A Prospective, Median 15-Year Comparison of Ponseti Casting and Surgical Treatment of Clubfoot.

BACKGROUND: In 2010, 2 authors of this current study reported the results of Ponseti treatment compared with primary posteromedial release (PMR) for congenital talipes equinovarus in a cohort of 51 prospective patients. This current study shows outcomes recorded at a median of 15 years after the original treatment. METHODS: Patient health records were available for all 51 patients at a median of 15 years (range, 13 to 17 years) following treatment of congenital talipes equinovarus with either the Ponseti method (25 patients [38 feet]) or PMR (26 patients [42 feet]). Thirty-eight of 51 patients could be contacted, and 33 patients (65%) participated in the clinical review, comprising patient-reported outcomes, clinical examination, 3-dimensional gait analysis, and plantar pressures. RESULTS: Sixteen (42%) of 38 Ponseti-treated feet and 20 (48%) of 42 PMR-treated feet had undergone a further surgical procedure. The PMR-treated feet were more likely to undergo osteotomies and intra-articular surgical procedures (15 feet) than the Ponseti-treated feet (5 feet) (p < 0.05). Of the 33 patients reviewed with multimodal assessment, the Ponseti group, compared with the PMR group, demonstrated better Dimeglio scores (5.8 compared with 7.0 points; p < 0.05), Disease Specific Instrument (80.7 compared with 65.6 points; p < 0.05), Functional Disability Inventory (1.1 compared with 5.1; p < 0.05), and American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Outcomes Questionnaire scores (52.2 compared with 46.6 points; p < 0.05), as well as improved total sagittal ankle range of motion in gait and ankle plantar flexion range at toe-off. The PMR group with clinical hindfoot varus displayed higher pressures in the lateral midfoot and the forefoot. CONCLUSIONS: Although the numbers of repeat surgical interventions following Ponseti treatment and primary PMR were similar, the PMR-treated feet had greater numbers of osteotomies and intra-articular surgical procedures. Functional outcomes were improved at a median of 15 years for feet treated with the Ponseti method compared with feet treated with PMR, with advantages seen in the Ponseti group over several domains. This study provides the most comprehensive evaluation of outcomes close to skeletal maturity in prospective cohorts, reinforcing the Ponseti method as the initial treatment of choice for idiopathic clubfeet. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The influence of age on spinal and lower limb muscle activity during repetitive lifting.

This study investigated the effects of age on upper erector spinae (UES), lower erector spinae (LES) and lower body (gluteus maximus; biceps femoris; and vastus lateralis) muscle activity during a repetitive lifting task. Twenty-four participants were assigned to two age groups: 'younger' (n = 12; mean age ± SD = 24.6 ± 3.6 yrs) and 'older' (n = 12; mean age = 46.5 ± 3.0 yrs). Participants lifted and lowered a box (13 kg) repetitively at a frequency of 10 lifts per minute for a maximum of 20 min. EMG signals were collected every minute and normalised to a maximum voluntary isometric contraction. A submaximal endurance test of UES and LES was used to assess fatigue. Older participants showed higher levels of UES and LES muscle activity (approximately 12-13%) throughout the task, but less fatigue compared to the younger group post-task completion. When lifting, lower-limb muscle activity was generally higher in older adults, although temporal changes were similar. While increased paraspinal muscle activity may increase the risk of back injury in older workers when repetitive lifting, younger workers may be more susceptible to fatigue-related effects. Education and training in manual materials handling should consider age-related differences when developing training programmes.

Validation of an Inertial Sensor System for Physical Therapists to Quantify Movement Coordination During Functional Tasks.

Physical therapists evaluate patients' movement patterns during functional tasks; yet, their ability to interpret these observations consistently and accurately is unclear. Physical therapists would benefit from a clinic-friendly method for accurately quantifying movement patterns during functional tasks. Inertial sensors, which are inexpensive, portable sensors capable of monitoring multiple body segments simultaneously, are a relatively new rehabilitation technology. We sought to validate an inertial sensor system by comparing lower limb and lumbar spine kinematic data collected simultaneously with a commercial inertial sensor system and a motion camera system while 10 subjects performed functional tasks. Mean and peak segment angular displacement data were calculated and compared between systems. Mean angular displacement root mean square error between the systems across all tasks and segments was <5°. Mean differences in peak displacements were generally acceptable (<5°) for the femur, tibia, and pelvis segments for all tasks; however, the inertial system overestimated lumbar flexion compared to the motion camera system. These data suggest that the inertial system is capable of measuring angular displacements within 5° of a system widely accepted for its accuracy. Standardization of sensor placement, better attachment methods, and improvement of inertial sensor algorithms will further increase the accuracy of the system.

A Comparison of Walking Gait Following Mechanical and Kinematic Alignment in Total Knee Joint Replacement.

BACKGROUND: Although previous studies have compared radiological, pain, and function scores in kinematically aligned (KA) and mechanically aligned (MA) total knee arthroplasty (TKA), no previous studies have undertaken a three-dimensional (3D) gait analysis in these groups. This study compared kinematic and kinetic variables recorded during level walking in patients at least 2 years post-surgery who underwent an MA or KA procedure. METHODS: Utilizing a 9-camera motion analysis system, gait analysis was undertaken on 29 patients (MA = 15, KA = 14). A 9-camera motion analysis system was used to collect 3D kinematic data of the involved and uninvolved limbs during walking at a self-selected speed. Additionally, 3D ground reaction forces and moments during the stance phase were recorded, and an inverse dynamics approach was utilized to analyze these data. RESULTS: There were no significant differences in spatial-temporal variables between MA and KA groups (P > .05). Local minima and maxima for knee joint angles were not significantly different (P > .05) across involved and uninvolved legs and MA/KA groups in any of the 3 planes of motion. Principal component analysis revealed a significant difference (P < .05) in the transverse plane moment in late stance. No other significant differences were observed for knee, hip, or ankle joint moments. CONCLUSION: Differences in gait parameters across the KA and MA groups at 2 years post-surgery were insufficient to support either one of the operative procedures over the other.

Contour interpolated radial basis functions with spline boundary correction for fast 3D reconstruction of the human articular cartilage from MR images.

PURPOSE: The aim of this work is to demonstrate a new image processing technique that can provide a "near real-time" 3D reconstruction of the articular cartilage of the human knee from MR images which is user friendly. This would serve as a point-of-care 3D visualization tool which would benefit a consultant radiologist in the visualization of the human articular cartilage. METHODS: The authors introduce a novel fusion of an adaptation of the contour method known as "contour interpolation (CI)" with radial basis functions (RBFs) which they describe as "CI-RBFs." The authors also present a spline boundary correction which further enhances volume estimation of the method. A subject cohort consisting of 17 right nonpathological knees (ten female and seven male) is assessed to validate the quality of the proposed method. The authors demonstrate how the CI-RBF method dramatically reduces the number of data points required for fitting an implicit surface to the entire cartilage, thus, significantly improving the speed of reconstruction over the comparable RBF reconstruction method of Carr. The authors compare the CI-RBF method volume estimation to a typical commercial package (3d doctor), Carr's RBF method, and a benchmark manual method for the reconstruction of the femoral, tibial, and patellar cartilages. RESULTS: The authors demonstrate how the CI-RBF method significantly reduces the number of data points (p-value < 0.0001) required for fitting an implicit surface to the cartilage, by 48%, 31%, and 44% for the patellar, tibial, and femoral cartilages, respectively. Thus, significantly improving the speed of reconstruction (p-value < 0.0001) by 39%, 40%, and 44% for the patellar, tibial, and femoral cartilages over the comparable RBF model of Carr providing a near real-time reconstruction of 6.49, 8.88, and 9.43 min for the patellar, tibial, and femoral cartilages, respectively. In addition, it is demonstrated how the CI-RBF method matches the volume estimation of a typical commercial package (3d doctor), Carr's RBF method, and a benchmark manual method for the reconstruction of the femoral, tibial, and patellar cartilages. Furthermore, the performance of the segmentation method used for the extraction of the femoral, tibial, and patellar cartilages is assessed with a Dice similarity coefficient, sensitivity, and specificity measure providing high agreement to manual segmentation. CONCLUSIONS: The CI-RBF method provides a fast, accurate, and robust 3D model reconstruction that matches Carr's RBF method, 3d doctor, and a manual benchmark method in accuracy and significantly improves upon Carr's RBF method in data requirement and computational speed. In addition, the visualization tool has been designed to quickly segment MR images requiring only four mouse clicks per MR image slice.

Age-related differences do affect postural kinematics and joint kinetics during repetitive lifting.

BACKGROUND: Age is considered a risk factor for manual handling-related injuries and older workers incur higher injury-related costs than younger co-workers. This study investigated the differences between the kinematics and kinetics of repetitive lifting in two groups of handlers of different ages. METHODS: Fourteen younger (mean 24.4 yr) and 14 older (mean 47.2 yr) males participated in the study. Participants repetitively lifted a box weighing 13 kg at a frequency of 10 lifts/min for a maximum of 20 min. Postural kinematics (joint and lumbosacral angles and angular velocities) and kinetics (joint moments) were measured throughout the lifting task using motion analysis and ground reaction forces. Muscle fatigue of the erector spinae was assessed using electromyography. FINDINGS: Peak lumbosacral, trunk, hip and knee flexion angles differed significantly between age groups over the duration of the task, as did lumbosacral and trunk angular velocities. The younger group increased peak lumbar flexion by approximately 18% and approached 99% of maximum lumbosacral flexion after 20 min, whereas the older group increased lumbar flexion by 4% and approached 82% maximum flexion. The younger group had a larger increase in peak lumbosacral and trunk angular velocities during extension, which may be related to the increased back muscle fatigue observed among the younger group. INTERPRETATION: Older participants appeared to control the detrimental effects of fatigue associated with repetitive lifting and limit lumbar spine range of motion. The higher rates of musculoskeletal injury among older workers may stem from a complex interaction of manual handling risk factors.

Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review.

OBJECTIVE: To establish the effectiveness of eccentric exercise as a treatment intervention for lateral epicondylitis. DATA SOURCES: ProQuest, Medline via EBSCO, AMED, Scopus, Web of Science, CINAHL. REVIEW METHODS: A systematic review was undertaken to identify randomized and controlled clinical trials incorporating eccentric exercise as a treatment for patients diagnosed with lateral epicondylitis. Studies were included if: they incorporated eccentric exercise, either in isolation or as part of a multimodal treatment protocol; they assessed at least one functional or disability outcome measure; and the patients had undergone diagnostic testing. The methodological quality of each study was assessed using the Modified Cochrane Musculoskeletal Injuries Group score sheet. RESULTS: Twelve studies met the inclusion criteria. Three were deemed 'high' quality, seven were 'medium' quality, and two were 'low' quality. Eight of the studies were randomized trials investigating a total of 334 subjects. Following treatment, all groups inclusive of eccentric exercise reported decreased pain and improved function and grip strength from baseline. Seven studies reported improvements in pain, function, and/or grip strength for therapy treatments inclusive of eccentric exercise when compared with those excluding eccentric exercise. Only one low-quality study investigated the isolated effects of eccentric exercise for treating lateral epicondylitis and found no significant improvements in pain when compared with other treatments. CONCLUSION: The majority of consistent findings support the inclusion of eccentric exercise as part of a multimodal therapy programme for improved outcomes in patients with lateral epicondylitis.

Exercise therapy for the management of osteoarthritis of the hip joint: a systematic review.

INTRODUCTION: Recent guidelines pertaining to exercise for individuals with osteoarthritis have been released. These guidelines have been based primarily on studies of knee-joint osteoarthritis. The current study was focused on the hip joint, which has different biomechanical features and risk factors for osteoarthritis and has received much less attention in the literature. The purpose was to conduct a systematic review of the literature to evaluate the exercise programs used in intervention studies focused solely on hip-joint osteoarthritis, to decide whether their exercise regimens met the new guidelines, and to determine the level of support for exercise-therapy interventions in the management of hip-joint osteoarthritis. METHODS: A systematic literature search of 14 electronic databases was undertaken to identify interventions that used exercise therapy as a treatment modality for hip osteoarthritis. The quality of each article was critically appraised and graded according to standardized methodologic approaches. A 'pattern-of-evidence' approach was used to determine the overall level of evidence in support of exercise-therapy interventions for treating hip osteoarthritis. RESULTS: More than 4,000 articles were identified, of which 338 were considered suitable for abstract review. Of these, only 6 intervention studies met the inclusion criteria. Few well-designed studies specifically investigated the use of exercise-therapy management on hip-joint osteoarthritis. Insufficient evidence was found to suggest that exercise therapy can be an effective short-term management approach for reducing pain levels, improving joint function and the quality of life. CONCLUSIONS: Limited information was available on which conclusions regarding the efficacy of exercise could be clearly based. No studies met the level of exercise recommended for individuals with osteoarthritis. High-quality trials are needed, and further consideration should be given to establishing the optimal exercises and exposure levels necessary for achieving long-term gains in the management of osteoarthritis of the hip.

A framework for the classification and diagnosis of work-related upper extremity conditions: systematic review.

OBJECTIVE: A frequently cited problem in epidemiological research is the inadequate operational definition of umbrella terms such as Musculoskeletal Disorders (MSD). Specific conditions attached to these labels and their corresponding signs and symptoms are also poorly defined. The purpose of this study was to identify internationally applied terminology and definitions appropriate to work-related upper extremity (UE) conditions. METHODS: An extensive literature search of 15 electronic databases supplemented by personal communications with representatives from national and international health and safety organizations was undertaken to identify recognized terminology and definitions appropriate to work-related UE conditions. RESULTS: Information specific to the umbrella terms and their corresponding conditions was obtained from 15 countries. The findings revealed a lack of international consensus over appropriate terminology to encapsulate the wide range of conditions falling within the umbrella terms used by these countries. UE conditions could be classified into 3 broad categories: (1) 14 "specific conditions" with evidence-based diagnostic criteria; (2) 34 "other specific conditions" with no clearly defined diagnosis; and (3) "nonspecific conditions" requiring a clear pattern of signs and symptoms to be present for a diagnosis to be made. A dynamic model for classifying work-related UE conditions is proposed which places greater emphasis on specific diagnosis. CONCLUSIONS: A systematic approach to the classification and diagnosis of work-related UE conditions is attractive, as it is likely to lead to more precise estimates of the prevalence and cost of UE conditions, as well as improved quality of information on the efficacy of medical and workplace interventions.

The effects of prior exposure, warning, and initial standing posture on muscular and kinematic responses to sudden loading of a hand-held box.

BACKGROUND: Twelve percent of work-related low back injuries have been attributed to sudden loading events. When a sudden load is applied to an object that is held in front of the body, postural responses are rapid, yet it is not clear whether these responses differ with respect to initial posture at the time of loading, or by providing prior exposure to, or warning of a sudden loading event. METHODS: Thirty male subjects in either an upright or stooped standing posture held a pre-weighted box that was suddenly pulled downwards. Surface electromyography techniques were used to detect onset latencies of seven muscles of the right lower limb and trunk, and two-dimensional motion data in the sagittal plane were simultaneously collected. The first trial involved sudden unexpected loading in the upright standing posture, without any prior experience or warning of the loading event. This was followed by a series of randomised loading trials in the upright and stooped standing posture, with and without prior warning of the loading event. FINDINGS: Prior exposure and warning was found to influence postural responses in the upright standing posture, decreasing muscle and joint onset latencies, and resultant maximal angular displacement of the trunk and lower limb. Perturbation in the stooped posture was less reliant on abdominal muscle activation and produced an overall different joint movement initiation pattern, with less joint displacement than in the upright standing position. INTERPRETATION: These findings indicate that prior exposure to, and warning of a sudden loading event lead to changes in postural responses and decreased joint excursion. These changes may contribute to increased stability and decreased risk of musculoskeletal injury.