Clinical Study Clinical and Functional Outcomes following Primary Repair versus Reconstruction of the Medial Patellofemoral Ligament for Recurrent Patellar Instability

Background. The purpose of this study was to compare outcomes of medial patellofemoral ligament (MPFL) repair or reconstruction. Methods. Fourteen knees that underwent MPFL repair and nine (F5, M4) knees that underwent reconstruction at our institution were evaluated for objective and subjective outcomes. The mean age at operation was 20.1 years for repair and 19.8 years for reconstruction. All patients had a minimum of 2 years of follow-up (range: 24-75 months). Patient subjective outcomes were obtained using the International Knee Documentation Committee (IKDC) and Kujala patellofemoral subjective evaluations, as well as Visual Analog (VAS) and Tegner Activity Scales. Bilateral isometric quadriceps strength and vastus medialis obliquus (VMO) and vastus lateralis (VL) surface EMG were measured during maximal isometric quadriceps contractions at 30 ∘ and 60 ∘ of flexion. Results. There were no redislocations in either group. There was no difference in IKDC ( = 0.16), Kujala ( = 0.43), Tegner ( = 0.12), or VAS ( = 0.05) scores at follow-up. There were no differences between repair and reconstruction in torque generation of the involved side at 30 ∘ ( = 0.96) and 60 ∘ ( = 0.99). In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO. Conclusions. There were minimal differences found between patients undergoing MPFL repair and MPFL reconstruction for the objective and subjective evaluations in this study

Unilateral Quadriceps Strengthening With Disinhibitory Cryotherapy and Quadriceps Symmetry After Anterior Cruciate Ligament Reconstruction

Context: The effect of unilateral cryotherapy-facilitated rehabilitation exercise on involved-limb quadriceps function and limb symmetry in individuals with quadriceps dysfunction after anterior cruciate ligament reconstruction (ACLR) remains unclear. Objective: To measure the effect of a 2-week unilateral cryotherapy-facilitated quadriceps-strengthening program on knee-extension strength and quadriceps central activation ratio (CAR) in participants with ACLR. Design: Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 10 volunteers with unilateral ACLR (1 man, 9 women; age = 21.0 ± 2.8 years, height = 164.6 ± 5.0 cm, mass = 64.0 ± 6.1 kg, body mass index = 23.7 ± 2.7 kg/m2) and 10 healthy volunteers serving as control participants (1 man, 9 women; age = 20.8 ± 2.5 years, height = 169.1 ± 6.2 cm, mass = 61.1 ± 6.4 kg, body mass index = 21.4 ± 2.3 kg/m2) participated. Intervention(s): Participants with ACLR completed a 2-week unilateral cryotherapy-facilitated quadriceps-strengthening intervention. Main Outcome Measure(s): Bilateral normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/kg) and quadriceps CAR (%) were assessed preintervention and postintervention. Limb symmetry index (LSI) was calculated at preintervention and postintervention testing. Preintervention between-groups differences in unilateral quadriceps function and LSI were evaluated using independent-samples t tests. Preintervention-to-postintervention differences in quadriceps function were evaluated using paired-samples t tests. Cohen d effect sizes (95% confidence interval [CI]) were calculated for each comparison. Results: Preintervention between-groups comparisons revealed less knee-extension MVIC torque and quadriceps CAR for the ACLR limb (MVIC: P = .01, Cohen d = −1.31 [95% CI = −2.28, −0.34]; CAR: P = .004, Cohen d = −1.48 [95% CI = −2.47, −0.49]) and uninvolved limb (MVIC: P = .03, Cohen d = −1.05 [95% CI = −1.99, −0.11]; CAR: P = .01, Cohen d = −1.27 [95% CI = −2.23, −0.31]) but not for the LSI (MVIC: P = .46, Cohen d = −0.34 [95% CI = −1.22, 0.54]; CAR: P = .60, Cohen d = 0.24 [95% CI = −0.64, 1.12]). In the ACLR group, participants had improved knee-extension MVIC torque in the involved limb (P = .04, Cohen d = 0.32 [95% CI = −0.56, 1.20]) and uninvolved limb (P = .03, Cohen d = 0.29 [95% CI = −0.59, 1.17]); however, the improvement in quadriceps CAR was limited to the involved limb (P = .02, Cohen d = 1.16 [95% CI = 0.21, 2.11]). We observed no change in the LSI with the intervention for knee-extension MVIC torque (P = .74, Cohen d = 0.09 [95% CI = −0.79, 0.97]) or quadriceps CAR (P = .61, Cohen d = 0.26 [95% CI = −0.62, 1.14]). Conclusions: Two weeks of cryotherapy-facilitated exercise may improve involved-limb quadriceps function while preserving between-limbs symmetry in patients with a history of ACLR

Clinical and Functional Outcomes following Primary Repair versus Reconstruction of the Medial Patellofemoral Ligament for Recurrent Patellar Instability

Background. The purpose of this study was to compare outcomes of medial patellofemoral ligament (MPFL) repair or reconstruction. Methods. Fourteen knees that underwent MPFL repair and nine (F5, M4) knees that underwent reconstruction at our institution were evaluated for objective and subjective outcomes. The mean age at operation was 20.1 years for repair and 19.8 years for reconstruction. All patients had a minimum of 2 years of follow-up (range: 24–75 months). Patient subjective outcomes were obtained using the International Knee Documentation Committee (IKDC) and Kujala patellofemoral subjective evaluations, as well as Visual Analog (VAS) and Tegner Activity Scales. Bilateral isometric quadriceps strength and vastus medialis obliquus (VMO) and vastus lateralis (VL) surface EMG were measured during maximal isometric quadriceps contractions at 30° and 60° of flexion. Results. There were no redislocations in either group. There was no difference in IKDC (P=0.16), Kujala (P=0.43), Tegner (P=0.12), or VAS (P=0.05) scores at follow-up. There were no differences between repair and reconstruction in torque generation of the involved side at 30° (P=0.96) and 60° (P=0.99). In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO. Conclusions. There were minimal differences found between patients undergoing MPFL repair and MPFL reconstruction for the objective and subjective evaluations in this study

Estimation of ground reaction forces during stair climbing in patients with ACL reconstruction using a depth sensor-driven musculoskeletal model

•Accuracy of stair GRFs using depth sensor-driven musculoskeletal model was assessed.•Study subjects were ACL patients following ACL reconstruction surgery.•The estimation of GRFs was highly dependent on the evaluated force component.•This method has the potential as a cost-effective tool in the clinical setting. Although stair ambulation should be included in the rehabilitation of the long-term effects of ACL injury on knee function, the assessment of kinetic parameter in the situation where stair gait can only be established using costly and cumbersome force platforms via conventional inverse dynamic analysis. Therefore, there is a need to develop a practical laboratory setup as an assessment tool of the stair gait abnormalities in lower extremity that arise from an ACL deficiency. Can the use of a single depth sensor-driven full-body musculoskeletal gait model be considered an accurate assessment tool of the ground reaction forces (GRFs) during stair climbing for patients following ACL reconstruction (ACLR) surgery? A total of 15 patients who underwent ACLR participated in this study. GRFs data during stair climbing was collected using a custom-built 3-step staircase with two embedded force platforms. A single depth sensor, commercially available and cost effective, was used to obtain participants’ depth map information to extract the full-body skeleton information. The AnyBody TM GaitFullBody model was utilized to estimate GRFs attained by 25 artificial muscle-like actuators placed under each foot. Mean differences between the measured and estimated GRFs were compared using paired samples t-tests. The ensemble curves of the GRFs were compared between both approaches during stance phase of the gait cycle. The findings of this study showed that the estimation of the GRFs produced during staircase gait using a depth sensor-driven musculoskeletal model can produce acceptable results when compared to the traditional inverse dynamics modelling approach as an alternative tool in clinical settings for individuals who had undergone ACLR. The introduced approach of full-body musculoskeletal modelling driven by a single depth sensor has the potential to be a cost-effective stair gait analysis tool for patients with ACL injury

Monitoring joint mechanics in anterior cruciate ligament reconstruction using depth sensor-driven musculoskeletal modeling and statistical parametric mapping

•Kinetics were estimated using a single depth sensor and musculoskeletal modeling.•Kinects were compared between both ACLR limbs and dominant limbs of controls.•No differences in kinetic waveforms were found between groups in over-ground gait.•ALCR exhibited differences in kinetic waveforms during terminal stair ascent.•Evidence of compensatory strategies may be task dependent in this ACLR cohort.The incidence of anterior cruciate ligament injury and reconstruction (ACLR) may set the stage for the development of early onset osteoarthritis in these patients. Development of accessible quantitative motion capture methodologies for recurrent monitoring of knee joint loading during daily activities following ACLR is necessary. This study aimed to compare lower extremity kinetics between ACLR affected limbs, ACLR unaffected limbs, and dominant limbs of healthy control subjects during over-ground gait and stair ascent using a single depth sensor-driven musculoskeletal modeling approach. No meaningful differences were found between groups during over-ground gait in any kinetic variables. When subjected to a stair ascent task, both ACLR limbs showed greater hip extension and internal rotation moments compared to control subjects at approximately 72–79% stance. This was coincident with greater knee flexion moments in both ALCR limbs compared to control. The absence of differences during over-ground gait but presence of compensatory strategies during stair ascent, suggests task dependent recovery in this cohort who were tested at least 1-year following surgery. Importantly, this was determined using a portable low-cost motion capture method which may be attractive to professionals in sports medicine for recurrent monitoring following ACLR

Comparative Effect of Power Training and High-Speed Yoga on Motor Function in Older Patients With Parkinson Disease

To compare the effects of power training (PWT) and a high-speed yoga program on physical performances in older patients with Parkinson disease (PD), and to test the hypothesis that both training interventions would attenuate PD symptoms and improve physical performance. Randomized controlled trial. A laboratory of neuromuscular research and active aging. Patients with PD (N=41; mean age ± SD, 72.2±6.5y). Two high-speed exercise interventions (specifically designed yoga program and PWT) were given for 12 weeks (twice a week), and 1 nonexercise control group. Unified Parkinson Disease Rating Scale motor score (UPDRSMS), Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go, functional reach, single leg stance (SLS), postural sway test, 10-m usual and maximal walking speed tests, 1 repetition maximum (RM), and peak power (PPW) for leg press. For the posttests, both training groups showed significant improvements (P<.05) in all physical measurements except functional reach on the more affected side, SLS, and postural sway compared with the pretests, and significantly better scores for UPDRSMS, BBS, Mini-BESTest, Timed Up and Go, functional reach on the less affected side, 10-m usual and maximal walking speed tests, 1RM, and PPW than controls, with no differences detected between the yoga program and PWT. Both the specially designed yoga program and PWT programs can significantly improve physical performance in older persons with PD

Assessment of dynamic balance via measurement of lower extremities tortuosity

Tortuosity describes how twisted or how much curvature is present in an observed movement or path. The purpose of this study was to investigate the differences in segmental tortuosity between Star Excursion Balance Test (SEBT) reach directions. Fifteen healthy participants completed this study. Participants completed the modified three direction (anterior, posteromedial, posterolateral) SEBT with three-dimensional motion analysis using an 8 camera BTS Smart 7000DX motion analysis system. The tortuosity of stance limb retro-reflective markers was then calculated and compared between reach directions using a 1 × 3 ANOVA with repeated measures, while the relationship between SEBT performance and tortuosity was established using Pearson product moment correlations. Anterior superior iliac spine tortuosity was significantly greater (p < 0.001) and lateral knee tortuosity was lesser (p = 0.018) in the anterior direction compared to the posteromedial and posterolateral directions. In addition, second metatarsal tortuosity was greater in the anterior reach direction when compared to posteromedial direction (p = 0.024). Tortuosity is a novel biomechanical measurement technique that provides an assessment of segmental movement during common dynamic tasks such as the SEBT. This enhanced level of detail compared to more global measures of joint kinematic may provide insight into compensatory movement strategies adopted following lower extremity joint injury

Ensuring scientific reproducibility in bio-macromolecular modeling via extensive, automated benchmarks

Each year vast international resources are wasted on irreproducible research. The scientific community has been slow to adopt standard software engineering practices, despite the increases in high-dimensional data, complexities of workflows, and computational environments. Here we show how scientific software applications can be created in a reproducible manner when simple design goals for reproducibility are met. We describe the implementation of a test server framework and 40 scientific benchmarks, covering numerous applications in Rosetta bio-macromolecular modeling. High performance computing cluster integration allows these benchmarks to run continuously and automatically. Detailed protocol captures are useful for developers and users of Rosetta and other macromolecular modeling tools. The framework and design concepts presented here are valuable for developers and users of any type of scientific software and for the scientific community to create reproducible methods. Specific examples highlight the utility of this framework, and the comprehensive documentation illustrates the ease of adding new tests in a matter of hours