Objectives. To date, no study has considered the impact of acromial morphology on shoulder range of movement (ROM). The purpose of our study was to evaluate the effects of lateralization of the centre of rotation (COR) and neck-shaft angle (NSA) on shoulder ROM after reverse shoulder arthroplasty (RSA) in patients with different scapular morphologies. Methods. 3D computer models were constructed from CT scans of 12 patients with a critical shoulder angle (CSA) of 25°, 30°, 35°, and 40°. For each model, shoulder ROM was evaluated at a NSA of 135° and 145°, and lateralization of 0 mm, 5 mm, and 10 mm for seven standardized movements: glenohumeral abduction, adduction, forward flexion, extension, internal rotation with the arm at 90° of abduction, as well as external rotation with the arm at 10° and 90° of abduction. Results. CSA did not seem to influence ROM in any of the models, but greater lateralization achieved greater ROM for all movements in all configurations. Internal and external rotation at 90° of abduction were impossible in most configurations, except in models with a CSA of 25°. Conclusion. Postoperative ROM following RSA depends on multiple patient and surgical factors. This study, based on computer simulation, suggests that CSA has no influence on ROM after RSA, while lateralization increases ROM in all configurations. Furthermore, increasing subacromial space is important to grant sufficient rotation at 90° of abduction. In summary, increased lateralization of the COR and increased subacromial space improve ROM in all CSA configurations. Cite this article: A. Lädermann, E. Tay, P. Collin, S. Piotton, C-H Chiu, A. Michelet, C. Charbonnier. Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty. Bone Joint Res 2019;8:378–386. DOI: 10.1302/2046-3758.88.BJR-2018-0293.R1

Aims. This study aims to evaluate a new home medical stretching device called the Self Treatment Assisted Knee (STAK) tool to treat knee arthrofibrosis. Methods. 35 patients post-major knee surgery with arthrofibrosis and mean range of movement (ROM) of 68° were recruited. Both the STAK intervention and control group received standard physiotherapy for eight weeks, with the intervention group additionally using the STAK at home. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Scores (OKS) were collected at all timepoints. An acceptability and home exercise questionnaire capturing adherence was recorded after each of the interventions. Results. Compared to the control group, the STAK intervention group made significant gains in mean ROM (30° versus 8°, p < 0.0005), WOMAC (19 points versus 3, p < 0.0005), and OKS (8 points versus 3, p < 0.0005). The improvements in the STAK group were maintained at long-term follow-up. No patients suffered any complications relating to the STAK, and 96% of patients found the STAK tool ‘perfectly acceptable’. Conclusion. The STAK tool is effective in increasing ROM and reducing pain and stiffness. Patients find it acceptable and adherence to treatment was high. This study indicates that the STAK tool would be of benefit in clinical practice and may offer a new, cost-effective treatment for arthrofibrosis. Cite this article: Bone Joint Open 2020;1-8:465–473

Aims. This study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of movement (ROM) after open elbow arthrolysis (OEA). We also assessed the proportion of patients who achieved MCID and SCB; and identified the factors associated with achieving MCID. Methods. A cohort of 265 patients treated by OEA were included. The MEPI and ROM were evaluated at baseline and at two-year follow-up. Distribution-based MDC was calculated with confidence intervals (CIs) reflecting 80% (MDC 80), 90% (MDC 90), and 95% (MDC 95) certainty, and MCID with changes from baseline to follow-up. Anchor-based MCID (anchored to somewhat satisfied) and SCB (very satisfied) were calculated using a five-level Likert satisfaction scale. Multivariate logistic regression of factors affecting MCID achievement was performed. Results. The MDC increased substantially based on selected CIs (MDC 80, MDC 90, and MDC 95), ranging from 5.0 to 7.6 points for the MEPI, and from 8.2° to 12.5° for ROM. The MCID of the MEPI were 8.3 points under distribution-based and 12.2 points under anchor-based methods; distribution- and anchor-based MCID of ROM were 14.1° and 25.0°. The SCB of the MEPI and ROM were 17.3 points and 43.4°, respectively. The proportion of the patients who attained anchor-based MCID for the MEPI and ROM were 74.0% and 94.7%, respectively; furthermore, 64.2% and 86.8% attained SCB. Non-dominant arm (p = 0.022), higher preoperative MEPI rating (p < 0.001), and postoperative visual analogue scale pain score (p < 0.001) were independent predictors of not achieving MCID for the MEPI, while atraumatic causes (p = 0.040) and higher preoperative ROM (p = 0.005) were independent risk factors for ROM. Conclusion. In patients undergoing OEA, the MCID for the increased MEPI is 12.2 points and 25° increased ROM. The SCB is 17.3 points and 43.3°, respectively. Future studies using the MEPI and ROM to assess OEA outcomes should report not only statistical significance but also clinical importance. Cite this article: Bone Joint J 2021;103-B(2):366–372

Ankle sprains are very common, and usually tear or partly tear one or more of the ligaments on the outer side of the ankle. The ankle joint is only designed to move up and down, whereas there is another joint immediately below the ankle joint, called the subtalar joint, which is designed to do the tilting in and out movement. If the foot tilts over too far, the subtalar joint reaches the end of its movement and then the ankle ligaments stretch and tear. It is possible that variations of subtalar range of movement may contribute to ankle sprains or symptoms of weakness or instability. In particular, if the subtalar joint is unusually restricted in its movement, then the foot does not have to tilt far before the lateral ligaments tear. If on the other hand the subtalar joint is particularly mobile and has excessive movement, then the foot may go right over without actually tearing ligaments and feel insecure or unstable simply as a result of abnormal excessive movement. Recent studies have demonstrated what we have always suspected, that clinical examination and assessment of subtalar range of movement is highly unreliable. In order to accurately assess whether your subtalar range of movement is unusually restricted or excessive, the only standard and accurate method to date has been to obtain a CT scan. We are now undertaking a study to establish whether plain xrays with a small metal clamp applied to the heel might not be a simpler, cheaper, quicker and equally reliable method of assessment of subtalar movement. If you would like to know if your subtalar movement might be a contributing factor to either stiffness or insecurity of your ankle, we invite you to be examined clinically, by plain xrays at SPORTSMED•SA, and by a CT scan at Jones & Partners Radiology at Burnside. The xray and CT investigations would be bulk billed under Medicare so that you would not incur any personal cost and the information could well be helpful in assessing your ankle problem, or at least be reassuring that the subtalar joint has a normal range of movement. The investigations can be arranged through your treating doctor, physiotherapist or podiatrist or by contacting Dr Roger Paterson, Foot and Ankle Surgeon, or Mr Stephen Landers, his Research Assistant, on Ph: 8362 7788. The CT scan would be a very limited investigation resulting in minimum radiation exposure, comparable to the normal xrays. Further information on what is involved in having a CT scan is attached. Neither the CT scan nor the plain xrays should cause any more than minor discomfort as the foot is tilted through its full range of movement, or from the padded pressure of the G clamp. SPORTSMED•SA remains committed to excellence in treating active people of all ages, and through these investigations, we plan to further enhance the quality of assessment and care of people who suffer ankle problems

Objective: To evaluate the impact of soft tissue release on range of movement following total knee replacement. Methods: Sixty four patients underwent PFC sigma total knee replacement through a medial arthrotomy. Range of active movement was measured preoperatively, and maximal flexion was measured after implantation, using the drop test while the patient was under anaesthetic. Soft tissue release was graded from 1 to 5, depending on the structures released. Range of movement was correlated with extent of soft tissue release, to see if release had any impact on increase in range of movement. Results: All patients had an improvement in range of movement following surgery. Post operative range of movement correlated strongly with preoperative ROM. Patients requiring extensive releases tended to have less preoperative ROM, but the gain was independent of medial release. Those requiring extensive posterior release had poorer preoperative movement, and significantly less improvement. In those requiring an extensive medial release, a posterior release improved gain in ROM. Conclusion: Postoperative ROM following TKR is independent of extent of medial release. In patients requiring extensive medial release, a posterior release improves gain in movement

Objective: To evaluate the impact of soft tissue release on range of movement following total knee replacement. Methods: Sixty four patients underwent next-gen (Zimmer) posterior stabilising total knee replacement through a medial arthrotomy. Range of active movement was measured preoperatively, and maximal flex-ion was measured after implantation, using the drop test while the patient was under anaesthetic. Soft tissue release was graded from 1 to 5, depending on the structures released. Range of movement (ROM) was correlated with extent of soft tissue release, to see if release had any impact on increase in range of movement. Results: All patients had an improvement in range of movement following surgery. Post operative range of movement correlated strongly with preoperative ROM. Patients requiring extensive releases tended to have less preoperative ROM, but the gain was independent of medial release. Those requiring extensive posterior release had poorer preoperative movement, and significantly less improvement. In those requiring an extensive medial release, a posterior release improved gain in ROM. Conclusion: Postoperative ROM following TKR is independent of extent of medial release. In patients requiring extensive medial release, a posterior release improves gain in movement

We investigated the effect of neck dimension upon cervical range of movement. Data relating to 100 subjects healthy subjects aged between 20 and 40yrs was recorded with respect to age, gender and ranges of movement in three planes. Additionally two commonly used methods of measuring neck motion, chin-sternal distance and uniplanar goniometer, were assessed against a validated measurement tool the CROM goniometer (Performance Attainment Associates, Roseville, MN). Using multiple linear regression analysis it was determined that sagittal flexion (P= 0.0021) and lateral rotation (P< 0.0001) were most closely related to neck circumference alone whereas lateral flexion (P< 0.0001) was most closely related to a ratio of circumference and length. The uniplanar goniometer has some usefulness when assessing neck motion, comparing favourably to chin-sternal distance that has almost no role. Neck dimension should be incorporated into cervical functional assessment. One should be wary about recorded values for neck motion from non-validated measurement tools

Background: The determinants of range of movement following knee replacement may be surgically modifiable (tibial slope, posterior condylar offset or the level of the joint line) or non modifiable (pre-operative range of movement, sex or BMI). We aimed to quantify the influence of these factors upon restoration of flexion in the arthritic knee following knee replacement. Methods: Patients were included from two prospective trials for three different designs of knee replacement. Range of movement was recorded using a standard measuring technique preoperatively and 12 months after surgery. Radiological measurement was done by an independent observer and included the preoperative posterior condylar offset and the postoperative tibial slope, posterior condylar offset, posterior condylar offset ratio, varus-valgus alignment and Insall ratio. Multivariate analysis using stepwise selection was performed to determine the significant predictors of the range of movement at 12 months. Results: The study includes 133 knee replacements performed on 125 patients. Complete clinical and radiographic data for preoperative and 12-month assessment was available for 101 knees and only these were included for the analyses. There was no significant difference between the three groups in terms of postoperative range of movement or the radiological parameters measured. Multivariate analysis after adjusting for age, sex, diagnosis and the type of prosthesis revealed that the only significant correlates of range of movement at 12-months were the difference in posterior condylar offset ratio, tibial slope and preoperative range of movement. Moderate correlation was noted between range of movement at 12 months and posterior tibial slope (R=0.58) and the difference of post femoral condylar offset (that is, post-operative minus preoperative posterior condylar offset, R=0.65). Preoperative range of movement had only a weak correlation with post-operative range of movement (R=0.20). Conclusions: We found that the posterior femoral condylar offset had the greatest impact upon final range of movement. We would encourage the operating surgeon at pre-operative templating to take this into account when choosing size and design of femoral component

We have attempted to quantify the influence of clinical, radiological and prosthetic design factors upon flexion following knee replacement. Our study examined the outcome following 101 knee replacements performed in two prospective randomized trials using similar cruciate retaining implants. Multivariate analyses, after adjusting for age, sex, diagnosis and the type of prosthesis revealed that the only significant correlates for range of movement at 12-months were the difference in posterior condylar offset ratio (p< 0.001), tibial slope (p< 0.001) and preoperative range of movement (p=0.025). We found a moderate correlation between 12-month range of movement and posterior tibial slope (R=0.58) and the difference of post femoral condylar offset (that is, post-operative minus preoperative posterior condylar offset, R=0.65). Posterior condylar offset had the greatest impact upon final range of movement highlighting this as an important consideration for the operating surgeon at pre-operative templating when choosing both the design and size of the femoral component

To determine whether resection of osteophyte at TKR improves movement, 139 TKRs were performed on knees with pre-operative posterior osteophyte. Randomisation was to have either resection of distal femoral osteophyte guided by a custom made ruler or no resection. After preparation of the femoral bone cuts the ruler measuring 19 mm was placed just proximal to the posterior chamfer cut. The proximal end of this ruler marked the bone to be resected and this was performed using an osteotome at 45 degrees. Knees randomised to no resection had no further femoral bony cuts. Three months after implantation the patients had range of motion assessed. One hundred and fourteen suitable knees were assessed, with 59 knees (57 patients) in the resection group and 55 knees (54 patients) in the no resection group. Full extension was more likely in the resection group (62%) than the group without resection (41%)(p=0.08). Flexion to at least 110 degrees was, however, less in the resection group (37%) than the no resection group (54%) (p=0.09). Our study failed to show a statistically significant difference if the bony osteophyte is removed. There were however sharp trends, with statistically a one in ten chance these results would be different if the trial was repeated. Although there is no indication as to the cause of improved extension this could be explained by the release of the posterior capsular structures allowing full extension. The reduction in flexion is harder to explain and this may be due to increase in perioperative trauma and resultant swelling, possibly with fibrosis. Range of movement, particularly flexion, is known to improve up to 1 year post-operatively and assessment of these groups at that stage would be beneficial

Introduction. Regular, repeated stretching increases joint range of movement (RoM), however the physiology underlying this is not well understood. The traditional view is that increased flexibility after stretching is due to an increase in muscle length or stiffness whereas recent research suggests that increased flexibility is due to modification of tolerance to stretching discomfort/pain. If the pain tolerance theory is correct the same degree of micro-damage to muscle fibres should be demonstrable at the end of RoM before and after a period of stretch training. We hypothesise that increased RoM following a 3 weeks hamstrings static stretching exercise programme may partly be due to adaptive changes in the muscle/tendon tissue. Materials and Methods. Knee angle and torque were recorded in healthy male subjects (n=18) during a maximum knee extension to sensation of pain. Muscle soreness (pain, creatine kinase activity, isometric active torque, RoM) was assessed before knee extension, and 24 and 48 hours after maximum stretch. An exercise group (n=10) was given a daily home hamstring stretching programme and reassessed after 3 weeks and compared to a control group (n=8). At reassessment each subject's hamstring muscles were stretched to the same maximum knee extension joint angle as determined on the first testing occasion. After 24 hours, a reassessment of maximum knee extension angle was made. Results. At the start of the study RoM was 71.3 ± 10.0 degrees and there was no significant difference between groups. After 3 weeks stretching RoM increased significantly (p=0.01) by 9 degrees; the control group showed no change. Stiffness did not differ for either group. Pain score and RoM were the most sensitive markers of muscle damage and were significantly changed 24 and 48 hours after the initial stretch to end of range, (p<0.005) and (p=0.004) respectively. Discussion. The results show that a 3 week stretching programme causes muscle adaptation resulting in an increase in the extensibility of the hamstring muscle/tendon unit but no change in stiffness. The lack of evidence of muscle damage suggests that participants in the stretching group are likely to have undergone a physical change/adaptation rather than simply an increase in pain threshold

Background: The main aim of this study is to compare the difference between early mobilisation versus non weight bearing in patients post ankle fracture fixation in terms of pain and functional outcome. Methods: We recruited 60 patients and were divide into two equal groups. Patients in Group A were treated with a below knee cast post ankle fracture fixation and remained non weight bearing for six weeks while groub B were patients that were treated with a backslab for two weeks post fixation. The backslab was removed and once their radiographs were deemed satisfactory, They were referred to the physiotherapy service in our unit for range of motion exercises while still remaining non-weight bearing. All patients were allowed to weight bear at six weeks time post fixation. The inclusion criteria included patients within the age of 18 to 40 years of age and all the fractures are classified using the Weber classification. Patients that were excluded from theses studies are those with unstable fractures and have high co-morbid conditions. All these patients were followed up at 2 weeks, 6 weeks, 3 months and 9 months post ankle fracture fixation. Pain and functional outcome were scored using the AOFAS scoring system. Results: We found that patients in both these groups scored almost equally during the 2 week follow up but at 6 week, group B showed much better range of movement with less pain and a much higher satisfaction rate with their range of movement. However, at 9 months, patients in both group were able to return to their normal physical activity. Conclusion: Our conclusion is that early mobilisation has an definite advantage over non weight bearing post ankle fracture with regards to functional outcome, pain scoring and patient satisfaction. Patient selection and compliance play a role in the outcome of the study

Objective

To compare the effectiveness of the Aspen, Aspen Vista, Philadelphia, Miami-J and Miami-J Advanced collars at restricting cervical spine movement in the sagittal, coronal and axial planes.

To evaluate the effect of implant articular geometry on postoperative range of motion (ROM) after primary total knee arthroplasty for osteoarthritis, we conducted a retrospective case-control study of one hundred and twenty patients (sixty in each group) comparing Scorpio® Posterior Cruciate Substituting implant using Superflex® versus traditional tibial insert. Cases and controls were matched 1:1 for surgeon and gender. Both groups had similar baseline characteristics. Except for KSS Clinical Score at six months (mean: 92.8 for Superflex® versus 87.6 for traditional insert; p=0.029), there was no statistically significant difference between the two groups in knee scores or ROM up to one-year postoperatively.

To evaluate the effect of implant articular geometry on postoperative range of motion (ROM) after primary TKA.

Despite the advent of high flexion knee designs, surgical technique and patient driven factors remain the overriding determining factors for ultimate flexion range achieved following TKA.

One hundred and twenty patients (sixty in each group) were included. Both groups had similar baseline characteristics. Except for KSS Clinical Score at 6 month (mean ± SD: 92.8 ± 5.8 for Superflex® versus 87.6 ± 14.6 for traditional insert; p=0.029), there was no statistically significant difference between the two groups in knee scores or ROM. Flexion at one year for Superflex® was 113.5° ± 10.5 compared with 113.2° ± 11.9 for traditional tibial insert (p=0.869).

Retrospective cohort study of a prospectively gathered database of TKA’s performed at a high-volume arthroplasty center from 1998 to 2003. Inclusion Criteria: primary TKA for osteoarthritis using Scorpio® Posterior Cruciate Substituting implant with Superflex® tibial insert versus traditional insert. Exclusion Criteria: WSIB, prior history of septic arthritis, and previous knee surgery. Cases and controls were matched 1:1 for surgeon and gender. Postoperative care was standardized. Data points included demographics, operative details, pre- and post-operative Knee Society Score (KSS), Oxford Knee Score and range of motion at six weeks, six months and one year postoperatively. P< 0.05 was considered statistically significant.

Despite improvements in knee prostheses design, patient factors and surgical technique remain the most important determinants of outcome in primary TKA, particularly ROM.

Introduction: The Oxford unicompartmental knee replacement (UKR) use in the lateral compartment has been associated with a reduced flexion range and increased medial compartment pain than seen with its medial counterpart due to, in part, the inadequacy of a flat tibial tray replacing the domed anatomy of the lateral tibia. A new design incorporating a domed tibial component and a biconcave meniscal bearing has been developed to overcome these problems.

This study reports a clinical comparison of new and old establishing whether this modified implant has maintained the established normal kinematic profile of the Oxford UKR.

Method: Patients undergoing lateral UKR for OA were recruited for the study. Fifty one patients who underwent UKR with the domed design were compared to 60 patients who had lateral UKR with a flat inferior bearing surface. Kinematic evaluation was performed on 3 equal subgroups (n = 20); Group 1-Normal volunteer knees, Group 2-Flat Oxford Lateral UKR’s and Group 3-Domed Oxford Lateral UKR’s. The sagittal plane kinematics of each knee was assessed using videofluoroscopic analysis whilst performing a step up and deep knee bend activity. The fluoroscopic images were recorded digitally, corrected for distortion using a global correction method and analysed using specially developed software to identify the anatomical landmarks needed to determine the Patella Tendon Angle (PTA) (the angle the patella tendon and the tibial axis).

Knee kinematics were assessed by analysing the movement of the femur relative to the tibia using the PTA.

Results: PTA/KFA values, for both devices, from extension to flexion did not show any significant difference in PTA values in comparison to the normals as measured by a 3-way ANOVA. The Domed implant achieved higher maximal active flexion during the lunge exercise than those with a flat implant. Only 33% of the flat UKR’s achieved KFA of 130° or more under load whilst performing a lunge, compared with 75% of domed UKR’s and 90% of normal knees. No flat UKR achieved a KFA of 140° or more, yet 50% of all domed UKR’s did, as did 60% of all normal knees.

Conclusions: There was no significant difference in sagittal plane kinematics of the domed and flat Oxford UKR’s. Both designs had favorable kinematic profiles closely resembling that of the normal knee, suggesting normal function of the cruciate mechanism. The domed knees had a greater range of motion under load compared to the flats, approaching levels seen with the normal knee, suggesting that limited flexion for the flat plateau results from over tightening in high flexion and that this is corrected with the domed plateau. Problems with the second generation of lateral Oxford UKA have been rectified by a new bi-concave bearing without losing bearing stability and normal kinematics.

Aims. Scapular notching is thought to have an adverse effect on the outcome of reverse total shoulder arthroplasty (RTSA). However, the matter is still controversial. The aim of this study was to determine the clinical impact of scapular notching on outcomes after RTSA. Methods. Three electronic databases (PubMed, Cochrane Database, and EMBASE) were searched for studies which evaluated the influence of scapular notching on clinical outcome after RTSA. The quality of each study was assessed. Functional outcome scores (the Constant-Murley scores (CMS), and the American Shoulder and Elbow Surgeons (ASES) scores), and postoperative range of movement (forward flexion (FF), abduction, and external rotation (ER)) were extracted and subjected to meta-analysis. Effect sizes were expressed as weighted mean differences (WMD). Results. In all, 11 studies (two level III and nine level IV) were included in the meta-analysis. All analyzed variables indicated that scapular notching has a negative effect on the outcome of RTSA . Statistical significance was found for the CMS (WMD –3.11; 95% confidence interval (CI) –4.98 to –1.23), the ASES score (WMD –6.50; 95% CI –10.80 to –2.19), FF (WMD –6.3°; 95% CI –9.9° to –2.6°), and abduction (WMD –9.4°; 95% CI –17.8° to –1.0°), but not for ER (WMD –0.6°; 95% CI –3.7° to 2.5°). Conclusion. The current literature suggests that patients with scapular notching after RTSA have significantly worse results when evaluated by the CMS, ASES score, and range of movement in flexion and abduction. Cite this article: Bone Joint J 2020;102-B(11):1438–1445

Ideally the hip arthroplasty should not be subject to bony or prosthetic impingement, in order to minimise complications and optimise outcomes. Modern 3d planning permits pre-operative simulation of the movements of the planned hip arthroplasty to check for such impingement. For this to be meaningful, however, it is necessary to know the range of movement (ROM) that should be simulated. Arbitrary “normal” values for hip ROM are of limited value in such simulations: it is well known that hip ROM is individualised for each patient. We have therefore developed a method to determine this individualised ROM using CT scans. CT scans were performed on 14 cadaveric hips, and the images were segmented to create 3d virtual models. Using Matlab software, each virtual hip was moved in all potential directions to the point of bony impingement, thus defining an individualised impingement-free 3d ROM envelope. This was then compared with the actual ROM as directly measured from each cadaver using a high-resolution motion capture system. For each hip, the ROM envelope free of bony impingement could be described from the CT and represented as a 3d shape. As expected, the directly measured ROM from the cadaver study for each hip was smaller than the CT-based prediction, owing to the presence of constraining soft tissues. However, for movements associated with hip dislocation (such as flexion with internal rotation), the cadaver measurements matched the CT prediction, to within 10°. It is possible to determine an individual's range of clinically important hip movements from a CT scan. This method could therefore be used to create truly personalised movement simulation as part of pre-operative 3d surgical planning

Technological advancements in orthopaedic surgery have mainly focused on increasing precision during the operation however, there have been few developments in post-operative physiotherapy. We have developed a computer vision program using machine learning that can virtually measure the range of movement of a joint to track progress after surgery. This data can be used by physiotherapists to change patients’ exercise regimes with more objectively and help patients visualise the progress that they have made. In this study, we tested our program's reliability and validity to find a benchmark for future use on patients. We compared 150 shoulder joint angles, measured using a goniometer, and those calculated by our program called ArmTracking in a group of 10 participants (5 males and 5 females). Reliability was tested using adjusted R squared and validity was tested using 95% limits of agreement. Our clinically acceptable limit of agreement was ± 10° for ArmTracking to be used interchangeably with goniometry. ArmTracking showed excellent overall reliability of 97.1% when all shoulder movements were combined but there were lower scores for some movements like shoulder extension at 75.8%. There was moderate validity shown when all shoulder movements were combined at 9.6° overestimation and 18.3° underestimation. Computer vision programs have a great potential to be used in telerehabilitation to collect useful information as patients carry out prescribed exercises at home. However, they need to be trained well for precise joint detections to reduce the range of errors in readings

Abstract. Introduction. Intra-articular distal humerus OTA type C fractures are challenging to treat. When osteosynthesis is not feasible one can choose to do a primary arthroplasty of elbow or manage non-operatively. The indications for treatment of this fracture pattern are evolving. Objectives. We present our outcomes and complications when this cohort of patients was managed with either open reduction internal fixator (ORIF), elbow arthroplasty or non-operatively. Methods. Retrospective study to include OTA type C2 and C3 fracture distal humerus of 36 patients over the age of 50 years managed with all the three modalities. Patient's clinical notes and radiographs were reviewed. Results. Between 2016 and 2022, 21 patients underwent ORIF – group 1, 10 patients were treated with arthroplasty – group 2 and 5 were managed conservatively- group 3. The mean age of patients was 62 years in group 1, 70 years in group 2 and 76 years in group 3. The mean range of movement (ROM) arc achieved in the group 1 & 2 was 103 while group 3 was 68. At least follow up was 6 months. 5 patients in group 1 underwent metalwork removal and 2 patients in group 3 under arthroplasty. Conclusion. The outcomes of arthroplasty and ORIF are comparable, but reoperation rates and stiffness were higher in ORIF and conservative group. Surgeon choice and patient factors play important role in decision towards choosing treatment modality. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Currently, the consensus regarding subscapularis tendon repair during a reverse total shoulder arthroplasty (rTSA) is to do so if it is possible. Repair is thought to decrease the risk of dislocation and improve internal rotation but may also increase stiffness and improvement in internal rotation may be of subclinical benefit. Aim is to retrospectively evaluate the outcomes of rTSA, with or without a subscapularis tendon repair. We completed a retrospective review of 51 participants (25 without and 26 with subscapularis repair) who received rTSR by a single-surgeon using a single-implant. Three patient reported outcome measures (PROM) were assessed pre-operatively and post-operative at twelve months, as well as range of movement (ROM) and plain radiographs. Statistical analysis utilized unpaired t tests for parametric variables and Mann-Whitney U test for nonparametric variables. External Rotation ROM pre-operatively was the only variable with a significance difference (p=0.02) with the subscapularis tendon repaired group having a greater range. Pre- and post-operative abduction (p=0.72 & 0.58), forward flexion (p=0.67 & 0.34), ASES (p=0.0.06 & 0.78), Oxford (p=0.0.27 & 0.73) and post-operative external rotation (p=0.17). Greater external rotation ROM pre-operatively may be indicative of the ability to repair the subscapularis tendon intra-operatively. However, repair does not seem to improve clinical outcome at 12 months. There was no difference of the PROMs and AROMs between the subscapularis repaired and not repaired groups for any of the variables at the pre-operative or 12 month post operative with the exception of the external rotation ROM pre-operatively. We can conclude that from PROM or AROM perspective there is no difference if the tendon is repaired or not in a rTSR and indeed the patients without the repair may have improved outcomes at 12 months