Difference In ROM Research Articles

Physical and technical attributes associated with on-water rowing performance in junior and elite rowers

ABSTRACT On-water rowing performance consists of the integration of physical and technical attributes. This exploratory study aimed to describe key physical and technical variables for elite and junior rowers and examine the associations and predictive capacity of these variables with on-water rowing performance outcomes. Twenty-eight junior (16 females, 16 ± 0.8 years and 12 males, 17 ± 0.7 years) and 24 elite rowers (12 females, 24 ± 2.7 years and 12 males, 27 ± 2.6 years) completed an on-water, single sculling biomechanics assessment combined with a series of physical, strength and power tests. Elite men and women were superior in mean gate force, distance per stroke and recovery distance compared to junior groups as determined by independent t-tests and effect size appraisal (p < 0.017, d > 1.2). Large associations (p < 0.01) were evident between anthropometry, strength and power assessments with the on-water measures of catch angle, mean gate force, recovery distance and boat speed. Differences in ROM and flexibility attributes did not distinguish between elite and junior rowers. Linear discriminant analysis revealed that individual rowers can be appropriately categorised by sex and performance level based on their physical and technical attributes. This battery of testing with world-class athletes represents an excellent level of ecological validity for the assessment of rowers pertinent to on-water performance.

The effect of different types of cupping therapy on acute changes in ankle dorsiflexion

IntroductionCupping therapy involves lifting and separating fascial tissue to facilitate stretching and promote blood flow. Although cupping is a common treatment modality for pain, various protocols exist and studies are inconsistent in regards to whether cupping improves outcomes such as range of motion. We aimed to determine the acute effect of different types of cupping therapy on ankle dorsiflexion. MethodsThirty-five generally healthy adults (mean ± SD; age: 22.1 ± 4.52 y; baseline ankle ROM: 34.68 ± 4.22°) were randomly assigned to one of four cupping therapy treatment groups: static, dynamic, static sham, or dynamic sham. Ankle ROM was measured using a digital inclinometer pre- and immediately post-intervention. ANCOVA was used to determine whether ROM differed between groups post-treatment when controlling for baseline ROM and the minimal detectable change (MDC) was used to determine clinical meaningfulness of the changes. ResultsBaseline ROM was significantly associated with post-intervention ROM (post-ROM: 38.41 ± 4.95°; p < .001), indicating an overall increase in ROM regardless of the intervention received. There was no difference in ROM between therapy groups post-intervention after controlling for baseline ROM. The dynamic cupping group experienced a change in ROM (baseline ROM: 34.11 ± 4.62°, post-ROM: 39.19 ± 6.44°) above the MDC (5.08°). ConclusionOur findings support cupping as a modality for improving ankle ROM in individuals with limited ROM. Dynamic cupping may be effective for improving ankle ROM due to the addition of functional movement. Clinicians may consider dynamic cupping as a potential intervention to address limited ankle ROM.

Comparison of wrist range of motion and muscle strength in assembly workers with and without lateral epicondylitis.

Lateral epicondylitis (LE), also called tennis elbow, is a common musculoskeletal disorder that causes pain in the elbow area and is highly prevalent in assembly workers who repeatedly move their wrists. The purpose of this study was to compare the wrist ROM and muscle strength of assembly workers with and without LE. Forty-five male assembly line workers (23 with LE) participated in the study. Participants had their wrist range of motion (flexion, extension, ulnar deviation, and radial deviation) and strength (wrist flexors, extensors, and hand grip) measured using Smart KEMA sensors. Workers with LE showed significantly reduced wrist extension and radial deviation ROM compared to workers without LE, with no significant differences in wrist flexion and ulnar deviation ROM between groups. Workers with LE had significantly lower wrist extensor strength compared to workers without LE, and there was no significant difference in wrist flexor and grip strength between the two groups. For workers with LE, the difference in wrist ROM and muscle strength will be useful for planning intervention and evaluating treatment outcomes for assembly workers with LE.

Comparative effects of myofascial release with and without eccentric resistance on pain, range of motion, and functional disability in patients with Achilles tendinopathy

BackgroundThe ankle is one of the most commonly injured areas in people with active and sedentary lives. Achilles tendinopathy (AT) is characterized by pain and stiffness that limits daily living work. Myofascial release and eccentric training are believed to improve soft tissue circulation, strength, pain, ROM, and function. ObjectiveTo compare the effects of myofascial release with and without eccentric resistance on pain, range of motion, and functional disability in patients with AT. MethodologyThis randomized clinical trial was conducted with a sample of 72 participants selected via a convenient sampling technique. Participants were divided into two groups, Group A was given myofascial release therapy, and Group B was given myofascial release with eccentric resistance. Numeric Pain Rating Scale (NPRS), Goniometer, and Foot ankle disability index (FADI) were outcome measure tools for pain, range of motion, and functional disability. The assessment was done at baseline, 2nd and 4th week. Mann-Whitney U Test and Friedman's ANOVA were applied to find between-group and within-group differences. P-value was set at ≤0.05. ResultsThere was a significant difference in pain (p = 0.03), plantarflexion ROM (p = 0.008), and functional disability (p = 0.02) between the two groups. However, no significant difference was observed in dorsiflexion (p = 0.06). Within-group differences were also significant (p < 0.05). ConclusionIt is concluded that myofascial release with eccentric resistance was more effective than myofascial release without eccentric resistance in improving pain, range of motion, and functional disability in Achilles tendinopathy.

Similar outcomes in collision athletes with subcritical glenoid bone loss and on-Track Hill Sachs lesion versus off-track Hill Sachs lesion managed with open Bankart repair plus inferior capsular shift.

Open Bankart repair plus inferior capsular shift has not yet been tested under the concept of glenoid track as a predictor of failure. The aim of this study was to compare the subjective and objective outcomes in collision athletes with subcritical glenoid bone loss and on-track Hill Sachs lesions versus those with off-track Hill Sachs lesions, all treated with open Bankart repair. Two study groups were created: 50 patients had on-track Hill Sachs lesions, while 38 had off-track lesions. The subcritical glenoid bone loss was ≤ 10%. A minimum follow-up period of 3 years was established. Preoperative and postoperative evaluation of each group and between them was performed. The Western Ontario Shoulder Instability Index score and the American Shoulder and Elbow Surgeons scale were used to assess subjective outcomes. Recurrence rate, range of motion and return to sport were evaluated as objective outcomes. Significant differences were reported in the WOSI and ASES scores between preoperative and postoperative values in each group. There were no significant differences between the two groups (p-value = 0.36 and 0.71). Three dislocations (6%) in the on-track group and 3 (7.8%) in the off-track group were recorded, showing no differences between the two groups (p-value = 0.83). There were no differences in ROM between pre- and post-operatively in each group or when comparing the two groups. We found no differences between the outcomes of the two groups. According to the surgeon's preference, we recommend performing open Bankart repair plus inferior capsular shift as a treatment alternative in collision athletes with SGBL ≤ 10% independently of the type of Hill Sachs lesion.

939 A Comparison of the Short-Term Outcomes Following Robotic-Assisted and Computer-Navigated Total Knee Replacements

Abstract Aim Total knee replacements (TKR) remain as one of the most effective procedures for restoring quality of life. Computer-navigated TKR (CN-TKR) have been consistently used for the last two decades whereas robotic-assisted TKR (RA-TKR) have been recently introduced into practice. The primary outcome of this study was to compare the early outcomes following RA-TKR and CN-TKR. Method This retrospective, single-centre, cohort study identified all the patients who underwent a TKR in the Golden Jubilee National Hospital by a single primary hip and knee replacement surgeon between 12th January 2021 and 22nd April 2022. Results were analysed for statistical significance. Results 111 patients underwent a TKR between January 2021 and April 2022. 26 patients underwent a RA-TKR using Stryker’s MAKO SmartRobotics and 85 patients underwent CN-TKR using B. Braun’s OrthoPilot®. Patients who had an RA-TKR were younger, with the average being 64 compared to 69. They also had a greater ROM pre-operatively, with an additional 9 degrees of movement on average. However, post-operatively there was no difference in ROM. There was no change in the mean length of stay (LOS), operation length, blood loss, Oxford score, EQ5-D score, and Forgotten Joint Score. At the 6-week follow-up, 96% of RA-TKR patients were either satisfied or very satisfied compared to 91% of CN-TKR patients. Conclusions This study found no significant difference in short-term clinical outcomes between RA-TKR and CN-TKR. However, a small sample size and a relatively short time frame in which data was collected limits this study to some extent and further research is recommended.

Paper 29: Incidental Teres Minor Atrophy in Patients Undergoing Arthroscopic Rotator Cuff Repair of the Supraspinatus Occurs Frequently and is Associated with Worse Postoperative Outcomes Without Higher Failure Rates

Objectives: Fatty infiltration and rotator cuff atrophy has been associated with poor clinical outcomes during rotator cuff repairs. Compared to supraspinatus and infraspinatus atrophy there has been minimal research on the effect of teres minor atrophy on surgical outcomes and failure rates in rotator cuff repairs. The purpose of this study was to assess the incidence and outcomes of arthroscopic rotator cuff repairs (ARCR) for partial and full thickness supraspinatus tears in patients with incidentally identified teres minor fatty infiltration. Methods: A consecutive series of 272 shoulders from 256 patients who underwent arthroscopic, double row transosseous equivalent repairs by 3 fellowship trained surgeons with minimum 1 years follow up for partial and full thickness tears of the supraspinatus tendon was reviewed. Revision repairs and concomitant subscapularis repairs were excluded. Preoperative MRI was reviewed to classify teres minor fatty infiltration using the modified Goutallier classification. Preoperative and postoperative range of motion, strength, visual analog scale (VAS), subjective shoulder value (SSV), Patient-Reported Outcomes Measurement Information System (PROMIS) mental/physical health, American Shoulder and Elbow Surgeons Shoulder Score (ASES), and Brophy shoulder activity scores were collected. Failure defined as a symptomatic retear identified on postoperative MRI or need for revision surgery was also collected. Paired t-tests, Chi-squared, and Fisher’s exact tests were utilized for continuous and binary variables, respectively. Statistical significance was at p &lt; 0.05. Results: A total of 106 patients met the inclusion criteria with 47 partial thickness tears and 59 full thickness tears. The average age of 67 and average follow-up of 30 months (range 10-92) were included. Tear size (16.37 vs 13.62, p = 0.30), and Goutallier classification of supraspinatus (0.51 vs 0.62, p =0.41), and infraspinatus (0.42 vs 0.47, p = 0.81) did not differ between the two groups. Incidental teres minor fat infiltration was present in 53% of cases with an overall frequency in Goutallier stage as follows: 47% - Grade 0, 38% - Grade 1, 14% - Grade 2, 1% - Grade 3, and 0% - Grade 4. For partial tears, postoperative PROMIS mental and physical scores were significantly better in those without teres minor fatty infiltration versus in those without (16.7 vs 14.3, p=0.01; 15.5 vs 13.5, p=0.02), while ROM, strength, and PROs were not statistically significant. For full tears, those without fat infiltration had statistically significantly better PROs on PROMIS physical (16.25 vs 14.07, p=0.01), ASES (83 vs 63, p=0.02), Brophy (8.3 vs 5.2, p=0.02), and SSV scores (94 vs 83, p=0.046). No other differences in ROM, strength, and other PROs were identified. No differences were identified for retear and revision rates among patients regardless of fatty infiltration (partial: retear, 7.7% vs 9.5%, p = 0.59; revision, 7.7% vs 9.5%, p = 0.59; revision, 12.5% vs 5.7%, p = 0.18). Conclusions: Our study demonstrates that incidentally noted teres minor fatty infiltration occurs in over 50% of patients undergoing arthroscopic rotator cuff repair for full thickness supraspinatus tears and is associated with worse postoperative outcome scores without higher failure rates. Compared to full thickness tears, teres minor atrophy in partial thickness tears showed a lesser effect on outcome scores with only significantly worse post operative PROMIS mental and physical scores. Identification of these patients preoperatively with strategies to optimize may be necessary to improve outcomes.

Operative Versus Nonoperative Treatment of Displaced Proximal Humerus Fractures in Adolescents: Results of a Prospective Multicenter Study.

Proximal humerus fractures (PHFx) constitute around 2% of all pediatric fractures. Although younger children with displaced fractures often undergo nonoperative treatments, optimal treatment for adolescents is not well defined. The study aimed to assess the outcomes of operative versus nonoperative treatment of displaced proximal humerus fractures in adolescents via a prospective multicenter study. This prospective study assessed adolescents aged 10 to 16 years with displaced PHFx from 2018 to 2022 at 6 level 1 trauma centers. Displacement criteria for inclusion were >50% shaft diameter or angulation >30 degrees on AP/lateral shoulder X-rays. Operative versus nonoperative treatment was decided by the treating physician. Radiographic and clinical data were collected at 6 weeks, 3, and 6 months. Patient-reported outcomes (PROs) included: Patient Reported Outcome Measures (PROMIS), Shoulder Pain and Disability Index (SPADI), and QuickDASH questionnaires. Patients were further grouped into a severe displacement cohort, defined as angulation >40° or displacement >75%. Clinical and radiographic data were compared between the 2 treatment cohorts. Out of 78 enrolled patients, 36 (46%) underwent operative treatment. Patients treated operatively were significantly older (13.5 vs. 12.2y, P <0.001) and exhibited greater mean angulation on AP shoulder view at presentation (31.1° vs. 23.5°, P <0.05). All PROs improved over time. At 6 weeks, operative patients demonstrated superior PROMIS upper extremity scores based on the minimally clinically important difference (MCID) (46.4 vs. 34.3, P =0.027); however, this distinction disappeared by 3 months. In a subanalysis of 35 patients with severe displacement, 21 (60.1%) underwent surgical intervention. No metrics showed significant differences between treatment modalities, with all PROs achieving population norm values by 3 months. Range of motion showed no difference between operative and nonoperative treatments, irrespective of fracture displacement. We found no differences in PROs and ROM between operative and nonoperative treatments of PHFx. If not contraindicated, nonoperative treatment may reduce healthcare costs and risks associated with surgery and should be considered for displaced adolescent proximal humerus fractures, irrespective of fracture displacement. II.

Gait kinematics differ by bout duration and setting

BackgroundGait kinematics differ between settings and among young and older adults with and without knee osteoarthritis. Out-of-lab data has a variety of walking bout characteristics compared to controlled in-lab settings. The effect of walking bout duration on gait analysis results is unclear, and there is no standardized procedure for segmenting or selecting out-of-lab data for analysis. Research questionDo gait kinematics differ by bout duration or setting in young and older adults with and without knee osteoarthritis? MethodsTen young (28.1±3.5 yrs), ten older adults (60.8±3.3 yrs), and ten older adults with knee osteoarthritis (64.1±3.6 yrs) performed a standard in-lab gait analysis followed by a prescribed walking route outside the lab at a comfortable speed with four IMUs. Walking speed, stride length, and sagittal hip, knee, and ankle angular excursion (ROM) were calculated for each identified stride. Out-of-lab strides included straight-line, level walking divided into strides that occurred during long (>60 s) or short (≤60 s) bouts. Gait kinematics were compared between in-lab and both out-of-lab bout durations among groups. ResultsSignificant main effects of setting or duration were found for walking speed and stride length, but there were no significant differences in hip, knee, or ankle joint ROM. Walking speed and stride length were greater in-lab followed by long and short bout out-of-lab. No significant interaction was observed between group and setting or bout duration for any spatiotemporal variables or joint ROMs. SignificanceOut-of-lab gait data can be beneficial in identifying gait characteristics that individuals may not encounter in the traditional lab setting. Setting has an impact on walking kinematics, so comparisons of in-lab and free-living gait may be impacted by the duration of walking bouts. A standardized approach for to analyzing out-of-lab gait data is important for comparing studies and populations.

Factors associated with knee osteoarthritis two years after anterior cruciate ligament reconstruction

PurposeTo determine factors that are associated with the presence and severity of radiologically confirmed knee osteoarthritis (OA) two years after anterior cruciate ligament reconstruction (ACLR). MethodsForty-one athletes with two years of ACLR participated in the study and completed the International Knee Documentation Committee 2000 (IKDC2000)and knee injury and osteoarthritis outcome score (KOOS) questionnaires. Limb-to-limb knee ROM differences were measured. Athletes completed knee radiographs. Medial- and lateral-compartment-OA were graded using Kellgren-Lawrence (KL) grades (Non-OA group (KL:≤1), OA group (KL:≥2; moderate (KL:2); severe (KL:3,4)). ResultsMedial-compartment-OA was found in 31.7% of athletes (Moderate:17.1%, Severe:14.6%) and lateral-compartment-OA in 19.5% (Moderate:12.2%, severe:7.3%). Age (r = 0.306) and BMI (r = 0.382) (p ≤ 0.014) correlated with medial-compartment-OA; while age (r = 0.433), BMI (r = 0.388), meniscus injury (r = 0.378), and injury-to-surgery time (r:0.376) (p ≤ 0.022) correlated with severe medial-compartment-OA. KOOS-Sport/Recreation (r = −0.386), IKDC 2000 (r = −0.343), and knee flexion ROM (r = −0.343) (p = 0.014) correlated with lateral-compartment-OA, while KOOS-Sport/Recreation (r = −0.376, p = 0.017) correlated with severe lateral-compartment-OA. ConclusionOlder athletes and high BMI were associated with medial-compartment-OA, while older athletes, high BMI, longer injury-to-surgery duration, and having a meniscus injury were associated with severe medial-compartment-OA. Lower KOOS-Sport/Recreation and IKDC2000 scores, and knee flexion ROM were associated with lateral-compartment-OA, while low KOOS-Sport/Recreation score was associated with severe lateral-compartment-OA.

Passive intervertebral restraint is different in patients with treatment-resistant chronic nonspecific low back pain: a retrospective cohort study and control comparison

PurposeIn vivo studies of continuous lumbar sagittal plane motion have found passive intervertebral motion to be more uneven in patients with chronic nonspecific low back pain (CNSLBP) than healthy controls, but the mechanisms are unclear. This study aimed to compare patients with CNSLBP with a matched group of pain-free controls for intervertebral restraint during passive recumbent bending.MethodsSeventeen patients with CNSLBP and minimal disc degeneration who had quantitative fluoroscopy investigations were matched to 17 healthy controls from a database acquired using the same imaging protocol. The entire database (n = 136) was examined for clustering of peaking times, magnitudes and ROM of the first derivatives of the intervertebral angle/motion curves (PTFD, PMFD and ROM) during flexion and return that might introduce confounding. The groups were then compared for differences in these variables.ResultsThere were significant segmental ROM differences among clusters in the database when PMFD and ROM were used as clustering variables, indicating heterogeneity. However, in the patient–control study, it was PTFD (velocity) that differentiated the groups. At L5-S1, this was at 10.82% of the motion path compared with 25.06% in the controls (p = 0.0002). For L4-5, PTFD was at 23.42% of the motion path in patients and 16.33% in controls (p = 0.0694) suggesting a reduced initial bending moment there. There were no significant differences for PMFD or ROM.ConclusionPeaking time of passive intervertebral velocity occurs early at L5-S1 in patients with CNSLBP; however, these findings should be treated with caution pending their replication. Future studies should explore relationships with altered disc pressures and biochemistry. Usefulness for monitoring regenerative disc therapies should be considered.

PHYSICAL AND TECHNICAL ATTRIBUTES ASSOCIATED ON-WATER ROWING PERFORMANCE IN JUNIOR AND ELITE ROWERS

INTRODUCTION &amp; AIMS On-water rowing performance consists of the integration of both physical and technical attributes. The aims of this exploratory study were to describe key physical and technical variables for elite and junior rowers and to examine the associations and predictive capacity of these variables with on-water rowing performance outcomes. METHODS Twenty-eight junior (16 females, 16 ± 0.8 years and 12 males, 17 ± 0.7 years) and 24 elite rowers (12 females, 24 ± 2.7 years and 12 males, 27 ± 2.6 years) volunteered to participate in the study. Participants completed an on-water single sculling biomechanics assessment combined with a series of physical, strength and power tests conducted in a high-performance training facility. RESULTS Descriptive analysis identified differences between junior and elite rowers separated by sex in several physical and on-water characteristics. Elite men and women were superior in mean gate force, distance per stroke and recovery distance compared to junior groups (P&amp;lt;0.0.17). Large correlations (P&amp;lt;0.01) were found between anthropometry, strength and power assessments with the on-water measures of catch angle, mean gate force, recovery distance and boat speed. Differences in ROM and flexibility attributes did not distinguish between elite and junior rowers, with other factors potentially involved. CONCLUSION This unique exploratory study combined a comprehensive physical assessment with an on-water single sculling biomechanical assessment to explore the interaction of physical attributes with on-water rowing technical variables. This battery of testing with world class athletes represents an excellent level of ecological validity for the assessment of rowers pertinent to on-water performance. The results provide a descriptive dataset of physical and technical characteristics for elite and junior rowers, of both sexes, which may be useful when evaluating the status of development rowers and to gauge the possibility of achieving further success in the sport.

The role of smoking status on survivorship and clinical outcomes following total shoulder arthroplasty

BackgroundSmoking has been strongly associated with poor healing and worse outcomes following various joint arthroplasties, including worse functional measurements and increased complication rates. While smoking is associated with adverse events and complications in shoulder arthroplasty, the role of smoking in functional measurements and patient-reported outcomes (PROs) remains to be fully characterized. MethodsInstitutional electronic medical records were used to study patients who underwent primary anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) between 2009 and 2020 with at least 2 years of follow-up. Patients were called to obtain PROs. Patients were stratified into 3 cohorts, by tobacco smoking status: current, former, and never smokers. ResultsAmong 498 patients who underwent TSA, 280 were aTSAs and 218 were rTSAs. Within aTSAs, 28 patients were classified as current, 99 as former, and 153 as never smokers. In rTSAs, 20 were current, 68 were former, and 130 were never smokers. Current smokers were younger at the time of surgery than former and never smokers in both aTSA (current: 58.8 ± 8.5; former: 63.9 ± 9.2; never: 62.8 ± 9.0 years; P = .031) and rTSA (current: 59.0 ± 6.8; former: 68.5 ± 7.2; never: 69.0 ± 9.0 years; P < .001). Furthermore, current smokers experienced lower 5-year implant survival in aTSA (current: 84.3%; former: 98.8%; never: 95.0%; P = .015) and rTSA (current: 82.4%; former: 94.5%; never: 94.1%; P = .004). No differences were found among the 3 cohorts for preoperative range of motion (ROM) and strength, or postoperative ROM and strength in the aTSA cohort. rTSA preoperative measurements demonstrated no differences in ROM and strength, and only postoperative forward elevation strength and external rotation strength were found to be different. PROs were found to be of similar magnitude for all patients in the aTSA and rTSA groups. ConclusionThe findings of this study indicate that current smokers exhibited a higher likelihood of necessitating TSA at a younger age and had higher implant failure rates. However, functional measurements were only marginally affected by smoking status.

Ankle and hindfoot motion of healthy adults during running revealed by dynamic biplane radiography: Side-to-side symmetry, sex-specific differences, and comparison with walking

This study aimed to characterize ankle and hindfoot kinematics of healthy men and women during overground running using biplane radiography, and to compare these data to those previously obtained in the same cohort during overground walking. Participants ran across an elevated platform at a self-selected pace while synchronized biplane radiographs of their ankle and hindfoot were acquired. Motion of the tibia, talus, and calcaneus was tracked using a validated volumetric model-based tracking process. Tibiotalar and subtalar 6DOF kinematics were obtained. Absolute side-to-side differences in ROM and kinematics waveforms were calculated. Side-to-side and sex-specific differences were evaluated at 10 % increments of stance phase with mixed model analysis. Pearson correlation coefficients were used to assess the relationship between stance-phase running and walking kinematics. 20 participants comprised the study cohort (10 men, mean age 30.8 ± 6.3 years, mean BMI 24.1 ± 3.1). Average absolute side-to-side differences in running kinematics waveforms were 5.6°/2.0 mm or less at the tibiotalar joint and 5.2°/3.2 mm or less at the subtalar joint. No differences in running kinematics waveforms between sides or between men and women were detected. Correlations were stronger at the tibiotalar joint (42/66 [64 %] of correlations were p < 0.05), than at the tibiotalar joint (38/66 [58 %] of correlations were p < 0.05). These results provide a normative reference for evaluating native ankle and hindfoot kinematics which may be informative in surgical or rehabilitation contexts. Sex-specific differences in ankle kinematics during overground running are likely not clinically or etiologically significant. Associations seen between walking and running kinematics suggest one could be used to predict the other.

Intermittent tourniquet compared to throughout tourniquet use during Total Knee Arthroplasty in patients with Body Mass Index of 30 or more: A retrospective cohort study

BackgroundTourniquet use during total knee arthroplasty (TKA) reduces bleeding which optimises bone-cement interface for prosthesis stability and improves surgical field visualisation. However, prolonged usage can lead to complications and poorer outcomes. Some surgeons advocate for intermittent tourniquet application. Limited literature exists for patients with high body mass index (BMI). This study aims to compare the outcomes of intermittent tourniquet (IT) to throughout tourniquet (TT) use among obese patients undergoing primary TKA for knee osteoarthritis. MethodsThis was a retrospective cohort study. In the TT group, tourniquet was inflated from the beginning and released once the bone cement has hardened. In the IT group, tourniquet was inflated at the beginning, released after initial incision and haemostasis, then inflated again during cementation. Tourniquet was released once the bone cement had set. Categorical outcome measures were analysed using Chi-squared or Fisher's exact test. T-test or Kruskal-Wallis test were used for continuous data. ResultsWhen comparing IT to TT among patients with BMI≥30 (IT n = 48, TT n = 47), the mean duration of surgery was shorter in the TT group (p < 0.05). The difference in haemoglobin drop between the two groups was not statistically significant from post-operative day three onwards. There was no difference in transfusion rate (p > 0.05). ROM was greater in the IT group up to three weeks post-operatively (p < 0.05). When comparing patients with BMI <30 (n = 71) and BMI≥30 (n = 48) with IT use, there was no statistically significant difference in ROM and LOS. ConclusionPatients with BMI≥30 in the IT group had greater ROM in the initial post-operative period. Although operative time and blood loss were greater among the IT group, there was no difference in transfusion rate. Outcomes of TKA performed with IT were similar for patients with BMI≥30 and BMI <30. The authors recommend intermittent tourniquet use during TKA for patients with BMI≥30. Level of evidence3.

The influence of women’s age and fall history on foot and lower limb kinematics during transition step descent

Falls are a major public health concern, with older women being at the greatest risk to experience a fall. Step descent increases the likelihood of a fall injury, yet the influence of age and fall history on lower extremity kinematics have not been extensively studied. The purpose of this study was to examine lower extremity and foot kinematics of women with and without a fall history during single step descent. Hip, knee, and foot kinematics of young women (n = 15, age = 22.6 ± 3.2 years), older women with no recent falls (n = 15, age = 71.6 ± 4.4 years), and older women with a fall history (n = 15, age = 71.5 ± 5.0 years) as they descended a 17 cm step were examined. Differences in initial contact angles and ROM during landing were examined with between group MANOVA tests. Distal foot initial contact angles were not significant between groups. For range of motion, both older groups went through greater hip extension (p = 0.003, partial η2 = 0.25), but less hip adduction (p = 0.002, partial η2 = 0.27) and less lateral midfoot dorsiflexion (p = 0.001, partial η2 = 0.28) than the younger women. The older fall group had reduced knee flexion (p = 0.004, partial η2 = 0.23) than the younger group, and the older non-fallers slightly plantarflexed at the medial midfoot (p = 0.005, partial η2 = 0.23) while the young women dorsiflexed. Thelanding phase ROMdifferences exhibited by the older adult groupsmayincrease the likelihood of a misstep, which may result in a fall.

Comparison of midterm efficacy of Kirschner wires and elastic intramedullary nails after closed reduction of Judet type 3 radial neck fractures in children: a multicenter study.

The objective of this study was to compare the midterm efficacy of Kirschner wires and elastic intramedullary nails after the closed reduction treatment of Judet 3 radial neck fractures in children. This was a retrospective multicenter study of patients diagnosed with Judet type 3 radial neck fractures who underwent closed reduction and internal fixation at four tertiary hospitals from January 2019 to December 2021. Gender, age, fracture type, operation time, follow-up time, x-ray results and complications were collected. The recovery of elbow joint between the two internal fixation methods, elbow motion and complications at the last follow-up were compared. The average operation time of EIN group was statistical significantly increased compared with KW group. There were no significant differences in MEPS score and ROM 3 months after surgery between the two groups, but the ROR Angle of EIN group was statistical significantly increased compared with KW group 3 months after surgery. There were no significant differences in MEPS score, ROM and ROR at the last follow-up. The incidence of complications in EIN group was significantly lower than that in KW group. The use of elastic intramedullary nails fixation or Kirschner wires fixation in the treatment of radial neck fractures in children can both achieve satisfactory fracture reduction and healing. Compared with elastic intramedullary nails, the operation time of Kirschner wires fixation is shorter, and the internal fixation does not need to be removed under anesthesia again, but the complication rate is higher.

Comparative effects of modified rotary scarf osteotomy and traditional scarf osteotomy in treating moderate to severe hallux valgus: a retrospective cohort study

BackgroundTraditional Scarf osteotomy (TSO) is an effective procedure with a good record in moderate to severe hallux valgus (MSHV) surgery. In order to overcome shortcomings of TSO, Modified Rotary Scarf osteotomy (MRSO) was introduced in this study, which aimed to compare the clinical and radiological outcome in the patients treated with MRSO or TSO.MethodsOf 175 patients (247 feet) with MSHV, 100 patients (138 feet) treated with MRSO and 75 patients (109 feet) treated with TSO were evaluated according to relevant indicators in twenty-four months follow-up. Pre-surgical and post-surgical HVA, IMA, DMAA, MTP-1 ROM, sesamoid grade and AOFAS (American Orthopaedic Foot and Ankle Society) scores and postsurgical complications were evaluated.ResultsBoth groups manifested similar baseline characters. The mean follow-up was of 25.9 (range, 22–37) months. Significantly lower IMA, lower Sesamoid grade and higher DMAA at six months, twelve months and twenty-four months post-surgically had been showed in MRSO group compared to TSO group. There was no significant difference in HVA, MTP-1 ROM and AOFAS data at each follow-up time point post-surgically between the two groups. No major complications occurred in either group.ConclusionMRSO showed comparable results to TSO, and improved IMA and sesamoid grade to a greater extent, with a lower probability of throughing effect. Although DMAA could be increased by MRSO, MRSO could still be a reproducible, non-dangerous and efficacious alternative procedure for treating HV patients which do not have severe DMAA.

ADJUNCT CPM THERAPY DOES NOT APPEAR TO IMPROVE THE ROM ACHIEVED AFTER MUA FOR STIFFNESS IN TOTAL KNEE ARTHROPLASTY

Stiffness is reported in up to 16% of patients after total knee replacement (TKR)1. Treatment of stiffness after TKR remains a challenge. Manipulation under anaesthesia (MUA) accounts for between 6%-36% of readmissions following TKR2,3. The outcomes of MUA remain variable/unpredictable. Post-operative CPM is used as an adjuvant to MUA, potentially offering improved ROM, however, remains the subject of debate. We report a retrospective study comparing MUA with and without post-operative CPM.In our institution patients undergoing MUA to receive CPM post-operatively. Owing to the COVID-19 pandemic hospital admissions were limited. During this period MUA procedures were undertaken without CPM. Two cohorts were included: 1) MUA + post-operative CPM 2) Daycase MUA. Patients’ demographics, pre-manipulation ROM, post-MUA ROM, and ROM at final follow-up were recorded.Between 2017-2022 126 patients underwent MUA and were admitted for CPM and 42 had daycase MUA. The median Age was 66.5 and 64% were female. 57% had extension deficit (&gt;5o), 70% had flexion deficit (&lt; 90o), and 37% had both. The mean Pre-operative ROM was 72.3o(SD:18.3o) vs. 68.5o(19.0o), ROM at MUA was 95.5o(SD:20.7o) vs 108.3o(SD:14.1o) [p&lt; 0.01], and at final follow-up 87.4o(SD:21.9o) vs. 92.1o(SD:18.2o) for daycase and CPM groups respectively. At final follow-up for the daycase and CPM groups respectively 10% vs. 7% improved, 29% vs. 13% maintained, and 57% vs. 79% regressed from the ROM achieved at MUA. The mean percentage of ROM gained at MUA maintained at final follow-up was 92%(SD:17) and 85%(SD:14)[p=0.03] for daycase and CPM groups respectively.There was no significant difference in ROM achieved at final follow-up despite the significantly greater improvement in ROM achieved at MUA for the CPM group. The CPM group lost a greater ROM after MUA (15% vs. 8%). We conclude that post-operative CPM does not improve ROM achieved after MUA.

Robotic-assisted total knee arthroplasty results in decreased incidence of anterior femoral notching compared to posterior referenced instrumented total knee arthroplasty.

Periprosthetic fracture (PPF) is an uncommon but devastating complication after total knee arthroplasty (TKA). Anterior femoral notching (AFN) is one of a perioperative risk factor for PPF. The main purpose of this study was to compare between the rates of anterior femoral notching (AFN) and supracondylar periprosthetic femoral fracture (sPPF) of manual TKA and robotic arm-assisted TKA (RATKA). Meanwhile, blood loss, transfusion rates, inflammatory responses, complications, early clinical and radiological outcomes were also assessed. This retrospective study included 330 patients (133 RATKA and 197 manual TKA). Differences in risks of inflammatory, blood loss, complications (periprosthetic fracture and periprosthetic joint infection), pre-operative and post-operative distal lateral femoral angle (LDFA), distal femoral width (DFW), prosthesis-distal femoral width (PDFW) ratio, AFN, femoral component flexion angle (FCFA), peri-operative and post-operative functional outcomes between the RATKA and manual TKA groups were compared. The operation time and postoperative CRP level in the RATKA group was significantly longer and higher than that in the manual TKA group (p < .001). However, there was no significant difference in postoperative WBC level (p = .217), hemoglobin loss (p = .362), postoperative drainage (p = .836), and periprosthetic fracture (p = 1.000). There was no significant difference in LDFA (p > .05), DFW(p = .834), PDFW ratio (p = .089) and FCFA (p = .315) between the two groups, but the rate of AFN in the RATKA group was significantly lower than that in the manual TKA group (p < .05). There was no significant difference in ROM between the two groups on POD3, POD 90 and 1 year (p < .05), but the FJS-12 score in the RATKA group was higher than that in the manual TKA group on 1 year (p = .001). Robotic-assisted total knee arthroplasty can decrease the incidence of anterior femoral notching compared to posterior referenced instrumented total knee arthroplasty.