Biomechanical Comparison of Four- versus Six-Strand Transosseous Suture Repair for Patellar Tendon Rupture.

BACKGROUND: Surgical repair is indicated for patellar tendon ruptures that result in loss of knee extensor mechanism function. However, biomechanical studies report conflicting results when comparing transosseous suture versus suture anchor repair techniques. This discrepancy may be due to inconsistencies in experimental design as these studies use various numbers of suture strands. Therefore, the main objective of this study is to compare the ultimate load of four- versus six-strand transosseous suture repair. Secondary objectives are to compare gap formation after cyclical loading and mode of failure. METHODS: Six pairs of fresh-frozen cadaveric specimen were randomly allocated to either four- or six-strand transosseous suture repair. Specimen underwent preconditioning cyclical loading and then load to failure. RESULTS: The six-strand repair had a significantly higher maximum load to failure compared with the four-strand repair (mean difference = 319.3 N [57.9%], p = 0.03). There was no significant difference in gap length after cyclical loading or at max load. There were no significant differences in mode of failure. CONCLUSION: Utilizing a six-stand transosseous patella tendon repair construct with one additional suture increases overall construct strength by over 50% compared with a four-strand construct.

Evaluating the Efficacy of Behavior Modification Strategies on Physical Activity Levels Among Incarcerated Youth.

This study examined the impact of prompting only and prompting combined with independent group-oriented contingency on incarcerated adolescent males' physical activity level during a sport-leadership program. An alternating treatment design was employed to allow for the evaluation among multiple treatment conditions. The study occurred during 35 consecutive sport programming lessons at a juvenile correctional facility. Participants were 16 adolescent males (Mage = 18.79). Two behavior modification strategies, prompting only and prompting combined with independent group-oriented contingency, were employed. Data were plotted graphically so visual analysis could be determined in order to explore any functional associations between the treatment conditions (e.g., interventions) and target behavior (e.g., step count). Prompting only slightly increased physical activity, whereas prompting in conjunction with independent group-oriented contingency elevated activity levels by 36%, with a smaller standard deviation indicating that all participants were equivalently physically active. The results of this study underpin the expansive benefits of sport-leadership programming, not just in similar programs' ability to develop life skill integration, positively impact life during incarceration, improve attitudes, and promote physical activity, but also to provide elevated opportunities for youth to be physically active.

Hip Strength Recovery After Anterior Cruciate Ligament Reconstruction.

Background: Return-to-play (RTP) assessment after anterior cruciate ligament reconstruction (ACLR) rarely includes hip strength. Hypothesis: It was hypothesized that (1) patients after ACLR will have weaker hip abduction (AB) and adduction (AD) strength compared with the contralateral limb, with larger deficits in women, (2) there will be a correlation between hip and thigh strength ratios and patient-reported outcomes (PROs), and (3) hip AB and AD strength will improve over time. Study Design: Descriptive laboratory study. Methods: Included were 140 patients (74 male, 66 female; mean age, 24.16 ± 10.82 years) who underwent RTP assessment at 6.1 ± 1.6 months after ACLR; 86 patients underwent a second assessment at 8.2 ± 2.2 months. Hip AB/AD and knee extension/flexion isometric strength were measured and normalized to body mass, and PRO scores were collected. Strength ratios (hip vs thigh), limb differences (injured vs uninjured), sex-based differences, and relationships between strength ratios and PROs were determined. Results: Hip AB strength was weaker on the ACLR limb (ACLR vs contralateral: 1.85 ± 0.49 vs 1.89 ± 0.48 N·m/kg; P < .001) and hip AD torque was stronger (ACLR vs contralateral: 1.80 ± 0.51 vs 1.76 ± 0.52 N·m/kg; P = .004), with no sex-by-limb interaction found. Lower hip-to-thigh strength ratios of the ACLR limb were correlated with higher PRO scores (r = -0.17 to -0.25). Over time, hip AB strength increased in the ACLR limb more than in the contralateral limb (P = .01); however, the ACLR limb remained weaker in hip AB at visit 2 (ACLR vs contralateral: 1.88 ± 0.46 vs 1.91 ± 0.45 N·m/kg; P = .04). In both limbs, hip AD strength was greater at visit 2 than visit 1 (ACLR: 1.82 ± 0.48 vs 1.70 ± 0.48 N·m/kg; contralateral: 1.76 ± 0.47 vs 1.67 ± 0.47 N·m/kg; P < .01 for both). Conclusion: The ACLR limb had weaker hip AB and stronger AD compared with the contralateral limb at initial assessment. Hip muscle strength recovery was not influenced by sex. Hip strength and symmetry improved over the course of rehabilitation. Although strength differences across limbs were minor, the clinical importance of these differences is still unknown. Clinical Relevance: The evidence provided highlights the need to integrate hip strength into RTP assessments to identify hip strength deficits that may increase reinjury or lead to poor long-term outcomes.

Exploring physical activity trends and lesson context of incarcerated youth in a sport-leadership program.

Incarcerated youth are one subset of the population in dire need of physical activity interventions. As inactivity within incarcerated populations has become a mounting public health concern, several sport-based physical activity and fitness programs within prisons have emerged. The purpose of this study is to explore physical activity levels and lesson context of a sport-leadership program in one juvenile detention center. Participants in this study were 27 incarcerated males (Mage = 19.3), imprisoned in one juvenile detention center. Participants participated in 20, 40-min sport-leadership lessons over the course of 3 months. Each lesson was live coded using the System for Observing Instructional Time (SOFIT) to examine physical activity levels and lesson context. Over the course of 20 lessons, participants engaged in moderate to vigorous physical activity (MVPA) for 61% of lesson time (24.5 min). Further, over 23% of lesson time was spent vigorously (9.5 min). Specific to lesson context, 18% of total lesson time (7.5 min) was spent in management whereas 7.96% (3.1 min) was consumed by knowledge acquisition. Furthermore, a vast majority of each session (70%) was spent in gameplay (28.04 min). This study is the first to adopt the SOFIT systematic observation instrument to evaluate and quantify MVPA and lesson context during a sport-leadership program within a juvenile detention center. Results from this study indicate incarcerated youth who participated in this program engaged in MVPA for more than 60% of lesson time. It was reported that overall MVPA of participants within programming slightly decreased across the 20 total lessons.

Physical Activity and Social Behaviors of Incarcerated Youth Participating in a Sport-Leadership Program.

Research illustrates that participation in physical activity is advantageous to overall health. Incarcerated populations are one subset that would benefit most from consistent engagement in physical activity, yet little is known about programs created to fulfill this need. The purpose of this study was to determine activity levels and social behaviors of incarcerated adolescent males during a structured sport-leadership program. Participants were 23 incarcerated males. The System for Observing Children's Activity and Relationships during Play was employed to evaluate activity and social behaviors. A major finding of this study demonstrated that incarcerated youth engaged in moderate to vigorous physical activity for a large portion of the sport-leadership programming time (50.6%). In this study, prosocial (11.7%) and antisocial (7.1%) interactions mirrored those observed in residential summer camps, on playgrounds, and during recess.

Research Brief: Physical Activity Trends Among Incarcerated Youth During a Sport Leadership Program.

Research indicates that engagement in physical activity is advantageous to adolescents' overall health. One subset of the population that is not provided with ample opportunities to be physically active includes incarcerated youth. To date, sport leadership programs have been designed to target this population; yet, little is known about physical activity opportunities for participants. The purpose of this study was to explore physical activity during a sport leadership program within a juvenile detention center. The participants were 27 incarcerated male youth (Mage = 18.7 years), all of whom participated in a sport leadership program. Physical activity was assessed during 32 sessions using Yamax DigiWalker SW 701 pedometers. Youth who participated in the sport leadership program accumulated an average of 3232 steps per session, with average standard deviation of 1245.5. As youth attended more sessions, overall physical activity levels during programming increased with a drastic reduction in variance among participants. This study is the first to closely examine and provide insights into youths' physical activity trends across programming and demonstrates a noticeable uptrend in activity and deceleration of variability among participants. Findings suggest that participation in a structured sport leadership program within juvenile detention centers can provide participants a critical opportunity to engage in physical activity.

Predictors of PROMIS Physical Function at 2 Years following Knee Surgery.

The purpose of this study was to evaluate Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) 2 years following knee surgery, and identify preoperative factors associated with postoperative PROMIS PF. Three hundred and sixty-five patients, age 17 years and older, undergoing knee surgery at one institution were studied. Patients completed multiple questionnaires prior to surgery and again 2 years postoperatively including PROMIS PF, International Knee Documentation Committee (IKDC), joint and body numeric pain scales (NPS), Tegner's activity scale (TAS), and Marx's activity rating scale (MARS). Mean PROMIS PF improved from 41.4 to 50.9 at 2 years postoperatively (p < 0.001) and was strongly correlated with 2-year IKDC scores. Older age, female gender, non-Hispanic ethnicity, unemployment, lower income, government insurance, smoking, preoperative opioid use, having a legal claim, comorbidities, previous surgeries, higher body mass index (BMI), and knee arthroplasty were associated with worse 2-year PROMIS PF. Multivariable analysis confirmed that lower BMI, less NPS body pain, and higher MARS were independent predictors of greater 2-year PROMIS PF and better improvement in PROMIS PF. In this large, broad cohort of knee surgery patients, multiple preoperative factors were associated with PROMIS PF 2 years postoperatively. PROMIS PF scores improved significantly, but worse 2 year PROMIS PF scores and less improvement from baseline were independently predicted by higher BMI, greater NPS body pain, and lower MARS activity level. PROMIS PF can be implemented as an efficient means to assess outcomes after knee surgery.

Predictors of two-year patient satisfaction following elective knee surgery.

BACKGROUND: Patient satisfaction metrics are increasingly being utilized as tools to evaluate the quality of healthcare and affect reimbursements. The objectives of this study were to (1) identify factors associated with two-year patient satisfaction after elective knee surgery, (2) compare the Surgical Satisfaction Questionnaire-8 (SSQ-8) and a numeric satisfaction scale (NSS), and (3) determine if two-year patient satisfaction can be predicted based on preoperative factors. METHODS: A total of 365 patients undergoing elective knee surgery at a single center were administered questionnaires to assess demographics, medical history, and various patient-reported outcomes preoperatively and at two years postoperatively. Patient satisfaction was measured at two years postoperatively with SSQ-8 and NSS. Bivariate and multivariate statistical analyses were performed to identify significant associations and independent predictors of satisfaction. RESULTS: SSQ-8 and NSS scores were significantly correlated (rs = 0.68, P < 0.0001). Lower SSQ-8 and NSS scores were associated with black race, higher BMI, more comorbidities, unemployment, smoking, higher ASA score, and greater Met Expectations (P < 0.05). Better scores on patient-based outcome measures and better improvement from baseline were significantly correlated with higher satisfaction on both SSQ-8 and NSS. Multivariable analysis identified greater Met Expectations and higher two-year Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference scores as independent predictors of greater SSQ-8 scores (adjusted r2 = .52). Greater Met Expectations and better two-year PROMIS Social Satisfaction scores were independent predictors of NSS score (adjusted r2 = .41). In contrast, when only preoperative variables were considered, the multivariable regression model accounted for only 14% of the variance in SSQ-8 and 6% of the variance in NSS. CONCLUSION: While there are multiple preoperative factors that are associated with two-year patient satisfaction after knee surgery, those factors contribute relatively little to satisfaction. Meeting expectations and better patient-based outcomes at two years are more important.

Predictors of met expectations two years after knee surgery.

INTRODUCTION: The purpose of this study is to determine which patient factors predict two-year postoperative met expectations in a cohort of patients undergoing knee surgery. Additionally, this study aims to measure the association between met expectations and postoperative outcomes. METHODS: 319 patients undergoing knee surgery at one institution were studied. Patients completed patient-reported outcome questionnaires prior to surgery and again two years postoperatively. Preoperative Expectations and postoperative Met Expectations were measured using the Musculoskeletal Outcomes and Data Evaluation Management System (MODEMS) Expectations domain. RESULTS: The mean Met Expectations score was significantly lower than the preoperative Expectations Score. Worse two-year Met Expectations were associated with older age, higher BMI, greater comorbidities, more previous surgeries, black race, unemployment, lower income, government insurance, Worker's Compensation, smoking, and no injury prior to surgery. Greater Met Expectations were correlated with better scores on all two-year outcome measures as well as greater improvement on most outcome measures. Race, insurance status, function, mental health, and knee pain were found to be independent predictors of Met Expectations. CONCLUSION: This study identified multiple patient factors and outcome measures that were associated with Met Expectations two years after knee surgery.

Impact of COVID-19 on School-Aged Male and Female Health-Related Fitness Markers.

PURPOSE: The purpose of this study was to examine the impact of the Coronavirus disease 2019 on male and female anthropometric variables and physical performance. METHODS: This study utilized a mixed (time [PRE vs POST], gender [male vs female]) methods design to examine changes in the body mass index and physical fitness performance measures prior to and following closures. Data were collected from 264 third through eighth graders. This sample consisted of 131 males and 133 females. The data was collected through anthropometric (body mass index) and physical performance measures and was analyzed with separate 2 × 2 mixed-factorial analyses of variance (time [PRE, POST] × gender [male, female]). RESULTS: The findings indicated both males and females exhibited mean increases in the body mass index (+10.6%; 18.8-20.8 kg·m-2, P < .001, partial η2 = .627) and decreases in push-ups (-35.6%; 7.3-4.7 repetitions, P < .001, partial η2 = .371), sit-ups (-19.4%; 22.7-18.3 repetitions, P < .001, partial η2 = .420), and the Progressive Aerobic Cardiovascular Endurance Run test (-26.7%; 31.4-22.4 laps, P < .001, partial η2 = .644) scores from PRE to POST. CONCLUSION: The results of this study demonstrate that both males and females exhibited significant anthropometric and physical performance losses during the Coronavirus disease 2019 shutdown.

An Observational Assessment of Physical Activity Levels and Social Behavior During Residential Summer Camp Unstructured Time.

PURPOSE: To evaluate children's physical activity (PA) levels, social play behavior, activity time, and social interactions during unstructured time. APPROACH: Systematic observation tool to record child's PA level, social group size, activity type, and social interaction during play. SETTING: Northeast US residential summer camp, pseudonym Forest Hills Camp. PARTICIPANTS: Fifty-nine third-grade campers (27 males and 32 females). METHOD: Observational data were obtained using the System for Observing Children's Activity and Relationships during Play (SOCARP). Data were analyzed using independent samples t tests (with Bonferroni adjustment) to assess statistical differences between boys and girls SOCARP categories. RESULTS: Both boys and girls spend over 50% of their time in moderate-to-vigorous physical activity (MVPA). Statistically significant differences between genders were observed: activity level-(a) girls sat more than boys, and (2) boys engaged in more vigorous activity; activity type-(1) boys engaged in more sport activity, girls engaged in more locomotion activity, and girls were more sedentary; and social interactions-(1) boys had more physical conflict, and (2) boys had more verbal conflict. CONCLUSION: Contrary to previous research suggesting that summer campers have increased sedentary behavior during unstructured time, our results indicate that third-grade campers engaged in MVPA over 50% of their unstructured time. This suggests that unstructured time in outdoor camp settings may provide valuable opportunities for adolescent children to choose PA.