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Proteus syndrome is a rare, sporadic, congenital syndrome that causes asymmetric and disproportionate overgrowth of limbs, connective tissue nevi, epidermal nevi, alteration of adipose tissue, and vascular malformations. Genetic mosaicism, such as activating mutations involving protein kinase AKT1, phosphoinositide 3 kinase (PI3-K), and phosphatase and tensin homolog (PTEN), may be important causes of Proteus syndrome. However, many patients have no evidence of mutations in these genes. Currently, the diagnosis is clinical and based on phenotypic features. This article reports a case of Proteus syndrome in a 14-year-old female patient who presented with linear epidermal nevi, viscera anomalies, and adipose tissue dysregulation. She showed an asymmetric progressive overgrowth of the right lower limb after birth bringing relevant functional and esthetic consequences. Therefore, she asked a plastic surgery consultation and a surgical treatment with a combined technique was planned. With our approach, we were able to reduce leg diameter and improve joint mobility reliably and safely with satisfying esthetic results. [ABSTRACT FROM AUTHOR]

Non-coding RNAs have distinct regulatory roles in the pathogenesis of joint diseases including osteoarthritis (OA) and rheumatoid arthritis (RA). As the amount of high-throughput profiling studies and mechanistic investigations of microRNAs, long non-coding RNAs and circular RNAs in joint tissues and biofluids has increased, data have emerged that suggest complex interactions among non-coding RNAs that are often overlooked as critical regulators of gene expression. Identifying these non-coding RNAs and their interactions is useful for understanding both joint health and disease. Non-coding RNAs regulate signalling pathways and biological processes that are important for normal joint development but, when dysregulated, can contribute to disease. The specific expression profiles of non-coding RNAs in various disease states support their roles as promising candidate biomarkers, mediators of pathogenic mechanisms and potential therapeutic targets. This Review synthesizes literature published in the past 2 years on the role of non-coding RNAs in OA and RA with a focus on inflammation, cell death, cell proliferation and extracellular matrix dysregulation. Research to date makes it apparent that 'non-coding' does not mean 'non-essential' and that non-coding RNAs are important parts of a complex interactome that underlies OA and RA. [ABSTRACT FROM AUTHOR]

Purpose: Despite several reports on risk factors for septic arthritis (SA) in adults, the outcomes on quality of life and joint function are sparsely reported. This study aimed to investigate the quality of life and joint function in adult patients treated for SA. Methods: This prospective observational study enrolled clinically diagnosed adult SA patients and estimated Euroqol 5-dimension 5 levels (EQ-5D-5L) questionnaire, Euroqol Visual Analog Scale (EQ-VAS) and a validated tool for joint function at 1, 3, 6 and 12 months after debridement. Results: Twenty seven patients (20 males/7 females) with 21 knees, four shoulders, and two elbows were evaluated. The mean age of the cases was 51(± 13.00) years. Three cases sustained mortality. EQ-5D-5L (P < 0.01) and EQ-VAS (P < 0.01) scores improved significantly between all time frames. Mean Knee society (P < 0.01), Shoulder QuickDASH, and Mayo elbow scores improved at all time frames. There was no difference in primary outcomes between early (< 14 days) and late (14 days or more) presentation. There was no difference in primary outcome measures between confirmed and suspected SA. Fifteen patients could ambulate without support, while 6 needed some support for walking at 1 year. Conclusion: Improved outcomes can be expected in quality of life and joint function in adults' septic arthritis at the end of 1 year after surgical treatment; however, the effects of delay in presentation need to be investigated further. Isolation of the microorganism from an infected joint has no bearing on the outcome measures. [ABSTRACT FROM AUTHOR]

In the wake of the quest to break the 2-h marathon barrier, carbon-fiber plates have become commonplace in marathon racing shoes. Despite the controversy surrounding this shoe technology, studies on the effects of increased longitudinal bending stiffness on running economy report mixed results. Here, we provide a comprehensive review of the current literature on midsole bending stiffness and carbon-fiber plates in distance running shoes, focusing on how longitudinal bending stiffness affects running energetics and lower limb mechanics. The current literature reports changes in running economy with increased longitudinal bending stiffness ranging from ~ 3% deterioration to ~ 3% improvement. In some studies, larger improvements have been observed, but often those shoes varied in many aspects, not just longitudinal bending stiffness. Biomechanically, increased longitudinal bending stiffness has the largest impact on metatarsal–phalangeal (MTP) and ankle joint mechanics. Plate location [top loaded (an insole), embedded (in between midsole foam), and bottom loaded (along the bottom of the shoe)] and geometry (flat/curved) affect joint moments and angular velocities at the MTP and ankle joint differently, which partly explains the mixed running economy results. Further research investigating how carbon-fiber plates interact with other footwear features (such as foam and midsole geometry), scaling of those with shoe size, body mass, and strike pattern, and comparing various plate placements is needed to better understand how longitudinal bending stiffness affects running economy. [ABSTRACT FROM AUTHOR]

Despite recent research on joint motion measurement to monitor human body movement, current measurement techniques and tools have significant limitations, including requiring large space for measurement and causing discomfort in test subjects wearing motion sensors. Our study aims, first, to develop carbon nanotube (CNT)-based textile joint motion sensors. Second, ours study aims to identify the most suitable CNT-based sensor structure and attachment method for use on a wearable platform during general exercise speeds. Lastly, we used these sensors on the human body, using sleeves and legs to find the most stable location, and we used the CNT-based sensor condition to monitor joint motions. We utilized our CNT-based sensor, which has proper elasticity as well as conductivity, and applied it to the elbow and knee joints. Based on the strain gauge principle, we monitored the variance of electric resistance that occurred when the CNT-based sensor was stretched due to limb motion. Our study tested 48 types of sensors. These sensors were applied to the CNT using different base knit textiles as well as different attachment methods, layers, sensor lengths, and sensor widths. The four most successful sensor types, which showed superior efficacy over the others in joint motion measurement, were selected for further study. These four sensors were then used to measure the elbow and knee joint motions of human subjects by placing them on different locations on sleeves and legs. The CNT knit textile sensors best suited to measuring joint motions are those with a double-layered CNT knit and 5 cm long × 0.5 cm or 1 cm wide sensors attached to a polyester¬-based knit using a welding method. The best position for the sensor to more stably monitor joint motions was the "below hinge position" from the elbow or knee hinge joint. Our study suggests an alternative strategy for joint-motion measurement that could contribute to the development of more comfortable and human-friendly methods of human limb motion measurement. [ABSTRACT FROM AUTHOR]

In recent years, gait analysis outside the laboratory attracts more and more attention in clinical applications as well as in life sciences. Wearable sensors such as inertial sensors show high potential in these applications. Unfortunately, they can only measure kinematic motions patterns indirectly and the outcome is currently jeopardized by measurement discrepancies compared with the gold standard of optical motion tracking. The aim of this study was to overcome the limitation of measurement discrepancies and the missing information on kinetic motion parameters using a machine learning application based on artificial neural networks. For this purpose, inertial sensor data-linear acceleration and angular rate-was simulated from a database of optical motion tracking data and used as input for a feedforward and long short-term memory neural network to predict the joint angles and moments of the lower limbs during gait. Both networks achieved mean correlation coefficients higher than 0.80 in the minor motion planes, and correlation coefficients higher than 0.98 in the sagittal plane. These results encourage further applications of artificial intelligence to support gait analysis. Graphical Abstract The graphical abstract displays the processing of the data: IMU data is used as input to a feedforward and a long short-term memory neural network to predict the joint kinematics and kinetics of the lower limbs during gait. [ABSTRACT FROM AUTHOR]

Sample entropy (SaEn) has been used to assess the regularity of lower limb joint angles during walking. However, changing sampling frequency and the number of included strides can potentially affect the outcome. The present study investigated the effect of sample frequency and the number of included strides on the calculations of SaEn in joint angle signals recorded during treadmill walking. Eleven subjects walked at their preferred walking speed for 10 min, and SaEn was calculated on sagittal plane hip, knee, and ankle angle signals extracted from 50, 100, 200, 300, and 400 strides at sampling frequencies of 60, 120, 240, and 480 Hz. Increase in sampling frequency decreased the SaEn significantly for the three joints. The number of included strides had no effect on the SaEn calculated on the hip joint angle and only limited effect on the SaEn calculated on the knee and ankle joint signals. The present study suggests that the number of data points within each stride to a greater extent determines the size of the SaEn compared to the number of strides and emphasizes the use of a fixed number of data points within each stride when applying SaEn to lower limb joint angles during walking. Graphical abstract Sampling frequency influences sample entropy of kinematics during walking. [ABSTRACT FROM AUTHOR]

Purpose: To analyse the relationship between several parameters of neuromuscular performance with unilateral dynamic balance measured through the Y-Balance test, as well as to determine the possible sex-related differences.Methods: The Y-Balance test, isokinetic (concentric and eccentric) knee flexion and extension strength, isometric hip abduction and adduction strength, lower extremity joint range of motion (ROM) (hip, knee and ankle) and core stability were assessed in male (n = 88) and female (n = 44) professional football players. A stepwise multivariate linear least square regression with backward elimination analysis was carried out to identify a group of factors that were independently associated with balance performance in both sexes.Results: Passive hip flexion and ankle dorsiflexion with knee flexed ROM were the main factors that retained a significant association to dominant (R2 = 23.1) and non-dominant (R2 = 33.5) balance scores for males. For females, core stability, hip abduction isometric peak torque, passive hip abduction and ankle dorsiflexion with knee flexed ROM variables retained a significant association with balance scores for both, dominant (R2 = 38.2) and non-dominant (R2 = 46.9) legs.Conclusions: Training interventions aimed at improving or maintaining unilateral dynamic balance in male football players should include, among other things, stretching exercises for the posterior chain of the lower extremity. However, females should also include exercises for strength and mobility of the hip abductors and core stability (especially in the frontal plane). This knowledge would allow clinicians and sport practitioners to develop more effective and tailored unilateral dynamic balance training interventions in male and female football players, possibly improving performance and reducing the risk of injury.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Introduction: In total hip arthroplasty via a direct anterior approach, the femur must be elevated at the time of femoral implant placement. For adequate elevation, division of the posterior soft tissues is necessary. However, if we damage and separate the posterior muscle tissue, we lose the benefits of the intermuscular approach. Furthermore, damage to the posterior soft tissue can result in posterior dislocation. We investigate that protecting the posterior soft tissue increases the joint stability in the early postoperative period and results in a lower dislocation rate.Methods: We evaluated muscle strength recovery by measuring the maximum width of the internal obturator muscle on CT images (GE-Healthcare Discovery CT 750HD). We compared the maximum width of the muscle belly preoperatively versus 10 days and 6 months postoperatively. As clinical evaluations, we also investigated the range of motion of the hip joint, hip joint function based on the Japanese Orthopaedic Association hip score (JOA score), and the dislocation rate 6 months after surgery.Results: The width of the internal obturator muscle increased significantly from 15.1 ± 3.1 mm before surgery to 16.4 ± 2.8 mm 6 months after surgery. The JOA score improved significantly from 50.8 ± 15.1 points to 95.6 ± 7.6 points. No dislocations occurred in this study.Conclusions: We cut only the posterosuperior articular capsule and protected the internal obturator muscle to preserve muscle strength. We repaired the entire posterosuperior and anterior articular capsule. These treatments increase joint stability in the early postoperative period, thus reducing the dislocation rate.Level of evidence: Therapeutic, Level IV. [ABSTRACT FROM AUTHOR]

Purpose: The quadrant method was described by Bernard et al. and it has been widely used for postoperative evaluation of anterior cruciate ligament (ACL) reconstruction. The purpose of this research is to further develop the quadrant method measuring four points, which we named four-point quadrant method, and to compare with the quadrant method.Methods: Three-dimensional computed tomography (3D-CT) analyses were performed in 25 patients who underwent double-bundle ACL reconstruction using the outside-in technique. The four points in this study's quadrant method were defined as point1-highest, point2-deepest, point3-lowest, and point4-shallowest, in femoral tunnel position. Value of depth and height in each point was measured. Antero-medial (AM) tunnel is (depth1, height2) and postero-lateral (PL) tunnel is (depth3, height4) in this four-point quadrant method. The 3D-CT images were evaluated independently by 2 orthopaedic surgeons. A second measurement was performed by both observers after a 4-week interval. Intra- and inter-observer reliability was calculated by means of intra-class correlation coefficient (ICC). Also, the accuracy of the method was evaluated against the quadrant method.Results: Intra-observer reliability was almost perfect for both AM and PL tunnel (ICC > 0.81). Inter-observer reliability of AM tunnel was substantial (ICC > 0.61) and that of PL tunnel was almost perfect (ICC > 0.81). The AM tunnel position was 0.13% deep, 0.58% high and PL tunnel position was 0.01% shallow, 0.13% low compared to quadrant method.Conclusions: The four-point quadrant method was found to have high intra- and inter-observer reliability and accuracy. This method can evaluate the tunnel position regardless of the shape and morphology of the bone tunnel aperture for use of comparison and can provide measurement that can be compared with various reconstruction methods. The four-point quadrant method of this study is considered to have clinical relevance in that it is a detailed and accurate tool for evaluating femoral tunnel position after ACL reconstruction.Level Of Evidence: Case series, Level IV. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the biomechanical consequences of reducing the base of support in patients with ataxia. Specifically, we evaluated the spatio-temporal parameters, upper- and lower-body kinematics, muscle co-activation, and energy recovery and expenditure. The gaits of 13 patients were recorded using a motion analysis system in unperturbed and perturbed walking conditions. In the latter condition, patients had to walk using the same step width and speed of healthy controls. The perturbed walking condition featured reduced gait speed, step length, hip and knee range of motion, and energy recovery and increased double support duration, gait variability, trunk oscillation, and ankle joint muscle co-activation. Narrowing the base of support increased gait instability (e.g., gait variability and trunk oscillations) and induced patients to further use alternative compensatory mechanisms to maintain dynamic balance at the expense of a reduced ability to recover mechanical energy. A widened step width gait is a global strategy employed by patients to increase dynamic stability, reduce the need for further compensatory mechanisms, and thus recover mechanical energy. Our findings suggest that rehabilitative treatment should more specifically focus on step width training. [ABSTRACT FROM AUTHOR]

Strength training is an aspect of gait rehabilitation, which complements balance control and weight-bearing training. However, conventional strength training does not show positive gait outcomes, due to lack of task specificity. Therefore, the aims of this study were to investigate the effects of a resistance force applied at the center of mass (CoM) and to investigate whether this exercise can be used for effective task-specific gait training. Using a novel robotic walker, a consistent resistive force was applied to the CoM of subjects in the posterior direction. Eleven healthy subjects were instructed to walk under five walking conditions with increasing forces, based on each subject's body weight (BW), at 0, 2.5, 5, 7.5, and 10% BW. Joint kinematics and mean amplitude and frequency of electromyography signals from nine major muscles were measured. The application of resistance resulted in significantly increased flexion angles at ankle, knee, and hip joints. A large amount of motor unit activation with lower firing rates was found at knee and hip joints, indicating that this type of resistance training can improve muscular strength and endurance in a task-specific manner. The long-term effects of the resistance training on neurologically challenged patients will be investigated in the future. [ABSTRACT FROM AUTHOR]

Purpose: Unique neuromuscular activation of the quadriceps femoris is observed during multi-joint leg extensions: lower activation of the biarticular rectus femoris (RF) than monoarticular vasti muscles. As one of the potential mechanisms for the lower RF activation, Ia afferent-mediated inhibitory connections between synergistic muscles and/or between agonist and antagonist muscles have been proposed. If this is the major factor, it is hypothesized that RF activation during multi-joint leg extensions increases after prolonged vibration to synergistic and/or antagonist muscles. This study tested the hypothesis.Methods: Fourteen men exerted maximal voluntary isometric knee extension and flexion and performed submaximal parallel squat before and after one of the following three interventions on different days: prolonged vibration to the vastus lateralis (VL, synergist) or biceps femoris (BF, antagonist), or quiet sitting for 30 min. Muscle activations of the quadriceps femoris and hamstrings were determined using surface electromyography.Results: After prolonged VL or BF vibration, VL (21%) or BF (30%) activation during isometric contractions significantly decreased, which was significantly correlated with the reduction of the maximal isometric knee extension or flexion strength. The magnitude of RF activation during squat was significantly lower than those of VL and the vastus medialis. No significant increase in RF activation during squat was observed after vibrations.Conclusion: The findings suggest that lower biarticular RF activation compared with the monoarticular vasti muscles during multi-joint exercises does not result from the modulation by peripheral inhibitory input from Ia afferents originating from synergist and/or antagonist muscles. [ABSTRACT FROM AUTHOR]

Resistance exercises can be considered to be multi-joint (MJ) or single-joint (SJ) in nature. Many strength coaches, trainers, and trainees believe that adding SJ exercises to a resistance training (RT) program may be required to optimize muscular size and strength. However, given that lack of time is a frequently cited barrier to exercise adoption, the time commitment resulting from these recommendations may not be convenient for many people. Therefore, it is important to find strategies that reduce the time commitment without negatively affecting results. The aim of this review was to analyze and discuss the present body of literature considering the acute responses to and long-term adaptations resulting from SJ and MJ exercise selection. Studies were deemed eligible for inclusion if they were experimental studies comparing the effects of MJ, SJ, or MJ + SJ on dependent variables; studies were excluded if they were reviews or abstracts only, if they involved clinical populations or persons with articular or musculoskeletal problems, or if the RT intervention was confounded by other factors. Taking these factors into account, a total of 23 studies were included. For the upper and lower limbs, analysis of surface electromyographic (sEMG) activation suggests that there are no differences between SJ and MJ exercises when comparing the prime movers. However, evidence is contrasting when considering the trunk extensor musculature. Only one study directly compared the effects of MJ and SJ on muscle recovery and the results suggest that SJ exercises resulted in increased muscle fatigue and soreness. Long-term studies comparing increases in muscle size and strength in the upper limbs reported no difference between SJ and MJ exercises and no additional effects when SJ exercises were included in an MJ exercise program. For the lumbar extensors, the studies reviewed tend to support the view that this muscle group may benefit from SJ exercise. People performing RT may not need to include SJ exercises in their program to obtain equivalent results in terms of muscle activation and long-term adaptations such as hypertrophy and strength. SJ exercises may only be necessary to strengthen lumbar extensors and to correct muscular imbalances. [ABSTRACT FROM AUTHOR]

Transforming growth factor-β (TGFβ) is a pleiotropic cytokine that is important in the regulation of joint homeostasis and disease. TGFβ signalling is induced by loading and has an important function in maintaining the differentiated phenotype of articular chondrocytes. Concentrations of active TGFβ differ greatly between healthy and osteoarthritic joints, being low in healthy joints and high in osteoarthritic joints, leading to the activation of different signalling pathways in joint cells. The characteristic pathology of osteoarthritic joints, such as cartilage damage, osteophyte formation and synovial fibrosis, seems to be stimulated or even caused by the high levels of active TGFβ, in combination with altered chondrocyte signalling pathways (which are also observed in ageing joints). In this Review, the changing role of TGFβ in normal joint homeostasis, ageing and osteoarthritis is discussed: TGFβ counteracts pathological changes in a young healthy joint, alters its signalling during ageing and is a driving force of pathology in osteoarthritic joints. [ABSTRACT FROM AUTHOR]

Introduction: Charcot arthropathy is a rare cause of debilitating joint destruction. Shoulder arthroplasty for Charcot arthropathy is challenging secondary to local bone and soft tissue loss, lack of protective sensation, and altered muscle control. The purpose of this study is to review the outcomes, complications, and survivorship of shoulder arthroplasty for Charcot arthropathy.Methods: Between January 2000 and December 2011, ten shoulders with Charcot arthropathy were treated with shoulder arthroplasty at our Institution (six hemiarthroplasty, one total shoulder arthroplasty, three reverse shoulder arthroplasty). Shoulders were followed for a minimum of two years or until re-operation. Outcomes measures included pain, range of motion, complications, and reoperation.Results: Shoulder arthroplasty improved pain to a mean score of 2.6 at follow up. However, gains in range of motion were not as substantial, with mean elevation of only 105°. External rotation improved from 20 to 43°. Subjectively, six of the ten patients rated the result as much better or better. Two shoulders underwent revision surgery at an average of five months after index arthroplasty.Conclusion: Shoulder arthroplasty for the treatment of the sequelae of a Charcot joint is a reasonable treatment option to provide substantial pain relief and improved motion. The relative indications of hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty for this particular condition continue to evolve. [ABSTRACT FROM AUTHOR]

Background: Overuse injuries are multifactorial resulting from cumulative loading. Therefore, clear differences between normal and at-risk individuals may not be present for individual risk factors. Using a holistic measure that incorporates many of the identified risk factors, focusing on multiple joint movement patterns may give better insight into overuse injuries. Lower body stiffness may provide such a measure. Objective: To identify how risk factors for Achilles tendon injuries influence measures of lower body stiffness. Methods: SPORTDiscus, Web of Science, CINAHL and PubMed were searched for Achilles tendon injury risk factors related to vertical, leg and joint stiffness in running athletes. Results: Increased braking force and low surface stiffness, which were clearly associated with increased risk of Achilles tendon injuries, were also found to be associated with increased lower body stiffness. High arches and increased vertical and propulsive forces were protective for Achilles tendon injuries and were also associated with increased lower body stiffness. Risk factors for Achilles tendon injuries that had unclear associations were also investigated with the evidence trending towards an increase in leg stiffness and a decrease in ankle stiffness being detrimental to Achilles tendon health. Conclusion: Few studies have investigated the link between lower body stiffness and Achilles injury. High stiffness is potentially associated with risk factors for Achilles tendon injuries although some of the evidence is controversial. Prospective injury studies are needed to confirm this relationship. Large amounts of high-intensity or high-speed work or running on soft surfaces such as sand may increase Achilles injury risk. Coaches and clinicians working with athletes with new or reoccurring injuries should consider training practices of the athlete and recommend reducing speed or sand running if loading is deemed to be excessive. [ABSTRACT FROM AUTHOR]

Introduction: The purposes of this study were (1) to compare the effect between contact force [first and second ground reaction force (GRF)] and decision making (anticipation vs unanticipation) on lower extremity biomechanics during a side-cutting maneuver in young soccer players; and (2) to identify which condition is more vulnerable to biomechanical risk factors of the anterior cruciate ligament (ACL) injury. Materials and Methods: Sixteen young, male middle school soccer players with right leg dominance participated in this study. Three-dimensional motion analysis featuring GRF and electromyography (EMG) of the right leg was used during the stance phase of the side-cutting maneuver. Kinematics, kinetics, and EMG data for each athlete were analyzed and averaged for three successful anticipated and unanticipated side-cutting maneuvers. Results: GRF was smaller and muscle activities were lower in most muscle groups in the first peak than that of the second peak. More flexion and internal rotational angles of the hip joint were observed in the unanticipated first peak that that of the second peak. Lesser flexion angle and moment of the knee joint observed in the first peak than that of the second peak, and abduction moment was increased after the unanticipation. Conclusion: The GRF and muscle activities were smaller in the first peak than those in the second peak; however, first peak showed a closer association with biomechanical risk factors of the ACL injury. There were some interactions between contact force and decision making and unanticipation made the first peak more risky to the ACL injury. [ABSTRACT FROM AUTHOR]

Cell-derived extracellular vesicles (EVs), present in synovial fluid and cartilage extracellular matrix (ECM), are involved in joint development and in the regulation of joint homeostasis. Although the exact function of EVs in these processes remains incompletely defined, the knowledge already acquired in this field suggests a role for these EVs as biomarkers of joint disease, and as a new tool to restore joint homeostasis and enhance articular tissue regeneration. In addition to direct injection of therapeutic EVs into the target site, surface coating of scaffolds and embedding of EVs in hydrogels might also lead to novel therapeutic possibilities. Based on the existing literature of EVs in synovial fluid and articular tissues, and investigation of the molecular factors (including microRNAs) active in joint homeostasis (or during its disturbance), we postulate novel perspectives for the implementation of EVs as a regenerative medicine approach in joint repair. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to verify and characterize the anatomical properties of the anterolateral capsule, with the aim of establishing a more accurate anatomical description of the anterolateral ligament (ALL). Furthermore, microscopic analysis of the tissue was performed to determine whether the ALL can morphologically be classified as ligamentous tissue, as well as reveal any potential functional characteristics.Methods: Three different modalities were used to validate the existence of the ALL: magnetic resonance imagining (MRI), anatomical dissection, and histological analysis. Ten fresh-frozen cadaveric knee specimens underwent MRI, followed by anatomical dissection which allowed comparison of MRI to gross anatomy. Nine additional fresh-frozen cadaveric knees (19 total) were dissected for a further anatomical description. Four specimens underwent H&E staining to look at morphological characteristics, and one specimen was analysed using immunohistochemistry to locate peripheral nervous innervation.Results: The ALL was found in all ten knees undergoing MRI and all nineteen knees undergoing anatomical dissection, with MRI being able to predict its corresponding anatomical dissection. The ALL was found to have bone-to-bone attachment points from the lateral femoral epicondyle to the lateral tibia, in addition to a prominent meniscal attachment. Histological sectioning showed ALL morphology to be characteristic of ligamentous tissue, having dense, regularly organized collagenous bundles. Immunohistochemistry revealed a large network of peripheral nervous innervation, indicating a potential proprioceptive role.Conclusion: From this study, the ALL is an independent structure in the anterolateral compartment of the knee and may serve a proprioceptive role in knee mechanics. [ABSTRACT FROM AUTHOR]

Calcification of joints and arteries (CALJA; MIM 211800) is an extremely rare mendelian disorder of isolated calcification that is characterized by late onset calcification of the extremity arteries and hand and foot joint capsules. Mutations of NT5E, encoding cluster of differentiation 73, have been implicated in CALJA. Here we report on a Chinese family with CALJA and novel compound heterozygous mutations (c.1360G>A (p.Gly454Arg) and c.1387C>T (p.Arg463X)) in NT5E. Our study represents the second report on patients with CALJA associated with NT5E mutations. The clinical features expand the previously reported phenotype of NT5E mutations. The propositus has calcification of the lower extremity arteries and hand and foot joint capsules similar to those previously reported patients. However, he also has calcification of the upper extremity arteries. By protein structural modeling, we found the mutation p.Gly454Arg may disrupt the folding of β-pleated sheet and destabilize the protein structure. Our findings will provide clues to the phenotype-genotype relations and may assist not only in the clinical diagnosis but also in the interpretation of genetic information used for prenatal diagnosis and genetic counseling. [ABSTRACT FROM AUTHOR]

Articular facets of the clinical subtalar joint (CSTJ) were analyzed using a total of 118 (right 57, left 61) dry, paired calcanei and tali from 68 Korean adult cadavers. The CSTJ facets were classified into the following three types depending on their continuity: type A, all three facets are separated; type B, the anterior and middle facets are partially connected; and type C, the anterior and middle facets are fused to form a single facet. The continuity between the anterior and middle facets was represented by the degree of separation (DS), which ranged between 2.00 (type A) and 1.00 (type C). Type A was most common (39.0 %) in calcanei and rarest (11.0 %) in tali. Matching of calcaneus-talus pairs yielded five combined types: A-A (11.0 %), A-B (28.0 %), B-B (18.6 %), B-C (13.6 %), and C-C (28.8 %). The mean DS was slightly greater in calcanei (1.53) than in tali (1.32), and decreased in the order of types A-A, A-B, B-B, B-C, and C-C. The intersecting angles between the anterior and middle facets, which are related to the mobility of the CSTJ, were inversely related to the DS. These findings indicate that the anterior and middle facets are fused more frequently in tali than in calcanei, and combinations of different CSTJ facet types (A-B, B-C) exist over 40 % of feet. Our results indicate that types with a smaller DS (such as B-C and C-C) are relatively mobile but less stable compared to those with a greater DS (such as A-A and A-B). [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to determine the immediate effects of pH change on the metabolism of bovine chondrocytes. Methods: Bovine osteochondral explants were pre-cultured and placed in Ringer's lactate solution. Thirty explants were randomly divided into 3 groups. Buffered Ringer's lactate, pH 7.2, was used in Group I; buffered Ringer's lactate, pH 7.4 (normal bovine knee joint pH), was used in Group II; and this group was also set as the control group. Buffered Ringer's lactate, pH 7.6, was used in Group III. All specimens were soaked for 2 h. RNA yield analyses were performed to evaluate the changes in cartilage metabolism at different pH levels. Results: Mean RNA yields of (hypoxia-induced factor) 1α that were immersed at pH 7.2 and 7.6 were 10.5- and 9.9-fold from base, respectively, which were lower compared to explants at pH 7.4 which was found as 15.2-fold. Mean RNA yields of aggrecan that were immersed at pH 7.2 and 7.6 were 12.2- and 13.6-fold from base, respectively, which were lower compared to explants at pH 7.4 which was found as 20-fold. RNA yields of collagen type II at pH 7.2 and 7.6 were 16.1- and 16.6-fold from base, respectively, which were lower compared to explants immersed at pH 7.4 which was found as 22.1-fold. Conclusion: The findings of the presented study suggest that short-term exposures to both acidic and basic pH may have effects on chondrocyte function. Our findings also indicate that exposures to solutions with a pH different from normal by only 0.2 unit could suppress chondrocyte metabolism and RNA synthesis. Clinical relevance: Using buffered irrigation solutions with a pH closer to the normal joint pH could be more physiologic and causes less ultra-structural damage than regular irrigation solutions. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Purpose: Knee osteoarthritis is one of the most common orthopaedic diseases. Therapeutic options for this disease include conservative treatments and arthroscopic debridement and partial or complete replacement. This meta-analysis aimed to collect and analyse the available information on the effects of arthroscopic joint debridement related to the clinical outcomes, the required conversion to replacement and the factors for patient selection. Methods: A search for publications was performed in the PubMed, Cochrane and EMBASE medical databases. The primary search resulted in a total of 1,512 citations. The results from 30 papers were included in this study. The extracted dates were listed in a standardised protocol. The statistical evaluation was performed using Comprehensive Meta-analysis software (V2 Biostat, Englewood, NJ, USA). Results: No randomised study that compared conservative and arthroscopic treatments for knee osteoarthritis was found. Most studies reported middle-term results after arthroscopic operations. The results of these studies showed excellent or good outcomes in more than 60 % of all patients. These results were correlated with a significant increase in the knee scores from baseline to follow-up; the standardised difference in means was 2.3 (CI 95 % 1.5-3.0, p < 0.001). The required conversion rate to replacement increased as the follow-up interval increased. The rates were as follows: 1 year-6.1 % (CI 95 %, 2.1-16.6 %), 2 years-16.8 % (CI 95 %, 10.2-26.3 %), 3 years-21.7 % (CI 95 %, 15.5-29.1 %) and 4 years-34.1 % (CI 95 %, 22.8-47.6 %). The mean survival time was 42.7 (CI 95 %, 14.5-71.1) months. Numerous factors influenced the outcome, including the radiological stage of the osteoarthritis and individual patient factors (e.g. time of history of osteoarthritis, weight and smoking). The local knee findings, such as axial dysalignment, missing effusion and massive crepitus, were also correlated with patient outcome. Conclusion: Arthroscopic joint debridement is a potential and sufficient treatment for knee osteoarthritis in a middle-term time interval. This procedure results in an excellent or good outcome in approximately 60 % of patients in approximately 5 years. Level of evidence: Systematic review of studies, Level III. [ABSTRACT FROM AUTHOR]

Eccentric (ECC) exercise is classically used to improve muscle strength and power in healthy subjects and athletes. Due to its specific physiological and mechanical properties, there is an increasing interest in employing ECC muscle work for rehabilitation and clinical purposes. Nowadays, ECC muscle actions can be generated using various exercise modalities that target small or large muscle masses with minimal or no muscle damage or pain. The most interesting feature of ECC muscle actions is to combine high muscle force with a low energy cost (typically 4- to 5-times lower than concentric muscle work) when measured during leg cycle ergometry at a similar mechanical power output. Therefore, if caution is taken to minimize the occurrence of muscle damage, ECC muscle exercise can be proposed not only to athletes and healthy subjects, but also to individuals with moderately to severely limited exercise capacity, with the ultimate goal being to improve their functional capacity and quality of life. The first part of this review article describes the available exercise modalities to generate ECC muscle work, including strength and conditioning exercises using the body's weight and/or additional external loads, classical isotonic or isokinetic exercises and, in addition, the oldest and newest specifically designed ECC ergometers. The second part highlights the physiological and mechanical properties of ECC muscle actions, such as the well-known higher muscle force-generating capacity and also the often overlooked specific cardiovascular and metabolic responses. This point is particularly emphasized by comparing ECC and concentric muscle work performed at similar mechanical (i.e., cycling mechanical power) or metabolic power (i.e., oxygen uptake, $$ \dot{V}{\text{O}}_{2} $$). In particular, at a similar mechanical power, ECC muscle work induces lower metabolic and cardiovascular responses than concentric muscle work. However, when both exercise modes are performed at a similar level of $$ \dot{V}{\text{O}}_{2} $$, a greater cardiovascular stress is observed during ECC muscle work. This observation underlines the need of cautious interpretation of the heart rate values for training load management because the same training heart rate actually elicits a lower $$ \dot{V}{\text{O}}_{2} $$ in ECC muscle work than in concentric muscle work. The last part of this article reviews the documented applications of ECC exercise training and, when possible, presents information on single-joint movement training and cycling or running training programs, respectively. The available knowledge is then summarized according to the specific training objectives including performance improvement for healthy subjects and athletes, and prevention of and/or rehabilitation after injury. The final part of the article also details the current knowledge on the effects of ECC exercise training in elderly populations and in patients with chronic cardiac, respiratory, metabolic or neurological disease, as well as cancer. In conclusion, ECC exercise is a promising training modality with many different domains of application. However, more research work is needed to better understand how the neuromuscular system adapts to ECC exercise training in order to optimize and better individualize future ECC training strategies. [ABSTRACT FROM AUTHOR]

There is substantial evidence that fatiguing exercise is accompanied by changes within the central nervous system that reduce the force that can be produced by working muscles. Here we review studies that used non-invasive neurophysiological techniques to show that sustained single-joint contractions have the capacity to increase corticospinal responsiveness and reduce motoneuronal responsiveness. We contrast these findings with new evidence from our laboratory regarding corticospinal responsiveness during sustained cycling exercise. There seems to be a similar increase in responsiveness of the intracortical inhibitory interneurons during sustained locomotor and single-joint exercise which might be due to acute exercise responses that are common to fatiguing exercise of any nature, such as local accumulation of fatigue metabolites. In contrast, the pattern of changes in corticospinal responsiveness is fundamentally different between the two modes of exercise which might be due to greater systemic fatigue responses to locomotor exercises. [ABSTRACT FROM AUTHOR]

The articular cartilage was studied under conditions of experimental osteoarthrosis with tunnelization of the subchondral zone and injection of autologous bone marrow into the channels. Histomorphological studies showed that tunnelization of the subchondral zone with injection of autologous bone marrow into the channels stimulated reparative regeneration of the chondral tissue by inhibiting destruction of the joints. [ABSTRACT FROM AUTHOR]

Stiffness, the relationship between applied load and elastic deformation, is an important neuromechanical component related to muscular performance and injury risk. The free-oscillation technique is a popular method for stiffness assessment. There has been wide application of this technique assessing a variety of musculature, including the triceps surae, knee flexors, knee extensors and pectorals. The methodology involves the modelling of the system as a linear damped mass-spring system. The use of such a model has certain advantages and limitations that will be discussed within this review. Perhaps the major advantage of such a model is the specificity of the measure, whereby it is possible for the assessment conditions to simulate the type of loading witnessed during functional tasks and sporting situations. High levels of reliability and construct validity have typically been reported using such procedures. Despite these assurances of accuracy, a number of issues have also been identified. The literature reveals some concerns surrounding the use of a linear model for stiffness assessment. Further, procedural issues surrounding the administration of the perturbation, attention focus of the participant during the perturbation, signal collection, data processing and analysis, presentation of stiffness as a linear or torsional value, assessment load (single vs multiple vs maximal) and the stiffness-load relationship have been identified, and are all fundamentally related to the quality of the calculated output data. Finally, several important considerations for practitioners have been recommended to ensure the quality and consistency of stiffness data collection, processing and interpretation. [ABSTRACT FROM AUTHOR]

The article discusses a study on the use of Bayesian Network (BN) in extracting causal information structure of human walking. Topics covered include the recording of muscle activities and joint motions during walking through BN, the use of different BNs to show normal walking and various impaired walking, and the study's objective of developing tools to assist in the diagnosis, prediction and evaluation of impairment in walking function in order to support therapy and rehabilitation.

Today neuromuscular simulations are used in several fields, such as diagnostics and planing of surgery, to get a deeper understanding of the musculoskeletal system. During the last year, new models and datasets have been presented which can provide us with more in-depth simulations and results. The same kind of development has occurred in the field of studying the human knee joint using complex three dimensional finite element models and simulations. In the field of musculoskeletal simulations, no such knee joints can be used. Instead the most common knee joint description is an idealized knee joint with limited accuracy or a planar knee joint which only describes the knee motion in a plane. In this paper, a new knee joint based on both equations and geometry is introduced and compared to a common clinical planar knee joint. The two kinematical models are analyzed using a gait motion, and are evaluated using the muscle activation and joint reaction forces which are compared to in-vivo measured forces. We show that we are able to predict the lateral, anterior and longitudinal moments, and that we are able to predict better knee and hip joint reaction forces. [ABSTRACT FROM AUTHOR]

Plyometric training (PLY) is a very popular form of physical conditioning of healthy individuals that has been extensively studied over the last 3 decades. In this article, we critically review the available literature related to lower-body PLY and its effects on human neural and musculoskeletal systems, athletic performance and injury prevention. We also considered studies that combined lower-body PLY with other popular training modalities, as well as studies that applied PLY on non-rigid surfaces. The available evidence suggests that PLY, either alone or in combination with other typical training modalities, elicits numerous positive changes in the neural and musculoskeletal systems, muscle function and athletic performance of healthy individuals. Specifically, the studies have shown that long-term PLY (i.e. 3-5 sessions a week for 5-12 months) represents an effective training method for enhancing bone mass in prepubertal/early pubertal children, young women and premenopausal women. Furthermore, short-term PLY (i.e. 2-3 sessions a week for 6-15 weeks) can change the stiffness of various elastic components of the muscle-tendon complex of plantar flexors in both athletes and non-athletes. Short-term PLY also improves the lower-extremity strength, power and stretch-shortening cycle (SSC) muscle function in healthy individuals. These adaptive changes in neuromuscular function are likely the result of (i) an increased neural drive to the agonist muscles; (ii) changes in the muscle activation strategies (i.e. improved intermuscular coordination); (iii) changes in the mechanical characteristics of the muscle-tendon complex of plantar flexors; (iv) changes in muscle size and/or architecture; and (v) changes in single-fibre mechanics. Our results also show that PLY, either alone or in combination with other training modalities, has the potential to (i) enhance a wide range of athletic performance (i.e. jumping, sprinting, agility and endurance performance) in children and young adults of both sexes; and (ii) to reduce the risk of lower-extremity injuries in female athletes. Finally, available evidence suggests that short-term PLY on non-rigid surfaces (i.e. aquatic- or sand-based PLY) could elicit similar increases in jumping and sprinting performance as traditional PLY, but with substantially less muscle soreness. Although many issues related to PLY remain to be resolved, the results of this review allow us to recommend the use of PLY as a safe and effective training modality for improving lower-extremity muscle function and functional performance of healthy individuals. For performance enhancement and injury prevention in competitive sports, we recommend an implementation of PLY into a well designed, sport-specific physical conditioning programme. [ABSTRACT FROM AUTHOR]

The classical stretch shortening cycle (SSC) describes sagittal joint flexion-extensions in motions like running or hopping. However, lateral movements are integral components of team sports and are associated with frontal plane joint displacements. The purpose of this study is to identify neuromuscular and kinematical mechanisms determining motor control and performance of reactive laterally conducted SSCs. Lateral jumps were performed from four distances in order to investigate the influence of lateral stretch loads on the lower extremity. Electromyographic (EMG) data of nine lower extremity muscles were collected. Foot, ankle, knee, and hip kinematics were recorded by 3-D motion analysis. High stretch loads were characterized by a greater foot exorotation during the initial phase of contact. In the sagittal plane knee and hip joint, displacements increased, whereas in the frontal plane only the hip joint displacement was significantly raised. In particular, frontal peak joint moments increased with stretch load. Thigh muscles' mean pre-activity amplitude was enhanced. It was possible to detect stretch reflexes in the thigh muscles, whereas in particular the short-latency reflex (SLR) was stretch load-dependently modulated. The results of the present study suggest that the foot exorotation seems to play a decisive role in the movement control of lateral jumps. The association between exorotation and increased sagittal joint displacements may be seen as a compensation strategy to shift load from the frontal to the sagittal plane. Lateral load compensation seems to strongly depend on upper leg's kinematic and neuromuscular adjustments, rather than on the ankle joint complex. [ABSTRACT FROM AUTHOR]

The fatigue-related reduction in joint range of motion (ROM) during dynamic contraction tasks may be related to muscle length-dependent alterations in torque and contractile kinetics, but this has not been systematically explored previously. Twelve young men performed a repetitive voluntary muscle shortening contraction task of the dorsiflexors at a contraction load of 30% of maximum voluntary isometric contraction (MVC) torque, until total 40 degrees ROM had decreased by 50% at task failure (POST) to 20 degrees ROM. At both a short (5 degrees dorsiflexion) and long muscle length (35 degrees plantar flexion joint angle relative to a 0 degrees neutral ankle joint position), voluntary activation, MVC torque, and evoked tibialis anterior contractile properties of a 52.8 Hz high-frequency isometric tetanus [peak evoked torque, maximum rate of torque development (MRTD), maximum rate of relaxation (MRR)] were evaluated at baseline (PRE), at POST, and up to 10 min of recovery. At POST, we measured similar fatigue-related reductions in torque (voluntary and evoked) and slowing of contractile kinetics (MRTD and MRR) at both the short and long muscle lengths. Thus, the fatigue-related reduction in ROM could not be explained by length-dependent fatigue. Although torque (voluntary and evoked) at both muscle lengths was depressed and remained blunted throughout the recovery period, this was not related to the rapid recovery of ROM at 0.5 min after task failure. The reduction in ROM, however, was strongly related to the reduction in joint angular velocity (R(2) = 0.80) during the fatiguing task, although additional factors cannot yet be overlooked. [ABSTRACT FROM AUTHOR]

The objectives of this study were to describe a technique for measuring in-vivo glenohumeral joint contact patterns during dynamic activities and to demonstrate application of this technique. The experimental technique calculated joint contact patterns by combining CT-based 3D bone models with joint motion data that were accurately measured from biplane x-ray images. Joint contact patterns were calculated for the repaired and contralateral shoulders of 20 patients who had undergone rotator cuff repair. Significant differences in joint contact patterns were detected due to abduction angle and shoulder condition (i.e., repaired versus contralateral). Abduction angle had a significant effect on the superior/inferior contact center position, with the average joint contact center of the repaired shoulder 12.1% higher on the glenoid than the contralateral shoulder. This technique provides clinically relevant information by calculating in-vivo joint contact patterns during dynamic conditions and overcomes many limitations associated with conventional techniques for quantifying joint mechanics. [ABSTRACT FROM AUTHOR]

We report a very rare case of fibroma of the tendon sheath arising from the anteromedial ankle joint capsule, with no apparent connection to any tendon in the area, found in a 58-year-old patient complaining of progressive local swelling. This uncommon tumor has its usual localization in tendon sheaths, is extremely rare in joint capsules, and has never been described in this location previously. MRI showed nonuniform low signal intensity in T1- and T2-weighted images and high intensity in STIR images. The mass was completely excised by open surgery. Histopathological analysis later confirmed the diagnosis of a fibroma of the tendon sheath. [ABSTRACT FROM AUTHOR]

Children with juvenile idiopathic arthritis (JIA) often have significant physical impairment. A minority is unresponsive to combinations of medications, and a possible treatment of resistant JIA is intense immunosuppression followed by autologous hematopoietic SCT (ASCT). Children resistant to conventional therapy have a poor prognosis with regard to long-term outcome of joint function, exercise tolerance and quality of life. It has previously been shown that ASCT can induce long-term remissions in such children. The long-term effects of this treatment are still largely unknown. This retrospective study investigates the exercise tolerance and functional ability in children with JIA who have undergone ASCT compared to healthy subjects. Ten children with JIA who received ASCT between 1997 and 2003 participated in this study. Patients were tested during their regular clinical follow-up. Exercise tolerance was determined using a maximal exercise test. Functional ability was measured using the Childhood Health Assessment Questionnaire and joint status. The study group showed significantly reduced exercise tolerance compared to healthy subjects. Functional ability and joint status were also decreased in patients after ASCT. Children with JIA postASCT have impaired exercise tolerance even 9 years postASCT.Bone Marrow Transplantation (2008) 42, 351–356; doi:10.1038/bmt.2008.171; published online 30 June 2008 [ABSTRACT FROM AUTHOR]

Zusammenfassung  Der Metatarsus des menschlichen Fußskeletts umfasst nicht nur die 5 Metatarsalia, sondern auch das nach proximal angrenzende Lisfranc-Gelenk, die nach distal folgenden 5 Zehengrundgliedgelenke sowie die Sesambeine. Korrekturmöglichkeiten im Sinne der reorientierenden Arthrodese nach Fehlheilungen sind am häufigsten nach nicht erkannter oder insuffizient behandelter Lisfranc-Luxationsfraktur beobachtbar. Knöcherne Fehlstellungen der Metatarsalia sind insgesamt relativ selten, am ehesten jedoch bei nach zu weit nach plantar fehlverheilten Metatarsaliaköpfchen. Diese führen zu erheblichen metatarsalgieformen Problemen, sodass nur eine deflektierende Osteotomie eine Verbesserung erwarten lässt. Pseudarthrosen sind am ehesten im Bereich des 5. Mittelfußstrahls beobachtbar, und zwar v. a. nach konservativ behandelter Abrissfraktur dessen Basis oder nach Jones-Fraktur, welche durch Anfrischung, lokoregionäre Spongiosaplastik, Zuggurtungs- oder Plättchenosteosynthese in der Regel zur Ausheilung zu bringen sind. Selbst bei diastatischem Nichtverheilen einer veralteten Sesambeinfraktur kann eine sekundäre Korrektur mit Minischrauben und/oder Zuggurtung einen großen Gewinn für den Patienten darstellen. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the acute effect of talocrural joint position on muscle activity and gross mechanical efficiency (GE). Eleven trained cyclists participated in three randomized 6-min cycling bouts at approximately 80% of maximal aerobic capacity on an electromagnetically braked cycle ergometer while oxygen consumption and muscle activity (EMG) were monitored during the subject's self-selected pedaling technique (control) and while using a dorsi- and plantarflexed pedaling technique. The mean differences in range of motion of the dorsi- and plantarflexed technique from the control position were 7.1 +/- 4.4 and 6.9 +/- 5.4 degrees , respectively. Gastrocnemius EMG activity was higher with the dorsiflexion technique than when using the self-selected control position (33.2 +/- 13.0 and 24.2 +/- 8.4 microV s, respectively; P < 0.05). Moreover, GE was 2.6% lower while riding with the dorsiflexion technique than the control position (19.0 +/- 1.2 and 19.5 +/- 1.3%, respectively; P < 0.05). The data suggested that introducing more dorsiflexion into the pedal stroke of a trained cyclist increases muscle activity of the gastrocnemius lateralis and decreased GE when compared to the self-selected pedal stroke. [ABSTRACT FROM AUTHOR]

Numerous publications provide measured biomechanical data relating to synovial joints. However, in general, they do not reflect the non-linear elastic joint properties in detail or do not consider all degrees of freedom (DOF), or the quantity of data is sparse. To perform more comprehensive, extended measurements of elastic joint properties, an optimised robot-based approach was developed. The basis was an industrial, high-precision robot that was capable of applying loads to the joint and measuring the joint displacement in 6 DOF. The system was equipped with novel, custom-made control hardware. In contrast to the commonly used sampling rates that are below 100 Hz, a rate of 4 kHz was realised for each DOF. This made it possible to implement advanced, highly dynamic, quasi-continuous closed-loop controllers. Thus oscillations of the robot were avoided, and measurements were speeded up. The stiffness of the entire system was greater than 44 kNm(-1) and 22 Nm deg(-1), and the maximum difference between two successive measurements was less than 0.5 deg. A sophisticated CT-based referencing routine facilitated the matching of kinematic data with the individual anatomy of the tested joint. The detailed detection of the elastic varus-valgus properties of a human knee joint is described, and the need for high spatial resolution is demonstrated. [ABSTRACT FROM AUTHOR]

Forty-four male and female subjects with no history of falling and whose ages ranged from 10 to 68 years participated in a series of experiments to assess movement at the joints during gait while walking in a straight line, in pivot turns and in turns of 0.33 and 0.66 m diameter. Acceleration at the joints in the forward and side-to-side direction was measured by dual-axis accelerometers placed at the ankles, knees, hips, shoulders, and on the head. Eye movement was assessed from electrodes placed on the sides of the eyes. The results of the experiments showed that for people whose age was above 40 years, significant increases in the forward-back and side-to-side movements occurred at all joints and progressively increased with age. By age 60, adverse movement of the joints as much as quadrupled in many subjects when compared to people whose age was 20-30 years. The increase in joint acceleration occurred equally in the front-back and side-to-side planes. The mechanism of the increased joint movement may be due to tendon laxness, peripheral neuropathy or loss of central control of gait due to age. Accelerometry may be a much more sensitive technique to analyze abnormalities in gait than standard video or observational gait analysis. Results are given as mean (SD) unless otherwise stated. [ABSTRACT FROM AUTHOR]

This paper offers a reference prediction for the changes of mechanical power generated during a maximal (vertical, horizontal or inclined) joint extension, as a consequence of just the changes of muscle force or cross-sectional area (CSA). Ceteris paribus (all other things being equal), for a given joint, the exponents at which the force changes have to be raised to predict the duration, final speed and power of the maximal extension are -0.5, 0.5, and 1.5, respectively, for horizontal movements. For example, a force decrease of 30% leads to an increase of 19.5% of the duration of the extension and to a decrease of 16.3% and of 41.4% of its final speed and power. The equations for vertical or inclined extension performances are subject to the same exponents. However, the actual prediction is dependent upon the ratio between muscle strength and body weight, reflecting the fraction of the muscle strength (or CSA) acting against gravity during the manoeuvre. For instance, during a vertical extension, a force decrease of 30% leads to an increase of 30.9% of the duration of the extension and to a decrease of 29.3% and of 50.5% of its final speed and power. Based on the proposed model, a methodology is also described to detect the effects on the extension power of other determinants, in addition to CSA, of the useful force change (e.g. neuromuscular factors, motor control). [ABSTRACT FROM AUTHOR]

4Abstract. In recent years, it has been recognised that improvements to classic models of muscle mechanical behaviour are often necessary for properly modelling coordinated multi-joint actions. In this respect, the purpose of the present study was to improve on modelling stretch-induced force enhancement and shortening-induced force depression of muscle contraction. For this purpose, two models were used: a modified Hill model and a model based loosely on mechano-chemistry of the cross-bridge cycle (exponential decay model). The models were compared with a classic Hill model and experimental data. Parameter values were based, as much as possible, on experimental findings in the literature, and tested with new experiments on the gastrocnemius of the rat. Both models describe many features of slow-ramp movements well during short contractions (300-500 ms), but long-duration behaviour is described only partly. The exponential decay model does not incorporate a force velocity curve. Therefore, its good performance indicates that the status of the classic force velocity characteristic may have to be reconsidered. Like movement-induced force depression and enhancement, it seems a particular manifestation of time-dependent force behaviour of muscle, rather than a fundamental property of muscle (like the length tension curve). It is argued that a combination of the exponential decay model (or other models based on the mechano-chemistry of contraction) and structurally based models may be fruitful in explaining this time-dependent contraction behaviour. Furthermore, not in the least... [ABSTRACT FROM AUTHOR]

Abstract. One of the main problems in motor-control research is the muscle load sharing problem, which originates from the fact that the number of muscles spanning a joint exceeds the number of degrees of freedom of the joint. As a consequence, many different possibilities exist for the activation of muscles in order to produce a desired joint torque. Several models describing muscle activation have been hypothesized over the last few decades to solve this problem. This study presents theoretical analyses of the various models and compares the predictions of these models with new data on muscle activation patterns for isometric contractions in various directions. None of the existing models fitted the experimental data in all aspects. The best fit was obtained by models based on minimization of the squared sum of muscle forces (SIGMA[sub m]phi[sup 2, sub m], which is almost equivalent to the Moore-Penrose pseudo-inverse solution), muscle stress a (SIGMA[sub m] sigma[sup 2, sub m] ) or muscle activation alpha (SIGMA[sub m]alpha[sup 2, sub m]). Since muscle activation patterns are different for isometric contractions and for movements, it could well be that other models or optimization criteria are better suited to describe muscle activation patterns for movements. The results of our simulations demonstrate that the predicted muscle activation patterns do not depend critically on the parameters in the model. This may explain why muscle activation patterns are highly stereotyped for all subjects irrespective of differences between subjects in many neuro-anatomical aspects, such as, for example, in the physiological cross-sectional area of muscle. [ABSTRACT FROM AUTHOR]

In the present paper the current clinical knowledge about proprioception is given for the shoulder, knee, ankle, elbow and the radiocarpal joint. Proprioceptive capabilities are decreased after joint injuries such as ACL or meniscus tears, shoulder dislocation, ankle sprain and in joints with degenerative joint disease. Some surgical procedures seem to restore the proprioceptive abilities; others do not. Elastic knee bandages or ankle braces increase different proprioceptive factors like ankle reproduction capability or sports-specific abilities. The present information on proprioception will influence our clinical practice in the future. We should choose surgical procedures that not only reconstruct the anatomy, but also the neurophysiologic feed-back mechanism. [ABSTRACT FROM AUTHOR]

We performed a clinical study examining 60 volunteers with stable shoulder joints randomized to two groups. In group 1 we injected 5 ml lidocaine intra-articularly. In group 2 we injected 5 ml saline with 5 ml contrast dye the same way. After the injection we measured the amount of passive anteroposterior translation that occurred during anterior and posterior drawer tests and the amount of inferior subluxation during downward stress. We documented the extent of the passive glenohumeral translation using ultrasound. We had no complications related to the intra-articular injection or to the stability measurement. After the injection neither group had significant pain, and the patients were not apprehensive about the ensuing stability test. In group 1 (lidocaine) anteroposterior translation of 13.2 +/- 6.3 mm was seen in the anterior and posterior drawer test, whereas in group 2 (no lidocaine) the anteroposterior translation was only 6.8 +/- 3.2 mm. The difference between the two groups was statistically significant (P < 0.05). With downward stress during the sulcus test the distance between the acromion and the humeral head increased by 5.6 mm (+/- 3.2) in group 1 and by 2.7 mm (+/- 2.1) in group 2. This difference was also statistically significant (P < 0.05). Clinical consequences: Taking our preliminary findings into account, the capsule of the glenohumeral joint seems to have proprioceptive capability. Nerve fibres and mechanoreceptors seem to be localized in the capsule tissue, being part of a physiological feedback mechanism. If our conclusions proprioceptive capability. Nerve fibres and mechanoreceptors seem to be localized in the capsule tissue, being part of a physiological feedback mechanism. [ABSTRACT FROM AUTHOR]

Purpose: The effects of the seat tube angle and crank arm length on metabolic responses, neuromuscular activation, and lower extremity joint kinematics were investigated during bicycling with a relatively lower seat height usually used for daily life.Methods: Eleven young males performed bicycling on ergometer with various seat tube angles (60°, 65°, and 70°) and crank arm lengths (127, 140, 152, and 165 mm). Oxygen consumption was measured with electromyography of the knee extensor muscle, and hip, knee, and ankle joint angles. The seat height was set as the shorter than subject's trochanter height, because this study simulates pedaling a bicycle in daily life on public roads.Results: Significantly higher oxygen consumption was noted with a 70° of seat tube angle on comparison with a 65° of seat tube angle (p < 0.05). There were no significant effects of the crank arm length on oxygen consumption (p > 0.05).Conclusions: From these results, the present study suggests that a shallower seat angle could help to decrease the physiological burden during bicycling with a relatively lower seat height. [ABSTRACT FROM AUTHOR]

Background: Walking and running provide cyclical loading to the knee which is thought essential for joint health within a physiological window. However, exercising outside the physiological window, e.g. excessive cyclical loading, may produce loading conditions that could be detrimental to joint health and lead to injury and, ultimately, osteoarthritis. The purpose of this study was to assess the effects of a stepwise increase in speed and duration of treadmill training on knee joint integrity and to identify the potential threshold for joint damage.Methods: Twenty-four Sprague-Dawley rats were randomized into four groups: no exercise, moderate duration, high duration, and extra high duration treadmill exercise. The treadmill training consisted of a 12-week progressive program. Following the intervention period, histologic serial sections of the left knee were graded using a modified Mankin Histology Scoring System. Mechanical testing of the tibial plateau cartilage and RT-qPCR analysis of mRNA from the fat pad, patellar tendon, and synovium were performed for the right knee. Kruskal-Wallis testing was used to assess differences between groups for all variables.Results: There were no differences in cartilage integrity or mechanical properties between groups and no differences in mRNA from the fat pad and patellar tendon. However, COX-2 mRNA levels in the synovium were lower for all animals in the exercise intervention groups compared to those in the no exercise group.Conclusions: Therefore, these exercise protocols did not exceed the joint physiological window and can likely be used safely in aerobic exercise intervention studies without affecting knee joint health. [ABSTRACT FROM AUTHOR]

The article discusses research on the role of autophagy in joint destruction in patients with rheumatoid arthritis (RA). It references a study by Neng-Yu Lin and colleagues, published in "Annals of the Rheumatic Diseases." Study authors analyzed the bone and cartilage destruction in tumor necrosis factor (TNF) transgenic mice. They found that autophagy plays an important role in joint destruction in RA.