Bone filling decreases donor site morbidity after anterior cruciate ligament reconstruction with bone-patellar tendon-bone autografts.

PURPOSE: Bone-patellar tendon-bone (BTB) autograft remains the most widely used graft source for anterior cruciate ligament reconstruction (ACLR). The drawback associated with BTB is increased donor-site morbidity, such as anterior knee pain. The purpose of this study was to evaluate and compare anterior knee pain after refilling the patella bony defect with bone substitute. METHODS: This is a retrospective analysis of consecutive patients who underwent BTB ACLR at a single institution between January 2015 and December 2020. The cohort was divided into two groups; one in which the patellar bony defect was refilled with bone substitute (Bone Graft group) and another in which this the bony defects were not treated (No Bone Graft group). Demographic variables, reported anterior knee pain, visual analog scale (VAS) score, complications, re-operation, and patient reported outcome measures, such as the IKDC, LYSHOLM and SF-12 scores, were compared between groups. RESULTS: A total of 286 patients who underwent BTB ACLR were included. The No Bone Graft group included 88 (30.7%) patients and the Bone Graft group included 198 (69.3%) patients. The Bone Graft group had less anterior knee pain at last clinic follow up (33.3% vs. 51.1% p = 0.004) as well as lower VAS anterior knee pain scores (2.18 vs. 3.13, p = 0.004). The Bone Graft group had lower complications rates (21.7% vs 34.1, p = 0.027). No differences were found in the LYSHOLM, IKDC, and SF-12 scores. CONCLUSION: Bone refilling in BTB ACLR significantly reduces prevalence and severity of anterior knee pain. Larger randomized trials are needed to confirm the benefits of bone refilling in ACLR patients. LEVEL OF EVIDENCE: Retrospective study-III.

The "Selfie Test": A Novel Test for the Diagnosis of Lateral Epicondylitis.

Background: Lateral epicondylitis (LE) is one of the most diagnosed elbow pathologies. The purpose of this study was to determine the diagnostic test accuracy of a new test (selfie test) for the diagnosis of LE. Methods: Medical data were collected from adult patients who presented with LE symptoms and ultrasound findings that supported the diagnosis. Patients underwent a physical examination, including provocative tests for diagnosis as well as the selfie test, and were asked to fill out the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire and subjectively rate the activity of their affected elbow. Results: Thirty patients were included in this study (seventeen females, 57%). The mean age was 50.1 years old (range of 35 to 68 years). The average duration of symptoms was 7 ± 3.1 months (range of 2 to 14 months). The mean PRTEE score was 61.5 ± 16.1 (range of 35 to 98), and the mean subjective elbow score was 63 ± 14.2 (range of 30 to 80). Mill's, Maudsley's, Cozen's, and the selfie tests had sensitivities of 0.867, 0.833, 0.967, and 0.933, respectively, with corresponding positive predictive values of 0.867, 0.833, 0.967, and 0.933. Conclusions: The selfie test's active nature, which allows patients to perform the assessment themselves, could be a valuable addition to the diagnostic process, potentially improving the accuracy of the diagnosis of LE (levels of evidence: IV).

Biomechanical evaluation of suture buttons versus cortical screws in the Latarjet-Bristow procedure: a fresh-frozen cadavers study.

INTRODUCTION: A commonly used method of fixation of the transferred coracoid in the traditional Latarjet-Bristow procedure (open or arthroscopic) is by two bicortical screws. Although mechanically effective, screw fixation is also a major source of hardware and neurologic complications. This study aimed to compare the biomechanical performances of traditional metal screws and endobuttons as fixators of the Latarjet-Bristow procedure. MATERIALS AND METHODS: Nine fresh-frozen cadaveric human scapulae with the conjoined tendon attached to the coracoid process were used for the Latarjet-Bristow procedure. The specimens were randomly assigned one of two groups: fixation using two 4.5-mm cannulated partially threaded Latarjet-Bristow experience screws or fixation using a suture-button construct. Specimens were secured in a material testing machine and cyclically preconditioned from 2 to 10 N at 0.1 Hz for ten cycles. They were then pulled to failure at a normalized displacement rate of 400% of the measured gauge length per minute. The maximal load-to-failure, stiffness and stress were calculated using a custom script. The failure mechanism and site were recorded for each specimen. RESULTS: There were no significant differences in the maximal load-to-failure or other biomechanical properties of the two fixation techniques, but the failure mechanisms were unique to each one. Four specimens fixated with screws underwent graft failures (fracture) through the proximal or distal drill hole. Five specimens fixated with endobuttons underwent failure due to glenoid bone fractures. CONCLUSIONS: A single endobutton fixation appears to be biomechanically comparable to screw fixation in the Latarjet-Bristow procedure and provides a lower risk for graft fracture. Further studies with more numerous specimens are warranted to conclusively validate these findings.

A Modified Triangular Arthroscopic Suture-Based Fixation for Tibial Eminence Fractures: Technique, Outcome and Literature Review.

Objectives: Tibial eminence fractures account for 2% to 5% of all knee injuries. Low-grade fractures, such as Type I, are typically treated conservatively, whereas high-grade fractures, such as Types III and IV, usually require surgical intervention. This paper describes a modified surgical arthroscopic technique, which employs pull-through triangle suture fixation for Type II and Type III arthroscopic intercondylar eminence avulsion fractures. In addition, we examined the efficacy and complication rate compared to the existing literature. Methods: Data were prospectively collected for knee arthroscopy surgeries and retrospectively analyzed with a minimum two-year follow-up. Twenty-three consecutive adults underwent arthroscopic treatment of displaced intercondylar Type II and Type III eminence fractures, as evidenced by clinical examination and imaging studies between May/2008 and May/2021. The patient's knee evaluation was performed using clinical symptoms and physical examination, along with International Knee Documentation Committee (IKDC) questionnaire and Tegner Activity Score. Compared to the literature, post-hoc power was calculated based on the mean Tegner Activity Score in our analysis. Results: fifteen females and eight males (mean age 33.9 years, range 19-56 years) were enrolled. The average postoperative follow-up was 35.4 months (27-53). The post-hoc power was 95% confidence in terms of the Tegner Activity Score. The mean ± standard deviation postoperative Tegner Activity Score was 8.2 ± 1.7 (6.8-10.0). Fifteen patients were classified as IKDC A (normal), six as IKDC B (nearly normal), and two as IKDC C (abnormal). The mean IKDC subjective score was 72.7 ± 23 (23-100). Twenty-four patients achieved normal flexion degrees compared with the unaffected side, while one patient achieved a flexion of only 0-90°. The group's mean flexion range of motion was 123 ± 16° (90-150°). Conclusion: This study presents a modified surgical arthroscopic suture fixation technique for tibial eminence fractures. The procedure is relatively simple and requires no more than basic arthroscopy equipment. The clinical and radiographic results indicate that this technique is safe, efficient, enables early initiation of rehabilitation, and has a lower complication rate in a variety of aspects compared with other fixation techniques used for tibial eminence fractures.

A unique foot-worn device for patients with degenerative meniscal tear.

PURPOSE: The purpose of the current study was to assess the effects of a new foot-worn device on the gait, physical function and pain in patients suffering from knee osteoarthritis (OA) who had a low-impact injury to the medial meniscus causing a degenerative meniscal tear. METHODS: A retrospective analysis of 34 patients with knee OA and a degenerative medial meniscal tear was performed. Patients underwent a gait evaluation, using an electronic walkway mat, and completed the SF-36 health survey and the WOMAC questionnaire at baseline and after 3 and 12 months of therapy. AposTherapy is a functional, biomechanical, non-invasive rehabilitation therapy consisting of a foot-worn device that is individually calibrated to each patient and is used during activities of daily living. Repeated-measures analyses were performed to compare gait parameters and self-evaluation questionnaires between baseline, and 3 and 12 months. RESULTS: Significant improvements were found in gait velocity, step length and single-limb support of the involved knee following 12 weeks of therapy (all p < 0.01), alongside an improvement in limb symmetry. These results were maintained at the 12-month follow-up examination. Significant improvements were also found in all three domains of the WOMAC index (pain, stiffness and physical function) and in the SF-36 Physical Health Scale and the SF-36 Mental Health Scale (all p < 0.01). CONCLUSIONS: Patients with knee OA and a degenerative medial meniscal tear using a biomechanical foot-worn device for a year showed improvement in gait, physical function and pain. Based on the findings of this study, it can be postulated that this biomechanical device might have a positive effect on this population. LEVEL OF EVIDENCE: Therapeutic study, Level IV.

Extensor mechanism reconstruction: a novel technique for bone patella allograft post partial patellectomy failure.

Extensor mechanism disruption, whether due to patella fracture or tendon rupture, generally occurs after low-energy trauma and frequently involves an indirect mechanism. When the fracture is comminuted and reconstruction is impossible, a partial or total patellectomy may be indicated. Although some authors advocate total patellectomy, partial patellectomy remains the standard treatment, especially for young and active patients. In the rare instance of a failed tendon repair after partial or total patellectomy, inadequate tissue is usually available for adequate restoration of the extensor mechanism. Extensor mechanism allograft, using the tibial tuberosity, patellar tendon, patella, and quadriceps tendon in continuity or the Achilles' tendon with calcaneal bone-block in continuity has been reported for extensor mechanism repair after total knee arthroplasty in patients who did not undergo patellectomy. We present a novel technique, using the bone patellar tendon bone allograft to reconstruct a posttraumatic defect of the extensor mechanism in a 28-year-old, active patient with a failed partial patellectomy following fracture of his patella. Union of the allograft was seen on x-ray after 4 months. After 6 months, the patient reached full range of motion and returned to his previous sporting activities.

Effects of focused continuous pulsed electromagnetic field therapy on early tendon-to-bone healing.

AIMS: Rotator cuff (RC) tears are common musculoskeletal injuries which often require surgical intervention. Noninvasive pulsed electromagnetic field (PEMF) devices have been approved for treatment of long-bone fracture nonunions and as an adjunct to lumbar and cervical spine fusion surgery. This study aimed to assess the effect of continuous PEMF on postoperative RC healing in a rat RC repair model. METHODS: A total of 30 Wistar rats underwent acute bilateral supraspinatus tear and repair. A miniaturized electromagnetic device (MED) was implanted at the right shoulder and generated focused PEMF therapy. The animals' left shoulders served as controls. Biomechanical, histological, and bone properties were assessed at three and six weeks. RESULTS: Extension of the tendon from preload to the maximum load to failure was significantly better in the PEMF-treated shoulders at three weeks compared to controls (p = 0.038). The percentage strain was significantly higher in the PEMF group at both timepoints (p = 0.037). Collagen organization was significantly better (p = 0.034) as was tissue mineral density in the PEMF-treated group at three weeks (p = 0.028). Tendon immunohistochemistry revealed a prominent increase in type I collagen at the repair site at three weeks following continuous PEMF treatment compared with controls. None of the other tested parameters differed between the groups. CONCLUSION: MED-generated PEMF may enhance early postoperative tendon-to-bone healing in an acute rat supraspinatus detachment and repair model. Superior biomechanical elasticity parameters together with better collagen organization suggest improved RC healing. Cite this article: Bone Joint Res 2021;10(5):298-306.

Giant cell tumors in the patellar tendon area.

Giant cell tumor of the tendon sheath is a benign tumor typically presenting as a nontender mass around the hand and wrist. Giant cell tumor of the tendon sheath in large joints is typically larger and shows higher rates of local recurrence, as well as common features with pigmented villonodular synovitis. We describe two cases of giant cell tumors in the patellar tendon area that were treated successfully with arthroscopically assisted complete excision. Orthopedic surgeons must be aware of this entity to prevent unnecessary adjuvant therapy or recurrent excision.

Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up.

Distal femoral varus osteotomy (DFVO) may be indicated for symptomatic lateral compartment gonarthrosis associated with valgus deformity in younger, active patients. Thirty-three consecutive DFVOs (31 patients) with a minimum follow-up of ten years (mean 15.1, range 10-25) were reviewed. Fifteen DFVOs were converted to total knee arthroplasty (TKA) and one DFVO was awaiting TKA, reaching an overall failure rate of 48.5% at a mean of 15.6 years (range 6-21.5). Of the remaining 17 DFVOs, ten (58.8%) had good or excellent results, two (11.8%) had fair results and five (29.4%) had poor results. Mean modified Knee Society scores improved significantly (p < 0.01) from 36.8 preoperatively to 77.5 at one year post DFVO. DFVO is a viable treatment alternative for lateral compartment gonarthrosis. Conversion to TKA is expected to be required in approximately half of the patients at a mean of 15.6 years.

[The treatment of focal chondral lesions of the knee].

Focal osteochondral lesions of the knee are a common cause of pain and other knee symptoms, and are mostly caused by traumatic injuries. The spontaneous repair ability of the articular cartilage tissue is very limited. Thus, focal chondral lesions result in early degenerative changes and post-traumatic osteoarthritis. The surgical treatment of focal osteochondral lesions can be divided into three major groups: cartilage debridement techniques, marrow stimulating techniques and transplantation techniques. Lesion debridement causes limited and temporary symptoms relief. While marrow stimulating techniques are considered simple, cheap and easy to perform, some of the transplantation techniques are complicated and consist of highly demanding surgery and new technologies of tissue engineering. Many published studies attempted to evaluate the efficacy of the treatment methods and to compare between them. There is no obvious or definite advantage of any one technique. There are relative advantages of some techniques according to the lesion size and patient's factors. Yet, among the current available treatment options none was found to produce hyaline cartilage consistently. In order to improve the current treatment and to find new treatment techniques, significant advances were achieved in the research of stem cells, scaffolds and growth factors in the last years. Further advances and more comparative and long term studies, particularly those that evaluate the efficacy of the new treatment techniques are needed.

The covid-19 pandemic did not affect rehabilitation following acl reconstruction / La pandemia de covid-19 no afectó a la rehabilitación tras la reconstrucción del lca / A pandemia de covid-19 não afetou a reabilitação depois de reconstrução do lca

ABSTRACT Objective: To assess postoperative rehabilitation patterns in patients who underwent Anterior Cruciate Ligament Reconstruction (ACLR) during the COVID-19 pandemic. Methods: A retrospective study of patients who underwent primary isolated ACLR between February 2019 and July 2020. Two different periods were evaluated. The "COVID group" represents the period from February 1st to July 1st of 2020 and the "non-COVID group" represents the equivalent period in 2019. Rehabilitation features and the effect of the COVID-19 pandemic on rehabilitation habits were assessed. Patient outcome scores were assessed using the Lysholm, Tegner, and International Knee Documentation Committee (IKDC) questionnaires. Subjective satisfaction, post-operative complications, and subsequent surgeries were recorded. Results: The groups did not differ significantly in demographics, functional outcome scores, or subjective satisfaction. There was no significant difference in rehabilitation patterns between the groups. In the COVID group, only one patient (4%) reported participation in online physiotherapy. Conclusions: There were no differences in the post-operative rehabilitation patterns, including duration, length, and environment of the training, between patients who underwent primary isolated ACLR during the COVID-19 pandemic and those who underwent the treatment in the preceding non-COVID year. Patient outcome scores, subjective satisfaction, and subsequent surgery rates did not differ between the groups. Level of evidence IV; Therapeutic studies - investigation of treatment results.

RESUMEN Objetivo: Evaluar los patrones de rehabilitación postoperatoria en pacientes sometidos a una reconstrucción del ligamento cruzado anterior (RLCA) durante la pandemia de COVID-19. Métodos: Se realizó un estudio retrospectivo de pacientes sometidos a RLCA aislada primaria entre febrero de 2019 y julio de 2020 evaluados en dos períodos distintos. El "grupo COVID" representa el período comprendido entre el 1de febrero y el 1 de julio de 2020 y el "grupo pre-COVID" representa el período equivalente en 2019. Se evaluaron los recursos de rehabilitación y el efecto de la pandemia de COVID-19 en los patrones de rehabilitación. Las puntuaciones de los resultados de los pacientes se evaluaron mediante los cuestionarios de Lysholm, Tegner y del International Knee Documentation Committee (IKDC). Se informaron datos de satisfacción subjetiva, complicaciones postoperatorias y cirugías posteriores. Resultados: En ambos grupos no se identificaron diferencias significativas en los datos demográficos, las puntuaciones funcionales y la satisfacción subjetiva, así como en los patrones de rehabilitación. En el "grupo COVID", sólo un paciente (4%) declaró haber participado en fisioterapia "online". Conclusiones: Los pacientes sometidos a RLCA aislada primaria durante la pandemia de COVID-19 no presentaron diferencias en los patrones de rehabilitación postoperatoria, incluida la duración, el alcance y el entorno del entrenamiento en comparación con los pacientes del grupo pre-COVID. Las puntuaciones de los resultados de los pacientes, la satisfacción subjetiva y las tasas de cirugía posterior no difirieron entre los grupos. Nivel de Evidencia IV; Estudios terapéuticos - Investigación de los resultados del tratamiento.

RESUMO Objetivos: Avaliar os padrões de reabilitação pós-operatória em pacientes submetidos à reconstrução do ligamento cruzado anterior (RLCA) durante a pandemia de COVID-19. Métodos: Foi realizado um estudo retrospectivo dos pacientes submetidos a RLCA isolada primária no período de fevereiro de 2019 a julho de 2020 avaliados em dois períodos distintos. O "grupo COVID" representa o período de 1 de fevereiro a 1 de julho 2020, e o "grupo pré-COVID" representa o período equivalente em 2019. Os recursos de reabilitação e o efeito da pandemia de COVID-19 sobre os padrões de reabilitação foram avaliados. Os escores dos resultados dos pacientes foram avaliados com os questionários Lysholm, Tegnes e pelo International Knee Documentation Committee (IKDC). Foram relatados os dados de satisfação subjetiva, complicações pós-operatórias e cirurgias subsequentes. Resultados: Em ambos os grupos não foram identificadas diferenças significativas nos dados demográficos, escores funcionais e na satisfação subjetiva, assim como nos padrões de reabilitação. No "grupo COVID", somente um paciente (4%) reportou participação em fisioterapia "on-line". Conclusões: Os pacientes submetidos à RLCA isolada primária durante a pandemia COVID-19 não apresentaram diferença nos padrões de reabilitação pós-operatória, incluindo duração, extensão e ambiente de treinamento em comparação com pacientes do grupo pré-COVID no ano anterior. Os escores dos resultados dos pacientes, a satisfação subjetiva e as taxas de cirurgia subsequentes não diferiram entre os grupos. Nível de Evidência IV; Estudos terapêuticos - Investigação dos resultados do tratamento.

Total knee replacement in previous recipients of fresh osteochondral allograft transplants.

BACKGROUND: Fresh osteochondral allograft transplantation is a treatment option for young patients with osteochondral lesions of the knee. The present study evaluated the surgical complexity of, and the prevalence of complications related to, total knee arthroplasty in patients who had had a previous osteochondral graft transplantation. METHODS: A retrospective analysis was performed on thirty-three consecutive patients (thirty-five knees) who underwent total knee arthroplasty from 1974 to 2000 after having had a previous transplantation of a fresh osteochondral allograft into the same knee. The mean duration of follow-up was ninety-two months. Perioperative data were analyzed with regard to etiology, preoperative impairment, intraoperative technical complications, early and late postoperative complications, and postoperative functional and subjective outcomes. The Knee Society clinical rating system was used for clinical evaluation beginning in 1990. RESULTS: Four knees required additional techniques for exposure. Three knees required stemmed components, one knee required a tibial augment, and two knees required morselized grafts. The mean Knee Society objective score (available for eighteen knees) improved from 34.7 preoperatively to 87.9 at the time of the latest follow-up, and the mean Knee Society function score improved from 45 to 82. The mean range of motion of all knees improved from 85 degrees to 105 degrees . Six of the thirty-five knees underwent revision total knee arthroplasty because of aseptic loosening, with two knees being revised within two years after the index total knee arthroplasty. CONCLUSIONS: Total knee arthroplasty after previous fresh osteochondral allograft transplantation provides improvements in knee function and range of motion, with manageable technical difficulties. Compared with routine total knee arthroplasty, an increased rate of early revision can be expected.

Detrimental Effect of Repeated and Single Subacromial Corticosteroid Injections on the Intact and Injured Rotator Cuff: A Biomechanical and Imaging Study in Rats.

BACKGROUND: The effect of corticosteroids on tendons is poorly understood, and current data are insufficient and conflicting. PURPOSE: To evaluate the effects of corticosteroid injections on intact and injured rotator cuffs (RCs) through biomechanical and radiographic analyses in a rat model. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 70 rats were assigned to 7 groups. Uninjured rats (no tear) received either a single saline injection, a single methylprednisolone acetate (MTA) injection, or triple MTA injections. Injured rats (unilateral supraspinatus injury) received either a single saline injection, triple saline injections, a single MTA injection, or triple MTA injections (injections were subacromial; repeat injections were administered weekly). Rats were sacrificed 1 week after final injection. Shoulders were harvested and grossly inspected, and the supraspinatus tendon was evaluated biomechanically. Bone density at the tendon insertion site on the greater tuberosity was assessed by micro-computed tomography. RESULTS: Intact RCs exposed to triple MTA injections had significantly decreased maximal load and stiffness compared with the control group (14.43 vs 21.25 N and 8.21 vs 16.6 N/mm, respectively; P < .05). Injured RCs exposed to steroid treatment had significantly lower maximal load (single saline: 10.91 N, single steroid: 8.43 N [P < .05]; triple control: 15.77 N, triple steroid: 11.65 N [P < .05]) compared with the control at 3 weeks. Greater tuberosity volume density and connectivity density were significantly lower in undamaged rats after triple MTA injection (P < .05). CONCLUSION: The study results clearly showed that repeated doses of corticosteroids significantly weaken rat RC and negatively affect bone quality in addition to possibly causing deterioration of the osteotendinous junction. However, data retrieved from animals must be scrupulously analyzed before extrapolation to humans. As such, the potential benefits and harms of subacromial corticosteroid treatment must be considered before administration. CLINICAL RELEVANCE: The potential benefit and detrimental effects of corticosteroid injection should be thoroughly considered before it is administered subacromially in patients with RC injuries.

Endoscopic treatment of hindfoot pathology.

The arthroscope has served the orthopaedic surgeon as a diagnostic and operative tool since 1931. Several reports on its use in the treatment of extra-articular injuries have been published over the past few years. The surgical approach to the posterior ankle region is associated with some complications stemming from the poor blood supply to this region that can lead to wound complications and the formation of painful scars that later cause irritation when shoes are worn. We describe our experience in treating 3 hindfoot pathologic conditions, chronic Achilles tendonitis, os trigonum syndrome, and Haglund's deformity, by using an endoscope as an alternative to open surgical techniques. All the patients underwent a 2-portal endoscopic procedure, they suffered no complications, and they resumed their daily and sports activities after 2 to 3 months. Our results with the endoscopic treatment of hindfoot and Achilles tendon injuries indicate it to be a good alternative to the surgical approach, and to have the added advantage of reducing postoperative morbidity.

A noninvasive biomechanical treatment as an additional tool in the rehabilitation of an acute anterior cruciate ligament tear: A case report.

OBJECTIVES: Conservative treatments for anterior cruciate ligament (ACL) tears may have just as good an outcome as invasive treatments. These include muscle strengthening and neuromuscular proprioceptive exercises to improve joint stability and restore motion to the knee. The Purpose of the current work presents was to examine the feasibility of a novel non-invasive biomechanical treatment to improve the rehabilitation process following an ACL tear. This is a single case report that presents the effect of this therapy in a patient with a complete ACL rupture who chose not to undergo reconstructive surgery. METHODS: A 29-year old female athlete with an acute indirect injury to the knee who chose not to undergo surgery was monitored. Two days after injury the patient began AposTherapy. A unique biomechanical device was specially calibrated to the patient's feet. The therapy program was initiated, which included carrying out her daily routine while wearing the device. The subject underwent a gait analysis at baseline and follow-up gait analyses at weeks 1, 2, 4, 8, 12 and 26. RESULTS: A severe abnormal gait was seen immediately after injury, including a substantial decrease in gait velocity, step length and single limb support. In addition, limb symmetry was substantially compromised following the injury. After 4 weeks of treatment, patient had returned to normal gait values and limbs asymmetry reached the normal range. CONCLUSIONS: The results of this case report suggest that this conservative biomechanical therapy may have helped this patient in her rehabilitation process. Further research is needed in order to determine the effect of this therapy for patients post ACL injuries.

Gait metric profile of 157 patients suffering from anterior knee pain. A controlled study.

PURPOSE: Gait metric alterations have been previously reported in patients suffering from anterior knee pain (AKP). Characterization of simple and measureable gait parameters in these patients may be valuable for assessing disease severity as well as for follow-up. Previous gait studies in this population have been comprised of relatively small cohorts and the findings of these studies are not uniform. The objective of the present study was to examine spatio-temporal gait parameters in patients with AKP in comparison to symptom-free controls. Furthermore, the study aimed to examine the relationship between self-reported disease severity and the magnitude of gait abnormalities. METHODS: 157 patients with AKP were identified and compared to 31 healthy controls. Patients were evaluated with a spatiotemporal gait analysis via a computerized mat, the Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire and the Short Form (SF)-36 health surveys. RESULTS: AKP patients walked with significantly lower velocity (15.9%) and cadence (5.9%), shorter step length (9.5%), stride length (9.6%), and showed significant differences in all gait cycle phases (P<0.05 for all). Study group reported higher levels of pain (96%), functional limitation (94%), and poorer perception of mental quality of life (30%) (P<0.05 for all). CONCLUSION: Significant differences were found between the spatiotemporal gait profile of AKP patients and symptom-free matched controls. In addition, an association was found between subjective disease severity and gait abnormalities. These findings suggest the usefulness of gait parameters, alongside with the use of self-evaluation questionnaires, in identifying deviations of these patients from healthy population.

The outcome of a novel biomechanical therapy for patients suffering from anterior knee pain.

BACKGROUND: This study was devised to examine the effect of a novel biomechanical therapy for patients suffering from anterior knee pain (AKP). METHODS: A retrospective analysis of 48 patients suffering from AKP was performed. Patients underwent a gait evaluation, using an electronic walkway mat, and completed the SF-36 health survey and the WOMAC questionnaire at baseline and after 3 and 6months of therapy. A special biomechanical device was individually calibrated for each patient. AposTherapy is a functional, non-invasive rehabilitation therapy consisting of a biomechanical foot-worn device that is used during activities of daily living. Repeated measures analyses were performed to compare gait parameters and self-evaluation questionnaires between baseline, 3months and 6months. RESULTS: Walking velocity significantly increased by 5.7cm/s, cadence increased by 1.6 steps/minute, and stride length increased by 3.4cm in relation to pretreatment testing (p<0.001 for all). End-point evaluation revealed additional improvement of these parameters; however these did not significantly differ from that of mid-treatment. Pain decreased by 36.6% and 49.2% following 13 and 26 weeks of treatment, respectively (P<0.01) and function improved by 25.2% and 41.7% following 13 and 26 weeks of treatment, respectively (P=0.01). CONCLUSIONS: Based on the current study's results it may be concluded that this therapy might have a positive effect for patients with AKP.

Long-term follow-up of distal femoral varus osteotomy of the knee.

Distal femoral varus osteotomy (DFVO) of the knee may be indicated for young, active patients with unicompartmental arthritis and valgus deformity. We report on 40 DFVOs with a mean follow-up of 123 months. At the most recent follow-up, 24 knees had good or excellent results (60%), 3 had fair results (7.5%), and 3 had poor results (7.5%). Four in the fair/poor group were awaiting total knee arthroplasty. Eight knees (20%) had been converted to total knee arthroplasty. Mean Knee Society objective score improved from 18 (range, 0-74) to 87.2 (range, 50-100). Mean Knee Society function score improved from 54 (range, 0-100) to 85.6 (range, 40-100). Ten-year survival rate of the DFVO was 82% (95% confidence interval, 75%-89%) and the 15-year survival rate was 45% (95% confidence interval, 33%-57%).