Test-Retest Reliability and Minimum Detectable Change for Various Frontal Plane Projection Angles during Dynamic Tasks

Objective: Establish between-day test-retest reliability metrics for 2-dimensional frontal plane projection angles (FPPAs) during the lateral step-down (LSD), single-limb squat (SLS), single-limb landing (SLL), and drop vertical jump (DVJ). Design: Test-retest reliability study Setting: University laboratory Participants: 20 healthy adults (12 female, age = 23.60±1.93 years old, body mass index = 24.26±2.54 kg/m2) were tested on 2 separate occasions 7-14 days apart. Main Outcome Measures: Intraclass correlation coefficients (ICC), standard errors of the measurement (SEM), and minimal detectable change (MDC) values across the LSD, SLS, SLL, and DVJ for the following body region variables: trunk, trunk on pelvis, pelvis, hip, thigh to vertical, knee, and shank to vertical. Results: There was moderate-to-substantial between-day test-retest reliability for nearly all body regions across all tasks (ICC = 0.65-0.96). SEM values varied across body regions and tasks (0.9-3.5 degrees). MDCs were variable (2.3-9.8 degrees). Of the body regions, MDCs were largest for the knee and hip. By task, MDCs were lowest for the LSD. Conclusions: This study identified between-day test-retest reliability metrics for 2-dimensional FPPAs across a variety of body regions during commonly assessed clinical tasks. These data allow clinicians and researchers to more confidently assess true change between assessments or over time

Reliability of 3-Dimensional Measures of Single-Leg Cross Drop Landing Across 3 Different Institutions: Implications for Multicenter Biomechanical and Epidemiological Research on ACL Injury Prevention

Background: Anterior cruciate ligament (ACL) injuries are physically and financially devastating but affect a relatively small percentage of the population. Prospective identification of risk factors for ACL injury necessitates a large sample size; therefore, study of this injury would benefit from a multicenter approach. Purpose: To determine the reliability of kinematic and kinetic measures of a single-leg cross drop task across 3 institutions. Study Design: Controlled laboratory study. Methods: Twenty-five female high school volleyball players participated in this study. Three-dimensional motion data of each participant performing the single-leg cross drop were collected at 3 institutions over a period of 4 weeks. Coefficients of multiple correlation were calculated to assess the reliability of kinematic and kinetic measures during the landing phase of the movement. Results: Between-centers reliability for kinematic waveforms in the frontal and sagittal planes was good, but moderate in the transverse plane. Between-centers reliability for kinetic waveforms was good in the sagittal, frontal, and transverse planes. Conclusion: Based on these findings, the single-leg cross drop task has moderate to good reliability of kinematic and kinetic measures across institutions after implementation of a standardized testing protocol. Clinical Relevance: Multicenter collaborations can increase study numbers and generalize results, which is beneficial for studies of relatively rare phenomena, such as ACL injury. An important step is to determine the reliability of risk assessments across institutions before a multicenter collaboration can be initiated

Patient-reported outcome measures for hip-related pain: A review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018

Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5

The fickle ACL deficient athlete: Investigation of the non-coper response to injury, surgery, and neuromuscular training

Background. Anterior cruciate ligament (ACL) injuries are the most prevalent sports-related knee injury and are estimated to affect up to 250,000 athletes in the United States every year. Gait abnormalities, quadriceps strength deficits, knee joint effusion, and limited range of motion are ubiquitous acutely after ACL rupture and often persist following ACL reconstruction. Early identification of those athletes at risk for poor outcomes after surgery can assist rehabilitation specialists in tailoring the most efficacious treatment protocol for this group. Purpose. The goal of this work was to identify and intervene with noncopers that may be more likely to require additional rehabilitation in order to achieve normal neuromuscular strategies after surgery and meet their return to sport goals. Unilateral stance mechanics were used to evaluate whether pre-operative neuromuscular intervention changes single limb positioning strategies. We also compared the differences between the clinical performance and gait variables of ACL-deficient males and females before and after ACL reconstruction. To further investigate the restoration of function after surgery, the effects of a post-operative neuromuscular intervention are described. Methods. The effects of injury, neuromuscular training, and ACL reconstruction were examined on male and female non-copers during (1) a unilateral stance task and walking gait using current motion analysis techniques and (2) clinical performance tests. Non-copers from a larger randomized controlled trial underwent each of the testing procedures before and after pre-operative physical therapy, and 6 months after ACL reconstruction. The same walking gait biomechanics and clinical performance measures were evaluated on ten additional non-copers who received post-operative perturbation training. Significance. The information gathered during this investigation adds to our understanding of non-copers in two distinct ways: (1) women were identified as a uniquely functioning group of non-copers and (2) the timing of neuromuscular training appears to affect the recovery process in a subgroup of non-copers. Biomechanical changes found in response to rehabilitation further suggest the malleability and diversity of this group of ACL-deficient athletes. By evaluating gender-specific responses to ACL injury, intervention, and surgery, we have defined important neuromuscular differences within the non-coper cohort that may be effectively addressed by tailored physical therapy intervention. This body of work provides a foundation for future research to investigate the effects of different neuromuscular treatments on the recovery of function in athletes who sustain ACL injuries

Sex Differences in Self-Reported Hip Function Up to 2 Years after Arthroscopic Surgery for Femoroacetabular Impingement

Background: Femoroacetabular impingement (FAI) is a significant cause of disability in young adults. Hip arthroscopic surgery restores bony congruence and improves function in the majority of patients, but recent evidence indicates that women may experience worse pre- and postoperative function than men. Purpose/Hypothesis: The purpose of this study was to identify whether self-reported hip function differed between men and women with symptomatic FAI. The hypothesis was that mean self-reported hip function scores would improve after arthroscopic surgery but that women would report poorer function than men both before and up to 2 years after arthroscopic surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 229 patients (68.4% women; mean [6SD] age, 31.6 6 10.8 years; mean [6SD] body mass index, 26.8 6 11.9 kg/m2) underwent hip arthroscopic surgery for unilateral symptomatic FAI. All eligible and consenting patients with radiologically and clinically confirmed FAI completed the International Hip Outcome Tool (iHOT-33) and the Hip Outcome Score activities of daily living subscale (HOS-ADL) before hip arthroscopic surgery and at 3, 6, 12, and 24 months after arthroscopic surgery. A linear mixed model for repeated measures was used to test for differences in self-reported hip function between men and women over the study period (P .05). Results: There were no significant time 3 sex interactions for either the HOS-ADL (P = .12) or iHOT-33 (P = .64), but both measures showed significant improvements between the preoperative time point and each of the 4 follow-up points (P\.0001); however, self-reported hip function did not improve between 6 and 24 months after arthroscopic surgery (P .11). Post hoc independent t tests indicated that women reported poorer hip function than did men before surgery (P .003) both on the HOS-ADL (mean 6 standard error of the mean [SEM], 67.4 6 1.9 [men] vs 60.5 6 1.3 [women]) and iHOT-33 (mean 6 SEM, 38.0 6 1.9 [men] vs 30.9 6 1.3 [women]); scores were not different between sexes at any other time point. Conclusion: These findings indicate improvements in self-reported hip function in patients with FAI, regardless of sex, until 6 months after hip arthroscopic surgery. Although women reported poorer preoperative function than did men, the differences were not significant 2 years after surgery. Keywords: femoroacetabular impingement; hip arthroscopic surgery; hip functio

DS_10.1177_0363546518787505 – Supplemental material for Biomechanical Deficits at the Hip in Athletes With ACL Reconstruction Are Ameliorated With Neuromuscular Training

<p>Supplemental material, DS_10.1177_0363546518787505 for Biomechanical Deficits at the Hip in Athletes With ACL Reconstruction Are Ameliorated With Neuromuscular Training by Christopher Nagelli, Samuel Wordeman, Stephanie Di Stasi, Joshua Hoffman, Tiffany Marulli and Timothy E. Hewett in The American Journal of Sports Medicine</p