Jeffrey Boyle

Joint position sense in the recurrently sprained ankle

Functional instability of the ankle joint following an acute sprain has been well documented. The present study measured joint position sense of the ankle in subjects who had sustained recurrent ankle sprains but no sprain for at least three months prior to testing, and compared them with uninjured subjects. The testing device, a pedal goniometer, attempted to replicate the most common position of ankle injury (plantarflexion/inversion). Joint position sense was assessed using active and passive methods for reproducing predetermined positions in ankle inversion in plantarflexion. In both groups, passive judgment of joint position was more accurate than active judgment. Significant differences were recorded with the recurrently sprained ankle demonstrating greater errors in joint position sense for all passive testing positions.

Morphological survey of the cervicothoracic junctional region

Study Design Vertebral morphology of the cervicothoracic junctional region was studied using the C6 to T4 vertebrae from 51 disarticulated skeletons (26 males and 25 females). Objectives Orientation of the facet joint pair relative to the plane of the superior endplate and the sagittal reference was recorded. A vertebral index was developed to compare the superior endplate surface area with the posterior vertebral body height. Summary of Background Data Vertebral morphometry was recorded for comparison with the limited published data for this region. Methods The disc‐facet angle was measured using a zygapophysial endplate protractor and the facet angle recorded from computer‐aided digitizing of photographs of each segment. Vertebral dimensions were measured using Mitutoyo digital calipers. Results A marked change in disc‐facet angle from C6 to T1 was recorded, with the incidence of right versus left asymmetry highest at the T1 level. The incidence of facet angle asymmetry greater than 10° was 24% at C6, 18% at C7, and 16% at T1. The vertebral index indicated no significant gender difference. Conclusion Consistent with other junctional regions of the spine, the cervicothoracic transition has significant morphological variations.

Functional measurement of knee joint position sense after anterior cruciate ligament reconstruction

OBJECTIVE To examine for differences in joint position sense (JPS) between knees with reconstructed anterior cruciate ligaments (ACLs) and uninjured knees by using a functional weight-bearing measurement method. DESIGN Two-way repeated-measures in a convenience sample. SETTING An Australian university rehabilitation laboratory. PARTICIPANTS Nine subjects presenting at 12 to 16 months after unilateral ACL reconstruction using the semitendinosus/gracilis graft who were recruited from 2 orthopedic surgeons. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES JPS of the reconstructed and uninjured knees was examined by using the Peak Motus motion measurement system to record target joint angles and to calculate reproduced angles after limb movement into flexion and extension, performed in a weight-bearing position. RESULTS There were no significant differences in JPS between reconstructed and uninjured knees (P=.68) or between the flexion and extension tasks (P=.47). CONCLUSION There was no deficit in knee JPS 12 to 16 months after ACL reconstruction, as measured by a functional weight-bearing method. Further studies should examine the clinical utility of the method as a way to evaluate functional aspects of knee joint proprioception.

Self evaluation and functional testing two to four years post ACL reconstruction

This study examined subjective perceptions of knee status and performance in single limb functional tests following anterior cruciate ligament reconstruction. The Tegner activity scale, modified Noyes and an analogue scale were administered to 20 subjects. Performance outcome in the 6m and 12m timed hop, cross-over hop and stairs hopple tests were described using the limb index. In general, subjects experienced minimal limitations during daily activities and a slight reduction in their present activity level. Poorer performance was noted in the operated limb in all functional tests. Subjective data gathered from the questionnaire compared favourably with functional outcome. Interpretation of subjective outcomes in relation to functional testing results potentially enhances the accuracy of post-operative knee evaluation.

Extensor strength in the anterior cruciate reconstructed knee

Truncated range average torque (TRAT), peak torque (PT) and angle of peak torque (APT) in the knee extensor musculature of subjects with patellar tendon autograft anterior cruciate ligament reconstructions were compared with non-operated limbs two to four years following surgery. Twenty subjects were assessed using a Kin-Com 500H isokinetic dynamometer at three velocities for both concentric and eccentric muscle actions. Results of TRAT for the knee extensors showed average concentric and eccentric deficits of 8.48 per cent and 6.73 per cent, respectively. Deficits in PT were 8.26 per cent concentrically and 7.96 per cent eccentrically. There was no difference in the APT for each action or velocity. Despite an accelerated rehabilitation program, significant residual deficits were evident. Continued strengthening of the knee extensor muscles is recommended.

Pattern of intervertebral disc degeneration in the cervicothoracic junctional region

Summary There have been no reports describing the pattern of degenerative changes of spinal segments within the cervicothoracic (CT) transitional junction. To address this deficiency, intervertebral disc degenerative changes in this region were studied between the C6 to T4 vertebrae, using hemisected spinal columns from 96 individuals (69 male and 27 female). Sagittally sectioned spinal columns were inspected macroscopically by one observer and graded using previously reported grading scales. In addition, endplate irregularity, intervertebral disc degenerative changes, discal splitting and vertebral body marginal osteophytes were recorded. Combining all classifications of degeneration, the frequency of disc degeneration at C6–C7 was 49%, C7−T1 = 42%, T1−T2 = 40%, T2−T3 = 50% and T3−T4 = 44%. Significant age trends were noted, with 25% of all discs showing degeneration in the youngest group, compared to 58% in the oldest group. The incidence of disc degenerative changes through this transition declined from the C6–C7 to the T1–T2 segments but increased slightly for the more severe changes at the T2–T3 and T3–T4 segments. In one third of cases demonstrating degenerative discal changes no evidence of osteophyte formation was present. The manual therapist should not exclude the possibility of discal pathology in patients presenting with cervicothoracic pain, particularly if the patient is over 30 years of age.

Hoe sterk is het ligamentum cruciatum anterius bij extensie na reconstructie

De verminderde gemiddelde kracht (vgk), de krachtpiek (kp) en de hoek van de krachtpiek (hkp) van de extensiemusculatuur van de knie bij proefpersonen met een reconstructief transplantaat van het lig. cruciatum anterius met de patellaire pees werden vergeleken met niet-geopereerde extremiteiten twee tot vier jaar na de operatie.