Platelet-Rich Plasma Improves Strength and Speed of Recovery in an Active-Duty Soldier with Isolated Injury to the Lateral Collateral Ligament of the Knee: A Case Report.

Ligamentous injuries of the knee occur in the military, but constitute an overwhelmingly disproportionate number of medical discharges, which can be due to prolonged recovery through traditional use of physical therapy (PT) and other non-operative modalities. The use of platelet-rich plasma (PRP) may substantially increase the speed of recovery and patient outcomes but is little explored for less common isolated ligamentous injuries, such as the lateral collateral ligament, especially in active-duty populations. We describe the use of PRP in a young, otherwise healthy active-duty male to treat an isolated LCL injury with significant positive outcomes. These findings support consideration for early use of PRP in similar cases to improve recovery timelines and aid in return to duty.

Sports rehabilitation in athletes with meniscal lesions based on electroacupuncture associated with sports therapy / Reabilitação esportiva de atletas com lesão meniscal baseada em eletroacupuntura combinada à terapia esportiva / Rehabilitación deportiva de atletas con lesión meniscal basada en electroacupuntura combinada con la terapia deportiva

ABSTRACT Introduction: Meniscal injury is a common condition that can lead to disability due to pain and proprioceptive failure, requiring immediate attention. Combination therapies involve advanced approaches aiming to accelerate rehabilitation in athletes, and electroacupuncture presents therapeutic benefits, although there is still no evidence of its combination with sports therapy. Objective: This paper analyzes the performance of sports rehabilitation in athletes with meniscal lesions using electroacupuncture combined with sports therapy. Methods: The intervention in the control group was based on a traditional range of motion work, muscle strength, proprioceptive training, and other exercise therapies, while the experimental group received a 30 min electro-acupuncture protocol three times a week for four consecutive weeks. The surrogate data (gender, age, disease course, location) are the same. Before treatment, joint activity, muscle strength, total joint scale score of the LYSHOLM questionnaire, and other observational indices were measured during the 6th and 12th week of treatment. The non-parametric statistical method and T-test were used to analyze the changes of each index before and after treatment. After 12 weeks of treatment, the difference between the experimental group and the combination before treatment was significant. Results: The treatment effect of the experimental group was significantly better than the control group. Conclusion: The effect of sports rehabilitation of athletes with meniscus injury based on electroacupuncture combined with sports therapy showed high resolutive application value, indicating an alternative for non-surgical treatment in knee meniscus injuries. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: A lesão meniscal é um acometimento comum que pode gerar incapacitação por dor e falha proprioceptiva, exigindo atenção imediata. Terapias combinadas envolvem abordagens avançadas com o objetivo de acelerar a reabilitação nos atletas, e a eletroacupuntura apresenta benefícios terapêuticos, embora ainda não possua evidencias de sua combinação com a terapia esportiva. Objetivo: Analisar o desempenho da reabilitação esportiva em atletas com lesão meniscal utilizando eletroacupuntura combinada à terapia esportiva. Métodos: A intervenção no grupo controle baseou-se no trabalho tradicional de amplitude de movimento, força muscular, treinamento proprioceptivo e outros tipos de terapias de exercício enquanto que ao grupo experimental foi adicionado um protocolo de eletro-acupuntura de 30 minutos de duração, 3 vezes por semana durante 4 semanas consecutivas. Os dados de substituição (sexo, idade, curso de doença, localização) são basicamente os mesmos. Antes do tratamento, a atividade articular, a força muscular, o escore total da escala articular do questionário LYSHOLM e outros índices de observação foram medidos na 6ª e 12ª semana do tratamento. O método estatístico não paramétrico e teste-T foram utilizados para analisar as alterações de cada índice antes e depois do tratamento. Após 12 semanas de tratamento, a diferença entre o grupo experimental e a combinação antes do tratamento foi significativa. Resultados: O efeito de tratamento do grupo experimental foi significativamente melhor do que o grupo controle. Conclusão: O efeito de reabilitação esportiva de atletas com lesão meniscal baseada em eletroacupuntura combinada à terapia esportiva demonstrou alto valor de aplicação resolutiva, indicada como alternativa para o tratamento não cirúrgico em lesões no menisco do joelho. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

Resumen Introducción: La lesión meniscal es una lesión común que puede causar incapacidad por dolor y fallo propioceptivo, requiriendo atención inmediata. Las terapias combinadas implican enfoques avanzados con el objetivo de acelerar la rehabilitación en los deportistas, y la electroacupuntura presenta beneficios terapéuticos, aunque todavía no hay pruebas de su combinación con la terapia deportiva. Objetivo: Analizar el rendimiento de la rehabilitación deportiva en atletas con lesión meniscal utilizando electroacupuntura combinada con la terapia deportiva. Métodos: La intervención en el grupo de control se basó en el trabajo tradicional de amplitud de movimiento, fuerza muscular, entrenamiento propioceptivo y otros tipos de terapias de ejercicio, mientras que al grupo experimental se le añadió un protocolo de electroacupuntura de 30 minutos de duración, 3 veces a la semana durante 4 semanas consecutivas. Los datos sustitutivos (sexo, edad, evolución de la enfermedad, localización) son básicamente los mismos. Antes del tratamiento, se midieron la actividad articular, la fuerza muscular, la puntuación total de la escala articular del cuestionario LYSHOLM y otros índices de observación en la 6ª y 12ª semana de tratamiento. Se utilizó el método estadístico no paramétrico y la prueba T para analizar los cambios de cada índice antes y después del tratamiento. Tras 12 semanas de tratamiento, la diferencia entre el grupo experimental y la combinación antes del tratamiento era significativa. Resultados: El efecto del tratamiento del grupo experimental fue significativamente mejor que el del grupo de control. Conclusión: El efecto de la rehabilitación deportiva de atletas con lesión de menisco basada en la electroacupuntura combinada con la terapia deportiva mostró un alto valor de aplicación resolutiva, indicada como alternativa de tratamiento no quirúrgico en las lesiones de menisco de rodilla. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Effect of motor imagery on enjoyment in knee-injury prevention and rehabilitation training: A randomized crossover study.

OBJECTIVES: The novel MOTor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) model takes a uniquely holistic approach by integrating mental and physical aspects into current training programs. The aim of this trial was to evaluate enjoyment of MOTIFS training as compared to Care-as-Usual (CaU) knee injury and/or rehabilitation training. The primary hypothesis was that enjoyment would be greater following MOTIFS training than CaU training. DESIGN: Block-randomized 2×2 cross-over trial. METHODS: Thirty athletes (18-31years, 50% women) currently or previously active in team ball sports, with no pain or injury preventing jump and/or directional changes. MOTIFS training integrates sport-specific experiences and equipment into physical exercises to increase individualized realism and meaning. The CaU condition included solely physical exercise. The main outcome was the Physical Activity Enjoyment Scale (PACES). Secondary outcomes included Self-Assessment Manikin (SAM; subscales Valence, Arousal, Dominance), Perceived exertion, pulse, duration, and movement quality. RESULTS: PACES scores were better following MOTIFS training than CaU (point estimate 24.67; 95% CI: 19.0; 30.3). Between-groups differences in SAM Valence (median 2, quartiles 1;3), Arousal (median 1, quartiles 0;2.25), and Dominance (median 0.5, quartiles 0;2), and RPE (median 1, quartiles -0.3;2), training duration (mean 5.34, 95% CI: -0.17; -0.73), and pulse (median 7.50, quartiles 0.25;16.75) were higher following MOTIFS training than CaU training. CONCLUSIONS: Results suggest that the MOTIFS model, which integrates simultaneous physical and psychological interventions, is a clinically plausible method of influencing enjoyment and other psychological outcomes. Further studies may explore effects of the MOTIFS principles on injury prevention and rehabilitation training.

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.

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.

Adding high-frequency transcutaneous electrical nerve stimulation to the first phase of post anterior cruciate ligament reconstruction rehabilitation does not improve pain and function in young male athletes more than exercise alone: a randomized single-blind clinical trial.

PURPOSE: Knee ligamentous trauma and the following pain is one of the most prevalent athletic injuries. Transcutaneous electrical nerve stimulation is one of the conservative approaches in controlling pain which is low cost, noninvasive, and safe with low complications. Our purpose was to study whether transcutaneous electrical nerve stimulation (TENS) could help athletes perform better during the first phase of rehabilitation (0-4 weeks) after anterior cruciate ligament (ACL) reconstruction surgery and until the follow-up. METHODS: This randomized single blind (exercise instructor and assessor) clinical trial was performed on 70 male athletes, undergone ACL surgery. After the surgery, patients were randomly divided into two groups: the first group received semi-supervised exercise plus high-frequency TENSTENS for 35 min a day and the second group only performed exercises. Treatment duration continued for 20 sessions, 4 weeks. The visual analog scale (VAS) score (100 mm), International Knee Documentation Committee (IKDC) questionnaire and knee flexion Range of motion (ROM) were evaluated for all patients after the surgery (before commencing the rehabilitation program), after 4 weeks and 14 weeks from the surgery. RESULTS: Mixed ANOVA was used to explore the interaction effects of time and group on outcome measures and post hoc additional tests were performed on the data. The VAS, IKDC questionnaire score and knee flexion ROM increased in both groups over time, but the amount of improvement did not differ between the two groups, implying no additional improvement in the group receiving TENS along with exercises. CONCLUSION: The findings of the present trial shows that adding TENS to a specific protocol of semi-supervised exercise in the first phase of rehabilitation after ACL reconstruction is not efficient on improving knee function and pain more than exercise alone. Implications for Rehabilitation Injury to the anterior cruciate ligament of the knee is a common injury specifically in athletes. Incorporating effective pain relieving strategies during the post anterior cruciate ligament reconstruction surgery rehabilitation could lead to improvement in regaining the range of motion and function of the knee which is of crucial importance after the surgery. Applying transcutaneous electrical nerve stimulation alongside a specific protocol of semi-supervised exercise in the first phase of rehabilitation after anterior cruciate ligament reconstruction did not have any additional effect to exercise alone.

Short-term effects of mobilisation with movement in patients with post-traumatic stiffness of the knee joint.

BACKGROUND: Mobilisation with movement treatment techniques have been used to increase the range of motion following pathologies associated with shoulder, elbow and ankle joints. Lack of posterior tibial glide and reflex muscle inhibition are common physical impairments in individuals with post-traumatic stiffness of the knee joint. Current evidence is lacking for the benefits of mobilisation with movement treatment techniques for the knee joint disorders. OBJECTIVE: The purpose of this study was to investigate the short-term effects of mobilisation with movement techniques following post-traumatic stiffness of the knee joint. METHODS: Twenty consecutive patients with post-traumatic stiffness of the knee joint with a minimum available 80° knee flexion range of motion were included. One group pre-to-post-test study design was employed, in which the active knee flexion range of motion was used as an outcome measure. The mobilisation with movement treatment techniques was implemented with three sets of ten repetitions on each treatment occasion for a period of 3 days. RESULTS: The mobilisation with movement treatment techniques significantly improved the active knee flexion range of motion (p = 0.000) from pre-treatment to post-treatment. CONCLUSIONS: The findings from this study demonstrated immediate benefits in outcomes following mobilisation with movement treatment techniques in a cohort of patients with post-traumatic stiffness of the knee joint.

Integrating self-management support for knee injuries into routine clinical practice: TRAK intervention design and delivery.

BACKGROUND: TRAK is a web-based intervention that provides knee patients with health information, personalised exercise plans and remote clinical support. The aim of this study was to fully define TRAK intervention content, setting and context and develop the training through an implementation study in a physiotherapy out-patient service. METHODS: A mixed methods study. Phase 1 was a qualitative interview study, whereby fifteen physiotherapists used TRAK for 1 month with a patient of their choice. Interviews explored patient and physiotherapist views of TRAK intervention and training requirements. In Phase 2 seventy-four patients were recruited, all received conventional physiotherapy, a subset of 48 patients used TRAK in addition to conventional Physiotherapy. Aspects of feasibility measured included: uptake and usage of TRAK. RESULTS: Patients and physiotherapists reported that TRAK was easy to use and highlighted the therapeutic benefit of the exercise videos and personalised exercise plans to remind them of their exercises and the correct technique. Patients reported needing to use TRAK with the guidance of their treating physiotherapist initially. Physiotherapists highlighted appointment time constraints and lack of familiarity with TRAK as factors limiting engagement. In Phase 2, 67% patients accessed TRAK outside of the clinical environment. A total of 91% of patients were given a personalised exercise plan, but these were only updated in 34% of cases. CONCLUSION: A comprehensive training package for patients and clinicians has been defined. The refined TRAK intervention is reported using the 'Template for Intervention Description and Replication in preparation for a definitive randomised control trial.

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?

Manipulation Under Anesthesia: A Safe and Effective Treatment for Posttraumatic Arthrofibrosis of the Knee.

OBJECTIVES: This study investigates the results of closed manipulations performed under anesthesia (MUA) to evaluate whether it is an effective means to treat posttraumatic knee arthrofibrosis. DESIGN: Retrospective review. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Twenty-two patients with a mean age of 40 underwent closed MUA for posttraumatic knee arthrofibrosis. Injuries included fractures of the femur, tibia, and patella as well as ligamentous injuries and traumatic arthrotomies. The mean time from treatment to manipulation was 90 days. Mean follow-up after manipulation was 7 months. INTERVENTION: Closed knee MUA. OUTCOME MEASUREMENTS: Improvement of knee range of motion (ROM) arc was the primary outcome. Patient demographics were correlated with manipulation success using a 2-sample t test. A delay in manipulation of 90 days or greater was also evaluated in this fashion with regard to its role in predicting the benefit of MUA. RESULTS: The mean premanipulation ROM arc was 59 ± 25 degrees. The mean intraoperative arc of motion, achieved at the time of the manipulation was 123 ± 14 degrees. No complications occurred during the MUA procedure. At the most recent follow-up, the mean ROM arc was 110 ± 19 degrees. Tobacco use, associated injuries, elevated body mass index, open fracture, and advanced age did not impact manipulation efficacy. Additionally, manipulations performed 90 days or more after surgical treatment provided a benefit equaling those performed more acutely (P = 0.12). DISCUSSION: MUA is a safe and effective method to increase knee ROM in the setting of posttraumatic arthrofibrosis. Improvement in ROM was noted in all patients. A 90-day window between fracture fixation and manipulation did not impact ROM at final follow-up and may prevent fracture displacement during the MUA. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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.

Glucosamine supplementation after anterior cruciate ligament reconstruction in athletes: a randomized placebo-controlled trial.

Although glucosamine is commonly consumed by athletes, its effectiveness in sports injuries is still under debate. We aimed to investigate the effects of glucosamine to the rehabilitation outcomes of anterior cruciate ligament (ACL) reconstructed athletes. Glucosamine-sulfate (1000 mg daily, for 8 weeks) was administered to half of the cohort of 30 male athletes, the other half used a placebo. Both groups received the same rehabilitation protocol. Knee pain and functions were evaluated by a visual analogue scale (VAS), International Knee Documentation Committee (IKDC) and Lysholm scores before and after oral administration. Additionally, an isokinetic test was performed after the administration period. The scores revealed significant improvements in both groups after 8 weeks, but no significant difference was detected between groups in any of the parameters. Glucosamine supplementation did not improve the rehabilitation outcomes of athletes after ACL reconstruction. This is the first study investigating this topic. Further studies will help to obtain clear evidence about glucosamine efficacy on ACL injured or ACL reconstructed athletes.

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.

Efectos del kinesio tape en la rehabilitación de pacientes con síndrome de dolor patelofemoral: una revisión sistemática / Effects of kinesio tape in rehabilitation of patients with patellofemoral pain syndrome: A systematic review

Objetivo: Evaluar los efectos del kinesio tape en la rehabilitación de pacientes con síndrome de dolor patelofemoral. Estrategia de búsqueda: Se realizó una búsqueda bibliográfica en las bases de datos Cochrane Bone, Joint and Muscle Trauma Group, Cochrane Central Register of Controlled Trials, CINAHL, Biomed Central, Lippincott, Williams & Wilkins, MEDLINE/Pubmed, Pubmed Central, SAGE publications, Springer, Science Direct, Wiley-Blackwell, e IOS Press, desde el 1 de enero de 1995 hasta el 12 de mayo del 2012. Selección de estudios: Se seleccionaron 6 artículos. Los estudios fueron evaluados a través de la escala PEDro. Síntesis de los resultados: El promedio de calidad de los estudios fue 4 (calidad baja) y el número total de participantes fue 111 sujetos (107 mujeres y 4 hombres). Solo un estudio de calidad baja señala que el kinesio tape, en menor tiempo, disminuye la tensión de isquiotibiales y aumenta la longitud del complejo banda iliotibial/tensor de la comparado con un grupo de ejercicios. No se observaron diferencias significativas al comparar el kinesio tape frente a otras intervenciones (ejercicio, electroestimulación más ejercicios, kinesio tape placebo y tape McConnell). El kinesio tape, al ser analizado pre y postratamiento, ejerce diferencias significativas en las variables: dolor, funcionalidad, rango articular, flexibilidad de tejidos blandos, sensación de posición articular, balance, fuerza y activación muscular. Conclusión: El kinesio tape no tiene suficiente evidencia clínica de calidad que respalde sus múltiples aplicaciones en pacientes con síndrome de dolor patelofemoral

Objective: To assess the effects of kinesio tape in rehabilitation of patients with patellofemoral pain syndrome. Search strategy: Bibliographic was searched in the following databases: Cochrane Bone, Joint and Muscle Trauma Group, Cochrane Central Register of Controlled Trials, CINAHL, Biomed Central, Lippincott, Williams & Wilkins, MEDLINE/Pubmed, Pubmed Central, SAGE publications, Springer, Science Direct, Wiley-Blackwell and IOS Press from January 1 1995 to May 12, 2012. Study selection: Six articles that met the inclusion criteria were selected. Validity of the articles were evaluated according to criteria PEDro. Summary of results: Average quality of the studies was 4 (low quality) A total of 111 patients were included in the reviews (107 women and 4 men). Only one low quality study indicated that the kinesio tape, used in less time, decreases hamstring tension and increases length of the complex Iliotibial band/tensor fascia lata compared to the exercise group. No significant differences were observed when comparing the kinesio tape versus other intervention (exercise, electrostimulation more exercises, placebo kinesio tape and tape McConnell). When the kinesio tape was analyzed pre- and post- treatment, significant differences were seen in the variables: pain, functionality, join range, flexibility of soft tissues, joint position sense, balance, strength and muscle activation. Conclusion There is not sufficient evidence of quality regarding Kinesio tape to support its many applications in patients with patellofemoral pain syndrome

A 12-week medical exercise therapy program leads to significant improvement in knee function after degenerative meniscectomy: a randomized controlled trial with one year follow-up.

There is no consensus in the postoperative rehabilitation regimen for patients who have undergone surgery for medial meniscus damage. The aim of this study was to examine whether it is necessary to undergo postoperative physiotherapy treatment these patients. A prospective randomized controlled clinical trial was performed. 42 participants (26 males, 16 women) were randomly assigned into an exercise group (EG) (n = 22) or a control group (CG) (n = 20). Prognostic variables were similar between the groups at baseline. The EG achieved significantly better outcome effects than the CG at pain (VAS reduced 1.9 in TG and 0.6 in CG, p < 0.01) and function (KOOS decreased 18.0 in TG and only 6.5 in CG, p < 0.01) during the 12 week intervention period. The results after a 12-month follow-up indicated the same results as at posttest 3 months postoperatively. In patients with surgery for degenerative meniscus damage, postoperative medical exercise therapy - as a model of physiotherapy - is an efficient treatment alternative compared to no systematic rehabilitation.

Manual therapy directed at the knee or lumbopelvic region does not influence quadriceps spinal reflex excitability.

UNLABELLED: Manual therapies, directed to the knee and lumbopelvic region, have demonstrated the ability to improve neuromuscular quadriceps function in individuals with knee pathology. It remains unknown if manual therapies may alter impaired spinal reflex excitability, thus identifying a potential mechanism in which manual therapy may improve neuromuscular function following knee injury. AIM: To determine the effect of local and distant mobilisation/manipulation interventions on quadriceps spinal reflex excitability. METHODS: Seventy-five individuals with a history of knee joint injury and current quadriceps inhibition volunteered for this study. Participants were randomised to one of five intervention groups: lumbopelvic manipulation (grade V), lumbopelvic manipulation positioning (no thrust), grade IV patellar mobilisation, grade I patellar mobilisation, and control (no treatment). Changes in spinal reflex excitability were quantified by assessing the Hoffmann reflex (H-reflex), presynaptic, and postsynaptic excitability. A hierarchical linear-mixed model for repeated measures was performed to compare changes in outcome variables between groups over time (pre, post 0, 30, 60, 90 min). RESULTS: There were no significant differences in H-reflex, presynaptic, or postsynaptic excitability between groups across time. CONCLUSIONS: Manual therapies directed to the knee or lumbopelvic region did not acutely change quadriceps spinal reflex excitability. Although manual therapies may improve impairments and functional outcomes the underlying mechanism does not appear to be related to changes in spinal reflex excitability.

Tratamiento hidrocinesiterápico de la rotura parcial del ligamento cruzado anterior de la rodilla. A propósito de un caso / Hydrokinesic therapy for partial tears in the anterior cruciate ligament of the knee. A case report

Paciente de 36 años de edad, con signos clínicos de rotura crónica a traumática de ligamento cruzado anterior de la rodilla dominante, con dolor moderado, inestabilidad articular y repercusión funcional constante en la vida diaria. Se confirma el diagnóstico mediante artroscopia, proponiéndose para cirugía reconstructiva. Mientras espera la cirugía, realizó tratamiento fisioterápico clásico con cinesiterapia, sin resultados positivos. Posteriormente, realiza tratamiento de hidrocinesiterapia como monoterapia, con el resultado de la desaparición total de la sintomatología, aplazando sine die la necesidad de realizar la cirugía programada, con recuperación funcional completa de la rodilla al alta. El éxito en esta intervención es un ejemplo de tratamiento no invasivo con escasas contraindicaciones, y se necesitan nuevos estudios que confirmen los beneficios de la hidrocinesiterapia pero podría ser una forma novedosa y sencilla de tratar esta afección

A 36-year-old patient with clinical signs of chronic atraumatic rupture in the anterior cruciate ligament of the dominant knee, with moderate pain, joint instability and constant functional impact on daily life. The diagnosis was confirmed by arthroscopic technique, and reconstructive surgery was proposed. While waiting for the surgery, classic physical therapy was performed, without positive results. Subsequently, hydrokinesic therapy was performed as monotherapy, resulting in the disappearance of the symptoms. The need for elective surgery was postponed indefinitely, with full functional recovery of the knee. The success in this intervention is an example of non-invasive treatment with few contraindications. Further research is needed to obtain conclusive proof of the benefits of hydrokinesitherapy, but this could be an easy and novel way to treat this disease

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.

Updating Recommendations for Rehabilitation after ACL Reconstruction: a Review.

OBJECTIVE: To review recent evidence in order to update previous systematic reviews on methods of rehabilitation after anterior cruciate ligament (ACL) reconstruction. DATA SOURCES: PubMed, Embase, and the Cochrane Controlled Trials Register were searched for the period January 2006 to December 2010, using terms related to ACL, rehabilitation, and randomized controlled trial (RCT). The search was done in triplicate, and the results reconciled (85 studies identified). STUDY SELECTION: Relevant studies in English that were peer-reviewed RCTs or prospective comparative studies evaluating methods of ACL rehabilitation were included (n = 29). Evidence was evaluated by all 3 authors using the CONSORT criteria. DATA EXTRACTION: The data extracted included number of patients, ACL reconstruction method, randomization method, intervention, length of, and loss to, follow-up, outcomes assessed, bias, and findings. The review included evidence on postoperative bracing, accelerated rehabilitation, home-based rehabilitation, proprioceptive and neuromuscular training, and miscellaneous topics that were investigated by single trials. MAIN RESULTS: In 6 studies of postoperative bracing, no study found a clinically significant benefit of bracing or of restricted range of knee motion for pain control, knee laxity, or rehabilitation. Postoperative treatment without the use of a brace was not associated with less favorable outcomes. In 5 studies of accelerated strengthening, beginning eccentric quadriceps strengthening and isokinetic hamstring strengthening 2 weeks after ACL surgery improved or accelerated strength gains. Immediately postoperative weight-bearing, range of knee motion from 0° to 90° of flexion, and strengthening with closed-chain exercises were probably all safe. Home-based rehabilitation was evaluated in 2 studies. One study demonstrated that this intervention was at least as successful as a standard accelerated program over the long term. The other study included very low compliance expectations and other methodologic problems that precluded a useful assessment of benefit. Nine trials of neuromuscular strengthening (including perturbation, vibration, and/or balance training by various means) compared with strength, traditional rehabilitation, or placebo found some small short-term benefits to proprioceptive training and no harm from any of the treatments. Vibration training in addition to other strengthening may lead to faster proprioceptive recovery but the benefits to overall functional outcome are less clear. A study of vitamin C and E supplementation found a correlation between higher presurgery vitamin C levels and greater strength at 3 months, but this strength increase was not related to postsurgical vitamin C supplementation. Hyaluronic acid injection at 8 weeks improved ambulation and peak torque more than other doses or placebo, but poor outcomes in the control group raise questions about the quality of the standard rehabilitation program. Running interval training and continuous active motion had unclear effects. Using the uninjured leg for single-leg cycling prevented the usual loss of aerobic fitness in the postoperative period. Preoperative and postoperative video instruction decreased expectations of pain and increased self-efficacy although it made no difference to performance. CONCLUSIONS: The review of rehabilitation interventions after ACL reconstruction suggests that both accelerated and home-based rehabilitation, neuromuscular training programs, hyaluronic acid injection, and single (uninjured) leg cycling may be beneficial. Preoperative and postoperative informational videos may be valuable for psychological well-being. Insufficient evidence was found to recommend bracing.