Lower Extremity Functional Scale Research Articles

Operative versus Nonoperative Treatment of Proximal Hamstring Avulsions.

Operative treatment is widely used for acute proximal hamstring avulsions, but its effectiveness compared with that of nonoperative treatment has not been shown in randomized trials. In this noninferiority trial at 10 centers in Sweden and Norway, we enrolled patients 30 to 70 years of age with a proximal hamstring avulsion in a randomized trial and a parallel observational cohort. Treatments were operative reinsertion of the tendons or nonoperative management. The primary end point was the Perth Hamstring Assessment Tool (PHAT) at 2 years of follow-up. Secondary outcomes included scores on the Lower Extremity Functional Scale (LEFS). A total of 119 patients were enrolled in the randomized trial and 97 patients in the observational cohort. In the per-protocol analysis of the randomized trial, the mean (±standard deviation) PHAT scores were 79.9±19.5 and 78.5±19.4 in the operative and nonoperative groups, respectively (PHAT scores range from 0 to 100, with higher scores indicating higher function). The prespecified noninferiority limit of 10 points was not crossed (mean difference, -1.2; 95% confidence interval [CI], -8.6 to 6.2; P=0.009 for noninferiority). Analyses of secondary outcomes, including a mean difference in the LEFS score of -1.6 (95% CI, -5.2 to 2.0), aligned with the primary outcome. The observed numbers of adverse events in the randomized trial were nine in the operative group versus three in the nonoperative group (odds ratio, 0.3; 95% CI, 0.1 to 1.2). In the analysis of the observational cohort, the mean PHAT score difference between the nonoperative and operative treatment groups was -2.6 (95% CI, -9.9 to 4.6). In patients 30 to 70 years of age with proximal hamstring avulsions, nonoperative treatment was noninferior to operative treatment. (Funded by Afa Försäkring and others; ClinicalTrials.gov number, NCT03311997.).

Effectiveness of extracorporeal shock wave therapy on functional ability in grade IV knee osteoarthritis – a randomized controlled trial

Extracorporeal shockwave therapy (ESWT) is a non-invasive physical therapy intervention that has emerged in the recent past to address the upswing of osteoarthritis (OA). However, insufficient evidence is present to prove the efficacy of ESWT on grade IV knee osteoarthritis (KOA). The present study aimed to examine the effects of ESWT on functional ability in patients suffering from grade IV KOA. Thirty volunteers aged 45–60 years with grade IV primary KOA diagnosed by an orthopaedic surgeon based on the Kellgren-Lawrence score participated in the study. The participants were equally and randomly divided into two groups (i.e. experimental and control), with 15 participants in each group. The participants in the control group performed conventional physiotherapy (CPT) that included ultrasound therapy, isometric quadriceps, SLR and isometric hip adductor strengthening exercises. The participants in the experimental group received ESWT in addition to CPT. Lower extremity functional scale (LEFS) score was measured before and after the four weeks of intervention. In both groups, a statistically significant (p = 0.001) improvement in LEFS was observed. In the experimental groups, it improved by 81.92% and in the control groups by 48.15%. A statistically significant (p < 0.001) difference was observed in LEFS post-intervention values between both groups. As demonstrated by our trial results, the addition of ESWT to the CPT program will yield beneficial results in ameliorating the functional disability in patients with primary KOA (grade IV). Further studies are needed to confirm and apply these findings to a larger cohort.

Long-term outcome of fibula flaps in complex limb reconstruction compared to alternative procedures, a median follow up of 41 months.

Complex open long bone fractures present a multidisciplinary surgical challenge. Various treatment options are discussed with no consensus. Fibula flaps (FF) are frequently used in maxillofacial surgery, however their use in limb injuries is less common. With the tremendous improvement in microsurgery, orthoplastic surgery gained importance. Our retrospective study aims to assess the long-term results and the quality of life of the patients operated by FF for complex traumatic limb reconstruction. We conducted an observational mono centric retrospective study from the year 2011 to the year 2021. Patients operated for complicated traumatic limb fractures using FF were included in the study. Not only long-term clinical results were evaluated, but also Patient-reported outcome measures (PROM). These included the Lower Extremity Functional Scale (LEFS), Quick Disabilities of the Arm, shoulder and hand (Qdash), and the Visual Analogue Scale (VAS). The statistical analysis was done using the R Software. Twenty patients were included in our study. 80% achieved complete union with no re fracture rate at a median follow-up of 41 months. All of the patients (n = 4) who underwent amputation were smokers (p = .09), were operated for lower limb fractures (p = .54), and were males (p = 1). The length of hospital stay was associated with an increased duration to complete bony union (p = .01, coefficient = 2.88). At the end of follow-up, the LEFS median score was 67 for the total population and 63.5 for the lower limb reconstructed sub group. VFF is an important tool in the armamentarium of orthoplastic surgeons. Encouraging long term functional and clinical outcomes were obtained in patients with complex traumatic limb fractures.

Comparing complex decongestive therapy in patients with lymphedema of different causes by measuring: extremity volume, quality of life, and functionality.

This study aimed to investigate the effects of complex decongestive therapy (CDT) applied to the lower extremities of patients with lymphedema of different causes on the extremity volume, quality of life (QoL), and functionality. The study included 90 patients, of whom 28 had primary lymphedema, 30 had secondary lymphedema, 18 had phlebolymphedema, and 14 had lipolymphedema. A total of 137 extremities were treated with CDT. The patients who received CDT for 5 days a week for 3 weeks (15 sessions in total) were included in the sample. Extremity volume was measured using a tape measure. The lymphedema QoL-Leg Questionnaire was used to evaluate QoL, and the lower extremity functional scale (LEFS) was administered to assess lower extremity functionality. The changes in QoL before and after treatment significantly differed in the primary lymphedema, phlebolymphedema, and lipolymphedema groups (p < 0.05). The post-treatment LEFS scores indicated a significant decrease in the phlebolymphedema and lipolymphedema groups compared to the pre-treatment scores (p < 0.05). The difference in appearance, which is one of the sub-parameters of QoL, significantly decreased in the comparisons performed between the groups, whereas the changes in the remaining parameters were not significant.

Impact of a Six-Week Treadmill Walking Program Combined with Submaximal Inspiratory Exercise in a Prehypertensive Female Living with Multiple Sclerosis: A Case Report

&amp;lt;i&amp;gt;Introduction:&amp;lt;/i&amp;gt; Multiple sclerosis (MS) can result in a range of disability, cognitive and ambulatory dysfunction, depression, fatigue, pain, and reduced quality of life. Hypertension has also been identified as a comorbidity for people living with MS. This case report investigated the impact of a six-week treadmill walking program combined with submaximal inspiratory exercise in a 39-year-old prehypertensive female living with MS. &amp;lt;i&amp;gt;Case Description:&amp;lt;/i&amp;gt; The patient was referred for outpatient physical therapy to manage prehypertension and symptoms associated with MS. The patient completed a six-week treadmill walking program combined with submaximal inspiratory exercise. Outcomes included were systolic blood pressure (SBP), diastolic blood pressure (DBP), Numeric Pain Rating Scale (NPRS), Modified Fatigue Impact Scale (MFIS), and Lower Extremity Functional Scale (LEFS). &amp;lt;i&amp;gt;Results:&amp;lt;/i&amp;gt; Following six weeks of intervention, the patient&amp;apos;s resting SBP decreased from 128 mmHg to 122 mmHg and resting DBP decreased from 88 mmHg to 82 mmHg. The patient&amp;apos;s fatigue level, measured with MFIS, improved from 57/84 to 35/84. LEFS increased from 26/80 to 39/80 with improvements in balance, walking, and stair-climbing activities. &amp;lt;i&amp;gt;Discussion:&amp;lt;/i&amp;gt; A six-week treadmill walking program combined with submaximal inspiratory exercise effectively lowered resting blood pressure and MS-related symptoms, improving the patient&amp;apos;s quality of life and functional capabilities.

A RANDOMIZED CONTROLLED TRIAL ASSESSING TRADITIONAL VERSUS DYNAMIC REHABILITATION REGIMES FOLLOWING SURGICAL REPAIR OF A PROXIMAL HAMSTRING TENDON AVULSION

Proximal hamstring tendon avulsion from the ischial tuberosity is a significant injury, with surgical repair shown to have superior functional outcomes compared to non-surgical treatment. However, limited data exists regarding the optimal rehabilitation regime following surgical repair. The aim of this study was to investigate patient outcomes following repair of proximal hamstring tendon avulsions between a conservative (CR) versus an accelerated rehabilitation (AR) regimen.This prospective randomized controlled trial (RCT) randomised 50 patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR=25) or an accelerated, unbraced regime, that permitted full weight-bearing as tolerated (AR=25).Patients were evaluated pre-operatively and at 3 and 6 months post-surgery, via patient-reported outcome measures (PROMs) including the Lower Extremity Functional Scale (LEFS), Perth Hamstring Assessment Tool (PHAT) and 12-item Short Form Health Survey (SF-12). Primary analysis was per protocol and based on linear mixed models.Both groups were matched at baseline with respect to patient characteristics. All PROMs improved (p&gt;0.05) and, while the AR group reported a significantly better Physical Component Score for the SF-12 at 3 months (p=0.022), there were no other group differences. Peak isometric hamstrings strength and peak isokinetic quadriceps and hamstrings torque symmetry were all comparable between groups (p&gt;0.05). Three re-injuries have been observed (CR=2, AR=1).After proximal hamstring repair surgery, post-operative outcomes following an accelerated rehabilitation regimen demonstrate comparable outcomes to a traditionally conservative rehabilitation pathway, albeit demonstrating better early physical health-related quality of life scores, without an increased incidence of early re-injury.

Treatment of Large Femoral and Tibial Bone Defects With Plate-Assisted Bone Segment Transport.

The purposes of this study were to assess clinical and radiographic outcomes following plate-assisted bone segment transport (PABST) in large bone defects of the lower extremities. Retrospective study of prospectively collected data. Level-1 trauma center located in Germany. Patients who underwent PABST and were at least 1 year postoperatively were included. Demographic data were collected. Radiographic apparent bone gap (RABG), time to consolidation, time to full weight-bearing, and consolidation index were calculated. Numeric rating scale, lower extremity functional scale (LEFS), and complications were assessed. Fifteen patients [13 male; mean age 51 years (range, 20-75)] underwent PABST and had follow-up at a mean of 29.1 months. The tibia was affected in 8 and the femur in 7 patients. Preoperative RABG was 60 mm [interquartile range (IQR): 40-125], and bone defects were caused by septic nonunions in 73% of patients. Fourteen patients (93%) demonstrated consolidated transport callus at 7.3 months [95% confidence interval (95% CI), 6-8.5], and 9 patients (60%) demonstrated complete consolidation of both docking site and transport callus at 11.5 months (95% CI, 7.3-15.3). Postoperative RABG was 0.1 mm (IQR: 0-0.8), and consolidation index was 1.9 months/cm (95% CI, 1.3-2.5). All patients achieved full weight-bearing at 8.7 months (IQR: 6.5-10.3). LEFS was 42 (95% CI, 34-50), and numeric rating scale was 3 (95% CI, 2-4). Patients treated for tibial defects had a significantly higher consolidation rate compared with patients treated for femoral defects ( P = 0.040). PABST demonstrated high consolidation of transport callus with few complications. Although full weight-bearing was achieved in all patients, complete consolidation of the docking site was only present in 60% of cases. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A RANDOMIZED CONTROLLED TRIAL ASSESSING A BRACE-FREE AND ACCELERATED WEIGHT-BEARING PROTOCOL AFTER SURGICAL REPAIR OF ACUTE PROXIMAL HAMSTRING TENDON AVULSIONS

INTRODUCTION &amp; AIMS Proximal hamstring tendon avulsion from the ischial tuberosity is a significant injury, with surgical repair advocated. After surgery, limited data exists regarding the optimal rehabilitation regime with extensive variation in published protocols. This study investigated patient outcomes following a traditionally conservative (CR) versus accelerated (AR) rehabilitation regimen after proximal hamstring tendon repair. METHODS This prospective randomized controlled trial (RCT) allocated 50 patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR=25) or an accelerated, unbraced regime, that permitted full weight-bearing as tolerated (AR=25). Patients were evaluated pre-operatively and at 3, 6 and 12 months post-surgery, via patient-reported outcome measures (PROMs) including the Lower Extremity Functional Scale (LEFS), Perth Hamstring Assessment Tool (PHAT) and 12-item Short Form Health Survey (SF-12). The single (SHD), triple (THD) and triple crossover (TCHD) hop tests were assessed at 6 and 12 months, as was peak isometric hamstring strength and peak isokinetic knee extensor and flexor torque. RESULTS All PROMs improved (p&amp;gt;0.05) and, while the AR group reported a significantly better Physical Component Score for the SF-12 at 3 months (p=0.022), as well as a lower severity of hamstring pain at 12 months (p=0.032), there were no other group differences. Peak isometric hamstrings strength and peak isokinetic quadriceps and hamstrings torque symmetry were all comparable between groups (p&amp;gt;0.05). While the AR group demonstrated significantly better (p=0.009) limb symmetry for the THD at 6 months, no other hop test differences were seen between groups. Three re-injuries have been observed (CR=2, AR=1). CONCLUSION After proximal hamstring repair surgery, post-operative outcomes following an accelerated rehabilitation regimen were largely comparable to a traditionally conservative

Comparison of pre- and post-implantation of Indonesian-made plates in fracture patients: Functional, radiological, biomechanical and chemical analyses.

Bone implants are important in the recovery of fractures and degenerative diseases. Although many implants have been marketed, study on Indonesian-made plates is still limited. The aim of this study was to assess the patients' functional and radiological improvements and biomechanical and chemical changes of Indonesian-made plates used in long bone fractures. retrospective study was conducted at Semen Gresik Hospital, Gresik, Indonesia. This study included adult patients with long bone fractures who had surgeries with Indonesian plates. Functional improvement (assessed using disabilities of arm, shoulder, and hand (DASH) or lower extremity functional scale (LEFS)) and radiological data (assessed using radiographic union score (RUS)) were assessed in week 4 and month 6, 12, and 15 after surgery. Biomechanical changes (hardness and roughness test) and chemical analysis were assessed after 15 months of use. The normality of the data was tested with Shapiro-Wilk while data analysis was conducted using paired Student t-test or Friedman test as appropriate with type of data. Our data indicated that the DASH and LEFS functional scores had significant improvement over the follow-ups indicating functional recovery. RUS scores also improved over time, indicating a good healing process. Hardness tests on post-surgery implants showed a decrease in hardness of 7.3% and an increase of 3.3% in roughness. Chemical analysis showed a reduction in chemical levels in the implant of 7.8%, indicating durability and minimal toxicity. This study highlights that Indonesian implants have been proven safe to use in fractures. Further examinations with a larger sample and a longer duration of monitoring are recommended for stronger validity.

Effectiveness of dry needling on pain & disability in athletes with iliotibial band tightness- a clinical trial

IntroductionDry needling (DN) for Myofascial trigger points (MTrP's) can be done on superficial or deep tissue levels for the management of a range of neuromusculoskeletal pain disorders. There is still much to learn about dry needling, despite the fact that it has been demonstrated to be useful for a variety of illnesses. The aim of the current study was to determine the effectiveness of DN with stretching on pain and disability in the treatment of athletes with iliotibial band (ITB) tightness. DesignA Clinical Trial. MethodsFor this study, 38 athletes both male and female, aged between 18 to 28 years, with tight iliotibial bands were divided into two groups: DN (n = 19) [Mean age (Years) 21.11 ± 2.96, Height (Cm) 171.16 ± 8.97, Weight (Kg) 63.73 ± 14.12, BMI (Kg/m2) 21.68 ± 3.53] and control group (n = 19) [Mean age 20.26 ± 2.37 (Years), Height (Cm) 166.31 ± 7.97, Weight (Kg) 56.02 ± 9.49, BMI (Kg/m2) 20.17 ± 2.39] who received ITB stretching. As outcome measures both before and after the treatment, the Visual Analogue Scale (VAS) and the Lower Extremity Functional Scale (LEFS) were used. ResultsThe difference in pain and functional scale was assessed using paired and unpaired t-tests. Post-treatment, individuals who received DN showed statistically greater improvements in pain (p = 0.000) and disability (p = 0.001) than those who received stretching. ConclusionAccording to this trial's findings, three sessions of DN with stretching are more effective at reducing pain and enhancing iliotibial band functionality.

PATIENT-REPORTED OUTCOME MEASURES AFTER OPEN LOWER LIMB FRACTURE REPAIR

IntroductionOpen fractures are complex injuries associated with substantial morbidity. These injuries are associated with harm to both physical and emotional health as well as preclusion of work, social, and leisure activities. Patient reported outcome measures (PROMs) and health related quality of life are critical indicators of successful rehabilitation following open fracture treatment. This study aimed to measure the PROMs for patients with open lower limb fractures and investigate the relationship with injury severity.Materials &amp; MethodsA retrospective cohort study was performed at a single major trauma centre in the UK. All adult patients with an open lower limb fracture were eligible for inclusion. Patients were identified through a search of a local Open Fracture Database. Epidemiological, clinical, and fracture classification data were obtained by reviewing case notes. Lower Extremity Function Scale (LEFS) and EQ5-D were used as PROMs and measured by a postal questionnaire, alongside return to employment data.ResultsA total of 73 patients responded to the questionnaire. Median LEFS was 42 (IQR 26.5 – 59.5), and median EQ5-D was 0.69 (IQR 0.48 – 0.89). There was no significant association between open fracture classification and PROMs. Over 40% of patients reported a change in employment due to their injury. Those who changed jobs had a statistically significant reduction in the EQ5-D of 0.12 (p = 0.021); no significant difference existed in LEFS.ConclusionsThis study demonstrates the devastating functional impact of open fractures. This cohort of open injuries reported lower functional and quality-of-life measures compared to population norms. Injury classification was not a valuable predictor of PROMs. A substantial proportion of patients were forced to change employment due to their injury, and these patients reported a significantly lower quality of life. Further work is required to understand the factors contributing to open fracture PROMs.

Validation and evaluation of the Russian version of the SEFAS questionnaire for assessing foot and ankle in surgically treated patients with forefoot disorders

Introduction The Self-reported Foot and Ankle Score (SEFAS) is one of the foot health assessment tools in Sweden. Validation procedures, reliability, validity, sensitivity, approval are essential for the Russian version of the questionnaire with a new language environment.The objective was to validate the Russian version of the SEFAS questionnaire and approve the tool in the Russian surgical patients with foot disorders.Material and methods The questionnaires the patients completed preoperatively included SEFAS, SF‑36, a general health survey questionnaire, and the Lower Extremity Functional Scale (LEFS). Patients were requested to complete the SEFAS questionnaire at 2 months of surgery to assess the sensitivity of the instrument. Based on the case histories clinical researcher recorded general and physical parameters of the patients to include gender, age, socio-demographic data, nature of the foot disorder, a dorsiflexion angle of the first metatarsophalangeal joint. To assess the reproducibility of the Russian version of the questionnaire, some patients were requested to complete the SEFAS questionnaire twice preoperatively with an interval of one day.Results The questionnaire was characterized by good internal consistency and reproducibility indicating acceptable reliability of the Russian version of SEFAS. Statistically significant correlations of varying strength were seen between the SF-36 scores and nearly all the selected questions of the SEFAS Russian version. Statistically significant correlations (moderate to weak) were observed between the LEFS total score and the selected SEFAS questions. Minimal clinically significant changes in MCID scored 3 in the assessment of clinical interpretability of the Russian version of SEFAS.Discussion The study demonstrated the reliability, validity and sensitivity of the Russian version of the SEFAS questionnaire. The questionnaire appeared to be an informative and clinically interpretable instrument for assessing foot in surgical adult patients with foot disorders.Conclusion The SEFAS questionnaire can be recommended for Russian trauma and orthopaedic practice to learn the patient's opinion of the condition.

Surgical outcome of angular deformity correction of lower limbs in rickets: a cross-sectional study.

This study aims to compare the functional and radiological outcomes following both guided growth surgery (GGS) and acute corrective osteotomy (ACO) correction of angular deformities in children with rickets. A total of 8 and 7 children who had gradual GGS and ACO correction, respectively, for angular deformities due to rickets from 2002 to 2022 were recalled for follow-up. Demographic data, types of rickets, data on pharmacological treatment, biochemical parameters, recurrence of angular deformity and postoperative complications were obtained from the medical records. A radiographic evaluation of the leg was performed to determine the tibiofemoral angle. For functional evaluation, the Active Scale for Kids (ASK) and Lower Extremity Functional Scale (LEFS) instruments were used for children below and above 15years old, respectively. In terms of the tibiofemoral angle, the GGS group documented greater angle changes compared to the ACO group, but the difference was not significant. In terms of functional outcomes, the overall score percentage of both groups was comparable with the GGS group showing a trend of higher score percentage compared to the ACO group. The GGS group presented no complication while 2 neurovascular injuries and 1 implant failure were recorded in the ACO group. Both GGS and ACO procedures resulted in similar radiographic and functional outcomes for the treatment of rickets in children. GGS may be advantageous in terms of reducing complications of surgery. Nevertheless, the choice of surgical intervention should be made based on the patient's circumstances and the surgeon's preference.

Validity and Reliability of the Lower Extremity Motor Coordination Test (LEMOCOT) in Patients with Multiple Sclerosis

The validity and reliability of the Lower Extremity Motor Coordination Test (LEMOCOT) were assessed in patients with multiple sclerosis (MS). The study involved 60 participants diagnosed with MS (mean age: 48.13 years, range: 24–80 years). Intra-rater reliability was assessed within-day (n = 12), and inter-rater reliability was assessed within-day (n = 45) and between-days (n = 22). For known-groups validity, test scores were compared between participants of different sexes; for convergent validity, test scores were correlated with age, the Five-Repetition Sit-to-Stand test (FSTS), the Berg Balance Scale (BBS), the Lower Extremity Functional Scale (LEFS), and the Expanded Disability Status Scale (EDSS). To test the discriminant validity, the LEMOCOT test scores were correlated with the Mini-Mental State Evaluation (MMSE) and compared according to social history (living alone or not). The LEMOCOT test was tested under three different conditions and found to be very reliable (intraclass correlation coefficient, ICC2,1 &gt; 0.94) with an acceptable error level (standard error of the measurement, SEM, between 1.39 and 3.47 targets and 95% minimum detectable change; MDC95%, between 3.84 and 9.58 targets). Convergent validity was verified, as the LEMOCOT registered very strong correlations with the FSTS test (r = −0.851) and the BBS scale (r = 0.815), a strong correlation with the LEFS scale (r = 0.78), a moderate correlation with the EDSS scale (r = −0.634), all highly significant (p &lt; 0.001), and a weak correlation with age (r = −0.332, p &lt; 0.01). Discriminant validity was also confirmed, as the LEMOCOT demonstrated a weak correlation with the MMSE scale (r = 0.365, p = 0.017) and no differences relative to living environment or sex. The LEMOCOT demonstrated excellent reliability and validity for patients with MS.

Effect of a Manual Lymphatic Drainage with Rehabilitation Exercise on Edema, Pain, And Lower Extremity Function in Gynecological Cancer After Surgery

This study aimed to determine the effects of manual lymphatic drainage with rehabilitation exercises on edema, pain, and lower extremity function in patients with gynecological cancer after surgery. The study included 20 patients with gynecological cancer with a Numeric Rating Scale (NRS) pain score &gt;3, who were either inpatients or outpatients in Seoul. The patients were randomly assigned to either the experimental group (n=10) or control group (n=10). The experimental group underwent manual lymphatic drainage with rehabilitation exercises, whereas the control group underwent manual lymphatic drainage with diaphragmatic breathing. Each patient was treated for 50 min twice a week for 4 weeks. Before and after the experiment, edema, pain, lower extremity function, and quality of life were evaluated using the Circumference Tape, Numeric Rating Scale, Lower Extremity Functional Scale, and Memorial Symptom Assessment Scale. The results of this study were as follows. First, the edema between the experimental and control groups significantly decreased before and after the intervention; however, there was no significant difference in the comparison between the groups. Second, the pain scores between the experimental and control groups significantly decreased before and after the intervention, and there was a significant difference in the comparison between the groups. Third, the lower extremity function between the experimental and control groups significantly increased before and after the intervention, and there was no significant difference between the groups. Forth, the quality of life between the experimental and control groups significantly increased before and after the intervention, and there was significant difference in the comparison between the group. The physical symptoms were significantly different between the groups; however, the emotional symptoms were not. The analysis of this experiment showed that, both the groups were effective in improving edema, pain, lower extremity function, and quality of life in patients with gynecological cancer undergoing surgery. In particular, manual lymphatic drainage with rehabilitation exercises was more effective than manual lymphatic drainage with diaphragmatic breathing for edema and physical symptoms of patients with gynecological cancer after surgery.

Quality of Life After Lower Leg Reconstruction With the Latissimus Dorsi Free Flap in Pediatric Patients.

The latissimus dorsi free flap is a widely used reconstructive technique for complex lower leg defects in the pediatric population due to its reliability and anatomical features. However, the impact of this technique on the postoperative quality of life in children and adolescents, who require appropriate lower extremity function during their developmental period, remains to be analyzed. Patients who underwent microsurgical lower leg reconstruction using the latissimus dorsi flap were analyzed retrospectively. The quality of life of these patients was assessed prospectively using the Lower Extremity Functional Scale (LEFS) at a minimum of 18 months after surgical reconstruction. Sixteen pediatric patients who had severe lower extremity injuries and underwent latissimus dorsi free flap reconstruction met the inclusion criteria. The mean follow-up period was 33.9 months (22-64 months). Two patients experienced postoperative complications: one had partial flap necrosis and surgical site infection, while the other developed a surgical site infection. The LEFS scores ranged from 26 to 80, with a mean score of 64.6. Remarkably, 14 of 16 patients achieved LEFS scores consistent with at least the 10th percentile when compared with normative data. Patients with severe associated fractures presented with the lowest scores. Based on our findings, the latissimus dorsi flap is reaffirmed to be an excellent choice for lower leg reconstruction in the pediatric population. It effectively restores the quality of life in patients who have experienced moderate to severe lower extremity injuries.

Proximal Hamstring Repair With All-Suture Anchors and an Accelerated Rehabilitation and Bracing Protocol Demonstrates Good Outcomes at 1-Year Follow-Up

To evaluate patient-reported outcomes and risk for rerupture after surgical treatment of proximal hamstring tendon ruptures using all-suture anchors and a unique postoperative bracing strategy. A retrospective review of a prospectively collected database was conducted of patients undergoing proximal hamstring repair or reconstruction from 2020 to 2022 at a tertiary, academic institution. Patients were included if they reached minimum 1-year follow-up and completed postoperative patient-reported outcomes. The surgical protocol for proximal hamstring repairs included all-suture anchors placed either in an open or endoscopic fashion in the ischial tuberosity. After surgery, all patients underwent an accelerated rehabilitation protocol, including 6 weeks touchdown weight-bearing in a hinged knee brace locked in extension for ambulation, allowing passive knee flexion to 90° while seated. Descriptive statistics were used to analyze the data. Twenty-one patients were included (mean age 50.4 ± 9.5 years, body mass index 24.4 ± 3.5, 66.7% female). Lower Extremity Functional Scale score achieved postoperatively was 74.2 ± 7.5 (out of 80). Patients had minimal pain (mean visual analog scale pain score of 0.9 ± 1.2). 61.9% of patients were able to return to the same level of activity after based on Tegner score by 1 year. Postoperative Single Assessment Numeric Evaluation activity of daily living was 94.3 ± 8.3, and Single Assessment Numeric Evaluation Sports was 82.3 ± 19.0. Mean Short Form Survey (SF-12) postoperative scores were 51.6 ± 6.8 for SF-12 Physical Component Score and 53.9 ± 9.7 for Mental Component Score. 95.2% (20 of 21) patients were satisfied with their outcome. There were no reruptures, infections, or reoperations. One patient of 21 (4.8%) incurred a postoperative deep venous thrombosis, which was treated with therapeutic anticoagulation for 3 months. All-suture anchors for proximal hamstring repair with a unique accelerated postoperative rehabilitation and bracing protocol result in good outcomes and patient satisfaction with minimal risk of complications. Level IV, case series, therapeutic.

Combined Hip and Knee Strengthening Compared With Knee Strengthening for Individuals With Lateral Patellar Dislocation: A Single-blind, Superiority, Randomized Controlled Trial

ObjectiveTo investigate whether a combined hip and knee muscle strengthening program is superior to a knee strengthening program for people after lateral patellar dislocation (LPD). DesignSingle-blind, superiority, randomized controlled trial with 48 weeks follow-up. SettingPhysiotherapy out-patient clinic. ParticipantsForty individuals aged 16 or older, with a history of non-traumatic LPD were randomized to a knee-based strengthening (KBSG) or quadriceps and hip strengthening exercise (HQSG) program (N=40). Inclusion criteria included a positive apprehension sign, pain on palpation along the medial retinaculum, and J sign. Exclusion criteria included restricted range of motion (<90° knee flexion), and traumatic or postsurgical LPD. InterventionsConcealed randomization was performed using random permuted blocks of size 4. Individuals received their corresponding exercise program according to randomization and group allocation: knee-based strengthening (n=20) or combined hip and quadriceps strengthening (n=20) twice weekly for 8 weeks over 16 appointments. Main Outcome MeasuresPrimary outcome was the Lysholm Knee Score. Secondary outcomes included Numerical Pain Ratings Scale (NPRS) at rest and during effort, Norwich Patellar Instability Score (NPIS), Kujala Anterior Knee Pain Scale (AKPS), Lower Extremity Functional Scale (LEFS), 4 domains of the WHOQOL-Bref, and recurrence rate. Patient-reported outcome measures were assessed from the baseline to 48 weeks. Assessments were performed by a physiotherapist who was blinded to the group allocation. Data were analyzed by using a repeated-measures ANOVA model with Tukey's post hoc test after an intention-to-treat principle. ResultsAt the primary time-point of 8 weeks, there were no substantial between-group differences in the Lysholm Knee Score: mean difference=-6.8 (95% CI -14.3 to 3.7); NPIS: mean difference=23.5 (95% CI 5.6 to 41.3); AKPS: mean difference=-1.54 (95% CI -8.6 to 5.6), NPRS at rest and during effort (mean difference=0.32 (95% CI -0.37 to 1); and mean difference=0.68 (95% CI -0.9 to 1.86); LEFS mean difference=-1.08 (95% CI -5.9 to 2.4), WHOQOL-Bref domains (physical health: mean difference=-0.12, (95% CI -1.26 to 1.02); psychological: mean difference=-0.32 (95% CI -2.04 to 1.4); social relations: mean difference=-0.7 (95% CI -2.2 to 0.82); environment: mean difference=0.44 (95% CI -1 to 1.9), and recurrence rate (P=.69). ConclusionThis study indicates that combined hip and knee muscle strengthening is not superior to knee-based strengthening for LPD treatment. The limitations stemming from the underpowered nature of the trial must be acknowledged, concerning the potential oversight of moderate intervention effects.

Comparative study of retrograde intramedullary nailing versus locking extramedullary plating in complete articular fractures with metaphyseal comminution of the distal femur.

Fractures of the distal femur with metaphyseal comminution and complete intra-articular involvement (AO/OTA classifications 33C2 and 33C3) present challenges for reduction and fixation. However, an optimal fixation method remains unknown. This study aimed to compare the clinical and radiographic outcomes of locking extramedullary plating (LEP) and retrograde intramedullary nailing (RIN) for complete distal femoral intra-articular fractures with metaphyseal comminution. Between January 2016 and May 2022, 80 patients (45 men and 35 women; average age, 56.7 years) diagnosed with AO/OTA 33C2 and 33C3 were treated with either LEP or RIN and followed up for at least one year. Post-operative evaluations included radiographic assessments of bone union rate, timing, and alignment. Clinically, the knee joint range of motion (ROM), lower extremity functional scale (LEFS), and Kellgren and Lawrence (KL) grade were analyzed. The complications were also compared. 36 underwent LEP and 44 underwent RIN. Bone union was observed in 69.4% and 63.6% of the patients in the LEP and RIN groups, respectively (p = 0.64). The average union time was 6.9 months for the LEP group and 6.6 months for the RIN group (p = 0.51). A tendency toward varus deformity was observed in the RIN group, although the difference was not statistically significant. No significant differences were observed in knee ROM, LEFS, or KL grade. Complications included non-union (33.8%; RIN, 11; LEP, 16), varus deformity (5%; RIN, 4; LEP, 0), infection (1.3%; RIN, 0; LEP, 1), heterotrophic ossification (1.3%; RIN, 0; LEP, 1), and wound dehiscence (2.5%; RIN, 2; LEP, 0). The surgical fixation methods, RIN and LEP, for complete distal femoral intra-articular fractures with metaphyseal comminution showed similar clinical and radiological outcomes. However, regardless of the type of fixation device used, there was a reduced rate of bone union owing to high energy and a less favorable prognosis.

Comparison of Self-Reported and Capacity-Based Measures of Mobility in Community-Dwelling Older Adults in Nigeria: The Mediating Role of Age, Cognitive Status, and Chronic Conditions.

Although the association between self-reported and capacity-based mobility outcomes is prominently researched, the pathways through which self-reported measures affect capacity-based measures remains poorly understood. Therefore, our study examines the association between self-reported and capacity-based mobility measures and explores which mobility determinants mediate the association in Nigerian community-dwelling older adults. This cross-sectional study included 169 older adults [mean age (SD) = 67.7 (7.0)]. Capacity-based mobility outcomes included the Short Physical Performance Battery (SPPB), the 6-Minute Walk Test (6MWT), and the 10-Meter Walk Test (10mWT), whereas the self-reported mobility outcomes included the Lower Extremity Functional scale (LEFS), the Life Space Questionnaire (LSQ), and the Mänty Preclinical Mobility scale (inability to walk 2 km, 0.5 km, or climb a flight of stairs). Spearman's correlations were conducted to examine the relationship between self-reported and capacity-based mobility measures, whereas structural equation modeling was used to determine the mediators. The correlation between SPPB and LEFS (rho = 0.284) and 0.5 km (rho = -0.251) were fair, whereas the correlation between SPPB and inability to walk 2 km (rho = -0.244) and inability to climb a flight of stairs (rho = -0.190) were poor. Similarly, correlations between 6MWT and the LEFS (rho = 0.286), inability to walk 2 km (rho = -0.269), and 0.5 km (rho = -0.303) were fair. The 6WMT was poorly correlated with inability to climb one flight of stairs (rho = -0.233). The LSQ was not correlated with SPPB or 10mWT. Age was the only significant mediator, whereas the number of chronic conditions and cognitive status were not. The correlation between self-reported and capacity-based mobility outcomes in older adults in Nigeria is lower than those in developed countries. Our analysis provides a foundation to explore mobility determinants that could be predictive mediators for mobility outcomes, making meaningful contributions to explaining mobility complexities.