The Effect of a Hip Strengthening Program on Mechanics during Running and Single Leg Squatting

STUDY DESIGN: Block randomized controlled trial. OBJECTIVES: To investigate whether a strengthening and movement education program, targeting the hip abductors and hip external rotators, alters hip mechanics during running and during a single-leg squat. BACKGROUND: Abnormal movement patterns during running and single-leg squatting have been associated with a number of running-related injuries in females. Therapeutic interventions for these aberrant movement patterns typically include hip strengthening. While these strengthening programs have been shown to improve symptoms, it is unknown if the underlying mechanics during functional movements is altered. METHODS: Twenty healthy females with excessive hip adduction during running, as determined by instrumented gait analysis, were recruited. The runners were matched by age and running distance, and randomized to either a training group or a control group. The training group completed a hip strengthening and movement education program 3 times per week for 6 weeks in addition to single-leg squat training with neuromuscular reeducation consisting of mirror and verbal feedback on proper mechanics. The control group did not receive an intervention but maintained the current running distance. Using a handheld dynamometer and standard motion capture procedures, hip strength and running and single-leg squat mechanics were compared before and after the strengthening and movement education program. RESULTS: While hip abductor and external rotation strength increased significantly (P<.005) in the training group, there were no significant changes in hip or knee mechanics during running. However, during the single-leg squat, hip adduction, hip internal rotation, and contralateral pelvic drop all decreased significantly (P = .006, P = .006, and P = .02, respectively). The control group exhibited no changes in hip strength, nor in the single-leg squat or running mechanics at the conclusion of the 6-week study. CONCLUSION: A training program that included hip strengthening and movement training specific to single-leg squatting did not alter running mechanics but did improve single-leg squat mechanics. These results suggest that hip strengthening and movement training, when not specific to running, do not alter abnormal running mechanics. LEVEL OF EVIDENCE: Therapy, level 2b. NOTE: This is not the final published version. The final version was published in the Journal of Orthopaedic and Sports Physical Therapy. 2011 Sep; 41(9): 625-32. doi: 10.2519/jospt.2011.347

Dynamic in vitro measurement of patellar movement after total knee arthroplasty: an in vitro study

BACKGROUND: Changing the kinematic behaviour of patellar movement could be one of the reasons for anterior knee pain after implantation of a total knee arthroplasty (TKA). The aim of the current study was to measure the potential influence on patellar kinematics of patellar resurfacing during TKA. METHODS: Patellar movement before and after TKA with and without patellar resurfacing was measured under dynamic conditions in an in vitro cadaver simulation. Physiologic Musculus quadriceps forces were applied to five physiologic human knee specimens undergoing simulated isokinetic extension motions, patellar movement was measured using an ultrasonic measurement system. Thereafter, the Interax(® )I.S.A.-prosthesis system was implanted without and with resurfacing the patella, and patellar movement was again measured. RESULTS: The physiologic patella center moved on a semilunar path up to 6.4 mm (SD 6.4 mm) medially during extension. After TKA, the unresurfaced patella showed significantly less medial translation (p = 0.04) than the resurfaced patella. Subsequent resurfacing of the patella then resulted in a return to mediolateral positioning of the patella similar to the physiological case, whereas the resurfaced patella tilted up to twice as much as physiologic. CONCLUSION: The results of this study suggest that resurfacing of the patella during TKA can result in a restoration of the physiologic mediolateral shift of the patellofemoral joint while angulation of the patella remains unphysiologic

Iliotibial band release as an adjunct to the surgical management of patellar stress fracture in the athlete: a case report and review of the literature

Stress fracture of the patella is rare. In this report, a case of patellar stress fracture occurring in an amateur athlete is presented, and an operative adjunct to the surgical management of this condition is proposed

Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

Patellofemoral Pain Syndrome (PFPS), a common cause of anterior knee pain, is successfully treated in over 2/3 of patients through rehabilitation protocols designed to reduce pain and return function to the individual. Applying preventive medicine strategies, the majority of cases of PFPS may be avoided if a pre-diagnosis can be made by clinician or certified athletic trainer testing the current researched potential risk factors during a Preparticipation Screening Evaluation (PPSE). We provide a detailed and comprehensive review of the soft tissue, arterial system, and innervation to the patellofemoral joint in order to supply the clinician with the knowledge required to assess the anatomy and make recommendations to patients identified as potentially at risk. The purpose of this article is to review knee anatomy and the literature regarding potential risk factors associated with patellofemoral pain syndrome and prehabilitation strategies. A comprehensive review of knee anatomy will present the relationships of arterial collateralization, innervations, and soft tissue alignment to the possible multifactoral mechanism involved in PFPS, while attempting to advocate future use of different treatments aimed at non-soft tissue causes of PFPS

Effects of Temporal Hydrostatic Pressure on Tissue-Engineered Bovine Articular Cartilage Constructs

The objective of this study was to determine the effects of temporal hydrostatic pressure (HP) on the properties of scaffoldless bovine articular cartilage constructs. The study was organized in three phases: First, a suitable control for HP application was identified. Second, 10 MPa static HP was applied at three different timepoints (6–10 days, 10–14 days, and 14–18 days) to identify a window in construct development when HP application would be most beneficial. Third, the temporal effects of 10–14-day static HP application, as determined in phase II, were assessed at 2, 4, and 8 weeks. Compressive and tensile mechanical properties, GAG and collagen content, histology for GAG and collagen, and immunohistochemistry for collagen types I and II were assessed. When a culture control identified in phase I was used in phase II, HP application from 10 to 14 days resulted in a significant 1.4-fold increase in aggregate modulus, accompanied by an increase in GAG content, while HP application at all timepoints enhanced tensile properties and collagen content. In phase III, HP had an immediate effect on GAG content, collagen content, and compressive stiffness, while there was a delayed increase in tensile stiffness. The enhanced tensile stiffness was still present at 8 weeks. For the first time, this study examined the immediate and long-term effects of HP on biomechanical properties, and demonstrated that HP has an optimal application time in construct development. These findings are exciting as HP stimulation allowed for the formation of robust tissue-engineered cartilage; for example, 10 MPa static HP resulted in an aggregate modulus of 273 ± 123 kPa, a Young's modulus of 1.6 ± 0.4 MPa, a GAG/wet weight of 6.1 ± 1.4%, and a collagen/wet weight of 10.6 ± 2.4% at 4 weeks