Marketta Henriksson

DOES THE FUNCTIONAL REACH TEST REFLECT STABILITY LIMITS IN ELDERLY PEOPLE

OBJECTIVE To explore how the Functional Reach test correlates with the displacement of the centre of pressure and whether the test is a measure of the stability limits in healthy elderly people. Also to explore the performance parameters during the Functional Reach test. DESIGN Method comparison study. SUBJECTS Twenty-seven healthy elderly subjects. METHODS Whole body kinematics (ELITE systems), ground reaction forces (AMTI) and muscle activity (EMG) parallel with clinical yardstick measure while performing the Functional Reach test. RESULTS This study showed a low correlation (r = 0.38) between reach distance and displacement of centre of pressure and a moderate correlation (r = 0.68) between forward rotation of the trunk and reach distance. The movement during the Functional Reach test was characterized by a large forward rotation of the trunk and a small extension in the ankle. The latter constraining centre of pressure forward displacement. CONCLUSIONS The results suggest that the Functional Reach test is a weak measure of the stability limits. Movement of the trunk seems to influence the test more than the displacement of the centre of pressure. When using the Functional Reach test for assessing balance, compensatory mechanisms should be taken into account.

Knee kinematics and kinetics in former soccer players with a 16-year-old ACL injury – the effects of twelve weeks of knee-specific training

BackgroundTraining of neuromuscular control has become increasingly important and plays a major role in rehabilitation of subjects with an injury to the anterior cruciate ligament (ACL). Little is known, however, of the influence of this training on knee stiffness during loading. Increased knee stiffness occurs as a loading strategy of ACL-injured subjects and is associated with increased joint contact forces. Increased or altered joint loads contribute to the development of osteoarthritis.The aim of the study was to determine if knee stiffness, defined by changes in knee kinetics and kinematics of gait, step activity and cross-over hop could be reduced through a knee-specific 12-week training programme.MethodsA 3-dimensional motion analysis system (VICON) and a force plate (AMTI) were used to calculate knee kinetics and kinematics before and after 12 weeks of knee-specific training in 12 males recruited from a cohort with ACL injury 16 years earlier. Twelve uninjured males matched for age, sex, BMI and activity level served as a reference group. Self-reported patient-relevant data were obtained by the KOOS questionnaire.ResultsThere were no significant changes in knee stiffness during gait and step activity after training. For the cross-over hop, increased peak knee flexion during landing (from 44 to 48 degrees, p = 0.031) and increased internal knee extensor moment (1.28 to 1.55 Nm/kg, p = 0.017) were seen after training, indicating reduced knee stiffness. The KOOS sport and recreation score improved from 70 to 77 (p = 0.005) and was significantly correlated with the changes in knee flexion during landing for the cross-over hop (r = 0.6, p = 0.039).ConclusionKnee-specific training improved lower extremity kinetics and kinematics, indicating reduced knee stiffness during demanding hop activity. Self-reported sport and recreational function correlated positively with the biomechanical changes supporting a clinical importance of the findings. Further studies are needed to confirm these results in women and in other ACL injured populations.

Functional and muscle morphometric effects of ACL reconstruction. A prospective CT study with 1 year follow-up.

Computed tomography (CT) was used to explore if changes in muscle cross‐sectional area and quality after anterior cruciate ligament (ACL) injury and reconstruction would be related to knee function. Fourteen females and 23 males (16–54 years) underwent clinical tests, subjective questionnaires, and CT 1 week before and 1 year after ACL surgery with semitendinosus‐gracilis (STG) graft and rehabilitation. Postoperatively, knee laxity was decreased and functional knee measures and subjective patient scores improved. The most obvious remaining deficit was the quadriceps atrophy, which was significantly larger if the right leg was injured. Right‐leg injury also tended to cause larger compensatory hypertrophy of the combined knee flexor and tibial internal rotator muscles (preoperatively). The quadriceps atrophy was significantly correlated with the scores and functional tests, the latter also being related to the remaining size of the gracilis muscle. Biceps femoris hypertrophy and, in males only, semimembranosus hypertrophy was observed following the ACL reconstruction. The lack of semimembranosus hypertrophy in the women could, via tibial internal rotation torque deficit, contribute to the less favorable functional and subjective outcome recorded for the women. The results indicate that the quadriceps, the combined knee flexor/tibial internal rotator muscles, side of ACL injury, and sex are important to consider in rehabilitation after STG graft.

Gait initiation characteristics in elderly patients with unilateral vestibular impairment

The study tested the hypothesis that vestibular patients (n=14) with chronic unsteadiness caused by a documented peripheral unilateral vestibular dysfunction would display differences in muscular activation and movement pattern during gait initiation compared to age-, gender- and body-size-matched healthy Controls (n=14). The displacements of the whole body Center of Pressure (CoP) during the preparatory phase before the swing leg is lifted, were markedly different in vestibular patients. The backward shift during this phase was significantly smaller than in Controls, coupled with a larger secondary corrective forward shift of the CoP. Conversely, the CoP-shift in the M-L direction towards the stance leg was larger in the vestibular patients. Most vestibular patients lacked the anticipatory tibialis anterior (TA) burst, which normally is a prerequisite for the backward displacement of the CoP that precedes the forward movement. The vestibular patients displayed more pronounced TA-Gastrocnemius coactivation in the stance leg when the swing leg was lifted. The duration of the preparatory phase was significantly longer in vestibular patients than in Controls, with no time differences in the later gait initiation events. The vestibular patients started from a more symmetrical stance and with less M-L variation than the Controls. It is concluded that chronically impaired vestibular function leads to a different strategy to create forward momentum to the body. In addition, there is evidence that vestibular patients have diminished postural stability, or alternatively a more cautious behaviour, when initiating the second step.

Post-operative bracing after ACL reconstruction has no effect on knee joint effusion. A prospective, randomized study

BACKGROUND It is unclear what factors contribute to knee joint effusion after anterior cruciate ligament (ACL) injury and reconstruction. Knee homeostasis after injury and surgery is crucial for rehabilitation and knee well-being. We examined if effusion was affected by post-operative bracing, and if patients with effusion fit into a common profile. METHODS Patients were randomized to wearing or not wearing a post-operative brace for three weeks after ACL reconstruction with semitendinosus-gracilis tendons. Knee joint effusion was detected by computed tomography in 60 patients (22 women), before and three and 12 months after surgery. Joint effusion, clinical and subjective tests were analyzed. RESULTS This is the first prospective, randomized study on post-operative bracing for patients with a semitendinosus-gracilis graft showed that bracing had no effect on three-months presence of joint effusion. Excessive joint effusion was present in 68% of the patients three months after surgery and was associated to prior meniscus injury (p=0.05) and higher prior Tegner activity level (p=0.006). We found a positive association between longer time from injury to surgery and joint effusion three months post-operatively (rho=0.29, p<0.05). Twelve months post-operatively, joint effusion had diminished to baseline levels. Subjective scores and activity levels were lower for women. Three-months joint effusion predicted lower final outcome scores in women. CONCLUSION Prior meniscus injury and pre-injury Tegner activity levels are predictive significant variables for excessive knee joint effusion after ACL reconstruction. Post-operative bracing had no effect. A larger clinical cohort is needed to confirm findings of this logistic regression.

In memoriam Jan Gillquist 1934-2016.

Dandy and Ejnar Eriksson. Later in his career, he became chairman of both the International Arthroscopy Association in 1987–1989 and the International Society of the Knee in 1991–1993. He organized the first combined meeting for the IAA and ISK in Copenhagen in 1993, which was the starting point for merging to form the current ISAKOS. He was elected to the AOSSM Hall of Fame. Jan was a truly multitalented person. He was born in 1934. His mother was a textile artist, whose work was characterized by perfection. His father was a lecturer in modern languages and Latin at Katedralskolan, the most prestigious high school in Linkoping, Sweden. In his adolescence, Jan was an award-winning guitarist, who played at dance Jan Gillquist will always be remembered as one of the greatest in the field of knee surgery and sports medicine. He picked up the idea of knee arthroscopy in the early 1970s and became one of the pioneers, together with colleagues like Robert Jackson, Richard O’Connor, David