Prospective assessment of functional and clinical results of surgical patellar stabilization in rural and urban populations. Equal chance to success?

INTRODUCTION AND OBJECTIVE: Patella dislocation represents 3.3% of all knee injuries often leading to persistent instability. Medial patello-femoral ligament(MPFL) reconstruction is the standard method of treatment in the patellar instability. Rehabilitation after MPFL-R is a long and demanding procedure. The hypothesis presented reflects the idea that despite relatively good access to hospital care and surgical options, the post-operative rehabilitation care system is still inferior in rural areas versus the one offered in major cities and towns. MATERIAL AND METHODS: Between January 2015 - January 2018, 47 patients met the study inclusion criteria, diagnosed and operated on due to patellar instability. 8 patients were lost for full follow-up. Finally, 39 patients were included, divided into two groups - group A (19 from cities), group B (20 from rural area). Prospective KOOS and Kujala scales assessments were conducted: preoperative, 6 and 12 months after surgery. Knee isokinetic muscle strength was measured at 3 stages; prior to surgery, 6 and 12 months after reconstruction. RESULTS: All patients showed significant improvement measured in the KOOS and Kujala scales after the procedure, compared to the pre-operational results. Despite equal clinical improvement, patients from Group A(city) achieved better functional outcomes as presented in the results of knee extensor functional tests using a Biodex dynamometer. CONCLUSIONS: Rehabilitation after MPFL reconstruction improves muscle strength and clinical outcome. Patients from rural areas had inferior functional results in comparison to the patients from major cities, even 12 months after surgical patella stabilization. Despite the development of roads and transport according to the EU cohesion policy, there are still differences in rehabilitation results between rural and city areas.

The Effect of Pressotherapy on Performance and Recovery in the Management of Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis.

Background: It has been demonstrated that pressotherapy used post-exercise (Po-E) can influence training performance, recovery, and physiological properties. This study examined the effectiveness of pressotherapy on the following parameters. Methods: The systematic review and meta-analysis were performed according to PRISMA guidelines. A literature search of MEDLINE, PubMed, EBSCO, Web of Science, SPORTDiscus, and ClinicalTrials has been completed up to March 2021. Inclusion criteria were: randomized control trials (RCTs) or cross-over studies, mean participant age between 18 and 65 years, ≥1 exercise mechanical pressotherapy intervention. The risk of bias was assessed by the Cochrane risk-of-bias tool for RCT (RoB 2.0). Results: 12 studies comprised of 322 participants were selected. The mean sample size was n = 25. Pressotherapy significantly reduced muscle soreness (Standard Mean Difference; SMD = −0.33; CI = −0.49, −0.18; p < 0.0001; I2 = 7%). Pressotherapy did not significantly affect jump height (SMD = −0.04; CI = −0.36, −0.29; p = 0.82). Pressotherapy did not significantly affect creatine kinase level 24−96 h after DOMS induction (SMD = 0.41; CI = −0.07, 0.89; p = 0.09; I2 = 63%). Conclusions: Only moderate benefits of using pressotherapy as a recovery intervention were observed (mostly for reduced muscle soreness), although, pressotherapy did not significantly influence exercise performance. Results differed between the type of exercise, study population, and applied treatment protocol. Pressotherapy should only be incorporated as an additional component of a more comprehensive recovery strategy. Study PROSPERO registration number­CRD42020189382.

The efficacy of intermittent pneumatic compression and negative pressure therapy on muscle function, soreness and serum indices of muscle damage: a randomized controlled trial.

BACKGROUND: The study aimed to assess whether intermittent pneumatic compression (IPC) and intermittent negative pressure (INP) would attenuate the muscle damaging effects of eccentric exercise. METHODS: Forty-five healthy males were recruited. Immediately post, 24 and 48 h post eccentric exercise consisting of 100 drop jumps, volunteers randomly received 30-min sessions of intermittent pneumatic compression (IPC, n = 15) or intermittent negative pressure (INP, n = 15), or sham microcurrent (PT, n = 15). Creatine kinase (CK), lactate dehydrogenase (LDH), isokinetic muscle strength, soreness and active flexion of the knee joint were measured after every therapy session. RESULTS: No significant intergroup differences were observed in biochemical or functional measurements. However, there was an increase in muscle soreness (P < 0.05), CK and LDH activity (P < 0.05), and a reduction in muscle strength (P < 0.05) and range of active knee flexion (P < 0.05). CONCLUSIONS: The prescription of IPC and INP did not attenuate the reduction of markers to muscle function or pain perception up to 48 h after muscle damaging exercise. Future research should focus on the potential impact of treatment frequency and duration on muscle recovery. Trial registration The study was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR); The trial registration number: ACTRN12621001294842; date of registration: 24/09/2021.