Knee osteoarthritis (OA) leads to the damage of all joint components, with consequent proprioceptive impairment leading to a decline in balance and an increase in the risk of falls. This study was ...aimed at assessing postural stability and proprioception in patients with knee OA, and the relation between the impairment in postural stability and proprioception with the severity of OA and functional performance. Thirty-eight patients with knee OA were recruited. OA severity was classified with the Kellgren–Lawrence score. Postural stability and proprioception were assessed in double- and single-limb stance, in open- and closed-eyes with an instrumented device. Functional performance was assessed using the Knee Score Society (KSS) and the Short Performance Physical Battery (SPPB). Relationships between variables were analyzed. Postural stability was reduced with respect to reference values in double-limb stance tests in all knee OA patients, while in single-stance only in females. Radiological OA severity, KSS-Functional score and SPPB were correlated with greater postural stability impairments in single-stance. Knee OA patients show decreased functional abilities and postural stability impairments. Proprioception seems to be impaired mostly in females. In conclusion, clinical management of patients with OA should include an ongoing assessment and training of proprioception and postural stability during rehabilitation.
Total Ankle Replacement (TAR) could, in theory, partially restore joint sensation and motion, enhancing motor coordination, functional stability, and proprioception in a joint affected by ...osteoarthritis. The aim of this study is to evaluate ankle proprioception before and after a Total Ankle Replacement via an instrumental objective assessment. The evaluation of proprioceptive stability was carried out using the dedicated Delos Postural Proprioceptive System (DPPS). The clinical evaluation was performed by administering validated questionnaires, namely the American Orthopaedic Foot and Ankle Society (AOFAS) score and Short Form-36 (SF-36). Twenty patients were selected, undergoing a complete procedure with clinical and instrumental pre-operative and post-operative evaluation at the end of the follow-up. AOFAS ankle–hindfoot and SF-36 both showed a statistically significant improvement between the pre-operative and post-operative state. The postural tests performed using the DPPS showed that the affected limb showed results slightly lower than in pre-operative. In conclusion, according to the current data, the TAR does not show an improvement in proprioceptive joint stability, and although the registered mean values do not present a statistical significance, the stabilometry shows data lower than the healthy limb. In this perspective, further studies are recommended to highlight any rehabilitation scheme or protocols, using wider case series.
Ankle osteoarthritis (OA) represents a significant social burden and is one of the main causes of chronic disability in a rapidly growing part of the world's population. Total ankle arthroplasty ...(TAA) has become increasingly popular despite the poor results obtained with the first dedicated designs. The purpose of this paper was to evaluate the ankle kinematics, in vivo and under weight-bearing conditions, of a TAA through a dynamic model-based radiostereometric analysis (MB-RSA). The clinical evaluation was performed by administering the American Orthopaedic Foot and Ankle Society ankle-hindfoot score and Short Form-36 questionnaires. The kinematic evaluation was conducted through MB-RSA during the execution of an open kinetic chain and a closed kinetic chain motor task. Double radiographic images of the ankle joint were processed using dedicated software to obtain a 3D reconstruction of the ankle prosthetic components' motion. Eighteen patients (five females) completed the clinical and instrumental preoperative and postoperative evaluations (age 59.1 ± 10.3). All clinical scores showed a marked improvement (
< 0.005). During the closed kinetic chain motor tasks, the ankle showed a total range of motion (ROM) in dorsi-plantarflexion of 19.84°. The parameters in varus-valgus were recorded. Physiological motion can be achieved in TAA, characterized by a wide range of motion and coupling of movements on the three planes. The results of the present work may help to understand the real movement of a widespread TAA model and possibly to improve future designs and instrumentation.
Background/Objective. Physical exercise plays a key role in the prevention and prognosis of chronic diseases. Despite this evidence, a low percentage of patients regularly perform physical activity. ...A better understanding of the variables associated with poor adherence may help to develop some strategies to encourage people to participate in exercise interventions. This study investigated the factors influencing adherence to an Adapted Physical Activity (APA) program in subjects suffering from Acute Coronary Syndrome (ACS) clinically stable, Type 2 diabetes, or metabolic syndrome. Secondary end point was to test the efficacy of the exercise training on fitness parameters (VO2, Speed and Time) by 1 km test. Methods. The program was planned in two phases. Phase 1: individual and supervised training free program for 4 weeks; Phase 2: paid training supervised program involved small groups of 4-6 participants for 8 weeks. Results. 117 patients (50-64 years, 49 men and 68 women) started the APA program, but only 32 patients (17 men and 15 women) completed phase 2. As collected during telephone interviews, the main factors that influenced adherence including health status, work commitments or family problems. Regarding the physical efficacy, an improvement of the three fitness parameters was observed in the 32 patients who completed the 12 weeks of the APA program. Conclusions. The identification of factors that can influence adherence to exercise programs is the first step in planning and improving health interventions. These parameters have an important public health interest.
Background:
Lateral extra-articular tenodesis in the context of anterior cruciate ligament (ACL) reconstruction (ACLR) is performed to better control anterolateral knee instability in patients with ...high-grade preoperative pivot shift. However, some authors believe these procedures may cause lateral compartment overconstraint, affecting knee motion in daily life.
Purpose/Hypothesis:
The primary aim of the present study was to identify kinematic differences during the execution of an activity under weightbearing conditions between knees having undergone ACLR using anatomic single-bundle (SB) versus single-bundle plus lateral plasty (SBLP) techniques. The secondary aim was to compare the postoperative kinematic data with those from the same knees before ACLR and from the healthy contralateral knees in order to investigate if ACLR was able to restore physiologic knee biomechanics during squat execution. The hypotheses were that (1) the SBLP technique would allow a better restoration of internal-external (IE) knee rotation than would SB and (2) regardless of the technique, ACLR would not fully restore physiologic knee biomechanics.
Study Design:
Randomized controlled trial; Level of evidence, 2.
Methods:
In total, 32 patients (42 knees) were included in the study. Patients were asked to perform a single-leg squat before surgery (ACL-injured group, n = 32; healthy contralateral group, n = 10) and at minimum 18-month follow-up after ACLR (SB group, n = 9; SBLP group, n = 18). Knee motion was determined using a validated model-based tracking process that matched patient-specific magnetic resonance imaging bone models to dynamic biplane radiographic images under the principles of roentgen stereophotogrammetric analysis. Data processing was performed using specific software. The authors compared IE and varus-valgus rotations and anterior-posterior and medial-lateral translations among the groups.
Results:
The mean follow-up period was 21.7 ± 4.5 months. No kinematic differences were found between the SB and SBLP groups (P > .05). A more medial tibial position (P < .05) of the ACL-injured group was reported during the entire motor task and persisted after ACLR in both the SB and the SBLP groups. Differences in IE and varus-valgus rotations were found between the ACL-injured and healthy groups.
Conclusion:
There were no relevant kinematic differences between SBLP and anatomic SB ACLR during the execution of a single-leg squat. Regardless of the surgical technique, ACLR failed in restoring knee biomechanics.
Registration:
NCT02323386 (ClinicalTrials.gov identifier).
Pivoting sports expose athletes to a high risk of knee injuries, mainly due to mechanical overloading of the joint which shatters overall tissue integrity. The present study explored the magnitude of ...tibiofemoral contact forces (TFCF) in high-risk dynamic tasks. A novel musculoskeletal model with modifiable frontal plane knee alignment was developed to estimate the total, medial, and lateral TFCF developed during vigorous activities. Thirty-one competitive soccer players performing deceleration and 90° sidestepping tasks were assessed via 3D motion analysis by using a marker-based optoelectronic system and TFCF were assessed via OpenSim software. Statistical parametric mapping was used to investigate the effect of frontal plane alignment, compartment laterality, and varus-valgus genu on TFCF. Further, in consideration of specific risk factors, sex influence was also assessed. A strong correlation (R = 0.71 ÷ 0.98,
< 0.001) was found between modification of compartmental forces and changes in frontal plane alignment. Medial and lateral TFCF were similar throughout most of the tasks with the exception of the initial phase, where the lateral compartment had to withstand to higher loadings (1.5 ÷ 3 BW higher,
= 0.010). Significant sex differences emerged in the late phase of the deceleration task. A comprehensive view of factors influencing the mediolateral distribution of TFCF would benefit knee injury prevention and rehabilitation in sport activities.
In the last two decades, osseointegrated prostheses have been shown to be a good alternative for lower limb amputees experiencing complications in using a traditional socket-type prosthesis; however, ...restraining biomechanical issues, such as peri-prosthetic bone fractures or loosening, are present. To better understand and overcome these limiting issues, and thus reduce the number of implant failures, many studies have investigated the stress distribution on bone and implant during normal daily activities. The aim of this study was a biomechanical analysis of two different osseointegrated implants, a screw-type (OPRA) and a press fit system (OPL, Osseointegrated Prosthetic Limb), to evaluate the stresses generated in bone and prosthesis during a fall. In particular, four scenarios have been experimentally reproduced to determine the loads on the limb during different kinds of fall. For this purpose, a motion capture system and a force plate have been used. Numerical FEM (Finite Element Method) simulations have been performed to compare the behaviour of the OPRA and OPL systems in different fall scenarios. The obtained results showed that a fall backwards due to balance loss is the most stressful scenario among the ones analysed. As regards the comparison between OPRA and OPL devices, it emerged they have similar behaviours in terms of peak values of the stress, but the OPL implant generates larger high-stress areas in the distal femur as compared with the OPRA system.
Total ankle prosthesis as a surgical solution in the case of end-stage osteoarthritis has seen a considerable increase in the last two decades. This study protocol arises from the need to understand ...the in vivo kinematics of mobile-bearing, flat tibial component total ankle replacement, evaluating the real range of motion and the reciprocal relationships between the components during normal motor tasks through the use of model-based radio-stereometric analysis (MB-RSA). In addition, pre- and post-operative evaluation of walking kinematics with inertial motion sensors, proprioception through a dedicated workstation, and clinical outcomes are discussed. We expect that based on our study protocol researchers will be able to improve future prosthetic designs and validate the setup of MB-RSA, as well as to understand “how an ankle prosthesis moves” once implanted in the patient.
Physical inactivity, a leading risk factor for chronic diseases and premature death, is prevalent worldwide. This study focuses on participant profiles and factors influencing continued participation ...and physical activity (PA) levels in the “Moving Parks” PA intervention in Bologna, Italy. This intervention offers free group activities in city parks during the summer. A questionnaire was administered to participants in 2022, gathering data on socio-demographic information, chronic diseases, participation in previous iterations, and PA levels. Out of 596 respondents, 85% were women, and the average age was 50. About 56% held a university degree, and 73% exercised regularly in the winter. Continuous participation was linked to older age, higher education, and chronic conditions. Prior participation predicted higher winter PA levels. Notably, the majority of participants were educated, physically active women. While the project continually engages individuals with higher education and chronic conditions, it needs further tailoring to reach less represented populations.
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