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Effect of knee bracing on clinical outcomes following anterior cruciate ligament reconstruction: A prospective randomised controlled study 膝关节支撑对前交叉韧带重建术后临床效果的影响:前瞻性随机对照研究
IF 2.1 Q3 ORTHOPEDICS Pub Date : 2024-02-20 DOI: 10.1016/j.asmart.2024.01.006
Ukris Gunadham , Patarawan Woratanarat

Objectives

While there is a consensus against bracing after anterior cruciate ligament (ACL) reconstruction, the question of its potential benefits, especially in cases involving meniscus repair, as well as its routine use by the majority of clinicians, remains a topic of debate. This study aims to assess the effectiveness of bracing in relation to clinical scores after ACL reconstruction, regardless of meniscus surgery.

Methods

This randomised controlled study involved patients aged 15–55 years who underwent arthroscopic ACL reconstruction surgery. All eligible patients were assigned into two groups: one group received an adjustable frame with a four-point fixation knee brace for a four-week period, while the other did not.

A single experienced surgeon performed standard anatomical single-bundle ACL reconstruction. All patients, irrespective of whether they underwent meniscus repair, followed the same rehabilitation protocol. Knee functional questionnaires, including the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner Activity Scale, Visual Analogue Scale (VAS), and examinations, were collected preoperatively, at six months, one year, and two years postoperatively. The study employed an intention-to-treat analysis and multilevel mixed-effects generalised linear models to compare continuous outcomes between the groups, adjusting for the times of follow-up.

Results

A total of 84 patients (42 patients per group) comprised of 75 males (89 %) and average age of 30 ± 9.4 years old. Patient-reported function, physical examination findings, and surgical characteristics were comparable between the two groups. (P-value >0.05) Both groups demonstrated significant improvement in IKDC and Lysholm scores at the end of the two-year follow-up period. (P-value <0.0001) In multivariate analysis, bracing was significantly associated with lower Tegner activity scale than the non-brace group after adjustment for VAS and time (coefficient −0.49, 95 % confidence interval −0.87, −0.10, P-value = 0.013). None of the graft ruptures were reported, and there was no significant difference of return to sports between the groups at the end of the follow-up.

Conclusion

The study suggests that knee bracing after ACL reconstruction, regardless of any additional meniscus procedures, fails to enhance subjective or objective outcomes and could potentially have a negative impact on the Tegner activity scale, although the difference is not clinically significant. The routine use of a postoperative brace should be discontinued.

Level of evidence

Level I, Randomised controlled trial with no negative criteria.

目的虽然人们一致反对在前交叉韧带(ACL)重建术后进行支撑,但其潜在益处(尤其是在涉及半月板修复的病例中)以及大多数临床医生的常规使用问题仍是一个争论不休的话题。本研究旨在评估支撑对前交叉韧带重建后临床评分的有效性,无论是否进行了半月板手术。所有符合条件的患者被分为两组:一组接受为期四周的四点固定可调式护膝架,另一组则不接受护膝架。所有患者,无论是否接受半月板修复,都遵循相同的康复方案。研究人员在术前、术后六个月、一年和两年收集了膝关节功能问卷,包括国际膝关节文献委员会(IKDC)评分、Lysholm评分、Tegner活动量表、视觉模拟量表(VAS)和检查。研究采用了意向治疗分析和多层次混合效应广义线性模型来比较各组间的连续性结果,并对随访时间进行了调整。 结果 84 名患者(每组 42 名)中有 75 名男性(89%),平均年龄为 30 ± 9.4 岁。患者报告的功能、体格检查结果和手术特征在两组之间具有可比性。(在两年随访期结束时,两组患者的 IKDC 和 Lysholm 评分均有显著改善。(P值<0.0001)在多变量分析中,对VAS和时间进行调整后,支架组的Tegner活动量评分明显低于非支架组(系数为-0.49,95%置信区间为-0.87,-0.10,P值=0.013)。结论:该研究表明,前交叉韧带重建术后无论是否进行了半月板手术,膝关节支具都无法改善主观或客观结果,并可能对 Tegner 活动量表产生负面影响,尽管这种差异在临床上并不显著。证据级别I级,随机对照试验,无否定标准。
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引用次数: 0
Factors affecting the post-operative over-constraint after anatomic double-bundle anterior cruciate ligament reconstruction 解剖双束前十字韧带重建术后过度约束的影响因素
IF 2.1 Q3 ORTHOPEDICS Pub Date : 2024-02-06 DOI: 10.1016/j.asmart.2024.01.002
Miki Kuroda , Tatsuo Mae , Hidenori Otsubo , Tomoyuki Suzuki , Shinichiro Okimura , Norinao Matsumoto

Objective

Initial tension at graft fixation is one of key factors for good outcomes in anterior cruciate ligament (ACL) reconstruction. Identifying the pre-operative factors that influence postoperative knee laxity under the anterior tibial load is useful in determining the initial tension at graft fixation. Thus, the purpose of this study was to clarify the pre-operative factors affecting the side-to-side difference in anterior laxity immediately after the anatomic double-bundle ACL reconstruction with a constant initial tension.

Methods

Fifty-five patients underwent the anatomic double-bundle ACL reconstruction with hamstring tendon grafts. Anterior tibial displacement (ATD) was measured on both knees using KT-2000 Knee Arthrometer under anterior drawer load of 67 N, 89 N, 134 N and manual maximum load at 30° of flexion before ACL reconstruction under anesthesia, and was also measured on the operated knees under 89 N immediately after ACL reconstruction under anesthesia. Then, side-to-side difference (SSD) before and immediately after ACL reconstruction was calculated. Correlative relation between the SSD immediately after ACL reconstruction and the ATD/the SSD in each condition was analyzed.

Results

The side-to-side difference of ATD immediately after surgery was −3.8 ± 1.7 mm (0 to -8mm) in response of 89 N of anterior load. There was correlation between the SSD immediately after ACL reconstruction and all ATD on both knees except for the ATD under manual maximum load on the injured knee, while little correlation between the SSD immediately after ACL reconstruction and that before ACL reconstruction was found. Especially, ATD under 89 N on the opposite knees and ATD under 134 N on the injured knees showed selective correlation with the SSD immediately after surgery in the step-wise multiple regression analysis.

Conclusion

As the anterior tibial displacements under 89 N on the contra-lateral knee and under 134 N on the injured knee had a significant correlation with the SSD immediately after ACL reconstruction, those values may be helpful in determining the increase or decrease in initial tension at graft fixation.

目的移植物固定时的初始张力是前交叉韧带(ACL)重建术取得良好疗效的关键因素之一。确定影响术后膝关节在胫骨前负荷下松弛的术前因素有助于确定移植物固定时的初始张力。因此,本研究旨在明确影响解剖双束前交叉韧带重建术后即刻前方松弛侧向差异的术前因素,并确定恒定的初始张力。在麻醉下进行前交叉韧带重建前,使用 KT-2000 膝关节测量仪在前牵引负荷 67 N、89 N、134 N 和屈曲 30°手动最大负荷下测量双膝的胫骨前位移(ATD),并在麻醉下进行前交叉韧带重建后立即在 89 N 负荷下测量手术膝的胫骨前位移(ATD)。然后计算前交叉韧带重建前和重建后的侧向差(SSD)。结果在 89 N 的前负荷作用下,术后即刻的 ATD 侧-侧差为 -3.8 ± 1.7 mm(0 至 -8mm)。前交叉韧带重建术后的SSD与双膝关节的所有ATD之间存在相关性,但受伤膝关节在人工最大负荷下的ATD除外,而前交叉韧带重建术后的SSD与前交叉韧带重建术前的SSD之间几乎没有相关性。结论 由于对侧膝关节的胫骨前位移在 89 N 以下和受伤膝关节的胫骨前位移在 134 N 以下与前交叉韧带重建后的 SSD 有显著相关性,这些值可能有助于判断移植物固定时初始张力的增减。
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引用次数: 0
The effect of continuous interscalene brachial plexus block for arthroscopic rotator cuff repair 关节镜肩袖修复术中连续臂丛神经疤痕间阻滞的效果
IF 2.1 Q3 ORTHOPEDICS Pub Date : 2024-02-02 DOI: 10.1016/j.asmart.2024.01.004
Tomohiro Uno , Nariyuki Mura , Issei Yuki , Ryuta Oishi , Michiaki Takagi

Background

Arthroscopic rotator cuff repair (ARCR) is a minimally invasive surgical technique. However, it is challenging to control postoperative pain. This study aimed to investigate the difference between a single-shot interscalene block and a combined continuous block for ARCR.

Methods

Ninety-four patients who underwent ARCR were included in this study. In the preceding period, 43 patients received a single-shot interscalene block and continuous postoperative intravenous opioid infusion (Single group). In the posterior period, 51 patients received a single-shot interscalene block preoperatively and a continuous block postoperatively (Continuous group). Their mean age at surgery was 64.9 years (range, 43–83 years). The mean follow-up period was 25.4 months (range, 24–54 months). The numerical rating scale (NRS) of pain was evaluated immediately after the surgery, at rest, and at night for 1–4 days after the surgery. One day postoperatively, the amount of food taken was assessed from 0 % (no food intake) to 100 % (all food taken). The University of California at Los Angeles (UCLA) shoulder score, range of motion (ROM), and isometric shoulder strength were evaluated.

Results

NRS at rest in the Continuous group on the day of surgery was 3.7 ± 2.5. This was significantly lower than in the Single group (5.2 ± 1.8) (P = 0.002). NRS at rest in the Continuous group on the second day after surgery was 3.0 ± 2.1, significantly lower than in the Single group (3.9 ± 1.8) (P = 0.04). The amount of food taken in the morning in the Continuous group was 61 % ± 37 %, which was significantly greater than in the Single group (35 % ± 41 %) (P = 0.004). The ROM of extension at 6 months postoperatively in the Continuous group was 47 ± 7°, which was significantly greater than in the Single group (43 ± 6°) (P = 0.02). The postoperative strength of the external rotator at 6 months in the Continuous group was 95 ± 33 N, significantly greater than in the Single group (78 ± 28 N) (P = 0.01). There was no significant difference in UCLA score at any time.

Conclusion

The continuous interscalene block with ultrasound guidance in ARCR effectively relieved pain. The recovery of ROM for extension and the strength of the external rotator was better in the Continuous group.

背景显微镜下肩袖修复术(ARCR)是一种微创手术技术。然而,控制术后疼痛是一项挑战。本研究旨在探讨单次肩胛间阻滞与联合连续阻滞在 ARCR 中的区别。在前期,43 名患者接受了单次椎间孔阻滞和术后持续静脉输注阿片类药物(单次组)。在后阶段,51 名患者术前接受单次椎间孔阻滞,术后接受连续阻滞(连续组)。他们手术时的平均年龄为 64.9 岁(43-83 岁)。平均随访时间为 25.4 个月(24-54 个月)。术后 1-4 天内,对术后即刻、休息时和夜间的疼痛进行了数字评分量表(NRS)评估。术后一天,对进食量进行评估,从0%(未进食)到100%(全部进食)不等。对加州大学洛杉矶分校(UCLA)的肩关节评分、活动范围(ROM)和肩关节等长肌力进行了评估。这明显低于单一组(5.2 ± 1.8)(P = 0.002)。术后第二天,持续组休息时的 NRS 为 3.0 ± 2.1,明显低于单一组(3.9 ± 1.8)(P = 0.04)。连续组患者早上进食量为 61 % ± 37 %,明显高于单一组(35 % ± 41 %)(P = 0.004)。术后 6 个月时,持续组的伸展 ROM 为 47 ± 7°,明显高于单一组(43 ± 6°)(P = 0.02)。连续组术后 6 个月的外旋肌力量为 95 ± 33 N,明显高于单一组(78 ± 28 N)(P = 0.01)。结论 超声引导下的连续椎间孔阻滞在 ARCR 中能有效缓解疼痛。连续组的伸展 ROM 和外旋肌力量恢复更好。
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引用次数: 0
In vivo three-dimensional kinematic comparison of normal knees between flexion and extension activities 正常膝关节屈伸活动的活体三维运动学比较
IF 2.1 Q3 ORTHOPEDICS Pub Date : 2024-02-01 DOI: 10.1016/j.asmart.2024.01.003
Kenichi Kono , Takaharu Yamazaki , Shuji Taketomi , Hiroshi Inui , Sakae Tanaka , Tetsuya Tomita

Background/Objective

Normal knee kinematics during flexion and extension activities over the whole range of motion remains unknown. This study aimed to clarify in vivo kinematics during knee flexion and extension activities of normal knees by comparing continuous flexion and extension activities up to a high flexion angle.

Methods

Twenty knees of 10 Japanese volunteers were enrolled in this study. Each volunteer performed a continuous squatting motion under fluoroscopy, and a two- or three-dimensional registration technique was used. Rotation and anteroposterior translation of the medial and lateral sides of the femur relative to the tibia at each flexion angle were evaluated.

Results

Femoral external rotation was significantly smaller from 10° to 40° flexion during extension activities than during flexion activities. However, the femoral external rotation was larger from 120° to 130° flexion during extension activities than during flexion activities. From 10° to 60° of flexion, the medial side was significantly more posteriorly located during extension activities than during flexion activities. Furthermore, the lateral side was significantly more posteriorly located at 130° of flexion during extension activities than during flexion activities.

Conclusion

In vivo kinematics of normal knees during extension activities differ from those during flexion activities in early and high flexion.

背景/目的正常膝关节在整个运动范围内进行屈伸活动时的运动学特性尚不清楚。本研究旨在通过比较连续屈伸活动至高屈曲角度时正常膝关节在膝关节屈伸活动过程中的活体运动学特性。每位志愿者都在透视下进行了连续下蹲运动,并使用了二维或三维登记技术。结果在伸展活动中,股骨外旋从 10°到 40°屈曲时明显小于屈曲活动时。然而,在伸展活动时,股骨外旋在屈曲 120°至 130°之间比在屈曲活动时大。从屈曲10°到60°,伸展活动时内侧明显比屈曲活动时更靠后。结论正常膝关节在伸展活动中的运动学特性与屈曲活动中早期和高度屈曲时的运动学特性不同。
{"title":"In vivo three-dimensional kinematic comparison of normal knees between flexion and extension activities","authors":"Kenichi Kono ,&nbsp;Takaharu Yamazaki ,&nbsp;Shuji Taketomi ,&nbsp;Hiroshi Inui ,&nbsp;Sakae Tanaka ,&nbsp;Tetsuya Tomita","doi":"10.1016/j.asmart.2024.01.003","DOIUrl":"https://doi.org/10.1016/j.asmart.2024.01.003","url":null,"abstract":"<div><h3>Background/Objective</h3><p>Normal knee kinematics during flexion and extension activities over the whole range of motion remains unknown. This study aimed to clarify in vivo kinematics during knee flexion and extension activities of normal knees by comparing continuous flexion and extension activities up to a high flexion angle.</p></div><div><h3>Methods</h3><p>Twenty knees of 10 Japanese volunteers were enrolled in this study. Each volunteer performed a continuous squatting motion under fluoroscopy, and a two- or three-dimensional registration technique was used. Rotation and anteroposterior translation of the medial and lateral sides of the femur relative to the tibia at each flexion angle were evaluated.</p></div><div><h3>Results</h3><p>Femoral external rotation was significantly smaller from 10° to 40° flexion during extension activities than during flexion activities. However, the femoral external rotation was larger from 120° to 130° flexion during extension activities than during flexion activities. From 10° to 60° of flexion, the medial side was significantly more posteriorly located during extension activities than during flexion activities. Furthermore, the lateral side was significantly more posteriorly located at 130° of flexion during extension activities than during flexion activities.</p></div><div><h3>Conclusion</h3><p>In vivo kinematics of normal knees during extension activities differ from those during flexion activities in early and high flexion.</p></div>","PeriodicalId":44283,"journal":{"name":"Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology","volume":"36 ","pages":"Pages 1-5"},"PeriodicalIF":2.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214687324000037/pdfft?md5=461452910d70e30cb9d1c2bd548eb04e&pid=1-s2.0-S2214687324000037-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139674139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of limb alignment correction on medial meniscus extrusion under loading condition in high tibial osteotomy 胫骨高位截骨负重条件下肢体对准矫正对内侧半月板挤压的影响
IF 2.1 Q3 ORTHOPEDICS Pub Date : 2023-10-01 DOI: 10.1016/j.asmart.2023.08.010
Yosuke Ishii , Masakazu Ishikawa , Goki Kamei , Yuko Nakashima , Yoshitaka Iwamoto , Makoto Takahashi , Nobuo Adachi

Background

This study aimed to investigate the effect of high tibial osteotomy (HTO) on medial meniscus extrusion (MME) and the association between the changes in limb alignment and MME under weight-bearing (WB) conditions after HTO.

Methods

We included 17 patients with knee osteoarthritis (OA) who underwent HTO. MME was evaluated using ultrasonography in supine and unipedal standing positions. Knee alignment was evaluated radiographically using WB, whole-leg radiographs with the hip-knee-ankle angle (HKAA), percentage of the mechanical axis (%MA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). All measurements were performed serially at four time points: preoperative and 3, 6, and 12 months postoperative. Clinical outcomes were assessed by knee injury and osteoarthrosis outcome score (KOOS) and visual analogue scale (VAS) value for pain.

Results

Mean MME in the WB position was significantly greater than that in the supine position in the preoperative condition; however, MME in both supine and WB positions was significantly lowered postoperatively. The ΔMME, difference of MME between supine and WB positions, was significantly lowered postoperatively and maintained for up to 1 year. MME change in the WB position between preop and postoperative conditions was significantly correlated with change in HKAA and %MA at 1 year postoperative. KOOS and VAS score were significantly improved after HTO.

Conclusions

HTO correcting varus alignment can decrease MME in WB position and minimise the change in MME between supine and WB positions. The changes in MME after HTO were correlated with changes in the mechanical alignments.

本研究旨在探讨胫骨高位截骨(HTO)对内侧半月板挤压(MME)的影响,以及HTO后负重(WB)条件下肢体排列变化与MME之间的关系。在仰卧位和单足站立位使用超声评估MME。使用WB、全腿X线片、髋膝踝关节角(HKAA)、机械轴百分比(%MA)、胫骨近端内侧角(MPTA)和关节线会聚角(JLCA)对膝关节对齐进行评估。所有测量在四个时间点连续进行:术前和术后3、6和12个月。通过膝关节损伤和骨关节病结果评分(KOOS)和疼痛视觉模拟评分(VAS)值评估临床结果。结果术前WB位平均MME明显高于仰卧位;然而,术后仰卧位和WB位的MME均显著降低。ΔMME,即仰卧位和WB位之间的MME差异,术后显著降低,并维持长达1年。术前和术后WB位置的MME变化与术后1年HKAA和%MA的变化显著相关。HTO后KOOS和VAS评分显著改善。结论HTO矫正内翻对齐可降低WB位MME,并最大限度地减少仰卧位和WB位之间MME的变化。HTO后MME的变化与机械排列的变化相关。
{"title":"Effect of limb alignment correction on medial meniscus extrusion under loading condition in high tibial osteotomy","authors":"Yosuke Ishii ,&nbsp;Masakazu Ishikawa ,&nbsp;Goki Kamei ,&nbsp;Yuko Nakashima ,&nbsp;Yoshitaka Iwamoto ,&nbsp;Makoto Takahashi ,&nbsp;Nobuo Adachi","doi":"10.1016/j.asmart.2023.08.010","DOIUrl":"10.1016/j.asmart.2023.08.010","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to investigate the effect of high tibial osteotomy (HTO) on medial meniscus extrusion (MME) and the association between the changes in limb alignment and MME under weight-bearing (WB) conditions after HTO.</p></div><div><h3>Methods</h3><p>We included 17 patients with knee osteoarthritis (OA) who underwent HTO. MME was evaluated using ultrasonography in supine and unipedal standing positions. Knee alignment was evaluated radiographically using WB, whole-leg radiographs with the hip-knee-ankle angle (HKAA), percentage of the mechanical axis (%MA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). All measurements were performed serially at four time points: preoperative and 3, 6, and 12 months postoperative. Clinical outcomes were assessed by knee injury and osteoarthrosis outcome score (KOOS) and visual analogue scale (VAS) value for pain.</p></div><div><h3>Results</h3><p>Mean MME in the WB position was significantly greater than that in the supine position in the preoperative condition; however, MME in both supine and WB positions was significantly lowered postoperatively. The ΔMME, difference of MME between supine and WB positions, was significantly lowered postoperatively and maintained for up to 1 year. MME change in the WB position between preop and postoperative conditions was significantly correlated with change in HKAA and %MA at 1 year postoperative. KOOS and VAS score were significantly improved after HTO.</p></div><div><h3>Conclusions</h3><p>HTO correcting varus alignment can decrease MME in WB position and minimise the change in MME between supine and WB positions. The changes in MME after HTO were correlated with changes in the mechanical alignments.</p></div>","PeriodicalId":44283,"journal":{"name":"Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology","volume":"34 ","pages":"Pages 1-8"},"PeriodicalIF":2.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/aa/81/main.PMC10493499.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10228392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Therapeutic effects following extracorporeal shock wave therapy for insertional and non-insertional Achilles tendinopathy 体外冲击波治疗插入性和非插入性跟腱病的疗效。
IF 2.1 Q3 ORTHOPEDICS Pub Date : 2023-10-01 DOI: 10.1016/j.asmart.2023.09.001
Hong Li , Wei Yao , Xiao'ao Xue , Yunxia Li , Yinghui Hua

Background

The treatment for Achilles tendinopathy varies widely, and there is no consensus regarding the optimal treatment for both non-insertional and insertional Achilles tendinopathy. The purpose of this study was to evaluate the clinical efficacy of extracorporeal shock wave therapy (ESWT) in the treatment of insertional and non-insertional Achilles tendinopathy (AT).

Methods

Sixty patients with AT were invited to participate in this study. Patients were allocated to one of two groups according to the site of the AT, including an insertional AT (IAT) group and a non-insertional AT (NIAT) group. ESWT was performed once a week for five weeks for both groups. The Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) score and the visual analog scale (VAS) were used five times to evaluate the clinical outcomes, including before treatment, immediately after treatment, as well as one month, three months, and five years after treatment.

Results

At three months after treatment, the IAT group exhibited a significantly higher VISA-A score (82 ± 6 vs. 76 ± 11; p = 0.01) and a significantly lower VAS score (1 ± 1 vs. 2 ± 1; p < 0.001) when compared with the NIAT group. At the five-year assessment, the IAT group (1 ± 1) had a significantly lower VAS score than the NIAT group (2 ± 1) (p = 0.02), while no significant difference for the VISA-A score was observed between the groups (84 ± 8 vs. 84 ± 10; p = 0.98).

Conclusions

Extracorporeal shock wave treatment can improve the symptoms of both insertional and non-insertional AT. The IAT patients experienced better clinical outcomes compared with the NIAT patients.

背景:跟腱病的治疗方法差异很大,对于非插入性和插入性跟腱病的最佳治疗方法没有达成共识。本研究旨在评价体外冲击波治疗(ESWT)治疗插入性和非插入性跟腱病(AT)的临床疗效。根据AT的部位,患者被分为两组中的一组,包括插入性AT(IAT)组和非插入式AT(NIAT)组。两组患者每周进行一次ESWT,共5周。维多利亚运动评估研究所阿喀琉斯问卷(VISA-A)评分和视觉模拟量表(VAS)用于评估临床结果五次,包括治疗前、治疗后以及治疗后一个月、三个月和五年。结果:在治疗后三个月,IAT组表现出显著较高的VISA-a评分(82±6 vs.76±11;p=0.01)和显著较低的VAS评分(1±1 vs.2±1;p=0.02),而VISA-A评分在两组之间没有显著差异(84±8 vs.84±10;p=0.098)。结论:体外冲击波治疗可以改善插入性和非插入性AT的症状。与NIAT患者相比,IAT患者的临床结果更好。
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引用次数: 0
Arthroscopic repair with transosseous sling-suture technique for acute and chronic bony Bankart lesions 关节镜下经骨吊带缝合技术修复急慢性骨Bankart损伤。
IF 2.1 Q3 ORTHOPEDICS Pub Date : 2023-10-01 DOI: 10.1016/j.asmart.2023.08.008
Xiaoxi Ji , Lingchao Ye , Yinghui Hua , Xiaobo Zhou
<div><h3>Background</h3><p>Failure to fix the fractured fragment can result in bony fragment resorption and consequent glenoid bone loss. Current arthroscopic repair techniques might lead to insecure fixation and refracture. The purpose of this study was to evaluate the effectiveness of the transosseous sling-suture technique for bony Bankart lesions, and to compare the clinical outcomes for acute and chronic bony Bankart lesions treated with this technique.</p></div><div><h3>Methods</h3><p>A retrospective case series consisting of 46 patients with bony fracture of the glenoid rim following traumatic injury was identified from May 2015 to August 2020. The patients were divided into the acute lesion group and the chronic lesion group according to the time from first injury to surgery. The size of bone fragment was used to group the patients into the small and the medium sized fragment groups. All the patients underwent arthroscopic repairs using the transosseous sling-suture technique. Preoperative and postoperative evaluations including Rowe score, West Ontario Shoulder Instability Index (WOSI), Visual Analogue Scale (VAS) for pain scores, ROMs and number of dislocations were recorded. No significant differences were found in the comparisons of postoperative ROMs ang functional outcomes regarding between the small and the medium sized fragment groups.</p></div><div><h3>Results</h3><p>No dislocations occurred for both groups postoperatively. At the last follow-up, all the ROMs (including anterior flexion, abduction, external rotation and internal rotation at the side), the Rowe score, the WOSI score and the VAS score for pain in the both groups were significantly improved compared to the preoperative evaluations (all <em>P</em>s < 0.001). In the comparisons between the acute and the chronic lesion groups, significantly greater anterior flexion (158.9 ± 8.9° vs. 153.0 ± 6.4°, <em>P</em> = 0.037), abduction (167.7 ± 10.1° vs. 161.0 ± 7.0°, <em>P</em> = 0.035) and external rotation at the side (88.3 ± 6.4° vs. 83.5 ± 5.5°, <em>P</em> = 0.024) were found in the acute lesion group. The comparisons of the Rowe score (86.0 ± 7.5 vs. 87.5 ± 10.6, <em>P</em> = 0.319), the WOSI score (223.5 ± 56.3 vs. 185.0 ± 79.9, <em>P</em> = 0.062), the VAS score for pain (0.4 ± 0.2 vs. 0.3 ± 0.2, <em>P</em> = 0.324) and the internal rotation at the side (74.6 ± 13.2° vs. 80.5 ± 11.1°, <em>P</em> = 0.116) between these two groups did not demonstrate significant differences between the two groups.</p></div><div><h3>Conclusion</h3><p>This arthroscopic transosseous sling-suture repair technique for shoulder anterior instability with acute and chronic bony Bankart lesion can restore joint stability, improve clinical outcomes and range of motion postoperatively. The acute bony Bankart lesion using the current technique can produce better range of motion compared to the chronic lesion.</p></div><div><h3>Study design</h3><p>Retrospective case series; Level of evidence, 4.</p
背景:未能固定骨折碎片可能导致骨碎片吸收和随后的关节盂骨丢失。目前的关节镜修复技术可能会导致不安全的固定和再骨折。本研究的目的是评估经骨吊带缝合技术治疗骨Bankart病变的有效性,并比较用该技术治疗急性和慢性骨Bankart损伤的临床结果。方法:回顾性分析2015年5月至2020年8月期间46例外伤性关节盂缘骨折患者的临床资料。根据首次损伤到手术的时间,将患者分为急性损伤组和慢性损伤组。根据骨片大小将患者分为小骨片组和中骨片组。所有患者均采用经骨悬吊缝合技术进行关节镜下修复。记录术前和术后评估,包括Rowe评分、西安大略肩部不稳定指数(WOSI)、疼痛评分的视觉模拟量表(VAS)、ROM和脱位次数。小片段组和中片段组术后ROM和功能结果的比较没有发现显著差异。结果:两组术后均未发生脱位。在最后一次随访中,与术前评估相比,两组的所有ROM(包括前屈、外展、外侧旋转和内侧旋转)、Rowe评分、WOSI评分和疼痛VAS评分均有显著改善(所有P均P=0.037),急性病变组出现外展(167.7±10.1°vs.161.0±7.0°,P=0.035)和侧旋(88.3±6.4°vs.83.5±5.5°,P=0.024)。Rowe评分(86.0±7.5 vs.87.5±10.6,P=0.0319)、WOSI评分(223.5±56.3 vs.185.0±79.9,P=0.062)、,两组之间疼痛VAS评分(0.4±0.2 vs.0.3±0.2,P=0.324)和侧部内旋(74.6±13.2°vs.80.5±11.1°,P=0.116)没有显示出两组之间的显著差异。结论:关节镜下经骨吊带缝合修复肩关节前部不稳定伴急慢性骨Bankart损伤,可恢复关节稳定性,改善临床疗效和术后活动范围。与慢性病变相比,使用当前技术的急性骨Bankart病变可以产生更好的运动范围。研究设计:回顾性病例系列;证据水平,4。
{"title":"Arthroscopic repair with transosseous sling-suture technique for acute and chronic bony Bankart lesions","authors":"Xiaoxi Ji ,&nbsp;Lingchao Ye ,&nbsp;Yinghui Hua ,&nbsp;Xiaobo Zhou","doi":"10.1016/j.asmart.2023.08.008","DOIUrl":"10.1016/j.asmart.2023.08.008","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Failure to fix the fractured fragment can result in bony fragment resorption and consequent glenoid bone loss. Current arthroscopic repair techniques might lead to insecure fixation and refracture. The purpose of this study was to evaluate the effectiveness of the transosseous sling-suture technique for bony Bankart lesions, and to compare the clinical outcomes for acute and chronic bony Bankart lesions treated with this technique.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A retrospective case series consisting of 46 patients with bony fracture of the glenoid rim following traumatic injury was identified from May 2015 to August 2020. The patients were divided into the acute lesion group and the chronic lesion group according to the time from first injury to surgery. The size of bone fragment was used to group the patients into the small and the medium sized fragment groups. All the patients underwent arthroscopic repairs using the transosseous sling-suture technique. Preoperative and postoperative evaluations including Rowe score, West Ontario Shoulder Instability Index (WOSI), Visual Analogue Scale (VAS) for pain scores, ROMs and number of dislocations were recorded. No significant differences were found in the comparisons of postoperative ROMs ang functional outcomes regarding between the small and the medium sized fragment groups.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;No dislocations occurred for both groups postoperatively. At the last follow-up, all the ROMs (including anterior flexion, abduction, external rotation and internal rotation at the side), the Rowe score, the WOSI score and the VAS score for pain in the both groups were significantly improved compared to the preoperative evaluations (all &lt;em&gt;P&lt;/em&gt;s &lt; 0.001). In the comparisons between the acute and the chronic lesion groups, significantly greater anterior flexion (158.9 ± 8.9° vs. 153.0 ± 6.4°, &lt;em&gt;P&lt;/em&gt; = 0.037), abduction (167.7 ± 10.1° vs. 161.0 ± 7.0°, &lt;em&gt;P&lt;/em&gt; = 0.035) and external rotation at the side (88.3 ± 6.4° vs. 83.5 ± 5.5°, &lt;em&gt;P&lt;/em&gt; = 0.024) were found in the acute lesion group. The comparisons of the Rowe score (86.0 ± 7.5 vs. 87.5 ± 10.6, &lt;em&gt;P&lt;/em&gt; = 0.319), the WOSI score (223.5 ± 56.3 vs. 185.0 ± 79.9, &lt;em&gt;P&lt;/em&gt; = 0.062), the VAS score for pain (0.4 ± 0.2 vs. 0.3 ± 0.2, &lt;em&gt;P&lt;/em&gt; = 0.324) and the internal rotation at the side (74.6 ± 13.2° vs. 80.5 ± 11.1°, &lt;em&gt;P&lt;/em&gt; = 0.116) between these two groups did not demonstrate significant differences between the two groups.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;This arthroscopic transosseous sling-suture repair technique for shoulder anterior instability with acute and chronic bony Bankart lesion can restore joint stability, improve clinical outcomes and range of motion postoperatively. The acute bony Bankart lesion using the current technique can produce better range of motion compared to the chronic lesion.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study design&lt;/h3&gt;&lt;p&gt;Retrospective case series; Level of evidence, 4.&lt;/p","PeriodicalId":44283,"journal":{"name":"Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology","volume":"34 ","pages":"Pages 9-14"},"PeriodicalIF":2.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/23/a2/main.PMC10511304.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of moxibustion on knee joint stiffness characteristics in recreational athletes pre- and post-fatigue 艾灸对休闲运动员疲劳前后膝关节僵硬特性的影响。
IF 2.1 Q3 ORTHOPEDICS Pub Date : 2023-10-01 DOI: 10.1016/j.asmart.2023.08.004
Yufeng Zhang , Zirong Bai , Zhiye Zhang , Peng Yuan , Yilin Xu , Zun Wang , David Sutton , Jun Ren , Eamonn Delahunt , Dan Wang

Objective

Joint stiffness results from the coupling of the nervous system and joint mechanics, and thus stiffness is a comprehensive representation of joint stability. It has been reported that moxibustion can alleviate general weakness and fatigue symptoms and subsequently may influence joint stiffness. This study investigated whether moxibustion could enhance knee joint stiffness in recreational athletes pre- and post-fatigue.

Methods

Eighteen participants were randomized into intervention (5 males: 20.6 ± 1.5 yr; 4 females: 20.8 ± 1.5 yr) and control groups (5 males: 19.4 ± 0.9 yr; 4 females: 20.5 ± 0.6 yr). The intervention group received indirect moxibustion applied to acupoints ST36 (bilateral) and CV4 for 30 min every other day for 4 consecutive weeks. The control group maintained regular exercise without moxibustion. Peak torque (PT) of right knee extensor, relaxed and contracted muscle stiffness (MS) of vastus lateralis, and knee extensor musculoarticular stiffness (MAS) was assessed with an isokinetic dynamometer (IsoMed 2000), myometer, and free oscillation technique, respectively. Measurements were taken at three time points: pre-intervention, post-intervention/pre-fatigue, and post-fatigue.

Results

MAS (P = 0.006) and PT (P = 0.007) in the intervention group increased more from pre-to post-intervention compared with the control group. Post-fatigue MAS (P = 0.016) and PT (P = 0.031) increased more in the intervention group than in the control group.

Conclusion

Moxibustion enhanced PT and knee MAS, suggesting that this intervention could be used in injury prevention and benefit fatigue resistance in young recreational athletes.

目的:关节刚度是神经系统和关节力学耦合的结果,因此刚度是关节稳定性的综合表征。据报道,艾灸可以缓解全身虚弱和疲劳症状,随后可能影响关节僵硬。方法:将18名运动员随机分为干预组(5名男性:20.6±1.5岁;4名女性:20.8±1.5年)和对照组(5例男性:19.4±0.9岁;4例女性:20.5±0.6岁)ST36穴(双侧)和CV4穴,隔日30min,连续4周。对照组在不艾灸的情况下保持规律的运动。分别用等速测功机(IsoMed 2000)、肌张力计和自由振荡技术评估右膝伸肌的峰值扭矩(PT)、股外侧肌的松弛和收缩肌肉硬度(MS)以及膝伸肌关节硬度(MAS)。在干预前、干预后/疲劳前和疲劳后三个时间点进行测量。结果:与对照组相比,干预组的MAS(P=0.006)和PT(P=0.007)在干预前后增加更多。与对照组相比,干预组疲劳后MAS(P=0.016)和PT(P=0.031)增加更多。结论:艾灸可增强PT和膝关节MAS,提示该干预措施可用于预防损伤,有利于青少年休闲运动员的抗疲劳能力。
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引用次数: 0
Validity and reliability of the Thai functional internal rotation scale for shoulder arthroplasty 泰国功能性内旋量表在肩关节置换术中的有效性和可靠性。
IF 2.1 Q3 ORTHOPEDICS Pub Date : 2023-10-01 DOI: 10.1016/j.asmart.2023.08.007
Nattha Kulkamthorn , Tharit Inkaratana , Pattanaket Cheewakongkiat

Background

The Functional Internal Rotation Scale is an excellent clinical tool for evaluating patients with shoulder arthroplasty, but it has not been adapted to the Thai version. The objectives of this study were to translate the English version and culturally adapt the Functional Internal Rotation Scale to the Thai version and to examine the psychometric properties of the Thai Functional Internal Rotation Scale among Thai participants having shoulder arthroplasty.

Methods

The Functional Internal Rotation Scale was translated to Thai, including cross-cultural adaptations, following standard guidelines. Psychometric properties were evaluated with shoulder arthroplasty patients. Content validity was evaluated using the content validity index (CVI). Criterion validity was assessed using the Pearson correlation coefficient. An Independent t-test was used to evaluate construct validity. Internal consistency reliability was assessed using Cronbach's alpha coefficient. Intraclass correlation coefficient (ICC) was used to determine test-retest reliability over a 14-day interval.

Results

Of 45 participants, 20 total shoulder arthroplasty (TSA) patients and 25 reverse shoulder arthroplasty (RSA) patients, the majority of participants were female (69%) and retired (91%) with a mean age of 72.9 years (SD 9.1). CVI evaluation was acceptable, with a total CVI of 0.92. The correlation of the Thai Functional Internal Rotation Scale with the Thai version of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (Thai ASES) and the internal rotation subscale (IR subscale) of the Thai ASES was 0.73 (P < 0.001) and 0.75 (P < 0.001), respectively. For construct validity, TSA patients scored, on average, 10.8 points higher than RSA patients (43.7 vs. 32.9, P < 0.001, 95% confidence interval 6.3–15.3). Cronbach's alpha coefficient of the Thai Functional Internal Rotation Scale was 0.95. The test-retest reliability revealed excellent reliability (ICC 0.99).

Conclusion

The Thai Functional Internal Rotation Scale has good validity and excellent reliability in assessing internal rotation function in Thai shoulder arthroplasty patients.

背景:功能性内旋量表是评估肩关节置换术患者的优秀临床工具,但尚未适用于泰国版本。本研究的目的是翻译英文版,并将功能性内旋量表从文化上改编为泰语版,并在接受肩部关节成形术的泰国参与者中检验泰语功能性内旋转量表的心理测量特性。方法:按照标准指南,将功能性内旋量表翻译成泰语,包括跨文化适应。对肩关节置换术患者的心理测量特性进行评估。使用内容有效性指数(CVI)评估内容有效性。使用Pearson相关系数评估标准的有效性。使用独立t检验来评估结构的有效性。使用Cronbachα系数评估内部一致性可靠性。组内相关系数(ICC)用于确定14天间隔内的重测可靠性。结果:在45名参与者、20名全肩关节置换术(TSA)患者和25名反肩关节置换手术(RSA)患者中,大多数参与者是女性(69%)和退休(91%),平均年龄为72.9岁(SD 9.1)。CVI评估是可接受的,总CVI为0.92。泰国功能性内旋量表与泰国版美国肩肘外科医生标准化肩部评估表(泰国ASES)和泰国ASES的内旋分量表(IR分量表)的相关性为0.73(P结论:泰式功能性内旋量表在评估泰式肩关节置换术患者内旋功能方面具有良好的有效性和可靠性。
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引用次数: 0
Comparison between the effect of immersive virtual reality training versus conventional rehabilitation on limb loading and functional outcomes in patients after anterior cruciate ligament reconstruction: A prospective randomized controlled trial 沉浸式虚拟现实训练与传统康复对前交叉韧带重建后患者肢体负荷和功能结果的影响比较:一项前瞻性随机对照试验。
IF 2.1 Q3 ORTHOPEDICS Pub Date : 2023-10-01 DOI: 10.1016/j.asmart.2023.09.002
Muhindra Rao Gsangaya , Ohnmar Htwe , Amaramalar Selvi Naicker , Badrul Akmal Hisham Md Yusoff , Norlelawati Mohammad , Elaine Zi Fan Soh , Murugeaswaran Silvaraju

Purpose

Anterior cruciate ligament injury (ACL) commonly occurs during sporting events. It causes pain, instability and reduction in range of movement of the knee which results in altered balance, reduced strength as well as loading to the involved knee. The challenge to get the patient back to competitive sports level much depends on the rehabilitation process. Post ACLR rehabilitation is challenging due to the long rehabilitation time as well as boring repetitive exercises. The aim of this study is to compare between the effectiveness of using immersive virtual reality (PlayStation VR) in addition to the conventional rehabilitation as an aid in rehabilitation of patients after ACLR in terms of objective functional assessment and pain and subjective knee function scoring.

Methods

This randomised controlled trial was undertaken in a tertiary hospital in Malaysia from July 2019 until July 2020. Thirty patients were randomised into a group undergoing purely conventional rehabilitation (Group 1) and a group undergoing both conventional rehabilitation and immersive virtual reality assisted rehabilitation (Group 2). The immersive virtual reality assisted rehabilitation was started at 3 months post operatively for 3 months duration. Limb loading, balance, range of motion, functional hop tests of the knee, pain and subjective scoring of the knee with the International Knee Documentation Committee (IKDC) Scores were measured preoperatively and at 6 months.

Results

There were significant differences in terms of improvement of pain scores (p = 0.012) as well as IKDC Scores (p = 0.024) in Group 2 as compared to Group 1. However, there were no significant differences with regards to limb loading, balance, range of motion and functional hop tests of the knee (p > 0.05). No adverse events were observed during the study period.

Conclusion

Immersive virtual reality can be used as an adjunct in rehabilitation of patients after ACL reconstruction in terms of improving their pain as well as their subjective knee evaluation. Large randomised control trial is recommended to further investigate the efficacy.

目的:前交叉韧带损伤(ACL)常见于体育赛事中。它会导致疼痛、不稳定和膝盖活动范围的减少,从而导致平衡改变、力量下降以及相关膝盖的负荷。让患者恢复竞技体育水平的挑战很大程度上取决于康复过程。ACLR后的康复具有挑战性,因为康复时间长,重复练习也很无聊。本研究的目的是在客观功能评估、疼痛和主观膝关节功能评分方面,比较除传统康复外,使用沉浸式虚拟现实(PlayStation VR)辅助ACLR后患者康复的有效性。方法:这项随机对照试验于2019年7月至2020年7月在马来西亚的一家三级医院进行。30名患者被随机分为一组接受纯常规康复(第1组)和一组接受常规康复和沉浸式虚拟现实辅助康复(第2组)。沉浸式虚拟现实辅助康复在术后3个月开始,持续3个月。术前和6个月时测量肢体负荷、平衡、活动范围、膝关节功能跳跃测试、疼痛和国际膝关节文献委员会(IKDC)对膝关节的主观评分。结果:与第1组相比,第2组的疼痛评分(p=0.012)和IKDC评分(p=0.024)的改善存在显著差异。然而,在肢体负荷、平衡、运动范围和膝关节功能跳跃测试方面没有显著差异(p>0.05)。在研究期间没有观察到不良事件。结论:沉浸式虚拟现实可以作为ACL重建后患者康复的辅助手段,改善患者的疼痛和主观膝关节评估。建议进行大型随机对照试验以进一步研究疗效。
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引用次数: 0
期刊
Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology
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