Electromyographic Assessment of Anterior Cruciate Ligament Injury Risk in Male Tennis Players: Which Role for Visual Input? A Proof-of-Concept Study

Knee functional outcomes and quadriceps hypotrophy after ACL reconstruction: a prospective observational study

BACKGROUND

ACL injuries are common among athletes and individuals experiencing trauma, leading to instability and functional impairments. Post-ACL reconstruction, patients often face challenges like pain and reduced knee function, impacting their daily lives and sports participation. The aim of this study was to describe knee functional outcomes of patients with ACL tears over three months through three subsequent visits.

METHODS

This prospective observational study involved patients with ACL tears who were assessed pre-ACLR and at 1 and 3 months post-ACLR. Measures included Tegner Activity Scale, IKDC Subjective Knee Evaluation, Lysholm Knee Scoring Scale, pain scales, quadriceps thickness via ultrasound, and Rectus femoris and Vastus lateralis muscle activation via surface electromyography.

RESULTS

A total of 98 patients were included in the study. Significant improvements were observed in Tegner Activity Scale scores (p < 0.001), IKDC scores (p < 0.001), Lysholm scores (p < 0.001), and pain scores (p < 0.001) over the study period. Ultrasonography and surface electromyography revealed ongoing quadriceps muscle hypotrophy and reduced neuromuscular function, highlighting the need for targeted rehabilitation.

CONCLUSION

Structured rehabilitation post-ACL reconstruction significantly improves functional outcomes and reduces pain. Challenges like muscle hypotrophy and decreased activation post-surgery emphasize the need for targeted rehabilitation strategies in the initial stages of recovery. Tailored programs focusing on these early deficits are crucial for optimizing recovery trajectories, enhancing knee stability, and preventing long-term complications. Immediate attention to these issues can help refine rehabilitation protocols, ensuring more effective outcomes as patients progress through their recovery. Further research should also focus on the long-term sustainability of these improvements.

Detection, identification and removing of artifacts from sEMG signals: Current studies and future challenges

Surface electromyography (sEMG), a non-invasive technique, offers the ability to identify insights into the activities of muscles in the form of electrical pulses. During the process of recording, the sEMG signals frequently become contaminated by a multitude of different artifacts, the origin of which may be attributed to numerous sources. These artifacts affect the reliability and accuracy of the pure sEMG activity, and subsequently reduce the quality of analysis and interpretation. This can lead to a misinterpretation of sEMG signals, incorrect diagnostic, or a false decision in the case of human-machine interfaces (HMI), etc. Currently, several approaches have been developed to remove or reduce the effect of artifacts on the sEMG activity. In this paper, a comprehensive review of the current studies dealing with identification, detection, and removal of artifacts from sEMG signals is proposed. In addition, this study presents different features used to characterize the artifacts from that of the clean sEMG recordings. Finally, in order to improve the quality of denoising methods, the associated challenges of detection and artifact removal approaches are discussed to be addressed carefully in the future works.

Oral Health and Oral Health-Related Quality of Life in Professional Soccer Players in Southern Italy: A Cross-Sectional Study

OBJECTIVES

To evaluate the oral health of professional footballers and to investigate possible determinants of oral health as well as the self-reported impacts on well-being, quality of life (QoL), and performance.

METHODS

This cross-sectional study was carried out on professional soccer players of the Calabria region, Italy. The outcome measures were the following: DMFT (decayed, missing and filled permanent teeth), DMFS (decayed, missing and filled permanent teeth surfaces), BEWE (basic erosive wear examination), CPI (community periodontal index), CPITN (community periodontal index of treatment needs), Oral Health Impact Profile-14 (OHIP-14).

RESULTS

One hundred and sixty footballers were recruited from seven clubs. The median age of the players was 25 years (19-39) years. The mean DMFT was 2.8 ± 2.9, and the multiple logistic regression analyses showed a positive association with frequent intake of drinks rich in sugar (OR = 3.69, 95% CI = 1.59-8.56) and sports drinks (OR = 3.73, 95% CI = 1.09-12.75). Dental erosions were present in 48.1% of footballers and periodontal diseases in 50%, with a positive association with frequent intake of energy drinks (OR = 2.86, 95% CI = 1.09-7.51). The OHIP-14 showed that 30.6% of participants reported having had pain in their teeth/mouth/dentures occasionally.

CONCLUSIONS

Results from the present study showed that the oral health of professional soccer players in Southern Italy was poor, especially regarding caries, erosion, and periodontal diseases. Moreover, OHIP-14 showed an impact on oral health in soccer players' QoL, revealing that poor oral health negatively affected professional well-being and performance. Results suggest the need for prevention interventions for professional athletes.

Role of the Flexion Relaxation Phenomenon in the Analysis of Low Back Pain Risk in the Powerlifter: A Proof-of-Principle Study

INTRODUCTION

Unlike the most common training approaches for bodybuilding, powerlifting programs are generally based on maximum and submaximal loads, putting enormous stresses on the lumbar spine. The flexion relaxation phenomenon evaluation is a clinical tool used for low back pain (LBP) assessment. This study aimed to evaluate the role of the flexion relaxation phenomenon in the analysis of LBP in the powerlifters.

METHODS

Healthy professional powerlifters participated in the study. In fact, we divided the participants into a LBP-low-risk group and a LBP-high-risk group, based on a prior history of LBP. Outcome measures included flexion relaxation ratio (FRR) and trough surface electromyography collected during trunk maximum voluntary flexion; furthermore, during a bench press lifting, we measured the height of the arched back (ARCH), using a camera and the Kinovea video editing software, to consider a potential correlation with the risk of LBP.

RESULTS

We included a group of 18 male (aged 24-39 y) powerlifters of 93 kg category. We measured a nonsignificant mean difference of ARCH between low-risk LBP group and high-risk LBP subjects. Curiously, maximum voluntary flexions were both above the threshold of 3.2 μV; therefore, with an absence of appropriate myoelectric silence, on the contrary, the FRR ratios were higher than 9.5, considering the presence of the phenomenon, exclusively for the low-risk group. The lumbar arched back measurement data did not report any association with the LBP risk, regarding the maximum voluntary flexion value, and even more than the FRR there is a relationship with the presence or the absence of LBP risk.

CONCLUSIONS

FRR could be considered as a useful parameter for studying the risk of LBP in powerlifting. The FRR index not only refers to the possible myoelectric silence of the lumbar muscles in trunk maximum forward flexion but also takes into account the energy value delivered by the lumbar muscles during the flexion. Furthermore, we can indicate that the size of the powerlifter ARCH may not be a determining factor in the occurrence of LBP.

Impact of yoga asanas on flexion and relaxation phenomenon in women with chronic low back pain: Prophet model prospective study

Chronic nonspecific low back pain (NSLBP) is a prevalent condition with socioeconomic and healthcare challenges. The flexion-relaxation phenomenon (FRP) evaluation is a valid clinical tool for low back pain (LBP) assessment. Yoga, a holistic mind-body practice, has been explored as an LBP intervention. This study aimed to evaluate the impact of yoga asanas on the FRP in women with NSLBP. The study included healthy and chronic NSLBP females who underwent an eight-session yoga asanas program, with the first session conducted in-clinic and the rest delivered with tele-approach. Outcome measures included pain intensity, flexion-relaxation ratio (FRR), and trough surface electromyography collected during trunk maximum voluntary flexion (MVF). The study included 11 healthy and 10 NSLBP women. Repeated measures test in chronic NSLBP group showed a significant decrease in pain intensity after the 4 weeks follow-up (visual analog scale [VAS]: 6.80 ± 1.48 vs. 3.30 ± 1.25; p < 0.001) and an FRR improvement after the intervention (5.12 ± 0.93 vs. 9.49 ± 0.92; p < 0.001). VAS and FRR effect sizes were 0.77 and 0.47, respectively. Therefore, we performed a Prophet evaluation to assess FRR trends, finding a growth rate (k) of 0.405 ± 0.448, with a forecast 1 month after the end of the intervention approaching the trend line of the control group. The findings suggested that tele-yoga asana might have a positive impact on pain intensity and the FRP in chronic LBP. Further research is warranted to confirm the long-term effects of yoga for managing LBP.

Genome-Wide Association Screens for Anterior Cruciate Ligament Tears

BACKGROUND

The etiopathogenesis of ACL rupture is not clarified. The aim of this study is to identify genomic regions and genetic variants relevant to anterior cruciate ligament injury susceptibility that could be involved in non-contact anterior cruciate ligament ruptures.

METHODS

A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with a PRISMA checklist and algorithm. A search of PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar databases was conducted using combinations of the terms "anterior cruciate ligament", "ACL", "rupture", "genetics", "single nucleotide polymorphisms", and "SNP" since the inception of the databases until 2021.

RESULTS

Twenty-three studies were included. A total of 7724 patients were analyzed. In total, 3477 patients had ACL ruptures and 4247 patients were controls. Genetic variants in genes encoding for collagens, elastin, fibrillin, matrix metalloproteinases, proteoglycans, angiogenesis-associated signaling cascade proteins, growth differentiation factors, tissue inhibitors of metalloproteases, interleukins, and fibrinogen were analyzed.

CONCLUSION

Findings regarding the association between genes encoding for collagen (COL3A1, COL1A1, and COL12A1), aggrecan (ACAN), decorin (DCN), matrix metalloproteinase (MMP3), interleukin 6 (IL-6), vascular endothelial growth factor A (VEGFA), biglycan (BGN), fibrinogen (FGB), and ACL injuries were found to be inconclusive. Additional evidence is required in order to establish substantial conclusions regarding the association between genetic variants and ACL rupture.

Risk of injury and kinematic assessment of the shoulder biomechanics during strokes in padel players: a cross-sectional study

BACKGROUND

Padel players commonly suffer from shoulder pain and the particularly high incidence is probably linked to the high frequency of strokes. In addition, due to the repetitive technical gesture, an adequate technique is essential in terms of performance and injury risk prevention. Aim of this study was to objectively evaluate shoulder kinematic during the athletic gesture to analyze the risk factors linked to padel strokes.

METHODS

Professional and amateur padel players underwent a three-dimensional motion analysis of the padel strokes utilizing optoelectronic and surface electromyography systems (BTS Bioengineering, Garbagnate Milanese, Milan, Italy).

RESULTS

Twelve padel players were included in this study (10 professional players in Group A and 10 amateurs in Group B). Experience influences the execution of padel strokes with a significant difference between group A and B in terms of gleno-humeral rotation and scapular tilt. Moreover, a subgroup analysis revealed that male players execute voleè with a higher external rotation (P=0.043), and forehand with a higher scapular tilt (P=0.044).

CONCLUSIONS

The results confirm that the high ranges of motion of the overhead strokes could rise the risk of slap lesion, impingement, and glenohumeral internal rotation deficit. However, a correct execution of the athletic gesture is linked with a dynamic stabilization of the humeral head. In conclusion, the kinematic analysis could help in the early identification of the kinematic alteration to build a tailored rehabilitation plan based on the athlete's needs.

Quadriceps muscle reaction time in obese children

This study aimed to determine the influence of obesity, according to body mass index (BMI) and fat mass percentage, on quadriceps muscle reaction times. The study utilized a cross-sectional design. The sample size consisted of 42 schoolchildren (54.5% girls) aged 11 to 12 years old. Participant measurements included weight and height, which were used to categorize individuals based on BMI. Additionally, the electrical bioimpedance technique was employed to categorize participants based on their body fat percentage. A sudden destabilization test of the lower limb was performed to assess the reaction time of the rectus femoris, vastus medialis, and vastus lateralis muscles. The results show that overweight/obese children have a longer muscle reaction time for both the rectus femoris (β = 18.13; p = 0.048) and the vastus lateralis (β = 14.51; p = 0.042). Likewise, when the children were classified by percentage of body fat the results showed that overfat/obese children have a longer muscle reaction time for both the rectus femoris (β = 18.13; p = 0.048) and the vastus lateralis (β = 14.51; p = 0.042). Our results indicate that BMI and fat mass classification negativity alter the muscle reaction time in children. Overweight/obese or overfat/obese children showed longer reaction times in the rectus femoris and vastus lateralis muscles compared to children with normal weight. Based on these findings, it is suggested that in overweight and obese children, efforts not only focus on reducing body weight but that be complemented with training and/or rehabilitation programs that focus on preserving the normal physiological function of the musculoskeletal system.

Postural Analysis Using Rasterstereography and Inertial Measurement Units in Volleyball Players: Different Roles as Indicators of Injury Predisposition

Background and Objectives: Acute and chronic injuries are frequent in volleyball. Biomechanics of sport-specific tasks can influence the risk of injury, which is also related to specific court positions. We investigated posture at raster-stereography, balance, and dynamic tasks using inertial motion units to find differences between roles, which can be predictive of a higher risk of injury. Materials and Methods: We cross-sectionally evaluated amateur volleyball athletes. Participants were divided into roles as outside hitters, setters, middle blockers, and opposite hitters. We excluded the "libero" position from our analysis. Results: Sixteen players were included in the analysis. A statistically significant difference was found in left lower limb stiffness among the outside hitter and setter groups. Conclusions: Differences in stiffness might be related to the different training and the different abilities among the two groups. Raster-stereography is extending its indications and should be implemented for non-invasive postural analysis. The use of inertial motion units provides objective measurements of variables that could go unrecognized within a clinical evaluation; its use should be considered in injury preventive programs.

Cryo plus Ultrasound Therapy, a Novel Rehabilitative Approach for Football Players with Acute Lateral Ankle Injury Sprain: A Pilot Randomized Controlled Trial

BACKGROUND

Acute lateral ankle sprains are common injuries among athletes, but the optimal treatment strategies in elite athletes are still debated. This proof-of-concept study aimed to assess the impact of cryo-ultrasound therapy on the short-term recovery of football players with acute lateral ankle sprains.

METHODS

Semi-professional football players with grade I or II lateral ankle sprains were randomly assigned to the experimental group (receiving cryo-ultrasound therapy combined with conventional physical therapy) or control group (sham cryo-ultrasound therapy combined with conventional physical therapy). Pain intensity and physical functioning were assessed by the Numeric Rating Scale (NRS) and Foot and Ankle Disability Index (FADI) at baseline (T0) at the end of treatment (T1), after one month (T2), and two months after treatment (T3).

RESULTS

After the study intervention, significant between groups differences were reported in terms of pain relief (NRS: 4.08 ± 1.29 vs. 5.87 ± 1.19; p = 0.003) and physical function (FADI: 50.9 ± 10.3 vs. 38.3 ± 11.5; p = 0.021). However, no significant between group differences were reported at T2 and T3. No adverse effects were reported.

CONCLUSIONS

Cryo-ultrasound therapy combined with conventional physical therapy can accelerate recovery and early return to sport in elite football players with acute lateral ankle sprains. While this study contributes valuable insights into the potential benefits of cryo-ultrasound therapy, further investigations with a longer follow-up are needed to validate and optimize the application of physical agent modalities in the management of ankle injuries.

Impact of COVID-19 Era on the Anterior Cruciate Ligament Injury Rehabilitation: A Scoping Review

The surgical intervention rate and the subsequent rehabilitation plan for anterior cruciate ligament (ACL) injury was crucially affected by the COVID-19 pandemic due to the necessity in the face of the emergency. This review aimed to evaluate potential persistent and residual symptoms after COVID-19 disease, including fatigue and neuromuscular disorders. A scoping review design and methodology were used due to the exploratory nature of the research question, according to literature searches on PubMed/Medline, Scopus, Web of Science (WoS), and Physiotherapy Evidence Database (PEDro) electronic databases using the following keywords: "Anterior Cruciate Ligament", "ACL", "SARS-CoV-2", and "COVID-19". Undertraining and muscular knee imbalance might cause inefficient movement strategies, lack of knee stability, and increasing load with negative implications in ACL injuries. In the post-surgery period, during COVID-19, telerehabilitation approaches appeared to be successfully applied to maintain strength and range of motion in this condition. However, no definitive data are available regarding the most effective interventions. This scoping review showed the influence of the COVID-19 pandemic and associated restrictions on postoperative and rehabilitative care of ACL injuries.

Efficacy of Proprioceptive Training on Plantar Pressure and Jump Performance in Volleyball Players: A Proof-of-Principle Study

Volleyball players are often subject to micro-traumatisms of the heel fat pad and ankle injuries. Recently, mat-based proprioceptive training has assumed a key role in recovery from these disorders. Therefore, this proof-of-principle study aimed to assess the efficacy of proprioceptive mat training on plantar pressures and athletic performance in volleyball players. The participants included adult semi-professional volleyball players allocated into two groups: an experimental group, with mat-based proprioceptive and balance training, and a control group, with a sham protocol. For the outcome, we evaluated the barefoot plantar pressure, performing an analysis on a baropodometric resistive platform. The countermovement jump and squat jump were measured using an inertial measurement unit. Nineteen subjects were included in the two groups: the active proprioceptive group (n = 10) or the control group (n = 9). The results show a more uniform redistribution of loads with pressure hindfoot relief in the experimental group compared to the control group (p = 0.021, RBC = 0.67). Moreover, we observed a significant increase in peak landing force and high concentric power development in the experimental group compared to the controls. Focused proprioceptive management provided hindfoot load attenuation by stimulating higher peaks of concentric force in the experimental group compared to the sham group. Even though the study included a small sample, the results obtained in this proof-of-principle study suggest a positive role of proprioceptive stimulation in the inter-seasonal scenario for volleyball players to improve their jump performance and reduce the micro-traumatisms of the heel fat pad and the ankle injury rate. However, further studies performed on larger samples are needed to confirm these preliminary results.

Effects of blood flow restriction on spine postural control using a robotic platform: A pilot randomized cross-over study

BACKGROUND

Blood flow restriction (BFR) training improves muscle strength and functional outcomes, but the proprioceptive implications of this technique in the rehabilitation field are still unknown.

OBJECTIVE

The present study aimed at assessing the effects of BFR in terms of stabilometric and balance performance.

METHODS

In this pilot randomized cross-over study, healthy young adults were included and randomly assigned to Groups A and B. Both groups underwent a postural assessment with and without wearing a BFR device. Study participants of Group A underwent postural baseline assessment wearing BFR and then removed BFR for further evaluations, whereas subjects in Group B performed the baseline assessment without BFR and then with BFR. Stabilometric and balance performance were assessed by the robotic platform Hunova, the Balance Error Scoring System (BESS), the self-reported perceived balance (7-point Likert scale), and discomfort self-rated assessment. Moreover, the safety profile was recorded.

RESULTS

Fourteen subjects were included and randomly assigned to Group A (n: 7) and Group B (n: 7). Significant differences were shown in balance tests in static conditions performed on the Hunova robot platform in terms of average distance RMS (root-mean-square) with open eyes (OE), anteroposterior (AP) trunk oscillation range with OE, mediolateral (ML) average speed of oscillation with OE, and total excursion AP range with closed eyes (CE) (BFR: 3.44 ± 1.06; without BFR: 2.75 ± 0.72; p= 0.041). Moreover, elastic balance test showed differences in Romberg index (BFR: 0.16 ±0.16; without BFR: 0.09 ± 0.07; p= 0.047). No adverse events were reported.

CONCLUSION

Taken together, our data showed that BFR affects balance performance of healthy subjects. Further studies are needed to better characterize the possible role of BFR treatment in the context of a specific rehabilitation protocol.

COVID-19 as a Potential Cause of Muscle Injuries in Professional Italian Serie A Soccer Players: A Retrospective Observational Study

The COVID-19 pandemic has shocked the entire planet. The soccer world has also suffered major upheavals, and many professional soccer players have been infected with the virus. The aim of this study was to evaluate the incidence of injuries in Italian Serie A professional soccer players before and during the COVID-19 pandemic. Methods: We evaluated the incidence of muscle injuries between four competitive seasons of the Italian Serie A (2016-2017, 2017-2018, and 2018-2019 pre-COVID-19 vs. 2020/2021 post-COVID-19) in professional soccer players. Results: Significant differences were found in muscular injuries between the post-COVID-19 season and the previous seasons (p < 0.001). The median split of the players' positivity duration was of 15 days. The players' long positivity (PLP) group showed a significant number of muscular injuries compared to the players' short positivity (PSP) group (p < 0.0014, ES = 0.81, Large). The total teams' days of positivity were significantly related to the total team number of muscular injuries (r = 0.86; CI 95% 0.66 to 0.94; p < 0.0001). In conclusion, this data showed that the competitive season post-COVID-19 lockdown has a higher incidence of muscle injuries in Italian Serie A soccer players compared to the pre-pandemic competitive season.

Reduced Vastus Medialis/Lateralis EMG Ratio in Volleyballers with Chronic Knee Pain on Sports-Specific Surfaces: A Pilot Study

BACKGROUND

Even though chronic knee pain is common in volleyball, neuromuscular imbalance as a potential risk factor has not been investigated in volleyball-specific tasks. The aim of the study was to compare neuromuscular control between healthy and injured players in a clinical jump test and a volleyball-specific jump task in real field conditions.

METHODS

Six athletes with knee pain and nine controls were included. Surface electromyographic data were recorded from the mm. vastus medialis (VM) and lateralis (VL) of both legs. VM/VL activation ratio was calculated from countermovement jump (CMJ) and volleyball spike indoors and on two beach surfaces.

RESULTS

All subjects had pain in the leading leg. Mann-Whitney U Test (M-W-U Test) revealed a significantly lower VM/VL ratio of the leading leg (always affected) of the injured compared with that of the healthy control group for the CMJ and spike jump on all three grounds. Bland-Altman analysis revealed low bias and low difference in standard deviation for the injured leg but high values for the uninvolved leg and healthy controls between tasks and grounds. These results could indicate that neuromuscular control might not adapt too well to different movement tasks and grounds in the injured leg.

CONCLUSION

Athletes with chronic knee pain might have lower VM/VL ratios than controls independent from movement task and ground. Neuromuscular control in injured athletes might be less adaptable to new circumstances. The results of neuromuscular control in laboratory settings might be applicable to field conditions in injured legs but not healthy ones.

Pre-operative knee extensor and flexor torque after secondary ACL rupture: a comparative retrospective analysis

Background

Secondary anterior cruciate ligament (ACL) ruptures are a relevant clinical concern after surgical treatment of a primary ACL rupture. However, there is a lack of scientific evidence related to the role of muscle strength prior to revision surgery in a second ACL rupture. The aim of this study was to assess differences in knee extensor and flexor strength in patients before primary and secondary ACL reconstruction compared to healthy controls.

Methods

In total, n = 69 age, weight and sex matched individuals were included in the study: n = 23 patients with isolated primary ACL rupture, n = 23 with secondary ACL rupture, and n = 23 matched healthy controls. Maximal isokinetic knee extension and flexion torque normalized to body mass was assessed for both legs.

Results

For patients with secondary ACL ruptures, torques were reduced in the non-injured (extension: 1.94 Nm/kg vs. 2.46 Nm/kg, p < 0.05, flexion: 1.25 Nm/kg vs. 1.59 Nm/kg, p < 0.05) and the injured leg (extension: 1.70 Nm/kg vs. 2.46 Nm/kg, p < 0.05, flexion: 1.14 Nm/kg vs. 1.59 Nm/kg, p < 0.05) compared to healthy controls. For patients with a primary ACL rupture torques were reduced in the non-injured (extension: 1.92 Nm/kg vs. 2.46 Nm/kg, p < 0.05, flexion: 1.24 Nm/kg vs. 1.59 Nm/kg, p < 0.05) and the injured leg (extension: 1.38 Nm/kg vs. 2.46 Nm/kg, p < 0.05, flexion: 1.01 Nm/kg vs. 1.59 Nm/kg, p < 0.05) compared to healthy controls. There were no differences between patients with primary and secondary ruptures, except of the knee extension on the injured leg showing higher values after a secondary ACL rupture (1.38 Nm/kg vs. 1.70 Nm/kg, p < 0.05).

Conclusions

The findings indicate that maximal knee torques were significantly reduced in patients with primary and secondary ACL ruptures before surgical reconstruction for the non-injured and injured leg as compared to healthy controls. Further investigations are needed to assess strength abilities before and after a second revision within a prospective design.

Advance in the Diagnostics and Management of Musculoskeletal Diseases

Musculoskeletal disorders are a broad spectrum of diseases, affecting muscles, bones, ligaments, and tendons worldwide [...].

Effect of Nursing in Operating Room Combined with Intraoperative Heat Preservation Intervention on Prevention of Incision Infection and Improvement of Hemodynamics in Patients with Anterior Cruciate Ligament Injury and Reconstruction under Knee Arthroscopy

Objective

To explore the effect of nursing in operating room combined with intraoperative heat preservation intervention on preventing incision infection and improving hemodynamics in patients with anterior cruciate ligament (ACL) injury and reconstruction under knee arthroscopy.

Methods

About 200 patients with knee arthroscopic ACL reconstruction in our hospital from January 2019 to July 2021 were enrolled. The patients were randomly assigned into two groups: the control group and the study group. The former group received nursing care in the operating room operating room and the latter group received nursing care in operating room combined with intraoperative heat preservation intervention. Nursing satisfaction, incidence of incision infection, knee joint VAS score, knee joint range of motion, knee joint Lysholm score, and hemodynamic indexes were compared.

Results

First of all, we compared the nursing satisfaction, the study group was very satisfied in 78 cases, satisfactory in 20 cases, and general in 2 cases, and the satisfaction rate was 100.00%, while in the control group, 445 cases were very satisfied, 20 cases were satisfied, 15 cases were general, and 8 cases were dissatisfied. The satisfaction rate was 82.00%. The nursing satisfaction of the study group was higher compared to the control group (P < 0.05). Secondly, we compared the incidence of incision infection. The incidence of incision infection in the study group was lower compared to the control group (P < 0.05). With regard to the knee joint VAS score, the knee joint VAS score of the study group was lower compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation (P < 0.05). In terms of the range of motion of the knee joint, the range of motion of the knee joint in the study group was higher compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation (P < 0.05). Regarding the knee joint Lysholm score, the knee joint Lysholm score of the study group was higher compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation (P < 0.05). Finally, we compared the hemodynamic indexes. Before nursing, there exhibited no significant difference (P > 0.05). During and after nursing, the indexes of HR and MAP in the study group fluctuated little (P < 0.05).

Conclusion

During the perioperative period of patients with ACL injury and reconstruction under knee arthroscopy, standardized and necessary operating room combined with intraoperative thermal insulation intervention measures should be given, attention should be paid to the management of operating room, and intraoperative thermal insulation intervention should be strengthened. It includes preoperative visit, psychological nursing of patients, strict application of antibiotics before operation, monitoring of air quality in operating room, disinfection and sterilization of surgical instruments, shortening operation time, maintaining body temperature during operation, and paying attention to hand hygiene of medical staff. It plays a supervisory role in promoting the attention of medical staff to the prevention of wound infection, which is beneficial to the healing of surgical wounds of patients. It plays a positive role in enhancing hemodynamic indexes. Comprehensive nursing intervention on the risk factors of each link can effectively prevent postoperative wound infection and strengthen the prognosis and quality of life of patients.

Effects of Radial Extracorporeal Shock Wave Therapy in Reducing Pain in Patients with Temporomandibular Disorders: A Pilot Randomized Controlled Trial

Temporomandibular disorders (TMD) are primarily characterized by pain as well as issues concerning the proper functioning of individual elements of the stomatognathic system. The aim of the study was to assess the safety and efficacy of physical exercise, with or without radial Extracorporeal Shock Wave Therapy (rESWT), in patients with TMD. Eligible patients were adults (≥18 years) with diagnosed myofascial pain with or without mouth opening limitation (Group Ia, Ib) based on the Diagnostic Criteria for TMD (DC/TMD). Enrolled patients (n = 15) were randomly assigned 1:1 to receive physical exercise combined with rESWT (n = 8) or sham rESWT (n = 7) for four weeks. The primary endpoint was the pain intensity measured by a visual analogue scale (VAS). The secondary endpoints were muscle activity and function assessed through the surface electromyography evaluation of the anterior temporalis and the masseter muscles. The rESWT group (mean age: 28.50 ± 8.85 years) showed a statistically significant pain reduction (VAS Right side: ΔT0-T1 MD = −3.00; p = 0.023, Left side: ΔT0-T1, MD = 3.57, p = 0.021), whereas patients in the sham WBV group (mean age: 30.71 ± 8.98 years), did not reach statistical significance (VAS: Right side: ΔT0-T1 MD = 1.00, p = 0.155; Left side: ΔT0-T1 MD = 1.25 SE = 0.25, p = 0.094). Concurrently, muscle activity and performance significantly improved in the active rESWT group, with an improvement in the percentage of the overlapping coefficient (POC) compared to the control group. No dropouts and no side effects were recorded. Taken together, the findings of this pilot RCT suggested that rESWT combined with physical therapy could be effective in relieving pain and improving function in muscle-related TMD patients.

Match Analysis, Physical Training, Risk of Injury and Rehabilitation in Padel: Overview of the Literature

Padel is a racket sport that has been gaining great popularity and scientific interest in recent years. It could be considered to be a high-intensity intermittent sport with valuable cardiovascular and neuromuscular benefits; however, the risk of injury cannot be neglected. To date, there is still a gap of knowledge in the scientific literature on this emergent sport. Therefore, the present review aims to synthetize the current knowledge on padel game dynamics to better characterize the main risk factors, the injury rate and characteristics, and the most effective rehabilitative treatment strategies. PubMed, Scopus, Cochrane, and PEDro were screened up to January 2022 to identify eligible studies focusing on padel players as participants. Out of 160 records, we included 19 studies, which were focused on match analysis, anthropometric and physical training, the risk of injury, and rehabilitative interventions. The results showed that the high action velocity and the sudden changes in direction during a padel match could represent a risk factor for injuries, especially in untrained players. However, the high heterogeneity of the studies in the literature hinders our ability to draw any strong conclusions, and the results should be carefully considered. Future research should address the lack of knowledge on injury mechanisms and type to implement a tailored rehabilitation program.

Effects of a Postural Exercise Program on Vertical Jump Height in Young Female Volleyball Players with Knee Valgus

Background: Although a knee valgus position is related to the increase in injury risk in volleyball players, there is a lack of studies on the relationship between knee valgus and vertical jump (VJ) performance. Hence, the aim of this study was to investigate the effects of a postural exercise program on VJ height in young female volleyball players with knee valgus. Methods: This pilot study included 19 young female volleyball players divided into the following groups: the Valgus Experimental Group (VEG); the Valgus Control Group (VCG); and the Neutral Control Group (NCG). All three groups carried out the same volleyball training program. In addition, only the VEG underwent a 3-month postural exercise program of 30–45 min/session, twice/week. VJ performance was measured through the Sargent test before (T0), at 6 weeks (T1), and at 12 weeks (T2). Results: A significant effect from T0 to T1 (p = 0.0017) and from T0 to T2 (p = 0.0001) was found in the VEG. No significant differences were found over time in the VCG and in the NCG. Conclusion: An integrated postural exercise program might lead to a more balanced muscle efficiency inducing athletes to obtain a higher VJ performance.

A Telerehabilitation Approach to Chronic Facial Paralysis in the COVID-19 Pandemic Scenario: What Role for Electromyography Assessment?

There is a lack of data on patient and diagnostic factors for prognostication of complete recovery in patients with peripheral facial palsy. Thus, the aim of this study was to evaluate the role of a telerehabilitave enhancement through the description of a case report with the use of short-wave diathermy and neuromuscular electrical stimulation combined to facial proprioceptive neuromuscular facilitation (PNF) rehabilitation in unrecovered facial palsy, in a COVID-19 pandemic scenario describing a paradigmatic telerehabilitation report. A 43-year-old woman underwent a facial rehabilitation plan consisting of a synergistic treatment with facial PNF rehabilitation, short-wave diathermy, and neuromuscular electrical stimulation (12 sessions lasting 45 min, three sessions/week for 4 weeks). Concerning the surface electromyography evaluation of frontal and orbicularis oris muscles, the calculated ratio between amplitude of the palsy side and normal side showed an improvement in terms of movement symmetry. At the end of the outpatient treatment, a daily telerehabilitation protocol with video and teleconsultation was provided, showing a further improvement in the functioning of a woman suffering from unresolved facial paralysis. Therefore, an adequate telerehabilitation follow-up seems to play a fundamental role in the management of patients with facial palsy.

Drop Jumping on Sand Is Characterized by Lower Power, Higher Rate of Force Development and Larger Knee Joint Range of Motion

Plyometric training on sand is suggested to result in advanced performance in vertical jumping. However, limited information exists concerning the biomechanics of drop jumps (DJ) on sand. The purpose of the study was to compare the biomechanical parameters of DJs executed on rigid (RIGID) and sand (SAND) surface. Sixteen high level male beach-volleyball players executed DJ from 40 cm on RIGID and SAND. Force- and video-recordings were analyzed to extract the kinetic and kinematic parameters of the DJ. Results of paired-samples t-tests revealed that DJ on SAND had significantly (p < 0.05) lower jumping height, peak vertical ground reaction force, power, peak leg stiffness and peak ankle flexion angular velocity than RIGID. In addition, DJ on SAND was characterized by significantly (p < 0.05) larger rate of force development and knee joint flexion in the downward phase. No differences (p > 0.05) were observed for the temporal parameters. The compliance of SAND decreases the efficiency of the mechanisms involved in the optimization of DJ performance. Nevertheless, SAND comprises an exercise surface with less loading during the eccentric phase of the DJ, thus it can be considered as a surface that can offer injury prevention under demands for large energy expenditure.

Neuromuscular Impairment of Knee Stabilizer Muscles in a COVID-19 Cluster of Female Volleyball Players: Which Role for Rehabilitation in the Post-COVID-19 Return-to-Play?

COVID-19 athletes reported persistent and residual symptoms many weeks after initial infection, including cough, fatigue, and neuromuscular disorders. Poor neuromuscular control may cause inefficient movement strategies increasing anterior cruciate ligament load. This is particularly relevant in female athletes, who show a 3-time higher risk than male counterparts. Aim is to evaluate the impairment in thigh muscles activation, body composition, and physical performance after COVID-19 in volleyball athletes. We recruited a cohort of female professional players from the same team. We assessed the pre-activation time of Rectus Femoris (RF), Vastus Medialis (VM), Medial Hamstring (MH), and Lateral Hamstring (LH) before (T0) and after (T1) COVID-19 infection, bioelectrical impedance analysis (BIA), and jump tests. We included 12 athletes with COVID-19 infection diagnosis in January 2021. At T1 we found a significant (p < 0.05) delay (ms) of the activation time of RF (426 ± 188 vs. 152 ± 106); VM (363 ± 192 vs. 140 ± 96); BF (229 ± 60 vs. 150 ± 63); MH (231 ± 88 vs. 203 ± 89), and a significant reduction of body composition at BIA. The neuromotor imbalance of the knee stabilizer muscle in female athletes after COVID-19 infection determines a deficit of knee stabilization. Physicians should consider neuromuscular and metabolic sequelae to identify athletes at higher risk of injury and set up specific neuromuscular rehabilitation protocols.

Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review

Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based interventions targeting at reducing ACL injury rate or mitigating risk factors of ACL injury in adult football players. Following PRISMA guidelines, a systematic search was conducted in CINAHL, Cochrane Library, PubMed, Scopus, SPORTDiscus and Web of Science. Studies assessing the effect of exercise-based interventions in ACL injury incidence or modifiable risk factors in adult football players were included. 29 studies evaluating 4502 male and 1589 female players were included (15 RCT, 8 NRCT, 6 single-arm): 14 included warm-up, 7 resistance training, 4 mixed training, 3 balance, 1 core stability and 1 technique modification interventions. 6 out of 29 studies investigated the effect of interventions on ACL injury incidence, while the remaining 23 investigated their effect on risk factors. Only 21% and 13% studies evaluating risk of injury variables reported reliability measures and/or smallest worthwhile change data. Warm-up, core stability, balance and technique modification appear effective and feasible interventions to be included in football teams. However, the use of more ecologically valid tests and individually tailored interventions targeting specific ACL injury mechanisms are required.

Identifying Clinical and MRI Characteristics Associated with Quality of Life in Patients with Anterior Cruciate Ligament Injury: Prognostic Factors for Long-Term

BACKGROUND

Associated lesions in the diagnostic MRI may be related to worse long-term subjective outcomes. There is a lack of conclusive information about the long-term outcomes of associated injuries in anterior cruciate ligament (ACL) tears. The purpose of this study is to assess the long-term effects of associated injuries in ACL tears measured by means of a quality of life (QOL) assessment.

METHODS

A retrospective cohort study of 225 consecutive patients admitted for physical therapy with ACL injury (42 ± 12 years, 28.2% female) were conducted. All demographic and clinical variables were used to measure a QOL. Univariate and multivariable analyses were completed.

RESULTS

The mean follow-up period was 8.4 ± 2.6 years. In univariate analysis, male gender, and sports as the cause of the ACL lesion were factors significantly associated with improved International Knee Documentation Committee (IKDC) scores at the end of follow-up (all p < 0.002). In multivariable analysis, the occurrence of bone contusion was positively associated with injury (OR = 2.12) and negatively associated with sports injury (OR = 0.44) and medial collateral ligament (MCL) injury (OR = 0.48).

CONCLUSIONS

After ACL injury, male gender and sports injury were associated with better clinical outcomes.

Pharmacological Treatment for Acute Traumatic Musculoskeletal Pain in Athletes

Pain management is a crucial issue for athletes who train and compete at the highest performance levels. There are still evidence gaps for the use of analgesics for sports injuries despite the growing interest in training and competition settings. However, high-quality research is needed to determine the most appropriate and optimal timing and formulations in non-steroidal anti-inflammatory drug and opioid management, particularly given the strictness of anti-doping regulations. Indeed, the role of pharmacological therapy in reducing acute traumatic pain in athletes should still be addressed to minimize the timing of return to sport. Therefore, the aim of this comprehensive review was to summarize the current evidence about pain management in the setting of acute injury in elite athletes, providing the most informed strategy for pain relief and performance recovery.

Impact of COVID-19 lockdown on the epidemiology of soccer muscle injuries in Italian Serie A professional football players

OBJECTIVE

To evaluate the influence that COVID-19 lockdown had on the epidemiology of soccer musculoskeletal injuries during 2019/2020 Italian First Football League Serie A in professional football players.

METHODS

In this retrospective study we analyzed records from media-based platform (Trasfermarkt, https://www.transfermarkt.com), describing the epidemiology of muscle injuries before and after the first COVID-19 lockdown phases in Italian professional football players. We also classified the severity of the injury as the number of missing days from participation.

RESULTS

We assessed a lower prevalence of post-lockdown injuries, albeit showing a similar injury rate at 1000 game-hours (pre-lockdown: 16.9 [13.0-20.7], post-lockdown: 15.5 [9.9-21.1]; RR: 0.92 [0.46-1.8]). All risk ratios for injury rate were not significantly different (p> .05) between pre- and post-lockdown.

CONCLUSIONS

The incidence of muscle injuries has not significantly changed after the first COVID-19 lockdown in Italian professional soccer players. Recognizing injury rates might be crucial for physician to evaluate adequate preventive measures.