Successful fixation of an intertrochanteric fracture after hip resurfacing arthroplasty using cannulated screws.

We report a case of successful treatment of a high, stable intertrochanteric fracture (type 1) in a 59-year-old man. He sustained the injury 8 years after the resurfacing procedure. The fracture was fixed using three 6.5-mm cannulated screws, and he has returned to his normal level of activities 8 months after the fixation. We have shown that fixation with cannulated screws may be an acceptable option for treatment of high trochanteric fractures where a stable anatomical reduction can be obtained. We have also included a review of the literature for other reported surgical treatment options of this complication.

Factors related to early recovery rate after partial knee meniscectomy.

A main role of clinicians treating patients after orthopedic surgery is to inform patients about their anticipated recovery rate and recovery endpoint. In estimating recovery rate, clinicians consider a series of potentially influencing factors, including the type and severity of injury and the characteristics of the patient. Unfortunately, this is done largely without evidence to support factors believed to be important in recovery rate. To our knowledge, no studies exist where factors that might influence recovery rate after arthroscopic partial meniscectomy have been evaluated. Eighty-three patients (11 women and 72 men) were evaluated 4 days after and then again 6 weeks after knee arthroscopic partial meniscectomy surgery. Recovery rate was calculated by dividing the change in a patient's Hughston Clinic knee self-assessment questionnaire during this period by his or her baseline Hughston score and relationships to independent variables (gender, age, body mass index [BMI], injury chronicity, affected meniscus, Hughston Clinic knee self-assessment score at baseline, knee flexion passive range of motion, and knee circumference). These were evaluated using backward stepwise regression analysis. The relationship between recovery rate and the independent variables was statistically significant (P,.05) for the following variables: injury chronicity, gender, and gender/injury type combination. The most unexpected finding in this study was the statistically nonsignificant relationship between recovery rate and the following variables: age, Hughston score, BMI, knee swelling, and knee flexion passive range of motion loss.

Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy.

BACKGROUND AND PURPOSE: Controversy exists about the effectiveness of physical therapy after arthroscopic partial meniscectomy. This randomized controlled trial evaluated the effectiveness of supervised physical therapy with a home program versus a home program alone. SUBJECTS: Eighty-four patients (86% males; overall mean age=39 years, SD=9, range=21-58; female mean age=39 years, SD=9, range=24-58; male mean age=40, SD=9, range=21-58) who underwent an uncomplicated arthroscopic partial meniscectomy participated. METHODS: Subjects were randomly assigned to either a group who received 6 weeks of supervised physical therapy with a home program or a group who received only a home program. Blinded test sessions were conducted 5 and 50 days after surgery. Outcome measures were: (1) Hughston Clinic questionnaire, (2) Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and EuroQol EQ-5D (EQ-5D) questionnaires, (3) number of days to return to work after surgery divided by the Factor Occupational Rating System score, (4) kinematic analysis of knee function during level walking and stair use, and (5) horizontal and vertical hops. RESULTS: No differences between groups were found for any of the outcomes measured. DISCUSSION AND CONCLUSION: The results indicate that the supervised physical therapy used in this study is not beneficial for patients in the early period after uncomplicated arthroscopic partial meniscectomy.

Effects of distally fixated versus nondistally fixated leg extensor resistance training on knee pain in the early period after anterior cruciate ligament reconstruction.

BACKGROUND AND PURPOSE: Nondistally fixated (ie, what is often referred to as "open kinetic chain" [OKC]) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism. In this randomized, single-blind clinical trial, nondistally fixated versus distally fixated (ie, often called "closed kinetic chain" [CKC]) leg extensor training were compared for their effects on knee pain. SUBJECTS: Forty-three patients recovering from anterior cruciate ligament (ACL) reconstruction surgery (34 male, 9 female; mean age=29 years, SD=7.9, range=16-54). METHODS: Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self-assessment questionnaire and during maximal isometric contractions of the knee extensors. Between test sessions, subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy. RESULTS: No differences in knee pain were found between the treatment groups. DISCUSSION AND CONCLUSION: Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain. Based on these findings, further studies are needed using different exercise dosages and patient groups.

Case report: bilateral slipped capital femoral epiphyses and hormone replacement.

A 24-year-old woman presented with an 11-year history of bilateral hip pain. Radiographs of the hips revealed severe bilateral slipped upper femoral epiphyses; the left side was more severely slipped than the right. While moving the hips under fluoroscopy we observed motion at the physes and reproduced the patient's pain; the motion confirmed the diagnosis of chronic slipped capital femoral epiphysis. Endocrinology tests showed hypothyroidism. After 1 year of thyroxin therapy, the patient's pain subsided and radiographs of the hips showed fusion of the physes. This case emphasizes the importance of screening for an endocrine disorder in patients with slipped capital femoral epiphysis particularly in adults and shows fusion can occur once the underlying endocrine abnormality is treated.

Knee extensors kinetic chain training in anterior cruciate ligament deficiency.

Open kinetic chain (OKC) knee extensor resistance training has lost favour in rehabilitation of patients with knee ACLD due to concerns that this exercise is harmful to the remaining portion of the ACL and its secondary stabilizers, and will be less effective in improving function. In this randomized, single-blind clinical trial, closed and OKC knee extensor training were compared for their effects on knee laxity and function in patients with ACLD knees. Sixty-four patients with a diagnosis of knee ACLD (49 M, 15 F; mean age=30 years) were measured for knee laxity, using a ligament arthrometer, and function with the Hughston Clinic knee self-assessment questionnaire and maximal effort single leg jump testing. Between the above tests and identical tests carried out 6 weeks later, subjects trained using either open or closed kinetic chain resistance of their knee and hip extensors as part of formal physical therapy sessions three times per week for 6 weeks. The groups exhibited no statistically significant differences (p<0.083) in outcome. These results indicate that knee extensor OKC training, as used in this study, can be safely applied to patients with knee ACL deficiency, and shows no superiority to CKC training.