Virtual versus in-person physiotherapy following total knee arthroplasty: a comparative analysis

PURPOSE

At our centre, we developed and implemented a video-based post-operative physiotherapy program for patients undergoing total knee arthroplasty (TKA). Our aims were to analyse and compare the outcomes of this program to in-person physiotherapy.

METHODS

We reviewed the outcomes of 112 patients and captured range-of-motion (ROM) measurements and pain scores (P4 questionnaire). We compared the outcomes to a cohort of 175 patients undergoing in-person therapy. Comparative analysis was performed using a two-tailed Student's t-test.

RESULTS

There was no significant difference between the two groups in age, sex, or initial post-operative knee ROM. On discharge from virtual physiotherapy, mean flexion was 122.6° (SD 7.6). There was no significant difference in improvement in knee flexion between the virtual and in-person groups (mean 30.6° vs 34.0°, p = 0.07). There was no significant difference in the proportion of patients achieving ≥ 120° of flexion (85.0% virtual vs 91.3% in-person, p = 0.11) or those achieving an extension deficit of ≤ 5° (96.0% vs 98.3%, p = 0.25). There was no difference in the number of PT visits to discharge (10.5 vs 11.1, p = 0.14) or final pain scores (12.4 vs 11.9, p = 0.61).

CONCLUSION

Improvements in knee ROM measures are comparable between virtual and in-person physiotherapy with both groups achieving a good functional range. These findings have implications for the virtual delivery of healthcare, especially among remote populations and patients with mobility limitations.

Short- to medium-term outcomes and future direction of reverse shoulder arthroplasty: Current concepts

Reverse shoulder arthroplasty is typically indicated for patients with severe shoulder osteoarthritis, rotator cuff tear arthropathy, or proximal humerus fractures that have failed to heal properly. The primary goal of reverse shoulder arthroplasty is to improve shoulder function and reduce pain, while also restoring the ability to perform daily activities. There is a growing body of evidence supporting the effectiveness of reverse shoulder arthroplasty in improving shoulder function and reducing pain in patients with severe shoulder osteoarthritis or rotator cuff tear arthropathy. Reverse shoulder arthroplasty is associated with significant improvements in shoulder function and pain reduction compared to non-surgical treatments. This paper aims to summarize current knowledge, practices and present a summary of the long-term effects of reverse shoulder arthroplasty (RSA) on patient outcomes, including how these outcomes are defined and what measures are typically used to assess them. It will also cover newer definitions of outcomes for RSA that have been developed in recent years in order to better understand the long-term effects of the procedure on patient-reported outcomes and functional ability, as well as information on revision surgery and implant survivorship, and the future of RSA (3D-navigation, patient-specific instrumentation, robotics and artificial intelligence) and its effects on outcomes.

Appropriate Reporting of Exercise Variables in Resistance Training Protocols: Much more than Load and Number of Repetitions

Manipulating resistance training variables is crucial to plan the induced stimuli correctly. When reporting the exercise variables in resistance training protocols, sports scientists and practitioners often refer to the load lifted and the total number of repetitions. The present conceptual review explores all within-exercise variables that may influence the strength and hypertrophic gains, and the changes in muscle architecture. Together with the (1) load and (2) the number of repetitions, (3) performing repetitions to failure or not to failure, (4) the displacement of the load or the range of movement (full or partial), (5) the portion of the partial movement to identify the muscle length at which the exercise is performed, (6) the total time under tension, the duration of each phase and the position of the two isometric phases, (7) whether the concentric, eccentric or concentric-eccentric phase is performed, (8) the use of internal or external focus and (9) the inter-set rest may all have repercussions on the adaptations induced by each resistance exercise. Manipulating one or more variable allows to increase, equalize or decrease the stimuli related to each exercise. Sports scientists and practitioners are invited to list all aforementioned variables for each exercise when reporting resistance training protocols.

A Review of Outcome Reporting Practices after Flexor Tendon Repair in Zones 1 and 2

Background: Outcome reporting following flexor tendon repair has historically concentrated on range of movement. Recently, there has been an increase in the use of patient-reported outcome measures (PROMs). At present, there is no agreed set of outcomes to report following flexor tendon repair. The aim of this study is to review outcome reporting practices after flexor tendon repair in zones 1 and 2. Methods: A search of Ovid MEDLINE, Ovid EMBASE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between 1 January 1980 and 31 December 2019 was performed to identify the studies that reported outcomes following the repair of flexor tendons in zones 1 and 2. Study characteristics and data with regard to the reporting of eight outcome domains was extracted: functional outcome (quantitative), functional outcome (subjective), activities of daily living (ADL), satisfaction/quality of life, post-treatment recovery, resources, aesthetics and safety. Results: A total of 94 out of 4,118 articles identified were included in the review. All studies reported range of motion using 17 different methods of measurement. Eleven studies defined measurement methods incorrectly or unclearly. Only 16 studies reported PROMs, with only one reporting data on assessment of quality of life. Eighteen studies reported time away from employment. Minimal data on resource utilisation and aesthetics were included. Conclusion: This review highlights wide heterogeneity and paucity of data reporting clinical outcomes of flexor tendon surgery. The development of a core outcome set that would ensure essential outcomes are correctly defined, measured and reported is required. Level of Evidence: Level IV (Prognostic).

Large joints are progressively involved in rheumatoid arthritis irrespective of rheumatoid factor status-results from the early rheumatoid arthritis study

This study aimed to examine the progression of large joint involvement from early to established RA in terms of range of movement (ROM) and time to joint surgery, according to the presence of rheumatoid factor (RF). We used a historical longitudinal cohort of early RA patients. Patients were deemed RF negative if all repeated assessments were negative. The rate of progression from normal to any loss of range of movement (ROM) from years 3 to 14 were modelled using generalized estimating equations, for elbows, wrists, hips, knees and ankle, adjusting for confounders. Time to joint surgery was analysed using multivariable Cox models. A total of 1458 patients were included (66% female, mean age 55 years) and 74% were RF-positive. The prevalence of any loss of ROM, from year 3 through to 14 was highest in the wrist followed by ankle, knee, elbow and hip. Odds of loss of ROM increased over time in all joint regions assessed, at around 7–13% per year from year 3 to 14. Time to surgery was similar according to RF-status for the wrist and ankle, but RF-positive cases had a lower hazard of surgery at the elbow (HR 0.37, 0.15–0.90), hip (HR 0.69, 0.48–0.99) and after 10 years at the knee (HR 0.41, 0.25–0.68). Large joints become progressively involved in RA, most frequently affecting the wrist followed by ankle, which is overlooked in composite disease activity indices. RF-negative and positive cases progressed similarly. Treat-to-target approaches should be followed irrespective of RF status.

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

BACKGROUND

This study was to evaluate and compare the biomechanical features of multilevel lateral lumbar interbody fusion (LLIF) with or without supplemental instrumentations.

METHODS

Six human lumbar specimens were tested under multidirectional nondestructive moments (7.5 N·m), with a 6 degree-of-freedom spine simulator. The overall and intervertebral range of motion (ROM) were measured optoelectronically. Each specimen was tested under the following conditions at L2-5 levels: intact; stand-alone; cage supplemented with lateral plate (LP); cage supplemented with unilateral or bilateral pedicle screw/rod (UPS or BPS).

RESULTS

Compared with intact condition, the overall and intersegmental ROM were significantly reduced after multilevel stand-alone LLIF. The ROM was further reduced after using LP instrumentation. In flexion-extension (FE) and axial rotation (AR), pedicle screw/rod demonstrated greater overall ROM reduction compared to LP (P < 0.01), and bilateral greater than unilateral (P < 0.01). In lateral bending (LB), BPS demonstrated greater overall ROM reduction compared to UPS and LP (P < 0.01), however, UPS and LP showed similar reduction (P = 0.245). Intervertebral ROM reductions showed similar trend as the overall ones after using different types of instrumentation. However, at L2/3 (P = 0.57) and L3/4 (P = 0.097) levels, the intervertebral ROM reductions in AR were similar between UPS and LP.

CONCLUSIONS

The overall and intervertebral stability increased significantly after multilevel LLIF with or without supplemental instrumentation. BPS provided the greatest stability, followed by UPS and LP. However, in clinical practice, less invasive adjunctive fixation methods including UPS and LP may provide sufficient biomechanical stability for multilevel LLIF.

Medical stretching devices are effective in the treatment of knee arthrofibrosis: A systematic review

AIMS

This systematic review examines the available evidence on the use of medical stretching devices to treat knee arthrofibrosis, it suggests a focus for future studies addressing limitations in current research and identifies gaps in the published literature to facilitate future works.

MATERIALS AND METHODS

Articles were identified using the Cochrane Library, MEDLINE, PubMed and SCOPUS databases. Articles from peer reviewed journals investigating the effectiveness of medical stretching devices to increase range of movement when treating arthrofibrosis of the knee were included.

RESULTS

A total of 13 studies (558 participants) met the inclusion criteria with the devices falling into the following categories; CPM, load control or displacement control stretching devices. A statistically significant increase in range of movement was demonstrated in CPM, load-control and displacement-control studies (p ​< ​0.001). The results show that the stretch doses applied using the CPM, load-control devices were performed over a considerably longer treatment time and involved significantly more additional physiotherapy compared to the displacement-control and patient actuated serial stretching devices.

CONCLUSION

The systematic review indicates that load-control and displacement-control devices are effective in increasing range of movement in the treatment of knee arthrofibrosis. Displacement-control devices involving patient actuated serial stretching techniques, may be more effective in increasing knee flexion than those utilising static progressive stretch.The paucity of research in this field indicates that more randomised controlled trials are required to investigate the superiority of the different types of displacement-control stretching devices and which of these would be most effective for use in clinical practice and to compare these with standard physiotherapy treatment.

What constitutes a clinically important change in Mayo Elbow Performance Index and range of movement after open elbow arthrolysis?

Aims

This study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of movement (ROM) after open elbow arthrolysis (OEA). We also assessed the proportion of patients who achieved MCID and SCB; and identified the factors associated with achieving MCID.

Methods

A cohort of 265 patients treated by OEA were included. The MEPI and ROM were evaluated at baseline and at two-year follow-up. Distribution-based MDC was calculated with confidence intervals (CIs) reflecting 80% (MDC 80), 90% (MDC 90), and 95% (MDC 95) certainty, and MCID with changes from baseline to follow-up. Anchor-based MCID (anchored to somewhat satisfied) and SCB (very satisfied) were calculated using a five-level Likert satisfaction scale. Multivariate logistic regression of factors affecting MCID achievement was performed.

Results

The MDC increased substantially based on selected CIs (MDC 80, MDC 90, and MDC 95), ranging from 5.0 to 7.6 points for the MEPI, and from 8.2° to 12.5° for ROM. The MCID of the MEPI were 8.3 points under distribution-based and 12.2 points under anchor-based methods; distribution- and anchor-based MCID of ROM were 14.1° and 25.0°. The SCB of the MEPI and ROM were 17.3 points and 43.4°, respectively. The proportion of the patients who attained anchor-based MCID for the MEPI and ROM were 74.0% and 94.7%, respectively; furthermore, 64.2% and 86.8% attained SCB. Non-dominant arm (p = 0.022), higher preoperative MEPI rating (p < 0.001), and postoperative visual analogue scale pain score (p < 0.001) were independent predictors of not achieving MCID for the MEPI, while atraumatic causes (p = 0.040) and higher preoperative ROM (p = 0.005) were independent risk factors for ROM.

Conclusion

In patients undergoing OEA, the MCID for the increased MEPI is 12.2 points and 25° increased ROM. The SCB is 17.3 points and 43.3°, respectively. Future studies using the MEPI and ROM to assess OEA outcomes should report not only statistical significance but also clinical importance.

Cite this article: Bone Joint J 2021;103-B(2):366–372.

The STAK tool: evaluation of a new device to treat arthrofibrosis and poor range of movement following total knee arthroplasty and major knee surgery

Aims

This study aims to evaluate a new home medical stretching device called the Self Treatment Assisted Knee (STAK) tool to treat knee arthrofibrosis.

Methods

35 patients post-major knee surgery with arthrofibrosis and mean range of movement (ROM) of 68° were recruited. Both the STAK intervention and control group received standard physiotherapy for eight weeks, with the intervention group additionally using the STAK at home. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Scores (OKS) were collected at all timepoints. An acceptability and home exercise questionnaire capturing adherence was recorded after each of the interventions.

Results

Compared to the control group, the STAK intervention group made significant gains in mean ROM (30° versus 8°, p < 0.0005), WOMAC (19 points versus 3, p < 0.0005), and OKS (8 points versus 3, p < 0.0005). The improvements in the STAK group were maintained at long-term follow-up. No patients suffered any complications relating to the STAK, and 96% of patients found the STAK tool ‘perfectly acceptable’.

Conclusion

The STAK tool is effective in increasing ROM and reducing pain and stiffness. Patients find it acceptable and adherence to treatment was high. This study indicates that the STAK tool would be of benefit in clinical practice and may offer a new, cost-effective treatment for arthrofibrosis.

Cite this article: Bone Joint Open 2020;1-8:465–473.

Effect of Turmacin supplementation on joint discomfort and functional outcome among healthy participants - A randomized placebo-controlled trial

OBJECTIVE

Curcuma longa has been widely used in Ayurveda for its medicinal properties and Turmacin was developed from C. longa as a standardized extract containing turmerosaccharides. In this clinical trial, the effect of Turmacin on knee joint discomfort in healthy adults subjected to strenuous physical activity was evaluated.

DESIGN

Double-blind, triple-arm, parallel-group, randomized placebo-controlled trial.

SETTING

Healthy participants from an urban tertiary care teaching hospital.

INTERVENTION

Healthy participants were randomized in 1:1:1 ratio to receive either Turmacin 0.5 g/1 g or placebo once daily for 84 days. The participants were subjected to 10-minute strenuous exercise.

OUTCOME MEASURES

Time to initial pain, final pain score on a visual analogue scale, range of movement (ROM) of knee and the force of contractions of muscles around the knee joint.

RESULTS

A total of n = 90 participants were recruited. The mean final pain scores were significantly lower in the Turmacin 1 g and Turmacin 0.5 g when compared with the placebo from day-7 and day-5 onwards respectively. The survival analysis consistently showed a decreased hazard for early onset of pain in both the Turmacin groups. On day-84, the difference in mean ROM between Turmacin 0.5 g and placebo was 4.79 degrees (p = 0.008) and that for Turmacin 1 g and placebo was 2.34 degrees (p = 0.306). The difference in muscle force for isokinetic contractions of the quadriceps at angular velocities of 120 and 180 was significant between Turmacin 0.5 g and placebo (p = 0.002 and p = 0.005 respectively) while that for Turmacin 1 g & Turmacin 0.5 g (p = 0.206 and p = 0.414 respectively) and Turmacin 1 g & Placebo (p = 0.046 and p = 0.037) were not significant. However, in the within group analysis participants in Turmacin 1 g group had better preserved muscle functions than Turmacin 0.5 g group at angular velocities of 120 and 180 when compared with placebo.

CONCLUSION

Turmacin (0.5 g and 1 g) was efficacious when compared to placebo in increasing the pain threshold and knee ROM in healthy participants with minor adverse events.

Functional outcomes evaluation after radial head arthoplasty in DR. Syaiful Anwar General Hospital: Case series

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Three case of radial head fracture treated with radial head arthroplasty.

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Evaluation of the functional outcomes after operative treatment of radial head arthroplasty.

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Functional outcomes assessment with active and passive range of motion.

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Satisfying result on pain and a fair result on functional outcome on patient follow-up.

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Good follow up is important to minimize the complications of radial head arthroplasty.

Introduction

Radial head arthroplasty (RHA) has become one of the mainstay surgical treatment for radial head fracture in certain conditions. Many previous studies compared the superiority of either open reduction and internal fixation (ORIF) and RHA with inconclusive result. Our case series aim to evaluate the functional outcome of the patients treated with RHA in our institution.

Presentation of case

We evaluated three patients who had RHA in 2018 and 2019. The function of flexion, extension, supination and pronation of the elbow was evaluated. The range of motion (ROM) was assessed in both active and passive way.

Discussion

An abundant of literatures stated that RHA result is superior than radial head resection and ORIF. Our case series present a satisfying result on pain and a fair result on functional outcome from the range of motion (ROM) evaluation on patient follow-up.

Conclusion

A good follow up for post-operative care plays an important role in management of RHA to minimize the rate of complications. In this case series, the functional outcomes after RHA is good, but a larger number of patient and longer follow up duration is needed for a better analysis.

Large osteophyte removal from the posterior femoral condyle significantly improves extension at the time of surgery in a total knee arthroplasty

Removing osteophytes from the posterior compartment of the femur eliminates the tenting effects on the joint capsule and consequently increases the extension gap in total knee arthroplasty. However, there is no clear association with the size of osteophytes removed and the potential degree of additional extension achieved at time of surgery.

Aims

Correlate the size of posterior osteophytes removed with the degree of extension gained intraoperatively in total knee arthroplasty and develop a radiological classification system to grade these osteophytes.

Methods

Patients who underwent a TKA had pre and post operative sagittal radiographs assessed and classified according to 4 different categories of a proposed classification system. Knee extension was then assessed by a computer navigated system before incision and after implant insertion. Confounding factors were controlled and considered on the analysis. The study was done retrospectively.

Results

147 patients were included in the study. Ninety-three (63.2%) patients had osteophytes on the posterior aspect of the femur completely removed and fifty-four patients (36.8%) did not have radiological evidence of osteophytes on the posterior aspect of the femur. There was a positive and linear correlation (Pearson correlation 0.327, p .005) between osteophyte size and degree of extension corrected at time of surgery. On Multivariate Logistic Regression Analysis, we found that small osteophytes (Grade 1) did not seem to affect the extension, while removing Grade 2 or Grade 3 osteophytes lead to a gain in extension of 2.7 and 4.5° respectively.

Conclusion

Removing large osteophytes (Grade 2 and Grade 3) from the posterior femoral compartment can be used as an adjuvant strategy to ensure that intraoperative extension is optimal. However removing small osteophytes (Grade 1) should not be expected to affect extension at the time of surgery in TKA and could increase intra-operative time and morbidity.

Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty

Objectives

To date, no study has considered the impact of acromial morphology on shoulder range of movement (ROM). The purpose of our study was to evaluate the effects of lateralization of the centre of rotation (COR) and neck-shaft angle (NSA) on shoulder ROM after reverse shoulder arthroplasty (RSA) in patients with different scapular morphologies.

Methods

3D computer models were constructed from CT scans of 12 patients with a critical shoulder angle (CSA) of 25°, 30°, 35°, and 40°. For each model, shoulder ROM was evaluated at a NSA of 135° and 145°, and lateralization of 0 mm, 5 mm, and 10 mm for seven standardized movements: glenohumeral abduction, adduction, forward flexion, extension, internal rotation with the arm at 90° of abduction, as well as external rotation with the arm at 10° and 90° of abduction.

Results

CSA did not seem to influence ROM in any of the models, but greater lateralization achieved greater ROM for all movements in all configurations. Internal and external rotation at 90° of abduction were impossible in most configurations, except in models with a CSA of 25°.

Conclusion

Postoperative ROM following RSA depends on multiple patient and surgical factors. This study, based on computer simulation, suggests that CSA has no influence on ROM after RSA, while lateralization increases ROM in all configurations. Furthermore, increasing subacromial space is important to grant sufficient rotation at 90° of abduction. In summary, increased lateralization of the COR and increased subacromial space improve ROM in all CSA configurations.Cite this article: A. Lädermann, E. Tay, P. Collin, S. Piotton, C-H Chiu, A. Michelet, C. Charbonnier. Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty. Bone Joint Res 2019;8:378-386. DOI: 10.1302/2046-3758.88.BJR-2018-0293.R1.

The Bologna-Oxford ankle replacement: a case series of clinical and radiological outcomes

PURPOSE

The Bologna-Oxford (BOX®) total ankle arthroplasty (TAA) is a three-component mobile-bearing implant gaining popularity in Europe. We aimed to analyse the outcomes of this TAA.

METHODS

We retrospectively analysed data on 34 consecutive BOX® TAAs performed at a single centre with a mean follow-up of 58 months. Radiographic outcomes, such as periprosthetic lucency and alignment, were measured and recorded. Prospectively captured clinical scores and range of movement (ROM) were also recorded.

RESULTS

There were significant improvements in patient-reported outcome scores recorded in the Manchester-Oxford Foot Questionnaire (MOxFQ) for pain (43.8 ± 20.2, p < 0.001), standing and walking (55.6 ± 19.8, p < 0.001), social activities (45.0 ± 26.9, p < 0.02) and visual analogue score (VAS) (3.1 ± 2.5, p < 0.001). Mean improvement in ROM postoperatively was 18.7° (p < 0.001), with post-operative dorsiflexion 8.8° (10°-25°) and plantar flexion 32.6° (20°-40°). There was evidence of asymptomatic lucency on five radiographs (15%), which was present in 10% at three years. Nine patients had complications (26%): six (18%) requiring secondary surgery and one requiring revision (3%) for infection.

CONCLUSIONS

We have demonstrated 97% survivorship at a mean of 58 months. There are maintained improvements in clinical and radiological outcomes and reoperation that are consistent with the literature.

Impact of adding a simultaneous cognitive task in the elbow's range of movement during arm curl test in women with fibromyalgia

BACKGROUND

Fibromyalgia symptoms cause a significant reduction in the ability to perform daily life activities. These activities require the ability to perform more than one task simultaneously. The main objective of this study was to evaluate how dual-task could modify range of movement, duration of repetitions and performance in the arm curl test in healthy controls and patients with fibromyalgia.

METHODS

Twenty women participated in this study, divided into two groups: 1) patients with fibromyalgia (N = 10, age = 52.00 [5.08]) and 2) age- and gender-matched healthy controls (N = 10; age = 51.60 [4.09]). The participants had to perform the arm curl test in two conditions: single test condition and performing a dual-task. The dual-task condition consisted of remembering three random unrelated words.

RESULTS

Patients with fibromyalgia completed fewer repetitions than controls during dual-task condition (p-value = 0.015). Furthermore, both groups showed a significant decrease in the range of movement in the dual-task condition when comparing the mean of the three first repetitions with the three last ones (p-value < 0.05).

INTERPRETATION

The motor task might be prioritized over the cognitive task at the beginning of the test. However, at the end of the test, the cognitive task could require more attention due to the increased time since the words were heard, and also the motor task could require less attention after some repetitions have been performed. Thus, the addition of a cognitive task could lead to a less conscious execution of the motor task at the end of the test, which may be consistent with a reduced range of movement.

Effect of adding interferential current stimulation to exercise on outcomes in primary care patients with chronic neck pain: a randomized controlled trial

OBJECTIVE

To evaluate the effect of adding interferential current stimulation to exercise on pain, disability, psychological status and range of motion in patients with neck pain.

DESIGN

A single-blinded randomized controlled trial.

SETTING

Primary care physiotherapy units.

SUBJECTS

A total of 84 patients diagnosed with non-specific mechanical neck pain. This sample was divided into two groups randomly: experimental (n = 42) versus control group (n = 42).

INTERVENTIONS

Patients in both groups had a supervised therapeutic exercise programme, with the experimental group having additional interferential current stimulation treatment.

MAIN MEASURES

The main measures used were intensity of neck pain according to the Visual Analogue Scale; the degree of disability according to the Neck Disability Index and the CORE Outcome Measure; anxiety and depression levels according to the Goldberg scale; apprehension as measured by the Personal Psychological Apprehension scale; and the range of motion of the cervical spine. The sample was evaluated at baseline and posttreatment (10 sessions/two weeks).

RESULTS

Statistically significant differences between groups at posttreatment were observed for Visual Analogue Scale (2.73 ± 1.24 vs 4.99 ± 1.56), Neck Disability Index scores (10.60 ± 4.77 vs 18.45 ± 9.04), CORE Outcome Measure scores (19.18 ± 9.99 vs 35.12 ± 13.36), Goldberg total score (6.17 ± 4.27 vs 7.90 ± 4.87), Goldberg Anxiety subscale, Personal Psychological Apprehension Scale scores (28.17 ± 9.61 vs 26.29 ± 11.14) and active and passive right rotation.

CONCLUSIONS

Adding interferential current stimulation to exercise resulted in better immediate outcome across a range of measures.

Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study

Background

Patients with non-operated traumatic primary anterior shoulder dislocation (PASD) are assumed to have less shoulder impairment than patients with recurrent anterior shoulder dislocations (RASD). This may impact treatment decision strategy. The aim was to study whether patients with non-operated traumatic PASD have less shoulder impairment than those with RASD.

Methods

In a cross-sectional study baseline data from patients with PASD and RASD in a randomised controlled trial of non-operative shoulder exercise treatment were used. Shoulder function was self-reported (Western Ontario Shoulder Instability (WOSI), Tampa Scale of Kinesiophobia (TSK), General Health (EQ-5D-VAS), Numeric Pain Rating Scale (NPRS)), and measured (Constant-Murley shoulder Score (CMS total), CMS - Range of Motion (CMS-ROM, CMS – strength, proprioception, clinical tests).

Results

In total, 56 patients (34 (28 men) with PASD and 22 (21 men) with RASD) (mean age 26 years) participated. WOSI total was 1064 and 1048, and TSK above 37 (indicating high re-injury fear) was present in 33 (97%) and 21 (96%) of the groups with PASD and RASD, with no group difference. CMS total (66.4 and 70.4), CMS-ROM (28.7 and 31.5), CMS-strength (injured shoulder: 7.6 kg and 9.1 kg), proprioception and clinical tests were the same. Furthermore, 26 (76%) with PASD and 13 (59%) with RASD reported not to have received non-operative shoulder treatment.

Conclusions

Non-operated patients with PASD and self-reported shoulder trouble three-six weeks after initial injury do not have less shoulder impairment (self-reportedly or objectively measured) than non-operated patients RASD and self-reported shoulder trouble three-six weeks after their latest shoulder dislocation event.

Immediate effects and one-week follow-up after neuromuscular electric stimulation alone or combined with stretching on hamstrings extensibility in healthy football players with hamstring shortening

OBJECTIVE

To assess the immediate and mid-term (after 7 days) effects of electric current combined with simultaneous muscle stretching (EME technique) per comparison to the isolated use of the same current (without applying simultaneous muscle stretching), over the hamstring extensibility in football players with hamstring shortening, and to estimate the clinical benefit of the interventions according to the muscular extensibility.

METHODS

Forty-eight participants were randomized to receive one session of EME technique (n = 26) or one session of the electrical current (EC) alone (n = 22). The measurement of the hamstrings extensibility through the active knee test was carried out before and immediately after each intervention and one week later.

RESULTS

A significant interaction group x time was observed (F_2,84 = 7.112, p = 0.001; partial eta squared = 0.145). The hamstrings extensibility changed significantly immediately after the EME technique (147.3° ± 16.4° to 153.5° ± 14.2°, p < 0.05), but not after the EC only (144.2 ± 10.2° to 141.7 ± 7.8°, p > 0.05). One week after the intervention no significant differences were found to the baseline values in both groups. The number needed to treat to prevent one new case of hamstring shortening was 3.

CONCLUSION

The combination of electric current with simultaneous stretching is an effective technique to acutely increase the hamstring extensibility of football players with hamstring shortness.

A comparison of clinical- and patient-reported outcomes of the cemented ATTUNE and PFC sigma fixed bearing cruciate sacrificing knee systems in patients who underwent total knee replacement with both prostheses in opposite knees

BACKGROUND

The ATTUNE Knee by DePuy Synthes was introduced in 2013. It is designed to provide better range of motion and address patient-reported instability. The PFC Sigma Knee, an earlier prosthesis by DePuy Synthes, is a common knee replacement with a strong clinical track record. Our aim is to compare the outcomes after primary total knee replacement for end-stage knee osteoarthritis of the PFC and ATTUNE knee systems in 21 patients who each have prosthesis in opposite knees using WOMAC, Oxford Knee and SF-12 scores and evaluation of range of motion.

METHODS

A review was carried out on 21 patients who underwent primary total knee replacement with both the ATTUNE and PFC knee systems. These were staged operations performed in the same institution and by the same surgeon. All cases were followed up for a minimum of 6 months. WOMAC, Oxford Knee and SF-12 scores, as well as knee range of motion were recorded preoperatively and at 6 months postoperatively.

RESULTS

There was a significant difference in pre- to 6-month post-operative outcomes in PFC and ATTUNE groups with regard to improvement in range of motion (10° ± 8 and 13° ± 11, respectively). There was also a significant improvement in WOMAC scores (PFC group) and Oxford Knee Scores (ATTUNE group) (8.9 ± 7.7 and 12.1 ± 8.4, respectively). There was a significant improvement in SF-12 Score in both groups (10.1 ± 9.3 for PFC and 15.8 ± 13.3 for ATTUNE). The minimum clinically important difference (MCID) in scoring systems at 6 months was reached by 6 patients in the PFC group and 12 in the ATTUNE group.

CONCLUSION

A significant difference was demonstrated in clinical outcome at 6 months postoperatively between PFC and ATTUNE knee systems in patients who underwent total knee arthroplasty with both prostheses. Superior results were recorded for the ATTUNE knee system.

Assessment of Range of Movement, Pain and Disability Following a Whiplash Injury

Background:

Whiplash has been suggested to cause chronic symptoms and long term disability. This study was designed to assess long term function after whiplash injury.

Material & Methods:

A random sample of patients in the outpatient clinic was interviewed, questionnaire completed and clinical examination performed. Assessment was made of passive cervical range of movement and Visual Analogue Scale pain scores. One hundred and sixty-four patients were divided into four different groups including patients with no whiplash injury but long-standing neck pain (Group A), previous symptomatic whiplash injury and long-standing neck pain (Group B), previous symptomatic whiplash injury and no neck symptoms (Group C), and a control group of patients with no history of whiplash injury or neck symptoms (Group D).

Results:

Data was analyzed by performing an Independent samples t-test and ANOVA, with level of significance taken as p<0.05. Comparing the four groups using a one-way ANOVA showed a significant difference between the groups (p<0.001). There were significant differences when comparing mean ranges of movement between Group A and Group D, and between Group B and Group D. There was no significant difference between Group C and Group D. similar differences were also seen in the pain scores.

Conclusion:

We conclude that osteoarthritis in the cervical spine, and whiplash injury with chronic problems cause a significantly decreased cervical range of movement with a higher pain score. Patients with shorter duration of whiplash symptoms appear to do better in the long-term.

Do radiological and functional outcomes correlate for fractures of the distal radius?

AIMS

We conducted a study to determine whether radiological parameters correlate with patient reported functional outcome, health-related quality of life and physical measures of function in patients with a fracture of the distal radius.

PATIENTS AND METHODS

The post-operative palmar tilt and ulnar variance at six weeks and 12 months were correlated with the Patient Rated Wrist Evaluation, Disabilities of the Arm, Shoulder and Hand, and EuroQol scores, grip strength, pinch strength and range of movement at three, six and 12 months for 50 patients (mean age 57 years; 26 to 85) having surgical fixation, with either percutaneous pinning or reconstruction with a volar plate, for a fracture of the distal radius.

RESULTS

Radiological parameters were found to correlate poorly with the patient reported outcomes (r = 0.00 to 0.47) and physical measures of function (r = 0.01 to 0.51) at all intervals.

CONCLUSION

This study raises concerns about the use of radiological parameters to determine management, and to act as a surrogates for successful treatment, in patients with a fracture of the distal radius. Restoration of 'normal' radiographic parameters may not be necessary to achieve a satisfactory functional outcome for the patient. Cite this article: Bone Joint J 2017;99-B:376-82.

A normative study of cervical range of motion measures including the flexion-rotation test in asymptomatic children: side-to-side variability and pain provocation

OBJECTIVES

Cervical movement impairment has been identified as a core component of cervicogenic headache evaluation. However, normal range of motion values in children has been investigated rarely and no study has reported such values for the flexion-rotation test (FRT). The purpose of this study was to identify normal values and side-to-side variation for cervical spine range of motion (ROM) and the FRT, in asymptomatic children aged 6-12 years. Another important purpose was to identify the presence of pain during the FRT.

METHODS

Thirty-four asymptomatic children without history of neck pain or headache (26 females and 8 males, mean age 125.38 months [SD 13.14]) were evaluated. Cervical spine cardinal plane ROM and the FRT were evaluated by a single examiner using a cervical ROM device.

RESULTS

Values for cardinal plane ROM measures are presented. No significant gender difference was found for any ROM measure. Mean difference in ROM for rotation, side flexion, and the FRT were less than one degree. However, intra-individual variation was greater, with lower bound scores of 9.32° for rotation, 5.30° for side flexion, and 10.89° for the FRT. Multiple linear regression analysis indicates that movement in the cardinal planes only explains 19% of the variance in the FRT. Pain scores reported following the FRT were less than 2/10.

DISCUSSION

Children have consistently greater cervical spine ROM than adults. In children, side-to-side variation in rotation and side flexion ROM and range recorded during the FRT indicates that the clinician should be cautious when using range in one direction to determine impairment in another. Range recorded during the FRT is independent of cardinal movement variables, which further adds to the importance of the FRT, as a test that mainly evaluates range of movement of the upper cervical spine.

Functional versus patient-reported outcome of the bicruciate and the standard condylar-stabilizing total knee arthroplasty

INTRODUCTION

The purpose of this retrospective comparative analysis in patients undergoing primary total knee arthroplasty (TKA) was to evaluate whether different TKA implant design would influence patient-rated outcomes, functioning, and range of motion (ROM). A secondary purpose of this study was to test for relationships between the patient-rated outcomes and the passive ROM.

MATERIALS AND METHODS

Thirty-one patients who had a primary bicruciate stabilized TKA performed between May 2010 and November 2012 were retrospectively reviewed and compared with a cohort of 30 patients who had condylar-stabilizing TKA during the same period.

RESULTS

No significant differences were observed between the two groups with respect to preoperative demographic characteristics, ROM and radiographic knee alignment. At a mean follow-up of 37 months (SD 7), the Triathlon group had higher mean Knee Injury and Osteoarthritis Outcome Score (KOOS) score in all subscales and a higher Knee Society Score (KSS) score than the Journey group. This difference was statistically significant for the KOOS subscales of pain (p = 0.0099) and activities of daily living (ADL) (p = 0.0003), as well as the KSS score (p = 0.03846). The ROM was significantly higher in the Journey group when compared to the Triathlon group (p = 0.0013). No significant correlation was observed between the ROM and KOOS pain, QOL and ADL subscores and KSS score.

CONCLUSIONS

Postoperative knee ROM and patient perception of knee function after primary TKA can be affected by the different prosthetic designs. However, functionality afforded by the bicruciate TKA is not equivalent to patient satisfaction.

LEVEL OF EVIDENCE

III.

The association between loss of ankle dorsiflexion range of movement, and hip adduction and internal rotation during a step down test

A pattern of excessive hip adduction and internal rotation with medial deviation of the knee has been associated with numerous musculo-skeletal dysfunctions. Research into the role that ankle dorsiflexion (DF) range of motion (ROM) play in lower limb kinematics is lacking. The objective of this cross-sectional, observational study was to investigate the relationship between ankle DF ROM, and hip adduction and hip internal rotation during a step-down test with and without heel elevation in a healthy female population. Hip and ankle ROM was measured kinematically using a ten-camera Optitrack motion analysis system. Thirty healthy female participants (mean age = 20.4 years; SD = 0.9 years) first performed a step-down test with the heel of the weight bearing foot flat on the step and then with the heel elevated on a platform. Ankle DF, hip adduction and hip internal rotation were measured kinematically for the supporting leg. Participants who had 17° or less of ankle DF ROM displayed significantly more hip adduction ROM (p = 0.001; Cohen's d effect size = 1.2) than the participants with more than 17° of DF during the step-down test. Participants with limited DF ROM showed a significant reduction in hip adduction ROM during the elevated-heel step-down test (p = 0.008). Hip internal rotation increased in both groups during the EHSD compared to the step-down test (p > 0.05) Reduced ankle DF ROM is associated with increased hip adduction utilised during the step-down test. Ankle DF should be taken into account when assessing patients with aberrant frontal plane lower limb alignment.

Patients' preoperative perspectives concerning the decision to undergo total knee arthroplasty and comparison of their clinical assessments

[Purpose] The aims of our study were, 1. to assess pain, limitation of movement ability, and functionality in osteoarthritis patients scheduled to undergo total knee arthroplasty, 2. to determine if pain (Group 1) or function loss (Group 2) has a greater influence on the decision of patients to have surgery, and 3. to compare results between Group 1 and Group 2. [Subject and Methods] Fifty-five osteoarthritis patients classified as grades 3 and 4 according to the Kellgren-Lawrence system of classification were evaluated for preoperative pain intensity with the Visual Analogue Scale, knee flexion/extension range of movement with a clinical goniometer, and function with the Western Ontario and McMaster Universities Osteoarthritis Index. Patients were examined to reveal their reasons regarding the decision to undergo total knee arthroplasty (pain or function loss). [Results] The Visual Analog Scale scores at rest and during activity were 5.62 and 7.42, the knee flexion range of movement and extension limitation were 93.17° and -7.04°, and the Western Ontario and McMaster Universities Osteoarthritis Index value was 82.09. Regarding the decision to undergo surgery, 47.3% (n=26) of the knees were in Group 1, and 52.7% were in Group 2; the two groups were not significantly different. There were also no significant differences between the groups in Visual Analog Scale score during activity, the Western Ontario and McMaster Universities Osteoarthritis Index value, and knee flexion range of movement and extension limitation. The only statistically significant difference was found in the Visual Analog Scale score at rest in Group 1, which was significantly higher than that in Group 2. [Conclusion] Our results showed that osteoarthritis patients decided to undergo surgery only if all of the parameters were impaired significantly. Both pain and function loss have a similar impact on a patient's decision to undergo surgery. We observed no significant difference in clinical and self-reported outcomes between patients who decided to undergo surgery due to pain or function loss.

The prognostic value of the fracture level in the treatment of Gartland type III supracondylar humeral fracture in children

A small proportion of children with Gartland type III supracondylar humeral fracture (SCHF) experience troubling limited or delayed recovery after operative treatment. We hypothesised that the fracture level relative to the isthmus of the humerus would affect the outcome. We retrospectively reviewed 230 children who underwent closed reduction and percutaneous pinning (CRPP) for their Gartland type III SCHFs between March 2003 and December 2012. There were 144 boys and 86 girls, with the mean age of six years (1.1 to 15.2). The clinico-radiological characteristics and surgical outcomes (recovery of the elbow range of movement, post-operative angulation, and the final Flynn grade) were recorded. Multivariate analysis was employed to identify prognostic factors that influenced outcome, including fracture level. Multivariate analysis revealed that a fracture below the humeral isthmus was significantly associated with poor prognosis in terms of the range of elbow movement (p < 0.001), angulation (p = 0.001) and Flynn grade (p = 0.003). Age over ten years was also a poor prognostic factor for recovery of the range of elbow movement (p = 0.027). This is the first study demonstrating a subclassification system of Gartland III fractures with prognostic significance. This will guide surgeons in peri-operative planning and counselling as well as directing future research aimed at improving outcomes.

Three-dimensional morphology and bony range of movement in hip joints in patients with hip dysplasia

To confirm whether developmental dysplasia of the hip has a risk of hip impingement, we analysed maximum ranges of movement to the point of bony impingement, and impingement location using three-dimensional (3D) surface models of the pelvis and femur in combination with 3D morphology of the hip joint using computer-assisted methods. Results of computed tomography were examined for 52 hip joints with DDH and 73 normal healthy hip joints. DDH shows larger maximum extension (p = 0.001) and internal rotation at 90° flexion (p < 0.001). Similar maximum flexion (p = 0.835) and external rotation (p = 0.713) were observed between groups, while high rates of extra-articular impingement were noticed in these directions in DDH (p < 0.001). Smaller cranial acetabular anteversion (p = 0.048), centre-edge angles (p < 0.001), a circumferentially shallower acetabulum, larger femoral neck anteversion (p < 0.001), and larger alpha angle were identified in DDH. Risk of anterior impingement in retroverted DDH hips is similar to that in retroverted normal hips in excessive adduction but minimal in less adduction. These findings might be borne in mind when considering the possibility of extra-articular posterior impingement in DDH being a source of pain, particularly for patients with a highly anteverted femoral neck.

Interrater and Intrarater Reliability of the Active Knee Extension (AKE) Test among Healthy Adults

[Purpose] The purpose of this study was to determine the reliability of the active knee extension (AKE) test among healthy adults. [Subjects] Fourteen healthy participants (10 men and 4 women) volunteered and gave informed consent. [Methods] Two raters conducted AKE tests independently with the aid of a simple and inexpensive stabilizing apparatus. Each knee was measured twice, and the AKE test was repeated one week later. [Results] The interrater reliability intraclass correlation coefficients (ICC_2,1) were 0.87 for the dominant knee and 0.81 for the nondominant knee. In addition, the intrarater (test-retest) reliability ICC_3,1 values range between 0.78–0.97 and 0.75–0.84 for raters 1 and 2 respectively. The percentages of agreement within 10° for AKE measurements were 93% for the dominant knee and 79% for the nondominant knee. [Conclusion] The finding suggests the current AKE test showed excellent interrater and intrarater reliability for assessing hamstring flexibility in healthy adults.

One-week time course of the effects of Mulligan's Mobilisation with Movement and taping in painful shoulders

Previous research suggests that Mulligan's Mobilisation-with-Movement (MWM) technique for the shoulder produces an immediate improvement in movement and pain. The aims of this study were to investigate the time course of the effects of a single MWM technique and to ascertain the effects of adding tape following MWM in people with shoulder pain. Twenty-five participants (15 males, 10 females), who responded positively to an initial application of MWM, were randomly assigned to MWM or MWM-with-Tape. Range of movement (ROM), pressure pain threshold (PPT) and current pain severity (PVAS) were measured pre- and post-intervention, 30-min, 24-h and one week follow-up. Following a one-week washout period, participants were crossed over to receive a single session of the opposite intervention with follow-up measures repeated. ROM significantly improved with MWM-with-Tape and was sustained over one week follow-up (p < 0.001; 18.8°, 95% confidence intervals (CI) 7.3-30.4), and in PVAS up to 30-min follow-up (38.4 mm, 95% CI 20.6-56.1 mm). MWM demonstrated an improvement in ROM (11.8°, 95% CI 1.9-21.7) and PVAS (40.4 mm, 95% CI 27.8-53.0 mm), but only up to 30-min follow-up. There was no significant improvement in PPT for either intervention at any time point. MWM-with-Tape significantly improved ROM over the one-week follow-up compared to MWM alone (15.9°, 95% CI 7.4-24.4). Both MWM and MWM-with-Tape provide a short-lasting improvement in pain and ROM, and MWM-with-Tape also provides a sustained improvement in ROM to one-week follow-up, which is superior to MWM alone.