ROM Measurements Research Articles

Fracture Patterns, Outcomes, and Complications of Terrible Triad Injury in Elderly Patients

AimsThe aim of this study was to describe the fracture patterns of terrible triad elbow injury (TTEI) and to evaluate complications, functional and radiographic outcomes in mid-term follow-up in patients older than 65 years. MethodsA retrospective study of 29 patients, mean follow-up of 48.7±4.6 months (range 65-78). Fractures were classified according to the Mason and Regan-Morrey classifications. All patients were evaluated by the Mayo Elbow Performance Scale (MEPS), Quick-Dash, EQVAS, EQ5D scores, and ROM measurement. ResultsThe mean age was 72.3 years and 79% were women. Mason Type III (72%) and Reagan-Morrey type II (69%) were the most frequent fracture type. All patients were managed with a lateral approach consisting of repair or replacement of the radial head and repair of the lateral ulnar collateral ligament (LUCL); of these patients, 19 underwent re-attachment of the coronoid process or anterior capsule. Mean functional scores were MEPS 90.3±7.5, Quick-DASH 18.4±4.6, EQ5D .89± 0.33, EQ-VAS 86.2 ± 21, and VAS 2.2± 1.5. Mean postoperative flexo-extension arc of elbow motion was 105º (range, 65º-145º). Two patients (7%) required revision surgery. We did not observe any joint instability in the elbow after surgery. ConclusionsPatients over 65 years old with a terrible triad elbow injury (TTEI) are at substantial risk of complex fracture patterns, particularly Mason type III radial head fractures and Regan-Morrey type II coronoid fractures. Complications such as joint stiffness and heterotopic ossification are infrequent, while associated capitellum fractures are not rare and should be considered in the assessment as they can impact elbow stability. Despite these challenges, surgical management generally achieves favorable functional outcomes with low complication and reoperation rates.

Single-Level CDA for Cervical Radiculopathy Maintained Some ROM Measures and Reduced Adjacent Segment Degeneration Vs. ACDF at 20 Years

Single-Level CDA for Cervical Radiculopathy Maintained Some ROM Measures and Reduced Adjacent Segment Degeneration Vs. ACDF at 20 Years

Efficacy of Intraoperative Platelet-Rich Plasma After Meniscal Repair: Systematic Review and Meta-analysis.

Meniscal injuries frequently require surgical intervention to restore knee joint function and stability. Intraoperative platelet-rich plasma (PRP) injection has emerged as a potential adjunctive therapy to enhance tissue healing post-meniscal repair. This systematic review and meta-analysis aimed to evaluate the efficacy of PRP in terms of pain relief, functional recovery, and overall success rates in patients undergoing meniscal repair procedures. A comprehensive search strategy was employed to identify relevant studies across Scopus, PubMed, Embase, and the Cochrane Library databases. The inclusion criteria encompassed human studies, including randomized controlled trials (RCTs), cohorts, and case-control studies, focusing on intraoperative platelet-rich plasma (PRP) use post-meniscal repair and reporting outcomes related to pain, functionality, and cure rates. Exclusion criteria comprised animal studies, non-English publications, studies lacking relevant outcome measures, and those with insufficient data. Two reviewers independently screened titles and abstracts, resolving disagreements through consensus or consultation with a third reviewer, followed by a full-text assessment for potentially eligible studies. Data extraction was conducted independently by two reviewers using a standardized form. The reliability of observational studies was evaluated using the Newcastle-Ottawa Scale. Subgroup analyses and pooled effect estimates for main outcomes were computed using RevMan 5.3, a meta-analysis tool. The demographic analysis revealed that the PRP group had an average age of 41.39years, while the control group had an average age of 42.1years. In terms of gender distribution, the PRP group consisted of 61 men and 29 women, while the control group had 62 men and 34 women. Pain ratings showed a preference for PRP with a mean difference of 4.83 (p = 0.13). However, there was no significant difference in Lysholm scores (mean difference: - 0.44, p = 0.91) or IKDC scores (mean difference: 2.80, p = 0.14) between the PRP and control groups. Similarly, ROM measures did not show a statistically significant difference, with a mean difference of 2.80 (p = 0.18). Additionally, there was no significant distinction in failure rates between the PRP and control groups, as indicated by a weighted mean difference of 0.71 (p = 0.52). These findings suggest that while PRP may offer some benefits in pain relief, its impact on functional recovery, range of motion, and failure rates following meniscal repair procedures is inconclusive. The current evidence regarding the effect of intraoperative platelet-rich plasma (PRP) injection on patients undergoing meniscal repair remains inconclusive. While some studies suggest potential benefits in terms of pain relief and functional recovery, others show no significant differences compared to control groups. The impact of PRP therapy on overall success rates, including rates of re-tear and revision surgery, is also uncertain. Further well-designed randomized controlled trials with larger sample sizes are needed to provide more robust evidence and guide clinical practice in orthopedic surgery.

PATIENTS WITH FEMOROACETABULAR IMPINGEMENT SYNDROME OBTAIN SIGNIFICANT AND SUSTAINED IMPROVEMENT FOLLOWING A COMBINED HIP INJECTION AND REHABILITATION PROGRAM

INTRODUCTION Initial treatment recommendations for symptomatic femoroacetabular impingement syndrome include non-surgical therapies such as injections and rehabilitation. However, many patients undergo isolated injections or a rudimentary exercise regime. This study investigated the benefit of a combined intra-articular hip injection and structured exercise rehabilitation program in patients with FAIS. METHODS Participants were recruited and underwent a guided intra-articular injection of corticosteroid and local anaesthetic, followed by a 12-week rehabilitation program. Patients were assessed pre-and post-injection(8 weeks, 4, 6, 12 and 24 months) via patient-reported outcome measures including the 33-item International Hip Outcome Tool and Hip Outcome score. Hip ROM and peak isometric hip strength in all planes were assessed, along with single-limb hop capacity. Limb Symmetry Indices were calculated. The percentage of patients transitioning toward surgery over the period was evaluated. RESULTS A total of 44 patients underwent the injection and completed the initial 8-week rehabilitation component. A significant improvement (p<0.05) in all PROMs was observed, with 93% of patients satisfied. A significant increase (p<0.05) in all active hip ROM and isometric strength measures was observed, sustained over the 24-month period. Bilateral improvements in hop capacity were observed, with all hop test LSIs significantly improving (p<0.05). Overall, 14 patients (32%) progressed toward surgical intervention over the 24-month post-injection period. These patients reported significantly worse (p<0.05) PROMs pre-surgery and more pain within the first 4 weeks post-injection. CONCLUSION This is the first study seeking to implement and comprehensively assess a best-practice, multimodal non-operative program consisting of an intra-articular injection and a structured exercise program. Most patients with symptomatic FAIS demonstrated significant improvement in symptoms.

“Varus knee dysfunction contributing to early medial knee arthritis: Novel pathomechanics, diagnosis and multi-modal conservative interventions”

ObjectiveEvaluate whether the three-planar spring test and pathomechanics-based interventions (manual therapy, strengthening, orthosis) increase the range of motion and explore potential changes in joint space of varus knee dysfunction, further investigating their potential association with the early development of medial knee arthritis (MKA). MethodsSingle group, pre-and post-test design. Adults (n = 54) exhibiting a positive spring test for varus knee dysfunction, characterised by extension lag with proximal tibia externally rotated and subluxed laterally, completed the study. Outcome measures include pain intensity, ROM, functional abilities and X-ray measures (joint space, tilt, and tibia position relative to the femur) following the interventions. ResultsAfter interventions, the spring test has become negative at the pre-assessment range. There is an increased ROM [internal rotation by 3.61° (95CI 3.22, 4.01) and extension by 3.92° (95CI −4.51, −3.33)], and X-ray measurements showed an increase in both medial and lateral joint space by 0.78 mm (95CI 0.63, 0.92) and 0.13 mm (95CI −0.03, 0.24) respectively. Additionally, total joint space expansion happened by 0.28 ± 0.23 mm. The proximal tibia medially shifted by 0.85 ± 0.96 mm, and the medial tilt was reduced by 1.79°±1.28°. A significant decrease in pain by five points (NPRS) and an increase in the overall functional abilities of participants by 36.9 points (95CI 34.72, 39.09). ConclusionThe study results indicate that diagnosis with a spring test and interventions have increased the medial joint space and ROM, possibly improved alignment and synovial fluid, contributing to decreasing the pain and improving the functional abilities, thereby supporting the study's objective.

Validity and Reliability of Upper Limb Kinematic Assessment Using a Markerless Motion Capture (MMC) System: A Pilot Study

ObjectiveTo investigate the validity and test-retest reliability of a customized markerless motion capture (MMC) system that used iPad Pros with a Light Detection And Ranging scanner at two different viewing angles to measure the active range of motion (AROM) and the angular waveform of the upper-limb-joint angles of healthy adults performing functional tasks. DesignParticipants were asked to perform shoulder and elbow actions for the investigator to take AROM measurements, followed by four tasks that simulated daily functioning. Each participant attended 2 experimental sessions, which were held at least 2 days and at most 14 days apart. SettingA Vicon system and 2 iPad Pros installed with our MMC system were placed at 2 different angles to the participants and recorded their movements concurrently during each task. ParticipantsThirty healthy adults (mean age: 28.9, M/F ratio: 40/60). InterventionsNot applicable. Main Outcome MeasuresThe AROM and the angular waveform of the upper-limb-joint angles. ResultsThe iPad Pro MMC system underestimated the shoulder joint and elbow joint angles in all four simulated functional tasks. The MMC demonstrated good to excellent test-retest reliability for the shoulder joint AROM measurements in all 4 tasks. ConclusionsThe maximal AROM measurements calculated by the MMC system had consistently smaller values than those measured by the goniometer. An MMC in iPad Pro system might not be able to replace conventional goniometry for clinical ROM measurements, but it is still suggested for use in home-based and telerehabilitation training for intra-subject measurements because of its good reliability, low cost, and portability. Further development to improve its performance in motion capture and analysis in disease populations is warranted.

Reliability and Concurrent Validity of a Markerless, Single Camera, Portable 3D Motion Capture System for Assessment of Glenohumeral Mobility.

Recent technological advancements have enabled medical, sport, and fitness professionals to utilize digital tools that assist with conducting movement examinations and screenings. One such advancement has been the implementation of a single camera, markerless, and portable 3D motion capture system designed to obtain ROM measurements for multiple body parts simultaneously. However, the reliability and validity of a markerless 3D motion capture system that uses a single camera has not been established. The purpose of this study was to investigate the reliability and concurrent validity of this 3D motion capture system compared to a goniometer in assessing ROM of the glenohumeral joint. Quasi-experimental reliability, convenience sampling. Forty healthy volunteers (mean ± SD, age 27.4 ± 12.4 years, height 173.4 ± 11.1 cm, weight 72.1 ± 16.2 kg) participated in this study. Intrarater reliability was analyzed by ICC(2,k) with a 95% CI using two repeated trials for each shoulder movement (flexion, abduction, external rotation, internal rotation) that were recorded simultaneously via two methods: a standard goniometer and a 3D motion capture system. Concurrent validity was analyzed using Pearson Correlation Coefficient (r). The intrarater reliability between the two instruments for glenohumeral motions yielded an overall ICC of 0.82 (95% CI: 0.74-0.88) indicating good reliability for both instruments.The 3D motion capture system demonstrated strong correlations with goniometry for shoulder flexion (r = 0.67), abduction (r = 0.63), and external rotation (r = 0.76), and very strong correlation for shoulder internal rotation (r = 0.84). Results from this study indicated that a markerless, single camera, portable 3D motion capture system can be a reliable and valid tool to assess glenohumeral joint ROM in comparison to a standard goniometer. 3.

Is Tension Band Wire Fixation Superior to Plate Fixation for Simple Displaced Olecranon Fractures? A Randomized Trial With Median Follow-up of 7.5 Years.

Surgeons disagree about the best surgical treatment for simple, displaced olecranon fractures. Although the tension band wiring technique and plate fixation are the most common surgical options for fixation, studies comparing both are limited. To date, there have been no randomized trials comparing patient-reported outcomes and complications at more than 5 years of follow-up. (1) Does tension band wiring or plate fixation result in better ROM and patient-reported outcome scores for simple displaced olecranon fractures? (2) What is the risk of complications associated with each technique? Between November 2012 and October 2017, 68 patients were treated for acute, displaced olecranon fracture in a hand and upper extremity surgery unit at a tertiary-care center. Patients 18 years or older with traumatic, nonpathologic, simple olecranon fractures who presented within 2 weeks of injury were considered potentially eligible. Based on that, 74% (50) of patients met the inclusion criteria; 16% (11) of patients declined to participate in the study, and another 10% (seven) were excluded because they did not meet the prespecified inclusion criteria. Patients were randomized on a 1:1 basis to either tension band wiring or plate fixation and were evaluated at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year after surgery. At the final follow-up interval, 16% (eight) were lost to follow-up: 4% (two) in the tension band wiring group and 12% (six) in the plate fixation group. The median follow-up time was 8 years (IQR 7 to 9 years). We evaluated complications at a minimum of 6 years after surgery. The primary outcome measure was the 1-year postoperative DASH score. Additional outcome measures included the patient-reported Oxford Elbow Score, ROM, and the proportion of patients in each group who reported hardware-related symptoms and had subsequent implant removal or postoperative infection. No differences were observed in the DASH score (tension band wiring 18 [range 3 to 65] versus plate fixation 24 [range 3 to 52], median difference -6 [95% CI -12.7 to 14.9]; p = 0.73), Oxford Elbow Score (tension band wiring 36 [range 10 to 48] versus plate fixation 39 [range 17 to 47], median difference -3; p = 0.53), or all ROM measurements (p > 0.05) between the groups at 1 year of follow-up. The odds of having surgery for symptomatic implant removal were lower for plate fixation than for tension band wiring (one of 19 versus eight of 23, OR 9.6 [95% CI 1.08 to 85.7]; p =0.02); the odds of infection, however, were higher in the plate group (three of 19 versus 0 of 23; p = 0.048). No differences were observed between the two techniques in terms of ROM or patient-reported outcomes. Surgeons should consider that although the risk of implant removal is higher in tension band wiring, patients older than 85 years undergoing plate fixation for simple olecranon fractures are at a greater risk of postoperative infection. Level I, therapeutic study.

COMPARING THE EFFICACY OF ROM EXERCISES WITH AND WITHOUT SCAPULAR MOBILIZATION IN PATIENTS WITH ADHESIVE CAPSULITIS

Objective: Adhesive capsulitis, or frozen shoulder, is a condition characterized by shoulder pain and limited range of motion. Its cause and pathophysiology are not well understood. The prevalence is estimated to range from 2% to 5% in the general population, with a higher incidence in women and individuals in their fifth and sixth decades of life. The optimal treatment approach for adhesive capsulitis is currently unclear, although ROM exercises are commonly prescribed. Scapular mobilization may enhance outcomes by addressing scapular dyskinesis and muscle imbalances.
 Methods: A comparative study with 30 subjects diagnosed with adhesive capsulitis was conducted. Subjects were randomly assigned to two groups: ROM exercises with scapular mobilization (Group 1) and ROM exercises without scapular mobilization (Group 2). The study took place at PMCH, Udaipur, for 12 w, with sessions lasting 30 min per day, 5 d a week. Inclusion and exclusion criteria were established, and outcome measures such as pain scores, ROM measurements, functional assessments, and patient-reported outcomes were used.
 Results: The analysis of SPADI scores revealed that Group A had a mean score of 41.73 (SD = 4.69, SE = 0.86), while Group B had a mean score of 42.40 (SD = 3.29, SE = 0.84), with a mean difference of 0.67. The t-test indicated a significant difference between the groups (t = 1.335, p = 0.021). Similarly, for VAS scores, Group A had a mean score of 3.20 (SD = 0.67, SE = 0.17), Group B had a mean score of 3.06 (SD = 0.70, SE = 0.18), with a mean difference of 0.14. The t-test also revealed a significant difference between the groups (t = 5.95, p = 0.038). These results demonstrate notable distinctions in both SPADI and VAS scores between Group A and Group B.
 Conclusion: The study supports the effectiveness of combining scapular mobilization with ROM exercises for adhesive capsulitis. The group receiving both interventions showed greater improvements in shoulder range of motion and pain reduction compared to the ROM exercises alone group. Incorporating scapular mobilization into the treatment approach may enhance the management of adhesive capsulitis. Further research is needed to validate these findings and customize treatments based on individual patient characteristics.

Lower Limb Anthropometric Profiling in Professional Female Soccer Players: A Proof of Concept for Asymmetry Assessment Using Video Analysis.

The objective was to evaluate the clinical joint and limb measures in professional female soccer players. The study was a cross-sectional observational design. It was a preseason clinical setting. The inclusion criteria were outfield professional female soccer players, based in the UK, competing in the highest English league. The exclusion criteria included players who had had surgery in the last six months or had missed a single training session or match due to injury in the previous three months. In terms of the outcome measures, the dependent variables were the true limb length, ankle dorsiflexion, knee flexion and extension, hip flexion, extension, internal rotation and external rotation, and straight leg raise measured using video analysis software. Additionally, passive clinical knee and ankle stability tests were conducted. The independent variables were leg dominance and playing position (defender, midfielder, and attacker). For the results, all the ROM measurements demonstrated limb symmetry (p = 0.621). However, there were significant main effects of the playing position on the ankle dorsiflexion and hip internal rotation, with defenders demonstrating a significantly reduced range of motion in comparison to midfielders and attackers. A notable finding from the bilateral passive stability measures was that 38.3% of players exhibited ankle talar inversion instability when using a talar tilt. In conclusion, bilateral differences do not appear to be apparent in this population; however, positional differences may occur in the ankle and hip range of motion measures. A high proportion of this population may present with passive ankle inversion instability. Future research should consider whether this leads to a higher risk of injury in this population.

The relationship between physical activity, structural deformity, and spinal mobility in adolescent idiopathic scoliosis patients.

Adolescent idiopathic scoliosis (AIS) patients experience structural spinal deformity, but the impact of AIS on physical activity is not widely studied. Reports of physical activity levels between children with AIS and their peers are mixed. This study sought to characterize the relationship between spinal deformity, spinal range of motion, and self-reported physical activity in AIS patients. Patients aged 11-21 completed self-reported measures of physical activity using the HSS Pedi-FABS and PROMIS Physical Activity questionnaires. Radiographic measures were obtained from standing biplanar radiographic imaging. Surface topographic (ST) imaging data was obtained using a whole-body ST scanning system. Hierarchical linear regression models analyzed the relationship between physical activity, ST, and radiographic deformity while controlling for age and BMI. 149 patients with AIS (mean age 14.5 ± 2.0years, mean Cobb angle 39.7° ± 18.9°) were included. In the hierarchical regression predicting physical activity from Cobb angle, no factors were significant predictors of physical activity. When predicting physical activity from ST ROM measurements, age and BMI served as covariates. No covariates or ST ROM measurements were significant predictors of physical activity levels for either activity measure. Physical activity levels of patients with AIS were not predicted by levels of radiographic deformity or surface topographic range of motion. Although patients may experience severe structural deformity and range of motion limitations, these factors do not appear to be associated with decreased physical activity level utilizing validated patient activity questionnaires. Level II.

Curcumin: The active compound in turmeric has the potential to reduce pain intensity and increase range of motion during exercise-induced muscle damage

This study aims to analyze and prove the effect of curcumin on pain intensity and ROM during EIMD. This experimental study used a pre and post-control group design. Research subjects were selected using a purposive sampling technique and then the subjects were divided into 2 groups, namely the group given a placebo and the group was given curcumin at a dose of 400 mg. A total of 24 healthy men aged between 20-30 years participated in this study. On the first day, all subjects took data on the characteristics of research subjects, then warmed up. Then the subjects did the high-intensity physical exercise in the form of squad and leg press exercises with an intensity of 80-90% of maximum ability. The exercise was carried out in 4 sets for each form of exercise and rest between sets for about 1 minute. On the second day, after 24 hours the subject took pre-test data to measure pain intensity and ROM, then the intervention was given based on each group. On the third day, after 24 hours the subject took post-test data to measure pain intensity and ROM. Measurement of pain intensity using the Visual Analytical Scale (VAS) and measurement of ROM performed in the knee joint using a goniometer. After the data was obtained, the data were analyzed using the IBM SPSS version 26 application. The results of this study reported that the group given curcumin during EIMD was able to significantly reduce pain intensity (*p<0.05) compared to the group given a placebo. Furthermore, the group given curcumin during EIMD was able to increase ROM significantly (*p<0.05) compared to the placebo group. We believe that the main cause of muscle soreness is the uncontrolled increase in pro-inflammatory cytokines such as TNF-a and IL-6 during EIMD and then decreased ROM for several days after exercise. Since pain intensity and ROM are needed to support body functions, we highly recommend the use of curcumin, which has many positive benefits for sports enthusiasts to support physical performance. Keywords: Curcumin, Pain Intensity, Range of Motion, Exercise-Induced Muscle Damage, Inflammation

COMPARATIVE STUDY ON THE EFFECTIVENESS OF MUSCLE ENERGY TECHNIQUE AND ACTIVE RELEASE TECHNIQUE ON THE GLENOHUMERAL INTERNAL ROTATION DEFICIT (GIRD) IN YOUNG THROWING ATHLETES

<p><strong>Background: </strong>Glenohumeral internal rotation deficit (GIRD) is one of the most common causes of impairments in overhead throwing athletes due to high intense and repeated throwing activities. The purpose of this study is to compare the effects of Muscle energy technique and Active release technique in overhead throwing athletes with Glenohumeral internal rotation deficits. <strong>Materials and Methods:</strong> A total of 42 athletes with age group 18-25 were selected for the study and a simple random lottery method was used to divide the sample into three groups; Group A (n=14) received muscle energy technique and conventional therapy, Group B (n=14) received active release technique and conventional therapy, Group C (n=14) received only conventional therapy. Measurements of shoulder internal rotation ROM (by Goniometer) and SPADI (shoulder pain and disability index) were assessed pre- and post-treatment after 4 weeks. <strong>Results:</strong> The results showed that Group A shows a significant difference in shoulder internal rotation ROM with a p-value <0.05 than Group B and C, but there was no significant difference was found between all the groups in the SPADI score with p-value >0.600. <strong>Conclusion:</strong> The study concluded that the muscle energy technique is more effective than the active release technique in improving shoulder internal rotation ROM, but both techniques have equally effective in improving shoulder function among athletes with GIRD.</p><p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/soc/0009/a.php" alt="Hit counter" /></p>

A NEW REMOTE METHOD FOR ASSESSING ANKLE RANGE OF MOTION USING A SMARTPHONE: THE DIJIA APP

Recently, several smartphone applications (apps) have been developed and validated for ankle ROM measurement tools like the universal goniometer. This is the first innovative study introduces a new smartphone application to measure ankle joint ROM as a remote solution. This study aimed to assess the correlation between smartphone ROM and universal goniometer measurements, and also report the evaluation of the DijiA app by users.The study included 22 healthy university students (14F/8M; 20.68±1.72 years) admitted to Yeditepe University. Fourty four feet was measured by both the universal goniometer (UG) and DijiA app. The datas were analyzed through using the intraclass correlation coefficient (ICC). The DijiA app was evaluated by usability testing with representative users.Pearson correlation coefficient test showed moderate correlation between the DijiA and UG for dorsiflexion (DF) and plantar flexion (PF) measurements (Pearson correlation coefficient: r=0.323, for DF; r=0.435 for PF 95% confidence interval). The application usability was found as high with 76.5 average score and users liked it.The DijiA app may be a more convenient and easy way to measure ankle DF and PF-ROM than UG. It can be used to evaluate ROM in clinical practice or home using as a personal smartphone.

Risk factors of reoperative post anterior cruciate ligament reconstruction

Background: ACL reconstruction (ACLR) is a surgical procedure to graft the ACL using tendon tissue to restore joint fixation and stabilization functions. Rehabilitation management is performed by physiotherapy in ACLR phase III patients to increase strength, balance, and functional motion control of patients with rehabilitation and exercise adaptation interventions. Case Description: On June 09, 2022, the patient was playing basketball, when the patient heard his leg "pop" due to sudden stopping and turning movements while playing basketball. The patient took the initiative to go to the hospital because his leg was painful and was advised to do an MRI, the results of the MRI examination stated that the patient had an ACL and Meniscus rupture. The patient has undergone ACL reconstruction surgery and partial lateral meniscectomy on July 20, 2022, the patient has been doing physiotherapy since the first postoperative day until now entering the 10th week, the patient still feels something is stuck in the knee, and feels that left leg is stiff and weak when moved. Conclusion: There is an increase in ROM measurement results, muscle strength, segment circumference, hamstring and trunk flexibility, functional knee, and decreased pain scale. It is hoped that this case can be used as a reference for providing exercise interventions in patients with ACL postoperative conditions, especially phase III with other comorbidities.

Clinical and Functional Results of Cementless Unicompartmental Knee Arthroplasty with a Minimum Follow Up of 5 Years—A Consecutive Cohort of 201 Patients

The number of unicompartmental knee replacements (UKR) is increasing. Alongside various advantages, the revision rate of cemented UKR is higher compared to total knee arthroplasty (TKR). In contrast, cementless fixation shows reduced revision rates, compared to the cemented UKR. However, most of the recent literature is based on designer-dependent studies. In this retrospective, single-center cohort study, we investigated patients who underwent cementless Oxford UKR (OUKR) between 2012 and 2016 in our hospital with a minimum follow-up of five years. Clinical outcome was evaluated using the OKS, AKSS-O, AKSS-F, FFbH-OA, UCLA, SF-36, EQ-5D-3L, FJS, ROM, pain, and satisfaction measures. Survival analysis was performed with reoperation and revision as endpoints. We included 201 patients (216 knees) for clinical evaluation. All outcome parameters increased significantly from pre- to postoperative stages. The five-year survival rate was 96.1% for revision surgery and 94.9% for reoperation. The main reasons for revision were the progression of osteoarthritis, inlay dislocation, and tibial overstuffing. Two iatrogenic tibial fractures appeared. Cementless OUKR shows excellent clinical outcome and high survival rates after five years. The tibial plateau fracture in cementless UKR represents a serious complication and requires modification of the surgical technique.

Extracorporeal Shock Wave Therapy Improves Nontraumatic Knee Contracture in a Rat Model.

Joint contractures occur frequently after trauma or immobilization, but few reliable treatments are available. Extracorporeal shock wave therapy (ESWT) is often used for various musculoskeletal conditions, but whether it is effective for treating joint contractures and the mechanisms through which it might work for that condition remain unclear. Using a rat model, we asked, does ESWT (1) inhibit the progression of knee contracture, (2) ameliorate histopathologic joint changes, and (3) improve serum and myofascial fibrosis-related factors? We also asked, (4) what is the possible mechanism by which ESWT inhibits knee contracture? Thirty-two male Sprague-Dawley rats (12 weeks old and weighing 300 to 400 g) were randomly separated into two groups: control group (eight rats) and noncontrol group (24) in the first week. Rats in the control group were kept free in cages for 4 weeks, and the right lower limbs of the rats in the noncontrol group were immobilized in plaster for 4 weeks. ROM was then measured for each rat with or without 4 weeks of immobilization. After ROM measurement, rats in the noncontrol group were randomly separated into three groups: immobilization group (eight rats), remobilization group (eight rats), and remobilization with ESWT group (eight rats) at Week 4. Knee contracture was induced in rats by fixing the right knee with a plaster cast as in a previous study. The plaster cast was removed after 4 weeks; knee contracture was established when passive ROM was decreased and dysfunction such as abnormal gait occurred. Subsequently, rats with a remobilized joint contracture were treated with or without ESWT for 15 days (on Days 5, 10, and 15). The therapeutic effect was examined using ROM, joint diameter (as an indication of swelling), histopathologic changes, and the levels of fibrosis-related extracellular matrix component factors (hyaluronic acid, serum procollagen peptide, and laminin). The effect of ESWT on fibrosis protein was also evaluated using immunohistochemistry, quantitative polymerase chain reaction (qPCR), and Western blot. The expressions of factors in the TGF-β/SMADs pathway were also determined using Western blot and qPCR. ESWT mitigated immobilization-induced knee contracture in rats by improving ROM (immobilization versus remobilization with ESWT: 53° ± 8° versus 32° ± 8° [95% confidence interval 13° to 30°]; p < 0.001) and joint swelling (immobilization versus remobilization with ESWT: 8 ± 0.8 cm versus 6 ± 0.3 cm [95% CI 0.4 to 2.2 cm]; p = 0.01). Histopathologic features of remission were alleviated after ESWT (immobilization versus remobilization with ESWT: thickness of the knee space: 0.2 ± 0.03 mm versus 0.6 ± 0.01 mm [95% CI -0.49 to -0.33 mm]; p < 0.001. On Masson staining, the positive expression area, which indicates collagen fiber deposition, was 24% ± 5% versus 9% ± 2% ([95% CI 10% to 21%]; p < 0.001). ESWT improved the serum fibrosis factors of hyaluronic acid, procollagen peptide, and laminin (immobilization versus remobilization with ESWT: hyaluronic acid: 412 ± 32 versus 326 ±15 ng/mL [95% CI 29 to 144 ng/mL]; p = 0.003; serum procollagen peptide: 19 ± 1 versus 12 ±1 ng/mL [95% CI 3 to 11 ng/mL]; p < 0.001; laminin: 624 ± 78 versus 468 ±9 ng/mL [95% CI 81 to 231 ng/mL]; p = 0.006) and myofascial factors of α-SMA and Type I collagen associated with immobilization-induced contractures. The findings suggest that ESWT improved joint contracture by inhibiting the TGF-β1/SMADs signaling pathway in rats. This work suggests ESWT may be worth exploring in preliminary research in humans to determine whether it may be a treatment option for patients with nontraumatic knee contractures. If the mechanism of ESWT can be confirmed in humans, ESWT might be a therapy for diseases involved in the TGF-β1/SMADs signaling pathway, such as hypertroic scarring and scleroderma.

The Effects of Tissue Flossing on Shoulder Range of Motion and Pain in Patients with Adhesive Capsulitis: A Case Study

Background and Purpose: The purpose of this case report is to describe the tissue flossing interventions for apatient with adhesive capsulitis.Case Description: The patient was a 56-year-old female, who presented with left shoulder pain and limitedrange of motion (ROM) following a fall 9 months prior. The patient had a past medical history of thyroid.The diagnosis of adhesive capsulitis was determined following radiographs, mechanism of injury, past medicalhistory, and physical therapy examination and evaluation.Intervention: The patient was seen for a total of 15 physical therapy sessions over the span of 6 weeks.Interventions included a tissue flossing, home exercise program, instruction in heat/ice use, mobilizations,therapeutic exercises, ROM, stretching, and glides. Outcome measures included ROM measurements, painratings, strength tests and the Shoulder Pain and Disability Index (SPADI).Outcomes: Following 6 weeks of physical therapy intervention, tissue flossing and home exercise program, thepatient demonstrated increased shoulder ROM, decreased pain and improved function based on the improvedSPADI.Discussion: Rationale for treatment was based on textbook information for shoulder interventions and researcharticles. The treatment was altered based on patient’s response.Conclusion: This case report is in concordance with the current research that shows flossing, strengthening,mobilizations, a home exercise program and stretching are appropriate combinations of interventions forindividuals with adhesive capsulitis. This patient returned to his prior level of function following the abovetreatment regimen.

Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years.

Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years.

Relation Analysis of Range of Motion and Motor Ability in Adult with Cerebral Palsy

Studies so far have not clarified the relationship with ROM by directly measuring the motor ability in adult with cerebral palsy, even though ROM is closely related to motor ability. Therefore, the purpose of this study is to reveal the relationship between AROM and motor ability based on the close relationship between ROM and motor ability of cerebral palsy.BR The subjects of this study were 101 adults with cerebral palsy (63 men and 38 women, 36.4±8.9 years old in average age, 162.8±9.6 cm in average height, 59.6±11.2 kg in weight, and 22.5±3.7 kg･m-2 in BMI) using three cerebral palsy welfare centers in Korea.BR The ROM measurement was performed by measuring the AROM (Active Range of Motion), and the items were 25 parts of 7 regions of the whole body. In addition, the motor ability measurements were a total of 10 items of motor ability (grip strength, shoulder strength, sit-up, left-back, and softball throwing) which mainly uses the upper extremities, and 5 items of motor ability (50 m running, side steps, single leg stance, standing long jump and 10 m shuttle run test).BR As a result of analyzing the correlation between AROM and motor ability, significant correlation with all exercise abilities was recognized in the ablation and under burst of foot joints in AROM (p.05). In particular, in the relationship between the bowing of the foot joint and standing long jump, the highest value of all correlation coefficients was shown (p.01). On the other hand, extra-shoulder joint rotation was not recognized to be correlated with all motor skills. In addition, there was less motor ability that showed a significant correlation with neck joint flexion and elongation, intra-shoulder joint rotation, and wrist joint extension. Most of the AROMs of the upper extremity were recognized to have a significant correlation with grip strength, shoulder muscle strength, and trunk forward flexion (p.05). In addition, most of the AROMs in the lower extremities were significantly correlated with sit-ups, convulsions, softball throwing, 50m running, side steps, single leg stance, long jump, and shuttle run test (p.05).BR Taken together, the development of foot and hip AROM among lower limb joints is considered the most important to obtain high motor skills in ambulatory cerebral palsy.