Symptomatic Limb Research Articles

Dynamic Perioperative Platelet Activity and Cardiovascular Events in Peripheral Artery Disease

ObjectivePatients with peripheral artery disease (PAD) undergo lower extremity revascularization (LER) for symptomatic relief or limb salvage. Despite LER, patients remain at increased risk of platelet-mediated complications, such as major adverse cardiac and limb events (MACLE). Platelet activity is associated with cardiovascular events; yet little is known about the dynamic nature of platelet activity over time. We therefore investigated the change in platelet activity over time and its association with long-term cardiovascular risk. MethodsPatients with PAD undergoing LER were enrolled into the multicenter, prospective Platelet Activity and Cardiovascular Events (PACE) study. Platelet aggregation was assessed by light transmission aggregometry (LTA) to submaximal epinephrine (0.4μ M) immediately prior to LER, and on post-operative day 1 or 2 (POD1) and 30 (POD30). A hyperreactive platelet phenotype was defined as >60% aggregation. Patients were followed longitudinally for MACLE, defined as the composite of death, myocardial infarction, stroke, major lower extremity amputation, or acute limb ischemia leading to reintervention. ResultsAmong 287 patients undergoing LER, mean age was 70 ± 11 years, 33% were female, 61% were white, and 89% were on baseline antiplatelet therapy. Platelet aggregation to submaximal epinephrine induced a bimodal response; 15.5%, 16.8%, and 16.4% of patients demonstrated a hyperreactive platelet phenotype at baseline, POD1, and POD30, respectively. Platelet aggregation increased by 18.5% (P=0.001) from baseline to POD1, which subsequently returned to baseline at POD30. After a median follow-up of 19 months, MACLE occurred in 165 (57%) patients. After adjustment for demographics, clinical risk factors, procedure type, and antiplatelet therapy, platelet hyperreactivity at POD1 was associated with a significant hazard of long-term MACLE (aHR 4.61, 95% CI 2.08-10.20, P<0.001). ConclusionAmong patients with severe PAD, platelet activity increases following LER. Platelet hyperreactivity to submaximal epinephrine on POD1 is associated with long-term MACLE. Platelet activity following LER may represent a modifiable biomarker associated with excess cardiovascular risk.

In-silico trial emulation to predict the cardiovascular protection of new lipid-lowering drugs: an illustration through the design of the SIRIUS programme.

Inclisiran, an siRNA targeting hepatic PCSK9 mRNA, administered twice-yearly (after initial and 3-month doses), substantially and sustainably reduced LDL-cholesterol (LDL-C) in Phase III trials. Whether lowering LDL-C with inclisiran translates into a reduced risk of major adverse cardiovascular events (MACE) is not yet established. In-silico trials applying a disease computational model to virtual patients receiving new treatments allow to emulate large scale long term clinical trials. The SIRIUS in-silico trial programme aims to predict the efficacy of inclisiran on CV events in individuals with established atherosclerotic cardiovascular disease (ASCVD). A knowledge-based mechanistic model of ASCVD was built, calibrated, and validated to conduct the SIRIUS programme (NCT05974345) aiming to predict the effect of inclisiran on CV outcomes.The SIRIUS Virtual Population included patients with established ASCVD (previous myocardial infarction (MI), previous ischemic stroke (IS), previous symptomatic lower limb peripheral arterial disease (PAD) defined as either intermittent claudication with ankle-brachial index <0.85, prior peripheral arterial revascularization procedure, or vascular amputation) and fasting LDL-C ≥ 70 mg/dL, despite stable (≥ 4 weeks) well-tolerated lipid lowering therapies.SIRIUS is an in-silico multi-arm trial programme. It follows an idealized crossover design where each virtual patient is its own control, comparing inclisiran to 1) placebo as adjunct to high-intensity statin therapy with or without ezetimibe, 2) ezetimibe as adjunct to high-intensity statin therapy, 3) evolocumab as adjunct to high-intensity statin therapy and ezetimibe.The co-primary efficacy outcomes are based on time to the first occurrence of any component of 3P-MACE (composite of CV death, nonfatal MI or nonfatal IS) and time to occurrence of CV death over 5 years. The SIRIUS in-silico trial programme will provide early insights regarding a potential effect of inclisiran on MACE in ASCVD patients, several years before the availability of the results from ongoing CV outcomes trials (ORION-4 and VICTORION-2-P).

Neurophysiological Assessment of H-Reflex Alterations in Compressive Radiculopathy.

This study aimed to investigate changes in the H-reflex recruitment curve in compressive radiculopathy, specifically assessing differences between symptomatic and asymptomatic limbs in patients with unilateral S1 radiculopathy through derived parameters. A total of 24 volunteers (15 male and 9 female, aged between 22 and 60 years) with confirmed nerve root compression in the L5/S1 segment participated. Nerve root compression was verified through clinical MRI examination and attributed to disc protrusion, spinal canal stenosis, or isthmic spondylolisthesis of L5/S1. Analysis revealed no difference in M-wave threshold intensity between symptomatic and non-symptomatic limbs. However, the H-reflex exhibited a trend toward increased threshold intensity in the symptomatic limb. Notably, a significant decrease in the slope of the H-reflex was observed on the symptomatic side, and the maximal H-reflex amplitude proved to be markedly different between the two limbs. The Hmax/Mmax ratio demonstrated a significant decrease in the symptomatic limb, indicating reduced effectiveness of signal translation. In conclusion, our findings emphasize the importance of H-reflex parameters in evaluating altered recruitment curves, offering valuable insights for neurological examinations. The observed differences in maximal values of M-wave, H-reflex, and their ratio in affected and unaffected limbs can enhance the diagnostic process for lumbosacral unilateral radiculopathy and contribute to a standardized approach in clinical assessments.

Participation of Arterial Ischemia in Positional-Related Symptoms among Patients Referred for Thoracic Outlet Syndrome.

Objectives: The coexistence of arterial compression with neurogenic thoracic outlet syndrome (TOS) is associated with a better post-surgical outcome. Forearm transcutaneous oxygen pressure (TcpO2) using the minimal decrease from rest of oxygen pressure (DROPmin) can provide an objective estimation of forearm ischemia in TOS. We hypothesized that a linear relationship exists between the prevalence of symptoms (PREVs) and DROPmin during 90° abduction external rotation (AER) provocative maneuvers. Thereafter, we aimed to estimate the proportion of TOS for which arterial participation is present. Methods: Starting in 2019, we simultaneously recorded forearm TcpO2 recordings (PF6000 Perimed®) and the presence/absence of ipsilateral symptoms during two consecutive 30 s AER maneuvers for all patients with suspected TOS. We retrospectively analyzed the relationship between the prevalence of symptoms and DROPmin results. We estimated the number of cases where ischemia likely played a role in the symptoms, assuming that the relationship should start from zero in the absence of ischemia and increase linearly to a plateau of 100% for the most severe ischemia. Results: We obtained 2560 TcpO2 results in 646 subjects (69% females). The correlation between PREVs and DROPmin was 0.443 (p < 0.001). From these results, we estimated the arterial participation in TOS symptoms to be 22.2% of our 1669 symptomatic upper limbs. Conclusions: TcpO2 appears to be an interesting tool to argue for an arterial role in symptoms in TOS. Arterial participation is frequent in TOS. Whether DROPmin could predict treatment outcomes better than the sole presence of compression is an interesting direction for the future.

The application of directional preference for chronic non-specific knee pain: A pragmatic, controlled, randomized clinical trial

Functional disability and chronic knee pain are frequent in combats sports participants. The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is a system for specific function examination and intervention for spinal and extremity musculoskeletal disorder. This clinical trial aimed to investigate the effectiveness of MDT, through Directional Preference, for specific function disability in Brazilian Jiu-Jitsu practitioners (BJJPs) experiencing chronic non-specific knee pain. MethodsSixty-five BJJPs with chronic non-specific knee pain were evaluated and classified according to the MDT system. Following classification, 28 BJJPs were randomized pairwise into intervention (IG) and control (CG) groups. The procedures were consistent with the principles of DP and the intervention period was 6 weeks and follow up was included. The primary outcome was specific functional disability evaluated using the Patient Specific Function Scale (PSFS) and the secondary outcomes were pain intensity and fear-avoidance in utilizing the symptomatic limb. Data were analyzed with a two-way analysis of variance (ANOVA) and repeated measures for the outcome factor were performed (p < 0.05). ResultsFor the specific functional disability, ANOVA revealed significant differences between groups based on group interaction and treatment factors (F (2, 52): 162,015; p < 0.001; η2: 0.208). The BJJPs allocated to the IG achieved significant improvements in specific functional disability, a mean difference of −4.36 (−5.01 to −3.72) post-interventional and −4.80 (−6.07 to −3.53) follow-up in the PSFS. Improvements in pain intensity and fear-avoidance were also achieved post-intervention and follow-up. ConclusionIntervention in accordance with DP promoted resulted in favorable outcomes for clinical effects on specific functional disability pain intensity, and symmetry index of the lower limbs. These findings suggest that intervention based on DP may be effective in the management of chronic knee pain in BJJPs.

Abstract 3017: Fluorine-18 Sodium Fluoride Positron Emission Tomography/ Computed Tomography Imaging Of Calcium Progression In Patients With Peripheral Artery Disease

Introduction: Peripheral artery disease (PAD) is an atherosclerotic disease that promotes lower extremity ischemia and is associated with necrosis, limb loss, and premature death. Fluorine-18 sodium fluoride ( 18 F-NaF) PET/CT imaging has been utilized for early detection of calcific disease progression in the coronary arteries; however, this technique has not been assessed in PAD to predict developing arterial calcification. Hypothesis: We hypothesized that 18 F-NaF PET/CT imaging could identify sites undergoing active microcalcification and predict the formation or expansion of vascular calcium. Methods: Patients with PAD (n=26) underwent 18 F-NaF PET/CT imaging at baseline and CT imaging 18 months later. Regions of interest were manually drawn on axial PET and CT images for the arteries of the symptomatic limb (totaling 8,001 arterial segments). Arterial uptake of 18 F-NaF was quantified and reported on a segment-by-segment basis as maximum standard uptake values (SUV max ). Baseline and 18-month CT images were co-registered to quantify serial changes in calcium density for each arterial segment using CT image cutoffs for calcium (≥130 Hounsfield Units). Differences in arterial uptake of 18 F-NaF were compared across 3 categories of segments: 1) no calcium at baseline or 18 months, 2) newly formed calcium and 3) existing calcified lesions with expansion of calcium. Results: Arterial segments containing newly formed calcium had significantly higher baseline uptake of 18 F-NaF than segments without calcium progression. Existing calcified arterial lesions with progression showed significantly higher 18 F-NaF uptake compared to segments with newly formed calcium and segments without calcium progression ( Figure 1 ). Conclusions: In conclusion, calcium progression can be detected and potentially predicted using 18 F-NaF PET/CT imaging, thereby providing a molecular imaging tool for monitoring PAD pathophysiology and responses to medical therapy.

Anterior Minimally Invasive Approach (AMIS) for Total Hip Arthroplasty: Analysis of the First 1000 Consecutive Patients Operated at a High Volume Center.

(1) Background: Direct anterior approach (DAA) has recently acquired popularity through improvements such as the anterior minimally invasive surgical technique (AMIS). This retrospective study examines the first 1000 consecutive THAs performed utilizing the AMIS approach in a high-volume center between 2012 and 2017. (2) Methods: 1000 consecutive THAs performed at a single institution utilizing the AMIS approach were retrospectively analyzed with a minimum five-year follow-up. Full evaluation of demographic information, clinical parameters, intraoperative complications, and radiological examinations are reported. (3) Results: Overall complication rate was 9.4% (94/1000), including 8 dislocations, 57 femoral-cutaneous nerve injuries, 12 intraoperative femoral fractures, 9 infections and 8 leg length discrepancy. Implant survival rates were 98.5% at 1 year, 97.5% at 3 years, 97% at 5 years, and 95.3% at 7 years. Causes of failure included periprosthetic fractures (0.8%), implant dislocations (0.6%), septic loosening (0.5%), aseptic mobilizations (0.2%), and symptomatic limb length discrepancies (0.2%). (4) Conclusions: Controversies persist around the direct anterior approach (DAA) for THA, primarily regarding the increased complications rate during the learning curve. However, this study advocates for widespread adoption of the DAA approach. The results demonstrate acceptable complication rates and remarkable functional outcomes, affirming its viability in the broader orthopedic patient population.

Polymer-based drug-eluting stent treatment extends the time to reintervention for patients with symptomatic femoropopliteal artery disease: clinical evidence and potential economic value.

Aim: Use long-term follow-up data from the IMPERIAL study to determine whether drug-eluting polymer-based nitinol stent treatment can delay the time to repeat intervention for femoropopliteal artery disease and how such a delay may result in cost savings in a value-based episode of care. Patients & methods: The IMPERIAL randomized controlled trial was an international study of a paclitaxel-eluting polymer-coated stent (Eluvia, Boston Scientific, MA, USA) versus a polymer-free paclitaxel-coated stent (Zilver PTX, Cook Corporation, IN, USA) for treating lesions of the femoropopliteal arterial segment. Study patients (n=465) had symptomatic lower limb ischemia. Safety and efficacy assessments were performed through 5years. Mean time to first reintervention was calculated in post-hoc analysis for patients who underwent a clinically driven target lesion revascularization (CD-TLR) through 3 or 5years following the index procedure. To simulate potential cost savings associated with differential CD-TLR burden over time, a cost-avoidance analysis using input parameters from IMPERIAL and US 100% Medicare standard analytical files was developed. Results: Among patients with a first CD-TLR through 3years of follow-up, mean time to reintervention was 5.5months longer (difference 166days, 95% CI: 51, 282days; p=0.0058) for patients treated with Eluvia (n=56) than for those treated with Zilver PTX (n=30). Through the 5-year study follow-up period, CD-TLR rates were 29.3% (68/232) for Eluvia and 34.2% (39/114) for Zilver PTX (p=0.3540) and mean time to first reintervention exceeded 2years for patients treated with Eluvia at 737days versus 645days for the Zilver PTX group (difference 92days, 95% CI: -85, 269days; p=0.3099). Simulated savings considering reinterventions occurring over 1 and 5years following initial use of Eluvia over Zilver PTX were US $1,395,635 and US $1,531,795, respectively, when IMPERIAL CD-TLR rates were extrapolated to 1000 patients. Conclusion: IMPERIAL data suggest initial treatment with Eluvia extends the time patients spend without undergoing reintervention. This extension may be associated with cost savings in relevant time frames.

Association Between Patellar Tendon Abnormality and Land-Jump Biomechanics in Male Collegiate Basketball Players During the Preseason.

Patellar tendinopathy is a degenerative condition that predominantly affects jumping athletes. Symptoms may be subtle or nonexistent at preseason, but structural abnormalities may be present. Assessing patellar tendon abnormality (PTA) through magnetic resonance imaging (MRI) and ultrasound (US) and classifying symptoms using the Victorian Institute for Sport Assessment-Patellar tendon (VISA-P) may provide useful insights if combined with biomechanics measurements. To (1) assess whether land-jump biomechanical patterns are associated with clinically pertinent PTA as seen on imaging and through VISA-P scores and (2) model the contributing risk and accuracy of biomechanics to classify PTA and symptomatic observations. Cross-sectional study; Level of evidence, 3. A total of 26 National Collegiate Athletic Association Division I and II male basketball players (n = 52 limbs) were recruited during the preseason. We collected VISA-P scores, bilateral PTA through US and MRI morphology measurements, and bilateral 3-dimensional lower extremity kinematics and kinetics measurements from a land-jump test from an 18-inch-high (45.7-cm-high) box. Statistically, each limb was treated independently. The association of biomechanics with PTA and symptoms (VISA-P score <80) was tested with multivariate models and post hoc tests. Logistic regression modeled relative risk and accuracy of biomechanical variables to classify PTA and symptomatic limbs. There were 19 to 24 limbs with PTA depending on US and MRI measurements. Differences in hip and knee kinematic strategies and ground-reaction loads were associated with PTA and symptomatic limbs. Peak landing vertical ground-reaction force was significantly decreased (169 ± 26 vs 195 ± 29 %body weight; P = .001), and maximum hip flexion velocity was significantly increased (416 ± 74 vs 343 ± 94 deg/s; P = .005) in limbs with versus without PTA on imaging. Knee flexion at the initial contact was decreased in symptomatic versus healthy limbs (17°± 5° vs 21°± 5°, respectively; P = .045). Regression models classified PTA limbs and symptomatic limbs with 71.2% to 86.5% accuracy. Hip and knee maximum flexion velocity and vertical ground-reaction force variables were most common across models observing clinically pertinent PTA. Our findings suggested that functional kinematic and kinetic biomechanical strategies at the hip and knee were associated with PTA, identified on imaging, and symptomatic limbs.

The incidence of venous thromboembolism after curative colon cancer surgery within an enhanced recovery after surgery programme

AimBased on three randomised controlled trials performed more than a decade ago, several national guidelines recommend prolonged venous thromboprophylaxis for 28 days following elective surgery for colon cancer. None of these studies were conducted within enhanced recovery after surgery setting. Newer studies indicate that prolonged prophylaxis might not be necessary with enhanced recovery after surgery. We aimed to provide further evidence to this unresolved discussion. MethodRetrospective study of patients undergoing elective surgery for colon cancer stage I-III with enhanced recovery after surgery in the Capital Region of Denmark from 2014 to 2017. Patients were excluded if discharged on postoperative day 28 or later, dying before discharge, undergoing concomitant rectum resection, or discharged with vitamin K antagonists, direct-oral anticoagulants, or low molecular weight heparin treatment. All patients received only low-dose low molecular weight heparin as prophylaxis during their admission.The primary endpoint was symptomatic lower limb deep venous thrombosis or pulmonary embolism diagnosed within 60 days postoperatively. ResultsOut of the included population of 1806 patients, only three experienced a symptomatic venous thromboembolic event; none was fatal. Two had pulmonary embolism associated with pneumonia, while one patient was diagnosed with lower limb deep venous thrombosis at postoperative day 15 after an uncomplicated course with first discharge at postoperative day 2. ConclusionThe risk of symptomatic venous thromboembolism after elective surgery for colon cancer with enhanced recovery after surgery seems negligible even without prolonged prophylaxis. The current guidelines need to be reconsidered.

Evaluation of the osteomuscular system through ultrasound examination of employees at thetime of admission: a new management proposal in a public hospital

The objectives of this research were: to identify the need to implement a service with assessment of the musculoskeletal system through ultrasound in employees of a public hospital at the time of admission; identify the prevalence of musculoskeletal injuries and painful symptoms in hospital employees; verify the association between musculoskeletal injuries and sociodemographic variables; verify the association between painful musculoskeletal symptoms and sociodemographic variables. 70 employees within 6 months of hiring agreed to participate in the research. Musculoskeletal ultrasound examinations of the wrist, elbow and shoulder of the dominant or symptomatic limb were performed. Additionally, information was obtained regarding sociodemographic parameters. The prevalence of tendinopathies in the sample was 67.1%. Additionally, a prevalence of painful musculoskeletal symptoms was observed in the upper limbs of 40 professionals. An association has been demonstrated between musculoskeletal injuries and female sex, as well as having worked for more than 10 years. In the same vein, a statistically significant association was observed between painful musculoskeletal symptoms and being female, working as a nursing professional and having worked for more than 10 years. It is concluded that there is a high prevalence of musculoskeletal injuries and painful symptoms among public hospital employees, with the shoulder joint being the most affected. Additionally, it has been demonstrated that female sex and working time are associated with musculoskeletal injuries, as well as musculoskeletal pain symptoms. In view of the above, the need to implement services with assessment of the musculoskeletal system through ultrasound in public hospital employees at the time of admission is evident.

Does lower-limb osteoarthritis alter motor cortex descending drive and voluntary activation? A systematic review and meta-analysis.

The aim of the study was to quantify motor cortex descending drive and voluntary activation (VA) in people with lower-limb OA compared to controls. A systematic review and meta-analysis according to the PRISMA guidelines was carried out. Seven databases were searched until 30 December 2022. Studies assessing VA or responses to transcranial magnetic stimulation (TMS; i.e. motor evoked potential, intracortical facilitation, motor threshold, short-interval intracortical inhibition, and silent period) were included. Study quality was assessed using Joanna Briggs Institute criteria and evidence certainty using GRADE. The meta-analysis was performed using RevMan inverse variance, mixed-effect models. Eighteen studies were included, all deemed low-quality. Quadriceps VA was impaired with knee OA compared to healthy controls (standardised mean difference (SMD) = 0.84, 95% CI = -1.12-0.56, low certainty). VA of the more symptomatic limb was impaired (SMD = 0.42, 95% CI = -0.75-0.09, moderate certainty) compared to the other limb in people with hip/knee OA. As only two studies assessed responses to TMS, very low-certainty evidence demonstrated no significant difference between knee OA and healthy controls for motor evoked potential, intracortical facilitation, resting motor threshold or short-interval intracortical inhibition. Low-certainty evidence suggests people with knee OA have substantial impairments in VA of their quadriceps muscle when compared to healthy controls. With moderate certainty we conclude that people with hip and knee OA had larger impairments in VA of the quadriceps in their more painful limb compared to their non-affected/other limb.

Supervised Exercise Training May Improve Postural Control in Patients with Symptomatic Lower Extremity Peripheral Artery Disease.

Patients with symptomatic peripheral artery disease (PAD) have been shown to present balance disorders and a history of falling, which are associated with functional and daily life impairments. Although postural control improvement is an important outcome, the benefits of supervised exercise training (SET) on postural control have been seldom investigated in these patients. This article investigates the effects of SET on traditional measures of postural control and on stabilogram-diffusion analysis (SDA) parameters in patients with symptomatic PAD. Patients with symptomatic chronic lower limb claudication were investigated. All subjects who completed the 3-month multimodal SET program and postural control assessment before and after SET were included. Center of pressure trajectory analysis and SDA parameters were investigated using a posturographic platform. Patients were instructed to stand on the platform and maintain balance to their best ability. Treadmill pain-free (PFWD) and maximal (MWD) walking distances were also assessed prior and following SET. Forty-four patients with PAD (65.2 ± 9.8 years, 34% women) were investigated. All postural control parameters were unchanged following SET, except the length of center of pressure displacement as a function of the surface of center of pressure trajectory (LFS), which was significantly increased (before SET: 1.4 ± 0.4; after SET: 1.5 ± 0.5; p = 0.042). PFWD (before SET: 103.5 ± 77.9 m; after SET: 176.8 ± 130.6 m; p ≤ 0.001) and MWD (before SET: 383.6 ± 272.0 m; after SET: 686.4 ± 509.0 m; p ≤ 0.001) significantly improved following SET. The increased LFS suggests a better postural control accuracy following SET in patients with symptomatic PAD.

Rotational Mechanical Thrombectomy to Treat Iliac Limb Occlusion after Endovascular Aortic Aneurysm Repair: The Rotational Mechanical Thrombectomy Italian Study

PurposeTo assess the safety and effectiveness of a rotational mechanical atherothrombectomy device in patients with symptomatic iliac limb occlusion after abdominal endovascular aneurysm repair (EVAR). Materials and MethodsA retrospective analysis was conducted on patients who underwent rotational mechanical thrombectomy using the Rotarex S device for symptomatic acute, subacute, or chronic graft limb thrombosis at 5 vascular centers between 2017 and 2021. This study comprised 23 male patients with a mean age of 74.5 years (SD ± 7.2) at the time of the procedure. The clinical presentation of the patients varied, with 1 patient experiencing acute limb ischemia and 11 patients (47.8%) experiencing disabling intermittent claudication. The remaining patients developed chronic limb-threatening ischemia after iliac limb occlusion. Early outcomes included technical success, postprocedural complications, and periprocedural mortality. Follow-up evaluations encompassed primary patency, patient survival, freedom from reintervention, and the need for surgical conversion. ResultsTechnical success was achieved in all cases, with no occurrences of distal embolization during or after the procedure, and no periprocedural deaths were reported. Endograft relining was performed in 82.6% of patients to establish a new, nonthrombogenic surface within the graft. Over a median follow-up period of 8 months (interquartile range, 3–16 months), 2 patients experienced iliac limb reocclusion. No deaths or other reinterventions occurred during the observational follow-up period. ConclusionsRotational mechanical thrombectomy for iliac limb occlusion after EVAR appears to be both safe and effective. This technique may uncover intraluminal defects contributing to graft occlusion and enable their resolution within the same procedure.

The association between hip/groin pain and hip strength in football players: An exploratory analysis of the FORCe cohort.

Explore associations between peak hip strength in football players with hip/groin pain and healthy controls. Cross-sectional study. Male and female sub-elite football players (soccer and Australian football) with hip/groin pain >6-month duration and players without hip/groin pain were recruited across Melbourne and Brisbane, Australia. Demographic information and two questionnaires; the Copenhagen Hip and Groin Outcome Score and the International Hip Outcome Tool 33 were collected. Hand-held dynamometry was used to measure isometric hip strength for flexion, extension, abduction, adduction, internal rotation, and external rotation. Linear mixed effects models were used to compare strength measures between groups. 190 football players with hip/groin pain (mean ± standard deviation age, 27.8 ± 6.3 years) and 64 controls (age, 27.3 ± 5.6 years) were included in this study. Of these, 291 symptomatic limbs and 128 control limbs were used for analyses. Symptomatic players had lower peak hip adduction (adjusted mean difference = -0.18: 95 % confidence interval -0.27 to -0.08, P : 0.001), external rotation (-0.06: 95 % confidence interval -0.09 to -0.02, P : 0.003), and internal rotation strength (-0.06: 95 % confidence interval -0.10 to -0.03, P : 0.001) compared to controls. A sport-specific interaction was observed for hip abduction strength. When separated by football code, abduction strength was lower in symptomatic Australian football players compared to their same sport peers (-0.20: 95 % confidence interval -0.33 to -0.06, P : 0.004), but not in symptomatic soccer players (-0.05: 95 % confidence interval -0.15 to 0.06, P : 0.382). Hip adduction, internal rotation, and external rotation strength appears lower in football players with hip/groin pain independent of sex and football code. Hip abduction strength was lower in symptomatic Australian football players but not in soccer players.

914 A Scoping Review of Studies Relating to Digital Healthcare Utilisation in Obese Patients Presenting with End Stage Hip and Knee Arthritis

Abstract Aim Digital health technologies provide high-reach, low cost, readily accessible and scalable interventions for large patient populations that address time and resource constraints. Weight loss may reduce the risk of symptomatic lower limb osteoarthritis and may lead to the resolution of symptoms. Musculoskeletal-focused digital apps are increasingly being used for physical therapy and rehabilitation. The scoping review will yield evidence from a breadth of healthcare services about how obese patients with musculoskeletal problems can benefit from digital advances in health care delivery. Method Search engines MEDLINE and CINAHL were used. We initially identified 109 papers from 2000 onwards. An inclusion criterion was added for terms relating to ‘osteoarthritis’, ‘obesity’, ‘weight/exercise interventions’ and ‘digital technology’ which yielded 11 studies, 6 of which were identified as being more specific to our scoping reviews’ aim. Results Several papers study the role of tele-rehabilitation by using online digital platforms. Several commercially available devices have been studied in activity monitoring, the most common being the Fitbit. Mobile-phone apps have been studied to monitor activity. The review also identified recent trial protocols studying weight loss before total joint arthroplasty using a remote dietitian and mobile app along with positive psychology and healthy living skills to slow the progression of symptoms. Conclusions This review indicated that research on digital care is limited but that comprehensive digital care programmes can significantly improve functional outcomes in obese patients with end-stage arthritis and identified the motives for weight loss, strategies utilized during past weight loss attempts, and preferences for future weight loss programmes.

The clinical and biomechanical effects of customized foot orthoses in individuals with plantar heel pain: A pre-post intervention study

BackgroundCustomized foot orthoses (CFOs) are often recommended for the management of plantar heel pain. However, there is a lack of information regarding lower limb and multi-segment foot motion during gait. Research questionThis study aimed to determine the effects of heat moulded CFOs on foot and lower limb kinematics when compared with prefabricated foot orthoses (PFOs) and wearing no orthoses (shod condition), and to determine the short-term effects of CFOs on pain intensity and foot function. MethodsThe immediate effects of CFOs on the lower limb and multi-segment foot motion were assessed. Participants were then asked to use the CFOs for one month and foot pain, function, and temporal-spatial parameters were assessed at baseline and at one month follow up. ResultsThirty-five participants (22 females), aged 40.1 (10.5) years, with a mean duration of symptoms of 12.59 months were recruited. The symptomatic limbs showed a higher forefoot varus angle and greater rearfoot and forefoot corrections were required compared to the non-symptomatic limbs. When compared with PFOs and shod conditions, CFOs provided the least forefoot and knee motion in the transverse plane during contact phase (P < 0.05, d=0.844–1.720), least rearfoot motion in the coronal plane during midstance (P < 0.05, d=0.652), and least forefoot motion in the frontal plane, knee motion in the transverse plane, and hallux motion during the propulsive phase (P < 0.05, d=0.921–1.513). Significant improvements were seen for foot pain and function (P < 0.05, d=1.390–2.231) with significant increases in cadence and walking velocity after one month of CFO use (P < 0.05, d=0.315–0.353), and those most likely to respond had greater pain and less ankle eversion (P < 0.05, d=0.855–1.115). SignificanceCFOs appear to improve pathological biomechanics associated with plantar heel pain. After one month follow up, the CFOs decreased pain intensity and increased foot function, and showed significant improvements in temporal and spatial parameters of gait.

Impact of postprocedural minimum lumen area on clinical outcome after femoropopliteal drug-eluting stent implantation.

Although favorable results of fluoropolymer-based drug-eluting stent (FP-DES) treatment for femoropopliteal lesions have been reported, it is unclear whether minimal lumen area (MLA) after FP-DES implantation affects clinical outcomes. This study aimed to reveal the association between intravascular ultrasound (IVUS)-evaluated MLA and the 1-year risk of restenosis and aneurysmal degeneration after FP-DES implantation for femoropopliteal lesions. A subanalysis of the CAPSICUM (Contemporary outcomes After Paclitaxel-eluting peripheral Stent implantation for symptomatic lower limb IsChemia with sUperficial feMoral or proximal popliteal lesion) study analyzed 718 limbs in 686 patients with available IVUS-evaluated MLA data. The association of MLA with the 1-year risk of restenosis and aneurysmal degeneration was analyzed using the generalized propensity score method. The 1-year incidence rate of restenosis was estimated to be 8.8% (95% CI, 6.1% to 12.5%) for the upper quartile of MLA (21.1 mm2) versus 14.3% (95% CI, 10.7% to 18.7%) for the lower quartile of MLA (15.2 mm2), with an odds ratio of 0.58 (95% CI, 0.36 to 0.93; p = 0.024), whereas the 1-year incidence rate of aneurysmal degeneration was 23.8% (95% CI, 19.5% to 28.8%) for the upper quartile versus 16.8% (95% CI, 12.6% to 22.0%) for the lower quartile, with an odds ratio of 1.55 (95% CI, 1.04 to 2.32; p = 0.031). A large MLA after FP-DES implantation for femoropopliteal lesions was associated with decreased restenosis risk but increased aneurysmal degeneration risk. These findings suggest that MLA is a valuable predictor of clinical outcomes.

Myofascial stiffness of plantar fascia and Achilles tendon in individuals with plantar fasciopathy: An observational cross-sectional study

BackgroundAssessment of myofascial tissue stiffness have a role in identifying physical impairments in plantar fasciopathy (PF). It is still unclear which specific functional and tissue differences exist between individuals with PF. AimTo compare myofascial stiffness of plantar fascia, Achilles tendon, and triceps surae between symptomatic and asymptomatic limbs in individuals with PF and between individuals with and without PF. MethodsThirty nine individuals diagnosed with PF and individuals with no history of PF were recruited. Myofascial stiffness of the plantar fascia, Achilles tendon, and triceps surae, range of motion, and clinical tests were performed. Mean difference (MD) and 95% confidence interval (CI) were calculated. ResultsIndividuals with PF showed lower mean stiffness in Achilles tendon insertion (MD = −1.00 N/mm; 95%CI: -1.80,-0.21) on the symptomatic limb compared to the corresponding symptomatic limb in control group, a lower mean stiffness in plantar fascia (MD = −0.16 N/mm; 95%CI: -0.30, −0.01) on the symptomatic limb compared to asymptomatic limb, and a lower mean stiffness in the region 3 cm above the Achilles tendon insertion (MD = −0.79; 95%CI: -1.59, −0.00) compared to control. Individuals with PF showed fewer repetitions in heel rise test (MD = −3.97 reps; 95%CI: -5.83, −2.12) and in the step-down test (MD = −5.23 reps; 95%CI: -7.02, −3.44) compared to control. ConclusionsIndividuals with PF present reduced stiffness in Achilles tendon insertion and plantar fascia. The reduced stiffness was more evident in Achilles tendon in individuals with PF compared to individuals without PF. Individuals with PF showed lower performance in clinical tests.

D40. Effects of Lymphaticovenular Anastomosis in Contralateral Leg in Patients with Acquired Bilateral Leg Lymphedema

PURPOSE: Lymphaticovenular anastomosis (LVA) is an established treatment for fluid-predominant lymphedema. Its mechanism of action is believed to be mechanical decompression and therefore its benefits limited to where it is established. When LVA is performed in one leg in bilateral leg lymphedema, improvement is conventionally expected only in the treated leg and not in the contralateral leg. We aimed to investigate this widely accepted hypothesis. METHODS: All patients with acquired bilateral leg lymphedema who underwent LVA in one leg between February 2020 and March 2022 were included. Baseline and postoperative outcomes (at 3, 6, 12 months, and annually) were assessed by relief of symptoms, clinical examination, and indocyanine green (ICG) lymphography. RESULTS: Ten patients (7 females,3 males) met the inclusion criteria. All sustained lymphatic injury secondary to lymphadenectomy and/or radiation for cancer treatment. Five patients (50%) were symptomatic in bilateral legs while all ten had ICG lymphography confirmed lymphatic dysfunction in both legs. LVA was successfully performed in all cases. Mean follow-up was 11.3 months. Following LVA, relief of symptoms and improved functions were reported by all patients and confirmed on examination in all symptomatic limbs, with correlating improvements on ICG lymphography. Favorable ICG lymphography changes were also seen in the contralateral leg in all (5/5) who had asymptomatic contralateral leg lymphedema. CONCLUSION: The benefit of LVA extends beyond the anatomic region in which it is established.