Quadriceps Strengthening Research Articles

Return to Sports After Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament (ACL) tears are one of the most common orthopedic injuries among athletes. Although a small proportion of patients with isolated tears can return to sports after completing a nonsurgical rehabilitation program, ACL reconstruction is frequently recommended for young athletes, especially those with concomitant knee injuries or symptomatic knee instability. Alongside emerging evidence for the effect of prehabilitation, the current standard of care for postoperative ACL physical therapy includes pain control, range of motion, quadriceps strengthening, weight bearing, postoperative bracing, and dynamic limb stabilization and control. The early rehabilitation period includes non-weight-bearing exercises and passive range of motion, which is followed by a longer period of gradual strengthening focused on regaining preinjury strength, proprioception, and control with progressively more demanding dynamic movements. The total rehabilitation period is expected to take around 9 months, during which the patient should be evaluated at frequent intervals by a licensed physical therapist in addition to a daily home exercise program. Prior to discharge from the rehabilitation program, patients should be evaluated by both the surgeon and physical therapist. Patients are encouraged to return to sports once they meet a set of perceptual, subjective, objective, neuromuscular, functional, sport-specific drills, and load management testing criteria.

Combined Hip and Knee Strengthening Compared With Knee Strengthening for Individuals With Lateral Patellar Dislocation: A Single-blind, Superiority, Randomized Controlled Trial

ObjectiveTo investigate whether a combined hip and knee muscle strengthening program is superior to a knee strengthening program for people after lateral patellar dislocation (LPD). DesignSingle-blind, superiority, randomized controlled trial with 48 weeks follow-up. SettingPhysiotherapy out-patient clinic. ParticipantsForty individuals aged 16 or older, with a history of non-traumatic LPD were randomized to a knee-based strengthening (KBSG) or quadriceps and hip strengthening exercise (HQSG) program (N=40). Inclusion criteria included a positive apprehension sign, pain on palpation along the medial retinaculum, and J sign. Exclusion criteria included restricted range of motion (<90° knee flexion), and traumatic or postsurgical LPD. InterventionsConcealed randomization was performed using random permuted blocks of size 4. Individuals received their corresponding exercise program according to randomization and group allocation: knee-based strengthening (n=20) or combined hip and quadriceps strengthening (n=20) twice weekly for 8 weeks over 16 appointments. Main Outcome MeasuresPrimary outcome was the Lysholm Knee Score. Secondary outcomes included Numerical Pain Ratings Scale (NPRS) at rest and during effort, Norwich Patellar Instability Score (NPIS), Kujala Anterior Knee Pain Scale (AKPS), Lower Extremity Functional Scale (LEFS), 4 domains of the WHOQOL-Bref, and recurrence rate. Patient-reported outcome measures were assessed from the baseline to 48 weeks. Assessments were performed by a physiotherapist who was blinded to the group allocation. Data were analyzed by using a repeated-measures ANOVA model with Tukey's post hoc test after an intention-to-treat principle. ResultsAt the primary time-point of 8 weeks, there were no substantial between-group differences in the Lysholm Knee Score: mean difference=-6.8 (95% CI -14.3 to 3.7); NPIS: mean difference=23.5 (95% CI 5.6 to 41.3); AKPS: mean difference=-1.54 (95% CI -8.6 to 5.6), NPRS at rest and during effort (mean difference=0.32 (95% CI -0.37 to 1); and mean difference=0.68 (95% CI -0.9 to 1.86); LEFS mean difference=-1.08 (95% CI -5.9 to 2.4), WHOQOL-Bref domains (physical health: mean difference=-0.12, (95% CI -1.26 to 1.02); psychological: mean difference=-0.32 (95% CI -2.04 to 1.4); social relations: mean difference=-0.7 (95% CI -2.2 to 0.82); environment: mean difference=0.44 (95% CI -1 to 1.9), and recurrence rate (P=.69). ConclusionThis study indicates that combined hip and knee muscle strengthening is not superior to knee-based strengthening for LPD treatment. The limitations stemming from the underpowered nature of the trial must be acknowledged, concerning the potential oversight of moderate intervention effects.

COMPARISON OF PATELLAR MOBILIZATION AND TAPING IN PATIENT WITH PATELLOFEMORAL PAIN SYNDROME

Background of the Study: To compare patellar taping and mobilization plus conventional therapy for reducing knee pain in patients with patellofemoral pain syndrome (PFPS). Methodology: Controlled trial with 50 participants divided into two groups who received different treatments for 6 weeks: Group A had patellar taping and iliotibial band stretching, while Group B had patellar mobilization and quadriceps strengthening. Participants received three treatment sessions weekly for six weeks. The VAS was used to conduct pre and post-test pain evaluations for groups A and B. Results: Knee pain decreased in PFPS patients receiving patellar taping (Group A) or mobilization (Group B) using VAS (p&lt;0.05). All treatments are effective for PFPS. The VAS scores after 6 weeks of post A and post B treatments assessed. After 6 weeks of taping, mean = 0.76±0.83. After 6 weeks, mean and SD = 1.20±1.12 from patellar mobilization. No significant difference between means (p = 0.12, α ≤ 0.05). Insignificance. Conclusion: The result of the study indicated that after 6 weeks of treatment for both patellar taping and patellar mobilization were effective in decreasing pain in PFPS. Keywords: Syndrome, mobilization, taping, visual analogue scale, pain, rehabilitation.

Effectiveness of Structured Exercise Protocol on Muscle Imbalance of Quadriceps and Hamstrings in Postmenopausal Obese Women

Background and Objectives: In a woman who experienced menopause, there is a decrease in the strength of the muscle due to hormonal changes and because of several changes related to the hormones that occur in the body, it affects the body’s BMI which then affects to daily life. Physiotherapy is an effective way of reducing the majority of difficulties while doing daily activities and thereby improving overall health. The study aims to determine how the structured exercise protocol affects a muscle imbalance of hamstrings and quadriceps in postmenopausal obese women. Methodology: This research study was carried out on 50 females who experienced menopause and were between the age group 50-60 years the inclusion criteria were satisfied by them and they were divided into 2 groups randomly. Pre-interventional and post-interventional measurements were taken by Modified Sphygmomanometer, by 90-90 SLR test, Range of knee joints by goniometer also pain was assessed. Group A (the Control group) received the treatment which included hot moist therapy along with hamstrings active stretching, isometric exercises for both hamstrings and quadriceps and quadriceps strengthening and Group B received the treatment which included mulligans technique for hamstrings and for quadriceps muscle, MET technique was used. Both groups received the treatment for 6 weeks. Results: Statistically significant changes (with p-value &lt;0.05) were seen in the pre and post-interventional measurements. But the value of the mean shows more progress in group B compared to group A. Research Conclusion: Both protocols are useful in the treatment of muscle imbalance in quadriceps and hamstrings in postmenopausal obese women but the Structured exercise protocol is more effective than the conventional protocol for muscle imbalance of quadriceps and hamstrings in postmenopausal obese women.

Effectiveness of Lateral Shoe Wedging along with Quadriceps Strengthening and Life Style Modification in Knee Osteoarthritis

Background: Knee osteoarthritis (OA), a common degenerative joint disorder, significantly impairs quality of life due to pain and functional limitations. Non-surgical interventions like lateral shoe wedging and quadriceps strengthening exercises are increasingly considered viable options for managing OA symptoms. Objective: To assess the efficacy of lateral shoe wedges, both alone and in combination with quadriceps strengthening exercises, in treating medial knee OA. Methods: In this randomized controlled trial, 60 adults with medial knee OA were assigned to one of three groups: Group A received only lateral shoe wedges; Group B received lateral shoe wedges and quadriceps strengthening exercises; Group C received lateral shoe wedges with lifestyle modifications. Measurements for pain, stiffness, and physical function were taken using the Numeric Pain Scale and WOMAC scale at baseline, 8 weeks, and 16 weeks. Results: By Week 16, Group A (wedge only) reported a 70% compliance rate, with no significant changes in WOMAC stiffness and physical function scores. Group B (wedge &amp; exercise) showed an 80% compliance rate, with pain scores reducing from 2.50±0.945 to 1.40±1.231 and significant improvements in WOMAC stiffness (1.40±1.231) and physical function (1.50±1.147). Group C (wedge &amp; lifestyle modification) achieved a 100% compliance rate, with moderate improvements in all measured parameters. Conclusion: The study concludes that the combination of lateral shoe wedging and quadriceps strengthening exercises (Group B) was most effective in alleviating pain and improving physical function in patients with medial knee OA. This suggests that a multimodal approach may be superior to singular interventions for managing OA symptoms.

Effect of Vastus Medialis Oblique Strengthening Versus Mulligan Knee Taping Technique (Mcconnell Tape) on Patellofemoral Pain Syndrome: A Comparative Study.

This study aims to determine the effectiveness of Vastus medialis oblique (VMO) strengthening and conventional therapy treatment (group A) andMulligan knee taping technique(McConnell tape) and conventional therapy treatment (group B) in patients with patellofemoral pain syndrome by VAS for pain andKPS for anterior knee pain scale is to compare VMO strengthening Versus Mulligan knee taping technique using McConnell tape in patellofemoral pain syndromeusing VAS for assessing pain and Kujala patellofemoral scale to assess knee pain and function. The most frequent cause of knee discomfort with retro patellar orperipatellar pain is patellofemoral pain syndrome (PFPS). The need for further studies to better understand the causes and treatment of PFPS is essential to provideoptimal care for individuals experiencing pain in the knee. Physical therapy is considered the most effective treatment for PFPS, but more research is needed todetermine each individual's best course of action. Proper diagnosis is the key to successful treatment and prevention of PFPS. Early intervention is also important forbetter outcomes. Patellofemoral pain syndrome (PFPS), which is often used interchangeably with "anterior knee pain" or "runner's knee," is the clinical entity ofstiffness or pain or both on prolonged sitting with the knees flexed and pain with activities that load the patellofemoral joint, such as climbing or descending stairs,squatting, running and kneeling. Varieties of conservative treatments are suggested, like quadriceps strengthening, stretching, braces and straps, electrotherapy, footorthosis, patellar taping, etc. Hence, a comparison between the vastus medialis obliqus muscle strengthening and patellar taping was undertaken to determine theireffectiveness concerning pain and function. A well-organized research study was conducted over 12 months to investigate the impact of strengthening the vastusmedialis oblique muscle and applying conventional therapy treatment. Group A received this combination of treatments, while Group B was assigned a treatmentprotocol involving the use of McConnell tape along with conventional therapy treatment. After taking informed and written consent, 30 subjects diagnosed withunilateral or bilateral PFPS were randomly selected and allocated into two groups - Group A (VMO muscle strengthening and conventional therapy treatment) andGroup B (Mulligan knee taping technique (McConnell tape) and conventional therapy treatment). Both groups received 6 therapy sessions every alternate day for 6weeks. The visual analog scale (VAS) and Kujala patellofemoral scale (KPS) measured pre and post-pain and function. "T-Test" was used for statistical analysis. Therewas a significant improvement in pain and function in patients with Patellofemoral pain syndrome at the end of 6 weeks regarding VAS and KPS within both groups,i.e., groups A and B (p&lt;0.01). But there was no significant difference regarding improvement in pain and functional status in patients with Patellofemoral painsyndrome at the end of 6 weeks in terms of VAS and KPS between groups. The effect of conventional therapy treatment along with VMO muscle strengthening issimilar to the conventional therapy treatment along with patellar taping in improving pain and functional level in patients with patellofemoral pain syndrome at theend of 6 weeks.

Physiotherapeutic interventions on quadriceps muscle architecture in patello-femoral pain syndrome.

Quadriceps weakness and morphological alteration is a documented phenomenon that can have a major impact on strength and functional performance of PFPS patients. An effective and trustworthy non-invasive technique for measuring the quadriceps muscle's anatomy and architecture is B- Mode Ultrasonography. The aim of the study is to assess and compare the effectiveness of neuromuscular electrical stimulation application, quadriceps strengthening and in combination on the quadriceps muscle architecture and functional capacity in patients with Patello femoral pain syndrome. One hundred and twenty-four participants aged 18 - 40 years old with anterior knee pain were included. Participants were randomly allocated into four groups. Group A participants were given NMES, group B were given QS, group C were given combination therapy (NMES+QS) and group D was control group. Cross sectional area, Fascicle length and pennation angle were measured using B-Mode (2D) ultrasound for Quadriceps Femoris muscle. Knee function and pain were assessed using Kujala score and VAS. All parameters were evaluated before and after the intervention. The mean age, weight, height and BMI of control, NMES, QS and NMES+QS were not statistically significant (P = 0.881, 0.960, 0.951 and 0.953) which shows that the control and experimental groups were homogenous. Combination group showed significant improvement when compared to QS group followed by NMES group. Control group did not show any improvement. Neuromuscular Electrical Stimulation in combination with quadriceps strengthening showed a better outcome than in isolation on quadriceps muscle architecture after 10 weeks.

Open Popliteus Tendon Reconstruction Using a Hamstring Tendon Autograft

The popliteus tendon plays a critical role in restraining the tibia against external rotation. It is often injured in the setting of posterolateral corner injuries. However, it is rarely injured in isolation from other structures of the posterolateral corner. This Technical Note describes an open anatomic reconstruction of the popliteus tendon. Although several techniques exist, this technique has been biomechanically validated and shown to have good outcomes. An early rehabilitation protocol focused on protected range of motion, edema control, quadriceps strengthening, and pain control is essential for maximizing patient outcomes.

KONDROMALAZİ PATELLA TANILI OLGULARDA KUADRİSEPS GÜÇLENDİRİCİ İZOMETRİK VE İZOTONİK EGZERSİZLERİN AĞRI, YAŞAM KALİTESİ VE FONKSİYONEL KAPASİTE ÜZERİNE ÜSTÜNLÜKLERİNİN KARŞILAŞTIRILMASI

Purpose: This study aims to investigate the superiority of different exercise modalities, including isotonic and isometric strengthening for quadriceps, over each other and their effect on pain, quality of life and functional capacity in patients diagnosed with chondromalacia patellae (CMP). &#x0D; Methods: This study was designed as a prospective study in 30 patients(15 patients in isometric, 15 patients in isotonic group) and 15 healthy volunteers aged 20–50 years who were diagnosed with CMP based on physical examination and magnetic resonance imaging and had pain complaints. Pain level was evaluated with Visual Analogue Scala (VAS), functional capacity with Lysholm scale, and quality of life with Short Form-36(SF-36). Q-angle, and thigh circumference were evaluated before and after exercise in all patients. &#x0D; Results: In patients with CMP, there were significant differences in Q-angle, pain, functional capacity, and some subcomponents of the SF-36 quality of life after performing isometric or isotonic exercises compared with the control group (p0,05). In the evaluation of the isotonic and isometric exercise groups, there were no significant difference in the assessment of Q-angle, thigh circumference, pain, functional capacity, and quality of life of patients with CMP (p&gt;0,05).&#x0D; Conclusion: Isometric and isotonic quadriceps strengthening exercises are not superior to each other in terms of pain, functional capacity, and quality of life in CMP treatment.

Effect of hip abductors and lateral rotators' muscle strengthening on pain and functional outcome in adult patients with patellofemoral pain: A systematic review and meta-analysis.

Even though literature indicates presence of weak hip abductors and lateral rotators' in Patellofemoral Pain (PFP), studies evaluating the effect of hip abductors and lateral rotators strengthening to improve knee function and quality of life in PFP are limited. This study systematically reviews and meta-analyzes the best evidence on the therapeutic value of strengthening hip abductors and lateral rotators muscles for treating PFP with a presumptive hypothesis that strengthening hip muscles stabilizes the patellofemoral joint, relieves pain, and enhances knee functions. Medline, EMBASE, CINAHL, PEDro and PubMed Central databases were searched between January 1994 and September 2019 using the PICOS tool. The methodological quality of the selected studies were appraised individually using the 20-item McMaster Critical Review Form for Quantitative Studies. Supplemental quality appraisal of randomized controlled clinical trials performed using the Cochrane Collaboration's 'Risk of bias' quality criteria. Data on patient population demographics, interventions, duration of intervention, and outcome measures were extracted and summarized in evidence tables and descriptive analysis. Meta-analyses under both fixed and random-effects models determined pooled effects size from appropriate RCTs. All fourteen studies demonstrated that hip muscle strengthening improved pain and knee function. All RCTs, except one, demonstrated that hip muscle strengthening is superior to quadriceps strengthening. Of the five RCTs assessing the additional effect of hip-quad versus quadriceps strengthening, four suggested that hip-quad strengthening is superior to standard quadriceps strengthening alone to improve PFP and knee function. In adult patients with PFP, strengthening hip abductors and lateral rotators' have beneficial therapeutic effects than the conventional quadriceps exercises in improving knee pain and function both in the short- and long term. However, the present review data can be used to develop a standardized hip-quad protocol in the future.

Effect of Isometric Exercises (Quadriceps Strengthening) in Patients with Osteoarthritis Knee

Effect of Isometric Exercises (Quadriceps Strengthening) in Patients with Osteoarthritis Knee

Recovery of Quadriceps Strength and Knee Function Using Adjuvant EMG-BF After Primary ACL Reconstruction

Introduction: Immobility and limited usage of operated limbs lead to weakness and atrophy of the muscle after anterior cruciate ligament (ACL) reconstruction. However, training programs for preventing biomechanical risk factors such as lower limb alignment and increased muscular contraction are very limited. Thus, the current study was carried out to evaluate the recovery of quadriceps muscle strength and the improvement of knee function using adjuvant electromyographic biofeedback (EMG-BF) after ACL reconstruction. Methods: This prospective randomized controlled trial was conducted among 40 patients (20=EMG-BF group, 20=Control group) with ACL reconstruction, who were referred to Akhtar Hospital from 2021 to 2022. In the EMG-BF group, EMG BFB was added to the standard rehabilitation protocol, and in the control group, the standard rehabilitation protocol with full postoperative weight-bearing, knee brace (zero degree of extension, 90 degrees of flexion), and electrical stimulation with maximal voluntary isometric knee extension was performed. Each group was intervened for 4 weeks and three sessions of 30 minutes per week. It should be noted that each patient participated in 16 outpatient physiotherapy sessions after surgery. Nicholas Hand-Held Dynamometer (HHD) was used for measuring quadriceps strength, and Knee Outcome Survey-Activities of Daily Living (KOS-ADLs) and Knee Outcome Survey Sports Activities Scale (KOS-SAS) questionnaires were used for assessing the knee function. Results: Four weeks after the treatment, the EMG-BF group showed a significant increase in quadriceps strength (P=0.0001). Quadriceps strength had a significant difference before and after 4 weeks of intervention (P=0.0001), but in the control group, no significant difference was observed (P=0.368). The EMG-BF group had a significant increase in KOS-ADLs and KOS-SAS scores after 4 weeks of intervention (P=0.0001). Conclusion: In our study, isometric strengthening of quadriceps with adjuvant EMG-BF significantly increased the strength of quadriceps and knee function during 4 weeks. EMG-BF is a low risk, low cost, and less invasive intervention and has high safety and adjustment ability. It is a valuable adjuvant method for achieving better functional recovery in a shorter time.

Fortalecimento do quadríceps através do método Kaatsu Training em mulheres com dor femoropatelar

ABSTRACT This is a cross-sectional, comparative, and randomized study aimed to evaluate the effects of the partial vascular occlusion technique (Kaatsu Training) associated with low load exercises in the muscle strengthening of quadriceps in women with patellofemoral pain. We evaluated 18 women with patellofemoral pain, aged from 18 to 35 years, allocated into two groups. The experimental group performed the strengthening with blood flow reduction with the aid of a sphygmomanometer, associated with low load (≅20% RM). Whereas the control group performed exercises with the same load, but without blood flow reduction. The treatment was performed three times a week for six weeks, totaling 18 sessions. We used the numerical pain rating scale (NPRS) and the anterior knee pain scale (AKPS) questionnaire for evaluation; we evaluated the muscle strength of knee extensors by the digital dynamometer. The results showed that the partial vascular occlusion technique significantly improved the values of quadriceps strength gain in the right, 6.22kg (p=0.03) and left limb, 6.98kg (p=0.04), in women with patellofemoral pain. Therefore, training with partial vascular occlusion can be useful for strengthening of the knee extensor musculature in women with patellofemoral pain who, because of the pain, have low tolerance to high load exercises for muscle strengthening. An effective, safe and cost-effective technique, which does not require an investment in a leg extension machine, since, with a cuff, low load exercises can offer significant results.

Popliteus Tendon Injuries.

Popliteus tendinopathies are rare injuries that can occur from overuse, trauma, or secondary causes, such as sesamoid bones or calcifications. They present with nonspecific symptoms and should be considered in any patient with posterolateral knee pain, instability, popliteus tenderness, and a positive Garrick test. Diagnosis can be made with magnetic resonance imaging, but arthroscopy remains the criterion standard. For minor popliteus tendinopathies, initial management involves conservative treatment, including rest, activity modification, physical therapy, and quadriceps strengthening. For more severe or refractory disease, corticosteroid injections and arthroscopy should be considered. [Orthopedics. 2023;46(4):e193-e198.].

Surgical Principles for Lateral Collateral and Posterolateral Knee Injuries

Injuries of the posterolateral corner of the knee have historically been difficult to treat. The primary stabilizers of the posterolateral corner include the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. Proper treatment of these injuries requires complete clinical workup including stress radiographs, alignment imaging, and magnetic resonance imaging. Recent developments in the understanding of the bony and soft tissue anatomy of the posterolateral corner have allowed for the development of verified anatomic based reconstruction techniques. These techniques, when performed in the acute window, have been shown to have good outcomes in patients as they restore the native kinematics of the knee. Early rehabilitation should begin on postoperative day 1 and focus on protected range of motion and quadriceps strengthening.

ACL Rehabilitation: How Can We Lessen Injury Rates?

Rehabilitation is commonly used following anterior cruciate ligament (ACL) injury, though specific protocols are widely varied. Regardless of whether the injury is managed operatively or nonoperatively, quadriceps strengthening and return to full range of motion are the main focus points of rehabilitation, both to regain function and prevent future injury. Preoperative ACL rehabilitation has been shown to improve clinical outcomes. Home exercise programs can also provide good clinical outcomes when compared to traditional in-person physical therapy. A multitude of specific modalities (bracing, functional testing, neuromuscular training, electrostimulation, cryotherapy, and blood flow restriction therapy) may also provide benefit in ACL rehabilitation. Analysis of biomechanics during rehabilitation allows for customization of rehabilitation approaches, provides insight on muscular deficiencies, and helps ACL-injured patients re-establish functionality with the goal of preventing future ipsilateral or contralateral injury. Given the lack of consensus on rehabilitation protocols following ACL injury, the purpose of this review was to examine the efficacy of a variety of protocols and specific modalities and discuss their roles in the prevention of future ACL injury.

Patellar MACI With Tibial Tubercle Osteotomy

Background: Chondral pathology is frequently encountered during knee arthroscopies with a prevalence rate of 63% to 66%. Prior studies have demonstrated that unaddressed or excised fragments result in poor knee function and arthritis. As a result, chondral-related procedures have increased in popularity, and now more than 200,000 procedures are performed annually. Indications: We present a case of an active 32-year-old woman, prior collegiate basketball player, with persistent left knee pain noted to have a full-thickness patellar articular cartilage defect and maltracking. Technique: A patellar autologous matrix-induced chondrocyte is implanted with a concomitant tibial tubercle osteotomy (TTO) and lateral retinacular lengthening. Results: At 9 weeks, the patient had no knee pain with full range of motion symmetric to the contralateral side while slowly progressing with quadriceps strengthening. Discussion/Conclusion: Successful outcomes addressing large patellar chondral defects and maltracking can be achieved with matrix autologous chondrocyte implantation and concomitant TTO with lateral retinacular lengthening.

Training Benefits and Injury Risks of Standing Yoga Applied in Musculoskeletal Problems: Lower Limb Biomechanical Analysis.

Standing yoga poses strengthen a person’s legs and helps to achieve the goal of musculoskeletal rehabilitation, but inadequate exercise planning can cause injuries. This study investigated changes in the electromyogram and joint moments of force (JMOFs) of lower extremities during common standing yoga poses in order to explore the feasibility and possible injury risk in dealing with musculoskeletal problems. Eleven yoga instructors were recruited to execute five yoga poses (Chair, Tree, Warrior 1, 2, and 3). The results revealed significant differences in hip, knee, and ankle JMOFs and varying degrees of muscle activation among the poses. Among these poses, rectus femoris muscle activation during the Chair pose was the highest, Warrior 2 produced the highest muscle activation in the vastus lateralis of the front limb, while Warrior 1 had the highest muscle activation in the vastus medialis of the back limb. Therefore, all three poses can possibly be suggested as a therapeutic intervention for quadriceps strengthening. Warrior 1 was possibly suggested as a therapeutic intervention in order to reduce excessive lateral overload of the patella, but the possible adverse effects of Warrior 2 with the highest knee adductor JMOF in the back limb could raise joint reaction forces across the medial condyles. In single-leg balance postures, Warrior 3 had unique training effects on the hamstring, and is therefore suggested as a part of hamstring rehabilitation exercises. The Tree pose induced low lower-extremity JMOFs and a low level of thigh muscle activations when it was performed by senior instructors with excellent balance control; however, for yoga beginners with insufficient stability, it will be a useful training mode for strengthening the muscles that help to keep one upright. This study quantified the physical demands of yoga poses using biomechanical data and elucidated the structures and principles underlying each yoga movement. This is crucial for yoga practitioners.

Acute Knee Injury During Professional Basketball Tournament In A ‘Bubble’ Setting

HISTORY: A 30 year-old professional male basketball athlete experienced sharp left knee pain after planting extended leg with knee in slight flexion during an abrupt defensive movement in a game. He immediately fell down holding left knee due to intense pain. Pain was ‘relieved’ after knee was placed in extension, but reported knee feeling ‘weird’. Prior to injury, athlete reported history of left patellar tendinitis 2 years prior treated conservatively, lack of strengthening program for 4 months in 2020 due to COVID pandemic, intense pre-bubble preparations consisting of 2-a-day full court basketball sessions, and a strenuous game schedule during the ‘bubble’. Prior left knee X-Ray remarkable for Patella Alta. He was treated for right patellar tendinitis and adductor strain during the bubble. He also suffered a suspected left knee contusion in a game 3 days prior that was gradually improving towards the day of injury. PHYSICAL EXAMINATION: Anterior left knee swelling and indentation on initial inspection. No tenderness to palpation on anterior knee after physician placed knee in extension. Able to perform left knee flexion, but markedly limited knee extension and mobility during walking. Further Inspection revealed indentation in below patella with knee flexion. Quadriceps contraction revealed anterior tilting of inferior pole of patella. Unable to perform straight leg raise test due to difficulty lifting knee. Negative Lachman’s, Valgus and Varus Stress Tests. DIFFERENTIAL DIAGNOSIS: Patellar Tendon Rupture, Patellar Dislocation, ACL Tear. TEST AND RESULTS: Diagnostic Ultrasound remarkable for hypoechoic region at proximal patellar tendon at insertion suggestive of discontinuity of the tendon. MRI confirmed full thickness tear of patellar tendon. FINAL WORKING DIAGNOSIS: Left Patellar Tendon Tear TREATMENT AND OUTCOMES: Left knee initially placed in full extension with ‘medial’ pull of patella due to initial suspicion of patellar dislocation. Athlete then immobilized in full extension until follow up with Orthopaedic Surgeon. Underwent left patellar tendon repair within 1 week of injury. Acute rehabilitation course consisted of immobilization of brace at 30 degrees with gradual range of motion exercises, light quadriceps strengthening and pain management modalities.

Pediatric Revision Anterior Cruciate Ligament Reconstruction: Current Concepts Review.

We present a review of revision anterior cruciate ligament (ACL) reconstruction in pediatric patients, discussing risk factors for rerupture, physical examination and imaging, treatment principles and surgical techniques, postoperative rehabilitation, and clinical outcomes. PubMed, Cochrane, and Embase databases were queried for relevant articles about revision ACL topics. All types of manuscripts, including clinical studies, basic science studies, case series, current concepts reviews, and systematic reviews were analyzed for relevant information. Current concepts on risk factors for rerupture, physical examination and imaging, treatment principles and surgical techniques, postoperative rehabilitation, and clinical outcomes were synthesized. Surgical treatment should be individualized, and the graft type, fixation devices, tunnel placement, and complementary procedures (eg, extra-articular tenodesis) should be tailored to the patient's needs and previous surgeries. Rehabilitation programs should also be centered around eccentric strengthening, isometric quadriceps strengthening, active flexion range of motion of the knee, and an emphasis on closed chain exercises. Despite adherence to strict surgical and postoperative rehabilitation principles, graft refailure rate is high, and return to sports rate is low. Rerupture of the ACL in the pediatric population is a challenging complication that requires special attention. Diagnostic evaluation of repeat ACL ruptures is similar to primary injuries. Although outcomes after revision ACL reconstruction are expectedly worse than after primary reconstruction, athletes do return to sport after proper rehabilitation. Further research is needed to continue to improve outcomes in this high-risk population, aimed at continued knee stability, graft survivorship, and improved quality of life.