Clinical value of ankle flexion and extension exercises combined with a psychological intervention in knee osteoarthritis

BACKGROUND Considering the limited effectiveness of clinical interventions for knee osteoarthritis(KOA),it is necessary to continue to explore appropriate and effective treatment strategies to improve the condition of KOA patients.AIM To clarify the influence of ankle flexion and extension exercises combined with a psychological intervention on the psychological status and activities of daily living(ADLs)of patients with KOA.METHODS The research participants were 116 KOA patients admitted to The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between May 2019 and May 2022,including 54 patients receiving routine treatment,care and psychological intervention(control group)and 62 patients additionally treated with ankle flexion and extension exercises(research group).The two groups were comparatively analyzed in terms of psychological status(Self-rating Anxiety/Depression Scale,SDS/SAS),ADLs,knee joint function(Lysholm Knee Scoring Scale),pain(Visual Analog Scale,VAS),fatigue(Multidimensional Fatigue Inventory,MFI),and quality of life(QoL;Short-Form 36 Item Health Survey,SF-36).RESULTS After evaluation,it was found that the postinterventional SDS,SAS,VAS,and MFI scores in the research group were significantly reduced compared with the baseline(before the intervention)values and those of the control group,while the postinterventional Lysholm,ADL and SF-36 scores were markedly elevated.CONCLUSION Therefore,ankle flexion and extension exercises are highly effective in easing negative psychological status,enhancing ADLs,daily living ability,knee joint function and QoL,and relieving pain and fatigue in KOA patients,thus warranting clinical promotion.

Use of Ilizarov technique for bilateral knees flexion contracture in Juvenile-onset ankylosing spondylitis: A case report

BACKGROUND Ankylosing spondylitis(AS)is a chronic rheumatic disease that primarily affects the spine and the sacroiliac and peripheral joints.Juvenile-onset AS(JoAS)patients will likely present with peripheral joint symptoms.Knee flexion contracture(KFC)and hip flexion contracture(HFC)are common in these patients due to subchondral bone inflammation.The Ilizarov technique is the most commonly used technique for treating KFC.However,its use to treat JoAS-associated KFC has not been reported.CASE SUMMARY This report presents a case study of a 31-year-old male patient with a squatting gait due to severe bilateral KFC and HFC.The patient had a normal walking pattern until the age of eight,after which he experienced knee and hip pain,leading to the gradual development of KFC and HFC.The patient’s primary complaint was an inability to walk upright.The patient was diagnosed with JoAS and under-went hip dissection and release,limited soft tissue release of the hamstring,and gradual traction using the Ilizarov method.Ultimately,the patient was able to walk upright.CONCLUSION The incidence of squatting gait due to KFC in individuals diagnosed with JoAS was low.Utilizing the Ilizarov technique has proven to be a secure and effective method for managing KFC in JoAS patients.Although the Ilizarov technique cannot substitute for total knee arthroplasty(TKA),its application can delay the need for primary TKA in JoAS patients and alleviate the intricacy and potential complications associated with the procedure.

Tracking of Thigh Flexion Angle during Gait Cycles in an Ambulatory Activity Monitoring Sensor Network

An accelerometry-based gait analysis approach via the platform of sensor network is reported in this paper. The hardware units of the sensor network are wearable accelerometers that are attached at the limbs of human body. For the specific task of gait analysis, flexion angles of the thighs during gait cycles are computed. A Kalman filter is designed to estimate the flexion-extension angle, angular velocity of the thigh using the output of the wearable accelerometers. The proposed approach has been applied to four subjects and the performance is compared with video-based approach. Comparative results indicate that with the proposed Kalman filter, the sensor network is able to track the movement of the thighs during gait cycles with good accuracy and simultaneously detect major gait event of foot contact from the waveform of the angular velocity.

Rebuilding motor function of the spinal cord based on functional electrical stimulation

Rebuilding the damaged motor function caused by spinal cord injury is one of the most serious challenges in clinical neuroscience.The function of the neural pathway under the damaged sites can be rebuilt using functional electrical stimulation technology.In this study,the locations of motor function sites in the lumbosacral spinal cord were determined with functional electrical stimulation technology.A three-dimensional map of the lumbosacral spinal cord comprising the relationship between the motor function sites and the corresponding muscle was drawn.Based on the individual experimental parameters and normalized coordinates of the motor function sites,the motor function sites that control a certain muscle were calculated.Phasing pulse sequences were delivered to the determined motor function sites in the spinal cord and hip extension,hip flexion,ankle plantarflexion,and ankle dorsiflexion movements were successfully achieved.The results show that the map of the spinal cord motor function sites was valid.This map can provide guidance for the selection of electrical stimulation sites during the rebuilding of motor function after spinal cord injury.

Activation of brain areas following ankle dorsiflexion versus plantar flexion Functional magnetic resonance imaging verification

Changes in activated areas of the brain during ankle active dorsiflexion and ankle active plantar flexion were observed in six healthy subjects using functional magnetic resonance imaging. Excited areas of ankle active dorsiflexion involved the bilateral primary motor area and the primary somatosensory area, as well as the bilateral supplementary sensory area, the primary visual area, the right second visual area, and the vermis of cerebellum. Excited areas of ankle active plantar flexion included the ipsilateral supplementary motor area, the limbic system, and the contralateral corpus striatum. Fine movements of the cerebral cortex control the function of the ankle dorsiflexion to a larger extent than ankle plate flexion, and the function of ankle plate flexion is more controlled by the subcortical area.

Effects of early rehabilitation in improvement of paediatric burnt hands function

BACKGROUND Hands are one of the most common burn sites in children.Hypertrophic scar contractures in hands after wound healing result in further reductions in their range of motion(ROM),motility,and fine motor activities.Rehabilitation can improve the function of hands.But the optimal time of rehabilitation intervention is still unclear.Therefore,this study was designed to investigate the effects of early rehabilitation management of paediatric burnt hands and to compare the efficacy between early and later rehabilitation intervention.AIM To investigate the effects of early rehabilitation management of paediatric burnt hands.METHODS A total of 52 children with burnt hands were allocated into the early intervention group(≤1 mo from onset)and a late intervention group(>1 mo from onset)between January 2016 and December 2017.The children received the same rehabilitation programme including skin care,scar massage,passive ROM exercises,active ROM exercises,compression therapy,orthotic devices wearing and game or music therapy.Rehabilitation assessments were performed before and after the rehabilitation treatment.RESULTS In the early intervention group,the ROM of the hands was significantly improved after rehabilitation(P=0.001).But in the late group the effect was not significant statistically(P=0.142).In the early group,38.5%of the patients showed significant improvement,while in the late group,69.2%of the patients showed no significant improvement.The time from onset to posttraumatic rehabilitation(P=0.0007)and length of hospital stay(P=0.003)were negatively correlated with the hand function improvement.The length of rehabilitation stay was positively correlated with the hand function improvement(P=0.005).CONCLUSION These findings suggest that early rehabilitation might show better results in terms of ROM.

Tibial tubercle osteotomy in revision total knee arthroplasty: A systematic review

BACKGROUND Tibial tubercle osteotomy(TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty(RTKA). However, several reports have described potential osteotomy-related complications such as nonunion, tibial tubercle migration and fragmentation, and metalware related pain.AIM To evaluate the literature and estimate the efficiency of TTO in RTKA in terms of osteotomy union, knee mobility and complications.METHODS MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were investigated for completed studies until February 2020. The principle outcome of the study was the incidence of union of the osteotomy. Secondary outcomes were the knee range of motion as well as the TTO-related and overall procedure complication rate.RESULTS Fifteen clinical studies with a total of 593 TTOs were included. The TTO union rate was 98.1%. Proximal migration and anterior knee pain were the most common TTO-related complications accounting for 6.9% and 6.4% of all cases,respectively. However, only 2.2% of cases suffering from anterior knee pain needed hardware removal. Knee flexion was improved from 82.9° preoperatively to 100.1° postoperatively and total knee range of motion was increased from 73.4° before surgery to 97° after surgery. Stiffness requiring manipulation under anesthesia was recorded in 4.6% of cases. No major complications were reported.CONCLUSION The current systematic review supports the use of TTO in RTKA, as it is associated with high union rate, significant improvement in knee motion and low osteotomy-related complication risk that rarely leads to secondary tibial tubercle procedures.

Functional and clinical outcome with modified lateral approach total hip arthroplasty in stiff hips with ankylosing spondylitis

BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.

Overhead shoulder press - In-front of the head or behind the head？

Background： Using a cross-sectional design comparison, two overhead press techniques （in-front of the head or behind the head） were compared. The purpose of this study was to determine the impact of behind the head or in-front of the head overhead pressing technique on shoulder range of movement （ROM） and spine posture. The overhead press is commonly prescribed exercise. The two techniques （in-front of the head or behind the head） may influence joint mechanics and therefore require an objective analysis. Methods： Passive shoulder ROM quantified using goniometric measures, dynamic ROM utilised three-dimensional （3D） biomechanical mea- sures （120 Hz） of 33 participants performing overhead pressing in a seated position. The timing and synchronisation of the upper limb shoulder and spine segments were quantified and influence of each technique was investigated. Results： The in-front technique commenced in lordotic position, whilst behind the head technique commenced in kyphotic position. Behind the head technique started with less thoracic extension than in-front condition. The thoracic spine remained extended and moved between 12~ and 15~ regardless of gender or technique. The techniques resulted in a significant difference between genders. Males were able to maintain a flat or normal lumbar lordosis, whereas females tended to kyphotic. Conclusion： Shoulder ROM was within passive ROM for all measures except external rotation for males with the behind the head technique. To avoid possible injury passive ROM should be increased prior to behind the head protocol. Females showed greater spine movements, suggesting trunk strengthening may assist overhead pressing techniques. For participants with normal trunk stability and ideal shoulder ROM, overhead pressing is a safe exercise （for the shoulder and spine） when performed either in-front of or behind the head.

Errors in visual estimation of flexion contractures during total knee arthroplasty

AIM: To quantify and reduce the errors in visual estimation of knee flexion contractures during total knee arthroplasty(TKA).METHODS: This study was divided into two parts: Quantification of error and reduction of error. To quantify error, 3 orthopedic surgeons visually estimated preoperative knee flexion contractures from lateral digital images of 23 patients prior to and after surgical draping. A repeated-measure analysis of variance was used to compare the estimated angles prior to and following the placement of the surgical drapes with the true knee angle measured with a long-arm goniometer. In an effort to reduce the error of visual estimation, a dual set of inclinometers was developed to improve intraoperative measurement of knee flexion contracture during TKA. A single surgeon performed 6 knee extension measurements with the device during 146 consecutive TKA cases. Three measurements were taken with the desired tibial liner trial thickness, and 3 were taken with a trial that was 2 mm thicker. An intraclass correlation coefficient(ICC) was calculated to assess the testretest reliability for the 3 measurements taken with the desired liner thickness, and a paired t test was used to determine if the knee extension measurements differed when a thicker tibial trial liner was placed.RESULTS: The surgeons significantly overestimated flexion contractures in 23 TKAs prior to draping and significantly underestimated the contractures after draping(actual knee angle = 6.1°± 6.4°, pre-drape estimate = 6.9°± 6.8°, post-drape estimate = 4.3°± 6.1°, P = 0.003). Following the development and application of the measurement devices, the measurements were highly reliable(ICC = 0.98), and the device indicated that 2.7°± 2.2° of knee extension was lost with the insertion of a 2 mm thicker tibial liner. The device failed to detect a difference in knee extension angle with the insertion of the 2 mm thicker liner in 9/146 cases(6.2%).CONCLUSION: We determined the amount of error associated with visual estimation of knee flexion contractures, and developed a simple, reliable device and method to improve feedback related to sagittal alignment during TKA.

Different squatting positions after total knee arthroplasty: A retrospective study

BACKGROUND Total knee arthroplasty(TKA)has been shown to improve quality of life and reduce pain.High-flexion activities such as squatting,kneeling,and floor transfers are mainly listed as demanding tasks.Among them,squatting is an important position.AIM To provide a new squat position classification and evaluate the different squatting positions of a series of patients after primary TKA.METHODS From May 2018 to October 2019,we retrospectively reviewed 154 video recordings of the squatting-related motions of patients after TKA.Among the included patients,119 were women and 35 were men.Their mean age at the index surgery was 61.4 years(range,30 to 77).RESULTS The median follow-up was 12 mo(range,6 to 156 mo).We classified those squatting-related motions into three major variations according to squatting depth:Half squat,parallel squat,and deep squat.The angles of hip flexion,knee flexion,and ankle dorsiflexion were measured in the screenshots captured from the videos at the moment of squatting nadir.A total of 26 patients were classified as half squats,75 as parallel squats,and 53 as deep squats.The angles of hip flexion,knee flexion,and ankle dorsiflexion all differed significantly among the three squatting positions(P<0.001).In the parallel squat group,the mean knee flexion angle(°)was 116.5(SD,8.1;range,97 to 137).In the deep squat group,the mean knee flexion angle(°)was 132.5(SD,9.3;range,116 to 158).CONCLUSION Among the three squatting positions,deep squat showed the highest hip,knee,and ankle flexion angles,followed by the parallel squat.With the improvement of squatting ability,the patient's postoperative satisfaction rate was also significantly enhanced.However,the different squatting abilities of the patients cannot be effectively distinguished from the scoring results(P>0.05).Our squatting position classification offers a pragmatic approach to evaluating patients’squatting ability after TKA.

Effect of osteoarthritic knee flexion deformity correction by total knee arthroplasty on sagittal spinopelvic alignment in Indian population

BACKGROUND Sagittal alignment of the spine,pelvis,and lower extremities is essential for maintaining a stable and efficient posture and ambulation.Imbalance in any element can result in compensatory changes in the other elements.Knee flexion is a compensatory mechanism for spinopelvic sagittal alignment and is markedly affected in severe knee osteoarthritis(OA).The correction of knee flexion deformity(KFD)by total knee arthroplasty(TKA)can lead to complementary changes in the sagittal spinopelvic parameters(SSPs).AIM To determine the SSP changes in patients with knee OA,with or without KFD undergoing TKA.METHODS The study was conducted in 32 patients who underwent TKA.A neutral standing whole-spine lateral radiograph was performed before surgery and 3 mo after surgery in these patients.Subjects were divided into two groups(Group 1 obtained>10°corrections in KFD;group B obtained<10°correction).The pelvic tilt(PT),pelvic incidence(PI),sacral slope(SS),lumbar lordosis(LL),and sagittal vertical axis(SVA)were measured.RESULTS The median of change in PT,PI,SS,LL,and SVA was 0.20 mm,1.00 mm,2.20 mm,−0.40 mm,and 6.8 mm,respectively.The difference in the change in SSPs between the two groups was statistically non-significant.CONCLUSION SSPs,such as PI,PT,SS,LL,and SVA,do not change significantly following TKA in end-stage knee OA despite a significant correction(>10°)in KFD.

Comparison of strength values and laterality in various muscle contractions between competitive swimmers and untrained persons

Competitive swimmers may gain a specific training effect as the result of long term exercise in the water. This study aimed to compare isometric, non-isokinetic and isokinetic muscle strengths in competitive swimmers and untrained persons. Twelve young male adults without exercise experience for over three years and twelve swimmers with over 10 years of competitive swimming experience performed various strength tests. Non-isokinetic tests were evaluated using one repetition of maximum half squat, vertical jump, and drop jump. Isometric and isokinetic (60 and 180 deg/s) muscle strengths were measured by both legs in knee extension and flexion. There were no significant differences between non-isokinetic and isometric muscle strengths of both groups. On the other hand, all isokinetic parameters in both angular velocities were significantly larger in competitive swimmers. There was significant laterality of isokinetic strength in untrained persons, but not in competitive swimmers. In addition, right and left differences of isokinetic strength tended to be smaller in competitive swimmers. In conclusion, competitive swimmers tended to be superior only in isokinetic strength, which is a similar muscle contraction in the water, and have less right and left differences.

Report of a Case of Genu Recurvatum Following Tibial Eminence Avulsion Treated by Proximal Tibial Flexion Osteotomy and Review of the Literature

We report a case of acquired genu recurvatum treated with a proximal tibial flexion osteotomy. A partial growth arrest at the anterior portion of the proximal tibial physis following a conservatively treated Meyers-McKeever type II injury of the tibial eminence. This is a reliable method in the correction of genu recurvatum. By using tricortical autogenous iliac crest graft, the osteotomy may be made very stable intra-operatively circumventing the need for fixation.

New Ideas of Treatment for Cerebral Palsy I Capital Flexion of the Neck： The Key Link in Prematurity Treatment

In a human, the head and spine work together in any kind of posture and movement. Any movement starts from the head through neck flexion and specifically capital flexion. Capital flexion initiates the straightening of the cervical spine which causes the connection of the head on the C1-C2 suboccipital part to the thoracic and lumbar parts. With this, the spine starts to move and postural tone increases. Without construction of the neck or alteration of the axis, as seen with cases of prematurity, postural tone becomes low. Typical features of children with prematurity include low postural tone, altered axis of the head and neck which generates incorrect or ineffective vestibular information and poor cortical movement caused by poor development of capital flexion. Therefore, the most important aspect to consider is the lack of capital flexion causing the absence of some initiation of movements of the spine which leads to further weakness of the neck and trunk.

Treatment of Post Burn Scar Extended Deformity of the Toes IV Degree and Using Bridge Cellular Cutaneous Flap

Post burn dorsal foot contractures of the toes of the IV degree cause functional limitations of all lower extremities, which creates a serious cosmetic defect, and therefore, needs surgical reconstruction. The series of 11 patients (7 men and 4 women) with extended contracture of the 4th degree of toes after burn were operated upon by using the new method with the flap including subcutaneous tissue (bridge-like stem), and the operations were performed at Samarkand Burn Center, Samarkand, Uzbekistan. We observed a good result with no complications. The flap was viable, and its sensibility was preserved. No marginal necrosis was noticed. As a result, the use of this method allowed achieving normal aesthetic outlines. The flap acquired the properties of the healthy skin without contracture. For the whole operated feet, it is important to wear pressure socks as soon as the wounds are fully healed and to continue this pressing therapy until the edema and recurrence of contracture are no longer being the problems. This usually means a period of 6 to 9 months.

A New Method of Limb Salvage and Functional Upper Limb Reconstruction

Amputation is frequently used to treat malignant tumors invading into the shoulder joint. When the vessels and major nerves of the upper arm are preserved, however, the limb may be salvaged with a combined osseous, myocutaneous flap. We reconstructed large defects, which included the shoulder joint, using a vascularized rib-latissmus dorsi combined flap. Ribs were connected via the ninth or tenth posterior intercostal artery. Several slits were cut in the ribs, and the rib was glass stick fractured to straighten it. The thoracodorsal nerve was preserved and the latissmus dorsi muscle was transferred to the defect previously occupied by the biceps humerus. The ribs were connected to the residual clavicle via a Leeds-Keio artificial ligament. The flaps completely engrafted. The patient was able to flex her elbow relatively early postoperatively. The function of the hand was preserved intact. In conclusion, the combined vascularized rib-latissmus dorsi flap is useful for patients who require functional or bony reconstruction of large defects involving the shoulder joint.

Comparative Study of Surgical Approaches for Distractive Flexion Injuries of Sub-Axial Cervical Spine

Distractive flexion injuries (DFI) of subaxial cervical spine are common after motor car accident or falling from height. The ideal surgical approaches to DFI are still unclear. A retrospective comparative study of surgical approaches for DFI of sub-axial cervical spine involved 60 patients throughout the years 2014 to 2016 at Al-Azhar University Hospitals. All patients were undergoing initial routine resuscitative measures, full general and neurological examinations. Neurologic function was assessed according to modified Frankel’s grading. All patients were received cervical plain antero-posterior, lateral and oblique X-ray, CT with 3D and MRI of cervical spine. Severity of DFI injury was assessed according to Allen and Ferguson’s classification. The most common level involved was C5-6 and most common grade was grade 3. The patients operated through anterior approach were 36 patients and through the posterior approach were 24 patients. Restoring cervical alignment was achieved in 29 patients (80.56%). The mean time of bone fusion was 5.454 months in anterior approach while it was 9.876 months in posterior approach. The extend of bone fusion was good in 30 patients (83.33%) after anterior approach and in 8 patients (33.33%) after posterior approach, while poor fusion was observed in 6 patients (16.67%) after anterior approach and 16 patients (66.67%) after posterior approach. We can conclude that anterior cervical approach is better in DFI stage 3 and 4 where there are associated ruptured intervertebral disc. Posterior approach is better in DFI stage 1 and 2 with or with presence of posterior compressing lesion.

INFLUENCE OF FLEXION POSITION OF THE KNEE ON LIMB ALIGNMENT

Objective To verify the influence of flexion position of the knee on limb alignment,the change of the standing femorotibial angle(FTA)with knee flexion was radiologically investigated. Methods Radiographs were taken on each left knee of 47 volunteers with seldom complaints in a one-leg standing position,The standing femorotibial angles(FTA)in full knee extension were compared with the corresponding ones in different angles of knee flexion,and the relationship between the FTA and the flexion angle was investigated. Results Standing FTAs in knee flexion were always smaller than the corresponding ones in full knee extension.With the increment of the flexion angle,the FTA decreased.Positive correlation was found between the difference(△FTA)of the standing FTA in full extension and in flexion and the flexion angle of the knee. Conclusion In the preoperative planning of knee surgeries such as high tibial osteotomy and arthroplasty,the influence of flexion contracture on limb alignment should be taken into consideration to avoid overcorrection or undercorrection.

Clinical study of correction of finger flexion deformity in Dupuytren's disease

Objective To explore surgical technique and its result in correcting finger contracture in Dupuytren’s disease. Methods Seventeen cases of Dupuytren’s disease with 58 years mean age were studied in this group ( 15 males and 2 females) . Among them,8 sides were with flexion eontracture of little finger,8 sides with flexion contracture of little and ring fingers,1 side with