Is the Rotatory Knee Stability Immediately Decreased Following a Competitive Soccer Match?

Fatigue induced by soccer playing increases physical efforts, which might alter the transverse knee stability, a known factor that promotes knee injuries, particularly anterior cruciate ligament injury. Thereby, primarily, we aimed to determine whether rotatory knee stability decreases immediately following a competitive soccer match in amateur players. Furthermore, we assessed the role of the preferred and non-preferred limbs to kick a ball in rotatory knee stability and the correlation between performance parameters and rotatory knee stability. We hypothesized that the knee stability decreases immediately after a competitive soccer match in amateur players. Eight healthy amateur soccer players (aged 27.2 ± 4.7 years and with body mass index of 23.8 ± 1.2 kg m−2) were included immediately before and after a competitive soccer match. The rotatory knee stability was assessed in the preferred and non-preferred limbs through the acceleration and jerk of the pivot shift maneuver and by the internal knee rotation of a pivoting landing task. Two-way repeated-measures ANOVA for factors time (before and after the soccer match) and limb (preferred and non-preferred) and multiple comparisons were performed using α = 5%. There was a statistical significance for the main factor time in the acceleration (5.04 vs. 6.90 ms−2, Δ = 1.86 ms−2, p = 0.020, η2 = 0.331) and jerk (18.46 vs. 32.10 ms−2, Δ = 13.64 ms−2, p = 0.004, η2 = 0.456) of the pivot shift maneuver. Rotatory stability decreases following a competitive soccer match in amateur soccer players under fatigue. Both the acceleration and jerk during the pivot shift maneuver is increased without significant internal knee rotation changes during the pivoting landing task

Knee sensorimotor control following anterior cruciate ligament reconstruction: A comparison between reconstruction techniques.

The sensorimotor system helps to maintain functional joint stability during movement. After anterior cruciate ligament (ACL) injury and reconstruction, several sensorimotor deficits may arise, including altered proprioception and changes in neuromuscular control. It is still unknown whether the type of autograft used in the reconstruction may influence knee sensorimotor impairments. The aim of this study was to comparatively assess the effects of the hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) ACL reconstruction techniques on knee sensorimotor control 6-12 months post-operation. A total of 83 male subjects participated in this study: 27 healthy participants, 30 BPTB-operated patients and 26 HT-operated patients. Active joint position sense in 3 ranges of motion (90-60°, 60-30°, and 30-0° of knee flexion), isometric steadiness, and onset of muscle activation were used to compare sensorimotor system function between groups. Both operated groups had a small (< 5°) but significant joint position sense error in the 30-0° range when compared to the healthy group. No significant differences were found between the operated and the control groups for isometric steadiness or onset of muscle activation. The results of this study suggest that operated patients present knee proprioceptive deficits independently of surgical technique. Nevertheless, the clinical implications of this impairment are still unknown. It seems that selected surgical approach for ACL reconstruction do not affect functioning of the sensorimotor system to a large degree

Diaphragm-sparing nerve blocks for shoulder surgery, revisited

Although interscalene brachial plexus block (ISB) remains the gold standard for analgesia after shoulder surgery, the inherent risks of ipsilateral phrenic nerve block and hemidiaphragmatic paralysis (HDP) limit its use in patients with preexisting pulmonary compromise. In a previous Daring Discourse (2017), our research team has identified potential diaphragm-sparing alternatives to ISB for patients undergoing shoulder surgery. In recent years, the field has been fertile with research, with the publication of multiple randomized controlled trials investigating supraclavicular blocks, upper trunk blocks, anterior suprascapular nerve blocks, costoclavicular blocks, and combined infraclavicular-suprascapular blocks. To date, the cumulative evidence (pre-2017 and post-2017) suggests that costoclavicular blocks may provide similar postoperative analgesia to ISB coupled with a 0%-incidence of HDP. However, in light of the small number of patients recruited by the single study investigating costoclavicular blocks, further confirmatory trials are required. Moreover, future investigation should also be undertaken to determine if costoclavicular blocks could achieve surgical anesthesia for shoulder surgery. Anterior suprascapular nerve blocks have been demonstrated to provide surgical anesthesia and similar analgesia to ISB. However, their risk of HDP has not been formally quantified. Of the remaining diaphragm-sparing nerve blocks, supraclavicular blocks (with local anesthetic injection posterolateral to the brachial plexus), upper trunk blocks, and combined infraclavicular-anterior suprascapular blocks merit further investigation, as they have been shown to achieve similar analgesia to ISB, coupled with an HDP incidence <10%