Ultrasonography-Guided Injection for Quadriceps Fat Pad Edema: Preliminary Report of a Six-Month Clinical and Radiological Follow-Up

Purpose: To investigate efficacy and safety of ultrasonography-guided local corticosteroid and anesthetic injection followed by physical therapy for the management of quadriceps fat pad (QFP) edema. Materials and Methods: We prospectively evaluated 1671 knee MRI examinations in 1542 patients for QFP edema with mass effect, which was present in 109 (6.5%) knees. Participants were assigned into injection and therapy groups (both received the same physical therapy program). Injection group was first treated with ultrasonography-guided QFP injection of 1 mL corticosteroid and 1 mL local anesthetic agent. Patients were evaluated at baseline and 1-, 2-, 6-month follow-up for pain using static and dynamic visual analogue scale (VAS), suprapatellar tenderness, and QFP edema on MRI. Results: Final sample size consisted of 19 knees (injection group, 10; therapy group, 9) in 17 patients. An overall improvement was detected in both groups between baseline and final assessments. The injection group fared better than the therapy group in static VAS scores (3.33 ± 1.70 versus 0.56 ± 1.33), while there was no such difference for dynamic VAS. Incidence of suprapatellar tenderness decreased in both groups, statistically significantly in the injection group (from 100% to 0%). Pain reduction was greater in the injection group at the first month (88.9% – 90% good response versus 50% – 66.7% good response, static-dynamic VAS scoring, respectively), whereas there was no such superiority at the sixth month. No severe adverse events were identified. Conclusion: Ultrasonography-guided local injection followed by physical therapy is safe in the management of QFP edema; however, it is not superior to stand-alone physical therapy program in the long term

Comparison of short-term effects of mobilization with movement and Kinesiotaping on pain, function and balance in patellofemoral pain

© 2017 Turkish Association of Orthopaedics and Traumatology Objective The aim of this study was to compare the short-term effects of Mobilization with movement (MWM) and Kinesiotaping (KT) on patients with patellofemoral pain (PFP) respect to pain, function and balance. Methods Thirty-five female patients diagnosed with unilateral PFP were assigned into 2 groups. The first group (n = 18) received two techniques of MWM intervention (Straight Leg-Raise with Traction and Tibial Gliding) while KT was applied to the other group (n = 17). Both groups received 4 sessions of treatment twice a week for a period of 2 weeks with a 6-week-home exercise program. Pain severity, knee range of motion, hamstring flexibility, and physical performance (10-step stair climbing test, timed up and go test), Kujala Patellofemoral Pain Scoring and Y-Balance test were assessed. These outcomes were evaluated before the treatment, 45 min after the initial treatment, at the end of the 4-session-treatment during 2-week period and 6 weeks later in both groups. Results Both treatment groups had statistically significant improvements on pain, function and balance (p < 0.05). Pain at rest (p = 0.008) and the hamstring muscle flexibility (p = 0.027) were demonstrated significant improvements in favor of MWM group. Conclusions Our results demonstrated similar results for both treatment techniques in terms of pain, function and balance. The MWM technique with exercise had a short-term favorable effect on pain at rest and hamstring muscle flexibility than the KT technique with exercise in patients with PFP. Level of evidence Level I, therapeutic study

Hospital-Based Versus Home-Based Proprioceptive And Strengthening Exercise Programs In Knee Osteoarthritis

Objectives: This study aimed to establish the effects of hospital- and home-based proprioceptive and strengthening exercise programs on proprioception, pain, and functional status in patients with knee osteoarthritis (OA). Methods: Sixty patients with bilateral knee OA were randomly allocated into either a home-based or hospital-based exercise program. Hospital-based exercise group (n=30, mean age 50.23 +/- 9.07 years) received functional training program with proprioceptive ability, ice, and home exercises. Home-based exercise group (n=30, mean age 54.4 +/- 7.9 years) had a program of ice and home exercises. Treatment programs was conducted 5 days per week for 6 weeks (30 sessions). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Monitorized Functional Squat System-Proprioceptive Test (MFSS), timed performance test (TUG), and visual analogue scale (VAS) for the intensity of pain were used to quantify the variables. Results: Both groups demonstrated significant improvement when pre- and post-treatment results were compared for pain intensity, WOMAC, and TUG test scores (p0.05). Hospital-based group demonstrated significantly greater improvement in MFSS, TUG test, and VAS in activity when compared with the home-based group (p<0.05). Conclusion: Both hospital- and home-based exercise programs decreased joint symptoms and improved function in patients with knee OA.WoSScopu

Current Trends In Reconstruction Surgery And Rehabilitation Of Anterior Cruciate Ligament In Turkey

Objectives: This study aims to determine the current approaches to surgical techniques and rehabilitation protocols used in anterior cruciate ligament (ACL) reconstruction performed by Turkish orthopedic surgeons and to compare their results with the data of "ACL Study Group". Methods: A questionnaire consisting of 16 questions on surgical techniques, preoperative prerequisites, routine postoperative applications, rehabilitation approaches, and return to sport following ACL reconstruction was sent via e-mail to the 55 orthopedic surgeons performing annually 25 or more ACL reconstructions. Results: Response rate to questionnaire was 70.9% (n=39). Nineteen surgeons (48.7%) regularly performed only hamstring tendon (HT) graft, and four surgeons (10.3%) performed only patellar tendon (PT) graft, while 16 surgeons (41%) performed both HT and PT grafts. Three (18.8%) of the 16 surgeons who performed both HT and PT grafts had individual rehabilitation protocols for the two graft types. No statistically significant difference was found between the responses for two graft types in terms of the starting times for specific activities (p > 0.05). Rehabilitation protocols were similar to the current data of "ACL Study Group". The use of a postoperative brace and continuous passive motion (CPM) was different between Turkish surgeons and "ACL Study Group". The CPM and postoperative brace use was more common in Turkey. Conclusion: There are only a few differences in the postoperative approach of ACL reconstruction with HT and PT grafts performed by Turkish orthopedic surgeons. The data obtained from the Turkish orthopedic surgeons showed similarities with the "ACL Study Group" current approaches.Wo

The Effects of Two Different Closed Kinetic Chain Exercises on Muscle Strength and Proprioception in Patients with Patellofemoral Pain Syndrome

Objectives: The effects of two different closed kinetic chain exercises were compared in patients with patellofemoral pain syndrome (PFPS). Methods: Forty female patients with unilateral PFPS were randomly divided into two groups to receive exercises with the hip internally rotated (n=20, mean age 39.1 +/- 8.0 years) or externally rotated (n=20, mean age 36.1 +/- 8.7 years) with the use of the Monitored Rehab Functional Squat (MRFS) System. The duration of exercises was four weeks with a total of 20 sessions. Both groups were evaluated before therapy, after four weeks of exercises, and after six weeks of home exercise program with the MRFS System for muscle strength and proprioception, with a visual analog scale for pain, and with the Kujala questionnaire for functional assessment. Results: Among baseline features, the only significant difference between the two groups was in the mean height (p0.05). Eccentric proprioceptive deficit, however, did not change significantly both after treatment and home exercises (p>0.05). No significant differences were observed between the two groups during the study period with respect to the parameters assessed (p>0.05). Conclusion: Our results show that functional knee squat exercises with internally and externally rotated hip positions provide similar improvements in muscle strength and proprioception in patients with PFPS.WoSScopu

The Effect of Postural Stabilization Exercises on Pain and Function in Females with Patellofemoral Pain Syndrome

Objective: This study aimed to investigate the effect of postural stabilization exercises on pain, muscle strength and function in females with patellofemoral pain. Methods: Forty-two volunteers with patellofemoral pain syndrome (PFPS) were included in this study. The subjects were randomly divided into two groups: Group 1 performed therapeutic knee and postural stabilization exercises (n=22); Group 2 performed therapeutic knee exercises only (n=20). All patients were evaluated for pain, hamstring flexibility, function, lower extremity strength and postural control before and after treatment and at the 12th week. A two-way ANOVA was done within each group before and after treatment and at the 12th week. The level of significance was set at p<0.05, and when this was observed, the Tukey test was used to determine which group had caused the significance. Results: The results were statistically significant between the groups in terms of pain, flexibility, function, strength, endurance, postural control and the parameters of the Kujala patellofemoral pain scale (p <0.05). For all parameters, Group 1 achieved the greater success after treatment (p<0.05). Conclusion: The implementation of physiotherapy and rehabilitation programs including postural stabilization exercises may improve strength and function and reduce pain in patients with PFPS.WoSScopu

Cross-Cultural Adaptation Of Kerlan-Jobe Orthopaedic Clinic Shoulder And Elbow Score: Reliability And Validity In Turkish-Speaking Overhead Athletes

Objective Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES) is a subjective assessment tool to measure functional status of the upper extremities in overhead athletes. The aim was to translate and culturally adapt the KJOC-SES and to evaluate the psychometric properties of the Turkish version (KJOC-SES-Tr) in overhead athletes. Methods The forward and back-translation method was followed. One hundred and twenty-three overhead athletes completed the KJOC-SES-Tr, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the American Shoulder and Elbow Surgeons Evaluation Form (ASES). Participants were assigned to one of the following subgroups: asymptomatic (playing without pain) or symptomatic (playing with pain, or not playing due to pain). Internal consistency, reliability, construct validity, discriminant validity, and content validity of the KJOC-SES-Tr were tested. Results The test–retest reliability of the KJOC-SES-Tr was excellent with an interclass coefficient of 0.93. There was a strong correlation between the KJOC-SES-Tr and the DASH and the ASES, indicating that the construct validity was good for all participants. Results of the KJOC-SES-Tr significantly differed between different subgroups and categories of athletes. The floor and ceiling effects were acceptable for symptomatic athletes. Conclusion The KJOC-SES-Tr was shown to be valid, reliable tool to monitor the return to sports following injuries in athletes.PubMedWoSScopu

Hacettepe University experience in an international multicenter project: development of an interdisciplinary clinical master program in rehabilitation sciences

Purpose: The aim of the project was to constitute an interdisciplinary, innovator, international clinical master program for physiotherapists and occupational therapists in Jordan University of Science and Technology (JUST) Rehabilitation Sciences. Methods: Project has started in 2016 supported by European Union as Erasmus + KA2 project. A total of six universities participated in the project (3 from Europe, 3 from Jordan). The mission of the Hacettepe University was to develop the curriculum. The Bologna process and European quality and lifelong learning standards and Jordan’s National Qualifications were utilized. The 8-step process, including needs analysis, profiling, structure of the program, mobility, learning-teaching measurement methodology, admission requirements, degree of master’s thesis, management and resources, was applied with common consensus. Eight mandatory and 15 elective courses a total of 120 ECTS were established. The digital teaching platform were created under the leadership of Portugal, while the quality processes were monitored by England. In 2017, 18 students enrolled in the program. Lecturers from all countries participated in the lessons. The theoretical education were given via the online system and practical education were given in Jordan face to face. Clinical practice training was done in three European countries. Results: European Union audits resulted in success. Application labs were created. The program was accredited by the Jordanian Higher Education Institution. Conclusion: A new and multidisciplinary program which has never been developed according to Bologna and EQF in Jordan. This program is original for the country and the Middle East. International cooperation between countries was achieved.N/