Joint Immobilization Research Articles

Fingerluxationen im PIP-Gelenk – Therapie einer sehr häufigen (Ball)Sportverletzung

Background Fractures or fracture dislocations of the proximal interphalangeal joint often occur during sports or accidents. Dislocations of the PIP-joint are the most common ligamentary injuries of the hand. As this kind of injury is so frequent, hand surgeons and other physicians should be aware of the correct treatment. Objectives This paper summarises the most common injury patterns and the correct treatment of PIP-joint dislocations. Materials and Methods This paper reviews the current literature and describes the standardised treatment of PIP-joint dislocations. Results What is most important is that reposition is anatomically correct, and this should be controlled by X-ray examination. Depending on the instability and possible combination with other injuries (e. g. injury to the palmar plate), early functional physiotherapy of the joint or a short immobilisation period is indicated. Conclusions Early functional treatment of the injured PIP-joint, initially using buddy taping, is important to restore PIP-joint movement and function. Depending on the injury, joint immobilisation using a K-wire may be indicated. Detailed informed consent is necessary to explain to the patient the severity of the injury and possible complications, such as chronic functional disorders or development of arthrosis.

OP-01 - Treatment of sarcopenia by targeting Akt and muscle specific ubiquitin ligases. Evidence from mice and from a clinical trial

Disuse muscle wasting may take place as a result of several such as joint immobilization, inactivity or bed rest. There are no good therapies to treat it. Allopurinol, a drug commonly used to treat hyperuricemia and gout, protects muscle damage, specially after exhaustive exercise and results in functional gains in old persons. Thus, we tested its effect in the prevention of atrophy of the soleus muscle after two weeks of hindlimb unloading in experimental animals (mice), and lower leg immobilization following ankle sprain in humans (Registration of the clinical Trial: EUDRACT2011-003541-17). We have found show that allopurinol protects against muscle atrophy in both mice and humans. The protective effect of allopurinol is similar, or even superior, to that of resistance exercise which is the best-known way to prevent muscle mass loss in disuse human models. We have also found that allopurinol protects against muscle mass loss by inhibiting the expression of ubiquitin ligases. Thus, the ubiquitin-proteasome pathway is an adequate therapeutic target to inhibit muscle wasting and underpins the role of allopurinol as a non-hormonal intervention to treat disuse muscle atrophy.

Simultaneous Bony Mallet Fingers of Two Phalanx in a Patient: A Rarely Seen Case Report

Mallet finger deformity is a common hand injury and usually occurs after a direct impact of sudden and extreme trauma forcing the distal interphalangeal Mallet finger deformity is a common hand injury and usually occurs after a direct impact of sudden and extreme trauma forcing the distal interphalangeal joint to get flexion with an extended proximal interphalangeal joint. Deformity is especially associated with ball use disrupting the extensor mechanism at the base of distal phalanx. Mallet finger deformity in acute stage can be treated by immobilization of distal interphalangeal joint with hyperextension splints. But the surgery becomes the choice in delayed cases and if there is a fracture including more than one third of articular surface of distal interphalangeal joint or distal phalanx volar subluxation. In the literature there are great sum of studies including mallet finger deformities as simultaneous, bilateral or multiple variations and treatment strategies. But in the literautre there is no study about simultaneous bony mallet fingers deformity reported. Here, we present the case of a 30 year old female with simultaneous bony mallet fingers in the third and fourth ray and the conservative treatment of with splinting for six weeks. At the last time follow up the patient was able to use her hand without any diffuculty and she had full range of motion of distal interphalangel joint.

Сучасний погляд на проблему застосування засобів фізичної реабілітації при артроскопічних оперативних втручаннях у хворих із ушкодженням передньої схрещеної зв’язки

Мета: систематизувати та узагальнити науково-методичні знання і результати практичного досвіду фізичної реабілітації хворих після реконструкції передньої схрещеної зв’язки при артроскопічних оперативних втручаннях. Методи: теоретичний комплексний аналіз і синтез даних науково-методичної літератури та джерел мережі Інтернет. Результати. Проаналізовано методи лікування декомпенсованої передньої нестабільності колінного суглоба, спричиненої розривом передньої схрещеної зв’язки. Весь післяопераційний реабілітаційний період перебігає на тлі етапних процесів інкорпорації трансплантату в кісткових тунелях. Саме стадійність відновлення трансплантату є основою для виділення різних періодів реабілітації. Розглянуто сучасні підходи до застосування засобів фізичної реабілітації при артроскопічних оперативних втручаннях у хворих з ушкодженням передньої схрещеної зв’язки. Висновки. Лікування таких хворих необхідно проводити з обов’язковим урахуванням анатомо-функціональних особливостей, використовувати методи раннього і повноцінного відновлення пошкоджених структур суглоба, прагнути до підбору відновлювальних операцій, що не вимагають іммобілізації суглоба. Крім цього, адекватні відновні комплекси, що враховують тип фіксації трансплантату, функціональні особливості ураженої кінцівки й інші чинники, у тому числі ступінь порушення функції колінного суглоба, розроблено далеко не для всіх випадків ушкоджень та їх наслідків. На сьогодні актуальною є розробка програм фізичної реабілітації, що враховують тип фіксації використаного трансплантату при артроскопічних оперативних втручаннях.

Effects of joint immobilization on changes in myofibroblasts and collagen in the rat knee contracture model.

The purpose of this study was to examine the time-dependent changes in the development of joint capsule fibrosis and in the number of myofibroblasts in the joint capsule after immobilization, using a rat knee contracture model. Both knee joints were fixed in full flexion for 1, 2, and 4 weeks (immobilization group). Untreated rats were bred for each immobilization period (control group). Histological analysis was performed to evaluate changes in the amount and density of collagen in the joint capsule. The changes in type I and III collagen mRNA were examined by in situ hybridization. The number of myofibroblasts in the joint capsule was assessed by immunohistochemical methods. In the immobilization group, the amount of collagen increased within 1 week and the density of collagen increased within 2 weeks, as compared with that in the control group. Type I collagen mRNA-positive cell numbers in the immobilization group increased at all time points. However, type III collagen mRNA-positive cell numbers did not increase. Myofibroblasts in the immobilization group significantly increased compared with those in the control group at all time points, and they increased significantly with the period of immobilization. These results suggest that joint capsule fibrosis with overexpression of type I collagen occurs and progresses within 1 week after immobilization, and an increase in myofibroblasts is related to the mechanism of joint capsule fibrosis. The findings suggest the need for a treatment targeting accumulation of type I collagen associated with an increase in myofibroblasts. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1998-2006, 2017.

Effect of immobilization of metacarpophalangeal joint in thumb carpometacarpal osteoarthritis on pain and function. A quasi-experimental trial

Study DesignA quasi-experimental trial. IntroductionOrthoses are effective to decrease pain and improve function in patients with carpometacarpal osteoarthritis (CMC OA). However, current research does not support one design of an orthosis as more effective and/or more favorable than another. Purpose of the StudyThe aim of this study was to compare the effectiveness of 2 different static orthosis on pain and functional abilities on CMC OA. MethodsEighty-four patients, 91.7% females (mean ± standard deviation age, 60.1 ± 9.6 years), with thumb CMC OA were randomized into 1 of 2 groups. For group A, a Ballena orthotic was constructed, and for group B, a Colditz orthotic was constructed. Both static orthoses were worn for 3 months. The outcome measures included pain with activity measured with the visual analog scale and functional abilities assessed with the Disabilities of the Arm, Shoulder and Hand. ResultsBoth orthoses improved pain level and functional abilities (F[1.0] = 413.327 and F[1.0] = 211.742; both P < .001). There was no statistically significant difference between 2 groups regarding to pain recovery and functional improvement (F[1.0] = 0.075 and F[1.0] = 7.248; both P > .05). DiscussionThe main purpose was to compare the effect of 2 different thermoplastic thumb orthoses. Previous studies support the use of CMC orthoses to decrease hand pain and improve hand function, but different orthoses have been described and in most cases, orthotic interventions were accompanied by other medical treatments. ConclusionsA clinically significant reduction in pain intensity and improvement in functional abilities was achieved with both orthoses in patients with thumb CMC OA. Level of Evidence2. Trial RegistrationClinicalTrials.gov registration number: NCT02780999.

Custom Design &amp; Fabrication of 3D printed cast for ankle immobilisation

&lt;p&gt;Management of bone and joint injuries is commonly done by immobilisation using plaster/fibreglass casts. This study describes design and fabrication of patient specific cast using 3D printing. The 3D printed cast while being patient friendly is superior to earlier casts in healing efficacy and hence redefines the joint immobilisation practice. We present here a case of “walk on brace” design and fabrication using 3D printing. The custom design of ankle immobilisation cast was done for an 18-year-old boy having tibia bone fracture during gymnastic activity. The workflow comprises of anatomical data acquisition, CAD, 3D printing, post processing and clinical approval for use. Additional features such as straps, anti-slip inner surface and tread for floor grip were incorporated in the design. &lt;/p&gt;

Overuse Physeal Injuries in Youth Athletes

Context:Despite rising awareness of the risks associated with sports participation, overuse injuries continue to increase in youth athlete populations. Physeal injuries are one type of overuse injury exclusive to pediatric populations that are often sustained during athletic practice or competition. Overuse physeal injuries are, in theory, preventable; however, little consensus has been reached surrounding the risk factors, prevention, and treatment strategies.Objective:This systematic review summarizes the best available evidence concerning overuse physeal injuries in youth and adolescent athletes. It can be used to develop prevention and treatment programs specific to this population.Data Sources:PubMed and Academic Search Complete (EBSCOhost) were explored using the keyword physeal injuries from January 1950 through May 2015 to identify 24 studies.Study Selection:Original research studies of athletic populations with mechanisms of injury related to sport were chosen.Study Design:Systematic review.Level of Evidence:Level 3.Data Extraction:Data were extracted as available from 24 eligible studies. Study quality was rated using the Oxford Centre for Evidence-based Medicine (OCEBM) guidelines.Results:Risk factors for injury include periods of accelerated growth, chronological age, body size, training volume, and previous injury. Injury prevention strategies currently emphasize participation limitations and sport-specific training programs in skeletally immature athletes. The most effective treatment after an overuse physeal injury was an extended period of active rest and joint immobilization when necessary.Conclusion:Overuse physeal injuries are multifactorial in nature. Muscular imbalances after accelerated growth periods predispose young athletes to overuse injuries. Modifiable risk factors such as flexibility, strength, and training volume should be regularly monitored to prevent these injuries.

Effects of joint immobilization and hindlimb unloading on collagen fibers of soleus muscles in rats.

[Purpose] The purpose of this study was to determine whether collagen fibers cause a difference in a contracture resulting from a combination of joint fixation and hindlimb unloading as compared to joint fixation only. [Subjects and Methods] The subjects of this study were 21 female Wistar rats divided into 4 groups as follows: Control Group (CON, n=7); Joint Fixation Group (JF, n=7), Hindlimb Unloading Group (HU, n=7), Joint Fixation Plus Hindlimb Unloading Group (JF+HU, n=7). This study was conducted for 1-week. Ankle joint range of motion and positive areas of collagen using fluorescent stain were analyzed. [Results] Ankle joint range of motion in JF + HU showed an increase compared to that of JF. Positive areas of Type I collagen in JF+HU showed an increase as compared with that of JF. [Conclusion] The results of this study suggested that the difference in a contracture caused by only joint immobilization and by a combination of joint immobilization and hindlimb unloading were significantly associated with Type I collagen.

Thinning of articular cartilage after joint unloading or immobilization. An experimental investigation of the pathogenesis in mice

Moderate mechanical stress generated by normal joint loading and movement is essential for the maintenance of healthy articular cartilage. However, the effects of reduced loading caused by the absence of weight bearing or joint motion on articular cartilage and subchondral bone is still poorly understood. We aimed to characterize morphological and metabolic responses of articular cartilage and subchondral bone to decreased mechanical stress invivo. Mice were subjected to periods of hindlimb unloading by tail suspension or external fixation of the knee joints. The articular surface was observed with digital microscope and the epiphyseal bone was assessed by micro-CT analysis. Articular cartilage and subchondral bone were further evaluated by histomorphometric, histochemical, and immunohistochemical analyses. The joint surface was intact, but thickness of both the total and uncalcified layer of articular cartilage were decreased both after joint unloading and immobilization. Subchondral bone atrophy with concomitant marrow expansion predisposed osteoclast activity at bone surface to invade into cartilaginous layer. Uncalcified cartilage showed decreased aggrecan content and increased aggrecanase expression. Alkaline phosphatase (ALP) activity was increased at uncalcified cartilage, whereas decreased at calcified cartilage. The distributions of hypertrophic chondrocyte markers remained unchanged. Thinning of articular cartilage induced by mechanical unloading may be mediated by metabolic changes in chondrocytes, including accelerated aggrecan catabolism and exquisitely modulated matrix mineralization, and cartilage matrix degradation and resorption by subchondral osteoclasts. Cartilage degeneration without chondrocyte hypertrophy under unloading condition indicate the possible existence of mechanism which is different from osteoarthritis pathogenesis.

Cyclooxygenase-2 inhibitor celecoxib attenuates joint contracture following immobilization in rat knees.

BackgroundThe aim of this study is to clarify the following two points: First, whether a cyclooxygenase-2 mediated pathway is involved in the formation of immobilization-induced joint contracture and, second, the effectiveness of oral administration of non-steroidal anti-inflammatory drug celecoxib (CBX) for the prevention of myogenic and arthrogenic contracture following immobilization in a rat model.MethodsThirty male rats were randomly divided into three groups: immobilization (Im), Im + CBX, and control (n = 10 each). External fixation immobilized the right knee joint of Im and Im + CBX groups in flexion for 3 weeks. 50 mg/kg of CBX was administrated daily to the Im + CBX group during this period. The passive range of motion (ROM) of knee joints was measured before and after transection of knee flexor muscles and myogenic and arthrogenic ROM restrictions were calculated. The semitendinosus muscles and knee joints were investigated histologically to elucidate factors responsible for contracture.ResultsMyogenic ROM restrictions were exhibited both in Im and Im + CBX groups (44 ± 5 and 36 ± 8 °, respectively), but restrictions significantly decreased in the Im + CBX group compared to the Im group. Significant reductions of the muscle length ratios (Rt/Lt) and sarcomere number ratios (Rt/Lt) in knee flexor semitendinosus muscle, which are responsible for myogenic contracture, were also seen both in Im group (92 ± 5 and 92 ± 4 %, respectively) and Im + CBX group (97 ± 3 and 97 ± 3 %, respectively), but were inhibited by CBX administration (P < 0.05). Im and Im + CBX groups exhibited arthrogenic ROM restrictions with no significant differences (82 ± 3 and 83 ± 5 °, respectively). Posterior synovial length shortening and pathological changes (hemorrhage in joint cavities and capsule edema) in the knee joints were comparable between Im and Im + CBX groups.ConclusionsOral administration of celecoxib partially reduced myogenic ROM restriction concomitantly with knee flexor muscle shortening following immobilization. These results imply that inflammation and nociception are involved in myogenic contracture formation independently of joint immobilization, and that CBX is effective in preventing joint contracture following immobilization in rats.

Astaxanthin supplementation attenuates immobilization-induced skeletal muscle fibrosis via suppression of oxidative stress.

Immobilization induces skeletal muscle fibrosis characterized by increasing collagen synthesis in the perimysium and endomysium. Transforming growth factor-β1 (TGF-β1) is associated with this lesion via promoting differentiation of fibroblasts into myofibroblasts. In addition, reactive oxygen species (ROS) are shown to mediate TGF-β1-induced fibrosis in tissues. These reports suggest the importance of ROS reduction for attenuating skeletal muscle fibrosis. Astaxanthin, a powerful antioxidant, has been shown to reduce ROS production in disused muscle. Therefore, we investigated the effects of astaxanthin supplementation on muscle fibrosis under immobilization. In the present study, immobilization increased the collagen fiber area, the expression levels of TGF-β1, α-smooth muscle actin, and superoxide dismutase-1 protein and ROS production. However, these changes induced by immobilization were attenuated by astaxanthin supplementation. These results indicate the effectiveness of astaxanthin supplementation on skeletal muscle fibrosis induced by ankle joint immobilization.

Effects of joint immobilization on the repair of articular cartilage of the rat knee

Effects of joint immobilization on the repair of articular cartilage of the rat knee

English

Osteoarthritis (OA) is characterized by low grade inflammation leading to progressive degenerative changes in articular cartilage (Morenko et al., 2004). Joint mobility is reduced owing to pain and swelling of affected area. Severity of OA depends on type of inducer that may be chemical, enzymatic or surgical. Cartilage metabolic disturbances lead to destabilization and degeneration. Clinical manifestations of OA include softening, fibrillation, ulceration, sclerosis, bone eburnation, osteophytes and sub-chondral cysts formation (Fernihough et al., 2004). Pain leading to joint immobilization is prominent manifestation of this chronic malady (Khan et al., 2012). Initially, soft swelling can be observed on affected joints which later on subside with the progression of diseases. Crackling sounds from affected joints during walking and standing (Brandt et al., 2009). Mostly, treatment of OA is done focusing the symptom of pain and joint dysfunction (Flood, 2010). Non-steroidal anti-inflammatory drugs (NSAIDS), opiates, corticosteroids and nutraceuticals are conventional therapeutics for OA (Sofat et al., 2011). Glycosaminoglycans (GAGs) are long un-branched polysaccharides of repeating disaccharide units abundantly present in connective tissues, vitreous humor, synovial fluid, mast cells and predominately in cartilages. The major constituents are chondroitin sulphate, dermatan sulphate, heparin/heparansulphate, glucosamine and hyaluronic acid. Among these, glucosamine sulphate (GS) and chondroitin sulphate (CS) are more effective and safe therapeutic agents for OA (Miller and Clegg, 2010). CS and GS stimulate chondrocyte synthesis of collagen (Adams et al., 2013). Concurrent use of CS and GS increase synthesis of cartilage matrix and decrease progression of OA which ultimately reduces signs and symptoms of disease. In present study, efficacy of glycosaminoglycans on clinical signs of osteoarthritis and C-terminal telopeptides of type II collagen (CTX-II) was evaluated in papain induced OA albino rat model.

Therapeutic effect of intra-articular injection of ribbon-type decoy oligonucleotides for hypoxia inducible factor-1 on joint contracture in an immobilized knee animal model.

Limited range of motion (ROM) as a result of joint contracture in treatment associated with joint immobilization or motor paralysis is a critical issue. However, its molecular mechanism has not been fully clarified and a therapeutic approach is not yet established. In the present study, we investigated its molecular mechanism, focusing on the role of a transcription factor, hypoxia inducible factor-1 (HIF-1), which regulates the expression of connective tissue growth factor (CTGF) and vascular endothelial growth factor (VEGF), and evaluated the possibility of molecular therapy to inhibit HIF-1 activation by ribbon-type decoy oligonucleotides (ODNs) for HIF-1 using immobilized knee animal models. In a mouse model, ROM of the immobilized knee significantly decreased in a time-dependent manner, accompanied by synovial hypertrophy. Immunohistochemical studies suggested that CTGF and VEGF are implicated in synovial hypertrophy with fibrosis. CTGF and VEGF were up-regulated at both the mRNA and protein levels at 1 and 2 weeks after immobilization, subsequent to up-regulation of HIF-1 mRNA and transcriptional activation of HIF-1. Of importance, intra-articular transfection of decoy ODNs for HIF-1 in a rat model successfully inhibited transcriptional activation of HIF-1, followed by suppression of expression of CTGF and VEGF, resulting in attenuation of restricted ROM, whereas transfection of scrambled decoy ODNs did not. The present study demonstrates the important role of HIF-1 in the initial progression of immobilization-induced joint contracture, and indicates the possibility of molecular treatment to prevent the progression of joint contracture prior to intervention with physical therapy. Copyright © 2016 John Wiley & Sons, Ltd.

Assessment of Workspace Attributes Under Simulated Index Finger Proximal Interphalangeal Arthrodesis.

This article presented an assessment of quantitative measures of workspace (WS) attributes under simulated proximal interphalangeal (PIP) joint arthrodesis of the index finger. Seven healthy subjects were tested with the PIP joint unconstrained (UC) and constrained to selected angles using a motion analysis system. A model of the constrained finger was developed in order to address the impact of the inclusion of prescribed joint arthrodesis angles on WS attributes. Model parameters were obtained from system identification experiments involving flexion-extension (FE) movements of the UC and constrained finger. The data of experimental FE movements of the constrained finger were used to generate the two-dimensional (2D) WS boundaries and to validate the model. A weighted criterion was formulated to define an optimal constraint angle among several system parameters. Results indicated that a PIP joint immobilization angle of 40-50 deg of flexion maximized the 2D WS. The analysis of the aspect ratio of the 2D WS indicated that the WS was more evenly distributed as the imposed PIP joint constraint angle increased. With the imposed PIP joint constraint angles of 30 deg, 40 deg, 50 deg, and 60 deg of flexion, the normalized maximum distance of fingertip reach was reduced by approximately 3%, 4%, 7%, and 9%, respectively.

Imobilização articular: efeitos sobre o tecido muscular de camundongos obesos e desnutridos

DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n1p1 Although it is a widely used resource for the treatment of musculoskeletal injuries, immobilization causes deleterious effects in muscle tissue after a short period of time. This study aimed to evaluate the gastrocnemius and tibialis anterior muscles of obese and protein malnourished animals under joint immobilization condition. Overall, 28 adult male mice were used (C57 / BL6), being divided into four groups (N = 7): Control Group (CG), Immobilized Control Group (ICG), Immobilized Obese Group (IOG) and Immobilized Malnourished Group (IMG). The immobilization protocol was performed by the use of adhesive tape and plaster. The conditions and obesity and protein malnutrition have been developed through the ingestion of diets specific for each group of animals. The histomorphometric analysis of muscles evaluated area and the diameter of muscle fibers. All immobilized groups showed reduction in the area and diameter of muscle fibers when compared to GC. Comparisons among immobilized groups showed that the area and diameter of muscle fibers of IOG and IMG were lower than ICG. The immobilization protocol caused reduction in muscle trophism in animals, and obese and malnourished animals suffered high losses under condition of muscle atrophy.

Designer Dual Therapy Nanolayered Implant Coatings Eradicate Biofilms and Accelerate Bone Tissue Repair.

Infections associated with orthopedic implants cause increased morbidity and significant healthcare cost. A prolonged and expensive two-stage procedure requiring two surgical steps and a 6-8 week period of joint immobilization exists as today's gold standard for the revision arthroplasty of an infected prosthesis. Because infection is much more common in implant replacement surgeries, these issues greatly impact long-term patient care for a continually growing part of the population. Here, we demonstrate that a single-stage revision using prostheses coated with self-assembled, hydrolytically degradable multilayers that sequentially deliver the antibiotic (gentamicin) and the osteoinductive growth factor (BMP-2) in a time-staggered manner enables both eradication of established biofilms and complete and rapid bone tissue repair around the implant in rats with induced osteomyelitis. The nanolayered construct allows precise independent control of release kinetics and loading for each therapeutic agent in an infected implant environment. Antibiotics contained in top layers can be tuned to provide a rapid release at early times sufficient to eliminate infection, followed by sustained release for several weeks, and the underlying BMP-2 component enables a long-term sustained release of BMP-2, which induced more significant and mechanically competent bone formation than a short-term burst release. The successful growth factor-mediated osteointegration of the multilayered implants with the host tissue improved bone-implant interfacial strength 15-fold when compared with the uncoated one. These findings demonstrate the potential of this layered release strategy to introduce a durable next-generation implant solution, ultimately an important step forward to future large animal models toward the clinic.

Right-Left Differences in Knee Extension Stiffness for the Normal Rat Knee: In Vitro Measurements Using a New Testing Apparatus.

Knee stiffness following joint injury or immobilization is a common clinical problem, and the rat has been used as a model for studies related to joint stiffness and limitation of motion. Knee stiffness measurements have been reported for the anesthetized rat, but it is difficult to separate the contributions of muscular and ligamentous restraints to the recorded values. in vitro testing of isolated rat knees devoid of musculature allows measurement of joint structural properties alone. In order to measure the effects of therapeutic or surgical interventions designed to alter joint stiffness, the opposite extremity is often used as a control. However, right-left stiffness differences for the normal rat knee have not been reported in the literature. If stiffness changes observed for a treatment group are within the normal right-left variation, validity of the results could be questioned. The objectives of this study were to utilize a new testing apparatus to measure right-left stiffness differences during knee extension in a population of normal rat knees and to document repeatability of the stiffness measurements on successive testing days. Moment versus rotation curves were recorded for 15 right-left pairs of normal rat knees on three consecutive days, with overnight specimen storage in a refrigerator. Each knee was subjected to ten loading-unloading cycles, with the last loading curve used for analysis. Angular rotation (AR), defined here as the change in flexion-extension angle from a specified applied joint moment, is commonly used as a measure of overall joint stiffness. For these tests, ARs were measured from the recorded test curves with a maximum applied extension moment of 100 g cm. Mean rotations for testing days 2 and 3 were 0.81-1.25 deg lower (p < 0.001) than for day 1, but were not significantly different from each other. For each testing day, mean rotations for right knees were 1.12-1.30 deg greater (p < 0.001) than left knees. These right-left stiffness differences should be considered when interpreting the results of knee treatment studies designed to alter knee stiffness when using the opposite extremity as a control.

Immobilizer Removable Articulate in Rehabilitation of Dogs Submitted to Tenorrhaphy Patellar

Background: In cases of patellar tendon ruptures, there is a need for primary repair by sutures aiming to restore the extensor mechanism of the knee and prevent degenerative sequelae. Even though the need for temporary immobilization of the joint reconstruction surgeries involving tendons and ligaments, seeks to avoid or minimize the undesirable effects of disuse without any interference at the surgical site. Thus, the objective of this research was to propose a model of joint immobilization adjustable in dogs undergoing patellar tenorrhaphy to allow, in the immediate postoperative period, the achievement of physical therapy modalities without interfering with the healing of the involved structures.Materials, Methods &amp; Results: The dogs were randomly divided into two groups called fixed immobilization or GF (6 dogs) and adjustable or GA (5 dogs) immobilization. Once on plane and restrained in dorsal decubitus, lateral incision was performed on the right knee in dogs GF and GA for total section of the patellar tendon at its insertion 10 mm at the tibial crest. Immediately, it was made with tenorrhaphy modified Kessler suture pattern using monofilament nylon wire nº 1, followed by a Wolff point involving modified Kessler suture with the same type of wire. In both groups, the joint was immobilized femorotibiopatelar percutaneous external fixation biplanar at an angle of 110° for 30 days. The groups differed by the material used to connect the percutaneous pins, being employed in the GF acrylic resin, and in GA dogs was made adjustable apparatus which consisted of two stainless steel plates with rounded ends with three equally spaced holes 2.5 mm between them in the central part of the plate and the edge of 6mm, which is joined with the other plate by a nut and bolt and allowing to adjust the desired angle of the device. Were utilized four Steinmann pins 2.5 mm, two in the femur and two tibia, introduced perpendicularly to the bone. The assembled apparatus was encased in percutaneous pins and stuck with stainless steel nuts and lock washers causing immobilization of the knee joint, however adjustable in the period of application of physiotherapy protocol. The results demonstrated a reduction in measures in the period of 30 days, indicating that there was muscle atrophy. At 60 days post-operative values demonstrating increased muscle mass gain probably the bearing of the affected limb to the ground. In this study, was possible to observe that the values at 60 days did not return to the same found preoperatively, and the dogs GF and GA were on average 92.19% of the initial values. As for gait analysis, all dogs GF and GA were grade 5, 1 and 3 of lameness in the preoperative period and after 30 and 60 days after surgery, respectively.Discussion: The joint immobilization in dogs submitted to tenorrhaphy is required, however, the member cannot be used properly, which can lead to sequelae such as muscle atrophy from disuse and especially joint blockage. Currently in human medicine assisted rehabilitation in the immediate post-operative recovery involving the reconstruction of tendons and ligaments, without the need for joint immobilization is required, because patients are instructed to restrict the movements postoperatively. In veterinary medicine, however, it becomes risky this type of conduct, especially the lack of control the movements made by animals, arousing interest in this research to propose joint that could be undone each day to allow implementation of a method of immobilization physiotherapy and at the end of the session, the joint was immobilized again. According to the results, we can conclude that the temporary immobilization with adjustable articulating fixator in dogs submitted to patellar tenorrhaphy allows the use of a physical therapy protocol during the period of immobilization, without interfering with the healing of tendon anastomosis.