Uninvolved Leg Research Articles

Assessment of metabolic response and functional changes after anterior cruciate ligament surgery.

The main purpose of this study was to investigate metabolic changes after anterior cruciate ligament reconstruction and to find out whether the statements on training intensity in the literature can also be applied to patients in rehabilitation. Twenty-four male patients, 16 wk (range: 11-21 wk) postoperative, volunteered to participate in the study. A new four-stage test with constant time and load increments on the legpress in the closed kinetic chain (CKC) was performed. Evaluative variables were the aerobic and anaerobic threshold, force at exhaustion, and the maximum strength. Besides the four-stage test, the other parameters evaluated were functional tests (one-legged single hop, one-legged triple hop), rating scales (Lysholm, subjective feeling scale), thigh circumference, peak torque (PT), work and explosive force in the open kinetic chain (OKC), and muscle activity via electromyographic examination. Positive correlations were established for the maximum force in the CKC and PT (P < 0.01) and maximum force in the CKC and the thigh circumference (P < 0.05). The Lysholm score correlated with the anaerobic threshold (P < 0.05) and with the functional tests (P < 0.01). Further correlations were established between the PT and the work (P < 0.05) and between the single hop and the triple hop (P < 0.001). While the maximum force of the uninvolved leg was significantly higher than that of the involved leg (P < 0.01), the forces measured at termination and at the aerobic and anaerobic threshold (given as percent of maximum force) were significantly higher in the involved leg (P < 0.01). It seems that the oxidative potential increases or remains constant in this phase of rehabilitation and therefore the intensity of strength training must be adapted to the needs of the patient. Our easy-to-perform method makes it possible to establish an optimal intensity of training.

Incidence of Asymptomatic, Nontraumatic Unilateral Knee Hyperextension in the High School Athlete

Four hundred sixty-seven high school athletes were screened in apreparticipation athletic physical. Forty-six (9.8%) of these athletes presented with asymptomatic, nontraumatic unilateral hyperextension. Twenty-three athletes were reexamined and compared to a normal control group. A 2.5-cm, statistically significant heel-to-heel difference was recorded in the hyperextension group. Between the involved hyperextended and uninvolved legs, there were differences in average range of motion (132.04° vs. 130.74°, respectively), average manual anterior translation by KT-1000 (5.39 mm vs. 5.15 mm, respectively), average posterior translation (2.07 mm vs. 2.00 mm, respectively), average peak quadriceps torque (86.25 ft-lb vs. 84.06 ft-lb, respectively), and hamstring average peak torque (53.89 ft-lb vs. 52.93 ft-lb, respectively), though these differences were not statistically significant. In the control group, there was no heel-to-heel difference in the right versus the left knee. Heel-to-heel difference between the experimental and control groups was statistically significant. There was no statistically significant difference between range of motion, anterior translation, or posterior translation between the experimental and control groups.

Reliability of lower extremity girth measurements after anterior cruciate ligament reconstruction.

The purpose of this study was to determine the intra- and inter-rater reliability of lower extremity girth measurements in patients recovering from anterior cruciate ligament (ACL) reconstructive surgery. Nine subjects, within several months of their surgery, volunteered. Circumferential measurements were taken of the involved and uninvolved legs at the following locations: 15 cm inferior to the joint line; 5, 10 and 15 cm superior to the joint line; at the joint line; and at mid-thigh. All subjects were supine with the knee in extension whilst a specially designed device, formulated to make circumferential measurements at locations around the knee, was applied to the extremity. Three physical therapists each repeated all measurements on two occasions, in random order, during the same test session. Intra-tester intraclass correlation (ICCs) calculated showed high coefficients (0.82-1.0) for both the involved and uninvolved sides for all locations of the measurement. Inter-tester ICCs ranged from 0.72 to 0.97. The measurements established sufficiently high reliability to justify their use both within and between examiners for subjects recovering from surgery of the ACL.

Surgical correction of leg alignment in unilateral knee osteoarthrosis reduces the load on the hip and knee joint bilaterally

Seventeen patients with strictly unilateral medial knee osteoarthrosis that justified surgical treatment constituted the study group. No patient had any symptoms from the hip or ankle joints or from the other knee. Eight patients were operated with high tibial osteotomy and nine were operated with unicompartmental prosthetic replacement (Brigham model). The forces and the external moment about the hip, knee, and ankle joints of the involved and uninvolved leg were calculated before and 1 year after corrective surgery and compared to the external moment in 10 normal controls. Clinical examinations was performed and the hip-knee-ankle angle in the involved leg was determined from whole-leg weightbearing radiographs before and 1 year after surgery. The external moments about the hip, knee, and ankle joints and the knee moment arms at mid-stance in the frontal plane during gait were determined with a Kistler force plate and a videorecording system. All patients improved clinically after surgery. The mean hip-knee-ankle angle changed from 11 ° of varus to 0 °. In the uninvolved leg the mid-stance adduction moments about the hip and knee joints were significantly increased compared to normal subjects in the control group before surgery, but reduced to a normal level 1 year after surgery. This reduction was mainly due to a significant reduction of the medially directed force. The moments about the ankle joints were not found to be changed by the knee deformity or by the corrective surgery.

Acute patellar dislocation during eccentric muscle testing on the Biodex dynamometer

Isokinetic training and muscle torque measurements are commonly used during rehabilitation after knee ligament injuries. Isokinetic maximal muscle strength tests are performed to monitor the progress in muscle rehabilitation. The muscle power is evaluated by measuring the applied force in the direction of motion (concentric muscle power) or the force against the direction of motion (eccentric muscle power). Both legs are examined to compare the total muscle work and peak torques of the involved leg with those of the uninvolved leg. We report the case of an acute patellar dislocation during eccentric testing of the uninvolved leg on the Biodex isokinetic dynamometer testing device (Biodex Corporation, Shirley, NY).

Improvement in gait one year after surgery for knee osteoarthrosis: a comparison between high tibial osteotomy and prosthetic replacement in a prospective randomized study

The aim of this study was to analyse gait improvement one year after high tibial osteotomy and unicompartmental knee arthroplasty in patients with strictly unilateral osteoarthrosis of the medial compartment of the knee. Thirty-six patients, 18 men and 18 women, received a unicompartmental Brigham knee prosthesis and 23 patients, 10 men and 13 women, were operated on with a high tibial osteotomy. Clinical and radiographical assessments were supplemented by a functional test, measurements of thigh muscle torque with a Cybex II dynamometer and analysis on a force plate walkway with electrogoniometers. All patients were assessed prior to, and one year after surgery. Both groups showed overall clinical improvement, as assessed by the British Orthopaedic Association (BOA) score. Pain during walking decreased. The range of knee flexion remained unchanged. The ability to ascend and descend steps improved. The isokinetic thigh muscle torque remained unchanged. In the prosthetic group free walking speed increased from 1.03 to 1.09 m/s (p &lt; 0.001). Step frequency and step length increased (p &lt; 0.001). Single stance phase ratio increased from 0.96 to 0.99 (p &lt; 0.01), indicating a more symmetrical gait. Double stance phase (% gait cycle) of both legs decreased (p &lt; 0.001), indicating a faster transfer of weight during walking. In the osteotomy group, free walking speed did not increase. Step length of the uninvolved leg increased (p &lt; 0.01). Double stance phase of the involved leg decreased (p &lt; 0.001) and double stance phase of the uninvolved leg decreased (p &lt; 0.01). Both groups improved after surgery and there was no difference between the groups.

A Flap Augmentation Technique for Achilles Tendon Repair

The efficacy of tendo-Achilles rupture repair by a modified version of Lindholm's technique was studied biomechanically and functionally. The procedure involves secondary reinforcement of a conventionally reapproximated rupture site by means of a backfolded augmentation flap. The flap cross section consisted of approximately one third of the proximal stump. In 18 paired fresh anatomic Achilles tendons, flap augmentation repairs had an average strength of 217.5 N (SD = 44.7), whereas conventional repairs (two interrupted Kessler sutures) failed at an average of 153.9 N (SD = 30.2). In a series of seven augmentation flap patients evaluated clinically and by Cybex dynamometry, an excellent result (by the Percy/Conochie rating) was obtained in six, and a good result in one. Plantar flexion strength in full extension averaged 94% of that of the uninvolved leg. There were no reruptures. These data suggest that flap augmentation may be a useful adjunct to conventional suture repair.

Light- and electron-microscopic studies in congenital pseudarthrosis.

This study presents the results of light- and electron-microscopic and enzyme histochemical investigations in ten cases of congenital pseudarthrosis of the lower limb. At the time of surgery, six of the ten patients had not been operated on previously. The characteristic histological feature of the "sclerotic type" of congenital pseudarthrosis was a marked fibromatous reaction consisting of cellular connective tissue. The constituent cells were arranged in bundles and had elongated nuclei. The number of nuclei per visual field was considerably higher in pathological specimens than in specimens from the uninvolved leg. In places, the histological appearance resembled somewhat that of palmar fibromatosis (Dupuytren's disease). Destruction and absorption of bone were always found. Electron-microscopic analysis showed that a large number of the cells represented myofibroblasts. These findings were supported by the positive reaction of the cells for the enzyme diaminopeptidase IV, a marker enzyme for myofibroblasts [30]. As yet it is not possible to decide whether the constriction of the pseudarthritic bone is caused by a thickened myofibroblast-containing periosteum [40] or by the aggressive osteolytic component of the fibromatosis [12, 19, 41]. Furthermore, the relationship of congenital pseudarthrosis to fibrous dysplasia of bone is still unknown. Obviously, there are histological similarities between the two diseases, including the presence of osteolytic fibrous tissue in the medullary cavity and C-shaped bone trabeculae. However, the pattern of bone involvement and prognosis are different. Irrespective of the type of congenital pseudarthrosis, focal angiomatous hyperplasia was noted in some cases. This proliferation of blood vessels is most likely a reactive change.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes of Achilles tendon reflex amplitudes during a fixed foreperiod of four seconds.

ABSTRACTPreparation for a voluntary foot or finger response was studied by evoking Achilles tendon (T) reflexes. Reflexes were evoked simultaneously in both legs at 13 points between 100 and 4300 msec after the warning signal. With this paradigm, the time course of changes in reflex amplitudes related to preparatory processes could be measured simultaneously in the leg involved in the response and in the uninvolved leg. Immediately following the warning stimulus, the reflex amplitudes increased in both involved and non‐involved muscles, presumably reflecting a general non‐specific arousal. During the second half of the foreperiod, reflex amplitudes in non‐involved muscles remained elevated, perhaps reflecting a general activation of the motor system, but returned to baseline in the involved muscles. It is hypothesized that the consistently smaller reflex amplitudes in the involved leg during the entire ISI reflect a presynaptic inhibition of the la afferents to the motoneurons involved in the response. Following the response stimulus, reflex amplitudes increased in both involved and non‐involved muscles, although in the former at an earlier point and to a greater extent. It is suggested that this increase following the response stimulus is a manifestation of the transition from motor preparation to response execution.

Brief maximal isotonic exercises in the treatment of knee injuries.

The clinical value of a specific technique of exercise was investigated in 47 adults with unilateral injuries to the knee. The patient, in the sitting position, used the quadriceps femoris to extend the knee against a maximum weight load and to maintain full extension for five seconds. This was done once daily. The load was increased by 1.25 lb. (0.63 kg.) each day. The strength of the uninvolved leg was determined not oftener than once weekly. Three case histories illustrate the sequence of events. Under these conditions the prescribed exercise produced a steady increase in strength of the ipsilateral muscle up to a maximum, with corresponing resolution of clinical symptoms; no crossing of strength effect between the ipsilateral and contralateral muscles was observed.