Evaluation of Strength and Functional Ability of Soccer Players Two Years After Anterior Cruciate Ligament Reconstruction: A Cross-sectional Study.

OBJECTIVES: This study examines the strength and functional capacity of active soccer players two years post anterior cruciate ligament reconstruction (ACLR). METHODS: Sixteen players, two years post ACLR, participated. Isokinetic tests assessed Peak Torque (PT) for concentric and eccentric contractions, along with conventional (H/Qconv) and functional (H/Qfunc) H/Q ratios at various angular velocities. Functional ability was gauged through hop tests. Paired-Samples T Test compared PT and hop test values, as well as H/Qconv and H/Qfunc ratios between involved and non-involved limbs. Limb symmetry was evaluated using the Limb Symmetry Index (LSI). RESULTS: After two years, participants exhibited significant differences in concentric PT between limbs. The non-involved limb demonstrated superior performance at isokinetic speeds. Eccentrically, PT for knee extensors and flexors showed no significant disparities between the operated and non-operated limbs across all velocities tested. Most participants did not achieve LSI 90-110% for knee extensors and flexors. No noteworthy distinctions were observed in H/Qconv, H/Qfunc, and hop tests between limbs. The majority met LSI 90-110% in hop tests, except in the 30-second side hop (37%). CONCLUSIONS: Two years post ACLR, soccer players still manifest strength and functional deficits, heightening the risk of injury.

Does strength deficit correlate with shoulder function in patients with rotator cuff tears? Characteristics of massive tears.

BACKGROUND: The correlation between shoulder strength deficits and function in rotator cuff tears remains uncertain. This study aimed to determine the correlation between shoulder strength deficits and shoulder function evaluated by various clinical scoring systems. METHODS: A total of 262 patients (mean age, 59.67 years [standard deviation, 8.06 years]) who underwent full-thickness rotator cuff repair were included. Patients in group I (n = 188) had small to large rotator cuff tears, whereas those in group II (n = 74) had massive rotator cuff tears. Demographic factors, isokinetic test results, and shoulder function evaluated using various scoring systems were obtained. Correlation differences according to severity of the rotator cuff tear were evaluated. RESULTS: We found weak correlations between shoulder strength deficits (peak torque and total work) and clinical outcomes in patients with rotator cuff tears (r = -0.288). For patients in group I (nonmassive tears), we found a weaker correlation (r = -0.242) according to the tear pattern. However, shoulder strength deficits in group II patients (massive tears) were strongly correlated with American Shoulder and Elbow Surgeons (r = -0.598), Constant (r = -0.582), and Short Form 36 (r = -0.511) scores, especially regarding internal rotator strength deficits. CONCLUSIONS: Shoulder strength deficits measured via isokinetic testing and shoulder function were weakly correlated in patients with rotator cuff tears. However, shoulder strength deficits in patients with massive tears considerably worsened shoulder function and systemic disability, but not regional disability. In particular, internal rotator strength deficits were strongly correlated with poor shoulder function.

Quantitative Elastosonography of the Myotendinous Junction: Normal Behavior and Correlation With a Standard Measurement System During Functional Tests.

OBJECTIVES: In recent years, an increasing need to use imaging to assess normal and adaptive muscle function, in addition to its anatomy and structure, has emerged. We evaluated the myotendinous junction's elastosonographic behavior in light of the most recent literature on its physiologic behavior. The elastosonographic studies were compared with the results obtained from a standard measurement system to ensure a correlation with maximal muscle contraction. METHODS: Nineteen male professional soccer players were assessed during functional tests. The participants performed 5 repetitions at 60°/s to assess muscle strength and 3 repetitions at 30°/s to assess the maximum force peak of thigh muscles. The participants were monitored by a strength-power measurement system and an ultrasound machine equipped with multifrequency (18-6-MHz) linear array transducers. RESULTS: The 19 soccer players were aged between 19 and 34 years (mean age, 28 years). For the right rectus femoris, the results of the elastosonographic studies showed a mean elasticity value ± SD of 30.75% ± 10.05% with the muscle relaxed and a value of 13.75% ± 8.44% during contraction (mean decrease, 17.00% ± 11.71%). Elasticity values were 36.48% ± 8.39% before contraction and 8.77% ± 6.55% during contraction of the left rectus femoris muscle (mean decrease, 27.71% ± 11.95%). For 30° eccentric contraction of the left leg, correlation with the standard measurement system showed Pearson r values of -0.53 and -0.51 when comparing force peak and mean work, respectively, with elasticity values. CONCLUSIONS: Our study shows that strain elastosonographic quantification of muscle elasticity seems to match the expected physiologic and biomechanical behavior of the myotendinous junction.

Clinical comparison of the two-stranded single and four-stranded double Krackow techniques for acute Achilles tendon ruptures.

PURPOSE: Several different Krackow stitch configurations have been used for acute Achilles tendon rupture repair. Although several biomechanical studies compared different Krackow stitch configurations, to our knowledge, no previous studies compared the clinical outcome of these different suture methods. Therefore, in this study, we aimed to compare the clinical outcomes and complications of the two-stranded single and four-stranded double Krackow techniques. METHODS: Sixty-eight consecutive patients who underwent open repair by using the four-stranded double Krackow (33 patients, group A) or the two-stranded single Krackow (35 patients, group B) techniques between September 2011 and August 2014 were reviewed retrospectively. The isokinetic strength of plantar flexion and dorsiflexion of both ankles was assessed on a Cybex dynamometer 3 and 6 months after surgery. Clinical outcomes were evaluated 3, 6, and 12 months post-operatively. RESULTS: No significant differences were found between the groups regarding patient demographics or activity levels prior to treatment. Significant differences in the Achilles tendon Total Rupture Score, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score, or the four-point Boyden scale were not found at any time during follow-up. Rerupture occurred only in one patient from group A. No significant differences were observed between the groups regarding the isokinetic plantar flexion and dorsiflexion strength at any time or any test speed. CONCLUSION: Equally favourable clinical outcomes and isokinetic muscle strength and a low complication rate were achieved with the two-stranded single Krackow technique as compared with the four-stranded double Krackow technique for acute Achilles tendon rupture repair. LEVEL OF EVIDENCE: III.

Core stability training on lower limb balance strength.

This study aimed to assess the effects of core stability training on lower limbs' muscular asymmetries and imbalances in team sport. Twenty footballers were divided into two groups, either core stability or control group. Before each daily practice, core stability group (n = 10) performed a core stability training programme, while control group (n = 10) did a standard warm-up. The effects of the core stability training programme were assessed by performing isokinetic tests and single-leg countermovement jumps. Significant improvement was found for knee extensors peak torque at 3.14 rad · s(-1) (14%; P < 0.05), knee flexors peak torque at 1.05 and 3.14 rad · s(-1) (19% and 22% with P < 0.01 and P < 0.01, respectively) and peak torque flexors/extensors ratios at 1.05 and 3.14 rad · s(-1) (7.7% and 8.5% with P < 0.05 and P < 0.05, respectively) only in the core stability group. The jump tests showed a significant reduction in the strength asymmetries in core stability group (-71.4%; P = 0.02) while a concurrent increase was seen in the control group (33.3%; P < 0.05). This study provides practical evidence in combining core exercises for optimal lower limbs strength balance development in young soccer players.

Combined chronic anterior cruciate ligament and posterior cruciate ligament reconstruction: functional and clinical results.

PURPOSE: Multiligamentous injury to the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) is an uncommon but debilitating event. Patients with combined ligament injuries typically complain of painful, debilitating knee instability that restricts their sports and daily activities. The purpose of this retrospective study was to evaluate functional and clinical outcomes of patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot. METHODS: Medical records of 20 consecutive patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot were retrospectively reviewed. All patients had received either an allograft (group A) or a semitendinosus-gracilis graft for ACL repair and a bone-patellar tibial-bone graft for PCL repair (group B). Functional outcomes, after the initial follow-up period at 24-month FU, were assessed with concentric isokinetic knee extensor-flexor testing at 60 and 180°/s. The secondary aim was to compare long-term clinical recovery by the administration of the IKDC (International Knee Document Committee) Knee Ligament Evaluation Form, the Lysholm Knee Scoring Scale and the Cincinnati Knee Rating Scale. RESULTS: The mean per cent quadriceps strength deficit in the operated as compared to the healthy knee was 13.5 % in group A and 15 % in group B (angular velocity 60°/s) and 13.5 % in group A and 9.4 % in group B (angular velocity 180°/s). The mean per cent flexor strength deficit in the operated as compared to the healthy knee was 10.4 % in group A and 12.3 % in group B (angular velocity 60°/s) and 12.2 % in group A and 9 % in group B (angular velocity of 180°/s). The flexor-quadriceps ratio was 49.4 % in group A and 48.8 % in group B in the healthy knee and 53.2 % in group A and 53.8 % in group B in the operated knee (angular velocity 60°/s) and 63.9 % in group A and 60.7 % in group B in the healthy knee and 65 % in group A and 64.9 % in group B in the operated knee (angular velocity 180°/s). Lysholm outcome was 93.9 ± 3.9 in group A and 89.1 ± 7.6 in group B (n.s). Cincinnati score was 89.6 ± 7.3 in group A and 91.0 ± 6.9 in group B (p = 0.791). IKDC results were group A in six patients (60 %), group B in three patients (30 %) and group C in one patient (10 %) in the allograft group and group A in seven patients (70 %) and group B in three patients (30 %) for autologous group. CONCLUSIONS: The results of this study suggest that one-stage arthroscopic bicruciate ligament reconstruction can restore good knee joint function. Surgical treatment should be followed by a comprehensive rehabilitation programme with specific goals, objectives and strategies, including pain management and assessment of progress in recovery of joint function and perception of knee stability. LEVEL OF EVIDENCE: Retrospective case series, Level IV.

Isokinetic Testing in Evaluation Rehabilitation Outcome After ACL Reconstruction.

INTRODUCTION: Numerous rehab protocols have been used in rehabilitation after ACL reconstruction. Isokinetic testing is an objective way to evaluate dynamic stability of the knee joint that estimates the quality of rehabilitation outcome after ACL reconstruction. Our investigation goal was to show importance of isokinetic testing in evaluation thigh muscle strength in patients which underwent ACL reconstruction and rehabilitation protocol. SUBJECTS AND METHODS: In prospective study, we evaluated 40 subjects which were divided into two groups. Experimental group consisted of 20 recreational males which underwent ACL reconstruction with hamstring tendon and rehabilitation protocol 6 months before isokinetic testing. Control group (20 subjects) consisted of healthy recreational males. In all subjects knee muscle testing was performed on a Biodex System 4 Pro isokinetic dynamo-meter et velocities of 60°/s and 180°/s. We followed average peak torque to body weight (PT/BW) and classic H/Q ratio. In statistical analysis Student's T test was used. RESULTS: There were statistically significant differences between groups in all evaluated parameters except of the mean value of PT/BW of the quadriceps et velocity of 60°/s (p>0.05). CONCLUSION: Isokinetic testing of dynamic stabilizers of the knee is need in diagnostic and treatment thigh muscle imbalance. We believe that isokinetic testing is an objective parameter for return to sport activities after ACL reconstruction.

A comparison between hypertonic dextrose prolotherapy and conventional physiotherapy in patients with knee osteoarthritis.

The aim of the present study was to compare the efficacy of hypertonic dextrose prolotherapy (HDP) with conventional physiotherapy (CPT) in improving symptoms in females with knee osteoarthritis (OA). The present study included 60 patients with a diagnosis of knee OA. The patients were randomly assigned to the HDP (n=30) and CPT (n=30) groups. The patients in the HDP group were treated with a dextrose injection into the knee joint (25% dextrose) and around the knee (15% dextrose) in two sessions for 1 month, while those in the CPT group received a hot pack, transcutaneous electrical nerve stimulation and therapeutic ultrasound in five sessions a week for 4 weeks. Prior to commencing the treatment, and at 1 and 3 months post-treatment, all the patients were evaluated using the visual analog scale (VAS), Western Ontario and McMaster Osteoarthritis Index (WOMAC), the goniometric measurement of active knee range of motion (ROM), a 50-m walking test and isokinetic knee muscle strength measurements. There were no statistically significant differences between the two groups as regards the demographic characteristics at pre-treatment (P>0.05). However, at 1 and 3 months post-treatment, the scores of all the outcome parameters were significantly improved in the HDP group compared with the CPT group (P<0.05 for all). In both groups, a significant improvement was observed in the VAS scores, WOMAC total values and ROM following the treatments, with the greatest improvement observed in the HDP group (P<0.001). The isokinetic quadriceps peak torque measurements were increased in both groups following treatment. All the scores exhibited a statistically significant improvement in the HDP group at both 1 and 3 months post-treatment. On the whole, the results of the present study demonstrate that both HDP and CPT are effective treatment modalities to relieve pain, and increase functionality and strength in patients with knee OA. However, greater improvements in pain and functionality can be achieved with prolotherapy.

Assessment of Isokinetics and Range of Motion of the Shoulder in Patients after Reverse Shoulder Arthroplasty in the Late Follow-Up Period.

(1) Background: The aim of the study was to evaluate the peak torque (PT) in isokinetic conditions and the range of motion of the shoulder joint in patients after reverse total shoulder arthroplasty in the late treatment period. (2) Methods: The study included fifteen patients aged 60-70 years (13 women and 2 men). The comparison group consisted of 15 healthy subjects (12 women and 3 men) aged 60-69 years. The study included measurement of peak torque (PT) and the range of motion of the shoulder joint, assessed using the Biodex System 4 Pro set, and an electronic goniometer. We conducted tests at two different angular velocities (60°/s and 90°/s), taking into account the operated and non-operated limb and comparing the results to healthy subjects. The average time from surgery to functional examination was 16 months. (3) Results: The non-operated limb generated significantly higher PT values than the operated limb (p < 0.001). The healthy limb of patients from the comparison group generated significantly higher PT values than the operated limb of patients from the study group (p < 0.001). A significant improvement (p < 0.001) in the range of motion in the operated limb was achieved after rTSA. (4) Conclusions: In patients 18 months after the rTSA, the non-operated upper limb has significantly greater muscle strength in flexion/extension and abduction/adduction movements compared to the operated limb. The non-operated limb also has a significantly greater range of motion compared to the operated limb.

Isokinetic performance and function are similar after total hip arthroplasty applied with a posterior or anterolateral approach: a randomised controlled trial.

BACKGROUND: There are ongoing debates on the effects of surgical approach on outcome after total hip arthroplasty (THA). It was hypothesised that with the anterolateral approach, trauma to the abductor arm can occur and related detrimental effects can diminish the postoperative outcomes. In this first randomised controlled trial in the literature on this subject, isokinetic performance and patient-reported functional outcomes were evaluated in patients undergoing THA with a posterior approach (PA) and an anterolateral approach (ALA). METHODS: A total of 48 patients scheduled to undergo THA were randomised to ALA or PA groups. The patients were evaluated preoperatively and at 6 and 12 months postoperatively, with flexion, extension and abduction strength measurements and the Harris Hip Score (HHS). The physiatrist performing isokinetic tests and the patients were blinded to the study groups. RESULTS: Both groups were similar in respect of age, body mass index (BMI), gender and preoperative isokinetic performance and HHS. Both groups demonstrated similar isokinetic performance (p < 0.05) and there was no difference in HHS (p < 0.05) at the 6- and 12-months follow-up evaluations. CONCLUSION: Although there is concern about potential abductor muscle damaging during ALA, the results of this randomised controlled study demonstrated that ALA can produce similar isokinetic performance and functional outcome to PA at 6 and 12 months, despite the close proximity to the abductor arm. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04640740 (retrospectively registered).

Return to Sports After ACL Augmentation With Anterolateral Reconstruction (ALR) Harvesting Gracilis Only Compared With ACL Reconstruction With ALR Harvesting Both Hamstring Tendons.

BACKGROUND: Anterior cruciate ligament (ACL) repair (ACL-Rp) is known to be a valuable alternative to ACL reconstruction (ACL-Rc) in selected indications. The majority of the ACL-Rp techniques recommend the use of a synthetic brace. The use of the gracilis allows both a biological internal brace and anterolateral ligament reconstruction (ALR). PURPOSE: The primary objective was to compare the early ability to return to sports between patients who underwent ACL-Rp using a gracilis autograft as an internal brace augmentation with ALR and patients who underwent the conventional ACL-Rc with ALR technique sacrificing both the gracilis and the semitendinosus. The secondary objective was to compare the failure rate, clinical scores, and return to sports at a minimum follow-up of 2 years. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective analysis was undertaken. A total of 49 patients who underwent ACL-Rp with ALR between December 2018 and May 2019 were propensity matched at a 1:1 ratio to those who underwent ACL-Rc with ALR during the same period. The decision to perform ACL-Rp with ALR was based on preoperative selection and intraoperative arthroscopic findings: proximal avulsion tear, partial ACL tear, low- to midlevel sports participation, and good tissue quality. The ability to return to sports was assessed using isokinetic tests and the Knee Santy Athletic Return to Sport test functional test at 6 months postoperatively. At the final follow-up, knee laxity parameters, return to sports, and clinical outcome (Lysholm score, Tegner Activity Scale score, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Anterior Cruciate Ligament-Return to Sport after Injury score) were recorded. RESULTS: The ACL-Rp group had significantly less hamstring strength deficit when compared with their counterparts who underwent ACL-Rc (0.2% vs 10.2% in concentric, P < .001; 2.5% vs 14% in eccentric, P < .001). The mean Knee Santy Athletic Return to Sport test score was significantly higher in the ACL-Rc group (69.7% ± 16.6% [range, 19%-100%] vs 61% ± 16.8% [range, 19%-100%]; P = .001). In the ACL-Rp group, 61% (30/49) of the patients were authorized to return to pivot sports versus 41% (20/49) in the ACL-Rc group (P = .04). At a mean final follow-up of 31.4 ± 3.5 months, no significant differences were demonstrated between groups with respect to clinical scores and knee laxity parameters. There was a trend for a higher failure rate in the ACL-Rp group without any significance (ACL-Rp: 6.1% [3/49] vs ACL-Rc: 0%; P = .08). CONCLUSION: At 6 months after operation, harvesting only the gracilis with this ACL-Rp and augmentation with ALR technique was linked to a better early ability to return to sports compared with the ACL-Rc with ALR technique harvesting both the gracilis and semitendinosus. This technique had a limited effect on early flexion strength and provided a satisfactory rerupture rate.

Importance of Initial Peak Torque of the Supraspinatus Muscle during Shoulder Flexion.

Background: Most previous studies have evaluated flexion strength to assess recovery after arthroscopic rotator cuff (RC) repair. However, limited data are available regarding peak torque at the initial angle (iPT) because most studies have measured flexion strength for peak torque (PT), particularly in small- and medium-sized supraspinatus tears. The purpose of this study was to compare conventional PT and iPT to evaluate supraspinatus muscle strength after arthroscopic RC repair in patients with small- and medium-sized supraspinatus tears. Methods: Isokinetic muscle performance testing was performed in 42 patients with small tears and in 47 patients with medium-sized tears. PT and iPT were evaluated before and 1 year after surgery and were recorded at an angular velocity of 60°/sec and 180°/sec with an isokinetic test. Results: PT and iPT were significantly lower in the involved-side shoulders than in the uninvolved-side shoulders (PT: small tear, p < 0.001; medium tear, p < 0.001; iPT: small tear, p < 0.001; medium tear, p < 0.001) in both groups, preoperatively. However, postoperatively, in the involved-side shoulders, PTs were not different in both small- and medium-sized tears (all p > 0.05), but iPTs were significantly lower in the involved-side shoulders (small tear, p < 0.001; medium tear, p < 0.001). iPT was significantly lower in the involved side shoulders in the medium-sized tear group than in the small-sized tear group before and after surgery (p < 0.05). In the small- and medium-sized tear groups, tear size was significantly correlated with preoperative iPT in the involved-side shoulders (small tear: r = -0.304, p = 0.046; medium tear: r = -0.323, p = 0.027). However, pain visual analog scale was significantly correlated with preoperative (small tear: r = -0.455, p = 0.002; medium tear: r = -0.286, p = 0.044) and postoperative (small tear: r = -0.430, p = 0.005; medium tear: r = -0.354, p = 0.021) iPT in the involved-side shoulders. Furthermore, fatty infiltration grade of the supraspinatus muscle and global fatty degeneration index were not associated with preoperative and postoperative PT and iPT in each group (all p > 0.05). Conclusions: iPT is as important as conventional PT in isokinetic testing to assess supraspinatus muscle strength before and after RC repair.

A Systematic Review and Meta-Analysis of Strength Recovery Measured by Isokinetic Dynamometer Technology after Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autografts vs. Hamstring Tendon Autografts or Patellar Tendon Autografts.

BACKGROUND: This systematic review and meta-analysis compared the isokinetic strength of the muscular knee joint between quadriceps tendon autografts (QTAs) and hamstring tendon autografts (HTAs) or patellar tendon autografts (PTAs) after anterior cruciate ligament (ACL) reconstruction by determining the isokinetic angular velocity and follow-up time points. The functional outcomes and knee stability at the same time points were also compared using isokinetic technology. METHODS: Two independent reviewers searched the Medline (via PubMed search engine), Scopus, Web of Science and Cochrane Library databases to include full text comparative studies that assessed isokinetic strength test following ACL reconstruction. The DerSimonian and Laird method was used. RESULTS: In total, ten studies were included; seven compared studies QTAs vs. HTAs, and three compared QTAs vs. PTAs. Five studies were included in the meta-analysis. Isokinetic strength data were reported 3, 6, 12 and 24 months after ACL reconstruction. CONCLUSIONS: The QTAs showed better and significant results with knee flexion compared with HTAs, similar results to PTAs at 6 and 12 months. While HTAs showed better and significant results with knee extension at 6 months and similar results at 12 months compared to QTAs. Furthermore, a standardized isokinetic strength test must be followed to achieve a more specific conclusion and better clinical comparison among participants.

Multiplanar knee kinematics-based test battery helpfully guide return-to-sports decision-making after anterior cruciate ligament reconstruction.

Background: There are currently no well-established criteria to guide return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). In this study, a new test battery consisting of subjective and objective tests, especially multiplanar knee kinematics assessment, was developed to aid RTS decision making after ACLR. Methods: This study was conducted with 30 patients who were assessed a mean of 9.2 ± 0.5 months after ACLR. All patients underwent complete evaluations of both lower limbs with four objective assessments [isokinetic, hop, knee laxity, and 6-degree of freedom (6DOF, angle: flexion-extension, varus-valgus, internal-external rotation; translation: anteroposterior, proximodistal, mediolateral) knee kinematics tests] and two subjective assessments [International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) questionnaires]. Limb symmetry indices (LSIs) of knee strength, hop distance, and range of motion (ROM) of knee kinematics were calculated. LSI ≥90%, IKDC scale score within the 15th percentile for healthy adults, and ACL-RSI score >56 were defined as RTS criteria. Results: Significant differences between affected and contralateral knees were observed in the quadriceps strength (p < 0.001), hamstring strength (p = 0.001), single hop distance (p < 0.001), triple hop distance (p < 0.001), and rotational ROM (p = 0.01). Only four patients fulfilled the overall RTS criteria. The percentages of patients fulfilling individual criteria were: quadriceps strength, 40%; hamstring strength, 40%; single hop distance, 30%; triple hop distance, 36.7%; knee ligament laxity, 80%; flexion-extension, 23.3%; varus-valgus rotation, 20%; internal-external rotation, 66.7%; anteroposterior translation, 20%; proximodistal translation, 33.3%; mediolateral translation, 26.7%; IKDC scale score, 53.3%; and ACL-RSI score, 33.3%. Conclusion: At an average of 9 months after ACLR, objectively and subjectively measured knee functional performance was generally unsatisfactory especially the recovery of knee kinematics, which is an important prerequisite for RTS.

Immediate Effects of Acupuncture on Explosive Force Production and Stiffness in Male Knee Joint.

Acupuncture can improve explosive force production and affect joint stiffness by affecting muscle activation levels. This study aims to explore the effects of true acupuncture (TA) compared with sham acupuncture (SA) on the explosive force production and stiffness of the knee joint in healthy male subjects. Twenty subjects were randomly divided into the TA group (n = 10) and SA group (n = 10) to complete isokinetic movement of the right knee joint at a speed of 240°/s before and after acupuncture. Futu (ST32), Liangqiu (ST34), Zusanli (ST36), Xuehai (SP10), and Chengshan (BL57) were selected for acupuncture. The intervention of SA is that needles with a blunt tip were pushed against the skin, giving an illusion of insertion. The results showed that acupuncture and the intervention time had a significant interaction effect on knee joint explosive force and joint stiffness (p < 0.05). The average maximum (max) torque, average work, average power, average peak power and total work of the TA group increased significantly after acupuncture (p < 0.05), while the SA group did not (p > 0.05). Therefore, true acupuncture can immediately improve the explosive force and joint stiffness of the male knee joint by inducing post-activation potentiation (PAP) and/or De-Qi.

A prospective evaluation of strength and endurance of ankle dorsiflexors-plantar flexors after conservative management of lateral malleolar fractures.

OBJECTIVES: This study aims to evaluate patients with conservatively treated stable lateral malleolar fractures with isokinetic tests. PATIENTS AND METHODS: Between January 2016 and November 2017, a total of 24 patients (12 males, 12 females; mean age 40.8±15.0 years; range, 18 to 68 years) with an isolated stable lateral malleolar fracture treated conservatively with the circular cast were included in this prospective study. Calf circumferences, ankle range of motion (ROM), pain levels, and functional outcomes were recorded. The muscle strengths and endurance of the injured side were compared with the non-injured side. All patients were evaluated by isokinetic test after removal of the cast, and three and six months after the rehabilitation period. RESULTS: The ROM was found to be lower after removal of the plaster cast, compared to the contralateral ankle. During cast removal, we also found that both dorsiflexor and plantar flexor muscle strength decreased by 25.6% and 44.7%, respectively, and decreased to 10.3% and 3.6% at three months post-rehabilitation. At the end of six months, no statistically significant difference was found between the two sides. In the dorsiflexion-plantar flexion endurance values, 37.8% and 54.1% deficit were detected before the rehabilitation protocol, respectively (p<0.05). At three months, these values decreased to 6.1% and 13.6%, respectively and the endurances of the injured sides surpassed the non-injured sides (p<0.05) at six months. CONCLUSION: Conservative management of stable isolated lateral malleolar fractures with circular cast causes atrophy and decreases strength-endurance of the calf muscles due to immobilization. These changes are expected to diminish over time and functional outcomes are excellent with a good rehabilitation program.

Effects of Chemotherapy Treatment on Muscle Strength, Quality of Life, Fatigue, and Anxiety in Women with Breast Cancer.

The study aimed to evaluate the effects of chemotherapy treatment on muscle strength, quality of life, fatigue, and anxiety in women with breast cancer. Nineteen women who were undergoing a chemotherapy treatment (breast cancer treatment [BCT] group, 52.2 ± 13.1 years) and 18 women without cancer (control [CNT] group, 55.8 ± 8.4 years) answered questionnaires for evaluation of fatigue (Fatigue Scale), quality of life (Short-Form Healthy Survey [SF-36] questionnaire), and anxiety (State-Trait Anxiety Inventory [IDATE]) levels. Muscle strength was also assessed by an isometric grip test and an isokinetic knee extension test. Physical limitations, social and emotional domains of quality of life were lower in the BCT group in comparison to the CNT group (p = 0.002; p = 0.003; p = 0.0003, respectively). The other domains did not differ between groups (p > 0.05). There were no differences in fatigue and anxiety levels between both the BCT and CNT groups (p > 0.05). Additionally, isometric grip strength was higher in the CNT group when compared to the BCT group (p = 0.048). However, there were no differences between the BCT and CNT groups for peak torque and total work at both 60°.s-1 (p = 0.95 and p = 0.61, respectively) and 180°.s-1 (p = 0.94 and p = 0.72, respectively). These results suggest that three cycles of chemotherapy treatment may impair handgrip isometric strength and quality of life in women with breast cancer.

Isokinetic Strength Comparison of Tuberosity Fractures of the Proximal Fifth Metatarsal Treated With Elastic Bandage vs Cast.

BACKGROUND: The aim of this study was to compare the strength of injured and healthy ankle muscle as well as functional and clinical outcomes between patients with proximal fifth metatarsal tuberosity fractures who received elastic bandage treatment and those who received cast immobilization. METHODS: Sixty-five patients who presented to our clinic between February 2018 and April 2019 were randomly divided into 2 groups: 33 received elastic bandages (group 1) and 32 received cast immobilization (group 2). All patients were scheduled for follow-up appointments at our clinic after 2, 4, 8, 12, and 24 weeks. Visual analog scale-foot and ankle (VAS-FA) score, time missed from work, and using assistive devices were recorded as clinical outcomes. Both ankle plantarflexion-dorsiflexion and inversion-eversion muscle strengths (peak torque) were measured using an isokinetic dynamometer for each group and were compared with those of the healthy extremities. RESULTS: The mean missed work was 11.3 days in group 1 and 27.6 days in group 2. Groups 1 and 2 used assistive devices for a mean of 6.7 and 16.2 days, respectively (P = .001). Group 1 had a significantly higher VAS-FA score at the 2nd, 4th, and 8th week of follow-up compared with group 2, and no significant differences were observed at the time of injury and at the 12th and 24th weeks. The muscle strength deficits in group 1 were present at the 4th week, whereas those in the cast immobilization group were determined at the 4th and 8th weeks in all muscles. During the 12th and 24th week of follow-up, no significantly differences in both extremities were observed between the groups. CONCLUSION: Elastic bandage treatment was better than cast immobilization in terms of preserving ankle muscle strength, clinical outcomes, and functional scores regardless of the degree of fracture displacement. Moreover, the present study emphasized that cast immobilization offered no advantages in this fracture treatment. LEVEL OF EVIDENCE: Level I, prognostic randomized controlled trial.

Isokinetic Evaluation of Shoulder Strength and Endurance after Reverse Shoulder Arthroplasty: A Comparative Study.

OBJECTIVE: The present study aimed to compare the isometric strength and endurance of shoulder abduction and internal and external rotation between operated shoulders and nonoperated, contralateral shoulders of patients who underwent reverse shoulder replacement due to unilateral rotator cuff tear arthropathy. PATIENTS AND METHODS: With a diagnosis of cuff tear arthropathy, 41 consecutive patients (mean age of 70.8 years; age range, 57 to 84; 36 females, 5 males) who underwent unilateral reverse shoulder arthroplasty were reviewed based on functional and radiological data. In all cases, cuff tear arthropathy was unilateral and contralateral shoulder was asymptomatic, with normal shoulder function. The average length of follow-up was 34 months (range of 12-67). To assess patients' functional level, the Constant score and the Disabilities of the Arm, Shoulder, and Hand (the Quick-DASH) outcome measure were used preoperatively and at the final examination. The primary outcomes of the present study were measurement of isokinetic strength and endurance of shoulder abduction and internal and external rotation using an isokinetic evaluator. RESULTS: Patients exhibited marked improvement in functional level as reflected by a significant increase in the mean Constant score from 38 preoperatively to 65 at the final follow-up (p = 0.03). The functional improvement was supported by a decrease in the mean Quick-DASH from 64 preoperatively to 26 at the final follow-up (p = 0.018). In the comparison of the isokinetic strength and endurance of shoulder abduction, no statistical difference was observed between operated shoulders and contralateral shoulders (p > 0.05). However; the strength and endurance of internal and external rotation were lower in operated shoulders than in contralateral shoulders (p < 0.05). Similarly, there was no statistically significant difference in comparisons of the durability of abduction (p > 0.05); however, the durability of internal and external rotation were significantly lower in operated shoulders (p < 0.05). CONCLUSION: In terms of durability and strength of abduction, similar results with the unaffected shoulder may be accomplished; nonetheless, the surgeon should be aware that durability and strength of rotation would be weak. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Outcomes of isokinetic tests and functional assessment of anterior cruciate ligament reconstruction: Transtibial versus single anatomic femoral tunnel technique.

OBJECTIVE: The aim of the study was to compare the outcomes of the transtibial and anatomical femoral single tunnel surgical techniques in ACL reconstruction. METHODS: A total of 30 patients, with 16 patients (15 males and 1 female; mean age: 27.2 ± 7.04) with anatomical femoral single-tunnel technique (AFT) and 14 (12 males and 2 females; mean age: 29.4 ± 8.82) with transtibial technique (TT) were included into the study. All patients were evaluated with isokinetic tests at an angular velocity of 60°/s and 180°/s and the IKDC and Lysholm tests were performed preoperatively and in third, sixth, and 12th months postoperatively. The results were compared between the groups. The mean follow-up time was 17.1 ± 6.48 months. RESULTS: Postoperative third month changes in extension parameters of peak torque (AFT: -93.286, TT: -61.500), peak work (AFT: -77.071, TT: -47.500), peak torque ext/kg (AFT: -1.182, TT: -0.773), peak work ext/kg (AFT: -0.982, TT: -0.604), peak work (AFT: -55.143 TT: -33.063) at an angular velocity of 60°/s and postoperative third month change in extension parameter of peak power (AFT: -86.786 TT: -54.875) at an angular velocity of 180°/s were found to be better in the transtibial group (p < 0.05) and postoperative sixth month peak torque (AFT: 1.429, TT: -5.688) value at an angular velocity of 60°/s was found to be less in the anatomical femoral single-tunnel group (p < 0.05). The IKDC (AFT: 94.671, TT: 90.025) (p < 0.05) and Lysholm (AFT: 96.714, TT: 92.375) (p < 0.05) scores of the anatomical femoral single-tunnel group were better than the transtibial group regarding to the postoperative final follow-up. There are positive intermediate correlations between preoperative IKDC and Lysholm scores with preoperative and postoperative some isokinetic test ratio (r = 0.539; p = 0.031), and preoperative peak power extension (r = 0.541; p = 0.030) at the both angular velocity of 60°/s and 180°/s in the transtibial group. There was no significant difference between the two groups with regards to the Lachman, anterior drawer and pivot shift tests (p < 0.05). CONCLUSION: There were differences in terms of isokinetic parameters in early outcomes but there was no statistical difference between isokinetic parameters at the end of 1st year between two groups. There were some correlations between IKDC and Lysholm scores with some isokinetic parameters. LEVEL OF EVIDENCE: Level III, Therapeutic Study.