The effects of progressive neuromuscular exercise program and taping on muscle strength and pain in patellofemoral pain. A randomized controlled blind study.

PURPOSE: To investigate the effects of corrective kinesio taping applied on patellofemoral and foot joint in addition to a progressive neuromuscular exercise program in women with Patellofemoral Pain (PFP) on knee pain and muscle strength. METHODS: Thirty females (20-45 years), diagnosed with unilateral PFP were randomly divided into two groups: the exercise (n = 15) and the exercise and taping (n = 15). Both groups performed three-stage progressive neuromuscular exercises for 12 weeks as home exercises. Plantar and knee corrective taping was additionally applied to the exercise and taping group. The knee pain was measured using the Visual Analogue Scale (VAS) during stair ascending and descending. Isokinetic dynamometer was used to evaluate the isokinetic muscle strength of the hamstring and quadriceps femoris muscles. All assessments were conducted before the treatment, at the end of the 6th-week treatment, and at the end of the 12th week of the treatment. RESULTS: After intervention, pain, and muscles peak torque were improved in all groups (p ˂ 0.05). The decrease in pain and the increase in quadriceps and hamstring muscle peak tork were found to be significant for both groups (p < 0.05). In the taping group, the decrease in pain during stair descending and the increase in hamstring muscle tork were higher than that of the exercise group (p < 0.05). CONCLUSION: In order to reduce pain in a short time and control it in the long term, it will be beneficial to tape the knee and foot in addition to neuromuscular exercises.

The effect of postural stabilization exercises on pain and function in females with patellofemoral pain syndrome.

OBJECTIVE: This study aimed to investigate the effect of postural stabilization exercises on pain, muscle strength and function in females with patellofemoral pain. METHODS: Forty-two volunteers with patellofemoral pain syndrome (PFPS) were included in this study. The subjects were randomly divided into two groups: Group 1 performed therapeutic knee and postural stabilization exercises (n=22); Group 2 performed therapeutic knee exercises only (n=20). All patients were evaluated for pain, hamstring flexibility, function, lower extremity strength and postural control before and after treatment and at the 12th week. A two-way ANOVA was done within each group before and after treatment and at the 12th week. The level of significance was set at p<0.05, and when this was observed, the Tukey test was used to determine which group had caused the significance. RESULTS: The results were statistically significant between the groups in terms of pain, flexibility, function, strength, endurance, postural control and the parameters of the Kujala patellofemoral pain scale (p<0.05). For all parameters, Group 1 achieved the greater success after treatment (p<0.05). CONCLUSION: The implementation of physiotherapy and rehabilitation programs including postural stabilization exercises may improve strength and function and reduce pain in patients with PFPS.

Surgical treatment of Achilles tendon ruptures: the comparison of open and percutaneous methods in a rabbit model.

BACKGROUND: This study was intended to investigate the healing properties of open and percutaneous techniques in a rabbit model and compare histological, electron microscopical, and biomechanical findings of the healed tendon between the groups. METHODS: Twenty-six rabbits were randomly assigned to two groups of thirteen rabbits each. Percutaneous tenotomy of the Achilles tendon (AT) was applied through a stab incision on the right side 1.5 cm above the calcaneal insertion in all animals. Using the same Bunnell suture, the first group was repaired with the open and the second group was repaired with the percutaneous method. ATs were harvested at the end of eight weeks for biomechanical and histological evaluation. RESULTS: When the sections were evaluated for fibrillar density under electron microscopy, it was noted that fibrils were more abundant in the percutaneous repair group. The tendon scores in the percutaneous group were less than the open group indicating closer histological morphology to normal. The difference was not significant (p=0.065). The mean force to rupture the tendon was 143.7± 9.5 N in percutaneous group and 139.2±8.2 N in the open group. The difference was not significant (p=0.33). CONCLUSION: Percutaneous techniques provide as good clinical results as the open techniques do. The healing tendon shows better findings in histological and electron microscopical level with percutaneous technique.

The clinical and sonographic effects of kinesiotaping and exercise in comparison with manual therapy and exercise for patients with subacromial impingement syndrome: a preliminary trial.

OBJECTIVE: The purpose of this study was to compare the effects of manual therapy with exercise to kinesiotaping with exercise for patients with subacromial impingement syndrome. METHODS: Randomized clinical before and after trial was used. Fifty-four patients diagnosed as having subacromial impingement syndrome who were referred for outpatient treatment were included. Eligible patients (between 30 and 60 years old, with unilateral shoulder pain) were randomly allocated to 2 study groups: kinesiotaping with exercise (n = 28) or manual therapy with exercise (n = 26). In addition, patients were advised to use cold packs 5 times per day to control for pain. Visual analog scale for pain, Disability of Arm and Shoulder Questionnaire for function, and diagnostic ultrasound assessment for supraspinatus tendon thickness were used as main outcome measures. Assessments were applied at the baseline and after completing 6 weeks of related interventions. RESULTS: At the baseline, there was no difference between the 2 group characteristics (P > .05). There were significant differences in both groups before and after treatment in terms of pain decrease and improvement of Disability of Arm and Shoulder Questionnaire scores (P < .05). No difference was observed on ultrasound for tendon thickness after treatment in both groups (P > .05). The only difference between the groups was at night pain, resulting in favor of the kinesiotaping with exercise group (P < .05). CONCLUSION: For the group of subjects studied, no differences were found between kinesiotaping with exercise and manual therapy with exercise. Both treatments may have similar results in reducing pain and disability in subacromial impingement in 6 weeks.

Can standing knee radiographs predict chondral lesions in young- and middle-aged population?

PURPOSE: The aim of the study is to investigate the correlation between arthroscopic findings and joint space width on the standing knee radiographs at various flexion degrees in the young- and middle-aged patients with complaints of knee pain. METHODS: Middle-aged patients with complaint of knee pain ongoing more than 6 months and failure in conservative treatment methods were included. Weight-bearing full extension, 30 and 45° of flexion radiographs were obtained. Joint space width was calculated on radiograms. Arthroscopy was performed to evaluate the chondral pathologies. Correlation analysis was performed. RESULTS: Fourty-three patients (18 female, 25 male) with a mean age of 44.6 (20-63) were included. Mean joint space width was 4.87 mm ± 1.45 (2-10) mm in medial and 5.43 mm ± 1.47 (1-9) in lateral on standing extension radiographs. In 30° flexion radiographs, mean joint space width was 4.33 mm ± 1.25 (1.5-7.5) in medial and 5.36 mm ± 1.69 (1-9) in lateral. In 45° flexion radiographs, medial joint space was 4.28 mm ± 1.59 (2-9) in medial and 5.15 mm ± 1.59 (1.5-9) in lateral. In arthroscopic evaluation, one knee had grade 1 (2.3%), three knees had grade 2 (7%), nine knees had grade 3 (20.9%), and twelve knees had grade 4 (27.9%) lesions in the medial compartment. In the lateral compartment, two knees had grade 3 (4.7%) and one knee had grade 4 lesion (2.3%). Radiological data did not correlate with the arthroscopic findings. CONCLUSION: Standing knee radiographs do not correlate with the arthroscopic findings in the middle-aged population with chondral lesions in knee joint. LEVEL OF EVIDENCE: Case series with no comparison group, Level IV.

Arthroscopy-assisted reduction versus open reduction in the fixation of medial malleolar fractures.

PURPOSE: Purpose of this case-control study was to evaluate the feasibility and advantages of arthroscopically assisted reduction and internal fixation of isolated medial malleolar fractures and compare the outcomes with conventional open reduction and internal fixation. METHODS: Forty-seven patients with medial malleolar fractures were grouped into two: arthroscopy-assisted group, and conventional open reduction and internal fixation group. Arthroscopic treatment group consisted of 21 patients. The mean age was 34 years (range: 22-49 years). Conventional open reduction and internal fixation group included 26 patients. The mean age was 42 years (range: 22-58 years). According to Herscovici system, 6 fractures in the arthroscopy group were classified as type-B, 13 fractures as type-C, and 2 fractures were classified as type-D. In both groups, fractures were classified according to Herscovici system. Radiological and clinical outcomes were evaluated according to van Dijk classification and Olerud-Molander scoring system, respectively. RESULTS: The mean follow-up period was 26 months (18-52 months) for arthroscopically assisted group and 38 months (24-58 months) for the conventional group. According to van Dijk classification, there was only one patient with Grade 1 osteoarthritic changes in arthroscopically assisted group compared with the conventional group where two patients had Grade 2 and one patient had Grade 1 osteoarthritic changes. Median Olerud Scores were 92.3 (75-100) and 86.3 (70-100) for the arthroscopically assisted group and for the conventional group, respectively. The difference was statistically significant (p = 0.015). CONCLUSIONS: With the use of arthroscopically assisted techniques in fixation of isolated medial malleolar fractures, surgeon can evaluate intra-articular surface and reduction that may be of value in the improvement in clinical outcomes over conventional surgical treatment. LEVEL OF EVIDENCE: Case-control study, Level III.

Palpation tests versus impingement tests in Neer stage I and II subacromial impingement syndrome.

PURPOSE: Using sonographic findings to test the diagnostic accuracy of impingement versus tendon palpation tests in Neer stage I and II subacromial impingement syndrome cases and examine their clinical potential. METHODS: Neer and Hawkins impingement tests and rotator cuff tendon palpation tests followed by bilateral shoulder sonography were conducted on 69 patients with a clinical diagnosis of unilateral subacromial impingement. RESULTS: The Neer and Hawkins tests had 74 and 62 % accuracy (sensitivity 80 and 67 %, and specificity 52 and 47 %, respectively) in comparison to 79 and 62 % accuracy rates for supraspinatus and biceps tendon palpation tests (sensitivity 92 and 41 %, and specificity 41 and 48 %, respectively). Overall, the palpation tests scored better than impingement tests in the diagnosis of Neer stage I and II subacromial impingement syndrome. No tendinosis or tear was noted in patients with negative findings in the supraspinatus palpation tests (sensitivity 100 %, specificity 21 %). CONCLUSION: Palpation tests for supraspinatus and biceps tendons have a slightly higher accuracy than the impingement tests, and if tenderness does not exist then supraspinatus tendinopathy can be ruled out. These findings warrant the use of palpation tests in a routine physical examination for tendinopathy. LEVEL OF EVIDENCE: I.

The outcomes of anterior cruciate ligament reconstructed and rehabilitated knees versus healthy knees: a functional comparison.

OBJECTIVE: In this study, we aimed to evaluate and compare the functional performance and muscle strength of cases of ACL reconstruction using bone-patellar tendon-bone graft followed by rehabilitation with those of healthy subjects. METHODS: This study included fifteen patients (range: 20 to 35 years) who underwent ACL reconstruction 18 to 24 months previously and a control group of 15 healthy volunteers with similar characteristics. Cases were evaluated with physical examinations, functional tests, subjective scales (Lysholm, Hospital for Special Surgery Knee Score (HSSS), and Tegner activity scale) and isokinetic test. Differences between the reconstruction group and control group were analyzed. RESULTS: Significant differences were found in the activity level of the reconstruction group (p<0.05) and in the clinical findings of the subjects with involved and uninvolved legs (p<0.05). When the reconstructed and control groups were compared according to the limb symmetry index, there were significant differences in single-leg hop test, timed hop test, shuttle run and stair hop test (p<0.05). The study also revealed a significant correlation between the vertical hop and quadriceps strength in the isokinetic test (r=0.56). When the operated knees were compared to the healthy side, mean limb symmetry index was over 92% (with two cases at 88%). When the dominant leg was compared to the non-dominant leg in the control group, the mean limb symmetry index was over 95%. CONCLUSION: Functional outcomes similar to those of healthy legs can be achieved following ACL reconstruction with bone-patellar tendon-bone grafting and rehabilitation. The similar functional test results of the operated and healthy subjects prove the effectiveness of the rehabilitation program.

The effects of additional kinesio taping over exercise in the treatment of patellofemoral pain syndrome.

OBJECTIVE: The purpose of this prospective, randomized, controlled study was to determine the effects of kinesio taping in the treatment of patients with patellofemoral pain syndrome (PFPS). METHODS: Thirty-one women with PFPS (mean age: 44.88 years; range: 17 to 50 years) were randomly assigned to either a kinesio taping (KT) (n=15) or control (n=16) group. Both groups received the same muscle strengthening and soft tissue stretching exercises for six weeks and the KT group additionally received kinesio taping at four day intervals for six weeks. Visual analog scale was used to measure pain intensity. Tension of the iliotibial band/tensor fascia lata and hamstring muscles and the mediolateral location of the patella were measured before the treatment and at the end of the third and sixth week. The Anterior Knee Pain Scale / Kujala Scale was used for the analysis of functional performance. RESULTS: Comparing pretreatment and 6th week values, significant improvements were found in pain, soft tissue flexibility and functional performance of both groups (p<0.05). However, patellar shift was unchanged (p>0.05). The KT group had significantly better hamstring flexibility than the control group at the end of three weeks (p<0.05). CONCLUSION: The addition of kinesio taping to the conventional exercise program does not improve the results in patients with PFPS, other than a faster improvement in hamstring muscle flexibility.

The effect of electrical stimulation in combination with Bobath techniques in the prevention of shoulder subluxation in acute stroke patients.

OBJECTIVE: To examine the efficiency of electrical stimulation in combination with Bobath techniques in the prevention of inferior and anterior shoulder subluxation in acute stroke patients. DESIGN: A prospective randomized controlled trial. SETTING: Intensive care unit and inpatient clinics of neurology in a university hospital. SUBJECTS: Forty-eight patients with acute stroke, divided equally into control and study groups. INTERVENTION: Subjects in both groups were treated in accordance with the Bobath concept during the early hospitalization period. In addition to Bobath techniques, electrical stimulation was also applied to the supraspinatus muscle, mid and posterior portions of the deltoid muscle of patients in the study group. MAIN MEASURES: Two radiological methods were used to measure the horizontal, vertical and total asymmetry and vertical distance values of the shoulder joint. Motor functions of the arm were evaluated with the Motor Assessment Scale. RESULTS: The hospitalization period was 12.62 ± 2.24 days for the control group and 11.66 ± 1.88 days for the study group. Shoulder subluxation occurred in 9 (37.5%) subjects in the control group, whereas it was not observed in the study group. All shoulder joint displacement values were higher in the control group than in the study group (horizontal asymmetry P = 0.0001, vertical asymmetry P = 0.0001, total asymmetry P = 0.0001, vertical range P = 0.002). CONCLUSION: Application of electrical stimulation combined with the Bobath approach proved to be efficient in preventing inferior and anterior shoulder subluxation in the acute stages of stroke.

Hospital-based versus home-based proprioceptive and strengthening exercise programs in knee osteoarthritis.

OBJECTIVES: This study aimed to establish the effects of hospital- and home-based proprioceptive and strengthening exercise programs on proprioception, pain, and functional status in patients with knee osteoarthritis (OA). METHODS: Sixty patients with bilateral knee OA were randomly allocated into either a home-based or hospital-based exercise program. Hospital-based exercise group (n=30, mean age 50.23±9.07 years) received functional training program with proprioceptive ability, ice, and home exercises. Home-based exercise group (n=30, mean age 54.4±7.9 years) had a program of ice and home exercises. Treatment programs was conducted 5 days per week for 6 weeks (30 sessions). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Monitorized Functional Squat System-Proprioceptive Test (MFSS), timed performance test (TUG), and visual analogue scale (VAS) for the intensity of pain were used to quantify the variables. RESULTS: Both groups demonstrated significant improvement when pre- and post-treatment results were compared for pain intensity, WOMAC, and TUG test scores (p<0.05). No statistically significant improvement was found in proprioception of the home-based group (p>0.05). Hospital-based group demonstrated significantly greater improvement in MFSS, TUG test, and VAS in activity when compared with the home-based group (p<0.05). CONCLUSION: Both hospital- and home-based exercise programs decreased joint symptoms and improved function in patients with knee OA.

[The effects of two different closed kinetic chain exercises on muscle strength and proprioception in patients with patellofemoral pain syndrome]. / Patellofemoral agri sendromunda farkli kapali kinetik zincir egzersizlerinin kuvvet ve propriyosepsiyon üzerine etkileri.

OBJECTIVES: The effects of two different closed kinetic chain exercises were compared in patients with patellofemoral pain syndrome (PFPS). METHODS: Forty female patients with unilateral PFPS were randomly divided into two groups to receive exercises with the hip internally rotated (n=20, mean age 39.1 + or - 8.0 years) or externally rotated (n=20, mean age 36.1 + or - 8.7 years) with the use of the Monitored Rehab Functional Squat (MRFS) System. The duration of exercises was four weeks with a total of 20 sessions. Both groups were evaluated before therapy, after four weeks of exercises, and after six weeks of home exercise program with the MRFS System for muscle strength and proprioception, with a visual analog scale for pain, and with the Kujala questionnaire for functional assessment. RESULTS: Among baseline features, the only significant difference between the two groups was in the mean height (p<0.05). Pain severity decreased significantly in both groups after treatment and home exercises (p<0.05). Concentric and eccentric peak forces, concentric proprioceptive deficit, and Kujala scores improved significantly in both groups after treatment (p<0.05), whereas improvements after home exercises were not significant in this respect (p>0.05). Eccentric proprioceptive deficit, however, did not change significantly both after treatment and home exercises (p>0.05). No significant differences were observed between the two groups during the study period with respect to the parameters assessed (p>0.05). CONCLUSION: Our results show that functional knee squat exercises with internally and externally rotated hip positions provide similar improvements in muscle strength and proprioception in patients with PFPS.

Fracture of the sustentaculum tali of the calcaneus in pediatric age: a case report.

There has been no earlier report in the literature on sustentaculum tali fractures in children (pediatric age). Here a pediatric case of a sustentaculum tali fracture that has not been previously reported in the literature is reported. A 9-year-old boy who presented with sustentaculum tali fracture and concomitant deltoid ligament rupture, 1 month after the injury, underwent fragment excision and reconstruction of the deltoid ligament. Radiography, computed tomography and MRI findings are discussed. This is a case report that describes the presentation and management of a comparatively rare and often miss-diagnosed fracture of sustentaculum tali in pediatric age.

A giant extrasynovial osteochondroma in the infrapatellar fat pad: end stage Hoffa's disease.

The infrapatellar fat pad of Hoffa is commonly injured but rarely discussed in the orthopaedic literature. Hoffa's disease is the extension of various traumatic events due to impingement and inflammation of the infrapatellar fat pad and known as a vague reason for anterior knee pain. Inflammation is foreground during acute phase of the disease while impingement due to fibrosis and scar tissue of infrapatellar fat pad plays a major role in the chronic phase. The osteochondroma of the infrapatellar fat pad secondary to the Hoffa's disease can be more problematic. Although, the fibrocartilaginous transformation and osteochondral metaplasia of infrapatellar fat pad was pointed out frequently in the literature, the published papers seem far from clarifying the relation between chronic impingement and formation of osteochondroma. We present a case of a giant ossifying chondroma in the infrapatellar fat pad that resulted from chronic Hoffa's disease. Complete open resection was performed successfully after arthroscopic examination. The infrapatellar fat pad contains the entire progenitor cells for the development of an osteochondroma and chronic impingement may have promoter affect on this issue, thus, an osteochondroma may occur at the end-stage Hoffa's disease.

Three-bundle popliteus tendon: a nonsymptomatic anatomical variation.

A 34-year-old man suffering from knee pain on the medial side of his right knee underwent knee arthroscopy. The arthroscopy revealed the popliteus tendon with an appearance of three bundles. Three-bundle popliteus tendon is a normal variant finding with no clinical significance.

Influence of irrigation solutions combined with colchicine and diclofenac sodium on articular cartilage in a rat model.

A two stage, controlled animal trial was designed to observe the effects on normal and manually damaged articular cartilage of the rat knee joint of colchicine (COL) and diclofenac sodium (DIC) added into washout solutions. In the first stage, 21 rats were randomized into three groups, and right knees of all groups were washed-out by either COL, DIC or physiologic saline (PS) solutions. The left side was kept as a paired control. After 18 months, all knees were evaluated macroscopically and microscopically for cartilage changes. In the second stage, 25 rats were randomized into four groups, and a 2 x 2 mm defect was created surgically on the medial condyle. The joints were washed out by either COL, DIC or PS solutions. At the end of the six months, macroscopic, microscopic and transmission electron microscopy (TEM) evaluations were performed to observe the changes to the defective area. The results showed that washout procedures with certain arthroscopic fluid modifications revealed macroscopically less fibrillation and surface changes for the COL and DIC groups in the first stage. Colchicine and diclofenac sodium solutions conducted a better effect on the thickness of the cartilage and gave better results according to Mankin's criteria for degeneration. In the second stage, COL and DIC groups showed better effects on the cartilage regeneration. The pharmacological agents added into the arthroscopic washout fluid may have an effect on the ultrastructure and biologic properties of the joint cartilage, and may improve the results of arthroscopic treatment in chondral pathologies, especially in secondary arthritis.