Prevalence and mechanisms of anterior cruciate ligament tears in military personnel: A cross-sectional study in Iran.

BACKGROUND: Anterior cruciate ligament (ACL) tear is common in military setting; such an injury increase institutional costs and workforce strain, however, few studies have investigated the mechanism and associated factors of ACL tear specifically in a military setting. The aim of this study was to investigate the prevalence and mechanisms of ACL tears in military personnel at a military referral hospital in Iran. MATERIAL AND METHODS: This cross-sectional study examined 402 military personnel who presented with knee complaints at a single referral Iranian military hospital. The ACL injury prevalence and mechanisms were assessed by physical examination, medical records, and magnetic resonance imaging (MRI) of the knee. Data were collected by an orthopedic resident. RESULTS: Of the total 402 patients, 285 were diagnosed with ACL tears; the prevalence was 70.9%. The most common mechanism leading to ACL tear was noncontact events. The knee changing direction-knee pivoting (54%) was the most frequent lower limb status, followed by a fall with the knee in valgus position (20.7%). The most commonly associated activity was military training (63.9%) and sports activities (32.6%). The incidence of ACL injuries was higher in soldiers compared with officers during military training, but higher in officers during sports exercises (P = 0.002). Common associated injuries involved the knee meniscus and cartilage. CONCLUSION: The findings support those of previous studies, that in military personnel, the most common knee injury is damage to the ACL, most frequently through noncontact events, specifically knee pivoting, during military activities rather than sports and among soldiers. These findings help develop ACL injury prevention programs.

Treatment of Femoral Head Osteonecrosis (Stages 2B, 3 Ficat) Through Open Direct Core Decompression by Allograft Impaction and Light Bulb Technique.

BACKGROUND: Femoral head avascular necrosis is the cause of paralyzing status of youth population. Initial diagnosis is the main element in treating the disease. Bone grafting and core decompression are the approved cures at the early steps of the disease. Hip replacement in a total manner is the common cure in the final stages. The optimal treatment in the intermediate stages is partially disputable. We investigated several patients with femoral head osteonecrosis cured with impacted cancellous allograft and open core decompression using the lightbulb technique. METHODS: A total of 46 patients (58 hips) suffering from femoral head osteonecrosis were evaluated in this cross-sectional study. Patients were classified into two groups: A (stage 2B Ficat) and B (stage 3 Ficat) to be treated with the impaction of cancellous allograft and by open core decompression. Radiographic results, demographic data, and range of hip joint motions were recorded. The patients were assessed through employing the Harris hip score (HHS) and visual analogue scale (VAS) index prior to operation and over five years following surgery. We also studied radiographic alterations of femoral head. RESULTS: The means of HHS and VAS were developed following the operation. Radiographic outcomes promoted in both groups, however, it was better in group A. 12 (40%) and six (22%) hips (40%) in groups A and B, respectively displayed developed stages following the operation. The hip ROM was enhanced with the mean of 15-20 degrees (P<0.005). CONCLUSION: Open core decompression combined with allograft impaction sounds to be influential in the developing steps of femoral head necrosis and leads to joint discomfort and diminished pain improving ROM of the hip joint and meanwhile procrastinating the worsening of the disease.

A theory of planned behavior-based intervention to improve quality of life in patients with knee/hip osteoarthritis: a randomized controlled trial.

Osteoarthritis (OA) is a common chronic disorder among elderly people that affects joints such as the knee and hip in particular. The objective of the current study was to examine the efficacy of an intervention based on a theory of planned behavior (TPB) in improving health-related quality of life in middle-age and older adults with this condition. One hundred twenty patients diagnosed with knee/hip OA were recruited from a general hospital. Measures administered at baseline were the SF-12, EuroQol (EQ-5D), Osteoarthritis Knee and Hip Quality of Life (OAKHQoL), and TPB questionnaire. Also assessed were body mass index (BMI), Kellgren-Lawrence Scale, six-minute walk test (SMWT), muscle strength, range of motion (ROM), and joint tenderness and swelling. Participants were randomly assigned to either the intervention (n = 60) or the control group (n = 60). The intervention group received an educational program based on TPB that was administered over 1 month. The control group did not receive this treatment. Three months after the intervention, both groups were reevaluated and comparisons made. Compared to the no-treatment control group, those in the intervention group scored higher on HRQoL, both general and specific, at 3-month follow-up (p < 0.01). The only exception was the vitality domain. Significant differences were also found on the TPB questionnaire, the SMWT, and muscle strength in the expected direction (p < 0.05). While those in the intervention group improved significantly on all clinical measures from pre-test to post-test, those in the control group showed improvement only on BMI and joint tenderness. This TPB-based intervention was found to be efficacious in improving HRQoL and several clinical parameters in patients with knee/hip OA. Studies are needed to examine the effectiveness of this intervention in patients with other chronic medical conditions.

Psychometric examination of the Persian version of Osteoarthritis Knee and Hip Quality of Life questionnaire.

AIM: Osteoarthritis is a serious and prevalent health problem that creates considerable disability when it involves the knee or hip joints. The aim of the study was to adapt and validate the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire for use in a Persian-speaking population. METHODS: A total of 434 patients were recruited. The forward-backward translation process was used to develop the Persian version. Participants were asked to complete the Short Form 12 Health Survey, EuroQoL, visual analog scale for pain and the OAKHQOL questionnaire. Reliability was assessed using Cronbach's alpha and the test-retest method. The structure of the questionnaire was evaluated by exploratory factor analysis. The OAKHQOL was correlated with related measures to establish construct validity. Convergent and discriminant validity were examined with demographic and clinical variables. Comparisons were performed between patients with different severity grades of osteoarthritis. RESULTS: The mean age of participants was 61.9 (SD 12.1) and the majority were female (91.2%). Principal component analysis demonstrated a five-factor solution that explained 58.4% of the variance. Cronbach's alpha coefficients ranged between 0.74 and 0.89 for all domains of the questionnaire with the exception of the social activities domain. The kappa for test-retest reliability was 0.85. The OAKHQOL demonstrated good discriminative and convergent validity. Construct validity was established by determining significant relationships between related measures. The results of known-groups validity indicated different scores on most domains (P < 0.001) across different levels of disease severity. CONCLUSION: The questionnaire may be used as a valid and reliable measure for assessing quality of life among Iranian patients with lower limb osteoarthritis.

Comparison of Indirect MR Arthrography With Conventional MRI in the Diagnosis of Knee Pathologies in Patients With Knee Pain.

BACKGROUND: Knee pain is a common problem in the general population. In order to determine the extent of the injury and the appropriate treatment, MRI provides the most accurate imaging method. This may be done through conventional MRI techniques or by injecting a contrast material (MR arthrography). OBJECTIVES: The purpose of this study was to compare the diagnostic value of these two methods. PATIENTS AND METHODS: The study involved the diagnostic evaluation on 60 patients with knee pain who received treatment over the course of a one-year period. Referred patients were randomly divided into two groups: indirect MR arthrography was performed on one group, and conventional MRI was performed on the other group. Both groups then underwent arthroscopy. The results from both groups were compared with the arthroscopic findings. RESULTS: In all of the pathologies studied, the sensitivity, specificity, and the positive and negative predictive values were evaluated. A high rate of accuracy was found between MR arthrography and arthroscopy (P < 0.05) for all knee injuries, however a similar rate of accuracy between conventional MRI and arthroscopy was only seen in patients with damage to the posterior cruciate ligament (PCL), the tibio-femoral articular cartilage, and patella chondromalacia (P < 0.05). The highest rate of accuracy was seen in cases where indirect MR arthrography was used for the diagnosis of anterior cruciate ligament (ACL) damage (K = 1). CONCLUSIONS: Our results have shown that indirect MR arthrography had greater diagnostic accuracy in regards to the sensitivity, specificity, and positive and negative predictive values than conventional MRI in knee pathologies.

Acute Cardiovascular and Hemodynamic Responses to Low Intensity Eccentric Resistance Exercise with Blood Flow Restriction.

BACKGROUND: Recently it has been suggested that low intensity (LI) resistance exercise (RE) alone or in combination with blood flow restriction (BFR) can be applied for cardiovascular function improvement or rehabilitation. OBJECTIVES: The aim of the present study was to investigate the acute effects of LI eccentric RE with and without BFR on heart rate (HR), rate pressure product (RPP), blood pressure (BP) parameters [systolic, diastolic, and mean arterial pressure (MAP)], oxygen saturation (SpO2) and rate of perceived exertion (RPE). METHODS: In a semi-experimental study 16 young adults (26.18 ± 3.67 years) volunteered and performed LI (30% maximum voluntary contraction) eccentric RE alone or combined with BFR. RESULTS: The results indicated that HR, RPP, and RPE increased significantly within both groups (P < 0.05); SBP and DBP increased significantly only with BFR (P < 0.05); MAP increased significantly during exercise without BFR (P < 0.05); and no change was observed in SpO2 in either groups (P > 0.05). Furthermore, studied parameters did not vary amongst different groups (P > 0.05). CONCLUSIONS: It is concluded that LI eccentric RE with BFR positively regulated the hemodynamic and cardiovascular responses. Therefore, the eccentric RE combined with BFR seems to be a good option for future studies with the aim of time efficacy, since it alters these parameters within normal values.

Studying the Relation Between Medial Tibial Stress Syndrome and Anatomic and Anthropometric Characteristics of Military Male Personnel.

BACKGROUND: Medial Tibial Stress Syndrome (MTSS) is common among military recruits and to our knowledge; the factors that might put the military recruits at higher risk of incidence of MTSS are not well known. OBJECTIVES: This study was done to investigate the association between some anthropometric and anatomical factors and the prevalence of MTSS among military recruits. PATIENTS AND METHODS: One hundred and eighty one randomly selected military recruits were included in this cross sectional study. Using history taking and physical examinations they were tested for MTSS. Accordingly the subjects were assigned to the case (those with MTSS) and control groups (normal healthy subjects). Using standard guidelines, the anthropometric and anatomical criteria of the subjects were measured. The correlation between the measurements and the prevalence of MTSS was tested using statistical analysis. RESULTS: Data of all the 181 subjects with the mean age of 30.7 ± 4.68 years were Included in the final analysis. The prevalence of MTSS was found to be 16.6% (30 people). Internal and external rotation range of motion, iliospinale height, the score of navicular drop test, and the trochanteric tibial lateral length were significantly different between healthy subjects and patients with MTSS (P < 0.05). DISCUSSION: The prevalence of MTSS was relatively lower in this study comparing to other studies on military personnel. It was not probably due to type of military shoes or exercise area surface (none of them were standardized); it could be due to low intensity trainings and the long intervals between training sessions.

Association of Soccer and Genu Varum in Adolescents.

BACKGROUND: Genu varum is a physical deformity marked by bowing of the leg. One of the risk factors of this musculoskeletal alignment is stress on the knee joint such as with exercise. OBJECTIVES: Since the evaluation of genu varum has not been widely studies, this study was conducted to examine the association between genu varum and playing soccer. MATERIALS AND METHODS: Between Septembers 2010-2012, 750 soccer players and 750 non-soccer players 10-18 years of age were included in the study. A questionnaire of data including age, height, weight, body mass index (BMI), years of soccer participation, the average time of playing soccer per week, previous trauma to the lower limbs, history of any fractures of the knee, previous hospitalizations, and the distance of joint lines between the knees was assessed for all subjects. Chi-square, student t-test, and one-way ANOVA were used for statistical analysis by SPSS v.19.0 software. In all tests, a P value of less than 0.05 was construed as statistically significant. RESULTS: Both soccer players and controls had genu varum. However, the incidence of genu varum was higher in the soccer players (P = 0.0001) and it was more prevalent in the 16-18 year age group (P = 0.0001). The results revealed a statistically significant association between the degree of practices and the prevalence of genu varum (P = 0.0001). Moreover, previous trauma to the knees and practicing in load-bearing sports led to an increase in the degree of genu varum (P = 0.0001). CONCLUSIONS: There was a higher incidence of genu varum in soccer players than in control adolescents; the stress and load imposed on the knee joint led to more severe genu varum.

Effects of preoperative use of oral dextromethorphan on postoperative need for analgesics in patients with knee arthroscopy.

BACKGROUND: Studies have shown that N-methyl-D-aspartate receptor (NMIDA) plays an essential role in postoperative pain. It seems that use of NMDA receptor antagonists such as Dextromethorphan intensifies the analgesic effects of opioids. OBJECTIVES: In this study, we evaluated the effect of preoperative administration of Dextromethorphan on postoperative pain reduction. PATIENTS AND METHODS: This double blind randomized clinical trial was conducted on arthroscopic surgery candidates. Participants were randomly allocated to interventions and assigned to two groups of Dextromethorphan and placebo. In Dextromethorphan group, the patients received 1 mg/kg Dextromethorphan orally the night before the operation. Pain severity based on the visual analog scale (VAS) up to 16 hours postoperation, use of opioids, and the first request for analgesics were recorded postoperatively. RESULTS: A total of 112 patients in the Dextromethorphan (n = 54) and placebo groups (n = 58) were evaluated. No significant difference was detected between the two groups for age, sex or ASA. The mean amount of opioid consumption was significantly lower in patients who received Dextromethorphan (10.7 ± 5.6 mg) compared to the placebo group (13.1 ± 5.6 mg), (P = 0.03). The mean time until the first opioid request in patients who received Dextromethorphan was longer than that in the placebo group (P = 0.01). CONCLUSIONS: The study results demonstrated that preemptive use of Dextromethorphan reduced postoperative pain and opioid consumption.

Concomitant ligamentous and meniscal knee injuries in femoral shaft fracture.

BACKGROUND: Concomitant knee injury is a common finding in femoral fractures but can be easily missed during early management of the initial trauma. Degrees of damage to the articular structures vary considerably; from only a mild effusion to complete ligamentous and meniscal tears. Since previous reports were mostly from developed societies, this study was designed to look into characteristics of associated knee injury in a sample from Iran, to represent a developing country perspective. MATERIALS AND METHODS: Consecutive patients admitted to an orthopedic ward of Baqiyatallah hospital (Tehran, Iran) with diagnosis of femoral fracture were enrolled in this study between October 2008 and September 2009. In patients who met the inclusion criteria of the study, arthroscopic or open surgical examination of the knee, ADT, Lachman test, varus and valgus stress tests under anesthesia were carried out to determine the incidence of knee injury. RESULTS: Forty patients with ipsilateral and two patients with bilateral femoral fractures were studied. Arthroscopy revealed medial meniscus injury in 12 (27%) knees. Three (7%) lateral meniscus injuries, 18 (40.9%) ACL injuries and 2 (4.5%) PCL injuries were also found. In varus and valgus stress tests, 15 (34%) MCL and 4 (9%) LCL laxities were noticed. The Lachman test was positive in 3 (6%), and ADT was positive in 2 (4.5%) patients. CONCLUSIONS: Based on our observations, concomitant ligamentous and meniscal knee injury is a common finding in femoral shaft fractures and rates of these injuries are generally in concert with reports from developed nations.

Knee Flexion Strength Before and After ACL Reconstruction Using Hamstring Tendon Autografts.

BACKGROUND: Anterior cruciate ligament (ACL) injury is the most common sports injury in both athletes and nonathletes; it can cause disability if not treated correctly. In cases with minor injuries, conservative treatments suffice. But, in cases with ACL tear, surgery by different methods and autografts are indicated. The most prevalent method for ACL reconstruction is the use of hamstring tendon autograft; this requires tendon removal and results in subsequent weakness in patient's knee flexion strength which can cause dissatisfaction. OBJECTIVES: In this study we evaluate a common procedure used for treating ACL injuries. PATIENTS AND METHODS: This study was performed at a hospital in Tehran on 30 patients with ACL tears. Patients' knee flexion strengths before and 2, 4, 6, and 12 months after reconstruction were measured separately at 20, 45, 90, and 110˚ knee flexion angles, and their means were analyzed using paired t-test. RESULTS: In this study, knee flexion strength decreased after ACL reconstruction. The greatest decrease in knee flexion strength was observed at 90 and 110˚ knee flexion angles. CONCLUSIONS: Some previous studies have confirmed reduced knee flexion strength following ACL reconstruction at high knee flexion angles. However, some others have denied it. The present study confirmed the reduction in knee flexion strength one year after ACL reconstruction at 90 and 110˚ flexion angles (P = 0.000). Furthermore, the need for physiotherapy, as a process for rehabilitating these patients was also confirmed.