Comparison between natural rubber knee support and sponge knee support on the protection of knee joint: A crossover randomized controlled study among patients with bleeding disorders.

Background and Aims: Knee support, frequently made from sponge, is used to reduce injury. Sponge has less elasticity and durability compared with natural rubber. To our knowledge, there was no study that demonstrated the effectiveness of natural rubber and sponge in prevention of injury in children with bleeding disorders. The study aimed to demonstrate the effectiveness and satisfaction of natural rubber knee support compared with sponge knee support among children with bleeding disorders. Methods: The study consisted of three phases: (I) measuring reduced compression force, (II) producing size-appropriate knee support prototypes, and (III) conducting a randomized crossover trial, including 8 weeks wearing natural rubber knee support and sponge knee support with a 4-week wash-out period. The number of knee bleeds and user satisfaction were recorded. Results: A better compression force reduction in natural rubber (60%) than sponge (12%) was demonstrated. Knee support comprised a body part, made from natural-stretchable cotton and a protection part, made from either natural rubber or sponge. They were produced in four sizes: S, M, L, and XL and appropriately applied to 42 patients (21 hemophilia, 21 platelet disorders) with a mean (SD) age of 7.0 (2.9) years. The results from randomization showed no significant difference in the number of knee bleeds between the two knee support groups (10 vs. 7, p = 0.37). In terms of satisfaction score, the natural rubber knee supports were more durable (45.2% vs. 23.8%, p = 0.04) and easier to use (28.5% vs. 14.3%, p = 0.03). In addition, a higher percentage of parents chose natural rubber knee support when compared with sponge knee supports (71.0% vs. 29.0%, p = 0.006). Conclusion: Natural rubber knee support showed comparable effectiveness in the prevention of knee bleeding but was superior to sponge knee support in compression force reduction and satisfaction.

The knee kinematic patterns and associated factors in healthy Thai adults.

BACKGROUND: Reference values for normal knee kinematics were limited in Asian population and were influenced by race and other factors. This study was aimed to establish the reference values and identify the factors associated with knee kinematics in healthy Thai adults, aged 18-40 years. METHODS: A retrospective cohort study was conducted between 2016 and 2020. Healthy Thai adults aged 18-40 years old with body mass index (BMI) between 18.5 and 24.9 kg/m2 were included. All eligible participants were attached with reflective markers. Their walking was captured by 8-digital cameras, and assessed by motion analysis software. The primary outcomes were average knee kinematic data (degrees) in three dimensional planes as valgus-varus, flexion-extension, and internal-external rotation. Paired t-test and multiple linear regression were applied to compare the outcomes and to determine their associated factors. RESULTS: Ninety-eight participants (60 females and 38 males) were included with mean age 28.5 ± 5.4 years, and BMI 21.1 ± 2.0 kg/m2. Knee kinematics showed slight adduction during the swing phase, flexion during the stance phase, and obvious external rotation throughout the gait cycle, with a peak of 30-31 degrees during mid-swing. Right knee was significantly more adducted, flexed and externally rotated than the left side, particularly at mid-stance (P = 0.047, 0.017, and < 0.001, respectively). Females had more knee abduction, flexion and external rotation than males. Age, sex, and BMI were significantly correlated with knee abduction at terminal stance (correlation coefficient - 0.12, 95% confidence interval (CI) -0.23, -0.01; -1.37, 95%CI -2.54, -0.20; and - 0.32, 95%CI -0.61, -0.39, respectively), and rotation at mid-swing (correlation coefficient - 0.36, 95%CI -0.69, -0.02; -7.37, 95%CI -10.82, -3.92; and 0.89, 95%CI 0.01, 1.78, respectively). CONCLUSION: Knee kinematics demonstrates external tibial rotation throughout the gait cycle, significant side differences, and are associated with age, sex, and BMI. Reference values from this study will be useful for functional gait assessment in healthy Thais. However, further comprehensive knee kinetic study including spatio-temporal parameter is recommended.

National strategic advocacy to manage patients with inherited bleeding disorders in low and lower-middle income countries.

INTRODUCTION: Inherited bleeding disorders (IBDs) including hemophilia, von Willebrand disease, platelet disorders, mucocutaneous bleeding disorders and coagulation factor deficiencies are rarely found and under-recognized in low and lower-middle-income countries. Some patients succumbed to serious bleeding without diagnosis and treatment during childhood. AREA COVERED: Diagnosis, management, and prevention should be integrated into the existing health care system. Although some countries have not implemented appropriate health care infrastructure, an initiative plan should be set up by cooperation of experienced experts and health care providers. Identification of patients with IBDs should be started in the antenatal setting to search for females at risk of carrier state. The investigations include bleeding assessment, mixing venous clotting time, coagulogram, coagulation factor assay and mutation detection. Genotypic analysis is helpful for confirming the definite diagnosis, carrier detection as well as prenatal diagnosis for females at risk of bearing an offspring with severe bleeding manifestations. Management involves replacement therapy ranging from blood component to virus-inactivated factor concentrate. Appropriate research is an essential backbone for improving patients' care. EXPERT OPINION: Effective national strategic advocacy to manage patients with IBDs requires intensive collaboration among policy makers, health care providers, patients, and family members.

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.

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.

A Comparison between Modified Robert Jones Bandage and Intermittent Cold Pack in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Controlled Trial.

Background: Modified Robert Jones bandage and intermittent cold pack are commonly used for postoperative care in arthroscopic anterior cruciate ligament reconstruction (ACLR). However, no study has been done to compare the postoperative pain and functional outcome of both methods in ACLR. Objective: To compare the postoperative pain and functional outcome of a modified Robert Jones bandage and intermittent cold pack in ACLR. Material and Method: Forty patients scheduled for ACLR were included. Computer-generated randomization allocated patients into either modified Robert Jones bandage group (MRJ) or intermittent cold pack group (ICT). Visual analog scale and morphine usage were assessed postoperatively. Blinded assessors assessed functional outcome, knee swelling, and patient's satisfaction. Results: There were 19 patients in each group. Two groups were well comparable for the prognostic variables. The postoperative VAS and total morphine usage in both groups were not statistically different. Postoperative knee swelling increment was significantly lower in ICT than MRJ group (p-value = 0.04). The patient's satisfaction and positive quadriceps set test were significantly higher in the ICT group than the MRJ group (p-value <0.01). Conclusion: Intermittent cold pack has not demonstrated the benefit of pain reduction or morphine usage when compared to the modified Robert Jones bandage, but it had significantly less knee swelling, a significantly higher patient's satisfaction and trend to have better functional outcome. We recommend intermittent cold pack for postoperative care in ACLR.

Aldosterone increases Na+ -K+ -ATPase activity in skeletal muscle of patients with Conn's syndrome.

OBJECTIVE: In Conn's syndrome, hypokalaemia normally results from renal potassium loss because of the effect of excess aldosterone on Na(+) -K(+) -ATPase in principal cells. Little is known about the effect of aldosterone on cellular potassium redistribution in skeletal muscle. Our study determined the effect of aldosterone on muscle Na(+) -K(+) -ATPase. DESIGN: Muscle biopsies were taken from six patients immediately before and 1 month after adrenalectomy. Ten age-matched subjects with normal levels of circulating aldosterone served as controls. RESULTS: Average plasma aldosterone was significantly higher in presurgery (235·0 ± 51·1 pg/ml) than postsurgery (64·5 ± 25·1 pg/ml) patients. Similarly, Na(+) -K(+) -ATPase activity, relative mRNA expression of α(2) (not α(1) or α(3) ) and ß(1) (not ß(2) or ß(3) ), and protein abundance of α(2) and ß(1) subunits were greater in pre- than postsurgery samples (128·7 ± 12·3 vs 79·4 ± 13·3 nmol·mg/protein/h, 2·45 ± 0·31 vs 1·04 ± 0·17, 1·92 ± 0·22 vs1·02 ± 0·14, 2·17 ± 0·33 vs 0·98 ± 0·09 and 1·70 ± 0·17 vs 0·90 ± 0·17, respectively, all P<0·05). The activity and mRNA expression of the α(2) and ß(1) subunits correlated well with plasma aldosterone levels (r = 0·71, r = 0·75 and r = 0·78, respectively, all P < 0·01). CONCLUSIONS: Our study provides the first evidence in human skeletal muscle that increased plasma aldosterone leads to increased Na(+) -K(+) -ATPase activity via increases in α(2) and ß(1) subunit mRNAs and their protein expressions. The increased activity may contribute in part to the induction of hypokalaemia in patients with Conn's syndrome.

The location of pes anserinus insertion in Thai people.

BACKGROUND: The semitendinosus and gracilis tendon are commonly used for ligamentous reconstruction. Inaccurate skin incision may cause complications such as cutting the main tendon, inadequate graft length and sciatic nerve injury. There have been no reports about the insertion site of these tendons among Thai people. OBJECTIVE: To describe the distance between pes anserinus insertion and tibial tuberosity. MATERIAL AND METHOD: Eighty five cadaveric knees were dissected. We measured the distance between tibial tuberosity and tendon insertion and collected by the side and sex. RESULTS: The median distance between tibial tuberosity and tendon insertion was 0.5 centimeter at the vertical plane and the horizontal plane below tibial tuberosity was 2 and 2.5 centimeters in female and male, respectively. There was a statistically significant difference of the horizontal plane between male and female (p-value < 0.01). CONCLUSION: The location of pes anserinus insertion in Thai population may be more proximal than previous report.

Gouty tophi caused limited knee range of motion: a case report.

BACKGROUND: Gout is a disease of purine metabolism characterized by monosodium urate crystal deposition. Gouty tophi can mimic many conditions such as infection or neoplasm. OBJECTIVE: We descriptively presented a case of a 29-year-old male with gouty toph. Data was obtained from patient chart. This patient presented with limited knee joint range of motion after sport injury. Arthroscopic examination was performed in order to confirm the diagnosis of the meniscal injury. RESULTS: The result showed the synovium with white toothpaste-like chalky urate crystals in the joint cartilage. CONCLUSION: An atypical presentation of gouty tophi can sometime mislead to diagnose an internal derangement of the knee.

Thyroid hormone increases mRNA and protein expression of Na+-K+-ATPase alpha2 and beta1 subunits in human skeletal muscles.

CONTEXT: Thyroid hormone regulates specific Na+-K+-ATPase isoforms in rodent skeletal muscles. No study has examined this relationship in human tissues. OBJECTIVE: This study investigated the effect of hyperthyroid status on the expression of the alpha- and beta-subunits of the Na+-K+-ATPase. DESIGN: The vastus lateralis muscles from eight hyperthyroid patients were biopsied before and after treatment. Ten age-matched euthyroid subjects served as controls. RESULTS: In hyperthyroid patients, the average T3 level was three times higher in pretreatment compared with posttreatment (262 +/- 75 vs. 86 +/- 21 ng/dl, P = 0.001). The relative mRNA expression of the alpha2, but not alpha1 or alpha3, subunit was increased approximately 3-fold in pretreatment (2.98 +/- 0.52 vs. 0.95 +/- 0.40, P < 0.01), whereas that of beta1, not beta2 or beta3, subunit was increased approximately 2.8-fold in pretreatment (2.83 +/- 0.38 vs. 1.10 +/- 0.27, P < 0.01). The relative mRNA expression of the alpha2 and beta1 subunits was positively correlated with the serum T3 (r = 0.75, P = 0.001 and r = 0.66, P = 0.003, respectively). Immunohistochemistry studies revealed an increase in protein abundance of the alpha2 and beta1, but not alpha1 or beta2, subunits in the plasma membrane of muscle fibers of hyperthyroid patients, which decreased after treatment. CONCLUSIONS: This provides the first evidence that, in human skeletal muscles, thyroid hormone up-regulates the Na+-K+-ATPase protein expression at least, in part, at mRNA level, and the alpha2 and beta1 subunits play the important role in this regulation.