Mean Flexion Angle Research Articles

Midterm treatment results of congenital dislocation of the knee in 14 knees of nine cases.

Patients with congenital dislocation of the knee (CDK) should be promptly treated surgically if conservative measures fail. This study aimed to achieve a better understanding of the diagnosis and management of CDK through sharing our experience and contributing to the existing literature. Nine patients with a total of 14 knees were included in the study. All patients except one were initially treated with gentle manipulation and serial casting. Surgery was performed on patients in whom sufficient joint mobility could not be achieved. Active and passive range of motion of the knees and functional outcome were measured. Of the 14 knees, five were classified as first grade, four as second grade and five as third grade. The mean age of the patients was 4.09 months and the follow-up period was 70 months. The initial mean flexion angle (MFA) was 18.2° (0-90) and the mean extension angle (MEA) was 8.2° (0-15). At the final follow-up, the mean MFA was 109.2° (80-140) and MEA was -2.85° (0 to -10). No patient had instability by the final follow-up. The results were classified as excellent (5 knees), good (5 knees) and moderate (4 knees) according to outcome assessment criteria. The functional outcomes were classified as excellent (7 knees), good (3 knees) and fair (4 knees) according to the functional outcome scoring. Treatment of CDK should be started in the first days of life, and if the desired functional outcome cannot be achieved through conservative treatment, surgical treatment should be planned without delay.

A minimally invasive fixation for boxers fracture – fifth metacarpal neck using antegrade K wire fixation – functional outcome study

Background: Fifth metacarpal fractures are more common fractures in hand which are treated by conservative or surgical methods. Using retrograde k-wire fixation is associated with more complications due to damage to articular surface causing deformity or decreasing range of motion. Studies are done using single k-wire usage by antegrade technique, results vary due to k-wire complications and surgeon experience. Aims and Objectives: In this study, we are used a technique to bend a K wire in S-shaped fashion to negotiate through fracture to hold and reduce the fracture by rotating the tip of K-wire. Materials and Methods: This prospective study was done for fracture neck of fifth metacarpal presenting to outpatient department in 36 patients with dorsal angulation of more than 300 treated by passing a single k wire bent at the tip and shaft to form an S shape retrogradely with a follow-up period of 6 months following surgery. Results: Majority of injuries were in males in the dominant hand with a mean age group of 27.25 years. The mean pre-operative flexion angle of distal fragment was 44.11° (SD–4.12), and after the end of follow-up healing was achieved in all cases with a mean flexion angle improvement to 5.25° (SD–2.16). Disabilities of the arm, shoulder, and hand score measured at the end of study showed a mean of 6.25, and total active motions core showed excellent results in 25 cases (69.4%) cases and poor in 1 case (2.77%). Conclusion: This study emphasizes that bending a K wire in a lazy S fashion and passing antegradely will replicate results similar to using 2 K wires and have a better prognosis than retrograde wiring through the head of metacarpal. Furthermore, this procedure can be done in a primary care setting with minimal resources.

Effect of single-radius design on in vivo kinematics during stair activities after total knee arthroplasty.

The single-radius design is one of the major total knee arthroplasty (TKA) designs and widely used all over the world. The objective of this study was to compare in vivo kinematics between the anteroposterior (AP) single-radius design with mediolateral (ML) single-radius (Non Restricted Geometry; NRG) and ML dual-radius (Triathlon) during stair activities. A total of 21 knees in 18 patients (NRG group: 10 knees in 7 patients, Triathlon group: 11 knees in 11 patients) with a clinically successful posterior stabilized TKA were examined. Under fluoroscopic surveillance, each patient performed stair ascending and descending motions. In vivo kinematics were analyzed using 2D/3D registration technique. The knee flexion angle, rotation angle, varus-valgus angle, AP translation of the femorotibial contact point for both the medial and lateral sides of the knee, and post-cam engagement were evaluated. There were no significant differences between the two groups in rotation angle and AP translation at each flexion angle. Examining the varus-valgus angle, the NRG group showed varus position at an early flexion angle during both stair activities.Post-cam engagement was observed in both groups during both stair activities. The mean flexion angle of engagement in the NRG group, the post of which was located anterior to the Triathlon, was larger than that in the Triathlon group during both stair activities. Despite the same AP single-radius TKA, ML single-radius might affect varus motion at an early flexion angle.

Implant Preference and Clinical Outcomes of Patients with Staged Bilateral Total Knee Arthroplasty: All-Polyethylene and Contralateral Metal-Backed Tibial Components

Numerous studies have compared metal-backed components (MBTs) and all-polyethylene tibial components (APTs), but none of them specifically analysed the clinical results and the overall patient preference in patients who had undergone a staged bilateral knee replacement. The purpose of this study is to compare clinical results, perceived range of motion, and overall implant preference among patients who had undergone staged bilateral knee replacement with an APT and contralateral knee replacement with MBTs. A dataset of 62 patients from a single centre who underwent staged bilateral TKA between 2009 and 2022 was selected and retrospectively analysed. Tibial component removal was performed in three knees overall, all of which had MBTs. The mean measured Knee Score (KS) of knees with APTs was 78.37 and that of contralateral knees with MBTs was 77.4. The mean measured Function (FS) of knees with APTs was 78.22, and that of contralateral knees with MBs was 76.29. The mean flexion angle of knees with APTs was 103.8 and that for knees with MBTs was 101.04 degrees. A total of 54.8% of the patients preferred the knee that received APTs over contralateral MBTs. In our cohort, TKA with an APT in one knee and an MBT in the contralateral knee recorded similar clinical results and perceived ranges of motion. Patients in general preferred the knee that received an APT over contralateral knee with an MBT.

Medial pivot total knee arthroplasty: Mid-term results.

This study aims to evaluate the mid-term results of patients who underwent medial pivot total knee arthroplasty at a single center. A total of 304 knees of 236 patients (40 males, 196 females; mean operation age and standard deviation : 66,64 ±7,09 years; range, 45 to 82 years) treated with medial pivot total knee prosthesis in our center between January 2010 and December 2014 were retrospectively analyzed. The American Knee Society Score, Oxford Knee Score, and especially flexion angles were recorded during pre- and postoperative follow-up. Of the operated knees, 71.2% were unilateral and 28.8% were bilateral. The mean follow-up was 79.30±14.76 months. The postoperative results with the Functional Score, Knee Score, Oxford Score, Total Knee Society Score, and flexion angles were significantly higher compared to baseline (p<0.01). All postoperative scores were significantly lower inpatients aged ≥65years, compared to those aged <65 years (p<0.01). In patients who underwent resection of anterior and posterior the cruciate ligaments, only the mean flexion angles were found to increase (p<0.01). Our study results suggest that medial pivot knee prostheses are reliable in the mid-term and provide favorable results in terms of function and patient satisfaction. Level of Evidence: Level IV retrospective study.

Kinematic Analysis of the Forward Head Posture Associated with Smartphone Use

Background: Frequent use of mobile devices has a known association with musculoskeletal neck pain. This study sought out to localize the region with greatest flexion in the cervical spine and explored the role of symmetry in maintaining the pose during texting. Methods: Three inertial measuring units (IMUs) superficially attached along the cervical spine divided the cervical spine into two measurable segments. Twenty-five subjects participated in the study and performed three tasks when using smartphones: sitting, standing, and walking. Data from each IMU were used to calculate the flexion of cervical divided into two segments: craniocervical junction (C0–C1) and subaxial (C1–C7). Results: The greatest flexion by far occurred at C0–C1. While sitting, standing, and walking, the mean flexion angles were 33.33 ± 13.56°, 27.50 ± 14.05°, and 32.03 ± 10.03° for the C0–C1 joint and −3.30 ± 10.10°, 2.50 ± 9.99°, and −1.05 ± 11.88° for the C2–C7 segment, respectively. There is a noticeable pattern of yaw movement of the head, with a slow rotation toward symmetry and a fast corrective movement toward the smartphone held in one hand. Conclusions: This study identified the region of greatest contribution toward forward flexion along the cervical parameters during various tasks involving smartphone use. With each task, the greatest contributor to head flexion was the C0–C1 joint. There is involuntary rotation of the cervical spine toward symmetry when texting.

Mid-Term Clinical and Radiological Results at a Tertiary Care Hospital in Türkiye: Is Residual Varus Really Important After Mechanically-Aligned Total Knee Arthroplasty?

Traditionally, in total knee arthroplasty (TKA), it is aimed to keep the mechanical axis of the lower extremity neutral (mechanical alignment:3° varus-valgus in thecoronalplane) to improve long-term outcomes. This study aimed to assess the mid-term radiological and clinical results of patients with postoperative residual varus (more than 3° of varus) aftermechanically-aligned TKA. A total of 616 individuals who had undergoneTKAforprimaryknee osteoarthritisbetween 2008 and 2013 in our tertiary care hospital were retrospectively examined.All TKAs were performed with the mechanical alignment strategy.For radiological evaluation, hip-knee-ankle (HKA) angle, knee alignment angle (KAA), mechanical medial proximal tibial angle (mMPTA), knee inclination (KI), joint line orientation angle relative to ground (JLOA-G), posterior tibial slope (PS), joint line convergence angle (JLCA) were measured. Besides, patients' latest radiographs were screened for any clue of aseptic loosening or mechanical failure. Knee Society Score (KSS) (knee and functional subgroups), and Lysholm, Oxford, and Tegner scores were used for clinical evaluation. In addition, knee flexion and extension limitations were assessed. After applying the exclusion criteria, a minimum of five-year follow-up result of 110 patients was demonstrated.There were 101 females (92%) and nine males (8%). The mean follow-up time was 65.8 ± 6.3 months (range: 60.8-75.8 years). The mean age was 65.9 ± 7.7 years (range: 39 to 89 years). Thepreoperative mean mechanical axis angle of the lower extremity was17.3° ± 7.8° (range: 13.4-43.9°), whereas it was 8.3° ± 3.6° (range: 3.2-19.8°) postoperatively.The preoperative mean flexion angle was 90.7° ±23.8° (range: 40-130°), andthe extension limitation was -2.5° ± 7.4° (range: -40-0°), whereas, postoperatively, they were102.8° ± 15.4° (range from 40° to 150°) and -3.7° ± 7.5°(range from -40° to0°), respectively.The latest follow-up's mean KSS knee subgroup was 67 ± 18.4 (range: 12-93), the mean KSS functional subgroup was 74 ± 23.6 (range: 20-100), the mean Lysholm score was 81.7 ± 15.7 (range:25-100), the mean Tegner score was 3.65 ± 0.99 (range: 1-5), the mean Oxford score was 37.4 ± 6.5 (range: 9-48). There was no patient with aseptic loosening or mechanical failure. In the mid-term follow-up of patients with residual varus aftermechanically-alignedTKA, satisfactoryclinicaland radiological results were obtained without aseptic loosening or implant failure.

RISK FACTORS FOR MANIPULATION UNDER ANAESTHESIA FOLLOWING TOTAL KNEE ARTHROPLASTY AND THE IMPORTANCE OF TIMING

The optimal timing of when to perform manipulation under anesthesia (MUA) for stiffness following total knee arthroplasty (TKA) is unclear. This study aimed to identify the risk factors for MUA following primary TKA and whether performing an “early” MUA within 3 months results in a greater improvement in range of motion.Primary TKAs performed between January 2013 and December 2018 at three tertiary New Zealand hospitals were reviewed. International Classification of Diseases discharge coding was used to identify patients who underwent an MUA. Multivariate Cox regression was performed to identify patient and surgical risk factors for MUA. Pre- and post-MUA knee flexion angles were identified through manual review of operation notes. Multivariate linear regression was performed to compare the mean flexion angles pre- and post-MUA, as well as the mean gain in flexion, between patients undergoing “early” (&lt;3 months) versus “late” MUA (&gt;3 months).7386 primary TKAs were analyzed in which 131 underwent subsequent MUA (1.8%). Patients aged &lt;65 years were two times more likely to undergo MUA compared to patients aged ≥65 years (2.5% versus 1.3%, adjusted hazard ratio = 2.1, p&lt;0.001). Gender, body mass index, patient comorbidities or a history of cancer were not associated with the risk of MUA. There was no difference in the final post-MUA flexion angle between patients who underwent early versus late MUA (104.7 versus 104.1 degrees, p = 0.819). However, patients who underwent early MUA had poorer pre-MUA flexion (72.3 versus 79.6 degrees, p = 0.012), and subsequently had a greater overall gain in flexion compared to patients who underwent late MUA (mean gain 33.1 versus 24.3 degrees, p&lt;0.001).Younger age was the only patient risk factor for MUA. A greater overall gain in flexion was achieved in patients who underwent early MUA within 3 months.

Open Arthrolysis for Chronic Elbow Dislocation with Extremely Severe Stiffness in Children.

Studies on extremely severe elbow stiffness after chronic dislocation in children are scarce. This study aims to investigate the choice of surgical treatment modalities and to analyze their treatment efficacy in children with chronic elbow dislocation with extremely severe periarticular stiffness. Data of 21 children with chronic elbow dislocation with extremely severe periarticular stiffness diagnosed and treated in our department between February 2015 and February 2021 were retrospectively analyzed. Twenty boys and one girl were included in the study, their mean age was 11 ± 2.5 years, and they had concomitant distal humerus fractures. For the treatment protocol, all children with extremely severe elbow stiffness were treated with open arthrolysis, and elbow joint stability was intraoperatively assessed. All children performed passive functional exercises the day after surgery. The elbow flexion and extension angles, range of motion (ROM), and Mayo score were evaluated preoperatively and at the final follow-up. Of the 21 children, only one had recurrent severe stiffness of the elbow joint after surgery; nevertheless, the function was still improved compared with that before surgery. Preoperatively, the mean elbow extension and flexion angles were 72.2° ± 12.7° and 93.6° ± 11.1°, respectively, and the range of motion (ROM) of the elbow joint was 17.8° ± 8.3°. At the final follow-up, the mean elbow extension and flexion angles were 22.7° ± 18.6° and 118.8° ± 15.4°, respectively, and the elbow joint ROM was 96.1° ± 17.4°. The differences in the preoperative and postoperative ROMs, flexion angles, and extension angles of the elbow joint were significant (p < 0.01). The MEPS at the final follow-up was 78.57 ± 14.24, which was significantly higher than preoperative (29.76 ± 10.89), and the excellent rate was 81%. Open arthrolysis and open reduction and internal fixation of the elbow joint are effective in treating chronic elbow dislocation with extremely severe stiffness in children.

Articular Involvement With Retrograde Headless Compression Screw Fixation of the Metacarpal

Retrograde headless compression screw (RHCS) fixation for metacarpal fractures can lead to metacarpal head articular cartilage violation. This study aimed to quantify the articular surface loss after insertion of the RHCS and determine the functional range of motion (ROM) of the metacarpophalangeal (MCP) joint at the point of contact between the proximal phalangeal (P1) base and the articular defect. Ten fresh-frozen cadaveric hand specimens were analyzed for prefixation MCP joint ROM. After screw insertion, the ROM at which the dorsal portion of the P1 base begins to engage the screw tract defect, as well as the ROM at which the midsagittal portion of the P1 bisector engages the screw tract defect, was recorded. The distal axial articular surface of the metacarpal and the defects from screw insertion were measured using a digital image software program. Nine men and one woman (mean age, 69 years) were examined. The prefixation mean extension-flexion arc for all MCP joints ranged from 1° to 85°. After screw insertion, the mean MCP ROM at which the dorsal P1 articular surface first engaged the screw tract was 31°. Only 7 digits had screw tract engagement with the midsagittal bisector of the P1 base at a mean flexion angle of-18° (18° hyperextension). Mean articular surface violation increased from the index finger moving ulnarly, with an average of 3.9% involvement. Articular surface loss of the metacarpal head following RHCS insertion is negligible in a cadaveric model, with minimal engagement between the corresponding defect and the P1 base during functional ROM. Retrograde headless compression screw fixation of metacarpals inevitably damages the cartilage. However, the actual defect is small in proportion to the articular surface area and not engaged during functional activity. These biomechanical features maymitigate the surgeon's concern about joint destruction, while ensuring the benefits ofearly rehabilitation and minimal invasiveness of this technique.

Reconstruction for Massive Proximal Tibial Bone Defects Using Patient-Customized Three-Dimensional-Printed Metaphyseal Cones in Revision Total Knee Arthroplasty.

ObjectiveTo review the clinical outcomes of revision total knee arthroplasty (RTKA) with massive proximal tibial bone defects using patient‐customized three‐dimensional (3D) printed highly porous metaphyseal cones.MethodsA retrospective study of all patients at our institution who underwent RTKA with the Anderson Orthopaedic Research Institute type III tibial defects using patient‐customized 3D‐printed highly porous metaphyseal cones was performed from 2016 to 2018. Seven patients were enrolled in this study. General results (age, sex, and body mass index); intraoperative results (interface compatibility and stability, and operating time); and perioperative complications (total blood loss, blood transfusion rate, and deep venous thrombosis) were recorded and analyzed. Clinical improvement and functional evaluation (survivorship of implant, improvement of Hospital for Special Surgery Score and McMaster Universities Osteoarthritis Index, and improvement of range of motion [ROM]), and radiographic improvement and implant evaluation (progressive radiolucent lines or radiographic loosening, and mechanical alignment) were evaluated at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and then annually, postoperatively.ResultsThe mean age at diagnosis was 68 (61–77) years. The mean follow‐up was 25.3 (19–36) months. At the latest follow‐up, no aseptic loosening, prosthetic joint infection, or other complications were noted. The mean Hospital for Special Surgery Score increased from 49 (39–63) to 78 (70–83) (P < 0.01), whereas the mean Western Ontario and McMaster Universities Osteoarthritis Index increased from 59 (46–73) to 26 (12–38) (P < 0.01). All patients achieved improved postoperative ROM with the mean flexion angle increasing from 66° (30°–80°) to 93° (80°–100°), and improved mechanical alignment with all hip–knee–ankle (HKA) angles within ±3°.ConclusionsThe patient‐customized 3D‐printed metaphyseal cone is useful technique for reconstructing massive proximal tibial bone defects, with encouraging clinical and radiological outcomes in RTKA.

Hand Motion Analysis during the Execution of the Action Research Arm Test Using Multiple Sensors

The Action Research Arm Test (ARAT) is a standardized outcome measure that can be improved by integrating sensors for hand motion analysis. The purpose of this study is to measure the flexion angle of the finger joints and fingertip forces during the performance of three subscales (Grasp, Grip, and Pinch) of the ARAT, using a data glove (CyberGlove II®) and five force-sensing resistors (FSRs) simultaneously. An experimental study was carried out with 25 healthy subjects (right-handed). The results showed that the mean flexion angles of the finger joints required to perform the 16 activities were Thumb (Carpometacarpal Joint (CMC) 28.56°, Metacarpophalangeal Joint (MCP) 26.84°, and Interphalangeal Joint (IP) 13.23°), Index (MCP 46.18°, Index Proximal Interphalangeal Joint (PIP) 38.89°), Middle (MCP 47.5°, PIP 42.62°), Ring (MCP 44.09°, PIP 39.22°), and Little (MCP 31.50°, PIP 22.10°). The averaged fingertip force exerted in the Grasp Subscale was 8.2 N, in Grip subscale 6.61 N and Pinch subscale 3.89 N. These results suggest that the integration of multiple sensors during the performance of the ARAT has clinical relevance, allowing therapists and other health professionals to perform a more sensitive, objective, and quantitative assessment of the hand function.

The effect of range of motion simulated with a patient-specific three-dimensional simulation analysis on dislocation after total hip arthroplasty.

Dislocation continues to be a common complication following total hip arthroplasty (THA). Although previous studies of computed simulation analysis investigated the range of motion (ROM), it is unclear whether the ROM before impingement simulated using computed tomography-based 3-dimensional simulation analysis (simulated ROM) is related to dislocation after THA. It is also unclear what angles are required in computed simulation analyses for stable hips after THA. In this study, we compared the simulated ROM in patients with and without dislocation. 16 patients with posterior dislocation were compared with 48 matched patients without dislocation. Risk factors including preoperative bone morphology of the hip, implant position, change of femoral offset, change of leg length, anterior aspect of the greater trochanter (GTa) length, and anterior inferior iliac spine length were also compared. The mean flexion angle, internal-rotation at 90° flexion (IR) angle, cup anteversion based on the anterior pelvic plane (APP), tilt-adjusted cup anteversion and GTa length were significantly different between patients with dislocation and patients without dislocation (p = 0.033, 0.002, 0.010, 0.047, 0.046). A receiver-operating characteristic curve analysis suggested cutoff points for flexion angle, IR angle, cup anteversion based on the APP, tilt-adjusted cup anteversion and GTa length, of 114.5°, 45.5°, 19.5°, 12.0° and 15.3 mm. This study suggests that preoperative planning to achieve a larger simulated ROM, flexion angle and IR angle, may reduce the risk of posterior dislocation. This study also suggests that fine-tuning of cup anteversion and/or trimming of the overhanging GTa during preoperative planning may reduce the risk of posterior dislocation.

Patient-specific instrumentation combined with a new tool for gap balancing is useful in total knee replacement: a 3-year follow-up of a retrospective study

ObjectiveThe purpose of this study was to determine whether the gap-balancing technique with patient-specific instrumentation (PSI) and a new balancing device in total knee arthroplasty (TKA) can improve knee function to a greater extent than can the measured resection technique.Materials and methodsData from 150 patients who underwent TKA from August 2014 to June 2016 were studied retrospectively. The gap-balancing technique assisted by PSI and the new balancing device was used in 80 patients (82 knees), and the measured resection technique was used in 70 patients (70 knees). The surgical, imaging, and knee function data were compared.ResultsThe gap-balancing technique assisted by PSI and the new balancing device was found to be feasible in all operated knees and reliable. In total, 150 patients (152 knees) of ages ranging from 52 to 78 years (mean 67 years) underwent TKA during the study period. The follow-up period ranged from 35 to 52 months (mean 45 months). Only one patient, who was included in the gap-balancing group, underwent a revision surgery at 2 years postoperatively due to infection. There were no differences in the incidence of anterior knee pain between the two groups. The mean flexion angle, KSS scores, and VAS scores did not significantly differ between the measured resection group and gap-balancing group at 12 weeks or 36 weeks postoperatively. The average joint line displacement was 1.3 ± 1.1 mm (range 0–3) proximally in the GB (gap-balancing) group and 1.2 ± 1.4 mm in the MR (measured-resection) group. No outliers >5 mm in either group were recorded. The mean leg axis deviation from the neutral mechanical axis was 1.8°±1.5° varus (range 0°–3°varus) versus the neutral mechanical axis in the GB group and 1.4°±1.2°(range 0°–3°)in the MR group. No outliers with >3° deviation in either group were recorded.ConclusionsThe gap-balancing technique performed with the new balancing device and PSI can yield accurate femoral component alignment as well as outcomes similar to those of measured resection at 3 years. The new balancing device can be taken into consideration by surgeons who prefer performing the gap-balancing technique with PSI.

Do different sit–stand workstations influence lumbar kinematics, lumbar muscle activity and musculoskeletal pain in office workers? A secondary analysis of a randomized controlled trial

Purpose. This study investigated the effect of different sit–stand workstations on lumbar spine kinematics, lumbar muscle activity and musculoskeletal pain. Methods. Thirty-two office workers were randomized to one of three sit–stand workstations (Group 1, ratio of minutes spent sitting to standing each hour at work 40:20, n = 8; Group 2, 30:30, n = 6; Group 3, 20:40, n = 7) and a control group (usual sitting, n = 11). Intervention groups (Groups 1, 2 and 3) were collapsed into one group for analysis (n = 21). Data on lumbar kinematics and muscle activity were only collected for 25 participants due to equipment availability. Results. Participants in the intervention group had lower overall lumbar spine flexion angles during the workday compared to the control group (mean difference 10.6°; 95% confidence interval [−18.1, −3.2]; p = 0.008; Cohen’s d = 1.5). There were no between-group differences for the remaining kinematic measures (i.e., mean flexion angle in standing and sitting, mean side flexion angle in standing and sitting, and percentage of time in upright sitting), muscle activity or presence of musculoskeletal pain. Conclusions. Sit–stand workstations reduced overall lumbar spine flexion angles over the course of a workday but had no effect on other kinematic measures, lumbar spine muscle activity or musculoskeletal pain. Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12615001018505..

Effect of posterior condylar offset in post operative range of motion in cruciate retaining and sacrificing TKR: A comparative analysis

BackgroundRestoration of posterior condylar offset (PCO) during TKA is believed to be an important to improve knee kinematics, maximizing range of motion (ROM) and minimizing flexion instability. The aim of prospective study was to find out the role of PCO in post-operative ROM after cruciate retaining (CR) and cruciate sacrificing (CS) TKA. Methods and materialsA total of 90 patients were divided into the CR knee group (49) and CS knee Group (41) intra-operatively by the surgeon based on the status of Posterior Cruciate Ligament. Preoperative and postoperative PCO was evaluated on true lateral knee radiographs. The ROM was measured pre operatively and post operatively at 4 weeks, 8 weeks, 3 months, 1 year and 2 years. Appropriate statistical tests were used and results were interpreted. ResultsThe mean flexion angle was 113.86° in CR knees and 118.29° in CS knees with a significantly greater improvement observed for the latter group. Preoperative mean PCO was 35.08 mm in CR knees and 36.37 mm in CS knees, while the corresponding values post operatively were 32.74 mm and 34.88 mm respectively, at follow-up. In order to evaluate the relationship between change of PCO and postoperative improvement in range of flexion, we divided the patients into three sub groups according to the difference in pre and post-operative PCO. The first sub group had a difference in PCO ≤ 1 mm after surgery (CR: 5 and CS: 8), second sub group with a difference in PCO 1–3 mm after surgery (CR: 28 and CS: 26) and the third subgroup with a difference in PCO >3 mm after surgery (CR: 16 and CS: 7). Then a comparison of difference in PCO and post-operative range of motion was done in both CR knees and CS knees separately. The final post-operative range of motion (flexion) in CR knees was 117.6°, 115.93° and 109.06° for the three subgroups respectively. Similarly, the final post-operative range of motion (flexion) in CS knees was 116.12°, 118.81° and 118.86° for the three subgroups respectively. Thus a significant difference between three sub groups was observed in CR knees (P < 0.0001), while no difference was observed in the PS knees. ConclusionThe postoperative decrease in posterior condylar offset by more than 3 mm decreases the post-operative ROM in CR TKA but not in CS TKA. So it is critical to preserve PCO in CR but perhaps not CS knees to ensure optimal ROM postoperatively.

Digital image processing technique to measure the range of motion of the elbow

Abstract Background Most photography-based arc of motion measurements require human assessment and their accuracy depends on the observer. Objectives To develop a digital image processing technique (DIPT) for measuring elbow range of motion (ROM), and to assess its validity and reliability compared with standard methods. Methods Physiotherapists performed digital goniometer and inclinometer ROM measurements bilaterally on healthy volunteer elbows. A photographer took digital images of elbows fully extended and fully flexed 3 times using an 8-megapixel smartphone camera. Extension and flexion angles were calculated using the DIPT. Intra- and inter-rater reliability of all methods was assessed using an intraclass correlation coefficient (ICC). A paired Student's t test and Wilcoxon-signed rank test were used to assess systematic bias. A Bland–Altman plot was used to show possible range of difference between the methods. Results We measured 56 elbows from 28 participants. Intra- and inter-rater ICCs of goniometer and inclinometer showed moderate-to-excellent agreement. Mean extension and flexion angles for the DIPT were greater than those for the goniometer and inclinometer measurements (P &lt; 0.05), but the total ROMs were not significantly different (vs goniometer P = 0.32, vs inclinometer P = 0.53). Limits of agreement were 9.93°–10.05° for extension angle, 9.81°–11.7° for flexion angle, and 13.84°–15.99° for total ROMs. Conclusions Elbow ROM measurement using the current DIPT produces results comparable with goniometer and inclinometer measurements, but the difference from the standard methods was up to 15.99° for total ROM.

Case Series of All-Arthroscopic Treatment for Terrible Triad of the Elbow: Indications and Clinical Outcomes

To evaluate the results of all-arthroscopic treatment of the terrible triad of the elbow, a combination of elbow dislocation, radial head dislocation, and coronoid process fracture, and its complications. We performed a retrospective review of consecutive patients with terrible triad who underwent all-arthroscopic treatment between January 2011 and December 2016. All-arthroscopic treatment was performed in the unstable elbows after manual reduction. Clinical evaluation was performed at least 2 years postoperatively. Patients with another fracture in the upper extremity and previous fracture of the affected elbow were excluded. A radial head fracture that was stable enough to reduce or involved less than 25% of the articular surface for partial excision and Regan-Morrey classification type I and type II coronoid process fractures were treated arthroscopically. Range of motion, radiologic outcomes, surgical complications, and the Mayo Elbow Performance Score were evaluated at the final follow-up. The Mann-Whitney test was used for statistical analysis. A total of 24 patients met the inclusion criteria, and the average age was 47.6 years. Coronoid process fractures were fixed in all patients, by use of Kirschner wires in 15 (62.5%) and pullout sutures in 9 (37.5%). Radial head fractures were treated using screw or K-wire fixation in 4 patients (16.7%); only the fragment of the fracture was resected in 11 patients (45.8%). In all 24 cases (100%), the lateral collateral ligaments were repaired. At the final follow-up, the mean flexion contracture angle was 4.8° ± 1.1° and the mean flexion angle was 132.5° ± 6.3°. Clinical scores were satisfactory, with a mean Mayo Elbow Performance Score of 93 points. However, nonunion of coronoid fractures was observed in 4 patients (16.7%). There was 1 case of pin-site irritation. All-arthroscopic treatment for the terrible triad can provide an excellent safety profile without the need for a large incision if the indications are met. Level IV, therapeutic case series.

In Vivo Anterior Cruciate Ligament Deformation During a Single-Legged Jump Measured by Magnetic Resonance Imaging and High-Speed Biplanar Radiography

Background: The in vivo mechanics of the anterior cruciate ligament (ACL) and its bundles during dynamic activities are not completely understood. An improved understanding of how the ACL stabilizes the knee is likely to aid in the identification and prevention of injurious maneuvers. Purpose/Hypothesis: The purpose was to measure in vivo ACL strain during a single-legged jump through use of magnetic resonance imaging (MRI) and high-speed biplanar radiography. We hypothesized that ACL strain would increase with the knee near extension, and a peak in ACL strain would occur just before landing from the jump, potentially due to quadriceps contraction in anticipation of landing. Study Design: Descriptive laboratory study. Methods: Models of the femur, tibia, and ACL attachment sites of 8 male participants were generated from MRI scans through use of solid modeling. High-speed biplanar radiographs were obtained from these participants as they performed a single-legged jump. The bone models were registered to the biplanar radiographs, thereby reproducing the in vivo positions of the joint throughout the jump. ACL and bundle elongations were defined as the centroid to centroid distances between attachment sites for each knee position. ACL strain was defined as ACL length normalized to its length measured in the position of the knee at the time of MRI. Results: Peaks in ACL strain were observed before toe-off and 55 ± 35 milliseconds before initial ground contact. These peaks were associated with the knee positioned at low flexion angles. Mean ACL strain was inversely related to mean flexion angle (rho = −0.73, P < .001), such that ACL strain generally increased with knee extension throughout the jumping motion. ACL bundle lengths were significantly (rho > 0.85, P < .001) correlated with overall ACL length. Conclusion: These findings provide insight into how landing in extension can increase the risk of ACL injury. Specifically, this study shows that peak ACL strain can occur just before landing from a single-legged jump. Thus, when an individual lands on an extended knee, the ACL is relatively taut, which may make it particularly vulnerable to injury, especially in the presence of a movement perturbation or unanticipated change in landing strategy. Clinical Relevance: This study provides a novel measurement of dynamic ACL strain during an athletic maneuver and lends insight into how landing in extension can increase the likelihood of ACL failure.

Management of knee flexion contracture in haemophilia with the Ilizarov technique

BackgroundThere are limited reports about management of Knee flexion contracture (KFC) in haemophiliacs with Ilizarov technique. The aim of this study was to retrospectively analyzed the results of Ilizarov technique to treat KFC. MethodsSix patients with haemophilia A and one with haemophilia B were included in this study, with an average age of 17 years old. The mean preoperative KFC and flexion angle of the knee were 58 ± 21° (mean ± standard deviation) and 127 ± 12°, respectively. Preoperative HSS score (hospital for special surgery knee score) was 51 ± 4. The average time of follow-up was 39.3 ± 23.3 months. ResultsAll the patients achieved full correction of flexion contracture at the end of distraction and maintained at the last follow-up. The mean flexion angle at the end of distraction and at the last follow-up were 41 ± 35° and 38 ± 19° respectively, which were significantly lower than preoperative flexion angle. The mean HSS score at the end of distraction and at the last follow-up were 65 ± 4 and 64 ± 2 respectively, which were significantly higher than the preoperative HSS score. One patient suffered from transient numbness of left leg, and all the patients had loss of range of knee flexion at last follow-up. ConclusionsIlizarov is an effective and safe procedure to treat KFC in haemophiliacs. However, loss of knee flexion was the most common complication.