Uninvolved Side Research Articles

Postural stability in patients with anterior cruciate ligament tears with and without medial meniscus tears

To compare postural stability in patients with isolated anterior cruciate ligament (ACL) tears and ACL tears with associated meniscal tears. Quadriceps and hamstring muscle strength and their ratio, as well as the relationships of these parameters with postural stability, were compared in 23 patients with isolated ACL tears and 27 with combined ACL and medial meniscus tears. Postural stability was determined from the anterior-posterior, medial-lateral, and overall stability indices using the Biodex Stability System. On both the involved and uninvolved sides, there were no differences in mean stability indices, including anterior-posterior, medial-lateral, and overall stability indices, in patients with isolated and combined ACL tears. In patients with isolated ACL tears, both overall (2.3 ± 1.2 vs. 1.8 ± 1.4, p = 0.033) and medial-lateral (1.2 ± 0.6 vs. 1.0 ± 0.5, p = 0.031) stability indices were significantly higher on the involved compared to the uninvolved side. These differences, however, were not observed in the combined ACL tear group. No significant differences in postural instability on the affected and unaffected sides were observed in patients with isolated ACL tears and those with combined ACL and medial meniscus tears. These findings indicate that there is no need to reduce the goal of restoring proprioception in patients with combined compared with isolated ACL tears. III.

High complication rate following distal biceps refixation with cortical button

There are several methods for the refixation of the distal biceps tendon which show a variable complication rate. The aim of the present study was to evaluate the clinical outcome and complication rate after distal biceps repair in cortical button technique. Clinical results, complications, strength of elbow flexion and supination and radiological evidence of heterotopic ossification in patients reporting persistent pain were evaluated in 27 male patients after an average of 36.1month following distal biceps tendon repair in cortical button technique. The mean Mayo elbow performance score was 95.9 (SD 11.9), the mean disabilities of the arm, shoulder and hand score was 1.9 (SD 4.9) and the mean American shoulder and elbow surgeons (ASES) score was 94.6 (SD 11.6). The mean flexion and supination strength of the involved side relative to the uninvolved side was 91.7% (SD 12.6) and 87.8% (SD 15.9). Nine patients had 14 different complications including four transient lesions of the posterior interosseous nerve, two persistent lesions of the superficial branch of the radial nerve, one symptomatic massive heterotopic ossification and one disengaged cortical button. Three patients had six revisions. Patients with complications had a significantly lower relative supination strength, Mayo elbow performance score, ASES score, pain on VAS (p<0.05 each) and satisfaction (p=0.005). As described for other techniques there is a high complication rate of distal biceps tendon repair in cortical button technique which resulted in inferior functional results and satisfaction. Surgeons treating patients with distal biceps tendon rupture should know the specific complications and know how to avoid them. Case series with no comparison group, Level IV.

Proximal Row Carpectomy: Minimum 20-Year Follow-Up

Proximal row carpectomy (PRC) is a motion-sparing procedure for degenerative disorders of the proximal carpal row. Reported results at a minimum 10-year follow-up consistently show maintenance of strength, motion, and satisfaction with an average conversion rate to radiocarpal arthrodesis of 12%. We hypothesized that PRC would continue to provide a high level of satisfaction and function at a minimum of 20 years. Seventeen wrists in 16 patients, including 7 laborers, underwent PRC for symptomatic degenerative disorders of the proximal carpal row at an average age of 36 years. Patients returned for radiographic and clinical evaluation, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and Patient-Related Wrist Evaluation were used for subjective assessment. Follow-up was a minimum of 20 years (average, 24 y). Eleven wrists (65%) underwent no further surgery at a minimum 20-year follow-up. The average time to failure of PRC, defined as the time from PRC to radiocarpal arthrodesis, was 11 years (range, 8 mo to 20 y). Ten of 11 patients who did not undergo radiocarpal arthrodesis continued to be satisfied, with minimal decrease in motion and grip strength compared with the uninvolved side. Average score for QuickDASH was 16 and for Patient-Related Wrist Evaluation was 26. The flexion-extension arc was 68°, and grip strength was 72% of the contralateral side. All patients returned to their original employment. There was no correlation between degenerative radiographic changes and satisfaction level. The predicted probability of failure revealed a higher risk in patients who underwent PRC at a younger age, which leveled off at age 40 years. PRC provides satisfaction at a minimum of 20 years with a survival rate of 65%. Whereas we recommend a minimum age for PRC between 35 and 40 years, young patients should not be excluded as PRC candidates; these patients should undergo appropriate preoperative counseling of their increased failure risk secondary to their young age. Therapeutic IV.

Differences in gait characteristics between total hip, knee, and ankle arthroplasty patients: a six-month postoperative comparison

BackgroundThe recovery of gait ability is one of the primary goals for patients following total arthroplasty of lower-limb joints. The aim of this study was to objectively compare gait differences of patients after unilateral total hip arthroplasty (THA), total knee arthroplasty (TKA) and total ankle arthroplasty (TAA) with a group of healthy controls.MethodsA total of 26 TAA, 26 TKA and 26 THA patients with a mean (± SD) age of 64 (± 9) years were evaluated six months after surgery and compared with 26 matched healthy controls. Subjects were asked to walk at self-selected normal and fast speeds on a validated pressure mat. The following spatiotemporal gait parameters were measured: walking velocity, cadence, single-limb support (SLS) time, double-limb support (DLS) time, stance time, step length and step width.ResultsTAA and TKA patients walked slower than controls at normal (p<0.05) and fast speeds (p<0.01). The involved side of TAA and TKA patients showed shorter SLS compared to controls at both normal and fast speeds (p<0.01). Regardless of walking speed, the uninvolved side of TAA and TKA patients demonstrated longer stance time and shorter step length than controls (p<0.01). TAA patients showed shorter SLS of the involved side, longer stance time and shorter step length of the uninvolved side compared to the contralateral side at both normal and fast speeds (p<0.001).ConclusionsGait disability after unilateral lower-limb joint arthroplasty was more marked for distal than for proximal joints at six months after surgery, with a proximal-to-distal progression in the impairment (TAA>TKA>THA). THA patients demonstrated no gait differences compared with controls. In contrast, TAA and TKA patients still demonstrated gait differences compared to controls, with slower walking velocity and reduced SLS in the involved limb. In addition, TAA patients presented marked side-to-side asymmetries in gait characteristics.

Bilateral Myofascial Trigger Points and Pressure Pain Thresholds in the Shoulder Muscles in Patients With Unilateral Shoulder Impingement Syndrome

To identify the presence of myofascial trigger points (TrPs) and pressure pain threshold (PPT) levels in the shoulder muscles of both involved and uninvolved sides in patients with unilateral shoulder impingement syndrome (SIS). Twenty-seven patients with SIS and 20 matched control patients participated in this study. TrPs of 10 shoulder muscles and 8 PPTs, including tibialis anterior PPT, were assessed. SIS group showed a greater number of TrPs (t=-2.697; P=0.010) than the control group. The muscles of the uninvolved side of the SIS group also presented some active TrPs. PPTs showed small differences between involved and uninvolved sides of patients with SIS and higher differences between both sides of the SIS group and dominant side of controls although with significant difference only in the supraspinatus PPT (F=3.239; P=0.045). The muscle PPTs of the patients presenting TrPs in each muscle of the involved side were lower than the PPTs of the patients without TrPs in the same muscle for both involved and uninvolved sides with few significant differences. The high number of TrPs in the involved side of patients with SIS suggests the presence of peripheral sensitization. The results reject the presence of central alterations. Finally, the patients with unilateral SIS may present bilateral deficits related to myofascial pain.

Compensatory muscle activation caused by tendon lengthening post-Achilles tendon rupture

The purpose of this study was to establish a relationship between the lengthening of the Achilles tendon post-rupture and surgical repair to muscle activation patterns during walking in order to serve as a reference for post-surgical assessment. The Achilles tendon lengths were collected from 4 patients with an Achilles tendon rupture 6 and 12 months post-surgery along with 5 healthy controls via ultrasound. EMG was collected from the triceps surae muscles and tibialis anterior during overground walking. Achilles lengths at 6 and 12 months post-surgery were significantly longer (p < 0.05) on the involved side compared to the uninvolved side, but there were no side-to-side differences in the healthy controls. The integrated EMG (iEMG) of the involved side was significantly higher than the uninvolved side in the lateral gastrocnemius at 6 months and for the medial gastrocnemius at 12 months in the patients with Achilles tendon rupture; no side-to-side difference was found in the healthy controls. The triceps surae muscles' activations were fair to moderately correlated to the Achilles lengths (0.38 < r < 0.52). The increased Achilles tendon length and iEMG from the triceps surae muscles indicate that loss of function is primarily caused by anatomical changes in the tendon and the appearance of muscle weakness is due to a lack of force transmission capability. This study indicates that when aiming for full return of function and strength, an important treatment goal appears to be to minimize tendon elongation.

Evaluation of Joint Position Sense Measured by Inversion Angle Replication Error in Patients with an Osteochondral Lesion of the Talus

The etiology of the osteochondral lesion of the talar dome (OLT) remains unclear. A joint position sense deficit of the ankle is reported to be a possible cause of ankle disorder. Repeated contact of the articular surface of the talar dome with the plafond during inversion might be a cause of OLT. The aim of the present study was to evaluate the joint position sense deficit by measuring the replication error of the inversion angle in patients with OLT. The replication error, which is the difference between the index angle and replication angle in inversion, was measured in 15 patients with OLT. The replication error in 15 healthy volunteers was evaluated as a control group. The side to side differences of the replication errors between the patients with OLT and healthy volunteers and the replication errors in each angle between the involved and uninvolved ankle in the patients with OLT were investigated. Finally, the side to side differences of the replication errors between the patients with OLT with a traumatic and nontraumatic history were compared. The side to side difference in the patients with OLT (1.3° ± 0.2°) was significantly greater than that in the healthy subjects (0.4° ± 0.7°) (p ≤ .05). Significant differences were found between the involved and uninvolved sides at 10°, 15°, 20°, and 25° in the patients with OLT. No significant difference (p > .05) was found between the patients with traumatic and nontraumatic OLT. The present study found that the patients with OLT have a joint position sense deficit during inversion movement, regardless of a traumatic history. Although various factors for the etiology of OLT have been reported, the joint position sense deficit in inversion might be a cause of OLT.

Increased acetabular depth may influence physeal stability in slipped capital femoral epiphysis.

Multiple mechanical factors affecting the hip have been associated with the development of slipped capital femoral epiphysis (SCFE). Whether acetabular depth plays a role in the development of a SCFE has not been elucidated. (1) What is the prevalence of a deep acetabulum in SCFE? (2) Is the presence of a deep acetabulum associated with physeal instability? (3) Is the presence of a deep acetabulum associated with the occurrence of a contralateral SCFE? We retrospectively reviewed 232 patients (156 males) who presented with a unilateral SCFE. Fifty (22%) subsequently developed a contralateral SCFE. The involved and uninvolved sides were evaluated for the presence of a deep acetabulum (DA). Preoperative radiographic parameters, slip stability, development of a contralateral SCFE, and demographic factors were then compared between patients with and without DA. DA was present in 120 hips (52%) with a SCFE. DA was more common in females (55 of 76 [72%]) than males (65 of 156 [42%]). Patients with DA presented with a higher lateral center-edge angle (33° versus 31°), slip angle (52° versus 43°), and with a lower body mass index (28.1 versus 30.0 kg/m(2)). Increased acetabular depth was more common in patients with an unstable SCFE (29 of 41 [71%]) than those with a stable SCFE (91 of 191 [48%]). The presence of DA either on the affected side or the contralateral side did not predict a contralateral SCFE. Despite not predicting a contralateral SCFE, DA may influence physeal stability if a SCFE does develop. Therefore, the contralateral hip with DA should be closely monitored. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Effect of 12 Weeks of Accelerated Rehabilitation Exercise on Muscle Function of Patients with ACL Reconstruction of the Knee Joint

[Purpose] To examine changes in the knee joint’s isokinetic muscle functions following systematic and gradual rehabilitation exercises lasting for 12 weeks for male and female patients who underwent anterior cruciate ligament (ACL) reconstruction. Differences in muscle functions between the uninvolved side (US) and the involved side (IS) before surgery, differences in muscle functions between US and IS after rehabilitation exercises lasting for 12 weeks, and changes in muscle functions on US and IS between before and after surgery were analyzed to examine the effects of accelerated rehabilitation exercises after ACL reconstruction. [Subjects] The study subjects were 10 patients, five females and five males, who underwent ACL reconstruction performed by the same surgeon. [Methods] As a measuring tool, a Biodex Multi-joint system 3pro (USA), which is an isokinetic measuring device, was used to examine the flexion and extension forces of the knee joint. During isokinetic muscle strength evaluation, the ROM of US was set to be the same as that of IS for consistency of measurement. [Results] At 60°/s, the isokinetic muscle functions of the females did not show any significant change between before and after surgery in any of the variables on both US and IS. At 60°/s, the isokinetic muscle functions of the males did not show any significant change between before and after surgery in the peak torque, average power, and entire work done on US. In extension, peak torque on IS did not show any significant change.

The Location of Multifidus Atrophy in Patients With a Single Level, Unilateral Lumbar Radiculopathy

ObjectiveTo identify the correlations between the location of multifidus atrophy and the level of lumbar radiculopathy.MethodsThirty-seven patients who had unilateral L4 or L5 radiculopathy were divided into 2 groups; the L4 radiculopathy (L4 RAD) group and the L5 radiculopathy (L5 RAD) group. Bilateral lumbar multifidus muscles at the mid-spinous process level of L4 vertebra (L4 MSP), the mid-spinous process level of L5 vertebra (L5 MSP), and the mid-sacral crest level of S1 vertebra (S1 MSC) were detected in T1 axial magnetic resonance imaging. The total muscle cross-sectional area of multifidus muscles (TMCSA) and the pure muscle cross-sectional area of multifidus muscles (PMCSA) were measured by a computerized analysis program, and the ratio of PMCSA to TMCSA (PMCSA/TMCSA) was calculated.ResultsThere were no significant differences in TMCSA between the involved and the uninvolved sides in both groups. PMCSA was only significantly smaller at the S1 MSC on the involved side as compared with the uninvolved side in the L5 RAD group. The ratio of PMCSA to TMCSA was the lowest at the L5 MSP on the involved side in the L4 RAD group and at the S1 MSC on the involved side in the L5 RAD group.ConclusionOur findings suggest that the most severe atrophy of multifidus muscle may occur at the mid-spinous process or mid-sacral crest level of the vertebra which is one level below the segmental number of the involved nerve root in patients with a single-level, unilateral lumbar radiculopathy.

Changes in hip and knee muscle strength in patients following total hip arthroplasty.

To investigate changes in hip and knee muscle strength in patients before and after total hip arthroplasty (THA) in comparison with that in healthy adults. The study included 21 women who underwent unilateral THA (THA group) and 21 age-matched healthy women (healthy group). Maximal isometric strengths of hip flexors, extensors, and abductors, and knee extensors and flexors were measured before surgery and at 4 weeks and 6 months after surgery. Before surgery, muscle strength on both sides, except for hip flexors on the uninvolved side, was significantly lower in the THA group than the corresponding muscle strength in the healthy group. Up to 6 months after THA, strength of all muscle groups on both sides was significantly improved compared with their preoperative status, although the knee extensor strength on the involved side temporarily worsened at 4 weeks. However, the strength of hip extensors and knee extensors on the involved side, and hip abductors on both sides in the THA group remained below that in the healthy group. Our results suggest that rehabilitation specialists should consider increasing the focus on the uninvolved side and encourage patients to continue strength training beyond 6 months after surgery.

Use of a Squatting Movement as a Clinical Marker of Function After Total Knee Arthroplasty

The aims of this study were to evaluate weight bearing during standing and 30- and 60-degree squats approximately 1 wk and 2 mos after surgery and determine whether weight bearing during squatting could be a better clinical marker than standing for identifying perceived functional limitation approximately 1 wk after surgery. A further objective was to determine whether age, body mass index, and number of outpatient visits over the course of rehabilitation predicted weight bearing during a squat approximately 2 mos after surgery. The percentage of body weight placed over both limbs during stand and 30- and 60-degree squats in 38 patients (25 women and 13 men) who had primary unilateral knee arthroplasty was determined. An asymmetry index would be used as a marker that could discriminate between those who perceived at least moderate difficulty with functional tasks and those who perceived only slight or no difficulty with functional activities based on the physical function dimension of the Western Ontario McMaster Universities Osteoarthritis index approximately 1 wk after surgery. Stepwise regression was conducted to determine whether clinical characteristics predicted weight-bearing asymmetry at discharge. At initial visit (first observation), and compared with the uninvolved side, individuals placed significantly less body weight over the involved or operated limb for stand and 30- and 60-degree squats (P < 0.0001). Results were similar at last rehabilitation visit (second observation). Identifying at least moderate self-reported difficulty with functional tasks based on the receiver operator characteristic curve for the asymmetry index for the stand position was 0.64, whereas for the 30- and 60-degree squats, the area under the curve was 0.81 and 0.89, respectively. At discharge from rehabilitation, there was a moderate to good direct relationship (r = 0.70) between the number of rehabilitation visits completed and the weight-bearing asymmetry index for the 60-degree squat. On the first outpatient visit, individuals who had primary unilateral knee arthroplasty placed more body weight over the uninvolved side for the three weight-bearing positions. With high probability, the asymmetry index for both squatting angles identified perceived functional difficulty. As rehabilitation visits increased, there was a direct association to improved interlimb weight-bearing symmetry when squatting to 60 degrees.

Unilateral Transnasal Endoscopic approach to Frontal Sinuses: Draf IIc

For chronic sinusitis surgery, the Draf III approach provides a common median drainage pathway for bilateral frontal sinuses from orbit to orbit. The Draf IIb provides unilateral drainage from orbit to septum. In several cases, inclusion of the nasal and frontal sinus septum in a Draf IIb was advantageous without extension to the opposite frontal recess. The proposed nomenclature is Draf IIc. This study was designed to (1) develop a surgical option for chronic frontal sinusitis where access to one frontal recess is limited or unnecessary and (2) minimize unnecessary surgical manipulation of uninvolved areas. Revision endoscopic frontal sinus surgery was performed on two patients with persistent frontal sinus opacification. Surgery crossed midline including one frontal recess with resection of the superior nasal septum. The surgical result was assessed on endoscopy and computed tomography (CT). The postoperative course was unremarkable with relief of frontal pressure. Postoperative CT scan showed well-aerated frontal sinuses with a widely patent common drainage pathway. Postoperative nasal endoscopy revealed normal mucosa with no exposed bone or edema. The Draf IIc extends the Draf IIb across the midline, without including the opposite frontal recess. This can be accomplished most easily using an interfrontal sinus septal cell or an eccentric interfrontal sinus septum. The Draf IIc is a surgical option in cases of chronic or recalcitrant frontal sinus diseases, including unilateral or bilateral obstruction, where access to the ipsilateral frontal recess is limited or favorable anatomy allows drainage with reduced manipulation of an uninvolved side.

Altered postural sway persists after anterior cruciate ligament reconstruction and return to sport

Postural sway is defined as the movement of a body's center of mass within the base of support to maintain postural equilibrium. Deficits in postural sway are present after ACL injury; however, current evidence linking it to future injury risk is unclear. The purpose of this study was to determine if postural sway deficits persist after ACL reconstruction (ACLR). The hypothesis tested was that after ACLR, patients who return to sport (RTS) would demonstrate differences in postural sway compared to control (CTRL) subjects. Fifty-six subjects with unilateral ACLR released to RTS, and 42 uninjured CTRL subjects participated. Dynamic postural sway was assessed and 3-way (2×2×2) ANOVA was used to analyze the variables. A side×group×sex (p=0.044) interaction in postural sway was observed. A side×group analysis also revealed an interaction (p=0.04) however, no effect of sex was observed (p=0.23). Analysis within the ACLR cohort showed less (p=0.001) postural sway on the involved side (1.82±0.84°) versus the uninvolved side (2.07±0.96°). No side-to-side differences (p=0.73) were observed in the CTRL group. The involved limb of subjects after ACLR demonstrated the least postural sway. In conclusion, these findings indicate that dynamic postural sway may be significantly altered in a population of athletes after ACLR and RTS compared to CTRL subjects. Further investigation is needed to determine if deficits in postural sway can be used as an effective criterion to assist in the decision to safely RTS after ACLR.

Intensity of chronic pain modifies postural control in low back patients

Some recent studies have provided evidence that alteration in central motor control may have causative impact on the emergence and sustenance of chronic pain. We hypothesized that comparison of postural control between patients with high (HP) and low pain (LP) level would display intergroup differences in favour of the LP group lending support for the postulated relationship between altered cortical function and pain. Motivated by this concept, we investigated postural control in 36 subjects with chronic low back pain (CLBP) stratified into two groups according to the reported rest pain intensity on a numerical rating scale: LP group (n = 16) and high pain (HP) group (n = 20). The pressure pain threshold (PPT) of selected muscles was assessed on the involved and uninvolved sides. Body balance was investigated on hard or soft surface using postural performance. As regards pain measurements, the PPT of muscles was lower in HP than in LP (P < 0.05), without differences between the involved and uninvolved sides. Results indicated that patients in HP group relied more on visual input on hard surface than those in LP group (P <0.05). Changing the stance condition from hard surface to foam decreased sway entropy in LP (P < 0.001), accounting for higher cognitive investment in balance control, while HP had the same level of sway entropy. Body balance measurements seemed to confirm the hypothesized role of the altered executive function in the CLBP problems, with a further support from pain assessment that indicated central sensitization. Patients with higher self-reported pain level displayed deficit in the postural adaptability to environmental challenge and lower level of postural automaticity.

Abnormalities in the Uninvolved Foot in Children With Spastic Hemiplegia

Although the uninvolved foot in patients with hemiplegia has been thought to be normal, we frequently observed valgus deformity of the uninvolved foot among those patients. The purpose of this study was to evaluate by dynamic pedobarograph the prevalence and pattern of foot deformity in the uninvolved limb among children with hemiplegia. In this study, we included 119 patients with hemiplegia (67 males and 52 females) who underwent gait analysis from 2001 to 2008. The mean age at evaluation was 9.2 ± 3.4 years (range, 5.1 to 19.8 y). Patient demographics, passive range of motion, kinematics, kinetics, and dynamic pedobarographic data were obtained from the medical records. Coronal index [(CI): the impulse percentage under the medial column minus the impulse percentage under the lateral column] was calculated from the pedobarographic data. Of 119 feet, 60 feet (50.4%) had a normal CI, whereas 52 feet (43.7%) showed a valgus CI. Only 7 feet (5.9%) had a varus CI. Compared with the patients with a normal CI, patients who had a valgus CI had increased ankle dorsiflexion at initial contact (-0.9 ± 4.1 vs. 0.8 ± 4.7, P=0.048) and knee extension moment (0.6 ± 0.31 vs. 0.73 ± 0.28, P=0.036) of the uninvolved foot. Actual limb-length discrepancy did not differ between the 2 groups (P=0.556). Valgus foot deformity of the uninvolved foot is common among children with hemiplegia. It is associated with increased ankle dorsiflexion and knee extension moments of the uninvolved side. Longer follow-up will be needed to evaluate the effect of the valgus foot deformity of the uninvolved limb on the gait in patients with hemiplegia. Level III. Diagnostic.

Selective intraoperative stimulation of the human larynx

Laryngeal contraction normally entails activation of mutually cooperative intrinsic laryngeal muscles (ILMs). Unfortunately, standard stimulating methods do not completely mimic the normal ongoing synchrony between the muscles. We submit that this problem can be addressed by modifying the stimulating waveform. This study extends prior canine research to the human using quasitrapezoidal (QT) currents instead of standard square waves, which while valuable incompletely express normal ILM interactions. In two patients undergoing laryngectomy for cancer, the recurrent laryngeal nerve on the uninvolved side received QT pulses (4 Hz, 60-2,000 μA, 100-500 μs width, 0-500-μs decay) via a bipolar cuff electrode. Pairs of needle electrodes placed into the posterior cricoarytenoideus (PCA), lateral cricoarytenoideus (LCA), and thyroarytenoideus (TA) were used to record electromyography amplitudes, and waveforms were analyzed by a specially designed computer program. With activity from square waves serving as control, we observed statistically significant (P < .05) shifts in mutual relationships among PCA, LCA, and TA for an array of specific QT configurations. Our preliminary data on selective ILM manipulation offer promise for improved dynamic control of faulty laryngeal contraction patterns.

The effect of sex and age on isokinetic hip-abduction torques.

As high school female athletes demonstrate a rate of noncontact anterior cruciate ligament (ACL) injury 3-6 times higher than their male counterparts, research suggests that sagittal-plane hip strength plays a role in factors associated with ACL injuries. To determine if gender or age affect hip-abductor strength in a functional standing position in young female and male athletes. Prospective cohort design. Biomechanical laboratory. Over a 3-y time period, 852 isokinetic hip-abduction evaluations were conducted on 351 (272 female, 79 male) adolescent soccer and basketball players. Before testing, athletes were secured in a standing position, facing the dynamometer head, with a strap secured from the uninvolved side and extending around the waist just above the iliac crest. The dynamometer head was positioned in line with the body in the coronal plane by aligning the axis of rotation of the dynamometer with the center of hip rotation. Subjects performed 5 maximum-effort repetitions at a speed of 120°/s. The peak torque was recorded and normalized to body mass. All test trials were conducted by a single tester to limit potential interrater test error. Standing isokinetic hip-abduction torque. Hip-abduction torque increased in both males and females with age (P < .001) on both the dominant and nondominant sides. A significant interaction of gender and age was observed (P < .001), which indicated that males experienced greater increases in peak torque relative to body weight than did females as they matured. Males exhibit a significant increase in normative hip-abduction strength, while females do not. Future study may determine if the absence of similar increased relative hip-abduction strength in adolescent females, as they age, may be related to their increased risk of ACL injury compared with males.

수중운동 프로그램이 전방십자인대 재건술 환자의 등속성 근기능에 미치는 영향

The purpose of this study was to identify effects of an aquatic therapy program on patients with anterior cruciate ligament injuries. All of the patients responded to notices containing a description of the study that were posted in the rehabilitation center where the study were conducted. Participants registered for the program in the rehabilitation center, obtained physician`s permission to participated, and completed required registration forms. 16 participants were randomly assigned into two groups: an aquatic therapy program group(N 8), a physical therapy group(N 8). All of the participants completed the exercise during one hour a day, three days a week for 12 weeks. The following results were found in the study: 1. Changes of extensor and flexor at 60°/sec Although no significant difference was found between two groups, an aquatic therapy group and a physical therapy group with respect to the measures of peak torque, there were significant increases between two groups over training time. While there progressively increases between two groups with respect to the measures of peak torque on the uninvolved side at 60°/sec, there was not found significant difference between two groups over training time. No significants difference was found in both involved side and uninvolved side by the training period. The training group showed a quick recovery fro m the muscle functions, followed by a aquatic therapy group. This study also revealed significant differences training period X both involved and uninvolved side X group interaction. 2. Changes of extensor and flexor at 180°/sec in % body weight in the peak torque % body weight of extensor and flexor at 180° /sec, no significant difference was found between two groups. No significants difference was found in both involved side and uninvolved side by the training period. The training group showed a quick recovery from the muscle functions, followed by a aquatic therapy group. This study also revealed significant differences training period X both involved and uninvolved side X group interaction. in summary, as a result of 12weeks of rehabilitation program, there were differences between two muscular functions, while not significantly different from each other. This was showed differences in the muscular functions of both involved and uninvolved side between two groups by the treatment period. Although aquatic therapy group showed a quick recovery from the muscular functions, followed by physical therapy group, there was no significant difference. These findings suggest that aquatic therapy program is more effective interventions to the patients with ACL injuries than physical therapy.

The Effect of Goniometric Alignment on Passive Ankle Dorsiflexion Range of Motion among Patients Following Ankle Arthrodesis or Arthroplasty

Goniometric measurement is a standard method used to quantify limited ankle dorsiflexion (DF). However, compensatory motion at the subtalar and midtarsal joints might also contribute to the amount of ankle DF obtained by goniometric measurements. The purpose of this study was to examine the effect of goniometric alignment on DF range of motion measurement among patients following ankle arthrodesis or arthroplasty and age- and gender-matched controls. A total of 22 participants were recruited to participate in this observational cohort study, including 7 patients following total ankle arthroplasty (2 male, 5 female; mean age = 67.5 years, standard deviation [SD] = 9.6 years), 4 patients following ankle arthrodesis (2 male, 2 female; mean age = 70.5 years, SD = 5.2 years), and 11 age- and gender-matched controls (4 male, 7 female; mean age 67.5 years, SD = 9.0 years). Two investigators measured and recorded ankle DF passive range of motion (PROM) using a randomly determined sequence of 2 alignment methods: (1) the distal aspect of the lateral calcaneus, and (2) the fifth metatarsal. One-sample t tests were performed to assess differences in ankle DF between the 2 different alignment methods. Significantly greater degrees of DF were obtained when aligning with the fifth metatarsal versus the lateral calcaneus on the patients' uninvolved sides and the randomly selected side of matched controls (P < .05) but not on the patients' operative side (P > .05). This study found that more degrees of DF PROM are measured when aligning a goniometer with the fifth metatarsal versus the calcaneus on the uninvolved side of patients and matched controls. Diagnostic, Level IV.