Healthy Limb Research Articles

Soft tissue reconstruction of foot and ankle defect using various flap cover: single centre experience

Introduction: Soft tissue defect at ankle and foot region are very common following road traffic accident. Reconstruction in this region is challenging to surgeon because of poor vascularity and paucity of available surrounding tissue. Purpose of study is to evaluate various ankle and foot defect, advantage and disadvantages of different methods of management, future prospective of suitable method according to defect.Materials and Methods: Retrospective study of 65 patients with soft tissue defects around foot and ankle region underwent various reconstructive procedures at SMS hospital Jaipur from January 2020 to December 2020. Study enumerates various etiological factors and describes different reconstructive surgical procedures.Results: Age at presentation range from 8 to 63 years and males were more common. Road traffic accident is most common cause for defect at foot and ankle region followed by diabetic foot and orthopedic implant exposure. Most common site of defect in foot and ankle defect were dorsum of foot followed by lateral malleolus region. Free ALT flap cover performed most frequently followed by cross leg flap.Conclusion: Reverse sural flap is reliable option for small ankle and foot defect near ankle. Cross leg flap is also most reliable option for large defect in opposite healthy limb. Reverse saphanous flap also used for small defects on medial side ankle. Larger defect of ankle and foot can be covered by free fasciocutaneous or myocutaneous flaps where microsurgical expertise available.

IMPROVING QUALITY OF LIFE AMONG MINISTRY OF NATIONAL DEFENCE WORKERS THROUGH PROPRIOCEPTIVE EXERCISES

Proprioceptive re-education improves stability and balance control and reduces the risk of injury. Through this research, we intend to emphasise that simple exercises such as simple assessment tests are equally useful in preventing knee sprain, in terms of primary prophylaxis and recurrence prevention. The study involved 15 active military workers (11 male and 4 female) from the Ministry of National Defence, who were included in the category of people practising the sports activities required by their profession. These sports activities are varied and consist of: athletics, martial arts, football, volleyball and military application routes specific to the training of this professional category. We aim to verify the effectiveness of proprioceptive exercises included in an original programme. We applied the Star Excursion Balance Test (SEBT), which is used by clinicians and researchers to assess static and dynamic balance, track performance changes after implementing a prevention or rehabilitation programme and identify people at risk of injury. For the assessment of knee function-related quality of life following the programme applied to participants, we used the Lysholm Scale and 2000 IKDC questionnaires. The statistical results obtained using the dependent t test indicate significant increases in dynamic balance and postural control for both the affected and healthy lower limbs, which demonstrates the effectiveness of the exercise programme used as well as its therapeutic and prophylactic effects. Consequently, the implementation of such a programme can be a measure aimed at improving the health-related quality of life of active military personnel in the Ministry of National Defence.

93. The Effects of Subnormothermic Plasma and Red Blood Cell Based Perfusion on the Function and Viability of Limb Allografts

Purpose: Vascularized composite allotranplantation (VCA) is an evolving area of modern transplantation medicine to reconstruct composite tissue defects such as abdominal wall, face, and limb. One of the challenges in VCA is the narrow window of tolerable ischemia time which limits the number of available donors and imposes a single center transplantation approach. Current standard of care, static cold storage, is only effective for short periods and may result in severe tissue damage and acute rejection when prolonged. Ex-situ perfusion has the potential to overcome these challenges by extending allowable pre-transplantation ischemia time. However, optimum perfusate composition, preservation temperature, and hemodynamic parameters of perfusion are still debated. Over the past decade, the benefits of addition of fresh plasma in hemorrhagic shock resuscitation and attenuation of subsequent reperfusion injury have been recognized. Whether these observations are due to high or low molecular weight (HMW and LMW, respectively) plasma proteins require further investigation. This study investigated the effects of the addition of plasma on the viability of perfused limb allografts with prolonged ischemia time. Methods: All limb transplantations were performed orthotopically between male Lewis rats (200-250 g). In group 1, amputated limbs were transplanted immediately to determine the effects of surgical trauma. In group 2, amputated limbs were preserved at 4°C simulating the clinical standard of care. In other groups, amputated limbs were perfused for 6 hours at 20° to 22°C using one of the following perfusates groups and transplanted to another recipient (in less than 90 minutes): RBC only (G3), RBC + whole plasma (G4), RBC + LMW plasma (G5), RBC + HMW plasma (G6). At 3 months post-transplantation, surviving recipients had end-point assessment using electromyography where compound muscle action potentials (CMAP) and extensor digitorum longus (EDL) muscle force generation were compared to contralateral healthy limb. Muscle and nerve histology samples were collected at the end of EMG testing. Results: Recipients in the group perfused with RBC and HMW plasma proteins had severe reperfusion injury and did not survive beyond 3 days. Among surviving recipients, the addition of whole plasma did not appear to improve amplitude and latency on gastrocnemius and EDL muscles compared to immediately transplanted limbs. Groups perfused with RBC only and RBC with LMW plasma demonstrated excellent amplitude and latencies on both muscle groups, with no significant difference compared to immediately transplanted limbs (p>0.05). The EDL muscle in these groups also generated similar tetanic and twitch forces compared to the immediate transplantation group (p>0.05). Conclusion: Ex-situ perfusion at 20° to 22°C for 6 hours using RBC and LMW plasma appears to protect both fast and slow twitch muscles, and improve axonal regeneration and myelin sheath thickness to a degree comparable with the immediately transplanted group.

Lymphoscintigraphy for prediction of effect of lymphaticovenular anastomosis for treatment of secondary lower limb lymphedema

ObjectiveThe outcomes of lymphaticovenular anastomosis (LVA), especially for the lower extremities, have varied. To determine the optimal patient selection for LVA, we evaluated the smooth muscle function of lymph vessels using preoperative lymphoscintigraphy images and compared the findings with the LVA outcomes. MethodsWe performed a retrospective study of 81 patients with secondary lower extremity lymphedema who had undergone LVA between 2016 and 2018. To reduce the variability in the surgeon-specific variables that can affect the outcomes of LVA, all the cases from 2016 onward were performed by only two surgeons using standardized protocols for preoperative care, surgical technique, number of anastomoses, postoperative ambulation, and compression. The outcomes were evaluated by comparing the circumferences of the pre- and postoperative limbs. The preoperative lymphoscintigraphy findings were categorized into three types according to the range of the cephalad extent of the tracer as follows: type 1, tracer extending to the thigh or groin region; type 2, tracer extending to the lower leg or knee; and type 3, tracer localized at the ankle. The quantitative outcomes were evaluated by measuring the circumferences of the ankle, mid-calf, knee, and thigh. ResultsThe average percentage in the reduction in the ankle, mid-calf, knee, and thigh circumference was 7.9%, 4.7%, 2.9%, and 3.0%, respectively. The average percentage in the reduction in the circumference for types 1 and 3 at the ankle, mid-calf, knee, and thigh was 11.6% and 8.6%, 7.6% and 1.6%, 5.2% and −0.5%, and 5.4% and −1.2%, respectively, with significant differences between types 1 and 3 in the thigh. The percentage of types 1, 2 and 3 was 60% to 76.4%, 11.7% to 20%, and 0% to 5.5% of the treated limbs that were similar in size to the contralateral healthy limb at the four sites of measurement, respectively. ConclusionsThe use of LVA can effectively reduce the circumference of the lower limb. Our results suggest that the lymphoscintigraphy findings could help to predict the effect of LVA and could facilitate optimal patient selection.

Cartilage Homeostasis and Osteoarthritis.

Healthy limb joints are important for maintaining health and attaining longevity. Endochondral ossification (the replacement of cartilage with bone, occurring during skeletal development) is essential for bone formation, especially in long-axis bones. In contrast to endochondral ossification, chondrocyte populations in articular cartilage persist and maintain joint tissue into adulthood. Articular cartilage, a connective tissue consisting of chondrocytes and their surrounding extracellular matrices, plays an essential role in the mechanical cushioning of joints in postnatal locomotion. Osteoarthritis (OA) pathology relates to disruptions in the balance between anabolic and catabolic signals, that is, the loss of chondrocyte homeostasis due to aging or overuse of cartilages. The onset of OA increases with age, shortening a person’s healthy life expectancy. Although many people with OA experience pain, the mainstay of treatment is symptomatic therapy, and no fundamental treatment has yet been established. To establish regenerative or preventative therapies for cartilage diseases, further understanding of the mechanisms of cartilage development, morphosis, and homeostasis is required. In this review, we describe the general development of cartilage and OA pathology, followed by a discussion on anabolic and catabolic signals in cartilage homeostasis, mainly microRNAs.

Impact of a Rehabilitation Program on the Change in Components of Body Mass of the Upper and Lower Limbs in People After Ischemic Stroke.

BackgroundThe aim of this study was to evaluate the effects of rehabilitation in terms of changes in the body mass composition in the upper and lower limbs depending on the length of time after stroke and the age of the patient.Material/MethodsEighty-two patients after ischemic stroke were tested 3 times: on admission, after 5 weeks, and 3 months after leaving the hospital (follow-up). During each examination, a segmental analysis of the components of the body mass of the upper limbs and lower limbs was performed, depending on the side of paresis.ResultsPatients between 7 and 12 months after stroke with right-sided paresis had a reduction of fat (P=0.027) and an increase in muscle tissue in the lower (P=0.030) and upper limbs with paresis (P=0.037), as well as in the healthy upper limb (P=0.034) after rehabilitation. Only in the youngest age group (25–44 years) and in patients with left-sided paresis was there a decrease of adipose tissue in the healthy upper (P=0.012) and paresis limbs (P=0.032) and an increase in the muscle tissue mass in the right upper limb (P=0.010) after rehabilitation.ConclusionsThe rehabilitation program had a significant impact on the change in the composition of body mass in upper and lower limbs in people with right-sided paresis, particularly 7 to 12 months after stroke and in the youngest age group (25–44 years). These results may be useful in planning a rehabilitation program for stroke patients to consider the patient’s dominant hand and neglect.

Медицинская реабилитация в спорте высших достижений после реконструкции передней крестообразной связки коленного сустава

The professional activity of high performance, or elite sportsmen involves loads approaching extreme exertion, which often leads to injuries of the lower limbs. Anterior cruciate ligament (ACL) injury is one of the most common types of knee injuries. This study aimed to evaluate the effectiveness of a comprehensive rehabilitation program for athletes that underwent arthroscopic ACL reconstruction. The study involved 64 athletes aged from 17 to 31 years. Treatment group participants were offered a comprehensive medical rehabilitation program that included isokinetic training sessions on the TECNOBODY IsoMove biomechanical exercising machine; the sessions followed a purpose-designed method. The results of medical rehabilitation of the athletes were assessed through gait analysis done with a DIERS Motion 4D complex. The assessments took place 8 and 15 weeks after the reconstruction. At 8 weeks after the surgery, gait analysis parameters revealed no significant differences between the groups. Fifteen weeks after the reconstruction, when treatment group (TG) members were through all the isokinetic training sessions, the results were as follows: for the Stand Time parameter, the operated limb (OL) support deficit was 0.04% compared to the healthy limb (HL) support, and for the Single Limb Support parameter it was 3.71%, while in the control group (CG) that had no isokinetic training sessions the values were 12.44% and 18.55%, respectively. As for the Swing Time parameter, TG participants showed the deficit of HL transfer symmetry (relative to OL) of 3.99%, while the value of this parameter in the CG was 20.54%. The difference is significant, which proves the effectiveness of the developed isokinetic training method as part of the comprehensive medical rehabilitation program, the application of which resulted in faster recovery of muscle strength and compromised walking-associated support and locomotor functions in TG athletes.

Substancje czynne i surowce kosmetyczne w wybranych preparatach kosmetologiczno-podologicznych pielęgnujących skórę kończyn dolnych i niwelujących hiperkeratozy

The paper presents the characteristics of cosmetic raw materials and active ingredients of selected preparations for the skin care and elimination of foot skin hyperkeratosis and their effect on the skin. The most common causes of the formation of significant thickening of the stratum corneum associated with hyperkeratosis are listed. Active substances and cosmetic raw materials contained in cosmetological and podological preparations have been shown as beneficial ingredients that have a positive effect on the condition, appearance and condition of the skin of the feet. They have a regenerating, moisturizing, smoothing effect – reducing the feeling of roughness, nourishing, some of them create a protective film on the surface of the epidermis. Their chemical compositions and methods of preparation are also presented. Calluses and cracked heels have been described as examples of excessively keratinized epidermis, consequences related to inadequately selected care, its lack or too high frequency. The term “podology” has been defined as a rapidly spreading and developing interdisciplinary field of science, the main goal of which is the care, diagnosis and treatment of diseases and abnormalities within the feet and ankle joint. The influence of this scientific field on the maintenance of healthy and well-groomed lower limbs was determined.

Giving a leg up part 2: the ethical challenges of Body Integrity Dysphoria

IntroductionBody Integrity Dysphoria (BID) is a diagnosis, newly described in ICD-11, “characterised by an intense and persistent desire to become physically disabled in a significant way… accompanied by persistent discomfort, or intense feelings of inappropriateness concerning current non-disabled body configuration”. Patients with BID may request the amputation of healthy limbs but this raises multiple ethical challenges.ObjectivesBy the end of the presentation, participants 1) will better understand the new diagnosis of Body Integrity Dysphoria; 2) will be able to have some landmarks to evaluate and manage this rare condition 3) will discern the ethical challenges raised by an elective or emergent amputation request.Methods We present a complex case we faced in Quebec City, Canada. A young adult admitted to the intensive care and burn unit was referred to our Consultation Liaison (CL) team. For the second time in a year, the individual deliberately burned his leg, with the intention of having an amputation. Based on the available literature and our experience, we explore the ethical aspects of this case.ResultsFor this situation, the multidisciplinary team faced uncertainty and ambivalence toward the best treatment options. Deontological concerns and ethical issues emerged from the patient’s request for amputation.ConclusionsWe outline how ethical concepts helped us to gain a shared comprehension of the patient’s extraordinary request, both during treatment and afterwards.DisclosureNo significant relationships.

Bilateral impairments of quadriceps neuromuscular function occur early after anterior cruciate ligament injury

ABSTRACT The study aimed to investigate the impairments in quadriceps neuromuscular function, including strength, rate of torque development (RTD) and activation failure (QAF) early after an ACL injury. A cross-sectional study was conducted. Thirty physically active patients with a primary ACL injury within three months, aged 18 to 40 years old, and who were scheduled for ACL reconstruction were included. Thirty matched healthy controls were also recruited. All the outcomes were measured on an isokinetic dynamometer with knee flexion at 45°. Quadriceps strength was measured by maximal voluntary isometric contractions (MVIC). Early (RTD0-50) and late (RTD100-200) phases of RTD were retrieved from the MVIC test from 0 to 50 ms and 100–200 ms, respectively. QAF was quantified by the central activation ratio (CAR) measured by superimposed burst technique. The results of Mann–Whitney U test showed that compared with the healthy limbs, the injured limbs of the ACL group showed lower quadriceps strength (P < 0.001), RTD0-50 (P < 0.001) and RTD100-200 (P < 0.001); the uninjured limbs showed lower quadriceps strength (P = 0.009), RTD0-50 (P = 0.006) as well as greater QAF (P = 0.010). To conclude, bilateral quadriceps suffered from neuromuscular impairments early after an ACL injury.

Modulation of Motor Cortex Activity After Intrathecal Baclofen Delivery in Chronic Thoracic Spinal Cord Injury.

ObjectivesIntrathecal baclofen (ITB) is commonly used for reduction of spasticity in chronic spinal cord injury (SCI). Its clinical effect is well-known; however, exact mechanisms of long-term effect of continuous ITB administration (cITBa) on modulation of cortical processes have not been elucidated. The aim of this study was to evaluate changes in motor cortex activation for healthy upper limbs in comparison to impaired lower limbs by functional magnetic resonance imaging (fMRI).MethodsTen subjects (eight males, 20–69 years) with thoracic SCI presenting no voluntary movements of lower limbs (except one) were enrolled in the fMRI study. fMRI at 1.5T with a finger tapping paradigm and mental movement simulating foot flexion on the dominant side were performed before, 3 months, and 1 year after start of cITBa. fMRI data processing was carried out using FMRI Expert Analysis Tool (FEAT), part of FSL. A second-level analysis was carried out using FLAME stages 1 and 2. The level of spasticity was assessed with the Modified Ashworth scale (MAS).ResultsContinuous ITB significantly decreased limb spasticity in all the subjects (group MAS spasticity dropped from 3 to 0.3). The second-level analysis (Z > 1.6, cluster significance threshold p =0.05) revealed increased activation of the primary sensorimotor cortex of the foot between baseline and 3 months, and 3 months and 1 year.ConclusionIncreased sensorimotor cortex activation with spasticity reduction after cITBa may reflect distant functional reorganization because of long-term mediated neuroplastic changes in the sensorimotor cortex. Better understanding of modulation of brain function in SCI after cITBa may influence the field of neurorehabilitation.

Anterior Cruciate Ligament Reconstruction Upregulates Vitamin D Activating Pathways within the Quadriceps

Anterior cruciate ligament (ACL) tears are prevalent sport‐related injuries that result in protracted quadriceps atrophy and weakness despite surgical reconstruction and physical therapy. Vitamin D and its receptor are integral for skeletal muscle development and homeostasis. In addition, vitamin D status is positively associated with muscle size and strength. If the vitamin D receptor and related enzymes are upregulated with ACL injury and reconstruction, then overall vitamin D status may be an important effector of recovery. Concentrations of vitamin D needed to support optimal recovery may differ from typical clinical cut points used to diagnose vitamin D deficiency, which could have powerful therapeutic implications following ACL injury and reconstruction. This is especially important given recent research showing over 50% of athletes have vitamin D inadequacy. We hypothesized that subjects with circulating vitamin D sufficient to suppress parathyroid hormone secretion (≥ 40 ng/mL) would be better protected against quadriceps atrophy at the conclusion of rehabilitation. Muscle biopsies (vastus lateralis) were obtained from ACL‐injured and Healthy limbs of 16 participants (6M,10F; 19±5yr, body mass index: 25.1±3.7kg/m2) prior to surgical reconstruction, 1 week following reconstruction (Recon), and following the completion of post‐surgical rehabilitation (6 months following surgery, Post‐Rehab). RNA was isolated from all quadriceps biopsies, followed by library construction, sequencing, and bioinformatics analysis. Transcript abundance of vitamin D activating pathway regulators (vitamin D receptor [VDR], and Cytochrome P450 2R1 [CYP2R1] and Family 27 Subfamily B Member 1 [CYP27B1]) was assessed following analysis using DESeq2 and false discovery rate (FDR) adjustment of p‐values. Additionally, 25‐hydroxy vitamin D (25(OH)D) was assessed in serum samples obtained at the time of reconstruction surgery. Quadriceps fiber cross‐sectional area was measured via laminin immunohistochemistry. Recon (1 week post‐surgery) muscle showed increased transcript abundance of the vitamin D receptor, VDR(elevated 7.8 fold, FDR&lt;0.05), and vitamin D‐activating pathway regulators CYP2R1 (elevated 1.5 fold, FDR&lt;0.05) and CYP27B1 (elevated 2.6 fold, FDR&lt;0.05) when compared to the Healthy limb. Following the completion of rehabilitation at the 6‐month follow‐up, participants with 25(OH)D above 40 ng/mL showed 6.4% atrophy of quadriceps fiber size compared to 22.8% atrophy in participants with 25(OH)D below 40 ng/mL (p=0.06). These findings provide evidence for surgically induced elevations in the vitamin D activating pathway within skeletal muscle. Upregulation of the vitamin D activating pathway may support quadriceps mitochondrial health and satellite cell activity and self‐renewal capacity, both of which are compromised following ACL reconstruction. In addition, elevated vitamin D concentrations may protect against protracted quadriceps atrophy. Future research should investigate if manipulation of vitamin D concentrations can enhance quadriceps functional recovery following ACL reconstruction.

In Patients with Grade I and II Ankle Sprains, Dynamic Taping Seems to Be Helpful during Certain Tasks, Exercises and Tests in Selected Phases of the Rehabilitation Process: A Preliminary Report.

We aimed to investigate changes in postural stability on a stable surface after the application of dynamic tape for patients with inversion ankle sprains. This study enrolled 30 patients (age 25.5 ± 8.0 years) with grade I and II ankle sprains, which occurred 7–21 days before enrolment. Postural stability (balance, coordination, feedback) was assessed before and after the application of dynamic tape using a stabilographic platform. Three 32-s exercises were performed on the stabilographic platform, one with eyes open, one with eyes closed and one with visual feedback. After the application of dynamic tape, an improvement was observed in terms of the mean radius of sway (4.2 ± 1.3 mm vs. 3.4 ± 0.9 mm; p = 0.012) and coordination (48.8 ± 19.2% vs. 59.3 ± 5.8%; p = 0.021). Selected balance parameters did not improve significantly in the tests with open and closed eyes. Asymmetric load improved for all tests, but significant differences were only observed with eyes closed (34.9 ± 24.4 vs. 41.7 ± 30.5; p < 0.01). We concluded that the use of dynamic tape after an ankle sprain significantly improved balance and coordination on a stable surface. The benefits were shown in terms of a significant improvement in the asymmetric load of the injured limb in comparison to the healthy limb during the test with closed eyes and a considerable improvement in the asymmetric load that was evaluated with visual feedback on a stable surface.

Morbidity of long head of the triceps motor branch neurotization to the axillary nerve: Retrospective subjective and objective assessment of triceps brachii strength after transfer

IntroductionMorbidity is considered to be negligible in Leechavengvongs transfer (LT) of the long head of the triceps onto the axillary nerve, but the assessment methods used may lack reproducibility. We assessed triceps strength after LT objectively by the isokinetic technique, addressing the following questions: Is strength lowered after LT compared to the healthy limb? And 2) is there a good correlation between isokinetic dynamometry and subjective assessment? HypothesisIsokinetic measurement shows a decrease in triceps strength at peak torque after LT compared to the healthy limb, and this morbidity is underestimated on subjective assessment. Material and methodsThis single-center retrospective study included patients undergoing LT for axillary nerve trunk palsy between 2008 and 2020, with M5 triceps preoperatively on the British Medical Research Council (BMRC) scale. Twenty patients, with a mean age of 25±9years (range, 15–48years) were assessed at a mean 58±47months (range, 6–174months). Elbow extension strength was assessed on a standardized questionnaire, BMRC isometric test and isokinetic test on an angular course of 90° at 60°/sec and 180°/sec concentrically and 30°/sec excentrically. ResultsStrength at 60°/sec and 180°/sec concentrically and 30°/sec excentrically was significantly lower than in the healthy limb: respectively, −17Nm, −15Nm, and −16Nm, (p<0.001) for a mean −23%. Loss of strength was mainly severe on isokinetic testing and mild on isometric testing. Seven patients reported contracture (35%), 12 fatigue (60%), and 3 weakness (15%). Satisfaction with extension strength was excellent or good for respectively 12 (60%) and 8 patients (40%). Triceps strength was graded BMRC M4 in 9 triceps (11%) and M5 in 11 (55%). DiscussionAfter LT, isokinetic measurement found generally severe loss of triceps strength, but without subjective impact on everyday life. Level of evidenceIV; retrospective study.

Not my body, not my pain? Pain perception and placebo analgesia in individuals with body integrity dysphoria

Acute and chronic states of physical pain are inherently linked to our bodily perception. Bodily illusion paradigms have demonstrated that an experimentally induced sense of body disownership can modulate both acute and chronic pain. Insight into the relationship between enduring clinical alterations in body perception and pain is much more limited. The current study examined both pain perception and placebo analgesia in Body Integrity Dysphoria (BID), a clinical model of long-term alterations of bodily disownership: in its most commonly studied variant, people feel like a part of their body does not belong to them, leading to a desire for amputation of a physically healthy limb. Heat stimulations were applied before and after a placebo intervention (sham analgesic cream) to the desired and the undesired leg of 19 patients with BID with a unilateral leg amputation desire. Pain perception was assessed using pain thresholds, and ratings for pain intensity and pain unpleasantness. Results show that pain perception and placebo efficacy were lower for the undesired than for the desired leg, demonstrating a potential link between a clinical disorder of body ownership, pain perception, and placebo analgesia.

Between-Limb Symmetry in ACL and Tibiofemoral Contact Forces in Athletes After ACL Reconstruction and Clearance for Return to Sport.

Background:Current return-to-sport (RTS) criteria after anterior cruciate ligament (ACL) reconstruction (ACLR) include demonstrating symmetry in functional and strength tests. It remains unknown if at the time that athletes are cleared to RTS, they exhibit between-limb symmetry in ACL and tibiofemoral contact forces or if these forces are comparable with those in uninjured athletes.Purposes:To (1) examine ACL and tibiofemoral contact forces in athletes who underwent ACLR and were cleared to RTS and (2) compare the involved leg to the healthy contralateral leg and healthy controls during functional tasks.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 26 male athletes who underwent ACLR were tested at the time of RTS during tasks that included single-leg vertical, horizontal, and side jumps; cutting maneuvers; and high-intensity running. We used an electromyography-constrained musculoskeletal modeling workflow to estimate ACL and tibiofemoral contact forces and compared the results with those of 23 healthy male participants.Results:The ACLR group presented no differences in peak tibiofemoral contact forces in the involved limb compared with the control group. However, there were significant between-limb differences mainly due to higher contact forces in the uninvolved (healthy) limb of the ACLR group compared with the control group. In the ACLR group, ACL forces were significantly higher in the uninvolved limb compared with the involved limb during cutting and running. Lateral contact forces were lower in the involved compared with the uninvolved limb, with large effect sizes during cutting (d = 1.14; P < .001) and running (d = 1.10; P < .001).Conclusion:Current discharge criteria for clearance to RTS after ACLR did not ensure the restoration of symmetric loading in our cohort of male athletes. ACL force asymmetry was observed during cutting and running, in addition to knee loading asymmetries on several tasks tested.

Complex Radiation Diagnostics of Non-Healed Fractures and Post-Traumatic False Joints of Long Tubular Bones

The dependence of severity, and accordingly, the number of complications and consequences, including false joints, on the mechanism of injury is known. Recently, there has been an increase in the number of injuries resulting from exposure to high kinetic energy (road traffic, firearms), leading to an increase in disability. In this regard, in order to reduce the severity of the social consequences of injuries, specialized assistance to victims, the introduction of new diagnostic and treatment technologies, both at the stage of primary care and at the stage of treatment of consequences, is becoming important. The purpose of the study. To improve the diagnosis of ungrown fractures and post-traumatic false joints of long tubular bones by using complex ultrasound diagnostics. The study of patients was carried out in a supine position or sitting at rest and was carried out both under conditions of plaster immobilization and without it. During plaster immobilization, the sensor was positioned through a "window" in the plaster splint, while control from the healthy limb was carried out in the same position of the sensor as on the affected side.

Adaptive Control System of Intelligent Lower Limb Prosthesis Based on 5G Virtual Reality

With the rapid development of computer science and technology in our country, especially the advent of the 5G network era, the emergence of smart prostheses makes it possible for disabled, injured, or amputee people with lower limbs to walk and exercise like normal people. However, due to the different selection of prosthetic materials, the final lower limb prostheses produced will also have different performance differences. How to select prosthetic materials to optimize the performance of the intelligent lower limb prosthesis is the focus of extensive discussion in the medical community. For this reason, this article takes the research of the adaptive control system of intelligent lower limb prosthesis based on 5G virtual reality as the research object. By using the current advanced 5G communication technology and virtual reality technology, a high-performance intelligent lower limb prosthesis is produced. Provide assistance with basic walking and motor abilities in daily life of patients with lower limb disabilities. This article first gives a systematic theoretical introduction to 5G virtual reality technology, expounds the current status of patients with lower limb disabilities, and proposes to use intelligent lower limb prosthetics to replace healthy lower limbs to solve the basic walking and sports needs of disabled patients in daily life and then use 5G virtual reality technology. The selection of human knee joints and ankle joints and structural system design were carried out. Finally, it was decided to use the four-bar linkage structure as the knee joint structure of the three-dimensional modeling of the intelligent lower limb prosthesis. At the end of this article, the application and simulation of the intelligent lower limb prosthesis to the human body were also carried out. The results of the experiment found that after 45 weeks of wearing exercises, the gait of the intelligent lower limb prosthesis is consistent with the expected effect whether it is walking on level ground and up and down the stairs or uphill. Due to the strong adaptiveness of the intelligent lower limb prosthesis sexual control, it can well assist the basic life movement ability of patients with lower limb disabilities.

I. Raimiste. Two symptoms in organic hemiplegia. Deux signes d'hémiplegie organique du membre inferieur. Revue neurologique, 1909, № 3

The symptoms published in this article relate to associative movements in organic hemiplegia and are detected as follows: the patient, who is in bed, when his legs are located at the edges of it, is offered to bring the healthy limb to the paralyzed one, and with the help of the hand they try to prevent this movement.

Real-Time Control of a Multi-Degree-of-Freedom Mirror Myoelectric Interface During Functional Task Training.

Motor learning mediated by motor training has in the past been explored for rehabilitation. Myoelectric interfaces together with exoskeletons allow patients to receive real-time feedback about their muscle activity. However, the number of degrees of freedom that can be simultaneously controlled is limited, which hinders the training of functional tasks and the effectiveness of the rehabilitation therapy. The objective of this study was to develop a myoelectric interface that would allow multi-degree-of-freedom control of an exoskeleton involving arm, wrist and hand joints, with an eye toward rehabilitation. We tested the effectiveness of a myoelectric decoder trained with data from one upper limb and mirrored to control a multi-degree-of-freedom exoskeleton with the opposite upper limb (i.e., mirror myoelectric interface) in 10 healthy participants. We demonstrated successful simultaneous control of multiple upper-limb joints by all participants. We showed evidence that subjects learned the mirror myoelectric model within the span of a five-session experiment, as reflected by a significant decrease in the time to execute trials and in the number of failed trials. These results are the necessary precursor to evaluating if a decoder trained with EMG from the healthy limb could foster learning of natural EMG patterns and lead to motor rehabilitation in stroke patients.