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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.

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Column-editor : Thomas W. Kaminski

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Thomas W. Kaminski

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Thomas W. Kaminski

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Thomas W. Kaminski

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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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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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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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Jaclyn B. Caccese, Thomas A. Buckley and Thomas W. Kaminski

The Balance Error Scoring System (BESS) is often used for sport-related concussion balance assessment. However, moderate intratester and intertester reliability may cause low initial sensitivity, suggesting that a more objective balance assessment method is needed. The MobileMat BESS was designed for objective BESS scoring, but the outcome measures must be validated with reliable balance measures. Thus, the purpose of this investigation was to compare MobileMat BESS scores to linear and nonlinear measures of balance. Eighty-eight healthy collegiate student-athletes (age: 20.0 ± 1.4 y, height: 177.7 ± 10.7 cm, mass: 74.8 ± 13.7 kg) completed the MobileMat BESS. MobileMat BESS scores were compared with 95% area, sway velocity, approximate entropy, and sample entropy. MobileMat BESS scores were significantly correlated with 95% area for single-leg (r = .332) and tandem firm (r = .474), and double-leg foam (r = .660); and with sway velocity for single-leg (r = .406) and tandem firm (r = .601), and double-leg (r = .575) and single-leg foam (r = .434). MobileMat BESS scores were not correlated with approximate or sample entropy. MobileMat BESS scores were low to moderately correlated with linear measures, suggesting the ability to identify changes in the center of mass–center of pressure relationship, but not higher-order processing associated with nonlinear measures. These results suggest that the MobileMat BESS may be a clinically-useful tool that provides objective linear balance measures.

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Peter R. Giacobbi Jr.

Column-editor : Thomas W. Kaminski