Men have higher risk of kinesiophobia after anterior cruciate ligament reconstruction in long term follow up.

Background Psychological and physiological factors could negatively affect patients' recovery and increase re-injury rate after anterior cruciate ligament reconstruction (ACLR). In daily practice surgeons and physiotherapists see athletes struggling to improve muscle strength and complaining of lack of self-confidence during the progress of return to sport. The Tampa Scale for Kinesiophobia is a valid questionnaire to measure a patient's psychological status and isokinetic test is widely used to measure muscle recovery. Hypothesis Patients with kinesiophobia have inferior self reported and functional outcomes after ACLR. Methods 140 patients, 100 (71%) men and 40 (29%) women, mean age 32.5 (±8.3), were included in the study 5.5 (±1.25) years after ACLR. All patients were operated by two senior surgeons. Preoperative and postoperative assessments were performed by two sports specialized physical therapists. Patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee score and Tampa Scale of Kinesiophobia (TSK-17). Quadriceps and hamstring muscle isokinetic strength was assessed at 60°/sec and 180°/sec using the HumacNorm dynamometer. Functional performance was tested with the single-leg-hop test for distance and the Y-balance test for anterior reach. Variables of the study were described by means and standard deviations. Shapiro-Wilk test was conducted to test for normality of the variables and unpaired t-tests were used to test for differences between subgroups. After tests were conducted, simple Bonferroni adjustment was applied to account for the number of tests made. Results 68/140 patients (48.6%) reported a Tampa kinesiophobia score equal or higher than 37 points, above which is the cut off score for kinesiophobia. Patients with kinesiophobia had statistically significant lower scores in the KOOS Symptoms (p=0.001) and Quality of Life subscores (p=0.001), Total score (p=0.001) and the Oxford Knee Score (p=0.024). Isokinetic peak torque muscle strength mean deficits at 60°/sec and 180°/sec for knee flexion and extension were between 6% and 7% for patients with kinesiophobia and between 2% to 4% for patients without kinesiophobia compared with the contralateral side, with no significant differences between groups. There was no statistically significant difference in the Single-leg-hop test for distance leg ratio (0.98 (±0.19) and 1.00 (±0.26)) and the Y-balance test for anterior reach leg ratio (0.99 (±0.08) and 1.01 (±0.07)) respectively between the groups. Conclusion At 5 years after ACLR operated leg functional performance is equal to nonoperated leg. However kinesiophobia is present in nearly half of patients. Strength and functional tests alone are not good enough instruments for assessing complete recovery, on the other hand self-reported questionnaires have high correlation to kinesiophobia after ALCR. Further studies are needed to avoid development of kinesiophobia as well how to recognize phobia at early stages of rehabilitation

More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement

Purpose: The purpose of the present study was to analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with shoulder impingement syndrome (SAIS) and compare them with samples from male patients with post-traumatic recurrent shoulder instability. The hypothesis of the study was that patients with SAIS would have more histologic and ultrastructural degenerative changes in their subscapularis tendon and joint capsule than patients with post-traumatic recurrent shoulder instability. Methods: Male patients scheduled for surgery, with either subacromial decompression or Bankart reconstruction, were included. Four biopsies from each patient were obtained from the capsule and four from the subscapularis tendon during arthroscopic surgery. The histologic characteristics and the presence of glycosaminoglycans were assessed using the light microscope, and the ultrastructure was assessed using a transmission electron microscope. Results: Eight patients, median age 53 (45–74) years (p  Conclusion: Male patients with subacromial impingement have more histologic and ultrastructural degenerative changes in their shoulder compared with patients with post-traumatic recurrent shoulder instability. Clinical relevance: It appears that in patients with subacromial impingement, the whole shoulder joint is affected and not only the subacromial space. It is the opinion of the authors that intra-articular therapeutic injections could be tried more often in these patients. Level of evidence: III

Hill-Sachs Remplissage Procedure Based on Posterosuperior Capsulomuscular Anatomy

The remplissage technique is a procedure designed to fill a posterosuperior humeral head defect with the infraspinatus tendon and posterior-superior capsule in patients with engaging Hill-Sachs lesions. We describe a remplissage technique using 2 posterior working portals that respects the anatomy of the posterior-superior area of the glenohumeral joint without compromising the vascularization

10 months 4000IU vitamin D supplementation decreases the risk of vitamin D deficiency but has no effect to physical performance during active military training in high-latitudes – a randomized controlled trial

Embargoed til publishedBackground: Vitamin D deficiency with related consequences to human health has growing interest to military specific researchers worldwide. Many specific conditions could put soldiers in to the higher risk of vitamin D deficiency. Under high level of physical pressure during military training might increase the need of vitamin D in human body and therefore supplementation with vitamin D could be crucial for general health and physical fitness. Study Design: Longitudinal, triple-blinded, randomized, controlled trial. Methods: 113 men conscripts from the Estonian Army were randomized into two vitamin D supplementation groups: 58 to an 4000 IU and 58 to an 600 IU group. The length of the follow-up was ten months, from July 2021 until May 2022. Physical fitness and hand grip tests were performed 3 times and blood serum (25(OH)D), parathyroid hormone, calcium, ionized calcium values were measured 4 times during the study period. Results: The 600IU group had a significantly lower mean value of 25(OH)D in all time points during the study compared to 4000IU group (p<0.001) except baseline. Non of the study subjects in the Group A 600IU reached sufficient level of 25(OH)D in January and May. 61.3% in the 600IU and 30.6% 4000IU group had 25(OH)D levels under 50 nmol/L in May. No statistically significant differences found in the body weight and vitamin D correlation analysis in any time point on between study groups. No statistically significant differences in PTH, i-Ca were found between study groups at any time point except Ca results. No significant differences at any time points were revealed in the physical fitness test and hand grip strength tests except in non-dominant hand grip test in October. Conclusion: Ten months vitamin D3 4000IU supplementation decreased risk of vitamin D deficiency but had no effect to physical fitness compared to low dosage vitamin D supplementation. Trial registration: ClinicalTrials.gov Identifier: NCT04939636. Prospectively registered 13 October 2020

Seven-month wintertime supplementation of 1200 IU vitamin D has no effect on hand grip strength in young, physically active males: A randomized, controlled study

Background There has been a growing interest in the role of vitamin D for the well-being and physical performance of humans under heavy training such as conscripts in military service; however, there is a lack of long-term supplementation studies performed on members of this type of young, physically active, male population. The hypothesis of the study was that vitamin D supplementation during wintertime will decrease the prevalence of critically low vitamin D blood serum levels and increase hand grip strength during the winter season among young male conscripts. Study Design Longitudinal, triple-blinded, randomized, placebo-controlled trial. Methods Fifty-three male conscripts from the Estonian Army were randomized into two groups: 27 to an intervention group and 26 to a placebo group. The groups were comparable in terms of their demographics. The intervention group received 1200 IU (30 µg) capsules of vitamin D3, and the control group received placebo oil capsules once per day. The length of the follow-up was 7 months, from October 2016 until April 2017. Blood serum vitamin D (25(OH)D), parathyroid hormone (PTH), calcium (Ca), ionized calcium (Ca-i), testosterone and cortisol values, and hand grip strength were measured four times during the study period. Results The mean 25(OH)D level decreased significantly in the control group to a critically low level during the study, with the lowest mean value of 22 nmol/l found in March 2017. At that time point, 65% in the control group vs 15% in the intervention group had 25(OH)D values of less than 25 nmol/l (p < 0.001). In the intervention group, the levels of 25(OH)D did not change significantly during the study period. All other blood tests revealed no significant differences at any time point. The corresponding result was found for hand grip strength at all time points. Conclusion Long-term vitamin D supplementation during wintertime results in fewer conscripts in the Estonian Army with critically low serum vitamin D (25(OH)D) levels during the winter season. However, this did not influence their physical performance in the form of the hand grip strength test