Search

Intramuscular (iEMG) and surface electromyographic (sEMG) signals have been compared previously using predictive regression equations, finite element modeling, and correlation and cross-correlation analyses. Although subcutaneous fat thickness (SCFT) has been identified as a primary source of sEMG signal amplitude attenuation and low-pass filter equivalence, few studies have explored the potential effect of SCFT on sEMG and iEMG signal characteristics. The purpose of this study was to investigate the relationship between normalized submaximal iEMG and sEMG signal amplitudes collected from 4 muscles (rectus femoris, vastus lateralis, infraspinatus, and erector spinae) and determine whether SCFT explains more variance in this relationship. The effect of sex was also explored. Linear regression models demonstrated that the relationship between sEMG and iEMG was highly variable across the muscles examined (adjusted coefficient of determination [Adj R2] =.02–.74). SCFT improved the model fit for vastus lateralis, although this relationship only emerged with the inclusion of sex as a covariate. Thus, this research suggests that SCFT is not a prominent factor affecting the linearity between sEMG and iEMG. Researchers should investigate other parameters that may affect the linearity between sEMG and iEMG signals. [ABSTRACT FROM AUTHOR]

Introduction: Lower extremity injuries are commonly evaluated and treated in the emergency department (ED). Pain management for these injuries often consists of acetaminophen, non-steroidal anti-inflammatories, and opioids. Despite this treatment regimen, adequate analgesia is not always achieved.Case Report: A 38-year-old man presented to the ED with a non-displaced tibia-fibula fracture. The patient did not attain analgesia with intravenous medications but did get complete anesthesia of his lower leg with a combination saphenous and popliteal sciatic nerve block.Conclusion: Emergency physicians possess the skill set required to effectively perform a saphenous and popliteal sciatic nerve block and should consider adding this procedure to their armamentarium of pain management techniques in treating injuries distal to the knee.

Objective: This study aimed to evaluate the effectiveness of robot-assisted gait training (RAGT) and explore the optimal exercise prescription using a network meta-analysis approach. Data sources: A comprehensive search was conducted on randomized controlled trials comparing robotic and conventional rehabilitation published up to January 2024 in PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, Wanfang, and SinoMed databases. Review methods: The evaluation parameters included Fugl-Meyer Assessment of Lower Extremity (FMA-LE), Functional Ambulation Category (FAC), Berg Balance Scale (BBS), and 6-Minute Walk Test (6MWT). Two investigators independently performed study screening, data extraction, and bias evaluation. Data were merged, analyzed, and plotted using Review Manager 5.4.1 and Stata 18.0 software. Results: A total of 21 articles involving 822 subjects were included in the analysis. RAGT positively influenced FMA-LE score (MD = 3.74, 95%CI 3.02–4.46, P < 0.05), FAC score (MD = 0.31, 95%CI 0.1–0.53, P < 0.05), BBS score (MD = 3.63, 95%CI 2.46–4.80, P < 0.05), and 6MWT score (MD = 23.73, 95%CI 15.31–32.14, P < 0.05). Surface under the cumulative ranking curve (SUCRA) values indicated that an exercise time of 40–60 min/training (97.4%), exercise frequency of 2–5 times/week (87.6%), and exercise duration of 8–12 weeks (78.1%) were most effective in improving the FMA-LE score. Conclusions: RAGT can effectively improve lower limb motor function, walking function, balance function, and walking endurance in stroke patients. For optimal improvement in FMA-LE score, an exercise time of 40–60 min/training, exercise frequency of 2–5 times/week, and exercise duration of 8–12 weeks are recommended. [ABSTRACT FROM AUTHOR]

Purpose: This meta-analysis aims to update the evidence on post-fasciotomy outcomes in lower limb acute compartment syndrome (ACS) by quantifying pooled prevalence rates for amputation and mortality and evaluating the impact of key risk factors. Methods: PRISMA-compliant search of Medline, Embase, CINAHL, and Web of Science was conducted from inception through July 2024. Risk of bias was assessed using the Joanna Briggs Institute and National Institutes of Health tools, with evidence certainty evaluated via the GRADE approach. Prevalence rates with 95% confidence intervals (CI) were calculated using the Freeman–Tukey double arcsine transformation, accounting for between- and within-study variance. Logistic regression models estimated odds ratios (OR) using a random-effects model, with sensitivity analyses excluding low-sample-size studies. Results: Eleven studies encompassing 2504 patients were included. The pooled prevalence of post-fasciotomy mortality was 7.7% (95% CI, 4.6–11.5%) across eight studies, while amputation prevalence was 10.5% (95% CI, 7.8–13.5%) across 10 studies. Vascular compromise increased amputation odds (OR 1.88, 95% CI 1.03–3.43) but showed no statistically significant association with mortality (OR 2.67, 95% CI 0.77–9.24). Early fasciotomy (< 6 h) reduced amputation odds (OR 0.31, 95% CI 0.13–0.75) and showed a modest trend towards lower mortality. Intracompartmental pressure monitoring (ICPM) was associated with reduced amputation odds (OR 0.23, 95% CI 0.10–0.54), although its effect on mortality was inconclusive. Conclusion: This meta-analysis demonstrates that early fasciotomy, particularly within six hours, and ICPM may mitigate amputation risk in lower limb ACS. While vascular compromise significantly increases the risk of amputation, its link to mortality remains uncertain. These findings emphasise the importance of timely surgical intervention and suggest potential benefits of ICPM for risk stratification. However, the reliance on observational studies, aggregate data, and retrospective research limits causal inferences. Further high-quality research is needed to validate these associations and inform clinical decision-making. [ABSTRACT FROM AUTHOR]

Background/Objectives: We aim to quantify the effect of sex upon the presentation of acute lower limb ischemia (ALI) and the outcomes after surgical thromboembolectomy with a Fogarty catheter. Methods: This was a monocentric retrospective observational study of ALI treated by a Fogarty catheter. Demographics, comorbidities, and clinical characteristics were analyzed. The logistic regressions were used to estimate mortality and secondary outcomes. Results: Over 8 years, 193 patients (79 males and 114 females) underwent Fogarty catheter thromboembolectomy to treat acute lower limb ischemia. Females were older (74.5 for females vs. 82.5 for males) and more affected by congestive heart failure (27% vs. 8%; p = 0.001) and atrial fibrillation (68% vs. 37%; p = <0.001) than the male counterparts. Regarding etiology (p < 0.001), a cardiac embolism (males: 35%; females: 67%) and aortic thrombosis (males: 1%; females: 8%) were more associated with the female gender in the development of acute lower limb ischemia, while vascular bypass/endograft failure (males: 20%; females: 7%) and iatrogenic complications (males: 13%; females: 1%) were more associated with the male gender. After 30 days from surgery, 19% of men and 32% of women had died. Males had higher rates of loss of vascular patency (males: 25%; females: 9%; p = 0.002) and vascular reintervention (males: 20%; females: 8%; p = 0.012). After 90 days from surgery, 23% of men and 41% of women had died. If women had higher mortality (males: 23%; females: 41%; p = 0.008), men had higher rates of loss of vascular patency (males: 27%; females: 12%; p = 0.011) and vascular reintervention (males: 23%; females: 9%; p = 0.007). Conclusions: Older females with atrial fibrillation and/or chronic heart failure are at high risk for ALI. Regarding the thromboembolectomy with a Fogarty catheter, male sex appears to be a risk factor (OR: 2.2, CI: 1.08–4.56) for loss of primary patency, major amputation, and new vascular surgery. A further prospective analysis is warranted to understand the impact of sex in the presentation of acute lower limb ischemia (ALI) and the outcome after surgical thromboembolectomy. [ABSTRACT FROM AUTHOR]

Objective: To analyze the influence of lower limb muscle strength and muscle power training on rate of force development (RFD) and peak force (PF) in elderly people with Parkinson's disease (PD), as well as the effect of these training sessions influence on the functional mobility (FM) of this population. Methods: This was a randomized controlled clinical trial and registered on the virtual platform for registration of experimental and non-experimental studies "Registro Brasileiro de Ensaios Clínicos (ReBEC)". Thirty four elderly people of both genders without and with PD were divided into four groups: strength training control (GSC, n = 8); potency training control (GPC), n = 9; subjects with PD submitted to strength training (GSPD, n = 8); subjects with PD submitted to potency training (GPPD, n = 9). GSC and GPC consisted of with no history of neurological diseases. PF and RFD in the first 50 and 200 milliseconds (ms) were determined. FM was also assessed using the following tests: gait speed test (GS), Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), Unified Parkinson's Disease Rating Scale (UPDRS); parallel feet on a force platform. Next, the participants underwent lower limbs muscle strength or muscle power training for eight consecutive weeks twice a week and were then re-evaluated. Results: The repeated measures ANOVA test showed a significant difference for PF, RFD and FM regardless of training type. Conclusion: The proposed muscle strength and muscle power training protocols influenced the increase in RFD, PF and FM of all participants; however, the increase in RFD in the first 200 ms was more pronounced in the groups submitted to power training and the increase in PF was more pronounced in the groups submitted to strength training. [ABSTRACT FROM AUTHOR]

Purpose: The primary treatment for localised soft tissue sarcoma (STS) is surgery. Surgery for lower limb sarcoma is associated with poorer functional outcomes than other anatomical sites. Rehabilitation is essential, yet provision is not standardised, and patient experience of current service delivery is unknown. This study therefore aimed to explore patients’ experiences of rehabilitation in the surgical pathway for lower limb STS at a United Kingdom (UK) specialist centre. Methods: A qualitative, descriptive phenomenological study was undertaken to explore patients’ rehabilitation experiences. Eight patients who had undergone lower limb STS surgery at a specialist centre were purposively sampled. Data were collected through semi-structured interviews and analysed using thematic analysis. Results: Three main themes were identified: (1) Accessing the right services at the right time. Participants described good access to inpatient rehabilitation post-operatively but delays and challenges in accessing local services affected continuity of care. Rehabilitation gaps pre-operatively, and in facilitating return to meaningful activities, were described; (2) “Communication is key” — providing knowledge and support to navigate uncertainty. Unclear and unrealistic expectations of recovery were challenging. Communication was key to patients feeling supported and facilitating access to rehabilitation; (3) The importance of person-centred rehabilitation. Collaborative, person-centred rehabilitation optimised motivation and engagement. Conclusion: Participants experienced good access to inpatient rehabilitation post-operatively. In contrast, gaps and delays at other timepoints led to missed opportunities to support preparation for, and recovery from, surgery. A multidisciplinary approach across settings from diagnosis, to deliver person-centred rehabilitation, may improve access, expectation management and continuity of care. [ABSTRACT FROM AUTHOR]

Background and Aims: The femoral nerve (FN) is commonly blocked using ropivacaine to provide postoperative analgesia after knee surgery. However, the minimal required concentration has not yet been defined. The aim of this study was to estimate the minimal ropivacaine concentration required to achieve adequate analgesic FN block in 90% of cases (EC90). Methods: This study included 50 patients who were scheduled for knee ligament reconstruction under combined nerve block and general anaesthesia. The FN block was performed using 15 mL of ropivacaine with varying concentrations and considered adequate when associated with pain-free recovery. The sciatic, obturator, and lateral femoral cutaneous nerves were blocked to negate other knee pain generators, and their block success was confirmed. We used the biased-coin design up–down sequential method where the adequacy of an FN block altered the ropivacaine concentration used for the next block. The adequacy of the analgesic block or lack of it was analysed to calculate the analgesic EC90. The quadriceps motor power and morphine requirement were also recorded. Results: The recommended analgesic ropivacaine EC90 was 0.05% w/v. The associated quadriceps weakness and morphine requirement were minimal. Conclusion: FN block using ropivacaine 0.05% w/v may provide adequate analgesia in 90% of patients. [ABSTRACT FROM AUTHOR]

Ulcerated tophaceous gout is an uncommon presentation of the lower limbs. Treatment of these wounds can be a challenge, as their optimal management remains to be determined. Therefore, a retrospective analysis of medical charts between 2015 and 2021 was conducted at a wound clinic of a university-affiliated hospital to determine the characteristics of patients treated for tophaceous wounds, their evolution and treatment. We report a total of five patients with ulcerated tophaceous gout of the foot who initially presented predominantly with soft tissue infection or osteomyelitis. All progressed well with local wound care, including conservative sharp debridement of the tophi and rapid initiation of urate-lowering therapy. Therefore, a diagnosis of tophi should be considered in an ulceration of the first metatarsophalangeal joint or other toes when whitish-chalky material is present, even if the patient was not previously known to have gout. Tophi ulceration is a rare complication; however, prompt diagnosis and management are important to avoid destruction of the underlying bone structures. [ABSTRACT FROM AUTHOR]

Background: Despite the importance of lower limb sensation in walking highlighted in systematic reviews, there is limited research investigating the effect of proprioceptive deficits after stroke and any relationship with walking ability. Objectives: With stroke survivors of different walking ability, this study aimed to (1) explore side (affected/unaffected) and movement direction (inversion/plantar flexion) effects in ankle joint position sense (JPS) acuity, and (2) compare ankle JPS acuity between groups of stroke survivors with different walking ability. Methods: Seventy subacute stroke survivors were recruited and divided into three groups based on walking ability, as determined by their gait speed on the 10-Meter Walking Test: household (<0.4 m/s), limited community (0.4–0.8 m/s) and community (>0.8 m/s). Ankle JPS acuity was measured by the active movement extent discrimination apparatus (AMEDA). Results: A significant difference was found between sides, with the AMEDA scores for the unaffected side significantly higher than for the affected side (F1.67 = 22.508, p < 0.001). The mean AMEDA scores for plantar flexion were significantly higher than for inversion (F1.67 = 21.366, p < 0.001). There was a significant linear increase in ankle JPS acuity with increasing walking ability among stroke survivors (F1.67 = 17.802, p < 0.001). Conclusion: After stroke, ankle JPS acuity on the affected side was lower than the unaffected side. Stroke survivors had higher ankle JPS acuity in plantar-flexion movements, compared with inversion movements. Overall, stroke survivors with higher ankle JPS acuity tended to have higher walking ability, highlighting the importance of ankle JPS acuity in walking ability after stroke. These findings provide new insights into proprioceptive deficits after stroke and their relevance in neurorehabilitation. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the psychometric properties of the Chinese version of the Stay Independent Questionnaire (C-SIQ) in evaluating individuals with stroke. Design: The study adopted a cross-sectional design. Setting: The research was conducted at a university-based neurorehabilitation center. Participants: The study included a total of 100 individuals with stroke and 49 healthy older adults. Methods: On Day 1, both individuals with stroke and healthy older adults underwent assessments using the C-SIQ. Additionally, individuals with stroke were evaluated using the Fugl–Meyer Assessment of Lower Extremity (FMA-LE), ankle dorsiflexion and plantarflexion strength, Berg Balance Scale (BBS), Timed-Up and Go Test (TUG), 10-meter walk test (10 mWT), Activities-specific Balance Confidence (ABC) Scale, Stroke Impact Scale (SIS), and Community Integration Measure (CIM). On Day 2 (7 days after Day 1), individuals with stroke were reassessed using the C-SIQ. Results: Individuals with stroke exhibited a higher C-SIQ score (6.22 ± 2.98) compared to healthy older adults (1.59 ± 2.01). The C-SIQ demonstrated good test–retest reliability (intraclass correlation coefficient = 0.847) and internal consistency (Cronbach's alpha = 0.709). The Minimal Detectable Change in C-SIQ score was calculated as 3.05. Exploratory factor analysis revealed four factors with eigenvalues ≥1.0, explaining 57.17% of the total variance. The C-SIQ score exhibited significant correlations (ranging from −0.553 to 0.362) with completion times of the TUG and 10 mWT, FMA-LE, BBS, ABC, SIS, CIM score, paretic ankle dorsiflexion strength, and 6 mWT distance. A cut-off score of 2.5 was identified as the optimal threshold for discriminating fall risk between individuals with stroke and healthy controls. Conclusion: The C-SIQ emerges as a reliable and valid tool for evaluating fall risk in individuals with stroke, showcasing strong correlations with key measures such as TUG times, 10 mWT, FMA-LE, BBS, ABC, SIS, CIM score, paretic ankle dorsiflexion strength, and 6 mWT distance. The C-SIQ demonstrated good test–retest reliability and internal consistency. Exploratory factor analysis revealed that this is a four factors assessment tool. The identified cut-off score of 2.5 effectively distinguishes fall risk between individuals with stroke and healthy controls. [ABSTRACT FROM AUTHOR]

Background: Wound repair methods are commonly used in clinical practice, such as skin graft and flap repair, which can cause secondary injuries, and high costs. Many methods for skin stretching and repair have been reported domestically and internationally. However, their clinical use is limited owing to lack of equipment, complexity, and high costs. Therefore, we introduce a novel technique to repair wound. Methods: We collected 125 patients with skin defects of lower limb from January 2019 to June 2024. Among them, 77 cases were repaired using our novel technique (suture-stretching technique, we designed a simple and feasible skin traction device that used 2–0 (polydioxanone sutures) PDS sutures, 2.0 mm Kirschner wires, and nylon binding tapes to repair skin defects and accommodate irregular wounds according to Ilizarov's "tension-stress" law, SS group); skin grafting (SG group) was used for repairing 48 cases of wounds. We collected the data of the two groups, including wound size, number of debridements, operation time, wound healing time, hospital stays, and surgury cost, and the data were analyzed statistically. Results: There was no statistically significant difference between the two groups in terms of age, gender, wound size and wound healing time (p > 0.05).However, the number of debridements (p < 0.0001), operation time (p < 0.0001), hospital stays (p < 0.0001) and surgery time (p < 0.0001) in the suture group were better than those in the skin grafting group with statistically significant difference. Conclusion: The application of suture-stretching technique to repair skin defect wounds of lower limb have good clinical efficacy, which can reduce the number of operations, shorten the operation time, and avoid secondary injuries caused by skin graft or skin flaps. Meanwhile, it also has obvious advantages regarding hospital stays and surgery costs. [ABSTRACT FROM AUTHOR]

Lower limb exoskeletons are widely studied to provide assistance for both disabled and healthy person. The assisting efficacy would be more significant if the assisting strategy is more in line with the movement characteristics of different wearers. However, how to optimize the timing and magnitude of the assisting torque so as to provide different wearers with more personalized, comfortable and balanced assistance is still not well tackled. To address the issue, an assisting strategy with adjustable assisting timing and magnitude was designed in this paper. First, we designed a framework for smart human-exoskeleton collaboration in which machine learning methods and human-in-the-loop methodology are combined to optimize the assisting timing and magnitude. Second, an assisting strategy based on hip joints trajectory, which is embedded in the framework was designed to separately plan the assisting torque for hip flexion and extension. Third, the efficacy of the designed method was both verified with quantitative and qualitative results. Quantitative results showed that the designed method reduced the net metabolic cost of walking during load carriage by 2.68% on average. And questionnaire survey results showed that the designed assisting strategy provided subjects with more significant, comfortable and balanced assistance. [ABSTRACT FROM AUTHOR]

Background: The lower limb venous system, a subject of extensive study due to its high clinical significance on deep vein thrombosis, presents a rare, intriguing, symmetrical variant in this dissection report. Case Report: We present the uncommon and clinically meaningful bilateral persistent sciatic vein (PSV) variant. The developmental variant was symmetrically detected during a dissection of an 81-year-old female donated cadaver. The symmetrical PSV originated from the popliteal vein (PV, merging of the anterior and posterior tibial vein), coursing through the abductor magnus muscle and draining into the common femoral vein after joining the femoral and greater saphenous vein. The enlarged PSV was the developmental variant at the saphenopopliteal junction, while the “typical” PV was hypoplastic as a regressed vessel. Conclusion: The typical PV was hypoplastic; the enlarged PSV was the lower limb’s primitive axial vein that acted as the central (main) drainage vessel. After a thorough literature search, the PSV variant was recorded as having a low prevalence in the general population. The current dissection finding is relatively rare due to its symmetric occurrence. The rare variant is related to Klippel-Trenaunay Syndrome, a congenital vascular malformation. Clinicians must distinguish the primitive axial vein (PSV) from the transformed axial vein (pathology) to avoid complications and iatrogenic injury. [ABSTRACT FROM AUTHOR]

Despite the widespread use of older adults (OA) as controls in movement disorder studies, the specific effects of aging on the neural control of upper and lower limb movements remain unclear. While functional MRI paradigms focusing on hand movements are widely used to investigate age-related brain changes, research on lower limb movements is limited due to technical challenges in an MRI environment. This study addressed this gap by examining both upper and lower limb movements in healthy young adults (YA) vs. OA. Sixteen YA and 20 OA, matched for sex, dominant side, and cognitive status, performed pinch grip and ankle dorsiflexion tasks, each requiring 15% of their maximum voluntary contraction. While both groups achieved the target force and exhibited similar force variability and accuracy, OA displayed distinct differences in force control dynamics, with a slower rate of force increase in the hand task and a greater rate of force decrease in the foot task. Imaging results revealed that OA exhibited more widespread activation, extending beyond brain regions typically involved in movement execution. In the hand task, OA showed increased activity in premotor and visuo-motor integration regions, as well as in the cerebellar hemispheres. During the foot task, OA engaged the cerebellar hemispheres more than YA. Collectively, results suggest that OA may recruit additional brain regions to manage motor tasks, possibly to achieve similar performance. Future longitudinal studies that track changes over time could help clarify if declines in motor performance lead to corresponding changes in brain activation. [ABSTRACT FROM AUTHOR]

Introduction: Clinicians involved in lower-limb prosthetic provision and care do not have an objective method for measuring patients' real-world prosthesis usage. This results in a poor understanding of the full picture of the patient's everyday life impacting the reporting of outcome following prosthetic prescriptions. There is need to understand what information from wearable prosthetic monitors would be relevant to clinicians and how that information should be displayed to enable health care professionals to make informed decisions. Moreover, clinicians' perspectives regarding potential use and application of information from monitoring technologies are important in the development and implementation of this technology to improve evidence-based systems for informed clinical decisions for lower-limb prosthesis users. This study aims to explore clinicians' experiences and perceptions of information obtained from free-living wearable prosthetic monitors used in clinical practice. Methods: Seven clinicians from private practice and academia were recruited to participate in the study. A semistructured interview was held for each participant, which lasted about 30–45 minutes. Data and transcripts were analyzed using inductive thematic analysis method. Results: Themes of objectiveness and motivation were identified as specific applications of monitoring technologies. Other themes such as awareness and integration were identified as the facilitators of monitoring technologies for prosthetic care in clinical settings. Clinicians identified frameworks in which these monitoring technologies could be incorporated into the clinic, how they can receive feedback as a multidisciplinary team, and the inclusion within patients' medical records. Conclusions: This information from prosthetic monitoring technologies could potentially change clinical practice in several ways: by improving the clinical assessment process, improving the prescription process, and improving the rehabilitation process. To improve the clinical assessment process, prosthetic monitoring information can provide real-world data of prosthesis user's utilization, which could be used to quantify patients' self-reports. To improve the prescription process, prosthetic monitoring information can enable clinicians to see if a patient was actively involved in any form of exercise and support them to position their prescription of components within an activity category for their patients. To improve the rehabilitation process, prosthetic monitoring information can be used to plan goals for patients, to measure the progress of patients, and to check for patients' compliance. Clinical Relevance Statement: The impact of these potential changes in clinical practice can ultimately lead to improved clinical decisions in prosthetic care and creation of an evidence-based system. [ABSTRACT FROM AUTHOR]

The anatomy of the sciatic nerve allows it to be blocked at different levels using various anesthetic approaches. However, for several reasons, performing these approaches may be challenging or disadvantageous in specific categories of patients, particularly in obese patients. The objective of this brief technical report is to describe a new technical approach to sciatic nerve block, designed to simplify the procedure for certain categories of patients and less experienced practitioners. Since 2010, more than 5000 procedures have been performed by both experienced anesthesiologists and novice trainees in several hospitals. The ultrasound lateral mid-shaft technique appears to be a safe and effective method for performing a sciatic nerve block, even in obese patients with significant subcutaneous fat and unclear ultrasound images. This approach is particularly beneficial given the various anatomical variations that can occur. By targeting the mid-thigh area, the ultrasound beam accesses anatomical structures that are more superficial, improving the technique's efficacy. Various hospital groups have been performing this technique as a routine procedure, achieving a success rate of nearly 100%. This impressive success rate exceeds that of other conventional techniques documented in the literature. Additionally, there have been significant improvements in comfort and ease for anesthetists. This method allows the anesthetic to spread around the paraneural sheath, covering the posterior femoral cutaneous nerve. Finally, it is performed in the supine position without the need to mobilize the lower limbs, ensuring patient comfort, especially in cases of fractures or lower limb injuries. Further studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Qian Liu,1,&ast; Xiangyu Kong,2,&ast; Jun Yang,3 Dongdong Zhang1 1Department of Oncology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China; 2Department of Radiology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China; 3Department of Neurology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jun Yang, Department of Neurology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China, Email 296051103@qq.com Dongdong Zhang, Department of Oncology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Jiefang Road No. 15, Xiangyang, Hubei, 441000, People’s Republic of China, Tel +8615072278600, Email zhangdongdong@whu.edu.cnBackground: Granular cell tumor (GCT) is a rare soft tissue tumor characterized by Schwann cell differentiation. While GCT can occur in any part of the body, it is less common in the lower limbs. We report a case of a giant atypical GCT located in the left thigh, the tumor was initially small and painless at the time of discovery but gradually grew to 17 cm over a two-year period.Case Presentation: A 60-year-old male patient presented to our hospital two years ago with a painless mass measuring 39× 22 mm on the left thigh. He refused treatment due to the absence of discomfort. Over the following two years, the painless mass gradually enlarged. Magnetic resonance imaging (MRI) upon admission revealed a mixed signal, spindle-shaped shadow measuring approximately 170 mm × 50 mm × 55 mm in the left femur’s subcutaneous soft tissue, accompanied by mild surrounding swelling. Surgical resection was performed. Microscopic examination revealed round or polygonal tumor cells distributed in sheets or nests, with no evident atypical cells or signs of nuclear division. Immunohistochemistry demonstrated positive staining for S100, SOX-10, Vimentin, NSE, CD56, and H3K27Me3 in the tumor cells, with a Ki-67 labeling index of approximately 15%. The postoperative pathological diagnosis confirmed giant GCT.Conclusion: We report a case of a benign giant GCT in the left thigh. Early diagnosis and treatment of painless lower-limb masses are essential to prevent their enlargement or malignant transformation. Surgery remains the primary treatment for this condition. Pathological assessment is crucial for definitive diagnosis and for distinguishing between benign and malignant forms.Keywords: granular cell tumor (GCT), lower limb, soft tissue tumor, histopathology, surgery

Researchers have been trying to develop lower-limb exoskeletons to reduce the metabolic cost for human augmentation. The research on (quasi-)passive exoskeletons has gained more widespread attention since the first passive ankle exoskeleton was demonstrated to reduce the metabolic cost of human walking in 2015. Here, we reviewed studies on lower-limb (quasi-)passive exoskeletons for human performance augmentation in the past decade and highlighted key innovations and techniques to enable some of these exoskeletons to achieve the goal of reducing metabolic cost. We reviewed the (quasi-)passive exoskeleton research from three aspects including biological fundamentals for exoskeleton design, assistive principle and mechanical design of exoskeleton, which are the primary considerations of designing and evaluating (quasi-)passive exoskeletons. Lastly, we underlined some practical challenges and emerging trends of (quasi-)passive exoskeleton technology for further enhancing human mobility performance in the future.

BACKGROUND: It has been found that anterior knee pain is related to the biomechanics of the lower limbs, but there is still a lack of research on the effects of gluteal muscle training on the knee joint and daily activities of the lower limbs. OBJECTIVE: To investigate the effects of gluteal muscle activation exercise therapy on the muscle strength of hip and knee joint muscle groups and pain in young male patients with anterior knee pain. METHODS: Twenty-five young male patients with anterior knee pain were enrolled and randomly divided into two groups: gluteal muscle activation group (n=12) and blank control group (n=13). The gluteal muscle activation group performed gluteal muscle activation exercises, 40 minutes each, 3 times/week, for 6 weeks. The blank control group did not perform any intervention. Assessments were conducted at the time of enrollment and again after 6 weeks. The relative peak torque, total work, ratio of flexors and extensors, and muscle endurance values of the affected hip and knee joints were evaluated through isokinetic flexion and extension tests at 60 (°)/s and 180 (°)/s. At the same time, floors at which climbing was stopped in the stair-climbing test were detected and the visual analog scale score was assessed. RESULTS AND CONCLUSION: (1) Isokinetic knee extension and flexion test: For the hip joint, the gluteal muscle activation group showed a significant increase in the relative peak torque at 60 (°)/s and 180 (°)/s by 29.74% and 25.95% respectively after intervention (P=0.022, P=0.024); the blank control group showed a 12.12% decrease in muscle endurance at 180 (°)/s compared to before intervention (P=0.000). For the knee joints, the gluteal muscle activation group had a significant increase in the relative peak torque at 60 (°)/s and 180 (°)/s by 18.69% and 7.27% respectively after intervention (P=0.006, P=0.033); there were no significant changes in the blank control group before and after intervention (P > 0.05). (2) Stair-climbing test: The number of floors climbed to cessation in the gluteal muscle activation group was (6.41±6.1) floors, which was higher than that in the blank control group (P=0.024), and increased by 33.11% compared with before intervention (P=0.016); there were no significant changes in all the indicators of the blank control group before and after intervention (P > 0.05). (3) Pain assessment: After intervention, the visual analogue scale score of the gluteal muscle activation group was significantly lower than that of the blank control (P=0.036), and also decreased compared to before intervention (P=0.000); there were no significant changes in the blank control group before and after intervention (P > 0.05). To conclude, the 6-week gluteal activation exercise therapy can improve the explosive power and endurance of the lower limb muscles, and reduce the degree of anterior knee pain. For patients with anterior knee pain, gluteal muscle training is necessary to promote recovery. [ABSTRACT FROM AUTHOR]

Context: Lower extremity physical performance tests (PPTs) have been widely used in sports rehabilitation and are commonly performed in person. However, some situations may disrupt the in-person health care delivery, such as social distancing due to the pandemic, traveling, and living in remote locations. Those situations may require adjustments in planning and applying measurement tests, and telehealth has become an alternative. Nevertheless, the reliability of lower extremity PPT tests via telehealth is still unknown. Objectives: To verify the test–retest reliability, SEM, and the minimum detectable change (MDC95) of PPTs via telehealth. Methods: Fifty asymptomatic athletes completed 2 assessment sessions 7 to 14 days apart. The assessment via telehealth consisted of warm-up exercises followed by the single-, triple-, and side-hop tests, and the long jump test, in random order. Intraclass correlation coefficient, SEM, and MDC95 were calculated for each PPT. Results: Single-hop test showed good to excellent reliability, with SEM and MDC95 ranging from 6.06 to 9.24 cm and 16.79 to 25.61 cm, respectively. The triple-hop test showed excellent reliability, with SEM and MDC95 ranging from 13.17 to 28.17 cm and 30.72 to 78.07 cm, respectively. Side-hop tests showed moderate reliability, with SEM and MDC95 ranging from 0.67 to 1.22 seconds and 2.00 to 3.39 seconds, respectively. The long jump test showed excellent reliability, with SEM and MDC95 ranging from 5.34 to 8.34 cm and 14.80 to 23.11 cm, respectively. Conclusion: The test–retest reliability of those PPTs via telehealth was acceptable. The SEM and MDC were provided to assist clinicians in interpreting those PPTs. [ABSTRACT FROM AUTHOR]

Aims: Lower limb reconstruction (LLR) has a profound impact on patients, affecting multiple areas of their lives. Many patient-reported outcome measures (PROMs) are employed to assess these impacts; however, there are concerns that they do not adequately capture all outcomes important to patients, and may lack content validity in this context. This review explored whether PROMs used with adults requiring, undergoing, or after undergoing LLR exhibited content validity and adequately captured outcomes considered relevant and important to patients. Methods: A total of 37 PROMs were identified. Systematic searches were performed to retrieve content validity studies in the adult LLR population, and hand-searches used to find PROM development studies. Content validity assessments for each measure were performed following Consensus-based Standards for the selection of health measurement Instruments (COSMIN) guidelines. A mapping exercise compared all PROMs to a conceptual framework previously developed by the study team (‘the PROLLIT framework’) to explore whether each PROM covered important and relevant concepts. Results: The systematic searches found 13 studies, while hand searches found 50 PROM development studies, and copies of all 37 measures. Although several studies discussed content validity, none were found which formally assessed this measurement property in the adult LLR population. Development of many PROMs was rated as inadequate, no PROM had sufficient content validity in the study population, and none covered all areas of the PROLLIT framework. The LIMB-Q was the most promising and comprehensive measure assessed, although further validation in a wider sample of LLR patients was recommended. Conclusion: Current PROMs used in adults requiring, undergoing, or after undergoing LLR lack content validity and do not assess all important and relevant outcomes. There is an urgent need for improved outcome measurement in this population. This can be achieved through development of a new PROM, or through validation of existing measures in representative samples. Cite this article: Bone Jt Open 2024;5(12):1049–1066.

Abstract Background Endoprosthetic knee replacement using megaprostheses has become a common strategy for preserving joint function in patients with distal femur tumors. While existing literature has primarily focused on surgical techniques, complications, and implants, recent improvements in patient survival rates have sparked increased interest in the long-term functional outcomes associated with this treatment. Methods This case-control study evaluated functional outcomes—Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), knee flexor and extensor muscle strength, and sagittal knee range of motion—and health-related quality of life (SF-36) between patients with distal femoral megaprostheses (n = 31) and healthy controls (n = 48). Participants performed the TUG and 6MWT equipped with an inertial measurement unit. Additionally, bivariate Spearman correlations were calculated within the patient group to assess relationships between Musculoskeletal Tumour Society (MSTS) scores and functional outcomes. Results Patients performed significantly worse than controls in the TUG test, with longer completion times (Mean Difference: -3.3 s; 95% CI: -5.7 to -0.9; p = 0.008), reduced rotational speed during the middle turn (Mean Difference: 16°/s; 95% CI: 7 to 25; p 0.05). In patient group, bivariate Spearman correlations indicated a very strong positive association between MSTS scores and knee extension strength (ρ = 0.710; p

Objectives: To comprehend the kinematic effects of hallux valgus (HV) deformity on young and older people, we assessed the angular acceleration of the joints in the lower limbs of these women. Methods: Forty-eight women in two groups, young adults (20-30 years old) and older adults (50-60 years old), participated in this study (12 healthy and 12 with HV). We used an inertial measurement unit (IMU)-based motion capture system to measure the kinematics of motion. Biomechanical variables were assessed at an ideal speed during gait (stance and swing phases). All modules were calibrated in advance and then attached to the right thigh, shank, and foot. Results: The results showed that in the young group, angular acceleration was significantly different during gait in all planes of the ankle joint, the sagittal plane of the knee joint, and the horizontal and frontal planes of the hip joint. In the older group, it was significantly different in the sagittal plane of the ankle and knee and the sagittal and frontal planes of the hip joint. Discussion: It appears that the angular acceleration of the lower limb joints was affected by HV, especially in the young group. Additionally, the angular acceleration of the knee joint was less affected in both groups.

Stroke is an important factor causing disability and death worldwide, and post-stroke hemiplegia is the main clinical symptom of patients. Lower limb motor dysfunction is one of the most common complications, seriously affecting patients' walking ability and daily living activities, and bringing huge burden to social economy and personal health. How to effectively promote the rehabilitation of lower limb function in stroke patients is a challenge that needs to be addressed in clinical rehabilitation. Repetitive transcranial magnetic stimulation (rTMS), as a non-invasive and painless neural regulation technique, has become a new supplementary method for improving limb dysfunction in stroke patients in recent years. It has been widely used to recover post-stroke motor dysfunction and has achieved good results. This review mainly summarized the application of TMS, rTMS and their different stimulation modes, bilateral brain rTMS, and individnalized targeted TMS in lower limb rehabilitation of stroke patients, to provide reference for related research and clinical applications.

Abstract To analyze the causes, locations, associated injuries, and relevant factors of lower limb and pelvic fractures in hospitalized children in China to provide a theoretical basis for reducing the incidence of such fractures. A retrospective analysis of children with lower limb and pelvic fractures admitted to 27 tertiary children’s hospitals affiliated with China’s Futang Research Center of Pediatric Development between December 1, 2015, and December 31, 2019, was conducted. Inpatient cases were analyzed in the following age groups: Infants (

Aims: Lower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate. The aim of this systematic review protocol is identifying differences in rates of infection, nonunion, and malunion of extra-articular femoral and tibial shaft fractures in LMICs treated with either internal or external fixation. Methods: This systematic review protocol describes a broad search of multiple databases to identify eligible papers. Studies must be published after 2000, include at least five patients, patients must be aged > 16 years or treated as skeletally mature, and the paper must describe a fracture of interest and at least one of our primary outcomes of interest. We did not place restrictions on language or journal. All abstracts and full texts will be screened and extracted by two independent reviewers. Risk of bias and quality of evidence will be analyzed using standardized appraisal tools. A random-effects meta-analysis followed by a subgroup analysis will be performed, given the anticipated heterogeneity among studies, if sufficient data are available. Conclusion: The lack of easily accessible LMIC outcome data, combined with international clinical guidelines that are often developed by HIC surgeons for use in HIC environments, makes the clinical decision-making process infinitely more difficult for surgeons in LMICs. This protocol will guide research on surgical management, outcomes, and complications of lower limb shaft fractures in LMICs, and can help guide policy development for better surgical intervention delivery and improve global surgical care. Cite this article: Bone Jt Open 2024;5(11):1020–1026.

Abstract Objectives Skeletal muscle dysfunction is the primary cause of functional limitations in osteoarthritis, associated biomarkers have the potential as targets for early disease identification, diagnosis, and prevention of osteoarthritis disability. This review aimed to identify associations between biomarkers and lower limb skeletal muscle function in individuals with osteoarthritis. Methods A systematic literature review and meta-analysis conducted in PubMed, MEDLINE, CINAHL, EMBASE, Scopus, SPORTDiscus and Web of Science databases from inception to 8th August 2023. Two independent reviewers performed the title, abstract, full-text screening, data extraction and methodological quality assessment. A meta-analysis was undertaken based on the available data. Results Twenty-four studies with 4101 participants with osteoarthritis were included (females: 78%; age range; 49 to 71 years). One study reported muscle-specific biomarkers (n = 3), whilst six studies reported osteoarthritis-specific markers (n = 5). Overall, 93 biomarkers were reported, predominately characterised as inflammatory (n = 35), metabolic (n = 15), and hormones (n = 10). Muscle strength and vitamin D reported a significant association (Hedge’s g: 0.58 (Standard Error (SE): 0.27; P = 0.03), k = 3 studies). Walking speed and high-sensitivity C-reactive protein reported no significant associations (Hedge’s g: -0.02 (SE: 0.05; P = 0.73), k = 3 studies). Conclusion Associations between biomarkers and lower limb skeletal muscle function in individuals with osteoarthritis was limited, the few studies exploring lower limb muscle measures were mainly secondary outcomes. Furthermore, biomarkers were largely related to overall health, with a lack of muscle specific biomarkers. As such, the mechanistic pathways through which these associations occur are less evident, and difficult to draw clear conclusions on these relationships. Trial registration Registered on PROSPERO (CRD42022359405).

Backgroud: The main function of the hamstring muscles is to bend the knee joint and support the function of the hip extensors. Their frequent injuries are the result of overload related to, among others, dynamic running or jumping, and inadequate preparation for athletics activities. The asymmetry of the work of individual flexor muscle groups is clearly marked in the case of valgus or varus of the knee joint, i.e., in different positions of the lower limb. The aim of the study was to determine the position and form of a rehabilitation exercise in which an isolated group of muscles flexing the knee joint will show the greatest bioelectrical activity. Methods: The study involved 25 students of the Jagiellonian University Medical College. The students were aged 20–26. The average age was 22.9 (±1.4). The study participants included 17 women with an average age of 23.0 (±1.1) and 8 men with an average age of 22.6 (±1.9). Women constituted 68% and men 32% of all respondents. All participants agreed to participate in the study. Surface electromyography measurements in both lower limbs provided an initial number of 50 cases. The activity of the knee flexor muscles during isometric contraction with resistance was measured in correlation with three foot and lower leg settings: internal rotation, neutral position, and external rotation. The bioelectrical activity of the semitendinosus muscle is significantly higher (p < 0.01) in the internal rotation position than in the neutral position of the lower leg, while the bioelectrical activity of the biceps femoris muscle is inversely higher (p < 0.01) in the external rotation position than in the neutral position. Results: The results are significant for both average and maximum values of muscle stimulation. During isometric contraction with resistance, the semitendinosus muscle shows the greatest bioelectrical activity in the internal rotation position of the lower leg and foot, and the biceps femoris muscle in the external rotation position of the lower leg and foot. Conclusions: The above information has important implicational applications when improving isolated groups of hamstrings. In the future, this may contribute to more effective rehabilitation of patients with injuries of the muscles described in the article.

Abstract Introduction Sarcopenia is defined by low measures of muscle quantity, quality and reduced physical performance. It is associated with higher levels of frailty. Individuals with diabetes mellitus (DM) undergo sarcopenia at an accelerated rate resulting in structural changes potentially culminating in limb loss. Aims To review the evidence on methods of detecting and measuring sarcopenic changes on magnetic resonance imaging (MRI) in the foot in patients with diabetes. Methods A literature review was conducted in accordance with PRISMA guidelines. We searched Embase and Medline (via Ovid), CINAHL (via Ebsco Host), Web of Science and Scopus as well as the grey literature. The MeSH terms “sarcopenia” AND “diabetes mellitus” AND “magnetic resonance imaging” were employed in the primary search string. Results 874 studies were identified. 404 articles were excluded in the title and abstract screening. 33 studies were assessed for eligibility after abstract and title screening was completed by two reviewers. 7 studies evaluating sarcopenia in the foot were included in the final review. Conclusion Sarcopenic changes are evident on MRI of the foot in patients with diabetes and is profound in patients with diabetic neuropathy. The general extent and severity of sarcopenia seems to correlate with clinical scores to assess neuropathy and is implicated in the development of diabetic foot disease.

Prior research has highlighted the therapeutic benefits of acute intermittent hypoxia (AIH) in enhancing motor performance after motor incomplete spinal cord injury and in able-bodied individuals. Although studies in rodents and humans indicate that AIH may facilitate motor excitability, the relationship between excitability changes and functional performance remains unclear. In addition, discrepancies in the effects of AIH on excitability in able-bodied individuals merit further investigation. Understanding the concurrent impact of repetitive AIH on voluntary activation and spinal reflex excitability may clarify the functional implications of AIH for muscle force production. High voluntary activation is vital for sustaining torque production during activities that require repeated muscle contractions. We hypothesized that repetitive AIH would attenuate decreases in both voluntary activation and maximum torque production typically observed during fatiguing contractions. To test this hypothesis, we examined the effects of four consecutive days of AIH on voluntary activation and torque generation during repeated maximal plantar flexion contractions. We assessed changes in voluntary activation using the central activation ratio by calculating the ratio of voluntary torque to the torque produced with supramaximal electrical stimulation. Consistent with our hypothesis, we show that repetitive AIH significantly increases both voluntary activation and peak torque during fatiguing contractions. We did not observe any changes in resting spinal reflex excitability or antagonist muscle coactivation during fatiguing contractions post-AIH. Together, these findings suggest that repetitive AIH reduces performance fatigability through enhanced descending neural drive. Optimizing voluntary activation is critical for facilitating the recovery of functional walking skills after neurological injury. NEW & NOTEWORTHY: This study shows that repetitive acute intermittent hypoxia (AIH) significantly increases both voluntary activation and peak torque during fatiguing lower limb contractions. However, resting spinal reflex excitability and antagonist muscle coactivation during fatiguing contractions did not change following repetitive AIH. Together, these observations indicate that repetitive AIH reduces performance fatigability through enhanced descending neural drive. These findings underscore the therapeutic potential of AIH for promoting motor recovery after neurological injury. [ABSTRACT FROM AUTHOR]

Objectives: With the increased use of 3D‐generated images in biological research, there is a critical need to adapt classical anatomical measurements, traditionally conducted with calipers, to a virtual environment. We present detailed protocols for measuring bicondylar length, a critical dimension of the femur, using three different imaging software programs—3D Slicer™, Amira™, and Simpleware™. These protocols provide researchers and practitioners in radiology, orthopedics, biomechanics, and biological anthropology with accurate and reproducible measurement techniques. The objective is to standardize and support virtual osteology in biomechanical research, stature estimation, and related medical and anthropological studies. Materials and Methods: Adhering to standardized protocols, we adapted femoral bicondylar length measurements for computed tomography images from a New Mexican collection (n = 10). The method was designed for applicability and reproducibility across three software platforms. By comparing measurements from the same sample across different observers and different platforms, this study validates the accuracy and consistency of the adapted protocol, demonstrating its utility for research and clinical assessments. Results: We present a step‐by‐step guide for each program, detailing bone alignment and measurement. We illustrate each step and provide video tutorials via links for an enhanced understanding of the process. Discussion: Bicondylar length can be measured effectively in each software program following the provided instructions. However, ease of measurement varied among the programs, with some offering a more straightforward process. This variability underscores the importance of choosing appropriate software for the user's needs and proficiency. It also suggests areas for improvement and standardization in software design and instructional clarity. Research Highlights: The study introduces a detailed protocol for measuring femoral bicondylar length in 3D bone renderings using three different software programs: 3D Slicer™, Amira™, and Simpleware™.Comprehensive step‐by‐step descriptions, accompanied by illustrative images and video tutorials, are available to researchers to replicate the measurement process easily.Error testing across all three software programs and among different observers on the same software program demonstrated low variability, indicating that this measurement protocol is precise and reliable across all three platforms and with different observers. [ABSTRACT FROM AUTHOR]

This study verified whether the level of gluteal activation during a controlled maximum voluntary contraction may discriminate functional performance in women. Forty-five moderately trained women were assigned to two groups based on the level of gluteal muscle activation on maximum voluntary isometric contraction (MVIC) tests in the dominant limb: higher gluteal activation (HG—n = 22) and lower gluteal activation (LG—n = 22), considering different situations: a) level of activation of the gluteus medius muscle (GMed), b) level of activation of the gluteus maximus muscle (GMax), and c) level of combined activation of the GMed and GMax muscles. The cut-off values for the allocation of participants to groups in each situation were established as a function of the median values of each data set. Functional performance was assessed using the shuttle run, triple hop test, and six-metre timed hop test (STHT). The level of significance was set at 5%. Cohen's d index was included to estimate the magnitude of existing differences. The HG showed significantly shorter times than the LG on STHT performance (p-values ranging from 0.03–0.04), with a moderate effect (Cohen's d = 0.60–0.68) in all situations. The level of gluteal activation could discriminate STHT performance in women. [ABSTRACT FROM AUTHOR]

Spasticity which is focal or segmental such as affecting a single muscle group or limb can be treated by chemical neurolysis or surgical denervation at the neurovascular hilus. This study determines the motor entry points (MEPs) of adductor muscles of the thigh in the adult Indian population and identifies precise anatomical landmarks for the successful performance motor point procedures for the relief of muscle spasticity. A total of 10 adult lower limbs were dissected, and nerve branches to adductor muscles were carefully exposed up to their MEP. The morphometry of adductor muscles, precise locations of proximal and distal MEPs, and ideal sites for motor point procedures were identified. The median number of MEPs in adductor longus was two. Most of them were located between 40% and 50% of the muscle length i.e., in the thirdfifth of the total muscle length. Adductor magnus and gracilis had a median number of one and six MEPs respectively. The ideal site of motor point procedures is in the second-fifth of the muscle length for both. This preliminary study describes the location of MEPs and ideal sites of motor point procedures in the adductor muscle of the thigh. However, further cadaveric and electromyographic studies with larger samples are necessary to investigate precise locations of MEPs aiding in the treatment of spasticity. [ABSTRACT FROM AUTHOR]