Evaluating the Reliability of MyotonPro in Assessing Muscle Properties: A Systematic Review of Diagnostic Test Accuracy.

Background and Objectives: Muscle properties are critical for performance and injury risk, with changes occurring due to physical exertion, aging, and neurological conditions. The MyotonPro device offers a non-invasive method to comprehensively assess muscle biomechanical properties. This systematic review evaluates the reliability of MyotonPro across various muscles for diagnostic purposes. Materials and Methods: Following PRISMA guidelines, a comprehensive literature search was conducted in Medline (PubMed), Ovid (Med), Epistemonikos, Embase, Cochrane Library, Clinical trials.gov, and the WHO International Clinical Trials platform. Studies assessing the reliability of MyotonPro across different muscles were included. A methodological quality assessment was performed using established tools, and reviewers independently conducted data extraction. Statistical analysis involved summarizing intra-rater and inter-rater reliability measures across muscles. Results: A total of 48 studies assessing 31 muscles were included in the systematic review. The intra-rater and inter-rater reliability were consistently high for parameters such as frequency and stiffness in muscles of the lower and upper extremities, as well as other muscle groups. Despite methodological heterogeneity and limited data on specific parameters, MyotonPro demonstrated promising reliability for diagnostic purposes across diverse patient populations. Conclusions: The findings suggest the potential of MyotonPro in clinical assessments for accurate diagnosis, treatment planning, and monitoring of muscle properties. Further research is needed to address limitations and enhance the applicability of MyotonPro in clinical practice. Reliable muscle assessments are crucial for optimizing treatment outcomes and improving patient care in various healthcare settings.

Improving the reliability of measurements in orthopaedics and sports medicine.

A large space still exists for improving the measurements used in orthopaedics and sports medicine, especially as we face rapid technological progress in devices used for diagnostic or patient monitoring purposes. For a specific measure to be valuable and applicable in clinical practice, its reliability must be established. Reliability refers to the extent to which measurements can be replicated, and three types of reliability can be distinguished: inter-rater, intra-rater, and test-retest. The present article aims to provide insights into reliability as one of the most important and relevant properties of measurement tools. It covers essential knowledge about the methods used in orthopaedics and sports medicine for reliability studies. From design to interpretation, this article guides readers through the reliability study process. It addresses crucial issues such as the number of raters needed, sample size calculation, and breaks between particular trials. Different statistical methods and tests are presented for determining reliability depending on the type of gathered data, with particular attention to the commonly used intraclass correlation coefficient.

A Systematic Review of Diagnostic Accuracy and Clinical Applications of Wearable Movement Sensors for Knee Joint Rehabilitation.

In clinical practice, only a few reliable measurement instruments are available for monitoring knee joint rehabilitation. Advances to replace motion capturing with sensor data measurement have been made in the last years. Thus, a systematic review of the literature was performed, focusing on the implementation, diagnostic accuracy, and facilitators and barriers of integrating wearable sensor technology in clinical practices based on a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. For critical appraisal, the COSMIN Risk of Bias tool for reliability and measurement of error was used. PUBMED, Prospero, Cochrane database, and EMBASE were searched for eligible studies. Six studies reporting reliability aspects in using wearable sensor technology at any point after knee surgery in humans were included. All studies reported excellent results with high reliability coefficients, high limits of agreement, or a few detectable errors. They used different or partly inappropriate methods for estimating reliability or missed reporting essential information. Therefore, a moderate risk of bias must be considered. Further quality criterion studies in clinical settings are needed to synthesize the evidence for providing transparent recommendations for the clinical use of wearable movement sensors in knee joint rehabilitation.

A new aspect of in vitro antimicrobial leukocyte- and platelet-rich plasma activity based on flow cytometry assessment.

The current literature suggests that the antibacterial effect of leukocyte- and platelet-rich plasma (L-PRP) is directly related to platelet and leukocyte concentrations. The aim of this study was twofold: first, to evaluate the antimicrobial effect of L-PRP against selected bacterial strains in vitro, and second, to correlate this effect with leukocyte and platelet content in the final concentration. Blood was collected from 20 healthy males, and L-PRP, acellular plasma (AP), and autologous thrombin were consecutively prepared. Flow cytometry analysis of the blood, L-PRP, and AP was performed. The L-PRP gel, liquid L-PRP, and thrombin samples were tested in vitro for their antibacterial properties against seven selected bacterial strains using the Kirby-Bauer disk-diffusion method. There was notable antimicrobial activity against selected bacterial strains. No statistically significant correlations between antimicrobial activities and the platelet concentration in L-PRP were observed. Statistically significant positive correlations between selected leukocyte subtypes and antimicrobial activity were noted. A negative correlation was found between elevated monocyte count and antimicrobial activity of L-PRP against one bacterial strain studied. L-PRP possesses antimicrobial activity and can be potentially useful in the fight against certain postoperative infections. The bactericidal effect of L-PRP is caused by leukocytes, and there exists a relationship among selected leukocyte subtypes and L-PRP antimicrobial activity.

A comparative clinical and functional assessment of cortical button versus suture anchor in distal biceps brachii tendon repair.

PURPOSE: The studies comparing the fixation methods being used for the ruptured distal biceps brachii tendon reinsertion show similar outcomes of cortical button and suture anchors usage, however, longer follow-up studies remain necessary. The goal of this study was to compare the clinical and functional three-year outcomes of the cortical button in contrast to the suture anchor fixation. METHODS: A retrospective cohort study comprised of 28 males on average 3 years after surgical reinsertion of the distal biceps brachii tendon with the use of a cortical button (Group I, n = 11) or a suture anchor (Group II, n = 17). The outcomes assessed were range of elbow joint and forearm motion (ROM), arm circumferences, visual analogue scale (VAS), Mayo Elbow Performance Index (MEPI), Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) and forearm flexor and supinator muscle torques measured under isometric and isokinetic conditions. RESULTS: The comparison between the two studied groups revealed no statistically significant differences in ROM (p = 0.24-1.00), circumferences (p = 0.15-0.50), VAS (p = 0.71), MEPI (p = 0.23), Quick DASH (p = 0.61) or in the obtained muscle torque values (p = 0.07-1.00). However, differences in supination ROM between the surgical and non-surgical side were found in both groups (p = 0.01-0.02), and differences in pronation (p = 0.02) were found in Group II. The muscle torque values obtained in the surgical, dominant limb were lower than those in the nonsurgical, nondominant limb. CONCLUSION: The comprehensive comparison of three-year outcomes of cortical button versus suture anchor fixations did not favour one fixation method over the other, and the results justify the clinical usage of both methods.

Effect of L-PRP treatment on wound healing after surgical skin incision in an experimental animal model.

AIM OF THE STUDY: The aim of the study was to evaluate the effect of leukocyte- and platelet-rich plasma (L-PRP) treatment on a noncomplicated would healing after surgical skin incision in an experimental animal model. MATERIALS AND METHODS: The blood from 64 male Wistar rats was used to prepare L-PRP before a transverse dorsal incision was made and consecutively closed. At the same time after the surgery was completed, autologous L-PRP in the rats from the L-PRP group (n = 32) and NaCl in the control group (n = 32) were injected subcutaneously into the wound. The examination included clinical observations, laboratory examination, and examination of biopsy specimens taken from sacrificed animals on the second, third, fourth, and sixth days after the surgery (histopathological examination, immunochemistry, molecular examination). RESULTS: In all cases, no healing process complications were noted. The intergroup comparison revealed no statistically significant differences in terms of histopathological, immunohistochemical, and molecular examinations results. In the intragroup analysis, statistically significant differences were observed within each group between periods of observations in terms of immunohistochemical and molecular examinations results. CONCLUSIONS: L-PRP treatment does not significantly accelerate a noncomplicated wound healing after surgical skin incision in an experimental animal model.

Two-Plane Assessment of Knee Muscles Isometric and Isokinetic Torques After Anterior Cruciate Ligament Reconstruction.

BACKGROUND We tested the hypothesis that, in patients participating in 17 weeks of postoperative physiotherapy after anterior cruciate ligament reconstruction (ACLR), maximal isometric torque (IT) and peak torque (PT) generated by the muscles affecting the operated knee joint in the sagittal and transverse planes are not restored. We also present the application of IT and PT measurements of the muscles affecting the knee joint in 2 planes of motion. MATERIAL AND METHODS IT and PT of the knee extensor and flexor muscles and the muscles internally rotating the shin were measured in 30 males who participated in postoperative physiotherapy for 17 weeks after ACLR (ACLR group) and 30 males with no injuries (control group). RESULTS Significantly lower IT and PT values were noted in the operated knee extensors and flexors. The differences were also noted in the PT for the muscles internally rotating the shin and in the IT of those muscles in the position of 25° of internal rotation. Significantly lower relative IT and PT values were noted for studied muscle groups in comparison to the control group. CONCLUSIONS Seventeen weeks of postoperative physiotherapy after ACLR did not result in complete restoration of IT and PT of the muscles affecting the operated knee joint, suggesting that even after 17 weeks of physiotherapy following ACLR, athletes may not be ready to return to sports. The results demonstrate the usefulness of biplanar analysis of muscle strength under isometric and isokinetic conditions in the monitoring and assessment of physiotherapeutic procedures.

Effects of Postoperative Physiotherapy Supervision Duration on Clinical Outcome, Speed, and Agility in Males 8 Months After Anterior Cruciate Ligament Reconstruction.

BACKGROUND We investigated whether the duration of postoperative physiotherapy supervision by a physiotherapist affects clinical outcome, speed, and agility in males 8 months after anterior cruciate ligament reconstruction (ACLR). MATERIAL AND METHODS From a group of 248 patients 8 months after ACLR, we used strict exclusion criteria to identify 2 groups of men who were well trained and frequently participated in sports pre-injury, with different durations of postoperative physiotherapy supervision: Group I (n=15; x=27.40 weeks) and Group II (n=15; x=8.07 weeks). Group III (n=30) were controls. Clinical evaluation (manual ligament assessment, knee joint and thigh circumferences, range of motion), pain assessment, and run test with maximal speed and change-of-direction manoeuvres, was performed. RESULTS No clinically significant abnormalities were noted in any studied groups in terms of clinical and pain assessments. The time of the run test was significantly increased in Group II (x=23.77 s) compared with Group I (x=21.76 s) and Group III (x=21.15 s). The average speed was significantly reduced in Group II (x=2.05 m*s-1) compared with Group I (x=2.22 m*s-1) and Group III (x=2.27 m*s-1). The duration of physiotherapy supervision was significantly negatively correlated with the time results of the run test (r=-0.353; p=0.046) and positively correlated with the average speed (r=0.360; p=0.049). CONCLUSIONS Both shorter and longer duration of postoperative physiotherapy supervision resulted in successful clinical outcomes in terms of studied features in males 8 months after ACLR. Nevertheless, longer physiotherapy supervision was more effective for improving speed and agility to the level of healthy individuals.

Surgical Management of Distal Biceps Tendon Anatomical Reinsertion Complications: Iatrogenic Posterior Interosseous Nerve Palsy.

BACKGROUND Although iatrogenic posterior interosseous nerve (PIN) palsy is an uncommon complication of ruptured distal biceps brachii tendon surgical anatomical reinsertion, it is the most severe complication leading to functional limitation. The present study investigated possible types of PIN palsy as a postoperative complication of anatomical distal biceps tendon reinsertion, and aimed to clinically assess patients at 2 years after its surgical treatment. MATERIAL AND METHODS The studied sample comprised 7 male patients diagnosed with an iatrogenic PIN palsies after anatomical reinsertion of the distal biceps tendon, who were referred to the reference center for management of a peripheral nervous system injury. The nerve injury was intraoperatively evaluated. The clinical assessment used the Medical Research Council (MRC) System for motor recovery, and the Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) was performed before the surgical treatment of the PIN injuries and at 2 years postoperatively. In all studied cases, electromyography was performed preoperatively and postoperatively. RESULTS The comparison of the preoperative (x=1.43±0.53) and postoperative (x=4.71±0.49) results of the motor recovery of the PIN demonstrated a statistically significant improvement (p<0.001). Moreover, the results of functional assessments with the use of the Quick DASH questionnaire significantly improved (p<0.001) postoperatively (x=6.14±6.86) compared to the preoperative evaluations (x=54.29±12.05). CONCLUSIONS The PIN palsies as complications of the surgical anatomical reinsertion of ruptured distal biceps brachii resulted from mechanical nerve compression or direct intraoperative damage. The 2-year outcomes justified the clinical use of surgical management for iatrogenic PIN palsy.

Polyethylene terephthalate tape augmentation as a solution in recurrent quadriceps tendon ruptures.

Quadriceps tendon rupture is a severe and demanding problem in knee surgery, especially when it is recurrent and when elderly patients are involved. It can have a devastating impact when it is a complication following knee arthroplasty. There are many procedures for dealing with this problem, but none of them offer reliable results. The most popular methods of treatment are traditional transosseous sutures and suture anchors, often in combination with semitendinosus augmentation. In cases of osteoporotic bone or hamstring insufficiency, these solutions are not appropriate. One way to manage quadriceps tendon rupture is to use polyethylene terephthalate tape (poly tape) as scaffolding for tissue ingrowth. Because of its structure, poly tape provides adequate strength and allows early mobilization. Besides being durable, multifilament high tenacity polyethylene terephthalate is flexible. Poly tape augmentation is particularly recommended in the following cases: recurrent rupture of the quadriceps tendon; extensor apparatus damage following total knee arthroplasty (TKA); delayed diagnosis of quadriceps tendon rupture; and in elderly patients (with weak bones and poor ligament quality). The surgical technique is simple and the procedure has a low complication rate. There have been many studies confirming the security of polyethylene terephthalate use in the human body. There is also a great deal of evidence concerning tissue ingrowth in the mesh structure of poly tape. Allergic reactions and inflammatory responses are rare.

Retrospective Evaluation of Surgical Anatomical Repair of Distal Biceps Brachii Tendon Rupture Using Suture Anchor Fixation.

BACKGROUND To date, no consensus has been reached regarding the preferred fixation method to use in the repair of distal biceps brachii tendon rupture. The aim of this study was to clinically and functionally (Mayo Elbow Performance Index, MEPI) assess the upper limb after surgical anatomic reinsertion of the distal biceps brachii tendon with the use of suture anchor fixation method with regard to postoperative time and limb dominance, and to assess postoperative complications. MATERIAL AND METHODS The sample comprised 18 males (age 52.09±8.89 years) after surgical anatomical distal biceps brachii reinsertion using suture anchor fixation. A comprehensive clinical and functional evaluation and pain assessment were performed. RESULTS In terms of postoperative complications, an isolated case of surgical site sensory disturbances was noted. Circumferences (p-value 0.21-1.00) and ROM (p-value 0.07-1.00) were similar in the operated and nonoperated limbs. The isometric torque (IT) values of muscles flexing and supinating the forearm were comparable in both limbs (p-value 0.14-0.95), but in patients with the operated dominant limb, the mean IT value was not higher than the value obtained in the nonoperated nondominant one. The MEPI indicated good and excellent results (80.00±15.00-90.00±8.66 points), but a detailed individual analysis showed that reported scores were not in line with objectively measured features. CONCLUSIONS The results of the comprehensive retrospective evaluation justify the clinical use of suture anchors fixation method in the surgical anatomical reinsertion of a ruptured distal biceps brachii tendon. The assessment of a patient should always report both subjective and objective measures.

Synthetic grafts in the treatment of ruptured anterior cruciate ligament of the knee joint.

The anterior cruciate ligament (ACL) is cited as the most frequently injured ligament in the knee. The standard treatment of ACL injury remains ligament reconstruction followed by a postoperative physiotherapeutic procedure. During the reconstruction, the torn ligament can be replaced with an autograft or an allograft. A synthetic ligament is also one of the available graft options. Synthetic grafts in ruptured ACL treatment have been used as scaffolds, stents, or prostheses. The story of using synthetic materials in ACL deficient knee treatment started in the beginning of the 20th century with the usage of silk and silver fibers. The second half of the 20th century abounded in new synthetic materials being proposed as torn ACL replacements, such as Supramid®, Teflon® or Dacron®, Proplast®, carbon fiber graft, ABC graft, Kennedy-LAD®, Trevia, Leeds-Keio, Gore-Tex®, PDS®, EULIT®, and Polyflex® or LARS®. Artificial ligaments have intrigued surgeons for all these years as they represent the hope for grafts that are easily available and stronger than soft tissue "off-the-shelf" grafts, simplifying the surgery, and avoiding graft harvesting and donor site morbidity. However, most of the artificial grafts have been characterized by high rates of failure. One of the very few synthetic grafts gaining more widespread popularity has been LARS®. However, it is suggested that the ligament not be considered as a potential graft for primary reconstruction of the ACL, and it should be rather treated as an alternative graft in special cases, so the optimal synthetic graft material remains controversial.

Comparison of Bioabsorbable Interference Screws Composed of Poly-l-lactic Acid and Hydroxyapatite (PLLA-HA) to WasherLoc Tibial Fixation in Patients After Anterior Cruciate Ligament Reconstruction of the Knee Joint.

BACKGROUND: The reconstruction of the anterior cruciate ligament (ACL) of the knee joint is a standard in ACL complete rupture treatment in athletes. One of the weakest points of this procedure is tibial fixation of grafts. OBJECTIVES: The aim was, firstly, to evaluate patients 3-4 years after primary ACL reconstruction with the use of autologous ipsilateral STGR grafts and with tibial fixation using a bioabsorbable interference screw composed of PLLA-HA or WasherLoc, comparing the postoperative result to the preoperative condition and, secondly, to compare the results between the two groups of patients with different tibial fixation. MATERIAL AND METHODS: Group I consisted of 20 patients with a bioabsorbable interference screw composed of PLLA-HA tibial fixation. In Group II, there were 22 patients after ACL reconstruction with the use of WasherLoc tibial fixation. The Lachman test, pivot-shift test, Lysholm Knee Scoring Scale and 2000 International Knee Documentation Committee (2000 IKDC) Subjective Knee Evaluation Form were used to evaluate the results. RESULTS: The intra-group comparison of the results of the 2000 IKDC Subjective Knee Evaluation Form and Lysholm Knee Scoring Scale obtained in the groups studied showed statistically significant differences between the evaluation performed preoperatively and postoperatively. The inter-group comparison of the results of the 2000 IKDC Subjective Knee Evaluation Form and Lysholm Knee Scoring Scale obtained postoperatively showed no statistically significant differences between the two groups. CONCLUSIONS: An evaluation 3-4 years after ACL reconstruction with the use of autologous ipsilateral STGR grafts demonstrated significant progress from the preoperative condition to the postoperative result in patients with tibial fixation using a bioabsorbable interference screw composed of PLLA-HA as well as in patients with WasherLoc tibial fixation. There were no differences found between the two groups of patients after ACL reconstruction in terms of manual stability testing or a subjective assessment of knee joint outcomes.

Postoperative Knee Joint Stability Following Anterior Cruciate Ligament Reconstruction Using the Ligament Advanced Reinforcement System.

BACKGROUND: One of the goals of the synthetic materials used in knee joint reconstruction of the anterior cruciate ligament (ACL) is to improve the strength and stability of the graft immediately after the reconstruction. One of the synthetic grafts is a non-absorbable synthetic ligament device made of terephthalic polyethylene polyester fibers, the Ligament Advanced Reinforcement System (LARS). OBJECTIVES: The aim of the study was to assess postoperative knee joint stability in patients who had undergone ACL reconstruction using the LARS graft. MATERIAL AND METHODS: The study group was comprised of 20 males who had undergone primary unilateral intraarticular ACL reconstruction using LARS. The patients were evaluated one day before the reconstruction and an average of six weeks postoperatively. Knee stability was evaluated manually using the Lachman test, anterior drawer test and pivot-shift test. Knee active range of motion (ROM) was measured. RESULTS: Preoperatively, the Lachman test indicated abnormal/2+ results in the vast majority of the patients. The postoperative results in most of the patients were normal/0. The anterior drawer test results were also abnormal/2+ preoperatively and normal/0 postoperatively. The pivot-shift test was positive in all of the patients before the ACL reconstruction and negative after the surgery. In general, no differences were found in the ROM between the involved and uninvolved limbs and in the between-measurement comparison. CONCLUSIONS: The evaluation demonstrated significant progress from the preoperative to postoperative results in reducing anterior translation and anterolateral rotational instability of the tibia in patients who had undergone ACL reconstruction using the synthetic LARS graft. In the short-term follow-up assessments, restoration of anterior and anterolateral rotational stability of the operated knee joints was observed.

A Retrospective Evaluation of Anatomical Reinsertion of the Distal Biceps Brachii Tendon Using an ACL TightRope® RT with a Titanium Cortical Button and Ultra High Molecular Weight Polyethylene Suture: A Preliminary Report.

BACKGROUND: Various surgical techniques for treating distal biceps brachii tendon injury have been described, and to date there is no consensus regarding the preferred fixation method for the anatomic reinsertion of the ruptured tendon. OBJECTIVES: The aim of the study was to clinically and functionally evaluate the upper limb after surgical anatomic reinsertion of the distal biceps brachii tendon using an ACL TightRope® RT with a titanium cortical button and ultra high molecular weight polyethylene (UHMWPE) suture, and to assess postoperative complications. MATERIAL AND METHODS: The sample comprised 3 patients. Clinical examination (history, measurements of the active range of forearm motion, arm circumference, the maximum isometric forearm supination and flexion muscle torque), pain evaluation (on a visual analogue scale [VAS]) and functional assessment (the Mayo Elbow Performance Index [MEPI] and Quick Disabilities of the Arm, Shoulder and Hand [DASH]) were carried out. Complications were documented. RESULTS: The results of the range of motion measurements, arm circumferences and normalized isometric torque values of the muscle groups being studied were comparable in the involved and uninvolved limbs. The MEPI (x = 95.00 ± 10.42) and Quick DASH (x = 8.66 ± 18.04) scores revealed very good results. The VAS results were close to no pain (x = 3.33 ± 5.77 mm). No complications were noted. CONCLUSIONS: The preliminary comprehensive clinical and functional assessment of the upper limb justify the clinical use of the ACL TightRope® RT with a titanium cortical button and UHMWPE suture in surgical anatomic reinsertion of the distal biceps brachii tendon. The early results with a small sample were encouraging, but studies with a larger number of cases and longer follow-up are needed.