Early Motion Exercises Research Articles

A Preclinical Assessment of Early Continuous Passive Motion and Treadmill Therapeutic Exercises for Generating Chondroprotective Effects After Anterior Cruciate Ligament Rupture

Background: Anterior cruciate ligament (ACL) injury is a well-known risk factor for the development of posttraumatic osteoarthritis (PTOA). However, whether using continuous passive motion (CPM) with or without additional treadmill exercise (TRE) in early ACL injury might provide chondroprotective effects and further decrease the risk of PTOA has yet to be determined. Hypothesis: CPM may offer an enhanced chondroprotective effect, but TRE may attenuate that effect due to the mechanical stress on the joint and inflammatory cytokines in the joint. Study Design: Controlled laboratory study. Methods: Thirty adult New Zealand White male rabbits were randomly allocated to sedentary (SED), CPM, TRE, or CPM+TRE groups. Each rabbit underwent an ACL transection (ACLT) on the right knee, with the contralateral knee used as an internal control (sham). The 4 joint surfaces (ie, medial and lateral femoral condyles and tibial plateaus) were evaluated 4 weeks after surgery for gross appearance, histological characteristics, and quantitative osteoarthritis (OA) scores. Results: Overall, at the end of testing, the CPM group experienced the best protective therapeutic effects in all compartments. In gross appearance, CPM resulted in normal articular surfaces, while the TRE and SED groups exhibited surface abrasion. Histological analysis showed significant differences in articular cartilage status. The CPM group had significantly better histological OA scores (P < .01), corresponding to the smoothest cartilage surface and sound chondrocyte and collagen arrangement. This group also showed abundant glycosaminoglycan (GAG) content and a sound growth microenvironment, with significantly lower expression levels of the inflammatory cytokine tumor necrosis factor α and the apoptotic marker caspase 3. In contrast, the TRE and SED groups showed several features of damage: distinct graded cartilage abrasion; damaged collagen fibers, corresponding to noticeable collagen type X (osteoarthritic cartilage); reduced cartilage thickness; fewer cartilaginous cells; and the appearance of chondrocyte clusters. These groups also showed loss of GAG, corresponding to higher levels of inflammatory cytokines and apoptosis of articular chondrocytes. Furthermore, the CPM+TRE group displayed visible pathological changes in the superficial cartilage, indicating that early loading exercise may contribute to osteoarthritis. The sham treatment showed no difference in the changes in all compartments between groups. Conclusion: Immediate CPM therapy produces a superior in situ microenvironment for reducing the occurrence of PTOA after ACL injury without reconstruction in rabbits. Clinical Relevance: These data suggest that immediate application of CPM therapy may be necessary to create a sound microenvironment in joints and possibly to decrease the risk of PTOA without or while awaiting ACL reconstruction. In contrast, both early active loading exercise and inactivity lead to the development of PTOA.

Treatment of Acute Achilles Tendon Rupture with a Standardized Protocol in Normal Clinical Setting

Category: Trauma Introduction/Purpose: Achilles tendon rupture (ATR) is a common trauma among active people. Recent high-quality randomized studies, have shown that using a standardized treatment protocol with early weight-bearing and controlled early range-of-motion exercises provides similar clinical outcome than operative treatment without surgery-related complications. The purpose of this study was to find out whether the clinical results and complication rates of standardized treatment protocol in normal clinical setting with non-selected population correspond to those achieved in RCT studies. Methods: A treatment protocol modified from RCT studies of acute ATR was implemented in standard clinical care of Tampere University Hospital in 2008. Both conservative protocol and postoperative care protocol were based on early weight bearing and early range-of motion exercises. All patients treated due to acute ATR in our hospital during 2008 – 2014 (n=514) were included in the study. The patient records were retrospectively evaluated. Results: 514 acute ATRs were treated. 407 (79.2%) of the patients were men and 107 (20,8%) women. The mean age of all patients was 47.2 years. In female patients the mean age was 47.0 years, in males 47.9 years. 239 (46%) of the ATRs were treated operatively and 275 (54%) non-operatively. The proportion of operatively treated patients declined from 70% (2008) to 21% (2014). The mean age of patients in the operative group was 39.7 years and 53.7 years in the non-operative group. The rerupture rate was 4.6% in operative and 5.8% in the non-operative group. 10,4% of patients in operative group had wound problems. Unsatisfactory clinical outcome was reported in 5,0% of the patients in the operative group and in 6,9% of the non-operative group. Conclusion: Our results show that the treatment of acute ATR in our clinic has changed remarkably during the years 2008 to 2014. In 2008 70% of acute ATRs were treated operatively whereas in 2014 only 21%. Our study shows that it is possible to implement a similar treatment protocol than used in the controlled study setting as a part of the daily clincal care. The most important finding, however, is that the clinical outcome of the patients seems to be fully comparable to the clinical results achieved in RCT-study settings despite the heterogenity of the treated patients and medical staff.

Difference between early versus delayed postoperative physical rehabilitation protocol following arthroscopic rotator cuff repair

Early passive motion exercise has been the standard rehabilitation protocol following rotator cuff repair. However, recent research studies show that longer immobilization may enhance tendon healing. The aim of this study was to compare early passive range of motion (ROM) exercise with a delayed rehabilitation protocol with regard to the effectiveness of stiffness reduction and functional improvements and rates of tendon healing in patients undergoing arthroscopic repair for torn rotator cuffs. This study was performed on 164 patients having a full-thickness tear of the supraspinatus muscle that was repaired using the arthroscopic single-row suture anchor technique along with subacromial decompression. The patients were divided into two groups, early (group 1) and delayed ROM (group 2). In group 1, 78 patients were started on passive elevation and rotation exercises on the second day after surgery. In group 2, 86 patients had their shoulder immobilized for 6 weeks, after which passive motion exercise was started. Patients were followed-up clinically for a minimum of 12 months, and rotator cuff healing was assessed using MRI. Both groups had a statistically significant difference between preoperative and postoperative results. As regards American Shoulder and Elbow Surgeon scores, the early group improved from 45.4 preoperatively to 90.9 postoperatively (P<0.0001) and the delayed group improved from 44.59 preoperatively to 91.6 postoperatively (P<0.0001). As regards Constant score, the early group improved from 35.7 preoperatively to 86.5 postoperatively (P<0.0001) and the delayed group improved from 37.8 preoperatively to 88.1 postoperatively (P<0.0001). However, there were no statistically significant differences in rotator cuff healing between the two groups. The follow-up mean of visual analog scale was significantly better in group 2 compared with group 1 at 6 weeks postoperatively but no difference was found after 3 months. In contrast, ROM was better in group 1 compared with group 2 at 6 months postoperatively but no difference was found after 1 year. Significant improvement in pain, ROM, and function after arthroscopic rotator cuff repair was seen at 1 year postoperatively, regardless of early or delayed postoperative rehabilitation protocols. However, early motion increases pain scores and may increase the possibility of rotator cuff retear but with early regain of ROM. A delayed rehabilitation protocol with immobilization for 6 weeks would be better for tendon healing without risk for retear or joint stiffness and easily convalescence with less postoperative pain.

External immobilization of index finger collateral ligament injuries using an improvised frame

Background: Proximal interphalangeal joint (PIPJ) dislocation is a common injury. Current management of instability after closed reduction is repair of the torn ligament followed by immobilization. Important sequelsafter prolonged immobilization include stiffness. On the other hand, early motion exercise may cause rerupture. Buddy taping has been used to partially stabilize the injured finger which also allows early gentle motion.However, this technique cannot be applied to collateral ligament injury of a border finger such as the radial collateral ligament of the index or ulnar collateral ligament of the little finger. Objectives: To describe functional outcomes after application of a frame improvised from a standard disposable syringe in cases of index radial collateral ligament injury. Methods: We constructed adjustable, customized, mobile frames improvised from standard disposable syringe barrels for stabilizing collateral ligaments of the PIPJ to improve motion and protect the repaired ligament. Twopatients with radial collateral ligament injury of the index finger were treated with the improvised frame for 4 weeks after an initial 3-week immobilization with Kirschner wire and a static splint. Results: The average range of motion of PIPJ after treatment was 0-105 with good radioulnar stability. The lifetime of the improvised frame is approximately 8 days, but it can be replaced easily and inexpensively inmost medical facilities. Conclusions: We introduce an improvised which we call a Sriracha frame, as a novel, inexpensive, easyto produce, and effective device that yields good, early joint motion and stability. Keywords: External immobilization, index finger, proximal interphalangeal joint

Rehabilitation Regimen After Surgical Treatment of Acute Achilles Tendon Ruptures

Background: The choice of rehabilitation management after the surgical repair of acute Achilles tendon (AT) ruptures remains controversial because of insufficient clinical evidence. The current study analyzes the postoperative rehabilitation of AT ruptures based on the current clinical evidence. Purpose: To identify and analyze the high-level clinical evidence regarding postoperative rehabilitation after the surgical repair of AT ruptures. Subgroup analyses were also performed to obtain more reliable and specific results. Study Design: Meta-analysis. Methods: The studies were retrieved by searching the Medline, Embase, and Cochrane databases through the OVID retrieval engine from 1990 to August 14, 2013. Two independent reviewers critically reviewed the studies using preset inclusion and exclusion criteria. The quality of the eligible studies was assessed by the Cochrane 12-item scale. All included studies were summarized, and their data were extracted. Subgroup analyses were performed according to the different protocols of early functional rehabilitation. Results: Nine studies, consisting of 6 randomized controlled trials and 3 quasi-randomized studies, were ultimately included. A total of 402 patients were identified. Six of the included studies utilized early weightbearing combined with early ankle motion exercises, while the other 3 only employed early ankle motion exercises. The subgroup analyses demonstrated that 11 of the 15 functional outcome measurements were significantly superior for patients who underwent both early weightbearing and ankle motion exercises than for those who underwent conventional cast immobilization. Similar rates of reruptures (odds ratio [OR], 1.36; 95% CI, 0.38-4.91; P = .64) and major complications (OR, 0.67; 95% CI, 0.24-1.87; P = .44) as well as a significantly lower rate of minor complications (OR, 0.51; 95% CI, 0.27-0.95; P = .03) were also observed in this early functional rehabilitation group. For the patients who solely performed early ankle motion exercises, only 2 of the 14 functional measurements were observed to be significantly superior to immobilization. There were also no significant differences in the rates of reruptures (OR, 0.47; 95% CI, 0.08-2.70; P = .40) and other complications (OR, 1.09; 95% CI, 0.41-2.92; P = .86) between the 2 groups. Conclusion: Postoperative early weightbearing combined with early ankle motion exercises is associated with a lower minor complication rate and achieves superior and more rapid functional recovery than conventional immobilization after surgical AT repair. In contrast, few advantages were identified when only early ankle motion exercises were applied.

Percutaneous Cannulated Screws with Tension Band Wiring Technique in Patella Fractures

IntroductionMost patellar fractures are transverse involving the central third. Open reduction and stabilization of transverse patellar fractures is indicated if there is more than 2-3 mm of fragment separation and/or articular incongruity.Surgical TechniqueThis study describes a percutaneous 2 cannulated screws and modified tension band wiring technique to treat transverse patellar fractures.Materials and MethodsWe performed 30 cases of displaced transverse patellar fractures with this technique. The clinical outcomes of these patients were evaluated with simple radiographs, range of motion and Lyshom score.ResultsThis technique has shown to provide satisfactory clinical results and excellent knee functions.ConclusionsThis technique provide stable fixation, allows early motion exercise by minimizing injury to extensor mechanism and reduce cosmetic problem in scar.

Comparison of two rehabilitation protocols to promote proprioception of the knee following anterior cruciate ligament reconstruction

Objective To compare the effects of 2 rehabilitation protocols on promotion of proprioception of the knee after anterior cruciate ligament (ACL) reconstruction.Methods We retrospectively reviewed 50 patients who had undergone an ACL reconstruction between August 2007 and June 2010 in our institution.They were divided into 2 groups according to their rehabilitation protocols.In the normal rehabilitation (NR) group there were 18 men and 7 women with an average age of 27.4 ± 3.3 years.They were trained to do straight leg raising and quadriceps isometric contraction under the protection of brace early after operation.In the proprioception rehabilitation (PR) group,there were 16 men and 9 women with an average age of 26.4 ± 3.6 years.They were trained to do motion exercise without brace early after operation,and received perturbation training (roller board and tilt board),dynamic balance training with treadmill and transcutaneous electrical nerve stimulation.Proprioception assessment was performed pre-reconstruction and at 3,6 and 12 months post-reconstruction.Proprioception recovery was expressed by difference percentage [=(pre-reconstruction proprioception-post-reconstruction proprioception)/post-reconstruction proprioception-× 100％].Results The 2 groups showed no significant differences at the knee flexion of 15°,45°,and 75° in proprioception recovery at 3 months post-reconstruction (P ＞ 0.05).At 6 and 12 months post-reconstruction,the PR group had significantly better proprioception recovery at the knee flexion of 15°,45°,and 75° than the NR group (-50.2％ ± 13.3％ vs.-27.5％ ±7.7％,-64.3％ ±16.9％ vs.-38.4％ ±7.6％,-60.3％ ± 14.1％ vs.-35.1％ ±7.6％ respectively at 12 months post-reconstruction) (P ＜ 0.05).Conclusion The protocol of early motion exercise in combination with perturbation training,dynamic balance training and transcutaneous electrical nerve stimulation can better promote proprioception recovery of the knee joint after ACL reconstruction because the nervous and muscular concordance of the patients can be reconstructed in static,uniformly and nonuniformly dynamic states. Key words: Anterior cruciate ligament; Proprioception; Arthroscopy; Rehabilitation

Evidence-Based Hand and Upper Extremity Surgery

Stiffness is a concern after rotator cuff surgery, but early exercises risk disrupting tendon sutures. A prospective randomized trial of 105 consecutive patients undergoing arthroscopic suturing of small to mediumsize full-thickness rotator cuff defects was undertaken comparing early (postoperative day 1) passive motion exercises 3 to 4 times per day with delayed passive motion following brace removal (4 wk for tears 1 cm and 5 weeks for tears of 1–3 cm). Both groups began strengthening at 9 to 12 weeks, and unrestricted activities were allowed at 6 months. There were no significant differences in demographics between groups. At 12 months, there were improvements in both groups with no significant differences in pain, range of motion (ROM) and functional outcomes (Constant Score, Simple Shoulder Test [SST], and American Shoulder and Elbow Surgeons [ASES] scores). Ultrasound (3–6 mo) and computed tomography (CT) or magnetic resonance imaging (MRI) (12 mo) revealed healing in 49/56 patients in the early motion group and 40/49 in the delayed motion group.

Turning over rough surface of aponeurosis of gastrocnemius for repairing freshly torn Achilles tendon

To evaluate the therapeutic outcomes of freshly torn Achilles tendon by turning over aponeurosis of gastrocnemius and holding its rough surface to contact with sutured tendons. Thirty-two patients with torn Achilles tendon received surgeries at our department. There were 20 males and 12 females with an age range of 22 - 45 years. All patients were injured during movement. The surgical techniques involved applying medial straight incision of tendon about 5 cm, under the help of long tractors, turning over aponeurosis of gastrocnemius and holding its rough surface to contact with sutured tendons. All patients were motivated to accept early motion exercises after surgery. The follow-up was carried out during May 2007 to January 2010 with an average period of 18 months. Based upon the Arner Lindholm score, their therapeutic outcomes were evaluated. Incisions were healing well in all patients. All patients removed long plaster and changed into short plaster when they received operation for 3 weeks. After 6 weeks, plaster was removed and they began to exercise movement of ankle. At Week 8, their ankle functions were close to normal. At Week 12, they could jog. The final outcomes were as follows: excellent (n = 24), good (n = 6) and poor (n = 2). The excellent rate was over 93.75%. Turning over aponeurosis of gastrocnemius and holding its rough surface to contact with sutured tendons is an excellent therapeutic method for freshly torn Achilles tendon so that the patients may be motivated to execute early motion exercises. Early motion exercise is essential for an earlier recovery of postoperative function.

Is Early Passive Motion Exercise Necessary After Arthroscopic Rotator Cuff Repair?

Background: Early passive motion exercise has been the standard rehabilitation protocol after rotator cuff repair for preventing postoperative stiffness. However, recent approaches show that longer immobilization may enhance tendon healing and quality. Purpose: To elucidate whether early passive motion exercise affects functional outcome and tendon healing after arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: One hundred five consecutive patients who underwent arthroscopic repair for small to medium-sized full-thickness rotator cuff tears were included. Patients with large to massive tears and concomitant stiffness or labral lesions were excluded. Patients were instructed to wear an abduction brace for 4 to 5 weeks after surgery and to start active-assisted shoulder exercise after brace weaning. Fifty-six patients were randomly allocated into group 1: early passive motion exercises were conducted 3 to 4 times per day during the abduction brace-wearing period. Forty-nine patients were allocated into group 2: no passive motion was allowed during the same period. Range of motion (ROM) and visual analog scale (VAS) for pain were measured preoperatively and 3, 6, and 12 months postoperatively. Functional evaluations, including Constant score, Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) score, were also evaluated at 6 and 12 months postoperatively. Ultrasonography, magnetic resonance imaging, or computed tomography arthrography was utilized to evaluate postoperative cuff healing. Results: There were no statistical differences between the 2 groups in ROM or VAS for pain at each time point. Functional evaluations were not statistically different between the 2 groups either. The final functional scores assessed at 12 months for groups 1 and 2 were as follows: Constant score, 69.81 ± 3.43 versus 69.83 ± 6.24 (P = .854); SST, 9.00 ± 2.12 versus 9.00 ± 2.59 (P = .631); and ASES score, 73.29 ± 18.48 versus 82.90 ± 12.35 (P = .216). Detachment of the repaired cuff was identified in 12% of group 1 and 18% of group 2 (P = .429). Conclusion: Early passive motion exercise after arthroscopic cuff repair did not guarantee early gain of ROM or pain relief but also did not negatively affect cuff healing. We suggest that early passive motion exercise is not mandatory after arthroscopic repair of small to medium-sized full-thickness rotator cuff tears, and postoperative rehabilitation can be modified to ensure patient compliance.

Surgical Technique: Articulated External Fixator for Treatment of Complex Knee Dislocation

Knee dislocation is a severe but relatively uncommon injury caused by violent trauma that can result in long-term complications, such as arthrofibrosis, stiffness, instability, and pain. Perhaps owing in part to its rarity, treatment of this injury is controversial. We therefore describe a treatment approach for these complex cases involving a novel dynamic knee external fixator. We performed open PCL reconstruction when possible and/or repair of other associated lesions. At the end of the surgical procedure, the surgeon applied an external fixator that reproduced normal knee kinematics, allowing early motion exercises and reducing the risk of joint stiffness while protecting the bony and soft tissue structures involved in the repair during the first healing phase. We retrospectively reviewed eight patients treated with this approach, four of whom had the PCL reconstructed and four of whom had only associated injuries reconstructed. We evaluated all patients with clinical scores (subjective International Knee Documentation Committee form, Lysholm score, and Tegner level), physical examination (objective International Knee Documentation Committee form), and KT-1000™ arthrometer for AP laxity. Minimum followup was 10 months (mean, 26 months; range, 10-45 months). One patient had manipulation under anesthesia. The median Lysholm score was 76, Tegner level was 4, and subjective International Knee Documentation Committee was 73. All patients recovered to their preinjury work activity, except one unemployed patient. Stability was normal or nearly normal in five patients; the mean side-to-side difference in AP displacement with manual maximum force was 2.9 mm. This approach with an external fixator allowed staged reconstruction and early motion and provided reasonable stability, ROM, and activity level at followup in patients with complex injuries. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Reduction of Postoperative Stiffness After Arthroscopic Rotator Cuff Repair: Results of a Customized Physical Therapy Regimen Based on Risk Factors for Stiffness

The purpose of this study was to determine the benefits of a modified rehabilitation protocol (incorporating early closed-chain overhead stretching) in reducing the risk of postoperative stiffness after arthroscopic rotator cuff repair. During a 17-month period, we performed primary arthroscopic rotator cuff repairs in 152 patients. After surgery, patients with risk factors identified in the previous study (calcific tendonitis, adhesive capsulitis, PASTA [partial articular surface tendon avulsion]-type rotator cuff repair, concomitant labral repair, or single-tendon cuff repair) were enrolled in a modified rehabilitation protocol that added early overhead closed-chain passive motion exercises to our standard protocol; alternatively, patients without risk factors received a standard conservative rehabilitation program. Historical controls were used and comprised patients in the senior author's practice who all received the conservative rehabilitation protocol. The prevalence of postoperative stiffness was compared between the historical cohort and current study patients by use of Fisher exact tests. Among the 152 patients studied, 79 were positive for at least 1 of the specified risk factors and received the modified protocol. Postoperative stiffness developed in none of the 79 patients enrolled in the modified program. This finding represented a significant improvement (Fisher exact test, P = .004) over the historical controls, in which 18 of the 231 at-risk patients had significant postoperative stiffness develop. In at-risk patients (with calcific tendonitis, adhesive capsulitis, PASTA repair, concomitant labral repair, and single-tendon repair), a postoperative rehabilitation regimen that incorporates early closed-chain passive overhead motion can reduce the incidence of postoperative stiffness after arthroscopic rotator cuff repair.

Early motion exercise for ulnar styloid base fractures associated with distal radius fractures

Early motion exercise for ulnar styloid base fractures associated with distal radius fractures

The Use of a Selective Peripheral Median Nerve Block for Pain-Free Early Active Motion After Hand Surgery

We describe a simple method in which a nearly selective sensory median nerve block is used for early motion exercises. In this method an 18-gauge epidural catheter with 3 side holes in the fine catheter tip is placed proximal to the carpal tunnel. A bolus of 5 mL of 0.25% bupivacaine is injected before a continuous infusion of 3 mL/60 min of 0.125% bupivacaine is started. This method allows a continuous and selective sensory blockade with preservation of motor function and proprioception for early motion after hand surgeries.

Hinged external fixation and closed reduction for distal humerus fracture

Elbow fractures are relatively rare in extremity injuries. Functional deficits often comprise the outcome. We report of a 77-year-old diabetic lady with a distal humerus fracture. She was treated with external fixation and closed reduction. Special emphasis was directed to early motion exercises. Follow-up after 1 year demonstrated a range of motion of 0-30-130 degrees for extension and flexion of the elbow joint. No neurovascular deficits were seen. The use of a hinged device was successful in re-establishing a good function. Although there are no earlier reports using this technique in acute treatment, we consider this strategy as an alternative option in carefully selected cases.

Double-Strand Suturing Fixation Technique for Treatment of Acute Volar Plate Avulsion Fracture of the Base of the Middle Phalanx

A new suturing technique for treatment of acute volar plate avulsion fracture of the proximal interphalangeal joint is reported. Because this technique that consists of double-strand suture is rigid enough and never obstructs joint motion, early motion exercise can be allowed. This technique only demands simple skill like conventional K-wire fixation. Furthermore, removal of fixation material is not necessary.

Effect of Postoperative Early Ankle Motion Exercise Using Hinged Ankle-Foot Orthoses in Clubfoot

The authors proposed early application of hinged ankle-foot orthoses for improving postoperative range of ankle motion after the complete subtalar release operation for clubfoot. Forty-eight patients (74 feet) with clubfoot were divided into two groups: group A patients (20 feet) were immobilized in plaster casts for 6 weeks after surgery, followed by non-hinged ankle-foot orthoses, and group B patients (54 feet) were immobilized in plaster casts for 4 weeks after surgery, followed by hinged ankle-foot orthoses. The range of ankle plantarflexion in group B showed a significant improvement compared with group A at 3 months and 1, 2, and 3 years after surgery. There was no statistical difference between the groups in the range of dorsiflexion except at 3 months of follow-up. The postoperative talo-calcaneal index was well maintained in both groups. Early range-of-motion exercises using the hinged ankle-foot orthoses achieved good ankle function, especially in plantarflexion, with no loss of radiologic correction.

Biomechanical and Histomorphometric Study of the Bone-Screw Interface of Calcium Pyrophosphate Coated Titanium Screws

The purpose of this study is to compare the osseointegration of calcium pyrophosphate(CPP) coated screws with uncoated screws. CPP coating was prepared and coated by dipping method. CPP coated and uncoated screws were inserted into the mongrel dogs. The insertion torques, radiographs, histology, histomorphometric analysis, and extraction torques were evaluated at 2, 4, and 8 weeks after surgery. The insertion torque was not different between CPP coated and uncoated screws. The extraction torques of CPP coated screws at 2, 4, and 8 weeks(5.45±2.05, 7.62±1.51 and 6.60±2.80 cNM) were significantly higher than their insertion torques(2.74±1.13, 2.98±0.70, and 2.18±1.34 cNM)(p&lt;0.0001, &lt;0.0001 and 0.0005 respectively) and significantly higher than the extraction torques of uncoated screws(1.14±0.470, 2.57±1.36, and 3.18 ±0.499 cNM). The percentages of direct bone-screw contact of CPP coated screws were statistically higher than those of uncoated screws at 2, 4, and 8 weeks. These results suggest that CPP coating may improve the clinical results by allowing early motion exercises and early weight bearing.

化膿性肩関節炎における開放運動療法の経験

We report a case of septic arthritis of the shoulder joint treated by arthrotomy followed by open wound and early motion exercie. The patient was a 55-year-old male taxi driver. The infecting organism was methicillin-resistant staphylococcus aureus. At first he was treated by arthroscopic debridment which had no effect. Then we performed arthrotomy followed by open wound and early motion exercise. This open wound method was successful for infection. Concomitant antibiotics were administrated. We think arthrotomy followed by open wound and early motion exercise is a useful method for treating arthritis of the shoulder.

The Polyester Patch: A New Technique to Promote Early Motion Exercises in Extensor Tendon Transfers

The polyester patch made from Bard-DeBakey Woven Fabric (C.R. Bard, Inc., Haeverhill, MA, U.S.A.) was used as the core of the interlacing suture. This new technique was applied mainly to extensor tendon transfers on the dorsum of the hand. The end-to-end interlacing suture technique with polyester patch was applied to seven patients with rupture of the extensor pollicis longus tendon, and the end-to-side transfer with a patch was applied to three patients with ruptures of the finger extensor tendon. Evaluation was performed using % total amount of motion. All seven patients who received the end-to-end interlacing suture with a patch were evaluated as good. Of the three patients who received the end-to-side transfer with a patch, two cases had a good result, and one case had a fair result. With this technique, active motion exercise may be started immediately after surgery without cast immobilization.