Evaluation of single and double limb support postural balance in patients with Anterior cruciate ligament (ACL)injury and comparison of the postural strategy adopted after ACL injury/deficiency(ACLD) with that of an age-matched healthy individual. Methods: The study group that included 33 subjects confirming inclusion criteria had undergone postural balance assessment using the HUMAC Balance system. The parameters of the center of pressure excursion were recorded on a force plate and compared with age, BMI matched 66 healthy volunteers of control group. The center of pressure excursions was monitored using dependable variables such as sway path length(cm), the average velocity of sway(cm/sec), and the mean COP stability score(%). The mobility component was recorded as the percentage (%) of time spent on each target. Result: A decrease in postural balance in the injury group was evidenced by a statistically significant decrease of stability score(p ¼ 0.015), increase in path length(p ¼ 0.002) and decrease on time on target mean score (p¼ <0.001),. Although, the stability score path length and average sway velocity scores in the sound limb of the ACLD group showed impaired balance, the differences were not statistically significant (p ¼ 0.180, p ¼ 0.561, and p ¼ 0.639 respectively) when compared with the dominant limb of the control group. Conclusion: HUMAC balance system is an effective and simplified measure for quantifying postural balance. Although overall postural stability in ACL injury is impaired, static postural balance is maintained by the compensatory of strategy of sound limb. However, the quantitative parameters of postural stability for the sound limb, despite of a lower mean value, did not show statistically significant differences from the dominant limb of the controlled group.
<p class="abstract"><strong>Background:</strong> Split hand/foot malformation with longitudinal deficiency of tibia (SHFLD1) is an extremely rare congenital anomaly, even rarer are the descriptions in the literature of suitable techniques of treatment. Most of the literature available are case reports, based on genetic studies. This study highlights on functional management rather than anatomic correction of deformity. A clinician may not come across a patient with such a rare congenital disorder during his entire career.</p><p class="abstract"><strong>Methods:</strong> On retrospective review of hospital record from July 2008 to July 2018, we observed 5 cases of tibial deficiency associated with split hand and or split foot anomalies and diagnosed as SHHLD syndrome. Clinical and radiological analysis was done to plan out surgical and rehabilitation protocol for individual cases.<strong></strong></p><p class="abstract"><strong>Results:</strong> As per Flatt’s grouping of split hand, 3 limbs (37.5%) were group-1 type, 3 limbs (37.5%) of group-2 type and group-3 type was seen in 2 limbs (25%) of a patient with bilateral involvement. With respect to Jone’s radiological classification system, 4 limbs (57%) were of type Ia, 2 limbs (29%) were having type IV deformity and 1 limb (14%) was with type II deformity. One case agreed for amputation was fitted with above knee prosthesis and another one with custom designed bend knee prosthesis. Eldest case was rehabilitated with tricycle and modified orthosis. Surgical correction was tried in one case.</p><p class="abstract"><strong>Conclusions:</strong> Functional rehabilitation instead of anatomic correction should be tried at late presentation. Cleft closure should be done before development of functional adaptability.</p>
Introduction: Primary full thickness Peroneus Longus Tendon Graft (PLTG) for Anterior Cruciate Ligament Reconstruction (ACLR) has been used with good clinical outcome. Recently, it is designated as a promising graft option for ACLR. The effect of harvesting PLTG on donor ankle function is still not completely understood. Peroneus Longus Tendon (PLT) is thought to play a major role in proprioceptive regulation of the ankle joint. All the studies till date did cross-sectional assessments of ankle and foot function at or after 6 months that might have overlooked the timely detection of donor site morbidities. Aim: To evaluate the ankle function and compare the affected and sound limb function in subjects with an ACLR with autologous PLTG starting at an early postoperative visit upto six months. Materials and Methods: A prospective cohort study was conducted at a tertiary rehabilitation centre from March 2019 to March 2021 including the follow-up evaluation. As per the inclusion criteria, 63 participants after ACLR with PLTG were considered for assessment using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hind foot scale and Foot and Ankle Ability Measure (FAAM) scale at 6 weeks, 3 months and 6 months post-ACLR follow-up. Comparison between sound and affected limbs was done during all follow-ups. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 18.0. Both FAAM and AOFAS ankle and foot scores were analysed with non parametric tests. Results: Mean age of 63 participants were 29.25 years. Median of AOFAS and FAAM score at 6 week, 3 month, and 6 month post- ACLR follow-ups were (88, 98 and 100) and (97.22, 98.80 and 100), respectively. Statistically significant increase in AOFAS and FAAM scores were observed at 3 month and 6 month as compared to 6 week follow-ups with p=0.001 and p-value=0.001 respectively. The group comparison between the affected and sound side functional scores at different study visits showed statistically significant greater values for the sound ankle than the affected ankle (FAAM: 6 week: p-value=0.001; 3 month: p-value=0.001; 6 month: p-value=0.001 and AOFAS p-value=0.001; p-value=0.001; p-value=0.001, respectively). Conclusion: The evaluation of functional outcomes showed gradual and linear improvement at subsequent postoperative visits and restores fully to 100% at 6 month indicating a near- normal to normal donor ankle function following ACLR with PLTG by 6 months. The group comparison showed only marginal but significant difference between affected and sound ankle function.
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