Patients with persistent symptoms after COVID-19 attending a multidisciplinary evaluation: Characteristics, medical conclusions, and satisfaction.

OBJECTIVE: Among patients attending a multidisciplinary day-hospital program for persistent symptoms after COVID-19, we aimed i) to describe their characteristics ii) to present the medical conclusions (diagnoses and recommendations) and iii) to assess the patients' satisfaction and its correlates. METHODS: For this retrospective chart review study, frequent symptoms were systematically assessed. Standardized questionnaires explored fatigue (Pichot scale), physical activity (Ricci & Gagnon scale), health-related quality of life (Short-Form Health Survey), anxiety and depressive symptoms (Hospital Anxiety and Depression scale) and associated psychological burden (Somatic-Symptom-Disorder B criteria Scale). Medical record conclusions were collected and a satisfaction survey was performed at 3-months follow-up. RESULTS: Among 286 consecutive patients (median age: 44 years; 70% women), the most frequent symptoms were fatigue (86%), breathlessness (65%), joint/muscular pain (61%) and cognitive dysfunction (58%), with a median duration of 429 days (Inter-quartile range (IqR): 216-624). Questionnaires revealed low levels of physical activity and quality of life, and high levels of fatigue, anxiety, depression, and psychological burden, with 32% and 23% meeting the diagnostic criteria for a depressive or anxiety disorder, respectively. Positive arguments for a functional somatic disorder were found in 76% of patients, including 96% with no abnormal clinical or test findings that may explain the symptoms. Physical activity rehabilitation was recommended for 91% of patients. Patients' median satisfaction was 8/10 (IqR: 6-9). CONCLUSION: Most patients attending this program presented with long-lasting symptoms and severe quality of life impairment, received a diagnosis of functional somatic disorder, and reported high levels of satisfaction regarding the program.

Re-ruptures and early outcomes after surgical repair of acute Achilles tendon ruptures: prospective, comparative multicenter study.

PURPOSE: The primary objective of this study was to compare the re-rupture rate, clinical results, and functional outcomes six months after the surgical repair of an acute Achilles tendon rupture between three different techniques (open repair, percutaneous repair with the Tenolig®, and minimally invasive repair). METHODS: A prospective, comparative, multicenter, non-randomized study was performed and included 111 patients who had an acute ruptured Achilles tendon: 74 underwent an open repair, 22 underwent a percutaneous repair using the Tenolig® and 15 had a minimally invasive repair. At six months follow-up we analyzed the number of re-ruptures, phlebitis, infections, complex regional pain syndrome, clinical outcomes (muscle atrophy, ankle dorsal flexion), functional scores (ATRS, VISA-A, EFAS, SF-12), and return to running. RESULTS: There were more re-ruptures (p=0.0001) after repair with the Tenolig® (27%) than with open repairs (1.3%) and minimally invasive repairs (0%). The rate of other complications was not different. No clinical differences were found between the three groups. Only some functional scores EFAS Total (p=0.006), and VISA-A (p=0.015) were worse in the Tenolig® group. All the other results were similar between the three groups. CONCLUSION: Despite heterogeneous studies in literature, the results of this comparative and prospective study between three surgical techniques of Achilles tendon repair confirmed that Tenolig® repair increased the rate of early re-rupture compared to open or minimally invasive techniques.

Which typical floor movements of men's artistic gymnastics result in the most extreme lumbar lordosis and ground reaction forces?

Back pain is prevalent among gymnast populations and extreme flexion or extension of the lumbar spine along with high ground reaction forces (GRFs) are known to increase intervertebral stress. The aim of this study was to determine which postures and dynamic conditions among common floor movements provide the greatest risk of injury in men's artistic gymnastics (MAG). For this purpose, lumbar spine curvatures, obtained through a full-body subject-specific kinematic model fed by motion capture data, and GRFs on feet and hands were compared between typical floor movements of MAG (pike jump, round off back handspring, front handspring, forward and backward tucked somersaults) performed by six adolescent gymnasts. The round off back handspring and the pike jump resulted respectively in the largest lumbar extension and flexion, and the forward tucked somersault take-off in the highest GRF. At ground impacts, the largest lumbar flexion was during the backward tucked somersault landing and only the back handspring hands ground contact phase led to lumbar extension. Such identification of high-risk conditions should enable better back pain management in gymnastics through more tailored training adaptations, particularly in case of pathologies or musculoskeletal specificities.

Effect of shoulder model complexity in upper-body kinematics analysis of the golf swing.

The golf swing is a complex full body movement during which the spine and shoulders are highly involved. In order to determine shoulder kinematics during this movement, multibody kinematics optimization (MKO) can be recommended to limit the effect of the soft tissue artifact and to avoid joint dislocations or bone penetration in reconstructed kinematics. Classically, in golf biomechanics research, the shoulder is represented by a 3 degrees-of-freedom model representing the glenohumeral joint. More complex and physiological models are already provided in the scientific literature. Particularly, the model used in this study was a full body model and also described motions of clavicles and scapulae. This study aimed at quantifying the effect of utilizing a more complex and physiological shoulder model when studying the golf swing. Results obtained on 20 golfers showed that a more complex and physiologically-accurate model can more efficiently track experimental markers, which resulted in differences in joint kinematics. Hence, the model with 3 degrees-of-freedom between the humerus and the thorax may be inadequate when combined with MKO and a more physiological model would be beneficial. Finally, results would also be improved through a subject-specific approach for the determination of the segment lengths.

Transverse translunate fracture-dislocation: A rare injury.

Perilunate fracture-dislocation is rare. We report the case of a 24-year-old male who fell from his motorcycle and presented with a transverse lunate fracture with perilunate ligament damage. The initial diagnosis based on X-rays was confirmed by CT scan. A dorsal approach was used to obtain good reduction, double screw fixation and ligament reinsertion protected by temporary K-wires. To the best of our knowledge, this is the first case of transverse lunate fracture within perilunate fracture-dislocation. The patient returned to normal activities after 6 months.

A new method for the evaluation of the end-to-end distance of the knee ligaments and popliteal complex during passive knee flexion.

BACKGROUND: Accurate knowledge about the length variation of the knee ligaments (ACL, PCL, MCL and LCL) and the popliteal complex during knee flexion/extension is essential for modelling and clinical applications. The aim of the present study is to provide this information by using an original technique able to faithfully reproduce the continuous passive knee flexion-extension kinematics and to reliably identify each ligament/tendon attachment site. METHODS: Twelve lower limbs (femur, tibia, fibula, patella) were tested and set in motion (0-120°) using an ad hoc rig. Tibio-femoral kinematics was obtained using an optoelectronic system. A 3D digital model of each bone was obtained using low-dosage stereoradiography. Knee specimens were dissected and the insertion of each ligament and popliteal complex were marked with radio opaque paint. ACL, PCL and MCL were separated into two bundles. Bone epiphyses were CT-scanned to obtain a digital model of each ligament insertion. Bones and attachment site models were registered and the end-to-end distance variation of each ligament/tendon was computed over knee flexion. RESULTS: A tibial internal rotation of 18°±4° with respect to the femur was observed. The different bundles of the ACL, MCL and LCL shortened, whereas all bundles of the PCL lengthened. The popliteal complex was found to shorten until 30° of knee flexion and then to lengthen. CONCLUSION: The end-to-end distance variation of the knee ligaments and popliteal complex can be estimated during knee flexion using a robust and reliable method based on marking the ligaments/tendon insertions with radiopaque paint. LEVEL OF EVIDENCE: Level IV.

Sequential 3D analysis of patellofemoral kinematics from biplanar x-rays: In vitro validation protocol.

BACKGROUND: Developing criteria for assessing patellofemoral kinematics is crucial to understand, evaluate, and monitor patellofemoral function. The objective of this study was to assess a sequential 3D analysis method based on biplanar radiographs, using an in vitro protocol. HYPOTHESIS: Biplanar radiography combined with novel 3D reconstruction methods provides a reliable evaluation of patellofemoral function, without previous imaging. MATERIAL AND METHODS: Eight cadaver specimens were studied during knee flexion cycles from 0° to 60° induced by an in vitro simulator. The protocol was validated by investigating sequential and continuous motion using an optoelectronic system, evaluating measurement accuracy and reproducibility using metallic beads embedded in the patella, and comparing the 3D patellar geometry to computed tomography (CT) images. RESULTS: The differences in position between the sequential and continuous kinematic analyses were less than 1mm and 1°. The protocol proved reliable for tracking several components of knee movements, including patellar translations, flexion, and tilt. In this analysis, uncertainty was less than 2 mm for translations and less than 3° for rotations, except rotation in the coronal plane. For patellar tilt, uncertainty was 5°. Mean difference in geometry was 0.49 mm. DISCUSSION: Sequential analysis results are consistent with continuous kinematics. This analysis method provides patellar position parameters without requiring previous CT or magnetic resonance imaging. A clinical study may deserve consideration to identify patellofemoral kinematic profiles and position criteria in vivo. LEVEL OF EVIDENCE: IV, experimental study.

EOS analysis of lower extremity segmental torsion in children and young adults.

INTRODUCTION: Lower limb torsion varies substantially among healthy children during growth. Values reported in the literature to date have been obtained using semi-quantitative clinical or 2D measurement methods. Quantitative 3D measurement would help determine the physiological range of lower limb torsion. Low-dose stereoradiography with 3D reconstruction provides a good alternative. Its use increases in pediatrics because of radiation minimization. Previous studies have shown accurate and reproducible results of lower limbs reconstruction in adults and children but the torsional parameters haven't been measured yet. The present study reports the values of lower limb segmental torsion and its course during growth in a cohort of healthy children and young adults using the EOS low-dose biplanar X-ray. HYPOTHESIS: EOS 3D reconstruction is an accurate and reproducible method to measure the torsional parameters in children. MATERIALS AND METHODS: Femoral torsion (FT) and tibial torsion (TT) were studied on 114 volunteers (228 lower limbs) from 6 to 30 years of age divided by age into 5 groups. The EOS™ acquisitions were obtained in subjects standing with their feet offset. RESULTS: Mean FT decreased during growth, passing from 21.6° to 18°, whereas mean TT increased from 26.8° to 34.7°. There was a statistically significant difference between the 2 extreme age groups, but no difference was found between any other age groups. The ICC for intra-observer reproducibility was 0.96 and 0.95 for FT and TT for the first operator, and 0.79 and 0.83 for the second operator respectively. The ICC for inter-observer reproducibility was 0.84 and 0.82 respectively. DISCUSSION: The course of lower limb segmental torsion observed was consistent with literature reports based upon clinical and 2D measurements. 3D reconstruction of EOS low-dose biplanar imaging appears to be a safe and reliable tool for lower limbs measurements, especially for investigating lower limb segmental torsion in children and adults. LEVEL OF EVIDENCE: Level IV.

Orthopedics coding and funding.

The French tarification à l'activité (T2A) prospective payment system is a financial system in which a health-care institution's resources are based on performed activity. Activity is described via the PMSI medical information system (programme de médicalisation du système d'information). The PMSI classifies hospital cases by clinical and economic categories known as diagnosis-related groups (DRG), each with an associated price tag. Coding a hospital case involves giving as realistic a description as possible so as to categorize it in the right DRG and thus ensure appropriate payment. For this, it is essential to understand what determines the pricing of inpatient stay: namely, the code for the surgical procedure, the patient's principal diagnosis (reason for admission), codes for comorbidities (everything that adds to management burden), and the management of the length of inpatient stay. The PMSI is used to analyze the institution's activity and dynamism: change on previous year, relation to target, and comparison with competing institutions based on indicators such as the mean length of stay performance indicator (MLS PI). The T2A system improves overall care efficiency. Quality of care, however, is not presently taken account of in the payment made to the institution, as there are no indicators for this; work needs to be done on this topic.

Three-dimensional reconstruction of the lower limb from biplanar calibrated radiographs.

Three-dimensional (3D) reconstruction of lower limbs is essential for surgical planning and clinical outcome evaluation. 3D reconstruction from biplanar calibrated radiographs may be an alternative to irradiation issues of CT-scan. A previous study proposed a two-step reconstruction method based on parametric models and statistical inferences leading to a fast Initial Solution (IS) followed by manual adjustments. This study aims to improve the IS using a new 3D database, a novel parametric model of the tibia and a different regression approach. The IS was evaluated in terms of shape accuracy on 9 lower limbs and reproducibility of clinical measurements on 22 lower limbs. Reconstruction time was also evaluated. Comparison to the previous method showed an improvement of the IS in terms of shape accuracy (1.3 vs. 1.6 and 2 mm respectively for both femur and tibia) and reproducibility of clinical measurements (i.e. 3.1° vs. 8.3° for neck-shaft-angle; 4.2° and 5° vs. 5° and 6° for tibial and femoral torsion respectively). The proposed approach constitutes a considerable step towards an automatic 3D reconstruction of lower limb.

Tibio-femoral joint constraints for bone pose estimation during movement using multi-body optimization.

When using skin markers and stereophotogrammetry for movement analysis, bone pose estimation may be performed using multi-body optimization with the intent of reducing the effect of soft tissue artefacts. When the joint of interest is the knee, improvement of this approach requires defining subject-specific relevant kinematic constraints. The aim of this work was to provide these constraints in the form of plausible values for the distances between origin and insertion of the main ligaments (ligament lengths), during loaded healthy knee flexion, taking into account the indeterminacies associated with landmark identification during anatomical calibration. Ligament attachment sites were identified through virtual palpation on digital bone templates. Attachments sites were estimated for six knee specimens by matching the femur and tibia templates to low-dose stereoradiography images. Movement data were obtained using stereophotogrammetry and pin markers. Relevant ligament lengths for the anterior and posterior cruciate, lateral collateral, and deep and superficial bundles of the medial collateral ligaments (ACL, PCL, LCL, MCLdeep, MCLsup) were calculated. The effect of landmark identification variability was evaluated performing a Monte Carlo simulation on the coordinates of the origin-insertion centroids. The ACL and LCL lengths were found to decrease, and the MCLdeep length to increase significantly during flexion, while variations in PCL and MCLsup length was concealed by the experimental indeterminacy. An analytical model is given that provides subject-specific plausible ligament length variations as functions of the knee flexion angle and that can be incorporated in a multi-body optimization procedure.