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Osteoporosis is reported to effect 44 million adults, of whom 80% are women. Exercise appears to influence the osteogenic response and can lead to higher values of Bone mineral density. A minimum research is done on bone mineral density using dual energy x-ray absorptiometry (DEXA) in India. Weight bearing exercises seem to have a better effect than nonweight bearing exercises. Aim: our aim of this retrospective cohort study is to confirm that weight bearing exercise is beneficial to bone mineral density than non weight bearing exercise. Materials and Methods: A total of 50 healthy active women (n=50) doing weight bearing exercises like tennis playing and gym weight workouts for atleast one hour, for 5 days a week were taken. (Group A). A total of 50 healthy walkers with minimum walking of one hour for 5 days a week were taken (Group B). Dual-energy X-ray absorptiometry (DXA) was done to assess the bone mineral density in all the participants. Bone mineral density (BMD) in gram per square centimeter of lumbar spine (L1-L4), surgical neck of right humerus and total body BMD was assessed with a hologic QDR-1000/W pencil-beam bone densitometer, using the spine scan mode. Statistical analysis was done using Statistical package for the social sciences (SPSS software, version 13.0). Analysis of covariance was used to determine whether there were significant differences between groups in bone mineral density, adusting height and weight. Results: The Total body BMD in gm/cm2 in group A is 1.172+ 0.034 and the Total body BMD in gm/cm2 in group B is 1.078+0.053. (P value < 0.001) Lumbar spine BMD in gm/cm2 in Group A is 1.216+0.122 and the Lumbar spine BMD in gm/cm2 in Group B is 0.968+/-0.128. (P value

While weight-bearing radiographs are considered the optimal method for evaluation of joint spaces in osteoarthritis, non-weight-bearing radiographs are often performed. The purpose of this study is to evaluate the rate of follow-up radiographs in patients receiving non-weight-bearing radiographs for chronic knee pain in the outpatient setting, compared with patients receiving weight-bearing radiographs. Consecutive patients who received non-weight-bearing knee radiographs for chronic knee pain between January 1, 2018, and June 15, 2019, were included. Exclusion criteria included trauma, concern for infection or tumor, and post-surgical radiographs. An age- and sex-matched control group of 100 patients who received weight-bearing knee radiographs was compiled. The proportion of follow-up radiographs within 1 year was compared between the study and control groups with chi-squared tests. Four hundred non-weight-bearing knee radiographic examinations were included. There were 74/400 (18.5%) follow-up radiographs within 12 months. All follow-up radiographs were weight-bearing. In the control group, 4/100 (4%) had follow-up weight-bearing radiographs within 1 year (p

Background: Autologous osteochondral transplantation (AOT) is one of the most effective treatments for osteochondral lesions of the talus (OLTs). Normally, medial malleolar osteotomy is used to expose posteromedial lesions. However, medial malleolar osteotomy causes additional ankle injuries and a risk of persistent pain in the ankle joint. The purpose of the current study was to evaluate a new medial malleolar triplane osteotomy method and the functional outcomes of AOT from a non-weight-bearing area of the talus for OLTs.Methods: Twenty-three patients (23 ankles), including 14 males and 9 females, received AOT with triplane osteotomy of the medial malleolus for symptomatic OLTs between September 2015 and December 2017. The mean age was 35.6 years. The mean size of the lesion area was 141.5 mm2. The visual analog scale (VAS) for pain during walking and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used for the pre- and postoperative evaluations. In addition, the incorporation of the grafts was assessed by computed tomography (CT).Results: All patients had a minimum follow-up of 22 months, with an average of 37.1 months. The mean time from osteotomy to full weight-bearing activity was 8.1±2.3 weeks (range, 5-12 weeks). The VAS score improved from 4.34 preoperatively to 0.53 postoperatively (P Conclusions: AOT combined with medial malleolus triplane osteotomy is a viable option for OLTs. Patients could perform weight-bearing exercise and return to sport as early as possible, with few complications at the osteotomy site and donor site.

Vassilis Chantziaras, currently a surgical resident at Willows Referral Service, invites Companion readers to consider a case of a 7-month old Yorkshire Terrier with acute onset non-weight bearing lameness, which he managed while working as a general practitioner.

Insufficiency fractures are a relatively common sub-type of stress fractures and occur as a result of decreased bone resistance due to underlying conditions such as osteoporosis. Insufficiency fractures of the knee most commonly occur at the central weight-bearing zone of the medial femoral condyle. We present five unusual cases of insufficiency fractures occurring at the posterior non-weight-bearing zone of condyles. After investigating commonalities between these patients, we discovered that all of these patients performed the daily practice of prayer rituals that include high knee flexion. We have chosen to coin this type of fracture a "Prayer's fracture". Considering the mechanics of high knee flexion, transient changes in the weight-bearing zone of knee explain the unusual location of this fracture. We describe these cases, the characteristic imaging appearance, and the probable biomechanics that we believe predispose patients to this type of injury.

Background Syndesmotic injures are common and weight bearing imaging studies are often advocated to assess disruption. Although studies have examined the anatomical relationship between the fibula and incisura, the effect of weight-bearing on the syndesmosis has not been well reported. We characterise the changes which occur at the syndesmosis during weight-bearing. Methods In this retrospective review we analysed the position of the fibula at the syndesmosis in a cohort of patients who underwent both non-weight-bearing and weight-bearing CT scans. The relative position of the fibula to the incisura was analysed to determine translation and rotation in the axial plane. Results 26 patients were included. Comparison of measurements revealed statistically significant differences between groups which indicated that on weight-bearing the fibula translated laterally and posteriorly, and rotated externally with respect to the incisura. Conclusions This is the first study to measure the differences in position of the syndesmosis during weight-bearing in a population of patients that have undergone both weight bearing and non weight bearing CT. Our study confirms that weight-bearing results in lateral and posterior translation, and external rotation of the fibula in relation to the incisura and our findings should help in future studies looking at the effect of weight bearing on syndesmotic pathology.

Background Older people who are non-weight-bearing after a lower limb fracture are at risk of poor outcomes but there are no clinical guidelines for this group of patients. Given the paucity of the research evidence base, we conducted a consensus exercise to ascertain expert opinion about the management of this group. Methods A three-round e-Delphi technique was planned to use the online JISC survey tool with a multidisciplinary panel of health professionals. Panellists were invited by email via professional organisations and UK NHS Trusts. The initial statements for this study were prepared by the authors based upon the findings of their scoping review. Consensus required >/= 70% agreement with statements. Results Only 2 survey rounds were required. Ninety panellists, representing seven clinical disciplines, reached consensus for 24 statements about general issues (osteoporosis detection and management, falls risk reduction and nutrition) and specific non-weight bearing issues (such as the need for activity to be promoted during this period). Conclusions These findings can be used in the generation of a clinical guideline for this group of patients.

Introduction: Various positioning techniques are utilized to enhance the visualization of lower cervical vertebrae on lateral radiographs. However, the effectiveness of these techniques still remains unclear. This study was conducted to determine the effect of the weight-bearing (WB) technique in visualizing lower cervical vertebrae and cervicothoracic junction (C7-T1) on standing lateral cervical radiographs of adult non-trauma patients. The study was conducted using both computed radiography (CR) and digital radiography (DR) systems.Methods: Forty-four CR (29 WB and 15 non-WB – NWB) and 61 DR (26 WB and 35 NWB) lateral C-spine radiographs were prospectively evaluated to assess the visible number of cervical vertebral bodies and C7-T1 junction. The instructions given by the radiographer to the patient for the imaging procedure were also assessed on the Likert scale (very good, good, fair, poor, very poor).Results: There was no significant difference (p > 0.05) in the visualization of the number of vertebral bodies between the two techniques of WB and NWB for CR or DR. Further, no significant relationship (p > 0.05) was observed between the WB technique and the visualization of C7-T1 junction in DR systems. However, a significant difference was identified for CR (p = 0.012). The instruction given to the patient significantly correlated with the visibility of the lower C-spine region within each group of WB and NWB in both imaging systems.Conclusions: The visibility of the number of vertebral bodies in the lower C-spine region in either CR or DR systems did not demonstrate any enhancement with the WB technique. Regardless of the imaging system or techniques used, adequate instructions given to the patient before and during the imaging procedure of C-spine lateral radiography demonstrated a significant improvement in visualizing the lower C-spine region. In this preliminary study, the application of erect WB radiography technique in evaluating the lower cervical region of adult non-trauma patients gives limited advantage.

Purpose: The meniscal kinematics in the full knee range of motion (ROM) have not been demonstrated by MRI, because the narrow bore of the superconducting magnet prevents full knee motion. The purpose of this study was to the investigate meniscal kinematics associated with femorotibial kinematics using an open-structure MRI unit that allows kinematic analysis of the menisci in full knee ROM. Methods: Non-weight-bearing MR images of the right knee of 10 subjects were acquired at six angles of knee flexion (0°, 30°, 60°, 90°, 120°, and full flexion) using a compact 0.2-T MRI system. The positions of the anterior and posterior horns of the medial and lateral menisci (MM/LM) and the medial and lateral femoral condyles (MFC/LFC) were measured at each angle of flexion. Results: Significant posterior LFC movement was observed in all sets of adjacent flexion angles of 60°–90° or more, indicating medial pivot motion of the femur. Significant differences in LM position were observed between adjacent flexion angles of 60°–90° or more. The positional relationship between the posterior horn of MM and the MFC was statistically significant in all but 60° flexion. The positional relationship between LM and LFC was significant at flexion angles of ≤90° in the anterior horn and at 60°, 90°, and full flexion in the posterior horn. Conclusion: Motion patterns of the menisci were analogous to those of the femoral condyle. Medial pivot motion of the femur caused the greatest posterior movement of the LM. Meniscal kinematics followed the femorotibial kinematics. Comprehension of meniscal kinematics in full knee ROM is important for understanding of injury mechanisms, planning meniscus transplant, and making postoperative care program for meniscus surgery.

Background: Thrust manipulation of the cervical spine has improved the range of motion (ROM). Hence, the study evaluated the effects of cervical thrust manipulation in weight-bearing (CTM-WB) and non-weight-bearing (CTMNWB) on the cervical ROM (CROM) in asymptomatic individuals. Methods: A randomized clinical trial was conducted on 74 asymptomatic subjects among 18 – 30 years who had reduced neck ROM. Participants were assessed for CROM using the digital goniometer at the baseline and immediately after the intervention, i.e., within 5 minutes post-intervention. They were randomized into two groups using the envelope method. Participants were given cervical manipulation in weight-bearing or non-weight-bearing positions based on their respective group allocation. The data were analyzed using the paired t-test and the unpaired t-test. Results: Statistical analysis revealed significant differences in pre and post-values of all the degrees of freedom in CTMWB (p < 0.05) and CTM-NWB (p < 0.05) groups. Conclusion: CTM-WB and CTM-NWB positions are both effective in improving CROM. Hence CTM-WB can also be used during clinical practice, especially in individuals who have difficulty lying in a supine position. Since manual therapy techniques are known to correct positional faults, the two cervical manipulation techniques' effects can be studied on individuals with forward head posture or parameters such as pain and disability.

The authors compared measurements of hindfoot alignment on MR imaging with weight-bearing CT (WB-CT) to establish the degree of correlation. Forty-seven feet in 44 patients had weight-bearing CT and MRI studies performed on the same day. Hindfoot alignment on MRI was assessed by two radiologists who calculated tibiocalcaneal angle (TCA) and calcaneofibular ligament angle (CFLA). On WB-CT, foot ankle offset (FAO), calcaneal offset (CO) and hindfoot angle (HA) were assessed by a senior Foot and Ankle Surgeon using dedicated software. Pearson correlation coefficient was used to evaluate the correlation between these measurements. The study group comprised 27 males and 17 females with a mean age of 45 years (range 13–79 years). A statistically significant positive correlation was identified between TCA on MRI and all measurements of hindfoot alignment on WB-CT (p = 0.001–0.005). The CFLA on MRI only had significant correlation with CO on WB-CT (p = 0.03). A significant negative correlation was observed between both MRI parameters (p

Background: In knee osteoarthritis, radiographic joint space width (JSW) is frequently used as a surrogate marker for cartilage thickness; however, longitudinal changes in radiographic JSW have shown poor correlations with those of magnetic resonance imaging (MRI) cartilage thickness. There are fundamental differences between the techniques: radiographic JSW represents two-dimensional (2D), weight-bearing, bone-to-bone distance, while on MRI three-dimensional (3D) non-weight-bearing cartilage thickness is measured. In this exploratory study, computed tomography (CT) was included as a third technique, as it can measure bone-to-bone under non-weight-bearing conditions. The objective was to use CT to compare the impact of weight-bearing versus non-weight-bearing, as well as bone-to-bone JSW versus actual cartilage thickness, in the knee. Methods: Osteoarthritis patients ( n = 20) who were treated with knee joint distraction were included. Weight-bearing radiographs, non-weight-bearing MRIs and CTs were acquired before and 2 years after treatment. The mean radiographic JSW and cartilage thickness of the most affected compartment were measured. From CT, the 3D median JSW was calculated and a 2D projectional image was rendered, positioned similarly and measured identically to the radiograph. Pearson correlations between the techniques were derived, both cross-sectionally and longitudinally. Results: Fourteen patients could be analyzed. Cross-sectionally, all comparisons showed moderate to strong significant correlations (R = 0.43–0.81; all p Conclusion: The poor correlation between changes in radiographic JSW and MRI cartilage thickness appears primarily to result from the difference in weight-bearing, and less so from measuring bone-to-bone distance versus cartilage thickness.

Hindfoot malalignment is a relatively common clinical finding and several studies have suggested that hindfoot valgus can be identified on non-weight-bearing ankle MRI. The aim of this study was to determine the awareness of hindfoot malalignment on ankle MRI amongst consultant musculoskeletal radiologists. All MRI studies referred by Foot and Ankle Unit Consultants reported by one of 14 consultant musculoskeletal radiologists between March 2016 and August 2019 were retrieved from the Hospital Radiology Information System. These were reviewed independently by a radiology fellow and a consultant radiologist. Tibiocalcaneal angle (TCA) was measured, and extra-articular talocalcaneal (EA-TCI) and calcaneofibular impingement (EA-CFI) were recorded. Radiology reports were then analysed for mention of hindfoot malalignment and the presence of EA-TCI and EA-CFI. The study group comprised 129 patients, 46 males and 83 females with a mean age of 46.8 years (range 8–84 years). Based on review, hindfoot valgus was present in 78–80 cases (60.5–62%), EA-TCI in 30–36 cases (23.2–27.9%) and EA-CFI in 18–21 cases (14–16.3%). By comparison, MRI reports mentioned hindfoot valgus in 18 cases (2 incorrectly), EA-TCI in 8 cases (1 incorrectly) and EA-CFI in 10 cases (1 incorrectly). Hindfoot valgus, EA-TCI and EA-CFI were present relatively commonly on review of ankle MRI studies in patients referred from a specialist Foot and Ankle Unit but were commonly under-reported highlighting a relative lack of awareness of hindfoot malalignment on ankle MRI amongst musculoskeletal radiologists, which could impact negatively on patient management.

Objective: To study the effects of absorbable materials in non-weight-bearing bone fractures of extremities. Methods: After 66 patients with non-weight-bearing bone fractures of extremities were selected, absorbable materials were used in the observation group and metal materials were used in the control group. Results: After treatment, the bone healing in the observation group was significantly improved (P

Objective To siscuss the clinical significance of the early diagnosis of knee varus and knee osteoarthritis with the combination of negative position and non‐negative position and radiography. Methods One hundred and eighty patients whose femorotibial angles, Full‐length Radiography of Both Lower Limbs at Weight‐bearing Position.

Background Post-operative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and limitation of weight-bearing may lead to poorer clinical outcomes. Traditional non-weight bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rate. Methods A pragmatic randomised controlled multi-centre trial, comparing IWB in a walking boot and ROM within 24 hours versus non-weight bearing (NWB) and immobilisation in a cast for six weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. Exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes include; Wound infection (deep and superficial), displacement of osteosynthesis, total arc of ankle motion (plantar flexion and dorsal-flection), RAND 36-Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial and this protocol follow the SPIRIT guidance. Discussion Traditional management of operatively treated ankle fractures includes an extended period of non-weight bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but with higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner. This pragmatic randomised-controlled multi-centre trial will investigate immediate weight-bearing following ORIF of all ankle fractures pattern in the usual condition of care. It is hoped that these results will contribute towards the modern management of ankle fractures.

Disuse and/or a non-weight-bearing condition changes muscle composition, with decreased skeletal muscle tissue and increased fat within (intramuscular adipose tissue, IntraMAT) and between (intermuscular adipose tissue, InterMAT) given muscles. Excessive adipose tissue contributes to dysfunctional and metabolically impaired muscle. How these adipose tissues change during orthopedic treatment (e.g., cast immobilization, daily use of crutches) is not well documented. This study aimed to quantify changes in IntraMAT, InterMAT, and thigh and calf muscle tissue during orthopedic treatment. We studied 8 patients with fifth metatarsal bone or fibular fractures. The ankle joint involved underwent plaster casting for approximately 4 weeks, with crutches used during that time. Axial T1-weighted MRI at the mid-thigh and a 30% proximal site at the calf were obtained to measure IntraMAT and InterMAT cross-sectional areas (CSAs) and skeletal muscle tissue CSA before treatment and 4 weeks afterward. Thigh and calf muscle tissue CSAs were significantly decreased from before to after treatment: thigh, 85.8 ± 7.6 to 77.1 ± 7.3 cm2; calf, 53.3 ± 5.5 to 48.9 ± 5.0 cm2 (p

Background Clavicle fractures are common injuries in the polytrauma population and frequently limit early mobilisation. This study evaluates the effect of immediate crutch weight-bearing (WB) in polytrauma patients after surgical stabilisation of a displaced midshaft clavicle fracture. Methods A retrospective review identified 26 polytrauma patients with operatively managed displaced midshaft clavicle fractures and a non–weight-bearing (NWB) lower extremity injury. Patients were allowed immediate WB after surgery or NWB. The primary outcome was total hospital length of stay. Statistical analysis was done using Mann–Whitney U test. Results The WB group had decreased total hospital length of stay (10.4 vs. 17.0 days, p = 0.012) and improved physical therapy score (3.9 vs. 2.9, p = 0.054) and postoperative length of stay (6.8 vs. 12.7 days, p = 0.006) compared with the NWB group. Conclusions Our data suggest that an immediate WB as tolerated protocol for polytrauma patients after surgical fixation of displaced clavicle fractures may decrease the overall length of stay.

When evaluating suspensory ligament branch splits, there is a discrepancy between high field MRI findings and weight bearing ultrasonographic imaging characteristics. In this descriptive and retrospective case series, ultrasonographic examination was performed on suspensory ligament branches with the limbs in weight bearing and non-weight bearing positions. Suspensory ligament branch splits were defined as linear regions of decreased echogenicity when imaged with the limb in a weight bearing position that increased in size and became anechoic with the limb in a non-weight bearing position. This appearance was considered an indication of pathologic change in the branch. A total of 62 suspensory ligament branches were included in the study from 37 horses, with 14 partial splits, 11 intrasubstance splits, and 14 complete splits of which two had extension of fetlock synovial fluid and synovial membrane through the split. Recheck ultrasonographic examinations performed in eight horses up to 14 months following the initial examination demonstrated persistence of the split in two horses, partial resolution in five horses, and complete resolution in one horse. Ultrasonographic examination using the non-weight bearing approach proved valuable for increasing the lesion conspicuity as compared to the weight bearing images. Certain abnormalities, such as longitudinal fiber disruption (split) in suspensory ligament branches may only be evident when imaged non-weight bearing. The use of this technique provides a more accurate representation of lesion severity and allows for monitoring over time. A longitudinal study is necessary to determine the clinical relevance of suspensory ligament branch splits.

A limited healing response to focal cartilage lesions is frequently encountered in the clinical cartilage pathology. This study compares the gene expression patterns of damaged and undamaged regions of cartilage obtained from the same patient with focal cartilage lesions. The aim of this study is to provide new genes and proteins, which may be a potential future target of research.During the autologous chondrocyte implantation (MACI) surgery, cartilage tissues (healthy non-weight bearing and Damaged-lesion side) were obtained from 10 patients with knee focal cartilage lesions. The degeneration status of the cartilage was characterized according to ICRS criteria. Whole genome microarray gene expression profiling was performed and some of the differentially regulated genes were validated with RT-PCR.Damaged and undamaged non-weight bearing cartilage showed distinct gene expression profiles. Genes involved in cell signaling, matrix degradation, hypoxia, and the inflammatory response showed significant up- or down-regulation. In the focal lesions, expression of genes such as HIF1α, TIMP-2, EID1, EID2, NCOA3, NBR1, SP100, and HSP90AA1 was significantly higher compared to healthy non-weight bearing cartilage from the same joint, whereas TIMP-4 was lower.The genes examined in this study differ distinctly between focal cartilage (ICRS 3-4) lesions and undamaged sites of the same joint. We believe that the data set forth in this study may be used for clinical purposes and be a guide in the development of new biological approaches for therapy.

This research aimed to investigate the relationship between abdominal obesity and lower bone mineral density (BMD) at non-weight-bearing site in Korean men using data from the Korea National Health and Nutrition Examination Survey, which is a nationwide cross-sectional survey. The study population ( n = 5,941) was selected from the 2009–2010 survey. Abdominal obesity in men was defined as waist circumference ⩾ 90 cm. Lower BMD state was defined as having T-score of −2.5 or below. To investigate the association, multiple logistic regression analysis was performed. Abdominal obesity was highly associated with lower non-weight-bearing site (lumbar spine [LS]) BMD after adjustment (odds ratio [OR] 1.61, 95% CI [1.06, 2.44], p = .026). Also, abdominal obesity was a risk factor for lower LS BMD, especially in age groups of those in their 20s and those over 60s (OR 5.53, 95% CI [1.27, 24.07], p = .023 for 20s; OR 2.19, 95% CI [1.19, 4.02], p = .011 for 60 years or older). Abdominal obesity in Korean men is associated with lower BMD at non-weight-bearing site (LS), especially in younger and older age groups. Further research might be recommended to prove the mechanism or causality.

Background: A period of non-weight-bearing is prescribed following many orthopaedic injuries and procedures. It is believed that a period of non-weight-bearing is important for proper healing and recovery. The degree to which patients are compliant with non-weight-bearing instructions is unknown. The purpose of this study was to measure patient compliance with a period of prescribed non-weight-bearing. Methods: In this single-blinded study, pressure-sensitive film was embedded into short leg casts of 51 consecutive adult orthopaedic patients with unilateral lower-extremity abnormality who had been instructed to be strictly non-weight-bearing. Sensors were retrieved at the time of cast removal (mean, 24.3 days [range, 7 to 48 days]) and then were analyzed for force distribution and magnitude. Noncompliance was defined as maximum detectable pressure exerted on ≥50% of the film. Patient characteristics and the time of year that the casts were worn were also examined to determine if they correlated with weight-bearing. Results: Fourteen (27.5%) of 51 patients were noncompliant with the non-weight-bearing restriction. Six (42.9%) of the 14 noncompliant patients compared with 11 (29.7%) of the 37 compliant patients experienced an adverse event (p = 0.51). Sex, age, language spoken, body mass index, time in the cast, and the treating surgeon did not have a significant influence on weight-bearing performance (p > 0.05). Significantly greater weight-bearing was found (p = 0.04) in warmer months (June to October) than in colder months (November to March) in the United States. Conclusions: The noncompliance rate with the postoperative non-weight-bearing restriction was 27.5% (95% confidence interval, 15.2% to 39.8%) in this patient group, despite explicit instructions and education about possible complications associated with weight-bearing. The only factor found to have a significant effect on weight-bearing compliance was the time of year that the cast was worn. No significant difference was found between the complication rate of the compliant patients and that of the noncompliant patients. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Article published in Muscles, Ligaments and Tendons Journal on 01 March 2020, available open access at: https://doi.org/10.32098/mltj.01.2020.14.

Action observation (AO) has been used to improve rehabilitation outcomes. We examined the effects of AO gait training on the acquisition of a non-weight-bearing (NWB) gait with crutches. Eighteen healthy young male participants were assigned to control (n = 9) and AO groups (n = 9). All subjects were instructed to walk with crutches at a comfortable speed on a 10-m walkway (10 trials). Participants received a verbal explanation of the experimental task (NWB gait with crutches), after which, those in the AO group watched a video of another person performing the task. An accelerometer was positioned on the third lumbar vertebra and used to measure the trunk acceleration during the experimental task. Gait speed and acceleration root mean squares (RMS) were calculated during the 1st, 5th, and 10th trials for each group. The two-way ANOVA for acceleration RMS revealed significant main effects of trial and group, as well as a significant trial by group interaction. During the first trial, fewer trunk fluctuations were observed in the AO group compared to that in the control group. Thus, AO is effective in improving NWB gait training with crutches during the early phase of acquisition.

Background: The aim of this study is to explore the changes in ground reaction force (GRF) produced by custom-made weightbearing and nonweight-bearing foot orthoses and by a prefabricated foot orthosis, in the control of the pronated foot. Methods: Thirty-nine participants were recruited. All were in good health, aged 18 to 25 years, and presented pronated foot. Three different types of foot orthosis were studied: prefabricated, weight-bearing, and nonweight-bearing. Results: No significant differences were observed in the phases of the gait cycle between the prefabricated, the weight-bearing, and the nonweight-bearing foot orthoses. Conclusions: Neither prefabricated insoles nor custom-made orthoses (weight-bearing or nonweight-bearing) modified GRF.

Excess body weight composes an important limitation to exercise in obese youth. The aim of this study was to compare the perceived exertion of obese adolescents between weight-bearing (WB; running) and non-weight-Bearing (NWB; cycling) exercises performed at moderate (55% VO2max) and high (75% VO2max) intensities. Twenty-four obese adolescents were recruited. After assessment of their body composition and physical capacities, they had to complete four isoenergetic exercise sessions: (1) a cycling session performed at 55% of their maximal capacities (NWB-55%); (2) a cycling session set at 75% (NWB-75%); (3) a running session at 55% (WB-55%); and (4) a running session at 75% (WB-75%). Perceived exertion was assessed using a visual scale at regular interval. While no significant difference between WB and NWB modalities was observed, the adolescents expressed a significantly lower rate of perceived exertion (RPE) during exercises at 55%VO2max (P0.0001). An intensity × modality interaction revealed that RPE was lower at 75% VO2max during NWB exercises (P0.05). While obese adolescents expressed lower RPE during exercise at moderate intensity whatever its modality, low level of perceived exertion has been observed during high-intensity exercises and especially during NWB. High-intensity exercise appears well tolerated in adolescents when their body weight is supported.

Background Ankle fractures are common injuries treated routinely by orthopaedic surgeons. A variety of different post-operative protocols have been described with differing periods of non-weight bearing after surgery. The aim of this study was to identify how patient injury characteristics and medical comorbidities contribute to the period of non-weight bearing chosen by orthopaedic surgeons after open reduction and internal fixation of rotational ankle fractures. Methods A cross sectional expert opinion survey was administered to members of the AOFAS as well as OTA to determine how long they would instruct patients to be non-weight bearing after open reduction and internal fixation of ankle fractures. Three different injury characteristics were described: supination external rotation type 4 equivalents, bimalleolar, and trimalleolar patterns. These patterns were combined with three different medical statuses: young and healthy, older and healthy, and older with significant medical comorbidity. Respondents selected how long they would keep the patient non-weight bearing after surgery for each of the potential scenarios. Finally, they were directly asked which factors they felt affected their decision about length of time to keep patients non-weight bearing. Results Seven hundred and two surgeons (31%) responded to the survey. The average time of non-weight bearing selected varied from 4.9 (±3.1) weeks for in young, healthy patients with SER4 equivalent injuries to 7.6 (±6.0) weeks for older patients with medical comorbidities with trimalleolar fractures. Responses had a high degree of heterogeneity, but both injury pattern and medical status were significant predictors of non-weight bearing period ( p Conclusions There is significant variation among orthopaedic surgeons when selecting period of non-weight bearing after fixation of ankle fractures, with both injury pattern and medical comorbidity playing a role in decision of time to keep patient non-weight bearing. Further research further evaluating the relationship between these factors and safe periods of non-weight bearing could help identify patients that may benefit from earlier mobilization, and improve surgeon's comfort with early mobilization. Level of evidence Therapeutic Level V.

The purpose of this study was to examine the relationships between the ankle dorsiflexion passive range of motion (DF PROM) under a non-weight bearing condition and the normalized reach distance in three directions of the Y-Balance Test (YBT). Sixty-one healthy adults (32 males and 29 females, age: years, height: , weight: ) participated in this study. The ankle DF PROM was measured using a goniometer. To assess dynamic balance, all subjects performed three trials to determine the maximum lower extremity reach in the anterior, posteromedial, and posterolateral directions of the YBT. The relationship between the ankle DF PROM and both the normalized reach distance in each direction and the composite score of the YBT were analyzed using the Pearson correlation. Only the normalized reach distance in the anterior direction of the YBT was significantly related to the ankle DF PROM measured under a non-weight bearing condition (r

Context: Fatigue is suggested to be a risk factor for anterior cruciate ligament injury. Fatiguing exercise can affect neuromuscular control and laxity of the knee joint, which may render the knee less able to resist externally applied loads. Few authors have examined the effects of fatiguing exercise on knee biomechanics during the in vivo transition of the knee from non–weight bearing to weight bearing, the time when anterior cruciate ligament injury likely occurs. Objective: To investigate the effect of fatiguing exercise on tibiofemoral joint biomechanics during the transition from non–weight bearing to early weight bearing. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: Ten participants (5 men and 5 women; age = 25.3 ± 4.0 years) with no previous history of knee-ligament injury to the dominant leg. Intervention(s): Participants were tested before (preexercise) and after (postexercise) a protocol consisting of repeated leg presses (15 repetitions from 10°–40° of knee flexion, 10 seconds' rest) against a 60% body-weight load until they were unable to complete a full bout of repetitions. Main Outcome Measure(s): Electromagnetic sensors measured anterior tibial translation and knee-flexion excursion during the application of a 40% body-weight axial compressive load to the bottom of the foot, simulating weight acceptance. A force transducer recorded axial compressive force. Results: The axial compressive force (351.8 ± 44.3 N versus 374.0 ± 47.9 N; P = .018), knee-flexion excursion (8.0° ± 4.0° versus 10.2° ± 3.7°; P = .046), and anterior tibial translation (6.7 ± 1.7 mm versus 8.2 ± 1.9 mm; P < .001) increased from preexercise to postexercise. No significant correlations were noted. Conclusions: Neuromuscular fatigue may impair initial knee-joint stabilization during weight acceptance, leading to greater accessory motion at the knee and the potential for greater anterior cruciate ligament loading.

What is your diagnosis? Acute non-weight bearing pelvic limb lameness in a dog - Question and answer

The 3-dimensional nature of adult acquired flatfoot deformity can be challenging to characterize using radiographs. We tested the hypothesis that measurements on weight-bearing (WB) cone-beam computed tomography (CT) images were more useful for demonstrating the severity of the deformity than non-weight-bearing (NWB) measurements.We prospectively enrolled 12 men and 8 women (mean age, 52 years; range, 20 to 88 years) with flexible adult acquired flatfoot deformity. The subjects underwent cone-beam CT while standing (WB) and seated (NWB), and images were assessed in the sagittal, coronal, and axial planes by 3 independent observers who performed multiple measurements. Intraobserver and interobserver reliabilities were assessed with the Pearson or Spearman correlation and the intraclass correlation coefficient (ICC), respectively. Measurements were compared using paired Student t tests or Wilcoxon rank-sum tests. P0.05 was considered significant.We found that overall the measurements had substantial intraobserver and interobserver reliability on both the NWB images (mean ICC, 0.80; range, 0.49 to 0.99) and the WB images (mean ICC, 0.81; range, 0.39 to 0.99). Eighteen of 19 measurements differed between WB and NWB cone-beam CT images, with more pronounced deformities on the WB images. The most reliable measurements, based on intraobserver and interobserver reliabilities and the difference between WB and NWB images, were the medial cuneiform-to-floor distance, which averaged 29 mm (95% confidence interval [CI] = 28 to 31 mm) on the NWB images and 18 mm (95% CI = 17 to 19 mm) on the WB images, and the forefoot arch angle (mean, 13° [95% CI = 12° to 15°] and 3.0° [95% CI = 1.4° to 4.6°], respectively) in the coronal view and the cuboid-to-floor distance (mean, 22 mm [95% CI = 21 to 23 mm] and 17 mm [95% CI = 16 to 18 mm], respectively) and the navicular-to-floor distance (mean, 38 mm [95% CI = 36 to 40 mm] and 23 mm [95% CI = 22 to 25 mm], respectively) in the sagittal view.Measurements analogous to traditional radiographic parameters of adult acquired flatfoot deformity are obtainable using high-resolution cone-beam CT. Compared with NWB images, WB images better demonstrated the severity of osseous derangement in patients with flexible adult acquired flatfoot deformity.Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

The aims of this study were to identify risk factors for the recurrence of hallux valgus deformity and to clarify whether recurrence after surgery to treat hallux valgus can be predicted using radiographic parameters assessed on immediate postoperative non-weight-bearing radiographs.A proximal chevron osteotomy combined with a distal soft-tissue procedure was performed by a single surgeon to treat moderate to severe hallux valgus deformity in 93 patients (117 feet). The feet were grouped according to nonrecurrence or recurrence. Changes in the hallux valgus angle, the intermetatarsal angle, and sesamoid position over time were analyzed by comparing values measured during each postoperative period. The relative risks of recurrence as indicated by preoperative and postoperative radiographic parameters were determined.Twenty (17.1%) of the 117 feet showed hallux valgus recurrence at the time of the last follow-up. The hallux valgus angle and the intermetatarsal angle stabilized at 6 months after surgery in the nonrecurrence group. An immediate postoperative hallux valgus angle of ≥8°, an immediate postoperative sesamoid position of grade 4 or greater, a preoperative metatarsus adductus angle of ≥23°, and a preoperative hallux valgus angle of ≥40° were significantly associated with recurrence.Recurrence of hallux valgus after a proximal chevron osteotomy can be reliably predicted from immediate postoperative non-weight-bearing radiographs.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Research in myoelectric pattern recognition (MPR) for the prediction of motor volition has primarily focused on the upper limbs. Recent studies in the lower limbs have mainly concentrated on prosthetic control, while MPR for lower limb rehabilitation purposes has received little attention. In this work we investigated the viability of a MPR system for the prediction of four degrees of freedom controlled in a near natural or physiologically appropriate fashion. We explored three different electrode configurations for acquiring electromyographic (EMG) signals: two targeted (bipolar and monopolar) and one untargeted (electrodes equally spaced axially). The targeted monopolar configuration yielded overall lower signal-to-noise ratios (SNR) but similar accuracy than those of the targeted bipolar configuration. The targeted bipolar and untargeted monopolar configurations were comparable in terms of SNR and offline accuracy when the same number of channels was used. However, the untargeted configuration tested with twice the channels yielded the best results in terms of accuracy. An advantage of the untargeted configuration is that it offers a simpler and more practical electrode placement. This work is the first step in our long-term goal of implementing a phantom limb pain (PLP) treatment for lower limb amputees based on MPR and augmented/virtual reality.

Avascular necrosis of the talus after severe ankle injury is well known. Avascular necrosis of talus is extremely rare in juveniles. However, it has been controversial whether the incidence of AVN after fracture of talus is higher in adult than in juveniles. It is possible that the immature talus can be more susceptible to circulatory. As treatment of avascular necrosis of the talus, non-operative treatment could be considered in juveniles. Prolonged non weight bearing might not be necessary for avascular necrosis of the talus.

To correctly assess abnormalities within the foot, reliable and accurate measurements are necessary for clinicians to prescribe foot orthoses that effectively manage malalignment (Elveru et al., 20...

Phantom motor execution (PME), facilitated by myoelectric pattern recognition (MPR) and virtual reality (VR), is positioned to be a viable option to treat phantom limb pain (PLP). A recent clinical trial using PME on upper-limb amputees with chronic intractable PLP yielded promising results. However, further work in the area of signal acquisition is needed if such technology is to be used on subjects with lower-limb amputation. We propose two alternative electrode configurations to conventional, bipolar, targeted recordings for acquiring surface electromyography. We evaluated their performance in a real-time MPR task for non-weight-bearing, lower-limb movements. We found that monopolar recordings using a circumferential electrode of conductive fabric, performed similarly to classical bipolar recordings, but were easier to use in a clinical setting. In addition, we present the first case study of a lower-limb amputee with chronic, intractable PLP treated with PME. The patient’s Pain Rating Index dropped by 22 points (from 32 to 10, 68%) after 23 PME sessions. These results represent a methodological advancement and a positive proof-of-concept of PME in lower limbs. Further work remains to be conducted for a high-evidence level clinical validation of PME as a treatment of PLP in lower-limb amputees.

Transient synovitis, septic hip, and Legg-Calve-Perthes disease are common conditions in children. Distinguishing between these disorders can be a diagnostic challenge. Similar presentations, in an age group difficult to examine, coupled with literature that is confusing creates difficulty. It is important to make the correct diagnosis of septic hip in a timely fashion to avoid serious and potentially crippling consequences. As there is no single test for discriminating between these conditions, knowledge of the nuances of clinical presentation, physical examination, laboratory investigations, and imaging is essential. Judicious use of clinical algorithms can complement clinical acumen.

Background Improving activity and strength of the gluteus medius muscle is a common goal among clinicians aiming to rehabilitate lower extremity and low back injuries. The functional anatomy of the hip is complex, particularly how position-dependent the activity and strength of many muscles surrounding the hip are, and the optimal exercise technique to isolate gluteus medius remains controversial. The objective of this study was to quantify the effect of altering hip orientation during side-lying clamshell and hip abduction exercises on the relative muscle activation profiles of gluteus medius and tensor fascae latae. Methods The ratio of gluteus-medius-to-tensor-fascae-latae peak electromyography signal amplitude of 13 healthy, male participants was compared across variations of the clamshell and abduction exercises. The hip flexion angle was varied from 30°, 45°, and 60° for the clamshell, while hip rotation orientation was varied from internal, neutral, and external rotation for the abduction exercise. Findings Varying hip angle – flexion in the clamshell exercise and internal/external rotation in the abduction exercise – did not significantly affect the interplay between gluteus medius and tensor fascae latae activation levels. Both exercises remained gluteus medius-dominant across all variations, but the gluteus-medius-to-tensor-fascae-latae ratio was far greater for the clamshell than for the abduction exercise; the clamshell may be the preferred rehabilitative exercise to prescribe when minimal tensor fascae latae muscle activation is desired by the clinician. Interpretation These findings provide information for clinical decision-making pertaining to effective gluteus medius activation in lower extremity and low back exercise rehabilitation programs.