The Effect of Conservatively Treated ACL Injury on Knee Joint Position Sense.

BACKGROUND: Proprioception is critical for effective movement patterns. However, methods of proprioceptive measurement in previous research have been inconsistent and lacking in reliability statistics making it applications to clinical practice difficult. Researchers have suggested that damage to the anterior cruciate ligament (ACL) can alter proprioceptive ability due to a loss of functioning mechanoreceptors. The majority of patients opt for reconstructive surgery following this injury. However, some patients chose conservative rehabilitation options rather than surgical intervention. PURPOSE: The purpose of this study was to determine the effect of ACL deficiency on knee joint position sense following conservative, non-operative treatment and return to physical activity. A secondary purpose was to report the reliability and measurement error of the technique used to measure joint position sense, (JPS) and comment on the clinical utility of this measurement. STUDY DESIGN: Observational study design using a cross-section of ACL deficient patients and matched uninjured controls. METHODS: Twenty active conservatively treated ACL deficient patients who had returned to physical activity and twenty active matched controls were included in the study. Knee joint position sense was measured using a seated passive-active reproductive angle technique. The average absolute angle of error score, between 10 °-30 ° of knee flexion was determined. This error score was derived from the difference between the target and repositioning angle. RESULTS: The ACL deficient patients had a greater error score (7.9 °±3.6) and hence poorer static proprioception ability that both the contra-lateral leg (2.0 °±1.6; p = 0.0001) and the control group (2.6 °±0.9; p = 0.0001). The standard error of the mean (SEM) of this JPS technique was 0.5 ° and 0.2 ° and the minimum detectable change (MDC) was 1.3 ° and 0.4 ° on asymptomatic and symptomatic subjects respectively. CONCLUSION: This study confirms a static proprioceptive deficiency exists in the knee joint following ACL injury and rehabilitation, potentially due to a reduction in functioning mechanoreceptors in the ligament over time. The differences between the ACL deficient knee and the control group were above the SEMs and MDCs of the measurement which suggests clinical relevance. Longitudinal studies are needed to evaluate if patients who return to activity with a joint position sense deficiency develop secondary injuries. LEVELS OF EVIDENCE: Individual Cohort Study (2b

Criterion-Related Validity of Knee Joint-Position-Sense Measurement Using Image Capture and Isokinetic Dynamometry

Context: Clinicians require portable, valid, and cost-effective methods to monitor knee joint-position-sense (JPS) ability. Objective: To examine the criterion-related validity of image-capture JPS measures against an isokinetic-dynamometer (IKD) procedure. Design: Random crossover design providing a comparison of knee JPS measures from image capture and IKD procedures. Participants: 10 healthy participants, 5 female, age 28.0 ± 13.29 y, mass 60.3 ± 9.02 kg, height 1.65 ± 0.07 m, and 5 male, 29.6 ± 10.74 y, mass 73.6 ± 5.86 kg, height 1.75 ± 0.07 m. Main Outcome Measures: The dependent variables were absolute error scores (AES) provided by 2 knee directions (flexion and extension). The independent variables were the method (image capture and IKD). Results: There was no significant difference between clinical and IKD AES into knee-flexion data (P = .263, r = 0.55). There was a significant difference between clinical and IKD AES into knee-extension data (P = .016, r = .70). Conclusions: Analysis of photographic images to assess JPS measurements using knee flexion is valid against an IKD positioning method, but JPS measurements using knee extension may not be valid against IKD techniques. However, photo-analysis measurements provided a lower error score using knee-extension data and thus may provide an optimal environment to produce maximal knee JPS acuity. Therefore, clinicians do not need expensive equipment to collect representative JPS ability

Musculoskeletal Injury Rates in Multiday Marathon Runners Performing Ten Consecutive Marathons on a Repeat Course

Objective: To describe musculoskeletal injury rates in recreational runners completing ten marathons over ten consecutive days to help event organisers plan future injury preventative advice and strategies. Methods: An observational study involving 27 recreational runners (age 45.1 ± 7.47 yrs, mass 74.5 ± 12.39 kg, years running 11.6 ± 9.42 yrs, average weekly mileage 41.9 ± 12.72 miles). Main outcome measures included total and percentage of musculoskeletal injuries, timing of injury occurrence during 10-day event, and daily individual marathon times. Results: Twenty-six runners sustained 108 injuries, averaging 4 injuries per runner (90.13 per 1000hr). 89% of injuries involved the lower extremity; 24.1% foot, 18.5% hip/buttock, 16.7% ankle and 16.7% lower leg. Common injuries were blisters (15.7%), Achilles tendinitis (11.1%), medial tibial stress syndrome (MTSS) (10.2%), iliotibial band syndrome (ITBS) (9.3%) and low back pain (LBP) (9.3%). 64.3% of injuries were sustained to the left limb. Chisquared analysis revealed more injuries in days 1-3 than days 4-6 (p=0.013) and days 7-10 (p=0.001). Repeated measures ANOVA comparing Days 1-3, 4-6 and 7-10 showed a significant main effect (p=0.039). Post hoc analysis revealed Days 1-3 were significantly quicker time than days 7-10 (p=0.037, difference of 0.276 hrs). Conclusion: Blisters, Achilles tendinitis, MTSS and ITBS are the most common lower extremity injuries in multiday marathons runners performing a repeat course over 10 consecutive days.Runners entering these events should perform appropriate injury prevention programmes. Runners should also be more reserved at the beginning of multiday events to avoid high initial injury risk. However, further investigation of injury rates and risk factors using larger sample sizes is required

Interexaminer, Intraexaminer, and Test–Retest Reliability of Clinical Knee Joint-Position-Sense Measurements Using an Image-Capture Technique

Context: Knee joint position sense (JPS) plays a critical role in controlled and stable joint movement. Poor ability to sense position of the knee can therefore increase risk of injury. There is no agreed consensus on JPS measurement techniques and a lack of reliability statistics on methods. Objective: To identify the most reliable knee JPS measurement technique using image capture. Design: Inter-examiner, intra-examiner and test-retest reliability of knee JPS measurements. Setting: Biomechanics laboratory. Participants: Ten asymptomatic participants. Interventions: None. Main Outcome Measures: Relative and absolute error scores of knee JPS in three conditions (sitting, prone, active) through three ranges of movement (10-30°, 30-60°, 60-90°), into two directions (flexion and extension) using both legs (dominant and non-dominant) collected during 15 trials and repeated seven days after the first data collection. Results: Statistical analysis by intraclass correlations revealed excellent inter-examiner reliability between researchers (0.98) and intra-examiner reliability within one researcher (0.96). Test-retest reliability was highest in the sitting condition from a starting angle of 0°, target angle through 60°-90°of flexion, using the dominant leg and AES variables (ICC = 0.92). However, it was noted smallest detectable differences (SDDs) were a high percentage of mean values for all measures. Conclusions: The most reliable JPS measurement for asymptomatic participants has been identified. Practitioners should use this protocol when collecting JPS data during pre-screening sessions. However, generalizability of findings to a class/group of clients exhibiting knee pathologies should be done with caution

Knee joint position sense ability in elite athletes who have returned to international level play following ACL reconstruction: A cross-sectional study.

Background: Following an ACL injury, reconstruction (ACL-R) and rehabilitation, athletes may return to play with a proprioceptive deficit. However, literature is lacking to support this hypothesis in elite athletic groups who have returned to international levels of performance. It is possible the potentially heightened proprioceptive ability evidenced in athletes may negate a deficit following injury. The purpose of this study was to consider the effects of ACL injury, reconstruction and rehabilitation on knee joint position sense (JPS) on a group of elite athletes who had returned to international performance. Methods: Using a cross-sectional design ten elite athletes with ACL-R and ten controls were evaluated. JPS was tested into knee extension and flexion using absolute error scores. Average data with 95% confidence intervals between the reconstructed, contralateral and uninjured control knees were analyzed using t-tests and effect sizes. Results: The reconstructed knee of the injured group demonstrated significantly greater angle of error scores when compared to the contralateral and uninjured control into knee flexion (p = 0.0001, r = 0.98) and knee extension (p = 0.0001, r = 0.91). There were no significant differences between the contralateral uninjured knee of the injured group and the uninjured control group. Conclusions: Elite athletes who have had an ACL injury, reconstruction, rehabilitation and returned to international play demonstrate lower JPS ability compared to control groups. It is unclear if this deficiency affects long-term performance or secondary injury and re-injury problems. In the future physical therapists should monitor athletes longitudinally when they return to play

Screening Tools as a Predictor of Injury in Dance: Systematic Literature Review and Meta-analysis

Abstract Background Dance involves movements of complexity and physical intensity which result in stress on the body. As a consequence, dancers are at risk of injury which can impact on their well-being. Screening tools are used for injury prevention to identify those dancers at risk of injury. The aim of this study was to investigate which screening tools can predict injury in dancers, encompassing all dance genres, levels and ages. Methods An electronic search of seven databases from their inception to December 2017 was conducted. The databases were the Allied and Complementary Medicine Database (AMED), CINAHL, eBOOK Collection (EBSCOhost), MEDLINE, Cochrane Database of Systematic Reviews, SPORTDiscus and PEDro: the Physiotherapy Evidence Base. The following search terms were used: (i) Dance AND injury AND Screening, (ii) Screening AND dance and (iii) Musculoskeletal AND Screening AND Dance. Studies were assessed using a 20-point scoring tool, and eligible studies were included in a meta-analysis. Results The mean methodological quality score was 12.2 points. Injured dancers had a significantly higher compensated turnout range of motion than non-injured dancers: pooled mean difference of compensated turnout (23.29°; 95% CI 14.85–31.73; P < 0.00001; I 2 = 0%). Injured dancers had significantly greater functional turnout range of motion when compared to non-injured dancers: pooled mean difference of functional turnout (14.08°; 95% CI 7.09–21.07; P < 0.0001; I 2 = 0%). There also some evidence for use of hip range of motion as a predictor of dance injury. Conclusions Some evidence exists for the potential use of dance-specific positions as a predictor of injury. A number of studies were limited by a lack of prospective injury design, injury definition and self-reporting of injury

Leadership development programme: a multi-method evaluation

This report investigates findings arising from a variety of forms of feedback provided by the first cohort of participants (2012-2013) in Cumbria Partnership Foundation Trust’s “Leadership Development” Programme (LDP). The report summarises both quantitative and qualitative feedback, and synthesises findings to provide a more three-dimensional overview of participant experience and systemic impact. Feedback reflects, throughout, the diversity of the participating cohort in terms of professional roles and levels of seniority