Gastrocnemius Strength Research Articles

Construction and validation of a nomogram model for predicting different sites of ankle pain in runners with chronic ankle instability

This study aimed to establish a risk prediction nomogram model for anterolateral, mediolateral, and posterolateral ankle pain in runners with chronic ankle instability (CAI) and analyse the potential risk factors for pain at different ankle sites. Thirty recreational runners with CAI who reported ankle pain in the anterolateral, mediolateral, or posterolateral regions were recruited for this study. Kinematic, kinetic, and electromyographic data during running were collected using motion capture system, 3-D force platform, and surface electromyography system. These data were used to generate a dynamic nomogram. The results showed that anterolateral ankle pain in runners with CAI may be caused by insufficient gastrocnemius muscle strength (OR 0.85, 95% CI 0.73–0.97), excessive ground reaction force (GRF, OR 2.64, 95% CI 1.25–6.22), and an increased percentage of ankle energy absorption (OR 9.11, 95% CI 1.50–77.79). Mediolateral ankle pain might be contributed by greater ankle inversion angle (OR 1.08, 95% CI 1.01–1.00) and GRF (OR 2.13, 95% CI 1.17–4.31). Moreover, posterolateral ankle pain was predicted by increased ankle adduction angle (OR 1.06, 95% CI 1.00–1.12), increased GRF (OR 2.16, 95% CI 1.07–4.80), and decreased dynamic stability (OR 0.20, 95% CI 0.05–0.68). To prevent ankle pain, runners with CAI should be encouraged to focus on improving the neuroreceptor sensitivity of the gastrocnemius muscles, and retraining their energy absorption patterns.

Determinants of Achilles tendon thickness and their influence on knee function and foot alignment in knee osteoarthritis

Knee osteoarthritis (OA) significantly impacts the quality of life of individuals globally. However, the interconnections between Achilles tendon thickness, knee symptoms/functions, and foot alignment remain understudied in knee OA patients. This study determines the relationships between Achilles tendon thickness (ATT), knee symptoms/functions, and foot alignment in knee OA patients, considering their interconnected biomechanical nature. In a cross-sectional analysis involving 122 knee OA patients, Knee injury and Osteoarthritis Outcome Score (KOOS) assessed knee function and symptoms. Forefoot, midfoot, and rearfoot alignment were measured using hallux valgus angle, navicular/foot ratio, and rearfoot angle. The navicular/foot ratio represented the ratio of navicular height to total foot length. ATT was measured using a digital calliper. Pearson correlations and stepwise multiple linear regression models were employed to explore relationships and determinants. Out of 122 participants, 88 (72.1%) were females. ATT correlated significantly with ankle range of motion, forefoot alignment, and midfoot alignment. In stepwise multivariable regression, ankle range of motion, navicular/foot ratio, and age were significantly associated with ATT (adjusted R2 = 0.44). Similarly, KOOS-Symptoms scores were linked to the OA severity, navicular/foot ratio, ankle range of motion, gastrocnemius strength, and age (adjusted R2 = 0.22). KOOS-Function scores were significantly associated with knee OA severity, gastrocnemius strength, ankle range of motion, and age (adjusted R2 = 0.19). Midfoot alignment was significantly associated with ATT and knee symptoms in patients with Knee OA. This suggests potential benefits of interventions targeting both Achilles tendon properties and foot alignment for improved knee OA outcomes.

[Translated article] Medial gastrocnemius proximal fasciotomy in patients with chronic plantar fasciitis: A systematic review

IntroductionPlantar fasciitis is the main cause of heel pain in middle-aged patients. In chronic cases, limited ankle dorsiflexion caused by isolated gastrocnemius contracture is considered the main risk factor for suffering it. Therefore, in recent years the number of patients operated on by proximal fasciotomy of the medial gastrocnemius (FPGM) has increased to treat chronic plantar fasciitis. Material and methodsSystematic review following the PRISMA guidelines. We have carried out a bibliographic search in Pubmed, Science Direct, Cochrane Library and Web of Science databases. One hundred and eighty-four articles were found. Data extraction was performed using the Covidence software, and a quality and risk of bias analysis of the included articles was performed based on the Cochrane risk of bias Tool 2.0. ResultsThree articles were included in the review: two randomised clinical trials and one cohort study with a total of 138 patients. In the analysed studies, patients after proximal fasciotomy of the medial gastrocnemius showed significant improvements in pain and in the AOFAS score with high levels of patient satisfaction. Increases in ankle dorsiflexion angle were found after 12 months of follow-up, with no loss of gastrocnemius strength. The complication rate was low and fewer occurred in the proximal fasciotomy compared to plantar fasciotomy. ConclusionProximal fasciotomy of the medial gastrocnemius provides clinical benefit in patients with chronic plantar fasciitis, with a low probability of complications and high patient satisfaction.

Fasciotomía proximal de gemelo interno en pacientes con fascitis plantar crónica: una revisión sistemática

IntroductionPlantar fasciitis is the main cause of heel pain in middle-aged patients. In chronic cases, limited ankle dorsiflexion caused by isolated gastrocnemius contracture is considered the main risk factor for suffering it. Therefore, in recent years the number of patients operated on by proximal fasciotomy of the medial gastrocnemius (FPGM) has increased to treat chronic plantar fasciitis. Material and methodsSystematic review following the PRISMA guidelines. We have carried out a bibliographic search in Pubmed, Science Direct, Cochrane Library and Web of Science databases. One hundred and eighty-four articles were found. Data extraction was performed using the Covidence software, and a quality and risk of bias analysis of the included articles was performed based on the Cochrane risk of bias Tool 2.0. ResultsThree articles were included in the review: two randomized clinical trials and one cohort study with a total of 138 patients. In the analyzed studies, patients after proximal fasciotomy of the medial gastrocnemius showed significant improvements in pain and in the AOFAS score with high levels of patient satisfaction. Increases in ankle dorsiflexion angle were found after 12 months of follow-up, with no loss of gastrocnemius strength. The complication rate was low and fewer occurred in the proximal fasciotomy compared to plantar fasciotomy. ConclusionProximal fasciotomy of the medial gastrocnemius provides clinical benefit in patients with chronic plantar fasciitis, with a low probability of complications and high patient satisfaction.

Efgartigimod restores muscle function in a humanized mouse model of immune-mediated necrotizing myopathy.

Immune-mediated necrotizing myopathies (IMNMs) are severe forms of myositis often associated with pathogenic anti-3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) autoantibodies (aAbs). Efgartigimod is an engineered human IgG1 Fc fragment that antagonizes the neonatal Fc receptor (FcRn), thereby preventing recycling and promoting lysosomal degradation of IgG, including aAbs. We evaluated the therapeutic effects of IgG reduction by efgartigimod in a humanized murine model of IMNM. Disease was induced in C5-deficient (C5def) or Rag2-deficient (Rag2-/-) mice receiving co-injections of anti-HMGCR+ IgG from an IMNM patient and human complement. C5def mice were treated in a preventive setting with s.c. injections of efgartigimod and Rag2-/- mice in a curative setting after disease was induced by anti-HMGCR+ IgG injections. Anti-HMGCR aAbs levels were monitored in mouse serum and muscle tissue. Histological analysis was performed on muscle sections. Muscle force was assessed by grip test or measurement of gastrocnemius strength upon electrostimulation. Administration of efgartigimod rapidly reduced total IgG levels, including the level of pathogenic anti-HMGCR aAbs, in both serum (P < 0.0001) and muscle (P < 0.001). In the preventive setting, efgartigimod prevented myofibre necrosis (P < 0.05), thus precluding loss of muscle strength (P < 0.05). In the therapeutic setting, efgartigimod prevented further necrosis and allowed muscle fibre regeneration (P < 0.05). Hence, muscle strength returned to normal (P < 0.01). Efgartigimod reduces circulating IgG levels, including pathogenic anti-HMGCR+ IgG aAbs, in a humanized mouse model of IMNM, preventing further necrosis and allowing muscle fibre regeneration. These results support investigating the therapeutic efficacy of efgartigimod through a clinical trial in IMNM patients.

Calcium pyrophosphate deposition disease mimicking spinal neuroarthropathy.

A 75-year-old male with degenerative joint disease status-post T12-L5 fusion five years ago presented with new-onset left lower extremity weakness. He denied any sensory abnormalities, saddle anaesthesia, or dysfunction of the bladder or bowels. Physical examination was notable for 2/5 left quadriceps and gastrocnemius strength, compared with 5/5 on the right side. CT scan shows erosion and sclerosis of the T10 and T11 end plates with gas within the disk space, consistent with Charcot spinal neuroarthropathy (Fig. 1A). Due to the persistent neurological deficits, the epidural mass was resected and a dural patch graft was placed. Histopathology revealed fibrocartilaginous tissue fragments with degenerative changes and deposition of positively birefringent crystals consistent with calcium pyrophosphate deposition disease (CPPD) (Fig. 1B). One month after resection, the patient’s lower extremity weakness had fully resolved. CPPD can mimic many joint pathologies, including gout and osteoarthritis, in atypical locations. In this case, the radiographic appearance of destruction, debris, distention, disorganization, and density changes resembled Charcot neuroarthropathy but in an unexpected location without the typical antecedent sensory neuropathy [1]. This case illustrates that, when radiographic evidence seems to contradict clinical signs and symptoms of joint disease, clinicians should reserve a high index of suspicion for CPPD [2]. Informed consent has been obtained.

Homemade pin-hook for surgical treatment of posterior cruciate ligament avulsion fractures

BackgroundHow to treat the posterior cruciate ligament (PCL) tibial insertion small and comminuted avulsion fracture is still challenging. Our study evaluated the clinical and radiological outcomes after ORIF of PCL tibial insertion avulsion fractures through the inverted L-shaped postero-medial approach using a homemade pin-hook.MethodsBetween January 2009 and December 2020, twenty-four patients with isolated PCL tibial insertion bony avulsion were enrolled. There were 16 males and 8 females. The age range was 18-48 (32.5 ± 9.3) years. The time from injury to surgery was 1-10 (4.4 ± 2.8) days. There were 11 cases in the left knee and 13 cases in the right knee. The patients received anticoagulant therapy to prevent thrombosis. Preoperative standard X-ray, computerized tomography (CT) and magnetic resonance imaging (MRI) were performed. According to the Meyers-McKeever classification, there were 8 cases of type II and 16 cases of type III.ResultsThe operation time was 60-120 (89.6 ± 19.8) min. Postoperative follow-up ranged from 3 to 18 months. The average follow-up was 11.4 ± 4.3 months. In all patients, one or two homemade pin-hooks were used to fix different sizes of fracture segments. X-ray or CT scans taken after surgery revealed fracture union. The fractures healed in 9-16 (11.8 ± 1.7) weeks. At the last follow-up, the patients were able to fully straighten. The ROM (132.6° ± 3.9°), the Tegner-Lysholm score (96.2 ± 2.3) and the IKDC scores (95.5 ± 1.6) were all significantly improved compared with the preoperative values (77.5° ± 13.1°, 46.8 ± 8.9, 36.2 ± 7.9). The posterior drawer test was negative. The gastrocnemius muscle strength did not diminish. No internal fixation migration was observed during the follow-up. No neurovascular bundle- or hardware-related complications were reported.ConclusionsThe inverted L-shaped postero-medial approach with homemade pin-hook fixation for the treatment of PCL avulsion fractures produces acceptable clinical and radiological results. Moreover, the homemade pin-hook made of K-wires is affordable and reduces patient costs. It is a practical application and worth recommending, especially for community hospitals.

Prevention of muscle atrophy in ICU patients without nerve injury by neuromuscular electrical stimulation: a randomized controlled study

BackgroundExtensive muscle atrophy is a common occurrence in orthopaedics patients who are bedridden or immobilized. The incidence is higher in intensive care unit (ICU) inpatients. There is still controversy about how to use neuromuscular electrical stimulation (NMES) in ICU patients. We aim to compare the effectiveness and safety of NMES to prevent muscle atrophy in intensive care unit (ICU) patients without nerve injury.MethodsICU patients without central and peripheral nerve injury were randomized into experimental group I (Exp I: active and passive activity training (APAT) + NMES treatment on the gastrocnemius and tibialis anterior muscle), experimental group II (Exp II: APAT + NMES treatment on gastrocnemius alone), and control group (Ctl: APAT alone). Changes in the strength of gastrocnemius, the ankle range of motion, and the muscle cross-section area of the lower leg were evaluated before and after the intervention. Also, changes in prothrombin time, lactic acid, and C-reactive protein were monitored during the treatment.ResultsThe gastrocnemius muscle strength, ankle joint range of motion, and cross-sectional muscle area of the lower leg in the three groups showed a downward trend, indicating that the overall trend of muscle atrophy in ICU patients was irreversible. The decrease in gastrocnemius muscle strength in Exp I and Exp II was smaller than that in the control group (P < 0.05), but there was no difference between Exp I and Exp II. The decrease in active ankle range of motion and cross-sectional area of the lower leg Exp I and Exp II was smaller than that in the control group (P < 0.05), and the decrease in Exp I was smaller than that of Exp II (all P < 0.05). The curative effect in Exp I was better than in Exp II. There were no significant differences in the dynamic changes of prothrombin time, lactic acid, and C-reactive protein during the three groups (P > 0.05).ConclusionIn addition to early exercise training, NMES should be applied to prevent muscle atrophy for patients without nerve injury in ICU. Also, simultaneous NMES treatment on agonist/antagonist muscle can enhance the effect of preventing muscle atrophy.Trial registrationThis study was prospectively registered in China Clinical Trial Registry (www.chictr.org.cn) on 16/05/2020 as ChiCTR2000032950.

Open reduction and internal fixation of the tibial avulsion fracture of the posterior cruciate ligament: which is better, a hollow lag screw combined with a gasket or a homemade hook plate?

ObjectiveTo compare the clinical results of homemade hook plates and hollow lag screws combined with spacers in the treatment of posterior cruciate tibial ligament avulsion fractures.Materials and methodsThis was a retrospective clinical cohort study that included 64 patients with PCL tibial avulsion fractures. Thirty-two of them were fixed with a homemade hook plate (hook plate group), and 32 were fixed with a hollow lag screen combined with a gasket (hollow lag screen group). By reviewing the medical record data and follow-up results, the operation time, postoperative drainage, fracture healing time, surgical complications, knee mobility, recovery of joint function, and whether postoperative gastrocnemius muscle strength changed in the two groups were compared.ResultsAll patients had successful wound and fracture healing. No adverse events, such as bone nonunion, infection, wound haematoma, or joint stiffness, occurred in either group. There were no patients with decreased gastrocnemius muscle strength in either group. Internal fixation failure occurred in 2 cases in the hollow lag screen group but not in the hook plate group. There were no significant differences between the two groups in terms of operative time, postoperative drainage, fracture healing time, knee mobility at the last follow-up, or Lysholm score.ConclusionIt is safe and effective to use a homemade hook plate to fix PCL tibial avulsion fractures through an inverted L-shaped posterior medial approach. A homemade hook plate may have potential advantages over a hollow lag screen combined with gasket fixation.

Outcomes of tibial avulsion fracture of the posterior cruciate ligament treated with a homemade hook plate

ObjectiveTo compare the clinical effects of an inverted L-shaped postero-medial approach with a homemade hook plate and arthroscopic fixation with Endobutton for tibial avulsion fractures of the posterior cruciate ligament. MethodsThe clinical data of 36 patients with PCL tibial avulsion fractures from January 2012 to December 2019 were analyzed retrospectively. The fractures were classified into Meyers-McKeever types II and III. Among them, 20 cases were treated with a homemade hook plate through an inverted L-shaped postero-medial approach (incision group), and 16 cases were treated with Endobutton under arthroscopy (arthroscopic group). The operative time, fracture union time, operative complications and range of motion of the knee joint were compared between the two groups. The stability of the knee joint was tested by the posterior drawer test, the functional recovery of the knee joint was evaluated by the Lysholm score, and the gastrocnemius muscle strength of the incision group was tested by performing heel raises with a single leg stance. ResultsThere were no adverse events, such as fracture nonunion, infection, deep-vein thrombosis, abnormal hematoma or joint stiffness, in either group. The operative time was shorter in the incision group, and the difference was statistically significant (P < 0.05). There was no significant difference in fracture union time between the two groups (P > 0.05). At the last follow-up, there was no significant difference in range of motion or the Lysholm score between the two groups. There was no decrease in gastrocnemius muscle strength in the incision group. ConclusionsThe fixation of PCL tibial avulsion fractures with a homemade hook plate through an inverted L-shaped postero-medial approach is safe and effective. It showed almost the same satisfactory outcomes as arthroscopic Endobutton fixation.

Improvements in Muscle Strength Are Associated With Improvements in Walking Capacity in Young Children With Cerebral Palsy: A Secondary Analysis.

To evaluate whether changes in lower-limb muscle strength explain changes in walking capacity during 14-week periods of usual care, power training and follow-up for children with spastic cerebral palsy. Secondary analysis of a previously conducted double-baseline controlled trial of 22 children with spastic cerebral palsy. Generalized estimating equations were used to evaluate the relationships between within-subject changes in isometric muscle strength and walking capacity over 3 periods. Changes in hip abductor strength were associated with changes in the Muscle Power Sprint Test, changes in gastrocnemius and hip abductor strength were associated with changes in the Shuttle Run Test, and changes in gastrocnemius strength were associated with changes in the 1-minute walk test. All associations supported better walking capacity with increased strength. Walking capacity, especially sprint capacity, can be improved by increasing strength by functional power training in this population.

Biomechanically-Informed Training: The Four Pillars for Knee and ACL Injury Prevention Built Upon Behavior Change and Motivation Principles

Injury prevention frameworks are critical for preventing musculoskeletal injury and improving rehabilitation outcomes. However, their relative successes in translation arguably rely on two interlinked components: (1) the quality of the empirical evidence used to develop the intervention (content), and (2) the effective application of behavior change and motivation principles to optimise participant adherence and engagement (delivery). The purpose of this commentary is to develop an injury prevention and rehabilitation framework using the best available physics-based simulation, biomechanics, and behavior change research. The intervention as a whole is entitled biomechanically-informed training (BIT). While investigators have previously examined the relative merits of different training genres (e.g., plyometric, balance, resistance), what makes BIT novel is that it explicitly targets the biomechanical mechanisms that mitigate musculoskeletal injury risk (i.e., force) in ways that are underpinned by established behavior change principles. The four pillars of BIT refer to focused exercise use, irrespective of the training genre, to improve an individual’s: (1) knee flexion dynamics, (2) dynamic trunk control, (3) gastrocnemius muscle strength, and (4) hip muscular strength. We also present experimental data from two independent training studies verifying the efficacy of BIT for the prevention of knee and anterior cruciate ligament (ACL) injury.

The Acute Effects of Different Intensity Whole-Body Vibration Exposure on Muscle Tone and Strength of the Lower Legs, and Hamstring Flexibility: A Pilot Study.

The research on the change in properties of the lower leg muscles by different intensity sinusoidal vertical whole-body vibration (SV-WBV) exposures has not yet been investigated. The purpose of this study was to determine effect of a 20-minute different intensity SV-WBV application to the ankle plantar flexor and dorsiflexor muscles properties and hamstring flexibility. Prospective preintervention-postintervention design. Physiotherapy department. A total of 50 recreationally active college-aged individuals with no history of a lower leg injury volunteered. The SV-WBV was applied throughout the session with an amplitude of 2 to 4mm and a frequency of 25Hz in moderate-intensity vibration group and 40Hz in a vigorous-intensity vibration group. The gastrocnemius and tibialis anterior muscle tone was assessed with MyotonPRO, and the strength evaluation was made on the same lower leg muscles using hand-held dynamometer. The sit and reach test was used for the lower leg flexibility evaluation. The gastrocnemius muscle tone decreased on the right side (d = 0.643, P = .01) and increased on the left (d = 0.593, P = .04) when vigorous-intensity vibration was applied. Bilateral gastrocnemius muscle strength did not change in both groups (P > .05). Without differences between groups, bilateral tibialis anterior muscle strength increased in both groups (P < .01). Bilateral gastrocnemius and tibialis anterior muscle tone did not change in the moderate-intensity vibration group (P > .05). Flexibility increased in both groups (P < .01); however, there was no statistically significant difference between the groups (d = 0.169, P = .55). According to study results, if SV-WBV is to be used in hamstring flexibility or ankle dorsiflexor muscle strengthening, both vibration exposures should be preferred. Different vibration programs could be proposed to increase ankle plantar flexor muscle strength in the acute results. Vigorous-intensity vibration exposure is effective in altering ankle plantar flexor muscle tone, but it is important to be aware of the differences between the lower legs.

Comparison of Gastrocnemius Muscle Strength between Basketballs and Non-basketball Player

Background : Basketball is one of the best aerobic-predominant exercises and the most important muscle used in this sport is the gastrocnemius muscle. This muscle plantar flexes the ankle when the knee is extended to maintain the balance and to stabilize the body during vigorous movements. Furthermore, the gluteus, quadriceps, hamstrings, and calves may get activated when running up and down the court and jump in the air when doing basketball training. This study was conducted to compare the gastrocnemius muscle strength in basketball and non-basketball players. Methods : This analytical study was to measure the gastrocnemius muscle strength in basketball (n=16) and non-basketball (n=16) players, using hand-held dynamometer (HHD). Gender, weight, height, Body Mass Index (BMI) and maximal gastrocnemius muscle strength were recorded and compared between groups. The study was conducted from August to October 2013 in the Faculty of Medicine, Universitas Padjadjaran. Results : The maximal gastrocnemius muscle strength showed no significant differences both in basketball and non-basketball players for females and males with p-value 0.092 and 0.711, respectively. Conclusions : There is no significant difference in gastrocnemius muscle strength between basketball and non-basketball players in males as well as in females. Presumably, there are other muscles that take parts to develop leg power by doing the right weight-training exercises.

T141. Nerve root monitoring with TcMEPs during lumbar spine cases

Lumbar spine discectomy and fusion surgeries are performed with the goal of improving low back pain, radiculopathy, or weakness. One study analyzed 792 patients undergoing open lumbar discectomy and showed 0.05% rate of post-operative root injury (Desai et al., 2012). Another review of minimally invasive lumbar spine surgeries demonstrated a root injury rate of up to 23.8% (Epstein, 2016). Transcranial motor evoked potentials (TcMEPs) is one modality used to monitor the integrity of the spinal cord. However, the utility and the warning criteria of TcMEPs for detecting root injury have not been definitively established. Amplitude warning criteria can range widely from 50% to 80% reduction (MacDonald et al., 2012). Our goal is to explore potential TcMEP criteria that may warn of root injury. This is a retrospective chart review of surgeries performed during 2016. We identified 102 patients undergoing lumbar spine surgeries with anatomical risk for injury to the nerve roots below the conus medullaris. We analyzed TcMEPs prior to incision and at skin closure. We excluded data from cases where the effect of neuromuscular blockade was present. For each TcMEP, we analyzed changes in stimulation voltage, % latency, % duration, % peak-to-peak (PTP) amplitude, % secondary PTP (sPTP) amplitude, and % area under the curve (AUC). We then compared the data to changes in the neurologic Medical Research Council (MRC) scale in the quadricep (quad), tibialis anterior (TA), and gastrocnemius muscles. We used gastrocnemius strength as a surrogate for foot strength as they share similar root innervations. We stratified MRC changes as either “mild to severe” (mild), “moderate to severe” (moderate), or “severe only” (severe) based on a reduction of greater than 0.5, 2, or 4 points, respectively. Baseline TcMEP data were available for 135 quads, 194 TAs, and 200 foot muscles. Post-operative deficits were seen in 3 quads, 5 TA, and 4 foot muscles. Measures of diagnostic accuracy (% sensitivity, % specificity, % positive predictive value, and % negative predictive value) were calculated using the following parameters: (A) 10% latency increase - mild (33/96/17/98), moderate (25/95/4.2/99), severe (100/95/4/100). (B) 67% decrease in PTP - mild (29/98/25/98), moderate (25/97/6/99), severe (100/97/6.3/100). (C) 67% decrease in sPTP - mild (29/96/16/98), moderate (25/95/4/99), severe (100/95/4/100). (D) 67% decrease in AUC- mild (43/96/24/98), moderate (50/96/9.5/99.6), severe (100/96/4.7/100). (E) Fifty-percent decrease in duration did not detect any injury. (F) Fifty-volt increase in TcMEP stimulation - mild (67/91/18/99), moderate (75/90/4.5/99.8), severe (100/89/1.5/100). TcMEP criteria for detecting root injury should be interpreted with caution. However, AUC and stimulation voltage changes may be helpful for detecting moderate-severe injury.

Muscle Strength of Lower Limbs as a Predictor of Postural Stability and Fear of Falling in Physically Active and Inactive Older Men and Women

Objectives: The aim of this study was to analyze the strength of lower limb muscles, adjusted for potential modulating effects of physical activity, as a predictor of postural stability and the fear of falling (FoF) in older women and men. Materials and Methods. The study included 113 physically active and inactive persons older than 60 years (73.35 ± 7.05 years). The strength of 4 groups of lower limb muscles was determined, along with postural stability, that is, Timed Up and Go (TUG) test, Functional Reach (FR) test, and subjective FoF. Results and Conclusions. Shorter time to complete TUG test coexisted with the greater strength of all examined muscles (from r = −0.28 to r = −0.48), except the gastrocnemius. The results of FR test in physically active individuals correlated significantly with gastrocnemius muscle strength (r = 0.34). Subjective FoF showed statistically significant correlations with the strength of all examined muscles (from R = −0.38 to R = −0.44), as well as with the results of TUG (R = 0.45) and FR tests (R = −0.43). Physically inactive older men show a considerable decrease in quadriceps muscle and hamstring strength. The strength of these muscles is similar to that observed in physically inactive women. The strength of quadriceps muscle, hamstrings, and hip abductors is a good predictor of the results of TUG test, whereas the strength of the gastrocnemius predicts the outcome of FR test. Lesser strength of lower limb muscles and worse results of TUG and FR tests are associated with greater subjective FoF.

Treatment of posterior cruciate ligament tibial avulsion by a minimally-invasive open posterior approach

ObjectiveTo assess the surgical technique and report the outcomes following fixation of PCL bony avulsions through mini-invasive posterior knee approach as described by Burks and Schaffer. MethodsFrom June 2012 to July 2015, 27 patients enrolled in the study (21 males and 6 females). Fixation of tibial PCL avulsion fractures was done with one or two cannulated screws, or sutures through Burks and Schaffer’s approach. The mean interval before surgery was 16days (1–70) .Patients was followed up for an average of 51 weeks. The outcome measures evaluated at final follow-up were (1) clinical stability as assessed by posterior drawer test, (2) radiologic union, (3) functional assessment by Lysholm score, and (4) gastrocnemius muscle strength as a measure of morbidity. ResultsAverage operative time was 43min. Improvement of both subjective Lysholm score (mean 93) and objective stability testing by posterior drawer test (returns to normal in 81.1% of patients) at the final follow-up. Good radiographic union at average of 5.6 weeks. No morbidity of the gastrocnemius with few complications. ConclusionsThe approach was fast and safe with excellent visualization. It allows surgeons to address other injuries in the same setting. It can be considered as a minimally-invasive open surgery without surgery-related morbidity. It is a reproducible technique that can be done at any trauma centre by surgeons with average experience. The subjective and objective results of the technique are excellent and comparable to the arthroscopic procedures that needs more specific centres with well-trained surgeons.

Low-Dye 테이핑 적용이 아치회복운동을 시행한 편평족의 장딴지근력에 미치는 효과

Low-Dye 테이핑 적용이 아치회복운동을 시행한 편평족의 장딴지근력에 미치는 효과

Clinical Reasoning: A 64-year-old woman with progressive quadriparesis

A 64-year-old right-handed woman presented to an outside hospital with a 1-week history of weakness noted while walking. She reported bilateral weakness greater on the right, and several falls. She denied lower extremity numbness. Her medical history was significant for lower-back osteoarthritis and a 20 pack-year smoking history. She denied constitutional symptoms. Her examination on admission was notable for 4/5 right gastrocnemius strength and unsteady gait. The authors thank Dr. Hal Blumenfeld for review of the manuscript.

Inhibition of the angiotensin-converting enzyme decreases skeletal muscle fibrosis in dystrophic mice by a diminution in the expression and activity of connective tissue growth factor (CTGF/CCN-2)

The renin-angiotensin system (RAS), through angiotensin II and the angiotensin-converting enzyme (ACE), is involved in the genesis and progression of fibrotic diseases characterized by the replacement of normal tissue by an accumulation of an extracellular matrix (ECM). Duchenne muscular dystrophy (DMD) presents fibrosis and a decrease in muscle strength produced by chronic damage. The mdx mouse is a murine model of DMD and develops the same characteristics as dystrophic patients when subjected to chronic exercise. The connective tissue growth factor (CTGF/CCN2) and transforming growth factor type beta (TGF-β), which are overexpressed in muscular dystrophies, play a major role in many progressive scarring conditions. We have tested the hypothesis that ACE inhibition decreases fibrosis in dystrophic skeletal muscle by treatment of mdx mice with the ACE inhibitor enalapril. Both sedentary and exercised mdx mice treated with enalapril showed improvement in gastrocnemius muscle strength explained by a reduction in both muscle damage and ECM accumulation. ACE inhibition decreased CTGF expression in sedentary or exercised mdx mice and diminished CTGF-induced pro-fibrotic activity in a model of CTGF overexpression by adenoviral infection. Enalapril did not have an effect on TGF-β1 expression or its signaling activity in sedentary or exercised dystrophic mice. Thus, ACE inhibition might improve muscle strength and decrease fibrosis by diminishing specifically CTGF expression and activity without affecting TGF-β1 signaling. Our data provide insights into the pathogenic events in dystrophic muscle. We propose ACE as a target for developing therapies for DMD and related diseases.