Lower Extremity Functional Score Research Articles

Functional Outcome of Long Proximal Femoral Nail Versus Short Proximal Femoral Nail in Peri-Trochanteric Fractures in Elderly Patient

Background: Intertrochanteric fractures account for 5% of all hip fractures and 35–40% of these fractures are unstable three or four part fractures. Operative treatment is the best option in most of the trochanteric fractures. Evolution of intramedullary devices is a result of dissatisfaction with the extra medullary devices in intertrochanteric unstable fractures. Intramedullary nailing, with less operative time and less operative blood loss allows early weight bearing with less resultant shortening on long term follow up. Our main aim was to compare the effectiveness and drawbacks of short proximal femoral nail (PFN) versus long PFN in the management of peri-trochanteric fractures. Materials and Methods: This study was randomized, time bound, hospital based study conducted in a tertiary hospital, between April 2019 to April 2022. The study included 41 cases of unstable peri-trochanteric fractures divided into two groups. Patients of Group-I were operated with Short PFN and Group-II were operated with Long PFN by standard technique. Intraoperative parameters, post-operative data and events were noted. During follow-ups, patients were assessed by clinico-radiological evaluation and Harris hip score. Results: Total of 41 patients of peri-trochanteric fracture have been included in study out of which 24 belonged to Group-I and were operated with short PFN and rest 17 were of Group-II operated with long PFN. Though there was no significant difference in results of two Groups but use of Long PFN was found to be advantages over Short PFN in terms of the less postoperative complications, less mean time of union and better lower extremity functional scores. Conclusion: In our short term results, it was evident that the use of Long PFN has advantages over Short PFN in terms of the less postoperative complications, less mean time of union and better lower extremity functional scores. A study with a larger sample size would have made a better assessment of this surgical intervention.

Functional outcome and quality of life following treatment for post-traumatic osteomyelitis of long bones.

The clinical outcomes and factors associated with treatment failure of post-traumatic osteomyelitis have been investigated in many studies. However, limb functionality and quality of life following treatment for this condition have not been thoroughly studied. This cross-sectional study included 47 patients with post-traumatic osteomyelitis of the lower limb. Functional outcome was assessed using the Lower Extremity Functional Score (LEFS), and quality of life was assessed using the validated Malay version of the Short Form-36 questionnaire version 2. The mean follow-up period was 4.6 (range 2.3-9.5) years, and the median age of the patients was 44 years. Osteomyelitis was located in the tibia for 26 patients and in the femur for 21 patients. Osteomyelitis was consequent to internal infection in 38 patients and due to infected open fractures in nine patients. 42 (89.4%) patients had fracture union and control of infection. Bone defect was found to be a significant contributing factor for treatment failure (p = 0.008). The median LEFS for the success group was 65, compared to 49 for the failure group. Although the success group showed better scores with regard to quality of life, the difference between the two groups was not statistically significant. Treatment of post-traumatic osteomyelitis of the lower limb had a high success rate. The presence of a bone defect was associated with treatment failure. Successfully treated patients had significantly better functional outcomes than in those in whom treatment failed.

The Effectivity of Prolotherapy Treatment in Shin Splint: A Randomized Controlled Study

Objective: Shin Splints (SS) is one of the most common reasons for post-exercise pain especially in athletes and in army recruits. The purpose of this randomized controlled clinical study is to evaluate the effectivity of prolotherapy for the treatment of SS.
 Materials-Methods: Forty-four patients with shin splints have symptoms more than three months were divided into prolotherapy (n=22) and exercise (n=22) groups. Ultrasound-guided injections were performed under aseptic conditions using a 27 G needle with a solution of 6.6 ml 15% dextrose and 0.4 ml lidocaine to the posteromedial border of the tibia through up to seven different points (1 cc solution to each point) in the prolotherapy group for 3 times in every 21 days. The exercise program was given for 12 weeks to exercise group. The VAS and functional scores were performed at the beginning, 3, 6 and 24 weeks.
 Results: There were statistically significant differences in Lower Extremity Functional Score after 3, 6, 24 weeks, and VAS after 3 and 6 weeks of the treatment (p= 0.023, p=0.006, p=0.005, p=0.013, p

Treatment options for entrapment neuropathy of infrapatellar branch of saphenous nerve post knee arthroplasty: a case report

BackgroundThe infrapatellar branch of the saphenous nerve is highly prone to form a neuroma or undergo transaction after midline incision of knee arthroplasty. The presence of neuroma and entrapment of these fibers can cause pain and numbness/tingling in the knee. The presence of these symptoms can significantly impact rehabilitation outcomes and long-term outcomes.Case presentationThe patient is a 63-year-old Caucasian female reported to an outpatient orthopedic physical therapy clinic post left knee arthroplasty. The patient reported severe pain (VAS-9/10) with knee range of motion from 5 to 64° flexion. The lower extremity functional score was 42/80 with moderate deficits in function.ConclusionThe anterior inferior knee pain with saphenous nerve entrapment can cause severe symptoms. Soft tissue mobilizations followed by neurodynamic techniques can improve neural mobility and functional outcomes (LEFS-52/80).

AO Reconstruction Plate as Buttressing for Greater Trochanter in Hemiarthroplasty Procedure

INTRODUCTIONThe trend of intertrochanter fractures has gradually increased leading to a high frequency of difficulties and damage as the result of the increased age and risk factors. Accordingly, the aim of stable fixation in these fractures is designed with appropriate surgical procedures and patient care. The contribution of a stable fixation is due to several considerations including fracture shape and assurance, bone quality, comminution pattern, implant choice, and surgical technique. This study aimed to assess the functional outcomes of the patients with an intertrochanteric fracture who underwent hemiarthroplasty with AO recon as buttressing.MATERIALS AND METHODSThis was a case series study conducted in Gadjah Mada University Academic Hospital in Yogyakarta from July 2017 to August 2018. Patients with Evans unstable intertrochanteric femoral fractures who underwent simultaneous bipolar hemiarthroplasty and fixation with AO reconstruction plate and SS wire as buttressing were evaluated. Pre and postoperative radiographs, postoperative Visual Analog Scale (VAS) score, walking ability using Harris Hip Score (HHS), and Lower Extremity Functional Score (LEFS) were the outcome parameters.RESULTSA total of 6 patients, 4 of whom were male with an average age of 81 years old were included in this study. All the mechanisms of injury were low-energy trauma. The mean VAS score was decreased, from 7 pre-operatively to 1.5 post-operatively at final follow-up (p-value 0.05). The patients had a mean HHS of 82.5 and a LEFS mean of 56.7.CONCLUSIONButtress plate fixation using an AO reconstruction plate for trochanteric fracture following bipolar hemiarthroplasty resulted in a good functional outcome.

Functional outcome and quality of life in surgically treated talar neck and body fractures; how is it affected by complications

BackgroundSince talus fractures are rare, study populations are frequently small. The aim of this study is to describe how surgical treatment of talar neck and body fractures and postoperative complications affect functional outcome and quality of life measured by validated questionnaires. MethodsAll patients following surgically treated talar neck and/or body fracture between January 2000 and December 2019 at a level 1 trauma center were included in this retrospective cohort study. Primary outcomes were functional outcomes measured by Lower Extremity Functional Score (LEFS), the Foot Function Index (FFI), and the Quality of Life (QOL) measured by the EuroQol 5-dimension questionnaire (EQ-5D). Linear regression was used to assess the relationship between continuous variables and the outcome, and multivariable linear regression was used to identify the predictors of the functional outcome. ResultsNinety patients were included, of which 73 responded to our questionnaires. The median follow-up time was 50.5 (interquartile range (IQR), 18.3–97.3) months. Our study showed the following results: a mean LEFS of 58.4 (range, 17–80), a median FFI of 15.7 (IQR, 3.5–35.2), a median EQ-5D index score of 0.83 (IQR, 0.81–1.00), a median patient satisfaction of 9.0 (IQR, 8.0–10.0), a patient reported health status of 76.8 (range, 20–100), and a mean AOFAS score of 75.7 (range, 28–100). Implant removal and secondary arthrodesis were associated with a reduced AOFAS outcome score (p=0.001, p<0.001), and implant removal was also a predictive factor for a less favorable LEFS outcome score (p=0.001). ConclusionPatients who underwent implant removal and/or secondary arthrodesis had poorer functional outcome compared to patients who did not undergo additional procedures. Careful consideration of re-intervention must be made in combination with patient expectation management. Future studies should focus on how to lower the rate of complications and the effect of secondary intervention with the use of validated questionnaires.

Intramedullary Nailing vs Plating of the Fibula for Ankle Fractures in the Young Active Patient

Category:Ankle; TraumaIntroduction/Purpose:The use of fibular nailing (FN) for fixation of lateral malleolar fractures has been rising in recent years. Currently, it has been validated as an effective minimally invasive approach to ankle fractures specially in patients with high risk of wound dehiscence, diabetics and elderly low-demand patients. While most of the studies comparing the use of a fibula nail versus plating (PL) are carried out in this population at risk, the use of FN in younger patients with higher functional demands has been hardly studied. The aim of this study is to compare the functional and quality of life outcomes of patients treated with FN and PL in an active population.Methods:We performed an IRB-approved retrospective study including ankle fractures treated in our hospital from January 2017 to February 2020, with a minimum followup of one year. We included only patients between 18 and 55 years old treated by five fellowship-trained foot and ankle surgeons and divided into two groups according to the method of fixation of the fibula: intramedullary nailing (FN) or plating (PL). Demographics, medical comorbidities, type of fracture, reoperations and complications were collected. Functional and clinical evaluation included the Lower Extremity Functional Score (LEFS) and Short form 12 (SF 12) were obtained at an average of 28 months follow-up (range 14-50).Results:Eighty-five patients were included in this study with a mean age of 36.9 years old (range 16-55). The FN group was conformed by 31 patients (18 men) while the PL group consisted of 54 patients (32 men). Both groups were comparable in terms of age, sex, type of fracture, open fractures, number of malleoli compromised (P>0.05). Union was achieved in all patients. The complication rate was 3.2% (1 patient) in the FN group versus 5,5% (3 patients) in the PL group (p=0.66). Two patients (6.5%) in the FN group and 7 patients (13%) in the PL group required hardware removal (p=0.36). There were no significant differences in SF-12 physical component (p=0.30), SF-12 Mental component (p=0.52) and LEFS Score (p=0.88).Conclusion:In this comparative study, there were no differences between the FN and PL groups for fixation of the fibula in terms of functional results and quality of life at an average of 28 months follow-up. Complications and hardware removal rates had no statistical differences between both groups. This is the first report on the literature comparing both fixation strategies on an active high-demand population.

A Novel Treatment Approach of Ultrasound-Guided Radiofrequency Ablation of the Greater Trochanteric Sensory Nerve for Recalcitrant Greater Trochanteric Pain Syndrome.

This report describes a novel technique for the treatment of recalcitrant greater trochanteric pain syndrome (GPTS) by radiofrequency ablation (RFA) of the greater trochanteric sensory nerve (GTsn). Here, we describe one patient suffering from recalcitrant GTPS treated with RFA of the GTsn in the outpatient pain clinic setting. Over the eight months subsequent to treatment, the patient was monitored for changes in the Numerical Pain Rating (NPR) and Lower Extremity Functional Score (LEFS). The patient demonstrated meaningful symptomatic and functional improvement as measured by both NPR and LEFS. GTsn RFA may be a viable treatment option for recalcitrant GTPS. Larger comparative trials are needed to establish improved results over conventional treatments.

Robotic Assistance in Unicompartmental Knee Arthroplasty Results in Superior Early Functional Recovery and Is More Likely to Meet Patient Expectations

Robotic technology has reduced the errors of implant alignment in unicompartmental knee arthroplasty (UKA), but its impact on functional recovery after UKA is poorly defined. The purpose of this study was to compare early functional recovery, pain levels, and satisfaction in UKA performed with either robotic assistance or conventional methods. A retrospective analysis was performed on 89 matched consecutive patients who underwent outpatient UKA by a single physician using either conventional instruments (n = 39) or robotic methods (n = 50), with otherwise identical perioperative protocols. Outcomes studied included Lower Extremity Functional Score (LEFS), new Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR.), VR/SF-12, Visual Analog Scale (VAS) pain scores, and perioperative opioid consumption. Patients in the robotic cohort had superior early functional outcomes, with greater LEFS (conventional = 23; robotic = 31) at 1 week post-op (p=0.015) and KOOS-JR (conventional = 74; robotic = 81) at up to 6 months post-op (p=0.037); these two values remained statistically significant after mixed-model regression analysis (p=0.010; p=0.023), respectively. At 1 year post-op, expectations were more likely to be met in those who received robotic assistance (p=0.06). No differences were reported with respect to postoperative opioid usage (p=0.320), reoperations (p=1.00), and complications (p=0.628). Robotic-assisted UKA resulted in more rapid recovery and less early postoperative pain and were more likely to meet expectations than conventional UKA, although functional differences equilibrated by 1 year postoperatively. Further follow-up is necessary to determine if implant durability is impacted by robotics.

ARE SPORTS INJURIES THE MOST COMMON CAUSE OF MOREL-LAVALLEE LESIONS IN THE PEDIATRIC POPULATION?

Background:Traumatic internal degloving injury i.e. Morel-Lavallée lesion (MLL) develops as a result of blunt trauma with tangential shear forces. In the pediatric population, these have been described only as small case reports till date. Purpose: To describe the largest case series of lower extremity Morel-Lavallée lesion (MLL) in the pediatric population, to determine its etiology (especially its relationship to sports), treatment and outcomes.Methods:Retrospective study of patients <18 years presenting to a tertiary children’s hospital with MLL between 2013-2019. Demographics, clinical data, imaging features, treatment and outcomes data was collected. Descriptive statistical analysis was conducted.Results:38 patients (21 males, 17 females) having MLL with mean age 14.6 years were classified into 2 groups- hip/thigh MLL (9 patients) and lower leg MLL (29) (Table 1.1). Most common cause of lower leg MLL was sports injury (79%). Most commonly implicated sports in MLL were football and baseball(24% each). Associated injuries were seen in 9 (23%) patients. Radiographs done in 58% of patients showed no bony abnormalities. Imaging modality of choice was MRI for lower leg MLLs (72%) and US for hip/thigh MLL (67%)(Fig.1.2). MLL size was larger for hip/thigh MLL (168 cm3) as compared to leg MLL (38.6 cm3). 25 (65.8%) of MLLs were treated with conservative management,12 (31.5%) with minimally invasive methods and 1(2.6%) needed surgical management. 2/9 (22.2%) of the associated injuries required operative management. 2/38 (5%) patients were given prophylactic antibiotics. 72.4% Lower leg MLLs were treated with conservative management while intervention was needed more in hip/thigh MLLs (55.6%). Patients returned to activities at 14.3 weeks for hip/thigh MLL;9.1 weeks for lower leg MLL. 24 patients with adequate documentation demonstrated lower extremity functional score (LEFS) and pain level of 74/80 (92.5%) and 0.7/10 respectively at mean 12.5 months follow-up. Leg cellulitis was seen as a complication in one patient.Conclusion:The largest case series on MLL exclusively in the pediatric population suggests that they are more common in knee/leg region region and usually caused by sports injuries which is notably different as compared to adult population. Most pediatric injuries are treated conservatively, especially sports related MLLs. Although return to activities takes longer for hip/thigh injuries, majority of patients regain satisfactory functionality post-injury.Table 1.1.Figure 1.2.MLL imaging – MRI and Ultrasound features of MLL

Responses to gait retraining using pressure-based auditory feedback for medial knee osteoarthritis

Responses to gait retraining using pressure-based auditory feedback for medial knee osteoarthritis

Clinical and radiological assessment of the induced membrane technique using beta-tricalcium phosphate in reconstructive surgery for lower extremity long bone defects.

To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (β-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes. A review of the medical records was conducted of consecutive 35 lower limbs (30 males and five females; median age 46 years (interquartile range (IQR) 40 to 61)) treated with IMT using β-TCP between 2014 and 2018. Lower Extremity Functional Score (LEFS) was examined preoperatively and at final follow-up to clarify patient-centered outcomes. Bone healing was assessed radiologically, and time from the second stage to bone healing was also evaluated. Patients were divided into ≥ 50 mm and < 50 mm defect groups and into femoral reconstruction, tibial reconstruction, and ankle arthrodesis groups. There were ten and 25 defects in the femur and tibia, respectively. Median LEFS improved significantly from 8 (IQR 1.5 to 19.3) preoperatively to 63.5 (IQR 57 to 73.3) at final follow-up (p < 0.001). Bone healing was achieved in all limbs, and median time from the second stage to bone healing was six months (IQR 5 to 10). Median time to bone healing, preoperative LEFS, or postoperative LEFS did not differ significantly between the defect size groups or among the treatment groups. IMT using β-TCP provided satisfactory clinical and radiological outcomes for segmental bone defects in the lower limbs; surgical outcomes were not influenced by bone defect size or operated part. Cite this article: Bone Joint J2021;103-B(3):456-461.

Outcome of Biological Plating of Extra-articular Proximal Tibia Fractures

Introduction: The most prominent transformation in the treatment of fractures has been modified from intensive open reduction and internal fixation with absolute stability to the biological fixation with relative stability and secondary healing with callus formation, with priority on preservation of the vascularity of bone and soft tissue to improve fracture healing. Aim: To evaluate the outcome of biological fixation of extra-articular proximal tibia fractures in adults using the locking compression plate. Materials and Methods: The present prospective longitudinal study was conducted at Government Medical College and Hospital, Nagpur, which included 30 patients who had extra- articular proximal tibia fractures belonging to AO type 41A2 and 41A3 treated by proximal tibia lateral locking plate 4.5/5.0 mm. The patients were followed-up at two weeks, six weeks, three months, six months and one year. The fracture union, coronal, sagittal alignment was assessed radiologically at the end of follow-up. Functionally the outcome was evaluated using lower extremity functional score. Descriptive statistics were used for statistical analysis. Results: Biological plating with locking compression plate has shown promising results both in terms of function and radiology. There was non-significant difference in lower extremity functional score between patients with malunion and normal alignment. Mean union time was 19.93 weeks with a standard deviation of 2.21 weeks. There was non-significant difference between the range of motion and fracture type (p-value 0.38) as well as that between Lower Extremity Functional Score (LEFS) and fracture type (p-value 0.0501). On functional evaluation of patients treated with biological plating, there was statistical significance in Knee Range of Motion (ROM) for the patients between malunion and normal alignment (p value 0.01). Conclusion: The biological fixation using minimally invasive techniques is an effective method of stabilisation for extra-articular proximal tibia fracture, yielding good mechanical alignment and protecting soft tissues and blood supply, leading to higher union rates with good functional outcome.

Correlation between muscle strength and the degrees of functionality and kinesiophobia reported by patients with chronic hip pain

ABSTRACT BACKGROUND AND OBJECTIVES: This study aimed to identify the association between hip muscle strength and the scores from subjective functional and psychological evaluation questionnaires in patients with chronic hip pain. METHODS: Fifty-fivepatients with painful hip injuries (30 males) performed isometric peak strength tests of the abductors, extensors, and internal and external rotators of the hips with a hand-held dynamometer. The degree of functionality was measured by the Hip Outcome Score (HOS) and Lower Extremity Functional Score (LEFS), pain was estimated by the Visual Analog Scale (VAS) and kinesiophobia was calculated using the Tampa questionnaire. The Pearson correlation coefficient was used (alfa=5%) to test the associations between the muscle strength and the scores from the questionnaires. RESULTS: There were significant correlations between the strength of all four hip muscles and the HOS (r>0.29). Only the hip external rotators showed a significant correlation with pain (r=-0.30). No significant correlations were found for LEFS (r<0.24) and Tampa questionnaires (r¬0.15). CONCLUSION: The reduction in peak strength of the hip extensors, abductors and external rotators was associated with a reduction in the level of hip functionality but did not correlate with neither the level of overall functionality of the lower limbs nor the degree of kinesiophobia. Also, a reduction of hip external rotators strength was related to an increase in the intensity of pain.

Outcomes of Surgical Repair Versus Primary Tenodesis for Proximal Rectus Femoris Avulsion Injuries in Professional Athletes

Background: Surgical repair of proximal rectus femoris avulsion injuries is associated with prolonged periods of rehabilitation and highly variable risk of injury recurrence. Surgical tenodesis of these injuries is often reserved for recurrent injuries or revision surgery. To our knowledge, the outcomes of proximal rectus femoris avulsion injuries treated with surgical repair versus primary tenodesis have not been previously reported. Hypothesis: Primary tenodesis of proximal rectus femoris avulsion injuries is associated with reduced risk of injury recurrence as compared with surgical repair. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 25 patients (22 male and 3 female) who underwent surgical repair versus 30 patients (26 male and 4 female) who received primary tenodesis for proximal rectus femoris avulsion injuries. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 27.9 months (range, 24.0-31.7 months) from date of surgery. Results: All patients returned to their preinjury levels of sporting activity. Primary tenodesis was associated with earlier return to preinjury level of sporting function as compared with surgical repair (mean ± SD, 12.4 ± 1.6 vs 15.8 ± 2.2 weeks; P < .001) and reduced risk of recurrence (0% vs 16%; P < .001). At 1-year follow-up, there was no difference in surgical repair versus primary tenodesis relating to patient satisfaction scores (12 very satisfied and 13 satisfied vs 16 very satisfied and 14 satisfied; P = .70), isometric quadriceps strength (95.6% ± 2.8% vs 95.2% ± 6.3%; P = .31), Tegner scores (median [interquartile range], 9 [8-9] vs 9 [8-9]; P = .54), and lower extremity functional scores (73 [72-76] vs 74 [72-75]; P = .41). High patient satisfaction, quadriceps muscle strength, and functional outcome scores were maintained and remained comparable between treatment groups at 2-year follow-up. Conclusion: Primary tenodesis was associated with reduced time for return to preinjury level of sporting function and decreased risk of injury recurrence when compared with surgical repair for proximal rectus femoris avulsion injuries. There were no differences in patient satisfaction, functional outcome scores, and quadriceps muscle strength between the treatment groups at 1- and 2-year follow-up.

Morel-Lavallée lesions (internal degloving injuries) of the lower extremity in the pediatric and adolescent population

ABSTRACT Purpose To describe the largest case series of lower extremity traumatic internal degloving injury, i.e. Morel-Lavallée lesion (MLL) in the pediatric and adolescent population, its treatment and outcomes. Methods Retrospective review of patients under 18 years who presented with MLL to a tertiary children’s hospital. Demographic, clinical, radiographic, treatment and outcomes data were collected. Descriptive statistical analysis was conducted. Results 38 patients having MLL with mean age 14.6 years were classified into two groups: hip/thigh MLL (nine patients) and lower leg MLL (29). Most common cause of lower leg and hip/thigh MLL was sports injury (79.3%) and motor vehicle accident (MVA) (33%) respectively. Most implicated sports were football and baseball. Primary care physicians/pediatricians were the initial treating providers for 63% of patients. Imaging modality of choice was magnetic resonance imaging (MRI) for lower leg MLLs (72.4%) and ultrasonography (US) for hip/thigh MLL (66.7%). Twenty-five (65.8%) patients were treated with conservative management, 12 (31.6%) with minimally invasive methods and 1 (2.6%) needed surgical management. Average return to normal activities took 14.3 and 9.1 weeks for hip/thigh and lower leg MLL, respectively. Twenty-four patients with adequate documentation demonstrated lower extremity functional score (LEFS) and pain level of 74/80 (92.5%) and 0.7/10, respectively, at mean 12.5 months follow-up. Conclusion In contrast to adult injury literature, pediatric MLLs are more common in the leg/knee than hip/thigh region and caused mostly by sports injuries. Primary care physicians are the initial treating providers for the majority of the patients. Intervention is more often needed in the hip/thigh MLLs as opposed to non-operative management for lower leg injuries. This large case series on MLL in the pediatric population demonstrates differences in the management of hip and thigh lesions when compared to the management of the knee and leg lesions in the majority of these patients. Non-operative management in the majority of these lesions provided overall satisfactory outcomes.

Hip Arthroscopy in Patients Aged 40 Years and Older: Greater Success With Labral Reconstruction Compared With Labral Repair

To assess the outcomes of complete, primary, arthroscopic hip labral reconstruction among patients aged 40 years and older compared with those who underwent primary labral repair and compared with patients aged 30 to 39 years who underwent complete, primary labral reconstruction. We recruited all patients who underwent arthroscopic labral reconstruction between March 2010 and June 2015 and were aged 30 to 65 years or who underwent arthroscopic labral repair between June 2009 and June 2015 and were aged 40 to 65 years. The modified Harris Hip Score (mHHS), Lower Extremity Function Score, and visual analog scale score for average pain were collected preoperatively and at minimum 2-year follow-up. Failure was defined as the need for revision ipsilateral hip surgery. The rate of conversion to total hip arthroplasty (a subset of failure) was assessed separately. A total of 363 hips in 343 patients met the inclusion criteria. Follow-up was available for 312 hips (86.0%), and the average time to follow-up was 4.2 years (range, 2.0-8.5 years). After adjustment for differences in follow-up time between groups, failure was 3.29 times more likely for hips in the repair group aged 40 years and older than for hips in the reconstruction group aged 40 years and older (relative rate, 3.29; 95% confidence interval, 1.25-8.69; P= .02), and there was no difference in the failure rate for hips in the reconstruction group aged 40 years and older compared with hips in the reconstruction group aged 30 to 39 years (relative rate, 0.58; 95% confidence interval, 0.18-1.89; P= .37). The rate of conversion to total hip arthroplasty was not meaningfully different between the 3 groups. Among hips for which treatment did not fail, average improvement in the mHHS measured 35 points and both labral reconstruction groups saw a greater mHHS improvement than the labral repair group of patients aged 40 years and older (P= .01 and P < .01). Labral reconstruction led to a lower failure rate, greater average improvement in the mHHS, and equivalent postoperative patient-reported outcome scores compared with labral repair among patients aged 40 years and older in this study population, and the outcomes of labral reconstruction were similar between patients aged 40 years and older and those aged 30 to 39 years. Complete labral reconstruction may be particularly advantageous in patients aged 40 years and older. Level III, retrospective comparative study.

No Difference in Functional Outcomes When Lateral Extra-Articular Tenodesis Is Added to Anterior Cruciate Ligament Reconstruction in Young Active Patients: The Stability Study

To assess the functional outcomes of patients included in the Stability Study randomized controlled trial comparing anterior cruciate ligament reconstruction (ACLR) alone with ACLR with lateral extra-articular tenodesis (LET) at 6, 12, and 24 months postoperatively. Six hundred eighteen patients undergoing ACLR, all under the age of 25 years either returning to contact pivoting sport or displaying signs of high-grade rotatory laxity or generalized ligamentous laxity, were randomly assigned to receive ACLR alone or ACLR plus LET. A total of 356 of these patients were randomized at centers participating in the functional assessments. Our primary outcome was Limb Symmetry Index, calculated using a series of 4-hop tests at 6, 12, and 24 months postoperatively. Secondary outcome measures included pain, patient-reported function, and isokinetic strength testing. We found no statistically significant difference in the proportion of patients either unwilling or unfit to complete the hop testing in the ACLR alone or ACLR with LET group at 6 months (40 vs 40 respectively; P= 1.00), 12 months (25 vs 27; P= .76), and 24 months (21 vs 23; P= .87). Of those who completed hop testing, there were no statistically significant differences between groups in Limb Symmetry Index at 6, 12, or 24 months. Self-reported function (Lower Extremity Functional Score) significantly favored the ACLR alone group at 3 (P= .01) and 6 months (P= .02) postoperative but was similar by 12 months postoperative. Pain scores (P4) also showed a statistically significant difference in favor of the ACL alone group, but this also resolved by 6 months. Quadriceps peak torque (P= .03) and average power (P= .01) were also significantly different in favor of the ACLR alone group at 6 months postoperative; however, these were similar between groups by 12 months postoperative (P= .11 and P= .32, respectively). The addition of a LET to ACLR results in slightly increased pain, a mild reduction in quadriceps strength, and reduced subjective functional recovery up to 6 months postoperatively. However, thesedifferences do not have any impact on objective function as measured by hop test limb symmetry index. I, Randomized Controlled Trial.

Functional outcome following fixation of distal tibial fracture (Extra articular) with locking compression plate (LCP) using the minimally invasive percutaneous osteosynthesis (MIPO) technique

Background: Distal tibia is more superficial, with minimal soft tissue coverage and poor blood supply, hence operative treatment can lead to complications, making it a challenging surgery. The aim is to see the results of the distal tibial fracture fixation with LCP using MIPO technique.Methodology: Twenty consecutive patients with type AO 43A distal tibia fractures were prospectively included into the study during the period of march 2018 to march 2019 with a follow-up of minimum one year. Fourteen male and six female patients with a mean age of 47 years were reviewed. Patients of Bidar institute of medical sciences with closed extra articular distal tibial fractures who fulfill the inclusion & exclusion criteria were taken in to study after obtaining informed written consent. History, Clinical examination and details of investigations were recorded in the study Performa. Minimally Invasive Percutaneous Plate Osteosynthesis was carried out depending on requirement for specific fracture pattern. These cases were reviewed periodically at 6, 12, 24 weeks and regularly both clinically and radiologically for bony union. Clinical outcome and Radiological criteria (RUST SCORE) regarding fracture union and complications was evaluated and documented. Functional outcome was measured by lower extremity functional score (LEFS).Results: Mean time to union was 6.5 months (range 4–16 months). Sixteen fractures healed with good functional outcome. Two patient had delayed union. One patient had nonunion which was treated with iliac crest bone grafting that ultimately healed with good functional outcome. One patient developed superficial infection that was treated with appropriate antibiotics and the fracture united eventually.Discussion: The MIPO technique for pilon A type fractures is proven ti be more effective over the conventional methods. Early mobilization with no risk of secondary displacement helps to prevent stiffness of the ankle joint and good wound healing.

Rectus femoris tendinopathy: a case report

Tendinopathy may not be noticed in the differential diagnosis due to the complaint of pain spreading to the leg in the presence of nerve radiculopathy in the lumbar discopathy which is seen more frequently in the clinic shows similarity to the leg pain of musculus rectus femoris tendinopathy which is rarely seen. This situation leads to time, labor force and economic loss for both the patient and the health professionals. The case referred to the hospital with severe lower extremity pain and the complaint of incapability to walk. Despite the absence of findings in the imaging reports supporting a discopathy; conventional physiotherapy, intramuscular injection, and nerve blockage treatments were administered for the discopathy due to the clinical presentation. However, the complaints of the patient did not recover. The patient who had pain with a maneuver during exercise training was evaluated regarding tendinopathy and m.rectus femoris tendinitis was diagnosed with ultrasonography. The pain, quality of life and lower extremity functions of the patient were evaluated before and after treatment. The isolated deep transverse friction massage was applied on the tendon for the treatment. A positive change in pain, quality of life and lower extremity function scores was obtained after the five sessions of treatment.