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Background: Posttraumatic extension contracture of the knee (PECK) is common after knee injury. Initial management is conservative to improve the range of motion; if it fails, surgery may be necessary. This systematic review analyses existing literature on Judet quadricepsplasty for PECK. We will assess clinical outcomes, complications, patient satisfaction and factors that may influence its success. Methods: A search was conducted on 25 November 2023, adhering to preferred reporting items for systematic reviews and meta‐analyses guidelines. PubMed, Embase and Google Scholar were used. Search strings were ([Judet] OR [quadricepsplasty]) AND (knee) AND (stiffness) and ([Judet] OR [quadricepsplasty]) AND (knee). Inclusion criteria: English articles focused on PECK, published between 2003 and 2023, and a minimum follow‐up of 24 months. Exclusion criteria: case reports, alternative techniques, knee stiffness cases not only due to trauma, a sample size of <10 patients and articles not reporting functional outcomes. Results: Among selected studies, 239 patients were considered. The average time between injury and Judet was 27 months. The population was predominantly male; the mean follow‐up was 33 months. An average intraoperative knee range of motion improvement of 79.1 degrees (confidence interval 76.9; 81.3) compared to the average preoperative starting value of 30.7 degrees was observed. This improvement decreased by 13.5 degrees at the first postoperative check and by an additional 2.4 degrees at the follow‐up, while maintaining an average value of bending above 90 degrees. Conclusion: Judet quadricepsplasty appears an effective technique for the management of PECK. The heterogeneity of included studies and the absence of standardized outcome measures limit the ability to draw definitive conclusions. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate post-operative lower limb function following second-generation mechanically aligned medial pivot (MP) TKA implantation. Standard gait analysis was performed to collect kinematic and kinetic data, which were then compared with physiological data from the literature obtained using the same evaluation methodology as the present study. The hypothesis was that this TKA would not fully restore normal knee and adjacent joint motion during walking. Methods: Our cohort comprised 15 patients consecutively enrolled from September 2019 to December 2022 who underwent primary TKA with the second-generation MP Evolution Knee System (MicroPort Orthopaedics Inc., Arlington, TN, USA). Pre-operatively and 6 months post-surgery, gait analysis during level walking was performed on all patients, as well as clinical evaluations using the Knee Society Score (KSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Visual Analogue Scale (VAS). Results: The clinical scores improved significantly (p < 0.001) after surgery (pre-/post-operative KSS functional, KSS clinical, VAS, and KOOS: 51.7 ± 17.3/84 ± 18.4, 45.3 ± 16.2/74.1 ± 12.6, 6.9 ± 1.8/2.0 ± 1.9, and 33.9 ± 11.8/69.1 ± 16.5, respectively). The statistical parametric mapping (SPM) analysis between the post-operative and reference control data revealed significant differences in the initial and final 20% of the gait cycle for the rotation of the knee in the frontal and transverse planes and for the rotation of the ankle in the sagittal plane. Conclusions: This study shows that new-generation MP TKA with mechanical alignment does not fully restore normal gait biomechanics, particularly in knee rotational movements, indicating a need for improved surgical techniques and prosthetic designs. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is the second leading cause of death in Europe. In the case of stroke survival (almost 70%), only 25% of patients recover completely, while the remaining 75% will undergo a rehabilitation phase that varying from months to years. The primary outcomes of a stroke involve motor impairment in the upper limbs, resulting in a partial or complete inability to move the limb on the right or left side, depending on the affected hemisphere. Furthermore, the motor deficit distorts the proprioception of the body and the embodiment ability of the injured limb. This could be rehabilitated through the paradigm of body illusion that modulates the motor rehabilitation. The present protocol aims to investigate the effectiveness of a Virtual Reality system for sensorimotor and proprioception upper limb deficit compared to a traditional upper limb rehabilitation program. Method: This study has a randomized and controlled design with control and experimental groups, and 4 measurement times: pre-intervention, immediately after the intervention, and two follow-ups (at 6 and 12 months). The inclusion criteria are: (a) Being 18 to 85 years old, both males and females; (b) Suffering from ischemic or haemorrhagic stroke; (c) The stroke event must have occurred from two to eighteen months before recruitment; (d) Patients must have moderate to severe upper limb motor deficit, and the alteration of sensorimotor and proprioception abilities of the injury upper limb; (e) Patients must understand and sign the written consent for enrolment. The rehabilitation last four weeks with three sessions per week at Bellaria Hospital of Bologna (Italy). The VR protocol uses two types of technology: immersive and non-immersive, and the control group follow the traditional rehabilitation program. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the survival rate and medium-term outcomes of patients after cemented posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasty (TKA) using a telemedicine platform during the COVID-19 pandemic in Italy. Methods: A total of 100 consecutive patients (mean age 73.5 ± 13.2 years) who received a cemented PS MB TKA were enrolled. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. A dedicated software that makes it possible to perform video calls, online questionnaires, and acquire X-rays remotely was used. Subjective clinical scores and objective range-of-motion (ROM) measurements were observed at an average follow-up of 54 ± 11.3 months. Results: A total of 42 of 100 enrolled patients (mean age 70.3 ± 8.4 years) completed the telemedicine follow-up. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. Age was found to be a statistically significant difference between the group that completed the telemedicine follow-up and the one that did not (p < 0.004). KOOS scores improved from 56.1 ± 11.3 to 77.4 ± 16.2, VAS scores decreased from 7.2 ± 2.1 to 2.8 ± 1.6, KSSf scores increased from 47.2 ± 13.3 to 77.1 ± 21.1, FJS scores improved from 43.4 ± 12.3 to 76.9 ± 22.9, and OKS scores increased from 31.9 ± 8.8 to 40.4 ± 9.9. All the differences were statistically significant (p < 0.05). The mean flexion improved from 88° ± 8° to 120° ± 12°. A radiographic evaluation showed a mean pre-operative mechanical axis deviation of 5.3 ± 8.0 degrees in varus, which improved to 0.4 ± 3.4 degrees of valgus post-operation. The survivorship at 5 years was 99%. Conclusions: Subject to small numbers, telemedicine presented as a useful instrument for performing remote monitoring after TKA. The most important factor in telemedicine success remains the patient's skill, which is usually age-related, as older patients have much more difficulty in approaching a technological tool. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the long-term outcomes of arthroscopic versus mini-open repair in patients with isolated subscapularis tendon tears. Methods: Google Scholar, PubMed, and Embase databases were searched for studies evaluating isolated subscapularis tears subsequently treated by arthroscopic or mini-open repair. The inclusion criteria were clinical studies reporting isolated subscapularis lesions treated by arthroscopic or mini-open repair, a minimum follow-up of 12 months, and clinical and functional outcomes reported in the study results. Articles not reporting functional outcomes or studies that reported results for anterosuperior rotator cuff tears without a separate analysis of subscapularis tendon tears were excluded. Studies older than 20 years and studies with a minimum follow-up of less than 12 months were also excluded. Results: A total of 12 studies met the inclusion criteria; 8 papers were included in the arthroscopic repair group, and 6 were included in the mini-open repair group (2 studies reported results for both techniques). The mean age reported was 49.3 years, and 85.1% of patients were male. The dominant limb was involved in 77.6% of the patients, and a traumatic onset of symptoms was verified in 76.3%. The mean time to surgery was 9.6 months. The Constant–Murley score showed positive results for the arthroscopic and mini-open groups, with mean postoperative values of 84.6 and 82.1, respectively. Promising results were also observed for pain, with a mean of 13.2 (out of 15) points for the arthroscopic group and 11.7 for the mini-open group. The long head of the biceps was involved in 78% of the patients, and LHB tenodesis or tenotomy were the most common concomitant procedures performed. Conclusions: There was no significant difference in clinical and functional outcomes between open and arthroscopic repair. Moreover, the same complication rates were reported in both treatments, but arthroscopic repair led to less postoperative pain. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Background: "Windswept" deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgical challenges that this condition might pose. Methods: A systematic review of the literature following the PRISMA guidelines was conducted. The relevant studies between 1979 and 2021 were identified. Four studies with a total of 68 patients were included for analysis. The mean follow-up for varus knees was 3.3 years, 3.1 years for valgus knees. The quality and rigor of the included studies was assessed using the Methodological index for non-randomized studies (MINORS). Results: All the studies reported improvement in knee function following knee replacement surgery, and a reduction in axial deviation of both knees, with similar results in valgus and varus knees in terms of patient satisfaction. The most relevant data were that unicompartmental knee arthroplasty (UKA) allowed for limited axial correction with slightly inferior functional results. Kinematic alignment (KA) allowed for similar results in both knees. Conclusion: The present review shows how satisfactory results can be achieved in both knees in patients with WSD and osteoarthrosis (OA). However, the operating surgeon should be aware of the importance of the implant choice in terms of functional outcomes. In the absence of extra-articular deformities, calipered KA total knee arthroplasty (TKA) can be performed on both knees with good axial correction and functional outcome. Level of evidence: II —Systematic review of cohort studies. [ABSTRACT FROM AUTHOR]

Background: Fall risk in the elderly is a major public health issue due to the injury-related consequences and the risk of associated long-term disability. However, delivering preventive interventions in usual clinical practice still represents a challenge. Aim: To evaluate the efficacy of a multiple-component combined with a multifactorial personalized intervention in reducing fall rates in a mixed population of community-dwelling elderly compared to usual care. Setting: Outpatients in two Italian centers. Population: 403 community-dwelling elderly at moderate-to-high fall risk, including subjects with Parkinson's Disease and stroke. Methods: After the randomization, the described interventions were administered to the intervention group (n = 203). The control group (n = 200) received usual care and recommendations to minimize fall risk factors. In addition, each participant received a fall diary, followed by 12 monthly phone calls. The primary endpoint was the total number of falls in each group over 12 months, while the secondary endpoints were other fall-related indicators recorded at one year. In addition, participants' functioning was assessed at baseline (T1) and 3-month (T3). Results: 690 falls were reported at 12 months, 48.8% in the intervention and 51.2% in the control group, with 1.66 (± 3.5) and 1.77 (± 3.2) mean falls per subject, respectively. Subjects with ≤ 1 fall and ≥2 falls were, respectively, 236 (58.6%) and 148 (36.7%). No statistically significant differences were observed between groups regarding the number of falls, the falling probability, and the time to the first fall. According to the subgroup analysis, no significant differences were reported. However, a statistically significant difference was found for the Mini-BESTest (p = 0.004) and the Fullerton Advanced Balance Scale (p = 0.006) for the intervention group, with a small effect size (Cohen's d 0.26 and 0.32, respectively), at T1 and T3 evaluations. Conclusions: The intervention was ineffective in reducing the number of falls, the falling probability, and the time to the first fall at 12 months in a mixed population of community-dwelling elderly. A significant improvement for two balance indicators was recorded in the intervention group. Future studies are needed to explore different effects of the proposed interventions to reduce falls and consequences. [ABSTRACT FROM AUTHOR]

Accurate outcome detection in neuro-rehabilitative settings is crucial for appropriate long-term rehabilitative decisions in patients with disorders of consciousness (DoC). EEG measures derived from high-density EEG can provide helpful information regarding diagnosis and recovery in DoC patients. However, the accuracy rate of EEG biomarkers to predict the clinical outcome in DoC patients is largely unknown. This study investigated the accuracy of psychophysiological biomarkers based on clinical EEG in predicting clinical outcomes in DoC patients. To this aim, we extracted a set of EEG biomarkers in 33 DoC patients with traumatic and nontraumatic etiologies and estimated their accuracy to discriminate patients' etiologies and predict clinical outcomes 6 months after the injury. Machine learning reached an accuracy of 83.3% (sensitivity = 92.3%, specificity = 60%) with EEG-based functional connectivity predicting clinical outcome in nontraumatic patients. Furthermore, the combination of functional connectivity and dominant frequency in EEG activity best predicted clinical outcomes in traumatic patients with an accuracy of 80% (sensitivity = 85.7%, specificity = 71.4%). These results highlight the importance of functional connectivity in predicting recovery in DoC patients. Moreover, this study shows the high translational value of EEG biomarkers both in terms of feasibility and accuracy for the assessment of DoC. [ABSTRACT FROM AUTHOR]

Ankle foot orthoses (AFOs) are medical devices prescribed to support the foot and ankle of drop-foot patients. Passive-dynamic AFOs (PD-AFOs) are an effective solution for less severe cases. While off-the-shelf PD-AFOs are rather inexpensive, they provide poor anatomical fit and do not account for the required patient-specific biomechanical support. Three-dimensional (3D) scanning and manufacturing technologies allow manufacturing PD-AFOs customized for the patient's anatomy and functional needs. This paper aimed to report the overall procedure for designing and manufacturing a novel, fiberglass-reinforced polyamide, custom PD-AFO. The feasibility of the proposed procedure was tested in a case study. The methodology can be divided into the following steps: (i) foot and leg scanning, (ii) 3D design, and (iii) additive manufacturing via selective laser sintering. A custom PD-AFO was designed and manufactured for a 67-year-old male drop-foot patient following paraparesis in severe discarthrosis after spine stabilization surgery. AFO mechanical properties were measured via an ad hoc setup based on a servohydraulic testing machine. The functional outcome was assessed via gait analysis in three conditions: shod (no AFO), wearing an off-the-shelf PD-AFO, and wearing the patient-specific PD-AFO. As expected, wearing the PD-AFO resulted in increased ankle dorsiflexion in the swing phase with respect to the shod condition. Sagittal rotations of the hip, knee, and ankle joints were similar across PD-AFO conditions, but the custom PD-AFO resulted in faster walking speed with respect to the off-the-shelf (walking speed: 0.91 m/s versus 0.85 m/s). Additionally, the patient scored the custom PD-AFO as more comfortable (VAS score: 9.7 vs. 7.3). While the present analysis should be extended to a larger cohort of drop-foot patients, the novel PD-AFO seems to offer a valid, custom solution for drop-foot patients not satisfied with standard orthotics. [ABSTRACT FROM AUTHOR]

Diabetic foot syndrome refers to heterogeneous clinical and biomechanical profiles, which render predictive models unsatisfactory. A valuable contribution may derive from identification and descriptive analysis of well-defined subgroups of patients. Clinics, biology, function, gait analysis, and plantar pressure variables were assessed in 78 patients with diabetes. In 15 of them, the 3D architecture of the foot bones was characterized by using weight-bearing CT. Patients were grouped by diabetes type (T1, T2), presence (DN) or absence (DNN) of neuropathy, and obesity. Glycated hemoglobin (HbA1c) and plantar lesions were monitored during a 48-month follow-up. Statistical analysis showed significant differences between the groups for at least one clinical (combined neuropathy score, disease duration, HbA1c), biological (age, BMI), functional (joint mobility, foot alignment), or biomechanical (regional peak pressure, pressure-time integral, cadence, velocity) variable. Twelve patients ulcerated during follow-up (22 lesions in total), distributed in all groups but not in the DNN T2 non-obese group. These showed biomechanical alterations, not always occurring at the site of lesion, and HbA1c and neuropathy scores higher than the expected range. Three of them, who also had weight-bearing CT analysis, showed >40% of architecture parameters outside the 95%CI. Appropriate grouping and profiling of patients based on multi-instrumental clinical and biomechanical analysis may help improve prediction modelling and management of diabetic foot syndrome. [ABSTRACT FROM AUTHOR]

While lower limb biomechanics of people with diabetes are well described, the effects of diabetes type and of peripheral neuropathy on foot joint kinematics have not been addressed in depth. A total of 70 patients with type 1 (n = 25) and type 2 (n = 45) diabetes mellitus, with and without peripheral neuropathy, underwent functional evaluation via gait analysis using an established multisegment foot kinematic model. ANCOVA was performed to assess differences in foot joints' range of motion (ROM) between groups with diabetes and a control group by accounting for the effects of age, body mass index (BMI) and normalized walking speed. Statistical parametric mapping was used to assess differences in temporal patterns of foot joint motion across normalized gait cycle. Small but significant correlations were found between age, BMI, speed and foot joints' ROM. Regardless of diabetes type and presence of neuropathy, all subgroups with diabetes showed limited ROM at the midtarsal and tarsometatarsal joints. Increased midtarsal joint dorsiflexion and adduction was associated with increased tarsometatarsal joint plantarflexion. After accounting for the effect of covariates, diabetes is associated with reduced ROM and to alterations of the kinematic patterns, especially at the midtarsal and tarsometatarsal joints, irrespective of type and neuropathy. [ABSTRACT FROM AUTHOR]

Left hemispatial neglect (LHSN) is a frequent and disabling condition affecting patients who suffered from traumatic brain injury (TBI). LHSN is a neuropsychological syndrome characterized clinically by difficulties in attending, responding, and consciously representing the right side of space. Despite its frequency, scientific evidence on effective treatments for this condition in TBI patients is still low. According to existing literature, we hypothesize that in TBI, LHSN is caused by an imbalance in inter-hemispheric activity due to hyperactivity of the left hemisphere, as observed in LHSN after right strokes. Thus, by inhibiting this left hyperactivity, repetitive Transcranial Magnetic Stimulation (rTMS) would have a rebalancing effect, reducing LHSN symptoms in TBI patients. We plan to test this hypothesis within a single-blind, randomized SHAM controlled trial in which TBI patients will receive inhibitory i-rTMS followed by cognitive treatment for 15 days. Neurophysiological and clinical measures will be collected before, afterward, and in the follow-up. This study will give the first empirical evidence about the efficacy of a novel approach to treating LHSN in TBI patients. Clinical Trial Registration: https://www.clinicaltrials.gov/ct2/show/NCT04573413?cond=Neglect%2C+Hemispatial&cntry=IT&city=Bologna&draw=2&rank=2, identifier: NCT04573413. [ABSTRACT FROM AUTHOR]

The article focuses on the use of virtual reality (VR) in the rehabilitation of stroke patients with upper-limb motor deficits, particularly addressing the body illusion paradigm to improve motor abilities. Topics include the neuroscience perspective of post-stroke motor deficits, the application of VR in upper-limb rehabilitation, and the Stroke-VR Project's investigation into the effectiveness of embodying a virtual arm for motor rehabilitation.

With the goal to restore ankle and foot function also in the long term, custom-made prostheses are becoming more frequently possible solutions for severe bone loss and avascular necrosis of the talus. A young professional rock climber was implanted with a custom-made talonavicular prosthesis, and short-term (30 months) assessment has been published. A thorough assessment at the intermediate term (60 months), with state-of-the-art gait and medical imaging analyses, is reported here. Level walking and more demanding motor tasks were analyzed with both a full-body and a multisegment foot protocol on the operated and contralateral limbs. Cone-beam computer-tomography was also used to obtain 3-dimensional (3D) position and orientation of bone models on the operated ankle. These models were also used for a 3D video fluoroscopy analysis, with the ankle in 3 joint positions at the extremes of motion. Distance map analysis was performed to check for possible changes over time of bone morphology and joint contact areas, in all 3 joint positions. Very satisfactory functional results were observed, with large and symmetric joint motion and physiological muscular recruitment even in demanding motor tasks. Distance map analyses revealed that very small morphologic and contact patterns changes occurred in the replaced ankle between 30 and 60 months. Concerns about possible wear of the cartilage in the tibial mortise are not yet supported by experimental evidence. [ABSTRACT FROM AUTHOR]

Objective: Soldiers' lower limbs and feet are frequently affected by overload- and overuse-related injuries. In order to prevent or limit the incidence of these injuries, the use of foot orthoses is often recommended. The aim of this study is to assess the effects of shock-absorbing insoles on in-shoe plantar pressure magnitude and distribution in a group of professional infantry soldiers wearing military boots during standard indoor military training.Methods: Twenty male professional soldiers of the Italian Army (age 35.1 ± 6.1 years; BMI 25.2 ± 2.3 kg/m2) were recruited for this study. Each subject underwent clinical examination to assess possible overuse-related diseases of the lower limb and trunk. Subjects with altered foot morphology according to the Foot Posture Index (FPI) were excluded from this study. Twelve subjects were considered eligible and therefore underwent an indoor training routine comprised of marching, running, jumping inside parallel bars and jumping from different heights. Soldiers repeated the training session twice wearing standard military boots along with two types of insoles: the standard prefabricated insole within the boots (STI), and a special shock-absorbing insole (SAI) featuring an elastic medial arch support. A 99-capacitive sensor insole system was used to record plantar pressure distribution in both feet. Analysis of in-shoe pressure parameters at rearfoot, midfoot and forefoot and in the total foot was performed via a custom-software application developed in MATLAB. Perceived foot comfort (VAS 0-15) was also assessed.Results: Pressure parameters recorded during walking and running were considered suitable for statistical analysis. In the whole foot region, pressure parameters were 18-22% lower in military boots fitted with the SAI during walking and 14-18% lower during running. SAI resulted in better comfort (+25%) with respect to the prefabricated boot orthotics (median comfort: SAI = 15/15; STI = 12/15; p = 0.0039) both during walking and running.Conclusions: Shock-absorbing insoles can be an effective solution when fitted inside military boots. The present functional evaluation shows that wearing a prefabricated shock-absorbing insole can provide a significant amelioration of perceived foot comfort and plantar pressure parameters. Further studies are now needed with a larger population and more demanding exercises. [ABSTRACT FROM AUTHOR]

After a total hip arthroplasty, a limited range of motion and lower-limb disability continue to be observed, with these being mainly associated with the implant design and the head-to-neck ratio. Larger diameters of the head bearings were assumed to provide better stability, a larger range of motion, and smaller risks of dislocation and stem-to-liner impingement. However, these claims have never been demonstrated in real patients. The specific aim of this study was to assess, via multi-instrumental analysis, whether the range of motion of a replaced hip is limited by the stem-to-liner contact in patients with large femoral head diameters. Twenty-three patients with a total hip arthroplasty were evaluated at their one-year follow-ups using clinical and instrumental examinations. A combined three-dimensional gait analysis of the full body and videofluoroscopy analysis of the replaced hip were performed during the execution of standard, i.e., daily living, and more demanding motor tasks. The latter were meant to reach the extreme range of motion at the replaced hip site, thus revealing possible stem-to-liner contact. An original technique based on imaging and computer-aided design (CAD) models of the prosthesis components was developed to calculate the stem-to-liner distance. Excellent clinical scores were observed in the study. The gait analysis showed that the range of motion of the replaced hip in the sagittal plane, averaged over all patients, ranged from 28° to 78° in standard activities. In more demanding tasks, single peaks were as high as 110°, 39°, and 60° in the sagittal, frontal, and transverse anatomical planes, respectively. In all motor tasks, the stem-to-liner distances ranged from 8.7 to 13.0 mm on average, with one outlier minimum distance being 2.2 mm. This study shows that, even in demanding motor tasks and with an extreme range of motion, the hip joint replaced with large femoral head diameters did not experience impingement between the prosthesis components. [ABSTRACT FROM AUTHOR]

Musculoskeletal radiology has been mostly limited by the option between imaging under load but in two dimensions (i.e., radiographs) and three-dimensional (3D) scans but in unloaded conditions (i.e., computed tomography [CT] and magnetic resonance imaging in a supine position). Cone-beam technology is now also a way to image the extremities with 3D and weight-bearing CT. This article discusses the initial experience over a few studies in progress at an orthopaedic center. The custom design of total ankle replacements, the patellofemoral alignment after medial ligament reconstruction, the overall architecture of the foot bones in the diabetic foot, and the radiographic assessment of the rearfoot after subtalar fusion for correction of severe flat foot have all taken advantage of the 3D and weight-bearing feature of relevant CT scans. To further support these novel assessments, techniques have been developed to obtain 3D models of the bones from the scans and to merge these with state-of-the-art gait analyses. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness in wound healing of negative pressure wound therapy (NPWT) versus a standard dressing in patients who underwent hip or knee revision surgery. Method: Participating patients scheduled for hip and knee prosthetic revision were randomised into two groups: one receiving standard povidone-iodine gauze and patch wound dressing (control group) and the other NPWT over the sutured wound area (NPWT group). Patients were evaluated by means of ASEPSIS score, occurrence of blisters, visual analogue scale (VAS) and dressing changes seven days after surgery. We hypothesised a five-point difference in ASEPSIS scores as clinically relevant. Results: A total of 110 patients were enrolled in the study. Mean ASEPSIS score was 5.1 for the control group and 3.0 for the NPWT group, with a significant difference in the ASEPSIS score between groups (p<0.001), although this was not clinically relevant. Considering patients with more than three risk factors for healing complication, a statistical difference of >5 points ASEPSIS score was recorded (p<0.0005). Blister occurrence, VAS score and number of dressing changes were significantly lower in the NPWT group. Conclusion: The results of this study do not support the routine use of NPWT after hip and knee revision. However, it could be beneficial for selected patients once specific risk factors for wound healing complications have been determined. [ABSTRACT FROM AUTHOR]

The article discusses the Tele-Neurorehab tele-neurorehabilitation project that was launched in Bologna, Italy to assess the efficacy and feasibility of a rehabilitation protocol for treating people with severe brain injury following a stroke or acquired brain injury. The Italian Ministry of Health-funded project featured the Khymeia HomeKit advanced technology system that provides exergames like virtual ball, drawing, and fishing.

Background: Forefoot offloading shoes are special orthopaedic footwear designed to protect and unload the injured part of the foot after surgery and for conservative treatments. The offloading action is often achieved by transferring plantar load to the rearfoot via rocker shoes with reduced contact area between shoe and ground. While these shoes are intended to be worn only for short periods, a compromise must be found between functionality and the risk of alterations in gait patterns at the lower limb joints. In this study, the pedobarographic, kinematic and kinetic effects of a traditional half-shoe and a double-rocker full-outsole shoe were compared to those of a comfortable shoe (control). Methods: Ten healthy female participants (28.2 ± 10.0 years) were asked to walk in three different footwear conditions for the left/right foot: control/half-shoe, control/full-outsole, and control/control. Full gait analysis was obtained in three walking trials for each participant in each condition. Simultaneously a sensor insole system recorded plantar pressure in different foot regions. Normalized root-mean-square error, coefficient of determination, and frame-by-frame statistical analysis were used to assess differences in time-histories of kinematic and kinetic parameters between shoes. Results: The half -shoe group showed the slowest walking speed and the shortest stride length. Forefoot plantar load was significantly reduced in the half-shoe (maximum force as % of Body Weight: half-shoe = 62.1; full-outsole = 86.9; control = 93.5; p < 0.001). At the rearfoot, mean pressure was the highest in the full-outsole shoe. At the ankle, sagittal-plane kinematics in the full-outsole shoe had a pattern more similar to control. Conclusions: The half-shoe appears significantly more effective in reducing plantar load at the forefoot than a double-rocker full-outsole shoe, which is designed to reduce forefoot loading by using an insole with a thicker profile anteriorly as to maintain the foot in slight dorsiflexion. However, the half-shoe is also associated with altered gait spatio-temporal parameters, more kinematic modifications at the proximal lower limb joints and reduced propulsion in late stance. [ABSTRACT FROM AUTHOR]

Background: Several rehabilitation systems based on inertial measurement units (IMU) are entering the market for the control of exercises and to measure performance progression, particularly for recovery after lower limb orthopaedic treatments. IMU are easy to wear also by the patient alone, but the extent to which IMU's malpositioning in routine use can affect the accuracy of the measurements is not known. A new such system (Riablo™, CoRehab, Trento, Italy), using audio-visual biofeedback based on videogames, was assessed against state-of-the-art gait analysis as the gold standard.Methods: The sensitivity of the system to errors in the IMU's position and orientation was measured in 5 healthy subjects performing two hip joint motion exercises. Root mean square deviation was used to assess differences in the system's kinematic output between the erroneous and correct IMU position and orientation.In order to estimate the system's accuracy, thorax and knee joint motion of 17 healthy subjects were tracked during the execution of standard rehabilitation tasks and compared with the corresponding measurements obtained with an established gait protocol using stereophotogrammetry.Results: A maximum mean error of 3.1 ± 1.8 deg and 1.9 ± 0.8 deg from the angle trajectory with correct IMU position was recorded respectively in the medio-lateral malposition and frontal-plane misalignment tests. Across the standard rehabilitation tasks, the mean distance between the IMU and gait analysis systems was on average smaller than 5°.Conclusions: These findings showed that the tested IMU based system has the necessary accuracy to be safely utilized in rehabilitation programs after orthopaedic treatments of the lower limb. [ABSTRACT FROM AUTHOR]