Symmetry Index Research Articles

Association Between Reactive Strength Index During Single-Limb Vertical Continuous Jumps and Isokinetic Knee Extensor Strength Following Anterior Cruciate Ligament Reconstruction

OBJECTIVE: To analyze the association between asymmetry in the reactive strength index (RSI) during single-limb vertical continuous jumps (SVCJs) and isokinetic knee extensor strength in athletes who have undergone anterior cruciate ligament reconstruction (ACLR) DESIGN: Cross-sectional study METHODS: This study included 75 athletes (40 female athletes) aged 23.7±8.6 years who had undergone ACLR (mean time from ACLR to measurement: 8.8±4.1 months). The ground contact time and flight time during SVCJs were measured using a force plate, and jump height was calculated from the flight time. The RSI during SVCJs was calculated as follows: RSI = jump height (cm)/contact time (s). The knee extensor strength was measured using an isokinetic dynamometer at 60°/s. The limb symmetry index (LSI) of RSI during SVCJs and knee extensor strength were calculated by dividing the values of the involved and uninvolved limbs. Age, sex, modified Tegner activity scale, and subjective knee function were also recorded. Univariable and multiple regression models were used to assess the association between these and the knee extensor strength. RESULTS: The involved limb showed significantly lower isokinetic knee extensor strength ( P<0.001, effect size=0.55) and RSI during SVCJs ( P<0.001, effect size=0.70) than did the uninvolved limb. In the multiple regression model, only LSI of RSI during SVCJs remained significant (B=0.440, SE=0.068, β=0.604) and accounted for 36.4% of the variance in knee extensor strength recovery ( P<0.001, r2=0.364). CONCLUSION: RSI asymmetry during SVCJs was strongly associated with isokinetic knee extensor strength asymmetry.

Gait asymmetry persists following unilateral and bilateral total ankle arthroplasty.

Total ankle arthroplasty (TAA) improves gait symmetry in patients with unilateral end-stage ankle arthritis but has not been studied in patients undergoing bilateral TAA (B-TAA), and few studies compare TAA patients to control subjects. The purpose of this study was to compare gait symmetry in U-TAA and B-TAA patients and healthy controls. Using prospective databases, 19 unilateral and 19 bilateral ankle arthritis patients undergoing TAA were matched to 19 control subjects by age, sex, and BMI. The Normalized Symmetry Index (NSI) was determined for joint mechanics and ground reaction forces (GRF) during walking trials at a single visit for controls and preoperatively and 1 to 2 years postoperatively for TAA patients. Data was analyzed using linear mixed-effects models to determine differences among time points and cohorts at a significance of α = 0.05. Following surgery, B-TAA and U-TAA experienced improved peak plantarflexion moment symmetry (p = 0.017) but remained less symmetric than controls. B-TAA patients had more symmetry than U-TAA patients during peak weight acceptance GRF (p = 0.002), while U-TAA patients had greater peak dorsiflexion symmetry than B-TAA patients. TAA patients demonstrated more asymmetry compared to control subjects for all outcome measures. There was no significant impact of TAA on gait symmetry for GRF or peak ankle angles, and neither U-TAA nor B-TAA was consistently associated with higher gait symmetry. These results indicate that TAA improves symmetry during peak plantarflexion moment, and that significant gait asymmetry persists for B-TAA and U-TAA patients compared to healthy participants.

Advanced Neuromuscular Training Differentially Changes Performance on Visuomotor Reaction Tests and Single-leg Hop Tests in Patients with ACL Reconstruction.

Advanced neuromuscular training prepares patients with anterior cruciate ligament reconstruction (ACLR) for sport participation. Return-to-sport testing often includes single-leg hop tests, yet combining motor and cognitive tasks (i.e., dual-task) might reveal neurocognitive reliance. This study examined changes in performance on visuomotor reactions tests and single-leg hop tests following advanced neuromuscular training in patients with ACLR. The hypothesis was that performance would improve less on reaction tests than on single-leg hop tests. Quasi experimental, Pretest-Posttest. Twenty-five patients with ACLR (11 males) completed 10 sessions of advanced neuromuscular training and pre-and post-training testing. Reaction tests outcomes were from a platform and visual display. The double-leg reaction test involved touching target dots with either leg for 20 seconds; correct touches and errors were recorded. The single-leg reaction test involved hopping on the test leg to 10 target dots; hop time and errors were recorded. Single-leg hop tests included forward, triple, crossover triple, and timed hop; limb symmetry index was recorded. Effect sizes were calculated for corrected touches on the double-leg reaction test, surgical side hop time on the single-leg reaction test, and surgical side hop distance or time on single-leg hop tests. Correct touches on the double-leg reaction test significantly increased from pre- to post-training (20.4 +/- 4.3 vs.23.9 +/- 2.8, p<0.001). Hop time on the single-leg reaction test significantly decreased from pre- to post-training (Surgical leg 13.2 vs.12.3 seconds, non-surgical leg 13.0 vs.12.1 seconds, p=0.003). Mean errors did not significantly change on either reaction test (p> 0.05). Cohens d effect sizes in descending order was single-leg hop tests (d=0.9 to 1.3), double-leg reaction test (d=0.9), and single-leg reaction test (d=0.5). Motor performance improved after advanced neuromuscular training, but the effect size was less on visuomotor reaction tests than single-leg hop tests. The results suggest persistence of neurocognitive reliance after ACLR and a need for more dual-task challenges in training. 3.

An observational study of lower limb muscle imbalance assessment and gait analysis of badminton players

PurposeThe imbalance of muscle strength indicators has a negative impact on players. Lower limb muscle imbalance can cause gait abnormalities and increase the risk of muscle injury or decreased performance in significantly asymmetrical situations. This study aims to assess the lower limb muscle imbalance and gait feature between the dominant and non-dominant sides of badminton players and the associations between the two variables.MethodsThe study included 15 badminton players with years of training experience. Muscle strength and gait parameters were obtained from isokinetic muscle strength testing and plantar pressure analysis systems. The symmetry index was calculated based on formulas such as plantar pressure distribution and percentage of plantar contact area.ResultsIn the isokinetic muscle strength test, significant differences were found in bilateral knee flexors’ average power and total work at 60°/s angular speed. The hamstring to quadriceps ratio (H/Q) range of knee joints of the dominant and non-dominant sides is 0.63–0.74 at low speed, while the H/Q range is 0.81–0.88 at fast speed. The H/Q of bilateral knees increases with increasing angular velocity. As the angular velocity increases, the peak torque to body weight ratio (PT/BW) of the participants’ bilateral knee flexors and extensors shows a decreasing trend. The asymmetry score of H/Q at 180°/s angular speed is positively related with step time and stance time. There are varying degrees of differences in gait staging parameters, plantar pressure in each area, plantar contact area, and symmetry index between the dominant and non-dominant sides of badminton players when walking.ConclusionBadminton players have weaker flexors of the knee joint, imbalanced muscle strength in flexors and extensors, decreased lower limb stability, and a risk of knee joint injury on the non-dominant side. The bending and stretching strength of the knee joint on the dominant side of the players is greater than that on the non-dominant side. The pressure in the first metatarsal region of the dominant side is higher, while that in the midfoot and heel regions is higher on the non-dominant side. badminton players have better forward foot force and heel cushioning ability. Long term badminton sports result in specialized changes in plantar pressure distribution and reduced symmetry.

Effect of Programed Walking Exercise Using Bot Fit in Younger Adults

IntroductionPhysical inactivity and sedentary behavior both increase the risk of chronic disease and mortality. Regular participation in physical activity and reducing sedentary behavior play important roles in maintaining physical health and disease prevention.ObjectiveThe purpose of this study was to investigate the effect of programed walking exercise using a wearable hip exoskeleton, Bot Fit on muscle strength, muscle effort, and the kinematics of the pelvis in younger adults.MethodsWe designed three parallel experimental conditions and randomly assigned participants to one of three groups: those assigned to exercise using an interval program of Bot Fit (interval group), those who used a power program of Bot Fit (power group), and a control group who exercised without Bot Fit. A total of 45 young adults participated in 18 exercise-intervention sessions over six weeks, and all participants were assessed at two time points: before and after the 18 exercise sessions. Each assessment evaluated muscle strength, muscle effort, and the kinematics of the pelvis during walking. In addition, the number of steps, distance, energy expenditure, and heart rate for 30 min during the exercise sessions were recorded.ResultsA significant increase in the maximum voluntary contraction (MVC) of the left biceps femoris (BF) was evident in the interval group, while significant changes in the MVC of the bilateral BF were seen in the power group after Bot Fit exercise. A significant decrease of muscle effort in the right BF in the interval group and right lumbar erector spinae and bilateral BF in the power group were also observed. In addition, the symmetry index of pelvic tilt significantly improved in the interval group, and greater exercise volume and intensity in both the interval and power groups compared with the control group were confirmed as measured by the number of steps, distance, energy expenditure, and heart rate.ConclusionsThe results of this study confirmed the beneficial effect of programed walking exercise using the Bot Fit on muscle strength of trunk and lower extremities, muscle effort, and pelvic movement symmetry in younger adults. Personalized exercise programs can be provided for younger adults using various resistance or assistance modes of robotic device with the Bot Fit.Trial RegistrationClinicalTrials.gov, NCT05862077. Registered 22 March 2022, https://register.clinicaltrials.gov/.

Comparison of pulmonary artery growth between ductus stent and systemic-to-pulmonary shunt as single-ventricle palliation

ObjectiveWe aimed to compare the pulmonary artery (PA) growth between infants with univentricular hearts who underwent a ductus stenting (DS) and those who received a systemic to pulmonary shunt (SPS) as an initial palliation. MethodsAll infants with ductal-dependent pulmonary blood flow who underwent initial palliation with either a DS or SPS between 2009 and 2022 in our institution were reviewed. PA development was compared between the groups using the PA index and the symmetry index. ResultsA total of 130 patients were evaluated including 49 patients after DS and 81 after SPS. The most frequent primary diagnosis was tricuspid atresia in 27, followed by pulmonary atresia with intact ventricular septum in 19. At stage II palliation, PA index (p=0.926), right PA index (p=0.692), left PA index (p=0.297) and the symmetry index (p=0.650) were similar between the groups. At stage III Fontan completion, PA index (p=0.115), right PA index (p=0.868), and the symmetry index (p=0.144) were similar between the groups. However, left PA index (60 vs. 74mm2/m2, p=0.015) was lower, and the incidence of veno-venous collaterals (24.2 vs. 7.8%, p=0.036) was higher in DS group compared to SPS group. Freedom from PA interventions between stage II and III palliation was lower in DS group compared to SPS group (p=0.009). ConclusionsIn patients after DS in infants with univentricular heart, freedom from PA interventions after stage II was lower and the left PA index was smaller, compared to those after SPS. Long-term outcomes after the Fontan procedure should be addressed in patients after DS.

Successful ACL repair by dynamic intraligamentary stabilisation is non-inferior in functional performance and worse in proprioception compared to healthy controls in a case-matched study.

The primary aim of this study was to assess non-inferiority in functional performance of the knee after dynamic intraligamentary stabilisation (DIS) surgery at a minimal follow-up of 1 year compared to healthy controls, based on limb symmetry index (LSI) of the single leg hop test (SLH). Additionally, functional performance based on the single leg triple hop test (SLTH) and side hop test (SH), proprioception and subjective outcome were evaluated. A total of 45 DIS patients were 1-to-1 matched to a healthy control. Functional performance was evaluated by LSI and absolute values on the SLH, SLTH and SH. Proprioception was assessed by joint position sense (JPS) test and International Knee Documentation Committee (IKDC) scores were obtained. Non-inferiority in functional performance after DIS compared to healthy controls was confirmed based on the mean LSI of the SLH and SLTH (97.6% vs. 99.6% and 97.5% vs. 100.6%, respectively) and non-confirmed on the SH (98.8% vs. 100.0%, respectively). No significant differences were found in absolute value of the SLH and SLTH and a significantly higher absolute value of the SH was found in the DIS group (p = 0.01). JPS absolute angular error was significantly higher in the DIS group compared to the control group (p = 0.01). The median IKDC score of the DIS group was significantly lower (92, IQR 85-95) than the control group (100, IQR 99-100), p < 0.001. In conclusion, functional performance after DIS was confirmed non-inferior compared to healthy controls based on the SLH and SLTH, although non-confirmed on the SH. Level III.

Females demonstrate lower levels of activity, psychological readiness and strength symmetry after anterior cruciate ligament reconstruction than males, and also recovery of quadriceps strength and hop symmetry is delayed in females undergoing reconstruction with a quadriceps tendon autograft.

To investigate sex-based recovery differences in patients undergoing anterior cruciate ligament reconstruction (ACLR) with a hamstring (HT) or quadriceps (QT) tendon autograft. This study included 97 patients, including 50 females (HT = 25, QT = 25) and 47 males (HT = 24, QT = 23), assessed presurgery and at 12- and 24-month postoperatively via surveys, laxity, isokinetic knee extensor and flexor torque and a 6-hop performance battery. Limb symmetry indices (LSIs) were calculated. Outcomes were compared between males and females, as well as within each graft type. Males reported significantly higher Tegner scores at 12 (p = 0.029) and 24 (p = 0.031) months, Anterior Cruciate Ligament Return to Sport after Injury scores at 12 (p = 0.009) and 24 (p = 0.010) months, and a significantly higher lateral hop LSI at 12 (p = 0.045) months, knee extensor torque LSI at 12 (p = 0.020) months, and knee flexor torque LSI at 12 (p = 0.001) and 24 (p = 0.039) months. Females undergoing ACLR with a QT (vs. HT) graft demonstrated a lower knee extensor torque LSI at 12 (p = 0.006) months, a lower lateral hop LSI at 12 (p = 0.038) months, and a lower medial hop LSI at 12 (p = 0.042) months. Females reported less activity and psychological readiness, as well as strength symmetry. Furthermore, the recovery of quadriceps strength and hop symmetry was delayed in females (vs. males) undergoing ACLR with a QT graft. A better understanding of these differences will assist in counselling on expectations, determining the most appropriate graft construct and permitting more targeted rehabilitation. Level IV.

Immediate effect of hip exercises-inducing motor unit recruitment on static and dynamic postural balance in patients with piriformis muscle syndrome

IntroductionA single session of exercises-inducing motor unit recruitment has been reported to immediately improve static and dynamic postural balance in different populations. It remains unclear whether such an effect occurs in patients with piriformis muscle syndrome (PMS). Thus, this study aimed to explore the immediate effect of hip exercises-inducing motor unit recruitment on postural balance in these patients. MethodsIn this pre-post-repeated measure study design, twelve patients with PMS were enrolled. These patients participated in a single session of hip exercises-inducing motor unit recruitment, consisting of two exercises, bilateral bridging to target hip extensors and side lying clams to target hip abductors and external rotators. Static (stabilometric platform) and dynamic (timed up and go test (TUGT) and Functional reach test (FRT)) postural balance, and pain were evaluated before and immediately after the intervention protocol. ResultsPatients with PMS had significant (p<0.001) lower centre of pressure velocity and symmetry index values during the unipedal posture (eyes closed) in post- compared to pre- session. However, no significant effects of hip exercises-inducing motor unit recruitment were found on static bipedal and dynamic postural balance or pain in these patients. ConclusionA single session of hip exercises-inducing motor unit recruitment immediately improved static postural balance (unipedal posture with eyes closed) in patients with PMS. Given that this protocol is simple and easy to implement, it is recommended that patients with PMS consider incorporating these exercises into their daily physical activity.

Using an integrated motor imagery and physical training intervention after knee injury: an interim analysis of the MOTIFS randomised controlled trial

ObjectivesPhysical function is often a main focus of knee injury rehabilitation, but recent recommendations include increasing attention to psychological factors. We have developed the MOTor Imagery to Facilitate Sensorimotor re-learning...

Autograft Choice and Jumping Performance After Anterior Cruciate Ligament Reconstruction: A Comparative Study on Professional Athletes.

The extensor apparatus of the knee is of paramount importance in generating the torque needed for a countermovement jump (CMJ), especially in jumping athletes. In anterior cruciate ligament reconstruction (ACLR) procedures, graft harvesting from the extensor apparatus may dramatically affect extensor strength and jumping performance. The focused jump training of professional jumping athletes would increase the likelihood of restoring jumping performance after ACLR, despite the graft choice (autologous bone-patellar tendon-bone [BPTB] or hamstring [HS] tendon). Cohort study; Level of evidence, 3. A retrospective evaluation of prospectively collected data was carried out. Only professional athletes were included, and all surgical procedures were performed by a single experienced surgeon. Data collection considered the type of surgery, sports activity, and functional evaluation at 3 months after surgery. From the functional evaluation, data on single-leg hop (SLH) test, triple hop (TH) test, and CMJ were extracted. Limb symmetry index (LSI) for maximal voluntary isometric contraction of the quadriceps and for each of the jumping tests was calculated. Multiple analysis of covariance (ANCOVA) models were used to assess mean differences among groups for the LSI in CMJ, SLH, and TH and estimate the effect of confounders. From a subsequent series of 208 athletes, 44 professional athletes were included for data collection. Of these, 26 were male and 18 were female. A jumping sport (basketball, volleyball) was played by 17 athletes, while a running sport (soccer, judo, rugby, tennis, ski) was performed by 27 athletes. The mean time from injury to surgery was 17.8 ± 14.5 days. At 90 days from surgery, the overall mean LSI for CMJ was 85.3% ± 8.9%, for SLH was 92.2% ± 6.4%, and for TH was 90.8% ± 6.1%. When ANCOVA was fitted using the interaction term with BPTB autograft and jumping sport, a nonsignificant effect on LSI for CMJ (P = .56), SLH (P = .72), and TH (P = .98) was observed. The results of the present investigation on professional athletes showed that no difference occurred within the study cohort in overall jumping performance between jumping and running athletes undergoing ACLR either with BPTB or with HS tendon grafts. Although some evidence suggests that quadriceps strength may be dramatically affected by the harvesting of BPTB, the overall performance of the jump was not compromised.

Relationship Between Single-Leg Vertical Jump and Drop Jump Performance, and Return to Sports After Primary Anterior Cruciate Ligament Reconstruction Using Hamstring Graft.

After anterior cruciate ligament reconstruction (ACLR), asymmetry is likely to persist in single-leg (SL) vertical jump and drop jump performance than in SL hop distance. However, its relationship with the return to sport (RTS) remains unclear. This study aimed to determine the association between vertical jump performance after primary ACLR using hamstring tendon autograft and RTS at a pre-injury competitive level. Cross-sectional study. Patients who underwent primary ACLR using hamstring tendon autograft were recruited for this study. Participants who returned to pre-injury competition after ACLR were recruited at least eight months postoperatively. Knee condition was assessed, including joint laxity, range of motion, muscle strength, and knee pain intensity during sports activities. Performance variables were also assessed, including SL hop distance, jump height in SL vertical jump, and reactive strength index (RSI; jump height/contact time) in SL drop jump. Participants were asked to subjectively report whether they had returned to the same level of competition as pre-injury and their perceived sport performance intensity. Those who answered "Yes" to the dichotomous question and had a postoperative subjective athletic performance of > 80% were categorized into the Yes-RTS group. The primary outcome was the ability to achieve RTS at the preinjury level. Sixty-five patients (female, 35; male, 30) at 13.0 (13.0) [median (interquartile)] months after ACLR participated in this study. Thirty-nine (60%) were assigned to the Yes-RTS group. Regarding knee conditions, the No-RTS group had a significantly higher knee pain intensity, as assessed using a numerical rating scale (p<0.001, effect size -0.45). In the performance tests, the No-RTS group exhibited a significantly lower limb symmetry index of RSI during the SL drop jump compared to the Yes-RTS group (p=0.002, effect size 0.81). Patients unable to achieve RTS after primary ACLR using hamstring grafts are more likely to exhibit asymmetric performance during the SL drop jump test, suggesting the significance of assessing jump symmetry when evaluating post-ACLR rehabilitation success. 3c.

Physical activity and symmetry following total knee arthroplasty: Results of a pilot randomized trial

ObjectiveThis pilot trial examined a Physical Activity and Symmetry (PAS) intervention focused on common deficits of physical inactivity and joint loading asymmetry following total knee arthroplasty (TKA). DesignParticipants (n ​= ​60) were enrolled during routine physical therapy (PT) following TKA and randomized to the PAS intervention or an attention (ATT) control group. The PAS intervention included physical activity counseling and balance exercise to address joint loading symmetry; content was delivered during 2 sessions at the end of routine PT plus supplemental sessions 4-weeks and 8-weeks following PT. The ATT control condition included supplemental sessions at 4-weeks and 8-weeks focused on general evaluation of surgical recovery benchmarks. Primary outcomes were weekly minutes of moderate to vigorous physical activity (MVPA), measured with an accelerometer, and peak force loading symmetry (limb symmetry index; LSI) during a 10 ​m walk, measured with a 3-sensor in-shoe device. General linear mixed models compared changes in outcomes between randomized groups at 3-month and 6-month follow-up. ResultsBoth PAS and ATT groups increased MVPA, but there were no clinically meaningful between-group differences at 3- or 6-month follow-up (p ​> ​0.05). There were also no clinically meaningful between-group differences LSI at 3- or 6-month follow-up (p ​> ​0.05). ConclusionThe PAS intervention did not yield improvements beyond ATT control. It is possible that PAS components were being delivered as part of routine PT, and a more intensive intervention (e.g., more visits, guidance for exercise progression) or targeted approach (e.g., those with deficits at end of routine care) may be needed to further improve outcomes.

Association of the COVID-19 Pandemic With Outcomes After Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Study Examining Changes in Health Care Access, Delivery, and Functional Outcomes.

Structured rehabilitation optimizes outcomes and reduces reinjury risk after anterior cruciate ligament reconstruction (ACLR). The coronavirus 2019 (COVID-19) pandemic interrupted standard rehabilitation, possibly affecting ACLR outcomes. To characterize changes to ACLR functional outcomes related to the COVID-19 pandemic. Cohort study; Level of evidence, 3. Patients who underwent ACLR between June 11, 2019, and March 11, 2020, (postpandemic group) were compared retrospectively with those who underwent ACLR the year before (June 11, 2018, to March 11, 2019). A mixed-effects linear regression model was used to estimate group differences in isokinetic quadriceps testing. A Kaplan-Meier analysis assessed the probability of achieving >90% limb symmetry index (LSI) for isokinetic quadriceps strength at 60 deg/s and passing all return-to-sport functional outcomes at 1 year postoperatively. A total of 176 patients (80 in the control group and 96 in the postpandemic group) were included. The rate of achieving >90% LSI in isokinetic strength at 60 deg/s at 1 year postoperatively was 39% (95% CI, 27%-49%) for the control group versus 22% (95% CI, 13%-30%) for the postpandemic group (P = .01). Similarly, the rate of achieving >90% LSI in all functional tests at 1 year postoperatively was 15% (95% CI, 7%-22%) for the control group versus 7% (95% CI, 2%-12%) for the postpandemic group (P = .04). The number of in-person physical therapy visits per patient was 25.8 ± 6.8 in the control group versus 24.4 ± 7.5 in the postpandemic group (P = .23). Only the postpandemic group accessed physical therapy using remote telemedicine. Each additional telehealth rehabilitation visit was associated with a 1-week delay in achieving >90% LSI in isokinetic quadriceps strength for the postpandemic group. The COVID-19 pandemic was associated with a decrease in lower extremity strength and a lower probability of achieving limb symmetry and passing the criteria for return to sport at 1 year postoperatively. These results were not due to lack of access to physical therapy.

Longitudinal Evaluation Using the Forgotten Joint Score-12 for Double-Bundle Primary Anterior Cruciate Ligament Reconstruction: A Retrospective Observational Study.

Introduction There are several postoperative evaluation methods for anterior cruciate ligament reconstruction (ACLR), and patient-reported outcome measurement (PROM) is one of the most important for evaluating postoperative clinical results. However, conventional PROMs have a high risk ofa ceiling effect at one and two years postoperatively and do not accurately reflect functional improvement over time. Therefore, a longitudinal evaluation using PROM with a low risk of ceiling effect is necessary. The forgotten joint score-12 (FJS) was developedfor clinical evaluation after arthroplasty. It is considered an evaluation method after arthroplasty with a low risk of demonstrating a ceiling effect. However, few studies have used the FJS as an evaluation method after ACLR, particularly those tracking changes over time. This study aimed to longitudinally evaluate FJS at one and two years after ACLR. Methods This is a retrospective observational study of postoperative patients using existing data and a questionnaire-based survey.This studyincluded patients who underwent primary double-bundle ACLRbetween August 2017 and August 2021. We compared the FJS, knee injury and osteoarthritis outcome score (KOOS), and Lysholm knee scale (LKS) scores at one and two years post-surgery using the Wilcoxon signed-rank test. The ceiling effect for each PROM was calculated at one and two years post-surgery.A ceiling was defined as obtaining a perfect score in PROMs, and the risk of demonstrating a ceiling effect was the percentage of perfect scores among all cases. The risk of demonstrating a ceiling effect for each PROM was compared using the McNemar test. To identify factors influencing FJS one-year post-ACLR across all cases, multivariate linear regression analysis was conducted for the FJS. Results Finally, 87 patients were included in this study.Fifty-six participants were women, and 31 were men, with an average age of 28.5 ± 11.8 years at the time of surgery and a BMI of 23.2 ± 3.7 kg/m2. Fifty-eight patients with meniscus injuries requiring treatment were observed. A total of 54 patients were used to compare the results at one and two years, while 87 patients were included in the multivariate analysis for FJS at one year.The median of FJS at one and two years post-surgery were 90.6 and 95.8, respectively. The FJS showed a statistically significant improvement from one to two years (p = 0.033). Question #12 in FJS showed a significant improvement from the first to the second year postoperatively (1.74 ± 1.46 vs 1.15 ± 1.25 at one year vs two years, respectively; p = 0.0016). FJS had a lower risk of demonstrating a ceiling effect than KOOS ADL at one and two years (FJS vs KOOS ADL; at first year: 20.4% and 48.1%, p < 0.001; at second year: 33.3% and 63.0%, p = 0.0013). There was no difference compared to the other PROMs. According to the multivariate linear regression analysis,predictive factors for higher FJS scoresat one year post-surgery were younger age and limb symmetry index of single-leg hop test(SLH-LSI) on the affected side that was close to that of the healthy side (SLH-LSI > 0.9). Conclusions The FJS continued to improve over two years after ACLR. The FJS post-ACLR was higher in younger individuals and those with SLH-LSI of 0.9 or higher.

Quantitative electroencephalography to assess post-stroke functional disability: A systematic review and meta-analysis

ObjectiveQuantitative electroencephalography (QEEG) is a non-invasive, reliable and easily accessible modality to assess neuronal activity. QEEG in acute stroke may predict short and long-term functional outcomes. The role of individual indices has not been studied in a meta-analysis. We aim to assess individual QEEG-derived indices to predict post-stroke disability. MethodsWe included studies (sample size ≥ 10) with stroke patients who underwent EEG and a follow-up outcome assessment was available either in the form of modified Rankin scale (mRS) or National Institute of Stroke scale (NIHSS) or Fugl-Meyer scale (FMA). QEEG indices analysed were delta-alpha ratio (DAR), delta-theta-alpha-beta ratio (DTABR), brain symmetry index (BSI) and pairwise derived brain symmetry (pdBSI). ResultsNine studies (8 had only ischemic stroke, and one had both ischemic and haemorrhagic stroke), including 482 participants were included for meta-analysis. Higher DAR was associated with worse mRS (n=300, Pearson's r 0.26, 95 % CI 0.21-0.31). Higher DTABR was associated with worse mRS (n=337, r=0.32, 95 % CI 0.26-0.39). Higher DAR was associated with higher NIHSS (n=161, r=0.42, 95 % CI0.24-0.6). Higher DTABR was associated with higher NIHSS (n=158, r=0.49, 95 % CI 0.31-0.67). ConclusionsQEEG-derived indices DAR and DTABR have the potential to assess post-stroke disability. Adding QEEG to the clinical and imaging biomarkers in the acute phase may help in better prediction of post-stroke recovery. RegistryPROSPERO 2022 CRD42022292281

Are there laterality differences in passive flexion and extension of the proximal limb joints in working Siberian Husky dogs?

Differences between left and right-side joint range of motion may affect canine locomotive ability and movement. Passive range of motion (PROM) joint measurement provides the limits that a particular joint can move in its physiological planes of motion without influence of muscle activity. To compare left and right-side flexion and extension of the glenohumeral, humeroulnar/humeroradial, coxofemoral and femorotibial joints and for laterality PROM differences. Siberian Husky dogs were selected (n = 18) of mixed gender, aged (1.4–11.8) years living and working together from a single kennel. Joint PROM was measured using goniometry, a validated, non-invasive method, by the same investigator previously tested for acceptable measurement repeatability. Dogs were conscious and placed in standing position. Triplicate measures of joint flexion and extension were taken on both sides of each dog for afore-mentioned joints. Median values of triplicate measures were computed. Paired t-tests compared laterality of joint PROM, gender, age (&lt; 6 vs. &gt; 6 years) effects. Inferential symmetry indices [SI] were calculated. There was no significant difference (p &gt; 0.05) between left and right-side flexion and extension measures for all joints. Gender had no significant effect (p &gt; 0.05) on joint flexion or extension measures for all joints. Age (&lt; 6 vs. &gt; 6 years) had a significant effect on right hip flexion (p &lt; 0.001) and for both left and right-side shoulder flexion (p &lt; 0.001); elbow flexion (p = 0.001 and p &lt; 0.001); hip extension (p = 0.02 and p &lt; 0.001) respectively. The shoulder joint showed greatest PROM asymmetry (SI = 3.63%). Bilateral PROM measures are important to consider in joint movement and assessment. These results warrant further investigation with larger cohorts of defined age groups.

Side differences in upper quarter mobility/stability are not related to serve velocity in tennis players with different levels of training experience

ObjectiveTennis is characterised by repetitive serves and strokes predominately performed with one arm. This can lead to differences in upper quarter mobility/stability between the stroke and non-stroke arm, which could even enlarge with increasing training experience and negatively affect serve velocity. Thus, we determined side differences (i.e., limb symmetry index) in upper quarter mobility/stability and their association with flat and slice serve velocity in advanced (ITN ≤ 4) female and male tennis players (N = 42, mean age = 23.9 ± 9.3 years) with different levels of training experience (< 2 years: n = 14, 2–5 years: n = 17, 6–8 years: n = 11).ResultsY Balance Test-Upper Quarter (YBT-UQ) side difference (i.e., composite score) and performances (i.e., medial reach) were largest in players with the lowest level of training experience (i.e., < 2 years). Further, YBT-UQ performances (i.e., medial reach and composite score) but not side differences were significantly correlated with flat and slice serve velocity, particularly in less experienced players. Our results suggest that significant side differences in upper quarter mobility/stability occur in less experienced players (indicative of increased injury risk) but they are not related to tennis-specific performance (i.e., serve velocity).

Clinical and radiological outcome of acute quadriceps tendon repair at 2 - year follow-up.

Though previous studies on surgical quadriceps tendon repair reported good to satisfactory results its impact on knee extensor strength and patellofemoral joint is unknown. The purpose of the study was to assess the clinical and functional outcome by quantifying subjective knee related outcome, isokinetic extensor strength complemented by magnetic resonance imaging (MRI). For this retrospective clinical trial twenty-one patients with a mean age of 59.1 (±14.9) years were carried out for follow-up evaluation. For clinical outcome numeric rating scale for pain (NRS), Kujala anterior knee pain score, Knee osteoarthritis outcome score (KOOS) with its subscores, Tegener Activity Score (TAS), Isokinetic extensor strength testing (ISO) and the Limb symmetry index (LSI) were utilized. Muscle volume (Vmqf), atrophy and cartilage status were assessed on MRI. Tendon integrity and implant loosening were evaluated. Statistical analysis was carried out using Student´s t-test, Pearson and Spearman correlation coefficient. Mean follow-up was 56.2 (± 17.5) months. Clinical outcomes in mean were as follows: NRS 1.7 (±2.0), Kujala score 75.8 (± 15.8) points; KOOS 62.9 (±30.6) % (Subscores: (KOOSPain 84 (± 18.3)%, KOOSSymptoms 63.4 (± 15.3) %, KOOSADL 79.8% (± 19.4)%, KOOSSports&Rec 61.5 (± 28.8))%, TAS 3.7 (± 1.2). Mean ISO difference was 3.7 (±32.3) %). 41.2% of patients had an LSI < 90% and showed non-significantly (p > 0.05) better outcomes in NRS, Kujala score and KOOS than patients with LSI < 90%. ISO correlated with better subjective outcome (r > 0.5) but not with MRI findings. Vmqf asymmetry > 10% was seen in 41,2% of patients. Degenerative muscle and cartilage changes were few and low grade. One tendon showed partial retear. Patients showed no signs of implant loosening. Distal quadriceps tendon repair leads to satisfactory subjective outcome in patients with low to moderate activity levels. Tendon integrity was reliably restored. However, extensor strength deficits remain in more than 40% of patients. Atrophy signs of advanced fatty infiltration were recorded in 15% and patellofemoral cartilage defects in 20% of all patients, indicating that previous assessment tools do not display functional outcome adequately.

Walking on different inclines affects gait symmetry differently in the anterior-posterior and vertical directions: implication for future sensorimotor training

A symmetric gait pattern in humans reflects near-identical movement in bilateral limbs during walking. However, little is known about how gait symmetry changes on different inclines. This study aimed to address this knowledge gap using the central pattern generator and internal model hypotheses. Eighteen healthy young adults underwent five 2-minute walking trials (inclines of +15%, +8%, 0%, −8%, and −15%). Dependent variables included step time, step length, step width, maximum heel clearance, time to peaks of maximum heel clearance, their corresponding coefficients of variation (CV), and respective symmetry indices (SI). Significant differences were observed in SI of step length (p = .022), step length variability (p &lt; .001), step width variability (p =.001), maximum heel clearance (p &lt; .001), and maximum heel clearance variability (p = .049). Compared to level walking, walking at −8% and −15% inclines increased SI of step length (p = .011, p = .039 respectively) but decreased SI of maximum heel clearance (p = .025, p = .019 respectively). These observations suggested that incline walking affected gait symmetry differently, possibly due to varied internal models used in locomotion. Downhill walking improved vertical gait symmetry but reduced anterior-posterior symmetry compared to level walking. Downhill walking may be a preferable rehabilitation protocol for enhancing gait symmetry, as it activates internal model controls. Even slight downhill inclines could increase active control loading, beneficial for the elderly and those with impaired gait.