Clinical Measures and Their Contribution to Dysfunction in Individuals With Patellar Tendinopathy

Context: Patellar tendinopathy is prevalent in physically active populations and it affects their quality of living, performance of activity, and may contribute to the early cessation of their athletic careers. A number of previous studies have identified contributing factors for patellar tendinopathy however their contributions to self-reported dysfunction remain unclear. Objective: The purpose of this investigation was to determine if strength, flexibility, and various lower extremity static alignments contributed to self-reported function and influence the severity of patellar tendinopathy. Design: Cross sectional research design. Setting: University Laboratory. Participants: 30 participants with patellar tendinopathy volunteered for this study (age: 23.4±3.6 years, height: 1.8±0.1m, mass: 80.0±20.3kg, BMI: 25.7±4.3). Main outcome measures: Participants completed seven different patient-reported outcomes. Isometric knee extension and flexion strength, hamstring flexibility and alignment measures of rearfoot angle, navicular drop, tibial torsion, q angle, genu recurvatum, pelvic tilt, and leg length differences were assessed. Pearson’s correlation coefficients were assessed to determine significantly correlated outcome variables with each of the patient-reported outcomes. The factors with the highest correlations were used to identify factors that contribute the most to pain and dysfunction using backward selection, linear regression models. Results: Correlation analysis found significant relationships between questionnaires and BMI (r=-0.35-0.46), normalized knee extension (r=0.38-0.50) and flexion strength (r=-0.34-0.50), flexibility (r=0.32- -0.38, q angle (r=0.38-0.56) and pelvic tilt (r=-0.40). Regression models (R2= 0.22-0.54) identified thigh musculature strength and supine q angle to have greatest predictability for severity in patient-reported outcomes. Conclusions: These findings put an emphasis of bodyweight management, improving knee extensor and flexor strength, posterior flexibility in patellar tendinopathy patients

Ankle Degenerative Joint Disease in a 23 year old male basketball player

Background: A third-year transfer Division I basketball player (23 years old, height=200.7cm, mass=104.3kg) complained of pain in his left ankle mortise of the talocrural joint after a strength and conditioning workout in August 2014. A radiograph revealed osteophytes anteriorly, calcification posteriorly, possible loose body and os trigonum. A magnetic resonance image (MRI) of the ankle revealed tearing of the anterior talofibular ligament, a small rounded ossicle as well as osteophyte formation in the subtalar joint signifying the early stages of degenerative joint disease of the ankle. Differential Diagnosis: Anterior tibiofibular ligament tear, osteochondral lesion of the talus, avulsion fracture, os trigonum syndrome, loose bodies, chronic ankle instability Treatment: Patient first received treatments including therapeutic ultrasound, joint mobilization and ice massages. Patient also received Graston® soft tissue mobilization on the Achilles tendon to relieve stiffness. As the symptoms persisted and progressed, the physician ordered a 40mg injection of Depo-Medrol (methylprednisolone acetate) with 3cc Marcaine (bupivacaine hydrochloride) in his anteromedial ankle twice and prescribed a nonsteroidal antiinflammatory drug (Naprosyn). Uniqueness: The uniqueness of this case extends from the young age of the patient experiencing osteoarthritis. Conclusion: The ankle is one of the most frequently injured joints. Accordingly, clinicians should be concerned of degenerative joint disease of the ankle in those young athletes with history of frequent ankle sprain

Clinical Measures and their Contribution to Dysfunction in Individuals with Patellar Tendinopathy

Patellar tendinopathy is an overuse of the patellar tendon during physical activity and it affects up to 45% of athletes involved in jumping sports. The purpose of this study is to determine if strength, flexibility and various lower extremity static alignments play a role in patellar tendinopathy patients and to determine if clinical measures influence the severity of patellar tendinopathy. Thirty patients with patellar tendinopathy will be recruited to be in this study. Participants are completing surveys of subjective measures of knee function, isometric knee extensor and flexor strength, sit-and-reach, active knee extension, rearfoot angle, navicular drop test, tibial torsion, supine q-angle, standing q-angle, genu recurvatum, pelvic tilt and leg length difference. 7 individuals with patellar tendinopathy have participated male=5, female=2, age=24.9±5.1 years, height=176.0±12.9cm, weight=79.4±18.6kg, anterior knee pain scale=78±3.8, Lower Extremity Functional Scale=65.6±14.9, visual analogue scale for pain= 5.3±2.6mm, activity of daily living scale= 61.9±12.1, Victorian Institute Scale Assessment-Patella=53.9±17.6, Lysholm=78.1±11.1, tegner activity scale=5.7±0.8, average peak knee extension torque=125.9±42.3Nm, Assessment-Patella=53.9±17.6, Lysholm=78.1±11.1, tegner activity scale=5.7±0.8, average peak knee flexion torque=66.1±19.9Nm, sit & reach=32.3±8.4cm, active knee extension=156.3±11.6⁰, rearfoot angle=8.8±2.1⁰, navicular drop=3.3±2.3mm, tibial torsion=17.7±7.3⁰, supine Q-angle=11.8±2.2⁰, standing Q-angle=14.1±5.7⁰, genu recurvatum=2.4±5.5⁰, pelvic tilt=12.1±4.0⁰, and leg length difference=0.3±0.5mm. This study will provides clinicians with beneficial information regarding individuals with patellar tendinopathy’s function, alignment and strength

Another Look at Obesity Paradox in Acute Ischemic Stroke: Association Rule Mining

Though obesity is generally associated with the development of cardiovascular disease (CVD) risk factors, previous reports have also reported that obesity has a beneficial effect on CVD outcomes. We aimed to verify the existing obesity paradox through binary logistic regression (BLR) and clarify the paradox via association rule mining (ARM). Patients with acute ischemic stroke (AIS) were assessed for their 3-month functional outcome using the modified Rankin Scale (mRS) score. Predictors for poor outcome (mRS 3–6) were analyzed through BLR, and ARM was performed to find out which combination of risk factors was concurrently associated with good outcomes using maximal support, confidence, and lift values. Among 2580 patients with AIS, being obese (OR [odds ratio], 0.78; 95% CI, 0.62–0.99) had beneficial effects on the outcome at 3 months in BLR analysis. In addition, the ARM algorithm showed obese patients with good outcomes were also associated with an age less than 55 years and mild stroke severity. While BLR analysis showed a beneficial effect of obesity on stroke outcome, in ARM analysis, obese patients had a relatively good combination of risk factor profiles compared to normal BMI patients. These results may partially explain the obesity paradox phenomenon in AIS patients