The purpose of this prospective and randomized study was to objectively evaluate isokinetic strength, clinical, and radiographical outcome in bilateral TKA using the same prosthesis with and without patella resurfacing. Bilateral TKA, one with, one without patella resurfacing was performed in 22 osteoarthritic patients, mean age was 68 years using the Low-Contact-Stress prosthesis. Minimum Follow-up was one year. Evaluation included clinical investigation, specific patella scores, radiographic analysis and isokinetic strength measurement of both knee flexion and extension at 60 degrees per second (Biodex). surement at 60 degrees per second (Biodex). There was no significant clinical score difference, but mean isokinetic strength of knee extension was significantly (p< .0001) stronger in the non-resurfaced patella TKA (40.5 Nm) compared with the resurfaced TKA (38,5 Nm). Flexion was also significantly stronger in the patella non-resurfaced group with 22.4 Nm versus 19.5 Nm in the resurfaced group. Mean lateral deviation was significantly (p< .001) less ideal in the resurfaced group as was postoperative patellofemoral congruent contact (p< .001). However, there was no correlation between lateral patella deviation or congruent contact and iso-kinetic strength. The results of this study indicate that mean isokinetic strength of both knee flexion and extension was significantly stronger in the non-resurfaced patella TKA. This study provides encouraging data for patella non-resurfacing. However, clinical scores or patient’s preference did not show any difference

Aims: The purpose of this study was to objectively evaluate isokinetic strength, clinical, and radiographical outcome of 22 patients with bilateral TKA using the same prosthesis with and without patella resurfacing. Methods: Bilateral TKA, one with, one without patella resurfacing was performed in 22 osteoarthritic patients, mean age was 68 years (58 to 79) using the Low-Contact-Stress prosthesis. Minimum Follow-up was one year at time of investigation. Evaluation included clinical investigation, speciþc patella scores, radiographic analysis and isokinetic strength measurement of both knee ßexion and extension at 60 degrees per second (Biodex). Results: There was no signiþcant difference in the clinical scores (mean: 26 out of 30 points), but mean iso-kinetic strength of knee extension was signiþcantly stronger (p< 0.0001) in the non-resurfaced TKA (40.5 Nm) compared with the resurfaced TKA (38,5 Nm). Flexion was also signiþcantly stronger in the patella non-resurfaced group with 22.4 Nm versus 19.5 Nm in the resurfaced group. Mean lateral deviation was significantly (p< 0.001) less optimal in the resurfaced group as was postoperative patello-femoral congruent contact (p< 0.001). However, there was no correlation between lateral patella deviation or congruent contact and iso-kinetic strength. Conclusions: The results of this prospective and randomized study indicate that mean isokinetic strength of both knee ßexion and extension was signiþcantly stronger in the non-resurfaced TKA. This study provides encouraging data for patella non-resurfacing

Background:. Patellectomized knees perform poorly with respect to extensor mechanism function and anterior knee pain. The clinical outcome after total knee arthroplasty (TKA) in this group of patients is inferior to patients with a patella independent of resurfacing. Purpose:. To evaluate clinical long-term outcome, isokinetic strength and radiographic appearance of a neo-patella in TKA, which was reconstructed using autologous bonegraft. Materials and Methods:. In the period of 1990 to 1995, nine previously patellectomized patients with a mean age of 55 years (range: 38 to 67) underwent cementless Low-Contact-Stress TKA for osteoathritis of the tibio-femoral joint. One patient deceased 5 years post surgery. Mean follow-up was 8. 0 years (range: 6 to 12) The autograft was taken in five cases from the iliac crest, in two cases from the posterior femoral condyle and in another two cases from the opposite patella at time of simultaneous bilateral TKA surgery. Evaluation included clinical investigation, specific patella score, radiographic analysis and isokinetic strength measurement at 60 degrees per second (Biodex). Results:. Clinical scores had a mean of 27 out of 30 points (range: 19 to 30) and mean isokinetic strength of knee extension reached 71Nm (81%) compared with the opposite site. One patient with bilateral patellectomy and unilateral TKA showed an increase of 50 % strength (51Nm versus 77Nm) in the kne with TKA and neo-patella. Radiographs in three planes showed minor signs of neo-patella bone resorption in three cases, but evidence of retrabeculation and bone remodelling in all neo-patellae. Conclusions:. Reconstruction of a neo-patella in TKA using autograft provides near to normal isokinetic strength, no evidence of considerable autograft resorption, excellent or good clinical outcome and high patients satisfaction after a mean of 8 years. The study provides encouraging data for reconstructing a neo-patella in TKA with autograft. Address for correspondence: 
 . jgboldt@hotmail.com

Aims: Patellectomized knees perform poorly with respect to extensor mechanism function and anterior knee pain. Methods: In the period of 1990 to 1995, nine previously patellectomized patients with a mean age of 55 years (range: 38 to 67) underwent cementless Low-Contact-Stress TKA with autologous reconstruction of a new patella. One patient deceased 5 years post surgery. Mean follow-up was 8.0 years (range: 6 to 12) The autograft was taken in five cases from the iliac crest, in two cases from the posterior femoral condyle and in another two cases from the opposite patella at time of simultaneous bilateral TKA surgery. Evaluation included clinical investigation, specific patella score, radiographic analysis and isokinetic strength measurement at 60 degrees per second (Biodex). Results: Clinical scores had a mean of 27 out of 30 points (range: 19 to 30) and mean isokinetic strength of knee extension reached 71Nm (81%) compared with the opposite site. One patient with bilateral patellectomy and unilateral TKA showed an increase of 50 % strength (51Nm versus 77Nm) in the knee with TKA and neo-patella. Radiographs in three planes showed minor signs of neo-patella bone resorption in three cases, but evidence of retrabeculation and bone remodelling in all neo-patellae. Conclusions: Reconstruction of a neo-patella in TKA using autograft provides near to normal isokinetic strength, no evidence of considerable autograft resorption, excellent or good clinical outcome and high patients satisfaction after a mean of 8 years. The study provides encouraging data for reconstructing a new patella in patellectomized knees during TKA

Aims Patellectomized knees perform poorly with respect to extensor mechanism function and anterior knee pain. Methods: In the period of 1990 to 1995, nine previously patellectomized patients with a mean age of 55 years (range: 38 to 67) underwent cementless Low-Contact-Stress TKA with autologous reconstruction of a new patella. One patient deceased 5 years post surgery. Mean follow-up was 8.0 years (range: 6 to 12) The autograft was taken in five cases from the iliac crest, in two cases from the posterior femoral condyle and in another two cases from the opposite patella at time of simultaneous bilateral TKA surgery. Evaluation included clinical investigation, specific patella score, radiographic analysis and isokinetic strength measurement at 60 degrees per second (Biodex). Results: Clinical scores had a mean of 27 out of 30 points (range: 19 to 30) and mean isokinetic strength of knee extension reached 71Nm (81%) compared with the opposite site. One patient with bilateral patellectomy and unilateral TKA showed an increase of 50% strength (51Nm versus 77Nm) in the kne with TKA and neo-patella. Radiographs in three planes showed minor signs of neo-patella bone resorption in three cases, but evidence of retrabeculation and bone remodelling in all neo-patellae. Conclusions: Reconstruction of a neo-patella in TKA using autograft provides near to normal isokinetic strength, no evidence of considerable autograft resorption, excellent or good clinical outcome and high patients satisfaction after a mean of 8 years. The study provides encouraging data for reconstructing a new patella in patellectomized knees during TKA

Aim: Patients treated with one-stage combined operations after walking age for developmental dysplasia of the hip (DDH), and whose follow-up revealed both clinical and radiological complete healing underwent flexor and extensor isokinetic muscle strength (IMS) measurements of the hip and results were evaluated in comparison with the contralateral hips. Methods: A total of 22 patients with unilateral DDH and treated with one-stage combined operations after walking age were included in the study. All patients were operated by the same surgeon. In their last follow-up visit, all patients were functionally excellent in accordance with the Barrett’s Modified McKay Criteria and according to the Severin’s Classification for radiological grading of the hip all cases were type I. IMS of hip flexors and extensors were tested by Biodex 3 Pro isokinetic test device at 120º/sc and 240º/sc. In all patients, peak torque (PT), peak torque angle (PTA), total work (TW), and average power (AP) values of operated and non-operated hips were measured at both angular velocities and recorded separately for flexors and extensors. For comparative evaluation, values of the operated and non-operated hips were used for determining the differences in IMS (DIMS), total work (DTW), and average power (DAP). In statistical assessment; Student’s t test, paired t test, and Spearman’s Rank correlation analysis were used. Results: The mean age of patients were 12,8±2,9 (9–18) years old. At the last control visit, the mean value of follow-up periods were 112,6±32,0 (68–159) months. Parameters like age, age at the time of operation, and the length of postoperative follow-up period showed no statistical relation with IMS measurements (p> 0,05). For flexors, TW was lower at the operated hip when compared with the non-operated hip at 120º/sc and 240º/sc (p=0,001 and p=0,002, respectively). AP was lower at the operated hip at 120º/sc and 240º/sc (p=0,011 and p=0,003, respectively). PT was lower at the operated hip (22,5±11,3) when compared with the non-operated hip (27,1±12,1) only at 120º/sc (p=0,001). For extensor muscles, PT, TW, AP, and PTA showed no statistically significant difference (p> 0,05). For flexors, the DIMS between operated and non-operated hips at 120º/sc and 240º/sc were measured as −15,3±22,2% (median;-14,4) and −8,0±21,4% (median;−2,5), respectively. Conclusions: In operated DDH patients with a mean follow-up period of around 10 years, IMS measurements revealed that the flexor muscle strength of the operated hip was still weaker than the non-operated hip. At 120º/sc, which represented evaluation against higher resistance, DIMS, DWF, and DAP were higher when compared with 240º/sc. This finding shows that hip flexors of these patients may remain weak in activities like sports, which require more resistance

Hamstring grafts have been associated with reduced strength, donor site pain and muscle strains following Anterior Cruciate Ligament Reconstruction (ACLR). Traditional graft fixation methods required both semitendinosus and gracilis tendons to achieve a graft of sufficient length and diameter, but newer techniques allow for shorter, broad single tendon grafts. This study seeks to compare the outcomes between Single Tendon (ST) and Dual Tendon (DT) ACLR, given there is no prospective randomised controlled trial (RCT) in the literature comparing outcomes between these options. In this ongoing RCT: (ANZ Clinical Trials Registry ACTRN126200000927921) patients were recruited and randomised into either ST or DT groups. All anaesthetic and surgical techniques were uniform aside from graft technique and tibial fixation. 13 patients were excluded at surgery as their ST graft did not achieve a minimum 8mm diameter. 70 patients (34 ST, 36DT) have been assessed at 6 months, using PROMS including IKDC2000, Lysholm and Modified Cincinnati Knee, visual analog scale for pain frequency (VAS-F) and severity (VAS-S), dedicated donor site morbidity score, KT-1000 assessment, and isokinetic strength. Graft diameters were significantly lesser in the ST group compared to the DT group (8.44mm/9.11mm mean difference [MD],-0.67mm; P<0.001). There was a significant and moderate effect in lower donor site morbidity in the ST group compared to the DT group (effect size [ES], 0.649; P = .01). No differences between groups were observed for knee laxity in the ACLR limb (P=0.362) or any of the patient-reported outcome measures (P>0.05). Between-group differences were observed for hamstrings strength LSI favouring the ST group, though these were small-to-moderate and non-significant (ES, 0.351; P = .147). ST (versus DT) harvest results in significantly less donor site morbidity and this is the first prospective RCT to determine this. There were no differences between ST and DT hamstring ACLR were observed in PROMs, knee laxity and hamstring strength. Younger female patients tend to have inadequate single tendon size to produce a graft of sufficient diameter, and alternative techniques should be considered. Further endpoints include radiological analysis, longer term donor site morbidity, revision rates and return to sport and will continue to be presented in the future

INTRODUCTION. The grip test is usually included in common protocols of functional evaluation. Till today a dynamometer Jamar was used to evaluate Maximum Isometric Strength. At this moment we use isokinetic dynamometers to analyse grip strength in isokinetic way. As a few bibliographic references for this valuation techniques we have designed an study at healthy population to obtain the normal values of grip strength and the influence of individual factors, like sex, age and side-dominance. MATERIAL AND METHODS. A 321 healthy hands serial was included. The average age was 37.2 years old (ranged 17–63). Mostly of them were men (211 cases, 65.7%). 150 are side-dominant cases (46.7%). All of them has been valuated by Dexter Hand Evaluation. Two speeds 30°/s and 60°/s was used in the study. And the extent used was 4.3 cm. Five trials was done in each velocity. We acquired Maximum Isokinetic Strength and Work. RESULTS. The values were for strength (Kg) 38.4 at 30°/s and 35.0 at 60°/s and for work (Kg-cm) 98.5 at 30°/s and 86.7 at 60°/s. The side-dominant hand are stronger than non-dominant ones (10.3% in 30°/s, p< 0.001; 11.9% in 60°/s, p< 0.001). Women had less strength than men (37% in both speeds, p< 0.001). The age has less important as isokinetic strength values are more or less the same till 39 years old. After that there is a slow drop of the strength in aged cases. At last we show tables of normal values at healthy population. The influence of sex and side-dominant are shown as a percentile distribution. CONCLUSIONS. The isokinetic strength evaluation of hand grip is a very value method in the functional evaluation of the hand. This study gives normal values in healthy hands and the influence of sex, age and side-dominance

Quadriceps femoris muscle weakness has long been associated with disuse atrophy in symptomatic knee osteoarthritis but more recently implicated in the aetiology of this condition. The purpose of this study was to assess the benefits of two interventions aimed at increasing quadriceps strength in subjects with moderate to severe knee osteoarthritis. Twenty-eight patients, aged fifty-five to seventy-five, were recruited and randomised to either a six-week home resistance-training exercise program or a six-week neuromuscular electrical stimulation (NMES) program. Eleven patients matched for age, gender and osteoarthritis severity formed a control group, receiving standard care. The resistance-training group performed six exercises three times per week, while the NMES group used the garment stimulator for twenty minutes five times per week Outcome measures included isometric and isokinetic quadriceps strength, functional capacity, quadriceps cross-sectional area, and validated health survey scores. These measures were assessed at baseline, post-intervention and at 6-weeks post-intervention. Both intervention groups showed significant improvements in all functional tests, in the global health survey, and in quadriceps cross-sectional area immediately post-intervention. An increase in isokinetic strength was seen in the exercise group only. With the exception of isokinetic strength, all benefits were maintained six weeks post-intervention. Both a six-week home resistance-training program and a six-week NMES program produce significant improvements in functional performance as well as physical and mental health for patients with moderate to severe knee osteoarthritis. Home-based NMES is an acceptable alternative to physical therapy, and is especially appropriate for patients who have difficulty complying with an exercise program

Background: Knee osteoarthritis is responsible for more chronic disability than any other medical condition. Quadriceps femoris muscle weakness has long been associated with disuse atrophy in symptomatic knee osteoarthritis but more recently implicated in the aetiology of this condition. The purpose of this study was to assess the benefits of two interventions aimed at increasing quadriceps strength in subjects with moderate to severe knee osteoarthritis. Methods: Twenty-eight patients, aged 55–75 years, diagnosed with moderate to severe knee osteoarthritis were recruited and randomised to either a six-week home resistance-training exercise program or a six-week home neuromuscular electrical stimulation (NMES) program. An additional eleven patients matched for age, gender and osteoarthritis severity formed a control group, receiving standard care. The resistance-training group performed six exercises three times per week, while the NMES group used the garment stimulator at the maximum intensity tolerated for twenty minutes five times per week. Outcome measures included isometric and isokinetic quadriceps strength, functional capacity (25m walk test, chair rise test, stair climb test), Western Ontario and McMaster Osteoarthritis Index (WOMAC) and Short Form 36 (SF-36) health surveys. These measures were assessed at baseline, pre-intervention (after familiarisation), post-intervention and at 6-weeks post-intervention. Additionally, quadriceps cross-sectional area (via MRI) and muscle atrophy/hypertrophy gene expression (via vastus lateralis biopsy) were assessed pre- and post-intervention. Results: Both intervention groups showed significant improvements in all functional tests (e.g. in the stair test, a 22% improvement in the exercise group versus 17% for the NMES group), in the SF36 health survey (25% & 22% respectively), and in quadriceps cross-sectional area (4.3% & 5.4%) immediately post-intervention. An increase in isokinetic strength was seen in the exercise group only (11%). WOMAC score improved only for the NMES group (19%). With the exception of isokinetic strength, all benefits were maintained six weeks post-intervention. Conclusions: Both a six-week home resistance-training program and a six-week home NMES program produced significant improvements in functional performance as well as physical and mental health for patients with moderate to severe knee osteoarthritis. Home-based NMES is an acceptable alternative to physical therapy for patients with knee osteoarthritis, and is especially appropriate for patients who have difficulty complying with an exercise program

Patella management in total knee arthroplasty remains controversial. Minimizing patella related problems is the main goal in any type of knee arthroplasty. This can be achieved with and without resurfacing. However, patella resurfacing resulted in, at times, catastrophic failures, which increased the popularity of patella non resurfacing, particularly with anatomical femoral groove designs. If patella non resurfacing is to be recommended, clinical outcomes must be equal or better than those of routine patella resurfacing in the specific prosthesis utilized. From a large cohort of over 6000 TKA five studies were conducted to analyze isokinetic strength, subjective, clinical, and radiographic outcomes as well as histopathological data. Isokinetic strength, subjective, clinical, and radiographic outcomes favor nonresurfacing in TKA with proper femoral component rotation and conforming patellar groove. Our data indicate that patella subluxation and femoral component malrotation is significantly associated with development of arthrofibrosis. On the base of our studies we propose specific surgical techniques for optimal patella treatment (patelloplasty) in TKA

Background:. The aim of this study was to investigate the outcome after ACL reconstruction between a group of patients receiving a standardized supervised physiotherapy guided rehabilitation program and a group of patients who followed an un-supervised, home-based rehabilitation program. Methods:. 40 patients with isolated anterior cruciate ligament injuries were allocated to either a supervised physiotherapy intervention group or home-based exercise group. Patients were investigated by an independent examiner pre-operative, 3, 6, 9 and 12 months post-surgery using the following outcome measures: Lysholm Score and Tegner Activity Scale, functional hopping tests, isometric and isokinetic strength assessments. Results:. Both groups improved significantly (p=0.01–0.04) following 12 months after surgery. The median Lysholm score increased from 57 (34–90) to 94 (90–100) in the supervised group and 60 (41–87) to 97 (95–100) in the unsupervised group. The median Tegner Activity Scale increased from 3 (2–8) to 6 (3–8) in the supervised group and 4 (2–8) to 5 (3–10) in the unsupervised group. The combined mean symmetry indices for the hopping tests improved from 77.3+ 18.7 to 86.8+11.1 (supervised) and from 78.1+30.5 to 88.3+10.9 (unsupervised). Isometric and isokinetic strength symmetry indices for knee extension improved from 68.9+23.5 to 82.8+11.9 resp. 63.7+22.8 to 82.7+15.1 in the supervised group and from 73.6+20.5 to 76.5+17.9 resp. 69.5+24.3 to 76.9+16.9 in the unsupervised group. Eccentric strength symmetry indices for knee extension improved from 67.9+27.7 to 87.8+6.8 in the supervised group and from 71.3+17.8 to 82.6+15.6 in the unsupervised group. Conclusion:. This study could not demonstrate a benefit in a rehabilitation program supervised by a physiotherapist in our population compared to an unsupervised cohort

Patellectomized knees often perform poorly with respect to extensor mechanism function. Reconstruction options and literature reports are limited. The purpose of this study was to describe and review bone graft patella reconstruction in TKA. Material_e_Methods: Since 1990 nine previously patel-lectomized patients underwent cementless Low-Contact-Stress TKA with autologous patella reconstruction. One patient died 5 years post surgery. Mean follow-up was 8.0 years (6 to 12). Autologous bonegraft was taken in five cases from the iliac crest, in two cases from the posterior femoral condyle and in two cases from the opposite patella at time of simultaneous bilateral TKA. Postoperative evaluation included clinical and radiographic analysis and bilateral comparative isokinetic strength measurement at 60 degrees per second (Biodex). Clinical scores had a mean of 27 points (max: 30) and mean isokinetic extension strength of 71Nm (81 percent) compared with the opposite healthy patella site. One patient with bilateral patellectomy and unilateral patella reconstruction showed a 50 percent increase of strength on the grafted side. Radiographs showed minor signs of neopatella bone resorption, but a maintained leaver arm. Reconstruction of a neo-patella in TKA with autograft provides marked improvement of isokinetic extensor strength, little evidence of autograft resorption, excellent or good clinical outcome and high patients satisfaction after a mean of 8 years. The results of this study indicate encouraging data for reconstructing a new patella and lever arm in patellectomized knees during primary or revision TKA. Cosmetic improvement in females is another subjective advantage

31 consecutive patients (mean 54.7 years) were examined mean follow-up time of 47 months. Patients were evaluated clinically; using Lysholm, Cincinnati, IKDC and Tegner Activities Scores. Objective assessments were made with KT1000 Arthrometer and Isokinetic strength testing. Lysholm scores improved from 62 preoperatively to 93 at review; Cincinnati 48 to 89; Tegner 3.6 to 5.2. 81 percent of knees were considered normal or nearly normal to IKDC, 6 abnormal, none severely abnormal. KT1000 manual max difference 2.9mm; Isokinetic flexion strength 102 percent; extension strength 95 percent. Poor results were mainly associated with advanced articular cartilage degenerative changes at time of surgery. This also correlated with increased time from injury to surgery, and increased preoperative injury rates. This study demonstrates that the anterior cruciate ligament can be reliably reconstructed in patients over the age of 50 years with good symptomatic relief, restoration of function and return to activity

While controversy remains as to the relative benefit of operative (OM) versus non-operative management (NOM) of Achilles tendon ruptures (ATR), few studies have examined the effect on high impact maneuvers such as jumping and hopping. The purpose of this study is to compare functional performance and musculotendinous morphology in patients following OM or NOM for acute ATR. Eligible patients were aged 18-65 years old with an ATR who underwent OM or NOM within three weeks of injury and were at least one-year post injury. Gastrocnemius muscle thickness and Achilles tendon length and thickness were assessed with ultrasound. Functional performance was examined with single-leg hop tests and isokinetic plantar strength at 60o/s and 120o/s. 24 participants completed testing (12/ group). Medial (OM: 2.2 ± 0.4 cm vs 1.9 ± 0.3 cm, NOM 2.15 ± 0.5 cm vs 1.7 ± 0.5 cm; p = 0.002) and lateral (OM 1.8 ± 0.3 cm vs 1.5 ± 0.4 cm, NOM 1.6 ± 0.4 cm vs 1.3 ± 0.5 cm; p = 0.008) gastrocnemius thickness were reduced on the affected limb. The Achilles tendon was longer (OM: 19.9 ± 2.2 cm vs 21.9 ± 1.6 cm; NOM: 19.0 ± 3.7 cm vs 21.4 ± 2.9 cm; p = 0.009) and thicker (OM: 0.48 ± 0.16 cm vs 1.24 ± 0.20 cm; NOM: 0.54 ± 0.08 cm vs 1.13 ± 0.23 cm; p < 0.001) on the affected limb with no differences between groups. Affected limb plantar flexion torque at 20o plantar flexion was reduced at 60o/s (OM: 55.6 ± 20.2 nm vs 47.8 ± 18.3 nm; NOM: 59.5 ± 27.5 nm vs 44.7 ± 21.0 nm; p = 0.06) and 120o/s (OM: 44.6 ± 17.9 nm vs 36.6 ± 15.0 nm; NOM: 48.6 ± 16.9 nm vs 35.8 ± 10.7 nm; p = 0.028) with no group effect. There was no difference in single leg hop performance. Achilles tendon length explained 31.6% (p = 0.003) and 18.0% (p = 0.025) of the variance in plantar flexion peak torque limb symmetry index (LSI) at 60o/s and 120o/s respectively. Tendon length explained 28.6% (p=0.006) and 9.5% (p = 0.087) of LSI when torque was measured at 20o plantar flexion at 60o/s and 120o/s respectively. Conversely, tendon length did not predict affected limb plantar flexion peak torque (nm), angle-specific torque at 20o plantar flexion (nm) and affected limb single leg hop distance (cm) or LSI (%). There was no difference in tendon length between treatment groups and deficits in gastrocnemius thickness and strength are persistent. Deficits in the plantar flexion strength LSI are partially explained by increased tendon length following Achilles tendon rupture, regardless of treatment strategy. Hop test performance is maintained and may be the result of compensatory movements at other joints despite persistent plantarflexion weakness

Isolated rupture of short head of biceps is a rare injury. There have been no published reports of rupture at the musculotendinous junction. We report two cases of complete rupture of the musculotendinous junction of the short head of biceps in young males both occurring during water skiing. Two males sustained water skiing injuries where the handle was forced against the flexor region of the arm. Whilst trying to adduct and flex the extended arm, they both sustained complete musculotendinous ruptured of their short head of biceps. Both underwent pre-operative magnetic resonance imaging and one underwent isokinetic strength testing of elbow flexion and supination. Surgical repair was performed using absorbable sutures. One patient had the short head muscle belly flipped distally to lie in a subcutaneous plane in front of the elbow. Post-operative management included cast immobilisation for three weeks then gentle range of motion exercises. Both patients recovered their full range of motion in the arm. There were no complications. Post-operative strength testing was performed and will be presented. This is a unique series of complete musculotendinous rupture of the short head of biceps. The mechanism of injury was resisted adduction and flexion against the towrope handle with the arm in extension. These ruptures occurred in high impact high velocity accidents. Surgical repair lead to an excellent outcome

Background. Return to sports after anterior cruciate ligament reconstruction (ACLR) is multifactorial and rotational stability is one of the main concerns. Anterolateral ligament reconstruction (ALLR) has been recommended to enhance rotational stability. Purpose. To assess the effect of ALLR on return to sports. Study Design. Retrospective comparative cohort study;. Level of evidence: III. Methods. A total of 68 patients who underwent ACLR after acute ACL injury between 2015 and 2018 with a follow-up of at least 24 months were enrolled in the study. Patients with isolated ACLR (group ALL(-), n=41) were compared to patients with ACLR+ALLR (group ALL(+), n=27) in regard to subjective knee assessment via Tegner activity scale, Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, Knee Documentation Committee (IKDC) form and Lysholm score. All tests were performed before the surgery, at 6 months and 24 months postoperatively. Results. Mean follow-up was 29.7±2.9 months for group ALL(-) and 31.6±3.0 for ALL(+) (p=0.587). Tegner, ACL-RSI and IKDC scores at last follow-up were significantly better in ALL(+) compared to ALL(-). There were no significant differences in isokinetic extensor strength and single-leg hop test results between the groups. 40 (97.6%) patients in ALL(-) and 27 (100%) in ALL(+) had a grade 2 or 3 pivot shift (p=0.812) preoperatively. Postoperatively, 28 (68.3%) patients in ALL(-) and 25 (92.6%) patients in ALL(+) had a negative pivot shift (p<0.001). 2 (5.9%) patients in ALL(-) and 1 (3.7%) patient in ALL(+) needed ACLR revision due to traumatic re-injury (p=0.165). There was no significant difference in the rate of return to any sports activity (87.8% in ALL(-) vs 88.9% in ALL(+); p=0.532), but ALL(+) showed a higher rate of return to the same level of sports activity (55.6%) than group ALL(-) (31.7%) (p=0.012). Conclusion. ACLR combined with ALLR provided a significantly higher rate of return to the same level sports activity than ACLR alone, probably due to enhanced rotational stability

There are some reports that the invasive surgery of knee joint replacement repair static and dynamic balance. We investigated the changes in static and dynamic balance and muscle strength in pre- and postoperative of TKA and UKA for the purpose of assessing time dependent improvement. A total of 168 patients (137 TKA; mean age 75.3, 31 UKA; mean age 78.1) were recruited to the study. These patients underwent static and dynamic balance assessment and muscle strength pre operation and 3, 6, 12 months post operation. The parameters of assessment were one leg standing time (open or close eyes), postural sway test (open or close eyes), 3m timed-up-and-go test, maximum stride and Isokinetic muscle strength. We have evaluated both the absolute value and the index which divided the value of the post-operation with the value of pre-operation. Alignment had improved significantly after surgery in TKA and UKA. Isokinetic muscle strength (Fig. 1), one leg standing time with open eyes, 3m timed-up-and-go test (Fig. 2) and maximum stride showed better improvement than pre operation at 3, 6, and 12 months after surgery in TKA and UKA. On the other hand, one leg standing time with close eyes and postural sway test showed no improvement than pre operation at any time after operation (Fig. 3). Butpostural sway test in UKA showed the improvement trend at 3 months after surgery. In contrast, those test in TKA showed no improvement at 3 months after surgery (Fig. 3). Our result showed the improvement of balance function correlated with muscle recovery and improvement of lower limb alignment than equilibrium function after the artificial knee joint replacement surgery. Because one leg standing time with close eyes and one leg postural sway test represent the equilibrium function than other tests. It is interesting that significant difference in the recovery of postural sway in three months after surgery in UKA compared with TKA

The Achilles tendon is the most commonly ruptured tendon in the body and yet its management remains controversial due to potential surgical complications. We believe that primary repair using LARS ligament augmentation, combined with early mobilisation will significantly reduce all these potential problems and lead to improved functional outcomes. Nine patients with acute Achilles tendon ruptures underwent primary repair using augmentation with a Ligament Augmentation and Reconstruction System (LARS) ligament. Day one postoperatively each patient was started on active range of motion exercises. Clinical parameters, isokinetic strength and outcome measurements (The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and Lower Extremity Functional Scale (LEFS) was utilised to assess pain and function, Tegner score to evaluate activity) were evaluated at an average follow-up of 17 months. Complications, if any, were also recorded. There were no re-ruptures and all patients returned to normal work (average time 9.2 weeks) and all but one returned to their previous level of recreational sporting activity (average time 20.8 weeks). The postoperative performance testing showed positive results with the mean decrease in calf circumference of affected leg was 1.0 cm (range, −0.5 to 2.0), and every patient was able to perform at least one heel-raise with the mean heel raise difference being −3.8 repetitions (range, −1 to −10 reps) when compared to the other leg. In terms of functional outcomes, all patients reported very good results. The mean AOFAS score postoperatively was 83.4% (range, 74% to 100%) and the mean LEFS score was 82.5% (range, 45 to 100%). The mean preoperative Tegner score was 4.75 (range, 2 to 8) and the postoperative score was 3.75 (range, 2 to 7). The results of our preliminary clinical series indicate that LARS ligament repair of acute Achilles tendon ruptures provides a reliable and effective technique for repair. It eliminates the need for graft harvesting, it decreases postoperative complications, but most importantly, patients have improved functional outcomes

Purpose: The purpose of this randomised controlled trial was to compare outcomes of operative and non-operative management of Achilles tendon ruptures. Method: Patients with acute complete Achilles tendon ruptures were randomised to receive open suture repair followed by graduated rehabilitation or graduated rehabilitation alone. The primary outcome measure was re-rupture rate. Assessments at three and six months, and one and two years included a modified Leppelhati score (no strength data), range of motion, calf circumference, and isokinetic strength at one and two years. We report the two year findings. Results: Two centres randomized 145 patients (118 males and 27 females), mean age 40.9±8.8 years (22.5 – 67.2) to operative (n=73) and non-operative (n=72) treatment. Fourteen were lost to follow-up. Re-rupture occurred in three patients in both groups. The mean modified Lep-pelhati score (out of 85) was 78.2±7.7 in the operative group and 79.7±7.0 in the non-operative group, which was not significant (−1.5 95%CI −6.4 to 3.5, p=0.55). Mean side-to-side difference in plantar flexion and calf-circumference in the operative group was −2.0±3.2° and −1.4±1.2cm, and in the non-operative group −0.9±3.0°and −1.6±1.8cm respectively. Mean isokinetic plantar flexion strength was 62.4±24.2 for the operative and 56.7±19.3 for the non-operative group, which was not significant (5.7, 95%CI −3.1 to 14.5, p=0.20). There were a greater number of serious adverse events in the operative group, including pulmonary embolus in one patient, deep vein thrombosis in one and deep infections requiring irrigation and debridement in three. Conclusion: This study suggests that non-operative management of Achilles tendon ruptures utilizing an accelerated rehabilitation programme may produce comparable results with fewer adverse events