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David M. Werner and Joaquin A. Barrios

Context: Core stability is considered critical for the successful execution of rehabilitative and athletic tasks. Although no consensus definition exists, different components related to core stability have been identified. An important component is the domain of motor control. There are few clinical tests assessing the motor control component of core stability (MCCS). Objective: To evaluate the interrater reliability and known-groups validity of a novel test of MCCS, the in-line half-kneeling test. The test is aimed at assessing MCCS by challenging the ability to maintain a static position with minimized contributions from the distal extremities over a minimized base of support. Design: Cross-sectional group comparison study. Setting: Laboratory. Patients or Other Participants: A total of 75 participants (25 individuals with a history of anterior cruciate ligament reconstruction, 25 uninjured Division 1 collegiate athletes, and 25 uninjured controls) were recruited from a university community. Intervention: Participants were video recorded while performing the in-line half-kneeling test for 120 seconds bilaterally. Three observers independently viewed each video to determine if individuals broke form during each test using 2 dichotomous criteria. Main Outcome Measures: Cohen’s kappa was used to assess interrater reliability, and chi-square tests of independence were used to compare break rates between groups. Results: Good-to-excellent interrater reliability (.732–.973) was seen between the 3 observers. Chi-square tests of independence revealed different break rates between all 3 groups. Compared to break rate for the reference control group (11/25—44%), those with a history of anterior cruciate ligament reconstruction broke at a higher rate (18/25—72%), whereas the uninjured collegiate athletes broke at a lower rate (4/25—16%). Conclusions: The in-line half-kneeling test is a reliable test between raters that can differentiate between groups expected to differ in MCCS.

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David Werner, John Willson, Richard Willy and Joaquin Barrios

Frontal plane knee alignment can influence the development and management of various knee pathologies. Valid and reliable clinical methods for assessment are needed. The primary purposes of this study were to assess the validity and reliability of inclinometer-based frontal plane tibial orientation as a limb alignment measure, and secondarily to establish normal values in healthy individuals. Frontal tibial orientation was validated per moderately strong correlation to radiographic knee alignment. Intra- and interrater reliability were excellent. The normative mean was approximately 7°. In summary, inclinometer-based frontal tibial orientation is a valid and reliable clinical measure of frontal plane knee alignment.

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Werner W.K. Hoeger, David R. Hopkins, Sherman Button and Troy A. Palmer

This study compared the proposed modified sit and reach test (MSR) and the commonly administered sit and reach test (SR) to determine if the MSR can administratively control possible limb-length biases. Subjects (N=258) were administered two trials of each test. The MSR test incorporates a finger-to-box distance (FBD) to account for proportional differences between legs and arms. Individuals with high FBD measurements demonstrated a poorer performance on the SR test. An analysis of the subjects failing to meet the Physical Best standard (25 cm) indicated a higher probability of failure for those with larger FBD scores. The subjects were subsequently separated into three groups: high, medium, and low FBD. There were no significant difference among the groups on MSR performance but a significant difference was found on SR performance. The MSR test appears to eliminate the concern of disproportionate limb-length bias expressed by many practitioners.

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Ian J. Dempsey, Grant E. Norte, Matthew Hall, John Goetschius, Lindsay V. Slater, Jourdan M. Cancienne, Brian C. Werner, David R. Diduch and Joseph M. Hart

Context: Postoperative rehabilitation is critical to optimize outcomes after anterior cruciate ligament reconstruction (ACLR). However, the relationship between physical therapy (PT) and clinical outcomes is unclear. Objective: To describe PT characteristics following ACLR and to assess the relationships between PT characteristics, surgical procedure, and clinical outcomes. Design: Cross-sectional. Setting: Laboratory. Patients (or Other Participants): A total of 60 patients (31 females/29 males, age = 22.4 [9.2] y, height = 171.7 [9.9] cm, and mass = 70.2 [14.7] kg) with a history of primary unilateral ACLR (53.6% patellar tendon and 46.4% hamstring) participated. Intervention(s): Patients completed a performance assessment and rated subjective knee function prior to physician clearance (mean = 6.3 [1.3] mo postoperatively) and were contacted within 6 months of clearance to complete a PT questionnaire. Main Outcome Measures: PT questionnaire item response, knee extension maximum voluntary isometric contraction (MVIC) torque, peak isokinetic knee extension torque, single leg hop distance, and International Knee Documentation Committee were measured. Correlations assessed relationships between PT quantity and clinical outcomes. Independent t tests compared PT quantity and clinical outcomes based on return-to-sport status, readiness to return to sport, and surgical procedure. Results: Patients completed regular PT (2 d/wk, 25 wk, 58 visits) and were most likely to conclude when discharged by the therapist (68.3%). More than half (56.7%) returned to sport, yet most (73.3%) felt unready at discharge. Isokinetic torque was correlated with days of PT/week (r = .29, P = .03). Isokinetic torque and hop symmetry were reduced in patients who returned to sport (P < .05). Patients who felt ready to return completed fewer weeks of PT (P < .05). Patients with a patellar tendon graft completed more days of PT/week and total visits, but demonstrated lower MVIC torque, MVIC symmetry, and isokinetic symmetry (P < .05). Conclusions: Many patients felt unready to return to sport at PT discharge. PT frequency was associated with isokinetic torque, yet this relationship was small. Outcomes were reduced in patients who returned to sport, suggesting premature resumption of preinjury activity.