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Driban JB, Vincent HK, Trojian TH, Ambrose KR, Baez S, Beresic N, Berkoff DJ, Callahan LF, Cohen B, Franek M, Golightly YM, Harkey M, Kuenze CM, Minnig MC, Mobasheri A, Naylor A, Newman CB, Padua DA, Pietrosimone B, Pinto D, Root H, Salzler M, Schmitt LC, Snyder-Mackler L, Taylor JB, Thoma LM, Vincent KR, Wellsandt E, Williams M. Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement. J Athl Train 2023; 58:193-197. [PMID: 37130278 PMCID: PMC10176846 DOI: 10.4085/1062-6050-0255.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
After an anterior cruciate ligament (ACL) injury, people need secondary prevention strategies to identify osteoarthritis at its earliest stages so that interventions can be implemented to halt or slow the progression toward its long-term burden. The Osteoarthritis Action Alliance formed an interdisciplinary Secondary Prevention Task Group to develop a consensus on recommendations to provide clinicians with secondary prevention strategies that are intended to reduce the risk of osteoarthritis after a person has an ACL injury. The group achieved consensus on 15 out of 16 recommendations that address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. We hope this statement raises awareness among clinicians and researchers on the importance of taking steps to mitigate the risk of osteoarthritis after an ACL injury.
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Affiliation(s)
- Jeffrey B. Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
| | - Heather K. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | | | - Kirsten R. Ambrose
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill
| | - Shelby Baez
- Department of Kinesiology, Michigan State University, East Lansing
| | - Nicholas Beresic
- Department of Orthopaedics, University of North Carolina, Chapel Hill
| | | | - Leigh F. Callahan
- Department of Orthopaedics, University of North Carolina, Chapel Hill
| | | | - Madison Franek
- Wellness Center at Meadowmont, Department of Therapy Services, University of North Carolina, Chapel Hill
| | | | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Mary Catherine Minnig
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Finland
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Department of Joint Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | - Adam Naylor
- Telos SPC, Boston, MA
- Deloitte US, Boston, MA
| | - Connie B. Newman
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, School of Medicine, New York University
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | - Brian Pietrosimone
- Department of Orthopaedics, University of North Carolina, Chapel Hill
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Hayley Root
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff
| | - Matthew Salzler
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, Tufts Medical Center, Boston, MA
| | - Laura C. Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | | | - Jeffrey B. Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina, Chapel Hill
| | - Kevin R. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
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Driban JB, Vincent HK, Trojian TH, Ambrose KR, Baez S, Beresic N, Berkoff DJ, Callahan LF, Cohen B, Franek M, Golightly YM, Harkey M, Kuenze CM, Minnig MC, Mobasheri A, Naylor A, Newman CB, Padua DA, Pietrosimone B, Pinto D, Root H, Salzler M, Schmitt L, Snyder-Mackler L, Taylor JB, Thoma LM, Vincent KR, Wellsandt E, Williams M. Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement. J Athl Train 2023; 58:198-219. [PMID: 37130279 PMCID: PMC10176847 DOI: 10.4085/1062-6050-0504.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
CONTEXT The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury. OBJECTIVE Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps. DESIGN Consensus process. SETTING Virtual video conference calls and online voting. PATIENTS OR OTHER PARTICIPANTS The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds. MAIN OUTCOME MEASURE(S) The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation. RESULTS The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. CONCLUSIONS This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury.
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Affiliation(s)
| | - Jeffrey B. Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
| | - Heather K. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Thomas H. Trojian
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | | | - Shelby Baez
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - David J. Berkoff
- Department of Kinesiology, Michigan State University, East Lansing
| | - Leigh F. Callahan
- Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
| | | | - Madison Franek
- University of North Carolina Therapy Services, UNC Wellness Center at Meadowmont, Chapel Hill
| | - Yvonne M. Golightly
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Mary Catherine Minnig
- Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania; Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | | | - Connie B. Newman
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, NYU Grossman School of Medicine, New York, NY
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Daniel Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Hayley Root
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Matthew Salzler
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff
| | - Laura Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus
| | | | - Jeffrey B. Taylor
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Kevin R. Vincent
- UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
| | - Monette Williams
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha
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Kuenze CM, Farner N, Lewis J, Lisee CM, Schorfhaar A, Erickson K. Adolescent Patient, Parent, and Clinician Perceptions of Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Qualitative Study. J Athl Train 2022; 57:929-936. [PMID: 35142825 PMCID: PMC9842128 DOI: 10.4085/1062-6050-0491.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Rehabilitation after anterior cruciate ligament reconstruction (ACLR) is challenging for adolescent patients concurrently experiencing growth and development, changes in attitudes and social interactions, and a gradual shift toward independence. OBJECTIVE To examine the perceptions of information sharing and interpersonal communication among adolescent patients going through ACLR, their parents, and physical therapists (PTs) treating adolescent patients with ACLR. DESIGN Cross-sectional study. SETTING University-affiliated sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS Nine adolescent patients who had recently completed physical rehabilitation after ACLR, one of their parents, and PTs who treated adolescent patients with ACLR were recruited and enrolled. MAIN OUTCOME MEASURE(S) Participants completed semistructured interviews. The interview scripts for patients, parents, and PTs intentionally addressed the same topics, with only minor modifications in wording as appropriate for each role. All interviews were recorded, transcribed verbatim, and analyzed using a hybrid of deductive and inductive coding by trained members of the study team. RESULTS Patients, parents, and PTs perceived that interpersonal dynamics (eg, communication, external motivation) and stakeholder knowledge (eg, understanding of the psychological consequences of injury) influenced intrapersonal experiences (eg, emotional response, intrinsic motivation) during rehabilitation after ACLR. Additionally, patients and parents indicated that a lack of information about the rehabilitation process hindered their ability to obtain additional information from the PT and surgeon. CONCLUSIONS Participants from all stakeholder groups reported that orthopaedic surgeons and other members of the health care team may consider being more consistent when setting expectations, physical restrictions, and recovery timelines.
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Affiliation(s)
- Christopher M. Kuenze
- Department of Kinesiology, College of Education, Michigan State University, East Lansing
- Department of Orthopedics, College of Osteopathic Medicine, Michigan State University, East Lansing
| | - Nathan Farner
- Department of Orthopedics, College of Osteopathic Medicine, Michigan State University, East Lansing
| | - Jordan Lewis
- Department of Orthopedics, College of Osteopathic Medicine, Michigan State University, East Lansing
| | - Caroline Michele Lisee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill. Dr Kuenze is now at the University of Virginia, Dr Schorfhaar is now at the Department of Orthopaedic Surgery, Sparrow Hospital, Lansing, MI, and Dr Erickson is now at the School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Andrew Schorfhaar
- Department of Orthopedics, College of Osteopathic Medicine, Michigan State University, East Lansing
| | - Karl Erickson
- Department of Kinesiology, College of Education, Michigan State University, East Lansing
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Triplett AN, Pivarnik JM, Currie KD, Wilcox L, Kuenze CM. Cardiovascular Health Of Individuals With Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000882884.21985.0e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Triplett AN, Collins KA, Lisee CM, McGuire TG, Wilcox CL, Kuenze CM. Adolescents With Recent ACL Reconstruction Take Fewer Steps Per Day Than Their Uninjured Peers. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000762124.26113.e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sherman D, Birchmeier T, Kuenze CM, Garrison C, Hannon J, Bothwell J, Bush C, Norte GE. Thigh-Muscle and Patient-Reported Function Early After Anterior Cruciate Ligament Reconstruction: Clinical Cutoffs Unique to Graft Type and Age. J Athl Train 2021; 55:826-833. [PMID: 32688373 DOI: 10.4085/1062-6050-370-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CONTEXT Patient-reported function is an important outcome in anterior cruciate ligament rehabilitation. Identifying which metrics of thigh-muscle function are indicators of normal patient-reported function can help guide treatment. OBJECTIVE To identify which metrics of thigh-muscle function discriminate between patients who meet and patients who fail to meet age- and sex-matched normative values for patient-reported knee function in the first 9 months after anterior cruciate ligament reconstruction (ACLR) and establish cutoffs for these metrics by covariate subgroups. DESIGN Cross-sectional retrospective study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 256 patients (129 females, 128 males; age = 17.1 ± 3.0 years, height = 1.7 ± 0.1 m, mass = 74.1 ± 17.9 kg, months since surgery = 6.4 ± 1.4), 3 to 9 months after primary unilateral ACLR. MAIN OUTCOME MEASURE(S) We stratified the sample into dichotomous groups by the International Knee Documentation Committee (IKDC) score (IKDCMET, IKDCNOT MET) using sex- and age-matched normative values. We measured quadriceps and hamstrings isokinetic (60°/s) torque and power bilaterally. Normalized quadriceps and hamstrings peak torque (Nm/kg) and power (W/kg), limb symmetry indices (LSI, %), and hamstrings : quadriceps ratios were calculated. Logistic regression indicated which of these metrics could predict IKDC classification while controlling for age, graft type, and sex. Receiver operating characteristic curves established cutoffs for explanatory variables for both total cohort and covariate subgroups. Odds ratios (OR) determined the utility of each cutoff to discriminate IKDC status. RESULTS Quadriceps torque LSI (≥69.4%, OR = 3.6), hamstrings torque (≥1.11 Nm/kg, OR = 2.1), and quadriceps power LSI (≥71.4%, OR = 2.0) discriminated between IKDC classification in the total cohort. Quadriceps torque LSI discriminated between IKDC classification in the patellar-tendon graft (≥61.6%, OR = 5.3), hamstrings-tendon graft (≥71.8%, OR = 10.5), and age <18 years (≥74.3%, OR = 5.2) subgroups. Hamstrings torque discriminated between IKDC classifications in the age <18 years (≥1.10 Nm/kg, OR = 2.6) subgroup. CONCLUSIONS Quadriceps torque LSI, hamstrings torque, and quadriceps power LSI were the most useful metrics for predicting normal patient-reported knee function early after ACLR. Further, cutoff values that best predicted normal patient-reported function differed by graft type and age.
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Triplett AN, Kuenze CM. Characterizing body composition, cardiorespiratory fitness, and physical activity in women with anterior cruciate ligament reconstruction. Phys Ther Sport 2020; 48:54-59. [PMID: 33373903 DOI: 10.1016/j.ptsp.2020.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose was to compare body composition, cardiorespiratory fitness, and physical activity (PA) engagement between women with ACLR and healthy controls. DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Ten women with ACLR (time since surgery = 33.0 ± 18.3 months; age = 21.4 ± 3.8 years) and 10 healthy women (age = 21.9 ± 3.1 years) matched based on age (±2 years) and Tegner Activity Level (±2) participated. MAIN OUTCOME MEASURES Body fat percentage (%BF) was estimated using air displacement plethysmography, cardiorespiratory fitness was assessed via a graded cycle test, and PA was assessed using accelerometers worn for 7 days. Groups were compared using Mann-Whitney U tests. Time (minutes/week) spent in moderate-to-vigorous PA and step count (steps/day) were compared between groups using a one-way ANCOVA with 7-day total wear time as the only covariate. Statistical significance was established a priori as α ≤ 0.05. RESULTS Women with ACLR had significantly higher %BF than controls (ACLR = 32.7 ± 6.7%, healthy = 22.6 ± 4.9%; p < 0.01) and participated in less steps per day (ACLR = 6650 ± 3227 steps/day, healthy = 9361 ± 2626 steps/day; p = 0.02). CONCLUSIONS There may be persistent negative effects on body composition and PA engagement for women following ACLR. Low PA and high %BF have adverse consequences for premature mortality and morbidity; therefore, it is crucial to assess these characteristics and determine interventions to maintain PA and healthy body composition following ACLR.
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Affiliation(s)
- Ashley N Triplett
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA.
| | - Christopher M Kuenze
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA; Department of Orthopaedics, Michigan State University, East Lansing, MI, USA.
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Lisee CM, DiSanti JS, Chan M, Ling J, Erickson K, Shingles M, Kuenze CM. Gender Differences in Psychological Responses to Recovery After Anterior Cruciate Ligament Reconstruction Before Return to Sport. J Athl Train 2020; 55:1098-1105. [PMID: 32966569 DOI: 10.4085/1062-6050-558.19] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Female patients with anterior cruciate ligament reconstruction (ACLR) are less likely to return to sport than males. Psychological readiness predicts successful return to sport, but it is unclear if psychological experiences differ between males and females during recovery. OBJECTIVE To explore gender differences in psychological readiness factors of return to sport after ACLR. DESIGN Qualitative study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 12 male (months since surgery = 6.2 ± 1.2) and 13 female (months since surgery = 6.4 ± 1.3) high school athletes with a history of ACLR. DATA COLLECTION AND ANALYSIS Participants were interviewed before physician clearance to return to activity. Transcribed interviews were analyzed using deductive thematic coding of 5 themes identified from previous research (psychological distress, self-efficacy, locus of control, athletic identity, and fear of reinjury) and inductive secondary subthematic coding. Gender comparisons were generated within primary themes and secondary subthemes. RESULTS All deductive themes were consistently reinforced. Male and female participants reported fear of movement, loss of athletic identity, and motivational mindsets for return to sport and self-improvement. Males reported a stronger sense of internal locus of control using positive internal reinforcement, whereas females described balancing internal and external control and valuing external support systems. Male participants described mood changes influenced by physical and social limitations. Female participants closely monitored their emotions throughout recovery and were influenced by rehabilitation fluctuations. CONCLUSIONS Male and female high school athletes described different psychological factors related to return to sport and locus of control as well as psychological distress. Gender-specific psychological interventions may be warranted to overcome psychological barriers after ACLR.
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Lisee CM, Montoye AHK, Lewallen NF, Hernandez M, Bell DR, Kuenze CM. Assessment of Free-Living Cadence Using ActiGraph Accelerometers Between Individuals With and Without Anterior Cruciate Ligament Reconstruction. J Athl Train 2020; 55:994-1000. [PMID: 32818959 DOI: 10.4085/1062-6050-425-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Anterior cruciate ligament reconstruction (ACLR) and gait speed are risk factors for developing knee osteoarthritis (OA). Measuring minute-level cadence during free-living activities may aid in identifying individuals at elevated risk of developing slow habitual gait speed and, in the long term, OA. OBJECTIVE To assess differences in peak 1-minute cadence and weekly time in different cadence intensities between individuals with and without ACLR. DESIGN Cross-sectional study. SETTING Short-term, free-living conditions. PATIENTS OR OTHER PARTICIPANTS A total of 57 participants with ACLR (34 women, 23 men; age = 20.9 ± 3.2 years, time since surgery = 28.7 ± 17.7 months) and 42 healthy control participants (22 women, 20 men; age = 20.7 ± 1.7 years). MAIN OUTCOME MEASURE(S) Each participant wore a physical activity monitor for 7 days. Data were collected at 30 Hz, processed in 60-second epochs, and included in the analyses if the activity monitor was worn for at least 10 hours per day over 4 days. Mean daily steps, peak 1-minute cadence, and weekly minutes spent at 60 to 79 (slow walking), 80 to 99 (medium walking), 100 to 119 (brisk walking), ≥100 (moderate- to vigorous-intensity ambulation), and ≥130 (vigorous-intensity ambulation) steps per minute were calculated. One-way analyses of covariance were conducted to determine differences between groups, controlling for height and activity-monitor wear time. RESULTS Those with ACLR took fewer daily steps (8422 ± 2663 versus 10 033 ± 3046 steps; P = .005) and spent fewer weekly minutes in moderate- to vigorous-intensity cadence (175.8 ± 116.5 minutes versus 218.5 ± 137.1 minutes; P = .048) than participants without ACLR. We observed no differences in minutes spent at slow (ACLR = 77.4 ± 40.5 minutes versus control = 83.9 ± 34.3 minutes; P = .88), medium (ACLR = 71.6 ± 40.2 minutes versus control = 82.9 ± 46.8 minutes; P = .56), brisk (ACLR = 115.3 ± 70.3 minutes versus control = 138.3 ± 73.3 minutes; P = .18), or vigorous-intensity (ACLR = 24.3 ± 36.5 minutes versus control = 38.1 ± 60.9 minutes; P = .10) cadences per week. CONCLUSIONS Participants with ACLR walked approximately 40 fewer minutes per week in moderate- to vigorous-intensity cadence than participants without ACLR. Increasing the time spent at cadence ≥100 steps per minute and overall volume of physical activity may be useful as interventional targets to help reduce the risk of early development of OA after ACLR.
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Affiliation(s)
- Caroline M Lisee
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill
| | | | - Noble F Lewallen
- Department of Integrative Physiology and Health Science, Alma College, MI
| | | | - David R Bell
- Department of Kinesiology, University of Wisconsin-Madison
| | - Christopher M Kuenze
- Department of Integrative Physiology and Health Science, Alma College, MI.,Department of Kinesiology, Michigan State University, East Lansing
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Triplett AN, Kuenze CM. Physical Activity And Body Composition Of Women With Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000687136.21817.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Triplett AN, Kuenze CM. Aerobic Fitness And Body Composition Of Individuals With Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563273.72013.f7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Warner K, Savage J, Kuenze CM, Erkenbeck A, Comstock RD, Covassin T. A Comparison of High School Boys' and Girls' Lacrosse Injuries: Academic Years 2008-2009 Through 2015-2016. J Athl Train 2018; 53:1049-1055. [PMID: 30451536 DOI: 10.4085/1062-6050-312-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The sex-based differences in the structure and rules of boys' and girls' lacrosse result in very different styles of play, which may have significant implications for the rates and patterns of injuries. OBJECTIVE To compare the epidemiology of injuries sustained by boys' and girls' lacrosse players. DESIGN Descriptive epidemiology study. SETTING Web-based online surveillance system. PATIENTS OR OTHER PARTICIPANTS The High School Reporting Information Online database was used to analyze injuries reported by certified athletic trainers from 2008-2009 through 2015-2016. MAIN OUTCOME MEASURE(S) Practice and competition injury rates, body site, diagnosis, and mechanism. RESULTS Boys had a higher injury rate than girls (20.9 versus 15.7 per 10 000 athlete-exposures, respectively; rate ratio = 1.3, 95% confidence interval = 1.2, 1.4). The most commonly injured body sites for boys and girls, respectively, were the lower extremities (38.0%, 56.4%) and the head/neck (28.3%, 29.8%). More specifically, the most frequently diagnosed injuries for both boys and girls, respectively, in competitions were concussions (23.1%, 25.6%), ankle ligament sprains (7.8%, 15.3%), upper leg strains (4.8%, 6.7%), and knee ligament sprains (4.2%, 6.7%). The most cited mechanism of injury overall was contact with another player (22.0%); among boys, it was contact with a stick (14.8%) and among girls, the most frequent mechanisms were overuse (25.0%) and contact with a stick (14.7%). CONCLUSIONS Injury rates and mechanisms of injuries differed between high school boys' and girls' lacrosse players. Boys had a higher rate of injury, with the most common mechanism of injury being contact with another player compared with overuse in girls. However, similarities were seen between sexes for the most frequently injured body sites and injury diagnoses. Future authors should continue to compare differences in injury rates, equipment upgrades, and rule changes in boys' and girls' lacrosse.
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Kuenze CM, Trigsted S, Lisee C, Post E, Bell DR. Sex Differences on the Landing Error Scoring System Among Individuals With Anterior Cruciate Ligament Reconstruction. J Athl Train 2018; 53:837-843. [PMID: 30273009 DOI: 10.4085/1062-6050-459-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CONTEXT: After anterior cruciate ligament reconstruction (ACLR), women have a greater risk of incurring a second anterior cruciate ligament injury and they display different landing movement patterns than men. It remains unclear if clinical movement-assessment tools, such as the Landing Error Scoring System (LESS), can detect sex differences in movement patterns after ACLR. OBJECTIVE: To compare total LESS scores and individual LESS errors between men and women with a history of ACLR. DESIGN: Cross-sectional study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 168 individuals (41 men and 127 women; mean age: men = 20 years [range, 19-25 years], women = 19 years [range, 18-20 years]; mean time since surgery: men = 21 months [range, 12-36 months], women = 27.5 months [range, 17-39 months]) with a history of primary, unilateral ACLR. MAIN OUTCOME MEASURE(S): Participants completed a minimum of 3 trials of a drop vertical-jump task scored using the LESS. The between-sexes difference in LESS score was assessed using analysis of covariance, whereas the associations between participant sex and errors on each LESS item were assessed using logistic or multinomial regression. RESULTS: Women displayed a greater number of total landing errors (men = 4.6 ± 2.3, women = 6.1 ± 2.3; P < .001) and were more likely to commit errors in trunk flexion at initial contact (men = 4.9%, women = 23.6%; odds ratio [OR] = 4.94), medial knee position at initial contact (men = 17.1%, women = 42.5%; OR = 6.01), medial knee displacement (men = 24.4%, women = 73.2%; OR = 7.88), total joint displacement (1 error: men = 58.5%, women = 71.7%, OR = 2.10; 2 errors: men = 7.3%, women = 14.2%, OR = 3.71), and overall impression (1 error: men = 75.6%, women = 84.3%, OR = 3.24; 2 errors: men = 2.4%, women = 10.2%, OR = 12.89) compared with men. CONCLUSIONS: Women with ACLR displayed worse LESS scores and were more likely to commit errors related to medial knee displacement and overall landing quality than men with ACLR.
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Affiliation(s)
- Christopher M Kuenze
- Department of Kinesiology, College of Education, Michigan State University, East Lansing.,Division of Sports Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing
| | - Stephanie Trigsted
- Department of Kinesiology, School of Education, School of Medicine and Public Health, The University of Wisconsin-Madison
| | - Caroline Lisee
- Department of Kinesiology, College of Education, Michigan State University, East Lansing
| | - Eric Post
- Department of Kinesiology, School of Education, School of Medicine and Public Health, The University of Wisconsin-Madison
| | - David R Bell
- Department of Kinesiology, School of Education, School of Medicine and Public Health, The University of Wisconsin-Madison.,Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, The University of Wisconsin-Madison
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Rendos NK, Eltoukhy M, Smith WN, Kuenze CM, Signorile JF. Muscle Activation Characteristics of the Posterior Oblique Sling System in High and Low Economy Runners. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535230.87464.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Slater LV, Hart JM, Kelly AR, Kuenze CM. Progressive Changes in Walking Kinematics and Kinetics After Anterior Cruciate Ligament Injury and Reconstruction: A Review and Meta-Analysis. J Athl Train 2018; 52:847-860. [PMID: 28985125 DOI: 10.4085/1062-6050-52.6.06] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
CONTEXT Anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) result in persistent alterations in lower extremity movement patterns. The progression of lower extremity biomechanics from the time of injury has not been described. OBJECTIVE To compare the 3-dimensional (3D) lower extremity kinematics and kinetics of walking among individuals with ACL deficiency (ACLD), individuals with ACLR, and healthy control participants from 3 to 64 months after ACLR. DATA SOURCES We searched PubMed and Web of Science from 1970 through 2013. STUDY SELECTION AND DATA EXTRACTION We selected only articles that provided peak kinematic and kinetic values during walking in individuals with ACLD or ACLR and comparison with a healthy control group or the contralateral uninjured limb. DATA SYNTHESIS A total of 27 of 511 identified studies were included. Weighted means, pooled standard deviations, and 95% confidence intervals were calculated for the healthy control, ACLD, and ACLR groups at each reported time since surgery. The magnitude of between-groups (ACLR versus ACLD, control, or contralateral limb) differences at each time point was evaluated using Cohen d effect sizes and associated 95% confidence intervals. Peak knee-flexion angle (Cohen d = -0.41) and external knee-extensor moment (Cohen d = -0.68) were smaller in the ACLD than in the healthy control group. Peak knee-flexion angle (Cohen d range = -0.78 to -1.23) and external knee-extensor moment (Cohen d range = -1.39 to -2.16) were smaller in the ACLR group from 10 to 40 months after ACLR. Reductions in external knee-adduction moment (Cohen d range = -0.50 to -1.23) were present from 9 to 42 months after ACLR. CONCLUSIONS Reductions in peak knee-flexion angle, external knee-flexion moment, and external knee-adduction moment were present in the ACLD and ACLR groups. This movement profile during the loading phase of gait has been linked to knee-cartilage degeneration and may contribute to the development of osteoarthritis after ACLR.
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Affiliation(s)
- Lindsay V Slater
- Department of Kinesiology, The University of Virginia, Charlottesville
| | - Joseph M Hart
- Department of Kinesiology, The University of Virginia, Charlottesville
| | - Adam R Kelly
- Department of Kinesiology, Michigan State University, East Lansing
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Lepley AS, Kuenze CM. Hip and Knee Kinematics and Kinetics During Landing Tasks After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. J Athl Train 2018; 53:144-159. [PMID: 29350551 DOI: 10.4085/1062-6050-334-16] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the current evidence concerning kinematic and kinetic strategies adopted during dynamic landing tasks by patients with anterior cruciate ligament reconstruction (ACLR). DATA SOURCES PubMed, Web of Science. STUDY SELECTION Original research articles that evaluated kinematics or kinetics (or both) during a landing task in those with a history of ACLR were included. DATA EXTRACTION Methodologic quality was assessed using the modified Downs and Black checklist. Means and standard deviations for knee or hip (or both) kinematics and kinetics were used to calculate Cohen d effect sizes and corresponding 95% confidence intervals between the injured limb of ACLR participants and contralateral or healthy matched limbs. Data were further stratified by landing tasks, either double- or single-limb landing. A random-effects-model meta-analysis was used to calculate pooled effect sizes and 95% confidence intervals. DATA SYNTHESIS The involved limbs of ACLR patients demonstrated clinically and significantly lower knee-extension moments during double-legged landing compared with healthy contralateral limbs and healthy control limbs (Cohen d range = -0.81 to -1.23) and decreased vertical ground reaction forces when compared with healthy controls, regardless of task (Cohen d range = -0.39 to -1.75). CONCLUSIONS During single- and double-legged landing tasks, individuals with ACLR demonstrated meaningful reductions in injured-limb knee-extension moments and vertical ground reaction forces. These findings indicate potential unloading of the injured limb after ACLR, which may have significant implications for secondary ACL injury and long-term joint health.
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Kuenze CM, Kelly AR, Jun HP, Eltoukhy M. Unilateral Quadriceps Strengthening With Disinhibitory Cryotherapy and Quadriceps Symmetry After Anterior Cruciate Ligament Reconstruction. J Athl Train 2017; 52:1010-1018. [PMID: 29257714 DOI: 10.4085/1062-6050-52.10.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The effect of unilateral cryotherapy-facilitated rehabilitation exercise on involved-limb quadriceps function and limb symmetry in individuals with quadriceps dysfunction after anterior cruciate ligament reconstruction (ACLR) remains unclear. OBJECTIVE To measure the effect of a 2-week unilateral cryotherapy-facilitated quadriceps-strengthening program on knee-extension strength and quadriceps central activation ratio (CAR) in participants with ACLR. DESIGN Controlled laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 10 volunteers with unilateral ACLR (1 man, 9 women; age = 21.0 ± 2.8 years, height = 164.6 ± 5.0 cm, mass = 64.0 ± 6.1 kg, body mass index = 23.7 ± 2.7 kg/m2) and 10 healthy volunteers serving as control participants (1 man, 9 women; age = 20.8 ± 2.5 years, height = 169.1 ± 6.2 cm, mass = 61.1 ± 6.4 kg, body mass index = 21.4 ± 2.3 kg/m2) participated. INTERVENTION(S) Participants with ACLR completed a 2-week unilateral cryotherapy-facilitated quadriceps-strengthening intervention. MAIN OUTCOME MEASURE(S) Bilateral normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/kg) and quadriceps CAR (%) were assessed preintervention and postintervention. Limb symmetry index (LSI) was calculated at preintervention and postintervention testing. Preintervention between-groups differences in unilateral quadriceps function and LSI were evaluated using independent-samples t tests. Preintervention-to-postintervention differences in quadriceps function were evaluated using paired-samples t tests. Cohen d effect sizes (95% confidence interval [CI]) were calculated for each comparison. RESULTS Preintervention between-groups comparisons revealed less knee-extension MVIC torque and quadriceps CAR for the ACLR limb (MVIC: P = .01, Cohen d = -1.31 [95% CI = -2.28, -0.34]; CAR: P = .004, Cohen d = -1.48 [95% CI = -2.47, -0.49]) and uninvolved limb (MVIC: P = .03, Cohen d = -1.05 [95% CI = -1.99, -0.11]; CAR: P = .01, Cohen d = -1.27 [95% CI = -2.23, -0.31]) but not for the LSI (MVIC: P = .46, Cohen d = -0.34 [95% CI = -1.22, 0.54]; CAR: P = .60, Cohen d = 0.24 [95% CI = -0.64, 1.12]). In the ACLR group, participants had improved knee-extension MVIC torque in the involved limb ( P = .04, Cohen d = 0.32 [95% CI = -0.56, 1.20]) and uninvolved limb ( P = .03, Cohen d = 0.29 [95% CI = -0.59, 1.17]); however, the improvement in quadriceps CAR was limited to the involved limb ( P = .02, Cohen d = 1.16 [95% CI = 0.21, 2.11]). We observed no change in the LSI with the intervention for knee-extension MVIC torque ( P = .74, Cohen d = 0.09 [95% CI = -0.79, 0.97]) or quadriceps CAR ( P = .61, Cohen d = 0.26 [95% CI = -0.62, 1.14]). CONCLUSIONS Two weeks of cryotherapy-facilitated exercise may improve involved-limb quadriceps function while preserving between-limbs symmetry in patients with a history of ACLR.
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Affiliation(s)
| | - Adam R Kelly
- Department of Kinesiology, Michigan State University, East Lansing
| | - Hyung-Pil Jun
- Department of Movement Sciences, University of Idaho, Moscow
| | - Moataz Eltoukhy
- Department of Kinesiology, University of Miami, Coral Gables, FL
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Slater LV, Hart JM, Kelly AR, Kuenze CM. Progressive Changes in Walking Kinematics and Kinetics After Anterior Cruciate Ligament Injury and Reconstruction: A Review and Meta-Analysis. J Athl Train 2017. [DOI: 10.4085/1062-6050.52.6.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lindsay V. Slater
- Department of Kinesiology, The University of Virginia, Charlottesville
| | - Joseph M. Hart
- Department of Kinesiology, The University of Virginia, Charlottesville
| | - Adam R. Kelly
- Department of Kinesiology, Michigan State University, East Lansing
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19
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Abstract
It remains unclear what role reduced volume and cross-section area (CSA) of individual quadriceps muscles may play in persistent quadriceps weakness and more global dysfunction following ACL reconstruction (ACLR). The purpose of this investigation was to establish the relationship between cross-sectional area of the quadriceps muscle group and measures of knee related and quadriceps function following ACLR. Thirty participants with a history of primary, unilateral ACLR experiencing persistent quadriceps activation failure participated in this cohort study. Clinical factors including International Knee Documentation Committee (IKDC) score, normalized knee extension MVIC torque (Nm/kg) and quadriceps central activation ratio (CAR, %) were assessed in addition to CSA. Quadriceps CSA was measured via magnetic resonance imaging (MRI; Siemens Avanto 1.5T). Quadriceps CSA (cm(2) ) and quadriceps volume (cm(3) ) as well as individual muscle estimates were identified within a 10 cm mid-thigh capture area. Pearson's product-moment correlation coefficients (r) established relationships between CSA and all other variables. Stepwise linear regression established which CSA factors were able to successfully predict clinical factors. Knee extension MVIC torque was strongly correlated with Vastus Intermedius (VI; r = 0.857, p < 0.001) CSA as well as partial VI (r = 0.849, p < 0.001) and quadriceps (r = 0.830, p < 0.001) volume. Partial VI (r = 0.365, p = 0.047) volume was weakly correlated with IKDC score. Knee extension MVIC torque was strongly predicted using VI CSA alone (R(2) = 0.725) or in combination with Vastus Medialis CSA (VM; R(2) = 0.756). Statement of Clinical Significance: Atrophy of the VI and VM muscles negatively impacts knee extension strength following ACLR. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1656-1662, 2016.
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Affiliation(s)
| | - Silvia S Blemker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
| | - Joseph M Hart
- Department of Human Services, Kinesiology Program Area, University of Virginia, Charlottesville, Virginia.,Department of Orthopaedic Surgery, Sports Medicine Division, University of Virginia, Charlottesville, Virginia
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20
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Rendos NK, Eltoukhy M, Smith WN, Kuenze CM, Asfour SS, Signorile JF. Identification of Sling Systems in High Economy and Low Economy Runners. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000488253.57915.8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Ni M, Signorile JF, Mooney K, Balachandran A, Potiaumpai M, Luca C, Moore JG, Kuenze CM, Eltoukhy M, Perry AC. Comparative Effect of Power Training and High-Speed Yoga on Motor Function in Older Patients With Parkinson Disease. Arch Phys Med Rehabil 2016; 97:345-354.e15. [DOI: 10.1016/j.apmr.2015.10.095] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/07/2015] [Accepted: 10/11/2015] [Indexed: 11/26/2022]
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22
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Gribbin TC, Slater LV, Herb CC, Hart JM, Chapman RM, Hertel J, Kuenze CM. Differences in hip-knee joint coupling during gait after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2016; 32:64-71. [PMID: 26851564 DOI: 10.1016/j.clinbiomech.2016.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/25/2015] [Accepted: 01/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND After anterior cruciate ligament injury, patients have increased risk for developing degenerative osteoarthritis, potentially due to the kinematic changes that persist after surgical reconstruction. Current research only describes single joint kinematic differences rather than the way in which two joints behave concurrently, termed joint coupling. The purpose of this study was to compare knee motion relative to hip motion in anterior cruciate ligament reconstructed and healthy limbs during walking and jogging. METHODS Thirty-seven recreationally active volunteers (22 reconstructed, 15 healthy) walked and jogged at 4.83 km/h and 9.66 km/h respectively. Vector coding methods were used to calculate stride-to-stride variability, magnitude, and vector angle of 6 joint couples during walking and jogging: hip frontal-knee frontal planes, hip frontal-knee sagittal, hip frontal-knee transverse, hip sagittal-knee frontal, hip sagittal-knee transverse, and hip transverse-knee frontal planes. FINDINGS The hip sagittal-knee frontal and hip sagittal-knee transverse joint couples had decreased variability during mid-stance, and all other couples had increased variability during the stance phase in the reconstructed group. The reconstructed group had decreased magnitude of joint excursion in the hip frontal-knee sagittal couple during all phases of gait during walking. Vector angles of the hip frontal-knee transverse couple increased in the reconstructed group during the loading, middle, and terminal stance phases, and swing phase of gait during walking. INTERPRETATION The increased variability and decreased magnitude of joint excursion indicate that movement patterns were less consistent during walking gait despite employing a more constrained system during movement in the reconstructed limb compared to healthy controls.
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Affiliation(s)
- Timothy C Gribbin
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA
| | - Lindsay V Slater
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA.
| | - C Collin Herb
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA
| | - Ryan M Chapman
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22904, USA
| | - Christopher M Kuenze
- Department of Kinesiology, Michigan State University, East Lansing, MI 48824, USA
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23
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Goetschius J, Kuenze CM, Hart JM. Knee extension torque variability after exercise in ACL reconstructed knees. J Orthop Res 2015; 33:1165-70. [PMID: 25994515 DOI: 10.1002/jor.22858] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/08/2015] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to compare knee extension torque variability in patients with ACL reconstructed knees before and after exercise. Thirty two patients with an ACL reconstructed knee (ACL-R group) and 32 healthy controls (control group) completed measures of maximal isometric knee extension torque (90° flexion) at baseline and following a 30-min exercise protocol (post-exercise). Exercise included 30-min of repeated cycles of inclined treadmill walking and hopping tasks. Dependent variables were the coefficient of variation (CV) and raw-change in CV (ΔCV): CV = (torque standard deviation/torque mean x 100), ΔCV = (post-exercise - baseline). There was a group-by-time interaction (p = 0.03) on CV. The ACL-R group demonstrated greater CV than the control group at baseline (ACL-R = 1.07 ± 0.55, control = 0.79 ± 0.42, p = 0.03) and post-exercise (ACL-R = 1.60 ± 0.91, control = 0.94 ± 0.41, p = 0.001). ΔCV was greater (p = 0.03) in the ACL-R group (0.52 ± 0.82) than control group (0.15 ± 0.46). CV significantly increased from baseline to post-exercise (p = 0.001) in the ACL-R group, while the control group did not (p = 0.06). The ACL-R group demonstrated greater knee extension torque variability than the control group. Exercise increased torque variability more in the ACL-R group than control group.
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Affiliation(s)
- John Goetschius
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Christopher M Kuenze
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, Florida
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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Kuenze CM, Hertel J, Hart JM. Quadriceps muscle function after exercise in men and women with a history of anterior cruciate ligament reconstruction. J Athl Train 2015; 49:740-6. [PMID: 25243735 DOI: 10.4085/1062-6050-49.3.46] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sex differences in lower extremity neuromuscular function have been reported after anterior cruciate ligament reconstruction (ACLR). Research evidence supports different levels of fatigability in men and women and between patients with ACLR and healthy controls. The influence of sex on the response to continuous exercise in patients with ACLR is not clear. OBJECTIVE To compare quadriceps neuromuscular function after exercise between men and women with ACLR. DESIGN Descriptive laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-six active volunteers (13 men [50%]: age = 24.1 ± 4.4 years, height = 179.1 ± 9.8 cm, mass = 80.1 ± 9.4 kg, months since surgery = 43.5 ± 37.0; 13 women [50%]: age = 24.2 ± 5.6 years, height = 163.0 ± 5.9 cm, mass = 62.3 ± 8.3 kg, months since surgery = 45.8 ± 42.7) with a history of unilateral primary ACLR at least 6 months earlier. INTERVENTION(S) Thirty minutes of continuous exercise comprising 5 separate 6-minute cycles, including 5 minutes of uphill walking and 1 minute of body-weight squatting and step-ups. MAIN OUTCOME MEASURE(S) Normalized knee-extension maximal voluntary isometric contraction torque, quadriceps superimposed-burst torque, and quadriceps central activation ratio before and after exercise. We performed separate 2 (sex: men, women) × 2 (time: preexercise, postexercise) repeated-measures analyses of variance for the 3 variables. Separate, independent-samples t tests were calculated to compare preexercise with postexercise change in all dependent variables between sexes. RESULTS A significant group-by-time interaction was present for knee-extension torque (P = .04). The percentage reduction in knee-extension maximal voluntary isometric contraction torque (men = 1.94%, women = -10.32%; P = .02) and quadriceps central activation ratio (men = -1.45%, women = -8.69%; P = .03) experienced by men was less than that observed in women. CONCLUSIONS In the presence of quadriceps dysfunction, female participants experienced greater-magnitude reductions in quadriceps function after 30 minutes of exercise than male participants. This indicates a reduced ability to absorb knee-joint loads, which may have significant implications for reinjury and joint osteoarthritis in women after ACLR.
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Affiliation(s)
- Christopher M Kuenze
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL
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Hart JM, Kuenze CM, Diduch DR, Ingersoll CD. Quadriceps muscle function after rehabilitation with cryotherapy in patients with anterior cruciate ligament reconstruction. J Athl Train 2015; 49:733-9. [PMID: 25299442 DOI: 10.4085/1062-6050-49.3.39] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CONTEXT Persistent muscle weakness after anterior cruciate ligament (ACL) reconstruction may be due to underlying activation failure and arthrogenic muscle inhibition (AMI). Knee-joint cryotherapy has been shown to improve quadriceps function transiently in those with AMI, thereby providing an opportunity to improve quadriceps muscle activation and strength in patients with a reconstructed ACL. OBJECTIVE To compare quadriceps muscle function in patients with a reconstructed ACL who completed a 2-week intervention including daily cryotherapy (ice bag), daily exercises, or both. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 30 patients with reconstructed ACLs who were at least 6 months post-index surgery and had measurable quadriceps AMI. INTERVENTION(S) The patients attended 4 supervised visits over a 2-week period. They were randomly assigned to receive 20 minutes of knee-joint cryotherapy, 1 hour of therapeutic rehabilitation exercises, or cryotherapy followed by exercises. MAIN OUTCOME MEASURE(S) We measured quadriceps Hoffmann reflex, normalized maximal voluntary isometric contraction torque, central activation ratio using the superimposed-burst technique, and patient-reported outcomes before and after the intervention period. RESULTS After the 2-week intervention period, patients who performed rehabilitation exercises immediately after cryotherapy had higher normalized maximal voluntary isometric contraction torques (P = .002, Cohen d effect size = 1.4) compared with those who received cryotherapy alone (P = .16, d = 0.58) or performed exercise alone (P = .16, d = 0.30). CONCLUSIONS After ACL reconstruction, patients with AMI who performed rehabilitation exercises immediately after cryotherapy experienced greater strength gains than those who performed cryotherapy or exercises alone.
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Abstract
CONTEXT Individuals with a history of anterior cruciate ligament reconstruction (ACLR) are at greater risk of reinjury and developing early-onset osteoarthritis due to persistent abnormal joint loading. Real-time clinical assessment tools may help identify patients experiencing abnormal movement patterns after ACLR. OBJECTIVE To compare performance on the Landing Error Scoring System (LESS) between participants with ACLR and uninjured control participants and to determine the relationship between LESS score and knee-extension strength in these participants. DESIGN Controlled laboratory study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Forty-six recreationally active participants, consisting of 22 with ACLR (12 men, 10 women; age = 22.5 ± 5.0 years, height = 172.8 ± 7.2 cm, mass = 74.2 ± 15.6 kg, body mass index = 24.6 ± 4.0) and 24 healthy control participants (12 men, 12 women; age = 21.7 ± 3.6 years, height = 168.0 ± 8.8 cm, mass = 69.2 ± 13.6 kg, body mass index = 24.3 ± 3.2) were enrolled. MAIN OUTCOME MEASURE(S) Bilateral normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/kg) and LESS scores were measured during a single testing session. We compared LESS scores between groups using a Mann-Whitney U test and the relationships between LESS scores and normalized knee-extension MVIC torque using Spearman ρ bivariate correlations. RESULTS The ACLR participants had a greater number of LESS errors (6.0 ± 3.6) than healthy control participants (2.8 ± 2.2; t44 = -3.73, P = .002). In ACLR participants, lower normalized knee-extension MVIC torque in the injured limb (ρ = -0.455, P = .03) was associated with a greater number of landing errors. CONCLUSIONS Participants with ACLR displayed more errors while landing. The occurrence of landing errors was negatively correlated with knee-extension strength, suggesting that weaker participants had more landing errors. Persistent quadriceps weakness commonly associated with ACLR may be related to a reduced quality of lower extremity movement during dynamic tasks.
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Affiliation(s)
| | - Nathaniel Foot
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville
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27
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Kuenze CM, Hertel J, Weltman A, Diduch D, Saliba SA, Hart JM. Persistent neuromuscular and corticomotor quadriceps asymmetry after anterior cruciate ligament reconstruction. J Athl Train 2015; 50:303-12. [PMID: 25622244 DOI: 10.4085/1062-6050-49.5.06] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT Return to activity in the presence of quadriceps dysfunction may predispose individuals with anterior cruciate ligament reconstruction (ACLR) to long-term joint degeneration. Asymmetry may manifest during movement and result in altered knee-joint-loading patterns; however, the underlying neurophysiologic mechanisms remain unclear. OBJECTIVE To compare limb symmetry of quadriceps neuromuscular function between participants with ACLR and participants serving as healthy controls. DESIGN Descriptive laboratory study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 22 individuals with ACLR (12 men, 10 women) and 24 individuals serving as healthy controls (12 men, 12 women). MAIN OUTCOME MEASURE(S) Normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/kg), quadriceps central activation ratio (CAR) (%), quadriceps motor-neuron-pool excitability (Hoffmann reflex to motor wave ratio), and quadriceps active motor threshold (AMT) (% 2.0 T) were measured bilaterally and used to calculate limb symmetry indices for comparison between groups. We used analyses of variance to compare quadriceps Hoffmann reflex to motor wave ratio, normalized knee-extension MVIC torque, quadriceps CAR, and quadriceps AMT between groups and limbs. RESULTS The ACLR group exhibited greater asymmetry in knee-extension MVIC torque (ACLR group = 0.85 ± 0.21, healthy group = 0.97 ± 0.14; t44 = 2.26, P = .03), quadriceps CAR (ACLR group = 0.94 ± 0.11, healthy group = 1.00 ± 0.08; t44 = 2.22, P = .04), and quadriceps AMT (ACLR group = 1.13 ± 0.18, healthy group = 1.02 ± 0.11; t34 = -2.46, P = .04) than the healthy control group. CONCLUSIONS Asymmetries in measures of quadriceps function and cortical excitability were present in patients with ACLR. Asymmetry in quadriceps strength, activation, and cortical excitability persisted in individuals with ACLR beyond return to recreational activity. Measuring the magnitude of asymmetry after ACLR represents an important step in understanding long-term reductions in self-reported function and increased rate of subsequent joint injury in otherwise healthy, active individuals after ACLR.
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Affiliation(s)
- Christopher M Kuenze
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL; Departments of
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Kuenze CM, Hertel J, Diduch DR, Saliba S, Weltman A, Hart JM. Neuromuscular Asymmetry Following Return To Activity In Individuals With A History Of ACL Reconstruction. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000493803.00207.8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tompkins M, Kuenze CM, Diduch DR, Miller MD, Milewski MD, Hart JP. Clinical and Functional Outcomes following Primary Repair versus Reconstruction of the Medial Patellofemoral Ligament for Recurrent Patellar Instability. J Sports Med (Hindawi Publ Corp) 2014; 2014:702358. [PMID: 26464893 PMCID: PMC4590910 DOI: 10.1155/2014/702358] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/11/2014] [Accepted: 02/12/2014] [Indexed: 06/05/2023]
Abstract
Background. The purpose of this study was to compare outcomes of medial patellofemoral ligament (MPFL) repair or reconstruction. Methods. Fourteen knees that underwent MPFL repair and nine (F5, M4) knees that underwent reconstruction at our institution were evaluated for objective and subjective outcomes. The mean age at operation was 20.1 years for repair and 19.8 years for reconstruction. All patients had a minimum of 2 years of follow-up (range: 24-75 months). Patient subjective outcomes were obtained using the International Knee Documentation Committee (IKDC) and Kujala patellofemoral subjective evaluations, as well as Visual Analog (VAS) and Tegner Activity Scales. Bilateral isometric quadriceps strength and vastus medialis obliquus (VMO) and vastus lateralis (VL) surface EMG were measured during maximal isometric quadriceps contractions at 30° and 60° of flexion. Results. There were no redislocations in either group. There was no difference in IKDC (P = 0.16), Kujala (P = 0.43), Tegner (P = 0.12), or VAS (P = 0.05) scores at follow-up. There were no differences between repair and reconstruction in torque generation of the involved side at 30° (P = 0.96) and 60° (P = 0.99). In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO. Conclusions. There were minimal differences found between patients undergoing MPFL repair and MPFL reconstruction for the objective and subjective evaluations in this study.
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Affiliation(s)
- Marc Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA
| | - Christopher M. Kuenze
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - David R. Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Mark D. Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Matthew D. Milewski
- Elite Sports Medicine, Connecticut Children's Medical Center, Hartford, CT 06032, USA
| | - Joseph P. Hart
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
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Goetschius J, Kuenze CM, Saliba S, Hart JM. Reposition Acuity and Postural Control after Exercise in Anterior Cruciate Ligament Reconstructed Knees. Med Sci Sports Exerc 2013; 45:2314-21. [DOI: 10.1249/mss.0b013e31829bc6ae] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hart JM, Kuenze CM, Pietrosimone BG, Ingersoll CD. Quadriceps function in anterior cruciate ligament-deficient knees exercising with transcutaneous electrical nerve stimulation and cryotherapy: a randomized controlled study. Clin Rehabil 2012; 26:974-81. [PMID: 22399575 DOI: 10.1177/0269215512438272] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare strength and quadriceps muscle activation in anterior cruciate ligament-deficient patients who underwent a two-week rehabilitation exercise program using TENS or cryotherapy. DESIGN Randomized, controlled study. SETTING Clinical research laboratory. SUBJECTS Thirty patients: 20 males, 10 females, 31.6 (13.0) years, 172.8 (10.0) cm, 75.8 (13.0) kg with diagnosed tear of the anterior cruciate ligament. INTERVENTIONS All patients attended four sessions of supervised quadriceps strengthening exercises over two weeks, prior to reconstruction surgery. Patients were randomly allocated (n = 10/group) to receive exercises alone, exercise while wearing a sensory transcutaneous electrical nerve stimulation (TENS) device on the knee joint for the duration of each daily session, or 20 minutes of knee joint cryotherapy immediately prior to each daily exercise session. MAIN MEASURES Normalized knee extension force and quadriceps central activation ratio were measured before and after the first supervised treatment session and within 24 hours of the last session. RESULTS When accounting for differences in baseline measures, there were no statistically significant group differences immediately following the first exercise session for knee extension force (P = 0.10) or central activation ratio (P = 0.30) nor were there statistically significant group differences after the two-week intervention for knee extension force (P = 0.92) or central activation ratio (P = 0.94). Effect sizes for the change in knee extension force and central activation ratio after two weeks of therapy were all large. CONCLUSIONS Quadriceps strength and central activation in anterior cruciate ligament deficient patients improved after two weeks of rehabilitaiton exercises, however, there were no significant differences between treatment groups.
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Affiliation(s)
- Joseph M Hart
- University of Virginia, Charlottesville, VA 22904, USA.
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