Early results of subvastus versus medial parapatellar approach in primary total knee arthroplasty.

INTRODUCTION: To evaluate the clinical and radiographic results immediately after total knee arthroplasty, we compared the parapatellar and subvastus approach. MATERIALS AND METHODS: Fifty-two patients with osteoarthritis were randomly assigned to two groups. The measurement was based on clinical and radiographic features. RESULTS: There was a significant difference in passive range of motion. Patients in the subvastus approach group revealed a full knee extension and flexion of 90 degrees significantly earlier than those in the parapatellar group. However, on the day of discharge, both groups were comparable. Radiological assessment revealed analogous results in both groups. Correction of varus or valgus deformity was required in 48 patients. CONCLUSION: Regardless of the surgical approach, the anteroposterior tibial femoral angle improved significantly in both groups. Concerning pain, operation time, blood loss, blood substitution and complications, no major differences could be seen.

[A systemic review of the value of physical therapy in whiplash neck injury]. / Wert der Physiotherapie bei der Halswirbelsäulendistorsion: ein systematischer Uberblick.

AIM: A systematic review is performed to evaluate the clinical effects of initial immobilisation by a neck collar and physiotherapy in whiplash neck injury. METHOD: A computer aided Medline research (1985 - 2002) of randomised clinical trials concerning both rehabilitation concepts was conducted. A rating system was used to assess the methodological score of each study. Their results were analysed and a final statement for evidence according to three main parameters (neck pain, range of motion, and patients comfort) was postulated. RESULTS: Eight randomised clinical trials were identified. Six studies were determined as high-quality trials. For the neck, back immobilisation do not appear to improve the patients' conditions sufficiently. In comparison, for physiotherapy there is strong benefit for pain, range of motion and patients' comfort in comparison to no treatment and a soft collar. CONCLUSION: Principally, am early active rehabilitation with physiotherapy without initial immobilisation is highly recommended in whiplash neck injury.

[Non-operative treatment of chronic low back pain: specific back muscular strength training versus improvement of physical fitness]. / Konservative Therapie des chronischen Rückenschmerzes: spezifisches Krafttraining der Rückenmuskulatur oder Steigerung der allgemeinen körperlichen Fitness.

AIM: A systematic review was performed to evaluate the clinical effects of specific back muscle and non-specific physical fitness training in chronic low back pain. METHOD: A computer-aided Medline research (19861999) of randomised clinical trials concerning both rehabilitation concepts was conducted. A rating system was used to assess the methodological score of each study. The results were analysed and a final statement for evidence according to three main parameters (back pain, physical capacity, and patients comfort) was postulated. RESULTS: Twelve randomised clinical trials were identified. Nine studies were determined as high-quality trials. For chronic low back pain specific back muscle exercises as well as non-specific fitness training were able to improve the patients' conditions sufficiently. In comparison with passive treatment or no treatment there is strong evidence for pain and physical capacity in both groups, but only a positive influence for patient' comfort in fitness groups. Nevertheless, a confrontation of both concepts in two studies did not reveal any notable differences in all three parameters. CONCLUSION: Principally, a specific strength training for back rnuscles as well as a non-specific fitness training are comparably effective to rehabilitate chronic low back pain.

Significance of sympathetic skin response in the assessment of autonomic failure in patients with spinal cord injury.

As a result of spinal cord injury (SCI) descending spinal sympathetic pathways can be severed. Because of its clinical significance, the aim of this study was to assess the disturbance of the spinal sympathetic pathway by clinical and electrophysiological examinations. The sympathetic skin response (SSR) due to electrical stimulation of median nerve and transcranial magnetic stimulation was examined in 70 patients with complete and incomplete spinal cord injury. Clinical and neurological examinations were performed in these patients according to the protocol of the American Spinal Injury Association (ASIA). The SSR can be used to assess the integrity of the spinal sympathetic nervous system. In patients with complete tetraplegia and paraplegics with high thoracical lesions (up to level T3) SSRs of the hands and feet were absent. In patients with complete paraplegia and thoroacic lesions from level T4 up to T8 the SSRs could be evoked in the hands but not in the feet. However, in paraplegics with lumbal and thoracic lesions below level T8 SSRs of the hands and feet could be recorded. In about 50% of the patients with clinically incomplete SCI lesions SSR potentials were abolished, indicating that the spinal sympathetic system was severely affected. There was no patient with preserved SSR potentials who developed symptoms of autonomic dysreflexia (AD). However, all patients with episodes of AD showed abolished SSR at the hands and feet even in incomplete SCI patients. The results of the SSR recordings in SCI patients fit with the assumption that the development of AD is related to the disconnection of the spinal sympathetic centers from supraspinal control.

Recovery of locomotion after spinal cord hemisection: an X-ray study of the cat hindlimb.

Hemisection of the spinal cord in adult cats is a suitable model to st udy the mechanisms underlying recovery of motor functions. The initial paresis of the hindlimb is followed by a considerable improvement of locomotor functions of the affected hindlimb. Kinematic analyses of treadmill locomotion were performed from 10 days to 8 months after complete hemisections (right side) of the spinal cord at the thoracolumbar level, using X-ray cinematography for precise measurements of the hindlimb joint angles. The footfall pattern and the electromyogram were recorded. Motor control of both proximal and distal hindlimb joints improved substantially during the 1st postoperative month. However, persistent locomotor deficits were still present several months after hemisection. They could be divided into three groups of symptoms: (1) The gait pattern was disturbed with regard to interlimb coordination. The stance-phase duration of the right hindlimb was shortened. (2) The flexor capacity of the affected hindlimb was reduced, resulting in a slow insufficient flexion of the hip, knee, and ankle during the swing phase. (3) The timing of the flexion-extension events was impaired. The onset of the E1-extension was delayed and the amplitude was reduced. Electromyographic patterns of muscle activity during locomotion of the lesioned side limb differed from the contralateral hindlimb, which served as a contro. The results indicate that in spite of a good short-term functional improvement there are long-term locomotor deficits present after spinal cord hemisection.

X-ray study of the cat hindlimb during treadmill locomotion.

With pulsed X-ray cinematography we have analysed the angular excursions of the distal hindlimb joints (proximal interphalangeal, PIP; metatarsophalangeal, MTP; ankle) in cats walking on a treadmill. These distal joints transmit the body weight and the dynamic forces onto the ground. We have included the knee and hip joints in the analysis to relate the angular excursions of the proximal and distal joints and to verify the data previously obtained with external markers on the kinematics of the proximal joints. At the beginning of the stance phase the PIP joints flexed rapidly, the MTP joints extended slowly and the ankle and knee yielded under body weight. Whereas the PIP joints maintained a rather constant angular position of approximately 75 degrees throughout the stance phase, extension continued in the MTP joints from approximately 230 degrees at touch-down to approximately 270 degrees at the end of the stance phase. Around 50 ms before lift-off the MTP joints flexed rapidly. Early (approximately 30 ms) after lift-off this flexion changed into a slow extension. The PIP joints extended swiftly at the stance-swing transition and moderately at the end of the swing phase. During the middle part of the swing phase they flexed slowly. Small rotatory movements around the long axis of the foot took place in the last 100 ms of the swing phase. The results of this study on the distal joints are discussed in relation to the placing of the paw, to the translation of forward propulsion into a MTP movement and to the lifting of the paw (conventionally described as toe curling). They show a differentiated mechanical interaction between the different distal limb joints during these different phases, which must be known in detail to interpret the corresponding electromyographic data and to understand how the hip is moved forward over the MTP joints which serve as the final pivot during stance.