OBJECTIVE: To compare early graft healing between over-the-top (OTT) and anatomic single-bundle (SB) anterior cruciate ligament (ACL) reconstruction. METHODS: A clinical data of 40 patients underwent ACL reconstruction, who admitted between June 2021 and October 2022 and met the selective criteria, was retrospectively analyzed. Among them, 20 patients were treated with OTT reconstruction (OTT group) and 20 with SB reconstruction (SB group). There was no significant difference between groups ( P>0.05) in the gender, age, affected side, disease duration, degree of meniscus injury, body mass index, and preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, pain visual analogue scale (VAS) score, and KT-2000 measurement. At 3, 6, and 12 months, MRI was performed to measure the signal noise quotient (SNQ) of the proximal end, middle, and distal end of the graft in the two groups, as well as at the corner of the graft with lateral femoral condyle and 1 cm around the femoral fixation point in the OTT group, to observe the degree of graft healing. Before operation and at 3, 6, and 12 months, the knee function and pain were evaluated by IKDC score, Lysholm score, and VAS score. Before operation and at 12 months after operation, the KT-2000 measurement was taken to evaluation the knee joint stability. RESULTS: All operations were successfully completed in both groups and the incisions healed by first intention. All patients were followed up 12-15 months (mean, 12.9 months), with no significant difference in the follow-up time between groups ( P>0.05). After operation, the IKDC score, VAS score, and Lysholm score improved gradually over time in both groups, with significant differences between different time points ( P<0.05). The differences between groups at 3, 6, and 12 months after operation were not significant ( P>0.05). The anterior and posterior stability of the knee joint improved significantly in both groups at 12 months after operation, and the difference in KT-2000 measurements was significant when compared with the preoperative value ( P<0.05), but the difference of pre- and post-operation between groups was not significant ( P>0.05). At 3, 6, and 12 months after operation, MRI showed that the differences in the SNQ of the proximal end and middle of the grafts between the two groups were not significant ( P>0.05), and the SNQ of distal end was significantly higher in the SB group than in the OTT group ( P<0.05). At each time point, grafts in the OTT group had the highest SNQ at the corner and the lowest at the fixation point, and the differences were significant compared to the other sites ( P<0.05). In the two groups, except for the fixation point, the SNQ of the remaining sites were highest at 6 months and lowest at 12 months ( P<0.05). In addition, there were significant differences in SNQ between the different sites of grafts ( P<0.05), and the SNQ was lowest at proximal end and highest at distal end. At last follow-up, the knee grafts in both groups were in good shape and no graft necrosis or loosening of the internal fixation was observed. CONCLUSION The knee joint function and graft healing after OTT reconstruction of ACL are similar to those of SB reconstruction, but it should be noted that the healing at the corner of the graft is slower.
Retrospective Studies ; Treatment Outcome ; Anterior Cruciate Ligament Reconstruction/rehabilitation* ; Follow-Up Studies ; Tibial Meniscus Injuries/surgery* ; Patient Positioning/methods* ; Recovery of Function ; Pain Measurement ; Knee Joint/surgery* ; Humans ; Male ; Female ; Adult ; Wound Healing

OBJECTIVE: To assess the efficacy on relieving pain and improving the range of motion of shoulder joint in post-stroke shoulder-hand syndrome of phlegm-stasis obstruction in treatment of the combined therapy of eye acupuncture, Tengliao (Chinese herbal warm dressing technique) and rehabilitation training (eye acupuncture + Tengliao + rehabilitation) as compared with the combined treatment of Tengliao and rehabilitation training (Tengliao + rehabilitation) and the simple rehabilitation training (rehabilitation). METHODS: A total of 356 patients with post-stroke shoulder-hand syndrome of phlegm-stasis obstruction were randomized into an eye acupuncture + Tengliao + rehabilitation group (group A, 122 cases, 2 cases dropped off), a Tengliao + rehabilitation group (group B, 120 cases, 3 cases dropped off) and a rehabilitation group (group C, 114 cases, 1 case dropped off). In the group C, the basic treatment was combined with routine rehabilitation training. In the group B, on the base of the treatment as the group C, Tengliao was exerted. A medical bag composed of over 20 Chinese herbal materials was heated and dressed at the affected area, 30 min each time, 5 times weekly. In the group A, besides the treatment as the group B, eye acupuncture was applied to heart region, kidney region, upper jiao region and lower jiao region, 30 min each time, 5 times weekly. The treatment lasted 28 days in all of three groups. Separately, before treatment, in 7, 14, 21 and 28 days of treatment, as well as in 14 days after treatment of follow-up, the score of visual analogue scale (VAS) for pain, the score of guides to evaluation of permanent impairment (GEPI) and the score of National Institutes of Health stroke scale (NIHSS) were observed in each group. RESULTS: The scores of VAS, GEPI and NIHSS were all improved with the treatment lasting in the three groups (P<0.000 1). In 7, 14, 21 and 28 days of treatment and in follow-up as well, VAS scores in the group A were all lower than the group C (P<0.05). After 14 days of treatment, GEPI score showed increasing trend, while NIHSS score showed decreasing trend in the group A compared with the group B. Before treatment, GEPI score was lower and NIHSS score was higher in the group A compared with the group C (P<0.05). It was suggested that the illness was slightly serious in the group A. After propensity score matching, in 14, 21 and 28 days as well as in follow-up, GEPI scores in the group A were higher than the group C respectively (P<0.05). Regarding NIHSS score at each time point, the difference had no statistical significance between the group A and the group C (P>0.05). CONCLUSION The combined therapy of eye acupuncture, Tengliao and rehabilitation training obtains a better efficacy on post-stroke shoulder-hand syndrome of phlegm-stasis obstruction as compared with rehabilitation training.
Acupuncture Points ; Acupuncture Therapy/methods* ; Humans ; Pain ; Reflex Sympathetic Dystrophy/therapy* ; Stroke/complications* ; Stroke Rehabilitation ; Treatment Outcome

PURPOSE: This study aimed to investigate the effect of hospital-based intensive rehabilitation program after ankle ligament operation.METHODS: A total of 35 patients were included in this randomized controlled trial. Fifty-minute sessions of hospital-based rehabilitation were performed three times weekly for 12 weeks in the intervention group. Home-based exercise was conducted in the control group. Outcomes were evaluated at baseline, 12 weeks, and 16 weeks. The primary outcome was measured using the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included the American Orthopedic Foot and Ankle Society (AOFAS) score, ankle strength measured using an isokinetic device, fall index measured using a Tetrax posturography device, and the Berg Balance Scale.RESULTS: Significant improvements in FAOS, AOFAS, ankle strength, and fall index were found in the intervention group after performing the hospital-based rehabilitation (all p<0.05) and these improvements were sustained at T2 (all p<0.05). Between-group comparisons demonstrated significantly greater improvements in FAOS, AOFAS, ankle strength, and fall index in the intervention group than those in the control group at both T1 (all p<0.05), and T2 (all p<0.05).CONCLUSION: The rehabilitation program in this study improved postoperative pain, sports function, quality of life, and strength and balance of the ankle significantly better than home-based self-care. Therefore, we recommend hospital-based systematic rehabilitation programs after surgical treatment for chronic ankle instability.
Ankle ; Foot ; Humans ; Ligaments ; Orthopedics ; Pain, Postoperative ; Quality of Life ; Recovery of Function ; Rehabilitation ; Self Care ; Sports

Chronic postoperative inguinal pain (CPIP) is a major complication after inguinal herniorrhaphy. We report the treatment of CPIP using ultrasonography-combined with nerve stimulator for injection of the genitofemoral nerve (GFN). A 59-year-old man underwent laparoscopic herniorrhaphy and presented with numbness from the inguinal region to the scrotum after operation. In the pain clinic, ultrasonography-guided GFN block and pharmacological treatments had little effect. Six month after operation, patient was referred to the Department of Physical Medicine and Rehabilitation, and ultrasonography-combined with nerve stimulator for GFN injection underwent to enhance the accuracy of neural approach. The induction of scrotal contraction and paresthesia on the GFN distribution was monitored by nerve stimulator and local anesthetic was injected. After the block, pain relief lasted for 6 months without analgesic use. Ultrasonography-combined with nerve stimulator is an effective approach to treat CPIP as it enhances precise localization and injection of small peripheral nerve like GFN.
Herniorrhaphy ; Humans ; Hypesthesia ; Middle Aged ; Pain Clinics ; Paresthesia ; Peripheral Nerves ; Physical and Rehabilitation Medicine ; Scrotum

BACKGROUND: The purpose of this study was to clarify the importance of preoperative pain control using corticosteroid injections in patients with persistent rest pain (RP) before arthroscopic rotator cuff repair (ARCR). METHODS: A total of 360 patients (374 shoulders) who underwent primary ARCR and were followed up for at least 2 years were enrolled. After one-to-one propensity score matching, 266 patients (145 men and 128 women, 273 shoulders) were included in the study. Their mean age was 65.2 ± 7.7 years (range, 42 to 88 years) at the time of surgery. The patients were divided into three groups: those who required several intra-articular or subacromial bursa corticosteroid injections preoperatively for refractory RP (group A+), those in whom RP was resolved preoperatively (group A−), and those who had no RP and did not require any injections (group B). The incidence of postoperative RP and preoperative and final follow-up American Shoulder and Elbow Surgeons (ASES) scores were compared among the three groups. RESULTS: The incidence of postoperative RP was significantly higher in group A+ (35/91 cases, 38.5%) than in group A− (10/91, 11.0%) and group B (7/91, 7.7%, p < 0.001 for both). The preoperative ASES score was significantly lower in group A+ (33.2 ± 14.2) than in group A− (53.9 ± 11.9) and group B (62.3 ± 11.2, p < 0.001 for both), and it was significantly lower in group A− than in group B (p = 0.000). The final follow-up ASES score was significantly lower in group A+ (92.1 ± 8.4) than in group A− (97.6 ± 5.4) and group B (99.0 ± 2.5, p < 0.001 for both). There was no significant difference in the final follow-up ASES score between group A− and group B (p = 0.242). CONCLUSIONS: Patients in whom preoperative RP could be resolved before surgery achieved postoperative outcomes comparable to those in patients who had no RP before surgery, whereas the outcomes in patients with refractory preoperative RP were inferior. The results suggest that preoperative pain control is important in patients undergoing ARCR.
Arthroscopy ; Elbow ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Pain Management ; Propensity Score ; Rehabilitation ; Rotator Cuff ; Shoulder ; Surgeons

Patients are faced with many questions surrounding the after effects of the various surgical procedures and their ability to return to preoperative activities. While patients often question whether surgery would provide alleviation of pain, weakness, and instability, they often have additional questions about sexual activity during their convalescence that are not always addressed. Although the literature shows postsurgical improvement in sexual activity in association with improved low back pain, reports vaguely address the variability in sexual activity recommendations based on anatomic location and type of spinal surgery. We conducted a PubMed search of the English language from 1990 to 2018 with the following keywords: sexual activity, postoperative, spinal fusion, spinal decompression, functional outcomes, laminectomy, rehabilitation, biomechanics, lumbar disc surgery, metabolic energy expenditure, coital position, and Oswestry Disability Index. Additional studies are needed that survey both patients and spine surgeons to examine current recommendations and to help formulate future guidelines.
Bariatric Surgery ; Convalescence ; Decompression ; Energy Metabolism ; Humans ; Laminectomy ; Low Back Pain ; Rehabilitation ; Sexual Behavior ; Spinal Fusion ; Spine ; Surgeons

BACKGROUND: It is difficult for surgeons to reconstruct soft tissue defects of the great toe. This report aims to evaluate the utility and efficacy of innervated distally based first dorsal metatarsal artery (FDMA) flap with a wide pedicle for reconstruction of soft tissue defects of the great toe. METHODS: This is a retrospective report. Between January 2015 and December 2017, six cases of skin defect of the great toe were reconstructed with an innervated distally based FDMA flap with a wide pedicle. One case was excluded in this report because of chronic pain on the metatarsophalangeal joint due to osteoarthritis before the injury. A total of five cases were evaluated for flap survival and sensory recovery. The sensory recovery was investigated by two-point discrimination and Semmes-Weinstein monofilament tests. The average age of the selected patients was 40 years (range, 36 to 56 years), and the average size of the defect in the toe was 8.3 cm2 (range, 4 to 13.8 cm2). The average follow-up period was 29.4 months (range, 18 to 38 months). RESULTS: All patients survived without any complications. The average two-point discrimination test value was 8.0 ± 0.89 mm (range, 7 to 9 mm), and the average value obtained from the Semmes-Weinstein monofilament test was 4.53 ± 0.33 (range, 4.17 to 4.93). The average residual pain score evaluated with a visual analog scale was 1 (range, 0 to 2). Two patients complained of stiffness in the great toe below 30° of total range of motion during the early stages after surgery, but this stiffness gradually improved after rehabilitation. The average range of motion of three patients with a remaining metatarsophalangeal joint after surgery was 80° (range, 70° to 90°). All five cases could walk regularly without any unique footwear at the final follow-up. CONCLUSIONS: The innervated distally based FDMA flap with a wide pedicle could be a good alternative method for repair of soft tissue defects of the great toe.
Arteries ; Chronic Pain ; Discrimination (Psychology) ; Follow-Up Studies ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint ; Methods ; Osteoarthritis ; Perforator Flap ; Range of Motion, Articular ; Rehabilitation ; Retrospective Studies ; Skin ; Surgeons ; Toes ; Visual Analog Scale

Most athletes with anterior cruciate ligament (ACL) ruptures undergo a surgical ACL reconstruction (ACLR) and rehabilitation. On the other hand, controversy still exists because neither a reconstruction nor rehabilitation have been proven to be superior in the management of ACL injury. This study reviewed the success rates of interventions to provide recommendations for the optimal management after an ACL injury. One of the most important considerations after an ACL injury is the timing and type of intervention. At the early stages, which involve the loss of volume and strength of quadriceps femoral muscle, weight bearing (closed kinetic chain) exercises with pain management followed by high velocity resistance exercises in an open kinetic chain environment are recommended to improve the quadriceps function. After that, it is important to apply intensive isokinetic exercise with a lower extension rate. In this case, it is important to apply overload to the muscles and to simultaneously lead the co-contraction of the hamstrings. Standards are essential because the timing and type of interventions are crucial to prevent re-injury and complications, such as osteoarthritis, as well as to confirm the successful outcome of the treatment. Different interventions recommended for ACL damage have yet to reach consensus. Further studies will be needed to observe the effects of the intervention through multidisciplinary approaches.
Anterior Cruciate Ligament ; Athletes ; Consensus ; Exercise ; Hand ; Humans ; Muscle Strength ; Muscles ; Osteoarthritis ; Pain Management ; Rehabilitation ; Rupture ; Weight-Bearing

OBJECTIVETo explore the clinical effect of exercise rehabilitation during perioperative period on residual pain, gait and activities of daily living (ADL) in patients with lumbar spinal stenosis (LSS) after lumbar percutaneous transforaminal endoscopic discectomy(PTED).

METHODSThe clinical data of 48 patients with LSS underwent PTED from December 2015 to December 2016 were retrospectively analyzed. Patients were divided into observation group and control group according to different rehabilitation patterns, being 24 cases in each group. The patients of observation group received exercise rehabilitation and the patients of control group received conventional rehabilitation. Visual analogue scale(VAS), Oswestry Disability Index (ODI) and the ratio of supporting phase were recorded before operation and 12 days, 6 months after operation. The correlation between the ratio of supporting phase and VAS, ODI was analyzed.

RESULTSThe ratio of supporting phase of observation group was significantly higher than that of control group at 12 days after operation(<0.05). The VAS and ODI in observation group were significantly lower than that of control group at 6 months after operation(<0.01). There was no correlation between the ratio of supporting phase and ODI or VAS in two groups (>0.05).

CONCLUSIONSLumbar percutaneous transforaminal endoscopic discectomy combined with exercise rehabilitation during the perioperative period can release or eliminate postoperative residual pain, improve gait balance, enable activities of daily living, and has a positive effect in patients with lumbar spinal stenosis.

Activities of Daily Living ; Diskectomy, Percutaneous ; Endoscopy ; Exercise Therapy ; Gait ; Humans ; Lumbar Vertebrae ; pathology ; surgery ; Pain, Postoperative ; therapy ; Perioperative Period ; Postural Balance ; Retrospective Studies ; Spinal Stenosis ; rehabilitation ; surgery ; Treatment Outcome

We grouped hemiplegic patients with shoulder subluxation according to the presence of hemiplegic shoulder pain (HSP) and aimed to compare the difference in clinical and magnetic resonance (MR) arthrography findings between 2 groups in the effort to find factors possibly related to HSP. We performed a retrospective, cross-sectional analysis of all eligible inpatients treated at one university rehabilitation hospital. Clinical findings including passive range of motion (ROM), motor power, and spasticity and MR arthrography findings in the affected shoulder were compared between the 2 groups. Of 59 patients who met the criteria, 21 (35.6%) and 38 (64.4%) were classified as HSP group and no-HSP group, respectively. Limitation of ROM in flexion and rotator cuff atrophy significantly related with HSP (R² = 0.449, p < 0.05). Limitation of ROM in flexion and rotator cuff atrophy in MR arthrography was 1.1 and 6.4 times more likely associated with HSP, respectively. Additionally, spasticity in flexion correlated with limitation of ROM in flexion (p = 0.049), external rotation (p = 0.034), and with total limitation of ROM (p = 0.033). A significant correlation was evident between HSP and ROM of the shoulder. However, HSP did not correlate with MR arthrography findings, except rotator cuff atrophy.
Arthrography ; Atrophy ; Cross-Sectional Studies ; Humans ; Inpatients ; Magnetic Resonance Imaging ; Muscle Spasticity ; Range of Motion, Articular* ; Rehabilitation ; Retrospective Studies ; Rotator Cuff ; Shoulder Dislocation ; Shoulder Pain* ; Shoulder* ; Stroke*