Knee Joint Range Of Motion Research Articles

Influence of pain quality on physical performance in subjects with osteoarthritis of knee

Objectives Neuropathic pain features are frequently observed in subjects with knee osteoarthritis, which reduces their physical performance. This study was done to compare the physical performance between the subjects with neuropathic and nociceptive pain features. In addition, to assess the relationship between pain quality and physical performance in subjects with osteoarthritis of the knee. Methods Eighty subjects, ranging from 40 − 70 years of both genders with symptomatic and radiologically verified unilateral knee osteoarthritis (OA) were included for the study. Before having them in the study, all the subjects completed baseline interviews and demographic data. The subjects were categorized under neuropathic and nociceptive groups using Pain Detect Questionnaire (PDQ). One-time measurement of pain intensity, isometric strength of Quadriceps & hamstrings, and knee joint range of motion were assessed in both groups. Physical performance was measured using Osteoarthritis Research Society International recommended physical performance tests for knee osteoarthritis (40 m Fast Paced Walk Test, 6 min walk test, 30 s chair stand test, Timed up and Go Test, Stair Climb Test) and OA knee-related disability using Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Results Of the eighty subjects, forty subjects were included in the neuropathic group (44%), forty in the nociceptive group based on PDQ. Physical performance (p < 0.05) was significantly reduced in the neuropathic group. There existed a weak negative correlation between pain quality and variables measured (p < 0.05). Conclusion Physical performance was significantly reduced in OA knee subjects with neuropathic pain features. There is a negative correlation between pain quality and most of the physical performance variables.

Effectiveness analysis of lateral condyle sliding osteotomy in total knee arthroplasty for the treatment of lateral femoral bowing deformity

To investigate the effectiveness of lateral condyle sliding osteotomy (LCSO) in total knee arthroplasty (TKA) for the treatment of lateral femoral bowing deformity. The clinical data of 17 patients with lateral femoral bowing deformity treated by LCSO during TKA between July 2018 and July 2020 was retrospectively analysed. There were 3 males and 14 females, with an average of 63.2 years (range, 58-68 years). The etiology of lateral femoral bowing deformity included 12 cases of femoral developmental deformity and 5 cases of femoral fracture malunion. Kellgren-Lawrence classification of knee osteoarthritis was 4 cases of grade Ⅲ and 13 cases of grade Ⅳ. The preoperative hip-knee shaft was 9.5°-12.5° (mean, 10.94°). The disease duration was 3-25 years (mean, 15.1 years). The mechanical lateral distal femur angle (mLDFA), hip-knee-ankle angle (HKA), and mechanical axis deviation (MAD) of the distal femur were measured before operation and at last follow-up to evaluate the correction of extra-articular deformities in the joints and the recovery of mechanical force lines of the lower extremities. The knee society score (KSS) knee score and function score, visual analogue scale (VAS) score, knee joint range of motion (ROM) were used to evaluate effectiveness. The knee varus/valgus stress test and osteotomy healing by X-ray films were performed to evaluate the joint stability and the safety of LCSO. All incisions of the patients healed by first intention after operation, and there was no early postoperative complication such as infection of the incision and deep vein thrombosis of the lower extremities. All 17 patients were followed up 12-36 months, with an average of 23.9 months. The osteotomy slices all achieved bony healing, and the healing time was 2-5 months, with an average of 3.1 months. After operation, the knee varus/valgus stress tests were negative, and there was no relaxation and rupture of the lateral collateral ligament, instability of the knee joint, loosening, revision and infection of the prosthesis occurred. At last follow-up, mLDFA, HKA, MAD, knee ROM, VAS score, KSS knee score and function score significantly improved when compared with preoperative ones ( P<0.05). LCSO is effective and safe in TKA with lateral femoral bowing deformity. Extra-articular deformities are corrected intra-articularly. The mechanical force line and joint balance of the lower extremities can be restored simultaneously in an operation.

Drop Jumping on Sand Is Characterized by Lower Power, Higher Rate of Force Development and Larger Knee Joint Range of Motion.

Plyometric training on sand is suggested to result in advanced performance in vertical jumping. However, limited information exists concerning the biomechanics of drop jumps (DJ) on sand. The purpose of the study was to compare the biomechanical parameters of DJs executed on rigid (RIGID) and sand (SAND) surface. Sixteen high level male beach-volleyball players executed DJ from 40 cm on RIGID and SAND. Force- and video-recordings were analyzed to extract the kinetic and kinematic parameters of the DJ. Results of paired-samples t-tests revealed that DJ on SAND had significantly (p < 0.05) lower jumping height, peak vertical ground reaction force, power, peak leg stiffness and peak ankle flexion angular velocity than RIGID. In addition, DJ on SAND was characterized by significantly (p < 0.05) larger rate of force development and knee joint flexion in the downward phase. No differences (p > 0.05) were observed for the temporal parameters. The compliance of SAND decreases the efficiency of the mechanisms involved in the optimization of DJ performance. Nevertheless, SAND comprises an exercise surface with less loading during the eccentric phase of the DJ, thus it can be considered as a surface that can offer injury prevention under demands for large energy expenditure.

Reliability of Measuring Leg Segments and Joint Angles Using Smartphones during Aquatic Exercise.

ObjectivesAquatic therapy is a significant intervention method for both patients and healthy individuals. However, in clinical practice, quantitative measurements are rarely applied in aquatic therapy due to the disadvantages of submerging expensive instruments in water. In this study, we used readily available smartphones and armbands to measure leg segments and joint angles during aquatic gait and evaluated the reliability of these measurements.MethodsWaterproof smartphones were strapped to the trunk, thighs, and shanks of 19 healthy young adults using armbands. The angles of the trunk, thigh, and shank segments were measured during aquatic gait. The measurements were repeated 1 day later. The data were analyzed to obtain the angles of the hip and knee joints.ResultsMeasurement repeatability, calculated using the intraclass correlation coefficient (ICC), was the highest for the shank segment range of motion (ROM) (first 46.79° ± 5.50°, second 50.12° ± 9.98°, ICC = 0.78). There was high agreement in trunk segment ROM (first 6.36° ± 1.42°, second 4.29° ± 1.83°, ICC = 0.73), thigh segment ROM (first 33.49° ± 5.18°, second 37.31° ± 8.70°, ICC = 0.62), and knee joint ROM (first 52.43° ± 11.26°, second 62.19° ± 16.65°, ICC = 0.68) and fair agreement in hip joint ROM (first 34.60°±4.71°, second 37.80° ± 7.84°, ICC = 0.59).ConclusionsSmartphones can be used to reliably measure leg segments and joint angles during aquatic gait, providing a simpler method for obtaining these measurements and enabling the wider use of aquatic motion analysis in clinical practice and research.

Modified Pulvertaft on Weave Technique Restores Full Active Knee Extension in Patients With Large Chronic Quadriceps Tendon Rupture: A Case Series

We aimed to investigate the clinical and functional outcomes, including maximal and explosive strength, after chronic quadriceps tendon rupture repair with Modified Pulvertaft on Weave (MPW) technique METHODS: Knee joint range of motion (ROM), patella height, thigh circumference, and Lysholm and International Knee Documentation Committee (IKDC) scores were assessed preoperatively and postoperatively. The knee extensors maximal (isokinetic peak torque and isometric maximal voluntary contraction (MVC) torque) and explosive strength-rate of torque development (RTD) early [RTD50 and RTD100] and late [RTD250]-were performed. We assessed the thigh circumference and vastus lateralis muscle thickness (MT) as indicators of quadriceps muscle mass, and the voluntary quadriceps activation using surface electromyography (EMG50). Nine patients (mean age: 53 ± 11 years) took part in the study. We observed a significant increase in the knee active ROM and a decreased extension deficit (both, P < .001), but not for pain (P= .07), IKDC (P= .07), and Lysholm (P= .21) after the surgery. We did not observe a difference between involved (n= 8) and uninvolved (n= 10) limbs for ROM, thigh circumference, and MT. We observed differences for extensors peak torque, MVC torque, and late RTD (all, P < .05). However, we did not observe differences for early RTD and EMG50. Significant positive correlations were observed for RTD50 (ρ= .80) and RTD100 (ρ= .81) vs EMG50. Both the IKDC and Lysholm were better correlated with the early than with later RTD. The MPW reestablished the active knee extension. The same level of quadriceps muscle mass was observed in both limbs, suggesting a lack of hypotrophy due to the injury. Although the involved limb had demonstrated lower knee extensors maximal strength, they demonstrate an equivalent early RTD when compared to the uninvolved limb. The early RTD seems to be better correlated with the patient's functionality than the later RTD and maximal strength. IV, case series.

Comparison of the Lower Extremity Kinematics and Center of Mass Variations in Sit-to-Stand and Stand-to-Sit Movements of Older Fallers and Nonfallers

ObjectiveTo compare the differences in sit-to-stand and stand-to-sit movements of older nonfalling males and older male fallers (also referred to herein as fallers) to contribute to the development of posture transfer–assisting devices or interventional therapies to prevent falls. DesignControlled study. SettingUniversity research laboratory. ParticipantsTen older men (mean age, 75.9±5.4 years) who had fallen or been unstable at least once in the past year and 10 nonfalling older men (mean age, 70.0±5.0 years) participated in this study. InterventionsNot applicable. Main Outcome MeasuresMovement duration; sagittal trunk, hip, knee, and ankle joint range of motion (ROM); anteroposterior and mediolateral (ML) center of mass (COM) total trajectory. ResultsDuring the sit-to-stand transition, fallers exhibited greater trunk joint ROM in the flexion and extension phase and smaller hip joint ROM in the extension phase as well as greater ML COM total trajectory. During stand-to-sit, older fallers exhibited greater trunk joint ROM in the flexion phase and smaller hip and knee joint ROM in the flexion phase as well as greater ML COM total trajectory. Older fallers took more time to perform the stand-to-sit and had greater ML COM total trajectory during the movement; additionally, they exhibited different proportional distributions of ROM for each joint compared with nonfaller. ConclusionOlder fallers had more difficulty performing stand-to-sit than sit-to-stand; they exhibited more body sway in COM motion and, in particular, were unable to control ML motion y. Older fallers were more likely to adopt trunk, hip, and knee joint flexion strategies to maintain balance during sit-to-stand and stand-to-sit than nonfaller participants were.

META analysis of mobile bearing and fixed bearing unicondyle replacement for medial knee osteoarthritis

To evaluate of the clinical effects of mobile-bearing(MB) and fixed-bearing(FB) unicompartmental knee arthroplasty(UKA) in the treatment of knee osteoarthritis by Meta-analysis. The literature on FB UKA and MB UKA in the treatment of knee osteoarthritis in PubMed, CNKI, Wanfang, Cochrane and EMBASE database were searched by computer from January 2000 to April 2020. According to the inclusion and exclusion criteria, two authors were selected independently and the selected literature was evaluated for quality.After literature data were extracted, Review Manager 5.3 software was used to analyze knee function score, postoperative activity, revision rate, polyethylene wear rate, pad dislocation, aseptic loosening, postoperative pain, knee arthritis progression, mechanical shaft alignment of lower limbs, and imaging clarity line respectively. A total of 13 literatures were included in this meta-analysis, including 2 randomized controlled studies and 11 cohort studies. A total of 1 871 patients were included, including 913 in FB UKA group and 958 in MB UKA group. Meta analysis results showed that:postoperative knee joint function score[MD=-0.84, 95%CI(-1.46, -0.21), P=0.008] and postoperative knee joint range of motion [MD=-1.51, 95%CI(-2.84, -0.18), P=0.03] in FB UKA group were better than those in MB UKA group. Compared with FB UKA group, MB UKA group had a higher lower limb mechanical axis alignment rate[OR=2.08, 95%CI(1.27, 3.39), P=0.003], and the wear rate of polyethylene [OR=0.11, 95%CI(0.01, 0.91), P=0.04] was lower. There were no differences between two groups in the renovation rate [OR=1.16, 95%CI(0.75, 1.80), P=0.50), liner dislocation rate[OR=3.78, 95%CI(0.93, 15.29), P=0.06], aseptic loosening [OR=2.11, 95%CI(0.81, 5.51), P=0.13], postoperative pain[OR=1.13, 95%CI(0.37, 3.43), P=0.83], osteoarthritis progression[OR=1.28, 95%CI(0.67, 2.47), P=0.46)and imaging radiolucent line[OR=1.62, 95%CI(0.09, 30.22), P=0.75]. FB UKA has a higher postoperative functional score and range of motion.MB UKA has more advantages in the correction of lower limb mechanical axis, and the wear rate of polyethylene is also lower. There was no significant difference between the two groups in revision rate, dislocation of the liner, aseptic loosening, postoperative pain, progression of osteoarthritis, and postoperative translucency.

Physical Therapy Following Saucerisation of Discoid Meniscus – a Case Study

Introduction: Discoid meniscus is a structure with altered shape, which causes it to frequently undergo injuries and lesions. Pain, limping, limited range of motion of the knee joint and swelling are characteristic signs of this pathology. Therapeutic possibilities include meniscectomy and saucerisation. Research objective: The study aim was assessment of the therapeutic effectiveness in a patient after saucerisation of discoid meniscus. Material and methods: A 12-year-old female patient after saucerisation of lower left limb lateral discoid meniscus (type I) was subjected to 32-week physical therapy treatment. Testing included determining the range of knee joint flexion and extension movements, as well as measuring the circumference of the lower extremities 15 cm above the patella. The Kujala Score (Anterior Knee Pain Scale) and Ikeuchi grading system were employed during the 1st, 3rd, 8th, 21st and 32nd weeks postoperatively. Results: In the final stage of physical therapy, complete range of knee joint motion was achieved, the Kujala Scale score totalled 98 points and the thigh circumference of the operated limb increased by 4 cm. The circumferences of the lower extremities differed by 2 cm in the final phase of physical therapy. Conclusions: The employed postoperative protocol effectively influenced the functional state of the patient.

Preoperative Factors Affecting Patient-reported Outcome Measures for Total Knee Arthroplasty.

ABSTRACTObjectives:The aim of this study was to investigate the preoperative factors affecting health-related quality of life (HRQOL) at 3 and 12 months after total knee arthroplasty (TKA).Methods:In total, 156 patients who underwent unilateral TKA for knee osteoarthritis were included in the study. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as a measure of HRQOL before surgery and 3 and 12 months post-TKA. The Modified Gait Efficacy Scale (mGES) score, tibiofemoral angle, rest pain, walking pain, knee joint range of motion, knee joint extensor strength, and walking speed were recorded preoperatively. Pearson’s correlation coefficient and the correlation ratio were used to calculate the correlation between KOOS and preoperative factors at 3 and 12 months post-TKA. Multiple regression analysis was performed using the stepwise method with the five postoperative KOOS subscales as dependent variables and the other preoperative factors as independent variables.Results:Preoperative mGES scores were significantly correlated with KOOS Activities of Daily Living, Sport/Rec, and QOL subscores at 3 months post-TKA and with all five KOOS subscales at 12 months post-TKA. Multiple regression analysis identified mGES as an influencing factor for all KOOS subscales except Pain at 3 months post-TKA and all KOOS subscales except Symptoms at 12 months post-TKA.Conclusions:Preoperative walking self-efficacy influenced HRQOL at 3 and 12 months post-TKA. Psychological factors such as self-efficacy should be considered when predicting postoperative outcomes.

Correlations between Functional Movement Screening (FMS) Results and the Range of Motion of Lower Limb Joints Young Middle Distance Runners

Background: The relationship between range of motion (ROM) in lower limb joints and Functional movement screen still not clear. The aim of this study was therefore to investigate the correlation between Functional Movement Screening (FMS) results and ROM in lower limb joints. Methods: Forty-eight young middle distance runners (26 men and 22 women) performed an FMS test and a ROM test of the lower limb joints. Nonparametric testing was used to compare the ROM of left and right lower extremities, an independent-sample T-test was used to compare FMS test scores between left and right sides, and Spearman correlation was used to analyze relationships between FMS test results and ROM of lower limb joints. Results: A negative correlation was observed between left hurdle step and ROM of right knee flexion (r = –0.435, p &lt; 0.05), while a positive correlation was observed between right hurdle step and ROM of right ankle flexion (r = 0.392, p &lt; 0.05). A negative correlation was observed between left in-line lunge and ROM of left knee flexion (r = –0.508, p &lt; 0.05), while a positive correlation was observed between right in-line lunge and ROM of right hip extension (r = 0.445, p &lt; 0.05). A positive correlation was observed between left active straight-leg-raise and ROM of left hip flexion (r = 0.464, p &lt; 0.05), and a positive correlation between right rotary stability and ROM of right ankle extension (r = 0.393, p &lt; 0.05). The trunk-stability push-up and ROM of left ankle flexion was negatively correlated (r = –0.446, p &lt; 0.01). Conclusions: FMS test results were significantly correlated with ROM of hip, knee and ankle joints on the sagittal plane, with differences observed between the left and right sides. The ROM of flexion, extension of hip and extension of ankle were positively correlated with the FMS test results, while larger knee flexion and ankle flexion ROM were negatively correlated with FMS test results. We propose that excessive ROM of the knee and ankle could affect the development of stability. The results of this study should help to further our understanding of FMS.

Single versus double plating for bicondylar tibia plateau fractures: Comparison of range of motion, muscle strength, clinical outcomes and accelerometer-measured physical activity levels

BackgroundOptimal treatment of bicondylar plateau fractures is still a matter of debate. Accelerometer-measured physical activity levels may help us to obtain objective information regarding the quality of life of patients. The aim of this study was to compare the physical activity levels, objective and subjective functional results and stabilities of fixations of patients with treated bicondylar plateau fractures. MethodsIn this cross-sectional study of 23 patients, accelerometer-measured physical activity levels, daily energy consumption and measurements of knee joint range of motion (ROM) and muscle strength were measured. While Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as a patient-reported outcome measurement, Rasmussen Radiological Score was used for radiological evaluation. ResultsThere was no significant difference between the groups in terms of physical activity levels and daily energy consumption (P = 0.667). While Total KOOS, Symptom and Stiffness and Sports Activities scores were higher in patients with a single plate (P = 0.034, P = 0.003 and P = 0.014, respectively), knee flexion and extension ROM and flexor and extensor muscle strength were similar between groups (P = 0.405, P = 0.095, P = 0.982 and P = 0.988, respectively). ConclusionsWhile patient-reported outcome measurements were better with single plating, there was no difference between the groups in terms of physical activity levels, ROM, muscle strength and radiological results. Although it should be kept in mind that the choice of the primary surgeon, the condition of the soft tissue and the fracture geometry are also effective in the decision-making process, single plating seems to be a valid surgical option in the treatment of bicondylar plateau fractures.

Effects of a Single Session of Floss Band Intervention on Flexibility of Thigh, Knee Joint Proprioception, Muscle Force Output, and Dynamic Balance in Young Adults

The floss band (FB) has been correlated with increases in the joint range of motion (ROM). However, the literature on FB effectiveness in knee joint ROM and athletic performance remains sparse. This study investigated the effects of FB on the flexibility of the quadriceps and hamstrings, knee joint proprioception, muscle force output, and dynamic balance in men. Thirty recreationally active men without musculoskeletal disorders were randomized to receive FB (Lime Green; Sanctband flossband) and elastic bandage (EB) intervention on the dominant knee joint. Participants received two interventions on two occasions with 2 days of rest between interventions. The primary outcome was the flexibility of the quadriceps and hamstrings; the secondary outcomes were knee proprioception (joint reposition angle error), knee muscle force output, and dynamic balance. Preintervention and postintervention (immediately following band removal and 20 min later) measurements were obtained. After FB intervention, hamstring flexibility (immediately: p &lt; 0.001; 20 min later: p &lt; 0.001) and quadriceps flexibility (immediately: p &lt; 0.001; 20 min later: p &lt; 0.001), quadriceps muscle force output (immediately: p = 0.007; 20 min later: p &lt; 0.001), and dynamic balance (both immediately and 20 min later, p &lt; 0.001) were significantly improved. Compared with EB intervention, FB intervention significantly improved knee extension ROM (immediately and 20 min later, both p &lt; 0.001), knee flexion ROM (immediately, p = 0.01; 20 min later, p = 0.03), hamstrings muscle force output (20 min later, p = 0.022) and dynamic balance (immediately, p = 0.016; 20 min later, p = 0.004). Regarding proprioception, no significant difference among time points and conditions was observed. In conclusion, FB intervention can significantly improve the flexibility of the quadriceps and hamstrings, quadriceps muscle force output, and dynamic balance without impeding knee proprioception. Physiotherapists or athletic professionals may consider FB intervention as a potential tool as a warmup to enhance the flexibility of the quadriceps and hamstrings, quadriceps muscle force output, and dynamic balance in young adults.

ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline.

Anterior cruciate ligament (ACL) reconstruction (ACLR) and postoperative rehabilitation continues to be a multidisciplinary focus in both research and clinical environments. Recent research on ACLR warrants a reexamination of clinicians' current rehabilitation practices to optimize the strikingly variable clinical outcomes after ACLR and return to sport. The purpose of the article and updated guidelines is to use contemporary evidence to systematically revisit our practice guidelines and validate our clinical milestones with data from our university-based practice. Using the PubMed search engine, articles that reported on ACLR rehabilitation and protocols, guidelines, graft type, healing and strain, return to sport, psychological considerations, and secondary injury prevention published from 1979 to 2020 were identified using the search terms ACLR protocols, guidelines, ACLR rehabilitation, ACL graft, ACL open kinetic chain (OKC) exercise and closed kinetic chain (CKC) exercise, ACLR return to sport, ACLR psychological factors, and ACL injury prevention. Clinical review. Level 5. Clinical milestones after ACLR were validated using clinical data collected from 2013 to 2017 at a university-based practice. Variables including knee joint range of motion, effusion, Knee Outcome Survey-Activities of Daily Living Scale, and quadriceps strength index were tracked throughout rehabilitation and analyzed to help inform an updated ACLR rehabilitation guideline. Incorporating the latest research, combined with direct clinical data, provides a current, realistic, and clinically benchmarked strategy for ACLR rehabilitation. Commonly held clinical beliefs regarding rehabilitation after ACL injury must be challenged by the latest research to improve patient outcomes and decrease the risk of reinjury. Key updates to the practice guidelines include the use of frequent and accurate quadriceps strength testing, delayed return-to-sport timeline, immediate use of open kinetic chain exercise, criterion-based progressions for running, sprinting, plyometrics, agility, cutting/pivoting, return to competition, and the inclusion of a secondary prevention program after return to sport. B.

Significant reduction of patellar height affected lower clinical outcomes and knee flexion over five-year follow-up after total knee arthroplasty.

AimsThis study aimed to investigate the relationship between changes in patellar height and clinical outcomes at a mean follow-up of 7.7 years (5 to 10) after fixed-bearing posterior-stabilized total knee arthroplasty (PS-TKA).MethodsWe retrospectively evaluated knee radiographs of 165 knees, which underwent fixed-bearing PS-TKA with patella resurfacing. The incidence of patella baja and changes in patellar height over a minimum of five years of follow-up were determined using Insall-Salvati ratio (ISR) measurement. We examined whether patella baja (ISR < 0.8) at final follow-up affected clinical outcomes, knee joint range of motion (ROM), and Knee Society Score (KSS). We also assessed inter- and intrarater reliability of ISR measurements and focused on the relationship between patellar height reduction beyond measurement error and clinical outcomes.ResultsThe ISR gradually decreased over five years after TKA, and finally 33 patients (20.0%) had patella baja. Patella baja at the final follow-up was not related to passive knee ROM or KSS. Interestingly, when we divided into two groups - patella baja and patella normal-alta (ISR ≥ 0.8) - the patella baja group already had a lower patellar height before surgery, compared with the patella normal-alta group. The ISR measurement error in this study was 0.17. Both passive knee flexion and KSS were significantly decreased in the group with a decrease in ISR of ≥ 0.17 at final follow-up.ConclusionPatellar height gradually decreased over five years of follow-up after TKA. The reduction in patellar height beyond measurement error following TKA was associated with lower clinical outcomes.Cite this article: Bone Jt Open 2021;2(12):1075–1081.

Relations between Knee Joint Range of Motion and Growth Motor Function Measure in Children with Hemiplegic Cerebral Palsy

Relations between Knee Joint Range of Motion and Growth Motor Function Measure in Children with Hemiplegic Cerebral Palsy

Reliability and Validity of a Digital Goniometer for Measuring Knee Joint Range of Motion

ABSTRACT Goniometry is commonly used to evaluate joint range of motion (ROM). The most widespread method, a manual universal goniometer (UG), is considered time-consuming and difficult to handle. The digital goniometer EasyAngle (EA) was developed to improve and simplify the evaluation of ROM. This study aimed to evaluate the reliability and validity of EA measuring active and passive flexion and extension of the knee joint. Reliability was assessed in a test–retest model, while validity was tested by comparing measurements from EA and UG. Thirty-six knee angles (18 individuals) were measured in standardized order. EA showed almost perfect reliability measuring active/passive flexion (ICC 0.994/0.994) and extension (ICC 0.978/0.987). EA’s validity was very high in active/passive flexion (r = 0.969/r = 0.97) and moderate-to-high measuring active/passive extension (r = 0.751/r = 0.892). EA is a reliable, valid, and effective assessment tool for measuring knee angles. Further studies should verify these findings for other joints and movement directions.

The Impact of ACTN3 Gene Polymorphisms on Susceptibility to Exercise-Induced Muscle Damage and Changes in Running Economy Following Downhill Running.

This study aimed to investigate if ACTN3 gene polymorphism impacts the susceptibility to exercise-induced muscle damage (EIMD) and changes in running economy (RE) following downhill running. Thirty-five healthy men were allocated to the two groups based on their ACTN3 gene variants: RR and X allele carriers. Neuromuscular function [knee extensor isometric peak torque (IPT), rate of torque development (RTD), and countermovement, and squat jump height], indirect markers of EIMD [muscle soreness, mid-thigh circumference, knee joint range of motion, and serum creatine kinase (CK) activity], and RE (oxygen uptake, minute ventilation, blood lactate concentration, and perceived exertion) for 5-min of running at a speed equivalent to 80% of individual maximal oxygen uptake speed were assessed before, immediately after, and 1–4 days after a 30-min downhill run (−15%). Neuromuscular function was compromised (P < 0.05) following downhill running with no differences between the groups, except for IPT, which was more affected in the RR individuals compared with the X allele carriers immediately (−24.9 ± 6.9% vs. −16.3 ± 6.5%, respectively) and 4 days (−16.6 ± 14.9% vs. −4.2 ± 9.5%, respectively) post-downhill running. EIMD manifested similarly for both the groups except for serum CK activity, which was greater for RR (398 ± 120 and 452 ± 126 U L–1 at 2 and 4 days following downhill running, respectively) compared with the X allele carriers (273 ± 121 and 352 ± 114 U L–1 at the same time points). RE was compromised following downhill running (16.7 ± 8.3% and 11 ± 7.5% increases in oxygen uptake immediately following downhill running for the RR and X allele carriers, respectively) with no difference between the groups. We conclude that although RR individuals appear to be more susceptible to EIMD following downhill running, this does not extend to the changes in RE.

Adjustments in the Range of Angular Motion during Walking after Amputation of the Toes: A Case Report

The forefoot plays an important role in providing body support and propulsion during walking. We investigated the effect of forefoot dysfunction on the gait pattern of a young adult with partial bilateral amputation of the toes. We measured our participant’s gait kinematics during barefoot and shod overground walking and analysed time-distance and joint range of motion (RoM) parameters against a group of healthy adults. Forefoot dysfunction gait is improved by footwear and walking experience; however, this improvement was still remarkably different (exceeded 95% CI) when compared to healthy gait at matching walking speed. Compared to healthy gait, walking barefoot had a slower speed and a 30% reduction in ankle and knee joint RoM, but a larger hip RoM. Shod gait resulted in a remarkable increase in ankle RoM and walking speed compared to barefoot gait. These results are consistent with the important role of the forefoot (tarsals and metatarsophalangeal joints) and suggest that footwear can facilitate gait function following toe amputation.

Multiple platelet-rich plasma injections are superior to single PRP injections or saline in osteoarthritis of the knee: the 2-year results of a randomized, double-blind, placebo-controlled clinical trial.

The primary purposes of this study were to prove the efficacy of PRP injection therapy on knee pain and functions by comparing patients with mild to moderate OA with a placebo control group, and also to understand the effectiveness of multiple doses compared to a single dose. It was hypothesized that PRP would lead to more favorable results than the placebo at 1, 3, 6, 12 and 24months after treatment. 237 patients diagnosed with OA were randomly separated into 4 groups, who were administered the following: single dose of PRP (n: 62), single dose of sodium saline (NS) (n: 59), three doses of PRP (n: 63), and three doses of NS (n: 53). Clinical evaluations were made pre-treatment and at 1, 3, 6, 12 and 24months post-treatment, using the Knee Injury and Osteoarthritis Result Score (KOOS), Kujala Patellofemoral Score, knee joint range of motion (ROM), measurements of knee circumference (KC), and mechanical axis angle (MAA) and a Visual Analog Scale (VAS) for the evaluation of pain. The better score values in the groups were recorded at 3 and 6months. Patients treated with PRP maintained better scores at 3, 6 and 12months compared to the NS groups (p < 0.05). Multiple doses of PRP were seen to be more effective than single-dose PRP at 6 and 12months (p < 0.05). At the end of 24months, there was no significant score difference across all the groups. The most positive change in scores was found in stage 2 OA, and the most positive change in ROM was in stage 3 OA patients. In the PRP groups, KC decreased more at 1 and 6months (p < 0.05). Compared to other age groups, patients aged 51-65years scored better at 6months (p < 0.05). A negative correlation was determined with MAA scores (r = -0.508, p < 0.001). In comparison to the placebo (NS), leukocyte-rich PRP treatment was determined to be effective in the treatment of OA. Multiple doses of PRP increase the treatment efficacy and duration. Of all the patients treated with PRP, the best results were obtained by patients aged 51-65years, with lower MAA, and by K/L stage 2 OA patients. Randomized controlled trial; Level of evidence, 1. NCT04454164 (ClinicalTrials.gov identifier).

The effect of patient positioning on the accuracy and reliability of assessment of knee range of motion over a telemedicine platform

Introduction Diagnostic accuracy is one of the key considerations of telemedicine usage in orthopedic surgery. The aim of this study was to determine the optimal patient positioning to achieve accurate and reliable visual estimation of the knee joint range of motion over a digital platform for telemedicine. Methods A single volunteer was recruited to perform a total of 120 discrete and random knee range of motion angles in three patient positions: sitting, standing and supine. The patient image was broadcast over a digital platform to six raters. The raters recorded their visual estimation of each discrete knee flexion angle independently. After each discrete knee flexion angle, a physical goniometer was used to obtain the actual flexion angle of the knee. Results A total of 120 discrete measurements (40 measurements in the sitting, standing, and supine positions each) were recorded by each of the six raters. The supine position resulted in the highest intraclass correlation of 0.97 (95% confidence interval: 0.98, 0.99). All three patient positions achieved low absolute difference between the goniometer and the raters with 5.6 degrees (95% limits of agreement: −21.0, 9.8) in sitting, 2.7 degrees (95% limits of agreement: −10.1, 15.4), and 1.2 degrees (95% limits of agreement: −9.8, 12.3) in the supine position. The supine position had the highest accuracy and reliability. Discussion Visual estimation of the knee joint range of motion over telemedicine is clinically accurate and reliable. Patients should be assessed in a supine position to obtain the highest accuracy and reliability for visual estimation of the knee joint range of motion during telemedicine.