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Lee Taylor - One of the best experts on this subject based on the ideXlab platform.
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surgical repair of failed Hip Abductors a new technique using graft jacket allograft human dermal matrix
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: Biyyam Rao, Michael Moss, Lee TaylorAbstract:Introduction Avulsion of Abductors from Hip is a debilitating complication after total Hip arthroplasty performed through a trans-gluteal approach. It results in intractable pain, Trendelenberg limp and instability of the Hip. Techniques described for repairing these abductor tears including direct trans osseous repairs, endoscopic repair techniques, Achilles tendon allograft, Gluteus Maximus and Vastus Lateralis muscle transfers. The aim of our study was to assess improvement in pain, limp and abductor strength in patients operated upon surgically for confirmed abductor avulsion using a modified trans osseous repair and augmentation of repair with a Graft Jacket allograft acellular human dermal matrix (Graft jacket; Wright Medical Technology, Arlington, TN). Patients and Methods In this prospective study we include 18 consecutive patients with Hip abductor avulsions following a primary total Hip arthroplasty through Hardinge approach for osteoarthritis. All the patients presented with pain around lateral aspect of Hip, walking with a significant Trendelenberg limp and used a crutch or a stick in the opposite hand. Diagnosis was made by clinical examination and confirmed by MRI scans. Surgical Technique Surgical procedure was through lateral approach using the old scar to mobilise combined aponeurosis of the Gluteal Medius and Gluteus Minimus from the bony bed on the ilium to permit advancement onto the trochanter. The conjoint Gluteus Medius and Minimus insertion was affixed to the greater trochanter with No.5 non absorbable trans-osseous suture using a Krackow stitch through a series of transverse tunnels made in anterior aspect of greater trochanter. An on lay augmentation (Fig. 1) of the osseo-tendinous junction was performed using a Graft Jacket matrix of 4 × 7 cms in size after rehydration according to the manufacturer9s instructions. Results At mean follow up of 22 months (15–34 months), pain improved in all patients with mean VAS score improving from 8.25 to 2.33 (p value-0.05). All the patients had improvement in their abductor strength with MRC grade 4 out of 5 in 16 patients and 3 out of 5 in 2 patients. Trendelenberg sign disappeared in all but two. Mean Harris Hip score improved from 34.05 to 81.26 (p value-0.001). All patients had improvement in gait except mild noticeable limp in two patients.13 patients did not use any walking aids and five felt more secure using a walking stick in the contralateral hand. The mean SF-36 Physical component score was 53.47 and Mental component score was 56.07. Conclusions The procedure is safe and associated with high patient satisfaction, without the morbidity of tendon or muscle transfers. The Graft Jacket Matrix provides biological bridging between the Hip Abductors and its insertion into greater trochanter. It provides a biological scaffold for cellular and vascular in-growth and constructive tissue remodelling. The described procedure appears to enhance the mechanical strength of repaired tendon immediately following surgery. The Graft Jacket allograft matrix has already been used successfully in rotator cuff repairs of shoulder and has showed encouraging results. The early success of this new procedure warrants further study with more patients, longer follow-up and possibly histological study of retrieved specimens.
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surgical repair of Hip Abductors a new technique using graft jacket allograft acellular human dermal matrix
International Orthopaedics, 2012Co-Authors: Biyyam Rao, Tamer Kamal, John Vafaye, Lee TaylorAbstract:Purpose Avulsion of the Abductors from the Hip can be an infrequent but debilitating complication after total Hip arthroplasty performed through a trans-gluteal approach. This can result in intractable pain, limp, Trendelenberg lurch and instability of the Hip. There have been various methods described for repairing or reconstruction of this abductor muscle complex including direct trans-osseous repair, muscle transfers, muscle and tendon sling, bone tendon allograft reconstruction and endoscopic repair techniques.
Armin Kibele - One of the best experts on this subject based on the ideXlab platform.
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Different strength declines in leg primary movers versus stabilizers across age-Implications for the risk of falls in older adults?
PloS one, 2019Co-Authors: Franziska Daun, Armin KibeleAbstract:This study investigated differences in the declines of isometric strength in Hip Abductors and adductors versus knee extensors across four different age groups (n = 31: 11.2 ± 1.0 y, n = 30: 23.1 ± 2.7 y, n = 27: 48.9 ± 4.4 y, and n = 33: 70.1 ± 4.2 y) with a total of 121 female subjects. As a starting point, we assumed that, during their daily activities, elderly people would use their leg stabilizers less frequently than their leg primary movers as compared to younger people. Given that muscle strength decreases in the course of the aging process, we hypothesized that larger strength declines in Hip Abductors and Hip adductors as compared to knee extensors would be detected across age. Maximal isometric force for these muscle groups was assessed with a digital hand-held dynamometer. Measurements were taken at 75% of the thigh or shank length and expressed relative to body weight and lever arm length. Intratester reliability of the normalized maximal torques was estimated by using Cronbach’s alpha and calculated to be larger than 0.95. The obtained results indicate a clearly more pronounced strength decline in Hip Abductors and Hip adductors across age than in the knee extensors. Therefore, a particular need for strength training of the lower extremity stabilizer muscles during the aging process is implied.
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Significances of Tukey-HSD post-hoc tests for the group mean difference of the normalized maximal torques (lower left corner shaded in grey) in the knee extensors (KE), the Hip Abductors (AB), and the Hip adductors (AD) as well as for the ratios (upp
2019Co-Authors: Franziska Daun, Armin KibeleAbstract:Significances of Tukey-HSD post-hoc tests for the group mean difference of the normalized maximal torques (lower left corner shaded in grey) in the knee extensors (KE), the Hip Abductors (AB), and the Hip adductors (AD) as well as for the ratios (upper right corner) between Hip Abductors vs Hip adductors vs knee extensors (AB/AD, AB/KE, AD/KE) in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 = 41- to 55-year old females, and AG70 = 63- to 79-year old females).
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Ratios of normalized maximal torque ratios between the Hip Abductors and Hip adductors in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 = 41- to 55-year old females, and AG70 = 63- to 79-year old female
2019Co-Authors: Franziska Daun, Armin KibeleAbstract:Ratios of normalized maximal torque ratios between the Hip Abductors and Hip adductors in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 = 41- to 55-year old females, and AG70 = 63- to 79-year old females).
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Normalized maximal torques in the knee extensors (KE = solid line), the Hip Abductors (AB = dashed line), and the Hip adductors (AD = dashdotted line) in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 =
2019Co-Authors: Franziska Daun, Armin KibeleAbstract:Normalized maximal torques in the knee extensors (KE = solid line), the Hip Abductors (AB = dashed line), and the Hip adductors (AD = dashdotted line) in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 = 41- to 55-year old females, and AG70 = 63- to 79-year old females).
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Ratios of normalized maximal torque ratios between the Hip Abductors and the knee extensors (AB-KE) (dashed line) and the Hip adductors and the knee extensors (AD-KE) (dashed line) in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- t
2019Co-Authors: Franziska Daun, Armin KibeleAbstract:Ratios of normalized maximal torque ratios between the Hip Abductors and the knee extensors (AB-KE) (dashed line) and the Hip adductors and the knee extensors (AD-KE) (dashed line) in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 = 41- to 55-year old females, and AG70 = 63- to 79-year old females).
Biyyam Rao - One of the best experts on this subject based on the ideXlab platform.
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surgical repair of failed Hip Abductors a new technique using graft jacket allograft human dermal matrix
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: Biyyam Rao, Michael Moss, Lee TaylorAbstract:Introduction Avulsion of Abductors from Hip is a debilitating complication after total Hip arthroplasty performed through a trans-gluteal approach. It results in intractable pain, Trendelenberg limp and instability of the Hip. Techniques described for repairing these abductor tears including direct trans osseous repairs, endoscopic repair techniques, Achilles tendon allograft, Gluteus Maximus and Vastus Lateralis muscle transfers. The aim of our study was to assess improvement in pain, limp and abductor strength in patients operated upon surgically for confirmed abductor avulsion using a modified trans osseous repair and augmentation of repair with a Graft Jacket allograft acellular human dermal matrix (Graft jacket; Wright Medical Technology, Arlington, TN). Patients and Methods In this prospective study we include 18 consecutive patients with Hip abductor avulsions following a primary total Hip arthroplasty through Hardinge approach for osteoarthritis. All the patients presented with pain around lateral aspect of Hip, walking with a significant Trendelenberg limp and used a crutch or a stick in the opposite hand. Diagnosis was made by clinical examination and confirmed by MRI scans. Surgical Technique Surgical procedure was through lateral approach using the old scar to mobilise combined aponeurosis of the Gluteal Medius and Gluteus Minimus from the bony bed on the ilium to permit advancement onto the trochanter. The conjoint Gluteus Medius and Minimus insertion was affixed to the greater trochanter with No.5 non absorbable trans-osseous suture using a Krackow stitch through a series of transverse tunnels made in anterior aspect of greater trochanter. An on lay augmentation (Fig. 1) of the osseo-tendinous junction was performed using a Graft Jacket matrix of 4 × 7 cms in size after rehydration according to the manufacturer9s instructions. Results At mean follow up of 22 months (15–34 months), pain improved in all patients with mean VAS score improving from 8.25 to 2.33 (p value-0.05). All the patients had improvement in their abductor strength with MRC grade 4 out of 5 in 16 patients and 3 out of 5 in 2 patients. Trendelenberg sign disappeared in all but two. Mean Harris Hip score improved from 34.05 to 81.26 (p value-0.001). All patients had improvement in gait except mild noticeable limp in two patients.13 patients did not use any walking aids and five felt more secure using a walking stick in the contralateral hand. The mean SF-36 Physical component score was 53.47 and Mental component score was 56.07. Conclusions The procedure is safe and associated with high patient satisfaction, without the morbidity of tendon or muscle transfers. The Graft Jacket Matrix provides biological bridging between the Hip Abductors and its insertion into greater trochanter. It provides a biological scaffold for cellular and vascular in-growth and constructive tissue remodelling. The described procedure appears to enhance the mechanical strength of repaired tendon immediately following surgery. The Graft Jacket allograft matrix has already been used successfully in rotator cuff repairs of shoulder and has showed encouraging results. The early success of this new procedure warrants further study with more patients, longer follow-up and possibly histological study of retrieved specimens.
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surgical repair of Hip Abductors a new technique using graft jacket allograft acellular human dermal matrix
International Orthopaedics, 2012Co-Authors: Biyyam Rao, Tamer Kamal, John Vafaye, Lee TaylorAbstract:Purpose Avulsion of the Abductors from the Hip can be an infrequent but debilitating complication after total Hip arthroplasty performed through a trans-gluteal approach. This can result in intractable pain, limp, Trendelenberg lurch and instability of the Hip. There have been various methods described for repairing or reconstruction of this abductor muscle complex including direct trans-osseous repair, muscle transfers, muscle and tendon sling, bone tendon allograft reconstruction and endoscopic repair techniques.
Christopher M. Powers - One of the best experts on this subject based on the ideXlab platform.
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improvements in Hip muscle performance result in increased use of the Hip extensors and Abductors during a landing task
American Journal of Sports Medicine, 2014Co-Authors: Kristen M Stearns, Christopher M. PowersAbstract:Background:Impaired Hip muscle performance has been implicated as a contributing factor to the increased risk of anterior cruciate ligament (ACL) injury in women.Purpose:To determine the influence of a Hip-focused training program on lower extremity biomechanics during a drop-jump task.Study Design:Descriptive laboratory study.Methods:Twenty-one recreationally active women (18-25 years of age) participated in a 4-week training program consisting of Hip-focused plyometric and balance perturbation exercises (3 times/wk, 30 min/session). Maximum isometric strength of the Hip extensors, Hip Abductors, and knee extensors was assessed, along with lower extremity biomechanics during a drop-jump task. All assessments were performed within 5 days of initiation and completion of the training program.Results:After training, subjects demonstrated significantly greater maximum isometric strength of the Hip extensors (2.87 ± 0.7 vs 3.11 ± 0.7 N·m/kg; P < .01) and Hip Abductors (2.08 ± 0.7 vs 2.23 ± 0.07 N·m/kg; P = .00...
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description of a weight bearing method to assess Hip abductor and external rotator muscle performance
Journal of Orthopaedic & Sports Physical Therapy, 2013Co-Authors: Szuping Lee, Christopher M. PowersAbstract:Study Design Measurements, descriptive. Objectives To describe a weight-bearing method to assess bilateral Hip abductor and external rotator muscle performance. Background The Hip Abductors and external rotators are important in maintaining lower extremity alignment during weight-bearing tasks. As such, there is a need for a method to assess Hip muscle performance in weight bearing. Methods The weight-bearing method of assessing Hip muscle performance utilized a force transducer connected to a nonstretchable fabric strap positioned around the distal ends of both thighs (proximal to the lateral epicondyles). The force generation capacity was recorded with the participants in a semi-squat position (30° of Hip flexion and 50° of knee flexion). To establish the reliability of the measurement, 20 participants were tested on 2 separate days, and intraclass correlation coefficient (model 3,1) and standard error of measurement were calculated to evaluate test-retest reliability and intersession consistency. The l...
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which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata electromyographic assessment using fine wire electrodes
Journal of Orthopaedic & Sports Physical Therapy, 2013Co-Authors: David M Selkowitz, George J Beneck, Christopher M. PowersAbstract:Study Design Controlled laboratory study, repeated-measures design. Objectives To compare Hip abductor muscle activity during selected exercises using fine-wire electromyography, and to determine which exercises are best for activating the gluteus medius and the superior portion of the gluteus maximus, while minimizing activity of the tensor fascia lata (TFL). Background Abnormal Hip kinematics (ie, excessive Hip adduction and internal rotation) has been linked to certain musculoskeletal disorders. The TFL is a Hip abductor, but it also internally rotates the Hip. As such, it may be important to select exercises that activate the gluteal Hip Abductors while minimizing activation of the TFL. Methods Twenty healthy persons participated. Electromyographic signals were obtained from the gluteus medius, superior gluteus maximus, and TFL muscles using fine-wire electrodes as subjects performed 11 different exercises. Normalized electromyographic signal amplitude was compared among muscles for each exercise, usi...
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management of patellofemoral pain targeting Hip pelvis and trunk muscle function 2 case reports
Journal of Orthopaedic & Sports Physical Therapy, 2003Co-Authors: Catherine L Mascal, Robert Landel, Christopher M. PowersAbstract:Study Design Case report. Objective To describe an alternative treatment approach for patellofemoral pain. Background Weakness of the Hip, pelvis, and trunk musculature has been hypothesized to influence lower-limb alignment and contribute to patellofemoral pain. Two patients who had a chief complaint of patellofemoral pain and demonstrated lack of control of the Hip in the frontal and transverse planes during functional movements were treated with an exercise program targeting the Hip, pelvis, and trunk musculature. Methods and Measures The patients presented in these 2 case reports did not exhibit obvious patellar malalignment or tracking problems; however, on qualitative assessment, both demonstrated excessive Hip adduction, internal rotation, and knee valgus during gait and while performing a step-down maneuver. In addition, both patients exhibited weakness of the Hip Abductors, extensors, and external rotators, as demonstrated by hand-held dynamometry testing. Treatment in both cases occurred over a ...
Franziska Daun - One of the best experts on this subject based on the ideXlab platform.
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Different strength declines in leg primary movers versus stabilizers across age-Implications for the risk of falls in older adults?
PloS one, 2019Co-Authors: Franziska Daun, Armin KibeleAbstract:This study investigated differences in the declines of isometric strength in Hip Abductors and adductors versus knee extensors across four different age groups (n = 31: 11.2 ± 1.0 y, n = 30: 23.1 ± 2.7 y, n = 27: 48.9 ± 4.4 y, and n = 33: 70.1 ± 4.2 y) with a total of 121 female subjects. As a starting point, we assumed that, during their daily activities, elderly people would use their leg stabilizers less frequently than their leg primary movers as compared to younger people. Given that muscle strength decreases in the course of the aging process, we hypothesized that larger strength declines in Hip Abductors and Hip adductors as compared to knee extensors would be detected across age. Maximal isometric force for these muscle groups was assessed with a digital hand-held dynamometer. Measurements were taken at 75% of the thigh or shank length and expressed relative to body weight and lever arm length. Intratester reliability of the normalized maximal torques was estimated by using Cronbach’s alpha and calculated to be larger than 0.95. The obtained results indicate a clearly more pronounced strength decline in Hip Abductors and Hip adductors across age than in the knee extensors. Therefore, a particular need for strength training of the lower extremity stabilizer muscles during the aging process is implied.
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Significances of Tukey-HSD post-hoc tests for the group mean difference of the normalized maximal torques (lower left corner shaded in grey) in the knee extensors (KE), the Hip Abductors (AB), and the Hip adductors (AD) as well as for the ratios (upp
2019Co-Authors: Franziska Daun, Armin KibeleAbstract:Significances of Tukey-HSD post-hoc tests for the group mean difference of the normalized maximal torques (lower left corner shaded in grey) in the knee extensors (KE), the Hip Abductors (AB), and the Hip adductors (AD) as well as for the ratios (upper right corner) between Hip Abductors vs Hip adductors vs knee extensors (AB/AD, AB/KE, AD/KE) in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 = 41- to 55-year old females, and AG70 = 63- to 79-year old females).
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Ratios of normalized maximal torque ratios between the Hip Abductors and Hip adductors in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 = 41- to 55-year old females, and AG70 = 63- to 79-year old female
2019Co-Authors: Franziska Daun, Armin KibeleAbstract:Ratios of normalized maximal torque ratios between the Hip Abductors and Hip adductors in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 = 41- to 55-year old females, and AG70 = 63- to 79-year old females).
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Normalized maximal torques in the knee extensors (KE = solid line), the Hip Abductors (AB = dashed line), and the Hip adductors (AD = dashdotted line) in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 =
2019Co-Authors: Franziska Daun, Armin KibeleAbstract:Normalized maximal torques in the knee extensors (KE = solid line), the Hip Abductors (AB = dashed line), and the Hip adductors (AD = dashdotted line) in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 = 41- to 55-year old females, and AG70 = 63- to 79-year old females).
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Ratios of normalized maximal torque ratios between the Hip Abductors and the knee extensors (AB-KE) (dashed line) and the Hip adductors and the knee extensors (AD-KE) (dashed line) in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- t
2019Co-Authors: Franziska Daun, Armin KibeleAbstract:Ratios of normalized maximal torque ratios between the Hip Abductors and the knee extensors (AB-KE) (dashed line) and the Hip adductors and the knee extensors (AD-KE) (dashed line) in the four age groups (AG10 = 10- to 13-year old girls, AG25 = 19- to 29-year old females, AG50 = 41- to 55-year old females, and AG70 = 63- to 79-year old females).