Correction of Long Standing Proximal Interphalangeal Flexion Contractures with Cross Finger Flaps and Vigorous Postoperative Exercises

Purpose

We reviewed the results of cross finger flaps after surgical release and vigorous postoperative exercises for long-standing, severe flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers.

Materials and Methods

In 9 patients, all contracted tissue was sequentially released and the resultant skin defect was covered with a cross-finger flap. The cause of the contracture was contact burn in 4, skin graft in 3, and a previous operation in 2. The mean follow-up period was 41.2 months.

Results

The mean flexion contracture/further flexion in the joints were improved from 73.4/87.8° to 8.4/95.4° at the last follow-up. A mean of 19.5° of extension was achieved with vigorous extension exercise after the operation. The mean gain in range of motion (ROM) was 79.4°. Near full ROM was achieved in 3 cases. There were no major complications.

Conclusions

In severe flexion contractures with scarring of the PIP joints of fingers, cross finger flaps after sufficient release and vigorous postoperative exercise seems to be a reasonable option to obtain satisfactory ROM of the joints.     

Tibiofemoral Joint Positioning for the Valgus Stress Test

Context:

Recommendations on the positioning of the tibiofemoral joint during a valgus stress test to optimize isolation of the medial collateral ligament (MCL) from other medial joint structures vary in the literature. If a specific amount of flexion could be identified as optimally isolating the MCL, teaching and using the technique would be more consistent in clinical application.

Objective:

To determine the angle of tibiofemoral joint flexion between 0° and 20° that causes a difference in the slope of the force-strain line when measuring the resistance to a valgus force applied to the joint.

Design:

Cross-sectional study.

Setting:

University research laboratory.

Patients or Other Participants:

Twelve healthy volunteers (6 men, 6 women: age  =  26.4 ± 5.6 years, height  =  170.9 ± 8.4 cm, mass  =  75.01 ± 14.6 kg).

Intervention(s):

Using an arthrometer, we applied a valgus force, over a range of 60 N, to the tibiofemoral joint in 0°, 5°, 10°, 15°, and 20° of flexion.

Main Outcome Measure(s):

Force-strain measurements were obtained for 5 positions of tibiofemoral joint flexion.

Results:

As knee flexion angle increased, slope values decreased (F_4,44  =  17.6, P < .001). The slope at full extension was not different from that at 5° of flexion, but it was different from the slopes at angles greater than 10° of flexion. Similarly, the slope at 5° of flexion was not different from that at 10° of flexion, but it was different from the slopes at 15° and 20° of flexion. Further, the slope at 10° of flexion was not different from that at 15° or 20° of flexion. Finally, the slope at 15° of flexion was not different from that at 20° of flexion.

Conclusions:

When performing the manual valgus stress test, the clinician should fully extend the tibiofemoral joint or flex it to 5° to assess all resisting medial tibiofemoral joint structures and again at 15° to 20° of joint flexion to further assess the MCL.     

Pulsed Shortwave Diathermy and Joint Mobilizations for Achieving Normal Elbow Range of Motion After Injury or Surgery With Implanted Metal: A Case Series

Context:

Regaining full, active range of motion (ROM) after trauma to the elbow is difficult.

Objective:

To report the cases of 6 patients who lacked full ROM in the elbow because of trauma. The treatment regimen was thermal pulsed shortwave diathermy and joint mobilizations.

Design:

Case series.

Setting:

University therapeutic modalities laboratory.

Patients or Other Participants:

Six patients (5 women [83%], 1 man [17%]) lacked a mean active ROM of 24.5° of extension approximately 4.8 years after trauma or surgery.

Intervention(s):

Treatment consisted of 20 minutes of pulsed shortwave diathermy at 800 pulses per second for 400 microseconds (40–48 W average power, 150 W peak power) applied to the cubital fossa, immediately followed by 7 to 8 minutes of joint mobilizations. After posttreatment ROM was recorded, ice was applied to the area for about 30 minutes.

Main Outcomes Measure(s):

Changes in extension active ROM were assessed before and after each treatment. Once the patient achieved full, active ROM or failed to improve on 2 consecutive visits, he or she was discharged from the study.

Results:

By the fifth treatment, 4 participants (67%) achieved normal extension active ROM, and 2 of the 4 (50%) exceeded the norm. Five participants (83%) returned to normal activities and full use of their elbows. One month later, the 5 participants had maintained, on average, (mean ± SD) 92% ± 6% of their final measurements.

Conclusions:

A combination of thermal pulsed shortwave diathermy and joint mobilizations was effective in restoring active ROM of elbow extension in 5 of the 6 patients (83%) who lacked full ROM after injury or surgery.Key Words: deep heat, therapeutic modalities, rehabilitation

Key Points

• Pulsed shortwave diathermy can increase the viscoelastic properties of collagen.
• Combined pulsed shortwave diathermy and joint mobilizations increased active elbow range of motion in 5 of 6 patients nearly 5 years after injury or surgery.

Individuals who have reduced active range of motion (AROM) in 1 or more limbs for extended periods have their lives altered. A person who can only extend the elbow halfway will find it difficult to throw objects or to reach a high shelf to retrieve a book. The elbow should extend to a full AROM (0°) as measured by a goniometer.¹Many^1–6 are of the opinion that using heat in concert with joint mobilizations can increase accessory and physiologic movements. In 2010, I⁷ reported on the treatment protocol for 6 patients who lacked full AROM in wrist flexion and extension due to injury. The treatment regimen was thermal ultrasound followed by joint mobilization. All 6 patients had at least 90% of their wrist-flexion and -extension range of motion (ROM) restored. Another heating modality, pulsed shortwave diathermy (PSWD), uses high-frequency electromagnetic waves to heat tissues up to 5 cm deep. Heat is produced by the resistance of tissue to the passage of energy.⁸ Although it heats to the same depth as 1-MHz ultrasound, PSWD heats a much larger area than ultrasound does,⁹ making it ideal to heat larger joints, such as the elbow, shoulder, hip, knee, and ankle.^1,3,5 With today''s modern PSWD devices, tissues at the elbow can be heated up to 4°C, or a peak temperature of more than 40°C,⁴ which is ideal for increasing the viscoelastic properties of collagen.¹⁰In this case series, a unique treatment protocol is presented, which combines PSWD and joint mobilizations. I used this protocol in 6 patients who had sustained severe elbow injuries.     

Conservative treatment of an acute traumatic extensor carpi ulnaris tendon subluxation in a collegiate basketball player: a case report

Objective:

To present the case of an acute traumatic extensor carpi ulnaris (ECU) subluxation in a National Collegiate Athletic Association Division II female basketball player.

Background:

The ECU tendon is stabilized in the ulnar groove by a subsheath located inferior to the extensor retinaculum. The subsheath can be injured with forced supination, ulnar deviation, and wrist flexion, resulting in the ECU tendon subluxing in the palmar and ulnar directions during wrist circumduction. Several methods of intervention exist, but controversy remains on how to best treat this condition.

Differential Diagnosis:

Distal ulnar fracture, ulnar collateral ligament sprain, triangular fibrocartilage complex lesion, lunotriquetral instability, distal radioulnar joint injury, pisotriquetral joint injury, ECU tendinopathy or subluxation.

Treatment:

The wrist was placed in a short-arm cast in slight extension and radial deviation for 4 weeks. At that time, the patient was still able to actively sublux the ECU tendon, so a long-arm cast was applied with the wrist in slight extension, radial deviation, and pronation for an additional 4 weeks. The ECU tendon was then found to be stable. She wore a rigid wrist brace for 3 more weeks while she pursued rehabilitation. At the final follow-up appointment, the ECU tendon remained stable, and the wrist was asymptomatic.

Uniqueness:

Subluxations of the ECU are rare. If the patient does not improve with conservative measures, surgical intervention is warranted to repair the sixth dorsal compartment.

Conclusions:

A long-arm cast with the elbow flexed to 90° and the wrist in approximately 30° of extension, radial deviation, and pronation was appropriate treatment for this type of injury.     

Two different fatigue protocols and lower extremity motion patterns during a stop-jump task

Context:

Altered neuromuscular control strategies during fatigue probably contribute to the increased incidence of non-contact anterior cruciate ligament injuries in female athletes.

Objective:

To determine biomechanical differences between 2 fatigue protocols (slow linear oxidative fatigue protocol [SLO-FP] and functional agility short-term fatigue protocol [FAST-FP]) when performing a running-stop-jump task.

Design:

Controlled laboratory study.

Setting:

Laboratory.

Patients or Other Participants:

A convenience sample of 15 female soccer players (age = 19.2 ±0.8 years, height = 1.67±0.05m, mass = 61.7 + 8.1 kg) without injury participated.

Intervention(s):

Five successful trials of a running–stop-jump task were obtained prefatigue and postfatigue during the 2 protocols. For the SLO-FP, a peak oxygen consumption (V˙o₂peak) test was conducted before the fatigue protocol. Five minutes after the conclusion of the V˙o₂peak test, participants started the fatigue protocol by performing a 30-minute interval run. The FAST-FP consisted of 4 sets of a functional circuit. Repeated 2 (fatigue protocol) × 2 (time) analyses of variance were conducted to assess differences between the 2 protocols and time (prefatigue, postfatigue).

Main Outcome Measure(s):

Kinematic and kinetic measures of the hip and knee were obtained at different times while participants performed both protocols during prefatigue and postfatigue.

Results:

Internal adduction moment at initial contact (IC) was greater during FAST-FP (0.064 ±0.09 Nm/kgm) than SLO-FP (0.024±0.06 Nm/kgm) (F_1,14 = 5.610, P=.03). At IC, participants had less hip flexion postfatigue (44.7°±8.1°) than prefatigue (50.1°±9.5°) (F_1,14 = 16.229, P=.001). At peak vertical ground reaction force, participants had less hip flexion postfatigue (44.7°±8.4°) than prefatigue (50.4°±10.3°) (F_1,14 = 17.026, P=.001). At peak vertical ground reaction force, participants had less knee flexion postfatigue (−35.9°±6.5°) than prefatigue (−38.8°±5.03°) (F_1,14 = 11.537, P=.001).

Conclusions:

Our results demonstrated a more erect landing posture due to a decrease in hip and knee flexion angles in the postfatigue condition. The changes were similar between protocols; however, the FAST-FP was a clinically applicable 5-minute protocol, whereas the SLO-FP lasted approximately 45 minutes.     

Whole-body vibration and the prevention and treatment of delayed-onset muscle soreness

Context:

Numerous recovery strategies have been used in an attempt to minimize the symptoms of delayed-onset muscle soreness (DOMS). Whole-body vibration (WBV) has been suggested as a viable warm-up for athletes. However, scientific evidence to support the protective effects of WBV training (WBVT) on muscle damage is lacking.

Objective:

To investigate the acute effect of WBVT applied before eccentric exercise in the prevention of DOMS.

Design:

Randomized controlled trial.

Setting:

University laboratory.

Patients or Other Participants:

A total of 32 healthy, untrained volunteers were randomly assigned to either the WBVT (n  =  15) or control (n  =  17) group.

Intervention(s):

Volunteers performed 6 sets of 10 maximal isokinetic (60°/s) eccentric contractions of the dominant-limb knee extensors on a dynamometer. In the WBVT group, the training was applied using a vibratory platform (35 Hz, 5 mm peak to peak) with 100° of knee flexion for 60 seconds before eccentric exercise. No vibration was applied in the control group.

Main Outcome Measure(s):

Muscle soreness, thigh circumference, and pressure pain threshold were recorded at baseline and at 1, 2, 3, 4, 7, and 14 days postexercise. Maximal voluntary isometric and isokinetic knee extensor strength were assessed at baseline, immediately after exercise, and at 1, 2, 7, and 14 days postexercise. Serum creatine kinase was measured at baseline and at 1, 2, and 7 days postexercise.

Results:

The WBVT group showed a reduction in DOMS symptoms in the form of less maximal isometric and isokinetic voluntary strength loss, lower creatine kinase levels, and less pressure pain threshold and muscle soreness (P < .05) compared with the control group. However, no effect on thigh circumference was evident (P < .05).

Conclusions:

Administered before eccentric exercise, WBVT may reduce DOMS via muscle function improvement. Further investigation should be undertaken to ascertain the effectiveness of WBVT in attenuating DOMS in athletes.     

Retest Reliability of Force-Time Variables of Neck Muscles Under Isometric Conditions

Context:

Proper conditioning of the neck muscles may play a role in reducing the risk of neck injury and, possibly, concussions in contact sports. However, the ability to reliably measure the force-time–based variables that might be relevant for this purpose has not been addressed.

Objective:

To assess the between-days reliability of discrete force-time–based variables of neck muscles during maximal voluntary isometric contractions in 5 directions.

Design:

Cohort study.

Setting:

University research center.

Patients or Other Participants:

Twenty-six highly physically active men (age  =  21.6 ± 2.1 years, height  =  1.85 ± 0.09 m, mass  =  81.6 ± 9.9 kg, head circumference  =  0.58 ± 0.01 m, neck circumference  =  0.39 ± 0.02 m).

Intervention(s):

We used a custom-built testing apparatus to measure maximal voluntary isometric contractions of the neck muscles in 5 directions (extension, flexion, protraction, left lateral bending, and right lateral bending) on 2 separate occasions separated by 7 to 8 days.

Main Outcome Measure(s):

Variables measured were peak force (PF), rate of force development (RFD), and time to 50% of PF (T₅₀PF). Reliability indices calculated for each variable comprised the difference in scores between the testing sessions, with corresponding 95% confidence intervals, the coefficient of variation of the typical error of measurement (CV_TE), and intraclass correlation coefficients (ICC [3,3]).

Results:

No evidence of systematic bias was detected for the dependent measures across any movement direction; retest differences in measurements were between 1.8% and 2.7%, with corresponding 95% confidence interval ranges of less than 10% and overlapping zero. The CV_TE was lowest for PF (range, 2.4%–6.3%) across all testing directions, followed by RFD (range, 4.8%–9.0%) and T₅₀PF (range, 7.1%–9.3%). The ICC score range for all dependent measures was 0.90 to 0.99.

Conclusions:

Discrete variables representative of the force-generating capacity of neck muscles under isometric conditions can be measured with an acceptable degree of reliability. This finding has possible applications for investigating the role of neck muscle strength-training programs in reducing the risk of injuries in sport settings.     

Isokinetic analysis of ankle and ground reaction forces in runners and triathletes

OBJECTIVE:

To analyze and compare the vertical component of ground reaction forces and isokinetic muscle parameters for plantar flexion and dorsiflexion of the ankle between long-distance runners, triathletes, and non-athletes.

METHODS:

Seventy-five males with a mean age of 30.26 (±6.5) years were divided into three groups: a triathlete group (n = 26), a long-distance runner group (n = 23), and a non-athlete control group. The kinetic parameters were measured during running using a force platform, and the isokinetic parameters were measured using an isokinetic dynamometer.

RESULTS:

The non-athlete control group and the triathlete group exhibited smaller vertical forces, a greater ground contact time, and a greater application of force during maximum vertical acceleration than the long-distance runner group. The total work (180°/s) was greater in eccentric dorsiflexion and concentric plantar flexion for the non-athlete control group and the triathlete group than the long-distance runner group. The peak torque (60°/s) was greater in eccentric plantar flexion and concentric dorsiflexion for the control group than the athlete groups.

CONCLUSIONS:

The athlete groups exhibited less muscle strength and resistance than the control group, and the triathletes exhibited less impact and better endurance performance than the runners.     

Temperature Increases in the Human Achilles Tendon During Ultrasound Treatments With Commercial Ultrasound Gel and Full-Thickness and Half-Thickness Gel Pads

Context:

Although originally manufactured for use in diagnostic imaging of internal structures, 2-cm-thick gel pads are also used as conducting media for therapeutic ultrasound over areas with bony prominences. Research on the ability of these pads to conduct enough energy to adequately heat tissues has provided mixed results. However, this research has mainly been performed on the triceps surae muscle, an area over which gel pads are not typically used. We wondered how much heating might be produced if a thinner pad was used over a tendon.

Objective:

To compare temperature rises in the human Achilles tendon during ultrasound treatments using ultrasound gel, a 2-cm-thick pad, and a 1-cm-thick pad.

Design:

Cross-sectional study.

Setting:

University therapeutic modality laboratory.

Patients or Other Participants:

Forty-eight healthy volunteers (24 women, 24 men).

Intervention(s):

We inserted a rigid thermocouple 1 cm deep into the Achilles tendon. Ultrasound was delivered at the following settings: 3 MHz, continuous, 1 W/cm², 10 minutes.

Main Outcome Measure(s):

Temperature was recorded every 30 seconds for 10 minutes.

Results:

Temperature increased the most in the ultrasound gel group (increase  =  13.3°C, peak  =  42°C). The 1-cm-thick pad resulted in higher tendon temperature (increase  =  9.3°C, peak  =  37.8°C) than the 2-cm-thick pad (increase  =  6.5°C, peak  =  4.8°C). The 1-cm pad produced approximately 30% more heating than the 2-cm pad (SE  =  0.72, P < .03).

Conclusions:

The thinner pad transmitted ultrasound more efficiently than the thicker pad. Thus, a gel pad of less than 1-cm thickness might be useful for superficial areas, such as the hands and ankles.     

Core temperature and sweat responses in professional women's tennis players during tournament play in the heat

Context:

Tennis is often played in hot, humid environments, intensifying the thermoregulatory strain placed on the athletes. As a safety measure, some tennis organizations allow for a 10-minute break in play between the second and third sets when environmental conditions are extreme. However, the actual effect of these breaks in reducing core temperature is unknown.

Objective:

To determine change in core temperature after a 10-minute break in play and assess fluid balance in professional female tennis players during tournament matches in the heat.

Design:

Cross-sectional study.

Setting:

A Women''s Tennis Association Tour–sanctioned outdoor tournament on hard courts under hot conditions (30.3°C ± 2.3°C).

Patients or Other Participants:

Seven professional tennis players.

Main Outcome Measure(s):

Change in core temperature after a 10-minute break in tournament play, fluid intake, and sweat losses during match play.

Results:

Core temperature was reduced from 38.92°C to 38.67°C (change of −0.25°C ± 0.20°C) when a break was taken (P  =  .02). Mean sweat rate during match play was 2.0 ± 0.5 L/h. During that time, mean fluid intake was 1.5 ± 0.5 L/h, resulting in a 1.2% ± 1.0% reduction in body mass.

Conclusions:

Female professional tennis players are subjected to high heat loads during match play in hot environments. However, a 10-minute break in play decreased core temperature in 6 of 7 players by an average of 0.25°C, indicating that the break provides practical benefits in the field. Furthermore, although mean sweat rate in this group of female tennis players was high, most athletes were still able to minimize mass loss to less than 2% of their prematch weight.     

Normative and Critical Criteria for Iliotibial Band and Iliopsoas Muscle Flexibility

Context:

The Ober and Thomas tests are subjective and involve a “negative” or “positive” assessment, making them difficult to apply within the paradigm of evidence-based medicine. No authors have combined the subjective clinical assessment with an objective measurement for these special tests.

Objective:

To compare the subjective assessment of iliotibial band and iliopsoas flexibility with the objective measurement of a digital inclinometer, to establish normative values, and to provide an evidence-based critical criterion for determining tissue tightness.

Design:

Cross-sectional study.

Setting:

Clinical research laboratory.

Patients or Other Participants:

Three hundred recreational athletes (125 men, 175 women; 250 in injured group, 50 in control group).

Main Outcome Measure(s):

Iliotibial band and iliopsoas muscle flexibility were determined subjectively using the modified Ober and Thomas tests, respectively. Using a digital inclinometer, we objectively measured limb position. Interrater reliability for the subjective assessment was compared between 2 clinicians for a random sample of 100 injured participants, who were classified subjectively as either negative or positive for iliotibial band and iliopsoas tightness. Percentage of agreement indicated interrater reliability for the subjective assessment.

Results:

For iliotibial band flexibility, the average inclinometer angle was −24.59° ± 7.27°. A total of 432 limbs were subjectively assessed as negative (−27.13° ± 5.53°) and 168 as positive (−16.29° ± 6.87°). For iliopsoas flexibility, the average inclinometer angle was −10.60° ± 9.61°. A total of 392 limbs were subjectively assessed as negative (−15.51° ± 5.82°) and 208 as positive (0.34° ± 7.00°). The critical criteria for iliotibial band and iliopsoas flexibility were determined to be −23.16° and −9.69°, respectively. Between-clinicians agreement was very good, ranging from 95.0% to 97.6% for the Thomas and Ober tests, respectively.

Conclusions:

Subjective assessments and instrumented measurements were combined to establish normative values and critical criterions for tissue flexibility for the modified Ober and Thomas tests.     

Core-temperature sensor ingestion timing and measurement variability

Context:

Telemetric core-temperature monitoring is becoming more widely used as a noninvasive means of monitoring core temperature during athletic events.

Objective:

To determine the effects of sensor ingestion timing on serial measures of core temperature during continuous exercise.

Design:

Crossover study.

Setting:

Outdoor dirt track at an average ambient temperature of 4.4°C ± 4.1°C and relative humidity of 74.1% ± 11.0%.

Patients or Other Participants:

Seven healthy, active participants (3 men, 4 women; age  =  27.0 ± 7.5 years, height  =  172.9 ± 6.8 cm, body mass  =  67.5 ± 6.1 kg, percentage body fat  =  12.7% ± 6.9%, peak oxygen uptake [V̇o_2peak]  =  54.4 ± 6.9 mL•kg⁻¹•min⁻¹) completed the study.

Intervention(s):

Participants completed a 45-minute exercise trial at approximately 70% V̇o_2peak. They consumed core-temperature sensors at 24 hours (P1) and 40 minutes (P2) before exercise.

Main Outcome Measure(s):

Core temperature was recorded continuously (1-minute intervals) using a wireless data logger worn by the participants. All data were analyzed using a 2-way repeated-measures analysis of variance (trial × time), Pearson product moment correlation, and Bland-Altman plot.

Results:

Fifteen comparisons were made between P1 and P2. The main effect of time indicated an increase in core temperature compared with the initial temperature. However, we did not find a main effect for trial or a trial × time interaction, indicating no differences in core temperature between the sensors (P1  =  38.3°C ± 0.2°C, P2  =  38.3°C ± 0.4°C).

Conclusions:

We found no differences in the temperature recordings between the 2 sensors. These results suggest that assumed sensor location (upper or lower gastrointestinal tract) does not appreciably alter the transmission of reliable and repeatable measures of core temperature during continuous running in the cold.     

Recombinant factor VIIa is associated with an improved 24-hour survival without an improvement in inpatient survival in massively transfused civilian trauma patients

OBJECTIVE:

To determine whether recombinant factor VIIa (rFVIIa) is associated with increased survival and/or thromboembolic complications.

INTRODUCTION:

Uncontrollable hemorrhage is the main cause of early mortality in trauma. rFVIIa has been suggested for the management of refractory hemorrhage. However, there is conflicting evidence about the survival benefit of rFVIIa in trauma. Furthermore, recent reports have raised concerns about increased thromboembolic events with rFVIIa use.

METHODS:

Consecutive massively transfused (≥ 8 units of red blood cells within 12 h) trauma patients were studied. Data on demographics, injury severity scores, baseline laboratory values and use of rFVIIa were collected. Rate of transfusion in the first 6 h was used as surrogate for bleeding. Study outcomes included 24‐hour and in‐hospital survival, and thromboembolic events. A multivariable logistic regression analysis was used to determine the impact of rFVIIa on 24‐hour and in‐hospital survival.

RESULTS:

Three‐hundred and twenty‐eight patients were massively transfused. Of these, 72 patients received rFVIIa. As expected, patients administered rFVIIa had a greater degree of shock than the non‐rFVIIa group. Using logistic regression to adjust for predictors of death in the regression analysis, rFVIIa was a significant predictor of 24‐hour survival (odds ratio (OR) =  2.65; confidence interval 1.26–5.59; p = 0.01) but not of in‐hospital survival (OR = 1.63; confidence interval 0.79–3.37; p = 0.19). No differences were seen in clinically relevant thromboembolic events.

CONCLUSIONS:

Despite being associated with improved 24‐hour survival, rFVIIa is not associated with a late survival to discharge in massively transfused civilian trauma patients.     

Response of Thermocouples Interfaced to Electrothermometers When Immersed in 5 Water Bath Temperatures

Context:

Thermocouples and electrothermometers are used in therapeutic modality research. Until recently, researchers assumed that these instruments were valid and reliable.

Objective:

To examine 3 different thermocouple types in 5°C, 15°C, 18.4°C, 25°C, and 35°C water baths.

Design:

Randomized controlled trial.

Setting:

Therapeutic modality laboratory.

Intervention(s):

Eighteen thermocouple leads were inserted through the wall of a foamed polystyrene cooler. The cooler was filled with water. Six thermocouples (2 of each model) were plugged into the 6 channels of the Datalogger and 6 randomly selected channels in the 2 Iso-Thermexes. A mercury thermometer was immersed into the water and was read every 10 seconds for 4 minutes during each of 6 trials. The entire process was repeated for each of 5 water bath temperatures (5°C, 15°C, 18.4°C, 25°C, 35°C).

Main Outcome Measure(s):

Temperature and absolute temperature differences among 3 thermocouple types (IT-21, IT-18, PT-6) and 3 electrothermometers (Datalogger, Iso-Thermex calibrated from −50°C to 50°C, Iso-Thermex calibrated from −20°C to 80°C).

Results:

Validity and reliability were dependent on thermocouple type, electrothermometer, and water bath temperature (P < .001; modified Levene P < .05). Statistically, the IT-18 and PT-6 thermocouples were not reliable in each electrothermometer; however, these differences were not practically different from each other. The PT-6 thermocouples were more valid than the IT-18s, and both thermocouple types were more valid than the IT-21s, regardless of water bath temperature (P < .001).

Conclusions:

The validity and reliability of thermocouples interfaced to an electrothermometer under experimental conditions should be tested before data collection. We also recommend that investigators report the validity, the reliability, and the calculated uncertainty (validity + reliability) of their temperature measurements for therapeutic modalities research. With this information, investigators and clinicians will be better able to interpret and compare results and conclusions.     

Evaluation of postoperative range of motion and functional outcomes after cruciate-retaining and posterior-stabilized high-flexion total knee arthroplasty

Purpose

The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses.

Materials and Methods

Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups.

Results

After the 2-year postoperative period, the mean range of motion was 131° in the CR-Flex group and 133° in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2±9.1 points) than in the PS-Flex group (11.9±9.6 points); however, this difference was not statistically significant (p=non-significant).

Conclusion

The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty.