Comparison of Foot Kinematics Between Normal Arch and Flexible Flatfoot Using the Oxford Foot Model: A Matched Case-Control Study.

Background: Symptomatic flexible flatfoot causes alterations in gait, but exactly how this condition affects the intersegmental motion of the foot during the gait cycle remains unclear. Previous studies have examined the kinematics, yielding inconsistent findings. Therefore, the objective of this study was to investigate how flexible flatfoot deformity, defined as Johnson and Strom classification staging II, affects the intersegmental motion of the foot during fast walking based on a comparison with the matched control group. Methods: Eleven participants with symptomatic flexible flatfoot and 11 healthy matched control participants were recruited using a foot screening protocol incorporated through a foot physical examinations and radiographic measurements. All demographic characteristics exhibited comparable profiles between the groups. During controlled walking, kinematic outcomes pertaining to the hallux, hindfoot, forefoot, and tibia were collected using the multisegmental Oxford Foot Model. Results: All spatiotemporal parameters were comparable between the groups. In comparison to the control group, individuals with symptomatic flexible flatfoot demonstrated increased hallux valgus and plantarflexion, increased forefoot abduction, heightened hindfoot eversion, and internal rotation. Notably, no significant major differences were observed in the tibia motion segment. Further, significant correlations were identified between static foot measurements and the extent of the maximum deviation observed during dynamic kinematic assessments. Conclusion: Compared with age- and gender-matched controls, participants with symptomatic flexible flatfoot exhibited significant gait pattern deviations. A significant correlation also exists between static foot deformity measurements and dynamic kinematic deviations. Collectively, these findings have implications for developing targeted therapeutic interventions to address flexible flatfoot. Level of evidence: Level III, diagnostic study.

Comparison of medial tibiofemoral joint mechanics between all-suture anchors and transtibial pullout technique for posterior medial meniscal root tears.

BACKGROUND: The posterior medial meniscal root tear (PMMRT) seriously impacts the tibiofemoral joint biomechanics. Two available techniques for PMMRT repair include the transtibial pullout (TPO) repair and all-suture anchor (ASA) repair techniques. These techniques have not been compared biomechanically. METHODS: A total of 20 fresh porcine cadaveric knee specimens were used. All 20 knees were randomly and evenly distributed into four groups (five specimens per group): (1) intact posterior meniscal root, (2) PMMRT, (3) TPO repair technique for PMMRT, and (4) ASA repair technique for PMMRT. The tibiofemoral contact mechanics were investigated using a pressure sensor. All knee specimens were tested by being loaded with 600 N axial compressive force at three different flexion angles (0°, 45°, and 90°). The contact surface area, contact pressure, peak pressure, and time-zero displacement were recorded. RESULTS: The PMMRT caused a significant decrease in contact surface area, an increase in contact pressure, and peak pressure from the reference values observed in the intact meniscus group (P = 0.05, 0.016, and 0.008, respectively). After fixation, no significant difference was observed between the ASA and intact group. Meanwhile, significant differences were found between the TPO and intact group in terms of contact surface area, contact pressure, and peak pressure. In the comparison between the two techniques, the ASA group demonstrated higher contact surface area than the TPO group at the average knee flexion angle (p = 0.05). CONCLUSION: For most testing conditions, the ASA technique demonstrated superior biomechanical property in terms of contact surface area compared with the TPO technique under compressive loading conditions. The ASA technique could also restore the tibiofemoral contact mechanics to be comparable with those of the native intact knee. Meanwhile, a significant difference in tibiofemoral mechanics, compared with the intact knee, could be observed in the TPO technique.

Periarticular injection in addition to interscalene nerve block can decrease opioid consumption and pain following total shoulder arthroplasty: a comparison cohort study.

BACKGROUND: Interscalene nerve block (INB) is an effective technique to provide postoperative analgesia for total shoulder arthroplasty (TSA). However, the analgesic effects of the block typically resolve between 8 and 24 hours postadministration, which results in rebound pain and subsequent increased opioid use. The objective of this study was to address this issue by determining how adding an intraoperative periarticular injection (PAI) in combination with INB affects acute postoperative opioid consumption and pain scores in patients undergoing TSA. We hypothesized that compared with INB alone, INB + PAI will significantly reduce opioid consumption and pain scores for the first 24 hours postsurgery. METHODS: We reviewed 130 consecutive patients who underwent elective primary TSA at a single tertiary institution. The first 65 patients were treated with INB alone, followed by 65 patients treated with INB + PAI. The INB used was 15-20 mL of 0.5% ropivacaine. The PAI used was 50 mL of a combination of ropivacaine (123 mg), epinephrine (0.25 mg), clonidine (40 µg), and ketorolac (15 mg). The PAI was injected using a standardized protocol: 10 mL into the subcutaneous tissues prior to incision, 15 mL into the supraspinatus fossa, 15 mL at the base of the coracoid process, and 10 mL into the deltoid and pectoralis muscles-a protocol analogous with a previously described technique. For all patients, a standardized postoperative oral pain medication protocol was used. The primary outcome was acute postoperative opioid consumption represented by morphine equivalent units (MEUs), whereas the secondary outcome was visual analog scale (VAS) pain scores over the first 24 hours postsurgery, operative time, length of stay, and acute perioperative complications. RESULTS: No significant differences in demographics existed between patients who received INB alone vs. INB + PAI. Patients who received INB + PAI had a significantly lower 24-hour postoperative opioid consumption compared to the INB alone group (38.6 ± 30.5 MEU vs. 60.5 ± 37.3 MEU, P < .001). Additionally, VAS pain scores for the first 24 hours postsurgery in the INB + PAI group were significantly lower compared to those for the INB alone group (2.9 ± 1.5 vs. 4.3 ± 1.6, P ≤ .001). No differences existed between groups regarding operative time, length of inpatient stay, and acute perioperative complications. CONCLUSION: Patients undergoing TSA with INB + PAI demonstrated significantly decreased 24-hour postoperative total opioid consumption and 24-hour postoperative pain scores compared to the group treated with INB alone. No increase in acute perioperative complications related to PAI was observed. Thus, compared to an INB, the addition of an intraoperative periarticular cocktail injection appears to be a safe and effective method to reduce acute postoperative pain following TSA.

The preferable shoulder position can isolate supraspinatus activity superior to the classic empty can test: an electromyographic study.

BACKGROUND: Supraspinatus (SSP) strength tests are an important shoulder examination tool for clinical evaluations of patients with a suspected SSP tear. While the empty can (EC) test is widely used to diagnose SSP dysfunction, the test cannot selectively activate SSP activity. The aim of this study was to access the electromyographic (EMG) activity within SSP, deltoid, and surrounding periscapular muscles after resisted abduction force to determine which shoulder position helps best isolate SSP from deltoid activity. METHODS: A controlled laboratory EMG study was conducted. Specifically, we conducted an EMG analysis of the seven periscapular muscles (i.e., the middle deltoid, anterior deltoid, SSP, upper trapezius, posterior deltoid, infraspinatus, and pectoralis major) in 21 healthy participants, without any history of shoulder disorder, aged 29 ± 0.9 years old with a dominant-right arm. EMG activities were measured during resisted abduction force according to comprehensive shoulder positions in abduction, horizontal flexion, and humeral rotation. The supraspinatus to middle deltoid (S:D) ratio was calculated using the standardized weighted EMG and the maximum voluntary isometric contraction of the SSP and middle deltoid muscles, for each shoulder position to determine the best isolated SSP muscle strength test position. Results were analyzed with the Kruskal-Wallis test for non-normally distributed data. RESULTS: Shoulder abduction, horizontal flexion, and humeral rotation significantly affected the activity of the middle deltoid, SSP, and S:D ratio (P < 0.05). The S:D ratio increased significantly in lower degrees of shoulder abduction, lower degrees of horizontal flexion, and external humeral rotation over internal rotation. The greatest S:D ratio (3.4 (0.5-9.1)) occurred at the shoulder position of 30° shoulder abduction combined with 30° horizontal flexion and external humeral rotation. Conversely, the classic EC position manifested nearly the smallest S:D ratio (0.8 (0.2-1.2)). CONCLUSION: Application of the SSP strength test in the shoulder position of 30 degrees abduction, 30 degrees horizontal flexion, and external humeral rotation offers the best position to isolate the abducting activity of the SSP from that of the deltoid, which could help with diagnosis among patients with chronic shoulder pain with a suspected SSP tear condition.

Anatomic Osteochondral Allograft Reconstruction for Concomitant Large Hill-Sachs and Reverse Hill-Sachs Lesions.

Glenohumeral instability causing bipolar bone loss is increasingly being recognized and treated to minimize recurrence. Large Hill-Sachs and reverse Hill-Sachs lesions of the humerus must be addressed at the time of surgery to prevent recurrent dislocations and restore the native anatomic track. For patients with epilepsy, locked dislocations may create defects that must be addressed with bony procedures, including osteochondral allograft reconstruction as soft-tissue remplissage may not adequately addresses the magnitude of the bone loss. Osteochondral allografts have been successfully used to address bony defects ranging from 20% to 30% of humeral bone loss whereas shoulder arthroplasty is indicated for larger defects where the native anatomy can no longer be restored. In this Technical Note, we present a technique to address concomitant large Hill-Sachs and reverse Hill-Sachs lesions.

Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients.

PURPOSE: Unplanned overnight admission (UOA) is an important indicator for quality of care with ambulatory knee arthroscopic surgery (AKAS). However, few studies have explored the factors related to the UOA and how to predict UOA after AKAS. This study aimed to evaluate the effectiveness of a standardized peri-operative protocol for the AKAS and identify whether a correlation exists between the peri-operative surgical factors and UOA in the patients undergoing AKAS. We hypothesized that more surgical invasiveness and prolong tourniquet time increase the risk of UOA after AKAS. METHOD: A prospective cohort study was conducted between October 2017 and March 2021. All 184 patients operated on standard AKAS protocol. The UOA is defined as overnight hospitalization of a patient undergoing AKAS. Demographic and peri-operative data were recorded, and the procedure was categorized based on the surgical invasiveness based on less invasive (intra-articular soft tissue surgery) (n = 65) and more complex surgery (involving extra-articular soft tissue surgery or ligamentous reconstruction) (n = 119). The clinical risk factors for UOA were identified and analyzed with multivariate analysis. RESULTS: The incidence of UOA in the more complex group (n = 7, 14.3%) was significantly higher than in the less invasive group (n = 3, 4.6%) (p = 0.049). The peri-operative factors significantly associated with UOA were age, more complex surgery, and longer tourniquet time (p < 0.10 all). However, the multivariate analysis revealed that longer tourniquet time was the only significant predictor for UOA (OR = 1.045, 95% CI = 1.022-1.067, p = 0.0001). The optimal cut-off points of tourniquet time for predicting UOA with the highest Youden index in the less invasive and more complex groups were 56 minutes and 107 minutes, respectively. CONCLUSION: The UOA after AKAS is more common in more complex surgery compared to less invasive surgery. This study showed that unplanned admission significantly associated with many factors-as patient factors, surgical invasiveness, and tourniquet time. However, tourniquet time is the only independent predictor for UOA. Therefore, strict perioperative management protocol must be applied in AKAS, and all patients having these risk factors should be prepared for UOA.

The University of California-Los Angeles (UCLA) shoulder scale: translation, reliability and validation of a Thai version of UCLA shoulder scale in rotator cuff tear patients.

BACKGROUND: UCLA Shoulder Scale is a useful evaluation tool to assess the functional outcome of shoulder after treatments. It has been translated into several languages. The objectives of this study were to translate UCLA Shoulder Scale into Thai language and validate the translated version in patients with rotator cuff tear. METHODS: This study consists of 2 phases: 1) Development of the Thai version of UCLA Shoulder Scale and 2) Validation of the translated version. The UCLA Shoulder Scale was translated into Thai according to the international guideline. Seventy-eight subjects with a mean age of 71 ± 11.5 took part in the study. All had shoulder pain and rotator cuff tear according to MRI from 2019 to 2020. Four patients were excluded due to incomplete questionnaires. The data from 21 patients whose symptoms in shoulder joint had not changed within 14 days were analyzed with the UCLA Shoulder Scale test-retest using intraclass correlation (ICC), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC). The Thai version of UCLA Shoulder Scale was compared to the validated Thai versions of American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff (WORC) and Shortened version of The Disability of the Arm, Shoulder and Hand (QuickDASH) shoulder scores. RESULTS: Thai version of UCLA Shoulder Scale was developed following the guideline. Moderate to strong correlations were found using Spearman's correlation coefficient between pain, function and total score of Thai version of UCLA Shoulder Scale. The reliability of total UCLA Shoulder Scale was excellent (ICC = 0.99, 95% CI 0.97-1.00), whereas agreement assessed with SEM and MDC (0.18 and 0.50 respectively) demonstrated a positive rating. The validity analysis of total UCLA Shoulder Scale (Thai version) showed moderate to strong correlations with total ASES, total WORC and QuickDASH (Thai versions). The Thai version of UCLA Shoulder Scale showed no floor and ceiling effects from the results. CONCLUSION: The Thai version of UCLA Shoulder Scale is a reliable and valid tool for assessing the function and disability of the shoulder in Thai patients who have rotator cuff tear.

Correlation between full-thickness degenerative supraspinatus tear and radiographic parameters including the acromiohumeral centre edge angle and the greater tuberosity angle.

BACKGROUND: Many radiographic parameters associated with the extrinsic cause of supraspinatus tears have been proposed. The aim of this study was to assess the relationship between a full-thickness degenerative supraspinatus tear (FTDST) and the patient's radiographic parameters, including the acromiohumeral centre edge angle (ACEA) and the greater tuberosity angle (GTA). METHODS: A retrospective study was conducted. We included 116 patients who underwent shoulder arthroscopic surgery at our institute. The case group included FTDST patients, whereas the control group also included patients without evidence of supraspinatus tears. In each patient, the ACEA and GTA values were measured and analyzed by two independent observers. Intra- and interobserver reliabilities were assessed. Multivariate regression analysis was performed. RESULTS: The ACEA values were significantly increased in the FTDST group with a mean of 26.44° ± 9.83° compared with 16.81° ± 7.72° in the control group (P < 0.001). Multivariate regression analysis also showed that higher ACEA values were associated with an FTDST (odds ratio 1.16 per degree, P = 0.01). For GTA values, a statistically significant difference was found with a mean of 70.92° ± 6.64 compared with 67.84° ± 5.56 in the control group (P = 0.02). However, stepwise regression analysis did not indicate that GTA was a predictor of FTDST. CONCLUSIONS: Our study demonstrated that the presence of increased ACEA values is an independent significant risk factor for the presence of FTDSTs. Consequently, GTA values may be less helpful in assessing the risk of FTDST, especially in this specific population.

Effectiveness of a Simple Auditory Feedback Insole (Sim-Insole) for Touchdown Weight-Bearing Training in At-Risk Volunteers with Poor Compliance: A Crossover Study.

INTRODUCTION: Recent studies have shown that biofeedback devices are effective for weight-bearing (WB) training. However, these devices have limitations due to high costs and inadequate evidence of their effectiveness among poor-compliance individuals. This study aimed to assess WB compliance after touchdown weight-bearing (TDWB) training by the standard bathroom scale (BS) method and to evaluate the efficacy of our innovative simple auditory feedback device (Sim-Insole). METHODS: In this crossover study, healthy volunteers were trained for TDWB (targeting 20% of bodyweight [BW]) with the BS method and assessed with the Sim-Insole without feedback (phase 1), and then completed a 30-min wash-out period and underwent re-assessment with Sim-Insole with feedback (phase 2). Satisfaction was evaluated with a self-assessment questionnaire. Those who had and had not experienced a weight-bearing force (WBF) >25% of BW were classified as high-risk and low-risk groups, respectively. Steps with percentage of WB &15%, 15%-25%, and >25% were defined as under-zone, in-zone, and over-zone, respectively. RESULTS: Fourteen volunteers (70%) were classified as high-risk after the BS method. Without auditory feedback, the high-risk group demonstrated a significantly higher average percentage of WB and higher average lowest WBF compared to the low-risk group (18.8% vs. 13.7% and 74.3N vs. 60.2N, respectively, p=0.002 for both). With the use of auditory feedback with Sim-Insole in the high-risk group, the cadence, percentage of WB, highest absolute WBF, proportion of over-zone step, and confidence for TDWB improved significantly compared to those with the BS method (p&0.05 for all). However, the low-risk group showed only a significant improvement in cadence (p=0.047) and a non-significant trend for improvement in the percentage of WB (p=0.089), compared to the BS method. CONCLUSION: Sim-Insole is effective for TDWB training. This device significantly improved WB compliance with regard to excessive WB, walking speed, and the confidence of volunteers in the high-risk group with poor compliance.

Reliability and Correlation of the Force-PRO Device and Computer-Assisted Navigation System for Measurement of Acetabular Cup Position in Total Hip Arthroplasty.

INTRODUCTION: Acetabular cup malposition is very common in total hip arthroplasty (THA) and is significantly associated with many serious postoperative complications, such as dislocation, wear and loosening, and decreased range of motion. To improve the accuracy of intraoperative assessment, we recently developed an innovative sensor-based navigation system (Force-PRO device) using an inertial measurement unit and a 3D-printed liner for acetabular cup measurement, and aimed to evaluate its reliability and correlate its accuracy with that of a computer-assisted navigation system (CANS). DESIGN: Method-comparison study between the Force-PRO device and a standard CANS in a 1:1 pelvic bone model. METHODS: The test-retest reliability of both the Force-PRO device and CANS, and agreement between the Force-PRO device and CANS, for the measurement of acetabular inclination and anteversion angles, were examined using 40 random acetabular cup positions. Statistical analysis was performed by using limits of agreement and intraclass correlation coefficient (ICC). RESULTS: The mean differences in the inclination angle and anteversion angle in test-retest of the Force-PRO device were -0.43°±1.03° and -0.40°±0.78°, respectively. The mean differences in the inclination angle and anteversion angle between the Force-PRO device and CANS were 0.70°±0.94° and -0.10°±0.44°, respectively. Excellent reliability in the inclination and anteversion angles of the Force-PRO device and excellent agreement between the Force-PRO device and CANS were demonstrated, with ICC values of 0.994 and 0.997, and 0.993 and 0.999, respectively. CONCLUSION: The Force-PRO device showed excellent reliability equivalent to CANS with excellent agreement in acetabular cup position measurement comparable to that with CANS. Future clinical studies will be needed to evaluate the efficacy of this device.

Innovative Force-PRO device to measure force and implant position in total hip arthroplasty.

Total hip arthroplasty (THA) is the appropriate treatment for hip pain, dislocation, and dysfunction. THA refers to surgery to replace a hip implant, which is an effective way to recover normal hip function. The design of an implant imitates hip functions and allows bone growth in the implant area. However, it should be noted that the implant can dislocate after surgery. The main factor that should be considered during surgery is the correct position of the implant component. The acetabular cup of the hip implant should be positioned at [Formula: see text] anteversion and [Formula: see text] inclination. The evaluation of the implant inclination and anteversion during the operation decrease the risk of the implant dislocation after surgery. Developing a new innovative Force-PRO device can aid the doctor in evaluating the force on the surface of the acetabular liner and the angle of the acetabular liner during the hip implant operation. This device consists of two main sensors-force sensors and inertial measurement unit sensors. Furthermore, the 3D printings of an implant's parts should be specifically designed to integrate with these sensors. To develop the graphical user interface application, C[Formula: see text] should be the programming language of use. The graphical user interface application communicates between the device and user via a wireless communication system. CT-based imaging and force gauge measurement are the methods to evaluate the efficiency of this device. For this purpose, the sterile method is considered.