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DeJong Lempke AF, Stephens SL, Thompson XD, Hart JM, Hryvniak DJ, Rodu JS, Hertel J. Transference of outdoor gait-training to treadmill running biomechanics and strength measures: A randomized controlled trial. J Biomech 2024; 168:112095. [PMID: 38636111 DOI: 10.1016/j.jbiomech.2024.112095] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/12/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024]
Abstract
Outdoor gait-training has been successful in improving pain and reducing contact time during outdoor running for runners with exercise-related lower leg pain (ERLLP). However, it is unclear if these adaptations translate to gold standard treadmill running and clinical strength assessments. The study purpose was to assess the influence of a 4-week outdoor gait-training intervention with home exercises (FBHE) on treadmill running biomechanics and lower extremity strength compared to home exercises alone (HE) among runners with ERLLP. Seventeen runners with ERLLP were randomly allocated to FBHE and HE groups (FBHE: 3 M, 6F, 23 ± 4 years, 22.0 ± 4.6 kg/m2; HE: 3 M, 5F, 25 ± 5 years, 24.0 ± 4.0 kg/m2). Both groups completed eight sessions of home exercises over 4 weeks. The FBHE group received gait-training through wearable sensors to reduce contact time. Treadmill running gait and clinical strength assessments were conducted at baseline and 4-weeks. Multivariate repeated measures analyses of variance were used to assess the influence of group and timepoint for all outcomes. The FBHE group demonstrated significantly decreased contact time at 4-weeks compared to baseline and the HE group (Mean Difference [MD] range: -42 ms - -39 ms; p-range: <0.001-0.02). The FBHE group had significantly increased cadence (MD: +21 steps/min; p = 0.003) and decreased loading impulse (MD: -51, p < 0.001) during treadmill running at 4-weeks compared to the HE group. Strength did not significantly differ adjusting for multiple comparisons (p > 0.007). The outdoor FBHE intervention transferred to favorable changes in treadmill running biomechanics. Clinicians treating runners with ERLLP patients should implement data-driven outdoor gait-training to maximize patient benefits across running locations.
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Affiliation(s)
- Alexandra F DeJong Lempke
- Virginia Commonwealth University, School of Medicine, Department of Physical Medicine and Rehabilitation, Richmond, VA, USA.
| | - Stephanie L Stephens
- Plymouth State University, Health and Human Performance, Plymouth, New Hampshire, USA
| | - Xavier D Thompson
- University of Virginia, School of Education and Human Development Department of Kinesiology, Charlottesville, VA, USA
| | - Joseph M Hart
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, USA
| | - David J Hryvniak
- University of Virginia Health Systems, Outpatient Physical and Occupational Therapy at Fontaine Building 515, Charlottesville, VA, USA
| | - Jordan S Rodu
- University of Virginia, College of Arts and Sciences Department of Statistics, Charlottesville, VA, USA
| | - Jay Hertel
- University of Virginia, School of Education and Human Development Department of Kinesiology, Charlottesville, VA, USA
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Kreulen RT, Anderson G, Yalcin S, Hart JM, Shank K, Fury MS, Elias JJ, Tanaka MJ, Farrow LD, Diduch DR, Cosgarea AJ. Evaluation of Differences in Patellar Height After Patellar Stabilization Procedures Not Intended to Address Patella Alta: A Multicenter Study. Orthop J Sports Med 2024; 12:23259671241235597. [PMID: 38515605 PMCID: PMC10956155 DOI: 10.1177/23259671241235597] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 03/23/2024] Open
Abstract
Background Recent studies have reported conflicting results as to whether isolated medial patellofemoral ligament reconstruction (MPFLr) leads to decreased patellar height. Purpose To investigate if patellar stabilization surgery not intended to address patella alta influences patellar height. Study Design Cohort study; Level of evidence, 3. Methods A multicenter retrospective chart review was conducted, and patients who underwent MPFLr, medializing tibial tuberosity osteotomy (TTO), and/or trochleoplasty between 2016 and 2020 were included. The Caton-Deschamps index (CDI) was calculated from radiographs obtained preoperatively, 2 weeks postoperatively, and 3 months postoperatively. The preoperative CDI value was compared with the 2-week postoperative and 3-month postoperative values according to stabilization procedure (isolated MPFLr, isolated TTO, MPFLr + TTO, MPFLr + trochleoplasty, and MPFLr + trochleoplasty + TTO) using the paired t test. Analyses of the 1-bundle versus 2-bundle MPFLr technique and the presence of lateral retinacular release or lateral retinacular lengthening were conducted on the isolated MPFLr and combined MPFLr + TTO cohorts. Results A total of 356 knees were included. Statistically significant pre- to postoperative decreases in CDI were seen in all stabilization procedures analyzed (P≤ .017 for all). Within the isolated MPFLr cohort, this significant decrease was seen at 2 weeks postoperatively with the 2-bundle technique (ΔCDI = -0.09; P < .001) but not with the 1-bundle technique (ΔCDI = -0.01; P = .621). Conclusion The different surgical techniques analyzed in the current study affected patellar height, even when a distalizing TTO was not performed. The decrease was dependent on surgical technique, with a 2-bundle MPFLr leading to a statistically significant decrease and a 1-bundle MPFLr effecting no change.
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Affiliation(s)
- R. Timothy Kreulen
- Department of Orthopaedic Surgery, Johns Hopkins, School of Medicine, Baltimore, Maryland, USA
| | - Gregory Anderson
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sercan Yalcin
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joseph M. Hart
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kaitlyn Shank
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew S. Fury
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John J. Elias
- Department of Health Sciences, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Miho J. Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lutul D. Farrow
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - David R. Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Andrew J. Cosgarea
- Department of Orthopaedic Surgery, Johns Hopkins, School of Medicine, Baltimore, Maryland, USA
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Aguero AD, Irrgang JJ, MacGregor AJ, Rothenberger SD, Hart JM, Fraser JJ. Sex, military occupation and rank are associated with risk of anterior cruciate ligament injury in tactical-athletes. BMJ Mil Health 2023; 169:535-541. [PMID: 35165197 PMCID: PMC10715491 DOI: 10.1136/bmjmilitary-2021-002059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 12/04/2021] [Accepted: 01/16/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) injury is common within the US military and represents a significant loss to readiness. Since recent changes to operational tempo, there has not been an analysis of ACL injury risk. The aim of this retrospective cohort study was to evaluate military occupation, sex, rank and branch of service on ACL injury risk in the US military from 2006 to 2018. METHODS The Defense Medical Epidemiology Database was queried for the number of US tactical athletes with International Classification of Diseases diagnosis codes 717.83 (old disruption of ACL), 844.2 (sprain of knee cruciate ligament), M23.61 (other spontaneous disruption of ACL) and S83.51 (sprain of ACL of knee) on their initial encounter. Relative risk and χ2 statistics were calculated to assess sex and military occupation effects on ACL injury. A multivariable negative binomial regression model evaluated changes in ACL injury incidence with respect to sex, branch of service and rank. RESULTS The study period displayed a significant decrease in the ACL injury rate at 0.18 cases per 1000 person-years or relative decrease of 4.08% each year (p<0.001) after averaging over the main and interactive effects of sex, rank and branch of service. The interaction effect of time with sex indicated a steeper decline in the incidence in men as compared with women. The risk of ACL injury by sex was modified by rank. The incidence among military personnel varied by occupation. CONCLUSION Despite the decline among tactical athletes over time, rates of ACL injury remain much higher than the general US population. Sex, rank, branch of service and military occupation were found to be risk factors for ACL injury. It is critical for policy makers to understand the salient risk factors for ACL injury to guide proactive measures to prevent injury.
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Affiliation(s)
- Aubrey D Aguero
- Physical Therapy Department, School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Naval Medical Leader & Professional Development Command, US Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA
| | - J J Irrgang
- Physical Therapy Department, School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - A J MacGregor
- Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, California, USA
| | - S D Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - J M Hart
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - J J Fraser
- Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, California, USA
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Knaus KR, Handsfield GG, Fiorentino NM, Hart JM, Meyer CH, Blemker SS. Athlete Muscular Phenotypes Identified and Compared with High-Dimensional Clustering of Lower Limb Muscle Volume Measurements. Med Sci Sports Exerc 2023; 55:1913-1922. [PMID: 37259254 DOI: 10.1249/mss.0000000000003224] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Athletes use their skeletal muscles to demonstrate performance. Muscle force generating capacity is correlated with volume, meaning that variations in sizes of different muscles may be indicative of how athletes meet different demands in their sports. Medical imaging enables in vivo quantification of muscle volumes; however, muscle volume distribution has not been compared across athletes of different sports. PURPOSE The goal of this work was to define "muscular phenotypes" in athletes of different sports and compare these using hierarchical clustering. METHODS Muscle volumes normalized by body mass of athletes (football, baseball, basketball, or track) were compared with control participants to quantify size differences using z -scores. z -Scores of 35 muscles described the pattern of volume deviation within each athlete's lower limb, characterizing their muscular phenotype. Data-driven high-dimensional clustering analysis was used to group athletes presenting similar phenotypes. Efficacy of clustering to identify similar phenotypes was demonstrated by grouping athletes' contralateral limbs before other athletes' limbs. RESULTS Analyses revealed that athletes did not tend to cluster with others competing in the same sport. Basketball players with similar phenotypes grouped by clustering also demonstrated similarities in performance. Clustering also identified muscles with similar volume variation patterns across athletes, and principal component analysis revealed specific muscles that accounted for most of the variance (gluteus maximus, sartorius, semitendinosus, vastus medialis, vastus lateralis, and rectus femoris). CONCLUSIONS Athletes exhibit heterogeneous lower limb muscle volumes that can be characterized and compared as individual muscular phenotypes. Clustering revealed that athletes with the most similar phenotypes do not always play the same sport such that patterns of muscular heterogeneity across a group of athletes reflect factors beyond their specific sports.
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Affiliation(s)
- Katherine R Knaus
- Department of Bioengineering, University of California San Diego, La Jolla, CA
| | | | | | - Joseph M Hart
- Department of Orthopedic Surgery, University of North Carolina, Chapel Hill, NC
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Moran TE, Ramamurti P, Wells DK, Thompson X, Hart JM, Diduch DR, Brockmeier SF, Miller MD, Gwathmey WF, Werner BC. No Deficits in Functional Outcomes of the Contralateral Limb Are Seen When the Hamstring Is Harvested for Augmentation of Small Diameter Ipsilateral Hamstring Autograft. Arthrosc Sports Med Rehabil 2023; 5:100798. [PMID: 37771676 PMCID: PMC10523181 DOI: 10.1016/j.asmr.2023.100798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/18/2023] [Indexed: 09/30/2023] Open
Abstract
Purpose To evaluate clinical outcomes of the contralateral, nonoperative limb in patients undergoing contralateral hamstring (HS) autograft harvest compared with patients undergoing ipsilateral HS autograft harvest alone. Methods This study included 96 patients who underwent isolated anterior cruciate ligament reconstruction (ACLR) using 4-stranded HS autograft (n = 85) or 4-stranded HS autograft augmented with contralateral HS (n = 13) due to inclusion of ipsilateral graft diameter <8 mm. Isokinetic flexion and extension strength and dynamic performance of the ipsilateral and contralateral limbs and limb symmetry index (LSI) were evaluated at 6 months' postoperatively. Rates of contralateral native ACL tear at minimum 2 years also were compared. For all comparisons, P < .05 was considered statistically significant. Results Normalized isokinetic knee flexion and extension strength of the contralateral limb did not differ between cohorts (P = .34; P = .21, respectively). LSI for knee extension peak torque and knee flexion peak torque did not differ between cohorts (P = .44; P = .67, respectively). No difference in LSI was seen for any dynamic performance testing (single leg hop, P = .97; triple leg hop, P = .14; 6-m timed hop, P = .99). No difference was observed in International Knee Documentation Committee (P = .99) or Knee Injury and Osteoarthritis Outcome Score subscale measures (P = .39-.86). No difference in rates of contralateral knee native ACL tears were seen between cohorts (HS autograft + contralateral HS augmentation, n = 2, 15.4%; HS autograft, n = 7, 8.4%; P = .26). Conclusions In this study, at the time of return to sport, we found no differences in contralateral limb functional performance or limb symmetry measurements between patients undergoing contralateral HS autograft harvest for augmentation of smaller (<8 mm) diameter HS autografts harvested from the injured extremity. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Thomas E. Moran
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Douglas K. Wells
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Xavier Thompson
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Joseph M. Hart
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - David R. Diduch
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Stephen F. Brockmeier
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Mark D. Miller
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Winston F. Gwathmey
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
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Walaszek MC, Grindstaff TL, Hart JM, Birchmeier T, Triplett A, Collins K, Harkey M, Shingles M, Straus M, Kuenze C. Quadriceps Strength and Knee-Related Symptom State 6 Months After Anterior Cruciate Ligament Reconstruction. J Athl Train 2023; 58:536-541. [PMID: 36094575 PMCID: PMC10496454 DOI: 10.4085/1062-6050-0207.22] [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: 11/09/2022]
Abstract
CONTEXT Isometric quadriceps strength metrics and patient-reported outcomes are commonly used in return-to-sport assessments in those with anterior cruciate ligament reconstruction (ACLR). Patients may experience clinical knee-related symptoms aggravating enough to seek additional medical care after ACLR. In addition to seeking additional medical care, these patient-reported clinical knee-related symptoms may also influence function after ACLR. However, whether an association exists between these common quadriceps metrics and the patient-reported clinical knee-related symptom state is unknown. OBJECTIVE To determine if meeting isometric quadriceps strength and symmetry criteria is associated with acceptable clinical knee-related symptoms at 5 to 7 months post-ACLR. DESIGN Cross-sectional study. SETTING Laboratories. PATIENTS OR OTHER PARTICIPANTS We classified individuals at 5 to 7 months post-ACLR based on their isometric ACLR and uninvolved-limb quadriceps strength or quadriceps strength symmetry. We also dichotomized participants based on the Englund et al criteria for unacceptable clinical knee-related symptoms. MAIN OUTCOME MEASURE(S) Quadriceps strength variables were compared between groups using analysis of covariance, and the relative risk of a participant in each quadriceps strength group reporting acceptable clinical knee-related symptoms was determined using binary logistic regression. RESULTS A total of 173 individuals participated. The isometric quadriceps strength and limb symmetry index were different (P < .001) between quadriceps strength groups. Those categorized as both strong and symmetric had a 1.28 (95% CI = 0.94, 1.74) and individuals categorized as symmetric only had a 1.29 (95% CI = 0.97, 1.73) times greater relative risk of reporting acceptable clinical knee-related symptoms compared with the neither strong nor symmetric group. CONCLUSIONS The majority of individuals (85%) recovering from ACLR failed to meet either the clinical quadriceps strength or symmetry criteria at 5 to 7 months post-ACLR. Quadriceps strength and quadriceps strength symmetry are clinically important but may not be primary determinants of the clinical knee-related symptom state within the first 6 months post-ACLR.
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Kuenze C, Weaver A, Grindstaff TL, Ulman S, Norte GE, Roman DP, Giampetruzzi N, Lisee CM, Birchmeier T, Triplett A, Farmer B, Hopper H, Sherman DA, Ness BM, Collins K, Walaszek M, Baez SE, Harkey MS, Tulchin-Francis K, Ellis H, Wilson PL, Chang ES, Wilcox CL, Schorfhaar A, Shingles M, Hart JM. Age-, Sex-, and Graft-Specific Reference Values From 783 Adolescent Patients at 5 to 7 Months After ACL Reconstruction: IKDC, Pedi-IKDC, KOOS, ACL-RSI, Single-Leg Hop, and Thigh Strength. J Orthop Sports Phys Ther 2023; 53:1-8. [PMID: 36688716 DOI: 10.2519/jospt.2023.11389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE: To describe age-, sex-, and graft source-specific reference values for patient-reported, physical function, and strength outcome measures in adolescents at 5 to 7 months after anterior cruciate ligament reconstruction. DESIGN: Cross-sectional study. METHODS: Data were collected at 3 universities and 2 children's hospitals. The participants completed at least one of the International Knee Documentation Committee (IKDC) Subjective Evaluation Form, Pediatric IKDC (Pedi-IKDC), Knee Injury and Osteoarthritis Outcomes Score (KOOS), and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale. Participants also completed single-leg hop tests and/or isokinetic quadriceps and hamstrings strength assessments (at 60°/s). Reference values were summarized using descriptive statistics and stratified for age, sex, and graft source. RESULTS: Reference values were reported for common patient-reported outcomes and measures of physical function and strength from 783 participants (56% females, age = 16. 4 ± 2.0 years) who were in early adolescence (12-14 years, N = 183, 52% females), middle adolescence (15-17 years, N = 456, 58% females), or late adolescence (18-20 years, N = 144, 55% females). Three hundred seventy-nine participants (48.4%) received a bone-patellar tendon-bone autograft, 292 participants (37.3%) received hamstring tendon autograft, and 112 participants (14.3%) received autograft or allograft from an alternative source. CONCLUSION: Reference values for common patient-reported outcomes and measures of physical function and strength differed depending on a patient's age, sex, and graft source. Using patient-specific reference values, in addition to previously described age-appropriate cutoff values, may help clinicians monitor and progress patients through rehabilitation and return to physical activity after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2023;53(4):1-8. Epub: 23 January 2023. doi:10.2519/jospt.2023.11389.
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Marrs RP, Covell HS, Peebles AT, Ford KR, Hart JM, Queen RM. Using load sensing insoles to identify knee kinetic asymmetries during landing in patients with an Anterior Cruciate Ligament reconstruction. Clin Biomech (Bristol, Avon) 2023; 104:105941. [PMID: 36958202 DOI: 10.1016/j.clinbiomech.2023.105941] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Knee extension moment asymmetry is a known second anterior cruciate ligament injury risk factor in patients who have had an anterior cruciate ligament reconstruction. Traditionally, assessing asymmetries requires motion capture and force platforms which are expensive and occupy a large space. Wireless force sensing insoles could be a feasible surrogate. METHODS Twenty-nine patients following anterior cruciate ligament reconstruction performed ten bilateral stop jumps while insole forces, ground reaction forces, and lower extremity kinematics were collected. Peak knee extension moment symmetry was computed using the kinematic and kinetic data, and peak impact force symmetry and impulse symmetry were computed using both the insole force data and vertical ground reaction force data. The relationship between outcomes was analyzed using Pearson correlation coefficients. Patients were classified as symmetric or asymmetric for each outcome based on an 85% symmetry cutoff. The resulting classifications were qualitatively compared across outcome measures. FINDINGS Peak knee extension moment symmetry had a strong association with the force plate symmetry outcomes (r = 0.72-0.96, p < 0.001) and a moderate to strong association with insole symmetry outcomes (r = 0.67-0.77, p < 0.001). There was strong agreement between insole and force plate symmetry outcomes (r = 0.69-0.90, p < 0.001). Four patients were identified as symmetric when using the peak knee extension moment symmetry, five when using force plate data, and eight when using insole data. INTERPRETATION Force sensing insoles could be used as a surrogate for knee extension moment asymmetry in patients who have had an anterior cruciate ligament reconstruction.
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Affiliation(s)
- Reilly P Marrs
- Kevin P. Granata Biomechanics Lab, Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA.
| | - Hannah S Covell
- Kevin P. Granata Biomechanics Lab, Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Alexander T Peebles
- Kevin P. Granata Biomechanics Lab, Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Kevin R Ford
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Joseph M Hart
- Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, USA
| | - Robin M Queen
- Kevin P. Granata Biomechanics Lab, Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA; Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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Bodkin SG, Pethick JT, Dooley EA, Russell SD, Hart JM. Torque complexity of maximal knee extensor isometric contraction in individuals following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2023; 104:105932. [PMID: 36931165 DOI: 10.1016/j.clinbiomech.2023.105932] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Current rehabilitation goals following anterior cruciate ligament reconstruction are structured around the maximal force generating capabilities of the muscle. Force fluctuations, an index of force control, have been observed to alter post- anterior cruciate ligament reconstruction. The temporal structure, or "complexity" of force fluctuations may provide important insight into the post-operative muscular recovery. The aims of this study were 1) to compare quadriceps torque complexity in anterior cruciate ligament reconstructed patients to the contralateral limb and to healthy, controls and 2) to assess the relationships between torque complexity to patient outcomes. METHODS Data from 120 anterior cruciate ligament reconstructed participants (65 Females, 21.0 ± 8.3 years, 5.96 ± 0.48-months post-surgery) and 95 healthy controls (50 Females, 21.5 ± 2.9 years) were collected. A 30-s knee extensor maximal isometric contraction was completed to calculate approximate entropy, a measure of torque complexity. FINDINGS Approximate entropy was found to decrease throughout the 30-s trial (P < .001, Cohen's d = 1.87 [1.64,2.10]). The anterior cruciate ligament reconstructed limb demonstrated greater approximate entropy compared to the contralateral limb or to healthy controls (P < .001, Cohen's d = 0.64 [0.38,0.90]). approximate entropy at the end of the trial demonstrated weak, negatively relationships with peak torque, patient reported outcome measures, and knee extensor fatigue (r = -0.21 to -0.32, P < .05). INTERPRETATION A greater torque complexity in individuals following anterior cruciate ligament reconstruction was weakly related to lower quadriceps strength, lower subjective function, and quadriceps fatigue resistance. The complexity of force fluctuations during a sustained maximal task may draw clinical insight into the recovery of motor function following anterior cruciate ligament reconstruction.
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Affiliation(s)
- S G Bodkin
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA.
| | - J T Pethick
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK
| | - E A Dooley
- Depatment of Biomedical Engineering, University of Virginia, Charlottesville, VA. USA
| | - S D Russell
- Depatment of Biomedical Engineering, University of Virginia, Charlottesville, VA. USA
| | - J M Hart
- Deparment of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Norte GE, Cousins M, Hogarth DA, Knaus KR, Slater LV, Blemker SS, Hart JM. Personalized volumetric assessment of lower body muscles in patients with knee injuries: A descriptive case series. Knee 2022; 39:38-49. [PMID: 36126493 DOI: 10.1016/j.knee.2022.08.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with knee joint pathology present with variable muscular responses across the muscles of the lower limb and pelvis. Conventional approaches to characterizing muscle function are limited to gross strength assessments that may overlook subtle changes both in the thigh, hip and shank musculature. PURPOSE To describe individualized patterns of lower extremity muscle volumes in patients with knee pathologies. METHODS This was a retrospective case series performed in a University medical center. Nine patients diagnosed with meniscus tear recommended to undergo meniscectomy volunteered. Participants underwent 3.0 Tesla magnetic resonance imaging (MRI) of the lower extremities. Thirty-five MRI-derived muscle volumes were compared between limbs and expressed as percentage asymmetry. For additional context, z-scores were also calculated for mass- and height-normalized muscles and pre-determined muscle groupings relative to a normative database. RESULTS There were no consistent patterns observed when considering between-limb asymmetries among all patients. The ankle musculature (dorsiflexors, plantar flexors, and invertors) was the only muscle group to be consistently smaller than normal for all patients, with the psoas major and flexor hallucis longus being the only individual muscles. The severity or chronicity of injury and presence of surgical intervention did not appear to have a clear effect on muscle volumes. CONCLUSION Patients with a history of meniscal pathology demonstrate inconsistent patterns of lower extremity muscle volumes about the hip, knee, and ankle between limbs and in comparison to uninjured individuals. These data support the need for individualized assessment and intervention in this population.
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Affiliation(s)
- Grant E Norte
- Department of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, United States.
| | | | - Danielle A Hogarth
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, United States
| | - Katherine R Knaus
- Department of Bioengineering, University of California at San Diego, San Diego, CA, United States
| | - Lindsay V Slater
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Silvia S Blemker
- Springbok Analytics, Charlottesville, VA, United States; Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, United States; Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States; Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, United States
| | - Joseph M Hart
- Springbok Analytics, Charlottesville, VA, United States; Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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DeJong Lempke AF, Stephens SL, Fish PN, Thompson XD, Hart JM, Hryvniak DJ, Rodu JS, Hertel J. Sensor-based gait training to reduce contact time for runners with exercise-related lower leg pain: a randomised controlled trial. BMJ Open Sport Exerc Med 2022; 8:e001293. [PMID: 36353183 PMCID: PMC9639130 DOI: 10.1136/bmjsem-2021-001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To assess the effects of a 4-week randomised controlled trial comparing an outdoor gait-training programme to reduce contact time in conjunction with home exercises (contact time gait-training feedback with home exercises (FBHE)) to home exercises (HEs) alone for runners with exercise-related lower leg pain on sensor-derived biomechanics and patient-reported outcomes. Design Randomised controlled trial. Setting Laboratory and field-based study. Participants 20 runners with exercise-related lower leg pain were randomly allocated into FBHE (4 male (M), 6 female (F), 23±4 years, 22.0±4.3 kg/m2) or HE groups (3 M, 7 F, 25±5 years, 23.6±3.9 kg/m2). Interventions Both groups completed eight sessions of HEs over 4 weeks. The FBHE group received vibrotactile feedback through wearable sensors to reduce contact time during outdoor running. Primary and secondary outcome measures Patient-reported outcome measures (PROMs) and outdoor gait assessments were conducted for both groups at baseline and 4 weeks. PROMs were repeated at 6 weeks, and feedback retention was assessed at 6 weeks for the FBHE group. Repeated measures analyses of variance were used to assess the influence of group and timepoint on primary outcomes. Results The FBHE group reported increased function and recovery on PROMs beyond the HE group at 6 weeks (p<0.001). There was a significant group by time interaction for Global Rating of Change (p=0.004) and contact time (p=0.002); the FBHE group reported greater subjective improvement and reduced contact time at 4 and 6 weeks compared with the HE group and compared with baseline. The FBHE group had increased cadence (mean difference: 7 steps/min, p=0.01) at 4 weeks during outdoor running compared with baseline. Conclusion FBHE was more effective than HE alone for runners with exercise-related lower leg pain, manifested with improved PROMs, reduced contact time and increased cadence. Trial registration number NCT04270565.
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Affiliation(s)
| | | | - Pamela N Fish
- Kidney Center, Fresenius Medical Care, Knoxville, Tennessee, USA
| | | | - Joseph M Hart
- Orthopaedics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David J Hryvniak
- Physical Medicine & Rehabilitation, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Jordan S Rodu
- Statistics, University of Virginia, Charlottesville, Virginia, USA
| | - Jay Hertel
- Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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DeJong Lempke AF, Hart JM, Hryvniak DJ, Rodu JS, Hertel J. Prospective Running Assessments Among Collegiate Cross-Country Athletes. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000875124.84787.bb] [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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Moran TE, Ignozzi AJ, Burnett Z, Bodkin S, Hart JM, Werner BC. Deficits in Contralateral Limb Strength Can Overestimate Limb Symmetry Index After Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e1713-e1719. [PMID: 36312704 PMCID: PMC9596901 DOI: 10.1016/j.asmr.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate whether contralateral limb strength represents a dynamic, rather than static, data point after anterior cruciate ligament reconstruction (ACL-R). Methods Patients who underwent isolated ACL-R at a single institution were identified. Patients completed an institutional Lower-Extremity Assessment Protocol (LEAP) testing protocol at 6 and 9 months postoperatively. Extension strength and flexion strength of the ipsilateral and contralateral limbs and limb symmetry index (LSI) were compared between the 6- and 9-month testing outcomes. Subgroup analysis compared patients demonstrating less than or greater than 10% change in contralateral limb flexion and extension strength between 6 and 9 months postoperatively. Results A total of 144 subjects were included in this study. On average, contralateral limb flexion and extension strength increased 2-4% between 6 and 9 months postoperatively. However, the contralateral limb increased >10% from 6 to 9 months in extension and flexion strength in 35/144 (24.3%) and 55/144 (38.2%) of patients, respectively. The cohort with >10% change between 6 and 9 months had significantly weaker contralateral extension and flexion strength at 6 months compared to the cohort that demonstrated <10% change (extension: 2.00 vs 2.39; P < .001; flexion: 0.84 vs 1.08; P < .001), but similar ipsilateral limb performance. Therefore, the >10% change cohort had a significantly greater LSI at 6 months compared to the <10% change cohort (67.3% vs 59.4%; P = .006). No demographic or operative factors correlated with which patients demonstrated >10% flexion or extension strength changes of the contralateral limb. Conclusion A large percentage of patients demonstrate significant changes in their contralateral limb flexion and extension strength between 6 and 9 months postoperatively that result from an initial contralateral limb strength deficit. This may limit the utility of the contralateral limb as a control for comparison to the operative extremity during return to sport assessment.
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Fraser JJ, Saliba SA, Hart JM, Park JS, Hertel J. Corrigendum to "Effects of midfoot joint mobilization on ankle-foot morphology and function following acute ankle sprain. A crossover clinical trial" [Musculoskel. Sci. Pract. 46 (2020) 102130]. Musculoskelet Sci Pract 2022; 59:102477. [PMID: 34838510 DOI: 10.1016/j.msksp.2021.102477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- John J Fraser
- Department of Kinesiology, University of Virginia, 550 Brandon Ave Room 340C, Charlottesville, VA, 22904-4407, USA; Warfighter Performance Department, Naval Health Research Center, USA.
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, 550 Brandon Ave Room 340C, Charlottesville, VA, 22904-4407, USA
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, 550 Brandon Ave Room 340C, Charlottesville, VA, 22904-4407, USA
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, 550 Brandon Ave Room 340C, Charlottesville, VA, 22904-4407, USA
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Moran TE, Ignozzi AJ, Taleghani ER, Bruce AS, Hart JM, Werner BC. Flexible Versus Rigid Reaming Systems for Independent Femoral Tunnel Reaming During ACL Reconstruction: Minimum 2-Year Clinical Outcomes. Orthop J Sports Med 2022; 10:23259671221083568. [PMID: 35321208 PMCID: PMC8935574 DOI: 10.1177/23259671221083568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Radiographic and cadaveric studies have suggested that anatomic anterior cruciate ligament reconstruction (ACLR) femoral tunnel drilling with the use of a flexible reaming system through an anteromedial portal (AM-FR) may result in a different graft and femoral tunnel position compared with using a rigid reamer through an accessory anteromedial portal with hyperflexion (AAM-RR). No prior studies have directly compared clinical outcomes between the use of these 2 techniques for femoral tunnel creation during ACLR. Purpose: To compare revision rates at a minimum of 2 years postoperatively for patients who underwent ACLR with AM-FR versus AAM-RR. The secondary objectives were to compare functional testing and patient-reported outcomes between the cohorts. Study Design: Cohort study; Level of evidence, 3. Methods: Included were consecutive patients at a single academic institution between 2013 and 2018 who underwent primary ACLR without additional ligamentous reconstruction. Patients were separated into 2 groups based on the type of anatomic femoral tunnel drilling: AM-FR or AAM-RR. Graft failure, determined by revision ACLR, was assessed with a minimum 2 years of postoperative follow-up. The authors also compared patient-reported outcome scores (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) and functional performance testing performed at 6 months postoperatively. Results: A total of 284 (AAM-RR, 232; AM-FR, 52) patients were included. The mean follow-up time was 3.7 ± 1.5 years, with a minimum 2-year follow-up rate of 90%. There was no significant difference in the rate of revision ACLR between the AAM-RR and AM-FR groups (10.8% vs 9.6%, respectively; P = .806). At 6 months postoperatively, there were no significant between-group differences in peak knee extension strength, peak knee flexion strength, limb symmetry indices, or hop testing, as well as no significant differences in IKDC (AAM-RR, 81.1; AM-FR, 78.9; P = .269) or KOOS (AAM-RR, 89.0; AM-FR, 86.7; P = .104). Conclusion: In this limited study, independent femoral tunnel drilling for ACLR using rigid or flexible reaming systems resulted in comparable rates of revision ACLR at a minimum of 2 years postoperatively, with no significant differences in strength assessments or patient-reported outcomes at 6 months postoperatively.
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Affiliation(s)
- Thomas E. Moran
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Anthony J. Ignozzi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Eric R. Taleghani
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Amelia S. Bruce
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Joseph M. Hart
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
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DeJong AF, Hart JM, Hryvniak DJ, Rodu JS, Hertel J. Prospective running assessments among division I cross-country athletes. Phys Ther Sport 2022; 55:37-45. [DOI: 10.1016/j.ptsp.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 02/05/2022] [Accepted: 02/06/2022] [Indexed: 01/05/2023]
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DeJong Lempke AF, Hart JM, Hryvniak DJ, Rodu JS, Hertel J. Running-Related Injuries Captured Using Wearable Technology during a Cross-Country Season: A Preliminary Study. Transl J ACSM 2022. [DOI: 10.1249/tjx.0000000000000217] [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: 02/04/2023]
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Mandalapu V, Hart JM, Lach J, Gong J. Rehabilitation Tracking of Athletes Post Anterior Cruciate Ligament Reconstruction (ACL-R) Surgery Through Causal Analysis of Gait Data & Computational Modeling. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:980-984. [PMID: 34891452 DOI: 10.1109/embc46164.2021.9630501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Early identification of motion disparities in Anterior Cruciate Ligament reconstructed (ACL-R) athletes may better post-operative decision making when returning athletes to sport. Existing return to play assessments consist of assessments of muscle strength, functional tasks, patient-reported outcomes, and 3D coordinate tracking. However, these methods primarily depend on the medical provider's intuition to release them to participate in an unrestricted activity after ACL-R that may cause reinjury or long-term impacts. This study proposes a wearable sensor-based system that helps track athlete rehabilitation progress and return to sport decision making. For this, we capture gait data from 89 ACL-R athletes during their walking and jogging trials. The raw gyroscope data collected from this system is used to extract causal features based on Nolte's phase slope index. Features extracted from this study are used to develop computational models that classify ACL-R athletes based on their reconstructed knee during two visits (3-6 months & 9 months) post ACL-R surgery. The classifier's performance degradation in detecting ACL-R athletes injured knee during multiple visits supports athletic trainers and physicians' decision-making process to confirm an athlete's safe return to sport.Clinical Relevance- This study develops computational models based on causal analysis of gait data to support athletic trainers and medical practitioners' decision to return athletes to sport post ACL-R surgery.
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Casp AJ, Bodkin SG, Gwathmey FW, Werner BC, Miller MD, Diduch DR, Brockmeier SF, Hart JM. Effect of Meniscal Treatment on Functional Outcomes 6 Months After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:23259671211031281. [PMID: 34646893 PMCID: PMC8504239 DOI: 10.1177/23259671211031281] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background Meniscal injuries are commonly associated with anterior cruciate ligament (ACL) tears. Treatment of meniscal injuries can impart delayed weightbearing and range of motion restrictions, which can affect the rehabilitation protocol. The effect of meniscal treatment and subsequent restrictions on strength recovery after ACL reconstruction is unclear. Purpose/Hypothesis The purpose of this study was to compare strength, jumping performance, and patient-reported outcomes between patients who underwent isolated ACL reconstruction (ACLR) and those who underwent surgical intervention for meniscal pathology at the time of ACLR. Our hypothesis was that patients who underwent concurrent meniscal repair (MR) would have lower strength recovery owing to postoperative restrictions. Study Design Cohort study; Level of evidence, 3. Methods Patients with ACLR were stratified into isolated ACLR, ACLR and meniscectomy (ACLR-MS), or ACLR-MR groups and were compared with healthy controls. The ACLR-MR group was restricted to partial weightbearing and to 90° of knee flexion for the first 6 weeks postoperatively. All participants completed patient-reported outcomes (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) and underwent bilateral isokinetic and isometric strength tests of the knee extensor and flexor groups as part of a return-to-sports test battery at 5 to 7 months postoperatively. Results A total of 165 patients with ACLR (50 with isolated ACLR, 44 with ACLR-MS, and 71 with ACLR-MR) and 140 healthy controls were included in the study. Follow-up occurred at a mean of 5.96 ± 0.47 months postoperatively. The control group demonstrated higher subjective knee function, unilateral peak extensor torque, and limb symmetry than did the ACLR-MS and ACLR-MR groups combined (P < .001 for all). There were no differences in IKDC, KOOS subscales, or unilateral or limb symmetry measures of peak knee extensor or flexor torque among the isolated ACLR, ACLR-MS, and ACLR-MR groups. Conclusion Persistent weakness, asymmetry, and reduced subjective outcome scores at 6-month follow-up after ACLR were not influenced by meniscal treatment. These findings suggested that the weightbearing and range of motion restrictions associated with meniscal repair recovery do not result in loss of early strength or worse patient-reported outcomes.
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Affiliation(s)
- Aaron J Casp
- All authors affiliated with the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephan G Bodkin
- All authors affiliated with the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - F Winston Gwathmey
- All authors affiliated with the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Brian C Werner
- All authors affiliated with the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D Miller
- All authors affiliated with the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - David R Diduch
- All authors affiliated with the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen F Brockmeier
- All authors affiliated with the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Joseph M Hart
- All authors affiliated with the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
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Le Q, Madhu V, Hart JM, Farber CR, Zunder ER, Dighe AS, Cui Q. Current evidence on potential of adipose derived stem cells to enhance bone regeneration and future projection. World J Stem Cells 2021; 13:1248-1277. [PMID: 34630861 PMCID: PMC8474721 DOI: 10.4252/wjsc.v13.i9.1248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/22/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Injuries to the postnatal skeleton are naturally repaired through successive steps involving specific cell types in a process collectively termed “bone regeneration”. Although complex, bone regeneration occurs through a series of well-orchestrated stages wherein endogenous bone stem cells play a central role. In most situations, bone regeneration is successful; however, there are instances when it fails and creates non-healing injuries or fracture nonunion requiring surgical or therapeutic interventions. Transplantation of adult or mesenchymal stem cells (MSCs) defined by the International Society for Cell and Gene Therapy (ISCT) as CD105+CD90+CD73+CD45-CD34-CD14orCD11b-CD79αorCD19-HLA-DR- is being investigated as an attractive therapy for bone regeneration throughout the world. MSCs isolated from adipose tissue, adipose-derived stem cells (ADSCs), are gaining increasing attention since this is the most abundant source of adult stem cells and the isolation process for ADSCs is straightforward. Currently, there is not a single Food and Drug Administration (FDA) approved ADSCs product for bone regeneration. Although the safety of ADSCs is established from their usage in numerous clinical trials, the bone-forming potential of ADSCs and MSCs, in general, is highly controversial. Growing evidence suggests that the ISCT defined phenotype may not represent bona fide osteoprogenitors. Transplantation of both ADSCs and the CD105- sub-population of ADSCs has been reported to induce bone regeneration. Most notably, cells expressing other markers such as CD146, AlphaV, CD200, PDPN, CD164, CXCR4, and PDGFRα have been shown to represent osteogenic sub-population within ADSCs. Amongst other strategies to improve the bone-forming ability of ADSCs, modulation of VEGF, TGF-β1 and BMP signaling pathways of ADSCs has shown promising results. The U.S. FDA reveals that 73% of Investigational New Drug applications for stem cell-based products rely on CD105 expression as the “positive” marker for adult stem cells. A concerted effort involving the scientific community, clinicians, industries, and regulatory bodies to redefine ADSCs using powerful selection markers and strategies to modulate signaling pathways of ADSCs will speed up the therapeutic use of ADSCs for bone regeneration.
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Affiliation(s)
- Quang Le
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Vedavathi Madhu
- Orthopaedic Surgery Research, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Joseph M Hart
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Charles R Farber
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA 22908, United States
- Departments of Public Health Sciences and Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA 22908, United States
| | - Eli R Zunder
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, United States
| | - Abhijit S Dighe
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
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Bruce AS, Thompson XD, Hopper HM, Stolzenfeld RL, Moler CB, Wahl AJ, Hart JM. Weight Distribution Progression During Bilateral Squatting Tasks Post-Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000760932.11804.d4] [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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Kaur M, Hart JM. How Do Fear-related Patient Reported Outcomes Changes Following ACL Reconstruction And Rehabilitation? Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000763812.00703.7a] [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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DeJong Lempke AF, Hart JM, Hryvniak DJ, Rodu JS, Hertel J. Use of wearable sensors to identify biomechanical alterations in runners with Exercise-Related lower leg pain. J Biomech 2021; 126:110646. [PMID: 34329881 DOI: 10.1016/j.jbiomech.2021.110646] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022]
Abstract
Exercise-related lower leg pain (ERLLP) is one of the most prevalent running-related injuries, however little is known about injured runners' mechanics during outdoor running. Establishing biomechanical alterations among ERLLP runners would help guide clinical interventions. Therefore, we sought to a) identify defining biomechanical features among ERLLP runners compared to healthy runners during outdoor running, and b) identify biomechanical thresholds to generate objective gait-training recommendations. Thirty-two ERLLP (13 M, age: 21 ± 5 years, BMI: 22.69 ± 2.25 kg/m2) and 32 healthy runners (13 M, age: 23 ± 6 years, BMI: 22.33 ± 3.20 kg/m2) were assessed using wearable sensors during one week of typical outdoor training. Step-by-step data were extracted to assess kinetic, kinematic, and spatiotemporal measures. Preliminary feature extraction analyses were conducted to determine key biomechanical differences between healthy and ERLLP groups. Analyses of covariance (ANCOVA) and variability assessments were used compare groups on the identified features. Participants were split into 3 pace bands, and mean differences across groups were calculated to establish biomechanical thresholds. Contact time was the key differentiating feature for ERRLP runners. ANCOVA assessments reflected that the ERLLP group had increased contact time (Mean Difference [95% Confidence Interval] = 8 ms [6.9,9.1], p < .001), and approximate entropy analyses reflected greater contact time variability. Contact time differences were dependent upon running pace, with larger between-group differences being exhibited at faster paces. In all, ERLLP runners demonstrated longer contact time than healthy runners during outdoor training. Clinicians should consider contact time when assessing and treating these ERLLP runner patients.
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Affiliation(s)
- Alexandra F DeJong Lempke
- University of Virginia School of Education Department of Kinesiology, Exercise and Sport Injury Lab, 210 Emmet Street South, Charlottesville, VA 22904, USA; Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States; Micheli Center for Sports Injury Prevention, Waltham, MA, United States.
| | - Joseph M Hart
- University of Virginia School of Education Department of Kinesiology, Exercise and Sport Injury Lab, 210 Emmet Street South, Charlottesville, VA 22904, USA; Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States
| | - David J Hryvniak
- University of Virginia Health Systems Outpatient Physical and Occupational Therapy at Fontaine Building 515, Fontaine Research Park, 515 Ray C. Hunt Drive, Charlottesville, VA 22903, USA
| | - Jordan S Rodu
- University of Virginia College of Arts and Sciences Department of Statistics, Halsey Hall 104, 148 Amphitheater Way, Charlottesville, VA 22904, USA
| | - Jay Hertel
- University of Virginia School of Education Department of Kinesiology, Exercise and Sport Injury Lab, 210 Emmet Street South, Charlottesville, VA 22904, USA
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Bodkin SG, Hertel J, Diduch DR, Saliba SA, Novicoff WM, Brockmeier SF, Miller MD, Gwathmey FW, Werner BC, Hart JM. Predicting ACL Reinjury from Return to Activity Assessments at 6-months Post-Surgery: A Prospective Cohort Study. J Athl Train 2021; 57:325-333. [PMID: 35439312 PMCID: PMC9020598 DOI: 10.4085/1062-6050-0407.20] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 11/09/2022]
Abstract
CONTEXT Return to activity(RTA) assessments are commonly administered following ACL-Reconstruction(ACLR) to manage post-operative progressions back to activity. To date, there is little knowledge on the clinical utility of these assessments to predict patient outcomes such as secondary ACL injury once returned to activity. OBJECTIVE To identify what measures of patient function at 6-months post-ACLR best predict return to activity and second ACL injury at a minimum of 2-years following ACLR. DESIGN Prospective-cohort Setting: Laboratory Patients: A total of 234 patients with primary, unilateral ACLR completed functional assessments at approximately 6-months post-ACLR. A total of 192(82%) completed follow-up ≥ 2-years post ACLR. MAIN OUTCOME MEASURES Six-month functional assessments consisted of patient reported outcomes, isokinetic knee flexor and extensor strength, and single-leg hopping. The ability to return to activity and secondary ACL injury were collected at a minimum of two-years following ACLR. RESULTS In patients who did RTA(n=155), a total of 44(28%) individuals had a subsequent ACL injury; graft n=24(15.5%), contralateral ACL n=20(13%). A greater proportion of females had a secondary injury to the contralateral ACL(15/24, 63%) whereas a greater proportion of males reinjured the ipsilateral ACL graft(15/20, 75%, P=.017) Greater knee extension symmetry at 6-months increased the probability of reinjury(B=.016, P=.048). In patients who RTA before 8-months, every 1% increase in quadriceps strength symmetry at 6-months increased the risk of reinjury by 2.1%(B=.021, P=.05). In patients who RTA after 8-months, every month that RTA was delayed reduced the risk of reinjury by 28.4%(B=-284, P=.042). CONCLUSIONS Patients with more symmetric quadriceps strength at 6-months post ACLR were more likely to experience another ACL rupture, especially in those who returned to sport earlier than 8-months after the index surgery. Clinicians should be cognizant that returning high functioning patients to activity earlier than 8-months post-ACLR may place them at an increased risk for reinjury.
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Affiliation(s)
- S G Bodkin
- Department of Physical Medicine and Rehabilitation. University of Colorado Anschutz Medical Campus. Aurora, CO
| | - J Hertel
- Department of Kinesiology. University of Virginia, Charlottesville, VA
| | - D R Diduch
- Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
| | - S A Saliba
- Department of Kinesiology. University of Virginia, Charlottesville, VA
| | - W M Novicoff
- Public Health Sciences, University of Virginia, Charlottesville, VA
| | - S F Brockmeier
- Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
| | - M D Miller
- Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
| | - F W Gwathmey
- Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
| | - B C Werner
- Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
| | - J M Hart
- Department of Kinesiology. University of Virginia, Charlottesville, VA.,Department of Orthopaedic Surgery. University of Virginia, Charlottesville, VA
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Duckett TR, Fox C, Hart JM, Norte GE. Rationale for a Parsimonious Measure of Subjective Knee Function after ACL Reconstruction: A Rasch Analysis. J Athl Train 2021; 56:1340-1348. [PMID: 33626140 DOI: 10.4085/490-20] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation is the most frequently used patient-reported measure of subjective knee function among individuals with ACL reconstruction (ACLR). Yet, limitations with traditional validation approaches leave it unclear whether the IKDC measures knee function as intended. Rasch analysis offers a robust validation approach, which may enhance clinical interpretation of the IKDC. OBJECTIVE 1) To assess the psychometric properties, 2) ability to classify health status, and 3) relationships between the IKDC and objective measures of strength and functional performance relative to a newly proposed reduced-item instrument. DESIGN Cross-sectional. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Seventy-seven individuals with primary, unilateral ACLR (21.9±7.8 years, 6.2±1.0 months post-surgery), and seventy-six age-matched controls. MAIN OUTCOME MEASURE(S) Rasch analysis was used to assess the psychometric properties of the IKDC. Receiver-operator-characteristic curves and logistic regression were used to assess the accuracy of classifying ACLR versus control participants. Correlations (Pearson and Spearman) were used to assess relationships between subjective knee function, quadriceps torque, and single-limb hop performance. RESULTS Rasch analysis aided the development of a reduced 8-item instrument (IKDC-8), which yielded improved psychometric properties in misfit analysis, percent of variance accounted for by one dimension (IKDC-8=71.5%; IKDC=56.7%), and item reliability. The IKDC was an outstanding diagnostic tool and the IKDC-8 was excellent, correctly classifying 87.2% and 82.7% of cases, respectively. The Hanley-McNeil formula found that there was no significant difference in the areas under the respective ROC curves. Equivalent associations between subjective and objective knee function were observed regardless of instrument used. CONCLUSIONS We observed evidence of enhanced reliability and validity for a parsimonious measure of subjective knee function. The proposed instrument reduces the number of items, increases score interpretability as measuring a single construct, and improves the rating scale functioning, while not significantly diminishing its ability to classify ACLR versus control participants or changing existing relationships with objective measures of recovery. We suggest the IKDC-8 may enhance clinical use by reducing administration time, improving the interpretation of the subjective knee function score, and clarifying functional ability.
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Affiliation(s)
- T Ryan Duckett
- University of Toledo, Department of Educational Research and Measurement, Toledo, OH
| | - Christine Fox
- University of Toledo, Department of Educational Research and Measurement, Toledo, OH
| | - Joseph M Hart
- University of Virginia, Kinesiology Department, Sports Medicine Program, Charlottesville, VA
| | - Grant E Norte
- University of Toledo, School of Exercise Science and Rehabilitation, Athletic Training Program, Toledo, OH
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Abstract
CONTEXT The causes of persistent muscle weakness after anterior cruciate ligament reconstruction (ACLR) are not well known. Changes in muscle oxygenation have been proposed as a possible mechanism. OBJECTIVE To investigate changes in quadriceps muscle oxygenation during knee extension in ACLR-involved and ACLR-uninvolved limbs. DESIGN Case-control study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 20 individuals: 10 patients with primary, unilateral ACLR (7 women, 3 men; age = 22.90 ± 3.45 years, height = 170.81 ± 7.93 cm, mass = 73.7 ± 15.1 kg) and 10 matched control individuals (7 women, 3 men; age = 21.50 ± 2.99 years, height = 170.4 ± 10.7 cm, mass = 68.86 ± 9.51 kg). INTERVENTION(S) Each participant completed a single data-collection session consisting of 5-second isometric contractions at 25%, 50%, and 75% of the volitional maximum followed by a 30-second maximal isometric knee-extension contraction. MAIN OUTCOME MEASURE(S) Oxygenated hemoglobin (O2Hb) measures in the reconstructed thigh were continuously recorded (versus the uninvolved contralateral limb as well as the nondominant thigh of healthy control individuals) using 3 wearable, wireless near-infrared spectroscopy units placed superficially to the vastus medialis, vastus lateralis, and rectus femoris muscles. Relative changes in oxygenation were ensemble averaged and plotted for each contraction intensity with associated 90% confidence intervals (CIs). Statistical significance occurred where portions of the exercise trials with confidence intervals on the O2Hb graph did not overlap. Effect sizes (Cohen d, 90% CI) were determined for statistical significance. RESULTS We observed less relative change in O2Hb in patients with ACLR than in healthy control participants in the rectus femoris at 25% (d = 2.1; 90% CI = 1.5, 2.7), 50% (d = 2.8; 90% CI = 2.6, 2.9), and 75% (d = 2.0; 90% CI = 1.9, 2.2) and for the vastus medialis at 75% (d = 1.5; 90% CI = 1.4, 1.5) and 100% (d = 2.6; 90% CI = 2.5, 2.7). Less relative change in O2Hb was also noted for the vastus medialis in ACLR-involved versus ACLR-uninvolved limbs at 100% (d = 2.62; 90% CI = 2.54, 2.70). CONCLUSIONS Quadriceps muscle oxygenation during exercise differed between patients with ACLR versus healthy control individuals. However, not all portions of the quadriceps were affected uniformly across contraction intensities.
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Xie T, Crump KB, Ni R, Meyer CH, Hart JM, Blemker SS, Feng X. Quantitative Relationships Between Individual Lower-Limb Muscle Volumes and Jump and Sprint Performances of Basketball Players. J Strength Cond Res 2020; 34:623-631. [PMID: 31703044 DOI: 10.1519/jsc.0000000000003421] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Xie, T, Crump, KB, Ni, R, Meyer, CH, Hart, JM, Blemker, SS, and Feng, X. Quantitative relationships between individual lower-limb muscle volumes and jump and sprint performances of basketball players. J Strength Cond Res 34(3): 623-631, 2020-Lower body skeletal muscles play an essential role in athletic performance; however, because of the difficulty in obtaining detailed information of each individual muscle, the quantitative relationships between individual muscle volumes and performance are not well studied. The aim of this study was to accurately measure individual muscle volumes and identify the muscles with strong correlations with jump and sprint performance metrics for basketball players. Ten male varsity basketball players and 8 club players were scanned using magnetic resonance imaging (MRI) and instructed to perform various jump and sprint tests. The volumes of all lower-limb muscles were calculated from MRI and normalized by body surface area to reduce the effect of the body size differences. In analysis, feature selection was first used to identify the most relevant muscles, followed by correlation analysis to quantify the relationships between the selected muscles and each performance metric. Vastus medialis and semimembranosus were found to be the most relevant muscles for jump while adductor longus and vastus medialis were selected for sprint. Strong correlations (r = 0.664-0.909) between the selected muscles and associated performance tests were found for varsity players, and moderate correlations (r = -0.203 to 0.635) were found for club players. One possible application is that for well-trained varsity players, a targeted training scheme focusing on the selected muscles may be an effective method to further improve jump and sprint performances.
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Affiliation(s)
| | | | - Renkun Ni
- Springbok, Inc., Charlottesville, VA
| | - Craig H Meyer
- Springbok, Inc., Charlottesville, VA.,Department of Biomedical Engineering, University of Virginia, Charlottesville, VA; and
| | - Joseph M Hart
- Springbok, Inc., Charlottesville, VA.,Department of Kinesiology, University of Virginia, Charlottesville, VA
| | - Silvia S Blemker
- Springbok, Inc., Charlottesville, VA.,Department of Biomedical Engineering, University of Virginia, Charlottesville, VA; and
| | - Xue Feng
- Springbok, Inc., Charlottesville, VA.,Department of Biomedical Engineering, University of Virginia, Charlottesville, VA; and
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Feger MA, Donovan L, Herb CC, Hart JM, Saliba SA, Abel MF, Hertel J. Effects of 4-week impairment-based rehabilitation on jump-landing biomechanics in chronic ankle instability patients. Phys Ther Sport 2020; 48:201-208. [PMID: 33515967 DOI: 10.1016/j.ptsp.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/21/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine effects of 4-weeks of impairment-based rehabilitation on lower extremity neuromechanics during jump-landing. DESIGN Descriptive laboratory study. PARTICIPANTS Twenty-six CAI subjects (age = 21.4 ± 3.1 sex=(M = 7,F = 19), height = 169.0 ± 8.8 cm, weight = 71.0 ± 13.8 kg) completed 15 jump-landing trials prior to and following 12 supervised rehabilitation sessions. MAIN OUTCOME MEASURES Frontal and sagittal lower extremity kinematics and kinetics and sEMG amplitudes (anterior tibialis, peroneus brevis, peroneus longus, and medial gastrocnemius). Means and 90% confidence intervals (CIs) were calculated for 100 ms prior to and 200 ms following ground contact. Areas where pre- and post-rehabilitation CIs did not overlap were considered significantly different. Kinematic and kinetic peaks and kinematic excursion were compared with paired t-test (P ≤ 0.05). RESULTS Following rehabilitation, CAI subjects exhibited less ankle (2.1° (0.8, 3.4), P < 0.01) and hip (2.0° (0.5, 3.7), P = 0.01) frontal plane excursion and lower peak hip abduction (2.5° (0.0, 5.0), P = 0.05). There was less ankle (5.0° (1.7, 8.3), P < 0.01) and knee (3.4° (0.8, 6.0), P = 0.01) sagittal plane excursion following rehabilitation. There was decreased peroneus longus activity from 9 ms to 135 ms post ground contact and decreased peak plantar flexion moment (0.08 N∗m/kg (0.01, 0.13), P = 0.02) following rehabilitation. CONCLUSION Progressive impairment-based rehabilitation resulted in reductions in kinematic excursion and peroneus longus muscle activity, suggesting a more efficient landing strategy.
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Affiliation(s)
- Mark A Feger
- University of Virginia, Department of Kinesiology, USA.
| | - Luke Donovan
- University of North Carolina at Charlotte, Department of Kinesiology, USA
| | - C Collin Herb
- Northern Kentucky University, School of Kinesiology, Counseling & Rehabilitative Sciences, USA
| | - Joseph M Hart
- University of Virginia, Department of Kinesiology, USA; University of Virginia, Department of Orthopedic Surgery, USA
| | | | - Mark F Abel
- University of Virginia, Department of Orthopedic Surgery, USA
| | - Jay Hertel
- University of Virginia, Department of Kinesiology, USA
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Slater LV, Hargrove LJ, Hart JM. Quantifying The Relationship Between Quadriceps Strength And Aerobic Fitness Following Acl Reconstruction. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000669960.13404.ad] [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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Bodkin SG, Dooley EA, Russel SD, Hart JM. Knee Extensor Torque Complexity During A Maximal Voluntary Isometric Contraction Differs Between Acl-reconstructed And Healthy Individuals. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000676220.78820.43] [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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Lesevic M, Kew ME, Bodkin SG, Diduch DR, Brockmeier SF, Miller MD, Gwathmey FW, Werner BC, Hart JM. The Affect of Patient Sex and Graft Type on Postoperative Functional Outcomes After Primary ACL Reconstruction. Orthop J Sports Med 2020; 8:2325967120926052. [PMID: 32637429 PMCID: PMC7313335 DOI: 10.1177/2325967120926052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/29/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Graft choice in anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation may affect strength recovery differently in men than women and therefore affect a timely and successful return to sport. Purpose: To compare knee extensor and flexor strength between men and women who underwent isolated ACLR with either patellar tendon or hamstring tendon (HST) autografts. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 166 patients (87 women, 79 men) with primary unilateral and uncomplicated ACLRs were recruited for participation. A total of 100 patients had bone–patellar tendon–bone (BPTB) autografts and 66 had HST autografts. At 6 months postoperatively, all patients completed the Tegner activity scale and International Knee Documentation Committee Subjective Knee Evaluation as well as underwent bilateral isokinetic (90 deg/s) tests of the knee extensor and flexor groups. Outcomes were recorded in a single session as part of a return-to-sport test battery. Surgical notes were obtained to determine the type of autograft and nerve block used at the time of ACLR. Results: There was a significant sex × graft type interaction for mass-normalized knee flexor torque (P = .017). Female patients with an HST graft had a significantly lower knee flexor torque compared with female patients with a BPTB graft (0.592 ± 0.49 N·m/kg vs 0.910 ± 0.24 N·m/kg; Cohen d [95% CI] = 0.91 [0.45, 1.36]). They also had a significantly lower knee flexor torque when compared with male patients with an HST graft (0.592 ± 0.49 N·m/kg vs 0.937 ± 0.35 N·m/kg; Cohen d [95% CI]= 0.88 [0.45, 1.31]). There were significant main effects for graft type with knee flexion (P = .001) and extension (P = .008) symmetry. Patients with a BPTB graft demonstrated lower knee extensor symmetry (65.7% ± 17.0%) and greater knee flexor symmetry (98.7% ± 18.0%) compared with patients with an HST graft (extension: 77.1% ± 32%, Cohen d [95% CI] = 0.47 [0.16, 0.79]; flexion: 82.9% ± 33.3%, Cohen d [95% CI] = 0.63 [0.31, 0.95]). We also observed a significant main effect for sex (P = .028) and graft type (P = .048) for mass-normalized knee extensor strength. Female participants and patients of either sex with BPTB grafts had lower knee extensor strength compared with male participants and patients with HST grafts, respectively. Conclusion: At approximately 6 months after ACLR, female patients reconstructed with HST autografts demonstrated weaker HST strength compared with female patients with a BPTB autograft. There were no differences in HST strength between graft types in male patients. Female patients appear to be recovering HST strength differently than male patients when using an HST autograft. These findings may have implications in surgical planning, postoperative rehabilitation, and return-to-sport decision making.
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Affiliation(s)
- Milos Lesevic
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Michelle E Kew
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephan G Bodkin
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Joseph M Hart
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.,Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Kew ME, Bodkin SG, Diduch DR, Smith MK, Wiggins A, Brockmeier SF, Werner BC, Gwathmey FW, Miller MD, Hart JM. The Influence of Perioperative Nerve Block on Strength and Functional Return to Sports After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2020; 48:1689-1695. [PMID: 32343596 DOI: 10.1177/0363546520914615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients often have quadriceps or hamstring weakness after anterior cruciate ligament reconstruction (ACLR), despite postoperative physical therapy regimens; however, little evidence exists connecting nerve blocks and ACLR outcomes. PURPOSE To compare muscle strength at return to play in patients who received a nerve block with ACLR and determine whether a specific block type affected subjective knee function. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients were recruited 5 to 7 months after primary, isolated ACLR and completed bilateral isokinetic strength tests of the knee extensor/flexor groups as a single-session return-to-sport test. Subjective outcomes were assessed with the International Knee Documentation Committee (IKDC) score. Strength was expressed as torque normalized to mass (N·m/kg) and limb symmetry index as involved/uninvolved torque. Chart review was used to determine the type of nerve block and graft used. Nerve block types were classified as knee extensor motor (femoral nerve), knee flexor motor (sciatic nerve), or isolated sensory (adductor canal block/saphenous nerve). A 1-way analysis of covariance controlling for graft type was used. RESULTS A total of 169 patients were included. Graft type distribution consisted of 102 (60.4%) ipsilateral bone-patellar tendon-bone (BTB) and 67 (39.6%) ipsilateral hamstring tendon. Nerve block type distribution consisted of 38 (22.5%) femoral, 25 (14.8%) saphenous, 45 (26.6%) femoral and sciatic, and 61 (36.1%) saphenous and sciatic. No significant difference was found in knee extensor strength (P = .113) or symmetry (P = .860) between patients with knee extensor motor blocks (1.57 ± 0.45 N·m/kg; 70.1% ± 15.3%) and those without (1.47 ± 0.47 N·m/kg; 69.6% ± 18.8%). A significant difference was found between patients with knee flexor motor blocks (0.83 ± 0.26 N·m/kg) and those without (0.92 ± 0.27 N·m/kg) for normalized knee flexor strength (P = .21) but not knee flexor symmetry (P = .592). Controlling for graft type, there were no differences in subjective knee function (IKDC score) between all nerve block groups (P = .57). CONCLUSION Our data showed that use of a sciatic nerve block with ACLR in patients with hamstring and BTB grafts influences persistent knee flexor strength deficits at time of return to sports. Although the cause of postoperative muscular weakness is multifactorial, this study adds to the growing body of evidence suggesting that perioperative nerve blocks affect muscle strength and functional rehabilitation after ACLR.
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Affiliation(s)
- Michelle E Kew
- Department of Orthopaedics, University of Virginia, Charlottesville, Virginia, USA
| | - Stephan G Bodkin
- Kinesiology Department, University of Virginia, Charlottesville, Virginia, USA
| | - David R Diduch
- Department of Orthopaedics, University of Virginia, Charlottesville, Virginia, USA
| | - Marvin K Smith
- Memorial Healthcare System, Department of Orthopaedics, Hollywood, Florida, USA
| | - Anthony Wiggins
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Stephen F Brockmeier
- Department of Orthopaedics, University of Virginia, Charlottesville, Virginia, USA
| | - Brian C Werner
- Department of Orthopaedics, University of Virginia, Charlottesville, Virginia, USA
| | - F Winston Gwathmey
- Department of Orthopaedics, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D Miller
- Department of Orthopaedics, University of Virginia, Charlottesville, Virginia, USA
| | - Joseph M Hart
- Kinesiology Department, University of Virginia, Charlottesville, Virginia, USA
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Bodkin SG, Werner BC, Slater LV, Hart JM. Post-traumatic osteoarthritis diagnosed within 5 years following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:790-796. [PMID: 30887068 DOI: 10.1007/s00167-019-05461-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 07/12/2018] [Accepted: 03/01/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose was to calculate the incidence of osteoarthritis in individuals following Anterior Cruciate Ligament Reconstruction (ACLR) in a large, national database and to examine the risk factors associated with OA development. METHODS A commercially available insurance database was queried to identify new diagnoses of knee OA in patients with ACLR. The cumulative incidence of knee OA diagnoses in patients after ACLR was calculated and stratified by time from reconstruction. Odds ratios were calculated using logistic regression to describe factors associated with a new OA diagnosis including age, sex, BMI, meniscus involvement, osteochondral graft use, and tobacco use. RESULTS A total of 10,565 patients with ACLR were identified that did not have an existing diagnosis of OA, 517 of which had a documented new diagnosis of knee OA 5 years after ACL reconstruction. When stratified by follow-up time points, the incidence of a new OA diagnosis within 6 months was 2.3%; within a 1-year follow-up was 4.1%; within 2 years, follow-up was 6.2%, within 3 years, follow-up was 8.4%; within 4 years, follow-up was 10.4%; and within 5 years, follow-up was 12.3%. Risk factors for new OA diagnoses were age (OR 2.44, P < 0.001), sex (OR 1.2, P = 0.002), obesity (OR 1.4, P < 0.001), tobacco use (OR = 1.3, P = 0.001), and meniscal involvement (OR 1.2, P = 0.005). CONCLUSION Approximately 12% of patients presenting within 5 years following ACLR are diagnosed with OA. Demographic factors associated with an increased risk of a diagnosis of PTOA within 5 years after ACLR are age, sex, BMI, tobacco use, and concomitant meniscal surgery. Clinicians should be cognizant of these risk factors to develop risk profiles in patients with the common goal to achieve optimal long-term outcomes after ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Stephan G Bodkin
- Department of Kinesiology, University of Virginia, 210 Emmet St So, PO Box 400407, Charlottesville, VA, 22904, USA.
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Fontaine Research Park, Suite 1100515 Ray C. Hunt Dr., Charlottesville, VA, 22903, USA
| | | | - Joseph M Hart
- Department of Kinesiology, University of Virginia, 210 Emmet St So, PO Box 400407, Charlottesville, VA, 22904, USA.,Department of Orthopaedic Surgery, University of Virginia Health System, Fontaine Research Park, Suite 1100515 Ray C. Hunt Dr., Charlottesville, VA, 22903, USA
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DeJong AF, Koldenhoven RM, Hart JM, Hertel J. Gluteus medius dysfunction in females with chronic ankle instability is consistent at different walking speeds. Clin Biomech (Bristol, Avon) 2020; 73:140-148. [PMID: 31986459 DOI: 10.1016/j.clinbiomech.2020.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/05/2019] [Revised: 12/22/2019] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with chronic ankle instability often present with altered gait mechanics compared to ankle sprain copers. There is increasing evidence to suggest proximal neuromuscular alterations contribute to the injury etiology, however little is known about how these changes manifest during gait. The purpose of this study was to investigate ipsilateral gluteus maximus and medius functional activity ratios throughout treadmill walking at three speeds (preferred, 120% preferred, and 1.35 m per second) in chronic ankle instability patients compared to copers. METHODS 28 females (14 chronic ankle instability, 14 copers) walked at the three gait speeds in randomized order. Ground reaction forces and 10-s gluteal ultrasound clips were simultaneously recorded. Clips were reduced using ground reaction forces to extract 55 measurement frames. Normalized gluteal thickness measures were used to determine functional activity ratios. 2 × 3 analyses of variance were run to assess group and speed effects on gluteal outcomes throughout walking using statistical parametric mapping. Post-hoc t-tests, mean differences, and Cohen's d effect sizes were assessed for significant findings (P ≤ .05). FINDINGS The chronic ankle instability group had significantly decreased gluteus medius activity throughout the entire gait cycle when compared to the coper group, independent of gait speed (P < .001, mean differences: 0.10-0.18; d: 1.00-3.17). There were no significant group or speed main effects, nor an interaction for gluteus maximus activity. INTERPRETATION Gluteal dysfunction throughout walking was identified in chronic ankle instability. The coper group remained within healthy reference muscle activity ranges, suggesting that proximal muscle activation alterations are associated chronic ankle impairments.
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Affiliation(s)
- Alexandra F DeJong
- University of Virginia, Exercise and Sports Injury Lab, 210 Emmet Street South, Charlottesville, VA 22904-4407, USA.
| | - Rachel M Koldenhoven
- Texas State University, Biomechanics/Sports Medicine Lab, 601 University Drive, San Marcos, TX 78666-4616, USA
| | - Joseph M Hart
- University of Virginia, Exercise and Sports Injury Lab, 210 Emmet Street South, Charlottesville, VA 22904-4407, USA
| | - Jay Hertel
- University of Virginia, Exercise and Sports Injury Lab, 210 Emmet Street South, Charlottesville, VA 22904-4407, USA
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Marshall AN, Hertel J, Hart JM, Russell S, Saliba SA. Visual Biofeedback and Changes in Lower Extremity Kinematics in Individuals With Medial Knee Displacement. J Athl Train 2020; 55:255-264. [PMID: 31986103 DOI: 10.4085/1062-6050-383-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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 Increased frontal-plane knee motion during functional tasks, or medial knee displacement, is a predictor of noncontact anterior cruciate ligament injury and patellofemoral pain. Intervention studies that resulted in a reduced risk of knee injury included some form of feedback to address aberrant lower extremity movement patterns. Research on integrating feedback into single-legged tasks and the ability to train 1 task and test another is limited. OBJECTIVE To determine if adding real-time visual biofeedback to common lower extremity exercises would improve single-legged landing mechanics in females with medial knee displacement. DESIGN Cohort study. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-four recreationally active females with medial knee displacement were randomized to a visual-biofeedback group (n = 12; age = 19.75 ± 0.87 years, height = 165.32 ± 8.69 cm, mass = 62.41 ± 8.91 kg) or a control group (n = 12; age = 19.75 ± 0.97 years, height = 166.98 ± 6.89 cm, mass = 59.98 ± 6.24 kg). INTERVENTION(S) Individuals in the feedback group viewed a real-time digital model of their body segments generated by Microsoft Kinect. The skeletal model changed color according to the knee-abduction angle of the test limb during the exercise tasks. MAIN OUTCOME MEASURE(S) Participants completed 3 trials of the single-legged drop vertical jump (SL-DVJ) while triplanar kinematics at the trunk, hip, knee, and ankle were collected via 3-dimensional motion capture. The feedback and control groups completed lower extremity exercises with or without real-time visual biofeedback, respectively. After the intervention, participants completed 3 additional trials of the SL-DVJ. RESULTS At baseline, the feedback group had 3.83° more ankle eversion than the control group after initial contact. After the intervention, the feedback group exhibited 13.03° more knee flexion during the flight phase of the SL-DVJ and 6.16° less knee abduction after initial contact than the control group. The feedback group also demonstrated a 3.02° decrease in peak knee-abduction excursion compared with the baseline values (P = .008). CONCLUSIONS Real-time visual biofeedback immediately improved faulty lower extremity kinematics related to knee-injury risk. Individuals with medial knee displacement adjusted their movement patterns after a single training session and reduced their medial knee motion during a dynamic task.
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Affiliation(s)
- Ashley N Marshall
- Department of Health and Exercise Science, Appalachian State University, Boone, NC
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville.,Department of Orthopedic Surgery, University of Virginia, Charlottesville
| | - Shawn Russell
- Department of Orthopedics and Mechanical Engineering, University of Virginia, Charlottesville
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, Charlottesville
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Slater LV, Blemker SS, Hertel J, Saliba SA, Weltman AL, Hart JM. Sex affects gait adaptations after exercise in individuals with anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2020; 71:189-195. [PMID: 31770661 DOI: 10.1016/j.clinbiomech.2019.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/30/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteoarthritis after anterior cruciate ligament reconstruction has been linked with changes in gait. Individuals with reconstruction demonstrate gait changes after exercise, however there is no information on altered gait after exercise based on sex. The purpose of this study was to examine the association of sex on changes in running gait after exercise in individuals with reconstruction compared to healthy. METHODS Forty females (22 reconstructed) and 22 men (11 reconstructed) ran before and after exercise. Triplanar lower extremity kinematics and kinetics were measured on the involved limb. Data were reduced to 0-100% of gait. Change scores were calculated for each 1% with 90% confidence intervals. Mean differences were calculated for all significant differences. FINDINGS After exercise, females with reconstruction increased knee valgus (1.81°), knee external rotation (2.02°), lateral trunk flexion (1.24°) and trunk rotation (2.15°) compared to healthy females. Females with reconstruction increased knee extension moment (0.07 Nm/kg), knee abduction moment (0.08 Nm/kg), hip extension moment (0.14 Nm/kg) and hip internal rotation moment (0.04 Nm/kg) compared to healthy females. After exercise, males with reconstruction decreased knee varus (-4.83°), hip adduction (-1.99°), and hip internal rotation (-4.44°), however increased lateral trunk flexion (1.94°) compared to healthy males. Males with reconstruction increased knee extension moment (0.07 Nm/kg), knee adduction moment (0.31 Nm/kg), knee internal rotation moment (0.13 Nm/kg), hip flexion moment (0.17 Nm/kg), and hip external rotation moment (0.05 Nm/kg) compared to healthy males. INTERPRETATION Males with reconstruction increased hip loading while women with reconstruction increased trunk motion post-exercise. Sex should be considered when evaluating response to exercise after reconstruction.
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Affiliation(s)
- Lindsay V Slater
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA.
| | - Silvia S Blemker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Arthur L Weltman
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
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Slater LV, Wasserman EB, Hart JM. Trends in Recurrent Anterior Cruciate Ligament Injuries Differ From New Anterior Cruciate Ligament Injuries in College and High School Sports: 2009-2010 Through 2016-2017. Orthop J Sports Med 2019; 7:2325967119883867. [PMID: 31799331 PMCID: PMC6873278 DOI: 10.1177/2325967119883867] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Knee injuries are common and result in extended time missed from sports participation. Little is known regarding the comparative characteristics of recurrent versus first-time anterior cruciate ligament (ACL) injuries sustained during athletic events and how they are influenced by sex, sports participation level, and game-time features. Purpose: To evaluate the characteristics (sex, sports level, and game timing [ie, early vs late in the game]) of recurrent ACL injury in National Collegiate Athletic Association (NCAA) and high school athletes compared with first-time ACL injury. Study Design: Descriptive epidemiology study. Methods: Athletic trainers reported ACL injury occurrences and characteristics for collegiate athletes during the 2009-2010 through 2016-2017 academic years and for high school athletes during the 2011-2012 through 2013-2014 academic years. Logistic regression was used to estimate odds ratios (ORs) and 95% CIs for recurrent versus first-time ACL injury. The number of ACL injuries, proportions, and ORs were calculated by sex, competition level, and time in game played. Results were also classified according to injury mechanism: noncontact, overuse, or surface contact. Results: A total of 705 ACL injuries were reported, including 644 first-time injures and 61 recurrent injuries. When restricting to noncontact ACL injuries, 416 were reported (373 first-time injuries and 43 recurrent injuries). The odds of a recurrent versus new ACL injury in NCAA student-athletes were 4.6 times that of high school student-athletes (95% CI, 1.41-15.24; P = .01). When restricting to noncontact ACL injuries, the odds of a recurrent versus new ACL injury during postseason and preseason were 4.5 and 2.8 times that during the regular season, respectively. Athletes in limited-contact and noncontact sports had greater odds of a recurrent versus new ACL injury compared with athletes playing football and other contact and collision sports. There was no significant difference in the odds of a recurrent ACL injury by sex or time in game. Conclusion: Based on the current study, the odds of recurrent ACL injuries are associated with the level of competition but not associated with sex or timing of game play. Determinants of reinjury after primary ACL reconstruction will help advance care for young injured athletes who continue to participate in competitive sports.
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Affiliation(s)
- Lindsay V Slater
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Erin B Wasserman
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, Indiana, USA
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Kirsch AN, Bodkin SG, Saliba SA, Hart JM. Measures of Agility and Single-Legged Balance as Clinical Assessments in Patients With Anterior Cruciate Ligament Reconstruction and Healthy Individuals. J Athl Train 2019; 54:1260-1268. [PMID: 31618074 DOI: 10.4085/1062-6050-266-18] [Citation(s) in RCA: 5] [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: 12/26/2022]
Abstract
CONTEXT Current clinical assessments used for patients with anterior cruciate ligament reconstruction (ACLR) may not enable clinicians to properly identify functional deficits that have been found in laboratory studies. Establishing muscular-function assessments, through agility and balance tasks, that can properly differentiate individuals with ACLR from healthy, active individuals may permit clinicians to detect deficits that increase the risk for poor outcomes. OBJECTIVE To compare lower extremity agility and balance between patients with ACLR and participants serving as healthy controls. DESIGN Case-control study. SETTING Controlled laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 47 volunteers in 2 groups, ACLR (9 males, 11 females; age = 23.28 ± 5.61 years, height = 173.52 ± 8.89 cm, mass = 70.67 ± 8.89 kg) and control (13 males, 12 females; age = 23.00 ± 6.44, height = 172.50 ± 9.24, mass = 69.81 ± 10.87 kg). MAIN OUTCOME MEASURE(S) Participants performed 3 timed agility tasks: Agility T Test, 17-hop test, and mat-hopping test. Balance was assessed in single-legged (SL) stance in 3 positions (straight knee, bent knee, squat) on 2 surfaces (firm, foam) with the participants' eyes open or closed for 10-second trials. Agility tasks were measured for time to completion. Eyes-open balance tasks were measured using center-of-pressure average velocity, and eyes-closed balance tasks were measured using the Balance Error Scoring System. RESULTS For the Agility T Test, the ACLR group had slower times than the control group (P = .05). Times on the Agility T Test demonstrated moderate to strong positive relationships for unipedal measures of agility. The ACLR group had greater center-of-pressure average velocity in the SL bent-knee position than the control group. No differences were found between groups for the SL straight-knee and SL-squat balance tasks (P > .05). No differences in errors were present between groups for the eyes-closed balance tasks (P > .05). CONCLUSIONS The ACLR group demonstrated slower bipedal agility times and decreased postural stability when assessed in an SL bent-knee position compared with the control group.
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Affiliation(s)
- Aleah N Kirsch
- Exercise and Sports Injury Laboratory, University of Virginia, Charlottesville
| | - Stephan G Bodkin
- Exercise and Sports Injury Laboratory, University of Virginia, Charlottesville
| | - Susan A Saliba
- Exercise and Sports Injury Laboratory, University of Virginia, Charlottesville
| | - Joseph M Hart
- Exercise and Sports Injury Laboratory, University of Virginia, Charlottesville
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Ni R, Meyer CH, Blemker SS, Hart JM, Feng X. Automatic segmentation of all lower limb muscles from high-resolution magnetic resonance imaging using a cascaded three-dimensional deep convolutional neural network. J Med Imaging (Bellingham) 2019; 6:044009. [PMID: 31903406 PMCID: PMC6935014 DOI: 10.1117/1.jmi.6.4.044009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/03/2019] [Indexed: 11/14/2022] Open
Abstract
High-resolution magnetic resonance imaging with fat suppression can obtain accurate anatomical information of all 35 lower limb muscles and individual segmentation can facilitate quantitative analysis. However, due to limited contrast and edge information, automatic segmentation of the muscles is very challenging, especially for athletes whose muscles are all well developed and more compact than the average population. Deep convolutional neural network (DCNN)-based segmentation methods showed great promise in many clinical applications, however, a direct adoption of DCNN to lower limb muscle segmentation is challenged by the large three-dimensional (3-D) image size and lack of the direct usage of muscle location information. We developed a cascaded 3-D DCNN model with the first step to localize each muscle using low-resolution images and the second step to segment it using cropped high-resolution images with individually trained networks. The workflow was optimized to account for different characteristics of each muscle for improved accuracy and reduced training and testing time. A testing augmentation technique was proposed to smooth the segmentation contours. The segmentation performance of 14 muscles was within interobserver variability and 21 were slightly worse than humans.
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Affiliation(s)
- Renkun Ni
- Springbok, Inc., Charlottesville, Virginia, United States
| | - Craig H. Meyer
- University of Virginia, Department of Biomedical Engineering, Charlottesville, Virginia, United States
| | - Silvia S. Blemker
- University of Virginia, Department of Biomedical Engineering, Charlottesville, Virginia, United States
| | - Joseph M. Hart
- University of Virginia, Department of Kinesiology, Charlottesville, Virginia, United States
| | - Xue Feng
- Springbok, Inc., Charlottesville, Virginia, United States
- University of Virginia, Department of Biomedical Engineering, Charlottesville, Virginia, United States
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Peebles AT, Ford KR, Taylor JB, Hart JM, Sands LP, Queen RM. Using force sensing insoles to predict kinetic knee symmetry during a stop jump. J Biomech 2019; 95:109293. [DOI: 10.1016/j.jbiomech.2019.07.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 11/28/2022]
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Norte GE, Solaas H, Saliba SA, Goetschius J, Slater LV, Hart JM. The relationships between kinesiophobia and clinical outcomes after ACL reconstruction differ by self-reported physical activity engagement. Phys Ther Sport 2019; 40:1-9. [PMID: 31421282 DOI: 10.1016/j.ptsp.2019.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To investigate whether relationships between kinesiophobia, lower extremity function, and patient-reported function differ by self-reported physical activity engagement after ACL reconstruction (ACLR). DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Seventy-seven patients with a primary, unilateral ACLR. MAIN OUTCOME MEASURES Kinesiophobia (TSK-17) was the primary outcome. Lower extremity function included quadriceps and hamstrings strength, fatigue, and hop performance. Patient-reported function included regional function (IKDC, KOOS subscales) and physical activity engagement (Godin Leisure-Time Exercise). Patients were evaluated together, then stratified by LOW and HIGH physical activity. Correlations and multiple regression analyses identified relationships between kinesiophobia and outcome measures. RESULTS Greater kinesiophobia was associated with lesser hamstrings strength, hop performance, and patient-reported function. Greater hamstrings fatigue and lesser KOOSADL explained greater kinesiophobia in patients reporting LOW physical activity. Lesser triple hop symmetry, crossover hop distance, and IKDC explained greater kinesiophobia in patients reporting HIGH physical activity. CONCLUSIONS Greater kinesiophobia associated with worse outcomes after ACLR. Relationships differed by self-reported physical activity engagement. Interventions that improve the ability to perform knee-related activities of daily living may be appropriate to minimize the impact of fear in less active patients, while those targeting hop performance and knee-related sport activities may be better suited for more active patients.
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Affiliation(s)
- Grant E Norte
- University of Toledo, School of Exercise and Rehabilitation Sciences, Athletic Training Program, 2801 W. Bancroft St.Health and Human Services 2505H, Mail Stop 119, Toledo, OH, 43606, United States.
| | - Haley Solaas
- University of Virginia, Kinesiology Department, Sports Medicine Program, 210 Emmet Street North, Memorial Gymnasium, 209 PO Box 400407, Charlottesville, VA, 22904, United States.
| | - Susan A Saliba
- University of Virginia, Kinesiology Department, Sports Medicine Program, 210 Emmet Street North, Memorial Gymnasium, 209 PO Box 400407, Charlottesville, VA, 22904, United States; University of Virginia, Department of Orthopedic Surgery, Sports Medicine Division, 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, Charlottesville, VA, 22908, United States.
| | - John Goetschius
- Adrian College Exercise Science & Athletic Training Department, 110 S. Madison Street Merillat 209, Adrian, MI, 49221, United States.
| | - Lindsay V Slater
- Shirley Ryan AbilityLab, Neuromechanics of Impaired Locomotion Lab, 355 East Erie, Chicago, IL, 60611, United States.
| | - Joseph M Hart
- University of Virginia, Kinesiology Department, Sports Medicine Program, 210 Emmet Street North, Memorial Gymnasium, 209 PO Box 400407, Charlottesville, VA, 22904, United States; University of Virginia, Department of Orthopedic Surgery, Sports Medicine Division, 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, Charlottesville, VA, 22908, United States.
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Fraser JJ, Hart JM, Saliba SF, Park JS, Tumperi M, Hertel J. Multisegmented ankle-foot kinematics during gait initiation in ankle sprains and chronic ankle instability. Clin Biomech (Bristol, Avon) 2019; 68:80-88. [PMID: 31174142 DOI: 10.1016/j.clinbiomech.2019.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/09/2018] [Revised: 01/09/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with lateral ankle sprain and chronic ankle instability have impaired postural control and altered motor strategies during walking. However, little is known regarding foot mechanics during gait. The purpose of this study was to compare three-dimensional multisegmented ankle-foot kinematics during stance phase following gait-initiation in acute lateral ankle sprain (Ankle-sprain), chronic ankle instability (Chronic-instability), Coper, and Control groups. METHODS 80 recreationally-active individuals (Control: n = 22, Coper: n = 21, Ankle-sprain: n = 17, Chronic-instability: n = 20) participated. Three-dimensional kinematics of the hallux, medial forefoot, lateral forefoot, medial midfoot, lateral midfoot, and rearfoot on shank were collected during the stance phase following gait initiation using an electromagnetic motion capture system. The average joint excursions of 10 steps were normalized to 101 points and analyzed using Statistical Parametric Mapping ANOVA and post hoc t-tests comparing Coper, Ankle-sprain, or Chronic-instability versus Control groups. Secondary analysis was performed comparing Chronic-instability versus Coper groups. FINDINGS The Ankle-sprain group had up to 4.1° more rearfoot inversion during midstance (mean difference: 3.1°) from 42 to 49% of stance phase compared to healthy controls. The Chronic-instability group had up to 5.3° more rearfoot inversion (mean difference: 3.6°) from 34% to 91% of stance phase compared to controls. There were no further statistical differences found between Chronic-instability and Copers, other planes, or segments of the ankle-foot complex. INTERPRETATION Ankle-sprain and Chronic-instability groups demonstrated more rearfoot inversion compared to controls with no differences in midfoot or forefoot mechanics. Clinicians and researchers should include interventions that control inversion and increase eversion following lateral ankle sprain.
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Affiliation(s)
- John J Fraser
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA; Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA.
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA; Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Susan F Saliba
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Marshall Tumperi
- Department of Mechanical & Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA; Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
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Erdman NK, Jimenez J, Buckley TA, Howell DR, Hart JM, Resch JE. The Test-Retest Reliability of a Clinically-Relevant Dual-Task Assessment in Healthy College Students. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
The dual-task (DT) paradigm consists of concurrent administration of motor and cognitive tasks which may demonstrate improved measurement properties of the included tasks as compared to independent administration. Our study examined the test-retest reliability of a clinically-relevant DT assessment.
Methods
Our prospective cohort study included 60 (53.3% female) healthy, recreationally active college students (Age=20.5–1.34 years; Height=171.7–9.33 cm). Participants completed the Standardized Assessment of Concussion (SAC) and timed tandem gait (TTG) test concurrently for the DT assessment at two time points separated by a two-week test-retest interval. The SAC composite score (45 points) was calculated by summing the domain scores of immediate memory (30 points) which consisted of a 10-word list, concentration (5 points), and delayed recall (10 points). The TTG composite score was calculated by summing the mean time to complete the TTG during each SAC task (3 trials for immediate memory, up to 5 trials for the digits-backwards task, and one trial for the months in reverse order and delayed recall tasks). Mixed-model intraclass correlation coefficients (ICC[3,1]) with 95% confidence intervals were calculated to evaluate test-retest reliability between time points for the SAC and TTG composite scores.
Results
Mean SAC (39.4–3.80 vs. 39.6–3.49 points) and TTG (52.1–9.44 vs. 48.2–8.33 sec) composite scores were observed at time points 1 and 2, respectively. Moderate (ICC[3,1]=0.56 [0.26, 0.74]) and good (ICC[3,1]=0.88 [0.80, 0.93]) test-retest reliability were observed for the SAC and TTG composite scores, respectively.
Conclusion
Test-retest reliability for our DT assessment aligns with previously established values for independent administration of the SAC and TTG.
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Feng X, Xie T, Meyer C, Blemker S, Hart JM. Quantitative Impact Of Individual Lower Limb Muscle Volumes On Athletic Performances. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562415.99000.fe] [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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Bodkin SG, Rutherford MH, Brockmeier SF, Diduch DR, Hart JM. Return To Play Testing In Individuals With ACL-Reconstructed Knees: Does Timing Of The Assessment Matter? Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563110.08690.54] [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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Hart JM, Mandalapu V, Bodkin S, Lach J, Homdee N, Gong J. Wearable Sensor-based Classification Of ACL Reconstructed Limbs During Exercise In Male And Female Patients. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561882.22658.e0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Mangum LC, Glaviano NR, Hryvniak D, Hart JM, Hertel J, Saliba SA. Muscle Thickness And Strength Relationships In Patients With Patellofemoral Pain Before And After Rehabilitation. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562030.05350.bf] [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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Bodkin SG, Norte GE, Hart JM. Corticospinal excitability can discriminate quadriceps strength indicative of knee function after ACL-reconstruction. Scand J Med Sci Sports 2019; 29:716-724. [PMID: 30672626 DOI: 10.1111/sms.13394] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/10/2019] [Accepted: 01/16/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate relationships between quadriceps strength and neural activity, and to establish a clinical threshold of corticospinal excitability able to discriminate between patients with quadriceps strength indicative of satisfactory and unsatisfactory knee function after ACLR. METHODS A total of 29 patients following primary, unilateral ACL-reconstruction (11 female, 23.2 ± 8.1 years of age, 7.3 ± 2.5 months since surgery) participated. Subjective knee function was quantified using the International Knee Documentation Committee (IKDC) subjective evaluation. Peak isokinetic knee extensor torque was assessed at 90°/s. Quadriceps corticospinal excitability was quantified via active motor threshold (AMT, %2-Tesla) using transcranial magnetic stimulation during a 5% maximal voluntary isometric contraction of the quadriceps. Pearson's r correlations were used to assess the relationship between peak knee extensor torque and AMT. Receiver operating characteristic (ROC) curves were used to establish a threshold of (a) mass-normalized peak knee extensor torque to discriminate satisfactory knee function (IKDC ≥ 75.9%), and (b) AMT to discriminate quadriceps strength indicative of satisfactory knee function. Likelihood ratios (LR) and the magnitude of change in pre-post-test probability were calculated for each threshold. RESULTS Active motor threshold was negatively correlated with mass-normalized peak knee extensor torque (r = -0.503, P = 0.005). Knee extensor torque ≥1.23 Nm/kg was an excellent discriminator of satisfactory knee function (AUC = 0.890, P = 0.002; (+)LR = 9.56). An AMT ≤50.5% was an excellent discriminator of quadriceps strength indicative of satisfactory knee function following ACLR (AUC = 0.839, P = 0.005; (+)LR = 23.75). CONCLUSION Lower corticospinal excitability was associated with lower quadriceps strength. An AMT above 50.5% was found to decrease the probability of having satisfactory knee strength by over 62%.
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Affiliation(s)
- Stephan G Bodkin
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Grant E Norte
- School of Exercise and Rehabilitation, University of Toledo, Toledo, Ohio
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
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Glaviano NR, Marshall AN, Mangum LC, Hart JM, Hertel J, Russell S, Saliba SA. Impairment-Based Rehabilitation With Patterned Electrical Neuromuscular Stimulation and Lower Extremity Function in Individuals With Patellofemoral Pain: A Preliminary Study. J Athl Train 2019; 54:255-269. [PMID: 30721093 DOI: 10.4085/1062-6050-490-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/28/2023]
Abstract
CONTEXT Patellofemoral pain (PFP) is a chronic condition that presents with lower extremity muscle weakness, decreased flexibility, subjective functional limitations, pain, and decreased physical activity. Patterned electrical neuromuscular stimulation (PENS) has been shown to affect muscle activation and pain after a single treatment, but its use has not been studied in a rehabilitation trial. OBJECTIVE To determine the effects of a 4-week impairment-based rehabilitation program using PENS on subjective function, pain, strength, range of motion, and physical activity in individuals with PFP. DESIGN Randomized controlled trial. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 21 patients with PFP (5 males, 16 females; age = 23.4 ± 7.6 years, height = 168.0 ± 7.5 cm, mass = 69.0 ± 19.5 kg). INTERVENTION(S) Participants completed a 4-week supervised rehabilitation program in conjunction with random assignment to receive PENS or sham treatments. MAIN OUTCOME MEASURE(S) Subjective function, pain, strength, range of motion, and physical activity levels were assessed prerehabilitation and postrehabilitation. Subjective function and pain were also assessed at 6 and 12 months postrehabilitation. Repeated-measures analyses of variance and Tukey post hoc testing were conducted with α ≤ .05. We calculated Cohen d effect sizes with 95% confidence intervals. RESULTS Both groups had statistically and clinically meaningful differences in subjective function, pain, strength, range of motion, and activity level after 4 weeks of impairment-based rehabilitation. Improved subjective function was observed in both groups at 6 and 12 months after the interventions. The PENS group had improvements in current pain for all 3 postrehabilitation times compared with baseline measures. CONCLUSIONS An impairment-based intervention effectively improved subjective function, pain, strength, range of motion, and physical activity levels in individuals with PFP. Participants who received PENS in addition to the rehabilitation program had improved current pain at 6 and 12 months postrehabilitation compared with baseline scores. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02441712.
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Affiliation(s)
- Neal R Glaviano
- College of Health and Human Services, School of Exercise and Rehabilitation Sciences, University of Toledo, OH
| | - Ashley N Marshall
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ
| | - L Colby Mangum
- College of Health Professions and Sciences, University of Central Florida, Orlando
| | - Joseph M Hart
- Department of Orthopedic Surgery, University of Virginia, Charlottesville
| | - Jay Hertel
- Department of Orthopedic Surgery, University of Virginia, Charlottesville
| | - Shawn Russell
- Department of Orthopedic Surgery, University of Virginia, Charlottesville
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, Charlottesville
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Williamson CL, Norte GE, Broshek DK, Hart JM, Resch JE. Return to Learn After Sport-Related Concussion: A Survey of Secondary School and Collegiate Athletic Trainers. J Athl Train 2018; 53:990-1003. [PMID: 30398928 DOI: 10.4085/1062-6050-234-17] [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: 01/11/2023]
Abstract
CONTEXT Recent recommendations have emphasized return-to-learn (RTL) protocols to aid athletes in recovery from sport-related concussion (SRC) but have been based primarily on anecdotal evidence. OBJECTIVE To investigate the RTL practices of certified athletic trainers (ATs) after an SRC. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS A total of 1083 individuals (27%) from a random sample of 4000 ATs in the National Athletic Trainers' Association membership database completed an electronic survey. Participants consisted of 729 self-identified secondary school ATs (SSATs; 67.3%; experience = 14.0 ± 9.7 years) and 354 self-identified collegiate ATs (CATs; 32.7%; experience = 13.4 ± 9.7 years). MAIN OUTCOME MEASURE(S) We used χ2 analyses to assess respondent differences related to current knowledge, current practices, and available resources. Independent t tests were used to compare SSATs and CATs on years of certification and annual number of SRCs evaluated. RESULTS Of our total respondents, 41.2% (n = 446) correctly indicated the absence of evidence-based RTL guidelines. Whereas most (73.9%, n = 800) respondents had an established RTL policy, only 38.1% (n = 413) used such guidelines in their clinical practice. Most (97.1%, n = 708) SSATs and 82.2% (n = 291) of CATs had access to (a) mental health professional(s); however, minorities of SSATs (21.4%, n = 156) and CATs (37.0%, n = 131) never accessed these resources to care for concussed student-athletes. CONCLUSIONS Our results suggested that, despite the absence of empirical evidence, most surveyed ATs incorporated some form of RTL protocol in their SRC management policy. The varying AT knowledge, clinical practices, and resources highlighted by our results should be considered when creating or refining an RTL protocol.
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Affiliation(s)
- Chelsea L Williamson
- Department of Kinesiology, Sports Medicine Program Area, University of Virginia, Charlottesville
| | - Grant E Norte
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville
| | - Donna K Broshek
- School of Exercise and Rehabilitation Sciences, Athletic Training Program, University of Toledo, OH
| | - Joseph M Hart
- Department of Kinesiology, Sports Medicine Program Area, University of Virginia, Charlottesville
| | - Jacob E Resch
- Department of Kinesiology, Sports Medicine Program Area, University of Virginia, Charlottesville
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