Gulcan Harput

Quadriceps and Hamstring Strength Recovery During Early Neuromuscular Rehabilitation After ACL Hamstring-Tendon Autograft Reconstruction

CONTEXT There is lack of information related to quadriceps and hamstring strength recovery during the early period of rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring-tendon graft (HTG). OBJECTIVE To investigate quadriceps and hamstring isometric strength at 4-, 8-, and 12-wk time points after ACLR and to document the strength changes of these muscles over time. DESIGN Longitudinal study. PARTICIPANTS 24 patients (age 28.1 ± 8.1 y) who underwent unilateral single-bundle anatomic ACLR with 4-strand semitendinosus and gracilis tendon graft. MAIN OUTCOME MEASURES The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at a 60° knee-flexion angle 4, 8, and 12 wk after surgery. RESULTS Quadriceps and hamstring strength significantly increased over time for both the involved limb (quadriceps F2,46 = 58.3, P < .001; hamstring F2,46 = 35.7, P < .001) and uninvolved limb (quadriceps F2,46 = 17.9, P < .001; hamstring F2,46 =56.9, P = .001). Quadriceps and hamstring indexes significantly changed from 4 wk (QI 57.9, HI 54.4) to 8 wk (QI 78.8, HI 69.9) and from 8 wk to 12 wk (QI 82, HI 75.7) (P < .001); however, there was no difference between indexes at the 12-wk time point (P = .17). CONCLUSIONS The results of this study serve as a reference for clinicians while directing a rehabilitation protocol for HTG ACLR patients to better appreciate expected strength changes of the muscles in the early phase of recovery.

Activation of Selected Ankle Muscles During Exercises Performed on Rigid and Compliant Balance Platforms

STUDY DESIGN Experimental laboratory study. OBJECTIVE To compare how the design of 2 balance platforms affects ankle musculature activation for various weight-bearing exercises. BACKGROUND Balance platforms are widely used in both training and rehabilitation, and a better understanding of how platform design and type of exercise modify the demands on the ankle musculature may be helpful in staging exercise progression. METHODS Surface electromyography was used to measure the activation level of the fibularis longus, tibialis anterior, and medial gastrocnemius while performing 4 exercises on 2 different balance platforms (compliant and rigid). Twenty-four (12 females, 12 males) healthy, sedentary subjects participated in the study. Analysis of variance was used for statistical analysis. RESULTS There was no significant interaction between balance platforms and exercises (P>.05), and the type of platform did not influence muscle activation for the 3 muscles monitored (P>.05). The highest activation level for the fibularis longus and medial gastrocnemius was obtained during single-leg stance, and for the tibialis anterior during the single-leg squat (P<.05). CONCLUSION In this study, although the demands on the ankle musculature were similar for selected exercises performed on a compliant versus a rigid balance platform, muscle activation level varied based on the exercise.

External supports improve knee performance in anterior cruciate ligament reconstructed individuals with higher kinesiophobia levels.

BACKGROUND The objectives of this study were to investigate the effects of knee brace (KB) and kinesiotaping (KT) on functional performance and self-reported function in individuals six months post-ACLR who desired to return to their pre-injury activity levels but felt unable to do so due to kinesiophobia. METHODS This was a cross-sectional study involving 30 individuals six months post-ACLR with Tampa Kinesiophobia Scores >37. Individuals were tested under three conditions: no intervention, KB and KT in a randomized order. Isokinetic concentric quadriceps and hamstring strength tests, one leg hop test, star excursion balance test and global rating scale were assessed under the three conditions. RESULTS The involved side showed that KT and KB significantly increased the hop distance (P=0.01, P=0.04) and improved balance (P=0.01, P=0.04), respectively, but only KB was found to increase the quadriceps and hamstring peak torques compared to no intervention (P<0.05). Individuals reported having better knee function with KB when compared to no intervention (P<0.001) and KT (P=0.03). CONCLUSIONS Both KB and KT have positive effects in individuals post-ACLR which may assist in reducing kinesiophobia when returning to their pre-injury activity levels, with the KB appearing to offer the participants better knee function compared to KT.

Short Term Effects of Mobilization Techniques on Neck Pain and Deep Neck Flexor Muscle Endurance in Patients with Mechanical Chronic Neck Pain

Objectives: The aim of the study was to investigate short term effects of cervical and scapular mobilization techniques on neck pain and deep cervical muscles endurance in chronical mechanical neck pain patients. Methods: 22 chronical mechanic neck pain patients four male 18 female (mean age: mean±sd 35.59± 15.85) were included. Before treatment, neck pain level (visual analog scale) and deep neck flexor muscles endurance (in supine position with digital chronometer) of all patients were evaluated. Cyriax cervical mobilization for 10 minutes and scapular mobilization for 10 repetition 10 sets were performed to patients as treatment protocol. After treatment, 24 hours after and a week after evaluations of neck pain and deep cervical muscles endurance were repeated. Results: Before treatment Neck pain Visual Analog Scale scores was 5.78±1.43 point, 2.80±1.99 point after treatment, 24 hours later 3.36±2.12 point, one week later 3.91±2.24 point. This alteration was found significant statistically (p<0.01). Before treatment deep cervical flexor muscle endurance score was 27.25±17.74 sec, after treatment 39.46±25.20 sec, 24 hours later 38.67±28.43 and one week later 40.11±27.82 sec. This alteration was also found significant statistically (p=0.01). Conclusion: Initially neck pain scores in our subjects decreased quickly, after 24 hours these scores increased but last scores were below first neck pain level in a week follow-up. Deep neck cervical flexor muscles test scores also increased quickly, after 24 hours later this scores were stable along a week. Mobilization techniques are effective methods on neck pain and endurance in chronical mechanic neck pain patients.

Self-reported outcomes are associated with knee strength and functional symmetry in individuals who have undergone anterior cruciate ligament reconstruction with hamstring tendon autograft

BACKGROUND The aim of this study was to investigate the relationship between self-reported knee outcomes and limb symmetry indices (LSIs) for hip and knee strength, postural control and single-leg hop distance in individuals who had undergone an anterior cruciate ligament (ACL) reconstruction via hamstring tendon autograft (HTG). METHODS A total of 72 participants with a history of unilateral ACL reconstruction via HTG (mean ± standard deviation (SD) age: 28.0 ± 7.6 years; height: 178.4 ± 6.7 cm; mass 76.9 ± 14.9 kg) were included. International Knee Documentation Committee 2000 Subjective Knee Form (IKDC), Lysholm, Knee Osteoarthritis Outcomes Scores (KOOS) and Tampa scores were used to evaluate self-reported outcomes. Concentric and eccentric knee extensor and flexor, and hip strength, postural control and single leg hop distance were evaluated for performance-based outcomes. The relationships between the LSI scores and the performance measures were explored using the Pearson correlation coefficient. RESULTS The IKDC, Lysholm and KOOS scores were positively correlated with knee extensor and flexor strength LSIs (P < 0.05, r = 0.34 to r = 0.50), and the Tampa score was negatively correlated with eccentric extensor LSI (P = 0.02, r = -0.34). Single-leg hop distance LSI was correlated with IKDC and Lysholm scores (P = 0.003, r = 0.50; P = 0.04, r = 0.29) respectively, while postural control was only correlated with the KOOS scores (P < 0.001, r = 0.51 to r = 0.52). CONCLUSIONS Compared to Lysholm and Tampa scores, KOOS and IKDC scores were more likely to be correlated with performance-based outcomes. Therefore, KOOS and IKDC scores may help clinicians in return to sport decision making when there is a limited time to perform extensive evaluations or access equipment.

Angle-specific knee muscle torques of ACL-reconstructed subjects and determinants of functional tests after reconstruction

ABSTRACT The purposes of this study were to analyse (a) if “angle-specific” (AS) flexor and extensor torques were different between ACL-reconstructed and uninvolved limbs, (b) the difference in peak torque occurrence angles for concentric and eccentric knee flexor and extensor torques between involved and uninvolved limbs and (c) if AS concentric and eccentric knee flexor and extensor torques are determinants of performance in the “single-leg hop test” (SLHT) and “vertical jump and reach test” (VJRT) in ACL-reconstructed legs. Twenty-seven male ACL-reconstructed volunteers were included in the study. Isokinetic knee muscle strength, SLHT and VJRT were performed 6 months after ACL reconstruction. No difference was found in extremity and knee joint angle interaction for concentric and eccentric flexor and extensor torques (p > 0.05). Peak torque occurrence angles were not different between involved and uninvolved limbs (p > 0.05). In involved extremities, concentric knee extensor strength at 90° was a determinant of SLHT performance (R2 = 0.403, p < 0.05), and concentric knee extensor strength at 60° was a determinant of VJRT (R2 = 0.224, p < 0.05). Assessment of AS concentric knee extensor strength at 60° and 90° might be important, because these were determinants of functional test performance.

Short-Term Results of Flexor Hallucis Longus Transfer in Delayed and Neglected Achilles Tendon Repair

Abstract Flexor hallucis longus (FHL) tendon transfer to the calcaneus in the repair of delayed or neglected Achilles tendon (AT) injuries is a viable and dynamic option. Nineteen patients (18 males, 1 female; mean age 47.4 ± 12.4, range 24 to 74, years; body mass index 27.5 ± 4.5, range 23.2 to 38.9, kg/m2; interval from injury to surgery 40.8 ± 11.6, range 28 to 60, days) with delayed or neglected repair of AT rupture were included in the present study. FHL transfer to the calcaneus through a single incision and repair of the defect with native tendon lengthening or a tendinous turndown flap was performed. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot and hallux scale scores, balance and jump performance, ankle dorsiflexion range of motion, and lower extremity concentric and eccentric strength were evaluated 6 months postoperatively. Students t test was used to compare the outcomes between the operated and nonoperated sides. AOFAS hindfoot and hallux scale scores were 93.83 and 86.9, respectively. No significant difference was found in vertical jump (p = .60), forward jump (p = .68), or balance performance (p > .05). However, less ankle dorsiflexion on the operated side was recorded compared with the nonoperated side (p = .008). Concentric/eccentric muscle strength between the operated and nonoperated side was similar (p > .05). The concentric strength of the operated side reached 92% and eccentric strength reached 101.7% of the nonoperated sides strength. All the patients were satisfied with their results and return to preinjury daily activities. AT repair of a delayed and neglected injury using FHL transfer to the calcaneus in a dynamic fashion provided excellent outcomes. &NA; Level of Clinical Evidence: 4

Active Scapular Retraction and Acromiohumeral Distance at Various Degrees of Shoulder Abduction

CONTEXT   Performing shoulder-abduction exercises with scapular retraction has been theorized to reduce the potential for shoulder impingement. However, objective data to support this premise are lacking. OBJECTIVE   To evaluate the influence of active scapular retraction on acromiohumeral distance (AHD) at 4 shoulder-abduction angles using real-time ultrasound. DESIGN   Cross-sectional study. SETTING   University laboratory. PATIENTS OR OTHER PARTICIPANTS   Twenty asymptomatic individuals (10 men, 10 women; age = 22.9 ± 2.8 years, height = 169.3 ± 9.5 cm, mass = 65.5 ± 12.9 kg) were recruited. MAIN OUTCOME MEASURE(S)   Real-time ultrasound images of AHD were obtained during nonretracted and retracted scapular conditions at 0°, 45°, 60°, and 90° of shoulder abduction. A 2-factor analysis of variance with repeated measures was used to evaluate the influence of shoulder retraction on AHD across shoulder-abduction angles. RESULTS   A scapular-retraction condition × shoulder-abduction-angle interaction for AHD was found ( F3,57 = 4.56, P = .006). The AHD was smaller at 0° (10.5 versus 11.2 mm, respectively; t19 = 2.22, P = .04) but larger at 90° (9.4 versus 8.7 mm, respectively; t19 = -2.30, P = .04) of shoulder abduction during the retracted than the nonretracted condition. No differences in AHD were observed between conditions at 45° ( t19 = 1.45, P = .16) and 60° ( t19 = 1.17, P = .86) of abduction. CONCLUSIONS   The observed differences in AHD at 0° and 90° of shoulder abduction were small and did not exceed the established minimal detectable change for either angle. Our findings suggest that active scapular retraction during shoulder abduction has a minimal influence on AHD at 0° and 90° in healthy individuals. Further investigations are needed to determine whether scapular retraction influences AHD in individuals with subacromial impingement.

Relation of Self-Reported Knee Function and Physical Performance with Psychological Responses in Anterior Cruciate Ligament Reconstructed Individuals

Purpose: The aim of this study was to investigate the correlation between anterior cruciate ligament return to sport index after injury (ACL-RSI) score and self-reported knee function, and physical performance in anterior cruciate ligament reconstructed individuals. Methods: Ninety ACL reconstructed individuals at 6 months post-surgery were included in this study. To evaluate psychological responses, ACL-RSI score; and to assess self-reported knee function, International Knee Documentation Committee Subjective Knee Form (IKDC), Knee Injury and Osteoarthritis Outcome (KOOS) and Lysholm scores were selected. One leg hop test and anterior, posteromedial and posterolateral reach distances of star excursion balance test were used to measure physical performance. Pearson correlation test was used for statistical analysis. Results: ACL-RSI score was positively correlated with IKDC, Lysholm and KOOS scores; one leg hop test; and posteromedial and posterolateral reach distances of the star excursion balance test (p<0.05). Discussion: Psychological responses were correlated with self-reported knee function and physical performance in anterior cruciate ligament reconstructed individuals. Therefore, maximizing knee function and performance is important to overcome individuals’ fear of re-injury which affects return to sport after surgery, negatively.

Shoulder-Rotator Strength, Range of Motion, and Acromiohumeral Distance in Asymptomatic Adolescent Volleyball Attackers

CONTEXT Sport-specific adaptations at the glenohumeral joint could occur in adolescent athletes because they start participating in high-performance sports in early childhood. OBJECTIVE To investigate shoulder-rotator strength, internal-rotation (IR) and external-rotation (ER) range of motion (ROM), and acromiohumeral distance (AHD) in asymptomatic adolescent volleyball attackers to determine if they have risk factors for injury. DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Thirty-nine adolescent high school-aged volleyball attackers (22 boys, 17 girls; age = 16.0 ± 1.4 years, height = 179.2 ± 9.0 cm, mass = 67.1 ± 10.9 kg, body mass index = 20.7 ± 2.6 kg/m2). MAIN OUTCOME MEASURE(S) Shoulder IR and ER ROM, total-rotation ROM, glenohumeral IR deficit, AHD, and concentric and eccentric strength of the shoulder internal and external rotators were tested bilaterally. RESULTS External-rotation ROM was greater (t38 = 4.92, P < .001), but IR ROM (t38 = -8.61, P < .001) and total ROM (t38 = -3.55, P = .01) were less in the dominant shoulder, and 15 athletes had a glenohumeral IR deficit (IR ROM loss > 18°). We observed greater concentric internal-rotator (t38 = 2.89, P = .006) and eccentric external-rotator (t38 = 2.65, P = .01) strength in the dominant than in the nondominant shoulder. The AHD was less in the dominant shoulder (t38 = -3.60, P < .001). CONCLUSIONS Adolescent volleyball attackers demonstrated decreased IR ROM, total ROM, and AHD and increased ER ROM in their dominant shoulder. Therefore, routine screening of adolescent athletes and designing training programs for hazardous adaptive changes could be important in preventing shoulder injuries.