scholarly journals Novel Approach to Improving Knee Range of Motion in Arthrogryposis with a New Working Classification

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 546
Author(s):  
David S. Feldman ◽  
Troy J. Rand ◽  
Aaron J. Huser
Keyword(s):  
Range Of Motion ◽  
Rare Condition ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Arthrogryposis Multiplex Congenita ◽  
Surgical Interventions ◽  
Flexion Contractures ◽  
Novel Approach ◽  
Femoral Shortening ◽  
The Mean

Arthrogryposis multiplex congenita (AMC) is a rare condition defined as contrac-tures in multiple joints. Surgical interventions for severe knee flexion contractures have included posterior release, distraction and extension with external fixation and distal femoral extension osteotomies. These operations have been able to achieve knee extension, but not increase the range of motion. The purpose of this study was to review our experience with peroneal nerve decompression, posterior knee release and proximal femoral shortening. We retrospectively reviewed the medical charts and radiographs of all patients with a diagnosis of arthrogryposis who underwent aforementioned procedure. There were 39 patients with 73 knees included in the analysis with a mean follow-up of 21 months. The mean preoperative arc of motion was 45° and last followup arc of motion was 79° (p < 0.0001). The mean last followup flexion contracture was 8° (p < 0.0001). Additional subanalyses were performed on those with followup greater than 24 months and those with flexion contractures > 60°; there were no differences found in these groups. This study demonstrates that it is possible to achieve a functional range of motion of the knees in patients with AMC while improving ambulatory function.

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

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.

Reliability of Heel-Height Measurement for Documenting Knee Extension Deficits

2002 ◽  
Vol 30 (4) ◽  
pp. 479-482 ◽  
Author(s):  
Theodore F. Schlegel ◽  
Martin Boublik ◽  
Richard J. Hawkins ◽  
J. Richard Steadman
Keyword(s):  
Range Of Motion ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Flexion Contracture ◽  
Height Measurement ◽  
Height Difference ◽  
Thigh Circumference ◽  
Flexion Contractures ◽  
Heel Height ◽  
Knee Flexion Contracture

Background Heel-height difference has been used to detect subtle knee flexion contractures, but the effects of thigh circumference differences and patient positioning during testing have not been evaluated. Hypothesis Differences in thigh circumference measurements and whether the patient's patellae are on or off the examination table during heel-height difference measurement will not affect the accuracy of detecting knee flexion contracture. Study Design Prospective cohort study. Methods Bilateral knee range of motion, prone heel-height difference with the patellae on and off the table, and thigh circumference at 5 and 15 cm proximal to the proximal pole of the patella were measured by one investigator on 50 consecutive patients who had undergone unilateral anterior cruciate ligament reconstruction. Results A high degree of correlation was demonstrated between the heel-height difference and the standard range of motion measurement. Differences in thigh girth and patellar position did not statistically affect the accuracy of the heel-height difference as an indicator of knee flexion contracture. Conclusion Heel-height difference is a valid method of documenting knee flexion contractures. Compared with traditional goniometer assessment, this test is a more meaningful and easier way for detecting subtle knee flexion contractures of less than 10°.

scholarly journals Gender-specific difference in the recurrence of flexion contracture after total knee arthroplasty

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Tomofumi Kinoshita ◽  
Kazunori Hino ◽  
Tatsuhiko Kutsuna ◽  
Kunihiko Watamori ◽  
Takashi Tsuda ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Specific Difference ◽  
Full Extension ◽  
Before And After ◽  
Total Knee ◽  
The Mean ◽  
Postoperative Knee ◽  
Gender Specific

Abstract Background Range of motion after total knee arthroplasty (TKA) can impact patients’ daily lives. Nevertheless, flexion contracture (FC) often recurs after TKA, even upon achieving full extension intraoperatively. This study aimed to evaluate the relationship among preoperative, intraoperative, and postoperative knee extension angles, and clarify the risk factor for postoperative FC. Methods One hundred forty-seven knees undergoing TKA using a navigation system were evaluated. We measured the pre- and postoperative (6 months after TKA) extension angles using a goniometer, and intraoperative (before and after TKA) extension angle using a navigation system; the correlation between these angles at each time point was evaluated. Results The mean preoperative, intraoperative (before and after TKA) and postoperative extension angles were -9.9°, -6.8°, -0.1°, and -2.0°. Regarding intraoperative extension angle after TKA, 58 knees showed ≤ 5° hyperextension and six knees showed > 5° hyperextension. At 6 months, no cases showed hyperextension and 105 knees showed full extension. The mean intraoperative extension angle after TKA in the postoperative full extension group was 0.4°. A significant correlation was found among extension angles at each point (p<0.01, respectively). However, the intraoperative extension angle after TKA correlated with the postoperative extension angle only in females. Contrarily, the recurrence rate of FC was significantly higher in males than in females (p<0.01). Conclusion Intraoperative extension angles significantly correlated with pre- and postoperative extension angles in TKA. Moreover, intraoperative mild (≤ 5°) hyperextension is acceptable for postoperative full extension. There was a gender-specific difference in correlation between intra- and postoperative knee extension angles. Level of evidence III.

scholarly journals The judet quadricepsplasty for elderly traumatic knee extension contracture: a case report and review of the literature

BioMedicine ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 21
Author(s):  
Benjamin Tze Keong Ding ◽  
Suheal Ali Khan
Keyword(s):  
Range Of Motion ◽  
Conservative Management ◽  
Age Groups ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Adult Males ◽  
Review Of The Literature ◽  
Traumatic Injuries ◽  
Sequential Release ◽  
Knee Contracture

Traumatic injuries to the knee are frequently complicated by extension contractures. The Judet Quadricepsplasty allows for controlled, sequential release of extrinsic and intrinsic knee contracture components while reducing the potential for iatrogenic quadriceps rupture. We document our institutions experience with this procedure and a systematic review of the current literature. We followed up on an elderly patient with posttraumatic flexion contracture that failed conservative management and underwent Judet Quadricepsplasty. Her knee range of motion improve dramatically from 20 degrees of flexion to 100 degrees of flexion. There was a residual extension lag of 5 degrees which did not impede on the patients daily activities. A review of the literature was performed and relevant data from 12 articles was extracted. The procedure was mainly performed in young adult males in most previous studies and the range of motion improvement ranged from 51° to 110°. Wound infections were the most common complication but otherwise other complications and severe extension lag were rare. The Judet Quadricepsplasty is a useful procedure for severe extension knee contractures that has failed conservative management in all age groups of patients. It is associated with significant increases in range of motion with low rates of complication or extension lag. Diagnostic IV

scholarly journals One-Stage Extension Shortening Osteotomy for Syndromic Camptodactyly

2020 ◽  
Vol 9 (11) ◽  
pp. 3731
Author(s):  
Byoung Kyu Park ◽  
Hyun Woo Kim ◽  
Hoon Park ◽  
Min Jung Park ◽  
Kee-Bum Hong ◽  
...  
Keyword(s):  
Simple Procedure ◽  
Proximal Phalanx ◽  
Severe Form ◽  
Flexion Contracture ◽  
Arthrogryposis Multiplex Congenita ◽  
One Stage ◽  
Tendon Lengthening ◽  
Shortening Osteotomy ◽  
Tendon Surgery ◽  
The Mean

Syndromic camptodactyly often affects multiple fingers, and severe deformities are common compared to idiopathic camptodactyly. This study aimed to evaluate the use of a one-stage extension shortening osteotomy of the proximal phalanx for patients with syndromic camptodactyly without tendon surgery. Forty-nine cases of syndromic camptodactyly were included. Forty fingers (81.6%) were associated with arthrogryposis multiplex congenita, and nine (18.4%) with other syndromes. Six fingers presented with a moderate form (30° to 60°) of camptodactyly, whereas 43 fingers manifested the severe form (>60°). The mean age at the time of surgery was 8.5 years, and the patients were followed for a mean of 3.9 years. The mean length of the shortening of the proximal phalanx was 4.9 mm, which averaged 17.8% of the proximal phalanx’s original preoperative length. The mean operative time was 25.8 min, and the PIP joint was fixed using Kirschner wires with an average flexion position of 7.6°. The mean flexion contracture improved from 76° preoperatively to 41° postoperatively. The mean preoperative active arc of motion was 23°, which improved to 49° postoperatively. A one-stage extension shortening osteotomy is a straightforward and effective technique for the improvement of finger function through the indirect lengthening of volar structures without the flexor tendon lengthening. The osteotomy could simultaneously correct bony abnormalities. This simple procedure is especially suitable for surgery on multiple fingers in patients with syndromic camptodactyly.

scholarly journals The Effect of Foam Rolling Duration on Hamstring Range of Motion

2015 ◽  
Vol 9 (1) ◽  
pp. 450-455 ◽  
Author(s):  
Grace Couture ◽  
Dustin Karlik ◽  
Stephen C Glass ◽  
Brian M Hatzel
Keyword(s):  
Range Of Motion ◽  
Total Duration ◽  
Knee Extension ◽  
Contributing Factors ◽  
Duration Of Treatment ◽  
Foam Rolling ◽  
Myofascial Release ◽  
Long Duration ◽  
Flexibility Training ◽  
The Mean

Musculoskeletal health benefits from flexibility training and maintaining a functional, or sport specific, range of motion is important to one’s overall fitness. Commercial foam rollers are commonly used in gyms, therapy clinics and homes, yet data are lacking on the optimal rolling duration and effect on range of motion. Purpose : The purpose of this study was to examine the effect of varied durations of a commercial foam roller treatment on hamstring range of motion. Methods : The knee extension range of motion of 33 college aged men and women (age= 20±1.5y, mass= 72.2±10.8 kg) was assessed after a short (2 sets of 10s) and long (4 sets of 30s) duration of hamstring self-administered myofascial release using a commercial foam roller. A one way ANOVA was performed to compare the mean knee extension angle for each condition to baseline measures. Results : Results indicated that neither the short duration (67.30 ± 10.60 deg) nor long duration (67.41 ± 10.81 deg) rolling condition produced significant increases in knee extension compared to baseline (67.70 ± 9.90 deg). Conclusion : Self-administered foam rolling for a total duration of up to 2 minutes is not adequate to induce improvements in knee joint flexibility. Contributing factors may include the amount of pressure imparted by the commercial roller as well as duration of treatment.

scholarly journals Distal Femoral Shortening Osteotomy for Severe Knee Flexion Contracture and Crouch Gait in Cerebral Palsy

2019 ◽  
Vol 8 (9) ◽  
pp. 1354 ◽  
Author(s):  
Hoon Park ◽  
Byoung Kyu Park ◽  
Kun-Bo Park ◽  
Sharkawy Wagih Abdel-Baki ◽  
Isaac Rhee ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Pelvic Tilt ◽  
Flexion Contracture ◽  
Knee Flexion Contracture ◽  
Shortening Osteotomy ◽  
Femoral Shortening ◽  
Crouch Gait ◽  
Anterior Pelvic Tilt ◽  
The Mean

Although there have been advancements of surgical techniques to correct gait abnormalities seen in patients with cerebral palsy, the crouch gait remains one of the most difficult problems to treat. The purpose of this retrospective study was to examine our results of distal femoral shortening osteotomy (DFSO) and patellar tendon advancement (PTA), performed in patients with crouch gait associated with severe knee flexion contracture. A total of 33 patients with a mean fixed knee contracture of 38° were included in the study. The mean age at the time of surgery was 12.2 years and the mean follow-up was 26.9 months. The measurements of clinical, radiological, and gait parameters were performed before and after surgery. The mean degrees of knee flexion contracture, Koshino index of patella height, and Gait Deviation Index were found to be significantly improved at the time of final follow-up. The maximum knee extension during the stance phase improved by an average of 25°, and the range of knee motion during gait increased postoperatively. On the other hand, the mean anterior pelvic tilt increased by 9.9°. Also, the maximum knee flexion during the swing phase decreased and the timing of peak knee flexion was observed to be delayed. We conclude that combined procedure of DFSO and PTA is an effective and safe surgical method for treating severe knee flexion contracture and crouch gait. However, the surgeons should be aware of the development of increased anterior pelvic tilt and stiff knee gait after the index operation.

scholarly journals Variations in knee range of motion during repeat knee extension with an amputated lower leg at different contraction rhythms over 8 consecutive days in a patient with severe diabetic neuropathy: A clinical study

2021 ◽  
pp. 23
Author(s):  
Keyword(s):  
Clinical Study ◽  
Diabetic Neuropathy ◽  
Range Of Motion ◽  
Burn Injury ◽  
Lower Leg ◽  
Knee Extension ◽  
Thigh Muscle ◽  
Mean Values ◽  
Free Trial ◽  
The Mean

Background: This clinical study sought to understand the knee range of motion (KROM) in an amputated stump during repeat voluntary knee extension with or without a 0.5 kg weight in the acute/early phase after amputation can vary between different target knee extension rhythm frequency (KER) levels in the amputated lower leg of a patient with severe diabetic sensory disorder and leg ischemia. Case Presentation: A 51-year-old male patient with severe diabetic neuropathy had a right lower leg amputation due to necrosis and ulcer lesion following a burn injury to the first toes and severe ischemic peripheral vascular disease. In a sitting position with the base of the foot of the non-amputated left leg on the ground, he performed repeat knee extension of the resected stump (knee active extension and passive flexion without a target KROM) for 1 min with both self-controlled free KER and different target KERs (30, 40, 50, 60, and 80 contractions per minute [cpm] using a metronome), with or without a 0.5 kg weight placed on the resected stump over 8 consecutive days. The KROM was measured using a goniometer placed between the resected stump and the thigh muscle with a continuous data acquisition system. The mean values achieved for KER, KROM, and angle rate during a 1 min session was determined during each daily session, and consecutively average values over sessions on 8 consecutive days was also evaluated. The achieved mean KER at all target KERs corresponded closely with the target KER. The average KROM was approximately 60 degrees over a range of targets between 30 and 60 cpm, but the value was lower at approximately 50 degrees at 80 cpm. The angle rate increased consistently with the increase from a target of 30 to 60 cpm, but it was reduced at 80 cpm. The mean KROM was inversely related (r=-0.390, P<0.01, n=40) to the mean KER without the weight, but not significantly (r=-0.256, P=ns, n=40) with the 0.5 kg weight. The achieved KER in the self-controlled free trial with or without the 0.5 kg weight might increase with an increase in sessions over 8 days with a range between approximately 30 and 60 cpm. Conclusion: The present case study showed that a higher contraction frequency may limit KROM determined below 60 cpm because of the reduced angle rate in an amputated lower leg. A low and moderate KER below 60 cpm may be appropriate to maintain KROM with a stable angle rate. Furthermore, voluntary KER with free self-controlled rhythm may increase over the course of multiple sessions as familiarity improves with kicking the amputated limb and generating a potential improvement in performance/ability effect with consecutive leg exercise with no use of a prothesis such as in the early/acute phase post-amputation using audible biofeedback.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Comparative Study of effectiveness of mobilization with movement (MWM) and End range mobilization (ERM) techniques in frozen shoulder

2018 ◽  
Vol 4 (4) ◽  
pp. 519-522
Author(s):  
Jeyakumar S ◽  
Jagatheesan Alagesan ◽  
T.S. Muthukumar
Keyword(s):  
Range Of Motion ◽  
Frozen Shoulder ◽  
Type I ◽  
Mean Values ◽  
Functional Activities ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Frozen shoulder is disorder of the connective tissue that limits the normal Range of motion of the shoulder in diabetes, frozen shoulder is thought to be caused by changes to the collagen in the shoulder joint as a result of long term Hypoglycemia. Mobilization is a therapeutic movement of the joint. The goal is to restore normal joint motion and rhythm. The use of mobilization with movement for peripheral joints was developed by mulligan. This technique combines a sustained application of manual technique “gliding” force to the joint with concurrent physiologic motion of joint, either actively or passively. This study aims to find out the effects of mobilization with movement and end range mobilization in frozen shoulder in Type I diabetics. Materials and Methods: 30 subjects both male and female, suffering with shoulder pain and clinically diagnosed with frozen shoulder was recruited for the study and divided into two groups with 15 patients each based on convenient sampling method. Group A patients received mobilization with movement and Group B patients received end range mobilization for three weeks. The outcome measurements were SPADI, Functional hand to back scale, abduction range of motion using goniometer and VAS. Results: The mean values of all parameters showed significant differences in group A as compared to group B in terms of decreased pain, increased abduction range and other outcome measures. Conclusion: Based on the results it has been concluded that treating the type 1 diabetic patient with frozen shoulder, mobilization with movement exercise shows better results than end range mobilization in reducing pain and increase functional activities and mobility in frozen shoulder.

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