The Relationship Between Hip Strength and the Y Balance Test.

CONTEXT: The Y Balance Test was developed as a test of dynamic postural control and has been shown to be predictive of lower-extremity injury. However, the relationship between hip strength and performance on the Y Balance Test has not been fully elucidated. OBJECTIVE: The goal of this study was to identify the relationship between components of isometric hip strength and the Y Balance Test, to provide clinicians better guidance as to specific areas of muscle performance to address in the event of poor performance on the Y Balance Test. DESIGN: Laboratory study. SETTING: Biomechanics laboratory. PARTICIPANTS: A total of 73 healthy participants (40 males and 33 females) volunteered for this study. INTERVENTION: None. MAIN OUTCOME MEASURES: Participants completed the Y Balance Test on the right leg. The authors then measured peak isometric torque in hip external rotation, abduction, and extension. Correlations were calculated between torque measurements, normalized for mass and Y Balance Test performance. Significant relationships were used in linear regression models to determine which variables were predictive of the Y Balance Test performance. RESULTS: The authors found significant positive correlations between Y Balance Test performance and hip abduction strength. They also found correlations between the Y Balance Test and hip extension and external rotation strengths. Linear regression analysis showed hip abduction to be the only significant predictor of Y Balance performance. CONCLUSIONS: The authors found the strongest association between the Y Balance Test and hip abduction strength. They also showed smaller but significant associations with hip extension and external rotation strength. When entered into a linear regression analysis, hip abduction strength was the only significant predictor of Y Balance performance. Using this information, practitioners should look to hip abduction strength when patients exhibit deficits in the Y Balance Test.

Descriptive Epidemiology of a Surgical Patellofemoral Instability Population of 492 Patients.

Background: Patellofemoral instability (PFI) occurs most commonly in pediatric and adolescent patients, with evolving indications for surgery and changes in surgical techniques over the past decade. Purpose: To characterize the demographic, clinical, and radiologic characteristics of a large cohort of patients undergoing PFI surgery and investigate longitudinal trends in techniques utilized over a 10-year period at a tertiary-care academic center. Study Design: Case series; Level of evidence, 4. Methods: Electronic medical records of patients younger than 25 years of age who underwent primary surgery for lateral PFI from 2008 to 2017 at a single center by 1 of 5 different sports medicine surgeons were retrospectively reviewed. Demographic, clinical, and radiographic parameters of instability were analyzed. Routine surgical techniques included medial retinacular plication/reefing/repair (MRP), medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy (TTO), or a combination thereof, with or without lateral retinacular release (LR) or lateral retinacular lengthening (LRL). Exclusion criteria, selected for potentially altering routine surgical indications or techniques, included fixed/syndromic PFI, a formally diagnosed collagen disorder, cases in which a chondral/osteochondral shear fragment underwent fixation or was >1 cm in diameter, and body mass index >30 kg/m2. Results: Of the 492 study patients (556 knees; 71% female; median age, 15.2 years; 38% open physes), 88% were athletes, with the most common sports participated in being soccer, basketball, dance, football, gymnastics, and baseball/softball. While 91% of the cohort had recurrent dislocations, the 9% with primary dislocations were more likely to have small osteochondral fractures/loose bodies (P < .001). Female patients were younger (P = .002), with greater patellar tilt (P = .005) than male patients. Utilization of MPFLR and TTO increased significantly over the study period, while use of MRP+LR decreased. Conclusion: Most patients younger than 25 years of age who underwent PFI surgery were skeletally immature, female, and athletes and had recurrent dislocations. The <10% who had primary dislocations and underwent surgery were likely to have osteochondral fractures. Surgical techniques have changed significantly over time, with increasing use of TTO and MPFLR, while the use of MRP+LR/LRL has significantly decreased.

Secondary Injuries After Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review With Quantitative Analysis.

BACKGROUND: In the skeletally mature anterior cruciate ligament (ACL) reconstruction population, patients aged <25 years are at significantly increased risk of graft failure and injury to the contralateral ACL. Skeletal immaturity often affects graft selection and reconstruction technique. PURPOSE: To examine the incidence of ipsilateral graft failure and contralateral ACL injury in the skeletally immature patient population. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Using the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines, we reviewed all literature that involved ACL reconstruction performed on skeletally immature patients between May 1976 and May 2019. Patient demographics, surgical technique, and the prevalence of ipsilateral graft failure or subsequent contralateral ACL injury were recorded. Ipsilateral, contralateral, and secondary ACL injuries were then compared between sexes via chi-square tests. RESULTS: A total of 24 articles (1254 children; 1258 knees) met inclusion criteria for analysis. Ipsilateral graft failures occurred in 105 of 1258 patients (8.3%), and there were no statistically significant sex differences in the prevalence of graft failures (female, 9.7%; male patients, 7.1%; P = .14). The prevalence of contralateral ACL injury was significantly greater in female (29/129; 22.5%) than male (18/206; 8.7%; P = .0004) patients in the 9 studies that reported contralateral injury. Skeletally immature female patients were at significantly increased risk of contralateral ACL injury (odds ratio = 3.0; P = .0006) when compared with their male counterparts. CONCLUSION: In the literature to date, 1 in 3 female skeletally immature patients experienced an ipsilateral graft failure or contralateral ACL injury. Regardless of sex, the 24% prevalence of secondary injury after pediatric ACL reconstruction is almost identical to previously published secondary injury rates in skeletally mature patients <25 years old. As such, skeletal maturity alone does not seem to be a determinant of secondary injury; however, there is a clear need to improve postoperative rehabilitation, activity progression, and return-to-play testing to allow a safe return to sports that protects the long-term health of the reconstructed and contralateral limbs, especially for female patients.

Benign paroxysmal positional vertigo after decompression sickness: a first case report and review of the literature.

Benign paroxysmal positional vertigo is a common cause of vertigo. We describe a previously unreported case of this clinical entity in a young, fit recreational water diver, having experienced decompression illness. Full recovery occurred after hyperbaric recompression therapy, and he remained symptom free on 6-week follow-up. We review the literature and discuss the pathogenesis of benign paroxysmal positional vertigo, proposing that semicircular canal nitrogen bubble formation could have been the primary etiological event leading to this condition.

Relationship of Hip and Trunk Muscle Function with Single Leg Step-Down Performance: Implications for Return to Play Screening and Rehabilitation.

OBJECTIVES: Evaluate the relationship of hip and trunk muscle function with the Single Leg Step-Down test (SLSD). STUDY DESIGN: Laboratory study. SETTING: Biomechanics Laboratory. PARTICIPANTS: 71 healthy participants with no history of anterior cruciate ligament (ACL) or lower extremity injury in the last 3 months completed this study (38 males, 33 females; mean 25.49 ± 0.62 years). MAIN OUTCOMES: Hip abduction (HABD), external rotation (HER), and extension (HEXT) peak isometric force were measured. Trunk endurance was measured with plank (PL) and side plank (SPL) tests. SLSD repetitions in 60-s and dynamic knee valgus (VAL) were recorded. RESULTS: PL, SPL, HABD, HER, and HEXT were positively correlated with SLSD repetitions. PL (r = 0.598, p < 0.001) was most correlated with SLSD repetitions, and regression demonstrated that PL (p = 0.001, R2 = 0.469) was a predictor of SLSD repetitions. VAL trended toward negative correlation with PL and SPL. Sex-specific differences were present, with PL, SPL, HABD, and HER showing stronger relationships with SLSD in females. CONCLUSION: Hip and trunk muscle function were positively correlated with SLSD performance, and these relationships were strongest in females. PL predicted performance on the SLSD. Further research is needed to investigate the utility of SLSD as a screening or return-to-play test for lower extremity conditions such as ACL injury and patellofemoral pain.

Comparison of Outcomes and Costs of Tension-Band and Locking-Plate Osteosynthesis in Transverse Olecranon Fractures: A Matched-Cohort Study.

To determine if there are significant differences in outcomes and costs between tension-band and locking-plate fixation of transverse olecranon fractures in adults, we retrospectively compared functional outcomes, complications, and costs in 2 cohorts of displaced transverse olecranon fractures. These cohorts (10 patients each) were matched on age and length of follow-up. There were no significant differences between the groups in range of motion, functional scores, or arthrosis. There were no infections or nonunions in either group. There was no significant difference in rate of implant removal or symptomatic implants, though a trend was found toward a higher rate of both with tension bands. Operative time was significantly (P = .025) less for tension-band than locking-plate fixation (55 vs 85 minutes). In the tension-band group, charges were significantly less for implant, index procedure, and overall operative charges including reoperations ($6598.36 vs $14,333.46; P = .001). If all tension bands and no locking plates had been removed, tension-band fixation still would have cost significantly less ($7307.31 vs $14,160.26; P = .0005).