Changes in peak fat oxidation in response to different doses of endurance training.

The effect of different doses of endurance training on the capacity to oxidize fat during exercise in sedentary, overweight men and assessment of variables associated with changes in peak fat oxidation (PFO) were evaluated. Young, sedentary, overweight men were randomized to either the high-dose (HIGH, 600 kcal/day, n = 17) or moderate-dose (MOD, 300 kcal/day, n = 18) endurance training groups or controls (CON, n = 15). PFO and peak oxygen uptake (VO2 peak) were measured using indirect calorimetry, body composition using dual-energy x-ray absorptiometry, and protein levels of mitochondrial enzymes determined by Western blotting. PFO increased in both MOD [1.2 mg/kg fat-free mass (FFM)/min, 95% confidence interval (CI): 0.08:2.3, P = 0.03] and HIGH (1.8 mg/kg FFM/min, CI: 0.6:2.9, P < 0.001) compared with CON. Skeletal muscle expression of citrate synthase, ß-hydroxyacyl-CoA dehydrogenase, and mitochondrial oxphos complexes II-V increased similarly in MOD and HIGH. Stepwise multiple linear regression analysis with backward elimination of individual variables correlated with changes in PFO revealed increases in cycling efficiency, FFM, and VO2 peak as the remaining associated variables. In conclusion, PFO during exercise increased with both moderate- and high-dose endurance training. Increases in PFO were mainly predicted by changes in VO2 peak, FFM, and cycling efficiency, and less with skeletal muscle mitochondrial enzymes.

Exercise training favors increased insulin-stimulated glucose uptake in skeletal muscle in contrast to adipose tissue: a randomized study using FDG PET imaging.

Physical exercise increases peripheral insulin sensitivity, but regional differences are poorly elucidated in humans. We investigated the effect of aerobic exercise training on insulin-stimulated glucose uptake in five individual femoral muscle groups and four different adipose tissue regions, using dynamic (femoral region) and static (abdominal region) 2-deoxy-2-[¹8F]fluoro-d-glucose (FDG) PET/CT methodology during steady-state insulin infusion (40 mU·m⁻²·min⁻¹). Body composition was measured by dual X-ray absorptiometry and MRI. Sixty-one healthy, sedentary [V(O2max) 36(5) ml·kg⁻¹·min⁻¹; mean(SD)], moderately overweight [BMI 28.1(1.8) kg/m²], young [age: 30(6) yr] men were randomized to sedentary living (CON; n = 17 completers) or moderate (MOD; 300 kcal/day, n = 18) or high (HIGH; 600 kcal/day, n = 18) dose physical exercise for 11 wk. At baseline, insulin-stimulated glucose uptake was highest in femoral skeletal muscle followed by intraperitoneal visceral adipose tissue (VAT), retroperitoneal VAT, abdominal (anterior + posterior) subcutaneous adipose tissue (SAT), and femoral SAT (P < 0.0001 between tissues). Metabolic rate of glucose increased similarly (~30%) in the two exercise groups in femoral skeletal muscle (MOD 24[9, 39] µmol·kg⁻¹·min⁻¹, P = 0.004; HIGH 22[9, 35] µmol·kg⁻¹·min⁻¹, P = 0.003) (mean[95% CI]) and in five individual femoral muscle groups but not in femoral SAT. Standardized uptake value of FDG decreased ~24% in anterior abdominal SAT and ~20% in posterior abdominal SAT compared with CON but not in either intra- or retroperitoneal VAT. Total adipose tissue mass decreased in both exercise groups, and the decrease was distributed equally among subcutaneous and intra-abdominal depots. In conclusion, aerobic exercise training increases insulin-stimulated glucose uptake in skeletal muscle but not in adipose tissue, which demonstrates some interregional differences.

Comparison of score evaluations and instrumented measurement after anterior cruciate ligament reconstruction.

Forty-four patients who had undergone unilateral anterior cruciate ligament reconstructions were evaluated retrospectively with seven different scoring systems (International Knee Documentation Committee, Orthopadische Arbeitsgruppe Knie, Lysholm, Feagin and Blake, Zarins and Rowe, Cincinnati, and Marshall scores). The results varied between systems and therefore lacked reliability. Of the 44 patients, 32 were rated as excellent according to the Cincinnati score while only 3 patients were rated as normal according to the International Knee Documentation Committee form. Good and excellent results were found twice as frequently with the Cincinnati and Lysholm scores compared with the scores of Zarins and Rowe or the International Knee Documentation Committee form. Statistical analysis confirmed this observation and revealed significant differences between the scoring systems. Side-to-side differences using the manual maximum displacement test with the KT-1000 arthrometer revealed good correlation with the International Knee Documentation Committee and the Orthopadische Arbeitsgruppe Knie questionnaires. None of the other scoring systems, which do not measure anterior laxity, produced reasonable correlation with instrumented measurements. We found that certain population-specific factors as well as the distribution of single findings can distort the results of scoring systems. To avoid these interference factors, the patient sample should be homogeneous and selected prospectively and there should be agreement about the value of single findings.

Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage.

We evaluated the outcome of partial lateral meniscectomy of 31 knees in 29 patients whose knees were otherwise normal. The mean follow-up was 10.3 years. According to the Lysholm score, 14 knees were rated as excellent, four as good, five as fair and eight as poor, with a mean score of 80.5 points. Radiologically, only one lateral compartment was classified as grade 0, eight as grade 1, nine as grade 2, 11 as grade 3, and two as grade 4 according to Tapper and Hoover. No significant (p < 0.05) correlation was found between the amount of tissue resected and the subjective, clinical and radiological outcome. Although early results of lateral meniscectomy may be satisfactory, we have demonstrated that in the long term there was a high incidence of degenerative changes, a high rate of reoperation (29%) and a relatively low functional outcome score.

Only minor additional metabolic health benefits of high as opposed to moderate dose physical exercise in young, moderately overweight men.

OBJECTIVE: The dose-response effects of exercise training on insulin sensitivity, metabolic risk, and quality of life were examined. METHODS: Sixty-one healthy, sedentary (VO2max: 35 ± 5 ml/kg/min), moderately overweight (BMI: 27.9 ± 1.8), young (age: 29 ± 6 years) men were randomized to sedentary living (sedentary control group; n = 18), moderate (moderate dose training group [MOD]: 300 kcal/day, n = 21), or high (high dose training group [HIGH]: 600 kcal/day, n = 22) dose physical exercise for 11 weeks. RESULTS: The return rate for post-intervention testing was 82-94% across groups. Weekly exercise amounted to 2,004 ± 24 and 3,774 ± 68 kcal, respectively, in MOD and HIGH. Cardiorespiratory fitness increased (P < 0.001) 18 ± 3% in MOD and 17 ± 3% in HIGH, and fat percentage decreased (P < 0.001) similarly in both exercise groups (MOD: 32 ± 1 to 29 ± 1%; HIGH: 30 ± 1 to 27 ± 1%). Peripheral insulin sensitivity increased (P < 0.01) (MOD: 28 ± 7%; HIGH: 36 ± 8%) and the homeostasis model assessment of insulin resistance decreased (P < 0.05) (MOD: -17 ± 7%; HIGH: -18 ± 10%). The number of subjects meeting the criteria of the metabolic syndrome decreased by 78% in MOD (P < 0.01) and by 80% in HIGH (P < 0.05). General health assessed by questionnaire increased similarly in MOD (P < 0.05) and HIGH (P < 0.01). CONCLUSIONS: Only minor additional health benefits were found when exercising ∼3,800 as opposed to ∼2,000 kcal/week in young moderately overweight men. This finding may have important public health implications.

[Comparison and outcome of grade II and III acromioclavicular joint injuries]. / Vergleich und Ergebnis von Schultereckgelenkverletzungen II. und III. Grades.

Eighty-five patients with grade 2 or grade 3 sprains of the acromioclavicular (AC) joint were evaluated clinically and radiographically 32 months after injury. Group I included 34 patients with grade 2 sprains (Tossy II) and group II included 51 patients with grade 3 injuries (Tossy III). In group I, 15 patients were treated surgically (group Ia) and 19 patients were treated conservatively (group Ib), while in group II, 41 patients were treated surgically (group IIa) and 10 patients were treated conservatively (group IIb). At surgery open reduction and transarticular fixation of the AC joint with Kirschner wires was performed. Conservative treatment included the initial use of a sling or a knapsack bandage and early performance of range-of-motion exercises. Shoulder function was assessed according to the score devised by Constant and Murley. In both groups, 97 of 100 possible points (minimum 72, maximum 100) were obtained after conservative and after surgical treatment. Nine of 10 patients (90%) with grade 3 sprains (group IIb) had more pronounced displacement and increased mobility of the lateral end of the clavicle after conservative treatment. After surgery, dislocation and increased horizontal, mobility of the lateral end of the clavicle occurred in 18 (44%) of 41 patients with grade 3 sprains (group IIa P < 0.0001). However, these findings did not correlate with the functional outcome. At follow-up there was a significant increase in degenerative changes seen on radiographs (P < 0.035) in all patients. Again these findings did not correlate with the functional outcome. More degenerative radiological changes were observed in patients who had undergone surgery (P < 0.003). Patients with grade 2 sprains were more frequently restricted in sporting activity after surgery (P < 0.05). Patients with grade 3 sprains who were treated surgically complained of pain more frequently (P < 0.01), and they returned to work later than patients who were treated conservatively after grade 3 sprains. An additional rehabilitation program guided by a physiotherapist seemed to have no impact on the functional outcome. A total of 56 patients were treated by surgery. Among these patients 11 complications occurred, requiring five additional surgical procedures. Among 29 conservatively treated patients, only in 1 patient did subacromially located arthritic changes of the AC joint have to be removed.

[Capacity to participate in sports after injuries of the acromioclavicular joint]. / Sportfähigkeit nach Verletzungen des Schultereckgelenks.

In 79 patients athletic activities were evaluated retrospectively 32 months after grade II and grade III sprains of the acromioclavicular joint. Group I consisted of 29 patients with grade II sprains according to Tossy and group II consisted of 50 patients with grade III sprains according to Tossy. In group Ia 14 patients underwent surgery, and in group Ib 15 patients were treated nonsurgically. In group IIa 41 patients were treated surgically, and in group IIb 9 patients were treated conservatively. Forty-seven patients were injured during participation in sports. Among these 16 were injured during participation in their specific sport. In group I patients had to curtail sports activities more frequently after surgery than after conservative treatment (p < 0.05). In group II the reduction of sports activities was not different for the two treatment groups. Of a total of 79 patients, 23 had to reduce their sports activities. Among these, 7 patients had to give up sports. All patients had performed overhead athletic activities. Climbers and patients performing strength training had to reduce their activities or give up sports. Additionally, sprains of the acromi-oclavicular joint adversely affected athletic activities in overhead ball sports, bicycling, and skiing irrespective of treatment.

[Preoperative computerized tomography diagnosis of fractures of the tibial plateau]. / Die präoperative computertomographische Abklärung bei Tibiakopffrakturen.

Within the last decade computed tomography has become an important instrument for skeletal diagnosis. In this study the value of helical CT-scan was compared with plan X-rays and conventional tomography in 45 patients having sustained an intraarticular tibia plateau fracture. Between plan roentgenogramms and CT-scan the fracture classification according to the AO-classification was changed in 40% of all patients, in 39 cases the amount of impression or dislocation increased with a mean of 4.2 mm. Especially tiny fragments were better visible and therefore responsible for the shift of many B1 fractures to group B3. The difference between conventional tomography and computed tomography was less impressive, a change of fracture classification could be observed in only 6.7% of all cases.

[Computer-assisted drilling of the lower extremity. Technique and indications]. / Computerassistierte Zielbohrungen an der unteren Extremität. Technik und Indikationen.

Computer assisted navigation-based surgery is a novel and interesting challenge for todays surgeons. One must however keep in mind, that the indications for these techniques (a) should be carefully considered, (b) used only if morbidity is not increased and (c) when previously problematic or inacurate surgical methods can be improved upon. This study reports that, using a non-invasive fixation method (FISCOFIX-Cast), lesions between the ankle- and knee-joints can be precisely localized, registered and treated. Due to the difficult access to lesions especially in the posterior areas of the talus, using conventional arthroscopic methods this procedure is very useful. Percutaneous retrograde drilling (cf. [6, 7, 9, 15, 20, 21]) spared the joint's cartilage in all cases. At the level of the knee joint we see the usefulness of this method for complex situations (cf. [12, 13]) requiring precise drilling.