Hassan Tarek Hakam

Purpose: To systematically evaluate the morphology, temporal evolution and musculoskeletal adaptations associated with semitendinosus tendon (ST) and muscle (SM) regeneration after isolated ST autograft harvest for primary anterior cruciate ligament reconstruction (ACLR). Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Embase, Scopus and Web of Science were searched from inception to 20 December 2025. Eligible studies included primary ACLR with isolated ST autografts and objective post‐operative assessment of ST or SM regeneration using imaging (ultrasound, magnetic resonance imaging and computed tomography) or histology. Methodological quality was evaluated using the JBI checklist for randomized controlled trials and the Methodological Index for Non‐Randomized Studies instrument for non‐randomized studies. Due to heterogeneity in surgical techniques, imaging protocols, follow‐up intervals and regeneration definitions, results were synthesized narratively according to synthesis without meta‐analysis principles, with regeneration frequencies reported by modality and predefined time windows. Results: Sixteen studies comprising 376 patients (mean age 25.5 years) were included. Across studies, tendon‐like continuity was frequently detected between 6 and 12 months post‐operatively, although reported regeneration rates varied depending on imaging modality and definitional criteria. The regenerated neotendon (NT) typically demonstrated non‐anatomical distal attachment or fusion patterns, accompanied by proximal migration of the musculotendinous junction, permanent shortening and atrophy of the SM. Conclusion: The ST and SM exhibit robust biological potential for regeneration after isolated harvest, typically forming a viable NT within the first post‐operative year. However, regeneration does not restore native anatomy; significant muscle shortening, atrophy and proximal insertion shifts are consistent findings. Despite these morphological deficits, the high rate of tissue continuity supports the isolated ST graft as a low‐morbidity option that preserves overall hamstring complex integrity. Level of Evidence: Level IV.

Introduction: Mobile applications targeting physiotherapeutic care after total joint replacements are increasing in popularity among end-users. However, these applications were primarily conceived out of financial interest and lack an evidence-based programs tailored to the specific needs of the target population. The primary objective of this study is to describe the conception of an evidence-based mobile health application that targets early postoperative physiotherapeutic care after total knee replacement (TKR).Methods: A literature search of eHealth applications targeting physical therapy after TKR was carried out. Articles were then screened and suggestions as well as recommendations were extracted to inform the design of a new application. The beta version of the application was then passed onto experts for evaluation. Final changes were then undertaken to account for the expert's opinions.Results: Several reviews with recommendations for the design of applications targeting patients after total joint replacement were identified. Primarily, mobile applications targeting rehabilitative care after TKR need to be tailored to the needs of the elderly population. Additionally, no unified rehabilitative physiotherapeutic (PT) program was found reflecting a discrepancy regarding what exercises are most useful. A comparison of different programs yielded no significant difference favoring one single exercise regimen.Discussion: As the elderly population was shown to be less proficient regarding the use of new technologies, the application at hand was explicitly made simple. Elements of different PT programs were incorporated and quadriceps strengthening exercises were included. application was composed based on the findings of the reviewed literature and then subsequently modified to incorporate the expert's suggestions. Experts mainly expressed concerns regarding the safety of patients during unsupervised physical therapy as well as the safety of the recorded data. Thus, password protection and a split between the physician's and the patient's interface was created.

Antigravity treadmill training provides a viable option for physiotherapeutic care after knee surgery, especially for conditions that do not allow full weight bearing during the early phase post-intervention. This overview of the current state of knowledge identifies gaps and highlights areas where more research on antigravity treadmill training after knee surgery is needed. This review aimed to analyze and summarize the available evidence concerning the effects of antigravity treadmill training on patients after knee joint surgical procedures, including anterior cruciate ligament reconstruction (ACLR) and total (TKA) and unicompartmental knee arthroplasty (UKA). Several databases were searched for relevant material, including PubMed, Epistemonikos, the Cochrane Library, the Web of Science, and Google Scholar. Seven studies investigating antigravity treadmill training after various procedures were included, including ACLR and TKA. The studies were summarized, and the quality of evidence was evaluated using the appropriate tools. The evidence yielded by these studies suggests that antigravity treadmill training might be useful after knee surgery. However, the superiority over traditional physiotherapeutic measures has yet to be established. Therefore, future high-quality randomized controlled trials (RCTs) are needed to investigate the effect of antigravity treadmill training due to the low quality of available evidence. Also, a cost-effectiveness analysis is required to determine whether the investigated intervention fits the purpose.

BACKGROUND Early postoperative physiotherapy following total knee arthrosplasty (TKA) has been demonstrated to improve patient-related outcomes. However, some studies suggest 50% of TKA patients are not active enough to maintain their physical health. Mobile applications have been reported to be as effective as face to face rehabilitation in prior systematic reviews. OBJECTIVE In the protocol at hand, a detailed description of the action plan regarding a randomized controlled trial (RCT) investigating the effect of a mobile reminder application on adherence to physical therapy and patient related outcome will be presented. METHODS This monocentric RCT is carried out at the University Clinic of Brandenburg. Patients between the ages of 55 and 80 with an indication for TKA are recruited during the first outpatient visit. Patients are then randomized into two groups. The treatment group is supplemented with the app-based physical therapy program while the controllers receive a paper-based program in accordance to the standard of procedure. Objective adherence to physical therapy is recorded using accelometry-based sensors. Additionally, patient-reported outcome measures (PROMs) and relevant performance-based measures (PBMs) are noted. The hypothesis of the study is that app-based physical therapy leads to higher compliance than a paper-based approach. Finally, a previously developped non-compliance questionnaire helps uncover the reasons behind non-adherence to physical therapy. RESULTS The primary outcome of this study is sensor-recorded compliance with physical therapy. Secondary outcomes includes the analysis of factors affecting compliance, patient-related outcome measures (PROMs), and patient-based measures (PBMs). CONCLUSIONS Compliance with a physical intervention is classically measured using questionnaires. The novelity of this study lies in the fact that adherence to the intervention is measured objectively using accelometers. As well, to our knowledge, no previous trial assessed a correlation between the degree of compliance to physical therapy on one hand and patient-related or performance-based measures. In the light of what was mentioned, this study might offer insights into regarding the extent to whch postoperative physical therapy has an effect on the postoperative outcome. CLINICALTRIAL The trial was registered at the Deutsches Register klinischer Studien. Registration number: DRKS00031414

Background and Objectives: Muscle properties are critical for performance and injury risk, with changes occurring due to physical exertion, aging, and neurological conditions. The MyotonPro device offers a non-invasive method to comprehensively assess muscle biomechanical properties. This systematic review evaluates the reliability of MyotonPro across various muscles for diagnostic purposes. Materials and Methods: Following PRISMA guidelines, a comprehensive literature search was conducted in Medline (PubMed), Ovid (Med), Epistemonikos, Embase, Cochrane Library, Clinical trials.gov, and the WHO International Clinical Trials platform. Studies assessing the reliability of MyotonPro across different muscles were included. A methodological quality assessment was performed using established tools, and reviewers independently conducted data extraction. Statistical analysis involved summarizing intra-rater and inter-rater reliability measures across muscles. Results: A total of 48 studies assessing 31 muscles were included in the systematic review. The intra-rater and inter-rater reliability were consistently high for parameters such as frequency and stiffness in muscles of the lower and upper extremities, as well as other muscle groups. Despite methodological heterogeneity and limited data on specific parameters, MyotonPro demonstrated promising reliability for diagnostic purposes across diverse patient populations. Conclusions: The findings suggest the potential of MyotonPro in clinical assessments for accurate diagnosis, treatment planning, and monitoring of muscle properties. Further research is needed to address limitations and enhance the applicability of MyotonPro in clinical practice. Reliable muscle assessments are crucial for optimizing treatment outcomes and improving patient care in various healthcare settings.