Range Of Motion Deficits Research Articles

Assessing the Effects of Scapular Positioning on the Morphology of the Median Nerve During Upper Limb Tension Test 1 (ULTT1)

Research Objectives To determine if there is a significant difference in median nerve morphology of the ULTT1 between resting and two scapular testing positions. Design Cross-sectional study utilizing diagnostic ultrasound to view the median nerve. Diagnostic ultrasound is a non-invasive method of viewing certain anatomical structures, as allowed by the ultrasound frequency. Setting Private University research facility. Participants Thirty healthy males and females between age 18-65 were recruited from a sample of convenience. Exclusion criteria: neck, shoulder, elbow, wrist, or back pain; range of motion deficits that would prevent them from doing the testing positions; or neurological symptoms of the upper quarter. Interventions Subjects were tested using the ULTT1 in both blocked and depressed scapular positions with the height and width of the median nerve measured by diagnostic ultrasound. Main Outcome Measures Investigators used the ultrasound unit calipers to measure the height and width of the median nerve in resting and each scapular position. Results Paired t-tests with a p-value of < 0.05 were utilized to compare median nerve measurements in resting and each scapular position. No significant difference in height or width was found between resting, blocked, or depressed scapular positioning, with p-values >0.05. Conclusions Scapular position did not affect the morphology of the median nerve in this study. Author(s) Disclosures No financial gain from this study. To determine if there is a significant difference in median nerve morphology of the ULTT1 between resting and two scapular testing positions. Cross-sectional study utilizing diagnostic ultrasound to view the median nerve. Diagnostic ultrasound is a non-invasive method of viewing certain anatomical structures, as allowed by the ultrasound frequency. Private University research facility. Thirty healthy males and females between age 18-65 were recruited from a sample of convenience. Exclusion criteria: neck, shoulder, elbow, wrist, or back pain; range of motion deficits that would prevent them from doing the testing positions; or neurological symptoms of the upper quarter. Subjects were tested using the ULTT1 in both blocked and depressed scapular positions with the height and width of the median nerve measured by diagnostic ultrasound. Investigators used the ultrasound unit calipers to measure the height and width of the median nerve in resting and each scapular position. Paired t-tests with a p-value of < 0.05 were utilized to compare median nerve measurements in resting and each scapular position. No significant difference in height or width was found between resting, blocked, or depressed scapular positioning, with p-values >0.05. Scapular position did not affect the morphology of the median nerve in this study.

Relaciones entre la extensibilidad, el rango de movimiento y la intensidad del dolor en jugadores de balonmano semiprofesionales

ObjectiveTo compare range of motion and extensibility between the throwing shoulder and non-throwing shoulder in handball athletes. To investigate the relationship between the time practicing handball with the extensibility, the range of motion (ROM) and shoulder pain intensity during throwing actions. MethodsA cross-sectional study was carried out. Forty-three semi-professional handball athletes were included. The time practicing handball, the extensibility of the tissues of the posterior part of the shoulder, the internal rotation and external rotation ROM and pain intensity during throwing actions were assessed. ResultsThe throwing shoulder presented a decreased in internal rotation ROM and extensibility of the tissues of the posterior part of the shoulder (P<.05), and a greater external rotation ROM (P=.044). Moderate negative associations were found between the time practicing handball and internal rotation ROM (P=.011) and the extensibility of the tissues of the posterior part of the shoulder (P=.033). A positive moderate association was found between internal rotation ROM and extensibility of the tissues of the posterior part of the shoulder (P=.002). No associations were found with pain intensity (P>.05). ConclusionsThe throwing shoulder presents a lesser internal rotation ROM, a greater external rotation ROM and a lack of extensibility. The internal rotation ROM deficit has been associated with the extensibility, and both variables have been associated with the time of practicing handball.

Effects of Muscle Architecture on Eccentric Exercise Induced Muscle Damage Responses.

There is a need to investigate the role of muscle architecture on muscle damage responses induced by exercise. The aim of this study was to determine the effect of muscle architecture and muscle length on eccentric exercise-induced muscle damage responses. Eccentric exercise-induced muscle damage was performed randomly to the elbow flexor (EF), knee extensor (KE), and knee flexor (KF) muscle groups with two week intervals in 12 sedentary male subjects. Before and after each eccentric exercise (immediately after, on the 1st, 2nd, 3rd, and 7th days) range of motion, delayed onset muscle soreness, creatine kinase activity, myoglobin concentration and isometric peak torque in short and long muscle positions were evaluated. Furthermore, muscle volume and pennation angle of each muscle group was evaluated before initiating the eccentric exercise protocol. Pennation angle and muscle volume was significantly higher and the workload per unit muscle volume was significantly lower in the KE muscles compared with the KF and EF muscles (p < 0.01). EF muscles showed significantly higher pain levels at post-exercise days 1 and 3 compared with the KE (p < 0.01-0.001) and KF (p < 0.01) muscles. The deficits in range of motion were higher in the EF muscles compared to the KE and KF muscles immediately after (day 0, p < 0.01), day 1 (p < 0.05-0.01), and day 3 (p < 0.05) evaluations. The EF muscles represented significantly greater increases in CK and Mb levels at day 1, 3, and 7 than the KE muscles (p < 0.05-0.01). The CK and Mb levels were also significantly higher in the KF muscles compared with the KE muscles (p < 0.05, p < 0.01 respectively). The KF and EF muscles represented higher isometric peak torque deficits in all the post-exercise evaluations at muscle short position (p < 0.05-0.001) compared with the KE muscle after eccentric exercise. Isometric peak torque deficits in muscle lengthened position was significantly higher in EF in all the post-exercise evaluations compared with the KE muscle (p < 0.05-0.01). According to the results of this study it can be concluded that muscle structural differences may be one of the responsible factors for the different muscle damage responses following eccentric exercise in various muscle groups.

Comparison of Bioabsorbable and Metallic Interference Screws for Graft Fixation During ACL Reconstruction: A Meta-analysis of Randomized Controlled Trials.

Background:Bioabsorbable interference screws and metallic interference screws are both widely used for graft fixation, but it remains unclear which screw type is superior.Purpose:To compare clinical outcomes and complications between bioabsorbable and metallic interference screws for anterior cruciate ligament reconstruction (ACLR).Study Design:Systematic review; Level of evidence, 1.Methods:The literature was searched for relevant randomized controlled trials published between 1966 and 2020. Two investigators independently assessed risk of bias in the included studies, and data were pooled to calculate mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, together with 95% CIs. Meta-analysis was performed using a random- or fixed-effects model, depending on the heterogeneity in the data.Results:Included were 14 randomized controlled trials involving 1032 patients who underwent ACLR: 528 patients with bioabsorbable screws and 504 patients with metallic screws. The 2 groups did not differ significantly in International Knee Documentation Committee score (RR, 1.04; 95% CI, 0.97 to 1.11), Lysholm score (MD, 0.59; 95% CI, –0.46 to 1.63), range of motion deficit (RR, 0.95; 95% CI, 0.67 to 1.34), positive pivot-shift test (RR, 0.87; 95% CI, 0.61 to 1.24), positive Lachman test (RR, 0.82; 95% CI, 0.48 to 1.39), or KT-1000 arthrometer value (MD, 0.01; 95% CI, –0.16 to 0.18). However, bioabsorbable screws were associated with a significantly higher risk of complications (RR, 1.70; 95% CI, 1.16 to 2.50), such as graft rupture, joint effusion, and infection.Conclusion:The results of this review showed that there was no difference between metallic and bioabsorbable screws for ACLR in terms of subjective knee function or knee laxity, but metallic interference screws had fewer complications.

Normative Reference Values for Trunk Range of Motion and Isometric Muscle Strength in Asymptomatic Young Indian Adults.

To determine normative reference values for trunk range of motion (ROM) and isometric strength (TIS) in asymptomatic young, Indian adults. Age, gender, body mass index, lifestyle, and dynamometer-based device measurements of trunk ROM and TIS in extension (EXT), flexion (FLX), and rotation (ROT) were recorded and analysed in 80 asymptomatic subjects between 20 and 40years of age. Correlation analysis was performed to determine factors influencing EXT and FLX ROM and TIS. The normative reference values for mean trunk EXT, FLX, right ROT, and left ROT ROM were 23° (95th percentile 31.9°), 40.2°(95th percentile 51.5°), 36.8°(95th percentile 57.7°), and 35.4° (95th percentile 55.7°), respectively; and for mean EXT, FLX, right ROT, and left ROT TIS were 118.1 Nm (95th percentile 278.8 Nm), 63.8 Nm (95th percentile 159.4 Nm), 39.9 Nm (95th percentile 113.6 Nm), and 42.8 Nm (95th percentile 108.9 Nm), respectively. The mean EXT (p = 0.0002), right (p = 0.02), and left ROT ROM (p = 0.01), and the mean EXT, FLX, and ROT TIS (p < 0.0001) were significantly greater in males compared to females. The FLX, EXT, and ROT TIS showed significant strong correlation with EXT and FLX TIS. Mean TIS values in Indian subjects were lower when compared to subjects from other countries. This study established normative reference values for trunk ROM and TIS in asymptomatic young Indian adults. These reference values can be helpful to diagnose trunk ROM and TIS deficits, identify subjects at risk for LBP and disability, and individualise rehabilitation treatment in them.

Glenohumeral Internal Rotation Deficit in the Adolescent Overhead Athlete: A Systematic Review and Meta-Analysis.

The objective of this review was to investigate the average glenohumeral internal rotation deficit (GIRD) in the dominant arm of adolescent overhead athletes and to examine the association with shoulder and elbow injuries. Systematic review and meta-analysis. MEDLINE, Embase, and PubMed were searched from inception to August 1, 2020. Adolescent overhead athletes with glenohumeral range of motion (ROM) measurements. Nonoperative treatments of GIRD. Glenohumeral ROM measurements comparing the dominant and nondominant extremities were pooled in a meta-analysis. Twenty-five studies were included in this review, which involved 2522 overhead athletes. Pooled internal rotation (IR) deficit of the dominant arm was 9.60° (95% confidence interval [CI] 7.87°-11.32°, P < 0.00001), with an external rotation (ER) gain of 6.78° (95% CI 4.97°-8.59°, P < 0.00001) and a total ROM (TROM) deficit of 1.78° (95% CI -0.70° to 4.26°, P = 0.16). The association between GIRD and shoulder or elbow injury was not clearly defined. Two studies reported treatment, and both used nonoperative treatment in the form of physiotherapy and sleeper stretches. The adolescent overhead athlete has roughly 10° of IR deficit in their dominant arm, accompanied by nearly 7° of ER gain, with similar ROM measurements for injured and uninjured athletes. Those with pathological GIRD have a greater degree of IR deficit, but without an accompanying compensatory increase in ER, leading to a TROM deficit of nearly 15°. Surgical treatment in the absence of other indications is rare, whereas physiotherapy and sleeper stretches remain the first-line treatment.

Acute compartment syndrome in pediatric patients: a case series.

Pediatric acute compartment syndrome (ACS) is an orthopedic emergency which requires timely recognition and management. There are unique considerations in children, as they may present with a wide array of symptoms and capacities to communicate. We sought to investigate the presentations, treatments and outcomes of pediatric ACS, hypothesizing that decompressive fasciotomy results in good outcomes, even with delayed treatment (>24 h). We performed a retrospective review of pediatric ACS from 2009 to 2018. Exclusion criteria were age ≥18 years, exertional compartment syndrome, and incomplete data. Twenty-one patients (mean age 11 years) were included. Swelling (100%) and worsening pain (100%) were the most common presenting signs and symptoms followed by paresthesias (75%). Increasing analgesia requirements were documented in six (29%) patients. Compartment pressures were measured in 52% of patients. All patients were managed with decompressive fasciotomies, which were performed at a median time of 20 h from injury. Strength and range of motion deficits (10%) were the most commonly reported complications. There were no infections. All patients who were treated in a delayed fashion (≥24 h) were found to have a good functional recovery, but 38% had minor complications. Overall, patients had good outcomes, achieving full functional recovery with return to preinjury activity level. Pediatric ACS should be approached as a distinct clinical entity from adult ACS, where risks of infection and wound complications from delayed fasciotomy generally outweigh the benefits. We recommend considering decompressive fasciotomy for all cases of pediatric ACS, including those with prolonged time from injury to diagnosis.

Limiting the Pitch Count in Youth Baseball Pitchers Decreases Elbow Pain.

Background:Reducing the number of pitches thrown is regarded as the most effective way to prevent throwing injuries in youth baseball pitchers. However, few studies have compared the effectiveness of limiting the pitch count versus the limiting the number of innings pitched in terms of elbow injuries.Hypothesis:We hypothesized that, compared with inning limits, pitch count limits would lead to greater decreases in elbow pain, range of motion deficits, positive moving valgus stress test results, and the risk of capitellar osteochondritis dissecans (OCD).Study Design:Cohort study; Level of evidence, 3.Methods:This study retrospectively reviewed baseball pitchers aged 8 to 12 years in 2017 and 2018. Inning and pitch count limits in games were set to a daily maximum of 7 innings in 2017 and 70 pitches in 2018. Elbow pain, range of motion, and moving valgus stress test results were evaluated. The presence of capitellar OCD was assessed on ultrasonographic and radiographic images.Results:A total of 352 pitchers in 2017 and 367 pitchers in 2018 participated. The mean pitch count per game was lower in the pitch count limit (CL) group (52.5 ± 16.0) than in the inning limit (IL) group (98.2 ± 19.5) (P < .001). Compared with the IL group, the CL group had significantly lower rates of elbow pain (40.9% vs 31.9%, respectively; P = .01) and reduced flexion (19.0% vs 10.6%, respectively; P = .001). Multivariate analysis revealed a significant association between elbow pain and age in both the IL and the CL groups (P < .0001 and P = .02, respectively) and between OCD and elbow pain in the CL group (P = .04).Conclusion:A pitch count limit of ≤70 pitches per day for baseball pitchers ≤12 years could be more protective against elbow pain and reduced flexion than a limit of ≤7 innings per day, but it may not be effective for reducing the risk of capitellar OCD.

Evaluation of Quadriceps Strength Post-medial Patellofemoral Ligament Reconstruction Using Quadriceps Tendon Autografts

BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction using quadriceps tendon (QT) grafts provides favorable results with minimal complications and can be performed in patients with open epiphyseal plates. Following MPFL reconstruction using QT grafts, the outcomes have been evaluated, but the residual quadriceps strength (QS) has never been evaluated.&#x0D; AIM: We analyzed the knee’s range of motion (ROM), thigh circumference (TC), and QS at donor leg sites compared with those at contralateral healthy sites after MPFL reconstruction. The hypothesis was that there is no morbidity at donor sites.&#x0D; MATERIALS AND METHODS: Patients who underwent MPFL reconstruction using QT autografts between January and December 2017 were recruited. The ROM, TC, and QS were measured 6 months postoperatively.&#x0D; RESULTS: Twenty-one patients (8 men, 14 women; mean age, 28.40 ± 10.78 years [range, 16–45]) were included in the study. The TCs at the donor and contralateral sites (medians: 37 and 37.5 cm, respectively) showed no significant difference (p = 0.64). QS measurements showed means of 182 ± 4.6 N and 190 ± 4.7 N at the donor and contralateral sites, respectively (p = 0.376). There were no ROM deficits.&#x0D; CONCLUSIONS: The ROM, TC, and QS at donor sites were similar to those at contralateral sites. The QT is a suitable graft for MPFL reconstruction.

Relationship between glenohumeral internal rotation deficit and shoulder conditions in professional baseball pitchers

Previous studies have reported that glenohumeral internal rotation deficit (GIRD) may increase the risk of throwing-shoulder injuries. The purpose of this study was to analyze the conditions of the throwing shoulder in professional baseball pitchers with GIRD by comparing with those in pitchers without GIRD. In total, 26 male professional baseball pitchers participated in this study. We evaluated passive range of motion (ROM) and isometric muscle strength at internal rotation (IR) and external rotation (ER) at 90° of abduction, as well as the muscle thickness of the supraspinatus (SSP) and infraspinatus (ISP) by ultrasound. The pitchers were divided into 2 groups: those who exhibited a loss of IR of ≥20° in the throwing shoulder (GIRD group) and those who did not (non-GIRD group). In the GIRD group, the total ROM deficit (throwing side - non-throwing side) (P < .001), the muscle thickness ratio (throwing to non-throwing) of the SSP and ISP (P = .017 and P = .014, respectively), and the muscle strength ratio (throwing to non-throwing) of ER (P = .028) were significantly lower than those in the non-GIRD group. In contrast, the muscle strength ratio (throwing to non-throwing) of IR was significantly higher in the GIRD group than in the non-GIRD group (P = .0064). We have shown that GIRD has significant correlations with several conditions, such as atrophy of the SSP and ISP, weakness of ER strength, enhancement of IR strength, limitation of total ROM, and throwing side, all of which could be important factors for throwing-shoulder injuries.

Kinematic versus mechanically aligned total knee arthroplasty: no difference in frequency of arthroscopic lysis of adhesions for arthrofibrosis.

Arthrofibrosis is a condition that can cause excessive scar tissue formation, leading to painful restriction of joint motion. Following total knee arthroplasty (TKA), significant arthrofibrosis can result in permanent deficits in range of motion (ROM) if not treated. Although arthroscopic lysis of adhesions (ALOA) reliably improves post-TKA ROM if performed in a timely fashion, it exposes patients to additional anesthesia, heightens the risk of infection, and increases overall medical expenses. Kinematically aligned TKA has emerged as an alternative method to mechanically aligned, basing bony cuts off of the patient's pre-arthritic anatomy while limiting need for soft tissue and ligamentous releases. This study aimed to determine whether there is a difference in the frequency of post-TKA arthrofibrosis requiring ALOA between kinematic and mechanically aligned TKA. Between 2012 and 2019, a retrospective analysis was conducted based on a single surgeon's experience. Two cohorts were made based on alignment technique. Postoperatively, patients were diagnosed with arthrofibrosis and indicated for ALOA if they had functional pain with < 90 degrees of terminal flexion at 6weeks postoperatively despite aggressive physical therapy. Frequency of ALOA was recorded for each cohort and was regressed using independent samples t-test. The results showed no significant difference between the mechanical and kinematic cohorts for frequency of ALOA following TKA (13.2% vs. 7.3%; p = 0.2659). However, the kinematic cohort demonstrated significantly greater post-ALOA ROM compared to the mechanical group (129° vs. 113°; p = 0.0097). Future higher-powered, prospective studies are needed to clarify whether a significant difference in rates of MUA/ALOA exists between the two alignment techniques.

Terminal knee extension deficit and female sex predict poorer quadriceps strength following ACL reconstruction using all-soft tissue quadriceps tendon autografts.

The all-soft tissue quadriceps tendon (QT) autograft is becoming increasingly popular for ACL reconstruction (ACLR); however, studies reporting strength recovery and early outcomes after QT autograft are limited with patient samples composed of predominantly males. The primary purpose was to characterize early, sex-specific recovery of strength, range of motion (ROM), and knee laxity in a large cohort of patients undergoing primary ACLR with standardized harvest technique of the all-soft tissue QT autograft. The secondary purpose was to examine the influence of demographic factors and clinical measures on 6-month quadriceps strength. Patients 14-25years who underwent primary, unilateral ACLR with all-soft tissue QT autografts were prospectively followed. Knee laxity and ROM were collected at 6weeks, 3 and 6months; while, quadriceps normalized torques and limb symmetry indices (LSI) were collected at 3 and 6months using isokinetic dynamometry at 60°/s. Two-way ANOVAs with repeated measures were conducted to determine recovery over time and between sexes. Stepwise linear multiple regressions were conducted to determine predictors of 6-month quadriceps strength. Three-hundred and twenty patients were included (18 ± 3years; 156 males:164 females; BMI = 24 ± 4kg/m2) with no early graft failures within the study period. For strength, there were significant main effects of time (p < 0.001) and sex (p < 0.001), indicating similar improvement from 3 to 6months with males demonstrating greater quadriceps LSI (6months: 72.1 vs 63.3%) and normalized strength (6months: 2.0 vs 1.6Nm/kg). A significantly higher proportion of females had knee extension ROM deficits ≥ 5° compared to males at 6weeks (61 vs 39%; p = 0.002). Female sex and 3-month extension ROM deficits were identified as significant predictors of 6-month quadriceps LSI (R2 = 0.083; p < 0.001). Female sex, BMI, and 6-week extension ROM deficits were identified as significant predictors of 6-month normalized quadriceps strength (R2 = 0.190; p < 0.001). Females had decreased quadriceps strength and greater extension ROM deficits at 3 and 6months following ACLR using all-soft tissue QT autografts. Female sex, higher BMI, and loss of extension ROM were independent predictors of poorer quadriceps strength at 6months. There were no early graft failures, and laxity remained within normal ranges for both males and females. Surgeons and rehabilitation clinicians should be aware of the increased risk of postoperative loss of extension ROM in females and its implications on quadriceps strength recovery. III.

Radiographic and Clinical Outcomes of the Shoulder in Long-Term Follow-Up of Brachial Plexus Birth Injury

The purpose of this study was to examine radiographic and functional outcomes of the shoulder in brachial plexus birth injury (BPBI) patients at long-term follow-up. Medical records were reviewed at the Shriners Hospital in St. Louis to identify patients older than 18 years with a diagnosis of BPBI. Twenty-five patients were included in this study. Evaluations included radiographic examination, clinical examination, and outcome measures including the Mallet classification, visual analog scale (VAS) for shoulder pain, American Shoulder and Elbow Shoulder score (ASES), quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Simple Shoulder Test (SST), and Patient-Reported Outcomes Measurement Information System (PROMIS) domain measures. The mean age of the patients included was 44 years. Average follow-up was 37 years. No patient had primary nerve reconstruction surgery. Thirteen patients had a history of shoulder surgery at an average age of 6 years. There was a wide spectrum of deformity seen radiographically. Fifty-five percent of patients had evidence of glenoid retroversion, posterior humeraltranslation, or a biconcave glenoid. An additional 20% of patients had complete posterior dislocation of the humeral head. Despite the degenerative changes seen on radiographs, the mean VAS for pain was low, at 2. The mean ASES shoulder score was 54. The mean QuickDASH score was 30. Mean PROMIS Physical Function, Pain Interference, Depression, and Anxiety scores were near the means for the general population, with similar outcomes inpatients treated with shoulder surgery compared with those treated without surgery. Adult BPBI patients experience minimal shoulder pain despite deformity and degenerative changes on shoulder radiographs. Whereas there are significant deficits in range of motion and function, PROMIS scores in adult BPBI patients are normal. Therapeutic IV.

Alterations in Muscle Architecture: A Review of the Relevance to Individuals After Limb Salvage Surgery for Bone Sarcoma.

Osteosarcoma and Ewing's sarcoma are the most common primary bone malignancies affecting children and adolescents. Optimal treatment requires a combination of chemotherapy and/or radiation along with surgical removal when feasible. Advances in multiple aspects of surgical management have allowed limb salvage surgery (LSS) to supplant amputation as the most common procedure for these tumors. However, individuals may experience significant impairment after LSS, including deficits in range of motion and strength that limit function and impact participation in work, school, and the community, ultimately affecting quality of life. Muscle force and speed of contraction are important contributors to normal function during activities such as gait, stairs, and other functional tasks. Muscle architecture is the primary contributor to muscle function and adapts to various stimuli, including periods of immobilization-protected weightbearing after surgery. The impacts of LSS on muscle architecture and how adaptations may impact deficits within the rehabilitation period and into long-term survivorship is not well-studied. The purpose of this paper is to [1] provide relevant background on bone sarcomas and LSS, [2] highlight the importance of muscle architecture, its measurement, and alterations as seen in other relevant populations and [3] discuss the clinical relevance of muscle architectural changes and the impact on muscle dysfunction in this population. Understanding the changes that occur in muscle architecture and its impact on long-term impairments in bone sarcoma survivors is important in developing new rehabilitation treatments that optimize functional outcomes.

Combined ACL and Anterolateral Reconstruction Is Not Associated With a Higher Risk of Adverse Outcomes: Preliminary Results From the SANTI Randomized Controlled Trial.

Background:The widespread historical abandonment of lateral extra-articular procedures in anterior cruciate ligament (ACL) injuries occurred as a result of concerns about high rates of adverse events. Recently, the popularity of lateral extra-articular procedures has resurged, warranting an urgent evaluation of their safety profile.Purpose/Hypothesis:The aim of this study was to perform an interim analysis of the ongoing SANTI randomized controlled trial to determine whether combined ACL and anterolateral ligament reconstruction (ACL + ALLR) is associated with an increased rate of adverse outcomes when compared with isolated ACL reconstruction (ACLR). The hypothesis was that there would be no significant difference between groups at a minimum follow-up of 1 year.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Recruitment commenced in November 2016. Patients scheduled for ACLR were randomized to either isolated ACLR (with bone–patellar tendon–bone [BPTB] autograft) or combined ACL + ALLR (with hamstring tendon autograft). All patients with a minimum follow-up of 1 year by March 2019 were included. The evaluated parameters included complications and reoperations, knee laxity parameters, range of motion, and scores on the Tegner, Lysholm, International Knee Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS) instruments.Results:A total of 224 patients (112 in each group) with a mean ± SD follow-up of 12.3 ± 1.9 months (range, 12-19 months) formed the study population. A significantly higher rate of reoperation for cyclops syndrome was noted in the isolated ACLR group compared with the combined ACL + ALLR group (8.9% vs 0%, respectively; P = .0012). No significant differences were found in frequency of graft rupture (ACLR, 5.4%; ACL + ALLR, 0.9%; P = .1191), range of motion deficits, pain, or reoperation for meniscectomy between groups. No cases of postoperative infection, venous thromboembolism, or arthrofibrosis were seen. Subjective IKDC (81.2 vs 86.8; P = .0048), Lysholm (88 vs 92; P = .0131), and some components of the KOOS were significantly better in the combined ACL + ALLR group.Conclusion:This study demonstrates no evidence of an increased risk of short-term adverse events after combined ACL + ALLR compared with isolated ACLR with BPTB graft.Registration:NCT03740022 (ClinicalTrials.gov Identifier)

Effects of lateral ankle sprain on range of motion, strength and postural balance in competitive basketball players: a cross-sectional study.

Lateral ankle sprain is the most common injury in basketball, and many of these sprains resulted in residual functional deficits. This study aimed to compare ankle strength and range of motion, and postural balance between competitive basketball players with and without lateral ankle sprain. This was a cross-sectional study involving 42 male competitive basketball players. Subjects were divided into the injured and uninjured groups based on self-reported questionnaires. Ankle range of motion (ROM) was measured using a goniometer, ankle isokinetic strength testing performed using Biodex System 4 PRO, and single-leg stability tests performed using Biodex Balance System SD. Between the injured and uninjured ankles, there was a decrease in plantarflexion ROM (44.89±6.85 vs. 50.75±9.31, P<0.05) and an increase in eversion ROM (14.50±5.63 vs. 11.74±4.53, P<0.05). There was a reduction in inversion and plantarflexion strength at 30°/s peak torque and 120 °/s peak torque (P<0.05). However, no significant difference observed in the postural stability indexes between the two groups. This study proves that there are residual ROM and strength deficits after an ankle sprain, however, these deficits do not affect their balance ability.

Deterioration of initially accepted radiological alignment of conservatively treated AO type-C distal radius fractures: mid-term outcome

Background and aimsIt still remains controversial how often the once-accepted radiological alignment of an AO type-C distal radius fracture deteriorates after conservative treatment, and to what extent this deterioration is perhaps associated with patient-rated outcome measures (PROms). Thus, we aimed to evaluate this radiological deterioration and its association with mid-term functional follow-up.Patients and methodsWe retrospectively reviewed 66 patients (mean age at fracture 53 years, SD 14.1, range 18–73, female 65%) with 68 C-type distal radius fractures at a mean of 6.7 years (SD 0.5 years, range 5.8–7.7 years) after primary closed reduction and cast immobilization. Radiographs of the wrists were taken and analysed for any radial shortening, dorsal tilt or step-off at the joint surface. Range of motion and grip strength were measured. In addition to the radiological result, primary outcome measures included Quick Disabilities of the Arm, Shoulder and Hand (QDash) and Patient-Rated Wrist Evaluation (PRWE).ResultsAt mid-term follow-up, an acceptable anatomical radiological result was seen in only 22 wrists (32%). Deterioration of the once-achieved and accepted primary alignment was seen in a majority of cases (68%). Radial shortening of ≥ 2 mm was found in 34 wrists (51%, mean 4 mm, range 2–8 mm), with no association with QDash (12.8 vs. 5.5, p = 0.22) or PRWE (9.1 vs. 5.7, p = 0.40). Only four patients (6%) showed step-off at the joint surface (mean 1.1 mm, range 0.5–2 mm). Twenty-two wrists (32%) showed dorsal tilt of ≥ 10° (five with volar tilt of 15°–25°), with no effect on QDash or PRWE (14.7 vs. 6.5, p = 0.241 and 10.1 vs. 5.8, p = 0.226). Altogether, patients with dorsal tilt, step-off or shortening did not show significantly worse QDash (10.3 vs. 5.7, p = 0.213) or PRWE (8.1 vs. 5.1, p = 0.126) versus those with none. Twenty-nine (43%) of the patients had deficits in range of motion (ROM), either in extension (39%), flexion (43%), supination (16%) or pronation (4%), or combinations of these. Worse extension was associated with worse QDash (15.9 vs. 5.0, p = 0.037), flexion deficit with worse PRWE (11.5 vs. 4.4, p = 0.005) and supination deficit with both QDash (21.7 vs. 6.8, p = 0.025) and PRWE (18.9 vs. 5.2, p = 0.007).ConclusionsThe initially accepted radiological alignment of AO type-C radius fractures deteriorated in a majority of cases during conservative treatment. However, this deterioration was fairly mild and showed no significant association with functional outcome. Restricted ROM showed some association with PROms.Level of evidenceIV.

632 Heterotopic Ossification Related Contractures: Success with Bodyweight Stretches

Abstract Introduction Heterotopic Ossification (HO) occurs following a trauma and is a complication in therapy recovery following burn injuries. Burn literature reveals the incidence of HO is present in approximately 2% of the burn population. There is limited evidence supporting bodyweight stretches in the treatment of HO related contractures. When present, HO can result in a loss of range of motion (ROM), significant pain and limit independence with daily activities. This case study identifies therapeutic interventions, specifically bodyweight stretches, with associated positive outcomes that improved HO related contractures. This challenges the common practice of discontinuation of aggressive ROM with an HO diagnosis. Methods Two patients were identified as having been diagnosed with HO and subsequent loss of joint ROM that successfully regained motion without requiring surgical intervention. Retrospective chart reviews were completed that compared demographics, hospital course, timing of HO diagnosis, outpatient therapy frequency and duration, treatment interventions and time to resolve ROM deficits. Graphs were created that tracked rehab course and ROM progression along with therapeutic interventions to identify common factors that contributed to regaining mobility. Results Both patients were of similar age with an average TBSA of 64% and comparable hospital stays. At the outpatient therapy evaluation, each patient presented with approximately 50% loss of joint ROM in one upper extremity joint. The pair received occupational and physical therapy services. With different frequencies and durations, both achieved nearly normal joint ROM at the completion of their rehab. Patient 1 attended therapy 3-4x weekly over 4 months and regained 70° of active shoulder flexion motion. Patient 2 attended burn therapy once weekly for a period of 9 months and regained 60° of elbow flexion. In each case, the most significant ROM improvements were noted after initiating bodyweight exercises to maximize end range stretches and total body strengthening. Interventions included planks, modified yoga positions, push ups and pull ups. Both patients demonstrated a high pain tolerance and motivation to progress stretches to end range that resulted in maximum ROM gains. Conclusions Therapy guided, self administered stretches using bodyweight as an external force strongly contributed to significant ROM improvements and remediation of HO related contractures. Higher therapy dosage with a frequency of 3x weekly resulted in quicker resolution of ROM deficits as compared to 1x weekly dosage. Applicability of Research to Practice Rehab success following a burn injury can be strongly limited with the diagnosis of HO. This research utilizes a common therapy practice of bodyweight stretches to improve HO related contractures, leading to greater mobility gains and a quicker return to their desired lifestyle.

Are Patients Who Undergo the Latarjet Procedure Ready to Return to Play at 6 Months? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study

Background: The Latarjet procedure is growing in popularity for treating athletes with recurrent anterior shoulder instability, largely because of the high recurrence rate of arthroscopic stabilization, particularly among contact athletes with bone loss. Purpose: (1) To evaluate return of strength and range of motion (ROM) 6 months after the Latarjet procedure and (2) to determine risk factors for failure to achieve return-to-play (RTP) criteria at 6 months. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 65 athletes (83% contact sports, 37% overhead sports; mean ± SD age, 24.5 ± 8.2 years; 59 male, 6 female) who enrolled in a prospective multicenter study underwent the Latarjet procedure for anterior instability (29% as primary procedure for instability, 71% for failed prior stabilization procedure). Strength and ROM were assessed preoperatively and 6 months after surgery. RTP criteria were defined as return to baseline strength and <20° side-to-side ROM deficits in all planes. The independent likelihood of achieving strength and motion RTP criteria at 6 months was assessed through multivariate logistic regression modeling with adjustment as needed for age, sex, subscapularis split versus tenotomy, preoperative strength/motion, percentage bone loss, number of prior dislocations, preoperative subjective shoulder function (American Shoulder and Elbow Surgeons and Western Ontario Shoulder Instability Index percentage), and participation in contact versus overhead sports. Results: Of the patients, 55% failed to meet ≥1 RTP criteria: 6% failed for persistent weakness and 51% for ≥20° side-to-side loss of motion. There was no difference in failure to achieve RTP criteria at 6 months between subscapularis split (57%) versus tenotomy (47%) (P = .49). Independent risk factors for failure to achieve either strength or ROM criteria were preoperative American Shoulder and Elbow Surgeons scores (per 10-point decrease: adjusted odds ratio [aOR], 1.61; 95% CI, 1.14-2.43; P = .006), Western Ontario Shoulder Instability Index percentage (per 10% decrease: aOR, 0.61; 95% CI, 0.38-0.92; P = .01), and a preoperative side-to-side ROM deficit ≥20° in any plane (aOR, 5.01; 95% CI, 1.42-21.5; P = .01) or deficits in external rotation at 90° of abduction (per 10° increased deficit: aOR, 1.64; 95% CI, 1.06-2.88; P = .02). Conclusion: A large percentage of athletes fail to achieve full strength and ROM 6 months after the Latarjet procedure. Greater preoperative stiffness and subjective disability are risk factors for failure to meet ROM or strength RTP criteria.

Pediatric acute compartment syndrome: a systematic review and meta-analysis.

Acute compartment syndrome (ACS) is an emergency with potentially devastating consequences. Delayed recognition may be especially concerning for the pediatric population, as children present with a wide variety of etiologies, symptoms, and levels of communication. We sought to determine the average time from injury to diagnosis, most common presentations, the degree to which providers obtained pressure measurements, and outcomes of ACS in the pediatric population. We performed a systematic review of multiple databases to include English-language clinical studies reporting ACS of the extremity in pediatric patients. Review articles, studies lacking statistical data, single case reports, and other evidence level V studies were excluded. Twelve studies were included, with all reporting clinical outcomes following diagnosis and intervention of ACS in children. There were 233 children with an average age of 9.7 years (SD: 5.9 years, range: 0-18 years). The most common causes were trauma-related: pedestrian versus motor vehicles (21%), motor vehicle accidents (12%), falls (12%), and sports/exercise-related injuries (12%). ACS occurred in all extremities, with lower leg (60%) and forearm (27%) being most common. Seventy-five percent of patients had concomitant fractures. Compartment pressures were measured in 68% of patients to aid diagnosis. Pain was the most common presenting symptom (88%) followed by paresthesias (32%). The mean time from injury to fasciotomy was 25.4 h. Patients had good outcomes, with 85% achieving full functional recovery. Range of motion deficit (10%) was the most common complication. We detected no significant difference in time from injury to fasciotomy, age, sex, the presence of a fracture, or anatomic location in those patients who achieved full functional recovery compared with patients who did not. Pediatric ACS occurs most often in the setting of trauma. Intracompartmental pressure measurements can aid diagnosis. Pediatric ACS differs from adult ACS, as pediatric patients generally achieve good outcomes even when presenting in delayed fashion and undergoing fasciotomies for at least 24 h. We recommend considering decompressive fasciotomy in children even if there is prolonged time from injury to diagnosis. Level of evidence: IV.