The Effects of Visuomotor Training on the Functional Recovery of Post-Surgery Musculoskeletal Conditions: A Randomized Controlled Trial

(1) Background: Musculoskeletal conditions show increasing prevalence and high economic/human burden. Recovery for hip or knee surgery may require more than 26 weeks, while universally accepted rehabilitation guidelines are missing. Provided that multisensory-based training enhances motor learning, the study aims to verify if visuomotor training accelerates the recovery of lower limb motor function after orthopedic surgery. (2) Methods: Post-surgery subjects were randomly assigned to receive visuomotor training as an add-on to the conventional physical therapy (VTG), or receive the conventional therapy alone (CG). Subjects performed 40 one-hour training sessions in 8 weeks. The primary endpoint was the improvement in the Lower Extremity Functional Scale (LEFS) over the minimally clinical important difference (MCID) at 4 weeks post-randomization. The secondary endpoint included pain reduction. (3) Results: Eighteen patients were equally distributed into the VTG and CG groups. While LEFS and pain scores significantly improved in both groups, the VTG exceeded the LEFS MCID by 12 points and halved the pain value after the first 4 weeks of treatment, while the CG reached the endpoints only after treatment end (p = 0.0001). (4) Conclusions: Visuomotor training offers an innovative rehabilitation approach that accelerates the recovery of lower limb motor function in patients undergoing orthopedic surgery.

Endoscopic Repair of Partial Thickness Under-Surface Tears of The Abductor Tendon (pusta): Clinical Outcomes with Minimum Two-year Follow-up

Objectives: To report the minimum two-year outcomes of trans-tendinous repairs of Partial Thickness Undersurface Tears of the Abductor (PUSTA) tendon using patient reported outcomes (PROs), visual analog scale (VAS), and patient satisfaction scores. Methods: All patients who underwent endoscopic trans-tendinous gluteus medius repair between October 2009 and May 2013 at one institution were prospectively evaluated. Exclusion criteria consisted of less than two-year follow-up, previous hip surgery, inflammatory arthritis, open surgery, full thickness abductor tear, and worker’s compensation patients. All patients had a documented pre-operative physical exam with strength testing (0-5) and observation of their gait. Patient satisfaction and PRO scores were recorded preoperatively, at 3 months postoperatively, and annually thereafter. The PRO scores collected were mHHS, HOS-ADL, HOS-SSS, NAHS, and VAS. Preoperative strength and gait were compared to latest follow-up. Results: There were 25 patients that fit our criteria. Significant improvement in PRO scores were demonstrated for mHHS, HOS-ADL, HOS-SSS, NAHS, and VAS from 54.9-76.2, 50.2-80.6, 30.1-67.3, 51.9-82.4, and 7.1-2.7 respectively (p<0.001). There were 11 patients with objective weakness prior to surgery; seven of these patients moved up at least one strength grade by final follow-up. There were 14 patients who had a Trendelenbrug gait pre-operatively, 12 of them had a normal gait at latest follow-up (p-<0.001). Average patient satisfaction was 7.5. There were no revision surgeries, and no complications noted. Conclusion: PUSTA lesions can be treated successfully with endoscopic trans-tendinous repair preserving the intact attachment of superficial fibers of the gluteus medius. We recommend this treatment for partial undersurface tears recalcitrant to non-operative treatment, as patients demonstrated clinical benefit at greater than 2 years follow up that exceeds substantial clinical benefit and minimally clinical important difference.