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1.
Sensors (Basel) ; 21(4)2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33670561

RESUMO

Although the external knee adduction moment (KAM) during gait was shown to be a quantitative parameter of medial knee osteoarthritis (OA), it requires expensive equipment and a dedicated large space to measure. Therefore, it becomes a major reason to limit KAM measurement in a clinical environment. The purpose of this study was to estimate KAM using a single inertial measurement unit (IMU) during gait in patients with knee OA. A total of 22 medial knee OA patients (44 knee joints) performed conventional gait analysis using three-dimensional (3D) motion capture system. At the same time, we attached commercial IMUs to six body segments (sternum, pelvis, both thighs, and both shanks), and IMU signals during gait were recorded synchronized with the motion capture system. The peak-to-peak difference of acceleration in the lateral/medial axis immediately after heel contact was defined as the thrust acceleration (TA). We hypothesized that TA would represent the lateral thrust of the knee during the stance phase and correlate with the first peak of KAM. The relationship between the peak KAM and TA of pelvis (R = 0.52, p < 0.001), shanks (R = 0.57, p < 0.001) and thighs (R = 0.49, p = 0.001) showed a significant correlation. The root mean square error (RMSE) of linear regression models of pelvis, shanks, and thighs to estimate KAM were 0.082, 0.079, and 0.084 Nm/(kg·m), respectively. Our newly established parameter TA showed a moderate correlation with conventional KAM. The current study confirmed our hypothesis that a single IMU would predict conventional KAM during gait. Since KAM is known as an indicator for prognosis and severity of knee OA, this new parameter has the potential to become an accessible predictor for medial knee OA instead of KAM.


Assuntos
Articulação do Joelho , Osteoartrite do Joelho , Fenômenos Biomecânicos , Feminino , Marcha , Humanos , Joelho , Masculino , Osteoartrite do Joelho/diagnóstico , Caminhada , Dispositivos Eletrônicos Vestíveis
2.
Rev Med Liege ; 76(2): 122-127, 2021 Feb.
Artigo em Francês | MEDLINE | ID: mdl-33543859

RESUMO

Because the knee is the joint of the human body with the largest surface, it is no wonder that gonalgia is one of the most common complaints in the general population. Although the management of a painful traumatic knee is relatively well standardized, that of a non-traumatic knee pain is less codified. History and a rigorous systematic clinical examination play a key role in the management of nontraumatic gonalgia. The diagnostic approach is mainly guided by the inflammatory or mechanical nature of the pain and its topography. This article aims to clarify the diagnostic approach to gonalgia without notion of prior trauma.


Assuntos
Articulação do Joelho , Joelho , Humanos , Dor , Exame Físico
3.
Sports Health ; 13(2): 128-135, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33560920

RESUMO

BACKGROUND: Single-leg vertical and horizontal hop tests are commonly used to assess performance of healthy athletes and as a measure of progress during rehabilitation from knee injury. It is unclear if they measure similar aspects of leg function, as the relative joint contributions of the hip, knee, and ankle joints during propulsion and landing are unknown. HYPOTHESIS: The proportion of work done by the hip, knee, and ankle will not be the same for these 2 jump types and will vary for propulsive and landing phases. STUDY DESIGN: Cross-sectional cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Twenty physically active participants completed instrumented single-leg hop analysis in both vertical and horizontal directions. Joint peak power, work generated or absorbed, and percentage contribution of each joint during propulsive and landing phases were compared between tasks using paired t tests. RESULTS: Vertical hop was performed with roughly similar contributions of the hip, knee, and ankle for both propulsion (31%, 34%, 35%, respectively) and landing (29%, 34%, 37%, respectively). Horizontal hop distance was mostly (87%) determined by the hip and ankle (44% and 43%), but landing was mostly (65%) performed by the knee with lesser contribution from the hip and ankle (24% and 11%). Propulsive phase showed a proximal-to-distal temporal sequence for both hop types, but landing was more complex. CONCLUSION: Performance during vertical and horizontal hops (jump height and jump distance, respectively) measures different aspects of hip, knee, and ankle function during the propulsive and landing phases. CLINICAL RELEVANCE: Assessment of knee joint function during rehabilitation should not be done using a horizontal hop. The knee contributes about a third to vertical hop height, but only about an eighth to horizontal hop distance. Practitioners carrying out performance testing using either vertical or horizontal hops should be mindful of the relative contributions for meaningful training inferences to be derived.


Assuntos
Tornozelo/fisiologia , Teste de Esforço/métodos , Quadril/fisiologia , Joelho/fisiologia , Exercício Pliométrico , Adulto , Fenômenos Biomecânicos , Estudos Transversais , Humanos , Traumatismos do Joelho/reabilitação , Masculino , Movimento , Força Muscular
4.
Sensors (Basel) ; 21(4)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33572170

RESUMO

Abnormalities and irregularities in walking (gait) are predictors and indicators of both disease and injury. Gait has traditionally been monitored and analyzed in clinical settings using complex video (camera-based) systems, pressure mats, or a combination thereof. Wearable gait sensors offer the opportunity to collect data in natural settings and to complement data collected in clinical settings, thereby offering the potential to improve quality of care and diagnosis for those whose gait varies from healthy patterns of movement. This paper presents a gait monitoring system designed to be worn on the inner knee or upper thigh. It consists of low-power Hall-effect sensors positioned on one leg and a compact magnet positioned on the opposite leg. Wireless data collected from the sensor system were used to analyze stride width, stride width variability, cadence, and cadence variability for four different individuals engaged in normal gait, two types of abnormal gait, and two types of irregular gait. Using leg gap variability as a proxy for stride width variability, 81% of abnormal or irregular strides were accurately identified as different from normal stride. Cadence was surprisingly 100% accurate in identifying strides which strayed from normal, but variability in cadence provided no useful information. This highly sensitive, non-contact Hall-effect sensing method for gait monitoring offers the possibility for detecting visually imperceptible gait variability in natural settings. These nuanced changes in gait are valuable for predicting early stages of disease and also for indicating progress in recovering from injury.


Assuntos
Transtornos dos Movimentos , Dispositivos Eletrônicos Vestíveis , Marcha , Humanos , Joelho , Caminhada
5.
Medicine (Baltimore) ; 100(4): e23809, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530177

RESUMO

OBJECTIVE: To evaluate the clinical and radiographic outcomes of total knee arthroplasties (TKA) between using medial-pivot (MP) and posterior-stabilized (PS) prosthesis. Does MP prosthesis and PS prosthesis influence the clinical results of a TKA? METHODS: An electronic literature search of PubMed Medline and the Cochrane Library was performed from inception to October 1, 2019. A meta-analysis to compare postoperative outcomes of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), range of motion (ROM), complications, and radiographic results between MP and PS prosthesis were conducted. RESULTS: Seven eligible studies involving 934 adult patients (MP group, n = 461; PS group, n = 473) were identified for analysis. This study showed no significant difference between the 2 groups in the WOMAC scores, KSS, ROM, and complications (P > .05). The differences of the femorotibial angle, position of implant, and patellar tilt were also not significant between the 2 groups (P > .05). CONCLUSION: The present meta-analysis has shown that patients with the MP prosthesis have similar clinical results as patients with PS prosthesis. Furthermore, the radiographic results, especially patella tilt angle, were also similar between the 2 groups. Therefore, surgeons should be aware that the types of prostheses are not a decisive factor to ensure successful operation.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Desenho de Prótese , Artroplastia do Joelho/métodos , Humanos , Joelho/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Radiografia , Amplitude de Movimento Articular , Resultado do Tratamento
6.
Arthroscopy ; 37(2): 635-637, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33546800

RESUMO

The ideal treatment of juvenile osteochondritis dissecans (OCD) varies according to the chronicity of symptoms and radiographic classification. Traditionally, "stable" OCD lesions of the knee are managed conservatively with limited weight bearing and nonoperative care. However, this can require up to 6 to 12 months of observation, and success rates are estimated at only 59%. By contrast, recent data suggest that early subchondral drilling of OCD lesions may more consistently facilitate new vascular channels and remodeling of the compromised osteochondral unit. When considering overarching health care costs and probabilistic modeling, contemporary treatment paradigms may preferentially suggest early surgical treatment of OCD lesions for greater cost-effectiveness and an optimized timeline for a return to full activity. Additionally, surgery may be prioritized for larger lesions, atypical locations, closing physes, and/or the presence of mechanical symptoms.


Assuntos
Osteocondrite Dissecante , Análise Custo-Benefício , Humanos , Joelho , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteocondrite Dissecante/cirurgia , Suporte de Carga
7.
Artigo em Inglês | MEDLINE | ID: mdl-33435559

RESUMO

Although asymmetries in lower limbs have been linked with players' performance in male soccer players, literature that has been published addressing female soccer is scarce. Thus, the aim of this study was twofold: (i) describe the asymmetries of women soccer players during jumping, change-of-direction and range-of-motion tests; and (ii) test possible relationships between asymmetries and injury risk in female soccer players. Sixteen female players (15.5 ± 1.5 years) performed a battery of fitness tests (i.e., jump ability, change-of-direction ability and passive range-of-motion) and muscle mass analysis via dual-energy X-ray absorptiometry, through which the specific asymmetry index and the related injury risk were calculated. Significant (p < 0.05) lower asymmetries in the change-of-direction test were observed in comparison to those observed in jumping and range-of-motion tests; significant (p < 0.05) lower asymmetries in muscle mass were also reported compared to those found in the change-of-direction and countermovement jump tests. Additionally, increased injury risk for countermovement jump and hip flexion with extended knee range-of-motion (relating to asymmetry values) and for ankle flexion with flexed knee range-of-motion in both legs (relating to reference range-of-motion values), as well as increased individual injury risk values, were observed across all tests. These findings suggest the necessity to implement individual approaches for asymmetry and injury risk analyses.


Assuntos
Futebol , Feminino , Humanos , Joelho , Articulação do Joelho , Extremidade Inferior , Masculino , Amplitude de Movimento Articular
8.
Anticancer Res ; 41(2): 1041-1046, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517313

RESUMO

BACKGROUND/AIM: This study aimed to investigate the effectiveness of knee rotationplasty (KRP) as salvage surgery for uncontrolled infection and implant failure of total knee arthroplasty (TKA) for sarcoma around the knee in adolescents and young adults (AYA). PATIENTS AND METHODS: This retrospective cohort study included 33 patients who underwent KRP and were grouped based on the treatment received: initial surgery for sarcoma around the knee (n=18) or as salvage surgery (n=15). Musculoskeletal Tumor Society (MSTS) score, range of motion (ROM) and postoperative results were analyzed. RESULTS: All 15 patients who underwent salvage KRP had TKA as an initial surgery. Although there were five infections in salvage KRP, which originated from the initial TKA, all cases were controllable, no implant failure occurred. MSTS score and ROM were deemed acceptable in both groups. CONCLUSION: Salvage KRP is an effective option for uncontrolled complications of initial TKA for sarcoma around the knee.


Assuntos
Salvamento de Membro/métodos , Infecções Relacionadas à Prótese/cirurgia , Reoperação/métodos , Sarcoma/cirurgia , Adolescente , Adulto , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Joelho/fisiopatologia , Masculino , Desenho de Prótese , Falha de Prótese , Amplitude de Movimento Articular , Estudos Retrospectivos , Rotação , Sarcoma/fisiopatologia , Resultado do Tratamento , Adulto Jovem
9.
Arthroscopy ; 37(1): 231-233, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384084

RESUMO

The anatomy, function, and existence of the anterolateral ligament (ALL) is still hotly debated and a controversial topic. Currently both basic biomechanical and clinical studies are not providing sufficient and strong evidence to either support or refute that the ALL plays an important role for knee stability. One could argue that stability is provided by the anterolateral complex, including the iliotibial band, Kaplan fibers, and the anterolateral capsule, which may contain a structure called the ALL. Magnetic resonance imaging (MRI) is routinely performed in patients with anterior cruciate ligament (ACL) injury, but unfortunately ALL injuries cannot be reliably diagnosed in patients with concomitant ACL tears. When dividing ALL injuries into high and low grade using preoperative MRI and investigating clinical outcomes after double-bundle ACL reconstruction, patients with high-grade injuries have inferior outcomes and a significantly greater revision rates. However, the limitations of this research reduce the validity of these conclusions: high rate of loss to follow-up above accepted standard, unequal size of their study groups, fragility index of zero, the inaccuracy of diagnosing ALL injuries in the presence of ACL tears on MRI, and the dilemma with randomly classifying high- and low-grade ALL injury based on MRI.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Joelho , Articulação do Joelho/cirurgia , Ligamentos/cirurgia
10.
Medicine (Baltimore) ; 100(1): e24138, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429788

RESUMO

ABSTRACT: Although the importance of quadriceps femoris function was reported previously, little is known about volume-related factors and their effects on clinical outcomes after total knee arthroplasty (TKA). We sought to determine whether there was a bilateral difference in vastus medialis muscle volume measured on single-photon emission computed tomography-computed tomography (SPECT-CT) in patients who underwent unilateral TKA. We also aimed to determine whether vastus medialis volume was related to osteoarthritis (OA) severity or scintigraphic uptake degree around the knee joint on SPECT-CT. And finally, we attempted to investigate the factors, such as vastus medialis volume and scintigraphic uptake degree, associated with the functional outcomes of TKA.This retrospective study included 50 patients (41 female, 9 male) undergone unilateral TKA due to primary OA. The maximal cross-sectional area of the vastus medialis was measured on axial SPECT-CT images. Scintigraphic uptake degrees and Kellgren-Lawrence (K-L) grade at the tibiofemoral joints were assessed. We compared maximal cross-sectional area of the vastus medialis on SPECT-CT for difference of bilateral lower limbs. We also analyzed the relationship between volume of vastus medialis and scintigraphic uptake measured on SPECT-CT and the severity of OA on conventional radiographs. The clinical outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at baseline and at 1 and 2 years after surgery. The relationship between preoperative muscle volume and scintigraphic uptake on SPECT-CT and WOMAC index was analyzed.The amount of muscle volume measured on SPECT-CT was smaller in operated limb in patients who underwent unilateral TKA. Preoperative vastus medialis muscle volume was not related to preoperative OA severity measured on conventional radiographs and scintigraphic uptake on SPECT-CT. However, a decreased vastus medialis muscle volume was related to worse clinical outcomes after TKA (P = .045), whereas the degree of scintigraphic uptake on SPECT-CT was not associated with postoperative clinical outcomes.Muscle volume of vastus medialis was decreased in the operated knee than in the nonoperated knee, and that was correlated with worse postoperative results. Even if the preoperative volume of vastus medialis were not related to OA severity on conventional radiographs and scintigraphic uptake on SPECT-CT, preservation and improvement of the muscle mass of the knee undergoing TKA is important.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Músculo Quadríceps/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/estatística & dados numéricos , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Pesos e Medidas/instrumentação
11.
Phys Ther Sport ; 47: 193-200, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33321267

RESUMO

OBJECTIVES: Noncontact knee injuries in netball are a concern due to a range of negative consequences. To reduce the number of injuries, identifying the situation and mechanism of injury is important. This systematic review examined the literature reporting the situation and mechanism of noncontact knee injury in netball. DESIGN: Systematic Review. METHODS: PRISMA guidelines were followed and specific key-term combinations used to search databases. Descriptive and analytic-observational studies reporting the situation or mechanism of noncontact knee injury in females playing netball were included (evaluated using frequency counts). RESULTS: Six articles were included (combined sample 11,401). Players self-reported the situation of injury in five studies, only one study reported both the situation and mechanism of injury. Landing was the most reported situation of knee injury, representing 46.6% of all knee injuries whilst knee abduction (valgus) collapse was the most observed mechanism. Situation and mechanism of noncontact knee injury in netball were not adequately reported. CONCLUSIONS: Despite the variations in reporting methods, landing is the most common situation of injury. As only one study reported mechanism of injury, it is difficult to draw conclusions but the mechanism of noncontact knee injury in netball appears similar to those identified in other female athletes.


Assuntos
Traumatismos em Atletas/fisiopatologia , Traumatismos do Joelho/fisiopatologia , Joelho/fisiopatologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Movimento
12.
Phys Ther Sport ; 48: 35-42, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33352396

RESUMO

OBJECTIVE: To compare self-report and functional outcomes between participants with anterior cruciate ligament reconstruction (ACLR) with age and activity matched controls. DESIGN: Cross-sectional study. SETTING: University laboratory-based study. PARTICIPANTS: Twenty-five participants (30.8 ± 9.7 years; 13 women), two to ten years post anterior cruciate ligament reconstruction; 24 controls (31.0 ± 10 years, 13 women). MAIN OUTCOME MEASURES: Knee Osteoarthritis and Injury Outcome Score (KOOS), Tegner, Marx Activity and Fear of Re-injury scales, and SF-12; isokinetic quadriceps and hamstring peak torque and single-leg hop distance. RESULTS: There were no between-groups differences for the Tegner and the Marx Activity Scales. The ACLR group had lower KOOS dimensions (p < 0.001), SF-12 Physical Component Scores (p = 0.008), and higher Fear of Reinjury Scores (<0.001) than the controls. No significant differences were found for physical performance measures between the ACLR and the control groups. Significant between-side differences for the ACLR group were evident for concentric quadriceps (p < 0.001) and concentric hamstring peak torque (p = 0.002), and hop distance (p < 0.001). CONCLUSION: Knee-specific symptoms and function, activity and quality of life were lower, and fear of re-injury was higher for participants with ACLR than controls. Side-to-side thigh muscle strength and hop distance deficits were evident for the ACLR group.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Joelho/fisiopatologia , Qualidade de Vida , Adulto , Estudos Transversais , Feminino , Músculos Isquiossurais/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Força Muscular , Medidas de Resultados Relatados pelo Paciente , Desempenho Físico Funcional , Músculo Quadríceps/fisiopatologia , Autorrelato , Coxa da Perna/fisiopatologia , Torque , Adulto Jovem
13.
Sports Health ; 13(2): 136-144, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33337984

RESUMO

BACKGROUND: Thigh muscle weakness after anterior cruciate ligament reconstruction (ACLR) can persist after returning to activity. While resistance training can improve muscle function, "nonfunctional" training methods are not optimal for inducing transfer of benefits to activities such as walking. Here, we tested the feasibility of a novel functional resistance training (FRT) approach to restore strength and function in an individual with ACLR. HYPOTHESIS: FRT would improve knee strength and function after ACLR. STUDY DESIGN: Case report. LEVEL OF EVIDENCE: Level 5. METHODS: A 15-year-old male patient volunteered for an 8-week intervention where he performed 30 minutes of treadmill walking, 3 times per week, while wearing a custom-designed knee brace that provided resistance to the thigh muscles of his ACLR leg. Thigh strength, gait mechanics, and corticospinal and spinal excitability were assessed before and immediately after the 8-week intervention. Voluntary muscle activation was evaluated immediately after the intervention. RESULTS: Knee extensor and flexor strength increased in the ACLR leg from pre- to posttraining (130 to 225 N·m [+74%] and 44 to 88 N·m [+99%], respectively) and increases in between-limb extensor and flexor strength symmetry (45% to 92% [+74%] and 47% to 72% [+65%], respectively) were also noted. After the intervention, voluntary muscle activation in the ACLR leg was 72%, compared with the non-ACLR leg at 75%. Knee angle and moment during late stance phase decreased (ie, improved) in the ACLR leg and appeared more similar to the non-ACLR leg after FRT training (18° to 14° [-23.4] and 0.07 to -0.02 N·m·kg-1·m-1 [-122.8%], respectively). Corticospinal and spinal excitability in the ACLR leg decreased (3511 to 2511 [-28.5%] and 0.42 to 0.24 [-43.7%], respectively) from pre- to posttraining. CONCLUSION: A full 8 weeks of FRT that targeted both quadriceps and hamstring muscles lead to improvements in strength and gait, suggesting that FRT may constitute a promising and practical alternative to traditional methods of resistance training. CLINICAL RELEVANCE: FRT may serve as a viable approach to improve knee strength and function after ACL reconstruction.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Terapia por Exercício/métodos , Joelho/fisiologia , Força Muscular , Treinamento de Resistência/métodos , Adolescente , Basquetebol/lesões , Fenômenos Biomecânicos , Braquetes , Desenho de Equipamento , Marcha/fisiologia , Músculos Isquiossurais/fisiologia , Humanos , Ligamentos Laterais do Tornozelo/lesões , Masculino , Tratos Piramidais/fisiologia , Músculo Quadríceps/fisiologia , Coxa da Perna/fisiologia
14.
Sports Health ; 13(1): 49-56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32790575

RESUMO

BACKGROUND: Patellofemoral pain (PFP) syndrome is closely associated with muscle tightness. However, studies regarding the effects of stretching exercises on PFP patients with inflexible hamstrings are scarce. The aim of the study was to compare the effects between static and dynamic hamstring stretching in patients with PFP who have inflexible hamstrings. HYPOTHESIS: Compared with static hamstring stretching, dynamic hamstring stretching will improve the parameters of hamstring flexibility, knee muscle strength, muscle activation time, and clinical outcomes in this patient population. STUDY DESIGN: Prospective randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 46 patients (25, static stretching; 21, dynamic stretching) participated. Hamstring flexibility was assessed according to the popliteal angle during active knee extension. Muscle strength and muscle activation time were measured using an isokinetic device. Clinical outcomes were evaluated using the visual analog scale (VAS) for pain and the anterior knee pain scale (AKPS). RESULTS: There were no differences in hamstring flexibility and knee muscle strength of the affected knees between the groups (P > 0.05). Significantly improved muscle activation time and clinical outcomes of the affected knees were observed in the dynamic stretching group compared with the static stretching group (all Ps < 0.01 for hamstring, quadriceps, VAS, and AKPS). CONCLUSION: In patients with PFP who have inflexible hamstrings, dynamic hamstring stretching with strengthening exercises was superior for improving muscle activation time and clinical outcomes compared with static hamstring stretching with strengthening exercises. CLINICAL RELEVANCE: Clinicians and therapists could implement dynamic hamstring stretching to improve function and reduce pain in patients with PFP who have inflexible hamstrings.


Assuntos
Músculos Isquiossurais/fisiologia , Exercícios de Alongamento Muscular/fisiologia , Síndrome da Dor Patelofemoral/terapia , Treinamento de Resistência , Humanos , Joelho/fisiologia , Força Muscular/fisiologia , Síndrome da Dor Patelofemoral/fisiopatologia , Estudos Prospectivos , Resultado do Tratamento
15.
Sports Health ; 13(1): 71-77, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32813597

RESUMO

CONTENT: Distance running is one of the most popular physical activities, and running-related injuries (RRIs) are also common. Foot strike patterns have been suggested to affect biomechanical variables related to RRI risks. OBJECTIVE: To determine the effects of foot strike techniques on running biomechanics. DATA SOURCES: The databases of Web of Science, PubMed, EMBASE, and EBSCO were searched from database inception through November 2018. STUDY SELECTION: The initial electronic search found 723 studies. Of these, 26 studies with a total of 472 participants were eligible for inclusion in this meta-analysis. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Means, standard deviations, and sample sizes were extracted from the eligible studies, and the standard mean differences (SMDs) were obtained for biomechanical variables between forefoot strike (FFS) and rearfoot strike (RFS) groups using a random-effects model. RESULTS: FFS showed significantly smaller magnitude (SMD, -1.84; 95% CI, -2.29 to -1.38; P < 0.001) and loading rate (mean: SMD, -2.1; 95% CI, -3.18 to -1.01; P < 0.001; peak: SMD, -1.77; 95% CI, -2.21 to -1.33; P < 0.001) of impact force, ankle stiffness (SMD, -1.69; 95% CI, -2.46 to -0.92; P < 0.001), knee extension moment (SMD, -0.64; 95% CI, -0.98 to -0.3; P < 0.001), knee eccentric power (SMD, -2.03; 95% CI, -2.51 to -1.54; P < 0.001), knee negative work (SMD, -1.56; 95% CI, -2.11 to -1.00; P < 0.001), and patellofemoral joint stress (peak: SMD, -0.71; 95% CI, -1.28 to -0.14; P = 0.01; integral: SMD, -0.63; 95% CI, -1.11 to -0.15; P = 0.01) compared with RFS. However, FFS significantly increased ankle plantarflexion moment (SMD, 1.31; 95% CI, 0.66 to 1.96; P < 0.001), eccentric power (SMD, 1.63; 95% CI, 1.18 to 2.08;P < 0.001), negative work (SMD, 2.60; 95% CI, 1.02 to 4.18; P = 0.001), and axial contact force (SMD, 1.26; 95% CI, 0.93 to 1.6; P < 0.001) compared with RFS. CONCLUSION: Running with RFS imposed higher biomechanical loads on overall ground impact and knee and patellofemoral joints, whereas FFS imposed higher biomechanical loads on the ankle joint and Achilles tendon. The modification of strike techniques may affect the specific biomechanical loads experienced on relevant structures or tissues during running.


Assuntos
Pé/fisiologia , Corrida/fisiologia , Tendão do Calcâneo/fisiologia , Tornozelo/fisiologia , Fenômenos Biomecânicos , Análise da Marcha , Humanos , Joelho/fisiologia , Fatores de Risco , Corrida/lesões , Estresse Mecânico
16.
Artigo em Inglês | MEDLINE | ID: mdl-33374580

RESUMO

The purpose of this study is to evaluate the differences in concentric isokinetic strength characteristics of the knee extensor and knee flexor musculature between international (IL) and non-international level (N-IL) soccer players. The second aim is to establish strength symmetry status in knee muscles for dominant (DL) and non-dominant (NDL) legs for both within and between groups. 100 male top elite soccer players (IL: n = 36, age = 27.5 ± 3.4 years and N-IL: n = 64, age = 27.7 ± 6.4 years) underwent concentric isokinetic strength tests, using a Biodex System 3 dynamometer. Results indicate that statistically significant differences between groups were noted for peak torque of hamstrings (PT-H), hamstrings/quadriceps (H/Q) ratio, and total work of hamstrings (TW-H), where mean values for the IL were similarly higher than for the N-IL group (p = 0.006, p < 0.001, and p = 0.012, respectively). Our results also showed statistically significant differences for peak torque of quadriceps (PT-Q), PT-H, total work of quadriceps (TW-Q) and TW-H between legs, where mean values noted for the DL were higher than for the NDL for both groups (p = 0.021, p < 0.001, p = 0.006, and p = 0.004, respectively). Additional results show that IL players presented more symmetrical strength between legs than N-IL. The results of this study indicate that that the greatest differences in isokinetic strength performance across players at different soccer levels relate to the hamstring muscle. As a result, systematic strength training of these muscle groups is strongly recommended.


Assuntos
Músculos Isquiossurais/fisiologia , Força Muscular , Músculo Quadríceps/fisiologia , Futebol , Adulto , Atletas , Lateralidade Funcional , Humanos , Joelho/fisiologia , Masculino , Torque , Adulto Jovem
17.
BMJ Open ; 10(12): e039857, 2020 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-33361075

RESUMO

INTRODUCTION: Knee osteoarthritis (KOA) is the most common cause of pain and disability worldwide. Dry cupping has been used as non-pharmacological approach to control pain and improve physical function. However, there is a lack of high-quality scientific evidence regarding its effects on this condition. This protocol describes a sham-controlled, randomised and simple blind study that aims to evaluate the effect of dry cupping on pain, function and quality of life in women with KOA. METHODS AND ANALYSIS: Sixty-two women diagnosed with KOA, based on American College of Rheumatology clinical criteria, and aged from 50 to 75 years, will be randomly distributed into two groups (31 per group): real and sham dry cupping. Both applications will occur with acrylic cups around the knee. The intervention will last 15 min, two times a week over six consecutive weeks, for a total of 12 sessions. Both groups will be assessed at four different times: before the intervention (T0), after 3 weeks intervention (T3), at the end of the protocol (T6) and 4 weeks after the interventions (follow-up: T10). The primary outcome will be pain intensity (Numerical Pain Rating Scale), and secondary outcomes will be knee-related health status (Western Ontario and McMaster Universities Osteoarthritis Index), functional capacity (8-step stair climb test, 40-metre fast-paced walk test and 30-second chair stand test), quality of life (Short-Form 36) and global perceived effect. ETHICS AND DISSEMINATION: This protocol was approved by the UFRN/FACISA Ethics Committee (number 3.737.688). The study results will be disseminated to the participants and submitted to a peer-reviewed journal and scientific meetings. TRIAL REGISTRATION NUMBER: NCT04331158.


Assuntos
Osteoartrite do Joelho , Qualidade de Vida , Idoso , Feminino , Humanos , Joelho , Articulação do Joelho , Pessoa de Meia-Idade , Osteoartrite do Joelho/terapia , Dor , Resultado do Tratamento
18.
PLoS One ; 15(10): e0239977, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33007010

RESUMO

The primary aim of the present study was to analyze mechanical responses during inertial knee- and hip-dominant hamstring strengthening exercises (flywheel leg-curl and hip-extension in conic-pulley), and the secondary aim was to measure and compare regional muscle use using functional magnetic resonance imaging. Mean power, peak power, mean velocity, peak velocity and time in the concentric (CON) and eccentric (ECC) phases were measured. The transverse relaxation time (T2) shift from pre- to post-exercise were calculated for the biceps femoris long (BFl) and short (BFs) heads, semitendinosus (ST) and semimembranosus (SM) muscles at proximal, middle and distal areas of the muscle length. Peak and mean power in flywheel leg-curl were higher during the CON than the ECC phase (p<0.01). ECC peak power was higher than CON phase (p<0.01) in conic-pulley hip-extension exercise, while mean power was higher during the CON than ECC phase (p<0.01). Flywheel leg-curl showed a higher T2 values in ST and BFs and BFl (p<0.05), while the conic-pulley hip-extension had a higher T2 values in the proximal region of the ST and BFl (p<0.05). In conclusion, ECC overload was only observed in peak power during the conic-pulley hip-extension exercise. Flywheel leg-curl involved a greater overall use of the 4 muscle bellies, more specifically in the ST and BFs, with a selective augmented activity (compared with the conic-pulley) in the 3 regions of the BFs, while conic-pulley hip-extension exercise selectively targeted the proximal and medial regions of the BFl. Physiotherapists and strength and conditioning coaches should consider this when optimizing the training and recovery process for hamstring muscles, especially after injury.


Assuntos
Atletas , Exercício Físico , Músculos Isquiossurais/fisiologia , Quadril/fisiologia , Joelho/fisiologia , Fenômenos Mecânicos , Futebol , Fenômenos Biomecânicos , Músculos Isquiossurais/diagnóstico por imagem , Quadril/diagnóstico por imagem , Humanos , Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Força Muscular , Suporte de Carga , Adulto Jovem
19.
PLoS One ; 15(10): e0238785, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052931

RESUMO

A human cadaveric specimen-specific knee model with appropriate soft tissue constraints was developed to appropriately simulate the biomechanical environment in the human knee, in order to pre-clinically evaluate the biomechanical and tribological performance of soft tissue interventions. Four human cadaveric knees were studied in a natural knee simulator under force control conditions in the anterior posterior (AP) and tibial rotation (TR) axes, using virtual springs to replicate the function of soft tissues. The most appropriate spring constraints for each knee were determined by comparing the kinematic outputs in terms of AP displacement and TR angle of the human knee with all the soft tissues intact, to the same knee with all the soft tissues resected and replaced with virtual spring constraints (spring rate and free length/degree). The virtual spring conditions that showed the least difference in the AP displacement and TR angle outputs compared to the intact knee were considered to be the most appropriate spring conditions for each knee. The resulting AP displacement and TR angle profiles under the appropriate virtual spring conditions all showed similar shapes to the individual intact knee for each donor. This indicated that the application of the combination of virtual AP and TR springs with appropriate free lengths/degrees was successful in simulating the natural human knee soft tissue function. Each human knee joint had different kinematics as a result of variations in anatomy and soft tissue laxity. The most appropriate AP spring rate for the four human knees varied from 20 to 55 N/mm and the TR spring rate varied from 0.3 to 1.0 Nm/°. Consequently, the most appropriate spring condition for each knee was unique and required specific combinations of spring rate and free length/degree in each of the two axes.


Assuntos
Joelho/fisiologia , Modelos Biológicos , Idoso , Fenômenos Biomecânicos , Cadáver , Simulação por Computador , Tecido Conjuntivo/anatomia & histologia , Tecido Conjuntivo/fisiologia , Feminino , Humanos , Joelho/anatomia & histologia , Articulação do Joelho/anatomia & histologia , Articulação do Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Rotação , Tíbia/anatomia & histologia , Tíbia/fisiologia , Torque
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3799-3802, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018828

RESUMO

Ultrasound (US) imaging of muscle has been introduced as a promising sensing modality for assistive device control. Ten able-bodied subjects completed level, incline and decline walking on a treadmill in a motion capture laboratory while wearing reflective markers on upper- and lower-body. A wearable US transducer was affixed to subjects' anterior thigh, and time-intensity features were extracted from transverse US images of the knee extensor muscles. These features were used to train and test Gaussian process regression models for continuous estimation of knee flexion/extension angular velocity. Four regression models were evaluated: (1) subject-dependent/task-specific, (2) subject-dependent/pooled-tasks, (3) subject-independent/task-specific, and (4) subject-independent/pooled-tasks. Subject-independent models were "tuned" with up to six strides of the test subject's data to boost performance. A two-factor analysis of variance test was used to assess the effect of each approach on root mean square error (RMSE) of estimated knee angular velocity (α=0.05). Statistical parametric mapping (SPM) was completed to compare actual vs. estimated knee angular velocity as a function of the gait cycle (α=0.05). For incline and level walking, the subject-dependent/pooled-tasks model resulted in the lowest error while the subject-dependent/task-specific model resulted in the lowest error for decline walk. Impressively, the two-factor test revealed no difference between task-specific and pooled-task models. Furthermore, despite capturing many important features of knee velocity across individuals there were, as expected, significant differences between subject-dependent and subject-independent models. Collectively, these results are promising for potential assistive device control with error rates <10% for all regression models that were tested.Clinical Relevance-This work is the first study to demonstrate the feasibility of using ultrasound-based sensing for estimation of knee angular velocity during multiple modes of ambulation.


Assuntos
Joelho , Caminhada , Marcha , Humanos , Joelho/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Ultrassonografia
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