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Background Stair climbing is a complex and demanding daily activity with increased physical loads. Therefore, analyzing stair climbing abilities is a frequently used diagnostic tool. Leg length inequalities (LLIs) are a common condition in the population, with individual consequences like lower back pain, scoliosis, and osteoarthritis. Despite its high prevalence, the necessary treatment, for mild LLIs, is still controversial. Previously, the focus was to analyze the effects of LLIs during static standing and walking. To create a holistic view on the dynamic effects of LLIs, and since climbing stairs produces a similar biomechanical imbalance as LLIs, the compensation mechanics during stair climbing are of special interest. Research question What are the biomechanical compensation mechanisms of (simulated) LLIs during ascending and descending stairs? Methods Thirty-five healthy participants were measured with the inertial measurement system MyoMotion during stair climbing with simulated LLIs of 0–3 cm. The maximum estimated lower limb joint angles of the long and short leg were analyzed with statistically repeated measurement models. Results The long leg showed significantly increased hip and knee flexion, while the short leg showed decreased hip and knee flexion, decreased dorsiflexion, and significantly increased plantarflexion. Different mechanisms were found in the case of 1 cm LLI when compared to greater LLIs. In the former, increased hip and knee flexion in the short leg accompanied by increased dorsiflexion in the long leg was observed. In the latter, the dorsiflexion of the long leg was reduced. Significance Except for the reduced dorsiflexion of the long leg (LLI >1 cm), during stair climbing compared compensation mechanisms as during walking were presented, with the long leg functionally shortened and the short leg lengthened. Although the feet were already on different levels, during stair climbing with the step-over-step technique, significant compensation mechanisms were found as a consequence of LLIs.

Recent studies have suggested that psychological factors are important components of a successful return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to survey physicians with respect to their criteria used to determine readiness to RTS after ACLR and to understand the significance of psychological factors on RTS.A survey was designed to understand the practices of clinicians managing rehabilitation after ACLR, consisting of 25 questions divided into 3 different sections, including one section about psychological scores and factors affecting RTS. The survey was delivered to three North American organizations for orthopedic sports medicine.The total number of respondents was 113. Of the respondents, 95% considered psychological tests at least "somewhat important" (33% "important", 23% selected "very important"). Routine use of psychological tests in practice was only reported by 35% of respondents. The ACL-Return to Sport after Injury Scale was the most frequently used psychological test (23%). Fear of reinjury was considered the most common patient-cited psychological factor affecting RTS. Psychological factors ranked 8th out of 9 outcomes measures in determining readiness to RTS.This study demonstrates a discrepancy between the importance of psychological tests and the frequency of use in practice. Additional education on this topic, web-based applications, and a multidisciplinary approach may increase the usage of psychological tests to determine RTS after ACLR.Psychische Faktoren sind laut neueren Studien wichtige Bestandteile einer erfolgreichen Rückkehr zum Sport (RTS) nach vorderer Kreuzbandrekonstruktion (ACLR). Das Ziel dieser Studie war es, Ärzte hinsichtlich der Kriterien zu befragen, die sie verwenden, um die Bereitschaft zu RTS nach ACLR zu bestimmen und somit die Bedeutung psychologischer Faktoren bei RTS zu verstehen.Die Umfrage wurde entwickelt, um den Ansatz von Ärzten zu verstehen, die die Rehabilitation nach ACLR betreuen. Die Umfrage bestand aus 25 Fragen, die in 3 verschiedene Abschnitte unterteilt waren. Ein Abschnitt befasste sich mit psychologischen Werten und Faktoren, die RTS beeinflussen. Die Umfrage wurde an 3 nordamerikanische Organisationen für orthopädische Sportmedizin geliefert.Die Gesamtzahl der Befragten lag bei 113, wobei 95% der Befragten psychologische Tests als mindestens „ziemlich wichtig“ einstuften (33% „wichtig“, 23% wählten „sehr wichtig“). Nur 35% der Befragten gaben an, in ihrer Praxis routinemäßig psychologische Tests einzusetzen. Die ACL-„Return-to-Sport-after-Injury-Skala“ war der am häufigsten verwendete psychologische Test (23%). Die Angst vor einer erneuten Verletzung wurde als der am häufigsten von Patienten genannte psychologische Faktor angesehen, der RTS beeinflusst. Psychologische Faktoren belegten den 8. Platz von 9 Ergebnismessungen bei der Bestimmung der Bereitschaft zu RTS.Diese Studie zeigt eine Diskrepanz zwischen der Bedeutung psychologischer Tests und der Häufigkeit der Anwendung in der Praxis. Zusätzliche Aufklärung zu diesem Thema, webbasierte Anwendungen und ein multidisziplinärer Ansatz können dazu beitragen, den Einsatz psychologischer Tests zur Bestimmung der Rückkehr zum Sport nach der Rekonstruktion des vorderen Kreuzbandes zu erhöhen.

Background Recent studies have suggested that psychological factors are important components of a successful return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to survey physicians with respect to their criteria used to determine readiness to RTS after ACLR and to understand the significance of psychological factors on RTS. Methods A survey was designed to understand the practices of clinicians managing rehabilitation after ACLR, consisting of 25 questions divided into 3 different sections, including one section about psychological scores and factors affecting RTS. The survey was delivered to three North American organizations for orthopedic sports medicine. Results The total number of respondents was 113. Of the respondents, 95% considered psychological tests at least “somewhat important” (33% “important”, 23% selected “very important”). Routine use of psychological tests in practice was only reported by 35% of respondents. The ACL-Return to Sport after Injury Scale was the most frequently used psychological test (23%). Fear of reinjury was considered the most common patient-cited psychological factor affecting RTS. Psychological factors ranked 8th out of 9 outcomes measures in determining readiness to RTS. Conclusion This study demonstrates a discrepancy between the importance of psychological tests and the frequency of use in practice. Additional education on this topic, web-based applications, and a multidisciplinary approach may increase the usage of psychological tests to determine RTS after ACLR.

Background Until recently, rasterstereographic analysis of the spine was limited to static measurements. However, understanding and evaluating the motion of the spine under dynamic conditions is an important factor in the diagnosis and treatment of spinal pathologies. The aim of this study was to study the spinal posture and pelvic position under dynamic conditions and compare it to static measurements using a dynamic rasterstereographic system. Methods A total of 121 healthy volunteers (56 females; 65 males) were included in this observational study. The parameters trunk inclination, trunk imbalance, pelvic obliquity, kyphotic angle, lordotic angle, surface rotation, and lateral deviation were studied and compared under static and dynamic (1, 2, 4, 5 km/h) conditions using the system “Formetric 4D Motion®“ (DIERS International GmbH, Germany). Results Female volunteers had a higher lordotic angle than males under static conditions (p < 0.001). Trunk inclination (5.31° vs. 6.74°), vertebral kyphotic angle (42.53° vs. 39, 59°), and surface rotation (3.35° vs. 3.81°) increase under dynamic conditions (p < 0.001). Trunk inclination and lordotic angle both show significant changes during walking compared to static conditions (p < 0.001). Conclusion The spinal posture differs between females and males during standing and during walking. Rasterstereography is a valuable tool for the dynamic evaluation of spinal posture and pelvic position, which can also be used to quantify motion in the spine and therefore it has the potential to improve the understanding and treatment of spinal pathologies. Trial registration Retrospectively registered

BMC musculoskeletal disorders 23, 174 (2022). doi:10.1186/s12891-022-05113-2, Published by BioMed Central, London

Archives of orthopaedic and trauma surgery 142(6), 1275-1281 (2022). doi:10.1007/s00402-021-03989-8, Published by Springer, Berlin ; Heidelberg

Aesthetic plastic surgery (2022). doi:10.1007/s00266-022-03141-w, Published by Springer, New York, NY ; Heidelberg ; Berlin

Background: Recent studies have suggested that psychological factors are important components of successful return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to survey physicians on their criteria used to determine readiness to RTS after ACLR and understand the significance of psychological factors on RTS.Methods: A survey was designed to understand the practices of clinicians managing rehabilitation after ACLR consisting of 25 questions divided in 3 different sections, including one section about psychological scores and factors affecting RTS. The survey was delivered to three North-American orthopaedic sports medicine organizations.Results: The total number of respondents was 113. 95% of respondents considered psychological tests at least “somewhat important” (33% “important”, 23% selected “very important”). Routine use of psychological tests in practice was only reported by 35% of respondents. The ACL-Return to Sport after Injury Scale was the most frequently used psychological test (23%). Fear of reinjury was considered the most common patient-cited psychological factor affecting RTS. Psychological factors ranked 8th out of 9 outcomes measures in determining readiness to RTS.Conclusion: This study demonstrates a discrepancy between the importance of psychological tests and the frequency of use in practice. Additional education on this topic, web-based applications and a multidisciplinary approach may increase the usage of psychological tests to determine RTS after ACLR.

Background Surface-topography has been used for almost two decades in the radiation-free clinical evaluation of spinal posture. So far, it was limited to the analysis of back surface and spine. In order to better understand, diagnose and treat complex spinal pathologies, it is important to measure the whole torso. Research question Purpose of this study was to introduce and test an application that allows 360° reconstruction and analysis of the patient’s torso. Methods The application uses the information gathered from eight distinct scans and angles. For validation we used an Alderson phantom as an anthropomorphic body. Defined areas and volumes were measured by CT and surface-topography. Inter- and intra-rater reliability was tested in 35 healthy subjects by two observers. Results The results revealed good correspondence between systems in the imaging and evaluation of the Alderson model (5.3–0.5%). Inter- (0.9–0.98) and intra-rater reliability (0.8–0.95) testing revealed good and excellent results in the detection of almost all body surface structures and measurement of areas and volumes. Only area and volume measurements using jugular notch as a reference showed partly moderate results in reliability (0.62–0.93) testing. Significance We were able to introduce a novel 360° torso scan application using surface topography to reconstruct torso measurements. The results of our study showed its high validity and reliability. In the future, this application needs to be tested in patients with spinal pathologies. In summary, this new application may help to better understand, diagnose and treat patients with pathologies of torso and spine.

Leg length inequalities (LLI) are a common problem in medicine. So far, the diagnosis and treatment are performed under static conditions. Surface Topography (ST) is an optical, non-invasive technique that uses the principle of triangulation to measure spinal posture and pelvic position. This technique offers the opportunity to detect and treat LLIs and their effects under dynamic conditions.question The aim of the study is to show that ST can detect simulated LLIs under dynamic conditions and to prove if there are differences between the effects on the human body under static and dynamic conditions.In the clinical study a total of 30 test subjects were examined with a ST measuring device. LLIs (1 to 4 cm) were simulated using a custom- built sandal and insoles of various thickness. The pelvic obliquity, the surface rotation and lateral deviation of the spine were detected on a treadmill under static and dynamic conditions (3 km/h).Under static and dynamic conditions LLIs lead to a significant increase of all measured parameters. The pelvic obliquity reaches a significant level of p 0.0001 under static and p = 0.0001-0.0421 under dynamic conditions. However, for all examined parameters the magnitudes of the parameters under dynamic conditions were smaller than under static conditions.The study showed that simulated LLIs also have a significant effect on the human pelvis and spine under dynamic conditions, but with a smaller magnitude than under static conditions. The human individuum is a dynamic one. Because of that, for the future it should be of great interest to use dynamic measurements to detect and treat LLIs to provide an over correction of LLIs.

Background Smartphones have become increasingly more popular and complicated tasks can be performed with these devices. However, the increasing use is associated with shoulder and neck pain, as well as with psychological addiction. Research question Do different smartphone tasks lead to changes in spinal posture and pelvic position? Is there a relationship between smartphone addiction and changes in posture? Methods A cross-sectional study including 50 participants was performed. Test subjects completed the Smartphone Addiction Scale and the SF-36 health questionnaire. Subjects spinal posture and pelvic position during different smartphone tasks were measured through a surface topography system. The different tasks were: standing in an upright position, simulating a phone call, texting with one or two hands during standing or while walking on a treadmill. Paired T-tests and ANOVA tests were performed to evaluate differences. The Kendall rank test was used to investigate the association between clinical scores and changes in spinal posture. Results All smartphone tasks lead to a significant increase in thoracic kyphosis and trunk inclination during standing and while walking. A significant increased lumbar lordosis was also found. Texting with one or two hands correlated with increased surface rotation. No associations between smartphone addiction and changes of the spinal posture were reported. Significance This represents the first surface topography study that investigated the influence of different smartphone tasks on the spinal posture and pelvic position during standing and while walking. With the results of this study we demonstrated that smartphone use leads to significant changes of sagittal and frontal spine parameters. Further research should focus on the evaluation of possible detrimental effects of long-term smartphone use on the spinal posture and on the development of preventive measures.

Background: Apart from eccentric exercises (EE), isometric exercises (ISO) might be a treatment option for Achilles tendinopathy. Shear wave elastography (SWE) provides information for diagnosis and for monitoring tissue elasticity, which is altered in symptomatic tendons. Hypothesis: Isometric exercises will have a beneficial effect on patients’ outcome scores. Based on SWE, insertional and midportion tendon parts will differ in their elastic properties according to current symptoms. Study Design: Randomized clinical trial. Level of Evidence: Level 2. Methods: Group 1 (EE; n = 20; 12 males, 8 females; mean age, 52 ± 8.98 years) and group 2 (EE + ISO; n = 22; 15 males, 7 females; mean age, 47 ± 15.11 years) performed exercises for 3 months. Measurement points were before exercises were initiated as well as after 1 and 3 months using the Victorian Institute of Sports Assessment–Achilles (VISA-A) score, American Orthopaedic Foot & Ankle Society score, and SWE (insertion and midportion). Results: Both groups improved significantly, but there were no significant interindividual differences (VISA-A; P = 0.362) between group 1 (n = 15; +15 VISA-A) and group 2 (n = 15; +15 VISA-A). The symptomatic insertion (symptomatic, 136.89 kPa; asymptomatic, 174.68 kPa; P = 0.045) and the symptomatic midportion of the Achilles tendon (symptomatic, 184.40 kPa; asymptomatic, 215.41 kPa; P = 0.039) had significantly lower Young modulus compared with the asymptomatic tendons. The midportion location had significantly higher Young modulus than the insertional part of the tendon ( P = 0.005). Conclusion: Isometric exercises do not have additional benefit when combined with eccentric exercises, as assessed over a 3-month intervention period. SWE is able to distinguish between insertional and midportion tendon parts in a symptomatic and asymptomatic state. Clinical Relevance: The present study shows no additional effect of ISO when added to baseline EE in treating Achilles tendinopathy. Different elastic properties of the insertional and midportion tendon have to be taken into consideration when rating a tendon as pathologic.

Background Surface topography can be used for the evaluation of spinal deformities without any radiation. However, so far this technique is limited to posterior trunk measurements due to the use of a single posterior camera. Research Question Purpose of this study was to introduce a new multi camera surface topography system and to test its reliability and validity. Methods The surface topograph uses a two-camera system for imaging and evaluating the subjects front and back simultaneously. Inter- and intra-rater reliability was tested on 40 human subjects by two observers. For validation human, subjects were scanned by MRI and surface-topography. For additional validation we used a phantom with an anthropomorphic body which was scanned by CT and surface topography. Results Inter- (0.97 - 0.99) and intra-rater reliability (0.81 - 0.98) testing revealed good and excellent results in the detection of the body surface structures and measurement of areas and volumes. CT based validation revealed good correspondence between systems in the imaging and evaluation of the phantom model (0.61 – 10.52 %). Results on validation of human subjects revealed good to moderate results in the detection and measurements of almost all body surface structures (1.36- 13.34%). Only measurements using jugular notch as a reference showed moderate results in validity (0.62 – 27.5%) testing. Significance We have introduced a novel and innovative surface topography system that allows for simultaneous anterior and posterior trunk measurements. The results of our reliability and validity tests are satisfactory. However, in particular around the jugular notch region further improvements in the surface topography reconstruction are needed.

Der vordere Knieschmerz ist eine der haufigsten Komplikationen nach endoprothetischer Versorgung des Kniegelenks. Seine Haufigkeit wird in der Literatur mit bis zu 30 % angegeben. Das Ziel unserer Arbeit ist eine systematische Literaturrecherche der Ursachen und Therapieoptionen bei vorderem Knieschmerz. Es werden patienten- und kniespezifische Grunde diskutiert, die Bedeutung des Prothesendesigns und der Operationstechnik untersucht und funktionelle sowie neurologische Ursachen analysiert. Instabilitaten, eine Druckerhohung im Patellofemoralgelenk oder ein Patellamaltracking konnen klinisch als vorderer Knieschmerz imponieren. Hervorgerufen werden sie oft durch mechanische Ursachen, wie eine Fehlrotation der Prothesenkomponenten, Offset-Fehler, Bandinsuffizienzen oder eine Patella baja. Typische funktionelle Grunde fur einen vorderen Knieschmerz sind pathologische Gangmuster, Muskelimbalancen oder ein dynamischer Knievalgus. Differenzialdiagnostisch sind diese von infektiosen und entzundlichen Ursachen ebenso zu differenzieren, wie von einem Weichteilimpingement und neurologischen Erkrankungen. Ein differenzierter Diagnose- und Behandlungs-Algorithmus wird prasentiert. In vielen Fallen existieren konservative Behandlungsmoglichkeiten. Bei mechanischen Ursachen ist jedoch haufig eine operative Revision erforderlich.

The purpose of forefoot off-loader shoes (FOS) is to unload the operated region of the foot in order to allow early mobilization and rehabilitation. However, little is known about the actual biomechanical effects of different designs of FOS on gait, pelvis and spine.Aim of this study was to analyse and compare the effects of two different designs of forefoot unloader shoes.Ortho-Wedge (FOS A) and Relief-Dual® (FOS B) were evaluated in this study during standing and while walking. Changes of the pelvic position and spinal posture were measured with a surface topography system and an instrumented treadmill. Gait phases were detected automatically by a built-in pressure plate.Both FOS resulted in a significant increase of pelvic obliquity, pelvic torsion, lateral deviation and surface rotation (p 0.001) while standing. Between both shoe models, pelvic obliquity and lateral deviation (p 0.05) were significantly different. During walking, both FOS had a significant effect on spine and pelvis (p 0.05), however only minor differences were found between the designs. All gait parameters were affected more, wearing FOS A than B. Step length were significantly longer by wearing FOS (p 0.005). However stance phase raised and swing phase is reduced on the leg wearing FOS A (p 0.001).The study showed that FOS lead to significant changes in pelvic position and spinal posture during standing and while walking. A compensating shoe on the contralateral side is therefore recommend. Gait parameters however were affected more by the traditional FOS A half-shoe. The sole- design and shape of FOS B leads to a more physiological roll-over of the foot.

Assessment of structural cartilage damage is of high scientific and clinical interest. Optical Coherence Tomography (OCT) is a light-based cross-sectional imaging modality that allows the real-time assessment of articular cartilage at near-histological resolution. Algorithm routines for the detection, parameterization and quantification of sub-surface defects as assessed by OCT were implemented and validated in this study. Standard defects of 0.9 mm, 1.1 mm and 1.3 mm diameter were created in the sub-surface regions of macroscopically intact human articular cartilage samples (n = 60 defects of variable sizes in n = 20 samples). Subsequently, samples were scanned by 3D OCT and defect size, height, width and distance to the surface were determined based on the algorithm and related to manual measurements. Histology served as the standard-of-reference. Statistical analysis included one-way ANOVA’s and Tukey’s post-hoc test. All defects were correctly identified by the algorithm, while five structural tissue inhomogeneities were erroneously marked as defects (sensitivity 100%, specificity: 92.3%). Inter-modality analysis revealed no significant differences in terms of defect area, height or width within the different defect sizes, while the distance to the surface was significantly different. The comprehensive algorithm-based characterization of cartilage defects is consistent and reliable and allows their more objective evaluation. Given further research in this field, OCT and OCT-based quantitative measures may become clinically useful in the arthroscopic detection and evaluation of sub-surface cartilage defects.

PLOS ONE 14(8), e0221695 (2019). doi:10.1371/journal.pone.0221695, Published by PLOS, San Francisco, California, US