Early identification of knee osteoarthritis (OA) symptoms after anterior cruciate ligament reconstruction (ACLR) could enable timely interventions to improve long-term outcomes. However, little is known about the change in early OA symptoms from 6 to 12 months post-ACLR. To evaluate the change over time in meeting classification criteria for early knee OA symptoms from 6 to 12 months after ACLR. Prospective cohort study. Research laboratory. Eighty-two participants aged 13 to 35 years who underwent unilateral primary ACLR. On average, participants’ first and second visits were 6.2 and 12.1 months post-ACLR. Early OA symptoms were classified using generic (Luyten Original) and patient population–specific (Luyten Patient Acceptable Symptom State [PASS]) thresholds on Knee injury and Osteoarthritis Outcome Score (KOOS) subscales. Changes in meeting early OA criteria were compared between an initial and follow-up visit at an average of 6 and 12 months post-ACLR, respectively. Twenty-two percent of participants exhibited persistent early OA symptoms across both visits using both the Luyten Original and PASS criteria. From initial to follow-up visit, 18% to 27% had resolution of early OA symptoms, while 4% to 9% developed incident symptoms. In total, 48% to 51% had no early OA symptoms at either visit. No differences were found for change in early OA status between adults and adolescents. Nearly one-quarter of participants exhibited persistent early knee OA symptoms based on KOOS thresholds from 6 to 12 months post-ACLR. Determining if this symptom persistence predicts worse long-term outcomes could inform the need for timely interventions after ACLR. Future researchers should examine if resolving persistent symptoms in this critical window improves later outcomes. Tracking early OA symptoms over time may identify high-risk patients who could benefit from early treatment.Context
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Low scores on psychological patient-reported outcomes measures, including the Anterior Cruciate Ligament—Return to Sport After Injury (ACL-RSI) and Injury-Psychological Readiness to Return to Sport (I-PRRS), after anterior cruciate ligament reconstruction (ACLR) have been associated with a maladaptive psychological response to injury and poor prognosis. To assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores and generate normative reference curves. Case series. Outpatient sports medicine and orthopaedic clinic. A total of 507 patients (age at ACLR, 17.9 ± 3.0 years) who had undergone primary ACLR and completed ACL-RSI or I-PRRS assessments ≥1 times (n = 796) between 0 and 1 year post-ACLR. An honest broker provided anonymous data from our institution’s knee-injury clinical database. Generalized additive models for location, scale, and shape and generalized least-squares analyses were used to assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores. The ACL-RSI and I-PRRS scores increased over time post-ACLR. Males had higher scores than females until approximately 5 months post-ACLR, with scores converging thereafter. Males reported higher ACL-RSI and I-PRRS scores than females in the initial stages of rehabilitation, but scores converged between sexes at times associated with return to play post-ACLR. Normative reference curves can be used to objectively appraise ACL-RSI and I-PRRS scores at any time post-ACLR. This may lead to timely recognition of patients with a maladaptive psychological response to injury and a higher likelihood of a poor prognosis, optimizing ACLR outcomes.Context
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It is unclear whether the response in femoral cartilage to running at different intensities is different. To examine the acute patterns of deformation and recovery in femoral cartilage thickness during and after running at different speeds. Crossover study. Laboratory. A total of 17 healthy men (age = 23.9 ± 2.3 years, height = 173.1 ± 5.5 cm, mass = 73.9 ± 8.0 kg). Participants performed a 40-minute treadmill run at speeds of 7.5 and 8.5 km/h. Ultrasonographic images of femoral cartilage thickness (intercondylar, lateral condyle, and medial condyle) were obtained every 5 minutes during the experiment (40 minutes of running followed by a 60-minute recovery period) at each session. Data were analyzed using analysis of variance and Bonferroni- and Dunnett-adjusted post hoc t tests. To identify patterns of cartilage response, we extracted principal components (PCs) from the cartilage-thickness data using PC analysis, and PC scores were analyzed using t tests. Regardless of time, femoral cartilage thicknesses were greater for the 8.5-km/h run than the 7.5-km/h run (intercondylar: F1,656 = 24.73, P < .001, effect size, 0.15; lateral condyle: F1,649 = 16.60, P < .001, effect size, 0.16; medial condyle: F1,649 = 16.55, P < .001, effect size, 0.12). We observed a time effect in intercondylar thickness (F20,656 = 2.15, P = .003), but the Dunnett-adjusted post hoc t test revealed that none of the time point values differed from the baseline value (P > .38 for all comparisons). Although the PC1 and PC2 captured the magnitudes of cartilage thickness and time shift (eg, earlier versus later response), respectively, t tests showed that the PC scores were not different between 7.5 and 8.5 km/h (intercondylar: P ≥ .32; lateral condyle: P ≥ .78; medial condyle: P ≥ .16). Although the 40-minute treadmill run with different speeds produced different levels of fatigue, morphologic differences (<3%) in the femoral cartilage at both speeds seemed to be negligible.Context
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Existing patellofemoral pain (PFP) literature has primarily been focused on quadriceps muscle volume, with limited attention given to the deep and superficial muscle volume of the lower limbs in individuals with unilateral and bilateral PFP. In this paper, we aim to fill this gap. To explore superficial and deep lower extremity muscle volume in women with unilateral or bilateral PFP compared with a normative database of pain-free women. Cross-sectional study. University imaging research center. Twenty women with PFP (10 unilateral and 10 bilateral) and 8 pain-free women from a normative database. We quantified lower extremity muscle volume via 3.0-T magnetic resonance imaging. Two separate 1-way analyses of variance were performed: (1) unilateral PFP (painful versus nonpainful limb) versus pain-free control groups and (2) bilateral PFP (more painful versus less painful limb) versus pain-free control groups. We observed no differences in age and body mass index across groups (P > .05). Compared with the pain-free group, the unilateral and bilateral PFP groups had bilaterally smaller volumes of the anterior (iliacus: P ≤ .0004; d range, 2.12–2.65), medial (adductor brevis, adductor longus, gracilis, and pectineus: P ≤ .02; d range, 1.25–2.48), posterior (obturator externus, obturator internus, and quadratus femoris: P < .05; d range, 1.17–4.82), and lateral (gluteus minimus: P ≤ .03; d range, 1.16–2.09) hip muscles and knee extensors (rectus femoris: P ≤ .003; d range, 1.67–2.16) and flexors (long and short head of the biceps femoris: P ≤ .01, d range, 1.56–1.93). Women with unilateral and those with bilateral PFP displayed less volume of multiple superficial and deep muscles of the bilateral hips and knees than pain-free women. Interventions should bilaterally target lower limb muscles when treating PFP, and hypertrophy exercises for specific muscles should be explored to increase choices for intervention.Context
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The supplementary motor area (SMA) is involved in the functional deficits of chronic ankle instability (CAI), but the structural basis of its abnormalities remains unclear. To determine the differences in volume- and surface-based morphologic features of the SMA between patients with CAI and healthy controls and the relationship between these features and the clinical features of CAI. Cross-sectional study. Sports medicine laboratory. A total of 32 patients with CAI (10 women, 22 men; age = 32.46 ± 7.51 years) and 31 healthy controls (12 women, 19 men; age = 29.70 ± 8.07 years) participated. We performed T1-weighted structural magnetic resonance imaging of participants and calculated volume- and surface-based morphologic features of SMA subregions. These subregions included anterior and posterior subdivisions of the medial portion of Brodmann area 6 (6 ma and 6 mp, respectively) and supplementary and cingulate eye fields. Between-group comparisons and correlation analysis with clinical features of CAI were performed. Moderately thinner 6 mp (motor-output site; Cohen d = −0.61; 95% CI = −1.11, −0.10; P = .02) and moderately plainer 6 ma (motor-planning site; Cohen d = −0.70; 95% CI = −1.20, −0.19; P = .01) were observed in the CAI than the control group. A thinner 6 mp was correlated with lower Foot and Ankle Ability Measure Activities of Daily Living subscale scores before (r = 0.400, P = .02) and after (r = 0.449, P = .01) controlling for covariates. Patients with CAI had a thinner 6 mp and a plainer 6 ma in the SMA compared with controls. The thin motor-output site of the SMA was associated with ankle dysfunction in patients. This morphologic evidence of maladaptive neuroplasticity in the SMA might promote more targeted rehabilitation of CAI.Context
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The Concussion Clinical Profiles Screening Tool (CP Screen) self-report concussion symptom inventory is often administered at weekly intervals. However, 1-week reliable change indices (RCIs) for clinical cutoffs and the test–retest reliability of the CP Screen are unknown. To document RCI cutoff scores and 1-week test–retest reliability for each profile and modifier of the CP Screen for men and women. Case series. A large US university. One hundred seventy-three healthy college students. Participants completed 2 administrations of the CP Screen 7 days apart. The CP Screen items yielded 5 clinical profiles and 2 modifiers. Spearman ρ coefficients (rs), intraclass correlation coefficients (ICCs), single measures, and unbiased estimates of reliability (UERs) were used to assess test-retest reliability. Wilcoxon signed-rank tests assessed differences across time. Reliable change index values and cutoff scores are provided at 90%/95% CIs. All analyses were performed for the total sample and separately for men and women. Reliable change index cutoffs for clinically significant change (increase/decrease) at a 90% CI for men were as follows: ocular, vestibular >2/>4; anxiety/mood, cognitive/fatigue, and migraine >3/>3; sleep >4/>6; and neck >2/>2. Reliable change index cutoffs for clinically significant change (increase/decrease) at a 90% CI for women were as follows: anxiety/mood ≥2/≥4; cognitive/fatigue, migraine, ocular, vestibular, and sleep ≥3/≥3; and neck ≥1/≥1. Correlations for the CP Screen ranged from 0.51 (migraine) to 0.79 (anxiety/mood) for the total sample, from 0.48 (migraine) to 0.84 (vestibular) for men, and from 0.51 (migraine) to 0.77 (ocular) for women. Test-retest indices for each profile and modifier were moderate to good for the total sample (ICC, 0.64–0.82; UER, 0.79–0.90), men (ICC, 0.60–0.87; UER, 0.76–0.94), and women (ICC, 0.64–0.80; UER, 0.78–0.89). The CP Screen is reliable and stable across a 1-week interval, and established RCIs for men and women can help identify meaningful change throughout recovery.Context
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There are different ways to deliver external focus (EF) and internal focus (IF) instruction. Understanding each modality better will help to develop more effective interventions to reduce injury risk. To investigate the difference in landing biomechanics between participants who received EF and IF instruction and control participants. A secondary aim was to evaluate participant perceptions of focus of attention. Randomized controlled trial. Laboratory. Forty-one healthy women (EF: n = 14, 23.0 ± 2.9 years, 1.69 ± 0.07 m, 64.0 ± 6.8 kg; IF: n = 15, 22.9 ± 3.2 years, 1.66 ± 0.08 m, 66.2 ± 12.4 kg; control: n = 12, 21.1 ± 2.9 years, 1.67 ± 0.11 m, 74.3 ± 15.1 kg). Participants scoring greater than or equal to 5 on the Landing Error Scoring System were allocated into the EF, IF, or control group. Knee and hip flexion and abduction were collected pre- and postintervention during 5 drop vertical jumps. For the intervention, each group was provided separate instructions. In between the intervention jumps, participants answered, “What strategy were you focusing on when completing the previous jump-landing trials?” Postintervention minus preintervention change scores were calculated, and separate 1-way analysis of variance assessments were performed to determine differences in the dependent variables. Individuals in the EF group had a greater change in hip and knee flexion angles than individuals in the control group. There was no significant difference between the EF and IF groups for any variables. There were no significant differences in frontal plane variables. In the EF group, 71.4% aligned with the instructions given; in the IF group, 80% aligned; and in the control group, 50% aligned. External focus instruction may not produce immediate changes in movement compared with IF instruction. Hip and knee flexion were greater in the EF group than in the control group but was not better than that in the IF group. Clinicians should provide instructions to patients, but the mode of instruction may not be as critical to see positive biomechanical changes. Patients may not always focus on the instruction being given; therefore, the relationship between instruction and patient experience should be further explored.Context
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Individuals with anterior cruciate ligament reconstruction (ACLR) often fail to return to their previous level of sport performance. Although multifaceted, this inability to regain preinjury performance may be influenced by impaired plyometric ability attributable to chronic quadriceps dysfunction. Whole-body vibration (WBV) acutely improves quadriceps function and biomechanics after ACLR, but its effects on jumping performance outcomes such as jump height, the reactive strength index (RSI), and knee work and power are unknown. To evaluate the acute effects of WBV on measures of jumping performance in those with ACLR. Crossover study design. Research laboratory. Thirty-six individuals with primary, unilateral ACLR. Participants stood on a WBV platform in a mini-squat position while vibration or no vibration (control) was applied during six 60-second bouts with 2 minutes of rest between bouts. Double-leg jumping tasks were completed preintervention and postintervention (WBV or control) and consisted of jumping off a 30-cm box to 2 force plates half the participant’s height away. The jumping task required participants to maximally jump vertically upon striking the force plates. Whole-body vibration did not produce significant improvements in any of the study outcomes (ie, jump height, RSI, and knee work and power) in either limb (P = .053–.839). These results suggest that a single bout of WBV is insufficient for improving jumping performance in individuals with ACLR. As such, using WBV to acutely improve jumping performance post-ACLR is likely not warranted. Future research should evaluate the effects of repeated exposure to WBV in combination with other plyometric interventions on jumping performance.Context
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Adults perceive certain factors to increase or decrease the risk of sustaining running-related injuries, but many of their perceptions are not supported by research. Little is known about the perceptions that adolescent runners hold. Investigating perceptions for adolescent runners is needed to assist in the development of future injury educational materials, as these resources may need to be tailored differently for adolescents and adults. To identify factors that adolescent runners perceive as risk or protective factors for running-related injuries and to compare these perceptions with those of adult runners. Cross-sectional study. Online survey. We surveyed 302 adolescent (164 females, 138 males; age = 16.0 ± 1.4 years [range, 12–19 years]) and 357 adult runners (197 women, 160 men; age = 40.7 ± 11.8 years [range, 20–77 years]). Participants completed a survey with questions about whether factors related to training habits, footwear, biomechanics, strength, stretching, or nutrition influence the risk of sustaining a running-related injury. If ≥75% of adolescents indicated that a factor increases or decreases the risk of sustaining an injury, we considered that factor to be a perceived risk or protective factor, respectively. We also performed Fisher’s exact test to compare the proportion of adolescent and adult runners who responded with “increase,” “decrease,” “neither increase or decrease,” or “I don’t know” to each question. Adolescent runners perceived training habits, footwear, biomechanics, strength, stretching, and nutrition to increase or decrease the risk of sustaining a running-related injury. A larger proportion of adolescents than adults perceived that more footwear cushioning and stretching decrease injury risk, but a smaller proportion perceived that overtraining increases injury risk and strength decreases injury risk. Differences in perceptions exist between adolescent and adult runners, and future educational materials and research questions may need to be tailored for different running populations.Context
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Participation in high school sports has physical, physiological, and social development benefits, while also increasing the risk of acute and overuse injuries. Risk of sport-related overuse injury differs between boys and girls. To investigate differences in overuse injuries among US high school athletes participating in the gender-comparable sports of soccer, basketball, and baseball/softball. Descriptive epidemiology study using a nationally representative sample from the High School Reporting Information Online (RIO) database. High schools. Athletes with overuse injuries during the 2006–2007 through 2018–2019 academic years. National estimates and rates of overuse injuries were extrapolated from weighted observed numbers with the following independent variables: sport, gender, academic year, class year, event type, body site, diagnosis, recurrence, activity, and position. Among an estimated 908 295 overuse injuries nationally, 43.9% (n = 398 419) occurred in boys’ soccer, basketball, and baseball, whereas 56.1% (n = 509 876) occurred in girls’ soccer, basketball, and softball. When comparing gender across sports, girls were more likely to sustain an overuse injury than boys (soccer, injury rate ratio [IRR]: 1.37, 95% CI = 1.20–1.57; basketball, IRR: 1.82, 95% CI = 1.56–2.14; baseball/softball, IRR: 1.21, 95% CI = 1.04–1.41). Most overuse injuries in soccer and basketball for both genders occurred to a lower extremity (soccer: 83.9% [175 369/209 071] for boys, 90.0% [243 879/271 092] for girls; basketball: 77.0% [59 239/76 884] for boys, 80.5% [81 826/101 709] for girls), whereas most overuse injuries in baseball and softball were to an upper extremity (72.5% [81 363/112 213] for boys, 53.7% [73 557/136 990] for girls). For boys’ baseball, pitching (43.5% [47 007/107 984]) was the most common activity associated with an overuse injury, which differed from the most common activity of throwing (31.7% [39 921/126 104]) for girls’ softball. Gender differences observed in this study can help guide future strategies that are more specific to gender and sport to reduce overuse injuries among high school athletes.Context
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Athletic trainers (ATs) have reported the need for more educational resources about clinical documentation. To investigate the effectiveness of passive and active educational interventions to improve practicing ATs’ clinical documentation knowledge. Randomized controlled trial, sequential explanatory mixed methods study. Online module(s), knowledge assessment, and interviews. We emailed 18 981 practicing ATs across employment settings, of which 524 ATs were enrolled into a group (personalized learning pathway [PLP = 178], passive reading list [PAS = 176], control [CON = 170]) then took the knowledge assessment. A total of 364 ATs did not complete the intervention or postknowledge assessment; therefore, complete responses from 160 ATs (PLP = 39, PAS = 44, CON = 77; age = 36.6 ± 11.2 years, years certified = 13.9 ± 10.7) were analyzed. Knowledge assessment (34 items) and interview guides (12–13 items) were developed, validated, and piloted with ATs before study commencement. We summed correct responses (1 point each, 34 points maximum) and calculated percentages and preknowledge and postknowledge mean change scores. Differences among groups (PLP, PAS, CON) and time (preintervention, postintervention) were calculated using a 3 × 2 repeated-measures analysis of variance (P ≤ .05) with post hoc Tukey HSD. Semistructured interviews were conducted (PLP = 15, PAS = 14), recorded, transcribed, and analyzed following the consensual qualitative research tradition. No differences in the preknowledge assessment were observed between groups. We observed a group × time interaction (F2,157 = 15.30, P < .001; partial η2 = 0.16). The PLP group exhibited greater mean change (M = 3.0 ± 2.7) than the PAS (M = 1.7 ± 3.0, P = .049) and CON (M = 0.4 ± 2.2, P < .001) groups. Descriptively, ATs scored lowest on the legal (61.3% ± 2.1%), value of the AT (63.7% ± 4.3%), and health information technology (65.3% ± 3.7%) items. Whereas ATs described being confident in their documentation knowledge, they also identified key content (eg, legal considerations, strategies) which they deemed valuable. The educational interventions improved ATs’ knowledge of clinical documentation and provided valuable resources for their clinical practice; however, targeted continuing education is needed to address knowledge gaps.Context
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Pain reduction following massage after induced fatigue is not mediated by changes in muscle stiffness or intramuscular fluid content: a randomized controlled trial with mediation analysis
Electrotherapy as a Rehabilitation Modality for Chronic Ankle Instability: A
Systematic Review
Driving After Concussion: Clinical Measures Associated with Post-concussion
The role of shoulder posture in pitching mechanics and injury risk in high school baseball pitchers
Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making
JAT eISSN: 1938-162X
JAT ISSN: 1062-6050
ATEJ ISSN: 1947-380X