Improved Knee Range Of Motion Research Articles

Extra-articular Osteotomy for the Management of Intra-articular Tibial Plateau Valgus Malunion.

To report a case series of extra-articular osteotomies for the management of intra-articular tibial plateau malunions and to assess the ability to correct deformity and improve knee range of motion (ROM). . Retrospective case series. Academic, tertiary, referral center. Adult patients with tibial plateau fracture malunion treated with extra-articular osteotomy of the femur and/or tibia between 2014 and 2023. Mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), lateral distal femoral angle (LDFA), and posterior proximal tibia angle (PPTA) correction; knee ROM; and time to weight bearing. There were 7 patients included, 6 (85.7%) were female and 1 (14.3%) were male. The median age was 43.5 years (IQR 38.5-51, range 32-62). Four (57.1%) patients were treated with a high tibial osteotomy (HTO), and 3 (42.9%) patients were treated with an HTO and distal femoral osteotomy. One patient had concomitant supramalleolar osteotomy with HTO to address distal tibia procurvatum and valgus. Four were treated with hexapod frames, and 3 were treated with plates and screws. Median follow-up was 22.5 months (IQR 10.5-107 months, range 7-148 months). Surgical intervention corrected median radiographic measures of valgus malalignment preoperatively relative to postoperative values. This included MAD (42.5 mm-0 mm), valgus angle (12.5 degrees-1.5 degrees), MPTA (95 degrees-88.0°), and LDFA (86.0°-87.3 degrees). Surgical intervention increased maximal knee range of motion preoperatively to postoperatively. Median time to full weight bearing was 81.5 days (IQR 46-57 days, range 41-184 days). Two patients were converted to total knee arthroplasty after 5 and 10 years following HTO with hexapod frame. Extra-articular osteotomy is an effective treatment for addressing intra-articular malunion after tibia plateau fractures. It is effective in correcting the MAD, valgus deformity, MPTA, LDFA, PPTA, and improving knee ROM (measured through knee extension and flexion). Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

One-day surgery is safe and effective in unicompartmental knee arthroplasty: A prospective comparative study at 1 year of follow-up.

To compare the outcomes and complications of two perioperative protocols for the management of patients who underwent medial unicompartmental knee arthroplasty (UKA): 24 h (1-day surgery [OS]) versus 72 h (enhanced recovery after surgery [ERAS]) of the length of hospital stay (LOS). In our hypothesis, the reduction of the LOS from 3 to 1 day did not influence the outcomes and complications. A total of 42 patients (21 in each group) with isolated anteromedial knee osteoarthritis and meeting specific criteria were prospectively included in the study. Clinical outcomes included Knee Society Score (KSS) and Forgotten joint score while pain evaluation was performed using a Visual Analogue Scale (VAS). Functional outcomes were assessed measuring the knee range of motion (ROM) while radiographic outcomes were evaluated measuring the amelioration of the varus deformity through the hip-knee-ankle angle (HKA). Clinical and functional outcomes did not significantly differ between the two groups. Complications occurred in 9.5% of OS and 4.7% of ERAS group patients. Significant improvements in knee ROM, VAS pain, KSS and HKA angle were observed postsurgery, with no significant differences between groups except in KSS expectations and function trends. The OS protocol is safe and effective and LOS, in a well-defined fast-track protocol, did not significantly impact clinical and functional outcomes. OS may lead to reduced hospitalisation costs and potential reductions in complications associated with prolonged stays, benefiting both patients and healthcare facilities. However, further research with larger sample sizes and longer follow-up periods is needed to confirm these findings. Early mobilisation and rehabilitation protocols are key components of successful patient recovery following UKA procedures. Level II.

Early outcomes of the Oxford unicompartmental knee arthroplasty: 140 cases from a single institute in Taiwan.

The clinical and radiologic outcomes of the Oxford unicompartmental knee arthroplasty utilizing Microplasty® instrumentation have not been extensively investigated in Taiwanese patients. Despite the efficacy of this treatment for unicompartmental knee diseases, its specific impact on this population remains unknown. We retrospectively analyzed prospectively collected data of patients who underwent OUKA with MP between 2018 and 2021, including demographic information, component position, preoperative and postoperative knee range of motion (ROM), numeric rating scale (NRS), and 2011 Knee Society Score-functional activity score (2011 KSS-FAS). We compared preoperative and postoperative data and analyzed the correlation between clinical and radiographic outcomes. Among 140 patients with an average age of 66.8 years, predominantly female, the majority exhibited components that fell within the radiographically acceptable tolerance ranges. The mean 2.5-year follow-up revealed significant improvements in knee ROM from 102.6° ± 12.9° to 127.3° ± 9.8° ( p < 0.05), pain reduction from 7.7 ± 0.8 to 0.4 ± 0.7 ( p < 0.001), and KSS-FAS from 30.7 ± 10.5 to 94.3 ± 5.2 ( p < 0.001). Notably, a tibial component medial overhang within tolerance predicted shorter hospital stays, and a higher preoperative KSS correlated with lower postoperative NRS. No independent variables were identified as predictors of a higher postoperative KSS. Our study on OUKA with MP in Taiwanese patients reveals promising early clinical and radiographic outcomes. Tibial component medial overhang <3 mm is associated with shorter hospital stays, and a higher preoperative KSS predicts lower NRS at 1 year postoperatively.

Calipered kinematic alignment restored the arithmetic hip-knee-ankle angle, achieved high satisfaction and improved clinical outcomes.

The purpose of this study was to determine whether unrestricted calipered kinematic alignment (KA), coupled with a medial-stabilised (MS) implant system, can reproduce the patient's constitutional alignment as per the arithmetic hip-knee-ankle (aHKA) and improve clinical outcomes. One-hundred and ninety-three patients received total knee arthroplastyby the senior author. To determine whether the constitutional alignment was achieved, the postoperative hip-knee-ankle (HKA) alignment was compared against the aHKA. Range of motion (ROM) was determined preoperative and postoperatively at 6 months and 2 years by measuring the active flexion and extension. Patient-Reported Outcomes Measures (PROMs) including Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score (FJS) and Visual Analogue Scalefor Satisfaction were also completed. The Sports and Recreation component of KOOS was used to assess the patient's ability to return to sports and daily activities. There was a strong correlation between postoperative HKA and aHKA (r = 0.7, p < 0.05). There was a significant improvement in both extension and flexion seen from as early as 6 months postoperatively, with a mean flexion of 123° ± 11° and extension of 1° ± 3° at 2 years. PROMs had significant improvements with a mean score of 42.8 ± 6.0 for the OKS and all KOOS subscales consisting of Symptoms (88.0 ± 11.7), Pain (91.4 ± 11.6), Activities of Daily Living(91.1 ± 12.4), Sports (76.8 ± 22.1) and Quality of Life(83.0 ± 19.1). The FJS had significant improvements from 6 months to 2 years of 19.9 (p < 0.05), with a mean score of 69.2 ± 26.6 at 2 years. Ninety-three percent (180 patients) were classified as 'satisfied' at the 2-year timepoint. The KOOS Sports component was completed by 64% (124 patients), whereby the mean age was younger than the noncompliant patients (67.7 ± 9.4vs. 71.7 ± 8.2 years). Unrestricted calipered KA can result in an alignment that closely resembles the patient's constitutional alignment, as per the aHKA. This resulted in improved knee ROM and patient satisfaction, as well as assisting younger patients to return to sports and daily activities. Level IV.

Arthroscopic Lysis of Adhesions for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction

Background: Arthrofibrosis (AF) after anterior cruciate ligament reconstruction (ACLR) remains a challenge. There is a paucity of data on arthroscopic interventions for AF after ACLR. Purpose: To (1) describe the patient, injury, and surgical characteristics and patient-reported outcomes (PROs) of those requiring an arthroscopic intervention for loss of motion after ACLR and (2) compare outcomes between patients undergoing an early intervention (within 3 months) versus those undergoing a late intervention (after 3 months). Study Design: Case series; Level of evidence, 4. Methods: Patients with a history of ACLR and a subsequent operative procedure for postoperative AF at a single institution between 2000 and 2018 were retrospectively identified. Arthroscopic interventions included lysis of adhesions, capsular release with or without manipulation under anesthesia, and excision of cyclops lesions. Patients were excluded if they had a knee dislocation or multiple-ligament injury, a periarticular fracture, or less than 2-year follow-up from the arthroscopic intervention. PROs including the Tegner activity score, visual analog scale pain score, and International Knee Documentation Committee score as well as knee range of motion (ROM) were recorded. Results: A total of 40 patients were included with a mean age of 27.2 years (range, 11.0-63.8 years) at surgery and a mean follow-up of 10.0 years (range, 2.9-20.7 years). The mean preoperative flexion and extension were 102° (range, 40°-150°) and 8° (range, 0°-25°), respectively. The mean postoperative flexion and extension were 131° (range, 110° to 150°) and 0° (range, –10° to 5°), respectively. After the arthroscopic intervention, the mean ROM improved from 94° (range, 40°-140°) preoperatively to 131° (range, 107°-152°) at final follow-up (P < .001), and the visual analog scale pain score improved from 3.0 preoperatively to 1.2 postoperatively (P = .001). Overall, 13 patients (32.5%) underwent an intervention within 3 months and 27 (67.5%) after 3 months. The early intervention group had a higher postoperative International Knee Documentation Committee score compared with the late intervention group (86.8 vs 71.7, respectively; P = .035). Conclusion: An arthroscopic intervention for AF after ACLR successfully improved knee ROM and pain. Patients who underwent either early or late surgery obtained satisfactory motion and function, although improved PROs were observed when the intervention occurred within 3 months of the primary procedure.

Satisfactory Outcomes and Improved Range of Motion With Arthroscopic Lysis of Adhesions and Manipulation for Arthrofibrosis After Multiligamentous Knee Reconstruction

To (1) evaluate the efficacy of surgery for arthrofibrosis (AF), as measured by preoperative and postoperative range of motion (ROM), and (2) evaluate patient-reported outcomes at mid- to long-term follow-up. We performed a retrospective review of a prospectively collected database including patients who sustained multiligamentous knee injuries (MLKIs) managed surgically, sustained loss of ROM after surgical intervention, and underwent subsequent lysis of adhesions (LOA) and/or manipulation under anesthesia (MUA). Loss of ROM was defined as clinically symptomatic loss of terminal extension (flexion deformity) and/or flexion compared with the contralateral side. In total, 12 patients (6 male and 6 female patients; age, 36.0 ± 8.7 years; body mass index, 36.3 ± 8.7) met the inclusion criteria and underwent LOA and/or MUA at a mean of 14 ± 27 months (median, 4.0 months; interquartile range, 3.5-9.3 months) after MLKI surgery. Prior to AF intervention, patients showed mean flexion of 75.9° ± 36.0° (range, 30°-129°), mean extension of 3.2° ± 5.2° (range, 0°-12°), and a mean arc of motion of 72.7° ± 34.1° (range, 30°-117°). At a mean follow-up of 7.0±3.9 years (range, 2.4-16.6 years) after AF intervention, patients showed a significant increase in knee flexion of 49° (P= .003), a significant increase in arc of motion of 51° (P= .002), and an increase in extension of 3° (P= .086). The mean final International Knee Documentation Committee score was 59.5 ± 23.9; Lysholm score, 72.1 ± 20.6; Tegner activity scale score, 5.6 ± 2.8; visual analog scale score at rest, 1.0 ± 1.6; and visual analog scale score with use, 3.3 ± 2.5. At final follow-up, 2 patients (17%) had undergone conversion to total knee arthroplasty (TKA) at 10.3 and 24.8 years after MLKI surgery. Of the 10 patients who did not go on to TKA, 9 (90%) reported that they were satisfied or very satisfied with their AF knee surgery. At mid-term follow-up, LOA and/or MUA for symptomatic AF after multiligamentous knee surgery results in high rates of patient satisfaction and improved knee ROM and pain scores, as well as durable and satisfactory functional outcomes in patients not undergoing TKA. Level IV, therapeutic case series.

Effectiveness of Maitland Mobilization versus Pain release phenomena for pain, range of motion and disability in early knee osteoarthritis

Aim: To compare the effectiveness of Maitland mobilization and pain release phenomena for Pain, Range of motion disability in early knee osteoarthritis. Methodology: Randomized control trail was conducted at Department of Physical Therapy, Railway General Hospital, Rawalpindi, Pakistan within a duration of 6 months. Participants aged between 35-60 years including both genders, diagnosed with stage 1 and 2 knee osteoarthritis were included. Range of motion (ROM) was assessed by Goniometer, Numeric pain rating scale(NPRS) used for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores used for knee disability. IBM SPSS 24 was used for statistical analysis. Non-parametric tests were used for NPRS while parametric test were used for knee ROM and knee disability . Results: Total 47 participants, were analyzed in which mean age in Experimental Maitland mobilization group A was 45.3±6.06 while mean age in experimental pain release phenomena group B was 45.4±4.59. Between-group analysis for NPRS was significantly improved at post intervention having p value (0.03). Between group comparison of knee ROM and WOMAC also showed significant p value. (p value=&lt;0.05). Conclusion: It is concluded that both techniques are equally effective in decreasing pain, improving knee ROMs and functional mobility in early knee osteoarthritis. Keywords: Knee Osteoarthritis; Early Mobilization ; Knee Joint Pain; Knee Joint Range Of Motion; Knee Disability.

Combining a transosseous cerclage wire after patellar tendon reattachment to treat patella distal pole fracture did not improve functional outcome

This study aims to investigate whether an augmented wire in the treatment of patella distal pole fracture could improve knee range of motion (ROM) and radiographic features. Thirty-five consecutive patients with patellar distal pole fracture were analyzed from January 2014 to July 2019. The treatment is divided into two groups according to the presence or absence of augmented wire. Knee ROM, bone union, extension lag, and patellar height were compared between these two groups as the clinical and radiological outcomes. There was no significant difference in mean knee ROM (110° vs. 108°, p = 0.79), proportion of patella baja or bone union. More extension lag was noted in the augmentation group (5/20, 25%) than in the tendon reattachment group (1/15, 6.7%) with no statistically significant difference. In the augmentation group, four cases (20%) would need to remove the fixator due to irritation or broken hardware. Maintaining the patella length by preserving the distal pole and repairing the torn retinaculum allowed early motion to avoid knee stiffness safely without augmentation wire, which doesn’t improve knee ROM. The patellar tendon reattachment alone could achieve a great recovery and prevent the need for a second surgery due to broken wire or irritation.

Should corticosteroids be administered for local infiltration analgesia in knee arthroplasty? A meta-analysis and systematic review.

The benefits of local infiltration analgesia (LIA) in knee arthroplasty (KA) have been well-documented. However, it is unknown whether adding a corticosteroid to the composition of the LIA is beneficial. This study aimed to investigate the efficacy and safety of administering periarticular steroids intraoperatively in patients who underwent KA through a systematic review and meta-analysis. A systematic search was conducted to identify relevant randomized controlled trials in the PubMed, Embase, Web of Science and Cochrane databases up to January 19th, 2021 to perform a meta-analysis. Outcome variables included pain scores, total opioid consumption, knee range of motion (ROM) and postoperative complications. Corticosteroid injections did not reduce pain scores at 6, 12, 24 or 72h postoperatively, although a minimal degree of transient pain relief was achieved at 48h postoperatively compared with those in the placebo group, nor was there a significant difference in total opioid consumption. However, patients receiving corticosteroids did exhibit a transient ROM increase on postoperative days 1, 2 and 3. Since the minimal clinically important difference (MCID) for ROM is unclear, it is unknown if the improvement in ROM is clinically significant. Our specific end-point analysis demonstrated that corticosteroid administration did not provide pain relief or reduce opioid consumption compared with placebo. However, corticosteroids might provide a statistically significant, though transient and minimal improvement in knee ROM after KA, although no firm conclusions about the benefits of administering corticosteroids in KA can be made based on the available evidence.

Arthroscopic Lysis of Adhesions With Manipulation for Management of Late-Presenting Stiffness After Total Knee Arthroplasty

BackgroundArthrofibrosis is a known complication of total knee arthroplasty (TKA). Closed manipulation is the treatment of choice for arthrofibrosis within 90 days of TKA. Treatment for arthrofibrosis that has failed prior interventions remains controversial, and the role for arthroscopic lysis of adhesions has not been examined for late-presenting arthrofibrosis. MethodsA retrospective analysis of patients who underwent arthroscopic lysis of adhesions (LOAs) with manipulation for post-TKA arthrofibrosis was performed. Chart review included patient characteristics, time from TKA, prior interventions, and range of motion (ROM) data. Knee extension, flexion, and total ROM were recorded preoperatively, intraoperatively, and throughout follow-up. Knee ROM was compared at the different time intervals using Wilcoxon signed-rank tests. ResultsA total of 13 patients (6 male and 7 female) with a mean age of 66.3 years were included. Average time since index TKA was 57.2 months (3.7-209.5). Ten of 13 patients had undergone prior interventions for arthrofibrosis, which included closed manipulation under anesthesia, open LOA, and revision arthroplasty. The mean preoperative knee flexion and extension values for the cohort were 76.5 ± 17.4 and −4.6 ± 6.1 degrees, respectively. Postoperative improvements in knee ROM were significant at all time points, with mean improvements of 17.2 ± 16.3 degrees at 1 week (P = .022), 17.2 ± 13.2 degrees at 4 weeks (P = .001), 19.2 ± 16.0 degrees at 8 weeks (P = .004), and 25.2 ± 13.1 degrees at 12 weeks (P = .005). No complications were recorded. ConclusionsArthroscopic LOAs with manipulation achieves significant improvements in knee ROM for late-presenting arthrofibrosis after TKA.

The influence of knee flexion position on postoperative blood loss and knee range of motion after total knee arthroplasty

To summarize research progress of the effect of knee flexion position on postoperative blood loss and knee range of motion (ROM) after total knee arthroplasty (TKA). The relevant literature at home and abroad was reviewed and summarized from mechanism, research status, progress, and clinical outcome. The differences of clinical results caused by different positions, flexion angles, and keeping time were compared. Keeping knee flexion after TKA can reduce postoperative blood loss through the angle change of blood vessels and increase knee early ROM by improving flexion muscle strength. When the flexion angle of the knee is large and the flexion position is keeping for a long time, the postoperative blood loss and the knee ROM can be significantly improved. However, the amount of blood loss and ROM are not further improved in the patients with keeping knee flexion for more than 24 hours compared with less than 24 hours. Keeping knee flexion after TKA is a simple and effective method to reduce postoperative blood loss and improve knee ROM. However, the optimal knee flexion angle and time are needed to be further explored.

Effects of Auricular Acupressure on Joint Pain, Range of Motion, and Sleep in the Elderly with Knee Osteoarthritis

Purpose: The purpose of this paper is to determine effects of auricular acupressure on knee pain, range of motion, and sleep in the elderly with knee osteoarthritis. Methods: This is an experimental study designed with randomization and single-blind in a placebo-control approach. The subjects included the elderly with knee osteoarthritis who were using an elderly welfare facility. In each of the groups, 28 subjects were assigned. For the experimental group, auricular acupressure was applied to five pressure points related to the pain caused by osteoarthritis and sleep. In the case of the placebo-control group, auricular acupressure was applied to other five points than the former. The intervention lasted eight weeks. In order to examine intervention effects of auricular acupressure, joint pain, Pressure Pain Thresholds (PPTs), and extension and flexion range of motion (ROM) were measured weekly. As for the preand post-examinations, pain, sleep quality, and the time-by-sleep stage of the patients with knee osteoarthritis were measured. Results: The VAS scores in the experimental group with auricular acupressure significantly decreased through time (p<.001) and WOMAC also significantly decreased (p<.01) compared with the placebo-control group. However, there were no significant differences in PPTs. The flexion (p<.01) and extension (p<.001) ROMs measured for eight weeks improved over time. Meanwhile, sleep quality improved significantly after the intervention termination (p<.01), but there was no significant difference found in the time-by-sleep stage. Conclusion: Auricular acupressure applied for eight weeks was found to be effective in reducing joint pain, improving knee ROM, and improving sleep quality in patients with degenerative knee arthritis.

Postoperative continuous adductor canal block for total knee arthroplasty improves pain and functional recovery: A randomized controlled clinical trial

Study objectiveInvestigate the use of a postoperative continuous adductor canal block (cACB) after epidural analgesia to decreases opioid consumption and improve visual analog scale (VAS) scores compared to a sham catheter. DesignDouble-blinded randomized placebo-controlled trial. SettingInpatient setting in tertiary care teaching hospital with outpatient follow-up. PatientsOne-hundred and sixty-five subjects (cACB n = 82 and sham catheter n = 83) with end-stage degenerative joint disease undergoing elective unilateral total knee arthroplasty. InterventionsPatients were block randomized to receive a cACB or sham catheter. An epidural catheter was placed preoperatively and discontinued on postoperative day 1. Patients then received a cACB with bupivacaine or sham catheter which remained for the duration of the hospitalization. MeasurementsPrimary outcome was total opioid consumption. Secondary outcomes included VAS scores, knee range of motion (ROM), ambulation distance, and WOMAC scores. Main resultsSeventy patients completed the study (cACB n = 38 and sham catheter n = 32). Compared to sham catheter, in the first 20 h after placement of a cACB, patients used 22.5 mg less opioid (95% CI: −43.1 to −1.94 mg, P = 0.03). VAS score area under the curve decreased 7.8 mm (95% CI: −15.5 – −0.058 mm, P = 0.04) with a cACB. At 3-week follow-up, WOMAC scores were significantly improved with the cACB with a mean difference of 8.72 (95% CI: −17.3 to −0.11, P = 0.04). There were no statistically significant differences in secondary outcomes on postoperative day 2. Paired outcomes at 6 weeks compared to baseline ROM, showed significant improvement in knee ROM with a cACB (mean difference 11.77°, 95% CI: 3.1–20.5°, P = 0.01). ConclusionA postoperative cACB after total knee arthroplasty significantly reduces total opioid consumption and pain scores compared to sham catheter. Ambulatory ability was not affected and patients recovered function earlier. ClinicalTrials.govNCT02121392.

Is it necessary to perform prehabilitation exercise for patients undergoing total knee arthroplasty: meta-analysis of randomized controlled trials

ABSTRACTObjectives: This study was designed to test whether it is necessary to perform prehabilitation exercise for patients undergoing total knee arthroplasty (TKA).Methods: Literatures were identified from Pubmed, Clinicaltrials, Cochrane library, and SpringerLink. All studies that compared a prehabilitation exercise group with control group before TKA were included. The primary outcome was length of hospital stay. Secondary outcomes were quadriceps strength and functional ability in short term (1.5 to 3 months) after TKA.Results: There was significant difference in the length of hospital stay, knee range of motion (ROM) and sit-to-stand test (P＜0.05). No statistical differences were found in quadriceps strength, 6-minute walk, ROM, knee extension, knee flexion, WOMAC pain, WOMAC function, WOMAC stiffness between the two groups in short term after TKA (P＞0.05).Conclusions: Our meta-analysis found that prehabilitation exercise was effective in reducing length of hospital stay. Importantly, it was an effective method for improving knee ROM and sit-to-stand test after TKA. However, there was no effect of prehabilitation exercise on the improvement of quadriceps strength, 6-minute walk, pain and functional recovery following TKA.

Target range of motion for rehabilitation after total knee arthroplasty.

Objective: Postoperative knee range of motion (ROM) is among the most important factors influencing patient satisfaction after total knee arthroplasty (TKA). The purpose of this study was to clarify the time course of improvement in knee ROM up to 12 months after TKA, including intraoperative knee ROM after implantation, and to clarify a target ROM for rehabilitation after TKA.Patients and Methods: In total, 39 knee joints in 26 patients with osteoarthritis who underwent TKA (retaining the posterior cruciate ligament) were evaluated. Goniometry was used to measure the knee range of extension and flexion preoperatively; intraoperatively; at 1 and 2 weeks after TKA; and then at 1, 3, 6, and 12 months after TKA.Results: The postoperative extension range gradually improved up to a maximum at 6 months after TKA; there were no significant differences in the extension range between intraoperative and 6 months after TKA, intraoperative and 12 months after TKA, or 6 and 12 months after TKA. The postoperative flexion range gradually improved, with the maximum improvement observed at 3 months after TKA; there were no significant differences in the flexion range before TKA and 3, 6, and 12 months after TKA. There were no significant differences between flexion ROM measured at 3, 6, and 12 months after TKA.Conclusions: The changes in the knee range of extension plateaued 6 months after TKA, and those in the knee range of flexion plateaued 3 months after TKA. The target range of extension for rehabilitation from 6 months to 12 months after TKA was the intraoperative range, and the target range of flexion for rehabilitation from 3 months to 12 months after TKA was the preoperative range.

Assessment of outcome of Quadricepsplasty in Knee contractures of patients with arthrogryposis

Arthrogryposis multiplex congenita (AMC) refers to a group of conditions, unrelated to one another, which are similarly characterized by the contracture of multiple joints in the body. One of the common therapies in patients with AMC and knee extension contracture is quadricepsplasty. However, no comprehensive studies have been conducted on the results of the application of this method.This prospective study included 14 patients (9 females and 5 males) with 23 hyperextension contractures of the knee. Before surgery, all patients had underwent non-surgical treatment (manipulation and serial casting) for at least 6 months, but none had responded to the treatment. Then patients underwent a Quadricepsplasty. Range of motion (ROM) of the knee and patients ambulation based on modified form of Functional Mobility Scale (FMS) before and after surgery were evaluated in a follow up 3 years.The mean passive knee ROM before surgery was 7.17° (0° to 15°), which increased to 65.65° (35° to 105°) after the operation. According to t-test results, this increase was statistically significant (P&lt;0.005).The mean ambulation score (modified FMS) of the patients before surgery was 1.57, which increased to 3.71. According to t-test results, this increase was statistically significant (P&lt;0.005).Quadricepsplasty is the method of choice for the surgical treatment of knee extension contracture in AMC patients, who do not respond to non-surgical treatments. This method leads to a significant improvement in knee ROM. On the other hand, it preserves quadriceps strength at 4/5 level, and finally, along with other therapeutic interventions for other lower limb deformities, leads to ambulation improvement in these patients.Bangladesh Journal of Medical Science Vol.14(4) 2015 p. 331-335

Faster recovery without the use of a tourniquet in total knee arthroplasty

Background and purpose— Tourniquet application is still a common practice in total knee arthroplasty (TKA) surgery despite being associated with several adverse effects. We evaluated the effects of tourniquet use on functional and clinical outcome and on knee range of motion (ROM).Patients and methods— 70 patients who underwent TKA were randomized into a tourniquet group (n = 35) and a non-tourniquet group (n = 35). All operations were performed by the same surgeon and follow-up was for 1 year. Primary outcomes were functional and clinical outcomes, as evaluated by KOOS and knee ROM. Secondary outcomes were intraoperative blood loss, surgical time and visibility, postoperative pain, analgesic consumption, and transfusion requirements.Results— Patients in the non-tourniquet group showed a better outcome in all KOOS subscores and better early knee ROM from surgery to week 8. No difference was detected at the 6- and 12-month follow-ups. Postoperative pain and analgesic consumption were less when a tourniquet was not used. Surgical time and visibility were similar between groups. Intraoperative blood loss was greater when not using a tourniquet, but no postoperative transfusions were required.Interpretation— This study shows that TKA without the use of a tourniquet results in faster recovery in terms of better functional outcome and improved knee ROM. Furthermore, reduced pain and analgesic use were registered and no intraoperative difficulties were encountered.

The effect of isolytic contraction and passive manual stretching on pain and knee range of motion after hip surgery: A prospective, double-blinded, randomized study

Abstract Stretching has its impact on both contractile and noncontractile tissues and is the most important rehabilitation technique utilised used to prevent and treat joint stiffness. Passive manual stretch (PMS) and muscle energy technique (MET) are two of the most commonly used techniques. Our study evaluates the effectiveness of isolytic form of MET in gaining knee range of motion (ROM) and decreasing pain in acute knee involvement and comparing it with standard PMS. We used the clinical scenario of knee joint mobilization in patients operated for hip fractures. Fifty-two subjects were alternatively randomized to two groups, isolytic contraction (ILC) group (n = 26) and PMS group (n = 26). In both the PMS and ILC groups, significant improvements in pain score (measured by the visual analog scale) and knee ROM were reported after the treatment period (p 0.05). Thus, isolytic form of MET may be a viable method to decrease pain and improve knee ROM in patients who had undergone surgery after a hip fracture.

Sprint and Vertical Jump Performances Are Not Affected by Six Weeks of Static Hamstring Stretching

The purpose of this study was to investigate whether 6 weeks of static hamstring stretching effects range of motion (ROM), sprint, and vertical jump performances in athletes. Twenty-one healthy division III women's track and field athletes participated in the study. Subjects were tested for bilateral knee ROM; 55-m sprint time; and vertical jump height before, at 3 weeks, and after the 6-week flexibility program. Subjects were randomly assigned to treatment and control groups and warmed up with a 10-minute jog on a track before a hamstring stretching protocol. The stretching protocol consisted of four repetitions held for 45 seconds, 4 days per week. Four variables (left and right leg ROM, 55-m sprint time, vertical jump) were analyzed using a repeated-measures analysis of variance design. No significant differences (P < or = 0.05) were found with any of the four variables between the stretching and control groups. Six weeks of a static hamstring stretching protocol did not improve knee ROM or sprint and vertical jump performances in women track and field athletes. The use of static stretching should be restricted to post practice or competition because of the detrimental effects reported throughout the literature. Based on the current investigation, it does not seem that chronic static stretching has a positive or negative impact on athletic performance. Thus, the efficacy of utilizing this practice is questionable and requires further investigation.