Active Knee Flexion Research Articles

Myofascial release; a diagnostic tool for knee-abdomen and knee myofascial pain syndromes in knee osteoarthritic patients. An interventional based prevalence study

Background. Knee osteoarthritis (OA) is detected in all grades in imaging of asymptomatic individuals. Knee-abdomen syndrome (KAS) and knee myofascial pain syndrome (KMPS) are newly identified syndromes of knee pain originating from myofascial induced stress upon the knee’s capsule. Objective. To measure the prevalence of KAS and KMPS among knee OA patients and explore the concepts of the new syndromes. Methods. An intervention-based prevalence study was conducted with a representative sample of 61 knee OA patients who underwent one session of Myofascial release (MFR). Pain was evaluated and averaged pre- and post-MFR during standing, active knee flexion, extension, and squats. A pain reduction of 50% is considered diagnostic for KMPS and KAS. Pain reduction maintained for one week indicates KAS. Results. KAS and KMPS were reconstructed as part of the knee myofascial pain spectrum (KMPs). 13% of patients had KMPs with asymptomatic OA and 100% pain reduction post-MFR. 20% had symptomatic OA with no pain reduction. 67% of patients had KMPs with more than 20% pain reduction. Conclusion. KMPs was identified in the majority of knee OA patients. Asymptomatic OA was misdiagnosed as the source of pain in 13% of patients.

Clinical and Radiological Outcomes at ≥10-Year Follow-up After Matrix-induced Autologous Chondrocyte Implantation in the Patellofemoral Joint

Background: Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging outcomes in the treatment of knee cartilage defects, although limited research is available on its longer term (≥10 years) sustainability in the patellofemoral joint. Purpose: To report the clinical and radiological outcomes at ≥10 years in a prospectively recruited cohort of patients undergoing MACI in the patellofemoral joint and compare outcomes in patients undergoing MACI on the patella versus the trochlea. Study Design: Case series; Level of evidence, 4. Methods: The current study prospectively enrolled 95 patients who underwent patellofemoral MACI, of whom 29 (13 patella, 16 trochlea) underwent concomitant tibial tubercle osteotomy. Patients were assessed preoperatively and at 2, 5, and ≥10 years using a range of patient-reported outcome measures (PROMs) including the Knee injury and Osteoarthritis Outcome Score, the 36-item Short Form Health Survey, and the frequency and severity of knee pain as well as patient satisfaction, full active knee flexion and extension, and peak isokinetic knee extensor and flexor torques. High-resolution magnetic resonance imaging (MRI) was performed to assess pertinent graft parameters, as well as determine an overall MRI composite score, per the Magnetic Resonance Observation of Cartilage Repair Tissue scoring system. Results were analyzed according to the graft location (patella or trochlea). Results: Of the 95 patients recruited, 82 patients (41 patella, 41 trochlea) were available for a clinical review at ≥10 years after surgery (mean follow-up, 11.9 years [range, 10-15 years]). For the whole patellofemoral MACI cohort, all PROMs significantly improved over time (P < .05), with no significant changes (P > .05) observed in any MRI-based score from 2 to ≥10 years after surgery. At ≥10 years, 90.2% (n = 74) were satisfied with MACI in relieving their knee pain, and 85.4% (n = 70) were satisfied with the improvement in their ability to participate in sports. No differences (P > .05) were observed in PROMs between those undergoing patellar MACI and those undergoing trochlear MACI, although a significant group effect was observed for limb symmetry indices of knee extensor (P = .009) and flexor (P = .041) strength, which were greater in those undergoing patellar (vs trochlear) MACI. No statistically significant differences (P > .05) were observed between patellar and trochlear grafts on any MRI-based measure. In the cohort assessed at ≥10 years after surgery, 4 patients (2 patella, 2 trochlea) demonstrated graft failure on MRI scans, although a further 3 patients (all trochlea) were omitted from the ≥10-year review for having already progressed to total knee arthroplasty. Conclusion: Good clinical scores, high levels of patient satisfaction, and adequate graft survivorship were observed at ≥10 years after MACI on the patella and trochlea.

Clinical efficacy of arthroscopic high-intensity suture binding combined with button plate suspension fixation in the treatment of posterior cruciate ligament tibial avulsion fractures

PurposeTo assess the clinical efficacy of arthroscopic treatment for posterior cruciate ligament (PCL) tibial avulsion fractures using high-intensity suture binding combined with button plate suspension fixation.MethodsWe retrospectively analyzed clinical data from 32 patients with PCL tibial avulsion fractures treated at our hospital from July 2020 to August 2023. We recorded operation time, intraoperative and postoperative complications, and used imaging to assess fracture reduction and healing. Pain and knee function were evaluated using the Visual Analogue Scale (VAS), range of knee motion, Lysholm score, and International Knee Documentation Committee (IKDC) score.Study DesignCase series; Level of evidence, 4.ResultsAll patients were followed for 6 to 18 months, averaging 13.6 months. All incisions healed successfully without postoperative complications. X-rays taken on the first postoperative day showed satisfactory fracture reduction. Three-month post-surgery imaging confirmed healed fractures and no internal fixation failures. At the final follow-up, knee function was well recovered, with only one patient exhibiting a positive posterior drawer test of degree I. Furthermore, the mean VAS score was 0. 5 (range 0.0 to 1.0), active knee extension was 2. 2° (range 0.0 to 5.0), and active knee flexion was 137.7° (range 130.0 to 145.0). The mean Lysholm score was 91.5(range 89.3 to 94.0), and the IKDC score averaged 83.8 ± 3.7, and these outcomes showed statistically significant improvement from preoperative levels (P < 0.001).ConclusionsArthroscopic high-intensity suture binding combined with button plate suspension fixation for PCL tibial avulsion fractures offers several benefits: it is minimally invasive, results in less postoperative pain, enables earlier functional exercise, and provides satisfactory clinical outcomes with fewer complications.

Paraspinal Muscle Stiffness during Hamstring Exercise Using Shear-Wave Elastography.

Soccer teams integrate specific exercises into their typical workout programs for injury prevention. This study examined the effects of hamstring exercise on paraspinal and hamstring stiffness. These findings can inform training and rehabilitation programs to improve muscle health and prevent injuries. Fifteen young, healthy males performed passive and active (submaximal) knee flexion efforts from 0°, 45°, to 90° angle of knee flexion from the prone position. Using shear-wave elastography (SWE) and surface electromyography, we measured the elastic modulus and root mean square (RMS) signal of the erector spinae (ES), multifidus (MF), semitendinosus (ST), and semimembranosus (SM) during different knee flexion angles. Passive SWE modulus at 0° was 12.44 ± 4.45 kPa (ES), 13.35 ± 6.12 kPa (MF), 22.01 ± 4.68 kPa (ST), and 21.57 ± 5.22 kPa (SM) and it was greater (p < 0.05) compared to 45° and 90°. The corresponding values during knee flexion contractions at 0° increased to 18.99 ± 6.11 kPa (ES), 20.65 ± 11.31 kPa (MF), 71.21 ± 13.88 kPa (ST), and 70.20 ± 14.29 kPa (SM) and did not differ between angles (p > 0.05). Compared to rest, the relative increase in the SWE modulus during active contraction had a median value (interquartile range) ranging from 68.11 (86.29) to 101.69 (54.33)% for the paraspinal muscles and it was moderately to strongly correlated (r > 0.672) with the corresponding increase of the hamstring muscles [ranging from 225.94 (114.72) to 463.16 (185.16)%]. The RMS signal was greater during active compared to passive conditions, and it was lower at 90° compared to 45° (for SM/ST) and 0° (for all muscles). The association between paraspinal and hamstring passive muscle stiffness indicates a potential transmission of forces through myofascial connections between the lumbar spine and the lower limbs. In this laboratory setting, hamstring exercises affected the stiffness of the paraspinal muscles.

Modern multiligament knee injury surgical reconstruction techniques can achieve excellent knee function and patient satisfaction, with low complication rates.

To report on the recovery of strength and functional capacity symmetry following multiligament knee surgical reconstruction (MLKR), as well as the capacity of athletes to return to sport. This prospective cohort study recruited 47 patients undergoing MLKR between February 2018 and July 2021. Forty patients had full outcome assessment postoperatively at 6, 12 and 24 months and were included in the analysis, 75% were knee dislocation one injuries and 60% were injured playing sport. Patient-reported outcome measures (PROMs) assessed included the International Knee Documentation Committee score, the Knee Outcome Survey, the Lysholm Knee Score and the Tegner Activity Scale (TAS). Patient satisfaction was also assessed. Objective assessment included assessment of active knee flexion and extension range of motion (ROM), the single (single horizontal hop for distance [SHD]) and triple (triple horizontal hop for distance [THD]) hop tests for distance and peak isokinetic knee flexor/extensor torque. All PROMs significantly improved (p < 0.001) from presurgery to 24 months postsurgery. At 24 months, 70% of patients were satisfied with their sports participation. Active knee flexion (p < 0.0001) and extension (p < 0.0001) ROM significantly improved over time, as did the limb symmetry indices (LSIs) for the SHD (p < 0.0001), THD (p < 0.0001), peak knee extensor (p < 0.0001) and flexor (p = 0.012) torque. While LSIs for the SHD, THD and knee flexor strength tended to plateau by 12 months, knee extensor strength continued to improve from 12 to 24 months. The majority of patients undergoing modern MLKR surgical techniques and rehabilitation can achieve excellent knee function, with low complication rates. Level IV.

Poster 227: Prospective Clinical and Radiological Follow-Up Beyond 10 Years in Patients Undergoing Matrix-Induced Autologous Chondrocyte Implantation (MACI) in the Patellofemoral Joint

Objectives: Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging outcomes in the treatment of knee cartilage defects, though limited research is available on its longer-term (≥10 years) sustainability in the patellofemoral joint. This prospective study sought to present and report the clinical and radiological outcome beyond 10 years in a prospectively recruited cohort of patients undergoing MACI in the patellofemoral knee joint. Methods: The current study included 82 patients (patella = 41, trochlea = 41) assessed at ≥10 years following patellofemoral MACI. Patients were assessed preoperatively and at 2, 5 and ≥10 years via the Knee Injury and Osteoarthritis Outcome score (KOOS), the 36-item Short Form Health Survey (SF-36), the frequency (VAS-F) and severity (VAS-S) of knee pain, patient satisfaction, active knee range of motion (ROM) and peak isokinetic knee extensor and flexor torque. High-resolution magnetic resonance imaging (MRI) assessed pertinent measures of graft outcome as per the magnetic resonance observation of cartilage repair tissue (MOCART) system, as well as an overall MRI composite score. Results were analyzed according to the graft location (patella or trochlea). Results: While no statistically significant differences (p&gt;0.05) were observed between those undergoing patella or trochlea MACI across the majority of demographic (age, weight, BMI), injury history (duration of symptoms) or surgery (defect size, prior procedures, requirement for concomitant patellofemoral re-alignment) variables, a significantly higher (p=0.013) proportion of males was seen in the trochlea MACI group. All patient-reported outcome measures significantly improved (p&lt;0.05), with no differences observed between those undergoing patella or trochlea MACI. No group differences (p&gt;0.05) were observed in active knee flexion or extension ROM between groups, though those undergoing patella (versus trochlea) MACI demonstrated significantly greater postoperative quadriceps (Figure 1) and hamstring strength limb symmetry indices. No statistically significant decline (p&gt;0.05) was seen from 2 years to final follow-up in any MRI-based measure, with no MRI-based differences observed between patella (Figure 2) and trochlea (Figure 3) grafts. In the cohort assessed at ≥10 years post-surgery, 4 patients (patella n=2, trochlea n=2) demonstrated graft failure on MRI, though a further 3 patients (all trochlea) were omitted from ≥10-year review that had already progressed toward total knee arthroplasty. Conclusions: Good clinical scores, high levels of patient satisfaction and adequate graft survivorship were observed at ≥10 years following MACI to the patella or trochlea.

Thoracolumbar Fascia and Lumbar Muscle Stiffness in Athletes with A History of Hamstring Injury.

The purpose of this study was to examine the differences in thoracolumbar fascia (TLF) and lumbar muscle modulus in individuals with and without hamstring injury using shear wave elastography (SWE). Thirteen male soccer players without a previous hamstring injury and eleven players with a history of hamstring injury performed passive and active (submaximal) knee flexion efforts from 0°, 45° and 90° angle of knee flexion as well as an active prone trunk extension test. The elastic modulus of the TLF, the erector spinae (ES) and the multifidus (MF) was measured using ultrasound SWE simultaneously with the surface electromyography (EMG) signal of the ES and MF. The TLF SWE modulus was significantly (p < 0.05) higher in the injured group (range: 29.86 ± 8.58 to 66.57 ± 11.71 kPa) than in the uninjured group (range: 17.47 ± 9.37 to 47.03 ± 16.04 kPa). The ES and MF modulus ranged from 14.97 ± 4.10 to 66.57 ± 11.71 kPa in the injured group and it was significantly (p < .05) greater compared to the uninjured group (range: 11.65 ± 5.99 to 40.49 ± 12.35 kPa). TLF modulus was greater than ES and MF modulus (p < 0.05). Active modulus was greater during the prone trunk extension test compared to the knee flexion tests and it was greater in the knee flexion test at 0° than at 90° (p < 0.05). The muscle EMG was greater in the injured compared to the uninjured group in the passive tests only (p < 0.05). SWE modulus of the TLF and ES and MF was greater in soccer players with previous hamstring injury than uninjured players. Further research could establish whether exercises that target the paraspinal muscles and the lumbar fascia can assist in preventing individuals with a history of hamstring injury from sustaining a new injury.

TELEREHABILITATION ASSESSMENT OF KNEE RANGE OF MOVEMENT; COMPARISON OF HUMAN POSE ESTIMATION TOOL, PHYSIOROM, VS 3D MOTION CAPTURE SYSTEM

INTRODUCTION AND AIMS Telerehabilitation is increasingly acknowledged, though uptake remains limited by an inability to accurately undertake objective measurement. This study sought to determine the validity of a human pose estimation tool (PhysioROM, Coviu) assessed via two-dimensional (2D) video to measure active knee flexion and extension movement during common rehabilitation exercises, versus gold-standard three-dimensional (3D) motion capture. METHODS Fifty participants were recruited (aged 18 to 30), each performing three common knee rehabilitation exercises; sit-to-stand, seated and reclined active knee flexion. Movements were recorded using the 12-camera, 3D Vicon motion capture system simultaneously with 2D video simulating a home telehealth consultation. Joint kinematics were calculated using the Vicon Plug-in Gait model (3D Vicon) or the human pose estimation tool within the PhysioROM algorithm (2D PhysioROM). RESULTS Mean peak knee flexion was 3.1°, 9.9° and 24.8° (p&amp;lt;0.001) greater for 3D Vicon versus 2D PhysioROM (sit-to-stand, seated flexion and reclined flexion, respectively). For peak knee extension, Vicon 3D was 2.4° and 1.93° greater than 2D PhysioROM in sit-to-stand (p=0.020) and seated flexion (p&amp;lt; 0.001), whilst 3.6° less than PhysioROM for reclined knee flexion (p=0.030). Statistical parametric mapping revealed significant differences between Vicon 3D and PhysioROM for 71% and 42% of timepoints (p&amp;lt;0.001) for seated and reclined movements, clustered around full knee flexion. Significant differences were also found at an additional 37% (p&amp;lt;0.001) of timepoints clustered around knee extension for reclined postures. Overall mean absolute deviation was 8.7°, 7.6° and 16.5° for sit-to-stand, seated flexion and reclined flexion, respectively. CONCLUSION Validity of PhysioROM to accurately measure knee flexion was high, less so in extension, during sit-to stand movements in a seated posture. Measurement in a reclined position were less accurate. PhysioROM may provide an effective method of accurately and objectively quantifying knee movement during a telerehabilitation session using 2D video.

The Intrarater and Interrater Reliability and Validity of Universal Goniometer, Digital Inclinometer, and Smartphone Application Measuring Range of Motion in Patients with Total Knee Arthroplasty.

The aim of this study was to investigate the intrarater and interrater reliability and validity of range of motion measurements obtained with a universal goniometer, digital inclinometer, and smartphone application in patients with total knee arthroplasty. Range of motion of the knee joint was measured by two examiners with a universal goniometer, digital inclinometer, and a smartphone application. Data were obtained from 51 knees of 27 patients at postoperative 6months. Two measurements made by the first examiner were compared to assess interrater reliability, and measurements from both examiners were compared to assess intrarater reliability. Statistical analysis was performed using intraclass correlation coefficient (ICC) and Spearman's rho values. With all three methods, active and passive knee flexion range of motion measurements showed high intrarater and interrater reliability (ICC = 0.749-0.949). Concurrent validity analysis also demonstrated statistically significant, moderate to strong correlation among the three methods (r = 0.775-0.941). The universal goniometer, digital inclinometer, and smartphone application were all found to be reliable and valid assessment tools in clinical practice for patients with total knee arthroplasty.

Maximum flexion and lateral rollback revealed better patient satisfaction after total knee arthroplasty

IntroductionPatient satisfaction is an important outcome of total knee arthroplasty (TKA). However, we cannot predict how and why patients are satisfied or dissatisfied with TKA. The hypothesis of this study was that patient-reported outcomes (PROs) correlate with in vivo kinematics after TKA.Materials and methodsOne hundred knees were analyzed after TKA. The in vivo kinematics of deep knee bending motion were estimated from single-plane fluoroscopy using a two-to-three-dimensional registration technique. Active knee flexion, femoral rotation and rollback were evaluated. The PROs were obtained after surgery using the 2011 Knee Society Scoring System (KSS), and their relationship with in vivo kinematics was determined.ResultsThe average minimum and maximum flexion were −2.4 ± 7.3° and 113.2 ± 13.6°, respectively. The average femoral rotation was 7.4 ± 3.4°, and the average medial and lateral rollback were 2.4 ± 4.8 mm and 7.2 ± 5.6 mm, respectively. The multiple regression analysis revealed that the maximum flexion angle significantly contributed to symptoms and satisfaction. In addition, lateral rollback was also a significant factor affecting patient satisfaction. Lateral rollback and lateral Anterior-Posterior (AP) position at maximum flexion were correlated with the maximum flexion angle, whereas femoral rotation did not correlate with flexion angles.ConclusionsMaximum flexion and lateral rollback are important for better patient satisfaction after TKA. To obtain the maximum flexion angle, it was necessary to perform the normal kinematic pattern with a large amount of lateral rollback.

A Prospective Randomized Controlled Trial Investigating Quadriceps Versus Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction

Background: Numerous graft options are available when undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although a lack of high-quality evidence exists comparing quadriceps (QT) and hamstring (HT) autografts. Purpose: To investigate patient outcomes in patients undergoing HT versus QT ACLR. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: After recruitment and randomization, 112 patients (HT = 55; QT = 57) underwent ACLR. Patients were assessed pre- and postoperatively (6 weeks and 3, 6, 12, and 24 months), with a range of patient-reported outcome measures (PROMs), graft laxity (KT-1000 arthrometer; primary outcome variable), active knee flexion and extension range of motion (ROM), peak isokinetic knee extensor and flexor strength, and a 6-hop performance battery. Limb symmetry indices (LSIs) were calculated for strength and hop measures. Secondary procedures, ACL retears, and contralateral ACL tears were reported. Results: All PROMs and knee ROM measures significantly improved (P < .0001), and no other group differences (P > .05) were observed—apart from the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score, which was significantly better in the HT group at 3 (P = .008), 6 (P = .010), and 12 (P = .014) months. No significant changes were observed in side-to-side laxity from 6 to 24 months (P = .105), and no group differences were observed (P = .487) at 6 (HT mean, 1.2; QT mean, 1.3), 12 (HT mean, 1.1; QT mean, 1.3), and 24 (HT mean, 1.1; QT mean, 1.2) months. While the HT group demonstrated significantly greater (P < .05) quadriceps strength LSIs at 6 and 12 months, the QT group showed significantly greater (P < .05) hamstring strength LSIs at 6, 12, and 24 months. The HT group showed significantly greater (P < .05) LSIs for the single horizontal (6 months), lateral (6 and 12 months), and medial (6 months) hop tests for distance. Up until 24 months, 1 patient (QT at 22 months) had a retear, with 2 contralateral ACL tears (QT at 19 months; HT at 23 months). Secondary procedures included 5 in the HT group (manipulation under anesthesia, notch debridement, meniscal repair, and knee arthroscopy for scar tissue) and 6 in the QT group (notch debridement, meniscal repair, knee arthroscopy for scar tissue, tibial tubercle transfer, and osteochondral autologous transplantation). Conclusion: Apart from the ACL-RSI, the 2 autograft groups compared well for PROMs, knee ROM, and laxity. However, greater hamstring strength LSIs were observed for the QT cohort, with greater quadriceps strength (and hop test) LSIs in the HT cohort. The longer-term review will continue to evaluate return to sports and later-stage reinjury between the 2 graft constructs. Registration: ACTRN12618001520224p (Australian New Zealand Clinical Trials Registry).

Is thoracolumbar fascia shear-wave modulus affected by active and passive knee flexion?

The purpose of this study was to examine the effect of passive and active knee flexion efforts on the stiffness of the thoracolumbar (TLF), semitendinosus (STF), and semimembranosus fascia (SMF). Fourteen young healthy males participated in this study. Using ultrasound shear-wave elastography, fascia elastic modulus was measured at rest (passive condition) and during submaximal isometric knee flexion efforts (active condition) with the hip at neutral position and the knee flexed at 0°, 45°, and 90°. Analysis of variance designs indicated that when the knee was passively extended from 90° to 0°, shear modulus of the TLF, SMF, and STF increased significantly (p < 0.05). Similarly, active knee flexion contractions caused a significant increase in TLF, SMF, and STF shear modulus (p < 0.001). Compared to hamstring fascia, the TLF showed greater thickness but a lower shear modulus (p < 0.05) while STF modulus was greater compared that to SMF during active contraction (p < 0.05). These results indicate that exercising the hamstring muscles can remotely influence the stiffness of the fascia which surrounds the lumbar area.

A Comparison of the Efficacy of Cannulated Screws against Modified Tension Band Wire in the Management of Slightly Displaced Fractures of the Patella: A Novel Technique.

The study aimed to compare the outcomes of Open Reduction and Cannulated Screw Fixation (ORCF) and Open Reduction and Tension Band Wire Fixation (ORTF) for treating minimally displaced patellar fractures, with the intention to discern the more efficacious surgical method in terms of various clinical and radiographic parameters. The research was a retrospective controlled trial encompassing 63 patients, culminating in a final data set of 52 patients with transverse patellar fractures with less than 8 mm of displacement. Patients were assessed postoperatively at three, six, and twelve months using measures such as the Lysholm score, Visual Analog Scale (VAS) for pain, and goniometry for active knee extensions and flexion. Statistical analyses were performed using SPSS version 22.0. Results indicated superior clinical outcomes for the ORCF group at twelve months post-treatment, with notable higher Lysholm scores and lower VAS scores for pain at three-, six-, and twelve-month intervals. The ORCF group also demonstrated improved flexion and range of motion, with an average fracture healing time of 2.65 months and significantly lower complication rates, compared to the ORTF group. The ORCF method, leveraging headless compression screws and cerclage wire fixation, emerges as a promising approach for managing minimally displaced transverse patellar fractures, potentially offering improved clinical results and patient satisfaction in comparison to the traditional ORTF method. Further expansive and diverse studies are warranted to substantiate these findings.

Evaluation of therapeutic management in women with lumbar spine pain complaints

Aim of the study: To evaluate the effects of two different modes of improvement on the level of perceived pain, spinal mobility, lumbar spinal motion control and limitations in activities of daily living in women aged 51–62 with lumbar spine pain. Material and methods: The study included a group of 31 women between the ages of 51 and 62. The subjects were divided into 2 groups. Group I (FK) received physical therapy treatments and general gymnastics, while group II (FS) received physical therapy treatments and exercises using a PBU stabilizer. The project covered a period of 10 treatment days excluding Saturdays and Sundays. Before and immediately after the rehabilitation, tests of flexion and extension control in the L-spine, active knee joint flexion test, Schober test were performed, and the NRS scale was used scale and QBPDS scale. Results: After the applied rehabilitation, a significant reduction in the level of perceived pain and improvement in spinal mobility in the direction of flexion were observed in both groups. In the FS group, there was also a significant improvement in lumbar flexion control and better lumbar spine control during the active knee flexion test. In addition, a reduction in disability as measured by the QBPDS scale was noted. Conclusions: The use of comprehensive rehabilitation brings significant improvements in terms of pain reduction and improvement in lumbar spine mobility in the flexion direction. A two-week exercise program using a stabilizer appears to yield significantly better results in terms of lumbar flexion control as well as better lumbar control during the active flexion test of both knee joints. And this, in turn, may affect the results obtained using the QBPDS scale among FS subjects.

Posterior cruciate ligament retention with medial ball-in-socket conformity promotes internal tibial rotation and knee flexion while providing high clinical outcome scores

BackgroundAlthough retaining the posterior cruciate ligament (PCL) is advantageous in unrestricted kinematically aligned TKA, it is often excised with a medial stabilized implant. The primary objectives were to determine whether PCL retention using an insert with ball-in-socket (B-in-S) medial conformity to maximize A-P stability promotes internal tibial rotation and flexion while providing high patient-reported outcome scores. MethodsTwo cohorts of 25 patients each were treated with unrestricted kinematically aligned (KA) TKA using a tibial insert with B-in-S medial conformity and a flat lateral articular surface. One cohort retained the PCL; the other had it excised. Patients performed deep knee bend and step-up exercises during fluoroscopic imaging. Following 3D model-to-2D image registration, anterior-posterior (A-P) positions of the femoral condyles and tibial rotation were determined. ResultsFor deep knee bend, mean internal tibial rotation with PCL retention was significantly greater at maximum flexion (17.7° ± 5.7° versus 10.4° ± 6.5°, p < 0.001) and significantly greater at 30°, 60°, and 90° flexion as well (p ≤ 0.0283). For step-up, mean internal tibial rotation with PCL retention was significantly greater at at 15°, 30°, and 45° flexion (p ≤ 0.0049) but was marginally not significantly greater at 60° (i.e. maximum) flexion (12.3° ± 4.4° versus 10.1° ± 5.4°, p = 0.0794). Mean flexion during active knee flexion with PCL retention was significantly greater (127° ± 8° versus 122° ± 6°, p = 0.0400). Both cohorts had high median Oxford Knee, WOMAC, and Forgotten Joint Scores that were not significantly different (p = 0.0918, 0.1448, and 0.0855, respectively) ConclusionSurgeons that perform unrestricted KA TKA should retain the PCL with an insert that has B-in-S medial conformity, as this maintains extension and flexion gaps while also promoting internal tibial rotation and knee flexion as well as providing high clinical outcome scores.

Mirror Therapy for Total Knee Arthroplasty: A Pilot Study

Background: One in five patients experience persistent pain and disability after total knee arthroplasty (TKA), often driven by increased sensitization of the nervous system and pain. Pain and a sensitized nervous system are major barriers to postoperative rehabilitation impeding improved movement, and function. Objective: To determine if mirror therapy following TKA yields any positive shifts in self-reported pain, active range of motion (ROM) and nerve sensitivity (pressure pain thresholds - PPT). Design: Case series with pre- and immediate post-intervention measurements. Methods: A convenience sample of patients who just underwent TKA was recruited for the study. Prior to mirror therapy, self-reported pain, active knee flexion ROM and PPTs were measured. In hook lying, a mirror was placed between the legs, separating the surgical and non-surgical legs. Patients performed 3 sets of 10 supine heel slides with the non-surgical leg while watching the leg in the mirror, mimicking active knee flexion of the surgical leg. Results: Eighteen patients (9 female), with a mean age of 65.94 years and mean time since TKA of 7.83 days participated in the study. Immediately following mirror therapy, mean active knee flexion improved by 3.84 degrees (p = 0.001), with 10 patients exceeding minimal detectable change. Self-reported pain (p = 0.08), PPT of the surgical knee (p = 0.95), PPT of the non-surgical knee (p = 0.21) and PPT of the upper trapezius (p = 0.23) failed to show any significant improvement after mirror therapy. Conclusion: The results of this study show that mirror therapy immediately following TKA may have some benefit in improving ROM, but not pain or sensitivity of the nervous system. This is the first study exploring the immediate effects of mirror therapy in postoperative TKA.

Management and Outcome of Elderly Patients With Patellar Fracture Treated With Novel Modified Cerclage Wiring.

The purpose of this study is to assess the efficacy and security of a fixation method for fixing patellar fractures in elderly patients utilizing modified cerclage wire. From January 2015 to December 2020, 31 cases (age≥65years old) of closed patellar fracture were treated by modified cerclage wiring. Patients in these instances ranged in age from 65 to 87 (73.7 ± 7.2years), with 15 men and 16 women. 4 instances were type 34-C1 (transverse fracture) according to the AO/OTA classification, 27 cases (87%) were comminuted fractures, including 11 cases that were type 34-C2 (3 fragments), and 16 cases that were type 34-C3 (more than 3 fragments). Postoperative problems such as fragment re-displacement, nonunion, internal fixation loosening, infection, and internal fixation rupture were evaluated. The clinical grading systems of Böstman were used to assess the postoperative clinical outcomes. Thirty one patients in all were monitored for 14 to 31months (22.2 ± 4.5months). After the procedure, the fracture took 2.5-3.5months (2.92 ± .25months) to heal. There were no postoperative issues like infection, dislocation, implant breakage, uncomfortable hardware, or post-traumatic osteoarthritis. According to the clinical grading scales of Böstman, the average score of the final follow-up was 28.6 ± 1.1 (range 26-30). 29 (94%) of the patients had excellent results, whereas just 2 (6%) had good results. The patient's knee flexion activity ranged from 110 to 140°, making for a favorable prognosis. Most patella fractures in the elderly are comminuted. Elderly patients with patellar fractures may be successfully treated with modified cerclage wire, with good results and no noticeable side effects.

Bicruciate-retaining total knee arthroplasty procedure reduced tensile force in the middle and posterior components of lateral collateral ligament during deep knee flexion activities with no effect on tensile force of the medial collateral ligament.

To analyse the effects of bicruciate-retaining total knee arthroplasty (BCR-TKA) on the tensile force of the collateral ligaments during two deep knee flexion activities, cross-leg sitting and squatting. Thirteen patients (15 knees) treated using bicruciate-retaining total knee arthroplasty (BCR-TKA) for knee joint osteoarthritis were analysed. Knee joint kinematics during cross-leg sitting (open-chain flexion) and squatting (closed-chain flexion) were evaluated through fluoroscopy. The tensile force was calculated in vivo based on the change in the distance between the femoral and tibial attachment areas for the anterior, middle, and posterior components of the superficial (sMCL) and deep (dMCL) medial collateral ligament and the lateral collateral ligament (LCL). Differences in the calculated tensile forces of the collateral ligaments were evaluated using repeated measures of analysis of variance, with post hoc pairwise comparison (Bonferroni test). Statistical significance was set at P ≤ 0.05. The correction of the coronal alignment was related to the surgical technique, not to the implant design. No significant change in the tensile force in all three components of the sMCL from pre- to post-TKA (n.s.) was observed. For dMCL, a pre- to post-TKA change in the tensile force was observed only for the anterior dMCL component (p = 0.03). No change was observed in the tensile force of the anterior LCL with increasing flexion, with no difference in pre- to post-TKA and between activities (n.s.). In contrast, tensile force in the middle LCL slightly decreased with increasing flexion during squatting, pre- and post-TKA. After surgery, lower forces were generated at 40° of flexion (p = 0.04). Tensile force in the posterior LCL was higher in extension than flexion, which remained high in the extension post-TKA. However, after surgery, lower tensile forces were generated at 10° (p = 0.04) and 40° (p = 0.04) of flexion. The in vivo change in tensile forces of the collateral ligaments of the knee before and after BCR-TKA can inform the development of appropriate ligament balancing strategies to facilitate recovery of deep knee flexion activities after TKA, as well as for continued improvement of BCR-TKA designs. III.

Rehabilitation approach in robot assisted total knee arthroplasty: an observational study

BackgroundThe purpose of this study is to evaluate the impact of total knee arthroplasty (TKA) with the aid of Navio Robot, comparing it with standard prosthetic surgery on the functional outcomes of patients after an intensive rehabilitation program.MethodA case–control observational study was conducted on patients undergoing TKA for severe KOA. All patients underwent the same intensive hospital rehabilitation program of 14 daily sessions lasting 3 h. The following rating scales were administered: Numeric Rating Scale (NRS), Knee Society Score (KSS) and 12-Item Short Form Survey scale. Patient assessments were performed 1 week post-surgery (T0), 1 month post-surgery (T2), and 3 months post-surgery (T3). The primary outcomes were active knee extension and flexion and pain severity. The secondary outcomes were functional capacity and quality of life.ResultsUsing repeated measures ANOVA, we observed at T1 a statistically different difference for the treatment group compared to the control group about KSS (p < 0.05), pain (p < 0.05), and knee flexion (p < 0.05). No statistically significant difference between the two groups was observed for knee extension (p = 0.09) and the SF-12 scale (p = 0.52). At T2 instead, we observed a statistically significant difference for the treatment group compared to the control group as regards KSS (p < 0.05) and knee flexion (p < 0.05), while no statistically significant difference was observed for pain (p = 0.83), knee extension (p = 0.60), and the SF-12 scale (0.44).ConclusionsOur study has demonstrated that robot-NAVIO assisted knee prosthesis surgery, associated with a specific intensive rehabilitation treatment, in the short and medium term, determines good pain control, better flexion recovery and a improvement of functional capacity.

Impact of Occupation on 12-Month Outcomes After Anterior Cruciate Ligament Reconstruction in Male Patients.

The impact of a physically demanding occupation on clinical outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) is largely unknown. The purpose of this study was to assess the influence of occupation on 12-month outcomes after ACLR in male patients. It was hypothesized that patients undertaking manual work would not only have better functional outcomes in terms of strength and range of motion but also higher rates of joint effusion and greater anterior knee laxity. Cohort study; Level of evidence, 3. From an initial cohort of 1829 patients, we identified 372 eligible patients aged 18 to 30 years who underwent primary ACLR between 2014 and 2017. Based on a preoperative self-assessment, 2 groups were established: patients engaged in heavy manual occupations and those engaged in low-impact occupations. Data were collected from a prospective database including effusion, knee range of motion (using side-to-side difference), anterior knee laxity, limb symmetry index for single hop and triple hop, International Knee Documentation Committee (IKDC) subjective score, and complications up to 12 months. Because of the significantly lower rate of female patients undertaking heavy manual occupations compared to low-impact occupations (12.5% and 40.0%, respectively), data analysis was focused on male patients. Outcome variables were assessed for normality, and statistical comparisons were made between the heavy manual and low-impact groups using either an independent-samples t test or the Mann-Whitney U test. Of 230 male patients, 98 were included in the heavy manual occupation group, and 132 were included in the low-impact occupation group. Patients in the heavy manual occupation group were significantly younger than those in the low-impact occupation group (mean age, 24.1 vs 25.9 years, respectively; P < .005). There was a greater range of active and passive knee flexion in the heavy manual occupation group than in the low-impact occupation group (mean active, 3.38° vs 5.33°, respectively [P = .021]; mean passive, 2.76° vs 5.00°, respectively [P = .005]). There was no difference in effusion, anterior knee laxity, limb symmetry index, IKDC score, return-to-sport rate, or graft rupture rate at 12 months. At 12 months after primary ACLR, male patients engaged in heavy manual occupations had a greater range of knee flexion, with no difference in the effusion rate or anterior knee laxity, compared with those engaged in low-impact occupations.