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Supervised Physiotherapy Improves Three-Dimensional (3D) Gait Parameters in Patients after Surgical Suturing of the Achilles Tendon Using an Open Method (SSATOM). J Clin Med 2022; 11:jcm11123335. [PMID: 35743407 PMCID: PMC9225029 DOI: 10.3390/jcm11123335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the effectiveness of 38 supervised postoperative physiotherapy (SVPh) visits conducted between 1 and 20 weeks after SSATOM on the values of 3D gait parameters measured at 10 and 20 weeks after surgery. MATERIAL Group I comprised male patients (n = 22) after SSATOM (SVPh x = 38 visits) and Group II comprised male patients (n = 22) from the control group. METHODS A non-randomized, open-label, controlled clinical trial was performed in the two groups to obtain the following values: Step length (cm), stride length (cm), step width (cm), next stance phase (%), swing phase (%), double support (%), gait velocity (m/s), and walking frequency (step/min). The measurements were carried out using the BTS SMART system (Italy). RESULTS Orthopedic examination showed no pain, a negative result of Thompson and Matles tests, and proper healing of Achilles tendon (ultrasound image). In Group I, between 10 and 20 weeks after SSATOM, there was a statistically significant improvement in all tested gait parameter values (p ≤ 0.001 to 0.009). CONCLUSIONS Conducting 38 SVPh visits significantly improved the values of the analyzed kinematic and spatiotemporal gait parameters in patients in the twentieth week after SSATOM, which were mostly close to the non-operated side and the results of the control group. However, the gait speed and stride length were not close to the results of the control group.
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Szwedowski D, Paczesny Ł, Zabrzyński J, Gagat M, Domżalski M, Huri G, Widuchowski W. The Comparison of Clinical Result between Primary Repair of the Anterior Cruciate Ligament with Additional Internal Bracing and Anatomic Single Bundle Reconstruction-A Retrospective Study. J Clin Med 2021; 10:jcm10173948. [PMID: 34501400 PMCID: PMC8432121 DOI: 10.3390/jcm10173948] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/30/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The current standard of treatment of anterior cruciate ligament (ACL) is reconstruction (ACLR). This technique has some disadvantages: poor proprioception, donor site morbidity and the inability to restore joint kinematics. ACL repair could be an alternative treatment. The purpose of the study was to compare the stability and the function after ACL primary repair versus single-bundle ACLR. METHODS In a retrospective study, 12 patients underwent primary ACL repair with internal bracing, 15 patients underwent standard ACLR. Follow-up examinations were evaluated at up to 2 years postoperatively. One patient in the ACL repair group was lost to follow-up due to re-rupture. The absolute value of anterior tibial translation (ATT) and the side-to-side difference in the same patient (ΔATT) were evaluated using the GNRB arthrometer. The Lysholm knee scoring was obtained. Re-ruptures and other complications were recorded. RESULTS Anterior tibial translation (ATT) was significantly decreased in the ACL repair group compared with the ACLR group (5.31 mm vs. 7.18 mm, respectively; p = 0.0137). Arthrometric measurements demonstrated a mean side-to-side difference (ΔATT) 1.87 (range 0.2 to 4.9) mm significantly decreased compared to ACLR 3.36 (range 1.2-5.6 mm; p = 0.0107). The mean Lysholm score was 85.3 points in the ACL repair group and 89.9 in ACLR group. No significant differences between ACL repair and ACLR were found for the Lysholm score. There was no association between AP laxity and clinical outcomes. There were two complications in the internal bracing group: one patient had re-rupture and was treated by ACLR, another had limited extension and had arthroscopic debridement. CONCLUSIONS Anterior tibial translation was significantly decreased after ACL repair. Additionally, the functional results after ACL repair with internal bracing were comparable with those after ACLR. It should be noted that the two complications occurred. The current study supports further development of ACL repair techniques.
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Affiliation(s)
- Dawid Szwedowski
- Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, 20133 Milan, Italy
- Correspondence:
| | - Łukasz Paczesny
- Citomed Healthcare Center, Department of Orthopaedics, Orvit Clinic, Sklodowskiej 73, 87-100 Toruń, Poland; (Ł.P.); (J.Z.)
| | - Jan Zabrzyński
- Citomed Healthcare Center, Department of Orthopaedics, Orvit Clinic, Sklodowskiej 73, 87-100 Toruń, Poland; (Ł.P.); (J.Z.)
- Department of General Orthopedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-701 Poznan, Poland
| | - Maciej Gagat
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-067 Bydgoszcz, Poland;
| | - Marcin Domżalski
- Department of Orthopedic and Traumatology, Veterans Memorial Hospital, Medical University of Lodz, 90-549 Lodz, Poland;
| | - Gazi Huri
- Orthopaedics and Traumatology Department, Hacettepe Universitesi, Ankara 06100, Turkey;
| | - Wojciech Widuchowski
- Department of the Knee Surgery, Arthroscopy and Sports Traumatology, District Hospital of Orthopedics and Trauma Surgery, 41-940 Piekary Slaskie, Poland;
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Gait Symmetry Analysis in Patients after Treatment of Pilon Fractures by the Ilizarov Method. Symmetry (Basel) 2021. [DOI: 10.3390/sym13020349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to comprehensively assess the gait parameters in patients who had undergone treatment of pilon fractures by the Ilizarov method. We analyzed gait parameters in patients who had undergone treatment for pilon fractures by the Ilizarov method; 20 patients aged 47.0 years (25.2–78.6) were included in the study. The control group consisted of 32 healthy volunteers. Gait examination was performed using the pedobarographic platform. Statistically significant differences in the following gait parameters: maximum forefoot force (%), step length (cm), and step time (s) were found between the study group and the control group, between the nonoperated leg, and both the operated leg and the dominant limb. Statistically significant differences in the study group between the treated lower limb and the healthy lower limb were only observed in the case of the maximum forefoot force parameter (%). Healthy subjects from the control group obtained significantly higher values during locomotion for stride time, cadence step, and velocity than the patients, with stride time being statistically significantly shorter and the velocity and the cadence step higher. We observed symmetry in the gait parameters after treating pilon fractures by the Ilizarov method. This method of stabilization allows the restoration of gait parameters, with results similar to those obtained after the treatment of other motor organ pathologies described in the literature, although different from those observed in healthy subjects. In particular, the biomechanics of the lower limbs remain disturbed.
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Millar LJ, Meng L, Rowe PJ. Routine clinical motion analysis: comparison of a bespoke real-time protocol to current clinical methods. Comput Methods Biomech Biomed Engin 2018; 22:149-158. [DOI: 10.1080/10255842.2018.1541089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lindsay Jane Millar
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Lin Meng
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Philip John Rowe
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Iliopoulos E, Galanis N, Zafeiridis A, Iosifidis M, Papadopoulos P, Potoupnis M, Geladas N, Vrabas IS, Kirkos J. Anatomic single-bundle anterior cruciate ligament reconstruction improves walking economy: hamstrings tendon versus patellar tendon grafts. Knee Surg Sports Traumatol Arthrosc 2017; 25:3155-3162. [PMID: 27371291 DOI: 10.1007/s00167-016-4229-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/22/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injury is associated with a pathologic gait pattern and increased energy cost during locomotion. ACL reconstruction could improve the gait pattern. Hamstrings tendon (HAM) and bone-patellar tendon-bone (BPTB) grafts are usually used for reconstruction. The aim of this study was to compare the efficacy of anatomic ACL reconstruction with HAM and BPTB grafts on improving and normalizing the energy cost and physiologic reserves during flat, uphill, and downhill walking. METHODS Twenty male subjects with unilateral ACL injuries were randomly assigned to ACL reconstruction with a HAM (n = 10) or BPTB (n = 10) graft. Ten matched controls were also enrolled. All participants performed three 8-min walking tasks at 0, +10, and -10 % gradients before and 9 months after surgery. Energy cost (oxygen consumption, VO2), heart rate (HR), and ventilation (VE) were measured. Lysholm/IKDC scores were recorded. RESULTS Pre-operatively, VO2, HR, and VE were higher in the HAM and BPTB groups than in controls during walking at 0, +10, and -10 % gradients (p < 0.001-0.01). Post-operatively, both HAM and BPTB groups showed reduced VO2, HR, and VE during the three walking tasks (p < 0.001-0.01). Although the post-operative VO2 in both surgical groups reached 90-95 % of the normative (control) value during walking, it remained elevated against the value observed in controls (p < 0.001-0.01). The HAM and BPTB groups showed no differences in post-surgical VO2 or HR during walking at all three gradients. CONCLUSION Anatomic ACL reconstruction with either HAM or BPTB graft resulted in similar short-term improvements in energy cost and nearly normalized locomotion economy and cardiorespiratory reserves during flat, uphill, and downhill walking. The improved locomotion economy is an additional benefit of anatomic ACL reconstruction, irrespective of the type of graft used, that the orthopaedic surgeons should consider. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Efthymios Iliopoulos
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, 56403, Thessaloniki, Greece
| | - Nikiforos Galanis
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, 56403, Thessaloniki, Greece.
| | - Andreas Zafeiridis
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Michael Iosifidis
- Sports Medicine Unit, 2nd Orthopaedic Department, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Pericles Papadopoulos
- 1st Department of Orthopaedics, Papanikolaou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Potoupnis
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, 56403, Thessaloniki, Greece
| | - Nikolaos Geladas
- Department of Sport Medicine and Biology of Exercise, School of Physical Education and Sport Science, University of Athens, Athens, Greece
| | - Ioannis S Vrabas
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - John Kirkos
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, 56403, Thessaloniki, Greece
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Abstract
Anterior cruciate ligament (ACL) reconstruction aims to restore the translational and rotational motion to the knee joint that is lost after injury. However, despite technical advancements, clinical outcomes are less than ideal, particularly in return to previous activity level. A major issue is the inability to standardize treatment protocols due to variations in materials and approaches used to accomplish ACL reconstruction. These include surgical techniques such as the transtibial and anteromedial portal methods that are currently under use and the wide availability of graft types that will be used to reconstruct the ACL. In addition, concomitant soft tissue injuries to the menisci and capsule are frequently present after ACL injury and, if left unaddressed, can lead to persistent instability even after the ACL has been reconstructed. Advances in the field of biomechanics that help to objectively measure motion of the knee joint may provide more precise data than current subjective clinical measurements. These technologies include extra-articular motion capture systems that measure the movement of the tibia in relation to the femur. With data gathered from these devices, a threshold for satisfactory knee stability may be established in order to correctly identify a successful reconstruction following ACL injury.
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Movement Patterns of the Knee During Gait Following ACL Reconstruction: A Systematic Review and Meta-Analysis. Sports Med 2016; 46:1869-1895. [DOI: 10.1007/s40279-016-0510-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Czamara A, Markowska I, Hagner-Derengowska M. Three-dimensional kinematic analysis of ankle, knee, hip, and pelvic rotation during gait in patients after anterior cruciate ligament reconstruction - early results. BMC Musculoskelet Disord 2015; 16:266. [PMID: 26416119 PMCID: PMC4587403 DOI: 10.1186/s12891-015-0726-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 09/18/2015] [Indexed: 11/21/2022] Open
Abstract
Background The goal of this study was to biomechanically assess tibial rotation in the knee joint simultaneous changes in rotation of large joints of the lower limbs and pelvis during gait in patients during early postoperative stages following anterior cruciate ligament (ACLR) reconstruction. We hypothesized that tibial rotation is associated with changes in rotation of the large joints of the lower limbs and the pelvis during gait in patients after ACLR reconstruction. Methods The patients were divided into two groups. The ACLR group (n = 32 males) underwent primary ACLR in one leg and postoperative physiotherapy. The control group (n = 30 males) had no knee injuries. After clinical assessment in both groups, the values of kinematic parameters of foot, tibial, femoral, and pelvic rotation were measured during gait on a flat surface using the three-dimensional BTS Smart System. In the ACLR group, measurements were taken during the 4th, 9th, and 14th weeks of postoperative physiotherapy. The results of the ACLR group were compared with those of the control group. Results During gait, between the 9th and 14th weeks following ACLR, there are normal values of foot, tibia, and pelvic rotation in the operated legs compared with results obtained from un-operated legs and the control group. Discussion Analysis of rotations occurring only in knee joints does not reflect all of the multiarticular disorders of gait kinematics. The study also suggests that analyzing tibial rotation in the knee joint with simultaneous changes in rotation in large joints of the lower limbs provides better opportunities than singular analysis of rotation in the knee joint for the assessment of disorders in gait kinematics. Conclusions In gait, at the maximal extension of the knee during preparation for the stance phase, external hip rotation patterns have not been fully restored 14 weeks after ACLR.
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Affiliation(s)
- Andrzej Czamara
- The College of Physiotherapy in Wroclaw, ul. Kościuszki 4, 50-038, Wroclaw, Poland. .,The Center of Rehabilitation and Medical Education, ul. Kościuszki 4, 50-038, Wroclaw, Poland.
| | - Iga Markowska
- The College of Physiotherapy in Wroclaw, ul. Kościuszki 4, 50-038, Wroclaw, Poland. .,The Center of Rehabilitation and Medical Education, ul. Kościuszki 4, 50-038, Wroclaw, Poland.
| | - Magdalena Hagner-Derengowska
- The Chair and Department of Clinical Neuropsychology, Collegium Medicum, The Nicolaus Copernicus University in Torun, ul. Jagiellonska 15, 85-067, Bydgoszcz, Poland. .,The University in Bydgoszcz, ul. Jana Karola Chodkiewicza 30, 85-064, Bydgoszcz, Poland.
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