Noninvolved Side Research Articles

Relationship Between Obesity and Medial Longitudinal Arch Bowing.

There have been reports about the association between obesity and the medial longitudinal arch (MLA) of foot. The purpose of this study is to investigate the change of various parameters related to the MLA according to obesity classification severity by the World Health Organization using weightbearing computed tomography (WBCT). WBCT data of the noninvolved side of patients presenting with unilateral foot and ankle problems or healthy candidates from September 2014 to October 2022 were extracted from a single referral hospital. Forty-four cases in each of 5 obesity classes were selected sequentially. Two orthopaedic surgeons measured foot and ankle offset, forefoot arch angle (FAA), hindfoot moment arm, percentage of uncoverage of the middle facet of the subtalar joint, talonavicular angle (TNA), navicular-medial cuneiform angle, medial cuneiform-first metatarsal angle, talus-first metatarsal angle (TMT1A), first tarsometatarsal subluxation (TMT1S), talonavicular coverage angle, navicular floor distance (NFD), and NFD per height. Positive values indicate plantar collapse. Intra- and interobserver reliabilities were assessed using intraclass correlation coefficients. One-way analysis of variance tests were performed for parametric data with equal variances, and Welch's test for unequal variances. Kruskal-Wallis test was performed for nonparametric data. Post hoc analysis was performed for statistically significant parameters. Correlation analysis between body mass index (BMI) and 12 parameters were performed using Pearson test. Intraobserver and interobserver reliability were excellent, except for TMT1S. The TNA and TMT1A showed a statistically significant difference. FAA (r = -0.2), TNA (r = 0.182), TMT1A (r = 0.296), and NFD (r = -0.173) showed a statistically significant correlation with BMI. In nonsymptomatic feet, we found that the talonavicular joint, as measured by the TNA, to be influenced by obesity classification. Obesity and increased BMI was associated with a negative influence on the MLA. Level III, retrospective cohort study.

The Effect of Immediate Functional Ankle Rehabilitation on a Range of Motion, Muscle Strength, and Stiffness after Achilles Tendon Repair in Soccer Player

PURPOSE This study aims to investigate the effect of immediate functional ankle rehabilitation after Achilles tendon repair on an ankle range of motion, muscle strength, and stiffness in soccer players.METHODS The subject of this case study is one soccer player belonging to team A. Athlete A (age 25 years, height 174 cm, weight 63 kg) visited hospital B due to an Achilles tendon rupture that occurred during the training in February 07, 2022. February 08, 2022, athlete A had Achilles tendon reconstruction at B hospital. Two weeks after the operation, athlete A visited the M exercise center and performed immediate functional rehabilitation exercises for 16 weeks.RESULTS As a result of 16 weeks of immediate functional ankle rehabilitation exercise, athlete A’s ankle joint range of motion (supine and prone dorsi flexion, supine and prone plantar flexion), muscle strength (supine and prone dorsi flexion, supine and prone plantar flexion, inversion, eversion), and stiffness(Achilles tendon, gastrocnemius medial and lateral) were positively improved. Also, the difference between the range of motion, muscle strength, and stiffness of the affected involved and noninvolved side of the ankle was decreased after 8 and 16 weeks compared to pre-exercise.CONCLUSIONS Therefore, it is suggested to apply immediate functional rehabilitation exercises to help soccer players return to play early after Achilles tendon surgery.

Pes anserine detachment in posteromedial approach to the tibial plateau fracture provides better intraoperative exposure without compromising the flexor muscle strength.

During the posteromedial approach to the tibial plateau fracture (TPF), pes anserine is generally retracted. However, pes anserine detachment could provide a better fracture site exposure. Even so, the general conception is that the latter could negatively affect flexor muscle strength. We aimed to evaluate the effect of pes anserine detachment on the flexion force and functional outcomes of TPF with posteromedial involvement. In this retrospective-prospective cohort study, 22 TPF patients with Schatzker type IV who were managed with posteromedial approach and pes anserine detachment were included. The knee flexion force was measured 12months after the surgery at several angles of flexion (30°, 60°, and 90°) and rotations (internal and external). The International Knee Documentation Committee (IKDC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess knee function. A visual analog scale (VAS) was used to measure knee pain. The mean strength of the knee flexor muscle was not statistically different between the involved and non-involved sides at 30°, 60°, and 90° knee flexion, and also at the internal and external rotation. The mean IKDC score of the patients was 81.6 ± 7.8. The mean KOOS score of the patients was 82.2 ± 9.1. The mean VAS for pain was 2.4 ± 1.8. The mean knee range of motion was 124 ± 10.5°. Pes anserine release and re-attachment in the posteromedial approach to the TPF has no detrimental effect on the flexion muscle strength and knee function. Therapeutic Level IV.

Synthetic Graft Augmentation Is Safe and Effective for the Repair of Acute Achilles Tendon Rupture in Patients With Preexisting Tendinopathy

To assess the safety and report the clinical outcomes of synthetic graft augmentation using polypropylene (PP) mesh in the repair of acute Achilles tendon (AT) rupture in patients with preexisting tendinopathy. Methods: Patients who underwent open repair for acute AT rupture at our institution between April 2017 and March 2019 were retrospectively identified. The inclusion criteria were acute AT rupture in patients with preexisting tendinopathy. All patients included in the study underwent acute repair augmented by an inlay PP mesh and had 30 months' follow-up. Patient characteristics, operative details, and outcomes were analyzed. Continuous data were described by mean, standard deviation, median, and range. The Wilcoxon signed rank test was used to analyze the change in patient-reported outcome measures. The significance level was set at a P-value of .05. Thirteen patients were included. There were 5 female and 8 male patients, withan average age of 52 years (range 49-56 years). No cases of rerupture or graft-related complications requiring additional treatment occurred during mean follow -up of 38 months. All patients reported good functional outcome, as shown from nonsignificant difference between the preinjury and 38-month postoperative Achilles Tendon Rupture Score (88.5 ± 2.2 vs 89.2 ± 2.2, P= .107) and the excellent postoperative American Orthopedic Foot and Ankle Society Ankle/Hindfoot Scale score (92.22 ± 2.2) at last follow-up. At the end of follow-up, all patients were able to perform single-legged heel rise as the noninvolved side. By average of 16 weeks, all patients returned to their preinjury activity level. The use of inlay PP mesh to augment the repair of acute AT rupture in patients with preexisting tendinopathy appears to be safe and effective, allowing early return to preinjury activity level with favorable clinical outcomes. Level IV, therapeutic case series.

Evaluation of overall gait quality in Perthes disease. Are global gait indices of value for a local musculoskeletal disorder?

BackgroundUntil now follow-up- and outcome evaluations in Perthes disease are analysing predominantly subjective results and clinical/radiological parameters. To enlarge the assessment by quantitative, functional aspects a summary measure for overall gait quality would be helpful. Therefore, the objective of this study is to evaluate whether commonly used global gait indices are sensitive to detect gait deviations during the early stages of the Perthes disease. Methods3D gait data of 70 patients scheduled for containment improving surgery with the diagnosis of Perthes were included. A group of 31 healthy children served as a control group. Based on 4 gait cycles of each subject the Gait Deviation Index, the Gillette Gait Index, the Hip Flexor Index and the Gait Deviation Index-Kinetic were calculated for the involved and non-involved side. The gait indices were compared (1) between patients and controls, (2) among patients sub-grouped by ROM/radiological classifications and (3) between the two limbs. FindingsAll applied gait indices besides the Gait Deviation Index-Kinetic of the patient-group are significantly different from the controls. The subgroup-analysis resulted only in significant differences between the radiological groups Herring B and C for the Gillette Gait Index. Comparing involved and non-involved side showed no significant differences. InterpretationThe evaluated gait indices are sensitive to identify a pathologic gait pattern in Perthes disease, so they can be used as a functional outcome parameter evaluating treatment concepts. Nevertheless, these are not applicable to identify the pathologic side indicating that a local hip problem leads to global gait deviations.

A New Approach for Pelvic Tumors Invading the Rectum

Objective: Sometimes pelvic tumors invade the rectal wall, needing removal Design: An alternative technique of radical/conservative surgery (trying to preserve as much as possible the muscular complex) is presented, inspired by De La Torre treatment of Hirschprung’s disease. The lower rectum is only partially resected on the non-involved side, where only mucosa is removed, followed by a lower end to end rectal anastomosis Results: Normal defecation Conclusion: A good surgical alternative

Hop Performance After Return to Sport in Anterior Cruciate Ligament-Reconstructed Gaelic Football and Hurling Athletes.

Anterior cruciate ligament (ACL) injuries are among the most severe injuries in the Gaelic Athletic Association. Hop tests measure functional performance after ACL reconstruction as they replicate the key requirements for a match situation. However, research examining functional recovery of ACL-reconstructed Gaelic athletes is lacking. The objective of this study is to determine if athletes restore normal hop symmetry after ACL reconstruction and to examine if bilateral deficiencies persist in hop performance following return to sport. A cross-sectional design was used to evaluate hop performance of 30 ACL-reconstructed Gaelic athletes who had returned to competition and 30 uninjured controls in a battery of hop tests including a single, 6-m, triple, and triple-crossover hop test. In each test, the mean symmetry score of the ACL reconstruction group was above the cutoff for normal performance of 90% adopted by this study (98%, 99%, 97%, and 99% for the single, 6-m, triple, and triple-crossover hop, respectively). No significant differences in absolute hop scores emerged between involved and control limbs, with the exception of the single-hop test where healthy dominant limbs hopped significantly further than ACL-reconstructed dominant limbs (P = .02). No significant deficits were identified on the noninvolved side. The majority of ACL-reconstructed Gaelic athletes demonstrate normal levels of hop symmetry after returning to competition. Suboptimal hop performance can persist on the involved side compared with control limbs. Targeted rehabilitation may be warranted after returning to competition to restore performance to levels of healthy uninjured athletes.

Anatomical and dynamic rotational alignment in spastic unilateral cerebral palsy

BackgroundEven in mild unilateral cerebral palsy increased internal hip rotation can be noted on physical- and gait examination. The influence of spasticity on femoral growth in the transverse plane is not clear. These deviations and asymmetry in movement pattern may negatively affect efficiency of gait and cause psychological concerns about appearance. Research questionIs increased internal hip rotation on the involved side in mild unilateral CP common and is there compensatory external pelvic rotation to keep foot progression symmetrical? MethodsThis prospective study included 45 individuals with unilateral cerebral palsy, mean age 17.7 (13.0−24.0) years. All were Gross Motor Function Classification Level I. Physical examination, three-dimensional gait analysis and magnetic resonance imaging for assessment of rotational alignment was performed. ResultsOn physical examination internal hip rotation was mean 50.6 (SD 10.4) degrees on the involved side and 44.3 (SD 10.3) on the non-involved side, p = 0.001.In gait analysis calculating the whole gait cycle, internal hip rotation was mean 2.3 (6.2) degrees on the involved side, and on the non-involved side external 1.8 (7.6) degrees, p = 0.004.Increased external pelvic rotation was noted on the involved side, mean 2.0 (4.3) degrees with corresponding internal rotation on the non-involved side, mean 3.6 (4.4), p = 0.001. There was no difference in foot progression, p = 0.067, with mean 5.1 (8.6) and 3.9 (6.4) external respectively.Magnetic resonance imaging revealed femoral torsion on the involved side mean 17.3 (11.3) degrees compared to 11.4 (10.8) on the non-involved side, p = 0.001. SignificanceTransverse plane asymmetry in the femur was noted in mild unilateral cerebral palsy. Increased anatomical and dynamic internal rotation was compensated for by external pelvic rotation. Rotational malalignment may contribute to gait deviations in this mild group and should be part of the overall assessment.

전방십자인대 제거 수술 후와 재재건술 후의 재활운동이 무릎관절의 건측ㆍ환측 근력, 굽힘폄비율, 통증척도 및 자기공명영상 사례연구

본 연구는 전방십자인대 재건술 실패로 인해 전방십자인대를 제거한 연구대상자를 제거 수술 후, 재재건술 후 각각 24주간 5단계의 재활운동프로그램을 동일하게 실시하여 무릎관절의 등장성 근력, 근력비율, 통증척도 및 자기공명 영상의 변화를 알아보고자 하였다. 웨이트 머신을 통해 무릎관절의 최대근력과 근력비율을 제거 수술 후 8주차, 16주차, 24주차, 재재건술 후 8주차, 16주차, 24주차로 총 6회 측정하였다. 그 결과 무릎관절의 폄근과 굽힘근 최대근력은 모두 증가하였으며 근력비율 또한 정상범위로 회복하였다. 통증척도는 재활운동 단계별 점차 낮아졌으며, 스쿼트를 이용한 통증척도에서도 기간에 따라 감소하였다. 따라서 본 연구의 결과 전방십자인대 재건술 실패로 인해 제거 수술 후, 재재건 술 후 각각 24주간 재활운동을 실시하였을때 건측과 환측의 폄근과 굽힘근의 최대근력이 증가하는 것을 확인하였으며, 또한 무릎관절의 안정성과 통증 개선에도 도움이 되는 것으로 판단된다.

Electromyographic Evidence of Excessive Achilles Tendon Elongation During Isometric Contractions After Achilles Tendon Repair

Objectives: It has been proposed that increased tendon elongation after Achilles tendon repair contributes to selective weakness in end-range plantar flexion (Mullaney et al 2006). Excessive tendon elongation during maximum voluntary contraction (MVC) means greater muscle fiber shortening. Since mean frequency (MF) of the electromyogram (EMG) increases with muscle fiber shortening, it was hypothesized that during isometric plantar flexor MVCs MF would be higher on the involved versus non-involved side. Therefore, the purpose of this study was to examine MF during isometric MVCs in patients with Achilles tendon repairs. Methods: Maximum isometric plantar flexion torque was measured at 20° and 10° dorsiflexion, neutral, and 10° and 20° plantar flexion in 17 patients (mean±SD age, 39±9 years; 15 men, 2 women) 43±24 months after surgery (range, 9 months to 8 years). Surface EMG signals were recorded during strength tests. MF was calculated from Fast Fourier Transforms of medial gastroc (MG) lateral gastroc (LG) and soleus (S) EMG signals. Effect of weakness on MF was assessed using analysis of variance. Based on reported plantar flexor MF values it was estimated that with 17 subjects there would be 80% power to detect a 16% difference in MF between involved and noninvolved legs at P<0.05. Results: Patients had marked weakness in 20° plantar flexion (deficit 28±18%, P<0.01; 14 of 17 deficit >20%) but no significant weakness in 20° dorsiflexion (deficit 8±15%, P=0.20; 4 of 17 deficit >20%). MF increased moving from dorsiflexion to plantar flexion (P<0.001) but overall was not different between involved and noninvolved sides (P=0.22). However, differences in MF between the involved and noninvolved sides were apparent in the patients with marked weakness. At 10° plantar flexion 8 of 17 patients had marked weakness (>20% deficit). MF at 10° plantar flexion was significantly higher on involved versus noninvolved side in patients with weakness but this was not apparent in patients with no weakness (side by group P=0.014; Table 1). MF at 10° plantar flexion average across the 3 muscles was 13% higher on the involved versus noninvolved side in patients with weakness (P=0.012) versus 3% lower in patients with no weakness (P=0.47). Conclusion: Higher MF on the involved versus noninvolved side in patients with significant plantar flexion weakness is consistent with greater muscle fiber shortening. This indicates that weakness was primarily due to excessive lengthening of the repaired Achilles tendon. If weakness were simply due to atrophy, a lower MF would have been be expected and patients would have had weakness throughout the range of motion. Surgical and rehabilitative strategies are needed to prevent excessive tendon elongation and weakness in end-range plantar flexion after Achilles repair. [Table: see text]

Electromyographic Evidence of Excessive Achilles Tendon Elongation During Isometric Contractions After Achilles Tendon Repair

PURPOSE: Increased tendon elongation after Achilles repair is thought to contribute to selective weakness in end-range plantarflexion (PF). Excessive tendon elongation during maximum voluntary contraction (MVC) means greater muscle fiber shortening. Since mean frequency (MF) of the electromyogram (EMG) increases with decreasing fiber length, it was hypothesized that MF would be higher on the involved (Inv) versus non-involved (Non) side during isometric PF MVCs. The purpose of this study was to examine MF during isometric MVCs in patients with Achilles tendon repairs. METHODS: Isometric PF MVC was measured at 20°, 10°, 0° dorsiflexion (DF), and 10°, 20° PF, in 17 patients (age, 39±9 years; 15 men, 2 women) 43±24 months after surgery. Surface EMG signals were recorded during MVCs. MF was calculated from Fast Fourier Transforms of medial gastroc (MG) lateral gastroc (LG) and soleus (S) EMG signals. Effect of weakness on MF was assessed using analysis of variance. RESULTS: Patients had weakness in 20° PF (deficit 28±18%, P<0.01; 14 of 17 deficit >20%) but no weakness in 20° DF (deficit 8±15%, P=0.20; 4 of 17 deficit >20%). MF increased moving from DF to PF (P<0.001) but was not different between Inv and Non (P=0.22). At 10° PF 8 of 17 patients had weakness (>20% deficit). MF was significantly higher on Inv versus Non, across all angles, in patients with weakness versus no weakness at 10° PF (side by group P=0.014; Table 1). MF was 13% higher on Inv versus Non in patients with weakness (P=0.012) versus 3% lower in patients with no weakness (P=0.47). CONCLUSIONS: Higher MF for Inv versus Non in patients with PF weakness is consistent with greater muscle fiber shortening. This indicates that weakness was primarily due to excessive lengthening of the repaired Achilles tendon. If weakness were simply due to atrophy, a lower MF would have been be expected.

The Effects of Exercise Rehabilitation on Shoulder Range of Motion, ASES Score and VAS After Rotator Cuff Repair

The purpose of the present study was to report the effect of exercise rehabilitation after rotator cuff repair. This case is a woman (54 years of age) who had been operated on for rotator cuff repair in 2017 and passed six weeks after surgery. Her job is a shop assistant in market. It showed that the ROM of shoulder flexion was deficit 70° from the non-involved side, abduction deficit 135°, internal rotation deficit 60°, external rotation deficit 80° at six weeks after surgery. She had rehabilitation exercise over eight weeks in a specific rehabilitation center. The ROM of shoulder was rapidly improved after two weeks a rehabilitation exercise. And after four weeks a rehabilitation, The ROM of shoulder and Shoulder instability score (ASES) were restored to nearly normal and VAS was well controlled. Shoulder ROM and ASES and VAS remained normal during the eight week rehabilitation exercise after rotator cuff repair. It was very effective to have rehabilitation exercise three times a week after rotator cuff repair. The shoulder range of motion (flexion, abduction, internal rotation and external rotation), ASES and VAS were consistently improved and restored to normal during the eight week rehabilitation after rotator cuff repair.

Muscle hypotrophy, not inhibition, is responsible for quadriceps weakness during rehabilitation after anterior cruciate ligament reconstruction.

Quadriceps weakness is common after anterior cruciate ligament reconstruction (ACLR). Limited neuromuscular activation may have a role in the weakness. The purpose of this study was to use peripheral magnetic stimulation to measure changes in quadriceps inhibition in patients during rehabilitation from ACLR. Ten patients (7M/3F; age 35 ± 8 years; BMI 26.0 ± 4.8kg/m2) who had ACLR with patellar tendon autograft were recruited. At 3 and 6months postoperatively, patients' knee extension peak torque was measured during maximum voluntary isometric contraction (MVIC), magnetic stimulation-evoked contraction, and MVIC augmented with superimposed burst magnetic stimulation to the femoral nerve. All tests were done bilaterally at 30° and 65° of knee flexion on a dynamometer. Central activation ratio was calculated by dividing the peak torque before stimulation by peak torque after stimulation. Patients had marked deficits in MVIC, with improvement from 3 to 6 months that was more apparent at 65° versus 30° (P < 0.05). There was significant deficit in stimulation-evoked torque on the involved side that diminished over time, and this change occurred differently between the two angles (P < 0.05). Central activation ratio was lower on the involved side versus the noninvolved side and this effect was more prominent at 3 versus 6 months: combining the angles, mean central activation ratio on the involved and noninvolved sides, respectively, was 91.4 ± 7.6% and 97.5 ± 5.3% at 3 months, and 93.0 ± 7.8% and 95.8 ± 6.8% at 6 months. At 3 and 6 months after ACLR, there were significant deficits in quadriceps strength and activation. Quadriceps activation levels were high (> 90%) for both sides at both time points. The substantial strength deficits at this postoperative period may be largely due to muscle atrophy with limited contribution from central inhibition. Rehabilitation interventions to normalize quadriceps strength should emphasize hypertrophic stimuli as opposed to neuromuscular activation strategies. II, prospective cohort study.

Sonoelastographic evaluation of the sciatic nerve in patients with unilateral lumbar disc herniation.

The aim of this study was to compare strain elastography (SE) and shear wave elastography (SWE) findings of the sciatic nerve in patients with unilateral lumbar disc herniation (LDH) and healthy control subjects. The study group included patients with complaints of unilateral sciatica for 3-12months, with foraminal stenosis due to one level of LDH (L4-L5 or L5-S1). An age- and gender-matched control group was formed of healthy subjects. Evaluations were performed on both the axial and longitudinal planes from the bilateral gluteal region using a 5-9MHz multifrequency convex probe. There were 40 patients (20 male, 20 female) with a mean age of 43.1 ± 12.7years in the study group, and 40 healthy subjects (22 male, 18 female) with a mean age of 42.9 ± 10.7years in the control group (p > 0.05). The sciatic nerve stiffness assessed on both the axial (12.3 ± 3.7 kPA) and longitudinal (14.3 ± 3.8 kPA) planes of the involved side was significantly higher than non-involved side (axial: 6.8 ± 2.1 and longitudinal: 8.3 ± 2.3 kPA) in the patient group (p < 0.001). Patients with unilateral LDH have increased stiffness of the sciatic nerve compared to healthy control subjects. Although the findings in this preliminary study show that shear wave elastography can detect a change in sciatic nerve stiffness in patients with unilateral LDH, larger studies are required to determine the clinical utility of this technique.

Comparison of the cross-sectional area of longus colli muscle between patients with cervical radicular pain and healthy controls

Previous studies have shown atrophy of paravertebral lumbar muscles in patients with lumbar radicular pain, and proposed rehabilitative approaches based on these findings. However, changes of cervical paravertebral muscles in patients with cervical radicular pain are still unknown. The aim of this study was to compare the cross-sectional area (CSA) of longus colli muscle (LCM) in patients with cervical radicular pain and healthy controls via ultrasound measurement. Twenty patients with more than 4 weeks of cervical radicular pain and 20 healthy matched (for body mass index, age, and gender) control subjects. The CSA of LCM at the level of C5–C6 was measured by ultrasound with the subject in a supine position. Also, Neck Disability Index (NDI), and Visual Analogue Scale (VAS) were reported by patients. Independent sample t -test was used for investigation of differences in cross-sectional area and other variables between both groups. Twenty patients with cervical radicular pain with mean (SD) age of 42.4(7) years and 20 healthy matched controls with mean (SD) age of 40.7 (7) years participated in the study. Patients with cervical radicular pain showed smaller CSA of LCM bilaterally compared with controls [mean (SD) difference: 0.37(0.15)] ( P -value < 0.001). Within patients group, there were no significant differences between CSA of LCM in the involved and non-involved sides. This is the first study which showed that patients with cervical radicular pain had smaller bilateral CSA of LCM in comparison with healthy controls via ultrasound assessment. It is also not clear whether atrophy of longus colli muscle in patients with cervical radicular pain is a consequence or a cause of it. Reduction in the stability of neck due to atrophy of LCM could make the cervical spine region susceptible to more injuries which might be prevented by functional and strengthening exercises.

Can Weakness in End-Range Plantar Flexion After Achilles Tendon Repair Be Prevented?

Background:Disproportionate end-range plantar flexion weakness, decreased passive stiffness, and inability to perform a heel rise on a decline after Achilles tendon repair are thought to reflect increased tendon compliance or tendon lengthening. Since this was first noted, we have performed stronger repairs and avoided stretching into dorsiflexion for the first 12 weeks after surgery.Hypothesis:Using stronger repairs and avoiding stretching into dorsiflexion would eliminate end-range plantar flexion weakness and normalize passive stiffness.Study Design:Case series; Level of evidence, 4.Methods:Achilles repairs with epitendinous augmentation were performed on 18 patients. Plantar flexion torque, dorsiflexion range of motion (ROM), passive joint stiffness, and standing single-legged heel rise on a decline were assessed at 43 ± 24 months after surgery (range, 9 months to 8 years). Maximum isometric plantar flexion torque was measured at 20° and 10° of dorsiflexion, neutral position, and 10° and 20° of plantar flexion. Passive dorsiflexion ROM was measured with a goniometer. Passive joint stiffness was computed from the increase in passive torque from 10° to 20° of dorsiflexion. Tendon thickness was measured by use of digital calipers. Plantar flexion electromyographic (EMG) data were recorded during strength and functional tests. Analysis of variance and chi-square tests were used to assess weakness and function.Results:Marked weakness was evident on the involved side at 20° of plantar flexion (deficit, 26% ± 18%; P < .001), with no weakness at 20° of dorsiflexion (deficit, 6% ± 17%; P = .390). Dorsiflexion ROM was decreased 5.5° ± 8° (P = .015), and tendon width was 8 ± 3 mm greater on the involved side (P < .001). Passive joint stiffness was similar between the involved and noninvolved sides. Only 2 of 18 patients could perform a decline heel rise on the involved side compared with 18 of 18 on the noninvolved side (P = .01). No difference in EMG amplitude was found between the involved and noninvolved sides during the strength or heel rise tests.Conclusion:The use of stronger repair techniques and attempts to limit tendon elongation by avoiding dorsiflexion stretching did not eliminate weakness in end-range plantar flexion. EMG data confirmed that end-range weakness was not due to neural inhibition. Physiological changes that alter the force transmission capability of the healing tendon may be responsible for this continued impairment. This weakness has implications for high-demand jumping and sprinting after Achilles tendon repair.

Measuring clearance mechanics based on dynamic leg length

ABSTRACTThe aim of this study was to quantify clearance mechanics during gait. Seventeen children diagnosed with hemiplegic cerebral palsy underwent a three-dimensional gait analysis evaluation. Dynamic leg lengths were measured from the hip joint center to the heel, to the ankle joint center and to the forefoot throughout the gait cycle. Significant asymmetry was observed during stance, initial and terminal swing phases, where the hemiplegic limb was found shorter by using a paired t-test at 51 sample points (p < .05). The hemiplegic side was restricted in achieving maximal length during terminal swing. The ratio between the maximal dynamic leg length during the stance phase to minimal dynamic leg length during the swing phase was found higher on the non-involved side and lower on the hemiplegic side (p < .05). Quantifying clearance mechanics based on dynamic leg length can provide an additional insight into the analysis of gait patterns and might assist in detecting time of abnormal kinematic deviations.

Isokinetic Extension Strength Is Associated With Single-Leg Vertical Jump Height.

Background:Isokinetic strength testing is an important tool in the evaluation of the physical capacities of athletes as well as for decision making regarding return to sports after anterior cruciate ligament (ACL) reconstruction in both athletes and the lay population. However, isokinetic testing is time consuming and requires special testing equipment.Hypothesis:A single-jump test, regardless of leg dominance, may provide information regarding knee extension strength through the use of correlation analysis of jump height and peak torque of isokinetic muscle strength.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 169 patients who underwent ACL reconstruction were included in this study. Isokinetic testing was performed on the injured and noninjured legs. Additionally, a single-leg countermovement jump was performed to assess jump height using a jump accelerometer sensor. Extension strength values were used to assess the association between isokinetic muscle strength and jump height.Results:The sample consisted of 60 female (mean age, 20.8 ± 8.3 years; mean weight, 61.7 ± 6.5 kg; mean height, 167.7 ± 5.3 cm) and 109 male (mean age, 23.2 ± 7.7 years; mean weight, 74.6 ± 10.2 kg; mean height, 179.9 ± 6.9 cm) patients. Bivariate correlation analysis showed an association (r = 0.56, P < .001) between jump height and isokinetic extension strength on the noninvolved side as well as an association (r = 0.52, P < .001) for the involved side. Regression analysis showed that in addition to jump height (beta = 0.49, P < .001), sex (beta = –0.17, P = .008) and body mass index (beta = 0.37, P < .001) affected isokinetic strength. The final model explained 51.1% of the variance in isokinetic muscle strength, with jump height having the strongest impact (beta = 0.49, P < .001) and explaining 31.5% of the variance.Conclusion:Initial analysis showed a strong association between isokinetic strength and jump height. The study population encompassed various backgrounds, skill levels, and activity profiles, which might have affected the outcome. Even after controlling for age and sex, isokinetic strength was still moderately associated with jump height. Therefore, the jump technique and type of sport should be considered in future research.

Can Weakness in End-Range Plantarflexion after Achilles Repair Be Prevented?

PURPOSE: Disproportionate end-range plantar flexion weakness, decreased passive stiffness, and inability to perform a heel rise on a decline after Achilles tendon repair, are thought to reflect increased tendon compliance or anatomical tendon lengthening. Since this was first noted, we have performed stronger repairs and avoided stretching into dorsiflexion for the first 12 weeks after surgery. It was hypothesized that these treatment changes would eliminate end-range plantar flexion weakness and normalize passive stiffness. METHODS: Achilles repairs with epitendinous augmentation were performed on 18 patients. Plantar flexion torque, dorsiflexion ROM, passive joint stiffness, and standing single-leg heel rise on a decline were assessed 43±24 months after surgery (range, 9 months-8 years). Maximum isometric plantar flexion torque was measured at 20° and 10° of dorsiflexion, neutral, and 10° and 20° of plantar flexion. Passive dorsiflexion ROM was measured goniometrically. Passive joint stiffness was computed from the increase in passive torque from 10° to 20° of dorsiflexion measured before isometric contractions. Tendon thickness was measured by digital calipers. Plantarflexor EMG was recorded during strength and functional tests. ANOVA and Wilcoxon tests were used to assess weakness and function. RESULTS: Marked weakness was evident on the involved side at 20° plantar flexion (deficit 26±18%; P<0.01) with no weakness at 20° dorsiflexion (deficit 6±17%; P=0.39). Compared to the noninvolved side, dorsiflexion range of motion was decreased 6±8° and tendon thickness was 7±3 mm greater (P<0.001) on the involved side. Passive joint stiffness was similar between the involved and noninvolved sides. Only 3 of 18 patients could perform a decline heel rise on the involved side versus 18 of 18 on the noninvolved side (P=0.01). There was no difference in EMG amplitude between the involved and noninvolved sides during all tests. CONCLUSION: Normalized passive joint stiffness and reduced dorsiflexion ROM were likely due to a stronger, protected repair. EMG data confirmed that end-range weakness was not due to neural inhibition. Weakness with the plantar flexors in a shortened position may be due to inefficient transmission of contractile forces through the thickened tendon when the muscles are in a shortened position.

Comparison of the Cross-Sectional Area of Longus Colli Muscle Between Patients With Cervical Radicular Pain and Healthy Controls

BackgroundPrevious studies have shown atrophy of paravertebral lumbar muscles in patients with lumbar radicular pain and have proposed rehabilitative approaches based on these findings. However, changes in cervical paravertebral muscles in patients with cervical radicular pain are still unknown. ObjectiveThe aim of this study was to compare the cross-sectional area (CSA) of the longus colli muscle (LCM) in patients with cervical radicular pain and healthy controls via ultrasound measurement. Study DesignCase-control study. SettingOutpatients who came for treatment to the neurosurgery clinic. ParticipantsA total of 20 patients with more than 4 weeks of cervical radicular pain and 20 healthy matched (for body mass index, age, and gender) control subjects. InterventionsUltrasound measurements. Main Outcome MeasuresThe CSA of the LCM at the level of C5-C6 was measured by ultrasound with the subject in supine position. Also, Neck Disability Index (NDI), and visual analogue scale (VAS) scores were reported by patients. An independent-sample t test was used for investigation of differences in CSA and other variables in both groups. ResultsA total of 20 patients with cervical radicular pain with a mean age of 42.4 years (standard deviation [SD] = 7 years) and 20 healthy matched controls with mean age of 40.7 years (SD = 7 years) participated in the study. Patients with cervical radicular pain showed smaller CSA of the LCM bilaterally compared with controls (mean difference: 0.37 [SD = 0.15]; P < .001). In the patient group, there were no significant differences between the CSA of the LCM in the involved and noninvolved sides. No correlations between the CSA of the LCM and VAS, Neck Disability Index, symptom duration, gender, BMI, and age of the patients were found. ConclusionsThis is the first study to show via ultrasound assessment that patients with cervical radicular pain had smaller bilateral CSA of the LCM in comparison with healthy controls. It is also not clear whether atrophy of the LCM in patients with cervical radicular pain is a consequence or a cause of the pain. Reduction in the stability of the neck due to atrophy of the LCM could make the cervical spine region susceptible to more injuries, which might be prevented by functional and strengthening exercises. Level of EvidenceIII