[Foot load with different restrictions of knee joint extension]. / Die Bedeutung der Kniestreckfähigkeit für die plantare Druckverteilung.

BACKGROUND: Dynamic pedobarography has been used for various orthopaedic issues. There is to date a lack of studies describing possible factors of influence with regard to lower limb function. MATERIAL AND METHODS: Ten healthy volunteers were asked to perform a total of six trials (12 left and right steps, data from the right foot) wearing the M.4® ACL/CL knee brace (De Royal Industries, Powell, USA) around the right knee. The limitation ranged from full extension (baseline) to an extension lag of 45 degrees. Peak pressure values were obtained from the hindfoot, midfoot, forefoot and toes with the pedar X system (novel Inc., Munich, Germany). Medians were compared with the two-tailed non-parametric Wilcoxon matched-pairs signed rank test; p-values of less than 0.05 were regarded to be statistically significant. RESULTS: Our study design allows the detection of differences in foot load of 20 % baseline with a power of 80 % or more. With this setting we found no statistically significant reduction of foot load up to a 20 degree extension lag of the knee joint. The opposite hindfoot load was significantly increased with 30 degrees extension lag and significantly reduced for the opposite hindfoot with 45 degrees. CONCLUSION: As can be seen from the perspective of foot load, the intact function of adjacent joints seems to compensate an extension lag of the knee joint up to 20 degrees, but hindfoot load changes significantly with 30 degrees or more, which may be clinically relevant for patients at risk of plantar ulcerations.

Advancement of physical process by mental activation: a prospective controlled study.

According to the literature, patients who are significantly impaired by physical mobility limitations can be rehabilitated if the patient's working memory is used to capacity. The conclusion that periodic mental activity improves physical rehabilitation should be evaluated. This is a prospective, controlled, and randomized open study of patients who underwent a total hip arthroplasty (THA). Sixteen patients who played the video game Dr. Kawashima's Brain Training: How Old Is Your Brain? were compared in terms of rehabilitation progress to 16 individuals who did not play. Harris Hip and Merle d'Aubigné scores were evaluated 1 d preoperation and again 12 +/- 1 d postoperation. Preoperation, no significant differences in hip scores between the gaming and control groups were found (median Harris Hip score: 39 vs 33, respectively, p = 0.304; median Merle D'Aubigné score: 12 vs 9, respectively, p = 0.254). Postoperation, there were significant differences between the gaming and control groups (median Harris Hip score: 76.0 vs 56.5, respectively, p = 0.001; median Merle D'Aubigné score: 16.0 vs 13.5, respectively, p = 0.014). Within both groups, the posttest scores significantly improved; however, the increase for the gaming group was greater for both measures. Because the influence of age, sex, and level of education can be excluded, it can be assumed that mental activities can improve physical rehabilitation after THA.

[Insufficiency fractures of the feet and lower limbs in rheumatoid arthritis]. / Insuffizienzfrakturen an Fuß und Unterschenkel bei rheumatoider Arthritis.

BACKGROUND: Insufficiency fractures are generally a rare event, especially of the hindfoot. These are often overlooked in the initial stage, however, they must be regarded as a differential diagnosis in the range of possible causes in patients with rheumatoid arthritis and unclear complaints. MATERIAL AND METHODS: Outpatients in an arthritis care unit from 2009-2011 were analyzed for fractures of the hindfoot and distal tibia. RESULTS: A total of six patients with seven fractures without adequate trauma were found in the cohort. All patients had received disease modifying therapy and corticosteroids. All fractures could be successfully treated without surgery. CONCLUSION: Insufficiency fractures in patients with rheumatoid arthritis are a typical finding after several years of the disease. They are directly related to the disease and medication and can usually be successfully treated conservatively.

Longitudinal in vivo reproducibility of cartilage volume and surface in osteoarthritis of the knee.

OBJECTIVE: The aim of this study was to evaluate the longitudinal reproducibility of cartilage volume and surface area measurements in moderate osteoarthritis (OA) of the knee. MATERIALS AND METHODS: We analysed 5 MRI (GE 1.5T, sagittal 3D SPGR) data sets of patients with osteoarthritis (OA) of the knee (Kellgren Lawrence grade I-II). Two scans were performed: one baseline scan and one follow-up scan 3 months later (96 +/- 10 days). For segmentation, 3D Slicer 2.5 software was used. Two segmentations were performed by two readers independently who were blinded to the scan dates. Tibial and femoral cartilage volume and surface were determined. Longitudinal and cross-sectional precision errors were calculated using the standard deviation (SD) and coefficient of variation (CV%=100x[SD/mean]) from the repeated measurements in each patient. The in vivo reproducibility was then calculated as the root mean square of these individual reproducibility errors. RESULTS: The cross-sectional root mean squared coefficient of variation (RMSE-CV) was 1.2, 2.2 and 2.4% for surface area measurements (femur, medial and lateral tibia respectively) and 1.4, 1.8 and 1.3% for the corresponding cartilage volumes. Longitudinal RMSE-CV was 3.3, 3.1 and 3.7% for the surface area measurements (femur, medial and lateral tibia respectively) and 2.3, 3.3 and 2.4% for femur, medial and lateral tibia cartilage volumes. CONCLUSION: The longitudinal in vivo reproducibility of cartilage surface and volume measurements in the knee using this segmentation method is excellent. To the best of our knowledge we measured, for the first time, the longitudinal reproducibility of cartilage volume and surface area in participants with mild to moderate OA.