Context: Athletes who have undergone an anterior cruciate ligament reconstruction often demonstrate more pronounced interlimb knee kinetic symmetry in comparison with uninjured athletes, even after they have completed rehabilitation. Part of the reason for the persistent asymmetry may be that sports medicine professionals are typically not able to assess knee joint kinetics within the clinic setting. Developing measures to assess knee joint kinetic symmetry could help to augment current rehabilitation practices. Objective: The purpose of this study was to explore the extent to which interlimb vertical ground reaction force (GRF) symmetry can predict knee kinetic symmetry during a drop landing task. Design: Cross-sectional study. Setting: Motion analysis laboratory. Participants: A total of 21 uninjured subjects (9 males and 12 females). Protocol: Three-dimensional kinematic data were collected using a multicamera system while subjects performed double-leg drop landings. GRF data were collected synchronously using 2 adjacent force plates. Main Outcome Measures: Knee joint moments and power were calculated for both limbs during the landing trials. An interlimb symmetry index (dominant/nondominant limb) was calculated for both the peak knee joint moment and power variables, as well as for the peak vertical GRFs. Linear regression analyses were performed to determine if the degree of symmetry in the peak vertical GRFs predicted the degree of symmetry for the kinetic variables. Results: The symmetry index for the vertical GRFs was a significant predictor of the symmetry indices for the knee joint moments (r = .81; P < .001) and power (r = .88; P < .001). Conclusion: Interlimb symmetry in the peak vertical GRFs can be used to predict knee joint kinetic symmetry during a double-leg drop landing task.
Aaron Nelson, Nathan Koslakiewicz and Thomas Gus Almonroeder
Megan P. Brady and Windee Weiss
Clinical Scenario: The anterior cruciate ligament (ACL) injury is a common knee injury within varying athletic levels. Clinical diagnostic tests and magnetic resonance imaging (MRI) are two methods of evaluating ACL injuries. Clinical Question: Are clinical diagnostic tests as accurate as MRI when diagnosing ACL tears? Summary of Key Findings: Three cross-sectional design studies were included. One study found that clinical diagnostic tests were superior to MRI when diagnosing an ACL tear. Another study found that clinical diagnostic tests were equal to MRI when measuring sensitivity, but scored higher in specificity, positive predictive value, negative predictive value, and diagnostic accuracy. The last study found that clinical diagnostic tests scored higher than MRI on specificity and positive predictive value, were equal when measuring accuracy, and scored lower when measuring sensitivity and negative predictive value. Clinical Bottom Line: The evidence supports the use of clinical diagnostic tests when diagnosing an ACL tear. Strength of Recommendation: Level 2–3.
Objectives : The efficacy of eccentric cycling has been proved in research, clinical, and sport training activities. However, several constraints make it difficult to use commercially available eccentric cycle ergometers. This study will stimulate the application of eccentric cycling as an exercise modality. Study Design: University research laboratory. Methods : In this study, the multiple-input single-output (MISO) Wiener nonlinear model was applied to the design of the eccentric training system. Particle Swarm Optimization (PSO) algorithm was then applied to identify the parameters of the MISO Wiener nonlinear model. The computer software embedded with MISO model was programmed for not only controlling and monitoring the running status of the eccentric training system, but also collecting data in a flexible and convenient manner. Results : The correlation coefficient of 0.9985 and root mean square error of 3.3264 between the collected power value and the estimated power value from the model shows the good performance of the model. Conclusion : The proposed method for the design of the eccentric training system using MISO Wiener nonlinear model provides a new way for eccentric research and training.
Christie Powell, Jody Jensen and Samantha Johnson
Context : As sport participation increases globally, so will injury-related risks. The process used to determine return-to-sport following injury is vital to future sport participation and injury prevention. Early specialization along with poor management of sport participation causes an increase in injury risk and potential long-term health consequences for youth athletes. Objectives : Previous injury is a common intrinsic risk factor for new injuries. Identifying functional performance deficits, defined by return-to-sport criteria, minimizes these risk factors and provides athletes with guidelines to return safely to sport. The purposes of this clinical commentary and literature review are to provide a summary of current concepts and clinical practices and to identify functional performance measures as clinical assessment tools for return-to-play criteria in the youth population. Evidence : A literature review was completed using numerous databases, where 154 relevant articles were reviewed and 22 articles were included in this commentary. Of the 22 articles using functional performance measures for return-to-sport criteria, 6 were specific to youth, 12 had mixed populations of adults and youth, and 4 were normative samples for specific youth populations. Acquisition : The gaps in the literature pertaining to functional performance measures in the youth population are addressed, and future research needs for return-to-sport criteria are identified. Evidence Synthesis : This descriptive literature review identifies 22 articles that meet the search criteria for the youth population discussing the use of clinical functional performance measures in order to identify return-to-sport criteria for lower-extremity injuries. Conclusions: Due to the inconsistencies in terminology, definitions, and standardization of clinical assessment tools, it seems necessary to create a comprehensive functional performance test battery for the lower extremity that can be used as return-to-sport criteria.
Julie A. Fuller, Heidi L. Hammil, Kelly J. Pronschinske and Chris J. Durall
Clinical Scenario: Acute patellar dislocations during adolescence often lead to future patellar instability. Two common treatment options include nonoperative treatment or operative repair of injured structures. Focused Clinical Question: In adolescents with acute patellar dislocation, how does operative stabilization compare with nonoperative treatment for reducing dislocation recurrence? Summary of Key Findings: Three studies were included: 2 randomized controlled trials and 1 nonrandomized study. All studies compared operative and nonoperative treatment outcomes in adolescents who experienced an acute patellar dislocation. Each study included nonoperative treatment such as patellar bracing and quadriceps strengthening. The operative treatments utilized in each study included lateral retinacular release and medial retinacular repair. All 3 of the studies included a follow-up of at least 6 years. Two of the studies concluded there to be no significant difference between treatment groups regarding redislocation rate, pain, and function. The third study reported a lower redislocation rate following operative treatment. Clinical Bottom Line: Reviewed evidence suggests that outcomes are similar when comparing operative and nonoperative treatment approaches with little agreement as to which is the optimal plan of action. Strength of Recommendation: One level II randomized controlled trial and a level III nonrandomized study suggest that patellar dislocation recurrence rates are similar among operative and nonoperative treatment approaches, while another level II randomized controlled trial suggests that an operative approach is superior.
Janie L. Kelly and Alison R. Valier
Overuse injuries are common in physically active populations. Lower limb overuse injuries can occur anywhere in the lower-extremity and include injuries such as medial tibial stress syndrome, plantar fasciitis, and anterior knee pain. One reason that overuse injuries have received attention is because they have both short- and long-term consequences on health and burden the lives of physically active people. Over the years, a variety of approaches have been proposed for prevention of lower limb overuse injury that addresses various intrinsic or extrinsic risk factors. One extrinsic risk factor is footwear and the use of orthotic insoles to prevent injury. To date, there is no consensus as to whether these supports prevented lower limb overuse injuries. A critical appraisal of recent studies examining the injury prevention capabilities of orthotic insoles was completed. The long-term objective of this research is to help identify effective strategies for preventing injuries in physically active people.
Francesca Genoese, Shelby Baez and Johanna M. Hoch
Clinical Question : Are fear-avoidance beliefs associated with self-reported knee function in patients with a knee injury? Clinical Bottom Line : There is currently consistent, good-quality, patient-oriented evidence that demonstrates an association between fear-avoidance beliefs and self-reported knee function in patients with a knee injury. Future research should longitudinally examine the association of fear-avoidance beliefs and self-reported knee function in patients with a knee injury.
Thomas M. Newman, Giampietro L. Vairo and William E. Buckley
Ankle sprains represent a common musculoskeletal injury that clinicians are tasked with preventing and treating. Because of the prevalence of this injury, ankle braces have been designed to prophylactically protect the joint and reduce the incidence of repetitive sprains. Although an abundance of literature exists focusing on the efficacy of braces in preventing ankle sprains in young, healthy, and physically active populations, there is a scarcity of evidence specific to the impact of these apparatuses on functional performance; therefore, the purpose of this critically appraised topic (CAT) is to investigate the effects of ankle braces on functional performance measures in such individuals. The outcomes of this CAT will assist sport rehabilitation specialists with informed clinical decision making in managing young, healthy, and physically active populations using ankle braces. Do ankle braces hinder functional performance measures when compared with an unbraced condition in a young, healthy, and physically active population? A minimum of level II evidence research studies were surveyed for this CAT. For this CAT, 1 randomized controlled trial and 3 prospective cohort studies were selected. One study found a statistically significant main effect of increased agility run times while participants wore ankle braces. Another study demonstrated a statistically significant decrease in vertical jump height and ankle range of motion while wearing braces. No other statistically significant findings were reported among studies comparing unbraced with braced conditions. Current data indicate that young, healthy, and physically active individuals may experience varied performance effects when executing specific functional performance tasks while wearing ankle braces. In general, bracing does not appear to significantly impair performance on most functional tasks; however, decrements were noted to increases in agility run time and decreases in vertical jump height. Subsequent analysis indicated that a brace may result in decreased ankle plantarflexion, dorsiflexion, eversion, and inversion range of motion, which may underpin noted performance deficits.
Mary Lynn Manduca and Stephen J. Straub
Clinical Scenario: Hamstring strains are common athletic injuries, with a high-recurrence rate (34%). Recently, platelet-rich plasma (PRP) injections have gained popularity as a potential treatment option to accelerate healing of hamstring injury. Focused Clinical Question: Does the combination of PRP injection and rehabilitation decrease recovery time of acute hamstring injury as compared to rehabilitation alone in college athletes? Summary of Key Findings: A literature search resulted in 3 randomized controlled trials. One study showed benefits in various outcome measures with PRP, compared to rehabilitation alone, while 2 showed no benefits. One study reported improved pain, ultrasonography regenerative indications, and recovery time with PRP injection following acute hamstring injury; however, larger studies have shown no benefits. The literature demonstrates conflicting evidence regarding benefits of PRP injections in hamstring injuries. Clinical Bottom Line: At this time, PRP injections cannot be recommended as having value for hamstring injuries, compared to rehabilitation alone. Strength of Recommendation: Due to inconsistent or limited quality patient-oriented evidence in existing literature, the strength of this recommendation is grade B, based on the strength of recommendation taxonomy.
Cameron J. Powden, Matthew C. Hoch and Johanna M. Hoch
Context: There is an increased emphasis on the need to capture and incorporate self-reported function to make clinical decisions when providing patient-centered care. Response shift (RS), or a change in an individual’s self-evaluation of a construct, may affect the accurate assessment of change in self-reported function throughout the course of rehabilitation. A systematic review of this phenomenon may provide valuable information regarding the accuracy of self-reported function. Objectives: To systematically locate and synthesize the existing evidence regarding RS during care for various orthopedic conditions. Evidence Acquisition: Electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, and Psychology & Behavioral Sciences Collection) were searched from inception to November 2016. Two investigators independently assessed methodological quality using the modified Downs and Black Quality Index. The quality of evidence was assessed using the Strength-of-Recommendation Taxonomy. The magnitude of RS was examined through effect sizes. Evidence Synthesis: Nine studies were included (7 high quality and 2 low quality) with a median Downs and Black Quality Index score of 81.25% (range = 56.25%–93.75%). Overall, the studies demonstrated weak to strong effect sizes (range = −1.58–0.33), indicating the potential for RS. Of the 36 point estimates calculated, 22 (61.11%), 2 (5.56%), and 12 (33.33%) were associated with weak, moderate negative, and strong negative effect sizes, respectively. Conclusions: There is grade B evidence that a weak RS, in which individuals initially underestimate their disability, may occur in people undergoing rehabilitation for an orthopedic condition. It is important for clinicians to be aware of the potential shift in their patients’ internal standards, as it can affect the evaluation of health-related quality of life changes during the care of orthopedic conditions. A shift in the internal standards of the patient can lead to subsequent misclassification of health-related quality of life changes that can adversely affect clinical decision making.