Previous Level Of Activity Research Articles

The importance of biomechanical assessment after Return to Play in athletes with ACL-Reconstruction.

Barriers to successful return to previous level of activity following Anterior Cruciate Ligament Reconstruction (ACLR) are multifactorial and recent research suggests that athletic performance deficits persist after completion of the rehabilitation course in a large percentage of patients. Do technology-based biomechanical assessments reveal underneath differences in both recreational and competitive athletes in Return to Play after ACL-Reconstruction? Thirty soccer athletes (26.9 ± 5.7 years old, male) with ACL injury were surgically treated with all-inside technique and semitendinosus tendon autograft. Before 2 years from surgery, they were called back for clinical examination, self-reported psychological scores, and biomechanical outcomes (balance, strength, agility and velocity, and symmetry). Athletes were classified into recreational (n = 15) and competitive (n = 15) according to the self-reported Return to Play Level based on the TALS post-injury. Nonparametric statistical tests have been adopted for group comparisons in terms of age, concomitant presence of meniscus tear, injury on dominant leg, presence of knee laxity, presence of varus/valgus, body sides, and return to different levels of sports. Competitive athletes showed better in terms of strength (45.3 ± 5.4 W kg-1 vs 39.3 ± 3.4 W kg-1, P ≤ 0.01) associated with good self-reported outcomes (TLKS, CRSQ) and low fear of reinjury (TSK). However, all the athletes had a functional deficit in at least one subtest, and a safe return to sports could not have been recommended. Our findings confirmed that demographics, physical function, and psychological factors were related to playing the preinjury level sport at mean 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial. A strict qualitative and quantitative assessment of athletes' status should be performed at different follow-ups after surgery to guarantee a safe and controlled RTP.

Anatomic reconstruction of the medial collateral ligament in multi-ligaments knee injury using achilles allograft : a modification of Marx’s technique

Medial Collateral Ligament (MCL) injury may require operative treatment. Marx et al. described the latest technique for reconstruction of MCL. While good results have been reported using the Marx technique, some issues have been observed. To address the mentioned issues, a modification to the Marx technique has been devised. Eleven patients were enrolled and their ligaments were repaired by the fixation of allograft on the proximal and distal attachment footprints of the superficial MCL. For preventing loss of knee ROM, MCL and other ligaments were reconstructed in 2 separate stages. At the last follow up the ROM, knee ligament laxity and functional outcome scores, subjective (IKDC) and Lysholm score were evaluated and recorded. Knee motion was maintained in all cases. Two cases demonstrated 1+ valgus instability at 30 degrees of knee flexion. Both were treated for combined MCL and PCL tear, the rest were stable. The average IKDC-subjective score was 93 ± 4 and the average Lysholm score was 92 ± 3. All patients were satisfied and returned to their previous level of activity. In this technique, the superficial MCL was recon- structed closer to its anatomical construct. Patients didn't have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Patients didn't have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Also reconstructing the ligaments in 2 stages helped to preserve the knee motion. Level of Evidence : Level IV therapeutic.

Fixation des traumatismes isolés du Lisfranc par TightRope™ : note technique

Treatment of Lisfranc ligament injury is still debatable. For this reason, we applied a standard suture button (TightRope™, Arthrex, Naples, FL), a device originally designed for syndesmosis fixation, in treating isolated Lisfranc ligament (ILL) injuries. Twelve patients diagnosed as having an ILL injury were recruited. All patients regained their previous activity level within 3 months after the surgery without any complications. We propose that standard suture button device in an ILL injury is an easy technique to perform with short learning curve, accompanied with satisfactory outcomes.

Suture Anchor Augmentation for Acute Unstable Isolated Ankle Syndesmosis Disruption in Athletes.

Isolated ankle syndesmosis disruption (without fibula fracture) causes acute pain and may cause chronic instability and pain. The aim of the present study was to evaluate the outcomes after anterior inferior tibiofibular ligament (AITFL) anatomical fixation using anchor sutures for unstable isolated syndesmosis disruption without fibular fractures. This study assessed 22 athletes who were diagnosed with unstable isolated syndesmosis disruption with a positive external rotation test, had more than 2-mm diastasis on ultrasound, and had complete AITFL rupture on magnetic resonance imaging between 2004 and 2020. Eighteen patients (82%) were elite-level athletes, and the remaining 4 were recreational athletes. Twelve patients (55%) were injured by an external rotation force. The athletes underwent open anatomical suture anchor fixation between the AITFL attachment sites, the fibula and tibia. The mechanism of injury, return-to-play time, and Foot and Ankle Outcome Score (FAOS) were evaluated. All athletes returned to previous play except 1 retired elite athlete. Twenty-two athletes returned to jogging, team training, and official game play at an average of 62, 89, and 102 days, respectively. The final average follow-up FAOS symptom, pain, daily activity, sports activity, and quality of life scores were 98, 97, 100, 99, and 97, respectively. Two athletes were reinjured, and 1 required reoperation in the follow-up period. Athletes with isolated syndesmosis disruption had a high likelihood to return to their previous activity level after suture anchor augmentation. Level IV, case series.

ACL Reconstruction–Tunnel Placement is Critical for Success!

The goal of anterior cruciate ligament reconstruction (ACLR) is to allow patients to return to their previous level of activity with a low rate of re-injury. To meet this goal, every ACL surgeon should strive to restore the native anatomy and kinematics of the knee. Although surgical techniques for ACLR have evolved, rates of ACL re-injury remain high, especially in young, active patients. While some of these reinjures may be unavoidable, many factors remain under the control of the surgeon. Despite all such factors contributing to a successful outcome, improper or non-anatomic tunnel placement remains the most common reported reason for technical failure. Proper knowledge and recreation of the insertional site anatomy of the ACL, on both the femur and tibia, allows surgeons to restore the patient's native anatomy and function. We present our surgical technique and rationale for placement of our ACL femoral and tibial tunnels which we have found easily reproducible and technically straightforward.

Upper Extremity Superficial Vein Thromboses Presenting as Acute Neck Pain in a Young and Healthy Male: A Case Report.

Background and PurposeNeck pain in the United States is pervasive and contributes to disability. While the majority of neck pain in young and healthy individuals is neuromusculoskeletal in nature, screening for red flags is necessary for ruling-out serious medical pathologies. The purpose of this case report is to describe a young and healthy male subject with a primary complaint of acute neck pain with multiple underlying upper extremity superficial vein thromboses (UESVTs).Case DescriptionThe subject was a 27-year-old male active-duty Soldier referred to physical therapy by his primary care provider (PCP) for acute left-sided neck pain. Prior to physical therapy, the subject had been treated with cyclobenzaprine, oxycodone-acetaminophen, trigger point injection and had undergone a D-dimer to rule out a potential thrombus due to air travel and lower extremity immobilization.OutcomesThe subject underwent a D-dimer, Doppler ultrasound, pharmacological treatment of Rivaroxaban, and was referred to hematology/oncology to rule out systemic causes of SVTs. Evidence of subtle increases in blood pressure over the course of three months, a positive D-dimer, and symptoms incongruent with clinical presentation contributed to referral to a hematology/oncology specialist and a diagnosis of multiple UESVTs. The subject was able to return to his previous level of activity by six months and remained free of SVTs at two-year follow-up.DiscussionUESVT events are rare and can be challenging to identify. This case report describes a unique presentation of acute neck pain caused by underlying UESVTs in an otherwise healthy and active young male.Level of EvidenceLevel 4

Lesão SLAP Tipo II Isolada em Desportistas – Reparação Labral ou Tenodese da Longa Porção do Bicípite. Análise de Resultados e Taxa de Return to Play

Introduction: SLAP injuries are common in young athletes and in the military men. In the failure of conservative treatment, surgical treatment is indicated. Objectives: To compare clinical results in two groups of sportsmen and military men with SLAP type II injuries who underwent two surgical techniques. Material and methods: Retrospective study, in sportsmen and military personnel submitted to surgical treatment between 2010 and 2018. Each group was submitted to the same technique by the same surgical team. Clinical evaluation was performed with a Constant (SC) score, complications were recorded, surgical re-interventions, rate of return to sports activity and rate of return to the previous level of activity. Results: We analyzed 25 patients, 12 who underwent labral repair (RL) and 13 who underwent bicipital tendon tenodesis (TLPB). The mean follow-up was 4.5 years, the mean age was 25.7 years for the RL group and 31 years for the TLPB group. There was an improvement in SC in both groups. In the RL, there were 4 cases of post-operative stiffness with two re-interventions, whereas with the TLPB there was a failure with tenodesis rupture. The rate of return to sports activity was 100% in both groups, but in the RL group the rate of return to the previous level was 42% and in the TLPB group 70%. Conclusions: Both techniques have good clinical results in the medium and long term. In our series, the results are superior for TLPB and without re-interventions. In the RL group, the rate of complications was higher and the rate of return to the previous level of sports activity was lower.

Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group

ObjectivesA precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS after ACL injury and description of the RTS continuum, as well as provide clinical guidance on RTS testing and decision-making.MethodsAn international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence.ResultsKey points include that RTS is characterised by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries.ConclusionThe resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biological assessment of healing and recovery.

A Scoping Review of Physical Activity in People With Lower-Limb Loss: 10,000 Steps Per Day?

After amputation, people with lower-limb loss (PLL) face challenges to regain their previous physical activity level. Assessing the scope of evidence regarding physical activity in PLL can identify sources of evidence and gaps within the literature that can influence amputation-related research, outcome assessment choices, and wellness activities. The purpose of this scoping review was to map the evidence regarding steps per day as a physical activity measure for PLL. Specific aims were to (1) identify research designs, (2) catalog population subgroups, (3) document steps per day measurement methods, and (4) provide descriptive data for steps per day in PLL. The MEDLINE, CINAHL, Embase, Web of Science, and AMED databases; and the Journal of Prosthetics and Orthotics archive were searched without language or time limits. Exclusion criteria included no PLL subjects, not peer-reviewed, and no direct step count measure. Inclusion criteria allowed any sample size, nonprosthetic use, and self-reported step count. As a scoping review, only descriptive statistics were compiled, and no methodologic quality assessment was performed. Twenty-one articles using crossover (8), cohort (4), cross-section (8), and case-study (1) designs were included that reported accelerometer (19) or pedometer (2) data. Studies often mixed amputation etiologies (15/21) and most (13/21) excluded transfemoral amputations. Studies primarily examined people with transtibial amputations (81.2%) and people at independent community walking levels (Medicare functional classifications: K3 = 49.2%, K4 = 36.3%). All 21 studies had fewer than 100 participants, and overall included 515 subjects (343, 66.6% male), mean (SD) age 53.2 (22.1) years. Mean (SD) number of pooled steps per day for PLL was 5087 (2998): 5929 (3047) for transtibial amputations and 3553 (2030) for transfemoral amputations. Most PLL have low activity levels compared with the 10,000 steps per day generally recommended or 6000 common in people with diabetes. Research with larger samples, defined subgroups, and data along the recovery continuum would enhance knowledge of physical activity level in PLL. This scoping review has identified gaps in the research related to steps per day as a measure of physical activity in people with lower-limb loss to guide future research. People with lower-limb loss take fewer steps per day than suggested for general health. Increasing steps per day may be a useful goal for this population, and this study is a first step in improving knowledge of physical activity levels in people with lower-limb loss.

Arthroscopic management of tibial eminence fracture: a review of treatment outcome

<p class="abstract">In this study outcomes of arthroscopic management of tibial eminence fracture have been described. We conducted a study of 15 patients of ACL avulsion fractures especially Meyer and Mckeever type II and III treated arthroscopically by pull through sutures. Outcome measures were assessed through International Knee Documentation Committee (IKDC) form, Tenger Activity scale and Lysholm knee score. The study group consisted of 15 patients who met the inclusion criteria, of which 9 were male and 6 were female. The range of patient age consisted of 13-37 years and the average patient age was 20.6 years. The average male age was 22.11 years and the average female age was 18.33 years. The fracture classification showed 7 being type II while 8 were type III. Tegner Activity level at follow up ranged from 5-8 and the mean score was 6.4. On follow-up evaluation, the mean Lysholm score was 92.8 (ranging from 76-100). 6 patients who had inter-meniscal interposition was retracted or resected showed no difference in functional outcome. We found that displaced tibial eminence fractures could be successfully treated using arthroscopic pull through sutures, with most patients returning to their previous activity level. Complications were avoided by anatomic reduction of fracture fragments and early post-operative rehabilitation.</p>

Fixation of isolated Lisfranc ligament injury with the TightRope™: A technical report

Treatment of Lisfranc ligament injury is still debatable. For this reason, we applied a standard suture button (TightRope™, Arthrex, Naples, FL), a device originally designed for syndesmosis fixation, in treating isolated Lisfranc ligament (ILL) injuries. Twelve patients diagnosed as having an ILL injury were recruited. All patients regained their previous activity level within 3 months after the surgery without any complications. We propose that standard suture button device in an ILL injury is an easy technique to perform with short learning curve, accompanied with satisfactory outcomes.

Clinical Evaluation, Functional Outcome and Complications of MicroEndoscopic Discectomy(MED) in Single or Double Level Lumbar Disc Herniation- A Retrospective Review of 156 Patients

Introduction: Lumbar disc herniation (LDH) is one of the most common causes for low back pain and related disabilities. Surgery is indicated in patients who do not respond to the conservative measures for at least 6 weeks or symptoms are worsened. Microendoscopic discectomy (MED) is a well-accepted minimally invasive surgical technique with similar results compared to open surgery. The purpose of this study was to evaluate the clinical outcome, functional improvement and analyze complications during MED. Methods: A retrospective analysis was conducted in 156 patients who were operated for single or double level LDH using MED between 2016 and 2018. All patients were evaluated for pain and disability using visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. Modified MabNab’s criteria used to evaluate overall outcome of surgery. Operation time, estimated blood loss (EBL), hospital stay and time to return back to previous activities were evaluated. Complications and revisions were noted during follow-up to analyze clinical results. Paired t-test was used to evaluate statistical difference in VAS and ODI score during follow-up. Results: All patients were followed up at 6 weeks, 3 months, 6 months, 1 year and yearly thereafter postoperatively. Average follow-up was 25.5±9.7 months and average age was 45.0±12.7 years. Average VAS scores improved significantly from preoperative 8.7±0.8 to 2.0±1.1 postoperatively (p<0.0001). Average preoperative ODI improved significantly from 53.8±6.1 to 22.6±5.1 postoperatively (p<0.0001). Both score were maintained at the final follow-up. The average time to return to previous activity level was 35.7±14.3 days. Average operation time, EBL and hospital stay were 57.6±14.6 minutes, 36.7±13.1 mL and 2.4±0.7 days, respectively. There were total 19 (12.2%) complications and 12 (7.7%) revisions in the series. Overall clinical outcome was excellent, good, fair and poor in 73.1%, 20.5%, 5.1% and 1.3% of cases using modi

MANAGEMENT OF HIGH VELOCITY TIBIAL PLATEAU FRACTURES BY LIGAMENTOTAXIS USING ILIZAROV EXTERNAL FIXATOR

Background: Tibial plateau fractures resulting from high energy trauma, typically Schatzker type IV, V and VI pattern fractures are difcult to deal with due to poor overlying soft tissue cover. Ligamentotaxis with ilizarov ring xator can be a suitable denitive treatment option for such injuries with fewer associated complications as compared to internal xation. Patients and Methods: 30 patients within the age group of 18-80 years with Schatzker type IV, V and VI pattern injuries were included in the study. A four ring ilizarov assembly was used with knee spanning with a proximal femoral ring. The patients were followed for 12 months and evaluation was analyzed as per Rasmussen clinical and radiological criteria. Results: The mean age of patients in our study was 39.76 years. Twenty cases were Schatzker type VI, 7 cases were Schatzker type IV (with extensive soft tissue swelling following high velocity trauma) and only 3 cases were type V. The mean duration of surgery was 47±12 mins without bone grafting and 72±14 mins with bone grafting. The mean interval from injury to surgery was 2.36 days (range 1-5 days). Rasmussen total anatomical outcome was excellent in 14 patients(46.66%) and good in 16 patients(53.33%). Rasmussen total functional outcome was excellent in 21 patients(70%) and good in 9 patients(30%). Final Outcome was excellent in 22 patients(73.33%) and good in 8 patient(26.66%). Discussion: High velocity tibial plateau fractures, when treated with internal xation and plating, carry a higher risk of associated complications ranging from deep infections to even compartment syndrome. The rate of re-operation following internal xation in such injuries has been high with most of the re-surgeries being required within one year of primary xation which adds to the morbidity of the patient. Ligamentotaxis with ilizarov ring xation as denitive treatment in such cases can be a fruitful operation with lesser complications and early return to previous level of activity.

All-Inside Anterior Cruciate Ligament Reconstruction With Augmentation Using the Native Anterior Cruciate Ligament Remnant by Suture Approximation

Anterior cruciate ligament (ACL) rupture remains a debilitating orthopaedic pathology with a substantial economic and psychological burden on patients, especially athletes. The purpose of ACL reconstruction is to attain maximum joint stability and functionality, allowing patients to resume their previous level of activity. Several graft options and techniques are available for ACL reconstruction. The all-inside remnant-preservation technique is a minimally invasive approach aiming for improved proprioception, better graft integration, and increased graft strength via ACL augmentation by suture approximation with an optimal anatomic reconstruction. ACL augmentation is associated with a decreased risk of rerupture. Moreover, enhancement of knee proprioception via the presented technique allows an early return to activity by patients because weight bearing (with a brace) can be initiated as early as day 1 postoperatively. Patients can resume running activities by 2 months postoperatively and return to pivot sports by 3 months postoperatively. Despite this surgical procedure being technically demanding, it is associated with improved clinical outcomes and functional capacities. Patients are also found to better tolerate the postoperative rehabilitation protocol.

Decreased motion with normal strength after Latarjet procedure has minimal impact on return to activity.

The Latarjet procedure can affect the range of motion (ROM) and strength of the shoulder, which determine the time to return to the preinjury level of activity. This study prospectively assessed whether the Latarjet procedure leads to a decrease in range of motion and muscle strength, affecting the time to return to the previous level of activity. Fifty-one consecutive patients who underwent the Latarjet procedure for recurrent dislocation of the shoulder were included prospectively. The ROM, strength, Walch-Duplay score, and Rowe score were measured every 3months for 1 year and then every 6months for 2 years. Radiological assessments were performed to confirm the graft location, union, and the humeral head position in abduction and external rotation (ER). Out of 51 patients, 49 completed all follow-ups. The median age was 27years (17-45years), and the dominant side was involved in 36 patients. The median number of dislocations was 11 (5-50). Twelve patients were sleep dislocators. There was a significant loss (p < 0.0001) of abduction, forward flexion (FF), ER, and internal rotation (IR) in the affected shoulder compared to the contralateral shoulder. Recovery plateaued at 12months. There was near complete recovery of muscle strength after the Latarjet procedure, and the difference between the affected and contralateral shoulders was not significant (n.s.). The modified Rowe score was excellent in 44 (90%) patients, and the Walch-Duplay score was excellent in 43 patients (88%) at 24months. Suboptimal results were associated with non-compliance with rehabilitation in two (4%) patients and neglected unreduced dislocation in one (2%) patient. The coracoid graft position was below the equator in 44 patients (90%). Forty-six patients (94%) could return to the previous level of activity. The Latarjet procedure results in a restricted ROM of the shoulder, but there is no loss of muscle strength. III.

Outcomes of one-stage reconstruction for chronic multiligament injuries of knee

PurposeThis article aims to evaluate patterns of chronic multiligament injuries and outcomes of treatment with single-stage reconstruction using autografts.MethodsAll patients with clinicoradiologically diagnosed multiligament knee injury (MKI) were included in this prospective observational study. As the time since injury was more than 6 weeks in all of the patients, they were categorized as having chronic MKI. Patients were assessed clinically for laxity, and the diagnosis was confirmed radiologically. Ipsilateral hamstring tendons were used for medial collateral ligament (MCL) or posterolateral corner reconstruction in a patient with Schenck knee dislocation (KD) type III. In these cases, the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) were reconstructed by using the peroneus longus and contralateral hamstring tendons respectively. Ipsilateral hamstring tendons were used for ACL reconstruction and an ipsilateral peroneus longus tendon graft was used for reconstruction of the PCL in a KD type II injury. In two cases of KD type IV injury, the lateral laxity was only grade II and was managed conservatively; the rest of the ligaments were addressed like a KD type III injury. Outcome evaluation was done using a visual analogue scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity level, preoperatively and postoperatively at 2 years’ follow-up.ResultsA total of 27 patients of mean age 33.48 ± 9.9 years with MKI were included in the study. The patients were classified as eight KD type II, 17 KD type III, and two KD type IV. The majority of the patients had associated meniscal (59.2%) or chondral (40.7%) injuries. At the 2 years’ follow-up visit, there were significant improvements in VAS score (p = 0.0001) IKDC score (p = 0.0001), Lysholm score (p = 0.0001), and range of motion (p = 0.001). None of the patients had residual laxity on clinical examination of the knee joint at the 2 years’ follow-up. All but two of the patients went back to their previous activity level. These two patients had progressive knee arthritis and needed knee arthroplasty.ConclusionSingle-stage surgical reconstruction for chronic MKI has favourable functional outcomes.Level of evidenceLevel IV, case series.

Patella Fracture Repair Using Multiple Fixation Modalities in a Dog

AbstractThe aim of this study was to describe the clinical use of a titanium locking plate and screws as an adjunct for the surgical treatment of an open, transverse, mid-body patellar fracture. A 2-year-old crossbreed dog was diagnosed with an open, transverse, mid-body patellar fracture. Initial fracture reduction and compression were achieved with two parallel Kirschner wires and a figure of eight tension band wire. This was followed by a titanium locking plate and screws placed on the cranial aspect of the patella. A transarticular circular external skeletal fixator was used as an additional augmentation for 5 weeks. Wire failure was noted in the transarticular circular external skeletal fixator at 10 days postoperation, necessitating wire replacement. Complete return to previous activity level and progressive radiographic osseous union were observed 8 weeks after surgery. Breakage of the Kirschner wires at the proximal pole of the patella was noted 3 years after surgery and explantation of all implants was performed. Recheck evaluation at 8 months after explantation confirmed full return to athletic function. This case report described the clinical use of a locking plate and screws as an adjunct for transverse patellar fracture repair and its long-term functional outcome.

Life in lockdown: a telephone survey to investigate the impact of COVID-19 lockdown measures on the lives of older people (≥75years).

Background: In response to the COVID-19 coronavirus pandemic, the UK government introduced social distancing measures and identified specific populations at high risk from the virus. People ≥70 were deemed “Clinically Vulnerable.” Distancing measures were introduced to reduce the risk of contracting COVID-19. However, these may have a negative impact on older people who are vulnerable to social isolation and may have challenges accessing services and provisions.Objectives: To investigate the impact of COVID-19 lockdown measures on the lives of older people.Study design and setting: Cross-sectional telephone survey.Participants: Community-dwelling older people, 76–97 years.Outcomes: Health anxiety; General health (RAND Short-form 36 Survey); Physical activity; Depression (PHQ-8); Anxiety (GAD-2); Loneliness; Access to services; Challenges, concerns and positive experiences.Data analysis: Counts (%), means (SDs). Thematic analysis was used to identify themes from open questions.Results: n = 142. 52% did not worry about their health; 76% rated their health as “good”, “very good” or “excellent”. < 10% met the criteria indicative of depression (PHQ-8), or anxiety (GAD-2). 42% were less active than before lockdown. 27% were lonely at least some of the time. Over half of participants identified positive aspects.Conclusions: Most participants reported good health with low levels of health anxiety, anxiety and depression. Many were able to identify positive aspects to lockdown and may be better equipped to deal with lockdown than anticipated. Strategies may be required to ameliorate the negative impact of loneliness for a minority of older people, and help some resume previous activity levels and pursuits.

ONCOLOGY REHABILITATION - AN ALTERNATIVE TO BREAST CANCER TREATMENT

Introduction: Worldwide breast cancer is the most common malignancy disease with a frequency of more than 6 million. The treatment consists of surgical intervention, chemotherapy, radiation, and often follow-up medical care in the long-term treatment is neglected. As a result of a partial or total mastectomy, one of the complications that patients develop is lymphedema, which may occur months or years after the surgery. This necessitates the search for systematic and effective approaches for these patients in order to improve physical and mental well-being, resocialization and return to previous levels of activity in daily life. Case report: In 2019 a 58-year-old female patient, visited Medical University of Varna and University center of East medicine with the following complaints: pain in the armpit area, lymphedema of a right upper limb, a sense of weight and motor deficiency in the hand. In 2017 she is diagnosed with breast cancer by conducting an operative intervention consisting of a partial mastectomy with removal of 12 lymph nodes, followed by chemotherapy, radiotherapy treatment and medication therapy. For 2 years, the patient seeks help from a variety of healthcare professionals whose methods lead to short and unsatisfactory results. Impaired quality of life in daily activities is the main reason the patient to refer to the specialists at the University center of East medicine, offering a different and complex approach aimed at the patient’s overall recovery. Conclusion: Early diagnosis and subsequent successful treatment approach are the path to holistic, systematic and effective treatment in cancer patients.

Good Subjective Outcomes, Stable Knee and High Return to Sport after Tibial Eminence Avulsion Fracture in Children.

Avulsion fracture of the tibial spine (TSA) is uncommon in children, although its incidence is increasing with the earlier practice of competitive sport activities. This study aims to report mid to long term outcomes in children who sustained a TSA, with a special focus on a return to sport activities. Skeletally immature patients with a TSA, treated in two orthopedic hospitals, were evaluated for range of motion and knee laxity using KT1000, KiRA and Rolimeter. The pediatric International Knee Documentation Committee score (Pedi-IKDC) and the Hospital for Special Surgery pediatric Functional Activity Brief Scale (Pedi-FABS) questionnaires were recorded during the latest visit. Forty-two children were included. Twenty-six were treated nonoperatively and 16 underwent surgery. At a mean follow-up of 6.9 ± 3.6 years, 36 patients completed the questionnaires and 23 patients were tested with arthrometers. Among them, 96% had normal knee laxity. The Pedi-IKDC score averaged 96.4 ± 5.7 points, while the mean Pedi-FABS was 22.2 ± 5.9 points, without statistically significant differences between groups. Twenty-eight patients (78%) returned to their previous level of sport activity (eight amateur, 13 competitive, seven elite athletes). Eight patients (22%) quit sport, mostly because of re-injury fear. If properly treated, pediatric TSAs achieve a high rate of successful healing, with complete restoration of knee stability and an early return to sport activities.