Results of ACL Reconstruction with Autologous Hamstrings Fixed by Two Bioabsorbable Cross Pins on the Femoral Side and a Bioabsorbable Interference Screw with Additional Fixation on the Tibial Side / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical outcomes of an anterior cruciate ligament reconstruction using autologous hamstring tendons with stable fixation. MATERIALS AND METHODS: Seventy-six ACL reconstructions using autologous hamstring tendons were reviewed for an average of 16.5 months (Range, 12-35.6 months) postoperatively. All the patients were examined using standard clinical techniques and evaluated by stress radiography, Cybex(TM), Lysholm score, and International Knee Documentation Committee (IKDC) ratings. RESULTS: In all cases, there were no limitations in the range of motion. The mean Lysholm score was 72.9 preoperatively, which later improved to 91.1 postoperatively. According to the IKDC grade, 74 cases were categorized as 'normal' or 'nearly normal' postoperatively. In addition, the CybexTM study showed that at an angular velocity of 60degrees/sec, the strength deficit of the hamstrings decreased to 16% from 24% while the strength deficit of the quadriceps decreased to 27% from 31%. The mean side-to-side difference in stress radiography was 2.4 mm postoperatively. There was a single case of graft failure resulting from a deep infection. CONCLUSION: ACL reconstructions using autologous hamstrings using stable fixation techniques showed satisfactory results at the 16.5 months follow-up. However, further studies will be needed to confirm these findings over a longer follow-up period.

Short Term Results of Cementless Total Hip Arthroplasty with Subtrochanteric Shortening Osteotomy in Severe Dysplasia of Hip

PURPOSE: This study examined the clinical, functional and radiological results of total hip arthroplasty with subtrochanteric shortening osteotomy in severe dysplasia of hip. MATERIALS AND METHODS: Seventeen cases of severe dysplasia of the hip, which were treated with total hip arthroplasty with subtrochanteric shortening osteotomy from August 1997 to September 2004, were evaluated. The mean follow-up duration was 52.9 months (range: 26~106). Harris hip score (HHS), leg length discrepancy (LLD) and complication were assessed clinically. Gait analysis (7 cases) and Cybex study (8 cases) for the abductor muscle power were assessed functionally. Bony union and stability around the osteotomy site of the femoral and acetabular components was assessed radiologically. RESULTS: The mean HHS improved from 65.1 (range: 23~87) points preoperatively to 88.2 (range: 72~100) points at the last follow-up. The mean LLD improved from 3.7 (range: 1~7) cm preoperatively to 1.6 (range: 0.5~3.3) cm postoperatively. All cases showed complete bony union of the allograft in the acetabulum and osteotomy site at a mean time of 6 months postoperatively. Gait analysis improved in all cases but there was some limping gait remaining. On the Cybex study, 6 out of 8 cases showed improved abductor muscle peak toque, postoperatively. CONCLUSION: A cementless total hip arthroplasty with subtrochanteric shortening osteotomy is believed to be a useful treatment for severe dysplasia of hip. Despite the improving HHS, the abductor power can be decreased. In these points, gait analysis and the Cybex study are helpful on the follow-up.

Estudo do equilíbrio estático da criança deficiente visual / Study of the static equilibriun of a visual impairment child

A deficiência visual pode levar a atrasos no processo de desenvolvimento neuropsicomotor, principalmente nos casos de cegueira congênita. É reconhecida a importância da visão em sua ação integradora das sensações captadas pelos outros sentidos. Além disso, a visão tem também um importante papel na manutenção do equilibro estático. Considerando esses aspectos, este estudo teve como propósito investigar possíveis alterações no equilíbrio estático de criança com cegueira congênita com idade entre 5 e 6 anos e relacionar a luz da literatura os resultados com os fatores causais. Para a avaliação qualitativa utilizaram-se provas do Exame Neurológico Evolutivo (ENE). Na avaliação quantitativa utilizou-se a Plataforma de Força Cybex Reactor. Concluiu-se que a criança cega deste estudo apresentou um equilíbrio estático diminuído em relação a uma criança vidente de idade semelhante. Quanto aos fatores causais descritos na literatura que podem argumentar esta alteração estão as alterações posturais, a provável falta de calibração que a visão pode deixar de exercer sobre os sistemas proprioceptivo e vestibular e seu efeito conseqüente na integração central desses estímulos.

Visual impairment can cause delay in neural and psychomotor development, especially in congenital blindness. It's known the importance of vision in the integrative action of sensations got by other senses Furthermore, vision has an important role in maintaining static equilibrium. This study had the objective to investigate alterations in the static equilibrium of a congenital blindness child's from 5 to 6 years old, and to relate the results with causal factors. To the quantitative evaluation, it was used the Evolutive Neurological Evaluation (ENE). To the qualitative evaluation, it was used the Cybex Reactor forcing platform. We concluded that the blind child of this study showed a lower static equilibrium when compared to other vision children. Related to causal factors found in the literature, we argue that the alterations are due to postural problems, due to the lack of calibration that vision earl perform on proprioceptive and vestibular systems and its consequence in the central integration of the stimulus.

Correlation Analysis of KT 2000 arthrometer, Cybex Isokinetic Test and Lysholm Knee Score in ACL deficient knees

PURPOSE: The authors performed correlation analysis among the values of KT 2000 arthrometer, Cybex isokinetic test, and Lysholm knee score to reveal the clinical significance and their role in functional evaluation of ACL insufficiency. MATERIALS AND METHODS: Fifty-one patients with isolated ACL insufficiency were evaluated with KT 2000 arthrometer (15, 20, 30 lb, max.manual), Cybex isokinetic test (60 & 180 degrees/sec), and Lysholm knee score. Correlation analysis was performed between the values of the tests. RESULTS: The Lysholm knee scores had significant linear correlation with the values of KT 2000 of maximal manual difference (r=0.587, P<0.05). The Lysholm knee score had significant linear correlation with all the values of Cybex test of hamstring & quadriceps muscle weakness (r=0.585, 0.635, 0.656, 0.720, p<0.05). The degree of muscle weakness and maximum manual difference in KT 2000 did not show any linear correlation. The time lap between injury and evaluation did not show any correlation with any of the above parameters. CONCLUSION: Lysholm knee score appears to be mostly influenced by the degree of muscle weakness than anterior displacement. The values of KT 2000 of maximal manual difference revealed to be best correlated with Lysholm knee score. The time interval after injury cannot be clinically correlated with muscle weakness or Lysholm knee score.

The Effect of Isometric and Isotonic Mixed Exercise in Patients with Degenerative Arthritis of Knee

OBJECTIVE: The purpose of this study is to identify how the isotonic and isometric mixed excercise training for 12 weeks take influence on the muscular strength, muscle size and foot pressure (by EMED ) in patients with degenerative knee joint disease. METHOD: Seven patients with degenerative knee joint disease were chosen for the experimental objects and were trained isotonic exercise program for twelve weeks. Before and after exercise, Cybex, Computed Tomography and EMED were examined. RESULTS: After exercise program, peak torque, peak torque %Bwt and average power were significantly increased at 60o/sec and 180o/sec in both knee flexors and extensors. But peak torque ratio flexor/extensor were not significantly increased. Cross-sectional area of quadriceps and hamstrings were significantly increased. But there were no significant difference in the peak pressure at the heel and time (from initiation of initial contact to peak pressure at the heel). CONCLUSION: We knew that isotonic and isometric mixed exercise training to the patients with degenerative knee joint disease for 12 weeks improved the muscular strength and muscle size, but this is not influenced on heel pressure. So, there may be needed to study with kinetic and kinematic analysis to more experimental patients.

Evaluation of Muscle Strength Using Isokinetic Testing and Functional Result after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Objective measurements of knee of flexor and extensor strength using isokinetic equipment and function after total knee arthroplasty (TKA) were evaluated until postoperative 12 months. MATERIALS AND METHODS: The control group constituted of 15 persons who were of same age and weight without knee problems. Most of the patients (70%) were operated on both knees simultaneously. The patient group consisted of constituted with 20 patients (34 cases). Isokinetic testing (Cybex) of knee flexor and extensor strength of knee and functional evaluation by HSS score was performed preoperatively and at 3, 6, 12 months postoperatively. RESULTS: The peak torque of the knee extensor and flexor muscle in the patient group was decreased by 17-41% compared to the control group. Especially, the peak torque of extensor was more decreased than flexor muscles. At postoperative 12 months, the peak-torque values of hamstring and quadriceps were able to attain the same strength levels of the preoperative knee. According to the grade of the Hospital for Special Surgery knee rating scales by Insall, 28 cases (82 %) in the patient group could obtain good result at postoperative one year. CONCLUSIONS: Exercises to increase the strength of extensor should be emphasized in the rehabilitation programs after TKA

Cybex Evaluation of Muscle Strength Following Arthroscopic Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

Cybex evaluation of muscle strength was performed on 15 patients with chronic anterior cruciate ligament tears following arthroscopic reconstruction using central one-third patella tendon autograft. Cybex testing was done preoperatively and at 3, 6, 9, and 12 months postoperatively. Peak torque and total work of the quadriceps and hamstrings at the angular velocity of 60 degree/sec and 180 degree/sec were measured and analyzed. The results were as follows: l. At the angular velocity of 60 degree/sec, the muscle strength of the quadriceps showed 45.4% deficit in peak torque and 50.9% deficit in total work compared to the contralateral normal knee preoperatively, 48.2% and 49.0% deficit respectively at 3 months after operation, 40.3% and 37.7% deficit at 6 months, 30.6% and 32.5% deficit at 9 months and 23.4% and 24.7% deficit at 1 year after operation. 2. At the angular velocity of 60 degree/sec, the muscle strenggth of the hamstrings showed 32.3% deficit in peak torque and 42.9% deficit in total work compared to the contralateral normal knee preoperatively, 39.3% and 42.4% deficit respectively at 3 months after operation, 27.3% and 32.3% deficit at 6 months, 21.2% and 22.3% deficit at 9 months and 17.9% and 18.4% deficit at 1 year after operation. 3. At the angular velocity of 180 degree/sec, the muscle strength of the quadriceps showed 38.4% deficit in peak torque and 42.0% deficit in total work compared to the contralateral normal knee preoperatively, 41.1% and 47.54% deficit respectively at 3 months after operation, 34.4% and 33.7% deficit at 6 months, 28.5% and 28.6% deficit at 9 months and 21.0% and 22.1% at 1 year after operation. 4. At the angular velocity of 180 degree/sec, the muscle strength of the hamstrings showed 26.9% deficit in peak torque and 31.8% deficit in total work compared to the contralateral normal knee preoperatively, 41.2% and 45.2% deficit respectively at 3 months after operation, 32.3% and 36.0% deficit at 6 months, 21.4% and 25.1% deficit at 9 months and 16.1% and 15.7% at 1 year after operation.

Analysis of Internal Rotator-External Rotator Muscle of the Shoulder with Cybex II / 대한정형외과학회잡지

In recent trends of popularized sports and increased industrial hazards, we need the therapeutic modality in clinical setting, as a training and testing device for sports practicians, and as a method for scientific examination of post-operative status of muscles and joint function for orthopedist. Isokinetic exercise with Cybex II overcomes many biomechanical factors and can be used for fatigued patients by control of resistance. We examined internal rotator and external rotator muscle force of the shoulder joint, in order to acquire the isokinetic normative data of the shoulder for clinical use. The result were as follows 1. Strength and Power decreased as ages getting old, and there was significantdiminishbetween5th decade and 6th decade. 2. Power endurance did not decrease significantly as ages getting old. 3. The mean values of strength and power in internal rotator were higher than external rotator.

Analysis of the Flexor / 대한정형외과학회잡지

As a new concept of resistive exercise, isokinetic exercise was developed during the early 1950's. In isokinetic exercise, the subject works at a fixed speed against variable and totally accommodating resistance. The isokinetic equipment has been used widely as a therapeutic modality in clinical setting, as a training and testing device for sports practicians, and as a method for scientific examination of postoperative status of muscles and joint function for orthopedists. In order to acquire the isokinetic normative data of the knee for clinical use, we examined the flexor and extensor muscle force of the knee joint in 160 subjects with Cybex II. The results were as follows; 1. Mean values of extensor strength were 76.04 ft.-1bs in right knee 75.45 ft.-lbs in left knee, 78.42 ft.-1bs in dominent hand side leg 73.84 ft.-1bs in non-dominent hand side leg, and 82.52 ft.-1bs in dominent leg 71.93 ft.-lbs in non-dominent leg. 2. Sex difference of extensor strength were 95.13 ft.-lbs in male 55.98 ft.-1bs in female, and that of flexor strength were 54.90 ft.-1bs in male 33.68 ft.-1bs in female. 3. Mean of position angle of maximal torque were between 58° and 65° for extensors, 35° and 45° for flexors. 4. Mean of total range of motion at working isokinetically with 60°/sec speed was 99°. 5. Mean values of extensor power were 54.43 ft.-1bs in male 30.63 ft.-lbs in female, and that of flexor power were 35.99 ft.-1bs in male 22.42 ft.-1bs in female. 6. Strength and power decreased as ages getting old, and there was significant diminish between 4th decade and 5th decade. 7. Power endurance had more difference when it was compared with occupation. Mean value of power endurance was between 12 times and 18 times.