Neuromuscular adaptations after osseointegration of a bone-anchored prosthesis in a unilateral transfemoral amputee - a case study.

PURPOSE: Many individuals with a lower limb amputation experience problems with the fitting of the socket of their prosthesis, leading to dissatisfaction or device rejection. Osseointegration (OI)- the implantation of a shaft directly interfacing with the remaining bone- is an alternative for these patients. In this observational study, we investigated how bone anchoring influences neuromuscular parameters during balance control in a patient with a unilateral transfemoral amputation. MATERIAL AND METHODS: Center of pressure (CoP) and electromyography (EMG) signals from muscles controlling the hip and the ankle of the intact leg were recorded during quiet standing six months before and one and a half years after this patient underwent an OI surgery. Results were compared to a control group of nine able-bodied individuals. RESULTS: Muscle co-activation and EMG intensity decreased after bone anchoring, approaching the levels of able-bodied individuals. Muscle co-activation controlling the ankle decreased in the high-frequency range, and the EMG intensity spectrum decreased in the lower-frequency range for all muscles when vision was allowed. With eyes closed, the ankle extensor muscle showed an increased EMG intensity in the high-frequency range post-surgery. CoP length increased in the mediolateral direction of the amputated leg. CONCLUSIONS: These findings point to shifts in the patient's neuromuscular profile towards the one of able-bodied individuals.

Injury and Illness Surveillance in Elite Para Athletes: An Urgent Need for Suitable Illness Prevention Strategies.

BACKGROUND: Longitudinal monitoring data of Para athletes are sparse. OBJECTIVE: The aim of the study was to describe the weekly prevalence and incidence of injuries and illnesses among German athletes preparing for the 2016 Rio de Janeiro Paralympic Games. METHODS: Athletes were invited to weekly report on medical problems, their severity/burden and training load, using the Oslo Sports Trauma Research Center Questionnaire on Health Problems. In case of any health problem, athletes were contacted and medical support offered. Data were analyzed with regard to impairment type. The acceptance of the monitoring program was evaluated. RESULTS: Fifty-eight athletes were followed for 29 wks, 10.927 athlete-days. At any given time, 28% (95% confidence interval = 26% to 30%) of athletes reported health problems, and 12% (11% to 14%) substantial health problems. The prevalence of health and illness problems diminished over time by 20.9 ± 4.1% and 16.1 ± 2.9%, P < 0.001, respectively, based on the means of the first and final 5 wks. Paraplegic athletes reported a significantly higher prevalence of all health problems (33%, 29% to 37%) than nonparaplegic athletes (26%, 23% to 29%; P = 0.007). Illnesses were in general more severe and resulted in more time loss days. Athletes reported a high satisfaction with the program. CONCLUSIONS: At any given time, 28% of German Para athletes reported health problems, and 12% experienced substantial health problems. For a health team, illnesses seem to be more important to handle than injuries. The Oslo Sports Trauma Research Center Questionnaire on Health Problems is a suitable method for injury and illness surveillance in Para athletes.

Is there clinical evidence to support autologous matrix-induced chondrogenesis (AMIC) for chondral defects in the talus? A systematic review and meta-analysis.

BACKGROUND: The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for treatment of osteochondral lesions of the talus (OCL) and compare the studies' outcomes. METHODS: Pubmed and Embase were searched in January 2020 for articles concerning OCL surgery. Studies were included if they had a minimum 1-year follow-up and the primary measures were functional outcomes. The meta-analysis compared the Visual Analogic Score (VAS), the American Orthopedic Foot and Ankle Score (AOFAS), and the Foot Function Index (FFI) between baseline and follow-up of 1-2years, and 3-5years. A random effects model was used to evaluate outcome changes. RESULTS: The search returned 15 studies, with a total of 492 patients. The VAS improved 4.45 and 4.6 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). AOFAS improved 31.59 and 32.47 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). The FFI showed a significant improvement of 30.93 points from baseline to year 3-5 (p<0.001). A total of 6 patients with revision surgeries have been reported within the follow up period. It was not possible to correlate clinical features like lesion size, surgical approach, and bone marrow stimulation technique to the reported outcome. CONCLUSION: Surgical treatment of OCL via the AMIC procedure provided significant improvement in the functional outcome and pain scores when compared to the pre-operative values. Improvements were observed up to 5years post-operatively.

Fluoroscopic guided tunnel placement during medial patellofemoral ligament reconstruction is not accurate in patients with severe trochlear dysplasia.

PURPOSE: Accurate femoral tunnel placement is of great importance during medial patellofemoral ligament (MPFL) reconstruction. Purpose of the present study was to investigate the influence of trochlear dysplasia on the accuracy of fluoroscopic guided femoral tunnel placement. METHODS: CT-Scans of 30 knees (five with regular shaped trochlea, 10 with a Type A and five each with a Type B, C, or D trochlear dysplasia) were imported into the image analysis platform MeVisLab. A 3D Bone Volume Rendering (VR) and a virtual lateral radiograph was created. The anatomic femoral MPFL insertion was identified on the 3D VR. On virtual lateral radiographs, the MPFL insertion was identified based on landmarks described by Schöttle et al. using three different perspectives: Best possible overlap of the femoral condyles (BC) and a tangent along posterior border of the posterior femoral cortex (pBC); a tangent along the anterior border of the posterior cortex (aBC); and best possible overlap of the distal part of the posterior femoral cortex (BF). Distances between the anatomic attachment and radiographically obtained insertions were measured on the 3D VR and compared according to the type of trochlear dysplasia. RESULTS: Significantly lower accuracy of fluoroscopy guided tunnel placement in MPFL reconstruction was found in knees with Type C and D dysplasia. This effect was observed irrespectively from the radiologic perspective (pBC, aBC, and FC). In the pBC view (highest accuracy), the mean distance from the centre of the anatomic MPFL attachment to the radiographically defined location was 4.3 mm in knees without trochlear dysplasia and increased to 4.8 mm in knees with Type A dysplasia, 3.8 mm in knees with Type B dysplasia, 6.7 mm (p < 0.001) in knees with Type C dysplasia, and 7.3 mm (p < 0.001) in knees with Type D dysplasia. CONCLUSION: Radiographic landmark-based femoral tunnel placement in the pBC view provides highest accuracy in knees with a normal shaped trochlea or low grade trochlear dysplasia. In patients with severe dysplasia, fluoroscopy guided tunnel placement has a low accuracy, exceeding a critical threshold of 5 mm distance to the anatomic MPFL insertion irrespective of the radiographic perspective. In these patients, utilization of anatomic landmarks may be beneficial. LEVEL OF EVIDENCE: IV.