Active Knee Flexion Research Articles

Effects of Elastic Band Exercise on Lower Limb Rehabilitation of Elderly Patients Undergoing Total Knee Arthroplasty.

The aim of the study was to investigate the effect of elastic band exercise activities on lower extremity rehabilitation in elderly patients subjected to an elastic band exercise intervention 2 and 4 weeks after total knee arthroplasty. A quasiexperimental study was conducted. Participants were recruited from southern Taiwan who were over 65 years old and had a first unilateral total knee arthroplasty for osteoarthritis. The control and experimental groups comprised 25 patients each. The control group received conventional treatment after total knee arthroplasty; by contrast, the experimental group engaged in elastic band exercise activities demonstrated by instructors, in addition to receiving conventional treatment. Effects of the lower extremity rehabilitation of the two groups were evaluated 2 and 4 weeks after total knee arthroplasty. Most of the participants were above 70 years of age, 17 of whom were in the control group (68%) and 16 in the experimental group (64%). The active and passive knee flexion angles of the experimental group were greater than those of the control group (p < .001) 2 and 4 weeks after surgery. The muscle strength of the quadriceps of the experimental group was higher than that of the control group (p < .001) 2 and 4 weeks after surgery. The experimental group exhibited significantly higher physical function than that of the control group 2 and 4 weeks after surgery (p < .001). The elastic band exercise program shows promising effects on improving the lower limb rehabilitation of elderly patients with total knee arthroplasty. Healthcare professionals who work with elderly patients with total knee arthroplasty may consider recommending and implementing the elastic band exercise program as a home rehabilitation method for this population. However, we recommend further testing of the long-term effects of this program on a larger population.

Manual Lymphatic Drainage Therapy in the Knee Joint Functional Rehabilitation After TKA in Diabetic Knee Osteoarthritis Patients: A Randomized Clinical Trial

To investigate the clinical effect of manual lymphatic drainage on functional rehabilitation of patients with diabetic knee osteoarthritis. A total of 199 patients with diabetic osteoarthritis who underwent total knee arthroplasty (TKA) were enrolled in the hospital and there were 72 males and 127 females in these patients. They were randomly divided into manual lymphatic drainage group (103 cases) and routine care group (96 cases). The manual lymphatic drainage group was treated with manual lymphatic drainage on the basis of routine functional rehabilitation nursing in March, while the routine nursing group only received perioperative nursing for conventional knee replacement. The patients with manual lymphatic drainage and routine nursing were studied before and 1 week, 1 month, 1 month, 3 months, and 6 months after operation to get the results of the changes of knee active flexion and extension, limb swelling degree, VAS pain score and preoperative group, the difference of HSS score and AKS score of knee joint in 6 months after operation. The active knee flexion activity of patients in the manual lymphatic drainage group was better than that of the routine care group (<i>P</i> < 0.05). The active knee extension and knee swelling were better in the manual lymphatic drainage group than that in the routine nursing group 1 week and 1 month after operation (<i>P</i> < 0.05); there was no significant difference in knee active activity and knee swelling between the two groups in March and June (<i>P</i> > 0.05); The scores of HSS in patients with manual lymphatic drainage in each stage after operation were better than that in the routine care group (<i>P</i> < 0.05). The AKS pain scores of the manual lymphatic drainage group were better than those of the routine care group (<i>P</i> < 0.05). There was no statistical difference (<i>P</i> > 0.05) in the AKS pain scores of the two groups in March and June. The AKS clinical score and AKS function score of patients in the manual lymphatic drainage group were better than that in the routine care group (<i>P</i> < 0.05). In general, manual lymphatic drainage treatment for patients with diabetes after total knee surgery can not only effectively alleviate postoperative knee swelling and pain but can also accelerate knee joint function recovery and improve postoperative satisfaction.

Influence of Patellar Tilt Angle in Merchant View on Postoperative Range of Motion in Posterior Cruciate Ligament-Substituting Fixed-Bearing Total Knee Arthroplasty.

BackgroundWe investigated whether the patellar tilt angle influences the maximum knee flexion after total knee arthroplasty (TKA) performed by using a posterior cruciate ligament-substituting (PS) fixed-bearing prosthesis in patients with relatively loose or tight flexion gap.MethodsIn this prospective cohort study, we followed up 169 patients for at least 2 years after TKA using PS fixed-bearing prosthesis. The patients were divided into two groups according to the flexion gap value—calculated by subtracting the thickness of the final bearing from the flexion gap measured intraoperatively under 200-cN·m force after patellar reduction and insertion of the final femoral and tibial components—into a relatively tight group (group T; 3–6.5 mm) and a relatively loose group (group L; 7–11 mm). Patellar tilt angles and maximum non–weight-bearing active knee flexion angles were assessed postoperatively. Group T was further divided into subgroup Tn if the patellar tilt angle was < 5° and subgroup Tw if the angle was ≥ 5°. Pearson correlation test was used for the correlation analysis of the flexion gap, patellar tilt angle, and postoperative flexion range.ResultsThe mean postoperative flexion was 137.3° in group T and 137.5° in group L. The mean patellar tilt angle was 6.5° in group T and 6.9° in group L. In group T, a strong negative correlation (r = −0.78, p < 0.05) was observed between the patellar tilt and postoperative flexion range. However, further analysis revealed that only the subgroup Tw showed a strong negative correlation (r = −0.76, p < 0.05). Significant correlations were not found in the subgroup Tn and group L.ConclusionsIn TKA where a relatively tight flexion gap (≤ 6.5 mm) is created because of concerns about postoperative flexion instability due to a loose flexion gap, the patellar tilt angle should be < 5° for maximal postoperative knee flexion.

The clinical effect of enhanced recovery after surgery to tibial plateau fractures patients applied arthroscopic minimally invasive treatment

Objective To explore and analyze the clinical effect of enhanced recovery after surgery to tibial plateau fractures patients applied arthroscopic minimally invasive treatment. Methods A total of 60 tibial plateau fractures patients were selected in our orthopedics department from January 2016 to July 2017 and who applied arthroscopic minimally invasive treatment, according to the last two-digit number of patient ID, divided them into observation group (n=30) and control group (n=30) randomly. The control group used regular perioperative strategies. The observation group used multidisciplinary cooperation fast track surgery idea, through preoperative assessment and education, nutrition and fasting, advance pre-rehabilitation and preventive analgesia; intraoperative optimization of anesthesia, body fluid management and body temperature control; postoperative nutritional support, multimodal analgesia, early ambulation and rehabilitation exercises, implied standardized and professional perioperative overall optimization management. The differences of the condition of 6 h, 12 h, 24 h after surgery, VAS score on discharge, time of first ambulation, active knee flexion 120° days; self-care ability at discharge and AKSS score one month after surgery between 2 groups were compared. Results The VAS scores 6 h, 12 h, 24 h after surgery and at discharge were 4.48±1.18, 3.81±1.68, 3.05±1.63, 2.65±1.65 in the observation group, and were 5.45±1.15, 4.15±1.05, 3.71±1.15, 3.23±1.68 in the control group. The differences were statistically significant (t= 0.796~0.902, P<0.05). The time of first ambulation, active knee flexion 120°days, self-care ability at discharge and AKSS scores one month after surgery were (5.61±1.4) hours, (4.01±1.1) days, 80.22±3.6, 71.89±6.56 and 64.13±6.15 in the observation group, and (35.8±8.1) hours, (6.82±1.6) days, 64.25±3.8, 63.45±8.36 and 60.95±8.98 in the control group. The differences were statistically significant (t=2.789~10.200, P<0.05). Conclusion Enhanced recovery after surgery to tibial plateau fractures patients applied arthroscopic minimally invasive treatment is worthy of being popularized as it’s beneficial to tibial plateau fractures patients. It can also fasten recovery and improve quality of life for postoperative patients. Key words: Enhanced recovery after surgery; Arthroscopy; Fracture of tibial plateau; Perioperative management

Stair Climbing and High Knee Flexion Activities in Bi-Cruciate Retaining Total Knee Arthroplasty: In Vivo Kinematics and Articular Contact Analysis

BackgroundBi-cruciate retaining (BCR) total knee arthroplasty (TKA) preserves both anterior and posterior cruciate ligaments with the potential to restore normal posterior femoral rollback and joint kinematics. However, there is limited information regarding articular contact behavior in the contemporary BCR TKA design during high knee flexion activities. This study aimed to investigate the articular knee contact performance in unilateral BCR TKA patients during strenuous flexion activities. MethodsTwenty-nine unilateral BCR TKA patients were evaluated for both knees during single deep lunges, step-ups, and sit-to-stand (STS) using a validated combined computer tomography and dual fluoroscopic imaging system. Medial and lateral condylar contact positions were quantified during weight-bearing flexion. ResultsContact excursions of the lateral condyle in BCR TKAs were significantly more anteriorly located than the contralateral non-operated knees during STS (−4.9 ± 3.1 vs −9.7 ± 4.6 mm, P < .05), single deep lunge (−5.7 ± 3.2 vs −10.0 ± 4.5 mm, P < .05), and step-ups (−4.8 ± 3.6 vs −9.1 ± 3.9 mm, P < .05). Contact points of BCR TKAs indicated reduced femoral external rotation during STS (2.1 ± 4.8° vs 7.7 ± 5.4°, P < .05), single deep lunges (1.8 ± 4.8° vs 7.0 ± 7.1°, P < .05), and step-ups (0.1 ± 4.1° vs 6.2 ± 4.9°, P < .05). Medial pivoting patterns were observed in only 59%, 56%, and 48% of the BCR TKA knees for step-ups, STS, and single deep lunge, respectively. ConclusionThe contemporary BCR TKA design demonstrated asymmetric femoral rollback, medial translation, as well as lateral pivoting in about half of the patient cohort, suggesting that in vivo tibiofemoral kinematic parameters were not fully restored in BCR patients during strenuous flexion activities.

Higher Quadriceps Roller Massage Forces Do Not Amplify Range-of-Motion Increases nor Impair Strength and Jump Performance.

Grabow, L, Young, JD, Alcock, LR, Quigley, PJ, Byrne, JM, Granacher, U, Škarabot, J, and Behm, DG. Higher quadriceps roller massage forces do not amplify range-of-motion increases nor impair strength and jump performance. J Strength Cond Res 32(11): 3059-3069, 2018-Roller massage (RM) has been reported to increase range of motion (ROM) without subsequent performance decrements. However, the effects of different rolling forces have not been examined. The purpose of this study was to compare the effects of sham (RMsham), moderate (RMmod), and high (RMhigh) RM forces, calculated relative to the individuals' pain perception, on ROM, strength, and jump parameters. Sixteen healthy individuals (27 ± 4 years) participated in this study. The intervention involved three 60-second quadriceps RM bouts with RMlow (3.9/10 ± 0.64 rating of perceived pain [RPP]), RMmod (6.2/10 ± 0.64 RPP), and RMhigh (8.2/10 ± 0.44 RPP) pain conditions, respectively. A within-subject design was used to assess dependent variables (active and passive knee flexion ROM, single-leg drop jump [DJ] height, DJ contact time, DJ performance index, maximum voluntary isometric contraction [MVIC] force, and force produced in the first 200 milliseconds [F200] of the knee extensors and flexors). A 2-way repeated measures analysis of variance showed a main effect of testing time in active (p < 0.001, d = 2.54) and passive (p < 0.001, d = 3.22) ROM. Independent of the RM forces, active and passive ROM increased by 7.0% (p = 0.03, d = 2.25) and 15.4% (p < 0.001, d = 3.73) from premeasure to postmeasure, respectively. Drop jump and MVIC parameters were unaffected from pretest to posttest (p > 0.05, d = 0.33-0.84). Roller massage can be efficiently used to increase ROM without substantial pain and without subsequent performance impairments.

Kinematically aligned total knee arthroplasty reproduces native patellofemoral biomechanics during deep knee flexion.

The implant positioning for kinematically aligned total knee arthroplasty (TKA) differs fundamentally from conventional mechanically aligned TKA. This difference may affect patellofemoral (PF) biomechanics after TKA. This cadaveric study tested the hypothesis that kinematically aligned TKA would restore PF biomechanics to the native condition better than mechanically aligned TKA. Seven pairs (14 knees) of fresh-frozen cadavers were tested. All specimens were mounted on a customized knee-testing system and digitized using a Microscribe 3DLX instrument (Revware Inc., Raleigh, NC, USA) to measure patellar kinematics in terms of patellar varus/valgus rotation, medial/lateral position, flexion/extension rotation and proximal/distal position at knee flexion angles of 0°, 30°, 60°, 90°, and 120°. The medial and lateral PF joint contact pressure distributions at 120° of knee flexion were measured using a K-scan system (Tekscan Inc., Boston, MA, USA). All patellae remained unresurfaced. For each pair, one knee was randomly assigned to kinematically aligned TKA and the other to mechanically aligned TKA performed using the conventional measured resection technique. During kinematically aligned TKA, the amount of femur and tibia resected was equivalent to implant thickness to maintain the patient-specific joint line. All patellar kinematics were measured and compared between the native condition and after surgery. The patellae of mechanically aligned TKA rotated more valgus and was positioned more laterally compared with those of kinematically aligned TKA at knee flexion angles ≥ 90°. Neither the patellar flexion/extension rotation nor the proximal/distal position differed between either prosthetic knee design and the native knee at all flexion angles. The contact pressure distribution between the medial and lateral PF joint after kinematically aligned TKA were similar to those of the native knee, while the lateral PF joint contact pressure after mechanically aligned TKA was higher than that of the native knee (p = 0.038). Kinematically aligned TKA better restores patellar kinematics and PF contact pressure distribution to the native condition than mechanically aligned TKA during deep knee flexion. These findings provide clues to understand why kinematically aligned TKA is associated with less anterior knee pain and better PF functional performance compared to mechanically aligned TKA. Patients undergoing kinematically aligned TKA may experience a more normal feeling during deep knee flexion activities.

Electroacupuncture Intervention Reduces Post-surgical Pain of Patients Undergoing Total Knee Arthroplasty

To observe the analgesic effect and safety of electroacupuncture (EA) intervention for patients undergoing total knee arthroplasty (TKA). A total of 40 patients undergoing TKA were randomly assigned to control group (simple multi-mode analgesia, n＝20) and EA group (EA combined with multi-mode analgesia, n＝20). Both groups were treated with epidural anesthesia during surgical operation, and conventional epidural automatic analgesia and oral Celecoxib after surgery. Following surgery, EA was applied to Liangqiu (ST 34)-Xuehai (SP 10), Yinlingquan (SP 9)-Zusanli (ST 36), Fenglong (ST 40)-Qiuxu(GB 40) on the operation side for 30 min, once daily for 7 consecutive days. The patients' pain state during rest and motion was assessed by using visual analogue scale (VAS). The active and passive knee flexion range of motion (ROM), use of painkillers including the number of patient's controlled epidural analgesia (PCEA) during 48 h after surgery, and other complications were recorded. After the treatment, the VAS scores under rest and motion state were both significantly lower in the EA group than in the control group on day 3, 5 and 7 after surgery (P<0.05). During 48 h after surgery, the number of PECA was significantly lower in the EA group than in the control group (P<0.05). Of the two 20 cases in the control and EA groups, 3 and 1 asked to receive muscular injection of Tramadol Hydrochloride for pain relief, 3 and 2 experienced nausea-vomiting, 2 and 1 had dizziness and headache, and 2 and 1 had a chest distress feeling, respectively, which had no significant differences between the two groups (P>0.05). The white blood cell (WBC) count in both groups were decreased gradually from day 1 to 7 after surgery, and plasma C-reactive protein content on day 5 and 7 were also lowered in both groups, without statistical differences between the two groups in the post-operative complications, dosages of additional postoperative analgesic drugs, and levels of plasma WBC and C-reactive protein (P>0.05). EA can effectively improve the early postoperative pain of TKA, reduce the incidence of postoperative complications and the use of analgesic drugs in TKA patients.

Acute effects of foam rolling on passive stiffness, stretch sensation, and fascial sliding: a randomized controlled trial

Abstract Purpose Foam Rolling (FR), aims to mimic the effects of manual therapy and tackle dysfunctions of the skeletal muscle and connective tissue. It has been shown to induce improvements in flexibility, but the underlying mechanisms are poorly understood. The aim of the present study was to further elucidate the acute, systemic and tissue-specific responses evoked by FR. Methods In a crossover study, 16 (34 ± 6y, 6f) participants received all of the following interventions in a random order: a) 2 × 60 seconds of FR at the anterior thigh, b) 2 × 60 seconds of passive static stretching of the anterior thigh (SS), and c) no intervention (CON). Maximal active and passive knee flexion range of motion (ROM), passive stiffness, sliding of fascial layers, as well as knee flexion angle of first subjectively perceived stretch sensation (FSS) were evaluated before and directly after each intervention. Results Flexibility increased only after, FR (active (+1.8 ± 1.9%) and passive ROM (+3.4 ± 2.7%), p = .006, respectively) and SS (passive ROM (+3.2 ± 3.5%), p = .002). Angle of FSS was altered following FR (+4.3° (95% CI: 1.4°–7.2°)) and SS (+6.7° (3.7°–9.6°)), while tissue stiffness remained unchanged after any intervention compared to baseline. Movement of the deepest layer (−5.7 mm (−11.3 mm to −0.1 mm)) as well as intrafascial sliding between deep and superficial layer (−4.9 mm (−9.mm to −0.7 mm)) decreased only after FR. Conclusion FR improved knee flexion ROM without altering passive stiffness, but modified the perception of stretch as well as the mobility of the deep layer of the fascia lata. The mechanisms leading to altered fascial sliding merit further investigation.

Representing fine-wire EMG with surface EMG in three thigh muscles during high knee flexion movements

Activation waveforms of vastus intermedius, adductor magnus, and semimembranosus have not been reported for high knee flexion activities such as kneeling or squatting, likely due to the invasive procedures required for their measurement. Their relatively large physiological cross sectional areas would suggest their contributions to knee joint loading could be considerable. Therefore, the purpose of this study was to quantify the activities of these muscles using fine-wire EMG and to assess easy to measure surface sites (vastus lateralis, rectus femoris, vastus medialis, semitendinosus, and biceps femoris) for their potential as proxy measures using <10 %MVC RMS and >0.85 R2 as criteria for successful representation of deep muscle activity by that measured at a surface site. Overall, no surface and fine-wire site pair met both criteria for these movements. When fine-wire measurement of muscle activity is infeasible or impractical, the waveforms presented in supplementary material could be used as a guide for the activity of these deep muscles. Although select muscles for some participants satisfied our criteria, inter-participant variability was considerable. Therefore, future muscle models may benefit from fine-wire measurement of these muscles, but researchers should be cautious of electrode site specificity.

Knee injuries in Rock climbing and Bouldering - An Update

Aims and Objectives: Rock climbing and bouldering is undergoing a worldwide “boom” and has recently been selected for the next Olympic summer games. Besides ground falls, an injury mechanism in this sport is the so-called heel hook position, which is used more frequently today due to changing training and competition modes, especially in indoor bouldering. With the rising number of knee injuries in climbing and bouldering, we now aimed to analyze this specific injury mechanisms and its underlying pathologies. Materials and Methods: Among 50 climbing athletes with unspecific knee pain, we identified 9 patients with injuries of the lower extremities after performing a heel hook. The outcome was evaluated at a minimum of 6 months after the injury and classified in a sport-specific score. After clinical examination and exclusion of the minor injuries we performed ultrasound and/or magnetic resonance imaging. Patients were treated conservatively with initial partial immobilization and early functional therapy with physiotherapy. Only one patient with a partial meniscus tear needed a surgical procedure. Results: All patients reported sudden dorsal-sided pain in the knee while performing the hook. Seven also reported hearing a snapping sound, similar to those reported in achilles tendon tears. Walking was difficult in all cases and all were limping. Five patients were diagnosed a strain of the lateral collateral ligament and two patients a lateral meniscus tear. The other patients had either a partial tear of the PCL, or a strain of the distal hamstring tendons. In 8 of 9 cases, we received “good” to “excellent” outcomes with a conservative approach. The popping sound at the time of injury may correspond to a change of the pivot of the tractus ileotibialis that then “jumps” over the condyle. While the hook is performed, there is frequently an active knee flexion involved, which thus changes the pivot of the tractus. Conclusion: In climbing and bouldering, injuries of the knee will further increase due to modern training and competition modes requiring the use of heel hooks. MRI shows the proper diagnosis and the proper therapeutic approach is conservative treatment. The outcome after heel hook injuries is good to excellent in most of the cases. Warm-up routine, an avoidance of muscular imbalances, and flexibility training can help to avoid injuries during heel hook.

Effects of gracilis tendon harvest on in vivo knee joint kinematics

Aims and Objectives: The gracilis tendon is a commonly used autologous tendon graft in orthopedic surgery (e.g. anterior cruciate ligament (ACL), medial patellofemoral ligament (MPFL) or chronic acromioclavicular joint (ACJ) reconstruction) but also for example in anal incontinence surgery for formation of a neosphincter. In previous studies the effects of gracilis tendon harvest were analyzed after ACL rupture, its reconstruction and rehabilitation. However, all of these three incidents influence the outcome. Thus, the purpose of the present study was to evaluate the effect of isolated gracilis tendon harvest from uninjured knees on knee kinematics during daily activities. Materials and Methods: Patients between 18 to 60 years with harvest of their gracilis tendon for reconstruction of the ACJ were included. Exclusion criteria were previous surgeries or injuries of their knees. Knee kinematics were evaluated during gait analysis using an infrared optical motion capture system with 10 cameras (T20 S cameras, Vicon, Oxford, United Kingdom) and reflective skin markers. A set of 59 markers was attached on anatomical landmarks of the patients’ lower extremities, pelvis, spine and shoulders with double-sided tape. The position of these markers was tracked at 120 Hz during the trials. Daily activities such as walking and running were performed. Additionally, kick-backs were performed to analyze maximal active knee flexion an important function of gracilis muscle. To quantify the tibiofemoral motion and reduce soft tissue artifacts, the OSSCA (OCST, SARA, and SCoRE combined approach) technique was used. (Boeth 2013) The D’Agostino&Pearson Test was used to test for a Gaussian distribution. For parametric data the dependent t-test, otherwise the Wilcoxon test was used. Results: Sixteen patients were evaluated. However, four had to be excluded after MRIs showed an accidental harvest of the semitendinosus tendon. The mean age was 43 years [standard deviation (SD) 13 years] and time to follow up was 44 months (SD 25). The affected limb showed an increased abduction of 1,38° (SD 4,05; p=0,31) during walking and 0,65° (SD 5,23; p=0,70) during running, as well as an increased rotational translation of 2,26 mm (SD 3,62; p=0,08) during walking and 1,38 mm (SD 3,27; p=0,21) during running. The mean anterior-posterior translation was larger for the healthy limb with 1,15 mm (SD=5,30; p=0,08) during walking and with 2,43 mm (SD=5,99; p=0,23) during running. A larger mean knee flexion angle was measured for the healthy limb during walking, running and kick-backs (mean difference during walking: 3,05°; SD=7,15; p=0,28; running: 2,39°; SD=7,34; p=0,33; kick-backs: 5,31°; SD=8,59; p=0,10). However, none of these results reached statistical significance. Conclusion: These results show that gracilis tendon harvest in healthy knees does not lead to altered knee kinematics. However, the small size of our cohort should be taken into consideration. These data support the use of the gracilis tendon as autologous graft for reconstructive surgery.

Excessive lateral patellar translation on axial computed tomography indicates positive patellar J sign.

The purpose of the study was to quantify the patellar J sign using traditional computed tomography (CT) scans. Fifty-three patients (fifty-three knees) who suffered from recurrent patellar instability were included and analyzed. The patellar J sign was evaluated pre-operatively during active knee flexion and extension. It was defined as positive when there was obvious lateral patellar translation, and negative when there was not. The CT scans were performed in all patients with full knee extension; and the parameters including bisect offset index (BOI), patellar-trochlear-groove (PTG) distance, and patellar lateral tilt angle (PLTA) were measured on the axial slices. All the three parameters were compared between the J sign-positive group (study group) and the J sign-negative group (control group). In addition, the optimal thresholds of the three CT scan parameters for predicting the positive patellar J sign were determined with receiver operating characteristic (ROC) curves, and the diagnostic values were assessed by the area under the curve (AUC). Among the fifty-three patients (fifty-three knees), thirty-seven (70%) showed obvious lateral patellar translation, which were defined as positive J sign (study group), and the remaining sixteen (30%) who showed no lateral translation were defined as negative J sign (control group). The mean values of the three CT parameters in the study group were all significantly larger compared to the control group, including BOI (121 ± 28% vs 88 ± 12%, P = 0.038), PTG distance (5.2 ± 6.6mm vs -4.4 ± 5.2mm, P<0.05), and PLTA (34.9 ± 10.5° vs 25.7 ± 3.4°, P = 0.001). Furthermore, the evaluation of ROC analysis showed that the AUC of BOI was the largest (AUC = 0.906) among the three parameters, and the optimal threshold of BOI to predict the positive patellar J sign was 97.5% (Sensitivity = 83.3%, Specificity = 87.5%). In this study, the prevalence of positive patellar J sign was 70%. The BOI measured from the axial CT scans of the knee joint can be used as an appropriate predictor to differentiate the positive J sign from the negative J sign, highlighting that the excessive lateral patellar translation on axial CT scan indicates positive patellar J sign. IV.

Unsatisfactory clinical outcomes of second-generation mobile bearing floating platform total knee arthroplasty: comparing outcomes with fixed bearing after five years minimum

The purpose of this retrospective study was to analyze and compare the clinical and radiologic outcomes of fixed bearing ultracongruent (UC) insert total knee arthroplasty (TKA) and mobile bearing (MB) floating platform TKA using the navigation-assisted gap balancing technique with a minimum follow-up of fiveyears. The study retrospectively enrolled 105 patients who received the UC type fixed bearing insert (group 1) and 95 patients who received the floating platform MB insert (group 2) during the period from August 2009 to June 2012. All surgery was performed using the navigation-assisted gap balancing technique. For strict assessment of gap measurements, the offset-type-force-controlled-spreader-system was used. Radiologic and clinical outcomes were assessed before operation and at the most recent follow-up using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. For statistical analysis, paired sample t tests were used. A p value less than 0.05 was considered significant. Although the radiologic alignments were satisfactory for both groups (99/105 [94%] cases were neutral for group 1 and 90/95 [94%] for group 2), the functional and total WOMAC scores were inferior in group 2 (p < 0.05). There were two cases of insert breakage in group 2 that required bearing exchange. The Kaplan-Meier survivorship rates for groups 1 and 2 at 77months were 100.0 and 97.9%, respectively. Second-generation MB floating platform TKA cases did not have satisfactory outcomes. There were two cases of insert breakage, which required bearing exchange. Other patients who underwent surgery with second-generation MB floating platform were encouraged to avoid high knee flexion activities, resulting in lower clinical performance.

The Effects of Active Stretching Exercise on Passive Stiffness of Rectus Femoris Muscle and Low Back Pain in Patients with Lumbar Extension Rotation Syndrome

Background A previous literature suggested that increased passive stiffness of rectus femoris muscle (RF) can cause compensatory lumbopelvic motion in sagittal plane or transverse plane during active knee flexion in patients with lumbar extension rotation syndrome (L-ext &amp; rot syn), resulting low back pain. Purpose The purpose of this study was to investigate the effects of active stretching exercise of RF during 6-week on passive muscle stiffness of RF and low back pain in patients with L-ext &amp; rot syn. Study design Pre/post-test design. Methods Twenty patients with L-ext &amp; rot syn were recruited for this study. Passive RF stiffness was measured in pre- and post-stretching period using specially designed motorized pulling machine. Subjective stretch sensation and intensity of low back pain were measured using numeric rating scale. The subjects performed the active RF stretching exercise during 6-week. The significance of the difference between pre- and post-stretching exercises was assessed using repeated one-way analysis of variance. Results Passive RF stiffness and stretch sensation after RF stretching exercise was significantly reduced in subjects with L-ext &amp; rot syn. However, pain intensity of low back during daily activity showed no significant difference between before and after stretching exercise. Conclusions Active RF stretching exercise during 6-week can decrease RF stiffness, but failed to decrease pain intensity of low back during daily activity in patients with L-ext &amp; rot syn.

Ultrasonography and return to play of the different clinical grading of quadriceps contusions: a case series.

Prognostication of quadriceps contusion is based on the patient's active knee flexion after the injury. Unlike ultrasonography, clinical grading does not define the extent of soft tissue injury and may provide inaccurate time for return to play. The purposes of this report are to describe the ultrasound findings of the different clinical grading of quadriceps contusion and document the return to play of each case. Seven patients were evaluated in this series. Results showed discrepancies in the disability time between clinical grading and ultrasound findings. Clinical grading did not consistently estimate the return to play as described in previously published literature. Contusions with hyperechoic lesions had earlier return to play compared to patients with hypoechoic findings. Contusions with hypoechoic lesions might require aggressive monitoring and therapy to decrease disability time and avoid complications such as myositis ossificans.

Guided self-rehabilitation and ambulation capacities in spastic paresis: Stretching postures vs. neuronal training vs. combined program. A randomized study

In chronic spastic paresis, intensity in rehabilitation programs leads to possible improvements in patients walking capacities. However, the implementation of intensive rehabilitation is limited by time and financial constraints of conventional physiotherapy programs. Thus, the use Guided Self-Rehabilitation Contract (GSC) programs makes it possible to overcome these disadvantages. GSC have proven their impact on functional activities using two rehabilitation technics: prolonged static stretch postures and motor training with fast alternating movements of maximal amplitude. The objective of this study was to compare the effects of 3 programs using GSC during 2 months on ambulation capacities in chronic spastic paresis: a program with prolonged static stretch postures, a motor training program with fast alternating movements of maximal amplitude and a combined program with prolonged static stretch postures and fast alternating movements of maximal amplitude. Eleven patients with spastic hemiparesis were included in this prospective randomized simple-blinded study from January to June 2016. They had no botulinum toxin injection in the last 2 months. Each patient followed a 60-minutes working per day program using GSC for 2 months targeting the antagonists of active ankle dorsiflexion, knee flexion and hip flexion in the stretching group, the training group or the combined group. The primary outcome was the comparison of the maximal speed barefoot in the 10-meter ambulation test at D-15 and D60. The median daily working duration was 39 ± 18 minutes. No difference was found between groups on the maximal speed barefoot on the 10-meter ambulation test after 2 months of programs using GSC. The whole population increased its maximal speed barefoot on the 10-meter ambulation test (from 0.89 ± 0.38 m/s to 0.99 ± 0.43 m/s; P = 0.006, Wilcoxon). The combined group and the training group increased their maximal speed on the 10-meter ambulation test barefoot by 16%, contrary to the stretching group which increased its maximal speed only by 5%. No difference between the 3 programs was found although tendencies seems to be in favor of the combined group. A larger prospective study should be planned in order to confirm these tendencies.

Effect of continuous adductor canal or femoral nerve block on pain relief and early rehabilitation following total knee arthroplasty

Objective To compare the analgesic effect of continuous adductor canal block(ACB) and continuous femoral nerve block(FNB) after total knee arthroplasty(TKA). Methods Sixty patients scheduled for unilateral TKA were randomly assigned into two groups, receiving continuous ACB(group A) or continuous FNB(group F). Intravenous anesthesia was applied throughout the operation. The adductor canal and the femoral nerve were catheterized for block under the guidance of sonography before induction of general anesthesia. Patient-controlled analgesia was provided immediately after surgery with 0.2% ropivacaine through the perineural catheter. The pain severity at rest and upon movement (passive knee flexion of 45 degrees) with a 0-10 numeric rating scale (NRS), the Lovett score of muscle strength of the quadriceps femoris, and the modified Bromage score of the motor block of the affected extremity were assessed 4, 8, 12, 24, 48 h after surgery. The maximal range of active/passive motion of the knee joint was recorded 1, 2, 3, 14 d after surgery. The number of effective patient-controlled bolus of ropivacaine and the number of need for opioid rescue within 48 h after surgery, the first time of out-of-bed activity, the time of active knee flexion reaching 90 degrees, and the hospital for special surgery(HSS) score of knee function 14 d after surgery were also recorded. Results There was no difference between group A and group F in terms of the NRS scores at rest and upon movement, the number of effective patient-controlled bolus of ropivacaine and the number of need for opioid rescue (P>0.05). Patients in group A had a higher Lovett score of muscle strength of the quadriceps femoris and a lower modified Bromage score of the motor block than those in group F within 12 h after surgery (P 0.05). Conclusions An equal postoperative analgesic efficacy was observed in patients receiving continuous ACB and continuous FNB. Furthermore, continuous ACB did not provide a superior effect on early rehabilitation than continuous FNB. Key words: Adductor canal block; Femoral nerve block; Total knee arthroplasty; Postoperative analgesia; Rehabilitation

Posterior Cruciate Ligament Injuries Associated With Military Survival Swim Training.

Posterior cruciate ligament (PCL) injuries are relatively common injuries associated with athletic activities and high-energy trauma. Posterolateral corner (PLC) injuries frequently accompany injury to the PCL. Diagnosis can be challenging and requires a comprehensive history and physical examination. Patients frequently report vague, nonspecific symptoms and the mechanism of injury is often useful in localizing injured structures. Two of the more common mechanisms for PCL injury include a direct blow to the proximal anterior tibia with the knee flexed, as well as a significant knee hyperextension injury. With a PCL tear, patients rarely describe an audible "pop" that is commonly reported in ACL injuries. On physical exam, a frequent finding in PCL tears is a loss of 10 to 20° of knee flexion. Although the most common clinical tests for PCL tears include the posterior drawer test, the posterior sag sign, and the quadriceps active test, there is a lack of high-quality diagnostic accuracy studies. Two cases of U.S. Military Academy Cadets who sustained PCL injuries while removing combat boots during military survival swim training are presented. The results of the clinical examination are accompanied by magnetic resonance imaging results and intraoperative arthroscopic images to highlight key findings. Both patients were evaluated and diagnosed with PCL injures within 10 days of their injuries. Each reported feeling/hearing a "pop," which is atypical in PCL tears. Both patients demonstrated a lack of active and passive knee flexion, which is a commonly reported impairment. One patient was managed nonsurgically with physical therapy and eventually returned to full duty without limitations 9 months after his injury. The other patient, who sustained a combined PCL-PLC injury, underwent a PCL reconstruction and PLC repair and reconstruction 8 weeks after his injury. He returned all training, with the exception of contact/collision sports, 9 months after surgery. Both patient's rehabilitation programs consisted of a progression of exercises to improve range of motion, muscle strength/endurance, motor control, and muscular power. Military and sports medicine professionals should be aware of the potential for PCL injury with this unusual, and previously unreported, mechanism of injury during survival swim training. Prompt diagnosis and appropriate treatment is essential to prevent long-term disability.

Short-term effects of mobilisation with movement in patients with post-traumatic stiffness of the knee joint

BackgroundMobilisation with movement treatment techniques have been used to increase the range of motion following pathologies associated with shoulder, elbow and ankle joints. Lack of posterior tibial glide and reflex muscle inhibition are common physical impairments in individuals with post-traumatic stiffness of the knee joint. Current evidence is lacking for the benefits of mobilisation with movement treatment techniques for the knee joint disorders. ObjectiveThe purpose of this study was to investigate the short-term effects of mobilisation with movement techniques following post-traumatic stiffness of the knee joint. MethodsTwenty consecutive patients with post-traumatic stiffness of the knee joint with a minimum available 80° knee flexion range of motion were included. One group pre-to-post-test study design was employed, in which the active knee flexion range of motion was used as an outcome measure. The mobilisation with movement treatment techniques was implemented with three sets of ten repetitions on each treatment occasion for a period of 3 days. ResultsThe mobilisation with movement treatment techniques significantly improved the active knee flexion range of motion (p = 0.000) from pre-treatment to post-treatment. ConclusionsThe findings from this study demonstrated immediate benefits in outcomes following mobilisation with movement treatment techniques in a cohort of patients with post-traumatic stiffness of the knee joint.