• Title/Summary/Keyword: Posterolateral instability

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The Effect of Fatigue on EMG Activity and Dynamic Balance of Subjects with Functional Lumbar Instability

  • Kim, Myong-Chul;Kim, Ho-Sung
    • The Journal of Korean Physical Therapy
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    • v.27 no.4
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    • pp.207-213
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    • 2015
  • Purpose: The aim of the current study was to investigate EMG activity on dynamic balance of subjects with functional lumbar instability following fatigue of low back. Methods: The subjects (24 university students) were divided into 2 groups; functional lumbar instability group (6 males and 6 females) and lumbar stable group (7 males and 5 females) who could complete a questionnaire and undergo a prone instability test. All participants were evaluated for distribution of muscle activity using the TeleMyo DTSTM system. Dynamic balance was tested by Y balance test. This study was conducted for measurement of EMG activity on dynamic balance with the difference between FLIG and control group following muscle fatigue. Results: The functional lumbar instability group (FLIG) showed a significantly lower YBT score (%) of anterior, posterolateral direction on Y-balance test (YBT) in dynamic balance than the lumbar stable group (LSG) (p<0.05). The FLIG was significantly lower than the LSG in anterior direction in EMG activity(%) of MF, RA, ES, GMX, GME, RF, and posteromedial direction in EMG activity(%) of IO, ES and then posterolateral direction in EMG activity(%) of IO, ES in dynamic balance (p<0.05). There was significant correlation of MF, RA, and GMX in anterior reach direction (p<0.05) and ES, GME (p<0.01) and IO, ES in posteromedial reach direction (p<0.05) and EO, ES, GMX in posterolateral reach direction (p<0.05) there was positive correlation. Conclusion: This study showed that FLIG effected EMG activity by dynamic balance following muscle fatigue. Further study is needed for measurement of various ages and work with lumbar instability for clinical application.

Prosthetic resurfacing of engaging posterior capitellar defects in recurrent posterolateral rotatory instability of the elbow

  • Dani Rotman;Jorge Rojas Lievano;Shawn W. O'Driscoll
    • Clinics in Shoulder and Elbow
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    • v.26 no.3
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    • pp.287-295
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    • 2023
  • Background: Posterolateral rotatory instability (PLRI) is a common mechanism of recurrent elbow instability. While the essential lesion is a deficiency in the lateral ulnar collateral ligament (LUCL), there are often associated concomitant bony lesions, such as an Osborne-Cotterill lesions (posterior capitellar fractures) and marginal radial head fractures, that compromise stability. Currently, there is no standard treatment for posterior capitellar deficiency associated with recurrent PLRI. Methods: We conducted a retrospective review of five patients with recurrent PLRI of the elbow associated with a posterior capitellar impaction fracture engaging with the radial head during normal range of motion. The patients were treated surgically with LUCL reconstruction or repair and off-label reconstruction of the capitellar joint surface using a small metal prosthesis designed for metatarsal head resurfacing (HemiCAP toe classic). Results: Five patients (three adolescent males, two adult females) were treated between 2007 and 2018. At a median follow-up of 5 years, all patients had complete relief of their symptomatic instability. No patients had pain at rest, but two patients had mild pain (visual analog scale 1-3) during physical activity. Three patients rated their elbow as normal, one as almost normal, and one as greatly improved. On short-term radiographic follow-up there were no signs of implant loosening. None of the patients needed reoperation. Conclusions: Recurrent PLRI of the elbow associated with an engaging posterior capitellar lesion can be treated successfully by LUCL reconstruction and repair and filling of the capitellar defect with a metal prosthesis. This treatment option has excellent clinical results in the short-medium term. Level of evidence: IV.

Dynamic Postural Control and Ankle Joint Laxity among Dancers and Non-dancers with Chronic Ankle Instability, and Healthy Dancers (만성 발목 불안정성을 가진 무용수와 비무용수, 건강한 무용수의 동적 자세 조절 및 발목 관절 이완성)

  • Eun Ji Hong;Jiho Kang;Hyung Gyu Jeon;Kyeongtak Song;Sae Yong Lee
    • Korean Journal of Applied Biomechanics
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    • v.34 no.2
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    • pp.93-103
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    • 2024
  • Objective: The purpose of this study was to investigate whether dancers with chronic ankle instability (CAI) exhibit different characteristics in dynamic postural control ability and ankle joint laxity compared to dancers without CAI and non-dancers with CAI. Method: Twelve dancers with CAI, 14 dancers without CAI, and 12 non-dancers with CAI participated in the study. Dynamic balance was evaluated using the Star Excursion Balance Test (SEBT) and the single-leg hop balance. The laxity of the ankle joint was evaluated through the anterior drawer test and the talar tilt test. SEBT measured maximum reach distances in anterior, posteromedial, and posterolateral directions. Single-leg hop assessed center of pressure (COP) and time-to-boundary (TTB) outcomes. One-way ANOVA and Chi-square tests were performed to compare the outcome variables among the three groups. Results: Dancers with CAI demonstrated greater reach distance in the posterolateral direction compared to non-dancers with CAI during SEBT (p=.014). Secondly, dancers without CAI showed greater reach distance in the posterolateral (p<.001) and posteromedial (p=.001) directions during SEBT compared to non-dancers with CAI. Additionally, dancers without CAI exhibited better postural control with higher TTB AP mean of minima (p=.003) and TTB AP standard deviation of minima (p=.012) during single-leg hop compared to nondancers with CAI. Thirdly, dancers with CAI showed a lower positive rate during the anterior drawer test compared to non-dancers with CAI (p=.019). Conclusion: Dancers with CAI demonstrated better ankle function and reduced mechanical instability compared to non-dancers with CAI. Therefore, to elucidate the underlying mechanisms of lateral ankle sprain and CAI development exacerbation in dancers, additional factors that can affect ankle sprain, such as visual dependence during postural control and evaluation in dance movements, should be explored.

Reconstruction of Posterior Cruciate Ligament and Posterolateral Structure with Allo-Achilles Tendon (동종 아킬레스 건을 이용한 후방 십자 인대 및 후 외방 구조물 재건술)

  • Oh, In-Suk;Lee, Dong-Joo;Cho, Kyu-Jung;Kim, Myung-Ku
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.2
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    • pp.162-166
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    • 2005
  • Purpose: The purpose of this study were to evaluate the results of arthroscopic PCL reconstruction and posterolateral structure reconstruction. Materials and Methods: We performed 10 cases of arthrocopic PCL and posterolateral structure reconstruction using allo-achilles tendon. The average follow-up period was 25 months. We performed KT-2000 testing and posterior drawer test for posterior instability and tibial external rotation test for posterolateral rotatory instability, and measure Tegner and Lysholm score preoperatively and compared these with the results of a final evaluation in each cases. Results: The Preoperative average KT-2000 tests was 7.1 mm, posterior drawer test was Grade III and tibial external rotation test was positive at both 30 and 90 degrees of knee flexion in all cases. Preoperative average Lysholm score was 65.9 and Tegner score was 3.1. At the final evaluation, an average KT-2000 test was 2.2 mm, posteior drawer test, Grade 0 was 2 cases, Grade 1.4 cases, Grade II, 3 cases, Grade III, 1 cases. The tibial external rotation test at both 30 and 90 degrees of knee flexion was positive in 1 cases and positive at only 90 degrees in 2 cases. Lysholm score was 87.6 and Tegner score was 5.7. The objective and subjective score of final evaluation is increased in compare with preoperative one. Conclusion: Arthrocopic PCL and posterolateral structure reconstruction using allo-achilles tendon is one of the good surgical treatment method in patients having posterior and posterolateral rotatory instability.

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Combined Reconstruction of Posterior Cruciate Ligament and Posterolateral Corner with a Fresh Frozen Achilles Tendon Allograft (한 개의 신선동결 동종아킬레스건을 이용한 후방십자인대 및 후외방구조의 동시 재건술)

  • Kyung, Hee-Soo;Oh, Chang-Wug;Lee, Hyun-Joo;Ihn, Joo-Chul
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.8 no.2
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    • pp.102-108
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    • 2009
  • Purpose: The purpose of this study is to report a result of the technique that reconstruct posterior cruciate ligament (PCL) and posterolateral corner (PLC) simultaneously using a fresh-frozen Achilles tendon allograft. Materials and Methods: Forty two patients (45 legs) underwent PCL and PLC reconstruction were included. There were 38 males and 4 females. Mean age was 39 years. Used graft was a fresh frozen Achilles tendon allograft, which was divided by two size, larger one (${\emptyset}$ 10 mm) for PCL reconstruction and smaller one (${\emptyset}$ 8 mm) for PLC reconstruction. Arthroscopic reconstruction of the PCL was performed using transtibial, single incision, and single bundle technique with 10mm fresh frozen Achilles allograft tendon first. After PCL reconstruction, reconstruction procedure for posterolateral instability was performed using modified figure of "8" technique using smaller gtaft. For clinical evaluation, range of motion, posterior drawer test, varus stress test, prone external rotation (dial) test, Lysholm score, Tegner activity scale and posterior stress radiograph were used. Mean follow up period was 25 months. Results: Preoperatively posterior drawer test was 5 cases in grade II and 40 cases in grade III posterior instability. At final follow-up 22 cases returned within normal condition, 18 cases grade I and 5 cases grade II posterior instability. Though all patients showed positive result over 10 degrees in dial and varus stress test preoperatively, but only 9 cases showed positive both test at final follow-up. The range of motion deficit over $10^{\circ}$ flexion was 3 cases. Lysholm score was improved from mean 50 preoperatively to mean 83(p<0.05) and Tegner activity scale improved from mean 2.1 preoperatively to mean 4.6(p<0.05). In posterior stress radiographs, posterior displacement was improve from mean 16mm preoperatively to 4.1mm after treatment(p<0.05). All patients had improved compared to their pre-operative status as measured by physical examination such as posterior drawer test, varus stress test, dial test. Conclusion: We had successful results by combined reconstruction of the PCL & PLC with a fresh frozen Achilles tendon allograft in patients with PCL and posterolateral rotatory instability at a time.

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Biceps Rerouting Technique(Modification of Clancy) for Posterolateral Rotatory Instability (대퇴이두건 전환술(Clancy 변형 술식)을 이용한 후외측 회전 불안정성의 재건)

  • Kim Sung-Jae;Shin Sang-Jin;Kim Jin-Yong;Rhee Dong-Joo
    • Journal of the Korean Arthroscopy Society
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    • v.4 no.1
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    • pp.25-31
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    • 2000
  • Introduction : This study compared the clinical results with biceps rerouting fer the isolated posterolateral instability (PLI) and for the PLI combined with PCL injuries. Methods : 21 cases of isolated PLI (group I) and 25 cases of PLI combined with PCL rupture were included in the study. The PLI was reconstructed by modified biceps femoris rerouting technique with PCL reconstructions performed prior to the PLI correction in cases of combined injury The clinical results were reviewed and analyzed. Results : Pre-operatively positive reverse pivot shift test turned negative in 43 cases post-operatively. Increased preoperative external rotation thigh foot angle (ERTFA) showed significant differences between the two groups and all fell within normal limits post-operatively At a mean follow-up of 40.3 months, the average Lysholm knee score and. The Hospital for Special Surgery Knee Ligament Score for group I and group II revealed above 90 points without statistically significant difference between the groups. 3 cases of tenodesis failure developed and re-operation was performed. Discussion and Conclusion : The advantages of modified Clancy technique include reduced surgical damages to the iliotibial band and fixation of the biceps tendon at the isometric position. The modified biceps rerouting technique is recommended for the reconstruction of both isolated and combined PLI except in patients with severe damages at the attachment of biceps tendon.

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Rehabilitation after Posterior Cruciate Ligament, Posterolateral Rotatory Instability, and Multiple Ligament Reconstruction (후방십자인대,후외측 회전 불안정성 및 다발성인대 재건술 후 재활 치료)

  • Yoo, Jae-Doo
    • Journal of the Korean Arthroscopy Society
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    • v.12 no.2
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    • pp.91-92
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    • 2008
  • 후방십자인대 및 후외측인대 재건술 후 결과는 많은 발전이 있었지만, evidence medicine의 측면에서 재활 방법에 관한 전향적 연구는 없다. 현재까지의 재활 방법은 다양하게 소개되었지만 전방십자인대 재건술처럼 가속 재활을 하는 것은 바람직스럽지 않다. 후방십자인대, 후외측인대 그리고 다발성 인대 재건술 후 재활은 수술 방법과 환자의 재건된 인대의 상태, 하지 정렬 등에 따라서 개별화하여 점진적으로 진행하여야 할 것이고, 재활기간 동안 의사의 세심한 관찰이 필요하다.

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Rehabilitation after Posterior Cruciate Ligament, Posterolateral Rotatory Instability, and Multiple Ligament Reconstruction

  • Yu, Jae-Du
    • 대한관절경학회:학술대회논문집
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    • 2008.04a
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    • pp.84-85
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    • 2008
  • 후방십자인대 및 후외측인대 재건술 후 결과는 많은 발전이 있었지만, evidence medicine의 측면에서 재활 방법에 관한 전향적 연구는 없다. 현재까지의 재활 방법은 다양하게 소개되었지만 전방십자인대 재건술처럼 가속 재활을 하는 것은 바람직스럽지 않다. 후방십자인대, 후외측인대 그리고 다발성 인대 재건술 후 재활은 수술 방법과 환자의 재건된 인대의 상태, 하지 정렬 등에 따라서 개별화하여 점진적으로 진행하여야 할 것이고, 재활기간 동안 의사의 세심한 관찰이 필요하다.

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Dual reconstruction of both the radial collateral ligament and lateral ulnar collateral ligament at the annular ligament in posterolateral rotatory instability of the elbow: a new technique - A report of 3 cases- (요측측부인대 및 외측척골측부인대의 동시재건술을 이용한 주관절 후외측회전 불안정성의 수술적치료: 새로운 수술 기법 - 증례 3예 보고 -)

  • Ryu, In-Hyeok;Kim, Hyeong-Jin;Jeong, Jae-Ik;Seo, Bo-Geon;Kim, Gyeong-Cheol
    • The Academic Congress of Korean Shoulder and Elbow Society
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    • 2009.03a
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    • pp.189-190
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    • 2009
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