Fixed Flexion Contracture

Research involving nerve transplantation has shown that tissue rejection limits the neurologic recovery unless the host is immunosuppressed. This study investigates an alternative to permanent or temporary immunosuppression using a rat model with nerve transplants from Brown- Norway rat donors to bridge defects in the sciatic nerve of Lewis rat recipients as these two inbred strains differ at both major and minor histocompatibility loci.The specific aim of this study was to evaluate if predegenerated nerve grafts decreased the tissue rejection and improved the neurologic recovery of animals with allogenic nerve grafts to avoid the problems associated with either short- or long-term immunosuppression. The animals in the experimental groups received cyclosporin-A, predegencrated grafts, both, or neither. The predegenerated grafts were produced by division of the nerve three weeks prior to grafting to allow for Wallerian degeneration to occur. The outcome was assessed by measurements stressing functional recovery (sensory testing, gait analysis, joint flexion contracture), studies of muscle recovery (muscle weight and hydroxyproline concentration), and histologic studies (axonal counts and inflammatory reaction). The animals receiving the predegenerated grafts without cyclosporin did have an improved recovery (joint flexion contracture 35° ± 8 ° and hydroxyproline ratio 1.52 ± 0.16) as compared to the joint flexion contractures and hydroxyproline ratios of the allograft group of animals without either cyclosporin- A or pretreatment and the ungrafted control group (47° ± 18°, 1.68 ± 0.34, and 53° ±15° ,4.50 ± 0.27, respectively, p < 0.01). However, all the isograft groups and allograft groups with cyclosporin-A, regardless of whether the graft had been predegenerated or not, had greater neurologic recovery than the allograft group with predegenerated grafts but without cyclosporin-A by the same parameters (p < 0.01). Allograft groups with short-term immunosuppression with cyclosporin-A did as well as isograft groups, and isograft groups with predegenerated grafts did not do any better than isografts without pretreatment (p <0.01).Clinical Relevance:Predegenerated nerve allografts will allow for greater neurologic recovery than standard nerve allografts avoiding the complications of immunosuppression, but the level of recovery is less than that of recipients of nerve allografts with immunosuppression. Nerve transplants would avoid the problems of neurologic deficits at the donor site and allow multiple large deficits to be treated easily.

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The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04362-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Evelina Pantzar-Castilla ◽

Brian Po-Jung Chen ◽

Freeman Miller ◽

Jacques Riad

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Surgical Procedures ◽

Orthopedic Surgery ◽

Knee Flexion ◽

Flexion Contracture ◽

Short Term ◽

Knee Flexion Contracture ◽

Group 2 ◽

Group 1

Abstract Background Indications and cutoff value of deformities to determine surgical procedures for flexed knee gait are not clear. The aim was to determine the influence of none or mild, and moderate preoperative knee flexion contracture on the improvement of gait after orthopedic surgery in children with bilateral cerebral palsy (CP). Methods Inclusion criteria; bilateral CP, Gross Motor Function Classification System level I-III, and pre- and post operative-gait analysis. The 132 individuals identified were categorized into 2 groups based on the severity of knee flexion contracture (group 1: none or less than 11°; group 2: greater than or equal to 11°), and then matched according to the exact same soft tissue and/or bony orthopedic surgical procedures performed. The indication for surgery was to prevent progressive development of knee flexion contracture and stance phase flexed knee gait. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectively. Results Sixty (30 + 30) children, with mean age 10.6 years in each group, were included. The average follow-up time was 17 months. Gait Deviation Index (GDI) improved in group 1 from mean 66 (SD 19) to 74 (15), p = 0.004, and in group 2 from 60 (13) to 69 (15), p = 0.001. Knee flexion in stance improved in group 1 from 21.4 (16.1) to 12.1 (16.0) degrees, p = 0.002, and in group 2 from 32.2 (14.2) to 17.0 (15.9), p = 0.001. Step length improved in both groups, p = 0.017 and p = 0.008, respectively. Only in group 2 significant improvement was noted in walking speed, p = 0.018 and standing function, Gross Motor Function Measure (GMFM-D), p = 0.001. Knee flexion contracture decreased in group 1 from mean 4.6 (5.3) to 2.1 (8.3) degrees, p = 0.071 and in group 2 from 17.2 (4.9) to 9.6 (9.3), p = 0.001. There was no statistical difference between groups in pre-post improvement of GDI or other variables, except GMFM-D. Conclusions Relative mild to moderate preoperative knee flexion contracture does not influence the short-term improvement of gait after orthopedic surgery in children with bilateral CP.

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Effect of stump flexion contracture with and without prosthetic alignment intervention towards postural stability among transtibial prosthesis users

IOP Conference Series Materials Science and Engineering ◽

10.1088/1757-899x/210/1/012002 ◽

2017 ◽

Vol 210 ◽

pp. 012002 ◽

Cited By ~ 1

Author(s):

M F Ghazali ◽

N A Abd Razak ◽

N A Abu Osman ◽

H Gholizadeh

Keyword(s):

Postural Stability ◽

Flexion Contracture ◽

Prosthetic Alignment ◽

Transtibial Prosthesis

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Patient Self-Assessed Passive Range of Motion of the Knee Cannot Replace Health Professional Measurements

The Journal of Knee Surgery ◽

10.1055/s-0037-1598174 ◽

2017 ◽

Vol 30 (08) ◽

pp. 829-834

Author(s):

Frank Madsen ◽

Anders Odgaard ◽

Jens Borgbjerg

Keyword(s):

Range Of Motion ◽

Knee Extension ◽

Flexion Contracture ◽

Patient Assessment ◽

Limits Of Agreement ◽

Self Assessment ◽

Knee Motion ◽

Bland Altman Method ◽

Flexion And Extension ◽

Patient Self Assessment

AbstractThe purpose of this study was to investigate whether patients can accurately self-assess their knee passive range of motion (PROM). A picture-based questionnaire for patient self-assessment of knee PROM was developed and posted to patients. The self-assessed PROM from 58 patients was compared with surgeon-assessed PROM using a short-arm goniometer. Agreement between the measurement methods was calculated with the Bland-Altman method. We calculated the sensitivity and specificity of patient-assessed PROM in dichotomously detecting knee motion impairment in both flexion (≤ 100 degrees) and extension (≥ 10-degree flexion contracture). Surgeon- and patient-assessed knee PROM showed a mean difference (95% limits of agreement) of −2.1 degrees (−42.5 to 38.3 degrees) for flexion and −8.1 degrees (−28.8 to 12.7 degrees) for extension. The sensitivity of patient self-assessed PROM in identifying knee flexion and extension impairments was 86 and 100%, respectively, whereas its specificity was 84 and 43%, respectively. Although wide limits of agreement were observed between surgeon- and patient-assessed knee PROM, the picture-based questionnaire for patient assessment of knee ROM was found to be a valid tool for dichotomously detecting knee motion impairment in flexion (≤ 100 degrees). However, the specificity of the questionnaire for detection of knee extension impairments (≥ 10-degree flexion contracture) was low, which limits is practical utility for this purpose.

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