Preinjury Level Of Function Research Articles

Surgical treatment options of displaced midshaft fractures of the clavicle in young adults: plate fixation versus intramedullary nailing.

This study aimed to compare the outcomes and complications of active young adults undergoing open reduction and plate fixation (ORPF) and intramedullary nailing (IMN) for displaced midshaft clavicle fractures (MCFs). A retrospective review was performed on all patients undergoing ORPF and IMN of complete MCFs at a single center between 2018 and 2022. Patients who were younger than 60 years with radiographic follow-up until union were included in the study. The mean age of the patients was 33.1 years. Outcome measures were achievement of union, time to healing, residual deformity, complications, and need for additional procedures. Of 39 patients, 29 underwent ORPF and 10 underwent IMN. Plate fixation provided faster functional recovery in the first 6 months, but no difference was observed after 1 year. All fractures in the IMN group healed (100%), compared to 90% in the ORPF group (P=0.08). Mean time to union was 21±8.9 weeks and was significantly different between the two groups (P<0.01), with the ORPF group averaging 23.1 weeks and the IMN group 20.8 weeks. Nonunion rates were higher in the ORPF group (10.3%) than in the IMN group (0.0%), but the difference was not significant (P=0.10). Both methods restored patients to their pre-injury functional levels. However, IMN, with its higher healing rate, fewer required revision surgeries, and lower incisional numbness, appears to be the preferred method for treating MSFs without comminution in young adults. Level of evidence: III.

Current views on preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia: An online-based cross-sectional survey.

Preoperative rehabilitation is an important stage to both physically and mentally prepare patients for anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation. This study aimed to investigate the current preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia. This was an online-based cross-sectional survey. A total of 114 physical therapists completed the survey. The survey consisted of 16 mandatory questions about management strategies, prescribed exercises, patients' physical and psychological concerns, and discussions about nonoperative management. The majority of the respondents used the following preoperative interventions: education (89.5%), closed kinetic chain exercises (66.7%), stretches (63.2%), open kinetic chain exercises (61.4%), proprioceptive exercises (59.6%), cold (56.1%), and activity modification advice (52.6%). More than half of the respondents would recommend patients awaiting ACLR to complete the exercises 2 to 4 times weekly (56.1%) for up to 8 weeks (80.7%) before ACLR. The respondents (73.7%) reported that patients awaiting ACLR did not receive preoperative rehabilitation due to 2 primary factors: the orthopedic team did not refer patients to rehabilitation specialists, and there was a lack of awareness about preoperative rehabilitation. Most therapists (86%) would discuss conservative management if a patient returned to their preinjury level of function before surgery. The surveyed physical therapists reported using various interventions and preoperative rehabilitation lengths with patients awaiting ACLR. The majority of the therapists indicated that patients awaiting ACLR did not receive preoperative rehabilitation. Future studies are needed to establish a consensus on the optimal preoperative rehabilitation program.

Vitamin D as an intervention for improving quadriceps muscle strength in patients after anterior cruciate ligament reconstruction: study protocol for a randomized double-blinded, placebo-controlled clinical trial

BackgroundThe goal of anterior cruciate ligament reconstruction (ACLR) is to restore the preinjury level of knee function to return to play (RTP). However, even after completing the rehabilitation programme, some patients may have persistent quadriceps muscle weakness affecting knee function which ultimately leads to a failure in returning to play. Vitamin D has been long recognized for its musculoskeletal effects. Vitamin D deficiency may impair muscle strength recovery after ACLR. Correcting vitamin D levels may improve muscle strength.MethodsThis is a double-blinded, randomized controlled trial to investigate the effects of vitamin D supplementation during the post-operative period on quadriceps muscle strength in anterior cruciate ligament (ACL)-injured patients. Patients aged 18–50 with serum vitamin D < 20 ng/ml, unilateral ACL injury, > 90% deficit in total quadriceps muscle volume on the involved leg compared with uninvolved leg, Tegner score 7 + , and no previous knee injury/surgery will be recruited. To assess patient improvement, we will perform isokinetic and isometric muscle assessments, ultrasound imaging for quadriceps thickness, self-reported outcomes, KT-1000 for knee laxity, biomechanical analysis, and Xtreme CT for bone mineral density. To investigate the effect of vitamin D status on quadriceps strength, blood serum samples will be taken before and after intervention.DiscussionPatients with low vitamin D levels had greater quadriceps fibre cross-sectional area loss and impaired muscle strength recovery after ACL. The proposed study will provide scientific support for using vitamin D supplementation to improve quadriceps strength recovery after ACLR.Trial registrationClinicalTrials.gov NCT05174611. Registered on 28 November 2021.

Subtle Syndesmotic Instability.

Latent or subtle syndesmotic instability is defined as an injury to the syndesmosis which is not apparent on static radiographs of the ankle. Syndesmotic injuries have also been referred to as high ankle sprains. Injury to the syndesmosis typically occurs with collision sports and often involves an external rotation force to the ankle. Diagnosis can be delayed because of negative initial imaging studies. Physical examination tests including the external rotation test, proximal squeeze test, and fibular shuck test can assist in the diagnosis. Advanced imaging modalities such as MRI and weight-bearing CT have been studied and can provide prognostic indications for management, although arthroscopic stress evaluation remains the benchmark for diagnosis. Both surgical and nonsurgical management techniques have been described, which can assist patients in returning to their preinjury level of function.

Long-term Functional and Pain Outcomes Following Arthroscopic Partial-Thickness Rotator Cuff Tear Completion and Repair

Objective: There remains little consensus on the optimal treatment approach for partial-thickness rotator cuff tears and few studies have examined the long-term outcomes of different surgical repair techniques. The purpose of this study is to identify the long-term functional and pain outcomes of arthroscopic tear completion followed by repair. The authors hypothesize that this technique will allow patients to have long-term pain relief and return to a pre-injury level of function. Methods: Patients (n=16) who underwent arthroscopic tear completion and repair for a partial-thickness rotator cuff tear were included in this case series. Each patient returned for a one-time follow-up visit, with an average follow-up time of 7.09 years, at which time physical and neurological exams were performed, quality of life was assessed through subjective questionnaires, American Shoulder and Elbow Society (ASES) and the University of California at Los Angeles (UCLA) shoulder scores were obtained, and magnetic resonance imaging was performed. Results: The average ASES score was 85.3, with 81% of patients reporting that they were able to return to a pre-injury level of function. Half of the patients reported the highest possible UCLA shoulder score of 35. Physical examination showed that patients had excellent strength and range of motion. Magnetic resonance imaging demonstrated continuity of the repair in all but one patient. However, 25% of patients reported return of symptoms since surgery, including pain and limited mobility. Conclusion: At an average of 7.09 years follow-up, most patients were found to have full mobility, pre-injury level of activity, and maintenance of rotator cuff integrity in the surgically treated shoulder. However, one fourth of patients reported return of symptoms. The authors conclude that the tear completion and repair technique can lead to long-term functional improvement, but has less favorable results in terms of subjective pain level and quality of life.

A Comparative Study Evaluating the Outcomes of Primary Cemented Bipolar Hemiarthroplasty Versus Proximal Femoral Nail Osteosynthesis for Unstable Intertrochanteric Femur Fractures in the Elderly Patient.

The objective of this study was to compare the outcomes of primary cemented bipolar hemiarthroplasty with proximal femoral nail (PFN) osteosynthesis as a management modality in unstable fractures of the intertrochanteric femur. Intertrochanteric fractures also referred to as extracapsular fractures occur in the area between the greater and lesser trochanters. Osteosynthesis is a prompt and efficient method for managing stable intertrochanteric fractures. Utilizing osteosynthesis procedures other than intramedullary fixation to address unstable intertrochanteric fractures has been linked to a relatively elevated failure rate. Hemiarthroplasty, a surgical procedure that avoids the problems of an IT fracture resulting from prolonged immobility and allows for early patient mobilization, could potentially resolve the problem. As part of this comparative analysis, we examined the surgical and functional results of PFN osteosynthesis and bipolar hemiarthroplasty in older patients with unstable intertrochanteric fractures. This study included 44 patients, consisting of 24 males and 20 females. The participants were chosen for the study depending on whether or not they met the specified criteria for inclusion and exclusion. The individuals presented with unstable intertrochanteric fractures. The study participants were included in the research after they gave their written informed consent in both English and regional languages. A total of 22 individuals underwent cemented bipolar hemiarthroplasty, whereas the remaining 22 cases underwent PFN osteosynthesis. In this study, a group of researchers monitored 44 patients who had unstable intertrochanteric femur fractures over 6 months. The subsequent results were generated by comparing the outcomes of the two groups after 1 month and 6 months: The mean duration of weight-bearing for patients who underwent bipolar hemiarthroplasty was 4 days, whereas, for patients who underwent PFN, it was 50 days. The mean blood loss following bipolar hemiarthroplasty is 288 ml, whereas the mean blood loss associated with PFN is approximately 174 ml. One month after undergoing bipolar hemiarthroplasty, the patient's Harris hip score was 69 and their PFN score was 59. The bipolar score at the 6-month follow-up was 76, whereas the PFN score was 78. The average duration of bipolar hemiarthroplasty was 84.8 min, whereas PFN had a duration of 67 min. In the group of patients who underwent bipolar hemiarthroplasty, the highest amount of shortening observed was 2.5 cm, whereas in the group of patients who underwent PFN, it was 2 cm. Our study showed that by performing cemented bipolar hemiarthroplasty in unstable intertrochanteric fractures, we were able to prevent the problems commonly associated with internal fixation. In addition, we could facilitate prompt mobilization in geriatric patients, allowing them to regain their pre-injury level of functioning and enhance their overall quality of life. At the 1-month mark, bipolar hemiarthroplasty yielded superior early functional results compared to PFN. However, by the 6-month mark, both groups exhibited similar scores for functional outcomes. In conclusion, primary cemented bipolar hemiarthroplasty offers a stable, pain-free, and mobile joint with an acceptable rate of complications and improved early recovery.

Insurance Not Socioeconomic Status is Associated With Access to Postacute Care After Injury: A Multicenter Cohort Study

IntroductionAccess to postacute care services in rehabilitation or skilled nursing facilities is essential to return trauma patients to their preinjury functional level but is often hindered by systemic barriers. We sought to study the association between the type of insurance, socioeconomic status (SES) measures, and postacute care utilization after injury. MethodsAdult trauma patients with an Injury Severity Score (ISS) ≥9 admitted to one of three Level I trauma centers were contacted 6-12 mo after injury to gather long-term functional and patient-centered outcome measures. In addition to SES inquiry specifically focused on education and income levels, patients were asked to subjectively categorize their perceived SES (p-SES) as high, mid-high, mid-low, or low. Insurance and income data were retrieved from trauma registries. Multivariable regression models were built to determine the association between type of insurance, SES, and discharge disposition after adjusting for patient and injury characteristics and hospitalization events. ResultsA total of 1373 patients were included, of which 44% were discharged to postacute care facilities. The median age (IQR) was 65 (46, 76) years, 56% of patients were male, 11% were on Medicaid, 68% had attained education higher than high school, 27% had low income, and 29% reported a low/mid-low p-SES. Medicaid patients were less likely to be discharged to postacute care compared to privately insured (OR [95% CI]: 0.41 [0.29-0.58]) and Medicare patients (OR [95% CI]: 0.29 [0.16-0.50]). The latter relationship was true across p-SES categories. P-SES, income and educational level were not associated with discharge destination. ConclusionsInsurance status, specifically having Medicaid, can pose a barrier to access to postacute care services in the trauma patient population across patients of all SES. Initiatives and policies that aim at reducing these access disparities are warranted.

Lower rates of return to sport in patients with generalised joint hypermobility two years after ACL reconstruction: a prospective cohort study

Objectives: Generalised joint hypermobility (GJH) is associated with an increased risk of suffering an anterior cruciate ligament (ACL) injury. Patients with GJH exhibit lower muscle strength and poorer scores for patient-reported outcomes after ACL reconstruction, compared with patients without GJH. The aim of this study was to examine differences in the percentages of patients who return to sport (RTS) or pre-injury level of activity (RTP), muscle function and patient-reported outcomes at the time of RTS or RTP, as well as the time of RTS or RTP in patients with GJH compared with patients without GJH in the first two years after ACL reconstruction. Methods: This prospective study used data from an ACL- and rehabilitation-specific register located in Gothenburg, Sweden. Patients aged between 16 and 50, who had a primary ACL injury treated with reconstruction, were included. Data up to two years after ACL reconstruction were used and consisted of achieving RTS and RTP, results in isokinetic muscle function tests for knee extension and flexion and patient-reported outcomes (Knee Self-Efficacy Scale, Knee injury and Osteoarthritis Outcome Score and ACL-Return to Sport after Injury scale) at the time of RTS, as well as the time of RTP. A Beighton Score of ≥ 5/9 was used to define GJH. A Tegner Activity Scale of ≥ 6 was used to define RTS, while a Tegner equal to or above pre-injury level was used to define RTP. Results: A total of 1,198 patients (54.7% women) with a mean age of 28.5 ± 8.6 years were included. A smaller proportion of patients with GJH achieved RTS compared with patients without GJH (49.2% vs 57.3%, Odds ratio: 0.720, p=0.041). Furthermore, patients with GJH were marginally less symmetrical on the knee extension strength test, expressed as a Limb Symmetry Index, at the time of RTP compared with patients without GJH (87.3 ± 13.5 vs 91.7 ± 14.3, Cohen’s d= 0.142, p=0.022). No further differences were found between groups regarding any muscle function tests or patient-reported outcomes. Conclusion: A smaller proportion of patients with GJH achieved RTS compared with patients without GJH. Patients with GJH display less symmetrical knee extension strength at the time of RTP compared with patients without GJH.

Lower rates of return to sport in patients with generalised joint hypermobility two years after ACL reconstruction: a prospective cohort study

BackgroundGeneralised joint hypermobility (GJH) has been associated with an increased risk of suffering an anterior cruciate ligament (ACL) injury. Patients with GJH exhibit lower muscle strength and poorer scores for patient-reported outcomes after ACL reconstruction, compared with patients without GJH. The aim of this study was to examine differences in the percentages of patients who return to sport (RTS) or pre-injury level of activity (RTP), muscle function and patient-reported outcomes at the time of RTS or RTP, as well as the time of RTS or RTP in patients with GJH compared with patients without GJH in the first two years after ACL reconstruction.MethodsThis prospective study used data from an ACL- and rehabilitation-specific register located in Gothenburg, Sweden. Patients aged between 16 and 50, who had a primary ACL injury treated with reconstruction, were included. Data up to two years after ACL reconstruction were used and consisted of achieving RTS and RTP, results from isokinetic muscle function tests for knee extension and flexion and patient-reported outcomes (Knee Self-Efficacy Scale, Knee injury and Osteoarthritis Outcome Score and ACL-Return to Sport after Injury scale) at the time of RTS, as well as the time of RTP. A Beighton Score of ≥ 5/9 was used to define GJH. A Tegner Activity Scale of ≥ 6 was used to define RTS, while a Tegner equal to or above pre-injury level was used to define RTP.ResultsA total of 1,198 patients (54.7% women) with a mean age of 28.5 ± 8.6 years were included. A smaller proportion of patients with GJH achieved RTS compared with patients without GJH (49.2% vs. 57.3%, Odds ratio: 0.720, p = 0.041). Furthermore, patients with GJH were marginally less symmetrical on the knee extension strength test, expressed as a Limb Symmetry Index, at the time of RTP compared with patients without GJH (87.3 ± 13.5 vs. 91.7 ± 14.3, Cohen’s d = 0.142, p = 0.022). No further differences were found between groups regarding any muscle function tests or patient-reported outcomes.ConclusionA smaller proportion of patients with GJH achieved RTS compared with patients without GJH. Patients with GJH displayed less symmetrical knee extension strength at the time of RTP compared with patients without GJH.

Hemiarthroplasty in geriatric population with neck femur fracture: A retrospective study of 43 cases

Abstract Introduction: Hip fractures in the elderly have represented a major public health concern. Studies have shown that over 90% of the patients having these fractures are people of more than 50 years. These fractures have been classified according to their anatomical location into the neck of femur fracture, intertrochanteric fracture, and subtrochanteric fracture. The neck of femur fractures is associated with high mortality in the elderly compared to young adults. Surgical treatment is an established gold standard, with the option being osteosynthesis and hip replacement. Hemiarthroplasty is one of the gold-standard treatments chosen for the geriatric age group and has yielded universally acceptable results. Materials and Methods: The study evaluates the clinical, radiological, and functional outcomes of hip hemiarthroplasty in elderly with fracture neck of the femur Data of patients above 60 years who were operated on for fracture neck of the femur by bipolar hemiarthroplasty from May 2018 till December 2021were retrieved from the Medical Records Department of SCL Municipal General Hospital, affiliated to NHL Municipal medical college. The patients fitting the inclusion criteria were selected for the study. The sample size was calculated to be 43. Data were collected from the inpatient files, and then patients were asked to complete the questionnaire form during the final follow-up. All the patients were evaluated clinically and radiologically during the follow-up, and the functional outcome was assessed using the Harris Hip Score. Thirty-five patients had a domestic fall as the mode of injury. The lateral decubitus position of all patients was used during the operation that was performed using the Southern Moore approach. Forty patients received cemented femoral stems; the remaining three received press-fit ones. Results: The average age was calculated to be 71.86 years with the male-to-female ratio of 1: 1.15 with an average follow-up of 12.7 months. Eight patients had acetabular erosion at the end of 1 year. There was no femoral stem malalignment or aseptic loosening at the final follow-up. Nine patients had excellent Harris Hip scores, and five had fair scores. The remaining 29 patients had good Harris hip scores. Bipolar hemiarthroplasty has served us well in the study. Forty-one patients were able to get back to their preinjury functional level. Only one patient reported major pain in the hip at the final follow-up. In this study, there was no incidence of dislocation or revision surgeries. Conclusion: The present study modular bipolar hemiarthroplasty provides better pain relief with early mobilization and a good level of return to daily routine activities with minimal complications.

FUNCTIONAL OUTCOME OF INTERTROCHANTERIC FRACTURES TREATED BY PROXIMAL FEMORAL NAIL ANTIROTATION

INTROCUCTION Intertrochanteric fractures are commonly encountered in elderly population. Nearly half of the fractures are unstable. Surgical fixation is mostly preferred due to early mobilization and to avoid complications of conservative treatment. Unsatisfactory results with extramedullary fixation led to the rise of intramedullary devices. Our aim in this study is to analyze the effectiveness and pitfalls of Proximal Femoral Nail Antirotation (PFNA) in the treatment of unstable intertrochanteric fractures. METHODS This prospective study was conducted during October 2017 to January 2019 in our hospital. A total of 20 patients (13 males, 7 females) above 50 years of age having unstable intertrochanteric fracture were treated with Proximal Femoral Nail Antirotation. About 75% of injuries occurred due to trivial fall. Mean interval between trauma and surgery was 3.95 days. All patients were treated by closed reduction. The study participants were followed up for a minimum duration of six months and were assesed using Harris Hip Score. RESULTS Anatomical reduction was achieved in 16 patients. Post operative complications include superficial infection, lag screw back out, delayed union in one case. The average time of union was 14.6 weeks. By the end of six months, good to excellent results were seen in 80% of patients. 75% patients returned to pre injury functional level. CONCLUSION PFNA gives optimal fixation for Intertrochanteric fractures, with good preoperative planning and intraoperative reduction. It’s the ideal implant for osteoporotic elderly population as it provides good cancellous bone compaction, less operative time and blood loss when compared to other fixation methods.

Mid Shaft Clavicle Fractures- Plate vs Titanium Elastic Nail System

Abstract It was believed that “all clavicle fractures heal well” is no longer valid. Recent trend is towards operative management, consists of Pre-contoured plate or Titanium Elastic Nail System(TENS) application. Plate fixation remains the mainstay of treatment but Titanium Elastic Nail System application has gained attention in recent years. This study highlights the comparison between two most common modalities available for treatment of mid-shaft clavicle fractures. Objectives:Compare the functional outcome using Neer’s scoring system, radiological outcome and secondary outcomes between two treatment groups. Methods:Patients satisfying inclusion criteria were included in our study and randomized into Group A-operated with plate fixation and Group B-operated with TENS. Routine postoperative protocol and physiotherapy followed. Regular follow up carried out and assessed as per protocol. Results: We had 15 patients in each group by end of our study. There was no significant difference between the two groups in terms of demographics, time to surgery, fracture types. Duration of hospital stay, mean fracture union time were significantly shorter and cosmetically more satisfied in TENS group. Operative time, length of incision, peri-operative blood loss was significantly higher in plate group and length of clavicle better restored. Functional outcome was excellent with no significant difference between two groups. Conclusion:Both methods return the patients to their pre-injury functional levels without significant complications with excellent functional outcome. Titanium Elastic Nail System application has a shorter operative time, lesser duration of hospital stay, lower infection rate and better cosmetic outcome suggesting this is the preferred method with no comminution whereas plate fixation is superior in comminuted fractures.

Functional Outcome in Patients with Hemorrhagic Stroke

Introduction: Hemorrhagic stroke is a condition in which the weakened blood vessels ruptures and bleed into surrounding brain parenchyma or in surrounding meningeal spaces. Despite of current advances in determining of its pathophysiology and new treatment approaches, acute hemorrhagic stroke remain a least treatable stroke and the overall mortality ranges from 20 to 40%. Objective: To determine functional outcome in patients with hemorrhagic stroke. Materials and methods: This study was cross sectional descriptive study carried out at the Department of Medicine, Lady Reading Hospital, Peshawar for duration of six months from January 2022 to July 2022. Data collection was done for all the patients by using pre-designed Performa. Data was entered in Excel sheet and analysis of data was done by employing SPSS version 17. Results: Functional outcome according to GCS score among 181 patients was observed as 13(7%) patients had good recovery (return to pre injury functional level), 32(18%) patients had moderate disability (deficit with ability to look after self), 54(30%) patients had severe disability (in able to look after self), 44(24%) patients had persistent vegetative state (no higher mental functions), 38(21%) patients had death (no vital signs). Conclusion: Our study concludes that in our setup 7% patients had good recovery, 18% patients had moderate disability, 30% patients had severe disability, 24% patients had persistent vegetative state while the motility rate was 21% patients. Keywords: functional outcome, hemorrhagic, stroke.

Paper 81: Quadriceps Tendon Autograft Yields Good Outcomes for Revision ACL Reconstruction after Failed Patellar Tendon Autograft

Objectives:Few studies have examined the viability of the quadriceps tendon autograft as a revision graft option following failed primary bone-patellar tendon-bone (PT) autograft reconstruction. Potential concerns include further disruption to the knee extensor mechanism, inhibition of the quadriceps muscle, and increased complication and reinjury rates. The purpose of this study was to assess knee extension strength, functional outcomes, patient reported outcomes, and return to play after revision ACL reconstruction using free quadriceps tendon autograft after a failed primary reconstruction using bone-patellar tendon-bone (PT) autograft.Methods:A retrospective case series was conducted in accordance with Strengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines using a prospective single surgeon ACL database (n = 1,514) that included 48 patients receiving revision ACL reconstruction using free QT autograft after failure of primary PT autograft ACL reconstruction from 2015-2019. Exclusion criteria are listed in Figure 1, and included ages <15 years or > 55 years, bi-cruciate ligament injuries, and meniscal allograft transplant. Baseline patient demographics and surgical variables were collected and included preinjury level of function (Marx Score). Functional and self-reported outcomes were obtained at the time of return to play and consisted of: single-leg squat symmetry, hip abduction strength, single-leg hop tests, agility testing, and isokinetic knee extension strength (60°, 180°, and 300°/sec). Self-reported outcomes at the time of return to play included the International Knee Disability Committee (IKDC-2000) scale and Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) psychological readiness survey. Return to play was defined as the time (mo) required to reach a threshold of 90% limb symmetry on objective functional testing compared to the contralateral extremity and ultimately, the surgeon’s discretion. Injury and complication surveillance was conducted for 2-years postoperatively, and patients were contacted via email or phone survey at 24-months to obtain functional status and single answer numeric evaluation (SANE) scores. Descriptive statistics were calculated using SPSS (version 26, IBM Inc, NY, USA).Results:Baseline patient demographics are listed in Table 1 for the 48 patients (mean age 23.9 ±9.5 years; 14/34 female/male) enrolled in the study. Isokinetic knee extension strength was 84.3 ±17.1% at 60°/sec, 88.6 ±16.4% at 180°/sec, and 92.0 ±19.5% at 300°/sec. The mean knee function SANE score at 2-years was 88.9 ±12.2%. All patients went through return to play testing prior to returning to sport. The mean time to return to play was 8.9 ±1.8 mo, and the mean 24-month assessment was conducted at 24.6 ±2.3 mo. Limb symmetry index scores ranged from 94.1%-102.6% across all objective functional tests (Table 2), and self-reported knee function via the IKDC-2000 was 86.3±16.8. Three patients were lost to follow up (6.3%) at 2-years, and of the 45 patients remaining in the study, 3 sustained graft reinjuries (6.7%). Two-year complications are listed in Table 3, and included meniscal tear (2.2%), DVT (4.4%), loss of motion requiring surgical lysis of adhesions (4.4%), anterior knee pain (11.1%), and symptomatic removal of hardware (2.2%).Conclusions:Free quadriceps tendon autograft is a viable autograft option for revision ACL reconstruction for failed PT autograft allowing return to high function without compromising knee extension strength with a low failure and complication rate. Two-year graft reinjury rates for revision ACL reconstruction with free QT autograft are similar or favorable to other autograft options previously reported in the literature in a revision setting. Additionally, functional outcomes are comparable to revision reconstructions using PT autograft and good to excellent outcomes can be obtainedTable 1.Patient DemographicsFig 1.Study DesignTable 2.Level of Return to SportTable 3.Return to Play Functional Performance Outcomes

Outcomes of Repair and Reconstruction of the Acute Posterolateral Corner Injuries of the Knee Combined with Cruciate Ligaments Injuries.

This study aimed to report objective and subjective knee stability scores for patients who underwent acute repair of avulsed posterolateral corner (PLC) structures or acute reconstruction of midsubstance tears combined with delayed reconstruction of cruciate ligaments. A total of 48 sport and vehicle accident traumatic patients were enrolled in a three-year follow-up study. The patients were investigated by clinical exams, subjective and objective International Knee Documentation Committee (IKDC) score, Tegner score, Lysholm score, and stress imaging. All scores were compared between the reconstruction and repair groups. Subjective IKDC scores were obtained at 83.3±9.6 and 88.3±4.39 for the reconstruction and repair groups, respectively. Only two patients in the reconstruction group had abnormal objective IKDC scores. Based on the Tegner score, 15 out of 18 patients in the repair group and 20 out of 24 patients in the reconstruction group regained their pre-injury functional level. Mean Lysholm scores for the reconstruction and repair groups were estimated at 83.4±8.2 and 88.2±4.1, respectively. Mean lateral joint opening differences between two knees in the reconstruction and repair groups were -0.2±0.1mm and 0.5±0.1mm, respectively. There were no statistically significant differences between groups outcomes. We had no failure of treatment at the final follow-up. Acute intervention within 3 weeks after PLC injuries combined with delayed cruciate ligaments reconstructions showed favorable outcomes. Both repair and reconstruction are effective when deciding based on the type of injury (i.e., avulsion and midsubstance tear).

Clinical and Radiological Outcome of Vancouver B2 Fracture Treated With Open Reduction and Internal Fixation. A Multicenter Cohort Analysis.

To determine whether open reduction and internal fixation (ORIF) of periprosthetic Vancouver B2 fractures can lead to successful fracture healing in selected patients, when attention is given to the surgical exposure and the creation of a balanced extramedullary construct. Retrospective. Two Level-1 trauma centers in Germany and United Kingdom. Patients with a B2 fracture receiving solely ORIF using a polyaxial locking plate were included for analysis. Patients with other fracture types, or treated with other methods, or with follow-up less than 12 months were excluded. Clinical characteristics, including the Charlson index, the American Society for Anesthesiologists score, and their preinjury functional levels, were recorded. Main outcome measures were 1-year mortality, revision rate, and radiological healing according to the Beals-Tower criteria. A total of 32 patients (mean age ,79 ± 12 years) were enrolled. Six patients died within the first year (1-year mortality: 19%), and 5 were unavailable for follow-up studies. The remaining 21 patients had a mean follow-up of 30 months. Of 21, 20 had an excellent/good result using the criteria of Beals-Tower. One patient required revision surgery due to loosening and secondary subsidence of the stem. ORIF can be offered to selected patients suffering from B2 fractures, especially if their functional demand is limited, and perioperative risk high for revision arthroplasty. In this challenging cohort of patients, ORIF was a safe and effective therapeutic option. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Intimate Partner Violence During Recovery from an Orthopaedic Injury: An Exploratory, Prospective, Multicenter, Observational Cohort Study.

Orthopaedic injuries may lead to an increased incidence of intimate partner violence (IPV) during recovery as people dependent on others' help are at a higher risk for abuse. Additionally, there is a lack of understanding of how IPV affects injury recovery. In women being treated for an orthopaedic injury, we aimed to determine the number of new IPV disclosures in the 12 months after an injury and to explore the impact of IPV on recovery. We enrolled 250 female participants from 6 orthopaedic fracture clinics in Canada, the Netherlands, Spain, and Finland. IPV disclosure and clinical outcomes were assessed at the initial visit and during the 12-month follow-up period. Of 250 participants, 81 (32.4% [95% confidence interval (CI), 26.6% to 38.2%]) had a history of IPV in their lifetime and disclosed this at their initial orthopaedic clinic appointment. Twenty-one participants (12.4% [95% CI, 7.5% to 17.8%]) who did not disclose abuse at the initial visit disclosed IPV during the follow-up. In our a priori unadjusted analysis, disclosure of IPV at the initial appointment or a subsequent follow-up appointment was associated with a 32% lower likelihood of returning to a pre-injury level of function with no restrictions regarding responsibilities at home (hazard ratio, 0.68 [95% CI, 0.46 to 0.99]; p = 0.046). Participants disclosing IPV had lower health-related quality of life on the EuroQol-5 Dimensions (EQ-5D) at the 6-month-follow-up, with adjusted mean differences of -5.3 (95% CI, -10.2 to -0.4, p = 0.04) for the visual analog scale and -0.06 (95% CI, -0.11 to -0.01; p = 0.02) for the Function Index. They also had lower Function Index scores at the final 12-month follow-up visit, with an adjusted mean difference of -0.06 (95% CI, -0.10 to -0.02; p = 0.006). A surprisingly high percentage of women disclosed IPV within 12 months after the injury. Our exploratory results suggest that women who disclose IPV may have lower health-related quality of life. This study supports the need to optimize orthopaedic clinics to provide appropriate support for asking about and assisting individuals who experienced IPV. Additional research is warranted to further explore these findings. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Patients With Un-Displaced Or Displaced Intra Capsular Proximal Femur Fractures Do Not Represent A Different Patient Group And Have Similar Short And Long Term Mortality

BackgroundProximal femur fractures in geriatric patients are associated with substantial mortality. Management of intracapsular proximal femur fractures has been based on age, displacement, cognition, and pre-injury mobility. However, over the last decade, there has been a tendency to offer arthroplasty rather than internal fixation for these patients irrespective of displacement, to allow early mobilisation and negate the higher rate of reoperation due to failed internal fixation. There are no previous investigations analysing whether the severity of fracture displacement is related to different patient characteristics. AimThis study examines whether patients sustaining undisplaced or displaced intracapsular proximal femur fractures represent different patient groups with different pre-injury characteristics and post-operative mortality, irrespective of treatment modality. MethodsA retrospective series of 329 consecutive patients over the age of 55 years who sustained intracapsular proximal femur fractures, who underwent surgical management at a district general hospital over a period of 2 years (2012-2013) were identified using the national hip fracture database. Demographics, American Society of Anaesthesiologist (ASA) grade, pre-injury outdoor mobility status, cognitive status, and admission serum investigations, fracture displacement, type of surgery, and mortality rates at short term (2 years) & long-term (7-9 years) were reviewed. ResultsThere were 109 male and 220 female patients with a minimum follow-up of 7 years. The mean age at surgery was 81.6 years (range 55-103 years). There were 63 (19.1%) undisplaced fractures (Garden 1 &2) and, 265 (80.5%) displaced fractures (Garden 3 & 4).The median survival in this cohort was 2.95 years (95% CI 2.3-3.6). Mortality rates were 77.4% (n=257) at long-term (7-9 years) follow-up. Admission patient characteristics showed no statistically significant difference between displaced and undisplaced fracture groups. This included ASA, pre-operative cognition, and mobility status. Fracture displacement was not an independent predictor of mortality at short or long term. ConclusionIn patients sustaining intracapsular proximal femur fractures, the degree of displacement is not a caveat for a different patient group. Fracture displacement is not predicted by the pre-injury level of function and does not predict short or long-term mortality.

Intrapartum pubic symphysis diastasis in a primigravida woman

Pubic symphysis diastasis in pregnancy is a rare obstetric complication. A case of a 35 year old primigravid woman with severe pubic symphysis diastasis and sacroiliac joint relaxation during non-operative vaginal delivery is reported and the literature reviewed. The patient was successfully treated by open reduction and internal fixation with plate and screws. During a 5 year follow-up, the patient presented with no pain and complete recovery to pre-injury functional level. Early diagnosis and immediate intervention by pelvic stabilization and in severe cases surgical intervention are the key points for the management of pubic symphyis diastasis, which optimize the maternal outcome.

Contemporary Principles for Postoperative Rehabilitation and Return to Sport for Athletes Undergoing Anterior Cruciate Ligament Reconstruction

AbstractDespite advancements in our understanding of anterior cruciate ligament (ACL) injury prevention and nonsurgical management, ACL reconstruction continues to occur at an alarming rate. Among athletic patients, individuals participating in basketball, soccer, and football have the highest incidence of ACL injury, often requiring surgical intervention. To ensure the optimal treatment strategy for return to sport and prevention of secondary graft re-tear, it is important to tailor to the specific demands of the injured athlete and apply evidence-based best practices and rehabilitation principles. The purpose of this review is to provide readers with a brief background regarding ACL injuries, a focused review of clinical outcome studies after ACL reconstruction, and an updated framework with expert-guided recommendations for postoperative rehabilitation and return to sporting activity. Currently, there is no gold standard for rehabilitation after ACL reconstruction, highlighting the need for robust studies evaluating the best modalities for athlete rehabilitation, as well as determining the efficacy of new tools for improving therapy including blood flow restriction therapy and neuromuscular electrical stimulation. Based on clinical experience, a renewed focus on objective, criteria-based milestones may maximize the ability of return to preinjury levels of athletic function.