Zn-regulated GTPase metalloprotein activator 1 modulates vertebrate zinc homeostasis.

Zinc (Zn) is an essential micronutrient and cofactor for up to 10% of proteins in living organisms. During Zn limitation, specialized enzymes called metallochaperones are predicted to allocate Zn to specific metalloproteins. This function has been putatively assigned to G3E GTPase COG0523 proteins, yet no Zn metallochaperone has been experimentally identified in any organism. Here, we functionally characterize a family of COG0523 proteins that is conserved across vertebrates. We identify Zn metalloprotease methionine aminopeptidase 1 (METAP1) as a COG0523 client, leading to the redesignation of this group of COG0523 proteins as the Zn-regulated GTPase metalloprotein activator (ZNG1) family. Using biochemical, structural, genetic, and pharmacological approaches across evolutionarily divergent models, including zebrafish and mice, we demonstrate a critical role for ZNG1 proteins in regulating cellular Zn homeostasis. Collectively, these data reveal the existence of a family of Zn metallochaperones and assign ZNG1 an important role for intracellular Zn trafficking.

Metal retention and replacement in QueD2 protect queuosine-tRNA biosynthesis in metal-starved Acinetobacter baumannii.

In response to bacterial infection, the vertebrate host employs the metal-sequestering protein calprotectin (CP) to withhold essential transition metals, notably Zn(II), to inhibit bacterial growth. Previous studies of the impact of CP-imposed transition-metal starvation in A. baumannii identified two enzymes in the de novo biosynthesis pathway of queuosine-transfer ribonucleic acid (Q-tRNA) that become cellularly abundant, one of which is QueD2, a 6-carboxy-5,6,7,8-tetrahydropterin (6-CPH4) synthase that catalyzes the initial, committed step of the pathway. Here, we show that CP strongly disrupts Q incorporation into tRNA. As such, we compare the AbQueD2 "low-zinc" paralog with a housekeeping, obligatory Zn(II)-dependent enzyme QueD. The crystallographic structure of Zn(II)-bound AbQueD2 reveals a distinct catalytic site coordination sphere and assembly state relative to QueD and possesses a dynamic loop, immediately adjacent to the catalytic site that coordinates a second Zn(II) in the structure. One of these loop-coordinating residues is an invariant Cys18, that protects QueD2 from dissociation of the catalytic Zn(II) while maintaining flux through the Q-tRNA biosynthesis pathway in cells. We propose a "metal retention" model where Cys18 introduces coordinative plasticity into the catalytic site which slows metal release, while also enhancing the metal promiscuity such that Fe(II) becomes an active cofactor. These studies reveal a complex, multipronged evolutionary adaptation to cellular Zn(II) limitation in a key Zn(II) metalloenzyme in an important human pathogen.

A second chance for protein targeting/folding: Ubiquitination and deubiquitination of nascent proteins.

Molecular chaperones in cells constantly monitor and bind to exposed hydrophobicity in newly synthesized proteins and assist them in folding or targeting to cellular membranes for insertion. However, proteins can be misfolded or mistargeted, which often causes hydrophobic amino acids to be exposed to the aqueous cytosol. Again, chaperones recognize exposed hydrophobicity in these proteins to prevent nonspecific interactions and aggregation, which are harmful to cells. The chaperone-bound misfolded proteins are then decorated with ubiquitin chains denoting them for proteasomal degradation. It remains enigmatic how molecular chaperones can mediate both maturation of nascent proteins and ubiquitination of misfolded proteins solely based on their exposed hydrophobic signals. In this review, we propose a dynamic ubiquitination and deubiquitination model in which ubiquitination of newly synthesized proteins serves as a "fix me" signal for either refolding of soluble proteins or retargeting of membrane proteins with the help of chaperones and deubiquitinases. Such a model would provide additional time for aberrant nascent proteins to fold or route for membrane insertion, thus avoiding excessive protein degradation and saving cellular energy spent on protein synthesis. Also see the video abstract here: https://youtu.be/gkElfmqaKG4.

Modeling the Early and Late Acceleration Phases of the Sprint Start in Elite Long Track Speed Skaters.

ABSTRACT: Zukowski, MH, Jordan, MJ, and Herzog, W. Modeling the early and late cceleration phases of the sprint start in elite long track speed skaters. J Strength Cond Res 38(2): 236-244, 2024-This study established the reliability of an exponential function to model the change in velocity during the speed skating sprint start and the validity of associated model parameters in a group of subelite and elite long track speed skaters. Long track speed skaters ( n = 38) performed maximal effort 50-m on-ice accelerations from a standing start while tethered to a horizontal robotic resistance device that sampled position and time data continuously. An exponential function was applied to the raw data to model the change in velocity throughout the acceleration phase and compute the maximal skating speed (MSS), maximal acceleration capacity (MAC), maximum relative net horizontal power ( PMax ), and an acceleration-time constant ( τ ). All constructed models provided a sufficient fit of the raw data ( R -squared > 0.95, mean bias <2%). Intraday reliability of all model parameters ranged from good to excellent (intraclass correlation coefficient >0.8 and coefficient of variation <5%). Strong negative correlations ( r : -0.72 to -0.96) were observed between MSS and PMax and the 10 and 20 m split times measured with the robotic resistance and with 100 split times obtained from 500 m races. Moderate-to-large between-group differences were observed in MSS, MAC, and PMax between the elite vs. subelite speed skaters (Cohen d effect sizes: 1.18-3.53). Our results indicate that monoexponential modeling is a valid and reliable method of monitoring initial acceleration performance in elite level long track speed skaters.

A Biopsychosocial Model for Understanding Training Load, Fatigue, and Musculoskeletal Sport Injury in University Athletes: A Scoping Review.

ABSTRACT: McClean, ZJ, Pasanen, K, Lun, V, Charest, J, Herzog, W, Werthner, P, Black, A, Vleuten, RV, Lacoste, E, and Jordan, MJ. A biopsychosocial model for understanding training load, fatigue, and musculoskeletal sport injury in university athletes: A scoping review. J Strength Cond Res 38(6): 1177-1188, 2024-The impact of musculoskeletal (MSK) injury on athlete health and performance has been studied extensively in youth sport and elite sport. Current research examining the relationship between training load, injury, and fatigue in university athletes is sparse. Furthermore, a range of contextual factors that influence the training load-fatigue-injury relationship exist, necessitating an integrative biopsychosocial model to address primary and secondary injury prevention research. The objectives of this review were (a) to review the scientific literature examining the relationship between training load, fatigue, and MSK injury in university athletes and (b) to use this review in conjunction with a transdisciplinary research team to identify biopsychosocial factors that influence MSK injury and develop an updated, holistic biopsychosocial model to inform injury prevention research and practice in university sport. Ten articles were identified for inclusion in this review. Key findings were an absence of injury surveillance methodology and contextual factors that can influence the training load-fatigue-MSK injury relationship. We highlight the inclusion of academic load, social load, and mental health load as key variables contributing to a multifactorial, gendered environmental, scientific inquiry on sport injury and reinjury in university sport. An integrative biopsychosocial model for MSK injury in university sport is presented that can be used to study the biological, psychological, and social factors that modulate injury and reinjury risk in university athletes. Finally, we provide an example of how causal inference can be used to maximize the utility of longitudinally collected observational data that is characteristic of sport performance research in university sport.

Differences in kinetic variables between injured and uninjured rearfoot runners: A hierarchical cluster analysis.

Running is a popular form of physical activity with a high incidence of running-related injuries. However, the etiology of running-related injuries remains elusive, possibly due to the heterogeneity of movement patterns. The purpose of this study was to investigate whether different clusters existed within a large group of injured and uninjured runners based on their kinetic gait patterns. A sample of 134 injured and uninjured runners were acquired from an existing database and 12 discrete kinetic and spatiotemporal variables which are commonly associated with running injuries were extracted from the ground reaction force waveforms. A principal components analysis followed by an unsupervised hierarchical cluster analysis was performed. The results revealed two distinct clusters of runners which were not associated with injury status (OR = 1.14 [0.57, 2.30], χ2  = 0.143, p = 0.706) or sex (OR = 1.72 [0.85, 3.49], χ2  = 2.3258, p = 0.127). These results suggest that while there appeared to be evidence for two distinct clusters within a large sample of injured and uninjured runners, there is no association between the kinetic variables and running related injuries.

Monitoring lower limb biomechanical asymmetry and psychological measures in athletic populations-A scoping review.

BACKGROUND: Lower limb biomechanics, including asymmetry, are frequently monitored to determine sport performance level and injury risk. However, contributing factors extend beyond biomechanical and asymmetry measures to include psychological, sociological, and environmental factors. Unfortunately, inadequate research has been conducted using holistic biopsychosocial models to characterize sport performance and injury risk. Therefore, this scoping review summarized the research landscape of studies concurrently assessing measures of lower limb biomechanics, asymmetry, and introspective psychological state (e.g., pain, fatigue, perceived exertion, stress, etc.) in healthy, competitive athletes. METHODS: A systematic search of MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science Core Collections was designed and conducted in accordance with PRISMA guidelines. Fifty-one articles were included in this review. RESULTS: Significant relationships between biomechanics (k = 22 studies) or asymmetry (k = 20 studies) and introspective state were found. Increased self-reported pain was associated with decreased range of motion, strength, and increased lower limb asymmetry. Higher ratings of perceived exertion were related to increased lower limb asymmetry, self-reported muscle soreness, and worse jump performance. Few studies (k = 4) monitored athletes longitudinally throughout one or more competitive season(s). CONCLUSION: This review highlights the need for concurrent analysis of introspective, psychological state, and biomechanical asymmetry measures along with longitudinal research to understand the contributing factors to sport performance and injury risk from biopsychosocial modeling. In doing so, this framework of biopsychosocial preventive and prognostic patient-centered practices may provide an actionable means of optimizing health, well-being, and sport performance in competitive athletes.

The Effect of Physical Exertional Testing on Postconcussion Symptom Scale Scores in Male and Female High School Students.

PURPOSE: Symptom scores commonly measured following concussion were compared between male and female adolescents with (Hx+) and without (Hx-) a history of concussion, pre and post physical exertion testing. METHODS: Eighty (males [n = 60; Hx+ = 19], female [n = 20; Hx+ = 5]) high school students (ages 15-17 y) completed the Buffalo Concussion Treadmill Test once and the modified shuttle run test twice. Symptom scores were collected using the 22-point Symptom Evaluation Scale on the Sport Concussion Assessment Tool (version 5) immediately pre and post physical exertion testing. RESULTS: The symptoms most reported during preexertional testing were fatigue/low energy, feeling slowed down, and nervous/anxious, whereas feeling slowed down, fatigue/low energy, "pressure in head" (males only), and headache (females only) were most frequently reported during postexertion testing. CONCLUSION: An understanding of the common exertion-related symptoms at baseline in a laboratory or field-based setting in adolescents may be advantageous for clinicians as they manage individual recovery postconcussion. This is particularly important during an adolescent's recovery and return to play when exertional testing may be implemented, especially since symptoms were reported pre and post exertional testing in both males and females regardless of concussion history.

Single Leg Lateral and Horizontal Loaded Jump Testing: Reliability and Correlation With Long Track Sprint Speed Skating Performance.

ABSTRACT: Zukowski, MH, Jordan, MJ, and Herzog, W. Single leg lateral and horizontal loaded jump testing: reliability and correlation with long track sprint speed skating performance. J Strength Cond Res 37(11): 2251-2259, 2023-This study examined the intraday reliability of 2 novel unilateral loaded jump protocols designed for long track speed skaters. Highly trained ( n = 26), national level athletes performed single leg jumps with a horizontal robotic resistance across 3 external load conditions (10 N, 7.5% of body mass and 15% of body mass) using their dominant limb. Jumps were performed in both the horizontal (Jump Horz ) and lateral (Jump Lat ) direction to replicate the body position and line of force application observed during the running and gliding phases of on-ice acceleration. Subjects completed 2 consecutive trials of the same jump protocol to examine the intraday reliability of the peak velocity achieved for each loading condition. Peak velocity across each jump type and loading condition had good reliability (intraclass correlation coefficient >0.8, coefficient of variation <5%). Significant positive relationships ( r = 0.5-0.8, p < 0.05; n = 22) were observed between all jump conditions and on-ice sprint race split times obtained including 100, 400, and 500 m. Our results indicate that unilateral loaded jump tests are reliable in speed skating athletes and may help practitioners diagnose and monitor lower-limb maximal muscle power capacity in a sport-specific manner.

Validity of Global Positioning System Technology to Measure Maximum Velocity Sprinting in Elite Sprinters.

ABSTRACT: Thome, M, Thorpe, RT, Jordan, MJ, and Nimphius, S. Validity of global positioning system (GPS) technology to measure maximum velocity sprinting in elite sprinters. J Strength Cond Res 37(12): 2438-2442, 2023-The objective of this study was to assess the concurrent validity of 10-Hz wearable Global Positioning System (GPS) technology to measure maximum velocity sprinting (Vmax) relative to Doppler radar in elite sprinters. Data were collected from a single training session performed by elite 100 and 200 m sprinters (males: n = 5; 100 m best times: 10.02 ± 0.07 seconds, range: 9.94-10.10 seconds; 200 m best times: 20.29 ± 0.42 seconds, range: 19.85-20.80 seconds; females: n = 2; age: 28.0 ± 4.2 years; body mass: 65.8 ± 4.6 kg; 100 m best times: 11.18 ± 0.34 seconds; 200 m best times: 22.53 ± 0.04 seconds). Velocity and time data from 16 maximal, 60-m sprint efforts were recorded simultaneously with 10 Hz GPS and 47 Hz radar. Validity was assessed using Bland-Altman 95% limits of agreement (LOA) and intraclass correlation coefficient (ICC), each with respective 95% confidence intervals (CI). Vmax measured with 10 Hz GPS demonstrated a LOA of -0.11 m·s-1 (-0.17, -0.05) and an ICC of 0.99 (0.98, 1.0) relative to the radar device.10 Hz GPS overestimated Vmax by 0.11 m·s-1 relative to the radar but could still be considered a suitable tool for monitoring external load in elite sprinters. However, the much smaller average annual improvement in this population (∼0.1-0.2%) in comparison with the ∼1% overestimation reduces the utility of 10 Hz GPS to detect meaningful performance changes in maximum velocity.

Mechanisms of Anterior Cruciate Ligament Tears in Professional National Basketball Association Players: A Video Analysis.

A systematic search was performed of online databases for any anterior cruciate ligament (ACL) injuries within the NBA. Video was obtained of injuries occurring during competition and downloaded for 2-dimensional video analysis. Thirty-five in-game videos were obtained for analysis. Of the reviewed cases, 19% were noncontact ACL injuries where there was no player-to-player contact from an opposing player. Three injury mechanism categories were found based on the events at the point of initial ground contact of the foot of the injured limb: single-leg casting (mean dorsiflexion angle 18.9° (14.4°); mean knee flexion angle 15.6° (7.8°); and mean trunk lateral flexion 18.2° (8.4°)); bilateral hop (mean dorsiflexion angle 18.2° (15.2°), mean knee flexion angle 21° (14.5°), mean trunk extension angle 6.9° (11.4°), and landing angle from the athlete's center of mass 47.9° (10.1°)); and single-leg landing after contact (mean abduction angle of the swing leg 105.4° (18.1°), mean knee flexion angle of the injured limb 34.2° (8.0°), and mean trunk ipsilateral flexion angle 22.2° (7.0°)).

Higher Anti-tumor Necrosis Factor-α Levels Correlate With Improved Radiologic Outcomes in Crohn's Perianal Fistulas.

BACKGROUND & AIMS: Higher anti-tumor necrosis factor-α (TNF) drug levels are associated with improved clinical healing of Crohn's perianal fistulas. It is unclear whether this leads to improved healing on radiologic assessment. We aimed to evaluate the association between anti-TNF drug levels and radiologic outcomes in perianal fistulising Crohn's disease. METHODS: A cross-sectional retrospective multicenter study was undertaken. Patients with perianal fistulising Crohn's disease on maintenance infliximab or adalimumab, with drug levels within 6 months of perianal magnetic resonance imaging were included. Patients receiving dose changes or fistula surgery between drug level and imaging were excluded. Radiologic disease activity was scored using the Van Assche Index, with an inflammatory subscore calculated using indices: T2-weighted imaging hyperintensity, collections >3 mm diameter, rectal wall involvement. Primary endpoint was radiologic healing (inflammatory subscore ≤6). Secondary endpoint was radiologic remission (inflammatory subscore = 0). RESULTS: Of 193 patients (infliximab, n = 117; adalimumab, n = 76), patients with radiologic healing had higher median drug levels compared with those with active disease (infliximab 6.0 vs 3.9 µg/mL; adalimumab 9.1 vs 6.2 µg/mL; both P < .05). Patients with radiologic remission also had higher median drug levels compared with those with active disease (infliximab 7.4 vs 3.9 µg/mL; P < .05; adalimumab 9.8 vs 6.2 µg/mL; P = .07). There was a significant incremental reduction in median inflammatory subscores with higher anti-TNF drug level tertiles. CONCLUSIONS: Higher anti-TNF drug levels were associated with improved radiologic outcomes on magnetic resonance imaging in perianal fistulising Crohn's disease, with an incremental improvement at higher drug level tertiles for both infliximab and adalimumab.

Selective and Chemical-Free Removal of Toxic Heavy Metal Cations from Water Using Shock Ion Extraction.

Electrochemical methods are known to have attractive features and capabilities when used for ion separations and water purification. In this study, we developed a new process called shock ion extraction (shock IX) for selective and chemical-free removal of toxic heavy metals from water. Shock IX is a hybrid process that combines shock electrodialysis (shock ED) and ion exchange using an ion exchange resin wafer (IERW), and this method can be thought of functionally as an electrochemically assisted variation of traditional ion exchange. In particular, shock IX exhibits greater ion removal and selectivity for longer periods of time, compared to the use of ion exchange alone. The use of an IERW in shock ED also increases multivalent ion selectivity, reduces energy consumption, and improves the hydrodynamics and scalability of the system.

Effects of lead leg selection on bilateral landing force-time characteristics: Return to sport testing implications.

We quantified the effect of lead leg selection on landing force-time characteristics during a vertical drop landing (VDL) initiated with a step-off. Plyometric-trained subjects (male: n = 8; female: n = 5; age =23 ± 3.3 years; body mass =74.4 ± 11.2 kg) performed 6 step-off-initiated VDLs from a 45-cm box (n = 3/lead leg). Pooled and lead leg stratified between-limb comparisons of limb-specific initial ground contact timing, peak vertical ground reaction force (Fzpeak ), and early landing-phase impulse (Impulse100ms ) were assessed by a two-factor, within-subject ANOVA, and limb symmetry indexes were calculated (α = 0.05). Pooled data showed that the lead leg made contact prior to the trail leg and contributed a greater fraction to Fzpeak compared with the trail leg. Stratifying trials by lead leg selection led to significant between-limb differences in Fzpeak (p < 0.05) and Impulse100ms (p < 0.01) with the right leg leading but not with the left leg leading. Lead leg selection in step-off-initiated VDLs influenced landing performance and limb symmetry indexes of variables associated with lower limb injury risk, suggesting the need to control for lead leg selection in these tasks. A step-off may not be a suitable technique to initiate landing tasks when assessing limb symmetry.

Focused Ion Beam Preparation of Low Melting Point Metals: Lessons Learned From Indium.

Indium (In) and other low melting point metals are used as interconnects in a variety of hybridized circuits and a full understanding of the metallurgy of these interconnects is important to the reliability and performance of the devices. This paper shows that room temperature focused ion beam (FIB) preparation of cross-sections, using Ga+ or Xe+ can result in artifacts that obscure the true In microbump structure. The use of modified milling strategies to minimize the increased local sample temperature are shown to produce cross-sections that are representative of the In bump microstructure in some sample configurations. Furthermore, cooling of the sample to cryogenic temperatures is shown to reliably eliminate artifacts in FIB prepared cross-sections of In bumps allowing the true bump microstructure to be observed.

Collagen and Vitamin C Supplementation Increases Lower Limb Rate of Force Development.

BACKGROUND: Exercise and vitamin C-enriched collagen supplementation increase collagen synthesis, potentially increasing matrix density, stiffness, and force transfer. PURPOSE: To determine whether vitamin C-enriched collagen (hydrolyzed collagen [HC] + C) supplementation improves rate of force development (RFD) alongside a strength training program. METHODS: Using a double-blinded parallel design, over 3 weeks, healthy male athletes (n = 50, 18-25 years) were randomly assigned to the intervention (HC + C; 20 g HC + 50 mg vitamin C) or placebo (20 g maltodextrin). Supplements were ingested daily 60 min prior to training. Athletes completed the same targeted maximal muscle power training program. Maximal isometric squats, countermovement jumps, and squat jumps were performed on a force plate at the same time each testing day (baseline, Tests 1, 2, and 3) to measure RFD and maximal force development. Mixed-model analysis of variance compared performance variables across the study timeline, whereas t tests were used to compare the change between baseline and Test 3. RESULTS: Over 3 weeks, maximal RFD in the HC + C group returned to baseline, whereas the placebo group remained depressed (p = .18). While both groups showed a decrease in RFD through Test 2, only the treatment group recovered RFD to baseline by Test 3 (p = .036). In the HC + C group, change in countermovement jumps eccentric deceleration impulse (p = .008) and eccentric deceleration RFD (p = .04) was improved. A strong trend was observed for lower limb stiffness assessed in the countermovement jumps (p = .08). No difference was observed in maximal force or squat jump parameters. CONCLUSION: The HC + C supplementation improved RFD in the squat and countermovement jump alongside training.

Mechanisms of Achilles Tendon Rupture in National Basketball Association Players.

A systematic search was performed of online databases for any Achilles tendon (AT) injuries occurring within the National Basketball Association (NBA). Video was obtained of injuries occurring during competition and downloaded for analysis in Dartfish. NBA athletes (n = 27) were identified with AT rupture over a 30-year period (1991-2021). Of the 27 NBA athletes found to have AT ruptures (mean age: 29.3 [3.3] y; average time in the NBA: 8.5 [3.8] y), 15 in-game videos were obtained for analysis. Noncontact rupture was presumed to have occurred in 12/13 cases. Eight of the 13 athletes had possession of the ball during time of injury. The ankle joint of the injured limb for all 13 athletes was in a dorsiflexed position during the time of injury (47.9° [6.5°]). All 13 athletes performed a false-step mechanism at time of injury where they initiated the movement by taking a rearward step posterior to their center of mass with the injured limb before translating forward. NBA basketball players that suffered AT ruptures appeared to present with a distinct sequence of events, including initiating a false step with ankle dorsiflexion of the injured limb at the time of injury.

Electromechanical delay of the hamstrings following semitendinosus tendon autografts in return to competition athletes.

PURPOSE: Knee flexor electromechanical delay (EMD) has been proposed as a contributing factor to non-contact anterior cruciate ligament (ACL) injury risk and the semitendinosus (ST) autograft technique has been shown to impair knee flexor torque at large angles of knee flexion. The purpose of this study was to analyse the effects of ACL reconstruction (ACLR) using the ST tendon autograft technique on knee flexor EMD across the knee flexion range of motion, in athletes who had returned to competition. METHODS: Athletes with ACLR (n = 8 females, n = 3 males, 1.7 ± 0.5 years post-surgery) and non-injured control athletes (n = 6 females, n = 4 males) performed rapid maximal voluntary contractions of isometric knee flexion and extension at 30°, 50°, 70°, 90°,and 105° of knee flexion. Electrical activity of the ST, biceps femoris (BF), vastus lateralis, and vastus medialis was recorded using surface electromyography. RESULTS: No change in EMD for the knee flexors or extensors was observed across joint angles. Greater EMD was found only for the BF in the ACLR limb of injured athletes compared to the contralateral limb (P < 0.05). In post-hoc analysis, evidence of ST tendon regrowth was noted for only 2/11 athletes. CONCLUSION: While the EMD-joint angle relationship appeared to be unaffected by ST tendon harvest for ACLR, the absence of ST tendon regrowth should be considered. Despite return to competition, greater BF EMD was found, which may impair knee joint stabilization capacity by delaying the transfer time of muscle tension to the tibia after ST autograft.

Contractile rate of force development after anterior cruciate ligament reconstruction-a comprehensive review and meta-analysis.

STUDY DESIGN: Comprehensive review and meta-analysis. BACKGROUND: The recovery in rapid force production measured as the rate of force development (RFD) is not clear after anterior cruciate ligament reconstruction (ACLR). OBJECTIVES: To evaluate (a) time-course change of between-limb asymmetries in isometric knee extension/flexion RFD in individuals post-ACLR and (b) differences in RFD between individuals post-ACLR and healthy controls. METHODS: A literature search of Web of Science, SPORTDiscus, PubMed-MEDLINE, and ScienceDirect identified 10 eligible studies (n = 246) assessing RFD after ACLR. RESULTS: Standard mean difference (SMD) for early-phase (<100 ms) knee extensor RFD was -1.07 (95% CI: -1.46, -0.68) when comparing ACLR vs uninjured limb, while SMD for late-phase (≥100 ms) RFD was -0.85 (95 CI%: -1.27, -0.42). SMD for early- and late-phase knee flexor RFD was -0.74 (95% CI: -1.19, -0.29) and -0.79 (95% CI: -1.19, -0.39), respectively. Comparing ACLR limbs to uninjured controls, knee extensor SMD for early- and late-phase RFD was -1.42 (95% CI: -2.10, -0.73) and 1.09 (95% CI: -1.81, -0.38). For the knee flexors, SMD for early- and late-phase RFD was -0.78 (95% CI: -1.96, -0.39) and -1.14 (95% CI: -1.60, -0.67). CONCLUSIONS: Anterior cruciate ligament reconstruction limbs demonstrated sustained post-surgical suppression in RFD capacity for the knee extensors/flexors compared to the contralateral limb as well as to healthy controls. Monitoring of RFD should be considered throughout rehabilitation and return to sport (RTS) after ACLR to assess the effectiveness of post-operative rehabilitation. Post-surgical ACLR rehabilitation should include training interventions to enhance RFD.

Reliability of the Dorsal Tangential View in Assessment of Distal Radioulnar Joint Reduction in the Neutral, Pronated, and Supinated Positions in a Cadaver Model.

PURPOSE: Intraoperative assessment of distal radioulnar joint (DRUJ) alignment is often based on lateral radiographs whose interpretation is dependent upon positioning the forearm in neutral rotation. The dorsal tangential view (DTV) is a near-axial view of the dorsal wrist used in assessing dorsal screw penetration during radius fixation. The purpose of this study was to determine whether the DTV can also reliably assess DRUJ alignment in multiple forearm positions. METHODS: Four transhumeral cadaveric specimens were used to simulate an unstable DRUJ. The stabilizing soft tissue structures of the DRUJ were sectioned. Fluoroscopic DTV images were obtained with the DRUJ of each specimen held in 5 positions: dorsally dislocated, dorsally subluxated, reduced, volarly subluxated, and volarly dislocated. In each position, images were taken with the forearm in neutral rotation, full pronation, and full supination. Three observers independently assessed DRUJ position on DTV images. Intra- and interobserver reliability were assessed in each forearm position. RESULTS: Observers correctly identified DRUJ position as reduced, volarly malreduced, or dorsally malreduced on 94% of the DTV images (97%, 95%, and 92% in the neutral, supinated, and pronated forearm positions, respectively). Weighted kappa values for intraobserver reliability were 0.965, 0.964, and 0.965 for the 3 observers. The mean kappas for intraobserver reliability were 1.000, 0.967, and 0.930 with the forearm in neutral, supinated, and pronated positions, respectively. Weighted kappa values for interobserver reliability between paired observers were 0.948, 0.912, and 0.929. The mean kappa for interobserver reliability was 0.926, 0.931, and 0.930 for the forearm in neutral, supinated, and pronated positions, respectively. CONCLUSIONS: The DTV reliably demonstrated the position of the DRUJ independent of forearm rotation in a cadaveric model. CLINICAL RELEVANCE: Surgeons may consider the DTV as another tool for fluoroscopic verification of the DRUJ reduction in the operating room or clinic.