Treatment approaches to flexion contractures of the knee

The knee is the most affected joint in children with cerebral palsy. Flexion contracture of the knee is the cause of crouch gait pattern, instability in stance phase of gait, and difficulties during standing and sitting, and for daily living activities. It may also cause patella alta, degeneration of the patellofemoral joint, and stress fractures of the patella and tibial tubercle in young adults. Children with cerebral palsy may even give up walking due to its high energy demand in the adult period. The purpose of this article is to review the causes of the knee flexion contractures, clinical and radiological evaluations, and treatment principles in children with cerebral palsy. The biomechanical reasons of knee flexion deformity are discussed in detail in the light of previous Studies and gait analysis data

Patient compliance with touchdown weight bearing after microfracture treatment of talar osteochondral lesions

WOS: 000396994500001PubMed ID: 28320425Background: The aim of this study was to prospectively evaluate the compliance of our patients with a touchdown weight bearing (without supporting any weight on the affected side by only touching the plantar aspect of the foot to the ground to maintain balance to protect the affected side from mechanical loading) postoperative rehabilitation protocol after treatment of talar osteochondral lesion (TOL). Methods: Fourteen patients, who had been treated with arthroscopic debridement and microfracture, were followed prospectively. The patients were evaluated for weight bearing compliance with using a stationary gait analysis and feedback system at the postoperative first day, first week, third week, and sixth week. Results: The mean visual analog scale (VAS) scores of the patients at the preoperative, postoperative first day, first week, third week, and sixth weeks were 5.5, 5.9, 3.6, 0.9, and 0.4, respectively. The decrease in VAS scores were statistically significant (p < 0.0001). First postoperative day revealed a mean value of transmitted weight of 4.08% +/- 0.8 (one non-compliant patient). The mean value was 4.34% +/- 0.8 at the first postoperative week (two non-compliant patients), 6.95% +/- 2.3 at the third postoperative week (eight non-compliant patients), and 10.8% +/- 4.8 at the sixth postoperative week (11 non-compliant patients). In the analysis of data, we found a negative correlation between VAS scores and transmitted weight (Kendall's tau b = -0.445 and p = 0.0228). Conclusions: Although patients were able to learn and adjust to the touchdown weight bearing gait protocol during the early postoperative period, most patients became non-compliant when their pain was relieved. To prevent this situation of non-compliance, patients should be warned to obey the weight bearing restrictions, and patients should be called for a follow-up at the third postoperative week

Effects of bone shapes and ligaments attachements on to passive knee motions

Creating three dimensional dynamic human knee model and investigating the reasons of problems after surgical treatment are the subjects which has been studying by many investigators. The aim of the study was determining the primer structures which effect on passive movement on human knee joint. The tibio-femoral joint model was created by guidance of literature and then it is simulated by using ADAMS package. Some of the ligament bundles were seen to elongate negligibly. Therefore simulation was repeated by assuming these bundles as inextensible links. During the simulation contact points were traced. Contact forces were defined between the traces and tibial plateau and it was resimulated. As a result the anterior bundle of anterior, posterior cruciates and medial collateral ligaments (MCL) and deep portion of MCL played an important role on shaping the bones which form the knee joint. The ligament surgeries should be developed by considering the ligament bundle reconstructions to reduce the unwanted side effects after the surgery

Three-dimensional knee model: Constrained by isometric ligament bundles and experimentally obtained tibio-femoral contacts

The purpose of this study is to investigate the effect of anterior portion of anterior cruciate ligament, posterior cruciate ligament, anterior and deep portions of medial collateral ligament and the tibio-femoral articular contacts on passive knee motion. A well-accepted reference model for a normal tibio-femoral joint is reconstructed from the literature. The proposed three-dimensional dynamic tibio-femoral model includes the isometric fascicles, ligament bundles and irregularly shaped medial-lateral contact surfaces. With the approach we aim to analyze bone shape and ligament related abnormalities of knee kinematics. The rotations, translations and the contact forces during passive knee flexion were compared against a reference model and the results were found in close accordance. This study demonstrated that isometric ligament bundles play an important role in understanding the femur shape from contact points on tibia. Femoral condyles are not necessarily spherical. The surgical treatments should consider both ligament bundle lengths and contact surface geometries to achieve a problem free knee kinematics after a knee surgery. (C) 2007 Elsevier Ltd. All rights reserved

Wireless dual accelerometer wearable system for torso-head angle measurement during walking

In the literature, there exists no study examining the effects of looking down gait on gait parameters and foot pressure. This study presents a system that is able to measure head-torso angle during walking. The hardware part of the system is composed of; two 3-axial digital accelerometers that are located in occipital and dorsal regions, a microprocessor, a Bluetooth module and a battery. The acceleration data that is acquired by the microprocessor via I2C protocol is sent to the client computer through Bluetooth module. The reception, angle estimation and visualization are realized by the graphical user interface which is the software part of the system and developed under Python language. Developed system is tested both on a 2 degree-of-freedom arm and during walk on a subject