Optimal Joint Function Research Articles

An integrative approach in the management of ACL injury through Ayurveda and Physiotherapy- A Case report

The knee joint is a synovial hinge joint pivotal to human locomotion and stability. Comprising intricate articulations between the femur, tibia and patella. It facilitates complex movements, from flexion and extension to rotation. Knee ligaments are commonly injured due to indirect forces, such as twisting or bending of the knee, or rotational movements of the joint. Among these ligaments, the anterior cruciate ligament (ACL) is particularly important as it primarily prevents excessive forward movement of the tibia relative to the femur. Additionally, it contributes to the stability of the knee joint in both frontal and transverse planes. Injury to the ACL, whether through trauma or overuse, can compromise knee stability and function, often requiring surgical intervention and rehabilitation to restore optimal joint function. In the conventional treatment regimen, options like exercises, braces, lifestyle changes, and surgeries, including graft fixation, are utilized. Surgical procedures may result in complications such as post-operative stiffness and pain. These complications can impact mobility and overall quality of life, Ayurvedic treatment modalities like Snehana (oleation), Swedana (sudation), Basti Karma (medicated enema), Upanaha (local application) etc. have demonstrated notable improvements in both traumatic and degenerative conditions, with a particular emphasis on delaying the onset of osteoarthritis. The present study concludes that the integrative approach of Ayurveda and Physiotherapy helps to manage ACL injury.

Periprosthetic Osteolysis (PPOL) Following Total Knee Arthroplasty (TKA) Treated with Hybrid Semiconstrained Prosthetic Revision: A Case Report

Periprosthetic Osteolysis (PPOL) is a significant complication following total knee arthroplasty (TKR), often leading to the need for surgical revisions. The precise etiology of aseptic loosening and PPOL remains unclear, but it is a growing problem due to an aging population and increased demand for TKR implants. A 70-year-old female presented with left knee pain following a fall. She had previously undergone left and right TKR due to osteoarthritis. X-rays revealed a dislodged femoral prosthesis component and bone lysis, indicating PPOL. The patient had poor bone quality and was at risk for further complications. Due to insurance limitations, a hybrid revision technique was chosen, preserving the tibial component and enhancing the femoral aspect with a new augmented implant. Periprosthetic osteolysis is complex, and treatment options can be limited by financial constraints, such as insurance coverage. In this case, the decision to perform an isolated femoral component revision was made to reduce costs, with close follow-up and rehabilitation planned to prevent complications. Hybrid revision requires careful monitoring. PPOL restoration necessitates immediate action and rehabilitation to promote optimal joint function. This case highlights the importance of balancing medical judgment and financial constraints, and the potential for hybrid revision in specific cases. It also emphasizes the need for a harmonious relationship between healthcare professionals and healthcare management for patient safety and satisfaction. Keywords: Complication; Hybrid revision; Periprosthetic osteolysis; Total knee arthroplasty.

A Descriptive Study on the Morphometric Aspects of the Articular Facets for the Talus in the Human Calcanei

Abstract Background: Subtalar joints stability is greatly dependent on the facets on the calcaneus for talus articulation. Understanding the various variances in these features will help clinicians develop a more effective and individualized strategy that will yield the greatest outcomes. Our study aimed to examine the morphometry and morphology of the articular facets for the talus on the calcanei in humans. Methodology: In the present descriptive study, an analysis was conducted on 300 calcanei, dry bones of human adults of undetermined sex and age. The facet on every calcaneus for articulation with the talus was studied meticulously. Statistical analysis was done to determine the percentage and P value. Results: In the present study out of 300 calcanei studied, type IB with a nonconstricted articular facet pattern was found in 49.67% of calcanei, followed by type I A with a constricted articular facet present in 27% of calcanei. This was followed by type IIA in 14% of calcanei, type IIB in 5.67% of calcanei, type II C was found in only 0.67% of calcanei, type III was found in 2.33% of calcanei, and Types IV and V were found in 0.33%. Conclusion: This research elucidates the interrelationship among the articular facets of the talus and its clinical implications. Identifying distinct facet types is crucial for implementing suitable interventions to prevent injuries and ensure optimal joint function. Understanding the morphometric characteristics of these facets will undoubtedly aid orthopedic surgeons in managing disorders of the ankle and subtalar joints effectively.

Total Knee Replacement in Valgus Knee

Total knee replacement (TKR) in valgus knee patients presents unique challenges and requires careful consideration of various factors to ensure optimal outcomes. Valgus knee deformity can be associated with various underlying conditions, including autoimmune diseases like rheumatoid arthritis. Nearly 10% of patients undergoing total knee replacement have valgus knee deformity, which is associated with poorer functional outcomes than varus knees. When planning TKR procedures for patients with valgus knee deformity, it is crucial to identify the underlying reason, as the surgical strategy and implant selection may vary according to the individual etiology and patient factor. Proper alignment and stability of the knee joint need precise bone cuts, soft tissue balance, and implant design. Soft tissue balance ensures optimal joint function and range of motion. A comprehensive pre-operative planning process that takes into account these factors is essential for achieving the best possible outcomes and patient satisfaction in TKR for valgus knee patients. Different surgical approaches, such as the medial parapatellar and lateral parapatellar approaches, offer distinct advantages and disadvantages in treating valgus knee patients, and the choice of approach should be based on the surgeon's expertise and the patient's specific anatomy and deformity. For a successful output, the coronal, sagittal, and rotational alignment must be in proper proportion. Therefore, before performing a total knee replacement on a valgus knee, it is necessary to have a thorough understanding of the problem and the treatment options available.

An electroencephalography-based human-machine interface combined with contralateral C7 transfer in the treatment of brachial plexus injury.

Transferring the contralateral C7 nerve root to the median or radial nerve has become an important means of repairing brachial plexus nerve injury. However, outcomes have been disappointing. Electroencephalography (EEG)-based human-machine interfaces have achieved promising results in promoting neurological recovery by controlling a distal exoskeleton to perform functional limb exercises early after nerve injury, which maintains target muscle activity and promotes the neurological rehabilitation effect. This review summarizes the progress of research in EEG-based human-machine interface combined with contralateral C7 transfer repair of brachial plexus nerve injury. Nerve transfer may result in loss of nerve function in the donor area, so only nerves with minimal impact on the donor area, such as the C7 nerve, should be selected as the donor. Single tendon transfer does not fully restore optimal joint function, so multiple functions often need to be reestablished simultaneously. Compared with traditional manual rehabilitation, EEG-based human-machine interfaces have the potential to maximize patient initiative and promote nerve regeneration and cortical remodeling, which facilitates neurological recovery. In the early stages of brachial plexus injury treatment, the use of an EEG-based human-machine interface combined with contralateral C7 transfer can facilitate postoperative neurological recovery by making full use of the brain’s computational capabilities and actively controlling functional exercise with the aid of external machinery. It can also prevent disuse atrophy of muscles and target organs and maintain neuromuscular junction effectiveness. Promoting cortical remodeling is also particularly important for neurological recovery after contralateral C7 transfer. Future studies are needed to investigate the mechanism by which early movement delays neuromuscular junction damage and promotes cortical remodeling. Understanding this mechanism should help guide the development of neurological rehabilitation strategies for patients with brachial plexus injury.

Temperature gradient modeling of a steel box-girder suspension bridge using Copulas probabilistic method and field monitoring

A novel copula-based probabilistic model is proposed to establish the temperature difference analysis model for a long-span suspension bridge’s steel box girder. The key idea is to express a two-dimensional function of the temperature difference in flat steel box girder by using copulas. The maximum and minimum values of daily temperature difference model was developed using long-terms structural health monitoring data. Then, the correlation between adjacent temperature differences is investigated using five types of copulas. Akaike information criterion (AIC) is used to select an optimal model from five types of copulas, and the optimal joint function (two-dimensional function) for steel box girder’s temperature difference is established. Finally, the structure’s temperature gradient model is extrapolated for the service life of the structure by using Monte Carlo method. Moreover, this paper discusses the temperature gradient models using five types of common copulas and four types of time-varying copulas. The result shows that the t-copula is the optimal function to build the two-dimensional functions for steel box girder’s temperature difference, and the temperature model along the transverse direction can offer useful information that is not available in the design codes.

Subjects with medial and lateral tibiofemoral articular cartilage defects do not alter compartmental loading during walking

BackgroundHealthy cartilage is essential for optimal joint function. Although, articular cartilage defects are highly prevalent in the active population and hamper joint function, the effect of articular cartilage defects on knee loading is not yet documented. Therefore, the present study compared knee contact forces and pressures between patients with tibiofemoral cartilage defects and healthy controls. Potentially this provides additional insights in movement adaptations and the role of altered loading in the progression from defect towards OA. MethodsExperimental gait data collected in 15 patients with isolated cartilage defects (8 medial involvement, 7 lateral-involvement) and 19 healthy asymptomatic controls was processed using a musculoskeletal model to calculate contact forces and pressures. Differences between two patient groups and controls were evaluated using Kruskal-Wallis tests and individually compared using Mann-Whitney-U tests (alpha <0.05). FindingsThe patients with lateral involvement walked significantly slower compared to the healthy controls. No movement adaptations to decrease the loading on the injured condyle were observed. Additionally, the location of loading was not significantly affected. InterpretationThe current results suggest that isolated cartilage defects do not induce significant changes in the knee joint loading distribution. Consequently, the involved condyle will capture a physiological loading magnitude that should however be distributed over the cartilage surrounding the defect. This may cause local degenerative changes in the cartilage and in combination with inflammatory responses, might play a key role in the progression from articular cartilage defect to a more severe OA phenotype.

Arthroscopic Hip Labral Reconstruction and Augmentation Using Knotless Anchors

Biomechanical stability is the primary function of the acetabular labrum. It provides a hip suction seal and optimal joint function. Labral tears are a common reason for hip arthroscopy, to improve patient function and to prevent long-term degenerative arthropathy. Arthroscopic labral repair has shown significantly better outcomes in return to premorbid activity levels when compared with labral debridement. Injury to the acetabular labrum is a challenge and can lead to long-term complications. In this scenario, arthroscopic labral reconstruction has shown good results regarding patient subjective and objective outcomes. We describe a technique for complete arthroscopic labral reconstruction using tensor fascia lata allograft.

Identification of Novel Synovial Fluid Biomarkers Associated with Meniscal Pathology.

The menisci are integral components within the knee for ensuring optimal joint function. The overall goal of this study was to identify proteomic markers of meniscal disease within synovial fluid samples obtained from control knees versus knees affected with varying degrees of meniscal injury and osteoarthritis. Joint fluid samples were collected before the patient underwent an arthroscopic knee procedure or total knee arthroplasty. Normal controls included patients younger than 30 years with no history of anterior cruciate ligament, posterior cruciate ligament, or meniscal injury. A total of 21 joint fluid aspirates were analyzed using mass spectrometry, and a total of 296 proteins were identified. Among these, 50 proteins were determined to be of interest as potential biomarkers based on initial analysis and known functions in articular metabolism. Further statistical analysis comparing protein concentrations among clinical groups identified 13 proteins with significant differences between at least two of the patient cohorts. These data provide novel information for the investigation of synovial fluid biomarkers and treatment strategies for meniscal pathology.

Smallest detectable differences in clinical functional temporomandibular joint examination variables in juvenile idiopathic arthritis

Temporomandibular joint (TMJ) arthritis in juvenile patients may interfere with optimal joint function and mouth opening patterns. Clinical assessment of maximal mouth opening capacity, laterotrusion and protrusion is critical to TMJ arthritis diagnosis, treatment choice and evaluation of a therapeutic intervention. The aim of the study was to determine the smallest minimal threshold at which differences in maximal mouth opening capacity, laterotrusion, and protrusion between two consecutive observations can be determined. Department of Orthodontics, University of Aarhus, Denmark. Forty-two consecutive patients with juvenile idiopathic arthritis. Two experienced dentists used a calibrated metallic ruler to measure maximal mouth opening capacity, laterotrusion, and protrusion. Each measurement was carried out thrice by each observer. Intra- and inter-observer variation and the smallest detectable difference were calculated for each variable. The smallest detectable differences were as follows: maximal mouth opening capacity 4.9 mm, laterotrusion 2.4 mm, and protrusion 2.8 mm (one observer and one measurement). These differences declined when measurements were repeated; maximal mouth opening capacity 3.3 mm, laterotrusion 1.4 mm, and protrusion 1.8 mm (two observers with three measurements each). We found no support for a relationship between measurement variation and patient age, measurement variation and TMJ pain, or between measurement variation and previous/current TMJ arthritis. The importance of the implementation of a standardized measurement protocol is emphasized including repeated measurements to reduce the smallest detectable difference.

Smallest detectable differences in clinical variables related to temporomandibular joint arthritis in juvenile idiopathic arthritis

Background Temporomandibular joint (TMJ) arthritis in juvenile patients may lead to craniofacial growth deviations as well as interfere with optimal joint function and mouth opening pattern. Clinical assessment of maximal mouth opening capacity, laterotrusion and protrusion is widely used in the diagnosis of TMJ arthritis as well as in the evaluation of a therapeutic intervention in spite of missing knowledge about the reproducibility of these measurements.

Classification of Distal Radioulnar Joint Disorders

The wrist is one of the most complex articulations in the human body. The distal radioulnar joint (DRUJ) is particularly controversial, enduring as the area least understood with regard to anatomy and pathomechanics. The popular systems of classifying DRUJ disorders are based on etiology and treatment, but this approach has inspired schemes that are cumbersome, redundant, and incomplete. The need for an improved system prompted us to devise a simplified system that is based on the pathomechanics of dysfunction and the mechanical requirements for optimal joint function.

Osteoarthritis: pathophysiology, clinical features, management.

A wide variety of pharmacologic and surgical approaches may be successfully used to control the pain of osteoarthritis and maintain optimal joint function. Understanding of the pathophysiologic mechanisms of the disease and their correlation with clinical and radiographic findings is essential in selecting an appropriate strategy. Clinical guidelines are discussed.