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

Ön Çapraz Bağ Rekonstrüksiyonu Sonrası Iki Farklı Stabilizasyon Eğitiminin Diz Kas Kuvvet Gelişimine Etkilerinin Karşılaştırılması

The aim of this study was to investigate the effects of different kinetic chain stabilization trainings on quadriceps and hamstring strength recovery in anterior cruciate ligament reconstructed patients with hamstring tendon autograft. 52 patients were randomly allocated into 3 groups. Group 1 (n=17, age: 28.3±9.0 yrs, BMI: 24.0±3.7 kg/m2) was included in both standard rehabilitation and open kinetic chain (OKC) stabilization training in isokinetic system (ISOMED 2000); Group 2 (n=18, age: 27.3±7.8 yrs, BMI: 26.1±4.0 kg/m2) was included in both standard rehabilitation and closed kinetic chain (CKC) stabilization training in functional squat system (Monitered Rehab System), while Group 3 (n=17, age: 27.0±6.3 yrs, BMI: 24.4±3.2 kg/m2) was only included in standard rehabilitation. 2 way repeated measures of ANOVA (time by group) was used for statistical analysis. Time by group interaction was found significant for quadriceps strength recovery (F(4,98)= 2.75, p=0.03). At the end of the training, quadriceps strength of Group 1 and Group 2 was greater than Group 3 (p0.05). As a result, for quadriceps strength recovery, stabilization trainings in OKC and CKC positions were found more effective than standard rehabilitation. Therefore, resistive hamstring quadriceps co-contraction training should be included in ACL rehabilitation program so as to increase quadriceps strength.Bu çalışmanın amacı hamstring tendon otogrefti kullanılarak ön çapraz bağ cerrahisi geçirmiş bireylerde farklı kinetik halka pozisyonunda verilen stabilizasyon eğitiminin quadriceps ve hamstring kas kuvvet gelişimi üzerine etkisini araştırmaktı. 52 hasta randomize olarak 3 gruba ayrıldı. Grup 1 (n=17, yaş: 28.3±9.0 yıl, VKİ: 24.0±3.7 kg/m2) standart rehabilitasyona ek olarak izokinetik sistemde (ISOMED 2000) açık kinetik halka (AKH) stabilizasyon eğitimine, Grup 2 (n=18, yaş: 27.3±7.8 yıl, VKİ: 26.1±4.0 kg/m2) standart rehabilitasyona ek olarak fonksiyonel squat aletinde (Monitered Rehab System) kapalı kinetik halka (KKH) stabilizasyon eğitimine dahil edilirken, Grup 3 (n=17, yaş: 27.0±6.3 yıl, VKİ: 24.4±3.2 kg/m2) ise sadece standart rehabilitasyon programına dahil edildi. Stabilizasyon eğitimi, quadriceps ve hamstring kaslarının ko-kontraksiyonu ile birlikte 60˚ diz fleksiyonunda yapıldı. Stabilizasyon eğitimi cerrahi sonrası 1.ayda başlatıldı ve 8 hafta süreyle 3 gün/hf olacak şekilde yapıldı. Quadriceps ve hamstring kaslarının cerrahi sonrası 1, 3 ve 6.aydaki izometrik kas kuvvetleri ve kasların 6.aydaki 60˚/s, 90˚/s ve 180˚/s'de konsentrik ve 90 ˚/s'de eksentrik kas kuvvetleri izokinetik dinamometre ile ölçüldü. Verilerin analizinde 2 yönlü (Zaman X grup) tekrarlayan ölçümlerde varyans analizi kullanıldı. Zaman ile grup arasındaki etkileşim quadriceps kuvvet gelişimi için anlamlı bulundu (F(4,98)= 2.75, p=0.03). Eğitim sonunda, 1. ve 2. grubun quadriceps kuvveti 3. gruptan daha fazla bulunurken (p0.05). Sonuç olarak, quadriceps kas kuvveti gelişiminde, AKH ve KKH pozisyonlarında yapılan stabilizasyon eğitimleri standart rehabilitasyona göre daha etkili bulundu. Bu nedenle, quadriceps kas kuvvetinin artırılması için dirençli hamstring quadriceps ko-kontraksiyon eğitimi ÖÇB cerrahisi sonrası rehabilitasyon programına dahil edilmelidir

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

Adolescent tennis players' injury profile and awareness level of sports injury

Objective: The aim of this study is to examine the relationship between injury risk profile and injury awareness, as well as the level of injury knowledge and the incidence of injuries among adolescent tennis players. Material and Methods: One hundred seventy-nine adolescent tennis players (n: 98 females and 81 males, age: 13.9±1.6 years), who had a history of at least one sports injury were included in the study. A questionnaire was designed by sport experts that questioned about the tennis injuries and awareness of tennis injuries. Results: The most injured area was the shoulder (22%). It was followed by elbow (19%), ankle (17%), wrist (16%), and the knee (12%). Experiencing more sport injuries (more than twice) increased 5.7 times (p<0.01) if they had medium knowledge level, and increased 22.4 times if they had low knowledge level (p<0.001). Conclusion: Upper extremity injuries are more common in adolescent tennis players comparing with lower extremity injuries. In addition, the number of previous tennis injuries was related to training load and the athletes' awareness of tennis injuries. Therefore, optimizing tennis training load and increasing the level of injury awareness in adolescent tennis players may be important in preventing future sports injuries

Achilles Tendon Open Repair Augmented With Volar Turndown Tendon Flap And Deep Posterior Crural Fasciotomy

Objectives: The aim of the study was to investigate the outcomes after open repair of Achilles tendon rupture with augmented volar turndown gastrocnemius flap and deep posterior crural fasciotomy. Methods: Twenty-three (22male/1female) patients with acute Achilles tendon injury were operated. Open end to end repair and augmentation with a volar turndown gastrocnemius flap and fasciotomy of the deep posterior compartment was performed in each patient. Home physiotherapy program was instructed for each patient. Muscle strength, balance and jump performance were assessed. Results: All patients returned to their preinjury activity level and repairs healed without any major complication. One patient had serous drainage who did not require surgical intervention (4,3%). There was no significant difference between involved and uninvolved leg in terms of concentric and eccentric muscle strength (p=0.82 and p=0.53, respectively). In Y balance test, there was no significant difference between involved and uninvolved legs in anterior (p=0.06), posteromedial (p=0.97) and posterolateral (p=1.00). In addition, there were no significant differences between leg in vertical jump (p=0.16) and one leg hop (p=0.15) tests. AOFAS Hindfoot score was 98.6±2.3 (93-100). Conclusion: Open end to end repair of the Achilles tendon rupture with augmentation and fasciotomy of the deep posterior compartment healed without any major complication. Fasciotomy of the deep posterior compartment decreased the tension at the skin repair site while decompressing the supeficial compartment anteriorly. Additionally, the augmented bulky repair construct of the Achilles tendon cambered volarly through the deep posterior compartment and decreased irritation sense during and after tendon healing.PubMe

Short Term Effects Of Mobilization Techniques On Neck Pain And Deep Neck Flexor Muscle Endurance In Patients With Mechanical Chronic Neck Pain

PubMe

THE EFFECTS OF ABDOMINAL BRACING MANEUVER ON QUADRICEPS MUSCLE TORQUE, TIME TO PEAK TORQUE AND MUSCLE ACTIVATION LEVELS AT DIFFERENT KNEE FLEXION ANGLES

Purpose: The aim of the present study was to investigate the effects of abdominal bracing maneuver (ABM) on quadriceps peak torque (PT), time to peak torque (TTPT) and muscle activation levels during maximal strength testing of the quadriceps muscle in healthy individuals. Methods: Sixteen healthy individuals (Age: 24.63 +/- 1.67 years) participated in the present study. Each participant was taught ABM technique by a physical therapist's guidance. Surface electromyography was used to measure internal oblique/transversus abdominis, vastus medialis, vastus lateralis, and rectus femoris activation levels. Isokinetic dynamometry was used to measure quadriceps PT and TTPT during maximum isometric muscle testing at 60 degrees and 90 degrees of knee flexion angles with and without ABM. Repeated measures of ANOVA was performed for statistical analysis. Results: There was a significant angle by condition interaction for quadriceps PT (F(1,15)=5.30, p=0.04). PT decreased when ABM was performed, but the decrease was greater at 600 compared to 900 of knee flexion (60 degrees: p=0.001, ES=0.68; 90 degrees: p=0.008, ES=0.33). Quadriceps activation levels also decreased during ABM (p=0.04) regardless of knee flexion angle. Conclusion: The present study revealed that ABM may decrease muscle activation levels and peak torque during maximal quadriceps strength testing. Researchers should evaluate compensatory movements of the lumbopelvic region in order to prevent the error of force transfer in test results