Osteoarthritis (OA) often results in significant degeneration of the knee’s tendons, ligaments, muscles, and joint capsules, frequently resulting in reduced proprioception. Total Knee Arthroplasty (TKA) is a widely used surgical intervention aimed at alleviating pain and improving the Quality of Life (QoL) for individuals with end-stage Knee Osteoarthritis (KOA). However, despite its effectiveness, many patients experience only modest functional improvements following surgery, highlighting the need for enhanced rehabilitation strategies. The present narrative review explores the impact of incorporating balance and proprioceptive training into postoperative rehabilitation for TKA patients, focusing on physical function, pain relief, and overall well-being. The purpose of the present review is to evaluate how proprioceptive and balance training affects physical function, pain management, and general QoL in postoperative rehabilitation for TKA patients. Regaining stability, mobility, and confidence in performing daily tasks is often challenging for individuals who have undergone TKA. Although the procedure primarily addresses structural joint damage and alleviates pain, it does not automatically improve sensory-motor function or neuromuscular coordination, both of which are essential for independent mobility and fall prevention. Findings indicate that early integration of balance and proprioceptive exercises can significantly improve recovery outcomes after TKA, enhancing balance, physical function, and QoL. Techniques such as Progressive Dynamic Balance Training (PDBT), combined kinetic chain exercises, and Neuromuscular Electrical Stimulation (NMES) have demonstrated particular effectiveness. However, variability in study designs and outcome measures underscores the need for standardised rehabilitation protocols. In conclusion, balance and proprioceptive training appear to offer substantial benefits for TKA patients by improving functional outcomes and reducing fall risk. Further research is needed to develop consistent training protocols, examine long-term outcomes, and validate findings in larger and more diverse patient populations.

Non-union of the patella is relatively rare, occurring in 2.4-12.5% of cases, yet it frequently requires surgical treatment due to discomfort and functional impairment. The proximal fracture fragment is usually displaced by the quadriceps, resulting in a gap that hinders recovery. Managing non-union in comminuted patella fractures is extremely challenging due to the presence of numerous tiny pieces and difficulties in attaining stable fixation. The present case series presents an innovative cerclage wiring procedure, referred to as the “Wire Mesh Technique,” employed for patients with comminuted patellar fractures and non-union. The present case series included three male patients aged 35, 42, and 66 years, each exhibiting non-union of comminuted patella fractures subsequent to trauma. All patients experienced difficulty bearing weight and extending the affected knee, characterised by extensor lag and limited range of motion. Radiographic assessments confirmed non-union of the patella in every case. After clinical and radiographic evaluation, the wire mesh procedure was utilised to address insufficient healing and the complex arrangement of fragments. Postoperative rehabilitation included early in-bed mobilisation and quadriceps exercises starting on day zero, walkerassisted non-weight bearing on day two, and gradual range of motion exercises initiated on day ten. Full weight-bearing began at two months. Postoperative imaging showed optimal implant placement and medullary healing. Patients successfully regained weight-bearing capacity and experienced enhanced knee flexibility and motion. This approach reduces circular tension and improves stability, facilitating rapid mobilisation and positive outcomes in complicated patellar fracture non-unions.

The influence of the screw configuration of the distal fibular plate on the biomechanics of lateral malleolar oblique fractures.

BACKGROUND Total knee arthroplasty (TKA) is an effective treatment for end-stage knee joint disease, but postoperative functional recovery outcomes vary significantly among patients. In recent years, researchers have increasingly focused on the influence of psychological factors on surgical outcomes, yet studies on the impact of preoperative anxiety on functional recovery after TKA remain relatively limited. AIM To investigate the effects of preoperative anxiety levels on functional recovery outcomes following TKA, providing a more comprehensive treatment strategy for clinical practice. METHODS A retrospective cohort study design was employed to collect clinical data from 186 patients who underwent TKA at a tertiary hospital between January 2020 and December 2023. Patients were divided into a study group (86 cases) and a control group (100 cases) based on preoperative anxiety status. The Hamilton Anxiety Scale and Hamilton Depression Scale were used to assess patients’ mental status. Postoperative rehabilitation time, joint function scores, complication rates, and other indicators were compared between the two groups. Multivariate logistic regression analysis was conducted to determine independent risk factors affecting functional recovery. RESULTS Compared to the control group, the study group showed significantly longer postoperative hospital stays [(14.3 ± 3.7) days vs (10.6 ± 2.4) days, P < 0.01], lower knee function scores at 3 months postoperatively [(68.2 ± 8.5) vs (79.9 ± 7.3), P < 0.05], and higher complication rates (32.3% vs 17.2%, P < 0.05). Multivariate analysis identified high preoperative anxiety levels [odds ratio (OR) = 2.47, 95% confidence interval (CI): 1.82-3.36], chronic stress (OR = 1.94, 95%CI: 1.43-2.65), and lack of social support (OR = 1.76, 95%CI: 1.21-2.54) as independent risk factors affecting postoperative functional recovery. Analysis of neuroendocrine and immune indicators revealed elevated stress hormone levels and abnormal expression of inflammatory factors in the study group, which may represent important mechanisms through which anxiety affects postoperative rehabilitation. CONCLUSION Preoperative anxiety is a significant factor influencing functional recovery following TKA. It interferes with the rehabilitation process through multiple pathways, including impacts on patients' self-care behaviors, sleep quality, endocrine function, and immune responses.

BACKGROUND Acute Achilles tendon rupture (AATR) is a debilitating injury that significantly impacts elite athletes, particularly those in the national football league (NFL). While return to play (RTP) and performance outcomes are critical to career longevity, these outcomes may be influenced by factors such as injury timing, player position, and unreported rehabilitation variation. Prior literature lacks a comprehensive synthesis of these outcomes in NFL athletes. AIM To systematically evaluate return-to-play rates, performance outcomes, and career longevity following AATR among NFL athletes, while considering the methodological quality of available evidence. METHODS A systematic review was conducted in May 2024 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, EMBASE, and Cochrane Library databases. Studies reporting outcomes following AATR in NFL players were included. Data were extracted on demographics, timing of injury, RTP, games played, and performance metrics. Pooled rates and weighted means were calculated based on sample size. Risk of bias was assessed using the Risk of Bias in Non-Randomised Studies of Interventions tool. No meta-analysis or statistical heterogeneity testing (e.g. , I ²) was performed due to the descriptive nature of the analysis. RESULTS Twelve studies including 676 NFL athletes met inclusion criteria. The weighted mean age at injury was 27.3 ± 1.4 years, with a mean of 5.2 ± 1.2 years in the NFL prior to injury. Linebackers (19.0%), wide receivers (11.9%), and running backs (9.0%) were most affected. AATRs occurred most often during the preseason (50.4%). The overall RTP rate was 66.2%, with a weighted mean time of 10.9 ± 1.3 months. Post-injury, players averaged 12.9 games/season and played for 2.2 ± 0.8 additional seasons. Performance significantly declined regardless of position. Most studies lacked data on rehabilitation protocols and exhibited moderate to critical risk of bias. CONCLUSION NFL athletes experience a relatively low return-to-play rate and substantial decline in performance following AATR. These outcomes are further influenced by high heterogeneity in study quality and the unreported variability in post-operative rehabilitation. These findings underscore the need for prospective, standardized research and may inform team physicians and athletic trainers in developing evidence-based RTP strategies.

Anterior cruciate ligament reconstruction (ACLR) rehabilitation is a multifactorial process that requires the integration of strength restoration, neuromuscular control, biomechanical symmetry, and objective return-to-sport criteria to achieve optimal functional recovery. Contemporary evidence supports criteria-based progression over purely time-based protocols, emphasizing performance-based decision-making to reduce reinjury risk and enhance long-term outcomes. However, variability persists in the implementation of rehabilitation progression models, biomechanical load management, and functional benchmarking strategies. This literature review synthesizes current evidence on postoperative ACLR rehabilitation and explores the theoretical integration of Body Engineering (BE) principles as a structured conceptual framework. BE conceptualizes rehabilitation as a dynamic systems process that systematically integrates biomechanical, physiological, and functional parameters into individualized progression pathways. By emphasizing objective assessment, load calibration, and functional symmetry restoration, this approach may enhance clinical decision-making and optimize recovery trajectories. Further empirical research is required to validate the clinical applicability and effectiveness of Body Engineering principles within standardized ACLR rehabilitation programs.

Degenerative pathologies of the cervical spine often involve facet and disc degeneration, leading to biomechanical instability of the cervical spine. A promising surgical solution is a cervical interfacet fusion system (CIFS), typically combined with an anterior disc cage to promote bone fusion and restore stability. However, the necessity of the anterior disc cage remains controversial because it increases surgical time, cost, and risk. The aim of this study was to evaluate the biomechanical performance of CIFS alone compared with its combination with an anterior disc cage using a C2-C7 finite element model. The model was validated against literature data in terms of range of motion (RoM) and used to simulate 3 surgical scenarios: (i) anterior disc cage alone, (ii) CIFS alone, and (iii) CIFS combined with an anterior disc cage. Simulations were performed with C4-C5, C5-C6, and C4-C6 treated levels under flexion, extension, axial rotation, and lateral bending. Models (i) and (iii) eliminated motion at the treated levels but induced hypermobility and increased intradiscal pressure (IDP) at adjacent levels. Conversely, model (ii) preserved residual motion at the treated levels, providing mobility with RoM values within the average range of a healthy population and reducing intradiscal pressure at both the treated and adjacent levels, potentially protecting adjacent discs. However, model (ii) has a higher risk of pseudarthrosis due to the residual motion. This study highlights how a CIFS in cervical spine surgery is a cost-effective alternative that preserves mobility but requires careful patient selection to minimize risks such as pseudarthrosis and adjacent segment degeneration while emphasizing the need for postoperative muscle rehabilitation. These results suggest that CIFS alone may provide a treatment that is both cost-effective and capable of preserving mobility with RoM values within the average range of a healthy population, especially with appropriate patient selection and muscle rehabilitation.

Early rehabilitation within 4 h following total knee arthroplasty involves passive exercise with manual therapy. The aim was to determine the beneficial effects of the single-joint hybrid assistive limb for rehabilitation within 4 h after total knee arthroplasty. This single-blinded randomized controlled trial included 68 participants who underwent primary total knee arthroplasty for knee osteoarthritis and were assigned to the early single-joint hybrid assistive limb (n = 22), HAL-SJ (n = 23), and control (n = 23) groups. The Knee Injury and Osteoarthritis Outcome Score quality of life (p = 0.007) scores of the early single-joint hybrid assistive limb group showed significantly higher values than the control groups at 12 months. The recovery time for extension lag was significantly improved in the early single-joint hybrid assistive limb group compared with the single-joint hybrid assistive limb (p = 0.006) and control (p < 0.001) groups. Additionally, the knee flexion range of motion of the early single-joint hybrid assistive limb group showed significantly higher values than the single-joint hybrid assistive limb (p = 0.029) and control (p = 0.031) groups at 1week. Early single-joint hybrid assistive limb rehabilitation may improve patient-reported quality of life at 12 months without exacerbating postoperative pain or swelling. These results suggest that the single-joint hybrid assistive limb may be a feasible adjunct to early postoperative rehabilitation after total knee arthroplasty, while further studies are required to clarify its clinical relevance and long-term benefits.

Background: Fingertip injuries are among the most common traumatic lesions of the upper extremity and carry a disproportionate functional and socioeconomic impact. Injuries corresponding to Allen type I and selected type II patterns frequently involve volar pulp loss with exposed bone, rendering conservative management or skin grafting unreliable. Despite the development of various local reconstructive options, the thenar flap remains a valuable technique for achieving durable, sensate coverage. Methods: A retrospective case series was conducted including adult patients who underwent staged thenar flap reconstruction for acute fingertip injuries. Eleven patients (10 male, 1 female; mean age 56 years) were treated. Follow-up of at least 7 months was achieved using patient-reported and objective outcome measures, including Visual Analog Scale (VAS) for pain, static two-point discrimination (2PD), and active range of motion (ROM). Surgical technique followed contemporary refinements in flap design ("mirror image" planning), positioning, and staged division, combined with a structured postoperative rehabilitation protocol. Results: No flap losses or secondary infections were observed. Functional outcomes were favorable, with preservation of interphalangeal joint motion in all but one patient, who developed a mild cicatricial contracture not requiring surgical intervention. One patient reported persistent sensory disturbance; however, protective sensibility was preserved in all evaluated cases. No clinically significant nail deformities or donor-site complications were recorded. Conclusion: In adult patients with fingertip injuries corresponding to Allen type I and selected type II patterns, the thenar flap remains a reliable and effective reconstructive option. When performed using modern planning principles and combined with structured rehabilitation, it provides durable glabrous padding, preserves digital length, and supports satisfactory functional and sensory recovery with a low complication profile.

ObjectiveFacial nerve injury remains a challenging complication of cerebellopontine angle (CPA) tumor surgery, often resulting in prolonged functional impairment. The present study aimed to examine the association between different postoperative rehabilitation strategies and long-term clinical and electrophysiological recovery following facial nerve reconstruction. MethodsWe conducted a single-center retrospective cohort study including adult patients who underwent CPA tumor resection with intraoperatively confirmed facial nerve injury requiring reconstructive intervention between 2018 and 2023. Based on rehabilitation approaches applied in routine clinical practice, patients were classified into three groups: standard postoperative therapy, standard therapy combined with transcutaneous electrical nerve stimulation (TENS), and a multimodal rehabilitation strategy integrating TENS with targeted pharmacological support. Clinical follow-up extended to 12 months. Facial nerve function was evaluated using the House–Brackmann scale, Yanagihara system, Sunnybrook Facial Grading System, and Facial Disability Index, alongside surface and needle electromyographic parameters. Multivariable analyses were performed to account for demographic, tumor-related, surgical, and baseline functional factors. ResultsAll groups demonstrated progressive improvement in facial nerve function over the follow-up period. Patients receiving rehabilitation protocols that included TENS exhibited greater improvements across clinical grading scales and electrophysiological measures compared with those receiving standard therapy alone. The multimodal rehabilitation group showed the largest magnitude of functional recovery, reflected by improved facial symmetry, voluntary movement, patient-reported physical and social function, and more favorable electromyographic patterns. These associations remained consistent after adjustment for potential confounders. ConclusionsIn this retrospective cohort, postoperative rehabilitation strategies incorporating electrical stimulation were associated with enhanced functional and electrophysiological recovery after facial nerve reconstruction. Multimodal rehabilitation approaches may offer added translational value in clinical neurorehabilitation following CPA tumor surgery. Prospective studies are warranted to further refine and validate optimized rehabilitation protocols.

Medication adherence among patients following total knee arthroplasty is generally suboptimal. Evidence confirms that medication beliefs constitute one of the key factors influencing patients' adherence to prescribed regimens. However, the mechanism by which medication beliefs affect adherence remains critically important to investigate. Poor medication adherence can significantly compromise postoperative rehabilitation and quality of life in these patients. This study aimed to investigate the mechanism by which medication beliefs influence medication adherence in patients following total knee arthroplasty (TKA). This study utilized a moderated mediation analysis. Data were obtained from patients who underwent TKA at four grade-A tertiary hospitals in Shandong Province, China. Upon discharge, all patients were instructed to adhere to regular anticoagulation therapy. Follow-up data were collected during orthopedic outpatient visits 1 month after surgery. The Chinese versions of the Morisky Medication Adherence Questionnaire, Medication Literacy Scale, Medication Beliefs Scale, and the Social Support Scale were employed as measurement instruments. Through moderated mediation and mediation analyses, the relationships among medication beliefs, medication adherence, medication literacy, and social support were examined. Medication adherence was significantly higher among patients with greater medication literacy (F = 3.951, p < 0.01). Positive correlations were observed between all measured scales (Medication Adherence Questionnaire, Medication Literacy Scale, Medication Beliefs Scale, and Social Support Scale; r = 0.407, 0.332, 0.206, 0.508, 0.216, 0.244; all p < 0.01). Medication beliefs directly influenced adherence (BootSE = 0.041, 95% CI = 0.077-0.240) and indirectly through medication literacy (BootSE = 0.030, 95% CI = 0.128-0.247), accounting for 45.18% and 54.82% of the total effect, respectively. Social support significantly moderated this mediation pathway (β = 0.124, t = 3.399, p < 0.01), particularly strengthening the relationship between medication literacy and adherence (β = 0.195, t = 5.456, p < 0.001). Medication adherence in post-TKA patients is associated with medication beliefs, with medication literacy serving as a partial mediator and social support as a significant moderator. The influence of both medication beliefs and literacy on adherence increases with higher levels of social support.

Background/Objectives: Neurogenic heterotopic ossification (HO) is an abnormal formation of lamellar bone in soft tissues, frequently developing near major joints in patients with spinal cord injury. While imaging provides valuable diagnostic insights, large and anatomically complex HO often requires advanced preoperative planning to minimize surgical risks. This study presents the development and clinical application of a structured six-stage workflow integrating three-dimensional (3D) technologies for the preoperative planning and surgical resection of giant iliofemoral HO. Materials and Methods: A workflow was developed comprising: (1) 3D imaging acquisition, (2) creation of a virtual model, (3) production of a life-size physical model, (4) preoperative simulation, (5) surgical resection, and (6) postoperative imaging validation. The workflow was applied to a 50-year-old male with paraplegia after a T12 fracture who developed a 26 cm iliofemoral bony bridge, confirmed by computed tomography and 3D reconstruction. Results: The physical model provided a precise anatomical reference, enabling detailed surgical rehearsal and safe planning of neurovascular dissection. Resection was performed using combined orthopedic and vascular techniques. The hip joint was preserved, and postoperative rehabilitation achieved improved range of motion and patient handling without major complications. Conclusions: This structured 3D-assisted workflow enhanced anatomical understanding and surgical precision in this complex case. The framework is applicable to other extensive ossifications with intricate anatomical relationships and warrants further evaluation in larger series.

Background: Posterior cruciate ligament reconstruction (PCLR) remains one of the most technically demanding procedures in knee ligament surgery, with complication rates considerably higher than those observed for other arthroscopic procedures. Residual laxity, arthrofibrosis, neurovascular injury, tunnel-related complications, and heterotopic ossification (HO) represent the most frequent adverse events. With increasing surgical volumes and complexity—particularly in multiligament knee injuries (MLKIs)—structured, evidence-based strategies for complication avoidance are essential. The objective of this review is to provide a comprehensive, evidence-based overview of the main complications associated with PCLR and to propose a structured, reproducible protocol for complication prevention integrating current literature and high-volume institutional experience. Methods: A narrative review of the literature was conducted using PubMed and Google Scholar to identify clinical, biomechanical, and systematic studies on PCLR complications published between 2010 and 2025. Overall, 58 studies were screened and 33 were included for qualitative synthesis. Among the included studies, the level of evidence was Level I in five systematic reviews/meta-analyses, Level III–IV in seven observational clinical studies and registries, and Level V in biomechanical studies, narrative reviews, and expert consensus reports. In parallel, the recommendations were informed by the cumulative experience of a high-volume tertiary referral center with 187 PCLR procedures performed between 2010 and 2025 (136 MLKI, 51 isolated). Results: Evidence identifies several key predictors of postoperative complications: low posterior tibial slope (&lt;6.54°), small graft diameter (&lt;7.0 mm), untreated posterolateral corner insufficiency, excessive tibial tunnel angle, and surgical trauma at the “killer turn.” Neurovascular complications primarily arise during tibial tunnel instrumentation, with knee hyperflexion (&gt;90°) significantly improving safety. Suture tape augmentation (STA) reduces graft elongation by 45–58% and is associated with improved biomechanical stability without increasing complication rates. Early controlled motion is critical to prevent arthrofibrosis, whereas HO—affecting up to 45% of MLKI patients—requires delayed surgical excision after maturation. Conclusions: Optimal outcomes after PCLR derive from a structured, complication-focused approach encompassing anatomical risk assessment, meticulous tunnel planning, neurovascular protection, biological augmentation, and disciplined postoperative rehabilitation. Adoption of standardized protocols—particularly in MLKIs—can substantially reduce the incidence of adverse events and improve long-term knee stability.

Implementation of digital health interventions in thyroid cancer care: A scoping review.

Revision osteochondral allograft transplantation (OCAT) has historically yielded inferior outcomes compared with primary procedures. This study evaluates outcomes following revision OCAT using high-chondrocyte-viability (HCV) OCAs for functional graft survival. A prospective registry was analyzed for HCV OCAT outcomes. Patients were grouped into primary (n = 182) or revision (n = 70) OCAT cohorts. Demographic, surgical, and follow-up data were collected. Revision cases were further subclassified based on prior cartilage procedures (marrow stimulation, osteochondral, or cell-matrix-based). Functional graft survival and validated patient-reported outcomes were assessed at a mean follow-up of 43 months. At final follow-up (FFU), functional graft survival was 79.1% for primary and 71.4% for revision OCAT. Overall survival at > 2-year follow-up was 84% (primary) and 80% (revision). Patients with failed revision OCAT reported significantly lower Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function scores at 1-year (mean: 40.8, p = 0.026). Bipolar tibiofemoral revisions conferred increased failure rates (odds ratio: 3.86, p = 0.033). Cell-matrix-based revision cases had significantly higher graft survival (100%) compared with osteochondral revisions (58.6%, p = 0.049). Satisfaction with revision OCAT was high (75.0%), and 84.1% would undergo the procedure again. With evidence-based patient selection, individuals who have failed previous cartilage defect surgical treatments and meet the indication criteria are likely to benefit from revision OCAT with HCV allografts. Optimal candidates for revision OCAT in the knee are patients with a history of marrow stimulation or cell-based matrix procedures who have limited comorbidities, do not require tibiofemoral bipolar OCAT, and strictly adhere to postoperative restriction and rehabilitation protocols.

Knee osteoarthritis (OA) causes pain, reduced function and disability and may require total knee replacement (TKR). Although TKR is effective, up to 20% of patients remain dissatisfied, partly due to poor preoperative function and unrealistic expectations. Long waiting times for surgery may worsen patients' function, yet preoperative physiotherapy is rarely offered. Prehabilitation-exercise and education before surgery-could improve postoperative recovery, but current evidence is limited. This trial investigates whether adding prehabilitation to standard care before TKR improves postoperative patient-reported joint awareness, enablement and knee function. This multicentre, randomised controlled parallel-group trial is planned to be conducted within two specialised orthopaedic outpatient rehabilitation units in the southeast healthcare region of Sweden. Eligible patients (40-85 years, awaiting unilateral TKR) are randomised 1:1, stratified by age (≤67, >67 years), to either 8 weeks of prehabilitation-comprising two times per week supervised exercise therapy (strength, range of motion and balance) and education-in addition to standard care, or to standard care alone. Standard care consists of self-care, a single standardised preoperative education session and standardised postoperative rehabilitation. Assessments are conducted at baseline, post-intervention, 1 week pre-surgery and 6, 12 and 52 weeks post-surgery. A total of 110 patients will be recruited to the trial. Primary outcomes are joint awareness (Forgotten Joint Score-12) and patient enablement (modified Patient Enablement Instrument-2). Secondary outcomes are patient satisfaction (5-category Likert scale), the Knee injury and Osteoarthritis Outcome Score, the EuroQol 5 Dimension 3 Level questionnaire, the International Physical Activity Questionnaire-short form, objective function and accelerometer-based physical activity. Analyses will follow intention-to-treat and per-protocol principles. Between-group and within-group differences will be tested using t-tests or non-parametric equivalents, and linear mixed models or generalised linear models. Multiple linear regression and logistic regression will be used to analyse predictor variables for the primary outcomes. Sensitivity analyses will be performed to quantify the magnitude of missing data from patients lost to follow-up. The trial has received ethical approval from the Swedish Ethical Review Authority (reg. no.2023-05120-01) and complies with the Declaration of Helsinki. Signed informed consent is collected for all patients before entering the trial. Results will be submitted for publication in a peer-reviewed journal and presented at international/national conferences. The findings may improve future clinical guidelines and care pathways for patients undergoing TKR. NCT06290336.

Despite advances in robotic-assisted prostatectomy and enhanced postoperative rehabilitation protocols, approximately 20% of patients still experience complications-most frequently hemorrhagic. To evaluate the effect of discontinuing systematic PAP (pharmacologic anticoagulant prophylaxis) on postoperative complications -specifically hemorrhagic and thrombotic events- after robotic-assisted prostatectomy. In this retrospective before-and-after study, 361 consecutive patients undergoing prostatectomy at a single center were included. Group I (n=173) received systematic PAP with low molecular weight heparin for 28 days postoperatively, alongside routine physical prophylaxis (early mobilization, adequate hydration, and intraoperative leg compression). Group II (n=188) received only routine physical prophylaxis. The primary endpoints were hemorrhagic and thrombotic complications. Clavien-Dindo≥II complications were significantly more frequent in Group I (20.2%) compared to Group II (12.2%, P<0.05). Hemorrhagic complications occurred in 10% of patients overall, with a significantly higher rate in Group I (15.0% vs. 3.7%, P<0.05). Thrombotic events were rare in both groups and not statistically different 2.3% vs. 3.7% (P=0.3). Thrombotic risk did not show a statistically significant difference in adjusted models with propensity score methods. Our study suggest that systematic anticoagulation may increase hemorrhagic morbidity without a clear thrombotic benefit. These findings support a risk-adapted, individualized approach rather than routine pharmacologic thromboprophylaxis.

We developed a novel unicompartmental pressure sensor to measure intraoperative medial compartment pressureduring robotic arm-assisted unicompartmental knee arthroplasty (UKA) and conventional jig-based UKA in order to assess the effect and impact of soft-tissue balance. This retrospective study evaluated 80 patients who underwent medial compartment UKA at our institution between November 2022 and June 2023, including 40 patients in conventional jig-based (mobile bearing) UKA and 40 patients in robotic arm-assisted (fixed bearing) UKA. After intraoperative soft-tissue balancing, the medial compartment pressure at 10°, 45°, and 90° of knee flexion was measured using a new unicompartmental pressure sensor. The knee range of motion (ROM), Numerical Rating Scale, and American Knee Society scores were recorded at three months and one year of follow-up. Conventional jig-based UKA did not achieve consistent medial compartment pressures at 10°, 45°, and 90° of knee flexion (p < 0.001), whereas robotic arm-assisted UKA achieved more balanced pressures at these angles (p-values between 10° vs 45°, 10° vs 90°, and 45° vs 90° were 0.132, 0.378, and > 0.999, respectively). In addition, robotic arm-assisted UKA showed better outcome scores and ROM at three months, but no significant clinical differences at the one-year follow-up. Intraoperative pressure measurements using the novel unicompartmental pressure sensor showed that robotic arm-assisted UKA was able to achieve more consistent pressure in the medial compartment than conventional jig-based UKA, which may improve early postoperative rehabilitation.

Background: The chief factor limiting athletes from returning to activity After Anterior cruciate Ligament Reconstruction (ACLR) prevails to be Quadriceps Muscle Atrophy. Inclusion of Blood Flow Restriction (BFR) in the Post-Operative Rehabilitation Program may accelerate Quadriceps Strengthening. Objective: The objective of the study is to evaluate the Effect of Blood Flow Restriction Training on Quadriceps Muscle Strength in Patients Post Anterior Cruciate Ligament Reconstruction. Methods: Patients Post ACLR from were evaluated and chosen based on the inclusion criteria and were randomly assigned to two groups BFR and control group. Randomized controlled trails. Study conducted at Out-Patient Department, Mannai Narayanasamy College of Physiotherapy and Out- Patient Departments of tie-up hospitals. All patients underwent a standard 12-week Post ACLR Exercise program with the BFR group performing the exercises with a pneumatic BFR cuff placed over the proximal thigh set to 80% Limb occlusion Pressure. Quadriceps strength was measured as peak quadriceps torque during high-seated leg extension at first week and twelfth week of the study. Patient Reported Outcome (PRO) of International Knee Documentation Committee (IKDC) measures were collected at 12th weeks of study. Results: At 12 weeks, the experimental group significantly outperformed the control. Experimental strength gains (t=9.41, mean=116.2) exceeded control gains (t=5.39, mean=110.1). Similarly, IKDC scores showed superior recovery for the experimental group (t=19.95, mean=57.6) compared to the control group (t=16.17, mean=55.5). Conclusion: Inclusion of BFR into the Post-operative exercise program improved strength as of 12th week of program and lead to an early transition to heavy resistance program possibly reducing to time of returning to activity which is beyond the scope of the trail Keywords: Blood flow restriction, BFR, BFRT, Anterior cruciate ligament reconstruction, Return to sports, Quadriceps muscle strength

Post-liver transplant metabolic syndrome is a common complication that threatens long-term outcomes. Exercise is a cornerstone of non-pharmacological management, yet adherence remains low. Guided by the COM-B framework, this study explored the barriers and facilitators of exercise behaviors to inform rehabilitation nursing strategies. A qualitative study was conducted with 16 liver transplant recipients diagnosed with metabolic syndrome at a tertiary transplant center in China. Semi-structured interviews were used to capture patients' experiences with exercise during postoperative rehabilitation. Data were analyzed thematically within the COM-B framework to identify behavioral determinants across capability, opportunity, and motivation domains. Barriers included limited physical capacity, misconceptions about exercise safety, and financial constraints, while facilitators involved time autonomy, digital literacy, and standardized education. Opportunity barriers were lack of structured guidance, unreliable information, and competing demands; facilitators included accessible digital resources, multi-level support, and convenient environments. Motivation barriers encompassed misperceptions, avoidance tendencies, and knowledge access issues, while facilitators included health threat awareness, positive experiences, trust in professionals, and engaging health livestreams. Rehabilitation nursing plays a pivotal role in addressing behavioral barriers and leveraging facilitators to enhance exercise adherence in liver transplant recipients with metabolic syndrome. Integrating COM-B informed insights into rehabilitation care through personalized education, digital support, and multi-level social reinforcement offers practical pathways to promote sustainable lifestyle change and improve long-term recovery and quality of life. Not applicable. This study did not involve a clinical trial.