Quadriceps tendon autograft ACL reconstructed subjects overshoot target knee extension angle during active proprioception testing

Purpose To compare the active joint position sense (JPS), muscle strength, and knee functions in individuals who had anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft, hamstring tendon autograft, tibialis anterior allograft and healthy individuals. It was hypothesized that when compared to an age and gender-matched healthy control group, subjects who were post-ACL reconstruction would display impaired active joint position sense, knee extensor and fexor strength symmetry and knee function at 1 year post-surgery. A secondary hypothesis was that diferences would exist between the quadriceps tendon autograft, hamstring tendon autograft and tibialis anterior allograft groups. Methods Sixty-seven patients with ACL reconstruction and 20 healthy individuals were included. Active JPS reproduction was measured at 15°, 45° and 75° of knee fexion. International Knee Documentation Committee (IKDC) subjective score and one-leg hop test were used to assess the functional status of the patients. Results The JPS detection was diferent at the 15° target angle between groups (F3.86=24.56, p<0.001). A signifcantly higher proportion of quadriceps tendon autograft group patients failed to identify the 15° active JPS assessment position compared to the other groups (p<0.0001). The quadriceps index was lower in patients compared to healthy individuals (p<0.001), while the hamstring index was similar (n.s.). The knee functional outcomes were similar between ACL reconstructed groups and healthy controls (n.s.). Conclusion Knee proprioception defcits and impaired muscle strength were evident among patients at a mean 13.5 months post-ACL reconstruction compared with healthy controls. Patients who underwent ACL reconstruction using a quadriceps tendon autograft may be more likely to actively over-estimate knee position near terminal extension. Physiotherapists may need to focus greater attention on terminal knee extension proprioceptive awareness among this patient group

Patellofemoral Ağrı Sendromunda Farklı Izokinetik Kuvvet Eğitimlerinin Karşılaştırılması

The aim of this study was to assess and to compare the efficacy of on each eccentric training (ECC), o concentric training (CON) and combined eccentric and Concentric training in women patients with Patellofemoral pain syndrome. The primary hypothesis was that Combined training would be more effective then ECC and CON training groups. Thirty-four patients were divided into three groups CON (n=13), ECC (n=10) and Combined training (n=11), randomly. The primary outcome measurement was M. Quadriceps femoris muscle strength. Secondary outcome measurements were Hamstring muscle strength, pain levels, knee joint position sense, functional level and performance and anxiety level. The patients were trained three times a week through 8 weeks. The measurements were applied before and 8 weeks after training. The results of this study showed that while Combined and ECC training were more effective on increasing M. Quadriceps femoris eccentric strength than CON training (p0.05), CON training was found more effective on concentric muscle strength than ECC and Combined training (p0.05). All outcome measurements were improved before and after 8 weeks training in all groups. According to these results, combined and eccentric training were seem more effective on improving muscle strength and joint position sense than concentric training. This study showed that eccentric training has a positive effect on improving patellofemol pain syndrome symptoms. We recommended that PFAS rehabilitation program should include both eccentric and concentric training.Bu çalışmanın amacı Patellofemoral ağrı sendromlu kadınlarda, tek başına eksentrik eğitim (EKS), tek başına konsentrik eğitim (KONS) ve kombine eğitimin (hem eksentrik, hem konsentrik) etkilerini araştırmak ve karşılaştırmaktı. Çalışmanın birincil hipotezi kombine eğitimin eksentrik ve konsentrik eğitimden daha etkili olacağı yönündeydi. Patellofemoral ağrı sendromu tanısı alan 34 hasta rastgele KONS (n=13), EKS (n=10) ve Kombine (n=11) eğitim grubuna dahil edildi. Çalışmanın parametreleri, M. Quadriceps femoris kas kuvveti ve Hamstring kas kuvveti, ağrı seviyesi, diz eklem pozisyon hissi, fonksiyonel seviye, performans seviyesi ve kaygı düzeyi idi. Hastalar 8 hafta suresince haftada 3 kez izokinetik dinamometre cihazında egzersiz eğitimine alındı. Tüm parametreler çalışmanın başlangıcında ve 8 haftanın sonunda ölçüldü. Bu çalışmanın sonunda, M. Quadriceps femoris eksentrik kuvveti üzerinde Kombine ve EKS eğitimin KONS eğitimden daha etkili olduğu görüldü (p0.05), konsentrik kuvveti üzerinde KONS eğitimin, EKS ve Kombine eğitimden daha etkili olduğu görüldü (p0.05). Dinlenmedeki ağrı şiddeti EKS ve Kombine grupta benzer (p>0.05) ve KONS gruptan düşük olduğu görüldü (p0.05). Her üç grubun tedavi sonrası tüm ölçüm parametrelerinde, başlangıç değerlerine oranla anlamlı iyileşme saptandı (p<0.05). Bu sonuçlara göre, PFAS'de kas kuvveti ve propriyosepsiyonun iyileştirilmesinde kombine eğitim konsentrik eğitimden daha etkili bulunurken, eksentrik eğitim ile benzer bulundu. PFAS tedavisinde, eksentrik eğitimin önemli yeri olduğu ve egzersiz programlarında konsentrik kuvvetlendirmenin yanı sıra mutlaka eksentrik egzersizlere de yer verilmesinin gerektiği sonucuna varıldı

Functional Strength Ratio In Athletes With And Without Glenohumeral Internal Rotation Deficit (Gird)

Objectives: Eccentric external rotator (ER) and concentric internal rotator (IR) strength is expressed as a functional strength ratio (ER:IR) for shoulder. The difference in functional strength ratio has been well documented in athletes, but no one compared the functional ratio in athletes with glenohumeral internal rotation deficit (GIRD). The aim of this study was to investigate the effects of GIRD on functional ER:IR strength ratio of the adolescent athletes. Methods: Fifty-three adolescent athletes (12-18 years) from basketball and volleyball teams participated in the study. All the athletes were filled a questionnaire to obtain demographic information and information about their sporting activity. To determine the GIRD, the range of glenohumeral internal rotation motion was measured with the use of a digital inclinometer. An isokinetic dynamometer was used for the assessment of eccentric and concentric muscle strength of the dominant and non-dominant shoulders. Student-t test was used to assess the difference on ER:IR strength ratio between groups. Results: After the clinical examination of all shoulders the athletes were divided into 2 different groups, which were shoulders with glenohumeral internal rotation deficit (Group 1, n=34) and shoulders without GIRD (Group 2, n=22). There was a significant difference among groups on functional ER: IR strength ratio (t=-2.172, p=0.034). The ratio was lower in shoulders with GIRD. Conclusion: GIRD has an adverse effect on functional shoulder ratio, which is one of the causes of shoulder injuries in adolescent athletes. Therefore, GIRD should be treated to prevent future injuries.PubMe

Effects Of Different Isokinetic Training Programs On Hamstring/Quadriceps Ratio And Proprioception In Patients With Patellofemoral Pain

Objectives: To determine the effects of different isokinetic training programs; eccentric training, concentric training and combined (concentric-eccentric) training on quadriceps and hamstring muscle strength functional ratio (H/Qfunc ) and knee proprioception in Patellofemoral Pain Syndrome (PFPS) patients. Methods: Thirty patients with unilateral PFPS were randomly assigned to 3 groups: concentric (CON, n=10) (31.23±3.12 years), eccentric (ECC, n=10) (33.73±2.21 years) and combined (combined, n=10) (30.41±4.35 years). In accordance with the progression principle, the training program was divided into 3 mesoscycles, and the sets and angular speeds were increased in each mesocycle. All groups were treated for 8 weeks. To determine H/Qfunc, eccentric quadriceps and concentric hamstring peak torques were evaluated at 60°/sec with Biodex System 3 (Biodex® Corp., Shirley, NY, USA). 20° and 60° of knee flexion target angles were used to evaluate the knee proprioception. Peak torques and proprioception were evaluated before and 8-week after training. Repeated measure of ANOVA was used for the analysis. Results: There was a significant difference in H/Qfunc between groups at 60°/sec (F= 9.048, p<0.001). The mean improvement difference in ECC and CON-ECC groups were better than CON group. Proprioception improvement was found significant after 8-weeks training for both on 20° (F=150.879 p<0.001) and 60° (F=247.561, p<0.001) of knee flexion. The mean improvement was similar for 20° (F=1.964, p=0.132) and 60° (F=0.493, p=0.711) of knee flexion between the groups. Conclusion: Isokinetic training with the emphasis on eccentric training of quadriceps muscle had a significant effect in H/Qfunc in PFPS patients. This is mostly based on the improvement in quadriceps eccentric peak torque and the improvement in balance between hamstring and quadriceps muscles. Eccentric and combined (concentric-eccentric) training is more appropriate model for strengthening compared to only concentric training.PubMe

Envisioning the atmospheric effect through (im)materiality

In an attempt to bridge the gap between architectural/interior design practice and education, ‘atmosphere’ as a prolific contemporary architectural debate in practice and theory is covered by the experiment of ‘Staging Poe’ carried out as a first year Design Studio through the study of Edgar Allen Poe’s selected poems. Poe’s 1846 text of ‘The Philosophy of Composition’, unfolding his analytical method of writing and emphasis on “effect” in poetry, provides a ground for experimenting with facets of materiality and structuring the studio. Aiming to cultivate intuitive design experiments of students into informed processes in hybridizing conceptual/textual and material/sensual aspects, studio is structured in two phases. In the first phase, “materialization”, idiosyncratic interpretations of students from words to materials with a focus on tectonic experiments and haptic experiences are sought in between materializing and dematerializing processes. In the second phase, the “atmospheric”, emphasis on dematerialization of the perception of materials through tools, such as light, color and sound is exercised to transform the object into a performance stage. Outcomes of the studio on aspects pertaining to material and materialities in creation of the immaterial that is the atmosphere is followed and evaluated through responses of students’ weekly reports

Rehabilitation after endoscopically percutaneous intramuscular splintage for vastus medialis partial rupture - A case report and review of the literature

Isolated rupture of the vastus medialis muscle is rare, and surgical repair is recommended. The results of rehabilitation programme after the percutaneous intramuscular splintage of a nearly total vastus medialis muscle tear in a 52-year professional-master degree weight-lifter is presented in this repor