Conectar
Functional tests commonly assess athletes' readiness to return to sports after knee surgery. Despite this, there are still more studies on clinical and patient-reported outcomes. The purpose of this study was to determine differences and combinations of various functional performances within and between athletes 6 months after anterior cruciate ligament (ACL)-reconstruction (ACLR) for the first time (ACLR-I group) versus second ACL injury on the same knee (ACLR-II group) versus ACLR procedures on both legs (ACLR-III group). A total of 88 patients with ACLR performed single-leg hop (maximum forward distance hop, SLH; side hop > 40 cm in 30 s, SH), Functional Movement Screen (FMS) and dynamic postural balance (Y Balance Test – YBT). Data were recorded during return-to-sport testing (6 months post-surgery). For each variable, a mixed-model analysis of variance, with a between-subjects factor of group (primary ACL injury, recurrent ACL injury and bilateral ACL injury) and a within-subjects factor of limb (involved, uninvolved), were conducted. Differences between the groups were found in different degrees of inter-limb asymmetry in the single-leg hop (p < 0.001) and side hop test (p < 0.02). There was a main effect of limb for the anterior and posteromedial YBT distances, and the single-leg hop and side hop test distances (p ≤ 0.04). For each variable, performance was worse for the involved limb compared to the uninvolved limb. Individuals after recurrent ACLR showed greater functional asymmetries at 6 months of treatment. Jumping tests detected greater performance deficits compared to YBT and FMS.
We used finite element analysis to study the mechanical stress distribution of a new intramedullary implant used for proximal interphalangeal joint (PIPJ) arthrodesis (PIPJA) to surgically correct the claw-hammer toe deformity that affects 20% of the population. After geometric reconstruction of the foot skeleton from claw toe images of a 36–year-old male patient, two implants were positioned, in the virtual model, one neutral implant (NI) and another one 10° angled (10°AI) within the PIPJ of the second through fourth HT during the toe-off phase of gait and results were compared to those derived for the non-surgical foot (NSF). A PIPJA was performed on the second toe using a NI reduced tensile stress at the proximal phalanx (PP) (45.83 MPa) compared to the NSF (59.44 MPa; p < 0.001). When using the 10°AI, the tensile stress was much higher at PP and middle phalanges (MP) of the same toe, measuring 147.58 and 160.58 MPa, respectively, versus 59.44 and 74.95 MPa at corresponding joints in the NSF (all p < 0.001). Similar results were found for compressive stresses. The NI reduced compressive stress at the second PP (−65.12 MPa) compared to the NSF (−113.23 MPa) and the 10°AI (−142 MPa) (all p < 0.001). The von Mises stresses within the implant were also significantly lower when using NI versus 10°AI (p < 0.001). Therefore, we do not recommend performing a PIPJA using the 10°AI due to the increase in stress concentration primarily at the second PP and MP, which could promote implant breakage.
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