Comparative biomechanical study of different screw fixation methods for minimally invasive hallux valgus surgery: A finite element analysis.

BACKGROUND: There are different screw configurations utilised for minimally invasive hallux valgus (HV) deformity despite limited biomechanical data assessing the stability and strength of each construct. We aimed to compare the strength of various screw configurations for minimally invasive HV surgery using finite element analysis (FEA). METHODS: A FEA model was developed from a CT of a female with moderate HV deformity. Five screw configurations utilizing one or two bicortical or intramedullary screws were tested. Stress analysis considered osteotomy displacement, maximum and minimum principal stresses, and von Mises stress for both implants and bone for each screw configuration. RESULTS: Fixation with two screws (one bicortical and one intramedullary) demonstrated the lowest values for osteotomy displacement, minimum and maximum total stress, and equivalent von Mises stress on the bone and screws in both loading conditions. CONCLUSION: The optimal configuration when performing minimally invasive surgery for moderate HV is one bicortical and one intramedullary screw. LEVEL OF EVIDENCE: Level III.

Corneal biomechanical properties and potential influencing factors in varying degrees of myopia.

To compare the corneal biomechanical parameters measured by Corvis ST in subjects with varying degrees of myopia. And the factors that may affect corneal biomechanical properties were also investigated. Participants in this prospective cross-sectional study were classified into three groups according to spherical equivalent (SE) and axial length (AL): Non-myopia (NM, SE > - 0.50 D and AL < 26 mm), Mild-to-moderate myopia (MM, - 6.00 D < SE ≤ - 0.50 D and AL < 26 mm), high myopia (HM, SE ≤ - 6.00 D or AL ≥ 26 mm). Ten corneal biomechanical parameters were finally included. Linear mixed-effects model accounting for using both eyes in the same participant was carried out to evaluate how the corneal biomechanical parameter was influenced by varying degrees of myopia after adjusting for biomechanically corrected intraocular pressure (bIOP) and central corneal thickness (CCT). Further, multiple linear regression was performed to explore the correlation between corneal biomechanical parameter and SE, AL, bIOP or CCT. A total of 304 eyes from 224 healthy myopic subjects were recorded. There were 95 eyes with NM, 122 eyes with MM, and 87 eyes with HM. After adjusting for bIOP and CCT, eyes with high myopia showed shorter highest concavity time (HC-time, p = 0.025), greater peak distance (PD, p = 0.001), greater deflection amplitude (DA-Max, p = 0.002), smaller whole eye movement (WEM-Max, p < 0.001) and reduced stiffness parameter (SP-A1, p < 0.001). Multiple regression analysis showed that five parameters (HC-time, p < 0.001; PD, p < 0.001; DA-Max, p = 0.001; WEM-Max, p < 0.001; and SP-A1, p < 0.001) of Corvis ST were significantly correlated with AL, and one parameter (Corvis biomechanical index, p = 0.016) has significant relationship with SE. With the increase of myopia, significant changes in several corneal biomechanical parameters indicated a progressive decrease in corneal stiffness, independent of bIOP and CCT. Corneal biomechanical parameters may be predictors of scleral mechanical strength in high myopia, which has certain application value in clinical management of myopia.

Effects of ankle joint degree of freedom of knee-ankle-foot orthoses on loading patterns and triceps surae muscle activity on the paretic side in individuals with subacute severe hemiplegia: a retrospective study.

BACKGROUND: Individuals with subacute severe hemiplegia often undergo alternate gait training to overcome challenges in achieving walking independence. However, the ankle joint setting in a knee-ankle-foot orthosis (KAFO) depends on trunk function or paralysis stage for alternate gait training with a KAFO. The optimal degree of ankle joint freedom in a KAFO and the specific ankle joint conditions for effective rehabilitation remain unclear. Therefore, this study aimed to investigate the effects of different degrees of freedom of the ankle joint on center-of-pressure (CoP) parameters and muscle activity on the paretic side using a KAFO and to investigate the recommended setting of ankle joint angle in a KAFO depending on physical function. METHODS: This study included 14 participants with subacute stroke (67.4 ± 13.3 years). The CoP parameters and muscle activity of the gastrocnemius lateralis (GCL) and soleus muscles were compared using a linear mixed model (LMM) under two ankle joint conditions in the KAFO: fixed at 0° and free ankle dorsiflexion. We confirmed the relationship between changes in CoP parameters or muscle activity under different conditions and physical functional characteristics such as the Fugl-Meyer Assessment of Lower Extremity Synergy Score (FMAs) and Trunk Impairment Scale (TIS) using LMM. RESULTS: Anterior-posterior displacement of CoP (AP_CoP) (p = 0.011) and muscle activity of the GCL (p = 0.043) increased in the free condition of ankle dorsiflexion compared with that in the fixed condition. The FMAs (p = 0.004) and TIS (p = 0.008) demonstrated a positive relationship with AP_CoP. A positive relationship was also found between TIS and the percentage of medial forefoot loading time in the CoP (p < 0.001). CONCLUSIONS: For individuals with severe subacute hemiplegia, the ankle dorsiflexion induction in the KAFO, which did not impede the forward tilt of the shank, promotes anterior movement in the CoP and muscle activity of the GCL. This study suggests that adjusting the dorsiflexion mobility of the ankle joint in the KAFO according to improvement in physical function promotes loading of the CoP to the medial forefoot.

Effects of attentional focus strategies in drop landing biomechanics of individuals with unilateral functional ankle instability.

Background: Functional Ankle Instability (FAI) is a pervasive condition that can emerge following inadequate management of lateral ankle sprains. It is hallmarked by chronic joint instability and a subsequent deterioration in physical performance. The modulation of motor patterns through attentional focus is a well-established concept in the realm of motor learning and performance optimization. However, the precise manner in which attentional focus can rehabilitate or refine movement patterns in individuals with FAI remains to be fully elucidated. Objective: The primary aim of this study was to evaluate the impact of attentional focus strategies on the biomechanics of single-leg drop landing movements among individuals with FAI. Methods: Eighteen males with unilateral FAI were recruited. Kinematic and kinetic data were collected using an infrared three-dimensional motion capture system and force plates. Participants performed single-leg drop landing tasks under no focus (baseline), internal focus (IF), and external focus (EF) conditions. Biomechanical characteristics, including joint angles, ground reaction forces, and leg stiffness, were assessed. A 2 × 3 [side (unstable and stable) × focus (baseline, IF, and EF)] Repeated Measures Analysis of Variance (RM-ANOVA) analyzed the effects of attentional focus on biomechanical variables in individuals with FAI. Results: No significant interaction effects were observed in this study. At peak vertical ground reaction force (vGRF), the knee flexion angle was significantly influenced by attentional focus, with a markedly greater angle under EF compared to IF (p < 0.001). Additionally, at peak vGRF, the ankle joint plantarflexion angle was significantly smaller with EF than with IF (p < 0.001). Significant main effects of focus were found for peak vGRF and the time to reach peak vGRF, with higher peak vGRF values observed under baseline and IF conditions compared to EF (p < 0.001). Participants reached peak vGRF more quickly under IF (p < 0.001). Leg Stiffness (kleg) was significantly higher under IF compared to EF (p = 0.001). Conclusion: IF enhances joint stability in FAI, whereas EF promotes a conservative landing strategy with increased knee flexion, dispersing impact and minimizing joint stress. Integrating these strategies into FAI rehabilitation programs can optimize lower limb biomechanics and reduce the risk of reinjury.

Non-conventional endpoints show higher sulfoxaflor toxicity to Chironomus riparius than conventional endpoints in a multistress environment.

Evidence grows that standard toxicity testing might underestimate the environmental risk of neurotoxic insecticides. Behavioural endpoints such as locomotion and mobility have been suggested as sensitive and ecologically relevant additions to the standard tested endpoints. Possible interactive effects of chemicals and additional stressors are typically overlooked in standardised testing. Therefore, we aimed to investigate how concurrent exposure to environmental stressors (increased temperature and predation cues) and a nicotinic acetylcholine receptor (nAChR)-modulating insecticide ('sulfoxaflor') impact Chironomus riparius across a range of conventional and non-conventional endpoints. We used a multifactorial experimental design encompassing three stressors, sulfoxaflor (2.0-110 µg/L), predation risk (presence/absence of predatory cues), and elevated temperature (20 °C and 23 °C), yielding a total of 24 distinct treatment conditions. Additional stressors did not change the sensitivity of C. riparius to sulfoxaflor. To assess potential additive effects, we applied an Independent Action (IA) model to predict the impact on eight endpoints, including conventional endpoints (growth, survival, total emergence, and emergence time) and less conventional endpoints (the size of the adults, swimming abilities and exploration behaviour). For the conventional endpoints, observed effects were either lower than expected or well-predicted by the IA model. In contrast, we found greater than predicted effects of predation cues and temperature in combination with sulfoxaflor on adult size, larval exploration, and swimming behaviour. However, in contrast to the non-conventional endpoints, no conventional endpoints detected interactive effects of the neurotoxic insecticide and the environmental stressors. Acknowledging these interactions, increasing ecological context of ecotoxicological test systems may, therefore, advance environmental risk analysis and interpretation as the safe environmental concentrations of neurotoxic insecticides depend on the context of both the test organism and its environment.

Evaluation of grafts fixation techniques for temporomandibular joint reconstruction with medial femoral condyle flap: A numerical study.

Reconstruction for large-scale temporomandibular joint (TMJ) defects can be challenging. Previously, we utilized the medial femoral condyle (MFC) flap for TMJ reconstruction. However, the optimal fixation method remains uncertain. In this study, finite element analysis was used to study the effects of three different fixation types of bone graft: overlap type, bevel type, and flush type. Models of different fixation types of MFC flap were reconstructed from CT images. A standard internal fixation model for extracapsular condylar fracture was also included as a control. Displacement of bone graft, deformation of plates and screws, and stress distribution of plates, screws, and cortical and cancellous of the bone graft were analyzed by finite element analysis to investigate their biomechanical features. The displacement of the bone graft and deformation of plates and screws in three different fixation types showed no significant difference. The overlap type and flush type of fixation displayed the lowest and highest stress respectively. All three fixation types could satisfy the mechanical requirement and face no risk of breakage and the major displacement of the MFC bone graft. These results provide insights into the optimal fixation approach for MFC bone grafts, offering valuable guidance and reference for clinical application.

Biomechanical model of minimally invasive hallux valgus surgery.

Hallux valgus is a common foot deformity characterized by outward tilting and twisting of the big toe, often accompanied by a medial prominence at the base. Minimally invasive surgical techniques are widely utilized for treating metatarsus adductus due to their advantages of smaller incisions, faster recovery, and early weight-bearing. However, due to individual variations and limited sample size, the biomechanical effects of different Kirschner wire fixation methods and the underlying mechanisms of postoperative metatarsalgia remain unclear. In this study, a finite element method was employed to develop a biomechanical model of metatarsus adductus. The influence of various Kirschner wire entry points and angles on foot loading characteristics was investigated. Six different Kirschner wire fixation models, including two entry methods (along the adjacent fracture line and proximal-biased entry at the midshaft of the metatarsal) with different entry angles, were analyzed. Mechanical parameters such as metatarsal stress distribution, plantar pressure distribution, and displacement of the first metatarsal osteotomy plane were assessed. This research aims to enhance understanding of minimally invasive surgery and its fixation methods for metatarsus adductus. By providing scientific support and reliable evidence, it seeks to contribute to the development of minimally invasive surgical techniques and the improvement of clinical practice in metatarsus adductus surgery. Ultimately, the goal is to reduce complications, increase surgical success rates, and enhance patient satisfaction.

Effects of different sensory integration tasks on the biomechanical characteristics of the lower limb during walking in patients with patellofemoral pain.

Purpose: This study aimed to analyze the biomechanical characteristics of the lower limb in patients with patellofemoral pain (PFP) while walking under different sensory integration tasks and elucidate the relationship between these biomechanical characteristics and patellofemoral joint stress (PFJS). Our study's findings may provide insights which could help to establish new approaches to treat and prevent PFP. Method: Overall, 28 male university students presenting with PFP were enrolled in this study. The kinematic and kinetic data of the participants during walking were collected. The effects of different sensory integration tasks including baseline (BL), Tactile integration task (TIT), listening integration task (LIT), visual integration task (VIT) on the biomechanical characteristics of the lower limb were examined using a One-way repeated measures ANOVA. The relationship between the aforementioned biomechanical characteristics and PFJS was investigated using Pearson correlation analysis. Results: The increased hip flexion angle (P = 0.016), increased knee extension moment (P = 0.047), decreased step length (P < 0.001), decreased knee flexion angle (P = 0.010), and decreased cadence (P < 0.001) exhibited by patients with PFP while performing a VIT were associated with increased patellofemoral joint stress. The reduced cadence (P < 0.050) achieved by patients with PFP when performing LIT were associated with increased patellofemoral joint stress. Conclusion: VIT significantly influenced lower limb movement patterns during walking in patients with PFP. Specifically, the increased hip flexion angle, increased knee extension moment, decreased knee flexion angle, and decreased cadence resulting from this task may have increased PFJS and may have contributed to the recurrence of PFP. Similarly, patients with PFP often demonstrate a reduction in cadence when exposed to TIT and LIT. This may be the main trigger for increased PFJS under TIT and LIT.

Focal adhesion kinase regulates tendon cell mechanoresponse and physiological tendon development.

Tendons enable locomotion by transmitting high tensile mechanical forces between muscle and bone via their dense extracellular matrix (ECM). The application of extrinsic mechanical stimuli via muscle contraction is necessary to regulate healthy tendon function. Specifically, applied physiological levels of mechanical loading elicit an anabolic tendon cell response, while decreased mechanical loading evokes a degradative tendon state. Although the tendon response to mechanical stimuli has implications in disease pathogenesis and clinical treatment strategies, the cell signaling mechanisms by which tendon cells sense and respond to mechanical stimuli within the native tendon ECM remain largely unknown. Therefore, we explored the role of cell-ECM adhesions in regulating tendon cell mechanotransduction by perturbing the genetic expression and signaling activity of focal adhesion kinase (FAK) through both in vitro and in vivo approaches. We determined that FAK regulates tendon cell spreading behavior and focal adhesion morphology, nuclear deformation in response to applied mechanical strain, and mechanosensitive gene expression. In addition, our data reveal that FAK signaling plays an essential role in in vivo tendon development and postnatal growth, as FAK-knockout mouse tendons demonstrated reduced tendon size, altered mechanical properties, differences in cellular composition, and reduced maturity of the deposited ECM. These data provide a foundational understanding of the role of FAK signaling as a critical regulator of in situ tendon cell mechanotransduction. Importantly, an increased understanding of tendon cell mechanotransductive mechanisms may inform clinical practice as well as lead to the discovery of diagnostic and/or therapeutic molecular targets.

Characterization of Limbus Biomechanical Properties Using Optical Coherence Elastography.

The elasticity of the limbus is crucial for ocular health, yet it remains inadequately explored. This study employs acoustic radiation force optical coherence elastography (ARF-OCE) to evaluate the biomechanical properties of the limbus under varying intraocular pressures. The method was validated using a heterogeneous phantom and subsequently applied to ex vivo porcine limbus samples. Elastic wave velocity at specific locations within the limbus was calculated, and the corresponding Young's modulus values were obtained. Spatial elasticity distribution maps were generated by correlating Young's modulus values with their respective locations in the two-dimensional structural images. The results indicate that ARF-OCE enhances the understanding of limbus biomechanical behavior and holds potential for diagnosing regional variations caused by ocular diseases.

Pelvis and thoracolumbar spine response in simulated under-body blast impacts and protective seat cushion design.

Purpose: The aim of this study is to investigate the dynamic and biomechanical response of the pelvis and thoracolumbar spine in simulated under-body blast (UBB) impacts and design of protective seat cushion for thoracolumbar spine injuries. Methods: A whole-body FE (finite element) human body model in the anthropometry of Chinese 50th% adult male (named as C-HBM) was validated against existing PHMS (Postmortem Human Subjects) test data and employed to understand the dynamic and biomechanical response of the pelvis and thoracolumbar spine from FE simulations of UBB impacts. Then, the protective capability of different seat cushion designs for UBB pelvis and thoracolumbar injury risk was compared based on the predictions of the C-HBM. Results: The predicted spinal accelerations from the C-HUM are almost within the PHMS corridors. UBB impact combined with the effects from physiological curve of the human thoracolumbar spine and torso inertia leads to thoracolumbar spine anterior bending and axial compression, which results in stress concentration in the segments of T4-T8, T12-L1 and L4-L5. Foam seat cushion can effectively reduce the risk of thoracolumbar spine injury of armored vehicle occupants in UBB impacts, and the DO3 foam has better protective performance than ordinary foam, the 60 mm thick DO3 foam could reduce pelvic acceleration peak and DRIz value by 52.8% and 17.2%, respectively. Conclusions: UBB spinal injury risk is sensitive to the input load level, but reducing the pelvic acceleration peak only is not enough for protection of spinal UBB injury risk, control of torso inertia effect would be much helpful.

Relationship Between Force-Velocity Characteristics and Sprint Performance in Elite Sprinters: A Pilot Study.

BACKGROUND: Sprinting is a type of running that consists of producing a short and intense effort in order to perform maximal speed in a short period of time. Sprinting is widely investigated because of the multiple and complex mechanisms involved. Sprint studies are now focusing on how to improve performance by focusing their analyses on the mechanic variables. The hamstrings are part of the most important muscle groups during sprinting because of their role of stabilization and propulsion, but they must be able to produce the maximum strength during a short moment, this ability is characterized by rate of torque development (RTD). The main of this study was to investigate the association between hamstring RTD (Nm.s-1.kg-1) and mechanical variables composed of maximal power output (Pmax) (W.kg-1), maximal theoretical velocity (V0) (m.s-1), and maximal horizontal force production (F0) (N.kg-1) on short sprints in elite sprinters. METHODS: For this clinical trial, we used a research method based on data collection. A single group composed of four male and one female elite sprinters (age: 17.2 ± 1.79 years) has been included in this study. The sprinters performed a hamstring strength test, which included five trials of four seconds for each leg. This test required a portable dynamometer, the Kforce®, to collect 100 and 200 milliseconds RTD. Then the subjects were submitted to a sprint test. My Sprint® application has been used to collect the sprint mechanical variables. The sprint test included two trials; a starting block has been used for this test. A linear regression analysis was used between the rates of torque development and mechanical variables composed of maximal power output (Pmax) (W.kg-1), maximal theoretical velocity (V0) (m. s-1), and maximal horizontal force production (F0) (N.kg-1). RESULTS: No significant correlation was observed between 100 and 200 ms hamstring RTD and sprint biomechanical variables: maximal power output (Pmax) (W.kg-1), maximal theoretical velocity (V0) (m. s-1), and horizontal force production (F0) (N.kg-1). However, 100 and 200 ms RTD collected on the dominant leg tends to be more correlated with maximal theoretical velocity (spearman's rho = 0.80; p-value = 0.13) and Pmax output (spearman's rho = 0.70; p-value = 0.23) while for non-dominant leg, RTD tends to be more correlated with maximal power output (spearman's rho = 0.60; p-value = 0.35) and horizontal force production (spearman's rho = 0.70; p-value = 0.23). CONCLUSIONS: Hamstring RTD is not correlated with sprint biomechanical variables in elite sprinters. Further investigations must be made to study the observed trends in this study.

The effect of humeral tray thickness on glenohumeral loads in a reverse shoulder 'smart' implant.

PURPOSE: The aim of this study was to observe the effects of changing humeral tray thickness on the resultant of intraoperative glenohumeral joint loads using a load-sensing system (LSS). METHODS: An rTSA was performed on fresh frozen full-body cadaver shoulders by using an internal proprietary LSS on the humeral side. The glenohumeral loads (Newtons) and the direction of the resultant force applied on the implant were recorded during four standard positions (External rotation, Extension, Abduction, Flexion) and three "complex" positions of Activity Daily Life ("behind back", "overhead reach" and "across chest"). For each position, the thickness was increased from 0 to 6 mm in a continuous fashion using the adjustment feature of the humeral system. Each manoeuvre was repeated three times. RESULTS: All shoulder positions showed a high repeatability of the glenohumeral load magnitude measured with an intra-class correlation coefficient of over 0.9. For each position, we observed a strong but no linear correlation between humeral tray thickness and joint loads. It was a cubical correlation (rs = 0,91) with a short ascending phase, then a plateau phase, and finally a phase with an exponential growth of the loads on the humeral implant. In addition, an increase in trail-poly thickness led to a recentering of force application at the interface of the two glenohumeral implants. CONCLUSION: This study provides further insight into the effects of humeral implant thickness on rTSA glenohumeral joint loads during different positions of the arm. Data obtained using this type of device could guide surgeons in finding the proper implant balance during rTSA.

An Instrumented Hammer to Detect the Rupture of the Pterygoid Plates.

PURPOSE: Craniofacial osteotomies involving pterygomaxillary disjunction are common procedures in maxillofacial surgery. Surgeons still rely on their proprioception to determine when to stop impacting the osteotome, which is important to avoid complications such as dental damage and bleeding. Our group has developed a technique consisting in using an instrumented hammer that can provide information on the mechanical properties of the tissue located around the osteotome tip. The aim of this study is to determine whether a mallet instrumented with a force sensor can be used to predict the crossing of the osteotome through the pterygoid plates. METHODS: 31 osteotomies were carried out in 16 lamb skulls. For each impact, the force signal obtained was analysed using a dedicated signal processing technique. A prediction algorithm based on an SVM classifier and a cost matrix was applied to the database. RESULTS: We showed that the device could always detect the crossing of the osteotome, sometimes before its occurrence. The prediction accuracy of the device was 94.7%. The method seemed to be sensitive to the thickness of the plate and to crack apparition and propagation. CONCLUSION: These results pave the way for the development of a per-operative decision support system in maxillofacial surgery.

Biomechanical Analysis of a New Odd-Numbered Strand Suture Technique for Early Active Mobilization After Primary Flexor Tendon Repair.

Purpose: The placement of multistrand sutures during flexor tendon repair is complex and challenging. We developed a new, simpler, nine-strand suture, which we term the Tajima nines. The Tajima nines repair method is a new odd-numbered strand tendon technique. Methods: Fourteen porcine flexor tendons were transected and repaired using the Tajima nines repair method, without placement of peripheral sutures. This technique is a modification of the Lim and Tsai repair method; it uses a 4-0 monofilament nylon, 3-strand line, and two needles. The repaired tendons were tested for linear, noncyclic, load-to-failure tensile strength. The initial gap, 2-mm gap-formation force, and ultimate strength were measured. Results: The initial gap-formation force was 27.9 ± 7.5 newtons (N), the 2-mm gap-formation force was 39.2 ± 4.7 N, and the ultimate strength was 76.7 ± 17.2 N. Eight, three, and three of the 14 tendons repaired using the Tajima nines method demonstrated failure because of thread breakage, knot failure, and suture pull-out, respectively. Conclusions: This biomechanical study demonstrated that Tajima nines repair was associated with particularly high initial tension at the repair site; there were minor variations in the initial load and 2-mm gap-formation load. Our results suggest that Tajima nines repair with peripheral suturing allows the repaired flexor tendon to tolerate the stresses encountered during early active mobilization. Clinical relevance: This simple nine-strand technique will be particularly useful for inexperienced surgeons who perform early active mobilization after primary flexor tendon repair because the technique is a modification of the Lim and Tsai repair method using a triple strand instead of a double strand.

The effect of structural changes on the low strain rate behaviour of the intervertebral disc.

The annuus fibrosus (AF) and nucleus pulposus (NP) of the intervertebral disc (IVD) work in conjunction to dissipate spinal loads. In this study we have isolated the contribution of the NP to the overall response of the disc and investigated the effect of extreme structural changes to the disc on the mechanical behaviour. Linear stiffness, overall load range, hysteresis area and total energy were used to evaluate the impact of these changes on the spine and surrounding structures. Six porcine lumbar isolated disc specimens were tested in 6 DOFs with a 400 N compressive axial preload at low strain rates in three conditions: intact (IN), after total nucleotomy (NN) and after the injection of bone cement into the nuclear void (SN). The latter two conditions, NN and SN, were chosen to emulate the effect of extreme changes to the NP on disc behaviour. When comparing with intact specimens, significant changes were noted primarily in axial compression-extension, mediolateral bending and flexion-extension. NN and SN cases demonstrated significant increases in linear stiffness, overall load range and total energy for mediolateral bending and flexion-extension compared to the intact (IN) state. SN also demonstrated a significant increase in total energy for axial compression-extension, and significant decreases in the elastic contribution to total energy in all axes except flexion-extension. These changes to total energy indicate that surrounding spinal structures would incur additional loading to produce the same motion in vivo after structural changes to the disc.

Risk factors of metatarsal stress fracture associated with repetitive sports activities: a systematic review.

Background: Metatarsal stress fracture is common in people engaged in repetitive weight-bearing activities, especially athletes and recruits. Identifying risk factors in these contexts is crucial for effective prevention. Methods: A systematic search on Web of Science, PubMed, EBSCO, SPORTDiscus, MEDLINE, and Cochrane Library was conducted and the date range for the retrieval was set from January 1984 to April 2024. Results: 32 eligible studies were selected from 1,728 related research. Anatomical and biomechanical factors, such as higher foot arch, abnormal inversion/eversion of foot, and longer metatarsal length or larger angles, relatively influence stress fracture risk. However, given that there is no standardized measurement, the results remain to be examined. Soccer is associated with fifth metatarsal fractures, while long-distance running and recruit training often lead to fractures of the second or third metatarsals. High exercise intensity, non-adaptive training, and inadequate equipment heighten fracture risk. Conclusion: This review highlights the complex interplay of anatomical, biomechanical, and sports-related factors in the risk of metatarsal stress fractures. Relatively, high arches, specific metatarsal morphologies, and foot inversion/eversion patterns are significant risk factors, particularly among athletes. Sports type also correlates with metatarsal stress fracture locations. Despite extensive research, study heterogeneity and inherent biases necessitate cautious interpretation. Comprehensive, multifactorial approaches and personalized injury prevention strategies are essential for reducing the incidence of these injuries and improving the health and performance of athletes.

Enhanced boxing punch impact with silicone cushioning.

Introduction: Elastic cushioning materials protect human tissue from injury by absorbing impact energy and delaying its transfer. However, the potential compromise in force delivery to the hitting target remains unknown. Methods: To examine if silicone cushioning compromises punch force delivery to a hitting target, a double-blind crossover trial with 12 elite boxers was conducted following material tests. Each boxer delivered five maximal punches under two conditions: silicone-hand wrapping and gauze-hand wrapping, in counterbalanced order, with a 3-day interval between sessions. Force distribution along the Z-axis indicated the punch's intended direction, while forces along the X and Y axes represented force dissipation toward unwanted direction. Results: The material tests (based on ASTM International, West Conshohocken, PA, USA) demonstrated substantially higher compression to disruption for silicone than gauze of similar thickness. During the punching trials, the silicon-based hand wrapping exhibited slightly higher total force production (436 ± 33 N vs. 372 ± 12 N, p < 0.001) than the gauze-based hand wrapping. Moreover, force wastage, calculated as the sum of forces along the X and Y axes vs. the total force produced in percentage, was notably lower for silicone material (2.0% wastage) compared to gauze (3.8% wastage) (p < 0.001). The use of silicone materials lengthened the contact time between the punching fist and the hitting target from 35 ms to 50 ms (p < 0.001). Conclusion: The elastic cushion does not compromise the force delivery of the boxing glove to the hitting target. Instead, it appears to allow for additional maneuvering time for alignment during the fist-target contact with higher impact.

Biomechanical and histological evaluation of aspirin in rotator cuff tear rat model.

Background: Aspirin is a representative non-steroidal anti-inflammatory drug (NSAIDs) and has been commonly used for the treatment of tendinopathy in clinical practice. In this study, we aimed to evaluate the biomechanical and histological healing effects of aspirin on the healing of the tendon-to-bone interface after rotator cuff tear repair. Methods: A total of 20 male Sprague-Dawley rats were randomly divided into two groups of 10 rats each. Group-C performed repaironly, and group-aspirin treated with aspirin after tendon repair. Group-aspirin rat were intraperitoneally injected with aspirin at 10 mg/kg every 24 h for 7 days. Eight weeks after surgery, the left shoulder of each rat was used for histological analysis and the right shoulder for biomechanical analysis. Results: In the biomechanical analysis, there was no significant difference in load-to-failure (group-C: 0.61 ± 0.32 N, group-aspirin: 0.74 ± 0.91 N; p = .697) and ultimate stress (group-C: 0.05 ± 0.01 MPa, group-aspirin: 0.29 ± 0.43 MPa; p = .095). For the elongation (group-C: 222.62 ± 57.98%, group-aspirin: 194.75 ± 75.16%; p = .028), group-aspirin confirmed a lower elongation level than group-C. In the histological evaluation, the Bonar score confirmed significant differences in collagen fiber density (group-C: 1.60 ± 0.52, group-aspirin: 2.60 ± 0.52, p = .001) and vascularity (group-C: 1.00 ± 0.47, group-aspirin: 2.20 ± 0.63, p = .001) between the groups. Conclusions: Aspirin injection after rotator cuff tear repair may enhance the healing effect during the early remodeling phase of tendon healing.

First metatarsophalangeal joint dorsiflexion resistance in individuals with plantar fasciopathy.

INTRODUCTION: Plantar fasciopathy is a common foot-related musculoskeletal disorder. It has been hypothesized that this disorder could be linked to a dysfunctional windlass mechanism. However, no study to date has quantified this link to validate or refute this hypothesis. The first metatarsophalangeal joint (1st MPJ) dorsiflexion resistance test is a reliable test to evaluate the force required to initiate the windlass mechanism. Comparing the results of this test in individuals with and without plantar fasciopathy will allow for a better understanding of the relationship between plantar fasciopathy and the windlass mechanism. Thus, this study aimed to compare 1st MPJ dorsiflexion resistance in individuals with plantar fasciopathy and healthy controls. Additionally, this study aimed to explore the correlations between 1st MPJ dorsiflexion resistance and other commonly used foot orthopedic tests, specifically the supination resistance test and the Foot Posture Index. MATERIAL AND METHODS: Twenty participants with plantar fasciopathy and 20 healthy controls were recruited in this case-control study. First MPJ dorsiflexion resistance was quantified and compared between groups and between feet using a repeated measures ANOVA with one within-subject factor with two levels and one between-subject factor with two levels. It was also correlated with supination resistance and the Foot Posture Index. RESULTS: There were no significant differences in 1st MPJ dorsiflexion resistance between injured and healthy feet as well as control and plantar fasciopathy groups. There was a moderate to strong correlation (r = 0.674 to 0.891) between 1st MPJ dorsiflexion resistance and supination resistance in both groups. There was no significant correlation between 1st MPJ dorsiflexion resistance and the Foot Posture Index. CONCLUSIONS: The lack of alterations in 1st MPJ dorsiflexion resistance among individuals with plantar fasciopathy implies a potential need to reconsider the biomechanical model, proposing that a dysfunctional windlass mechanism is associated with the development of plantar fasciopathy, may need reconsideration.