BACKGROUND: Education and encouragement to remain active are considered first-line treatments for acute non-specific low back pain (NSLBP). Aim: to assess the effectiveness of an early physiotherapy education intervention-including also a posture exercise - combined with standard medical care, compared to standard medical care alone, in patients presenting with acute NSLBP in the emergency department (ED). METHODS: Adults with acute NSLBP were randomized to receive either standard care plus a physiotherapy session involving education, reassurance, pain neuroscience, and a guided lumbar exercise or standard medical care. Participants were assessed at three timepoints: before treatment (baseline), at 1 month, and at 3 months post-treatment. Outcome measures included the 0-10 Numerical Rating Scale (NRS), the Roland-Morris Disability Questionnaire (RMDQ), and the 5-level EuroQol-5D (EQ-5D-5L) for assessing quality of life (QoL). Linear mixed model analyses for repeated measures were performed for each outcome (P<0.01). RESULTS: Significant time effects were observed for NRS, RMDQ, and EQ-5D-5L (P<0.001) in both groups across all timepoints. No significant group effects or time-by-group interactions were found at any timepoint. CONCLUSIONS: An early, single-session physiotherapy education program added to standard ED care resulted in equal clinical outcomes compared to standard care alone in patients with acute NSLBP. Future studies should investigate more structured models of care to improve outcomes in this population.
BACKGROUND: Proximal hamstring tendon avulsions represent severe injuries that often require surgical repair. Postoperative failure and prolonged immobilization remain clinical challenges. Botulinum toxin A (BoNT-A) has been proposed as a chemoprotective adjunct to reduce muscle tension and protect tendon repairs. Evidence in adult populations remains limited. The aim of this article is to describe the feasibility, safety profile, and preliminary functional outcomes of BoNT-A administration as an adjunct to surgical repair of complete proximal hamstring tendon avulsions in adults. METHODS: In this retrospective case series, five adult patients with complete proximal hamstring tendon avulsions underwent surgical repair between 2019 and 2021. All patients received three ultrasound-guided intramuscular injections of BoNT-A (3 IU/kg) prior to surgery. Demographic and clinical data were retrospectively collected. At final follow-up, functional outcomes were assessed using the Perth Hamstring Assessment Tool (PHAT), and return-to-sport status was recorded. Complications were documented descriptively. RESULTS: At a mean follow-up of two years, all patients achieved full range of motion and reported no subjective weakness. The mean PHAT score was 91.2 +/- 8.3. All patients returned to their pre-injury level of activity at a mean of four months postoperatively. One patient reported partial sciatic nerve hypoesthesia, which resolved without intervention. No re-ruptures were observed. CONCLUSIONS: In this small retrospective case series, good outcomes were observed with the adjunctive use of BoNT-A in proximal hamstring tendon repair. These preliminary findings support further prospective controlled studies to evaluate the potential role of chemoprotection in proximal hamstring repair.
BACKGROUND: Distal biceps tendon rupture is a rare injury, predominantly affecting active males aged 30-60 years, often resulting from traumatic events during forceful exertion. Surgical repair is the preferred treatment, especially for young, active individuals, to restore optimal function. This study compares patient-reported outcome measures (PROMS) and complication rates between two surgical techniques for distal biceps tenodesis: a single-incision volar approach and a minimally invasive double-incision technique. METHODS: A retrospective analysis was conducted on 24 male patients treated between February 2019 and January 2022. The enrolled population was divided into two groups: Group A, single-incision volar approach (N.=13) and Group B, minimally invasive double-incision technique (N.=11). Functional outcomes were assessed using the MAYO and DASH scores, while strength recovery, range of motion (ROM), and radiographic findings were evaluated at a mean follow-up of 24 months. RESULTS: Both techniques yielded excellent/good satisfaction in 89% of cases, with no significant differences in surgical duration, BMI, or risk factors. However, Group A demonstrated superior supination recovery (mean loss of 1.5 degrees vs. 8.6 degrees in Group B, P<0.001) and more anatomical tendon reattachment (77% vs. 45%, P<0.05). Neurological complications were more frequent in Group B (54% vs. 23%, P=0.039), though resolved spontaneously. Heterotopic ossifications were observed in 35% of Group A and 39% of Group B cases. CONCLUSIONS: Both techniques provide satisfactory functional outcomes, but the single-incision approach offers better anatomical restoration and lower complication rates. The choice of technique and fixation device should be guided by surgeon experience.
BACKGROUND: In total knee arthroplasty (TKA), malrotation of the femoral component has been associated with postoperative pain and patient dissatisfaction. Two main surgical techniques are commonly used to perform TKA: measured resection (MR) and gap balancing (GB). However, it is still debated which technique provides more accurate femoral component rotation and better clinical outcomes. METHODS: Fifty patients with symptomatic primary knee osteoarthritis were included. Twenty-five patients underwent TKA using the MR technique and 25 using the GB technique. Preoperative and postoperative CT scans were performed to assess femoral rotational alignment. Clinical outcomes were evaluated using the Knee Society Score (KSS), Functional Knee Society Score (FKSS), and WOMAC score preoperatively and at 6 months, 1, 3, 5, and 7 years postoperatively. RESULTS: The mean postoperative femoral component alignment was +3 degrees in the MR group and +0.48 degrees in the GB group (P=0.005). No statistically significant differences were observed between the two groups in any of the clinical outcome scores at all follow-up time points. CONCLUSIONS: Both MR and GB techniques resulted in excellent long-term clinical outcomes. Although the MR technique showed a tendency toward greater external femoral component rotation, this did not translate into clinically relevant differences.
The expansion of same-day discharge (SDD) total joint arthroplasty (TJA) has reshaped perioperative care, emphasizing safety, efficiency, and patient-centered recovery. Remote patient monitoring (RPM) represents a cornerstone of this transition, providing continuous assessment of clinical parameters, mobility, and pain through telemedicine, wearable devices, and smart implants. By integrating digital communication and artificial intelligence, RPM enables early detection of complications, reduces readmission, and promotes adherence to rehabilitation. This paper explores the synergistic role of telemedicine, wearable technology, and smart implants in the postoperative management of arthroplasty, discussing their technological basis, evidence of effectiveness and future prospects. Through continuous data collection and artificial intelligence (AI)-assisted analytics, RPM facilitates proactive clinical decisions and personalized care pathways. Despite challenges including regulatory approval, data integration, and patient digital literacy, the convergence of these innovations marks a paradigm shift toward precision and preventive orthopedic care.
