Current Issue : October - December Volume : 2013 Issue Number : 4 Articles : 4 Articles
Purpose: Describe the evolution of the reconstruction of meniscal rim with semitendinosus tendon in a patient\r\nwith knee pain after a subtotal meniscectomy and absence of meniscal wall.\r\nMethod: 32 years old male with a six-month history of the left knee pain after a subtotal meniscectomy. The MRI\r\nindicated a small internal meniscal remainder without posterior horn attachment. Taking this absence as a relative\r\ncontraindication for implant and meniscal transplantation, the reconstruction of a new meniscal wall with semitendinosus\r\ntendon autograft was considered. A collagen meniscal implant was attached to the new wall five months later.\r\nResults: After two years the patient referred only non specific discomfort with full pain relief in the medial compartment.\r\nThe MRI revealed integration of implants without significant degenerative changes compared to previous images.\r\nConclusions: This staged technique was designed to restore medial meniscus-like biologic tissue in a symptomatic\r\npatient following arthroscopic subtotal meniscectomy with a significant loss of the peripheral meniscus rim. Symptomatic\r\nimprovement was obtained at two years follow-up....
The Paralympic Games are the pinnacle of sport for many athletes with a disability. A potential issue for many\r\nwheelchair athletes is how to train hard to maximise performance while also reducing the risk of injuries,\r\nparticularly to the shoulder due to the accumulation of stress placed on this joint during activities of daily living,\r\ntraining and competition. The overall purpose of this narrative review was to use the constraints-led approach of\r\ndynamical systems theory to examine how various constraints acting upon the wheelchair-user interface may alter\r\nhand rim wheelchair performance during sporting activities, and to a lesser extent, their injury risk. As we found no\r\nstudies involving Paralympic athletes that have directly utilised the dynamical systems approach to interpret their\r\ndata, we have used this approach to select some potential constraints and discussed how they may alter\r\nwheelchair performance and/or injury risk. Organism constraints examined included player classifications,\r\nwheelchair setup, training and intrinsic injury risk factors. Task constraints examined the influence of velocity and\r\ntypes of locomotion (court sports vs racing) in wheelchair propulsion, while environmental constraints focused on\r\nforces that tend to oppose motion such as friction and surface inclination. Finally, the ecological validity of the\r\nresearch studies assessing wheelchair propulsion was critiqued prior to recommendations for practice and future\r\nresearch being given....
Background: Total knee arthroplasty (TKA) is an effective procedure. However, for some patients, the outcomes are\r\nnot satisfactory. Identification of TKA determinants could help manage these patients more efficiently. The purpose\r\nof this study was to identify pre- and perioperative determinants of pain, functional limitations and health-related\r\nquality of life (HRQoL) 6 months after TKA.\r\nMethods: 138 participants were recruited from 3 hospitals in Quebec City, Canada and followed up until 6 months\r\nafter surgery. Data were collected through review of the subjects� medical files and structured telephone interviews\r\nbefore and 6 months after TKA. Pain and functional limitations were measured with the Western Ontario and\r\nMcMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the SF-36 Health Survey. Independent\r\nvariables included demographic, socioeconomic, psychosocial, clinical and surgical characteristics of participants as\r\nwell as data on health services utilization. Stepwise multiple regression analysis was used to assess the strength of\r\nthe associations between the independent variables and the WOMAC and SF-36 scores.\r\nResults: Higher preoperative pain, cruciate retaining implants and the number of complications were significantly\r\nassociated with worse pain 6 months after TKA (p < 0.05) and explained 11% of the variance of the WOMAC pain\r\nscore. Higher preoperative functional limitations, being single, separated, divorced or widowed, being unemployed\r\nor retired and the number of complications were significantly associated (p < 0.05) with worse functional limitations\r\n6 months after TKA and explained 16% of the variance of the WOMAC function score. Lower preoperative HRQoL,\r\ncontralateral knee pain, higher psychological distress and comorbidities were significantly associated (p < 0.05) with\r\nworse HRQoL 6 months after TKA and explained 23% of the variance of the SF-36 physical functioning score.\r\nConclusions: Several variables were found to be significantly associated with worse outcomes 6 months after TKA\r\nand may help identify patients at risk of poorer outcome. The identification of these determinants could help\r\nmanage patients more efficiently and may help target patients who may benefit from extensive rehabilitation....
Background: The purpose of this study was to evaluate the influence of image-free computer-assisted navigation\r\nsystem update on outcome in total knee arthroplasty.\r\nMethods: Thirty-three knees were replaced using the Stryker 3.1 image-free navigation system and 49 knees were\r\nreplaced using the Stryker 4.0 system. One surgeon took part in all procedures as chief surgeon or first assistant. All\r\npatients received the Stryker Scopio NRG CR total knee prosthesis. We compared the accuracy of component\r\npositioning measured using radiographs and CT scans, operating time and clinical outcome 1 year after surgery.\r\nResults: The mean hip-knee-ankle, frontal femoral and tibial component angle were 179.8�° (ideally implanted 85%),\r\n89.8�° (88%), 90.4�° (88%) respectively for the 3.1 group and 179.5�° (96%), 90.6�° (92%), 90.2�° (94%) for the 4.0 group.\r\nThe mean sagittal tibial component angle was 85.5�° (82%) for the 3.1 group and 85.6�° (92%) for the 4.0 group. The\r\nmean rotational femoral and tibial component angle were -0.5�° (81%), -0.7�° (73%) for the 3.1 group and 0.0�° (84%),\r\n0.4�° (72%) for the 4.0 group. There were no statistically significant findings with regard to component positioning.\r\nOperating time was significantly longer in the 3.1 group (3.1 group: 137 min, 4.1group: 125 min, P < 0.01).\r\nNo significant difference was detected in postoperative clinical outcome.\r\nConclusion: The navigation system update from Stryker 3.1 to Stryker 4.0 reduced operating time by 12 min.\r\nHowever, there were no statistically significant findings with regard to component positioning and clinical\r\noutcome....
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