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1.
Nat Med ; 27(10): 1783-1788, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34635852

RESUMO

Above-knee amputation severely reduces the mobility and quality of life of millions of individuals. Walking with available leg prostheses is highly inefficient, and poor walking economy is a major problem limiting mobility. Here we show that an autonomous powered hip exoskeleton assisting the residual limb significantly improves metabolic walking economy by 15.6 ± 2.9% (mean ± s.e.m.; two-tailed paired t-test, P = 0.002) in six individuals with above-knee amputation walking on a treadmill. The observed metabolic cost improvement is equivalent to removing a 12-kg backpack from a nonamputee individual. All participants were able to walk overground with the exoskeleton, including starting and stopping, without notable changes in gait balance or stability. This study shows that assistance of the user's residual limb with a powered hip exoskeleton is a viable solution for improving amputee walking economy. By significantly reducing the metabolic cost of walking, the proposed hip exoskeleton may have a considerable positive impact on mobility, improving the quality of life of individuals with above-knee amputations.


Assuntos
Amputados/reabilitação , Exoesqueleto Energizado , Próteses e Implantes , Caminhada/fisiologia , Adulto , Amputação/tendências , Fenômenos Biomecânicos , Extremidades/fisiopatologia , Extremidades/cirurgia , Feminino , Marcha/fisiologia , Quadril/fisiopatologia , Quadril/cirurgia , Humanos , Joelho/fisiopatologia , Joelho/cirurgia , Masculino , Qualidade de Vida
2.
Biomed Res Int ; 2021: 3454475, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34527735

RESUMO

We analyzed tunnel length, graft bending angle, and stress of the graft according to tunnel entry position and aspect ratio (ASR: ratio of anteroposterior depth to mediolateral width) of the articular surface for the distal femur during single-bundle outside-in anterior cruciate ligament reconstruction (ACLR) surgery. We performed multiflexible body dynamic analyses with four ASR (98, 105, 111, and 117%) knee models. The various ASRs were associated with approximately 1 mm changes in tunnel length. The graft bending angle increased when the entry point was far from the lateral epicondyle and was larger when the ASR was smaller. The graft was at maximum stress, 117% ASR, when the tunnel entry point was near the lateral epicondyle. The maximum stress value at a 5 mm distance from the lateral epicondyle was 3.5 times higher than the 15 mm entry position, and the cases set to 111% and 105% ASR showed 1.9 times higher stress values when at a 5 mm distance compared with a 15 mm distance. In the case set at 98% ASR, the low-stress value showed a without-distance difference from the lateral epicondyle. Our results suggest that there is no relationship between the ASR and femoral tunnel length. A smaller ASR causes a higher graft bending angle, and a larger ASR causes greater stress in the graft.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/cirurgia , Articulação do Joelho/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Bases de Dados Factuais , Fêmur/cirurgia , Humanos , Imageamento Tridimensional/métodos , Joelho/cirurgia , Tomografia Computadorizada por Raios X/métodos
3.
Am J Sports Med ; 49(10): 2638-2644, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34236927

RESUMO

BACKGROUND: Proper lower extremity biomechanics during bilateral landing is important for reducing injury risk in athletes returning to sports after anterior cruciate ligament reconstruction (ACLR). Although landing is a quick ballistic movement that is difficult to modify, squatting is a slower cyclic movement that is ideal for motor learning. HYPOTHESIS: There is a relationship between lower extremity biomechanics during bilateral landing and bilateral squatting in patients with an ACLR. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 41 patients after a unilateral ACLR (24 men, 17 women; 5.9 ± 1.4 months after ACLR) completed 15 unweighted bilateral squats and 10 bilateral stop-jumps. Three-dimensional lower extremity kinematics and kinetics were collected, and peak knee abduction angle, knee abduction/adduction range of motion, peak vertical ground-reaction force limb symmetry index (LSI), vertical ground-reaction force impulse LSI, and peak knee extension moment LSI were computed during the descending phase of the squatting and landing tasks. Wilcoxon signed-rank tests were used to compare each outcome between limbs, and Spearman correlations were used to compare outcomes between the squatting and landing tasks. RESULTS: The peak vertical ground reaction force, the vertical ground reaction force impulse, and the peak knee extension moment were reduced in the surgical (Sx) limb relative to the nonsurgical (NSx) limb during both the squatting and landing tasks (P < .001). The relationship between squatting and landing tasks was strong for the peak knee abduction angle (R = 0.697-0.737; P < .001); moderate for the frontal plane knee range of motion (NSx: R = 0.366, P = .019; Sx: R = 0.418, P = 0.007), the peak knee extension moment LSI (R = 0.573; P < .001), the vertical ground reaction force impulse LSI (R = 0.382; P < .014); and weak for the peak vertical ground reaction force LSI (R = 0.323; P = .039). CONCLUSION: Patients who have undergone an ACLR continue to offload their surgical limb during both squatting and landing. Additionally, there is a relationship between movement deficits during squatting and movement deficits during landing in patients with an ACLR preparing to return to sports. CLINICAL RELEVANCE: As movement deficits during squatting and landing were related before return to sports, this study suggests that interventional approaches to improve squatting biomechanics may translate to improved landing biomechanics in patients with an ACLR.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Feminino , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Amplitude de Movimento Articular
4.
Orthopedics ; 44(4): 235-240, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34292810

RESUMO

The goal of this study was to evaluate the stiffness and resistance to elongation of an internal bracing (IB) construct in posterior cruciate ligament reconstruction (PCLR). The authors hypothesized that augmentation with an internal brace would increase construct stiffness and decrease posterior tibial translation during cyclic loading in a fresh frozen cadaveric model. Ten cadaver knees underwent PCL reconstruction with (PCLR+IB) and without (PCLR) augmentation with an internal brace and were compared with an intact PCL state. Knees were subjected to cyclic posterior drawer loading at 45 N, 90 N, and 134 N. The PCLR+IB showed significantly less tibial translation with posterior drawer loading compared with the PCLR. Posterior tibial translation measured 8.83 mm for the PCLR vs 6.59 mm for the PCLR+IB (P=.05) at 45 N posterior load. This difference remained significant at higher loads, with posterior translation of 10.84 mm and 8.44 mm for PCLR and PCLR+IB, respectively, at 90 N (P=.035) and posterior translation of 12.80 mm and 10.23 mm for PCLR and PCLR+IB, respectively, at 134 N (P=.023). No significant differences were found in overall construct stiffness between groups. These data suggest a checkrein mechanism of action for the internal brace in this construct, rather than a load-sharing mechanism. Importantly, the PCLR+IB technique did not constrain posterior translation more than the intact, physiologic state. Clinical studies are warranted to determine whether these ex vivo biomechanical benefits will translate to improved outcomes. [Orthopedics. 2021;44(4):235-240.].


Assuntos
Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Fenômenos Biomecânicos , Cadáver , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Tíbia/cirurgia
5.
Am J Sports Med ; 49(8): 2150-2158, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34038185

RESUMO

BACKGROUND: The acute effects of exercise on anterior knee laxity (AKL) and anterior knee stiffness (AKS) have been documented in healthy participants, but only limited evidence has been provided for athletes cleared to return to sports after anterior cruciate ligament (ACL) reconstruction (ACLR). PURPOSE/HYPOTHESIS: The purpose was to determine if 45 minutes of a soccer match simulation lead to acute changes in AKL and AKS in soccer players returning to sport within 12 months after ACLR. We hypothesized that the reconstructed knee of the ACLR group would exhibit an altered response to sport-specific exercise. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 13 soccer players cleared to return to sport after ACLR and 13 healthy control soccer players matched for age, physical activity level, limb dominance, and anthropometric characteristics were recruited. To assess the effects of a standardized soccer match simulation (Soccer Aerobic Field Test [SAFT45]) on AKL and AKS, an arthrometric evaluation was carried out bilaterally before and immediately after SAFT45. To conduct a comprehensive examination of the force-displacement curve, the absolute and side-to-side difference (SSD) values of both AKL and AKS were extracted at 67, 134, and 200 N. RESULTS: The ACLR and control groups showed similar AKL and AKS at baseline (P > .05). In response to SAFT45, laxity increased bilaterally at all force levels by 14% to 17% only in the control group (P < .025). Similarly, AKS at 134 and 200 N decreased in response to SAFT45 only in the control group (10.5% and 20.5%, respectively; P < .025). After SAFT45, the ACLR group had 1.9 and 2.5 times higher SSDs of AKS at 67 and 134 N compared with the control group, respectively (P < .025), as well as a 1.9 times higher SSD of AKS at 134 N compared with baseline (P = .014). CONCLUSION: Soccer players at the time of return to sport after ACLR showed an altered mechanical response to a sport-specific match simulation consisting of bilaterally unchanged AKL and AKS. CLINICAL RELEVANCE: Soccer players showing altered AKL and AKS in response to exercise after ACLR may not be ready to sustain their preinjury levels of sport, thus potentially increasing the risk of second ACL injuries.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Futebol , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Volta ao Esporte
6.
Knee ; 30: 344-352, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34038856

RESUMO

BACKGROUND: iASSIST is one of the novel accelerometer-based navigation systems for total knee arthroplasty (TKA). Although the accuracy of iASSIST compared with conventional instruments has been reported, such evaluations were performed on two-dimensional (2D) images (X-rays). This multi-center prospective randomized controlled trial aimed to assess component positioning between TKA with and without iASSIST by 3D image assessment, and to clarify whether the iASSIST provides any benefit with regard to alignment accuracy. METHODS: Eighty-three knees with primary knee osteoarthritis were enrolled in this study. iASSIST was used for distal femoral and proximal tibial resection in 42 knees (iA group) and a conventional guide was used in 41 knees (CONV group). At 6 months postoperatively, component alignment was evaluated with 3D images by the independent orthopaedic surgeons, and surgical parameters, range of motion and clinical outcomes were examined. RESULTS: The rate of knees who have the alignment within 3° of neutral compared with the iA group and CONV group were 92.9% (39/42) vs. 87.8% (36/41) for femur and 76.2% (32/42) vs. 56.1% (23/41) for tibia in the coronal plane, respectively, whereas in the sagittal plane, the rate was 85.7% (36/42) vs. 58.5% (24/41) for femur and 83.3% (35/42) vs. 78.0% (32/41) for tibia, respectively. Compared with the CONV group, the iA group had a significantly improved femoral alignment in the sagittal plane (P = 0.006). There were no clinical or patient-reported differences at 6 months postoperatively. CONCLUSIONS: The iASSIST provides technically high accuracy in femoral resection at TKA compared with a conventional procedure.


Assuntos
Artroplastia do Joelho/métodos , Joelho/diagnóstico por imagem , Cirurgia Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/fisiologia , Fêmur/cirurgia , Humanos , Imageamento Tridimensional , Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Amplitude de Movimento Articular , Tíbia/fisiologia , Tíbia/cirurgia
7.
Orthopedics ; 44(3): 187-191, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34039213

RESUMO

Negative pressure wound therapy (NPWT) has shown promise in reducing postoperative complications in several applications in orthopedic surgery, including trauma and arthroplasty. To the authors' knowledge, no study has evaluated its use in multiligament knee reconstruction. Multiligament knee reconstruction is often fraught with arthrofibrosis and wound-healing complications. This retrospective study assessed complications requiring reoperation in patients who underwent multiligament knee reconstruction and received either NPWT (n=14) or a dry sterile dressing (DSD) (n=44). There were significantly more reoperations in the cohort of patients who received a DSD (P=.011). Arthrofibrosis in particular showed a significantly lower rate of occurrence in the NPWT cohort compared with the DSD cohort (P=.025). There was a trend toward a lower infection rate in the NPWT cohort (P=.322). This study provides evidence that NPWT may be effective in reducing reoperation after multiligament knee reconstruction. Further investigations with prospective studies are needed to draw stronger conclusions about the benefits of NPWT. [Orthopedics. 2021;44(3):187-191.].


Assuntos
Joelho/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adulto , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Reoperação , Estudos Retrospectivos , Cicatrização
8.
Knee ; 30: 176-184, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33940305

RESUMO

BACKGROUND: Hop performance and isokinetic knee extensor strength (IKES) asymmetry are associated with re-injury after anterior cruciate ligament reconstruction (ACLR). This study investigated deficits after ACLR, and which hop tests are most correlated with IKES and patient-reported outcome measures (PROMs). METHODS: 50 patients were assessed 9-12 months after ACLR using the International Knee Documentation Committee (IKDC) and ACL Return to Sport after Injury (ACL-RSI) scores. Peak IKES and eight hop tests were assessed: single (SHD), triple (THD) and triple crossover (TCHD) hop for distance, 6 m timed hop (6MTH), single medial (MHD) and single lateral (LHD) hop for distance, single countermovement jump (SLCMJ) and timed speedy hop (SHT). The percentage of patients with limb symmetry indices (LSIs) < 90% was reported. Pearson's correlations investigated the correlation between PROMs, IKES and hop LSIs. RESULTS: The majority (80%) of patients had IKES LSIs < 90%. While 12-14% of patients demonstrated LSIs < 90% for the SHD, 6MTH, THD and TCHD, 52-80% demonstrated LSIs < 90% for the other hop tests. The IKES LSI was significantly different (p < 0.05) from all hop LSIs, besides the SLCMJ (p = 0.638). Large correlations were only observed between the IKES LSI and the SLCMJ (r = 0.82), MHD (r = 0.71) and LHD (r = 0.53). The SLCMJ, MHD and IKES LSIs demonstrated the largest significant correlations with the IKDC (r = 0.51-0.53) and ACL-RSI (r = 0.38-0.40). CONCLUSIONS: Hop tests such as the MHD and SLCMJ may present a more practical alternative to quantifying peak IKES, especially in the absence of more sophisticated testing equipment. While not surrogates as such, these selective hop measures may better inform the clinician as to whether significant underlying quadriceps deficits are still present throughout the post-operative rehabilitation period.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Joelho/fisiologia , Força Muscular/fisiologia , Músculo Quadríceps/fisiologia , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Teste de Esforço , Feminino , Humanos , Joelho/cirurgia , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Volta ao Esporte , Adulto Jovem
9.
Knee ; 30: 185-194, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33940306

RESUMO

BACKGROUND: The purpose of this study was to evaluate true change in leg length after open-wedge high tibial osteotomy (OWHTO) using three-dimensional (3D) assessments, examine the factors that influence leg lengthening and verify their validity in clinical practice. METHODS: Study 1: a retrospective case series simulation study, included 46 patients (55 knees) that underwent knee arthroplasty or HTO. OWHTO was simulated from preoperative computed tomography using 3D preoperative planning software. Uni- and multivariate regression analyses were conducted to identify predictors related to change in leg length. Study 2: a retrospective case series study, included 53 patients (55 knees) that underwent OWHTO in another institution. Change in leg length was measured preoperatively and 1 year postoperatively and was compared with the predicted change in leg length calculated using the formula obtained from Study 1. RESULTS: Study 1: the true change in leg length significantly increased and showed a strong correlation with the opening width. The change in leg length was predicted using the formula "change in leg length = opening width × 0.75-1.5." Study 2: the predicted change in leg length showed no significant difference from the change in leg length 1 year postoperatively and a strong correlation with the measured change. CONCLUSIONS: The true change in leg length after OWHTO was predicted using the formula obtained from the 3D model. Predicting the change in leg length preoperatively can be a basis to consider other HTOs.


Assuntos
Perna (Membro)/anatomia & histologia , Osteotomia/métodos , Tíbia/cirurgia , Idoso , Artroplastia do Joelho , Feminino , Humanos , Joelho/cirurgia , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Realidade Virtual
10.
Knee ; 30: 163-169, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33932828

RESUMO

BACKGROUND: While patellar resurfacing can affect patellofemoral kinematics, the effect on tibiofemoral kinematics is unknown. We hypothesized that patellar resurfacing would affect tibiofemoral kinematics during deep knee flexion due to biomechanical alteration of the extensor mechanism. METHODS: We performed cruciate-retaining TKA in fresh-frozen human cadaveric knees (N = 5) and recorded fluoroscopic kinematics during deep knee flexion before and after the patellar resurfacing. To simulate deep knee flexion, cadaver knees were tested on a dynamic, quadriceps-driven, closed-kinetic chain simulator based on the Oxford knee rig design under loads equivalent to stair climbing. To measure knee kinematics, a 2-dimensional to 3-dimensional fluoroscopic registration technique was used. Component rotation, varus-valgus angle, and anteroposterior translation of medial and lateral contact points of the femoral component relative to the tibial component were calculated over the range of flexion. RESULTS: There were no significant differences in femoral component external rotation (before patellar resurfacing: 6.6 ± 2.3°, after patellar resurfacing: 7.2 ± 1.8°, p = 0.36), and less than 1° difference in femorotibial varus-valgus angle between patellar resurfacing and non-resurfacing (p = 0.01). For both conditions, the medial and lateral femorotibial contact points moved posteriorly from 0° to 30° of flexion, but not beyond 30° of flexion. At 10° of flexion, after patellar resurfacing, the medial contact point was more anteriorly located than before patellar resurfacing. CONCLUSION: Despite the potential for alteration of the knee extensor biomechanics, patellar resurfacing had minimal effect on tibiofemoral kinematics. Patellar resurfacing, if performed adequately, is unlikely to affect postoperative knee function.


Assuntos
Artroplastia do Joelho , Fêmur/cirurgia , Articulação do Joelho/cirurgia , Joelho/cirurgia , Patela/cirurgia , Tíbia/cirurgia , Fenômenos Biomecânicos , Cadáver , Fêmur/fisiologia , Fluoroscopia , Humanos , Joelho/fisiologia , Articulação do Joelho/fisiologia , Prótese do Joelho , Músculo Quadríceps/cirurgia , Amplitude de Movimento Articular , Rotação , Tíbia/fisiologia
11.
Knee ; 30: 283-290, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33984747

RESUMO

BACKGROUND: Patients suffering from bilateral combined medial osteoarthritis and varus alignment of the knee are eligible for bilateral high tibial osteotomy (HTO) in two-staged surgery. The impact of bilateral HTO surgery on rehabilitation and early outcomes have not yet been reported in the literature, even though these features are decisive in establishing whether a patient is preferably treated in one or two stages. METHODS: A total of 29 patients were followed after simultaneous bilateral HTO surgery. Numeric Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS) and Lysholm scores were recorded at 3, 6 and 12 months. Results were compared with outcomes of unilateral HTO surgery to asses the additional impact of simultaneous bilateral HTO surgery on the early rehabilitation and recovery of simultaneous bilateral HTO surgery. RESULTS: Three months after surgery, NRS pain scores decreased from 60.5 to 40.9 and subsequently to 30.4 and 24.3 after 6 and 12 months, respectively. KOOS-PS scores improved from 50.0 to 44.3 after 3 months, to 33.9 and 29.8 after 6 and 12 months, respectively. Lysholm scores did not improve after 3 months (45.2-44.2), but significantly improved after 6 and 12 months (66.1 and 75.7, respectively). Compared with unilateral HTO surgery, similar improvements were seen after 6 and 12 months. CONCLUSION: Simultaneous bilateral HTO surgery generates similar clinical outcomes compared with unilateral HTO surgery and moreover it does not excessively prolong time to achieve these outcomes. It is safe and presumably a more effective approach to treat patients suffering bilateral medial osteoarthritis and varus alignment of the knee compared with two-staged surgery.


Assuntos
Aloenxertos , Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Tíbia/cirurgia , Adulto , Idoso , Aloenxertos/cirurgia , Feminino , Humanos , Joelho/diagnóstico por imagem , Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteotomia/reabilitação , Dor/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
Knee ; 30: 90-99, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33878682

RESUMO

BACKGROUND: This study aimed to evaluate clinical and biomechanical changes in self-report survey, quadriceps strength and gait analysis over 3- and 6-months post-total knee arthroplasty (TKA) and confirm the immediate effects of two forms of kinetic biofeedback on improving inter-limb biomechanics during a physically demanding decline walking task. METHODS: Thirty patients with unilateral TKA underwent testing at 3- and 6-months following surgery. All underwent self-report survey, quadriceps strength and gait analysis testing. Patients were assigned to one of two types of biofeedback [vertical ground reaction force (vGRF), knee extensor moment (KEM)]. RESULTS: No decrease in gait asymmetry was observed in non-biofeedback trials over time (p > 0.05), despite significant improvements in self-report physical function (p < 0.01, Cohen d = 0.44), pain interference (p = 0.01, Cohen d = 0.68), numeric knee pain (p = 0.01, Cohen d = 0.74) and quadriceps strength (p = 0.01, Cohen d = 0.49) outcomes. KEM biofeedback induced significant decrease in total support moment (p = 0.05, Cohen f2 = 0.14) and knee extensor moment (p = 0.05, Cohen f2 = 0.21) asymmetry compared to using vGRF biofeedback at 6-months. vGRF biofeedback demonstrated significant decrease in hip flexion kinematic asymmetry compared to KEM biofeedback (p = 0.05, Cohen f2 = 0.18) at 6-months. CONCLUSION: Gait compensation remained similar from 3- to 6-months during a task requiring greater knee demand compared to overground walking post-TKA, despite improvements in self-report survey and quadriceps strength. Single session gait symmetry training at 6-month supports findings at 3-month testing that motor learning is possible. KEM biofeedback is more effective at immediately improving joint kinetic loading compared to vGRF biofeedback post-TKA.


Assuntos
Artroplastia do Joelho/reabilitação , Marcha , Articulação do Joelho/cirurgia , Joelho/cirurgia , Músculo Quadríceps/fisiopatologia , Idoso , Biorretroalimentação Psicológica , Fenômenos Biomecânicos , Feminino , Seguimentos , Análise da Marcha , Humanos , Cinética , Articulação do Joelho/fisiopatologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Movimento , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Inquéritos e Questionários , Resultado do Tratamento , Caminhada/fisiologia
14.
Knee ; 30: 35-40, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33836302

RESUMO

In this article we report a case of stiff, neglected extreme recurvatum knee deformity in a 17-year-old female. This is the first reported case in the literature of an acquired ligamentous stiff extreme knee recurvatum following manipulation under anesthesia and botulinum neurotoxin injection. Μodified Judet quadricepsplasty combined with Ilizarov external hinged frame fixation was implemented. This dual technique can be considered as a rational approach for such an extreme deformity as it stabilizes, progressively corrects, and prevents recurrence. A patellar tendon rupture caused by the increasing tension of the extensor mechanism following the correction was treated successfully using a cadaveric Achilles tendon allograft.


Assuntos
Anestesia/efeitos adversos , Toxinas Botulínicas/efeitos adversos , Joelho/fisiopatologia , Joelho/cirurgia , Procedimentos Ortopédicos/métodos , Tendão do Calcâneo/transplante , Adolescente , Toxinas Botulínicas/administração & dosagem , Feminino , Humanos , Técnica de Ilizarov , Joelho/diagnóstico por imagem , Ligamento Patelar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ruptura/etiologia , Ruptura/terapia , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia , Transplante Homólogo/métodos
15.
Rev. bras. ortop ; 56(2): 256-257, Apr.-June 2021.
Artigo em Inglês | LILACS | ID: biblio-1251335

RESUMO

Abstract The arthroscopic reconstruction of the anterior cruciate ligament is a common surgery performed by the orthopedic surgeons willing to restore the knee stability of physically active patients. Despite the fact that it is usually an uneventful procedure, surgeons must always look for better post-operative results; in this scenario, the arthroscopic reconstruction of the anterior cruciate ligament without a tourniquet is a promising alternative. The aim of the present paper is to share with other orthopedic surgeons around the world our experience with this procedure and some technical tips that may be helpful.


Resumo A reconstrução artroscópica do ligamento cruzado anterior é uma cirurgia comum realizada pelos cirurgiões ortopédicos dispostos a restaurar a estabilidade do joelho de pacientes fisicamente ativos. Apesar de ser geralmente um procedimento sem intercorrências, os cirurgiões devem sempre procurar melhores resultados pós-operatórios; neste cenário, a reconstrução artroscópica do ligamento anterior sem torniquete é uma alternativa promissora. O objetivo deste artigo é compartilhar com outros cirurgiões ortopédicos ao redor do mundo nossa experiência com este procedimento e algumas dicas técnicas que podem ser úteis.


Assuntos
Torniquetes , Reconstrução do Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior , Cirurgiões Ortopédicos , Joelho/cirurgia
16.
Phys Ther Sport ; 49: 157-163, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33721625

RESUMO

OBJECTIVES: To examine knee flexion range-of-motion, quadriceps strength, and knee self-efficacy trajectory curves over 6 months after anterior cruciate ligament reconstruction (ACLR), stratified by patients' Month-6 sports activity level. DESIGN: Prospective longitudinal study. SETTING: Hospital outpatient physiotherapy department. PARTICIPANTS: 595 individuals after unilateral ACLR (mean age, 27 years). MAIN OUTCOME MEASURES: At 2-, 3-, and 6-months post-surgery, knee flexion range-of-motion, quadriceps strength, and self-efficacy were quantified. Flexion range-of-motion was additionally measured at 2- and 4-weeks post-surgery. Sports activity levels were assessed using the Tegner Activity Score at 6-months post ACLR. RESULTS: The various measures improved nonlinearly over time, with substantial improvements observed in the first 2-4 months post-surgery. In multivariable generalized least squares models, greater knee flexion range-of-motion, quadriceps strength, and self-efficacy over time were significantly associated with higher Month-6 Tegner levels (all P values < 0.01). Additionally, receiving a bone-patellar-tendon-bone graft or meniscal repair was associated with lower quadriceps strength trajectories (P-values<0.001) while female sex was associated with lower knee self-efficacy trajectories (P = 0.02). CONCLUSIONS: Greater knee flexion range-of-motion, quadriceps strength, and self-efficacy were associated with higher Month-6 Tegner levels. The derived trajectory curves may be useful for effective management decision making and adequate results interpretation during the rehabilitation process.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/reabilitação , Joelho/fisiologia , Força Muscular , Músculo Quadríceps/fisiologia , Autoeficácia , Adulto , Lesões do Ligamento Cruzado Anterior/reabilitação , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Joelho/cirurgia , Estudos Longitudinais , Masculino , Estudos Prospectivos , Amplitude de Movimento Articular , Adulto Jovem
17.
J Orthop Surg (Hong Kong) ; 29(1): 23094990211002002, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33787403

RESUMO

PURPOSE: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. METHODS: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. RESULTS: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. CONCLUSION: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/fisiologia , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/reabilitação , Feminino , Humanos , Deformidades Articulares Adquiridas/patologia , Deformidades Articulares Adquiridas/fisiopatologia , Deformidades Articulares Adquiridas/cirurgia , Joelho/fisiologia , Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Fenômenos Mecânicos , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Período Pós-Operatório
18.
Knee ; 30: 1-8, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33784535

RESUMO

BACKGROUND: The relationship between the femoral component design in total knee arthroplasty (TKA) and the patellofemoral contact force, as well as the soft tissue balance, has not been well reported thus far. METHODS: Twenty-eight mobile-bearing posterior-stabilized (PS) TKAs using the traditional model (PFC Sigma) and 27 mobile-bearing PS TKAs using the latest model (Attune) were included. Surgeries were performed using the measured resection technique assisted with the computed tomography (CT)-based free-hand navigation system. After all the trial components were placed, patellar contact forces on the medial and lateral sides were measured using two uniaxial ultrathin force transducers with the knee at 0°, 10°, 30°, 60°, 90°, 120°, and 135° of flexion. The joint component gap and the varus ligament balance of the femorotibial joint were also measured. The non-paired Student's t-test was conducted to compare the values of the two groups. RESULTS: The medial patellar contact force was significantly lower for Attune group than for PFC Sigma group at 120° of knee flexion (P = 0.0058). The lateral patellar contact force was also significantly lower for Attune group than PFC Sigma group at 120° and 135° of knee flexion (P = 0.0068 and P = 0.036). The joint component gap, as well as the varus ligament balance, showed no statistically significant difference between the two groups. CONCLUSIONS: Reduced thickness and width of the anterior flange of the femoral component in the Attune may play a role in low patellar contact force.


Assuntos
Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Patela/fisiologia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Fêmur/fisiologia , Fêmur/cirurgia , Humanos , Cuidados Intraoperatórios , Joelho/fisiologia , Joelho/cirurgia , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Masculino , Osteoartrite do Joelho/fisiopatologia , Patela/cirurgia , Desenho de Prótese , Amplitude de Movimento Articular
19.
Pain Physician ; 24(2): E177-E183, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33740351

RESUMO

BACKGROUND: Over the last decade, several authors have reported that percutaneous peripheral nerve stimulation (PNS) can be used to assist in verifying the position of the procedure needle tip in relation to nerve structures, and that the combined technique using both ultrasound (US) guidance and PNS may serve as a reliable method for confirmation of the correct position of the procedure needle tip. It has also been reported that, when combined with US guidance, PNS may increase the success rate of pain management interventions. OBJECTIVES: The aim of this technical report was to standardize an effective and easy to learn illustrated step-by-step technical approach to nerve identification during US-guided genicular nerve blocks, using percutaneous PNS as a verification instrument for procedure needle tip location. STUDY DESIGN: This technical protocol was developed based on the results of the authors' most recent cadaveric study on the innervation of the knee joint capsule. The technique was developed and tested by 4 different interventionists with different levels of expertise in US-guided procedures. SETTING: The cadaveric study of the knee joint capsule innervation was performed at the laboratory of the Division of Anatomy of one institution. The technical protocol using US and PNS was later developed at the medical simulation center of a different institution. METHODS: A team of anatomists from a division of anatomy of one institution performed the cadaveric study on the innervation of the knee joint capsule. A team of physicians then developed the step-by-step approach to this technical protocol at the medical simulation center of  a different institution. Finally, the illustrated step-by-step approach was tested by 4 different interventionists with different levels of expertise in US-guided procedures (1 beginner-level user; 1 intermediate-level user; 2 expert-level users), using a portable percutaneous PNS and 2 different US transducers at 2 different institutions. RESULTS: This technical protocol was successfully developed based on the results of the cadaveric study on the innervation of the knee joint capsule. Additionally, it was later successfully tested by interventionists with various levels of expertise utilizing different US equipment at separate institutions. LIMITATIONS: By combining US and nerve stimulation, this protocol requires the availability of both US equipment and necessary equipment for nerve stimulation that must all be made available in the sterile field. Another potential disadvantage is that nerve stimulation controls and the US image screen are generally located on 2 separate display panels, which could cause difficulty with visualization and simultaneous calibration for 2 individual devices. CONCLUSIONS: Our illustrated step-by-step technical protocol can be effectively and safely utilized as a reliable method of training, by which physicians with little to moderate US experience can improve their skills in accurately identifying the genicular nerves while performing US-guided examinations with the intent of executing a peripheral nerve block.


Assuntos
Articulação do Joelho/cirurgia , Joelho/cirurgia , Bloqueio Nervoso/métodos , Nervos Periféricos/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Humanos , Joelho/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/inervação , Estimulação Elétrica Nervosa Transcutânea
20.
J Arthroplasty ; 36(7): 2445-2451.e1, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33741244

RESUMO

BACKGROUND: Prior ipsilateral knee surgery may increase the risk for complications after total knee arthroplasty (TKA). It remains unclear if the extent of previous surgery affects those risks disparately. The purpose of this study is to evaluate prior nonarthroplasty bony procedure (BP) and soft tissue only procedure (STP) as a potential risk factor for complications after TKA and determine the association with charges or reimbursement of the primary TKA. METHODS: Patients who underwent primary TKA with previous knee surgery were identified using a national Medicare database and matched 1:5 to controls without prior knee surgery. Rates of postoperative medical and surgical complications were calculated in addition to hospital-associated charges and reimbursements. Logistic regression analysis was used to control for confounding factors. RESULTS: Patients who underwent BP (n = 835) had increased risk of readmission (58.6% vs 45.3%, odds ratio (OR) 1.72, 95% confidence interval (CI) 1.59-1.85, P < .001) and emergency room visits (14.5% vs 10.4%, OR 1.44, 95% CI 1.29-1.61, P = .001). Patients who underwent STP (n = 6766) had increased risk of readmission (58.1% vs 45.2%, OR 1.69, 95% CI 1.64-1.73, P < .001), emergency room visits (12.6% vs 0.7%, OR 1.33, 1.28-1.39, P < .001), revision (1.8% vs 1.4%, OR 1.33, 95% CI 1.21-1.47, P = .006), cerebrovascular accident (2.3% vs 1.7%, OR 1.33, 95% CI 1.22-1.46, P = .002), and venous thromboembolism (3.8% vs 3.2%, OR 1.21, 95% CI 1.13-1.29, P = .009). Prior surgery was associated with increased charges and reimbursements. CONCLUSION: Prior ipsilateral knee surgery is associated with significantly increased risks of postoperative complications after primary TKA. Interestingly, previous STP but not BP increased the risk of short-term revision and venous thromboembolism.


Assuntos
Artroplastia do Joelho , Idoso , Artroplastia do Joelho/efeitos adversos , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Medicare , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
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