Treatment of Floating Knee Injury in Children

The necessity and superiority of the surgical operation on children with floating knee injury and the fracture union and complications were investigated. Twenty-eight children with floating knee injury were subjected to open reduction and internal fixation or external fixator. The patients were followed up for 18 months to 7 years. The curative effectiveness was scored by Karlstrom criteria. The results showed that no nonunion or deformity was found. The affected limb was 1.2 cm to 1.5 cm longer in 2 cases, 0.8 to 1.2 cm shorter in 3 cases than the contralateral. No severe dysfunction of knee joint occurred. The excellent-good rate was 92.8 % and the curative rate 71.4 respectively. So for children whose age is older than 5 years, it＇s a good way to treat the fractures of femur and tibia with open reduction and internal fixation or external fixator. The method can be advantageous for the nursing care, early function recovery, shortening of the hospital stay and avoidance of severe complications.

Chondroitin sulfate and glucosamine combination in patients with knee and hip osteoarthritis:A long-term observational study in Russia

BACKGROUND Oral treatment of glucosamine(GA) combined with chondroitin sulfate(CS) was reportedly effective for pain relief and function improvement in osteoarthritis patients with moderate to severe knee pain in clinical trials. While the effectiveness of GA and CS on both clinical and radiological findings has been demonstrated, only a few high-quality trials exist. Therefore, controversy regarding their effectiveness in real-world clinical practice remains.AIM To investigate the impact of GA + CS on clinical outcomes of patients with knee and hip osteoarthritis in routine clinical practice.METHODS A multicenter prospective observational cohort study included 1102 patients of both genders with knee or hip osteoarthritis(Kellgren & Lawrence grades Ⅰ-Ⅲ) in 51 clinical centers in the Russian Federation from November 20, 2017, to March 20,2020, who had started to receive oral capsules of glucosamine hydrochloride 500 mg and CS 400mg according to the approved patient information leaflet starting from 3 capsules daily for 3 wk,followed by a reduced dosage of 2 capsules daily before study inclusion(minimal recommended treatment duration is 3-6 mo). Changes in subscale scores [Pain, Symptoms, Function, and Quality of Life(QOL)] of the Knee Injury and Osteoarthritis Outcome Score(KOOS)/Hip Disability and Osteoarthritis Outcome Score(HOOS) questionnaires during the observational period(up to 54-64wk with a total of 4 visits). Patients’ treatment satisfaction, data on the combined oral use of glucosamine hydrochloride and CS, concomitant use of non-steroidal anti-inflammatory drugs(NSAIDs), and adverse events(AEs) were also evaluated.RESULTS A total of 1102 patients with knee and hip osteoarthritis were included in the study. The mean patient age was 60.4 years, most patients were women(87.8%), and their average body mass index was 29.49 kg/m2. All subscale scores(Pain, Symptoms, Function, and QOL) of the KOOS and HOOS demonstrated clinically and statistically significant improvements. In patients with knee osteoarthritis, the mean score increases from baseline to the end of Week 64 were 22.87, 20.78,16.60, and 24.87 on Pain, Symptoms, Physical Function(KOOS-PS), and QOL subscales(P < 0.001for all), respectively. In patients with hip osteoarthritis, the mean score increases were 22.81, 19.93,18.77, and 22.71 on Pain, Symptoms, Physical Function(HOOS-PS), and QOL subscales(P < 0.001for all), respectively. The number of patients using any NSAIDs decreased from 43.1% to 13.5%(P < 0.001) at the end of the observation period. Treatment-related AEs occurred in 2.8% of the patients and mainly included gastrointestinal disorders [25 AEs in 24(2.2%) patients]. Most patients(78.1%) were satisfied with the treatment.CONCLUSION Long-term oral GA + CS was associated with decreased pain, reduced concomitant NSAID therapy, improved joint function and QOL in patients with knee and hip osteoarthritis in routine clinical practice.

Creating Prep to Play PRO for women playing elite Australian football:A how-to guide for developing injury-prevention programs

Background:Developing context-specific,evidence-informed,and implementable injury-prevention programs is challenging.Women playing in the elite Australian Football League for Women are at high risk of serious knee injuries,and no specific injury-prevention program exists.The objective of the study was to describe the collaborative process used to create a context-specific injury-prevention program.Methods:A previously used intervention-development process was modified to incorporate a partnership with the sport’s governing organization and focus on engaging program implementers.The Reach Effectiveness Adoption Implementation and Maintenance(RE-AIM)Sports Setting Matrix guided program development and implementation strategies.Results:The 7-step process,aligned with the RE-AIM Sports Setting Matrix,was applied to develop the injury-prevention program and was titled Prep to Play PRO.The steps were:(Step 1)gaining organizational support and establishing a project partnership;(Step 2)using research evidence and clinical experience;(Step 3)consulting content and context experts;(Step 4)engaging the organization,experts,program implementers,and end-users to concreate the intervention and develop implementation strategies;(Step 5)testing the intervention acceptability and feasibility;(Step 6)evaluating the intervention and implementation strategies against theory;and(Step 7)obtaining feedback from early implementers and end-users.Conclusion:Engaging critical stakeholders at multiple ecological levels(organization,team,and athlete)throughout program development and implementation planning support real-world use.The processes and activities described can guide future sports injury-prevention program development and implementation.

Lateral femoral tunnel preparation and graft fixation for anterior cruciate ligament reconstruction–A discussion

This article provides a discussion and commentary around the recent advances in arthroscopic anterior cruciate ligament reconstruction(ACLR),with a focus on the aspects of lateral femoral tunnel preparation and graft fixation techniques.The paper explores and comments on a recently published review by Dai et al,titled"Research progress on preparation of lateral femoral tunnel and graft fixation in ACLR",while providing insight into its relevance within the field of ACLR,and recommendations for future research.

A Mesh Meta-Analysis of the Effectiveness of Different Warm-Up Exercises to Prevent Knee Injuries in Young Child Soccer Players

Objective: A mesh Meta-analysis was used to evaluate the effectiveness of four warm-up exercises to prevent knee injuries in juvenile soccer players. Method: They are a randomized controlled trial (RCT) on FIFA 11+ integrated warm-up, FIFA 11+ Kids integrated warm-up, and neuromuscular training (NMT) warm-up for the prevention of knee joint in juvenile soccer players by a computer search of CNKI, CBMdisc, WanFangdata, Pubmed, Web of science, and SPORTDicus database. The search period was from the establishment of each database to February 2022. Two investigators screened the literature, extracted data, and assessed risk bias for the included studies according to the pre-defined inclusion and exclusion criteria, and finally analyzed the data using Stata 14.0 software and OpenBUGS software. Results: A total of 10 RCT studies with 17,143 subjects, spanning the age range of 7 to 19 years, were included. The results of the reticulated Meta-analysis showed that all three warm-up modalities were effective in reducing the incidence of knee injuries in junior soccer players compared to conventional warm-up, with the optimality in descending order of FIFA 11+ Kids comprehensive warm-up (SUCRA = 85.3), neuromuscular training warm-up (SUCRA = 66.7), and FIFA 11+ combined warm-up (SUCRA = 44). Conclusion: The FIFA 11+ Kids comprehensive warm-up is the most effective warm-up exercise for the prevention of knee injuries in junior and child soccer players, but the above findings need further validation due to the quantity and quality of the literature and the quality of the evidence.

“When you’re down, stay down”:A lesson for all competitive alpine skiers supported by an ACL rupture measured in vivo

Background:During an experiment,a ski racer equipped with various measurement devices suffered an anterior cruciate ligament(ACL)rupture in his right knee.The aim of this study was to describe the underlying injury mechanism from a functional perspective.Methods:Eight giant slalom turns(i.e.,4 left turns),followed by 1 left turn at which the ACL injury occurred,were recorded by 2 video cameras,electromyography of 4 relevant muscle groups,inertial measurement units to measure knee and hip angles,and pressure insoles to determine ground reaction forces.Results:Due to a loss of balance,the ski racer began to slide sideways at the apex of a left turn.During sliding,his right(outside)leg was actively abducted upward without touching the ground.The ski racer then attempted to stand up again by dropping his leg back towards the snow surface.The end of this dropping was accompanied by a decrease in electromyographic activity in the knee stabilizing muscles.Once the inside edge of the outer ski caught the snow surface,a rapidly increasing peak force,knee flexion,and an aggressive sudden activation of the vastus medialis muscle were observed,while biceps femoris and rectus femoris further decreased their activation levels.This likely resulted in excessive anterior translation of the tibia relative to the femur,causing damage to the ACL.Conclusion:Our example emphasizes that ski racers should not get up until they stop sliding.Remember:“When you’re down,stay down.”