BACKGROUND: Painful habitual instability of the thumb basal joint (PHIT) is a rarely diagnosed condition that can severely impair hand function. Furthermore, it can increase the risk of developing carpometacarpal arthritis of the thumb (CMAOT). Clinical examination and radiographic imaging provide the foundation for a correct diagnosis, but early detection is still challenging. We investigated two objective, radiographically obtainable parameters as potential risk factors for PHIT.
METHODS: Clinical data and radiographic images of 33 patients suffering from PHIT were collected and compared to those of 35 people serving as the control group. The two main objectives, the slope angle and the bony offset of the thumb joint, were gathered from the X-rays and statistically analyzed.
RESULTS: The analysis showed no differences between the study and the control group concerning the slope angle. Gender and the bony offset, on the other hand, had a significant influence. Female sex and higher offset values were associated with an increased risk of PHIT.
CONCLUSIONS: The results of this study prove a connection between a high bony offset and PHIT. We believe this information can be valuable in early detection and will allow more efficient treatment of this condition in the future.

BACKGROUND: Posterior-stabilized (PS)-total knee arthroplasty (TKA) arose as an alternative to cruciate-retaining (CR)-TKA in the 1970s. Since then, it has become a popularly utilized TKA design with outcomes comparable to CR-TKA. The post-cam mechanism is unique to PS-TKA as it substitutes the function of the posterior cruciate ligament (PCL). The study aimed to understand the kinematic and laxity changes in PS-TKA with under- and overstuffing of the tibiofemoral joint space with the polyethylene (PE) insert.
METHODS: This study employed a hybrid computational-experimental joint motion simulation on a VIVO 6 degrees of freedom (6-DoF) joint motion simulator (AMTI, Watertown, MA, USA). Physical prototypes of a virtually-performed TKA in mechanical alignment (MA) and kinematic alignment (KA) based on cadaveric CT scans and a virtual ligament model were utilized. The reference, understuffed (down 2 mm) and overstuffed (up 2 mm) joint spaces were simulated, neutral flexion and laxity testing loads and motions were performed for each configuration.
RESULTS: The PE insert thickness influenced post-cam engagement, which occurred after 60º in the overstuffed configurations, after 60º-75º in the reference configurations and after 75º in the understuffed configurations. The understuffed configurations, compared to the reference configurations, resulted in a mean 2.0º (28%) and 2.0º (31%) increase in the coronal laxity in MA and KA respectively. The overstuffed configurations, compared to the reference configuration, resulted in an increase in the mean joint compressive forces (JCFs) by 73 N (61%) and 77 N (62%) in MA and KA models, respectively.
CONCLUSIONS: The under- and overstuffing in PS-TKA alter the kinematics with variable effects. Understuffing decreases the stability, JCFs and inverse with overstuffing. Subtle changes in the PE insert thickness alter the post-cam mechanics.

UNASSIGNED: Ligamentous laxity is a condition that leads to joints\' hypermobility beyond their average and normal range of motion. It can cause musculoskeletal and joint injuries. This national multi-centered study investigated the epidemiology of generalized ligamentous laxity and its relationship with musculoskeletal disorders among Iranian adults with different ethnic backgrounds.
UNASSIGNED: A total of 1,488 people (age range: 17-40 years) were selected from eight cities and six different ethnicities of Iran and included in this cross-sectional study. The presence of ligamentous laxity with clinical examinations was searched according to Beighton score criteria. They were also examined for any kind of musculoskeletal disorders that might accompany ligamentous laxity. The Chi-square test was used to compare the frequency of ligamentous laxity based on gender and ethnicity; moreover, the t-test was utilized to compare the frequency of ligamentous laxity based on age.
UNASSIGNED: In total, 280 (18.8%) participants had generalized ligamentous laxity, and it was more prevalent in women (22.7%), compared to men (14.4%). Regarding ethnicity, the highest and lowest prevalence rates were in Gilak (37.9%) and Persian-Arab (6%) ethnicities, respectively (P<0.001). Ligamentous laxity showed a significant relationship with sports injury, joint complaint, joint dislocation, ligament sprain, sciatica and back pain, Baker\'s cyst, and varicose veins (P<0.001). Most participants with generalized ligamentous laxity (93.6%) had no knowledge of their problem and its importance in choosing an appropriate sports activity.
UNASSIGNED: The prevalence of generalized ligamentous laxity seems to be relatively high among the 17-40-year-old population of Iran, especially in women. It seems to be significantly related to ethnicity. It is strongly recommended that examinations, screening, and information be provided at an early age in schools or at least in areas with a high prevalence as national programs.

UNASSIGNED: The aim of this study was to investigate the frequency of mitral valve prolapse between healthy females with generalized joint hypermobility and healthy controls.
UNASSIGNED: This observational, cross-sectional, controlled study included female individuals with generalized joint hypermobility (n=39, mean age: 20.5±1.1 years; range, 19 to 23 years) and healthy controls (n=42, mean age: 20.6±1.2 years; range, 18 to 23 years) between July 2017 and November 2017. The generalized joint hypermobility consisted of women with a Beighton score of ≥4, while the control group consisted of women with a Beighton score of ≤3. Echocardiography was performed to all participants. Mitral valve prolapse was defined as having single or bileaflet prolapse of at least 2 mm beyond the long-axis annular plane with or without mitral leaflet thickening.
UNASSIGNED: No significant difference was found in the age, height, body weight, and body mass index between the groups (p>0.05). The median Beighton score was 5 in the generalized joint hypermobility group and 2 in the control group. No mitral valve prolapse was detected in those with generalized joint hypermobility, while non-classical mitral valve prolapse was observed in one participant in the control group, indicating no statistically significant difference between the two groups (p>0.05).
UNASSIGNED: Our study results suggest that the frequency of mitral valve prolapse is comparable between the women with generalized joint hypermobility and healthy controls. Based on these results, routine assessment of mitral valve prolapse is not recommended in this population.

BACKGROUND: Soft tissue balancing in bicruciate-retaining (BCR) total knee arthroplasty (TKA) is a challenge that must be overcome to achieve excellent clinical outcomes. However, the optimal degree of joint laxity has yet to be clarified. This cadaveric study sought to examine joint laxity after BCR TKA using a navigation system.
METHODS: Knee joint laxity was quantified using an image-free navigation system in 8 intact fresh frozen cadavers under three conditions: the native knee, BCR TKA knee, and BCR TKA knee after anterior cruciate ligament resection. Rotational kinematics in the BCR TKA knee during flexion were compared according to whether joint laxity was increased or decreased.
RESULTS: Knee joint laxity after BCR TKA under varus-valgus movement, anterior translation, and internal-external rotation loadings was similar to that of the native knee. However, lateral joint laxity was decreased during flexion in some cases. BCR TKA-treated knees with decreased lateral joint laxity at 90° of flexion demonstrated more limited tibial internal rotation in deep flexion than the native knee (p < 0.05). The loss of internal rotation in deep flexion was partly recovered by using a lateral insert with a posterior slope of +3°.
CONCLUSIONS: Restoring optimal joint laxity was not always straightforward in BCR TKA if the 4 ligaments were preserved. Lateral joint laxity was potentially decreased in BCR TKA and may result in kinematic conflict during flexion. Surgeons should be aware of the need to achieve sufficient lateral joint laxity in this type of BCR TKA.

BACKGROUND: A high incidence of joint laxity has been reported among Asians compared with Western populations, but clear differences between more specific ethnic populations have not been established. This study aimed to determine the average knee laxity in the Malaysian and Jordanian populations.
METHODS: Jordanian and Malaysian medical students from our institution were invited to participate in the study. General demographic data and factors affecting joint laxity were obtained from each participant using a printed questionnaire. Both knees were examined using the anterior drawer test while in 90° of flexion. Knee laxity was measured by three separate independent investigators through a knee laxity tester.
RESULTS: One hundred and eighty-six participants (95 females) were enrolled in the study. Among them, 108 Malaysians participated. The Jordanians had significantly higher knee laxity in both knees compared with the Malaysians. The mean average right knee laxity for Jordanians was 2.98 mm vs. 2.72 mm for Malaysians (P = 0.005). Similarly, the mean average left knee laxity for Jordanians was 2.95 mm, while for Malaysians, it was 2.62 mm (P = 0.0001). Furthermore, smokers had significantly more laxity in both knees. After performing a multivariate linear regression analysis for all factors, race was the only independent factor that affected knee laxity in both knees.
CONCLUSIONS: Race is directly associated with knee laxity. Jordanians tend to have more laxity in knee joints compared with Malaysians. Larger multi-center and genetic studies are recommended to establish the racial differences between different ethnic groups.

Little attention has been paid to psychosocial factors in Joint Hypermobility Syndrome and Ehlers-Danlos Syndrome (hypermobility type). This study sought to identify the psychosocial impact by examining participants\' lived experiences; and identify characteristics of effective coping.
Adults with Joint Hypermobility Syndrome and Ehlers-Danlos Syndrome (Hypermobility Type) were invited to discuss their own lived experiences and the impact of the condition. All met recognized criteria for clinically significant joint hypermobility, and had a self-confirmed diagnosis. The transcripts were coded and analyzed using inductive thematic analysis.
Seventeen participants (14 women, 3 men) purposively selected to broadly represent different genders, ages and ethnicities. Analysis identified five key themes: healthcare limitations, a lack of awareness of Joint Hypermobility, and Ehlers-Danlos Syndrome (Hypermobility Type) among healthcare professionals; a restricted life; social stigma; fear of the unknown; and ways of coping.
The results highlight the significant psychosocial impact on participants\' lives. Coping approaches identified included acceptance, building social networks, learning about joint hypermobility, and adapting activities. Physiotherapists supported regular exercise. Further research should consider potential interventions to improve information provision, address psychological support, and increase awareness of hypermobility among healthcare professionals.Implications for rehabilitationParticipants who had help from family members to complete activities described guilt and shame, highlighting the need for a greater rehabilitation focus on maintaining independence.Difficulties with sexual relationships due to prolapse or erectile dysfunction, and associated anxieties have indicated a need for greater awareness of these issues within primary care.The provision of reliable information and materials is vital, both for healthcare professionals and patients, to reduce misinformation and fear.Physiotherapists with knowledge of Joint Hypermobility Syndrome and Ehlers-Danlos Syndrome hypermobility type were cited as sources of support and hope, which helped people to cope with and manage their condition.

Subjects with Down syndrome (DS) are known to be affected by various foot deformities. Despite the fact that some of these deformities have been reported in the literature, a more comprehensive description would be of benefit. The aim of this study is to investigate the prevalence of known foot deformities in patients with DS and of other previously non-described foot anomalies in this population.
Subjects with DS have an increased prevalence of foot deformities compared to control subjects.
Fifty-five subjects with DS (age: 14.6±7.4 years) had undergone podiatric clinical and podoscopic examinations to study their main foot deformities and their footprints, respectively. The results of these examinations were compared to those of an age-matched asymptomatic control group of fifty-three subjects (age: 13.4±11.2 years).
Significantly more prevalent foot deformities were found in the DS group: hallux valgus (36.4%), syndactyly between the 2nd and 3rd toes (9.1%), grade II pes planus (39.1%) and grade III pes planus (30%). Moreover, joint laxity (43.6%) was significantly more prevalent in the DS group. Furthermore, the presence of an increased space between the 1st and 2nd toes in patients with DS and its prevalence (73.6%) were described for the first time. A multivariate analysis revealed a significant relationship between the presence of joint laxity and flatfoot in only the control but not the DS group. Other foot deformities were found to be consistently more frequent in the DS population but not significantly higher than the control group.
Although subjects with DS had significantly greater joint laxity and BMI compared to the control group, neither of these factors was found to be related to the increased prevalence of flatfoot in DS patients.
IV-retrospective study.