Predictability of Invisalign® Clear Aligners Using OrthoPulse®: A Retrospective Study

This preliminary retrospective study evaluates how effective the OrthoPulse (Biolux Technology, Austria) is in increasing the predictability of orthodontic treatment in patients treated with Invisalign (R) clear aligners (Align Technology Inc., Tempe, AZ, USA). A group of 376 patients were treated with Invisalign (R) orthodontic clear aligners in association with an OrthoPulse (R) . The OrthoPulse (R) was prescribed for 10 min a day for the entire duration of the orthodontic treatment. The OrthoPulse (R) App remotely tracked the percentage compliance of each patient. The number of aligners planned with the ClinCheck software at the beginning of the treatment and the number of total aligners (including the adjunctive aligners) used to finish the treatment were then considered. After applying inclusion/exclusion criteria, a total of 40 patients remained in the study and were compared with a control group of 40 patients with the same characteristics as the study group. A statistical analysis was carried out to investigate whether using OrthoPulse (R) led to a statistical reduction in the number of adjunctive aligners, thus leading to a more accurate prediction of the treatment. The statistical analysis showed that patients who used OrthoPulse (R) needed fewer finishing aligners and a greater predictability of the treatment was obtained. In fact, in the treated group the average number of additional aligners represented 66.5% of the initial aligners, whereas in the control group 103.4% of the initially planned aligners were needed. In conclusion, in patients treated with clear aligners, OrthoPulse (R) would appear to increase the predictability of orthodontic treatment with clear aligners, thus reducing the number of finishing phase requirements

Equinus foot classification in cerebral palsy: an agreement study between clinical and gait analysis assessment.

Background Excessive ankle plantar flexion (equinus foot) is a common problem in Cerebral Palsy (CP) and several treatment options can be considered depending on the equinus type. Few attempts have been made to classify different forms of equinus foot for specific treatment. Aim This study is aimed at defining equinus foot types in CP patients according to the Ferrari classification, integrating clinical and instrumental assessments. The hypothesis is that clinical differentiation of equinus foot can be evidenced by recurrent anomalies identifiable through Gait Analysis (GA), which can make the assessment, usually based only on clinician semeiotics, more objective. Design Clinical and instrumental assessments were performed separately by a senior CP physiatrist and a senior GA physiatrist, the latter was blind to the clinical diagnosis of equinus type. Setting Outpatients Population Twenty patients, 16 diplegics and 4 hemiplegics (mean age 11 years, SD 4 years 11 months). Methods Clinical assessment by means of Modified Ashworth Scale, Gross Motor Function Measure (GMFM), Observational Gait Analysis (OGA), and measurement of lower limb muscle strength by dynamometer were used to classify the equinus type. Gait analysis assessed the kinematics of affected lower limbs. Results Ten different equinus types were identified. Since various forms of equinus can be present in the same patient, we were able to classify a total of 61 types of equinus in 36 feet. Substantial agreement was found between Clinical and Gait Analysis equinus assignment matched in 50 out of 61 types (Index of agreement with Fleiss\u2019 Kappa 79.3 % ). In some case only Gait Analysis was able to identify the equinus type, while in others it did not confirm clinical assignment. Conclusion Gait analysis is able to distinguish different equinus types according to Ferrari classification, making the clinical decision less arbitrary. Clinical rehabilitation impact Correct objective diagnosis of equinus foot in CP patients is of paramount importance when choosing suitable rehabilitative interventions

Long term results of acute Achilles repair with triple-bundle technique and early rehabilitation protocol

Background The best treatment for acute rupture of the Achilles tendon is still under debate. Our purpose was to evaluate surgical triple-bundle technique in selected patients with full subcutaneous rupture of Achilles tendon. Methods Sixty-six consecutive patients (56 men, 10 women; age range 20-61 years) with full unilateral rupture of the Achilles tendon were surgically treated by the triple-bundle technique. Seventy-four percent of the lesions occurred during sport activity. Each patient was assessed by: (1) The American Orthopaedic Foot and Ankle Society (AOFAS) score; (2) the Leppilahti score; (3) the range of movement measurement of ankle joint; (4) ipsilateral thigh, calf, and ankle circumferences compared to the contralateral limb; (5) functional evaluation with isokinetic dynamometry of both limbs. Results 80.3% of the patients were fully satisfied (AOFAS 6590) with treatment and resumed their previous level of sport. Concerning the outcomes, (1) the mean AOFAS score at 36 months was 93.9; (2) the mean Leppilahti score at 36 months was 91.8; (3) the mean difference in dorsiflexion and plantarflexion between the healthy side and the operated side was 4.3\ub0 and 6.9\ub0, respectively. We observed calf muscle hypotrophy in two cases and scar complication in one. No re-ruptures occurred. Isokinetic tests performed 36 months after surgery showed a good restoration of plantarflexion. At univariate analysis AOFAS was influenced by age and difference between the healthy side and the operated side in dorsiflexion, plantarflexion, and circumference at all three levels and strenght at 60\ub0/s. At univariate analysis, Leppilahti score confirmed the significant parameters of the AOFAS with the exception of age and difference of thigh circumference. The only predictive parameters in multivariate analysis were dorsiflexion difference (O.R. = 0.831; 95% C.I. 0.694-0.995; p = 0.044) and plantarflexion difference (O.R. = 0.777; 95% C.I. 0.631-0.958; p = 0.018). Conclusion In this case series the triple-bundle technique showed a low rate of complications and good functional restore tested with isokinetic tests. For these reasons afforded by biomechanical strength test reported in literature, this technique has to be considered a valid choice for the treatment of Achilles tendon rupture in young patients with a high level of sport activity. \ua9 2014 Elsevier Ltd

Immune response against surface-exposed epitopes of Borrelia: A specific tool for serodiagnosis

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Long term results of acute Achilles repair with triple-bundle technique and early rehabilitation protocol.

Background: The best treatment for acute rupture of the Achilles tendon is still under debate. Our purpose was to evaluate surgical triple-bundle technique in selected patients with full subcutaneous rupture of Achilles tendon. Methods: Sixty-six consecutive patients (56 men, 10 women; age range 20-61 years) with full unilateral rupture of the Achilles tendon were surgically treated by the triple-bundle technique. Seventy-four percent of the lesions occurred during sport activity. Each patient was assessed by: (1) The American Orthopaedic Foot and Ankle Society (AOFAS) score; (2) the Leppilahti score; (3) the range of movement measurement of ankle joint; (4) ipsilateral thigh, calf, and ankle circumferences compared to the contralateral limb; (5) functional evaluation with isokinetic dynamometry of both limbs. Results: 80.3% of the patients were fully satisfied (AOFAS >= 90) with treatment and resumed their previous level of sport. Concerning the outcomes, (1) the mean AOFAS score at 36 months was 93.9; (2) the mean Leppilahti score at 36 months was 91.8; (3) the mean difference in dorsiflexion and plantarflexion between the healthy side and the operated side was 4.3 degrees and 6.9 degrees, respectively. We observed calf muscle hypotrophy in two cases and scar complication in one. No re-ruptures occurred. Isokinetic tests performed 36 months after surgery showed a good restoration of plantarflexion. At univariate analysis AOFAS was influenced by age and difference between the healthy side and the operated side in dorsiflexion, plantarflexion, and circumference at all three levels and strenght at 60 degrees/s. At univariate analysis, Leppilahti score confirmed the significant parameters of the AOFAS with the exception of age and difference of thigh circumference. The only predictive parameters in multivariate analysis were dorsiflexion difference (O.R. = 0.831; 95% C.I. 0.694-0.995; p = 0.044) and plantarflexion difference (O.R. = 0.777; 95% C.I. 0.631-0.958; p = 0.018). Conclusion: In this case series the triple-bundle technique showed a low rate of complications and good functional restore tested with isokinetic tests. For these reasons afforded by biomechanical strength test reported in literature, this technique has to be considered a valid choice for the treatment of Achilles tendon rupture in young patients with a high level of sport activity