Knee Range Of Motion Research Articles

Poster 314: Early Full Knee Extension Predicts Successful Return to Sport Following Anterior Cruciate Ligament Reconstruction

Objectives: To identify predictive factors for successful return to sport (RTS) following anterior cruciate ligament reconstruction (ACL-R) with quadriceps tendon (QT) autograft. Methods: Data was retrospectively collected on consecutive patients who underwent ACL-R with QT autograft at a single institution between 2010-2020. Patient demographics, knee range of motion (ROM), injury characteristics, and intraoperative data were collected from the electronic medical record. Full RTS was defined as the patient returning to their prior level of sport and the presence of a clinical documentation of no further complications. Univariate and multivariate cox regression were utilized to conduct time-to-event analyses to identify predictors of early RTS clearance by surgeon. Additionally, both logistic regression analysis and generalized estimating equations were used to identify significant predictors of successful full RTS. STATA 16SE software was utilized for all analyses with statistical significance set to p < 0.05. Results: A total of 307 patients were included, consisting of 176 males (57.3%) and 131 females (42.7%), with an average of 20.7 ± 7.1 years of age and 14.5 ± 8.9 months follow-up. Ten patients (3.3%) were professional/semi-professional athletes, 38 (12.4%) were collegiate athletes, 144 (46.9%) were high school athletes (46.9%), and 115 (37.5%) were recreational athletes. Complete knee extension was achieved by 64.1% of patients at 6 weeks postoperatively, by 77.7% at 3 months, by 84.4% at 6 months, and by 84.7% at 1 year. Full knee extension at 3 (HR: 1.55, 95% CI: 1.13–2.12, p = 0.007) and 6 months (HR: 1.49, 95% CI: 1.05–2.12, p = 0.025) postoperatively were predictors of a higher rate of RTS clearance. Moreover, patients who achieved full knee extension at 3 months follow-up had a greater rate of RTS (1.02/person-years) compared to patients who did not achieve full knee extension at 3 months (0.83 per person-years). When considering RTS, only full knee extension at 4-6 weeks (OR:2.02, 95% CI:1.02–4.03, p = 0.045) and at 3 months (OR:2.36, 95% CI: 1.12–4.99, p = 0.024) postoperatively were predictive of successful RTS. No other significant predictors were identified. Conclusions: Restoration of full knee extension was strongly associated with higher rates of both surgeon clearance and successful RTS. The role of full knee extension in the ability to regain strength at 6 months, as measured by limb symmetry indices, after ACL-R has been previously described. While both ROM and strength play crucial roles in the rehabilitation process, achieving full ROM typically precedes restoration of full strength. Lack of full extension 3 months postoperatively may require further investigation and serves as a possible opportunity for a goal metric to maximize RTS rates and minimize complications after ACL-R.

Comparison of Patients Based on Their Self-Selected Discharge Pathway after Total Knee Arthroplasty at an Ambulatory Surgical Center.

Outpatient total knee arthroplasty (TKA) is being performed more frequently in ambulatory surgical centers (ASCs) to decrease the cost of care. Discharge pathways include 23-hour observation (OBSERVATION) or same-day discharge home (HOME), which differ in postoperative medical supervision. Few studies allow patients to self-select their discharge pathway. This study compared patient variables between self-selected OBSERVATION or HOME discharge after TKA at an ASC. We hypothesized that age, sex, and distance lived from the ASC would differ between discharge pathways. Clinical and patient-reported outcomes were explored.A chart review identified 130 patients with TKA at an ASC between November 2017 and December 2019. Patients self-selected OBSERVATION or HOME during a preoperative physician visit. Patient variables obtained from the electronic medical record were age, sex, race/ethnicity, marital status, body mass index, diabetic status, American Society of Anesthesiologists (ASA) class, distance lived from the ASC, anesthesia type, procedure time, and time in the postanesthesia recovery unit. Clinical outcomes (knee range of motion, infection rate, and reoperation rate) and patient-reported outcomes (Knee Injury and Osteoarthritis Outcome Score, Joint Replacement [KOOS, JR]; Oxford Knee Score [OKS]) were collected at either 6 or 12 weeks postsurgery. Variables were compared between groups.Pathway selection was n = 70 OBSERVATION and n = 60 HOME, and all patients completed their self-selected discharge pathway. Age and proportion of females were significantly higher in OBSERVATION than in HOME (61.3 ± 3.5 vs. 58.5 ± 5.4 years, 85.7 vs. 65.0%, respectively; p < 0.05). Distance lived from the ASC tended to be greater in OBSERVATION than HOME (22.1 ± 24.6 vs. 15.3 ± 10.1 miles, p = 0.056). Across groups, clinical outcomes were favorable (i.e., >88% met the 6-week knee flexion milestone, 1.9% infection rate, and 3.1% manipulation under anesthesia), and the preoperative to 12-week postoperative change in KOOS, JR and OKS scores met the minimal clinically important difference.Older age, female sex, and farther distance lived from the ASC may influence patients to select OBSERVATION over HOME discharge following TKA at an ASC. No robust differences were found in early outcomes.

Thompson Versus Judet Techniques for Quadricepsplasty: A Systematic Review and Meta-analysis of Outcomes and Complications.

Quadricepsplasty has been used for over half a century to improve range of motion (ROM) in knees with severe arthrofibrosis. Various surgical techniques for quadricepsplasty exist, including Judet and Thompson, as well as novel minimally invasive approaches. The goal of this review was to compare outcomes between quadricepsplasty techniques for knee contractures. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Available databases were queried for all articles on quadricepsplasty. Outcomes included postoperative ROM, outcome scores, and complication rates. Secondarily, we summarized rehabilitation protocols and descriptions of all modified and novel techniques. Thirty-three articles comprising 797 patients were included in final analysis. Thirty-five percent of patients underwent Thompson quadricepsplasty, 36% underwent Judet, and 29% underwent other techniques. After Judet and Thompson quadricepsplasty, patients achieved a mean postoperative active flexion of 92.7° and 106.4°, respectively (p < 0.01). Complication rates after Judet and Thompson were 17% and 24%, respectively. Wound infection was the most frequently recorded complication after Judet, whereas extension lag predominated for Thompson. Both the Thompson and Judet quadricepsplasty techniques offer successful treatment options to restore functional knee ROM. Although the Thompson technique resulted in greater postoperative knee flexion compared with the Judet, the difference may be attributable to differences in preoperative flexion and time from injury to quadricepsplasty. Overall, the difference in flexion gained between the 2 techniques is comparable and clinically negligible. Level IV. See Instructions for Authors for a complete description of levels of evidence.

Virtual reality training combined with physical therapy program for children with tibial eminence fracture: a randomized controlled trial

Background. Tibial eminence fracture is an injury referred to the interarticular portion of the neighbouring plateau of the tibia. Non-operative treatment is recommended for type I and II. The study aimed to investigate the effect of virtual reality (VR) training combined with a physical therapy program (PTP) in the management of children after tibial eminence fractures. Methods. Forty eight children suffering from tibial eminence fracture (type I and type II). Their age ranged from 7 to 14 years old. The control group (G1) received only a physiotherapy program (PTP) and the experimental group (G2) received the same PTP plus virtual reality (VR) in form of Wii Sport Training. Both groups received the treatment protocol for six successive months (3 sessions per week). Participants were assessed before and after the treatment for six successive months. The outcomes were range of motion (ROM) of knee joint using goniometry, knee pain using the visual analogue scale (VAS) and balance by Pediatric Balance Scale (PBS). Results. Post-treatment, there was a a statistically substantial difference in pain, PBS, knee flexion and extension ROM in both groups (P-value &lt; 0.05). Also, there was a statistically substantial difference in PBS and knee flexion ROM between the two groups (P-value &lt; 0.05), favouring the VR group. Conclusions. These findings from this study reveal the value of physical therapy combined with VR in the rehabilitation of children with tibial eminence fractures. Virtual reality used in conjunction with PTP enhances those children’s knee range of motion and body stability.

Virtual reality training combined with physical therapy program for children with tibial eminence fracture: a randomized controlled trial

Background. Tibial eminence fracture is an injury referred to the interarticular portion of the neighbouring plateau of the tibia. Non-operative treatment is recommended for type I and II. The study aimed to investigate the effect of virtual reality (VR) training combined with a physical therapy program (PTP) in the management of children after tibial eminence fractures. Methods. Forty eight children suffering from tibial eminence fracture (type I and type II). Their age ranged from 7 to 14 years old. The control group (G1) received only a physiotherapy program (PTP) and the experimental group (G2) received the same PTP plus virtual reality (VR) in form of Wii Sport Training. Both groups received the treatment protocol for six successive months (3 sessions per week). Participants were assessed before and after the treatment for six successive months. The outcomes were range of motion (ROM) of knee joint using goniometry, knee pain using the visual analogue scale (VAS) and balance by Pediatric Balance Scale (PBS). Results. Post-treatment, there was a a statistically substantial difference in pain, PBS, knee flexion and extension ROM in both groups (P-value &lt; 0.05). Also, there was a statistically substantial difference in PBS and knee flexion ROM between the two groups (P-value &lt; 0.05), favouring the VR group. Conclusions. These findings from this study reveal the value of physical therapy combined with VR in the rehabilitation of children with tibial eminence fractures. Virtual reality used in conjunction with PTP enhances those children’s knee range of motion and body stability.

Quadriceps muscle quality and quantity following tibial plateau fracture repair.

To investigate the qualitative and quantitative changes seen in quadriceps muscles [QM] following tibial plateau fracture and surgery. A consecutive series of patients with an isolated tibial plateau fracture presenting to a single academic center were enrolled and prospectively followed. Bilateral knee MRIs were performed preoperatively and 3 and 12 months postoperatively to assess quantity and quality of the quadriceps muscles. All patients underwent tibial plateau operative repair and were made non-weight-bearing for 10 weeks postoperatively then advanced to weight-bearing as tolerated. Functional status assessed via the short musculoskeletal functional assessment (SMFA); knee range of motion [ROM]; vastus medialis oblique [VMO] and vastus lateralis [VL] muscle quantity (axial width, cross sectional area [CSA] and volume) on injured and contralateral limb; VMO, sartorius, semi-membranous and biceps femoris [BF] muscle quality (fat and water content, and proton density fat fraction). All muscle quantitative and qualitative measurements were compared across all time points. Ten patients were included in the final analysis, 6 males and 4 females, with average age of 43.62 ± 16.3years. While the VMO and VL axial width and CSA were significantly decreased at 3months preoperatively, this was not statistically significant. There was no significant difference between any QM quantitative measurements at any time points. There was no difference in fat content, water content or PDFF at any time point for the VMO, sartorius, semi-membranous and BF muscles. Regression analysis also showed no association between 12-month SMFA scores and knee ROM with VMO/VL CSA at 1year. QM quantity and quality do not significantly change at 3months and 1year postoperatively following tibial plateau fracture surgery. Prognostic Level II.

THE IMPACT OF A SENSOR BASED PLATFORM ON THE OUTCOME OF MEDIAL OFF-LOADER BRACING IN INDIVIDUALS WITH KNEE OSTEOARTHRITIS: A PILOT RANDOMIZED CLINICAL TRIAL.

Determine the effectiveness of a medial off-loader brace with sensor monitoring capabilities and associated phone application in improving outcomes for individuals with knee osteoarthritis (OA). Randomized clinical trial of participants with knee OA, aged 40-75 with two groups: 1) brace-only 2) brace+sensor (sensor providing walking time, knee range of motion and 7-day activity streak). Both groups received a prefabricated custom-fitted medial off-loader brace and 12-week self-guided exercise therapy program. Baseline and post-intervention assessments included subjective and objective outcomes. 60 participants were recruited (n = 30/group). The brace+sensor group demonstrated higher study retention(88.89%) compared to the brace-only group(73.33%). Significant improvement in KOOS knee pain and other KOOS sub-scores compared to baseline was observed for both groups. However, only the brace+sensor group improved beyond the established minimal clinically important difference for KOOS pain(11.31+/-13.87). KOOS ADL was also significantly improved in the brace+sensor group compared to brace only group(p = 0.049). Both treatment groups had significant improvement in functional outcomes(10 m walk, 5x sit-to-stand, p < 0.05). Only the brace+sensor group had significant improvements in the 6-minute walk test(p = 0.02) and reduction in participant weight(p = 0.01) at 12 weeks. Incorporating wearable technology in standard bracing for individuals with knee OA has potential in improving clinical outcomes.

A novel approach for anterior cruciate ligament tibial avulsion fracture: arthroscopic modified suture bridge fixation technique.

Anterior cruciate ligament (ACL) tibial avulsion fracture is a rare injury, which usually happens in adults with traffic accidents or sports injuries. Surgery interventions are common treatment methods, they can restore knee function and help to return to normal life. In this study, we described an arthroscopic modified suture bridge fixation technique for ACL tibial avulsion fractures and explored the feasibility and therapeutic effects. This retrospective study reviewed data from January 2020 to May 2022. Data were collected on 18 patients (10 males and 8 females) with ACL tibial avulsion fractures and underwent arthroscopic modified suture bridge fixation technique. The study analyzed surgical data about intraoperative blood loss, operation time, hospital stay, fracture healing time, and visual analog scale (VAS). Functional evaluation of the knee joint was performed using the anterior drawer test, Lysholm knee scoring scale, International Knee Documentation Committee (IKDC), and knee range of motion (ROM). All 18 patients were followed up between 12 and 20 months, with an average of 15.22 ± 1.96 months. The intraoperative blood loss was approximately 15-40 mL, averaging 25.78 ± 6.19 mL. The operation time was 65-85min, with a mean of 74.89 ± 4.86min. The hospital stay of patients was 3-5 days, with a mean of 3.89 ± 0.76 days. The mean fracture healing time was 8-12 weeks after surgery, with a mean of 9.22 ± 1.7 weeks. All incisions healed grade I without infection. There were no internal fixation failures, neurovascular injuries, and lower extremity deep venous thrombosis. The anterior drawer test was negative in all patients. At the final follow-up, the mean VAS score was 0-3, averaging 1.56 ± 0.71. The Lysholm score of the injured knee was 89-96, with an average of 92.50 ± 2.50; the IKDC score was 88-93, with an average of 90.44 ± 1.89; the knee ROM was 110-126°, with an average of 120.67° ± 4.31°. Results demonstrated that the modified suture bridge fixation technique under arthroscope could provide reliable fixation and favorable clinical effects for ACL tibial avulsion fractures. This is a simple, minimally invasive, effective, and clinically applicable surgical method for ACL tibial avulsion fracture.

Prosthetic spacers in two-stage revision for knee periprosthetic joint infection achieve better function and similar infection control.

To explore the clinical efficacy of using two different types of articulating spacers in two-stage revision for chronic knee periprosthetic joint infection (kPJI). A retrospective cohort study of 50 chronic kPJI patients treated with two types of articulating spacers between January 2014 and March 2022 was conducted. The clinical outcomes and functional status of the different articulating spacers were compared. Overall, 17 patients were treated with prosthetic spacers (prosthetic group (PG)), and 33 patients were treated with cement spacers (cement group (CG)). The CG had a longer mean follow-up period (46.67 months (SD 26.61)) than the PG (24.82 months (SD 16.46); p = 0.001). Infection was eradicated in 45 patients overall (90%). The PG had a better knee range of motion (ROM) and Knee Society Score (KSS) after the first-stage revision (p = 0.004; p = 0.002), while both groups had similar ROMs and KSSs at the last follow-up (p = 0.136; p = 0.895). The KSS in the CG was significantly better at the last follow-up (p = 0.013), while a larger percentage (10 in 17, 58.82%) of patients in the PG chose to retain the spacer (p = 0.008). Prosthetic spacers and cement spacers are both effective at treating chronic kPJI because they encourage infection control, and the former improved knee function status between stages. For some patients, prosthetic spacers may not require reimplantation.

Comparing the Effectiveness of Instrument-Assisted Soft Tissue Mobilization and Foam Rolling on Knee Range of Motion: A Critically Appraised Topic

Comparing the Effectiveness of Instrument-Assisted Soft Tissue Mobilization and Foam Rolling on Knee Range of Motion: A Critically Appraised Topic

Serial Assessment of Factors Associated With Patient-Reported Outcomes up to 2 Years After ACL Reconstruction Using Autologous Hamstring Tendon: Results From the TMDU MAKS Study.

Understanding the factors related to patient-reported outcomes (PROs) after anterior cruciate ligament reconstruction (ACLR) can lead to more effective interventions. The purpose of this study was to identify factors associated with PRO scores after ACLR. It was hypothesized that concomitant meniscal treatment and postoperative range of motion (ROM) would be associated with early postoperative PRO scores and that postoperative physical findings would be associated with 2-year postoperative PRO scores. Cohort study; Level of evidence, 2. We examined the data from the Tokyo Medical and Dental University Multicenter Arthroscopic Knee Surgery (TMDU MAKS) Study for patients who underwent primary ACLR with autologous hamstring tendon grafts; 1252 patients in the TMDU MAKS Study were eligible for inclusion. The International Knee Documentation Committee (IKDC) subjective score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score of the patients at 3 months (n = 675), 1 year (n = 660), and 2 years (n = 375) postoperatively were assessed using multiple regression to evaluate the strength of the relationship between PRO scores and the following predictor variables: patient-specific factors, treatment-specific factors, and physical findings. Improvement in all PROs significantly exceeded the minimal important change at 1 and 2 years postoperatively. Older age and female sex were predictive of lower PRO scores up to 2 years postoperatively. Concurrent meniscal treatment and limited range of knee motion were predictive of lower PRO scores at 3 months and 1 year postoperatively. A tighter knee (ie, less anterior translation) on the injured side compared with the contralateral knee was predictive of lower KOOS-Quality of Life and IKDC scores at 2 years postoperatively. At all 3 postoperative time points, greater side-to-side difference in knee ROM was predictive of lower PRO scores. Inferior PRO scores were associated with concomitant meniscal treatment and limited postoperative ROM until 1 year postoperatively and with older age and female sex up to 2 years postoperatively. PRO scores were associated with knee stability at all assessed time points.

Clinical Outcomes of Arthroscopic Adhesiolysis: A Case Series of 40 Patients With Postoperative Knee Stiffness.

Introduction Restricted range of motion over the knee joint is a known complication following the surgical procedure. Aggressive rehabilitation protocols can initially manage knee stiffness due to arthrofibrosis. If conservative management fails, surgical (open or arthroscopic) release is the preferred modality of management. We present a series of 40 patients with postoperativeknee stiffness who were treated with arthroscopic adhesiolysis. Material and methods This is a retrospective study conducted at Phoenix Orthopedic Superspeciality Hospital, Nagpur, India, from 2017 to 2021. Our study included 40 patients with postoperative knee joint stiffness, of whom 27 were males and 13 were females. The study considered the duration of stiffness, which ranged from six months to five years. All patients underwent arthroscopic knee release. A rigorously supervised physical therapy program followed this procedure. Patients were examined at three months, six months, and one year to assess improvement in knee range of movement. Results Out of 40 patients, six were classified as Shelbourne type 4, and the remaining were Shelbourne type 3. Twenty-three of 40 patients developed arthrofibrosis following intra-articular or peri-articular fracture fixation surgery; 11 patients were operated on arthroscopically for anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) reconstruction. Three patients developed stiffness following total knee replacement, one following patellectomy, and three following infection after fracture fixation. The mean pre-op knee range of motion (ROM) was 48.875 degrees. Following arthroscopic release, the mean improvement in ROM was 60 degrees intra-operatively. The average postoperative range was 108.25 degrees. Conclusion Arthroscopic adhesiolysis and quadriceps release are reliable methods for dealing with postoperative knee stiffness. It prevents wound complications and increases the chances of surgical site infection due to smaller incisions. Postoperatively, we achieved an average increase of 60 degrees in ROM over the knee joint.

Normative Values for Daily Functional Recovery Patterns Following Total Knee Arthroplasty

BackgroundWearable devices provide the ability for clinical teams to continuously monitor patients’ rehabilitation progress with objective data. Understanding expected recovery patterns following total knee arthroplasty (TKA) enables prompt identification of patients failing to meet these milestones. The aim of this study was to establish normative values for daily functional recovery in the first 6 weeks after TKA using a wearable device. MethodsThis prospective study included patients who underwent TKA between 2020 and 2023, treated by 11 surgeons from 8 institutions. Eligible participants were aged 18 or older, had a primary unilateral TKA, and owned a smartphone. Knee range of motion, total daily steps, cadence, and device usage were measured continuously over 6 weeks. Statistical analysis included analysis of variance using post hoc Tukey honest significant difference tests. ResultsThe cohort of 566 participants had a mean age of 65 and 69 for men and women, respectively (range, 50 to 80). Women comprised 61% (n = 345) of study participants. There were 82% of women and 90% of men who had a body mass index > 30. The average daily wear time of the device was 12 hours (±4) for a total of 45 days (±27). Recovery was nonlinear, with the greatest gains in the first 3 weeks postsurgery for all metrics. Men demonstrated greater total daily step counts and cadence when compared to women. Obese patients demonstrated poorer performance when compared to lower body mass index patients. ConclusionsTo our knowledge, this study presents the first normative data for tracking daily functional recovery in TKA patients using wearable sensors. Standardizing the TKA recovery timeline allows surgeons to isolate factors affecting patients’ healing processes, accurately counsel them preoperatively, and intervene more promptly postoperatively when rehabilitation is not within standard recovery parameters.

Combining mobile health, action and coping plans to improve exercise adherence and functionality among elderly with knee pain in Bangkok

Purpose The known advantage of exercise for older adults who had knee pain is limited by low adherence to an exercise program. This study aims to determine the effect of the LINE application on action and coping plans on exercise adherence, self-efficacy for exercise, specific self-efficacy (task, maintenance and recovery), functional performance (knee range of motion, time up and go, 30-s chair stand and knee outcome for activities of daily living) and knee pain scale among older adults with knee pain in suburban Bangkok, Thailand. Design/methodology/approach A total of 86 participants aged between 50 and 65 years old were divided into two groups for a period of 14 weeks: intervention (received action and coping plans via the LINE application) and control group (received usual care). All outcomes were measured at baseline and posttest except exercise adherence, which was collected postintervention. Findings A significant difference between intervention and control groups across all outcomes. Within group comparisons before and after, the intervention indicates that participants of the intervention group significantly improved posttest. In conclusion, using mobile health technology in combination with action and coping plans was found to enhance older adults’ exercise adherence and motivation, thus, decreasing knee pain while increasing functionality. Originality/value This study provides new insight into the combination of action and coping plans implementing with instant messaging through the LINE application which had a positive impact on enhance exercise adherence and knee functional performance of Thai elderly with knee pain.

Short-Term Outcomes of Total Knee Arthroplasty Using a Conventional, Computer-Assisted, and Robotic Technique: A Pilot Clinical Trial.

Background: Total Knee Arthroplasty (TKA) is a prevalent surgical procedure for treating severe knee arthritis, aiming to alleviate pain and restore function. Recent advancements have introduced computer-assisted (CAS) and robot-assisted (RA-TKA) surgical techniques as alternatives to conventional methods, promising improved accuracy and patient outcomes. However, comprehensive comparative studies evaluating the short-term outcomes and prostheses survivorship among these techniques are limited. We hypothesized that the outcome of RA-TKA and/or CAS- TKA is advantageous in function and prosthesis survivorship compared to manually implanted prostheses. Methods: This prospective controlled study compared the short-term outcomes and prostheses survivorship following TKA using conventional, CAS, and RA-TKA techniques. One hundred seventy-eight patients requiring TKA were randomly assigned to one of the three surgical groups. The primary outcomes were knee function (KSS knee score) and functional recovery (KSS function score), which were assessed before surgery three years postoperatively. Secondary outcomes included prosthesis alignment, knee range of movements, and complication rates. Survivorship analysis was conducted using Kaplan-Meier curves, with revision surgery as the endpoint. Results: While all three groups showed significant improvements in knee function postoperatively (p < 0.001), the CAS and RA-TKA groups demonstrated superior prosthetic alignment and higher survivorship rates than the conventional group (100%, 97%, and 96%, respectively). However, although the RA-TKA group had a maximal 100% survivorship rate, its knee score was significantly lower than following CAS and conventional techniques (mean 91 ± 3SD vs. mean 93 ± 3SD, p = 0.011). Conclusion: The RA-TKA technique offers advantages over conventional and CAS methods regarding alignment accuracy and short-term survivorship of TKA prostheses. Since short-term prosthesis survivorship indicates the foreseen rates of mid- and long-term survivorship, the current data have a promising indication of the improved TKA prosthesis's long-term survivorship by implementing RA-TKA. According to the presented data, although the survival rates were 100%, 97%, and 96% in the three study groups, no clinical difference in the functional outcome was found despite the better mechanical alignment and higher survivorship in the group of patients treated by the RA-TKA.

Effect of Spinal and Lower limb Re-alignment Protocol on Bilateral Medial Compartment Osteoarthritis of Knee in Postmenopausal Women

The alignment of spine-pelvis-lower extremity axis is significantly influenced by knee osteoarthritis. Joint alignment is the main bio-mechanical risk factor for progression of knee osteoarthritis. The purpose of this study was to find out the effect of spinal and lower limb realignment protocol on bilateral medial compartment knee osteoarthritis in postmenopausal women and to compare it with the conventional method of treatment for osteoarthritis of knee. A study sample of 128 post-menopausal subjects within age group 50-70 and BMI between 25-35 kg/m2 having bilateral knee osteoarthritis with medial compartment involvement were selected and equally divided into two groups as the control group and the experimental group. Assessment of pain, knee range of motion, quadriceps and hip abductor strength, and posture for spinal and lower limb malalignment was taken before and after giving the treatment regime to both the groups. Comparison was carried out between the results of the two groups.The results showed how significantly the mal-aligned structures were re-aligned after giving 8 weeks of realignment protocol and how significantly this resulted in better reduction of pain intensity and improvement in knee range of motion and strength of quadriceps and hip abductor muscles in experimental group as compared to the control group. Re-aligning the spinal and lower limb malalignment present in postmenopausal women with bilateral medial compartment knee osteoarthritis results in pain reduction associated with knee joint and improved knee range of motion and strength of quadriceps and hip abductor muscles in these individuals as compared to the ones receiving conventional physiotherapy.

A New Approach to Postoperative Rehabilitation following Mosaicplasty and Bone Marrow Aspiration Concentrate (BMAC) Augmentation.

Chondral defects in the knee present a significant challenge due to their limited self-healing capacity, often leading to joint degeneration and functional disability. Current treatments, including surgical approaches like mosaicplasty and regenerative therapies such as bone marrow aspirate concentrate (BMAC) augmentation, aim to address these defects and improve patient outcomes. This study conducted a single-center, randomized controlled trial to evaluate the efficacy of different treatment approaches and rehabilitation protocols for chondral defects. Thirty-seven subjects presenting with symptomatic chondral or osteochondral defects (>3 cm2) in the weight-bearing region of the femoral condyle were partitioned into three groups, and underwent mosaicplasty with or without BMAC augmentation, followed by either a 6-week or 12-week rehabilitation program. Group 1 (n = 10) received mosaicplasty combined with BMAC augmentation and engaged in a twelve-week two-phase rehabilitation protocol. Group 2 (n = 15) underwent mosaicplasty alone and participated in the same twelve-week two-phase rehabilitation regimen. Meanwhile, Group 3 (n = 12) underwent mosaicplasty and underwent a shorter six-week one-phase rehabilitation program. Clinical assessments were performed using the visual analog scale (VAS) for pain, goniometry for the knee's range of motion (ROM), manual muscle testing (MMT) for quadricep strength, and the Western Ontario and McMaster University Arthritis Index (WOMAC) for functional evaluation in three test phases. Significant differences in WOMAC scale scores were observed between the three groups at the intermediate (F(2, 34) = 5.24, p < 0.010) and final (F(2, 34) = 111, p < 0.000) stages, with post hoc Tukey tests revealing variations shared among all three groups. The between-group analysis of the VAS scale demonstrated no statistically significant difference initially (F(2, 34) = 0.18, p < 0.982), but significant differences emerged following the intermediate (F(2, 34) = 11.40, p < 0.000) and final assessments (F(2, 34) = 59.87, p < 0.000), with post hoc Tukey tests revealing specific group variations, notably between Group 1 and both Group 2 and Group 3, and also between Group 3 and Group 2. The between-group analysis of quadricep muscle strength using MMT scores revealed no statistically significant differences initially (F(2, 34) = 0.376, p < 0.689) or following the intermediate assessment (F(2, 34) = 2.090, p < 0.139). The one-way ANOVA analysis showed no significant difference in the knee ROM initially (F(2, 34) = 1.037, p < 0.366), but significant differences emerged following intermediate (F(2, 34) = 9.38, p < 0.001) and final assessments (F(2, 34) = 11.60, p < 0.000). Post hoc Tukey tests revealed significant differences between Groups 1 and 2, Groups 1 and 3, and Groups 2 and 3 at intermediate and final assessments. The patients who received BMAC augmentation and completed a 12-week rehabilitation protocol had significantly better outcomes in pain relief, knee function, and ROM when compared to those who did not receive BMAC augmentation or those who completed a shorter rehabilitation period. Our findings suggest that combining mosaicplasty with BMAC augmentation and a comprehensive rehabilitation program can lead to superior clinical outcomes for patients with chondral defects in the knee.

Lower-extremity inter-joint coordination variability in active individuals with transtibial amputation and healthy males during gait.

This study was aimed to compare the variability of inter-joint coordination in the lower-extremities during gait between active individuals with transtibial amputation (TTAs) and healthy individuals (HIs). Fifteen active male TTAs (age: 40.6±16.24years, height: 1.74±0.09m, and mass: 71.2 ± 8.87kg) and HIs (age: 37.25±13.11years, height: 1.75±0.06m, and mass: 74 ± 8.75kg) without gait disabilities voluntarily participated in the study. Participants walked along a level walkway covered with Vicon motion capture system, and their lower-extremity kinematics data were recorded during gait. The spatiotemporal gait parameters, lower-extremity joint range of motion (ROM), and their coordination and variability were calculated and averaged to report a single value for each parameter based on biomechanical symmetry assumption in the lower limbs of HIs. Additionally, these parameters were separately calculated and reported for the intact limb (IL) and the prosthesis limb (PL) in TTAs individuals. Finally, a comparison was made between the averaged values in HIs and those in the IL and PL of TTAs subjects. The results showed that the IL had a significantly lower stride length than that of the PL and averaged value in HIs, and the IL had a significantly lower knee ROM and greater stance-phase duration than that of HIs. Moreover, TTAs showed different coordination patterns in pelvis-to-hip, hip-to-knee, and hip-to-ankle couplings in some parts of the gait cycle. It concludes that the active TTAs with PLs walked with more flexion of the knee and hip, which may indicate a progressive walking strategy and the differences in coordination patterns suggest active TTA individuals used different neuromuscular control strategies to adapt to their amputation. Researchers can extend this work by investigating variations in these parameters across diverse patient populations, including different amputation etiologies and prosthetic designs. Moreover, Clinicians can use the findings to tailor rehabilitation programs for TTAs, emphasizing joint flexibility and coordination.

Early outcomes of the Oxford unicompartmental knee arthroplasty: 140 cases from a single institute in Taiwan.

The clinical and radiologic outcomes of the Oxford unicompartmental knee arthroplasty utilizing Microplasty® instrumentation have not been extensively investigated in Taiwanese patients. Despite the efficacy of this treatment for unicompartmental knee diseases, its specific impact on this population remains unknown. We retrospectively analyzed prospectively collected data of patients who underwent OUKA with MP between 2018 and 2021, including demographic information, component position, preoperative and postoperative knee range of motion (ROM), numeric rating scale (NRS), and 2011 Knee Society Score-functional activity score (2011 KSS-FAS). We compared preoperative and postoperative data and analyzed the correlation between clinical and radiographic outcomes. Among 140 patients with an average age of 66.8 years, predominantly female, the majority exhibited components that fell within the radiographically acceptable tolerance ranges. The mean 2.5-year follow-up revealed significant improvements in knee ROM from 102.6° ± 12.9° to 127.3° ± 9.8° ( p < 0.05), pain reduction from 7.7 ± 0.8 to 0.4 ± 0.7 ( p < 0.001), and KSS-FAS from 30.7 ± 10.5 to 94.3 ± 5.2 ( p < 0.001). Notably, a tibial component medial overhang within tolerance predicted shorter hospital stays, and a higher preoperative KSS correlated with lower postoperative NRS. No independent variables were identified as predictors of a higher postoperative KSS. Our study on OUKA with MP in Taiwanese patients reveals promising early clinical and radiographic outcomes. Tibial component medial overhang <3 mm is associated with shorter hospital stays, and a higher preoperative KSS predicts lower NRS at 1 year postoperatively.

Intraoperative intravenous versus periarticular injection of glucocorticoids in improving clinical outcomes after total knee arthroplasty: A prospective, randomized and controlled study.

Glucocorticoids have been widely used in perioperative period for postoperative pain relief after total knee arthroplasty (TKA). However, the optimal administration protocols of glucocorticoids remain controversial. This study aims to compare the efficacy of glucocorticoids between intravenous and periarticular injection on clinical outcomes. A total of 114 patients were randomly assigned to intravenous (IV) group (n = 57) and periarticular injection (PI) group (n = 57). The IV group received 10mg dexamethasone intravenously and the PI group received periarticular injection of 10mg dexamethasone during the procedure. The clinical outcomes were assessed using visual analogue scale (VAS), knee society score (KSS), range of motion (ROM), knee swelling, inflammation markers and complications after TKA. The VAS score during walking at 2nd day postoperatively was lower in the PI group compared with the IV group (2.08 ± 1.45 vs 2.73 ± 1.69, p = .039), and there was no significant difference at the other time points of VAS score in two groups. The inflammation markers, knee swelling, knee ROM and KSS score were not statistically different. Vomiting and other complications occurrence were not significantly different between the two groups. Intraoperative periarticular injection of glucocorticoids has similar analgesic effect compared to intravenous in the postoperative period following TKA and may be even more effective on the second postoperative day. In addition, periarticular injection of glucocorticoids does not impose an excess risk or complication on patients.