The test-retest reliability and concurrent validity of 360° turn test in patients with knee osteoarthritis.

PURPOSE: The aim of this study is to determine whether the 360° turn test is a reliable and valid evaluator that can be used to assess dynamic balance in patients with early (radiographic grades I and II) and advanced (radiographic grades III and IV) knee osteoarthritis. MATERIALS AND METHODS: This study is a methodological research. For the test time and step count of 360° turn test; test-retest reliability were determined by calculating the intraclass correlation coefficient and concurrent validity in patients with knee osteoarthritis was investigated by correlation with the timed up and go test time. RESULTS: The final analysis was made on 117 participants. The intraclass correlation coefficient values for the test time and step count of 360° turn test in patients with early knee osteoarthritis are 0.931 and 0.902, respectively, while they are 0.923 and 0.943 in patients with advanced knee osteoarthritis. The Pearson correlation coefficients between the time and step count of 360° turn test and the test time of the timed up and go test in patients with early knee osteoarthritis, respectively; while they are 0.547 and 0.388, the correlation in patients with advanced knee osteoarthritis are 0.697 and 0.700, respectively (p < 0.01). CONCLUSIONS: The 360° turn test is a evaluator that has excellent test-retest reliability and moderate to strong concurrent validity in patients with both early and advanced knee osteoarthritis and can be used in the assessment of dynamic balance in this population.

Biomechanical Comparison of a Closed-Loop Double Endobutton to a Lag Screw in Fixation of Posterior Malleolar Fractures.

Anteroposterior (AP) lag screw, posteroanterior (PA) lag screw, or posterior buttress plate are usually performed for posterior malleolar fixation, but the biomechanically strongest technique is unclear. The aim of our study was to biomechanically compare 3 different fixation methods for posterior malleolar fractures; AP lag screw, PA lag screw, and closed-loop double endobutton. Fracture models were created using a thin blade power saw after drawing the fracture line. The resultant fracture involved 30% of the joint on the distal tibial joint surface and extends with an angulation of approximately 50 degrees using 15 tibia composite bone samples. After anatomical reduction, fixation was achieved with 3.5 mm cortical screw in PA direction and in AP direction for group PA and AP, respectively. In Group DL, fixation was achieved with a closed-loop double endobutton (double lift loop, Orthomed, Turkey). The highest compression force to generate all displacement amounts was required for the double loop group (Group DL). The strongest fixation against compression was a double loop. The PA group was the second strongest fixation, and the AP group was the biomechanically weakest among these 3 fixation techniques. The closed-loop double endobutton technique was found biomechanically superior to anterior to posterior or posterior to anterior screw fixation techniques for posterior malleolar fracture.

Active heel-slide exercise therapy facilitates the functional and proprioceptive enhancement following total knee arthroplasty compared to continuous passive motion.

PURPOSE: The aim was to compare active heel-slide exercise (AHSE) + standard physiotherapy (PT) to continuous passive motion (CPM) + standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of postoperative outcomes. METHODS: Patients were randomly assigned into AHSE or CPM groups. Both groups received standard PT (range of motion and strengthening exercises, and ambulation) during hospital stay. Patients were evaluated regarding functional outcomes, knee proprioception, pain intensity, active range of motion, knee circumference, length of hospital stay, time for achieving straight leg raise actively, time for achieving 70° knee flexion. RESULTS: Groups were similar at baseline (n.s.). At discharge, AHSE group was better in terms of pain intensity (p < 0.001), Hospital for Special Surgery knee score (p = 0.001), rise from sitting (p = 0.015), ascend/descend stairs (p = 0.038), and timed up and go test (p = 0.028) compared to CPM group. AHSE group was able to perform the straight leg raise earlier than CPM group during inpatient period (p = 0.001) and demonstrated improved proprioception at discharge and at 3-month follow-up (p < 0.05). No statistical differences were detected between groups in other evaluation parameters (n.s.). CONCLUSION: Our findings support AHSE therapy offers a more functional rehabilitation and leads beneficial results for patients following TKA. Therefore, active exercise approach encouraging patients to participate in their rehabilitation should be first choice in acute postoperative rehabilitation following TKA rather than CPM. LEVEL OF EVIDENCE: II.

Measurement of regional trabecular bone attenuation of the knee following anterior cruciate ligament rupture.

INTRODUCTION: The purpose of this study was to determine regional trabecular bone attenuation changes of the knee using computed tomography after anterior cruciate ligament rupture. MATERIALS AND METHODS: Thirty one patients'-computed tomography images of the injured knees were used to measure trabecular bone attenuation in seven predetermined regions. RESULTS: Trabecular bone attenuation at four of seven regions (anteromedial area of the proximal tibia, anterolateral area of the proximal tibia, posteromedial area of the proximal tibia, and posterocentral area of the proximal tibia) was negatively correlated with the duration after injury. Independent negative correlation between the duration after injury and the density in anteromedial area of the proximal tibia was detected. CONCLUSIONS: After anterior cruciate ligament injury, trabecular bone attenuation of the knee decreases by time in certain regions of proximal tibia. Anteromedial region is the most significantly effected of all, which it is the anterior cruciate ligament fixation area.

The effect of inclination angle on the strength of vertical mattress configuration for meniscus repair.

PURPOSE: Vertical mattress configuration is the strongest of all other configurations and the repairing devices of meniscus repair. The purpose was whether increasing the inclination angle between two strands of the vertical mattress configuration by increasing the amount of meniscus tissue captured would enhance the initial strength of the construction. METHODS: A 2-cm long anteroposterior vertical longitudinal incision was created in two groups of bovine medial menisci. In the first group, the distance between the two vertical suture strands and the vertical horizontal sutures on the capsular side of the meniscal lesion was 2 mm (Group 1). In the second group, the distance was 5 mm (Group 2). The following repair specimens underwent cyclic loading prior to loading the failure testing. The endpoints included ultimate failure load (N), stiffness (N/mm) and cyclic displacement (mm) after the 100 cycles and the mode of failure. RESULTS: Group 1 (2 mm) (90.7 (±19.9) N) had lower ultimate load than Group 2 (5 mm) (120.8 (±24.5)) (P < 0.05). Stiffness and displacements during the cycling were not different between the groups (n.s.). All specimens failed by suture rupture. CONCLUSION: Increased inclination angle with increased distance between the two vertical suture strands on the capsular side of the meniscal lesion resulted in higher failure load compared to control group with lower inclination angle and distance on the capsular side.

Mechanical Comparison of Headless Screw Fixation and Locking Plate Fixation for Talar Neck Fractures.

For talar neck fractures, open reduction and internal fixation have been thought to facilitate revascularization and prevent osteonecrosis. Newer screw systems allow for placement of cannulated headless screws, which provide compression by virtue of a variable pitch thread. The present study compared the biomechanical fixation strength of cannulated headless variable-pitch screw fixation and locking plate fixation. A reproducible talar neck fracture was created in 14 fresh cadaver talar necks. Talar head fixation was then performed using 2 cannulated headless variable-pitch 4-mm/5-mm diameter (4/5) screws (Acutrak; Acumed, Hillsboro, OR) and locking plate fixation. Headless variable-pitch screw fixation had lower failure displacement than did locking plate fixation. No statistically significant differences were found in failure stiffness, yield stiffness (p = .655), yield load (p = .142), or ultimate load between the 2 fixation techniques. Cannulated headless variable-pitch screw fixation resulted in better failure displacement than locking plate fixation in a cadaveric talus model and could be considered a viable option for talus fracture fixation. Headless, fully threaded, variable-pitch screw fixation has inherent advantages compared with locking plate fixation, because it might cause less damage to the articular surface and can compress the fracture for improved reduction. Additionally, plate fixation can increase the risk of avascular necrosis owing to the wider incision and dissection of soft tissues.

Short-term clinical outcomes after first metatarsal head resurfacing hemiarthroplasty for late stage hallux rigidus.

The purpose of the present study was to evaluate the short-term results of metatarsal head resurfacing hemiarthroplasty in the treatment of advanced hallux rigidus. We reviewed 14 consecutive patients (5 males [35.71%], 9 females [64.29%]; mean age, 58.7 ± 7.4 years). These patients underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP(®)) for hallux rigidus from March 2010 to September 2012 at our institution. According to the Coughlin and Shurnas clinical and radiographic classification, 10 feet (71.43%) were classified as grade III and 4 (28.57%) as grade IV. We clinically rated all patients before surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal scale, the visual analog scale for pain, and first metatarsophalangeal joint (MTPJ) range of motion. The mean follow-up duration was 24.2 ± 7.2 (range 12 to 36) months. The mean preoperative hallux metatarsophalangeal-interphalangeal scale score was 33.9 ± 9.8 (range 22 to 59), and it increased to 81.6 ± 10.1 (range 54 to 96; p < .05) postoperatively. The mean preoperative 10-cm visual analog scale for pain score was 8.4 ± 0.9 (range 7 to 10), which decreased to 1.21 ± 1.2 (range 0 to 5; p < .05) postoperatively. The mean preoperative MTPJ range of motion was 22.8° ± 7.7° (range 15° to 45°), which increased to 69.6° ± 11.8° (range 50° to 90°; p < .05) postoperatively. None of the 14 patients experienced component malalignment or loosening, infection, or neurovascular compromise during the follow-up period. One patient (7.14%) experienced postoperative pain and subsequently underwent first MTPJ arthrodesis. From the results of our investigation, first MTPJ arthroplasty is an effective treatment modality that can reduce pain and increase motion in the case of advanced hallux rigidus.

Effects of Eccentric Versus Concentric Strengthening in Patients With Subacromial Pain Syndrome: A Randomized Controlled Trial.

BACKGROUND: Subacromial pain syndrome (SPS) is the most common cause of shoulder pain. Therapeutic exercise is the first-line treatment for SPS; however, the ideal exercise type remains unclear. Here, we compared the effects of eccentric and concentric strengthening in patients with SPS. HYPOTHESIS: Adding isolated eccentric strengthening to a multimodal physiotherapy program (MPP) would lead to greater improvements in outcomes compared with either MPP alone or adding isolated concentric strengthening to the MPP. STUDY DESIGN: Randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 45 patients were randomized to eccentric strengthening (ESG), concentric strengthening (CSG), and control (CG) groups; all groups received the MPP. The strengthening groups also performed group-specific strengthening. Shoulder pain, abduction and external rotation (ER) strength, joint position sense (JPS), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand score were collected at baseline, after 12 weeks of treatment, and at week 24. RESULTS: For CMS, ESG exhibited a greater, but not clinically meaningful, improvement than CSG and CG (P < 0.05). Eccentric abduction strength increased in ESG compared with CG. From baseline to follow-up, abduction strength increased in ESG compared with CSG and CG. Eccentric abduction strength increased in CSG compared with CG. JPS at abduction improved in the ESG compared with CG. Other between-group comparisons were not significant (P > 0.05). CONCLUSION: In SPS, eccentric strengthening provided added benefits, improving shoulder abduction strength and JPS at abduction, and was superior to concentric strengthening for improving shoulder abduction strength. Neither strengthening approach had an additional effect on shoulder function, pain, ER strength, or rotational JPS. CLINICAL RELEVANCE: Clinicians could implement eccentric strengthening as a motor control retraining for strength and proprioception gain rather than for pain relief and reducing disability.

Novel Posterior Shoulder Stretching With Rapid Eccentric Contraction and Static Stretching in Patients With Subacromial Pain Syndrome: A Randomized Trial.

BACKGROUND: In subacromial pain syndrome (SPS), it is unknown whether posterior shoulder stretching exercises (PSSE) with rapid eccentric contraction, a muscle energy technique, improve clinical and ultrasonographic outcomes more than no stretching or static PSSE. HYPOTHESIS: PSSE with rapid eccentric contraction is superior to no stretching and static PSSE in improving clinical and ultrasonographic outcomes in SPS. STUDY DESIGN: Randomized controlled trial. LEVEL OF EVIDENCE: Level 1. METHODS: Seventy patients with SPS and glenohumeral internal rotation deficit were randomized into the modified cross-body stretching with rapid eccentric contraction group (EMCBS; n = 24), static MCBS group (SMCBS; n = 23), or control group (CG; n = 23). In addition to 4-week physical therapy, EMCBS received PSSE with rapid eccentric contraction, SMCBS static PSSE, and CG no PSSE. The primary outcome was internal rotation range of motion (ROM). Secondary outcomes were posterior shoulder tightness, external rotation ROM (ERROM), pain, modified Constant-Murley score, short form of the disabilities of the arm, shoulder, and hand questionnaire (QuickDASH), rotator cuff strength, acromiohumeral distance (AHD), supraspinatus tendon thickness, and supraspinatus tendon occupation ratio (STOR). RESULTS: Shoulder mobility, pain, function and disability, strength, AHD, and STOR improved in all groups (P < 0.05). CONCLUSION: In patients with SPS, PSSE with rapid eccentric contraction and static PSSE were superior to no stretching in improving clinical and ultrasonographic outcomes. Stretching with rapid eccentric contraction was not superior to static stretching, but improved ERROM compared with no stretching. CLINICAL RELEVANCE: In SPS, both PSSE with rapid eccentric contraction and static PSSE included in physical therapy program are beneficial to improve posterior shoulder mobility and other clinical and ultrasonographic outcomes. In the case of ERROM deficiency, rapid eccentric contraction might be preferred.

Strength of different Krackow stitch configurations using high-strength suture.

The purpose of the present study concerning high-strength sutures was to determine whether increasing the number of locking loops with different size sutures or decreasing the suture size with increased suture strands would have any influence on the strength of Achilles tendon repair. A total of 32 fresh bovine Achilles tendon specimens were randomly assigned to 4 groups. For 3 of the groups, 1 suture was used (no. 2 or no. 5 FiberWire™ with 2 or 4 Krackow locking loops). For the fourth group, 2 sutures (2-0 FiberWire™) with 2 locking loops were used. After repair, the study groups underwent cyclic loading (0 to 200 N, 200 cycles) and then underwent tension to failure in a testing machine. Cyclic elongation, peak to peak displacement, ultimate load, stiffness, and failure mode were recorded for each specimen. The tendon width and thickness were measured in all specimens. The mean width, thickness, cyclic displacement, load to failure, and pull-out stiffness showed no differences among the 4 groups. The cyclic peak to peak displacements (0.01 ± 0.01 mm) were smallest with the no. 5 suture with 4 locking loops (p < .05), with no failure during cyclic loading, unlike in the other groups. In the group with 2-0 suture with 4 strands and 2 locking loops, 6 failed during cyclic loading. The number of locking loops used might have had an influence on the strength of the Krackow suture configuration using the larger diameter, high-strength sutures. However, decreasing the suture diameter, with a simultaneous increase in the number of strands, failed to improve the initial strength of the repair.

The test-retest reliability and concurrent validity of performance-based task tests in patients with knee osteoarthritis.

BACKGROUND: The measurement tool used for an accurate balance assessment should produce valid and reliable results in the population in which it is used. OBJECTIVES: To examine whether two performance-based task tests are a reliable and valid measurement test to assess balance in patients with early and advanced knee osteoarthritis (KO). DESIGN: Reliability and concurrent validity research. METHOD: Test-retest reliability by calculating the intraclass correlation coefficient (ICC) between the first and second trial periods of performance-based task tests (Alternate Step Test & Pen Pick up Test); their correlations with the Timed Up and Go Test (TUGT) were calculated and their concurrent validity in balance assessment were examined. RESULTS: A total of 100 patients (75% women, 25% men, mean 59 ± 10 years) with KO, 50 early (54 ± 7 years, 34 women, 16 men) and 50 advanced (64 ± 9 years, 41 women, 9 men), participated in the study. The ICC values for the Alternate Step Test (AST) and Pen Pick up Test (PPT) in patients with early KO are 0.881 (0.747-0.939, 95% confidence intervals) and 0.815 (0.689-0.892, 95% confidence intervals), respectively, while it is 0.852 (0.752-0.913, 95% confidence intervals) and 0.861 (0.756-0.922, 95% confidence intervals) in patients with advanced KO. Pearson correlation coefficient between AST & PPT times and TUGT time in patients with early and advanced KO was in the range of 0.535-0.746 (p < 0.01). CONCLUSIONS: Both task tests are reliable and valid clinical measurement tests that can be used to assess balance in patients with both early and advanced KO.

A Novel Plate for Vertical Shear Fractures of Medial Malleolus: A Biomechanical Study.

BACKGROUND: This study aims to evaluate and compare stiffness and the load to failure values of our novel medial malleolus compression plate (MP) and 3,5mm 1/3 tubular plate (TP) in the treatment of vertical shear fractures of medial malleolar fractures. METHODS: Fourteen identical synthetic third generation composite polyurethane bone models of right distal tibia were randomly separated into two groups. Fracture models were created with a custom-made osteotomy guide to provide the same fracture characteristics in every sample (AO OTA type 44A2). Fractures were reduced and novel medial malleolus compression plate was applied to bone models in MP group and tubular plate was applied to TP group. All samples were evaluated biomechanically, force/displacement and the load to failure values were recorded. RESULTS: The force required to create displacement in MP group was twice of that of the TP group. There was a significant difference between two groups in all amounts of displacement (p = .006, p = .005, p = .007 and .015 for 0.5, 1.0, 1.5, and 2.0 mm, respectively). CONCLUSIONS: In the treatment of vertical shear fractures of the medial malleolus, the strength of fixation with the novel medial malleolar compression plate is biomechanically higher than the one-third semi-tubular plate.

The Effect of Radial Extracorporeal Shock Wave Therapy in the Treatment of Trigger Finger.

Objective The aim of this study was to investigate the effect of radial extracorporeal shock wave therapy (rESWT) on the treatment of trigger finger. Methods Eighteen patients, who were 2nd grade according to Quinnel classification and diagnosed with trigger finger, were included in this prospective cohort clinical study. The study consisted of only the experimental group and no control group. Eighteen patients with trigger fingers were applied to ten sessions, twice a week, for five weeks of rESWT (2000 impulses, 2 bar, 10 Hz). Pain scores (Numeric Pain Rating Scale), general functional capacity (Quick-DASH), range of motion, grip strength, and pinch strength were evaluated before treatment, after treatment, and three months after the treatment. Results Evaluation of ten sessions of rESWT that applied twice a week, for five weeks, was made before treatment, after treatment, and three months after the treatment. Statistical analyses were performed with the Friedman test. As a result of the analyses, there was a decrease in the pain levels (p < 0.001) and increase in general functional capacity, grip strength and pinch strength (p < 0.001), and range of motion (p < 0.001; p < 0.005). After the treatment and after three months, all outcome measures showed statistically significant improvements. Conclusion rESWT is an effective method to decrease pain severity and improve general functional capacity, range of motion, grip strength, and pinch strength in patients with trigger finger. We concluded that the treatment of rESWT might be a non-invasive option to treat the trigger finger. However, randomized controlled trials are needed to provide more evidence of this treatment.

Comparison of Radial Extracorporeal Shock Wave Therapy in Plantar Fasciitis Treatment Using Two Different Frequencies.

Objective To compare results of two different frequencies and densities of radial extracorporeal shock wave therapy (rESWT) after 10 sessions. Methods A total of 41 patients with plantar fasciitis were included in this study. Patients were randomly divided into two groups. Both groups were administered 10 sessions of treatment consisting of 15 Hz frequency, 3.0 Bar density and 2000 impulses/ session for the 1st group, and 10 Hz frequency, 2.0 Bar density and 2000 impulses/ session for the 2nd group. Visual analog scale (VAS) and a modification of the clinical rating system of the American Orthopedic Foot and Ankle Society (AOFAS) were used for outcome measurement. The patients were assessed before treatment and followed up four weeks, and 12 weeks after end of treatment. Results Mean VAS scores were reduced after rESWT from 7.52 ± 2.34 (mean ± SEM) at baseline to 0.57 ± 0.68 at 12 weeks in the 1st group and from 6.45 ± 2.04 at baseline to 0.40 ± 0.60 at 12 weeks in the 2nd group. Similar changes were found for mean AOFAS scores from baseline after rESWT but were not observed significance between groups. Conclusion There is no significant different effect between the two treatment groups' results.

An Unusual Presentation of Insert Dislocation and MCL Rupture in Unicompartmental Knee Replacement with 2 Years Postoperative Results: Does It Functional?

According to our knowledge, there is no prior article that reports functional results of medial collateral ligament (MCL) primary repair and insert change after MCL rupture and mobile-bearing dislocation as a late complication of unicompartmental knee replacement (UKR). Firstly, 63-year-old woman was treated with UKR due to anteromedial knee osteoarthritis of the right knee joint. 1 year after UKR surgery, she suffered from MCL rupture and mobile-bearing dislocation because of falls while getting on a public bus, and therefore, secondly, she was operated with MCL primary repair and mobile-bearing change and followed up for 2 years. The patient was evaluated regarding functional capacity, pain intensity, range of motion (RoM), and quality of life. Our case showed an improvement in the functional level and the other outcomes (pain intensity and quality of life) at postoperative 2nd year when compared to the preoperative period. The wellbeing of our case in about the postop 2nd year functional capacity and also other outcomes after revision surgery prompted us to continue to this surgery approach in the surgical management of similar cases that may arise thereafter.

[Proprioception of the knee joint in patellofemoral pain syndrome]. / Patellofemoral agri sendromunda diz ekleminin propriyosepsiyonu.

OBJECTIVES: The importance of proprioception in the etiology, treatment, and prevention of sports injuries and joint diseases has become increasingly clear. The purpose of this study was to investigate knee proprioception in patients with patellofemoral pain syndrome (PFPS). METHODS: The study included 28 patients (18 females, 10 males; mean age 28 years; range 16 to 48 years) with a clinical diagnosis of unilateral PFPS and 27 normal volunteers (13 females, 14 males; mean age 26 years; range 19 to 32 years) without any complaint related to the knee. The mean duration of complaints was 35.8 weeks (range 2 weeks to 3 years). In both patient and control groups, proprioception of the knee was measured by means of active joint position sense at four different target angles (15 degrees , 30 degrees , 45 degrees , 60 degrees ) with the use of a digital goniometer and the results were compared. RESULTS: Proprioceptive errors were greater at all target angles in the affected knees compared to those measured in the contralateral knees and both knees of the controls. Differences between affected knees and contralateral knees ranged from 1.01+/-0.25 degrees to 1.65+/-0.43 degrees and were significant at three target angles (15 degrees , 30 degrees , 60 degrees ; p<0.05). Comparisons between the affected knees and both knees of the controls also showed significant differences at all target angles ranging from 2.48+/-0.92 degrees to 3.87+/-2.46 degrees (p<0.001). Errors obtained in the normal knees of the patients were also significantly greater compared to those seen in both knees of the controls, exceeding 2.7 degrees at some target angles (p<0.001). CONCLUSION: Our results show that patients with PFPS have impaired proprioception in the affected knee accompanied by significant losses in the proprioception of the contralateral normal knee. Based on these findings, proprioceptive rehabilitation techniques should be incorporated into the treatment of PFPS.

The assessment of portal-tract healing after knee arthroscopy.

OBJECTIVE: The aim of this study was to analyse the pattern of portal-tract healing, to compare the healing time of anteromedial and anterolateral portal tracts and to assess the impact of portal-tract delayed healing on the post-operative sub-acute and chronic anterior knee tenderness. METHODS: The study included 104 patients (68 males and 36 females; mean age: 49 ± 3.16 years (range; 17-66)) who have undergone knee arthroscopy. Puncture wounds were divided into two groups, (1) anteromedial and (2) anterolateral groups. Each group contained 104 portal-tracts. Healing of portal tracts was evaluated using sequential superficial ultrasonographic examinaitons. Visual analogue scale (VAS) was used to measure pain related to delayed tract healing and its association with the post-operative sub-acute and chronic anterior knee tenderness. RESULTS: Anteromedial and anterolateral tracts total healing time average values were 47 days and 28 days respectively. The VAS average values of anteromedial tracts after 2 weeks, one month, three months, six months and one year were 8.2, 6.3, 4, 1.9 and 0.6 respectively, and for the anterolateral tracts 7.4, 5.5, 2.8, 1.2 and 0.2 respectively. A statistical significance was detected between the two groups at the first and third months with P values 0.042 and 0.0035 respectively. CONCLUSIONS: Anteromedial tracts closed later than anterolateral tracts. Both portal-tracts delayed closure is a potential for post-operative sub-acute and chronic anterior knee tenderness after arthroscopic surgery. Four grades of tract healing were recognized. Portal-tract ultrasonography is advised in persistent post-operative sub-acute and chronic anterior knee tenderness. LEVEL OF EVIDENCE: Level III, Therapeutic study.

The impact of medial cuneiform bone variant measures on the severity of hallux valgus: A radiological study.

PURPOSE: The aetiology of hallux valgus (HV) is multifactorial in nature. The first metatarsocuneiform joint obliquity is a well-known factor in the development of the deformity. The purpose of this study is to assess the correlation of different medial cuneiform radiological measures on the severity of HV. METHODS: Full weight-bearing anteroposterior views of 152 feet with different clinical severity are divided into four groups: without deformity and with mild, moderate and severe deformities. Three medial cuneiform angles were assessed, namely, the first metatarsocuneiform angle (MCA), the first metatarsocuneiform slope angle (MCSA) and the medial cuneiform lateral tilt angle (MCLTA). RESULTS: The first MCA average values of groups 1, 2, 3 and 4 were (25.16 ± 5.74°, 27.38 ± 6.14°, 30.27 ± 5.62° and 34.28 ± 6.81°), respectively. Statistical differences were detected between groups (1, 3) and (1, 4) with p values of 0.034 and 0.001, respectively. The average values of the first MCSA of groups 1, 2, 3 and 4 were 19.26 ± 4.97°, 22.54 ± 5.62°, 26.13 ± 6.36° and 32.17 ± 5.85°, respectively. Significant differences were detected between groups (1, 3) and (1, 4) with p values of 0.04 and 0.023, respectively. Average values of the MCLTA of groups 1, 2, 3 and 4 were 80.85 ± 4.49°, 74.56 ± 5.28°, 62.38 ± 6.34° and 58.78 ± 6.25°, respectively. Statistical significances were detected between groups (1, 2), (1, 3) and (1, 4) with p values of 0.026, 0.018 and 0.001, respectively. CONCLUSIONS: Increasing the medial cuneiform lateral tilt increases the first metatarsocuneiform articulation obliquity demonstrated by the increase in the first MCSA which in term enhances the progression of varus deformity of the first metatarsal bone explained by the increase in the first MCA.

A novel anatomical patellar plate for transverse patellar fracture - A biomechanical in-vitro study.

OBJECTIVE: The aim of this study was to assess the safety and stability of our novel anatomical patella plate and to compare its stability with tension band-wire technique. METHODS: A total of 12 cadaveric preserved knees (six right and six left patellae) with close patellar size were chosen to form two groups of six samples. Each group received either plate or tension band-wiring fixation for an experimentally created patella fracture. Cyclic load of an average of 350 N was applied for all specimens and after accomplishing 50 cycles the displacements of all fracture edges were recorded. RESULTS: After completing 50 cycles in each group, the average fracture edges displacement measured in the plate group was 1.98 ± 0.299 mm, whereas the average fracture edges displacement measured in the tension band-wire group was 2.85 ± 0.768 mm (p = 0.016). CONCLUSION: In the operative treatment of displaced transverse patellar fractures, the strength of fixation obtained by titanium curved plates is highly stronger when compared to the fixation with a tension band-wire technique. Fixation with titanium curved plates provides satisfactory stability at the fracture site which allow withstanding the cyclic loads during the postoperative rehabilitation.