Patellar Tendon Bearing Research Articles

Design and Evaluation of a Patellar Tendon-Bearing Brace with Off-Loading Mechanism on Tibia.

The current study aimed to design a patellar-tendon-bearing (PTB) brace capable of measuring and quantifying weight offloading on the tibia. The PTB brace was designed with off-loading mechanism on the tibia with features, including ankle joint, vertical sliding adaptor, vertical sliding piece, and upper connector of load cells to PTB brace. Also, the present study investigated the effect of brace on 20 healthy individuals under 8 different off-loading conditions, based on measuring the vertical distance between the calf shells and foot plate through a sliding adapter at 0.5, 1, 1.5, 2, 2.5, 3, and 3.5 cm. The Pedar device and load cells embedded in PTB brace were used to determine the extent of offloading and assess the reliability and validity of brace. Increasing the vertical distance between the calf shells and the footplate can lead to a greater amount of offloading. Accordingly, off-loading ranged from a minimum of 16.5% at 0 cm position to a maximum of 60.48% at 3.5 cm position of sliding adapter. Percentage values of tibia off-loading in 8 conditions were not significantly different in Padar devices and PTB brace. Therefore, PTB brace load cells, as a valid method, can measure off-loading levels. When fabricating a PTB brace, a monitoring system with load cells is essential to measure the amount of tibial offloading, leading to readjustment if limb slides down inside the brace. Additionally, a component is needed to correctly position limb in off-loading condition. In the current study, sliding adapter of brace can provide that capability.

Methodology to Investigate Effect of Prosthetic Interface Design on Residual Limb Soft Tissue Deformation.

Residual limb discomfort and injury is a common experience for people living with lower limb amputation. Frequently, inadequate load distribution between the prosthetic device and the residual limb is the root cause of this issue. To advance our understanding of prosthetic interface fit, tools are needed to evaluate the mechanical interaction at the prosthetic interface, allowing interface designs to be evaluated and optimised. Present a methodology report designed to facilitate comprehension of the mechanical interaction between the prosthetic interface and the residual limb. As a pilot study, this methodology is used to compare a hands-on and hands-off interface for a single transtibial prosthesis user using secondary Magnetic Resonance Imaging (MRI) data. MRI data of the residual limb while wearing a prosthetic interface is segmented into a hard tissue and a skin surface model. These models are exported as stereolithography (STL) files. Two methods are used to analyse the interface designs. Firstly, CloudCompare software is used to compute the nearest vertex on the skin surface for every vertex on the compiled internal bony surface for both interface types. Secondly, CloudCompare software is used to compare registered skin surfaces of the residual limb while wearing the hands-on and hands-off interfaces. The maximum and minimum nearest distances between the internal bony surface and skin surface were similar between interface types. However, the distribution of nearest distances was different. When comparing the skin surface while wearing both interfaces, where the fit is more compressive can be visualized. For the dataset used in this study, the classic features of a hands-on Patella Tendon Bearing interface and hands-off pressure cast interface could be identified. The methodology presented in this report may give researchers a further tool to better understand how interface designs affect the soft tissues of the residual limb.

Insights into the spectrum of transtibial prosthetic socket design from expert clinicians and their digital records.

Transtibial prosthetic sockets are often grouped into patella tendon bearing (PTB) or total surface bearing (TSB) designs, but many variations in rectifications are used to apply these principles to an individual's personalised socket. Prosthetists currently have little objective evidence to assist them as they make design choices. To compare rectifications made by experienced prosthetists across a range of patient demographics and limb shapes to improve understanding of socket design strategies. 163 residual limb surface scans and corresponding CAD/CAM sockets were analysed for 134 randomly selected individuals in a UK prosthetics service. This included 142 PTB and 21 TSB designs. The limb and socket scans were compared to determine the location and size of rectifications. Rectifications were compiled for PTB and TSB designs, and associations between different rectification sizes were assessed using a variety of methods including linear regression, kernel density estimation (KDE) and a Naïve Bayes (NB) classification. Differences in design features were apparent between PTB and TSB sockets, notably for paratibial carves, gross volume reduction and distal end elongation. However, socket designs varied across a spectrum, with most showing a hybrid of the PTB and TSB principles. Pairwise correlations were observed between the size of some rectifications (e.g., paratibial carves; fibular head build and gross volume reduction). Conversely, the patellar tendon carve depth was not associated significantly with any other rectification, indicating its relative design insensitivity. The Naïve Bayes classifier produced design patterns consistent with expert clinician practice. For example, subtle local rectifications were associated with a large volume reduction (i.e., a TSB-like design), whereas more substantial local rectifications (i.e., a PTB-like design) were associated with a low volume reduction. This study demonstrates how we might learn from design records to support education and enhance evidence-based socket design. The method could be used to predict design features for newly presenting patients, based on categorisations of their limb shape and other demographics, implemented alongside expert clinical judgement as smart CAD/CAM design templates.

A study on the outcome of open tibial fractures managed definitively by external fixator

Introduction: High energy tibial diaphyseal open fractures are a common occurrence in modern times. In a resource strapped country like India, AO unilateral external fixator is a cheap, technically easier method for the definitive management of the same. The aim of the paper is to present the results of the treatment of 33 patients with open tibia fractures, as well as the complications that accompany the treatment of these fractures. Method: An observational prospective study was undertaken including all open diaphyseal tibia fractures with Gustilo Anderson classification Type II, IIIA, IIIB and Ganga hospital open injury severity score of 6-12. Patients underwent debridement, definitive fixation with exfix, and later Patellar Tendon Bearing Cast after removal. Outcome was measured by the Association for the Study and Application of the Method of Ilizarov Group score. Results: In 81.8% cases the mechanism of injury was road traffic accident. Mean time for complete weight bearing was 19.33 weeks, mean time for union was 26.18 months. ASAMI Radiological outcome was Excellent in 45.5%, Good in 30.3%, Fair in 9.1% and Poor in 15.2% cases. ASAMI Functional outcome was Excellent in 33.3%, Good in 51.5%, Poor in 15.2% cases. Pin tract infection was found in 39.4% and malunion in 24.2%. The mean time for union (p=0.0004), incidence of non-union (p=0.014) was found to be statistically significant to the severity of initial injury. Conclusion: Thus by this study it can be expressed that external fixator is a feasible implant in the definitive management of open tibia fractures.

Determining educational assessment criteria for patellar-tendon-bearing impressions for transtibial prosthetic sockets: A Delphi study.

Validated criteria to guide assessment of student performance in clinical tasks in prosthetics and orthotics education have not been established. Lack of established criteria and assessment methods presents challenges in evaluating student performance on clinical tasks, such as taking impressions for patellar-tendon-bearing (PTB) sockets. To establish assessment criteria for the PTB impression process for use in educational settings. Delphi consensus process. Initial Delphi survey items were based on interviews with prosthetic instructors and focus groups with prosthetic students. Expert prosthetic educators were then identified by purposive sampling to complete multiple-round Internet-based Delphi surveys. The Delphi surveys asked experts to indicate their level of agreement on various assessment methods and criteria in PTB education. Consensus for survey items was reviewed after each survey round and used to determine the content of and need for subsequent rounds. Fourteen experts completed two Delphi survey rounds. Items were categorized into educational materials/strategies, impression stages/materials, measurement tools, measurements taken, assessment during impression, assessment after impression, feedback, student self-assessment, and grading. In two survey rounds, 40 items guiding assessment methods and criteria for PTB impressions achieved 80% consensus. A high level of consensus was achieved in two survey rounds. Lower levels of consensus were reached on specific objective criteria, such as use of measurement thresholds when evaluating student impressions. Standardized assessment of student performance on PTB impression-taking instead relies primarily on qualitative assessments based on instructor expertise.

The Current Role of Ankle Arthrodesis in Hemophilic Patients.

There are several manners to take care of the hemophilic ankle in the initial phases of degeneration of the articular cartilage, in the event that hematologic prophylaxis is unsuccessful in accomplishing no bleeds. Some of these are nonoperative, with which management must start. These are Physical and Rehabilitation Medicine protocols and the utilization of orthoses (patellar tendon bearing). When these are unsuccessful, more aggressive types of treatment can be utilized, such as radiosynovectomy and some surgical operations (open or arthroscopic removal of anterior osteophyte of the distal part of the tibia, arthroscopic ankle debridement). Nonetheless, in the late phases of degeneration of the articular cartilage (advanced arthropathy), the solely options are surgical: ankle fusion or total ankle arthroplasty. The review of the literature has shown that the percentage of consolidation is between 90% and 100%, and that the percentage of postoperative infection is between 0% and 10%%. When the Ilizarov external fixator is utilized for ankle fusion, the percentage of pin tract infection is around 14%. Ankle fusion is a secure surgical technique that meliorates articular pain and improves the quality of life of hemophilic patients.

Biomechanical Analysis of an Improvement of Prosthetic Liner using Polyurethane Focusing at the Anterior-Distal Part of Residual Limb: A Case Study

Most transtibial prosthesis users always experience pain sensation at the distal of the residual limb due to bony prominences and nerve endings. Many initiatives have been taken to resolve this problem, including using softer materials such as silicone or gel liner and designing a distal off load prosthetic socket. Another promising approach is to incorporate polyurethane foam in the manufacturing of prosthetic liner. This study aimed to design a new prosthetic liner using polyurethane at the anterior-distal part of the residual limb as a Pelite replacement and to compare the biomechanical gait analysis between the new modified polyurethane liner and the common Pelite liner. A unilateral transtibial amputee was recruited as the subject. Two Patellar Tendon Bearing transtibial prostheses with different liners were fabricated for the subject, which were Pelite liner and a modified polyurethane foam liner. The modified liner using polyurethane foam consisted of Ethylene vinyl-acetate – Polyurethane – Ethylene vinyl-acetate sandwich placed at the anterior-distal part of the residual limb. The Ethylene vinyl-acetate – Polyurethane – Ethylene vinyl-acetate sandwich function was to improve the walking gait and compensate for the pain sensation experienced by the subject when wearing the Pelite liner. Biomechanical analysis was done using the Vicon Motion Analysis System on the subject when using the two newly fabricated transtibial prostheses and the subject’s original prosthesis with Pelite liner. During the loading response phase, the original liner exerted a slightly higher force than the Pelite and the modified liner. At 30% and 50% of the gait cycle, the original liner exerted low force than the Pelite liner and the modified liner for Ground Reaction Force at the amputated side. However, no significant difference (p>0.05) was found between all prosthetic liners for Ground Reaction Force (Non-Amputated). The biomechanical analysis showed that the modified liner using polyurethane foam improved the prosthesis user gait cycle and the walking gait of the prosthesis user.

Characterising Residual Limb Morphology and Prosthetic Socket Design Based on Expert Clinician Practice

Functional, comfortable prosthetic limbs depend on personalised sockets, currently designed using an iterative, expert-led process, which can be expensive and inconvenient. Computer-aided design and manufacturing (CAD/CAM) offers enhanced repeatability, but far more use could be made from clinicians’ extensive digital design records. Knowledge-based socket design using smart templates could collate successful design features and tailor them to a new patient. Based on 67 residual limb scans and corresponding sockets, this paper develops a method of objectively analysing personalised design approaches by expert prosthetists, using machine learning: principal component analysis (PCA) to extract key categories in anatomic and surgical variation, and k-means clustering to identify local ‘rectification’ design features. Rectification patterns representing Total Surface Bearing and Patella Tendon Bearing design philosophies are identified automatically by PCA, which reveals trends in socket design choice for different limb shapes that match clinical guidelines. Expert design practice is quantified by measuring the size of local rectifications identified by k-means clustering. Implementing smart templates based on these trends requires clinical assessment by prosthetists and does not substitute training. This study provides methods for population-based socket design analysis, and example data, which will support developments in CAD/CAM clinical practice and accuracy of biomechanics research.

English

BACKGROUND Tibial shaft fracture is one of the commonest fractures encountered in orthopaedic clinics today. With recent trend being surgical management, it has increased the economic burden in developing countries like India. Thus, interest in functional cast bracing can manage many of the fractures safely with less cost and shorter hospital stay with equally good results. METHODS This prospective study included 30 patients with closed tibial shaft fracture with minimal displacements who were treated with 3 weeks of initial long leg cast followed by functional cast bracing as described by Sarmiento in 1967 with a below knee patellar tendon bearing (PTB) cast with encouraged progressive weight bearing for 6 to 9 weeks. Our goal was to achieve shortening of < 10 mm, angulations of less than 5 degrees in any plane with full range of motion at knee as per Sarmiento. RESULTS Union was seen in 25 (83 %) cases. Angulations of < 5 degrees was noted in any plane in 79 % cases. Varus and apex posterior angulations were the most common deformity. Shortening 10 mm was noted in 72 % cases with almost complete ROM of knee joint in all patients. Non-union was noticed in 2 (7 %) cases. CONCLUSIONS Functional cast bracing can still be an ideal method of management for many of the tibial shaft fractures and with better understanding of the technique and proper application, it can safely be used on other long bones as well. KEYWORDS Closed Fracture Tibia, Functional Cast Brace

Stress Fracture Tibia among Military Recruits Management by Patellar Tendon Bearing Cast

Introduction: Lower limb overuse injuries are common features of military training. Female recruits have significantly higher incidence of fracture than male recruits. In addition to the cost and time of rehabilitation, injury leads to disillusionment among recruits. Conventionally stress fracture tibia is treated with long leg posterior cast for 6-8 weeks but little is known about the length of time required for rehabilitation and to return to pre-injury level.
 Objectives: To see the outcome of management of stress fracture tibia among military recruits treated with Patellar Tendon Bearing (PTB) cast for 8 weeks and to find out the rehabilitation time to return to pre-injury level.
 Materials and Methods: This prospective study was conducted in Combined Military Hospital, Bogura, Bangladesh, from January 2015 to December 2016. Out of 2600 recruits 74 (male 60 females 14) were diagnosed as case of stress fracture tibia during the period. They were treated by PTB cast for 08 weeks and their treatment and rehabilitation to pre-injury level (follow-up) were recorded prospectively.
 Results: Total 85 patients were clinically suspected to have stress fracture tibia, out of them 74(87.06%) patients were finally diagnosed as case of stress fracture. Of these 74 patients 44(59.46%) were diagnosed by initial x-ray and 30(40.54%) were diagnosed by MRI scan. Prevalence of stress fracture in male was 2.45% and in female recruits 9.33%, overall prevalence was 2.85%.About 56(75.67%) patients developed stress fracture in 0-8 weeks of training, mean rehabilitation time to return to pre-injury level was 15.51 weeks, there was no recurrence of stress fracture and all the patients completed 12 months training, none of them was relegated or withdrawn from training on medical ground.
 Conclusion:Patellar tendon bearing cast is an effective, technically simple method for treating stress fracture of tibia in military recruits with excellent outcome. This method not only treats the fracture but also prevents depressive disorders.
 JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 196-199

Sustainable, affordable and functional: reimagining prosthetic liners in resource limited environments

Purpose The purpose of this study was to evaluate function and performance of unilateral trans-tibial prosthesis users wearing an affordable liner in three types of socket designs. Methods Five unilateral trans-tibial amputees participated, were provided an Affordable Ethyl-Vinyl-Acetate Roll-On liner (AERO) roll-on liner with patella tendon bearing (PTB) prosthesis, PE-Lite liner with PTB prosthesis, and an (AERO) liner with total-surface bearing (TSB) prosthesis. A battery of outcome measures; step-counts, socket comfort score (SCS), orthotics prosthetics user survey (OPUS) and socket pressure measurement during walking were administered. Results Comparisons of step-counts indicated that PTB-AERO (3604 ± 815) was not significantly different than PTB-PE-Lite (3386 ± 942). Mean SCS was 9.2 ± .83 and 7.2 ± 2.1 for PTB-AERO and PTB-PE-Lite. A 6.6% decrease in mean peak pressure was observed between PTB-PE-Lite and TSB-AERO, and 3.2% difference between PTB-PE-Lite and PTB-AERO. Conclusion An affordable ($20 USD) and sustainably fabricated prosthesis liner was created and evaluated in trans-tibial prosthesis users. These initial results garner preliminary support for use of the AERO prosthetic liner and continued research. Implications for rehabilitation Lower limb prosthetics in less-resourced settings can leverage locally sourced and affordable materials to fabricate roll-on liners for use in modern prosthetic sockets. The cost of the AERO liner is markedly lower than current standard of care gel liners, yet still facilitates use of current prosthetic sockets.

Rearfoot disorders and conservative treatment: a narrative review.

Rearfoot disorders are frequently encountered in clinical practice. We reviewed common rearfoot disorders and present conservative treatments, focusing on shoe modification and the application of insoles or orthoses. Achilles tendinopathy is caused by excessive mechanical loads on the gastrocnemius and soleus muscles. Heel lifts, rocker shoes, and the AirHeel Brace can be used to reduce symptoms. Haglund's deformity is an osseous prominence of the posterosuperior part of the calcaneus bone, the pain from which can be alleviated by reducing pressure on the affected area by appropriately modifying the back of the shoe to prevent contact with the lesion. The pain from retrocalcaneal bursitis can be controlled by lifting the heel and loosening the shoe counter. Plantar fasciitis causes plantar heel pain, and its orthotic treatments include the application of a heel cup, heel pad, heel wedge, Thomas heel, and night splint. Calcaneal stress fractures are generally caused by repetitive loads and occur mainly in sporting activities. Patellar tendon-bearing (PTB) orthoses are helpful in reducing the load on the calcaneal bone. Heel fat pad atrophy refers to the loss of the fat pad that absorbs shock in the heel. To reduce pain caused by heel fat pad atrophy, rocker soles, heel pads, and solid ankle cushion heels (SACHs) may be used. Tarsal tunnel syndrome is caused by compression of the tibial nerve within the tarsal tunnel and its symptoms can be managed by rocker soles, supporting medial arches, Thomas heels, and SACHs. Shoe modification or application of orthoses can be helpful for managing rearfoot pain. However, for the active and wide application of these conservative treatment methods, more clinical studies should be conducted.

The Impact of Different Application Techniques on Fiberglass Casts: A Mechanical Experimental Study.

Cast immobilization is a part of treatment in most of the orthopaedic injuries. The fiberglass material has several advantages over plaster of Paris which makes it more preferable. Some techniques are frequently used in daily fiberglass cast application to ease molding, shorten curing time and increase stiffness. The aim of this study is to assess the effects of two techniques on fiberglass cast strength and curing time. A cruris model was prepared to mimic a patella tendon bearing (PTB) cast. Three groups were created for the study (n = 30 each). The casts in the first group were treated with foam soap during molding. The casts in the second group were wrapped with a wet bandage after application. The third group was the control group. The samples were mechanically tested in the 5th, 15th and 30thmin. Maximum load, elastic strength, and Young's modulus were assessed via 3-point bending. All data were compared using linear regression analysis and p < 0.05 was determined as statistical significance. The results showed statistically significant improvement in cast mechanics in the wet bandage group at full curing time by means of maximum load, elastic strength and Young's modulus (p < 0.0001). Although the foam soap group had higher values in the 5th and 15th min, there was no statistically significant difference from the control group at full curing time (p > 0.05). This study revealed that wet bandage wrapping over circular fiberglass casts improved the cast strength. The use of foam soap during fiberglass cast molding did not alter cast mechanics at full curing time.

Predictive prosthetic socket design: part 2\u2014generating person-specific candidate designs using multi-objective genetic algorithms

In post-amputation rehabilitation, a common goal is to return to ambulation using a prosthetic limb, suspended by a customised socket. Prosthetic socket design aims to optimise load transfer between the residual limb and mechanical limb, by customisation to the user. This is a time-consuming process, and with the increase in people requiring these prosthetics, it is vital that these personalised devices can be produced rapidly while maintaining excellent fit, to maximise function and comfort. Prosthetic sockets are designed by capturing the residual limb’s shape and applying a series of geometrical modifications, called rectifications. Expert knowledge is required to achieve a comfortable fit in this iterative process. A variety of rectifications can be made, grouped into established strategies [e.g. in transtibial sockets: patellar tendon bearing (PTB) and total surface bearing (TSB)], creating a complex design space. To date, adoption of advanced engineering solutions to support fitting has been limited. One method is numerical optimisation, which allows the designer a number of likely candidate solutions to start the design process. Numerical optimisation is commonly used in many industries but not prevalent in the design of prosthetic sockets. This paper therefore presents candidate shape optimisation methods which might benefit the prosthetist and the limb user, by blending the state of the art from prosthetic mechanical design, surrogate modelling and evolutionary computation. The result of the analysis is a series of prosthetic socket designs that preferentially load and unload the pressure tolerant and intolerant regions of the residual limb. This spectrum is bounded by the general forms of the PTB and TSB designs, with a series of variations in between that represent a compromise between these accepted approaches. This results in a difference in pressure of up to 31 kPa over the fibula head and 14 kPa over the residuum tip. The presented methods would allow a trained prosthetist to rapidly assess these likely candidates and then to make final detailed modifications and fine-tuning. Importantly, insights gained about the design should be seen as a compliment, not a replacement, for the prosthetist’s skill and experience. We propose instead that this method might reduce the time spent on the early stages of socket design and allow prosthetists to focus on the most skilled and creative tasks of fine-tuning the design, in face-to-face consultation with their client.

Patellar tendon morphology in trans-tibial amputees utilizing a prosthesis with a patellar-tendon-bearing feature

A patellar-tendon-bearing (PTB) bar is a common design feature used in the socket of trans-tibial prostheses to place load on the pressure-tolerant tissue. As the patellar tendon in the residual limb is subjected to the perpendicular compressive force not commonly experienced in normal tendons, it is possible for tendon degeneration to occur over time. The purpose of this study was to compare patellar tendon morphology and neovascularity between the residual and intact limbs in trans-tibial amputees and healthy controls. Fifteen unilateral trans-tibial amputees who utilized a prosthesis with a PTB feature and 15 age- and sex- matched controls participated. Sonography was performed at the proximal, mid-, and distal portions of each patellar tendon. One-way ANOVAs were conducted to compare thickness and collagen fiber organization and a chi-square analysis was used to compare the presence of neovascularity between the three tendon groups. Compared to healthy controls, both tendons in the amputees exhibited increased thickness at the mid- and distal portions and a higher degree of collagen fiber disorganization. Furthermore, neovascularity was more common in the tendon of the residual limb. Our results suggest that the use of a prosthesis with a PTB feature contributes to morphological changes in bilateral patellar tendons.

Transtibial Prosthetic Socket Design and Suspension Mechanism: A Literature Review

ABSTRACT Introduction The body weight of the prosthetic user is supported and distributed by the prosthetic socket during the stance phase of gait. Throughout swing phase, inertial forces (pressure and shear) are exerted by the socket suspension mechanism onto the residuum to facilitate suspension. Objectives in the study were to identify and investigate available evidence in transtibial (TT) socket design and suspension to highlight the most effective weight transfer mechanisms and suspension techniques. Methods A literature research was conducted comprising two parts: socket design and suspension. Boolean search terms and truncation were used using relevant keywords in online search engines to obtain precise results. Results Seventeen articles that met inclusion criteria were reviewed. Conclusions A conclusion on whether socket preference is due to the suspension mechanism or socket design itself cannot be drawn. Patellar tendon bearing (PTB) sockets are still successfully used and, in some studies, preferred over total surface bearing (TSB) sockets. Biomechanically, however, TSB sockets allow for a more even weight distribution when combined with suction, particularly vacuum-assisted socket suspension (VASS). Some limited evidence exists to support that such designs may have some effect on wound healing and early ambulation. Further research must be conducted to standardize acclimation periods. Crossover randomized controlled trials with larger sample sizes are required to establish an evidence base to improve clinical practice.

MEASUREMENT OF THE CONSISTENCY OF PATELLA-TENDON-BEARING MODIFICATION USING CAD

Study design: Pilot studyBackground: Computer aided design (CAD) is now commonly used in prosthetic clinical practice. To create a patellar tendon bearing (PTB) socket, further modification of the transtibial shape is required. Objectives: To investigate the consistency of transtibial shape modification for a PTB socket design using CAD.Methods: 13 transtibial models with marked anatomical landmarks were made, each linked to a fictitious patient history. Three clinicians were asked to complete modification for a PTB socket with suspension sleeve at weekly intervals over the course of three weeks. Measurements were recorded at landmarks and compared for intra and inter reliability.Results: Clinicians showed high intraclass and interclass correlation (ICC) values with narrow confidence intervals for the tibial tubercle, medial and lateral flares and distal end of the tibia. One clinician demonstrated moderate intra rater reliability for modification over the patellar tendon. All other ICC values for the patellar tendon and fibular head modification were low. Inter rater reliability was not calculated for fibular head and patellar tendon as intra ICC values should be above 0.6.Conclusions: All clinicians showed good consistency at tibial tubercle, distal tibia, medial and lateral flares. Patellar tendon (0.345&lt; ICC &lt; 0.641) and fibular head (0.165&lt; ICC &lt; 0.513) showed poorer consistency and require improvement.&#x0D; LAYMAN’S ABSTRACT Computer aided design (CAD) is now commonly used to create artificial limbs. However, the shape of the amputated limb is captured when the patient is sitting down and therefore requires further adjustment. Modification of the shape is carried out by clinicians using a range on on-screen tools to remove and add material to the virtual model.This study aims to investigate the consistency of clinicians when making these modifications. A range of 13 below the knee amputation models were made, each linked to a made-up patient history. Three clinicians were asked to randomly complete modification three times on each model at weekly intervals over the course of three weeks. Measurements were recorded at landmarks and compared.Clinicians showed high reliability values for most landmark positions. However, modification was less reliable over important areas such as the patellar tendon and fibular head. Errors in such areas could potentially cause discomfort to the artificial limb wearer and greater consistency is required. This is only an initial study and further work is required to confirm results.&#x0D; ARTICLE PDF LINK: https://jps.library.utoronto.ca/index.php/cpoj/article/view/30006/22878&#x0D; How to cite: O'Byrne M, McFadyen A K, Hannett D, McGarry A. Measurement of The Consistency of Patella-Tendon-Bearing Modification Using CAD. Canadian Prosthetics &amp; Orthotics Journal, Volume 1, Issue 1, No 2, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.30006

Evaluation of Depigmenting Activity of AHPL/AYTOP/1914 in Mice

Background: The main purpose of all suspension systems is prosthesis retention. Numerous means to suspend below-knee (BK) prostheses have been developed. Although suspension systems generally used for BK prostheses have similar functions, choices for prescription are not totally clear. Patellar tendon bearing (PTB) suspension principles are effective with many patients; however, those with short limbs may not achieve complication-free suspension. The fact that variations of BK suspensions continue to appear suggests that a universal suspension system is not yet available.Objective: To find out the effect of two types of suspension system on gait parameters and locomotor capabilities index in subject with unilateral transtibial amputee.Study design: Single study with post experimental design.Methods and measures: Two different suspension systems such as supracondylar and cuff suspension for below knee prostheses were tested on 30 adults with unilateral transtibial amputees. All subjects walked with prosthesis. Data regarding gait parameters and Locomotor capabilities index were measured. Gait parameters such as velocity, cadence, step length, stride length were evaluated by CDG gait analyser and walking abilities of the subjects were evaluated by locomotor capabilities index (LCI).Result: The results revealed that the statistical difference between two suspension systems is significant (p<0.05). Study suggested that using supracondylar suspension velocity, cadence, stride length and step length increased compared to cuff suspension. But value of Locomotor capability index was more in cuff suspension compared to supracondylar suspension which indicates use of cuff suspension reduces fear of falling and patients feels more secure.Conclusion: The findings of the study thus support the hypothesis that there were significant difference with different suspension systems on gait parameters and locomotor capabilities index.

Transtibial Prosthetic Socket Shape in a Developing Country: A study to compare initial outcomes in Pressure Cast hydrostatic and Patella Tendon Bearing designs

This study compared the physical function and comfort level of patients with unilateral transtibial amputation after being fitted with a hand-cast Patella Tendon Bearing (PTB) socket and a pressure-cast (PCAST) hydrocast socket. The latter technique aims to reduce the skill dependency currently required for socket manufacture and fit. The study was conducted at the Vietnamese Training Centre for Orthopaedic Technologies and involved seventeen Vietnamese participants with unilateral transtibial amputation, all of whom were long term users of prosthetics. All participants were fitted with two sockets manufactured using both hand-cast and PCAST techniques with International Committee of the Red Cross components. Walking tests (timed up and go test and six-minute-walk-test), spatio-temporal gait analyses and subjective comfort assessments were completed after a short acclimatisation period with each socket. The participant-preferred socket was also noted. No significant differences were found for the measures of mobility, functional capacity, spatio-temporal gait parameters, gait symmetry, perceived comfort or participant socket preference. The results show the initial patient outcomes are similar when participants are fitted with a hand-cast PTB socket and a PCAST hydrocast sockets. Future work should confirm these findings in a longer trial.

To Compare the Effect of Vertical Ground Reaction force in Conventional below Knee Prosthesis Versus Modular below Knee Prosthesis on Unilateral Transtibial Amputee Patients

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Proper prescription of prosthetic device and potential rehabilitation increases the quality of life for subjects with amputations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective&lt;/strong&gt;: To compare the effect of vertical ground reaction force (Fz) on unilateral Transtibial amputees those who are using conventional and modular patellar tendon bearing (PTB) prosthesis with stump exercises.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and Methodology&lt;/strong&gt;: A sample of 120 persons with below knee amputees who were trained to wear prosthesis were studied with an comparative follow up study design with purposive sampling technique. The 120 adult amputee patients were divided in to two groups having 60 samples in each group, group A patients were given conventional patellar tendon bearing (PTB) prosthesis with intensive stump exercises and group B patients were given modular PTB prosthesis with intensive stump exercises respectively. Data analyzed statistically.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: The unilateral transtibial amputees who trained with modular prosthesis along with stump exercises group patients Fz-force in newton were increased as compared to the unilateral transtibial amputees who were trained with conventional PTB prosthesis along with stump exercises. There was no significant difference seen in both the groups while giving stump exercises alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: The unilateral transtibial amputees who were trained with modular PTB prosthesis along with stump exercises group patient's Fz-force in newton (VGRF) has increased drastically compared with conventional PTB prosthesis.&lt;/p&gt;