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Matt Greig, Hannah Emmerson and John McCreadie

is to compare mechanical loading derived from triaxial accelerometry at the tibia with the traditional C7 location across a number of functional tasks. These tasks have been designed to reflect the multiplanar mechanism of injury, and a progression of drills used in late functional rehabilitation

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Kerry E. Costello, Janie L. Astephen Wilson, William D. Stanish, Nathan Urquhart and Cheryl L. Hubley-Kozey

arthroplasty may be indicated once nonsurgical interventions become ineffective. 4 Under this model, patients spend years living with pain and disability, and the underlying disease processes are not addressed. A better understanding of factors involved in OA progression is essential to inform interventions

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Ken Tokunaga, Yuki Nakai, Ryo Matsumoto, Ryoji Kiyama, Masayuki Kawada, Akihiko Ohwatashi, Kiyohiro Fukudome, Tadasu Ohshige and Tetsuo Maeda

This study evaluated the effect of foot progression angle on the reduction in knee adduction moment caused by a lateral wedged insole during walking. Twenty healthy, young volunteers walked 10 m at their comfortable velocity wearing a lateral wedged insole or control flat insole in 3 foot progression angle conditions: natural, toe-out, and toe-in. A 3-dimensional rigid link model was used to calculate the external knee adduction moment, the moment arm of ground reaction force to knee joint center, and the reduction ratio of knee adduction moment and moment arm. The result indicated that the toe-out condition and lateral wedged insole decreased the knee adduction moment in the whole stance phase. The reduction ratio of the knee adduction moment and the moment arm exhibited a close relationship. Lateral wedged insoles decreased the knee adduction moment in various foot progression angle conditions due to decrease of the moment arm of the ground reaction force. Moreover, the knee adduction moment during the toe-out gait with lateral wedged insole was the smallest due to the synergistic effect of the lateral wedged insole and foot progression angle. Lateral wedged insoles may be a valid intervention for patients with knee osteoarthritis regardless of the foot progression angle.

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Joanna E. Gelinas and Greg Reid

The purpose was to determine whether traditional learn-to-swim progressions, leading to a 10-m front and 10-m back swim, were developmentally valid for children with physical disabilities. Forty children (22 boys, 18 girls) ages 5 to 12 years participated. They were classified according to disability type, functional sport classification, mode of ambulation, and flotation device use. Developmental validity was assessed by testing the children on rhythmic breathing, front float, front glide, front swim, back float, back glide, and back swim. Each skill was deemed successful if the child accomplished all performance criteria of that skill. Atypical progression was evident if a child performed a skill without the ability to perform skills previously listed in that progression. Atypical progression occurred in 32 (80%) children in the front skills and 22 (55%) in the back skills, which indicates that the traditional learn-to-swim progressions for both the 10-m front swim and the 10-m back swim were not developmentally valid for most children with physical disabilities in the conducted research.

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David J. Ralston

The RAMP system of athletic-injury rehabilitation, its name an acronym representing its component phases, has its foundation in the frequent reassessment of the injury condition. The patient is progressed systematically through a sequence of rehabilitation goals: management of the acute responses to injury, restoration of mobility, and successful completion of performance goals. The RAMP system designates the current highest-priority rehabilitation goal as the primary objective and any other goals as secondary. This ensures that the pursuit of 1 rehabilitation goal is not at the expense of another, more currently relevant goal. The RAMP system provides a systematic format to help less-experienced clinicians progress injured athletes through the phases of recovery from injury. Daily reassessment of an injury allows the rehabilitation plan to be current and appropriate. The goal-based progression of the system ensures maximum resolution of each rehabilitation objective, contributing to athletes’ optimal return to sport or activity

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Mark A. Merrick and Nicole M. McBrier

Context:

Acute musculoskeletal-injury management largely focuses on inhibiting secondary injury, although the data describing secondary injury and the timeline for its progression are sparse.

Objective:

To describe the timeline and early progression of secondary injury in skeletal muscle over the first 5 h after blunt trauma.

Design:

A controlled laboratory study with 2 independent variables (injury status and postinjury time point) in a 2 × 21 factorial.

Setting:

University research laboratory.

Subjects:

168 male Sprague Dawley rats (250 to 275 g).

Interventions:

Uniform blunt-contusion injury was caused to the right triceps surae using a drop-weight method; the contralateral limb served as an uninjured control. Both triceps surae were excised and flash frozen at 21 intervals across 5 h postinjury (8 animals, each 15 min).

Main Outcome Measures:

Cytochrome-c oxidase activity via reduction of triphenyltetrazolium chloride (TTC) to triphenyl-formazan.

Results:

There was an interaction effect (P = .041) between and main effects for both injury status (P < .0005) and postinjury time point (P = .038). In the first 30 min after injury, uninjured tissues did not differ from injured tissues, and both displayed TTC reduction rates in the vicinity of 7.1 ± 0.94 μg · mg−1 · h−1. Statistical differences between uninjured and injured tissues became evident starting at 30 min. TTC reduction for uninjured tissues did not change, but injured tissues declined in a roughly linear fashion across the entire 5-h period to 4.8 ± 1.04 μg · mg−1 · h−1.

Conclusions:

Cytochrome-c oxidase activity, an indicator of oxidative phosphorylation and mitochondrial viability, is diminished by events that follow muscle trauma. Loss of this enzymatic activity becomes statistically evident at 30 min postinjury and continues linearly for at least 5 h. This suggests that secondary injury is a slowly developing problem of more than 5 h duration. A window of opportunity for intervention may lie somewhere within the first 30 min after injury.

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Martin A. Fees

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Assane E.S. Niang and Bradford J. McFadyen

The present study investigated the adaptations of specific power bursts during the combined contexts of the proximity (lead vs. trail limb) and height of an obstruction in relation to limb elevation versus progression. Ten young, adult, male subjects walked at their natural speed during unobstructed walking and the bilateral avoidance of moderate and high obstacles. Hip flexor generation power was unaffected by obstacle height for the leading limb and always delayed for the trailing limb. The knee extensor absorption power burst at toe-off was also eliminated for the trailing limb and was found to reappear in mid-swing. Few differences were seen for ankle push-off power. The results suggest that the hip joint is dedicated to limb advancement only, while the knee joint is directly involved in limb elevation and the control of multiarticular effects.

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Jay R. Ebert, Anne Smith, Peter K. Edwards and Timothy R. Ackland

Context:

Matrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects. Despite the reported clinical improvement in knee pain and symptoms, little is known on the recovery of knee strength and its return to an appropriate level compared with the unaffected limb.

Objective:

To investigate the progression of isokinetic knee strength and limb symmetry after MACI.

Design:

Prospective cohort.

Setting:

Private functional rehabilitation facility.

Patients:

58 patients treated with MACI for full-thickness cartilage defects to the femoral condyles.

Intervention:

MACI and a standardized rehabilitation protocol.

Main Outcome Measures:

Preoperatively and at 1, 2, and 5 y postsurgery, patients underwent a 3-repetition-maximum straight-leg raise test, as well as assessment of isokinetic knee-flexor and -extensor torque and hamstring:quadriceps (H:Q) ratios. Correlation analysis investigated the association between strength and pain, demographics, defect, and surgery characteristics. Linear-regression analysis estimated differences in strength measures between the operated and nonoperated limbs, as well as Limb Symmetry Indexes (LSI) over time.

Results:

Peak knee-extension torque improved significantly over time for both limbs but was significantly lower on the operated limb preoperatively and at 1, 2, and 5 y. Mean LSIs of 77.0%, 83.0%, and 86.5% were observed at 1, 2, and 5 y, respectively, while 53.4–72.4% of patients demonstrated an LSI ≤ 90% across the postoperative timeline. Peak knee-flexion torque was significantly lower on the operated limb preoperatively and at 1 year. H:Q ratios were significantly higher on the operated limb at all time points.

Conclusions:

While peak knee-flexion and hip-flexor strength were within normal limits, the majority of patients in this study still demonstrated an LSI for peak knee-extensor strength ≤ 90%, even at 5 y. It is unknown how this prolonged knee-extensor deficit may affect long-term graft outcome and risk of reinjury after return to activity.

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Susana Meireles, Neil D. Reeves, Richard K. Jones, Colin R. Smith, Darryl G. Thelen and Ilse Jonkers

been deeply explored in OA with most studies in literature focusing on knee loading during level walking as a biomarker for OA onset and progression. Previous literature has shown reduced knee flexion moments (KFM), 4 , 7 , 9 nonconclusive findings in knee adduction moments (KAM), 4 , 10 and altered