Effect of heat and cold on tendon flexibility and force to flex the human knee

Intraday Variation of Ankle Dorsiflexion in Short-Track Speed Skaters

PURPOSE

Optimal ankle dorsiflexion range of motion plays a vital role in attaining the essential crouched posture necessary for excelling in speed skating. The purpose of this study was to determine how the ankle dorsiflexion angle evolves throughout a day of training and to identify the factors that influence this angle.

METHODS

Thirty short-track speed skaters, from 2 teams, participated in this study. The maximum ankle dorsiflexion angle was obtained in a lunge position facing a wall, using a digital inclinometer. All measures were obtained 3 times per side, 6 times per day, on 2 training days separated by at least a week. We conducted multiple tests to study the impact of repetition, day, side, team level, sex, and moment on the ankle dorsiflexion angle.

RESULTS

The 3 times repeated measures and the 2 days of training did not have a significant influence on the results. There was a statistically significant difference between the first time point of the day and the 5 other time points for both ankles. Moreover, the influence of sex and team level was not statistically significant.

CONCLUSIONS

The results indicate that there are significant changes in ankle dorsiflexion range of motion but only after the first warm-up of the day. Such findings could enable team staff to enhance athletes' precompetition preparation and tailor ankle mobility training regimens more effectively.

Kirigami-enabled stretchable laser-induced graphene heaters for wearable thermotherapy

Flexible and stretchable heaters are increasingly recognized for their great potential in wearable thermotherapy to treat muscle spasms, joint injuries and arthritis. However, issues like lengthy processing, high fabrication cost, and toxic chemical involvement are obstacles on the way to popularize stretchable heaters for medical use. Herein, using a single-step customizable laser fabrication method, we put forward the design of cost-effective wearable laser-induced graphene (LIG) heaters with kirigami patterns, which offer multimodal stretchability and conformal fit to the skin around the human body. First, we develop the manufacturing process of the LIG heaters with three different kirigami patterns enabling reliable stretchability by out-of-plane buckling. Then, by adjusting the laser parameters, we confirm that the LIG produced by medium laser power could maintain a balance between mechanical strength and electrical conductivity. By optimizing cutting-spacing ratios through experimental measurements of stress, resistance and temperature profiles, as well as finite element analysis (FEA), we determine that a larger cutting-spacing ratio within the machining precision will lead to better mechanical, electrical and heating performance. The optimized stretchable heater in this paper could bear significant unidirectional strain over 100% or multidirectional strain over 20% without major loss in conductivity and heating performance. On-body tests and fatigue tests also proved great robustness in practical scenarios. With the advantage of safe usage, simple and customizable fabrication, easy bonding with skin, and multidirectional stretchability, the on-skin heaters are promising to substitute the traditional heating packs/wraps for thermotherapy.

Potential role of physical labor and cultural views of menstruation in high incidence of pelvic organ prolapse in Nepalese women: a comparative study across the menstrual cycle

Introduction

Pelvic organ prolapse (POP) is a significant health concern for young Nepali women, with potential risk factors including pelvic floor trauma from vaginal delivery and heavy lifting. The prevalence of symptomatic POP (SPOP) among nulliparous women in Nepal is 6%, while the general population of Nepali women aged 15-49 years reports a prevalence of 7%. Surprisingly, the average age of SPOP onset in Nepal is 27 years, challenging the assumption that postmenopausal age and vaginal delivery are the sole risk factors. This study aims to investigate the influence of increased intra-abdominal pressure (IAP) during lifting tasks on pelvic organ descent in Nepali women across different menstrual cycle stages.

Methods

The study included 22 asymptomatic Nepali women aged 18-30 years who regularly engage in heavy lifting. Intra-abdominal pressure was measured intra-vaginally during typical and simulated lifting tasks, which encompassed various scenarios such as ballistic lifting, ramped lifting, and pre-contraction of pelvic floor muscles, as well as coughing, Valsalva maneuver, and pelvic floor contractions. Pelvic floor displacement was recorded using transperineal ultrasound during menstruation, ovulation, and the mid-luteal phase.

Results

Results indicated that pelvic floor displacement was greater during menstruation than ovulation when performing a simulated ballistic lifting task (6.0 ± 1.6 mm vs. 5.1 ± 1.5 mm, p = 0.03, d = 0.6). However, there was no significant difference in pelvic floor displacement during lifting when the pelvic muscles were pre-contracted.

Conclusion

These findings suggest that lifting heavy loads during menstruation may increase the risk of stretching and injuring pelvic floor supportive tissues, potentially contributing to SPOP in young Nepali women. Pre-contracting pelvic floor muscles during lifting tasks may offer a protective effect. Understanding these factors could aid in developing targeted preventive measures and raising awareness about the impact of heavy lifting on pelvic floor health among Nepali women.

The Influence of Weather Conditions on the Diurnal Variation in Range of Motion in Older Adults with Knee Osteoarthritis

(1) Background: This study investigated the relationship between weather conditions, diurnal patterns, and total knee range of motion (ROM), as well as the severity of symptoms (pain and stiffness) in older adults with knee osteoarthritis. (2) Methods: An exploratory longitudinal study was conducted on 28 older adults with knee osteoarthritis (mean age 71.86 ± 4.49 years; 46.4% men, 53.6% women). We used as assessment tools the Visual Analog Scales (VAS) for self-reported local knee pain and stiffness, and goniometry for ROM. Measurements were taken twice, six months apart, in winter and summer, in the morning and evening of each selected day. Recorded weather factors comprised temperature, relative humidity, barometric pressure, and maximum wind speed. (3) Results: The study revealed significant effects of season and time of day on pain and stiffness, respectively (p < 0.001). Additionally, a significant interaction between season and time influenced total knee ROM (p < 0.001). Moreover, there was a statistically significant relationship between time and total knee ROM (p < 0.001). (4) Conclusions: This research underscores the complex link between seasonal fluctuations and daily variations in some symptomatic and functional aspects of knee osteoarthritis in older adults.

Motor symptoms of Parkinson's disease are affected by temperature: A controlled pilot study

PURPOSE

The motor symptoms (MS) of Parkinson's disease (PD) have been affecting the quality of life in patients. In clinical practice, most patients with PD report that MS are more severe in winter than in summer, and hyperthermic baths (HTB) could temporarily improve MS. The study aimed to evaluate the effects of seasonal variation and aquatic thermal environment of HTB on the MS of PD.

PATIENTS AND METHODS

A cross-sectional study of 203 Chinese Han patients was performed. Univariate and multivariate analyses were performed to analyze seasonal variation in MS relative to baseline data (sex, age at onset, duration, season of birth, Hoehn and Yahr stage, family history, levodopa equivalent dose, and the effect of HTB on MS). Ten subjects participated in the HTB study, and one patient dropped out. The paired Wilcoxon rank test was used to assess the differences in the Movement Disorder Society-United Parkinson's disease Rating Scale (MDS-UPDRS) part III motor examination total scores and the modified Webster Symptoms Score between non-HTB and before HTB and between non-HTB and after HTB.

RESULTS

The improvement of MS after HTB was an independent risk factor for seasonal variation in MS (OR, 25.203; 95% CI, 10.951-58.006; p = .000). Patients with PD had significant improvements in the MDS-UPDRS part III motor examination total scores, especially in bradykinesia (p = .043), rigidity (p = .008), posture (p = .038), and rest tremor amplitude (p = .047).

CONCLUSION

Seasonal variation in temperature and water temperature of HTB may affect MS in some patients with PD. Simple HTB could be recommended as physiotherapy for patients with PD who report temperature-sensitive MS.

Metal-Like Stretchable Nanocomposite Using Locally-Bundled Nanowires for Skin-Mountable Devices

Stretchable conductive nanocomposites have been intensively studied for wearable bioelectronics. However, development of nanocomposites that simultaneously feature metal-like conductivity(> 100 000 S cm-1 ) and high stretchability (> 100%) for high-performance skin-mountable devices is still extremely challenging. Here a material strategy for such a nanocomposite is presented by using local bundling of silver nanowires stabilized with dual ligands (i.e., 1-propanethiols and 1-decanethiols). When the nanocomposite is solidified via solvent evaporation under a highly humid condition, the nanowires in the organic solution are bundled and stabilized. The resulting locally-bundled nanowires lower contact resistance while maintain their percolation network, leading to high conductivity. Dual ligands of 1-propanethiol and 1-decanethiol further boost up the conductivity. As a result, a nanocomposite with both high conductivity of ≈122,120 S cm-1 and high stretchability of ≈200% is obtained. Such superb electrical and mechanical properties are critical for various applications in skin-like electronics, and herein, a wearable thermo-stimulation device is demonstrated.

Effects of wearable therapies on jump performance in sport horses

Introduction

Failure to properly prepare the equine athlete for exercise and support post-exercise recovery is a contributing factor to physical breakdown and lameness. Equine physiotherapy was not introduced until the early twentieth century and has since evolved to allow for wearable therapies such as therapeutic boots to be accessible to a broad spectrum of equestrians. The purpose of this study was to evaluate the effects of ceramic boots, boots combining vibration and cryotherapy, and boots containing tourmaline on the performance of sport horses during jumping as well as to examine changes in vital signs in response to treatment.

Methods

Eight healthy horses received the 3 therapeutic boot treatments or a control (no boot) in a Latin square experiment for a period of 5 days each. Horses performed approximately 10 min of exercise through a jump chute for the 5 consecutive days and jump performance parameters were recorded during each exercise session. Therapeutics were applied in the morning prior to exercise per the manufacturer's recommendation and were removed only for exercise.

Results and Discussion

In a Bayesian network analysis, changes in vital signs (heart rate, respiration, and temperature) were driven by individual animal, rather than boot treatment. Jump performance was influenced by boot treatment, physiological measurements, and individual animal. Therapeutic boots were associated with changes in conditional probabilities of numerous performance outcomes. This study indicates the use of wearable therapies may result in improved performance outcomes of sport horses in jumping exercises.

Stretchable and Skin-Attachable Electronic Device for Remotely Controlled Wearable Cancer Therapy

Surgery represents a primary clinical treatment of solid tumors. The high risk of local relapse typically requires frequent hospital visits for postoperative adjuvant therapy. Here, device designs and system integration of a stretchable electronic device for wearable cancer treatment are presented. The soft electronic patch harnesses compliant materials to achieve conformal and stable attachment to the surgical wound. A composite nanotextile dressing is laminated to the electronic patch to allow the on-demand release of anticancer drugs under electro-thermal actuation. An additional flexible circuit and a compact battery complete an untethered wearable system to execute remote therapeutic commands from a smartphone. The successful implementation of combined chemothermotherapy to inhibit tumor recurrence demonstrates the promising potential of stretchable electronics for advanced wearable therapies without interfering with daily activities.

Relationship of Healthy Building Determinants With Musculoskeletal Disorders of the Extremities: A Systematic Review

Musculoskeletal disorders (MSDs) are a substantial societal burden and various factors affect their causation, recovery, and prognosis. Management of MSDs is complex and requires multifaceted interventions. Given the challenges of MSDs and their continued burden, it is possible that additional elements could impact these disorders that have not been fully researched, for example, indoor environmental quality. Our previous review provided preliminary evidence that healthy building determinants (HBDs) are associated with the risk of back and neck pain. However, the relationship of HBDs with extremity MSDs and general MSDs (i.e., MSDs involving multiple body regions or in which body regions were unspecified in the original reports) has not been formally studied. The purpose of this review was to conduct a systematic literature review to assess the relationship of HBDs with extremity and general MSDs (PROSPERO ID: CRD42022314832). PubMed, CINAHL, Embase, and PEDRo databases were searched through April 2022. Inclusion criteria for study eligibility were as follows: humans of ages ≥18 years, reported on one or more of eight HBDs (1. air quality and ventilation, 2. dust and pests, 3. lighting and views, 4. moisture, 5. noise, 6. safety and security, 7. thermal health, 8. water quality), and compared these HBDs with extremity MSDs or general MSDs, original research, English. Exclusion criteria were as follows: articles not published in peer-reviewed journals, full-text articles unavailable. Review procedures were conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Empirical evidence statements were developed for 33 pairwise comparisons of HBDs with MSDs. The search uncovered 53 eligible studies with 178,532 participants. A total of 74.6% (39/53) of the studies were cross-sectional and 81.1% (43/53) were fair quality. Overall, the majority of uncovered evidence indicates that HBDs are related to risk of extremity and general MSDs. Nineteen comparisons support that as HBDs worsen, the risk of MSDs increases. Six comparisons had conflicting evidence. Three comparisons support that poor HBDs are not related to increased risk of extremity and general MSDs. Five comparisons had no evidence. This systematic review builds upon previous work to provide useful starting points to enhance awareness about the HBD-MSD relationship. These findings can help inform research and public health efforts aimed at addressing suboptimal HBDs through appropriate interventions to improve the lives of those suffering from MSDs.

The Effectiveness of Whole-Body Vibration and Heat Therapy on the Muscle Strength, Flexibility, and Balance Abilities of Elderly Groups

Whole-body vibration (WBV) is a novel exercise training measure that promotes the muscle strength, flexibility, and balance abilities of elderly groups. The feasibility and applicability of 20-30 min (lowering a heat pack at 73 °C by wrapping it in multiple layers of towels to 40-43 °C before it touched the skin) thermotherapy are increasingly being demonstrated by applications and clinical trials. Studies show that it increases the flexibility of macules and ligament. However, no studies have examined the interactions between the pre-exercise and post-exercise application of heat therapy (duration a training course). Therefore, this study investigates the effects of WBV and heat therapy on the muscle strength, flexibility, and balance abilities of elderly groups. Eighty middle-age and elderly participants with no regular exercise habits were enrolled in this study. They were randomly assigned to a WBV group, a WBV plus heat therapy group, a heat therapy alone group, and a control group. The WBV groups underwent 5-min, fixed-amplitude (4 mm), thrice-weekly WBV training sessions for 3 consecutive months on a WBV training machine. Participants' balance was measured using the limits of stability (LOS) test on a balance system. The pretest and posttest knee extensor and flexor strength were tested using an isokinetic lower extremity dynamometer. Pretest and posttest flexibility changes were measured using the sit-and-reach test. Significantly larger pretest and posttest differences in flexibility and muscle strength were observed in the WBV and WBV plus heat therapy groups. The addition of heat therapy to WBV resulted in the largest flexibility improvements.

Relationship of Healthy Building Determinants With Back and Neck Pain: A Systematic Review

OBJECTIVE

Back pain and neck pain are very common, costly, and disabling. Healthy building determinants within the built environment have not been adequately assessed as contributors to these conditions. The objective of this study was to systematically review the literature on the relationship of healthy building determinants with back and neck pain.

DATA SOURCE

PubMed, CINAHL, EMBASE, Google Scholar, and PEDRo. Study Inclusion and Exclusion Criteria: Studies were included if they met the following criteria: Adults, comparison of healthy building determinants (air quality, ventilation, dust and pests, lighting and views, moisture, noise, safety/security, thermal health, water quality) with back and neck pain, original research, English. Studies were excluded if full text articles were unavailable and if the focus was patient and materials handling or ergonomics.

DATA EXTRACTION

Data extraction and other review procedures were elaborated according to PRISMA guidelines. Data Synthesis: Data were synthesized with an approach adapted from Oxford Centre for Evidence-Based Medicine and American Physical Therapy Association.

RESULTS

37 articles enrolling 46,223 participants were eligible. Most articles were cross-sectional (31/37) and fair quality (28/37). None were interventional. Evidence was found to generally support a relationship indicating that as healthy building determinants worsen, the risk of back and neck pain increases.

CONCLUSION

Although the available evidence precludes interpretations about causality, the study's findings are starting points to guide future research, knowledge creation, and health promotion initiatives about the relationships of the built environment with back and neck pain.

Musculoskeletal Pain Management and Thermotherapy: An Exploratory Analysis of Italian Physicians' Attitude, Beliefs, and Prescribing Habits

Purpose

In Italy, musculoskeletal (MSK) disorders are pervasive with one-third of adults seeking medical consultation for a MSK issue in the past year. MSK pain is often treated with local heat applications (LHAs) which can be integrated into MSK care by different specialists and in different settings. Compared to analgesia and physical exercise, LHAs have been less evaluated, and the quality of randomized clinical trials is generally low. The aim of the survey is to assess the knowledge, attitude, perception/practices of general practitioners (GPs), physiatrists and sports medicine doctors towards thermotherapy as delivered by superficial heat pads or wraps.

Patients and Methods

The survey was conducted between June and September 2022 in Italy. An online questionnaire with 22 multiple-choice questions was administered to explore the demographics and prescribing habits of the participants; the clinical profile of MSK patients; and physicians' attitude and beliefs about the use of thermotherapy/superficial heat applications in MSK pain management.

Results

GPs are at the forefront of the MSK patient journey and preferentially select NSAIDs as first-line option in arthrosis, muscle stiffness, and strain while prescribing heat wraps as preferred choice in presence of muscle spasm/contracture. Similar pattern of prescribing habits was found among specialists who, in contrast to GPs, adopted more frequently ice/cold therapy to relieve pain due to muscle strain and limited paracetamol use. Generally, survey participants agreed on the benefits of thermotherapy in MSK care management, namely increased blood flow and local tissue metabolism as well as connective tissue elasticity and pain relief which all may be of help in attaining pain control and improvement of function.

Conclusion

Our findings provided the basis for further investigations aimed at optimizing the MSK patient journey while building up additional evidence supporting the benefit of using superficial heat applications to effectively manage patients with MSK disorders.

The Influence of a Single Instrument-Assisted Manual Therapy (IAMT) for the Lower Back on the Structural and Functional Properties of the Dorsal Myofascial Chain in Female Soccer Players: A Randomised, Placebo-Controlled Trial

Background: Instrument-assisted manual therapy (IAMT) is indicated to improve flexibility, reduce pain, and induce hyperaemia locally and along myofascial chains. The underlying effects are largely unclear. This randomised, placebo-controlled pilot study aimed to gain first insights into these effects, primarily on the structural level, through ultrasonography. Methods: 67 healthy female soccer players aged 20.9 (±3.9) years were examined after right lumbar intervention (IAMT: intervention group (IG), heat application: comparison group (CG), pressure-less placebo: placebo group (PG)). Ultrasonography (absolute movement and shear motion), flexibility tests (passive straight leg raise test (PSLR), lumbar and thoracic double inclinometry), and superficial skin temperature were recorded before (t0), immediately (t1) and 45 min after the intervention (t2). Results: IAMT decreased the absolute mobility of the superficial lamina and its shear motion to the superficial fascia compared with the PG (t1; p < 0.05). PSLR improved in the IG compared with the CG (t2) and PG (t1, t2; p < 0.05). The temperature increased in the IG and CG compared with the PG (t1, t2) and in the CG compared with the IG (t1; p < 0.05). Conclusion: IAMT of the lumbar back briefly reduces absolute mobility of the superficial lamina and its shear motion to the superficial fascia, improves flexibility, and increases the temperature.

A Biaxially Stretchable and Self-Sensing Textile Heater Using Silver Nanowire Composite

Wearable heaters have garnered significant attention from academia and industry for their great potential in thermotherapy. Silver nanowire (AgNW) is a promising conductive material for flexible and stretchable electrodes. Here, a resistive, biaxially stretchable heater based on AgNW composite is reported for the first time, where a AgNW percolation network is encased in a thin polyimide (PI) film and integrated with a highly stretchable textile. AgNW/PI is patterned with a 2D Kirigami structure, which enables constant resistance under a large tensile strain (up to uniaxial 100% strain and 50% biaxial strain). The heater can achieve a high temperature of ∼140 °C with a low current of 0.125 A, fast heating and cooling rates of ∼16.5 and ∼14.1 °C s^-1, respectively, and stable performance over 400 heating cycles. A feedback control system is developed to provide constant heating temperature under a temperature change of the surrounding environment. Demonstrated applications in applying thermotherapy at the curvilinear surface of the knee using the stretchable heater illustrate its promising potential for wearable applications.

The Effectiveness of Thermal Neuromodulation Using Precise Heat in the Treatment of Chronic Low Back Pain Over 60 Days: An In-Home User Trial

PURPOSE

Two previous independent double-blind randomized studies demonstrated that thermal neuromodulation using high temperature pulsed heat reduced pain in subjects with chronic low back pain. The present study examined the effects of high temperature pulsed heat via an experimental device in a real-world In-Home Use Trial (IHUT) over a sixty-day period.

MATERIALS AND METHODS

This in-home study recruited 34 subjects with chronic low back pain, provided them with an experimental device that delivered treatment session of high temperature pulsed heat up to 45°C, and followed them for eight weeks. Subjects were allowed to use the device as needed. Primary outcome was pain rating as measured by the 11-point Numeric Pain Scale at baseline, four and eight weeks of treatment. The secondary outcome measures were the interference with daily living components of the Brief Pain Inventory at baseline versus eight weeks of treatment.

RESULTS

Thirty-two subjects completed the study. Pain levels were 5.81 at baseline, 2.79 at four weeks and 2.25 at eight weeks. All changes in pain levels between baseline and four weeks, baseline, and eight weeks and between four and eight weeks were statistically significant (p < 0.05). At eight weeks, the seven components of pain interference with activities of daily living and pain interference with walking were statistically reduced (P < 0.05). About 72% of subjects reported a single 30-minute treatment session produced over 3 hours of pain relief.

CONCLUSION

An eight-week in-home trial of high-temperature thermal modulation devices produced significant reductions in pain and pain interference with activities of daily living, an important measure of function. Efforts were made to control and reduce study contamination. This study provides important initial data for long-term outcome studies of thermal neuromodulation using high temperature pulsed heat to treat low back pain and to improve subject function and demonstrated that individuals with chronic pain can effectively self-manage pain.

The Effect of Local Heat Therapy versus Cold Rub Gel on Pain and Joint Functions in Patients with Knee Osteoarthritis

This study was compared the effect of local heat therapy versus cold rub gel on pain and joint function in patients with knee osteoarthritis. One hundred seventeen patients with knee osteoarthritis were randomly assigned to cold rub gel, local heat therapy, and control group. Data were collected by knee injury and osteoarthritis outcome score at a week prior to the interventions and on weeks of 1, 2, 3, and 4 of the interventions. A significant difference was found between the three groups in terms of pain severity (p = .001), joint symptoms (p = .001), ADL function (p = .001), Sport and Recreation function (p = .001), except Knee related QOL (p = .3). Cold rub gel and heat therapy were both effective in improving pain and joint function in patients with knee osteoarthritis.

Local heat applications as a treatment of physical and functional parameters in acute and chronic musculoskeletal disorders or pain

OBJECTIVES

The aim of this systematic review and meta-analysis was to evaluate the effectiveness of local heat applications (LHA) in individuals with acute or chronic musculoskeletal disorders.

DATA SOURCES

An electronic search was conducted on MEDLINE, CENTRAL, CINHAL and the PEDro databases up to December 2019.

STUDY SELECTION

Studies incorporating adults suffering from any kind of musculoskeletal issues treated by LHA compared to any treatment other than heat were included.

QUALITY ASSESSMENT

Two authors independently performed the methodological quality assessment using the Cochrane Risk of Bias tool.

DATA SYNTHESIS

LHA showed beneficial immediate effects to reduce pain vs no treatment (p < 0.001), standard therapy (p = 0.020), pharmacological therapy (p < 0.001) and placebo/sham (p = 0.044). Physical function was restored after LHA compared to no treatment (p = 0.025) and standard therapy (p = 0.006) whilst disability improved directly after LHA compared to pharmacological therapy (p = 0.003) and placebo/sham (p < 0.028). Quality of life was improved directly after LHA treatment compared to exercise therapy (p < 0.021). Range of motion increased and stiffness decreased after LHA treatment compared to pharmacological therapy (p = 0.009., p < 0.001) and placebo/sham (p < 0.001, p = 0.023). The immediate superior effects of LHA on muscular strength could be observed compared to no treatment (p < 0.001), cold (p < 0.001) and placebo/sham (p = 0.023).

CONCLUSIONS

Individuals suffering from acute musculoskeletal disorders might benefit from using LHA as an adjunct therapy. However, the studies included in this meta-analysis demonstrated a high heterogeneity and mostly an unclear risk of bias.

Thermographic Analysis of the Metacarpal and Metatarsal Areas in Jumping Sport Horses and Leisure Horses in Response to Warm-Up Duration

This study aimed to assess the impact of various types of warm-up on the metacarpal and metatarsal surface temperature in jumping sport horses in comparison to leisure horses, which work usually less intensively. Six clinically healthy sport geldings, contestants in showjumping competitions, and six geldings used for leisure riding were included in the study. The experiment was conducted for four consecutive days, during which the horses were warmed up by walking and trotting for various durations. Images were taken with a FLUKE Ti9 thermal imager to determine the resting, post-effort, and recovery temperature of the dorsal and plantar surface of the metacarpus and metatarsus of the four limbs. The obtained data were analysed with SmartView 4.1. software. The increase of measured rectal and surface temperatures was proportional to the warm-up duration. The surface temperature increase in the distal limb parts in jumping sport horses was greater than in horses used for leisure. The plantar surface was also warmer than the dorsal surface of the metacarpal/metatarsal areas, with a forelimb being warmer than a hind limb. Elevated temperatures after warm-up persist for 30 min in the recovery period, especially in jumping sport horses compared to leisure horses. Thus, the warming up effect is achieved earlier and lasts longer in heavily trained horses than in non-performance horses.

Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?

Cold therapy has been used regularly as an immediate treatment to induce analgesia following acute soft-tissue injuries, however, a prolonged ice application has proved to delay the start of the healing and lengthen the recovery process. Hyperbaric gaseous cryotherapy, also known as neurocryostimulation, has shown the ability to overcome most of the limitations of traditional cold therapy, and meanwhile promotes the analgesic and anti-inflammatory effects well, but the current existing studies have shown conflicting results on its effects. Traditional cold therapy still has beneficial effect especially when injuries are severe and swelling is the limiting factor for recovery after soft-tissue injuries, and therefore no need to be entirely put out to pasture in the rehabilitation practice. Strong randomized controlled trials with good methodological quality are still needed in the future to evaluate the effects of different cryotherapy modalities.

Effect of Handgrip Training in Extreme Heat on the Development of Handgrip Maximal Isometric Strength among Young Males

The aim of this study was to evaluate the acute and adaptive effects of passive extreme heat (100 ± 3 °C) exposition in combination with a strength training protocol on maximal isometric handgrip strength. Fifty-four untrained male university students participated in this investigation. Twenty-nine formed the control group (NG) and 25 the heat-exposed group (HG). All the participants performed a 3-week isotonic handgrip strength training program twice a week with a training volume of 10 series of 10 repetitions with 45-s rest between series, per session. All the subjects only trained their right hand, leaving their left hand untrained. HG performed the same training protocol in hot (100 ± 3 °C) conditions in a dry sauna. Maximal isometric handgrip strength was evaluated each training day before and after the session. NG participants did not experience any modifications in either hand by the end of the study while HG increased maximal strength values in both hands (p < 0.05), decreased the difference between hands (p < 0.05), and recorded higher values than the controls in the trained (p < 0.05) and untrained (p < 0.01) hands after the intervention period. These changes were not accompanied by any modification in body composition in either group. The performance of a unilateral isotonic handgrip strength program in hot conditions during the three weeks induced an increase in maximal isometric handgrip strength in both hands without modifications to bodyweight or absolute body composition.

Altered muscle activation in agility dogs performing warm-up exercises: an acoustic myography study

Agility is physically demanding and dogs encounter a considerable risk of injury during training and competition. Pre-performance warm-up is used routinely among human athletes to prepare the tissues for these physical demands, but in canine sports evidence for effects of warm-up is lacking. The aim of this study was to investigate the effects of warm-up in dogs on two major muscles involved in locomotion. It was hypothesised that, after warm-up, the muscles would be used more efficiently (more fibre resting time/total time), recruit fewer fibres (reduced spatial summation) and/or activated with a lower firing frequency (reduced temporal summation). The following factors ‘sex, age, weight, height, training level and agility experience’ were evaluated for their potential impact on muscle function parameters. Fourteen large (≥46 cm at the withers) agility dogs of different breeds and training levels performed a 5 min warm-up program three times, with a 2 min break between the programs for recording purposes. Acoustic myography sensors were attached on the skin over the muscles m. triceps brachii (TB) and m. gluteus superficialis (GS). Recordings of muscle activity were made, while the dogs trotted before warm-up and after each 5 min warm-up program. The dogs used TB more efficiently after 5 min (P<0.05), 10 min (P<0.05) and 15 min (P<0.001) of exercise compared to pre-warm-up values. No changes were found in the activity of GS. For well-trained dogs, TB recruited fewer muscle fibres after 10 and 15 min of warm-up compared to dogs that trained less than 1 h weekly (P<0.03). For dogs with more than 2 years of experience, GS had a lower firing frequency before and after 10 min warm-up compared to dogs with less experience. The results indicate that warm-up alters muscle activation by an increased muscular efficiency. Training level and experience have an influence on muscle function parameters.

The Beighton Score as a measure of generalised joint hypermobility

The Beighton Score (BS) is a set of manoeuvres in a nine-point scoring system, used as the standard method of assessment for Generalised Joint Hypermobility (GJH). It was originally developed as an epidemiological tool used in screening large populations for GJH, but later adopted as a clinical tool for diagnostic purposes. Its ability to truly reflect GJH remains controversial, as joints within the scoring system are predominantly of the upper limb and disregard many of the major joints, preventing a direct identification of GJH. Furthermore, a consistent finding in the literature whereby the BS failed to identify hypermobility in joints outside the scoring system suggests its use as an indirect indicator of GJH is also not viable. As such, the collective findings of this review demonstrate a need for a change in clinical thinking. The BS should not be used as the principle tool to differentiate between localised and generalised hypermobility, nor used alone to exclude the presence of GJH. Greater emphasis should be placed on a clinician’s judgement to identify or exclude GJH, according to its full definition.

Thermophysiological responses to capacitive resistive monopolar radiofrequency electromagnetic radiation in patients with osteoarthritis of the knee joint: A randomised controlled experimental study

This study investigated the effect of 448 kHz capacitive resistive monopolar radiofrequency (CRMRF) on the superficial and deep physiological responses of patients with osteoarthritis (OA) of the knee(s). Forty-five patients diagnosed with OA in their knee(s) were enrolled into a three-group randomised controlled study, from the waiting list of a local hospital. They received localized treatment with either CRMRF, CRMRF placebo or a control (no treatment) to the knee for 15 minutes. Pre, post, and 20 min follow-up measurements of skin temperature (SKT) and skin blood flow (SBF) were obtained from the knee using the FlexComp Infiniti (SA7550) physiological measurement system. Pre and post-treatment deep blood flow were recorded using Doppler ultrasound. Core temperature, blood pressure (BP) and pulse rate (PR) were concurrently monitored. Group data were compared using the ANOVA model. Statistical significance was set at p ≤ 0.05, 0.8 power, and 95% CI. Significant increases and sustenance of SKT and SBF, and significant increases in volume and intensity of deep blood flow were demonstrated with CRMRF over the placebo and control interventions in all comparisons (p< .001). No meaningful changes in blood flow velocity, core temperature, BP, or PR were noted for any condition. The findings were markedly more pronounced than those previously reported in asymptomatic adults. However, the patients had received a higher average dose of CRMRF (mean (SD): 46.87 (4.08) W) compared to the asymptomatic sample (mean (SD): 42.37 (4.64) W); therefore, further research is needed to better understand the differences in physiological responses between patients and asymptomatic people.

Effect of environmental temperature change on the neuromechanical function of the quadriceps muscle

AbstractThis study compared neuromechanical characteristics of voluntary (maximum voluntary contraction (MVC) peak torque, rate of torque development (RTD), voluntary activation (VA)) and electrically stimulated contractions (peak torque, RTD) when performed under the same temperature conditions. Twelve physically active males performed two isometric MVCs of the quadriceps muscle group in an isokinetic dynamometer. The MVCs were performed after lower limb submersion for 20 min in hot (40°C) or cold (10°C) water. A control MVC was performed in ambient room temperature (17 ± 0.7°C). Electrical twitches were delivered at rest pre-MVC (Unpotentiated), during the plateau phase of the MVC (Superimposed) and post-MVC (Potentiated). Peak torque for MVC, Unpotentiated and Potentiated was recorded. RTD was calculated for the MVC (at 50, 100, 150, 200 ms and peak torque time points), Unpotentiated and Potentiated twitches, while VA (using the central activation ratio method) was calculated. There was no significant change between conditions in MVC peak torque, MVC RTD, VA and (averaged) twitch peak torque (p > 0.05). Twitch RTD for the hot condition (1025.0 ± 163.0 N·m·s^-1) was significantly higher (p = 0.003) than control (872.3 ± 142.9 N·m·s^-1). In conclusion, environmental temperature changes, in the range examined, do not affect the ability to generate maximum torque or any of the RTD parameters in maximum voluntary isometric contractions. In contrast, increased heat results in higher RTD in electrically stimulated contractions, most likely induced by reduced contraction time. This has practical implications for the use of electromyostimulation for injury prevention.

Acute Effects of Whole-Body Vibration Exercises at 2 Different Frequencies Versus an Aerobic Exercise on Some Cardiovascular, Neuromotor and Musculoskeletal Parameters in Adult Patients With Obesity

Whole-body vibration exercise (WBVE), a nonimpact, viable and safe type of exercise, has been reported to be useful in the physical rehabilitation of obesity. Aim of the study was to compare the acute effects of WBVE with a session of walking and running (AER) on cardiovascular, neuromotor and musculoskeletal parameters in obese subjects. Sixteen adult obese subjects performed 3 tests (WBVE at 30 and 45 Hz, AER) randomly in different days. An increase in heart rate was recorded after AER and 45 Hz WBVE (p < 0.001), while only AER increased systolic (p = 0.003) and diastolic blood pressure (p = 0.004) and ratings of perceived exertion (p < 0.001). All 3 exercises determined lactate increase [AER p < 0.001, 45 Hz (p = 0.04), 30 Hz (p = 0.03) WBVE] and sit-and-reach (AER p = 0.002, 45 and 30 Hz WBVE p < 0.001) and fingertip-to-floor improvements (AER p = 0.003, 30 and 45 Hz WBVE p < 0.001), while only 30 Hz WBVE determined improvement in stair climbing test (p < 0.05). Considering the lack of effects of 30 Hz WBVE on the cardiovascular system and fatigue and its positive effect on flexibility and muscle power, this procedure can be considered an appropriate exercise protocol for the obese population.

The effects of stretching with cryotherapy, stretching with heat and stretching alone on hamstring flexibility in physically active females

Background/Aims

A pre- and post-intervention study was conducted to examine the effects of acute cryotherapy with stretching, heat with stretching, and stretching alone on hamstring flexibility.

Methods

Thirty female participants were randomly allocated into three groups: stretching with cryotherapy, stretching with heat, or stretching without an intervention. A sit and reach test and the 90/90 active knee extension test were conducted before and after a 20-minute stretching routine to measure hamstring flexibility.

Results

Differences were observed pre- and post-test in the sit and reach test and knee 90/90 extension tasks (P<0.05) within all three groups. However, there were no significant differences (P>0.05) between the three intervention groups.

Conclusions

Combining stretching with cryotherapy or heat application potentially provides no additional benefit to stretching alone in short-term enhancements to hamstring muscle flexibility in physically active females.

On-Demand Printing of Wearable Thermotherapy Pad

Thermotherapy is an effective method for pain relief, recovery from injury, and general healthcare. The ordinary heat pad used for thermotherapy at home is not usually tailored to the individual but supplied in a few different pre-fixed sizes and shapes for mass marketing. A customized wearable heat pad often requires expert support. Herein, an instant, custom-fit, and on-demand heat pad for thermotherapy is demonstrated. The heater is directly printed using silver nanoparticle ink on an off-the-shelf medical grade tape by inkjet technology. By coating the tape with silica nanoparticles as ink-absorbing layer and chloride ions as chemical sintering agent, stable heater patterns are printed without the need for subsequent high temperature sintering process. A 3D scanner is used to acquire body information, and a customized heater is produced using the information. The printed heat pad is attached to the shoulder and the effect of thermotherapy is verified objectively through electroencephalography and subjectively through survey. This printed heat pad produced by simple and low-cost fabrication provides wearable medical devices for personal thermotherapy.

Stretchable Tattoo-Like Heater with On-Site Temperature Feedback Control

Wearable tissue heaters can play many important roles in the medical field. They may be used for heat therapy, perioperative warming and controlled transdermal drug delivery, among other applications. State-of-the-art heaters are too bulky, rigid, or difficult to control to be able to maintain long-term wearability and safety. Recently, there has been progress in the development of stretchable heaters that may be attached directly to the skin surface, but they often use expensive materials or processes and take significant time to fabricate. Moreover, they lack continuously active, on-site, unobstructive temperature feedback control, which is critical for accommodating the dynamic temperatures required for most medical applications. We have developed, fabricated and tested a cost-effective, large area, ultra-thin and ultra-soft tattoo-like heater that has autonomous proportional-integral-derivative (PID) temperature control. The device comprises a stretchable aluminum heater and a stretchable gold resistance temperature detector (RTD) on a soft medical tape as fabricated using the cost and time effective “cut-and-paste” method. It can be noninvasively laminated onto human skin and can follow skin deformation during flexure without imposing any constraint. We demonstrate the device’s ability to maintain a target temperature typical of medical uses over extended durations of time and to accurately adjust to a new set point in process. The cost of the device is low enough to justify disposable use.

Differences Between Men and Women in Balance and Tremor in Relation to Plantar Fascia Laxity During the Menstrual Cycle

CONTEXT

  Although much attention has been paid to the effect of estrogen on the knee ligaments, little has been done to examine the ligaments in the foot, such as the plantar fascia, and how they may be altered during the menstrual cycle.

OBJECTIVE

  To (1) examine sex differences in plantar fascia thickness and laxity and postural sway and (2) identify any menstrual cycle effects on plantar fascia laxity, postural sway, and neuromuscular tremor between menstruation and the ovulation phase.

DESIGN

  Case-control study.

SETTING

  Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

  Fifteen healthy women (age = 25.9 ± 1.8 years) and 15 healthy men (age = 27.3 ± 2.0 years) volunteered to participate in this study.

INTERVENTION(S)

  We asked participants to perform 8 balance tasks on a force platform while we assessed postural sway and tremor.

MAIN OUTCOME MEASURE(S)

  Plantar fascia length and thickness unloaded and loaded with body weight were measured via ultrasound. Postural sway and tremor were measured using a force platform.

RESULTS

  Plantar fascia length and thickness with pressure were greater in ovulating women compared with men ( P < .001), but no differences were found between women during menstruation and men. Postural sway and tremor were greater at ovulation than during menstruation ( P < .05), and men had less sway than ovulating women on the 3 most difficult balance tasks ( P < .01).

CONCLUSIONS

  Plantar fascia laxity was increased and postural sway and tremor were decreased at ovulation compared with menstruation in women. Postural sway and tremor in men were the same as in women during menstruation. These findings support the need to be aware of the effect of sex hormones on balance to prevent lower extremity injuries during sport activities.

Simple Approach to High-Performance Stretchable Heaters Based on Kirigami Patterning of Conductive Paper for Wearable Thermotherapy Applications

Recent efforts to develop stretchable resistive heaters open up the possibility for their use in wearable thermotherapy applications. Such heaters should have high electrothermal performance and stability to be used practically, and the fabrication must be simple, economic, reproducible, and scalable. Here we present a simple yet highly efficient way of producing high-performance stretchable heaters, which is based on a facile kirigami pattering (the art of cutting and folding paper) of a highly conductive paper for practical wearable thermotherapy. The resulting kirigami heater exhibits high heating performance at low voltage (>40 °C at 1.2 V) and fast thermal response (<60 s). The simple kirigami patterning approach enables the heater to be extremely stretchable (>400%) while stably retaining its excellent performance. Furthermore, the heater shows the uniform spatial distribution of heat over the whole heating area and is highly durable (1000 cycles at 300% strain). The heater attached to curvilinear body parts shows stable heating performance even under large motions while maintaining intimate conformal contact with the skin thanks to the high stretchability and sufficient restoring force. The usability of the heater as a wearable thermotherapy device is demonstrated by increased blood flow at the wrist during operation.

The Effect of Therapeutic Whirlpool and Hot Packs on Hand Volume During Rehabilitation After Distal Radius Fracture: A Blinded Randomized Controlled Trial

BACKGROUND

Edema is a possibility with all heating modalities due to the increase in local blood flow caused by vasodilation. Despite the frequent application of superficial heat modalities, their relative effect on hand volume has not been determined for the upper extremity. The objective of this study was to compare the immediate effects of hot packs and whirlpool on hand volume for patients with distal radius fracture (DRF) and to determine whether any changes in volume between these modalities were still present 30 minutes after heat application. Finally, to determine whether there were any differences in volume change between groups after 3 repeated therapy visits.

METHODS

Sixty patients with clinically healed DRFs were divided into 2 groups. Half received therapeutic whirlpool at each therapy visit, and the other half received a moist hot pack treatment for 3 consecutive visits. Hand volume was measured before heat, after heat, and at the end of each 30-minute therapy session.

RESULTS

There was a significant difference between groups immediately after heat application, as patients in the whirlpool group experienced an initial volume increase greater than those who received a hot pack. When remeasured after a hand therapy session approximately 30 minutes later, this group difference in volume change was no longer significant. The overall change in volume from enrollment in the study to completion of the study 3 weeks later was not statistically different between groups.

CONCLUSION

Whirlpool is a potential consideration when selecting a heat modality for patients with DRF.

Ultraflexible Transparent Film Heater Made of Ag Nanowire/PVA Composite for Rapid-Response Thermotherapy Pads

Ultraflexible transparent film heaters have been fabricated by embedding conductive silver (Ag) nanowires into a thin poly(vinyl alcohol) film (AgNW/PVA). A cold-pressing method was used to rationally adjust the sheet resistance of the composite films and thus the heating powers of the AgNW/PVA film heaters at certain biases. The film heaters have a favorable optical transmittance (93.1% at 26 Ω/sq) and an outstanding mechanical flexibility (no visible change in sheet resistance after 10 000 bending cycles and at a radius of curvature ≤1 mm). The film heaters have an environmental endurance, and there is no significant performance degradation after being kept at high temperature (80 °C) and high humidity (45 °C, 80% humidity) for half a year. The efficient Joule heating can increase the temperature of the film heaters (20 Ω/sq) to 74 °C in ∼20 s at a bias of 5 V. The fast-heating characteristics at low voltages (a few volts) associated with its transparent and flexibility properties make the poly(dimethylsiloxane)/AgNW/PVA composite film a potential candidate in medical thermotherapy pads.

Highly Stretchable and Conductive Copper Nanowire Based Fibers with Hierarchical Structure for Wearable Heaters

Wearable heaters have been increasingly attracting researchers' great interest due to their efficient utility in maintaining warmth and in thermotherapy. Nowadays carbon nanomaterials and metallic nanowires tend to become the mainstream heating elements in wearable heaters considering their excellent electrical and mechanical properties. Though considerable progress has been made, there still exist challenging issues that need to be addressed in practical applications, including bad breathability and poor endurance to mechanical deformations. Here, we devise a copper nanowire based composite fiber with a unique hierarchical structure. This fiber possesses not only excellent heating performance, but also fantastic tolerance to mechanical impact, such as bending, twisting, and stretching. We further weave these fibers into a wearable heating fabric and realize smart personal heating management through an Android phone by integrating with a microcontroller unit. Two practical applications are demonstrated including a heating kneepad for articular thermotherapy and a heating coat on an infant model for maintaining warmth.

Use of Low Level of Continuous Heat as an Adjunct to Physical Therapy Improves Knee Pain Recovery and the Compliance for Home Exercise in Patients With Chronic Knee Pain: A Randomized Controlled Trial

Petrofsky, JS, Laymon, MS, Alshammari, FS, and Lee, H. Use of low level of continuous heat as an adjunct to physical therapy improves knee pain recovery and the compliance for home exercise in patients with chronic knee pain: a randomized controlled trial. J Strength Cond Res 30(11): 3107-3115, 2016-This study examined if the use of low level continuous heat (LLCH) wraps at home between physical therapy sessions at a clinic resulted in better therapy outcomes in patients with chronic knee pain. Fifty individuals with chronic nonspecific knee pain was randomly allocated to 2 groups: the LLCH group and the placebo group. All subjects underwent 1 hour of conventional physical therapy twice per week for 2 weeks at the outpatient clinic and they were asked to accomplish 1 hour of therapeutic exercise at home each day between sessions. The LLCH group applied LLCH knee wraps for 6 hours at home before home exercise while placebo group took a placebo ibuprofen. (This was done since placebo heat is impossible to use since subjects would notice that the wraps were cold) Before, during, and after intervention, pain intensity, active range of motion of the knee (AROM), knee strength, and home exercise compliance were measured. The LLCH group showed pain attenuation after 2 weeks of therapy sessions (p ≤ 0.05). AROM and strength of the knee significantly improved over time compared to the placebo group. Home exercise compliance was significantly higher in the LLCH group than placebo group (p ≤ 0.05). These results indicated that the use of LLCH as an adjunct to conventional physical therapy for chronic knee pain significantly improved pain attenuation and recovery of strength and movement in patients with chronic knee pain.

Emerging flexible and wearable physical sensing platforms for healthcare and biomedical applications

There are now numerous emerging flexible and wearable sensing technologies that can perform a myriad of physical and physiological measurements. Rapid advances in developing and implementing such sensors in the last several years have demonstrated the growing significance and potential utility of this unique class of sensing platforms. Applications include wearable consumer electronics, soft robotics, medical prosthetics, electronic skin, and health monitoring. In this review, we provide a state-of-the-art overview of the emerging flexible and wearable sensing platforms for healthcare and biomedical applications. We first introduce the selection of flexible and stretchable materials and the fabrication of sensors based on these materials. We then compare the different solid-state and liquid-state physical sensing platforms and examine the mechanical deformation-based working mechanisms of these sensors. We also highlight some of the exciting applications of flexible and wearable physical sensors in emerging healthcare and biomedical applications, in particular for artificial electronic skins, physiological health monitoring and assessment, and therapeutic and drug delivery. Finally, we conclude this review by offering some insight into the challenges and opportunities facing this field.

Greater Reduction of Balance as a Result of Increased Plantar Fascia Elasticity at Ovulation during the Menstrual Cycle

One of the sexual hormones, estrogen, increases elasticity of human connective tissue such as the anterior cruciate ligament during the menstrual cycle in women. In the present investigation, the plantar fascia was investigated to see if there is a difference in elasticity with the menstrual cycle. Fifteen young healthy females in the age range of 18-35 years old with a regular menstrual cycle were tested twice throughout one full menstrual cycle; once during the early follicular phases and once at ovulation. Foot length, while standing on both feet and one foot were used to assess plantar fascia elasticity, ultrasound measured plantar fascia thickness while lying and standing, and posture sway and tremor using a balance platform during 8 different balance tests were assessed to see the impact of elasticity changes. Foot length increased significantly at ovulation compared to menstruation when standing on two feet (p = 0.03) and standing on one foot (p < 0.001). There was also a significant increase in plantar fascia in thinning per kilogram weight applied to the foot at ovulation compared to menstruation (p = 0.014). Associated with this increase in elasticity at ovulation, there was a reduction in balance in the most difficult balance tasks and an increase in tremor during ovulation (p < 0.05). Plantar fascia elasticity change during the menstrual cycle might have effects on posture sway and tremor, which could have a potential risk of falling. Therefore, healthy professionals working with young female adults should recognize these physiological effects.

Stretchable Heater Using Ligand-Exchanged Silver Nanowire Nanocomposite for Wearable Articular Thermotherapy

Thermal therapy is one of the most popular physiotherapies and it is particularly useful for treating joint injuries. Conventional devices adapted for thermal therapy including heat packs and wraps have often caused discomfort to their wearers because of their rigidity and heavy weight. In our study, we developed a soft, thin, and stretchable heater by using a nanocomposite of silver nanowires and a thermoplastic elastomer. A ligand exchange reaction enabled the formation of a highly conductive and homogeneous nanocomposite. By patterning the nanocomposite with serpentine-mesh structures, conformal lamination of devices on curvilinear joints and effective heat transfer even during motion were achieved. The combination of homogeneous conductive elastomer, stretchable design, and a custom-designed electronic band created a novel wearable system for long-term, continuous articular thermotherapy.

Surgical treatment of combined posterior root tears of the lateral meniscus and ACL tears

BACKGROUND

The treatment of anterior cruciate ligament (ACL) rupture complicated with posterior lateral meniscus root (PLMR) tears remains controversial. The goal of this study was to evaluate clinical outcomes of PLMR tear refixation versus left untreated at the time of reconstruction.

MATERIAL/METHODS

From August 2001 to January 2012, 31 patients who undergone repair of PLMR tears were evaluated and compared with a matched control group with untreated PLMR tears. Clinical evaluation consisted of the Lysholm scale, subjective International Knee Documentation Committee (IKDC) questionnaires, and radiographic evaluation with MRI.

RESULTS

Regarding to the Lysholm score and the subjective questionnaire score, there were no statistical difference between the 2 groups. However, patients after operative treatment reach higher functional scores and lower rates of osteoarthritis (normal: group A, 80%, and group B, 48%, respectively) with statistical significance (P<0.05) compared to the matched control group.

CONCLUSIONS

Surgical and conservative treatment of the PLMR can both effectively improve knee function. However, a tendency towards higher functional scores and lower rates of osteoarthritis for patients with operative treatment was observed.