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Purpose: Digital technologies, including mobile applications, websites, and wearable devices, like smartwatches are among the newest approaches in prevention, care, and treatment studies; they could provide public access to high-quality rehabilitation services. The current review study aimed to evaluate the effects of digital technologies for enhancing physical activity, as well as improving and managing pain in individuals with knee injuries and pain. Methods: The keywords “digital care program”, “e-health”, “physical activity”, and “knee pain” were used to search the studies in the PubMed, Scopus, and Google Scholar databases. In total, 734 articles were found. Then, studies published in languages other than English; the articles with completely similar results; the studies on diseases other than knee problems, and those investigating children or adolescents were excluded. Thus, valid articles indexed in these databases that digital technologies were an except original in the intervention; databases that investigated the impact of digital technologies on osteoarthritis and total knee arthroplasty knee improvement, and the randomized controlled trials were included in this research. Eventually, 8 articles were evaluated in this study. The methodological quality of the studies was assessed using the PEDro score. Results: The overall outcome of the explored studies indicated that digital technologies significantly impact pain relief, and improve mobility, quality of life, and self-care in patients with osteoarthritis and total knee arthroplasty. Conclusion: Digital technologies increase the effectiveness of rehabilitation programs and play an essential role in creating a self-care culture. These technologies have resulted in savings in medical, commuting, pharmacotherapy, and surgery costs by communicating between patient and therapist at any time in any place. more...

Knee injuries such as ACL tears commonly occur and there is a high re-injury rate after primary ACL reconstruction with figures estimated at 25%-33%. Clinicians often use hip strengthening as a key component of knee rehabilitation. Evidence suggests that adopting a "regional" or "proximal" approach to rehabilitation can increase hip strength, but motor control often remains unchanged, particularly during more complex tasks such as running and jumping. It has been previously suggested that the current approach to "regional/proximal" rehabilitation is too basic and is constrained by a reductionist philosophy. This clinical commentary provides the clinician a framework for optimizing knee rehabilitation, underpinned by a more global approach. Although this approach remains hip-focused, it can be easily adapted to modify exercise complexity and key loading variables (speed, direction, flight), which will help the clinician to better replicate the sport specific demands on the knee. Level of evidence 5. more...

The aim of the study was to compare changes in the concentration of serum biomarkers in response to continuous versus interval walking exercise in participants with knee osteoarthritis.This study used a two-phase sequential design. Twenty-seven participants with unilateral knee osteoarthritis completed two separate treadmill walking sessions: (1) continuous 45-min walking exercise and (2) three 15-min bouts of walking exercise separated by 1-hr rest periods for a total of 45 mins in an interval format. Participants reported their knee pain using the numeric pain rating scale and serum levels of biomarkers associated with tissue turnover (cartilage oligomeric matrix protein), inflammation (tumor necrosis factor α), and pain (neuropeptide Y) were evaluated at baseline and every 15 mins for both conditions.Continuous walking resulted in a cumulative increase in cartilage oligomeric matrix protein concentration up to 45 mins, whereas interval walking was associated with return of cartilage oligomeric matrix protein concentrations back to baseline at 45 mins. There were no significant changes in tumor necrosis factor α and neuropeptide Y concentration during walking. There was a significant increase in pain compared with baseline in the continuous walking regimen only.Incorporating rest breaks in walking regimens may affect the potential deleterious effects of longer continuous bouts on the knee joint as well as limit pain during exercise. more...

Three-dimensional human motion analysis provides in-depth understanding in order to optimize sports performance or rehabilitation following disease or injury. Recent developments of statistical methods for functional data allow for novel ways to analyze often complex biomechanical data. Even so, for such methods as well as for traditional well-established statistical methods, the interpretations of the results may be influenced by analysis choices made prior to the analysis. We evaluated the consequences of three such choices when comparing one-leg vertical hop (OLVH) performance in individuals who had ruptured their anterior cruciate ligament (ACL), to that of asymptomatic controls, and also athletes. Kinematic data were analyzed using a statistical approach for functional data, targeting entire curve data. This was done not only for one joint at a time but also for multiple lower limb joints and movement planes simultaneously using a multi-aspect methodology, testing for group differences while also accounting for covariates. We present the results of when an individual representative curve out of three available was either: (1) a mean curve (Mean), (2) a curve from the highest hop (Max), or (3) a curve describing the variability (Var), as a representation of performance stability. We also evaluated choice of sample leg comparison; e.g., ACL-injured leg compared to either the dominant or non-dominant leg of asymptomatic groups. Finally, we explored potential outcome effects of different combinations of included joints. There were slightly more pronounced group differences when using Mean compared to Max, while the specifics of the observed differences depended on the outcome variable. For Var there were less significant group differences. Generally, there were more disparities throughout the hop movement when comparing the injured leg to the dominant leg of controls, resulting in e.g., group differences for trunk and ankle kinematics, for both Mean and Max. When the injured leg was instead compared to the non-dominant leg of controls, there were trunk, hip and knee joint differences. For a more stringent comparison, we suggest considering to compare the injured leg to the non-dominant leg. Finally, the multiple-joint analyses were coherent with the single-joint analyses. The direct effects of analysis choices can be explored interactively by the reader in the Supplementary Material. To summarize, the choices definitively have an impact on the interpretation of a hop test results commonly used in rehabilitation following knee injuries. We therefore strongly recommend well-documented methodological analysis choices with regards to comparisons and representative values of the measures of interests. more...

Walking and running at different speeds are common in daily life. This study investigated 6 degrees of freedom (DOF) kinematics of normal knees of Chinese during walking and running. Forty healthy participants were investigated in 4 conditions: comfortable walking, normal walking, slow running and ordinary running. The range of motion (ROM) and peak values in 6 DOF kinematics were analysed. As the speed increased, a general increase in flexion, lateral and proximal translations occurred. Significant increases of ROM in flexion/extension, axial rotation and medial/lateral translations were observed. The ROM of adduction/abduction, anterior/posterior and proximal/distal translations were greatest during normal walking. The maximum and minimum flexion/extension, maximum internal rotation and tibial lateral translations increased with the increase of speed. The maximum and minimum tibial proximal translations in running were found being greater than walking. A phenomenon between walking and running was observed: both tibial proximal/distal and medial/lateral translations increased when changed from walking to running. Non-linear transition exists in 6 DOF kinematics during walking to running. Discoveries in this study may have potential clinical values to serve as references of normal walking and running in the management of knee injury and knee rehabilitation. more...

Rehabilitation engineering, as one of the active research areas in biomedical science, needs further investigations and improvements. The process of rehabilitation, whether after a stroke, ligament, or accident-related injuries, is commonly based on clinical assessment tools, which can be executed, either by self-reported (home-based) treatment or through observer-rated therapy. However, people with reduced mobility (e.g., stroke, surgical, and ligament patients) can benefit from rehabilitation programs only if effective and appropriate assistive tools are provided. In this paper, a new internet of things (IoT)-based telemonitoring system is introduced for knee injuries’ rehabilitation (Knee-Rehab). The proposed system is a real-time rehabilitation and monitoring framework designed to be a portable, home-based, and online-based instrument comprised of bio-mechanical, bio-instrumentation and IoT-based elements. The system helps patients to rest at home after surgeries or physical treatment, do their rehab-exercises, and receive suggestions form their advisors, which gain the ability to monitor the situation over the exercising time and propose necessary medication/activities to be followed by the patients accordingly, based on their current status. The experimental measurements show the high accuracy achieved by the developed system in terms of monitored knee joint angle, where the maximum error is 3.5° compared to manual goniometer measurements. more...

Zusammenfassung Ziel Ziel der Untersuchung war es, Prädiktoren für das Rehabilitationssetting (ambulant vs. stationär) nach Akutaufenthalt zu bestimmen, um Hinweise auf die Bedeutung der Fallschwere beim Zugang zu einer bestimmten Rehabilitationsform zu erhalten. Methode Für die Auswertungen wurden Patienten2 ausgewählt, bei denen zwischen 2005 und 2010 eine Totalendoprothese (TEP) an Hüfte oder Kniegelenk implantiert oder eine Bandscheibenoperation vorgenommen wurde. Anhand anonymisierter Routinedaten der AOK Baden-Württemberg sowie der Deutschen Rentenversicherungen Bund und Baden-Württemberg wurde mittels logistischer Regression die Wahrscheinlichkeit modelliert, eine stationäre Anschlussrehabilitation (AR) durchzuführen. Ergebnisse Über alle 3 Operationsgruppen hinweg führten Patienten, die unmittelbar nach dem Akutaufenthalt zur AR kamen, eher eine stationäre Maßnahme durch, als Patienten, die nach einer häuslichen Übergangszeit zur Rehabilitation kamen. Mit zunehmendem Alter sowie bei Komorbiditäten wurde häufiger eine stationäre AR in Anspruch genommen. Die Wahrscheinlichkeit einer stationären Durchführung nahm im Zeitraum zwischen 2005 und 2009 ab. Schlussfolgerung Neben der Fallschwere scheinen Kontextfaktoren für das Setting der AR eine Rolle zu spielen. Bei der bedarfsorientierten Zugangssteuerung zu einer bestimmten Rehabilitationsform sind individuelle Rahmenbedingungen, wie bspw. die Versorgung durch das familiäre Umfeld bzw. die Erreichbarkeit therapeutischer, pflegerischer und medizinischer Angebote, und medizinische Parameter, d. h. die Erkrankungsschwere, gegeneinander abzuwägen. more...

An important milestone in the recovery following total knee replacement (TKR) is the ability to return to driving. With advances in pain control and the widespread introduction of rapid rehab programs, we hypothesized that the ability to drive would also return sooner than had been traditionally observed. In our group of consecutive right TKR patients, using a driving simulator, we showed that at the 2-week mark, 36 of the 40 patients tested had returned to their preoperative driving capabilities and the other 4 had reached baseline at 3 weeks. While the eventual decision to return to driving is complex and dependent on many factors, we conclude that one of the benefits of enhanced pain and rehab protocols is that patients undergoing right TKR can return to driving in most instances at the 2-week mark rather than the traditional 6-week mark. more...

Objective: To assess the effects of early self-managed focal sensorimotor training compared to functional exercise training after total knee replacement on functional mobility and sensorimotor function. Design: A single-blind controlled clinical trial. Setting: University Hospital of Rion, Greece. Subjects: A total of 52 participants following total knee replacement. Outcome measures: The primary outcome was the Timed Up and Go Test and the secondary outcomes were balance, joint position error, the Knee Outcome Survey Activities of Daily Living Scale, and pain. Patients were assessed on three separate occasions (presurgery, 8 weeks post surgery, and 14 weeks post surgery). Intervention: Participants were randomized to either focal sensorimotor exercise training (experimental group) or functional exercise training (control group). Both groups received a 12-week home-based programme prescribed for 3–5 sessions/week (35–45 minutes). Results: Consistently greater improvements ( F2,98 = 4.3 to 24.8; P Conclusions: Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement. more...

Zusammenfassung Hintergrund Nach der Akutbehandlung bei Implantation einer Hüft- oder Knietotalendoprothese (TEP) erfolgt meist eine sich daran anschließende Rehabilitationsmaßnahme, entweder unmittelbar im Anschluss oder nach vorangegangener häuslicher Übergangszeit. Aber auch eine ausschließlich ambulante Nachbehandlung ohne Rehabilitation ist möglich. Ziel der Arbeit war die Analyse von personen- und behandlungsbezogenen Faktoren auf die Inanspruchnahme der jeweiligen Nachbehandlung. Methode Auf Basis eines verknüpften Datensatzes bestehend aus Routinedaten der AOK Baden-Württemberg sowie der Deutschen Rentenversicherung Bund und der Deutschen Rentenversicherung Baden-Württemberg erfolgte eine sektorenübergreifende Analyse des Versorgungsgeschehens. Mittels 2 logistischer Regressionsmodelle (Backward-Selektion) wurden Prädiktoren der Inanspruchnahme einer Anschlussrehabilitation (AR) sowie einer häuslichen Übergangszeit getrennt für Hüft- und Knie-TEP-Patienten ermittelt. Ergebnisse Von 9 232 Hüft-TEP-Patienten nahmen 82,6% eine AR entweder direkt nach dem Akutaufenthalt (58,7%) oder nach häuslicher Übergangszeit (23,9%) in Anspruch. Jüngere, männliche und nicht-deutsche Hüft-TEP-Patienten gingen dabei deutlich seltener zur AR. Von den insgesamt 7 656 Knie-TEP-Patienten nahmen 83,9% eine AR in Anspruch, 59,7% direkt und 24,2% mit Übergangszeit. Dabei waren ebenfalls soziodemografische Merkmale für die Inanspruchnahme prognostisch bedeutsam. Die Analyse zeigte, dass die Inanspruchnahme einer AR sowohl von Alter, Geschlecht und Staatsangehörigkeit, als auch von Komorbiditäten, Behandlungen sowie Medikamentenverordnungen beeinflusst wird. Schlussfolgerung Die Ergebnisse liefern Hinweise auf eine höhere Fallschwere von direkt verlegten Patienten, was für eine bedarfsorientierte Inanspruchnahme einer Rehabilitation spricht. Dennoch lassen einige Anhaltspunkte für bestimmte Patientengruppen eine Unterinanspruchnahme vermuten. more...

This research aims to design and implement a novel task-based knee rehabilitation strategy through kinematic synthesis, assist-as-needed control strategy, and recovery tracking system. Experimental kinematic data collected through motion capture system are utilized as an input to the mechanism synthesis procedure. Parallel mechanisms with single degree-of-freedom are considered to generate the complex three-dimensional (3D) motions of the lower leg. An exact workspace synthesis approach is utilized, in which the implicit description of the workspace is made to be a function of the structural parameters of the serial chains of the parallel mechanism, making it easy to relate those parameters to the desired trajectory from the motion capture. The synthesis procedure resulted an exoskeleton which can guide the complex motion of the human knee without the need of mimicking the joint by the exoskeleton counterpart. This can potentially reduce the improper alignment problems arising due to the constantly varying axis of rotation of human joint, which is often very difficult to predict. An assist-as-needed control and recovery tracking strategy is outlined based on an electromyography (EMG) signals and force sensing resistors (FSRs) mounted on the user and exoskeleton, respectively. The EMG signal is captured from the user leg and FSRs are applied at the attachment area of the exoskeleton and the leg, this helps to get the amount of force applied by the exoskeleton to the leg as well as for the recovery tracking. The assist-as-needed controller eliminates the need of constant supervision, and hence saves time and reduces cost of the rehabilitation process. Similarly, the real-time progress tracking system will motivate and actively engage users more...

Completing a set of therapeutic exercises correctly and regularly is essential for early and safe recovery from knee reconstructive surgery. We propose EXTRA, a platform for monitoring and improving the quality of therapeutic exercises that the patients need to perform during the recovery. The data acquisition framework obtains observations of the knee movement using an embedded flex sensor in a hinged knee brace. A connected Android application transmits the data to the database real-time. We evaluated the accuracy of the knee joint angle measurement and the usability in a study with young healthy adults. The mean absolute error of the knee angle measurements was 13.31 degrees. The high score of the usability questionnaire indicates that EXTRA provides a user-friendly interface to motivate therapeutic exercises. EXTRA maintains high standards in accurately monitoring and interpreting the exercises. Our proposed platform has the potential to provide effective guidelines and improve the rehabilitation process for orthopedic professionals and patients. more...

Physical inactivity is a leading risk factor for developing disability. Although randomized clinical trials have demonstrated improving physical activity can reduce this risk in older adults with arthritis, these studies did not specifically evaluate inactive adults.The aim of this study was to evaluate the relationship of changes in physical activity with disability changes among initially inactive adults with or at high risk of knee osteoarthritis from Osteoarthritis Initiative.Inactive persons were identified at baseline based on the US Department of Health and Human Services classification (no [zero] 10-minute session of moderate-to-vigorous [MV] activity over 1 week) from objective accelerometer monitoring. Two years later, physical activity change status was classified as follows: (1) met Federal physical activity guidelines (≥150 MV minutes/week acquired in bouts ≥10 minutes), (2) insufficiently increased activity (some but150 MV bout minutes/week), or (3) remained inactive. Disability at baseline and 2 years was assessed by Late Life Disability Instrument limitation and frequency scores. Multiple regression evaluated the relationship of physical activity change status with baseline-to-2-year changes in disability scores adjusting for socioeconomics, health factors, and baseline disability score.Increased physical activity showed a graded relationship with improved disability scores in Late Life Disability Instrument limitation (P0.001) and frequency scores (P = 0.027). While increasing MV activity to guideline levels showed the greatest reduction, even insufficiently increased physical activity was related to reduced disability.Findings support advice to increase MV physical activity to reduce disability among inactive adults with or at high risk of knee osteoarthritis, even when guidelines are not met. more...

Neuromuscular electrical stimulation (NMES) involves the application of preprogrammed trains of stimuli to superficial skeletal muscles—by means of surface electrodes placed over the muscle belly—with the ultimate goal to evoke visible tetanic contractions. Unlike other electrical stimulation more...

Demand for hip and knee arthroplasty in the United States is rising rapidly. This is creating considerable strain on healthcare systems' institutional resources and finances. To reduce this strain, Spectrum Health in Grand Rapids, MI, developed a strategy to decrease length of stay for most primary hip and knee joint replacement patients. Four specific interventions were undertaken concurrently: (1) communication with providers, (2) modification of patient communications, (3) standardized risk assessment and prediction, and (4) physical therapy on POD (postoperative day) 0 (i.e., the day of surgery). Length of stay was reduced an average of 0.5 days per patient for primary hip and knee joint replacement surgeries, creating a positive financial outcome without negatively affecting quality and patient satisfaction. This demonstrated the ability of a large, high-volume joint replacement center to transform organizational culture and generate rapid, measureable change. more...

Context:Distinct exercises have been proposed for knee rehabilitation after anterior cruciate ligament (ACL) reconstruction. There is a need to understand ACL strain behavior during different rehabilitation exercises to protect the graft from excessive strain that could interfere with its healing process.Objective:To critically review studies that directly measured normal ACL strain in vivo during different movements, conditions, or exercises to gain insight into which of them may produce more strain on the ligament or the ligament graft in the case of reconstructed knees.Data Sources:A literature search of PubMed, CINAHL, SPORTDiscus, and PEDro databases was conducted. Keywords included a nterior cruciate ligament, strain, stress, deformation, transducer, rehabilitation, rehabilitation exercise, physical therapy, and physiotherapy.Study Selection:Inclusion criteria were (1) peer-reviewed studies published in English or Spanish, (2) research conducted on adult human subjects with normal ACLs and healthy knees, and (3) ACL strain directly measured during different movements, conditions, or exercises by using a transducer.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Specific data were abstracted from the selected studies, including isometric quadriceps and hamstrings activity, active and passive flexion-extension of the knee, closed kinetic chain exercises, and application of joint compressive load.Results:A total of 10 studies met all criteria and were included in the final analysis. The strain values produced by closed kinetic chain and open kinetic chain exercises were similar. However, closed kinetic chain exercises appear to attenuate the strain increase that occurs in open kinetic chain exercises when increasing resistance.Conclusion:These data may be relevant to develop rehabilitation exercises or programs that do not endanger the healing ACL graft and to provide a basis for future clinical trials. more...

Background and Aims: Adductor canal block (ACB), though an effective procedure for postoperative analgesia in total knee arthroplasty (TKA), does not provide analgesia to the posterior articular aspect of the knee joint. Infiltration between the popliteal artery and the capsule of the knee (IPACK block) and sensory posterior articular nerves of the knee (SPANK block) are two single injection techniques that have been shown to provide effective analgesia in posterior knee pain. This study aims to compare the effect of IPACK block and SPANK block when combined with ACB for analgesia and postoperative rehabilitation in TKA. Methods: A total of 82 patients were randomised into two groups: (1) ACB combined with IPACK, (2) ACB combined with SPANK block. The primary outcome was the pain scores from 6 h to 48 h after surgery and the duration of postoperative analgesia. The secondary outcome measures were 24 h opioid consumption, ambulation parameters like mobilisation ability, quadriceps muscle strength and patient satisfaction score at discharge. Results: Numerical rating scale (NRS) scores at rest and on movement, duration of analgesia, total opioid consumption, and patient satisfaction were significantly better (P < 0.05%) in the IPACK group than in the SPANK block. There were no significant differences in the knee rehabilitation parameters between the blocks. Conclusion: ACB with IPACK block offers better analgesia, less opioid consumption and better patient satisfaction with comparable knee rehabilitation parameters in the immediate postoperative period after TKA compared to ACB with SPANK block. more...

This article analyzes different trajectories that different patients take when performing knee rehabilitation movements, which are flexion-extension movements in the supine position, analyzing the trajectory taking the patient’s ankle as a reference point, aiming to design a mechanism that can offer a solution to the following more than one trajectory issue, which will allow it to be used for more than one movement, in more than one patient. more...

Study aim: There are currently limited methods available to access dynamic knee range of motion (ROM) during free-living activities. This type of method would be valuable for monitoring and progressing knee rehabilitation. Therefore, the aim of this study was to evaluate the functioning of stretch sensors for the measurement of knee ROM and to assess the level of the measurement error. Material and methods: Nine healthy participants were included in the study. Three stretch sensors (StretchSense™, Auckland, NZ) were attached on the participants’ right knees by Kinesiotape®. A Cybex dynamometer was used to standardise movement speed of the knee joint. Data was recorded through the StretchSense™ BLE application. Knee angles were obtained from the video clips recorded during the testing and were analysed by MaxTraq® 2D motion analysis software. The knee angles were then synchronised with the sensor capacitance through R programme. Results: Seven out of the nine participants presented with high coefficient of determination (R2) (>0.98) and low root mean square error (RMSE) (5°). The equations generated from these 7 participants’ data were used individually to predict knee angles. Conclusions: The stretch sensors can be used to measure knee ROM in healthy adults during a passive, non-weight-bearing movement with a clinically acceptable level of error. Further research is needed to establish the validity and reliability of the methodology under different conditions before considered within a clinical setting. more...

Rehabilitation following knee injury or surgery is critical for recovery of function and independence. However, patient non-adherence remains a significant barrier to success. Remote rehabilitation using mobile health (mHealth) technologies have potential for improving adherence to and execution of home exercise. We developed a remote rehabilitation management system combining two wireless inertial measurement units (IMUs) with an interactive mobile application and a web-based clinician portal (interACTION). However, in order to translate interACTION into the clinical setting, it was first necessary to verify the efficacy of measuring knee motion during rehabilitation exercises for physical therapy and determine if visual feedback significantly improves the participant&rsquo, s ability to perform the exercises correctly. Therefore, the aim of this study was to verify the accuracy of the IMU-based knee angle measurement system during three common physical therapy exercises, quantify the effect of visual feedback on exercise performance, and understand the qualitative experience of the user interface through survey data. A convenience sample of ten healthy control participants were recruited for an IRB-approved protocol. Using the interACTION application in a controlled laboratory environment, participants performed ten repetitions of three knee rehabilitation exercises: heel slides, short arc quadriceps contractions, and sit-to-stand. The heel slide exercise was completed without feedback from the mobile application, then all exercises were performed with visual feedback. Exercises were recorded simultaneously by the IMU motion tracking sensors and a video-based motion tracking system. Validation showed moderate to good agreement between the two systems for all exercises and accuracy was within three degrees. Based on custom usability survey results, interACTION was well received. Overall, this study demonstrated the potential of interACTION to measure range of motion during rehabilitation exercises for physical therapy and visual feedback significantly improved the participant&rsquo, s ability to perform the exercises correctly. more...

Knee injuries are common in people of all ages, due to physical activity and other reasons. In all cases, physical therapy is prescribed but it will depend on the type of injury suffered. Latest research in robotics has developed assistive devices to contribute to improving the patient’s quality of life. In this paper, we propose a five-bars-linkage knee rehabilitation device, which is reconfigurable according to the patient’s height. We present the kinematic modeling of the device to show that it can reproduce certain exercises or routines prescribed at physiotherapy during the knee rehabilitation according to a processor developed. For this, we show the corresponding workspace and the required mechanical configuration of the five-bars-linkage system. To validate the functionality of the processor and of the mechanism, we implement a real case routine performed by a healthy subject. We use the hip and knee angular positions to process them and show the feasibility of the system, obtaining and comparing the corresponding workspaces. more...

Background: Knee joint is a common site for injury among younger people, the purpose of this study is to measure the skeletal muscle endurance and strength on people with prior knee reconstruction surgery. Methods: Young healthy female subjects were tested who reported having knee reconstruction surgery of over one year prior to testing. The skeletal muscle endurance index of the hamstring and quadriceps muscles was determined as the decline in the specific muscle acceleration in response to 2, 4, and 6 Hz electrical stimulation. Maximal isometric muscle strength (MVC) was measured in the hamstring and quadriceps muscles. Results: The hamstring muscles in the affected leg had less endurance than the non-affected leg at 6 Hz stimulation (55.5 ± 13.2% versus 78.0 ± 13.3%, P = 0.01). Muscle endurance was not reduced in the quadriceps muscles in the affected leg compared to the non-affected leg at 6 Hz stimulation (78.0 ± 13.3% versus 80.3 ± 10.0%, P = 0.69). There were no differences in MVC between the affected and non-affected legs for either the hamstring (P= 0.20) or quadriceps muscles (p = 0.67). Conclusions: Muscle endurance is reduced in the hamstring muscles at least one-year post injury, while hamstring strength is not. Reduced hamstring muscle endurance could be a result of a lack of focus on muscle endurance during rehabilitation after injury and may contribute to re-injury in the particular muscle even in people who have recovered muscle strength.&nbsp more...

In this paper is present a new type of a rehabilitation system for both knee and ankle that integrate two treatment types. The system allows a continuous passive motion consisting of two rotations of the leg segments, one of the knee articulation and one of the ankle joint, allowing the functional rehabilitation of the individuals that have an impairment of walking due to a disease or an accident. This is one novelty of the system because all the system that are on the market now consider to one articulation that can be knee or the ankle. In addition, the system allows the application of a mechanical vibration at the lower level of the leg, which have a beneficial action on the bones, muscle, and nerves, which is a well-known treatment. more...

Supplemental digital content is available in the text., Objective The objective of this study was to evaluate the clinical efficacy of mudpack therapy for the treatment of knee osteoarthritis and identify the likely factors associated with the high heterogeneity of combined studies. Design The Medline, Embase, and Cochrane Library databases were systematically searched for randomized controlled trials in which mudpack therapy was used to treat knee osteoarthritis. Results Ten publications that reported the results from a total of 1010 subjects were included in this meta-analysis. Meta-analysis of improvement in joint function at the final follow-up visit suggested, given that the follow-up time was less than 4 mos, that the combined effect size of four studies was −0.30 (−0.62 to 0.02) and the difference did not reach the level of statistical significance. When the follow-up time reached 4 mos, the combined effect size was −1.10 (−2.07 to −0.14) and the difference was significant. The I2 values of the two groups were 21.4% and 93.8%. Conclusion Functional improvement of the knee joint in patients treated with mudpack therapy was not significantly different from that of control subjects at the end of the 4-mo follow-up. The quality of current publications was a factor causing heterogeneity. more...

The aim of the article is to present an experimental research on the behavior of a pneumatic muscle actuated rehabilitation device for hip/knee affections, developed in a laboratory from Transylvania University of Brașov. The equipment has been tested and studied its response to some rehabilitation programs implemented: one for hip joint recovery and other for knee joint recovery. For the research was used WINPISA software with the two programs created by the researchers using NC commands. The knee rehabilitation program consists of slider displacement corresponding to a rotating angle of the knee of 75 degrees with a short temporization and the hip joint rehabilitation program consists of slider displacement corresponding to a rotating angle of the hip of 40 degrees. The results of experiments present the displacement of the slider which effectuates the rehabilitation moves, the velocity and acceleration in a proposed time. more...

Einleitung: Ziele von multidisziplinaren Therapieansatzen nach Einsatz einer Kniegelenksendoprothese (TEP) sind: Senkung postoperativer Komplikationen, fruhe Wiederherstellung der Funktionsfahigkeit, schnellere Rekonvaleszenz, zugigere Wiedereingliederung in den Alltag und Kostenreduktion. Die Fast-Track-Rehabilitation als multidisziplinares Rehabilitationskonzept versucht durch Optimierung des perioperativen Settings insbesondere die Verweildauer im Akutkrankenhaus zu senken, eine fruhfunktionelle Verbesserung zu erreichen und Kosten zu sparen. Methode: Es erfolgte eine Literaturrecherche fur den Zeitraum 1960–2013 zu den Stichwortern: „rehabilitation“, „training“, „physiotherapy“, „physical therapy“, „recovery“, „exercise program“, „knee surgery“, „TKA“, „total knee replacement“, „arthroplasty“, „intensive“, „multidisciplinary“, „accelerated“, „rapid“ oder „fast track“. Eingeschlossen wurden nur prospektive, randomisierte Studien und Metaanalysen. Zusatzlich wurde eine postalische Umfrage in den orthopadischen Rehabilitationskliniken Nordrhein-Westfalens zur Erfassung der Versorgungsrealitat durchgefuhrt. Ergebnisse: Insgesamt wurden 729 Artikel identifiziert; 11 Studien wurden eingeschlossen. Durch Anwendung eines Fast-Track-Konzepts konnen die Verweildauer signifikant verkurzt und Kosten gesenkt werden. Anhand der Studienlage kann eine Verbesserung des kurz- bis mittelfristigen klinischen Outcomes angenommen werden, ohne eine signifikante Verbesserung der klinischen Langzeitergebnisse. Die Ergebnisse der postalischen Umfrage zeigen, dass sich Patienten bei Rehaeintritt in einem reduzierten Allgemeinzustand befinden und die Gehfahigkeit sowie die Bewegungsausmase des Kniegelenks eingeschrankt sind. Schlussfolgerungen: Die Anwendung einer Fast-Track-Rehabilitation ermoglicht eine Reduktion der mittleren Verweildauer im Krankenhaus und fuhrt zu Kostenersparnissen. Zusatzlich bestehen Hinweise, dass sie den korperlichen Zustand des Patienten zu Beginn der Rehabilitation verbessern kann. more...

Die Dauer einer stationaren Anschlussheilbehandlung nach Erstimplantation eines unkomplizierten alloarthroplastischen Huft- und Kniegelenkersatzes bei einer vorbekannten Cox- bzw. Gonarthrose wird in der Fachliteratur nur selten berucksichtigt. In der Literatur liegt der Schwerpunkt stattdessen im Bereich der Wirksamkeit einzelner rehabilitativer Anwendungen und Therapien. Aus diesem Grund steht die Dauer der medizinischen stationaren Anschlussheilbehandlung im Fokus der vorliegenden Studie. In der vorliegenden prospektiven Studie wurden 127 Patienten mit unkomplizierter Hufttotalendoprothesen- (Huft-TEP-)Erstimplantation und 110 Patienten mit einer unkomplizierten Knie-TEP-Erstimplantation aufgrund einer fortgeschrittenen Cox- bzw. Gonarthrose postoperativ untersucht. Im Rahmen eines Modellprojekts mit der AOK Rheinland/Hamburg wurden nur Patienten mit diesem Kostentrager in die Studie aufgenommen. Zur Erfassung des Mobilitatsgrades des Patienten wurde der Staffelstein-Score verwendet. Der Staffelstein-Score wurde am Aufnahmetag des Patienten (T1) und anschliesend in einem wochentlichen Follow-up bis zur Entlassung aus der stationaren Rehabilitation (T2–T4) und zuletzt am Entlassungstag erhoben (T5). Zur besseren Einschatzung der notwendigen Rehabilitationsdauer des einzelnen Patienten wurde im Staffelstein-Score eine Zielpunktezahl festgelegt, deren Erreichen als Rehabilitationsziel definiert wurde. Am Aufnahmetag und in den folgenden Rehabilitationswochen des Rehabilitanden wurde dessen Mobilitatsgrad erfasst und beurteilt, um anschliesend die Rehabilitationsdauer der individuellen Situation des einzelnen Patienten anzupassen. Die vorliegende Studie konnte zeigen, dass der Rehabilitationsfortschritt mit einer deutlichen Besserung des Mobilitatsgrades bei den Huft-TEP- bzw. Knie-TEP-Patienten einhergeht und zum Ende der zweiten Rehabilitationswoche (T2–T3) am hochsten war. Somit hatten im Staffelstein-Score 45 % der Huft-TEP-Patienten und 44 % der Knie-TEP-Patienten ihr Rehabilitationsziel zwischen T2 und T3 erreicht. Der Mobilitatsgrad konnte sowohl bei den Huft- (n = 127), als auch bei den Knie-TEP-Patienten (n = 110) zum Ende der Rehabilitation signifikant verbessert werden (t-Test: p more...

Controversy in management of athletes exists after anterior cruciate ligament (ACL) injury and reconstruction. Consensus criteria for evaluating successful outcomes following ACL injury include no reinjury or recurrent giving way, no joint effusion, quadriceps strength symmetry, restored activity level and function, and returning to preinjury sports. Using these criteria, the success rates of current management strategies after ACL injury are reviewed and recommendations are provided for the counseling of athletes after ACL injury. more...

Inertial measurement units have the ability to accurately record the acceleration and angular velocity of human limb segments during discrete joint movements. These movements are commonly used in exercise rehabilitation programmes following orthopaedic surgery such as total knee replacement. This provides the potential for a biofeedback system with data mining technique for patients undertaking exercises at home without physician supervision. We propose to use machine learning techniques to automatically analyse inertial measurement unit data collected during these exercises, and then assess whether each repetition of the exercise was executed correctly or not. Our approach consists of two main phases: signal segmentation, and segment classification. Accurate pre-processing and feature extraction are paramount topics in order for the technique to work. In this paper, we present a classification method for unsupervised rehabilitation exercises, based on a segmentation process that extracts repetitions from a longer signal activity. The results obtained from experimental datasets of both clinical and healthy subjects, for a set of 4 knee exercises commonly used in rehabilitation, are very promising., 4 pages, 3 figures more...

The goals of knee rehabilitation are to improve range of motion and muscle status. The aim of the study was to investigate accuracy and reproducibility of a newly designed knee-training device (KT) under standardized laboratory conditions.Two application-based software programs, one to measure maximum force and the other intended to improve users' coordination were developed to be used on a tablet during exercises, wirelessly connected to KT placed under the popliteal fossa.KT was loaded for 20 intervals of 15 seconds (s) ranging between 0-350 Newton (N) each. The interval of times was chosen to be enough to take right measurement for accurate results. In addition, a 300-s continuous measurement was undertaken. The pressure readings were developed through a servo-hydraulic system and used as reference values. KT results were compared with the reference values to assess its accuracy. In addition, KT was tested on a force-measuring platform in a close to reality measurement.Based on Bland-Altman plots, the mean difference between KT and material testing machine was -0.63 N (0.4%), between KT and force-measuring platform was -0.11 N (0.7%), which proves the accuracy of its result.Laboratory experiments confirm that KT delivers precise and reproducible values, which provide base for clinical trials. more...

The Microsoft Kinect sensors and wearable sensors are considered as low-cost portable alternative of advanced marker-based motion capture systems for tracking human physical activities. These sensors are widely utilized in several clinical applications. Many studies were conducted to evaluate accuracy, reliability, and usability of the Microsoft Kinect sensors for tracking in static body postures, gait and other daily activities. This study was aimed to asses and compare accuracy and usability of both generation of the Microsoft Kinect sensors and wearable sensors for tracking daily knee rehabilitation exercises. Hence, several common exercises for knee rehabilitation were utilized. Knee angle was estimated as an outcome. The results indicated only second generation of Microsoft Kinect sensors and wearable sensors had acceptable accuracy, where average root mean square error for Microsoft Kinect v2, accelerometers and inertial measure units were 2.09°, 3.11°, and 4.93° respectively. Both generation of Microsoft Kinect sensors were unsuccessful to track joint position while the subject was lying in a bed. This limitation may argue usability of Microsoft Kinect sensors for knee rehabilitation applications. more...

Background: Isokinetic strength and hop tests are commonly used to assess athletes’ readiness to return to sport after knee surgery. Purpose/Hypothesis: The purpose of this study was to investigate the results of single-leg hop and isokinetic knee strength testing in athletes who underwent anterior cruciate ligament reconstruction (ACLR) upon returning to sport participation as well as to study the correlation between these 2 test batteries. The secondary purpose was to compare the test results by graft type (patellar tendon or hamstring). It was hypothesized that there would be no statistically significant limb difference in either isokinetic knee strength or single-leg hop tests, that there would be a moderate to strong correlation between the 2 test batteries, and that there would be no significant difference between graft types. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty-nine high school and collegiate athletes who underwent ACLR participated in this study. At the time of return to full sport participation, a series of hop tests and knee extension/flexion isokinetic strength measurements were conducted. The results were analyzed using analysis of variance and Pearson correlation (r). Results: The timed 6-m hop test was the only hop test that showed a significant difference between the involved and uninvolved limbs (2.3 and 2.2 seconds, respectively; P = .02). A significant difference between limbs in knee strength was found for flexion peak torque/body weight at 180 deg/s (P = .03), flexion total work/body weight at 180 deg/s (P = .04), and flexion peak torque/body weight at 300 deg/s (P = .03). The strongest correlation between the hop tests and knee strength was found between the total distance of the hop tests and flexion total work/body weight at 300 deg/s (r = 0.69) and between the timed 6-m hop test and flexion peak torque/body weight at 300 deg/s (r = –0.54). There was no statistically significant difference in hop test performance or isokinetic knee strength between graft types. Conclusion: The single-leg hop tests and isokinetic strength measurements were both useful for a bilateral comparison of knee functional performance and strength. Knee flexion strength deficits and flexion-to-extension ratios seemed to be correlated with single-leg hop test performance. There was no difference in postoperative hop test performance or knee strength according to graft type. more...

In the case of individuals with paresis, generation of the required knee-extension moment, so as to perform common mobility tasks, is partially lost [1], [2]. Robotic solutions such as rigid exoskeletons are often heavy and bulky and may lead to discomfort and increased dependency on supervised physical therapy. Therefore, there is a need for lightweight devices that offer a higher degree of compliance to the user and can successfully assist in rehabilitation scenarios. One such device to assist the knee extension motion in patients recovering from stroke is presented. more...

Objectives: To design rehabilitation program that can improve proprioception in patient with grade-II anterior cruciate ligament (ACL) injury. Methods: 30 subjects fulfilling the inclusion criteria were recruited. Subjects were randomly distributed into standard non-operative ACL injury rehabilitation group (control group, n = 15) and proprioceptive training group (experimental group, n = 15). Standing balance was assessed by single leg stance and time HOP test. Control group subjects were given knee rehabilitation program like strengthening exercise, flexibility exercise while experimental group were given knee rehabilitation along with proprioception training on wobble board. Subjects completed 12 training sessions, each approximately 30 minutes for the duration of three weeks (4 sessions a week). Results: The results show that the experimental group significantly improved with (P < 0.05) than control group. Conclusions: The study shows that impaired proprioceptive are improved by giving training on wobble board in grade-II ACL injury in athletes. more...

Hintergrund Valgisierende Orthesen stellen eine kostengunstige Alternative in der Behandlung der medialen Gonarthrose dar. Sie helfen zum einen in der praoperativen Diagnostik als Entscheidungshilfe, ob ein Patient aller Voraussicht nach von einer valgisierenden Osteotomie des Tibiakopfes profitiert. Daruber hinaus ist ein direkter klinischer Nutzen in Form einer Schmerzlinderung und Besserung der Kniegelenkfunktion in einigen Arbeiten gezeigt worden. more...

Background Knee injuries form a large part of musculoskeletal trauma in sporting activities and the rehabilitation can require a long period, for both the patients and the specialists, to restore healthy condition. A reliable, portable, and low-cost system that could allow quick, simple, and effective measurement of knee flexion angles would greatly improve the evaluation of the rehabilitation process and the subsequent planning procedure, with meaningful reduction of recovery time and cost. Methods A novel tool for nonstop measurements of knee flexion angles based on the adoption of an elastic sensor embedded in an easy-to-realize wearable kneepad has been proposed. We fully characterized this tool in terms of accuracy, repeatability, and reliability of measure, and validated it against the gold-standard Vicon. Results Our tool demonstrated good reproducibility and repeatability among testers (mean range of measures = 5.82° ± 1.93°) and high accuracy (root mean square error Conclusions The proposed tool demonstrates good performance, is portable, cheap, easy to use, and allows automatic measurements, so as to be a valuable system for accurate nonstop measurement of knee angles. Clinical Relevance Our sensor-based measurement system is suitable for the evaluation of the rehabilitation course after knee traumas, because it furnishes a low-cost but accurate monitor of knee flexion movements, during an amount of time as long as desired. more...