Differences in Pivot Leg Kinematics and Electromyography Activation in Various Round House Kicking Heights.

The round house kick (RHK) is a common technique in taekwondo (TKD). The kicking action originates from the dynamic stability of the pivot leg. However, some knee injuries are caused by more difficult kicking strategies, such as kicks to the opponent's head. This study analyses the effects on TKD players in the lower extremity kinematic and neuromuscular reactions from different kicking heights. This study recruited 12 TKD players (age=20.3 ± 1.3 years, height = 1.72 ± 0.09 m, mass = 62.17 ± 9.45 kg) with no previous lower extremity ligament injuries. All athletes randomly performed 3 RHK at different heights (head, chest, and abdomen), repeating each kick 5 times. During the RHK action, the kinematics and muscle activations of the pivot leg were collected using six high-speed cameras and electromyography devices. The results found that during the RHK return period a high kicking position demonstrated larger knee valgus with the straight knee, and more hamstring activation on the pivot leg. The RHK pivot foot for TKD players encountered more risk of injury from high target kicking. The hamstring muscle played an important stabilizing role. It is recommended that sports medicine clinicians or sports coaches use this information to provide further protective injury prevention strategies.

The Jumper's Knee - a New Look at Non-surgical Treatment. Pilot Study.

BACKGROUND: There are many opinions and views regarding the methods of treatment of patellar ligament enthesopathy. No gold standard of treatment exists. This paper presents our approach involving conservative treatment and an appropriate rehabilitation regime. Our aim was to assess the effectiveness of a combination of various conservative treatment techniques and the time needed to return to sport. MATERIAL AND METHODS: The study enrolled 14 patients treated in 2019 and 2020. Knee joint evaluation was based on clinical and radiological examination (sonography and MR). All patients were treated conservatively according to a specially prepared treatment protocol. Patients were evaluated at two-week intervals until the symptoms subsided completely. The KOOS, Kujala and SF36 questionnaires were used to evaluate the results. RESULTS: All of the patients returned to painless physical activity within 3-4 weeks from the start of treatment. In the group of professional athletes, 100% returned to sport. The return to sport took slightly longer for pa-tients with bilateral (5-6 weeks) in comparison to unilateral jumper's knee (3-4 weeks). The longest period of return to sport, in a patient who had severe pain at rest before starting treatment, was 7 weeks. Statistically significant improvement was noted in all of the questionnaires used and in all subdomains at 6 months after the beginning of the treatment. CONCLUSIONS: 1. The conservative approach proposed by us generated promising results in the treatment of the jumper's knee. 2. A 100% rate of return to sport was recorded among our patients.

The effect of a single high velocity low amplitude hip mobilization on strength in subjects with knee injuries.

BACKGROUND: Manual therapy have been used as a disinhibitory intervention to increase muscle activation before performing functional tasks that are limited by weakness. Knee injuries are commonly associated with weakness in quadriceps and gluteus. Currently, there is no evidence to support anecdotal experience that a hip distraction mobilization improves muscle performance in subjects with knee injuries and lower extremity weakness. OBJECTIVES: To determine if a hip distraction mobilization would result in an immediate change of maximal force output of the quadriceps and gluteus. DESIGN: Non-controlled observational pre-post design. METHODS: Forty individuals with knee pathology were included. Subjects underwent quadriceps, gluteus maximus, and gluteus medius muscle strength assessment before a single hip distraction of the symptomatic side. An immediate re-assessment of muscle strength of both symptomatic and asymptomatic sides followed the mobilization. RESULTS: /findings: Comparing pre-to post-mobilization strength on the symptomatic side, a significant increase was found with the gluteus maximus (average change = 2.0 kg [95%CI 0.6-3.4]; p < 0.01) but not gluteus medius (0.2 kg [-0.7-1.0]; p = 0.71) or quadriceps (0.1 kg [-1.4-1.7]; p = 0.86). When comparing the strength on the symptomatic side in subjects with weakness greater than the MDD95 (0.7-2.9 kg), a significant increase was again found for gluteus maximus (4.7 kg [2.6-6.8]; p < 0.01) but not for gluteus medius (0.2 kg [-1.0-1.4]; p = 0.71) or quadriceps (1.6 kg [-0.7-3.9]; p = 0.15). CONCLUSION: A single hip distraction resulted in a significant increase in gluteus maximus strength but did not produce a change in gluteus medius or quadriceps strength in subjects with knee injuries.

Real-Time Three-Dimensional Knee Moment Estimation in Knee Osteoarthritis: Toward Biodynamic Knee Osteoarthritis Evaluation and Training.

We investigated differences in knee kinetic variables (external knee adduction, flexion, internal rotation moments, and impulses) between patients with knee osteoarthritis (KOA) and healthy controls during stepping on a custom elliptical trainer; and searched knee kinetic variable candidates for real-time biofeedback and for complementing diagnosis/evaluation on the elliptical trainer based on the knee kinetic variables' associations with the knee injury and osteoarthritis outcome score (KOOS). Furthermore, we explored potential gait re-training strategies on the elliptical trainer by investigating the knee kinetic variables' associations with 3-D ankle angles. The knee kinetic variables and ankle angles were determined in real-time in a patient group of 10 patients with KOA and an age-and sex-matched control group of 10 healthy subjects. The mean peak external knee adduction moment of the patient group was 47% higher than that of the control group. The KOOS-Sports and Recreational Activities and KOOS-Pain scores were found to be significantly associated with the knee kinetic variables. All the ankle angles were associated with the knee kinetic variables. The findings support the use of the knee kinetic variables on the elliptical trainer to complement KOA diagnosis quantitatively and provide potential real-time KOA gait re-training strategies/guides.

Effect of Cabbage Wraps on the Reduction of Post-Traumatic Knee Exudates in Men.

OBJECTIVES: The study investigates measurable effects of cabbage leaf wraps on post-traumatic knee injury exudate absorption in men. DESIGN: Case-control experiment on the same group of patients (before and after treatment). SETTINGS/LOCATION: One academic center and two hospitals. SUBJECTS: The study was carried out on a group of patients with different degrees of injury severity in the acute stage of the knee injury who were divided into three groups based on the width of suprapatellar recess gap (3-5 mm in group 1, 6-10 mm in group 2, and 11 mm or more in group 3) as assessed by ultrasonography. INTERVENTIONS: Each group of patients was divided into two subgroups, one of which comprised patients whose knees were treated with wraps containing cabbage leaves with ice (cases) and the others comprised patients treated with wraps without cabbage leaves, with cooling dressing only (controls). RESULTS: Significant progression in knee fluid uptake was observed in the acute stage of the knee injuries treated with cabbage wraps compared with control groups (p < 0.05). It was shown that the time, type of wraps, and a degree of severity of post-traumatic exudative knee inflammation affect the process of knee recovery (Friedman test for repeated measures p < 0.05). The most significant results were observed within first 24 h after the injury. Further decrease in the width of the recess gap after 5 days was observed. CONCLUSIONS: Application of cabbage wraps with ice to the knee in men may promote a reduction of swelling (by accelerating absorption of knee exudates) if applied during the acute stage of the knee injury.

Manipulation under anesthesia for post traumatic stiff knee-pearls, pitfalls and risk factors for failure.

BACKGROUND: Stiffness is common following fractures around knee. Manipulation under anesthesia (MUA) is the initial noninvasive procedure usually performed for such patients. Though MUA has been extensively evaluated for knee arthroplasty, there is paucity of literature regarding its benefits in trauma cases. The purpose of this study was to define the role of manipulation in post traumatic stiff knees. METHODS: Hospital inpatient and outpatient records from January 2010 to June 2014 were retrospectively reviewed to identify patients undergoing MUA at our institution. Patients with more than one year follow up and adequate data were included. Clinical and radiographic parameters were analyzed to assess outcomes, complications, effect of timing on flexion gain as well as identify risk factors associated with failure. RESULTS: Out of 45 patients undergoing manipulation, 41 patients with 48 knees (34 unilateral and 7 bilateral) met inclusion criteria. Thirty six manipulations were successful while 3 were abandoned due to tight tissues and 9 developed complications.Successful MUA resulted in immediate gain of 62.36° of flexion which decreased to 49.86° at 1year. There was statistically significant loss of flexion of 12.5° over a year (p value 0.0013). Arc of motion improved from 48.5° to 106.1° at 1year (p value <0.0001). Significant improvement was also seen in extension and fixed flexion deformity (p value <0.0001). No significant difference could be detected between early (<3 months) and late (>3 months) groups with respect to outcomes (p value 0.883)or complications (p value 0.3193). Failed group had significantly lower pre MUA flexion and pre MUA range of motion (p value 0.003). Univariate analysis showed that extensor mechanism ruptures during injury (p value <0.0001) and knees with Flexion <40° (p value 0.0022) or ROM<30° (p value 0.0002) were significantly associated with failures. CONCLUSION: MUA is a suitable non invasive treatment option for post traumatic stiffness. There is no effect of timing on outcome and late manipulation also results in good outcome. Extensor mechanism rupture and pre manipulation ROM<30° or flexion <40° are associated with failure and such cases should be considered for alternative options for better outcome.

[Case-control study on Chinese medicine fumigation and massage therapy for the treatment of knee stability and func tional recovery after anterior cruciate ligament reconstruction operation].

OBJECTIVE: To study clinical outcomes of Chinese medidine fumigation and massage therapy for the treatment of knee stability and functional recovery after anterior cruciate ligament reconstruction operation,and to explore the effect on tendon-bone healing. METHODS: Total 50 patients were divided into two groups: the control group (normal rehabilitation therapy group),the treatment group (Chinese medicine fumigation and manipulation group). There were 25 patients in the control group, including 16 males and 9 females, who were treated with isometric muscle training, with the gradually enlarging amplitude of flexion and progressive loading of bearing training for knee recovery. There were 25 patients in the treatment group, including 15 males and 10 females,who were treated with the conventional rehabilitation therapy combined with Chinese medicine fumigation and massage therapy. The Chinese herbs named as Haitongpi decoction was steamed by a special equipment to fumigate the knee after operation; Based on the biomechanical parameters of the ligament reconstruction, the massage therapy was designed to control the degree of the knee flexion and release the adhesion for early recovery of knee functions. The Lysholm knee function evaluation system was used, and MRI examination was performed to measure the change in width of ligament tunnel in femur and tibia to evaluate the safety and stability of the treatment. RESULTS: Lysholm system showed that two groups both had improving results from the 1st month after operation to the 3rd month (treatment group, F=36.54, P<0.05; the control group, F=28.12, P<0.05), and the results of the treatment group was better than that of the control group at the observation point (the 1st month, t=0.105, P<0.05; the 3rd month, t=5.361, P<0.01). There was no difference between the two groups when evaluating the bone and tendon healing 3 and 12 months after operation (P>0.05), indicating that Chinese rehabilitation therapy was a safety treatment without the influence on the loosing of tendon. CONCLUSION: Chinese medicine fumigation and massage therapy can early improve the knee function after the anterior cruciate ligament reconstruction operation without the disturbance of the knee stability.

Comparison of Transcutaneous Electrical Nerve Stimulation and Cryotherapy for Increasing Quadriceps Activation in Patients With Knee Pathologies.

CLINICAL SCENARIO: Proper neuromuscular activation of the quadriceps muscle is essential for maintaining quadriceps (quad) strength and lower-extremity function. Quad activation (QA) failure is a common characteristic observed in patients with knee pathologies, defined as an inability to voluntarily activate the entire alpha-motor-neuron pool innervating the quad. One of the more popular techniques used to assess QA is the superimposed burst (SIB) technique, a force-based technique that uses a supramaximal, percutaneous electrical stimulation to activate all of the motor units in the quad during a maximal, voluntary isometric contraction. Central activation ratio (CAR) is the formula used to calculate QA level (CAR = voluntary force/SIB force) with the SIB technique. People who can voluntarily activate 95% or more (CAR = 0.95-1.0) of their motor units are defined as being fully activated. Therapeutic exercises aimed at improving quad strength in patients with knee pathologies are limited in their effectiveness due to a failure to fully activate the muscle. Within the past decade, several disinhibitory interventions have been introduced to treat QA failure in patients with knee pathologies. Transcutaneous electrical nerve stimulation (TENS) and cryotherapy are sensory-targeted modalities traditionally used to treat pain, but they have been shown to be 2 of the most successful treatments for increasing QA levels in patients with QA failure. Both modalities are hypothesized to positively affect voluntary QA by disinhibiting the motor-neuron pool of the quad. In essence, these modalities provide excitatory afferent stimuli to the spinal cord, which thereby overrides the inhibitory afferent signaling that arises from the involved joint. However, it remains unknown whether 1 is more effective than the other for restoring QA levels in patients with knee pathologies. By knowing the capabilities of each disinhibitory modality, clinicians can tailor treatments based on the rehabilitation goals of their patients. Focused Clinical Question: Is TENS or cryotherapy the more effective disinhibitory modality for treating QA failure (quantified via CAR) in patients with knee pathologies?

Treatment of a medial collateral ligament sprain using prolotherapy: a case study.

Prolotherapy is effective in treating refractory tendinopathies, but inadequate clinical evidence exists to recommend its use as a treatment for acute or chronic, medial collateral ligament (MCL) injuries. The current case study documents an illustrative case of a rugby player who had a grade 2 sprain of the MCL and shows the clinical and radiological outcomes following injections of 15% dextrose combined with 0.2% lidocaine. In his case, the prolotherapy, together with an exercise therapy, lasted 3 wk. At the end of the 3 wk, the patient was pain free, with a full range of motion (ROM), and he was able to perform all rugby-specific movements. The mean duration for recovery with conservative treatment of isolated, complete tears of the MCL is normally 4-8 wk.

Clinical strategies for addressing muscle weakness following knee injury.

Muscle strength is a determinate of physical function and increasing muscle strength is an important clinical goal for patients with knee injury. This article discusses the emerging evidence regarding a novel rehabilitation strategy that uses disinhibitory modalities to increase neuromuscular activation in conjunction with traditional muscle strengthening for the purpose of maximizing strength gains following acute knee injury or surgery and in patients with knee osteoarthritis. The use of disinhibitory modalities and specific types of neuromuscular training for clinically maximizing strength are discussed.

Combination of eccentric exercise and neuromuscular electrical stimulation to improve quadriceps function post-ACL reconstruction.

BACKGROUND: Neuromuscular electrical stimulation (NMES) has been shown to reduce quadriceps activation failure (QAF), and eccentric exercise has been shown to lessen muscle atrophy post-ACL reconstruction. Given that these are two critical components of quadriceps strength, intervention combining these therapies may be effective at reinstituting quadriceps function post-reconstruction. Thus, the aim of this study was to evaluate the effectiveness of a combined NMES and eccentric exercise intervention to improve the recovery of quadriceps activation and strength post-reconstruction. METHODS: Thirty-six individuals post-injury were placed into four treatment groups (N&E, NMES and eccentrics; E-only, eccentrics only; N-only, NMES-only; and STND, standard of care) and ten healthy controls participated. N&E and N-only received the NMES protocol 2× per week for the first 6 weeks post-reconstruction. N&E and E-only received the eccentric exercise protocol 2× per week beginning 6 weeks post-reconstruction. Quadriceps activation was assessed via the superimposed burst technique and quantified via the central activation ratio. Quadriceps strength was assessed via maximal voluntary isomeric contractions (Nm/kg). Data was gathered on three occasions: pre-operative, 12-weeks-post-surgery and at return-to-play. RESULTS: No differences in pre-operative measures existed (P>0.05). E-only recovered quadriceps activation better than N-only or STND (P<0.05). N&E and E-only recovered strength better than N-only or the STND (P<0.05) and had strength values that were similar to healthy at return-to-play (P>0.05). CONCLUSION: Eccentric exercise was capable of restoring levels of quadriceps activation and strength that were similar to those of healthy adults and better than NMES alone. LEVEL OF EVIDENCE: Level 3, Parallel longitudinal study.

Real-time biofeedback to target risk of anterior cruciate ligament injury: a technical report for injury prevention and rehabilitation.

CONTEXT: Biofeedback training enables an athlete to alter biomechanical and physiological function by receiving biomechanical and physiological data concurrent with or immediately after a task. OBJECTIVE: To compare the effects of 2 different modes of real-time biofeedback focused on reducing risk factors related to anterior cruciate ligament injury. DESIGN: Randomized crossover study design. SETTING: Biomechanics laboratory and sports medicine center. PARTICIPANTS: Female high school soccer players (age 14.8 ± 1.0 y, height 162.6 ± 6.8 cm, mass 55.9 ± 7.0 kg; n = 4). INTERVENTION: A battery of kinetic- or kinematic-based real-time biofeedback during repetitive double-leg squats. MAIN OUTCOME MEASURES: Baseline and posttraining drop vertical jumps were collected to determine if either feedback method improved high injury risk landing mechanics. RESULTS: Maximum knee abduction moment and angle during the landing was significantly decreased after kinetic-focused biofeedback (P = .04). The reduced knee abduction moment during the drop vertical jumps after kinematic-focused biofeedback was not different (P = .2). Maximum knee abduction angle was significantly decreased after kinetic biofeedback (P < .01) but only showed a trend toward reduction after kinematic biofeedback (P = .08). CONCLUSIONS: The innovative biofeedback employed in the current study reduced knee abduction load and posture from baseline to posttraining during a drop vertical jump.

Patellar tendinopathy - recent developments toward treatment.

Patellar tendinopathy (PT) is a clinical and chronic overuse condition of unknown pathogenesis and etiology marked by anterior knee pain typically manifested at the inferior pole of the patella. PT has been referred to as "jumper's knee" since it is particularly common among populations of jumping athletes, such as basketball and volleyball players. Due to its common refractory response to conservative treatment, a variety of new treatments have emerged recently that include dry-needling, sclerosing injections, platelet-rich plasma therapy, arthroscopic surgical procedures, surgical resection of the inferior patellar pole, extracorporeal shock wave treatment, and hyperthermia thermotherapy. Since PT has an unknown pathogenesis and etiology, PT treatment is more a result of physician experience than evidence-based science. This review will summarize the current literature on this topic, identify current research efforts aimed to understand the pathological changes in abnormal tendons, provide exposure to the emerging treatment techniques, and provide suggested direction for future research.

[Electrophysiological mechanisms of spinal systems plasticity in people with dysfunctions of the locomotor system].

The reflex motor responses of some bilateral muscles of hip, shin and foot were evoked by percutaneous surface electrical spinal cord stimulation at the lumbosacral levels (T11-L3) in the patients with marked lumbosacral radiculopathy caused by spinal osteochondrosis and in neurologically healthy physically inactive individuals, as well as in healthy qualified athletes and athletes with knee joint injuries. There was used the technique of registration of posterior root-muscle reflexes. In the subjects with neurologic pathology and in the group of athletes with knee joint injuries the data demonstrated similar signs of plasticity of spinal neural circuits, innervating the muscles of the low extremities.

Disinhibitory interventions and voluntary quadriceps activation: a systematic review.

OBJECTIVE: To determine the effects of various therapeutic interventions on increasing voluntary quadriceps muscle activation. BACKGROUND: Decreased voluntary quadriceps activation is commonly associated with knee injury. Recently, research has focused on developing specific disinhibitory interventions to improve voluntary quadriceps activation; yet, it remains unknown which interventions are most effective in promoting this improvement. DATA SOURCES: We searched Web of Science from January 1, 1965 through September 27, 2012, using the key words quadriceps activation and transcutaneous electrical nerve stimulation, transcranial magnetic stimulation, cryotherapy, focal joint cooling, joint mobilization, joint mobilisation, joint manipulation, manual therapy, and neuromuscular electrical stimulation. STUDY SELECTION: Studies evaluating the effect of disinhibitory interventions on volitional quadriceps activation were used in our review. Standardized effect sizes (Cohen d) and 95% confidence intervals (CIs) were calculated from voluntary quadriceps activation means and standard deviations measured at baseline and at all available postintervention time points from each study. DATA SYNTHESIS: Ten studies were grouped into 5 categories based on intervention type: manual therapy (4 studies), transcutaneous electrical nerve stimulation (2 studies), cryotherapy (2 studies), neuromuscular electrical stimulation (2 studies), and transcranial magnetic stimulation (1 study). Transcutaneous electrical nerve stimulation demonstrated the strongest immediate effects (d = 1.03; 95% CI = 0.06, 1.92) and long-term effects (d = 1.93; 95% CI = 0.91, 2.83). Cryotherapy (d = 0.76; 95% CI = -0.13, 1.59) and transcranial magnetic stimulation (d = 0.54; 95% CI = -0.33, 1.37) had moderate immediate effects in improving voluntary quadriceps activation, whereas manual therapy (d = 0.38; 95% CI = -0.35, 1.09) elicited only weak immediate effects. Neuromuscular electrical stimulation produced weak negative to strong positive effects (range of d values = -0.50 to 1.87) over a period of 3 weeks to 6 months. CONCLUSIONS: Transcutaneous electrical nerve stimulation demonstrated the strongest and most consistent effects in increasing voluntary quadriceps activation and may be the best disinhibitory intervention for improving the same.

Low-level laser therapy in meniscal pathology: a double-blinded placebo-controlled trial.

We performed a randomized, double-blinded, placebo-controlled study (ISRCTN24203769) to assess the effectiveness of low-level laser therapy (LLLT) in patients with meniscal pathology, including only symptomatic patients with tiny focus of grade 3 attenuation (seen only on 0.7 thickness sequences) or intrasubstance tears with spot of grade 3 signal intensity approaching the articular surface. None of the patients in the study group underwent arthroscopy or new magnetic resonance imaging investigation. Paired-samples t test was used to detect significant changes in subjective knee pain over the experimental period within groups, and ANOVA was used to detect any significant differences between the two groups. Pain was significantly improved for the LLLT group than for the placebo group (F = 154, p < 0.0001). Pain scores were significantly better after LLLT. Four (12.5 %) patients did not respond to LLLT. At baseline, the average Lysholm score was 77 ± 4.6 for the LLLT group and 77.2 ± 2.6 for the placebo group (p > 0.05). Four weeks after LLLT or placebo therapy, the laser group reported an average Lysholm score of 82.5 ± 4.6, and the placebo group scored 79.0 ± 1.9. At 6 months, the laser group had an average Lysholm score of 82.2 ± 5.7, and after 1 year, they scored 81.6 ± 6.6 (F = 14.82923, p = 0.002). Treatment with LLLT was associated with a significant decrease of symptoms compared to the placebo group: it should be considered in patients with meniscal tears who do not wish to undergo surgery.

Neuromuscular prehabilitation to prevent osteoarthritis after a traumatic joint injury.

Post-traumatic osteoarthritis (PTOA) is a process resulting from direct forces applied to a joint that cause injury and degenerative changes. An estimated 12% of all symptomatic osteoarthritis (OA) of the hip, knee, and ankle can be attributed to a post-traumatic cause. Neuromuscular prehabilitation is the process of improving neuromuscular function to prevent development of PTOA after an initial traumatic joint injury. Prehabilitation strategies include restoration of normative movement patterns that have been altered as the result of traumatic injury, along with neuromuscular exercises and gait retraining to prevent the development of OA after an injury occurs. A review of the current literature shows that no studies have been performed to evaluate methods of neuromuscular prehabilitation to prevent PTOA after a joint injury. Instead, current research has focused on management strategies after knee injuries, the value of exercise in the management of OA, and neuromuscular exercises after total knee arthroplasty. Recent work in gait retraining that alters knee joint loading holds promise for preventing the development of PTOA after joint trauma. Future research should evaluate methods of neuromuscular prehabilitation strategies in relationship to the outcome of PTOA after joint injury.

Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of electromyographic biofeedback training and electrical stimulation therapy for rehabilitation following arthroscopic partial meniscectomy. DESIGN: Randomized, prospective, controlled single-blind trial. SETTING: Department of physical medicine and rehabilitation, university hospital. SUBJECTS: Forty-five patients who had undergone surgery for arthroscopic partial meniscectomy were randomly divided into three groups with 15 patients in each group. INTERVENTIONS: The control group had home exercise, the second and third groups received electromyographic biofeedback training or electrical stimulation therapy to quadriceps muscle in addition to home exercise. MAIN MEASURES: The patients were evaluated for: visual analogue scale, gait velocity (m/s), time using a walking aid after surgery, Lysholm Knee Scoring Scale score, knee flexion-extension angle, maximum and average contraction powers of vastus medialis obliquus and vastus lateralis muscles on the day before the operation and two and six weeks after. RESULTS: The time using a walking aid was 8.3 ± 8.0, 1.5 ± 2.5 and 4.5 ± 5.5 days, respectively, for the home exercise, electromyographic biofeedback training and electrical stimulation groups, and significantly shorter in the electromyographic biofeedback training than in the home exercise group (P < 0.017). While significant progress was detected in Lysholm Knee Scoring Scale score in the second and sixth postoperative weeks compared to the preoperative within-group evaluation for each of the three groups (P < 0.017), there was significant difference in Lysholm Knee Scoring Scale in the second postoperative week in favour of electromyographic biofeedback training compared to home exercise (P < 0.017). There were significant differences in vastus medialis obliquus average and vastus lateralis maximum and average contractions in favour of electromyographic biofeedback compared to home exercise and electrical stimulation in the second postoperative week (P < 0.017). CONCLUSIONS: The addition of electromyographic biofeedback training to a conventional exercise programme following arthroscopic partial meniscectomy helps to speed up the rehabilitation process.

Hinged cast brace for persistent flexion contracture following total knee replacement.

The reported incidence of persistent knee flexion contracture following total knee arthroplasty (TKA) has varied from 1-15 percent Various treatment modalities have been described in attempts to manage this often difficult problem. This paper describes a novel method of treatment by using a hinged cast brace (previously reported for treatment of femur fractures and knee contractures secondary to hemophilia and cerebral palsy) for use in patients with symptomatic knee flexion contractures. Application of this cast brace with frequent adjustment (every three to four days, initially) toward full extension can often improve knee extension, after physical therapy and other modalities such as extension-assist braces have failed. Care must be taken in the application and use of this device which utilizes frequent manipulations to reduce and maintain the knee flexion angle. We report two clinical cases in which this protocol was effectively used in decreasing symptomatic knee flexion contractures.

The effect of protein and carbohydrate supplementation on strength training outcome of rehabilitation in ACL patients.

Patients with anterior cruciate ligament (ACL) injury experience atrophy and weakening of the extensor as well as the hamstrings muscles at the injured leg. Especially, the weakness of the quadriceps muscle has been ascribed to hamper daily physical tasks. The purpose of the present study was therefore to investigate if nutrient supplementation during 12 weeks of conservative rehabilitation strength training could enhance hypertrophy and strength of the quadriceps muscle in ACL-injured patients. Twenty-six ACL-injured men and women were included and randomly distributed into three supplementation groups: Protein+Carbohydrate (PC), Isocaloric-Carbohydrate (IC), or Placebo (PL), ingesting the supplementation immediately after each of 36 training sessions. Determined from images of thigh cross-sections (magnetic resonance imaging) the hypertrophy of the quadriceps muscle differed significantly between groups at the distal part, with the PC group demonstrating the largest hypertrophy. Peak torque of the quadriceps muscle at constant velocity 60 degrees.s-1 was significantly elevated in the PC group only, and the time to reach peak torque tended to decrease as well only in the PC group. The results from this study demonstrate that restoration of the distal vasti muscle mass and knee extension muscle strength with resistance training is promoted further by protein-containing nutrient supplementation immediately after single exercise sessions. Thus, exercise-related protein supplementation may seem important for surgery-related rehabilitation of skeletal muscle.