Defining Clinically Meaningful Cut Points for Leg Power Impairment Using Physical Performance in Older Adults: A Secondary Analysis From Boston RISE.

OBJECTIVE: To identify clinically meaningful thresholds of leg power impairment identified by the stair climb power test (SCPT). DESIGN: Cross-sectional analysis using the baseline data from an observational cohort study. SETTING: The Boston Rehabilitative Impairment Study of the Elderly. PARTICIPANTS: Community-dwelling older adults (N=413). MAIN OUTCOME MEASURES: SCPT and the Short Physical Performance Battery (SPPB). RESULTS: Using the receiver operating characteristic curves and Youden's J statistics, the optimal threshold for the SCPT associated with mobility limitation as defined by an SPPB score ≤9 was 3.07 Watts/kg for men with a sensitivity of 74%, a specificity of 73% and, an area under the curve (AUC) value of 0.78. For women, the optimal threshold was 2.59 Watts/kg with a sensitivity of 83%, a specificity of 69%, and an AUC value of 0.81. The classification and regression tree sensitivity analysis demonstrated similar thresholds, 2.88 Watts/kg and 2.53 Watts/kg for men and women, respectively. CONCLUSIONS: The study identified clinically meaningful thresholds of impairment for the SCPT for mobility limited older primary care patients. These thresholds may be used to inform rehabilitation care to improve functional mobility of older adults and should be validated in larger more representative clinical trials.

Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review.

OBJECTIVE: To determine the efficacy of extracorporeal shockwave therapy (ESWT) and investigate outcomes following the use of ESWT for athletes and physically active individuals. DESIGN: Systematic review. DATA SOURCES: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and searched four databases: PubMed (NLM), Embase (Elsevier), CINAHL Complete (EBSCO) and Web of Science (Clarivate). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Included studies were randomised controlled trials, cohort and case-control studies, cases series and reports that evaluated outcomes following ESWT for athletes, physically active individuals and occupational groups requiring regular physical activity such as military cadets. RESULTS: 56 studies with 1874 athletes or physically active individuals were included. Using the Oxford level of evidence rating, included studies were 18 level I (32.1%), 3 level II (5.4%), 10 level III (17.9%), 13 level IV (23.2%) and 12 level V (21.4%). Based on the level I studies, ESWT may be effective alone in plantar fasciitis, lateral epicondylitis and proximal hamstring tendinopathy and as an adjunct to exercise treatment in medial tibial stress syndrome and osteitis pubis in athletes or physically active individuals. In most studies, athletes were allowed to continue activities and training and tolerated ESWT with minimal side effects. CONCLUSION: ESWT may offer an efficacious treatment alone or as an adjunct to concurrent exercise therapy in selected sports-related injuries and without major adverse events. Further high-level research is needed to better define the role and clinical outcomes of ESWT.

Targeting the Sweet Spot: A Systematic Review With Meta-Analysis of Anterior Versus Posterior Glenohumeral Joint Injections for Adhesive Capsulitis.

OBJECTIVE: To compare clinical outcomes following steroid injections using the anterior and posterior approaches. DESIGN: Systematic review with meta-analysis. SETTING: Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies. PATIENTS: Patients with adhesive capsulitis. INTERVENTIONS: Glenohumeral steroid injections using either anterior or posterior approach. MAIN OUTCOME MEASURES: Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs. RESULTS: We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, -0.86; 95% CI, -1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, -0.52; 95% CI, -0.98 to -0.07). Overall, procedures were well tolerated without major complications. CONCLUSIONS: While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks.

Validation of an Ear-Worn Wearable Gait Analysis Device.

Wearable devices capable of measuring gait parameters may provide a means to more economical gait analysis compared to conventional equipment comprising of a motion capture system and a forced treadmill. Beflex Coach (Beflex, Republic of Korea) is one such device but worn on the ear as Bluetooth earphones, unlike other wearables worn on the wrist, feet, or torso. In this study, the validity of the device was examined against a motion capture system and a forced treadmill for walking and running parameters. Five walking parameters (cadence, single support time, double support time, vertical oscillation (VO), and instantaneous vertical loading rate (IVLR)) and six running parameters (cadence, stance time, flight time, peak force, VO, and IVLR) were studied. Twenty young adults participated in walking or running on a forced treadmill at different speeds (walking: 0.8, 1.25, and 1.7 m/s for walking; running: 2, 2.5, and 3 m/s) while the two systems operated simultaneously. As a result, all parameters showed excellent associations (ICC > 0.75) and good agreements in Bland-Altman plots. The results of the study support the potential use of the ear-worn device as an inexpensive gait analysis equipment.

Effect of Adding Kinesio Taping to Exercise Therapy in the Treatment of Patellofemoral Pain Syndrome.

Background and objectives: Patellar taping has been widely used for the primary or adjunctive treatment of patellofemoral pain syndrome (PFPS); however, there are limited data in terms of functional outcomes. This study aimed to investigate whether there is any beneficial effect of adding Kinesio Taping® (KT) to exercise therapy in the treatment of PFPS. Materials and Methods: Twenty patients (27.5 ± 5.4 years) with PFPS who applied KT and 19 patients (27.3 ± 7.4 years) who did not were included in this study. Quadriceps muscle strength and acceleration time (AT) were assessed using an isokinetic device. Patient-reported outcomes were evaluated using the Kujala anterior knee pain scale (AKPS). Both groups underwent one-month exercise therapy. Results: There was no significant difference in quadriceps strength, AT, and AKPS at baseline and at 1 month between the taping and non-taping groups (p > 0.05). However, for quadriceps muscle strength, the effect of time*group interaction was statistically significant (F(1.37) = 4.543, p < 0.05, partial eta squared 0.109), showing that improvement in the quadriceps strength was higher in the non-taping group than that in the taping group. Conclusions: Adding KT to exercise therapy did not elicit extra benefits in quadriceps muscle strength and AT, and AKPS among PFPS with abnormal patellar tracking at one month.

Association of Cardiovascular Mortality with Concurrent Coronary Artery Calcification and Physical Activity: A Cohort Study.

Background: Increased coronary artery calcification (CAC) has been reported in individuals with high levels of physical activity (PA). However, the association between increased CAC in a physically active population and cardiovascular mortality has not yet been well-established. This study aimed to investigate the association between PA levels and the presence or absence of CAC and cardiovascular mortality. Methods: A cohort study was conducted from 1 January 2011 to 30 December 2019. Mortality data were updated until 30 December 2020. The study population comprised 56,469 individuals who had completed the International Physical Activity Short Form Questionnaire and had undergone CAC score evaluation using a CT scan. We divided the participants into four groups: physically inactive individuals without CAC, physically inactive individuals with CAC, moderately active and health-enhancing physically active (HEPA) individuals without CAC, and moderately active and HEPA individuals with CAC. The primary outcome was cardiovascular mortality. The Cox proportional hazard model with confounding factor adjustment was conducted. Inverse probability of treatment weighting-based marginal-structural modelling was conducted. Results: The median follow-up duration was 6.60 years. The mean (SD) age of the study participants was 41.67 (±10.91) years, with 76.78% (n = 43,359) men. Compared with individuals without CAC, individuals with CAC demonstrated higher cardiovascular disease mortality regardless of PA level (Inactive and CAC > 0, HR 2.81, 95% CI: 1.76-19.19; moderately active and HEPA HR 3.27, 95% CI: 1.14-9.38). Conclusions: The presence of CAC might be associated with cardiovascular mortality regardless of PA level.

Acute Obturator Externus Injury in Professional Soccer Players: A Case Series.

When patients present with hip or groin pain, proximal quadriceps or adductor injuries are often initially suspected. In this case report, however, we present three cases of professional soccer players who were found to have obturator externus injury. A 30-year-old player and a 24-year-old player complained of pain in the left side after long distance shooting during an in-season training session and a match, respectively. Another 24-year-old player complained of pain in the right side after long distance passing during a preseason training session. On physical examination, active hip external rotation and passive hip internal rotation and extension elicited pain in all three players. All three players underwent magnetic resonance imaging (MRI) which found obturator externus grade II injuries for two players and grade I injury for one player. Rehabilitation protocols included relative rest, cryotherapy, and electrotherapy over a period of one week. All patients were able to return to play after 10 days. Correct identification of obturator externus injury afforded our players a favorable prognosis and a relatively quick return-to-sport compared with quadricep or adductor injury.

Characteristics and Future Direction of Tibialis Posterior Tendinopathy Research: A Scoping Review.

Background and Objectives: Tibialis posterior tendon pathologies have been traditionally categorized into different stages of posterior tibial tendon dysfunction (PTTD), or adult acquired flatfoot deformity (AAFD), and more recently to progressive collapsing foot deformity (PCFD). The purpose of this scoping review is to synthesize and characterize literature on early stages of PTTD (previously known as Stage I and II), which we will describe as tibialis posterior tendinopathy (TPT). We aim to identify what is known about TPT, identify gaps in knowledge on the topics of TPT, and propose future research direction. Materials and Methods: We included 44 studies and categorized them into epidemiology, diagnosis, evaluation, biomechanics outcome measure, imaging, and nonsurgical treatment. Results: A majority of studies (86.4%, 38 of 44 studies) recruited patients with mean or median ages greater than 40. For studies that reported body mass index (BMI) of the patients, 81.5% had mean or median BMI meeting criteria for being overweight. All but two papers described study populations as predominantly or entirely female gender. Biomechanical studies characterized findings associated with TPT to include increased forefoot abduction and rearfoot eversion during gait cycle, weak hip and ankle performance, and poor balance. Research on non-surgical treatment focused on orthotics with evidence mostly limited to observational studies. The optimal exercise regimen for the management of TPT remains unclear due to the limited number of high-quality studies. Conclusions: More epidemiological studies from diverse patient populations are necessary to better understand prevalence, incidence, and risk factors for TPT. The lack of high-quality studies investigating nonsurgical treatment options is concerning because, regardless of coexisting foot deformity, the initial treatment for TPT is typically conservative. Additional studies comparing various exercise programs may help identify optimal exercise therapy, and investigation into further nonsurgical treatments is needed to optimize the management for TPT.

Frailty and hospitalization-associated disability after pneumonia: A prospective cohort study.

BACKGROUND: Pneumonia is a major cause of morbidity and mortality in older adults. The role of frailty assessment in older adults with pneumonia is not well defined. Our purpose of the study was to investigate 30-day clinical course and functional outcomes of pneumonia in older adults with different levels of frailty. METHODS: A prospective cohort was conducted at a university hospital in Seoul, Korea with 176 patients who were 65 years or older and hospitalized with pneumonia. A 50-item deficit-accumulation frailty index (FI) (range: 0-1; robust < 0.15, pre-frail 0.15-0.24, mild-to-moderately frail 0.25-0.44, and severely frail ≥ 0.45) and the pneumonia severity CURB-65 score (range: 0-5) were measured. Primary outcome was death or functional decline, defined as worsening dependencies in 21 daily activities and physical tasks in 30 days. Secondary outcomes were intensive care unit admission, psychoactive drug use, nasogastric tube feeding, prolonged hospitalization (length of stay > 15 days), and discharge to a long-term care institution. RESULTS: The population had a median age 79 (interquartile range, 75-84) years, 68 (38.6 %) female, and 45 (25.5 %) robust, 36 (47.4 %) pre-frail, 37 (21.0 %) mild-to-moderately frail, and 58 (33.0 %) severely frail patients. After adjusting for age, sex, and CURB-65, the risk of primary outcome for increasing frailty categories was 46.7 %, 61.1 %, 83.8 %, and 86.2 %, respectively (p = 0.014). The risk was higher in patients with frailty (FI ≥ 0.25) than without (FI < 0.25) among those with CURB-65 0-2 points (75 % vs. 52 %; p = 0.022) and among those with CURB-65 3-5 points (93 % vs. 65 %; p = 0.007). In addition, patients with greater frailty were more likely to require nasogastric tube feeding (robust vs. severe frailty: 13.9 % vs. 60.3 %) and prolonged hospitalization (18.2 % vs. 50.9 %) and discharge to a long-term care institution (4.4 % vs. 59.3 %) (p < 0.05 for all). Rates of intensive care unit admission and psychoactive drug use were similar. CONCLUSIONS: Older adults with frailty experience high rates of death or functional decline in 30 days of pneumonia hospitalization, regardless of the pneumonia severity. These results underscore the importance of frailty assessment in the acute care setting.

A Preliminary Study on Uncovering Medical Students' Unprofessional Behaviors from YouTube Videos.

Creation of guidelines and education on digital professionalism have been sluggish despite the ever-increasing use of social media by digitally native medical students, who are at risk of blurring the line between their professional and personal lives online. A qualitative thematic analysis was applied on 79 videos extracted from 70,154 YouTube videos uploaded by Korean medical students between March and April 2020. We found 20% contained at least one concerning behavior themed under 'failure to engage,' 'disrespectful behaviors,' or 'poor self-awareness.' Professional lapses identified were classified into seriousness levels. Mostly were "controversial' or 'concerning' but some 'highly concerning' contents were also found. This is the first study on digital professionalism behavior on medical students' YouTube videos. The potential negative impact on the medical profession of the easily accessible public online videos cannot be ignored and thus we suggest the need for them to be taken more seriously.

Supervised Rehabilitation May Lead to Better Outcome than Home-Based Rehabilitation Up to 1 Year after Anterior Cruciate Ligament Reconstruction.

Background and objectives: Previous studies consistently found no significant difference between supervised and home-based rehabilitation after anterior cruciate ligament reconstruction (ACLR). However, the function of the nonoperative knee, hamstring strength at deep flexion, and neuromuscular control have been overlooked. This prospective observational study was performed to investigate the outcomes after ACLR in operative and nonoperative knees between supervised and home-based rehabilitations. Materials and Methods: After surgery, instructional videos demonstrating the rehabilitation process and exercises were provided for the home-based rehabilitation group. The supervised rehabilitation group visited our sports medicine center and physical therapists followed up all patients during the entire duration of the study. Isokinetic muscle strength and neuromuscular control (acceleration time (AT) and overall stability index (OSI)) of both operative and nonoperative knees, as well as patient-reported knee function (Lysholm score), were measured and compared between the two groups 6 months and 1 year postoperatively. Results: The supervised rehabilitation group showed higher muscle strength of hamstring and quadriceps in nonoperative knees at 6 months (hamstring, p = 0.033; quadriceps, p = 0.045) and higher hamstring strength in operative and nonoperative knees at 1 year (operative knees, p = 0.035; nonoperative knees, p = 0.010) than the home-based rehabilitation group. At 6 months and 1 year, OSIs in operative and nonoperative knees were significantly better in the supervised rehabilitation group than in the home-based rehabilitation group (operative knees, p < 0.001, p < 0.001; nonoperative knees, p < 0.001, p < 0.001, at 6 months and 1 year, respectively). At 1 year, the supervised rehabilitation group also demonstrated faster AT of the hamstrings (operative knees, p = 0.016; nonoperative knees, p = 0.036). Lysholm scores gradually improved in both groups over 1 year; however, the supervised rehabilitation group showed higher scores at 1 year (87.3 ± 5.8 vs. 75.6 ± 15.1, p = 0.016). Conclusions: This study demonstrated that supervised rehabilitation may offer additional benefits in improving muscle strength, neuromuscular control, and patient-reported knee function compared with home-based rehabilitation up to 1 year after ACLR.

The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis.

INTRODUCTION: The efficacy and safety of arginine supplements in erectile dysfunction (ED) remain debatable. AIM: To assess the potential role of arginine supplements on ED as alternatives to phosphodiesterase inhibitors. METHODS: Studies published up to April 2018 that evaluated the efficacy of arginine supplements were identified from multiple databases (Google Scholar, PubMed, Medline, Embase, Kiss, DBpia, and Cochrane databases). Studies comparing arginine supplements with placebo or no treatment; focusing only on patients with mild to moderate severity of ED; and presenting outcomes such as improvement rate, International Index of Erectile Function (IIEF) score, and adverse effects were included. Subgroup analysis for arginine alone and arginine in combination with other substances was further conducted to increase interpretability. MAIN OUTCOME MEASURE: The strength of the association between arginine supplements and ED was assessed using relative odds ratios and weighted mean differences with 95% CI. RESULTS: In total, 10 randomized controlled trials met the inclusion criteria, reporting the outcomes of 540 patients with ED. The analysis demonstrated that arginine supplements with dosage ranging from 1,500 to 5,000 mg significantly improved ED compared with placebo or no treatment (odds ratios, 3.37 [1.29, 8.77], P = .01, I2 = 44). Arginine supplements also caused significant improvements in the IIEF subdomain scores of overall satisfaction, intercourse satisfaction, orgasmic function, and erectile function, whereas the IIEF sexual desire score remain unchanged. The adverse effect rate in the arginine-treated group was 8.3%, and that in the placebo group was 2.3%, none of which were severe. CLINICAL IMPLICATIONS: Arginine supplements can be recommended to patients with mild to moderate ED. STRENGTH & LIMITATIONS: The strength of this study is that it is the first meta-analysis to assess the potential role of arginine supplements in ED compared with placebo or no treatment. A limitation is that the treatment dosage and duration varied among studies, which may have contributed to study heterogeneity. CONCLUSION: The results of our systematic review and meta-analysis provide evidence on the effectiveness of arginine supplements for mild to moderate ED. Rhim HC, Kim MS, Park Y-J, et al. The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis. J Sex Med 2019;16:223-234.

Spontaneous Adductor Hematoma in a 75-Year-Old Male With Acute Thigh Bruises.

Patients with a history of blood clots are commonly placed on anticoagulation therapy, but a common adverse effect of this therapy is hemorrhage. Our patient with a history of left ventricle thrombus in a free-standing inpatient rehabilitation hospital had ecchymoses that expanded over a large portion of the posterior thigh in one day. The rapid expansion of the ecchymoses coupled with a decline in hemoglobin levels prompted an immediate evaluation that showed an intramuscular hematoma. With hemoglobin levels dropping significantly, the patient was then transferred to the emergency department for higher levels of care. A multidisciplinary team of vascular surgery and electrophysiology physicians decided to discontinue anticoagulation and monitor the hematoma with serial compartment checks. The hematoma had stabilized throughout the hospital stay without surgical intervention. This case will discuss the difficulty of managing a patient with a history of previous blood clots with an adductor magnus hematoma in the setting of concurrent iatrogenic anticoagulation. Furthermore, we will review the current management and evaluation of intramuscular hematomas.

Patient-reported outcomes during telehealth versus in-person follow-up visits for patients treated with extracorporeal shockwave therapy.

BACKGROUND: The limited research describing clinical outcomes using telehealth for management of musculoskeletal conditions is primarily within orthopedic surgery care. OBJECTIVE: To characterize differences in patient reported outcomes using telehealth compared with in-person follow-up visits in patients with Achilles tendinopathy (AT) or plantar fasciitis (PF) treated using extracorporeal shockwave therapy (ESWT). DESIGN: Retrospective chart review. SETTING: Outpatient sports medicine clinic. PATIENTS: 82 patients with AT and 46 patients with PF. INTERVENTIONS: In-person (n = 76) and telehealth (n = 52) follow-up visits. MAIN OUTCOME MEASUREMENTS: Victorian Institute of Sports Assessment-Achilles (VISA-A) for AT and Foot and Ankle Ability Measure (FAAM) for PF as well as billing level. RESULTS: There was significant improvement from baseline to final VISA-A (p < .01) and FAAM (p < .01) following ESWT. No significant difference existed in the proportion of patients who met the minimal clinically important difference based on in-person (71.1%) versus telehealth (71.2%) follow-up (p = .99). The in-person group demonstrated higher billing levels compared to the telehealth group (Level: 3.5 ± 0.6 vs. 2.8 ± 0.7, p < .01). CONCLUSIONS: Given no significant differences in outcomes between two modes of follow-ups, telehealth may serve as an alternative method to guide management of musculoskeletal injuries with ESWT and other procedures.

Nonsteroidal Anti-Inflammatory Drug Injections versus Steroid Injections in the Management of Upper and Lower Extremity Orthopedic Conditions: A Systematic Review with Meta-Analysis.

BACKGROUND: Although corticosteroid injections are an effective treatment for musculoskeletal pathologies, they may not be suitable for all patients. The purpose of this systematic review was to compare clinical outcomes between patients who received NSAID and corticosteroid injections for various orthopedic conditions. METHODS: Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched, and meta-analyses were performed using a random-effects model for outcomes presented in three or more studies. Other studies were qualitatively analyzed. RESULTS: A total of 28 articles with 2113 patients were included. A meta-analysis of five studies in patients with shoulder impingement syndrome demonstrated that there was no significant difference in the pain visual analogue scale (VAS) between subacromial NSAID injections and corticosteroid injections at 1 month [weighted mean difference (WMD) -0.244; 95% CI, -1.232 to 0.745; I2, 94.5%]. For patients with knee osteoarthritis, a meta-analysis of three studies demonstrated that there was no significant difference between intraarticular NSAID injections and corticosteroid injections in pain VAS at 1 month (WMD 0.754; 95% CI, -0.413 to 1.921; I2, 90.2%) and 3 months (WMD-0.089; 95% CI, -0.345 to 0.166; I2, 0%). A review of the studies assessing pain outcomes for hip osteoarthritis, adhesive capsulitis, and plantar fasciitis showed no significant differences between the NSAID and corticosteroid groups. CONCLUSION: NSAID injections may be safe and effective alternatives to steroid injections, especially in shoulder impingement syndrome and knee osteoarthritis.

Epidemiology of injuries in U.S. high school track and field throwing events from 2008 to 2019.

BACKGROUND: Injury characteristics of high school track and field throwing athletes in the United States are not well studied. Understanding epidemiology of injuries is important to identify treatment and prevention strategies. OBJECTIVE: To describe injury rates and patterns in U.S. high school track and field throwing events from a longitudinal national sports injury surveillance system. DESIGN: Descriptive epidemiology study. SETTING: Data were provided by the National High School Sports Related Injury Surveillance System, High School RIO (Reporting Information Online). METHODS: Athletic trainers reported injury and exposure data through the High School RIO website on a weekly basis. An athlete exposure (AE) was defined as one athlete participating in one school-sanctioned practice or competition. Throwing events of discus, shot put, and javelin were analyzed in this study. MAIN OUTCOME MEASURES: Injury rate, rate ratios (RR), injury proportion ratios (IPR). PARTICIPANTS: U.S. high school athletes. RESULTS: A total of 267 track and field throwing injuries occurred during 5,486,279 AEs. Overall, the rate of injuries in competition was higher than in practice (RR 1.35, 95% confidence interval [CI] 1.01-1.80). In practice, the rate of injuries was higher for girls than boys (RR 1.53, 95% CI 1.12-2.08). The most frequently injured body part was the shoulder (21.7%), followed by the ankle (16.5%) and knee (12.0%). The most common types of injury were muscle strains (26.14%) and ligament sprains (25%). Recurrent injuries accounted for a higher proportion of chronic injuries compared to new injuries (IPR 1.85, 95% CI 1.16-2.97). CONCLUSION: This study described injury characteristics of high school track and field throwing athletes from 2008 to 2019. Based on our results, injury prevention may be particularly important for female throwers with prior injury.

Comparison of Functional Outcomes after Anterior Cruciate Ligament Reconstruction with Meniscal Repair for Unstable versus Stable Meniscal Tears.

This study aimed to compare functional outcomes including knee muscle strength in the quadriceps and hamstrings, and proprioception, assessed through dynamic postural stability (overall stability index [OSI]) and self-reported outcomes in the operated and non-operated knees between anterior cruciate ligament reconstruction (ACLR) with meniscal repair for unstable (root and radial tears) and stable (longitudinal, horizontal, and bucket handle tears) meniscal tears. A total of 76 patients were randomly selected (41 with ACLR with meniscal repair for unstable meniscal tears and 35 with ACLR with meniscal repair for stable meniscal tears) at three different time points (preoperative, 6 months, and 12 months). Repeated measures analysis of variance was used to investigate the differences in outcomes for between-subject and within-subject factors. In the operated knees, there were no significant differences for functional outcomes between the two groups (all p > 0.05). In the non-operated knees, a significant difference was observed for the OSI between the two groups, which was significantly higher in ACLR with meniscal repair for unstable meniscal tears than for stable meniscal tears at 6 months (p < 0.001). Multiple linear regression analysis showed that age (p = 0.027), preoperative OSI in the operated knees (p = 0.005), and postoperative OSI in the operated knees at 6 months (p = 0.002) were significant and independent predictors for OSI in the non-operated knees at 6 months postoperatively. Therefore, while no differences were observed in functional outcomes between the two groups in the operated knees, dynamic postural stability was poorer at 6 months postoperatively in the non-operated knees of patients with ACLR with meniscal repair for unstable meniscal tears. Furthermore, a significant correlation was observed between preoperative/postoperative dynamic postural stability in the operated knees and postoperative dynamic postural stability in the non-operated knees. Hence, we recommend incorporating balance exercises for both knees in post-surgical rehabilitation, particularly for patients with unstable meniscal tears.

Utilizing Extracorporeal Shockwave Therapy for in-Season Athletes.

An athlete's health and availability to train and compete at an optimal performance level is a growing focus for professional sports organizations [...].