Introduction: While pedobarography is emerging in Malaysia for foot-related clinical and research use, there are no published normative foot plantar pressure values. This study aimed to identify pressure values and areas of distribution in the normal foot of the multiracial population in Pahang, Malaysia. The differences by ethnic groups, gender, and BMI levels were also investigated. Materials and methods: In this cross-sectional study, 600 normal feet without pre-existing diabetes mellitus and any lower limb and spine pain were assessed using Emed-q100 pedobarography platform device and EMED/E (Expert) software from January 2018 to December 2018. The data were analysed using SPSS, with descriptive statistics for demographics and foot pressure, Pearson Chi-Square for associations, t-tests for gender differences, and one-way ANOVA for comparisons across ethnicity and BMI groups. Results: The mean maximum peak pressure (MPP) was measured at 508.98 kPa (SD 164.06) with significant differences by BMI whereby the score was highest in the obese (p<0.001). No significant differences by gender and ethnicity were reported. In terms of peak pressure area (PPA), most (42.2%) were observed in the first metatarsal head and big toe region (1MH&T), followed by second metatarsal head (2MH) (31.5%). For overweight and obese, PPA mostly distributed in 2MH (34.8% and 50%, respectively). Significant differences in PPA were also seen between races. There was no significant difference in the pressure area distribution by gender. Conclusion: The MPP is affected by BMI while PPA distribution is affected by BMI and ethnicity. These findings can be used as an initial reference for further studies related to orthopaedic clinical applications, particularly involving the Malaysian population with various ethnicities and cultural backgrounds.

Introduction: There is paucity of research regarding the incidence of hamstring injuries and its inherent causes within youth Malaysian football contexts. We aim to investigate the incidence of hamstring injuries among youth footballers and analyse the risk between intrinsic risk variables (anthropometric and hip strength) and the risk of hamstring strain injuries (HSI). Materials and methods: This was a prospective cohort study involving 72 youth Malaysian professional footballers from a single prestigious club. This study was conducted during the 2023 Malaysian football league. Pre-season medical evaluations encompassed demographic information, anthropometric measurements, and isometric strength examinations of the hamstrings, quadriceps, hip abductors, and hip adductors. Injury surveillance was conducted during the season. Results: The incidence of HSI in this study was 0.331 injuries per 1000 H, with incidence of injury during match higher 2.79 injuries per 1000 H compared to training 0.216 injuries per 1000 H. There was no hamstring injuries reported in U20. Forty-one (56.9%) has hamstring to quadriceps (H:Q) ratio <0.6 and forty-six (63.9%) has hip abductor to adductor ratio <0.8. The binary logistic regression analysis revealed increasing age (OR: 1.227, CI: 0.98 – 5.03), increased body mass index (OR: 1.79, CI: 0.415 – 7.77), increased body fat mass (OR: 1.39, CI: 0.33 – 5.89), and low H:Q ratio (OR: 4.274, CI: 0.347 – 58.1), increase the risk of HSI. Conclusion: Injury prevention programs in youth footballers should incorporate these modifiable risk factors into account to reduce the risk of hamstring injuries.

Introduction: Musculoskeletal disorders (MSDs) are a critical occupational health issue, particularly among dental professionals, where repetitive tasks, prolonged postures, ergonomic challenges, and psychosocial stressors contribute to their high prevalence. Existing literature highlights musculoskeletal issues, but gaps remain in understanding their prevalence and causes among primary oral healthcare personnel in Malaysia. Materials and methods: A multistage sampling technique was used to recruit a representative sample of 330 respondents from Malaysian primary oral healthcare personnel in various job roles within government dentistry facilities. Nordic Musculoskeletal Questionnaires (NMQ) were distributed to investigate the prevalence of musculoskeletal issues among the participants. Results: Of the participants, 53.4% of females and 46.6% of males reported experiencing work-related musculoskeletal disorders (WR-MSD). The neck was the most affected region, with a prevalence of 65.5%. Musculoskeletal disorders were more prevalent among individuals with longer years of service, with dental officers being the most affected type of designation. Conclusion: This study highlights the high prevalence of musculoskeletal disorders (MSDs) among Malaysian primary oral healthcare personnel, emphasising the need for targeted ergonomic interventions and workplace practice improvements to enhance occupational health and wellbeing.

Introduction: For extensive osseous involvement of primary tumours in the distal femur and proximal tibia, knee resection arthrodesis (KRA) is an economic alternative to endoprosthetic reconstruction in developing countries. Enneking (1977) described the use of an intramedullary (IM) nail for KRA and is still regarded as the most reliable method for fusion. We sought to determine if dual plating or IM nailing for KRA would produce comparable outcomes. Materials and methods: This is a cross-sectional study of 30 patients who underwent KRA with either IM nail or dual plates for tumours about the knee. Demographic and surgical profile, functional scores using the Musculoskeletal Tumour Society (MSTS) score, and incidence of complications were determined. Results: Mean follow-up was 2.28 years (SD 20.4). IM nail was utilised in 12 (40%) and dual plating in 18 (60%). 21 complications occurred, with 11 (52.38%) and 10 (47.62%) occurring in the IM nail and dual plating group respectively. MSTS score was higher with the IM nail (23.5 vs 22.5). Mean operative time was longer with the IM nail compared to dual plating (8.29 vs 7.80 hours). Blood loss was higher with the IM nail (1309.09 vs 1138.89mL). Conclusion: Outcomes of IM nailing and dual plating KRA are comparable, including the incidence of complications. While blood loss and operative time were noted to be longer in the IM nailing group, and hospital admission was longer in the dual plating group, the difference was not significant. Larger, prospective studies are recommended to report outcomes for fusion done following tumour resection.

Introduction: Young active patients with significant pain from knee osteoarthritis are a challenging group of patients to treat. For patients with symptomatic osteoarthritis involving both medial and lateral compartments, total knee arthroplasty (TKA) would traditionally be their only surgical option. Knee joint distraction (KJD) is a novel procedure in Asia that offers a joint preserving alternative for this cohort of patients. This study aims to evaluate patients with knee osteoarthritis treated with knee joint distraction (KJD). Materials and methods: Patients were included in this study if they had medial and lateral knee pain refractory to conservative treatment for more than 6 months, aged less than 50 and radiographs confirmed osteoarthritic changes in both the medial and lateral tibio-femoral compartments. An external fixator was placed in the distal femur and proximal tibia, and the knee joint was progressively distracted over a period of 3 days, to a total distance of 5mm. After six weeks, the external fixator is removed. Manipulation under anaesthesia was performed for patients who experienced stiffness post external fixator removal to achieved desired range of motion. Results: A total of three patients underwent KJD from 2020 to 2021. The patients’ age ranged from 44 to 49 years. The mean pre-operative Oxford Knee Score (OKS) was 37.6. At final follow-up at 2 years, the mean post-operative OKS was 17.6. All patients managed to attain the minimal clinically important difference in the OKS. Conclusion: In young patients with symptomatic bicompartmental knee osteoarthritis, KJD can be considered before doing a total knee replacement.

Introduction: Conservative treatment in flexible flat foot (FFF) is preferred in most cases; only in symptomatic and conservative-refractory cases is surgical treatment proposed. Subtalar arthroereisis (STA) is a well-established technique, but there remains a paucity of information surrounding the effectiveness and outcome. The aim of this study was to evaluate radiological and functional outcome of STA in FFF. Materials and methods: This study is a case series of 15ft with symptomatic FFF treated by STA from a period of 2018-2024. Mean age at the time of surgery was 10.1±0.83 years. There was a significant increase in both American Orthopaedic Foot and Ankle Society score (AOFAS) and The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) subjective scoring with p-value of <0.001. Degree of valgus correction was statistically significant (p=0.001). There were significant differences between preand post-operative lateral radiographic measurements with p-value of <0.005. One patient with the lowest radiological angle of correction and increased femoral anteversion had loosened implant in two years follow-up. Results: Despite results in earlier studies, recent evidence, including randomised control trials, supports the reliability of STA in managing FFF, advocating its use over traditional osteotomies due to fewer complications and quicker rehabilitation periods. In our study, all subjects had significant improvement in lateral radiographic measurements and subjective scoring evaluation during follow-up. Conclusion: STA is an option for surgical treatment in symptomatic FFF patients. In this study, all presented subjects showed overall satisfying functional and radiological outcome.

Introduction: Total Knee Arthroplasty (TKA) has been widely reported to improve outcomes and quality of life (QoL) in patients with knee osteoarthritis (KOA), but there are still 15 - 20% of patients still experience pain, physical limitations, and other complications after TKA. Therefore, it is necessary to identify various factors that correlate with QoL from current evidence. The objective is to review the literature on factors that correlate with QoL in patients who underwent TKA. Materials and methods: A literature search was conducted on five databases, i.e. ProQuest, CINAHL, Medline, Embase, and Scopus, using the following keywords: total knee arthroplasty (TKA), post-operative, quality of life (QoL), and outcome. There were no restrictions on the research design. Results: This review found 14 articles (7 prospective studies and 7 retrospective studies) involving 15,972 patients who underwent TKA, with an age range of 32 - 94 years. All articles reported improvement in QoL after TKA. The review revealed 30 factors, of which 15 factors were significantly correlated with QoL after TKA. The factors were grouped into four types: demographic, socioeconomic, clinical, and psychosocial factors. Conclusion: Information regarding factors that correlate with QoL after TKA can be used for directing treatment and discharge planning according to the patient's factors.

Introduction: Both knotted all suture anchors and metal anchors are used for arthroscopic Bankart repair. We retrospectively evaluated and compared clinical and functional outcomes after arthroscopic Bankart repair using the knotted all-suture anchors and knotted metal anchors. Materials and methods: In a retrospective cohort analysis, patients who underwent arthroscopic Bankart repair without any concomitant additional lesion repair using either allsuture anchors or metal anchors, between January 2015 and May 2018 were identified. Their pre- and post-operative functional and clinical outcomes were compared using Rowe and WOSI scores. The recurrence rate in the two groups was also compared. Results: A total of 41 patients in all suture anchors group and 47 in the metal anchors group were identified as per inclusion and exclusion criteria. The demographic profile of both groups was comparable. There was no significant difference in clinical and functional outcome between the two suture anchor groups as per Rowe (pre-operative 40.13+6.51 vs 38.09+6.24 and post-operative 2 years 93.28+7.09 vs 92.55+9.2) and WOSI (pre-operative 943.05+216.64 vs 977.55+165.46 and post-operative 2 years 278.21+227.56 vs 270.94+186.25) scores. There was a significant improvement in both the groups between preoperative and post-operative ROWE and WOSI scores at 6 months and 2 years follow-up as compared to pre-operative scores (p<0.001). Re-dislocation rates were also comparable (4.8% vs 6.3%). Conclusion: All-suture anchors showed comparable clinical and functional results as the metal anchors for arthroscopic Bankart repair at two-year follow-up.

Introduction: External rotation of femoral component is controversial in Total knee arthroplasty (TKA). The aim of our study is to assess the precision of femoral component external rotation in Robotic Assisted All Burr TKA. Materials and methods: This is a prospective study of 30 cases who underwent All Burr Robotic Assisted TKA at our institute, RNH hospital. Inclusion criteria were primary and secondary osteoarthritis of the knee and exclusion criteria were revision and partial knee replacement. On Navio robotic system femoral external rotation was planned as per medio-lateral flexion gap balancing and executed with burr. Post-operative CT scan was done in all patients to assess intra-operative planned femoral external rotation. Results: Out of 30 cases, 20 were female and 10 were male. Mean age was 66.06±7.43 years. On Navio the planned external rotation of femoral component was 2.86±1.16. Average of femoral component external rotation on postoperative CT scan was 3.11±1.16. The mean deviation of achieved femoral component external rotation from planned external rotation was -0.24 to ±0.28. Only 37% patients required 3° external rotation. Correlation between planned and achieved femoral component external rotation was significant, positive and very strong as indicated by r=0.97 and p=0.0001. Conclusion: All Burr Robotic Assisted TKA provides near accurate femoral component external rotation as planned on Navio with deviation of less than 0.3° between planned and achieved external rotation.