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Purpose: Immobilization, especially of the lower extremity, after orthopaedic surgery has been associated with reduced physical activity. Previous interventions from our study group showed even in young, healthy people reduced activity levels after immobilization of the shoulder. Therefore, this study investigates the change in physical activity due to shoulder immobilization after a reconstructive surgery. Methods: This prospective study includes 40 patients undergoing surgery from May 2019 to December 2020. Daily activity was measured before surgery, after discharge and three weeks postoperatively each time for six days. Activity including step counts and active time were measured by Fitbit™ inspire. Range of motion before and after surgery as well as Pain (VAS) were documented. Results: Steps became significantly less immediately postoperatively with an immobilized shoulder joint than before surgery (9728.8 vs. 6022.6, p < 0.05). At follow-up, the number of steps increased again, but still showed a significantly lower number of steps (mean 8833.2) compared to preoperative. Patients preoperatively showed mostly an "active" activity pattern, whereas postoperatively a "low active" behaviour predominated. The proportion of sedentary behaviour ("basal activity" and "limited activity") was almost three times higher postoperatively (12.5% vs. 30%). Conclusion: General physical activity is restricted during upper limb immobilization in adults. Therefore, activity-enhancing measures should be implemented in the early phase of rehabilitation after upper extremity surgery. [ABSTRACT FROM AUTHOR]

Purpose: Evaluating the short- and long-term efficacy of a continuous ten day suprascapular nerve block combined with daily multidisciplinary rehabilitation on shoulder range of motion (ROM), pain, and function in patients with refractory adhesive capsulitis (AC). Methods: In this retrospective cohort study, patients admitted to a specialized pain clinic for refractory AC for more than 6 months underwent continuous suprascapular nerve blockade for ten days and received 2 hours of physiotherapy and occupational therapy daily. Standardized assessments were performed at baseline, at days three, six, ten, 30, 90, and 180, and included active and passive ROM measurements, the visual analog scale (VAS) for pain and the disabilities of the arm, shoulder and hand (DASH) questionnaire to assess pain, disability, and quality of life. Improvements over time were assessed using ANOVAs. Results: Thirty-two patients were followed (age: 52 ± 8 years, 25 females, mean symptoms duration of two years). There was a significant improvement in ROM for all amplitudes at day ten (short-term; range: 20–35°, p < 0.001) and at day 180 (long-term; range: 18–47°, p < 0.001). The pain and disability scores significantly reduced by day 180 (mean VAS reduction: 2.6 units, p < 0.001; mean DASH reduction: 9.5 points, p < 0.001). Conclusion: Continuous SSNB combined with intensive multidisciplinary rehabilitation represents an efficient therapeutic option for patients with chronic AC who did not respond to conventional treatments. [ABSTRACT FROM AUTHOR]

Purpose: This narrative review explores the applications and benefits of immersive virtual reality (VR) in orthopaedics, with a focus on surgical training, patient functional recovery, and pain management. Methods: The review examines existing literature and research studies on immersive VR in orthopaedics, analyzing both experimental and clinical studies. Results: Immersive VR provides a realistic simulation environment for orthopaedic surgery training, enhancing surgical skills, reducing errors, and improving overall performance. In post-surgical recovery and rehabilitation, immersive VR environments can facilitate motor learning and functional recovery through virtual embodiment, motor imagery during action observation, and virtual training. Additionally VR-based functional recovery programs can improve patient adherence and outcomes. Moreover, VR has the potential to revolutionize pain management, offering a non-invasive, drug-free alternative. Virtual reality analgesia acts by a variety of means including engagement and diverting patients' attention, anxiety reduction, and specific virtual-body transformations. Conclusion: Immersive virtual reality holds significant promise in orthopaedics, demonstrating potential for improved surgical training, patient functional recovery, and pain management but further research is needed to fully exploit the benefits of VR technology in these areas. [ABSTRACT FROM AUTHOR]

Purpose: The use of biophysical stimuli produced by extracorporeal shock wave therapy (ESWT) can improve the rehabilitation treatment of patients undergoing total knee arthroplasty (TKA). The aim of our study is to evaluate the short-term efficacy of early postoperative ESWT in combination with physiotherapy in terms of pain reduction and motor function recovery of patients undergoing TKA and compare it with conventional physiotherapy treatment. Methods: Fifty-six patients undergoing TKA were enrolled in the study from January 2019 to February 2020. Patients received two sessions of physiotherapy daily, with (experimental group) or without (control group) four sessions of ESWT within seven days after surgery. Patients were prospectively evaluated at baseline and at post-operative day two and seven. Assessment included active knee range of motion (aROM), timed up and go (TUG) test, visual analogue scale (VAS) for pain, and Borg scale. Results: Fifty patients completed the study. Both treatments proved to be effective in reducing pain and improving the knee range of motion and functional scores at seven days after surgery: the aROM in the ESWT group was 36.8 ± 11.0 grades (p < 0.001), while in control group was 19.8 ± 7.8 grades (p < 0.001). TUG, VAS, and BORG scores showed a similar trend. Comparative analysis revealed superior clinical results for the experimental group in all the outcomes, in particular aROM (96.0 ± 5.40 vs. 81.20 ± 11.01, p < 0.001) and TUG test (17.4 ± 5.61 vs. 21.24 ± 5.88, p < 0.001), at day seven after surgery. Conclusion: Early application of ESWT in addition to physiotherapy can positively influence the rehabilitation process after TKA. The treatment proved to be well tolerated and safe. Preliminary results demonstrated better pain control and functional scores compared to physiotherapy alone. [ABSTRACT FROM AUTHOR]

Purpose: We compared early and late physiotherapy for patients with small and medium size rotator cuff tears following arthroscopic repair. Methods: A single-centre, single-blinded, prospective parallel RCT was performed with two arms: early physiotherapy (start within the first week) versus late physiotherapy (start 4 weeks after surgery). Patients with small- to medium-sized isolated full-thickness superior rotator cuff tears were included and followed for 12 months. The primary outcome measures were shoulder function and range of motion (ROM) measured by the Constant-Murley score (CMS) at three months, six months, and 12 months. The other outcomes were the visual analog scale (VAS) pain and the rotator cuff ultrasound (US) evaluation by the Sugaya classification. Results: In three and six month follow-ups, CMS was significantly superior in the intervention group compared to controls (P < 0.05). However, only at the three month follow-up between-group difference met the minimal clinically important difference (MCID) (MCID = 10.4) (59.8 vs. 48.9). The intervention group experienced less pain than controls in the first six months (P < 0.001), and only the three month follow-up was clinically meaningful based on MCID (MCID = 1.4). Moreover, in the first six months, the shoulder ROM favoured the intervention group (P < 0.05). US grading of the supraspinatus and infraspinatus was similar between groups (P = 0.07). One retear occurred in the intervention group and another in the controls, detected by examination and US evaluation. Conclusion: Following the arthroscopic repair of a small- to medium-sized rotator cuff tear, early physiotherapy showed promising results for pain, function, and range of motion. Level of evidence: Level I therapeutic [ABSTRACT FROM AUTHOR]

Purpose: The aim of this observational cohort study was to assess actigraphy-based sleep characteristics and pain scores in patients undergoing knee or hip joint replacement and hospitalized for ten days after surgery. Methods: N=20 subjects (mean age: 64.0±10.39 years old) wore the Actiwatch 2 actigraph (Philips Respironics, USA) to record sleep parameters for 11 consecutive days. Subjective scores of pain, by a visual analog scale (VAS), were constantly monitored and the following evaluation time points were considered for the analysis: pre-surgery (PRE), the first (POST1), the fourth (POST4), and the tenth day (POST10) after surgery. Results: Sleep quantity and timing parameters did not differ from PRE to POST10, during the hospitalization whereas sleep efficiency and immobility time significantly decreased at POST1 compared to PRE by 10.8% (p=0.003; ES: 0.9, moderate) and 9.4% (p=0.005; ES: 0.86, moderate) respectively, and sleep latency increased by 18.7 min (+320%) at POST1 compared to PRE (p=0.046; ES: 0.70, moderate). Overall, all sleep quality parameters showed a trend of constant improvement from POST1 to POST10. VAS scores were higher in the first day post-surgery (4.58 ± 2.46; p=0.0011 and ES: 1.40, large) compared to POST10 (1.68 ± 1.58). During the time, mean VAS showed significant negative correlations with mean sleep efficiency (r = −0.71; p=0.021). Conclusion: Sleep quantity and timing parameters were stable during the entire hospitalization whereas sleep quality parameters significantly worsened the first night after surgery compared to the pre-surgery night. High scores of pain were associated with lower overall sleep quality. [ABSTRACT FROM AUTHOR]

Purpose: We sought to externally validate ultrasonography (US) for quantification of suprapatellar effusion size to improve diagnosis and individualised rehabilitation strategies in knee rehabilitation after anterior cruciate ligament reconstruction (ACLR) surgery. Methods: US was performed on 35 patients as part of the ongoing CAMOPED study. Data were collected in ACLR and post surgery in defined intervals up to one year post-operation. The palpatory assessment was graded using the International Knee Documentation Committee (oIKDC). Results: In a total of 164 sonographies, a strong correlation between palpatory and US effusion (r = 0.83, p < 0.01) with lower deviations in US quantification compared to palpatory quantification Y = 1.15 + 0.15* x was seen. Threshold values could be determined for the detection of effusions by palpation and for the differentiation between mild and moderate/severe effusions (effusion depth: 2.6 mm and resp. 5.8 mm, respectively). Conclusions: As demonstrated in this multicenter study, the size of suprapatellar effusions can be easily quantified with high accuracy using standardised bedside ultrasound. Especially in moderate to severe effusions, US provides a practical and reliable tool for outcome measurement superior to palpatory assessment with the goal of optimising individual recommendations during the rehabilitation course. Furthermore, for the first time, it has been possible to define sonographic threshold values for the detection of effusion and differentiation of mild vs. moderate/severe effusion by means of palpation. [ABSTRACT FROM AUTHOR]

Introduction: Continuous passive motion (CPM) is a frequently used method in the early post-operative rehabilitation of patients after knee surgery. In this study, the effectiveness of the CPM method was evaluated after primary total knee arthroplasty during an early recovery period. Methods: Eighty patients undergoing total knee arthroplasty were assigned into two groups. The experimental group received CPM and active exercises, while the control group active exercises only. All subjects were evaluated once before the surgery and at a discharge, in terms of mean active range of motion (AROM), mean Knee Society Score (KSS), and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Results: The mean AROM for the experimental group was 82.3° ± 14.3° and 76.1° ± 22.2° for the control. The mean KSS score was 136.4 ± 19.3 points for the experimental group, and 135.7 ± 15.1 for the control. There were no statistical differences between the two groups. The KSS functional score was 66.4 ± 8.1 points for the experimental group compared to 62.2 ± 7.3 points for the control, but there was a statistically significant difference between the groups at discharge from the hospital (p = 0.009). A subjective estimation of the pain level, joint stiffness and function also showed a statistically significant difference between the two groups (38.6 ± 14.3 points for the CPM group and 21.2 ± 15.7 for the control). Conclusion: These findings show that there is no significant effect of CPM in terms of improving clinical measurements. However, there was a significant beneficial effect on the subjective assessment of pain level, joint stiffness, and functional ability. [ABSTRACT FROM AUTHOR]

Purpose: This review aims to summarize the evidence for the role of mechanotherapies and rehabilitation in supporting the synergy between regeneration and repair after an orthobiologic intervention.Methods: A selective literature search was performed using Web of Science, OVID, and PubMed to review research articles that discuss the effects of combining mechanotherapy with various forms of regenerative medicine.Results: Various mechanotherapies can encourage the healing process for patients at different stages. Taping, bracing, cold water immersion, and extracorporeal shockwave therapy can be used throughout the duration of acute inflammatory response. The regulation of angiogenesis can be sustained with blood flow restriction and resistance training, whereas heat therapy and tissue loading during exercise are recommended in the remodeling phase.Conclusion: Combining mechanotherapy with various forms of regenerative medicine has shown promise for improving treatment outcomes. However, further studies that reveal a greater volume of evidence are needed to support clinical decisions. [ABSTRACT FROM AUTHOR]

Introduction: As the demand for rehabilitation in orthopaedics increases, so too has the development in advanced rehabilitation technology. However, to date, there are no review papers outlining the broad scope of advanced rehabilitation technology used within the orthopaedic population. The aim of this study is to identify, describe and summarise the evidence for efficacy for all advanced rehabilitation technologies applicable to orthopaedic practice. Methods: The relevant literature describing the use of advanced rehabilitation technology in orthopaedics was identified from appropriate electronic databases (PubMed and EMBASE) and a narrative review undertaken. Results: Advanced rehabilitation technologies were classified into two groups: hospital-based and home-based rehabilitation. In the hospital-based technology group, we describe the use of continuous passive motion and robotic devices (after spinal cord injury) and their effect on improving clinical outcomes. We also report on the use of electromagnetic sensor technology for measuring kinematics of upper and lower limbs during rehabilitation. In the home-based technology group, we describe the use of inertial sensors, smartphones, software applications and commercial game hardware that are relatively inexpensive, user-friendly and widely available. We outline the evidence for videoconferencing for promoting knowledge and motivation for rehabilitation as well as the emerging role of virtual reality. Conclusions: The use of advanced rehabilitation technology in orthopaedics is promising and evidence for its efficacy is generally supportive. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate that Špišić's photographs were used as a tool in representing the strategies and public health position of orthopaedics as an emerging medical specialty in Croatia in the period from 1915 to 1917. Methods: Formal and contextual analysis of photographs included in the book How we help our invalids: Images from our orthopaedic hospital and courses for disabled people, which was published in 1917 by the founder of orthopaedics in Croatia Božidar Špišić (1879–1957), as well as historical documents and articles. Results: Špišić's 102 photographs cover all phases of the rehabilitation of disabled war veterans and depict them holistically and during typical everyday activities. Conclusion: Špišić's visualization of disabled veterans attempted to demonstrate the transformation and reactivation of disabled bodies, using them as a persuasive tool in the rehabilitation not only of individuals, but of the society as a whole. [ABSTRACT FROM AUTHOR]

Purpose: We attempted to determine the effect of immediate post-operative knee range of motion (ROM) photographs on improving ROM after total knee arthroplasty (TKA).Methods: Sixty patients, scheduled for unilateral primary TKA, were randomized into two groups. The photo group (n = 30) were immediately shown post-TKA knee ROM photographs as motivation for rehabilitation. The non-photo group (n = 30) received identical post-operative pain control and rehabilitation programs. Post-operative knee ROM and Knee Society Scores (KSS) at day three, six weeks, three months, six months, one year, and two years were evaluated. Outcome assessors were blinded to the groups during the study.Results: Patients in the photo group had better knee flexion on day three (99.9° ± 15.3°, 95% confidence interval (CI) 94.1-105.7° vs. 92.3° ± 11.4°, 95% CI 87.9-96.8°; p = 0.038) and at six weeks (120.9° ± 13.4°, 95% CI 115.7-126.0° vs. 112.5° ± 13.6°, 95% CI 107.2-117.8°; p = 0.023); however, there were no differences in range of flexion beyond six weeks post-operatively. Knee extension did not significantly differ throughout. Clinical KSS was significantly higher in the photo group at six weeks (90.7° ± 6.2° vs. 86.6° ± 6.4°, p = 0.017). Functional KSS showed no differences between groups during follow-up.Conclusion: Showing knee ROM photographs seemed to result in significant improvement of knee flexion and clinical KSS in the first 6 weeks post-TKA and may be recommended as part of post-TKA rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: To describe the main features of the rehabilitation protocols for RC disease based on the phases of tendon healing and to investigate about the use of wearable devices as monitoring systems.Methods: We performed a comprehensive search of PubMed, Medline, Cochrane, CINAHL, and EMBASE databases using various combination of the keywords "rotator cuff," "rotator cuff tear," "rehabilitation protocol," "accelerated," "conservative," "stiffness," "exercises," and "wearable devices." All articles concerning precision orthopaedic rehabilitation therapy in rotator cuff disease were retrieved.Results: To date, rehabilitation protocols are not comparable due to wide heterogeneity of RC diseases. Wearable technologies are becoming a revolutionary tool for movement and posture monitoring.Conclusion: Rehabilitation protocols for RC disease should be tailored on the basis of the different phases of tendon healing. Wearable devices hold the promise to offer a new outlook for long-term follow-up during the postoperative period providing information to the clinician about patient's status. [ABSTRACT FROM AUTHOR]

Purpose: Due to improved prosthesis designs and surgical techniques, indications for total hip arthroplasty (THA) now include younger and more active patients. Preserving bone stock and soft tissue in these patients is paramount to allow for future revision. Designed for anatomical reconstruction, short femoral stems have the potential to reduce adaptive bone loss and stress shielding. To confirm this, we evaluated bone remodeling around a short femoral stem and the accuracy of hip joint reconstruction.Methods: This prospective observational study involved 46 patients with short-stem THA for clinical and radiographic analysis. We evaluated bone remodeling by Gruen zone using dual-energy X-ray absorptiometry in 45 patients and assessed the accuracy of hip joint reconstruction using caput-collum-diaphyseal angles. Additionally, we reported functional scores and pain.Results: Patients were followed for a mean of 24.1 (SD 2.2) months. Bone mineral density increased mainly in the lateral region (Gruen zones 2 and 3) and in the distal-medial region (Gruen zone 5), suggestive of lateral loading. Most caput-collum-diaphyseal angles remained stable after surgery, especially in patients with varus hips. Harris Hip Scores improved significantly, from 57.2 (SD 20.0) pre-operatively to 97.2 (SD 4.0) at 24 months post-operatively (P < 0.0001). Finally, we encountered one peri-operative dislocation but no post-operative complications.Conclusion: Short femoral stems successfully limited stress shielding and minimized periprosthetic bone loss without compromising primary stability. We were able to accurately reconstruct anatomical relationships in most patients. Finally, excellent clinical outcomes and low complication rates confirmed the favourable results of short-stem THA.Trial Registration: DRKS00017076. [ABSTRACT FROM AUTHOR]

Purpose: Scapular motion is an important component of shoulder function. This study determined the contribution of the scapula to active shoulder motion in control subjects and patients with loss of shoulder function.Methods: The Kinect system was used to assess active scapulothoracic (ST) and humerothoracic (HT) abduction in 12 controls and in 352 patients before elective shoulder surgery.Results: For the controls, ST abduction averaged 26 ± 7° or 19% of the active HT abduction (135 ± 5°). For the 352 patients having elective surgery, active ST abduction averaged 12 ± 10°, or 17% of the active HT abduction (72 ± 38). For 10 of the 12 SST functions, patients unable to perform the function had significantly less scapulothoracic abduction, e.g., shoulders unable to lift one pound to shoulder level had 9 ± 8° of ST abduction in contrast to 17 ± 10 for those able to perform this function (p < .001).Conclusions: Scapulothoracic motion is an important component of active shoulder motion and function in both healthy shoulders and in those compromised by common pathologies. This study suggests that rehabilitation directed at improving active scapulothoracic motion may improve the function of shoulders with loss of glenohumeral motion.Level Of Evidence: Level III Prognostic Study. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to assess the factors influencing the final results of treatment of the femoral head osteonecrosis (ONFH) with core decompression and bone substitute grafting. The special interest was focused on comparison between alcohol- and steroid-induced ONFHs.Material and Methods: In this prospective study, a total of 53 patients (58 hips) in the mean age of 35.5 years were included: 29 had a history of alcohol use (32 hips) and 24 of steroid use (26 hips). The mean follow-up was 4.2 years (minimum 3 years).Results: At last follow-up, significant improvements were noted in the Harris Hip Score (HHS) (mean 44.0 vs 55.9 points, p < 0.00002) and VAS scores (mean 7.0 vs 5.8 points, p < 0.0002) for the whole ONFH cohort, comparing to pre-operative status. The degree of improvement did not differ between Ficat and Arlet grade II and grade III (mean 14.9 vs 6.2 points, respectively, p = 0.1). No change was found between the final and initial results in this group in the steroid group (HHS mean 42.2 vs 45.5 points, p = 0.5 and VAS mean 6.8 vs 6.5 points, p = 0.5), but the improvement was noted in the alcohol group (HHS mean 45.5 vs 64.4 points, p < 0.0001; VAS mean 7.1 vs 5.2 points, p < 0.0001) comparing to pre-operative status.Conclusions: Presented treatment of ONFH significantly improves hip function, offers pain reduction, and gives similar functional improvement for hips scoring grade II and III on the Ficat and Arlet scale. A good response to operative treatment is seen in patients with alcohol-induced ONFH, but not in those with steroid-induced ONFH. [ABSTRACT FROM AUTHOR]

Background: The aim of this prospective, randomised and single blinded study was to evaluate the efficiency and safety of a new cryotherapy device in patients undergoing unilateral, primary total knee arthroplasty (TKA). Our hypothesis was that patients administered to the new cryotherapy device would perform better than patients receiving a conventional standard cold therapy regimen.Methods: Ninety-seven patients were randomised into two groups receiving either the cTreatment® (new cryotherapy device) or the standard cold therapy protocol (including cold pack application for six days after the surgical intervention). We evaluated the following endpoints consisting of range of motion (ROM), pain intensity, and knee girth on admission day and the second, fourth, and sixth post-operative day (POD).Results: A statistically significant benefit of the new cryotherapy device was detected regarding the ROM on the sixth POD with an average gain of 7 degrees (p = 0.021). Pain in the numeric rating scale (NRS) score in motion was significantly lower in the cTreatment® group on the second POD (p = 0.034). There were no statistically significant differences between groups regarding the NRS in rest, patient controlled analgesia (PCA) consumption, and girth measurements. No adverse effects were observed in both study groups.Conclusion: The new computer-controlled cooling therapy device provides benefits in terms of early post-operative remobilisation with respect to ROM and pain, which might be attributed to a reduced inflammatory response, as well as reduced secretion and bleeding. The cTreatment® system appears to be a safe and efficient procedure. [ABSTRACT FROM AUTHOR]

Purpose: Early post-operative exercise and weight-bearing activities are found to improve the functional recovery of patients with displaced intra-articular calcaneal fractures (DIACFs). We hypothesized that early functional exercise after surgery might have a secondary reduction effect on the subtalar joint, in particular the smaller fracture fragments that were not fixed firmly. A prospective study was conducted to verify this hypothesis.Methods: From December 2012 to September 2013, patients with unilateral DIACFs were enrolled and received a treatment consisting of percutaneous leverage and minimally invasive fixation. After surgery, patients in the study group started exercising on days two to three, using partial weight bearing starting week three, and full weight bearing starting week 12. Patients in the control group followed a conventional post-operative protocol of partial weight bearing after week six and full weight bearing after the bone healed. Computed tomography (CT) scanning was performed at post-operative day one, week four, week eight, and week 12 to reconstruct coronal, sagittal, and axial images, on which the maximal residual displacements of the fractures were measured. Function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale at the 12th post-operative month.Results: Twenty-eight patients in the study group and 32 in the control group were followed up for more than 12 months; their data were collected and used for the final analysis. Repeated-measures analysis of variance (ANOVA) of the maximal residual displacements of the fracture measured on CT images revealed significant differences between the study and the control groups. There were interaction effects between group and time point. Except for the first time point, the differences between the groups at all studied time points were significant. In the study group, the differences between all studied time points were significant. Strong correlations were observed between the AOFAS score at post-operative month 12 and the maximal residual displacement of the fractures on the CT images at postoperative week 12.Conclusions: Early functional exercise and weight bearing activity can smooth and shape the subtalar joint and reduce the residual displacement of the articular surface, improving functional recovery of the affected foot. Therefore, early rehabilitation functional exercise can be recommended in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Severe post-operative pain is one of the main problems after total knee arthroplasty. In this study, we investigated the effect of a peri-articular multimodal drugs injections pre-emptively on post-operative pain control and knee functions following total knee arthroplasty.Methods and Materials: This study was a double-blind randomized clinical trial. Eligible cases including 137 patients-aged 30 to 80 years old-were randomly divided into one of two groups: the drug group received a cocktail consisting of bupivacaine hydrochloride, morphine sulphate, epinephrine, and ketorolac. The control group received epinephrine only. The injections were given 15 minutes before incision. Joint range of motion (ROM) and the severity of pain by using visual analog scale (VAS) of 1 to 10 and patient's facial expression, were assessed in the pre-operative visit, after 24 hours, 48 hours, and six weeks after operation. Knee Society score (KSS) was recorded before the operation, six weeks, and six months after the operation for each patient.Results: The data of VAS showed no significant difference between the groups before operation but there was statistically significant difference between the two groups at 24 hours, 48 hours, and six weeks after the operation. In KSS, difference was not significant between the two groups before the operation and six months after surgery while our results showed a statistically significant difference between groups six weeks after the operation. In ROM, there was no significant difference between the groups before operation. There was a statistically significant difference between the two groups at 24 hours, 48 hours and six weeks after the operation. Complications were recorded at six weeks after surgery.Conclusion: Peri-articular multimodal injection including bupivacaine, morphine, and ketorolac preferably with pre-emptive injection method provided proper post-operative pain relief, less opioid consumption, and better early rehabilitation following TKA at 48 hours after surgery.Level Of Study: Level I. [ABSTRACT FROM AUTHOR]

Purpose: Autologous Matrix-Induced Chondrogenesis (AMIC®) utilizing a type I/III collagen membrane was compared with microfracture (MFx) alone in focal cartilage lesions of the knee at one, two and five years.Methods: Forty-seven patients (aged 37 ± 10 years, mean defect size 3.6 ± 1.6 cm2) were randomized and treated either with MFx, with sutured or glued AMIC® in a prospective multicentre clinical trial.Results: After improvement for the first two years in all subgroups, a progressive and significant score degradation was observed in the MFx group, while all functional parameters remained stable for least five years in the AMIC® groups. At two and five years, MRI defect filling was more complete in the AMIC® groups. No treatment-related adverse events were reported.Conclusions: AMIC® is an effective cartilage repair procedure in the knee resulting in stable clinical results significantly better than the MFx group at five years. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the outcome of a minimally invasive surgical technique for the treatment of patients with acromioclavicular joint dislocation.Methods: Sixteen patients with complete acromioclavicular joint dislocation were enrolled in this study. All patients were asked to follow the less active rehabilitation protocol post-operatively. Computed tomography with 3-D reconstruction of the injured shoulder was performed on each patient post operatively for the assessment of the accuracy of the suture anchor placement in the coracoid process and the reduction of the acromioclavicular joint. Radiographs of Zanca view and axillary view of both shoulders were taken for evaluating the maintenance of the acromioclavicular joint reduction at each follow-up visit. The Constant shoulder score was used for function assessment at the final follow-up.Results: Twenty seven of the 32 anchors implanted in the coracoid process met the criteria of good position. One patient developed complete loss of reduction and another had partial loss of reduction in the anteroposterior plane. For the other 14 patients, the mean Constant score was 90 (range, 82-95). For the patients with partial and complete loss of reduction, the Constant score were 92 and 76 respectively. All of them got nearly normal range of motion of the shoulders and restored to pre-operative life and works.Conclusion: With this minimally invasive approach and limited exposure of the coracoid, a surgeon can place the suture anchors at the anatomical insertions of the coracoclavicular ligament and allow the dislocated joint reduced and maintained well.Level Of Evidence: Level IV, Case series; therapeutic study. [ABSTRACT FROM AUTHOR]

Purpose: The reporting of gait analysis data on operated fractures of the tibial plateau, while extensive for studies of knee osteoarthritis of mostly undisclosed aetiology and ACL deficient knees, is rather limited in literature. Methods: In the present study we investigated 25 tibial plateau fractures classified as Schatzker II, IV, V and VI that underwent operative reduction and lateral plate osteosynthesis. Apart from routine radiographic exploration and patient completed (KOOS) scores at three (mean of 3.2 months), six (mean of 5.6 months) and 12 months (mean of 11.3 months) postoperatively, gait analysis was performed at these intervals as well. Cadence, step time and knee flexion were the gait parameters that were selected for the comparison at six and 12 months postoperatively. Results: The analysed gait parameters were significantly improved between the six and the 12-month session and statistically significant differences were found between the two groups of values. Cadence had a mean value of 41 steps/minute at six months and 45 steps/minute at 12 months ( p = 0.99). Step time was a mean of 0.74 seconds at six months while at 12 months the median value was 0.66 seconds ( p = 0.94). Knee flexion angles evolved in a similar manner with mean values of 58° at six months and 69° at 12 months ( p = 0.95). The mean KOOS scores were 42.4, 56.3 and 67.99 at three, six and 12 months postoperatively, respectively. Conclusion: Complex intra-articular fractures, classified as Schatzker IV, V and VI, had a higher impact on joint function than Schatzker II fractures treated with similar techniques and implants. There were statistically significant improvements in the recovery status at 12 months postoperatively compared to six months with extended chances for improvement. [ABSTRACT FROM AUTHOR]

Purpose: The risk for re-tear following anterior cruciate ligament (ACL) reconstruction is influenced by several hormonal, neuromuscular, biomechanical and anatomic factors. One of the most important negative prognostic factors that markedly increase the risk for ACL re-tear is the presence of high knee-abduction moment (KAM), which can be measured immediately by landing on both feet after a vertical jump. We evaluated the effect in postoperative values for KAM according to the type of graft used for ACL reconstruction (hamstring vs patellar tendon) and a specific rehabilitation protocol focusing on recovery of muscular strength, proprioception and joint stabilisation. Methods: From November 2010 to September 2012, we enrolled 40 female recreational athletes with clinical and imaging evidence of ACL tear and randomised them in two groups. One group of patients underwent reconstruction with a hamstring-tendon graft and the second with a patellar-tendon graft. A custom rehabilitation programme focusing on proprioception was adopted. Clinical outcomes [International Knee Documentation Committee (IKDC) and Lysholm scores] and performance in functional test for stability (single-leg hop, timed hop, crossover triple hop, KAM test) were assessed preoperatively at three and six months postoperatively. Results: All patients showed statistically significant clinical improvements postoperatively when compared with preoperative values ( P < 0.0001). No significant intergroup difference was observed in all clinical scores and functional tests, with the exception of the value registered for the KAM test ( P < 0.0001). Conclusions: ACL reconstruction using patellar-tendon graft followed by rehabilitation centred on strength, proprioception and stability restoration can produce satisfactory values for KAM within the physiological range. The surgical strategies should be adapted to the patient on the basis of a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to report our results of glucocorticoid therapy combined with pregabalin and a home exercise program in patients with frozen shoulder. Methods: Thirty-three patients (seven males, 26 females; mean age 52, range 43-71) diagnosed with primary idiopathic frozen shoulder were included in the study. Secondary causes and systemic diseases related to frozen shoulder were excluded. Administration of 0.5 mg/kg/day methylprednisolone was halved each week and ceased at the end of first month. Pregabalin, paracetamol and proton pump inhibitor was also included in the treatment. Physical therapy as a home program was initiated as the pain subsided. Patients were evaluated using the Constant, DASH and ASES scores in the sixth week and first year. Pain was evaluated with VAS and range of motion at each visit. Results: Patients were followed up for an average period of 21 months (range 12-37). No adverse effect related to glucocorticoid therapy was observed during the treatment. The DASH, ASES and Constant scores improved significantly in the sixth week and first year ( p > 0.05). Average range of motion and pain improved significantly every week until full recovery ( p > 0.05). Conclusion: Glucocorticoid therapy combined with pregabalin and a home exercise program is an effective treatment in the first stage of frozen shoulder. [ABSTRACT FROM AUTHOR]

Purpose: Microfractures at the footprint may be a potential additional source of growth factor and enhance the tendon healing at the bone-tendon junction when repairing rotator cuff tears. Methods: Fifty-seven patients who underwent shoulder arthroscopy for repair of complete rotator cuff tears were randomly divided into two groups, using a block randomisation procedure. Patients underwent microfracture at the footprint in the treatment group. The patients in the control group ( n = 29) did not receive that treatment. All patients had the same post-operative rehabilitation protocol. Results: The two groups were homogeneous. There was a significant improvement from baseline to the last minimum follow-up of two years. At three months from the index procedure, visual analogue scale (VAS), range of motion (ROM) and University of California at Los Angeles (UCLA) and Constant scores were significantly better in group 1 than in group 2 ( P < .05). At the last follow-up (minimum two years), clinical and functional outcomes were further improved in both the groups but inter-group differences were not significant. No technique-related complications were recorded. Conclusions: Microfractures at the footprint are simple, safe, inexpensive and effective at producing less pain in the short term in patients who undergo rotator cuff repair, but at two years they do not result in significantly different outcomes, either clinically or at imaging, compared to traditional rotator cuff repair. [ABSTRACT FROM AUTHOR]

Purpose: There is little evidence to support immediate weight bearing after uncemented total hip arthroplasty (THA). Methods: Thirty-seven patients with unilateral osteoarthritis of the hip received a press-fit cup. Cup stability was assessed with radiostereometry (RSA) over five years. Patients were randomised to immediate full weight bearing, or partial weight bearing for three months. Results: At five years, we found no difference in micromotion as assessed with radiostereometry. Numerically, there was more proximal translation and increased inclination with immediate weight bearing, but these values barely exceeded the precision limit for the method. Pooled data for the two groups revealed translations of 0.1-0.3 mm and rotations of 0.2-0.3° over the five year follow-up period. Conclusions: We found no adverse effects of immediate weight bearing after THA in relation to stability of these press-fit cups. Early mobilisation might have other advantages. [ABSTRACT FROM AUTHOR]

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Purpose: Losing a limb (or a part of a limb) usually leads to loss of functionality and subsequent disability. This paper aims at pointing out the importance of comprehensive and multidisciplinary care that includes early, direct or indirect, involvement of rehabilitation service providers even in an emergency context. Methods: We underline the links between amputation and disability as well as the milestones and main purposes of the rehabilitation process following amputation. We then emphasise the influence that the level of amputation has on functional outcomes. Results: In order for functional outcomes to balance purely medical factors when identifying the best site for amputation in emergency settings where preoperative involvement of a rehabilitation professional is difficult due to limited resources, we enunciate five general rules to be used as guidelines by the medical team in the absence of a rehabilitation service provider. These five rules, remaining general enough to apply to most contexts and patients, still need to be balanced against contextual and personal factors that can only be identified at the time of the amputation. Conclusions: The main expectations of people who undergo surgery are, usually, to remain actors in the society and regain functional abilities. Therefore, surgical outcomes are closely related to functional outcomes. In order for the functional and personal factors to be taken into account, we recommend, even in an emergency context, preoperative involvement of rehabilitation care providers. [ABSTRACT FROM AUTHOR]