RESUMEN

BACKGROUND: Strength and neuromuscular decrements following knee musculoskeletal injury may accelerate knee osteoarthritis development. This study assessed isometric knee extensor and flexor strength and steadiness between individuals with knee injury, i.e., ligament reconstruction, and knee osteoarthritis to healthy age-matched controls. METHODS: Four cohorts (1: knee injury and 2: age-matched controls, and 3: radiographic knee osteoarthritis and 4: age-matched controls) were recruited. Participants performed maximal voluntary isometric knee extensor and flexor contractions. Then, strength (e.g., peak and rate of torque development) and steadiness (e.g., peak power, mean, and median frequency) were derived from each raw torque-time curve and associated power spectral density. A Kruskal-Wallis H test and Spearman's rho correlation analysis assessed cohort differences and association between knee extensor and flexor strength and steadiness. FINDINGS: The young adult control and knee injury cohorts exhibited greater knee extensor and flexor strength than the older, knee osteoarthritis cohort (p < 0.043). The knee injury cohort, despite being as strong as their healthy counterparts, were significantly less steady with a 92% increase in peak power frequency (p = 0.046). The osteoarthritis cohort exhibited 157% less total power compared to the knee injury and young control cohorts (p < 0.019). Knee extensor and flexor peak torque, rate of torque development, and mean torque exhibit a significant, positive relation with total power (p < 0.018). INTERPRETATION: Individuals with knee injury and disease may exhibit weaker or less steady knee musculature, predisposing them to degenerative joint disease. Clinicians may need to restore knee extensor and flexor steadiness to facilitate better joint neuromuscular control.

Asunto(s)

Fuerza Muscular , Osteoartritis de la Rodilla , Humanos , Osteoartritis de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/cirugía , Masculino , Femenino , Adulto , Persona de Mediana Edad , Reconstrucción del Ligamento Cruzado Anterior/métodos , Articulación de la Rodilla/fisiopatología , Torque , Músculo Esquelético/fisiopatología , Contracción Isométrica , Ligamento Cruzado Anterior/fisiopatología , Ligamento Cruzado Anterior/cirugía , Adulto Joven , Anciano , Traumatismos de la Rodilla/fisiopatología

RESUMEN

Athletes commonly use compression garments (CGs) for perceived effectiveness in preventing injury occurrence. However, limited evidence is available on whether lower-limb CGs reduce the risk of injury. This study aimed at (1) evaluating the effects of CGs on mitigating the risk factors of cutting-related knee injuries; (2) identifying undesirable side-effects of CGs on other joints and cutting performance; and (3) identifying possible interactions between sex and condition. 62 healthy adults performed pre-planned 90˚ cutting tasks under four conditions: control, knee sleeves, placebo leggings and stiffness-altered leggings. Joint angle at initial contact, range of motion, moments, and ground reaction force were measured. A mixed two-way (sex*condition) ANOVA was performed, followed by post-hoc comparisons and subset analyses for sexes. Results showed that the leggings restricted hip sagittal (45.4 ± 1.3 vs. control 50.0 ± 1.3˚, p = 0.001) and rotational (16.8 ± 0.8 vs. control 22.5 ± 1.1˚, p < 0.001) motion. At initial contact, the stiffness-altered leggings reduced knee valgus (0.4 ± 0.8 vs. control -2.1 ± 0.8˚, p = 0.031). However, the altered alignment of lower-limb joints did not reduce multiplanar knee joint moments (p > 0.05). CGs were not effective protective equipment yet. There was no significant difference between knee sleeves and control, nor between leggings conditions (p > 0.05). Force plate measurements, such as increased rate of force development (stiffness-altered 42.6 ± 1.1 & placebo 42.9 ± 1.1 vs. control 39.9 ± 1.0 BW/s, p < 0.028), implied the possibility of performance enhancement through CGs. While further investigations on the optimal compression and stiffness alterations are warranted, athletes are recommended to be aware of the discrepancies between the claimed and actual biomechanical effects of CGs.

Asunto(s)

Articulación de la Rodilla , Humanos , Masculino , Femenino , Adulto , Fenómenos Biomecánicos , Articulación de la Rodilla/fisiología , Rango del Movimiento Articular , Extremidad Inferior/fisiología , Traumatismos de la Rodilla/prevención & control , Traumatismos de la Rodilla/fisiopatología , Adulto Joven , Traumatismos en Atletas/prevención & control , Traumatismos en Atletas/fisiopatología

RESUMEN

BACKGROUND: Preventing severe arthrogenic muscle inhibition (AMI) after knee injury is critical for better prognosis. The novel Sonnery-Cottet classification of AMI enables the evaluation of AMI severity but requires validation. This study aimed to investigate the electromyography (EMG) patterns of leg muscles in the examination position from the classification during isometric contraction to confirm its validity. We hypothesised that the AMI pattern, which is characterised by quadriceps inhibition and hamstring hypercontraction, would be detectable in the supine position during isometric contraction. METHODS: Patients with meniscal or knee ligament injuries were enrolled between August 2023 and May 2024. Surface EMG was assessed during submaximal voluntary isometric contractions (sMVIC) at 0° extension in the supine position for the vastus medialis (VM) and vastus lateralis (VL) muscles and at 20° flexion in the prone position for the semitendinosus (ST) and biceps femoris (BF) muscles. Reference values for normalisation were obtained from the EMG activity during the gait of the uninjured leg. The Kruskal-Wallis test was used to compare the activation patterns of the muscle groups within the same leg, and the post-hoc tests were conducted using the Mann-Whitney U test and Bonferroni correction. RESULTS: Electromyographic data of 40 patients with knee injuries were analyzed. During sMVIC, the extensor and flexor muscles of the injured leg showed distinct behaviours (P < 0.001), whereas the uninjured side did not (P = 0.144). In the injured leg, the VM differed significantly from the ST (P = 0.018), and the VL differed significantly from the ST and BF (P = 0.001 and P = 0.026, respectively). However, there were no statistically significant differences within the extensor muscle groups (VM and VL, P = 0.487) or flexor muscle groups (ST and BF, P = 0.377). CONCLUSION: AMI was detectable in the examination position suggested by the Sonnery-Cottet classification. The flexor and extensor muscles of the injured leg exhibited distinct activation behaviours, with inhibition predominantly occurring in the quadriceps muscles, whereas the hamstrings showed excitation.

Asunto(s)

Electromiografía , Contracción Isométrica , Músculo Cuádriceps , Humanos , Electromiografía/métodos , Músculo Cuádriceps/fisiopatología , Músculo Cuádriceps/fisiología , Contracción Isométrica/fisiología , Masculino , Estudios Transversales , Adulto , Femenino , Posición Supina/fisiología , Traumatismos de la Rodilla/fisiopatología , Adulto Joven , Examen Físico/métodos , Persona de Mediana Edad , Estudios de Factibilidad

RESUMEN

BACKGROUND: Single-leg landing (SL) is an essential technique in sports such as basketball, soccer, and volleyball, which is often associated with a high risk of knee-related injury. The ankle motion pattern plays a crucial role in absorbing the load shocks during SL, but the effect on the knee joint is not yet clear. This work aims to explore the effects of different ankle plantarflexion angles during SL on the risk of knee-related injury. METHODS: Thirty healthy male subjects were recruited to perform SL biomechanics tests, and one standard subject was selected to develop the finite element model of foot-ankle-knee integration. The joint impact force was used to evaluate the impact loads on the knee at various landing angles. The internal load forces (musculoskeletal modeling) and stress (finite element analysis) around the knee joint were simulated and calculated to evaluate the risk of knee-related injury during SL. To more realistically revert and simulate the anterior cruciate ligament (ACL) injury mechanics, we developed a knee musculoskeletal model that reverts the ACL ligament to a nonlinear short-term viscoelastic mechanical mechanism (strain rate-dependent) generated by the dense connective tissue as a function of strain. RESULTS: As the ankle plantarflexion angle increased during landing, both the peak knee vertical impact force (p = 0.001) and ACL force (p = 0.001) decreased significantly. The maximum von Mises stress of ACL, meniscus, and femoral cartilage decreased as the ankle plantarflexion angle increased. The overall range of variation in ACL stress was small and was mainly distributed in the femoral and tibial attachment regions, as well as in the mid-lateral region. CONCLUSION: The current findings revealed that the use of larger ankle plantarflexion angles during landing may be an effective solution to reduce knee impact load and the risk of rupture of the medial femoral attachment area in the ACL. The findings of this study have the potential to offer novel perspectives in the optimized application of landing strategies, thus giving crucial theoretical backing for decreasing the risk of knee-related injury.

Asunto(s)

Articulación del Tobillo , Humanos , Masculino , Articulación del Tobillo/fisiología , Adulto , Traumatismos de la Rodilla/fisiopatología , Traumatismos de la Rodilla/prevención & control , Articulación de la Rodilla/fisiología , Modelos Biológicos , Fenómenos Biomecánicos/fisiología , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Análisis de Elementos Finitos , Movimiento/fisiología

RESUMEN

OBJECTIVES: To compile a battery of test including various aspects of physical fitness that could be used on the field and to assess whether any of these tests are associated with future traumatic knee injuries in youth female team sports athletes. DESIGN: Prospective cohort. SETTING: Sport setting. PARTICIPANTS: Female athletes (n = 117, age 15-19 years), from Swedish sport high schools, active in soccer, handball, or floorball. MAIN OUTCOME MEASURES: Differences in pre-injury tests values of 11 physical fitness tests in injured versus non-injured athletes, assessed as number of traumatic knee injuries over one season. RESULTS: 28 athletes sustained 34 traumatic knee injuries. Athletes who sustained an injury had a shorter distance on the Yo-Yo IR1 test at baseline than those without an injury (mean difference -193 m, CI -293- -65 m). None of the other tests, assessed for muscular strength, endurance, power, flexibility and dynamic knee valgus, differed between injured and non-injured athletes. CONCLUSIONS: Youth female athletes with lower intermittent endurance capacity, assessed with the Yo-Yo IR1, seemed to be at greater risk of traumatic knee injury. Neither hop performance, flexibility, dynamic knee valgus nor isolated strength tests at baseline could distinguish between injured and non-injured youth female athletes at follow-up.

Asunto(s)

Traumatismos en Atletas , Traumatismos de la Rodilla , Aptitud Física , Humanos , Femenino , Estudios Prospectivos , Adolescente , Aptitud Física/fisiología , Traumatismos de la Rodilla/fisiopatología , Traumatismos en Atletas/fisiopatología , Adulto Joven , Prueba de Esfuerzo , Fuerza Muscular/fisiología , Atletas , Suecia

RESUMEN

BACKGROUND: An athlete's career inevitably goes through periods of forced physical exercise interruption like a knee injury. Advanced echocardiographic methods and cardiopulmonary exercise testing (CPET) are essential in evaluating athletes in the period elapsing after the injury. However, the feasibility of a maximal pre-surgery CPET and the capacity of resting advanced echocardiographic techniques to predict cardiorespiratory capacity still need to be clarified. METHODS: We evaluated 28 non-professional athletes aged 18-52, involved in prevalently aerobic or alternate aerobic/anaerobic sports activities, affected by a knee pathology with indications for surgical treatment. The evaluation was performed at rest by trans-thoracic echocardiography, including global longitudinal strain (GLS) and myocardial work (MW) assessment, and during exercise by CPET. RESULTS: The percent-predicted peak oxygen consumption (peak VO2%) was 82.8±13.7%, the mean respiratory exchange ratio was 1.16±0.08, and the mean ventilation/carbon dioxide (VE/VCO2) slope was 24.23±3.36. Peak VO2% negatively correlated with GLS (r=-0.518, P=0.003) and global wasted work (GWW) (r =-0.441, P=0.015) and positively correlated with global work efficiency (GWE) (r=0.455, P=0.012). Finally, we found that the VE/VCO2 slope during exercise was negatively correlated with GWE (r=-0.585, P=0.001) and positively correlated with GWW (r=0.499, P=0.005). CONCLUSIONS: A maximal CPET can be obtained in deconditioned athletes because of a knee injury, allowing a comprehensive functional pre-surgery evaluation. In these patients, peak VO2 is reduced due to decreased physical activity after injury; however, a lower cardiopulmonary efficiency may be a concause of the injury itself. In addition, we demonstrated that the MW indexes obtained at rest could predict exercise capacity and ventilatory efficiency as evaluated by CPET.

Asunto(s)

Prueba de Esfuerzo , Traumatismos de la Rodilla , Consumo de Oxígeno , Humanos , Prueba de Esfuerzo/métodos , Adulto , Consumo de Oxígeno/fisiología , Masculino , Traumatismos de la Rodilla/fisiopatología , Adulto Joven , Femenino , Persona de Mediana Edad , Ecocardiografía , Adolescente , Capacidad Cardiovascular/fisiología , Atletas

RESUMEN

BACKGROUND: An isokinetic moment curve (IMC) pattern-damaged structure prediction model may be of considerable value in assisting the diagnosis of knee injuries in clinical scenarios. This study aimed to explore the association between irregular IMC patterns and specific structural damages in the knee, including anterior cruciate ligament (ACL) rupture, meniscus (MS) injury, and patellofemoral joint (PFJ) lesions, and to develop an IMC pattern-damaged structure prediction model. METHODS: A total of 94 subjects were enrolled in this study and underwent isokinetic testing of the knee joint (5 consecutive flexion-extension movements within the range of motion of 90°-10°, 60°/s). Qualitative analysis of the IMCs for all subjects was completed by two blinded examiners. A multinomial logistic regression analysis was used to investigate whether a specific abnormal curve pattern was associated with specific knee structural injuries and to test the predictive effectiveness of IMC patterns for specific structural damage in the knee. RESULTS: The results of the multinomial logistic regression revealed a significant association between the irregular IMC patterns of the knee extensors and specific structural damages ("Valley" - ACL, PFJ, and ACL + MS, "Drop" - ACL, and ACL + MS, "Shaking" - ACL, MS, PFJ, and ACL + MS). The accuracy and Macro-averaged F1 score of the predicting model were 56.1% and 0.426, respectively. CONCLUSION: The associations between irregular IMC patterns and specific knee structural injuries were identified. However, the accuracy and Macro-averaged F1 score of the established predictive model indicated its relatively low predictive efficacy. For the development of a more accurate predictive model, it may be essential to incorporate angle-specific and/or speed-specific analyses of qualitative and quantitative data in isokinetic testing. Furthermore, the utilization of artificial intelligence image recognition technology may prove beneficial for analyzing large datasets in the future.

Asunto(s)

Lesiones del Ligamento Cruzado Anterior , Articulación de la Rodilla , Rango del Movimiento Articular , Humanos , Masculino , Femenino , Adulto , Rango del Movimiento Articular/fisiología , Articulación de la Rodilla/fisiopatología , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Adulto Joven , Fenómenos Biomecánicos/fisiología , Traumatismos de la Rodilla/fisiopatología , Valor Predictivo de las Pruebas , Lesiones de Menisco Tibial/fisiopatología , Articulación Patelofemoral/fisiopatología , Articulación Patelofemoral/lesiones , Persona de Mediana Edad

RESUMEN

BACKGROUND: Injuries to the medial collateral ligament (MCL), specifically the deep MCL (dMCL) and superficial MCL (sMCL), are both reported to be factors in anteromedial rotatory instability (AMRI); however, a partial sMCL (psMCL) injury is often present, the effect of which on AMRI is unknown. PURPOSE: To investigate the effect of a dMCL injury with or without a psMCL injury on knee joint laxity. STUDY DESIGN: Controlled laboratory study. METHODS: Sixteen fresh-frozen human cadaveric knees were tested using a 6 degrees of freedom robotic simulator. The anterior cruciate ligament (ACL) was cut first and last in protocols 1 and 2, respectively. The dMCL was cut completely, followed by an intermediary psMCL injury state before the sMCL was completely sectioned. Tibiofemoral kinematics were measured at 0°, 30°, 60°, and 90° of knee flexion for the following measurements: 8 N·m of valgus rotation (VR), 4 N·m of external tibial rotation, 4 N·m of internal tibial rotation, and combined 89 N of anterior tibial translation and 4 N·m of external tibial rotation for both anteromedial rotation (AMR) and anteromedial translation. The differences between subsequent states, as well as differences with respect to the intact state, were analyzed. RESULTS: In an ACL-intact or -deficient joint, a combined dMCL and psMCL injury increased external tibial rotation and VR compared with the intact state at all angles. A significant increase in AMR was seen in the ACL-intact knee after this combined injury. Cutting the dMCL alone showed lower mean increases in AMR compared with the psMCL injury, which were significant only when the ACL was intact in knee flexion. Moreover, cutting the dMCL had no effect on VR. The ACL was the most important structure in controlling anteromedial translation, followed by the psMCL or dMCL depending on the knee flexion angle. CONCLUSION: A dMCL injury alone may produce a small increase in AMRI but not in VR. A combined dMCL and psMCL injury caused an increase in AMRI and VR. CLINICAL RELEVANCE: In clinical practice, if an increase in AMRI at 30° and 90° of knee flexion is seen together with some increase in VR, a combined dMCL and psMCL injury should be suspected.

Asunto(s)

Cadáver , Inestabilidad de la Articulación , Articulación de la Rodilla , Ligamento Colateral Medial de la Rodilla , Humanos , Inestabilidad de la Articulación/fisiopatología , Ligamento Colateral Medial de la Rodilla/lesiones , Ligamento Colateral Medial de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiopatología , Fenómenos Biomecánicos , Persona de Mediana Edad , Masculino , Femenino , Anciano , Rotación , Traumatismos de la Rodilla/fisiopatología , Rango del Movimiento Articular

RESUMEN

BACKGROUND: Injuries to the deep medial collateral ligament (dMCL) and partial superficial MCL (psMCL) can cause anteromedial rotatory instability; however, the contribution of each these injuries in restraining anteromedial rotatory instability and the effect on the anterior cruciate ligament (ACL) load remain unknown. PURPOSE: To investigate the contributions of the different MCL structures in restraining tibiofemoral motion and to evaluate the load through the ACL after MCL injury, especially after combined dMCL/psMCL injury. STUDY DESIGN: Controlled laboratory study. METHODS: Sixteen fresh-frozen human cadaveric knees were tested using a 6 degrees of freedom robotic simulator. Tibiofemoral kinematic parameters were recorded at 0°, 30°, 60°, and 90° of knee flexion for the following measurements: 8-N·m valgus rotation, 4-N·m external tibial rotation (ER), 4-N·m internal tibial rotation, and a combined 89-N anterior tibial translation and 4-N·m ER for both anteromedial rotation (AMR) and anteromedial translation (AMT). The kinematic parameters of the 3 different MCL injuries (dMCL; dMCL/psMCL; dMCL/superficial MCL (sMCL)) were recorded and reapplied either in an ACL-deficient joint (load sharing) or before and after cutting the ACL (ACL load). The loads were calculated by applying the principle of superposition. RESULTS: The dMCL had the largest effect on reducing the force/torque during ER, AMR, and AMT in extension and the psMCL injury at 30° to 90° of knee flexion (P < .05). In a comparison of the load through the ACL when the MCL was intact, the ACL load increased by 46% and 127% after dMCL injury and combined dMCL/psMCL injury, respectively, at 30° of knee flexion during ER. In valgus rotation, a significant increase in ACL load was seen only at 90° of knee flexion. CONCLUSION: The psMCL injury made the largest contribution to the reduction of net force/torque during AMR/AMT at 30° to 90° of flexion. Concomitant dMCL/psMCL injury increased the ACL load, mainly during ER. CLINICAL RELEVANCE: If a surgical procedure is being considered to treat anteromedial rotatory instability, then the procedure should focus on restoring sMCL function, as injury to this structure causes a major loss of the knee joint's capacity to restrain AMR/AMT.

Asunto(s)

Ligamento Cruzado Anterior , Ligamento Colateral Medial de la Rodilla , Soporte de Peso , Humanos , Ligamento Colateral Medial de la Rodilla/lesiones , Ligamento Colateral Medial de la Rodilla/fisiopatología , Fenómenos Biomecánicos , Soporte de Peso/fisiología , Persona de Mediana Edad , Ligamento Cruzado Anterior/fisiopatología , Ligamento Cruzado Anterior/fisiología , Masculino , Cadáver , Femenino , Inestabilidad de la Articulación/fisiopatología , Anciano , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Lesiones del Ligamento Cruzado Anterior/cirugía , Rotación , Articulación de la Rodilla/fisiología , Articulación de la Rodilla/fisiopatología , Traumatismos de la Rodilla/fisiopatología , Adulto , Rango del Movimiento Articular/fisiología

RESUMEN

BACKGROUND: The single-leg squat (SLS) is a safe and widespread functional test commonly performed in the mid-stages of rehabilitation after severe knee injuries. The use of reliable objective measures has been advocated to improve the quality of SLS assessment. The aim of this study was to describe a qualitative whole-body scoring system based on two-dimensional (2D) video analysis during SLS test and validate it against three-dimensional (3D) kinetics and kinematics. METHODS: Thirty-four competitive football (soccer) players performed a series of SLS tasks. 3D kinematics and kinetics were collected through infrared cameras, and 2D video analysis was performed through a scoring system with sub-scores ranging from 0/2 (non-adequate movement) to 2/2 (adequate movement) based on frontal and lateral planes objective measurements. 3D kinematics and kinetics were grouped according to the results of the 2D evaluation and compared through the analysis of variance (P < 0.05). RESULTS: Higher hip adduction, hip internalrotation, and knee valgus collapse were found in trials rated 0/2 or 1/2 compared with theone rated 2/2 in the limb stability score. Hip flexion and hip/knee moment ratio were lower in those scoring 0/2 comparedwith those scoring 2/2 in the movement strategy criterion. A low total score was associated with higherknee valgus collapse and lower hip/knee extensor moment ratio. Compensatory strategieswere found in frontal plane scores. CONCLUSIONS: The 2D scoring system described was strongly associated with kinematics and kinetics from gold-standard 3D motion capture and might represent a valid tool to describe the movement quality of an SLS task.

Asunto(s)

Rango del Movimiento Articular , Fútbol , Humanos , Fútbol/fisiología , Masculino , Fenómenos Biomecánicos/fisiología , Rango del Movimiento Articular/fisiología , Adulto Joven , Grabación en Video , Adulto , Prueba de Esfuerzo/métodos , Traumatismos de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiología , Articulación de la Rodilla/fisiopatología , Movimiento/fisiología

RESUMEN

Echo intensity (EI) is a novel tool for assessing muscle quality. EI has traditionally been reported as the mean of the pixel histogram, with 0 and 255 arbitrary units (A.U.) representing excellent and poor muscle quality, respectively. Recent work conducted in youth and younger and older adults suggested that analyzing specific EI bands, rather than the mean, may provide unique insights into the effectiveness of exercise and rehabilitation interventions. As our previous work showed deterioration of muscle quality after knee joint immobilization, we sought to investigate whether the increase in EI following disuse was limited to specific EI bands. Thirteen females (age = 21 yrs) underwent two weeks of left knee immobilization and ambulated via crutches. B-mode ultrasonography was utilized to obtain images of the immobilized vastus lateralis. The percentage of the total number of pixels within bands of 0-50, 51-100, 101-150, 151-200, and 201-255 A.U. was examined before and after immobilization. We also sought to determine if further subdividing the histogram into 25 A.U. bands (i.e., 0-25, 26-50, etc.) would be a more sensitive methodological approach. Immobilization resulted in a decrease in the percentage of pixels within the 0-50 A.U. band (-3.11 ± 3.98%), but an increase in the 101-150 A.U. (2.94 ± 2.64%) and 151-200 A.U. (0.93 ± 1.42%) bands. Analyses of variance on the change scores indicated that these differences were large and significant (%EI0-50 vs. %EI101-150: p < .001, d = 1.243); %EI0-50 vs. %EI151-200: p = .043, d = 0.831). The effect size for the %EI51-100 versus %EI101-150 comparison was medium/large (d = 0.762), but not statistically significant (p = .085). Further analysis of the 25 A.U. bands indicated that the percentage of pixels within the 25-50 A.U. band decreased (-2.97 ± 3.64%), whereas the 101-125 (1.62 ± 1.47%) and 126-150 A.U. (1.18 ± 1.07%) bands increased. Comparison of the 50 A.U. and 25 A.U. band methods found that 25 A.U. bands offer little additional insight. Though studies are needed to ascertain the factors that may influence specific bands, changes in EI during muscle disuse are not homogeneous across the pixel histogram. We encourage investigators to think critically about the robustness of data obtained from EI histograms, rather than simply reporting the EImean value, in muscle quality research.

Asunto(s)

Ejercicio Físico , Traumatismos de la Rodilla/fisiopatología , Fuerza Muscular , Músculo Esquelético/fisiopatología , Músculo Cuádriceps/fisiopatología , Adulto , Femenino , Humanos , Traumatismos de la Rodilla/rehabilitación , Músculo Esquelético/diagnóstico por imagen , Músculo Cuádriceps/diagnóstico por imagen , Estudios Retrospectivos , Ultrasonografía/métodos , Adulto Joven

Asunto(s)

Humanos , Traumatismos de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiopatología

Asunto(s)

Humanos , Articulación de la Rodilla/fisiopatología , Traumatismos de la Rodilla/fisiopatología , Osteoartritis de la Rodilla

Asunto(s)

Humanos , Rodilla/anatomía & histología , Articulación de la Rodilla/fisiopatología , Traumatismos de la Rodilla/fisiopatología , Osteoartritis de la Rodilla

RESUMEN

Meniscus tears of the knee are among the most common orthopedic knee injury. Specifically, tears of the posterior root can result in abnormal meniscal extrusion leading to decreased function and progressive osteoarthritis. Despite contemporary surgical treatments of posterior meniscus root tears, there is a low rate of healing and an incidence of residual meniscus extrusion approaching 30%, illustrating an inability to recapitulate native meniscus function. Here, we characterized the differential functional behavior of the medial and lateral meniscus during axial compression load and dynamic knee motion using a cadaveric model. We hypothesized essential differences in extrusion between the medial and lateral meniscus in response to axial compression and knee range of motion. We found no differences in the amount of meniscus extrusion between the medial and lateral meniscus with a competent posterior root (0.338mm vs. 0.235mm; p-value = 0.181). However, posterior root detachment resulted in a consistently increased meniscus extrusion for the medial meniscus compared to the lateral meniscus (2.233mm vs. 0.4705mm; p-value < 0.0001). Moreover, detachment of the posterior root of the medial meniscus resulted in an increase in extrusion at all angles of knee flexion and was most pronounced (4.00mm ± 1.26mm) at 30-degrees of knee flexion. In contrast, the maximum mean extrusion of the lateral meniscus was 1.65mm ± 0.97mm, occurring in full extension. Furthermore, only the medial meniscus extruded during dynamic knee flexion after posterior root detachment. Given the differential functional behaviors between the medial and lateral meniscus, these findings suggest that posterior root repair requires reducing overall meniscus extrusion and recapitulating the native functional responses specific to each meniscus.

Asunto(s)

Meniscos Tibiales/fisiología , Menisco/fisiología , Rango del Movimiento Articular/fisiología , Humanos , Traumatismos de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiología , Extremidad Inferior/fisiología

RESUMEN

The round house kick (RHK) is a common technique in taekwondo (TKD). The kicking action originates from the dynamic stability of the pivot leg. However, some knee injuries are caused by more difficult kicking strategies, such as kicks to the opponent's head. This study analyses the effects on TKD players in the lower extremity kinematic and neuromuscular reactions from different kicking heights. This study recruited 12 TKD players (age=20.3 ± 1.3 years, height = 1.72 ± 0.09 m, mass = 62.17 ± 9.45 kg) with no previous lower extremity ligament injuries. All athletes randomly performed 3 RHK at different heights (head, chest, and abdomen), repeating each kick 5 times. During the RHK action, the kinematics and muscle activations of the pivot leg were collected using six high-speed cameras and electromyography devices. The results found that during the RHK return period a high kicking position demonstrated larger knee valgus with the straight knee, and more hamstring activation on the pivot leg. The RHK pivot foot for TKD players encountered more risk of injury from high target kicking. The hamstring muscle played an important stabilizing role. It is recommended that sports medicine clinicians or sports coaches use this information to provide further protective injury prevention strategies.

Asunto(s)

Pierna/fisiología , Artes Marciales/fisiología , Músculo Esquelético/fisiología , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Fenómenos Biomecánicos , Electromiografía , Femenino , Músculos Isquiosurales/fisiología , Cadera/fisiología , Humanos , Traumatismos de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiología , Masculino , Rango del Movimiento Articular , Factores de Riesgo , Análisis y Desempeño de Tareas , Adulto Joven

RESUMEN

OBJECTIVE: To examine the associations of knee injury, radiographic osteoarthritis severity, and quadriceps strength with knee pain exacerbation during walking. DESIGN: Within-person knee-matched case-control study. METHODS: Participants from the Osteoarthritis Initiative who completed a 20-m walking test at the 24-month visit were included. Pain exacerbation was defined as an increase in pain intensity of 1 or more on a numeric rating scale (0 as no pain and 10 as the worst imaginable pain) while completing the 20-m walking test. We used conditional logistic regression to assess the relation of recent knee injury, Kellgren-Lawrence (KL) grade, and quadriceps strength to unilateral knee pain exacerbation during walking. RESULTS: We included 277 people who experienced unilateral knee pain exacerbation during the walking test. Recent knee injury was associated with pain exacerbation during walking, with an odds ratio of 3.4 (95% confidence interval [CI]: 1.3, 9.2). Compared with knees with a KL grade of 0, the odds ratios of pain exacerbation during walking were 1.3 (95% CI: 0.7, 2.7), 3.3 (95% CI: 1.5, 7.1), and 8.1 (95% CI: 3.1, 21.1) for knees with KL grades of 2, 3, and 4, respectively. Painful knees with a deficit in quadriceps strength of greater than or equal to 4% had a 1.4-fold (95% CI: 1.0, 1.9) higher risk of pain exacerbation during walking than their pain-free counterparts. CONCLUSION: Recent knee injury, more severe radiographic osteoarthritis, and lower quadriceps strength were associated with an increased risk of knee pain exacerbation during walking. J Orthop Sports Phys Ther 2021;51(6):298-304. Epub 10 May 2021. doi:10.2519/jospt.2021.9735.

Asunto(s)

Artralgia/fisiopatología , Traumatismos de la Rodilla/fisiopatología , Fuerza Muscular/fisiología , Osteoartritis de la Rodilla/fisiopatología , Músculo Cuádriceps/fisiopatología , Caminata/fisiología , Anciano , Anciano de 80 o más Años , Artralgia/diagnóstico por imagen , Estudios de Casos y Controles , Femenino , Humanos , Traumatismos de la Rodilla/diagnóstico por imagen , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Radiografía , Prueba de Paso

RESUMEN

Posterior cruciate ligament (PCL) injuries commonly occur in association with participation in sporting or recreational activities or due to a direct trauma. Cartilage and meniscal lesions are prevalent in PCL-injured knees with increasing likelihood and severity based on extent and duration of trauma to the knee. As such, comprehensive diagnostics should be performed to ascertain all related pathology, and patients should be thoroughly educated regarding treatment options, likely sequelae including posttraumatic osteoarthritis, and associated outcomes. Treatments should address the joint as an organ, ensuring stability, alignment, and functional tissue restoration are optimized by the most efficient and effective means possible. Compliance with patient- and procedure-specific postoperative management protocols is critical for optimizing successful outcomes for these complex cases. The objectives of this review article are to highlight the likelihood and importance of osteochondral and meniscal pathology in the PCL-injured knee, and to provide the best current evidence regarding comprehensive evaluation and management for PCL-injured knees with cartilage and/or meniscal comorbidities.

Asunto(s)

Enfermedades de los Cartílagos , Cartílago Articular , Traumatismos de la Rodilla , Ligamento Cruzado Posterior/lesiones , Lesiones de Menisco Tibial , Algoritmos , Enfermedades de los Cartílagos/complicaciones , Enfermedades de los Cartílagos/diagnóstico , Enfermedades de los Cartílagos/fisiopatología , Enfermedades de los Cartílagos/cirugía , Cartílago Articular/lesiones , Cartílago Articular/fisiopatología , Cartílago Articular/cirugía , Humanos , Traumatismos de la Rodilla/complicaciones , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/fisiopatología , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Meniscos Tibiales/fisiopatología , Meniscos Tibiales/cirugía , Osteoartritis/etiología , Ligamento Cruzado Posterior/fisiopatología , Ligamento Cruzado Posterior/cirugía , Lesiones de Menisco Tibial/diagnóstico , Lesiones de Menisco Tibial/fisiopatología , Lesiones de Menisco Tibial/cirugía

RESUMEN

Posterior cruciate ligament (PCL) injuries are often encountered in the setting of other knee pathology and sometimes in isolation. A thorough understanding of the native PCL anatomy is crucial in the successful treatment of these injuries. The PCL consists of two independent bundles that function in a codominant relationship to perform the primary role of resisting posterior tibial translation relative to the femur. A secondary role of the PCL is to provide rotatory stability. The anterolateral (AL) bundle has a more vertical orientation when compared with the posteromedial (PM) bundle. The AL bundle has a more anterior origin than the PM bundle on the lateral wall of the medial femoral condyle. The tibial insertion of AL bundle on the PCL facet is medial and anterior to the PM bundle. The AL and PM bundles are 12-mm apart at the center of the femoral origins, while the tibial insertions are more tightly grouped. The different spatial orientation of the two bundles and large distance between the femoral centers is responsible for the codominance of the PCL bundles. The AL bundle is the dominant restraint to posterior tibial translation throughout midrange flexion, while the PM bundle is the primary restraint in extension and deep flexion. Biomechanical testing has shown independent reconstruction of the two bundles that better reproduces native knee biomechanics, while significant differences in clinical outcomes remain to be seen. Stress X-rays may play an important role in clinical decision-making process for operative versus nonoperative management of isolated PCL injuries. Strong understanding of PCL anatomy and biomechanics can aid surgical management.

Asunto(s)

Traumatismos de la Rodilla , Articulación de la Rodilla , Ligamento Cruzado Posterior , Fenómenos Biomecánicos , Fémur/anatomía & histología , Humanos , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/diagnóstico por imagen , Traumatismos de la Rodilla/fisiopatología , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/anatomía & histología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiología , Articulación de la Rodilla/cirugía , Ligamento Cruzado Posterior/anatomía & histología , Ligamento Cruzado Posterior/diagnóstico por imagen , Ligamento Cruzado Posterior/fisiología , Ligamento Cruzado Posterior/cirugía , Reconstrucción del Ligamento Cruzado Posterior/métodos , Rango del Movimiento Articular , Rotación , Tibia/anatomía & histología

RESUMEN

The degeneration of radial tie fibres of the central meniscal layer, and thinning of its lamellar layer results in increased intensity signals on magnetic resonance imaging, making it difficult to differentiate from true meniscal tear. This study aimed to assess the rate of encountered MRI grades 1 and 2 intrasubstance meniscal changes, and to set guidelines to report these changes based on predicted clinical outcome. A systematic review approach was employed using search engines, libraries, and databases (Google Scholar, ERIC, PubMed, and Medline) to search for scholarly sources on meniscal lesions and their significance in MRI published between 1 January 2000 and 30 June 2019. It retrieved 2750 abstracts, out of which 2738 were excluded and 13 studies meeting inclusion criteria were meta-analysed. It found an association between intrasubstances meniscal changes and outcomes. It resulted that intrasubstance meniscal changes were preservable through the protective functioning of the meniscus. Other than weight gain, no other significant risk factor of developing true meniscal tears later in life was found. It is important to examine intrasubstance meniscal change when patients suffer from mechanical meniscal symptoms especially in old age.

Asunto(s)

Traumatismos de la Rodilla/fisiopatología , Meniscos Tibiales/fisiopatología , Menisco/diagnóstico por imagen , Lesiones de Menisco Tibial/fisiopatología , Anciano , Anciano de 80 o más Años , Artroscopía/métodos , Femenino , Humanos , Traumatismos de la Rodilla/diagnóstico por imagen , Traumatismos de la Rodilla/epidemiología , Imagen por Resonancia Magnética , Masculino , Meniscos Tibiales/diagnóstico por imagen , Menisco/fisiopatología , Persona de Mediana Edad , Lesiones de Menisco Tibial/diagnóstico por imagen , Lesiones de Menisco Tibial/epidemiología