Premorbid Activity Level Research Articles

Satisfaction rates, function, and return to activity following young adult total hip arthroplasty.

Young adults undergoing total hip arthroplasty (THA) largely have different indications for surgery, preoperative function, and postoperative goals compared to a standard patient group. The aim of our study was to describe young adult THA preoperative function and quality of life, and to assess postoperative satisfaction and compare this with functional outcome measures. A retrospective cohort analysis of young adults (aged < 50 years) undergoing THA between May 2018 and May 2023 in a single tertiary centre was undertaken. Median follow-up was 31 months (12 to 61). Oxford Hip Score (OHS) and focus group-designed questionnaires were distributed. Searches identified 244 cases in 225 patients. Those aged aged under 30 years represented 22.7% of the cohort. Developmental dysplasia of the hip (50; 45.5%) and Perthes' disease (15; 13.6%) were the commonest indications for THA. Preoperatively, of 110 patients, 19 (17.2%) were unable to work before THA, 57 (52%) required opioid analgesia, 51 (46.4%) were reliant upon walking aids, and 70 (63.6%) had sexual activity limited by their pathology. One patient required revision due to instability. Mean OHS was 39 (9 to 48). There was a significant difference between the OHS of cases where THA met expectation, compared with the OHS when it did not (satisfied: 86 (78.2%), OHS: 41.2 (36.1%) vs non-satisfied: 24 (21%), OHS: 31.6; p ≤ 0.001). Only one of the 83 patients (75.5%) who returned to premorbid levels of activity did so after 12 months. Satisfaction rates of THA in young adults is high, albeit lower than commonly quoted figures. Young adults awaiting THA have poor function with high requirements for mobility aids, analgesia, and difficulties in working and undertaking leisure activities. The OHS provided a useful insight into patient function and was predictive of satisfaction rates, although it did not address the specific demands of young adults undertaking THA. Function at one year postoperatively is a good indication of overall outcomes.

Advancing Research and Treatment: An Overview of Clinical Trials in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Future Perspectives.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, debilitating, and multi-faceted illness. Heterogenous onset and clinical presentation with additional comorbidities make it difficult to diagnose, characterize, and successfully treat. Current treatment guidelines focus on symptom management, but with no clear target or causative mechanism, remission rates are low, and fewer than 5% of patients return to their pre-morbid activity levels. Therefore, there is an urgent need to undertake robust clinical trials to identify effective treatments. This review synthesizes insights from clinical trials exploring pharmacological interventions and dietary supplements targeting immunological, metabolic, gastrointestinal, neurological, and neuroendocrine dysfunction in ME/CFS patients which require further exploration. Additionally, the trialling of alternative interventions in ME/CFS based on reported efficacy in the treatment of illnesses with overlapping symptomology is also discussed. Finally, we provide important considerations and make recommendations, focusing on outcome measures, to ensure the execution of future high-quality clinical trials to establish clinical efficacy of evidence-based interventions that are needed for adoption in clinical practice.

POST-PROCEDURAL REHABILITATION: NICE TO DO OR NEED TO DO?

Patients with musculoskeletal disorders who are recalcitrant to formal rehabilitation may seek non-surgical interventions such as orthobiologics. The care pathway following an orthobiologic procedure may include but is not limited to ancillary modalities, supplements, booster injections, and formal rehabilitation. In some cases, the decision to pursue post-procedural rehabilitation may be questioned due to a paucity of evi-dence supporting efficacy and safety following orthobiologic procedures. Moreover, patients and physicians may possess a level of uncertainty in pursuing an intervention that may have been previously unsuccessful. Although higher-level evidence does not exist to support routine post-procedural rehabilitation, a body of evidence supports enhanced physical functioning as well as cellular and molecular effects synergistic to orthobiologics. Given the potential benefits of post-procedural rehabilitation, there would seem to be little downside to participation, provided that the physician and rehabilitation specialist consider individual patient characteristics such as the current pathoanatomical diagnosis, stage of acuity, and pre-morbid activity levels.

Possibilities neuroimaging and neurophysiological research methods to objectify rehabilitation potential in patients with ischemic stroke (analytical review of the literature)

Cerebral stroke (CS) remains the most important medical and social problem. According to available data, only 25% of stroke survivors return to the premorbid level of daily or work activity, most patients have residual neurological disorders of varying severity. Effective rehabilitation of patients with CS requires not only timely initiation of treatment, but also an individual choice of rehabilitation program. To optimize the rehabilitation strategy in each case, it is necessary to set goals and objectives taking into account the rehabilitation potential (RP) and the prognosis of the patient’s recovery. This paper provides a definition of RP and ways to describe it. The existing neurophysiological methods for assessing the RP of functional recovery after CS, such as electroencephalography, evoked potentials and diagnostic transcranial magnetic stimulation (TMS), are considered. Information about neuroimaging diagnostic methods – computer (CT) and magnetic resonance imaging (MRI) in the context of determining RP is presented. The possibilities of functional and diffusion-t ensor MRI of the brain for assessing RP in various periods of the disease are highlighted in detail. Other possible predictors of the restoration of impaired functions are also considered – the volume and localization of the brain lesion, the patient’s age, cognitive functions and laboratory parameters. Modern complex approaches to the formation of algorithms for the quantitative assessment of RP are described. In particular, the current algorithms for evaluating RP – PREP2 for the upper limb and TWIST for predicting the recovery of walking disorders are described. Currently, there are no generally accepted methods for determining and quantifying RP. The instruments proposed for this purpose are insufficiently sensitive and specific or are not suitable for routine clinical practice.

Exploring Physical Activity During the Discharge Transition Phase in People With Acquired Brain Injury—An Observational Study

ObjectiveTo explore physical activity trajectories during the discharge transition phase after in-hospital rehabilitation after acquired brain injury (ABI). DesignA cross-sectional observational study. SettingTransition from an in-hospital rehabilitation center to community-based living. ParticipantsIndependently walking patients with ABI (n=10) who were ready for discharge. InterventionsNot applicable. Main Outcome MeasuresTwo weeks of physically active time continuously monitored with an accelerometer and classified by a machine learning algorithm summed as daily average and total active time for each participant and classified into standing, walking, running, bike riding, stair climbing, ambulation, and sedentary time. Physical activity trajectories showing the total daily active time for all participants were inspected before and after discharge, and the average active time per participant was plotted against self-reported scores of potentially explanatory factors. ResultsAverage total physically active time was 5:49 hours (range 4:26-7:13 hours). Average daily physically active time for participants appeared to be related to functional independence measure sub scores, fatigue, and pre-morbid physical activity level. Individual physical activity trajectories showed a decreased walking activity after discharge, which increased again after 1-2 days. ConclusionsDaily total physically active time among participants was higher than expected. Factors expectedly related to physical activity trajectories in the discharge transition phase were explored and showed some relation to functional scores.

Dynamic Visual Stimulations Produced in a Controlled Virtual Reality Environment Reveals Long-Lasting Postural Deficits in Children With Mild Traumatic Brain Injury.

Motor control deficits outlasting self-reported symptoms are often reported following mild traumatic brain injury (mTBI). The exact duration and nature of these deficits remains unknown. The current study aimed to compare postural responses to static or dynamic virtual visual inputs and during standard clinical tests of balance in 38 children between 9 and 18 years-of-age, at 2 weeks, 3 and 12 months post-concussion. Body sway amplitude (BSA) and postural instability (vRMS) were measured in a 3D virtual reality (VR) tunnel (i.e., optic flow) moving in the antero-posterior direction in different conditions. Measures derived from standard clinical balance evaluations (BOT-2, Timed tasks) and post-concussion symptoms (PCSS-R) were also assessed. Results were compared to those of 38 healthy non-injured children following a similar testing schedule and matched according to age, gender, and premorbid level of physical activity. Results highlighted greater postural response with BSA and vRMS measures at 3 months post-mTBI, but not at 12 months when compared to controls, whereas no differences were observed in post-concussion symptoms between mTBI and controls at 3 and 12 months. These deficits were specifically identified using measures of postural response in reaction to 3D dynamic visual inputs in the VR paradigm, while items from the BOT-2 and the 3 timed tasks did not reveal deficits at any of the test sessions. PCSS-R scores correlated between sessions and with the most challenging condition of the BOT-2 and as well as with the timed tasks, but not with BSA and vRMS. Scores obtained in the most challenging conditions of clinical balance tests also correlated weakly with BSA and vRMS measures in the dynamic conditions. These preliminary findings suggest that using 3D dynamic visual inputs such as optic flow in a controlled VR environment could help detect subtle postural impairments and inspire the development of clinical tools to guide rehabilitation and return to play recommendations.

Exercise improves health-related quality of life sleep and fatigue domains in adult high- and low-grade glioma patients.

The impact of exercise on health-related quality of life (HRQOL) in patients with glioma remains unknown. We hypothesized that glioma patients with low exercise tolerance experience more distress in HRQOL sleep and fatigue domains than patients with high tolerance to exercise. Thirty-eight male and female patients with low- or high-grade glioma treated at a single tertiary care institution participated. Patients completed a validated telephone survey to determine their exercise habits before and following diagnosis. An unpaired t-test was run to measure the interaction between exercise tolerances on HRQOL functional and impairment domains. Those with low pre-morbid physical activity levels had more distress in HRQOL sleep and fatigue domains. The effects were independent of plasma brain-derived neurotrophic factor (BDNF) levels and the degree of exercise did not appear to impact plasma BDNF in adult glioma patients. The aim of this study was to examine the significance of exercise habits on perioperative functional outcomes in patients with low-grade or high-grade glioma. We found that glioma patients with low tolerance to exercise had more sleep disturbances and greater fatigue than glioma patients with high tolerance to exercise. Furthermore, exercise tolerance in the adult glioma population does not appear to impact plasma BDNF secretion.

Modified Broström-Gould With Gracilis Autograft Augmentation Surgery and Accelerated Noncasted Rehabilitation in High Demand Patients With Lateral Ankle Instability

Lateral ankle instability that has failed conservative management can be physically debilitating. Good outcomes are obtained from Broström-Gould augmented repair techniques, however there are few studies evaluating the use of a gracilis autograft augmentation coupled with an accelerated rehabilitation program in high functional demand patients. We believe that the modified Broström-Gould technique utilizing a Gracilis autograft will provide significant improvements in stability while maintaining normal ankle biomechanics in young, high demand patients. The prospective cohort study involved 19 patients (20 ankles) who underwent surgery for chronic lateral ankle instability by a single surgeon, at a single institution between October 2014 and April 2016. Patients were followed for 33.8 ± 11.7 (range 12-48) months. Patients were assessed both pre- and postoperatively for talar tilt angle radiographically and with both American Orthopaedic Foot and Ankle Society Ankle and Hindfoot scores and Karlsson-Peterson scores. A Tegner activity score was taken at the last follow-up. The mean American Orthopaedic Foot and Ankle Society score increased from 68.85 ± 10.57 to 91.56 ± 5.31 points (p < .01) and mean Karlsson-Peterson score increased from 50.9 ± 15.53 to 88.11 ± 8.64 points (p value <.01) when compared preoperatively to mean postoperative follow-up of 33.8 months. Tegner activity score was 7.05 ± 0.89 at last follow-up. The technique was found to be effective in treating chronic lateral ankle instability and in combination with an accelerated rehabilitation protocol, patients returned to their premorbid level of activity with improved stability and no significant effect on donor graft site morbidity.

Paediatric chronic fatigue syndrome patients’ and parents’ perceptions of recovery

ObjectivesChronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is common in children and adolescents; however, little is known about how we should define recovery. This study aims to explore perceptions of recovery held...

Atypical traumatic anterior shoulder instability with excessive joint laxity: recurrent shoulder subluxation without a history of dislocation

BackgroundNo previously published studies have examined recurrent traumatic incomplete events in patients with excessive joint laxity. The purpose of this study is to investigate outcomes after arthroscopic stabilization for recurrent traumatic shoulder subluxation in patients with excessive joint laxity but no history of dislocation.MethodsThis study included 23 patients with glenoid bone defects less than 20% who underwent arthroscopic stabilization of recurrent shoulder subluxation and were available for at least 2 years follow-up. Outcomes were assessed with the subjective shoulder value (SSV), University of California Los Angeles (UCLA) shoulder score, Rowe score, and sports/recreation activity level.ResultsPostoperatively, overall functional scores improved significantly (p < 0.001), compared to preoperative scores: SSV improved from 49.1 to 90.4; Rowe score improved from 36.7 to 90.2; and UCLA shoulder score improved from 26.3 to 32.5. Patient satisfaction rate was 87% (20/23 patients). Sports/recreation activity level (return to premorbid activity level; grade I = 100% to grade IV = less than 70%) was grade I in 7 patients, grade II in 11, grade III in 3, grade IV in 2. The incidence of any glenoid bone defect was 61% (14/23 patients), and the mean glenoid bone defect size was 8%; among these 14 patients, 8 (35%) exhibited 15–20% glenoid bone defects. Instability reoccurred in 2 patients (9%) who had 15–20% glenoid bone defect.ConclusionDespite excessive joint laxity, overall functional outcomes after arthroscopic stabilization of recurrent shoulder subluxation were satisfactory. However, arthroscopic Bankart repair may not be reliable in patients with excessive joint laxity plus a glenoid bone defect size of more than approximately 15%.

Outcome of surgical management of stress fractures in high demand individuals.

Stress fractures represent one-fifth of overuse injuries in sport. Successful healing of stress fractures in high demand individuals is important to prevent complications upon early return to activity. This article reviews the literature on outcomes of surgical management of stress fractures in high demand individuals. An online literature search was carried out for articles published up to and including January 2017. Twenty five papers were reviewed. In the majority of studies, no complications were reported, clinical and radiographic healing was achieved, and patients returned to their premorbid level of activity. Current literature suggests good outcomes after surgical management of stress fractures in high demand individuals, particularly those in whom conservative treatment has failed. Further studies comparing surgical techniques are necessary to demonstrate the most efficacious.

Comparative study between proximal femoral nail and bipolar prosthesis in intertrochanteric fracture femur

Objective: To evaluate the clinical outcome and compare the advantages, disadvantages and possible complications associated with fixation of intertrocantric fractures with proximal femoral nail (PFN) and hemiarthroplasty. Introduction: Surgery in trochanteric fractures is important in elderly patients for prevention of complications associated with conservative treatment like pressure sores, pulmonary infection, malunion etc, and aimed at early rehabilitation and mobilization. Internal fixation does provide immediate fracture fixation. The present study was undertaken to compare outcomes of reduction of intertrochanteric fractures using internal fixation with the use of PFN and bipolar hemiarthroplasty (BPH) in elderly patients. This study compares bipolar hemiarthroplasty with proximal femoral nail (PFN) in ambulatory elderly patients, focusing on functional results and return to premorbid level of activity. Treatment modality like DHS is time tested but with availability of better hemiarthroplasty techniques and implant, mortality and morbidity can be reduced. This study was undertaken to compare clinical outcomes of intertrochanteric fractures treated with PFN compared to bipolar hemiarthroplasty (BPH) in elderly patients Methodology: A Prospective Comparative Study was conducted in 20 elderly patients who were admitted and operated between November 2013 to November 2015 and had fulfilled the inclusion /exclusion criteria. They were allocated into two groups 10 patients each for PFN and BIPOLAR PROSTHESIS as group A and group B respectively. Harris hip score was used for assessment of the results of surgery. The results thus obtained was analysed and compared. Results: 8 of the 10 patient treated with PFN and 9 of the 10 patient treated with Bipolar regained their pre injury walking ability at the fourth month of follow-up. Patients treated with PFN had a significantly lower pain score at the sixth month of follow up. The outcomes of the stable fractures treated with either Bipolar or PFN were similar. Unstable comminuted fractures treated with Bipolar showed significantly better outcomes with all patients having good results.

Functional outcome of fixation of unstable distal end radius fracture with volar buttress plating, A prospective study

Background: Distal end of radius fracture accounts for 17% of all fractures in adults. The primary goal of treatment is to return the patient to his or her pre fracture functional status and to independent to carry out there daily needs. There are multiple options for distal end radius treatment, CRIF with K wire / external fixator, But there are disadvantages like malunion, pin tract infection, which may results in poor range of movement. Hence ORIF with volar plating is commonly done for unstable distal end radius. Materials and methods: In this study 30 patients with age above 18 years with distal end radius fractures treated with ORIF with volar plating. same post operative protocol, complications of surgery Intra operative and post operative were observed, functional outcome of all patients were recorded at regular follow up assessed with modified Gartlad & Werley’s wrist grading system.Results: In ORIF with volar plating, we noted patient with poor outcome of 10%, fair outcome of 23.33%, good outcome of 50% and excellent outcome of 16.67% at the end of 6 months. With mean range of movement Flexion =66.50, Dorsiflexion = 69.830, Radial deviation =18.830, Ulnar deviation =27.170, Pronation 700, Supination =72.670 and patient with satisfactory ROM with no complications. Conclusion: ORIF with volar plating is a successful procedure for distal end radius fractures. Early return to pre morbid level of activity and functions occurs very swiftly.

Conservative Management of a Femoral Neck Stress Fracture in a Female Athlete. A Case Report and Review of the Literature

Femoral-neck stress fractures are relatively rare and may present as sports-related injuries. The presentation is variable, and prompt diagnosis facilitates the earliest return to pre-morbid functional activity levels. Delayed detection may precipitate femoral non-union or avascular necrosis, resulting in long-term functional deficit. We describe the clinical, diagnostic and therapeutic approach of a femoral-neck stress fracture that occurred in a 28-year-old female recreational runner. The pathophysiology and practical management issues related to this unusual injury pattern are discussed. The growing interest in amateur athletic activities should raise the index of suspicion for stress fractures of the femoral neck in healthy adults with atypical hip pain. In-creased levels of patient education and physician awareness can reduce the incidence of long-term morbidity in cases of this unusual sports-related injury. Moreover, measures to avoid stress fractures of the femoral neck should include proper nutrition, suitable training techniques, training intensity and appropriate foot wear. Close follow-up of athletes with a history of deep groin pain during exercise might, together with swift examination by magnetic resonance imaging or radionuclide scanning, be essential in preventing displacement of fractures and possible avascular necrosis of the femoral head as a consequence.

Arthroscopic Hip Labral Reconstruction and Augmentation Using Knotless Anchors

Biomechanical stability is the primary function of the acetabular labrum. It provides a hip suction seal and optimal joint function. Labral tears are a common reason for hip arthroscopy, to improve patient function and to prevent long-term degenerative arthropathy. Arthroscopic labral repair has shown significantly better outcomes in return to premorbid activity levels when compared with labral debridement. Injury to the acetabular labrum is a challenge and can lead to long-term complications. In this scenario, arthroscopic labral reconstruction has shown good results regarding patient subjective and objective outcomes. We describe a technique for complete arthroscopic labral reconstruction using tensor fascia lata allograft.

Left Atrial Myxoma - An Unusual Cause of Dyspnoea

A 58 year old hypertensive lady presented to her General Practitioner with a 3 month history of exertional dyspnoea, paroxysmal nocturnal dyspnoea, orthopnoea, decreased appetite and weight loss of 10 kilograms. Physical examination revealed a non-radiating apical soft systolic murmur and mild bipedal oedema, but was otherwise unremarkable. Electrocardiogram demonstrated normal sinus rhythm only and a chest radiograph was normal. She was initiated on heart failure therapy with little improvement. Her symptoms progressed to dyspnoea on minimal exertion. Trans-thoracic echocardiography demonstrated a large echogenic mobile mass measuring 4.8 centimeters (cm) by 3.6 cm in the left atrium (LA) attached to the inter-atrial septum (Figure 1A). The mass occupied approximately 70% of the LA and protruded towards the mitral valve leaflets causing transient obstruction of the left ventricular (LV) inflow (Figure 1B). No vasculature was seen within the mass. Overall LV function was preserved. Urgent coronary angiography excluded concurrent coronary artery disease prior to transfer to a tertiary cardiothoracic unit. The patient underwent surgery within 24 hours and excision confirmed a large atrial myxoma. She recovered well with a rapid return to her pre-morbid level of activity. This case highlights the importance of urgent echocardiography in a dyspnoeic patient presenting with alarming symptoms. It supports previous studies which have illustrated two-dimensional echocardiography as a fast, accurate and a non-invasive diagnostic procedure for left atrial myxomas [1].

Contributing factors in children who present with calcaneal apophysitis

Background: Rupture of the Anterior Cruciate Ligament (ACL) results in increased tibiofemoral laxity and usually disturbs neuromuscular function, thereby ultimately resulting in knee instability and dysfunction. However, ACL rupture does not automatically result in functional impairment and instability, as confirmed by the ACL deficient (ACLD) coper, who can resume pre-morbid activity levels. Few studies have shown that ACL reconstruction (ACLR) actually restores dynamic knee stability or enables full return to pre-injury activity level in most individuals. The purpose of this meta-analysis was to review the dilemma regarding which ACL injured individuals need to undergo ACLR. Methods: Electronic searches of Medline, EMBase, CINAHL and the Musculoskeletal Injuries Group’s specialized register were performed up to June 2009 using medical subject headings and free-text words. Subject-specific search was based on the terms “ACL rehabilitation”, “copers” “noncopers”. Results: Three prospective, longitudinal trials have been undertaken following an ACL screening examination. Copers (nonoperated) and noncopers (operated) have been followed over a few years post-injury. The results show that a similar percentage of subjects in both groups return to sporting activity. Regarding the differences between copers and noncopers, there exists investigative evidence that noncopers have deficits in quadriceps strength, vastus lateralis atrophy, quadriceps activation deficits, altered knee movement patterns, reduced knee flexion moment, higher quadriceps/hamstring co-contraction and a tendency to hold the tibia in a more posterior position. Conclusion: No single measurement tool is sufficient in determining the functional status of the ACLD individual. Passive instability tests are a poor predictor of future rehabilitation outcome. A collaboration of tests to determine the functional status of the ACL deficient individual is recommended, specifically incorporating the KOS-Sport, Global Knee Function Rating, hop tests and Quadriceps Index. The ACL screening examination shows preliminary evidence for detecting potential copers, however a gold-standard method of detecting who will be successful is still lacking. ACL injured subjects should be informed of the possibility of good knee function following a non-operative rehabilitation program.

Arthroscopic Stabilization for Recurrent Shoulder Instability With Moderate Glenoid Bone Defect in Patients With Moderate to Low Functional Demand

The purpose of this study was to investigate the functional outcomes of arthroscopic Bankart repair for recurrent shoulder instability in the setting of moderate glenoid bone defect ranging from 20% to 30% in patients with moderate to low functional demand. This study included 36 patients with unilateral recurrent instability and glenoid bone defects of 20% to 30% treated with arthroscopic stabilization. Glenoid bone loss was estimated on the en-face view of preoperative 3-dimensional computed tomography. Joint laxity was assessed clinically by use of the Beighton and Horan criteria, and patients were divided into 2 groups based on the presence of excessive joint laxity, group L (n=13), or absence of excessive joint laxity, group N (n= 23). Functional assessments were performed with the patient-reported activity level; subjective shoulder value; Rowe score; and University of California, Los Angeles shoulder score. The mean glenoid defect size was 25.1% (range, 20% to 29%), and the overall functional outcomes improved significantly after surgery. A return to greater than 90% of the premorbid activity level was reported by 72% of patients (26 of 36 patients), and patient satisfaction was 83% (30 of 36 patients). There was no significant difference in functional outcomes between groups L and N (subjective shoulder value, 85.0% for group L v 88.9% for group N, P= .397; Rowe score, 83.5 for group L v 92.8 for group N, P= .537; and University of California, Los Angeles shoulder score, 32.2 for group L v 31.9 for group N, P= .697). Recurrent instability occurred in 4 patients (11%), 3 patients in group L (3 of 13, 23%) and 1 patient in group N (1 of 23, 4%), but this difference was not statistically significant (P= .125). Arthroscopic stabilization for recurrent shoulder instability in patients with moderate to low functional demand produced satisfactory outcomes despite the presence of moderate glenoid bone defects of 20% to 30%. For patients with excessive joint laxity, however, arthroscopic stabilization may not be reliable, with a recurrence rate of 23%. Level IV, therapeutic case series.

Anterior Cruciate Ligament injured copers and noncopers: The surgical dilemma revisited

Background: Rupture of the Anterior Cruciate Ligament (ACL) results in increased tibiofemoral laxity and usually disturbs neuromuscular function, thereby ultimately resulting in knee instability and dysfunction. However, ACL rupture does not automatically result in functional impairment and instability, as confirmed by the ACL deficient (ACLD) coper, who can resume pre-morbid activity levels. Few studies have shown that ACL reconstruction (ACLR) actually restores dynamic knee stability or enables full return to pre-injury activity level in most individuals.

Contributing factors in children who present with calcaneal apophysitis

Background: Rupture of the Anterior Cruciate Ligament (ACL) results in increased tibiofemoral laxity and usually disturbs neuromuscular function, thereby ultimately resulting in knee instability and dysfunction. However, ACL rupture does not automatically result in functional impairment and instability, as confirmed by the ACL deficient (ACLD) coper, who can resume pre-morbid activity levels. Few studies have shown that ACL reconstruction (ACLR) actually restores dynamic knee stability or enables full return to pre-injury activity level in most individuals. The purpose of this meta-analysis was to review the dilemma regarding which ACL injured individuals need to undergo ACLR. Methods: Electronic searches of Medline, EMBase, CINAHL and the Musculoskeletal Injuries Group’s specialized register were performed up to June 2009 using medical subject headings and free-text words. Subject-specific search was based on the terms “ACL rehabilitation”, “copers” “noncopers”. Results: Three prospective, longitudinal trials have been undertaken following an ACL screening examination. Copers (nonoperated) and noncopers (operated) have been followed over a few years post-injury. The results show that a similar percentage of subjects in both groups return to sporting activity. Regarding the differences between copers and noncopers, there exists investigative evidence that noncopers have deficits in quadriceps strength, vastus lateralis atrophy, quadriceps activation deficits, altered knee movement patterns, reduced knee flexion moment, higher quadriceps/hamstring co-contraction and a tendency to hold the tibia in a more posterior position. Conclusion: No single measurement tool is sufficient in determining the functional status of the ACLD individual. Passive instability tests are a poor predictor of future rehabilitation outcome. A collaboration of tests to determine the functional status of the ACL deficient individual is recommended, specifically incorporating the KOS-Sport, Global Knee Function Rating, hop tests and Quadriceps Index. The ACL screening examination shows preliminary evidence for detecting potential copers, however a gold-standard method of detecting who will be successful is still lacking. ACL injured subjects should be informed of the possibility of good knee function following a non-operative rehabilitation program.