[Conservative treatment of congenital patellar dislocation]. / Konservative Therapie bei kongenitaler Patellaluxation.

This article presents the rare case of a boy who was born in our hospital with valgus deformity and external rotation of the right lower leg because of congenital patellar dislocation. In the case presented a stable repositioning of the patella could be achieved by redressment with a plaster cast and leg brace. During a 4-year follow-up there were no tendencies towards dislocation during the clinical examination and no dislocation events were documented. In selected cases an attempt at conservative repositioning and retention treatment appears to be worthwhile before surgical treatment is indicated.

Congenital fibular deficiency.

Congenital fibular deficiency (CFD) is characterized by a wide spectrum of manifestations ranging from mild limb length inequality (LLI) to severe shortening, with foot and ankle deformities and associated anomalies. The etiology of CFD remains unclear. Treatment goals are to achieve normal weight bearing, a functional plantigrade foot, and equal limb length. The recent Birch classification system has been proposed to provide a treatment guide: the functionality of the foot, LLI, and associated anomalies should be taken into account for decision-making. Treatment options include orthosis or epiphysiodesis, Syme or Boyd amputation and prosthetic rehabilitation, limb lengthening procedures, and foot and ankle reconstruction. The outcome of amputation for severe forms of CFD has shown favorable results and fewer complications compared with those of limb lengthening. Nevertheless, advances in the limb lengthening techniques may change our approach to treating patients with CFD and might extend the indications for reconstructive procedures to the treatment of severe LLI and foot deformities.

Effects of an elastic resistance band exercise program on kinetics and muscle activities during walking in young adults with genu valgus: A double-blinded randomized controlled trial.

BACKGROUND: This double-blinded randomized-controlled-trial aimed to identify the effects of an elastic band resistance training on walking kinetics and muscle activities in young adults with genu valgus. METHODS: Forty-two male young adults aged 22.5(2.7) years with genu valgus were randomly allocated to two experimental groups. The intervention group (n = 21) conducted a 14-weeks elastic band resistance training. The control group was passive during the intervention period and received the same treatment after the post-tests. Pre and post training, ground reaction forces and lower limb muscle activities were recorded during walking. FINDINGS: Results revealed significant group-by-time interactions for peak medial ground reaction force and time-to-peak for posterior ground reaction force in favor of the intervention group (p < 0.012; d = 0.83-3.76). Resistance training with elastic bands resulted in significantly larger peak medial ground reaction force (p < 0.001; d = 1.45) and longer time-to-peak for posterior ground reaction force (p < 0.001; d = 1.85). Finding showed significant group-by-time interactions for peak positive free moment amplitudes in favor of the intervention group (p < 0.001; d = 1.18-2.02). Resistance training resulted in a lower peak positive free moment amplitude (p = 0.001; d = 1.46). With regards to muscle activities, the analysis revealed significant group-by-time interactions for rectus femoris and gluteus medius activities during the push-off phase in favor of the intervention group (p < 0.038; d = 0.68-0.89). Resistance training induced higher rectus femoris (p = 0.038; d = 0.84) and gluteus medius (p = 0.007; d = 0.54) activities. INTERPRETATION: This study proved the effectiveness of resistance training using elastic bands on kinetics and muscle activities during walking in male adults with genu valgus disorder. Given that this training regime is low cost, effective, and easy-to-administer, we suggest that it should be implemented as a rehabilitative or preventive means for young adults with genu valgus.

Immediate effects of valgus knee bracing on tibiofemoral contact forces and knee muscle forces.

Background Valgus knee braces have been reported to reduce the external knee adduction moment during walking. However, mechanistic investigations into the effects of valgus bracing on medial compartment contact forces using electromyogram-driven neuromusculoskeletal models are limited. Research question What are the immediate effects of valgus bracing on medial tibiofemoral contact forces and muscular loading of the tibiofemoral joint? Methods Sixteen (9 male) healthy adults (27.7 ± 4.4 years) performed 20 over-ground walking trials at self-selected speed both with and without an Ossür Unloader One® brace. Assessment order (i.e., with or without brace) was randomised and counterbalanced to prevent order effects. While walking, three-dimensional lower-body motion, ground reaction forces, and surface electromyograms from eight lower-limb muscles were acquired. These data were used to calibrate an electromyogram-driven neuromusculoskeletal model of muscle and tibiofemoral contact forces (N), from which muscle and external load contributions (%) to those contact forces were determined. Results Although walking with the brace resulted in no significant changes in peak tibiofemoral contact forces at the group-level, individual responses were variable and non-uniform. At the group-level, wearing the brace resulted in a 2.35% (95% CI 0.46-4.24; p = 0.02) greater relative contribution of muscle to lateral compartment contact loading (54.2 ± 11.1%) compared to not wearing the brace (51.8 ± 12.1%) (p < 0.05). Average relative contributions of muscle and external loads to medial compartment loading were comparable between brace and no brace conditions (p ≥ 0.05). Significance Wearing a valgus knee brace did not immediately reduce peak tibiofemoral contact forces in healthy adults during normal walking. It appears this population may modulate muscle activation patterns to support brace-generated valgus moments, thereby maintaining normal walking knee moments and tibiofemoral contact forces. Future investigations are warranted to better understand effects of valgus knee brace in people with medial knee osteoarthritis using an electromyogram-driven neuromusculoskeletal model.

Effects of a knee valgus unloader brace on medial femoral articular cartilage deformation following walking in varus-aligned individuals.

BACKGROUND: Knee varus alignment may increase loading in the medial tibiofemoral compartment, which can increase strain on the articular cartilage. Knee valgus unloader braces seek to reduce loading through the medial femoral compartment, but their effects on cartilage characteristics during dynamic tasks have not been evaluated. OBJECTIVE: To determine the effects of a knee valgus unloader brace on medial femoral articular cartilage deformation following a single 5000-step walking protocol in individuals with varus-knee alignment. METHODS: Twenty-four healthy individuals (63% female, BMI = 22 ±â€¯3 kg/m2, age = 21 ±â€¯3 years) completed two testing sessions (braced and unbraced) separated by one week. During both sessions, femoral cartilage ultrasound images were acquired prior to and following a 5000-step treadmill walking protocol at self-selected speed. Percent change scores in medial cartilage cross-sectional area (MCCA) were calculated and used as the primary outcome, and compared between the braced and unbraced conditions. RESULTS: There was no difference in percent change of MCCA between conditions (braced = -2.77%, unbraced = -3.15%, p = 0.699). Individuals whose cartilage deformed more than a previously established minimal detectable change (MDC ≥ 1.58 mm2) deformed less during the braced condition (braced = -2.94%, unbraced = -6.34%, p = 0.028), compared to individuals who did not deform greater than the MDC (n = 15, braced = -2.67%, unbraced = -1.23%, p = 0.210). CONCLUSIONS: There was no significant difference in MCCA percent change between the braced and unbraced conditions across the entire cohort; yet a valgus unloader braces may serve as a potential intervention strategy for reducing articular cartilage deformation in certain varus-aligned individuals who normally undergo measurable deformation during walking.

Efficacy of Injury Prevention Training Is Greater for High-Risk vs Low-Risk Elite Female Youth Soccer Players.

BACKGROUND: The efficacy of robustness training for high- versus low-risk individuals within high-risk groups is currently unknown. PURPOSE: To explore the efficacy of robustness training on injury risk factors among female youth soccer players and to examine if high-risk athletes are greater responders to such training. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 125 elite youth female soccer players on the English FA talent pathway were randomly selected into a training group (n = 71) or a control group (n = 54). Relative leg stiffness, 2-dimensional knee valgus and knee flexion range of motion from a single-legged countermovement jump, and probability of high knee abduction moment (pKAM) risk were all determined before and after a 16-week robustness training program. For further analysis, participants in the training group were split into groups based on risk: high risk (pKAM >0.80, n = 33) and low risk (pKAM <0.55, n = 33). Magnitude-based inferences were used to explore differences between the control and intervention groups and the high- and low-risk groups. RESULTS: Magnitude-based inferences demonstrated significant beneficial effects in the training group for knee valgus, pKAM, and leg stiffness as compared with the control group. The control group demonstrated possible worthwhile differences in knee flexion range of motion as compared with the intervention group. The high-risk group demonstrated likely/very likely worthwhile differences versus the low-risk group for all parameters. CONCLUSION/CLINICAL RELEVANCE: Robustness training induces significant beneficial improvements in injury risk factors among female youth soccer players. The beneficial effects of this multidimensional program are greater for those classified as high risk.

Relationship between knee alignment in asymptomatic subjects and flexibility of the main muscles that are functionally related to the knee.

Objective To assess the relationship between static frontal knee alignment in asymptomatic subjects and flexibility of the main muscles functionally related to the knee. Methods A descriptive cross-sectional study was performed in 33 healthy adults (19-31 years). The frontal knee angle (valgus/varus angle) was measured by photogrammetry and it was measured in the lateral side. Therefore, high values were assigned for genu varum and low values for genu valgum. Iliopsoas, gluteus maximus and medius, rectus femoris, biceps femoris, vastus of the quadriceps, and gastrocnemius muscles were stretched. Muscles were classified as normal, reflex hypomobile, or structural hypomobile. Results Women had significantly greater valgus than did men (right angle, women: 174.41°/men: 177.41°; left angle, women: 174.20°/men: 178.70°). The right frontal plane knee angle was higher in women with structural hypomobile vastus. The left frontal plane knee angle was higher in women with structural hypomobile iliopsoas. No relationships were found in men. Conclusions A tighter vastus of the quadriceps and tighter iliopsoas are related to greater genu varum in adult women. Stretching the vastus of the quadriceps and iliopsoas when there is a tendency for excess varus in the knee, to prevent overuse injury or early osteoarthritis, might be clinically relevant.

[Crooked legs- just an aesthetic problem]. / Krumme Beine - mehr als ein ästhetisches Problem?

Because the lower extremities are weight bearing, malalignment plays a key role in the development of degenerative disease of the joints. This is particularly true as degenerative arthropathy is of mechanical and not inflammatory cause. Deviation of the axis has been shown to alter the load and force distribution in the joint and thereby causing excessive wear. Whether or not a deformity is clinically relevant or not depends on the symptoms, the amount of the deformity and the location of the deformity. Relevant deformities can be treated with orthotics or corrective osteotomies in early stages. In late stages fusions or joint replacement is the mainstay of treatment.

Parce que les extrémités inférieures portent un poids, un mauvais alignement de ces dernières joue un rôle clé dans le développement des atteintes dégénératives des articulations. Cela est particulièrement vrai puisque l'arthropathie dégénérative est d'origine mécanique et non pas inflammatoire. Une déviation axiale a été montrée modifier la répartition des charges et des forces dans l'articulation et provoquer ainsi un poids excessif. Qu'une déformation soit significative ou non sur le plan clinique dépend des symptômes, de l'importance et de la localisation de la déformation. Les déformations significatives peuvent être traitées dans des stades précoces par des ostéotomies orthotiques ou correctrices. Dans les stades tardifs des fusions ou des remplacements articulaires représentent les options thérapeutiques principales.

[Genu valgum after proximal metaphyseal tibial fracture in children]. / Genu valgum som følge af proksimal metafysær tibiafraktur hos børn.

Valgus deformity after fracture of the proximal part of the tibia in children was first reported in 1953 by Cozen. Since that time, numerous reports describing this entity have appeared in the literature. There is no consensus regarding the aetiology or the treatment of this posttraumatic deformity. We would like to recommend an algorithm, how to approach and address this complication.