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Objective To investigate variables for assessment of stroke-related sarcopenia that are alternative options to the current assessment for sarcopenia, which focuses on age-related sarcopenia and also has limitations in addressing sarcopenia due to weakness resulting from stroke. Methods Forty patients (17 men, 23 women; mean age, 66.9±15.4 years) with first-ever stroke who can walk independently were included. Muscle mass was determined by measuring ultrasonographic muscle thickness of vastus intermedius, rectus femoris, tibialis anterior, medial gastrocnemius, and biceps brachii muscles in addition to using the skeletal muscle index (SMI) with bioelectrical impedance analysis. Muscle strength was assessed with the Medical Research Council (MRC) sum score as well as handgrip (HG) strength. Physical performance was measured by the Berg Balance Scale (BBS) along with 4-meter gait speed (4MGS). Correlations between each assessment in the three categories were analyzed and adjusted by stroke severity, comorbidity, and nutritional status. Results For muscle mass, SMI showed the highest correlation with the tibialis anterior muscle (r=0.783, p

Objective To investigate if the extent of lumbar segmental motion is correlated with the recovery process in the form of pain intensity in patients with acute single level lumbar disc herniation (LDH). Methods A retrospective review of medical records was performed on patients presented with acute low back pain from January 2011 to December 2017. With prerequisites of undergoing both lumbar spine magnetic resonance imaging and functional radiography, patients with etiologies other than single level LDH were excluded. A total of 46 patients were selected, including 27 patients with disc herniation at L4-5 level and 19 patients at L5-S1 level. Pearson correlation analysis of pain intensity against segmental range of motion (sROM) and percentage of sROM of each lumbar segment was performed at the initial evaluation point and follow-ups. Results Serial documentation of pain intensity and functional radiography exhibited an inverse correlation between changes in visual analogue scale (VAS) and sROM in single level LDH at L4-5 level (r=-0.69, p

Objectives To investigate the effects of Computerized Neuropsychologic Test (CNT) on cognitive function and daily life performance in subacute post-stroke patients with cognitive impairment. Methods Korean Mini-Mentals State Examination (K-MMSE), Korean version of Modified Barthel Index (K-MBI) were investigated in 125 subacute post-stroke patients with cognitive impairment. We analyzed K-MMSE and K-MBI which were conducted 63 patients who had received CNT and 62 patient who had not received CNT from baseline to 8 weeks follow-up. In the experimental group, initial K-MMSE and K-MBI were conducted 13.3 ± 6.8 weeks after the onset of stroke and their age was 63.4 ± 13.3. In the control group, initial K-MMSE and K-MBI were conducted 13.2 ± 7.7 weeks after the onset of stroke and their age was 65.1 ± 11.6. Results The 8 weeks follow-up total K-MMSE score and total K-MBI score of experimental group were significantly higher than control group (P < 0.05). In K-MMSE subsection, orientation, judgement, recall, language & visual reconstruction were significantly higher in experimental group than control group (P < 0.05). In K-MBI subsection, personal hygiene, bathing self, toilet, dressing, ambulation, chair/bed transfer were significantly higher in experimental group than control group (P < 0.05). The change of total K-MMSE score of experimental group was significantly correlated with change of total K-MBI score (P < 0.05), but control group was not (P > 0.05). In K-MMSE subsection, change of orientation, registration, language and visual reconstruction were correlated with total K-MBI s core after CNT. Especially, the experimental group, total K-MBI score of the left hemisphere damage group was significantly higher than the right hemisphere damage group (P < 0.05). Conclusions This study shows that CNT is effective on subacute post-stroke patients with cognitive impairment. Improvement of cognitive function can expect a positive outcome on daily life performance, in particular, it can be expected to improve the prognosis of patients with stroke, the left hemisphere lesions.

Purpose: We hypothesized that the low contact stress (LCS) posterior stabilization system in knees with ≤3° deviation of coronal alignment would provide more favorable clinical outcomes and survival rate over the course of time. Materials and Methods: A retrospective study was performed on 253 consecutive cases of primary total knee arthroplasty (TKA). Patients were classified according to the degree of deviation of coronal alignment on the initial postoperative radiograph as Group 1 (≤3° deviation) and Group 2 (>3° deviation). The clinical assessments were performed using the Knee Society score and Hospital for Special Surgery systems and Western Ontario and McMaster Universities index. Results: The survival rate was 97.4% in Group 1 and 96.8% in Group 2. No statistically significant intergroup difference was observed in the clinical scores before surgery and since 1 year after surgery (p>0.05). However, a significant intergroup difference was noted between 6 months to 1 year after surgery (p<0.001). Less than 2 mm radiolucent lines were found more frequently in Group 2. Time-dependent improvement was noted within one year after TKA in both groups. Conclusions: Most of the expected improvements were achieved at 6 months after surgery in Group 1 and at 1 year after surgery in Group 2. The present study suggests that the LCS system yields time-dependent improvement regardless of coronal alignment deviation. [ABSTRACT FROM AUTHOR]

The article presents the surgical technique for arthroscopic revision posterior cruciate ligament (PCL) reconstruction using modified tibial-inlay double-bundle method without a change of the patient's position from supine to prone. Steps include graft preparation, patient position, and femoral tunnel preparation, as well as tibial tunnel preparation, graft passage, and graft fixation. The postoperative rehabilitation is also discussed.

The current case report describes an adult male with an intracortical lipoma accompanied by cystic changes in the tibial diaphysis. To the best of our knowledge, intracortical lipoma in an adult tibia has not been previously described. An anteroposterior radiograph of the tibia revealed an osteolytic lesion on the diaphysis. Magnetic resonance imaging and computed tomography revealed that the lesion was located in the cortex and consisted of fat and cyst tissue. Surgical excision of the lesion confirmed diagnosis of an intracortical lipoma. [ABSTRACT FROM AUTHOR]

Background: Despite the suitable characteristics of ropivacaine as an epidural analgesic agent, such as better preservation of motor function and less neurotoxicity, we are aware of no data on its clinical application in pain management following lumbar spine surgery. The purpose of the present study was to evaluate the preemptive analgesic effects and safety of a single epidural injection of ropivacaine during lumbar arthrodesis. Methods: We performed a randomized, double-blinded, intention-to-treat study. Patients with planned one-level posterior lumbar interbody arthrodesis were randomly assigned to either the injection group (n = 32) or the control group (n = 34). The injection group received a 10-ml epidural injection of 0.1% ropivacaine twenty minutes before the skin incision at the planned vertebral level, and the control group received an epidural injection of 10 ml of 0.9% saline solution. A numeric rating scale (from 0 to 10) was measured at seven time points after surgery (at two, four, eight, twelve, twenty-four, and forty-eight hours and at the time of discharge), and the frequency of pushed-button patient-controlled analgesia and total fentanyl consumption were assessed at similar time points (up to two, up to four, up to eight, up to twelve, up to twenty-four, and up to forty-eight hours after surgery). Postoperative nausea and vomiting, the duration of the hospital stay, and the Likert satisfaction score at the time of discharge were evaluated. Results: There were no significant differences between the two groups preoperatively. The numeric rating scale score was higher until twelve hours (p < 0.05) and the frequency of button pushes was higher at every time point except eight to twelve hours (p < 0.05) in the control group as compared with the injection group. Fentanyl consumption until eight to twelve hours (p < 0.05) and total consumption (p < 0.001) at discharge were higher in the control group. There were no differences between the two groups in terms of postoperative nausea and vomiting, the duration of hospital stay, or the mean satisfaction score, and no transient motor weakness was seen in relation to epidural injection of ropivacaine. Conclusions: A single-dose epidural injection of 0.1% ropivacaine before lumbar spine surgery is effective for reducing early postoperative pain without related complications such as transient motor weakness. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Revision of an unsuccessful posterior cruciate ligament (PCL) reconstruction is a complicated clinical procedure with an outcome that may be less satisfactory than that after a typical primary PCL reconstruction. The purpose of this study was to evaluate the reasons for failure of primary PCL reconstructions and to determine the clinical outcomes of revision PCL reconstruction after a minimum of two years of follow-up. Methods: Twenty-eight revision PCL reconstructions were performed by a single surgeon. Four cases that involved diverse operative procedures and two cases with a duration of follow-up of less than twenty-four months were excluded; the outcomes of the remaining twenty-two reconstructions were analyzed at the time of the latest follow-up (at least twenty-four months postoperatively). A technique involving a double femoral tunnel, a modified tibial inlay, and Achilles tendon allograft was used in all twenty-two of these revision reconstructions. Seventeen patients (77%) underwent concomitant reconstruction of posterolateral corner structures. Knee stability was measured with use of posterior stress radiography as well as with a maximum manual displacement test utilizing a KT1000 arthrometer. The subjective International Knee Documentation Committee (IKDC) and objective Orthopadische Arbeitsgruppe Knie (OAK) scoring systems were used to evaluate the clinical outcome. Results: Nine (41%) of the primary PCL reconstructions most likely failed because of a single factor and thirteen (59%) most likely failed because of multiple factors. The most common probable causes of failure were posterolateral rotatory instability (seventeen knees, 77%) and improper graft tunnel placement (nine knees, 41%). Side-to-side differences during posterior stress radiography improved from 9.9 ± 2.8 mm preoperatively to 2.8 ± 1.8 mm at the time of the latest follow-up (p < 0.001). The subjective and objective clinical scores at the latest follow-up evaluation were significantly better than the preoperative scores (p < 0.001). Conclusions: Arthroscopic revision PCL reconstruction with use of the modified tibial-inlay double-bundle technique improved knee stability, as measured with posterior stress radiography and clinically, and outcomes. Associated pos-terolateral rotatory instability should be surgically corrected during PCL reconstruction to prevent graft failure resulting from abnormal opening of the lateral aspect of the tibiofemoral joint. [ABSTRACT FROM AUTHOR]

Soft tissue allografts, such as the bone-patellar tendon-bone (BPTB) graft, have been frequently used for anterior cruciate ligament (ACL) reconstruction. As allografts are subjected to freezing and thawing for multiple cycles, the objective of this study was to measure the changes of the biomechanical properties of the human BPTB allograft after 4 and 8 freeze-thaw cycles in comparison to a single freeze-thaw cycle. Three BPTB specimens were procured from 21 human donors and divided into three groups: 1, 4, or 8 freeze-thaw cycles. Each freeze-thaw cycle consisted of freezing at −20 ± 10°C for more than 6 h and thawing at 22 ± 3°C for at least 6 h. Tensile testing of the BPTB specimens consisted of loading between 50 N and 250 N for 100 cycles and then loading to failure. Cyclic loading revealed a similar amount of creep (∼0.5 mm) among the three freeze-thaw cycles groups ( p = 0.38). The stiffness of the BPTB graft for the 1, 4, and 8 freeze-thaw cycle groups were 244 ± 42 N/mm, 235 ± 39 N/mm, and 231 ± 40 N/mm, respectively ( p = 0.43). Similar findings were obtained for the ultimate load of the BPTB graft ( p = 0.14) and the tangent modulus of the PT substance ( p = 0.41). The results of this study suggest that there would be little measurable effect on the structural properties of the BPTB graft or mechanical properties of the PT tissue substance following 8 freeze-thaw cycles. These BPTB allografts could potentially be re-frozen without a loss in their biomechanical properties, given appropriate storage and care. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29: 1193-1198, 2011 [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the relationship between the proximity of neural structures to standard posterior portals in different knee positions. Methods: Ten fresh cadaveric knees were used to establish the standard posteromedial and posterolateral portals using an outside-in technique with arthroscopic transillumination. The distance from each portal site to the adjacent neurovascular structures (infrapatellar branches of the saphenous nerve) and the sartorial branch of saphenous nerve from the posteromedial portal, and the common peroneal nerve from posterolateral portal was measured using a precision caliper. Distances were recorded with the knees in extension, 45° of flexion and 90° of flexion in order to examine the effect of dynamic knee motion on nerve position. Results: The mean distance between the posteromedial portal and the superior and inferior branches of infrapatellar branches of the saphenous nerve at full extension was significantly greater than at 90° of flexion. However, there was no difference observed between at 45° and at 90° of flexion. The mean distance from the posteromedial portal to the sartorial branch of saphenous nerve at 90° of flexion was significantly greater (26.1 mm, SD: 4.7) than that at 45° of flexion (18.4 mm, SD: 4.6), and at full extension (14 mm, SD: 4.3) ( P < 0.0001). The mean distance between the posterolateral portal to the common peroneal nerve at 90° of flexion was also significantly greater (25.4 mm, SD: 9.2) than that at 45° of flexion (22.5 mm, SD: 8.1), and at full extension (20.1 mm, SD: 9.1) ( P < 0.0001). Conclusion: In this cadaveric study, it shows that position of 90° knee flexion is reasonably safe, in order to establish a posterior portal in knee arthroscopy using the technique described in the current study, especially to avoid the sartorial branch of saphenous nerve and the common peroneal nerve injuries. Results of this study suggest the establishment of posterior portals, while the knee is flexed at an angle of 90° is recommended to ensure the safety of these structures. [ABSTRACT FROM AUTHOR]

The article focuses on the case of a 25 year old man who presented to physicians with a four year history of pain and swelling in the anterolateral aspect of the right ankle. A discussion of a diagnosis of psuedoaneurysm of the anterior tibial artery which was given to the man and of successful treatment that he received with ultrasound guided compression therapy is presented.

The article presents two cases of stress fracture associated with a transcortical pin track which was drilled to allow placement of navigation trackers during a computer-navigated total knee arthroplasties. The two case provides information about the risk of the development of a stress fracture after placement of a transcortical pin. Therapeutic procedures to correct the situations are presented along with the discussion of the associated conditions.

BACKGROUND: The tibial inlay method for reconstruction of the posterior cruciate ligament has been performed with the patient in the prone or lateral decubitus position. The purpose of this report is to present a modification of this method wherein the patient is positioned supine throughout the procedure. METHODS: Between May 1995 and September 1998, twelve patients who had an isolated tear of the posterior cruciate ligament underwent reconstruction with use of the modified tibial inlay technique. Eleven patients were evaluated after a minimum duration of follow-up of two years. Stability was measured on posterior stress radiographs and with a maximum manual displacement test performed with a KT-1000 arthrometer. Clinical evaluation was carried out with use of the scoring systems of the Orthopädische Arbeitsgruppe Knie and the International Knee Documentation Committee. Second-look arthroscopy was performed in five patients at the time of follow-up. RESULTS: The mean side-to-side difference in displacement (and standard deviation) was reduced from 10.8 ± 1.9 mm preoperatively to 3.4 ± 2.4 mm at the time of follow-up as measured on the stress radiographs, and it was reduced from 9.0 ± 2.1 mm preoperatively to 1.8 ± 1.2 mm at the time of follow-up as measured with the KT-1000 arthrometer. The average Orthopädische Arbeitsgruppe Knie score was improved from 71.6 ± 6.8 to 92.5 ± 4.8 points. All eleven patients had a satisfactory clinical outcome at the time of the final clinical evaluation. The second-look arthroscopic examination in the five patients showed no evidence of partial tearing or abrasion of the graft. CONCLUSIONS: Use of our modified tibial inlay technique for reconstruction of the posterior cruciate ligament achieved a good clinical result in eleven of twelve patients. The advantages of the technique are (1) minimal tendon abrasion at the posterior opening of the tibial tunnel, and (2) elimination of the need to change the patient's position during surgery. [ABSTRACT FROM AUTHOR]

Background: The tibial inlay method for reconstruction of the posterior cruciate ligament has been performed with the patient in the prone or lateral decubitus position. The purpose of this report is to present a modification of this method wherein the patient is positioned supine throughout the procedure. Methods: Between May 1995 and September 1998, twelve patients who had an isolated tear of the posterior cruciate ligament underwent reconstruction with use of the modified tibial inlay technique. Eleven patients were evaluated after a minimum duration of follow-up of two years. Stability was measured on posterior stress radiographs and with a maximum manual displacement test performed with a KT-1000 arthrometer. Clinical evaluation was carried out with use of the scoring systems of the Orthopädische Arbeitsgruppe Knie and the International Knee Documentation Committee. Second-look arthroscopy was performed in five patients at the time of follow-up. Results: The mean side-to-side difference in displacement (and standard deviation) was reduced from 10.8 ± 1.9 mm preoperatively to 3.4 ± 2.4 mm at the time of follow-up as measured on the stress radiographs, and it was reduced from 9.0 ± 2.1 mm preoperatively to 1.8 ± 1.2 mm at the time of follow-up as measured with the KT-1000 arthrometer. The average Orthopädische Arbeitsgruppe Knie score was improved from 71.6 ± 6.8 to 92.5 ± 4.8 points. All eleven patients had a satisfactory clinical outcome at the time of the final clinical evaluation. The second-look arthroscopic examination in the five patients showed no evidence of partial tearing or abrasion of the graft. Conclusions: Use of our modified tibial inlay technique for reconstruction of the posterior cruciate ligament achieved a good clinical result in eleven of twelve patients. The advantages of the technique are (1) minimal tendon abrasion at the posterior opening of the tibial tunnel, and (2) elimination of the need to change the patient's position during surgery. Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]