Anterolateral ligament of the knee-Cadaver study in a Caucasian population / Ligamento anterolateral de la rodilla. Estudio en cadáver en una población caucásica

Introduction: Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships. Materials and methods: The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured. Results: The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from de tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament. Conclusions: The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.(AU)

Introducción: Aunque ha sido reconocida la importancia del ligamento anterolateral (ALL) en la estabilidad rotacional de la rodilla, algunos estudios siguen negando su existencia. Estudiamos la prevalencia del ALL en una población caucásica, así como sus características y relaciones anatómicas. Métodos: El estudio se realizó en 20 rodillas de 10 cadáveres embalsamados. Se utilizó un abordaje lateral, como lo describe Steven Claes, y se registraron las relaciones del ALL con el epicóndilo lateral, la arteria genicular inferior lateral, el menisco lateral, el tubérculo de Gerdy y la cabeza del peroné. También se midió el ancho y el largo. Resultados: El ALL fue identificado en 16 rodillas. Su origen estaba a una distancia inferior a 1mm posterior y proximal al epicóndilo femoral lateral y su inserción a una distancia media de 2,1±0,6mm de la superficie articular tibial, 20,6±1,3mm de la tuberosidad de Gerdy y 20,3±1,2mm de la cabeza del peroné. En todos los casos se presentaban fibras mutuas con el menisco lateral. El largo fue de 35,8±4,6mm y el ancho fue de 4,2±1,3/4,9±1,0/6,5±1,5mm en su tercio proximal, medio y distal. Conclusiones: El ALL se encontró en el 80% de las rodillas. Su origen está íntimamente relacionado con el ligamento colateral lateral y su inserción se encuentra a media distancia entre la cabeza del peroné y el tubérculo de Gerdy. En todos los casos comprobamos la conexión entre el ALL y el menisco lateral.(AU)

[Artículo traducido] Ligamento anterolateral de la rodilla. Estudio en cadáver en una población caucásica / Anterolateral ligament of the knee-Cadaver study in a Caucasian population

Introduction: Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships. Materials and methods: The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured. Results: The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from de tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament. Conclusions: The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.(AU)

Introducción: Aunque ha sido reconocida la importancia del ligamento anterolateral (ALL) en la estabilidad rotacional de la rodilla, algunos estudios siguen negando su existencia. Estudiamos la prevalencia del ALL en una población caucásica, así como sus características y relaciones anatómicas. Métodos: El estudio se realizó en 20 rodillas de 10 cadáveres embalsamados. Se utilizó un abordaje lateral, como lo describe Steven Claes, y se registraron las relaciones del ALL con el epicóndilo lateral, la arteria genicular inferior lateral, el menisco lateral, el tubérculo de Gerdy y la cabeza del peroné. También se midió el ancho y el largo. Resultados: El ALL fue identificado en 16 rodillas. Su origen estaba a una distancia inferior a 1mm posterior y proximal al epicóndilo femoral lateral y su inserción a una distancia media de 2,1±0,6mm de la superficie articular tibial, 20,6±1,3mm de la tuberosidad de Gerdy y 20,3±1,2mm de la cabeza del peroné. En todos los casos se presentaban fibras mutuas con el menisco lateral. El largo fue de 35,8±4,6mm y el ancho fue de 4,2±1,3/4,9±1,0/6,5±1,5mm en su tercio proximal, medio y distal. Conclusiones: El ALL se encontró en el 80% de las rodillas. Su origen está íntimamente relacionado con el ligamento colateral lateral y su inserción se encuentra a media distancia entre la cabeza del peroné y el tubérculo de Gerdy. En todos los casos comprobamos la conexión entre el ALL y el menisco lateral.(AU)

Efectividad de la diatermia por radiofrecuencia en el tratamiento de las patologías de rodilla. Una revisión sistemática / Effectiveness of radiofrequency diathermy in the treatment of knee pathologies. A systematic review

Objetivo La diatermia es una terapia que permite aumentar la temperatura y el metabolismo de los tejidos biológicos mediante la emisión de radiaciones electromagnéticas. A pesar de que esta forma de terapia está ampliamente extendida, no existen revisiones acerca de su utilidad en el tratamiento de patologías de rodilla. Por eso, en la presente revisión bibliográfica se valoró la efectividad de la diatermia por radiofrecuencia como tratamiento conservador en el abordaje de diferentes patologías de rodilla. Material y métodos Se realizó una búsqueda de ensayos clínicos controlados y aleatorizados en las bases de datos PubMed, Web of Science (WOS) y Scopus con las palabras clave «Radiofrequency», «Capacitive», «Resistive», «Dielectric», «Knee» y «Diathermy». Se seleccionaron ensayos clínicos aleatorizados publicados desde 2011 hasta la fecha actual, en inglés y en español. Para valorar la calidad de estos, se usó la escala PEDro. Resultados Cuatro ensayos clínicos aleatorizados fueron seleccionados atendiendo a los criterios de inclusión y exclusión. Todos ellos mostraron resultados positivos a favor del grupo experimental en las variables de dolor percibido y funcionalidad. Conclusión La diatermia por radiofrecuencia es una terapia no invasiva eficaz para mejorar la funcionalidad y reducir el dolor a corto plazo en pacientes con diferentes patologías de rodilla (AU)

Objective Radiofrequency diathermy is a treatment technique that increase temperature and metabolism of the biologic tissues by the emission of electromagnetic radiation. Even though this therapy is widely used, there are no reviews about its effectiveness in the treatment of knee pathologies. For this reason, the aim of this systematic review is to assess the efficacy of radiofrequency diathermy as conservative treatment for different knee pathologies. Methods A bibliographic search of randomized clinical trials was carried out in Pubmed, Scopus and WOS, using «Radiofrequency», «Capacitive», «Resistive», «Dielectric», «Knee» and «Diathermy» as descriptors. Only randomized clinical trials in English and Spanish from 2011 to date were chosen. PEDro scale was used to assess the quality of the studies. Results Four randomized clinical trials were selected according to the inclusion and exclusion criteria. All studies showed positive results in favor to the experimental group regarding pain reduction and knee function. Conclusions Radiofrequency diathermy is an effective non-invasive therapy to improve the quality of life, the functionality and the pain in short-term in patients with different knee conditions (AU)

A Health-Impact Assessment of an Ergonomic Measure to Reduce the Risk of Work-Related Lower Back Pain, Lumbosacral Radicular Syndrome and Knee Osteoarthritis among Floor Layers in The Netherlands.

Sand-cement-bound screed floor layers are at risk of work-related lower back pain, lumbosacral radicular syndrome and knee osteoarthritis, given their working technique of levelling screed with their trunk bent while mainly supported by their hands and knees. To reduce the physical demands of bending of the trunk and kneeling, a manually movable screed-levelling machine was developed for floor layers in the Netherlands. The aim of this paper is to estimate the potential health gains of working with a manually movable screed-levelling machine on the risk of lower back pain (LBP), lumbosacral radicular syndrome (LRS) and knee osteoarthritis (KOA) compared to traditional working techniques. This potential health gain was assessed using the epidemiological population estimates of the Population Attributable Fraction (PAF) and the Potential Impact Fraction (PIF), combined with work-related risk estimates for these three disorders from systematic reviews. The percentage of workers exceeding these risk estimates was based on worksite observations among 28 floor layers. For LBP, 16/18 workers were at risk when using traditional working techniques, with a PAF = 38%, and for those using a manually movable screed-levelling machine, this was 6/10 with a PIF = 13%. For LRS, these data were 16/18 with a PAF = 55% and 14/18 with a PIF = 18%, and for KOA, 8/10 with a PAF = 35% and 2/10 with a PIF = 26%. A manually movable screed-levelling machine might have a significant impact on the prevention of LBP, LRS and KOA among floor layers in the Netherlands, and health-impact assessments are a feasible approach for assessing health gains in an efficient way.

An integrated evaluation approach of wearable lower limb exoskeletons for human performance augmentation.

Wearable robots have been growing exponentially during the past years and it is crucial to quantify the performance effectiveness and to convert them into practical benchmarks. Although there exist some common metrics such as metabolic cost, many other characteristics still needs to be presented and demonstrated. In this study, we developed an integrated evaluation (IE) approach of wearable exoskeletons of lower limb focusing on human performance augmentation. We proposed a novel classification of trial tasks closely related to exoskeleton functions, which were divided into three categories, namely, basic trial at the preliminary phase, semi-reality trial at the intermediate phase, and reality trial at the advanced phase. In the present study, the IE approach has been exercised with a subject who wore an active power-assisted knee (APAK) exoskeleton with three types of trial tasks, including walking on a treadmill at a certain angle, walking up and down on three-step stairs, and ascending in 11-storey stairs. Three wearable conditions were carried out in each trial task, i.e. with unpowered exoskeleton, with powered exoskeleton, and without the exoskeleton. Nine performance indicators (PIs) for evaluating performance effectiveness were adopted basing on three aspects of goal-level, task-based kinematics, and human-robot interactions. Results indicated that compared with other conditions, the powered APAK exoskeleton make generally lesser heart rate (HR), Metabolic equivalent (METs), biceps femoris (BF) and rectus femoris (RF) muscles activation of the subject at the preliminary phase and intermediate phase, however, with minimal performance augmentation at advanced phase, suggesting that the APAK exoskeleton is not suitable for marketing and should be further improved. In the future, continuous iterative optimization for the IE approach may help the robot community to attain a comprehensive benchmarking methodology for robot-assisted locomotion more efficiently.

[Automatic modeling of the knee joint based on artificial intelligence].

Objective: To investigate an artificial intelligence (AI) automatic segmentation and modeling method for knee joints, aiming to improve the efficiency of knee joint modeling. Methods: Knee CT images of 3 volunteers were randomly selected. AI automatic segmentation and manual segmentation of images and modeling were performed in Mimics software. The AI-automated modeling time was recorded. The anatomical landmarks of the distal femur and proximal tibia were selected with reference to previous literature, and the indexes related to the surgical design were calculated. Pearson correlation coefficient ( r) was used to judge the correlation of the modeling results of the two methods; the consistency of the modeling results of the two methods were analyzed by DICE coefficient. Results: The three-dimensional model of the knee joint was successfully constructed by both automatic modeling and manual modeling. The time required for AI to reconstruct each knee model was 10.45, 9.50, and 10.20 minutes, respectively, which was shorter than the manual modeling [(64.73±17.07) minutes] in the previous literature. Pearson correlation analysis showed that there was a strong correlation between the models generated by manual and automatic segmentation ( r=0.999, P<0.001). The DICE coefficients of the 3 knee models were 0.990, 0.996, and 0.944 for the femur and 0.943, 0.978, and 0.981 for the tibia, respectively, verifying a high degree of consistency between automatic modeling and manual modeling. Conclusion: The AI segmentation method in Mimics software can be used to quickly reconstruct a valid knee model.

Generalized joint hypermobility subjects without knee hyperextension have greater walking anterior tibial translation and flexion angle than those with knee hyperextension.

BACKGROUND: The walking knee kinematic results of generalized joint hypermobility (GJH) subjects were controversial in previous studies. We proposed that this could be related to the knee statuses of GJH subjects with/without knee hyperextension (KH) and assumed that there are significant sagittal knee kinematic differences between GJH subjects with/without KH during gait. RESEARCH QUESTION: Do GJH subjects with KH exhibit significantly different kinematic characteristics than those without KH during walking? METHODS: 35 GJH subjects without KH, 34 GJH subjects with KH, and 30 healthy controls were recruited in this study. A three-dimensional gait analysis system was used to record and compare the knee kinematics of the participants. RESULTS: Significant walking knee kinematics differences were found between GJH subjects with/without KH during walking. GJH subjects without KH had greater flexion angles (4.7-6.0°, 24-53 % gait cycle (GC), p < 0.001; 5.1-6.1°, 65-77 % GC, p = 0.008) and anterior tibial translation (ATT) (3.3-4.1 mm, 0-4 % GC, p = 0.015; 3.8-4.3 mm, 91-100 % GC, p = 0.01) than those with KH. Compared to controls, GJH without KH exhibited increased ATT (4.0-5.7 mm, 0-26 % GC, p < 0.001; 5.1-6.7 mm, 78-100 % GC, p < 0.001), and range of motion of ATT (3.3 mm, p = 0.028) whereas GJH with KH only exhibited increased extension angle (6.9-7.3°, 62-66 % GC, p = 0.015) during walking. SIGNIFICANCE: The findings confirmed the hypothesis and suggested that GJH subjects without KH had more walking ATT and flexion angle asymmetries than those with KH. This may raise concerns about the differences in knee health and risk of knee diseases between GJH subjects with/without KH. However, further investigations should be done to explore the exact influence of walking ATT and flexion angle asymmetries in GJH subjects without KH.

The use of a 30-degree radiolucent triangle during surgery in distal avulsion fractures of the patella.

BACKGROUND: Avoiding patella baja or alta after the Krackow suture technique for distal avulsion fractures of the patella can be challenging. We aim to introduce a simple and reproducible technique using a 30-degree radiolucent triangle involving the contralateral knee to ensure the correct positioning of the patella intraoperatively. METHOD: The radiolucent triangle is positioned under the contralateral knee before operating the injured knee. A strict lateral view is obtained using fluoroscopy as a reference before a Krackow technique is performed on the avulsion fracture of the patella. RESULTS: The triangle technique is straightforward and easily reproducible by surgeons of all levels. It allows the surgeon to correctly position the patella intraoperatively in avulsion fracture repair and modify tension on the patellar tendon. CONCLUSION: This method avoids millimetric mispositioning of the operated patella, thus improving the management intraoperatively and could decrease postoperative complications.

The Influence of Hip and Knee Joint Angles on Quadriceps Muscle-Tendon Unit Properties during Maximal Voluntary Isometric Contraction.

Determining how the quadriceps femoris musculotendinous unit functions, according to hip and knee joint angles, may help with clinical decisions when prescribing knee extension exercises. We aimed to determine the effect of hip and knee joint angles on structure and neuromuscular functioning of all constituents of the quadriceps femoris and patellar tendon properties. Twenty young males were evaluated in four positions: seated and supine in both 20° and 60° of knee flexion (SIT20, SIT60, SUP20, and SUP60). Peak knee extension torque was determined during maximal voluntary isometric contraction (MVIC). Ultrasound imaging was used at rest and during MVIC to characterize quadriceps femoris muscle and tendon aponeurosis complex stiffness. We found that peak torque and neuromuscular efficiency were higher for SUP60 and SIT60 compared to SUP20 and SIT20 position. We found higher fascicle length and lower pennation angle in positions with the knee flexed at 60°. The tendon aponeurosis complex stiffness, tendon force, stiffness, stress, and Young's modulus seemed greater in more elongated positions (60°) than in shortened positions (20°). In conclusion, clinicians should consider positioning at 60° of knee flexion rather than 20°, regardless if seated or supine, during rehabilitation to load the musculotendinous unit enough to stimulate a cellular response.

A Novel Classification of Coronal Plane Knee Joint Instability Using Nine-Axis Inertial Measurement Units in Patients with Medial Knee Osteoarthritis.

The purpose of this study was to propose a novel classification of varus thrust based on gait analysis with inertial motion sensor units (IMUs) in patients with medial knee osteoarthritis (MKOA). We investigated thigh and shank acceleration using a nine-axis IMU in 69 knees with MKOA and 24 (control) knees. We classified varus thrust into four phenotypes according to the relative medial-lateral acceleration vector patterns of the thigh and shank segments: pattern A (thigh medial, shank medial), pattern B (medial, lateral), pattern C (lateral, medial), and pattern D (lateral, lateral). Quantitative varus thrust was calculated using an extended Kalman filter-based algorithm. We compared the differences between our proposed IMU classification and the Kellgren-Lawrence (KL) grades for quantitative varus thrust and visible varus thrust. Most of the varus thrust was not visually perceptible in early-stage OA. In advanced MKOA, increased proportions of patterns C and D with lateral thigh acceleration were observed. Quantitative varus thrust was significantly increased stepwise from patterns A to D. This novel IMU classification has better clinical utility due to its ability to detect subtle kinematic changes that cannot be captured with conventional motion analysis even in the early stage of MKOA.

The Kinetic Chain Has a Brain: Could Adding Cognitive Demands in Lower Limb Injury Prevention Programs Improve Outcomes?

SYNOPSIS: The most effective lower limb injury prevention programs include strength training, balance exercises, and instructions on how to land safely from a jump or hop. Yet, the programs are not 100% effective-lower extremity noncontact injuries continue to be a significant problem. We suggest that adding cognitive training to motor tasks that currently comprise current lower limb injury prevention programs might help clinicians, athletes, and coaches continue to make inroads into preventing knee injuries. We ground our hypotheses in robust findings from cognitive neuroscience and rehabilitation, suggesting that when task demands exceed the attentional capacity of an individual, the risk for noncontact lower extremity injuries increases. In this editorial, we explain the concepts of attentional capacity and attentional demands, and the interplay of the two in sport, to justify including cognitive tasks to injury prevention programs to improve outcomes. J Orthop Sports Phys Ther 2023;53(4):1-3. doi:10.2519/jospt.2023.11403.

Effects of Bilateral Extracephalic Transcranial Direct Current Stimulation on Lower Limb Kinetics in Countermovement Jumps.

OBJECTIVE: Transcranial direct current stimulation (tDCS) is an effective method for improving sports/exercise performance in humans. However, studies examining the effects of tDCS on jumping performance have reported inconsistent findings, and there is a paucity of studies investigating the effects of tDCS on lower limb energy and kinetics in countermovement jumps (CMJs). Thus, we investigated the effects of tDCS on countermovement jump (CMJ) performance and analysed kinetic variations in the ankle, knee, and hip joints. METHODS: In total, 15 healthy young participants randomly received anodal or sham bilateral stimulation of the primary motor cortex (M1). The bilateral tDCS (Bi-tDCS) montage used an intensity of 2 mA for a 20 min monophasic continuous current. Jump height, energy, and lower limb kinetic data in CMJs were collected at pre-stimulation (Pre), post-0 min (Post-0), and post-30 min (Post-30) using a motion capture system and two 3D force plates. Jump height, lower extremity energy, and kinetic variables in CMJs were analysed with two-way repeated-measures ANOVA. RESULTS: (1) Compared to the baseline and sham conditions, the jump height increased except that at Post-30 relative to the sham condition, and the total net energy of lower limbs increased at Post-30 relative to the baseline. (2) Compared to the baseline, the ankle positive energy and net energy decreased in the sham condition; Compared to the baseline and values at Post-0, the maximum ankle torque at Post-30 decreased in both stimulation conditions. (3) The maximum knee power increased compared to the baseline and sham conditions. (4) Regardless of time points, the maximum hip torque in the tDCS condition was higher than it was in the sham condition. CONCLUSION: Bi-tDCS is an effective method for improving jump height by modulating ankle and knee net energy. The net energy improvement of the lower extremities may be due to variation in the kinetic chain resulting from tDCS-enhanced knee exploration force and maximum hip strength in CMJs. The effects of Bi-tDCS gradually decrease.

Can radiological findings detect neuropathic pain in patients with osteoarthritis of the knee undergoing surgery?

OBJECTIVES: The mechanism underlying neuropathic pain (NP) in osteoarthritis (OA) of the knee is not completely understood. This study aimed to investigate whether possible NP in patients with knee OA undergoing knee surgery is associated with specific radiological findings. METHODS: This study included 197 patients who underwent knee surgery for symptomatic knee OA. Clinical evaluation was performed using the Central Sensitization Inventory (CSI), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and PainDETECT questionnaire. Radiological evaluation was performed using the hip-knee-ankle (HKA) angle, posterior tibial slope (PTS), varus and valgus laxities, and magnetic resonance imaging OA Knee Score (MOAKS). Radiological findings were compared between patients with possible and unlikely NP. Logistic regression analysis was performed to identify the predictive factors for NP. RESULTS: There were 163 and 34 patients with unlikely NP and with possible NP, respectively. The percentage of patients with CSI score ≥ 40 was significantly higher in the possible NP group than in the unlikely NP group (17.6% vs. 6.1%). Patients with possible NP had worse WOMAC scores than patients with unlikely NP. There were no significant positive associations between the possible NP and radiological findings in knee OA. Regression analysis showed no predictive factors for possible NP. CONCLUSIONS: Possible NP is not associated with specific radiological findings in knee OA. Patients with possible NP may mediate CS and experience more severe symptoms, including decreased knee function and lower quality of life, than patients with unlikely NP.

Characterization of Static Strength, Vertical Jumping, and Isokinetic Strength in Soccer Players According to Age, Competitive Level, and Field Position.

Muscular strength is strongly related to speed and agility tasks, which have been described as the most decisive actions preceding goals in the soccer game. This study aimed to characterize the players' strength indicators and to analyze the variation associated with age, competition level, and positional role. Eighty-three male soccer players from A team (n = 22), B team (n = 17), U-23 (n = 19), and U-19 (n = 25) participated in this study. Handgrip strength was assessed using a hand dynamometer (Jamar Plus+), countermovement jump (CMJ) and the squat jump (SJ) were evaluated using Optojump Next, and a Biodex System 4 Pro Dynamometer was used to assess the isokinetic strength of knee extension/flexion. Team A players showed increased lower-body strength compared to their peers, mainly through their increased vertical jumping capacity (i.e., CMJ and SJ; ps < 0.019), and superior performance in isokinetic assessments (i.e., peak torque, total work, and average power). Overall, older players outperformed their younger peers regarding vertical jumping, static strength, and average power in isokinetic strength (ps < 0.005). This study emphasizes the superior strength levels of professional soccer players compared with their lower-division peers, even after controlling by age. This information is of great value to sports agents and coaches, underlining the need to design and include strength-specific content during soccer training.

A numerical study towards shape memory alloys application in orthotic management of pediatric knee lateral deviations.

Exerting a constant load would likely improve orthosis effectiveness in treating knee lateral deviations during childhood and early adolescence. Shape memory alloys are potential candidates for such applications due to their so called pseudoelastic effect. The present study aims to quantitatively define the applicable mechanical loads, in order to reduce treatment duration while avoiding tissular damage and patient discomfort. This is essential for performing a more efficient design of correction devices. We use a patient-specific finite elements model of a pediatric knee to determine safe loading levels. The achievable correction rates are estimated using a stochastic three-dimensional growth model. Results are compared against those obtained for a mechanical stimulus decreasing in proportion to the achieved correction, emulating the behavior of conventional orthoses. A constant flexor moment of 1.1 Nm is estimated to change femorotibial angle at a rate of (7.4 ± 4.6) deg/year (mean ± std). This rate is similar to the achieved by more invasive growth modulation methods, and represents an improvement in the order of 25% in the necessary time for reducing deformities of (10 ± 5) deg by half, as compared with conventional orthoses.

Impact of Pilates mat-based exercises on knee kinematics during running.

INTRODUCTION: Core strengthening, balance, and flexibility programs such as Pilates have been advocated to positively impact running mechanics and prevent lower extremity injuries. The purpose of this study was to assess the effects of a 12-week mat-based Pilates exercise program on dynamic knee valgus alignment in runners. METHODS: Thirty-four novice runners, including young male and female adults performed a running protocol at baseline. The protocol consisted of the participants running on a treadmill at a constant five miles per hour (mph) for 4 min. Post-examination, participants were randomly assigned to a Pilates or control group (n = 16 and n = 18, respectively). A certified Pilates instructor gave the Pilates group a 12-week home-based program. To ensure participants in the Pilates group performed exercises correctly, the Pilates instructor conducted the first session, and provided feedback to each participant. Participants in both groups performed the same running testing protocol every four weeks. Knee valgus was measured as the medial displacement of the knee joint center during the running stance phase. Repeated measures Analysis of Variance (RepANOVA) was calculated at baseline and 4-, 8-, and 12-weeks post examinations to compare knee valgus during running. RESULTS: Although a reduction in dynamic knee valgus was observed within the Pilates group, the RepANOVA analysis revealed this change was not statistically significant. CONCLUSIONS: Pilates mat-based exercises may improve knee valgus after 12 weeks but a larger sample size, longer intervention duration, or a supervised program should be considered for future research to evaluate its effectiveness.

Genicular nerve radiofrequency ablation: An option for knee osteoarthritis pain.

ABSTRACT: Genicular nerve radiofrequency ablation is an option to treat osteoarthritic knee pain unresponsive to conservative and minimally invasive measures. This article reviews genicular nerve radiofrequency ablation, neuroanatomy of the knee, patient selection, results, and risks and complications of the procedure.

Shorter High-Intensity Cycling Intervals Reduce Performance and Perceived Fatigability at Work-Matched but Not Task Failure.

INTRODUCTION: The intensity, duration, and distribution of work and recovery phases during high-intensity interval training (HIIT) modulate metabolic perturbations during exercise and subsequently influence the development of performance fatigability and exercise tolerance. This study aimed to characterize neuromuscular, perceptual, and cardiorespiratory responses to work-to-rest ratio-matched HIIT protocols differing in work and rest interval duration. METHODS: Twelve healthy individuals (six women) first completed a ramp incremental test to determine 90% of peak power output, and then in three randomized visits, they completed three cycling protocols to task failure at 90% of peak power output: (i) 3- to 3-min work-to-passive rest ratio HIIT (HIIT 3min ), (ii) 1- to 1-min work-to-passive rest ratio HIIT (HIIT 1min ), and (iii) constant load (CL). Interpolated twitch technique, including maximal voluntary isometric knee extensions and femoral nerve electrical stimuli, was performed at baseline, every 6 min of work, and task failure. Perceptual and cardiorespiratory responses were recorded every 3 min and continuously across the exercises, respectively. RESULTS: The work completed during HIIT 1min (8447 ± 5124 kJ) was considerably greater than HIIT 3min (1930 ± 712 kJ) and CL (1076 ± 356) ( P < 0.001). At work-matched, HIIT 1min resulted in a lesser decline in maximal voluntary contraction and twitch force compared with HIIT 3min and CL ( P < 0.001). Perceived effort, pain, and dyspnea were least in HIIT 1min and HIIT 3min compared with CL ( P < 0.001). At task failure, HIIT 1min resulted in less voluntary activation than HIIT 3min ( P = 0.010) and CL ( P = 0.043), and engendered less twitch force decline than CL ( P = 0.021). CONCLUSIONS: Overall, the mitigated physiological and perceptual responses during shorter work periods (HIIT 1min ) enhance exercise tolerance in comparison to longer work intervals at the same intensity (HIIT 3min , CL).

Weaker Quadriceps Corticomuscular Coherence in Individuals after ACL Reconstruction during Force Tracing.

PURPOSE: This study aimed to compare quadriceps corticomuscular coherence (CMC) and force steadiness between individuals with anterior cruciate ligament reconstruction (ACLR) and uninjured controls during a force tracing task. METHODS: Individuals with ACLR ( n = 20) and controls ( n = 20) performed a knee extension force-control task at 50% of maximal voluntary effort. Electrocortical activity, electromyographic activity, and torque output were recorded concurrently. CMC in beta (13-30 Hz) and gamma (31-80 Hz) frequency bands was assessed using partial directed coherence between the contralateral motor cortex (e.g., C4-C2-Cz electrodes) and the ipsilateral quadriceps muscles (e.g., left vastus medialis and lateralis). Force steadiness was quantified using root-mean-square error and coefficient of variation. Active motor threshold was determined using transcranial magnetic stimulation. Differences between groups (ACLR vs control) and limbs (involved vs uninvolved) were assessed using peak knee extension strength and active motor threshold as a priori covariates. RESULTS: Participants with ACLR had lower gamma band connectivity bilaterally when compared with controls (vastus medialis: d = 0.8; vastus lateralis: d = 0.7). Further, the ACLR group demonstrated worse quadriceps force steadiness (root-mean-square error, d = 0.5), lower involved limb quadriceps strength ( d = 1.1), and higher active motor threshold ( d = 1.0) compared with controls. CONCLUSIONS: Lower quadriceps gamma band CMC in the ACLR group suggests lower cortical drive (e.g., corticomotor decoupling) to the quadriceps compared with matched controls. Further, the ACLR group demonstrated worse quadriceps force steadiness, suggesting impaired ability to modulate quadriceps neuromuscular control. Notably, CMC differences were present only in the gamma frequency band, suggesting impairments may be specific to multisensory integration and force modulation.