Normal Range Of Motion Research Articles

THE SPECTRUM OF PRESENTATION OF HOFFA’S DISEASE: A CASE SERIES

Background: To study the functional outcome of surgical management in Hoffa’s disease. Methods: This prospective study was conducted in the Department of Orthopaedics in a tertiary health care centre between 1st January 2020 and 31st December 2021. A total of three patients (2 males and 1 female) with Hoffa’s disease were included in the study. Results: “Tegner-Lysholm score” was used for evaluation of function, and the mean Tegner–Lysholm score was 93. All the three patients had normal range of motion at 1 year follow-up. Conclusion: Hoffa’s disease has low incidence, and hence diagnosing the condition correctly is of utmost importance for its proper management.

Three-dimensional Kinematic Analysis and Muscle Activation of the Upper Extremity in Ruesi Dutton Exercises

Objective: To investigate 3-D upper extremity joint angles and muscle activities in selected Ruesi-Dutton exercises.Material and Methods: Twenty-six healthy participants (mean age of 25.65, mean height of 165.08 cm, and mean weight of 56.69 Kg) volunteered to take part in this study. 3-D motion analysis consisted of eight cameras synchronized with a wireless electromyography (EMG) system to collect kinematic data and muscle activity. Participants performed five postures, including the Kae Lom Kho Mue posture, Kae Puat Thong Kae Kho Thao posture, Kae Kiat posture, Kae Puat Thong Sabak Chom posture, and Kae Lom Puat Sisa. The upper extremity joint angles and range of motion (ROM) and EMG were analyzed.Results: Most postures were in the normal range of motion. The percentage of MVIC was more than 1% and the Trapezius muscle is the most active in all postures.Conclusion: The data in this research is useful to help select the correct posture and exercise for a specific condition.

Mid-Term Results of the First Dorsal Metacarpal Artery Flap for Thumb Defects.

Background: The thumb plays an important role in the function of the hand. Sensate reconstruction of the pulp is important in restoring function to the thumb. The aim of this study is to present outcomes of a sensate islanded first dorsal metacarpal artery (FDMA) flap used for the reconstruction of skin defects of the thumb. Methods: Patients who had a FDMA flap reconstruction of thumb pulp defects in the orthopaedics and traumatology clinic of affiliated hospital were included in the study. This included eight thumbs of eight patients. The range of motion, sensation and cosmetic satisfaction in the donor and recipient areas were evaluated at a minimum of 2-year follow-up. Results: There were no partial or complete flap failures. The mean static 2-point discrimination was 15 mm and the mean Semmes-Weinstein monofilament test score was 3.93. Cortical re-orientation was observed in 65% of patients. Near normal range of motion and Kapandji scores were regained in all patients. Conclusions: Excellent motion and sensory outcomes were obtained following the FDMA flap reconstruction of thumb pulp defects. The donor morbidity of the flap is minimal, and this flap can be considered as one of the primary options for reconstruction of thumb pulp defects. Level of Evidence: Level V (Therapeutic).

Open reduction and internal fixation of Ideberg type IA glenoid fractures: Tricks, pearls, and potential pitfalls based on a retrospective cohort of 33 patients focusing on the rehabilitation protocol.

The standard treatment of anterior glenaoid fractures carrying > 20% of the glenoid fossa is open reduction and internal fixation (ORIF). In the herein study, we report our outcomes in a retrospective cohort of anterior and anteroinferior glenoid rim fractures using an accelerated postoperative rehabilitation protocol. A secondary aim is to describe the surgical steps for ORIF of anterior and anteroinferior glenoid rim fractures using the anterior axillary approach, describing the tricks, pearls, and pitfalls of this surgical technique. A retrospective cohort of skeletally mature patients treated for an anterior glenoid rim fracture carrying > 20% of the glenoid fossa during a 10-year period were operated on using a vertical axillary incision, osteosynthesis with 2.0-mm cortical screws, and labral repair with small diameter metallic anchors and non-absorbable sutures. Rehabilitation began on the first postoperative day, including passive external rotation exercises and active-assisted flexion, adduction, and abduction exercises as tolerated. The exercises are performed with the patient sitting or lying down. Phase 1 is continued for 6-10weeks until the patient regains painless, normal, or near-normal ROM. Usually by 10weeks, the fracture and labrum are healed, so phase 2 rehabilitation begins with strengthening and ROM exercises. Radiologic and clinical outcomes, including active range of motion (ROM), glenohumeral stability, and visual analogue scale (VAS) were measured. About 33 patients (35 fractures) had complete medical records and pre- and post-operative imaging exams available for further analysis regarding the surgical protocol, with a mean of 4.8years. The mean DASH questionnaire was 3.75 ± 9.0 and the mean CM score was 62.5 ± 0.1. Active flexion and internal rotation were recovered in all patients, while external rotation presented an average loss of 8° (p = 0.12) and abduction of 5° (p = 0.33). The mean VAS was 1.1 ± 0.8. No patient reported major or disabling symptoms, or great difficulty or inability to perform daily or recreational activities. No patient presented residual instability of the glenohumeral joint. In this retrospective cohort, ORIF using a vertical axillary incision, osteosynthesis with 2.0-mm screws, and labral repair with small diameter metallic anchors and non-absorbable sutures was a safe approach, with a minimal risk of complications and residual instability. The accelerated postoperative rehabilitation protocol, allowing immediate passive external rotation of the operated shoulder, resulted in a non-significant loss of ROM compared to the contralateral side. Therefore, we recommend this management strategy for anterior glenoid rim fractures in patients with unstable shoulder joint after traumatic glenohumeral dislocation. Therapeutic Study (Surgical technique and Retrospective cohort).

Efficacy analysis of three kinds of surgery for trigger thumb.

To study the efficacy of three kinds of surgery for trigger thumb. A total of 60 cases of trigger thumb (Quinnell Grade IV) were randomly divided into three groups. The A1 pulley was disconnected at the middle in Group A, at the extreme radial side in Group B, excised in Group C. The following indicators were recorded pre-operatively (D0), and at one (D1), three (D3), seven (D7), 14 (D14), and 28 (D28) days post-operatively: 1. the pain visual analogue score (VAS) when flexing the affected thumb; 2. range of motion (ROM) of the interphalangeal joint with pain tolerance; 3. the time of pain disappearance when flexing the affected thumb. The differences of VAS and ROM between D1 and D0, D3 and D1, D7 and D3, D14 and D7, D28 and D14 were statistically significant (P < 0.05). There was no significant difference in changes of VAS (or ROM) at D1 or D28 in contrast to D0 among the three groups. The differences of VAS (or ROM) changes at D3, D7, and D14 in contrast to D0 among the three groups were statistically significant (P < 0.05). The difference of the time when the pain disappearing in the normal range of motion among the three groups were statistically significant (P < 0.05). Disconnecting the A1-pulley at the extreme radial side is better than another two methods for treating the trigger thumb (Quinnell Grade IV). It has been shown to effectively accelerate postoperative pain relief and functional recovery. Clinical trial registry number: ChiCTR2100051193.

An Unusual Cause Of Knee Pain Impacting An ICU Nurse’s Ability To Run For Codes

History: A 49 yo active female ICU nurse who enjoys hiking presented with right achy knee pain that hadstarted 6 months prior, but worsened 3 months ago when she twisted her knee playing with her nephewin the pool. The pain was worse with prolonged time on her feet preventing her from exercising andimpacting her ability to work, particularly running to code blues. She also noted pain in her distal thighand intermittent swelling with increase in venous distension. PHYSICAL EXAMINATION:Right Knee examAppearance: No skin abnormalities. Mild varum deformity. Small effusion. Gait: Antalgic Palpation: Lateral joint line tenderness to palpation Range of motion: Normal range of motion, pain with flexion. Meniscal testing: Positive McMurray’s, Thessaly, and bounce test. Ligament testing: Negative Lachman’s, anterior drawer, posterior drawer. Pain but no laxity with varusstress at 30 degrees. Patellar testing: Positive inhibition Strength/Function: 5-/5 quadriceps strength DIFFERENTIAL DIAGNOSIS:1. Meniscal tear 2. Venous thromboembolism 3. Malignancy 4. Osteoarthritis Tests/Results:XR 3V Right Knee:There are small spurs along the lateral and patellofemoral compartment. The joint spaces are normal.There is a small right effusion. There is a 2.4 cm focus of ill-defined sclerosis in the distal femoral shaft.This was not evident on the comparison study. MRI Right Knee without Contrast:There is a distal femoral metaphyseal lesion with chondroid matrix measuring 28 mm. There is a 2 mmextraosseous component anteriorly at the prefemoral fat pad.There is a T2 hyperintense focus in the proximal fibula which may represent a intraosseous ganglionversus an additional small cartilaginous lesion. FINAL DIAGNOSIS:Chondrosarcoma of the femur TREATMENT/OUTCOMES:The patient was referred to Orthopedic Oncology. Follow-up CT scan of the femur and chest showed nometastasis. The patient’s case was reviewed with the medical tumor board and she was scheduled fordistal femur replacement.

Limping Toward Improvement: The Value of Communicating Diagnostic Uncertainty.

Limping Toward Improvement: The Value of Communicating Diagnostic Uncertainty.

Poster 118: The Accuracy of a Smartphone App in Measuring Shoulder Range of Motion

Objectives:Measuring shoulder movements, specifically range of motion (ROM) of the shoulder joint is an important clinical parameter related to glenohumeral disorders and for functional evaluation of the shoulder before and after treatment, which may include surgery. Currently shoulder ROM measurements are performed in an office setting by the provider or alternatively may be performed by a physical therapist, traditionally with the use of a goniometer. The purpose of this study was to determine the accuracy of a smartphone-based digital ROM tool in assessing active shoulder ROM, compared to traditional goniometry measured by a physical therapist in an office setting.Methods:A prospective, non-blinded study was conducted at a single institution (University of St. Augustine, Austin< TX). Thirty (30) eligible and consenting participants with normal shoulder ROM were recruited. Each participant self-assessed their active shoulder ROM using the smartphone App. A physical therapist concurrently measured each participant’s active shoulder ROM using a hand-held goniometer. This concurrent data collection was designed for greater efficiency and minimal bias. Forward flexion (FF), abduction (AB) external rotation (ER), internal rotation (IR) and extension (EX) were measured. Agreement between the smartphone App and goniometric measurements, as well as intra-rater reliability (precision) was assessed using intraclass correlation coefficients (ICC) and Limits of Agreement analysis. Each measurement was performed in duplicate to assess precision. Statistical analysis was performed using R (https://www.r-project.org/)Results:Data were analyzed for 60 shoulders (30 right, 30 left) from 30 participants (mean age was 31.4, 92% female.) The inter-rater reliability between the two methods was excellent for all movements, with ICC ranging from 0.9 to 0.96. For all movements except AB, the mean difference in the measurements between PT and App was less than 1.3 degrees, and the difference was within 6 degrees of the mean differences for 80% of the participants. For AB, the mean difference was 2.08, and the difference was within 15 degrees of the mean difference for 80% of the participants. The intra-rater reliability or precision ranged from good to excellent. For all movements except IR, both PT and App showed excellent intra-rater reliability (ICCs > 0.90). For IR, good intra-rater reliability (ICCs >= 0.75) was observed.Conclusions:These data provide evidence that the smartphone App can be a reliable and valid tool for measuring shoulder ROM. Smartphone Apps enable self-assessment of ROM by patients at the convenience of their home and allow for remote monitoring at zero visit cost to the patient.

Shoulder Injury Related to Vaccine Administration (SIRVA) in 16 Patients Following COVID-19 Vaccination Who Presented to Chiropractic, Orthopedic, and Physiotherapy Clinics in Hong Kong During 2021

BackgroundShoulder injury related to vaccine administration (SIRVA) occurs when an intramuscular deltoid injection is administered into the shoulder joint. This observational study describes clinical features in 16 patients with SIRVA following Coronavirus 2019 (COVID-19) vaccination who presented to chiropractic, orthopedic, and physiotherapy clinics in Hong Kong between January 1, 2021, and January 1, 2022.Material/MethodsAdults age ≥18 with new-onset shoulder pain and imaging-confirmed shoulder pathology were retrospectively identified from 35 clinics. Patient demographics and clinical and vaccination details were extracted from the electronic medical record. Shoulder injury was determined by correlating clinical and imaging features.ResultsOf 730 patients with shoulder pain, 16 SIRVA cases (mean age, 49±10 years, 75% female) were identified; (12/16, 75%) of patients received the Pfizer-BioNTech vaccine while (4/16, 25%) received Sinovac-CoronaVac. The most common diagnosis was adhesive capsulitis (10/16, 63%), followed by bursitis (3/16, 19%) and supraspinatus tear (3/16, 19%). Mean symptom onset was 3.5±2.5 days post-vaccination, and always occurred after the 2nd or 3rd vaccination, involving reduced shoulder range of motion (ROM). Mean baseline pain was 8.1±1 (out of 10). All patients received conservative care (eg, exercise, manual therapies). At 3-month follow-up, mean pain reduced to 2.4±1.4; all patients had normal shoulder ROM.ConclusionsIn the past 2 years, millions of intramuscular COVID-19 vaccinations have been administered. It is important that clinicians are aware of SIRVA as a cause of new symptoms of shoulder injury and should ask the patient about recent vaccinations, including for COVID-19.

Treatment of Knee Osteochondral Fractures.

Osteochondral lesions (OCLs) that are frequently encountered in skeletally immature and adult patients are more common than once thought, and their incidence rate is rising. These lesions can appear in many synovial joints of the body, such as the shoulder, elbow, hip, and ankle, occurring most often in the knee. The term osteochondral lesion includes a vast spectrum of pathologies such as osteochondritis dissecans, osteochondral defects, osteochondral fractures, and osteonecrosis of the subchondral bone. When considering this, the term osteochondral fracture is preserved only for an osteochondral defect that combines disruption of the articular cartilage and subchondral bone. These fractures commonly occur after sports practice and are associated with acute lateral patellar dislocations. Many of these lesions are initially diagnosed by plain radiographs; however, a computed tomography (CT) scan or magnetic resonance imaging (MRI) can add significant value to the diagnosis and treatment. Treatment methods may vary depending on the location and size of the fracture, fragment instability, and skeletal maturity. The paper reports a 14-year-old boy case with an osteochondral fracture due to sports trauma. The medical approach involved an arthrotomy of the knee, drainage of the hematoma, two Kirschner wires (K-wires) for temporary fixation to restructure anatomic alignment, and a titanium Herbert screw fixing the fracture permanently. The patient had a favorable postoperative outcome with no residual pain, adequate knee stability, and a normal range of motion. The mobility of the knee was fully recovered.

Posterior cruciate ligament reconstruction with independent internal brace reinforcement: surgical technique and clinical outcomes with a minimum two year follow-up

PurposeWe developed an augmentation technique for PCL reconstruction with independent internal brace reinforcement and evaluated the functional outcome after PCL reconstruction employing autologous hamstrings augmented with an internal brace system for patients with isolated or combined grade 3 posterior instability who were treated with this technique.MethodsFrom January 2016 to January 2018, patients with isolated or combined grade 3 PCL tears who underwent single-bundle PCL reconstruction using autologous hamstrings augmented with independent internal braces were studied. The function of the operated knee was evaluated according to the International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity score. The patients were asked the level of returned to their previous sport. Posterior knee laxity was examined with a KT-1000 arthrometer, and data on range of motion (ROM), re-operation, and other complications were collected.ResultsA total of 33 consecutive patients who received single-bundle PCL reconstruction using autologous hamstrings augmented with independent internal braces with a minimum two years follow-up were included in this study. Two patients had undergone this procedure during the study period and were not included in this study (one had combined bone fractures, and one patient had previous meniscus surgery). Thirty-one patients were available for final analysis. The mean follow-up was 45.35 ± 10.88 months (range 29–66 months). The average IKDC subjective knee evaluation scores from 51.65 ± 12.35 to 84.52 ± 6.42, the Lysholm score from 53.90 ± 11.86 to 85.68 ± 4.99, and the Tegner score from 2.81 ± 0.79 to 6.71 ± 1.83 (P < 0.05 for all). The mean total posterior side-to-side difference in knee laxity, assessed using a KT-1000 arthrometer, decreased from 12.13 ± 2.66 mm pre-operatively to 1.87 ± 0.56 mm post-operatively at 70° (P < 0.05). Most patients (29/31) had normal or near normal knee ROM post-operatively; two patients revealed a 6–15° loss of knee flexion compared with the contralateral knee. Twenty-nine patients (93.55%) returned to a normal daily exercise level. Twenty-three patients (74.19%) returned to competitive sports with high-level sports (Tegner score of 6 or above; eleven patients (35.48%) reported to be on the same level as well as the Tegner level); six patients (19.35%) returned to recreational sports (Tegner score of 4 or 5). Two patients had Tegner scores of 2 and 3, indicating poor function level. No patient needed PCL revision surgery during the follow-up period.ConclusionSingle-bundle PCL reconstruction with internal brace augmentation for PCL injury exhibited satisfactory posterior stability and clinical outcomes in patients with isolated or combined grade 3 PCL injuries at a minimum two year follow-up.

A case report on rare case of chronic osteomyelitis of the distal fibula in adult

&lt;p&gt;Osteomyelitis of the fibula is uncommon. It can occur secondary to trauma however it can also occur as a result of haematogenous spread from distant sites of infection. There is usually a period of sub clinical infection and this can lead to delay in diagnosis. But it is clinical diagnosis with support of various investigation with proper surgical technique and various differential diagnosis it is treated with good satisfactory result. A 24-year-female was asymptomatic but for last 6 days She started developing pain, swelling and redness of skin from lateral aspect of distal third of leg. We investigated and did incision and pus drainage with abnormal tissue was excised out, but very unusual presentation intraoperative pus and tissue debris was there. However, after biopsy, it was diagnosed pyogenic osteomyelitis 2 weeks of injectable and 6 weeks of oral antibiotics were given. After 4-6 weeks weight bearing was started, the patient returned to his obvious activities with normal range of motion. The osteomyelitis of fibula with various differential diagnosis clinically and intraoperatively with pus discharge but after proper debridement and biopsy report probable diagnosis is made with proper duration of antibiotic treatment chronic osteomyelitis is treated with satisfactory result with good outcome.&lt;/p&gt;

Does range of motion measurement and reference values differ?: a multi-centered study

This study is aimed to estimate and measure reference values in the normal range of motion of extremity joints in females and to provide a database for the assessment of impairments related to the mobility of the joints. This observational cross-sectional study was conducted at seven major educational institutes areas of Rawalpindi and Islamabad in Pakistan from January to June 2020 with a sample size of 600 healthy females aged 15 to 45 years and divided into three groups through non-probability sampling technique. In study Instruments, an electronic Goniometer was used for the measurement of the range of motions for different joints and then those ranges were recorded. The questionnaire had two sections demographic characteristics and ROM for both upper and lower limbs. Data was analyzed using SPSS V21. A p &lt; 0.05 was considered statistically significant.In the result,Out of 600 participants,there was a statistically significant difference of (p &lt; 0.001) in both upper and lower extremities motion between all the three groups for the measurements and noticeably no significant difference (p &gt; 0.005) between group 1, 2 comparisons for the knee joint extension.To conclude, In most joints, the range of motion increases with age. The transition from group 1 to group 2 was aided by increased hormone participation in growth, an active lifestyle, and generally good health. Because of degenerative changes and joint stiffness, group 3’s range of motion deteriorated, leading to a sedentary lifestyle and lack of physical activity. Standardized biomechanical measurements can help health practitioners, such as physiotherapists, choose appropriate therapy interventions to assess musculoskeletal disorders. To resolve the inconsistencies in the reliability and validity of goniometry values, more research is required.

Sports Medicine

Key Points A joint effusion is never normal and requires further evaluation and imaging.Athletes should not be allowed to play sports while still exhibiting symptoms of a concussion.Athletes should be asymptomatic for at least 24 hours after being diagnosed with a concussion before starting a return-to-play protocol preferably under the supervision/direction of the physician, physical therapist, or athletic trainer.The athlete should ideally be pain free with normal range of motion and no swelling before they are allowed to practice without restrictions and play in competition.

Effectiveness of Maitland And Mulligan Mobilization In Cervical Radiculopathy Patients

The objective of the study is to differentiate the effectiveness of Mulligan and Maitland mobilization in cervical radiculopathy. Methods: 200 patients were selected and divided by lottery method into two groups. In one group i.e., Group A Maitland mobilization and in group B Mulligan mobilization was given. Patients were followed till 2 weeks. Results: There were 124(62%) male and 76(38%) female cases in study. The average age in group-A and group-B was 38.90 ± 6.97 years and 42.07±7.03 years, p-value 0.085. Before treatment the mean of pain in both group were calculated. So, in group-A was 7.40±1.45 and in group-B was 7.63±1.27 respectively, with insignificant difference. After treatment the mean pain in group-A was 3.40±1.73 and group-B was 2.53±1.57 respectively, P-value&lt; 0.05 with significantly much less pain in group-B. The difference of pain represents in group-A and group-B was 3.77±2.18 and 4.90±1.83 while group A shows better results with, p-value &lt; 0.05. Before treatment range of motion was restricted in all patients, while after treatment 80% of cases achieved normal range of movement in group-A while in group-B 92% cases achieved normal movement range. The improvement in both study groups was significantly higher at 2nd week of treatment, but in group B the improvement was higher when compared to group-A, p-value. Conclusion: The study concluded “Mulligan technique is much more effective than Maitland technique in terms of less pain and normal range of motion for cervical radiculopathy patients”.

A Pain in the Neck: An Adolescent with Neck Pain.

A Pain in the Neck: An Adolescent with Neck Pain.

Epidemiology of Generalized Ligamentous Laxity in Iran: A National Study Including Different Iranian Ethnic Groups and its Relationship with Musculoskeletal Disorders.

Ligamentous laxity is a condition that leads to joints' hypermobility beyond their average and normal range of motion. It can cause musculoskeletal and joint injuries. This national multi-centered study investigated the epidemiology of generalized ligamentous laxity and its relationship with musculoskeletal disorders among Iranian adults with different ethnic backgrounds. A total of 1,488 people (age range: 17-40 years) were selected from eight cities and six different ethnicities of Iran and included in this cross-sectional study. The presence of ligamentous laxity with clinical examinations was searched according to Beighton score criteria. They were also examined for any kind of musculoskeletal disorders that might accompany ligamentous laxity. The Chi-square test was used to compare the frequency of ligamentous laxity based on gender and ethnicity; moreover, the t-test was utilized to compare the frequency of ligamentous laxity based on age. In total, 280 (18.8%) participants had generalized ligamentous laxity, and it was more prevalent in women (22.7%), compared to men (14.4%). Regarding ethnicity, the highest and lowest prevalence rates were in Gilak (37.9%) and Persian-Arab (6%) ethnicities, respectively (P<0.001). Ligamentous laxity showed a significant relationship with sports injury, joint complaint, joint dislocation, ligament sprain, sciatica and back pain, Baker's cyst, and varicose veins (P<0.001). Most participants with generalized ligamentous laxity (93.6%) had no knowledge of their problem and its importance in choosing an appropriate sports activity. The prevalence of generalized ligamentous laxity seems to be relatively high among the 17-40-year-old population of Iran, especially in women. It seems to be significantly related to ethnicity. It is strongly recommended that examinations, screening, and information be provided at an early age in schools or at least in areas with a high prevalence as national programs.

Effectiveness of Maitland And Mulligan Mobilization In Cervical Radiculopathy Patients

The objective of the study is to differentiate the effectiveness of Mulligan and Maitland mobilization in cervical radiculopathy. Methods: 200 patients were selected and divided by lottery method into two groups. In one group i.e., Group A Maitland mobilization and in group B Mulligan mobilization was given. Patients were followed till 2 weeks. Results: There were 124(62%) male and 76(38%) female cases in study. The average age in group-A and group-B was 38.90 ± 6.97 years and 42.07±7.03 years, p-value 0.085. Before treatment the mean of pain in both group were calculated. So, in group-A was 7.40±1.45 and in group-B was 7.63±1.27 respectively, with insignificant difference. After treatment the mean pain in group-A was 3.40±1.73 and group-B was 2.53±1.57 respectively, P-value&lt; 0.05 with significantly much less pain in group-B. The difference of pain represents in group-A and group-B was 3.77±2.18 and 4.90±1.83 while group A shows better results with, p-value &lt; 0.05. Before treatment range of motion was restricted in all patients, while after treatment 80% of cases achieved normal range of movement in group-A while in group-B 92% cases achieved normal movement range. The improvement in both study groups was significantly higher at 2nd week of treatment, but in group B the improvement was higher when compared to group-A, p-value. Conclusion: The study concluded “Mulligan technique is much more effective than Maitland technique in terms of less pain and normal range of motion for cervical radiculopathy patients”.

Bilateral patellar tendon rupture: a case report

&lt;p&gt;Bilateral patellar tendon rupture is a rare injury, usually associated with systemic disease or chronic medication side effect. Early diagnosis and prompt surgical repair are essential to achieve good functional outcomes. The authors report a case of a 44-year-old male with history of multiple urinary tract infection treated with fluoroquinolones who sustained spontaneous simultaneous bilateral patellar tendon rupture. Patient underwent bilateral transosseus tendon repair with autologous semitendinosus augmentation. Nine months after surgery, the patient was able to walk without pain and unassisted, had a normal range of motion in both knees and performed his daily activities without limitation. Surgical treatment of patellar tendon rupture is recommended to allow prevention of extensor mechanism disfunction sequelae. Transosseus tendon repair with autologous semitendinosus augment plasty is a valid surgical technique for treatment of this pathology with biomechanical and literature support.&lt;/p&gt;

Normal range of motion at the hip show different pressure behavior in the lateral and acetabular compartments: a cadaveric investigation

PurposeThe techniques used previously to assess intracapsular pressures did not allow the assessment of pressure variations in both compartments throughout the entire range of motion without puncturing the capsular tissue. Our hypothesis was that the intra-capsular pressure would be different in the lateral and acetabular compartment depending on the movement assessed.MethodsEight hip joints from four cadaveric specimens (78.5 ± 7.9 years) were assessed using intra-osseous tunnels reaching the lateral and acetabular compartments. Using injector adaptors, 2.7 ml of liquid were inserted in both compartments to simulate synovial liquid. Optic pressure transducers were used to measure pressure variations. We manually performed hip adduction, abduction, extension, flexion and internal rotation at 90° of flexion.ResultsHip extension and internal rotation show the highest intra-capsular pressures in the lateral compartment with increases of 20.56 ± 19.29 and 19.27 ± 18.96 mmHg, respectively. Hip abduction and hip internal rotation showed depressurisations of − 16.86 ± 18.01 and − 31.88 ± 30.71 mmHg in the acetabular compartment, respectively. The pressures measured in the lateral compartment and in the acetabular compartment were significantly (P < 0.05) different for the hip abduction, 90° of flexion and internal rotation. Pressure variations showed that maximum intracapsular fluid pressures in the lateral compartment occur at maximum range of motion for all movements.ConclusionAs an increase in pressure may produce hip pain, clinician should assess pain at maximum range of motion in the lateral compartment. The pressure measured in the acetabular compartment vary depending on the hip position. The movements assessed are used in clinical practice to evaluate hip integrity and might bring pain. The pressure variations throughout the entire range of motion are a relevant information during hip clinical assessment and might help clinicians to better understand the manifestations of pain.