INTER AND INTRA-RATER RELIABILITY OF THE DROP VERTICAL JUMP (DVJ) ASSESSMENT.

BACKGROUND: Non-contact injuries are common in sports as abnormal lower extremity joint mechanics can place athletes at risk for injury. It is important to have reliable, feasible, cost-effective assessment tools to determine lower limb control and injury risk. HYPOTHESIS/PURPOSE: The purpose of the study was to assess the intra- and inter-rater reliability of a three-tiered anterior cruciate ligament (ACL) injury risk rating assessment of the drop vertical jump using frontal plane, two-dimensional (2-D) motion capture. STUDY DESIGN: Repeated measures. METHODS: Twenty male elite basketball athletes performed the drop vertical jump during a 2-D video assessment at Mayo Clinic Sports Medicine Center in Minneapolis, Minnesota. DVJ scores indicated the following: 1 no visible knee valgus, 2 slight wobble, inward motion of the knees, and 3 knee collision or large frontal plane knee excursion. Score assessment from video of the drop vertical jump was obtained by four independent investigators. The four raters then re-examined the same videos 1 month later, blinded to their original scores. RESULTS: Intra-rater reliability Fleiss Kappa measure of agreement was substantial amongst all four raters at all scoring time points: initial contact (0.672), first landing (0.728), second landing (0.670), and peak valgus (0.662) (p < 0.001). The intra-rater ICC values were good at initial contact (0.809), second landing (0.874), and max valgus (0.885), however were excellent at first landing (0.914) (p < 0.001). Inter-rater reliability Fleiss Kappa measurement scores were slight at initial contact (0.173), fair at max valgus (0.343), and moderate at first landing (0.532) and second landing (0.514; p < 0.001). Inter-rater ICC values were moderate at initial contact (0.588), excellent at first landing (0.919), and good at second landing (0.883) and max valgus (0.882; p<0.001). CONCLUSION: When comparing scores of the drop vertical jump between four independent raters across two sessions, the study demonstrated substantial Kappa and good to excellent ICC intra-rater reliability. Inter-rater reliability demonstrated slight to moderate Kappa measurements of agreement and moderate to excellent ICC's. Thus, for excellent reliability using this assessment, patients should be scored by one individual. For moderate reliability between multiple raters, the first landing of the DVJ should be scored. Findings indicate that the proposed drop vertical jump assessment may be used for reliable identification of abnormal landing mechanics. LEVEL OF EVIDENCE: Level 3.

MEDIAL AND LATERAL HAMSTRINGS RESPONSE AND FORCE PRODUCTION AT VARYING DEGREES OF KNEE FLEXION AND TIBIAL ROTATION IN HEALTHY INDIVIDUALS.

BACKGROUND: Hamstring weakness is a contributor to lower extremity pathology. Influence of knee flexion and tibial rotation on hamstrings muscle activation and knee flexion force has not been documented in the literature. HYPOTHESIS/PURPOSE: The purpose of the study was to determine the angle of knee flexion and tibial rotation that elicits the greatest knee flexion force and hamstrings activation in healthy, physically active adults. STUDY DESIGN: Descriptive, observational cohort study. METHODS: Eighteen young healthy adults were recruited for study participation. Each individual performed maximal voluntary isometric hamstrings contractions at six different knee flexion angles (15 °, 30 °, 45 °, 60 °, 75 ° & 90 °), each positioned at three different tibial rotation positions (internal rotation, neutral rotation and external rotation). Electromyographic activity of the medial and lateral hamstrings and knee flexion force production were recorded. RESULTS: On average, greatest force production was recorded at 30 ° knee flexion with tibia either in neutral rotation (124.1% of max) or in external rotation (123.5% of max). This same lower limb orientation also produced the highest amount of lateral hamstring activation (156.4% of max). Results also showed that force production and lateral hamstring activation decreased as knee flexion angle increased. Muscle activation for the medial hamstrings was not affected by knee flexion angle but did show higher activation in neutral or tibial internal rotation. CONCLUSION: The results of the current research describe the relationship between knee flexion and tibial rotation and their effect on overall knee flexion force production and hamstrings activation. This research provides key insights about the specific knee joint angles and tibial orientation that may be preferred in exercise prescription for maximizing hamstring activation. LEVEL OF EVIDENCE: Level III.

Ununited Bone Ossicle in a Patient With Patellar Tendinopathy.

A 40-year-old man presented to a physician for knee pain when squatting and in resisted knee extension. The initial diagnosis was patellar tendinopathy. Following physical therapy treatment, a sports medicine physician was consulted for a second opinion. Radiography, diagnostic ultrasound, and magnetic resonance imaging were performed, confirming the original diagnosis and revealing Hoffa's fat pad impingement secondary to an ununited ossicle. J Orthop Sports Phys Ther 2017;47(11):885. doi:10.2519/jospt.2017.7443.

Stop waiting and start creating: service learning with an outpatient bone marrow transplant unit art cart program.

This paper examines how master of occupational therapy students, their occupational therapy instructor, and a community-based licensed clinical social worker collaborated in a service learning art cart program on an outpatient bone marrow transplant unit. As they progressed through the phases of Kolb's model of service learning, occupational therapy students, their occupational therapy instructor, and the licensed clinical social worker were all able to meet mutual goals of serving a unique patient population, increasing knowledge of best practices, and building and fostering university/community relationships.