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Wearable devices for knee rehabilitation have been studied extensively in the past few years, with particular applications in tackling ageing problems all over the world. Such devices were firstly created 40 years ago. Although numerous solutions have been proposed since then, many challenges still exist, like high energy consumption compared to their short battery lifetime, low portability and incompatibility anthropomorphic mechanisms. Recently, these issues are resolved with different methods, including the development of better-designed actuators and artificial muscles, and the improvement of gait models. However, there are questions associated with each of these methods such as the self-weight of actuators and muscles which decrease the portability of the devices, while increased complexity is associated with more accurate models. The resulting device from this thesis aims to overcome the difficulties mentioned above and acts as lightweight and functional wearable devices/joints. The device consists of two rings fixed on the femur and tibia, respectively, connected with two crossing flexural shells. The design concept comes from the anatomy and physiology of the human knees concluded in the bio-joint model. Two designs, cross-spring pivot and the crossing four-bar linkage, are studied in this thesis. The kinetostatic models of the two designs are established for the intended bionic characteristics. After optimizing the two designs by using the analytical models, it shows that the crossing four-bar linkage is much better than the cross-spring pivot for matching the bio-joint. A comparison between analytical model and FEA for each design is implemented, showing acceptable agreement. A prototype is fabricated, and preliminarily static experiment tests are conducted.

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.

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.

U ovom radu osmišljen je koncept interaktivne rehabilitacije koljena primjenom igrifikacije u sustavu biološke povratne veze. Navedeni koncept je implementiran za mobilne Android platforme koristeći razvojnu okolinu Android Studio i Unity Engine. Kao izvor signala korištena je sklopovska platforma KneEMG koja mjeri, prikuplja i Bluetooth bežičnom vezom šalje elektromiografske signale mišića kvadricepsa te signale inercijskog senzorskog sustava koji daju podatak o kretanju potkoljenice. Za razvijenu aplikaciju izrađena je popratna dokumentacija s uputama za instalaciju i konfiguraciju sustava. Aplikacija pod nazivom BlueBird je igrica zabavnog i uzbudljivog karaktera u kojoj korisnik pravilnom izvedbom rehabilitacijskih vježbi osvaja dodatne bodove i ispunjava svoj dnevni zadatak. In this thesis, the concept of interactive rehabilitation was used to apply games in the biological feedback system. This concept has been implemented for Android mobile platforms using Android Studio and Unity Engine. The KneEMG hardware platform was used as the signal source, which measures, collects, and sends electromyographic signals from the muscles of the quadriceps and signals from the inertial sensor system via Bluetooth connection to provide information about the movement of the lower leg. Supporting documentation for system installation and configuration has been created for the developed application. The app called BlueBird is a game with fun and excitng character where the user with correctly performed rehabilitation exercises wins additional points and completes a daily task.

espanolIntroduccion. Multiples estudios de procesamiento de senales han reportado la aplicacion de las senales de electromiografia de superficie (sEMG) en robotica y en procesos de rehabilitacion motora. Objetivo. Realizar una revision de la literatura sobre el uso de senales de sEMG como alternativa para la estimacion del par de rodilla con el fin de medir objetivamente el progreso de los pacientes en las diferentes etapas de rehabilitacion de lesiones de rodilla. Materiales y metodos. Se realizo una revision de la literatura publicada entre 1986 y 2018, sin limites geograficos, en las bases de datos Engineering Village, IEEE Xplore, ScienceDirect, Web of Science, Scopus y PubMed mediante la combinacion de 8 terminos de busqueda. Resultados. Al finalizar la busqueda inicial se obtuvieron 355 registros. Luego de realizar la remocion de duplicados esta cifra descendio a 308, los cuales fueron analizados para determinar si cumplian con los criterios de inclusion. Finalmente se incluyeron 18 estudios que describen de forma comparativa como estimar el par a partir de senales de sEMG. Conclusion. El uso de senales de sEMG para calcular el par en una articulacion es una herramienta alternativa que permite al terapeuta acceder a parametros cuantitativos y, de esta forma, valorar el progreso de los pacientes durante el proceso de rehabilitacion de rodilla. EnglishIntroduction: Multiple signal processing studies have reported the application of surface electromyography (sEMG) signals in robotics and motor rehabilitation processes. Objective: To conduct a literature review on the use of sEMG signals as an alternative method for knee torque estimation in order to objectively measure the progress of patients at different stages of knee injury rehabilitation. Materials and methods: A literature review of studies published between 1986 and 2018, without geographical limits, was carried out in the Engineering Village, IEEE Xplore, Science- Direct, Web of Science, Scopus, and PubMed databases by combining 8 search terms. Results: After completing the initial search, 355 records were retrieved. Duplicated publications were eliminated, and 308 articles were analyzed to determine if they met the inclusion criteria. Finally, 18 studies describing, in a comparative way, how to estimate torque based on sEMG signals were included. Conclusion: The use of sEMG signals to calculate joint torque is an alternative method that allows therapists to obtain quantitative parameters and assess the progress of patients undergoing knee rehabilitation processes.

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.

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

For total knee replacement (TKR) patients, rehabilitation after the surgery is key to regaining mobility. This study proposes a sensor-based system for effectively monitoring rehabilitation progress after TKR. The system comprises a hardware module consisting of the triaxial accelerometer and gyroscope, a microcontroller, and a Bluetooth module, and a software app for monitoring the motion of the knee joint. Three indices, namely the number of swings, the maximum knee flexion angle, and the duration of practice each time, were used as metrics to measure the knee rehabilitation progress. The proposed sensor device has advantages such as usability without spatiotemporal constraints and accuracy in monitoring the rehabilitation progress. The performance of the proposed system was compared with the measured range of motion of the Cybex isokinetic dynamometer (or Cybex) professional rehabilitation equipment, and the results revealed that the average absolute errors of the measured angles were between 1.65° and 3.27° for the TKR subjects, depending on the swing speed. Experimental results verified that the proposed system is effective and comparable with the professional equipment.

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.

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.

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.

In this paper a novel knee joint rehabilitation device made for controlled active motion (CAM) therapy is presented and tested. More precisely, the system is a redesign of an originally passive CAM device, called CAMOped. Instead of a break, the adjustable resistance, which is needed for CAM therapy, is now provided via a torque-controlled pneumatic-muscle-actuator-driven joint. These actuators are inherently compliant and can produce both a variable restistance and, by co-contraction, a variable stiffness. It will be shown that, by measuring the foot contact forces and using them as feedback information, the foot load can be adjusted very precisely up to 100 N. Furthermore, it will be demonstrated that, in contrast to passive systems, the presented active systems is capable of varying the resistance while the device is in use. This facilitates adapting the resistance to the patient’s needs in real time and to use joint-angle- or foot-position-dependent resistance curves.

The posterolateral tibial plateau fracture was not easy to be exposed and fixed with usual techniques. The aim of this study was to investigate the biomechanical stability and clinical outcome of the isolated posterolateral tibial plateau fracture fixed with a single horizontal belt plate through the anterolateral supra-fibular-head approach. Fracture models were created by 18 synthetic tibias and fixed with three different fixation modes. Each group was fixed and tested on the loading machine, and final vertical displacement of the fragment was detected and calculated. Clinically, a retrospective analysis of 12 cases of posterolateral tibial plateau fracture from January 2013 to December 2017 was performed. There were 8 males and 4 females, aged 33-72 years, with an average age of 49.6 years. Isolated posterolateral tibial plateau fractures were identified according to preoperative X-ray and computed tomography scan. Through the modified anterolateral supra-fibular-head approach, the fracture was reduced and fixed by a prebending T-shaped distal radius plate and rafting screws, with bone substitute grafting or autogenous iliac bone implantation. Patients were followed up to a minimum one year of time period, and the outcome was evaluated clinically and radiologically. The biomechanical study shows that horizontal belt plate fixation for the isolated PL tibial plateau fracture can provide sufficient stability, allowing early knee functional exercise and partial weight bearing. For clinical case series, the average operation time in this group was 73.3 ± 10.2 mins (range: 55-90), and the average duration of hospitalization was 9.1 ± 3.3 days (range: 5-16). Patients were followed up for 12-24 months with an average of 16.5 months, and all patients achieved radiological fracture union after an average of 13.7 weeks. At one year after operation, the average knee score of the Hospital for Special Surgery (HSS) scale was 93.2 ± 4.2 points(range: 90-98), the average score of SMFA was 21.1 ± 5.6 points (range: 14-31), and the average knee range of motion (ROM) was 121.48 ° ± 8.88 ° (range: 105°-135°). There were 8 cases that were very satisfied and 3 cases that were satisfied with the operation. For an isolated posterolateral tibial plateau fracture, the supra-fibular-head approach can fully expose the fracture site; the horizontal belt plate fixation of the fracture is stable and reliable to allow for early-stage knee rehabilitation, and the outcome of medium-term clinical follow-up was satisfactory.

Precision and transient performance of trajectory tracking has practical significance for rehabilitation robot. A robust finite-time convergence control (RFTCC) strategy was developed for improving control accuracy and transient performance of knee rehabilitation robot in this paper. Firstly, uncertainties of dynamic model of knee rehabilitation robot were analyzed. Secondly, a RFTCC was developed to guarantee the robustness and accuracy of trajectory tracking with model uncertainties, unknown load, and external disturbances. Finally, simulation and experiment were performed on the knee rehabilitation robot. Simulations and experiments demonstrated that this new control method can provide robust and accurate control.

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.

IntroductionTelerehabilitation programmes have been attracting increasing attention as a potential alternative to conventional rehabilitation. Video conferencing can facilitate communication between healthcare professionals and patients. However, in certain cases, video conferencing may face practical limitations. As an alternative to real-time conferencing, sensor-based technologies can transmit the acquired data to healthcare providers. This study aimed to design and develop a sensor-based telerehabilitation programme and to outline the corresponding requirements for such a system.DevelopmentThe development of the sensor-based telerehabilitation programme was carried out based on user needs. The programme includes a portable platform for the patient as well as a web-based platform for the healthcare professional, thus allowing for an individualised rehabilitation programme. Communication, training, reporting, and information services were provided for the patients. Moreover, the portability and usability of the programme were enhanced by utilising the system in offline mode as well.ApplicationThe programme is currently being tested in the North Denmark Region to assess the feasibility and acceptance of a telerehabilitation programme as an alternative solution to the self-training programme for patients who have been discharged from knee surgery. The preliminary results of our assessment showed a high level of acceptance among the users.DiscussionIn this study, a semi-online sensor-based telerehabilitation programme was tested. It is argued that a similar sensor-based telerehabilitation programme can be utilised as an alternative solution for self-training rehabilitation in the future; however; further studies and development are required to ensure the quality and reliability of sensor-based services.

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.

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

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.

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.

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.

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.

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.

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.