Pulsed electromagnetic fields after arthroscopic treatment for osteochondral defects of the talus: double-blind randomized controlled multicenter trial

Background. Osteochondral talar defects usually affect athletic patients. The primary surgical treatment consists of arthroscopic debridement and microfracturing. Although this is mostly successful, early sport resumption is difficult to achieve, and it can take up to one year to obtain clinical improvement. Pulsed electromagnetic fields (PEMFs) may be effective for talar defects after arthroscopic treatment by promoting tissue healing, suppressing inflammation, and relieving pain. We hypothesize that PEMF-treatment compared to sham-treatment after arthroscopy will lead to earlier resumption of sports, and aim at 25% increase in patients that resume sports. Methods/Design. A prospective, double-blind, randomized, placebo-controlled trial (RCT) will be conducted in five centers throughout the Netherlands and Belgium. 68 patients will be randomized to either active PEMF-treatment or sham-treatment for 60 days, four hours daily. They will be followed-up for one year. The combined primary outcome measures are (a) the percentage of patients that resume and maintain sports, and (b) the time to resumption of sports, defined by the Ankle Activity Score. Secondary outcome measures include resumption of work, subjective and objective scoring systems (American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, Foot Ankle Outcome Score, Numeric Rating Scales of pain and satisfaction, EuroQol-5D), and computed tomography. Time to resumption of sports will be analyzed using Kaplan-Meier curves and log-rank tests. Discussion. This trial will provide level-1 evidence on the effectiveness of PEMFs in the management of osteochondral ankle lesions after arthroscopy. Trial registration. Netherlands Trial Register (NTR1636)

Do orthotic walkers affect knee and hip function during gait?

Study Design: A repeated measures cross over study. Background: The majority of previous studies on the use of orthotic walkers have been focussed on their ability to off load the structures in the foot and ankle, however little is known about their effects on hip and knee mechanics. Objectives: The objective of this study was to determine the effects of two designs orthotic walker on the knee and hip joints compared to normal footwear. Methods: Ten subjects with no history of lower limb problems walked under three randomised conditions; Össur Rebound, Aircast FP and normal footwear. Kinematic and kinetic data were collected using a ten camera Qualisys motion analysis system and four AMTI force plates and analysed using the Calibrated Anatomical System Technique. Results: Significant differences in hip kinematics between both walkers and normal footwear and in knee kinematics between the Össur Rebound and normal footwear. Significant differences were also seen in the knee moments between both walkers and normal footwear. Conclusion: Both walkers show significant differences compared with normal footwear, however the Össur Rebound appears to produce the greatest deviation which includes a greater hyperextension moment at the knee which could be damaging over long term usage. Clinical Relevance: Further research is needed into the effects of orthotic walkers on the knee and hip joint mechanics, which should help to inform future designs of walker, with a greater focus on obtaining a more normal gait pattern