The Efects of Kinetotherapy in the Recovery of Patients with Gonartrosis

Gonarthrosis is one of the most frequent forms of degenerative rheumatism, characterized bybenign evolution andprognosis. Itequally interests both sexes, manifesting itself around the age of 40, and affecting mostly the elderly population. The disease appears as a consequence of the wearingaway of the epiphyseal cartilages, which lose their elasticity and resistance due to mechanical shocks during walking.The localization of the osteoarthritic process at the knee level is considered to be the most common, and, according toits gender based incidence pool, women are by far the most affected, especially after entering menopause. The degenerative osteoarthritic process of the knee is the result of an imbalance between the resistance of the joint structures and the stressorsthey are subjected to.In contrast to hiposteoarthritis, knee osteoarthritis could transform intoa dysfunctional disease early on, due to pain and impaired muscular strength, especially of the leg extensors. It is true, however, that severe degenerative, dysfunctional forms can be found almost exclusively in secondary gonarthrosis, caused by misalignments (genuvarum, valgum, etc.), meniscopathies, ligamentous instability, traumas interesting intra-articular bone insertion, chronic nonspecific or specific inflammatory articular processes, endocrine-metabolic disorders.Starting from these assumptions and taking into account the number of people searching treatment for this condition, we believed that thorough theoretical and practical research was needed regarding the efficiency of kinetotherapyin slowing down the evolutionary process of the disease.

3D Talar Kinematics During External Rotation Stress Testing in Hindfoot Varus and Valgus Using a Model of Syndesmotic and Deep Deltoid Instability

Background: External rotation stress (ERS) identifies ankle instability after fibular reduction of rotational ankle injuries. Combined hindfoot and ankle motions and an inconsistent starting position could mask differing degrees of instability resulting from syndesmotic and/or deltoid ligament disruption. The goal of this work was to use full 3D talar kinematics to evaluate the effects of hindfoot orientation and foot starting position during ERS on the ability to detect instability caused by ligament disruptions. Methods: Six cadaveric ankles with metallic fiducial markers were CT scanned in neutral and 3 stress positions: varus hindfoot internal rotation stress (IRS-var), valgus hindfoot ERS (ERS-val), and varus hindfoot ERS (ERS-var). Scans were obtained in stress positions after transecting the deep deltoid ligament (tDDL) and then the syndesmotic ligaments (tDDL+Syn). Talar rotations and translations were computed in the axial, coronal, and sagittal planes in each stress position. Changes in a fixed center of rotation (CoR) relative to the intact sequence were calculated. Results: Axial plane rotation beginning from IRS-var increased significantly for each level of ligamentous instability ( P < .05 for all conditions) (10.9 degrees, intact; 14.1 degrees, tDDL; 22.7 degrees, tDDL+Syn during ERS-val; and 16.4 degrees, intact; 23.1 degrees, tDDL; 29.9 degrees, tDDL+Syn during ERS-var). With ERS-val, the talar CoR moved medially (3.6-5.4 mm) and posteriorly (0.5-5.2 mm); ERS-var moved anterior/laterally or posterior/medially depending on the specific ligamentous instability. With tDDL+Syn the ankle became grossly unstable and there were no clear trends in sagittal/coronal rotation or translation. Conclusion: An ERS test from internal to external rotation consistently differentiates between normal, tDDL, and tDDL+Syn. Talar CoR moved outside the mortise with ligamentous instability. Clinical Relevance: Significant residual deep deltoid instability is likely underrecognized with current practice. The most discriminatory test for detecting such instability in our laboratory was an ERS test performed by internally rotating the foot to a hard, bony endpoint, positioning the hindfoot in varus, and then performing the entire external rotation maneuver while maintaining the varus hindfoot position.

Conversion Knee Arthroplasty Using a Rotating Hinge as a Salvage Prosthesis Following Periprosthetic Joint Infection and Ligamentous Insufficiency: A Case Report

BackgroundIn the event of a complex revision TKA in which there is extensor mechanism involvement and ligamentous instability or insufficiency, non-linked levels of constraint may not be adequate for achieving restoration of patient function. Total knee arthroplasty devices that incorporate a linked level of constraint are successful alternatives to unlinked devices (PS and PS-Constrained) in this clinical context.Case PresentationWe present the case of a 62 year-old male patient that required a non-articulating knee fusion and multiple total knee arthroplasty revisions in conjunction with a ruptured and repaired extensor mechanism, ligamentous instability, bone loss and periprosthetic joint infection. (Revision knee prosthesis that includes a increasing degree of nodularity and physical constraint). The subsequent risk factors associated with the loss of bone and ligamentous insufficiency required performing conversion arthroplasty with a knee prosthesis that includes an increasing degree of modularity and physical constraint not commonly used in revision total knee arthroplasty.DiscussionThe authors report on a patient who underwent multiple operative procedures, we outline the step wise decision making progression that lead to the successful eradication of the PJI and reimplant device strategy based on the confounding factors presented. We assess the use of revision TKA systems that offer extreme degrees of constraint which should be considered in complex revision knee revision procedures.

Wrist

The carpus is characterized by complex anatomy and biomechanics. Twenty-four tendons traverse the eight bones and several named extrinsic and intrinsic ligaments. The joint are controlled by integrated co-ordination of the tendons and interosseous ligaments such that that movement yet stability in any direction can be achieved. Pathologies include ligamentous instability, ganglia, osteoarthritis, Kienbock’s, dorsal rim impingement, infection, rheumatoid. Treatment options depend on the diagnosis but include hand therapy, steroid injections, and surgery (arthroscopy, replacement, partial fusion, total fusion, excision arthoplasty).

Successful Nonoperative Treatment of Isolated Popliteus Tendon Avulsion Fractures in Two Adolescents

Isolated popliteal tendon avulsion fractures are relatively uncommon in the pediatric population as other posterolateral lateral structures are often involved. This report describes two skeletally immature male patients who presented with knee injuries without ligamentous instability and were subsequently diagnosed with isolated popliteus tendon avulsion fractures. Both of these patients were managed nonoperatively and had subjectively full recoveries. As the treatment for isolated popliteal tendon avulsion fractures is still unclear, the report here may contribute to strategies regarding conservative treatment of these injuries.