Gain In Range Of Motion Research Articles

Uso da corrente russa na reabilitação neurológica de paciente com traumatismo crânio encefálico: relato de caso

Introdução: O traumatismo cranioencefálico (TCE) é qualquer agressão capaz de lesão anatômica ou comprometimento funcional do couro cabeludo, crânio, meninges ou encéfalo, que pode causar importantes perdas cognitivas e motoras. Os principais mecanismos de trauma são os acidentes automobilísticos, quedas e as agressões físicas e/ou lesões por arma de fogo. Este estudo objetivou relatar os efeitos de um protocolo de intervenção fisioterapêutica que inclui o uso da Corrente Russa (CR) na reabilitação de um paciente com TCE. Relato de caso: Paciente do sexo masculino, 26 anos, mecânico, etilista crônico, diagnóstico médico de TCE e hemiparesia esquerda desproporcionada com predominância no membro superior, dependente de cadeira de rodas. A avaliação fisioterapêutica foi constituída de aferição de sinais vitais, avaliação dos reflexos superficiais e tendinosos e do tônus muscular, goniometria e teste de força muscular específico. Após avaliação inicial foi aplicado um protocolo de intervenção fisioterapêutico constituído de exercícios terapêuticos e eletroestimulação com CR, com frequência de duas sessões semanais de 50 minutos de duração, por um período de 16 semanas, seguidas de reavaliação. Conclusão: O protocolo de intervenção aplicado contribuiu para a reabilitação funcional do paciente, verificado pelo ganho de amplitude de movimento das articulações do punho, cotovelo, tornozelo e joelho esquerdos; e aumento na graduação de força muscular dos flexores e extensores do punho e do cotovelo, flexores e extensores do joelho e tornozelo esquerdos. Além disso, a deambulação independente foi restituída,com retorno à atividade profissional.

Conventional Versus Computer-Assisted Corrective Osteotomy of the Forearm: a Retrospective Analysis of 56 Consecutive Cases

Accuracy and feasibility of corrective osteotomies using 3-dimensional planning tools and patient-specific instrumentation has been reported by multiple authors with promising results. However, studies describing clinical outcomes following these procedures are rare. Therefore, the purpose of this study was to compare the results of computer-assisted corrective osteotomies of the diaphyseal and distal radius with a conventional non-computer-assisted technique regarding duration of surgery, consolidation of the osteotomy, and complications. Also, subjective and objective clinical outcome parameters were assessed. We retrospectively compared the results of 31 patients who underwent a corrective osteotomy performed conventionally with 25 patients treated with a computer-assisted method (CA) using patient-specific instrumentation. Baseline data were similar among both groups. The duration of surgery, bony consolidation, complications, gain in range of motion, and subjective outcome were recorded. The mean operating time was significantly shorter in the CA group compared with the conventional group. After 12 weeks, significantly more osteotomies were considered healed in the CA group compared with the conventional group. Two patients in the CA group required revision surgery to treat nonunion of the osteotomy. Otherwise clinical results were similar among both groups. The results demonstrate that the computer-assisted method facilitates shorter operation times while providing similar clinical results. Therapeutic IV.

Influence of Body Mass Index on Sagittal Knee Range of Motion and Gait Speed Recovery 1-Year After Total Knee Arthroplasty

BackgroundThe purpose of this prospective study was to investigate the influence of body mass index (BMI) on gait parameters preoperatively and 1 year after total knee arthroplasty (TKA). MethodsSeventy-nine patients were evaluated before and 1 year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and 1 year after TKA), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Nonobese (BMI <30 kg/m2) and obese patients (BMI ≥30 kg/m2) were compared. Healthy controls were also assessed. Univariate and multivariate linear regression analyses were used to assess the association between gait speed and ROM gains. Adjustment was performed for gender, age, and WOMAC pain improvement. ResultsAt baseline, gait velocity and knee ROM were significantly lower in obese compared with those in the nonobese patients (0.99 ± 0.27 m/s vs 1.11 ± 0.18 m/s; effect size, 0.53; P = .021; and ROM, 41.33° ± 9.6° vs 46.05° ± 8.39°; effect size, 0.52; P = .022). Univariate and multivariate linear regressions did not show any significant relation between gait speed gain or knee ROM gain and BMI. At baseline, obese patients were more symptomatic than nonobese (WOMAC pain: 36.1 ± 14.0 vs 50.4 ± 16.9; effect size, 0.9; P < .001), and their improvement was significantly higher (WOMAC pain gain, 44.5 vs 32.3; effect size, 0.59; P = .011). ConclusionThese findings show that all patients improved biomechanically and clinically, regardless of their BMI.

Arthroscopic 360 degrees capsular release for treatment of adhesive capsulitis– A study of 40 cases

Introduction: Adhesive capsulitis, better known as frozen shoulder is a common disabling musculoskeletal disease, characterized classically by pain and restriction in range of motion. Management of this condition is controversial, ranging from non-operative to operative interventions, all intending to decrease pain and restore joint function. Arthroscopic capsular release has emerged as an effective surgical procedure for treating adhesive capsulitis. The aim of this study was to evaluate the results of arthroscopic capsular release for adhesive capsulitis Methods: Between February 2013 and May 2015, 40 patients underwent arthroscopic capsular release non responsive to conservative management. Patients having rotator cuff disease, osteoarthritis, history of fracture upper end humerus and bilateral adhesive capsulitis were excluded from the study. Patients were followed up for a minimum period of 11 months. Results were evaluated using Constant score, UCLA (University of California Los Angeles) and VAS (Visual Analog Scale) scoring system. Results: The mean age of the patients was 57.1 years, with 13 male (32.5%) and 27 female (67.5.5%) patients. The right and left shoulder were affected in 31 patients (77.5%) and 9 patients (22.5%) respectively. 21 patients were diabetic (52.5%), 6 patients had a history of trauma (15%) whereas 13 patients had primary idiopathic adhesive capsulitis (42.5%). Post-operatively, the mean time to achieve maximum pain relief was 1.7 months, whereas the mean time to achieve maximum gain in range of motion was 2 months. Mean preoperative range of motion (Anterior Elevation/ Abduction/ External Rotation/ Internal Rotation) was 98.20/36.30/21.10/13.80 whereas post-operatively it increased to 178.50/166.80/55.70/48.10. The average VAS, Constant and UCLA score was 8.7, 27.5 & 12.8, which improved to 2.3, 88.8 & 31.3 respectively.Conclusion: The results of arthroscopic capsular release for adhesive capsulitis are encouraging and provide an effective treatment modality to provide pain relief restore joint function in cases resistant to conservative management

Influence of body mass index on sagittal knee range of motion and gait speed recovery one year after total knee arthroplasty

Introduction Little is known concerning the influence of body mass index (BMI) on patient recovery after total knee arthroplasty (TKA), in terms of gait performance. Indeed, no studies have documented its influence on the recovery of range of motion (ROM) of the knee during gait and of gait velocity. Therefore, the objective of this study was to investigate the influence of BMI on these parameters before and 1 year after surgery. Materials and methods Seventy-nine patients were evaluated before and one year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and one year post-TKA), the Western Ontario and MacMaster Osteoarthritis Index (WOMAC), quality of life and patient satisfaction were assessed. Non-obese (BMI Results At baseline, gait velocity and knee ROM were significantly lower in obese compared to non-obese patients (0.99 ± 0.27 m/s vs. 1.11 ± 0.18 m/s, effect size, 0.53; P = 0.021. ROM: 41.33 ± 9.6 vs. 46.05 ± 8.39, effect size, 0.52; P = 0.022). Univariate and multivariate linear regressions did not show any significant relation between gait speed gain or knee ROM gain and BMI. At baseline, obese patients were more symptomatic than non-obese (WOMAC pain: 36.1 ± 14.0 vs. 50.4 ± 16.9, effect size, 0.9; P Conclusions These findings show that all patients improved biomechanically and clinically regardless of their BMI.

Percutaneous needle tenotomy in the treatment of neuro-orthopedic complications of upper limb related to central nervous system impairment: Open study on 12 patients

The musculotendinous retractions are common complications of central neurological damage with consequences for comfort and function. Treatment of uncomfortable retractions is often surgical, mainly based on tendon gestures. The objective of this study was to evaluate the efficiency of percutaneous needle tenotomy in these indications. The indication was accepted at a medical-surgical consultation. Tenotomy was performed using an 18 Gauge needle. The patients were older than 18 years, had a history of central neurological disease, and had a musculotendinous retraction regarding a superficial tendon of upper limb. The primary endpoint was the Goal Attainment Scale (GAS). Secondary outcomes were pain, the pulp-palm distance and range of motion gain. The evaluation was conducted in pre-tenotomy, immediately post-tenotomy, 3 months and 6 months. Twelve patients (8 women) were included in our study. The mean age was 62.91 years (28–87). Neuro-orthopedic disorders were related to a stroke ( n = 4), head trauma ( n = 2), to Parkinsonian syndrome ( n = 3) at a cerebral palsy ( n = 3). The objectives identified were nursing ( n = 12), pain ( n = 11), the skin condition ( n = 5), gripping ( n = 2), posture ( n = 1) and dressing ( n = 1). The targets were achieved in all cases. The average score GAS per patient ranged from 0 to 2. GAS score was unchanged at 3 months and 6 months. Our experience confirms the locations already described for percutaneous needle tenotomy of the flexor of the fingers. We also report the effectiveness of percutaneous tenotomy in the wrist and elbow flexors without vascular and nerve injury elbow.

What Variables Influence Final Range of Motion Following Total Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: While studies have demonstrated a predictable incremental increase in the range of motion (ROM) following total ankle arthroplasty (TAA) it remains unclear what variables affect the post-operative ROM. This study was undertaken to further investigate this question with the goal of providing guidance for patients and surgeons deciding between TAA and arthrodesis. Methods: This is a prospective review of 223 consecutive patients who underwent primary TAA using a single prosthesis performed between 2010-2013 for painful ankle arthritis that failed conservative therapy. Weight bearing flexion and extension X- rays were obtained preoperatively and again at 1 year following surgery. The patients were compared for demographics, type of arthritis, preoperative malalignment, prior trauma, obesity, medical co-morbidities, and the effect of concurrent surgery on post operative ankle ROM. Results: 191 patients had adequate follow-up and met all the inclusion criteria. The preoperative diagnosis, hindfoot or ankle varus or valgus, and concurrent percutaneous tendon Achilles lengthening (TAL) procedures were positive predictors of greater improvement in ankle ROM after TAA. Patients with valgus ankle malalignment had better post TAA DF, PF and total ankle range of motion compared to those in varus (P &lt; 0.05). Percutaneous tendon Achilles lengthening (TAL) improved the DF, but not the PF (P &lt; 0.05). Patients with primary ankle osteoarthritis (n=105) had the best improvement in ROM with an average gain of 3.39° in dorsiflexion (DF), 2.47° in plantar flexion (PF) and 5.84° in total ankle ROM (P &lt; 0.05). An analysis of this subgroup demonstrated greater gain in ankle ROM in patients with lower preoperative ROM compared to those with higher preoperative ankle ROM(P &lt; 0.01). Conclusion: Our results indicated primary ankle OA, preoperative ankle valgus malalignment and intraoperative TAL are significant factors in predicting increased ankle ROM after TAA. Ultimately, ankle motion is a function of the extent of arthritis, fibrosis and the surrounding soft tissue envelope. While TAA restores the function of the joint, it may not adequately correct periarticular fibrosis. Early weight bearing and physical therapy may alleviate postoperative stiffness, and increase the post operative gain in ROM. Further study is underway to determine the effect of early weight bearing and initiation of physical therapy on the ROM following TAA.

Functional Range of Motion Following Total Ankle Replacement

Category: Ankle Introduction/Purpose: Total ankle replacement (TAR) is an accepted option for the surgical treatment of end-stage ankle arthritis. The potential benefit of TAR over ankle arthrodesis is the preservation of motion following TAR, however, little is reported concerning the true gain of range of motion (ROM) following TAR. This study compares standard goniometric measurements with two radiographic measurement techniques, as well as reports the changes in ROM following TAR. Methods: Between 2007 and 2012, 48 TAR in 46 patients were performed by a single surgeon, using a modern, fixed-bearing design. 40 patients (19 female, 21 male) had complete clinical and radiographic follow-up greater than 2 years postoperatively. Mean age at surgery was 73 +/- 9 years. Patients were evaluated with pre-operative and 2 year post-operative goniometric weight- bearing exam, as well as plantarflexion (PF) and dorsiflexion (DF) lateral radiographs. Radiographs were analyzed using the talocrural method, which measures the angle between the long axis of the tibia and talus, as well as a “full foot” method, which utilizes the angle created by the long axis of the tibia and medial cuneiform. The difference between the PF and DF angles was considered the arc ROM. Means were compared using a Wilcoxon signed-rank test to evaluate the significance of the difference between means (p &lt; 0.05) Results: Mean arc range of motion increased from pre-operatively to post-operatively for all methods analyzed. Goniometric arc ROM significantly increased from 27.1° +/- 9.4° to 39.6° +/- 14.0°, a difference of 12.5° +/- 13.6° (p&lt; .001). Talocural arc ROM significantly increased from 22.7° =/- 11.9° to 27. 8° +/- 10.2°, a difference of 5.1° +/- 11.2° (p=.006). Full foot arc ROM increased, but not significantly, from 46.7° +/- 15.5° to 48.8° +/- 12.6°, a difference of 2.6° +/- 11.2° (p=0.154). There was no significant difference observed between the mean gain in arc ROM between the two radiographic measurements (p=.062). However, the mean gain in arc ROM for goniometry significantly differed from both the talocural and full foot radiographic methods (p=.012 and p= .001, respectively). Conclusion: In this study, goniometry measurements tended to overestimate motion gained following TAR when compared to 2 radiographic measurement techniques. Interestingly, the talocrural method, which evaluates the ankle in isolation, was almost double the motion noted with the full foot method (5.1° vs. 2.6°) The full foot method may take into consideration the compensatory changes through the hindfoot and midfoot to account for ankle arthritis, that is alleviated post-TAR, hence, more modest gains in “full foot” arc ROM.

Extension deficit after ACL reconstruction: Is open posterior release a safe and efficient procedure?

BackgroundExtension loss is a potentially devastating consequence of anterior cruciate ligament reconstruction (ACLR). It can often be treated by anterior arthroscopic release. In rare cases, a chronic flexion contracture requires an additional posterior open release. To our knowledge, no study analysing the results of both posteromedial and posterolateral approaches has been performed so far.The purposes of this study were (1) to analyse the midterm outcome and complications of a combined procedure, anterior arthroscopic debridement and posterior open capsulotomy — for the treatment of chronic extension deficits after ACLR and (2) to describe the surgical technique of posterior open release with both posteromedial and posterolateral approaches. Material and methodsThis is a retrospective clinical cohort study. Twelve patients presenting a chronic flexion contracture of 10° or more after ACLR treated by open posterior arthrolysis with an average follow-up time of 38months (range six to 90) were included. At last follow-up, they underwent both a clinical examination with range of motion analysis, International Knee Documentation Committee (IKDC) and KOOS scores. ResultsAt follow-up, all patients except one (93%) achieved complete extension. Only one patient (7%) had a residual post-operative flexion deformity of five degrees. The range of motion (ROM) improved significantly after arthrolysis from 96°±14.3° (SD) to 14.3°±7°(SD)(p<0.001).No post-operative complications were recorded. No patients required further open debridement.The post-operative objective IKDC score was grade A for five patients, B for seven versus C for five patients and D for seven preoperatively. The mean post-operative subjective IKDC score was 86.4±9.7. The post-operative Knee injury and Osteoarthritis Outcome Score (KOOS) distribution was as follows: pain 93.8±5 (SD); symptoms 88±8.6 (SD); ADL 96.8±3.7 (SD); sports activities 83.6±12.3 (SD); and quality of life 82.9±8.8 (SD). Mean patients' satisfaction was 9.25±0.6 (SD) out of 10 after arthrolysis. ConclusionsOpen posterior release with both posteromedial and posterolateral approaches is a safe and efficient additional procedure in case of persistent flexion contracture after ACLR with good ROM gain, functional scores and patients' satisfaction. Level of evidenceTherapeutic study — Level IV

Three-dimensional shoulder kinematics normalize after rotator cuff repair

Patients with a rotator cuff (RC) tear often exhibit scapular dyskinesia with increased scapular lateral rotation and decreased glenohumeral elevation with arm abduction. We hypothesized that in patients with an RC tear, scapular lateral rotation, and thus glenohumeral elevation, will be restored to normal after RC repair. Shoulder kinematics were quantitatively analyzed in 26 patients with an electromagnetic tracking device (Flock of Birds) before and 1 year after RC repair in this observational case series. We focused on humeral range of motion and scapular kinematics during abduction. The asymptomatic contralateral shoulder was used as the control. Changes in scapular kinematics were associated with the gain in range of motion. Shoulder kinematics were analyzed using a linear mixed model. Mean arm abduction and forward flexion improved after surgery by 20° (95% confidence interval [CI], 2.7°-36.5°; P = .025) and 13° (95% CI, 1.2°-36.5°; P = .044), respectively. Kinematic analyses showed decreases in mean scapular protraction (ie, internal rotation) and lateral rotation (ie, upward rotation) during abduction by 3° (95% CI, 0.0°-5.2°; P = .046) and 4° (95% CI, 1.6°-8.4°; P = .042), respectively. Glenohumeral elevation increased by 5° (95% CI, 0.6°-9.7°; P = .028) at 80°. Humeral range of motion increased when scapular lateral rotation decreased and posterior tilt increased. Scapular kinematics normalize after RC repair toward a symmetrical scapular motion pattern as observed in the asymptomatic contralateral shoulder. The observed changes in scapular kinematics are associated with an increased overall range of motion and suggest restored function of shoulder muscles.

Long-Term Outcomes of Total Knee Arthroplasty following Soft-Tissue Defect Reconstruction with Muscle and Fasciocutaneous Flaps.

Insufficient soft-tissue coverage following total knee arthroplasty jeopardizes prosthesis retention and may lead to significant complications. The aim of this study was to evaluate the natural history of total knee arthroplasty following flap reconstruction of soft-tissue defects. A retrospective review of patients treated with flaps after failed total knee arthroplasty between 1998 and 2013 was conducted. Patients with preexisting soft-tissue defects who required reactive flap reconstruction were included in group 1. Patients with no preexisting soft-tissue defects, but with extensive débridement during revision total knee arthroplasty requiring immediate proactive flap coverage, were included in group 2. Fifty-eight patients in group 1 were treated with 86 flaps, and 15 patients in group 2 were treated with 17 flaps. Mean length of follow-up was 67.0 and 54.7 months, respectively (p = 0.21). Flap-related complications and number of subsequent flap revisions were comparable in both groups. Patients in group 1 had a higher rate of implant reinfection (58 percent versus 27 percent; p < 0.05), amputations (25 percent versus 0 percent; p < 0.05), and subsequent prosthesis revisions (2.2 versus 0.9; p < 0.05). Functional joint was preserved in 54 percent and 80 percent of cases, respectively. Mean gain in range of motion and quality of life were significantly better in group 2 (p < 0.05). Early proactive soft-tissue coverage of total-knee arthroplasty is critical to long-term success. In cases where reactive treatment is required, significantly worse outcomes and a high rate of complications should be expected. Therapeutic, III.

Radial Head Prosthesis Removal: a Retrospective Case Series of 14 Patients.

The purpose of this study was to report the preoperative complaints and postoperative outcome of patients after removal of the radial head prosthesis. This is a retrospective review of 14 adult patients (6 females and 8 males) from 2007 to 2011, who underwent radial head prosthesis removal by three surgeons. The average time between implantation and removal was 23 months (range from 2 weeks to 12 years, median 12 months). The leading reported complaints before removal were restricted mobility of the elbow (active range of motion of less than 100 degrees) in 6, pain in 3, and pain together with restricted mobility in 4 patients. The objective findings before removal were restricted mobility of the elbow in 10 (71%), capitellar cartilage wear, loose implants, and heterotopic ossification each in 8 (57%), subluxation of the radio-capitellar joint or malpositioning of the stem in 5 (36%), and chronic infection in 2 (14%) patients. All patients with pain had wear of the capitellar cartilage on radiographs. The ulnar nerve was decompressed in four patients at the time of removal. Four patients underwent a subsequent operation for postoperative ulnar nerve symptoms 5 to 21 months after removal. Four patients were still complaining about persistent pain at the last follow-up visit. Except two patients, the total range of motion improved with a mean of 34 degrees (range 5 to 70) after a mean follow-up of 11 months. Removal of radial head prosthesis improved function and lessened pain in our case series. The reoperation rate was yet nearly 30% due to ulnar neuritis. Selective ulnar nerve decompression at the time of removal must be evaluated, especially in patients with expected large gain in range of motion after removal.

Imatinib Mesylate for the Treatment of Steroid-Refractory Sclerotic-Type Cutaneous Chronic Graft-versus-Host Disease

Sclerotic skin manifestations of chronic graft-versus-host disease (ScGVHD) lead to significant morbidity, including functional disability from joint range of motion (ROM) restriction. No superior second-line therapy has been established for steroid-refractory disease. Imatinib mesylate is a multikinase inhibitor of several signaling pathways implicated in skin fibrosis with in vitro antifibrotic activity. We performed an open-label pilot phase II trial of imatinib in children and adults with corticosteroid-refractory ScGVHD. Twenty patients were enrolled in a 6-month trial. Eight received a standard dose (adult, 400 mg daily; children, 260 mg/m2 daily). Because of poor tolerability, 12 additional patients underwent a dose escalation regimen (adult, 100 mg daily initial dose up to 200 mg daily maximum; children, initial dose 65 mg/m2 daily up to 130 mg/m2 daily). Fourteen patients were assessable for primary response, improvement in joint ROM deficit, at 6 months. Primary outcome criteria for partial response was met in 5 of 14 (36%), stable disease in 7 of 14 (50%), and progressive disease in 2 of 14 (14%) patients. Eleven patients (79%), including 5 with partial response and 6 with stable disease, demonstrated a positive gain in ROM (range of 3% to 94% improvement in deficit). Of 13 patients with measurable changes at 6 months, the average improvement in ROM deficit was 24.2% (interquartile range, 15.5% to 30.5%; P = .011). This trial is registered at http://clinicaltrials.gov as NCT007020689.

The palmar approach for PIP-arthroplasty according to Simmen: results after 8 years follow-up

Background Alloarthroplasty of the proximal interphalangeal joint is indicated for patients with osteoarthritis, an inflammatory disease of the joint. According to the current literature, implants made of silicone are not inferior to newer implants and the complications are well known. Therefore, focus should be shifted to the operative approach to improve the results.Methods Eleven silicone arthroplasties in 7 patients with arthritis and 35 silicone arthroplasties in 23 patients with osteoarthritis were reviewed after 15.6 months and after 105.3 months. All implants were inserted using the palmar approach according to Simmen. We compared the pre- and postoperative arc of motion, pain, and strength, and present postoperative complications and satisfaction.Results Patients with arthritis showed a gain in range of motion of 36° and patients with osteoarthritis of 39°. No implant failure occurred, and one revision was performed,. Average extension lag over all operated joints of patients was 2.8°. No swan-neck deformity or extensor tendon adhesion was observed. There was no significant difference in the postoperative results between patients with osteoarthritis and arthritis or between first and second follow-up.Conclusion Silicone arthroplasty restores the functionality of proximal interphalangeal joints in patients with osteoarthritis and inflammatory joint disease. Using a palmar approach, the surgeon can reach palmar and dorsal osteophytes. The extensor mechanism stays intact reducing the risk for extensor lag and other complications compared to the dorsal approach. The results do not change significantly between 1 and 8 years postoperatively.

Effect of patellar thickness on early results of total knee replacement with patellar resurfacing.

Patellar thickness is a concern in total knee replacement with patellar resurfacing because of the risk of patellar fracture or implant loosening. The aim of this study was to evaluate if patellar thickness is related to clinical outcome in the absence of patellar fracture or implant loosening. Early results of 169 patients who underwent total knee replacement with patellar resurfacing were reviewed to assess the effect of patellar thickness on clinical outcome. The mean follow-up was 13 months. The range of motion, Knee Society Score, Function Score and WOMAC Score were assessed preoperatively, at day 0, 6 months and 1 year. Radiographs were assessed for patellar fracture or implant loosening. Thirty-one percent of all patients had preoperative thickness <21 mm. Seven percent had <12 mm residual thickness after patellar cut, all were female. Twenty-three percent had ≥1 mm increase of thickness after surgery. Radiographs did not show any patellar fracture or implant loosening. However, preoperative patellar thickness <21 mm had poorer gain in range of motion at 1 year. Preoperative range of motion had greater influence on postoperative range of motion than preoperative patellar thickness. Residual thickness <12 mm had lower gain in WOMAC score at 1 year and an increase in thickness ≥1 mm postoperatively was associated with lower gain in WOMAC score at 6 months. Early results of patellar resurfacing with preoperative thickness <21 mm or residual thickness <12 mm were found to be inferior even in the absence of patellar fracture or implant loosening. Conservative cutting resulting in 1 mm increase in thickness was also found to have inferior clinical results. II.

Low-Dose Irradiation and Constrained Revision for Severe, Idiopathic, Arthrofibrosis Following Total Knee Arthroplasty

Treatment options for arthrofibrosis following total knee arthroplasty include manipulation under anesthesia, open or arthroscopic arthrolysis, and revision surgery to correct identifiable problems. We propose preoperative low-dose irradiation and Constrained Condylar or Rotating-hinge revision for severe, idiopathic arthrofibrosis. Irradiation may decrease fibro-osseous proliferation while constrained implants allow femoral shortening and release of contracted collateral ligaments. Fourteen patients underwent fifteen procedures for a mean overall motion of 46° and flexion contracture of 30°. One patient had worsening range of motion while thirteen patients had 57° mean gain in range of motion (range 5°–90°). Flexion contractures decreased by a mean of 28°. There were no significant complications at a mean follow up of 34months (range 24 to 74months).

Manipulation under anesthesia for stiffness after total knee replacement: A systematic review

Introduction: Stiffness following total knee replacement (TKR) is a debilitating complication. Manipulation under anesthesia (MUA), arthroscopy, and open arthrolysis are used to treat the stiffness. Objectives: The aim of the review was to answer the following questions. What is the gain in range of motion (ROM) after MUA for stiffness following TKR? Is the gain in ROM after MUA for stiffness following TKR retained at the last follow-up? What is the gender distribution amongst the patients presenting for MUA following TKR? What is the mean age of the patients presenting for MUA following TKR? What is the influence of timing of MUA following TKR on the ROM? The review was aimed towards establishing the current available evidence regarding MUA for stiffness. Materials and Methods: A systematic review of the current available literature was performed and the relevant studies were critically appraised. Results: Nine studies were identified to be relevant to the review (1-Level 2; 2-Level 3; 6-Level 4). It was found that there was a gain in the ROM after MUA and it was retained at the final follow-up. The patients presenting for MUA were younger and were predominantly females. Early MUA was found to be more effective, although late MUA was also beneficial. Conclusions: With limited and low quality of evidence, it is not possible to draw any conclusions.

Mid-term Results of Total Knee Arthroplasty Using PFC Sigma RP-F

PurposeWe compared the mid-term results after total knee arthroplasty (TKA) using PFC Sigma RP-F mobile model with PFC Sigma PS fixed model.Materials and MethodsWe analyzed 45 knees that underwent TKA with PFC Sigma RP-Fn (study group) and 45 knees with PFC Sigma PS (control group). The mean follow-up period was 65 months (range, 60-69 months). The evaluation system of the American knee society was used for clinical and radiological assessment. Also, the maximal knee flexion angle was assessed.ResultsThe mean maximum flexion angle in the study group (135°) was greater than that in the control group (125°) at the early post-operation & final follow-up period (p=0.033). The range of motion (ROM) in the study group was recovered earlier at the postoperative 6 months, and ROM gain was improved to a greater extent at the final follow-up period (p=0.039). The knee score and function score and radiographic evaluation were no difference between the two groups (p>0.05) at the final follow-up. The two cases of radiolucency in posterior condyle and medial tibial plateau and one case of patellar elongation were seen in the study group.ConclusionsThe PFC Sigma RP-F mobile system appears to facilitate greater maximum flexion angle and ROM gain with two cases of radiolucent line.

Tratamento Cinesioterapêutico nas Sequelas de Fraturas de Cabeça de Rádio

Radial head fractures have important place among the traumatic injuries of the elbow. Physical therapy treatment has been shown to be beneficial for controlling inflammation, improving healing, reducing edema and pain, increasing strength and range of motion. Objective: To analyze the functional evolution of patients that after radial head fractures underwent a kinesiotherapeutic protocol, because they had stiffness or blockage of the elbow joint. Methods: Five patients, mean age of 37.4±14.8 years, with comminuted radial head fractures, up to one year from date of injury, and that received surgical treatment were subjected to fifteen physiotherapy sessions twice a week, using of hydrotherapy associated with kinesiotherapy. Data were analyzed on the BioEstat Software 5.0 by means of the t-Student test. Results: It was found pain reduction, improvement in member functionality and gain in range of motion statistically significant for flexion (p = 0.0154), extension (p = 0.0062) and supination (p = 0.0323), with a significance level of  ≤ 0.05. No significant difference was found for the movement of pronation (p = 0.1201). Conclusion: Despite the little gain in range of movement of pronation, were achieved results that showed the effectiveness of the proposed treatment. Further researches are needed to be conducted in order to ratify kinesiotherapeutic efficiency. DESCRIPTORES: Physical Therapy Specialty. Elbow. Rehabilitation

Ulnar Collateral Ligament Reconstruction in Posttraumatic Elbow Release

The purpose of this retrospective cohort comparison study was to determine the effect of ulnar collateral ligament reconstruction on postoperative range of motion (ROM) in patients undergoing posttraumatic elbow contracture release. Twenty-four consecutive patients underwent elbow arthrolysis. Six patients also underwent simultaneous collateral ligament excision and reconstruction, and 18 did not require ligament excision. All patients followed the same postoperative rehabilitation program. Minimum follow-up was 12 months. Final flexion/extension ROMs were similar in both groups. No subjective reports of postoperative elbow instability occurred in either group. Ligament reconstruction and early postoperative motion can be safely performed in the setting of posttraumatic elbow capsulectomy without sacrificing ROM gain or compromising stability provided by the ligament reconstruction.