Single-leg Stance Research Articles

Validity and reliability of performance tests as balance measures in patients with total knee arthroplasty

PurposeThis study aimed to investigate validity and reliability of the Timed Up and Go Test (TUG), 10 Meter Walk Test (10MWT), Single Leg Stance Test (SLST), 2 Minute Walk Test (2MWT), and Five Times Sit-to-Stand Test (5xSST) for evaluating balance in patients with total knee arthroplasty (TKA).Materials and MethodsThis cross-sectional study included 41 participants who had undergone TKA 6 months before the study due to osteoarthritis. Participants performed the TUG, 10MWT, SLST, 5xSST, and 2MWT. Each of the tests was performed twice, with a 1-day interval between tests. Intraclass correlation coefficient (ICC) models were used to determine the test–retest reliability. The level of correlations between performance tests and Berg Balance Scale and Fall Efficacy Scale-International were used to establish concurrent and convergent validity of the performance tests, respectively.ResultsThe mean age of the subjects was 64.07 ± 10.57 years. All tests showed excellent reliability (ICC > 0.94), excluding SLST that demonstrated good test–retest reliability (ICC = 0.72). All of the tests (SLST, 10MWT, 5xSST, 2MWT, TUG) were found to have good validity (rho > 0.704).ConclusionsAccording to these results, TUG, 10MWT, SLST, 5xSST, and 2MWT are reliable and valid outcome measures in patients with TKA, and could be used to assess balance after TKA surgery.

Fear of falling does not predict self-reported physical activity: an observational study with community-dwelling older adults

ObjectivesTo investigate the relationship between FOF and self-reported physical activity levels among older adults. DesignObservational cross-sectional. Setting and participantsCommunity-dwelling older adults aged 60 years and over and without cognitive deficits were recruited. Main outcome measuresData collected included cognitive function [i.e., Mini Mental Status Examination (MMSE)], FOF [i.e., Iconographic Falls Efficacy Scale (Icon-FES); Falls Efficacy Scale – International (FES-I)], self-reported physical activity (i.e., Modified Baecke Questionnaire for Elderly People), history of falls, number of comorbidities and clinical tests of balance and mobility (i.e., Short Physical Performance Battery and the single leg stance test with closed and opened eyes). Multivariable linear regression was used to test whether FOF predicts self-reported physical activity levels. ResultsA total of 200 older adults living in the community were enrolled in this study. Our results showed that FOF, as measured by FES-I or Icon-FES, did not predict self-reported physical activity levels in community-dwelling older adults. ConclusionOur results did not support previous evidence that higher FOF predicts lower levels of self-reported physical activity. These results question the role of FOF in influencing self-reported physical activity levels among community-dwelling older adults.

Old before their time: Comparisons of people with SMI and healthy older adults.

Compare physical functional measures of people with severe mental illness (SMI) to standardized geriatric values. Retrospective analysis of physical functioning sample data of middle-aged people with SMI was compared to standardized older adult data. Compared: Sit to Stand Test (STS; n = 68), 6 min Walk Test (6MWT; n = 71), and Single Legged Stance Test (SLS; n = 55). One sample t tests were computed, using standardized values for older adult healthy populations, to identify differences for the group. STS (M = 11.3 SD = 5.36), for the sample were comparable to 80-89 year old. The 6MWT values were significantly worse than 80-89-year-old range for women, t(28) = -2.88, p < .01, and men, t(40) = -5.32, p =. 00. SLS values for women and men were comparable to the 70-79-year-old range in the general population. People with SMI have functional fitness levels that are older than chronological age, and should be assessed regularly for physical functioning to support independent living. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Clinical Tests for Predicting Fallers Among Ambulatory Patients with Amyotrophic Lateral Sclerosis: A Preliminary Cohort Study.

Few studies have examined falls and their predictors in patients with amyotrophic lateral sclerosis (ALS). The aim of this study was to survey fall incidence and to identify variables predicting the presence or absence of falls occurring within 3 months after discharge of patients with ALS from hospital. The following variables were evaluated in 14 patients with ALS: timed up and go test (TUG), functional reach test, 10-m comfortable gait speed, single-leg stance time, manual muscle test (MMT) scores for the lower limb, total modified Ashworth scale score for the lower limbs, fear of falling, and pull test score. The primary outcome variable was the occurrence of a fall within 3 months after discharge. The fall rate was calculated based on fall record forms. The specific circumstances of each fall were also recorded. Univariate and multiple regression analyses were used to identify fall predictors. Seven of the 14 ALS patients (50%) experienced a fall within 3 months. Five fallers reported experiencing a fall that had caused injury, and three reported experiencing a fall that had required a hospital visit. Univariate logistic regression analysis identified TUG time, gait speed and MMT of the ankle dorsiflexors as factors associated with falls (p = 0.02-0.04). Multiple linear regression analysis of fall numbers identified age and TUG time as predictor models (p = 0.03). TUG time and MMT of ankle dorsiflexors may help predict falls in ALS patients. Validation studies in larger cohorts are needed.

축구선수들의 포지션에 따른 균형 능력 비교 분석

The purpose of this study was to comparison of balance ability in male soccer athletes according to the position. In this study, the subject were 31 male high school soccer athletes. The displacement of center of pressure (CoP), standard deviation of CoP, velocity of CoP and trace length of CoP of both feet was evaluated with wireless foot pressure device (Moticon, Germany). And also, one single leg stance was measured. As a result of the study, This study was significantly lower the defender and midfielders than the forwards at the standard deviation of CoP in the non-dominant foot (p<.01). But, there was no statistically significant difference to the position; CoP of anterior-posterior (AP) in the both feet, CoP of medial-lateral (ML) in the both feet, deviation of CoP in the dominant foot, velocity of CoP in the both feet, trace length of CoP of both feet, (p>.05). In conclusion, this study was suggested that the men soccer players were showed differences in standard deviation of CoP of non-dominant foot according to the position.

The effect of cryotherapy on postural stabilization assessed by standardized horizontal perturbations of a movable platform

BackgroundCryotherapy is a frequently used therapy in the acute treatment of sports injuries, although it has possible negative effects on dynamic postural stabilization. Research questionWhat is the effect of cryotherapy on the postural stabilization assessed by imposed platform perturbations? MethodsTwenty-four healthy participants (15 male, 9 female) performed 2 test sessions (before and after cryotherapy) consisting of 4 trials each. Each trial included 30 s single leg stance (SLS) on both legs and 4 testing blocks (2 for each leg) of 30 s for the dynamic testing. A single testing block comprised 4 perturbations. After the first session, cryotherapy was applied to the right leg by placing it in ice water at a temperature between 10 °C and 12 ° for 20 min. Outcome measuresWe assessed the Center of Pressure speed (CoPs) and the mean force variation for both static and dynamic tests. Additionally, the Time To Stability (TTS) was calculated for the perturbations. ResultsIn the static trials there was an interaction between leg and session present for the mean force variation (p = 0.01) with a large η2 of 0.24, which shows higher variation of vertical force after application of the cryotherapy on the right leg. During the dynamic trials we found an interaction between leg and session for the TTS suggesting increase of the TTS due to the cryotherapy (p = 0.04), with a large η2 of 0.17. No interaction effect was present for the CoPs in the mediolateral and anteroposterior direction (p = 0.62 and p = 0.12, respectively). SignificanceCryotherapy applied to the lower extremity results in a worse postural stabilization when assessed by platform perturbations. This might be the result of an altered balance strategy, due to impaired proprioception from the affected body part. More research is needed to examine the duration of this effect. Level of evidenceLevel 3, associative study

Medial talar resection: how much remains stable?

PurposePathologies of the medial talus (e.g., fractures, tarsal coalitions) can lead to symptomatic problems such as pain and nonunion. Bony resection may be a good solution for both. It is unclear how much of the medial talus can be taken before the subtalar joint becomes unstable. The aim of this study was to evaluate the effect a limited resection of the medial talar facet and the anteromedial portion of the posterior talar facet has on subtalar stability.MethodsEight fresh-frozen human cadaveric lower limbs were mounted in a frame for simulated weight-bearing. Computed tomography scans were obtained under 700 N single-legged stance loading, with the foot in neutral, 15° inversion, and 15° eversion positions. A sequential resection of 10, 20, and 30% of the medial facet and the anteromedial portion of the posterior talar facet to the calcaneus, based on the intact talus width, was performed. Measurements of subtalar vertical angulation, talar subluxation, coronal posterior facet angle and talocalcaneal (Kite) angle in the anteroposterior and lateral view were performed.ResultsGross clinical instability was not observed in any of the specimens. No significant differences were detected in the measurements between the resected and intact states (P ≥ 0.10) as well as among the resected states (P ≥ 0.11).ConclusionIn a biomechanical setting, resecting up to 30% of the medial facet and anteromedial portion of the posterior facet based on the intact talus width—does not result in any measurable instability of the subtalar joint in presence of intact ligamentous structures.Level of evidenceV.

Is there an increased risk for subtrochanteric stress fracture with the Femoral Neck System versus multiple cannulated screws fixation?

PurposeThis study sought to compare the risk of subtrochanteric stress-riser fractures and biomechanical stability of the Femoral Neck System (FNS) versus multiple screw fixation (MSF). MethodsEight paired cadaveric femurs were randomly assigned to FNS or MSF. Physiologic load mimicking single leg stance at the subtrochanteric region was applied to the constructs. ResultsNo constructs failed in the subtrochanteric region during loading. There was no significant difference in force (P = 0.364) or loading cycles (P = 0.348) between groups. ConclusionFNS constructs were not associated with an increased incidence of iatrogenic subtrochanteric fractures or biomechanical stability versus MSF.

Postural Stability in Single-Leg Quiet Stance in Highly Trained Athletes: Sex and Sport Differences.

This study aimed to determine if there is a difference in postural stability in highly trained adolescents and young adult athletes regarding sex and sport. The participants were young athletes (n = 464) from seven different sports. We considered the center of pressure (CoP) velocity (total, anterior–posterior (AP) and medial–lateral (ML)), CoP amplitude (AP and ML), and CoP frequency (AP and ML), as assessed by single-leg quiet stance test. Significant interactions were found between sex and sport for all CoP variables (p < 0.02). Additionally, a significant main effect of sport was also found in all CoP variables (p = 0.01). Regarding sex, significant effects were found for all CoP amplitude variables (p = 0.01), as well as for CoP velocity variables, except for CoP ML (p = 0.06). Moreover, there was no sex effect for CoP frequency AP (p = 0.18). The results of the current study confirm the claim that the criteria for optimal postural strategies for elite athletes likely depend on a given sport.

Vitamin D Status and Health Outcomes in School Children in Northern Ireland: Year One Results from the D-VinCHI Study.

(1) Background: Vitamin D status has never been investigated in children in Northern Ireland (UK). (2) Methods: Children (4–11 years) (n = 47) were recruited from November 2019 to March 2020 onto the cross-sectional study. Anthropometry was assessed. Plasma 25-hydroxyvitamin D (25(OH)D) was analysed. Vitamin D intake, parental knowledge and perceptions, participant habits, physical activity and sedentary behaviour were established via questionnaire. Muscle strength was assessed via isometric grip strength dynamometry and balance via dominant single-leg and tandem stance. Parathyroid hormone, bone turnover markers (OC, CTX and P1NP), glycated haemoglobin and inflammatory markers (CRP, IFN-γ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8 and TNF-α) were analysed. (3) Results: Mean (SD) 25(OH)D was 49.17 (17.04) nmol/L (n = 47); 44.7% of the children were vitamin D sufficient (25(OH)D >50 nmol/L), 48.9% were insufficient (25–50 nmol/L) and 6.4% were deficient (<25 nmol/L). 25(OH)D was positively correlated with vitamin D intake (µg/day) (p = 0.012, r = 0.374), spring/summer outdoor hours (p = 0.006, r = 0.402) and dominant grip strength (kg) (p = 0.044, r = 0.317). Vitamin D sufficient participants had higher dietary vitamin D intake (µg/day) (p = 0.021), supplement intake (µg/day) (p = 0.028) and spring/summer outdoor hours (p = 0.015). (4) Conclusion: Over half of the children were vitamin D deficient or insufficient. Wintertime supplementation, the consumption of vitamin D rich foods and spring/summer outdoor activities should be encouraged to minimise the risk of vitamin D inadequacy.

Effects of Fatigue on Postural Sway and Electromyography Modulation in Young Expert Acrobatic Gymnasts and Healthy Non-trained Controls During Unipedal Stance.

This study investigated whether expert acrobatic gymnasts respond differentially than their non-trained counterparts during a single-legged stance task performed before and after a protocol designed to induce fatigue in the ankle plantarflexor muscles in terms of (a) postural steadiness and (b) electromyography (EMG) activation. We hypothesized that neuromuscular adaptation due to training would lead to different behavior of center of pressure (COP) and EMG quantifiers after fatigue. Twenty eight female volunteers (aged 11 to 24 years) formed two groups: expert acrobatic gymnastics athletes (GYN, n = 14) and age-matched non-gymnasts [control (CTRL), n = 14]. Fatigue of the ankle plantarflexors (dominant leg) was induced by a sustained posture (standing on the toes) until exhaustion. Traditional COP parameters (area, RMS, mean velocity, and power spectrum at low and high frequency ranges) were obtained with a force plate, and time and frequency-domain EMG parameters were obtained by surface electrodes positioned on the tibialis anterior, soleus, lateral gastrocnemius, medial gastrocnemius, vastus lateralis, biceps femoris, spinal erector and rectus abdominis muscles. The main results showed that fatigue induced a significant increase in postural oscillations in the ML axis (including RMS, velocity and frequency components of the power spectrum), with no significant effects in the AP axis. In terms of postural sway parameters (i.e., COP quantifiers), no superior balance stability was found for the GYN group as compared to CTRL, irrespective of the fatigue condition. On the other hand, the modulation of EMG parameters (in both time and frequency domains) indicated that expert acrobatic gymnastics athletes (as compared to healthy untrained matched controls) used different neuromuscular control strategies to keep their postures on single-legged quiet standing after the fatiguing protocol. The present results improve our knowledge of the mechanisms behind the interplay between fatigue and postural performance associated with the neuromuscular adaptations induced by sport practice. The design of gymnastics training might consider strategies aimed at improving the performance of specific muscles (i.e., tibialis anterior, soleus, biceps femoris, spinal erector) for which particular activation patterns were used by the acrobatic gymnastics to control single-legged quiet standing.

Improved ability to achieve single leg stance increases gait efficiency following single leg stance intervention in adults post brain injury

Improved ability to achieve single leg stance increases gait efficiency following single leg stance intervention in adults post brain injury

Reliability of Center of Pressure measures of Postural Stability in Anterior Cruciate Ligament Reconstructed Athletes: Effect of Vibration and Cognitive Load.

To evaluate intra and intersession reliability of the Center of Pressure (COP) parameters in Anterior Cruciate Ligament Reconstructed (ACLR) athletes with and without ankle vibration using a dual-task paradigm. Postural sway of 14 ACLR individuals was assessed during a single-leg stance on a force platform. COP parameters were assessed with manipulating sensory inputs via vision and ankle vibration under single and dual-task conditions. The outcome variables included COP displacement in medial-lateral (ML) and anterior-posterior (AP) range, mean velocity (mV), and area. During dual-task conditions, the auditory Stroop Task was applied. Intraclass correlation coefficient (ICC) values and standard error of measurement (SEM) were assessed for relative and absolute reliability. The COP measures had moderate to very high intrasession reliability (ICC range: 0.51-0.93) for conditions with vibration and cognitive task, with the highest ICCs for mV and the lowest for area, regardless of eyes being open or closed. The intersession reliability was moderate to high for mV (ICC range: 0.60-0.82) and little to very high (ICC range: 0.21-0.97) for the range of ML and AP, as well as an area in conditions with vibration and cognitive task. The mV is the most reliable COP parameter for assessing postural control under ankle vibration and dual-task conditions for both operated and non-operated sides. During closed-eye conditions, the application of vibration affected the intersession reliability with decreased ICCs on the operated side and increased ICCs on the non-operated side.

Mechanical effects of surgical variations in the femoral neck system on Pauwels type III femoral neck fracture : a finite element analysis.

AimsIn this study, we aimed to explore surgical variations in the Femoral Neck System (FNS) used for stable fixation of Pauwels type III femoral neck fractures.MethodsFinite element models were established with surgical variations in the distance between the implant tip and subchondral bone, the gap between the plate and lateral femoral cortex, and inferior implant positioning. The models were subjected to physiological load.ResultsUnder a load of single-leg stance, Pauwels type III femoral neck fractures fixed with 10 mm shorter bolts revealed a 7% increase of the interfragmentary gap. The interfragmentary sliding, compressive, and shear stress remained similar to models with bolt tips positioned close to the subchondral bone. Inferior positioning of FNS provided a similar interfragmentary distance, but with 6% increase of the interfragmentary sliding distance compared to central positioning of bolts. Inferior positioning resulted in a one-third increase in interfragmentary compressive and shear stress. A 5 mm gap placed between the diaphysis and plate provided stability comparable to standard fixation, with a 7% decrease of interfragmentary gap and sliding distance, but similar compressive and shear stress.ConclusionFinite element analysis with FNS on Pauwels type III femoral neck fractures revealed that placement of the bolt tip close to subchondral bone provides increased stability. Inferior positioning of FNS bolt increased interfragmentary sliding distance, compressive, and shear stress. The comparable stability of the fixation model with the standard model suggests that a 5 mm gap placed between the plate and diaphysis could viably adjust the depth of the bolt.Cite this article: Bone Joint Res 2022;11(2):102–111.

Association between demographic characteristics, lower limb range of motion, functional performance, ability to dual task, quality of life and risk of falls in older adults of the United Arab Emirates - A cross-sectional study

BackgroundWith increasing age, decreased range of motion of lower limb joints, impaired functional performance and balance, pain status, altered dual tasking, and poor quality of life may predict the risk for falls in older adults. Therefore, this study aimed to identify which of the aforementioned variables and demographic factors predict falls in older adults in the United Arab Emirates. In addition, the study examined the association between demographic characteristics and the risk of falls in older adults. MethodsThis cross-sectional study included 100 (50 women) community-dwelling older adults (age: 75 ± 3.6 years). Participant demographic characteristics (sex, age, body mass index, limb dominance, exercise status, etc.) were documented. The independent variables included the outcomes of demographic characteristics, active range of motion of the hip, knee, and ankle, single-leg stance, five times sit-to-stand, timed up and go test, dynamic gait index, pain, and World Health Organization Quality of Life Assessment-Bref questionnaire. The dependent variable was the risk of falls (self-reported presence or absence of falls) in the past 12 months. ResultsOut of 100 older adults, forty-two reported a fall and among them 26 were women. Many of the independent variables were significantly associated with the risk of falls in univariate analysis. However, multivariable logistic regression revealed that none of them were independently associated with the risk of falls in older adults living in the United Arab Emirates. ConclusionsRelying specifically on one of the included variables as an independent (risk) factor associated with falls in older adults of the United Arab Emirates warrants further investigation.

Acute Effects of Tissue Flossing Coupled with Functional Movements on Knee Range of Motion, Static Balance, in Single-Leg Hop Distance, and Landing Stabilization Performance in Female College Students.

Flexibility, specifically that in the amplitude of sagittal-plane range of motion (ROM), can improve jump landing patterns and reduce the potential for sports injury. The use of floss bands (FLOSS) reportedly increases joint range of motion (ROM) in the shoulder, ankle, and elbow joints. However, little research on the effectiveness of FLOSS on the knee joint has been conducted. This study investigated the effects of FLOSS on knee ROM, static balance, single-leg-hop distance, and landing stabilization performance in women. This study had a crossover design. Twenty active female college students without musculoskeletal disorders were randomly assigned to receive a FLOSS intervention or elastic bandage (ELA) control on their dominant knees. The participants underwent FLOSS and ELA activities on two occasions with 48 h of rest between both sets of activities. The outcomes were flexibility of the quadriceps and hamstrings, how long one could maintain a single-leg stance (with and without eyes closed), distance on a single-leg triple hop, and score on the Landing Error Scoring System (LESS); these outcomes were evaluated at preintervention and postintervention (immediately following band removal and 20 min later). After the FLOSS intervention, the participants’ hamstring flexibility improved significantly (immediately after: p = 0.001; 20 min later: p = 0.002), but their quadricep flexibility did not. In addition, FLOSS use did not result in worse single-leg stance timing, single-leg triple-hop distance, or landing stabilization performance relative to ELA use. Compared with the ELA control, the FLOSS intervention yielded significantly better LESS at 20 min postintervention (p = 0.032), suggesting that tissue flossing can improve landing stability. In conclusion, the application of FLOSS to the knee improves hamstring flexibility without impeding static balance, and improves single-leg hop distance and landing stabilization performance in women for up to 20 min. Our findings elucidate the effects of tissue flossing on the knee joint and may serve as a reference for physiotherapists or athletic professionals in athletic practice settings.

Timed Up and Go and Five Times Sit to Stand Test among community ambulant, overweight, obese Saudi elderly population.

To investigate the effect of Timed Up and Go category on the Five Times Sit to Stand Test, and to determine the role of recreational status on Timed Up and Go rating. The descriptive, cross-sectional study was conducted between October 2018 and April 2019 at the College of Medical Rehabilitation Sciences, Taibah University, Madina, Saudi Arabia, and comprised community-ambulant retired overweight or obese subjects of either gender aged 60-69 years. Timed Up and Go, Five Times Sit to Stand Test and Single-Leg Stance Test were used to measure basic mobility, transitional skills and static balance respectively. Data was analysed using SPSS 23. Of the 150 subjects, 108(72%) were males and 42(28%) were females. The overall mean age was 63.1}2.5 years and the mean body mass index was 29.6}3.8 kg/m2. There were 46(31.5%) subjects who were freely mobile, 60(41.1%) who were mostly independent and 40(27.4%) who had variable mobility. Also, 36(24%) subjects were recreationally active, while 114(76%) were recreationally inactive. The freely mobile subjects managed to finish the Five Times Sit to Stand Test in less time than the other groups (p<0.05). The recreationally active subjects took significantly less time to finish the Timed Up and Go test compared to the inactive. Besides, the males had longer Single-Leg Stance Test timing than females (p<0.05). The elderly belonging to different Timed Up and Go mobility categories demonstrated variable Five Times Sit to Stand abilities, with the recreational mobility status significantly affecting the category.

The effect of sports participation in obese boys on some obesity indicators and physical fitness parameters

Background. To examine the effects of sports participation in obese boys on body mass index (BMI), waist circumference, hip circumference, muscle strength, muscular endurance, balance and agility. Materials and methods. Sixty-three obese children with a mean age of 10.80 ± 0.58 were included in the study. Participants participated in sports, including judo, table tennis and basketball, for three months at their schools. Body weight, waist circumference and hip circumference of the participants were measured before and after participating in sports. Before and after participating in sports, grip strength, bent arm hanging, single-leg stance balance and plate tapping tests were applied to the participants. Results. While before participating in sports, BMI, waist and hip circumference outcomes of the participants were 23.04 ± 2.89 cm/m2, 81.61 ± 8.56 cm and 87.69 ± 6.52 cm, respectively; after participating in sports, BMI, waist circumference and hip circumference outcomes were 22.51 ± 2.88 cm/m2, 79.38 ± 8.74 cm and 85.73 ± 6.65 cm, respectively. The results of the single leg balance and bent arm-hanging tests after participation in sports increased compared to the results which before participating in sports (p &lt; 0.05). However, the results of plate tapping test results that after participation in sports were less than the results which before participating in sports (p &lt; 0.05). The result obtained from the grip strength after participation in sports was not different from the result obtained before participating in sports (p &gt; 0.05). Conclusions. Participation in regular sports in obese children has positive effects on BMI, waist circumference and hip circumference, which are associated with chronic diseases. Additionally, the participation of obese children in regular sports contributes to the development of physical fitness parameters, which are indicators of health.

Anterior Cruciate Ligament Reconstructed Patients Who Recovered Normal Postural Control Have Dissimilar Brain Activation Patterns Compared to Healthy Controls.

Simple SummaryWe report that patients with anterior cruciate ligament reconstruction have similar postural control but different cortical activation patterns in several regions of the brain when compared to healthy controls. This is significant because dissimilar cortical activation patterns indicate that neural adaptation in the brain is responsible for motor coordination, possibly due to altered proprioception, despite having a surgical reconstruction after an anterior cruciate ligament injury. Such neuroplasticity in ACLR patients may imply compensatory neural protective mechanisms in order to sustain postural control, which is a fundamental functional skill in daily activities. We believe that our findings will elucidate other researchers and clinicians about the effects of a peripheral joint injury on the brain’s function during postural control.Postural control, which is a fundamental functional skill, reflects integration and coordination of sensory information. Damaged anterior cruciate ligament (ACL) may alter neural activation patterns in the brain, despite patients’ surgical reconstruction (ACLR). However, it is unknown whether ACLR patients with normal postural control have persistent neural adaptation in the brain. Therefore, we explored theta (4–8 Hz) and alpha-2 (10–12 Hz) oscillation bands at the prefrontal, premotor/supplementary motor, primary motor, somatosensory, and primary visual cortices, in which electrocortical activation is highly associated with goal-directed decision-making, preparation of movement, motor output, sensory input, and visual processing, respectively, during first 3 s of a single-leg stance at two different task complexities (stable/unstable) between ACLR patients and healthy controls. We observed that ACLR patients showed similar postural control ability to healthy controls, but dissimilar neural activation patterns in the brain. To conclude, we demonstrated that ACLR patients may rely on more neural sources on movement preparation in conjunction with sensory feedback during the early single-leg stance period relative to healthy controls to maintain postural control. This may be a compensatory protective mechanism to accommodate for the altered sensory inputs from the reconstructed knee and task complexity. Our study elucidates the strategically different brain activity utilized by ACLR patients to sustain postural control.

A single intraarticular platelet-rich plasma improves pain and function for patients with early knee osteoarthritis: Analyses by radiographic severity and age.

Most studies use platelet-rich plasma (PRP) requiring multiple intraarticular injections for knee osteoarthritis (OA). To investigate the efficacy of a single intraarticular PRP injection for patients with early knee OA and consider subgroup analyses of radiographic severity and age, respectively. Forty-one patients with knee OA (Kellgren-Lawrence grade 1-2) received a single PRP injection into the target knee and were assessed at baseline and 1, 3, and 6 months postinjection. The primary outcome was the mean change from baseline in the visual analog scale (VAS) pain (0-100 mm) at 6 months postinjection. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, single leg stance test (SLS), use of rescue analgesics and patients' satisfaction. Thirty-eight patients completed the study. The mean pain VAS decreased significantly from 45.6 ± 13.0 mm at baseline to 16.9 ± 13.4 mm, 14.0 ± 13.1 mm and 15.5 ± 14.0 mm at 1, 3 and 6-month follow-ups (p< 0.001 for all). Significant improvements in WOMAC, Lequesne index, SLS and consumption of analgesics from baseline (p< 0.001 for all) were noted at each follow-up. Patients' satisfaction was high. No serious adverse events occurred. Subgroup analyses revealed that patients with grade 1 OA showed significantly greater VAS pain reduction at 3 months (p= 0.006) and 6 months (p= 0.005) than patients with grade 2 OA. The older-age group (age > 60) showed significantly greater improvements in VAS pain, WOMAC function subscale scores and total scores at 6-month postinjection, compared with the younger age-group (age ≤ 60). The younger-age group reported better satisfaction at 1 and 3-month postinjection. One injection of PRP improved pain and function for 6 months for patients with early knee OA. This study supports putting the one-injection regimen into clinical practice. Further research is needed for more definite conclusions.