Validation of Panoramic Ultrasound Measurement of the Cross-Sectional Area of the Vastus Medialis.

ABSTRACT: Minnehan, KS, Dexter, WW, Holt, CT, Scharnetzki, L, Alex, JP, Chin, KE, and Kokmeyer, DJ. Validation of panoramic ultrasound measurement of the cross-sectional area of the vastus medialis. J Strength Cond Res 37(1): 41-45, 2023-The cross-sectional area (CSA) of the vastus medialis (VM) is an independent predictor of important clinical outcomes in musculoskeletal conditions of the knee, such as pain and long-term function. Previous studies validated ultrasound (US) to measure larger muscles of the thigh, but this approach has limited accuracy in measuring smaller muscles, such as the VM. In this study, we aimed to validate panoramic US measurements of the CSA of the VM and compare the results with those from the gold standard of magnetic resonance imaging (MRI) (significance set p ≤ 0.05). In this retrospective, single-center study, we compared pairs of US and MRIs taken of 25 adults who participated in a 10-week study of non-weight-bearing activity at a National Aeronautics and Space Administration facility. Images were acquired from various locations on the right thigh at multiple time points. Two researchers independently analyzed the US and MRI pairs by outlining the intermuscular border of the VM in the most distal image. We found excellent agreement between the US and MRI measurements of the CSA of the VM analyzed by researcher 1 (interclass correlation coefficient [ICC]: 0.997) and researcher 2 (ICC: 0.980). We also found excellent agreement for interrater reliability for MRI (ICC: 0.988) and US (ICC: 0.982) and intrarater reliability for US for researcher 1 (ICC: 0.999) and researcher 2 (ICC: 0.996). Our findings demonstrate that US is a valid and reliable tool for measuring the CSA of the VM compared with MRI.

Clinical Results After Conservative Management for Grade III Acromioclavicular Joint Injuries: Does Eventual Surgery Affect Overall Outcomes?

PURPOSE: To compare the clinical outcomes in patients with grade III acromioclavicular (AC) joint injuries in whom nonoperative therapy was successfully completed and those who had nonoperative therapy failure and who proceeded to undergo surgical reconstruction. METHODS: Forty-nine patients were initially treated nonoperatively for grade III AC joint injuries with physical therapy. Patients completed questionnaires at initial presentation and after a follow-up period of 2 years. Outcome measures included the Short Form 12 Physical Component Score; American Shoulder and Elbow Surgeons score; Quick Disabilities of the Arm, Shoulder and Hand score; and Single Assessment Numeric Evaluation score. Failure of nonoperative treatment occurred when a patient underwent AC reconstruction before final follow-up. RESULTS: Forty-one patients with a mean age of 39 years (range, 18 to 79 years) were included. In this cohort, 29 of 41 patients (71%) successfully completed nonoperative therapy whereas 12 of 41 (30%) had nonoperative therapy failure at a median of 42 days (range, 6 days to 17.0 months). Of the 41 patients, 39 (95.3%) were contacted to determine treatment success. Of the 12 patients who had nonoperative therapy failure, 11 (92%) had sought treatment more than 30 days after the injury. Subjective follow-up data were available for 10 of 12 patients (83.3%) who had nonoperative therapy failure and for 23 of 29 patients (79.3%) who were successfully treated nonoperatively. The mean length of follow-up was 3.3 years (range, 1.8 to 5.9 years). Although there were no statistically significant differences in outcome scores between groups, those who sought treatment more than 30 days after their injury showed decreased postoperative Single Assessment Numeric Evaluation scores (P = .002) and Short Form 12 Physical Component Scores (P = .037). CONCLUSIONS: According to our results, (1) a trial of nonoperative treatment is warranted because successful outcomes can be expected even in patients who eventually opt for surgery and (2) patients who presented more than 30 days after their injury were less likely to complete nonoperative treatment successfully. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Prognosis Driven Rehabilitation After Rotator Cuff Repair Surgery.

BACKGROUND: Rehabilitation after rotator cuff repair surgery has been the focus of several clinical trials in the past decade. Many illuminate new evidence with regard to the prognosis of structural and functional success after surgery. METHODS: A selective literature search was performed and personal physiotherapeutic and surgical experiences are reported. RESULTS: Post-operative rehabilitation parameters, namely the decision to delay or allow early range of motion after surgery, play a large role in the overall success after surgery. Using a prognosis driven rehabilitation program offers clinicians a means of prescribing optimal rehabilitation parameters while ensuring structural and functional success. This commentary aims to synthesize the evidence in a spectrum of prognostic factors to guide post-operative rehabilitation. CONCLUSION: The optimal rehabilitation program after rotator cuff repair surgery is debatable; therefore, we suggest using a spectrum of prognostic factors to determine a rehabilitation program suited to ensure structural and functional success, quickly and safely.

Gait considerations in patients with femoroacetabular impingement.

UNLABELLED: The literature describing the characteristic features of femoroacetabular impingement (FAI) has been on the rise, increasing awareness of this pathology in the young, active population. The physical therapist should consider FAI as a contributing factor to anterior hip pain, impairments, and functional deficits of the lower quarter. The dynamic interplay of anatomical variations, pain, and muscle function and their effects on gait in patients with FAI, however, is poorly understood. Small sample populations and variability in radiological, demographic, and clinical presentations in those with FAI have precluded meaningful insight into gait analysis and FAI, reiterating the need for further research in this domain. The purpose of this clinical commentary is to review the literature that defines normal gait at the hip joint and abnormal gait as a result of FAI and labral pathology or surgery aimed at correcting it. Secondarily, the authors aim to offer clinicians a strategy to progress the post-surgical patient to normal, unassisted gait while reducing the risk for anterior hip pain. Lastly, the authors of this commentary aim to identify specific areas for future research directed at therapeutic interventions in patients with FAI and those who have undergone surgery to correct it. LEVEL OF EVIDENCE: 5.

Suggestions from the field for return-to-sport rehabilitation following anterior cruciate ligament reconstruction: alpine skiing.

Alpine skiing is a high-risk sport for injuries to the anterior cruciate ligament (ACL). While descending a hill, a skier must resist large centrifugal forces at a high velocity, while the knees are positioned in postures that place the ACL at risk of injury. Skiers who undergo ACL reconstructive surgery are prone to a high rate of reinjury to the same knee and even ACL injury in the uninjured knee. A rehabilitation program that integrates the best current evidence of ACL rehabilitation and the science of skiing is essential to a successful return to alpine skiing. Unlike rehabilitation programs developed for court or field athletes, a skiing program must place a large emphasis on slow eccentric-loading and weight-bearing (closed-chain) power and endurance. The purpose of this clinical commentary is to provide the rehabilitation specialist such a program directed toward safely returning the athlete to alpine skiing.

Rehabilitation after arthroscopic rotator cuff repair: current concepts review and evidence-based guidelines.

PURPOSE: To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation of rotator cuff repairs. The authors' protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed. BACKGROUND: If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. To this end, rehabilitation protocols have proven challenging to both the orthopaedic surgeon and the involved physical therapist. Instead of being based on scientific rationale, traditionally most rehabilitation protocols are solely based on clinical experience and expert opinion. METHODS: A review of currently available literature on rehabilitation after arthroscopic rotator cuff tear repair on PUBMED / MEDLINE and EMBASE databases was performed to illustrate the available evidence behind various postoperative treatment modalities. RESULTS: There is little high-level scientific evidence available to support or contest current postoperative rotator cuff rehabilitation protocols. Most existing protocols are based on clinical experience with modest incorporation of scientific data. CONCLUSION: Little scientific evidence is available to guide the timing of postsurgical rotator cuff rehabilitation. To this end, expert opinion and clinical experience remains a large facet of rehabilitation protocols. This review describes a rotator cuff rehabilitation protocol that incorporates currently available scientific literature guiding rehabilitation.

Shoulder injuries in the throwing athlete.

Pathologic conditions in the shoulder of a throwing athlete frequently represent a breakdown of multiple elements of the shoulder restraint system, both static and dynamic, and also a breakdown in the kinetic chain. Physical therapy and rehabilitation should be, with only a few exceptions, the primary treatment for throwing athletes before operative treatment is considered. Articular-sided partial rotator cuff tears and superior labral tears are common in throwing athletes. Operative treatment can be successful when nonoperative measures have failed. Throwing athletes who have a glenohumeral internal rotation deficit have a good response, in most cases, to stretching of the posteroinferior aspect of the capsule.

The reliability of multitest regimens with sacroiliac pain provocation tests.

BACKGROUND: Studies concerning the reliability of individual sacroiliac tests have inconsistent results. It has been suggested that the use of a test regimen is a more reliable form of diagnosis than individually performed tests. OBJECTIVE: To assess the interrater reliability of multitest scores by using a regimen of 5 commonly used sacroiliac pain provocation tests. METHODS: Two examiners examined 78 subjects. The threshold for a positive selection was set at 3 positive tests out of 5 tests performed. The test order and the order in which the subjects were examined were randomized per patient, and the examiners were blinded from all information regarding the subjects tested. Fifty-nine of the subjects were symptomatic for low back pain, and 19 of the subjects were asymptomatic. Weighted kappa statistic, bias-adjusted kappa, prevalence-adjusted kappa, and 95% CI intervals were used to evaluate the interrater reliability of the test regimen. RESULTS: Weighted kappa was found to be 0.70 (95% CI = 0.45-0.95). CONCLUSIONS: A multitest regimen of 5 sacroiliac joint pain provocation tests is a reliable method to evaluate sacroiliac joint dysfunction, although further study is needed to assess the validity of this test method.