Rehabilitation Guidelines Research Articles

No Difference in Return to Duty Between Minimally Invasive, Percutaneous Achilles Tendon Repair and Nonoperative Functional Rehabilitation in Active Duty Military Members

Category:Sports; Trauma; OtherIntroduction/Purpose:Achilles tendon ruptures are common injuries in the active duty US military population. Timely rehabilitation has critical importance in force readiness. There remains debate about optimal treatment of Achilles tendon ruptures. Recent studies have found decreased risk of rerupture but increased complication rates with operative management, with similar times to full recovery. The development of a minimally invasive, percutaneous Achilles tendon technique has shown lower rates of wound complications than open management, with similar re-rupture rates. However, there exists no comparative studies between the percutaneous, minimally invasive Achilles tendon surgery and nonoperative management. This was a retrospective cohort study comparing the results of the Percutaneous Achilles Repair System (PARS) and nonoperative management in the active duty military population.Methods:All Achilles tendon injuries in active duty patients were identified using the MHS system M2 from January 1, 2016 to December 31, 2020. Inclusion and exclusion criteria were applied and charts were reviewed. Demographic and treatment information were recorded. Time to return to duty, rerupture, complications, and deep vein thrombosis (DVT) were recorded and compared between each cohort. 47 patients met inclusion criteria with an average age of 38.7 years. There were 23 patients in the percutaneous operative group and 24 patients in the nonoperative group. Patients in the nonoperative group underwent regular functional rehabilitation supervised by a licensed physical therapist under the tri-service rehabilitation guidelines, based on the Willits protocol for nonoperative management (2010). 2 patients failed nonoperative management and underwent open Achilles reconstruction. They were excluded from the time to return to duty analysis. Demographics were described. There were no significant differences in group demographics.Results:There was no difference in time to return to duty in the nonoperative and percutaneous Achilles tendon repair (160.5 days, 5.35 months vs 161.7 days, 5.39 months) cohorts (p=0.47). No patient failed to return to duty due to treatment of an Achilles rupture. There were no DVTs in either group. There was 1 wound complication (infection) (4.3%) and 3 instances of postoperative paresthesias (2 sural, 1 peroneal) 13% in the operative cohort. 2 patients failed nonoperative management (reruptured Achilles tendon) and underwent open reconstruction with flexor halluces longus augmentation (8%). The operative cohort had a higher rate of complications (17.3% vs 8.3%, p=0.42, OR=2.11, CI= (0.34, 12.86)), although this was not statistically significant. There were no reruptures in the operative cohort.Conclusion:There was no difference in time to return to duty in the nonoperative and percutaneous Achilles tendon repairs. There was a higher rate of reruptures in the nonoperative group. Percutaneous operative treatment had a higher risk of complications. There were no failures in the operative cohort. The final decision on management of acute Achilles tendon ruptures should be based on specific patient factors and shared decision to return military members back to duty as quickly as possible. Prospective or well designed randomized controlled trials are necessary in the future to better delineate outcomes between nonoperative and percutaneous Achilles rupture management.

Cardiopulmonary Rehabilitation in Long-COVID-19 Patients with Persistent Breathlessness and Fatigue: The COVID-Rehab Study.

(1) Background: Cardiopulmonary and brain functions are frequently impaired after COVID-19 infection. Exercise rehabilitation could have a major impact on the healing process of patients affected by long COVID-19. (2) Methods: The COVID-Rehab study will investigate the effectiveness of an eight-week cardiopulmonary rehabilitation program on cardiorespiratory fitness (O2max) in long-COVID-19 individuals. Secondary objectives will include functional capacity, quality of life, perceived stress, sleep quality (questionnaires), respiratory capacity (spirometry test), coagulation, inflammatory and oxidative-stress profile (blood draw), cognition (neuropsychological tests), neurovascular coupling and pulsatility (fNIRS). The COVID-Rehab project was a randomised clinical trial with two intervention arms (1:1 ratio) that will be blindly evaluated. It will recruit a total of 40 individuals: (1) rehabilitation: centre-based exercise-training program (eight weeks, three times per week); (2) control: individuals will have to maintain their daily habits. (3) Conclusions: Currently, there are no specific rehabilitation guidelines for long-COVID-19 patients, but preliminary studies show encouraging results. Clinicaltrials.gov (NCT05035628).

Current Practice of Italian Association of Revision Surgery Members in the Treatment of Unified Classification System Type B Periprosthetic Femoral Fracture Around Hip Arthroplasty: A Cross-Sectional Survey.

IntroductionPeriprosthetic femoral fracture around hip arthroplasty are growing in the world, nevertheless management and treatment options for fractures “around the stem” are still debated due to lack of high-level studies.Materials and methodA 85-item survey were fill out by 40 Italian Orthopedic Surgeon member of SIOT (Società Italiana di Ortopedia e Traumatologia) and AIR (Associazione Italiana Riprotesizzazione) to assess their current opinion in the management of type B periprosthetic femoral fractures. Responses were summarized using proportions, and further stratified by practice type, case volume, surgeon age, and fellowship training.ResultsVancouver/UCS fracture classification showed a good interobserver agreement (k value = .76). ORIF were the treatment of choice for UCS type B1 fractures (100%), revision stem for B2 (85%) and B3 (100%). Locked plates were preferred to cable plate and cerclage without a plate for B1 fractures (50% vs 40% vs 10%); revision with modular stem was preferred to monoblock stem for B2 fractures (50% vs 35%) and B3 (75% vs 15%). Responders tended to postpone at 1-month weight-bearing in patients with B1 fractures. Regarding postoperative pharmacological treatment there was absolute lack of consensus.DiscussionThe primary finding of our survey confirmed the preference of ORIF for B1 fractures and stem revision for B2 and B3 fractures. However, there is no definitive operative technique for all UCS B fractures. Surgeons tended to favor locked plating over cable plating, although only slightly. This general lack of consensus coincides with the inconclusive evidence that currently exists in the literature, which demonstrates both favorable and unfavorable outcomes for both techniquesConclusionsThe absence of complete homogeneity among participants showed the need for prospective randomized studies to set up stronger guidelines for classification, management, surgical treatment, rehabilitation, and pharmacological support of periprosthetic femoral fractures.

Modern Principles for Rehabilitation for Medial and Lateral Knee Ligament Surgery: How to Optimize Outcomes

The medial collateral (MCL) and fibular collateral (FCL) ligaments are the primary frontal plane stabilizers in the knee joint. Extreme varus, valgus, or rotational moments about the knee may cause the failure of these ligaments and contribute to persistent knee instability and functional deficits that may not respond to rehabilitation alone. Surgical intervention may be warranted when a complete disruption occurs to address resultant instability. Due to lower incidences of surgery to address MCL and FCL injuries, by comparison to anterior cruciate ligament reconstruction (ACLR), fewer high-quality studies exist addressing postoperative rehabilitation guidelines for the collateral ligaments. Additionally, little is known on performance-based outcomes and return to sport within this population, especially within the postoperative population. Standardized postoperative protocols for this population currently do not exist in the literature. Therefore, basic science on collateral ligament anatomy and biomechanics provides the foundation for postoperative rehabilitation, including precautions and the continuum of care to return a patient to sport. The objective of this text is to define the rationale for postoperative precautions, provide a template for phased rehabilitation strategies, and describe physical performance testing protocols to guide decisions on care progression and return to activity/sport following surgery to address medial and lateral knee instability.

Overview of practice of Consultation-Liaison Psychiatry.

Overview of practice of Consultation-Liaison Psychiatry.

THE USE OF TRANSCUTANEOUS SUPRAORBITAL NERVE STIMULATION IN THE TREATMENT OF ASTHENIC SYNDROME AFTER COVID-19

Resume. Aim: to assess the efficacy of Transcutaneous Supraorbital Nerve Stimulation (t-SNS) with the Cefaly® Device on the parameters of asthenia and anxiety, as the main components of psychosomatic changes after suffering COVID-19. Materials and methods: an open prospective study in parallel groups was conducted. 60 patients, 30 men and 30 women, average age (61,3 ± 4,1) years, after a coronavirus infection (COVID-19) more than 6 months ago, meeting the following criteria: age from 60 to 75 years old, presence of asthenic syndrome, no contraindications to supraorbital neurostimulation was included. By the envelope method, patients were randomized into two groups. In the Cefaly® group (30 people), patients underwent 10 procedures (3 times a week) of t-SNS with the Cefaly® Device (Cefaly Technology sprl, Herstal, Belgium) in combination with restorative treatment according to temporary methodological guidelines for medical rehabilitation for a new coronavirus infection (COVID-19), in the control group (30 people), patients received only rehabilitation treatment. The results were evaluated using the Multidimensional Fatigue Inventory (MFI-20) and the Hamilton Anxiety Rating Scale (HAM-A) at baseline and after 24 days of therapy. Results: Cefaly® in addition to the standard rehabilitation program effectively reduces the severity of asthenia symptoms -in the Cefaly® group it was 33,6 %, in the control group - 14,4 %. The use of Cefaly® affects all components of the asthenic syndrome (reduced activity, reduced motivation, physical and mental asthenia). The standard rehabilitation program had an effect only on physical asthenia and reduced activity, but not on parameters of reduced motivation and mental asthenia. The reduction in total score from baseline on the HAM-A anxiety scale in the Cefaly® group was 55,16%, in control group -19,74 %. Cefaly® therapy had the greatest effect on insomnia and tension. It should be noted that the standard rehabilitation program has little effect on anxiety scores. However, after treatment, both groups maintained a high mean total asthenia score (MFI-20 - 42,5 points in the Cefaly® group, 63 points in the control group), which once again confirms that post-COVID changes (Long COVID) are long-term in nature even with availability of adequate therapy. Conclusions: The use of transcutaneous supraorbital nerve stimulation can more effectively reduce the severity of symptoms of asthenia and anxiety in people who have recovered from COVID-19.

Usability of Functional Electrical Stimulation in Upper Limb Rehabilitation in Post-Stroke Patients: A Narrative Review.

Stroke leads to significant impairment in upper limb (UL) function. The goal of rehabilitation is the reestablishment of pre-stroke motor stroke skills by stimulating neuroplasticity. Among several rehabilitation approaches, functional electrical stimulation (FES) is highlighted in stroke rehabilitation guidelines as a supplementary therapy alongside the standard care modalities. The aim of this study is to present a comprehensive review regarding the usability of FES in post-stroke UL rehabilitation. Specifically, the factors related to UL rehabilitation that should be considered in FES usability, as well a critical review of the outcomes used to assess FES usability, are presented. This review reinforces the FES as a promising tool to induce neuroplastic modifications in post-stroke rehabilitation by enabling the possibility of delivering intensive periods of treatment with comparatively less demand on human resources. However, the lack of studies evaluating FES usability through motor control outcomes, specifically movement quality indicators, combined with user satisfaction limits the definition of FES optimal therapeutical window for different UL functional tasks. FES systems capable of integrating postural control muscles involving other anatomic regions, such as the trunk, during reaching tasks are required to improve UL function in post-stroke patients.

Disparities in discharge patterns of admitted older patients with ocular trauma

PurposeIn older patients, poor vision from ocular trauma increases the likelihood of further injuries and repeat hospitalizations, underscoring the need for appropriate post-hospitalization care. We sought to evaluate disposition patterns of older patients admitted with ocular trauma. Methods/MaterialsThis retrospective observational study analyzed the National Trauma Data Bank (2008–2014) and de-identified data of patients, ≥65 years old, admitted with ocular trauma were identified using ICD-9CM and E-codes. Age, gender, race/ethnicity, type of ocular injury, comorbidities, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, length of hospital stay, location and US region, insurance, and discharge disposition were extracted. Analysis was performed with student's t-test, Chi-squared test, and odds ratios (OR) using SPSS software. Statistical significance was set at P <.05. Results58,074 (18.3%) of 316,485 patients admitted with ocular trauma were >65yrs. 26,346 (45.4%) were discharged home and 23,314 (40.1%) to an advanced care facility (ACF). Nursing home residents were most likely to return to ACF (OR, 4.76; 95%CI, 4.40–5.14; P < .001). Patients with severe traumatic brain injury (Glasgow coma score [GCS]<8) (OR, 4.57; 95%CI, 4.09–5.11; P < .001), very severe injury severity score (ISS ≥24) (OR, 3.73; 95%CI, 3.46–4.01; P < .001), females (OR, 1.27; 95%CI, 1.23–1.32; P < .001), white patients (OR, 1.29; 95%CI, 1.24–1.36; P < .001) and Medicare beneficiaries (OR, 1.14; 95%CI, 1.09–1.19; P < .001) were most likely to be discharged to an ACF. Demography-related discharge propensities prevailed nationwide and within insurance categories. Multivariate regression analysis revealed factors determining ACF placement were, in order: length of hospital stay, nursing home residency, GCS<8, ISS>24, female gender, white race, and Medicare insurance. ConclusionsHispanic, black, male, and self-paying patients were disproportionately discharged home. Ocular injuries had low impact on ACF placement. Understanding these disparities will assist in developing guidelines for appropriate and equitable post-trauma rehabilitation in this vulnerable population.

Blood flow Restriction training After patellar INStability (BRAINS Trial)

BackgroundPatellar instability is a common and understudied condition that disproportionally affects athletes and military personnel. The rate of post-traumatic osteoarthritis that develops following a patellar dislocation can be up to 50% of individuals 5–15 years after injury. Conservative treatment is the standard of care for patellar instability however, there are no evidence-informed rehabilitation guidelines in the scientific literature. The purpose of this study is to assess the effectiveness of blood-flow restriction training (BFRT) for patellar instability. Our hypotheses are that this strategy will improve patient-reported outcomes and accelerate restoration of symmetric strength and knee biomechanics necessary to safely return to activity.Methods/designThis is a parallel-group, superiority, randomized, double-blinded, placebo-controlled clinical trial at the University of Kentucky, sports medicine clinic that aims to recruit 78 patients with acute patellar dislocations randomly allocated into two groups: (1) sham BFRT and (2) BFRT. Both groups will receive the current standard of care physical therapy 3 times per week for up to 9 weeks. Physical therapy sessions will consist of typical standard of care treatment followed by BFRT or sham BFRT. Primary outcomes include the Norwich Patellar Instability Scale, quadriceps strength, and imaging and biochemical biomarkers of cartilage degradation.DiscussionThe current standard of care for non-operative treatment of patellar instability is highly variable does not adequately address the mechanisms necessary to restore lower extremity function and protect the long-term health of articular cartilage following injury. This proposed novel intervention strategy uses an easily implementable therapy to evaluate if BFRT significantly improves patient-reported outcomes, function, and joint health over the first year of recovery.Trial registrationBlood Flow Restriction Training, Aspiration, and Intraarticular Normal Saline (BRAINS) NCT04554212. Registered on 18 September 2020.

Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts

BackgroundGroin pain is a very common injury in multidirectional sports such as soccer, ice hockey, rugby and Australian football. Long-standing adductor-related groin pain is a persistent clinical condition and a frequent complaint in athletes involved in sports that require multiplanar movement patterns (change of direction, high-speed sprinting and kicking). To date, the lack of rehabilitation guidelines and return-to-play criteria makes this clinical entity difficult to manage. The aim of the present Delphi was to suggest, based on opinion and practical experience of a panel of experts, potential criteria that could be taken into consideration by clinicians in the RTP decision-making process in athletes suffering from long-standing adductor-related groin pain.MethodsThirty two out of 40 experts participated to a 3-Round Delphi questionnaire. In round 1, open-ended and closed questions about 9 different sections (palpation, flexibility, strength, patient-reported outcome measures, imaging, intersegmental control, performance tests, sport-specific skills, training load) were proposed to investigate return to play evaluation criteria used by each expert. Responses were analysed and coded to produce round 2 questionnaire that investigated only the sections and the items that reached the cut-off value (≥ 70%). Round 3 questionnaire was based on sections and items that reached cut-off value in previous rounds and experts rated their agreement for return to play criteria with a 5-point Likert Scale. Descriptive statistics enabled interpretation of consensus.ResultsHigh participation rate (80%) and response rate across the 3 rounds (100%) were recorded. 6 sections reached positive consensus in round 1, 1 section reached negative consensus. In round 2 positive consensus was confirmed only for 3 sections and negative consensus for 1 section. In round 3, positive agreement was established for strength (3 items), performance tests (3 items) and sport-specific skills (2 items) sections. Negative consensus was confirmed for imaging section.ConclusionExperts agreed that strength, performance tests and sport-specific skills can be used to support RTP decision, while imaging cannot be used. These findings could be useful in assisting clinicians in the RTP decision making.

From heart to muscle: pathophysiological mechanisms underlying long-term physical sequelae from SARS-CoV-2 infection.

The long-term sequelae of the coronavirus disease 2019 (COVID-19) are multifaceted and, besides the lungs, impact other organs and tissues, even in cases of mild infection. Along with commonly reported symptoms such as fatigue and dyspnea, a significant proportion of those with prior COVID-19 infection also exhibit signs of cardiac damage, muscle weakness, and ultimately, poor exercise tolerance. This review provides an overview of evidence indicating cardiac impairments and persistent endothelial dysfunction in the peripheral vasculature of those previously infected with COVID-19, irrespective of the severity of the acute phase of illness. In addition, V̇o2peak appears to be lower in convalescent patients, which may stem, in part, from alterations in O2 transport such as impaired diffusional O2 conductance. Together, the persistent multi-organ dysfunction induced by COVID-19 may set previously healthy individuals on a trajectory towards frailty and disease. Given the large proportion of individuals recovering from COVID-19, it is critically important to better understand the physical sequelae of COVID-19, the underlying biological mechanisms contributing to these outcomes, and the long-term effects on future disease risk. This review highlights relevant literature on the pathophysiology post-COVID-19 infection, gaps in the literature, and emphasizes the need for the development of evidence-based rehabilitation guidelines.

Rehabilitation Care at the Time of Coronavirus Disease-19 (COVID-19) Pandemic: A Scoping Review of Health System Recommendations.

Purpose: The coronavirus disease-19 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. COVID-19, caused by SARS-CoV-2 has imposed a significant burden on health care systems, economies, and social systems in many countries around the world. The provision of rehabilitation services for persons with active COVID-19 infection poses challenges to maintaining a safe environment for patients and treating providers.Materials and Methods: Established frameworks were used to guide the scoping review methodology. Medline, Embase, Pubmed, CINAHL databases from inception to August 1, 2020, and prominent rehabilitation organizations’ websites were searched.Study Selection: We included articles and reports if they were focused on rehabilitation related recommendations for COVID-19 patients, treating providers, or the general population.Data Extraction: Pairs of team members used a pre-tested data abstraction form to extract data from included full-text articles. The strength and the quality of the extracted recommendations were evaluated by two reviewers using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.Results: We retrieved 6,468 citations, of which 2,086 were eligible for review, after duplicates were removed. We excluded 1,980 citations based on title and abstract screening. Of the screened full-text articles, we included all 106 studies. A summary of recommendations is presented. We assessed the overall evidence to be strong and of fair quality.Conclusion: The rehabilitation setting, and processes, logistics, and patient and healthcare provider precaution recommendations identified aim to reduce the spread of SARS-CoV-2 infection and ensure adequate and safe rehabilitation services, whether face-to-face or through teleservices. The COVID-19 pandemic is rapidly changing. Further updates will be needed over time in order to incorporate emerging best evidence into rehabilitation guidelines.

Cardiac Rehabilitation Program at CUHK Medical Centre

According to World Health Organization (WHO), heart disease remained the leading cause of death globally during 2000-2019[1]. In Hong Kong, heart diseases have been the third leading cause of mortality since 1960s[2]. According to the statistics on the number of hospital discharges and deaths by heart disease group in Hong Kong in 2019, 21578 cases were of heart failure, which accounted for 25% among all other heart diseases[3]. In order to improve the management for heart failure, cardiac rehabilitation is crucial to help patients to improve functional capacity and quality of life, and most importantly to reduce mortality[4]. Guideline for cardiac rehabilitation in CUHK Medical Centre (CUHKMC), the Hong Kong's first non-profit private teaching hospital, has been developed based on evidence-based practices and international guidelines[5]. The experience of cardiac rehabilitation by the CUHKMC physiotherapy team will be shared in this session. According to World Health Organization (WHO), heart disease remained the leading cause of death globally during 2000-2019[1]. In Hong Kong, heart diseases have been the third leading cause of mortality since 1960s[2]. According to the statistics on the number of hospital discharges and deaths by heart disease group in Hong Kong in 2019, 21578 cases were of heart failure, which accounted for 25% among all other heart diseases[3]. In order to improve the management for heart failure, cardiac rehabilitation is crucial to help patients to improve functional capacity and quality of life, and most importantly to reduce mortality[4]. Guideline for cardiac rehabilitation in CUHK Medical Centre (CUHKMC), the Hong Kong's first non-profit private teaching hospital, has been developed based on evidence-based practices and international guidelines[5]. The experience of cardiac rehabilitation by the CUHKMC physiotherapy team will be shared in this session.

Treatment and rehabilitation guidelines before and after wearing cochlear implants—Previous Ministry of Health, Labor and Welfare research and discussion from 2018

Treatment and rehabilitation guidelines before and after wearing cochlear implants—Previous Ministry of Health, Labor and Welfare research and discussion from 2018

Nutritional Supplementation in Stroke Rehabilitation: A Narrative Review.

Malnutrition is associated with increased mortality and poor functional recovery after stroke. Most guidelines for stroke rehabilitation strongly recommend nutritional screening for malnutrition. Nutritional status after stroke is related to long-term outcomes, and nutritional supplementation is recommended for stroke patients with malnutrition and those at risk of malnutrition. However, routine nutritional supplementation in stroke patients, regardless of nutritional status, is not correlated with improved functional outcomes, and nutritional supplementation is not recommended if the nutritional status is adequate. Nutritional supplementation with protein, amino acids, vitamins, and minerals positively affects recovery after stroke, with improvements seen in motor function, cognition, activities of living, and mood. However, the evidence is insufficient due to the small number of studies and the lack of well-designed randomized controlled studies. Therefore, nutritional supplementation for stroke patients in rehabilitation should not be uniform, and individual nutritional interventions based on an assessment of the patient's nutritional status should be provided.

Structured Graded Lung Rehabilitation for Children with Mechanical Ventilation

Lung rehabilitation is safe and feasible, and it has positive benefits in weaning the machine as soon as possible, shortening the time of hospitalization and improving the prognosis of children with mechanical ventilation. However, at present, the traditional medical concept is deep-rooted, and doctors' understanding of early rehabilitation is inadequate. It is necessary to make in-depth exploration in the relevant guidelines and expert consensus to formulate standardized early rehabilitation diagnosis and treatment procedures and standards for mechanically ventilated children. In the paper, a structured graded lung rehabilitation program is constructed for children with mechanical ventilation to improve their respiratory function, shorten the time of mechanical ventilation and pediatric intensive care unit (PICU) hospitalization, and reduce their anxiety, based on the principal component analysis of functional pneumonia data. Scientific evaluation and dynamic monitoring ensure the safety of the implementation of the program and promote the prognosis and prognosis of the disease. The proposed lung rehabilitation program provides a reference basis for the formulation of lung rehabilitation guidelines for children with mechanical ventilation. And It has important reference significance for clinical pulmonary rehabilitation to alleviate the concerns of clinicians and lay the foundation for the large-scale promotion of early lung rehabilitation.

Blood Flow Restriction Therapy and Its Use for Rehabilitation and Return to Sport: Physiology, Application, and Guidelines for Implementation

Blood flow restriction (BFR) is an expanding rehabilitation modality that uses a tourniquet to reduce arterial inflow and occlude venous outflow in the setting of resistance training or exercise. Initially, this technique was seen as a way to stimulate muscular development, but improved understanding of its physiologic benefits and mechanism of action has allowed for innovative clinical applications. BFR represents a way to decrease stress placed on the joints without compromising improvements in strength, whereas for postoperative, injured, or load-compromised individuals BFR represents a way to accelerate recovery and prevent atrophy. There is also growing evidence to suggest that it augments cardiovascular fitness and attenuates pain. The purpose of this review is to highlight the physiology and evidence behind the various applications of BFR, with a focus on postoperative rehabilitation. While much remains to be learned, it is clear that blood flow restriction therapy stimulates muscle hypertrophy via a synergistic response to metabolic stress and mechanical tension, with supplemental benefits on cardiovascular fitness and pain. New forms of BFR and expanding applications in postoperative patients and athletes hold promise for expedited recovery. Continued adherence to rehabilitation guidelines and exploration of BFRs physiology and various applications will help optimize its effect and prescription. Level of EvidenceV, expert opinion.

Technique for Arthroscopic Transtibial Medial Meniscus Posterior Root Repair

Background: Medial meniscus posterior root tears (MMPRT) can lead to significant pain, functional limitations, and osteoarthritis (OA). Biomechanically, MMPRT has been shown to be equivalent to total meniscectomy in terms of peak contact pressure in the medial compartment. Transtibial repair of a meniscus root tear has also been shown to restore hoop stresses and reduced peak contact pressure to the normal intact state. Clinically, root repair was shown to reduce rates of OA progression and need for total knee arthroplasty when compared with nonoperative treatment or partial meniscectomy for MMPRT. Indications: Medial meniscus posterior root repair is indicated in patients with a symptomatic MMPRT who are appropriate surgical candidates: age ≤65 years, body mass index ≤40 kg/m2, &lt;5° varus alignment, no more than Kellgren-Lawrence grade 2 changes, and willing and able to undergo the demanding postoperative rehabilitation program. Technique Description: This surgical technique video demonstrates our preferred technique for arthroscopic transtibial medial meniscus posterior root repair using a case example in a commonly encountered patient. The repair is completed using a 3 simple suture triangle configuration with 2 tibial tunnels to create a broad footprint for healing. Results: There are a number of case series and comparative studies published with good clinical outcomes using similar transtibial medial meniscus posterior root repair techniques. In short-term follow-up of 18 patients at a mean of 10.5 months post-operatively, we have demonstrated improvements in pain and functional status with a 16.7% clinical failure rate and 11% rate of conversion to arthroplasty. Discussion: In this surgical technique video, we review the anatomy of the native medial meniscus posterior root and the biomechanical and clinical consequences of a MMPRT. We highlight important technique pearls and pitfalls to avoid failures and complications during the surgical demonstration. Finally, we review postoperative rehabilitation guidelines and clinical outcomes within the existing literature. In patients with MMPRT, transtibial repair provides a safe and reliable technique to achieve healing of the medial meniscus posterior root and return patients to full activities with reduced risk of OA progression.

Factors influencing the success of hand-reared juvenile brushtail possums (

Context Wildlife is ubiquitous in urban environments, resulting in frequent interactions with humans and human infrastructure. The result of these interactions is often negative, in the form of road injury, orphaning of dependent young or eviction from natural home ranges. Wildlife rehabilitation programmes are devised to counter these negative interactions. However, the success of current management strategies is rarely assessed. Aims We aimed to determine whether short-term survival of juvenile hand-reared common brushtail possums (Trichosurus vulpecula) released in the wild was a function of (1) intrinsic factors such as sex, individual personality and level of human habituation, and (2) extrinsic factors such as release practice (soft vs hard-release) or location (urban vs rural). We also evaluated the relationship between habituation to humans and time spent in care by possums, if presence of conspecifics during the rehabilitation process influenced the development of individual personality, and if this differed in hand-raised animals compared with wild individuals. Methods We radio-tracked and monitored 20 hand-reared juvenile possums (10 females and 10 males) for up to 40 days after release in the wild. Key results Eight possums (40%) survived until the end of the study, nine possums (45%) were killed by foxes or had to be returned into care and three possums (15%) had unknown fates (i.e. lost VHF signal). We found that more exploratory individuals and those less human-habituated were more likely to be successful in the wild in both rural and urban areas, whether or not they were hard or soft released. Conclusions Our results suggest that personality is a key criterion to consider when evaluating the success of rehabilitation programmes. Behavioural traits of hand-reared brushtail possums differed significantly from those of wild individuals, showing that captive conditions can affect the development of personality. Hand-reared possums that spent more time in care were also more likely to display highly human-habituated behaviours. Implications By demonstrating which factors influence success of hand-reared wildlife after release in the wild, our results help in evaluating current rearing and release practices, and improve the evidence base for developing best practice wildlife rehabilitation guidelines.

Unique Considerations for the Pediatric Athlete During Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injuries and surgical intervention in the pediatric population have increased in the recent years. Although surgical techniques have advanced, evidence-based rehabilitation guidelines that consider all aspects of the youth athlete are currently lacking. The purpose of this commentary is to review the current evidence on unique considerations for the pediatric and adolescent population during rehabilitation and return to sport after ACL reconstruction (ACLR), with a focus on children under 18 years of age. This review revealed that returning a youth athlete to sport after ACLR requires knowledge and appreciation of various aspects of the growing athlete different from adults. In addition to postoperative precautions that contribute to a slow rehabilitation process, young athletes need additional time for strength gains. Address risk of reinjury and for contralateral injury by using neuromuscular training and rigorous return-to-sport training programs. Consider return to sport after 9 months because the reinjury rate is high in this population. A combination of time and objective measures, both quantitative and qualitative criteria, and psychological readiness should be used to assess readiness to return to sport and decrease risk of future injury. Healthcare providers should be aware of the psychosocial impact of injury on the youth athletes and refer to sport psychology when necessary. Level of EvidenceLevel V.