flexion and rotation on L3,4 and L4,5,between non-fusion group and control group (P>0.05),while ROM of fusion group was significantly reduced compared with the other two groups (P<0.05). There were no significant difference in ROM of L2,3 intervertebral flexion and extension,lateral flexion and rotation between non-fusion group and control group (P>0.05),while fusion group was significantly increased compared with the other two groups (P<0.001). (2) There was no significant difference in overall lumbar ROM of L2-5 (P> 0.05). The individual MALC could restore intervertebral height of lumbar vertebra while maintaining the stability of lumbar vertebra and re-establishing motor function of lumbar space.

O243: The effect of midcarpal fusions on dart thrower’s motion: a cadaveric study

Abstract Introduction Midcarpal osteoarthritis can be managed with several types of partial wrist fusion. Limited information is available regarding their effects on functional movement. Many daily activities require a coupled wrist movement, from radial extension to ulnar flexion, termed dart thrower’s motion (DTM). This study aimed to compare the effect of four different midcarpal fusions on DTM. Methods Twelve fresh-frozen cadaveric specimens were dissected. Sequential loading of tendons into radial extension and ulnar flexion enabled full DTM to be measured using goniometry. Specimens were tested at baseline and following each fusion, performed sequentially using Kirschner wires: (1) scaphocapitate fusion, (2) lunocapitate fusion with scaphoid excision, (3) four-corner fusion with scaphoid excision and (4) three-corner fusion with scaphoid and triquetral excision. A one-way ANOVA and Tukey test established the significance of differences in range of motion. Results Each procedure significantly decreased DTM compared with intact wrists. Scaphocapitate fusion resulted in the smallest mean reduction in movement from 78°–70° (p=0.0014). Four-corner fusion produced the greatest reduction in DTM from 78°–63° (p&amp;lt;0.0001). There was a significant difference in DTM between four-corner and scaphocapitate fusions (p=0.0338). There was no significant difference in the range of postoperative DTM between lunocapitate, three-corner, or four-corner fusions. Conclusion DTM was minimally affected by scaphocapitate fusion and maximally affected by four-corner fusion, with a significant difference seen between these two operations. However, as a 44°–87° range of DTM was maintained for four-corner fusions, this is felt to be adequate for function. These results could aid preoperative decision-making.

Incidence of patella baja and pseudopatella baja in aseptic revision total knee arthroplasty.

There are two variants regarding the low location of the patella in relation to the tibio-femoral joint line: patella baja (PB) and pseudo-patella baja (PPB). The purpose of this study is to investigate the incidence of PB and PPB in a cohort of patients that underwent revision total knee arthroplasty (rTKA) for aseptic reasons and describe any differences in each group's ROM. This retrospective study included 114 patients that underwent aseptic revision TKA surgery between 2017 and 2022. Patients were revised either for stiffness (Group 1) or aseptic loosening/instability (Group 2). The Insall-Salvati ratio (ISR) and Blackburne-Peel ratio (BPR) were used to evaluate the patellar position. ISR < 0.8 defined PB, while cases with ISR ≥ 0.8 and BPI < 0.54 were defined as PPB. ROM was measured and a subanalysis was conducted to investigate the progression of the values of ISR and BPR. 55 patients comprised Group 1, and 59 patients comprised Group 2. Overall, 13 cases (11.4%) had PB before rTKA and 24 (21%) had PB after rTKA. Cases with PPB were 13 (11.4%) before and 34 (29.9%) after rTKA. Group 1 patients presented with more PB before and after rTKA (12.8% vs 10.2% and 27.3% vs 15.2% respectively). However, after rTKA Group 1 patients presented with less PPB (20%) compared to Group 2 (39%) (p = 0.02). In Group 1, patients with PPB after rTKA had less ROM compared to those without PPB [83.2 (± 21.9) vs 102.1 (± 19.9) (p = 0.025)]. The subanalysis (69 patients) showed a statistically significant decrease in ISR before and after rTKA (p = 0.041), and from the native knee to post-rTKA (p = 0.001). There was a statistically significant decrease in BPR before and after rTKA (p = 0.001) and from the native knee to both pre- and post-rTKA (p < 001). After undergoing rTKA, the incidences of both patella baja (PB) and pseudo-patella baja (PPB) increased. Stiffness in the knee was associated with a higher incidence of PB, while non-stiffness cases showed a significantly higher incidence of PPB. Patients with stiff knees and PPB after rTKA experienced a significant reduction in range of motion (ROM). Additionally, the study revealed a noteworthy decrease in ISR and BPR with each subsequent surgery. This information is crucial for healthcare providers, as it sheds light on potential risks and outcomes of rTKA, allowing for improved patient management and surgical decision-making. III.

A Modified Arthroscopic Triple-row Repair Technique for L-shaped Delaminated Rotator Cuff Tears.

To compare the clinical outcomes of a modified arthroscopic triple-row (TR) repair technique with the suture bridge (SB) repair technique in treating L-shaped delaminated rotator cuff tears. Various surgical techniques for L-shaped delaminated rotator cuff tears have been reported, many of which aid in increasing the contact area and pressure of the rotator cuff. However, there is still debate over which technique yields superior results. From January 2017 to March 2020, 61 cases of L-shaped delaminated rotator cuff tears were included in this study. Of these, 34 cases underwent the modified arthroscopic triple-row repair technique, while 27 cases were addressed with the suture bridge repair technique. Functional assessment was conducted using the American Shoulder and Elbow Surgeons (ASES) score, the University of California Los Angeles (UCLA) shoulder score, the Constant score (CS), and the visual analogue scale (VAS) score. Magnetic Resonance Imaging (MRI) assessments for rotator cuff healing were performed at the 24-month postoperative mark. Statistical evaluations were conducted using SPSS for Windows (Version 25.0, IBM, Armonk, NY, USA), employing the Wilcoxon signed-rank test to compare preoperative and postoperative data and ROM differences, and the Mann-Whitney U test for statistical differences in clinical outcome scores between the two groups. A p-value of less than 0.05 was considered statistically significant. Comparative analysis of the preoperative and final follow-up scores revealed a substantial enhancement in shoulder function, as indicated by the ASES, UCLA, CS, and VAS scores, with statistical significance (p < 0.001). At both the preoperative stage and final follow-up, no notable differences were observed in ASES, UCLA, CS, and VAS scores between the two groups. However, the TR repair group exhibited lower VAS scores than the SB group at 1 and 3 months postoperatively. Active range of motion (ROM) showed significant improvement in both groups. No significant differences in ROM were noted between the two groups either before the surgery or at the final follow-up. The study demonstrates that both the modified arthroscopic TR and SB techniques for L-shaped delaminated cuff tears yield satisfactory outcomes, with no significant differences in overall clinical performance. Notably, early postoperative pain management appears more effective with the modified TR technique, suggesting its potential for enhanced early recovery experiences. This technique's design, promoting securer fixation and optimal contact conditions, is implied to facilitate superior long-term healing, warranting further investigation into its long-term benefits.

Disease severity versus pain severity: Range of motion differences during single- and multiplanar tasks in women with carpometacarpal osteoarthritis.

In carpometacarpal osteoarthritis (CMC OA) of the thumb, to what extent treatments should be directed by radiographic disease severity versus pain-based indicators remains an open question. To address this gap, this study investigated the relative impact of disease severity and pain severity on the range of motion in participants with CMC OA. We hypothesized larger differences would exist between extremes in the pain severity cohort than the disease severity cohort, suggesting pain modulates movement to a greater extent than joint degradation. Thirty-one female participants (64.6 ± 10.9 years) were grouped as symptomatic or asymptomatic (pain severity cohort) and early stage OA or end-stage OA (disease severity cohort) using radiographs and questionnaires. Kinematics were measured during single-planar and multiplanar range of motion tasks. Joint angle differences between groups were statistically compared. Differences in self-reported pain, function, and disability were evident in both participant cohorts. Notably, substantial distinctions emerged exclusively during multiplanar tasks, with a greater prevalence in the disease severity cohort compared to the pain severity cohort. Participants with end-stage OA also exhibited similar overall area covered during circumduction in comparison to those with early-stage OA, despite having a decreased range of motion at the CMC joint. The study underscores the importance of assessing multiplanar tasks, potentially leading to earlier identification of CMC OA. While movement compensations such as employing the distal thumb joints over the CMC joint were observed, delving deeper into the interplay between pain and movement could yield greater insight into the underlying factors steering these compensatory mechanisms.

Does having an external focus in immersive virtual reality increase range of motion in people with neck pain?

BackgroundWhen instructing exercises to improve Range of Motion (ROM), clinicians often create an internal focus of attention, while motor performance may improve more when using an external focus. Objectives: Using Virtual Reality (VR), we investigated the effect of tasks with an internal and external focus on maximal ROM in people with neck pain and explored whether this effect was associated with fear of movement. MethodIn this cross-over experimental design study, the cervical ROM of 54 participants was measured while performing a target-seeking exercise in a VR-environment (external focus task) and during three maximal rotation and flexion-extension movements with the VR-headset on, without signal (internal focus task). The main statistical analysis included two dependent T-tests. Pearson correlation coefficients were calculated to investigate whether the differences in ROM in both conditions were correlated to fear of movement. ResultsMaximal neck rotation was larger in the external focus condition than in the internal focus condition (mean difference: 26.4°, 95% CI [20.6, 32.3]; p < 0.001, d = 1.24). However, there was a difference favouring the internal focus condition for flexion-extension (mean difference: 8.2°, 95% CI [-14.9, −1.5]; p = 0.018, d = 0.33). The variability in ROM was not explained by variability in fear of movement (for all correlations p ≥ 0.197). ConclusionAn external focus resulted in a larger range of rotation, but our flexion-extension findings suggest that the task has to be specific to elicit such an effect. Further research, using a task that sufficiently elicits movement in all directions, is needed to determine the value of an external focus during exercise.

Dyslipidemia may impact initial recovery following arthroscopic rotator cuff repair: a retrospective study

BackgroundThe current literature shows that dyslipidemia can lead to a higher incidence of rotator cuff tears (RCTs) and an increased retear rate after repair. We aimed to evaluate the influence of preoperative dyslipidemia on postoperative pain, patient-reported outcomes (PROs), active range of motion (ROM), and structural integrity.MethodsA cohort of 111 patients who underwent arthroscopic RCT repair between January 2021 and July 2022, and whose complete preoperative serum lipid data were available within one week prior to surgery was retrospectively reviewed. Dyslipidemia was defined as the presence of an increase or decrease in at least one blood lipid profile (triglycerides, total cholesterol, low-density lipoprotein, high-density lipoprotein, or non-high-density lipoprotein). There were 43 patients in the dyslipidemia group and 68 in the ortholiposis group. Patient evaluations, including pain score, PROs, and ROMs, were conducted preoperatively; at 3 and 6 months postoperatively; and at the last follow-up. Structural integrity was assessed by magnetic resonance imaging (MRI) 6 months after surgery if possible, and Sugaya type 4 or 5 was considered a retear. Propensity score matching (PSM) was used to reduce bias.ResultsThe RCT size, surgical technique, preoperative pain status, PROs, and active ROM were comparable between patients with dyslipidemia and those with ortholiposis. Three months after surgery, patients in the dyslipidemia group had worse average PROs (Constant score: P = 0.001; ASES score: P = 0.012; UCLA score: P = 0.015), forward flexion (P = 0.012), and internal rotation (P = 0.001) than patients in the ortholiposis group did. The difference between the two groups persisted after PSM but disappeared at the sixth month after surgery. No significant differences in pain score, PROs, or active ROMs were detected between the dyslipidemia and ortholiposis groups after a mean follow-up of 24 months. Of the 72 patients who underwent MRI, 4 retears (5.6%) were found, and all were in the ortholiposis group. There was no difference in the rate of retears between the two groups (P = 0.291) or with (P = 0.495) PSM.ConclusionsIn conclusion, we found that perioperative dyslipidemia may impact initial recovery within the first 3 months following arthroscopic rotator cuff repair but may have no effect on pain, PROs, or active ROMs at a mean 2-year follow-up or rotator cuff integrity at 6 months postoperatively.Trail registration Retrospectively registered.

Limited total arc range of motion increases sheer stress in the shoulder while pitching in collegiate baseball pitchers.

Upper extremity injuries in baseball pitchers cause significant time-loss from competing and decreased quality of life. Although shoulder range of motion (ROM) is reported as a key factor to prevent potential injury, it remains unclear how limited glenohumeral ROM affects pitching biomechanics which may contribute to upper extremity injuries. To investigate how pitchers with decreased total arc glenohumeral ROM of the throwing arm differed in upper extremity pitching kinematics and kinetics as well as ball velocity compared to pitchers with greater levels of glenohumeral ROM. Cross-sectional Study. Laboratory. Fifty-seven baseball pitchers (ages 18-24) were divided into either control (≧160° total arc) or lower ROM (<160° total arc) groups. The mean glenohumeral ROM deficits, pitching kinematic and kinetic outcomes, and ball velocity were compared between groups. The control group demonstrated significantly less deficit in total arc ROM between arms than the lower ROM (Control: -1.5±10.0°, Lower ROM: -12.4±13.9°, p<.001). While, the lower ROM group displayed less maximal shoulder external rotation (ER) while pitching, the control group had significantly less difference in ROM between maximal shoulder ER while pitching and clinically-measured ER (Lower ROM: 64.4±12.1°, Control: 55.8±16.6°, p=.025). The control group had significantly faster ball velocity compared to the lower ROM group (Control: 85.0 ± 4.3mph, Lower ROM: 82.4 ± 4.8mph, p=.024). Pitchers with decreased total arc glenohumeral ROM (<160° total arc) may undergo over-stretching toward ER in the shoulder during the late cocking phase. Pitchers with higher total arc ROM can pitch the same or faster ball without increasing loading in the upper extremity. Total arc glenohumeral ROM measurement can be a clinical screening tool to monitor shoulder condition over the time, and pitchers with limited total arc ROM might be at higher risk of shoulder injury.

Teardrop Alignment Changes After Volar Locking Plate Fixation of Distal Radius Fractures With Volar Ulnar Fragments.

We assessed factors associated with change in radiographic teardrop angle following volar locking plate (VLP) fixation of volarly displaced intra-articular distal radius fractures with volar ulnar fragments (VUF) within the ICUC database. The primary outcome was change in radiographic alignment on follow-up imaging, defined as a change in teardrop angle from intra-operative fluoroscopy greater than 5°. Patients with distal radius fractures treated with a VLP within the ICUC database, an international collaborative and publicly available dataset, were identified. The primary outcome was volar rim loss of reduction on follow-up imaging, defined as a change in radiographic alignment from intra-operative fluoroscopy, teardrop angle less than 50°, or loss of normal radiocarpal alignment. Secondary outcomes were final range of motion (ROM) of the affected extremity. Radiographic Soong classification was used to grade plate position. Descriptive statistics were used to assess variables' distributions. A Random Forest supervised machine learning algorithm was used to classify variable importance for predicting the primary outcome. Traditional descriptive statistics were used to compare patient, fracture, and treatment characteristics with volar rim loss of reduction. Volar rim loss of reduction and final ROM in degrees and as compared with contralateral unaffected limb were also assessed. Fifty patients with volarly displaced, intra-articular distal radius fractures treated with a VLP were identified. Six patients were observed to have a volar rim loss of reduction, but none required reoperation. Volar ulnar fragment size, Soong grade 0, and postfixation axial plate position in relation to the sigmoid notch were significantly associated (P < .05) with volar rim loss of reduction. All cases of volar rim loss of reduction occurred when VUF was 10.8 mm or less. The size of the VUF was the most important variable for predicting volar rim loss of reduction followed by postfixation plate position in an axial position to the sigmoid notch and the number of volar fragments in the Random Forest machine learning algorithm. There were no significant differences in ROM between patients with volar ulnar escape and those without.