Effects of different initial bundle tensioning strategies on the outcome of double-bundle ACL reconstruction: a cohort study

<p>Abstract</p> <p>Background</p> <p>This study was performed to investigate the effects of different strategies and initial tension applied to each one of the bundles, antero-medial (AM) and postero-lateral (PL), on clinical outcome in double bundle (DB) ACL reconstruction.</p> <p>Methods</p> <p>One hundred fifty-one primary unilateral DB ACL reconstructions performed by a single surgeon from 1994 through 2002 were included in the study with a follow-up of at least 24 months. They were divided in the following 3 groups: Group I - Higher initial tension applied manually in the AM bundle compared to PL. II - Higher tension applied in the PL bundle compared to AM. III - The 2 bundles were attempted to be equally tensioned. All fixations were performed in 30 degrees of flexion. Group I = 59 patients, group II = 53 patients and group III = 39 patients. The groups had no statistical differences concerning demographic distribution. Clinical outcome was retrospectively evaluated by use of knee range of motion, manual knee laxity tests, KT-1000, Lysholm knee scale, subjective recovery scale and sports performance recovery scale. The differences of data were analyzed among the three groups.</p> <p>Results</p> <p>Group I showed a significant extension deficit compared with groups II and III. ANOVA revealed a significant difference of anterior laxity measured by the KT-1000 (average KT difference of 2.1, 2.1 and 1.2 mm in Group I, II and III, respectively). A statistical difference was found among the three groups regarding subjective and sports performance recovery scales with Group II showing higher scores in recovery than Group I.</p> <p>Conclusions</p> <p>The current clinical study does not recommend manual maximum of initial tension applied to the anteromedial or posterolateral bundles with graft tension imbalance at 30 degrees of flexion in double-bundle ACL reconstruction to achieve a better clinical outcome.</p

Effectiveness of KOJI AWARENESS tool

Background : The KOJI AWARENESS™ screening test is a self-administered screening tool for assessment of mobility, stability, and strength. It provides corrective exercises corresponding to the individual’s answers to the KOJI AWARENESS™ test questions. However, there is no evidence of the effectiveness of corrective exercises in improving KOJI AWARENESS™ screening test scores and activity-related pain. Methods : Twenty- six healthy subjects (11 female and 15 male ; age 20–50 years) were selected for participation. In a controlled laboratory setting, subjects were administered the KOJI AWARENESS™ test and were provided with individualized exercise programs based on the results of this first test. KOJI AWARENESS™ results were checked on the first day immediately after the first exercise session, and then again after the two-week program. Pain intensity was also assessed during daily training using a numerical rating scale. Results : Compared to pre-intervention, KOJI AWARENESS™ scores were significantly higher immediately after the first corrective exercise session and after 2 weeks of intervention (p < 0.001). Moreover, pain intensity was significantly lower after 2 weeks of intervention (p < 0.001). Conclusions : Individualized KOJI AWARENESS™ corrective exercises were effective immediately on the first day and also after the two-week program in improving the KOJI AWARENESS™ score and reducing pain intensity during daily training

The difference of ground reaction force during anterior step motion in collegiate male long-distance runners between with or without a history of medial tibial stress syndrome

本研究は代表的なランニング障害の一つである内側脛骨過労性骨膜炎（MTSS）を発症したアスリートのリハビリテーションや再発予防の一助とするために、MTSSの既往がある男子長距離ランナーにおける前方ステップ動作中の着地衝撃パターンを明らかにすることを目的とした。対象は大学男子長距離ランナー15名とした。自記式アンケートを用いて基本属性に関する情報を得た。最大一歩幅の距離をステップ幅とした前方ステップ時の片脚着地動作（前方ステップ動作）を行わせ、最大垂直床反力（pVGRF）、初期接地からpVGRFまでの時間、loading rate 、およびfree moment（FM）を計測、算出した。対象をMTSS既往あり群（4名6脚）とMTSS既往なし群（13名24脚）に分け、床反力パラメータを群間で比較した。MTSS既往なし群と比較してMTSS既往あり群のpVGRFとFMは有意に小さかった。省スペースで動作の評価が可能な前方ステップ動作において、MTSSの既往がある男子長距離ランナーと既往がない男子長距離ランナーの前方ステップ動作中の床反力パターンに違いがみられた。このことはMTSSの発症予防に向けた動作指導に役立つ可能性があるが、本研究の結果がMTSSの発症要因となるか、MTSSを発症した結果生じた動作戦略であるかは不明である。東京都立大学学位論乙第254号　副論文journal articl

Comparative Analysis of Thoracic Rotation Exercises: Range of Motion Improvement in Standing and Quadruped Variants

There have been few investigations into the effectiveness of thoracic spine exercises for improving thoracic range of motion (ROM) in any plane. This study assessed the effectiveness of two thoracic spine exercises: one in the quadruped position and one in the thoracic standing position. We determined how these exercises affect thoracic spine mobility ROM over a 2-week intervention period. Thirty-nine healthy participants were enrolled and assigned to a Quadruped Thoracic Rotation group (n=17 participants: 9 females and 8 males) or Flamenco Thoracic Spine Rotation group (n=22: 14 females and 8 males). All participants were administered a KOJI AWARENESSTM screening test, and the initial thoracic spine ROM before intervention exercise was measured in a laboratory setting. Quadruped Thoracic Rotation was performed as the quadruped exercise and Flamenco Thoracic Spine Rotation as the standing exercise. The KOJI AWARENESSTM thoracic spine test and ROM were evaluated on the day after the first exercise session and again after the program. Despite their different approaches to thoracic mobility, the quadruped exercise and standing exercise achieved equivalent improvement in thoracic ROM after 2 weeks. Practitioners have a range of exercise options for enhancing thoracic mobility based on their environmental or task-specific needs

Injury-related fear in athletes returning to sports after anterior cruciate ligament reconstruction - A quantitative content analysis of an open-ended questionnaire

Background/objective: Injury-related fear during sport activities are major psychological factors inhibiting a person’s return to sports (RTS) following anterior cruciate ligament reconstruction (ACLR). Currently, there are no studies that quantitatively analyse the open-ended questionnaire for knee injury-related fear in post-ACLR athletes.The purpose of this study was to identify knee injury-related fear in athletes who return to ball-centric sports via the use of an open-ended questionnaire. We aimed to determine the main concepts of injury-related fear according to sex, type of sport, and participation level. Methods: In this study, a quantitative analysis of an open-ended questionnaire was used to examine the type of fear athletes experience after returning to ball-centric sports. The RTS and fear questionnaire collected open-ended questionnaire to knee injury-related fear during sport activities; this questionnaire was completed at the outpatient visit post-RTS. Quantitative content analysis was performed to extract frequently occurring words from the responses to the questionnaire to create a co-occurrence network. The resulting co-occurrence network and extracted words were used to create concepts regarding knee injury-related fear. The relationship between each concept and subject demographics (sex, returned sports events, and participation level) were analysed using the chi-squared test. Results: Fifty-four athletes (30 females and 24 males) aged 16–45 [median age: 21.2; interquartile range (IQR): 11.0] years with an average RTS of 8.0 (IQR: 3.3) months from ACLR participated in the study. A total of 79 responses were included in the analysis. The knee injury-related fear can be summarized as follows: (1) Quick response to the opponent; (2) Ball-related play; (3) Jump-landing; (4) Contact; (5) Loss of balance; and (6) Athletic movement. Chi-squared tests showed that athletes participating in sport events with potential contact with an opponent (soccer, futsal, basketball, handball, lacrosse, and ultimate (frisbee)) were more likely to experience fear in quick response to the opponent (P < 0.01, adjusted residual = 2.943, ϕ = 0.301). Conclusion: The knee injury-related fear can be summarized into six concepts. Post-ACLR athletes participating in ball-centric sports need to assess fear in situations such as quick responses to the opponent’s movements and ball-related play, in addition to simple movements such as jumping, cutting, and contact

Postoperative outcome is affected by an intraoperative combination of each graft tension change pattern in a double-bundle anterior cruciate ligament reconstruction

Background: The purpose of this study is to evaluate the intraoperative tension change pattern of each anteromedial (AM) graft and posterolateral (PL) graft and to investigate the optimal femoral tunnel position in double bundle (DB) anterior cruciate ligament reconstruction (ACLR) by comparing postoperative outcomes with each combination of graft tension change pattern. Methods: Eighty-four unilateral primary DB ACLR cases from 2006 to 2008 with a follow-up of 24 months or more were analysed. The tension change pattern of each AM and PL graft after graft fixation was recorded during DB ACLR, and divided into over-the-top (OTT; tension at 0° > 120°) and reverse OTT (graft tension at 0° < 120°) pattern. The combinations of these patterns were then categorized into four groups and the postoperative results were analysed. The femoral tunnel position was measured by a modified quadrant method. The relationship between the femoral tunnel position and the tension change pattern of each graft was evaluated. Results: The cases that presented reverse tension change pattern of native anterior cruciate ligament (ACL) performed most poorly in postoperative knee laxity among the four groups. In this group, the femoral tunnel of the AM bundle was placed significantly higher in flexion. Conclusion: This study suggests that the least effective method for knee stability recovery is for the ACL to be reconstructed with the reverse tension change to the native ACL. It is necessary to refrain from placing the femoral tunnel for the AM bundle in a high position in knee flexion in DB ACLR

Development of a Wearable Mouth Guard Device for Monitoring Teeth Clenching during Exercise

Teeth clenching during exercise is important for sports performance and health. Recently, several mouth guard (MG)-type wearable devices for exercise were studied because they do not disrupt the exercise. In this study, we developed a wearable MG device with force sensors on both sides of the maxillary first molars to monitor teeth clenching. The force sensor output increased linearly up to 70 N. In four simple occlusion tests, the trends exhibited by the outputs of the MG sensor were consistent with those of an electromyogram (EMG), and the MG device featured sufficient temporal resolution to measure the timing of teeth clenching. When the jaw moved, the MG sensor outputs depended on the sensor position. The MG sensor output from the teeth-grinding test agreed with the video-motion analysis results. It was comparatively difficult to use the EMG because it contained a significant noise level. Finally, the usefulness of the MG sensor was confirmed through an exercise tolerance test. This study indicated that the developed wearable MG device is useful for monitoring clenching timing and duration, and the degree of clenching during exercise, which can contribute to explaining the relationship between teeth clenching and sports performance