Uninjured Contralateral Limb Research Articles

Dynamic Single-Leg Postural Control Is Impaired Bilaterally Following Anterior Cruciate Ligament Reconstruction: Implications for Reinjury Risk.

Study Design Cross-sectional, controlled laboratory study. Background Postural control following anterior cruciate ligament reconstruction (ACLR) primarily has been investigated during static single-leg balance tasks. Little is known about dynamic postural control deficits post-ACLR. Objectives To compare dynamic postural control (bilaterally) in individuals who have undergone ACLR and in healthy controls, and to evaluate the relationship between dynamic postural control and self-reported and objective function. Methods Ninety-seven participants (66 male; median age, 28 years) 12 months post-ACLR and 48 healthy controls (20 male; median age, 30 years) underwent balance assessment using a Nintendo Wii Balance Board during a single-leg squat. Center-of-pressure (CoP) path velocity, as well as CoP amplitude and standard deviation, in both mediolateral (ML) and anteroposterior (AP) directions were recorded. Self-reported function was assessed with the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), while hop for distance was used to evaluate functional status. Results Compared to healthy controls, the ACLR group had greater mean CoP path velocity (16% higher, P = .004), ML range (23%, P<.001), ML SD (28%, P<.001), AP range (14%, P = .009), and AP SD (15%, P = .013), indicating worse dynamic balance post-ACLR. Dynamic balance performance was similar between the ACLR limb and the uninjured contralateral limb. The AP SD was weakly associated with hop performance (β = -.2, P = .046); no balance measures were associated with IKDC score. Conclusion Individuals who have undergone ACLR demonstrate impaired dynamic balance bilaterally when performing a single-leg squat, which may have implications for physical function and future injury risk. Routine dynamic balance assessment may help identify patients who could benefit from targeted neuromuscular training programs to improve objective function and potentially lower reinjury risk. J Orthop Sports Phys Ther 2016;46(5):357-364. Epub 21 Mar 2016. doi:10.2519/jospt.2016.6305.

Biceps Femoris Architecture and Strength in Athletes with a Previous Anterior Cruciate Ligament Reconstruction.

This study aimed to determine whether limbs with a history of anterior cruciate ligament (ACL) injury reconstructed from the semitendinosus display different biceps femoris long head (BFlh) architecture and eccentric strength, assessed during the Nordic hamstring exercise, compared with the contralateral uninjured limb. The architectural characteristics of the BFlh were assessed at rest and at 25% of a maximal voluntary isometric contraction (MVIC) in the control group (n = 52) and in the group who had previous ACL injury (n = 15) using two-dimensional ultrasonography. Eccentric knee flexor strength was assessed during the Nordic hamstring exercise. Fascicle length was shorter (P = 0.001; d range, 0.90-1.31) and pennation angle (P range, 0.001-0.006; d range, 0.87-0.93) was greater in the BFlh of the ACL-injured limb compared with those in the contralateral uninjured limb at rest and during a 25% MVIC. Eccentric strength was lower in the ACL-injured limb when compared with the contralateral uninjured limb. Fascicle length, MVIC, and eccentric strength were not different between the left and right limb in the control group. Limbs with a history of ACL injury reconstructed from the semitendinosus have shorter fascicles and greater pennation angles in the BFlh compared with those of the contralateral uninjured side. Eccentric strength during the Nordic hamstring exercise of the ACL-injured limb is significantly lower than that of the contralateral side. These findings have implications for ACL rehabilitation and hamstring injury prevention practices, which should consider altered architectural characteristics.

Serial Changes of Quadriceps and Hamstring Muscle Strength Following Total Knee Arthroplasty: A Meta-Analysis.

This meta-analysis was performed to analyze serial changes in thigh muscles, including quadriceps and hamstring muscles, from before to one year after total knee arthroplasty (TKA). All studies sequentially comparing isokinetic quadriceps and hamstring muscle strengths between the TKA side and the contralateral uninjured limb were included in this meta-analysis. Five studies with 7 cohorts were included in this meta-analysis. The mean differences in the strengths of quadriceps and hamstring muscles between the TKA and uninjured sides were greatest three months after surgery (26.8 N∙m, 12.8 N∙m, P<0.001), but were similar to preoperative level at six months (18.4 N∙m, 7.4 N∙m P<0.001) and were maintained for up to one year (15.9 N∙m, 4.1 N∙m P<0.001). The pooled mean differences in changes in quadriceps and hamstring strengths relative to preoperative levels were 9.2 N∙m and 4.9 N∙m, respectively, three months postoperatively (P = 0.041), but were no longer significant after six months and one year. During the year after TKA, quadriceps and hamstring muscle strengths were lowest after 3 months, recovering to preoperative level after six months, but not reaching the muscle strength on the contralateral side. Relative to preoperative levels, the difference in muscle strength between the TKA and contralateral knees was only significant at three months. Because decrease of strength of the quadriceps was significantly greater than decrease in hamstring muscle strength at postoperative three months, early rehabilitation after TKA should focus on recovery of quadriceps muscle strength.

Medial Subluxation of the Tibia After Anterior Cruciate Ligament Rupture as Revealed by Standing Radiographs and Comparison With a Cadaveric Model

Background: Biomechanical studies indicate that the tibia shifts medially and has a more valgus orientation in the anterior cruciate ligament (ACL)–deficient knee. However, it is not known whether these differences can be detected on standing radiographs. Purpose: To determine whether medial subluxation and more changes in coronal alignment of the tibia are detectable in both weightbearing radiographs and a cadaveric model simulating quiet standing. Study Design: Case series; Level of evidence, 4, and Descriptive laboratory study. Methods: Radiographic data were available for a cross-section of 74 patients with unilateral ACL tears. Tibial subluxation and coronal limb alignment were measured on hip-to-ankle weightbearing radiographs. Eight cadaveric knees were mounted on a 6 degree of freedom robot. Mediolateral position and varus-valgus alignment of the tibia relative to the femur were measured in response to 300-N axial compression simulating quiet standing at 5° and 15° of flexion with the ACL intact and sectioned. Results: Across all 74 patients included in the clinical study, the ACL-injured knee experienced 1.6 ± 2.3 mm (mean ± SD) of medial tibial subluxation compared with the contralateral uninjured knee (P < .001). The 24 patients with isolated ACL rupture exhibited 2.0 ± 1.8 mm of medial subluxation (P < .001). The mean coronal alignment of all 74 patients in the study was 0.7° ± 2.8° varus in the injured limb and 1.3° ± 2.6° varus in the uninjured contralateral limb (P = .0187). In the cadaveric model, the tibia translated 0.4 ± 0.5 mm more medially after sectioning of the ACL at 15° of flexion (P = .0485); however, no changes in coronal alignment were detected. Conclusion: The tibia shifts medially and is less varus in the ACL-deficient knee on standing radiographs. The medial tibial shift is reproduced in an axially loaded cadaveric model. Clinical Relevance: Medial tibiofemoral subluxation seen on frontal plane standing radiograph is an underappreciated sequela of isolated ACL rupture. The ability of ACL reconstruction to restore this aspect of ACL injury is not well understood and should be investigated further. Cadaveric models may be used to directly measure the mechanical effect of subtle changes in mediolateral position on articular contact stress as an indicator of the importance of this finding.

Are Muscle Strength and Function of the Uninjured Lower Limb Weakened After Anterior Cruciate Ligament Injury?

Background: After an anterior cruciate ligament (ACL) injury, the uninjured contralateral lower limb may become weakened because of neuromuscular changes, proprioceptive deficits, and disuse of the limb; this weakness predisposes the limb to ACL injury. However, no results have been reported regarding weakness in the contralateral limb after ACL injury. Hypothesis: Muscle strength and functional status of the contralateral lower limb are reduced after unilateral ACL injury. Study Design: Cohort study; Level of evidence, 3. Methods: The ACL group consisted of 75 patients who underwent primary unilateral ACL reconstruction and were followed at 3, 6, 12, and 24 months postoperatively. A group of 75 healthy individuals (controls) were matched one-to-one with the ACL group for age, sex, body mass index, and initial Tegner activity level. The side that was evaluated in each control subject corresponded to the injured limb in the matched ACL subject. Isokinetic muscle strength, including extension peak torque per body weight (EPT) and flexion peak torque per body weight (FPT), was evaluated at angular velocities of 60 and 180 deg/s. Patients were also evaluated by single-legged hop test. Results: Compared with the EPT at 60 deg/s in the control group (290.9 ± 40.1 N·m/kg), the value in the ACL group 24-month follow-up (276.6 ± 42.8 N·m/kg) as well as other follow-up times was significantly lower (P < .05), whereas the EPT at 180 deg/s and the FPT at 60 and 180 deg/s in the ACL group were significantly lower than the control group at 3-month follow-up but were restored to normal levels at final follow-up. Results from the single-legged hop test demonstrated that the ACL group performed at a significantly lower level than the control group at 24-month follow-up (158.4 ± 25.3 vs 176.3 ± 24.7 cm; P < .05) as well as other follow-up times. However, both measurements improved significantly as the follow-up time progressed. Conclusion: After ACL injury, isokinetic extensor muscle strength and functional status of the contralateral limb were reduced, even at 24 months after ACL reconstruction. However, both measurements improved significantly as the follow-up time progressed. In contrast, flexion muscle strength was restored to normal levels. Therefore, care should be taken to restore muscle strength and functional status in not only the ACL-reconstructed knee but also the uninjured limb.

Muscle activation patterns in the Nordic hamstring exercise: Impact of prior strain injury.

This study aimed to determine: (a) the spatial patterns of hamstring activation during the Nordic hamstring exercise (NHE); (b) whether previously injured hamstrings display activation deficits during the NHE; and (c) whether previously injured hamstrings exhibit altered cross-sectional area (CSA). Ten healthy, recreationally active men with a history of unilateral hamstring strain injury underwent functional magnetic resonance imaging of their thighs before and after six sets of 10 repetitions of the NHE. Transverse (T2) relaxation times of all hamstring muscles [biceps femoris long head (BFlh); biceps femoris short head (BFsh); semitendinosus (ST); semimembranosus (SM)] were measured at rest and immediately after the NHE and CSA was measured at rest. For the uninjured limb, the ST's percentage increase in T2 with exercise was 16.8%, 15.8%, and 20.2% greater than the increases exhibited by the BFlh, BFsh, and SM, respectively (P < 0.002 for all). Previously injured hamstring muscles (n = 10) displayed significantly smaller increases in T2 post-exercise than the homonymous muscles in the uninjured contralateral limb (mean difference -7.2%, P = 0.001). No muscles displayed significant between-limb differences in CSA. During the NHE, the ST is preferentially activated and previously injured hamstring muscles display chronic activation deficits compared with uninjured contralateral muscles.

Biceps femoris long head architecture: a reliability and retrospective injury study.

This study aimed (i) to determine the reliability of two-dimensional ultrasonography for the assessment of biceps femoris long head (BFlh) architectural characteristics and (ii) to determine whether limbs with a history of strain injury in the BFlh display different architecture and eccentric strength compared to uninjured limbs. This case-control study (control [n = 20], injured group [n = 16], males) assessed the BFlh architecture at rest and during graded isometric contractions using two-dimensional ultrasonography. The control group were assessed three times (>24 h apart) to determine reliability. Previously injured individuals were evaluated once. The assessment of BFlh architecture was highly reliable (intraclass correlations >0.90). Fascicle length (P < 0.001; d range = 0.67-1.34) and fascicle length relative to muscle thickness (P < 0.001; d range = 0.58-0.85) of the previously injured BFlh were significantly less than the contralateral uninjured BFlh at all intensities. Pennation angle of the previously injured BFlh was significantly greater (P < 0.001; d range = 0.62-0.88) than the contralateral uninjured BFlh at all intensities. Eccentric strength in the previously injured limb was significantly lower than that in the contralateral limb (-15.4%; -52.5 N, 95% confidence interval = -76.2 to -28.4; P < 0.001, d = 0.56). These data indicate that two-dimensional ultrasonography is reliable for assessing BFlh architecture at rest and during graded isometric contractions. Fascicle length, fascicle length relative to muscle thickness, and pennation angle are significantly different in previously injured BFlh compared to an uninjured contralateral BFlh. Eccentric strength of the previously injured limb is also significantly lower than that of the uninjured contralateral limb. These findings have implications for rehabilitation and injury prevention practices, which should consider altered architectural characteristics.

Hamstring muscle activation during high-speed overground running: Impact of previous strain injury

Background Hamstring strain injuries (HSIs) are a common and recurrent complaint in sport, with most insults occurring during high-speed overground running. Objective To determine, during high-speed overground running, the spatial patterns of hamstring muscle voluntary activation (VA) in limbs with and without a history of HSI. Design Retrospective cross-sectional study. Setting Elite and sub-elite level track and field (T&F). Participants Five healthy, elite (n=4) and sub-elite (n=1) level TF average age 20±1.8 years; stature 182.1±6.5 cm and mass 78.3±4.8 kg). Assessment of risk factors Functional MRI was performed on participants thighs before and after 3 sets of 6, 40m sprints (30s rest between reps; 1 min rest between sets). T2 relaxation times of all hamstring muscles (biceps femoris long (BFlh) and short head (BFsh); semitendinosus (ST); semimembranosus (SM)), were measured at rest and immediately after the running protocol. Main outcome measurements The percentage change in T2 relaxation time for each hamstring muscle, in both the previously injured and contralateral uninjured limbs. Results For the spatial analysis of uninjured limbs, no significant differences were observed in the percentage increase in T2 relaxation for any muscles (BFlh vs ST, P=.07; BFlh vs BFsh, P=.66; BFlh vs SM, P=.08; BFsh vs ST, P=.08; BFsh vs SM, P=.54; SM vs ST, P=.57). However, previously injured hamstring muscles displayed significantly smaller increases in T2 relaxation time compared with homonymous muscles in the uninjured contralateral limb (mean difference=–8.1%, 95% CI=-16.5 to -0.3%, P=.02). Conclusions These preliminary findings indicate that the hamstrings of uninjured limbs are activated somewhat uniformly during high-speed overground running however, following an HSI, VA is chronically reduced in the previously injured muscle.

Increased bilateral expression of α1-adrenoceptors on peripheral nerves, blood vessels and keratinocytes does not account for pain or neuroinflammatory changes after distal tibia fracture in rats

In certain forms of nerve injury and inflammation, noradrenaline augments pain via actions on up-regulated α1-adrenoceptors (α1-ARs). The aim of this study was to use immunohistochemistry to examine α1-AR expression on peripheral neurons, cutaneous blood vessels and keratinocytes after distal tibia fracture and cast immobilization, a model of complex regional pain syndrome type 1. We hypothesized that there would be increased α1-AR expression on neurons and keratinocytes in the injured limb in comparison to the contralateral unaffected limb after distal tibia fracture, in association with inflammatory changes and pain. α1-AR expression was increased on plantar keratinocytes, dermal blood vessels and peripheral nerve fibers at 16weeks after injury both in the fractured and contralateral uninjured limb. Similar changes were seen in controls whose limb had been immobilized in a cast for 4weeks but not fractured. Neurofilament 200 (NF200), a marker of myelinated neurons, and calcitonin gene-related peptide (CGRP), a neuropeptide involved in neuro-inflammatory signaling, decreased 4weeks after fracture and casting but then increased at the 16-week time point. As some of these changes were also detected in the contralateral hind limb, they probably were triggered by a systemic response to fracture and casting. Soon after the cast was removed, intraplantar injections of the α1-AR antagonist prazosin released local vasoconstrictor tone but had no effect on pain behaviors. However, systemic injection of prazosin inhibited behavioral signs of pain, suggesting that fracture and/or casting triggered an up-regulation of α1-ARs in central nociceptive pathways that augmented pain. Together, these findings indicate that α1-AR expression increases in the hind limbs after distal tibia fracture and cast immobilization. However, these peripheral increases do not contribute directly to residual pain.

Effect of Posterior Horn Medial Meniscus Root Tear on In Vivo Knee Kinematics.

Background:Medial meniscus root tear (MMRT) is a recently recognized yet frequently missed meniscal tear pattern that biomechanically creates an environment approaching meniscal deficiency.Hypothesis/Purpose:The purpose of this study was to assess the effect of MMRT on tibiofemoral kinematics and arthrokinematics during daily activities by comparing the injured knees of subjects with isolated MMRT to their uninjured contralateral knees. The hypothesis was that the injured knee will demonstrate significantly more lateral tibial translation and adduction than the uninjured knee, and that the medial compartment will exhibit significantly different arthrokinematics than the lateral compartment in the affected limb.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Seven subjects with isolated MMRT were recruited and volumetric, density-based 3-dimensional models of their distal femurs and proximal tibia were created from computed tomography scans. High-speed, biplane radiographs were obtained of both their affected and unaffected knees. Moving 3-dimensional models of tibiofemoral kinematics were calculated using model-based tracking to assess overall kinematic variables and specific measures of tibiofemoral joint contact. The affected knees of the subjects were then compared to their unaffected contralateral knees.Results:Affected knees demonstrated significantly more lateral tibial translation than the uninjured contralateral limb in all dynamic activities. Additionally, the medial compartment displayed greater amounts of mobility than the lateral compartment in the injured limbs.Conclusion:This study suggests that MMRT causes significant changes in in vivo knee kinematics and arthrokinematics and that the magnitude of these changes is influenced by dynamic task difficulty.Clinical Relevance:Medial meniscus root tears lead to significant changes in joint arthrokinematics, with increased lateral tibial translation and greater medial compartment excursion. With complete root tears, essentially 100% of circumferential fibers are lost. This study will further our knowledge of meniscal deficiency and osteoarthritis and provide a baseline for more common forms of medial meniscal injuries (vertical, horizontal, radial), with various degrees of circumferential fiber function remaining.

HAMSTRING MUSCLE ACTIVATION DURING HIGH-SPEED OVERGROUND RUNNING: IMPACT OF PREVIOUS STRAIN INJURY

BackgroundHamstring strain injuries (HSIs) are a common and recurrent complaint in sport, with most insults occurring during high-speed overground running.ObjectiveTo determine, during high-speed overground running, the spatial patterns of hamstring...

ASSESSMENT OF HAMSTRING MUSCLE VOLUNTARY ACTIVATION: IMPACT OF CONTRACTION MODE AND PREVIOUS INJURY

BackgroundHamstring strain injury (HSI) burdens athletes due to high occurrence and recurrence rates. Previous surface EMG evidence suggests reduced voluntary activation (VA) may contribute to high recurrence rates however no...

BICEPS FEMORIS MUSCLE ARCHITECTURE – THE INFLUENCE OF PREVIOUS INJURY

BackgroundA history of hamstring strain injury (HSI) has been indicated as a primary risk factor for a future injury. It is unknown whether a prior strain influences the architectural characteristics...

A Novel Device Using the Nordic Hamstring Exercise to Assess Eccentric Knee Flexor Strength: A Reliability and Retrospective Injury Study

Reliability and case-control injury study. To determine if a novel device designed to measure eccentric knee flexor strength via the Nordic hamstring exercise displays acceptable test-retest reliability; to determine normative values for eccentric knee flexor strength derived from the device in individuals without a history of hamstring strain injury (HSI); and to determine if the device can detect weakness in elite athletes with a previous history of unilateral HSI. HSI and reinjury are the most common cause of lost playing time in a number of sports. Eccentric knee flexor weakness is a major modifiable risk factor for future HSI. However, at present, there is a lack of easily accessible equipment to assess eccentric knee flexor strength. Thirty recreationally active males without a history of HSI completed the Nordic hamstring exercise on the device on 2 separate occasions. Intraclass correlation coefficients, typical error, typical error as a coefficient of variation, and minimal detectable change at a 95% confidence level were calculated. Normative strength data were determined using the most reliable measurement. An additional 20 elite athletes with a unilateral history of HSI within the previous 12 months performed the Nordic hamstring exercise on the device to determine if residual eccentric muscle weakness existed in the previously injured limb. The device displayed high to moderate reliability (intraclass correlation coefficient = 0.83-0.90; typical error, 21.7-27.5 N; typical error as a coefficient of variation, 5.8%-8.5%; minimal detectable change at a 95% confidence level, 60.1-76.2 N). Mean ± SD normative eccentric flexor strength in the uninjured group was 344.7 ± 61.1 N for the left and 361.2 ± 65.1 N for the right side. The previously injured limb was 15% weaker than the contralateral uninjured limb (mean difference, 50.3 N; 95% confidence interval: 25.7, 74.9; P<.01), 15% weaker than the normative left limb (mean difference, 50.0 N; 95% confidence interval: 1.4, 98.5; P = .04), and 18% weaker than the normative right limb (mean difference, 66.5 N; 95% confidence interval: 18.0, 115.1; P<.01). The experimental device offers a reliable method to measure eccentric knee flexor strength and strength asymmetry and to detect residual weakness in previously injured elite athletes.

Rate of Torque and Electromyographic Development During Anticipated Eccentric Contraction Is Lower in Previously Strained Hamstrings

Background: The effect of prior strain injury on myoelectrical activity of the hamstrings during tasks requiring high rates of torque development has received little attention. Purpose: To determine if recreational athletes with a history of unilateral hamstring strain injury will exhibit lower levels of myoelectrical activity during eccentric contraction, rate of torque development (RTD), and impulse (IMP) at 30, 50, and 100 milliseconds after the onset of myoelectrical activity or torque development in the previously injured limb compared with the uninjured limb. Study Design: Case control study; Level of evidence, 3. Methods: Twenty-six recreational athletes were recruited. Of these, 13 athletes had a history of unilateral hamstring strain injury (all confined to biceps femoris long head), and 13 had no history of hamstring strain injury. Following familiarization, all athletes undertook isokinetic dynamometry testing and surface electromyography (integrated EMG; iEMG) assessment of the biceps femoris long head and medial hamstrings during eccentric contractions at −60 and −180 deg·s−1. Results: In the injured limb of the injured group, compared with the contralateral uninjured limb, RTD and IMP was lower during −60 deg·s−1 eccentric contractions at 50 milliseconds (RTD: injured limb, 312.27 ± 191.78 N·m·s−1 vs uninjured limb, 518.54 ± 172.81 N·m·s−1, P = .008; IMP: injured limb, 0.73 ± 0.30 N·m·s vs uninjured limb, 0.97 ± 0.23 N·m·s, P = .005) and 100 milliseconds (RTD: injured limb, 280.03 ± 131.42 N·m·s−1 vs uninjured limb, 460.54 ± 152.94 N·m·s−1, P = .001; IMP: injured limb, 2.15 ± 0.89 N·m·s vs uninjured limb, 3.07 ± 0.63 N·m·s, P < .001) after the onset of contraction. Biceps femoris long head muscle activation was lower at 100 milliseconds at both contraction speeds (–60 deg·s−1, normalized iEMG activity [×1000]: injured limb, 26.25 ± 10.11 vs uninjured limb, 33.57 ± 8.29, P = .009; –180 deg·s−1, normalized iEMG activity [×1000]: injured limb, 31.16 ± 10.01 vs uninjured limb, 39.64 ± 8.36, P = .009). Medial hamstring activation did not differ between limbs in the injured group. Comparisons in the uninjured group showed no significant between limbs difference for any variables. Conclusion: Previously injured hamstrings displayed lower RTD and IMP during slow maximal eccentric contraction compared with the contralateral uninjured limb. Lower myoelectrical activity was confined to the biceps femoris long head. Regardless of whether these deficits are the cause of or the result of injury, these findings could have important implications for hamstring strain injury and reinjury. Particularly, given the importance of high levels of muscle activity to bring about specific muscular adaptations, lower levels of myoelectrical activity may limit the adaptive response to rehabilitation interventions and suggest that greater attention be given to neural function of the knee flexors after hamstring strain injury.

Early Radial Head Excision for Displaced and Comminuted Radial Head Fractures

The aim of this study is to retrospectively review the outcomes of patients with comminuted radial head fractures surgically treated with early radial head excision. Retrospective follow-up study. University orthopaedic trauma center. Forty-two patients with unilateral, isolated, closed, displaced, or comminuted radial head fracture (Mason type 2-10, Type 3-32). Early radial head excision. Patients were clinically and radiographically evaluated at an average follow-up of 18 years. The uninjured contralateral limb was used as a comparison. Clinical evaluation was rated using the Broberg and Morrey system, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the visual analog scale (VAS) for pain. At last follow-up, 36 patients had no complaints, whereas six admitted to occasional pain. The mean Broberg and Morrey score was 91.2 ± 6.3, and the mean Disabilities of the Arm, Shoulder and Hand score was 10.1 ± 8.8. Early radial head excision represents a viable option in case of displaced and comminuted fractures. According to the results of this study, it demonstrated a high rate of good results and patient satisfaction, a quick recovery after surgery, and a low rate of complications with durable results at long-term follow-up. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Bone marrow−derived cells do not engraft into skeletal muscle microvasculature but promote angiogenesis after acute injury

The skeletal muscle is supported by a vast network of microvessels with the capacity to regenerate in response to injury. However, the dynamics of microvascular repair and the origin of reconstituted endothelial cells in the skeletal muscle are poorly understood. A growing body of literature exists to indicate bone marrow (BM)-derived cells engraft into regenerating vascular endothelium and muscle macrovasculature. Therefore, we investigated the extent of BM contribution to skeletal muscle microvasculature after acute injury. Because reporters and markers commonly used to trace donor BM cells are not endothelial specific but are also expressed by leukocytes, we generated novel BM chimeras utilizing Tie2-green fluorescent protein BM cells transplanted into CD31 and Caveolin-1 knockout recipients. In turn, we surveyed BM vascular contribution, not just by the presence of green fluorescent protein, but also CD31 and Caveolin-1, respectively. After stable BM reconstitution, chimera limb muscles were cardiotoxin (CTX) injured and examined 21 days post-injury for the presence of green fluorescent protein, CD31, and Caveolin-1. Acute muscle injury by CTX is characterized by initial microvasculature death followed by rapid endothelial regeneration within 14 days post-damage. Histological analysis of injured and uninjured contralateral limb muscles revealed a complete absence of BM engraftment in the muscle vasculature of wild-type and CD31/Caveolin-1 knockout chimeras. In contrast, F4/80(+) cells isolated from CTX-injured muscle, expressed endothelial-related markers and promoted angiogenesis invitro. Therefore, despite the absence of BM engraftment to regenerated skeletal muscle microvasculature, macrophages recruited after injury promote angiogenesis and, in turn, vascular regeneration.

Altered hamstring strength profile in Gaelic footballers with a previous hamstring injury

Hamstring injuries are common in many sports involving high-load eccentric hamstring activation, including Gaelic football. Eccentric hamstring peak torque (PT) and hamstring angle to peak torque (AngPT) have not been examined in previously injured Gaelic footballers. This study aimed to determine whether significant hamstring and quadriceps PT deficits were present in Gaelic footballers after a hamstring injury. Concentric hamstring and quadriceps PT at 60 and 180 degrees/second ( � /s) and eccentric hamstring PT at 30 � /s were measured using an isokinetic dynamometer in 18 male Gaelic footballers (nine previously injured, nine controls). Hamstring AngPT, as well as hamstring and quadriceps PT and PT ratios were analysed. For previously injured limbs, hamstring AngPT occurred at significantly sh orter muscle lengths (p = 0.038) than for the contralateral uninjured limbs in eccentric testing only. There were no other signific ant differences (p > 0.05) at any velocity, for within-subject or between-subject comparisons. The results showed that the previously injured hamstrings generated their eccentric ha mstring AngPT at significantly shorter muscle lengths than the contr alateral hamstrings. The results imply footballers with a p revious hamstring injury who have returned to full participation may remain at increased risk of re-injury because of an alterat ion in their eccentric hamstring AngPT.

ASB Clinical Biomechanics Award Paper 2010: Virtual pre-operative reconstruction planning for comminuted articular fractures

Background Highly comminuted intra-articular fractures are complex and difficult injuries to treat. Once emergent care is rendered, the definitive treatment objective is to restore the original anatomy while minimizing surgically induced trauma. Operations that use limited or percutaneous approaches help preserve tissue vitality, but reduced visibility makes reconstruction more difficult. A pre-operative plan of how comminuted fragments would best be re-positioned to restore anatomy helps in executing a successful reduction. Methods In this study, the methods for virtually reconstructing a tibial plafond fracture were developed and applied to clinical cases. Building upon previous benchtop work, novel image analysis techniques and puzzle solving algorithms were developed for clinical application. Specialty image analysis tools were used to segment the fracture fragment geometries from CT data. The original anatomy was then restored by matching fragment native (periosteal and subchondral) bone surfaces to an intact template, generated from the uninjured contralateral limb. Findings Virtual reconstructions obtained for ten tibial plafond fracture cases had average alignment errors of 0.39 (0.5 standard deviation) mm. In addition to precise reduction planning, 3D puzzle solutions can help identify articular deformities and bone loss. Interpretation The results from this study indicate that 3D puzzle solving provides a powerful new tool for planning the surgical reconstruction of comminuted articular fractures.

Tibiofemoral Joint Kinematics of the Anterior Cruciate Ligament-Reconstructed Knee During a Single-Legged Hop Landing

Background: Abnormal 3-dimensional tibiofemoral joint kinematics have been identified in anterior cruciate ligament-reconstructed knees during functional gait tasks, which is suggested to directly affect risk of knee osteoarthritis. However, the extent to which similar high-risk abnormalities are present during more demanding maneuvers, such as single-legged hopping, is largely unknown. Hypothesis: When performing a single-legged forward hop landing, the reconstructed knee will demonstrate altered sagittal, frontal, and transverse plane kinematics compared with the contralateral limb. Study Design: Controlled laboratory study. Methods: High-speed biplane radiography was used to quantify bilateral 3-dimensional tibiofemoral joint kinematics in 9 subjects with unilaterally reconstructed anterior cruciate ligaments (mean time after surgery, 4 months) during 3 single-legged, forward hop landing trials. Mean subject-based initial foot contact and maximum stance (0-250 ms) values were calculated for each kinematic variable. Two-tailed paired t tests were subsequently applied to examine for the main effect of limb (reconstructed vs contralateral). Results: The reconstructed knees exhibited significantly greater extension (P = .04), external tibial rotation (P = .006), and medial tibial translation (P = .02) than the contralateral knees at initial contact. Reconstructed knees underwent significantly greater maximum flexion (P = .05), maximum external tibial rotation (P = .01), and maximum anterior tibial translation (P = .02). No significant differences existed between limbs for initial contact (P = .65) or maximum adduction-abduction (P = .55). Conclusion: Tibiofemoral joint kinematics of the anterior cruciate ligament-reconstructed knee are significantly different from those of the uninjured contralateral limb during a single-legged hop landing. This altered kinematic profile, in conjunction with the large impact loads associated with hopping, may further contribute to the risk of posttraumatic knee osteoarthritis. Clinical Relevance: Returning to sports involving dynamic single-legged landings at 4 months after anterior cruciate ligament reconstruction surgery may contribute to accelerated knee joint degeneration.