Lower leg muscle recovery takes at least 12 months for functional tests to recover after late reconstruction of the tibialis posterior tendon retinaculum.

Traumatic dislocation of the tibialis posterior tendon is an extremely rare injury with few reported cases. It is a complicated injury with high risk of misdiagnosis and mistreatment. MRI is the best tool for diagnosis. Surgical treatment has been reported to have a better outcome than conservative treatment. In the present case, a 23-year-old female athlete sustained a sports-related traumatic tibialis posterior tendon dislocation with retinaculum rupture. The patient underwent late reconstruction of the ruptured retinaculum followed by a personalised rehabilitation programme. Full recovery was achieved after 19 months according to European Foot and Ankle Society Score and Foot and Ankle Outcome Score. Lower leg muscle strength continued to improve until 6 months after surgery in isokinetic strength and physical performance tests.

The posteromedial corner of the knee: an international expert consensus statement on diagnosis, classification, treatment, and rehabilitation.

PURPOSE: To establish recommendations for diagnosis, classification, treatment, and rehabilitation of posteromedial corner (PMC) knee injuries using a modified Delphi technique. METHODS: A list of statements concerning the diagnosis, classification, treatment and rehabilitation of PMC injuries was created by a working group of four individuals. Using a modified Delphi technique, a group of 35 surgeons with expertise in PMC injuries was surveyed, on three occasions, to establish consensus on the inclusion or exclusion of each statement. Experts were encouraged to propose further suggestions or modifications following each round. Pre-defined criteria were used to refine item lists after each survey. The final document included statements reaching consensus in round three. RESULTS: Thirty-five experts had a 100% response rate for all three rounds. A total of 53 items achieved over 75% consensus. The overall rate of consensus was 82.8%. Statements pertaining to PMC reconstruction and those regarding the treatment of combined cruciate and PMC injuries reached 100% consensus. Consensus was reached for 85.7% of the statements on anatomy of the PMC, 90% for those relating to diagnosis, 70% relating to classification, 64.3% relating to the treatment of isolated PMC injuries, and 83.3% relating to rehabilitation after PMC reconstruction. CONCLUSION: A modified Delphi technique was applied to generate an expert consensus statement concerning the diagnosis, classification, treatment, and rehabilitation practices for PMC injuries of the knee with high levels of expert agreement. Though the majority of statements pertaining to anatomy, diagnosis, and rehabilitation reached consensus, there remains inconsistency as to the optimal approach to treating isolated PMC injuries. Additionally, there is a need for improved PMC injury classification. LEVEL OF EVIDENCE: Level V.

Anabolic Adaptations Occur in Conscripts During Basic Military Training Despite High Prevalence of Vitamin D Deficiency and Decrease in Iron Status.

INTRODUCTION: In Estonian Defense Forces that are drawn up on the basis of the conscription model considerable numbers of young men are prematurely discharged from military service for medical reasons, but causes leading to premature dropout of conscripts have not been systematically studied. However, one of the factors involved could be relatively demanding physical training that starts at the beginning of military service in the form of basic military training (BMT). Cumulative training and nontraining stresses experienced by conscripts during BMT may exceed their physiological adaptability and increase the probability of becoming prematurely discharged. Therefore, the primary purpose of this study was to assess physiological responses to 10-week BMT in Estonian conscripts. MATERIALS AND METHODS: The protocol of the study confirmed to the standards set by the Declaration of Helsinki and it was approved by the Research Ethics Committee of the University of Tartu. Mean ± SD age and body mass index of 94 conscripts studied was 20.9 ± 1.7 years and 24.2 ± 3.0 kg · m-2, respectively. Fasting venous blood analysis was performed four times during BMT (October to December) and once 15 weeks after the end of BMT (in March). One-factor (time) repeated measures analysis of variance was used to evaluate the differences within the variables. Statistical significance was set at p < 0.05. Where a significant main effect was observed, Tukey's honesty significant difference post-hoc analysis was used to locate differences between the means. A Pearson product moment coefficient of correlation (r) with α level set at 0.05 was applied to determine the relationship between variables. RESULTS: Significant increases in serum testosterone concentration (60.6%), testosterone to cortisol ratio (61.1%), blood erythrocyte count (4.3%), hemoglobin concentration (3.8%) and hematocrit (2.2%), and decrease in serum ferritin concentration (39.3%) occurred between weeks 1 and 10 during BMT (in all cases p < 0.0001). Fifteen weeks later, these parameters were still at increased or decreased levels, respectively, compared to week 1. The prevalence of vitamin D deficiency (serum 25(OH) D concentration <50 nmol · L-1) increased from 42.6% in week 1 to 80.8% in week 10 and to 91.5% 15 weeks later. Serum 25(OH)D levels did not correlate with testosterone concentrations (r = 0.062, p = 0.552 in Wk-1 and r = -0.079, p = 0.448 in Wk-25). CONCLUSION: These findings suggest that BMT induces anabolic physiological adaptations in conscripts despite vitamin D deficiency and decrease in iron status. However, high prevalence of vitamin D deficiency and decline in iron status may limit physiological adaptations and improvement in physical work capacity to a suboptimal level. Furthermore, as vitamin D influences a variety of functions important for health, deficiency in conscripts should be considered a major concern that needs treatment. An acknowledged limitation of the study is the lack of a control group of conscripts possessing normal vitamin D status and stable serum ferritin levels throughout the study period. Nevertheless, the research design employed enabled to determine two factors that potentially limit physiological adaptability of conscripts to military training loads in ecologically authentic environment.