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Background: Although the severity of knee osteoarthritis (OA) usually is assessed using different measures of joint structure, function, and pain, the relationships between these measures are unclear. Purpose: Therefore, we: (1) examined the relationships between the measures of knee structure (flexion-extension range of motion, radiographic tibiofemoral angle, and medial joint space), function (Knee Osteoarthritis Outcome Scores [KOOS], peak adduction angle, and moment), and pain (visual analog scale [VAS]); and (2) identified variables that best predicted knee pain. Methods: We assessed 15 patients with medial knee OA using VAS pain, KOOS questionnaire, 3-D gait analysis, and radiographic examination. Parameter relationships were assessed using Pearson correlation, and variables most predictive of knee pain were determined using a stepwise multiple regression. Results: Subjective measurements correlated (|r| ≥ 0.54) with one another, as did most of the objective measurements (|r| ≥ 0.56) except for adduction moment which did not correlate with any variable. All variables correlated (|r| > 0.54) with VAS knee pain except peak adduction moment. Medial joint space and peak adduction angle best predicted knee pain, accounting for approximately three-quarters of the model variance (r = 0.73). Conclusions: Medial joint space and peak adduction angle may be useful for predicting knee pain in patients with medial knee OA. Therapies that target these structural and functional variables may reduce knee pain in this population. Clinical Relevance: Increasing the medial joint space and limiting the peak knee adduction angle may be critical in achieving effective pain relief in patients with varus knee OA. [ABSTRACT FROM AUTHOR]

Background: In treating patients with brachial plexus injury, there are no comparative data on the outcomes of nerve grafts or nerve transfers for isolated upper trunk or C5-C6-C7 root injuries. The purpose of our study was to compare, with systematic review, the outcomes for modern intraplexal nerve transfers for shoulder and elbow function with autogenous nerve grafting for upper brachial plexus traumatic injuries. Methods: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for studies in which patients had surgery for traumatic upper brachial plexus palsy within one year of injury and with a minimum follow-up of twelve months; Strength and shoulder and elbow motion were assessed as outcome measures. The Fisher exact test and Mann-Whitney U test were used to compare outcomes, with an alpha level of 0.05. Results: Thirty-one studies met the inclusion criteria. Two hundred and forty-seven (83%) and 286 (96%) of 299 patients with nerve transfers achieved elbow flexion strength of grade M4 or greater and M3 or greater, respectively, compared with thirty-two (56%) and forty-seven (82%) of fifty-seven patients with nerve grafts (p < 0.05). Forty (74%) of fifty-four patients with dual nerve transfers for shoulder function had shoulder abduction strength of grade M4 or greater compared with twenty (35%) of fifty-seven patients with nerve transfer to a single nerve and thirteen (46%) of twenty-eight patients with nerve grafts (p < 0.05). The average shoulder abduction and external rotation was 122° (range, 45° to 170°) and 108° (range, 60° to 140°) after dual nerve transfers and 50° (range, 0° to 100°) and 45° (range, 0° to 140°) in patients with nerve transfers to a single nerve. Conclusions: In patients with demonstrated complete traumatic upper brachial plexus injuries of C5-C6, the pooled international data strongly favors dual nerve transfer over traditional nerve grafting for restoration of improved shoulder and elbow function. These data may be helpful to surgeons considering intraoperative options, particularly in cases in which the native nerve root or trunk may appear less than optimal; or when long nerve grafts are contemplated. [ABSTRACT FROM AUTHOR]

Background: The complex interactions between capsuloligamentous structures and muscle-recruitment strategies that maintain glenohumeral stability remain unclear. The purposes of the present study were to determine whether stiffness regulation and muscle-activation strategies differed under varying joint positions and levels of contraction in the shoulder and to determine the relationship between generalized joint laxity, glenohumeral joint laxity, and joint stiffness. Methods: Forty healthy, physically active subjects with a mean age (and standard deviation) of 25.2 ± 4.6 years, a mean height of 174.7 ± 6.7 cm, and a mean mass of 73.1 ± 13.8 kg were tested. Shoulder stiffness and the activation of muscles (including the rotator cuff and the anterior deltoid) were measured at two levels of internal rotation torque (0% and 50% of maximum) and two joint positions (0° and 90% of maximum external rotation) before and after a 5° external rotation perturbation. Generalized laxity and glenohumeral joint laxity (in the anterior, posterior, and inferior directions) were also assessed. Results: Stiffness was 77% greater at 50% of maximum internal rotation torque than at 0% of maximum internal rotation torque (p < 0.001) but was not significantly different between joint positions (p = 0.73). From 0% to 50% of maximum internal rotation torque, preparatory and reactive recruitment of the subscapularis increased significantly more (p < 0.05) than those of the other muscles. Also, subscapularis preparatory activity was 36% greater in 0° of external rotation than in 90% of maximum external rotation (p < 0.01). Generalized joint laxity (as indicated by a score of ≥4) was present in 20% of the subjects. Glenohumeral joint laxity (as indicated by a grade of ≥2) was present in the anterior, posterior, and inferior directions in 13%, 15%, and 15% of the subjects, respectively. No correlation existed between passive stiffness and generalized or glenohumeral laxity (r = -0.12 to 0.29; p = 0.08 to 0.48). Conclusions: Moderate levels of muscle contraction can significantly increase glenohumeral joint stiffness and stability. Preactivation of the subscapularis appears to be the primary dynamic stabilizer with the arm in 0° of external rotation. However, with the arm in 90% of maximum external rotation (the apprehension position), less subscapularis activity is observed and the maintenance of stability may shift toward other musculoskeletal structures because joint stiffness does not change. A relationship between generalized joint laxity, glenohumeral laxity, and stiffness was not observed in healthy subjects. Clinical Relevance: Clinically, healthy populations have comparable levels of stiffness, or joint stability, in 0° of external rotation and in 90% of maximum external rotation (the apprehension position). [ABSTRACT FROM AUTHOR]

Study Design: Retrospective case series., Objective: To characterize the change in angle of trunk rotation (ATR), axial vertebral rotation (AVR), and body surface rotation (BSR) in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) with en-bloc derotation across multiple postoperative visits., Summary of Background Data: Previous research has documented ATR, AVR, and BSR correction for AIS patients after surgery. However, there is a lack of evidence on the sustainability of this correction over time., Methods: This was a retrospective study from a single-center prospective surface topographic registry of patients with AIS, age 11-20 at time of surgery, who underwent PSF with en-bloc derotation. Patients with previous spine surgery were excluded. ATR was measured with a scoliometer, AVR through EOS radiographic imaging, and BSR via surface topographic scanning, Data collection occurred at: preoperative, six-week, three-month, six-month, one-year, and two-year postoperative visits. BSR and AVR were tracked at the preoperative apical vertebral level, and the level with maximum deformity, at each respective timepoint. Generalized estimating equations models were used for statistical analysis. Covariates included age, sex, and body mass index., Results: 49 patients (73.4% female, mean age 14.6±2.2 years, mean preoperative coronal curve angle 57.9°±8.5, and 67% major thoracic) were evaluated. ATR correction was significantly improved at all postoperative timepoints and there was no significant loss of correction. AVR Max and AVR Apex were significantly improved at all timepoints but there was a significant loss of correction for AVR Apex between the six-week and one-year visit (P=0.032). BSR Max achieved significant improvement at the three-month visit. BSR Apex was significantly improved at the three-month and one-year visit., Conclusion: ATR and AVR demonstrated significant axial plane correction at two-years postoperative in patients undergoing PSF for AIS. BSR did not maintain significant improvement by the two-year visit., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)