The reliability and validity of the Turkish version of the self-administered neck mobility assessment tool (s-rom-neck) in patients with chronic neck pain.

BACKGROUND: The self-administered neck mobility assessment tool (S-ROM-Neck) is the subjective cervical region range of motion (S-ROM) assessment scale. The study aimed to demonstrate the reliability and validity of the Turkish version of the S-ROM-Neck in patients with chronic neck pain. METHODS: : A cross-sectional study was conducted with a total of 60 chronic neck pain patients in the Physical Therapy and Rehabilitation Clinic of Pamukkale University Hospital between January and August 2021. The mean age of the individuals was 34.1 ± 9.9 years. Patients were assessed with S-ROM-Neck twice to prove the test-retest reliability. In addition, Visual Analogue Scale (VAS), Neck Disability Index (NDI) and bubble inclinometer measurement were used to analyze the construct validity of S-ROM-Neck. RESULTS: The intraclass correlation coefficients of the S-ROM-Neck were higher than 0.80 (ICC > 80, CI: 0.90-98). The internal consistency of the S-ROM-Neck total score was within the acceptable limits (α = 0.754). Construct validity was high regarding the correlation analysis (r > 0.05, p < 0.01). DISCUSSION: Turkish S-ROM-Neck is a valid and reliable tool to assess the S-ROM of individuals with chronic neck pain.

The adaptations in muscle architecture following whole body vibration training.

OBJECTIVE: This study aims to investigate the effect of 8-week whole-body vibration (WBV) added to conventional training on muscular architecture, dynamic muscle strength and physical performance compared to controls in young basketball players. METHODS: Sixteen young basketball players between the ages of 14-16 years were randomly assigned to whole body vibration group (VG) or control group (CG). Both groups were trained with a conventional program. Pennation angle (PeA), fascicle length and muscle thickness of Rectus Femoris (RF) and Vastus lateralis were measured by ultrasonography. Isokinetic dynamic muscle testing at 180 °/s and 60°/s, squat jump (SJ) and flexibility were evaluated before and after 8 weeks of training programs. Primary outcome measure was the fascicle length. RESULTS: Fascicle length of RF, SJ height and flexibility increased significantly within VG compared to pretraining (p<0.05). SJ height increased in VG compared to CG significantly following training (p<0.05). PeA, fascicle length, muscle thicknesses, strength and flexibility did not differ between groups. CONCLUSION: Eight weeks of WBV training improved fascicle length of RF, SJ height, and flexibility compared to pre-training. Addition of WBV to conventional training did not cause improvement in muscle architecture, strength and flexibility compared to conventional training alone.

Effects of low-density pulsed ultrasound treatment on transforming growth factor-beta, collagen level, histology, biomechanics, and function in repaired rat tendons.

OBJECTIVES: The aim of this study is to compare the effects of low-density pulsed ultrasound (LIPUS) treatment on growth factors/collagen production, histological, biomechanical, and function of rats with Achilles tendon injury. MATERIALS AND METHODS: A total of 44 Wistar Albino rats were used in the study between April 2017 and June 2018. The rats were randomized to two treatment groups. Group 1 (n=6) received LIPUS treatment (0.3 Watt/cm2; 1 MHz, 1:5 pulse mode) and Group 2 (n=6)received sham ultrasound (US) treatment following Achilles tendon surgery. Transforming growth factor-beta 1 (TGF-ß1) and collagen gene expression levels were evaluated using polymerase chain reaction. The histological evaluation was performed with the Bonar scoring system. The tensile strength was measured by biomechanical testing and the function was evaluated with the Achilles Functional Index (AFI). RESULTS: Although TGF-ß1 expression and tensile strength evaluation showed a tendency to improve in favor of the LIPUS group, no statistically significant difference was found (p=0.065 and p=0.053, respectively). The COL3 gene expression in the LIPUS group and the COL1 expression in the sham US group were significantly higher. Bonar scores and AFI scores showed a statistically significant improvement in the LIPUS group, compared to the sham US group. CONCLUSION: Our study results show that LIPUS yields positive effects on tendon histology and functional status in repaired Achilles tendon in rats.

EURO-MUSCULUS/USPRM Global Report on Musculoskeletal Ultrasound Publications.

The developments in technology have improved access to the use of musculoskeletal ultrasound (MSUS) in different clinical settings. Accordingly, MSUS has been applied to a wide range of musculoskeletal problems including inflammatory and degenerative diseases, sport injuries, and regional pain syndromes both for clinical practice and research. In this report, the authors aimed to globally examine the publications on MSUS among different specialties, countries, and topics. Sixteen reviewers under the umbrella of the European Musculoskeletal Ultrasonography Society Group and the Ultrasound Study Group of International Society of Physical and Rehabilitation Medicine have evaluated approximately 15,000 publications on MSUS. The authors believe that the results of this comparative analysis may provide a holistic snapshot with regard to the utility of MSUS, not only for clinicians/academicians but also for the industry. Accordingly, while aiming to further increase their awareness, this article would possibly guide future investments as well.

Evaluation of balance in young adults with idiopathic scoliosis.

OBJECTIVES: This study aims to evaluate the relation of scoliosis with coronal and sagittal balance parameters and the effect of postural balancing in young adults with idiopathic scoliosis. PATIENTS AND METHODS: Between April 2017 and June 2017, a total of 24 patients (7 males, 24 females; mean age 20.3±2 years; range 17 to 24) who were diagnosed with scoliosis and 65 age- and sex-matched healthy controls (20 males, 45 females; mean age 20.3±1.6 years; range 19 to 25) were included in the study. The Cobb angle, sagittal balance, coronal balance, and truncal shift were measured with radiographs in the patient group. The Biodex Balance System (BBS) was used to assess the general stability index, anterior- posterior and medial-lateral stability index, and fall risk. RESULTS: All balance parameters were significantly worse in the patient group than in the control group (p<0.05). The static balance was mostly associated with sagittal balance, followed by coronal balance. In the patients with left scoliosis, sagittal balance was 93% negative and 67% of the patients gave their weight to the back. Coronal balance was negative in 60% of the patients and 93.3% of the patients were weighted to the right side. In 89% of the patients with right scoliosis, sagittal balance was negative and 89% of the patients gave their weight to the back. Coronal balance was 44% neutral and 78% of the patients gave their weight to the right side. CONCLUSION: In patients with scoliosis, the static balance is worse than healthy individuals. Static balance is mostly related to sagittal balance and also to coronal balance. While the coronal balance tends to be in the direction of the curve, both right and left scoliosis give more weight to the right.

Strain Ratio Measurements of Patellar and Achilles Tendons With Different Reference Regions in Healthy Volunteers.

Strain ratio measurements of tendons vary because of the reference tissue selection. The main purpose of this study is to highlight, in detail, the numeric variability attributable to the use of various reference materials on strain ratio measurements of patellar and Achilles tendons. Measurements were performed at the proximal, middle and distal thirds of the patellar and Achilles tendons on the dominant site of healthy volunteers. A total of 3 references were used: the Hoffa's fat pad for the patellar tendon, the Kager's fat pad for the Achilles tendon, subcutaneous tissue and Aquaflex gel pads (Parker Laboratories, Fairfield, NJ, USA) for both tendons. Although the same methods were used by the same physician for each tendon site on repeated measurements, strain ratio values had numeric variability with various reference materials in each measurement. Therefore, comparison of numeric strain ratio results of various studies with various reference materials could confuse the clinical interpretations of these numeric data, and, using a reference material with standard stiffness like Aquaflex ultrasound gel pads, should be considered by verifying these results with further studies.

Ultrasonographic imaging of the effects of continuous, pulsed or sham ultrasound treatments on carpal tunnel syndrome: A randomized controlled study.

BACKGROUND: Clinical and electrophysiological effects of therapeutic ultrasound (US) were researched in many studies on patients with CTS with conflicting results. OBJECTIVE: To assess the effects of continuous and pulsed US treatments by ultrasonographic imaging in addition to clinical and electrophysilogical parameters in patients with carpal tunnel syndrome (CTS). METHOD: Fifty-four patients with idiopathic CTS were randomly divided into three groups. All patients used night splints for two weeks. In addition to splint therapy, continuous, pulsed or sham US treatments were applied to patients 10 min/session, 5 sessions/week for two weeks. Clinical situation (pain, hand function, strength), electrophysiological studies (motor distal latency, MDL, sensorial distal latency, SDL), and ultrasonographic area measurements of median nerve were evaluated. All evaluations were applied at pretreatment (baseline), posttreatment (2nd week) and in the 6th week. RESULTS: Whereas significant differences were detected for clinical, functional and ultrasonographic imaging findings in each group in the 2nd week and 6th week compared to baseline (p< 0.0167 for both), no electrophysiological improvements were detected in pulsed-US (p> 0.0167) and only improvement for SDL in sham US group in the 2nd week evaluation (p< 0.0167). CONCLUSION: According to the results of this study, continuous, pulsed or sham US treatments combined with splinting had similar effects on clinical, electrophysiological and ultrasonographic imaging improvements. Additionally, ultrasonographic imaging may be a preferable objective evaluation tool to prove the early posttreatment clinical improvements when electrophysiological changes could not be detected.

The association between different molecular weights of hyaluronic acid and CHAD, HIF-1α, COL2A1 expression in chondrocyte cultures.

The aim of the present study was to investigate the effects of three different formulations of hyaluronic acid (HA): Low molecular weight (MW) Sinovial One®, medium MW Viscoplus® and high MW Durolane®, on chondrocyte proliferation and collagen type II (COL2A1), hypoxia-inducible factor 1α (HIF-1α) and chondroadherin (CHAD) expression in primary chondrocyte cultures. Standard primary chondrocyte cultures were established from osteochondral tissues surgically obtained from 6 patients with gonarthrosis. Cell morphology was evaluated using an inverted light microscope; cell proliferation was determined with a MTT assay and confirmed with acridine orange/propidium iodide staining. Levels of CHAD, COL2A1 and HIF-1α expression were assessed using specific TaqMan gene expression assays. The results demonstrated the positive effect of HA treatment on cell proliferation, which was independent from the MW. COL2A1 expression increased in the medium and high MW HA treated groups. It was observed that HIF-1α expression increased in the high MW treated group alone. CHAD expression increased only in the medium MW HA treated group. Evaluation of gene expression revealed that levels of expression increased as the duration of HA application increased, in the medium and high MW HA treated groups. In terms of increased viability and proliferation, a longer duration of HA application was more effective. Taken together, it may be concluded that the administration of medium and high MW HA may be a successful way of treating diseases affecting chondrocytes in a clinical setting.

A case with rheumatod arthritis and atraumatic odontoid fracture: disappearence of bony landmarks.

We aim to draw attention to occult, atraumatic fractures of the odontoid process in patients with rheumatoid arthritis (RA) and to underline difficulties encountered during clinical and radiological diagnosis. A forty-seven years old man with RA for 4 years had occipital pain for 1 year without any history of trauma. Later, he developed weakness in the upper extremities, but he did not realize weakness in the lower extremities due to deformities. Contrast magnetic resonance imaging revealed a linear fracture of odontiod process and myelopathy. Cervical computed tomography scan revealed an old fracture border with separated and almost disappeared remnant of the tip of the odontoid without free particles in the cord. It was impossible to evaluate atlantoaxial and vertical subluxations with craniometric measurements due to destruction of the tip of odontoid. Following occipitocervical fusion and decompression and a rehabilitation program, his muscle strength improved; however, functional myelopathy stage did not change. Atraumatic fractures of the odontoid process may be more common than reported and may cause compression of the spinal cord or brain stem. Surgery is the treatment of choice but functional recovery is limited once neuronal damage has occurred. Erosion of the critical landmarks makes it difficult to diagnose and follow up atlantoaxial subluxation and/or vertical subluxation, therefore clinicians should consider radiographical follow-ups during the course of the disease.

Effects of weighted and un-weighted pendulum exercises on ultrasonographic acromiohumeral distance in patients with subacromial impingement syndrome.

BACKGROUND: Although functional results of combined rehabilitation programs are reported, there have been no reports studying the effects of solo pendulum exercises on ultrasonographic measurements of acromiohumeral distance (AHD). OBJECTIVE: To investigate the effects of weighted and un-weighted pendulum exercises on ultrasonographic AHD and clinical symptoms in patients with subacromial impingement syndrome. METHODS: Patients with subacromial impingement syndrome were randomized to performing weighted (1.5 kilograms hand held dumbbell, N= 18) or un-weighted (free of weight, N= 16) pendulum exercises for 4 weeks, 3 sessions/day. Exercises were repeated for each direction of shoulder motion in each session (ten minutes). Clinical situation was evaluated by Constant score and Shoulder Pain Disability Index (SPADI). Ultrasonographic measurements of AHD at 0°, 30° and 60° shoulder abduction were performed. All clinical and ultrasonographic evaluations were performed at the beginning of the exercise program and at end of 4 weeks of exercise program. RESULTS: Thirty-four patients (23 females, 11 males; mean age 41.7 ± 8.9 years) were evaluated. Significant clinical improvements were detected in both exercise groups between pre and post-treatment evaluations (p < 0.05). There was no significant difference for pre and post-treatment AHD measurements at 0°, 30°, and 60° shoulder abduction between groups (p > 0.05). There was no significant difference for pre and post-treatment narrowing of AHD (narrowing of 0°-30°, and 0°-60°) between groups (p > 0.05). CONCLUSION: While significant clinical improvements were achieved with both weighted and un-weighted solo pendulum exercises, no significant difference was detected for ultrasonographic AHD measurements between exercise groups.

Comparison of effectiveness of Transcutaneous Electrical Nerve Stimulation and Kinesio Taping added to exercises in patients with myofascial pain syndrome.

BACKGROUND: Although there are several studies of Transcutaneous Electrical Nerve Stimulation (TENS) and exercise in myofascial pain syndrome, there are no studies comparing the effectiveness of Kinesio Taping (KT) and TENS in myofascial pain syndrome patients. OBJECTIVE: To compare the early and late effects of TENS and KT on pain, disability and range of motion in myofascial pain syndrome patients. METHODS: Sixty-nine patients were divided into three groups randomly as TENS+Exercise, KT+Exercise and exercise groups. Visual Analogue Scale (VAS), pain threshold, Neck Disability Index and cervical contralateral lateral flexion were employed in the evaluation of the patients performed before treatment, after treatment and 3rd month after treatment. RESULTS: The VAS, pain threshold, Neck Disability Index and contralateral lateral flexion values were improved in all groups both in after treatment and 3rd month after treatment (p< 0.01). In the comparison of after treatment vs. before treatment evaluations, VAS score was decreased in KT group compared to the TENS and control group (p= 0.001), in the TENS group compared to control group (p= 0.011). In the comparison of 3rd month and before treatment evaluations, VAS score was decreased in the TENS group compared to control group (p= 0.001) and in the KT group compared to the control group (p= 0.001). There was no significant difference between TENS and KT groups. All other parameters did not differ between the groups. CONCLUSIONS: TENS and KT added exercises can decrease pain severity and increase pain threshold, function and cervical range of motion in myofascial pain syndrome patients. Addition of TENS or KT to the exercise therapy resulted in more significant improvement compared to exercise therapy alone with a more pronounced improvement in KT group compared to the TENS group in the early period. Because KT was found to be more effective in decreasing the pain and had the advantage of being used in every 3 days, it seems to be beneficial in acute painful periods in myofascial pain syndrome patients.

Efficacy of moderate-intensity walking provided feedback by ECE PEDO on abdominal fat in overweight and obese women: A randomized, exercise study.

OBJECTIVES: The aim of this study was to investigate the effectiveness of walking with Equipment for Clever Exercise (ECE PEDO) compared to supervised, moderate-intensity, aerobic, treadmill walking exercise in overweight and obese women. PATIENTS AND METHODS: Between September 2014 and January 2015, 28 women with overweight and obesity were assigned to two groups: supervised treadmill walking (Group 1, n=14) or walking with ECE PEDO (Group 2, n=14). The target heart rate (HR) corresponding to values of 50 to 70% VO2max were determined by submaximal treadmill test. Group 1 was instructed walking at their target HR on treadmill. The number of steps in a min corresponding to the target HR was calculated by a criterion pedometer and Group 2 was instructed walking in this step range recorded to the ECE PEDO giving audible feedback. Before and after a 12-week exercise program, all participants were evaluated by Body Mass Index (BMI) and waist circumference (WC). Ultrasonographic visceral fat thickness (VFT) and ergospirometric VO2max. RESULTS: The VFT decreased in both walking groups in association with reduced WC and weight loss and also significant increases in the VO2max after exercise intervention (p<0.05). The VFT decreased only in women by walking with ECE PEDO compared to the other group (p<0.05). CONCLUSION: Our study results showed that both moderate-intensity exercise provided by a novel pedometer and supervised treadmill walking showed significant improvements in abdominal obesity and VO2max.

Factors affecting the results of the functional dexterity test.

STUDY DESIGN: Cross-sectional study. PURPOSE OF THE STUDY: The purpose of this study was to identify which demographic and anthropometric features affect performance (time) on the functional dexterity test (FDT). METHODS: One hundred fifty-two healthy subjects between the ages of 20 and 80 years were included in this cross-sectional study. Demographic characteristics (age, gender, height, weight, and dominant hand) and anthropometric (the girths of the first 3 fingers) variables were recorded, and the FDT (net time and total score) was performed. RESULTS: Hand dexterity (time) was slower in participants aged 60 years (35.7 ± 9.4 seconds) and older compared with those aged 40-59 (27.1 ± 7.2 seconds) years and 20-39 (23.9 ± 4.9 seconds) years (P < .001 for both) in dominant side. DISCUSSION: There was no significant difference between males (29.1 ± 9 in dominant hands and 30.9 ± 9.5 in nondominant hands) and females (27.9 ± 8.4 in dominant hands and 30.8 ± 8.1 in nondominant hands) in all groups in terms of FDT net time. The factors associated with hand dexterity were age in dominant hands (R2 = 0.321) and age and thickness of the second and third fingers in nondominant hands (R2 = 0.282). CONCLUSION: FDT scores increased with increasing age for both dominant and nondominant hands. Finger thickness, especially in nondominant hands, should be taken into account while evaluating FDT scores because of its negative effect on dexterity. LEVEL OF EVIDENCE: Level 2.

Effects of Cigarette Smoking on Elastographic Strain Ratio Measurements of Patellar and Achilles Tendons.

OBJECTIVES: The aim of this study was to explore the sonographic and elastographic properties of patellar and Achilles tendons in smoking and nonsmoking otherwise healthy adults. METHODS: We conducted a level 3 case-control analytical study. Smoking and nonsmoking volunteers (>18 years) without musculoskeletal system disorders were included in the study. Demographic characteristics and smoking habits (pack-years) were recorded. Proximal, middle, and distal third thicknesses of the patellar and Achilles tendons were measured by B-mode sonography. Strain ratio measurements of the same regions were measured by real-time ultrasound elastography. RESULTS: A total of 69 participants (57 male and 12 female; mean age ± SD, 35.5 ± 7.8 years) were evaluated in the study. Smoking (n = 35) and nonsmoking (n = 34) groups had no significant differences in terms of age, body mass index, sex, and activity level (all P > .05). Proximal, middle, and distal thirds of the patellar and Achilles tendons were significantly thinner in the smoking group (all P < .05). Furthermore, strain ratio measurements in the same regions were significantly lower in the smoking group (all P< .05). Patellar tendon thicknesses and strain ratios had negative correlations with the smoking amount (all P < .05). CONCLUSIONS: Thickness and strain ratio measurements of patellar and Achilles tendons were reduced (thinner and harder tendons) in smokers. Clinical implications of these morphologic and elastographic changes should be investigated in future studies.

Real-time elastography of patellar tendon in patients with auto-graft bone-tendon-bone anterior cruciate ligament reconstruction.

INTRODUCTION: Patellar tendon donor site has been previously evaluated in patients with auto-graft bone-tendon-bone (BTB) anterior cruciate ligament (ACL) reconstruction using either magnetic resonance imaging or B mode ultrasound. However, donor site patellar tendon strain ratio-reflecting structural features-has not been studied with US elastography. Here, we ascertain real-time elastography properties of patellar tendon donor site and clinical relevance of these properties in patients with auto-graft BTB ACL reconstruction in the postoperative period. METHODS: Patients who underwent ACL reconstruction using BTB autograft were evaluated. Demographic, operative and clinical data (severity of pain, Lysholm Knee score, sit to stand test, packages/year for smoking amount) were noted. Patellar tendons of the operated knees were evaluated by ultrasound (length and thickness) and sonoelastography (strain ratio). The healthy knees of the patients constituted the control group. RESULTS: Eighteen patients (17 M, 1 F; mean age 30.9 ± 7 years) were evaluated. Mean postoperative follow-up period was 22.1 ± 2.6 (range 18-26) months. Patellar tendons were shorter and thicker on the operated side when compared with the contralateral side (both p = 0.001). Patellar tendon strain ratios of the operated side were lower than the contralateral side (harder tendon on operated side). While there was no correlation between strain ratios and clinical variables (age, BMI, postoperative time, severity of pain, Lysholm score, all p values > 0.05), significant negative correlations were detected between strain ratios of proximal, middle and distal thirds of operated side and amount of smoking (p = 0.008, r = -0.607, p = 0.009, r = -0.598, p = 0.023, r = -0.533, respectively). CONCLUSION: Patellar tendons on the operated sides seemed to thicken and shorten with decreased strain ratios at the donor side compared to the healthy side at an average of 2-year follow-up in patients with ACL reconstruction using BTB autograft, and amount of smoking had negative relationship with strain ratio of donor patellar tendon.

Ultrasonographic measurement of the femoral cartilage thickness in patients with transfemoral amputation.

OBJECTIVE: To compare the distal femoral cartilage thickness of the non-amputee sides in patients who had unilateral transfemoral amputation with those of healthy subjects by using ultrasound. METHODS: Thirty transfemoral amputees (27 male, 3 female) and 30 age-, sex-, and body mass index-matched healthy controls were included. Functional usage of the prosthesis was evaluated by using Houghton score. The cartilage thickness was measured from the following midpoints; medial femoral condyle (MFC), intercondylar area, and lateral femoral condyle. RESULTS: Thirty patients with unilateral transfemoral amputation (mean age; 38.6 ± 9.5 years) and 30 healthy controls (mean age; 38.4 ± 9.4 years) were included. Although femoral cartilage thicknesses were found to be lower for all measurements in the amputees, the difference reached significance only in the MFC (p= 0.031). In the patient group, cartilage thickness values did not correlate with age, duration of amputation, daily walking time, stump length or Houghton score. CONCLUSION: The distal femoral cartilage thickness seems to be decreased medially on the non-amputee sides of the transfemoral amputees when compared with the healthy subjects. Further studies concerning the follow-up designs, functional parameters and osteoarthritis scales are awaited.

The Effects of Smoking on Ultrasonographic Thickness and Elastosonographic Strain Ratio Measurements of Distal Femoral Cartilage.

Although adverse effects of smoking on bone health are all well known, data on how smoking interacts with cartilage structure in otherwise healthy individuals remains conflicting. Here, we ascertain the effects of cigarette smoking on sonoelastographic properties of distal femoral cartilage in asymptomatic adults. Demographic characteristics and smoking habits (packets/year) of healthy volunteers were recorded. Medial, intercondylar, and lateral distal femoral cartilage thicknesses and strain ratios on the dominant extremity were measured with ultrasonography (US) and real time US elastography. A total of 88 subjects (71 M, 17 F; aged 18-56 years, N = 43 smokers and N = 45 nonsmokers) were evaluated. Mean amount of cigarette smoking was 10.3 ± 8.9 (1-45) packets/year. Medial, intercondylar and lateral cartilage were thicker in smokers than nonsmokers (p = 0.002, p = 0.017, and p = 0.004, respectively). Medial distal femoral cartilage strain ratio was lower in smokers (p = 0.003). The amount of smoking was positively correlated with cartilage thicknesses and negatively correlated with medial cartilage strain ratios (p < 0.05). Femoral cartilage is thicker in smokers but has less strain ratio representing harder cartilage on the medial side. Future studies are needed to understand how these structural changes in the knee cartilage should be interpreted with regard to the development of knee osteoarthritis in smokers.

Preoperative and postoperative serial assessments of postural balance and fall risk in patients with arthroscopic anterior cruciate ligament reconstruction.

BACKGROUND: Impaired postural balance due to somatosensory data loss with mechanical instability has been shown in patients with ACL deficiency. OBJECTIVE: To assess postural balance in patients with ACL insufficiency prior to surgery and following reconstruction with serial evaluations. METHODS: Thirty patients (mean age of 27.7 ± 6.7 years) who underwent arthroscopic reconstruction of ACL with bone-patellar tendon-bone autograft were examined for clinical and functional variables at preoperative day and postoperative 12th week. Posturographic analysis were performed by using Tetrax Interactive Balance System (Sunlight Medical Ltd, Israel) at preoperative day, at 4th, 8th, and 12th weeks following reconstruction. Data computed by posturographic software by the considerations of the oscillation velocities of body sways is fall risk as a numeric value (0-100, lower values indicate better condition). RESULTS: All of the patients (mean age of 27.7 ± 6.7 years) had significant improvements for clinical, functional evaluations and fall risk (p< 0.05). Mean fall risk was within high-risk category (59.9 ± 22.8) preoperatively. The highest fall risk was detected at postoperative 4th week. Patients had high fall risk at 8th week similar to preoperative value. Mean fall risk decreased to low level risk at 12th week. Preoperative symptom duration had relationships with preoperative fall risk and postoperative improvement of fall risk (p= 0.001, r= -0.632, p= 0.001, r= -0.870, respectively). The improvement of fall risk was higher in patients with symptoms shorter than 6 months (p= 0.001). CONCLUSIONS: According to these results, mean fall risk of patients with ACL insufficiency was within high risk category preoperatively, and fall risk improves after surgical reconstruction, but as the duration of complaints lengthens especially longer than 6 months, the improvement of fall risk decreases following reconstruction.

Sonoelastographic evaluation of the distal femoral cartilage in patients with anterior cruciate ligament reconstruction.

OBJECTIVES: This study aims to evaluate sonoelastographic properties of the distal femoral cartilage in patients with anterior cruciate ligament (ACL) reconstruction. PATIENTS AND METHODS: Demographic characteristics and operative data of 28 patients (27 males, 1 female; mean age 31.7±7.1 years; range 22 to 48 years) with unilateral ACL reconstruction were evaluated. Reconstruction was performed with patellar tendon graft in 22 patients (78.6%) and hamstring tendon graft in six patients (21.4%). Lysholm knee score was used for functional evaluation and chair stand test was used for lower extremity strength. Medial, intercondylar, and lateral distal femoral cartilage thicknesses of operated knees and healthy knees were measured with B-mode ultrasound, while strain ratios were measured with real time sonoelastography. RESULTS: Postoperative mean follow-up duration was 20.4±9.8 months. Mean Lysholm knee and patient satisfaction scores were 88.0±8.5 and 8.2±1.8, respectively. Cartilage thicknesses were similar between operated and healthy knees (all p>0.05). Sonoelastographic strain ratio of medial distal femoral cartilage in operated knees was significantly higher (softer cartilage) (p=0.026). There was a negative correlation between strain ratio difference of medial cartilage of operated knees and lower extremity muscle strength (p=0.009, r= -0.487). CONCLUSION: While there was no difference for cartilage thickness between operated and healthy knees in B-mode ultrasound evaluation, detection of sonoelastographic strain ratio changes in medial distal femoral cartilage on the operated sides may indicate early structural changes following ACL reconstruction. Further studies are required to highlight the clinical effects of this relationship between the changes in cartilage structure and sonoelastography features.

Ultrasonographic assessment of the quadriceps muscle and femoral cartilage in transtibial amputees using different prostheses.

BACKGROUND: In patients with lower limb amputations, gait alteration, increased loading on the intact extremity, and use of prosthesis may lead to joint degeneration. OBJECTIVE: To explore the effects of prosthesis type on quadriceps muscle and distal femoral cartilage thicknesses in transtibial amputees. STUDY DESIGN: A cross-sectional study. METHODS: A total of 38 below-knee amputees were enrolled in the study, of which 13 patients were using vacuum system type prosthesis and 25 patients were using silicon liner pin system prosthesis. Patients' femoral cartilage and quadriceps muscle thickness measurements were performed using musculoskeletal ultrasound. RESULTS: When compared with the intact sides, cartilage and rectus femoris, vastus intermedius, and vastus medialis muscle thickness values were significantly decreased on the amputee sides (all p < 0.05). Clinical characteristics and ultrasound measurements were similar between the two groups except the lateral and medial femoral condyle thicknesses, thinner in the silicon liner pin system users (both p < 0.05). CONCLUSION: The distal femoral cartilage and quadriceps muscle thicknesses were found to be decreased on the amputated sides, and the negative impact on the cartilage seemed to be worse in the silicon liner pin system users. CLINICAL RELEVANCE: This study might provide another argument as regards the preference of vacuum system type prosthesis to prevent possible knee osteoarthritis due to cartilage thinning in adult transtibial amputees.