Knee joint proprioception in normal volunteers and patients with anterior cruciate ligament tears,taking special account of the effect of a knee bandage

Proprioception of the knee joint was tested in 30 healthy volunteers with clinically inconspicuous knee joints. To examine proprioception, an angle reproduction test was performed. We could not document any differences between the left and the right knee joint or between men and women. At the mid-range, proprioception was worse compared with the end range of motion. In addition, 25 patients with an isolated rupture of the anterior cruciate ligament were evaluated, 14 before and 11 after operative anterior cruciate ligament (ACL) reconstruction. Preoperatively, there was a significant deterioration of proprioception compared with the control group. We were able to show a positive influence of a knee bandage on the proprioception of the injured knee. Patients after ACL reconstruction showed no significantly better proprioception compared with the preoperative group.     

Effect of the posterior cruciate ligament in knee-joint proprioception in total knee arthroplasty

The primary purpose of the study was to examine the role of the posterior cruciate ligament (PCL) in knee-joint proprioception after total knee arthroplasty (TKA). Knee-joint proprioception was measured in 10 patients with nonsacrificed PCL TKAs and 10 with sacrificed PCL TKAs. Knee-joint proprioception was evaluated through reproduction of static knee angles using a Penny and Giles™ electrogoniometer. The primary variable was absolute angular error (AAE). AAE was defined as the absolute value of the difference between the test angle and the patient's perceived version of the test angle. Proprioception deficit was compared to the WOMAC questionnaire which evaluates pain, stiffness, and physical function of the lower extremity. No significant difference was found between the nonsacrificed PCL TKA (4.33° ± 1.52°) and sacrificed PCL TKA (4.38° ± 1.39°) AAE values (P > .4). Furthermore, no significant differences were observed in the WOMAC questionnaire scores for all three parameters between the two types of knee prosthesis (P > .35). The current findings suggest that the preservation of the PCL in TKA may not improve knee-joint proprioception and subsequently may not improve TKA functional performance.     

Diagnosis and treatment of excessive lateral pressure syndrome of the patellofemoral joint caused by military training

Objective: To investigate the diagnosis and surgical treatment of excessive lateral pressure syndrome of the patellofemoral joint caused by military training. Methods: Fifteen patients (patient group) and 18 healthy volunteers (control group) were involved in this retrospective study. Radiographs of the knee joints of all patients and volunteers were taken. The bone architecture was assessed, the trochlear angle, coincidence angle and patellofemoral joint index measured in both groups, and the resulting data compared. All 15 patients (17 knees) were treated by lateral collateral retinaculum release. Pre‐ and post‐operative pain was evaluated with a visual analog scale (VAS). Results: The differences between the two groups in coincidence angle (patient group: 7.67°± 5.81°; control group: ?2.2°±?2.71°) and patellofemoral joint index (patient group: 2.49 ± 1.40; control group: 1.25 ± 0.15) were statistically significant. Subchondral bone sclerosis and osteophytosis in the patellofemoral joint were more pronounced in the patient group than in the control group. The VAS was higher preoperatively (7.06 ± 0.85) than postoperatively (6 months postoperatively: 3.87 ± 0.24; 1 year postoperatively: 3.01 ± 0.17), and the differences between preoperative and postoperative were statistically significant. Conclusions: Apart from the case history, typical symptoms and physical signs, X‐ray examination is the most basic way to diagnose excessive lateral pressure syndrome of the patellofemoral joint, and the patellofemoral joint index is the most reliable for diagnosis. Lateral collateral retinaculum release with a small‐incision is an effective treatment for this disease.     

Joint proprioception in normal, osteoarthritic and replaced knees

We measured joint position sense in the knee by a new method which tests the proprioceptive contribution of the joint capsule and ligaments. The leg was supported on a splint, and held in several positions of flexion. The subjects' perception of the position was recorded on a visual analogue model and compared with the actual angle of flexion. Eighty-one normal and 45 osteoarthritic knees were examined, as were 10 knees with semi-constrained and 11 with hinged joint replacements. All were assessed with and without an elastic bandage around the knee. There was a steady decline in joint position sense with age in subjects with normal knees. Those with osteoarthritic knees had impaired joint position sense at all ages (p less than 0.001). Knee replacement improved the joint position sense slightly (p less than 0.02); semi-constrained replacement had a greater effect than hinged replacement. The effect of an elastic bandage in subjects with poor position sense was dramatic, improving accuracy by 40% (p less than 0.001). It is proposed that reduced proprioception in elderly and osteoarthritic subjects may be responsible for initiation or advancement of degeneration of the knee.     

An investigation into the effect of number of trials during proprioceptive testing in patients with patellofemoral pain syndrome

The purpose of this study was to investigate the effect of increasing the number of test trials in the assessment of knee joint position sense, in a group of patellofemoral patients, and second, to investigate the effects of joint angle and type of test. Thirty‐two patients with a diagnosis of patellofemoral pain syndrome were admitted to this study. Knee joint position sense was measured by performing an ipsilateral matching activity at target angles of 20° and 60° using two techniques; Passive Angle Reproduction (PAR), and Active Angle Reproduction (AAR). The results show that five repetitions are required for AAR and six for PAR. A two‐way repeated‐measures ANOVA showed that there was no significant difference (p = 0.559) in the accuracy of angle reproduction for the two angles (60° and 20°); however, there was a significant difference (p = 0.001) between the two types of test (AAR and PAR). The results of this study have implications for clinicians and researchers who examine knee joint proprioception as part of functional assessment in a variety of knee joint pathologies including PFPS. A “quick” one‐off assessment of knee joint position sense may give erroneous data; subjects need to have several trials before a true picture of their proprioceptive status emerges. Type of testing performed, active or passive, is also important, although the angle of testing may not be relevant. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 24:1218–1224, 2006     

Four Weeks of Mobility After 8 Weeks of Immobility Fails to Restore Normal Motion

Prolonged immobilization reduces passive range of motion of joints creating joint contractures. Whether and to what extent these iatrogenic contractures can be reduced is unknown. We raised three questions using an animal model: What degree of contracture remains at the end of a defined remobilization period? Do contractures in sham-operated and immobilized joints differ? What is the contribution of the posterior knee capsule in limiting knee extension? We immobilized one knee of 11 adult male rats in flexion to induce a joint contracture; 10 control animals underwent a sham operation. After 8 weeks, the internal fixation device was removed, and the animals were allowed to resume unrestricted activity for 4 weeks at the end of which the knee range of motion was measured with standardized torques. The mean flexion contracture was higher in the immobilized group (51.9° ± 2.8°) than in the sham-operated group (18.9° ± 2.1°). Eighty-eight percent of the contractures remained in the immobilized group after dividing skin and muscle, suggesting an important contribution of the posterior knee capsule in limiting knee mobility. Based on our preliminary study the range of motion of rat knees immobilized for 8 weeks remained substantially reduced after a 4-week period of unassisted remobilization.     

Functional outcomes of total knee arthroplasty in patients with Parkinson's disease: A case control study

BackgroundParkinson's disease is a neurodegenerative condition causing coordination loss in musculoskeletal system. Many studies suggest that total knee arthroplasty in patients with Parkinson's disease has unfavorable treatment results and high complication rates. Our hypothesis was that total knee arthroplasty might be an effective procedure in patients with Parkinson's disease.MethodsParkinson's disease patients who underwent total knee arthroplasty between 2006 and 2018 were retrospectively evaluated. Patients who had Parkinson's disease diagnosis before surgery and who had a minimum follow-up duration of 12 months were included. Secondary knee osteoarthritis patients were excluded. A matched control group was randomly formed. Outcome measures were evaluated by preoperative and postoperative Knee Society Score and joint range of motion values. Comparison was made by means of increase in Knee Society Score and range of motion values. Study group patients were reviewed according to Columbia Classification System to determine disease severity. Stages I-II were accepted as “low-grade” and III-IV-V as “high-grade” disease. Another comparison was made between “low-grade” and “high-grade” patients. Patient who showed disease progression after surgery were also compared to patients without progression.ResultsThere were 13 patients in both groups. In study group, mean preoperative and postoperative Knee Society Score values were 45.4 (±16.8) and 85.6 (±7.60); range of motion values were 93.9° (±17.0°) and 99.5° (±9.37°) respectively with a mean follow-up of 64.5 (±44.7) months. In control group, mean preoperative and postoperative Knee Society Score values were 38.8 (±11.5) and 86.1 (±10.0); range of motion values were 100.4° (±14.6°) and 109.2° (±10.2°) respectively with a mean follow-up of 51.8 (±13.6) months. No significant difference was observed between 2 groups (p > 0.05). Mean preoperative KSS and ROM values were significantly lower in high-grade patients (30.0 (±17.0) and 78.8° (±11.8°) respectively) compared to low-grade patients (52.2 (±11.9) and 100.6° (±14.7°) respectively) (p < 0.05). However, mean increase in KSS and ROM values were significantly higher for high-grade patients (p < 0.05). Mean increase in Knee Society Score and range of motion was 32.4 (±10.9) and 1.00° (±9.46°) respectively in patients with progression, 45.4 (±16.8) and 8.63° (±8.00°) in patients without progression (p > 0.05).ConclusionTotal knee arthroplasty is a successful treatment of knee osteoarthritis in Parkionson's disease patients with similar outcomes compared to general population despite disease severity and progression.     

胫骨高位嵌插截骨与传统高位截骨治疗高龄屈曲型膝内侧间隙骨关节炎的对比研究

目的:报告胫骨高位嵌插截骨治疗高龄屈曲型膝内侧间隙骨关节炎的方法疗效,并与传统高位胫骨截骨的疗效进行比较。方法:2003年7月至2007年7月对年龄60～82岁,病史3～20年,屈曲度7°～19°的膝内侧间隙骨关节炎的30例患者随机分成2组,分别进行胫骨高位嵌插截骨和传统高位截骨手术治疗。术后观察骨折愈合时间、膝关节内翻畸形和屈曲畸形恢复、膝关节功能恢复等情况。要求患者术后第4、6、8、9、10、12、14、16周及5、7、9、12个月复查,记录骨折愈合时间及内翻、屈曲角度纠正情况。术后12个月时根据Lysholm膝关节评分标准进行评分,并对2组的疗效进行比较。结果:胫骨高位嵌插截骨组平均骨折愈合时间(9.26±2.23)周,传统高位截骨组平均(11.53±3.15)周,2组相比差异有统计学意义(P0.05)。膝关节功能恢复方面,术后1年,根据Lysholm评分标准进行评分,胫骨高位嵌插截骨平均(88.5±4.4)分,优14例,良1例;传统高位截骨组平均(78.1±5.7)分,优8例,良5例,可2例。胫骨高位嵌插截骨组术后膝关节伸直位角度0°～-1.1°,术后平均矫正(13±3.3)°;传统高位截骨组术后膝关节伸直位角度与术前相同,为(14°±3.3)°。两组术后站立位X线测量,FTA平均170.2°(l69.1°～172.3°),平均矫正12.3°～12.5°。结论:胫骨高位嵌插截骨手术治疗膝关节内侧间隙骨关节炎缩短了骨折愈合时间,同时矫正了膝关节内翻畸形和屈曲畸形,更好地恢复了膝关节的功能,此手术方式明显优于传统的高位截骨术。     

10%盐水冰袋联合弹力绷带持续加压冷敷用于全膝关节置换术后关节肿痛

目的 探讨安全经济有效的减轻全膝关节置换术后关节肿胀及疼痛的方法.方法 将60例膝关节骨性关节炎实施全膝关节置换术患者按住院号单双数分为观察组和对照组各30例.术后对照组采用绷带包扎,10％盐水冰袋冷敷;观察组用弹力绷带包裹患肢后用10％盐水冰袋冷敷,再用弹力绷带加压包扎,均持续3d.结果 观察组下肢肿胀、疼痛程度显著轻于对照组,肿胀及疼痛消退时间显著短于对照组(均P＜0.01).结论 10％盐水冰袋联合弹力绷带持续加压冷敷可有效减轻全膝关节置换术后膝关节肿胀和疼痛,加快肿胀、疼痛消退.     

Patellofemoral contact pressures exceed the compressive yield strength of UHMWPE in total knee arthroplasties

To address mechanisms involved in wear and permanent deformation of patellofemoral components in total knee arthroplasties, a previously reported knee joint loading model and pressure-sensitive film were used to measure patellofemoral contact areas and pressures in human cadaver knee joints after implantation with six different total knee joint designs. The joints were tested at three different Q angles (physiologic, −10°, and +10°) and four different flexion angles (30°, 60°, 90°, and 120°). Patellofemoral contact areas at normal Q angles ranged from 0.13 to 0.68 cm² and increased with flexion angle up to 90°. These contact areas differed significantly with flexion angle but not with Q angle. Variations in contact area with type of knee system were only marginally significant (P < .04), and post hoc tests showed no significant differences between individual knee designs. Contact pressures at normal Q angle also increased with flexion angle and ranged from 10 MPa to more than 49 MPa. Contact pressures at flexion angles greater than 60° were, for all systems, well in excess of the compressive yield strength of ultrahigh-molecular-weight polyethylene and at least three to four times greater than the recommended maximum compressive stress level of 10 MPa.     

In‐vivo patellar tracking in individuals with patellofemoral pain and healthy individuals

Understanding of the exact cause of patellofemoral pain has been limited by methodological challenges to evaluate in‐vivo joint motion. This study compared six degree‐of‐freedom patellar motion during a dynamic lunge task between individuals with patellofemoral pain and healthy individuals. Knee joints of eight females with patellofemoral pain and ten healthy females were imaged using a CT scanner in supine lying position, then by a dual‐orthogonal fluoroscope while they performed a lunge. To quantify patellar motion, the three‐dimensional models of the knee bones, reconstructed from CT scans, were registered on the fluoroscopy images using the Fluomotion registration software. At full knee extension, the patella was in a significantly laterally tilted (PFP: 11.77° ± 7.58° vs. healthy: 0.86° ± 4.90°; p = 0.002) and superiorly shifted (PFP: 17.49 ± 8.44 mm vs. healthy: 9.47 ± 6.16 mm, p = 0. 033) position in the patellofemoral pain group compared with the healthy group. There were also significant differences between the groups for patellar tilt at 45°, 60°, and 75° of knee flexion, and for superior‐inferior shift of the patella at 30° flexion (p ≤ 0.031). In the non‐weight‐bearing knee extended position, the patella was in a significantly laterally tilted position in the patellofemoral pain group (7.44° ± 6.53°) compared with the healthy group (0.71° ± 4.99°). These findings suggest the critical role of passive and active patellar stabilizers as potential causative factors for patellar malalignment/maltracking. Future studies should investigate the associations between patellar kinematics with joint morphology, muscle activity, and tendon function in a same sample for a thorough understanding of the causes of patellofemoral pain. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2193–2201, 2018.

     

Proprioception in people with anterior cruciate ligament-deficient knees: comparison of symptomatic and asymptomatic patients

STUDY DESIGN: Nonrandomized prospective study. OBJECTIVE: To evaluate proprioception in 2 groups of patients with anterior cruciate ligament (ACL) deficiency who had different severity of symptoms. BACKGROUND: Defective proprioception has previously been found in patients with ACL-deficient knees. It has been suggested that sensory receptors of the ACL and other knee joint ligaments contribute to proprioception and knee joint function and stability. METHODS AND MEASURES: A total of 17 patients with ACL deficiency (mean [SD] age, 28.8 +/- 5.6 years; range, 22-39 years) with few, if any, symptoms were compared with 20 patients with ACL deficiency (mean [SD] age, 26.6 +/- 6.1 years; range, 18-39 years) having instability and episodes of giving way. The groups were compared with each other and with an age-matched reference group of 19 nonimpaired subjects. Their mean (SD) age was 25.6 +/- 3.7 years (range, 20-37 years). Three tests of proprioception were used: threshold to detection of passive motion from 2 starting positions (20 degrees and 40 degrees of knee flexion) toward flexion and extension, active reproduction of a 30 degrees passive angle change, and visual reproduction of a 30 degrees passive angle change. The Wilcoxon rank sum test was used for between-group comparisons. RESULTS: Symptomatic patients had higher threshold to detection of passive motion in their injured side in the flexion trial from 20 degrees (median of 1.5 degrees vs median of 0.5 degree) and in the extension trial from 40 degrees (median of 1.0 degree vs median of 0.5 degree) than the asymptomatic patients. No differences were found in the other threshold tests, active or visual reproduction tests. CONCLUSIONS: Patients with severe symptoms related to ACL deficiency were found to have inferior proprioceptive ability in some measurements compared with patients with a good knee function. The findings indicate that proprioceptive deficits might influence the outcome of an ACL injury treated nonoperatively.     

半月板成形对前交叉韧带重建术后膝关节功能恢复影响的病例对照研究

目的:观察半月板成形对前交叉韧带重建术后膝关节功能和稳定性的影响。方法:收集2013年1月至2015年1月接受符合纳入标准的前交叉韧带重建患者64例,分为对照组和成形组。对照组30例,为半月板完整的前交叉韧带重建患者,男24例,女6例;年龄22~43岁;左侧17例,右侧13例;随访时间12~19个月。成形组34例,为接受半月板成形的前交叉韧带重建患者,男27例,女7例;年龄23~42岁;左侧22例,右侧12例;随访时间12~20个月。观测术前患侧胫骨前移度、膝关节功能评分及末次随访时健侧和患侧胫骨前移度、主动本体感觉和膝关节功能评分。胫骨前移度采用KT-1000测量,膝关节功能采用Lysholm评分量表和KOOS量表评估,主动本体感觉测量膝关节重复30°、45°、60°的3个角度的误差。结果:对照组术后患侧胫骨前移度(1.4±0.2)mm,低于成形组的(2.2±0.4)mm(P0.05)。对照组和成形组术后膝关节Lysholm总分分别为93.7±2.7和92.3±3.0,均较术前的52.8±3.9和51.6±5.1提高(P0.05),但术后对照组Lysholm总分与成形组比较差异无统计学意义(P0.05)。在KOOS量表的评分中,对照组术后症状、疼痛、日常生活、运动能力及生活质量分别为90.7±5.5、93.2±4.3、96.8±2.2、90.9±5.3和91.8±4.5,高于术前的72.7±6.0、70.6±7.3、72.5±7.4、52.8±5.4和36.2±6.5(P0.05);成形组术后症状、疼痛、日常生活、运动能力及生活质量分别为88.9±5.8、92.6±3.5、96.5±2.1、89.3±7.2和90.6±4.1,高于治疗前的71.9±5.1、71.2±7.1、71.3±6.2、53.1±6.1和35.6±4.7(P0.05),对照组术后KOOS量表各项评分与成形组比较差异无统计学意义(P0.05)。术后对照组健侧主动本体感觉误差为(12.2±3.4)°,与成形组健侧的(12.8±3.2)°相比差异无统计学意义(P0.05);对照组患侧主动本体感觉误差为(13.5±3.7)°,小于成形组患侧的(17.1±4.2)°(P0.05);对照组患侧主动本体感觉误差与健侧比较差异无统计学意义(P0.05),而成形组患侧主动本体感觉误差明显大于健侧(P0.05)。结论:半月板成形对前交叉韧带重建术后患者中短期内膝关节功能无显著影响,但膝关节本体感觉及稳定性减弱。     

电针疗法对膝关节骨折患者术后康复训练的临床研究

目的：探究电针疗法对膝关节骨折患者术后康复训练的影响。方法：选取2020年7月至2021年7月膝关节骨折患者,按照双盲原则采用随机数字表法分为试验组和对照组。两组均给予手术治疗,术后均进行常规康复训练。对照组40例,男27例,女13例;年龄20～66(36.46±6.29)岁;术后采取持续被动运动(continuous passive motion,CPM)训练。试验组40例,男24例,女16例;年龄21～68(37.62±7.08)岁;在对照组基础上给予电针疗法。干预4周后,比较两组膝关节功能评分优良率,干预前后疼痛视觉模拟评分(visual analogue scale,VAS),采用酶联免疫吸附法检测血清疼痛介质：前列腺素E(prostaglandin E,PGE)、P物质(substance P,SP)、缓激肽(bradykinin,BK),关节活动范围及生活质量。结果：干预4周后,试验组膝关节功能Rasmussen评分(24.15±1.36)分,高于对照组(21.25±2.20)分(P<0.001);试验组干预4周后VAS (2.04±0.51)分,低于对照组(2.78...     

Posture Influence on the Pendulum Test of Spasticity in Patients with Spinal Cord Injury

The study aims to investigate the influence of different postures on spasticity results by pendulum test in patients with spinal cord injury (SCI). The setting was at the University of Campinas (UNICAMP), Campinas, SP, Brazil. Five individuals with SCI and five individuals in the control group were included. All individuals went through the pendulum test in three different positions: supine, semi‐supine at an angle of 30°, and sitting up at an angle of 60°. An electrogoniometer was attached to the right leg for measurement of knee joint angles. All situations were performed five times. Blood pressure was monitored during tests. Relaxation index (RI), normalized relaxation index (RIn), test duration in seconds, initial flexion angle, and resting angle were analyzed at three different positions. Results were compared between different positions, and statistically no differences were found. In individuals with SCI, RI (1.83 ± 0.2), RIn (1.14 ± 0.13), and test duration values (13.95 ± 4.14), in sitting up position, were similar to the control group results. In sitting up position, patients showed spasticity reduction. However, the other two postures produce pain and increase blood pressure in patients with tetraplegia. Therefore, these postures should be avoided in patients with lesions above T6, due to possible autonomic dysreflexia symptoms.     

Comparison of minimally invasive arthrolysis vs. conventional arthrolysis for post-traumatic knee stiffness

Background

Minimally invasive surgery in knee arthroplasty can reduce postoperative pain and the rehabilitation period. The goal of this study was to explore the therapeutic effect of minimally invasive arthrolysis in post-traumatic knee stiffness.

Effect of Total Knee Arthroplasty on Coronal Alignment of the Ankle Joint

BackgroundThe effect of total knee arthroplasty (TKA) on the ankle joint is not entirely clear. The purpose of this study is to assess postoperative changes in the coronal alignment of the ankle joint in patients undergoing TKA for various degrees of knee deformity.MethodsThis retrospective study included 107 patients who had undergone TKA for primary osteoarthritis. In all cases, preoperative coronal alignment deformity of the knee was corrected in an attempt to restore the native mechanical axis of the knee. Patients were stratified into 3 groups according to the degree of knee coronal alignment correction achieved intraoperatively: group 1 (<10° varus/valgus correction, n = 60), group 2 (≥10° varus correction, n = 30), and group 3 (≥10° valgus correction, n = 17). Knee/ankle alignment angles were measured on full-length, standing anteroposterior imaging preoperatively and postoperatively and included the following: hip-knee-ankle angle, tibial plafond inclination (TPI), talar inclination (TI), and tibiotalar tilt angle.ResultsSignificant changes in ankle alignment, specifically with regard to TPI (9.5° ± 6.9°, P < .01) and TI (8.8° ± 8.8°, P = .03) were noted in the ≥10° valgus correction group compared to the other 2 groups. Regardless of the degree of knee deformity correction, TKA did not lead to significant changes in the tibiotalar tilt angle.ConclusionA correction of ≥10° in a genu valgum deformity can affect ankle joint alignment, leading to alterations in TPI and TI. These findings need to be taken into consideration in assessing candidates for TKA as a possible cause of postoperative ankle pain.     

Evaluation of Joint Position Sense Measured by Inversion Angle Replication Error in Patients with an Osteochondral Lesion of the Talus

The etiology of the osteochondral lesion of the talar dome (OLT) remains unclear. A joint position sense deficit of the ankle is reported to be a possible cause of ankle disorder. Repeated contact of the articular surface of the talar dome with the plafond during inversion might be a cause of OLT. The aim of the present study was to evaluate the joint position sense deficit by measuring the replication error of the inversion angle in patients with OLT. The replication error, which is the difference between the index angle and replication angle in inversion, was measured in 15 patients with OLT. The replication error in 15 healthy volunteers was evaluated as a control group. The side to side differences of the replication errors between the patients with OLT and healthy volunteers and the replication errors in each angle between the involved and uninvolved ankle in the patients with OLT were investigated. Finally, the side to side differences of the replication errors between the patients with OLT with a traumatic and nontraumatic history were compared. The side to side difference in the patients with OLT (1.3° ± 0.2°) was significantly greater than that in the healthy subjects (0.4° ± 0.7°) (p ≤ .05). Significant differences were found between the involved and uninvolved sides at 10°, 15°, 20°, and 25° in the patients with OLT. No significant difference (p > .05) was found between the patients with traumatic and nontraumatic OLT. The present study found that the patients with OLT have a joint position sense deficit during inversion movement, regardless of a traumatic history. Although various factors for the etiology of OLT have been reported, the joint position sense deficit in inversion might be a cause of OLT.     

Proprioception after an acute knee ligament injury: A longitudinal study on 16 consecutive patients

A defect in proprioception has been found in selected patient groups that have an anterior cruciate ligament deficient knee at different times after the original injury. The time of development and the extent of such defects were studied ongitudinally on 16 consecutive patients. During the first year after a primary knee injury, which included a complete rupture of the anterior cruciate ligament, we repeatedly performed three tests of proprioception: (a) one to determine the threshold for detecting a passive motion from starting positions of 20 and 40°, (b) an active reproduction of a passive angular change, and (c) a visual estimation of a passive angular change. The injured limb was compared with the uninjured limb and with the limbs of an age-matched reference group of healthy subjects. The population did not have a normal distribution, and some patients had consistently extreme recordings in the threshold tests at the various times of testing. Significant differences were found between the groups at the starting position of 20°, when the injured knee was compared with the uninjured knee, after 1 month (p = 0.05), and after 2 months (p = 0.03). There was a trend toward a higher threshold for detecting a passive motion when the injured side was compared with the knees of the reference group at 1 month (p = 0.06) but not later on. A similar pattern was found for the injured knee at the starting position of 40°, but it was not significant. An impaired ability to detect a passive motion was registered for the nearly extended knee 1 and 2 months after a primary injury. In the active reproduction and visual estimation tests, no significant defects were found at any time during the first year in these consecutively studied patients.     

First Metatarsophalangeal Joint Arthrodesis: Does the Addition of a Lag Screw to a Dorsal Locking Plate Influence Union Rate and/or Final Alignment after Fusion

First metatarsophalangeal (MTP-1) joint fusion is a reliable method for the correction of various deformities, including hallux valgus and hallux rigidus. Ideal constructs provide high rates of fusion in the desired alignment. The present study examined the union rates and the change in dorsiflexion angle during the follow-up period in patients who had undergone MTP-1 fusion with a dorsal locking plate and a lag screw compared with patients who had undergone fusion with a dorsal locking plate alone. We performed a retrospective review of 99 feet undergoing MTP-1 fusion. The joints were fused using either a dorsal locking plate alone or a lag screw plus a dorsal locking plate. Union was determined radiographically during the follow-up period. Suspected nonunions were confirmed by computed tomography. The dorsiflexion angles were radiographically measured at the first postoperative visit and at the final follow-up visit. Of the 99 feet, 36 (36.4%) were in the lag screw plus dorsal plate group and 63 (63.6%) in the dorsal plate group. The mean follow-up period was 12.9 (range 12 to 33.5) months. The dorsal plate plus lag screw group had a significantly lower change in the mean dorsiflexion angle (0.57°?±?5.01°) during the postoperative period compared with the dorsal plate group (6.73°?±?7.07°). The addition of a lag screw to a dorsal locking plate for MTP-1 arthrodesis might offer improved stability of the joint in the sagittal plane over time compared with a dorsal plate alone.