OCON Orthopedische kliniek

This cross-sectional study aimed to determine normative values for hip strength and range of motion in professional female football players and to explore associations of age, playing position, leg dominance, hip/groin symptoms and previous hip/groin injuries. By establishing baseline measures, this study aims to provide reference values that can help guide injury prevention strategies in female football players. Cross-sectional. 100 professional female football players from the highest Dutch football league (Eredivisie) were assessed at three participating hospitals. Primary outcome measures included normalized eccentric hip adduction and abduction (Nm/kg), hip adduction/abduction ratio, adduction squeeze (N/kg), internal and external hip rotation (°), total hip rotation (°), hip flexion (°) and bent knee fall out (cm). Normative values for hip strength (mean ± SD) were: adduction 3.0 ± 0.6 Nm/kg, abduction 3.1 ± 0.6 Nm/kg, adduction/abduction ratio 1.0 ± 0.1, and adductor squeeze 4.2 ± 0.7. Age showed a positive association with abduction and adduction strength. Goalkeepers had lower values for all strength measurements compared with field players. Normative values for ROM (mean ± SD) were: internal rotation 36 ± 8°, external rotation 49 ± 7°, total rotation 86 ± 10°, hip flexion 128 ± 6°, and bent knee fall out 14 ± 4 cm. Dominant legs showed lower mean values for internal rotation, total rotation, and hip flexion compared to non-dominant legs. This study established normative values for hip strength and range of motion in professional female football players that can be used as reference profiles and can aid in injury prevention strategies and return-to-play protocols.

To determine whether posterior tibial slope (PTS) measured to proximal anatomical axes can serve as a reliable proxy for PTS measured to the mechanical tibial axis (mTA). In patients ≥18 years with failed anterior cruciate ligament reconstruction, medial and lateral PTS were measured relative to the mTA on a lateral lower-leg radiograph, and relative to the proximal tibial anatomical axis (PTAA), anterior tibial cortical axis (ATC) and posterior tibial cortical axis (PTC) on a lateral knee radiograph. Agreement was assessed using correlation coefficients, measurement error and Bland-Altman analysis. Diagnostic accuracy of the conventional ≥12° PTAA-based PTS cut-off for slope-reducing osteotomy was determined. Fifty-nine knees were analyzed. Correlation between proximal anatomical axes and mTA-based PTS measurements was strong (r ≥ 0.71), but agreement was poor. Mean measurement error for PTAA was 0.1 ± 2.4° (range: -5.7° to 7.6°) and -0.5 ± 2.4° (range: -6.6° to 5.2°), for ATC -3.4 ± 2.6° (range: -8.6° to 5.9°) and -3.7 ± 2.6° (range: -9.9° to 2.7°) and for PTC 3.0 ± 2.6° (range: -2.9° to 10.4°) and 2.7 ± 2.4° (range: -3.6° to 7.8°) for the medial and lateral plateau, respectively. For PTAA, absolute measurement error ≥2° occurred in approximately 50% of knees. Bland-Altman analysis showed 95% levels of agreement ranging from -4.89° to 4.62° (medial) and -5.11° to 4.11° (lateral). Using the ≥12° cut-off on PTAA-based PTS values misclassified approximately one in three knees (19.5% false-positive and 13.2% false-negative) relative to the mTA-based PTS reference values. Despite strong correlation, proximal anatomical axes-based PTS measurements on routine lateral knee radiographs show substantial, bidirectional measurement error outside clinically acceptable limits of agreement compared to mTA-based PTS measurements on full-length lateral lower-leg radiographs. Single-exposure, full-length lateral lower-leg radiographs should be obtained to measure PTS relative to the mTA when considering slope-reducing osteotomy. Level IV.

PurposeTo reach consensus among international experts on a structured framework for standardized 3D leg alignment analysis based on 3D bone models, ensuring consistency and improving clinical applicability.MethodsA Delphi study was performed in four rounds. Rounds 1 and 2 involved a steering and rating group that developed statements based on principles preserving the 3D complexity of anatomical structures, identified through a systematic review. These statements encompassed approaches for deriving joint centres and joint orientations, and defining coordinate systems using 3D bone models. In Rounds 3 and 4, a panel of 35 international experts, including clinicians (54%) and engineers (46%), with participants from Europe (80%), Oceania (9%), Asia (6%), and the Americas (6%), evaluated these statements. Consensus was defined as ≥80% agreement.ResultsRounds 1 and 2 resulted in 31 statements to be included in the survey. Of these, 26 achieved consensus in Round 3, with the five remaining statements refined and reaching consensus in Round 4. Experts agreed on utilising all available relevant surface data to define joint centres, joint orientations, and individual femoral and tibial coordinate systems alongside a combined leg coordinate system, and adopting central 3D axes for femoral version and tibial torsion.ConclusionsThis international Delphi consensus study provides a structured framework for a standardized 3D leg alignment analysis based on 3D bone models. This framework aims to enhance clinical applicability for preoperative planning and execution of uni‐ and multiplanar correction osteotomies around the knee, reduce the methodological variability in 3D leg alignment analysis literature, and improve cross‐study comparability.Level of EvidenceLevel V.

Flucloxacillin-induced hypokalaemia can be progressive and life-threatening, despite of potassium supplementation. In this case description, a high dose of intravenous flucloxacillin was started after a 68-year-old patient presented with an infected knee replacement. After two days, hypokalaemia was noted with an inadequate response to potassium supplementation. It was decided to change antibiotics and increase potassium supplementation, with good results. It is advisable to include monitoring of potassium levels in local treatment protocols when flucloxacillin is prescribed.

PurposeTo evaluate the anxiety level to perform movements in patients after revision anterior cruciate ligament reconstruction (ACLR) combined with lateral extra-articular tenodesis (LET) compared to patients after revision ACLR without LET.MethodsNinety patients who underwent revision ACLR with ipsilateral bone-patellar tendon-bone autograft and with a minimum of 12 months follow-up were included in this study. Patients were divided into two groups: patients who received revision ACLR in combination with LET (revision ACLR_LET group; mean follow-up: 29.4 months, range: 12–80 months), and patients who received revision ACLR without LET (revision ACLR group; mean follow-up: 61.1 months, range: 22–192 months). All patients filled in a questionnaire about anxiety level related to physical activity and sports, the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee subjective form (IKDCsubjective), and the Tegner Activity Score.ResultsPatients in the revision ACLR_LET group had a significantly lower anxiety level to perform movements than patients in the revision ACLR group (p < 0.05). No significant differences were found in KOOS, IKDCsubjective, and Tegner Activity Scores.ConclusionsPatients who received LET in addition to revision ACLR have a lower anxiety level to perform movements than patients with revision ACLR alone, despite non-different subjective functional outcomes.Study designRetrospective cohort study, Level of evidence: III.

Limited information is available on the experiences of patients during rehabilitation after anterior cruciate ligament reconstruction (ACLR). The current study aimed to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. A survey-based study with an online platform was used to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. Seventy-two patients (age 27.8 [8.8]y) after ACLR participated. Data were analyzed and themes were identified by comparing categories and subcategories on similarity. Positive patient experiences were room for own input, supervision, attention, knowledge, honesty, and professionalism of the physiotherapist. Additionally, a varied and structured rehabilitation program, adequate facilities, and contact with other patients were identified as positive patient experiences. Negative experiences were a lack of attention, lack of professionalism of the physiotherapists, a lack of sport-specific field training, a lack of goal setting, a lack of adequate facilities, and health insurance costs. The current study identified factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. These findings can help physiotherapists in understanding the patient experiences during rehabilitation after ACLR.

A fracture through the neck of the femoral stem in total hip arthroplasty is extremely rare. We report a neck fracture of a cementless Zweymüller stem, one of the most implanted stems worldwide. According to our knowledge, this is the first thorough case description of a neck fracture of a cementless Zweymüller stem. The case concerns a 53-year-old man, with a body weight of 103 kg and a body mass index of 31. We consider potential risk factors for a femoral stem fracture, such as patient-related factors, suboptimal implant positioning, surgical technique and implant characteristics.

BackgroundAsthma is one of the most common chronic diseases in childhood, occurring in up to 10% of all children. Exercise-induced bronchoconstriction (EIB) is indicative of uncontrolled asthma and can be assessed using an exercise challenge test (ECT). However, this test requires children to undergo demanding repetitive forced breathing manoeuvres. We aimed to study the electrical activity of the diaphragm using surface electromyography (EMG) as an alternative measure to assess EIB.MethodsForty-two children suspected of EIB performed an ECT wearing a portable EMG amplifier. EIB was defined as a fall in FEV1 of more than 13%. Children performed spirometry before exercise, and at 1, 3 and 6 min after exercise until the nadir FEV1 was attained and after the use of a bronchodilator. EMG measurements were obtained between spirometry measurements.ResultsTwenty out of 42 children were diagnosed with EIB. EMG peak amplitudes measured at the diaphragm increased significantly more in children with EIB; 4.85 μV (1.82–7.84), compared to children without EIB; 0.20 μV (−0.10–0.54), (p<0.001) at the lowest FEV1 post-exercise. Furthermore, the increase in EMG peak amplitude could accurately distinguish between EIB and non-EIB using a cut-off of 1.15 μV (sensitivity 95%, specificity 91%).ConclusionEMG measurements of the diaphragm are strongly related to the FEV1 and can accurately identify EIB. EMG measurements are a less invasive, effort-independent measure to assess EIB and could be an alternative when spirometry is not feasible.