Correction: Cross-cultural translation and psychometric validation of the French version of the Fear-Avoidance Components Scale (FACS).

[This corrects the article DOI: 10.1371/journal.pone.0288899.].

Apelin stimulation of the vascular skeletal muscle stem cell niche enhances endogenous repair in dystrophic mice.

Impaired skeletal muscle stem cell (MuSC) function has long been suspected to contribute to the pathogenesis of muscular dystrophy (MD). Here, we showed that defects in the endothelial cell (EC) compartment of the vascular stem cell niche in mouse models of Duchenne MD, laminin α2-related MD, and collagen VI-related myopathy were associated with inefficient mobilization of MuSCs after tissue damage. Using chemoinformatic analysis, we identified the 13-amino acid form of the peptide hormone apelin (AP-13) as a candidate for systemic stimulation of skeletal muscle ECs. Systemic administration of AP-13 using osmotic pumps generated a pro-proliferative EC-rich niche that supported MuSC function through angiocrine factors and markedly improved tissue regeneration and muscle strength in all three dystrophic mouse models. Moreover, EC-specific knockout of the apelin receptor led to regenerative defects that phenocopied key pathological features of MD, including vascular defects, fibrosis, muscle fiber necrosis, impaired MuSC function, and reduced force generation. Together, these studies provide in vivo proof of concept that enhancing endogenous skeletal muscle repair by targeting the vascular niche is a viable therapeutic avenue for MD and characterized AP-13 as a candidate for further study for the systemic treatment of MuSC dysfunction.

Functional recovery of wrist surgery with regional versus general anesthesia: a prospective observational study.

PURPOSE: Regional anesthesia may favour postoperative rehabilitation by inhibiting peripheral sensitization and secondary hyperalgesia. The literature on this subject is limited. In the present FUNCTION study, we sought to compare the functional recovery post orthopedic wrist surgery with regional versus general anesthesia. METHODS: We conducted a single-centre prospective observational cohort study in adult patients with a distal radial fracture. Functional recovery was assessed with validated psychometrics questionnaires (Quick Disabilities of Arm, Shoulder and Hand [QuickDASH] and Patient-Rated Wrist Evaluation [PRWE]), range of motion, and grip strength. We used a linear mixed regression model to assess the impact of the anesthesia technique on functional recovery. Postoperative pain and patient satisfaction were evaluated using a visual analog scale. RESULTS: We recruited 76 patients. At 12 weeks post surgery, there was no difference between the type of anesthesia and functional recovery with the QuickDASH (higher scores worse; regional anesthesia [RA], 22.7 vs general anesthesia [GA], 19.3; adjusted mean difference [aMD], -0.3; 95% confidence interval [CI], -9.6 to 9.0; P = 0.9) and PRWE (higher scores worse; RA group, 21.0 vs GA group, 20.5; aMD, -3.3; 95% CI, -12.1 to 5.6; P = 0.93) questionnaires. Range of motion, satisfaction, and postoperative pain were similar between groups. Right-hand grip strength was higher in the GA group. CONCLUSION: Regional anesthesia was not associated with improved functional recovery compared with general anesthesia. The dominance of the operated limb was a confusion factor in all evaluation modalities. Further research taking into account the dominance of the hand is necessary to establish the effects of regional anesthesia on functional recovery. STUDY REGISTRATION: ClinicalTrials.gov (NCT04541745); registered 9 September 2020.

RéSUMé: OBJECTIF: L'anesthésie régionale pourrait favoriser la rééducation postopératoire en inhibant la sensibilisation périphérique et l'hyperalgésie secondaire. La littérature à ce sujet est limitée. Dans la présente étude nommée FUNCTION, nous avons cherché à comparer la récupération fonctionnelle après une chirurgie orthopédique du poignet réalisée sous anesthésie régionale vs sous anesthésie générale. MéTHODE: Nous avons réalisé une étude de cohorte observationnelle prospective monocentrique auprès de patient·es adultes présentant une fracture radiale distale. La récupération fonctionnelle a été évaluée à l'aide de questionnaires psychométriques validés (questionnaires QuickDASH [Quick Disabilities of Arm, Shoulder and Hand] et PRWE [Patient-Rated Wrist Evaluation]), de l'amplitude des mouvements et de la force de préhension. Nous avons utilisé un modèle de régression linéaire mixte pour évaluer l'impact de la technique d'anesthésie sur la récupération fonctionnelle. La douleur postopératoire et la satisfaction des patient·es ont été évaluées à l'aide d'une échelle visuelle analogique. RéSULTATS: Nous avons recruté 76 personnes. Douze semaines après la chirurgie, il n'y avait aucune différence entre le type d'anesthésie et la récupération fonctionnelle selon le questionnaire QuickDASH (scores plus élevés les pires; anesthésie régionale [AR], 22,7 vs anesthésie générale [AG], 19,3; différence moyenne ajustée [DMa], −0,3; intervalle de confiance [IC] à 95 %, −9,6 à 9,0; P = 0,9) et PRWE (scores plus élevés les pires; groupe AR, 21,0 vs groupe AG, 20,5; DMa, −3,3; IC 95 %, −12,1 à 5,6; P = 0,93). L'amplitude des mouvements, la satisfaction et la douleur postopératoire étaient similaires entre les groupes. La force de préhension de la main droite était plus élevée dans le groupe AG. CONCLUSION: L'anesthésie régionale n'a pas été associée à une amélioration de la récupération fonctionnelle par rapport à l'anesthésie générale. La prédominance du membre opéré était un facteur de confusion dans toutes les modalités d'évaluation. D'autres recherches tenant compte du côté dominant au niveau des mains sont nécessaires pour déterminer les effets de l'anesthésie régionale sur la récupération fonctionnelle. ENREGISTREMENT DE L'éTUDE: ClinicalTrials.gov (NCT04541745); enregistrée le 9 septembre 2020.

Estimated diameter increase from a 4S to a 6S hamstring graft configuration - A cadaveric study.

PURPOSE: Graft diameter in anterior cruciate ligament reconstructions has been shown to influence the risk of failure. It is therefore important to be able to adjust the graft configuration to modify the diameter. To measure the impact of a 6-strand (6S) hamstring autograft configuration on graft diameter compared to the standard 4-strand (4S) configuration. METHODS: Cadaveric study on 33 knees, using the usual hamstring graft harvesting technique. Semitendinosus and gracilis tendons were harvested and their length, width, and diameter were measured in 4S and 6S configurations separately by three evaluators. RESULTS: 6S configuration leads to a median increase of 1.5 (range: 0.0-2.0) mm in diameter compared to 4S (p < 0.001). A graft diameter of more than 8 mm is attained in less than a third of 4S grafts within this population in comparison to 84% when the 6S configuration is used. DISCUSSION: The 6S hamstring graft configuration increases the graft diameter by a median of 1.5 millimeters compared to the traditional 4S configuration. It can reliably be used to obtain an 8.5 mm graft diameter or more in cases where the semitendinosus measures at least 270.5 mm and the 4S configuration has a diameter of 7.5 mm or 8 mm. This information helps to better delineate the impact of a 6S configuration in a pre-operative or intra-operative setting to optimize the decisional process and surgical flow and to easily adapt the graft diameter. LEVEL OF EVIDENCE: V (cadaveric study).

Cross-cultural translation and psychometric validation of the French version of the Fear-Avoidance Components Scale (FACS).

BACKGROUND: The Fear-Avoidance Components Scale (FACS) is a reliable and valid instrument widely used to assess fear-avoidance beliefs related to pain and disability. However, there is a scarcity of validated translations of the FACS in different cultural and linguistic contexts, including the French population. This study aimed to translate and validate the French version of the FACS (FACS-Fr/CF), examining its psychometric properties among French-speaking individuals. METHODS: A cross-cultural translation process-including forward translation, backward translation, expert committee review, and pre-testing-was conducted to develop the FACS-Fr/CF. The translated version was administered to a sample of French-speaking adults (n = 55) with chronic musculoskeletal pain. Internal consistency (including confirmatory analyses of the 2 factors identified in the Serbian version), test-retest reliability and convergent validity were then assessed. RESULTS: The FACS-Fr/CF demonstrated high global internal consistency (α = 0.94, 95% CI: 0.91-0.96) as well as high internal consistency of the 2 factors identified in the Serbian version (α = 0.90, 95% CI: 0.86-0.94 and α = 0.90, 95% CI: 0.85-0.94, respectively). Test-retest analysis revealed a moderate (close to high) reliability (ICC = 0.89; 95% CI: 0.82-0.94 and r = 0.89; p<0.005). Convergent validity was supported by significant correlations between the FACS-Fr/CF scores and the Tampa Scale for Kinesiophobia (r = 0.82; p < 0.005), the Pain Catastrophizing Scale (r = 0.72; p < 0.005) and the Hospital Anxiety and Depression Scale (r = 0.66; p < 0.005). CONCLUSION: The present study provides evidence for the cross-cultural translation and psychometric validation of the FACS-Fr/CF. The FACS-Fr/CF exhibits a high internal consistency, a moderate (close to high) test-retest reliability, and good construct validity, suggesting its utility in assessing fear-avoidance beliefs in the French-speaking population. This validated tool can enhance the assessment and understanding of fear-avoidance behaviors and facilitate cross-cultural research in pain-related studies.

A Partial-Thickness Quadriceps Autograft Reliably Augments the Size of the Hamstring Graft During Anterior Cruciate Ligament Reconstruction.

Purpose: To measure the increase in diameter resulting from the augmentation of a hamstring autograft with a partial width rectus femoris tendon band in anterior cruciate ligament reconstruction. Methods: Thirty-three cadaveric knees were dissected to harvest semitendinosus and gracilis tendons (4S) along with a 6-mm wide tendon band from the rectus femoris. Harvesting was done according to the usual surgical techniques of both harvests. Measures of length and diameter in 4S and 4S augmented with the rectus femoris band (4S +Q) configurations were performed separately by 3 evaluators. Results: The quadriceps augmentation led to an average increase of 1.49 mm (95% confidence interval 1.03-1.95 mm) in diameter of the 4-strand hamstring grafts. The previously demonstrated threshold diameter of 8.5 mm was attained in only 30% of 4S grafts within this population in comparison with 88% when augmented with a quadriceps band. Conclusions: In conclusion, supplementing doubled hamstring graft (4S) with quadricipital tendon in anterior cruciate ligament reconstruction (ACLR) increases the graft diameter by an average of 1.49 mm. It has the physical potential to reliably augment hamstring grafts that measure 7.5 mm in diameter or more in order to obtain an 8.5 mm when necessitated. Clinical Relevance: Increased graft diameter is associated with a decreased risk of graft failure after ACLR. Because of this, it is important to identify methods to increase the size of grafts. This study investigates the use of a partial-width rectus femoris tendon band as an option to reliably augment graft sizes during ACLR.

Anterior Cruciate Ligament Sizing Tools Can Be Interchanged Without Affecting Graft Diameter Measurement.

Purpose: To determine whether different types of measurement tools can be interchanged without significantly affecting the resulting graft diameter. Methods: Hamstrings (gracilis and semitendinosus) and quadriceps tendons in 33 cadaver knees were harvested. Three different anterior cruciate ligament (ACL) graft combinations were created using these tendons, making 99 cadaver grafts samples available to measure. The grafts were randomly passed through sizing tubes and a slotted measurement block to determine their diameter. Interobserver and intraobserver reliabilities of measurements were assessed. Pearson correlation test, as well as Bland Altman graph, were used to evaluate the interchangeability of the tools. Results: In 95% of cases, the diameter difference between the tubes and the block measures was less than the 0.5 mm in increment cutoff. Both the intraobserver and interobserver reliability were excellent. Conclusions: This study showed that the ACL graft diameter measurement does not vary whether a slotted block or sizing tube from the same company is used. Clinical Relevance: ACL graft size has an influence on the surgical technique and clinical outcomes. Therefore it is important to have reliable sizing tools.

Neurorrhaphy of anterior and posterior interosseous nerves in the prevention of neuroma following a radical neurectomy: A case report.

Selective wrist denervation is a surgical technique frequently performed for the treatment of chronic wrist pain. While this technique is often effective in pain reduction, it is still associated with certain complications such as pain recurrence secondary to neuroma formation. We present a case report that details the clinical case of a young yoga teacher suffering from debilitating chronic wrist pain, refractory to conservative treatments. We describe a new surgical technique for the treatment of chronic wrist pain: posterior interosseous nerve and anterior interosseous nerve neurectomy followed by neurorrhaphy in preventing neuroma formation. Post-operatively, the patient's wrist pain continuously improved and completely resolved without any signs of recurrence. Posterior interosseous nerve and anterior interosseous nerve neurectomy followed by an end-to-end neurorrhaphy can be used as an effective novel surgical technique in the management of chronic wrist pain with prevention of neuroma formation.

Using ultrasound imaging to assess novice physiotherapy students' ability to locate musculoskeletal structures with palpation.

OBJECTIVE: Use ultrasound imaging to assess success rates of novice physiotherapy students attempting to locate two tendons and two joint spaces using palpation. DESIGN: Cross-sectional study. SETTING: Master of physiotherapy program at an academic institution. PARTICIPANTS: Twenty-two end of first-year physiotherapy students. METHODS: Participants were asked to palpate and locate the long head of the biceps (LHBT) and tibialis posterior (PTT) tendons as well as the acromioclavicular joint (ACJ) and medial tibiofemoral joint (TFJ) spaces on two human models. A truncated needle was taped onto the skin, parallel to the palpated structure. Ultrasound imaging was used to assess the position of the needle relative to the structures. MAIN OUTCOME MEASURES: Success or failure was determined based on a judgment call on the needle position relative to the targeted structure on the ultrasound images. Inter-evaluator agreement for judgment criteria was investigated using Cohen's kappa tests and success rates subsequently calculated. RESULTS: Kappa coefficients were 1.00 for all structures collectively, 1.00 for LHBT and PTT tendons, 1.006 for ACJ, and 0.79 for TFJ. Palpation success rates were: 9% for LHBT, 64% for PTT, 23% for ACJ, and 31% for medial TFJ. CONCLUSION: These results highlight the fact that there is room for improvement in anatomy and palpation skill teaching methods and ultrasound imaging is valuable tool to assess this important skill.

Transcranial direct current stimulation (a-tCDS) after subacromial injections in patients with subacromial pain syndrome: a randomized controlled pilot study.

BACKGROUND: Subacromial pain syndrome (SAPS) is a common complaint in orthopaedics. Subacromial corticosteroid injections (CSI) can relieve pain in the short term. Anodal transcranial direct current stimulation (a-tDCS) has been used for symptomatic pain relief in a variety of chronic pain conditions. The aim of this pilot study was to assess whether the application a-tDCS could enhance the symptomatic relief provided by CSI in patients affected by SAPS. METHODS: Thirty-eight participants (18 to 65-year-old) suffering from SAPS were recruited to have a CSI and randomly allocated to receive, 1 weeks post CSI, real a-tDCS (r-tDCS), sham tDCS (s-tDCS) or no intervention (Control). Upper limb function was measured 1 week prior to the CSI, at the 2- and 4-week follow-ups using self-administered questionnaires and physical measures. Self-reported pain and activity during each day were logged by the participants using visual analog scales (VAS). Differences between groups were tested using repeated-measures ANOVAs. RESULTS: Pain VAS and the Single Assessment Numeric Evaluation scale (SANE) showed significant improvement from baseline 2 weeks and 4 weeks after CSI in all groups (p < 0.05). There were no significant group X time interaction 2 weeks following tDCS treatment in any of the variables. CONCLUSION: All groups showed significant improvement in pain VAS and SANE scores following the CSI. One session of a-tDCS treatment 2 weeks following CSI did not result in any additive or potentializing effects when compared to a s-tDCS or a control group. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03967574 . Registered 30 May 2019 - Retrospectively registered.

Wrist-Based Accelerometers and Visual Analog Scales as Outcome Measures for Shoulder Activity During Daily Living in Patients With Rotator Cuff Tendinopathy: Instrument Validation Study.

BACKGROUND: Shoulder pain secondary to rotator cuff tendinopathy affects a large proportion of patients in orthopedic surgery practices. Corticosteroid injections are a common intervention proposed for these patients. The clinical evaluation of a response to corticosteroid injections is usually based only on the patient's self-evaluation of his function, activity, and pain by multiple questionnaires with varying metrological qualities. Objective measures of upper extremity functions are lacking, but wearable sensors are emerging as potential tools to assess upper extremity function and activity. OBJECTIVE: This study aimed (1) to evaluate and compare test-retest reliability and sensitivity to change of known clinical assessments of shoulder function to wrist-based accelerometer measures and visual analog scales (VAS) of shoulder activity during daily living in patients with rotator cuff tendinopathy convergent validity and (2) to determine the acceptability and compliance of using wrist-based wearable sensors. METHODS: A total of 38 patients affected by rotator cuff tendinopathy wore wrist accelerometers on the affected side for a total of 5 weeks. Western Ontario Rotator Cuff (WORC) index; Short version of the Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH); and clinical examination (range of motion and strength) were performed the week before the corticosteroid injections, the day of the corticosteroid injections, and 2 and 4 weeks after the corticosteroid injections. Daily Single Assessment Numeric Evaluation (SANE) and VAS were filled by participants to record shoulder pain and activity. Accelerometer data were processed to extract daily upper extremity activity in the form of active time; activity counts; and ratio of low-intensity activities, medium-intensity activities, and high-intensity activities. RESULTS: Daily pain measured using VAS and SANE correlated well with the WORC and QuickDASH questionnaires (r=0.564-0.815) but not with accelerometry measures, amplitude, and strength. Daily activity measured with VAS had good correlation with active time (r=0.484, P=.02). All questionnaires had excellent test-retest reliability at 1 week before corticosteroid injections (intraclass correlation coefficient [ICC]=0.883-0.950). Acceptable reliability was observed with accelerometry (ICC=0.621-0.724), apart from low-intensity activities (ICC=0.104). Sensitivity to change was excellent at 2 and 4 weeks for all questionnaires (standardized response mean=1.039-2.094) except for activity VAS (standardized response mean=0.50). Accelerometry measures had low sensitivity to change at 2 weeks, but excellent sensitivity at 4 weeks (standardized response mean=0.803-1.032). CONCLUSIONS: Daily pain VAS and SANE had good correlation with the validated questionnaires, excellent reliability at 1 week, and excellent sensitivity to change at 2 and 4 weeks. Daily activity VAS and accelerometry-derived active time correlated well together. Activity VAS had excellent reliability, but moderate sensitivity to change. Accelerometry measures had moderate reliability and acceptable sensitivity to change at 4 weeks.

Can a physiotherapy student assume the role of an advanced practice physiotherapist in Orthopaedic surgery triage? A prospective observational study.

BACKGROUND: Advanced practice physiotherapists (APP) have helped improve accessibility to orthopaedic outpatient care. Several studies have validated the APP practice model in orthopaedic care, demonstrating high agreement between APPs and orthopaedic surgeons (OS) regarding diagnosis and management. However, as APPs tend to be experienced senior physiotherapists, such a study involving physiotherapy students (PS) has not yet been explored. The objective of this study was to evaluate the agreement for orthopaedic diagnoses and surgical triage between a PS and OSs. METHODS: A prospective study involving a final year PS and seven OSs was conducted in a university hospital, after the PS had undergone a three-week intensive training. Eighty-six adult patients referred to OSs for knee osteoarthritis, hip osteoarthritis or shoulder problem were independently evaluated by the PS, and then re-evaluated by an OS. The diagnoses and surgical triage recommendations of both clinicians were analyzed for agreement using raw percent agreement and Cohen's kappa. Patient satisfaction with the outpatient clinic experience was noted using a modified version of the Visit-Specific Satisfaction Instrument. RESULTS: Our sample consisted of 86 patients (mean age = 63.4 years). Reasons for consultation included shoulder problems (36%), knee osteoarthritis (52%) and hip osteoarthritis (12%). The raw percent agreement for diagnosis was 95.3%. The agreement for surgical triage was high (κ = 0.86, 95% CI: 0.74-0.98) with a raw agreement of 94.2%. Patient satisfaction was high. CONCLUSIONS: The PS and OSs made similar diagnoses and triage recommendations suggesting that clinical experience alone is not a prerequisite for physiotherapists to help increase accessibility to orthopaedic care.

The Addition of Glenohumeral Adductor Coactivation to a Rotator Cuff Exercise Program for Rotator Cuff Tendinopathy: A Single-Blind Randomized Controlled Trial.

BACKGROUND: Treatments for rotator cuff tendinopathy include rotator cuff muscle strengthening to promote better muscle recruitment in order to minimize subacromial narrowing during active movement. Glenohumeral adductor recruitment has also been shown to prevent such narrowing in asymptomatic individuals; therefore, adding glenohumeral adductor coactivation during rotator cuff strengthening could enhance the efficacy of rotator cuff strengthening. However, no study has explored its benefits. OBJECTIVES: To compare the short-term efficacy of adding glenohumeral adductor coactivation to a rotator cuff-strengthening program to improve function, reduce symptoms, and increase acromiohumeral distance in adults with rotator cuff tendinopathy. METHODS: In this single-blind randomized controlled trial, 42 participants with rotator cuff tendinopathy were randomly assigned to 2 groups, one that received strengthening of the scapular and rotator cuff muscles or one that received rotator cuff strengthening plus coactivation with pectoralis major and latissimus dorsi recruitment. The daily programs were performed at home for 6 weeks, with supervised training and follow-up sessions. Functional limitations/symptoms (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire as the primary outcome, and the Western Ontario Rotator Cuff index), pain (visual analog scale), and acromiohumeral distance were measured at baseline, 3 weeks, and 6 weeks. Data were analyzed using a mixed-model analysis of variance. RESULTS: No significant group-by-time interaction was observed for the Disabilities of the Arm, Shoulder and Hand questionnaire, Western Ontario Rotator Cuff index, visual analog scale, and acromiohumeral distance (P≥.055). Significant time effects were obtained for the Western Ontario Rotator Cuff index and visual analog scale for pain with movement (P<.001). CONCLUSION: The present findings show that adding glenohumeral adductor coactivation to a rotator cuff-strengthening program does not result in improved short-term efficacy in any of the measured outcomes. This study was registered with ClinicalTrials.gov (NCT02837848). LEVEL OF EVIDENCE: Therapy, level 1b. J Orthop Sports Phys Ther 2019;49(3):126-135. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8240.