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This study examined a potential age-dependency of both posture and stability (balance) control in children and adolescents in a healthy population. Body posture with open and closed eyes was examined for a total of 456 test persons (age 6.7-17.6 years. Posture parameters (posture index, upper body tilt, trunk tilt) were assessed in the sagittal plane. Additionally, the oscillation of the center of pressure with open and closed eyes was additionally analyzed in a sub-sample of 318 subjects. Absolute values of stability control parameters changed significantly during childhood and adolescence for both boys (p = 0.005) and girls (p = 0.01). Relative changes of stability and posture parameters when closing the eyes did not change (p > 0.05) and were independent of age, gender or sports activity in healthy children and adolescents. The shifting of the body segments towards each other, as a result of the loss of visual information, does not seem to be primarily responsible for the increase in COP fluctuation. This is a further indication that stability control and posture control are complex interdependent mechanisms whose interaction is not yet fully understood.

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BACKGROUND AND OBJECTIVES: The causative factors or conditions leading to increased intestinal permeability (IIP) have only been partly elucidated, suggesting excessive zonulin release to be a key factor among them. Likewise, it is known that athletic activity predisposes individuals towards the development of IIP; however, little is understood about the nature of this phenomenon. We decided to test the actual coincidence between IIP and increased stool zonulin (ISZ) in actively training athletes. Materials and Methods: We compared intestinal permeability tested with lactulose/mannitol differential absorption (lactulose/mannitol (L/M) test) and zonulin concentration in stool in 20 professional athletes (PRO), 9 amateur athletes (AMA), and 9 non-athletes (CTR). Results: The results confirmed that professional athletic activity showed significant positive association with intestinal permeability. ISZ was observed exclusively in athletes (CTR vs. AMA vs. PRO, respectively, 0% vs. 22% vs. 55%), and its prevalence was significantly higher in PRO than CTR. When we divided the participants into four categories related to exceeding the upper reference limits for both tested parameters (ISZ + or - and IIP + or -), significant differences were found between CTR and PRO; however, no significant differences were found between CTR and AMA or AMA and PRO. Conclusions: Our trial confirmed previous findings that professional athletic activity predisposes individuals to IIP. We also demonstrated that although ISZ was associated with intense training, there was no statistically significant association between ISZ and IIP in the tested group of professional athletes, which suggests the existence of additional mechanisms causing IIP.

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BACKGROUND: Total hip and knee replacements are being performed in increasing numbers in progressively younger patients with higher activity demands. Many such patients have expectations of returning to athletic activity post-operatively yet are not always able to do so and the reasons behind this have not been extensively examined. We hypothesise that any reasons for a failure to return to athletic activity post-operatively are multi-factorial. AIM: To quantify the return to athletic activity following lower limb joint arthroplasty and understand qualitative reasons for altered activity participation. METHODS: A single centre, single surgeon retrospective questionnaire for hip and knee arthroplasty patients under age 60 years, minimum two years post-surgery with exclusion criteria of multiple degenerative joint involvement and multiple medical co-morbidities. Outcomes were validated joint-specific (Oxford hip and knee) and lifestyle questionnaires [short form 12 (SF-12) and University of California, Los Angeles (UCLA)] and an activity questionnaire assessing ability participation in athletic activity post-operatively. Statistical analysis was performed on the validated outcome data, including comparison between hip and knee replacements. Frequency tables were produced to quantify the different athletic activities participated in by patients. RESULTS: Responses were received from 64 patients (80% response rate). There was a statistically significant improvement in Oxford hip and knee scores following surgery. SF-12 scores also improved for all patients, but no statistically significant difference was seen between joints (P = 0.88). Mean UCLA scores pre-operatively were 7.67 and at two years post-operatively were 7.69, with no statistically significant change (P = 0.91). All patients reported high satisfaction and improved ability to perform athletic activity at a higher frequency compared to pre-operatively. The most common reasons for changing activity participation were not wanting to stress their joint replacement or instructions by other doctors or the lead surgeon. There was no difference in the responses to the questionnaire based on type of joint replacement (P = 0.995). CONCLUSION: Patients receiving a joint replacement are able to participate in athletic activity to high levels and are satisfied with their outcomes. Reasons for non-participation are multi-factorial.

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BACKGROUND: Autologous chondrocyte implantation (ACI) has been shown to provide adequate durability, pain relief, and improved long-term functional outcomes in the average patient, but proof of its efficacy in individuals with greater than average physical demands is scarce. Further knowledge is required to understand which patients may benefit from ACI and to identify which risk factors are associated with failure to return to the preinjury activity level. PURPOSE: To determine the occupational outcomes, rates of reoperation, and variables predictive of suboptimal outcomes after ACI. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All active-duty military servicemembers in the United States who underwent ACI of the knee between 2004 and 2014 were identified. Demographic information, injury characteristics, surgical variables, and clinical and surgical outcomes were extracted from the medical record. Univariate and multivariate analyses were used to determine significant independent predictors of clinical and surgical failures. RESULTS: A total of 90 patients (91 knees) met the inclusion criteria. The cohort was predominantly male (86%), with a mean age of 34.5 ± 6.3 years (range, 20-50 years). The most common location of the articular cartilage lesion was the patellofemoral compartment (54 lesions, 59%), and the mean Outerbridge grade and size were 3.8 ± 0.4 and 4.00 ± 2.77 cm2 (range, 1.2-15.0 cm2), respectively. A total of 72 patients (79%) had at least 1 previous knee procedure. Nearly three-quarters of patients (71%) underwent concomitant procedures. At a mean follow-up of 59.9 ± 27.1 months (range, 24.0-140.1 months), 60% of our patients reported significant improvement in knee pain and did not require further surgical intervention. Multivariate analysis identified age <30 years as the only significant independent predictor of both clinical (P = .011) and overall failure (P = .014). Moderate-demand military occupational specialties (P = .036), exclusive involvement of the patellofemoral compartment (P = .045), and use of a periosteal patch (P = .0173) were additionally found to be independent predictors of surgical failure. CONCLUSION: Treatment of articular cartilage defects of the knee with ACI in physically active young individuals can return nearly two-thirds of individuals to daily activity with decreased pain and improved function. Risk factors for failure after ACI surgery were age younger than 30 years, lower demand occupation, exclusive involvement of the patellofemoral compartment, prior microfracture, and use of a periosteal patch.

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Nasal fractures represent approximately 60% of all maxillofacial injuries that occur in athletic activities; however, there are no current guidelines regarding immediate sideline management of these injuries. Therefore, the purpose of this article was to (1) summarize the anatomy, etiology, and incidence of nasal fractures, and (2) evaluate the current body of literature regarding immediate on-field and subsequent outpatient management. It is imperative to establish that the athlete's airway is not compromised and there are no other severe concomitant injuries, such as a concussion, ocular injury, or leakage of cerebrospinal fluid. Immediate closed reduction should not be attempted unless there is airway compromise or the practitioner has experience in performing it. The majority of athletes with these injuries in isolation may return to play; however, in our practice, we recommend they wear a face mask for 6 weeks after their injury. Despite our recommendations, we know there is a paucity of clinical studies on immediate sideline and longer-term management. Future studies should focus on establishing therapeutic algorithms that will allow physicians to make treatment recommendations to patients with strong evidence to support their decision.

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OBJECTIVE: To examine whether passive hip rotation motion was different between people with and without low back pain (LBP) who regularly participate in sports that require repeated rotation of the trunk and hips. We hypothesized that people with LBP would have less total hip rotation motion and more asymmetry of motion between sides than people without LBP. DESIGN: Two group, case-control. SETTING: University-based musculoskeletal analysis laboratory. PARTICIPANTS: Forty-eight subjects (35 males, 13 females; mean age: 26.56+/-7.44 years) who reported regular participation in a rotation-related sport participated. Two groups were compared; people with LBP (N=24) and people without LBP (N=24; NoLBP). MAIN OUTCOME MEASURES: Data were collected on participant-related, LBP-related, sport-related and activity-related variables. Measures of passive hip rotation range of motion were obtained. The differences between the LBP and NoLBP groups were examined. RESULTS: People with and without a history of LBP were the same with regard to all participant-related, sport-related and activity-related variables. The LBP group had significantly less total rotation (P=.035) and more asymmetry of total rotation, right hip versus left hip, (P=.022) than the NoLBP group. Left total hip rotation was more limited than right total hip rotation in the LBP group (P=.004). There were no significant differences in left and right total hip rotation for the NoLBP group (P=.323). CONCLUSIONS: Among people who participate in rotation-related sports, those with LBP had less overall passive hip rotation motion and more asymmetry of rotation between sides than people without LBP. These findings suggest that the specific directional demands imposed on the hip and trunk during regularly performed activities may be an important consideration in deciding which impairments may be most relevant to test and to consider in prevention and intervention strategies.

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