Search

Introduction: Distal tibia fractures often occur in younger, high demand patients, though the literature surrounding management remains contentious. This study sought to quantitatively determine differences in kneeling ability and self-reported knee function in patients managed with either intramedullary nailing (IMN) or open reduction internal fixation (ORIF) with compression plating following distal tibia fracture to assist in the preoperative consent process., Hypothesis: There is no difference in kneeling tolerance following either tibial nailing or plate fixation of distal tibia fractures., Material and Methods: Retrospective sampling of public hospital data with outpatient prospective functional testing were completed. The primary outcome measure was the Kneeling Test (KT). Secondary outcome measures were The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Forgotten Joint Score (FJS) for the knee joint. There were 28 patients recruited (18 IMN and 10 ORIF) with a mean age of 44years. Mean overall follow-up was 13.3months (range 8-25, SD 3.6). All fractures had completely healed without postoperative complication., Results: The IMN affected limb had a significantly worse overall kneeling function than their non-affected limb (mean KT: 70.4 vs. 94.9 respectively, p<0.005) Additionally, the IMN group performed significantly worse when compared to the ORIF group (mean KT 70.4 vs. 92.5 respectively, p<0.005). No significant differences (p>0.05) in kneeling function existed for the ORIF group when comparing affected to non-affected limbs. Secondary outcome analysis showed significantly worse overall WOMAC and FJS in the IMN group compared to the ORIF group (mean WOMAC 19.3 vs. 6.9 respectively, p=0.040; mean FJS 38.3 vs. 75.9 respectively, p=0.005)., Discussion: The use of intramedullary nailing for the treatment of distal tibia fracture results in a mean reduction of 20% in kneeling tolerance in comparison to ORIF. The resulting kneeling tolerance is comparable to that of patients post-total knee arthroplasty. The present findings should assist in the consent process for patients with high kneeling demands in sportive, professional or cultural pastimes., Level of Evidence: IV; retrospective cohort study with quantitative outcome measurement., (Crown Copyright © 2022. Published by Elsevier Masson SAS. All rights reserved.)

Background: Electromyography (EMG) is frequently used as a guide for exercise rehabilitation progression following rotator cuff repair. Knowledge of EMG activity during passive and active-assisted exercises may help guide clinicians when considering exercise prescription in the early post-operative period., Purpose: The purpose of this study was to investigate EMG activity of the rotator cuff and deltoid musculature during passive and active-assisted shoulder range of motion (ROM) exercises commonly performed in post-operative rehabilitation., Study Design: Descriptive cohort laboratory study using healthy subjects., Methods: In sixteen active healthy volunteers, surface and fine-wire EMG activity was measured in the supraspinatus, infraspinatus, subscapularis, and anterior, middle and posterior deltoid muscles during eight common ROM exercises. Mean %MVIC values and 95% confidence intervals were used to rank exercises from the least to the most amount of muscular activity generated during the exercises., Results: Standard pendulum exercises generated low levels of EMG activity in the supraspinatus and infraspinatus (≤15% MVIC), while active-assisted table slides, and the upright wall slide generated low levels of EMG activity in only the supraspinatus. No exercises were found to generate low levels of muscular activation (≤15% MVIC) in the subscapularis., Conclusion: This study found no clear distinctions between the EMG activity of the supraspinatus or the infraspinatus occurring during common passive and active-assisted ROM exercises. Subdividing ROM exercises based on muscle activity, may not be necessary to guide progression of exercises prior to commencing active motion after rotator cuff repair., Level of Evidence: Level 3b., Competing Interests: No other authors have any conflicts of interest.

Background: High-quality evidence supports the integration of exercise to mitigate treatment-related side effects in a wide range of paediatric and adult cancer cohorts. However, the implementation of exercise in adolescent and young adult (AYA) cancer patients is yet to be explored in depth. FiGHTINGF!T is a randomised controlled cross over trial designed to determine if a supervised, structured, and progressive exercise programme can reduce the decline in physical fitness (V0 2peak ) associated with cancer treatment in AYAs from diagnosis., Methods/design: A total of 40 AYAs recently diagnosed and due to commence systemic treatment (± 2 weeks) for a primary haematological malignancy or solid tumour will be recruited and randomised to either an immediate exercise intervention or usual care (delayed exercise) for 10 weeks. This randomised controlled crossover trial will see both groups engage in a supervised exercise intervention from either diagnosis (baseline assessment) for 10 weeks (0-10 weeks) or following an interim assessment to 20 weeks (10-20 weeks). The bi-weekly tailored exercise programme will combine aerobic and resistance exercises and be supervised by an Accredited Exercise Physiologist. Participants will complete a range of assessments at 0, 10, and 20 weeks including cardiopulmonary exercise tests, 1 repetition maximum strength measures, physical functioning, and self-reported quality of life measurements. Patient-reported treatment-related toxicities will be recorded on a weekly basis., Discussion: The FiGHTINGF!T trial will provide insight into the potential benefits of a supervised exercise programme in AYAs undergoing cancer treatment. This trial will contribute to the evidence supporting the necessary integration of exercise during cancer treatment, specifically in the under-reported AYA cohort., Trial Registration: This trial was registered retrospectively with the Australia New Zealand Clinical Trial registry ( ACTRN12620000663954 ). Registered on 10 June 2020., (© 2021. The Author(s).)

Background: Rehabilitation contributes to post-operative success following reverse total shoulder arthroplasty; however, randomised trials comparing the effectiveness of rehabilitation following reverse total shoulder arthroplasty are lacking. This study sought to determine if early, active mobilisation targeting the deltoid and the external rotator muscles, would exhibit greater improvements in post-operative outcomes compared to a delayed and deltoid-focused mobilisation programme., Methods: Patients scheduled for reverse total shoulder arthroplasty were randomly assigned to either an early active or delayed active rehabilitation group. Patient-reported outcomes for pain and function were assessed pre-surgery and at 3, 6 and 12 months post-surgery. Objective measures (Constant Score, range of motion, isometric strength) were assessed at 3, 6 and 12 months post-surgery., Results: Sixty-one patients (63 shoulders) underwent reverse total shoulder arthroplasty. There were no significant interaction effects or between-group differences for any patient-reported outcomes or objective measures at 3, 6 or 12 months post-surgery. However, significantly better ( p  = 0.019) active arm flexion was observed in the early active group at three months post-surgery. Significantly more patients in the early active group reported improvement in patient-reported function that reached minimal clinically important difference from three to six months post-surgery ( p  = 0.016)., Conclusion: Early, active rehabilitation after reverse total shoulder arthroplasty is safe and effective, and may have early clinical benefits over a conservative, delayed mobilisation programme., Level of Evidence: Therapy, level 1b. Trial registered 15 June 2016 at www.anzctr.org.au (ACTRN12616000779471)., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AW holds stock options and receives institutional research support from Exactech, Inc; Gainesville, FL. No other authors have any conflicts of interest., (© 2020 The British Elbow & Shoulder Society.)

Background: Physical therapy is considered routine practice following total shoulder arthroplasty. To date, current regimens are based on clinical opinion, with evidence-based recommendations. The aim of this systematic review was to evaluate the effectiveness of total shoulder arthroplasty physical therapy programmes with a view to inform current clinical practice, as well as to develop a platform upon which future research might be conducted., Methods: An electronic search of MEDLINE, EMBASE, CINAHL and Cochrane Library to March 2018 was complemented by hand and citation-searching. Studies were selected in relation to pre-defined criteria. A narrative synthesis was undertaken., Results: A total of 506 papers were identified in the electronic database search, with only one study showing moderate evidence of early physical therapy promoting a more rapid return of short-term improvement in function and pain. No studies evaluated the effectiveness of physical therapy programmes in reverse total shoulder arthroplasty procedures., Discussion: Restoring range of motion and strength following total shoulder arthroplasty is considered important for patients to obtain a good outcome post-surgery and, when applied early, may offer more rapid recovery. Given the rising incidence of total shoulder arthroplasties, especially reverse total shoulder arthroplasty, there is an urgent need for high-quality, adequately powered randomised controlled trials to determine the effectiveness of rehabilitation programmes following these surgeries., (© 2018 The British Elbow & Shoulder Society.)

Background: Preventing and mitigating the risk of reinjury after anterior cruciate ligament reconstruction (ACLR) rest on variables including age, surgical restoration of knee stability, adequate physical function, and thorough and complete postoperative rehabilitation, but to what degree these factors influence return to sport is unclear., Purpose: To investigate factors predictive of return to sport 12 months after ACLR. The factors specifically evaluated were strength, hop function, self-reported knee function, patient age, and quality of postoperative rehabilitation., Study Design: Case-control study; Level of evidence, 3., Methods: This study evaluated 113 patients approximately 12 months after ACLR using a rehabilitation grading tool, the subjective International Knee Documentation Committee (IKDC) form, and a return-to-sport battery consisting of maximal isokinetic quadriceps and hamstring strength and 4 functional hop tests. Mann-Whitney U tests and chi-square analyses were used to determine differences between patients who had or had not returned to sport. A subsequent binary logistic hierarchical regression determined the factors predictive of a patient's return to sport. In those patients who had returned to sport, relationships between either age or level of rehabilitation and passing the return-to-sport battery were also investigated., Results: Complete rehabilitation (adjusted odds ratio [OR], 7.95; P = .009), age ≤25 years (adjusted OR, 3.84; P = .024), and higher IKDC scores ( P < .001) were predictive of return to sport at 12 months. In participants who had returned to sport, 21% passed the return-to-sport battery compared with only 5% who did not. Of those who had returned to sport, 37% who underwent complete rehabilitation passed the return-to-sport battery as opposed to 5% who underwent incomplete rehabilitation. In patients aged ≤25 years, only 48% underwent complete rehabilitation, despite having returned to sport. Additionally, in this group of patients, 40% underwent complete rehabilitation and passed the physical performance battery as opposed to only 4% who did not undergo complete rehabilitation., Conclusion: Younger patients and higher subjective IKDC scores were predictive of return to sport. Patients who completed 6 months of rehabilitation incorporating jumping and agility tasks had a higher rate of return to sport, suggesting that postoperative rehabilitation is important in predicting return to sport. Specialists and physical therapists alike should stress the importance of thorough postoperative rehabilitation and adequate neuromuscular strength and function to patients whose goals are to return to sport., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: Limb symmetry after anterior cruciate ligament reconstruction may be evaluated using maximal strength and hop tests, which are typically reported using Limb Symmetry Indices (LSIs) which may overestimate function., Purpose: The purpose of this study was to compare the Back in Action (BIA) test battery to standard hop and muscle strength tests used to determine readiness to return to sport (RTS)., Study Design: Prospective cohort., Methods: Over two test sessions, 40 ACLR patients were assessed at a mean 11.3 months post-surgery. Initially, participants completed the 6 m timed hop and the single, triple and triple crossover hops for distance, and isokinetic knee extensor and flexor strength assessment. The second session involved completion of the BIA battery, including stability tests, single and double leg countermovement jumps (CMJ), and plyometric, speedy jump, and quick feet tests. Pass rates for test batteries were statistically compared, including the BIA, a four-hop battery (≥90% LSI in every one of the four hop tests) and a combined 4-hop and strength battery (≥90% LSI in every one of the four hop tests, as well as ≥90% for both peak knee extensor and flexor strength). LSI differences between the four standard hop tests and the BIA single limb functional tests (the single limb CMJ and the speedy jump test) were evaluated., Results: Significantly less participants passed the BIA battery (n = 1, 2.5%), compared with the four-hop test battery (n = 27, 67.5%) (p<0.001) and the four-hop test and isokinetic strength battery (n = 17, 42.5%) (p<0.001). Collectively, LSI's for the standard hop tests were significantly higher than the BIA functional single limb tests (difference  =  12.9%, 95% CI: 11.1% to 14.6%, p<0.001)., Conclusion: The BIA test battery appears to include some single limb functional tests that are more physically challenging than standard hop and isokinetic strength tests, highlighted by the significantly lower mean LSI's during the single limb BIA tests and the lower pass rate when employing the BIA protocol., Level of Evidence: Level 4, case series.

Background: The anatomy of the articularis genus muscle has prompted speculation that it elevates the suprapatellar bursa during extension of the knee joint. However, its architectural parameters indicate that this muscle is not capable of generating enough force to fulfill this function. The purpose of the present study was to investigate the anatomy of the articularis genus, with special emphasis on its relationship with the adjacent vastus intermedius and vastus medialis muscles., Methods: The articularis genus muscle was investigated in 18 human cadaveric lower limbs with use of macrodissection techniques. All components of the quadriceps muscle group were traced from origin to insertion, and their affiliations were determined. Six limbs were cut transversely in the middle third of the thigh. The modes of origin and insertion of the articularis genus, its nerve supply, and its connections with the vastus intermedius and vastus medialis were studied., Results: The muscle bundles of the articularis genus were organized into 3 main layers: superficial, intermediate, and deep. The bundles of the superficial layer and, in 60% of the specimens, the bundles of the intermediate layer originated from both the vastus intermedius and the anterior and anterolateral surfaces of the femur. The bundles of the deep layer and, in 40% of the specimens, the bundles of the intermediate layer arose solely from the anterior surface of the femur. The distal insertion sites included different levels of the suprapatellar bursa and the joint capsule. A number of connections between the articularis genus and the vastus intermedius were found. While the vastus medialis inserted into the whole length of the vastus intermedius aponeurosis, it included muscle fibers of the articularis genus, building an intricate muscle system supplied by nerve branches of the same medial deep division of the femoral nerve., Conclusions: The articularis genus, vastus medialis, and vastus intermedius have a complex, interacting architecture, suggesting that the articularis genus most likely does not act as an independent muscle. With support of the vastus intermedius and vastus medialis, the articularis genus might be able to function as a retractor of the suprapatellar bursa. The finding of likely interplay between the articularis genus, vastus intermedius, and vastus medialis is supported by their concurrent innervation., Clinical Relevance: The association between the articularis genus, vastus medialis, and vastus intermedius may be more complex than previously believed, and this close anatomical connection could have functional implications for knee surgery. Dysfunction, scarring, or postoperative arthrofibrosis of the sophisticated interactive mechanism needs further investigation.

Background: Published data regarding the structure of the quadriceps tendon are diverse. Dissection of the quadriceps muscle group revealed that beside the rectus femoris, vastus lateralis, vastus intermedius and vastus medialis a fifth muscle component- named the tensor vastus intermedius consistently fused into quadriceps tendon. It can be hypothesized that all these elements of the extensor apparatus of the knee joint must also be represented in the quadriceps tendon. This study investigated the multi-layered quadriceps tendon with special emphasis on all components of the quadriceps muscle group including the newly discovered tensor vastus intermedius., Methods: Ten cadaveric lower limbs were dissected. All muscle bellies of the extensor apparatus of the knee joint were identified and traced distally until they merged into the quadriceps tendon. Connections between the different aponeurotic layers of each muscle were studied from origin to insertion. The fusing points of each layer were marked. Their distance to the patella and the distances between the fusing points were measured., Results: Six elements of the quadriceps muscle group form a tri-laminar structure of the quadriceps tendon. The intermediate layer could be further sub-divided. The elements of the quadriceps tendon are 1. lateral aponeurosis of the vastus intermedius, 2. deep and 3. superficial medial aponeurosis of the vastus intermedius, 4. vastus lateralis, 5. tensor vastus intermedius and 6. rectus femoris. Even with differences in fiber direction - these elements join each other a certain distance proximal to the patella. All elements were fused over a region measuring 13 to 90 mm proximal to the patella. Lateral parts of the vastus intermedius formed the deepest layer of the quadriceps tendon. The superficial and deep layer of the medial vastus intermedius aponeurosis fused 56 mm (range, 30 to 90 mm) and 33 mm (range, 13 to 53 mm) above the patella with the aponeurosis of the tensor vastus intermedius and vastus lateralis respectively. Together they built the two-layered intermediate layer of the quadriceps tendon. The tendon of the rectus femoris forms the superficial layer. The vastus medialis inserts medially in all layers of the quadriceps tendon. Fibers of the lateral muscle components were oriented towards the medial, and fibers of the medial muscle components were oriented towards the lateral femoral condyle., Conclusions: The three-layered quadriceps tendon is formed by six elements. These are 1. lateral aponeurosis of the vastus intermedius, 2. deep and 3. superficial medial aponeurosis of the vastus intermedius, 4. vastus lateralis, 5. tensor vastus intermedius and 6. rectus femoris. These elements of the extensor apparatus join each other proximal to the patella in a complex onion-like architecture. Its two-layered intermediate layer shows variable fusions points. The vastus medialis contributes to the quadriceps tendon with its medial insertion into all layers of the quadriceps tendon.

Unlabelled: The incidence of rotator cuff tears increases with age, with full-thickness rotator cuff tears present in approximately 25% of individuals in their sixties, and more than 50% of those in their eighties. While surgery is considered an effective treatment, recurrent tears at the insertion site are common, especially with degenerative tears, which are frequent in the older population. More recently, there has been increasing interest in exercise rehabilitation and physical therapy as a means to manage partial and full thickness tears of the rotator cuff by addressing weakness and functional deficits. Recent studies have suggested that patients opting for physical therapy have demonstrated high satisfaction, an improvement in function, and success in avoiding surgery. When considering the increasing rate of shoulder surgery and the associated economic and social burden rotator cuff surgery places on both the patient and the health care system, non-surgical management such as physical therapy and exercise may, in selected cases, be a treatment alternative to surgical repair. The purpose of this clinical commentary is to provide an overview of rotator cuff pathology and pathogenesis, and to present an evidence-based case for the role of conservative rehabilitation in the management of rotator cuff injuries., Level of Evidence: Level 5.

Background: Regular consumption of diets with increased protein or fibre intakes may benefit body weight and composition and cardiovascular disease risk factors. Lupin flour is a novel food ingredient high in protein and fibre., Objective: To investigate the effects of a lupin-enriched diet, during and following energy restriction, on body weight and composition and cardiovascular disease risk factors in overweight individuals., Design: Participants (n = 131) were recruited to a 12-month parallel-design trial. They were randomly assigned to consume lupin-enriched foods or matching high-carbohydrate control foods. All participants underwent 3 months of weight loss, 1 month of weight stabilization and 8 months of weight maintenance. Body weight and composition and cardiovascular disease risk factors were assessed at baseline, 4 and 12 months., Results: Lupin, relative to control, did not significantly influence (mean difference (95% CI)) weight loss at 4 months (0.1 kg (-1.2, 1.4)) and 12 months (-0.6 kg (-2.0, 0.8)), maintenance of weight loss from 4 to 12 months (-0.7 kg (-1.83, 0.48)) or measures of body fat and fat-free mass. Relative to control, 24-h ambulatory systolic (-1.3 mm Hg (-2.4, -0.3), P = 0.016) and diastolic (-1.0 mm Hg (-1.9, -0.2), P = 0.021) blood pressures were lower at 12 months but not at 4 months; fasting insulin concentrations and homeostasis model assessment (HOMA) scores were significantly lower at 4 months (-1.2 mU l(-1) (-1.3, -1.1), P = 0.004 and -0.6 units (-1.0, -0.19), P = 0.004) and 12 months (-1.3 mU l(-1) (-1.4, -1.1), P < 0.001 and -0.7 units (-1.1, -0.24), P = 0.002)., Conclusions: A diet higher in protein and fibre derived from lupin-enriched foods does not enhance weight loss or improve the maintenance of weight loss. However, such a diet may provide cardiovascular health benefits in terms of insulin sensitivity and blood pressure.

Objective: To assess the safety and efficacy of accelerated compared with traditional postoperative weightbearing (WB) rehabilitation following matrix-induced autologous chondrocyte implantation (MACI) of the knee, using MRI., Methods: A randomized controlled study design was used to assess MRI-based outcomes of MACI grafts in 70 patients (45 men, 25 women) who underwent MACI to the medial or lateral femoral condyle, in combination with either traditional or accelerated approaches to postoperative WB rehabilitation. High-resolution MRI was undertaken and assessed 8 previously defined pertinent parameters of graft repair, as well as a combined MRI composite score at 3, 12, and 24 months postsurgery. The association between clinical and MRI-based outcomes, patient demographics, chondral defect parameters, and injury/surgery history was investigated., Results: Both groups significantly improved (P < 0.05) in the MRI composite score and pertinent descriptors of graft repair throughout the postoperative period until 24 months postsurgery. There were no differences (P > 0.05) observed between the 2 groups. Patient age, body mass index, chondral defect size, and duration of preoperative symptoms were significantly correlated (P < 0.05) with several MRI-based outcomes at 24 months, whereas there were no significant pertinent correlations (P > 0.05) observed between clinical and MRI-based outcomes., Conclusion: The accelerated WB approach was not detrimental to graft development at any stage throughout the postoperative assessment timeline from baseline to 24 months postsurgery and may potentially accelerate patient return to normal function, while reducing postoperative muscle loss, intra-articular adhesions, and associated gait abnormalities.

Objective: To determine the safety and efficacy of "accelerated" postoperative load-bearing rehabilitation following matrix-induced autologous chondrocyte implantation (MACI)., Design: A randomized controlled study design was used to investigate clinical outcomes in 70 patients following MACI, in conjunction with either accelerated or traditional approaches to postoperative weight-bearing (WB) rehabilitation. Both interventions sought to protect the implant for an initial period and then incrementally increase WB. Under the accelerated protocol, patients reached full WB at 8 weeks postsurgery, compared to 11 weeks for the traditional group. Clinical outcomes were assessed presurgery and at 3, 6, 12, and 24 months postsurgery., Results: A significant effect (P < 0.017) for time existed for all clinical measures, demonstrating improvement up to 24 months in both groups. A significant interaction effect (P < 0.017) existed for pain severity and the 6-minute walk test, with accelerated group patients reporting significantly less severe pain and demonstrating superior 6-minute walk distance over the period. Although there was a significant group effect (P < 0.017) for maximal active knee extension range in favor of the accelerated regime, no further significant differences existed. There was no incidence of graft delamination up to 24 months that resulted directly from the 3-month postoperative rehabilitation program., Conclusion: The accelerated load-bearing approach that reduced the length of time spent ambulating on crutches produced comparable if not superior clinical outcomes up to 24 months postsurgery in the accelerated rehabilitation group, without compromising graft integrity. This accelerated regime is safe and effective and demonstrates a faster return to normal function postsurgery.

Purpose: Obesity is epidemic in Western societies, with rapid rates of increase in the young. Various methods exist for the assessment of body composition, but these have not been compared in obese children and adolescents. This study compared methods of body composition assessment in obese young people to determine whether changes in various measures of body composition as a result of exercise training were correlated., Methods: Multiple anthropometric measures (weight, height, body mass index (BMI), skinfolds, waist and hip girths) and dual-energy x-ray absorptiometry (DEXA) were undertaken in 38 obese children and adolescents (12.7 +/- 2.1 yr) at baseline and following 8 wk of exercise training., Results: At baseline, there were strong relationships (all P < 0.01) between DEXA total fat and weight (r = 0.83), BMI (r = 0.86), waist girth (r = 0.81), hip girth (r = 0.88), sum of six skinfolds (sum6, r = 0.79), and percent body fat (percent body fat) calculated using a four-skinfold equation (EQ4; r = 0.69). Similar relationships (all P < 0.001) existed between DEXA abdominal fat and weight (r = 0.79), waist girth (r = 0.83), hip girth (r = 0.69), and height (r = 0.71). Neither skinfold sums, nor percent body fat calculated from skinfold equations, were selected as independent predictors of DEXA total or abdominal fat by stepwise hierarchical linear regression. The reductions in DEXA total and abdominal fat following exercise were not predicted by changes in skinfolds or percent body fat calculated from skinfolds., Conclusion: These data suggest that body fat derived from skinfold measures is poorly predictive of abdominal and total fat derived from DEXA in obese children and adolescents. This finding highlights the limitations of skinfolds in obese subjects and questions the validity of their use to assess changes in body composition with interventions such as exercise training.

Purpose: To determine how unanticipated performance of cutting maneuvers in sport affects the external loads applied to the knee joint and the potential risk for ligament injury., Methods: A 50-Hz VICON motion analysis system was used to determine the lower limb kinematics of 11 healthy male subjects during running and cutting tasks performed under preplanned (PP) and unanticipated (UN) conditions. Subjects performed the UN tasks in response to a light stimulus on a target board. A kinematic model was then used in conjunction with force place data to calculate the three-dimensional loads at the knee joint., Results: External flexion/extension moments at the knee joint were similar between PP and UN conditions; however, the varus/valgus and internal/external rotation moments during the UN cutting tasks were up to twice the magnitude of the moments measured during the PP condition., Conclusion: Cutting maneuvers performed without adequate planning may increase the risk of noncontact knee ligament injury due to the increased external varus/valgus and internal/external rotation moments applied to the knee. These results are probably due to the small amount of time to make appropriate postural adjustments before performance of the task, such as the position of the foot on the ground relative to the body center of mass. Subsequently, training for the game situation should involve drills that familiarize players with making unanticipated changes of direction. Practice sessions should also incorporate plyometrics and should focus on better interpretation of visual cues to increase the time available to preplan a movement.

Purpose: To investigate the external loads applied to the knee joint during dynamic cutting tasks and assess the potential for ligament loading., Methods: A 50-Hz VICON motion analysis system was used to determine the lower limb kinematics of 11 healthy male subjects during running, sidestepping, and crossover cut. A kinematic model was used in conjunction with force place data to calculate the three-dimensional loads at the knee joint during stance phase., Results: External flexion/extension loads at the knee joint were similar across tasks; however, the varus/valgus and internal/external rotation moments applied to the knee during sidestepping and crossover cutting were considerably larger than those measured during normal running (P < 0.05). Sidestepping tasks elicited combined loads of flexion, valgus, and internal rotation, whereas crossover cutting tasks elicited combined loads of flexion, varus, and external rotation., Conclusion: Compared with running, the potential for increased ligament loading during sidestepping and crossover cutting maneuvers is a result of the large increase in varus/valgus and internal/external rotation moments rather than any change in the external flexion moment. The combined external moments applied to the knee joint during stance phase of the cutting tasks are believed to place the ACL and collateral ligaments at risk of injury, particularly at knee flexion angles between 0 degrees and 40 degrees, if appropriate muscle activation strategies are not used to counter these moments.

Understanding the stress/strain relationship between exercise and bone is critical to understanding the potential benefit of exercise in preventing postmenopausal bone loss. This study examined the effect of a 2-year exercise intervention and calcium supplementation (600 mg) on bone mineral density (BMD) in 126 postmenopausal women (mean age, 60 +/- 5 years). Assignment was by block randomization to one of three groups: strength (S), fitness (F), or nonexercise control (C). The two exercise groups completed three sets of the same nine exercises, three times a week. The S group increased the loading, while the F group had additional stationary bicycle riding with minimal increase in loading. Retention at 2 years was 71% (59% in the S group, 69% in the F group, and 83% in the C group), while the exercise compliance did not differ between the exercise groups (S group, 74 +/- 13%; F group, 77 +/- 14%). BMD was measured at the hip, lumbar spine, and forearm sites every 6 months using a Hologic 4500. Whole body BMD also was measured every 6 months on a Hologic 2000. There was no difference between the groups at the forearm, lumbar spine, or whole body sites. There was a significant effect of the strength program at the total (0.9 +/- 2.6%; p < 0.05) and intertrochanter hip site (1.1 +/- 3.0%; p < 0.01). There was a significant time and group interaction (p < 0.05) at the intertrochanter site by repeated measures. This study shows the effectiveness of a progressive strength program in increasing bone density at the clinically important hip site. We concluded that a strength program could be recommended as an adjunct lifestyle approach to osteoporosis treatment or used in combination with other therapies.

In the quest to optimize performance of the elite athlete the sport scientist has sought to determine the ideal physique for a given sport or event. For some sports, specific structural characteristics offer definite performance advantages; for example in rowing, in addition to height, a large arm span has been identified as important. In other sports. such as long distance running, low levels of adiposity or 'fatness' appear to be linked with faster running times. There are four areas where appraisal of the athlete's physique can provide useful information: (1) identification of talented athletes; (2) to assess and monitor the growing athlete; (3) to monitor training and performance; and (4) to determine 'race weight' in weight-category sports. As a research tool a particular method must be reliable and valid. Other considerations include how expensive the method is, if it is suitable for a field situation and if large amounts of data on a number of subjects can be collected quickly. The method should be safe for both the athlete and the tester and provide useful feedback for the athlete or coach. Anthropometry, with training is able to fulfil most of these criteria and is the most widely used method of physique assessment in sports science. Large anthropometric data bases have been collected on elite athletes at Olympic games and world championships according to a standard protocol. Kinanthropometry, which has developed from anthropometry, is concerned with measurement and evaluation of different aspects of human movement and individual variation in body shape, size, proportion and composition. For the assessment of adiposity a sum of skinfolds, usually over six sites, is most commonly used rather than percentage body fat formulae. Muscle mass can be assessed indirectly through girth and corrected girth measurements. Limb lengths and breadths are used to assess skeletal structure and proportional differences in limb size. The anthropometric methods most commonly used to describe the physique of the athlete, which appraise shape, size, proportion and composition, will be discussed.