Margaret I. Bullock

Factors Involved in the Development of Osteoarthritis after Anterior Cruciate Ligament Surgery

Background The incidence of osteoarthritis after anterior cruciate ligament reconstruction is disturbingly high, with reports of nearly 50% of patients developing mild to moderate osteoarthritis 6 years after surgery. Few studies have assessed the factors involved in the development of osteoarthritis. Hypothesis: The following 10 factors will be found to be predictive of osteoarthritis meniscectomy, chondral damage, patellar tendon grafting, age at surgery, time delay between injury and surgery, type and intensity of postsurgery sport, quadriceps strength, hamstring strength, quadriceps-to-hamstring strength ratio, and residual joint laxity. Study Design Cohort study (prognosis); Level of evidence, 1. Methods Fifty-six subjects with anterior cruciate ligament reconstruction were followed for 6 years after surgery. Assessment included KT-1000 arthrometer testing, isokinetic strength testing, a return-to-sport questionnaire, and a radiograph assessment. A discriminant analysis was performed to assess which of the 10 factors could discriminate between those patients who developed tibiofemoral and patellofemoral osteoarthritis and those who did not. Results Five factors were found to be predictive of tibiofemoral osteoarthritis. Meniscectomy (r = .72) and chondral damage (r = .41) were the strongest discriminators, followed by patellar tendon grafting (r = .37) (χ2 [7, n = 56] = 25.48; P = .001). Weak quadriceps (r = .39) and low quadriceps-to-hamstring strength ratios (r = .6) were very close discriminators (χ2 [8, n = 42] = 15.02; P = .059). For patellofemoral osteoarthritis, meniscectomy (r = .45), chondral damage (r = .75), and age at surgery (r = .65) were predictors or close predictors (χ2 [7, n = 54] = 13.30; P = .065). Conclusion As not all 10 factors studied were predictive of osteoarthritis, the hypothesis was only partially proven. Preventing further meniscal and chondral damage in patients with anterior cruciate ligament deficiency is critical. Grafting using the hamstring tendons and restoration of quadriceps-to-hamstring strength balance are associated with less osteoarthritis.

A 6-Year Follow-up of the Effect of Graft Site on Strength, Stability, Range of Motion, Function, and Joint Degeneration After Anterior Cruciate Ligament Reconstruction Patellar Tendon Versus Semitendinosus and Gracilis Tendon Graft

Background The choice of graft material for anterior cruciate ligament reconstruction remains controversial. Despite the need for well-controlled, long-term outcome studies comparing patellar tendon with hamstring grafting, few studies have followed results for more than 5 years. Hypothesis Graft source will not affect outcome 6 years after reconstruction. Study Design Cohort study; Level of evidence, 2. Methods Sixty-two patients with anterior cruciate ligament reconstruction and 18 uninjured control subjects were studied over 6 years. Thirty-one patients received patellar tendon grafts, and 31 received hamstring tendon grafts. Assessment included knee joint stability, range of motion, muscle strength, subjective function, objective function (running, sidestepping, carioca, and hop tests), and joint degeneration. Results Clinical stability was restored to all patients other than to the 2 hamstring graft recipients who suffered reinjuries. The KT-1000 arthrometer side-to-side differences were similar in the patellar tendon (1.9 mm) and hamstring tendon (2.0 mm) groups but were significantly greater than that of uninjured control subjects (P < .001). There were no significant strength differences between surgical and control groups, although a 6% quadriceps deficit existed after patellar tendon grafting. In the more demanding functional tests (hop and triple-hop indices and carioca), the hamstring graft recipients performed similarly to the control group, whereas a significant difference (P < .05) existed between the patellar tendon graft and the control group. The incidence of early tibiofemoral osteoarthritis was significantly greater after reconstruction using patellar tendon (62%) than after hamstring tendon grafting (33%; P = .002). Conclusion Six-year outcomes were very satisfactory irrespective of graft source. However, reconstruction using the hamstring tendons resulted in improved functional performance and a lower incidence of osteoarthritis.

Reflex activation of gluteal muscles in walking : an approach to restoration of muscle function for patients with low-back pain

Gluteal activation and pelvic stability often are decreased in chronic low-back pain sufferers, but the importance of motor control and programming in treatment has not been fully evaluated. This study investigated whether gluteal muscles could be activated more affectively by stimulating the proprioceptive mechanism during walking. Labile support, through wearing “balance shoes,” offered facilitation of cerabellovestibular circuits, Electromyographic recordings of gluteus maximus and medius in 15 healthy subjects were made during barefoot and balance shoes walking before and after 1 week of facilitation. Singnificant increases (P<0.0002) in gluteal activity and significant decreases(P<0.01) In time to 75% maximum contraction, demonstrated the value of sensorimotor elicitation of subconscious and automatic responses in muscles often weakened in back pain sufferers.

The Relationship of Low Back Pain to Postural Changes During Pregnancy

To determine the nature of the postural changes in women during pregnancy, the degrees of lordosis, kyphosis and pelvic inclination in 34 pregnant women were measured progressively. The incidence of low back pain at each of the three occasions was also monitored. Analyses revealed that significant increases occurred in the lumbar and thoracic curvatures and that 82 percent of the women experienced back pain at some stage during their pregnancy. However, no significant relationship was revealed between posture and back pain and the study did not support the frequently made assertions that back pain in pregnancy is due to an increase in lordosis.

A motion profile of the lumbar spine in an ageing population assessed by manual examination

Manipulative physiotherapists routinely examine abnormal lumbar intersegmental motion in back pain sufferers. However, they do so without sufficient information of the changes occurring normally with age. Although age changes in mechanical properties of tissues and in range of lumbar movement have been documented, no data have been available on which a level of abnormality might be judged directly applicable to manual perception of movement. This study is aimed at providing such data. Two hundred adult subjects (100 males and 100 females) who had never suffered back pain were studied. Their ages spanned 15-65 years. The lumbar segments L5- S, to T12- L1 were examined by manual methods for all physiological directions and postero-anterior accessory glides. Motion was rated on a five point motion rating scale. The results indicated that there is an increasing incidence of hypomobility with age (p < 0.001) but that the decline in motion is not marked. Gender is not a major determining factor in mobility. This study has provided a succinct set of data relating to normal lumbar intersegmental motion in various age groups, which should form a basis for future comparisons with low back pain sufferers.

The Interrelation of Spinal Curves, Pelvic Tilt and Muscle Lengths in the Adolescent Female

Thoracic kyphosis, lumbar lordosis and pelvic tilt were measured in standing in one hundred and three adolescent females, using a specially designed inclinometer. Indices of the muscle lengths (abdominals, erector spinae, iliopsoas, gluteals, rectus femoris and hamstrings) were measured using inclinometry and goniometry and expressed as angles of joint position. Multiple regression analysis revealed that the index of erector spinae length was negatively correlated with lumbar lordosis (r = - 0.24, p < 0.05). The abdominal length index was positively correlated with lumbar lordosis (r = 0.209, p < 0.05), and the hamstring length index was negatively correlated with lordosis (r = - 0.213, p < 0.05). No muscle length index was significantly related to pelvic tilt. A negative association between the degree of thoracic kyphosis and the abdominal length index was found (r = -0.245, p < 0.05).

The Determination of Functional Arm Reach Boundaries for Operation of Manual Controls

In the planning of the manual workspace of automobiles and aircraft cockpits, it is important that the designer should have access to data which can illustrate the reach capabilities of the potential user population. This paper presents a method which has been developed for the collection of such data. The subjects used for measurement represented the male and female Australian pilot population in terms of height and, during the measurement procedure, they were firmly restrained by-lap and sash harness while seated on an experimental chair with specifications similar to those found in current light aircraft. A description is given of the apparatus which allowed rapid recording of the measurements required for the determination of functional arm reach boundaries to an accuracy of ± 2 mm. The procedure which was followed while measuring maximum arm reach to 170 positions in space around each subject is outlined, together with the details which ensured experimental consistency throughout the project. Results...

The Measurement of Three-Dimensional Body Movements by the Use of Photogrammetry

Stereophotogrammetry is evaluated as a method of studying dynamic posture, the particular activity used during experimentation being the depression of a foot pedal, whose position and resistance was set to produce large-range trunk and pelvic movements in three dimensions. A description is given of the experimental procedure which was followed in order to measure the extent and direction of movements in three-dimensional space, to record velocities and to analyse the sequence and. pattern of motion in the whole body. The procedures for acquiring, recording and reducing data, using stereophotography, stercoplotting and computation, are explained. An evaluation of the accuracy attained indicates that, with this particular equipment and geometrical configuration, measurements of small movements, of the order of 0-3 m, have a standard error of 0.6mm even when the subject moves at a rate of up to 30 cm per sec. Suggestions are given for possible improvements which could be made to the procedure and for the application of this method of study to investigations in the field of ergonomics.

Normal lumbo-pelvic muscle lengths and their interrelationships in adolescent females

Length indices of the erector spinae, abdominal, gluteal iliopsoas, rectus femoris and hamstring muscles were measured in 103 adolescent females. Means and standard deviations were calculated and the 95 per cent confidence intervals for the population and the 95 per cent individual tolerance limits were derived for each index. Analysis of the interrelationships of the muscle length indices using multiple correlation analysis revealed significant positive correlations between the lumbar erector spinae and iliopsoas and rectus femoris indices, between the abdominal and gluteal indices and between the iliopsoas and hamstring indices. Significant negative correlations exist between the lumbar erector spinae and gluteal indices, between the iliopsoas and abdominal indices and between the rectus femoris and hamstring indices.

A study of the effectiveness of physiotherapy in the management of young children with minimal cerebral dysfunction.

Minimal cerebral dysfunction (MCD) is one of many terms used to describe the syndrome exhibited by children who demonstrate mild abnormalities on clinical neurological assessment. The neurological signs of minimal cerebral dysfunction are manifested in the nature of the reflex and automatic sensory responses as well as in the motor responses to specific stimulations. Those reactions which persist beyond the normal age for their integration, together with other mild signs of neurological dysfunction are also symptomatic of minimal cerebral dysfunction.