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The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury. Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps. Consensus process. Virtual video conference calls and online voting. The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds. The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation. The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury. [ABSTRACT FROM AUTHOR]

Researchers have not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with patellar tendon structural abnormality (PTA) compared with healthy athletes. To compare involved-limb landing biomechanics between male athletes with and those without patellar tendinopathy. Cross-sectional study. Laboratory. A total of 43 male athletes were grouped based on patellar tendon pain and ultrasound imaging of the proximal patellar tendon: symptomatic with PTA (SYM; n = 13; age = 19.62 ± 1.61 years, height = 1.82 ± 0.05 m, mass = 83.46 ± 5.12 kg), asymptomatic with PTA (ASYM; n = 15; age = 21.13 ± 1.88 years, height = 1.84 ± 0.07 m, mass = 81.45 ± 13.26 kg), and healthy control (CON; n = 15; age = 19.60 ± 1.55 years, height = 1.84 ± 0.09 m, mass = 79.09 ± 12.37 kg). Three-dimensional biomechanics were collected during a double-limb jump-landing task. Kinematic (knee-flexion angle [KF]) and kinetic (vertical ground reaction force, internal knee-extension moment [KEM], patellar tendon force [FPT]) variables were analyzed as continuous waveforms during the stance phase for the involved limb. Mean values were calculated for each 1% of stance, normalized over 202 data points (0%–100%), and plotted with 95% CIs. Statistical significance was defined as a lack of 95% CI overlap for a minimum of a consecutive 3% of the stance phase. The SYM group had less KF than the CON group throughout the stance phase (8%–76%: Cohen d = 1.14 ± 0.12, mean difference [MD] = 15.83° ± 2.71°). The ASYM group had less KF than the CON group in the early (8%–13%: Cohen d = 0.99 ± 0.04, MD = 7.99° ± 0.39°; 21%–24%: Cohen d = 1.01 ± 0.01, MD = 11.11° ± 0.32°) and late (74%–94%: Cohen d = 0.96 ± 0.07, MD = 9.55° ± 1.13°) stance phases. The SYM group had a smaller KEM (6.5%–9%: Cohen d = 1.21 ± 0.08, MD = 0.04 ± 0.004 N·m/[Nbw·mht]) and less FPT (6%–9%: Cohen d = 1.15 ± 0.15, MD = 0.85 ± 0.15 body weight) than the CON group in the early stance phase. The SYM group also displayed a smaller KEM (38%–56%: Cohen d = 1.17 ± 0.06, MD = 0.03 ± 0.001 N·m/[Nbw·mht]) and less FPT (36%–60%: Cohen d = 1.22 ± 0.08, MD = 0.66 ± 0.05 body weight) than the ASYM group in the midstance phase. The SYM group demonstrated a patellar tendon load-avoidance profile compared with the ASYM and CON groups. The ASYM group showed no evidence of overloading compared with the CON group. Our findings support the need for individualized treatments for athletes with tendinopathy to maximize load capacity. [ABSTRACT FROM AUTHOR]

Prolonged training leads to changes in autonomic cardiac balance. This sympathetic and parasympathetic balance can now be studied using heart rate variability (HRV). Studies have shown that endurance athletes have an elevated level of parasympathetic tone in comparison to sedentary people. The effect of resistance training on autonomic tone is less clear. We hypothesized a significant difference in HRV indices in endurance-trained vs. power-trained track-and-field athletes. One hundred forty-five athletes (58 women) were tested prior to the 2004 U.S.A. Olympic Trials. Heart rate variability data were collected using the Omegawave Sport Technology System. Subjects were grouped according to training emphasis and gender. The mean age of the athletes was 24.8 years in each group. There were significant (p < 0.01) differences by sex in selected frequency domain variables (HFnu, LFnu, LH, LHnu) and for PNN50 (p < 0.04) for the time domain variables. Two-factor analyses of variance showed differences for only the main effect of sex and not for any other grouping method or interaction. Elite athletes have been shown to have higher parasympathetic tone than recreational athletes and nonathletes. Our data show differences by sex, but not between aerobically and power-based athletes. Whether this is due to an aerobic component of resistance training, an overall prolonged training effect, or some genetic difference remains unclear. Further study is needed to assess the impact of resistance training programs on autonomic tone and cardiovascular fitness. This information will be valuable for the practitioner to use in assessing an athlete's response to a prescribed training regimen. KEY WORDS. endurance training, parasympathetic tone, sympathetic tone

Interleukin‐1 (IL1) is a cytokine that plays a role in inflammation and is a potential contributor to the inflammation present in tendinopathy. Its inhibition may be of use in the treatment of tendinopathy and has been a target for treatment. To evaluate how an IL1‐receptor antagonist (IL1‐RA) reverses pathologic changes associated with established patellar tendinopathy, we randomized 48 Sprague‐Dawley retired breeder rats into three groups having weekly bilateral patellar tendon injections for 6 weeks. The control group received 0.1 mL saline for 6 weeks. The intervention groups were treated with 0.1 mL 2% carrageenan for 4 weeks. Beginning at week three, the IL1‐RA group received 0.94 mg of the IL1‐RA (2.5 mg/kg) added to the 0.1 mL 2% carrageenan and 0.94 mg of the IL1‐RA alone for the final 2 weeks, while the CAR received 0.1 mL saline for the final 2 weeks. Animals were euthanized 6 weeks after initial injection. The CAR group demonstrated significantly (P < 0.05) shorter tendon lengths (7.81 ± 0.44 mm) than the control (8.25 ± 0.58 mm) and IL1‐RA (8.34 ± 0.52 mm) group (P < 0.05). Macroscopically, plaque‐like formations were reduced and margins of the tendon were more evident in the IL1‐RA group compared to the CAR group. CAR group demonstrated significantly greater histopathologic changes (inflammatory cell density, disorganization of collagen, nuclear rounding, and angiogenesis) than the control and IL1‐RA group. No significant difference in mechanical properties of the tendon was noted. These findings demonstrate IL1‐RA can reduce pathologic changes in the patellar tendon in an established tendonitis model although did not demonstrate a difference in mechanical properties. [ABSTRACT FROM AUTHOR]

Background and Purpose: The accurate performance of physical therapy exercises can be difficult. In this evolving healthcare climate it is important to continually look for better methods to educate patients. The use of handouts, inperson demonstration, and video instruction are all potential avenues used to teach proper exercise form. The purpose of this study was to examine if a corrected error video (CEV) would be as effective as a single visit with a physical therapist (PT) to teach healthy subjects how to properly perform four different shoulder rehabilitation exercises. Study Design: This was a prospective, single-blinded interventional trial. Methods: Fifty-eight subjects with no shoulder complaints were recruited from two institutions and randomized into one of two groups: the CEV group (30 subjects) was given a CEV comprised of four shoulder exercises, while the physical therapy group (28 subjects) had one session with a PT as well as a handout of how to complete the exercises. Each subject practiced the exercises for one week and was then videotaped performing them during a return visit. Videos were scored with the shoulder exam assessment tool (SEAT) created by the authors. Results: There was no difference between the groups on total SEAT score (13.66 ± 0.29 vs 13.46 ± 0.30 for CEV vs PT, p = 0.64, 95% CI [-0.06, 0.037]). Average scores for individual exercises also showed no significant difference. Conclusion/Clinical Relevance: These results demonstrate that the inexpensive and accessible CEV is as beneficial as direct instruction in teaching subjects to properly perform shoulder rehabilitation exercises. Level of Evidence: 1b [ABSTRACT FROM AUTHOR]

Intra-articular corticosteroid and hyaluronic acid injections provide short-term symptom amelioration for arthritic conditions involving structural damage or degenerative changes in the knee. Conventional palpation-guided anatomical injections frequently result in inaccurate needle placement into extra-articular tissue and adjacent structures. The purpose of this review was to determine the effect of ultrasound guidance on the accuracy of needle placement, clinical outcomes, and cost-effectiveness in comparison with anatomical landmarkguided intra-articular large joint injections, with particular emphasis on the knee. A total of 13 relevant studies were identified; five studied the knee, seven studied the shoulder, one used both the knee and shoulder, and none studied the hip. Ultrasound was used in seven studies; the remaining studies utilized air arthrography, fluoroscopy, magnetic resonance arthrography, or magnetic resonance imaging. Across all studies (using all imaging modalities and all joints), needle placement accuracy ranged from 63% to 100% with ultrasound and from 39% to 100% with conventional anatomical guidance. Imaging guidance improved the accuracy of intraarticular injections of the knee (96.7% versus 81.0%, P , 0.001) and shoulder (97.3% versus 65.4%, P , 0.001). In particular, ultrasound guidance of knee injections resulted in better accuracy than anatomical guidance (95.8% versus 77.8%, P , 0.001), yielding an odds ratio of 6.4 (95% confidence interval 2.9-14). Ultrasound guidance notably improves injection accuracy in the target intra-articular joint space of large joints including the knee. The enhanced injection accuracy achieved with ultrasound needle guidance directly improves patient-reported clinical outcomes and cost-effectiveness [ABSTRACT FROM AUTHOR]

Context: Prior research has not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with patellar tendon structural abnormality (PTA) compared to healthy athletes., Objective: The purpose was to compare involved limb landing biomechanics between male athletes with and without patellar tendinopathy., Design: Cross-sectional study Setting: Laboratory Patients or Other Participants: 43 males were grouped based on patellar tendon pain & ultrasound imaging of the proximal patellar tendon: symptomatic with PTA (SYM-PTA; n=13; 20±2yrs; 1.8±0.1m; 84±5kg), asymptomatic with PTA (ASYM-PTA; n=15; 21±2yrs; 1.8±0.1m; 82±13kg), and healthy control (CON; n=15; 20±2yrs; 1.8±0.1m; 79±12kg)., Main Outcome Measures: 3D biomechanics were collected during double-limb jump-landing. Kinematic (knee flexion angle (KF)) and kinetic (vertical ground reaction force (VGRF); internal knee extension moment (KEM); patellar tendon force (FPT)) variables were analyzed as continuous waveforms during the stance phase for the involved limb. Mean values were calculated for each 1% of stance, normalized over 202 data points (0-100%), and plotted with 95% confidence intervals. Statistical significance was defined as a lack of 95% CI overlap for ≥ 6 consecutive data points., Results: SYM-PTA had lesser KF than CON throughout the stance phase. ASYM-PTA had lesser KF than CON in the early and late stance phase. SYM-PTA group had lesser KEM and FPT than CON in early stance, as well as ASYM-PTA in mid-stance., Conclusions: Male athletes with SYM-PTA demonstrated a patellar tendon load-avoidance profile compared to ASYM-PTA and CON athletes. ASYM-PTA did not show evidence of overloading compared to CON. Our findings support the need for individualized treatments for athletes with tendinopathy to maximize load-capacity., Trial Registry: ClinicalTrials.gov (#XXX).