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Courtney E Shell, Glenn K Klute, Richard R Neptune
Advanced prosthetic foot designs often incorporate mechanisms that adapt to terrain changes in real-time to improve mobility. Early identification of terrain (e.g., cross-slopes) is critical to appropriate adaptation. This study suggests that a simple classifier based on linear discriminant analysis can accurately predict a cross-slope encountered (0°, -15°, 15°) using measurements from the residual limb, primarily from the prosthesis itself. The classifier was trained and tested offline using motion capture and in-pylon sensor data collected during walking trials in mid-swing and early stance...
2018: PloS One
Daan T van Yperen, Max Reijman, Eline M van Es, Sita M A Bierma-Zeinstra, Duncan E Meuffels
BACKGROUND: An anterior cruciate ligament (ACL) rupture has major consequences at midterm follow-up, with an increasing chance of developing an old knee in a young patient. The long-term (≥20 years) effects of the operative and nonoperative treatment of ACL ruptures are still unclear. PURPOSE: To compare the long-term treatment outcomes of operative versus nonoperative treatment of ACL ruptures in high-level athletes. STUDY DESIGN: Cohort study; Level of evidence, 2...
February 1, 2018: American Journal of Sports Medicine
P M Bennett, T Stevenson, I D Sargeant, A Mountain, J G Penn-Barwell
OBJECTIVES: The surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function. METHODS: Follow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures...
February 2018: Bone & Joint Research
Sara J Morgan, Cody L McDonald, Elizabeth G Halsne, Sarah M Cheever, Rana Salem, Patricia A Kramer, Brian J Hafner
Contemporary prosthetic feet are generally optimized for either daily or high-level activities. Prosthesis users, therefore, often require multiple prostheses to participate in activities that span a range of mobility. Crossover feet (XF) are designed to increase the range of activities that can be performed with a single prosthesis. However, little evidence exists to guide clinical prescription of XF relative to traditional energy storing feet (ESF). The objective of this study was to assess the effects of XF and ESF on health outcomes in people with transtibial amputation...
2018: PloS One
Brecca M M Gaffney, Cory L Christiansen, Amanda M Murray, Bradley S Davidson
The objective of this investigation was to identify demands from core muscles that corresponded with trunk movement compensations during bilateral step ambulation in people with unilateral transtibial amputation (TTA). Trunk rotational angular momentum (RAM) was measured using motion capture and bilateral surface EMG was measured from four bilateral core muscles during step ascent and descent tasks in people with TTA and healthy controls. During step ascent, the TTA group generated larger mediolateral (P = 0...
January 24, 2018: Journal of Electromyography and Kinesiology
Aaron J Krych
Medial meniscus root tears are becoming increasingly recognized in clinical practice as a source of profound pain and dysfunction in patients. There has been considerable debate about the cause of these distinct meniscus tears, and what the optimal treatment should be for an individual patient. Midterm medial meniscus root repair results suggest that in a well-aligned knee with minimal degenerative change, transtibial root repair is an effective technique for improving pain, function, and possibly preventing further cartilage degeneration...
February 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Jaclyn Megan Sions, Emma Haldane Beisheim, Tara Jo Manal, Sarah Carolyn Smith, John Robert Horne, Frank Bernard Sarlo
OBJECTIVE: To determine if differences in physical function, assessed via self-report questionnaires and physical performance tests, exist between individuals with lower-limb loss using a prosthetic device classified as a K3 versus a K4 functional level. DESIGN: Cross-sectional study. SETTING: University of Delaware Physical Therapy Amputee Clinic. PARTICIPANTS: Participants (n=55) were included if they were aged ≥18 years with a unilateral transfemoral or transtibial amputation, classified as K3 or K4 functional level, completed all relevant outcome measures, and currently were using a prosthesis...
January 31, 2018: Archives of Physical Medicine and Rehabilitation
Jia-Lin Wu, Chian-Her Lee, Chan-Tsung Yang, Chia-Ming Chang, Guoan Li, Cheng-Kung Cheng, Chih-Hwa Chen, Hsu-Shan Huang, Yu-Shu Lai
Transtibial pullout suture (TPS) repair of posterior medial meniscus root (PMMR) tears was shown to achieve good clinical outcomes. The purpose of this study was to compare biomechanically, a novel technique designed to repair PMMR tears using tendon graft (TG) and conventional TPS repair. Twelve porcine tibiae (n = 6 each) TG group: flexor digitorum profundus tendon was passed through an incision in the root area, created 5 mm postero-medially along the edge of the attachment area. TPS group: a modified Mason-Allen suture was created using no...
2018: PloS One
Brian S Baum, Hiroaki Hobara, Kyung Koh, Hyun Joon Kwon, Ross H Miller, Jae Kun Shim
OBJECTIVE: The objective of this study was to investigate 3D lower extremity joint moment differences between limbs and speed influences on these differences in individuals with lower extremity amputations using running-specific prostheses. DESIGN: 8 individuals with unilateral transtibial amputations and 8 control subjects with no amputations ran overground at three constant velocities (2.5, 3.0, and 3.5 m/s). A 2x2x3 (group x leg x speed) repeated-measures ANOVA with Bonferroni adjustments determined statistical significance...
February 5, 2018: American Journal of Physical Medicine & Rehabilitation
Matthew Quigley, Michael P Dillon, Stefania Fatone
BACKGROUND: Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care...
February 1, 2018: Prosthetics and Orthotics International
Samuel F Ray, Shane R Wurdeman, Kota Z Takahashi
BACKGROUND: There are many studies that have investigated biomechanical differences among prosthetic feet, but not changes due to adaptation over time. There is a need for objective measures to quantify the process of adaptation for individuals with a transtibial amputation. Mechanical power and work profiles are a primary focus for modern energy-storage-and-return type prostheses, which strive to increase energy return from the prosthesis. The amount of energy a prosthesis stores and returns (i...
January 27, 2018: Journal of Neuroengineering and Rehabilitation
Kyu Sung Chung, Choong Hyeok Choi, Tae Soo Bae, Jeong Ku Ha, Dal Jae Jun, Joon Ho Wang, Jin Goo Kim
PURPOSE: To compare tibiofemoral contact mechanics after fixation for medial meniscus posterior root radial tears (MMPRTs). METHODS: Seven fresh knees from mature pigs were used. Each knee was tested under 5 conditions: normal knee, MMPRT, pullout fixation with simple sutures, fixation with modified Mason-Allen sutures, and all-inside fixation using Fastfix 360. The peak contact pressure and contact surface area were evaluated using a capacitive sensor positioned between the meniscus and tibial plateau, under a 1,000-N compression force, at different flexion angles (0°, 30°, 60°, and 90°)...
January 20, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Jason A Actis, Luis A Nolasco, Deanna H Gates, Anne K Silverman
People with a transtibial amputation have numerous secondary health conditions, including an increased prevalence of low back pain. This increased prevalence may be partially explained by altered low back biomechanics during movement. The purpose of this study was to compare trunk kinematics and L4-L5 lumbar loads in people with and without a transtibial amputation during sit-to-stand. Motion capture, ground reaction force and electromyographic data were collected from eight people with a unilateral transtibial amputation and eight people without an amputation during five self-paced sit-to-stand motions...
January 5, 2018: Journal of Biomechanics
Dhong Won Lee, Hyeuk Woo Choi, Jin Goo Kim
We describe a surgical technique for arthroscopic posterior cruciate ligament (PCL) reconstruction with remnant preservation of the original PCL fibers using a posterior trans-septal portal approach. Using the transtibial technique and the posterior trans-septal portal approach allows good visualization of the tibial tunnel preparation, easy access to the tibial tunnel without neurovascular injury, and preservation of remnant PCL fibers. In the preparation of the tibial tunnel, we expose the PCL tibial attachment site completely, detach the posterior capsule from the PCL, and preserve the distal stump of the PCL without neurovascular injury...
October 2017: Arthroscopy Techniques
Dhong Won Lee, Russel Haque, Kyu Sung Chung, Jin Goo Kim
There have been several techniques to repair the medial meniscus posterior root tears (MMPRTs) with the goal of restoring the anatomic and firm fixation of the meniscal root to bone. Many anatomic studies about the menisci also have been developed, so a better understanding of the anatomy could help surgeons perform correct fixation of the MMPRTs. The meniscal roots have ligament-like structures that firmly attach the menisci to the tibial plateau, and this structural concept is important to restore normal biomechanics after anatomic root repair...
August 2017: Arthroscopy Techniques
Karan A Patel, Anikar Chhabra, Justin L Makovicka, Joshua Bingham, Dana P Piasecki, David E Hartigan
Reconstruction techniques for the anterior cruciate ligament (ACL) have evolved considerably over the past 3 decades. The femoral tunnel is most commonly made via a transtibial or separate anteromedial portal approach. Benefits and drawbacks for each of these techniques exist. Improper tunnel placement is the cause of failure for ACL reconstruction 70% of the time. We present a hybrid technique for femoral tunnel placement using the Pathfinder ACL guide, which attempts to give the surgeon many of the benefits of both the transtibial and anteromedial portal techniques without the drawbacks...
August 2017: Arthroscopy Techniques
Pawel R Golyski, Brad D Hendershot
Prior work has identified alterations in trunk-pelvic dynamics with lower limb amputation (LLA) during in-line walking; however, evaluations of other ambulatory tasks are limited. Turns are ubiquitous in daily life but can be challenging for individuals with LLA, prompting additional or unique proximal compensations when changing direction, which over time may lead to development of low back pain. We hypothesized such proximal kinematic differences between persons with and without LLA would exist in the sagittal and frontal planes...
January 16, 2018: Human Movement Science
Elizabeth Russell Esposito, Ross H Miller
Recent studies on relatively young and fit individuals with limb loss suggest that maintaining muscle strength after limb loss may mitigate the high metabolic cost of walking typically seen in the larger general limb loss population. However, these data are cross-sectional and the muscle strength prior to limb loss is unknown, and it is therefore difficult to draw causal inferences on changes in strength and gait energetics. Here we used musculoskeletal modeling and optimal control simulations to perform a longitudinal study (25 virtual "subjects") of the metabolic cost of walking pre- and post-limb loss (unilateral transtibial)...
2018: PloS One
Dong-Yeong Lee, Dong-Hee Kim, Hyun-Jung Kim, Hyeong-Sik Ahn, Tae-Ho Lee, Sun-Chul Hwang
BACKGROUND: Transtibial (TT) or tibial inlay (TI) techniques are commonly used for posterior cruciate ligament reconstruction (PCLR). However, the optimum method for PCLR after PCL injury remains debatable. Hypothesis/Purpose: The hypothesis was that TT and TI techniques would not show significant differences for all outcome measures. The purpose was to determine the biomechanical and clinical outcomes of TT and TI surgical techniques for PCLR. STUDY DESIGN: Meta-analysis; Level of evidence, 3...
January 1, 2018: American Journal of Sports Medicine
Courtney Frengopoulos, Michael Wc Payne, Jeffrey Holmes, Ricardo Viana, Susan W Hunter
OBJECTIVES: To determine the relative and absolute reliability of a dual-task functional mobility assessment. DESIGN: Cross-sectional study. SETTING: Academic Rehabilitation Hospital. PARTICIPANTS: Sixty individuals with lower extremity amputation (LEA) attending an outpatient amputee clinic (age= 58.21±12.59; 80.0% male). Subjects were stratified into three groups: 1) transtibial amputations of vascular etiology (TTA-vas), transtibial amputations of non-vascular etiology (TTA-nonvas); transfemoral or bilateral amputees (TFA/bilat) of any etiology...
January 6, 2018: Archives of Physical Medicine and Rehabilitation
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