PATELLOFEMORAL JOINT FORCES DURING RUNNING IN MENISCECTOMISED KNEES

Meniscal injuries in sports are common and often require surgical treatment. Individuals who undergo a partial meniscectomy often complain of patellofemoral pain and later develop degenerative changes in the patella. This study compared peak patellofemoral joint (PFJ) stresses during running in those who have had a meniscectomy (both affected and contralateral limbs) with healthy individuals. Kinematic and kinetic data were collected during running and used to estimate PFJ stresses. Peak hip, knee, ankle angles and moments were calculated. PFJ stresses were lower in the affected limb compared to the contralateral limb and healthy group. The affected limb also demonstrated reduced knee and ankle moments compared to the healthy group. Reduced PFJ stresses following a meniscectomy are likely to be a result of a quadriceps avoidance strategy which is likely to be used to compensate for the quadriceps weakness and atrophy often reported following a meniscectomy. Reduced PFJ stresses, if prolonged, could lead to tissue atrophy and a greater risk of injury

No differences in knee joint loading between individuals who had a medial or lateral meniscectomy: An ancillary study

BackgroundArthroscopic partial meniscectomy is a frequently undertaken procedure for traumatic meniscal injuries. The location of knee joint degeneration and long-term prognosis differs between knees who have had a medial or lateral meniscectomy. However, there is no evidence comparing knee loading following a medial or lateral meniscectomy during sporting tasks. This study compared knee loading during walking and running between individuals who either had a medial or lateral meniscectomy.MethodsKnee kinematic and kinetic data were collected during walking and running in individuals three to twelve months post-surgery. Participants were grouped according to the location of surgery (medial, n = 12, and lateral, n = 16). An independent t-test compared knee biomechanics between the groups and Hedge’s g effects sizes were also conducted.ResultsExternal knee adduction and knee flexion moments were similar between groups for walking and running with negligible to small effect sizes (effect size, 0.08–0.30). Kinematic (effect size, 0.03–0.22) and spatiotemporal (effect size, 0.02–0.59) outcomes were also similar between the groups.ConclusionsThe lack of differences in surrogate knee loading variables between medial and lateral meniscectomy groups was unexpected. These findings suggest that combining groups in the short-term period following surgery is applicable. However, the data presented in this study cannot explain the differences in long-term prognosis between medial and lateral meniscectomies

Knee Offloading by Patients During Walking and Running After Meniscectomy

Background:: Changes in knee loading have been reported after meniscectomy. Knee loading has previously been assessed during jogging and treadmill running rather than overground running, which could give altered results. Purpose/Hypothesis:: The purpose of this study was to evaluate knee function during overground running and walking after meniscectomy. It was hypothesized that the affected limb would demonstrate higher external knee adduction moment, lower knee flexion moment (KFM), and lower knee rotation moment (KRM) compared with the contralateral limb and with healthy individuals. Study Design:: Controlled laboratory study. Methods:: Kinematic and kinetic data were collected during running and walking in individuals after a meniscectomy and healthy individuals. Total knee joint moments (TKJM) were calculated from the sagittal, frontal, and transverse knee moments. Isometric quadriceps strength, perceived knee function, and kinesiophobia were also assessed. A mixed linear model compared differences between the affected leg, the contralateral leg, and the healthy leg. Results:: Data were collected on 20 healthy individuals and 30 individuals after a meniscectomy (mean ± SD, 5.7 ± 2.9 months postsurgery), with 12, 16, and 2 individuals who had medial, lateral, and both medial and lateral meniscectomy, respectively. The affected limb demonstrated lower TKJM (P < .001), KFM (P = .004), and KRM (P < .001) during late stance of walking compared with the healthy group. Lower TKJM and KFM were observed during running in the affected limb compared with the contralateral limb and healthy group. No significant differences were observed between contralateral and healthy limbs except for KRM during late stance of walking. Lower quadriceps strength was observed in the affected (P < .001) and contralateral limbs (P = .001) compared with the healthy group. Individuals after a meniscectomy also reported greater kinesiophobia (P = .006) and lower perceived knee function (31.1%; P < .001) compared with the healthy group. Conclusion:: After meniscectomy, individuals who sustained a traumatic meniscal injury showed lower TKJM in the affected limb compared with the contralateral limb and healthy individuals. This decrease in TKJM can be attributed to altered knee-loading strategies in the sagittal and transverse planes. Clinical Relevance:: Improving movement strategies, quadriceps strength, and kinesiophobia through rehabilitation approaches will allow individuals to load their knee appropriately when returning to sport. Registration:: NCT03379415 (ClinicalTrials.gov identifier)

Mortality Patterns in Patients with Multiple Trauma: A Systematic Review of Autopsy Studies.

PURPOSE:A high percentage (50%-60%) of trauma patients die due to their injuries prior to arrival at the hospital. Studies on preclinical mortality including post-mortem examinations are rare. In this review, we summarized the literature focusing on clinical and preclinical mortality and studies included post-mortem examinations. METHODS:A literature search was conducted using PubMed/Medline database for relevant medical literature in English or German language published within the last four decades (1980-2015). The following MeSH search terms were used in different combinations: "multiple trauma", "epidemiology", "mortality ", "cause of death", and "autopsy". References from available studies were searched as well. RESULTS:Marked differences in demographic parameters and injury severity between studies were identified. Moreover, the incidence of penetrating injuries has shown a wide range (between 4% and 38%). Both unimodal and bimodal concepts of trauma mortality have been favored. Studies have shown a wide variation in time intervals used to analyze the distribution of death. Thus, it is difficult to say which distribution is correct. CONCLUSIONS:We have identified variable results indicating bimodal or unimodal death distribution. Further more stundardized studies in this field are needed. We would like to encourage investigators to choose the inclusion criteria more critically and to consider factors affecting the pattern of mortality

Summary of inclusion and exclusion criteria of studies included in to this review.

<p>Summary of inclusion and exclusion criteria of studies included in to this review.</p

Demographic parameters of patients included in to the study.

<p>Over the observation period of 30 years we observed an increased age of study populations. The meant Injury Severity Score (ISS) has shown a wide range between 9 points and up to 62.3 points.</p

This flow diagram demonstrates the inclusion and exclusion of articles found in databases.

<p>This flow diagram demonstrates the inclusion and exclusion of articles found in databases.</p

The majority of studies included both penetrating and blunt trauma patients.

<p>The rate of penetrating injuries shows a wide range from 4% to 38%. However, 4 studies excluded preclinical deaths from the analysis.</p