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Rishiraj N, Taunton JE, Lloyd-Smith R, Regan W, Niven B, Woollard R. Functional knee brace use for 21 h leads to a longer duration to achieve peak vertical ground reaction forces and the removal of the brace after 17.5 h results in faster loading of the knee joint. Knee Surg Sports Traumatol Arthrosc 2024; 32:1096-1104. [PMID: 38461373 DOI: 10.1002/ksa.12135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To investigate the landing strategies used after discontinuing and continuing the use of a functional knee brace (FKB) while performing a drop jump. METHODS Following published methodology and power analysis, 23 uninjured male athletes, mean age of 19.4 ± 3.0 years, performed seven tests, during three test conditions (nonbraced, braced and removed brace or continued brace use), over 6 days of 12 testing sessions (S) for a total of 38.5 h. Each subject was provided with a custom-fitted FKB. This study focuses on the single leg drop jump kinetics during S12 when subjects were randomly selected to remove the FKB after 17.5 h or continued use of FKB. The time to peak vertical ground reaction forces (PVGRF) and PVGRF were recorded on landing in eight trials. RESULTS After brace removal, a significantly shorter mean time to PVGRF was recorded (9.4 ± 22.9 msec (3.9%), p = 0.005, 95% confidence interval (95% CI): -168.1, 36.1), while continued brace use required a nonsignificant (n.s.) longer mean duration to achieve PVGRF (19.4 ± 53.6 msec (8.9%), n.s., 95% CI: -49.7, 73.4). No significant mean PVGRF difference was found in brace removal (25.3 ± 65.8 N) and continued brace use (25.1 ± 23.0 N). CONCLUSION Removal of FKB after 17.5 h of use led to a significantly shorter time to achieve PVGRF, while continued brace use for 21 h required a longer duration to achieve PVGRF, suggesting faster and slower knee joint loading, respectively. Understanding the concerns associated with the use of FKB and the kinetics of the knee joint will assist clinicians in counselling athletes about the risks and benefits of using an FKB. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Neetu Rishiraj
- High Performance and Rehabilitation, ACTIN Health & Rehabilitation Inc., Vancouver, British Columbia, Canada
| | - Jack E Taunton
- Allan McGavin Sports Medicine Clinic (Primary Care), University of British Columbia, Vancouver, British Columbia, Canada
| | - Rob Lloyd-Smith
- Allan McGavin Sports Medicine Clinic (Primary Care), University of British Columbia, Vancouver, British Columbia, Canada
| | - William Regan
- Allan McGavin Sports Medicine Clinic (Orthopaedics), University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Niven
- Department of Mathematics & Statistics, University of Otago, Otago, New Zealand
| | - Robert Woollard
- Department of Family Practice, University of British Columbia, British Columbia, Canada
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Kalem M, Özbek EA, Kocaoğlu H, Merter A, Karaca MO, Şahin E, Başarir K. The increase in paediatric orthopaedic trauma injuries following the end of the curfew during the COVID-19 period. J Child Orthop 2021; 15:409-414. [PMID: 34476032 PMCID: PMC8381397 DOI: 10.1302/1863-2548.15.210071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/13/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this study was to compare the injury patterns of orthopaedic trauma patients in the paediatric age group who presented to our hospital during and after lifting the curfew due to the pandemic, with the patients of the same age group who presented to our institution during the same time period last year. METHODS Patients, aged 0 years to 18 years, who presented to our clinic between 21 March 2020 and 31 May 2020 (during curfew) (Group A1, n = 111), between 01 June 2020 and 31 August 2020 (Group A2, n = 214) and during the same periods in 2019 Group B1 (n = 220) and Group B2 (n = 211) were included. Patients with pathological fractures, traumas occurring earlier than the aforementioned date range and those consulted while being hospitalized in another department were excluded from study. Patients' demographics, the department they presented to, the anatomical region affected by trauma, trauma mechanism, the location of trauma, the treatment applied and the length of hospital stay were recorded. RESULTS The prevalence of outdoor traumas (72.9% versus 61.1%), high-energy traumas (40.1% versus 26.5%), the rate of the patients treated with surgery (28% versus 17.1%) and the rate of admission to the emergency department (90.2% versus 58.3%) were significantly higher in Group A2 when compared with Group B2 (p < 0.05). CONCLUSION The significant increase was observed in the number of outdoor injuries, high-energy traumas and fracture patterns that require surgical treatment during the first three months following the lift of the curfew, in comparison with the corresponding dates from last year. We think that children's lower extremity muscle strength and neuromuscular control was decreased due to staying home for a prolonged period of time. LEVEL OF EVIDENCE Level III, Case-control study.
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Affiliation(s)
- Mahmut Kalem
- İn’i Sina Training and Research Hospital, University of Ankara, Orthopedics and Traumatology Department, Ankara, Turkey
| | - Emre Anıl Özbek
- İn’i Sina Training and Research Hospital, University of Ankara, Orthopedics and Traumatology Department, Ankara, Turkey,Correspondence should be sent to E. A. Özbek, İbn’i Sina Training and Research Hospital, University of Ankara, Orthopedics and Traumatology Department, İbn’i Sina Hospital, Ankara University Medicine Faculty, 06100 Samanpazarı, Ankara, Turkey. E-mail:
| | - Hakan Kocaoğlu
- İn’i Sina Training and Research Hospital, University of Ankara, Orthopedics and Traumatology Department, Ankara, Turkey
| | - Abdullah Merter
- İn’i Sina Training and Research Hospital, University of Ankara, Orthopedics and Traumatology Department, Ankara, Turkey
| | - Mustafa Onur Karaca
- İn’i Sina Training and Research Hospital, University of Ankara, Orthopedics and Traumatology Department, Ankara, Turkey
| | - Ercan Şahin
- Bulent Ecevit University School of Medicine Hospital Orthopedic Surgery Department, Zonguldak, Turkey
| | - Kerem Başarir
- İn’i Sina Training and Research Hospital, University of Ankara, Orthopedics and Traumatology Department, Ankara, Turkey
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Sex differences in muscle activation patterns associated with anterior cruciate ligament injury during landing and cutting tasks: A systematic review. J Electromyogr Kinesiol 2021; 60:102583. [PMID: 34392010 DOI: 10.1016/j.jelekin.2021.102583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/22/2021] [Accepted: 07/24/2021] [Indexed: 01/13/2023] Open
Abstract
Neuromuscular control is critical for maintaining dynamic joint stability and mitigating the risk of anterior cruciate ligament (ACL) injury. Given the increased risk of ACL injury in females, sex-based differential muscle activation strategies are often associated with this risk. For example, the quadriceps-dominant muscle activation strategy sometimes observed in females has been discussed as a cause of their increased risk of ACL injury. However, there has been no synthesised knowledge on sex differences in muscle activation patterns associated with ACL injuries. Therefore, the purpose of this review was to synthesise sex differences in muscle activation patterns in movements associated with ACL injuries in both adult and adolescent populations. A systematic electronic database search was conducted. Thirty studies were included in the review. Females demonstrated higher pre- and post-landing activation of the quadriceps and lower activation of the hamstrings in 15 studies. Females also had higher quadriceps-to-hamstring co-contraction ratios during pre- and post-landing phases compared to their male counterparts in 4 of 9 studies that considered co-contraction. While some studies supported the quadriceps-dominant activation strategies in females, no consensus can be drawn due to methodological inconsistencies and limitations. Also, despite the importance of ACL injury prevention in children and adolescents, the evidence on sex difference in muscle activation patterns in this population is insufficient to draw meaningful conclusions.
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Giesche F, Stief F, Groneberg DA, Wilke J. Effect of unplanned athletic movement on knee mechanics: a systematic review with multilevel meta-analysis. Br J Sports Med 2021; 55:1366-1378. [PMID: 34344709 DOI: 10.1136/bjsports-2021-103933] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare the effects of pre-planned and unplanned movement tasks on knee biomechanics in uninjured individuals. DESIGN Systematic review with meta-analysis. DATA SOURCES Five databases (PubMed, Google Scholar, Cochrane Library, ScienceDirect and Web of Science) were searched from inception to November 2020. Cross-sectional, (randomised) controlled/non-controlled trials comparing knee angles/moments of pre-planned and unplanned single-leg landings/cuttings were included. Quality of evidence was assessed using the tool of the Grading of Recommendations Assessment, Development and Evaluation working group. METHODS A multilevel meta-analysis with a robust random-effects meta-regression model was used to pool the standardised mean differences (SMD) of knee mechanics between pre-planned and unplanned tasks. The influence of possible effect modifiers (eg, competitive performance level) was examined in a moderator analysis. RESULTS Twenty-five trials (485 participants) with good methodological quality (Downs and Black) were identified. Quality of evidence was downgraded due to potential risk of bias (eg, confounding). Moderate-quality evidence indicates that unplanned tasks evoked significantly higher external knee abduction (SMD: 0.34, 95% CI: 0.16 to 0.51, 14 studies) and tibial internal rotation moments (SMD: 0.51, 95% CI: 0.23 to 0.79, 11 studies). No significant between-condition differences were detected for sagittal plane mechanics (p>0.05). According to the moderator analysis, increased abduction moments particularly occurred in non-professional athletes (SMD: 0.55, 95% CI: 0.14 to 0.95, 5 studies). CONCLUSION Unplanned movement entails higher knee abduction and tibial internal rotation moments, which could predispose for knee injury. Exercise professionals designing injury-prevention protocols, especially for non-elite athletes, should consider the implementation of assessments and exercises requiring time-constrained decision-making. PROSPERO REGISTRATION NUMBER CRD42019140331.
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Affiliation(s)
- Florian Giesche
- Division of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Stief
- University Hospital Frankfurt, Department of Orthopedics (Friedrichsheim), Movement Analysis Lab, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - David A Groneberg
- Division of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan Wilke
- Division of Health and Performance, Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
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Lower limb kinematics differ at the time of foot contact between successful and unsuccessful single limb landings following anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 51:17-21. [PMID: 34174529 DOI: 10.1016/j.ptsp.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate differences in lower extremity kinematics at initial ground contact between successful and unsuccessful single limb landings following anterior cruciate ligament (ACL) reconstruction. DESIGN Observational study. SETTING Controlled laboratory environment. PARTICIPANTS 22 male participants (aged 17-40 years) who had undergone unilateral ACL reconstruction attended a single test session. MAIN OUTCOME MEASURES Within-subjects comparisons was performed for pelvis, hip, knee and ankle kinematics using paired t-tests. RESULTS When unsuccessful at landing on the ACL reconstructed limb, participants had significantly increased knee flexion (P = 0.04) and reduced ankle plantarflexion (P = 0.03) compared to their successful landings. In contrast, when unsuccessful at landing on the unaffected limb, participants had significantly increased pelvic contralateral hitch (P < 0.01) and increased hip abduction (P < 0.01) compared to successful landings. CONCLUSION Body position at the time of initial contact was different for landings that were successful compared to landings that were unsuccessful. These differences were limb-specific: altered position in sagittal plane preceded unsuccessful landings on the reconstructed limb whereas altered position in the coronal plane body position that preceded unsuccessful landings on the unaffected limb. These findings suggest that limb specific landing strategies may be required to improve athletes' performance following ACL reconstruction. LEVEL OF EVIDENCE IV.
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Wu X, Wang Y, Wang C, Wang W, Dong F. Moving average convergence and divergence indexes based online intelligent expert diagnosis system for anaerobic wastewater treatment process. BIORESOURCE TECHNOLOGY 2021; 324:124662. [PMID: 33434874 DOI: 10.1016/j.biortech.2020.124662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
Anaerobic wastewater treatment process is efficient but unstable due to various disturbances, such as refractory organics and influent organic overloading. Therefore, sensitive and accurate status diagnosis is important for reasonable control to improve the stability of anaerobic process. In this study, an online intelligent expert diagnosis system for anaerobic process was established based on moving average convergence and divergence (MACD) indexes of gas- and liquid-phase parameters, combined with online monitoring system and expert diagnosis database. The effect of this diagnosis system was verified through refractory organics and organic overloading shock experiments. Results showed that this diagnosis system could make rapid, accurate and comprehensive diagnosis, predictions and early-warning. MACD algorithm could enhance pattern recognition capacity of status parameters, overcome the lagging of anaerobic process and filter irregular noisy fluctuations of status parameters. MACD index of H2 partial pressure is suitable as sensitive early-warning indicator in the initial shock stage.
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Affiliation(s)
- Xu Wu
- Department of Municipal Engineering, School of Civil Engineering, Hefei University of Technology, Hefei 230009, China; Anhui Provincial Engineering Laboratory for Rural Water Environment and Resources, Hefei 230009, China; Anhui Province Key Laboratory of Industrial Wastewater and Environmental Treatment, Hefei 230024, China
| | - Yulan Wang
- Department of Municipal Engineering, School of Civil Engineering, Hefei University of Technology, Hefei 230009, China; Anhui Provincial Engineering Laboratory for Rural Water Environment and Resources, Hefei 230009, China; Anhui Province Key Laboratory of Industrial Wastewater and Environmental Treatment, Hefei 230024, China
| | - Cheng Wang
- Department of Municipal Engineering, School of Civil Engineering, Hefei University of Technology, Hefei 230009, China; Anhui Provincial Engineering Laboratory for Rural Water Environment and Resources, Hefei 230009, China; Anhui Province Key Laboratory of Industrial Wastewater and Environmental Treatment, Hefei 230024, China
| | - Wei Wang
- Department of Municipal Engineering, School of Civil Engineering, Hefei University of Technology, Hefei 230009, China; Anhui Provincial Engineering Laboratory for Rural Water Environment and Resources, Hefei 230009, China; Anhui Province Key Laboratory of Industrial Wastewater and Environmental Treatment, Hefei 230024, China
| | - Fang Dong
- Department of Municipal Engineering, School of Civil Engineering, Hefei University of Technology, Hefei 230009, China; Anhui Provincial Engineering Laboratory for Rural Water Environment and Resources, Hefei 230009, China; Anhui Province Key Laboratory of Industrial Wastewater and Environmental Treatment, Hefei 230024, China.
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