Does cruciate retention primary total knee arthroplasty affect proprioception, strength and clinical outcome?

PURPOSE: It remains unclear what the contribution of the PCL is in total knee arthroplasty (TKA). The goal of this study was to investigate the influence of the PCL in TKA in relationship to clinical outcome, strength and proprioception. METHODS: Two arthroplasty designs were compared: a posterior cruciate-substituting (PS) and a posterior cruciate-retaining (CR) TKA. A retrospective analysis was performed of 27 CR and 18 PS implants with a minimum of 1 year in vivo. Both groups were compared in terms of clinical outcome (range of motion, visual analogue scale for pain, Hospital for Special Surgery Knee Scoring system, Lysholm score and Knee Injury and Osteoarthritis Outcome Score), strength (Biodex System 3 Dynamometer(®)) and proprioception (balance and postural control using the Balance Master system(®)). Each design was also compared to the non-operated contralateral side in terms of strength and proprioception. RESULTS: There were no significant differences between both designs in terms of clinical outcome and strength. In terms of proprioception, only the rhythmic weight test at slow and moderate speed shifting from left to right was significant in favour of the CR design. None of the unilateral stance tests showed any significant difference between both designs. There was no difference in terms of strength and proprioception between the operated side and the non-operated side. CONCLUSION: Retaining the PCL in TKA does not result in an improved performance in terms of clinical outcome and proprioception and does not show any difference in muscle strength. LEVEL OF EVIDENCE: III.

Passive mobilization after arthroscopic rotator cuff repair is not detrimental in the early postoperative period.

This prospective randomized study compares the clinical results of immediate passive mobilization versus delayed mobilization in the rehabilitation of rotator cuff repair during the early postoperative period. The mobilization group (79 patients) received immediate daily passive mobilization. The immobilization group (51 patients) was immobilized for 4 weeks until physiotherapy was started. Passive range of motion was noted preoperatively, at 6 weeks and 4 months. Strength was measured preoperatively and at 4 months. Constant-Murley, Simple Shoulder Test, SPADI and UCLA scores were noted at baseline and at 4 months. Ultrasonography was performed at 6 weeks to exclude early failures of repair. We noted no significant difference between the two groups regarding range of motion at 6 weeks and range of motion, strength and functional outcome scores at 4 months. Ultrasound didn't show a difference in healing at 6 w in either of both groups. Both rehabilitation protocols seem applicable as well as safe in the early post-operative phase.

THE MULTIDISCIPLINARY BIOPSYCHOSOCIAL REHABILITATION PROGRAMME FOR PATIENTS WITH CHRONIC SPINAL PAIN: OUTCOMES WITH WORK STATUS AS THE PRIMARY FOCUS.

Objective: To assess the efficacy of the multidisciplinary biopsychosocial rehabilitation programme for chronic spinal patients as to work status, physical functioning, pain intensity, health-related quality of life and the psychosocial domain. Design: This is a retrospective, single-centre, observational cohort study. Subjects/Patients: A total of 209 subjects (mean age 41.5 ± 11.4 years) with chronic spinal pain participated in the rehabilitation programme. Methods: Evaluations were conducted through standardized questionnaires at baseline and at the end of the rehabilitation programme. Results: Patients were more likely to be at work. Sick leave and work VAS changed significantly. Patients in blue-collar jobs are less likely to return to work. Pain intensity, physical functioning, health-related quality of life and lumbar and cervical range of motion improved significantly. Conclusion: The multidisciplinary biopsychosocial rehabilitation programme for chronic spinal patients improved the rate of return to work. In daily clinical practice, attention must be given to reducing mobility issues in daily life in order to get patients back to work. The occupational therapist should give patients with blue-collar jobs sufficient attention early in the programme in order to achieve a higher rate of return to work.

Exertion induced rhabdomyolysis in both triceps muscles in a 36-year old woman: A case report.

Rhabdomyolysis is a condition, often caused by strenuous exercise, which can lead to acute kidney injury, severe electrolyte imbalances, coagulopathies, compartment syndromes, and even have a fatal outcome in a few cases. Recognition and management of fluid and electrolyte abnormalities is one of the first steps of treatment and key to a good outcome. We report a case of a 36-year old woman who was referred to the ER by her general practitioner with severe muscle tenderness to the upper arms and highly elevated creatine kinase (CK) serum levels. Initial ultrasound imagery showed a patent venous system but demonstrated a moderate edematous infiltration of the muscle bellies of both m. triceps. Additional magnetic resonance imagery showed a hyperintense signal in T2 in both triceps' muscles. Given the clinical presentation, the MRI-findings were consistent with a form of exertion-induced rhabdomyolysis of both triceps' muscles. The patient was admitted for administration of IV-fluids to prevent acute kidney injury. Symptoms resolved in a few days and new magnetic resonance imagery showed a regression of the subcutaneous soft tissue infiltration. The aim of this paper is to raise awareness about this diagnosis. If overlooked, severe complications as mentioned above can occur.

Cervical radiculopathy caused by vertebral artery loop formation: a case report.

Vertebral artery loop formation is a rare cause of cervical radiculopathy. We report a case of a 70-year-old man who was referred because of a chronic cervicobrachialgia. Initial plain cervical x-ray showed widening of the left C3-C4 intervertebral foramen. Additional magnetic resonance angiography revealed the presence of a vertebral artery loop, which had migrated into the left C3-C4 neural foramen and caused compression of the left C4 nerve root. Surgery was considered, but the patient's symptoms resolved with conservative treatment. The aim of this case report is to raise the knowledge of both clinicians and radiologists about vertebral artery loop formation as a rare but potentially life-threatening cause of cervical radiculopathy. If overlooked, cerebrovascular stroke during transforaminal cervical steroid injections or catastrophic vertebral artery damage during surgery may occur.

The M6-C Cervical Disk Prosthesis: First Clinical Experience in 33 Patients.

STUDY DESIGN: Retrospective study. OBJECTIVE: To determine the short-term clinical succesrate of the M6-C cervical disk prosthesis in primary and secondary surgery. SUMMARY OF BACKGROUND DATA: Cervical disk arthroplasty (CDA) provides an alternative to anterior cervical decompression and fusion for the treatment of spondylotic radiculopathy or myelopathy. The prevention of adjacent segment disease (ASD), a possible complication of anterior cervical decompression and fusion, is its most cited--although unproven--benefit. Unlike older arthroplasty devices that rely on a ball-and-socket-type design, the M6-C cervical disk prosthesis represents a new generation of unconstrained implants, developed to achieve better restoration of natural segmental biomechanics. This device should therefore optimize clinical performance of CDA and reduce ASD. MATERIALS AND METHODS: All patients had preoperative computed tomography or magnetic resonance imaging and postoperative x-rays. Clinical outcome was assessed using the Neck Disability Index, a Visual Analog Scale, and the SF-36 questionnaire. Patients were asked about overall satisfaction and whether they would have the surgery again. RESULTS: Thirty-three patients were evaluated 17.1 months after surgery, on average. Nine patients had a history of cervical interventions. Results for Neck Disability Index, Visual Analog Scale, and SF-36 were significantly better among patients who had undergone primary surgery. In this group, 87.5% of patients reported a good or excellent result and 91.7% would have the procedure again. In contrast, all 4 device-related complications occurred in the small group of patients who had secondary surgery. CONCLUSIONS: The M6-C prosthesis appears to be a valuable addition to the CDA armatorium. It generates very good results in patients undergoing primary surgery, although its use in secondary surgery should be avoided. Longer follow-up is needed to determine to what measure this device can prevent ASD.