Range Of Motion Deficits Research Articles

Increasing Hamstring Range of Motion via Plantar Myofascial Release: A Critically Appraised Topic

Context: The concept of anatomical fascial trains and myofascial release are heavily researched topics independently. However, few studies have determined if myofascial release of remote areas can cause lengthening throughout more distal aspects of these fascial trains. Clinical Question: In healthy individuals, what is the effect of myofascial release on the plantar aspect of the foot in improving flexibility and hamstring length as determined by a sit-and-reach test? Clinical Bottom Line: The usage of myofascial release on the plantar aspect of the foot via a firm object has been shown to improve sit-and-reach distance. Each article included for analysis utilized similar methods of instructing self-myofascial release with regard to time as well as type of object used for the intervention. Though this was consistent between studies, the authors should have implemented secondary outcome measures. Despite the limitations to each of the studies analyzed, there is a Strength of Recommendation Taxonomy (SORT) Level B evidence to support the implementation self-myofascial release to the plantar fascia. This intervention should be considered a concurrent option for individuals with range of motion deficits or fascial restrictions in the upper thigh.

Assessment of Hip and Lumbar Spine Range of Motion After Total Hip Arthroplasty Using a Single Camera Markerless System.

Total hip arthroplasty (THA) is one of the most cost-effective and successful procedures in orthopedics. However, assessing the post-operative range of motion (ROM) remains a challenge due to the limitations of traditional measurement methods. This study aimed to evaluate hip and spine ROMpost-operativelyand single-leg balance, using a single-camera markerless motion capture system, and compare outcomes with pre-operative ROM and with an age-matched healthy control group. An interventional study was conducted from January 2018 to December 2021. Twenty patients with hip osteoarthritisunderwent THA and were assessed using a single-camera markerless system (Kinetisense software). Measurements were taken one month pre-operatively and one year post-operatively. Significant improvements were observed in hip and lumbar spine ROM variables after THA. The most notable enhancements were in hip and spinal flexion. Compared to the control group, the THA group showed minor deficits in hip ROM, particularly in external rotation. Single-leg balance demonstrated improved stability post-operatively. The single-camera markerless motion capture system offers a promising alternative for assessing hip and lumbar spine ROM, presenting potential advantages over manual goniometry and traditional 3D motion capture systems. Using this system for the evaluation of patients after THA, it seems that THA significantly enhances hip and lumbar spine ROM. Future research should focus on validating the accuracy of markerless systems.

Retracted Article: Validity and Reliability of Sensor-based Measures of Lower Limb Range of Motion in Soccer Players: a Cross-sectional Study.

A deficit in range of motion (ROM) is considered a risk factor for lower extremity injuries in soccer. Analog goniometers are used to measure the ROM of a joint. Sensor-based methods are increasingly being developed, but their quality of testing has not been sufficiently investigated. The purpose of this study was to determine the agreement and the intra- and inter-tester reliability of sensor-based lower extremity ROM measures in soccer players. 36 symptom-free male amateur soccer players (age: 26.3±4.7 years) were included in the study. Three out of five physiotherapists were randomly selected to perform the measurements. Two testers performed the measurements (1. ROM knee from sitting; 2. extension deficit knee from sitting; 3. ROM knee from standing; 4. ROM ankle dorsiflexion [DF] during lunge; 5. ROM ankle plantar flexion [PF] while sitting on a chair) with the digital sensor (index test). The third examiner performed the measurements with the analog goniometer using the neutral-zero method with the subjects in the supine position (reference standard). Pearson's correlation coefficient r, Bland-Altman analysis (BAA), and intraclass correlation coefficient (ICC) were used for statistical analysis (p≤0.05). Only measurements 4 and 5 showed acceptable mean differences of 8.4° (DF) and -10.2° (PF) in the BAA. Measurement 1 showed a moderate correlation (r=0.582). The sensor-based measurements of knee and ankle ROM revealed excellent intra- and inter-tester reliability (ICC =0.949-0.986; ICC =0.895-0.968). However, they showed limited agreement with the established reference standard used here, which can be explained by the different starting positions between the index test and the reference standard.

Limited total arc range of motion increases sheer stress in the shoulder while pitching in collegiate baseball pitchers.

Upper extremity injuries in baseball pitchers cause significant time-loss from competing and decreased quality of life. Although shoulder range of motion (ROM) is reported as a key factor to prevent potential injury, it remains unclear how limited glenohumeral ROM affects pitching biomechanics which may contribute to upper extremity injuries. To investigate how pitchers with decreased total arc glenohumeral ROM of the throwing arm differed in upper extremity pitching kinematics and kinetics as well as ball velocity compared to pitchers with greater levels of glenohumeral ROM. Cross-sectional Study. Laboratory. Fifty-seven baseball pitchers (ages 18-24) were divided into either control (≧160° total arc) or lower ROM (<160° total arc) groups. The mean glenohumeral ROM deficits, pitching kinematic and kinetic outcomes, and ball velocity were compared between groups. The control group demonstrated significantly less deficit in total arc ROM between arms than the lower ROM (Control: -1.5±10.0°, Lower ROM: -12.4±13.9°, p<.001). While, the lower ROM group displayed less maximal shoulder external rotation (ER) while pitching, the control group had significantly less difference in ROM between maximal shoulder ER while pitching and clinically-measured ER (Lower ROM: 64.4±12.1°, Control: 55.8±16.6°, p=.025). The control group had significantly faster ball velocity compared to the lower ROM group (Control: 85.0 ± 4.3mph, Lower ROM: 82.4 ± 4.8mph, p=.024). Pitchers with decreased total arc glenohumeral ROM (<160° total arc) may undergo over-stretching toward ER in the shoulder during the late cocking phase. Pitchers with higher total arc ROM can pitch the same or faster ball without increasing loading in the upper extremity. Total arc glenohumeral ROM measurement can be a clinical screening tool to monitor shoulder condition over the time, and pitchers with limited total arc ROM might be at higher risk of shoulder injury.

Concurrent Force Feedback on Load Symmetry in Total Knee Arthroplasty Patients.

Load asymmetry can be present before and after total knee arthroplasty (TKA), which may affect progress during knee rehabilitation in an outpatient sports medicine setting. Current rehabilitation primarily focuses on strength, pain, and range of motion deficits; however, recent evidence suggests the use of movement retraining strategies such as load feedback to address load asymmetry. Therefore, the purpose of this study was to examine how a single session of concurrent force feedback influences load symmetry during the leg-press and body-weight squat exercises in individuals following TKA. Additionally, a secondary purpose was to examine the retention of any changes over the course of a week. Case-series study. This observational, repeated-measures study design examined the effect of concurrent force feedback training on the mean and standard deviation of load symmetry index during the leg press and squat exercises in 26 patients with TKA in an outpatient sports medicine clinic.The load asymmetry was measured with loadpad sensors placed underneath the each extremity during leg press and squat (baseline), after one training session consisting of concurrent force feedback during these exercises within a single physical therapy session (post feedback), and after seven to ten days of a washout period (post retention). Separate 2 x 3 repeated measures analysis of variance was used to compare the mean and standard deviation of load symmetry across exercise (leg press and squat) and across time (baseline, post feedback and post retention). There was a time effect for the mean load symmetry index (p=0.027) but not for the standard deviation (p=0.441) during these exercises. The leg press showed a greater mean symmetry index compared to the squat regardless of time (p=0.001). A reduction in the mean load symmetry index following concurrent feedback training suggests improved use of the surgical limb during both leg press and squat exercises during the same therapy session but the more symmetric loading pattern was not retained one week later. Overall, the leg press showed greater mean asymmetry than the squat. Standard deviation in the load symmetry index did not change across time or by exercise. 3©The Author(s).

Poster 349: Outcomes Following ACL Reconstruction with Concomitant Meniscus Allograft Transplantation Versus Isolated ACL Reconstruction

Objectives: Meniscus allograft transplantation (MAT) is used in the setting of ACL reconstruction to restore proper arthrokinematics and load distribution for the meniscus deficient knee. Objective outcomes following ACL reconstruction with concomitant MAT in athletic populations are scarcely reported and highly variable. Thus, the purpose of this study was to compare patient outcomes using an objective functional performance battery, self-reported outcomes, and return to activity rates between individuals undergoing an ACL reconstruction with concomitant MAT and the outcomes of patients undergoing isolated ACL reconstruction. We hypothesized that patients in the ACL reconstruction with MAT group would exhibit lower performance on objective functional tests, delayed time to release to activity, and lower return to activity rates when compared to those undergoing isolated ACL reconstruction. Methods: A single surgeon ACL database (n = 1,431) was utilized to identify patients undergoing ACL reconstruction with concomitant MAT from 2014-2019. A comparison group undergoing an isolated ACL reconstruction were identified to serve as a known control. Baseline patient and surgical demographics data were collected. Patients completed an objective functional performance battery at the time of return to activity which included range of motion (ROM), single leg squat performance, single leg hop test performance, subjective function (International Knee Documentation Committee score (IKDC)), and psychological readiness (ACL Return to Sports After Injury scale (ACL-RSI). Between limb comparisons were assessed using limb symmetry indices (LSI). Injury surveillance was conducted for two-years and included the Single Assessment Numeric Evaluation (SANE), re-injury rates, complications, and current level of sports participation. Between group comparisons at time of return to activity and two years were analyzed using generalized linear models utilizing an a-priori alpha level of .05. Results: Forty-four patients were included in the ACL reconstruction with concomitant MAT group along with 45 in the isolated ACL reconstruction group (Figure 1). Baseline demographic differences existed between groups with the MAT group being significantly older ( P=.001), having a higher BMI ( P=.001), and a lower MARX score (p=.001) (Table 1). The MAT group had a significantly delayed release to activity timeline (10.8 ±3.2mo vs 7.8 ±1.8mo, P = .001) and reported significantly lower IKDC scores (82.4 ±13.8 vs 93.7 ±10.1, P = .001) and ACL-RSI scores (62.8 ±21.3 vs 80.3 ±9.7, P = .001) at time of release to activity (Table 2). Likewise, the MAT group had significantly greater flexion ROM deficits (6.4 ±5.6 deg. vs 3.0 ±2.6 deg., P = .011) and lower single-leg hop symmetry (90.2 ±12.3% vs 97.1 ±5.3%, P = .001). At two- year follow-up the MAT group also demonstrated a significantly lower return to activity rate (69.7% vs 95%, P=.001), lower rate of participation in Level 1 sports (9.1% vs 63.3%, P=.001), and lower SANE scores (80.9 ±16.1 vs 92.5 ±8.3, P = .001) (Table 3). No significant differences existed between groups for ACL graft re-injury rates. Conclusions: The majority of patients undergoing ACL reconstruction with concomitant MAT are able to return to at least level 3 sports at two years post-surgery with low risk of graft re-injury. Patients receiving a concomitant MAT exhibit lower return to sport rates, delayed time to release to activity, and lower subjective function compared to those undergoing an isolated ACL reconstruction. Clinicians should consider patient expectations, surgical demographics, functional outcomes, extended rehabilitation timelines, and lower return to activity rates when counseling patients return to activity following ACL reconstruction with MAT. [Table: see text][Table: see text][Table: see text]

Early Complication Analysis of Dynamic Intraligamentary Stabilization versus Anterior Cruciate Ligament Reconstruction.

Both dynamic intraligamentary stabilization (DIS) and reconstruction (RECO) are common treatment methods for anterior cruciate ligament (ACL) rupture. We report short term outcomes after DIS (Ligamys, Mathys, Bettlach, Switzerland) and RECO using semitendinosus tendon. We compared postoperative complications, deficits of range-of-motion (ROM), and revision rates between the two treatment options. A total of 690 patients (437 male, 253 female), after either DIS or RECO, were included. Of these, 147 patients (21%) received DIS and 543 (79%) underwent RECO. Follow-up examination focused on clinical examination, complications and revision rates. Anteroposterior instability and ROM deficits were analyzed in order to evaluate our policy of early intervention for all cases of ROM restrictions. Relevant ROM restrictions occurred at a significantly higher rate after DIS than after RECO (4.8% vs. 1.3%; p = 0.008). Flexion was more restricted after DIS than RECO (110° vs. 124°, p < 0.001). Extension deficits also occurred more frequently after DIS compared to RECO (49.7% vs. 24.5%; p < 0.001). Total revision surgery rate was 9.1%, with patients after DIS being significantly more frequently affected (20.4% vs. 6.1%; p < 0.001). Our findings indicate a significantly higher risk for ROM restriction after DIS compared to RECO, resulting in a significantly higher revision rate.

Latarjet procedure without capsular repair produces favorable clinical results and avoids limitation in external rotation.

This study aimed at analyzing the range of motion (ROM) and other clinical outcomes in patients with > 20% glenoid bone loss who underwent the Latarjet procedure with or without anterior capsule repair. This retrospective study included 47 patients with > 20% glenoid bone loss who underwent the classic Latarjet procedure from 2016 to 2021. Of these, 25 did not undergo capsular repair (no-capsular-repair group; group I) whereas 22 patients did (capsular-repair group; group II). The Rowe score, American Shoulder and Elbow Surgeons score, Visual Analogue Scale, ROM, recurrence, and complications were evaluated before and 3, 6, and 12months after the surgery. A goniometer was used to measure the forward flexion and external rotation (arm adducted, 90° abducted) of both shoulders. The ROM deficit was measured as the difference from the contralateral healthy shoulder. The external rotation in arm adduction at 3 and 6months after surgery showedsignificantly better results in group I than group II(p = 0.002 at 3months; p = 0.005 at 6months). The deficit in external rotation with arm adduction was also significantly lower in group I at 3months (p = 0.001) and 6months (p = 0.001) after surgery. However, external rotation with arm adduction at 12months after surgery did not significantly differ between the groups. Moreover, the ROM in external rotation with 90° arm abduction was significantly better in group I than that in group II at 3, 6, and 12months postoperatively (p = 0.002, p = 0.001, and p = 0.005, respectively). The deficit in external rotation with 90° arm abduction gradually decreased with time after surgery and differed significantly between the groups. However, the difference in deficit between the two groups at 12months after surgery did not exceed the measurement error. All clinical scores significantly improved after surgery compared to before surgery; however, the improvement did not significantly differ between the two groups. The Latarjet procedure without capsular repair showed good laxity restoration and clinical results with less early postoperative external rotation limitation than that achieved by the same procedure with capsular repair. However, external rotation deficit at 1year after surgery did not show a clinically relevant difference difference between the two groups. Level III.

Shoulder Rotational Strength and Range of Motion in Unilateral and Bilateral Overhead Elite Athletes.

Overhead athletes place tremendous demands on the shoulder complex, which result in adaptive kinematics but potential susceptibility to injury. This study aimed to compare shoulder glenohumeral range of motion (ROM) and rotator muscles strength in bilateral and unilateral overhead sports. Cross-sectional study; secondary care. Forty-two elite athletes (17.7 [4.5]y; 42.9% female), including 18 swimmers and 24 badminton players, were included. Preseason glenohumeral rotation ROM and isokinetic shoulder internal and external rotator muscles strength was tested (60°·s-1). Bilateral (nondominant:dominant) and agonist:antagonist (external rotator:internal rotator) conventional and functional deceleration ratios (eccentric to concentric) were calculated. The impact of sport and number of competitive years on shoulder ROM and strength was tested. Badminton players had greater glenohumeral internal rotation deficit, total ROM deficit, and lower bilateral strength ratio than swimmers (P < .050). Rotational strength was positively associated with the competitive years, but greater in swimmers (P < .050) and on the internal rotator (P < .001). The functional deceleration ratio was negatively associated with the competitive years on the dominant side in swimmers and for both sides in badminton. Unilateral overhead athletes had greater ROM and rotational strength asymmetries than bilateral athletes. Interestingly, the functional deceleration ratio was lower over time on the dominant shoulder for both sports, but, surprisingly, also on the nondominant shoulder in badminton, potentially creating a greater risk for shoulder injuries.

Psychological readiness at 9 months after anterior cruciate ligament reconstruction –which factors affect?

ObjectiveTo investigate the association of psychological readiness at 9 months after anterior cruciate ligament reconstruction (ACLR) with knee strength and range-of-motion (ROM) at 3 and 9 months postoperatively. DesignRetrospective cohort study. SettingPrivate orthopedic hospital. ParticipantsSeventy-eight patients after ACLR. Main outcomes measuresThe participants completed the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale as an assessment of psychological readiness at 9 months after ACLR. Isometric and isokinetic quadriceps and hamstring strength were measured by a dynamometer at 3 and 9 months postoperatively. Knee extension and flexion ROM were measured in 5° increments with a standard goniometer at 3 and 9 months postoperatively. ResultsUnivariate regression analysis showed that age, limb symmetry index (LSI) of quadriceps strength at 3 and 9 months, and knee extension ROM deficit (>5°) at 3 and 9 months were associated with ACL-RSI scores at 9 months (P < 0.05). Age and LSI of quadriceps strength at 3 months remained significant predictors of ACL-RSI scores at 9 months in multiple regression analysis (R2 = 0.20, P < 0.001). ConclusionsEarly improvements in quadriceps strength after ACLR may have a positive impact on psychological readiness at 9 months postoperatively.

Using the articularis genu to test peri-articular muscle health during knee osteoarthritis

Knee osteoarthritis (OA) involves peri-articular sarcopenia. The infrapatellar articularis genu (AG) links to the quadriceps femoris (QF) and can be sampled from discarded tissue during arthroplasty. We predict disuse-mediated changes in AG myofiber type ratio and atrophy similar to reports on the QF during OA. OA AGs (n = 40) were preserved and grouped by poor (≤ 85°; n = 11), fair (90°–110°; n = 19), and good (≥ 115°; n = 10) range of motion (ROM). Immunolabeling of slow and fast myosin heavy chains in AG sections allowed comparing distribution and cross-sectional area (CSA) of type-I (T1) and type-II (T2) myofibers between groups and associating to ROM. T1/T2 ratios in fair and poor ROM groups was consistent with those published in OA QF. Increasing mean ± SD T2 percentages from good (43.31 ± 11.76), to fair (50.96 ± 5.85), and poor (60.02 ± 8.29) ROM groups was significant between poor versus fair (p = 0.018) and good (p < 0.0001) in association with ROM deficits (r = − 0.729; p < 0.0001). T1 and T2 CSA decreased with worsening ROM, which associates with lower symptom scores (r = 0.3198; p = 0.0472). In-depth evaluation of the OA AG as a surrogate for the OA QF relative to serum and/or synovial fluid biomarkers of sarcopenia could refine diagnostics of peri-articular muscle health to guide individualized strength rehabilitation after surgery.

Chronic insertional Achilles tendinopathy secondary to congenital os Achilles: A case report.

IntroductionInsertional Achilles tendinopathy is a common overuse disorder affecting the foot and ankle that can lead to the development of a Haglund's deformity with chronicity, a retrocalcaneal exostosis that forms at the Achilles insertion site, further increasing pain and dysfunction.Presentation of caseWe report a case of a healthy, 35–40-year-old male with chronic left-sided insertional Achilles pain beginning in early adolescence. Physical exam demonstrated bilateral prominences on the posterior aspect of both heels, exquisitely tender on the left and without range of motion deficits. Imaging demonstrated a large calcific ossicle clearly within the tendinous insertion of the Achilles onto the left calcaneus. He underwent surgical intervention to provide pain relief and restore function. He exhibited full recovery post-operatively and has now returned to full functional activities.DiscussionGiven his symptom pathogenesis and progression, this patient may likely have suffered from chronic insertional Achilles tendinopathy due to an accessory ossicle that we believe was congenital. Current literature describes an additional secondary ossification center that appears over the dorsal, posterosuperior surface of the calcaneus. We suspect that there was a lapse in fusion at this additional ossification center that contributed to his pathological condition.ConclusionThis case report presents a unique occurrence of Achilles tendinopathy likely due to an accessory ossicle of congenital etiology. This highlights the importance of investigating the prevalence of this condition in those with chronic insertional Achilles tendinopathy, thus providing meaningful insight in considering effective treatment modalities in the management of these patients.

In-Office Needle Arthroscopy for Anterior Ankle Impingement

Anterior ankle impingement is a common cause of chronic ankle pain characterized by altered joint mechanics with considerable deficits in range of motion. The benefits of in-office nano arthroscopy (IONA) include the ability to diagnosis and treat anterior ankle impingement, quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing in-office nano arthroscopy for anterior ankle impingement, with special consideration of the technique for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.

Early Identification of Arthrofibrosis in Adolescents Following Anterior Cruciate Ligament Reconstruction Is Associated With the Need for Subsequent Surgery: A Matched Case–Control Study

To identify the postoperative characteristics associated with the need for subsequent surgical intervention in pediatric anterior cruciate ligament reconstruction (ACLR). Patients ≤18 years old who received operative treatment for arthrofibrosis following ACLR versus age- and sex-matched controls with a satisfactory postoperative course were retrospectively reviewed. The range of knee motion preoperatively and at each postoperative visit was recorded. Based on the typical post-operative protocols, visits were categorized into 3 groups: first (first 4 weeks), second (weeks 5-8), and third (weeks 9-16) visits. The deficit in the total arc of range of motion (ROM) in the operative knee relative to the nonoperative knee and the change in ROM between visits were compared. Receiver operating characteristic analysis was performed to determine the time point in which a diagnosis of arthrofibrosis could be predicted with the greatest accuracy. In total, 18 patients with arthrofibrosis (mean age 14.2 ± 2.7 years, 9 male) and 36 control patients were included in the final analysis. Arthrofibrosis patients had significantly larger ROM deficits at all visits, 93° vs 69° for the first, 69° vs 24° for the second, and 56° vs 2º for the third, compared with controls (P < .001 for all). Pairwise comparisons showed that in arthrofibrosis cases, the total ROM did not change significantly between the second and third visits (P= .77), contrary to the controls. Receiver operating characteristic analysis revealed that the total ROM deficit of 50.7° at the second postoperative visit is 89% sensitive and 92.5% specific for development of arthrofibrosis. We found that patients who go on to need manipulation of the knee under anesthesia/arthroscopic lysis of adhesions do not experience a significant improvement in ROM after the first 5-8 weeks, and that a ROM deficit of >50° at the 5- to 8-week mark postoperatively, is associated with ultimately needing operative intervention for arthrofibrosis. Based on these findings, it may be appropriate to intervene earlier if a patient still has a ROM deficit exceeding 50° by the second postoperative month. Level III, retrospective comparative prognostic trial.

Early and Delayed Surgery for Isolated ACL and Multiligamentous Knee Injuries Have Equivalent Results: A Systematic Review and Meta-analysis

Background: Early surgery for acute ligamentous injuries has recently shown good clinical and functional outcomes. Purpose: To assess the advantages of early vs delayed surgery in patients undergoing isolated anterior cruciate ligament (ACL) or multiligament-injured knee (MLIK) surgery. Study Design: Meta-analyses of Level 1, 2, and 3 studies; Level of evidence, 4. Methods: A systematic search was performed via PubMed, EMBASE, and Cochrane for studies reporting outcomes of timing of surgery after isolated ACL injury or in the MLIK setting using accelerated rehabilitation protocols. Two analyses were conducted to differentiate early and delayed treatment (3- and 6-week cutoffs). Collected outcomes included meniscal or chondral lesions, failure and reoperation rates, range of motion (ROM) deficits, other complications, muscle strength, instrumented laxity, and functional outcomes. Outcomes were reported in risk ratios (RR) or mean differences with 95% CIs. Results: For timing of isolated ACL surgery, 16 studies were included with 2093 patients. High-grade evidence indicated that there were no differences in meniscal or chondral lesions, failure and reoperation rates, stiffness, ROM deficits, complications, muscle strength, instrumented laxity, and functional outcomes between patients treated early and late (all P > .05). When including only studies that set no preoperative criteria for early surgery, the findings were similar. Regarding MLIK surgery, 14 studies were included with 1172 patients. Low evidence was noted for the following: patients treated early had significantly fewer meniscal injuries (RR, 0.7; P = .04) and chondral injuries (RR, 0.5; P < .001), while no differences were found in reoperation rates, complications, stiffness, ROM deficits, muscle strength, instrumented laxity, and functional outcomes between the groups. Other than higher Lysholm scores in the early group for the 3-week analysis (mean difference, 6.8; P = .01), there were no differences between cutoff analyses. Conclusion: This systematic review with meta-analysis found no differences in clinical and functional outcomes between early and delayed surgery for isolated ACL injuries. For MLIK injuries, there were also no differences in surgical outcomes between early and delayed surgery.

Does Syndesmosis Screw Breakage Affect Patient Outcomes? A Retrospective Comparative Study

Category:AnkleIntroduction/Purpose:Metal screw fixation remains a common and effective way to repair syndesmotic injuries. They are inexpensive, familiar, and provide superior torsional resistance to sagittal translation compared to other fixation modalities. Symptomatic screw breakage is one of the most common complications of metal screw fixation. Routine removal remains unsupported by literature. Consequently, many patients retain broken screws and are at risk for pain; particularly when the breakage occurs within the tibia or the fibula. The purpose of this study is to analyze outcomes of patients with intact syndesmosis screws and those with syndesmosis screw breakage.Methods:A total of 176 patients (260 screws) with syndesmotic disruption treated with syndesmosis screw fixation were included in the study. Half of the patients had broken syndesmosis screws while the other half had intact syndesmosis screws. Basic patient demographic data was collected including BMI, age, and gender. Further collection of patient comorbidities was compiled using two comorbidity indices (Charlson, Elixhauser). Outcome analysis included revision rate, removal secondary to pain, complication rate, range of motion deficits, and patient pain scores. In patients who had their screws removed, further analysis was conducted to compare strength, range of motion deficits, complication rates, pain scores and revision rates between the intact and breakage group.Results:BMI averages of 33.64 (SD=8.77) and 30.64 (SD=6.76) were seen in breakage and intact group, respectively. A complication rate of 24.0% was seen the breakage group versus 36.1% in the control group. Revision rates of 12.4% and 20.10% were seen in the breakage and control group, respectively. Range of motion deficits were seen in 50.2% in the intact group and 39.7% in the breakage group (P = 0.2253). Removal secondary to pain occurred in 60.30% (n = 73) in the broken group compared to 24.5% (n = 34) in the control group. Decreased complication rate (P =.002), increased BMI (P = <.001), and increased risk of removal secondary to pain (P = <.001) were all associated with screw breakage. Following screw removal, no difference was seen in range of motion, pain scores (P =.003) and complications rates (P = 0.147) were higher in the intact group.Conclusion:Metal screw fixation remains a popular treatment of syndesmotic disruption. Many patients retain broken screws and intact screws which can be associated with future complications. Patients with syndesmosis screw breakage are a high comorbid population. Syndesmosis screw breakage is associated with decreased complication rates, increased BMI, and increased risk of eventual removal secondary to pain. Range of motion deficits were seen more commonly when in patients with intact syndesmosis screws. Additionally, revisions rates were higher in the intact group compared to the breakage group. Following screw removal, the intact group had a non-statistically significant increase in complication rate and range.

Validation of an on-screen application-based measurement of shoulder range of motion over telehealth medium.

Shoulder range-of-motion (ROM) assessment is vital for the follow-up evaluation of operated patients and for the outcome-based research studies. The aim of this study was to investigate the accuracy and reliability of a remote on-screen application (app)-based method of shoulder ROM measurement through a telehealth medium. A consultant shoulder surgeon, a board-certified orthopedic resident, and a graduate medical doctor served as the examiners. The cohort consisted of 24 healthy volunteers and 16 symptomatic patients with expected shoulder ROM deficits. Shoulder ROM was first examined physically using a goniometer in the clinic and then over Zoom remote conferencing using the protractor extension app of the Chrome browser. Instrument validity was examined by comparing the goniometer method with the protractor app-based method of the expert shoulder consultant using Bland-Altman analysis. It showed only minor mean differences between the healthy volunteers and the patients in elevation (2.0° and 5.0°, respectively), abduction (2.0° and 3.0°, respectively), external rotation with the elbow adducted (1.9° and 0.2°, respectively), external rotation with the elbow abducted at 90° (0.4° and 4°, respectively), and internal rotation with elbow abducted at 90° (2.3° and 1.2°, respectively), with limits of agreement that were below the well-established minimal clinically important difference values. The intraclass correlation coefficient (ICC) values varied between 0.83 and 0.96 for the volunteers and between 0.90 and 0.98 for the patients, indicating excellent correlation between the 2 methods. The interobserver reliability between 2 examiners for the protractor app-based method as evaluated by ICC scores was excellent; it ranged between 0.86 and 0.98 for the volunteers and between 0.88 and 0.99 for the patients. Comparison of the protractor app-based method with the gold-standard goniometer method for the resident and the graduate doctor showed excellent ICC values. A protractor app-based method of measuring shoulder ROM over a telehealth medium is accurate and reliable compared with a clinical goniometer method. This validated method can be used during remote telehealth consultation with significant benefits of saving patients travel and time during the COVID-19 (coronavirus disease 2019) pandemic and even later.

Postural Balance in Individuals With Knee Osteoarthritis During Stand-to-Sit Task.

Objective: Stand-to-sit task is an important daily function, but there is a lack of research evidence on whether knee osteoarthritis (knee OA) affects the postural balance during the task. This study aimed to compare individuals with knee OA and asymptomatic controls in postural balance and identify kinematic and lower extremity muscle activity characteristics in individuals with knee OA during the stand-to-sit task.Methods: In total, 30 individuals with knee OA and 30 age-matched asymptomatic controls performed the 30-s Chair Stand Test (30sCST) at self-selected speeds. Motion analysis data and surface electromyography (sEMG) were collected while participants performed the 30sCST. To quantify postural balance, the displacement of the center of mass (CoM) and the peak instantaneous velocity of the CoM were calculated. The kinematic data included forward lean angles of the trunk and pelvic, range of motion (RoM) of the hip, knee, and ankle joints in the sagittal plane. The averaged activation levels of gluteus maximus, vastus lateralis, vastus medialis, rectus femoris, biceps femoris (BF), tibialis anterior (TA), and medial head of gastrocnemius muscles were indicated by the normalized root mean square amplitudes.Results: Compared with the asymptomatic control group, the knee OA group prolonged the duration of the stand-to-sit task, demonstrated significantly larger CoM displacement and peak instantaneous CoM velocity in the anterior-posterior direction, reduced ankle dorsiflexion RoM, greater anterior pelvic tilt RoM, and lower quadriceps femoris and muscles activation level coupled with higher BF muscle activation level during the stand-to-sit task.Conclusion: This study indicates that individuals with knee OA adopt greater pelvic forward lean RoM and higher BF muscle activation level during the stand-to-sit task. However, these individuals exist greater CoM excursion in the anterior-posterior direction and take more time to complete the task. This daily functional activity should be added to the rehabilitation goals for individuals with knee OA. The knee OA group performs reduced ankle dorsiflexion RoM, quadriceps femoris, and TA activation deficit. In the future, the rehabilitation programs targeting these impairments could be beneficial for restoring the functional transfer in individuals with knee OA.

Anatomic total shoulder arthroplasty for patients with preserved preoperative motion

BackgroundFor patients with end-stage glenohumeral osteoarthritis, anatomic total shoulder arthroplasty (TSA) serves as a reliable option for pain relief and improving function. It is not well understood if patients with pain due to osteoarthritis but preserved preoperative active range of motion (ROM) experience a similar postoperative benefit compared with those with more pronounced preoperative ROM deficits. MethodsA multicenter shoulder arthroplasty registry was queried to identify all patients who underwent TSA with minimum 2-year clinical follow-up. These patients were separated into two cohorts: (1) preserved preoperative active motion, defined as both forward flexion (FF) and external rotation (ER) at the side a minimum of one standard deviation greater than the mean (>140° FF and >45° ER), and (2) a control group with restrictions in preoperative motion, defined by both preoperative FF < 140° and ER < 45°. Controls were matched 2:1 to study patients by preoperative visual analog pain scale ± 1.5 points, sex, and age ± 2 years. Outcome measures were patient-reported outcomes, active ROM, and strength and satisfaction at a minimum of 2 years postoperatively. ResultsThirty patients were identified in the preserved preoperative motion group (mean baseline 154 ± 10° FF and 57 ± 11° ER). Sixty control patients with restricted motion were matched (mean baseline 97 ± 24° FF and 23 ± 16° ER). There were no significant differences in other baseline patient characteristics other than the Constant-Murley score and strength. At 2-year follow-up, there were no significant differences in visual analog pain scale (0.8 vs. 1.1, P = .446), all patient-reported outcomes, or any ROM measures other than FF which was higher in the preserved group (158 ± 15° vs. 146 ± 19°, P = .003). The change in ROM was significantly higher for all ROM measurements in the restricted motion cohort with restricted preoperative motion compared with study patients. Patients with restricted motion had a significantly greater increase in Constant scores than those with preserved motion (32.6 vs. 19.0, P < .001). There were no significant differences in rates of patients who were satisfied with their surgical result for all domains assessed between groups. ConclusionPatients undergoing TSA with preserved preoperative active ROM can expect similar final pain levels and improvement in pain compared with patients with greater limitations in preoperative ROM. As expected, patients with more restricted preoperative ROM have substantially greater improvement in ROM after TSA. However, there are no differences in satisfaction at 2 years after TSA regardless of preoperative active ROM. Level of evidenceLevel III; Retrospective Cohort Comparison; Treatment Study

Traumatic Hip Dislocation in an NCAA DI Football Player with Occult Sequelae: A Case Report.

Background and PurposeAmerican football generates the most sports-related injuries in the United States, with tackling as the leading injury mechanism. Overall injury rate at the collegiate level has been reported as 8.61 per 1,000 athlete exposures (AEs) – twice the rate of high school levels; competition injury rates are reported as high as 36.94/1000 AEs. Traumatic hip dislocation is an uncommon injury typically arising from high-energy axial impact with only 2-5.5% occurring during sports activities.Case DescriptionA 22-year-old NCAA Division I football defensive back who experienced extreme left hip pain following contact with another player with his hip flexed during a game was diagnosed with a type 1 posterior hip dislocation, a grade 1 medial collateral ligament sprain with concomitant posterior thigh and hip muscle strains. Key impairments were limited left lower extremity motor performance, range of motion deficits, left hip pain, and diminished function and weight-bearing ability.OutcomesThe athlete reintegrated into typical defensive back off-season training approximately four to five months post injury without restrictions, however presented with new anterior hip pain seven months post injury revealing occult sequelae requiring surgical intervention. He was able to return to full play the following football season.DiscussionThis case report describes the successful return to sport of a Division I football player who sustained a traumatic posterior hip dislocation and complicated course including surgical intervention secondary to associated sequelae.Level of Evidence5