Lower Extremity Functional Scale Research Articles

Is Prehabilitation Effective on Modified Broström Procedure for Chronic Lateral Ankle Instability?

Category: Sports; Ankle Introduction/Purpose: The clinical features of chronic lateral ankle instability (CLAI) consist of mechanical and functional instability. Mechanical instability can be identified by physical examination of the injured anterior talofibular ligament laxity and can be treated with surgical ligament repair. Functional instability is more related to the patient's subjective symptoms due to decreased muscle strength, range of motion (ROM), coordination, and proprioception. In a previous report, ankle instability recurred in 16% after the modified Broström procedure (MBP) despite postoperative rehabilitation. Functional instability should be treated along with mechanical instability. We hypothesized that applying preoperative physiotherapy (prehabilitation) to patients with CLAI would improve postoperative functional recovery. We designed and performed a structured prehabilitation protocol for CLAI patients scheduled for MBP and investigated postoperative effects. Methods: Between March 2021 and December 2022, 28 patients were prospectively enrolled. Patients were randomly assigned to prehabilitation group (P) or non-prehabilitation group (N). Fourteen patients were enrolled in group P, and they started a 4-week prehabilitation protocol that continued the physiotherapy until 6 weeks postoperatively. Group N included 14 patients who received the same protocol of physiotherapy only for 6 weeks after surgery. The physiotherapy protocol consisted of peroneal muscle strengthening using Thera-band, gastro-soleus stretching, bipedal calf raises, single limb stance, step down with single limb, and box hop/quadrant hop. Outcome measurement was performed 1 day before MBP, 4 weeks and 6 weeks after surgery. The visual analogue scale, AOFAS ankle hindfoot scale, Karlsson scale, Foot and Ankle Ability Measure (FAAM-activities of daily living: ADL and FAAM-sports), Lower Extremity Functional Scale (LEFS), and ankle ROM were investigated. All data were statistically analyzed. Results: The mean ages were 27.0 ± 8.46(P), 29.7 ± 7.54(N), and there were 4 (28.6%, P) and 6 (42.9%, N) males. There were no statistical differences between the two groups in age and gender distribution. As shown in the attached table comparing clinical outcomes between the two groups, AOFAS ankle hindfoot scale, Karlsson scale, FAAM-ADL, and LEFS 1 day before MBP were statistically significantly higher in group P than in group N. Compared to group N, group P improved ankle inversion and eversion 1 day before MBP (p < 0.05 each). Although there was no statistical significance, the mean of Karlsson scale, FAAM-ADL subscale, FAAM-sports subscale, and LEFS were all maintained higher in group P than in group N from before MBP to 6 weeks after surgery. Conclusion: Our findings demonstrated the importance of functional recovery along with mechanical stability in the treatment of CLAI. Functional scores tended to be maintained higher in group P than in group N from preoperative to postoperative follow-up period. However, the number of participants included in our study was relatively small at 28. Larger studies with long-time follow- up will be needed. In conclusion, a structured prehabilitation may improve functional recovery when performing MBP for CLAI.

Should We Fix Them? A Comparison of Outcomes at Mid-Term Follow-Up of Operatively and Non- Operatively Treated Weber B Ankle Fractures

Category: Trauma; Ankle Introduction/Purpose: Our group previously presented a novel protocol for non-operative management of Weber B ankle fractures with medial clear space (MCS) < 7mm on gravity stress (GS) radiographs and within 2mm of ipsilateral superior clear space and contralateral GS MCS. The goal of this study is to recruit an operative cohort for comparison of clinical, radiographic, and patient reported outcomes. Methods: We recruited a cohort of patients who may have been considered for the non-operative protocol but underwent surgery instead. Outcome measures were obtained including Kellgren-Lawrence scale for evaluation of arthritis, American Orthopedic Foot & Ankle Society (AOFAS) Hindfoot, Olerud Molander Ankle (OMA), Lower Extremity Functional Scale (LEFS), and PROMIS (physical function, depression, pain interference) scores. This data was then compared to the non-operative cohort. Results: There were 20 patients in the operative cohort and 29 in the original non-operative cohort. Mean follow-up was 6.9 and 6.7 years, respectively. Average outcome scores were as follows for the operative and non-operative groups, respectively: LEFS, 68.1 and 75.2 (p=0.009); OMA, 89.0 and 94.1 (p=0.05); AOFAS, 91.7 and 98.5 (p=0.0003); PROMIS Physical Function, 50.4 and 58.2 (p=0.01); PROMIS Depression, 45.4 and 42.8 (p=0.29); PROMIS Pain Interference, 49.7 and 42.2 (p=0.004). All patients in both groups achieved union of their fracture. There was no difference in Kellgren-Lawrence arthritis scores though interobserver reliability for scoring was poor. In the surgical cohort there were 3 (15%) cases of implant removal, 1 (%) SPN neurapraxia, and 1 (%) delayed wound healing. Conclusion: In carefully selected patients with isolated Weber B fractures and MCS < 7mm on gravity stress radiographs that is within 2mm of ipsilateral superior clear space and contralateral GS MCS, non-operative management may be considered as it can lead to equivalent or superior outcomes with none of the risks typically associated with surgical intervention.

The effect of post-traumatic long bone non-unions on health-related quality of life

BackgroundFracture non-unions have a detrimental effect on patients due to reduced mobility and severe pain. Current literature on the quality of life in non-unions is limited, hence the purpose of this study, to quantify the health-related quality of life (HRQoL) among patients with post-traumatic long bone non-unions. It was hypothesized that the HRQoL of these patients is lower than the Dutch population standard as well as for multiple chronic diseases and musculoskeletal disorders. Patients and methodsFrom January 2020 to December 2021, this study included consecutive patients who were referred to a multidisciplinary (trauma, orthopedic and plastic surgery), non-union clinic at the Maastricht UMC+. All non-unions were evaluated using the Non-Union Scoring System (NUSS) questionnaire. Patient reported HRQoL outcomes were acquired using the EQ-5D-5L questionnaire and the Lower Extremity Functional Scale (LEFS). Results50 patients were included, 18 females and 32 males, with a mean age of 55 years (± 15.5 SD). Eighteen patients presented with an open fracture, nine non-unions were infected and 39 patients had a lower extremity non-union. The mean NUSS score was 39.61 (± 14.6 SD). The mean EQ-5D-5L index score was 0.490 (± 0.261 SD), where patients experienced most problems with mobility. The mean EQ-5D-5L VAS was 61.4 (± 19.6 SD). The patients had a mean LEFS score of 28.7 (± 16.4 SD). The health-related quality of life was well below the age-corrected normative score of the Dutch population (EQ-5D-5L 0.857(p < 0.001); LEFS 77(p < 0.001)). This cohort's HRQoL was significantly lower than the HRQoL of multiple chronic and musculoskeletal disorders, including different forms of cancer and osteoarthritis. ConclusionsThis study has quantified the detrimental effect of post-traumatic long bone non-unions on patient's health-related quality of life, being significantly lower than the HRQoL of the Dutch population as well as for multiple chronic and musculoskeletal medical conditions. This cohort demonstrates a patient population in need of more specialized care with a low health-related quality of life.

Patient-Reported Outcomes Following Breast Reconstruction With the Transverse Myocutaneous Gracilis Flap Using the BREAST-Q and Lower Extremity Function Scale.

The transverse myocutaneous gracilis (TMG) flap is a viable and safe option for breast reconstruction in patients with limited abdominal tissue or other contraindications for abdominal-based flaps. Although it is one of the most common flaps employed for breast reconstruction, data on patient-reported outcomes is limited. The authors seek to evaluate patient satisfaction and aesthetic outcome after breast reconstruction with the TMG flap. All patients who underwent breast reconstruction with a TMG flap between March 2010 and October 2020 were identified. Invitation to a digital version of the BREAST-Q reconstructive module and the Lower Extremity Function Scale (LEFS) was sent to 105 patients. Patient demographics, complications, and surgical details were collected and retrospectively analyzed. BREAST-Q and LEFS scores were calculated and compared to the literature. Eighty-two patients participated in the study. Median follow-up was 5.9 years, with a mean patient age of 45.7 years. Most patients (90.2%) received treatment due to previous cancer of the breast, and 17.1% underwent immediate reconstruction. The mean score for "Satisfaction with Breast" was 66/100. Postoperative lower extremity function was high, with a median LEFS score of 78/80. A LEFS score below the median value was found to be significantly associated with active smoking (P = .049). Patients also reported high satisfaction with donor sites (8/11). Patient satisfaction and aesthetic outcome after breast reconstruction with TMG flaps is high and comparable to other common techniques. Lower extremity function is not impaired after flap harvest.

Impact of multimodal analgesia on postoperative anxiety and depression following total knee arthroplasty

BackgroundPostoperative pain after total knee arthroplasty (TKA) can cause negative emotions, such as anxiety and depression, which can severely affect a patient’s long-term quality of life.ObjectiveThis study aimed to investigate the impact of multimodal analgesia (MMA) on postoperative anxiety and depression following total knee arthroplasty.MethodsThis study included 161 patients who underwent TKA from October 2020 to October 2022 in the First Affiliated Hospital of Wannan Medical College, including 79 cases in the control group and 82 cases in the multimodal analgesia group (MMA). The MMA group were administered acetaminophen 0.5 g/d orally 3 days before the surgery, and an ultrasound-guided fascia iliac compartment block (FICB) with 0.25% ropivacaine 30 ml in the inguinal region ipsilateral to the surgery was performed 1 h before surgery. After the surgery, 100 ml solution includes 100 mg ropivacaine, 2.5 mg morphine, and 0.25 mg epinephrine for intra-articular and periarticular injection. Postoperative conventional intravenous analgesia was used in the control group, including 100 mg ropivacaine, 2.5 mg morphine, and 0.25 mg epinephrine for intra-articular and periarticular injection. Patients were scored for pain, anxiety, and depression in the ward at 3 and 7 days postoperatively, and postoperative patients were scored using telephone callbacks at 3 months postoperatively.ResultsIt was found that the visual analog scale (VAS) scores for pain at rest at 3 days, 7 days, and 3 months postoperatively were significantly lower in the MMA group than in the control group (P < 0.05). The scores for pain with movement were significantly lower in the MMA group than in the control group at 3 days and 7 days postoperatively (P < 0.01), but they were similar at 3 months postoperatively. Compared to the control group, the MMA group had significantly higher American Knee Society scores (AKS) at 3 days, 7 days, and 3 months postoperatively (P < 0.05). Compared to the control group, the MMA group had significantly higher Lower Extremity Functional Scale and Hospital Anxiety and Depression Scale scores (HADS) (P < 0.05) at 3 days and 7 days postoperatively; compared to the control group, the MMA group had a significantly shorter hospital stay (P < 0.01).ConclusionMultimodal analgesia can alleviate postoperative anxiety and depression in the short term, reduce perioperative pain, improve postoperative recovery, and shorten the length of hospital stay.

Patient Reported Outcome Measures (PROMs) Amongst Lower Extremity Agonist–Antagonist Myoneural Interface (AMI) Amputees

(1) Background: The standard surgical approach to amputation has failed to evolve significantly over the past century. Consequently, standard amputations often fall short with regard to improving the quality of life (QoL) for patients. A modified lower extremity amputation technique incorporating agonist–antagonist myoneural interface (AMI) constructs provides patients with a novel alternative to standard amputation and, to-date, has demonstrated overall significant improvements in their physical and mental wellbeing. (2) Methods: Five PROMs surveys, (1) EQ-5D-3L, (2) Lower Extremity Functional Scale (LEFS), (3) PROMIS-57, (4) Short Form-36 (SF-36), and (5) Sickness Impact Profile (SIP), were administered to our research cohort pre-operatively (baseline) and at various timepoints post-operatively. (3) Results: The cohort’s baseline and 12-month post-operative responses were compared to determine score improvement. Significant improvements were demonstrated across all survey domains (p &lt; 0.05). (4) Conclusions: Modified lower extremity amputation with AMI construction has the potential to provide amputees with increased quality of life when compared to the pre-operative state. However, further investigation is necessary to determine whether the patient-reported outcome measures of the AMI amputee cohort are superior to those who receive a standard amputation.

Efficacy and Safety of the Phytochemical Product Linfadren in the Management of Patients With Persistent Ankle Edema Following Trauma or Surgery: A Randomized Controlled Trial.

Persistent posttraumatic/postsurgery ankle edema (PPAE) is edema that persists from 2 weeks to 3 months after injury or surgery. PPAE has negative effects on the healing process and quality of life. This study aimed to evaluate the efficacy of a phytochemical product containing diosmin, coumarin, and arbutin (Linfadren) in addition to the conventional treatment, in patients with PPAE. Between October 2018 and February 2020, 60 outpatients with PPAE (42 with ankle fractures and 18 with ankle sprains) were enrolled and randomized (1:1 ratio) to receive either 6-week conventional treatment plus Linfadren (study group) or conventional treatment alone (control group). Primary outcome was ankle edema as measured by the "figure-of-8-20" method. Secondary outcomes were ankle function measured by the Lower Extremity Functional Scale (LEFS), and patient's overall perceived treatment efficacy. Tolerability of Linfadren was also evaluated. Assessments were performed at baseline, at end of treatment (6 weeks after baseline), and 3 months after the end of treatment (follow-up). A subgroup analysis was also conducted for the injury type (fracture/sprain) to identify if this factor affected the results of the primary outcome measure. At the end of treatment, the study group had a significantly greater improvement in ankle edema, improved ankle function, and more patients who considered this treatment effective compared with the control group. The measured difference in circumference by the figure-of-8-20 method averaged 4% at 6 weeks and 5% at 3 months. No difference between groups was seen in rescue medication. No adverse events were recorded. Subgroup analysis revealed no significant influence of the injury type on the primary outcome measure. Linfadren in addition to conventional treatment was more effective than conventional treatment alone in patients with PPAE. Level I, randomized controlled trial.

Adjustable Cortical Fixation Repair Is a Safe and Effective Technique for Quadriceps Tendon Rupture

To report the clinical outcomes of quadriceps tendon repair using adjustable cortical fixation devices at a minimum 2-year follow-up. A retrospective chart review identified patients who underwent quadriceps tendon repair using adjustable cortical fixation devices between January 2017 and March 2020. Patients with a partial tendon rupture were excluded. Demographic and injury-specific variables were gathered preoperatively and postoperatively from the electronic medical record and patient-reported outcomes (Lysholm Knee Questionnaire, Lower Extremity Functional Scale, and SF-12) were collected via telephone at a minimum of 2 years postoperatively. Fourteen quadriceps tendon repairs were included in a total of 13 patients. The average time to follow-up was 3.5 ± 1.2 years with a range of 1.9 to 5.7 years. The mean age of this cohort was 55.7 ± 11.6 years, and the mean body mass index was 32.9 ± 6.0. Ten injuries (71.4%) were sustained by mechanical fall, 2 patients (14.3%) suffered a direct blow to the knee, and 2 patients (14.3%) reported a noncontact injury mechanism. Thirteen quadriceps ruptures (13/14, 92.9%) underwent surgery within 10 days of their injury. One knee (7.1%) had a postoperative extensor lag of 5°, whereas another knee (7.1%) required a reoperation for manipulation under anesthesia and arthroscopic lysis of adhesions at 3 months' postoperatively. None of the included patients (0.0%) developed a tendon re-rupture, venous thromboembolism, delayed wound healing, surgical-site infection, neuropraxia or nerve injury, hardware irritation, patella fracture, or heterotopic ossification. In this study, adjustable cortical fixation was a safe and effective surgical technique for quadriceps tendon repair, with adequate restoration of quadriceps function and a low rate of adverse events at 2 years postoperatively. Level IV, therapeutic case series.

Investigation of mid-term functional skills and psychological factors in female patients undergoing total knee arthroplasty

Background/Aim: Previous studies have yielded conflicting clinical, psychological, and functional outcomes in patients undergoing total knee arthroplasty (TKA). This study aimed to more precisely evaluate the clinical outcomes, mid-term general physical and psychological health status, functional abilities, and improvements in patients’ quality-of-life undergoing TKA. Methods: This cross-sectional study included 25 female patients older than 55 years who underwent unilateral TKA due to osteoarthritis (OA). The Five Repetition Sit-to-Stand Test (5STS), Stair-Climbing Test (SCT), 6-Minute Walking Test (6MWT), Berg Balance Scale (BBS), Tampa Scale for Kinesiophobia (TSK), and Short Form Health Survey (SF-12) scores of the patients were evaluated using means. Meanwhile, the Lower Limb Length (LLL), Navicular Drop Test (NDT), Proprioception Assessment, Foot Posture Index (FPI-6), Foot Function Index (FFI), Lower Extremity Functional Scale (LEFS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Oxford Knee Score (OKS) were evaluated by comparing the operated (OP) sides that underwent TKA with the non-operated (NONOP) sides diagnosed with OA. Results: The study found that LLL (P=0.001), abduction/adduction forefoot on rearfoot (ABD) (P=0.017), and T.FPI-6 (P=0.014) in the FPI-6 parameters, as well as KOOS (P&lt;0.001), OKS (P&lt;0.001), LEFS (P&lt;0.001), and FFI (P&lt;0.001) results, were significantly in favor of the OP limb. Besides some parameters in FPI-6, no significant difference was found between the OP and NONOP extremities in terms of prone and supine proprioception values (P&gt;0.05). Conclusion: Overall, it was found that TKA plays a crucial role in recovery and regaining functional skills. Including preoperative evaluations with a control group and patients of both sexes in future studies and examining the relationships between the conducted tests and scales may contribute to better evaluating the results.

Deformity correction and limb lengthening with externally controlled motorized extendable intramedullary nails: Comparison of 2 different nails.

The aim of this study was to assess and compare the clinical, radiological, and functional results of patients treated with FITBONE or PRECICE nails due to deformity and length discrepancy in their lower extremities. This retrospective cohort study included 41 patients with length discrepancy and deformity in their lower extremities, who underwent limb lengthening surgery with either FITBONE (group F) or PRECICE (group P) nails between 2010 and 2020. The mean postoperative follow-up period was 15.95 ± 4.75 months in group F (20 patients) and 20.48 ± 7.57 months in group P (21 patients). Lower extremity mechanical and anatomical axes were measured on x-rays preoperatively and at the end of treatment. Consolidation and distraction indexes were also calculated to assess bone healing. Lower Extremity Functional Scale test was used to evaluate functional outcomes and quality of life. Neither of the treatment methods caused deviations in the mechanical axes and femoral distal angles (P > .05). No statistically significant difference in consolidation and distraction indexes was found between the groups (P > .05). Postoperative complications were seen in 3 of the patients in group F and 4 of the patients from group P. There was no significant difference in Lower Extremity Functional Scale scores between groups (P = .425). This study has demonstrated that treatment with both the FITBONE and PRECICE nails resulted in improved physical and emotional functional outcomes. Both nails had similar radiographic results, complication rates, high patient compliance, and good cosmesis. Level III, Therapeutic Study.

Comparison between Total Contact Custom-Made Insole versus Over the Counter Insole in Rehabilitation of Rheumatoid Arthritis Patients

Objective To compare the effect of total contact custom-made foot insoles versus over-thecounter flat silicone insoles on pain and foot function in rheumatoid arthritis patients. Patients and Methods This study included 30 patients diagnosed with rheumatoid arthritis according to the 2010ACR/EULAR classification criteria. All underwent history, clinical examination of foot, plantar pressure assessment, pain assessment by visual analog scale (VAS), foot functionality, assessed by Lower Extremity Functional Scale (LEFS). Patients were randomly assigned to group (A) 15 patients which received total contact custom made insoles. And group B, 15 patients received a flat over the counter insole made of silicone, follow up was done after two weeks using VAS and LEFS scores. Results A total of 30 patients, aged 46.07 ± 10.78 years, with disease duration ranged from 2 – 18 years with Median (IQR) of 5.50, body mass index (BMI) ranged from 19.5 to 37 kg/m2 with mean ±SD of 29.01 ± 4.00. In both groups, significant difference in the VAS after using insoles, observed more in -group A with mean ± SD 22.67 ± 11.47, while mean ± SD of group B was 39.00 ± 14.04. Regarding LEFS score: significant improvement of the score ―improved lower limb functionality‖ in both groups after using the insoles, slightly higher in group B more than group A. No significant differences in functionality between the two groups (LEFS score after intervention for group A with Mean ± SD 40.13 ± 9.88, group B with Mean ± SD 43.20 ± 6.82). Conclusion The custom-made foot orthoses significantly reduced the patients’ foot pain, although they did not have significantly positive effects on disability and foot functionality compared with only cushioning.

Evaluation of the Efficacy of Ultrasound-Guided Dry Needling Therapy and Exercise in Piriformis Muscle Syndrome.

Piriformis muscle syndrome (PMS) is characterized by symptoms of buttock pain and numbness radiating to the back of the thigh due to irritation of the sciatic nerve. This study aimed to evaluate the efficacy of dry needling (DN) therapy and exercise programs on pain, neuropathic pain, physical function, and disability in patients with PMS. Forty-four patients with PMS were included in the study. Patients were divided into two groups, those who were treated with DN three times once per week under ultrasound guidance and those who had an exercise program for three weeks. To identify the outcomes of the treatment modalities, pre-treatment and post-treatment first-month and third-month visual analog scale (VAS), Oswestry Disability Index (ODI) questionnaire, Lower Extremity Functional Scale (LEFS), and Douleur Neuropathique 4 (DN4) questionnaire scores were used. There was no statistically significant difference between the groups in baseline scores of VAS (p = 0.548), DN4 (p = 0.446), and LEFS (p = 0.880), but in the DN group, baseline ODI scores were significantly higher than in the exercise group (p = 0.001). The group comparisons showed no statistically significant differences in decreasing pain, reducing disability, and increasing functional status scores among the groups at post-treatment first-month and third-month assessments (p > 0.05). Both treatment modalities are beneficial in reducing pain and disability, and increasing the functional status of the patients with PMS in three months of follow-up. In patients who cannot adapt to exercise programs, DN treatment under ultrasound guidance should be kept in mind as a minimally invasive treatment modality with no adverse effects.

Radiological and Functional Outcomes and Associated Factors After Secondary Intramedullary Nailing Among Patients With Open Fractures of the Lower Limb.

Background Open fractures of the lower limb are serious injuries caused by high-energy trauma that can lead to long-term disability. Initial treatment includes wound debridement, fracture reduction, and external fixation to stabilize bone fragments. Secondary nailing, a surgical technique to provide additional stability, has been shown to promote early mobilization and improve fracture alignment. However, there is a lack of consensus on the optimal timing and technique for secondary nailing. This study aims to evaluate the functional and radiological outcomes of patients who undergo secondary nailing for open fractures of the lower limb. Methods The study was a hospital-based prospective study of 53 patients who underwent secondary nailing for open fractures of the lower limbs. Patients aged 18 years or older, with Gustilo-Anderson classification grades 1, 2, or 3 A and B, who underwent wound debridement and external fixator application, followed by conversion to secondary intramedullary nail fixation between January 2019 and December 2021 were included in the study. The primary outcome measures were functional and radiological outcomes at follow-ups, assessed using the Lower Extremity Functional Scale (LEFS) and Radiographic Union Scale for Tibia fractures (RUST) score. Data were collected prospectively and analyzed using Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Version 25.0, Armonk, NY). Descriptive statistics were used to summarize patient demographics and injury characteristics, and the Student's t-test and analysis of variance (ANOVA) were used to compare continuous variables between groups. The study had a final analysis of 39 patients. Results The study reports the baseline characteristics, radiological, and functional outcomes of 39 patients who underwent secondary nailing for open fractures of the lower limb. The majority of the fractures occurred in the tibia (71.8%), with most classified as grade 3 (A and B) (69.2%). At the end of the six-month period after secondary nailing, 74.4% of the fractures had a union. Radiological and functional outcomes showed significant improvement after undergoing secondary nailing. Gender and age group did not have a significant association with the radiological outcome, while the time interval between external fixation and secondary nailing was significantly associated with the radiological outcome at six weeks and threemonths. Conclusion According to a study, secondary nailing is effective in managing lower limb open fractures with good radiological and functional outcomes. The time interval between external fixation and secondary nailing affects radiological outcomes, with longer delays leading to lower RUST scores. Orthopaedic surgeons should consider this factor when planning surgical management. Larger sample sizes and more extended follow-up periods are needed to confirm findings and evaluate the effect of other variables on the outcome.

Cross-Cultural Adaptation of the University of Wisconsin Running Injury and Recovery Index in Turkish Runners.

The University of Wisconsin Running Injury and Recovery Index (UWRI) was developed to evaluate the key elements that runners use to self-assess their own running ability following common running-related injuries. The aim of this study was to translate and culturally adapt the UWRI and to evaluate the psychometric properties of its Turkish version (UWRI-Tr) in runners. Prospective cohort study. The study included 129 runners. The UWRI-Tr, the Lower Extremity Functional Scale, the Oswestry Disability Index, the Hip Outcome Score, the International Knee Documentation Committee Subjective Knee Evaluation Form, and the Foot and Ankle Ability Measure were applied for the validation purposes. Internal consistency, reliability, construct validity, and discriminant validity of the UWRI-Tr were tested. The test-retest reliability of the UWRI-Tr was excellent with an intraclass correlation coefficient of .85 and a Cronbach α value of .84. There was a small to strong correlation among the UWRI-Tr and Lower Extremity Functional Scale (r = .278), Oswestry Disability Index (r = -.744), Hip Outcome Score (r = .684), The International Knee Documentation Committee Subjective Knee Evaluation Form (r = .758), and Foot and Ankle Ability Measure (r = .498 and .767), indicating that its construct validity was appropriate for use with Turkish runners. The UWRI-Tr was shown to be a valid and reliable tool to use in clinical and research settings as a sport-specific measurement tool.

Spatiotemporal parameters from remote smartphone-based gait analysis are associated with lower extremity functional scale categories.

Self-report tools are recommended in research and clinical practice to capture individual perceptions regarding health status; however, only modest correlations are found with performance-based results. The Lower Extremity Functional Scale (LEFS) is one well-validated measure of impairment affecting physical activities that has been compared with objective tests. More recently, mobile gait assessment software can provide comprehensive motion tracking output from ecologically valid environments, but how this data relates to subjective scales is unknown. Therefore, the association between the LEFS and walking variables remotely collected by a smartphone was explored. Proprietary algorithms extracted spatiotemporal parameters detected by a standard integrated inertial measurement unit from 132 subjects enrolled in physical therapy for orthopedic or neurological rehabilitation. Users initiated ambulation recordings and completed questionnaires through the OneStep digital platform. Discrete categories were created based on LEFS score cut-offs and Analysis of Variance was applied to estimate the difference in gait metrics across functional groups (Low-Medium-High). The main finding of this cross-sectional retrospective study is that remotely-collected biomechanical walking data are significantly associated with individuals' self-evaluated function as defined by LEFS categorization (n = 132) and many variables differ between groups. Velocity was found to have the strongest effect size. When patients are classified according to subjective mobility level, there are significant differences in quantitative measures of ambulation analyzed with smartphone-based technology. Capturing real-time information about movement is important to obtain accurate impressions of how individuals perform in daily life while understanding the relationship between enacted activity and relevant clinical outcomes.

Cross-cultural validation of the Lower Extremity Functional Scale in Serbian postmenopausal women with knee osteoarthritis.

Translation and cross-cultural validation of the Serbian version of the Lower Extremity Functional Scale (Srb-LEFS). This prospective cross-sectional study initially included 186 postmenopausal women aged 60 to 75 years who underwent an x-ray examination of both knees, along with body mass, body height, waist circumference, knee range of motion, and blood pressure measurements. The laboratory analyses included the evaluation of fasting glucose levels and lipid profile. All participants completed the LEFS, Lequesne index, and 36-Item Short-Form Survey-RAND. The analyses revealed good internal consistency (α = 0.95), good test-retest reliability, and a two-factor structure of the Srb-LEFS. Concurrent validity analysis confirmed a significant positive correlation between Srb-LEFS scores and the 36-Item Short-Form Survey-RAND Physical Functioning subscale ( r = 0.889, P < 0.0001), the Lequesne index ( r = -0.976, P < 0.0001), and the Numeric Rating Scale for pain ( r = -0.762, P < 0.0001). Convergent validity analyses revealed a statistically significant negative correlation between the Srb-LEFS scores and age ( r = -0.25, P = 0.006), body mass index ( r = -0.31, P < 0.01), and waist circumference ( r = -0.37, P < 0.0001). The Srb-LEFS scores were statistically significantly higher among participants that reported moderate physical activity levels, as well as those that had fewer comorbidities, minor structural knee damage, greater knee range of motion, and greater quadriceps femoris muscle strength. The Serbian version of the LEFS is feasible, valid, and reliable for use in both clinical practice and clinical studies to assess self-reported physical functioning in older individuals with knee osteoarthritis.

Prospective, Long-Term Functional Outcomes of Extra-Osseous Talotarsal Stabilization (EOTTS) Using HyProCure in Adult Patients with Talotarsal Joint Instability: Assessment of Physical Activity and Patient Satisfaction.

The partial dislocation of the talus from the calcaneus and navicular bones is a primary factor leading to a prolonged overpronation during weightbearing. This study aimed to assess the possibility of returning to physical activity and long-term patient satisfaction after an extra-osseous talotarsal stabilization (EOTTS) procedure with a HyProCure sinus tarsi implant for partial talotarsal joint dislocation (TTJ). A total of 41 adult patients (61 feet), with an average age of 46.41, were included and treated surgically with EOTTS as a stand-alone surgery. Physical activity and functional scores were assessed pre- and post-operatively using questionnaires-the UCLA Activity Score, Symptom-Related Ankle Activity Scale (SAAS), Sports Frequency Score (SFS), Lower Extremity Functional Scale (LEFS), and VAS scale. Satisfaction was assessed on a ten-point scale. The follow-up period was on average 8.61 years (from 7.33 to 10.31). EOTTS had a positive impact on physical activity, and a high rate of patient satisfaction (8.95 ± 1.9) was noted. The treatment led to a reduction in foot pain, as well as an increase in SAAS and LEFS scores (15,6% and 19,3%, respectively, p <0.01). The VAS pain score decreased by 18,6% (p <0.001). SFS and UCLA scores showed a small increase, but it was not statistically significant. A positive correlation was noted between patient satisfaction and time of physical activity per week (R = 0.33, p =0.04), and also between patient satisfaction and SAAS scores (R = 0.43, p =0.005). Pain from other joints (knee, hip) was eliminated or reduced in 40% of patients after surgery. EOTTS with a HyProCure implant is an effective long-term treatment option for partial talotarsal joint dislocation, leading to a reduction in foot pain and increased patient satisfaction, and allowing for a return to physical activity.

ADAPTations to low load blood flow restriction exercise versus conventional heavier load resistance exercise in UK military personnel with persistent knee pain: protocol for the ADAPT study, a multi-centre randomized controlled trial

BackgroundMuscle atrophy, muscle weakness and localised pain are commonly reported following musculoskeletal injury (MSKI). To mitigate this risk and prepare individuals to return to sport or physically demanding occupations, resistance training (RT) is considered a vital component of rehabilitation. However, to elicit adaptations in muscle strength, exercise guidelines recommend lifting loads ≥ 70% of an individual’s one repetition maximum (1-RM). Unfortunately, individuals with persistent knee pain are often unable to tolerate such high loads and this may negatively impact the duration and extent of their recovery. Low load blood flow restriction (LL-BFR) is an alternative RT technique that has demonstrated improvements in muscle strength, hypertrophy, and pain in the absence of high mechanical loading. However, the effectiveness of high-frequency LL-BFR in a residential rehabilitation environment remains unclear. This study will compare the efficacy of high frequency LL-BFR to ‘conventional’ heavier load resistance training (HL-RT) on measures of physical function and pain in adults with persistent knee pain.MethodsThis is a multicentre randomised controlled trial (RCT) of 150 UK service personnel (aged 18–55) admitted for a 3-week residential rehabilitation course with persistent knee pain. Participants will be randomised to receive: a) LL-BFR delivered twice daily at 20% 1-RM or b) HL-RT three-times per week at 70% 1-RM. Outcomes will be recorded at baseline (T1), course discharge (T2) and at three-months following course (T3). The primary outcome will be the lower extremity functional scale (LEFS) at T2. Secondary outcomes will include patient reported perceptions of pain, physical and occupational function and objective measures of muscle strength and neuromuscular performance. Additional biomechanical and physiological mechanisms underpinning both RT interventions will also be investigated as part of a nested mechanistic study.DiscussionLL-BFR is a rehabilitation modality that has the potential to induce positive clinical adaptations in the absence of high mechanical loads and therefore could be considered a treatment option for patients suffering significant functional deficits who are unable to tolerate heavy load RT. Consequently, results from this study will have a direct clinical application to healthcare service providers and patients involved in the rehabilitation of physically active adults suffering MSKI.Trial registrationClinicalTrials.org reference number, NCT05719922

Soft tissue coverage of the ankle: An algorithm for appropriate flap selection and the experiences of a newly established Major Trauma Network

IntroductionReplication of the thin and pliable native skin around the ankle remains a challenge for plastic surgeons treating soft tissue defects in this region. Flap reconstruction constitutes the mainstay of management of such injuries. Subsequent management often entails revisional debulking surgery to permit normal footwear and an acceptable aesthetic outcome. In light of limited elective operating capacity throughout the covid-19 pandemic, we adopted an algorithm to inform reconstruction in such injuries and limit the need for revisional surgeries. This study presents this algorithm, which considers patient age, functional status, co-morbidities, body habitus and defect location. MethodsRetrospective analysis of a prospectively maintained database of all patients undergoing lower limb soft tissue reconstruction over 21 months was performed. All flap-based reconstructions of ankle defects were included; direct closures and skin grafts were excluded. All trauma patients were managed via a combined orthoplastic approach as per BOA-BAPRAS standards. All patients had Computed Tomography Angiography prior to their definitive reconstruction. Lower Extremity Functional Scale (LEFS) scores were analysed for patients with over 12 months of postoperative follow up, where available. Results71 flaps were performed in 69 patients. Open ankle fracture was the most common cause (86%); other indications included osteomyelitis and surgical wound dehiscence. Mean age was 50 (13–87 years) with a higher proportion of males to females (ratio 1.25:1). There were 26 pedicled flaps (18 Medial Plantar Artery and 8 Peroneus Brevis) and 45 free flaps (22 Anterolateral thigh, 11 Superficial Circumflex Iliac Artery Perforator, 11 Gracilis and 1 Medial Sural Artery Perforator). Mean follow-up is 13.6 months. There were three flap failures, and four patients subsequently underwent delayed below knee amputation despite successful soft tissue healing. For the patients with a minimum of 12 months follow up, LEFS scores with an average of 51% were achieved (range 15–88%). Four patients have been listed for revisional/debulking surgery. ConclusionAlthough soft tissue defects around the ankle can be difficult to manage, with careful planning and addressing each patient individually, supported by an algorithmic approach, good functional and aesthetic outcomes can be achieved with low rates of secondary revision surgery.

Republication of "Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO): Short-term Prospective Case Series With a Novel Technique and Topic Review".

Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. IV, prospective case series.