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Salter-Harris Type III Fracture of the Medial Femoral Condyle in an Adolescent Football Player

Thomas W. Kaminski and Thomas L. Schildwachter

Epiphyseal injuries present a special challenge to the sports medicine professional Salter-Harris Type III fractures involving the physis, epiphysis, and articular surface are uncommon (1). Because of the proximity of this fracture site to the knee joint, it is especially important that the clinician be aware of this type of injury when working with the adolescent athlete. This case adds to others previously reported in the English literature.

Open access

Does Low-Level Laser Therapy Decrease Muscle-Damaging Mediators After Performance in Soccer Athletes Versus Sham Laser Treatment? A Critically Appraised Topic

Jordan Bettleyon and Thomas W. Kaminski

Clinical Scenario: Low-level laser therapy (LLLT) is a controversial topic for its use in athletic recovery, mainly due to inconsistency in research regarding the application of LLLT. Articles on LLLT have assessed its effectiveness in untrained humans through pain scales, functional scales, and blood draws, and it has been found capable in nonathletic rehabilitative use. The controversy lies with LLLT in the recovering athlete. Not only do athletes need to perform at high levels, but each sport is unique in the metabolic demands placed on the athletes’ bodies. This modality can alter chemical mediators of the inflammatory process, specifically blood lactate (BL) and creatine kinase (CK). During soccer contests, it is a common problem for athletes to have an average CK level of 800 U/L and BL of 8 mmol·L, increasing delayed-onset muscle soreness and fatigue. Micro-CK level elevation is associated with cellular membrane damage, localized hypoxia, and electrolyte imbalances, hindering the recovery process. Clinical Question: Does LLLT decrease muscle-damaging mediators effecting player fatigue and delayed-onset muscle soreness after performance in soccer athletes versus sham treatment? Summary of Key Findings: In 3 studies, preperformance, postperformance, or preperformance and postperformance LLLT was performed and evaluated BL (2 of 3) and CK (2 of 3). In each article, BL and CK showed a significant decrease (P < .05) when performed either preperformance or postperformance versus the control group. The greatest decrease in these mediators was noticed when postperformance laser therapy was performed. Clinical Bottom Line: LLLT at 10, 30, or 50 J performed at a minimum of 2 locations on the rectus femoris, vastus lateralis, and vastus medialis bilaterally for 10 seconds each is significant in decreasing blood serum levels of BL and CK when performed postexercise. Strength of Recommendations: All 3 articles obtained a Physiotherapy Evidence Database score of ≥8/10.

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Comparing Computer-Derived and Human-Observed Scores for the Balance Error Scoring System

Jaclyn B. Caccese and Thomas W. Kaminski

Context:

The Balance Error Scoring System (BESS) is the current standard for assessing postural stability in concussed athletes on the sideline. However, research has questioned the objectivity and validity of the BESS, suggesting that while certain subcategories of the BESS have sufficient reliability to be used in evaluation of postural stability, the total score is not reliable, demonstrating limited interrater and intrarater reliability. Recently, a computerized BESS test was developed to automate scoring.

Objective:

To compare computerderived BESS scores with those taken from 3 trained human scorers.

Design:

Interrater reliability study.

Setting:

Athletic training room.

Patients:

NCAA Division I student athletes (53 male, 58 female; 19 ± 2 y, 168 ± 41 cm, 69 ± 4 kg).

Interventions:

Subjects were asked to perform the BESS while standing on the Tekscan (Boston, MA) MobileMat® BESS. The MobileMat BESS software displayed an error score at the end of each trial. Simultaneously, errors were recorded by 3 separate examiners. Errors were counted using the standard BESS scoring criteria.

Main Outcome Measures:

The number of BESS errors was computed for the 6 stances from the software and each of the 3 human scorers. Interclass correlation coefficients (ICCs) were used to compare errors for each stance scored by the MobileMat BESS software with each of 3 raters individually. The ICC values were converted to Fisher Z scores, averaged, and converted back into ICC values.

Results:

The double-leg, single-leg, and tandem-firm stances resulted in good agreement with human scorers (ICC = .999, .731, and .648). All foam stances resulted in fair agreement.

Conclusions:

Our results suggest that the MobileMat BESS is suitable for identifying BESS errors involving each of the 6 stances of the BESS protocol. Because the MobileMat BESS scores consistently and reliably, this system can be used with confidence by clinicians as an effective alternative to scoring the BESS.

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Reliability of Inversion and Eversion Peak- and Average-Torque Measurements from the Biodex System 3 Dynamometer

Thomas W. Kaminski and Geoff C. Dover

Objective:

To determine the reliability of inversion and eversion concentric isokinetic-strength measurements from the Biodex System 3 isokinetic dynamometer.

Setting:

University biomechanics research laboratory.

Subjects:

Thirty-five volunteers free from any lower leg and ankle injuries within the preceding year.

Measurements:

Peak (PT) and average (AT) isokinetic torque at 30°/s and 120°/s for subtalar-joint inversion and eversion.

Results:

PT intraclass correlation coefficients (ICC2,1) ranged from .54 to .92. AT ICC2,1 ranged from .55 to .91. These ICCs were good to excellent for both PT and AT at each speed and motion tested, except for fair ICCs produced from right-foot-eversion measurements at 30°/s.

Conclusions:

Inversion and eversion subtalar-joint strength measurements from the Biodex System 3 isokinetic dynamometer are reliable.

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The Effectiveness of Autologous Conditioned Serum in the Treatment of Knee Osteoarthritis

Matthew Astolfi, Kelly McGuire, and Thomas W. Kaminski

Clinical Scenario:

Osteoarthritis (OA) is a debilitating degenerative disease affecting an estimated 27 million Americans. A systematic review found that patients with a previous history of traumatic knee injury are at increased risk of developing knee OA, regardless of specific injury. It is vital for the maintenance of quality of life for individuals affected with OA that the treatment options available be able to reduce symptoms and restore quality of living. The pain-relief benefits of traditional injection treatments are small to moderate and have a limited duration. It was found that at 2 wk postinjection that corticosteroids were more effective than hyaluronic acid (HA) injections. Autologous conditioned serum (ACS) injection is a novel treatment that has shown favorable results. However, many clinicians continue to use HA injections for reduction of symptoms in patients with osteoarthritis when the use of ACS may be more beneficial.

Focused Clinical Question:

For patients with knee OA, is an ACS injection more efficient at producing a reduction in symptoms than HA or a saline injection?

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The Effect of Ankle Kinesio Tape on Ankle Muscle Activity During a Drop Landing

Shirleeah D. Fayson, Alan R. Needle, and Thomas W. Kaminski

Context:

The use of Kinesio Tape among health care professional has grown recently in efforts to efficiently prevent and treat joint injuries. However, limited evidence exists regarding the efficacy of this technique in enhancing joint stability and neuromuscular control.

Objective:

To determine how Kinesio Tape application to the ankle joint alters forces and muscle activity during a drop-jump maneuver.

Design:

Single-group pretest– posttest.

Setting:

University laboratory.

Subjects:

22 healthy adults with no previous history of ankle injury.

Interventions:

Participants were instrumented with electromyography on the lower-leg muscles as they jumped from a 35-cm platform onto force plates. Test trials were performed without tape (BL), immediately after application of Kinesio Tape to the ankle (KT-I), and after 24 h of continued use (KT-24).

Main Outcome Measures:

Peak ground-reaction forces (GRFs) and time to peak GRF were compared across taping conditions, and the timing and amplitude of muscle activity from the tibialis anterior, peroneus longus, and lateral gastrocnemius were compared across taping conditions.

Results:

No significant differences in amplitude or timing of GRFs were observed (P > .05). However, muscle activity was observed to decrease from BL to KT-I in the tibialis anterior (P = .027) and from BL to KT-24 in the PL (P = .022).

Conclusions:

The data suggest that Kinesio Tape decreases muscle activity in the ankle during a drop-jump maneuver, although no changes in GRFs were observed. This is contrary to the proposed mechanisms of Kinesio Tape. Further research might investigate how this affects participants with a history of injury.

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Reliability of Intratester and Intertester Measurements Derived from an Instrumented Ankle Arthrometer

Tricia J. Hubbard, John E. Kovaleski, and Thomas W. Kaminski

Context:

Measurement reliability is critical when new sports-medicine devices or techniques are developed.

Objective:

To determine the reliability of laxity measurements obtained from an instrumented ankle arthrometer.

Design:

Intratester reliability was examined using a test–retest design, and intertester reliability was assessed using the measurements recorded by 2 different examiners on a separate group of participants.

Setting:

Sports-medicine research laboratory.

Participants:

40 participants with no history of ankle injury, equally divided across the 2 studies.

Measurements:

Laxity measurements included anteroposterior (AP) displacement during loading to 125 N. Inversion–eversion (I–E) rotation was tested during loading to 4000 N-mm. The measures were analyzed using intraclass correlation coefficients (ICCs) and dependent t tests.

Results:

Good to excellent ICCs (.80–.99) for intratester and intertester reliability. A significant difference in measures was observed between testers for both AP displacement and I–E rotation.

Conclusions:

Laxity measurements from an instrumented ankle arthrometer are reliable across test days and examiners

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Effect of Fatigue on Neuromuscular Function at the Ankle

Gregory M. Gutierrez, Nicole D. Jackson, Kristin A. Dorr, Sarah E. Margiotta, and Thomas W. Kaminski

Context:

Lateral ankle sprains occur more frequently than any other orthopedic injury. Athletes often report sustaining more injuries late in competition when fatigue is present.

Objective:

To evaluate neuromuscular function of the ankle musculature after fatigue. Design: Experimental, pretest-posttest.

Setting:

Research laboratory.

Participants:

Ten female and 9 male college-aged subjects.

Intervention:

Fatigue was induced via continuous concentric and eccentric muscle actions of the ankle: inversion (INV), eversion (EV), plantar flexion (PF), and dorsiflexion (DF).

Main Outcome Measures:

Peak torque (PT), peak EMG, and median frequency (MF) were calculated prefatigue and postfatigue in the tibialis anterior (TA), peroneus longus (PER), and lateral gastrocnemius (GAS) muscles.

Results:

Main effects were noted for test (P < 0.0125) in all statistical tests performed indicating changes in PT, peak EMG, and MF after fatigue.

Conclusions:

A significant decrease in MF of the PER muscle after PF fatigue and corresponding with a decreased firing rate, may be of importance, especially with regard to the role in countering the violent moment seen with inversion ankle sprains.

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Evaluating Postural Control and Ankle Laxity Between Taping and High-Top Cleats in High School Football Players

Douglas A. Pizac, Charles B. Swanik, Joseph J. Glutting, and Thomas W. Kaminski

Context: Lateral ankle sprains are the most common injuries in high school sports. While ankle taping is a preferred method of external prophylactic support, its restrictive properties decline during exercise. The Under Armour® Highlight cleat is marketed on the premise that it provides added support without the need for additional ankle taping. Objective: To determine if differences in ankle joint laxity and postural control exist between football players wearing the Under Armour® Highlight cleat (Under Armour Inc, Baltimore, MD) as compared to a low/mid-top cleat with ankle tape. Design: Crossover trial. Setting: Athletic training room and football practice field sideline. Patients: 32 interscholastic football players (15.8 ± 1.0 y; 178.9 ± 7.4 cm; 87.1 ± 21.4 kg). Interventions: Ankle laxity was assessed using an instrumented ankle arthrometer (Blue Bay Research Inc, Milton, FL), while postural control testing was performed on the Tekscan MobileMat™ Balanced Error Scoring System (BESS; South Boston, MA). The 2 treatments included Under Armour® Highlight cleats and a low/mid-top cleat with ankle tape applied to the nondominant ankle only. Measurements were taken before and immediately after practice. Main Outcome Measures: The independent variable was treatment (Highlight vs low/mid-top cleat with ankle tape). Dependent variables included ankle arthrometry measures of anterior displacement (mm), inversion/eversion rotation (deg), and the modified BESS error scores. A linear mixed-effects model was used for analysis. Results: The low/mid-top cleat with tape condition had significantly higher inversion range-of-motion (ROM) and inversion/eversion rotation postexercise when compared to the Highlight cleat (P < 0.05). Conclusions: The results of this study provide some evidence that the Under Armour® Highlight cleat restricts ankle ROM following a training session better than the taped low/mid-top cleat. Further study is warranted to determine if this high-top style of football cleat can reduce the incidence of ankle sprains and how it might compare to spat taping.

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The Reliability and Validity of Ankle Inversion and Everson Torque Measurements from the Kin Com II Isokinetic Dynamometer

Thomas W. Kaminski, David H. Perrin, Carl G. Mattacola, Joseph E. Szczerba, and Julie N. Bernier

This study examined the test-retest reliability of a prototype device used to measure ankle inversion and eversion isokinetic average torque values. The purpose of this paper was to illustrate a situation where common isokinetic measures were reliable but not valid. Concentric and eccentric average torque was assessed at 90 deg/s on the Kin Com II dynamometer using 14 healthy subjects in two sessions; a manufactured prototype ankle inversion/eversion attachment device was used. Reliability was assessed by performing separate intraclass correlations (ICC 2,1) on the results. The data indicated that the average torque calculated from the clockwise direction was consistently higher than those values from the counterclockwise direction, regardless of ankle movement or side measured. The validity of this prototype device to accurately measure average torque for these two ankle motions is questionable. This finding demonstrates a situation where the measures appear to be reliable while the validity of the device used to obtain the measures is suspect.