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BACKGROUND AND AIMS: Sarcopenia is defined as a reduction in skeletal muscle mass, strength, and endurance observed with advancing age. Although Vitamin D receptor (VDR) polymorphism is reported to be associated with muscle mass and strength, evidence for this is limited and conflicting. In this study, we examined the association between the polymorphisms of VDR gene BsmI, TaqI and FokI and muscular mass and strength in elderly men. METHODS: This is a cross-sectional study conducted in a university hospital. One hundred and twenty men over 65 years of age participated, all participants were active men living independently in Istanbul, who were followed as outpatients in geriatric polyclinics. Most common diagnoses were hypertension, hyperlipidemia, and mild to moderate osteoarthritis. Morbid obese patients were not included in the study. Genomic DNA was extracted from peripheral blood, and VDR genotypes were determined by the polymerase chain reaction. The peak torque of the knee flexors and extensors was measured on a Cybex 350 dynamometer. Body muscle mass was calculated by using bioelectric impedance analysis. RESULTS: The extensor strength of the knee was higher in BB homozygotic men than in the Bb/bb group. No significant association was found with TaqI and FokI haplotypes. There was no significant association between muscle mass and strength, or between muscle mass and VDR genotype. CONCLUSION: Our data suggest that VDR gene BsmI polymorphism is associated with muscular strength in elderly men. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the effects of the Traditional acupuncture point ST.36 and 'Omura's ST.36 Point' ('True ST.36') needling on the isokinetic knee extension & flexion strength of young soccer players. The Bi-Digital O-Ring Test (B.D.O.R.T.) of Yoshiaki Omura, M.D.,Sc.D. was used to determine the 'True ST.36'. Young soccer players (N= 24) between 16-18 years of age (Mean = 16.92 ± 0.65) were involved in the study. The extension & flexion strengths of dominant legs were measured with Cybex 350 Extremity System isokinetically. The testing velocity was 60°/sec. The peak torque value in Newton meters (Nm) was evaluated. Subjects were tested 3 times. Extension & Flexion 1 (EXT1, FLEX1) without acupuncture application, EXT2 & FLEX2 after application on the traditional acupuncture point, ST.36 and EXT3 & FLEX3 after application onto the 'Omura's New Foot-point'('True ST.36'). Before each test, subjects warmed up for 10 minutes by cycling on an isokinetic ergometer at 50 RPM, 75 Watts load followed by stretching exercises of lower extremity. Mean EXT1, EXT2, EXT3 values were 196,92±28,70; 210,00±23,00; 224,42±21,70 respectively, where FLEX1, FLEX2, FLEX3 were 140,88±22,45; 151,13±21,27; 161,00±22,23. Comparisons of EXT1-EXT2, EXT1-EXT3, EXT2-EXT3, FLEX1-FLEX2, FLEX1-FLEX3, FLEX2-FLEX3 strength values showed all very high significance (P<0,001) in favor of 1) Needling on relevant points and 2) Omura's ST.36 Point ('True ST.36'). We conclude that B.D.O.R.T. can help to determine new (True) Acupuncture points and, both points were effective for increasing the isokinetic knee extension & flexion strength of young soccer players very significantly where as Omura's ST.36 Point ('True ST.36') was more effective than Traditional Acupuncture point, ST.36. [ABSTRACT FROM AUTHOR]

The aim of our study is to evaluate preserving gracilis tendon in anterior cruciate ligament reconstruction (ACLR) surgery and its effect to the flexion of the knee joint and tibial internal rotation strength and the stability of the knee. Patients who underwent primary single-bundle arthroscopic ACLR using all-inside technique and using hamstring tendon autograft were evaluated retrospectively. Patients were divided into two groups as gracilis preserved (St) and gracilis harvested (StG) groups. The International Knee Documentation Committee (IKDC) score, Lysholm, Knee Injury and Osteoarthritis Outcome Score-Knee-related quality of life (KOOS-QOL) score, ACL-Return to Sport after Injury scale score were used to evaluate as postoperative functional scores at last follow-up. Anterior tibial translation was evaluated using the KT-1000 device. Knee joint flexion, extension, and internal rotation strength were evaluated using isokinetic dynamometer. Dynamic balance performances were measured using the Biodex Balance System. There were 24 patients in the St group and 23 patients in the StG group. Demographic data and clinical results showed no significant difference. Anteroposterior movement of the tibia was found to be significantly higher in the StG group than in the St group in measurements at 89 and 134 N, respectively ( p  = 0.01 and <0.001). No statistically significant difference was found between both standard and deep flexor and extensor and internal rotator strength. No statistically significant difference was found in the amount of total, anteroposterior, and mediolateral balance deficit between the two groups. Additional gracilis harvesting does not have a negative effect on both standard and deep knee flexion, and tibial internal rotation strength compared with the St group. Although semitendinosus and StG group showed significantly more anterior tibial translation, there was no significant difference in clinical and dynamic stability measurements., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Adjustable femoral suspensory fixation for anterior cruciate ligament reconstruction (ACLR) become popular in recent years. The purpose of this study is to evaluate and compare the clinical outcomes of three different techniques using an adjustable-loop fixation in ACRL., Methods: This study included 38 patients who underwent ACLR using the adjustable-loop device for femoral fixation between January 2018 and November 2021. All the participants were randomly assigned to a standard (group 1), retensioning (group 2), retensioning and knot tying (group 3). Clinical outcome parametres included Tegner - Lysholm Score, IKDC score, KT-1000 displacement and isokinetic muscle function tests., Results: Overall, 38 patients (group 1: n = 13 [mean ± SD age, 30.1 ± 9.40 years]; group 2: n = 12 [mean ± SD age, 24.5 ± 7.79 years]; group 3 = 13 [mean ± SD age, 27.8 ± 6.59 years]) were included in the final analysis. The follow-up period was 9.7 ± 1.2; 9.5 ± 1.7 and 10 ± 1.5 months for groups 1, 2 and 3 respectively. From preoperatively to postoperatively, the mean Tegner-Lysholm scores improved significantly in all three groups (group 1: from 63.5 to 95.6; group 2: from 61.58 to 98.5; group 3: from 66.6 to 95.9, P < 0.0001 for all), as did the mean IKDC score (group 1: 53.9-88.8; group 2: 61.3-94.9; group 3: 60.7-94.6 (P < 0.0001 for all)., Conclusion: The retensioning with or without knot-tying method is believed to increase stability in graft fixation. However, there were no significant differences in clinical outcomes in each technique., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The present randomized controlled study aims to evaluate whether tourniquet application during total knee arthroplasty (TKA) has an effect on (1) thigh muscle strength (quadriceps and hamstring muscle strength) and (2) clinical outcomes (postoperative knee range of motion [ROM], postoperative pain level, and Knee Society Score [KSS]). The effects of tourniquet application during TKA were investigated in 65 patients randomly allocated to one of two groups: TKA with a tourniquet and TKA without a tourniquet. Patients in both groups were comparable in terms of the demographic and clinical data ( p  > 0.05 for age, number of patients, sex, radiographic gonarthrosis grade, American Society of Anesthesiologists [ASA] classification, and body mass index [BMI]). All patients in both groups were operated by the same surgeon using one type of prosthesis. Isokinetic muscle strength (peak torque and total work) of knee extensors (quadriceps) and flexors (hamstrings) was measured in Newton meters (Nm) using a CYBEX 350 isokinetic dynamometer (HUMAC/CYBEX 2009, Stoughton, MA). The combined KSS (knee score + function score), visual analog scale (VAS), and knee ROM were measured preoperatively and at 1 and 3 months postoperatively to evaluate clinical outcomes. There were no significant differences between the two groups in preoperative and postoperative values of isokinetic muscle strength (peak torque and total work) and aforementioned clinical outcomes ( p  < 0.05). The present study has shown that quadriceps strength and clinical outcomes were not improved in the early postoperative period (3 months) when a tourniquet was not used during TKA., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Little data exist regarding the adverse effects of Achilles tendon (AT) elongation after rupture repair on plantarflexion strength. This study aimed to investigate the effect of AT elongation measured using AT resting angle (ATRA) on the plantarflexion strength in patients with surgically treated acute AT rupture., Methods: A retrospective chart review was performed on 40 patients (15 female and 25 female) who underwent open operative repair due to an acute AT rupture. At the final follow-up, AT elongation was assessed using ATRA. Plantarflexion strength (peak torques and angle-specific torques) was measured using an isokinetic dynamometer. All variables were obtained from the operated and unoperated contralateral ankles of the patients., Results: The mean ATRA was greater in the operated ankles (mean, 57 degrees; range, 39-71 degrees) compared with the unoperated ones (mean, 52 degrees; range, 36-66 degrees; P = .009). Except the plantarflexion torque at 20 degrees of plantarflexion ( P = .246), all the other angle-specific torques were lower in the operated ankles ( P < .05). Peak flexion torque at 30 degrees/s was lower in the operated ankle ( P = .002). A negative correlation was found between operated/unoperated (O/N) ATRA and O/N plantarflexion torque ratios at 0 degrees ( r = -0.404; P = .01), 10 degrees ( r = -0.399; P = .011), and 20 degrees ( r = -0.387; P = .014)., Conclusion: Postoperative AT elongation measured using ATRA may have a deleterious effect on the plantarflexion strength in patients with surgically treated acute AT rupture., Level of Evidence: Level IV, case series.

Objectives: To investigate the effects of whole body vibration (WBV) training on isokinetic muscular performance, pain, function, and quality of life in patients with patellofemoral pain (PFP)., Methods: Forty women with PFP were included in this study and assigned to either a WBV group that received WBV training plus home exercise or a control group that performed home exercise only. A supervised WBV training was performed in 24 sessions on a synchronous vertical vibration platform three times a week for eight weeks. The home exercise program in the control group was identical to that in the WBV group. Isokinetic measurements were performed at baseline and post-treatment. In addition, patients were assessed after 6 months using a visual analog scale (VAS), Kujala Patellofemoral Score (KPS), and Short Form-36 (SF-36)., Results: Total work of knee extensors and VAS improved significantly post-treatment in the WBV group compared to the control group (P=0.041, P=0.003, respectively). However, there was no significant difference between groups at the 6-month follow-up (P>0.05)., Conclusions: The present findings recommended that eight weeks of WBV training plus home exercise can more effectively reduce pain and improve the endurance of the knee extensors than that of home exercise of patient with PFP.

Purpose: Latarjet, which is a coracoid bone block procedure, is an effective treatment for anterior shoulder instability with glenoid bone loss. During this reconstructive procedure the subscapularis may be tenotomized or be split to expose the glenoid neck. The aim of this study was to assess the effect of subscapularis management on functional outcomes and internal and external rotation durability and strength. Hypothesis is that the subscapularis split approach will result in better functional results and superior internal rotation strength and endurance., Methods: The study included 48 patients [median age 30 (range 16-69); 42 males, 6 females], who underwent a modified Latarjet procedure for anterior shoulder instability. There were 20 patients in the subscapularis tenotomy group and 28 patients in the subscapularis split group. The groups were compared isokinetically using a computerized dynamometer for internal and external rotation durability and strength. At the latest follow-up, the patients were evaluated with the American Shoulder and Elbow Surgeons (ASES) and ROWE scores for functional outcomes., Results: At a median follow-up period of 25 (range 12-73) months after the Latarjet procedure, the internal rotation durability was significantly higher in the split group (p = 0.045). However, a statistically significant difference could not be found for internal and external rotational strengths (n.s.). There was also no significant difference between the final ASES and ROWE scores (n.s.)., Conclusion: Although both approaches offer promising results, the subscapularis split approach appears to provide better internal rotation durability compared to subscapularis tenotomy. Therefore, the subscapularis split approach may be more preferable for the management of the subscapularis muscle during Latarjet procedure., Level of Evidence: Retrospective cohort study, Level III.

In this study, we explained the effects of compression garment and electrostimulation on athletes' recovery period by evaluating blood lactate and isokinetic peak torque parameters. Twenty volunteers (15.55± 0.51 yr) were included to study. At recovery period, blood samples was taken for lactate values at 0th, 3rd, 5th, 15th, 30th min. The isokinetic strength test was performed on right ankle at 15th min and on the left ankle at 30th min. The same protocol was performed for compression garment on 2 weeks and for electrostimulation on third weeks and results were compared. There wasn't any significant difference on blood lactate levels within groups. At women; there was not any significant difference on isokinetic peak torques within two groups. but at electro-stimulation usage we found significant increases on right plantar flexion (P<0.1), right dorsal flexion (RDF) (P<0.1) and left plantar flexion (LPF) (P<0.1) values compared to control measurements. At men; with compression garment usage, there was significant increase on LPF values compared to control measurements. At electrostimulation usage, we found significant increases on RDF (P<0.1) and left dorsal flexion (P<0.1) values compared to control measurements. During recovery, there is not any beneficial effect seen on blood lactate level within two groups. When compared to passive rest, compression garments and electrostimulation interventions effects on force generation capacity at recovery are statically significant. Also in terms of force generation capacity; usage of electrostimulation during 15 min and compression garments during 30 min were statically more significant.

Introduction: Most of the ACL reconstruction is done with isometric single-bundle technique. Traditionally, surgeons were trained to use the transtibial technique (TT) for drilling the femoral tunnel. Our study compared the early postoperative period functional and clinical outcomes of patients who had ACL reconstruction with TT and patients who had ACL reconstruction with anatomical single-bundle technique (AT)., Material Method: Fifty-five patients who had ACL reconstruction and adequate follow-up between January 2010-December 2013 were included the study. Patients were grouped by their surgery technique. 28 patients included into anatomical single-bundle ACL reconstruction surgery group (group 1) and 27 patients were included into transtibial AC reconstruction group (group 2). Average age of patients in group 1 and group 2 was 28.3 ± 6, and 27.9 ± 6.4, respectively. Lachman and Pivot-shift tests were performed to patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. All patients' muscle strength between both extremities were evaluated with Cybex II (Humac) at 60°/sec, 240°/sec frequencies with flexion and extension peak torque. The maximum force values of non-operated knee and the operated knee were compared to each other. Groups were evaluated by using International Knee Documentation Committee (IKDC) knee ligament healing Standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and exercise time of patients were compared. Functional and clinical outcomes of two groups were compared. NCSS 2007 and PASS 2008 Statistical Software programs were used for statistical analysis., Result: There was no statistically significant difference between Lachman and Pivot-shift results (p > 0.01). Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the patients who had TT. Lysholm activity level of patients who had TT, 33.3% (n = 9) were excellent, 51.9% (n = 14) were good and 14.8% (n = 4) were moderate; patients who had AT, 57.1% (n = 16) were excellent, 39.3% (n = 11) were good and 3.6% (n = 1) was good level. There was no statistically significant difference between Lysholm Activity level of the patients (p < 0.01). Lysholm Activity level of patients who had AT significantly higher than TT. There was no statistically significant difference between Modified Cincinnati activity level of the patients (p < 0.05). Modified Cincinnati activity level of patients who had AT were significantly higher than those had TT. There was no statistically significant difference between two groups with post treatment IKDC activity level (p < 0.01). Intense activity after treatment rate of patient who had AT was significantly higher than those had TT. There was statistically significant difference between Cybex extension-flexion 60 measurement and extension 240 measurement of the patients (p < 0.01). KT-1000 arthrometer test results with AT was better than the TT in antero-posterior translation of the knee kinematics at 20 and 30 pound of forces. Return to exercise time of patients who had TT was significantly higher than those had AT (p < 0.01). There was no statistically significant difference between return to work time of patients (p > 0.05)., Conclusion: Single-bundle anatomic ACL reconstruction was better than the TT in term of clinical, functional, and laboratory results. We believe that AT ACL reconstruction will increase in use and traditional method which is TT ACL reconstruction surgery will decrease in the long term. Theoretically, anatomic relocation of the ACL can provide better knee kinematics., (Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Diabetes is reported to accelerate sarcopenia (age-related loss of muscle mass and function). We aimed to assess muscle mass and strength in elderly diabetics, elderly non-diabetics, younger diabetics and healthy subjects, and to define correlates of muscle mass and strength in these subjects., Methods: Sixteen elderly diabetics, 16 younger diabetics, 16 elderly non-diabetics and 18 younger non-diabetics were included. Elderly and diabetic subjects were first evaluated with exercise testing. Isokinetic leg extension and flexion tests were performed using a Cybex 350 dynamometer. Muscle mass was calculated using bioelectric impedance analysis., Results: Muscle mass was similar between all groups; however, muscle strength was significantly lower in diabetic and non-diabetic elderly subjects compared with younger diabetic subjects and non-diabetics. Muscle strength was positively correlated with albumin, metabolic equivalent and hemoglobin, and inversely correlated with age, HbA1c, functional capacity and CRP. Independent correlates of muscle strength were age and hemoglobin. There was no clinically significant correlate of muscle mass. Presence or duration of diabetes was not associated with muscle mass or strength., Conclusions: Uncomplicated diabetes does not seem to accelerate aging-related muscle mass or strength loss. Exercise test parameters may be useful markers in the screening of sarcopenia.

Objective: The aim of this study was to evaluate the mid-term functional outcomes of ankles following biological open Achilles tendon repair and early postoperative mobilization., Methods: The study retrospectively evaluated 22 male patients who underwent one-sided biological open Achilles tendon repair. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, isokinetic muscle strength and endurance tests and active angle reproduction test at 15° of dorsiflexion and 20° of plantarflexion of the injured and uninjured sides were measured and compared., Results: Mean age was 38.6 years and mean follow-up was 33.7 months. One patient had rerupture following a blunt trauma 1 month after operation. No other complication was seen. Mean AOFAS hindfoot score was 97.9 (range: 90 to 100). Peak isokinetic torque at 30°/sec (isokinetic muscle strength) and total work at 120°/sec (isokinetic muscle endurance) did not significantly differ between the operated and uninjured ankles. Proprioceptive evaluation with active angle reproduction test at 15°of dorsiflexion and 20° of plantarflexion was similar between the two sides., Conclusion: Biological open Achilles tendon repair with early postoperative mobilization appears to be a convenient intervention for acute Achilles tendon rupture in active young patients. Treatment results in low complication rates and restores ankle strength, endurance and position sense.

The purpose of this study was to compare the effects of the Traditional acupuncture point ST.36 and 'Omura's ST.36 Point' ("True ST.36") needling on the isokinetic knee extension & flexion strength of young soccer players. The Bi-Digital O-Ring Test (B.D.O.R.T.) of Yoshiaki Omura, M.D.,Sc.D. was used to determine the "True ST.36". Young soccer players (N = 24) between 16-18 years of age (Mean = 16.92 +/- 0.65) were involved in the study. The extension & flexion strengths of dominant legs were measured with Cybex 350 Extremity System isokinetically. The testing velocity was 60 degrees/sec. The peak torque value in Newton meters (Nm) was evaluated. Subjects were tested 3 times. Extension & Flexion 1 (EXT1, FLEX1) without acupuncture application, EXT2 & FLEX2 after application on the traditional acupuncture point, ST.36 and EXT3 & FLEX3 after application onto the 'Omura's New Foot-point' ("True ST.36"). Before each test, subjects warmed up for 10 minutes by cycling on an isokinetic ergometer at 50 RPM, 75 Watts load followed by stretching exercises of lower extremity. Mean EXT1, EXT2, EXT3 values were 196.92 +/- 28.70: 210.00 +/- 23.00; 224.42 +/- 21.70 respectively, where FLEX1, FLEX2, FLEX3 were 140.88 +/- 22.45; 151.13 +/- 21.27; 161.00 +/- 22.23. Comparisons of EXT1-EXT2, EXT1-EXT3, EXT2-EXT3, FLEX1-FLEX2, FLEX1-FLEX3, FLEX2-FLEX3 strength values showed all very high significance (P < 0.001) in favor of 1) Needling on relevant points and 2) Omura's ST.36 Point ("True ST.36"). We conclude that B.D.O.R.T. can help to determine new (True) Acupuncture points and, both points were effective for increasing the isokinetic knee extension & flexion strength of young soccer players very significantly where as Omura's ST.36 Point ("True ST.36") was more effective than Traditional Acupuncture point, ST.36.