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Introduction: Fu's subcutaneous needling (FSN) is a new type of acupuncture that uses subcutaneous tissue to oscillate from side to side to improve muscle pathology status and can be effective in treating Knee osteoarthritis. Nonetheless, whether the clinical effect is similar to that of most commonly used drugs is unclear. Thus, this study aims to determine the pain-relieving effect and improvement in the joint function of the FSN therapy by comparing it with that of a positive control drug (celecoxib). Furthermore, this clinical trial also aims to evaluate the effect of FSN on gait and lower limb muscle flexibility, which can further explore the scientific mechanisms of the FSN therapy. Methods and analysis: This study is a randomized, parallel-controlled, single-center prospective clinical study that includes 60 participants, with an FSN group (n = 30) and a drug group (n = 30). The Fu's subcutaneous needling (FSN) group undergo the FSN therapy 3 times a week for 2 weeks, while the drug group receives 0.2 g/day oral celecoxib for 2 weeks, with a follow-up period of 4 weeks after the completion of treatment. The primary outcome is the difference in the visual analog scale score after 2 weeks of treatment compared with baseline. The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, joint active range of motion test, three-dimensional gait analysis, and shear wave elastic imaging technology analysis in lower limb muscles are also performed to demonstrate clinical efficacy. Ethics and dissemination: The trial is performed following the Declaration of Helsinki. The study protocol and consent form have been approved by the Ethics Committee of Guangdong Provincial Hospital of Chinese Medicine. All patients will give informed consent before participation and the trial is initiated after approval. The results of this trial will be disseminated through publication in peer-reviewed journals. Trial registration number: NCT06328153. [ABSTRACT FROM AUTHOR]

Background: Nonunion after ankle or hindfoot arthrodesis is associated with poor outcomes. Cellular bone allograft is an alternative to autograft for use in these procedures. The purpose of this study was to prospectively evaluate the early efficacy and safety of cellular bone allograft use in hindfoot and ankle arthrodesis procedures. Methods: Fourteen patients undergoing hindfoot or ankle arthrodesis supplemented with cellular bone allograft were prospectively enrolled. Computed tomography (CT) scans were obtained postoperatively at set time points and reviewed by 3 fellowship-trained foot and ankle surgeons as well as 1 musculoskeletal radiologist. Primary outcome was CT-verified union, defined as >25% of joint surface. Complications were recorded and revision procedures offered as indicated. Results: CT-verified union rate during the study period was 76.7% (23 of 30 joints). Union was 100% for the ankle joint (2 of 2), 50% for the talonavicular joint (5 of 10), 100% for the calcaneocuboid joint (8 of 8), and 80.0% for the subtalar joint (8 of 10). One patient underwent revision fusion procedure, and 1 patient underwent hardware removal during the study period. Conclusion: Our initial experience suggests that use of cellular bone allograft augmentation in hindfoot and ankle arthrodesis may offer an alternative to autograft without potential of donor site morbidity. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

In this study, we aimed to compare and contrast the intralimb coordinative patterns of habitual forefoot strikers (FFS) and rearfoot strikers (RFS) during steady‐state running across three different shoe types: minimalist, neutral and cushioned shoes. To describe these coordinative patterns, we implemented the concept of the 'preferred movement path' which represents the movement path that runners naturally select in response to their physical capacity and external environment. We quantified cycle‐to‐cycle consistency (ACC) and within‐trial variance in coordination patterns (SoV) using joint angle data from the ankle and knee for ankle‐knee coupling and from the knee and hip for knee‐hip coupling. Additionally, we calculated the measure of shape difference in joint coupling as the sum of squared distances (SSD) between/within conditions and groups. The percentage of runners who displayed shape differences below certain SSD thresholds was also evaluated. Our findings revealed no significant group or shoe type effect on any of the variability measures (ACC: p = 0.460 for ankle‐knee and p = 0.832 for knee‐hip; SoV: p = 0.345 for ankle‐knee and p = 0.755 for knee‐hip). However, there was a significant (p < 0.001) shape difference observed between the most extreme shoe conditions. Despite this, when runners switched shoes, 70%–90% of them maintained their original coordinative pattern across both joint couplings, indicating a strong adherence to their preferred movement path. This suggests that while shoe type can influence the shape of the coordinative pattern, the inherent movement tendencies of the runners remain largely consistent. Highlights: The study found no differences in the cyclogram variability between habitual foot strike classification groups when wearing different shoes.The largest number of different movement responses was present at the ankle‐knee coupling.A significantly greater proportion of participants changed their ankle‐knee and knee‐hip coordinative patterns between the High versus Low Minimal Index (MI) conditions compared to the other shoe comparisons.No differences were found between the groups in terms of cyclogram variability. [ABSTRACT FROM AUTHOR]

Background: This study aimed to: (1) identify assessment methods that can detect greater ankle dorsiflexion range of motion (DROM) limitation in the injured limb; (2) determine whether differences in weightbearing measurements exist even in the absence of DROM limitations in the injured limb according to non-weightbearing measurements; and (3) examine associations between DROM in the weightbearing and non-weightbearing positions and compare those between a patient group with foot and ankle injuries and a healthy group. Methods: Eighty-two patients with foot and ankle injuries (e.g., fractures, ligament and tendon injuries) and 49 healthy individuals participated in this study. Non-weightbearing DROM was measured under two different conditions: prone position with knee extended and prone position with knee flexed. Weightbearing DROM was measured as the tibia inclination angle (weightbearing angle) and distance between the big toe and wall (weightbearing distance) at maximum dorsiflexion. The effects of side (injured, uninjured) and measurement method on DROM in the patient groups were assessed using two-way repeated-measures ANOVA and t-tests. Pearson correlations between measurements were assessed. In addition, we analyzed whether patients without non-weightbearing DROM limitation (≤ 3 degrees) showed limitations in weightbearing DROM using t-tests with Bonferroni correction. Results: DROM in patient groups differed significantly between legs with all measurement methods (all: P < 0.001), with the largest effect size for weightbearing angle (d = 0.95). Patients without non-weightbearing DROM limitation (n = 37) displayed significantly smaller weightbearing angle and weightbearing distance on the injured side than on the uninjured side (P < 0.001 each), with large effect sizes (d = 0.97–1.06). Correlation coefficients between DROM in non-weightbearing and weightbearing positions were very weak (R = 0.17, P = 0.123) to moderate (R = 0.26–0.49, P < 0.05) for the patient group, and moderate to strong for the healthy group (R = 0.51–0.69, P < 0.05). Conclusions: DROM limitations due to foot and ankle injuries may be overlooked if measurements are only taken in the non-weightbearing position and should also be measured in the weightbearing position. Furthermore, DROM measurements in non-weightbearing and weightbearing positions may assess different characteristics, particularly in patient group. Level of evidence: Level IV, cross-sectional study. [ABSTRACT FROM AUTHOR]

This study empirically investigated the effects of repetitive movements of body parts through an experiment, and evaluated the suitability of the scoring systems of the existing observational methods for repetitive movements, based on the experimental results. Eighteen healthy college students participated in the experiment to assess discomfort, wherein joint movement, its repetition, and external load were used as independent variables. Postural loads for 16 postures used in the experiment were assessed using rapid upper limb assessment (RULA) and loading on the entire body assessment (LEBA). Three independent variables, joint motion, its repetition, and external load, as well as the interaction between motion repetition and external load, had significant effects on discomfort. Joint motion and external load significantly affected the RULA grand score, whereas all three independent variables affected the LEBA score. This finding may indicate that LEBA more accurately reflects the effect of repetitive body part movements. Additionally, the scoring systems for repetitive back motions by quick exposure check (QEC) and for repetitive wrist motions via a risk assessment and management tool for manual handling proactively II (RAMP II) may be reasonable based on the results of this study. The findings of this study can be used as reference information for better evaluation of postural loads assessed using the existing observational techniques, and as useful baseline data for the development of a new observational method to accurately assess stress caused by repetitive movements. [ABSTRACT FROM AUTHOR]

Biomechanics researchers often experimentally measure static or fluctuating dynamic contact forces, areas, and stresses at the interface of natural and artificial joints, including the shoulders, elbows, hips, and knees. This information helps explain joint contact mechanics, as well as mechanisms that may contribute to disease, damage, and degradation. Currently, the most common in vitro experimental technique involves a thin pressure-sensitive film inserted into the joint space; but, the film's finite thickness disturbs the joint's ordinary articulation. Similarly, the most common in vivo experimental technique uses video recording of 3D limb motion combined with dynamic analysis of a 3D link-segment model to calculate joint contact force, but this does not provide joint contact area or stress distribution. Moreover, many researchers may be unaware of older or newer alternative techniques that may be more suitable for their particular research application. Thus, this article surveys over 50 years of English-language scientific literature in order to (a) describe the basic working principles, advantages, and disadvantages of each technique, (b) examine the trends among the studies and methods, and (c) make recommendations for future directions. This article will hopefully inform biomechanics investigators about various in vitro and in vivo experimental methods for studying the contact mechanics of joints. [ABSTRACT FROM AUTHOR]

Purpose: Individuals with anterior cruciate ligament reconstruction (ACLR) generally exhibit limb underloading behaviors during walking, but most research focuses on per-step comparisons. Cumulative loading metrics offer unique insight into joint loading as magnitude, duration, and total steps are considered, but few studies have evaluated if cumulative loads are altered post-ACLR. Here, we evaluated if underloading behaviors are apparent in ACLR limbs when using cumulative load metrics and how load metrics change in response to walking speed modifications. Methods: Treadmill walking biomechanics were evaluated in 21 participants with ACLR at three speeds (self-selected (SS); 120% SS and 80% SS). Cumulative loads per step and per kilometer were calculated using knee flexion and adduction moment (KFM and KAM) and vertical ground reaction force (GRF) impulses. Traditional magnitude metrics for KFM, KAM, and GRF were also calculated. Results: The ACLR limb displayed smaller KFM and GRF in early and late stances, but larger KFM and GRF during midstance compared with the contralateral limb (P <0.01). Only GRF cumulative loads (per step and per kilometer) were reduced in the ACLR limb (P <0.01). In response to speed modifications, load magnitudes generally increased with speed. Conversely, cumulative load metrics (per step and per kilometer) decreased at faster speeds and increased at slow speeds (P < 0.01). Conclusions: Patients with ACLR underload their knee in the sagittal plane per step, but cumulatively over the course of many steps/distance, this underloading phenomenon was not apparent. Furthermore, cumulative load increased at slower speeds, opposite to what is identified with traditional single-step metrics. Assessing cumulative load metrics may offer additional insight into how load outcomes may be impacted in injured populations or in response to gait modifications. [ABSTRACT FROM AUTHOR]

Background There is conflicting data on which kinetic variables are important to consider with running injuries. Furthermore, less is understood regarding differences in these variables when considering demographics such as age, sex, weight, and running speed. The primary question was what joint power kinetic variables were different between non-injured and injured runners. Purpose The purpose of this study was to identify if there were differences in joint power kinetic variables between non-injured runners and injured runners. Study Design Case-Control Study Methods Kinetic data were collected on 122 runners (26 non-injured and 96 injured) over three years with a Bertec force plated treadmill and Qualisys 3D motion capture. The subjects were considered eligible if they self-identified themselves as runners or had running as a key component of their activity. The subjects ran at a comfortable, self-selected pace while two 10-second trials of recordings were used to calculate the means of peak power generated at the hips, knees, and ankles of each gait cycle. Foot strike was categorized by kinematic data. Two sample T-tests were used to compare peak power variables at the hips, knees, and ankles between non-injured and injured runners. Logistic regression analyses examined how a combination of demographics and peak power variables were associated with injuries. Results No peak power variable at the hip, knee, or ankle was significantly different between injured and non-injured runners (p=0.07-0.87). However, higher hip power absorbed was found to be protective against injuries (odds ratio, .16; 95% CI .025-.88) when considering demographics using a logistic regression model including sex, foot strike, BMI, speed, age, and power variables from the hip, knee, and ankle. The area under the ROC curve was .74, which is acceptable discrimination. Conclusion When controlling for age, sex, BMI, foot strike, and speed; higher hip power absorbed was found to be protective against injury. This could be due to the hip muscles' unique role in absorbing force during early stance phase. Level of Evidence 3b [ABSTRACT FROM AUTHOR]

Prosthetics are an extension of the human body and must provide functionality similar to that of a non-disabled individual to be effective. Sports prosthetics such as the Flex-Foot Cheetah from Össur have demonstrated the value of creating devices that both provide mechanical support and introduce passive energy return to mimic forces otherwise produced at joints. These energy return mechanisms have not yet been demonstrated for upper limb prosthetics but could improve their effectiveness and provide a greater range of motion and control. Using multi-material 3D printing technology, we extend energy return components to upper limb prosthetics by developing novel force-sensing springs and applying them to a basketball prosthetic. The 3D-printed springs compensate for the forces otherwise generated by wrist and finger flexion while measuring the mechanical deflection. We discuss design guidelines, methods for integrated 3D printed energy return within prosthetics, and broader applications in assistive technologies. [ABSTRACT FROM AUTHOR]

Background The purpose of this study is to examine the association between physical activity and contracture in older patients confined to bed in long-term care (LTC) facilities. Methods Patients wore ActiGraph GT3X+ for 8 hours on their wrists, and vector magnitude (VM) counts were obtained as the amount of activity. The passive range of motion (ROM) of joints was measured. The severity of ROM restriction classified, as the tertile value of the reference ROM of each joint, was scored 1-3 points. Spearman's rank correlation coefficients (Rs) were used to measure the association between the VM counts per day and ROM restrictions. Results The sample comprised 128 patients with a mean (SD) age of 84.8 (8.8) years. The mean (SD) of VM was 84574.6 (115195.2) per day. ROM restriction was observed in most joints and movement directions. ROMs in all joints and movement directions, except wrist flexion and hip abduction, were significantly correlated with VM. Furthermore, the VM and ROM severity scores showed a significant negative correlation (Rs = -0.582, p < .0001). Conclusions A significant correlation between the physical activity and ROM restrictions indicates that a decrease in the amount of physical activity could be one of the causes of contracture. [ABSTRACT FROM AUTHOR]

Introduction: Mild cognitive impairment (MCI) is considered a transitional stage between soundness of mind and dementia, often involving problems with memory, which may lead to abnormal postural control and altered end-point control when dealing with neuromechanical challenges during obstacle-crossing. The study aimed to identify the end-point control and angular kinematics of the pelvis-leg apparatus while crossing obstacles for both leading and trailing limbs. Methods: 12 patients with MCI (age: 66.7 ± 4.2 y/o; height: 161.3 ± 7.3 cm; mass: 62.0 ± 13.6 kg) and 12 healthy adults (age: 67.7 ± 2.9 y/o; height: 159.3 ± 6.1 cm; mass: 61.2 ± 12.0 kg) each walked and crossed obstacles of three different heights (10, 20, and 30% of leg length). Angular motions of the pelvis and lower limbs and toe-obstacle clearances during leading- and trailing-limb crossings were calculated. Two-way analyses of variance were used to study between-subject (group) and within-subject (obstacle height) effects on the variables. Whenever a height effect was found, a polynomial test was used to determine the trend. A significance level of α = 0.05 was set for all tests. Results: Patients with MCI significantly increased pelvic anterior tilt, hip abduction, and knee adduction in the swing limb during leading-limb crossing when compared to controls (p < 0.05). During trailing-limb crossing, the MCI group showed significantly decreased pelvic posterior tilt, as well as ankle dorsiflexion in the trailing swing limb (p < 0.05). Conclusion: Patients with MCI adopt altered kinematic strategies for successful obstacle-crossing. The patients were able to maintain normal leading and trailing toe-obstacle clearances for all tested obstacle heights with a specific kinematic strategy, namely increased pelvic anterior tilt, swing hip abduction, and knee adduction during leading-limb crossing, and decreased pelvic posterior tilt and swing ankle dorsiflexion during trailing-limb crossing. The current results suggest that regular monitoring of obstacle-crossing kinematics for reduced toe-obstacle clearance or any signs of changes in crossing strategy may be helpful for early detection of compromised obstacle-crossing ability in patients with single-domain amnestic MCI. Further studies using a motor/cognitive dual-task approach on the kinematic strategies adopted by multiple-domain MCI will be needed for a complete picture of the functional adaptations in such a patient group. [ABSTRACT FROM AUTHOR]

Purpose: Running with increased duty factors (DF) has been shown to effectively reduce external forces during running. In this study, we investigated whether running with increased DF (INCR) also reduces internal musculoskeletal loading measures, defined as peak muscle forces, muscle force impulses, and peak joint contact forces compared with a runners' preferred running pattern (PREF). Method: Ten subjects were instructed to run with increased DF at 2.1 m·s−1. Ground reaction forces and three-dimensional kinematics were simultaneously measured. A musculoskeletal model was used to estimate muscle forces based on a dynamic optimization approach, which in turn were used to calculate muscle force impulses and (resultant and three-dimensional) joint contact forces of the ankle, knee, and hip joint during stance. Results: Runners successfully increased their DF from 40.6% to 49.2% on average. This reduced peak muscle forces of muscles that contribute to support during running, i.e., the ankle plantar flexors (−19%), knee extensors (−18%), and hip extensors (−15%). As a consequence, peak joint contact forces of the ankle, knee, and hip joint reduced in the INCR condition. However, several hip flexors generated higher peak muscle forces near the end of stance. Conclusions: Running with increased DF lowers internal loading measures related to support during stance. Although some swing-related muscles generated higher forces near the end of stance, running with increased DF can be considered as a preventive strategy to reduce the occurrence of running-related injuries, especially in running populations that are prone to overuse injuries. [ABSTRACT FROM AUTHOR]

Purpose: Due to the paucity of information regarding the lower limb biomechanics in running at slow speed, as well as the concentration of most previous studies on a single movement plane, this study aimed to investigate lower limb joint kinetics with increasing running speed. Methods: Twenty-eight runners were asked to stay on the treadmill at a bent velocity which was incrementally increased to 2.5 m/s, 3.5 m/s, and 4.5 m/s speeds. The three-dimensional joint moment and sagittal mechanical muscle power of the lower limb were calculated during the stance phase of running. Repeated measures analysis of variance (ANOVA) with Bonferroni post hoc test was used to examine the variables during running at various speeds. Results: The results showed that at the hip joint in the frontal plane, an adduction moment developed in the middle of the stance phase, and the highest peak adduction moment was obvious at the highest speed condition (4.5 m/s). Also, the time elapsed to peak in the highest speed condition was less than the others. In the transverse plane, although the 3.5 m/s-speed condition experienced the maximum external rotation peak moment, the 4.5 m/s-condition speed reached the internal status earlier than the two other speeds. In the sagittal plane, the highest speed condition showed the highest extension and flexion moments. Conclusion: Increasing running speed in runners leads to more kinetic output and mechanical power gradient. [ABSTRACT FROM AUTHOR]

Background: Passive energy storage and return has long been recognized as one of the central mechanisms for minimizing the energy cost needed for terrestrial locomotion. Although the iliofemoral ligament (IFL) is the strongest ligament in the body, its potential role in energy-efficient walking remains unexplored. Purpose: To identify the contribution of the IFL to the amount of work performed by the hip muscles for normal, straight-level walking. Study Design: Controlled laboratory study. Methods: Straight-level walking of 50 healthy and injury-free adults was simulated using the AnyBody Modeling System. For each participant, the bone morphology and soft tissue properties were nonuniformly scaled. The superior and inferior parts of the IFL were represented by 2 springs each, and a linear force-strain relation was defined. A parameter study was conducted to account for the uncertainty surrounding the mechanical properties of the IFL. The work required from the gluteus, quadriceps, iliopsoas, and sartorius with and without inclusion of the IFL was calculated. Analysis of variance with subsequent post hoc paired t test was used to test the significance of IFL presence on the required mechanical work. Results: During walking, the strain in the IFL reached a median of 18.7% (95% CI, 8.0%-26.5%), with the largest values obtained at toe-off. With the IFL undamaged and fully operational, the effort required by the hip flexor muscles was reduced by a median of 54% (99% CI, 45%-62%) for the iliopsoas and by a median of 41% (99% CI, 27%-54%) for the sartorius muscles. The inclusion of the IFL did not significantly alter the work required by the gluteus and the quadriceps. Conclusion: The findings emphasized the key role the IFL plays in hip flexion by working synergistically with the hip musculature. Clinical Relevance: The importance of the contribution of the IFL to the hip flexors warrants careful handling and repair of these ligaments in cases of surgery and structural damage. [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]

Objective: To analyze the application of concept nursing of accelerated rehabilitation surgery in orthopedic postoperative recovery. Methods: A total of 120 patients who received orthopedic surgery were divided into the control group undergoing routine orthopedic nursing and the observation group undergoing the concept of accelerated rehabilitation surgery nursing. Results: Patients in the observation group had shorter in-bed activity time and out-of-bed activity time, average time of hospital stay, and lower total treatment costs. The incidence of incision infection, respiratory system infection, digestive tract infection, urinary tract infection, deep vein thrombosis, and other complications in the observation group was much lower. The recovery scores of joint function in the observation group at 1, 3, 6, and 12 months after the operation were all better, and the recovery rate of joint function within 1 year after the operation was higher. Conclusion: Following the concept of accelerated rehabilitation surgery nursing during the perioperative period can improve the quality of postoperative orthopedic recovery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate differences in lower extremity joint angles between a forward (FSD) and lateral (LSD) step-down task at different heights (4 and 6 inches). Methods: Eighteen healthy adults performed four variations of the step-down task while hip, knee, and ankle kinematics were measured. A two-way repeated measures analysis of variance was performed. Results: There was a significant interaction and main effect for step direction and height for knee external rotation and ankle dorsiflexion angle (P <.05). Participants exhibited greater hip adduction, knee flexion, knee adduction, and ankle dorsiflexion during performance of the FSD than the LSD at the 4- and 6-inch height. For each step direction, participants demonstrated greater hip flexion, hip adduction, knee flexion, knee adduction, and ankle dorsiflexion during performance of the task at the 6-inch height. Conclusions: The FSD requires greater movement of the lower extremity than the LSD and increasing step height increases the biomechanical demands of the lower extremity. [Athletic Training & Sports Health Care. 2021;13(4):e212–e220.] [ABSTRACT FROM AUTHOR]

Background Yttrium-90 (90Y) is approved in several countries as a radiosynoviorthesis agent in the intra-articular treatment of synovitis, however, no such radiopharmaceuticals are approved in Canada. The aim of this Health Canada–approved study was to examine the safety and efficacy of 90Y synovectomy among patients with refractory synovitis. Methods We performed a subset analysis of a prospective, phase III, single-arm, pan-Canadian trial. Large and medium-sized joints of adults with refractory inflammatory mono- or oligo-arthritis and minimal cartilage/bone destruction who failed treatment with two intra-articular corticosteroid injections were eligible. Patient follow-up was at 3, 6 and 12 months. Outcome measures included joint tenderness, swelling, effusion, joint function and bone scans. Results A total of 79 joints were included (90% knees). The underlying diagnosis included SpA (35.2% of patients), RA (26.8%), JIA (8.5%) and other (29.6%). Non-biologic DMARDs were concurrently used in 59.2% of patients and biologic/targeted synthetic DMARDs in 31%. Five adverse events occurred, including one serious radiation burn requiring surgery. All events were non-life-threatening and resolved. Significant improvements in joint tenderness, swelling and effusion were achieved at 3 months (P  < 0.001), which were maintained until 12 months. During follow-up, 92.3% of joints did not show radiographic progression. Per the treating physician, clinically important improvement in joint function was observed in 90% of joints. Conclusion Our results confirm the safety of 90Y radiosynoviorthesis in refractory synovitis and provide preliminary evidence supporting its clinical efficacy with sustained benefit at 12 months, suggesting that it is a safe alternative to surgical synovectomy in such cases. This is the first such study in a Canadian cohort. [ABSTRACT FROM AUTHOR]

Background: The spring-like behavior of the leg and the joints of the lower body during running are thought to influence a wide range of physiologic and mechanical phenomena, including susceptibility to overuse injury. If leg and joint stiffness are associated with running-related injuries, altering joint or leg stiffness may be a useful avenue for injury rehabilitation and injury prevention programs. Purpose: To test the associations between running-related injury and leg stiffness, knee stiffness, and ankle stiffness in a prospective study of recreational runners. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 49 healthy recreational runners took part in a year-long study. Participants completed a 3-dimensional kinematic and kinetic biomechanical assessment at baseline and reported training volume and injury status in a weekly survey during the follow-up period. Relationships between stiffness and injury were assessed at the level of individual legs (n = 98) using spline terms in Cox proportional hazards models. Results: During follow-up, 23 participants (29 legs) sustained injury. The median time to injury was 27 weeks (53.27 hours of training). Relative injury rate as a function of knee stiffness displayed a weak and nonsignificant U -shaped curve (P =.187-.661); ankle and leg stiffness displayed no discernable associations with relative injury rate (leg stiffness, P =.215-.605; ankle stiffness, P =.419-.712). Conclusion: Leg and joint stiffness may not be important factors in the development of running-related injuries. Moderate changes in leg and joint stiffness are unlikely to substantially alter injury risk. [ABSTRACT FROM AUTHOR]

Objective: To present a robust methodology for evaluating ankle health during ambulation using a wearable device. Methods: We developed a novel data capture system that leverages changes within the ankle during ambulation for real-time tracking of bioimpedance. The novel analysis compares the range of reactance at 5 kHz to the range of reactance at 100 kHz; which removes the technique's previous reliance on a known baseline. To aid in interpretation of the measurements, we developed a quantitative simulation model based on a literature review of the effects on joint bioimpedance of variations in edematous fluid volume, muscle fiber tears, and blood flow changes. Results: The results of the simulation predicted a significant difference in the ratio of the range of the reactance from 5 kHz to 100 kHz between the healthy and injured ankles. These results were validated in 15 subjects - with 11 healthy ankles and 7 injured ankles measured. The injured subjects had lateral ankle sprains 2-4 weeks prior to the measurement. The analysis technique differentiated between the healthy and the injured population (p<<0.01), and a correlation (R = 0.8) with a static protocol previously validated for its sensitivity to edema. Conclusion: The technology presented can detect variations in ankle edema and structural integrity of ankles, and thus could provide valuable feedback to clinicians and patients during the rehabilitation of an ankle injury. Significance: This technology could lead to better-informed decision making regarding a patient's readiness to return to activity and / or tailoring rehabilitation activities to an individual's changing needs. [ABSTRACT FROM AUTHOR]

Objective: To report the 2‐year efficacy and safety of tocilizumab (TCZ) in patients with polyarticular‐course juvenile idiopathic arthritis (JIA). Methods: Patients ages 2–17 years with active polyarticular‐course JIA, in whom treatment with methotrexate was unsuccessful, received 16 weeks of open‐label intravenous TCZ in part 1 (once every 4 weeks: 8 mg/kg or 10 mg/kg for body weight [BW] <30 kg; 8 mg/kg for BW ≥30 kg). Assessments were based on the JIA–American College of Rheumatology (ACR) response (defined as percentage of improvement in ≥3 of the 6 JIA core response variables [CRVs]). Patients with at least a JIA‐ACR30 response (defined as ≥30% improvement in ≥3 of the 6 JIA CRVs without worsening in >1 of the remaining JIA CRVs by >30%) at week 16 were randomly assigned (1:1) to receive TCZ or placebo in part 2. Patients remained in part 2 until either week 40 or the occurrence of JIA flare. Upon starting part 3, all patients received open‐label TCZ. At week 104 of the study, efficacy was assessed using JIA‐ACR50/70/90 response rates (defined as 50%, 70%, or 90% improvement, respectively), achievement of inactive disease, and the Juvenile Arthritis Disease Activity Score in 71 joints (JADAS‐71). Safety was assessed in the all‐exposure population per 100 patient‐years of exposure. Results: Overall, 188 patients entered part 1, 166 patients entered part 2, and 160 patients entered part 3. By week 104, among the 188 patients in the modified intent‐to‐treat group who received TCZ, JIA‐ACR50/70/90 response rates were 80.3%/77.1%/59.6%, respectively, the median JADAS‐71 score decreased from 3.6 at week 40 to 0.7 at week 104, 51.1% of patients had achieved inactive disease, and 31 of 66 patients who had been receiving glucocorticoids discontinued them. Adverse event (AE) and serious AE rates were 406.5 per 100 patient‐years and 11.1 per 100 patient‐years, respectively. The infection rate was 151.4 per 100 patient‐years, and the serious infection rate was 5.2 per 100 patient‐years. Conclusion: Patients treated with TCZ for polyarticular‐course JIA showed high‐level disease control for up to 2 years. The TCZ safety profile was consistent with that previously reported. [ABSTRACT FROM AUTHOR]

The article presents questions and answers related to Rheumatoid Arthritis (RA) including what is irreversible damage in RA; and what have we learned from other diseases.

The authors comment on a study on the contribution of clock genes in the maintenance of cartilage health and osteoarthritis development. Topics covered include the strengths of the study such as its advocating of lifestyle interventions, which may provide an opportunity to prevent or slow down progression of diseases like osteoarthritis, the failure of the study to highlight circadian clock as a therapeutic target in osteoarthritis, and the clinical implications of the study.

Supplemental digital content is available in the text. Introduction: Athletes returning to sport after anterior cruciate ligament reconstruction (ACLR) demonstrate prolonged changes in landing kinematics, kinetics, and muscle activation, predisposing them for reinjury, knee osteoarthritis, and/or knee instability. So far, researchers have been focusing on how kinematics and kinetics change in every joint separately. However, as the human body operates within a kinetic chain, we will assess whether single-joint changes are associated with whole-body changes. Methods: Twenty-one athletes who had an ACLR and 21 uninjured controls performed five unilateral landing tasks, whereas lower limb kinematics, kinetics, and muscle activations of vastus medialis, vastus lateralis, biceps femoris, semitendinosus, semimembranosus, gastrocnemius, and gluteus medius were recorded. Single-joint landing kinematics, kinetics, and muscle activations of the ACL-injured leg were compared with the uninjured leg and compared with the control group. Whole-body changes were assessed by decomposing movements into fundamental components using marker-based principal component analysis (PCA). Results: We found several single-joint changes in landing kinematics, kinetics, and muscle activations in the athletes with ACLR that were seen across all tasks and therefore of major interest as they are likely to occur during sports as well. Hamstrings activation increased and external knee flexion moments decreased in the ACL-injured leg compared with their uninjured leg. Furthermore, hip adduction moments and knee abduction angles decreased compared with the control group. The PCA could detect changes in whole-body movement, which were task-specific. Conclusions: Athletes with ACLR still show protective task-independent single-joint kinematic, kinetic, and muscle activation changes during single-leg landings at the time of return to sport. These single-joint changes were not consistently accompanied by changes in whole-body movements (revealed by marker-based PCA). Whole-body expressions of the single-joint compensations are likely to be affected by the demands of the task. [ABSTRACT FROM AUTHOR]

To evaluate the effects of silicone ankle sleeves (SASs) and lace-up ankle braces (LABs) on neuromuscular control, net joint torques, and cutting agility in healthy, active individuals. Markerless motion-capture technology tracked subjects fitted with SASs, LABs, or no brace while they performed the movements: Y-excursion, left cutting, right cutting, single-leg drop vertical jump (SLDVJ), 45-degree bound, and single-leg squat (SLS). University Laboratory. Ten healthy, active individuals (5 males and 5 females, mean ± SD 23.60 ± 1.43 years of age). Degrees of joint range of motion (ROM), Newton-meters of joint torque, time to perform a cutting maneuver. SASs and LABs resulted in significantly different knee and ankle ROM and hip internal rotation in the SLDVJ, SLS, Y-excursion, cutting maneuver, and 45-degree bound when compared to control (p <.05). Both ankle and knee torque were significantly reduced in the 45-degree bound and cutting movements with both types of PABs (p <.05). There were minimal differences between the SASs and LABs for all conditions. There were no statistically significant differences in cutting times for any of the 3 conditions. Both SAS and LAB positively impacted neuromuscular control, reduced net joint torque, and neither impaired cutting agility when compared to control. • Silicone ankle sleeves (SAS) and lace-up ankle braces (LAB) reduced net joint torque. • SAS and LAB improved neuromuscular control during dynamic movement. • SAS and LAB did not impact cutting agility. [ABSTRACT FROM AUTHOR]

Background: Deteriorated bone-graft interaction at the tunnel entrance following ACL reconstruction (ACLR) is considered one of the primary causes of long-term tunnel enlargement and graft wear. Methods have been introduced to improve the long-term outcome, such as novel graft materials or alternative fixation methods, but have been met with varying degrees of success. This study aims to design a protection liner to improve the bone-graft interaction at the tunnel entrances. Methods: A finite element model of a human cadaveric knee was used to simulate traditional ACLR and ACLR using the protection liner. Stress distribution around the tunnel entrances and on the ACL graft were calculated under a combined loading of 103 N anterior tibial load, 7.5 Nm internal tibial moment, and 6.9 Nm valgus tibial moment at a joint flexion angle of 20°. Results were compared between the traditional ACLR and ACLR using a double liner (femoral and tibial) setup, as well as between the ACLR using a double liner setup and a single liner (femoral side) setup. Different materials (PEEK, Ti-6Al-4V, CoCrMo) for the liner were also evaluated. Results: The traditional ACLR resulted in concentrated stress on the graft where it contacted the tunnel entrance. Correspondingly, there were stress concentrations at the distal posterior zone of the femoral tunnel entrance and medial posterior zone of the tibial tunnel entrance, while the other zones suffered from a stress reduction. Use of the protection liner reduced the stress concentration around the tunnel entrances by up to 89% and increased the stress at the unloaded zones by up to 106%. Also, stress concentration on the graft was slightly decreased (15.4 vs 15.1 MPa) after using the liner. The single liner setup increased the stress concentration around the tibial tunnel entrance. Stiffer materials improved the stress distribution around tunnel entrances but had little effect on the stress on the graft. Conclusions: The novel protection liner can improve the stress distribution on the graft and at the tunnel entrances, which may be beneficial for improving the clinical outcome of ACLR. [ABSTRACT FROM AUTHOR]

Background: Osteochondral defects caused by an acute traumatic injury or articular degeneration remains difficult to be manipulated. Repair of articular defects is still a great challenge for both tissue engineers and orthopedic surgeons. Therefore, combination of biomaterials with cartilage promotive drugs is well worth being developed to support the regeneration of both cartilage and subchondral bone. Methods: Rabbits undergoing osteochondral defect surgery were intrarticularly injected with icariin-conditioned serum (ICS), chitosan (CSSH) and combination of ICS with CSSH, respectively. Gait analysis was performed using VICON motion capture system. ICRS score and immunohistochemical (IHC) analysis including H&E, Safranin O, toluidine blue and collagen II staining was employed to evaluate macroscopic cartilage regeneration and determine the morphologic repair of cartilage. Results: Rabbits with the treatment of ICS or CSSH alone showed mild improvement in hopping time and range of joint angles while ICS-CSSH group exhibited longer jumping time and larger range of joint angles. In addition, femoral condyle in ICS-CSSH rabbits could be seen with more native cartilage and subchondral bone regeneration in both macroscopic observation and IHC analysis. Conclusion: ICS combined with CSSH could promote the repair of osteochondral defect in rabbit knees. Combination of biomaterials with cartilage promotive drugs may ultimately have profound implications in the management of cartilage defect. [ABSTRACT FROM AUTHOR]

Badminton atypical actions and hitting movements often occur during the game; therefore, many special footwork methods have been developed to facilitate the rapid movements required to hit the shuttlecock, including quick turning and jumping and quick directional change movements. Studies have shown that the majority of badminton sport injuries occur in the lower extremity joints of athletes. The purpose of this study was to investigate the influences of hitting motion and unanticipated hitting direction on landing mechanics after backhand lateral jump smashing and landing to analyze joint stiffness and torque changes in three lower extremity joints. Recruited sixteen badminton athletes.The capture frequency of the Vicon Motion System (300Hz), Kistler force platform (1500Hz) and Vicon Nexus Version 1.8.5 software were used simultaneously to capture the kinematic and kinetic parameter of backhand side lateral jump smash footwork. The swing actions were divided into two situations, shadow (footwork and racket swinging practice without targets) and hitting (footwork and stroke shuttlecock) actions, whereas the directions were divided into directional and non-directional. Two-way repeated measures ANOVA with the LSD correction was used to compare the differences among the four conditions. The significance level was set to a = 0.05. Results shown that, at the peak of torque, the ankle plantar flexion of the non-directional shadow (p < 0.05) were greater than that of directional shadow (p < 0.05); meantime, ankle torque change of non-directional shadow (p < 0.05) and directional hitting (p < 0.05) was lower than that of non-directional hitting, but the non-directional hitting was larger compared to non-directional shadow (p < 0.05) at the maximum vertical GRF. The hip extension at peak of torque of directional hitting were larger than that of non-directional shadow (p < 0.05). The shadow actions hip flexion angle was larger than that of directional hitting at initial contact, but the non-directional hitting hip abduction was has the significant difference among all the conditioning. The hip flexion angle of non-directional shadow was larger than that of directional hitting (p < 0.05), the hip abduction angle of the nondirectional hitting was greater than that of non-directional shadow (p < 0.05) at the peak VGRF. Elite badminton players execute different training movements; the joint stiffness was in the same state. In the hitting actions has greater ankle and hip joint torque than shadow actions. The badminton player was change joint range of motion to adjust lower limbs stiffness. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate the correlations between clinical features and mouth opening in patients with systemic sclerosis (SSc). Patients and methods: Eighty patients with SSc (13 males, 67 females; mean age 53.4±11.7 years; range, 31 to 76 years) followed in our clinic were enrolled in the study. Skin involvement was assessed using the modified Rodnan skin score (mRSS), joint/tendon involvement with finger-tip to palm (FTP) distance and interstitial lung disease (ILD) was evaluated with clinical and radiologic methods. The interincisal distance (ID) measurement was used to assess the maximal mouth opening capacity. We examined associations between the ID and clinical features of SSc. Results: The ID was lower in females compared with males, and in diffuse type compared with the limited type (p<0.001 and p<0.001, respectively). A significant negative correlation was found between the ID with mRSS and FTP distance (p<0.001 and p=0.001, respectively). The ID was lower in patients with ILD than in patients without ILD (p=0.006). A formula was constituted to predict the maximal mouth opening of the patient with regression analysis. According to the formula, being male was associated with an increase of 6.14 mm, the presence of ILD with a decrease of 3.19 mm, every 10 mm increment in mRSS with a decrease of 3.72 mm and FTP distance >0 mm with a decrease of 5.13 mm in mouth opening. Conclusion: Microstomia is associated with low quality of life in patients with SSc. In our study, sex, ILD, mRSS, and FTP distance were observed to be the most important factors that were related with mouth opening in patients with SSc. [ABSTRACT FROM AUTHOR]

Conflicting methodologies are used to define certain countermovement vertical jump (CMVJ) phases, which limits the identification of performance-enhancing factors (e.g., rate of force development). Purpose: We (a) utilized a joint power approach to define CMVJ phases that accurately describe body weight unloading (i.e., unweighting) and eccentric (i.e., braking) actions, which were combined with the robustly defined concentric (i.e., propulsion) phase, and (b) determined whether the phases can be identified using only ground reaction force (GRF) data. Methods: Twenty-one men performed eight maximal CMVJs while kinematic and GRF data were obtained. Hip, knee, and ankle joint powers were calculated by multiplying net joint moments (obtained using inverse dynamics) by joint angular velocities. The net sum of the joint powers (JPSUM) was calculated to define phases by the preeminence of negative (i.e., net eccentric actions) or positive (i.e., net concentric actions) power where appropriate. Unloading, eccentric, and concentric phases were identified using JPSUM and linked to GRF and center of mass velocity features. Results: Bland and Altman plots of the bias and 95% confidence intervals for the limits of agreement (LOA), intraclass correlation coefficients (ICC), and coefficients of variation (CV) indicated precise agreement for detecting the unloading (bias, 0.060 s; LOA, −0.110 to 0.229 s) and eccentric (bias, 0.012 s; LOA, −0.010 to 0.040 s) phases with moderate (ICC, 0.578; CV, 40.72%) and excellent (ICC, 0.993; CV, 2.18%) reliability, respectively. The eccentric phase should be divided into yielding (eccentric actions while accelerating downward) and braking (eccentric actions while decelerating downward) subphases for detailed assessments. Conclusion: CMVJ phases defined by combining joint and center of mass mechanics can be detected using only force platform data, enabling functionally relevant CMVJ assessments using instrumentation commonly available to practitioners. [ABSTRACT FROM AUTHOR]

Objective: We present a robust methodology for tracking ankle edema longitudinally based on bioimpedance spectroscopy (BIS). Methods: We designed a miniaturized BIS measurement system and employed a novel calibration method that enables accurate, high-resolution measurements with substantially lower power consumption than conventional approaches. Using this state-of-the-art wearable BIS measurement system, we developed a differential measurement technique for robust assessment of ankle edema. This technique addresses many of the major challenges in longitudinal BIS-based edema assessment, including day-to-day variability in electrode placement, positional/postural variability, and intersubject variability. Results: We first evaluated the hardware in bench-top testing, and determined the error of the bioimpedance measurements to be 0.4 Ω for the real components and 0.54 Ω for the imaginary components with a resolution of 0.2 Ω. We then validated the hardware and differential measurement technique in: 1) an ex vivo, fresh-frozen, cadaveric limb model, and 2) a cohort of 11 human subjects for proof of concept (eight healthy controls and five subjects with recently acquired acute unilateral ankle injury). Conclusion: The hardware design, with novel calibration methodology, and differential measurement technique can potentially enable long-term quantification of ankle edema throughout the course of rehabilitation following acute ankle injuries. Significance: This could lead to better-informed decision making regarding readiness to return to activities and/or tailoring of rehabilitation activities to an individual's changing needs. [ABSTRACT FROM AUTHOR]

This study proposes a motion-assist arm that can accurately support the positioning of a human upper limb. The motion-assist arm is a three-degree-of-freedom (DOF) planer under-actuated robotic arm with a 1-DOF passive joint that can be driven by an human. A control method for the robot arm is as follows. First, when the human moves an output point of the arm manually, the passive joint is rotated with the movement of the output point. Then, for accurate positioning of the output point on a target path, the actuated joints are controlled according to the displacement of the passive joint. Based on the above method, the human can adjust the velocity of the output point deliberately while its position is accurately corrected by the actuated joints. To confirm its effectiveness, the authors conducted tests to assist the human's upper limb movement along straight target paths, a square path, and free curves paths such as italic letters with the proposed robot arm prototype. From the results of the tests, the authors confirmed that the proposed robot arm can accurately position the upper limb of the human on the target paths while the human intentionally moves the upper limb. It is expected that the proposed arm will be used for rehabilitation because it can aid patients to move their arms correctly. In addition, the proposed arm will enable any human to achieve complex work easily. [ABSTRACT FROM AUTHOR]

BACKGROUND: The inherent stride-to-stride fluctuations during walking are altered in the aging population and could provide insight into gait impairments and falls in patients with COPD. Stride-to-stride fluctuations are quantified two ways: variability of the fluctuations (eg, standard deviation), and movement patterns within the fluctuations. Our objective was to investigate stride-to-stride fluctuations by evaluating the variability and movement patterns of lower limb joints in subjects with COPD compared to subjects without COPD as control subjects. METHODS: In this cross-sectional study, 22 subjects with COPD (age 63 ± 9 y; FEV1 54 ± 19% predicted) and 22 control subjects (age 62 ± 9 y; FEV1 95 ± 18% predicted) walked for 3 min on a treadmill while their gait was recorded. The amount of variability (ie, standard deviation and coefficient of variation) and movement patterns (ie, predictability and consistency in organization) were quantified for the range of motion and joint angle of the hip, knee, and ankle, at 3 walking speeds (ie, self-selected, fast, and slow). General linear mixed models were used for analysis. RESULTS: Control subjects had more consistent organization of the hip and knee joint movement patterns compared to subjects with COPD (P = .02 and P = .02, respectively). Further, control subjects adapted to speed changes by demonstrating more consistent organization of movement patterns with faster speeds, whereas subjects with COPD did not. At the fast walking speed, subjects with COPD demonstrated less consistent organization of knee and hip joint movement patterns as compared to control subjects without COPD (P = .03 and P = .005, respectively). The amount of variability did not differ between groups. CONCLUSIONS: Although subjects with COPD did not demonstrate decreased amount of variability, their hip and knee joint movement patterns were less consistent in organization during walking. Reduced consistency in organization of movement patterns may be a contributing factor to falls and mobility problems experienced by patients with COPD. [ABSTRACT FROM AUTHOR]

Context: Foam rolling (FR) is considered an effective postexercise modality for reducing delayed-onset muscle soreness and enhancing recovery of muscle function. However, the effects of FR on muscle and joint proprioception have not been investigated. Objective: To examine the effects of FR on muscle and joint proprioception after an intense exercise protocol. Design: Controlled laboratory study. Setting: University-based laboratory. Patients or Other Participants: A total of 80 healthy, physically active male students were randomly assigned to either the FR (n = 40; age = 22.8 ± 3.3 years, height = 176.4 ± 5.3 cm, mass = 74.2 ± 6.4 kg) or passive-recovery (PR; n = 40; age = 23.0 ± 3.2 years, height = 178.1 ± 5.5 cm, mass = 74.6 ± 6.2 kg) group. Intervention(s): Participants in both groups performed 4 sets of 25 repetitions of voluntary maximal eccentric contractions at 608/s from 208 to 1008 of knee flexion to induce exercise- induced muscle damage. The exercise was followed by either PR or 2 minutes of FR immediately (1 hour) and 24, 48, and 72 hours postexercise. Main Outcome Measure(s): Muscle soreness, pressure- pain threshold, quadriceps-muscle strength, joint position sense, isometric force sense, and threshold to detect passive movement at baseline and immediately, 24, 48, and 72 hours postexercise after FR. Results: Foam rolling resulted in decreased muscle pain, increased pressure-pain threshold, improved joint position sense, attenuated force loss, and reduced threshold to detect passive movement compared with PR at 24 and 48 hours postexercise. Conclusions: Foam rolling postexercise diminished de- layed-onset muscle soreness and improved recovery of muscle strength and joint proprioception. These results suggested that FR enhanced recovery from exercise-induced damage. [ABSTRACT FROM AUTHOR]

Background: Accidental falls could have severe and far-reaching consequences for older adults, their families and society at large. Healthcare practitioners' (HCPs) perspectives on fall risk factors in older adults could assist in reducing and even preventing falls. Currently, no universal tool exists for this purpose. The World Health Organization's globally accepted International Classification of Functioning, Disability and Health (ICF) was used. Aim: This study aimed to (1) describe the perspectives of HCPs on fall risk factors in older adults in South Africa and (2) link these factors to the ICF. Setting: Eighteen HCPs participated in two focus groups. Methods: Using a qualitative research design, an inductive thematic analysis allowed for the identification of important themes, which were linked to the ICF. Results: The factors mentioned by participants were categorised into 38 themes, which were linked to 142 ICF codes, of which 43% (n = 61) were linked to the Body Function category, 23% (n = 32) to the Environmental Factors category, 18% (n = 26) to the Body Structure category and 16% (n = 23) to the Activities and Participation category. HCPs revealed two relevant factors that were not captured in existing fall risk assessment tools (FRATs), namely 'muscle-power functions' and 'mobility-of-joint functions', which directly relate to the ability to execute mobility activities. Combining HCPs' perspectives with other stakeholders and with literature provides a holistic picture of fall risk factors in older adults. [ABSTRACT FROM AUTHOR]

A systematic literature search was conducted to review the forceenhancing mechanisms caused by a stretch-shortening cycle (SSC). The review aims to yield an overview of the contraction modalities influencing the SSC performance in animals and single joint movements in humans. The search was executed in common with the PRISMA statement. CINAHL, MEDLINE (via ProQuest), PubMed, ScienceDirect, Scopus and Web of Science databases were used for the systematic search from its inception until February 2019. A quality assessment was conducted with a modified Downs and Black checklist. Twenty-five studies were included. SSC effects, leading to increased force/work during a SSC and a reduced force depression (FD) compared to a pure shortening contraction, are existent on different levels of the muscle, from single fiber experiments to the level of in vivo muscletendon complex. Muscle performance is dependent on shortening velocity, shortening distance, stretch distance, the time (transition phase) between stretch and shortening and the active prephase duration. Concerning stretch velocity we found conflicting results. The findings from this systematic review indicate that the mechanisms in the early phase of shortening are associated with preactivation effects, elastic recoil and stretch reflex. Furthermore, we speculate that residual force enhancement (RFE) is mainly responsible for an increased steady-state force compared to a pure shortening contraction. [ABSTRACT FROM AUTHOR]

The importance of response time (RT) in sports is well known, but there is an evident lack of reliable and valid sport-specific measurement tools applicable in the evaluation of RT in trained athletes. This study aimed to identify the validity, reliability, and usefulness of four newly developed RT testing protocols among athletes from agility-saturated (AG) and non-agility-saturated (NAG) sports. Thirty-seven AG and ten NAG athletes (age: 20.9 ± 2.9; eleven females) volunteered to undergo: three randomized simple response time (SRT-1, SRT-2, and SRT-3) protocols that included a single limb movement, and one complex response time (CRT) protocol that included multi joint movements and whole body transition over a short distance (1.5 and 1.8m). Each RT test involved 3 trials with 5 randomized attempts per trial. Two sensors were placed at the left- and right-hand side for SRT-1 and SRT-2. Three sensors were positioned (left, middle, right) in SRT-3 and CRT. The intra-class-correlation coefficient (ICC) was calculated as a measure of reliability. Independent sample ttest, effect size (d), and area-under-the-curve (AUC) were calculated to define discriminative validity of the tests. The results showed the newly developed tests were more reliable and useful in the AG than NAG athletes (i.e., ICC between 0.68 and 0.97 versus 0.31 - 0.90, respectively). The RT of AG athletes was faster than that of NAG athletes in the CRT test from the left (p <0.01, d = 2.40, AUC: 0.98), centre (p < 0.01, d = 1.57, AUC: 0.89), and right sensor (p < 0.01, d = 1.93, AUC: 0.89) locations. In contrast, there were no differences between the groups in the SRT tests. The weak correlation (i.e., r= 0.00 - 0.33) between the SRT and CRT tests suggests that response time of the single limb and multijoint limb movements should not be considered as a single motor capacity. In conclusion, this study showed that AG athletes had faster response time than their NAG peers during complex motor tasks. Such enhanced ability to rapidly and accurately reprogram complex motor tasks can be considered one of the essential qualities required for advanced performance in agilitybased sports. [ABSTRACT FROM AUTHOR]

The article provides information on the challenge of diagnosing rheumatoid arthritis (RA) in patients who test negative for classical autoantibodies. It focuses on the role of type H blood vessels in pathologic ontogenesis and angiogenesis in spondyloarthritis (SpA). Article also highlights the potential of targeting type H vessel-mediated osteogenesis as a therapeutic approach for SpA.

Joint contracture is increasingly regarded as a clinical problem that leads to irreversible dysfunction of the joint. It is a pathophysiological process following joint injury, which is marked by the activation of myofibroblasts. There is currently no effective treatment for the prevention of joint contracture. Curcumin is a polyphenol pigment extracted from turmeric, which possesses anti-inflammatory, antioxidative, and antitumor properties. In the present study, we demonstrated that curcumin exerts a protective effect against joint contracture via the inhibition of myofibroblast proliferation and migration in a time- and concentration-dependent manner. Moreover, we indicated that phosphatase and tension homolog (PTEN) was downregulated in myofibroblasts in vitro and in the contracture capsule tissues of patients in vivo. Additionally, western blot analysis revealed a negative correlation between the expression levels of PTEN and the fibrosis marker protein alpha smooth muscle cell actin. Methylation-specific PCR results suggested that curcumin was able to demethylate PTEN in a similar manner to the demethylation agent 5-azacytidine, increasing PTEN expression and further inhibiting phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin signaling. In conclusion, our data illustrate part of the mechanism of curcumin inhibition in joint contracture. These results support the hypothesis that curcumin may potentially be used as a novel candidate for the treatment of joint contracture. [ABSTRACT FROM AUTHOR]

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Supplemental digital content is available in the text. Introduction: Advanced age brings a distal-to-proximal redistribution of positive joint work during walking that is relevant to walking performance and economy. It is unclear whether negative joint work is similarly redistributed in old age. Negative work can affect positive work through elastic energy return in gait. We determined the effects of age, walking speed, and grade on positive and negative joint work in young and older adults. Methods: Bilateral ground reaction force and marker data were collected from healthy young (age = 22.5 yr, n = 18) and older (age = 76.0 yr, n = 22) adults walking on a split-belt instrumented treadmill at 1.1, 1.4, and 1.7 m·s−1 at each of three grades (0%, 10%, and −10%). Subjects also performed maximal voluntary eccentric, isometric, and concentric contractions for the knee extensors (120°·s−1, 90°·s−1, and 0°·s−1) and plantarflexors (90°·s−1, 30°·s−1, and 0°·s−1). Results: Compared with young adults, older adults exhibited a distal-to-proximal redistribution of positive leg joint work during level (P < 0.001) and uphill (P < 0.001) walking, with larger differences at faster walking speeds. However, the distribution of negative joint work was unaffected by age during level (P = 0.150) and downhill (P = 0.350) walking. Finally, the age-related loss of maximal voluntary knee extensor (P < 0.001) and plantarflexor (P = 0.001) strength was smaller during an eccentric contraction versus concentric contraction for the knee extensors (P < 0.001) but not for the plantarflexors (P = 0.320). Conclusion: The distal-to-proximal redistribution of positive joint work during level and uphill walking is absent for negative joint work during level and downhill walking. Exercise prescription should focus on improving ankle muscle function while preserving knee muscle function in older adults trying to maintain their independence. [ABSTRACT FROM AUTHOR]

Purpose: The present study was designed to investigate the effects of lower limb joint kinetics on energy cost during jumping. Methods: Eight male middle and long-distance runners volunteered for the study. The subjects were asked to repeat vertical jumps at a frequency of 2 Hz for 3 min on a force platform in three different surface inclination conditions: Incline (+8°), Level (0°), and Decline (−8°). Sagittal plane kinematics were obtained using a high-speed video camera. Simultaneously, ground reaction forces and EMG of the lower limb muscles were recorded. Energy cost was calculated using steady-state oxygen uptake, respiratory ratio, and vertical distance of the body. Results: In all conditions, energy cost correlated positively with total mechanical work of the knee joint (r = 0.636, P < 0.01), but negatively with total mechanical work of the ankle joint (r = −0.584, P < 0.01). The muscle–tendon complex length of the gastrocnemius and soleus muscles were significantly longer in incline than in level and decline. The gastrocnemius muscle showed different activity pattern in decline as compared with the incline and level conditions. Conclusions: The present study revealed that the ankle and knee joint kinematics and, therefore muscles' coordination are associated with energy cost during repeated vertical jumping. The lower limb joints contributed different efficiencies to generate the same total mechanical work in repeated vertical jumping on different surface inclinations. Energy cost was smaller when mechanical work was mainly done by ankle joint. Whereas, when the ankle joint did less mechanical work, the knee and/or hip joints compensated for the lack of mechanical work of the ankle joint and energy cost was increased. [ABSTRACT FROM AUTHOR]

Both foam rolling and joint distraction training with elastic bands are very popular interventions designed to improve muscular function, motor performance, and joint range of motion, as well as to reduce feeling of fatigue and delayed onset of muscle soreness. The heterogeneity of methods used among studies however prevents from drawing firm conclusions about the optimal content of pre/post interventions. The present study aims at answering the following questions: i) Do foam rolling and joint distraction with elastic band training improve joint range of motion in national rugby players? ii) Do short and long rolling durations have similar effects on range of motion? In a first experiment, we compared ankle, knee, and hip flexibility scores in 30 national rugby players after a 7-week foam rolling training program involving either a short (20s) or long (40s) rolling duration. Data revealed that foam rolling substantially improved all range of motion scores, regardless the rolling duration (performance gains ranged from 9 to 18° in the foam rolling groups, i.e. 8 to 20% increase, but remained under 2° in the control group). In a second experiment, we investigated the effect of a 5-week joint distraction with elastic band training program on hamstring and adductor range of motion in 23 national rugby players. Data showed that elastic band training significantly improved sit-and-reach (29.16% increase, p = 0.01) as well as side split (2.31% increase, p < 0.001) stretching performances. Taken together, present findings confirm that both foam rolling and joint distraction exercises with elastic bands are likely to enhance joint range of motion and specific mobility patterns during sport performance, and further serve prophylaxis. Such effects therefore constitute a promising avenue for clinical, home therapy, and personal flexibility training. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Purpose: To investigate the joint-specific contributions to the total lower-extremity joint work during a prolonged fatiguing run. Methods: Recreational long-distance runners (n = 13) and competitive long-distance runners (n = 12) performed a 10-km treadmill run with near-maximal effort. A three-dimensional motion capture system synchronized with a force-instrumented treadmill was used to calculate joint kinetics and kinematics of the lower extremity in the sagittal plane during the stance phase at 13 distance points over the 10-km run. Results: A significant (P < 0.05) decrease of positive ankle joint work as well as an increase of positive knee and hip joint work was found. These findings were associated with a redistribution of the individual contributions to total lower-extremity work away from the ankle toward the knee and hip joint which was more distinctive in the recreational runner group than in the competitive runner group. This redistribution was accomplished by significant (P < 0.05) reductions of the external ground-reaction force lever arm and joint torque at the ankle and by the significant (P < 0.05) increase of the external ground-reaction force lever arm and joint torque at the knee and hip. Conclusions: The redistribution of joint work from the ankle to more proximal joints might be a biomechanical mechanism that could partly explain the decreased running economy in a prolonged fatiguing run. This might be because muscle–tendon units crossing proximal joints are less equipped for energy storage and return compared with ankle plantar flexors and require greater muscle volume activation for a given force. To improve running performance, long-distance runners may benefit from an exercise-induced enhancement of ankle plantar flexor muscle–tendon unit capacities. [ABSTRACT FROM AUTHOR]

Objective: To provide certified athletic trainers (ATs) with recommendations and guidelines for the immediate management of patients with joint dislocations. Background: One of the primary responsibilities of ATs is to provide immediate injury care for active individuals. Although ATs are confronted with managing patients who have many kinds of injuries, the onsite management of a joint dislocation presents challenges in evaluation and immediate treatment. The critical concern in managing a dislocation is deciding when a joint can be reduced onsite and when the patient should be splinted and transported for reduction to be performed in the hospital or medical setting. Factors that influence the decisionmaking process include the following: whether the AT possesses a documented protocol that is supported by his or her supervising physician(s), employer documents, and respective state regulations; the AT's qualifications and experience; the dislocated joint; whether the dislocation is first time or recurrent; the patient's age and general health; and whether associated injuries are present. Recommendations: These guidelines are intended to provide considerations for the initial care of specific joint dislocations. They are not intended to represent the standard of care and should not be interpreted as a standard of care for therapeutic or legal discussion. INSET: -. [ABSTRACT FROM AUTHOR]

Background: Ankle sprains frequently result in persistent sensorimotor deficits. Sufficient evidence of effects of sensorimotor training using unstable devices on physical functions is lacking. There is no insight as to whether simultaneous tactile stimulation of plantar foot mechanoreceptors using textured surfaces may influence outcomes in people with a history of ankle sprain. Purpose: The purpose of this study was to investigate the potential effects of sensorimotor training using unstable textured surfaces on balance, strength, joint function, and plantar sensitivity in recreational athletes with a history of ankle sprain. Participants: Nineteen recreational athletes (6 females, 13 males; mean age: 29 ± 7 years) with a history of ankle sprain and self-reported sensation of instability participated. Methods: Self-reported function of the ankle joint, plantar cutaneous detection threshold to light touch, balance during single-leg stance as well as maximal isometric strength of the ankle joint in eversion and inversion were measured. Participants were randomly allocated to either a training group using unstable textured surfaces or a training group using unstable smooth surfaces or a control group. Outcome measurements were repeated after six weeks of training and at follow-up after 10 weeks. Within and between group differences were analyzed using ANOVA, Friedman tests, or Kruskal Wallis tests (p<0.05) and post-hoc tests with Bonferroni correction. Correlations between outcome-parameters from baseline measurements were analyzed using Spearman's rho (p<0.05). Results: No significant between-group differences in all outcome measures were detected. However, a significant increase of strength in eversion was found for the training group using textured surfaces after 10 weeks (p=0.01). A moderate correlation existed between plantar detection threshold of metatarsal head (MT) I and strength of inversion (r = 0.51, p<0.05) before training across all groups. There were moderate negative correlations between balance parameters and strength in eversion (r = -0.57 -- -0.64, p≤0.01) as well as plantar detection thresholds at MT V (r = -0.48 -- -0.62, p<0.05) at baseline across all groups. Conclusion: A six-week sensorimotor training using unstable smooth and textured surfaces demonstrated no significant differences in balance, strength in eversion and inversion, plantar foot sensitivity, and self-reported ankle instability between training groups and the control group in recreational athletes with a history of ankle sprain. A better score on balance testing seems to correlate with an increase in eversion ankle strength and a decreased plantar sensitivity at MT V. [ABSTRACT FROM AUTHOR]

Repeatability and reproducibility indices are often used in gait analysis to validate models and assess patients in their follow-up. When comparing joint kinematics, their interpretation can be ambiguous due to a lack of understanding of the exact sources of their variations. This paper studied four indices (Root Mean Square Deviation, Mean Absolute Variability, Coefficient of Multiple Correlation, and Linear Fit Method) in relation to five confusing-factors: joints' range of motion, sample-by-sample amplitude variability, offset, time shift and curve shape. A first simulation was conducted to test the mathematics behind each index. A second simulation tested the influence of the curve shape on the indices using a Fourier's decomposition. The Coefficient of Multiple Correlation and the Linear Fit method Coefficients were independent from the range of motion. Different Coefficients of Multiple Correlation were found among different joints, leading to misinterpretation of the results. The Linear Fit Method coefficients should not be adopted when time shift increases. Root Mean Square Deviation and Mean Absolute Variability were sensitive to all the confusing-factors. The Linear Fit Method coefficients seemed to be the most suitable to assess gait data variability, complemented with Root Mean Square Deviation or Mean Absolute Variability as measurements of data dispersion. [ABSTRACT FROM AUTHOR]