Altered Ankle Muscle Activation at 2-Year Post Achilles Tendon Repair: An Age, Gender, and Activity Level-Matched Comparison With Healthy Subjects.

CONTEXT: The study purpose was to compare the ankle muscle activation and dynamic ankle joint stability of subjects who underwent endoscopy-assisted Achilles tendon repair (ATR; at ≥ 2 y postsurgery) with age, gender, and activity level-matched healthy control group subjects. DESIGN: Prospective, cross-sectional study. All functional tests were performed on the involved ankle of the ATR group, and at the matched side of healthy age, gender, and activity-level control group subjects. METHODS: Fifteen men in each group were evaluated for medial and lateral gastrocnemius, soleus, tibialis anterior, and peroneus longus muscle activation during modified star excursion balance test and heel-rise test performance. The weight-bearing lunge test (ankle dorsiflexion) and heel-rise test distance (ankle plantar flexion) also determined weight-bearing, active ankle mobility magnitudes. The Achilles Tendon Total Rupture Score and Foot and Ankle Outcome Score provided patient-reported outcome perceptions specific to Achilles tendon rupture and comprehensive foot and ankle symptoms and function, respectively. RESULTS: Medial (P = .005) and lateral (P = .012) gastrocnemius displayed greater activation amplitudes in the ATR group during the star excursion balance test, and peroneus longus displayed greater activation amplitudes during the heel-rise test (P = .006). The star excursion balance test reach distance was comparable between groups. Active weight-bearing ankle plantar flexion (heel-rise test) and dorsiflexion (weight-bearing lunge test) mobility magnitudes were lower in the ATR group. CONCLUSIONS: Subjects who underwent endoscopy-assisted percutaneous ATR had reduced active weight-bearing ankle dorsiflexion and plantar flexion mobility magnitudes and greater gastrocnemius and peroneus longus neuromuscular activation when performing the same tasks as healthy control group subjects. As surgical approaches evolve to less invasive, soft tissue preserving methods with less tissue morbidity and faster healing, rehabilitation approaches may likewise need to evolve. LEVEL OF EVIDENCE: Level III.

A Tunable Hyperspectral Imager for Detection and Quantification of Marine Biofouling on Coated Surfaces.

Fouling control coatings (FCCs) are used to prevent the accumulation of marine biofouling on, e.g., ship hulls, which causes increased fuel consumption and the global spread of non-indigenous species. The standards for performance evaluations of FCCs rely on visual inspections, which induce a degree of subjectivity. The use of RGB images for objective evaluations has already received interest from several authors, but the limited acquired information restricts detailed analyses class-wise. This study demonstrates that hyperspectral imaging (HSI) expands the specificity of biofouling assessments of FCCs by capturing distinguishing spectral features. We developed a staring-type hyperspectral imager using a liquid crystal tunable filter as the wavelength selective element. A novel light-emitting diode illumination system with high and uniform irradiance was designed to compensate for the low-filter transmittance. A spectral library was created from reflectance-calibrated optical signatures of representative biofouling species and coated panels. We trained a neural network on the annotated library to assign a class to each pixel. The model was evaluated on an artificially generated target, and global accuracy of 95% was estimated. The classifier was tested on coated panels (exposed at the CoaST Maritime Test Centre) with visible intergrown biofouling. The segmentation results were used to determine the coverage percentage per class. Although a detailed taxonomic description might be complex due to spectral similarities among groups, these results demonstrate the feasibility of HSI for repeatable and quantifiable biofouling detection on coated surfaces.

Single-tunnel and double-tunnel medial patellofemoral ligament reconstructions have similar clinical, radiological and functional results.

PURPOSE: The aim of the present study was to evaluate the clinical, radiological and functional results of patients underwent single-tunnel (ST) and double-tunnel (DT) medial patellofemoral ligament(MPFL) reconstructions with hamstring autograft following recurrent patella dislocation prospectively in a single institution. METHODS: From 2013 to 2017, 80 patients with symptomatic recurrent patellar dislocation or instability were randomly divided into 2 groups for MPFL reconstruction with ST technique or DT technique and evaluated prospectively. In the ST group, there were 20 male and 20 female with a median follow-up of 46.5 months (range 24-74). The median age was 15 years (range 10-28). In the DT group, there were 18 male and 22 female with a median follow-up of 40 months (range 24-74). The median age was 19 years (range 14-29). Clinical scores (Kujala score, Lysholm score, Tegner score and IKDC score) and radiological measurements (congruence angle and patellar tilt angle) of the patients were evaluated preoperatively and at postoperative 24th month. Isokinetic dynamometric tests were performed at postoperative 24th month and the difference between the operated leg and the non-operated leg was found as a percentage deficit. RESULTS: There were no postoperative complications, redislocation or subluxation in any patient. Kujala, Lysholm, Tegner and IKDC scores were better and statistically significant postoperatively in both groups (p < 0.05). However, there was no statistically significant difference between the groups (n.s.). The congruence angle and patellar tilt angle were found to be returned to normal values postoperatively, but there was no statistically significant difference between the groups (n.s.). There was no statistically significant difference between the two groups in isokinetic dynamometric tests performed as 60° flexion, 60° extension, 180° flexion and 180° extension (n.s.). CONCLUSION: The present study is the first that compared the clinical, radiological and functional results of the ST and DT techniques to date. Regardless of the number of the tunnels, similar results were obtained in ST and DT reconstruction using transpatellar tunnel technique. LEVEL OF EVIDENCE: Level I.

Cross-education improves quadriceps strength recovery after ACL reconstruction: a randomized controlled trial.

PURPOSE: The aim of this study was to investigate the effects of concentric and eccentric cross-education (CE) on quadriceps strength and knee function recoveries after anterior cruciate ligament (ACL) reconstruction. METHODS: Forty-eight patients (age: 29.5 ± 6.8 years, body mass index: 26.1 ± 3.2 kg/m2) who had undergone ACL reconstruction with hamstring tendon autograft were included in the study. The patients were randomly divided into three groups when they reached four weeks post surgery: (1) concentric CE (n = 16); (2) eccentric CE (n = 16); and (3) control (n = 16). All groups followed the same post-surgical rehabilitation program for their reconstructed limb. Additionally, the two experimental groups followed eight weeks of isokinetic training for the uninjured knee at 60°/s for 3 days per week. Quadriceps maximum voluntary isometric strength (MVIC) was measured during the 4th week (pre-training), 12th week (post training), and 24th week post surgery. The single-leg hop distance and International Knee Documentary Committee (IKDC) scores were also evaluated during the 24th week post surgery. Analysis of variance was used for statistical analysis. RESULTS: Group-by-time interaction was significant for quadriceps MVICs for reconstructed and healthy limbs (p = 0.02). Quadriceps strength of both knees was greater in concentric and eccentric CE groups compared to control group during the 12th- and 24th weeks post surgery (p < 0.05). Strength gain was 28% and 31% in concentric and eccentric CE groups, respectively, when compared with the control group. Concentric and eccentric CE had similar effects on quadriceps strength recovery (n.s.). IKDC score, and single-leg hop distances were not significantly different among groups (n.s.). CONCLUSIONS: Concentric and eccentric quadricep strengthening of healthy limbs in early phases of ACL rehabilitation improved post-surgical quadriceps strength recovery of the reconstructed limb. CE should be integrated into ACL reconstruction rehabilitation, especially in the early rehabilitative phases to restore quadriceps strength. LEVEL OF EVIDENCE: Randomized controlled trial, Level I.

Translation and cross-cultural adaptation of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Turkish.

PURPOSE: To translate and culturally adapt the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Turkish (ACL-RSI-Tr) and examine and evaluate the psychometric properties of the Turkish version in individuals who have undergone anterior cruciate ligament (ACL) reconstruction. METHODS: The ACL-RSI was forward- and back-translated, culturally adapted and validated on ninety-three Turkish individuals who had undergone ACL reconstruction (5 females, 88 males; age 28.7 ± 8.6 years; body mass 80.1 ± 13.9 kg; height 178.8 ± 6.9 cm; body mass index 25.0 ± 3.7 kg/m2). All patients completed the translated ACL-RSI, Tampa Scale of Kinesiophobia (TSK), Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentary Committee (IKDC) and Lysholm questionnaires. We then analysed the internal consistency, reliability and validity of the newly formed ACL-RSI-Tr scale. RESULTS: The ACL-RSI-Tr showed good internal consistency (Cronbach's alpha 0.86) and test-retest reliability (ICC 0.92) and was significantly correlated with the KOOS 'quality of life' (r = 0.58, p < 0.002), 'symptoms and stiffness' (r = 0.35, p = 0.001), 'pain' (r = 0.49, p < 0.001), 'sports' (r = 0.44, p < 0.001) and 'daily life' (r = 0.42, p < 0.001) subscales. The ACL-RSI-Tr also correlated significantly with the TSK (r = - 0.45, p < 0.001), Lysholm (r = 0.45, p < 0.001) and IKDC (r = 0.44, p < 0.001) scores. CONCLUSIONS: The Turkish version of the ACL-RSI scale was valid, discriminant, consistent and reliable in patients who had undergone ACL reconstruction. This score could be useful to evaluate the effect of psychological factors on return to sport following ACL surgery. LEVEL OF EVIDENCE: Diagnostic study, Level I.

Comparison between Nintendo Wii Fit and conventional rehabilitation on functional performance outcomes after hamstring anterior cruciate ligament reconstruction: prospective, randomized, controlled, double-blind clinical trial.

PURPOSE: The aim of this prospective, randomized, controlled, double-blind clinical trial was to compare the outcomes, including knee strength, balance, coordination, proprioception and response time, of Nintendo Wii Fit with those of conventional rehabilitation on the subjects with anterior cruciate ligament reconstruction. METHODS: Thirty volunteer subjects were enrolled in either Wii Fit (n = 15; mean age, 29 ± 7 years) or conventional rehabilitation (n = 15; mean age, 29 ± 6 years) programmes from the first week up to 12th weeks of the operation. Endoscopic reconstruction of a completely ruptured ACL was performed by using graft harvested from hamstrings. Each subject underwent an individual therapeutic programme. Functional examinations included the measurements of the balance using modified star excursion balance test, coordination, proprioception and response time using functional squat system and strength of flexor and extensor muscles of the involved and uninvolved leg using an isokinetic machine. RESULTS: There was no significant difference between Wii Fit and conventional group in terms of isokinetic knee strength at 12th week, and dynamic balance, and functional squat tests including coordination, proprioception and response time at first, 8th and 12th weeks of the rehabilitation. CONCLUSION: Two different 12-week-physiotherapy programmes following ACL reconstruction have the same affect on muscle strength, dynamic balance and functional performance values in both groups. We considered that the practice of Wii Fit activities like conventional rehabilitation could also address physical therapy goals, which included improving visual-perceptual processing, coordination, proprioception and functional mobility.

Recovery of the shoulder kinematics after reverse shoulder arthroplasty.

BACKGROUND: There is very limited information about the changes in shoulder kinematics in patients with reverse shoulder arthroplasty. The aim of the study was to investigate the changes in the scapulohumeral rhythm and shoulder kinematics over time after the reverse shoulder procedure. METHODS: Nineteen patients with reverse shoulder arthroplasty (age: 65.8 ± 10.3 years) were included to the study. During arm elevation in the sagittal and scapular planes, operated shoulder kinematics (humerothoracic elevation, glenohumeral elevation, scapulohumeral rhythm, and scapular rotations) were assessed using an electromagnetic tracking system at the postoperative 3rd, 6th, and 18th months. Asymptomatic shoulder kinematics were also assessed at the postoperative 18th month. Shoulder function was assessed using The Disabilities of the Arm Shoulder and Hand score at the postoperative 3rd, 6th, and 18th months. FINDINGS: Maximum humerothoracic elevation increased from 98° to 109° over the postoperative period (p = 0.01). The scapulohumeral rhythm was similar on the operated and asymptomatic shoulders at the final follow-up (p = 0.11). Both the operated and asymptomatic shoulder demonstrated similar scapular kinematics at the postoperative 18th month (p > 0.05). The Disabilities of the Arm Shoulder and Hand score decreased over time in the postoperative period (p < 0.05). INTERPRETATION: Shoulder kinematics may be improved after reverse shoulder arthroplasty in the postoperative period. Focusing on scapular stabilization and deltoid muscle control in the postoperative rehabilitation program may enhance the shoulder kinematics and upper extremity function.

Effects of Different Frequencies of Physical Therapy Visits on Shoulder Function After Arthroscopic Rotator Cuff Repair.

OBJECTIVE: There is no consensus about the optimal frequency of patient visits during the rehabilitation program after arthroscopic rotator cuff repair (ARCR). This study aimed to investigate the short- and long-term effects of high-frequency (HF) and low-frequency (LF) visits of the patients in the first 12 weeks of rehabilitation after ARCR. METHODS: This was a quasi-randomized study with 2 parallel groups. Forty-seven patients with ARCR were included in 2 different patient visit frequency protocols (HF = 23, LF = 24) in 12 weeks of postoperative rehabilitation. Patients in the HF group visited the clinic twice a week, whereas patients in the LF group visited once every 2 weeks for the first 6 weeks and once a week for the following 6 weeks. Both groups performed the same exercise protocol. Outcome measurements were pain and range of motion measured at baseline; at the 3rd, 5th, 8th, 12th, and 24th weeks; and at 1-year follow-up. Shoulder function was assessed at the 12th and 24th weeks and at 1-year follow-up with an American Shoulder and Elbow Surgeons score. RESULTS: There was a significant group × time interaction in pain intensity during the activity between the groups. The activity pain intensity was higher in the LF group (4.2 points) at 8 weeks post surgery than in the HF group (2.7 points) (mean difference: 1.5 points, P < .05), whereas it was similar in both groups at other time periods. The interaction term was not significant between the groups for pain intensity during rest and night through the 1-year follow-up. No group × time interactions were observed in shoulder range of motion and American Shoulder and Elbow Surgeons score over the postoperative period. CONCLUSION: Both rehabilitation programs at different visit frequencies after ARCR showed similar clinical results in the long term. A supervised, controlled rehabilitation program with LF visits in the first 12 weeks after surgery can be sufficient to achieve optimal clinical results and reduce rehabilitation-related costs after ARCR. IMPACT: This study highlights that LF treatment protocols under the supervision of the therapist can be adopted after the arthroscopic rotator cuff repair to achieve successful results while decreasing the treatment costs. Physical therapists should plan the treatment sessions efficiently for the compliance of the patients to the exercise treatment. LAY SUMMARY: If you are a patient with arthroscopic rotator cuff repair, a supervised, controlled rehabilitation program with low-frequency visits in the first 12 weeks after surgery could help you achieve the best outcome and help lower the costs of rehabilitation. A total of 3 visits in the first 6 weeks might be sufficient (once every 2 weeks). More frequent visits (1-2 visits a week) should happen 6 to 12 weeks after the surgery.

Comparison of muscle activation levels and knee valgus between individuals with medial patellofemoral ligament reconstruction and healthy individuals during fatiguing step down task.

BACKGROUND: Medial patellofemoral ligament reconstruction becomes first-choice surgical procedure for patients with a history of lateral patellar dislocations but there is limited knowledge about neuromuscular activation patterns of individuals with a history of patellar dislocation who underwent medial patellofemoral ligament reconstruction. OBJECTIVE: The aim of this study was to compare muscle activation levels and knee valgus during step down performance test between individuals with a history of medial patellofemoral ligament reconstruction and healthy individuals. METHODS: Fifteen individuals with medial patellofemoral ligament reconstruction and 15 healthy individuals were included. Vastus medialis obliquus, vastus lateralis and gluteus medius muscle activation levels and knee valgus were measured during 60-s- step down performance test. Two-way repeated-measures of analysis of covariance was used for statistical analysis. FINDINGS: Compared to the healthy individuals, individuals with medial patellofemoral ligament reconstruction showed lower vastus medialis obliquus (p = .04) and gluteus medius (p = .005) activation levels, and higher knee valgus (p = .002) in last period of the step down performance test. INTERPRETATION: Since the significant results were only observed in the fatiguing section of the test, endurance tests may provide more information about neuromuscular control of the individuals with history of medial patellofemoral ligament reconstruction. Future studies should investigate whether endurance exercises that target to improve vastus medialis obliquus and gluteus medius activity result in better clinical outcomes than conventional programs for individuals with medial patellofemoral ligament reconstruction.

The repeatability of 3-dimensional scapular kinematic analysis during bilateral upper extremity movements.

Although three-dimensional electromagnetic systems are widely used to evaluate the 3-dimensional scapular kinematics their reliability when testing bilateral upper extremity tasks is unknown. The purpose of this study was to investigate the repeatability of the scapular kinematic analyses using the Flock of Birds (FOB) system during bilateral upper extremity movements. Twenty-one volunteers without shoulder problems were included (aged 24.8 years; body mass index averaged 21.2 kg/m2) to the study. Scapular internal-external rotation, upward-downward rotation, and anterior-posterior tilt was recorded during bilateral arm elevation on sagittal, scapular and frontal planes. Measurements were repeated at 5-7 days intervals. Intra-session and inter-session repeatability were determined using intraclass correlation coefficients (ICC) scores and standard errors of measurements (SEM). The ICC scores were found to be 0.81 to 0.99 for intra-session measurements and 0.60 to 0.83 for inter-session measurements. The SEM scores were 0.8°-3.4° and 2°-7.2° for the intra and inter-session measurements respectively. The repeatability of the FOB system was excellent for the intra-session measurements, but it was weaker for the inter-session measurements. These results support the use of the FOB system for assessing scapular orientation but the analyses should be conducted more carefully when it is applied to the longitudinal measurements.

Shoulder kinematics and mobility adaptations in water-polo players.

BACKGROUND: There is limited research to demonstrate how scapular kinematics and shoulder-related physical characteristics are affected in water-polo players, who undertake swimming and repetitive throwing activity. The aim of this study was to investigate possible adaptations in the three-dimensional scapular kinematics and in glenohumeral internal rotation, external rotation range of motion and shoulder posterior-capsule tightness in water-polo players. METHODS: Fourteen water-polo players and 14 asymptomatic volunteers participated in the study. The scapular kinematics were recorded using an electromagnetic tracking device during the scapular plane shoulder elevation. Additionally, shoulder range of motion and posterior-capsule tightness were evaluated. Analysis of variance models were used to make comparisons between groups. RESULTS: Although there was a trend toward increased scapular internal rotation and downward rotation in the throwing shoulders of water-polo players, comparisons revealed there was no significant differences in kinematics, shoulder internal-external range of motion and posterior-capsule tightness between the throwing shoulders of the players and dominant shoulders of the control participants. CONCLUSIONS: The throwing shoulders of water-polo players did not demonstrate alterations in shoulder kinematics and mobility parameters.

External supports improve knee performance in anterior cruciate ligament reconstructed individuals with higher kinesiophobia levels.

BACKGROUND: The objectives of this study were to investigate the effects of knee brace (KB) and kinesiotaping (KT) on functional performance and self-reported function in individuals six months post-ACLR who desired to return to their pre-injury activity levels but felt unable to do so due to kinesiophobia. METHODS: This was a cross-sectional study involving 30 individuals six months post-ACLR with Tampa Kinesiophobia Scores >37. Individuals were tested under three conditions: no intervention, KB and KT in a randomized order. Isokinetic concentric quadriceps and hamstring strength tests, one leg hop test, star excursion balance test and global rating scale were assessed under the three conditions. RESULTS: The involved side showed that KT and KB significantly increased the hop distance (P=0.01, P=0.04) and improved balance (P=0.01, P=0.04), respectively, but only KB was found to increase the quadriceps and hamstring peak torques compared to no intervention (P<0.05). Individuals reported having better knee function with KB when compared to no intervention (P<0.001) and KT (P=0.03). CONCLUSIONS: Both KB and KT have positive effects in individuals post-ACLR which may assist in reducing kinesiophobia when returning to their pre-injury activity levels, with the KB appearing to offer the participants better knee function compared to KT.