Anna Cronström

Gender differences in knee abduction during weight-bearing activities: A systematic review and meta-analysis

BACKGROUND Increased knee abduction during weight-bearing activities is suggested to be a contributing factor for the high knee injury risk reported in women. However, studies investigating gender difference in knee abduction are inconclusive. OBJECTIVE To systematically review gender-differences in knee abduction during weight-bearing activities in individuals with or without knee injury. METHODS A systematic review and meta-analysis were conducted according to the PRISMA guidelines. A search in the databases Medline, CINAHL and EMBASE was performed until September 2015. Inclusion criteria were studies that reported (1) gender differences, (2) healthy individuals and/or those with anterior cruciate ligament (ACL) deficiency or reconstruction or patellofemoral pain PFP, and (3) knee abduction assessed with either motion analysis or visual observation during weight-bearing activity. RESULTS Fifty-eight articles met the inclusion criteria. Women with PFP had greater peak knee abduction compared to men (Std diff in mean; -1.34, 95%CI; -1.83 to -0.84). In healthy individuals, women performed weight-bearing tasks with greater knee abduction throughout the movement (initial contact, peak abduction, excursion) (Std diff in mean; -0.68 to -0.79, 95%CI; -1.04 to -0.37). In subgroup analyses by task, differences in knee abduction between genders were present for most tasks, including running, jump landings and cutting movements. There were too few studies in individuals with ACL injury to perform meta-analysis. CONCLUSION The gender difference in knee abduction during weight-bearing activities should be considered in training programs aimed at preventing or treating knee injury.

Association between sensory function and medio-lateral knee position during functional tasks in patients with anterior cruciate ligament injury

BackgroundPatients with anterior cruciate ligament (ACL) injury often exhibit reduced movement quality during functional tasks in the form of a knee-medial-to-foot position (KMFP). This movement pattern is suggested to be more common in women than in men, but the possible contributing sensorimotor factors for this altered knee position are poorly studied in these patients. The aim of this study was to evaluate the association between sensory function and medio-lateral knee position during functional tasks in men and women with ACL injury.MethodsFifty-one patients (23 women) aged 18–40 years with ACL injury were included in this cross-sectional study. Measures of sensory function were assessed by the threshold to detection of passive motion (TDPM) for knee kinesthesia and by the vibration perception threshold (VPT) for vibration sense. Movement quality was assessed by visual observation of the position of the knee relative to the foot during the following four functional tasks with different degrees of difficulty: the single-limb mini-squat, stair descending, the forward lunge, and the drop-jump. Spearman’s rank correlation coefficient was used to determine the relationship between the sensory measures and the medio-lateral knee position during the functional tasks. Differences in TDPM and/or VPT between subjects with good and poor movement quality were evaluated using the independent t-test. Separate gender analyses were performed.ResultsWorse TDPM was associated with a KMFP during the drop jump in men. Worse VPT at the toe and ankle was associated with a KMFP during stair descending and the forward lunge in women, but no associations were found in men.ConclusionWorse kinesthesia, measured by TDPM, might be associated with KMFP during the drop jump in men with ACL injury while worse vibration sense, measured by the VPT, at the foot and ankle might be related to KMFP in women. Further studies are needed to confirm these results.

Measurement properties of visual rating of postural orientation errors of the lower extremity – A systematic review and meta-analysis

OBJECTIVES To systematically review measurement properties of visual assessment and rating of Postural Orientation Errors (POEs) in participants with or without lower extremity musculoskeletal disorders. METHODS A systematic review according to the PRISMA guidelines was conducted. The search was performed in Medline (Pubmed), CINAHL and EMBASE (OVID) databases until August 2016. Studies reporting measurement properties for visual rating of postural orientation during the performance of weight-bearing functional tasks were included. No limits were placed on participant age, sex or whether they had a musculoskeletal disorder affecting the lower extremity. RESULTS Twenty-eight articles were included, 5 of which included populations with a musculoskeletal disorder. Visual rating of the knee-medial-to-foot position (KMFP) was reliable within and between raters, and meta-analyses showed that this POE was valid against 2D and 3D kinematics in asymptomatic populations. Other segment-specific POEs showed either poor to moderate reliability or there were too few studies to permit synthesis. Intra-rater reliability was at least moderate for POEs within a task whereas inter-rater reliability was at most moderate. CONCLUSIONS Visual rating of KMFP appears to be valid and reliable in asymptomatic adult populations. Measurement properties remain to be determined for POEs other than KMPF.

Agreement between test procedures for the single-leg hop for distance and the single-leg mini squat as measures of lower extremity function

BackgroundDifferent test procedures are often used within performance-based measures, causing uncertainty as to whether results can be compared between studies. Thus, the aim of this study was to assess agreement between different test procedures for the single-leg hop for distance (SLHD) and the single-leg mini squat (SLMS), respectively, two commonly used tasks for assessing deficiency in lower extremity muscle function.MethodsTwenty-three participants (20–42 years) with lower extremity injury performed the SLHD with arms free and with arms behind back, and the Limb Symmetry Index (LSI; injured leg divided by uninjured and multiplied by 100) was calculated. Another group of 28 participants (mean 18–38 years) performed five SLMSs at a pre-defined speed and maximum number of SLMSs during 30 seconds, and were visually observed and scored as either having a knee-over-foot or a knee-medial-to-foot position (KMFP).ResultsNo systematic difference between test procedures for the LSI of the SLHD was noted (p=0.736), Cohen’s kappa = 0.42. The Bland & Altman plot showed wide limits of agreement between test procedures, with particularly poor agreement for participants with abnormal LSI (<90%). Ten participants were scored as having a KMFP during five SLMSs at a predefined speed, while five had a KMFP during maximum number of SLMSs during 30 seconds (p=0.063, Cohen’s kappa = 0.56).ConclusionsThe moderate agreement between the two test procedures for the SLHD and the SLMS, respectively, indicate that results from these different test procedures should not be compared across studies. SLHD with arms behind back, and five SLMSs at a pre-defined speed, respectively, were the most sensitive procedures to detect individuals with poor functional performance.

Is poor proprioception associated with worse movement quality of the knee in individuals with anterior cruciate ligament deficiency or reconstruction

[Purpose] To investigate the association between proprioception and a knee medial to foot position during weight-bearing activities in patients with anterior cruciate ligament reconstruction and anterior cruciate ligament deficiency. [Participants and Methods] Thirty-eight patients with anterior cruciate ligament reconstruction and 13 patients with anterior cruciate ligament deficiency aged 18–40 years were included. Proprioception was assessed by knee kinesthesia measured by the threshold to detection of passive motion. Movement quality was assessed by visual observation of the position of the knee in relation to the foot during the mini squat, the single-leg hop for distance, and the cross-over hop for distance. [Results] In patients with anterior cruciate ligament deficiency, worse kinesthesia was significantly associated with a knee medial to foot position during the single-leg hop for distance. No statistically significant associations were observed between kinesthesia and a knee medial to foot position during the three tasks in patients with anterior cruciate ligament reconstruction. [Conclusion] Poor proprioception may be associated with worse movement quality of the knee in patients with anterior cruciate ligament deficiency, but not in patients with anterior cruciate ligament reconstruction. Differences in sensorimotor function between patients with reconstructed and non-reconstructed anterior cruciate ligament should be considered in training and rehabilitation regimens aiming to enhance performance and prevent further injuries in these patients.

Factors associated with patients’ willingness to consider joint surgery after completion of a digital osteoarthritis treatment program: A prospective cohort study

To examine patient willingness and a possible shift in willingness for surgery and to investigate factors associated with this shift, following participation in the digital nonsurgical osteoarthritis (OA) treatment program Joint Academy.

Validity of visual rating of the lower extremity against 3D kinematics in people with an ACL injury

FP01-177 Clinical outcomes after fixation, arthroplasty and resection for treatment of comminuted fracture radial head (Mason type III or IV): a systematic review and network meta-analysis Arirachakaran, Alisara*; Boonard, M.; Kanchanatawan, W.; Kongtharvonskul, J. Orthopedics Department, Police General Hospital, Bangkok, Thailand; Srinakarin Hospital, Khonkaen, Thailand; Orthopedics Department, Lerdsin general hospital, Bangkok, Thailand; Mahidol University, Bangkok, Thailand Objectives: Radial head fractures make up approximately 3% of all fractures and they are the most common elbow fracture in adults. The treatment for comminuted radial head fracture remains controversial. Currently, the most frequently used treatment for comminuted radial head fracture is fixation, resection or arthroplasty. Therefore, we conducted a systematic review and network meta-analysis to compare the post-operative outcomes among surgical treatment and identify which method is the best for comminuted radial head fractures Mason type III–IV. Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies were identified from Medline and Scopus from inception to August 18th, 2017 that reported Mayo elbow performance score (MYPS) and postoperative complications of either treatment. A network meta-analysis was applied to assess treatment outcomes. Probability of being besttreatment was estimated using surface under the cumulative ranking curves (SUCRA). Results: Twelve comparative studies and one RCT (N = 526 patients) met the inclusion criteria. Intervention included ORIF (N = 210 patient), RHA (N = 227 patients) and RHR (N = 152 patients). A network-meta-analysis showed that MYPS of RHA was significantly higher when compared to ORIF and RHR, with the pooled mean MYPS of 7.28 (1.69, 12.86) and -7.32 (-13.21, -1.43) respectively. In terms of complications, RHA and RHR had lower risk with RRs of 0.61 (0.29, 1.31) and 0.54 (0.24, 1.25) when compared to ORIF. The SUCRA probabilities of RHA and RHR were in the first rank with 99.2% in MYPS and 60.6% in complications, respectively. Conclusions: The best surgical treatment option class that have the highest post-operative function scores is radial head arthroplasty followed by ORIF in treatment comminuted radial head fracture Mason type III–IV. While the lowest risk of having complications after surgery is radial head resection followed by radial head arthroplasty. This study suggest radial head arthroplasty and resection that have the first rank for both safety and efficacy outcome should be recommend for treatment comminuted radial head fracture Mason type III–IV. Further research with an increased sample size and a prospective randomized controlled trial study design are required to determine as to which surgical treatment options be the best should be done in the future. FP01-545 Lower amputation rate after fasciotomy by straight midline incision technique for a 22,900-volt electrical injury to the upper extremities Lee, B. H.* Kang-Dong Sacred Heart Hospital, Hallym University Medical School, Seoul, Korea, Republic of (South Korea) Objectives: The purpose of this study is to compare the major amputation rate following two different fasciotomy techniques, conventional versus straight midline, in patients with high-voltage arc burn injury by electric currents of 22,900 V to the upper extremities. Methods: A retrospective analysis of 230 patients (270 burned upper limbs) who underwent fasciotomy after high-voltage electrical injuries between 1996 and 2007 was performed. The patients were divided into two groups according to the fasciotomy method used. From 1996 to 2002, 158 patients (184 limbs) underwent conventional fasciotomy by Green’s volar-ulnar incision (conventional fasciotomy group). From 2003 to 2007, 72 patients (86 limbs) underwent fasciotomy using a straight midline curved incision (midline fasciotomy group). The patients were also divided into two groups based on whether the fasciotomy procedure was performed early or late. Patients who underwent fasciotomies\ 8 h after injury were classified as early, while those who underwent it[ 8 h after injury were classified as late. Major amputation rates were compared between two fasciotomy methods and analyzed following fasciotomy timing. The incidence of major amputation was numbered and compared between the two groups. Statistical significance was determined using Pearson’s chi-square analysis or Fisher’s exact test. Results: The midline fasciotomy group had a significantly lower major amputation rate (33.7%) than the conventional fasciotomy group (59.2%) (p\ 0.001). A subsequently decreased major amputation rate of 27.8% was observed in the early fasciotomy subgroup of the midline fasciotomy group (p = 0.025). Most cases treated with microsurgery consisted of the trans-positional or rotational local flap in the conventional fasciotomy group as the second most common approach (20%; 15/75 limbs). It was almost impossible to perform direct skin repair using a shoelace suture or gradual wiring due to the extensive areas of the open wounds. After confirmation of the vascular condition using angiography, microsurgery was done to revascularize and restore better function in the involved limbs in good condition. In the midline fasciotomy group, wound coverage was possible using free vascularized flap surgery with omental free flaps or latissimus dorsi muscle flaps etc. Direct skin repair using a shoelace suture or gradual wiring could be also used to cover open wounds in 12.3% (7/57 limbs) of cases. Conclusions: Early fasciotomy remarkably reduced the major amputation rate after high-voltage arc injury; in the setting of minimized vascular exposure after fasciotomy, a midline straight incision could ensure that various types of reconstructive microsurgical procedures and primary skin closures can be used to save limbs.

Association between sensory function and hop performance and self-reported outcomes in patients with anterior cruciate ligament injury.

Background In patients with anterior cruciate ligament (ACL) deficiency (ACLD) or reconstruction (ACLR), sensory deficits are commonly assessed as knee kinesthesia using time-consuming laboratory equipment. Portable equipment such as that used for evaluation of vibration sense would be preferable. In contrast to kinesthesia, vibration sense is not well studied in these patients. Objectives 1) To study the association between kinesthesia and vibration sense to investigate if one sensory measurement can replace the other; and 2) to determine the clinical relevance by investigating associations between the sensory measurements and functional performance and patient-reported outcomes in patients with ACLD or ACLR. Methods Twenty patients with ACLD and 33 patients with ACLR were assessed with knee kinesthesia, vibration sense, the one-leg hop test for distance, as well as the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Scale. Results There were no significant correlations between kinesthesia and vibration sense (r= −0.267, p>0.269) or between the sensory measures and hop performance (r= −0.351, p>0.199). In patients with ACLD, worse knee kinesthesia was associated with worse scores on KOOS subscales pain (r= −0.464, p=0.046) and activities of daily living (r= −0.491, p=0.033), and worse vibration sense was associated with worse scores on KOOS subscale quality of life (r= −0.469, p=0.037) and worse knee confidence (item Q3 from subscale quality of life) (rs=0.436, p=0.054). In patients with ACLR, worse vibration sense was associated with worse scores on KOOS subscales pain (r= −0.402, p=0.020) and activities of daily living (r= −0.385, p=0.027). Conclusion Kinesthesia and vibration sense cannot be used interchangeably as measures of sensory function in patients with ACLD or ACLR. Both sensory measurements were weakly related to hop performance. Adequate sensory function appears to have importance for perceived function in patients with ACLD or ACLR and may therefore be a factor that needs to be addressed in rehabilitation programs for these patients.