Glide Test Research Articles

Characterization of HPMC and PEG 400 Mucoadhesive Film Loaded with Retinyl Palmitate and Ketorolac for Intravaginal Administration

Intravaginal drug administration offers several advantages over other routes, primarily bypassing the initial stages of metabolism. Additionally, this route has demonstrated both local and systemic effects. Mucoadhesive polymeric systems can be utilized to prevent dose loss due to the mucous barriers and the formation of wet cavities. This study employed various techniques to evaluate the performance and characteristics of a mucoadhesive film composed of HPMC-PEG 400 containing retinyl palmitate and ketorolac molecules. Scanning Electron Microscopy (SEM) was employed to analyze the porous structure of the film. Thermogravimetric Analysis (TGA) was conducted at different temperatures to assess thermal stability. Fourier Transform Infrared Spectroscopy (FTIR) was used to analyze the functional groups and intermolecular interactions between the film and the drug. Swelling and weight loss tests indicated that the film disintegrated within 3–4 days. UV-VIS spectroscopy was used for drug release evaluation based on the Higuchi equation. Additionally, the surface wetting properties were assessed through contact angle measurements. The system’s biocompatibility was confirmed using the MTT assay. Finally, adhesion and glide tests demonstrated the film’s interaction with porcine uterine tissue. This study shows that the HPMC-PEG 400 film containing retinyl palmitate molecules interacts effectively with tissue and could be considered a novel tool for treating damaged epithelial tissues.

Influence of Pain, Risk Factors, and Functional Ability on Physical Activity Levels in Women with Anterior Knee Pain: A Cross-Sectional Study.

Background and Objectives: Anterior knee pain (AKP) refers to chronic prepatellar pain and is one of the most common knee complaints in physically active women. This condition can significantly affect daily activities and overall quality of life. This study aims to assess the impact of pain, risk factors, and functional ability on different levels of physical activity (comparing low versus moderate activity) in women with AKP. Materials and Methods: This cross-sectional study involved fifty-six women diagnosed with AKP (aged 20-45 years) who were equally allocated into low and moderate physical activity groups. Their AKP and functional ability were assessed using the visual analog scale (VAS) and double squats and step-down tests, respectively. Possible risk factors were assessed using the Q-angle, modified Thomas test, sit and reach test, and patellar glide test. A person's correlation coefficient and independent t-tests were used to determine the relationship and the differences between these variables while keeping the confidence interval level at 95%. Result: Women with moderate activity levels showed significantly higher scores on the VAS than those with low activity levels (p = 0.040). However, both groups had no significant difference in their functional ability or potential risk factors (p > 0.05). Additionally, their functional ability (double squat) showed a positive association with hamstring flexibility (Pearson correlation coefficient [r]:0.3; p = 0.006). Conclusions: Women with AKP who were engaged in moderate physical activity experienced higher levels of pain compared to those with low activity levels. These findings underscore the urgent need for further investigation into different levels of physical activity to develop appropriate prevention and treatment strategies for women with AKP.

Impact of asymptomatic genu recurvatum on patellar mobility in young males

BACKGROUND: Genu recurvatum is one of the most commonly presented lower extremity postural malalignments in individuals. Though genu recurvatum and its impact on impaired knee proprioception, anterior cruciate injuries and posterior soft tissue dysfunctions are reported, its association with patellar mobility is scarcely reported and warrants exploration. OBJECTIVES: To evaluate the medial and lateral patellar mobility differences in adult young males with genu recurvatum and normal knee alignment. METHODS: The ethical approval for this cross-sectional study protocol was obtained and the study was conducted in Research Department of Alva’s College of Physiotherapy and Research Centre, Moodubidire, DK, Karnataka, India. The study participants were recruited through an institutional-based musculoskeletal and sports clinic. The estimated sample size for this study was 174. A total of 87 young males with genu recurvatum and 87 young males with normal knee alignment fulfilling the selection criteria were enrolled in two groups. Participants' knee joint was examined by an assessor and individuals with > 5⁰ knee hyperextension were assigned to genu recurvatum group, and individuals with knee extension < 5⁰ from neutral were assigned to the normal knee alignment group. Further, the patellar glide test was performed to examine the presence of patellar hypermobility in both groups. RESULTS: The mean age of the participants in genu recurvatum and normal knee alignment group was 22.04 + 1.860 and 21.91 + 1.869, respectively. A significant higher proportion (86.2%) of participants with genu recurvatum identified with patellar hypermobility compared to normal knee alignment. Within the genu recurvatum subjects, 66.66& and 19.54% were observed to have medial and lateral patellar hypermobility. The odds for occurrence of patellar hypermobility in genu recurvatum was estimated to be 13.007 (95%, CI, 5.481 – 30.866), respectively. CONCLUSION: The study result suggests that medial patellar hypermobility is more common in individuals with genu recurvatum. Further study investigating on the mechanism contributing towards medial patellar mobility in genu recurvatum populations could validate the present study findings.

Poster 291: Ultrasound-based patellar glide test: A new dynamic assessment of patellar instability

Objectives: Patellar instability can be difficult to assess due to the dynamic nature of this condition. While MRI and CT can demonstrate the morphology of the patellofemoral joint, the assessment of instability relies on dynamic testing. The patellar glide test is commonly utilized as a method of dynamic assessment on physical examination, yet precise quantification with this method remains difficult. Recently, cadaveric studies have demonstrated the utility of ultrasound in quantifying patellar translation. Therefore, our study aimed to apply the ultrasound-based patellar glide test to determine its utility in differentiating between knees with and without patellar instability in a clinical population. Methods: Patients with recurrent patellar instability were included in this study. Using a portable device, the ultrasound-based patellar glide test was performed with the knee in extension, and patellar position was visualized with and without a manual lateralizing force. The ultrasound probe was placed at the medial patellofemoral joint to visualize the relation of the medial patellar facet to the medial trochlea. Descriptive statistics were used to describe patellar position in the unloaded and loaded states, and patellar translation was calculated as the difference between the loaded and unloaded positions. Values were compared between symptomatic and asymptomatic knees. For each measurement of translation, receiver operating characteristic (ROC) curve analysis was performed. Youden’s J statistic was calculated to determine the optimal cutoff values to distinguish between asymptomatic vs symptomatic knees. Results: 50 knees from 25 patients (17F, 8M, mean age 26.9+/-9.4) were included in this study, of which 29 knees were unstable and 21 were stable and asymptomatic. When comparing symptomatic and asymptomatic knees, patellar position in the unloaded (4.6+/-2.8mm vs 3.8+/-2.3mm, p=0.277) and loaded states (1.1+/-3.24mm, 2.1+/-2.5mm, p=0.252) were not significantly different. Patellar translation was found to be significantly different between the symptomatic and asymptomatic states (3.5+/-2.2mm vs 1.7+/-1.5mm, p=0.002). ROC curve analysis demonstrated that patellar translation >3mm detected the presence of patellar instability with AUC 0.88 (95% CI 0.77, 0.98). 3mm translation was found to identify patellar instability with sensitivity 43.4%, specificity 95.2%, PPV 90.9%, and NPV 60.6%. Conclusions: The ultrasound-based patellar glide test was found to differentiate between symptomatic and asymptomatic knees in patients with patellar instability with high accuracy. Given the increasing availability of portable ultrasound devices and the need for quantification of patellar laxity, further studies are recommended to evaluate the role of this method of assessment in the diagnosis and management of patellar instability.

Medial patellofemoral ligament reconstruction in skeletally immature patients without correction of bony risk factors leads to acceptable outcomes but higher failure rates

ObjectivesTo report outcomes and re-dislocation rates of medial patellar stabilizers reconstruction without bone procedures for correction of anatomical risk factors for patellar instability in skeletally immature patients; to compare isolated medial patellofemoral ligament (MPFL) reconstruction to combined MPFL and medial patellotibial ligament (MPTL) reconstruction in this population. MethodsPatients with open physis and bone abnormalities including patella alta and/or increased tibial tubercle-trochlear groove (TT-TG) distance and/or trochlear dysplasia underwent MPFL reconstruction, either isolated or associated with MPTL reconstruction. Preoperative, 1-year follow-up and the latest follow-up (5 years minimum) data were collected. Radiological and clinical evaluations were conducted, with special attention to failure rate. Comparison of results from isolated MPFL and combined MPFL/MPTL reconstructions was performed. ResultsTwenty-nine patients were included, 19 in the isolated MPFL group (median 14 years old; follow-up 5.8 ​± ​1.7 years) and 10 in the combined MPFL/MPTL group (median 13.5 years old; follow-up 5.2 ​± ​1.4 years). Kujala and Tegner scores increased over time, although without statistically significant differences between the two groups at the latest follow-up (p ​= ​0.840 and p ​> ​0.999, respectively). During follow-up, 5 of 19 (26.3%) isolated MPFL and 2 of 10 (20%) MPFL/MPTL reconstructions experienced recurrence of patellar dislocation (p ​> ​0.999). Trochlear dysplasia type D (p ​= ​0.028), knee rotation (p ​= ​0.009) and lateral patellar tilt angle (p ​= ​0.003) were associated with patellar instability recurrence. The isolated MPFL group showed increased laxity on physical exam at the latest follow-up compared to the 1-year follow-up (patellar glide test (p ​= ​0.002), patellar tilt test (p ​= ​0.042) and subluxation in extension (p ​= ​0.019). This increased laxity was not observed in the MPFL/MPTL group (p ​> ​0.999). Comparing both groups, the glide test was significantly better in the combined MPFL/MPTL group in comparison to the isolated MPFL reconstruction group at the latest follow-up (p ​= ​0.021). ConclusionMPFL reconstruction in isolation or combined with MPTL reconstruction in skeletally immature patients with additional uncorrected anatomical patellofemoral abnormalities leads to acceptable clinical outcomes within a minimum of 5 years follow-up, although has a high failure rate of 24.1%. Addition of a MPTL reconstruction to the MPFL may result in decreased patellar laxity on physical exams, as demonstrated by better patellar glide test, patellar tilt test and subluxation in extension. Level of evidenceLevel III; retrospective cohort study.

Customizable Low-Friction Tough Hydrogels for Potential Cartilage Tissue Engineering by a Rapid Orthogonal Photoreactive 3D-Printing Design.

Hydrogels have demonstrated wide applications in tissue engineering, but it is still challenging to develop strong, customizable, low-friction artificial scaffolds. Here, we report a rapid orthogonal photoreactive 3D-printing (ROP3P) strategy to achieve the design of high-performance hydrogels in tens of minutes. The orthogonal ruthenium chemistry enables the formation of multinetworks in hydrogels via phenol-coupling reaction and traditional radical polymerization. Further Ca2+-cross-linking treatment greatly improves their mechanical properties (6.4 MPa at a critical strain of 300%) and toughness (10.85 MJ m-3). The tribological investigation reveals that the high elastic moduli of the as-prepared hydrogels improve their lubrication (∼0.02) and wear-resistance performances. These hydrogels are biocompatible and nontoxic and promote bone marrow mesenchymal stem cell adhesion and propagation. The introduction of 1-hydroxy-3-(acryloylamino)-1,1-propanediylbisphosphonic acid units can greatly enhance their antibacterial property to kill typical Escherichia coli and Staphylococcus aureus. Moreover, the rapid ROP3P can achieve hydrogel preparation in several seconds and is readily compatible with making artificial meniscus scaffolds. The printed meniscus-like materials are mechanically stable and can maintain their shape under long-term gliding tests. It is anticipated that these high-performance customizable low-friction tough hydrogels and the highly efficient ROP3P strategy could promote further development and practical applications of hydrogels in biomimetic tissue engineering, materials chemistry, bioelectronics, and so on.

Utility of Diagnostic Ultrasound in the Assessment of Patellar Instability.

Background:The use of imaging to diagnose patellofemoral instability is often limited by the inability to dynamically load the joint during assessment. Therefore, the diagnosis is typically based on physical examination using the glide test to assess and quantify lateral patellar translation. However, precise quantification with this technique remains difficult.Purpose:To quantify patellar position using ultrasound imaging under dynamic loading conditions to distinguish between knees with and without medial patellofemoral complex (MPFC) injury.Study Design:Controlled laboratory study.Methods:In 10 cadaveric knees, the medial patellofemoral distance was measured to quantify patellar position from 0° to 40° of knee flexion at 10° increments. Knees were evaluated at each flexion angle under unloaded conditions and with 20 N of laterally directed force on the patella to mimic the glide test. Patellar position measurements were made on ultrasound images obtained before and after MPFC transection and compared for significant differences. To determine the ability of medial patellofemoral measurements to differentiate between MPFC-intact and MPFC-deficient states, area under the receiver operating characteristic (ROC) curve analysis and the Delong test were used. The optimal cutoff value to distinguish between the deficient and intact states was determined using the Youden J statistic.Results:A significant increase in medial patellofemoral distance was observed in the MPFC-deficient state as compared with the intact state at all flexion angles (P = .005 to P < .001). When compared with the intact state, MPFC deficiency increased medial patellofemoral distance by 32.8% (6 mm) at 20° of knee flexion under 20-N load. Based on ROC analysis and the J statistic, the optimal threshold for identifying MPFC injury was 19.2 mm of medial patellofemoral distance at 20° of flexion under dynamic loading conditions (area under the ROC curve = 0.93, sensitivity = 77.8%, specificity = 100%, accuracy = 88.9%).Conclusion:Using dynamic ultrasound assessment, we found that medial patellofemoral distance significantly increases with disruption of the MPFC.Clinical Relevance:Dynamic ultrasound measurements can be used to accurately detect the presence of complete MPFC injury.

Patellofemoral Pain Syndrome in Young Female Athletes: A Case-Control Study

Background Patellofemoral pain syndrome (PFPS) is the most common cause of anterior knee pain in children and adolescents, and it is characterized by highly limiting, recurrent, frontal pain. Objectives The purpose of the study is to assess the incidence and onset of PFPS in the young female athletes and to compare it to healthy individuals. Methods Between 2017 and 2019, 51 subjects were reviewed and divided in three groups: rhythmic gymnastics athletes (RG; 21 individuals, mean age: 13.8 ± 3.6 years), basketball athletes (BG; 17 individuals, mean age: 14.2 ± 3.1 years), and control group (CG; 13 individuals, mean age: 14.5 ± 4.3 years). All patients underwent physical examination including patellar glide, tilt, grind and apprehension tests, tiptoe and jack tests, Coleman block, and navicular drop tests. The clinical and functional outcomes of the subjects were assessed using the Kujala patellofemoral score (KPS). Results In RG patients were recorded 66.7% of normal footprint (NF), 9.5% of cavus feet (FCF), and 23.8% of flatfeet (FFF); 14.8% patellar positive tests, KS = 98.6 ± 13.7. BG patients had 70.6% of NF, 11.8% FCF, and 17.6% of FFF; 23.5% patellar positive tests, KS = 98.3 ± 12.4. CG patients had 61.5% of NF, 7.7% of FCF and 30.8% of FFF; 15.4% patellar positive tests, KPS = 98,9 ± 15.3. No statistically significance was found between the three cohorts of patients. Conclusions PFPS is a common pathology; muscular imbalance and overuse could exacerbate pain and discomfort in young female athletes. Our findings show high type and level of sport activity are not related to increase frequency of clinical symptoms related to PFPS.

Laboratory testing of cross-country skis – Investigating tribometer precision on laboratory-grown dendritic snow

Small differences in ski-snow friction results in large time gaps, and glide testing is therefore an important part of racing. To test ski-snow friction without the influence of changing weather, snow conditions and skier position is therefore valuable. In this study, a full-scale ski-snow tribometer was developed and we investigated the degree of precision obtainable for different snow types, speeds, between separate ski tracks and snow surface preparations. The precision within new snow test tracks was 1.45%, and changing between parallel tracks added another 1.03% to the precision. Measurements across several dendritic snow testbeds were associated with a further 2.39% contribution to the precision. On aged snow, better precision was obtained within and between tracks on the same snow surface.

Utility of dynamic ultrasound in the assessment of patellar instability (158)

Objectives:Few imaging modalities currently exist that allow for dynamic assessment of the patellofemoral joint. Dynamic evaluation of patellar instability is typically based on physical examination using the Glide test to assess and quantify lateral patellar translation. However, this method can be limited for inexperienced examiners, and precise quantification with this method remains difficult. Therefore, this study aimed to utilize ultrasound imaging to quantify patellar position and translation under dynamic loading conditions to compare knees with and without injury to the medial soft tissue restraints.Methods:10 fresh frozen, unpaired cadaveric knee specimens underwent assessment of lateral patellar translation using a portable ultrasound device. The probe was positioned 1cm above the medial joint line, and measurements were performed based on the distance between the articular edge of the medial patellar facet and the most prominent edge of the medial trochlear facet. Using an electronic force gauge, two standardized loading conditions were created: (1) Unloaded (0N of force), and (2) loaded with 20N of laterally directed force on the patella to mimic the Glide test. Patellar translation in the lateral direction was assessed from 0-40 degrees of knee flexion at 10 degree increments using a hand held goniometer. Measurements were performed in intact knees and were repeated after arthroscopic transection of the medial soft tissue restraints (both medial patellofemoral ligament [MPFL] and medial quadriceps tendon-femoral ligament [MQTFL]). All measurements were performed using Image J. Paired t-test was used to compare the findings of the intact vs injured states. Sensitivity, specificity, accuracy, negative, and positive predictive value for the injury state were determined based on the values from the intact state +2 standard deviations (SD). P-value <0.05 was considered statistically significant.Results:Compared with the intact state, significant increases in lateralized patellar position and translation were observed when the MPFL and MQTFL were transected, at all flexion angles between 0 and 40 degrees (p values ranging from .005 to <.001). Results are listed in Table 1. The greatest difference was noted with a laterally directed force of 20N at 20 degrees knee flexion, where a 32.8% (6mm) increase in lateral translation was observed in the injured state, when compared to the intact state. Based on 2 SD from normal values at 20 and 30 degrees, the optimal cutoff point to identify MPFL/MQTFL injury was 17.5 mm of distance from the medial trochlea to the medial patellar facet (sensitivity 95.1%; specificity 86.7%; accuracy 90%).Conclusions:Under dynamic ultrasonographic assessment, the integrity of the medial patellar restraints can be effectively evaluated based on measurements of patellar position and translation, with patellar position >17.5mm from the medial trochlea at 20 and 30 degrees knee flexion indicating the presence of injury. As dynamic ultrasound can be performed without radiation or invasive testing in multiple clinical settings, further studies are recommended to assess the utility of ultrasound based assessments in the evaluation and management of patellar instability.

"Complications in Blepharoplasty and How to Resolve Them"

Any type of eyelid correction or postoperative blepharoplasty complication should be well managed and studied before attempting its correction, as it could lead to a worsening of the original alteration. Although postoperative scars in a blepharoplasty are relatively rare, they can generally be improved by massage and late with the application of topical corticosteroids, with the understanding that their best use is during the first twelve months. An early intervention should be avoided as this can worsen the result and rarely improve the final result, when there is a healing problem, remembering that stress is a determining factor in the final result. The laxity of the canthus tendons should always be evaluated either by directly pulling the eyelid down, with an eyelid glide test, the impingement test, and a poor eyelid position prior to surgery should always be documented. In these cases, the surgeon who operates blepharoplasty must have a perfect knowledge of the management of the canthal tendons and have within his surgical resources the realization of the canthal application or the repositioning of the palpebral canthal tendon.

The Development and Precision of a Custom-Made Skitester

In the sport of cross-country skiing, equipment has a direct influence on results. Ski teams do extensive testing of different ski base grinds and products on a yearly basis. To achieve reliable results, the quality of methods used for testing skis needs to be taken in to account in addition to factors including the physical characteristics of testing personnel and changes in weather conditions. The aim of this study was to introduce a custom-made skitester, that was developed for testing skis on real snow, in laboratory conditions, and to evaluate its precision. The current skitester is capable of glide testing both classic and skate skis as well as kick simulation for the testing of grip waxes. In the present study, glide testing precision was completed in three different conditions. Velocity and pressure of skis were evaluated in three different temperature conditions. During kick simulation, precision was determined in one temperature condition. For glide testing, the precision of the measurement unit was able to distinguish the differences between skis with a relative variation of 0.6–1.1%. However, the track preparation process caused variation. For kick simulation, precision of the measurement unit was slightly higher (2.5%), and track preparation caused less variation. The skitester is capable of distinguishing the differences between both skate and classic cross-country skis with certain limitations.

Medial Patellofemoral Complex Advancement for Recurrent Lateral Patellar Instability and Selective Acute Primary Patellar Dislocations

Medial patellofemoral complex (MPFC) is considered as the primary medial patellar restraint and has a static, as well as dynamic, component. MPFL reconstruction (MPFL-R) restores only the static component of MPFC, is associated with multiple technical concerns, and has a steep learning curve. Need for physeal sparing techniques and relatively high rates of complications including patella fracture are some other concerns with MPFL-R. We propose a simple procedure for advancement of MPFC onto patella, which is indicated in most of the recurrent lateral instabilities (with a positive lateral glide test result and an intact MPFL on magnetic resonance imaging). The procedure is also indicated in selective acute primary dislocations—those with associated chondral lesions and magnetic resonance imaging–documented isolated patellar side avulsion/injury. MPFC advancement is a more anatomical procedure that also restores dynamic medial checkrein of patella and can be performed even by a novice surgeon. MPFC advancement is devoid of the multiple technicalities of MPFL-R, does not require intraoperative imaging or any postoperative immobilization, and renders complications like donor graft-site morbidity and patella fractures irrelevant. It requires no modifications in patients with open physes and can be performed in isolation or with other procedures as per à la carte principle.

Medial patellofemoral ligament reconstruction technique

Backgroud Recurrent patellar dislocation is a challenging medical problem for both the patient and the surgeon because of its multifactorial etiology.The medial patellofemoral ligament (MPFL) extends between the superomedial border of the patella and the anterior aspect of the medial femoral epicondyle in layer 2 of the medial soft tissue structures In the last decade, there have been many techniques for reconstruction of the MPFL. All techniques rely on supplying tendinous reconstruct from the medial border of the patella to the adductor tubercle, using different tendonsThe aim of this study was to describe the technique of reconstruction of MPFL and evaluation of the results using transverse holes in the patella and femoral interference screw. Patients and methods From January 2013 to April 2016, 20 cases underwent isolated MPFL reconstruction, after institutional ethics approval and informed consent was obtained from every patient. Out of the operated 20 cases, there were 12 females and eight males, with an average age of 24 years. Average age at the first dislocation episode was 21±2 years. Mean follow-up is about 18.3 months (range: 9–28), a mean of 4.8 dislocations per patient (range: 3–16 times). All were caused by either trauma or physical activity (14 trauma, six physical activity). Results All cases regained full range of motion; the apprehension sign dropped from 90% preoperative in 18 cases to 15% postoperative (only three cases). The glide test dropped from 100to 0% in follow-up. Mean Lysholm score improved significantly from 58%±3 to 93%±4. Conclusion MPFL reconstruction for treatment of recurrent patellar dislocation with a gracilis tendon autograft, using transverse holes in the patella and a screw for femoral fixation, showed good results at short-term follow-up

When to Add Lateral Soft Tissue Balancing?

Lateral patellofemoral (PF) soft tissue abnormalities range from excessive lateral PF tightness (lateral patellar compression syndrome, lateral patellar instability and arthritis), to excessive laxity (iatrogenic lateral PF soft tissue insufficiency postlateral release). The lateral soft tissue complex is composed of the iliotibial band extension to the patella, the vastus lateralis tendon, the lateral PF ligament, lateral patellotibial ligament, and lateral patellomeniscal ligament, with intimate connections between those structures. To identify lateral retinaculum tightness or insufficiency the most important tests are the patellar glide test and patellar tilt test. Imaging aids in that evaluation relying mostly on the patella position assessed by radiographs, computed tomography, and magnetic resonance imaging with referencing to the posterior femoral condyles. Lateral retinaculum lengthening (preferred) or release may be added when there is excessive lateral retinaculum tightness. A lengthening may be performed using a minimally invasive approach without compromising the lateral patella restraint. Lateral retinaculum repair or reconstruction is indicated when there is lateral retinaculum insufficiency. Lateral retinaculum surgery to balance the medial/lateral soft tissue restraints, improves patellar positioning and clinical results.

Development and experiments of a bio-inspired robot with multi-mode in aerial and terrestrial locomotion

This paper introduces a new multi-modal robot capable of terrestrial and aerial locomotion, aiming to operate in a wider range of environments. The robot was built to achieve two locomotion modes of walking and gliding while preventing one modality hindering the other. To achieve this goal, we found the solution from Pteromyini, commonly known as the flying squirrel. Pteromyini utilizes its flexible membrane to glide in the air, and it shows agile movements on the ground. We studied Pteromyini to mimic the key features that allow Pteromyini to perform aerial and terrestrial locomotion. We adopted the flexible membrane and gliding strategy of Pteromyini to the robot. Through dynamics analysis and simulations, the overall design was determined. The flexibility of the membrane was also chosen considering the robot’s performance in the air and on the ground. The leg was optimized to perform with regulated motor torques in both walking and gliding. From gliding tests, the robot showed an average gliding ratio of 1.88. Inspired by Pteromyini, controlling the robot’s angle of attack with leg and tail movement was also adopted and tested. Different gait patterns and changing walking directions were tested to demonstrate the robot’s terrestrial performance. The average walking speed was 13.38 cm s−1. The experimental results demonstrated the robot’s functionality in aerial and terrestrial locomotion.

Relationship between post-operative residual patellar J sign and the laxity of reconstructed medial patellofemoral ligament in recurrent patellar instability adult patients

Objective To discover the relationship between the post-operative positive residual patellar J sign and the laxity of reconstructed medial patellofemoral ligament (MPFL) after MPFL reconstruction combined with tibial tubercle osteotomy (TTO). Methods A total of 39 consecutive recurrent patellar dislocation (RPD) adult patients who were performed MPFL reconstruction and TTO with more than 2 follow-up time were analyzed retrospectively in the present study. The patellar tracking of all the patients was evaluated and was classified into positive patellar J sign group and negative J sign control group during knee active flexion and extension at final follow up. The computed tomography (CT) examination was performed in all patients at 0° extension of the knee. The patellar laxity index measured by patellar glide test (PGT) and the radiographic parameters (tibial tuberosity-trochlear groove distance, bisect offset index, patella trochlear-groove distance, patella lateral tilt angle, femoral anteversion angle, tibial external angle and knee rotational angle) calculated by CT scans slices as well as the pre-/post- operative knee functional scores including International Knee Documentation Committee (IKDC) score, Kujala score, and Lysholm score were compared between the positive group and negative group at final follow up. Results The average follow-up duration was 26.3±6.7 months (range 24-31) and all the patients did not suffer from the RPD during the follow-up. Ten (26%, 10/39) patients performed positive J sign, and the remaining 29 (74%, 29/39) performed negatively. The two groups were compatible with no significant difference in age, gender, injury side, follow-up duration and preoperative knee function scores (P>0.05). At the final follow up, the patellar laxity index in the positive J sign group was 34.9%±6.9%, while that in the negative group was 24.6%±8.6%. There was significantly difference in the patellar laxity index between two groups (t=-3.413, P=0.002). The bisect offset index in the positive group was 102.9%±12.4%, while that in the negative group was 76.0%±18.4%. There was significantly difference in the bisect offset index between two groups (t=-4.268, P=0.000). The patella trochlear-groove distance in the positive group was 2.2±3.7 mm, while that in the negative group was -7.6±5.8 mm. There was significantly difference in the patella trochlear-groove distance between two groups (t=-4.233, P=0.000). The two groups were compatible with no significant difference in tibial tuberosity-trochlear groove distance, patella lateral tilt angle, femoral anteversion angle, tibial external angle and knee rotational angle (P>0.05). The IKDC, Kujala, and Lysholm in the positive group were 86.4±6.5, 85.3±1.1, 91.5±7.9 respectively with significantly differences compared with preoperative scores 53.3±2.4, 73.2±9.7, 76.7±6.6 (t=-10.163, P=0.000; t=-1.274, P=0.023; t=-8.533, P=0.018). The IKDC, Kujala, and Lysholm in the negative group were 87.3±8.6, 84.3±4.7, 93.1±4.3 respectively with significantly differences compared with preoperative scores 49.1±4.6, 71.4±6.5, 79.5±7.0 (t=-14.381, P=0.000; t=-0.068, P=0.037; t=-6.902, P=0.013). There were no significant difference in the postoperative knee function scores between the two groups (P>0.05). Conclusion RPD patients can recover the patellar instability from the surgical technique of MPFL reconstruction and TTO and none of them suffer from the RPD during the follow-up. However, the morbidity of post-operative positive residual patellar J sign was 26%. The positive J sign might increase the laxity of patella. Key words: Patellofemoral joint; Wounds and injuries; Arthroscopy; Joint instability

Clinical Tests Have Limited Predictive Value for Chronic Ankle Instability When Conducted in the Acute Phase of a First-Time Lateral Ankle Sprain Injury

ObjectiveTo evaluate whether a battery of clinical assessments for acute lateral ankle sprain (LAS) can be used to predict long-term recovery. DesignCohort study. SettingUniversity biomechanics laboratory. ParticipantsIndividuals (N=82) were assessed using a clinical test battery within 2 weeks of incurring a first-time LAS. InterventionsNot applicable. Main Outcome MeasuresThe clinical test battery included scores on the talar glide test (degrees), the anterior drawer, talar tilt, figure of 8 for swelling (millimeters) and knee to wall (millimeters) tests, and handheld goniometric range of motion (inversion, eversion, and plantarflexion [in degrees]). Scores on the Cumberland Ankle Instability Tool taken 12 months after the clinical test battery were used to classify participants as having chronic ankle instability (CAI) or as being LAS copers. ResultsForty percent of participants were designated as having CAI, with 60% being designated as LAS copers. A logistic regression analysis revealed that a combined model using scores from the talar glide, talar tilt, and anterior drawer tests in addition to plantarflexion range of motion was statistically significant (P<.01) and correctly classified cases with moderate accuracy (68.8%). The final model had moderate sensitivity (64%) and good specificity (72%). ConclusionsThe clinical tests used in this investigation have limited predictive value for CAI when conducted in the acute phase of a first-time LAS injury.

Lateral retinaculum plasty instead of lateral retinacular release with concomitant medial patellofemoral ligament reconstruction can achieve better results for patellar dislocation.

To elucidate the outcomes of lateral retinaculum plasty versus lateral retinacular release with concomitant medial patellofemoral ligament (MPFL) reconstruction. In a prospective study, 59 patients treated at our institution from 2012 to 2014 were included. The 59 patients were randomly divided into two groups. Group I included 27 patients who underwent lateral retinacular release and MPFL reconstruction. Group II included 32 patients who underwent lateral retinaculum plasty and MPFL reconstruction. All patients were followed up for at least 2years and all assessments were performed both pre- and post-operation. Clinical evaluation consisted of the Kujala score, patellar medial glide test, and patellar tilt angle, patellar lateral shift, and congruence angle, measured on CT scan. Significant improvement was seen after surgery in both groups. The group of lateral retinaculum plasty achieved better results than the group of lateral retinacular release. No statistically significant differences were found in lateral patellar shift (ns) or congruence angle (ns) between the groups. There were significant differences in Kujala score (P < 0.05) patellar tilt angle (P < 0.05), and patellar medial glide test (P < 0.05) between the groups. MPFL reconstruction with lateral retinaculum plasty yielded better results than MPFL with lateral retinacular release. Postoperatively, medial and lateral function were restored, and patellar tracking was normal. Lateral retinaculum plasty is a new method that reduces the complications of lateral retinacular release for patellar dislocation. II.

MPFL Reconstruction Combined with Anteromedialization Tibial Tubercle Osteotomy Versus Isolated MPFL Reconstruction in Patients with Recurrent Patellar Instability: A Quasi-Randomized Controlled Trial

Recurrent patellar instability is frequently associated with patellar maltracking. Distal realignment is usually recommended for patients with TT-TG greater than 20mm. Nevertheless, selected patients with subtle abnormalities, TT-TG distance <20mm, may benefit from the distal realignment improving clinical outcomes when combined to MPFL reconstruction in comparison to MPFL reconstruction alone. Compare the clinical outcomes of the anteromedialization tibial tubercle osteotomy (TTO) combined with medial patellofemoral ligament reconstruction (MPFLR) versus MPFLR alone for the treatment of recurrent patellar instability (RPI) in patients with TT-TG 17 to 20 mm presenting its mid-term outcomes. From January 2008 to August 2013, skeletally mature patients with RPI and TT-TG 17-20mm were quasi-randomized into two groups: TTO combined with MPFLR (TTO+MPFLR) or MPFLR alone (MPFLRa). Quasi-randomization: both interventions were explained to the patients and they chose which one to be submitted. Subjects were evaluated for patellar tracking lateralization, patellar glide, apprehension test, increased femoral anteversion, Caton index, trochlea dysplasia by Dejour classification, TT-TG, Kujala, IKDC, Lysholm and Tegner. Forty-two patients composed the study. TTO+MPFLR group was comprised of 18 patients and MPFLRa group was comprised of 24 patients. Demographics between groups were not significantly different related to age, gender, side, and cartilage lesion. Results are presented comparing TTO+MPFLR and MPFLa, respectively, as follows. Follow-up: 41.33±10.26, 40.5±11.63 months, p=0.81. Patellar tracking lateralization preoperatively: 3.33±0.84, 3.25±0.67, p=0.182. Patellar tracking lateralization postoperatively: 1±0, 1.33±0.48, p=0.006. Patellar glide and apprehension test preoperatively: All patients had a positive apprehension test or a patellar luxation at the patellar glide test rated as grade 4 before surgery. Patellar glide postoperatively: 1.17±0.38, 1.21±0.41, p=0.734. Apprehension test postoperatively: none. Increased femoral anteversion: 6%, 25%, p=0.9. Caton index preoperatively: 1.12±0.14, 1.12±0.11, p=0.97. Caton index postoperatively: 1±0.08, 1.12±0.11 (the same preoperatively), p=0.0012. TTO+MPFLR patients submitted to concurrent tibial tubercle distalization: 44%. Trochlea dysplasia: no significant difference between groups, p=0.67. TT-TG preoperatively: 18.5±1.24, 18.04±1.12, p=0.16. TT-TG postoperatively: 10.55±0.83, 18.04±1.12 (the same preoperatively), p<.001. No significant difference was seen in the preoperatively scores (Kujala, IKDC, Lysholm and Tegner) between the groups. Significant improvements were seen in all scores except Tegner from the preoperative baseline to the latest follow-up for both groups. Also, the improvement from the baseline was statistically significant higher in the TTO+MPFLR group compared with the MPFLRa group in all scores, except for Tegner. Kujala improvement: 30.27±4.94, 23.95±8.37, p=0.003, also clinically significant favoring TTO+MPFLR. IKDC improvement: 38.59±7.26, 31.6±8.67, p=0.002. Lysholm improvement: 40.5±9, 36.2±8.9, p=0.02. Tegner improvement: -0.11±0.47, -0.25±0.53, p=0.5. No major complications were described in both groups. TTO combined with MPFLR was better than MPFLRa in the surgical treatment of RPI patients with TT-TG 17-20mm.