Left Knee Joint Research Articles

합기도 술기 칼넣기 동작의 운동학적 분석

The purpose of this study is to conduct a kinematic comparative analysis of the hapkido skill Kalnugki motion. To this end, an infrared high-speed camera were used for motion analysis. The Kwon3d program was used for the analysis of kinematic variables. Additionally, an independent t-test was conducted to verify the differences between the skilled and the unskilled, and this time, the statistical significance level was set at .05. The results were as follows. First, the time required for the completion of the Sulki and Kalnugki techniques was short for those skilled in Hapkido. Second, there was no difference in the movement of the COM(center of mass) by event for both the skilled and unskilled. Third, there was no difference in the left/right and forward/backward velocities of the COM during demonstrations of Sulki and Kalnugki between the skilled and unskilled. In event 2, the vertical velocity of the COM in the vertical upward direction was faster in the skilled. Fourth, there was no difference in the hip joint, and ankle joint angles. However, in event 2 and 3 of the right knee joint angle, skilled showed smaller angles than unskilled, and for left knee joint angles in event 1 and 2, skilled showed smaller angles than unskilled.

Rare clinical cases of tularemia

The most common clinical form of tularemia in Europe is ulcerative bubonic , which has a summer-autumn seasonality . When infected with water and food , the development of oropharyngeal and abdominal forms is possible . The rarity of registration of such forms is associated not only with the low frequency of such cases of infection , but also with the complexity of diagnosing diseases with an atypical clinic . Important for the correct diagnosis are the results of specific laboratory diagnostics and a qualitatively collected epidemiological history . The results of zooparasitological monitoring allow assessing the risk of infection in certain territories . The article provides descriptions of two cases of severe abdominal tularemia , registered in autumn 2021 – winter 2022 in the Republic of Karelia , which has been one of the most disadvantaged regions of Russia in recent years . In the first case , in a 15-year-old boy , the disease began acutely , the main symptoms were high fever , abdominal pain , vomiting , loose stools , foci of skin hyperemia with clear uneven edges without infiltration in the left knee joint and right inguinal region , hepatomegaly , mesoadenitis . In indirect gemagglutination reaction with tularemia diagnosticum on the third day from the onset of the disease antibodies in titer 1:640. Infection probably occurred when eating food during a trip to the forest zone of the city , where infected rodents were previously detected . In the second case , a 17-year-old girl living in a village was diagnosed with a peritonsillar abscess 3 weeks before a sharp rise in temperature , abdominal pain , vomiting and loose stools . Later he developed renal and hepatic insufficiency , polyserositis . The antibodies titer was 1:320 after 3 weeks and 1:2650 after 5 weeks . Infection probably occurred through consumption of rodent-contaminated v egetables .

Multidisciplinary rehabilitation intervention on mobility and hemodynamics of joint contracture animal model

BackgroundJoint contracture causes a decrease in range of motion (ROM), which severely affects activities of daily living of patients. We have investigated the effectiveness of a multidisciplinary rehabilitation on joint contracture by rat model.MethodsWe used 60 Wistar rats in this study. The rats were divided into five groups as follows: group 1 was the normal control group; except the group 1, we created left hind limb knee joint contracture using Nagai method for other four groups. The joint contracture modeling group 2 was the model control group for monitoring the spontaneous recovery, and other three groups were given different rehabilitation treatments; for example, group 3 was treadmill running group; group 4 was medication group; group 5 was treadmill running plus medication group. The left hind limbs knee joint ROM and the femoral blood flow indicators (FBFI) including PS, ED, RI, and PI were measured right before and after the 4 weeks of rehabilitation.ResultAfter 4 weeks of rehabilitation treatments, the measured values of ROM and FBFI are compared with the corresponding values of group 2. Firstly, we did not see clear difference in the values of ROM and FBFI for group 2 before and after 4 weeks spontaneous recovery. The improvement of left lower limb ROM for group 4 and group 5 as compared to the group 2 was statistically significant (p < 0.05), whereas a less recovery for group 3 was observed. However as compared to the group 1, we did not observe full recovery in ROM of group 4 and group 5 after 4 weeks of rehabilitation. The PS and ED level for rehabilitation treatment groups was significantly higher than those modeling ones (Tables 2, 3, Figs. 4, 5), while the RI and PI values show the contrary trends (Tables 4, 5, Figs. 6, 7).ConclusionOur results indicate that multidisciplinary rehabilitation treatments had a curative effect on both contracture of joints and the abnormal femoral circulations.

Alleviating effect of lycorine on CFA‑induced arthritic pain via inhibition of spinal inflammation and oxidative stress.

Chronic pain is the primary symptom of osteoarthritis affecting a patient's quality of life. Neuroinflammation and oxidative stress in the spinal cord contribute to arthritic pain and represent ideal targets for pain management. In the present study, a model of arthritis was established by intra-articular injection of complete Freund's adjuvant (CFA) into the left knee joint in mice. After CFA inducement, knee width and pain hypersensitivity in the mice were increased, motor disability was impaired, spinal inflammatory reaction was induced, spinal astrocytes were activated, antioxidant responses were decreased, and glycogen synthase kinase 3β (GSK-3β) activity was inhibited. To explore the potential therapeutic options for arthritic pain, lycorine was intraperitoneally injected for 3 days in the CFA mice. Lycorine treatment significantly reduced mechanical pain sensitivity, suppressed spontaneous pain, and recovered motor coordination in the CFA-induced mice. Additionally, in the spinal cord, lycorine treatment decreased the inflammatory score, reduced NOD-like receptor protein 3 inflammasome (NLRP3) activity and IL-1β expression, suppressed astrocytic activation, downregulated NF-κB levels, increased nuclear factor erythroid 2-related factor 2 expression and superoxide dismutase activity. Furthermore, lycorine was shown to bind to GSK-3β through three electrovalent bonds, to inhibit GSK-3β activity. In summary, lycorine treatment inhibited GSK-3β activity, suppressed NLRP3 inflammasome activation, increased the antioxidant response, reduced spinal inflammation, and relieved arthritic pain.

A RARE CLINICAL CASE SERIES OF LEIOMYOSARCOMA OF BONE WITH REVIEW OF LITERATURE

Introduction: Leiomyosarcoma is a rare malignant sarcoma which occurs in different anatomic sites including bone with similar histological characteristics but heterogenous clinical behaviour and prognosis. Primary LMS of bone is a rare aggressive sarcoma which presents as a high grade destructive tumour with poor prognosis and limited treatment options. Final diagnosis of LMS includes a combination of histomorphological features along with immunohistochemistry. Due to rarity of disease there is limited understanding of its pathology , prognosis and treatment . Objective: Due to rarity of this disease a case series of primary LMS of bone is prepared to understand its behaviour and management in accordance with the current literature. Material And Methods: 3 cases of primary LMS of Bone is documented in this case series along with history, imaging , diagnosis and treatment. 1] LMS Left Fibula :- A 55 year old male patient reported with pain and partial limitation of motion of the left knee joint. Patient managed with Surgery and Radiotherapy. 2] LMS Right Shoulder :- A 40 year old female patient reported with complaints of lump over right back with associated pain and restriction of joint movements. Patient managed with Surgery, Radiotherapy and Chemotherapy. 3] LMS Right Hip :- A 50 year old male patient reported with lump over right hip with pus discharge. Patient managed with Chemotherapy , Surgery and Radiotherapy . Conclusion: Due to rarity of LMS Bone cases little is known about its clinical behaviour and treatment outcomes. A multidisciplinary approach is needed for the optimal management of the disease. Surgery with a curative intent is the corner stone of treatment of localised disease along with the combination of neoadjuvant or adjuvant chemotherapy and radiotherapy. Further research is needed to identify more effective outcomes.

Ayurvedic management of venous vascular malformation: A case report

The venous vascular malformation is a congenital venous anomaly in which clusters of veins are filled with blood but are not used by the body. This condition can be compared with Shiragranthi Vikar described in the context of Srotadusti in Ayurvedic classics. The manifestation of Shiragranthi occurs due to the vitiation of Mamsa (muscle), Asrik (blood), Meda (fat), and Shira (blood vessels) by Vatadi Dosha. As a result, circular edematous swelling appears on the affected part. In the present case study, a 2.5 years old, female child approached to Kaumarabhritya OPD presented with thigh swelling and pain, bulky mass with tenderness in the lateral aspect of the left knee. The child was unable to walk properly for six months. 3T CE MRI of left thigh and knee joint revealed venous vascular malformation. The child was taking regular allopathy treatment. After approaching our hospital, she was advised for Ayurvedic treatment with the regular follow up visit in every 15 days to determine the clinical progress. The child was administered with Kumarkalyan Rasa, Aravinda Sava, Kalyanaka Ghrita, Varunadi Kashaya, and Abhyanga with Balaswagandha taila for a period of 2 months and follow up of study conducted for another one month. After treatment, the study confessed that there was remission from pain, tenderness, swelling, and bluishness in the affected part. The child walks without any difficulty. The study highlights the clinical efficacy of Ayurvedic drugs in venous vascular malformation with significant improvement of all clinical features.

Assessment of Joint Health Status of Haemophilia Patients in a Tertiary Care Hospital of Bangladesh

Background: Haemophilia is a sex-linked bleeding disorder. Affected patients suffer spontaneous or post-traumatic bleeding into various sites of the body, mainly into joints, depending on the level of coagulation factor deficiency. Recurrent joint bleeds lead to progressive disability. Susceptibility to joint haemorrhage in persons with haemophilia suggests that the routine assessment of joint health is an important aspect of clinical management and outcome studies assessing the efficacy of treatment. Aim: The aim of the study was to assess of joint health status in haemophilia patients attending in a tertiary care hospital, Bangladesh. Methodology: A descriptive observational study was carried out in the department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. A total number of 45 patients who were attended in OPD and IPD, meeting inclusion and exclusion criteria of enrolled haemophilia patients, were included in the study. Joint assessment or any kind of joint impairment was assessed by the Haemophilia Joint Health Score (HJHS) score 2.1 version (an eight-item scoring tool for assessing joint impairments of the six index joints in boys with haemophilia aged 4–18 years. Clinical and laboratory information was recorded with a semi structured questionnaire. Result: Among 45 haemophilia patients, the mean age was 12.9±3.4 years while males were predominant (91.1%). Majority (80.0%) of the patients (36) were diagnosed as haemophilia A. This study observed that, 48.9% of the patients had moderate and 28.9% had severe haemophilia. Knee joint was the predominant target joint. Left knee joint involved in 80% cases and right knee joint were involved in 55.6% of patients. The mean global gait score was found 1.49±0.66 and mean HJHS score was 15.8±4.4. There was no significant correlation between HJHS score and severity of haemophilia (r= -0.081; p=0.596) while significant correlation between the ages of patient with HJHS score (r=0.536; p=0.001) was observed. Conclusion: Haemophilia is a debilitating and life-threatening disease that affects mostly knee, ankle and elbow joints. The joint evaluation system is of paramount importance in clinical practice which is capable to prevent major haemarthrosis and chronic haemophilic synovitis. Haemophilia Joint Health Score (HJHS) is an effective and reliable tool to detect early and subtle changes in joint health and function. This study finding will help in future to assess early the joint conditions and complications, which will assist to modify the treatment approach on demand and start prophylaxis.

Promotion of Knee Cartilage Degradation by IκB Kinase ε in the Pathogenesis of Osteoarthritis in Human and Murine Models.

NF-κB signaling is an important modulator in osteoarthritis (OA), and IκB kinase ε (IKKε) regulates the NF-κB pathway. This study was undertaken to identify the functional involvement of IKKε in the pathogenesis of OA and the effectiveness of IKKε inhibition as a modulatory treatment. IKKε expression in normal and OA human knee joints was analyzed immunohistochemically. Gain- or loss-of-function experiments were performed using human chondrocytes. Furthermore, OA was surgically induced in mice, followed by intraarticular injection of BAY-985, an IKKε/TANK-binding kinase 1 inhibitor, into the left knee joint every 5 days for 8 weeks. Mice were subsequently examined for histologic features of cartilage damage and inflammation. IKKε protein expression was increased in human OA cartilage. In vitro, expression levels of OA-related factors were down-regulated following knockdown of IKKε with the use of small interfering RNA in human OA chondrocytes or following treatment with BAY-985. Conversely, IKKε overexpression significantly increased the expression of OA-related catabolic mediators. In Western blot analysis of human chondrocytes, IKKε overexpression increased the phosphorylation of IκBα and p65. In vivo, intraarticular injection of BAY-985 into the knee joints of mice attenuated OA-related cartilage degradation and hyperalgesia via NF-κB signaling. These results suggest that IKKε regulates cartilage degradation through a catabolic response mediated by NF-κB signaling, and this could represent a potential target for OA treatment. Furthermore, BAY-985 may serve as a major disease-modifying compound among the drugs developed for OA.

Experimental substantiation of the use of platelet-rich plasma in combination with microfracturing in the treatment of local osteochondral defects of the hyaline cartilage of the knee joint: non-randomized controlled study

BACKGROUND: Dissecting osteochondritis of the knee joint is one of the common diseases accompanied by damage to the articular cartilage. Existing conservative and surgical methods of treating osteochondral defects of the hyaline cartilage do not give full satisfactory results of restorative treatment.&#x0D; OBJECTIVE: This study aimed to evaluate the effectiveness of the combined method proposed for the treatment of full-layer osteochondral defects of the knee joint.&#x0D; MATERIALS AND METHODS: The experiment was conducted on 27 Romanov sheep aged 5 months to 1 year and weighing 2035 kg. All animals were conditionally divided into three experimental groups of nine animals, each of which intraoperatively modeled the osteochondral defect of the medial condyle of both hind limbs. Moreover, the left knee joint was assigned to the experimental group, whereas the right knee joint was assigned to the control group. Thus, in first experimental group, microfracturing was performed on the left knee joint in addition to the osteochondral defect of the femoral condyle; in the second experimental groups, microfracturing and platelet-rich plasma (PRP) administration; in the third experimental group, microfracturing, and PRP administration after 3 weeks. From each group, three animals were sacrificed at 1, 3, and 6 months. Results were evaluated by macro- and microscopic examination.&#x0D; RESULTS: In the first experimental group, cartilage regeneration was slow. In the second experimental group using PRP, more intensive regeneration of cartilage tissue occurred. In the third experimental group, cartilage tissue regeneration occurred more intensively.&#x0D; CONCLUSION: During the experiment, in which several methods of treating osteochondral defects of the knee joint were employed, the most effective was the combined method of microfracturization and PRP administration 3 weeks after surgery.

Assessment of the Impact of Physical Activity on the Musculoskeletal System in Early Degenerative Knee Joint Lesions in an Animal Model.

Osteoarthritis (OA) is one of the most prevalent diseases of the osteoarticular system. Progressive destruction of joints is accompanied by development of pathological changes in the muscle tissue, i.e., weakening, atrophy, and remodelling (sarcopenia). The aim of the present study is to assess the impact of physical activity on the musculoskeletal system in an animal model of early degenerative lesions in the knee joint. The study involved 30 male Wistar rats. The animals were allocated to three subgroups of 10 animals each. Each animal from the three subgroups received sodium iodoacetate by injection into the patellar ligament of the right knee joint, whereas saline was administered through the patellar ligament in the left knee joint. The rats in the first group were stimulated to exercise on a treadmill. The animals in the second group were allowed to lead a natural lifestyle (no treadmill stimulation). In the third group, all parts of the right hind limb muscle were injected with Clostridium botulinum toxin type A. The study demonstrated that, compared to the active rats, bone density in the immobilised rats decreased, as indicated by the densitometric assessment of the whole body and the examination of rats' hind limbs and knee joints alone. This clearly evidenced the impact of physical activity on bone mineralisation. The weight of both fat and muscle tissues in the physically inactive rats was reduced. Additionally, the adipose tissue had higher weight in the entire right hind limbs, where monoiodoacetic acid was administered to the knee joint. The animal model clearly showed the importance of physical activity in the early stages of OA, as it slows down the process of joint destruction, bone atrophy, and muscle wasting, whereas physical inactivity contributes to progression of generalised changes in the musculoskeletal system.

Diagnostic Problem in a Patient with Tuberculosis Arthritis

Extra-pulmonary tuberculosis (TB) remains a big public health problem worldwide. Although TB most commonly affects the lungs, any organ or tissue can be involved. TB arthritis is a rare form of extra-pulmonary TB. TB arthritis usually manifests as mild and non-specific arthritis. A 35-year-old male was admitted to the emergency room of Dr. Soetomo General Academic Hospital Surabaya due to pain of left knee since two days prior to admission. His symptom began on previous six months with the swelling of the left knee that gradually worsened so that he had an antalgic gait. Radiological examination of left knee joint showed inflammatory arthritis, accompanied by joint effusion and soft tissue swelling. USG examination of the left knee showed the presence of non-specific left knee arthritis. Patient underwent debridement. Anatomical pathology examination of the tissue obtained at the time of debridement, showed the TB granulomatous inflammation. The Ziehl-Nielson stain of left knee tissue also showed the TB granulomatous inflammation. Patient was then treated with analgesics and anti-TB drugs. The intensive phase of anti-TB therapy was planned to be 2 month, then evaluated and followed by continuation phase for about 7 months. The knee joint is the third most common site of osteoarticular TB after spine and hip. Insidious onset of pain which, in some patients may be present for years, is the usual presentation. The joint is usually warm, and wasting of the thigh muscles is usually marked. Synovial hypertrophy and effusion are present in most patients. The gold standard for diagnosis of TB arthritis is synovial biopsy, with positive results in 80% of cases. It shows caseating granulomas, lymphocytes, and giant cells with caseation, which are characteristics of TB arthritis. Synovial biopsy is generally recommended in any arthritis where clinical evaluation and routine investigations do not give a clear diagnosis.

Effects of Ziziphus Jujuba Extract Alone and Combined with Boswellia Serrata Extract on Monosodium Iodoacetate Model of Osteoarthritis in Mice.

As a chronic joint condition, osteoarthritis (OA) is a common problem among older people. Pain, aching, stiffness, swelling, decreased flexibility, reduced function, and disability are the symptoms of arthritis. In this study, we tested the extracts of Ziziphus jujuba (ZJE) and Boswellia serrata (BSE) to reduce OA symptoms as an alternative treatment. NMRI mice were administered an intra-articular injection of monosodium iodoacetate (MIA; 1 mg/10 mL) in the left knee joint cavity for the induction of OA. Hydroalcoholic extracts of ZJE (250 and 500 mg/kg), BSE (100 and 200 mg/kg), and combined ZJE and BSE were orally administered daily for 21 days. Following behavioral tests, plasma samples were collected to detect inflammatory factors. To screen for general toxicity, acute oral toxicity was evaluated. Oral administration of all the hydroalcoholic extracts significantly increased the locomotor activity, pixel values of the foot-print area, paw withdrawal threshold, the latency of the withdrawal response to heat stimulation, and decreased the difference between pixel values of hind limbs compared to the vehicle group. Also, the elevated levels of IL-1β, IL-6, and TNF-α were reduced. As tested in this study, ZJE and BSE were practically nontoxic and had a high degree of safety. This study demonstrated that the oral administration of ZJE and BSE slows the progression of OA through anti-nociceptive and anti-inflammatory properties. Oral co-administration of ZJE and BSE extracts can be used as herbal medicine to inhibit OA progression.

Design and Experimental Characterization of Artificial Neural Network Controller for a Lower Limb Robotic Exoskeleton

This study aims to develop a lower limb robotic exoskeleton with the use of artificial neural networks for the purpose of rehabilitation. First, the PID control with iterative learning controller is used to test the proposed lower limb robotic exoskeleton robot (LLRER). Although the hip part using the flat brushless DC motors actuation has good tracking results, the knee part using the pneumatic actuated muscle (PAM) actuation cannot perform very well. Second, to compensate this nonlinearity of PAM actuation, the artificial neural network (ANN) feedforward control based on the inverse model trained in advance are used to compensate the nonlinearity of the PAM. Third, a particle swarm optimization (PSO) is used to optimize the PID parameters based on the ANN-feedforward architecture. The developed controller can complete the tracking of one gait cycle within 3.6 s for the knee joint. Among the three controllers, the controller of the ANN-feedforward with PID control (PSO tuned) performs the best, even when the LLRER is worn by the user and the tracking performance is still very good. The average Mean Absolute Error (MAE) of the left knee joint is 1.658 degrees and the average MAE of the right knee joint is 1.392 degrees. In the rehabilitation tests, the controller of ANN-feedforward with PID control is found to be suitable and its versatility for different walking gaits is verified during human tests. The establishment of its inverse model does not need to use complex mathematical formulas and parameters for modeling. Moreover, this study introduces the PSO to search for the optimal parameters of the PID. The architecture diagram and the control signal given by the ANN compensation with the PID control can reduce the error very well.

CYFROWA ANALIZA CHODU PSA JAKO NARZĘDZIE WCZESNEJ DIAGNOSTYKI ZABURZEŃ APARATU RUCHU

The use of digital kinematic analysis in veterinary medicine provides great opportunities to diagnose lameness in dogs. The aim of the study was to determine the lateralization of the dog's gait and to create a gait model for a given individual at walk and trot. The material used for the study was a boxer bitch. The study was carried out on a dogPACER treadmill at feed speeds allowing the dog to move at walk and trot. The analysis performed in the Noraxon MyoVideo program included the length of the step and angulation in the joints in the three phases of movement. A comparative analysis of the angle values in the joints in both gait types indicates statistically significantly larger angulation (P &lt; 0.05) in the joints of the pelvic and thoracic limbs and a reflection of these changes in the distance between the steps taken. Deviations are most often visible for the left hip, knee and ankle joints and intensify when the gait rate increases in the initial phase of limb transfer. In addition to differences for the pelvic limbs, significant differences were found for angulation in the shoulder and elbow joints. The results indicate the advantages of kinematic analysis as a tool for early diagnosis of changes in the locomotor apparatus, which allows the implementation of appropriate therapy aimed at restoring the normal motor functions of the body.

Free-floating medial meniscus implant kinematics do not change after simulation of medial open-wedge high tibial osteotomy and notchplasty

PurposeThe purpose of this in-vitro study was to examine the kinematics of an artificial, free-floating medial meniscus replacement device under dynamic loading situations and different knee joint states.MethodsA dynamic knee simulator was used to perform dynamic loading exercises on three neutrally aligned and three 10° valgus aligned (simulating a medial openwedge high tibial osteotomy - MOWHTO) left human cadaveric knee joints. The knee joints were tested in three states (intact, conventional notchplasty, extended notchplasty) while 11 randomised exercises were simulated (jump landing, squatting, tibial rotation and axial ground impacts at 10°, 30° and 60° knee joint flexion) to investigate the knee joint and implant kinematics by means of rigidly attached reflective marker sets and an according motion analysis.ResultsThe maximum implant translation relative to the tibial plateau was < 13 mm and the maximum implant rotation was < 19° for all exercises. Both, the notchplasties and the valgus knee alignment did not affect the device kinematics.ConclusionsThe results of the present in-vitro study showed that the non-anchored free-floating device remains within the medial knee joint gap under challenging dynamic loading situations without indicating any luxation tendencies. This also provides initial benchtop evidence that the device offers suitable stability and kinematic behaviour to be considered a potential alternative to meniscus allograft transplantation in combination with an MOWHTO, potentially expanding the patient collective in the future.

Relapse and complications of brucellosis: Findings of a disease quality registry

Background: Brucellosis can be chronic or associated with relapse and complications like other chronic diseases, and quality registry system is required. Aim: This study was designed and carried out with the aim of recording the quality of relapse and complications of brucellosis in Hamadan, west of Iran. Methods: In a quality registry study, in the first phase, all patients referred to Sina Hospital and Imam Khomeini Clinic in Hamadan were entered the study from September 2015 to January 2017. All information of the patients including demographic characteristics, clinical signs and symptoms, complications and laboratory findings have been entered in the questionnaire and designed software of quality regiatry of relapse and complications of brucellosis. Results: A total of 248 patients with brucellosis with a mean age of 43.38± 17.67 (range: 13 to 92) years old were enrolled the study, of which 155 patients (62.5%) were male and 80.65% of patients lived in rural areas.The most common complications were sacroilitis 33.06% ( 95% CI: 27.24%, 39.29%), arthritis 29.44% (95% CI: 23.83%, 35.53%) (the most common involvement were left and right knee joints 38.36% and 35. 62%, respectively), spondylitis 22.98% (95% CI: 17.89%, 28.72%) (in lumbar vertebrae L4 and L5 were 70.18% and 68.24%, respectively), epididymorchitis (14.84%, 95% CI: 9.64%, 21.42%) in men, neurobrucellosis (3.63%, 95% CI: 1.67%, 6.77%), hepatitis (1.21%, 95% CI: 0.25%, 3.53%), and abortion in 3 of 4 pregnant women and one case of eye involvement. Conclusion: The results of this study can be used for evidence-based decision-making to diagnose and better management of relapse and complications in patients with brucellosis.

REPERCURSSÕES DO TREINO DE RESISTÊNCIA DO CORE SOBRE O DESEMPENHO DOS JOGADORES DE FUTEBOL

ABSTRACT Introduction: Soccer players are athletes who need to develop advanced characteristics of strength and speed. The resistance training of the muscles involved in the core is a new training theory applicable to modern sports that is gaining prominence due to its amazing results. It is of great value for researchers to integrate the strengths of core strengthening into soccer training, improve their protocols, and compensate for their limitations. Objective: This study aimed to analyze the relationship between core strength training and physical conditioning in soccer players. At the same time, this article discusses the influence of core muscle strength characteristics on athletes’ physical performance. Methods: This article selects advanced soccer players as research subjects. Volunteers were randomly divided into two groups (control and experimental groups). The experimental group received core muscle strength training, while the control group received daily training. This paper analyzed the muscle strength characteristics of the two groups of volunteers. Then, this paper conducts a statistical and mathematical analysis of the muscle strength level data in two groups of athletes. Results: The experimental group showed significant differences in bilateral hip and ankle joint flexors after core muscle strength training (P&lt;0.01). The relative peak moment of flexion and extension of the left hip was lower than that of the right hip, a factor justified by the predominant motor laterality principle on the players. The muscle strength of the left knee and ankle joints was greater than that of the right. Both experimental and control groups showed that the strength of the ankle flexors was better than the ankle extensors (knee toe flexors). The data were very significantly different (P&lt;0.01). Conclusion: Muscular endurance training can help improve the physical conditioning of soccer players. Athletes can reinforce core strength training in their daily training. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Hereditary Multiple Exostoses (HME) with Peroneal Nerve Compresion: A Case Report

Introduction: Hereditary multiple exostosis (HME) is a hereditary disorder characterized by multiple osteochondromas. Clinical symptoms can result from compression of adjacent structures such as peripheral nerves. In Indonesia, HME with nerve compression cases have rarely reported. Presentation of Case: An eleven-year-old female with complaining of left knee joint pain and progressive masses in left lower leg since 6 years ago. This complains followed by numbness and difficulty to dorso flexion motion on left ankle joint since four months ago. Physical examination showed of the bony masses was detected at the left lateral upper third lower leg with measuring about six into eight centimeters. Range of motion of left ankle joint patient had difficult to dorso flexion. X-ray imaging viewed demonstrates multiple exostosis appearance involving distal femoral, proximal fibula, proximal tibia and distal fibula bone. MR Imaging revealed cartilage cap of head fibula is thin less 1.5 cm and the axially specimen showed peroneal nerve compression. The patient underwent left head fibula wide resection. Intraoperative findings peripheral nerve peroneal compression and was decompression. Medical rehabilitation for physiotherapy was advised. The results of the follow-up after 2 years, no pain feels and the patient was able to dorso flexion of left ankle joint and no additional bumps in other areas of the body. These lesions may arise from any bone which was pre-formed in the cartilage. Nerve compression syndromes are the neurological complex symptom caused by the mechanical or dynamic compression of a specific single segment. MRI was excellent demonstration of blood vessels compromise and represents choices with peripheral nerves structures and to measuring cartilage cap thickness for criterion of osteochondromas differentiation and exostotic grade. Complete resection was importance of the cartilaginous cap to prevent recurrence. The decompressing the peroneal nerve that pressured by the masses and vascular problems occured. Conclusion: Hereditary multiple exostosis is an inherited disorder characterized by multiple osteochondromas. It is important to monitor all cases of HME especially if the patient complains of pain or growth of an osteochondroma. The surgical excision, with complete resection of the cartilaginous cap of the tumor, is important in preventing recurrence.

Management of Chronic Patellar Tendon Rupture Left Knee Joint with Primary Repair Using Fiber Wire and Endo Button As A Cost-Effective and Simple Anatomical Reconstruction Without Grafts: A Case Report

Patellar tendon ruptures mostly occur in persons under 40 years of age, typically during sports activities. Neglected ruptures of the patellar tendon, defined as ruptures presenting after six weeks, are often difficult to repair, and different techniques have been described for reconstruction of this uncommon problem including the use of auto-grafts, allografts, and synthetic materials. We hereby describe a cost-effective and simple anatomical reconstruction without the requirement for grafts for chronic patellar tendon injuries. This is a retrospective study of a 29-year-old man who came to the orthopaedic clinic with the chief complaint of pain in the left knee. Pain has been felt since 2 years ago after the patient falls when were playing football. After the incident, the patient was taken to alternative therapy, but still felt the pain and difficulty moving the left knee. From the physical examination, the patient presented elevation of left patella height, localized tenderness, palpable gap below the inferior pole of the patella, and limited range of movement on the left knee. There was also a straight leg raise provocative test positive. The x-ray results were obtained patella alta with Insall-Salvatti Index was 1.6. An MRI examination was also performed, showing patella contusion and marrow edema, suspicious of soft tissue rupture, with intact ACL/PCL. The patient was diagnosed with chronic patellar tendon rupture of the left knee. At the time of surgery, it was found that the patellar tendon ruptured with remnants still on the distal part, and the cartilage was still in good condition. The next step is to perform a primary repair of the patellar tendon using fiber wire and endo button at the tibial part. Postoperative rehabilitation was carried out by starting limited ROM exercise of the left knee on day 4. Six weeks after surgery, there was an improvement in left knee ROM and improvement in walking ability. In this case, primary repair of patellar tendon using fiber wire and endo button provides good results and can be used as a costeffective and simple anatomical reconstruction without the requirement for grafts.

Lipoma arborescence of knee joint in an adolescent male patient: a case report

&lt;p&gt;A very uncommon benign synovial membrane tumor is called lipoma arborescens. It often affects a single articulation, the knee. Despite a conventional imaging assessment, the lesion&amp;rsquo;s histological analysis is still required for the ultimate diagnosis. A 15-year-old boy attended the outpatient clinic of the Lahore General Hospital Lahore, Pakistan with pain and swelling in his left knee that had been steadily worsening over the previous 4 years. There were no concomitant prodromal symptoms, and the swelling was soft and non-tender while also inhibiting knee flexion. Soft tissue shadows were observed on radiographs. A large amount of subarticular erosion in the nearby tibial and femoral condyle was caused by the frond-like proliferation of fatty synovium, according to magnetic resonance imaging. Only the left knee joint showed focused areas of unusually elevated radionuclide uptake during the Technetium (Tc99m) bone scan. After an open synovectomy, the specimen underwent histological analysis, which revealed villiform fatty tissue, a hallmark of Lipoma arborescens coated by somewhat thicker synovium. Although infrequent, open synovectomy is currently the preferred course of treatment for lipoma arborescens, which should be taken into account when making a differential diagnosis of knee diseases. Approximately 3 months after surgery, the patient underwent his most recent follow-up and was asymptomatic with a small amount of joint effusion.&lt;/p&gt;