Knee ROM Research Articles

Does Intra-operative PRP Improve Patient Function & Complication Rates Following ACL Reconstruction With Meniscus Repair?

Objectives: The frequent injury and compromised healing of intra-articular structures (i.e. cruciate ligaments and menisci) has led to an intense interest among surgeons and scientists for discovering new methods of enhancing the biological healing response of these tissues. Platelet-rich-plasma (PRP) contains various growth factors that positively effect biological healing, unfortunately few existing clinical studies are available to determine the risks and benefits of these therapies. Therefore, the purpose of this study was to determine the influence of intraoperative PRP on postoperative knee function and complications out to 2-years following ACL reconstruction with meniscus repair. Methods: A matched case-control study was conducted using a single surgeon database of 673 patients undergoing ACL reconstruction with concomitant meniscus repair (Figure 1) resulting in 324 patients [PRP (n = 162) vs matched-control (n = 162)] who met the study criteria. Patients were matched on age, gender, graft type, and meniscus tear size and location. The single assessment numeric evaluation (SANE) was administered at 2-years and served as the primary outcome measure. Secondary outcomes included the time to return-to-activity (mo), self-reported knee function [International Knee Disability Committee (IKDC)], objective functional testing (knee ROM, single-leg balance, single leg-hopping, agility testing), and postoperative complications (graft failure, infection, loss of motion, venous thrombosis, etc). Univariate models were used for between groups comparisons and alpha was set at .05 for all analyses. Results: There were no differences in SANE knee function scores between the PRP and matched-control groups at 2-years, respectively (91.6 ±11.2 vs 92.4 ±10.6, P = .599). Additionally, no differences were observed between groups for self-reported function (IKDC score; 87.6 ±13.3 vs 88.1 ±12.6, P = .952), objective functional testing (P > .05), and timing of return-to-activity (7.8 ±1.9 vs 8.0 ±1.9, P = .765). The PRP group demonstrated a higher rate of postoperative knee motion loss complications when compared to the control group (13.5% vs 4.9%, P < .001). No other differences were observed in postoperative complications (P > .05). Conclusion: The added use of intraoperative PRP did not improve self-reported knee function, objective functional testing, and timing of return-to-activity for patients undergoing ACL reconstruction with concomitant meniscus repair. Furthermore, the use of PRP may have negative consequences for regaining knee ROM after surgery. Based on these data, surgeons should cautiously consider the application of PRP when surgical planning for intra-articular injuries of the knee.

The Effects of Tourniquet Application in Total Knee Arthroplasty on the Recovery of Thigh Muscle Strength and Clinical Outcomes.

The present randomized controlled study aims to evaluate whether tourniquet application during total knee arthroplasty (TKA) has an effect on (1) thigh muscle strength (quadriceps and hamstring muscle strength) and (2) clinical outcomes (postoperative knee range of motion [ROM], postoperative pain level, and Knee Society Score [KSS]). The effects of tourniquet application during TKA were investigated in 65 patients randomly allocated to one of two groups: TKA with a tourniquet and TKA without a tourniquet. Patients in both groups were comparable in terms of the demographic and clinical data (p > 0.05 for age, number of patients, sex, radiographic gonarthrosis grade, American Society of Anesthesiologists [ASA] classification, and body mass index [BMI]). All patients in both groups were operated by the same surgeon using one type of prosthesis. Isokinetic muscle strength (peak torque and total work) of knee extensors (quadriceps) and flexors (hamstrings) was measured in Newton meters (Nm) using a CYBEX 350 isokinetic dynamometer (HUMAC/CYBEX 2009, Stoughton, MA). The combined KSS (knee score + function score), visual analog scale (VAS), and knee ROM were measured preoperatively and at 1 and 3 months postoperatively to evaluate clinical outcomes. There were no significant differences between the two groups in preoperative and postoperative values of isokinetic muscle strength (peak torque and total work) and aforementioned clinical outcomes (p < 0.05). The present study has shown that quadriceps strength and clinical outcomes were not improved in the early postoperative period (3 months) when a tourniquet was not used during TKA.

The effects of tai chi chuan exercise training on countermovement jump performance in the elderly

ABSTRACT This study sought to compare the biomechanical parameters of the lower extremities during a countermovement jump in elderly people who are engaged in frequent practice of tai chi chuan (TCG) and in the general population of healthy elderly people (HG). Each group included 12 participants. Ten Vicon Motion System infrared cameras and two Kistler force plates were employed for measurement. The jump height, duration, centre of mass (COM) displacement, joint ROM, and upward velocity were analysed in this study. Motion analysis and force platform data were combined to calculate joint moments and powers during the takeoff phase. The data were analysed using independent sample t-tests. The results showed that the tai chi chuan practitioner group (0.13 m) achieved 44% higher jump heights (p < 0.05). The COM displacement during squatting was lower in the TCG (0.25 m) than in the HG (0.19 m) (p < 0.05). The knee and ankle ROMs of the TCG were higher than those of the HG (p < 0.05). Peak knee moment 23% and peak knee power 32% higher in TCG compared to the HG (p < 0.05), suggesting that frequent practice of tai chi chuan may slow the rate of knee degeneration.

Arthroscopically-assisted Reduction and Internal Fixation (ARIF) of tibial plateau fractures: clinical and radiographic medium-term follow-up.

Background and Aim of the work:Tibial plateau fractures include a wide spectrum of lesions with potentially disabling sequelae. Arthroscopically-assisted Reduction and Internal Fixation (ARIF) is an alternative to traditional ORIF. The aim of this retrospective single centre study is to evaluate medium-term clinical and radiographic outcomes achieved in a consecutive series of patients treated with ARIF.Methods:21 patients, with a mean age of 52.2 ± 13.4 years at surgery, were included. According to Schatzker classification, there were 9 type II, 10 type III, 2 type IV fractures. Associated intra-articular injuries (meniscal tears, tibial spine fractures, chondral lesions) were detected in 8 patients. At follow up, patients were clinically and radiographically evaluated according to knee ROM, KOOS, OKS and Rasmussen Clinical and Radiological Scores.Results:At an average follow-up of 84 ± 22.5 months, 18 patients were evaluated. Mean values recorded were the following: knee ROM 1° - 135°, OKS 41.6 / 48 ± 8.18, subscale KOOS scores ranged from 75% ± 25.4 (Quality of Life) to 91.1% ± 11.2 (Pain), Rasmussen Clinical e Radiological 27.2 ± 2.64 (14 excellent, 3 good, 1 fair) and 9.1 ± 0.64 (15 excellent, 3 good), respectively. Worse results were observed in 5 patients with pre-existing degenerative chondropathy.Conclusions:ARIF revealed to be an effective technique for surgical treatment of unicondylar tibial plateau fractures. Our findings support the favourable results reported by other authors. ARIF is not a simple technique and requires specific experience in knee arthroscopy and a steep learning curve. (www.actabiomedica.it)

Comparision of knee range of movement by using static verses dynamic spacer in total knee infection

Introduction: Prosthetic joint infections (PJIs) of total knee arthroplasty (TKA) are the one of the most dreaded complications resulting from TKA. Although different methods of treatment protocols are followed around the world, a two staged exchange arthroplasty is the considered gold standard for PJI’s. The purpose of the present study was to determine the recovery of knee ROM in patients undergoing two stage revision total knee arthroplasty with either dynamic or static antibiotic loaded cement spacers. Methods: This was a retrospective case series performed between 2016 and 2019, Patients with a documented TKA infection that under-went a two-stage revision of both the femoral and tibial component of their TKA were included into the study. A total number of 44 patients who were treated with a spacer made of antibiotic-loaded acrylic cement were included. Twenty two patients were treated with temporary static spacer and 22 patients were treated with dynamic spacers. Results: At 6 months post operative visit, none of the patients had a recurrence in infection. Knee flexion was higher in dynamic spacer group at 2 week, 3 months and 6 months during the post operative period when compared to static spacer group the operation time of revision implantation was also shorter for dynamic spacer group. Conclusion: Our study results suggest that patients treated with dynamic spacer had a faster recovery in terms of range of motion of the knee, and shorter operating time for reimplantation. Our results support the use of dynamic spacers in an infected TKA that are treated with two-stage revision of arthroplasty.

Unreamed solid interlocking nail for the management of compound tibial diaphyseal fracture? A prospective study

Background: Compound tibial fractures have always been a challenge to the orthopedic fraternity. Goals of treating these fractures are preventing infection, restoring soft-tissue vitality, achieving union, and instituting early joint motion and rehabilitation. Aim: The aim was to evaluate the rate of union, infection rate, post-union deformity, and the functional outcome following unreamed solid interlocking nailing in compound tibial diphyseal fracture of Gustilo–Anderson Grade I to IIIB. Materials and Methods: Twenty patients presenting to the emergency orthopedic department with compound tibial fractures, between 2014 and 2016, were included in the study. This was a hospital-based, prospective study. The fractures were classified according to Gustilo–Anderson classification, and the final outcome was measured by Johner and Wruh's criteria with modification. Results: We had more cases of male patients than females (75% vs. 25%) in the age group of 20–60 years (average 37.10). Road traffic accident was the most common cause in our study (75%) followed by fall from height (25%). Gustilo and Anderson classification was used, and 10% were Grade I, 20% were Grade II, 65% were Grade IIIA, and 5% were Grade IIIB. The average time to union was 22.53 weeks and the average time to start full weight bearing was 11 weeks with a standard deviation of 1.38 weeks. Complications such as delayed union (10%), nonunion (5%), shortening (5%), superficial infection (10%), gait disturbance (5%), and angulation (10%) were found; 5% had more than 25° of restriction of ankle rom and 5% had more than 10° of restriction of knee rom. Final outcome was excellent results in 65%, good in 20%, fair in 10%, and poor in 5% of cases. Conclusion: The present study demonstrates that unreamed solid interlocking nailing is considered a good option for the management of compound tibial fractures (Grade I–IIIB) as it allows early weight bearing, early rehabilitation with high union rate, and low complication rate.

Impact of knee osteoarthritis on surgical outcomes of lumbar spinal canal stenosis.

Lumbar spinal canal stenosis (LSS) and knee osteoarthritis (KOA), both of which are age-related degenerative diseases, are independently correlated with increased pain and dysfunction of the lower extremities. However, there have been few studies that investigated whether LSS patients with KOA exhibit poor clinical recovery following lumbar spinal surgery. The aim of this study was to elucidate the surgical outcomes of lumbar spinal surgery for LSS patients with KOA using multiple health-related quality of life (HRQOL) parameters. A total of 865 consecutive patients who underwent posterior lumbar spinal surgery for LSS were retrospectively reviewed. Baseline characteristics, radiographic parameters, perioperative factors, and multiple HRQOL parameters were analyzed preoperatively and at 1-year follow-up. HRQOL items included the Zurich Claudication Questionnaire, Oswestry Disability Index, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The effectiveness of surgical treatment was assessed using the JOABPEQ. The treatment was regarded as effective when it resulted in an increase in postoperative JOABPEQ score by ≥ 20 points compared with preoperative score or achievement of a postoperative score of ≥ 90 points in those with a preoperative score of < 90 points. A total of 32 LSS patients with KOA were identified, and 128 age- and sex-matched LSS patients without KOA were selected as controls. In both groups, all HRQOL parameters markedly improved at the 1-year follow-up. On the SF-36, the postoperative mean score for the role physical domain was significantly lower in the KOA group than in the control group (p = 0.034). The treatment was significantly less "effective" in the social life domain of JOABPEQ in the KOA group than in the control group (p < 0.001). The surgical outcomes of LSS patients with KOA are favorable, although poorer than those of LSS patients without KOA, particularly in terms of social life and activities. These results indicate that LSS patients with KOA experience difficulty in routine work or ordinary activities due to knee pain or restricted knee ROM even after lumbar spinal surgery. Hence, preoperative KOA status warrants consideration when planning lumbar spinal surgery and estimating surgical outcomes of LSS.

Oval femoral tunnel technique is superior to the conventional round femoral tunnel technique using the hamstring tendon in anatomical anterior cruciate ligament reconstruction.

This study was conducted to compare the efficacy between the oval femoral tunnel technique and the conventional round femoral tunnel technique in ACL reconstruction using an autologous hamstring tendon on the basis of the postoperative clinical outcomes and ACL graft tendon maturity. The hypothesis was that ACL reconstruction performed using the oval femoral tunnel technique was better than that performed using the round femoral tunnel technique in clinical functions and graft maturity. One hundred and eight patients who underwent anatomical single-bundle ACL reconstruction were included in this study and the follow-up period was at least 2years. Thirty-nine patients admitted between February and August in 2016 were included in the oval femoral tunnel group and 69 patients admitted between September 2016 and March 2017 were included in the round femoral tunnel group. The Lachman test result, pivot-shift test result, Lysholm score, IKDC score, and VAS score were used for the clinical evaluation. An objective assessment of anteroposterior stability was performed using a KT1000 arthrometer. Postoperative MRI was conducted to compare the ACL graft maturity differences between the oval femoral tunnel group and round femoral tunnel group, where the signal/noise quotient (SNQ) was calculated. In addition, second-look arthroscopy was conducted to compare the graft status and synovial coverage at 24months postoperatively. All the patients presented with significant improvement in all clinical scores from the preoperative period to the 24-month follow-up. During the postoperative follow-up period, no statistically significant differences were found between the two groups in terms of the VAS score, knee ROM, Lachman test results, and graft status determined in the second-look arthroscopic evaluation. The Lysholm score was 97.1 ± 3.9 and 94.8 ± 5.6 in the oval femoral tunnel group and round femoral tunnel group, respectively, at the 24-month follow-up (p = 0.031). The IKDC subjective score was 92.0 ± 2.6 and 89.0 ± 3.6 in the oval femoral tunnel group and round femoral tunnel group, respectively, at the end of the follow-up period (p < 0.001). Significantly more patients with 1-degree positive pivot-shift test results were observed in the round femoral tunnel group (10/65) than in the oval femoral tunnel group (1/37) at the end of the follow-up period (p = 0.048). The mean SNQ of the oval femoral tunnel group was 2.7 ± 0.9, which was significantly lower than that of the round femoral tunnel group (3.6 ± 1.1) at the 24-month postoperative follow-up (p < 0.001). Based on the clinical evaluations, MRI findings and second-look arthroscopy results of the two groups, the oval femoral tunnel technique yielded significantly better knee function and knee laxity restoration and more mature ACL grafts than the round femoral tunnel technique, whereas no significant differences were found at the second-look arthroscopy. III.

Clinical and radiographic outcomes of computer-navigated total knee arthroplasty are not adversely affected by body mass index

AimTo study the effect of obesity on clinical and radiographic outcomes of computer-navigated knee arthroplasty. Materials and methods117 patients underwent primary computer-navigated total knee arthroplasty. Eight were lost to follow-up and 8 had incomplete data. ResultsEighty-four (83.2%) female, 17 (16.8%) male patients age 65.3 ± 6.9 years with a pre-operative BMI 27.2 ± 4.1 (18.6–40.0) kg/m2, 7.3 ± 0.98 years follow-up. Forty-two (41.6%) had a BMI>27.5 kg/m2 indicative of obesity in Singapore. Post-operative radiographic alignment, 2-year Oxford knee scores and ROM were not significantly associated with BMI. ConclusionBMI is not a determinant of functional scores when computer navigation is used.

Early Mechanical Failure of a Tumoral Endoprosthesic Rotating Hinge in the Knee: Does Bumper Wear Contribute to Hyperextension Failure?

Tumor surgeons use a variety of endoprosthetic designs for reconstruction after bone tumor resection. However, functional results and implant survival have not been evaluated for each design. Because the outcomes and failure modes (for example, implant breakage, loosening) may differ between prosthetic design types, it is important to examine the problems associated with different designs. Because of experiences in our practice, we became concerned about a surprisingly high frequency of device breakage with one particular design, and we wished to report on that experience. QUESTION/PURPOSES: (1) In a small series of patients, what proportion of a particular design (Zimmer® Segmental [Zimmer Inc, Warsaw, IN, USA]) of rotating-hinge endoprosthesis experienced implant breakage at short-term follow-up? (2) What patient symptoms were associated with this finding? (3) What is the function as assessed by Musculoskeletal Tumor Society (MSTS) score with the use of this implant before and after revision? We treated 87 patients in our tertiary center from 1987 to 2014 who had sarcomas around the knee with wide resection and reconstruction with tumoral endoprosthesis; five patients were lost to follow-up. In all, 33 of the remanining 82 prostheses, treated from 1987 to 2006, were reconstructed with fixed-hinge designs. From 2006 to 2014, 49 patients were reconstructed with a knee endoprosthesis, and 48 of them had a rotating-hinge prosthesis. In our center, we mostly used four designs: 16 of 49 patients were reconstructed with GMRS (Stryker Howmedica, Kalamazoo, MI, USA), seven received the LPS™ (DePuy Synthes, Warsaw, IN, USA), 20 of 49 had the METS (Stanmore, Hertfordshire, UK), and six of 49 received the Zimmer Segmental. The focus of this report is on the six patients with the Segmental. We retrospectively gathered clinical and radiologic data from these six patients' records and we assessed radiographic images. We evaluated function with the MSTS score of the 49 patients. The median follow-up duration of the Segmental prosthesis reconstruction was 65 months (range 24 to 85). Three of the six patients had posterior instability and recurrent joint effusion on physical examination. Three patients who did not have hyperextension presented with restricted knee ROM. Six revision procedures were performed in three patients. The median MSTS score at 6 months for the Segmental® prosthesis was 15 of 30 (range 6 to 24). The score in the three patients who had posterior instability was 9 of 30 (range 6 to 15) and it improved to median 25 of 30 (range 19 to 30) 6 months after revision. The patients with the Segmental® prosthesis who did not undergo revision had a median MSTS score of 20 (range 16 to 24). The Zimmer Segmental rotating-hinge tumoral prosthesis underwent revision for implant breakage at short term in three of six patients after tumor resection and reconstruction of the knee. Bumper breakage was associated with posterior instability that was related to wear of the bushing blocking system. We are unaware of reports of these issues by other observers or in other prosthetic designs, but we feel larger registries should be created to see if this failure mechanism has been observed by others. If so, this design needs to be improved or the blocking system should be avoided.Level of Evidence Level IV, therapeutic study.

Comparison of Immediate Effect of New Knee brace and Conventional Three-Points Knee Valgus Brace on Knee Adduction Moment and ROM in Patients with Medial Knee Osteoarthritis.

The knee unloader brace can change loading on knee which may be effective in reducing symptoms and progression of disease in people with knee osteoarthritis. The purpose of this study was to evaluate the effect of a new knee brace during walking in a patient with medial compartment knee osteoarthritis. Two brace types were used: new brace and conventional brace. A pneumatic cuff of novel brace was fitted in the bottom of the medical slipper that was connected to the cuff section of the knee through the tube. After the knee brace is deployed, its force can vary in different stages of the gait. During the heel strike, the weight of the cuff is compressed on the floor, causing the air to flow inside it and entering the volume of air into the knee pad. The results of using this pneumatic knee brace compared with conventional knee braces on a patient showed that in both cases, the open and closed palatal pump, the adduction moment and ROM was decreased in the stance phase. But the three-point knee pressure, however, was less effective in reducing the adduction moment but also reduced the knee ROM. Using novel brace can eliminate the patient’s need for painful and costly surgery to reduce the symptoms of osteoarthritis.

The comparison of gap balance technique and measured resection technique in total knee arthroplasty

Objective To compare the difference in imaging and clinical effects between gap balance technique and measured resection technique in total knee arthroplasty (TKA). Methods We recruited 300 patients undertaking TKA from July 2014 to July 2016. TKA were performed by using gap balance technique or measured resection technique randomly. The intraoperative rotation of femoral prosthesis, changes of joint line, osteotomy volume, preoperative and postoperative KSS score, WOMAC score, VAS and ROM were compared between the two groups. Results A total of 292 patients were included in the present study, and 248 patients were successfully followed up for 2 years. The operation duration of the gap balance group was 65.9±14.1 min, which was significantly less than that of the measured osteotomy group 70.5±16.5 min (t=2.36, P=0.02). The rotation angle α of the femoral prosthesis measured on CT scan postoperative in gap balance group was 0.67°±1.71°, which was significantly smaller than that of the measured resection technique group 1.25°±2.53° (t=2.12, P=0.03). The external rotation angle β between the osteotomy plate and femoral posterior condyle line in the gap balance group was 1.25°±1.26°, which was significantly greater than that of the measured resection technique 0.28°±0.19° (t=6.57, P<0.01). The bone cut volume of femoral medial posterior condyle in gap balance group 9.85±1.37 mm showed a statistically difference (t=2.02, P=0.04) compared with that of the measured osteotomy group 9.52±1.19 mm. The KSS score was 83.8±10.2 in the gap balance group after 1 month. It was superior to the measured resection technique group of 80.5±9.4 with statistical significance (t=2.65, P=0.01). The knee ROM was 101.7°±12.7° in the gap balance group at 1 month after surgery, which was better than that in the measured resection technique group 98.2°±11.8° (t=2.25, P=0.03). Conclusion The axis of the femoral prosthesis was more consistent with STEA in the gap balance group of TKA. The gap balance group had better ROM and KSS functional scores at the first month after surgery. However, there was no statistical difference in knee function at the 2-year follow-up between the two groups. Key words: Arthroplasty, replacement, knee; Osteotomy; Treatment outcome

Early initiation of home-based sensori-motor training improves muscle strength, activation and size in patients after knee replacement: a secondary analysis of a controlled clinical trial

BackgroundThere is accumulating evidence for the advantages of rehabilitation involving sensori-motor training (SMT) following total knee replacement (TKR). However, the best way in which to deliver SMT remains elusive because of potential interference effects amongst concurrent exercise stimuli for optimal neuromuscular and morphological adaptations. The aim of this study was to use additional outcomes (i.e. muscle strength, activation and size) from a published parent study to compare the effects of early-initiated home-based rehabilitative SMT with functional exercise training (usual care) in patients undergoing TKR.MethodsA controlled clinical trial was conducted at the Orthopedic University Hospital of Rion, Greece involving allocation concealment to patients. Fifty-two patients electing to undergo TKR were randomised to either early-initiated SMT [experimental] or functional exercise training [control] in a home-based environment. Groups were prescribed equivalent duration of exercise during 12-weeks, 3–5 sessions of ~ 40 min per week of home-based programmes. Muscle strength and activation (peak force [PF]; peak amplitude [Peak Amp.] and root mean square of integrated electromyography [RMS iEMG]), muscular size (including rectus femoris muscle cross-sectional area [CSARF]), and knee ROM were assessed on three separate occasions (pre-surgery [0 weeks]; 8 weeks post-surgery; 14 weeks post-surgery).ResultsPatients undertaking SMT rehabilitation showed significantly greater improvements over the 14 weeks compared to control in outcomes including quadriceps PF (25.1 ± 18.5 N vs 12.4 ± 20.8 N); iPeak Amp. (188 ± 109.5% vs 25 ± 105.8%); CSARF (252.0 ± 101.0 mm2 vs 156.7 ± 76.2 mm2), respectively (p < 0.005); Knee ROM did not offer clinically relevant changes (p: ns) between groups over time. At 14 weeks post-surgery, the SMT group’s and control group’s performances differed by relative effect sizes (Cohen’s d) ranging between 0.64 and 1.06.ConclusionA prescribed equivalent time spent in SMT compared to usual practice, delivered within a home-based environment, elicited superior restoration of muscle strength, activation and size in patients following TKR.Trial registrationISRCTN12101643, December 2017 (retrospective registration).

An evaluation of the use of a lateral wedged insole and a valgus knee brace in combination in subjects with medial compartment knee osteoarthritis (OA)

ABSTRACT Aim: The aim of this study was to evaluate the effect (6 weeks) of the use of a knee brace and a lateral wedge insole, both in isolation and combined, on the knee adduction moment (KAM), pain levels, kinematics (velocity, stride length, cadence), knee ROM, function, and satisfaction in patients with knee osteoarthritis (OA). Methods: Twenty-one patients with medial compartment knee OA were participated in this study. A relatively light three-point valgus knee brace (VB) and full length custom-made lateral wedge insole with arch support were prepared for each subject. Patients divided into three groups at random. Results: The use of a custom fit valgus brace with lateral edge insole concurrently can reduce a greater peak KAM than use in isolation (30%). In addition, the use of both interventions can improve walking velocity, cadence, and reduce levels of pain in patients with medial compartment OA. Conclusion: All parameters except stride length and KAM in comparison with first day of wearing interventions improved significantly in the combined, concurrent usage group. The use of a lateral wedge insole and a valgus knee brace in combination can improve the kinetic and kinematic parameters in patients with medial compartment knee OA.

Randomized clinical trial of medial unicompartmentel versus total knee arthroplasty for anteromedial tibio-femoral osteoarthritis. The study-protocol

BackgroundIn treatment of isolated medial unicondylar osteoarthritis of the knee, it is possible to choose between medial unicondylar knee arthroplasty (mUKA), or a total knee prosthesis (TKA). The demand for a blinded multicenter RCT with the comparison of mUKA and TKA has been increasing in recent years, to determine which prosthesis is better. Supporters of TKA suggest this treatment gives a more predictable and better result, whereas supporters of UKA suggest it is unnecessary to remove functional cartilage in other compartments. If the mUKA is worn or loosens, revision surgery will be relatively easy, whereas revision-surgery after a TKA can be more problematic.MethodsA double-blinded multicenter Randomized Clinical Trial setup is the aim of the study. 6 hospitals throughout all 5 municipal regions of Denmark will be participating in the study. 350 patients will be included prospectively. Follow-up will be with PROM-questionnaires and clinical controls up to 20 years.DiscussionResults will be assessed in terms of 1) PROM-questionnaires, 2) Clinical assessment of knee condition, 3) cost analysis. To avoid bias, all participants except the theatre-staff will be blinded.PROMsOKS, KOOS, SF36, Forgotten Joint Score, EQ5D, UCLA activity scale, Copenhagen Knee ROM scale, and Anchor questions. Publications are planned at 2, 5 and 10 years after inclusion of the last patient. The development of variables over time will be analyzed by calculating the area under the curve (AUC) for the variable relative to the initial value, and comparisons of the between-group differences will be based on parametric statistics. In this study, we feel that we have designed a study that will address these concerns with a well-designed double-blinded multicentre RCT.Trial registrationClinicalTrials.gov ID: NCT03396640.Initial Release: 09/19/2017.Date of enrolment of first participant: 10/11/17.

Professional Dancers Distinct Biomechanical Pattern during Multidirectional Landings.

This study aimed to compare lower extremity (LE) biomechanics between professional dancers (PD) and nondancers (ND) during multidirectional single-leg landings. Fifteen PD (27 ± 7 yr, 1.69 ± 0.1 m, 57.8 ± 9.3 kg) and 15 ND (25 ± 5 yr, 1.69 ± 0.1 m, 66 ± 10.2 kg) performed single-leg jumps in three directions: 1) lateral, 2) diagonal, and 3) forward. Dominant LE biomechanical data were collected using a motion capture system. Data were processed in Visual3D. LE kinematic (hip, knee, and ankle joint angles in sagittal and frontal planes, and range of motion [ROM]) and kinetics (hip and knee internal joint moments and vertical ground reaction force) variables were analyzed at initial contact (IC), peak vertical ground reaction force (PvGRF), and peak knee flexion (PKF). Repeated-measures ANOVA was conducted (P < 0.05). At IC, statistically significant interactions were found for ankle frontal and hip sagittal angles (P < 0.05). The main effects for groups and jump directions were attained (P < 0.05). PD at IC had lower hip and knee flexion and higher ankle plantarflexion than ND. PD had significantly higher knee (PD, 41 ± 6.1; ND, 33.8 ± 8.4) and ankle (PD, 53.7 ± 3.4; ND, 38.9 ± 8.9) ROM than ND. At IC, the lateral jump had higher hip abduction moment, hip abduction, and ankle inversion and lower hip flexion and ankle plantarflexion than the forward and diagonal jumps. The lateral jump (15.5 ± 7.7) had higher hip excursion than the forward jump (12.7 ± 5.4). The higher extended posture of PD at IC promoted an efficient use of the knee and ankle ROM to dissipate the landing forces. Regardless of the group, jump directions also solicited different biomechanical responses, particularly between lateral and forward directions. These strategies should be considered for implementation in prevention programs, as it can foster adequate LE neuromuscular control.

Modalities of treatment for segmental tibia fracture

Background: Segmental tibia fractures (AO 42-C2) are defined by two or more distinct fracture lines isolating an interposed cortical segment which excludes butterfly fragmentation. Severe soft tissue defects are common due to their association with high energy trauma mechanisms of injury. Objectives: This study is an attempt to observe the various outcome of operative management of segmental tibia fracture treated by various modalities like intramedullary nailing, plating and external fixator. The results have been studied in depth to determine which modality is better for management of this type of fracture. Material & Methods: This is a prospective study of 25 cases of segmental tibia fracture treated by intra medullary nailing or plating or external fixator with minimum 6 months of follow up. All cases are evaluated according to time of union, complications, range of motion and modified knee society score. Modified knee society Score on residual effects on clinical ground at final examination. Points are given for pain, function and range of motion in modified knee society score. Result: Mean knee ROM in intramedullary nailing group is 118, while in plating group is 113.33.Average time of union in intramedullary nailing group is 18.61weeks; while in plating group is 25.33 weeks. Result according to Modified knee society score was found to be excellent to good in 18(72%) patients.11(73%) patients treated by interlocking intramedullary nailing had excellent to good knee score. Conclusion: Interlocking intramedullary nailing is a excellent method of treatment for the segmental tibia fracture as it provides rotational stability, gives excellent to good result, lower rate of complications and good knee ROM. Key words: Segmental tibia fracture, Modified knee society score, Intramedullary nailing.

A 25 Years Old Female with Meloheostosis: A Case Report

Background: Melorheostosis is a rare sclerosing bone dysplasia characterized by its classic radiographic feature of flowing/dripping candle wax. It usually affects one limb, more often the lower extremity, and rarely the axial skeleton. The etiology remains unknown and various theories have been proposed to explain the pathogenesis of this disease. It often has an insidious onset in early adult life. Symptoms include pain, oedema, and limitation of joint movement. Case presentation: A patient aged 25 year old male complaint of pain on the left lower extremity for the last 3 years. There is muscle atrophy at left extremity, bowing of the thigh, awelling at the foot. There is palpable mass at the left bottom, solid consistency and fixed. There are also limitation ROM of hip, knee and ankle. From the radiography examination showed inhomogen thickening of the periosteal cortical and endosteal, dripping candle wax appearance, and sclerotic lesion at soft tissue. Conculsion: X-ray is a sufficient method for diagnosis of melorheostosis.Other imaging techniques are essential for decision about therapeutic intervention (CT or MRI). Laboratory findings are usually in physiological range. Symptomatic therapy proved to be sufficient in subjective symptoms management. Keywords: Melorheostosis, sclerosing bone dysplasia, dripping candle wax Correspondence: Pamudji Utomo. Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: utomodr@yahoo.com. Indonesian Journal of Medicine (2019), 4(1): 59-64 https://doi.org/10.26911/theijmed.2019.04.01.10

A Study to Analyze the effectiveness of Mobilization with movement in OA knee Dysfunction: A Quasi Experimental Study

Objective: To evaluate the effectiveness of Mobilization with Movement in unilateral knee pain, ROM and ADL associated with knee dysfunction. Methods: Thirty patients with knee pain were selected according to inclusion and exclusion criteria and were divided into two groups of fifteen each. Group A received Exercise and IFT and Group B received Mulligan’s Mobilization with Movement and IFT. Pre and post values NPRS, ROM, and OKS were measured on day 1 and at the end of treatment by 4 weeks. Data were analysed using paired and unpaired p-test. Results: There was a significant reduction in NPRS, and increase Oxford Knee Score at 4 weeks when compared to pre-procedure scores (p<0.05) for both groups, but was significantly more in Group B when compared to Group A. The range of motion of the Knee joint in both the groups showed steady improvement. Conclusion: Applying Mobilisation with Movement is more effective for knee dysfunction as it has shown superior results over the pain, range of motion and the functional outcome. This may be incorporated while treating knee dysfunction.

Additional benefit of local infiltration of analgesia to femoral nerve block in total knee arthroplasty: double-blind randomized control study.

Multimodal analgesia has become an important concept in current pain management following total knee arthroplasty (TKA). However, controversy remains over what is the most accepted combination. In this study, the additional benefits of local infiltration of analgesia to femoral nerve block were evaluated. Forty patients were randomly allocated into a combined local infiltration of analgesia and femoral nerve block or femoral nerve block alone group. In the former, analgesic drugs consisting of ropivacaine and dexamethasone were injected into the peri-articular tissues, while the same amount of saline was injected into the femoral nerve block group. The primary outcome measure was the total amount of fentanyl consumption by the patient-controlled analgesia pump during the 48-h post-operative period. A combination of local infiltration of analgesia and femoral nerve block had less total fentanyl consumption and a larger knee ROM at post-operative day 2 than femoral nerve block alone (p < 0.05). C-reactive protein levels in the combined treatment group were significantly lower than the femoral nerve block group at post-operative day 3 (p < 0.01). There was no difference between the two groups, post-operatively, on the visual analogue scale for pain at rest or while walking, quadriceps strength, timed up and go test, circumference of thigh, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index. The addition of local infiltration of analgesia to femoral nerve block promoted post-operative pain relief and the recovery of knee ROM in the early post-operative period. This combination is an effective method for post-operative pain management after TKA. Randomized controlled trial, Level I.