Flexion Range Of Motion Research Articles

Development and in vivo biomechanics of goat mobile artificial lumbar spine complex

Mobile artificial lumbar complex (MALC) which suitable for reconstruction after subtotal lumbar resection in goats was developed,and to test stability of the complex and postoperative lumbar segmental motor function. Eighteen male boer goats aged from 1 to 2 years old (weighted from 35 to 45 kg) were selected and divided into control group,fusion group and non-fusion group,with 6 goats in each group. According to preoperative CT scans and MRI examinations of lumbar,the goat MALC was designed and performed by 3D printed for non-fusion group. Operation was performed on three groups respectively,and only vertebral body and disc were exposed in control group. In fusion group,L4 part of vertebral body and the upper and lower complete disc tissues were removed,and the lumbar spine bone plate fixation was performed with titanium mesh bone grafting. In non-fusion group,vertebral body and disc were removed in the same way,and MALC was implanted. AP and lateral X-rays of lumbar vertebrae in goat were taken at 6 months after surgery,in order to understand whether the plant was dislocated,displaced and fractured. Biomechanical tests were performed on the specimens by mechanical instrument to measure range of motion (ROM) of L2,3,L3,4,L4,5 intervertebral space and the overall ROM of L2-5 lumbar vertebrae. MALC of lumbar vertebra was designed by 3D printing,and its component artificial vertebrae and upper and lower artificial end plates were manufactured. The semi-spherical structure was fabricated by precision lathe using high-crosslinked polyethylene material,and the prosthesis was assembled. Postoperative AP and lateral X-rays of lumbar vertebra at 6 months showed the implant position of implant and MALC were good without displacement and dislocation. In vitro biomechanical test of lumbar vertebrae specimens:(1) There were no statistical significance in ROM of lumbar intervertebral space flexion and extension,lateral flexion and rotation on L3,4 and L4,5,between non-fusion group and control group (P>0.05),while ROM of fusion group was significantly reduced compared with the other two groups (P<0.05). There were no significant difference in ROM of L2,3 intervertebral flexion and extension,lateral flexion and rotation between non-fusion group and control group (P>0.05),while fusion group was significantly increased compared with the other two groups (P<0.001). (2) There was no significant difference in overall lumbar ROM of L2-5 (P> 0.05). The individual MALC could restore intervertebral height of lumbar vertebra while maintaining the stability of lumbar vertebra and re-establishing motor function of lumbar space.

The Biomechanical and Functional Status of Patients with Knee Osteoarthritis - A Cross Sectional Study

Background and Objectives: Knee deformity associated with osteoarthritis (OA) is one of the most common complications reported to orthopaedic surgeons. Genu valgum and genu varum are the most commonly occurring deformities due to knee osteoarthritis. When there is progression in degeneration due to osteoarthritis, deformities tend to worsen and will eventually lead to reduction in cadence rate, hindfoot angle, range of motion in both hip and knee. Thus, this study is conducted to analyze these parameters like cadence, hindfoot angle, hip internal flexion, knee flexion, WOMAC scale and VAS pain rating scale between the groups of individuals with genu valgum and genu varum deformity. Methodology: A convenient division was made of a total of 80 knee osteoarthritis (OA) patients into two groups by measuring their medial tibiofemoral angle, namely genu valgum and genu varum. The patients were evaluated for various parameters including gait cadence, reduced knee flexion, hip internal rotation, hind foot angle, WOMAC scale, and VAS pain scale. The discrepancies in these parameters were analyzed between the genu valgum and genu varum groups. This study design represents a cross-sectional approach. Results: The Independent t-test was used to examine the results among the groups, with a significance level set at p ≤ 0.05. Considerable statistical changes were observed in cadence, hindfoot angle, knee flexion ROM, and hip internal rotation ROM, with corresponding p-values of 0.0006, 0.049, 0.002, and 0.01, respectively. However, no significant differences were found in the case of the WOMAC scale and VAS pain rating scale between the groups with genu valgum and genu varum deformities, as their p-values were considerably higher than the significance level (0.169, 0.948). Conclusion: The objective of the study was to gain insight into the biomechanical and functional condition of individuals suffering from knee osteoarthritis. Substantial differences were observed between the groups regarding cadence, hindfoot angle, knee flexion range of motion (ROM), and hip internal rotation ROM. However, when evaluating the WOMAC scale and VAS pain rating scale, both groups exhibited nearly identical values, indicating a lack of statistical significance in these outcome measures. Keywords: Knee osteoarthritis, genu valgum, genu varum, tibiofemoral angle, cadence, hindfoot angle, knee flexion ROM, hip internal rotation ROM, WOMAC scale, VAS scale.

Early effectiveness of arthroscopic tri-anchor double-pulley suture-bridge repair of medium-size supraspinatus tendon tears

To explore the early effectiveness of arthroscopic tri-anchor double-pulley suture-bridge in treatment of medium-size supraspinatus tendon tears. Between December 2020 and January 2023, 40 patients with medium-size supraspinatus tendon tears were treated with arthroscopic tri-anchor double-pulley suture-bridge. There were 18 males and 22 females, with an average age of 62.6 years (mean, 45-73 years). Among them, 17 patients had trauma history. The main clinical symptom was shoulder pain with hug resistance test (+). The interval from symptom onset to operation was 10.7 months on average (range, 3-36 months). Visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and shoulder range of motion (ROM) of forward flexion, abduction, and external rotation were used to evaluate shoulder function. MRI was performed to assess the structural integrity and tension of reattached tendon. Patient satisfactions were calculated at last follow-up. All incisions healed by first intention, no complications such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.2 months). At 12 months after operation, VAS score, UCLA score, and ASES score significantly improved when compared with the preoperative scores ( P<0.05). At 3 and 12 months after operation, the ROM of external rotation significantly improved when compared with preoperative one ( P<0.05), and further improved at 12 months after operation ( P<0.05). However, the ROMs of abduction and forward flexion did not improve at 3 months after operation when compared with those before operation ( P>0.05), but significantly improved at 12 months after operation ( P<0.05). Twenty-six patients underwent MRI at 3-6 months, of which 23 patients possessed intact structural integrity, good tendon tension, and tendon healing; 3 patients underwent tendon re-tear. The self-rated satisfaction rate was 92.5% at last follow-up. Arthroscopic tri-anchor double-pulley suture-bridge in treatment of medium-size supraspinatus tendon tears can maximize the tendon-bone contact area, obtain satisfied early effectiveness with high satisfaction rate and low incidence of tendon re-tear. However, the function of abduction is limited at 3 months after operation, and patients need to adhere to rehabilitation training to further improve the joint activity.

Effects of Different Taping Techniques in Individuals with Myofascial Pain Syndrome with a Trigger Point in the Trapezius Muscle: A Sham-controlled Randomized Study.

This study aimed to compare the effects of three different kinesio taping (KT) techniques in individuals with myofascial pain syndrome (MPS) who have a trigger point in the trapezius muscle. The individuals included in our study were randomly divided into four groups: Group 1: Functional correlation technique, group 2: Fascia correlation technique, group 3: Star taping technique (STT), and group 4: Sham group. The visual analog scale was used to assess pain, cervical joint range of motion (ROM) with a universal goniometer, grip strength with a hand dynamometer, number of active trigger points by palpation, pressure-pain threshold with an algometer, quality of life with the Nottingham Health Profile and functional level with the Neck Disability index were evaluated before and after treatment. There was no difference between the groups in terms of demographic data and pre-treatment outcome measures (p>0.05). There was a significant difference in the pain score between the groups after treatment (p<0.05). A statistically significant difference was found in the cervical flexion ROM of all groups after treatment (p<0.05). In pairwise comparisons, these differences were found due to group 3 (p<0.05). The three KT techniques are effective in reducing pain, increasing ROM, reducing the number of active trigger points, and increasing grip strength. Among these techniques, STT was found to be more effective in reducing pain and increasing cervical flexion ROM. KT is a method that can be used in the clinic for patients with MPS.

Effects of exercise combined with cervicothoracic spine self-mobilization on chronic non-specific neck pain

To investigate the short-term effects and differences between exercise alone and exercise combined with self-mobilization training on chronic non-specific neck pain (CNSNP). Thirty subjects who met the criteria were recruited and randomly assigned to the exercise training group, the exercise combined with cervical self-mobilization training group (ECCM), and the exercise combined with cervicothoracic self-mobilization training group (ECCTM). The exercise training group received 6 weeks of deep neck flexor under biofeedback and scapular stability training, and the other two groups received 6 weeks of cervical self-mobilization and cervicothoracic self-mobilization, respectively, in addition to exercise training. Neck pain, cervical range of motion (ROM), neck disability, strength and endurance of deep neck flexor and quality of life were assessed before and after 6 weeks of training. The study results showed that all the three training programs for 6 weeks increased the strength and endurance of deep neck flexor, increased cervical ROM, reduced pain, and improved neck function (P < 0.05). The exercise combined with self-mobilization two groups compared with only the exercise training group had better improvement in ROM of extension, lateral flexion, rotation and quality of life (P < 0.05). Compared with exercise alone and exercise combined with cervical self-mobilization training, the exercise combined with cervicothoracic self-mobilization training was the best in improving ROM of right lateral flexion (exercise training group vs ECCTM: P < 0.01, d = 1.61, ECCM vs ECCTM: P < 0.05, d = 1.14) and pain (exercise training group vs ECCTM: P < 0.05, d = 1.34, ECCM vs ECCTM: P < 0.05, d = 1.23). Deep flexor muscle and shoulder stability training can improve the endurance and strength of the deep flexor muscles of the neck and coordinate the movement patterns of the shoulder and neck. Self-mobilization techniques can promote improvements in cervical lateral flexion and rotation range of motion, alleviate neck disability and further improve quality of life. A combination of exercise and cervicothoracic self-mobilization training appears beneficial for the management of neck pain.

Evaluation and comparison of functional and esthetic outcomes of pectoralis major myocutaneous flap with or without removal of sternocleidomastoid muscle following neck dissection in patients being operated for oral squamous cell carcinoma

India comprising the burden of oral squamous cell carcinoma which grow locally and then spreads to the cervical lymph nodes. Neck dissection is a beneficial procedure for addressing metastases in the neck arising from head and neck cancers. This surgical technique aims to remove lymph nodes on one side of the neck where cancer cells may have spread. However, this procedure can significantly impact a patient's appearance and cause distortion in the cervical area, particularly when it involves the removal of the sternocleidomastoid muscle, leading to a flattening effect in the lateral neck area. Reconstructing tissue defects following extensive surgeries in the head and neck region presents a distinct challenge for surgeons. They have the option to use either pedicled or free tissue transfer for this purpose. We compared and evaluated functional and esthetics outcomes of pectoralis major myocutaneous flap with or without removal of sternocleidomastoid muscle following neck dissection. We concluded that lack of notable distinction between the MRND type II and III groups. Both groups exhibited restricted range of motion in flexion, abduction, and external rotation. Notably, there was a significant impact on neck circumference, while shoulder functionality demonstrated gradual improvement over time. Interestingly, no substantial variances were observed between the groups in terms of drainage and wound healing. The quality of life reported by participants was generally favorable, with composite scores, social-emotional sub-scores, and average physical function aligning with acceptable standards. It's important to note that achieving a more substantial sample size is imperative to obtain results of greater significance and reliability.

Randomized controlled trial of compressive cryotherapy versus standard cryotherapy after total knee arthroplasty: pain, swelling, range of motion and functional recovery

BackgroundAfter total knee arthroplasty (TKA), patients have limited knee range of motion (ROM), trophic changes and pain. Cryotherapy and compression are recommended in the literature, but no study has shown that cryotherapy and compression combined leads to better results than cryotherapy alone. The primary objective was to compare knee ROM after 21 days of rehabilitation post-TKA between patients who underwent rehabilitation with compressive cryotherapy with those who had cryotherapy alone. The secondary objectives were to compare other trophic, pain and functional outcomes.MethodsForty patients were randomized into two groups: Standard Cryotherapy (SC = 20, median age 77 years), which applied cold packs along with their rehabilitation; and Compressive Cryotherapy (CC = 20, median age 76 years), which received cold compression. Knee joint’s passive and active ROM (primary outcome) were measured with a goniometer. Knee’s circumference, fluctuation test, pain at rest and during activity, 6-minute walking test (6MWT) and KOOS questionnaire were secondary outcomes. The groups were compared on D1 (baseline) and D21 of rehabilitation. A survival analysis has compared the groups on D1, D8, D15, D21.ResultsAll subjects had a significant improvement in all the parameters on D21 relative to D1 (p < .05), except for pain at rest (p = .065 for CC and p = .052 for SC). On D21, the CC group had a significantly larger improvement in the joint effusion (p = .002), pain during activity (p = .005), 6MWT (p = .018) and KOOS (p = .004) than the SC group. Based on the survival analysis, the CC group had significantly faster improvement in the joint ROM (p = .011 for flexion and p = .038 for extension) and knee circumference (p = .013) than the SC group.ConclusionsBoth cryotherapy methods improved joint ROM, trophic changes, pain and function. Adding dynamic compression to a cryotherapy protocol provided further benefits: a significantly faster improvement in passive knee flexion ROM, a greater reduction of swelling, and pain during activity. Similarly, walking distance and KOOS questionnaire were significantly better for CC.Trials registrationThe study was registered in the ClinicalTrials.gov database on 14/09/2023 (identifier: NCT06037824).

Effectiveness of eye-cervical re-education versus motor imagery therapy on chronic neck pain: A randomized controlled trial

The aim of this study was to investigate the effect of adding eye cervical re-education exercises (ECRE) versus motor imagery therapy (MIT) to conventional physical therapy (CPT) on pain, functional disability, and cervical range of motion (ROM) in subjects with chronic neck pain (CNP). The study employed a randomized controlled trial design with 60 patients with CNP. Participants were selected from the outpatient clinics of the Faculty of Physical Therapy at Cairo University and were randomly assigned to three groups: conventional physical therapy only (CPT) (Group I, N = 20), eye-cervical re-education exercises plus CPT (Group II, N = 20), and motor imagery therapy plus CPT (Group III, N = 20). All participants received 3 sessions per week for 4 weeks. Visual Analogue Scale (VAS), Neck Range of Motion (ROM) and Neck Disability Index (NDI) were measured at baseline and after 4 weeks of intervention. In terms of pain intensity, neck disability index, neck flexion and extension, right and left lateral flexion, and right and left rotation ROM outcome measures, the results revealed statistically significant differences between groups (p &lt; 0.05). Group II showed statistically significant improvement compared to both Group I and Group III in all measured outcomes (p &lt; 0.05). Additionally, Group III showed statistically significant improvement compared to Group I in all measured outcomes (p &lt; 0.05). Adding eye-cervical re-education exercises or motor imagery therapy to conventional physical therapy resulted in notable improvements. Eye-cervical re-education exercises, in particular, showed greater benefits in reducing pain, enhancing cervical ROM, and decreasing disability compared to conventional physical therapy alone in patients with chronic neck pain.

A controlled randomized trial with a 12-week follow-up investigating the effects of medium-frequency neuromuscular electrical stimulation on pain, VMO thickness, and functionality in patients with knee osteoarthritis

BackgroundOne of the major contributors to disability in Knee osteoarthritis (KOA) patients is weakness in the Quadriceps Femoris muscle. Neuromuscular electrical stimulation (NMES) has been used in rehabilitation for patients suffering from muscle weakness. Thus, the purpose of the study was to assess the effectiveness of NMES and exercise therapy, for improving pain, muscle weakness and function among patients with KOA.MethodsA randomized controlled trial was conducted with 75 female patients diagnosed with KOA. Participants were divided into three intervention groups: NMES-only, exercise therapy (Exs) alone, and a combination of NMES and exercise (NMES + Exs). All patients underwent 12 supervised treatment sessions, three times a week. Outcome measures included pain intensity measured by visual analog scale (VAS), knee flexion range of motion (FROM), thigh muscle girth (TG), thickness of the Vastus Medialis Oblique (VMO), timed up and go test (TUG), six-minute walk test (6MWT), and WOMAC scores. Statistical analyses (ANOVA and Kruskal–Wallis) methods were done to compare the amounts at the baseline, immediately after treatment and after 12 weeks.ResultsThe NMES group exhibited a significant reduction in pain at the 12-week follow-up compared to the other groups(p = 0.022). The NMES + Exs group showed better outcomes in terms of FROM, TG, and VMO thickness post-intervention (p < 0.0001, p < 0.004, p = 0.003, respectively) and at the 12-week follow-up (p < 0.0001, p < 0.0001, p < 0.0001, respectively). Additionally, NMES was superior in improving TUG and 6MWT post-intervention (p < 0.0001, p = 0.038, respectively) and during the follow-up assessments (p < 0.0001, p = 0.029, respectively). The NMES + Exs group achieved better WOMAC stiffness scores at both post-intervention and follow-up evaluations (p < 0.0001, p < 0.0001, respectively). Furthermore, at the 12-week follow-up, NMES + Exs group outperformed the others in WOMAC pain and function subscales (p = 0.003, p = 0.017, respectively), while the NMES group demonstrated better WOMAC total scores compared to the other groups (p = 0.007).ConclusionThe combination of NMES and exercise seems to be an efficient approach for managing KOA, as it enhances knee flexion range and TG, increases VMO thickness, and improves WOMAC scores. On the other hand, NMES alone was found to be effective in improving the physical function of KOA patients.Trial registrationIRCT20101228005486N7 (06–02-2020).

Transphyseal ACL reconstruction and tenodesis in skeletally immature patients demonstrates encouraging clinical scores, without growth disturbance, excessive laxity or re-injury

PurposePaediatric patients demonstrate high re-rupture rates after anterior cruciate ligament reconstruction (ACLR), with numerous surgical techniques proposed to deal with this challenging cohort. This study investigated the early clinical outcomes, complications, return to sport (RTS) and re-rupture rates up until 2-years post-surgery in paediatric patients presenting with open growth plates undergoing transphyseal ACLR that was combined with an extra-articular tenodesis (LET). MethodsBetween October 2017 and September 2020, 20 skeletally immature patients were consecutively recruited and underwent transphyseal ACLR and LET. Patient reported outcome measures (PROMs), KT-1000 laxity, knee range of motion (ROM), maximal isokinetic knee torque and a 3-hop battery were assessed at 6-, 12- and 24-months. Limb Symmetry Indices (LSIs), RTS rates, complications, re-ruptures and re-operations were reviewed. ResultsAll PROMs improved (p < 0.05). No change (p = 0.903) in laxity between limbs was seen, while 18 patients (90%) demonstrated normal (<3 mm) or near normal (3–5 mm) laxity differences. Peak knee flexion ROM improved over time (p = 0.028), while LSIs for knee extensor strength (p < 0.001), the single (p = 0.002) and triple crossover (p = 0.038) hop tests improved. At 24 months, 18 patients (90%) were participating in their pre-injury pivoting sport activities. No complications, growth disturbances, re-injuries or subsequent surgeries were observed. ConclusionsTransphyseal ACLR combined with LET, undertaken in skeletally immature paediatric patients, demonstrated high scoring PROMs, physical performance and RTS overall, without evidence of growth disturbance or excessive graft laxity. No re-injuries have been observed at this time with ongoing review required in this high-risk cohort.

Pulsed Radiofrequency Neuromodulation for Post-Stroke Shoulder Pain in Patients with Hemorrhagic Stroke.

Post-stroke shoulder pain (PSSP) is a common complication that limits the range of motion (ROM) of the shoulder, the patient's rehabilitation and in turn, affects the patients' quality of life (QoL). Several treatment modalities such as sling, positioning, strapping, functional electrical stimulation, and nerve block have been suggested in literatures, however none of the treatments had long-term effects for PSSP. In this study, the authors evaluated clinical efficacy of pulsed radiofrequency (PRF) neuromodulation on the suprascapular nerve for PSSP, and suggested it as a potential treatment with long-term effect. This retrospective case series was conducted at a single center, a private practice institution. From 2013 to 2021, 13 patients with PSSP underwent PRF neuromodulation of the suprascapular nerve. The primary outcome measure was the Visual analog scale (VAS) score. The secondary outcome measurements included the shoulder ROM, Disability assessment scale (DAS), modified Ashworth scale, modified Rankin scale (mRS), and EuroQol-5 dimension-3L questionnaire (EQ-5D-3L) scores. These parameters were evaluated before PRF modulation, immediately after PRF modulation, and every 3 months until the final follow-up visit. Six men and seven women were enrolled, and all patients were followed-up for a minimum of 12 months. The mean VAS score was 7.07 points before PRF neuromodulation and 2.38 points immediately post-procedure. Shoulder ROM for abduction and flexion, DAS for pain, mRS, and EQ-5D-3L demonstrated marked improvement. No complications were reported. PRF neuromodulation of the suprascapular nerve is an effective modality in patients with PSSP, and has long-term effect of pain relief, improvement of QoL.

Comparison of the Post Treatment Outcomes of a Conservative Physiotherapy Protocol for Subacromial Impingement Syndrome in Terms of Acromion Morphology

Objective: The present study aimed to compare the results of a conservative physiotherapy (CP) protocol for subacromial impingement syndrome (SIS) in terms of the morphological types of acromion. Methods: Fifty patients participated in the present study, and they were divided into 3 groups according to the acromion morphology types. A 8-week CP (4-week treatment period at the clinic and, in addition, an exercise program at home for 4 weeks) was applied to all patients. The patients were evaluated in terms of pain (at rest and activity) by the Visual Analog Scale, range of motion (ROM), joint position sense (laser pointer), muscle strength (digital dinamometer), and functionality (the Shoulder Pain and Disability Index, SPADI) before and after the treatment. Result: In the pre- and post-treatment changes (delta), the shoulder flexion angle increased less in the type 3 group than in the type 1 and type 2 groups (p&lt;0.05). In the shoulder abduction angle, there was a similar increase in the type 3 group compared to the type 2 group, while there was less increase in the type 1 group (p&lt;0.05). It was determined that there was more deviation in the change value of shoulder abduction position sense in the type 3 group compared to the other groups (p&lt;0.05). There was no difference between the groups in the change values of pain, muscle strength, or the SPADI score (p &gt; 0.05). Conclusion: Type 3 acromion may have a handicap in improving shoulder flexion and abduction ROM and shoulder abduction position compared to other types.

Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study

BackgroundIt’s difficult to treat segmental tibial fractures (STFs), which are intricate injuries associated with significant soft tissue damage. The aim of this study was to compare the clinical effect of hexaxial external fixator (HEF) and intramedullary nail (IMN) in treatment of STFs.MethodsA total of 42 patients with STFs were finally recruited between January 2018 and June 2022. There were 25 males and 17 females with age range of 20 to 60 years. All fractures were classified as type 42C2 using the Arbeitsgemeinschaftfür Osteosythese/Orthopaedic Trauma Association (AO/OTA) classification. 22 patients were treated with HEF and 20 patients were treated with IMN. The condition of vascular and neural injuries, time of full weight bearing, bone union time and infection rate were documented and analyzed between the two groups. The mechanical medial proximal tibial angle (mMPTA), mechanical posterior proximal tibial angle (mPPTA), mechanical lateral distal tibial angle (mLDTA), mechanical anterior distal tibial angle (mADTA), hospital for special surgery (HSS) knee joint score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle joint score, range of motion (ROM) of flexion of keen joint and ROM of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last clinical visit.ResultsThere were no vascular and neural injuries or other severe complications in both groups. All 22 patients in HEF group underwent closed reduction but 3 patients in IMN group were treated by open reduction. The time of full weight bearing was (11.3 ± 3.2) days in HEF group and (67.8 ± 5.8) days in IMN group(P < 0.05), with bone union time for (6.9 ± 0.8) months and (7.7 ± 1.4) months, respectively(P < 0.05). There was no deep infection in both groups. In the HEF group and IMN group, mMPTA was (86.9 ± 1.5)° and (89.7 ± 1.8)°(P < 0.05), mPPTA was (80.8 ± 1.9)° and (78.6 ± 2.0)°(P < 0.05), mLDTA was (88.5 ± 1.7)° and (90.3 ± 1.7)°(P < 0.05), while mADTA was (80.8 ± 1.5)° and (78.4 ± 1.3)°(P < 0.05). No significant differences were found between the two groups at the last clinical visit concerning HSS knee joint score and AOFAS ankle joint score, ROM of flexion of keen joint and ROM of plantar flexion of ankle joint (P > 0.05). The ROM of dorsal flexion of ankle joint in IMN group was (30.4 ± 3.5)°, better than (21.6 ± 2.8)° in HEF group (P < 0.05).ConclusionIn terms of final clinical outcomes, the use of either HEF or IMN for STFs can achieve good therapeutic effects. While HEF is superior to IMN in terms of completely closed reduction, early full weight bearing, early bone union and alignment. Nevertheless, HEF has a greater impact on the ROM of dorsal flexion of the ankle joint, and much more care and adjustment are needed for the patients than IMN.

Hip and Trunk Variables in University Students with and without Recurrent Low Back Pain.

Low back pain (LBP) is a leading cause of disability. Recurrent low back pain (rLBP) is defined as two or more episodes of LBP in a 12-month period, each lasting more than 24 hours and separated by at least one pain-free month. Many studies have shown that hip and trunk variables have an influence on LBP. However, most of these are studies of participants with acute or chronic LBP rather than rLBP. To examine the difference between hip and trunk variables of university students with and without rLBP. Cross-Sectional. Participants with and without rLBP between 18 and 35 years of age not currently undergoing clinical orthopedic care were recruited for this cross-sectional study. Bilateral hip range of motion (ROM) and trunk ROM were measured with a goniometer or measuring tape (hip motions in all planes along with trunk flexion, extension, and lateral flexion). Strength of the hip extensors, abductors, and external rotators was measured using a handheld dynamometer, and a single-leg bridge endurance test was performed to assess differences and correlations between outcomes. Twenty-six subjects aged 18 to 35 years with rLBP (n=10) and without rLBP (n=16) participated. Statistically significant differences between the two groups were found for right and left hip flexion (p = 0.029 and 0.039, respectively), right hip adduction (p = 0.043), and right hip extension (p = 0.021). No significant differences were found between groups for strength, endurance, or other ROM measures. The findings of this study show statistically significant although clinically non-meaningful differences in hip flexion, extension, and adduction ROM in the rLBP group compared to the control group. This lack of clinically meaningful difference may be relevant to testing procedures and treatment of patients or athletes with rLBP. This study also suggests that hip strength and endurance may not play a major role in the development or treatment of rLBP. Level of Evidence: 3.

Comparison of Multiple Surgical Treatments for Massive Irreparable Rotator Cuff Tears in Patients Younger Than 70 Years of Age: A Systematic Review and Network Meta-analysis

Background: Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis. Purpose: To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients <70 years of age for several patient-reported outcomes, range of motion (ROM), and acromiohumeral distance (AHD). Study Design: Network meta-analysis of comparative studies; Level of evidence, 3. Methods: A systematic review of the literature, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of the MEDLINE, Embase, and Cochrane Library databases was conducted from 2017 to 2022. Inclusion criteria were (1) clinical comparative studies of MIRCTs (with several study-specific criteria); (2) ≥1 outcome of interest reported on, with standard deviations; (3) minimum 1-year follow-up; and (4) mean age of <70 years for both cohorts, without arthritis or pseudoparalysis. There were 8 treatment arms compared. Outcomes of interest were the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, visual analog scale for pain, AHD, and forward flexion and external rotation ROM. A frequentist approach to network meta-analysis with a random-effects model was performed using the netmeta package Version 0.9-6 in R. Results: A total of 23 studies met the inclusion criteria, with 1178 patients included in the network meta-analysis. There was a mean weighted age of 62.8 years, 568 (48.2%) men, with a mean follow-up of 28.9 months. There were no significant differences between groups in regard to sex (P = .732) or age (P = .469). For the ASES score, InSpace balloon arthroplasty (mean difference [MD], 12.34; 95% CI, 2.18 to 22.50; P = .017), arthroscopic bridging graft (aBG) (MD, 7.07; 95% CI, 0.28 to 13.85; P = .041), and long head of biceps augmented superior capsular reconstruction (BSCR) (MD, 5.16; 95% CI, 1.10 to 9.22; P = .013) resulted in the highest P-scores. For the Constant-Murley score, debridement (MD, 21.03; 95% CI, 8.98 to 33.08; P < .001) and aBG (MD, 6.97; 95% CI, 1.88 to 12.05; P = .007) resulted in the highest P-scores. For AHD, BSCR resulted in the highest P-score (MD, 1.46; 95% CI, 0.45 to 2.48; P = .005). For forward flexion ROM, debridement (MD, 45.77; 95% CI, 25.41 to 66.13; P < .001) resulted in the highest P-score, while RSA resulted in the lowest P-score (MD, –16.70; 95% CI, −31.20 to −2.20; P = .024). Conclusion: For patients <70 years with MIRCT without significant arthritis or pseudoparalysis, it appears that graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains, while RSA provides the least benefit in forward flexion.

[Translated article] Immobilisation with compression bandage vs. antebraquial splint in distal radius fractures operated by open reduction and locking plate. Randomised clinical trial

IntroductionCurrently, there is a lack of prospective studies to unify criteria about type and time for postoperative immobilisation in surgical distal radius fractures. The aim of this study is to compare functional and radiological results in two groups of distal radius fractures treated with internal fixation with locking plate, and immobilised with antebrachial splint or compression bandage for 3 weeks. Material and methodA randomised clinical trial was carried out with two parallel groups with 3, 6, and 12 weeks of follow-up. Main and secondary functional variables were measured, such as pain on VAS scale, values on PRWE, DASH and MRS scale, range of motion in flexion–extension, complications, etc. In addition, some radiological variables were measured at preoperative period and one week after surgery, such as union time, dorsal displacement, shortening, ulnar variance, etc. ResultsA total of 62 patients were evaluated: 27 immobilised with bandage and 35 with splint. Analysis of the results obtained showed significant differences in both groups for almost all radiological variables from pre to postoperative period, and for all functional variables from 3 to 12 weeks after surgery. No significant differences were found between the two groups for any of the radiological and functional variables evaluated (VAS 3–12 weeks: p=.584; PWRE 3–12 weeks: p=.248; flexion range of motion 3–12 weeks: p=.959; extension range of motion: p=.50; union time: p=.89). ConclusionsWe do not find clinical or radiological differences between immobilisation with antebrachial splint or compression bandage for distal radius fractures operated with locking plate. A greater number of patients and follow-up are necessary to extrapolate the results to the general population and to establish criteria for good postoperative management of these fractures.

Short-term effectiveness of arthroscopic repair via modified subacromial viewing portal in treatment of Lafosse Ⅰ subscapularis tendon tears

To investigate short-term effectiveness of arthroscopic repair via modified subacromial viewing portal (hereinafter referred to as modified viewing portal) in treatment of LafosseⅠsubscapularis tendon tears. A clinical data of 52 patients with LafosseⅠsubscapularis tendon tears, who underwent the arthroscopic repair via modified viewing portal between October 2020 and November 2022 and met the selective criteria, was retrospectively analyzed. There were 15 males and 37 females with an average age of 63.4 years (range, 41-76 years). Twelve patients had trauma history and the other 40 patients had no obvious inducement. The main clinical symptom was shoulder pain and the hug resistance tests were positive in all patients. The interval between symptom onset and admission ranged from 3 to 26 months (mean, 7.2 months). The shoulder pain and function were evaluated by visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score before operation and at 12 months after operation. The shoulder range of motion (ROM) of forward flexion, abduction, and external rotation and the internal rotation strength were measured before operation and at 3 and 12 months after operation. MRI was performed at 3-6 months after operation to assess the tendon healing and the structural integrity and tension of reattached tendon. Patient's satisfactions were calculated at last follow-up. All incisions healed by first intention, no complication such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.5 months). The VAS, UCLA, and ASES scores at 12 months after operation significantly improved when compared with those before operation ( P<0.05). The ROMs of abduction and forward flexion and the internal rotation strength at 3 and 12 months significantly improved when compared with those before operation ( P<0.05); and the ROMs at 12 months significantly improved compared to that at 3 months ( P<0.05). However, there was no significant difference ( P>0.05) in the ROM of external rotation at 3 months compared to that before operation; but the ROM at 12 months significantly improved compared to that before operation and at 3 months after operation ( P<0.05). Thirty-one patients underwent MRI at 3-6 months, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing; 3 patients underwent tendon re-tear. At last follow-up, 41 patients (78.8%) were very satisfied with the effectiveness, 7 were satisfied (13.5%), and 4 were dissatisfied (7.7%). Arthroscopic repair via modified viewing portal for Lafosse Ⅰsubscapularis tendon tears, which can achieve the satisfactory visualization and working space, can obtain good short-term effectiveness with low overall re-tear risk.

Effects of scapular stabilization program on pain, range of motion, and disability in patients with chronic non-specific neck pain

Objectives: The objective of this study was to analyze the impacts of the scapular stabilization program (SSP) on pain, range of motion (ROM), and disability in chronic non-specific neck pain (NNP). Methods: It was a randomized clinical trial. The study was conducted at University Medical Centre, Lahore. According to eligibility criteria, 28 participants were randomly allocated to the experimental and control groups through the lottery method. While the control group received only relaxation exercises, the experimental group received SSP exercises along with the relaxation exercises on the cervicoscapular region. Three sessions of 45 min each, three times/week, on alternating days for three weeks were given. The outcome measures for pain, ROM, and disability were the numeric pain rating scale (NPRS), goniometer, and neck disability index (NDI), respectively. These were assessed before the intervention and at the end of the third week. Results: The mean age of Groups A and B was 24.76 ± 4.53 and 27.76 ± 4.62, respectively. Within-group analysis of NPRS, NDI, and cervical flexion and extension ROM showed significant improvement in both groups. Between-group analysis showed post-treatment NPRS (P = 0.000), NDI (P = 0.000), cervical flexion (P = 0.004), and extension (P = 0.000). A significant improvement (P &lt; 0.05) in pain, disability, and flexion and extension was observed in the experimental group. Conclusion: Both groups showed improved outcomes, but a significant difference was found in the control and experiment groups. The trial concluded that in treating NNP, the SSP effectively alleviates pain and improves disability and mobility.

Baseplate inferior offset affects shoulder range of motion in reverse shoulder arthroplasty in Asian population

BackgroundImpingement is a common complication of reverse shoulder arthroplasty. Placement of the baseplate with a wide impingement-free angle is ideal; however, there are few studies on Asian populations, which have smaller height and physique, and there is a lack of guidance on achieving optimal outcomes. The purpose of the present study was to explore the impingement-free range of motion reverse shoulder arthroplasty and analyze the suitable baseplate position or tilt for the Asian population using simulation software.MethodsWe uploaded computed tomography scan data from 20 Asian patients to three-dimensional (3D) simulation software. The implantation of the reverse shoulder arthroplasty component was performed on the 3D humerus and scapula using software, and range of motion was assessed until impingement occurred.ResultsThe range of motion in flexion significantly improved when the baseplate was lowered up to 3 mm inferiorly. Range of motion in abduction and internal and external rotation significantly improved as the baseplate was lowered up to 4 mm. There was no significant difference in range of motion in any motion after changing the inferior tilt, except in internal and external rotation.ConclusionsThe range of motion in abduction, flexion, and internal and external rotations significantly improved with increased inferior offset. These results may prove valuable in determining the optimal baseplate position for RSA, particularly in Asian populations.

Effects of manual lymphatic drainage on total knee replacement: a systematic review and meta-analysis of randomized controlled trials

BackgroundTotal knee joint replacement (TKR) is an effective method for the treatment of severe knee osteoarthritis. With an increasing number of surgeries, complications such as lower limb edema, pain, and limited mobility have caused a heavy burden. Manual lymphatic drainage (MLD) may be a solution to solve the problem. The study aims to evaluate the efficacy of MLD in reducing knee edema, pain, and improving range of motion (ROM) in patients after TKR.MethodsA search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIPs, WanFang database, and Google Scholar from inception to June 2023. Only randomized controlled trials (RCTs) that compared the effects of MLD and non-MLD (or another physiotherapy) on improving knee edema, pain, and ROM after TKR were included. Stata 16.0 was used for meta-analysis. GRADE was used to assess the quality of evidence.ResultsIn total, 7 RCTs with 285 patients were identified. There were no significant differences found in the ROM of knee flexion (standardized mean difference (SMD) = 0.03, 95% confidence interval (CI): -0.22, 0.28, P = 0.812) and the ROM of knee extension (SMD= -0.30, 95%CI: -0.64, 0.04, P = 0.084). No differences were observed in the lower extremity circumference after TKR (SMD= -0.09, 95%CI: -0.27, 0.09, P = 0.324). For postoperative pain, there was no significant advantage between the MLD and non-MLD groups (SMD= -0.33, 95%CI: -0.71, 0.04, P = 0.083).ConclusionsBased on the current evidence from RCTs, manual lymphatic drainage is not recommended for the rehabilitation of patients following total knee replacement.