Short-time Effect of Sterile Kinesio Tape applied during Anterior Cruciate Ligament Reconstruction on Edema, Pain and Range of Motion.

The purpose of this study was to investigate the effects of edema, pain, and range of motion of knee by sterile kinesio taping within 3 days after ACLR. We hypothesized that sterile taping which is a new material of kinesio taping reduces knee pain and swelling and improves knee range of movement after ACLR. Fifty-sixth subjects who underwent an elective ACLR with were randomized into intervention(n=28) and control groups(n=28). Subjects from both groups received standardized postoperative physiotherapy. Pain by VAS, total ROM of the knee, and circumferential girth were measured at the first, second- and third-day post-surgery. There were found statistically significant differences in all study parameters within each group. Comparison of the study parameters between both groups revealed a statistical significance at various time points except the reduction of pain in the taping group in the early postoperative phase (between the first and second day) (P<0.05). There was no statistical significance in the reduction of swelling or improvement of knee total ROM with kinesio taping. This study showed that sterile kinesio taping reduced pain, improved ROM of the knee and decreased edema in the early post-operative period after ACLR.

Tender point examination with palpation in different shoulder pathologies: A retrospective study.

BACKGROUND: Shoulder pain is a common symptom for non-traumatic shoulder pathologies and affects 4.7-66.7% of entire population. Even with the latest technological advantages, palpation still is a cost and time efficient tool to evaluate the shoulder pathologies. Our aim was to investigate and compare palpation findings in different shoulder pathologies. METHOD: We used first assessments of impingement syndrome (IS) (n = 205), rotator cuff tear (RCT) (n = 185) and frozen shoulder (FS) (n = 210) patients who received treatment between 2010 and 2019 years. Two experienced physiotherapists palpated predefined points: long head of biceps brachii, pectoralis minor, lateral intermuscular septum, proximal tendons of extensor group. These points categorized into "proximal", "mid-proximal", "mid-distal", "distal", "irregular". We also grouped patients by their BMIs. RESULTS: We found RCT patients had higher BMI than IS and FS patients (p < 0.001, p = 0.001); more tender intermuscular septum points and night pain than IS patients (p = 0.001, p = 0.003) and more extensor group proximal tendon points than IS and FS patients (p < 0.001, p = 0.001). "No tenderness" group had lesser resting pain than distal group (p < 0.001) and lesser activity and night pain than middle-proximal, middle-distal, and distal groups (all ps < 0.002). Distal group had higher night pain than middle-proximal group (p = 0.003). Morbidly obese patients had higher night pain than normal and overweight patients (p = 0.003 and p = 0.009). CONCLUSIONS: Tender point distribution varies depending on the pathology with biceps brachii being the most common. RCT patients had higher night pain related to more distal tender points. Patients with higher night pain had increased tenderness in septum intermuscular and extensor muscles' proximal tendons.

Short foot exercises have additional effects on knee pain, foot biomechanics, and lower extremity muscle strength in patients with patellofemoral pain.

BACKGROUND: Patellofemoral pain (PFP) is a common knee problem. The foot posture in a relaxed stance is reported as a distal factor of PFP. However, the effects of short foot exercise (SFE) on the knee and functional factors have not yet been investigated in patients with PFP. OBJECTIVE: This study aimed to investigate the additional effects of SFE on knee pain, foot biomechanics, and lower extremity muscle strength in patients with PFP following a standard exercise program. METHODS: Thirty patients with a 'weak and pronated' foot subgroup of PFP were randomized into a control group (ConG, n= 15) and a short foot exercise group (SFEG, n= 15) with concealed allocation and blinded to the group assignment. The program of ConG consisted of hip and knee strengthening and stretching exercises. SFEG program consisted of additional SFE. Both groups performed the supervised training protocol two times per week for 6 weeks. Assessment measures were pain visual analog scale (pVAS), Kujala Patellofemoral Score (KPS), navicular drop test (NDT), rearfoot angle (RA), foot posture index (FPI), and strength tests of the lower extremity muscles. RESULTS: Both groups displayed decreases in pVAS scores, but it was only significant in favor of SFEG. NDT, RA, and FPI scores decreased in SFEG whereas they increased in ConG. There was a significant group-by-time interaction effect in hip extensor strength and between-group difference was found to be significantly in favor of SFEG. CONCLUSIONS: An intervention program consisting of additional SFE had positive effects on knee pain, navicular position, and rearfoot posture. An increase in the strength of the hip extensors may also be associated with improved stabilization by SFE.

Osteochondral autograft transplantation of the femoral head in sequelae of developmental dysplasia of hip: A case report and review of the literature.

Although osteochondral autograft transplantation (OAT) in the knee and ankle has gained much popularity on the other hand the technique has rarely been applied in the femoral head. In this article, we present a 15-year-old female patient with unstable chondral lesion on the right femoral head. She had a history of open reduction for developmental dysplasia which resulted in avascular necrosis. She had coxa magna, breva and trochanteric overgrowth along with an unstable chondral lesion on the superolateral part of the femoral head. She underwent OAT for chondral lesion, femoral head reshaping and relative neck lengthening. Her Harris Hip Score improved from 55 to 90 in the 18 months of follow-up. The case is unique in a way that the autografts were harvested from the anterior part of the same femoral head that was already intended to be removed during osteochondroplasty.

Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization?

OBJECTIVES: This study aimed to compare the superiority of scapular mobilization, manual capsule stretching, and the combination of these two techniques in the treatment of frozen shoulder patients to evaluate the acute effects of these techniques on shoulder movements. METHODS: This study designed to a single-blinded, randomized, and pre-post assessment study. This study was included 54 patients diagnosed with stage 3 frozen shoulder. Group 1 (n=27) received scapular mobilization, and Group 2 (n=27) received manual posterior capsule stretching. After the patients were assessed, the interventions were re-applied with a crossover design to obtain results for the combined application (n=54). The range of motion, active total elevation, active internal rotation, and posterior capsule tensions of the shoulder joint were recorded before and immediately after mobilization. RESULTS: Statistical analysis showed an increase in all range of motion values (p<0.05), except for shoulder internal rotation (p>0.05), without significant difference among the groups (p>0.05). The posterior capsule flexibility did not change in any group (p>0.05). CONCLUSIONS: Scapular mobilization and manual posterior capsule interventions were effective in improving the acute joint range of motion in frozen shoulder patients.

Turkish version of the Anterior Cruciate Ligament Quality of Life questionnaire.

PURPOSE: To test the measurement properties of Turkish version of the Anterior Cruciate Ligament Quality of Life (ACL-QOL) questionnaire. METHODS: One hundred and nineteen patients with ACL reconstruction (ACL-R) completed internal consistency, agreement, construct validity, floor and ceiling effect analyses. Eighty out of 119 patients with ACL-R completed Turkish version of the ACL-QOL questionnaire twice for the test-retest reliability. A subgroup of thirty-nine patients undergoing physiotherapy were also asked to answer the ACL-QOL questionnaire, the Lysholm Knee Scale (LKS), Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and the short form 36 (SF-36) at pre-operative, 16th week and 2 years post-operatively to assess responsiveness. RESULTS: The questionnaire had high internal consistency (Cronbach's α = 0.95). The paired t test showed no significant difference between the test-retest means. The intraclass correlation was excellent for reliability and agreement in five domains and overall score (ICC 0.95, 0.95, 0.97, 0.95, 0.96 and 0.95; p < 0.001). The standard error of measurement and the minimum detectable change (MDC95) were found to be 3.1 points and 8.7 points, respectively. The questionnaire showed a fair correlation (r = 0.23) with LKS and a poor correlation (r = 0.14) with KOS-ADLS; good and very good construct validity (r = 0.51, r = 0.62) with SF-36 physical component score and mental component score, respectively. No ceiling and floor effects were observed except the subdomain of 'work-related concerns' (22.9 %). A dramatic effect size was demonstrated at the 16th week (2.1) and 2 years (1.1) of follow-up. CONCLUSION: Turkish version of the ACL-QOL questionnaire is a reproducible and responsive instrument that can be used in clinical studies. LEVEL OF EVIDENCE: Diagnostic study, Level I.

Anterior cruciate ligament reconstruction using a hamstring graft: a retrospective comparison of tunnel widening upon use of two different femoral fixation methods.

PURPOSE: To compare femoral and tibial tunnel widening (TW) in patients undergoing anterior cruciate ligament (ACL) reconstruction using an interference screw (IS), or an EndoButton-Continuous Loop(®) on the femoral side, and an IS/staple on the tibial side. METHODS: Between 2006 and 2009, at a single institution, 72 patients who underwent arthroscopic ACL reconstruction with quadrupled hamstring tendon grafting were retrospectively reviewed. Fixation was performed, and with the EndoButton-Continuous Loop(®) device (Group Ι) in 48 patients (mean age 29.1 ± 7.3 years) with a bioabsorbable IS (Group ΙΙ) in 24 patients (mean age 28.5 ± 8.4 years) on the femoral side. Evaluation included standardized anteroposterior (AP) and lateral radiography. The diameters of tunnels at the last follow-up visit (at a median time of 17 months postoperatively) were compared to those noted on radiographs taken 1 day postoperatively. RESULTS: The two groups were similar in terms of age and gender distribution, the operated side, the size of the tunnel created, and the follow-up period (n.s.). Femoral TW at the proximal and middle levels (on both AP and lateral views) in Group ΙΙ was significantly greater than in Group Ι (p < 0.050 for all comparisons). No significant difference in femoral TW at the distal level was evident between the groups, and tibial TW at all levels was similar in both groups (n.s.). CONCLUSION: Femoral TW is less after EndoButton-Continuous Loop(®) fixation and not reduced after IS fixation. Surgeons should be aware of TW when selecting a fixation device for hamstring graft. LEVEL OF EVIDENCE: Therapeutic, retrospective comparative study, Level III.

The effect of progressive eccentric and concentric training on functional performance after autogenous hamstring anterior cruciate ligament reconstruction: a randomized controlled study.

OBJECTIVE: The aim of this study was to assess the functional results of an early onset progressive eccentric and concentric training in patients with autogen hamstring anterior cruciate ligament (ACL) reconstruction. METHODS: Thirty-three patients with autogenous hamstring ACL reconstruction were randomly divided into study (n=16, mean age; 33.87±8.19) and control (n=17, mean age; 32.64±8.21) groups and followed the same ACL rehabilitation program. Additionally, the study group followed a progressive eccentric and concentric training for 12 weeks on the Monitorized Functional Squat System (MFSS) beginning 3 weeks after surgery. The groups were compared according to the isokinetic strength of the knee extensors and flexors, functional performance (the vertical jump test, a single hop for distance test) and the Lysholm knee scale, the Anterior Cruciate Ligament-Quality of Life Questionnaire (ACL-QOL), before and 16 weeks after the surgery. RESULTS: The functional outcomes in terms of the vertical jump test (p=0.012), a single hop-for-distance test (p=0.027), the Lysholm knee scale (p=0.002) and the ACL-QOL questionnaire (p=0.000) demonstrated significantly greater improvement in the study group. No significant difference was reported between groups for isokinetic strength of the knee extensors and flexors (p>0.05). CONCLUSION: Adding progressive eccentric and concentric exercises to the standard rehabilitation protocol may improve the functional results after ACL reconstruction with autogen hamstring grafts.

Comparison of magnetic resonance imaging findings with arthroscopic findings in discoid meniscus.

PURPOSE: It is widely accepted that although valuable in the diagnosis of the discoid meniscus and tears, magnetic resonance imaging (MRI) can be insufficient in determining the type of the tear. This study calculates the sensitivity and specificity of MRI in determining the presence and absence of tears and how these values differ for different types of tears. METHODS: This study is a retrospective review of 10 years of our experience with arthroscopic discoid meniscus treatment between 1999 and 2009. MRI findings were compared with the intraoperative arthroscopic findings in 52 patients with 50 lateral and two medial discoid menisci of which 24 were complete and 28 were incomplete. Tears were classified into six groups: (1) no tear, (2) simple horizontal tear, (3) radial tear, (4) combined horizontal tear, (5) complex tear and (6) longitudinal tear. Sensitivity, specificity, positive and negative predictive values of MRI were calculated for each group separately and for the presence and absence of tears in general. In addition, the effect of age, type of discoid meniscus, and presence and absence of shift on the distribution of tear types were analysed. RESULTS: MRI was found to be 100 % specific and 97.8 % sensitive for determining the presence or absence of a tear with a negative predictive value of 85.7 % and a positive predictive value of 100 %. The specificities were 80 % for simple horizontal, 50 % for radial, 66.7 % for combined horizontal, 55.6 % for complex and 14.3 % for longitudinal tears, whereas the sensitivities were 66.7 % for simple horizontal, 96.9 % for radial, 87.5 % for combined horizontal, 94.6 % for complex and 100 % for longitudinal tears. The presence and absence of shift and type of the discoid were found to affect the distribution of the tear type. CONCLUSIONS: MRI is successful in determining the presence or absence of tears in discoid menisci; however, its ability to determine the tear type is questionable. Complete discoid menisci were found to have tendency towards having a simple horizontal or longitudinal tear, whereas incomplete discoid menisci tend to have radial or combined horizontal tears. Determination of the shift prior to surgery is important since it alters the surgical technique.

Proprioception level after endoscopically guided percutaneous Achilles tendon.

PURPOSE: To evaluate ankle function following endoscopically guided percutaneous Achilles tendon repair. The hypothesis of this study was that patients with percutaneous repair of the Achilles tendon would still display impaired involved side ankle proprioception. METHODS: Nineteen male patients with percutaneous Achilles tendon surgery were tested for bilateral ankle active angle reproduction at 10° dorsiflexion and 15° plantar flexion, peak concentric isokinetic ankle dorsiflexor and plantar flexor torque, one-leg hop for distance, and single-leg vertical jump height. Dominant sides of age- and sex-matched 19 healthy controls were evaluated for ankle active angle reproduction at 10° dorsiflexion and 15° plantar flexion, peak concentric isokinetic ankle dorsiflexor and plantar flexor torque. RESULTS: Peak isokinetic torque, one-leg hop for distance, single-leg vertical jump for height and ankle joint position sense at 10° dorsiflexion did not differ between the affected and unaffected side. Ankle joint position sense for active angle replication at 15° plantar flexion revealed a significant side-to-side difference. Joint position sense at 10° dorsiflexion and at 15° plantar flexion at affected side was poor in patients compared with the controls, while joint position sense at 10° dorsiflexion and at 15° plantar flexion at unaffected side was same in patients compared with the controls. CONCLUSIONS: It has revealed a significant difference in joint position sense at plantar flexion of the patients at least 1 year after percutaneous Achilles tendon surgery compared to their unaffected limb. Large prospective longitudinal studies are needed to evaluate therapeutic interventions designed to improve proprioception.

Manual therapy is an effective treatment for frozen shoulder in diabetics: an observational study.

OBJECTIVES: This study aims to compare the efficacy of manual therapy in the frozen shoulder patients with or without diabetes mellitus. PATIENTS AND METHODS: Between May 2006 and January 2008, 50 patients (10 males, 40 females; mean age 52 ± 10 years; range 40 to 65 years) orthopedic surgeons referred to the Sports Physiotherapy Unit were included in the study. The patients were divided into two groups, including patients with primary frozen shoulder with type II diabetes mellitus (n=12) and non diabetics (n=38). All patients underwent a rehabilitation program including cold application, manual therapy and exercises twice a week. A total of 16 treatment sessions were performed. The most important part of the manual therapy included scapular mobilization and posterior capsule stretching. The range of motion was measured by goniometry. Functional activity status was assessed by Constant's score. The pain level was evaluated by visual analog scale, while muscle strength was evaluated by hand-held dynamometer. Student t-test was used to compare between the parameters of groups, while Paired sample t-test was used to compare pre- and post-treatment parameters of the patients. RESULTS: The range of motion, functional activity status and muscular strength were improved and the pain level was reduced after rehabilitation in all of the patients in both groups (p<0.05). There was no difference in duration of the treatment between the groups (p>0.05). There were no differences in range of motion, functional activity status, pain level, and muscle strength before and after rehabilitation between the groups (p>0.05). CONCLUSION: Manual therapy approaches may be safely applied in diabetic patients with frozen shoulder.

Development of femoral trochlear groove in growing rabbit after patellar instability.

PURPOSE: The geometry of an articular surface is an important determinant of joint function. Although the geometry of the trochlear groove is considered to be important in the pathogenesis of patellofemoral joint disorders, the effects of the patella during the development of the femoral trochlear groove are unclear. This animal study aimed to investigate the relationship between the position of the patella and development of femoral trochlear groove in growing rabbits. METHODS: Twenty-four knees of 12 rabbits were included in this study and were divided into two groups. First group consisted of the left knees and was used as the control group to which no surgical procedures were applied. Second group involved the right knees to which medial soft tissue restraints release was applied before 1 month of age. Computed tomographic (CT) evaluation of both knees of each rabbit was made in their first month of age before medial retinacular release and also during post-op 1-year follow-up. CT measurements included both the angle and depth of the femoral trochlear groove from 3 different parts (proximal, middle and distal) of the distal femur, and then these measurements were averaged. RESULTS: Measurements revealed that while in the control group the groove angle decreased 27.4 degrees and the depth increased 0.11 mm, in the operated counterparts groove angle decreased 16.8 degrees and groove depth increased 0.03 mm, which indicated the flattening of the femoral groove in the operated group. These differences were found to be statistically significant (P < 0.05). CONCLUSION: The results indicated that distal femoral groove with inadequate patellar position becomes more flattened and causes predisposition for patellar instability. Consequently, the clinical relevance of this study was that early reconstruction of the patellofemoral joint should be performed in the childhood to prevent the patellofemoral problems that are likely to be encountered in the following years.

Women with patellofemoral pain syndrome have quadriceps femoris volume and strength deficiency.

PURPOSE: the aim of this study was to assess muscle torque, total volume, and cross-sectional area, and lower limb function of the quadriceps muscle in women with unilateral patellofemoral pain syndrome (PFPS). METHODS: twenty-four women with unilateral patellofemoral pain participated in the study, with each subject acting as their own internal control by using the unaffected limb. quadriceps muscle torque was measured with the Isomed 2000. The total volume and cross-sectional area (CSA) of the quadriceps muscle were measured by using magnetic resonance imaging. Lower limb function was assessed by hop and step-down tests. RESULTS: there was a significant difference in the total volume (P < 0.05) and in the cross-sectional area (P < 0.05) of the quadriceps muscle between affected and unaffected sides. There was a significant difference in the peak torque of the quadriceps muscle at 60°/s between affected and unaffected sides (P < 0.05). There were significant correlations between quadriceps largest CSA and volume on the affected side (P < 0.05) and on the unaffected side (P < 0.05). There were significant negative correlations between the smallest CSA and the peak torque at 180°/s (P < 0.05) and at 60°/s (P < 0.05) on the affected side. CONCLUSIONS: decreased torque, total volume, and CSA of the quadriceps muscle are presented in unilateral with PFPS although cause or effect cannot be established. Large prospective longitudinal studies are needed to detect the changes in the muscle structure and to establish whether these features are a cause of PFPS.

Static balance in patients with patellofemoral pain syndrome.

BACKGROUND: The relationship between one-leg static standing balance (OLSSB) and patellofemoral pain syndrome (PFPS) is unknown. HYPOTHESIS: OLSSB decreases in patients with PFPS. DESIGN: Prospective case series. METHODS: Fifty-two women with unilateral PFPS were enrolled in this study. OLSSB was evaluated with a stabilometer. Q angle was measured with a lengthened-arm universal goniometer. Lower extremity alignment was analyzed with full-length standing anteroposterior teleroentgenograms. Quadriceps and hamstring strength was measured on an isokinetic dynamometer. RESULTS: There were significant differences in OLSSB, Q angle, and strength of quadriceps and hamstring between the symptomatic and asymptomatic sides. There was a correlation between the strength of the quadriceps and hamstring and OLSSB, while there was no correlation between OLSSB and the severity of pain, lower extremity alignment, and Q angle on the symptomatic side. CONCLUSIONS: OLSSB and quadriceps and hamstring strength decreased and Q angle increased on the symptomatic side in PFPS patients. A relationship between OLSSB and pain, Q angle, and lower extremity alignment was not detected, while there was a correlation between the strength of the quadriceps and hamstring and OLSSB. CLINICAL RELEVANCE: A quadriceps and hamstring strengthening may be beneficial to improve OLSSB in patients with PFPS.

Foot biomechanics and initial effects of infrapatellar strap on gait parameters in patients with unilateral patellofemoral pain syndrome.

BACKGROUND: There is limited information on the relationship between plantar foot pressure and patellofemoral pain syndrome (PFPS). In addition, there is not enough research on the effects of an infrapatellar strap on PFPS. OBJECTIVE: The aim of this study was to evaluate the immediate effects of an infrapatellar strap on dynamic pedabarography in patients with unilateral PFPS. METHODS: Clinical case control study design. 18 females subjects with unilateral PFPS were included in the study. Gait parameters were tested using pedabarography during barefoot walking with and without an infrapatellar strap. RESULTS: There were no statistically significant differences in gait trials comparing infrapatellar strap to no strap (P>0.05). In addition, a significant difference (P=0.043) in the % forefoot surface on the involved side demonstrated that body weight is transferred to medial aspect of the foot. DISCUSSION: Although our results show a difference between the forefoot surface % of the affected and unaffected sides of subjects with PFPS there was no indication that an infrapatellar strap had any immediate effect on this parameter. CONCLUSION: It is not clear whether PFPS is a cause or effect of abnormal gait. Further research is warranted to investigate the long-term effects of wearing an infrapatellar strap and associated altered foot biomechanics due to PFPS.

Functional anatomy of the Achilles tendon.

The Achilles tendon is the strongest and thickest tendon in the human body. It is also the commonest tendon to rupture. It begins near the middle of the calf and is the conjoint tendon of the gastrocnemius and soleus muscles. The relative contribution of the two muscles to the tendon varies. Spiralisation of the fibres of the tendon produces an area of concentrated stress and confers a mechanical advantage. The calcaneal insertion is specialised and designed to aid the dissipation of stress from the tendon to the calcaneum. The insertion is crescent shaped and has significant medial and lateral projections. The blood supply of the tendon is from the musculotendinous junction, vessels in surrounding connective tissue and the osteotendinous junction. The vascular territories can be classified simply in three, with the midsection supplied by the peroneal artery, and the proximal and distal sections supplied by the posterior tibial artery. This leaves a relatively hypovascular area in the mid-portion of the tendon where most problems occur. The Achilles tendon derives its innervation from the sural nerve with a smaller supply from the tibial nerve. Tenocytes produce type I collagen and form 90% of the cellular component of the normal tendon. Evidence suggests ruptured or pathological tendon produce more type III collagen, which may affect the tensile strength of the tendon. Direct measurements of forces reveal loading in the Achilles tendon as high as 9 KN during running, which is up to 12.5 times body weight.

Achilles tendon rupture: physiotherapy and endoscopy-assisted surgical treatment of a common sports injury.

Although the Achilles tendon (AT) is the strongest tendon in the human body, rupture of this tendon is one of the most common sports injuries in the athletic population. Despite numerous nonoperative and operative methods that have been described, there is no universal agreement about the optimal management strategy of acute total AT ruptures. The management of AT ruptures should aim to minimize the morbidity of the injury, optimize rapid return to full function, and prevent complications. Since endoscopy-assisted percutaneous AT repair allows direct visualization of the synovia and protects the paratenon that is important in biological healing of the AT, this technique becomes a reasonable treatment option in AT ruptures. Furthermore, Achilles tendoscopy technique may decrease the complications about the sural nerve. Also, early functional postoperative physiotherapy following surgery may improve the surgical outcomes.

The effect of an exercise program in conjunction with short-period patellar taping on pain, electromyogram activity, and muscle strength in patellofemoral pain syndrome.

BACKGROUND: McConnell recommended that patellar tape be kept on all day, until patients learn how to activate their vastus medialis obliquus (VMO) during an exercise program. This application may pose problems because prolonged taping may be inadvisable for some patients or even contraindicated owing to skin discomfort, irritation, or allergic reaction. HYPOTHESIS: Wearing patellofemoral tape for a shorter duration during an exercise program would be just as beneficial as a prolonged taping application. STUDY DESIGN: Prospective cohort. METHODS: Twelve patients and 16 healthy people participated. Patients underwent short-period patellar taping plus an exercise program for 3 months. Numeric pain rating, muscle strength of the knee extensors, and electromyogram activity of the vastus lateralis and VMO were evaluated. RESULTS: There were significant differences in electromyogram activity (P = .04) and knee extensor muscle strength (P = .03) between involved and uninvolved sides before treatment. After treatment, pain scores decreased, and there were no significant differences between involved and uninvolved sides in electromyogram activity (P = .68) and knee extensor strength (P = .62). Before treatment, mean VMO activation started significantly later than that of vastus lateralis, as compared with the matched healthy control group (P = .01). After treatment, these differences were nonsignificant (P = .08). CONCLUSION: Short-period patellar taping plus an exercise program improves VMO and vastus lateralis activation. CLINICAL RELEVANCE: A shorter period of taping for the exercise program may be as beneficial as a prolonged taping application.

Percutaneous suturing of the ruptured Achilles tendon with endoscopic control.

INTRODUCTION: A prospective study of modified percutaneous Achilles tendon repair performed between 1999 and 2005 under local infiltration anesthesia is presented; the study evaluated the results of percutaneous repair technique by visualization of the synovia under endoscopic control, followed by early functional postoperative treatment for surgical intervention of acute Achilles tendon ruptures. PATIENTS: Sixty-two patients (58 males, 4 females, mean age 32) were treated by percutaneous suturing with modified Bunnel technique under endoscopic control within 10 days after acute total rupture. Physiotherapy was initiated immediately after the operation and patients were encouraged to weight-bearing ambulation with a walking brace-moon boot as tolerated. Full weight-bearing was allowed minimum after 3 weeks postoperatively without brace. RESULTS: The procedure was tolerated in all patients. There were no significant ROM limitation was observed. Two patients experienced transient hypoesthesia in the region of sural nerve that spontaneously resolved in 6 months. Fifty-nine patients (95%) including professional athletes returned to their previous sportive activities, while 18 of them (29%) had some minor complaints. The interval from injury to return to regular work and rehabilitation training was 11.7 weeks (10-13 weeks). At the latest follow-up (mean: 46 months; range: 12-78 months), all the patients had satisfactory results with a mean American Orthopedic Foot and Ankle Society's ankle-hindfoot score of 94.6. No re-ruptures, deep venous thrombosis or wound problems occurred. CONCLUSION: The proposed method offers a reasonable treatment option for acute total Achilles tendon rupture with a low number of complications. The rerupture rate and return to preinjury activities are comparable to open and percutaneous without endoscopic control procedures.

Hallux valgus in patients with patellofemoral pain syndrome.

The aim of this study was to investigate the presence of hallux valgus (HV) in patellofemoral pain syndrome (PFPS). Ninety-nine patients with unilateral patellofemoral pain participated. The study was designed with each subject acting as their own internal control by using the unaffected limb for comparison. The HV and intermetatarsal angles were measured by weight-bearing anteroposterior radiographs in patients. Eighty-four out of 99 patients had an abnormal HV angle on the affected side and 78 of 99 patients had an abnormal HV angle on the unaffected side. There were significant differences in the HV angle between affected and unaffected sides (P = 0.003). This study is the first to demonstrate the relationship between HV and PFPS. Further comprehensive biomechanical studies are warranted to analyse the relationship between HV and PFPS.