Shear wave elastography properties of vastus lateralis and vastus medialis obliquus muscles in normal subjects and female patients with patellofemoral pain syndrome

Objective

The aim of our study was to define and compare the mechanical properties of the vastus lateralis (VL) and vastus medialis obliquus muscles (VMO) by the way of quantitative shear-wave elastography in male and female healthy control (HC) subjects, and in female patients with patellofemoral pain syndrome (PFPS).

Materials and methods

Twenty-two healthy volunteers (11 male and 11 female) and 11 female patients with anterior knee pain were included in the study. The SWE examinations for VL and VMO were performed while the subjects were performing open kinetic chain exercises in neutral and 30° hip abduction. The contraction capacity (CC) and contraction ratio (CR) values were determined in resting and contraction phases in both hip positions.

Results

The mean elasticity values in the CC for VL and VMO muscles were significantly higher in male HC subjects when compared to female HC subjects (p?<?0.05). The CR of the VL muscle in female patients with PFPS was not significantly different than the female HC group. The CR for the VMO muscle was significantly lower in female patients with PFPS when compared to female HC subjects (p?<?0.05).

Conclusions

We found a significant VMO weakness, and this method may provide quantitative data that might influence the diagnosis of muscle weakness, in female patients with PFPS.     

The effects of weight-bearing conditions on patellofemoral indices in individuals without and with patellofemoral pain syndrome

Objective

The purpose of this study is to evaluate differences between the patellofemoral joint indices after supine, non-weight-bearing and standing position, and weight-bearing Merchant view radiographs in individuals without and with patellofemoral pain syndrome (PFPS).

Materials and methods

Radiographs of 44 knees without PFPS and 51 knees with PFPS were retrospectively evaluated. In both positions, the non-weight-bearing and weight-bearing Merchant views, patellar indices such as patellar tilt angle, lateral patellofemoral angle, lateral subluxation distance, lateral patellar displacement, and congruence angle were measured, respectively. The differences between the patellofemoral joint indices in knees with and without PFPS were analyzed using univariate and multivariate regression analysis, in regards to correlation factors.

Results

The patellar tilt angle (p?=?0.0002), lateral subluxation distance (p?=?0.038), lateral patellar displacement (p?=?0.0004), and congruence angle (p?<?0.0001) on the weight-bearing Merchant view was significantly decreased in normal knees without PFPS. In pathologic knees with PFPS, the patellar tilt angle (p?<?0.0001), lateral subluxation distance (p?<?0.0001), lateral patella displacement (p?<?0.0001), and congruence angle (p?<?0.0001) on weight-bearing Merchant view was also significantly decreased. The difference between the patellofemoral indices was significantly more in knees specifically with PFPS (p?<?0.05).

Conclusions

These results suggest that patellofemoral indices measured during non-weight-bearing supine position do not sufficiently represent the patellofemoral kinematics during normal weight-bearing activities. We conclude that this study establishes the clinical significance and relevance of assessing the patellofemoral kinematics by weight-bearing, standing Merchant view radiographs, when evaluating patients with patellofemoral problems.     

Is there a relationship between tracking ability, joint position sense, and functional level in patellofemoral pain syndrome?

Purpose

This prospective cohort study investigated proprioception and motor control changes in patients with patellofemoral pain syndrome (PFPS), and how these changes related to knee function, pain, muscle strength and muscle endurance.

Methods

The study included 43 women diagnosed with unilateral patellofemoral pain syndrome. Thirty-one healthy women were recruited as control group. Peak quadriceps femoris and hamstring muscle isokinetic torques were recorded at 60 and 180°/s. Joint position sense was tested by active reproduction of joint position during horizontal squat performance. Muscle coordination and motor control ability were tested by a multi-joint lower limb tracking-trajectory test. Muscle endurance was tested using a computerized functional squat system. Severity of pain in during stair ascent/descent, squatting, and prolonged sitting with knees 90° flexed were measured using a 10 category modified visual analogue scale. Functional levels of patients were determined using Kujala patellofemoral scores.

Results

Active reproduction of joint position did not differ between PFPS and control groups. However, tracking-trajectory error was significantly higher in PFPS group than control subjects. Hamstring and quadriceps peak isokinetic torque and muscle endurance scores were significantly lower in the PFPS group. Kujala patellofemoral score displayed significant relationships with peak isokinetic quadriceps torque, knee pain, and joint position sense scores. Pain during stair descent, sitting, and quadriceps torque at 180°/s explained 57.7 % of the variation in Kujala patellofemoral score.

Conclusion

Although lower extremity joint position sense did not differ between groups, the PFPS group displayed a target-trajectory muscular coordination deficit, decreased muscular endurance, and decreased muscular strength compared to control group subjects. Pain level directly related to motor control performance while joint position sense scores did not. Knee pain and impaired strength related more to functional performance impairment than joint position sense scores in patients with PFPS.

Level of evidence

Prospective case–control study, Level III.     

Eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy: a randomized,single blinded,clinical trial

Purpose

To investigate the effectiveness of isolated eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy.

Methods

Thirty-six patients with rotator cuff tendinopathy, diagnosed by an orthopaedic surgeon, were included and randomly allocated to an isolated eccentric exercise (EE) group (n = 20, mean age = 50.2 ± 10.8 years) or a conventional exercise (CG) group (n = 16, mean age = 48.6 ± 12.3 years). Both groups fulfilled a 12-week daily home-based exercise programme and received a total amount of nine treatment sessions. The Constant Murley score was used to evaluate both objective (e.g. range of motion and strength) and subjective measures (e.g. pain and activities of daily living). A visual analogue scale (VAS) was used to evaluate pain during daily activities. As secondary outcomes, shoulder range of motion and isometric abduction strength in 45° in the scapular plane were evaluated. All measurements were taken at baseline, at 6, 12 and 26 weeks.

Results

After 26 weeks, both groups showed a significant increase in the Constant Murley score and a significant decrease in VAS scores. No difference was found between the groups, for any of the evaluated outcome measures.

Conclusion

A 12-week-isolated eccentric training programme of the rotator cuff is beneficial for shoulder function and pain after 26 weeks in patients with rotator cuff tendinopathy. However, it is no more beneficial than a conventional exercise programme for the rotator cuff and scapular muscles. Based on the results, clinicians should take into account that performing two eccentric exercises twice a day is as effective as performing six concentric/eccentric exercises once a day in patients with rotator cuff tendinopathy.

     

Uninvolved versus target muscle contraction during contract–relax proprioceptive neuromuscular facilitation stretching

Objective

The purpose of this study was to compare the acute effect of the contract–relax (CR) stretching technique on knee active range of motion (ROM) using target muscle contraction or an uninvolved muscle contraction.

Design

pre-test post-test control experimental design.

Setting

Clinical research laboratory.

Participants

Sixty healthy men were randomly assigned to one of three groups.

Interventions

The Contract–Relax group (CR) performed a traditional hamstring CR stretch, the Modified Contract–Relax group (MCR) performed hamstring CR stretching using contraction of an uninvolved muscle distant from the target muscle, and the Control group (CG) did not stretch.

Main Outcome Measures

Active knee extension test was performed before and after the stretching procedure.

Results

Two-way between-within analysis of variance (ANOVA) results showed a significant interaction between group and pre-test to post-test (p < 0.001). Post-hoc examination of individual groups showed no significant change in ROM for the CG (0.8°, p = 0.084), and a significant moderate increase in ROM for both the CR (7.0°, p < 0.001) and MCR (7.0°, p < 0.001) groups.

Conclusions

ROM gain following a CR PNF procedure is the same whether the target stretching muscle is contracted, or an uninvolved muscle is contracted.     

Correlation of WOMAC and KOOS scores to tibiofemoral cartilage loss on plain radiography and 3 Tesla MRI: data from the osteoarthritis initiative

Purpose

The purpose of this study was to determine the correlation between the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) and Knee Injury Osteoarthritis Outcomes scores (KOOS) and the degree of tibiofemoral cartilage loss on plain radiography and 3T magnetic resonance imaging (MRI). We hypothesize that these subjective outcome scores will have a significant correlation to quantitative joint space loss.

Methods

Data used in the preparation of this article were obtained from the osteoarthritis initiative (OAI) database (OAI public use data sets kMRI_QCart_Eckstein18 and kXR_QJSW_Duryea16). Four hundred and forty-five patients had WOMAC/KOOS scores, quantitative tibiofemoral joints space width on plain radiographs and quantitative tibiofemoral cartilage thickness and per cent full thickness cartilage loss on 3T MRI. Joint space width on plain radiographs was correlated to cartilage thickness on MRI, and WOMAC/KOOS scores were correlated to the degree of cartilage loss using Pearson correlation coefficients.

Results

There was a statistically significant correlation between medial and lateral compartment cartilage thickness on MRI and medial and lateral joint space width on plain radiography (r = 0.86, r = 0.80) (p < 0.001). KOOS knee pain score was significantly correlated to increasing per cent full thickness cartilage loss in the medial femoral compartment (r = 0.34) (p < 0.001). KOOS symptom score was significantly correlated to decreasing joint space width in the medial (r = 0.16) and lateral (r = 0.15) compartment and increasing per cent full thickness cartilage loss in the medial femoral compartment (r = 0.36) (p < 0.001). No WOMAC score was correlated to degree of joint space width, cartilage thickness or per cent full thickness cartilage loss (n.s).

Conclusion

The WOMAC and KOOS scores are poor indicators of tibiofemoral cartilage loss, with only the KOOS symptom and knee pain score being weakly correlated. Osteoarthritis is a multifactorial process and the need to treat patients based off their symptoms and rely on radiographs as confirmatory modalities, and not diagnostic modalities, when talking about OA and medical intervention.

Level of evidence

Level 2.     

Kinematic and electromyographic analysis in patients with patellofemoral pain syndrome during single leg triple hop test

Possible delays in pre-activation or deficiencies in the activity of the dynamic muscle stabilizers of the knee and hip joints are the most common causes of the patellofemoral pain syndrome (PFPS). The aim of the study was to compare kinematic variables and electromyographic activity of the vastus lateralis, biceps femoris, gluteus maximus and gluteus medius muscles between patients with PFPS and health subjects during the single leg triple hop test (SLTHT). This study included 14 female with PFPS (PFPS group) and 14 female healthy with no history of knee pain (Healthy group). Kinematic and EMG data ware collected through participants performed a single session of the SLTHT. The PFPS group exhibited a significant increase (p < 0.05) in the EMG activity of the biceps femoris and vastus lateralis muscles, when compared with the healthy group in pre-activity and during the stance phase. This same result was also found for the vastus lateralis muscle (p < 0.05) when analyzing the EMG activity during the eccentric phase of the stance phase. In kinematic analysis, no significant differences were found between the groups. These results indicate that biceps femoris and vastus lateralis muscles mainly during the pre-activation phase and stance phases of the SLTHT are more active in PFPS group among healthy group.     

Lower limb strength and flexibility in athletes with and without patellar tendinopathy

ObjectivesTo compare the hip, knee and ankle torques, as well as knee and ankle flexibility between athletes with patellar tendinopathy and asymptomatic controls.DesignCross-sectional study.SettingLaboratory setting.ParticipantsFourteen male volleyball, basketball or handball athletes, divided into 2 groups, patellar tendinopathy group (TG; n = 7) and asymptomatic control group (CG; n = 7).Main outcome measuresHip, knee and ankle isometric torques were measured with a handheld dynamometer. Weight-bearing ankle dorsiflexion, hamstring and quadriceps flexibility were measured with a gravity inclinometer.ResultsThe TG had 27% lower hip extensor torque when compared to the CG (P = 0.031), with no group differences in knee and ankle torques (P > 0.05). Also, the TG had smaller weight-bearing ankle dorsiflexion (P = 0.038) and hamstring flexibility (P = 0.006) when compared to the CG. Regarding quadriceps flexibility, no group differences were found (P = 0.828).ConclusionsStrength and flexibility deficits might contribute to a greater overload on the knee extensor mechanism, possibly contributing to the origin/perpetuation of patellar tendinopathy. Interventions aiming at increasing hip extensors strength as well as ankle and knee flexibility might be important for the rehabilitation of athletes with patellar tendinopathy.     

No difference in prevalence of spine and hip pain in young Elite skiers

Purpose

To investigate the prevalence between back and hip pain in young Elite skiers.

Methods

Sample group (n = 102), consisted of young Elite skiers (n = 75) and age-matched non-athletes (n = 27), all completed a three-part back and hip pain questionnaire, Oswestry Disability Index and EuroQoL to evaluate general health, activity level, back and hip pain prevalence.

Results

No significant differences were shown for lifetime prevalence of back pain in the skiers (50%) compared with controls (44%) (n.s.). Duration of back pain for the skiers showed (30%) > 1 year, whilst (46%) > 5 years. A significant difference was shown with increased Visual Analogue Scale back pain levels for skiers 5.3 (SD 3.1) compared with controls 2.4 (SD 1.9, p = 0.025). No significant differences were shown for lifetime prevalence of hip pain in skiers (21%) compared with controls (8%) (n.s.).

Conclusion

Young Elite skiers are shown not to have increased lifetime prevalence for back and hip pain compared with a non-athletic control group.

Level of evidence

II.

     

Youth baseball players with elbow and shoulder pain have both low back and knee pain: a cross-sectional study

Purpose

Serious arm injuries in youth baseball players have been increasing. Though a breakage in the kinetic chain could affect arm injuries, an association between arm injuries and insufficient support of the trunk and lower extremities is not well understood. The purpose of this study was to investigate the association of low back and knee pain with elbow and/or shoulder complaints among youth baseball players.

Methods

A self-administered questionnaire and document informed consent were mailed to youth athletes belonging to the Miyagi Amateur Sports Association. Multiple logistic regression analysis was used to examine the association of low back and knee pain with elbow and/or shoulder pain at the time of the questionnaire. Variables considered in the models were as follows: sex, age, BMI, years of athletic experience, position, team level, the amount of practice, participating day in team practice and game per week, frequency of participation in games, and practice intensity.

Results

The final study population was comprised 1582 youth baseball players (aged 6–15 years old, male 95.6 %) who had responded to the questionnaire. A total of 24.8 % (n = 381) had elbow and/or shoulder pain, whereas 8.5 % (n = 130) had low back pain and 13.1 % (n = 201) had knee pain. The prevalence of elbow and/or shoulder pain with concomitant low back and knee pain was 61.2 % (n = 82) and 51.9 % (n = 108) (p < 0.001), respectively. The presence of low back and knee pain was significantly associated with the prevalence of elbow and/or shoulder pain among youth baseball players [adjusted odds ratio (ORs): 4.31, 95 % confidence interval (95 % CI): 2.86–6.51, p < 0.001, and ORs: 2.92, 95 % CI: 2.09–4.09, p < 0.001, respectively]. For other variables, older age (10- and 11-year old: ORs: 1.73, 95 % CI 1.10–2.73, p = 0.018; 12–15 year old: ORs: 1.62, 95 % CI: 1.18–2.58, p = 0.006), pitcher (ORs: 1.46, 95 % CI: 1.10–1.94, p = 0.009), catcher (ORs: 1.69, 95 % CI: 1.24–2.31, p = 0.001,), and practice intensity (ORs: 1.58, 95 % CI: 1.22–2.06, p = 0.001) were significantly associated with elbow and/or shoulder pain.

Conclusion

Both low back and knee pain were significantly associated with elbow and/or shoulder pain in youth baseball players. Clinicians should check the complaints of the trunk and lower extremities as well as those of the elbow and shoulder for preventing severe injuries in youth baseball players. Level of Evidence III.

     

Difference in knee joint position sense in athletes with and without patellofemoral pain syndrome

Purpose

The purpose of this study was to evaluate knee joint position sense (JPS) in athletes with patellofemoral pain syndrome (PFPS) and compare it with healthy participants under non-weight bearing (sitting) and weight bearing (standing) conditions.

Methods

Twenty patients and 20 healthy athletes participated in this study. JPS was evaluated by active replication of knee angles with visual cues eliminated. Two target angles in sitting and one in standing were tested. Each test and replication was repeated three times. By subtracting the test angle from the replicated angle, the absolute error was calculated as a dependent variable.

Results

No significant difference in knee JPS was found between groups either in the sitting or in the standing tests.

Conclusion

It seems that PFPS does not affect the knee JPS in athletes. The lack of deficiency in patients could possibly be attributed to their severity of knee pathology, pain intensity and their physical activity level.

Level of evidence

Case–control study, Level III.     

Alignment in knee flexion position during navigation-assisted total knee arthroplasty

Purpose

The aim of this study was to demonstrate the lower limb alignment in knee flexion position after navigation-assisted total knee arthroplasty using the gap technique and to identify the correlative factors.

Methods

One hundred and twenty consecutive osteoarthritic knees (120 patients) were prospectively enrolled for intraoperative data collection. All TKA surgeries were performed using the navigation system (OrthoPilot?, version 4.0; B. Braun Aesculap, Tuttlingen, Germany). Before and after final prosthesis implantation, the lower limb navigation alignment in both knee extension (0°) and knee flexion (90°) position was recorded. The knee flexion alignment was divided into three groups: varus, neutral and valgus alignment. To determine the factors of the alignment in knee flexion position, preoperative demographics, radiologic and intraoperative data were obtained. Pearson’s correlation (r) analysis was performed to find the correlation. The Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were compared between groups.

Results

Although all postoperative extension alignment was within neutral position (between ?2° and +2°), postoperative knee flexion alignment was divided into three groups: varus (≤?3°), 24 cases (20 %); neutral (between ?2° and +2°), 85 cases (70.8 %) and valgus (≥+3°) alignment, 11 cases (9.2 %). There were a good correlation of alignment in knee flexion position with the rotation of femoral component relative to posterior condylar axis (r = ?0.502, p = 0.000) and weak correlations with posterior femoral cut thickness (lateral condyle) (r = 0.207, p = 0.026), medial flexion (90°) gap after femoral component rotation adjustment (r = 0.276, p = 0.003). Other variables did not show correlations. There were no statistical clinical differences between varus, neutral and valgus knee flexion alignment groups.

Conclusion

About 30 % of the cases showed malalignment of more than 3° in knee flexion position although with neutral alignment in extension position. The knee flexion alignment had a good correlation with the rotation of femoral component relative to posterior condylar axis. Neutral alignment in knee flexion position may be adjusted by femoral component rotation especially by the use of navigation system.

Level of evidence

IV.

     

Learning curves of two different techniques for the intra-articular injection of the knee joint under fluoroscopic guidance

Aim

The aim of the study was to compare the learning curves of three beginner operators using two different techniques of intra-articular injection of the knee under fluoroscopic guidance with a superolateral approach.

Materials and methods

In total, 177 consecutive patients (72 females (40.7%) and 105 males (59.3%), mean age 42.2 ± 15.0 years) scheduled for a computed tomography (CT) arthrography and without joint effusion on the lateral X-rays were enrolled. They underwent an intra-articular injection of the knee under fluoroscopic guidance with a superolateral approach. Patients were randomly assigned to three different operators, including a junior supervisor and two first-year residents in radiology who never performed an intra-articular injection of the knee before the present study. Procedures in lateral or supine position were randomly assigned to three operators.

Results

There was a higher rate of successful injections with the lateral position (92.1%) than with supine position (80.2%) (odds ratio (OR) 4.52, 95% confidence interval (CI) 1.46–14.0). A significant learning effect was observed for the supine position, while none was observed for the lateral position. Pain and time of fluoroscopy did not differ between the two procedures (p = 0.85 and p = 0.10, respectively). Junior supervisor had a higher rate of successful intra-articular injection compared with the other two operators (p = 0.0072). There was a statistically significant higher rate of extravasation with the supine position (66.3%) than with lateral position (19.7%) (p < 0.0001, OR 0.13, 95% CI 0.06–0.25).

Conclusion

The intra-articular injection of the knee under fluoroscopic guidance with the patient in lateral position is an easy technique for operators in training with a low rate of extravasation. Lateral position does not require a supplementary irradiation and does not increase the procedural pain. Personal operator’s skill is an independent factor in determining the success of the training.

     

Inter-rater reliability of Rolimeter measurements between anterior cruciate ligament injured and normal contra lateral knees

The Rolimeter device can provide measurements of anterior/posterior tibial displacement using maximal manual force. The Rolimeter reliability is still under research when used as an independent knee tester. The purpose of this study is to determine the inter-rater reliability of the Rolimeter measurements between anterior cruciate ligament (ACL) injured and normal contra lateral knees. Twelve male patients with ACL deficiency participated in this study. Three physical therapists (PT) performed the Rolimeter measurements in supine position with an approximate 25° flexion of the knees. Each therapist performed three trials on each knee and the difference in results in millimeters between injured knee and normal contra lateral knee was determined. Spearmans rho correlations showed weak relationships between the PT 1, 3 and 2, 3 (PT 1 vs. PT 3 r=0.55, PT 2 vs. PT 3 r=0.57) and the high relation between 1, 2 (PT 1 vs. PT 2 r=0.96) of Rolimeter measurements. Intraclass correlation coefficient showed no significant reliability coefficients among the three PT Rolimeter measurements between ACL injured and normal contra lateral knees (R=0.24, p=0.05). These results reflect the variations among the means of the three physical therapists Rolimeter measurements between ACL injured and normal contra lateral knees.     

Partial lateral facetectomy plus Insall’s procedure for the treatment of isolated patellofemoral osteoarthritis: survival analysis

Purpose

The purpose of this study was to report the survival analysis of partial lateral facetectomy and Insall’s procedure in patients with isolated patellofemoral osteoarthritis, and to assess the risk and protective factors for failure of this procedure.

Methods

From 1992 to 2004, all subjects with isolated patellofemoral osteoarthritis who met the inclusion criteria and underwent this procedure were enrolled. Risk and protective factors for failure (failure considered as the need for total knee arthroplasty) were assessed by comparing obtained baseline data between failed and non-failed cases. Eighty-seven cases (mean (SD) age 61.8 (7.7) years, mean (SD) follow-up 9.6 (3.2) years) were included.

Results

Twenty-three failed cases were found. Mean (SD) survival time was 13.6 (0.5) years. At 13 years (last failure case), the cumulative survival was 59.3 %. Baseline medial tibiofemoral pain, genu flexum, and worst grade of tibiofemoral osteoarthritis were significant risk factors for failure (p < 0.0001, p = 0.02, p < 0.0001, respectively). In contrast, higher anatomical (p = 0.02) and total (p = 0.03) knee society score (KSS) scores, absence of knee effusion (p = 0.03), higher value of the Caton–Deschamps index (p = 0.03), and lateral position of the patella (p = 0.01) were all protective factors against failure.

Conclusion

The treatment for isolated patellofemoral osteoarthritis through partial lateral facetectomy and Insall’s procedure demonstrated good long-term survival. The presence of preoperative medial tibiofemoral pain, genu flexum, and incipient tibiofemoral osteoarthritis increased the risk of failure of this procedure. In contrast, higher anatomical and total KSS scores, absence of knee effusion, higher value of the Caton–Deschamps index, and lateral position of the patella were found to protect against failure.

Level of evidence

Prospective case series, Level IV.     

Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective,randomized study

Purpose

Anterior knee pain is a major cause of complaint in total knee arthroplasty (TKA) without patellar resurfacing. The concept of improved patellar tracking and decreased retropatellar contact pressure for lateral retinacular release theoretically suggests that patients with lateral retinacular release in TKA would achieve a lower incidence of anterior knee pain when compared without lateral retinacular release. We sought to determine (1) whether those patients who received a routine lateral retinacular release in TKA would attain lower incidence of anterior knee pain as compared to patients who received TKA without lateral retinacular release and (2) whether lateral retinacular release would increase the lateral retinacular release-related complications.

Methods

A total of 148 patients who underwent TKA with the use of the Gemini MK II mobile bearing were randomized to receive either routine lateral retinacular release (intervention group) or not (control group). Patients were assessed by the visual analogue scale for anterior knee pain, the Knee Society clinical scoring system of knee score and function score, and patellar score for clinical function. Patients’ satisfaction and lateral retinacular release-related complications were also evaluated.

Results

The overall incidence of anterior knee pain in the intervention group at 18 months follow-up was 5.6 %, while that of the control group was 20.6 % (p = 0.009). No statistical difference was detected between the two groups in terms of lateral retinacular release-related complications (n.s.), patients’ satisfaction (n.s.), knee score (n.s.), function score (n.s.), and patellar score (n.s.) at 18 months follow-up.

Conclusion

The present study suggests that routine lateral retinacular release can reduce anterior knee pain and does not increase lateral retinacular release-related complications, in TKA with the use of the Gemini MK II mobile bearing without patellar resurfacing.

Level of evidence

Therapeutic, Level I.     

Hip and knee muscle torque and its relationship with dynamic balance in chronic ankle instability,copers and controls

ObjectivesWe compared hip and knee isometric muscle torque between individuals with chronic ankle instability (CAI), those who have sustained one ankle sprain with no ongoing problems (copers) and healthy controls. Our secondary objective was to compare balance between groups and investigate the relationship between muscle torque and balance.DesignCross-sectional study.Methods22 CAI, 20 copers and 22 uninjured participants were tested. Isometric torque (normalised to body mass (Nm/kg)) was measured using a rigidly-fixated hand-held dynamometer. Balance was assessed with the Y-balance test.ResultsKnee and hip flexor and extensor, and hip adductor and abductor muscle torque was less in individuals with CAI compared to controls (standardised mean difference (SMD) >1.2). Hip and knee flexor and extensor muscle torque was less in CAI participants than copers (SMD: 0.69–1.1). Hip external and internal rotator torque did not differ between groups. There was no difference in hip or knee muscle torque between controls and copers (SMD: 0.01–0. 54). Balance was impaired in CAI participants compared to copers and controls in all directions. There was a strong positive correlation between posterolateral Y-balance test performance and torque of the hip adductors (r = 0.53), flexors (r = 0.52) and extensors (r = 0.50).ConclusionsIndividuals with CAI have weak knee and hip muscles compared to copers and controls. Hip strength was shown to be related to posterolateral balance performance. Future studies may investigate the effect of hip and knee strengthening exercise on ongoing ankle problems, such as episodic giving way in individuals with CAI.     

Courses of change in knee adduction moment and lateral thrust differ up to 1 year after TKA

Purpose

In total knee arthroplasty (TKA), dynamic knee loading may loosen the artificial joint and bone or cause polyethylene wear after prolonged use. TKA decreases knee adduction moment at 6 months, but this effect is lost by 1 year post-operatively. However, lateral thrust after TKA has not been clarified. We hypothesized that like knee adduction moment, lateral thrust would return to baseline levels by 1 year post-operatively.

Methods

Participants were 15 patients who underwent TKA for medial knee OA. Japanese Orthopaedic Association (JOA) score, numeric rating scale, and gait analysis (measurement of peak knee adduction moment, knee varus angle at peak knee adduction moment, lateral thrust, and gait speed) were performed preoperatively (baseline) and 3 weeks, 3 and 6 months, and 1 year post-operatively.

Results

JOA score improved from 55 ± 9.8 to 78 ± 12.1 at 1 year post-operatively, and pain decreased significantly from baseline at each follow-up (p < 0.001). Significant increases in gait speed were observed at 6 months and 1 year (p < 0.001). Peak knee adduction moment during stance phase was significantly lower at 3 weeks, 3 months, and 6 months compared to baseline (p < 0.05), but no significant changes were seen at 1 year. Knee varus at peak knee adduction moment did not differ significantly between any measurement points, while lateral thrust was decreased at 6 months and 1 year compared to baseline (p < 0.05).

Conclusions

Temporal courses of changes up to 1 year after TKA differed between knee adduction moment and lateral thrust, so our hypothesis was rejected.

Level of evidence

IV.

     

Radiographers’ attitudes towards persons with dementia

Objectives

Improvements in the competency level and changes in attitude of staff are extremely important due to the projected increase in the percentage of persons with dementias, who are frequently referred to imaging departments. The aim of this study is to assess the attitude of radiographers towards people with dementia and to identify whether there is any association between attitude and background variables such as age, gender and length of work experience.

Methods

Six University hospitals’ diagnostic imaging departments in Norway were surveyed, using the Norwegian translation of the validated Swedish version of the “Strain in nursing care assessment scale” (SNC). The study population was radiographers (N = 146).

Results

Significant differences in attitudes have been identified. Male radiographers reported significantly more negative attitudes than female radiographers (p = 0.02). Radiographers aged over 50 years reported a significantly more positive attitude than staff of aged 30 and under (p = 0.02). Staff with fewer than 10 years of work experience reported significantly more negative attitudes than staff with more than 20 years of experience (p = 0.04).

Conclusion

Overall, the attitude of the radiographers towards people with dementia was measured to be of a negative rather than a positive nature.     

Effects of arthroscopy-guided suprascapular nerve block combined with ultrasound-guided interscalene brachial plexus block for arthroscopic rotator cuff repair: a randomized controlled trial

Purpose

The aim of this study was to compare the pain relieving effect of ultrasound-guided interscalene brachial plexus block (ISB) combined with arthroscopy-guided suprascapular nerve block (SSNB) with that of ultrasound-guided ISB alone within the first 48 h after arthroscopic rotator cuff repair.

Methods

Forty-eight patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled. The 24 patients in group 1 received ultrasound-guided ISB and arthroscopy-guided SSNB; the remaining 24 patients in group 2 underwent ultrasound-guided ISB alone. Visual analogue scale pain score and patient satisfaction score were checked at 1, 3, 6, 12, 18, 24, and 48 h post-operatively.

Results

Group 1 had a lower visual analogue scale pain score at 3, 6, 12, 18, 24, and 48 h post-operatively (1.7 < 2.6, 1.6 < 4.0, 3.5 < 5.8, 3.6 < 5.2, 3.2 < 4.2, 1.3 < 2.0), and a higher patient satisfaction score at 6, 12, 18, 24, and 36 h post-operatively than group 2 (7.8 > 6.0, 6.2 > 4.3, 6.4 > 5.1, 6.9 > 5.9, 7.9 > 7.1). Six patients in group 1 developed rebound pain twice, and the others in group 1 developed it once. All of the patients in group 2 had one rebound phenomenon each (p = 0.010). The mean timing of rebound pain in group 1 was later than that in group 2 (15.5 > 9.3 h, p < 0.001), and the mean size of rebound pain was smaller in group 1 than that in group 2 (2.5 > 4.0, p = 0.001).

Conclusion

Arthroscopy-guided SSNB combined with ultrasound-guided ISB resulted in lower visual analogue scale pain scores at 3–24 and 48 h post-operatively, and higher patient satisfaction scores at 6–36 h post-operatively with the attenuated rebound pain compared to scores in patients who received ultrasound-guided ISB alone after arthroscopic rotator cuff repair. The combined blocks may relieve post-operative pain more effectively than the single block within 48 h after arthroscopic cuff repair.

Level of evidence

Randomized controlled trial, Level I.ClinicalTrials.gov Identifier: NCT02424630.