Passive Knee Motion Research Articles

Impact of implant positions in total knee arthroplasty on the postoperative knee kinematics of tibial rotation

IntroductionIn total knee arthroplasty (TKA), the implant positions and knee kinematics, as well as the manifestation of medial pivot motion, play pivotal roles in determining postoperative clinical outcomes. The purpose of the current study was to analyze the correlation between knee kinematics, which was measured during TKA and implant positions derived using computed tomography (CT) examination after TKA. MethodsThis study comprised 64 patients (76 knees) who underwent primary TKA between 2015 and 2022. A navigation system was used in TKA procedures, and intraoperative knee kinematics were automatically calculated with it. Utilizing three-dimensional evaluation software, positioning of implants was quantified with CT images taken pre- and post-operatively. Multiple regression analyses were employed to explore the impact of femoral component position (FP) and tibial component position (TP) on knee kinematics, focusing on the extent of tibial rotational motion (TRM) during passive knee motion. ResultsFP affected TRM between knee extension and 90° flexion (p = 0.003, 95 % confidence interval [CI]: 0.315–1.384) and between knee extension and full flexion (p = 0.0002, 95 % CI: 0.654–1.844) after TKA. FP in internal rotation positively affected internal TRM after TKA. TP was not associated with TRM. ConclusionsFindings of the current study suggest that FP in internal rotation positively impacts knee kinematics after TKA.

Hot-pack therapy increased gliding function of the iliotibial band during passive knee motion: An exploratory study

IntroductionQuantifying soft tissue dynamics during joint motion is important for the valid assessment and development of effective therapeutic interventions for the soft tissues. This study aimed to examine the immediate effect of thermotherapy on gliding of the iliotibial band (ITB), including the subcutaneous tissue, and vastus lateralis (VL) muscle during passive knee joint motion. MethodsTen participants (age, 20.4 ± 0.7 years; height, 172.0 ± 8.9 cm; weight, 64.1 ± 9.7 kg; BMI, 21.6 ± 1.7 kg/m2) with no history of lower extremity surgery or neuromuscular disease participated in the study. An electrothermal hot pack with an internal temperature of 65 °C was applied to one of the lateral thighs, followed by measuring its stiffness using a durometer. Movements of both the ITB and VL were recorded using ultrasound imaging during isokinetic knee motion. The Farneback method and optical flow algorithm analysis software were adapted to create the movement velocity from ultrasound imaging. Gliding coefficient was calculated using the coefficient of correlation for each velocity in the proximal-distal direction during knee motion. The mean velocity during knee motion was calculated using absolute values. The differences between the pre-intervention values and between the pre- and post-intervention values were examined. ResultsAfter applying the hot pack, the stiffness significantly decreased (p = 0.01), and the mean velocity of the ITB significantly increased (p = 0.03). The gliding coefficient and VL mean velocity did not significant differ (p = 0.65 and p = 0.80, respectively) between pre- and post-hot-pack applications. ConclusionsHot-pack therapy might increase gliding function of the ITB during passive knee motion.

Dual-Task Interference Slows Down Proprioception.

It is well-known that multitasking impairs the performance of one or both of the concomitant ongoing tasks. Previous studies have mainly focused on how a secondary task can compromise visual or auditory information processing. However, despite dual tasking being critical to motor performance, the effects of dual-task performance on proprioceptive information processing have not been studied yet. The purpose of the present study was, therefore, to investigate whether sensorimotor task performance would be affected by the dual task and if so, in which phase of the sensorimotor task performance would this negative effect occur. The kinematic variables of passive and active knee movements elicited by the leg drop test were analyzed. Thirteen young adults participated in the study. The dual task consisted of performing serial subtractions. The results showed that the dual task increased both the reaction time to counteract passive knee-joint movements in the leg drop test and the threshold to detect those movements. The dual task did not affect the speed and time during the active knee movement and the absolute angle error between the final and the target knee angles. Furthermore, the results showed that the time to complete the sensorimotor task was prolonged in dual tasking. Our findings suggest that dual tasking reduces motor performance due to slowing down proprioceptive information processing without affecting movement execution.

Enhanced Respiratory Frequency Response to Lower Limb Mechanoreceptors Activation in Patients with Chronic Obstructive Pulmonary Disease.

To investigate the mechanoreflex control of respiration and circulation in patients with chronic obstructive pulmonary disease (COPD). Twenty-eight patients with moderate-to-severe COPD (mean ± SD: 67.0 ± 7.9 yr, 10 women) and 14 age- and sex-matched controls (67.9 ± 2.6 yr, 7 women) participated in the study. Their dominant knee was passively moved to stimulate mechanoreceptors, whereas vastus lateralis surface electrical activity checked active contractions. A differential pressure flowmeter, an electrocardiogram, and a servo-controlled finger photoplethysmograph acquired cardiorespiratory data. To gain insight into the mechanoreflex arc, we further analyzed reduced/oxidized glutathione ratio and mechanoreceptor-related gene expression in a vastus lateralis biopsy of additional nine patients (63.9 ± 8.1 yr, 33% women) and eight controls (62.9 ± 9.1 yr, 38% women). Patients with COPD had a greater peak respiratory frequency response (COPD: Δ = 3.2 ± 2.3 vs Controls: 1.8 ± 1.2 cycles per minute, P = 0.036) and a smaller peak tidal volume response to passive knee movement than controls. Ventilation, heart rate, stroke volume, and cardiac output peak responses, and total peripheral resistance nadir response, were unaltered by COPD. In addition, patients had a diminished glutathione ratio (COPD: 13.3 ± 3.8 vs controls: 20.0 ± 5.5 a.u., P = 0.015) and an augmented brain-derived neurotrophic factor expression (COPD: 2.0 ± 0.7 vs controls: 1.1 ± 0.4 a.u., P = 0.002) than controls. Prostaglandin E receptor 4, cyclooxygenase 2, and Piezo1 expression were similar between groups. Respiratory frequency response to mechanoreceptors activation is increased in patients with COPD. This abnormality is possibly linked to glutathione redox imbalance and augmented brain-derived neurotrophic factor expression within locomotor muscles, which could increase mechanically sensitive afferents' stimulation and sensitivity.

What is the Effect of Posterior Osteophytes on Flexion and Extension Gaps in Total Knee Arthroplasty? A Cadaveric Study.

BackgroundPosterior compartment knee osteophytes may pose a challenge in achieving soft-tissue balance during total knee arthroplasty (TKA). Obtaining symmetry of flexion and extension gaps involves balance of both bony and soft-tissue structures. We hypothesize that space-occupying posteromedial femoral osteophytes affect soft-tissue balance.MethodsFive cadaveric limbs were acquired. Computed tomography scans were obtained to define the osseous contours. Three-dimensionally printed, specimen-specific synthetic posterior femoral osteophytes were fabricated in 10-mm and 15-mm sizes. TKAs were implanted. Medial and lateral compartment contact forces were measured during passive knee motion using pressure-sensing technology. For each specimen, trials were completed without osteophytes and with 10-mm and 15-mm osteophytes affixed to the posteromedial femoral condyle. Contact forces were obtained at full extension, 10°, 30°, 45°, 60°, and 90° of flexion. These were recorded across each specimen in each condition for three trials. Tukey post hoc tests were used with a repeated measures ANOVA for statistical data analysis.ResultsThe presence of posteromedial osteophytes increased asymmetric loading from full extension to 45° of flexion, with statistically significant differences observed at full extension and 30°. A reduction in lateral compartment forces was noted. The 25%-75% bounds of variability in the contact force was less than 3.5 lbs.ConclusionsPosteromedial femoral osteophytes caused an asymmetric increase in medial contact forces from full extension continuing into mid-flexion. The soft-tissue imbalance created from these osteophytes supports their removal before performing ligament releases to obtain desired soft-tissue balancing during TKA.

Effects of Total Knee Arthroplasty on Coronal and Sagittal Whole-Body Alignments: Serial Assessments Using Whole-Body EOS.

Background: The aims of this study were to evaluate the effects of correcting lower limb alignment by total knee arthroplasty (TKA) on the spinopelvic alignment and to identify patients with difference in the knee joint between clinically measured passive motion and the actual standing posture. Methods: In this retrospective study, 101 patients who underwent TKA and whose serial whole-body EOS X-ray were available were included. The relationship of the knee and spinopelvic alignment was analyzed by evaluating the parameters of standing anterior-posterior and lateral whole-body EOS X-ray. The differences between postoperative passive motion and weight-bearing posture in the knee joint were assessed in both coronal and sagittal planes. Furthermore, the causes of such differences were analyzed. Results: Significant correlations between Δpelvic obliquity and coronal ΔHip-Knee-Ankle (HKA)Rt-Lt angle between the preoperative and 3-month and 1-year postoperative data (p < 0.001 and p < 0.005, respectively) and improved with coronal lower limb alignment close to neutral resulted in decreased pelvic obliquity (p < 0.001, ß = 0.085 and p = 0.005, ß = 0.065, respectively) were observed. The correlations between Δpelvic tilt (PT) and Δsacral slope (SS) and sagittal ΔHKARt-Lt angle were statistically significant (PT: p < 0.001 and p < 0.045; SS: p = 0.002 and p < 0.001, respectively). The improved sagittal alignment close to neutral resulted in decreased PT and increased SS. The difference between postoperative passive motion and the weight-bearing posture of the knee joint was correlated with lumbar lordosis and sagittal C7 plumb line-sacrum distance (p = 0.042 and p < 0.001, respectively). Conclusions: The correction of lower limb alignment with TKA affected pelvic parameters dominantly; however, there was little effect on the spinal alignment. Additionally, patients with anterior stooping or lumbar flat back demonstrated difference in extension between passive knee motion and standing. Therefore, rather than only focusing on changes in the knee alignment correction, knee surgeons should also evaluate the spinopelvic alignment before surgery to consider the prognosis of the standing and predict the possible changes in the whole-body alignment. This preoperative assessment may improve the prognosis of TKA.

Intermittent adductor canal block for post-operative pain management and faster rehabilitation following unilateral total knee replacement

BackgroundTotal knee arthroplasty (TKA) is usually associated with intense, early postoperative pain thereby interfering with patient’s sleep and rehabilitation activities. To control the post-operative pain various traditional analgesic techniques have been recommended. But due to various systemic side effects, adductor canal blocks (ACBs) have emerged as a newer modality with effective postoperative analgesia and aids in faster rehabilitation. We retrospectively analysed the outcomes of USG guided intermittent adductor canal block in patients undergoing Unilateral TKA as a better mode for pain relief with fast track recovery. Material and methodsA total of 51 patients underwent Unilateral TKA for arthritic knee were included in the study. Post-operatively all patients underwent an USG guided ACB with indwelling catheter. All patients received a standardized multimodal analgesic regimen (unless contraindicated) and intermittent 8th hourly 0.25% 8 ml bupivacaine through ACB catheter. Post-operative VAS score reading was noted twice in a day (morning and evening) on post-operative day 1, 2 and day 3(morning). The readings were recorded in 2 ways-Without movement of knee (at rest) and with passive movement of knee (slight flexion). Post-operative rehabilitation was evaluated in terms of Quadriceps power, ambulation ability with walker or cane, climbing stairs and duration of hospital stay. ResultsVAS score statistically reduced from POD1 to POD2 and POD1 to POD3 both at rest and during movement and post-operative pain management was successful using ACB in 88% patients without any opioid supplementation. ConclusionIn our study we recommend intermittent ACB as a very good modality for post-operative pain management, preserving quadriceps strength, early rehabilitation and short hospital stay with minimal or no bupivacaine related side effects in patients undergoing unilateral total knee replacement.

Modeling the resistance mechanism of passive knee joint flexion and extension for use in rehabilitation equipment.

The purpose of this study was to model the resistance mechanism of Passive Knee Joint Flexion and Extension to create a similar torque mechanism in rehabilitation equipment. In order to better model the behavior of passive knee tissues, it is necessary to exactly calculate the two coefficients of elasticity of time-independent and time-dependent parts. Ten healthy male volunteers (mean height 176.4+/-4.59 cm) participated in this study. Passive knee joint flexion and extension occurred at velocities of 15, 45, and 120 (degree/s), and in five consecutive cycles and within the range of 0 to 100° of knee movement on the sagittal plane on Cybex isokinetic dynamometer. To ensure that the muscles were relaxed, the electrical activity of knee muscles was recorded. The elastic coefficient, (KS) increased with elevating the passive velocity in flexion and extension. The elastic coefficient, (KP) was observed to grow with the passive velocity increase. While, the viscous coefficient (C) diminished with passive velocity rise in extension and flexion. The heightened passive velocity of the motion resulted in increased hysteresis (at a rate of 42%). The desired of passive velocity is lower so that there is less energy lost and the viscoelastic resistance of the tissue in the movement decreases. The Coefficient of Determination, R2 between the model-responses and experimental curves in the extension was 0.96 < R2 < 0.99 and in flexion was 0.95 < R2 < 0.99. This modeling is capable of predicting the true performance of the components of passive knee movement and we can create a resistance mechanism in the rehabilitation equipment to perform knee joint movement. Quantitative measurements of two elastic coefficients of Time-independent and Time-dependent parts passive knee joint coefficients should be used for better accurate simulation the behavior of passive tissues in the knee which is not seen in other studies.

Myofascial Compression Interventions: Comparison of Roller Massage, Instrument Assisted Soft-Tissue Mobilization, and Floss Band on Passive Knee Motion Among Inexperienced Individuals

Myofascial compression interventions have become popular in rehabilitation and fitness. To date, no studies have directly compared roller massage, instrument assisted soft-tissue mobilization, and floss band among unexperienced individuals. The primary purpose of this investigation was to compare the immediate post-intervention effects of roller massage, instrument assisted soft-tissue mobilization, and floss band on passive knee range of motion (ROM) among inexperienced individuals using a standard treatment time. The secondary purpose was to determine the interchangeability of the interventions and to provide preliminary research for longer-term comparison studies. This pretest, posttest randomized controlled trial was conducted in a university laboratory. Thirty participants (M=15, W=15) were randomly assigned to three groups: (1) foam roller, (2) instrument assisted soft-tissue mobilization, and (3) floss band. The intervention time for each group was 2-minutes. The outcome was passive knee ROM. Between group analysis revealed a statistically significant post-intervention difference between the three interventions for passive knee flexion ROM (p <.001). Within group comparison for ROM revealed a 2 degree (p<.001) post-intervention increase for roller massage, a 3.5-degree (p<.001) increase for the instrument assisted soft-tissue mobilization, and a 4-degree (p<.001) increase for the floss band. The three interventions produced similar immediate post-intervention effects on passive knee ROM among inexperienced individuals. Clinically, these interventions may be interchangeable by producing similar effects on knee ROM. Clinicians may want to consider these finding prior to administering these interventions with their clients.

Effects of intraarticular ketamine combined with periarticular bupivacaine on postoperative pain after arthroscopic meniscectomy.

Objectives This study aims to evaluate the effects of two different doses of intraarticular ketamine on visual analog scale (VAS) scores at rest and movement, time to first analgesic requirement, and 24-h morphine consumption in patients undergoing arthroscopic meniscectomy as well as to assess the frequency of postoperative nausea&vomiting, respiratory depression, pruritus, urinary retention, and constipation and to compare the time to discharge.Patients and methods This prospective randomized double- blind study was performed between August 2013 and August 2014 on 75 patients (32 males, 43 females; mean age 46.7±13 years; range, 18 to 75 years) with American Society of Anesthesiologists scores of I-II scheduled for unilateral meniscectomy. Patients were randomized to receive 0.5 mg.kg-1 ketamine (group K1), 1 mg.kg-1 ketamine (group K2) or saline (group S) to a total volume of 20 mL intraarticularly at the end of the surgery. All patients were performed periarticular 10 mL 0.5% bupivacaine infiltration. Visual analog scale at rest and during passive knee movement was used to evaluate pain both preoperatively and at postoperative 0, 30 min, and 1, 2, 4, 6, 12, and 24 h. Time to first analgesic requirement and morphine consumption were recorded.Results Visual analog scale scores at rest and during movement at postoperative 0 were significantly reduced in group K2 compared with group S (p<0.05). The first analgesic requirement time was significantly longer in group K1 (76.9±25.2 min) and group K2 (93.4±26.1 min) than group S (29.3±7.1 min). Morphine consumption was lower in group K2 compared to group K1 and group S at postoperative 30 min, and 1 and 2 h. However, 24-h morphine consumption was similar in all groups.ConclusionIntraarticular injection of 0.5 mg.kg-1 and 1 mg.kg-1 ketamine for postoperative pain management provided similar analgesic efficacy. However, high dose ketamine more noticeably decreased opioid requirement in the early postoperative period.

Strain Assessment of Deep Fascia of the Thigh During Leg Movement: An in situ Study.

Fascia is a fibrous connective tissue present all over the body. At the lower limb level, the deep fascia that is overlying muscles of the outer thigh and sheathing them (fascia lata) is involved in various pathologies. However, the understanding and quantification of the mechanisms involved in these sheathing effects are still unclear. The aim of this study is to observe and quantify the strain field of the fascia lata, including the iliotibial tract (ITT), during a passive movement of the knee. Three fresh postmortem human subjects were studied. To measure hip and knee angles during knee flexion-extension, passive movements from 0° to around 120° were recorded with a motion analysis system and strain fields of the fascia were acquired using digital image correlation. Strains were computed for three areas of the fascia lata: anterior fascia, lateral fascia, and ITT. Mean principal strains showed different strain mechanisms depending on location on the fascia and knee angle. For the ITT, two strain mechanisms were observed depending on knee movement: compression is observed when the knee is extended relative to the reference position of 47°, however, tension and pure shear can be observed when the knee is flexed. For the anterior and lateral fascia, in most cases, minor strain is higher than major strain in absolute value, suggesting high tissue compression probably due to microstructural fiber rearrangements. This in situ study is the first attempt to quantify the superficial strain field of fascia lata during passive leg movement. The study presents some limitations but provides a step in understanding strain mechanism of the fascia lata during passive knee movement.

Superior Dislocation of Patella Without Osteophytes – A Rare Case

A 66-year-old woman sustained a “sprain” of her right knee while walking inside a supermarket. She complained of sudden knee pain and was unable to walk or move her right knee. She attended Accident and Emergency Department and was admitted into Orthopaedic ward with a diagnosis of “patella tendon rupture”. Physical examination on admission showed swelling, bruise and local tenderness just below the inferior pole of upward migrated patella bone. The extensor mechanism was loss. Passive knee motion was 0-20 degree only, limited by pain. Plain radiographs showed superior migrated patella. Beside ultrasound showed intact patella tendon. Closed reduction without anaesthesia was done successfully with an immediate regain of knee motion to 0-80 degree. Post-reduction x ray showed reduced patella with no fracture. Follow-up at 6 weeks showed normal active motion knee motion with full quadriceps power.Superior patellar dislocation is a rare condition. At 2016, only 23 cases were reported in English literature. It should be considered as a differential diagnosis of patella tendon rupture or locked knee. Pathognomonic radiographic features include proximal displaced patella with superior pole tilted away from femur and a dimple in skin. Ultrasonography may be used to exclude patella tendon rupture, which is a more common diagnosis in elderly. Most superior dislocations are due to interlocking patella and trochlear osteophyte. This may the second reported case of superior dislocation of patella without osteophytes. Closed reduction may be done without general anaesthesia. After reduction of superior patella dislocation, the functional recovery is rapid.

Rotational and varus-valgus laxity affects kinematics of the normal knee: A cadaveric study.

The aim of this study was to evaluate the relationship between soft tissue laxity and kinematics of the normal knee using a navigation system. Fifteen cadaveric knees from 11 fresh frozen whole-body specimens were included in this study. The navigation system automatically recorded the rotation angle of the tibia as the internal-external (IE) kinematics and the coronal alignment of the lower limb as the varus-valgus (VV) kinematics. These measurements were made with the joint in maximal extension, at 10° intervals from 0° to 120° of flexion, and at maximal flexion during passive knee motion. For evaluation of laxity, the examiner gently applied maximum manual IE and VV stress to the knee at 0°, 30°, 60°, and 90° of flexion. The measurements showed almost perfect reliability. The mean correlation coefficient between the intraoperative tibial rotation angle and the intermediate angle of IE laxity was 0.82, while that between the coronal alignment of the lower limb and the intermediate angle of the VV laxity was 0.96. There was a statistically significant correlation between kinematics and laxity at all degrees of knee flexion. The present study revealed that the rotation angle of the tibia was correlated to the intermediate angle of IE laxity at 0°, 30°, 60°, and 90° of knee flexion and the coronal alignment of the lower limb also correlated to the intermediate angle of VV laxity. These findings provide important reference data on soft tissue laxity and kinematics of the normal knee.

Behind-remnant approach for anatomic anterior cruciate ligament reconstruction

A newly proposed femoral tunnel creation concept, a behind-remnant (BR) approach, for remnant-preserving double-bundle (DB) anterior cruciate ligament (ACL) reconstruction, was introduced. In this technique, femoral tunnels are created based on the arthroscopic observation from behind the ACL remnant, using the remnant fold at the ACL femoral attachment and posterior cartilage margin as landmarks, without any removal of the remnant tissue. Graft tension changes and femoral tunnel position of the anteromedial bundle (AMB) and posterolateral bundle (PLB) in the BR approach (BR group, 23 patients) were compared with those in the control group (25 patients). Two-year clinical results in 48 patients who had DB ACL reconstruction using BR approach were evaluated. During passive knee movement, the control group indicated reciprocal tension pattern between the AMB and PLB. The PLB generally showed greater tension in extension than the AMB. The BR group indicated equivalent tension pattern between the AMB and PLB. The AM tunnel position was significantly more posterior in the BR group with the smaller variances than in the control group. During 2-year follow-up, there was 1 graft tear of the reconstructed ACL. Average KT measurements improved from 6.1 mm preoperatively to 0.6 mm. Lachman test became negative in all cases. Pivot shift result was also improved, although 6 cases had residual pivot shift test. Average Lysholm score was improved from 79 preoperatively to 98, and average time required to return to athletic activities was 8 months. The BR approach made femoral tunnel creation possible with better reproducibility. More posterior tunnel creation using BR approach indicated similar tension pattern between the AMB and PLB. Short-term clinical results after remnant-preserving DB ACL reconstruction using BR approach were satisfactory in both subjective and objective findings.

Hyperadditive ventilatory response arising from interaction between the carotid chemoreflex and the muscle mechanoreflex in healthy humans.

Physical exercise potentiates the carotid chemoreflex control of ventilation (VE). Hyperadditive neural interactions may partially mediate the potentiation. However, some neural interactions remain incompletely explored. As the potentiation occurs even during low-intensity exercise, we tested the hypothesis that the carotid chemoreflex and the muscle mechanoreflex could interact in a hyperadditive fashion. Fourteen young healthy subjects inhaled randomly, in separate visits, 12% O2 to stimulate the carotid chemoreflex and 21% O2 as control. A rebreathing circuit maintained isocapnia. During gases administration, subjects either remained at rest (i.e., normoxic and hypoxic rest) or the muscle mechanoreflex was stimulated via passive knee movement (i.e., normoxic and hypoxic movement). Surface muscle electrical activity did not increase during the passive movement, confirming the absence of active contractions. Hypoxic rest and normoxic movement similarly increased VE [change (mean ± SE) = 1.24 ± 0.72 vs. 0.73 ± 0.43 l/min, respectively; P = 0.46], but hypoxic rest only increased tidal volume (Vt), and normoxic movement only increased breathing frequency (BF). Hypoxic movement induced greater VE and mean inspiratory flow (Vt/Ti) increase than the sum of hypoxic rest and normoxic movement isolated responses (VE change: hypoxic movement = 3.72 ± 0.81 l/min vs. sum = 1.96 ± 0.83 l/min, P = 0.01; Vt/Ti change: hypoxic movement = 0.13 ± 0.03 l/s vs. sum = 0.06 ± 0.03 l/s, P = 0.02). Moreover, hypoxic movement increased both Vt and BF. Collectively, the results indicate that the carotid chemoreflex and the muscle mechanoreflex interacted, mediating a hyperadditive ventilatory response in healthy humans. NEW & NOTEWORTHY The main finding of this study was that concomitant carotid chemoreflex and muscle mechanoreflex stimulation provoked greater ventilation increase than the sum of ventilation increase induced by stimulation of each reflex in isolation, which, consequently, supports that the carotid chemoreflex and the muscle mechanoreflex interacted, mediating a hyperadditive ventilatory response in healthy humans.

Clinical and radiological outcomes of arthroscopically assisted cannulated screw fixation for tibial eminence fracture in children and adolescents

BackgroundThe purpose of this study was to determine the efficacy and complications of arthroscopically assisted reduction and fixation with cannulated screws for tibial eminence fracture in skeletally immature patients.MethodsThis was a retrospective case series study. Forty-eight patients who were skeletally immature at the time of tibial eminence fracture were treated in a tertiary children’s hospital between May 2004 and August 2015. Twenty-one patients were excluded due to non-operative treatment (n = 10), other surgical treatments (n = 9), multiple fracture (n = 1), and follow-up < 1 year (n = 1). Twenty-seven knees of 27 patients were analyzed. Avulsed fragment was reduced arthroscopically. One to three cannulated screws (4.0 mm or 5.0 mm in diameter) were used for fixation. Passive knee motion was started in 3–4 weeks. Clinical outcomes were evaluated by Lysholm score, instability of the knee, and complications. Radiological outcomes including nonunion and malunion of the avulsed fragment and physeal growth disturbance were evaluated.ResultsMean age at the time of surgery was 10.1 years (range, 6.2 to 13.8 years). Patients were followed up for a mean of 3.9 years (range, 1.0 to 7.6 years). Fracture types included type III (n = 13), type II (n = 12), and type IV (n = 2) according to Zaricznyj modification of Meyers and McKeever classification. Meniscus was entrapped in five patients. Six patients showed concomitant meniscal tear. Mean Lysholm score at the latest follow-up was 95 (range, 78 to 100). Joint instability was not observed in any patient except one (instability of 5–10 mm). All patients showed full range of knee motion except one (10 degrees of flexion contracture). Screw head impingement against intercondylar notch of the femur was observed in two patients during screw removal procedure. Five knees showed prominent tibial eminence without symptoms. The injured lower limb was longer than the contralateral normal side by a mean of 6.2 mm (range, − 4 to 18 mm).ConclusionsArthroscopically assisted reduction and fixation with cannulated screws is an effective and safe surgical option for treating tibial eminence fracture with few complications.

Effects of strength exercise on the knee and ankle proprioception of individuals with knee osteoarthritis

ABSTRACTThis study aims to investigate the effects of 8-week strength exercise on knee and ankle proprioception of individuals with knee osteoarthritis (KOA). Forty participants were randomly divided into control and strength exercise groups. Strength exercise group underwent squat training of three times a week for 8 weeks, while control group received an education programme. Threshold for detection of passive movement of knee and ankle joint was tested using an electrically driven movable frame. Between- and within-group differences were evaluated through repeated-measurement analysis of variance. After intervention, passive motion sense in knee flexion of participants in strength exercise group significantly improved (p = 0.033, 95% confidence interval of mean difference: 0.019–1.478) with significant difference between groups. No significant differences of passive motion senses were found in knee extension and ankle between strength exercise and control groups. Eight-week squat training significantly improves the motion sense of knee flexion in patients with KOA.

Spasmodic hemiplegia after stroke treated with scalp acupuncture, music therapy and rehabilitation: a randomized controlled trial

To evaluate the differences in the clinical therapeutic effects on spasmodic hemiplegia after stroke among the alliance therapy of scalp acupuncture, music therapy combined with rehabilitation, the simple rehabilitation therapy and the combination of music therapy and rehabilitation. A total of 76 patients of post-stroke spasmodic hemiplegia were randomized into a rehabilitation group (25 cases), a combination group with music therapy and rehabilitation (25 cases) and an alliance therapy group with scalp acupuncture, music therapy and rehabilitation (26 cases). In the rehabilitation group, the routine rehabilitation therapy was applied, including the removal of various incentives that cause spasm, the correction of body position and the physical therapy. In the combination group, the music therapy was added on the basis of the treatment as the rehabilitation group. The music physician used the rhythmic auditory stimulation, the patterned sensory enhancement and the therapeutic instrumental music playing to set up the task in the treatment. In the alliance therapy group, scalp acupuncture was added on the basis of the treatment as the combination group. The anterior oblique line of vertex-tempora (MS 6) and the posterior oblique line of vertex-tempora (MS 7) on the contralateral side were selected and stimulated with penetrating needling technique. The needles were retained. During the needling retaining, the needles were rotated once every 10 min, for 2 min each time. The treatment was given one session a day, totally for 5 sessions a week, continuously for 4 weeks. The Fugl-Meyer assessment (FMA), Barthel index (BI) and the modified Ashworth scale (MAS) of the affected elbow and the passive knee movement at static condition were observed in the patients before and after treatment. The results of FMA, BI and MAS were not different before treatment in the patients among the three groups (all P>0.05), indicating the comparability among groups. After treatment, FMA and BI scores were all increased apparently in the three groups as compared with those before treatment (all P<0.05). MAS grade was reduced remarkably as compared with that before treatment (all P<0.05). After treatment, FMA and BI scores in the alliance therapy group were higher than those in the combination group and the rehabilitation group (all P<0.05). FMA and BI scores in the combination group were higher than those in the rehabilitation group (both P<0.05). MAS grade in the alliance therapy group was lower than those in the combination group and the rehabilitation group (both P<0.05). MAS grade in the combination group was lower than that in the rehabilitation group (P<0.05). The alliance therapy with scalp acupuncture, music therapy and rehabilitation achieve the remarkable clinical therapeutic effects on post-stroke spasmodic hemiplegia as compared with the routine rehabilitation and the combination of music therapy and rehabilitation.

Sole vibration improves locomotion through the recovery of joint movements in a mouse cast model.

We investigated the effects of a vibratory stimulus on the plantar surface of the hind limb for motor, sensory, and locomotive function using a mouse cast model. The right knee joint of C57BL/6 male mice (7 weeks, 20 g, n = 31) was flexed with aluminum splint and tape for 6 weeks. These mice were randomly divided into 2 groups (control group, n = 11 and vibration group, n = 12). The mice in the vibration group received vibration on the sole of the ankle for 15 minutes per day, 5 days per week. After the knee joint cast was removed, we measured the range of motion (ROM) of both knee and ankle joints and the sensory threshold of the sole. Further, both walking and swimming movements were analyzed with a digital video. The sole vibration did not affect the passive ROM of the knee joint and sensory threshold after cast removal. However, it increased the ankle dorsiflexion range and improved free walking, swimming, and active movement of the knee joint. In conclusion, we show that the vibration recovered both walking and swimming movements, which resulted from improvements in both the passive ankle dorsiflexion and active knee movement.

Local infiltration of analgesia and sciatic nerve block provide similar pain relief after total knee arthroplasty

BackgroundAlthough femoral nerve block provides satisfactory analgesia after total knee arthroplasty (TKA), residual posterior knee pain may decrease patient satisfaction. We conducted a randomized controlled trial to clarify the efficacy of the sciatic nerve block (SNB) and local infiltration of analgesia with steroid (LIA) regarding postoperative analgesia after TKA, when administrated in addition to femoral nerve block (FNB).MethodsSeventy-eight patients were randomly allocated to the two groups: concomitant administration of FNB and SNB or FNB and LIA. The outcome measures included post-operative pain, passive knee motion, C-reactive protein level, time to achieve rehabilitation goals, the Knee Society Score at the time of discharge, patient satisfaction level with anesthesia, length of hospital stay, surgical time, and complications related to local anesthesia.ResultsThe patients in group SNB showed less pain than group LIA only on postoperative hours 0 and 3. Satisfactory postoperative analgesia after TKA was also achieved with LIA combined with FNB, while averting the risks associated with SNB. The influence on progress of rehabilitation and length of hospital stay was similar for both anesthesia techniques.ConclusionsThe LIA offers a potentially safer alternative to SNB as an adjunct to FNB, particularly for patients who have risk factors for sciatic nerve injury.