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Objective: To compare the clinical outcomes between patients with moderate and severe slipped capital femoral epiphysis (SCFE) treated with osteotomy at the base of neck and osteoplasty and with healthy individuals. Methods: Comparative cohort with 12 patients (14 hips) with moderate and severe SCFE who underwent osteotomy at the base of neck and osteoplasty between 2007 and 2014. The mean age at surgery was 13.3 ± 2.5 years and the mean follow-up was 3.8 ± 2.2 years. We assessed the level of hip pain by the visual analog scale (VAS) and anterior impingement test (AIT); the level of function using the Harris Hip Score (HHS) and 12-Item Short Form Health Survey (SF-12), the range of motion (ROM) by goniometry and Drehmann sign, and the hip muscular strength by isokinetic and Trendelenburg sign. Results: The level of pain was slightly higher in the SCFE cohort compared with healthy hips (VAS, 0.8 ± 1.4 vs 0 ± 0, 0.007; AIT, 14% vs 0%, p = 0.06; respectively). No differences were observed between the SCFE and control cohort for the functional scores (HHS, 94 ± 7 vs 100 ± 1, p = 0.135); except for ROM, with increased internal rotation (37.3º ± 9.4º vs 28.7º ± 8.2º, p < 0.001), and strength, with decreased abduction torque (75.5 ± 36.9 Nm/Kg vs 88.5 ± 27.6 Nm/Kg, p = 0.045) in the SCFE cohort. Conclusion: The osteotomy at the base of neck and the osteoplasty restored the hip motion and muscle strength, except for the abductor strength, to near normal levels, representing a viable option for the treatment of moderate and severe SCFE. Level of Evidence III, Ambidirectional Cohort Study. RESUMO Objetivo: Comparar resultados clínicos de pacientes com escorregamento epifisário proximal do fêmur (EEPF) moderado e grave tratados com osteotomia basocervical e cervicoplastia com indivíduos saudáveis. Métodos: Coorte comparativa com 12 voluntários saudáveis e 12 pacientes (14 quadris) com EEPF moderado e grave submetidos à osteotomia basocervical e cervicoplastia entre 2007 e 2014. A média de idade na cirurgia foi de 13,3 ± 2,5 anos e o seguimento médio de 3,8 ± 2,2 anos. Avaliou-se nível de dor no quadril utilizando a escala visual analógica (EVA) e o teste de impacto anterior (TIA); nível de função usando o Harris Hip Score (HHS) e o 12-Item Short Form Health Survey (SF-12); amplitude de movimento (ADM) com goniometria e sinal de Drehmann; e força muscular do quadril com dinamômetro isocinético e sinal de Trendelenburg. Resultados: O nível de dor foi ligeiramente maior na coorte de EEPF comparado a quadris saudáveis (EVA, 0,8 ± 1,4 vs 0 ± 0, 0,007; TIA, 14% vs 0%, p = 0,06; respectivamente). Não foram observadas diferenças entre os grupos EEPF e controle para os escores funcionais (HHS, 94 ± 7 vs 100 ± 1, p = 0,135), exceto para ADM, com aumento da rotação interna (37,3º ± 9,4º vs 28,7º ± 8,2º, p < 0,001), e força, com diminuição do torque de abdução (75,5 ± 36,9 Nm/Kg vs 88,5 ± 27,6 Nm/Kg, p = 0,045), para o grupo EEPF. Conclusão: A osteotomia basocervical e a cervicoplastia restauraram o movimento do quadril e a força muscular, com exceção da força abdutora, a níveis próximos do normal, representando uma opção viável para o tratamento de EEPF moderado e grave. Nível de Evidência III, Estudo de Coorte Ambidirecional.

To quantify pelvic retroversion during clinical evaluation of hip flexion with accelerometers and to verify the reliability of these sensors to measure hip flexion.An accelerometer was positioned laterally in the pelvis to measure pelvic retroversion. Another accelerometer was positioned anteriorly on the thigh to evaluate hip flexion amplitude. The evaluations were performed with volunteers in supine position by three raters. For evaluation of pelvic retroversion, the mean ± SD (minimum-maximum) was calculated. Reliability of the accelerometer between raters was determined by intraclass correlation coefficients (ICC). The linear correlation coefficient between hip flexion was determined by using goniometer and accelerometer.The mean pelvic retroversion was 7.3° ± 0.93° (6°-11°) in the clinical limit of the hip range of motion, which was 106.25° ± 10.46° (93°-130°). The ICC between two raters were 0.60, 0.71 and 0.74 (goniometer) and 0.46, 0.71 and 0.83 (accelerometer). The linear correlation between hip flexion measurements with goniometer and accelerometer was 0.87.During clinical evaluation of the final range of hip flexion, there was an associated pelvic movement of approximately 7.3º. Accelerometers have proven to be reliable for measurement of hip flexion.Quantificar a retroversão pélvica durante avaliação clínica da flexão do quadril com acelerômetros e verificar a confiabilidade destes sensores para mensurar flexão do quadril.Posicionou-se um acelerômetro lateralmente na pelve para mensurar retroversão pélvica. Outro foi posicionado anteriormente sobre a coxa para avaliar flexão do quadril. As avaliações foram realizadas com voluntários, em decúbito dorsal, por três avaliadores. Para avaliação da retroversão pélvica, determinou-se a média ± DP (mínimo-máximo). Avaliou-se a confiabilidade dos acelerômetros entre avaliadores pelo coeficiente de correlação intraclasse (CCI). Determinou-se o coeficiente de correlação linear entre as mensurações de flexão do quadril com goniômetro e acelerômetro.A retroversão pélvica média foi de 7,3° ± 0,93° (6°-11°), mensurada no limite clínico da flexão do quadril, que foi de 106,25° ± 10,46° (93°-130°), ambos com acelerômetro. Os CCI entre dois avaliadores diferentes nas avaliações de flexão do quadril foram de 0,60, 0,71 e 0,74 (goniômetro) e 0,46, 0,71 e 0,83 (acelerômetro). A correlação linear entre as mensurações de flexão do quadril com goniômetro e acelerômetro foi de 0,87.Durante avaliação clínica da amplitude final de flexão do quadril, houve movimentação associada da pelve aproximadamente de 7,3°. Acelerômetros mostraram-se confiáveis para mensuração da flexão do quadril. Nível de evidência III, Estudo de pacientes não consecutivos sem padrão de referência “ouro” aplicado uniformemente.

Existe limitada evidência comparativa para o tratamento do EEPF moderado e grave. Nós investigamos o nível de dor no quadril, escores clínicos, mobilidade e força muscular do quadril em três grupos de pacientes com EEPF divididos de acordo com o tratamento em epifisiodese in situ, osteotomia basocervical e cervicoplastia ou procedimento modificado de Dunn, comparando-os com quadris de indivíduos saudáveis. Foram incluídos 31 pacientes (35 quadris) diagnosticados com EEPF entre 2007 e 2014, com um tempo de seguimento mínimo de dois anos. Oito pacientes (10 quadris) foram submetidos à epifisiodese in situ devido EEPF leve. Vinte e três pacientes (25 quadris) com EEPF moderado ou grave foram submetidos ao procedimento modificado de Dunn (11 pacientes; 11 quadris) ou osteotomia basocervical e cervicoplastia (12 pacientes; 14 quadris). Doze voluntários saudáveis sem sintomas no quadril compuseram o grupo controle. Foi avaliado o nível de dor no quadril por meio da escala visual analógica, teste de impacto anterior, Harris Hip Score (HHS), 12-Item Short Form Health Survey (SF12), amplitude de movimento, sinal de Drehmann, dinamometria muscular isocinética e teste de Trendelenburg. Dor, força muscular e prevalência do teste de Trendelenburg foram similares entre EEPF leve e EEPF moderado ou grave. Piores resultados no teste de impacto anterior, HHS e amplitude de flexão foram observados em EEPF moderado e grave, comparado com EEPF leve e indivíduos saudáveis. Além disso, nós identificamos que procedimento modificado de Dunn resultou em maior nível de dor, prevalência aumentada de teste de impacto anterior e Trendelenburg positivos, menor HHS, menor amplitude de flexão e rotações do quadril em comparação com osteotomia basocervical e cervicoplastia. O tratamento do EEPF moderado e grave com osteotomia basocervical e cervicoplastia ou procedimento modificado de Dunn restaurou parcialmente o nível de dor e força muscular para níveis de escorregamentos leves tratados com epifisiodese in situ. A associação da osteotomia basocervical e cervicoplastia pode proporcionar resultados satisfatórios para EEPF moderado e grave. Limited comparative evidence exists for the treatment of moderate and severe SCFE. We aimed to investigate the level of hip pain, clinical scores, motion, and muscle strength in three cohorts of patients with SCFE who underwent in situ epiphysiodesis, base of neck osteotomy and osteoplasty, or modified Dunn procedure, comparing them to hips from healthy individuals.We included 31 patients diagnosed with SCFE between 2007 and 2014, and a minimum follow-up of two years. Eight patients (10 hips) underwent in situ epiphysiodesis due to a mild SCFE. Twenty-three patients (25 hips) with moderate or severe SCFE underwent the modified Dunn procedure (11 patients; 11 hips) or the base of neck osteotomy and osteoplasty (12 patients; 14 hips). Twelve healthy volunteers without hip symptoms composed the control cohort. We evaluated the level of hip pain using the visual analog scale, anterior impingement test, Harris Hip Score (HHS), 12-Item Short Form Health Survey (SF12), range of motion, Drehmann sign, isokinetic muscle dynamometry and Trendelenburg test. Pain, muscle strength and prevalence of Trendelenburg test were similar between mild and moderate or severe SCFE. Worse outcomes for the anterior impingement test, HHS, and range of flexion were observed for moderate and severe SCFE, compared with mild SCFE and controls. Furthermore, we identified that the modified Dunn procedure presented with higher level of pain and prevalence of positive anterior impingement and Trendelenburg tests, lower HHS, lower range of hip flexion and rotations in comparison with the base of neck osteotomy and osteoplasty.The treatment of moderate and severe SCFE with the base of neck osteotomy or modified Dunn procedure partially restored the level of pain and muscle strength to the levels of mild slips treated with in situ epiphysiodesis. The association of the base of neck osteotomy and osteoplasty may provide satisfactory outcomes for moderate and severe SCFE.

The productivity of perennial ryegrass (Lolium perenne L.) is constrained by summer water deficit. We hypothesised that selection for desirable water relations traits might partially mitigate this constraint. Genotypes of a 1970s, and two recent ryegrass cultivars were grown in 55 cm tall pots for three months and exposed to moisture deficit for four weeks, then 66 plants were assessed for shoot (SDW) and root (RDW) dry weight, leaf elongation rate (LER), specific water use (SWU), leaf osmotic potential (OP), OP change, leaf relative water content (RWC), and gravimetric soil moisture. Among the 66 genotypes, SWU ranged from 935 ± 19 to 1754 ± 74 g H2O g–1 DM. In principal component (PC) analysis, PC1 indicated greater growth and lower SWU from greater soil water extraction as the common trait association among genotypes tested and ANOVA of PC scores indicated that recent cultivars outperformed the 1970s cultivar. PC2 indicated water saving by decreased LER and SDW, with increased RDW indicative of summer dormancy. PC3 associated more negative OP with improved SWU and RWC. This experiment demonstrates not only genotypic diversity for SWU but also diversity in trait associations determining SWU, which should be considered when investigating SWU, both in ecology and agronomy research.

Aims The aims of this study were to evaluate the abductor function in moderate and severe slipped capital femoral epiphysis (SCFE), comparing the results of a corrective osteotomy at the base of the femoral neck and osteoplasty with 1) in situ epiphysiodesis for mild SCFE, 2) contralateral unaffected hips, and 3) hips from healthy individuals. Patients and Methods A total of 24 patients (mean age 14.9 years (sd 1.6); 17 male and seven female patients) with moderate or severe SCFE (28 hips) underwent base of neck osteotomy and osteoplasty between 2012 and 2015. In situ epiphysiodesis was performed in seven contralateral hips with mild slip. A control cohort was composed of 15 healthy individuals (mean age 16.5 years (sd 2.5); six male and nine female patients). The abductor function was assessed using isokinetic dynamometry and range of abduction, with a minimum one-year follow-up. Results We found no differences in mean peak abductor torque between the hips that underwent osteotomy and those that received in situ epiphysiodesis (p = 0.63), but the torque was inferior in comparison with contralateral hips without a slip (p < 0.01) and hips from control individuals (p < 0.001). The abduction strength was positively correlated with the range of hip abduction (R = 0.36; p < 0.001). Conclusion Although the abductor strength was not restored to normal levels, moderate and severe SCFE treated with osteotomy at the base of the femoral neck and osteoplasty showed abductor function similar to in situ epiphysiodesis in hips with less severe displacement. Cite this article: Bone Joint J 2018;100-B:1524–32.

The objective of this study was to assess electromyographic features of the brachial biceps muscle after the application of cryotherapy and short-wave diathermy. Sixty healthy volunteers participated in the study and were equally divided into three groups: cryotherapy - application of ice packs for 30 min; short-wave diathermy for 20 min; and control. The thermal agents were applied to the anterior and posterior regions of the non-dominant arm. The electromyographic (EMG) signal from the brachial biceps was recorded before and after the application of thermal agents during flexion of the elbow joint at 25%, 50%, 75% of a maximum voluntary isometric contraction defined at least two days before the actual experiments (MVICbl). The volunteers also were asked to execute a free MVIC before and after the application of the thermal agents (MVIC free). A linear regression model with mixed effects (random and fixed) was used. Intra-group analysis showed a reduction in root mean square (RMS) at MVIC free, with no change in the median frequency of the EMG signal at any contraction level for the short-wave diathermy group. An increase on RMS values and a decrease on median frequencies were found after the application of cryotherapy for all contraction levels. The results imply that cryotherapy plays an important role on changing neuromuscular responses at various levels of muscle contraction. Therapists should be aware of that and carefully consider its use prior to activities in which neuromuscular precision is required.