Journal of Musculoskeletal Research

Background: With an increasing trend toward home-based rehabilitation, it is important to distinguish non-inferior and improved virtual rehabilitation methods. A Systematic review and meta-analysis were conducted to examine the effect of combined digital rehabilitation, including smartphone applications and wearable devices, on quality of life following total joint arthroplasty (TJA), total knee arthroplasty (TKA), and total hip arthroplasty (THA) in comparison to standard of care physical therapy (PT).

Methods: A systematic review and single-proportion meta-analysis was conducted employing the PRISMA 2020 guidelines in January 2024. A comprehensive review of the literature was conducted, yielding four randomized controlled trials, encompassing a sample size of 496 patients who underwent combined digital rehabilitation.

Results: Differences in quality of life using EQ-5D-5L were non-significant between groups ($Q$ = 0.35, $p$ = 0.56). In the combined digital group, knee ROM was non-significantly increased ($Q$ = 0.23, $p$ = 0.63) and KOOS JR was non-significantly decreased ($Q$ = 1.04, $p$ = 0.31).

Conclusions: Adhering to specified inclusion and exclusion criteria, there was limited data available regarding the impact of applications and wearable devices on THA patients. Consequently, our analysis included a single available study that employed the EQ-5D-5L measurement for THA patients. More studies involving wearable devices and digital applications should be considered in order to further test the efficacy of these treatments for TJA compared to standard treatment modalities. Despite this limitation, the findings of this review indicate that at-home treatment using wearable devices and digital applications yields outcomes comparable to those achieved through conventional treatment models for patient rehabilitation. Furthermore, at-home wearable and digital treatments may present a cost-effective and convenient alternative to in-person treatment.

Introduction: The purpose of this study was to ascertain the primary ex vivo biomechanical stability of a novel bioabsorbable magnesium alloy (ZX00: Mg–Zn–Ca) bone anchor in human cadaveric proximal humeri, indicated in the reconstruction of the rotator cuff.

Methods: Twenty human Thiel-embalmed cadaveric humeri were prepared and freed from soft tissue. One $\varnothing$5.7 × 20.5-mm ZX00 anchor and one $\varnothing$5.5 mm × 16.3 mm Arthrex Titanium FT Corkscrew (ATC) control anchor were inserted into the footprint of the supraspinatus tendon, 15 mm apart. The humeri were mounted onto a material testing machine and following a 40 N preload, cyclic loading was performed over 400 cycles. If the construct remained intact, ultimate load to failure (ULTF) was measured using an increasing axial load of 1 mm/s, ULTF and mode of failure were recorded.

Results: No difference was found in the ability to withstand cyclic loading, mode or load-to-failure strengths between ZX00 and control anchors. The maximum tractional force loaded for the ZX00 anchors had a median of 257.4 N (range 165.3–328.2). The corresponding value for the ATC anchors averaged 239.9 N (range 118.9–306.7).

Conclusion: ZX00 alloy anchors appear to provide adequate initial biomechanical stability when compared to an industry-standard control in a cadaveric rotator cuff repair model.

Sickle cell disease is a common hemoglobinopathy in Iraq, specifically in Basrah province. Sacroiliac joint involvement is rarely reported in the literature.

Objectives: To find out how often the sacroiliac joint is involved in sickler patients and to describe its clinical and radiological features using plain radiographs and magnetic resonance imaging (MRI).

Methods: A descriptive cross-sectional study was conducted at Basrah Teaching Hospital, Basrah arthroplasty center and Basrah Center for Hereditary Diseases from the 1st of October 2021 to the 1st of December 2022. A prepared questionnaire was used for data collection which focused on the history and clinical examination of all patients with sickle cell disease with or without lower backache. Radiological imaging was offered to all patients and MRI to selected patients.

Results: A total of 217 patients with sickle cell disease were involved. 62 (28.6%) of patients with sickle cell disease have lower back pain, and it is mostly common in patients with moderate severity — 43 patients (19.8%) — according to VAS score. FABER test was positive in 43 (19.8%) of patients with sickle cell disease and lower backache. Plain radiography was positive in about one-fifth of the enrolled patients in the study 44/217 (20.3%). MRI was able to detect an abnormality in 19/31 (64.2%) of the examined cases, and the most common MRI finding is subchondral sclerosis.

Conclusions: The sacroiliac joint is involved in sickle cell disease but the diagnosis is vague, requiring comprehensive history, clinical and specific radiological imaging.

Rotation of the cervical spine beyond its normal range of motion is a leading cause of fall-related spinal cord injuries (SCIs) in older adults. This rotation is constrained, in part, by the spinal ligaments. The experimentally measured properties of these ligaments are tabulated in literature, including sex- specific properties; however, their influence on the rotation kinematics of the cervical spine has not been compared. We examined how different mechanical properties of spinal ligaments, including sex- specific properties, affected the rotational kinematics of the cervical spine using finite element analysis (FEA). Ligament properties most influenced the rotation of the lower cervical spine, with increased ligament stiffness reducing rotation. Ligament deformation remained mostly in the toe region of their force-displacement curves, emphasizing the need to incorporate non-linear ligament behavior in FEA. Predictions made using one set of experimental properties (Property 1) better-matched experimental kinematic data. Using sex-specific properties had a moderate effect (6% in extension, − 3% in flexion) on rotation, with a greater impact on extension. Ligament properties also affected the segmental distribution of rotation, causing a variability of 3–21% at different levels. We emphasized the need to incorporate tailored approaches to FEA to obtain clinically relevant results when modeling flexion/extension rotation.

Background: Tourniquets are used during total knee arthroplasty for better surgical fields and improved cementation. The functional benefits of tourniquet application for limited periods compared with total duration applications during total knee joint arthroplasty (TKA) surgery have not been well explored.

Aim of the study: To evaluate and compare the outcomes of limited use of a tourniquet (LT) for a shorter duration (just before cement application) with total use of a tourniquet (TT) for a longer duration (from skin incision to the completion of surgery).

Patients and method: A sum of 100 patients who undertook primary total knee arthroplasty were involved in this study, they were allocated randomly into two groups according to whether a limited or total tourniquet was used during the surgery. Both groups underwent the same surgical procedures with a digital tourniquet applied to all patients using the same technique. Intraoperative and postoperative assessment of blood loss, knee functional society score (KSS), visual analogue score (VAS) for thigh pain and knee pain evaluation, surgical complications like deep vein thrombosis (DVT), wound infections and nerve injuries are the main factors evaluated in the study.

Results: Patients with LT required more intraoperative blood transfusion compared with those with TT who required more blood transfusion postoperatively. There were no significant differences in KSS, VAS for thigh pain and knee pain evaluation, and surgical complications like DVT, wound infections and nerve injuries.

Conclusion: Limited tourniquet application from starting of cementing is associated with a higher need for intraoperative blood transfusion, but the use of a TT throughout surgery is associated with a higher need for postoperative blood transfusion.

Purpose: This study aimed to investigate the changes in pain following exercise sessions with different intensities in patients who underwent total knee arthroplasty (TKA).

Methods: This is a repeated measure and single-blinded randomized controlled study. Thirty-six patients who underwent TKA (age, 64.9 ± 7.42 years) were randomly assigned to either low-intensity exercises (LIEs) group or high-intensity exercises (HIEs) group. Exercise programs lasted for five days during the hospitalization period. Pain intensity was assessed by visual analog scale (VAS) and pressure pain thresholds (PPTs) were measured over quadriceps and biceps brachii and muscles immediately before and after exercise. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale (pain, stiffness, and physical function) scores were recorded at two points in baseline and discharge from the hospital.

Results: The pain intensity decreased in patients in both groups after TKA. PPTs increased in both groups at all tested sites following the first, third, and fifth exercise bouts. HIE program had a greater positive effect on the pain intensity after the first exercise session than LIE program on the PPTs ($p$ $<$ 0.05). HIE program was more effective in order to reduce pain severity immediately after the exercise sessions in patients ($d$ : 0.5, $p$ $<$ 0.05). WOMAC scores significantly improved in both groups during the discharge from the hospital ($p$ = 0.001).

Conclusion: Our results found that both LIE and HIE programs performed during hospitalization after TKA declined pain intensity. Particularly notable were the substantial improvements observed in managing post-operative pain, especially following the second exercise session. The HIE program proved more effective in improving stiffness, and enhancing physical function.

Introduction: Neuromuscular electrostimulation (NMES) represents a therapeutic approach for addressing chronic low back pain (CLBP); however, the influence of NMES dose on muscle activity remains subject to debate.

Objective : To compare the impact of two distinct NMES protocols employing Aussie current, characterized by varying dosages emphasizing time cycle alterations, on electromyographic activity within the multifidus muscles in individuals afflicted with CLBP.

Methods : A randomized clinical trial encompassed 18 volunteers diagnosed with mechanical CLBP. These volunteers were randomly assigned to two NMES intervention groups with dissimilar dosages: 15 repetitions ($E_{15}$) and 30 repetitions ($E_{30}$). In both interventions, the current amplitude was tailored to individual perception and documented at the culmination of each session. Over the course of four weeks, two sessions took place per week. Electromyographic activity of the multifidus muscles was evaluated using surface electromyography before and after the intervention. The assessment focuses on both time-domain analysis using Root Mean Square (RMS) and frequency-domain analysis involving mean activation frequency (FREQ).

Results : There are no interactions between the time and intervention, but there is the time effect on RMS, indicating that post-intervention muscle activity exceeded pre-intervention values in both groups. FREQ values did not exhibit statistically significant discrepancies.

Conclusions : This study showed that NMES using the Aussie current is effective in increasing muscle activity in individuals with CLBP, and the results were not influenced by the different cycle times with equal volumes.

Purpose: Low back pain is a common issue among older adults, often attributed to weakened trunk muscles. Understanding the relationship between muscle mass and abdominal pressure can offer valuable insights for managing low back pain. This study aimed to explore the correlation of external abdominal pressure using a novel device with abdominal muscle mass and low back pain.

Methods: Elderly individuals over the age of sixty-five were recruited. External abdominal pressure was measured using RECORE, while muscle mass and thickness were assessed via impedance measurement and ultrasound. The presence of low back pain was also investigated.

Results: Correlation analysis showed a weak correlation between abdominal pressure and trunk muscle mass, as well as a weak correlation with the thickness of deep muscles, transversus abdominis ($r$ = 0.37) and internal oblique ($r$ = 0.33). Logistic analysis demonstrated a significant association between abdominal pressure and the presence of low back pain.

Conclusion: Our findings suggest that abdominal pressure is weakly linked to abdominal muscle size, particularly the deep muscles, and that measuring external abdominal pressure can provide insights into abdominal muscle function and low back pain in older adults.

Proximal rectus femoris avulsion is an uncommon injury that is usually seen in athletes, particularly in the Western population. While the existing literature largely focuses on surgical treatment as the main approach, growing evidence suggests that conservative management for these injuries can also be effective. Such injuries are rarely associated with non-sport activities and have not been documented in the Indian population to date. In this report, we present a case of partial proximal avulsion of the rectus femoris that was managed conservatively with a structured rehabilitation programme, leading to good functional outcome.

Introduction: Giant cell Tumors (GCT) are relatively common lesions that are most often encountered in middle aged women [Salunke AA, Shah J, Warikoo V, Chakraborty A, Pokharkar H, Chen Y, Pruthi M, Pandit J. Giant cell tumor of distal radius treated with ulnar translocation and wrist arthrodesis. J Orthop Surg 2017 25(1): 2309499016684972, 2017, doi:10.1177/2309499016684972]. As 25% of these are usually locally aggressive, early diagnosis, and treatment are of paramount importance [Dorfman HD, Czerniak B. Bone Tumors. St. Louis, Mosby (1998)]. Due to the high incidence of local recurrence following simple curettage, it is no longer a preferred line of treatment. In recent times, extended curettage, wide resection or en-bloc resection with bone grafting have supplanted simple curettage [Şirin E, Akgülle AH, Topkar OM, Sofulu Ö, Baykan SE, Erol B. Mid-term results of intralesional extended curettage, cauterization, and polymethylmethacrylate cementation in the treatment of giant cell tumor of bone: A retrospective case series. Acta Orthop Traumatol Turc 54(5): 524–529, 2020, doi: 10.5152/j.aott.2020.19082].

Case Scenario: A 22-year-old female patient presented to the OPD with a swelling in her right wrist which she noticed two years back. The swelling gradually increased to the size of a lemon at presentation and was initially painless but eventually became painful. The patient was evaluated based on clinical history, examination, and radiography. A clinical and radiological diagnosis of GCT of the distal radius was made. FNAC was done to confirm the same. Further, the lungs were screened for metastasis. She underwent en-bloc resection of the lesion followed by reconstruction with non-vascularized proximal fibular autograft secured with a DCP and $K$-wires. The excised specimen was dispatched for Fig. 1. The swelling at presentation histopathological examination and confirmed to be a Giant Cell Tumor. Regular follow-up schedule was initiated at 2 weeks, 6 weeks, 3 months, 1 year, 36 weeks, and 2 years postoperatively. Her functional outcome was monitored by assessing the wrist range of movements and the Mayo wrist scores.

Results: The patient’s Mayo wrist scores showed an increasing trend during follow-up, indicating improved functional outcomes. Recurrence was not noted during the follow-up period.

Discussion: Tumor in the distal radius metaphyseoepiphyseal region is commonly associated with extracompartmental involvement, cortical invasion, and pathologic fracture [Yang YF, Wang JW, Huang P, Xu ZH. Distal radius reconstruction with vascularized proximal fibular autograft after en-bloc resection of recurrent giant cell tumor. BMC Musculoskelet Disord 17 (1): 346, 2016. doi:10.1186/s12891-016-1211-8]. Hence, curettage is not an optimal method in the distal radius. Thus, wide excision is the optimal choice of treatment. However, this creates a defect at the distal end of the radius. The preferred options for the management of the defect comprise of osteoarticular allografts, vascularized grafts, non-vascularized bone grafts, and custom-made prostheses [Saini R, Bali K, Bachhal V, Mootha AK, Dhillon MS, Gill SS. En bloc excision and autogenous fibular reconstruction for aggressive giant cell tumor of distal radius: a report of 12 cases and review of literature. J Orthop Surg Res 6: 14, 2011, doi: 10.1186/1749-799X-6-14]. Vascularized bone grafts have been proposed to have a better union rate and lesser complication rate as compared to non-vascularized options. Thus, with our case report, we would like to highlight the effectiveness of the non-vascularized proximal fibular autograft in the reconstruction following en bloc excision of the distal radius.

Conclusion: Hence, en-bloc resection and non-vascularized fibular bone grafting is a valuable method of treatment of GCTs of the distal radius. It is also associated with low recurrence rates and improved wrist function in the course of follow-up.