Range Of Motion Parameters Research Articles

Clinical Application of 3D-Assisted Surgery Techniques in Treatment of Intra-Articular Distal Radius Fractures: A Systematic Review in 718 Patients.

Objectives: Three-dimensional (3D) technology is increasingly applied in the surgical treatment of distal radial fractures and may optimize surgical planning, improve fracture reduction, facilitate implant and screw positioning, and thus prevent surgical complications. The main research questions of this review were as follows: (1) "How do 3D-assisted versus 2D-assisted distal radius fracture surgery compare in terms of intraoperative metrics (i.e., operation time and fluoroscopy frequency)?", and (2) "What are the effects of 3D-assisted versus 2D-assisted surgery on postoperative outcomes (patient-reported outcome measures (PROMs), range of motion (ROM), fracture reduction, complication rate, and screw placement accuracy)?" Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. In total, 873 articles were found between 1 January 2010 and 1 April 2024, of which 12 (718 patients) were suitable for inclusion. The quality of the studies, assessed using the McMaster quality assessment, ranged from moderate to excellent, although the surgical techniques and outcome measures varied widely. Articles comparing a 3D group to a 2D group (conventional imaging) and reporting on primary or secondary outcomes were included in the analysis, for which weighted means and ranges were calculated. Results: Three different concepts of 3D-assisted surgery techniques were identified: (1) 3D virtual surgical planning (VSP), (2) 3D-printed handheld models, and (3) 3D intraoperative guides. Differences between 3D-assisted and conventional 2D-assisted surgery were evaluated. Regarding intraoperative metrics, 3D-assisted surgery significantly reduced operation time by 6 min (weighted mean 66.9 versus 73.2 min) and reduced the fluoroscopy frequency by 1.1 images (5.8 versus 4.7 times). Regarding postoperative outcomes, the weighted mean of the DASH score differed between the 3D- and 2D-assisted groups (17.8 versus 23.9 points), and no differences in PRWE or VAS score were found. Furthermore, our results showed no significant differences in the ROM and fracture reduction parameters. In terms of complications, the application of 3D-assisted surgery decreased the complication rate from 10.7% to 3.6%, and the use of screws with appropriate lengths improved from 75% to 86%. Conclusions: Applications of 3D-assisted surgery in distal radial fracture surgery can slightly reduce the operation time and fluoroscopy frequency. Evidence for the improvement of fracture reduction and functional outcomes is still lacking, although it likely reduces the complication rate and improves the use of appropriate screw lengths.

Evaluating transosseous anchorless repair for arthroscopic rotator cuff surgery: a comparative study with double row anchor repair

Background: This retrospective observational study aimed to compare the outcomes of arthroscopic rotator cuff surgery using double row anchor repair (DRR) versus transosseous anchorless repair (TAR) in patients with small to large full-thickness rotator cuff tears.Methods: A total of 42 patients underwent either DRR (n=20) or TAR (n=22) between January 2022 and May 2023. Patients were matched based on age, sex, body mass index, and tear severity to ensure comparability. Baseline demographics, including age, sex distribution, diabetes mellitus, smoking status, and Cofield full-thickness tear classification, were compared between the two groups. Functional outcomes were assessed using the University of California, Los Angeles and American Shoulder and Elbow Surgeons scores, as well as range of motion (ROM) parameters including forward flexion (FF), extension (EXT), internal rotation (IR), external rotation (ER), and abduction (AB). Independent t-tests and chi-square tests were used to compare continuous and categorical variables, respectively, with a significance level set at P<0.05.Results: The two groups showed similar baseline characteristics with no significant differences in age, sex distribution, smoking status, or tear classification (P>0.05 for all). At 3- and 6-month post-surgery, TAR demonstrated significantly higher ULCA scores compared to DRR (3 month: TAR, 23.82 vs. DRR, 22.30, P<0.001; 6 month: TAR, 8.18 vs. DRR, 26.60, P<0.001). Similarly, TAR showed superior ASES scores at 3 months (TAR, 67.55 vs. DRR, 64.49; P=0.025) and 6 months (TAR, 95.33 vs. DRR, 91.48; P<0.001). However, these differences had decreased by the 1-year follow-up, at which time there were no significant disparities in ULCA (TAR, 28.95 vs. DRR, 28.40; P=0.101) or ASES scores (TAR, 96.19 vs. DRR, 95.09; P=0.051). There were no statistically significant differences in ROM parameters between the groups at the 1-year follow-up (P>0.05 for FF, EXT, IR, ER, AB).Conclusion: The DRR and TAR techniques resulted in comparable outcomes regarding baseline characteristics and 1-year functional recovery in patients undergoing arthroscopic rotator cuff repair for medium to large tears. TAR showed early advantages in functional scores at 3- and 6-months post-surgery, suggesting potential benefits in the initial recovery phase. These findings can aid the practitioner in selecting appropriate surgical techniques based on individual patient needs and expectations.Level of evidence: III.

Design and Development of Automated Lower Limb Continuous Passive Motion (CPM) Machine

Abstract: Post-operative rehabilitation is critical in orthopedic surgery, especially for hip joint surgeries. Traditional therapies like manual exercises and resource limits in rehabilitation centers might be tough, but early mobilization and rehabilitation are critical for regaining joint function and allowing patient return to normal activities. Continuously Passive Motion (CPM) devices, primarily developed for knee joint rehabilitation, offer a non-invasive method for passive joint mobility, restoring joint range of motion and lowering post-operative stiffness risk. Their application in hip joint healing is gaining pace, offering better results and increased patient satisfaction. The research also investigates abduction mobility in the hip joint, which is necessary for daily actions like stepping to the side, getting out of bed, or exiting a car. Understanding hip joint biomechanics and range of motion parameters is vital for establishing efficient rehabilitation approaches. By merging clinical insights with technology innovations, this research intends to optimize post-surgery rehabilitation regimens, enhancing patient outcomes and quality of life. The subject of orthopedic rehabilitation continues to expand through interdisciplinary collaboration and innovation, bringing new choices for enhancing patient care and recovery trajectories.

Effects of acupuncture on pain and function in patients with subacromial impingement syndrome: A randomized sham-controlled trial

BackgroundSubacromial impingement syndrome (SIS) is the most common cause of shoulder pain. Acupuncture is a traditional medicine that is effective on pain. This study aimed to evaluate the effect of acupuncture treatment on pain, function, range of motion (ROM) and quality of life compared to sham acupuncture in patients diagnosed with SIS. MethodsA randomized, prospective, double-blinded, sham-controlled trial was conducted. In acupuncture group 40 participants received acupuncture treatment plus exercise therapy while in control group 40 participants received sham acupuncture plus exercise therapy. Primary outcomes included pain-rest, activity and night pain. Secondary outcomes included function [Shoulder Pain and Disability Index (SPADI) and The Disabilities of the Arm, Shoulder and Hand Score (Quick DASH)], ROM, and quality of life [The Western Ontario Rotator Cuff Index (WORC)] in patients with SIS. ResultsBoth groups had significant improvements for pain-rest, activity night pain scores, SPADI, Quick DASH and WORC after treatment and at the first month follow-up. Significant improvements were recorded in the acupuncture group for all ROM after treatment and at the first month follow-up while in control group only in passive internal rotation. Acupuncture group had better improvements for Quick DASH, WORC and all ROM parameters after the treatment, as well as for all parameters except pain-night and passive flexion at the first month follow-up. ConclusionThis study suggest that acupuncture treatment is a safe, effective and non-invasive treatment option in patients with SIS. Trial registrationThe study protocol is registered at clinicaltrials.gov (NCT05794633).

3D kinematics of tibiotalar motion in patients with mobile bearing and fixed bearing total ankle arthroplasty: In vivo videofluoroscopic feasibility study

BackgroundAs total ankle arthroplasty (TAA) is an increasingly common surgical intervention for patients with end-stage ankle arthritis, there is a need to better understand the dynamic performance of prosthetic implants during activities of daily living. Our purpose was to quantify and compare relative tibiotalar motion during gait in persons with a fixed-bearing (FB) and mobile-bearing (MB) total ankle arthroplasty. We hypothesized a FB prosthesis would have lower tibiotalar range of motion (ROM). MethodsPatients at least 12 months postoperative with either a FB (n=5) or MB (n=3) total ankle arthroplasty were tested. We used high-speed biplanar videoradiography to quantify tibiotalar kinematics during self-selected gait. Angular and linear ROM in three axes were compared between the groups. ResultsROM for dorsiflexion-plantarflexion, internal-external rotation, and inversion-eversion angles in FB subjects averaged 7.47±4.05°, 7.39±3.63°, and 4.51±2.13°, respectively. ROM in MB subjects averaged 6.74±2.04°, 6.28±4.51°, and 5.68±2.81°, respectively. Linear ROM along anteroposterior, mediolateral, and superior-inferior axes in FB subjects averaged 1.47±2.07 mm, 1.13±1.49 mm, and 0.28±0.30 mm, respectively. Linear ROM in MB subjects averaged 0.68±1.44 mm, 0.60±1.41 mm, and 0.20±0.13 mm, respectively. We found no significant difference between the two groups for any of these ROM parameters (p>0.05). ConclusionTotal ankle arthroplasty using either FB or MB design appears to confer similar ankle motion during the gait cycle in this biplanar fluoroscopic model. Level of evidenceLevel IV, case series.

Reconsidering the Gold Standard for the Assessment of Spastic Equinus Foot.

To determine whether differences exist in the measured range of motion (ROM) by the goniometer, equinometer, and 3-dimensional (3D) gait analysis in different settings (under general anesthesia (GA) or in the clinic) among patients with cerebral palsy. A prospective comparative cohort study was conducted at our orthopaedics center, where 15 patients with diplegic cerebral palsy (30 limbs) were evaluated, all of whom had Gross Motor Function Classification System (GMFCS) level I and II. ROM was measured by (1) goniometer under GA (benchmark), (2) goniometer analysis during clinical examination, (3) equinometer under GA, (4) equinometer in the clinic, and (5) 3D gait analysis. ROM was measured during both knee flexion and extension. Subgroup analysis based on the GMFCS level was performed. Nine patients were male with GMFCS level I and a mean age of 14.3 (SD=7.2) years. Statistically significant differences were noted between all studied measurement techniques in terms of ROM, dorsiflexion, and plantarflexion during both knee flexion and extension. The GMFCS level was an effect modifier of ROM measurements. The ROM parameters during both knee flexion and extension differed from one measurement device/technique to another. The GMFCS level played a notable effect-modifying role on the ROM parameters.

Comparison of anatomic total shoulder arthroplasty outcomes in younger and older patients with primary glenohumeral arthritis

BackgroundElective shoulder arthroplasty is commonly performed in elderly patients with end-stage arthritis. However, a significant number of young patients also undergo this procedure. The surgical outcomes for young patients are not extensively studied compared to older patients. This study aimed to assess the short-term outcomes of anatomic total shoulder arthroplasty (aTSA) in patients aged 18-50 years with primary glenohumeral arthritis and compare them to patients aged 65-75 years. MethodsA retrospective review was conducted on aTSA procedures performed for glenohumeral arthritis at a single hospital system between January 1st, 2005, to September 15th, 2023. Patients aged 18-50 years with a minimum 2-years of follow-up were compared to a cohort of patients aged 65-75 years. Data included range of motion and patient-reported outcome measures (Disabilities of the Arm, Shoulder, and Hand [DASH], American Shoulder and Elbow Surgeons, Simple Shoulder [SS], and Visual Analog Scale pain scores), which were compared between the two groups preoperatively and at final follow-up. ResultsThe younger group included 19 shoulders with a mean age of 44.2 ± 6.4 years at the time of surgery and a mean follow-up of 3.9 ± 1.9 years. The older group included 27 shoulders with a mean age of 70.3 ± 3.0 years at the time of surgery and a mean follow-up of 2.5 ± 0.8 years. The younger group failed to show improvements in all range of motion parameters at final follow-up, while the older group demonstrated improvement in range of motion for all measures. The older group had superior forward elevation and abduction at final follow-up. Both groups exhibited improvements in pain and shoulder function at final follow-up. The younger group did not show significant improvement in DASH scores at final follow-up. Preoperatively, the older group had significantly better DASH and SS scores compared to the younger group. The older group had significantly better DASH, American Shoulder and Elbow Surgeons, SS, and pain scores at final follow-up compared to the younger group. DiscussionBoth groups experienced significant improvement in pain and subjective outcome measures after a 2-year follow-up. Despite this, the younger cohort had worse shoulder range of motion outcomes and lower function and higher pain scores than the older cohort. Nonetheless, aTSA remains a valuable treatment option for young patients in the short-term. However, it is crucial to consider that younger patients may experience dissatisfaction and receive less pain relief compared to older patients, and these factors should be considered when determining the suitability of this treatment approach.

Efficacy of Integrated Neuromuscular Inhibition Technique on Pain and Range of Motion in Patients with Upper Trapezius Triggers Point: A Literature Review

Introduction: Myofascial Pain Syndrome (MPS) is current musculoskeletal pain disorder that affects the majority of chronic pain population. Myofascial Trigger Points (MTrPs) are hyperexcitable spots in a tight band within the skeletal muscle, which ache upon shortening, elongating and manifest referred pain. Integrated Neuromuscular Inhibition Technique (INIT) is a single coordinated technique, which is used to decrease the pain intensity, increase the function and range of motion due to the increased blood supply by intermittent pressure, muscle relaxation by strain-counter strain and tone reduction by muscle energy technique. Thus, the review of literature was suggested to explore the efficacy of techniques like INIT on pain and range of motion parameters. Aim: To evaluate the current literatures on the efficacy of INIT on pain and range of motion in patients with upper trapezius trigger point. Materials and Methods: A literature review was conducted from December 2023 to February 2024, using PubMed, the Cochrane Library, and PEDro databases to identify studies on the Integrated Neuromuscular Inhibition Technique (INIT) in patients with upper trapezius trigger points. Seven articles meeting inclusion criteria were selected for detailed analysis to evaluate INIT’s effects on pain and range of motion in this population. Results: From the initial search of PubMed, the Cochrane Library, and PEDro databases, seven articles met inclusion criteria for analysis. Among these, four studies reported positive outcomes for the Integrated Neuromuscular Inhibition Technique (INIT) in treating upper trapezius trigger points. INIT interventions consistently improved pain levels and range of motion, indicating its efficacy in managing myofascial pain syndromes in this muscle group. Conclusion: An integrated strategy, INIT is proved to be effective in reducing pain and improving quality of life in patients with non specific neck pain, stiffness, and enhancing functionality.

Higher femoral head–to–femoral neck ratio are associated with limited range of motion of hip joints in hereditary multiple exostosis patients

Hip involvement is one of the most common skeletal manifestations of hereditary multiple exostoses (HME) in 30-90% of the patients. The anatomical changes in the proximal femur in patients with HME, may lead to deformities and related functional deficits. Its effect on the range of motion (ROM) of the hip joint is not well described. The aim of this study was to evaluate the role of hip deformity of HME disease in the ROM of the hip joint. It was hypothesized that certain morphological parameters affect the ROM of the hip joint. Conclusively, 44 patients including 27 men and 17 women (88 hips) were evaluated. Hips are divided in Group 1 (no ROM limitation group) and Group 2 (ROM limitation group). The head-neck ratio (HNR), center edge angle (CE), Sharp’s acetabular angle (SAA), alpha angle (AA), neck shaft angle (NSA) and ROM parameters were measured. The correlations between radiological parameters (SAA, CE, NSA, AA and HNR), and the ROM data (F, E, Abd, Add, IR and ER) were statistically evaluated. All evaluated parameters (SAA, CE, NSA, AA) except the HNR do not show significant differences between study group 1 (no ROM limitation group) and group 2 (ROM limitation group). The means of the HNR in group 1 were significantly higher than those in group 2 (HNR: 1.23 vs. 0.92, p<0.001). In group 2 HNR showed a strong positive correlation with Abd (PC 0.72, p<0.001), E (PC 0.7, p<0.001), ER (PC 0.67, p<0.001), IR (PC 0.67, p<0.001) and F (PC 0.66, p<0.001). HME patients with hip involvement have better ROM of the hip joint, if they have the higher HNR. Additionally, a positive correlation between HNR and ROM capacity was determined.

Comparison of the effectiveness of instrument-assisted soft tissue mobilization and extracorporeal shock wave therapy in myofascial pain syndrome.

To compare the effectiveness of instrument-assisted soft tissue mobilization (IASTM) and extracorporeal shock wave therapy (ESWT) used in myofascial pain syndrome (MPS) and to determine whether they are superior to conservative treatment (CT). A total of 42 female patients (aged 18-60 years) diagnosed with MPS were enrolled and randomly assigned to either the CT (n = 14), CT+IASTM (n = 14), or CT+ESWT group (n = 14). All of the groups received treatment for 3 weeks (CT: 5 sessions per week, 15 sessions in total, ESWT and IASTM: 2 sessions per week, 6 sessions in total). Neck stretching exercises were given to all of the patients as a home program. The pain intensity of the patients was determined using the visual analog scale (VAS). The pressure pain threshold (PPT) was measured with an algometer. Cervical joint range of motion (ROM) was measured with a cervical ROM (CROM) device. Pain, cervical disability, quality of life, and sleep disturbances were evaluated with the Neck Outcome Score (NOOS). Depression and anxiety parameters were evaluated with the Hospital Anxiety and Depression Scale (HADS). Evaluations were made before treatment and 3 days after the last treatment session. The CT+IASTM group was more successful than the other groups in terms of pain intensity, PPT, and improvements in the ROM parameters (p < 0.05). No significant difference was found between the NOOS and HADS scores of the groups when the posttreatment changes were compared to pretreatment (p > 0.05). All 3 of these treatments can be used to alleviate the negative effects of MPS. IASTM treatment can be preferred primarily in the creation of combined treatment programs for patients with ROM limitations and low PPTs.

Kinetic and Kinematic Analysis of Gait Termination: A Comparison between Planned and Unplanned Conditions

Purpose: Gait termination (GT) is the transition from steady-state walking to a complete stop, occurring under planned gait termination (PGT) or unplanned gait termination (UGT) conditions. This study aimed to investigate the biomechanical differences between PGT and UGT, which could help develop therapeutic interventions for individuals experiencing difficulty with GT. Methods: Twenty healthy adults performed three walking trials, followed by PGT and UGT trials. Gait termination was analyzed in three phases as follows: Phase 1 (pre-stopping), Phase 2 (initial stopping phase), and Phase 3 (terminal stopping phase). Spatiotemporal, kinematic, and kinetic data during each phase were compared between conditions. Results: The GT time and GT step length were significantly different between the PGT and UGT trials. Ankle range of motion (ROM) demonstrated significant differences in Phase 1, with the PGT having a slightly lower ankle ROM than the UGT. In Phase 2, the hip, knee, and ankle ROM exhibited significant differences between the conditions. Finally, in Phase 3, UGT showed reduced hip ROM but increased knee ROM and kinetic parameters compared to PGT. Conclusion: Our results indicate that the ankle joint primarily contributes to deceleration during the initial preparation for generating braking force during PGT. Conversely, UGT reveals disrupted kinesthetic control due to instability, leading to a preference for a hip and knee strategy to absorb force and control the center of mass for a safe and rapid GT in response to unexpected stimuli. These findings provide valuable insights into the biomechanical mechanisms underlying body stability during GT and may contribute to the development of effective rehabilitation strategies for individuals with gait impairment.

Comparison of Corticosteroids vs Conventional Physical Therapy for Management of Adhesive Capsulitis

Objective: To compare the role of corticosteroids and conventional physical therapy for management of adhesive capsulitis Methodology: This comparative study was conducted in Orthopedic Department, Combined Military Hospital Abbottabad. March 2022 to February 2023. Patient of active adhesive capsulitis of shoulder joint diagnosed by orthopedic surgeon were recruited. Patients in group A received single shot of methylprednisolone with local anesthesia with in the joint cavity while group B received conventional physical therapy at rehab department of our hospital. Pain scores via visual analogue scale and range of motion via goniometer was compared in both groups at baseline and at 8 weeks of treatment. Results: A total of 160 patients of adhesive capsulitis were recruited. Mean age was 42.55±10.96 years. 70 (43.7%) patients were female while 90 (56.3%) were male. Baseline pain scores and range of motion parameters were not statistically significant between the two comparison groups. At the end of 8 weeks mean pain scores were statistically significantly low in patients who took intra-articular corticosteroids as compared to those who underwent physiotherapy sessions (p-value&lt;0.001). Range of motion parameters were also statistically significantly better in patients who took corticosteroids as compared to those who underwent physiotherapy (p-value&lt;0.001). Conclusion: Use of corticosteroids emerged as a better option for treatment of pain and restricted range of motion in patients of adhesive capsulitis when compared to routine physiotherapy offered in our clinical settings. Keywords: Adhesive Capsulitis; Corticosteroids; Efficacy; Physiotherapy

Abstract P4-07-43: Effect of acupuncture and exercise therapy in rehabilitation of physical disfunctions in breast cancer survivors: randomized clinical trial

Abstract Introduction: The treatment of breast cancer can trigger physical dysfunctions and psychological difficulties such as pain, depression, limitation of upper limb function and shoulder range of motion (ROM) deficits. Exercise therapy is a treatment well established in the literature for these disorders and another form of treatment is acupuncture. However, most studies using acupuncture only assess pain. Objective: To compare three distinct rehabilitation treatments (exercise therapy, acupuncture and Stiper®) in women undergoing breast cancer surgery, assessing pain, depression, upper limb function and range of motion parameters (ROM). Methods: Seventy-nine women with pain above 3 on the visual analogue pain scale (VAS) and with more than 90 days of surgery were included. They were divided into three groups that received weekly treatment for 10 weeks: group I (G1) treated with standard, pre-defined exercise therapy, based on stretching of the cervical muscles, shoulder girdle and shoulder ROM exercises with a duration of 30 minutes, group II (G2) treated with 30 minutes of acupuncture using predefined points and group III (G3) treated with the same acupuncture points as group II, however, using the Stiper ® (silicon oxide micronized quartz pellet) in place of needles. Results: Sixty-seven patients completed the treatment, being 26 from G1, 23 from G2 and 18 from G3. There was an improvement of pain over time in all groups (first session compared with the fifth (p &amp;lt; 0.001) and with the tenth (p &amp;lt; 0.001), but not between groups. There was a statistically significant difference in depressive symptoms using the Beck questionnaire over time in the three groups (between the first and tenth sessions (p = 0.001), between the first and fifth sessions (p = 0.052), but not between groups. Regarding the DASH questionnaire for shoulder function, there were significant differences overtime at all evaluated moments (p&amp;lt; 0.001), but not between groups. There was a statistically significant difference in ROM over time in the three groups, but not between groups. Conclusion: The rehabilitation of physical dysfunctions in women who survived breast cancer through exercise therapy, acupuncture and Stiper® in pain, depression, upper limb function and ROM, proved to be effective, without statistically difference between the groups, which in leads to the conclusion that acupuncture don’t showed the superiority of results when compared with exercise therapy, thus being an effective approach in the rehabilitation of these women. Citation Format: Patricia Santolia, Gil Facina, Cinira Haddad, Afonso Nazário, Samantha K. Lopes de Almeida Rizzi, Simone Elias. Effect of acupuncture and exercise therapy in rehabilitation of physical disfunctions in breast cancer survivors: randomized clinical trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-43.

Retracted: Efficacy of Posterior Cervical Laminectomy and Decompression plus Lateral Mass Screw-Rod Internal Fixation in the Treatment of Multisegment Cervical Spinal Canal Stenosis and Effects on Cervical Curvature and Range of Motion Parameters.

[This retracts the article DOI: 10.1155/2021/6001877.].

Does glenohumeral offset affect clinical outcomes in a lateralized reverse total shoulder arthroplasty?

Reverse total shoulder arthroplasty (rTSA) exhibits high rates of success and low complication rates. rTSA has undergone numerous design adaptations over recent years, and lateralization of implant components provides theoretical and biomechanical benefits in stability and range of motion (ROM) as well as decreased rates of notching. However, the magnitude of implant lateralization and its effect on these outcomes is less well understood. The purpose of this study was to evaluate how increasing glenohumeral offset affects outcomes after rTSA, specifically in a lateralized humerus+medialized glenoid implant model. Primary rTSA using a lateralized humeral+medialized glenoid implant model performed at a single academic institution between 2012 and 2018 were retrospectively reviewed. Patient-reported outcome (PRO) parameters and clinical outcomes including ROM were evaluated both pre- and postoperatively. Pre- and postoperative radiographs were analyzed for measurement of glenohumeral offset, defined as the acromial-tuberosity offset (ATO) distance on the anteroposterior radiograph. A total of 130 rTSAs were included in the analysis, with a mean follow-up of 35 mo. The mean postoperative absolute ATO was 16 mm, and the mean delta ATO (difference from pre- to postoperatively) was 4.6 mm further lateralized. Among all study patients, improvements in all ROM parameters and all PROs were observed from pre- to postoperative assessments. When assessing for the effects of lateralization on these outcomes, multivariate analysis failed to reveal a significant effect from the absolute postoperative ATO or the delta ATO on any outcome parameter. rTSA using a lateralized humeral+medialized glenoid implant model exhibits excellent clinical outcomes in ROM and PROs. However, the magnitude of lateralization as measured radiographically by the ATO did not significantly affect these outcomes; patients exhibited universally good outcomes irrespective of the degree of offset restoration.

Prospective Analysis of Functional and Structural Changes in Patients with Spinal Muscular Atrophy-A Pilot Study.

Spinal muscular atrophy (SMA) is a rare, autosomal recessive neuromuscular disease. Recent years have seen a significant development of therapeutic options for SMA patients. With the development of treatment methods, it has become necessary to adapt a physiotherapeutic approach to the evolving clinical picture of SMA patients. We presented an analysis of 40 SMA patients undergoing pharmacological treatment, examined twice in an average interval of 5 months. Twelve patients (non-sitters) were evaluated using CHOP-INTEND, while 28 (sitters) were tested using the Hammersmith scale. The research protocol consisted of measurements of upper and lower limb ranges of motion, and four tests for early detection of musculoskeletal changes. Both non-sitters and sitters patients showed motor improvement between the first and second examinations. Favorable changes in range of motion parameters were noted in most children, except for hip extension (HE) range, which deteriorated. An association was also observed between scale scores and the presence of contractures in the hip and knee joints depending on the group studied. Our findings showed that the presence of contractures at the hip and knee joint negatively affected functional improvement as measured by the scale scores.

Early Joint Use Following Elbow Dislocation Limits Range-of-Motion Loss and Tissue Pathology in Posttraumatic Joint Contracture.

Simple elbow dislocation occurs at an incidence of 2.9 to 5.21 dislocations per 100,000 person-years, with as many as 62% of these patients experiencing long-term elbow joint contracture, stiffness, and/or pain. Poor outcomes and the need for secondary surgical intervention can often be prevented nonoperatively with early or immediate active mobilization and physical therapy. However, immobilization or limited mobilization may be necessary following trauma, and it is unknown how different periods of immobilization affect pathological changes in elbow joint tissue and how these changes relate to range of motion (ROM). The purpose of this study was to investigate the effects of varying the initiation of free mobilization on elbow ROM and histological features in an animal model of elbow posttraumatic joint contracture. Traumatic elbow dislocation was surgically induced unilaterally in rats. Injured forelimbs were immobilized in bandages for 3, 7, 14, or 21 days; free mobilization was then allowed until 42 days after injury. Post-mortem joint ROM testing and histological analysis were performed. One-way analysis of variance was used to compare ROM data between control and injured groups, and Pearson correlations were performed between ROM parameters and histological outcomes. Longer immobilization periods resulted in greater ROM reductions. The anterior and posterior capsule showed increases in cellularity, fibroblasts, adhesions, fibrosis, and thickness, whereas the measured outcomes in cartilage were mostly unaffected. All measured histological characteristics of the capsule were negatively correlated with ROM, indicating that higher degrees of pathology corresponded with less ROM. Longer immobilization periods resulted in greater ROM reductions, which correlated with worse histological outcomes in the capsule in an animal model of posttraumatic elbow contracture. The subtle differences in the timing of ROM and capsule tissue changes revealed in the present study provide new insight into the distinct timelines of biomechanical changes as well as regional tissue pathology. This study showed that beginning active mobilization 3 days after injury minimized posttraumatic joint contracture, thereby supporting an immediate-motion clinical treatment strategy (when possible). Furthermore, uninjured but pathologically altered periarticular tissues near the injury location may contribute to more severe contracture during longer immobilization periods as the disease state progresses.

Efficacy of rectus femoris stretching on pain, range of motion and spatiotemporal gait parameters in patients with knee osteoarthritis: a randomised controlled trial

ObjectiveThis study aimed to investigate the efficacy of rectus femoris stretching on pain intensity, knee range of motion (ROM), spatiotemporal gait parameters and function in patients with knee osteoarthritis (KOA).MethodsThis...

Early-Term Results of the Cadence Total Ankle Prosthesis: An European Noninventor Study.

Although considerable literature can be found on the outcome of total ankle replacement (TAR), only a few studies have reported the results of the fixed-bearing Cadence prosthesis. This noninventor study reports a consecutive series of 60 Cadence TAR systems with a mean of 2.9 years' follow-up, focusing on clinical and radiographic outcomes and early complications. This study is the first to assess true postoperative radiographic ankle prosthesis range of motion (ROM) and to report an unanticipated serious adverse device effect. Sixty patients who underwent primary TAR with the Cadence prosthesis between July 2016 and July 2019 were clinically and radiographically evaluated preoperatively and at last follow-up after the procedure. Revisions, additional procedures, implant failure, and complications were reported according to the classifications of Vander Griend and Glazebrook. Radiographic outcomes included radiographic TAR ROM, bone-implant interface, and alignment parameters. The survival rate of the prosthesis was 98.3%. The mean radiographic ankle ROM at the last follow-up was 24 degrees (9 degrees of dorsiflexion and 15 degrees of plantarflexion). The coronal and sagittal alignment of TAR was 90.8 degrees and 3.9 degrees, respectively. Bone-implant interface analysis revealed osteolysis in 9 ankles (15%) and radiolucent lines in 33 ankles (55%) occurring at both component interfaces. Intraoperative complications were 3 periprosthetic malleolar fractures (5%). Five talar implant fractures (implant failure of 8.3%) were observed, and 1 unexplained persistent pain that required a conversion from TAR to a tibiotalocalcaneal arthrodesis. Clinical, radiograph ROM, implant position outcomes, and survival rate at an early-term follow-up of 2.9 years were similar to those reported in recent Cadence studies. However, this study reports 5 unanticipated talar implant fractures and a high rate of posterior radiolucent lines. Level IV, retrospective case series.

81. Mobility parameters in two level-lumbar TDR vs hybrid construct: clinical results in 235 patients

<h3>BACKGROUND CONTEXT</h3> Lumbar total disc replacement (TDR) is a treatment option with 30 years experience and extensive publications on clinical results. However, there are few publications on mid- and long-term mobility. There is also sparse literature on the quality of mobility or the difference between L4-S1 2-level TDR vs TDR/ALIF hybrid constructs. <h3>PURPOSE</h3> To measure mobility parameters in flexion-extension for two groups (L4-S1 TDR vs hybrid); compare motion at L4–L5; participation of pelvis mobility; global lumbar motion; and flexion-extension effectiveness by measuring L1 race. Besides determining the difference of mobility between TDR and hybrid, we discussed potential compensations above and below L5-S1 fusion/L4-L5 TDR, as compared to two-level TDR. <h3>STUDY DESIGN/SETTING</h3> Retrospective clinical study. <h3>PATIENT SAMPLE</h3> This study included 235 patients, operated between 2003-2013: 170 patients received 2-level TDR (TDR group) and 65 received L4-L5 TDR and L5-S1 ALIF (hybrid group). <h3>OUTCOME MEASURES</h3> Data collected included radiographic, neurological/physical assessment, self-evaluation using the Oswestry Disability Index (ODI) and visual analog back and leg pain scores (VAS). Complication, reoperation/revision rates, and perioperative data points were also assessed. <h3>METHODS</h3> Both groups were equivalent in age, body habitus and preoperative clinical parameters (ODI, VAS). Patient selection for evaluation was based on presence of clinical success criteria and pre- and postoperative sagittal X-rays and dynamic flexion-extension films at minimum 24-month follow-up. Pelvic parameters (Incidence, Pelvic Tilt, Sacral Slope) were measured. L4-L5 and L5-S1 flexion-extension range of motion (ROM) was measured pre- and postoperatively. Pelvic motion was determined by measuring sacral slope in flexion-extension. The influence on lumbar lordosis (L1-S1) was also analyzed. To show the effect the lumbopelvic complex has on global motion, we measured L1 race (flexion-extension L1 ROM). <h3>RESULTS</h3> The absolute motion and relative gain of 2-level TDR shows its superiority over hybrid constructs in all measured parameters. When L5-S1 is fused, there is no compensation from pelvic motion to overcome the loss of mobility. TDR group shows a pelvi-femoral ROM gain of 16.77°, vs a gain of only 6.11° in the Hybrid group. L5-S1 fusion also reduces L4-L5 TDR mobility in Hybrid group, compared to 2-level TDR, and decreases flexion compared to baseline. There is a mean reduction in ROM of 1.53° in Hybrid group vs 20.02° gain in TDR group. L1 race also reflects the superiority of 2-level TDR vs hybrid with a gain of 32.58° in TDR vs 4.68° in hybrid, demonstrating that reduced global motion is principally due to loss of L5-S1 motion. <h3>CONCLUSIONS</h3> This comparison between 2-level TDR and hybrid demonstrates a lack of compensation through lumbar mobility and pelvic motion when L5-S1 is fused, and debunks these preconceived ideas. Although clinical measures of activity (ODI) and pain (VAS back and leg pain) are equivalent between the groups, functional superiority of 2-level TDR is confirmed. Two new ROM parameters introduced here—pelvic motion and L1 race—must be integrated in all ROM studies as they quantify pelvic participation in mobility and the functional effectiveness of motion preservation. In this first long-term comparison of mobility between 2-level TDR vs L4-S1 hybrid, 2-level TDR demonstrates overall superiority. Consequently, 2-level TDR must be systematically indicated whenever TDR is indicated for both levels, and accepted as the "gold standard" for reimbursement purposes. <h3>FDA DEVICE/DRUG STATUS</h3> Prodisc L 1- and 2-level (Approved for this indication), Prodisc L hybrid constructs (Not approved for this indication)