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

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:. 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

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

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