Cross-cultural adaptation and validation of a revised Italian Anterior Knee Pain Scale version

BACKGROUND

The study aimed to validate a revised Italian version of the Anterior Knee Pain Scale (AKPS) by addressing shortcomings in previous adaptations and following the COSMIN guidelines to ensure robust psychometric evaluation.

METHODS

One hundred thirty patients with anterior knee pain symptoms were recruited, with 65 undergoing a retest after 7 days to assess the scale's reliability. Structural validity was assessed through confirmatory factor analysis (CFA) to evaluate the scale's dimensionality. Internal consistency was measured using Cronbach's alpha, while test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Measurement error was evaluated using the standard error of measurement (SEM) and the smallest detectable change (SDC). Construct validity was examined by correlating the AKPS with other established scales, including the Knee Injury and Osteoarthritis Outcome Score, Internal Knee Documentation Committee, Victorian Institute of Sport Assessment - Patella, Short-Form 36 Health Survey, and the Visual Analogue Scale.

RESULTS

The CFA supported a three-factor model encompassing pain intensity and interference, functional limitations in daily activities, and knee structural and functional issues. The scale demonstrated good internal consistency (Cronbach's α=0.79) and excellent test-retest reliability (ICC=0.91), with low measurement error (SEM<5%). Construct validity was confirmed through moderate-to-strong correlations with related scales, particularly in domains related to pain intensity, symptoms, and daily functioning.

CONCLUSIONS

The newly validated scale, demonstrating strong psychometric properties, meets international standards for clinical assessment tools, making it a reliable and effective instrument for assessing anterior knee pain in the Italian context.

Comprehensive analysis of participant characteristics in clinical trials on patellar tendinopathy: A systematic review

Several randomized controlled trials (RCTs) have been developed to identify effective treatment approaches for patellar tendinopathy (PT). However, descriptions of study participants often lack clarity, which complicates clinicians' ability to determine if the results are applicable to their patients. Recently, the International Tendinopathy Consensus (ICON-T) established recommendations on participant characteristics that should be reported in RCTs on tendinopathies. This review aims to assess the comprehensiveness of participant information reporting in RCTs involving individuals with PT. A systematic review was conducted in electronic databases up to January 2024, targeting RCTs that included individuals with PT. The quality of participant information reporting was evaluated using a scale based on ICON-T recommendations. Pearson's correlation test was utilized to explore the relationship between the publication year and the quality of reporting. Forty-three RCTs were reviewed, involving 1647 participants (1244 men, average age 28.35 ± 4.28 years). The studies' average score on the quality reporting scale was 10.16 ± 2.37 (range 6-15 points) out of a possible 16 points. The most frequently omitted details were medication usage and comorbidity presence. There was a significant correlation between publication year and report quality (r = 0.349; p = 0.024). In conclusion, RCTs involving PT subjects often have heterogeneous inclusion criteria and incomplete participant information, potentially confusing researchers and clinicians about the effectiveness of different PT treatments. However, the situation has improved following the ICON-T publication, enhancing the quality of reports.

Complete and Partial Tears of the Anterior Cruciate Ligament: Acute and Evolution

Anterior cruciate ligament tears represent a prevalent injury in sports that involves rotational movements and rapid changes in direction, such as pivot-contact sports. The anterior cruciate ligament serves as the primary stabilizer of the knee, preventing anterior tibial translation and medial tibial rotation. Although clinical examination is essential for diagnosis, magnetic resonance imaging plays a crucial role in confirming complete tears and evaluating associated injuries, particularly meniscal injuries. Diagnosis relies on both direct and secondary signs that are instrumental in assessing knee laxity and stability. Despite advancements in imaging techniques, challenges persist in using magnetic resonance imaging to distinguish between complete and partial tears, evaluate knee instability, and determine the potential for anterior cruciate ligament healing.

The effects of blood flow restriction combined with low-intensity resistance training on muscle strength and pain during postoperative recovery in patients with knee injuries: a meta-analysis

To investigate the effects of low-load blood flow restriction training (LL-BFRT) on muscle strength and pain during postoperative rehabilitation in patients with knee injuries. A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Comprehensive searches through PubMed, EBSCO, Cochrane, Web of Science, and Embase yielded 1049 articles, of which 13 studies met the inclusion criteria. Quantitative analyses were performed using Review Manager 5.3 and Stata. LL-BFRT showed a significant positive effect on muscle strength, with a standardized mean difference (SMD) of 0.70 (p < 0.00001, 95%CI: 0.49, 0.92, I2 = 42%, p = 0.07). In terms of pain reduction, LL-BFRT significantly lowered the outcome of visual analog scale (VAS), with an SMD of -0.60 (p < 0.00001, 95% CI: -0.85, -0.36, I2 = 0%, p = 0.44). LL-BFRT effectively improves muscle strength and reduces pain in patients recovering from knee injuries postoperatively. It presents an alternative rehabilitation method for patients who are unable to perform high-intensity resistance training.

Exercise for patellar tendinopathy

BACKGROUND

Patellar tendinopathy is a prevalent condition that commonly affects the tendon's origin, causing pain at the front of the knee. The main treatment for patellar tendinopathy involves different types of exercise (e.g. strengthening and stretching). The most common method of strengthening exercise is eccentric (lengthening) muscle loading. Strengthening exercises can be land-based or water-based, weight-bearing or non-weight-bearing, or both. Other treatments include surgery and glucocorticoid injections.

OBJECTIVES

To evaluate the benefits and harms of exercise for the treatment of patellar tendinopathy.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and two trials registers to 5 September 2023, with no restrictions by language.

SELECTION CRITERIA

We included randomized controlled trials of strengthening exercise interventions compared to placebo or sham intervention; no treatment, usual care, or minimal intervention; or other active intervention. Strengthening exercises include concentric, eccentric, eccentric-concentric, and isometric exercises designed to enhance the strength and power of muscles.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. Major outcomes included pain, function, participant-reported global assessment of treatment success, quality of life, return to sport, proportion of participants with adverse events, and proportion of participant withdrawals.

MAIN RESULTS

We included seven trials (211 participants with chronic patellar tendinopathy) comparing strengthening exercises with no treatment (3 trials, 93 participants), glucocorticoid injection (1 trial, 38 participants), surgery (1 trial, 40 participants), stretching exercise (1 trial, 15 participants), or pulsed ultrasound and transverse friction (1 trial, 30 participants). All trials included athletes (88% males, mean age 26 years) with a mean duration of symptoms of 41.6 months. Most trials were susceptible to bias, particularly selection bias/random sequence (57.1%), selection bias/allocation concealment (42.8%), detection bias (28.5%), attrition bias (71.4%), and selective reporting biases (28.5%). Given the nature of the intervention, neither participants nor investigators were blinded to group allocation in any trials (performance bias). We did not find any studies that compared exercise with placebo or sham intervention. Strengthening exercise versus no treatment We are very uncertain whether strengthening exercise reduces pain compared to no treatment. Mean pain with no treatment was 62.00 points on a 0 to 100 scale (0 = no pain) compared to 27.06 points with exercise (mean difference (MD) 34.94 points better, 95% confidence interval (CI) 20.94 better to 48.94 better; 1 study, 39 participants; very low-certainty evidence (downgraded twice for imprecision and once for bias)). Strengthening exercise may make little or no difference to function compared to no treatment at the end of treatment. Mean function with no treatment was 65.00 points on a 0 to 100 scale (100 = best function) compared to 72.04 points with exercise (MD 7.04 points better, 95% CI 6.94 points worse to 21.02 points better; 2 studies, 95 participants; low-certainty evidence (downgraded once for imprecision and once for bias)). The studies reported none of the other outcomes. Strengthening exercise versus glucocorticoid injection Strengthening exercise may make little or no difference to pain compared to glucocorticoid injection at the end of treatment. Mean pain with glucocorticoid injection was 18.00 points on a 0 to 100 scale (0 = no pain) compared to 24.04 points with exercise (MD 6.04 points worse, 95% CI 8.19 better to 20.26 better; 1 trial, 38 participants; low-certainty evidence (downgraded twice for imprecision)). Strengthening exercise may make little or no difference to function compared to glucocorticoid injection at the end of treatment. Mean function with no treatment was 82.00 points on a 0 to 100 scale (100 = best function) compared to 76.25 points with exercise (MD 5.75 points worse, 95% CI 17.41 worse to 5.93 better; 1 trial, 38 participants; low-certainty evidence (downgraded twice for imprecision)). The trial reported none of the other outcomes. Strengthening exercise versus surgery We are very uncertain whether strengthening exercise reduces pain compared to surgery at 12-month follow-up. Mean pain with surgery was 13.00 points on a 0 to 100 scale (0 = no pain) compared to 17.00 points with exercise (MD 4.00 points worse, 95% CI 4.06 better to 12.06 worse; 1 trial, 40 participants; very low-certainty evidence). We are very uncertain whether strengthening exercise improves function compared to surgery. Mean function in the surgery group at the end of treatment was 45.10 points on a 0 to 100 scale (100 = best function) compared to 52.4 points in the exercise group (MD 7.30 points better, 95% CI 5.02 worse to 19.62 better; 1 trial, 40 participants; very low-certainty evidence (downgraded once for bias and twice for serious imprecision)). Strengthening exercise may make little or no difference to treatment success compared to surgery at the end of treatment. The mean global assessment of treatment success with surgery was 0.2 points on a -5 to +5 scale (+5 maximum was improvement) compared to 1.76 points with exercise (MD 1.56 points better, 95% CI 0.52 worse to 3.64 better; 1 trial, 40 participants; low-certainty evidence (downgraded once for bias and once for imprecision)). Strengthening exercise may make little or no difference to the rate of participants who returned fully or partially to sport when compared to surgery at 12-month follow-up. The return to sport rate with surgery was 86% compared to 85% with exercise (risk ratio 1.02, 95% CI 0.78 to 1.34; 1 trial, 40 participants; low-certainty evidence (downgraded once for bias and once for imprecision)). The trial reported none of the other outcomes.

AUTHORS' CONCLUSIONS

We are very uncertain whether strengthening exercise reduces pain compared to no treatment. Strengthening exercise may make little or no difference to function compared to no treatment and to function or pain compared to glucocorticoid injection. Compared to surgery, we are very uncertain whether strengthening exercise reduces pain or improves function, and it may make little or no difference to treatment success and the proportion of athletes returning to sport. No trials measured adverse events. All trials analyzed in this review included participants who were athletes, limiting the findings to athletes rather than the general public.

Treatment Decision-Making for Anterior Cruciate Ligament Rupture From the Perspective of Physical Therapists in Australia: A Mixed Methods Study

IMPORTANCE

In Australia, few people with acute anterior cruciate ligament (ACL) rupture are managed with rehabilitation alone despite clinical trials demonstrating similar outcomes to ACL reconstruction (ACLR). The reasons for the low uptake of rehabilitation alone for the treatment of acute ACL rupture in Australia are unclear.

OBJECTIVES

The objectives of this study were to evaluate physical therapists' beliefs and the information they provide to patients about treatment options for ACL rupture, and to explore ACL rupture treatment decision-making from the perspective of physical therapists.

DESIGN

The design was a mixed-methods convergent parallel design comprising an Australia-wide survey (n = 246) and semi-structured interviews (n = 10).

PARTICIPANTS

Participants included physical therapists who manage people with ACL rupture in Australia.

MAIN OUTCOMES

The survey contained 41 items that assessed demographics, treatment of ACL rupture, referral pathways, treatment beliefs, and the information provided to patients with ACL rupture.

RESULTS

Physical therapists' beliefs about treatment options varied and did not always reflect the information they provided to patients. Although 60% agreed that ACLR and rehabilitation-alone result in similar outcomes on average, only 37% reported regularly informing patients about this. To return to pivoting/contact sport, 23% believed that ACLR was required and 79% informed patients that ACLR was the best treatment to do so. Physical therapists felt that rehabilitation-alone is underutilized as a treatment for ACL rupture. Physical therapists encountered barriers to offering and providing rehabilitation-alone for ACL rupture, reflected in 7 qualitative themes: preference for surgery reflecting societal beliefs; more weight given to surgeon's opinion; unbalanced information from surgeon; referral pathways; uncertain recovery timeline; beliefs about treatment suitability; and knowledge and experience.

CONCLUSIONS

Physical therapists had mixed beliefs about treatment options and the information provided to patients was not always evidence based. Physical therapists felt that nonsurgical management was underutilized, and experienced barriers to offering and providing non-surgical management of ACL rupture in clinical practice.

RELEVANCE

Informed decision-making can only occur if accurate, evidence-based information about ACL rupture treatment options is provided to patients. These findings may be used to guide professional development for physical therapists and inform strategies to improve evidence uptake by physical therapists.

MRI analysis of the physiological patellofemoral joint morphology of adult knees

OBJECTIVE

The aim of the present study was to determine physiological reference values for the morphology of the patella and to analyse these parameters according to patella position in healthy knee joints.

MATERIAL AND METHODS

Healthy knee joints of 409 patients (mean age, 52.3 years [± 16.8]) were analysed retrospectively on MRI images for Insall-Salvati index (ISI), sagittal patella thickness (PTS) and patella length (PLS) as well as axial patella thickness (PTA) and patella width (PWA). Differences between patellar diameters were analysed depending on ISI, side, age and gender.

RESULTS

Mean PTS was 20.1 mm (± 2.4), PLS 44.0 mm (± 4.4), PTA 21.8 mm (± 2.4) and PWA 44.5 mm (± 4.7). Depending on the vertical patellar position (ISI), all patellar parameters (p < 0.01) showed significant differences between patients with a patella alta, norma and baja. In general, a smaller ISI showed higher measured values for the patellar parameters. There were no significant differences for the laterality. Only PTS showed a significant age difference (p = 0.031). All parameters were significantly larger in male compared to female knees (p < 0.001).

CONCLUSION

Reference parameters for the patella morphology are reported. Concluding from the results, a relationship between vertical patellar position and patellar morphology seems to exist. This finding should be taken into account in diagnostics and therapy of patella disorders.

Effect of heel height on patellofemoral joint stress during stair descent

This study aimed to investigate the effect of heel height on patellofemoral joint stress (PFJS) in young women during stair descent. A total of 25 healthy females were recruited. They were instructed to descend a six-step staircase while wearing heeled shoes of different heel heights: flat heel (1 cm), low heel (3 cm), medium heel (5 cm), and high heel (7 cm). Then, PFJS was calculated using kinematic and kinetic data obtained from a biomechanical model of the patellofemoral joint. Compared with the flat heel condition, the high, medium, and low heel conditions resulted in significant increases in peak PFJS (Phigh = 0.001, Pmedium < 0.001, Plow = 0.018), peak patellofemoral joint reaction force (PFJRF) (Phigh < 0.001, Pmedium < 0.001, Plow = 0.039), peak quadriceps force (Phigh < 0.001, Pmedium < 0.001, Plow = 0.026), and peak knee extensor moment (Phigh = 0.004, Pmedium < 0.001, Plow = 0.017); in addition, the knee flexion angle (Phigh < 0.001, Pmedium = 0.025) and patellofemoral joint contact area (Phigh < 0.001, Pmedium = 0.037) at the time of peak PFJS between the high and medium heel conditions showed a significant increase. The increase in PFJS was mainly driven by an increase in PFJRF, owing to increased knee extensor moments and knee flexion angle. Our findings support the premise that wearing high-heeled shoes with a height of 3 cm or more may be a contributing factor with respect to the development of patellofemoral pain.

Effects of Blood Flow Restriction Training on Strength and Functionality in People With Knee Arthropathies: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials

Background: Previous meta-analyses show contrasting findings regarding the effects of blood flow restriction training (BFRT) in different knee conditions. Furthermore, no previous dose-response analysis has been conducted to determine the dose of BFRT required for maximal strength and functionality adaptations. Objective: To analyze the evidence on the effects of BFRT on strength and functionality in patients with knee osteoarthritis or rheumatoid arthritis through a systematic review with dose-response meta-analysis. Methods: Included studies met the following criteria: participants with knee osteoarthritis or rheumatoid arthritis; low-load resistance BFRT as intervention; control group with traditional moderate or high intensity resistance training (MIRT and HIRT); include muscle strength and functionality as primary and secondary outcome measures, respectively; and only randomized controlled trials. A random-effects and a dose-response model estimated strength and functionality using estimates of the total repetitions performed. Results: We included five studies with a sample of 205 participants. No statistically significant differences were found between BFRT and MIRT or HIRT for strength (SMD = -0.06; 95% CI = -0.78-0.67; and p > 0.05) and functionality (SMD = 0.07; 95% CI = -0.23-0.37; and p > 0.05). We found an inverted U-shaped association between the increase in total repetitions and strength gain and between the increase in total repetitions and functional improvement. Conclusions: People with knee osteoarthritis or rheumatoid arthritis can use low-load BFRT for strength and functionality as a similarly effective alternative to MIRT and HIRT. A total of 2000 repetitions per BFRT program are necessary to maximize strength gains in these patients, while functional improvement requires 1800 total repetitions.

Impact of Heavy Slow Resistance vs. Convectional Exercise in Lateral Epicondylitis-A Pilot Study

Background

The extensor carpi radial muscle may become imbalanced compared to other muscles in the upper arm and can disrupt the overall muscle balance in the upper limb. This muscular imbalance may then cause inflammation or irritation in the tendon. Regular physical activity is rarely used as the only treatment for lowering limb edema. Heavy slow resistance (HSR) training is effective compared to regular exercises. HSR affects functional abilities and physical refinement differently from conventional workouts. This study evaluated the effects of HSR and conventional exercise (CE) on subjects aged 45-65 years with unilateral elbow pain on, in Chennai city.

Methods

Patient received conservative care in the Physiotherapy Department from January 2022 to April 2022. This study compares the pre- and posttypes. Tennis Elbow Evaluation (Patient-Rated Tennis Elbow Evaluation, PRTEE) questionnaires, a patient-specific functional scale, and grip strength tests were used in the study. Results from the study's treatment HSR group and treatment CE group are contrasted.

Results

After 12 weeks of therapy, investigators reassessed grip strength, PRTEE scores, and functional scale responses. In the posttest results of the Patient-Rated Tennis Elbow Evaluation survey, there is a statistically significant difference between Group HSR and Group CE (p < 0.001). The posttest outcomes from the patient-specific activity scoring scheme questionnaire revealed a statistically significant disparity between Groups HSR and CE (p < 0.001). The mean values for both groups exhibited a noteworthy change, with Team HSR demonstrating higher values in contrast to the control treatment.

Conclusion

HSR exercise demonstrates superior effectiveness over CEs for lateral epicondylitis (LE) management, emphasizing its significance in treatment.

Translation, cross-cultural adaptation, and psychometric properties of the Persian version of the Pain Severity Scale in patients with patellofemoral pain

PURPOSE

To translate the Pain Severity Scale (PSS) into Persian (PSS-Persian) and study its psychometric properties in patients with patellofemoral pain (PFP).

MATERIALS AND METHODS

The psychometric properties of 112 patients with PFP were evaluated using a questionnaire. The structural validity, construct validity, reliability, internal consistency, and floor and ceiling effects were evaluated. Convergent validity was examined using Pearson's correlation coefficient between the PSS-Persian, Oxford Knee Score (OKS), Kujala Anterior Knee Pain Scale (AKPS), and Knee Outcome Survey Activities for Daily Living (KOS-ADL).

RESULTS

Good internal consistency was found (Cronbach's alpha = 0.889), and if the item was deleted varied from 0.868 to 0.886. The intraclass correlation coefficient (ICC) for test-retest reliability was 0.784. The factor loading for each item was >0.55. The PSS-Persian score showed a moderate correlation with the AKPS (r = -0.315, p = 0.001). The PSS-Persian score was also significantly correlated with the OKS (r = -0.231, p = 0.004) and KOS-ADL (r = -0.226, p = 0.017).

CONCLUSION

The data showed that the cultural adaptation process was successful. The PSS-Persian has acceptable measurement properties and is suitable for use in epidemiological, rehabilitation, and clinical contexts of patients with PFP in the Persian population.

Neural Markers Predict Tendon Healing Outcomes in an Ovine Achilles Tendon Injury Model: Spontaneous Repair Versus Amniotic Epithelial Cell-Induced Regeneration

Tendon injuries pose a clinical challenge due to tendons' limited recovery. Emerging evidence points to the nervous system's critical role in tendon healing, with neural markers NGF, NF-200, NPY, CGRP, and GAL modulating inflammation, cell proliferation, and extracellular matrix (ECM) remodeling. This study investigates the predictive role of selected neural markers in a validated ovine Achilles tendon injury model, comparing spatio-temporal expression patterns in regenerating tendons transplanted with amniotic epithelial stem cells (AECs) versus spontaneous healing (CTR) 14 and 28 days post-injury (p.i.). AEC-treated tissues showed a spatio-temporal modulation of NF-200, NGF, NPY, CGRP, GAL, and enhanced ECM remodeling, with greater cell alignment, lower angle deviation, and accelerated collagen maturation, with a favorable Collagen type 1 (COL1) to Collagen type 3 (COL3) ratio. Pearson's matrix analysis revealed significant positive correlations between NGF, CGRP, and GAL expression, along a positive correlation between the three neural markers and cell alignment and angle deviation. As opposed to CTR, in AEC-treated tendons, lower levels of NGF, CGRP, and GAL correlated positively with improved tissue organization, suggesting these markers may predict successful tendon regeneration. The findings highlight the neuro-mediated activity of AECs in tendon regeneration, with NGF, CGRP, and GAL emerging as key predictive biomarkers for tendon healing.

Effect of Low-Intensity Bloodflow Restriction Training on Nontraumatic Knee Joint Conditions: A Systematic Review and Meta-analysis

CONTEXT

Nontraumatic knee conditions are common in clinical practice. Existing pharmaceutical and immobilization approaches provide limited pain relief and functional enhancement. Low-intensity bloodflow restriction training (LI-BFRT) is being investigated as a nonpharmacological alternative; however, its efficacy is uncertain.

OBJECTIVE

To assess the effectiveness of LI-BFRT for nontraumatic knee conditions and compare it with high-intensity resistance training (HI-RT) and low-intensity resistance training (LI-RT).

DATA SOURCES

PubMed, EBSCO, Science Direct, Cochrane Library, China Knowledge Infrastructure, Wanfang Data, and VIP databases were searched until May 30, 2023.

STUDY SELECTION

Original randomized controlled trials involving nontraumatic knee joint conditions with interventions consisting mainly of LI-BFRT, HI-RT, or LI-RT. The results assessed mainly pain and muscle performance.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 1.

DATA EXTRACTION

Sample characteristics, study design, country, disease, groups, evaluation time, duration, and outcomes were extracted.

RESULTS

A total of 13 randomized controlled trials were included in the systematic review. Compared with pretreatment, LI-BFRT significantly alleviated pain (weighted standardized mean difference [SMD], -1.33; 95% CI, -1.62 to -1.05), with better additional effects on hip muscle training (SMD, -3.14; 95% CI, -4.07 to -2.75). Compared with LI-RT, LI-BFRT significantly relieved pain in male patients (SMD, -1.47; 95% CI, -1.92 to -1.01). LI-BFRT significantly increased quadriceps cross-sectional area (SMD, 0.53; 95% CI, 0.27-0.78), knee extension strength (SMD, 0.84; 95% CI, 0.48-1.2), and leg press strength (SMD, 0.64; 95% CI, 0.34-0.94) compared with pretreatment. Its effects were superior to those of LI-RT and similar to those of HI-RT. However, sex differences in muscle strength improvement were observed.

CONCLUSION

In patients with nontraumatic knee joint conditions, LI-BFRT effectively alleviated pain, increased muscle cross-sectional area, and enhanced muscle strength. LI-BFRT showed pain relief comparable with that of LI-RT while surpassing LI-RT in muscle growth and strength improvement.

Cross-cultural adaptation and psychometric properties of the Argentine version of the shoulder pain and disability index (SPADI) in patients with shoulder disorders

Background

Shoulder disorders are some of the leading causes of musculoskeletal conditions with a significant economic impact worldwide. The Shoulder Pain and Disability Index (SPADI) questionnaire has proved to be a valid and useful tool for the assessment of disability; however, reporting of properties in several languages has been inconsistent, and the quality of the studies available is low. Moreover, there is only one version in Spanish, designed in Spain, which does not consider the linguistic differences existing in Argentina. Therefore, the aim of the present study was to conduct the cross-cultural adaptation of the SPADI and assess its reliability, validity, responsiveness, and interpretability in subjects with shoulder disorders.

Materials and methods

The study was conducted following the COSMIN Guidelines (COnsensus-based Standards for the Selection of health Measurement INstruments). We included Argentine residents, older than 18 years of age, referred to physiotherapy for shoulder disorders.

Results

A total of 101 patients were evaluated. Reliability was acceptable with an intraclass correlation coefficient of 0.89. The standard error of measurement and minimal detectable change were 2.18 and 6.05, respectively. Construct validity was excellent, and responsiveness was high. Also, the minimal clinically important difference was 18.46 points, the substantial clinical benefit was 27.69 points, and the symptom acceptable level value was 21.35 points.

Conclusion

A cross-cultural adaptation of the Argentine version of the SPADI was conducted. This version proved to be valid, reliable, and responsive with interpretability values.

Changes in Shoulder Girdle Muscle Activity and Ratio During Pilates-Based Exercises

Among the Pilates-based exercises, the modified side-arm (MSA) and modified high-five (MHF) are commonly used for shoulder strengthening and rehabilitation. This study examined shoulder girdle muscle activity and ratios across different spring intensities. Twenty-two healthy males performed the MSA and MHF using yellow (low), blue (medium), and red (high) springs. Surface electromyography (EMG) was used to measure serratus anterior (SA), lower trapezius (LT), levator scapulae (LS), upper trapezius (UT), and middle deltoid (MD) muscle activity, along with LS/SA, LS/LT, and UT/LT ratios during concentric, isometric, and eccentric phases. Muscle activities were generally higher in the MHF than in the MSA with the same spring. Both exercises demonstrated a proportional increase in activity with spring intensity, though the activity of the SA and LT in the MHF plateaued. MHF ratios were significantly higher with the red spring. These findings indicate that the MHF stimulates shoulder girdle muscles more than the MSA, and that the MSA can further stimulate shoulder girdle muscles by increasing spring intensity. Additionally, optimal spring intensity exists in the MHF for targeting shoulder stabilization muscles. However, excessive spring intensity during the MHF may lead to abnormal compensation, emphasizing the need for careful spring intensity progression.

Mechanisms of blood flow restriction training for knee pain: a mini review

Knee pain, affecting an estimated 654 million people worldwide, so blood flow restriction training (BFRT) is catching the spotlight as an effective intervention. Evidence continues to demonstrate the effectiveness of BFRT in managing knee pain. However, the mechanism by which BFRT alleviates knee pain remains unclear, thereby limiting its application in clinical pain management. This study aims to elucidate the underlying mechanisms of BFRT to better understand its efficacy in treating knee pain. This review will discuss the influence of muscle hypertrophy, endogenous opioid system, endocannabinoids, inflammation regulation, and conditional pain regulation on BFRT treatment of knee pain. Current studies on BFRT have limitations, such as small sample sizes, relatively low-quality evidence, and lack of mechanistic studies. Therefore, further research on BFRT is needed, particularly high-quality and large-sized randomized controlled trials.

Osteoarthritis

Osteoarthritis is a heterogeneous whole-joint disease that can cause pain and is a leading cause of disability and premature work loss. The predominant disease risk factors - obesity and joint injury - are well recognized and modifiable. A greater understanding of the complex mechanisms, including inflammatory, metabolic and post-traumatic processes, that can lead to disease and of the pathophysiology of pain is helping to delineate mechanistic targets. Currently, management is primarily focused on alleviating the main symptoms of pain and obstructed function through lifestyle interventions such as self-management programmes, education, physical activity, exercise and weight management. However, lack of adherence to known effective osteoarthritis therapeutic strategies also contributes to the high global disease burden. For those who have persistent symptoms that are compromising quality of life and have not responded adequately to core treatments, joint replacement is an option to consider. The burden imparted by the disease causes a substantial impact on individuals affected in terms of quality of life. For society, this disease is a substantial driver of increased health-care costs and underemployment. This Primer highlights advances and controversies in osteoarthritis, drawing key insights from the current evidence base.

How can Blood Flow Restriction Exercise be Utilised for the Management of Persistent Pain Following Complex Injuries in Military Personnel? A Narrative Review

BACKGROUND

Persistent pain is a complicated phenomenon associated with a wide array of complex pathologies and conditions (e.g., complex regional pain syndrome, non-freezing cold injury), leading to extensive disability and reduced physical function. Conventional resistance training is commonly contraindicated in load compromised and/or persistent pain populations, compromising rehabilitation progression and potentially leading to extensive pharmacological intervention, invasive procedures, and reduced occupational status. The management of persistent pain and utility of adjunct therapies has become a clinical and research priority within numerous healthcare settings, including defence medical services.

MAIN BODY

Blood flow restriction (BFR) exercise has demonstrated beneficial morphological and physiological adaptions in load-compromised populations, as well as being able to elicit acute hypoalgesia. The aims of this narrative review are to: (1) explore the use of BFR exercise to elicit hypoalgesia; (2) briefly review the mechanisms of BFR-induced hypoalgesia; (3) discuss potential implications and applications of BFR during the rehabilitation of complex conditions where persistent pain is the primary limiting factor to progress, within defence rehabilitation healthcare settings. The review found BFR application is a feasible intervention across numerous load-compromised clinical populations (e.g., post-surgical, post-traumatic osteoarthritis), and there is mechanistic rationale for use in persistent pain pathologies. Utilisation may also be pleiotropic in nature by ameliorating pathological changes while also modulating pain response. Numerous application methods (e.g., with aerobic exercise, passive application, or resistance training) allow practitioners to cater for specific limitations (e.g., passive, or contralateral application with kinesiophobia) in clinical populations. Additionally, the low-mechanical load nature of BFR exercise may allow for high-frequency use within residential military rehabilitation, providing a platform for conventional resistance training thereafter.

CONCLUSION

Future research needs to examine the differences in pain modulation between persistent pain and pain-free populations with BFR application, supporting the investigation of mechanisms for BFR-induced hypoalgesia, the dose-response relationship between BFR-exercise and pain modulation, and the efficacy and effectiveness of BFR application in complex musculoskeletal and persistent pain populations.

The Effects of Noxious Electrical Stimulation and Eccentric Exercise on Mechanical and Thermal Pain Sensitivity in Recreational Runners with Achilles Tendinopathy

Background

Achilles tendinopathy is a common overuse condition that can become persistent despite conservative treatment. Sensitization of both the peripheral and central nervous systems may contribute to the persistent pain. Both exercise and electrical stimulation have the potential to modulate the nervous system's sensitivity to painful stimuli.

Hypothesis/Purpose

The purpose of this study was to describe the changes in pain sensitivity and self-reported function in runners with chronic Achilles tendon pain following sequential treatment with noxious electrical stimulation (NxES) and eccentric plantarflexion exercise.

Study Design

Single group, repeated measures design.

Methods

Sixteen participants with chronic Achilles tendinopathy completed the Lower Extremity Functional Scale (LEFS) and the Victorian Institute of Sport Assessment-Achilles scale (VISA-A) and quantitative sensory tests (pressure pain threshold, heat temporal summation, and heat pain threshold) at baseline, one week, seven weeks, and then at a one month post intervention follow-up. The NxES was applied for one week, then followed by plantarflexion eccentric exercise for six weeks. Changes across timepoints were assessed using repeated measures ANOVA and post hoc analysis to describe differences. Hedges g effect sizes were also calculated.

Results

There was a significant improvement in LEFS (p < 0.001) and VISA-A (p < 0.001) from baseline to one month follow-up, with a mean change of 9.6 ± 7.7 and 19.4 ± 17.7 points respectively. Pressure pain threshold of the involved Achilles tendon increased over time (p < 0.001) with significant improvements after NxES application (p = 0.002) and after six weeks of eccentric exercise (p < 0.001). There were significant improvements from baseline to one month follow-up for heat temporal summation (p = 0.001) and heat pain threshold ( p < 0.001).

Conclusions

For individuals with chronic Achilles tendinopathy, a sequential treatment of NxES followed by eccentric exercise resulted in a clinically significant improvement in self-reported pain and function. During the first week of treatment there was a reduction in mechanical hyperalgesia during the NxES-only phase, while a large reduction in primary heat hyperalgesia and additional desensitization to mechanical pain occurred during the eccentric training phase of treatment.

Level of Evidence

2b.

Ultrasound tissue characterization and function of Achilles tendon in psoriatic arthritis patients: a cross-sectional study

BACKGROUND

The Achilles tendon is one of the most frequent sites of tendinopathy in both healthy and pathological subjects. An innovative approach for the quantitative assessment of the Achilles tendon structure, named Ultrasound Tissue Characterization (UTC), has recently been developed. However, no previous study performed the UTC-based assessment of the tendon structure in rheumatologic patients affected by insertional Achilles tendinopathy.

AIM

To characterize the Achilles tendon structure and function in psoriatic arthritis patients with symptomatic insertional tendinopathy.

DESIGN

Cross-sectional study.

SETTING

University laboratory.

POPULATION

Psoriatic arthritis patients (N.=17).

METHODS

Anthropometric measurements, administration of outcome and pain questionnaires, and tendon function and structure assessments were performed in a single experimental session.

RESULTS

Pain intensity and interference and the perceived tendinopathy-related disability were moderate-severe. A relevant impairment of the strength (for both lower limbs) and walking performance was observed in all patients. In fact, the plantarflexion strength values (median values for the two sides: 10.0 and 11.5 kg) and fast walking speed (median value: 1.7 m/s) were lower than the normative values for healthy controls, respectively, in all patients for the strength values and in 14 out of 17 patients for the walking speed. The conventional ultrasound (i.e., the quantification of tendon thickness and the qualitative assessments of tendon structure and neovascularization) showed greater changes in the symptomatic (or more symptomatic) side compared with the asymptomatic (or less symptomatic) side of the insertional region of the Achilles tendon. The UTC imaging showed comparable impairment of the tendon structure between the symptomatic (or more symptomatic) side and the asymptomatic (or less symptomatic) side of the insertional region of the Achilles tendon (i.e., reduced echo-type I percentages in both tendons of all patients).

CONCLUSIONS

Psoriatic arthritis patients with symptomatic insertional Achilles tendinopathy present moderate-severe pain and perceived disability, physical function impairments, and bilateral deterioration of the tendon structure (also in case of unilateral symptoms) that can be documented through the UTC analysis.

CLINICAL REHABILITATION IMPACT

The evaluation of the insertional Achilles tendinopathy through UTC imaging can be useful for the diagnostic and prognostic assessment of psoriatic arthritis patients in combination with the assessments of pain, disability, and functional performance.

Dutch multidisciplinary guideline on anterior knee pain: Patellofemoral pain and patellar tendinopathy

PURPOSE

The purpose of this study was to develop a multidisciplinary guideline for patellofemoral pain (PFP) and patellar tendinopathy (PT) to facilitate clinical decision-making in primary and secondary care.

METHODS

A multidisciplinary expert panel identified questions in clinical decision-making. Based on a systematic literature search, the strength of the scientific evidence was determined according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method and the weight assigned to the considerations by the expert panel together determined the strength of the recommendations.

RESULTS

After confirming PFP or PT as a clinical diagnosis, patients should start with exercise therapy. Additional conservative treatments are indicated only when exercise therapy does not result in clinically relevant changes after six (PFP) or 12 (PT) weeks. Pain medications should be reserved for cases of severe pain. The additional value of imaging assessments for PT is limited. Open surgery is reserved for very specific cases of nonresponders to exercise therapy and those requiring additional conservative treatments. Although the certainty of evidence regarding exercise therapy for PFP and PT had to be downgraded ('very low GRADE' and 'low GRADE'), the expert panel advocates its use as the primary treatment strategy. The panel further formulated weaker recommendations regarding additional conservative treatments, pain medications, imaging assessments and open surgery ('very low GRADE' to 'low GRADE' assessment or absence of scientific evidence).

CONCLUSION

This guideline recommends starting with exercise therapy for PFP and PT. The recommendations facilitate clinical decision-making, and thereby optimizing treatment and preventing unnecessary burdens, risks and costs to patients and society.

LEVEL OF EVIDENCE

Level V, clinical practice guideline.

Effects of Instrument-Assisted Soft Tissue Mobilization and Extracorporeal Shock Wave Therapy in Individuals With Lateral Elbow Pain: A Randomized Single-Blind Clinical Trial

CONTEXT

In lateral elbow pain (LEP), it is important to improve pain, grip strength, and function. The aim of this study is to compare the effects of Instrument-Assisted Soft Tissue Mobilization (IASTM) and extracorporeal shock wave therapy (ESWT) methods on pain, grip strength, and function in LEP.

DESIGN

Randomized single-blind clinical trial.

METHODS

Forty-eight adults with LEP were randomly assigned to the IASTM, ESWT, and control groups. Home exercise consisting of special static stretching and eccentric strengthening exercises was given to the control group. The ESWT group received a total of 8 sessions of ESWT in addition to home exercise. The IASTM group received a total of 8 sessions of IASTM in addition to home exercise. The visual analog scale for pain, hydraulic hand dynamometer for grip strength, and Patient-Rated Tennis Elbow Evaluation scale for functionality were used for assessment. Data were collected at baseline, after intervention, and at 4-weeks postintervention.

RESULTS

At the end of the treatment and the 4-week follow-up, a decrease in pain scores and improvement in muscle strength and functionality was detected in all 3 groups (P < .001). IASTM applications were more effective than ESWT and control groups in reducing pain both after application and at follow-up (P < .001), whereas ESWT application was also effective compared with the control group (P < .001). IASTM applications were more effective than the ESWT and control groups in reducing Patient-Rated Tennis Elbow Evaluation total scores both after the applications and follow-up (P < .001). IASTM was more effective in grip strength than ESWT and control groups (P < .001).

CONCLUSION

It was determined that IASTM and ESWT treatments were effective in reducing pain and increasing grip strength and functionality in both the short and long term in patients with LEP. It was determined that IASTM treatment was superior to ESWT treatment in reducing pain and improving grip strength and functionality.

Reliability and Validity Measures of the Patellofemoral Subscale KOOS-PF in Greek Patients with Patellofemoral Pain

Background: Patellofemoral pain (PFP) is one of the most common multifactorial musculoskeletal pathologies affecting the knee joint. The prevalence of PFP in the general population ranges from 11% to 17%, with higher rates observed in specific groups such as females, runners, military personnel, and young athletes. To assess symptoms associated with PFP, the patellofemoral subscale (KOOS-PF) was developed, consisting of 11 questions that evaluate pain, stiffness, and quality of life. The KOOS-PF scale has already been validated and shown to be reliable in both its Spanish and Arabic versions. Objectives: The aim of this study was to assess the reliability and validity of the KOOS-PF scale in the Greek language among the Greek population with patellofemoral pain. Methods: Fifty-five participants aged 18-65 years who suffered from PFP were evaluated in two phases on the first and third days to determine the reliability and validity of the measures of KOOS-PF in the Greek language. Construct validity was assessed using the knee outcome survey scale-activities of daily living scale (KOS-ADLS). Reliability was measured through repeated measurements (test-retest) using intraclass coefficient correlation (ICC), standard error of measurement (SEM), and smallest detectable difference (SDD). Internal consistency was evaluated using Cronbach's coefficient a. The significance level was set at 5% (α = 0.05). Results: The KOOS-PF measures showed high internal consistency reliability (Cronbach's alpha 0.87, p = 0.05) and high test-retest reliability (ICC = 0.95, p = 0.05, SEM = 3.7, SDC = 13.57). Additionally, the Greek version of the KOOS-PF exhibited high construct validity when correlated with the KOS-ADLS scale (r = 0.72, p = 0.001). Conclusions: The KOOS-PF scale displayed high reliability and construct validity for measuring patellofemoral pain in the Greek population.

Exploring New Tools in Upper Limb Rehabilitation After Stroke Using an Exoskeletal Aid: A Pilot Randomized Control Study

BACKGROUND/OBJECTIVES

Spasticity commonly occurs in individuals after experiencing a stroke, impairing their hand function and limiting activities of daily living (ADLs). In this paper, we introduce an exoskeletal aid, combined with a set of augmented reality (AR) games consisting of the Rehabotics rehabilitation solution, designed for individuals with upper limb spasticity following stroke.

METHODS

Our study, involving 60 post-stroke patients (mean ± SD age: 70.97  ±  4.89 years), demonstrates significant improvements in Ashworth Scale (AS) scores and Box and Block test (BBT) scores when the Rehabotics solution is employed.

RESULTS

The intervention group showed slightly greater improvement compared to the control group in terms of the AS (-0.23, with a confidence interval of -0.53 to 0.07) and BBT (1.67, with a confidence interval of 1.18 to 2.16). Additionally, the Rehabotics solution was particularly effective for patients with more severe deficits. Patients with an AS score of 3 showed more substantial improvements, with their AS scores increasing by -1.17 ± 0.39 and BBT scores increasing by -4.83 ± 0.72.

CONCLUSIONS

These findings underscore the potential of wearable hand robotics in enhancing stroke survivors' hand rehabilitation, emphasizing the need for further investigations into its broader applications.

Literature review of non-pharmacological treatment for patients with axial spondyloarthritis

Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder affecting the sacroiliac joints and axial spine. Along with pharmacotherapy, non-pharmacological interventions for axSpA are crucial and constitute the cornerstone of treatment. Here, we review the evidence for non-pharmacological treatment of axSpA as a basis for the 2023 Korean treatment recommendations for patients with axSpA. The effectiveness of the core non-pharmacological approaches, such as education, smoking cessation, and exercise, has been reaffirmed. High-quality research on surgical treatment is limited. However, total hip replacement is advised in patients with ongoing pain or disability and visible structural damage to the hip on imaging. Urgent spinal intervention should be considered in cases of acute spinal pain with neurological deficiency or concurrent unstable fractures. Evidence for complementary therapies, including spas and acupuncture, remains insufficient.

Altered anconeus muscle activation characteristics during isometric gripping in individuals with lateral elbow tendinopathy compared with age- and sex-matched control

BACKGROUND

Individuals with lateral epicondyle tendinopathy (LET) commonly experience gripping deficits, which are marked by pain and altered motor control of the forearm extensors and flexors. Although delayed activation of the anconeus muscle during rapid wrist extension has been observed in LET, its role during gripping is not well understood. This study aimed to investigate anconeus activation and its relation to forearm muscle activity during gripping in individuals with LET.

METHODS

Eleven participants with LET and 11 healthy, age-, sex-, and limb-matched controls performed steady-state isometric gripping at 15% and 30% of their maximum voluntary contraction (MVC). Surface electromyography was recorded from anconeus and 6 forearm muscles. Standard clinical assessments for LET were conducted to evaluate the severity of the condition.

RESULTS

Participants with LET exhibited increased relative activation of the anconeus compared with the forearm flexors, but not with the extensors, during both 15% and 30% MVC gripping. In addition, the LET group demonstrated an increased coactivation ratio between anconeus and extensor carpi radialis brevis, as well as the flexor digitorum superficialis, during 15% MVC. At 30% MVC, this increased coactivation was observed between anconeus and all 3 flexors (flexor digitorum superficialis, flexor carpi radialis, and flexor carpi ulnaris). Lower anconeus activation was associated with greater LET-related disability, whereas higher anconeus activation was associated with increased anconeus tenderness.

CONCLUSION

This study presents novel evidence of an adaptive motor pattern in LET, characterized by increased relative activation and coactivation of the anconeus muscle depending on grip force. Signs of maladaptive motor patterns emerge when grip force becomes painful. These findings enhance our understanding of anconeus dysfunction in LET and the gripping deficits that accompany it, offering new insights into potential management strategies for this condition.

Impact of telehealth-based therapeutic exercise on pain, functional performance and dynamic knee valgus in young adult females with patellofemoral pain: a randomised controlled trial

Objectives

This study aimed to evaluate the effectiveness of a telehealth-based therapeutic exercise (TTE) programme with real-time video conference supervision for young adult females with patellofemoral pain (PFP).

Methods

The study design was a randomised controlled trial. Forty-two participants with PFP were allocated to either the TTE group or the control (C) group. The TTE group received a 4-week telehealth-based exercise programme supervised through real-time video conferencing, while the C group followed a self-guided stretching exercise. Pain intensity was assessed using the Visual Analogue Scale, while functional performance was evaluated with hop tests and the step-down test. Dynamic knee valgus was measured by the frontal plane projection angle during a single-leg squat. In addition, the study used a specific health questionnaire which evaluated knee pain and function, including the self-administered Kujala Patellofemoral Questionnaire (KPQ). All outcomes were assessed both before and after the intervention.

Results

After the 4-week interventions, the results showed a significant interaction between the group and the time of pain intensity, functional performance and dynamic knee valgus (p<0.001). The TTE group demonstrated significant pain reduction (p<0.001) and improved KPQ score (p<0.001), while the C group showed no significant changes. TTE participants also exhibited improved functional performance in the hop and step-down tests. Additionally, dynamic knee valgus was significantly decreased in the TTE group.

Conclusion

The telehealth-based exercise programmes offer a convenient and effective alternative for managing PFP symptoms, providing remotely accessible and specialised care.

Obesity, Osteoarthritis, and Myokines: Balancing Weight Management Strategies, Myokine Regulation, and Muscle Health

Obesity and osteoarthritis (OA) are increasingly prevalent conditions that are intricately linked, with each exacerbating the other's pathogenesis and worsening patient outcomes. This review explores the dual impact of obesity on OA, highlighting the role of excessive weight in aggravating joint degeneration and the limitations OA imposes on physical activity, which further perpetuates obesity. The role of muscle tissue, particularly the release of myokines during physical activity, is examined in the context of OA and obesity. Myokines such as irisin, IL-6, and myostatin are discussed for their roles in metabolic regulation, inflammation, and tissue repair, offering insights into their potential therapeutic targets. This review emphasizes the importance of supervised weight management methods in parallel with muscle rehabilitation in improving joint health and metabolic balance. The potential for myokine modulation through targeted exercise and weight loss interventions to mitigate the adverse effects of obesity and OA is also discussed, suggesting avenues for future research and therapy development to reduce the burden of these chronic conditions.

Can blood flow restriction therapy improve quality of life and function in dissatisfied knee arthroplasty patients?

Aims

Approximately 10% to 20% of knee arthroplasty patients are not satisfied with the result, while a clear indication for revision surgery might not be present. Therapeutic options for these patients, who often lack adequate quadriceps strength, are limited. Therefore, the primary aim of this study was to evaluate the clinical effect of a novel rehabilitation protocol that combines low-load resistance training (LL-RT) with blood flow restriction (BFR).

Methods

Between May 2022 and March 2024, we enrolled 45 dissatisfied knee arthroplasty patients who lacked any clear indication for revision to this prospective cohort study. All patients were at least six months post-surgery and had undergone conventional physiotherapy previously. The patients participated in a supervised LL-RT combined with BFR in 18 sessions. Primary assessments included the following patient-reported outcome measures (PROMs): Knee injury and Osteoarthritis Outcome Score (KOOS); Knee Society Score: satisfaction (KSSs); the EuroQol five-dimension five-level questionnaire (EQ-5D-5L); and the pain catastrophizing scale (PCS). Functionality was assessed using the six-minute walk Test (6MWT) and the 30-second chair stand test (30CST). Follow-up timepoints were at baseline, six weeks, three months, and six months after the start.

Results

Six weeks of BFR with LL-RT improved all the PROMs except the sports subscale of the KOOS compared to baseline. Highest improvements after six weeks were found for quality of life (QoL) (mean 28.2 (SD 17.2) vs 19 (SD 14.7); p = 0.002), activities of daily living (mean 54.7 (SD 18.7) vs 42.9 (SD 17.3); p < 0.001), and KSSs (mean 17.1 (SD 8.8) vs 12.8 (SD 6.7); p < 0.001). PROMs improvements continued to be present at three-month and six-month follow-up compared to baseline. However, no significant differences were observed in the paired comparisons of the six-week, three-month, and six-month follow-up. The same trends are observed for the 6MWT and 30CST.

Conclusion

The reported regime demonstrates improved QoL and function of dissatisfied knee arthroplasty patients. In light of this, the pathway described may provide a valuable and safe treatment option for dissatisfied knee arthroplasty patients for whom therapeutic options are limited.

Peak hip external rotation torque and single-rater reliability is influenced by measurement position in the ISOMED2000

Measurement of hip external rotation strength (ERS) is important for preventive and rehabilitative purposes. ERS can be measured in 3 different positions in the isokinetic dynamometer ISOMED2000. However, it is not clear whether these measurement positions effect ERS nor if these positions are reliable in the ISOMED2000. Hence, the purpose of this study was to compare ERS in these positions, the reliability and the agreement. A cross-sectional design was conducted to compare measurement positions and a test-retest design to assess intra-rater reliability and agreement. Twenty-four healthy, physically active athletes participated in the study. Peak isometric torque was measured in the ISOMED in prone, supine, and side-lying position across two sessions on one day. Differences between positions were evaluated with the Wilcoxon-signed-rank test and cliff's delta. Reliability was assessed via intraclass correlation. Agreement was determined using the standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman analysis (BAA). Results indicated a significant influence of measurement position on ERS (p < 0.001) with high effect sizes (>0.74). Reliability and agreement were high in all positions, but highest for the side-lying position (ICC = 0.90 [0.78, 0.96]; SEM = 0.08; MDC = 0.23; BAA_bias = 3.4 %, BAA_loA = 37 %). There were only poor to moderate correlations between measurement positions. These findings suggest that measurement position significantly affects ERS. Furthermore, the effect varies across individuals indicating that normative values cannot be used interchangeably or be adapted across positions. In diagnostic testing ERS should be measured in the same position, but preferably in the side-lying position.

The current status of various preclinical therapeutic approaches for tendon repair

Tendons are fibroblastic structures that link muscle and bone. There are two kinds of tendon injuries, including acute and chronic. Each form of injury or deterioration can result in significant pain and loss of tendon function. The recovery of tendon damage is a complex and time-consuming recovery process. Depending on the anatomical location of the tendon tissue, the clinical outcomes are not the same. The healing of the wound process is divided into three stages that overlap: inflammation, proliferation, and tissue remodeling. Furthermore, the curing tendon has a high re-tear rate. Faced with the challenges, tendon injury management is still a clinical issue that must be resolved as soon as possible. Several newer directions and breakthroughs in tendon recovery have emerged in recent years. This article describes tendon injury and summarizes recent advances in tendon recovery, along with stem cell therapy, gene therapy, Platelet-rich plasma remedy, growth factors, drug treatment, and tissue engineering. Despite the recent fast-growing research in tendon recovery treatment, still, none of them translated to the clinical setting. This review provides a detailed overview of tendon injuries and potential preclinical approaches for treating tendon injuries.

Reliability and validity of the Turkish version of the patellofemoral pain severity scale in patients with patellofemoral pain syndrome

PURPOSE

The aim of this study was to investigate the Turkish validity and reliability of the Patellofemoral Pain Severity Scale (PSS) in patients with patellofemoral pain (PFP) and to adapt it to Turkish.

MATERIALS AND METHODS

A pilot study was conducted with 10 patients. 123 patients underwent PSS test-retest at 24-48 h intervals. Construct validity, correlations of PSS with other scales Timed Up and Go Test (TUG), Stair Climbing and Descending Test (SCD), Anterior Knee Pain Scale (AKPS), Tegner Activity Scale (TAS), Lysholm Knee Scoring Scale (LDSS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL) were evaluated.

RESULTS

The content validity index value of the scale was 0.95. The overall internal consistency (Cronbach α: 0.88) was high. Item-total correlations of the scale were between 0.51 and 0.7. In the evaluation of the convergent validity of the PSS, it was found that there was a positive correlation between the PSSS and TUG and SCD, and a negative correlation between the PSS, TAS, LDSS and KOS-ADL (p = 0.000).

CONCLUSIONS

In this study, it was determined that the PSSS scale had good internal consistency, test-retest validity and adequate construct validity when compared with the KOS-ADL, LDSS and AKPS.

Comparison of high intensity laser therapy and extracorporeal shock wave in treatment of lateral epicondylitis: a randomized controlled study

This study aims to evaluate and compare the short-term efficacies of high-intensity laser therapy (HILT) and ESWT(focused) on pain, sensitivity, handgrip strength and functions, in the treatment of lateral epicondylitis (LE). Fourty seven patients (age range, 18 to 65 years) with unilateral elbow pain were randomized into two groups. HILT group (n = 24) and ESWT group(n = 23). The HILT and ESWT were administered three times a week for three weeks, and each treatment was combined with exercises. All paticipant in both of two groups were evaluated with ultrasonography for common extansor tendon thickness. A visual analog scale (VAS), quick Disabilities of the Arm, Shoulder, and Hand (QDASH), hand grip strength test were used to evaluate the patients before, one and six weeks after treatment. There were significant improvement in VAS, hand grip strength, QuickDASH scores and CET thickness before and after treatment in both group(p < 0,05). But there were no significant differences between the groups pre-treatment, at the 1st week, and 6th week after treatment (p > 0.05). Only hand grip strength was smilar to the pretreatment outcomes in HILT group. Both treatment methods were found to be effective and safe in the short-term treatment of LE. Consequently, these non-invasive, effective and safe techniques can be successfully used in the treatment of common pathology of the elbow.

Advancements in Therapeutic Approaches for Degenerative Tendinopathy: Evaluating Efficacy and Challenges

Degenerative tendinopathy results from the accumulation of minor injuries following unsuccessful tendon repair during acute tendon injuries. The process of tendon repair is prolonged and varies between individuals, making it susceptible to reinjury. Moreover, treating chronic tendinopathy often requires expensive and extensive rehabilitation, along with a variety of combined therapies to facilitate recovery. This condition significantly affects the quality of life of affected individuals, underscoring the urgent need for more efficient and cost-effective treatment options. Although traditional treatments have improved significantly and are being used as substitutes for surgical interventions, the findings have been inconsistent and conflicting. This review aims to clarify these issues by exploring the strengths and limitations of current treatments as well as recent innovations in managing various forms of degenerative tendinopathy.

Characteristics of patients seeking national health service (NHS) care for Achilles tendinopathy: A service evaluation of 573 patients

BACKGROUND

Achilles tendinopathy is a common condition that is often still symptomatic 10 years after onset. Much of the available research has focussed on active populations, however our experience is patients seeking care in the UK's National Health Service (NHS) may be different.

OBJECTIVES

To determine the characteristics of patients receiving NHS care for Achilles tendinopathy (AT). To describe the utilisation of resources and the effectiveness of AT management in the NHS.

METHODS

A data extraction tool was developed and used to retrospectively extract the characteristics of 573 patients diagnosed with Achilles tendinopathy.

RESULTS

NHS Achilles tendinopathy patients averaged 57 years old, had a Body Mass Index of 31, and 69% had at least one other long-term health condition. These included musculoskeletal complaints (59%), hypertension (30%), Chronic Obstructive Pulmonary Disease or asthma (17%), cardiovascular disease (13%) and diabetes (13%). Subsequently medication usage was higher than the general population and included drugs that have been linked to the pathogenesis of tendinopathy. On average, healthcare providers conducted 3.8 therapy sessions and 26% of patients had radiological investigations. Outcome measures were commonly absent with Visual Analog Scale (VAS) scores documented in 51% of records, and patient-reported outcome measures like VISA-A only appearing in 3% of cases. Reports on psychosocial factors were seldom documented.

CONCLUSION

Individuals diagnosed with Achilles tendinopathy through NHS services exhibit distinct characteristics that diverge considerably from those currently represented in the published research used to develop clinical guidelines. NHS Achilles tendinopathy patients have multiple long-term health conditions and higher medication usage.

Current Non-Surgical Curative Regenerative Therapies for Knee Osteoarthritis

Osteoarthritis (OA) is a prevalent musculoskeletal disease affecting middle-aged and elderly individuals, with knee pain as a common complaint. Standard therapy approaches generally attempt to alleviate pain and inflammation, using various pharmacological and non-pharmacological options. However, the efficacy of these therapies in long-term tissue repair remains debated. As an alternative, regenerative medicine offers a promising strategy, with decreased adverse event rates and increasing evidence of safety and efficacy. This review will outline current advances in regenerative medicine for knee OA, emphasizing outpatient clinic-based therapies that use orthobiological and non-biological products. Different strategies based on orthobiologics are discussed as potential regenerative options for the management of knee OA. Cell-free therapies including platelet-rich plasma, autologous anti-inflammatories, exosomes, human placenta extract, and mitochondrial transplantation are discussed, focusing on their potential for cartilage regeneration. Additionally, cell-based therapies with regenerative properties including bone marrow aspirate concentrate, adipose stromal vascular fraction, microfat, nanofat, stem cell therapy, and genetically modified cells as part of orthobiologics, are being investigated. Also, this study is looking into non-biological approaches such as using gold-induced cytokines, extracorporeal shockwave therapy, and ozone therapy. The mechanisms of action, effectiveness, and clinical applications of each therapy are being explored, providing insights into their role in the management of knee OA.

Effects of Russian and Aussie Currents Combined With Isokinetic Training on Symptoms, Pain, Functional Mobility, and Quality of Life in Individuals With Patellofemoral Pain Syndrome: A Randomized, Placebo-Controlled Study

OBJECTIVE

To find out if burst-modulated medium frequency alternating currents (Russian and Aussie types) contribute to the effects of isokinetic-training in patients with patellofemoral pain, and to compare their effectiveness on symptoms, pain, functional mobility, and quality of life.

DESIGN

Forty-five patients with patellofemoral pain were randomized into Russian current, Aussie current or placebo electrical stimulation groups. Patellofemoral Pain Severity Scale, Stair Climbing Test, Anterior Knee Pain Scale, Knee Outcome Survey Activities of Daily Living Scale, and Short Form-36 data were obtained before and after 15 sessions of interventions and at the end of a 3-wk follow-up period.

RESULTS

Severity of symptoms and pain decreased; functional mobility, activity limitations and quality of life improved significantly after interventions ( P < 0.05), and these effects were maintained at the follow-up period ( P < 0.05). The amount of improvements in symptom and pain severity, and quality of life was higher in the Russian and Aussie current groups than in the placebo group ( P < 0.05).

CONCLUSIONS

In patients with patellofemoral pain, burst-modulated medium frequency alternating currents may provide extra benefit in improving symptoms, pain, functional mobility and quality of life, and the Aussie currents provide greater improvement in symptom and pain severity.

Short-term Effects of Pulsed Electromagnetic Field Therapy for Achilles Tendinopathy: A Randomized Controlled Trial

Background

Pulsed electromagnetic field (PEMF) therapy is a potential nonoperative treatment for Achilles tendinopathy, but the current published literature on its effects is sparse.

Purpose

To evaluate the therapeutic efficacy of PEMF therapy and eccentric exercise for Achilles tendinopathy.

Study Design

Randomized controlled trial; Level of evidence, 1.

Methods

A total of 65 participants met the inclusion criteria and were randomly assigned to either the active PEMF group (n = 33) or the sham group (n = 32). The PEMF group received biweekly PEMF therapy (10 minutes per session) for 8 weeks, plus eccentric exercise for 12 weeks. The sham group received the same eccentric exercise for 12 weeks minus active PEMF exposure. The primary outcome was the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. The secondary outcomes were numeric pain rating scale (NPRS) score, tendon neovascularity, and total time spent on sports per week. A physical therapist assessed all outcomes at baseline and then 4, 8, and 12 weeks after the commencement of the PEMF treatment. The level of tendon neovascularity was determined by the Öhberg score (range, 0-3).

Results

VISA-A scores improved significantly from baseline to 12 weeks posttreatment in both the PEMF group (from 57.9 to 71.7) and the sham group (from 55.1 to 66.8) (P < .001 for both), with no significant difference in scores between treatment groups throughout the 12 weeks (P = .527). NPRS scores during sports also improved significantly from baseline to 12 weeks for the PEMF group (from 6.05 to 2.95) and the sham group (from 6.45 to 3.85) (P < .001), with no group differences (P = .346).

Conclusion

PEMF therapy, in addition to eccentric exercise, did not improve outcome scores or tendon neovascularity compared with eccentric exercise alone in participants with Achilles tendinopathy.

Registration

NCT05316961 (ClinicalTrials.gov identifier).

Injury Characteristics Among Japanese International Athletes: Report on the Pre-competition Medical Check-Up Data of the Japanese Olympic Committee

Introduction Injury trends among international athletes across sports remain underexplored in out-of-competition settings, particularly among Asians. The aim of this descriptive epidemiological study is to investigate the characteristics of injuries among Japanese international athletes during pre-competition medical check-ups from 2008 to 2019. Methods We analyzed the medical check-up data of candidates for international multi-sport events according to the International Olympic Committee consensus statement. At the medical check-up, athletes' injuries were categorized into two groups based on clinical assessment. "Injuries" refer to conditions that necessitate immediate treatment or further detailed examination. On the other hand, "complaints" encompass both such "injuries" and conditions for which treatment has already commenced, allowing athletes to continue participating in competitions or training while still requiring ongoing medical monitoring. The cohort was categorized into youth and adult groups, with adults defined as those aged ≥18 years. Results Overall, 10,854 athletes (4,966 females, 45.8%; 5,888 males, 54.2%; median age 22.0 {20.0-25.0} years, 56 sports) were enrolled; 2,333 "injuries" were registered (21.5 "injuries" per 100 athletes). The "injury" prevalence was 16.2% (95% CI, 0.16-0.17) and significantly associated with females (odds ratio {OR} 1.21; 95% CI, 1.09-1.34) and adult group (OR, 1.35; 95% CI, 1.08-1.69) based on binomial logistic regression analysis. Of a total of 10,027 "complaints" (92.4 "complaints" per 100 athletes), the "complaint" prevalence was 55.3% (95% CI, 0.54-0.56) and higher in females (OR, 1.44; 95% CI, 1.33-1.55) and adult group (OR, 1.50; 95% CI, 1.29-1.75). Stratified by sport, male soccer players had a higher "injury" prevalence than females (95% CI, 0.45-0.98), whereas females had a higher "injury" prevalence in hockey (1.70-7.29) and fencing (1.12-5.44). The "complaint" prevalence was higher in females for athletics, skiing, swimming, hockey, judo, badminton, fencing, water polo, weightlifting, and golf. There was no significant difference between the sexes in other sports. The knee ("injury," 20.1%; "complaint," 20.2%), lumbosacral (15.5%; 17.0%), ankle (13.0%; 15.4%), and shoulder (13.0%; 12.1%) were most commonly affected. The injury proportion ratio for the ankle was "injury"/"complaint" 0.82 (95% CI, 0.72-0.94), with the ankle "complaint" proportion being higher than "injury." When stratified by injury location and sex, knee "injury" was more common in males (206 in females vs. 262 in males; 95% CI, 0.59-0.88), whereas ankle "complaint" was more common in females (842 in females vs. 700 in males; 95% CI, 1.04-1.29). Conclusion This is the first cross-sectional report of injuries in Asian international athletes outside of competition periods. Injury prevalence was higher in females than in males and in adults than in youths. Sex differences in injury varied by site and severity. These findings may suggest the need for more tailored injury prevention and performance support strategies for international competitions.

How effective is proprioception exercise on pain, grip force, dexterity and proprioception of elbow joint in patients with tennis elbow? A randomized controlled trial

BACKGROUND

Patients with tennis elbow (TE) disorder suffer from proprioception deficits alongside other symptoms, which usually is neglected to be targeted in different physiotherapy protocols. This study aimed to investigate the effects of proprioception exercises on treatment outcomes.

METHODS

In this RCT, 14 males and 30 females TE volunteered patients were randomly divided into two intervention (IG) and control (CG) groups, in which CG received routine physiotherapy, while IG underwent further proprioception exercises for 18 sessions within six weeks. Pain, function, grip force, dexterity, and proprioception of elbow joint were evaluated using Patient-Rated Elbow Evaluation (PREE) questionnaire, handheld dynamometer, Purdue Pegboard, and isokinetic dynamometer, respectively.

RESULTS

A significant within group improvement was observed in terms of pain (IG: 49.93%, CG: 42.75%), function (IG: 61.9%, CG: 48.95%), grip force (IG: 22.1% CG: 16.9%), dexterity (IG: 18.96% CG: 11.82%), active joint position error (IG: 32.99, CG: 7.33 %), and the threshold to detection of passive motion (TTDPM) for both groups (IG: 24.35, CG: 24.86%) in both groups after treatment as compared to before treatment (p < .0001), with no statistically significant differences between the groups for these variables except for active joint position error, which showed a significant reduction in the IG (p < .02).

CONCLUSION

It could be concluded that proprioception exercises has a limited added value on routine physiotherapy it terms of pain, function, grip force, and dexterity. However, adding proprioception exercises found to be beneficial for improving variables determining joint position sense.

Recommendations from the French Societies of Rheumatology and Physical Medicine and Rehabilitation on the non-pharmacological management of knee osteoarthritis

BACKGROUND

Although non-pharmacological therapies for knee osteoarthritis (OA) are essential pillars of care, they are often poorly considered and inconsistently applied.

OBJECTIVES

Under the umbrella of the French Society of Rheumatology (SFR) and the French Society of Physical Medicine and Rehabilitation (SOFMER), we aimed to establish consensual recommendations for the non-pharmacological management of people with knee OA.

METHODS

A group of fellows performed a systematic literature review on the efficacy and safety of non-pharmacological modalities (up to October 2021). The fellows then took part in discussions with a multidisciplinary group of experts to draft a list of recommendations. The list was then submitted to an independent reading committee who rated their level of agreement with each recommendation. Each recommendation was assigned a strength of recommendation and a level of evidence.

RESULTS

Five general principles were unanimously accepted: (A) the need to combine non-pharmacological and pharmacological measures; (B) the need for personalized management; (C) the need to promote adherence; (D) the need for adapted physical activity; and (E) the need for person-centered education. Specific positive or negative recommendations were defined for 11 modalities: (1) unloading knee brace; (2) kinesiotaping or knee sleeves; (3) shoes and/or insoles; (4) using a cane; (5) physical exercise program; (6) joint mobilization; (7) electro- or thermo-therapy; (8) acupuncture; (9) weight loss; (10) thermal spa therapy; and (11) workplace accommodation.

CONCLUSIONS

These SFR/SOFMER recommendations provide important and consensual knowledge to assist health professionals in decision-making for non-pharmacological treatments for knee OA.

Physiotherapy practices in the clinical assessment of lateral elbow tendinopathy: An international survey

BACKGROUND AND PURPOSE

Understanding physiotherapy practices is important to identify variations from empirical evidence and highlight requirements for training. This survey explored international physiotherapy practices for assessment of lateral elbow tendinopathy (LET).

METHODS

Two hundred ninety-nine surveyed physiotherapists from eight member countries of the International Federation of Manual and Orthopaedic Physical Therapists completed the survey. Respondents rated their frequency of use (never, rarely, sometimes, often, and always) for items related to: patient history; diagnostic tests; grip and upper limb strength; cervical and neurological assessment; and medical imaging. To establish practices, the five response categories were dichotomised into routine practice (often, always) and not-routine practice (sometimes, rarely, never). A response rate of ≥70% for each dichotomy was used to determine whether an assessment item was deemed routine practice or not, with items not meeting either criterion considered neither routine nor not-routine practice.

RESULTS

Most respondents were from United States (63%). The 'chair pick up test', 'cervical special tests', and 'plain radiograph' met our criteria for not routine practice (i.e., 70%, 72%, and 71%, respectively). All other assessment items did not meet the criteria to be considered routine or not-routine practice.

CONCLUSION

The chair pick-up test, cervical spine special tests (e.g., Spurling's test), and plain radiography appear to not be routinely used in the assessment of LET. The finding that no assessment technique met the criteria for routine use may imply that physiotherapists adopt a nuanced approach to selecting clinical assessment items as opposed to routinely applying tests.

The effects of the addition of Mulligan mobilization with movement to exercise on elbow pain and function associated with lateral elbow tendinopathy

BACKGROUND

Mulligan mobilization with movement (MWM) and eccentric exercise (EE) have been shown to be effective for the treatment of chronic lateral elbow tendinopathy (LET). However, the addition of MWM to EE effects on LET remained unknown. The objective of the study was to determine the effects of adding of Mulligan mobilization with movement to eccentric exercise for the treatment of LET.

METHODS

In this quasi-experimental study, thirty participants with unilateral LET were assigned into two groups: 15 in MWM (received MWM + EE) (7 M and 8 F, mean age 36.8 ± 8.3 years) and 15 in EE (9 M and 6 F, mean age 46 ± 8.1 years). Both groups received education about painful activities and eccentric exercise, while the MWM group received MWM with the same eccentric exercise as the EE group. The visual analog scale (VAS) and the patient-rated tennis elbow evaluation (PRTEE) were used to assess pain and upper limb function, respectively, at baseline and at the end of 4 weeks. The data was analyzed using an independent t-test and a paired t-test.

RESULTS

There was no significant difference (p > 0.05) between groups at baseline. At the end of 4 weeks, significant and clinically meaningful improvements in pain and function were observed for both groups (p < 0.001); however, MWM group showed much better results in VAS (p < 0.001, d = 1.3) and PRTEE (p < 0.001, d = 5.2) CONCLUSION: This study showed that adding MWM to eccentric exercise resulted in enhanced pain reduction and improved function of the upper limb.

Cognitive behavioral therapy for insomnia in people with chronic musculoskeletal pain. A systematic review and dose-response meta-analysis

The aims were (i) to determine the effects of Cognitive behavioral therapy for insomnia (CBT-I) on sleep disturbances, pain intensity and disability in patients with chronic musculoskeletal pain (CMP), and (ii) to determine the dose-response association between CBT-I dose (total minutes) and improvements in sleep disorders, pain intensity and disability in patients with CMP. A comprehensive search was conducted in PubMed/MEDLINE, Web of Science, CINAHL, and SCOPUS until December 17, 2023. Randomized clinical trials (RCTs) using CBT-I without co-interventions in people with CMP and sleep disorders were eligible. Two reviewers independently extracted data and assessed risk of bias and certainty of the evidence. A random effects meta-analysis was applied to determine the effects on the variables of interest. The dose-response association was assessed using a restricted cubic spline model. Eleven RCTs (n = 1801 participants) were included. We found a significant effect in favor of CBT-I for insomnia (SMD: -1.34; 95%CI: -2.12 to -0.56), with a peak effect size at 450 min of CBT-I (-1.65, 95%CI: -1.89 to -1.40). A non-significant effect was found for pain intensity. A meta-analysis of disability was not possible due to the lack of data. This review found benefits of CBT-I for insomnia compared to control interventions, with a large effect size. In addition, it was estimated that a 250-min dose of CBT-I had a large effect on reducing insomnia and that the peak effect was reached at 450 min. These novel findings may guide clinicians in optimizing the use of CBT-I in people with CMP and insomnia.

Pain improvement after three weeks of daily self-executed cross-friction massage using a fascia ball in a patient with recent-onset plantar heel pain: a case report

BACKGROUND

Plantar heel pain is described as sharp pain at the medial plantar aspect of the calcaneus and medial longitudinal arch of the foot. There are various treatment options that usually need a clinician or a therapist for application. The present case report aimed to describe the outcomes of self-executed cross-friction massage using a fascia ball in a patient with recent-onset plantar heel pain.

CASE DESCRIPTION

The patient was a 42-year-old man who reported plantar heel pain during the first steps in the morning along with decreased function of the foot and ankle lasting about three months. He was instructed to self-execute cross-friction massage using a fascia ball daily in the evening at home for six weeks.

OUTCOMES

Pain during treatment decreased from a Numeric Pain Rating Scale (NPRS)-score of 8/10 and from a Short-Form McGill Pain Questionnaire (SF-MPQ)-score of 34/60 at initial treatment to NPRS- and SF-MPQ-scores of 0/10 and 0/60, respectively, after about three weeks. The patient reported no pain and restored function after six weeks of treatment, and in the follow-up measurements.

DISCUSSION

Daily self-executed cross-friction massage using a fascia ball may be a useful alternative intervention for treating recent-onset plantar heel pain.

Anatomic physeal-sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24-month follow-up

Purpose

Recurrent patellar dislocation is a prevalent orthopaedic issue among active paediatric and adolescent populations. Bony surgical procedures are not recommended in growing patients; therefore, the focus of surgery is on restoring the medial patellar ligaments, with different reconstructive techniques available. This retrospective case series focuses on the 2-year outcomes of medial patellofemoral ligament (MPFL) reconstruction in skeletally immature patients with open physis.

Methods

Twenty-four consecutive patients with patellofemoral instability and open growth plates underwent anatomic MPFL reconstruction with a physeal-sparing technique. All subjects have had more than three episodes of true patellar dislocations. Preoperative radiographic examination included anteroposterior and lateral views to assess patella alta and limb alignment. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and tibial tubercle-trochlear groove (TT-TG) distance. The patients were questioned regarding complications and clinical outcomes using the visual analogue scale (VAS), Kujala and Paediatric International Knee Documentation Committee (Pedi-IKDC) score. Variables were evaluated using paired t test with significance at p < 0.05.

Results

The mean age at the time of operation was 13.04 years (9-16 years). The cohort was followed for a mean duration of 38.66 months (24-86 months). The mean time from injury to surgery was 50.45 days (16-80 days). No growth arrest, limb-length discrepancies or angular deformities were observed post-operatively during the whole follow-up period. No patellar re-dislocations were recorded throughout the study period. The VAS score improved significantly from 5.67 (4-8) to 1.88 (0-4) (p < 0.01). The Kujala score improved significantly from 64.67 (44-81) preoperatively to 87.58 (77-100) post-operatively (p < 0.01). The Pedi-IKDC also increased significantly from 58.81 (34.80-77.70) preoperatively to 90.64 (70.70-100) post-operatively (p < 0.01). The vast majority of patients (87.5%) returned to their pre-injury activity level. Boys scored better than girls in VAS, Pedi-IKDC and Kujala score post-operatively, but these differences were not statistically significant.

Conclusion

Physeal-sparing MPFL reconstruction in children and adolescents yields excellent midterm results and allows patients to return to sports without redislocation of the patella. Boys scored better than girls in VAS, Pedi-IKDC and Kujala score post-operatively, but these differences were not statistically significant.

Level of Evidence

IV: case series with no comparative group.

Pulsed negative pressure myofascial vacuum therapy and percutaneous electrolysis in the treatment of lateral epicondylalgia: A single-blind randomized controlled trial

BACKGROUND

Lateral Epicondylalgia (LE) represents one of the most common injuries of the upper limb. It is necessary to find effective treatments that reduce pain and increase functionality.

PURPOSE

To determine the effects of an integrated intervention of Pulsed Negative Pressure Myofascial Vacuum Therapy (VT), Percutaneous Electrolysis (PE) and eccentric exercise (EE) in the treatment of LE compared versus Manual Therapy soft tissue mobilization (MT) and Ultrasound therapy (US) and EE.

STUDY DESIGN

Single-blind randomized controlled trial.

METHODS

Forty participants, with unilateral LE, were randomly divided into two groups: VT + PE + EE group (n = 20) and MT + US + EE group (n = 20). The VT + PE + EE group received one weekly session for four weeks and a regimen of EE daily at-home, and the MT + US + EE group received 10 sessions over a period of two weeks and a regimen of EE daily at-home. Numerical pain rating scale (NPRS), range of motion (ROM) pressure pain threshold (PPT) and function (PRTEE questionnaire) were measured before treatment, at the end of treatment, and at one- and three-month follow-ups.

RESULTS

The statistically significant improvements were found post-treatment, favoring the VT + PE group in pain intensity (p < 0.001; ES = 0.408), PRTEE-S Pain (p = 0.001; ES = 0.377), PRTEE-S Specific function (p = 0.004; ES = 0.306) and PRTEE-S Total (p = 0.001; ES = 0.355). The VT + PE + EE treatment showed greater effectiveness than the MT + US + EE treatment at immediate post-treatment, as well as at the one-month and three-months follow-up.

CONCLUSIONS

VT and PE added to an EE program could be an effective treatment for pain, ROM, PPT, and function in patients with LE.

Comparative effects of myofascial release with and without eccentric resistance on pain, range of motion, and functional disability in patients with Achilles tendinopathy

BACKGROUND

The ankle is one of the most commonly injured areas in people with active and sedentary lives. Achilles tendinopathy (AT) is characterized by pain and stiffness that limits daily living work. Myofascial release and eccentric training are believed to improve soft tissue circulation, strength, pain, ROM, and function.

OBJECTIVE

To compare the effects of myofascial release with and without eccentric resistance on pain, range of motion, and functional disability in patients with AT.

METHODOLOGY

This randomized clinical trial was conducted with a sample of 72 participants selected via a convenient sampling technique. Participants were divided into two groups, Group A was given myofascial release therapy, and Group B was given myofascial release with eccentric resistance. Numeric Pain Rating Scale (NPRS), Goniometer, and Foot ankle disability index (FADI) were outcome measure tools for pain, range of motion, and functional disability. The assessment was done at baseline, 2nd and 4th week. Mann-Whitney U Test and Friedman's ANOVA were applied to find between-group and within-group differences. P-value was set at ≤0.05.

RESULTS

There was a significant difference in pain (p = 0.03), plantarflexion ROM (p = 0.008), and functional disability (p = 0.02) between the two groups. However, no significant difference was observed in dorsiflexion (p = 0.06). Within-group differences were also significant (p < 0.05).

CONCLUSION

It is concluded that myofascial release with eccentric resistance was more effective than myofascial release without eccentric resistance in improving pain, range of motion, and functional disability in Achilles tendinopathy.