ORCID Profile
0000-0001-5892-129X
Current Organisation
La Trobe University
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Calculus of Variations, Systems Theory and Control Theory | Biomedical Engineering | Artificial Intelligence and Image Processing | Simulation and Modelling | Biomechanical Engineering | Systems Theory And Control | Simulation And Modelling | Biomechanics | Biomechanical Engineering |
Health not elsewhere classified | Skeletal System and Disorders (incl. Arthritis) | Health Related to Ageing | Expanding Knowledge in Engineering | Skeletal system and disorders (incl. arthritis) | Mathematical sciences | Other
Publisher: Wiley
Date: 09-2003
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 05-2016
Abstract: Study Design Cross-sectional, controlled laboratory study. Background Postural control following anterior cruciate ligament reconstruction (ACLR) primarily has been investigated during static single-leg balance tasks. Little is known about dynamic postural control deficits post-ACLR. Objectives To compare dynamic postural control (bilaterally) in in iduals who have undergone ACLR and in healthy controls, and to evaluate the relationship between dynamic postural control and self-reported and objective function. Methods Ninety-seven participants (66 male median age, 28 years) 12 months post-ACLR and 48 healthy controls (20 male median age, 30 years) underwent balance assessment using a Nintendo Wii Balance Board during a single-leg squat. Center-of-pressure (CoP) path velocity, as well as CoP litude and standard deviation, in both mediolateral (ML) and anteroposterior (AP) directions were recorded. Self-reported function was assessed with the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), while hop for distance was used to evaluate functional status. Results Compared to healthy controls, the ACLR group had greater mean CoP path velocity (16% higher, P = .004), ML range (23%, P<.001), ML SD (28%, P<.001), AP range (14%, P = .009), and AP SD (15%, P = .013), indicating worse dynamic balance post-ACLR. Dynamic balance performance was similar between the ACLR limb and the uninjured contralateral limb. The AP SD was weakly associated with hop performance (β = -.2, P = .046) no balance measures were associated with IKDC score. Conclusion In iduals who have undergone ACLR demonstrate impaired dynamic balance bilaterally when performing a single-leg squat, which may have implications for physical function and future injury risk. Routine dynamic balance assessment may help identify patients who could benefit from targeted neuromuscular training programs to improve objective function and potentially lower reinjury risk. J Orthop Sports Phys Ther 2016 (5):357-364. Epub 21 Mar 2016. doi:10.2519/jospt.2016.6305.
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.PTSP.2019.10.006
Abstract: To determine whether knee confidence, fear of movement, psychological readiness to return-to-sport or pain are associated with patient-reported and performance-based function and return to pivoting sport in in iduals one-year after anterior cruciate ligament reconstruction (ACLR). Cross-sectional study. University-laboratory. 118 in iduals one-year post-ACLR. The KOOS-sport/recreation and IKDC and three hopping tasks were used to assess patient-reported and performance-based function, respectively. Questions regarding return to pivoting sport assessed return-to-sport status. Fear of movement (T a Scale), knee confidence (an item from KOOS, Visual Analogue Scale-VAS confidence during hopping tasks), knee pain (KOOS-pain, VAS pain during hopping tasks) and psychological readiness to return-to-sport (ACL-RSI) were also assessed. Worse fear of movement (p = 0.019), KOOS-pain (p < 0.001), ACL-RSI (p < 0.001), task-specific knee confidence and pain were associated with poorer patient-reported function. Worse task-specific knee confidence (p < 0.001) and pain (p < 0006) and ACL-RSI (p < 0.016) were associated with poorer performance-based function. Higher ACL-RSI scores were associated with higher odds of returning to pivoting sport one-year post-ACLR (p < 0.001). In idual's fear of movement, knee confidence, psychological readiness to return-to-sport and pain are related to function. Evaluating and considering knee confidence, fear of movement, and psychological readiness should be an important part of comprehensive post-ACLR rehabilitation.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.KNEE.2015.05.006
Abstract: This pilot study evaluated the immediate and four-week effects of an unloader knee brace on knee-related symptoms and performance-based function in people with knee osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR). In iduals with knee OA, five to 20years post-ACLR, were recruited for two within-subject randomized studies: immediate effects (n=18) and four-week effects (n=11). Patient-reported knee-related symptoms (knee pain, perceived task difficulty, confidence, stability) were assessed during hop for distance and step-down tests, while performance-based function was assessed with hopping distance under three conditions: i) no brace ii) unadjusted brace (sagittal plane support) and iii) adjusted brace (sagittal plane support with varus/valgus readjustment). Participants in the four-week brace effect study were randomized to wear the unadjusted or adjusted brace for four weeks after baseline (no brace) testing, and repeated tests in their allocated brace at four-week follow-up. Friedman tests evaluated differences between the three brace conditions for each variable for the immediate brace effect study (p<0.05), and Wilcoxon signed-rank tests evaluated differences between no brace and allocated brace for the four-week study (p<0.05). The adjusted and unadjusted unloader braces produced immediate improvements in knee confidence during hop for distance, and knee pain during step-down. Following the four-week brace intervention, the allocated brace improved knee confidence, perceived task difficulty and stability during hop for distance and knee pain, perceived task difficulty, confidence, and stability during step-down. The unloader knee brace, adjusted or unadjusted, has the potential to improve knee-related symptoms associated with knee OA after ACLR.
Publisher: Springer Science and Business Media LLC
Date: 16-03-2012
DOI: 10.1007/S10067-012-1970-Z
Abstract: Osteoarthritis (OA) and hip fracture are two common musculoskeletal disorders associated with substantial societal and personal burden. The objective of this systematic review was to determine the association between hip or knee OA and risk of hip fractures in people aged 45 years and older as compared to people aged 45 years and older who do not have OA. We searched CINAHL, Cochrane Database of Systematic Reviews, Embase, OVID Medline, PUBMED, and SCOPUS for studies published up to July 2010 and conducted forward searches of included studies using Web of Science. Two reviewers independently screened articles for inclusion, extracted data, and evaluated the risk of bias of included studies using the Newcastle-Ottawa Scale. Eleven articles were included. Three investigated in iduals with knee OA, two included adults with knee or hip OA, and six investigated adults with hip OA. We did not combine the hip OA or the knee OA studies in a meta-analysis due to the heterogeneity in: study populations and covariates adjusted for in estimates of association. Hip OA may be related to a decreased risk of hip fracture when considering crude estimates of association or estimates of association adjusted for a limited number of covariates, although not all studies found support for the presence of this association. The association between knee OA and hip fracture remains unclear. The presence of OA in the hip or knee should not act as an indication that assessment for hip fracture risk is unnecessary.
Publisher: Wiley
Date: 02-06-2011
DOI: 10.1111/J.1600-0838.2011.01334.X
Abstract: Patellar tendinopathy (PT) is one of the most common overuse injuries of the knee. Recent reports indicate that increased body mass is frequently associated with tendinopathy, not only biomechanically but biochemically. Abnormalities of other structures within the knee extensor mechanism [patellofemoral joint (PFJ) alignment and patellar tendon length] that can directly influence the strain distribution of the patellar tendon are inconsistently implicated in PT. The aim of this study was to compare the infrapatellar fat pad volume, patellar tendon length and PFJ alignment in people with chronic PT and a group of age-, gender-, height-, and activity-matched controls with normal tendons. Axial magnetic resonance (MR) images, from 26 participants with PT and 28 control participants were obtained. Fat pad size, patellar tendon length and PFJ alignment were measured digitally from the MR images, using measurement software, and the results compared between the PT group and control group. People with PT had a significantly larger fat pad than healthy controls when controlled for height (P=0.04). Patellar tendon length was not significantly different between groups (P=0.16), nor were there between-group differences for the measures of PFJ alignment (P=0.07-0.76). Thus, the infrapatellar fat pad may play an important role in PT.
Publisher: BMJ
Date: 25-11-2015
Publisher: BMJ
Date: 13-12-2012
DOI: 10.1136/BJSPORTS-2012-091696
Abstract: Describe proportions of in iduals with patellofemoral pain (PFP) with an unfavourable recovery over 12 months identify clinical predictors of poor recovery at 3 and 12 months and determine baseline values of predictors that identify those with poor 12-month prognosis. An observational analysis utilised data from 310 in iduals with PFP enrolled in two randomised clinical trials. Thirteen baseline variables (participant, PFP, study characteristics) were investigated for their prognostic ability. Pain, function and global recovery were measured at 3 and 12 months. Multivariate backward stepwise regression analyses (treatment-adjusted, p<0.10) were performed for each follow-up measure. Receiver operator characteristic curves identified cut-points associated with unfavourable recovery at 12 months. 55% and 40% of participants had an unfavourable recovery at 3 and 12 months, respectively. Longer baseline pain duration was significantly associated with poor 3-month and 12-month recovery on measures of pain severity (β 11.36 to 24.94), Anterior Knee Pain (AKP) Scale (-4.44 to -11.33) and global recovery (OR: 2.32 to 6.11). Greater baseline pain severity and lower AKP Scale score were significantly associated with poor recovery on multiple measures (p 2 months and AKP Scale score 2 months is the most consistent prognostic indicator, followed by AKP Scale score <70. Sports medicine practitioners should utilise interventions with known efficacy in reducing PFP, and promote early intervention to maximise prognosis. Australian study: Australian Clinical Trials Registry (ACTRN012605000463673), ClinicalTrials.gov (NCT00118521) Dutch study: International Standard Randomised Controlled Trial Number Register (ISRCTN83938749).
Publisher: Springer Science and Business Media LLC
Date: 16-09-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-1999
DOI: 10.1097/00005768-199908000-00002
Abstract: Tibial stress fracture is a common overuse running injury resulting from repetitive mechanical loading. This research project aimed to determine whether runners with a history of tibial stress fracture (TSF) differ in tibial bone geometry, tibial bone mass, and ground reaction force (GRF) parameters during running from those who have never sustained a stress fracture (NSF). Forty-six male running athletes (23 TSF 23 NSF) ranging in age from 18 to 42 yr were recruited for this cross-sectional study. A force platform was used to measure selected GRF parameters (peak and time to peak for vertical impact force, vertical active force, and horizontal braking force) during running at 4.0 m x s(-1). Tibial bone geometry (cross-sectional dimensions and area) was calculated from a computerized tomography (CT) scan at the junction of the middle and distal thirds. Dual energy x-ray absorptiometry (DXA) provided measurements of tibial bone area, bone mineral content (BMC), and bone mineral density (BMD). The TSF group had significantly smaller tibial cross-sectional area (P = 0.02) and DXA tibial bone area (P = 0.02), after adjusting for height and weight, than the NSF group. There were no significant differences between groups for GRF, tibial BMC, or tibial BMD. These findings support the contention that bone geometry plays a role in stress fracture development and that male athletes with smaller bones in relation to body size are at greater risk for this bony injury.
Publisher: Wiley
Date: 30-03-2009
DOI: 10.1002/ART.24278
Abstract: To investigate the relationship between quadriceps strength and the peak knee adduction moment during walking in medial tibiofemoral osteoarthritis (OA), and whether varus malalignment influences this relationship. Maximum isometric quadriceps strength at 60 degrees flexion relative to body mass and the peak knee adduction moment during walking were assessed in 184 community volunteers with medial knee OA. Mechanical knee alignment was determined either directly from full-leg radiograph or extrapolated from anatomic alignment on knee radiograph using regression equations. Pearson's correlation coefficient was used to assess the association between quadriceps strength and peak knee adduction moment. The independent relationship between quadriceps strength and peak knee adduction moment, and the impact of varus malalignment on this relationship, was assessed using multiple regression analyses with and without adjustment for covariates. Quadriceps strength was not significantly associated with peak knee adduction moment (r = 0.14, P = 0.059). Neither quadriceps strength (b = 0.25, P = 0.142) nor the interaction between quadriceps strength and varus malalignment (b = -0.01, P = 0.693) significantly contributed to the variance in peak knee adduction moment. Results were unchanged with the inclusion of covariates. No significant association was observed between quadriceps strength and the peak knee adduction moment, and the severity of varus malalignment did not influence the relationship. Results suggest that clinicians should not be concerned that patients with knee OA and stronger quadriceps are more likely to demonstrate a higher knee adduction moment.
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.JSAMS.2019.10.019
Abstract: To engage physiotherapists experienced in female elite sport and athletes to co-create a sport-specific anterior cruciate ligament (ACL) injury risk reduction program. Concept Mapping. The Concept Systems Global MAX™ web platform was used to collect and analyse data from 27 context and content experts (22 physiotherapists, 5 athletes). Participants brainstormed statements representing the critical elements that should be included in an ACL injury risk reduction program for women playing elite Australian Football (AF). Twenty-two participants brainstormed 56 statements that were synthesised and edited to 62 statements. Statements were sorted into clusters by twenty-three participants and rated on importance and feasibility using six-point scales. Multidimensional scaling and cluster analysis identified a 5-cluster solution as follows: Football-specific preparation (15 statements) Movement skills (17 statements) Strength and conditioning (15 statements) In idual preparation (7 statements) and Education (8 statements). Calculation of mean ratings for each cluster and statement identified the Movement skills cluster as most important (mean=3.61 out of 5) and the Football-specific preparation cluster as most feasible (3.75 out of 5). By contrast, the In idual preparation cluster was rated the least important (mean=2.9 out of 5), and the least feasible (3.12 out of 5), to include in the program. The five clusters of critical elements to include in an ACL injury risk reduction program for women playing elite AF, in order of most to least importance were: movement skills, football-specific preparation, education, strength and conditioning and in idual preparation.
Publisher: Springer Science and Business Media LLC
Date: 23-09-2020
DOI: 10.1186/S13047-020-00426-8
Abstract: Foot and ankle characteristics are associated with patellofemoral pain (PFP) and may also relate to patellofemoral osteoarthritis (PFOA). A greater understanding of these characteristics and PFOA, could help to identify effective targeted treatments. To determine whether foot and ankle characteristics are associated with knee symptoms and function in in iduals with PFOA. For this cross-sectional study we measured weightbearing ankle dorsiflexion range of motion, foot posture (via the Foot Posture Index [FPI]), and midfoot mobility (via the Foot Measurement Platform), and obtained patient-reported outcomes for knee symptoms and function (100 mm visual analogue scales, Anterior Knee Pain Scale [AKPS], Knee injury and Osteoarthritis Outcome Score, repeated single step-ups and double-leg sit-to-stand to knee pain onset). Pearson’s r with significance set at p 0.05 was used to determine the association between foot and ankle charateristics, with knee symptoms and function, adjusting for age. 188 participants (126 [67%] women, mean [SD] age of 59.9 [7.1] years, BMI 29.3 [5.6] kg/m 2 ) with symptomatic PFOA were included in this study. Lower weightbearing ankle dorsiflexion range of motion had a small significant association with higher average knee pain (partial r = − 0.272, p 0.001) and maximum knee pain during stair ambulation (partial r = − 0.164, p = 0.028), and lower scores on the AKPS (indicative of greater disability partial r = 0.151, p = 0.042). Higher FPI scores (indicating a more pronated foot posture) and greater midfoot mobility (foot mobility magnitude) were significantly associated with fewer repeated single step-ups (partial r = − 0.181, p = 0.023 and partial r = − 0.197, p = 0.009, respectively) and double-leg sit-to-stands (partial r = − 0.202, p = 0.022 and partial r = − 0.169, p = 0.045, respectively) to knee pain onset, although the magnitude of these relationships was small. The amount of variance in knee pain and disability explained by the foot and ankle characteristics was small (R 2 -squared 2 to 8%). Lower weightbearing ankle dorsiflexion range of motion, a more pronated foot posture, and greater midfoot mobility demonstrated small associations with worse knee pain and greater disability in in iduals with PFOA. Given the small magnitude of these relationships, it is unlikely that interventions aimed solely at addressing foot and ankle mobility will have substantial effects on knee symptoms and function in this population. The RCT was prospectively registered on 15 March 2017 with the Australia and New Zealand Clinical Trials Registry ( ANZCTRN12617000385347 ).
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Publisher: Center for Open Science
Date: 25-01-2023
Abstract: The primary objective of this review is to critically appraise, compare and summarize the quality of the measurement properties of functional performance tests assessing physical function in persons with ACL or meniscus injury. A secondary objective is to critically appraise, compare and summarize the quality of the measurement properties of muscle strength tests assessing knee extensor or flexor muscle strength in persons with ACL or meniscus injury.
Publisher: BMJ
Date: 28-10-2020
DOI: 10.1136/BJSPORTS-2020-102973
Abstract: To evaluate the effectiveness of interventions to reduce the risk of incident patellofemoral pain. Systematic review and meta-analysis, with strength of evidence evaluated separately for each intervention type. MEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus. Randomised controlled trials evaluating the effectiveness of interventions to reduce patellofemoral pain risk compared with a control/non-exposed group. Thirteen trials of mostly military recruits and young athletes analysed six different interventions. There was low certainty evidence from two trials (227 participants) that patellofemoral braces worn during physical activity (compared with no brace) effectively reduced the risk of patellofemoral pain (risk ratio (RR) 0.40, 95% CI 0.22 to 0.73 I 2 =24.0%). There was low certainty evidence from one trial (320 participants) that running technique retraining to (run softer) reduced patellofemoral pain risk (RR 0.21, 95% CI 0.07 to 0.60). There was low certainty evidence from four trials (3364 participants) that multicomponent (strengthening/neuromuscular) exercise programmes did not significantly reduce the risk of patellofemoral pain (RR 0.49, 95% CI 0.18 to 1.36 I 2 =64.9%), although broad CIs may reflect exercise dose variations among studies. There was very low certainty evidence from four trials (2314 participants) that foot orthoses (compared with flat inserts/no orthosis) did not significantly reduce the risk of patellofemoral pain (RR 0.63, 95% CI 0.35 to 1.13 I 2 =0.0%). Static stretching and a running programme that progressed intensity (compared with volume) did not significantly influence patellofemoral pain risk (single studies). There is low-level evidence that patellofemoral braces and running technique retraining can reduce the risk of patellofemoral pain by 60%–79%.
Publisher: BMJ
Date: 10-04-2020
DOI: 10.1136/BJSPORTS-2019-101503
Abstract: Not meeting functional performance criteria increases reinjury risk after ACL reconstruction (ACLR), but the implications for osteoarthritis are not well known. To determine if poor functional performance post-ACLR is associated with risk of worsening early osteoarthritis features, knee symptoms, function and quality of life (QoL). Seventy-eight participants (48 men) aged 28±15 years completed a functional performance test battery (three hop tests, one-leg-rise) 1 year post-ACLR. Poor functional performance was defined as % limb symmetry index (LSI) on each test. At 1 and 5 years, MRI, Knee injury Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective form were completed. Primary outcomes were: (i) worsening patellofemoral and tibiofemoral MRI-osteoarthritis features (cartilage, bone marrow lesions (BMLs) and meniscus) and (ii) change in KOOS and IKDC scores, between 1 and 5 years. Only 14 (18%) passed (≥90% LSI on all tests) the functional test battery. Poor functional performance on the battery (all four tests % LSI) 1 year post-ACLR was associated with 3.66 times (95% CI 1.12 to 12.01) greater risk of worsening patellofemoral BMLs. A triple-crossover hop % LSI was associated with 2.09 (95% CI 1.15 to 3.81) times greater risk of worsening patellofemoral cartilage. There was generally no association between functional performance and tibiofemoral MRI-osteoarthritis features, or KOOS/IKDC scores. Only one in five participants met common functional performance criteria (≥90% LSI all four tests) 1 year post-ACLR. Poor function on all four tests was associated with a 3.66 times increased risk of worsening patellofemoral BMLs, and generally not associated with decline in self-reported outcomes.
Publisher: Center for Open Science
Date: 25-01-2023
Abstract: The objective of this review is to summarize the effectiveness of rehabilitation interventions on knee joint structural and biological outcomes in in iduals with ACL and/or meniscal injuries.
Publisher: BMJ
Date: 14-06-2021
DOI: 10.1136/BJSPORTS-2020-103700
Abstract: Patellofemoral pain is a common and often debilitating musculoskeletal condition. Clinical translation and evidence synthesis of patellofemoral pain research are compromised by heterogenous and often inadequately reported study details. This consensus statement and associated checklist provides standards for REPORTing of quantitative PatelloFemoral Pain (REPORT-PFP) research to enhance clinical translation and evidence synthesis, and support clinician engagement with research and data collection. A three-stage Delphi process was initiated at the 2015 International Patellofemoral Research Network (iPFRN) retreat. An initial e-Delphi activity (n=24) generated topics and items, which were refined at the 2017 iPFRN retreat, and voted on prior to and following the 2019 iPFRN retreat (n=51 current and past retreat participants). Voting criteria included ‘strongly recommended’ (essential), ‘recommended’ (encouraged) and uncertain/unsure. An item was included in the checklist if ≥70% respondents voted ‘recommended’. Items receiving ≥70% votes for ‘strongly recommended’ were labelled as such. The final REPORT-PFP checklist includes 31 items (11 strongly recommended, 20 recommended), covering (i) demographics (n=2,4) (ii) baseline symptoms and previous treatments (n=3,7) (iii) outcome measures (2,4) (iv) outcomes measure description (n=1,2) (v) clinical trial methodology (0,3) and (vi) reporting study results (n=3,0). The REPORT-PFP checklist is ready to be used by researchers and clinicians. Strong stakeholder engagement from clinical academics during development means consistent application by the international patellofemoral pain research community is likely. Checklist adherence will improve research accessibility for clinicians and enhance future evidence synthesis.
Publisher: BMJ
Date: 04-2019
DOI: 10.1136/BMJOPEN-2018-025315
Abstract: Patellofemoral (PF) osteoarthritis (OA) is a common and burdensome subgroup of knee OA, with very little evidence for effective treatments. Prefabricated foot orthoses are an affordable and accessible intervention that have been shown to reduce PF pain in younger adults. Similarities between PF pain and PFOA, as well as our pilot work, suggest that foot orthoses may also be an effective intervention for PFOA. The primary objective of this study is to compare the 3 month efficacy of prefabricated foot orthoses and flat shoe inserts in people with PFOA, on knee pain severity. The FOOTPATH Study (FOot OrThoses for PAtellofemoral osteoarTHritis) is a multicentre, randomised, participant- and assessor-blinded superiority trial with two parallel groups, a 3 month observation period (pre-randomisation) and 12 month follow-up. 160 participants with a clinical diagnosis of PFOA will be recruited from three sites in Australia, and randomised to one of two groups (prefabricated foot orthoses or flat shoe inserts). The primary outcome is worst knee pain severity during a self-nominated aggravating activity in the previous week (100 mm visual analogue scale) at 3 months, with a secondary endpoint at 12 months. Secondary outcomes include global rating of change, symptoms, function, health-related quality of life, kinesiophobia, self-efficacy and use of co-interventions for knee pain. Blinded, intention-to-treat analyses of primary and secondary patient-reported outcomes will be performed, as well as economic analyses. Ethical approval has been granted by La Trobe University’s Human Ethics Committee and The University of Queensland’s Medical Research Ethics Committee. Study outcomes will be disseminated via peer-reviewed journals, conference presentations targeting a range of healthcare disciplines and an open access website with clinician resources. ANZCTRN12617000385347 Pre-results.
Publisher: Wiley
Date: 29-12-2017
DOI: 10.1002/ACR.23261
Abstract: Patellofemoral (PF) joint osteoarthritis (OA) is common, yet little is known about how this condition influences lower-extremity biomechanical function. This study compared pelvis and lower-extremity kinematics in people with and without PF joint OA. Sixty-nine participants (64% women, mean ± SD age 56 ± 10 years) with anterior knee pain aggravated by PF joint-loaded activities (e.g., stair ambulation, rising from sitting, or squatting) and radiographic lateral PF joint OA on skyline radiographs were compared with 18 controls (78% women, mean ± SD age 53 ± 7 years) with no lower-extremity pain or radiographic OA. Knee Injury and Osteoarthritis Outcome Score (KOOS) data were collected from participants with PF joint OA. Quantitative gait analyses were conducted during overground walking at a self-selected speed. Pelvis and lower-extremity kinematics were calculated across the stance phase. Data were statistically analyzed using analyses of covariance, with age and sex as covariates (P < 0.05). Participants with PF joint OA reported a mean ± SD KOOS pain subscale score of 65 ± 15, KOOS symptoms subscale score of 63 ± 16, KOOS activities of daily living subscale score of 73 ± 13, KOOS sports/recreation subscale score of 45 ± 23, and KOOS quality of life subscale score of 43 ± 16. Participants with PF joint OA walked with greater anterior pelvic tilt throughout the stance phase, as well as greater lateral pelvic tilt (i.e., pelvis lower on the contralateral side), greater hip adduction, and lower hip extension during the late stance phase. No differences in knee and ankle joint angles were observed between groups. People with PF joint OA walk with altered pelvic and hip movement patterns compared with aged-matched controls. Restoring normal movement patterns during walking in people with PF joint OA may be warranted to help alleviate symptoms.
Publisher: BMJ
Date: 08-03-2023
DOI: 10.1136/BJSPORTS-2022-106099
Abstract: Investigate sex/gender differences in self-reported activity and knee-related outcomes after anterior cruciate ligament (ACL) injury. Systematic review with meta-analysis. Seven databases were searched in December 2021. Observational or interventional studies with self-reported activity (including return to sport) or knee-related outcomes after ACL injury. We included 242 studies (n=123 687, 43% females/women/girls, mean age 26 years at surgery). One hundred and six studies contributed to 1 of 35 meta-analyses (n=59 552). After ACL injury/reconstruction, very low-certainty evidence suggests females/women/girls had inferior self-reported activity (ie, return to sport, Tegner Activity Score, Marx Activity Scale) compared with males/men/boys on most (88%, 7/8) meta-analyses. Females/women/girls had 23%–25% reduced odds of returning to sport within 1-year post-ACL injury/reconstruction (12 studies, OR 0.76 95% CI 0.63 to 0.92), 1–5 years (45 studies, OR 0.75 95% CI 0.69 to 0.82) and 5–10 years (9 studies, OR 0.77 95% CI 0.57 to 1.04). Age-stratified analysis ( years) suggests female athletes/girls had 32% reduced odds of returning to sport compared with male athletes/boys (OR 0.68, 95% CI 0.41 to 1.13, I 2 0.0%). Very low-certainty evidence suggests females/women/girls experienced inferior knee-related outcomes (eg, function, quality of life) on many (70%, 19/27) meta-analyses: standardised mean difference ranging from −0.02 (Knee injury and Osteoarthritis Outcome Score, KOOS-activities of daily living, 9 studies, 95% CI −0.05 to 0.02) to −0.31 (KOOS-sport and recreation, 7 studies, 95% CI −0.36 to –0.26). Very low-certainty evidence suggests inferior self-reported activity and knee-related outcomes for females/women/girls compared with males/men/boys after an ACL injury. Future studies should explore factors and design targeted interventions to improve outcomes for females/women/girls. CRD42021205998.
Publisher: Elsevier BV
Date: 07-2018
Publisher: Springer Science and Business Media LLC
Date: 14-07-2023
DOI: 10.1186/S40798-023-00602-7
Abstract: The impact of activity-related joint loading on cartilage is not clear. Abnormal loading is considered to be a mechanical driver of osteoarthritis (OA), yet moderate amounts of physical activity and rehabilitation exercise can have positive effects on articular cartilage. Our aim was to investigate the immediate effects of joint loading activities on knee and hip cartilage in healthy adults, as assessed using magnetic resonance imaging. We also investigated delayed effects of activities on healthy cartilage and the effects of activities on cartilage in adults with, or at risk of, OA. We explored the association of sex, age and loading duration with cartilage changes. A systematic review of six databases identified studies assessing change in adult hip and knee cartilage using MRI within 48 h before and after application of a joint loading intervention/activity. Studies included adults with healthy cartilage or those with, or at risk of, OA. Joint loading activities included walking, hopping, cycling, weightbearing knee bends and simulated standing within the scanner. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random-effects meta-analysis estimated the percentage change in compartment-specific cartilage thickness or volume and composition (T2 relaxation time) outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system evaluated certainty of evidence. Forty studies of 653 participants were included after screening 5159 retrieved studies. Knee cartilage thickness or volume decreased immediately following all loading activities investigating healthy adults however, GRADE assessment indicated very low certainty evidence. Patellar cartilage thickness and volume reduced 5.0% (95% CI 3.5, 6.4, I 2 = 89.3%) after body weight knee bends, and tibial cartilage composition (T2 relaxation time) decreased 5.1% (95% CI 3.7, 6.5, I 2 = 0.0%) after simulated standing within the scanner. Hip cartilage data were insufficient for pooling. Secondary outcomes synthesised narratively suggest knee cartilage recovers within 30 min of walking and 90 min of 100 knee bends. We found contrasting effects of simulated standing and walking in adults with, or at risk of, OA. An increase of 10 knee bend repetitions was associated with 2% greater reduction in patellar thickness or volume. There is very low certainty evidence that minimal knee cartilage thickness and volume and composition (T2 relaxation time) reductions (0–5%) occur after weightbearing knee bends, simulated standing, walking, hopping/jumping and cycling, and the impact of knee bends may be dose dependent. Our findings provide a framework of cartilage responses to loading in healthy adults which may have utility for clinicians when designing and prescribing rehabilitation programs and providing exercise advice.
Publisher: Oxford University Press (OUP)
Date: 09-05-2007
DOI: 10.1093/RHEUMATOLOGY/KEM114
Abstract: Knee osteoarthritis (OA) is a prevalent disease afflicting elderly people. As the knee joint is tri-compartmental, numerous radiographic patterns of disease are possible. The patellofemoral joint (PFJ) is one of the most commonly affected compartments. Although PFJ OA is frequently observed, this particular disease sub-group has gone largely unrecognised. Recent research suggests that not only is the PFJ an important source of symptoms in knee OA, but also that afflicted in iduals demonstrate disease features distinct from those observed in tibiofemoral joint OA. This has implications for the assessment and treatment of patients with PFJ OA. This review summarises the evidence suggesting why PFJ OA should be considered a distinct clinical entity and how it may best be managed using conservative, non-pharmacological treatment approaches that are targeted to the PFJ. Interventions such as patella taping, patella bracing and physiotherapy have the potential to alleviate joint stress and symptoms for people with this condition.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.CLINBIOMECH.2019.06.001
Abstract: The effect of pain on lower limb biomechanics during walking has been found to be sex specific for certain joint diseases. However, it is not known if sex is an effect-modifier in people with hip pain. Therefore, the aim of the study was to determine the differences in lower limb biomechanics between men and women with hip-related groin pain during functional tasks. 65 male and 23 female football players with hip-related groin pain were recruited. Biomechanical data were recorded during walking and the single-leg drop jump. Hip, knee and ankle joint kinematics and kinetics were calculated. Differences between men and women were assessed using statistical parametric mapping. Walking: Men with hip-related groin pain walked with lower hip flexion and internal rotation angles during stance compared to women. During different sections of stance, men also displayed a lower hip adduction angle and 'external' adduction moment, a lower knee flexion angle and 'external' flexion moment, as well as greater 'external' dorsi-flexion moment and impulse. Single-leg drop jump: Men with hip-related groin pain displayed a lower hip flexion angle during early stance, and greater 'external' knee flexion and ankle dorsi-flexion moments. The impulse of the 'external' dorsi-flexion moment was also greater for men compared to women. Men and women with hip-related groin pain display differing lower limb biomechanics in both low and high impact tasks. Sex may therefore be a potential effect modifier in people with hip-related groin pain. Future research in this area should incorporate sex-specific analyses. NA.
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.JOCA.2021.04.003
Abstract: To evaluate if returning to pivoting sport following anterior cruciate ligament reconstruction (ACLR) is associated with longitudinal structural and symptomatic osteoarthritis outcomes. Eighty-one adults aged 18-50 years were followed prospectively 1- to 5-years post-ACLR. Return to pivoting sport was assessed at 1-, 3- and 5-years. Longitudinal changes in osteoarthritis features were evaluated from 1- and 5-year magnetic resonance imaging (MRI)s using MRI Osteoarthritis Knee Score (MOAKS). Radiographic osteoarthritis and self-reported knee symptoms, function and quality of life were assessed using the Osteoarthritis Research Society International (OARSI) atlas and Knee injury Osteoarthritis Outcome Score (KOOS), respectively, at 5 years post-ACLR. Generalised linear models (adjusted for baseline characteristics) assessed whether returning to pivoting sport was associated with risk of worsening osteoarthritis features on MRI, radiographic osteoarthritis and KOOS. Thirty participants returned to pivoting sport 1-year post-ACLR and 50 returned at any time (i.e., 1-, 3- or 5-years). Returning to pivoting sport was not associated with worsening of any MRI osteoarthritis feature (risk ratio (RR) range: 0.59-2.91) or 5-year KOOS (β range: -2.73-3.69). Returning to pivoting sport at 1-year and up to 5-years post-ACLR was associated with a 50% (RR 0.49, 95%CI 0.10-2.37) and 40% (RR 0.60, 95%CI 0.16-2.17) reduced risk of radiographic osteoarthritis, respectively, but these risk reductions were inconclusive due to wide confidence intervals. After ACLR, returning to pivoting sport was not associated with increased risk of worsening knee osteoarthritis features on MRI, radiographic osteoarthritis or knee symptoms. Participation in pivoting sport need not be avoided as part of osteoarthritis secondary prevention strategies.
Publisher: Wiley
Date: 24-01-2022
DOI: 10.1111/SMS.14119
Abstract: Cam morphology size and location might affect the severity of reported burden in people with femoroacetabular impingement (FAI) syndrome. We investigated the relationship between cam morphology size (i.e., alpha angle) and self‐reported hip/groin burden (i.e., scores for the International Hip Outcome Tool‐33 (iHOT‐33) and Copenhagen Hip and Groin Outcome Score (HAGOS)), examined separately for the anteroposterior pelvis (AP) and Dunn 45° radiographs in football players with FAI syndrome. In total, 118 (12 women) subelite football (soccer or Australian football) players with FAI syndrome with cam morphology (alpha angle ≥60°) participated. One blinded assessor quantified superior and anterosuperior cam morphology size by measuring alpha angles for the AP and Dunn 45° radiographs, respectively. Linear regression models investigated relationships between alpha angle (continuous independent variable, separately measured for the AP and Dunn 45° radiographs) and iHOT‐33 and HAGOS scores (dependent variables). Larger anterosuperior cam morphology (seen on the Dunn 45° radiograph) was associated with lower (i.e., worse) scores for the iHOT‐Total, iHOT‐Symptoms, iHOT‐Job, and iHOT‐Social subscales (unadjusted estimate range −0.553 to −0.319 [95% confidence interval −0.900 to −0.037], p = 0.002 to 0.027), but not the iHOT‐Sport ( p = 0.459) nor any HAGOS scores ( p = 0.110 to 0.802). Superior cam morphology size (measured using the AP radiograph) was not associated with any iHOT‐33 or HAGOS scores ( p = 0.085 to 0.975). Larger anterosuperior cam morphology may be more relevant to pain and symptoms in football players with FAI syndrome than superior cam morphology, warranting investigation of its effects on reported burden and hip disease over time.
Publisher: BMJ
Date: 13-02-2018
DOI: 10.1136/BJSPORTS-2017-097839
Abstract: (1) Identify differences in hip and pelvic biomechanics in patients with femoroacetabular impingement syndrome (FAIS) compared with controls during everyday activities (eg, walking, squatting) and (2) evaluate the effects of interventions on hip and pelvic biomechanics during everyday activities. Systematic review. Medline, CINAHL, EMBASE, Scopus and SPORTDiscus until February 2017. Primary aim: studies that investigated hip or pelvic kinematics and/or joint torques of everyday activities in patients with FAIS compared with the asymptomatic contralateral limb or a control group. Secondary aim: studies that evaluated effects of conservative or surgical interventions on patients with FAIS using pre-post or controlled clinical trial designs. Biomechanical data must have been collected using three-dimensional motion capture devices. Reporting quality was assessed using the Epidemiological Appraisal Instrument and data were pooled (standardised mean difference (SMD), 95% CI) where populations and primary outcomes were similar. Fourteen studies were included (11 cross-sectional and three pre ost intervention), varying between low and moderate reporting quality. Patients with FAIS walked with a lower: peak hip extension angle (SMD −0.40, 95% CI −0.71 to −0.09), peak internal rotation angle (−0.67, 95% CI −1.19 to −0.16) and external rotation joint torque (−0.71, 95% CI −1.07 to −0.35), and squatted to a lesser depth with no difference in hip flexion range. Pre ost intervention data were limited in number and quality, and to surgical cohorts. This review suggests that patients with FAIS may demonstrate hip biomechanical impairments during walking and squatting, with minimal literature available to comment on other tasks. The information presented in the review provides insight into the biomechanical differences associated with FAIS however, the between-group differences were small to moderate. This information may aid in the development of management strategies for people with the condition. CRD42016038677.
Publisher: BMJ
Date: 11-10-2019
Publisher: Center for Open Science
Date: 25-01-2023
Abstract: This systematic review aims to (i) identify all published PROMs where thresholds were measured with the aim of defining meaningful outcomes in in iduals who have experienced an ACL or meniscus injury and (ii) synthesize the literature to provide estimates for thresholds defining meaningful outcomes in these PROMs, in in iduals who ruptured their ACL or sustained a meniscal injury.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Wiley
Date: 27-04-2007
DOI: 10.1002/JOR.20415
Abstract: This study investigated the clinical features of patellar tendinopathy (PT), with focus on in iduals with unilateral and bilateral PT. A cross-sectional study design was employed to compare in iduals with unilateral (n = 14) or bilateral (n = 13) PT and those without PT (control, n = 31). Features assessed included thigh strength (normalized peak knee extensor torque) and flexibility (sit-and-reach and active knee extension), calf endurance (heel-rise test), ankle flexibility (dorsiflexion), alignment measures (arch height and leg length difference), and functional measures (hop for distance and 6 m hop test). Groups were matched for age and height however, unilateral and bilateral PT had greater mass with a higher body mass index (BMI) than control. Also, bilateral PT performed more sport hours per week than both unilateral PT and control. Unilateral PT had less thigh strength than control and bilateral PT, whereas bilateral PT had more thigh flexibility than control and unilateral PT. Both unilateral and bilateral PT had altered alignment measures compared to control. Features that predicted symptoms in PT were lower thigh flexibility and strength, whereas those that predicted function were higher thigh strength and lower ankle flexibility. These findings indicate that unilateral and bilateral PT represent distinct entities, and that thigh strength appears particularly important in PT as it predicted both symptoms and function in PT.
Publisher: Walter de Gruyter GmbH
Date: 12-2016
Abstract: The ability of machine learning techniques to predict athlete ratings of perceived exertion (RPE) was investigated in professional Australian football players. RPE is commonly used to quantifying internal training loads and manage injury risk in team sports. Data from global positioning systems, heart-rate monitors, accelerometers and wellness questionnaires were recorded for each training session (n=3398) from 45 professional Australian football players across a full season. A variety of modelling approaches were considered to investigate the ability of objective data to predict RPE. Models were compared using nested cross validation and root mean square error (RMSE) on RPE predictions. A random forest model using player normalised running and heart rate variables provided the most accurate predictions (RMSE ± SD = 0.96 ± 0.08 au). A simplification of the model using only total distance, distance covered at speeds between 18-24 km·h −1 , and the product of total distance and mean speed provided similarly accurate predictions (RMSE ± SD = 1.09 ± 0.05 au), suggesting that running distances and speeds are the strongest predictors of RPE in Australian football players. The ability of non-linear machine learning models to accurately predict athlete RPE has applications in live player monitoring and training load planning.
Publisher: BMJ
Date: 06-11-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-02-2020
DOI: 10.1249/MSS.0000000000002297
Abstract: This study aimed to evaluate the differences in lower-limb biomechanics between adult subelite competitive football players with and without hip-related pain during two contrasting tasks—walking and single-leg drop jump (SLDJ)—and to determine whether potential differences, if present, are sex dependent. Eighty-eight football players with hip-related pain (23 women, 65 men) and 30 asymptomatic control football players (13 women, 17 men) who were currently participating in competitive sport were recruited. Biomechanical data were collected for the stance phase of walking and SLDJ. Pelvis, hip, knee, and ankle angles, as well as the impulse of the external joint moments, were calculated. Differences between groups and sex-specific effects were calculated using linear regression models. Compared with their asymptomatic counterparts, football players with hip-related pain displayed a lower average pelvic drop angle during walking ( P = 0.03) and a greater average pelvic hike angle during SLDJ ( P 0.05). Men with hip-related pain displayed a smaller total range of motion (excursion) for the transverse plane pelvis angle ( P = 0.03) and a smaller impulse of the hip external rotation moment ( P 0.01) during walking compared with asymptomatic men. Women with hip-related pain displayed a greater total range of motion (excursion) for the sagittal plane knee angle ( P = 0.01) during walking compared with asymptomatic women. Overall, few differences were observed in lower-limb biomechanics between football players with and without hip-related pain, irrespective of the task. This outcome suggests that, despite the presence of symptoms, impairments in lower-limb biomechanics during function do not appear to be a prominent feature of people with hip-related pain who are still participating in sport.
Publisher: SAGE Publications
Date: 06-05-2020
Abstract: Patellofemoral joint (PFJ) osteoarthritis may occur after anterior cruciate ligament reconstruction (ACLR). The mechanisms underpinning the development of PFJ osteoarthritis are not known but may relate to altered PFJ loading. Few studies have assessed PFJ loads during high-impact tasks, such as running, beyond the acute rehabilitation phase (ie, months) after ACLR. The purpose was to compare between-limb joint angles, joint moments, and PFJ contact force during running in in iduals at 12 to 24 months after unilateral ACLR. We hypothesized that peak knee flexion angle, knee extension moment, and PFJ contact force during stance would be lower in the ACLR limb compared with the uninjured limb. Controlled laboratory study. A total of 55 participants (mean ± SD age, 28 ± 7 years), 12 to 24 months after ACLR, ran at a self-selected speed (2.9 ± 0.3 m/s). Measured kinematics and ground-reaction forces were input into musculoskeletal models to calculate joint moments and muscle forces. These values were subsequently input into a PFJ model to calculate contact force peak and impulse. Outcome measures were compared between the ACLR and uninjured limbs. In the ACLR limb, compared with the uninjured limb, the PFJ contact force displayed a lower peak (ACLR, 6.1 ± 1.3 body weight [BW] uninjured, 6.7 ± 1.4 BW P .001) and impulse (ACLR, 0.72 ± 0.17 BW*seconds [BWs] uninjured, 0.81 ± 0.17 BWs P .001). At the time of the peak PFJ contact force, the knee extension moment was lower in the ACLR limb (ACLR, 14.0 ± 2.4 %BW*height [%BW*HT] uninjured, 15.5 ± 2.5 %BW*HT P .001). The opposite was true for the ankle plantarflexion moment (ACLR, 12.1 ± 2.6 %BW*HT uninjured, 11.5 ± 2.7 %BW*HT P = .019) and the hip extension moment (ACLR, 2.3 ± 2.5 %BW*HT uninjured, 1.6 ± 2.3 %BW*HT P = .013). The foot-ground center of pressure was located more anteriorly with respect to the ankle joint center (ACLR, 5.8 ± 0.9 %height [%HT] uninjured, 5.4 ± 1.0 %HT P = .001). No differences were found for the sagittal plane hip, knee, and ankle angles. The ACLR limb experienced lower peak PFJ loads during running, explained by a small anterior shift in the foot-ground center of pressure during stance that offloaded the torque demand away from the ACLR knee. Lower net PFJ loading during running in the ACLR limb more than 12 months after ACLR suggests that underloading might play a role in the onset of PFJ osteoarthritis after ACLR.
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.JOCA.2012.04.009
Abstract: This study aimed to (1) compare the volumes of vastus medialis (VM), vastus lateralis (VL), vastus intermedius and rectus femoris and the ratio of VM/VL volumes between asymptomatic controls and patellofemoral joint osteoarthritis (PFJ OA) participants and (2) assess the relationships between cross-sectional area (CSA) and volumes of the VM and VL in in iduals with and without PFJ OA. Twenty-two participants with PFJ OA and 11 controls aged ≥ 40 years were recruited from the community and practitioner referrals. Muscle volumes of in idual quadriceps components were measured from thigh magnetic resonance (MR) images. The CSA of the VM and lateralis were measured at 10 equally distributed levels (femoral condyles to lesser femoral trochanter). PFJ OA in iduals had smaller normalized VM (mean difference 0.90 cm(3) · kg(-1), α = 0.011), VL (1.50 cm(3) · kg(-1), α = 0.012) and rectus femoris (0.71 cm(3) · kg(-1), α = 0.009) volumes than controls. No differences in the VM/VL ratio were observed. The CSA at the third level (controls) and fourth level (PFJ OA) above the femoral condyles best predicted VM volume, whereas the VL volume was best predicted by the CSA at the seventh level (controls) and sixth level (PFJ OA) above the femoral condyles. Reduced quadriceps muscle volume was a feature of PFJ OA. Muscle volume could be predicted from CSA measurements at specific levels in PFJ OA patients and controls.
Publisher: BMJ
Date: 12-04-2006
Publisher: Oxford University Press (OUP)
Date: 16-05-2003
Publisher: SAGE Publications
Date: 06-12-2013
Abstract: Anterior cruciate ligament reconstructions (ACLRs) are frequently performed on young, active patients and can result in persistent knee symptoms and activity limitations that may affect health-related quality of life (HRQoL). To date, there has been no systematic review of HRQoL outcomes after ACLR. The objectives of this study were to report HRQoL ≥5 years after ACLR, compare HRQoL outcomes with available population norms, and describe factors that may affect HRQoL in this population. Systematic review. All studies reporting HRQoL ≥5 years after ACLR with hamstring or patellar tendon autografts were eligible for review. Common HRQoL outcomes were pooled using a random-effects meta-analysis and compared with published population norms. The Spearman rank correlation coefficient (ρ) was used to identify variables associated with HRQoL outcomes. Where insufficient data were available, outcomes were reported descriptively. Fourteen studies were eligible for review, and HRQoL was reported for 2493 patients at a mean of 9 years (range, 5-16 years) after ACLR. Pooling of knee-related quality of life outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS]–QOL) found impairments after ACLR when compared with population norms. In comparison, studies using the Short Form–36 (SF-36) reported similar or better HRQoL compared with normative data. The KOOS-QOL subscores correlated strongly with KOOS-sport/recreation (ρ = .70, P = .04) and KOOS-pain (ρ = .85, P = .003) subscores. Severe radiographic osteoarthritis, meniscal injuries sustained after surgery, and revision ACLR were associated with poorer HRQoL outcomes at a minimum 5-year follow-up. The negative influence of concomitant meniscal surgery on HRQoL became apparent more than 10 years after ACLR. This review found that patients assessed using a knee-specific measure (KOOS-QOL) were more likely to report poorer HRQoL values, compared with population norms, than those assessed using a generic HRQoL measure (SF-36). Revision surgeries, meniscal injuries, and severe radiographic osteoarthritis were associated with poorer HRQoL outcomes after ACLR. However, these relationships should be interpreted with caution, as they were only investigated in a small number of studies. These results can be used by clinicians to educate patients about potential long-term outcomes after ACLR and to develop strategies for optimizing postoperative HRQoL.
Publisher: Wiley
Date: 27-02-2020
DOI: 10.1002/ACR.23854
Publisher: BMJ
Date: 13-10-2015
DOI: 10.1136/BJSPORTS-2015-094664
Abstract: Patellofemoral pain (PFP) has traditionally been viewed as self-limiting, but recent studies show that a large proportion of patients report chronic knee pain at long-term follow-up. We identified those patients with an unfavourable recovery ('moderate improvement' to 'worse than ever' measured on a Likert scale) and examined whether there is an association between PFP and osteoarthritis (OA) at 5-8-year follow-up. Long-term follow-up data were derived from 2 randomised controlled trials (n=179, n=131). Patient-reported measures were obtained at baseline. Pain severity (100 mm visual analogue scale (VAS)), function (Anterior Knee Pain Scale (AKPS)) and self-reported recovery were measured 5-8 years later, along with knee radiographs. Multivariate backward stepwise linear regression analyses were used to evaluate the prognostic ability of baseline pain duration, pain VAS and AKPS on outcomes of pain VAS and AKPS at 5-8 years. 60 (19.3%) participants completed the questionnaires at 5-8-year follow-up (45 women, mean age at baseline 26 years) and 50 underwent knee radiographs. No differences were observed between responders and non-responders regarding baseline demographics, and 3-month and 12-month pain severity and recovery. 34 (57%) reported unfavourable recovery at 5-8 years. 48 out of 50 participants (98%) had no signs of radiographic knee OA. Multivariate models revealed that baseline PFP duration (>12 months R(2)=0.22) and lower AKPS (R(2)=0.196) were significant predictors of poor prognosis at 5-8 years on measures of worst pain VAS and AKPS, respectively. More than half of participants with PFP reported an unfavourable recovery 5-8 years after recruitment, but did not have radiographic knee OA. Longer PFP duration and worse AKPS score at baseline predict poor PFP prognosis. Education of health practitioners and the general public will provide patients with more realistic expectations regarding prognosis.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.JOCA.2016.05.010
Abstract: Patellofemoral osteoarthritis (PFOA) commonly occurs following anterior cruciate ligament reconstruction (ACLR). Our study aimed to compare knee kinematics and kinetics during a hop-landing task between in iduals with and without early PFOA post-ACLR. Forty-five in iduals (mean ± SD 26 ± 5 years) 1-2 years post-ACLR underwent 3T isotropic MRI scans and 3D biomechanical assessment of a standardised forward hop task. Knee kinematics (initial contact, peak, excursion) in all three planes and sagittal plane kinetics (peak) were compared between 15 participants with early PFOA (MRI-defined patellofemoral cartilage lesion) and 30 participants with no PFOA (absence of patellofemoral cartilage lesion on MRI) using analysis of covariance (ANCOVA), adjusted for age, BMI, sex and the presence of early tibiofemoral OA. Compared to participants without PFOA, those with early PFOA exhibited smaller peak knee flexion angles (mean difference, 95% confidence interval [CI]: -5.2°, -9.9 to -0.4 P = 0.035) and moments (-4.2 Nm/kg.m, -7.8 to -0.6 P = 0.024), and greater knee internal rotation excursion (5.3°, 2.0 to 8.6 P = 0.002). In iduals with early PFOA within the first 2-years following ACLR exhibit distinct kinematic and kinetic features during a high-load landing task. These findings provide new information regarding common post-ACLR biomechanical patterns and PFOA. Since management strategies, such as altering knee load, are more effective during the early stages of disease, this knowledge will help to inform clinical management of early PFOA post-ACLR.
Publisher: Wiley
Date: 26-05-2016
DOI: 10.1002/ACR.22761
Abstract: To determine whether the presence of magnetic resonance imaging (MRI) osteoarthritis (OA) features in the patellofemoral or tibiofemoral joint (i.e., bone marrow lesions, cartilage lesions, and osteophytes) and/or functional impairments, 1 year following anterior cruciate ligament reconstruction (ACLR), can predict Knee Injury and Osteoarthritis Outcome Score (KOOS) at 3 years. A total of 93 participants (56 [60%] men, mean ± SD age 29 ± 9 years) who had undergone MRI examination and functional testing at 1‐year post‐ACLR, completed the KOOS at 3 years postsurgery. Multivariate regression models evaluated the prognostic capacity of compartment‐specific osteochondral OA features, scored using the MRI Osteoarthritis Knee Score, and functional performance (hop for distance, 1‐leg rise), to predict outcome on 4 KOOS subscales (pain, symptoms, sport/recreation, and quality of life [QOL]). Presence of patellofemoral cartilage lesions 1‐year post‐ACLR predicted worse score on all KOOS subscales at 3 years ( P ≤ 0.01). Regression coefficients (B) were −5.1 (95% confidence interval [95% CI] −9.1, −1.2) for symptoms, −4.0 (95% CI −6.7, −1.4) for pain, −6.7 (95% CI −11.0, −2.4) for sport/recreation, and −8.6 (95% CI −15.1, −2.1) for QOL. No significant associations were found between tibiofemoral MRI features and knee symptoms. Poorer performance on the 1‐leg‐rise test predicted worse KOOS‐QOL (B −6.5 [95% CI −12.4, −0.5], P = 0.03). The presence of a patellofemoral articular cartilage lesion and lower 1‐leg‐rise performance at 1 year postsurgery are prognostic for poorer 3‐year outcome following ACLR. Particular attention to patellofemoral compartment lesions and functional capacity is warranted during postoperative rehabilitation programs, as these features represent potential targets for therapy aimed at minimizing symptomatic disease progression in these young adults.
Publisher: Wiley
Date: 28-01-2011
DOI: 10.1002/ACR.20341
Publisher: BMJ
Date: 2004
DOI: 10.1136/EBM.9.1.18
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.GAITPOST.2019.04.003
Abstract: Anterior pericapsular muscles potentially contribute to active hip joint stability in walking by controlling anterior femoral translation in peak extension. Alternatively, these muscles could flex the hip and tension the anterior capsule to aid initiation of swing. Although never investigated, the location of Iliocapsularis and its extensive anterior hip capsule attachment imply a potential role in these functions. We hypothesised if these muscles contribute to control of femoral head translation (rather than hip flexion), their activation would decrease when peak hip extension is reduced during shorter stride walking. To provide the first description of iliocapsularis activity during walking and challenge the hypothesised roles of the anterior pericapsular hip muscles in gait by walking with shortened strides. Fifteen healthy volunteers walked with self-selected and shortened stride lengths. Electromyographic recordings were made from iliocapsularis, iliacus and anterior gluteus minimus with intramuscular electrodes, and rectus femoris with surface electrodes. Stride characteristics were measured using force sensors and 3D motion capture. Ensembles of burst activity profiles for each stride length were compared. Iliocapsularis displayed a consistent EMG burst around toe-off (terminal hip extension) that peaked during early swing phase with self-selected strides. In shortened strides, iliocapsularis EMG increased during mid to late stance (p = 0.03), with no difference in other muscles. Iliocapsularis, iliacus and rectus femoris activity decreased during early stance (p < 0.01) in short strides, whereas gluteus minimus EMG increased (p = 0.03). Iliocapsularis displayed an EMG burst around toe-off during walking, and greater EMG during mid-late stance in short stride walking, which was not seen in other pericapsular muscles. Shortened strides increase the demand for active tensioning of the hip joint capsule in initial swing, and suggests a role for iliocapsularis during active hip flexion in pain free young in iduals.
Publisher: BMJ
Date: 14-03-2018
DOI: 10.1136/BJSPORTS-2017-098264
Abstract: Intra-articular hip pathologies are thought to be associated with the development of hip and groin pain. A better understanding of the relationship between symptoms and imaging findings may improve the management of in iduals with intra-articular hip pathologies. To undertake a systematic review and meta-analysis to determine the prevalence of intra-articular hip pathologies in in iduals with and without pain. Seven electronic databases were searched in February 2017 for studies investigating the prevalence of intra-articular hip pathologies using MRI, MRA or CT. Two independent reviewers conducted the search, study selection, quality appraisal and data extraction. Meta-analysis was performed when studies were deemed homogenous, with a strength of evidence assigned to pooled results. In general, studies were moderate to high risk of bias, with only five studies adjudged to be low risk of bias. The 29 studies reporting on the prevalence of intra-articular hip pathologies identified limited evidence of a labral tear prevalence of 62% (95% CI 47% to 75%) in symptomatic in iduals, with moderate evidence identifying a labral tear prevalence of 54% (95% CI 41% to 66%) in asymptomatic in iduals. Limited evidence demonstrated a cartilage defect prevalence of 64% (95% CI 25% to 91%) in symptomatic in iduals, compared with moderate evidence of a cartilage defect prevalence of 12% (95% CI 7% to 21%) in asymptomatic in iduals. The prevalence of intra-articular hip pathologies is highly variable in both symptomatic and asymptomatic populations. The prevalence of intra-articular hip pathologies appears to be higher in symptomatic in iduals. However, imaging-defined intra-articular hip pathologies are also frequently seen in asymptomatic in iduals, highlighting a potential discordant relationship between imaging pathology and pain. CRD42016035444 .
Publisher: Springer Science and Business Media LLC
Date: 2012
DOI: 10.2165/11594460-000000000-00000
Abstract: Anterior knee pain is a chronic condition that presents frequently to sports medicine clinics, and can have a long-term impact on participation in physical activity. Conceivably, effective early management may prevent chronicity and facilitate physical activity. Although a variety of nonsurgical interventions have been advocated, previous systematic reviews have consistently been unable to reach conclusions to support their use. Considering a decade has lapsed since publication of the most recent data in these reviews, it is timely to provide an updated synthesis of the literature to assist sports medicine practitioners in making informed, evidence-based decisions. A systematic review and meta-analysis was conducted to evaluate the evidence for nonsurgical interventions for anterior knee pain. A comprehensive search strategy was used to search MEDLINE, EMBASE, CINAHL and Pre-CINAHL, PEDro, PubMed, SportDiscus, Web of Science, BIOSIS Previews, and the full Cochrane Library, while reference lists of included papers and previous systematic reviews were hand searched. Studies were eligible for inclusion if they were randomized clinical trials that used a measure of pain to evaluate at least one nonsurgical intervention over at least 2 weeks in participants with anterior knee pain. A modified version of the PEDro scale was used to rate methodological quality and risk of bias. Effect size calculation and meta-analyses were based on random effects models. Of 48 suitable studies, 27 studies with low-to-moderate risk of bias were included. There was minimal opportunity for meta-analysis because of heterogeneity of interventions, comparators and follow-up times. Meta-analysis of high-quality clinical trials supports the use of a 6-week multimodal physiotherapy programme (standardized mean difference [SMD] 1.08, 95% CI 0.73, 1.43), but does not support the addition of electromyography biofeedback to an exercise programme in the short-term (4 weeks: SMD -0.21, 95% CI -0.64, 0.21 8-12 weeks: SMD -0.22, 95% CI -0.65, 0.20). In idual study data showed beneficial effects for foot orthoses with and without multimodal physiotherapy (vs flat inserts), exercise (vs control), closed chain exercises (vs open chain exercises), patella taping in conjunction with exercise (vs exercise alone) and acupuncture (vs control). Findings suggest that, in implementing evidence-based practice for the nonsurgical management of anterior knee pain, sports medicine practitioners should prescribe local, proximal and distal components of multimodal physiotherapy in the first instance for suitable patients, and then consider foot orthoses or acupuncture as required.
Publisher: Wiley
Date: 22-04-2014
DOI: 10.1002/ACR.22193
Abstract: Impaired balance control has been reported in the elderly with hip osteoarthritis, yet this relationship has not been explored in young adults with hip chondropathy. This study aimed to determine whether people with hip chondropathy demonstrated impaired balance ability during a dynamic single-leg squat with eyes open (SquatEO) and a single-leg standing task with eyes closed (StandEC) and whether hip range of motion (ROM) and hip muscle strength were correlated with balance measures in adults with hip chondropathy. Sixty-three adults with hip chondropathy and 60 controls performed 2 tasks: SquatEO and StandEC while standing on a Nintendo Wii Balance Board. Center of pressure (COP) movement in mediolateral and anteroposterior directions was extracted. Hip ROM and muscle strength were measured with an inclinometer and dynamometer. Data were analyzed using an analysis of covariance and stepwise multiple regression model. During SquatEO, greater COP mediolateral range (P = 0.023) and anteroposterior SD (P = 0.043) were observed in those with hip chondropathy compared to controls. No significant between-group differences were observed for StandEC. Hip external rotation ROM was significantly associated with mediolateral range during SquatEO. Dynamic single-leg balance squat performance is reduced in people with hip chondropathy compared to healthy adults, but static single-leg standing balance is not. This may be reflective of reduced control of dynamic movements. Those with greater hip joint external rotation ROM appear to have worse single-leg squat balance performance. Further investigation into balance deficits associated with hip disease is necessary to establish early identification strategies and a tailored approach to rehabilitation.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.BERH.2019.02.004
Abstract: Patellofemoral pain is one of the most common knee complaints, particularly among physically active young in iduals. Although once thought to be self-limiting, prospective studies have demonstrated the propensity towards the chronicity of patellofemoral pain (PFP). The pathogenesis of PFP is complex, with multiple interactive pathways suggested to contribute to its onset and persistence. Quadriceps weakness is one of the few risk factors of PFP, with at least moderate evidence from prospective studies, although limited clinical trials of lower limb strengthening have generally not been successful in preventing PFP. The challenge of managing PFP is reflected by a lack of evidence-based clinical guidelines. International consensus and current evidence recommends exercise therapy, focussed on hip and knee strengthening, as a cornerstone of management to reduce PFP. Rethinking management approaches beyond exercise therapy to incorporate movement retraining, education and psychosocial aspects provides potential avenues to enhance outcomes for patients with PFP.
Publisher: SAGE Publications
Date: 2014
Publisher: BMJ
Date: 27-11-2013
DOI: 10.1136/BJSPORTS-2013-092975
Abstract: To evaluate the compartmental distribution of knee osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR), to determine if patellofemoral or tibiofemoral OA is more strongly associated with knee symptoms and function, and to evaluate the contribution of associated injuries and surgical delay to the development of OA. This cross-sectional study recruited 70 participants who underwent hamstring tendon (HT) ACLR 5-10 years previously. Radiographic OA was assessed according to the Osteoarthritis Research Society International (OARSI) criteria. Knee symptoms were assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Anterior Knee Pain Scale (AKPS), while function was assessed with three lower limb tasks (hop-for-distance, one-leg rise and side-hop). Multivariate and binary logistic regression analyses were performed to assess the relationship between OA and symptomatic/functional outcomes and associated injuries/surgical delay, respectively. Radiographic OA was observed in the patellofemoral (47%) and tibiofemoral joints (31%). Pain, symptoms and quality of life on the KOOS and the AKPS were associated with severity of patellofemoral OA (standardised regression coefficient (β)=-0.3 to -0.5, p=0.001-0.042), whereas only the KOOS-pain subscale was associated with tibiofemoral OA (β=-0.3, p=0.037). For each functional task, greater patellofemoral OA severity was associated with worse performance, independent of tibiofemoral OA severity (β=-0.3 to -0.4, p=0.001-0.026). Medial meniscal and patellofemoral chondral lesions at surgery were associated with tibiofemoral and patellofemoral OA development at follow-up, respectively, while a longer surgery delay was associated with patellofemoral OA. Patellofemoral OA is common following HT ACLR and is associated with worse knee-related symptoms, including anterior knee pain, and decreased functional performance.
Publisher: BMJ
Date: 24-03-2017
Publisher: Elsevier BV
Date: 10-2017
Publisher: Wiley
Date: 15-04-2020
DOI: 10.1002/JMRI.27164
Publisher: Elsevier BV
Date: 09-2019
Publisher: Wiley
Date: 03-07-2019
DOI: 10.1002/ACR.23726
Abstract: To describe the prevalence of radiographic features of patellofemoral (PF) osteoarthritis (OA) in adults with persistent PF pain, to describe the prevalence of magnetic resonance imaging (MRI)-defined PF OA and compare it to that in age- and sex-matched controls, and to explore the prevalence of radiographic and MRI-defined PF OA across age, sex, and body mass index (BMI) groups. This cross-sectional study included 84 in iduals with PF pain ≥3 months duration and 26 age- and sex-matched controls. In participants with PF pain, posteroanterior, lateral, and skyline radiographs were obtained. Radiographic OA features were scored using Kellgren/Lawrence (K/L) criteria and a radiographic atlas, with K/L grade ≥2 defined as OA, and K/L grade 1 as early OA. Both groups underwent 3.0 Tesla MRI scans, scored using the MRI Osteoarthritis Knee Score criteria. Compartmental prevalence of MRI OA features was based on cartilage lesions, bone marrow lesions (BMLs), and osteophytes. Overall, 20 participants (24%) with PF pain had radiographic PF OA (K/L grade ≥2), and 36 participants (43%) had early PF OA (K/L grade 1). MRI-defined PF OA was more prevalent in participants with PF pain (16-29%) than in controls (4-12%), irrespective of how PF OA was defined. Within the PF pain group, the prevalence of PF OA on radiographs and MRI was greater in participants who were older or female or who had a higher BMI. Features of radiographic and MRI-defined PF OA were evident in 20-30% of adults ages 26-50 years with persistent PF pain, with greater prevalence observed in those who were older, or female, or who had a higher BMI. MRI-defined PF OA was more prevalent in in iduals with PF pain than in pain-free controls, especially when defined as a full-thickness cartilage lesion with BML.
Publisher: Wiley
Date: 2005
DOI: 10.1016/J.ORTHRES.2004.06.008
Abstract: The ability to sense the position of limb segments is a highly specialised proprioceptive function important for control of movement. Abnormal knee proprioception has been found in association with several musculoskeletal pathologies but whether nociceptive stimulation can produce these proprioceptive changes is unclear. This study evaluated the effect of experimentally induced knee pain on knee joint position sense (JPS) in healthy in iduals. Repeated measures, within-subject design. Knee JPS was tested in 16 in iduals with no history of knee pathology under three experimental conditions: baseline control, a distraction task and knee pain induced by injection of hypertonic saline into the infrapatellar fat pad. Knee JPS was measured using active ipsilateral limb matching responses at 20 degrees and 60 degrees flexion whilst non-weightbearing (NWB) and 20 degrees flexion single leg stance. During the tasks, the subjective perception of distraction and severity of pain were measured using 11-point numerical rating scales. Knee JPS was not altered by acute knee pain in any of the positions tested. The distraction task resulted in poorer concentration, greater JPS absolute errors at 20 degrees NWB, and greater variability in errors during the WB tests. There were no significant correlations between levels of pain and changes in JPS errors. Changes in JPS with pain and distraction were inversely related to baseline knee JPS variable error in all test positions (r=-0.56 to -0.91) but less related to baseline absolute error. Knee JPS is reduced by an attention-demanding task but not by experimentally induced pain.
Publisher: Wiley
Date: 05-12-2017
DOI: 10.1002/JOR.23805
Abstract: The purpose of this study was to compare hip and knee biomechanics during walking in in iduals with isolated tibiofemoral osteoarthritis (TFOA), combined TFOA and patellofemoral osteoarthritis (PFOA), and those without knee osteoarthritis (OA), and to compare patient-reported symptoms and function in in iduals with isolated TFOA and those with combined TFOA and PFOA. Participants with and without knee OA were assessed and categorized into (i) no OA, (ii) isolated TFOA, and (iii) combined TFOA and PFOA, based on Kellgren and Lawrence diagnostic criteria. Quantitative motion analyses were conducted during walking, and hip and knee kinematics, and external moments were calculated. Peak values in the sagittal and frontal planes during stance phase were computed. Patient-reported symptoms and function data were obtained using the Western Ontario McMaster Universities Arthritis Index. Multivariate analyses of variance were conducted to compare between-group differences in gait and patient-reported symptoms and function data. The results showed no statistically significant differences in hip and knee kinematics and external moments between the three groups. Relative to those with isolated TFOA, in iduals with combined TFOA and PFOA had greater pain (mean difference [95%CI]: 1.5 [0.05-3.1]), stiffness (0.8 [0.02-1.5]), and poorer function (5.4 [0.2-10.7]). In conclusion, the combined TFOA and PFOA radiographic disease pattern is associated with worse pain and function compared to the isolated TFOA disease pattern. The results of the present study provide no indications that treatments designed to change walking biomechanics should differ between in iduals with isolated TFOA and those with combined TFOA and PFOA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1666-1672, 2018.
Publisher: Human Kinetics
Date: 2023
Publisher: Elsevier
Date: 2018
Publisher: Informa UK Limited
Date: 19-04-2021
DOI: 10.1080/09593985.2021.1906805
Abstract: To determine the knowledge and confidence of physiotherapists in managing knee osteoarthritis (OA) and patellofemoral pain (PFP) and explore their learning behaviors and preferences related to the management of these knee conditions. One hundred and sixteen Australian and Canadian Physiotherapists were recruited via social media, e-mail, and an online course. Part 1: Quantitative involved an online survey evaluating knowledge of evidence and confidence in providing treatments for knee OA and PFP. Part 2: Qualitative involved semi-structured interviews with 13 participants exploring current practice and learning needs, that were analyzed using an initial framework structured on interview questions, followed by inductive approach to identify additional themes. Awareness regarding evidence supporting exercise for knee OA and PFP was good (89-96%), and qualitative themes indicated physiotherapists emphasized exercise-therapy and education. Perceived value of passive treatments and surgery varied. Preference for face-to-face workshops to address learning needs, alongside describing time and cost barriers to access them, emerged from qualitative findings. Online learning formats were viewed as convenient, but not as effective as face-to-face learning. Knowledge and confidence related to interventions for knee OA and PFP of Australian and Canadian physiotherapist participants broadly aligns with guidelines. Knowledge translation strategies focused on face-to-face workshops, supported by online education may help to bridge evidence-to-practice gaps.
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.JOCA.2016.09.012
Abstract: To prospectively evaluate the relationship between the presence or persistence of anterior knee pain (AKP) during the first 2-years following anterior cruciate ligament reconstruction (ACLR) and patellofemoral osteoarthritis (PFOA) at 15- and 20-years. This study was ancillary to a long-term prospective cohort study of 221 participants following bone-patellar-tendon-bone ACLR. AKP was assessed at 1- and 2-years post-ACLR using part of the Cincinnati knee score with an additional pain location question (persistence defined as presence at both follow-ups). Radiographic PFOA (definite patellofemoral osteophyte) and symptomatic PFOA (patellofemoral osteophyte, with knee pain during past 4 weeks) was assessed at 15- and 20-years follow-up. We used generalized linear models with Poisson regression to assess the relationship between AKP and PFOA. Of the 181 participants (82%) who were assessed at 15-years post-ACLR (age 39 ± 9 years 42% female), 36 (24%) and 33 (22%) had AKP at 1- and 2-years, respectively, while 14 (8%) reported persistent AKP. Radiographic and symptomatic PFOA was observed at 15-years in 130 (72%) and 70 (39%) participants, respectively, and at 20-years in 115 (80%) and 60 (42%) participants, respectively. Neither the presence nor persistence of AKP at 1- and/or 2-years post-ACLR was associated with significantly higher risk of radiographic or symptomatic PFOA at 15- or 20-years (risk ratios <2.1). Although AKP and PFOA were prevalent, AKP does not appear to be associated with long-term PFOA following ACLR.
Publisher: Human Kinetics
Date: 02-2018
Abstract: To investigate whether preseason training plans for Australian football can be computer generated using current training-load guidelines to optimize injury-risk reduction and performance improvement. A constrained optimization problem was defined for daily total and sprint distance, using the preseason schedule of an elite Australian football team as a template. Maximizing total training volume and maximizing Banister-model-projected performance were both considered optimization objectives. Cumulative workload and acute:chronic workload-ratio constraints were placed on training programs to reflect current guidelines on relative and absolute training loads for injury-risk reduction. Optimization software was then used to generate preseason training plans. The optimization framework was able to generate training plans that satisfied relative and absolute workload constraints. Increasing the off-season chronic training loads enabled the optimization algorithm to prescribe higher amounts of "safe" training and attain higher projected performance levels. Simulations showed that using a Banister-model objective led to plans that included a taper in training load prior to competition to minimize fatigue and maximize projected performance. In contrast, when the objective was to maximize total training volume, more frequent training was prescribed to accumulate as much load as possible. Feasible training plans that maximize projected performance and satisfy injury-risk constraints can be automatically generated by an optimization problem for Australian football. The optimization methods allow for in idualized training-plan design and the ability to adapt to changing training objectives and different training-load metrics.
Publisher: BMJ
Date: 06-2018
Publisher: Elsevier BV
Date: 02-2010
DOI: 10.1016/J.GAITPOST.2009.10.009
Abstract: Sagittal bending moments acting on the lower leg during running may play a role in tibial stress fracture development. The purpose of this study was to evaluate these moments at nine equidistant points along the length of the lower leg (10% point-90% point) during running. Kinematic and ground reaction force data were collected for 20 male runners, who each performed 10 running trials. Inverse dynamics and musculoskeletal modelling techniques were used to estimate sagittal bending moments due to reaction forces and muscle contraction. The muscle moment was typically positive during stance, except at the most proximal location (10% point) on the lower leg. The reaction moment was predominantly negative throughout stance and greater in magnitude than the muscle moment. Hence, the net sagittal bending moment acting on the lower leg was principally negative (indicating tensile loads on the posterior tibia). Peak moments typically occurred around mid-stance, and were greater in magnitude at the distal, compared with proximal, lower leg. For ex le, the peak reaction moment at the most distal point was -9.61+ or - 2.07%Bw.Ht., and -2.73 + or - 1.18%Bw.Ht. at the most proximal point. These data suggest that tensile loads on the posterior tibia are likely to be higher toward the distal end of the bone. This finding may explain the higher incidence of stress fracture in the distal aspect of the tibia, observed by some authors. Stress fracture susceptibility will also be influenced by bone strength and this should also be accounted for in future studies.
Publisher: Wiley
Date: 30-11-2009
DOI: 10.1002/ART.24872
Abstract: Patellar taping is a conservative treatment that may reduce patellar malalignment and pain in people with patellofemoral joint osteoarthritis (OA). This study aimed to compare patellar alignment in people with and without patellofemoral joint OA and to evaluate immediate effects of patellar taping on patellar alignment and pain in people with patellofemoral joint OA. Patellar malalignment was measured from magnetic resonance imaging (MRI 15 degrees knee flexion) in 28 in iduals (14 with patellofemoral joint OA and 14 asymptomatic, age-matched controls). In the patellofemoral joint OA group, MRI data were collected in 2 randomly allocated conditions (tape and no tape). Patellar alignment indices were measured from deidentified axial scans by 1 examiner. Pain during squatting was recorded in the 2 conditions (tape and no tape). People with patellofemoral joint OA exhibited greater lateral displacement and bisect offset compared with controls (P < 0.001). Lateral patellar tilt angle did not differ between groups. In the patellofemoral joint OA group, patellar tape resulted in a significant lessening of lateral alignment, with reduced lateral displacement (P = 0.028) and increased lateral patellar tilt angle (P < 0.001). Mean pain during squatting decreased with patellar tape by 15 mm on a 100-mm scale (P = 0.045). Patellar tape may reduce malalignment and pain associated with patellofemoral joint OA.
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.CLINBIOMECH.2007.12.008
Abstract: This study investigated the extent to which reference frame convention affects the interpretation of how gait modification alters the external knee adduction moment. Data were collected from a single male able-bodied subject performing three gait tasks: normal, toe out and medial thrust. The net external moment vector at the knee was expressed in five alternative reference frames: the femur anatomical frame, the proximal tibia anatomical frame, the distal tibia anatomical frame, the laboratory frame and a non-orthogonal knee joint coordinate system. For each reference frame, the knee adduction moment was taken as the component about the frame's anteroposterior axis. Gait modification and selected reference frame both influenced the calculated knee adduction moment. Furthermore, these two effects were interactive, with the magnitude of the changes in the knee adduction moment produced by toe out and medial thrust gait being highly dependent on selected reference frame. Choice of reference frame for calculating the external knee adduction moment is therefore an important consideration for studies investigating the relative effectiveness of interventions such as gait modification.
Publisher: BMJ
Date: 06-06-2014
Publisher: SAGE Publications
Date: 04-12-2019
Abstract: Successful return to sports activity after surgery requires both physical and psychological readiness. The Hip–Return to Sport After Injury (Short Form) has been developed to assess psychological readiness to return to sports after hip injury and hip surgery, including hip arthroscopy. To evaluate the reliability, validity, responsiveness, and interpretability of the scale for a cohort of patients after hip arthroscopy with a range of sports participation levels. Cohort study (diagnosis) Level of evidence, 2. Invitations to participate were sent to 145 patients from 3 specialist surgeons. The study included 77 participants 1 to 24 months after hip arthroscopy (mean ± SD age, 35 ± 9 years 62% women) and 33 healthy age-matched controls (age, 37 ± 7 years 52% women). The scale was administered electronically on 3 occasions to patients: baseline (≥1 month postarthroscopy), 1 week later, and 6 months later. In addition to the scale, participants were asked about sports participation status and their global rating of postsurgical change. The scale was administered to healthy controls on 1 occasion. The minimal detectable difference, discriminant validity, floor and ceiling effects, responsiveness, and interpretability (minimally important change) were determined for the scale. Among the postarthroscopy group, excellent test-retest reliability was found (intraclass correlation coefficient = 0.869 95% CI, 0.756-0.932) with a minimal detectable difference of 26 points out of 100 at the in idual level and 4 points out of 100 at the group level. At baseline discriminant validity was evident between those who had returned to sports (median = 69, n = 35) and those who had not returned to sports (median = 30, n = 42 Mann-Whitney U score = 232.5, z = −5.141, P .001) and between the returned-to-sports postarthroscopy group and healthy controls (median = 96, n = 33 Mann-Whitney U score = 165.500, z = 5.666, P .001). No floor or ceiling effects were evident. Responsiveness was demonstrated for the scale in relation to sports status. With sports status as an anchor, a minimally important change of 26 points was identified. Assessment of the Hip–Return to Sport After Injury (Short Form) supports its use as a reliable and valid measure of psychological readiness to return to sports in patients after hip arthroscopy.
Publisher: Springer Science and Business Media LLC
Date: 03-07-2015
DOI: 10.1007/S00167-015-3679-4
Abstract: If physical impairments that are associated with poorer outcomes can be identified in people with chondrolabral hip pathology, then rehabilitation programmes that target such modifiable impairments could potentially be established to improve quality of life. The aim of this study was to examine the relationship between quality-of-life PROs and physical impairment measurements in people with chondrolabral pathology post-hip arthroscopic surgery. This was a cross-sectional study where multiple stepwise linear regression analyses were conducted to determine which physical impairment measurements were most associated with poorer quality-of-life patient-reported outcomes (PROs). Eighty-four patients (42 women all aged 36 ± 10 years) with hip chondrolabral pathology 12- to 24-month post-hip arthroscopy were included. The Hip disability and Osteoarthritis Outcome Score Quality-of-life (HOOS-Q) subscale and International Hip Outcome Tool (IHOT-33) PROs were collected. Measurements of active hip ROM and strength were assessed. Modifiable post-surgical physical impairments were associated with PRO in patients with chondrolabral pathology. Greater hip flexion ROM was independently associated with better scores in both HOOS-Q and IHOT-33 (adjusted r Hip flexion ROM and adduction strength were associated with better quality-of-life PRO scores in patients with chondrolabral pathology 12- to 24-month post-hip arthroscopy. These impairments could be targeted by clinicians designing rehabilitation programmes to this patient group. Cross-sectional study, Level IV.
Publisher: BMJ
Date: 04-10-2012
DOI: 10.1136/BJSPORTS-2012-091490
Abstract: Patellofemoral joint (PFJ) osteoarthritis (OA) is a prevalent disease capable of being a potent source of knee symptoms. Although anterior cruciate ligament (ACL) injury and reconstruction (ACLR) are well-established risk factors for the development of tibiofemoral joint OA, PFJ OA after ACL reconstruction has gone largely unrecognised. This is despite the high prevalence of anterior knee pain after ACLR, which can reduce the capacity for physical activity and quality of life. The susceptibility of the PFJ to degenerative change after ACLR may have implications for current rehabilitation strategies. This review summarises the evidence describing the prevalence of PFJ OA after ACLR and examines why this compartment may be at increased risk of early onset OA after ACLR. Strategies that address the modifiable factors for risk of PFJ OA may aid in alleviating joint loads and symptoms for people after ACLR.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.SEMARTHRIT.2017.09.009
Abstract: To present the current status of knowledge in the field of patellofemoral (PF) osteoarthritis (OA) and formulate a research agenda in order to guide future research on this topic. A 1-day meeting was organized with the aim to bring together international experts in the field to discuss the current state of knowledge on PF OA. Experts from multiple disciplines were invited based on their scientific publications in the field of PF OA and interest in the subject. Topics discussed include the diagnosis, impact, prognosis, and treatment of PF OA. Following context-setting presentations, an interactive discussion was held in order to achieve consensus on the PF OA topics of interest: (1) diagnosis and definition (2) burden (3) outcome measures (4) prognosis (5) risk factors, and (6) treatment. Groups of meeting attendees reviewed the literature on these topics and narratively summarized the current state of knowledge, and each group formulated research agenda items relevant to the specific topics of interest. Each consortium member consequently ranked the importance of all items on a 0-10 Numerical Rating Scale (NRS) (10 = extremely important, to 0 = not at all important). After ranking all formulated items on importance, 6 of the 28 research agenda items formulated received an average of 7.5 points on the NRS. The most highly ranked items covered the fields of treatment, diagnosis, and definition of PF OA. We recommend to develop clear clinical criteria for PF OA and to reach consensus on the definition of PF OA by both radiographs and MRI. Additionally, more understanding is necessary to be able to distinguish PF symptoms from those arising from the tibiofemoral joint. More insight is needed on effective treatment strategies for PF OA specifically, tailoring nonpharmacological treatments to in iduals with PF OA, and determining whether isolated PF OA requires different treatment strategies than combined PF and tibiofemoral OA.
Publisher: BMJ
Date: 15-11-2022
DOI: 10.1136/BJSPORTS-2022-106299
Abstract: The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries risk factors for post-traumatic knee OA rehabilitation to prevent post-traumatic knee OA and patient-reported outcomes, muscle function and functional performance tests to monitor people at risk of post-traumatic knee OA. Draft consensus definitions, and clinical and research recommendations were generated, iteratively refined, and discussed at 6, tri-weekly, 2-hour videoconferencing meetings. After each meeting, items were finalised before the expert group (n=36) rated the level of appropriateness for each using a 9-point Likert scale, and recorded dissenting viewpoints through an anonymous online survey. Seven definitions, and 8 clinical recommendations (who to target, what to target and when, rehabilitation approach and interventions, what outcomes to monitor and how) and 6 research recommendations (research priorities, study design considerations, what outcomes to monitor and how) were voted on. All definitions and recommendations were rated appropriate (median appropriateness scores of 7-9) except for two subcomponents of one clinical recommendation, which were rated uncertain (median appropriateness score of 4.5-5.5). Varying levels of evidence supported each recommendation. Clinicians, patients, researchers and other stakeholders may use the definitions and recommendations to advocate for, guide, develop, test and implement person-centred evidence-based rehabilitation programmes following traumatic knee injury, and facilitate data synthesis to reduce the burden of knee post-traumatic knee OA.
Publisher: Springer Science and Business Media LLC
Date: 22-04-2004
DOI: 10.1007/S00167-003-0485-1
Abstract: Opening wedge high tibial osteotomy (OWHTO) is a recently described procedure for medial compartment arthritis of the knee in the active, younger population. Despite having a number of advantages over the traditional closing wedge high tibial osteotomy (CWHTO) a potential complication of OWHTO is a high rate of delayed- and non-union. This study reports the occurrence of delayed- and non-union following OWHTO for medial compartment arthritis of the knee. Questionnaires were sent to all current members of the Australian Knee Society (n=45), a special interest group of the Australian Orthopaedic Group. Surgeons were asked primarily to indicate how many OWHTOs they had performed, and how many of these had progressed to union, delayed-union and non-union. All 45 questionnaires were returned, with 21 surgeons (47%) performing OWHTOs. A total of 188 OWHTO cases were reported, of which 182 were complete. Of these complete cases 167 (91.8%) were classed as united, 12 (6.6%) delay-united and 3 (1.6%) non-united. The results of this study demonstrate that the rate of delayed- and non-union following OWHTO for medial compartment arthritis of the knee is relatively low and comparable to that reported for traditional CWHTO.
Publisher: Springer Science and Business Media LLC
Date: 03-05-2016
DOI: 10.1007/S40279-016-0545-6
Abstract: The patellofemoral (PF) joint is the knee compartment most commonly affected by osteoarthritis (OA). Even mild PF OA is associated with considerable pain and functional limitations. Despite its prevalence and impact, little is understood of the etiology or structural and functional features of PF OA. The clinical symptoms of PF OA, such as anterior knee pain during stair ambulation and squatting, share many similarities with PF pain in adolescents and young adults. PF joint OA is most commonly diagnosed in people aged >40 years, many of whom report a history of PF pain. As such, there is growing evidence that PF pain and PF OA form a continuum of disease. This review explores the possible relationship between the presence of PF pain and the development of PF OA. We review the evidence for altered neuromotor control and biomechanical factors that may be associated with altered PF loading in people with PF pain and PF OA. In doing so, we highlight similarities and differences that may evolve along the continuum. By improving our understanding of the neuromotor and biomechanical links between PF pain and PF OA, we may highlight potential targets for new rehabilitation strategies.
Publisher: Elsevier BV
Date: 06-2021
DOI: 10.1016/J.JPHYS.2021.06.011
Abstract: Is patient education effective as a standalone intervention or combined with other interventions for people with knee osteoarthritis? Systematic review of randomised controlled trials. MEDLINE, EMBASE, SPORTDiscus, CINAHL and Web of Science were searched from inception to April 2020. The Cochrane Risk of Bias tool was used for included studies, and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to interpret certainty of results. People with knee osteoarthritis. Any patient education intervention compared with any non-pharmacological comparator. Primary outcomes were self-reported pain and function. Twenty-nine trials involving 4,107 participants were included, informing low to very-low certainty evidence. Nineteen of 28 (68%) pooled comparisons were not statistically significant. Patient education was superior to usual care for pain (SMD -0.35, 95% CI -0.56 to -0.14) and function in the short term (-0.31, 95% CI -0.62 to 0.00), but inferior to exercise therapy for pain in the short term (0.77, 95% CI 0.07 to 1.47). Combining patient education with exercise therapy produced superior outcomes compared with patient education alone for pain in the short term (0.44, 95% CI 0.19 to 0.69) and function in the short (0.81, 95% CI 0.54 to 1.08) and medium term (0.39, 95% CI 0.15 to 0.62). When using the Western Ontario and McMaster Universities Osteoarthritis Index for these comparisons, clinically important differences indicated that patient education was inferior to exercise therapy for pain in the short term (MD 1.56, 95% CI 0.14 to 2.98) and the combination of patient education and exercise therapy for function in the short term (8.94, 95% CI 6.05 to 11.82). Although patient education produced statistically superior short-term pain and function outcomes compared with usual care, differences were small and may not be clinically important. Patient education should not be provided as a standalone treatment and should be combined with exercise therapy to provide statistically superior and clinically important short-term improvements in function compared with education alone. PROSPERO CRD42019122004.
Publisher: Wiley
Date: 30-06-2020
DOI: 10.1002/MSC.1490
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.GAITPOST.2019.10.019
Abstract: Foot orthoses are a recommended treatment for patellofemoral (PF) pain and a number of lower limb osteoarthritic (OA) conditions. However, their mechanism of effect is poorly understood. To compare the immediate effects of foot orthoses and flat inserts on lower limb biomechanics, knee pain and confidence in in iduals with PFOA. Twenty-one participants (14 females mean ± SD age 58 ± 8 years) with PFOA underwent three-dimensional motion analysis during level-walking, stair ascent, and stair descent under three footwear conditions: (i) their own shoes (ii) prefabricated foot orthoses and (iii) flat shoe inserts. Participants reported their average levels of knee pain and confidence after each task. Data were analysed with repeated-measures analysis of variance (ANOVA), effect sizes (partial eta squared), and Bonferroni post-hoc tests. During level-walking, there was a significant main effect of foot orthoses on peak ankle dorsiflexion angle (F Prefabricated foot orthoses altered sagittal plane biomechanics of the ankle during level-walking and stair descent in in iduals with PFOA. Further research is required to determine whether these changes are clinically beneficial.
Publisher: Center for Open Science
Date: 19-01-2023
Abstract: Objective To identify and quantify potential risk factors for osteoarthritis (OA) following traumatic knee injury.Design Systematic review and meta-analyses that estimated the odds of OA for in idual risk factors assessed in more than four studies using random-effects models. Remaining risk factors underwent semiquantitative synthesis. The modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach for prognostic factors guided the assessment.Data sources MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to 2009–2021.Eligibility Randomised controlled trials and cohort studies assessing risk factors for symptomatic or structural OA in persons with a traumatic knee injury, mean injury age ≤30 years and minimum 2-year follow-up.Results Across 66 included studies, 81 unique potential risk factors were identified. High risk of bias due to attrition or confounding was present in 64% and 49% of studies, respectively. Ten risk factors for structural OA underwent meta-analysis (sex, rehabilitation for anterior cruciate ligament (ACL) tear, ACL reconstruction (ACLR), ACLR age, ACLR body mass index, ACLR graft source, ACLR graft augmentation, ACLR+cartilage injury, ACLR+partial meniscectomy, ACLR+total medial meniscectomy). Very-low certainty evidence suggests increased odds of structural OA related to ACLR+cartilage injury (OR=2.31 95% CI 1.35 to 3.94), ACLR+partial meniscectomy (OR=1.87 1.45 to 2.42) and ACLR+total medial meniscectomy (OR=3.14 2.20 to 4.48). Semiquantitative syntheses identified moderate-certainty evidence that cruciate ligament, collateral ligament, meniscal, chondral, patellar/tibiofemoral dislocation, fracture and multistructure injuries increase the odds of symptomatic OA.Conclusion Moderate-certainty evidence suggests that various single and multistructure knee injuries (beyond ACL tears) increase the odds of symptomatic OA. Risk factor heterogeneity, high risk of bias, and inconsistency in risk factors and OA definition make identifying treatment targets for preventing post-traumatic knee OA challenging.
Publisher: BMJ
Date: 20-06-2018
DOI: 10.1136/BJSPORTS-2018-099397
Abstract: Patellofemoral pain affects a large proportion of the population, from adolescents to older adults, and carries a substantial personal and societal burden. An international group of scientists and clinicians meets biennially at the International Patellofemoral Research Retreat to share research findings related to patellofemoral pain conditions and develop consensus statements using best practice methods. This consensus statement, from the 5th International Patellofemoral Research Retreat held in Australia in July 2017, focuses on exercise therapy and physical interventions (eg, orthoses, taping and manual therapy) for patellofemoral pain. Literature searches were conducted to identify new systematic reviews and randomised controlled trials (RCTs) published since the 2016 Consensus Statement. The methodological quality of included systematic reviews and RCTs was graded using AMSTAR and PEDro, respectively. Evidence-based statements were developed from included papers and presented to a panel of 41 patellofemoral pain experts for consensus discussion and voting. Recommendations from the expert panel support the use of exercise therapy (especially the combination of hip-focused and knee-focused exercises), combined interventions and foot orthoses to improve pain and/or function in people with patellofemoral pain. The use of patellofemoral, knee or lumbar mobilisations in isolation, or electrophysical agents, is not recommended. There is uncertainty regarding the use of patellar taping/bracing, acupuncture/dry needling, manual soft tissue techniques, blood flow restriction training and gait retraining in patients with patellofemoral pain. In 2017, we launched the International Patellofemoral Research Network ( www.ipfrn.org ) to consolidate and grow our patellofemoral research community, facilitate collaboration and disseminate patellofemoral pain knowledge to clinicians and the general public. The 6th International Patellofemoral Research Retreat will be held in Milwaukee, Wisconsin, USA, in October 2019.
Publisher: BMJ
Date: 11-01-2023
DOI: 10.1136/BJSPORTS-2022-106055
Abstract: We aimed to determine (1) the proportion of women authors overall, in first (lead) and last (senior) author positions, (2) the proportion of women research participants and (3) the association between women in first and/or last author positions and the proportion of women research participants in original research articles and editorials/opinion pieces in four sport and exercise medicine hysiotherapy journals. The journals evaluated were the British Journal of Sports Medicine , Journal of Orthopaedic and Sports Physical Therapy , Physical Therapy in Sport and International Journal of Sports Physical Therapy . We reviewed all original research articles and editorials/opinion pieces published in 2008, 2009, 2018 and 2019. For each, we aimed to determine the gender/sex of all authors (through gender pronouns, Google Scholar, ResearchGate, institutional profiles, personal websites, photographs and/or social media), and the gender/sex of study participants reported as ‘female’ or ‘male’ or ‘women’ or ‘men’ or ‘girls’ or ‘boys’. We included 952 original studies and 219 editorials/opinion pieces. There were 5146 authors of original studies and 706 authors of editorials/opinion pieces. Compared with 2008/2009, the proportion of women as first and last authors was 3.6% (33.0% compared with 29.4%) and 4.8% (33.2% compared with 27.4%) higher respectively in 2018/2019. On average, the proportion of women participants in original studies remained largely unchanged over the 10-year period, only 10% of all participants were women in studies. Women are strikingly under-represented in first and last author positions, as are women participants in sports and exercise medicine hysiotherapy journals.
Publisher: Mark Allen Group
Date: 02-11-2018
DOI: 10.12968/IJTR.2018.25.11.613
Abstract: Literature supports outpatient physiotherapy rehabilitation following total hip replacement. Current physiotherapy practice for this patient cohort is unknown. This study aimed to establish current physiotherapy practice for outpatient total hip replacement rehabilitation in Australia, and compare current practice with clinical evidence. An online self-administered questionnaire was designed to reveal current practice for physiotherapy rehabilitation following hospital discharge of total hip replacement patients. The questionnaire was distributed to 151 Australian physiotherapists involved in the care of total hip replacement patients. A response rate of 77% (116/151) was obtained. Current practice consists of: referral for outpatient physiotherapy, three to four sessions of physiotherapy at a frequency of one to two times a fortnight commence within two weeks of hospital discharge and last five to six weeks. They include strengthening, education on hip precautions and exercise progression, gait retraining, stairs practice, range of motion exercises. Physiotherapy sessions are complemented by a home exercise programme. The high rate of referral for outpatient physiotherapy and provision of home exercise programmes are evidence-based. The infrequent use of resistance in strength training does not align with current evidence. There is insufficient literature regarding content, timing, frequency and duration to advise whether current practice regarding these aspects is evidence-based.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Wiley
Date: 04-05-2016
DOI: 10.1002/JOR.23264
Abstract: This study quantified the contributions by muscles, gravity, and inertia to the tibiofemoral compartment forces in the symptomatic (SYM) and asymptomatic (ASYM) limbs of varus mal-aligned medial knee osteoarthritis (OA) patients, and compared the results with healthy controls (CON). Muscle forces and tibiofemoral compartment loads were calculated using gait data from 39 OA patients and 15 controls aged 49 ± 7 years. Patients exhibited lower knee flexion angle, higher hip abduction, and knee adduction angles, lower internal knee flexion torque but higher external knee adduction moment. Muscle forces were highest in CON except hamstrings, which was highest in SYM. ASYM muscle forces were lowest for biceps femoris short head and gastrocnemius but otherwise intermediate between SYM and CON. In all subjects, vasti, hamstrings, gastrocnemius, soleus, gluteus medius, gluteus maximus, and gravity were the largest contributors to medial compartment force (MCF). Inertial contributions were negligible. Highest MCF was found in SYM throughout stance. Small increases in contributions from hamstrings, gluteus maximus, gastrocnemius, and gravity at the first peak soleus and rectus femoris at the second peak and soleus, gluteus maximus, gluteus medius, and gravity during mid-stance summed to produce significantly higher total MCF. Compared to CON, the ASYM limb exhibited similar peak MCF but higher mid-stance MCF. In patients, diminished non-knee-spanning muscle forces did not produce correspondingly diminished MCF contributions due to the influence of mal-alignment. Our findings emphasize consideration of muscle function, lower-limb alignment, and mid-stance loads in developing interventions for OA, and inclusion of the asymptomatic limb in clinical assessments. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:321-330, 2017.
Publisher: Wiley
Date: 27-12-2019
DOI: 10.1002/ACR.23864
Publisher: BMJ
Date: 13-06-2022
DOI: 10.1136/BJSPORTS-2022-105510
Abstract: To critically appraise and summarise measurement properties of functional performance tests in in iduals following anterior cruciate ligament (ACL) or meniscal injury. Systematic review. Systematic searches were performed in Medline (Ovid), Embase (Ovid), CINAHL (EBSCO) and SPORTSDiscus (EBSCO) on 7 July 2021. Studies evaluating at least one measurement property of a functional performance test including in iduals following an ACL tear or meniscal injury with a mean injury age of ≤30 years. The COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist was used to assess methodological quality. A modified Grading of Recommendations Assessment, Development and Evaluation assessed evidence quality. Thirty studies evaluating 26 functional performance tests following ACL injury were included. No studies were found in in iduals with an isolated meniscal injury. Included studies evaluated reliability (n=5), measurement error (n=3), construct validity (n=26), structural validity (n=1) and responsiveness (n=1). The Single Leg Hop and Crossover Hop tests showed sufficient intrarater reliability (high and moderate quality evidence, respectively), construct validity (low-quality and moderate-quality evidence, respectively) and responsiveness (low-quality evidence). Frequently used functional performance tests for in iduals with ACL or meniscal injury lack evidence supporting their measurement properties. The Single Leg Hop and Crossover Hop are currently the most promising tests following ACL injury. High-quality studies are required to facilitate stronger recommendations of performance-based outcomes following ACL or meniscal injury.
Publisher: Wiley
Date: 03-2019
DOI: 10.1002/JOR.24237
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2020
Publisher: BMJ
Date: 22-12-2011
DOI: 10.1136/BJSPORTS-2011-090428
Abstract: Arthroscopy is increasingly used to improve pain and function in athletes with hip joint pathology. Surgical techniques have evolved to utilise arthroscopic femoral osteoplasty to address potential morphological contributors to pathology. Investigate pain and function outcomes following hip arthroscopy with and without femoral osteoplasty in in iduals with intra-articular hip pathology. Systematic review. A comprehensive search strategy identified studies that evaluated the outcome over at least 3 months following arthroscopy for intra-articular hip pathology, using patient-reported outcomes of pain and/or function. Methodological quality was evaluated (Downs and Black scale), and effect sizes calculated when sufficient data were available. Twenty-nine studies of moderate methodological quality were included. Of 16 studies investigating arthroscopy alone, two studies showed large effects (3.12-5.46) at 1-2 years. Pain reduction and functional improvement (median 47%) were consistently reported by the remaining 14 studies up to 10 years postsurgery. Of 15 studies investigating arthroscopy with osteoplasty, nine papers showed mostly large effects (0.78-2.93) over 6-28 months. Adverse events were minimal (7% of participants, 12 studies, predominantly transient neuropraxia (83%)). Current evidence indicates that hip arthroscopy can significantly reduce pain and improve function in patients with intra-articular hip pathology. While benefits of arthroscopy alone can persist up to 10 years postsurgery, effects of osteoplasty beyond 3 years need to be established. Future studies should investigate rehabilitation in this population, and the impact of surgery on development of osteoarthritis.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.PTSP.2018.07.007
Abstract: Compare anthropometric characteristics, function, kinesiophobia, catastrophism and knee extensor strength between women (i) with PFP and crepitus (PFP Cross-sectional. Laboratory study. 65 women with PFP and 51 pain-free women. Objective assessment of knee crepitus, forward step-down and single leg hop tests knee extensor strength tests and subjective ratings of function, kinesiophobia, pain catastrophising and knee stiffness. Crepitus was more common in women with PFP (50.7%) compared to those without (33.3%) (χ Kinesiophobia, catastrophism, knee stiffness, strength and physical function are all impaired in women with PFP, regardless of crepitus. In pain-free women, crepitus was associated with poorer objective function.
Publisher: Springer Science and Business Media LLC
Date: 23-04-2019
DOI: 10.1007/S40279-019-01108-7
Abstract: The original article can be found online.
Publisher: Center for Open Science
Date: 25-01-2023
Abstract: The objective of this review is to investigate the effectiveness of rehabilitationinterventions to optimise symptomatic, functional, psychosocial and quality of life outcomes, and preventreinjury after ACL and/or meniscal injury.
Publisher: JMIR Publications Inc.
Date: 22-07-2020
DOI: 10.2196/18584
Abstract: Patellofemoral pain (PFP) impairs joint- and health-related quality of life and may be associated with knee osteoarthritis. We developed a novel, 2-phase, stepped-care approach for PFP, combining (1) self-directed web-based education and exercise therapy with (2) physiotherapist-supported education and exercise therapy. Physiotherapy sessions can be provided using 2 different modalities: face-to-face and telerehabilitation. This study aims to (1) determine the feasibility of our stepped-care approach, (2) explore patient-reported outcomes following self-directed web-based education and exercise therapy in people with PFP (phase 1), and (3) estimate the differences in treatment effects between face-to-face and telerehabilitation to support further education and exercise therapy (phase 2) in those who had not completely recovered following self-directed care. Phase 1 involved 6 weeks of self-directed web-based education and exercise therapy. Phase 2 involved random allocation to a further 12 weeks of physiotherapist-led (up to 8 sessions) education and exercise therapy delivered face-to-face or via telerehabilitation to participants who did not rate themselves as completely recovered following phase 1. Feasibility indicators of process, adherence, and participant retention were collected as primary outcomes alongside patient-reported outcomes on Global Rating of Change and knee pain, disability, knee-related quality of life, pain catastrophism, kinesiophobia, and knee self-efficacy. All participants were assessed at baseline, 6 weeks, and 18 weeks. A total of 71 participants were screened to identify 35 participants with PFP to enter the study. Overall, 100% (35/35) and 88% (31/35) of the participants were followed up with at 6 and 18 weeks, respectively. In phase 1 of the study, participants accessed the My Knee Cap website for an average of 6 (7.5) days and performed the exercises for an average of 2.5 (3.6) times per week. A total of 20% (7/35) of the participants reported that they had completely recovered at 6 weeks. Furthermore, 93% (26/28) of the participants who were followed up and had not completely recovered at 6 weeks agreed to be enrolled in phase 2. No statistically significant differences were found between the face-to-face and telerehabilitation groups for any outcome. The novel stepped-care approach was associated with marked improvement or complete recovery in 40% (14/35) of the participants following phase 1 and 71% (25/35) of the participants following phase 2. Self-directed web-based education and exercise therapy for people with PFP is feasible, as noted by the high rate of participant retention and home exercise adherence achieved in this study. Furthermore, 20% (7/35) of people reported complete recovery at 6 weeks. Both face-to-face and telerehabilitation physiotherapy should be considered for those continuing to seek care, as there is no difference in outcomes between these delivery modes. Determining the efficacy of the stepped-care model may help guide more efficient health care for PFP.
Publisher: Elsevier BV
Date: 2018
Publisher: BMJ
Date: 20-07-2010
Abstract: Patellofemoral pain syndrome (PFPS) often results in reduced functional performance. There is growing evidence for the use of foot orthoses to treat this multifactorial condition. In this study, the immediate effects of foot orthoses on functional performance and the association of foot posture and footwear with improvements in function were evaluated. Fifty-two in iduals with PFPS (18-35 years) were prescribed prefabricated foot orthoses (Vasyli Pro Vasyli International, Labrador, Australia). Functional outcome measures evaluated included the change in (1) pain and (2) ease of a single-leg squat on a five-point Likert scale, and change in the number of (3) pain-free step downs and (4) single-leg rises from sitting. The association of foot posture using the Foot Posture Index, navicular drop and calcaneal angle relative to subtalar joint neutral and the footwear motion control properties scale score with improved function were evaluated using Spearman's ρ statistics. Prefabricated foot orthoses produced significant improvements (p<0.05) for all functional outcome measures. A more pronated foot type and poorer footwear motion control properties were found to be associated with reduced pain during the single-leg squat and improvements in the number of pain-free single-leg rises from sitting when wearing foot orthoses. In addition, a more pronated foot type was also found to be associated with improved ease of completing a single-leg squat when wearing foot orthoses. Prefabricated foot orthoses provide immediate improvements in functional performance, and these improvements are associated with a more pronated foot type and poorer footwear motion control properties.
Publisher: BMJ
Date: 13-01-2015
DOI: 10.1136/BJSPORTS-2014-094224
Abstract: To recommend Patient-Reported Outcome (PRO) questionnaires to measure hip and groin disability in young-aged to middle-aged adults. A systematic review was performed in June 2014. The methodological quality of the studies included was determined using the COnsensus-based Standards for the selection of health Measurement INstruments list (COSMIN) together with standardised evaluations of measurement properties of each PRO. Twenty studies were included. Nine different questionnaires for patients with hip disability, and one for hip and groin disability, were identified. Hip And Groin Outcome Score (HAGOS), Hip Outcome Score (HOS), International Hip Outcome Tool-12 (IHOT-12) and IHOT-33 were the most thoroughly investigated PROs and studies including these PROs reported key aspects of the COSMIN checklist. HAGOS and IHOT-12 were based on studies with the least ratings of poor study methodology (23% and 31%, respectively), whereas IHOT-33 and HOS had a somewhat larger distribution (46%). These PROs all contain adequate measurement qualities for content validity (except HOS), test-retest reliability, construct validity, responsiveness and interpretability. No information or poor quality rating on methodological aspects made it impossible to fully evaluate the remaining PROs at present. HAGOS, HOS, IHOT-12 and IHOT-33 can be recommended for assessment of young-aged to middle-aged adults with pain related to the hip joint, undergoing non-surgical treatment or hip arthroscopy. At present, HAGOS is the only PRO also aimed for young-aged to middle-aged adults presenting with groin pain and is recommended for use in this population. CRD42014009995.
Publisher: BMJ
Date: 11-03-2016
Publisher: BMJ
Date: 12-2022
Publisher: Elsevier BV
Date: 04-2021
DOI: 10.1016/J.JOCA.2020.12.024
Abstract: To report outcomes across three countries for patients with symptomatic knee or hip OA attending the evidence-based education and exercise therapy program Good Life with osteoArthritis from Denmark (GLA:D®). GLA:D® is a structured treatment program including 2-3 patient education sessions and 12 supervised exercise sessions delivered over 8 weeks by certified health care practitioners. The program was introduced in Denmark in 2013, in Canada 2015 and in Australia 2016. Absolute mean change in pain intensity, number of chair stands in 30 s, 40 m walk test time and Knee injury and Osteoarthritis Outcome Score (KOOS)/Hip dysfunction and Osteoarthritis Outcome Score (HOOS) QOL subscale scores from baseline to immediately after treatment were reported as means and 95 % CIs and proportion of responders for each country. Patients from the three countries improved 26-33% in mean pain intensity, 8-12% in walking speed, 18-30% in chair stand ability and 12-26% in joint-related quality of life from baseline to immediately after treatment, with no clinically relevant differences between patients with hip and knee OA. These improvements correspond with moderate to large within-group effect sizes and 43-47 % of the patients experienced clinically relevant pain reductions. About half or more of patients across the three countries were categorized as responders for pain and objective function following the implementation of GLA:D®. These findings indicate positive patient outcomes associated with GLA:D® participation across varying health care systems from implementation of guideline-based patient education and exercise therapy for knee and hip OA.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2001
DOI: 10.1097/00042752-200104000-00007
Abstract: Physical interventions (nonpharmacological and nonsurgical) are the mainstay of treatment for patellofemoral pain syndrome (PFPS). Physiotherapy is the most common of all physical interventions and includes specific vastus medialis obliquus or general quadriceps strengthening and/or realignment procedures (tape, brace, stretching). These treatments appear to be based on sound theoretical rationale and have attained widespread acceptance, but evidence for the efficacy of these interventions is not well established. This review will present the available evidence for physical interventions for PFPS. Computerized bibliographic databases (MEDLINE, Current Contents, CINAHL) were searched, including the keywords "patellofemoral," "patella," and "anterior knee pain," combined with "treatment," "rehabilitation," and limited to clinical trials through October 2000. The critical eligibility criteria used for inclusion were that the study be a controlled trial, that outcome assessments were adequately described, and that the treatment was a nonpharmacological, nonsurgical physical intervention. Of the 89 potentially relevant titles, 16 studies were reviewed and none of these fulfilled all of the requirements for a randomized, controlled trial. Physiotherapy interventions were evaluated in eight trials, and the remaining eight trials examined different physical interventions. Significant reductions in PFPS symptoms were found with a corrective foot orthosis and a progressive resistance brace, but there is no evidence to support the use of patellofemoral orthoses, acupuncture, low-level laser, chiropractic patellar mobilization, or patellar taping. Overall the physiotherapy interventions had significant beneficial effects but these interventions were not compared with a placebo control. There is inconclusive evidence to support the superiority of one physiotherapy intervention compared with others. The evidence to support the use of physical interventions in the management of PFPS is limited. There appears to be a consistent improvement in short-term pain and function due to physiotherapy treatment, but comparison with a placebo group is required to determine efficacy, and further trials are warranted for the other interventions.
Publisher: Springer Science and Business Media LLC
Date: 14-12-2015
DOI: 10.1007/S00167-015-3908-X
Abstract: In iduals following anterior cruciate ligament reconstruction (ACLR) with concomitant meniscal pathology have a higher risk of developing knee osteoarthritis (OA) compared to those with isolated ACLR. Knee extensor weakness and altered dynamic knee joint biomechanics have been suggested to play a role in the development of knee OA following ACLR. This study investigated whether these factors differ in people following ACLR who have concomitant meniscal pathology compared to patients with isolated ACLR. Thirty-three patients with isolated ACLR and 34 patients with ACLR and meniscal pathology underwent strength and gait assessment 12-24 months post-operatively. Primary measures were peak isometric knee extensor torque and knee adduction moment (peak and impulse). Secondary measures included peak knee flexion moment and knee kinematics (sagittal and transverse). There were no between-group differences in knee extensor strength [mean difference (95 % CI) 0.09 (-0.23 to 0.42) Nm/kg, n.s.], peak knee adduction moment [-0.02 (-0.54 to 0.49) Nm/(BW × HT) %, n.s.] or knee adduction moment impulse [0.01 (-0.15 to 0.17) Nm/(BW × HT) %, p = n.s.]. No between-group differences were found for any secondary measures. No evidence was found to suggest that the higher prevalence of OA in patients with ACLR and meniscal pathology compared to patients with isolated ACLR is attributed to reduced knee muscle strength or altered knee joint biomechanics assessed 1-2 years post-surgery. Given that there is a higher incidence of knee OA in patients with concomitant meniscal pathology and ACLR, further investigation is needed so that population-specific rehabilitation protocols can be developed. III.
Publisher: SAGE Publications
Date: 03-06-2019
Abstract: Hip pain is associated with reduced muscle strength, range of movement (ROM), and function. Hip arthroscopy is undertaken to address coexistent intra-articular pathologies with the aim of reducing pain and improving function. To evaluate changes in strength and ROM in a cohort with chondrolabral pathology before surgery to 3 and 6 months after hip arthroscopy. Case series Level of evidence, 4. Sixty-seven in iduals with hip pain who were scheduled for hip arthroscopy were matched with 67 healthy controls. Hip strength and ROM were collected preoperatively and at 3 and 6 months postoperatively. Repeated measures analysis of variance evaluated whether strength and ROM differed between limbs and among time points. Bonferroni post hoc tests determined differences in hip strength and ROM among testing times and between the hip pain group and matched controls. Hip extension, internal rotation (IR), external rotation (ER), and adduction ( P .040) strength were greater at 3 months after surgery all directions, including flexion, abduction, and squeeze, were greater at 6 months ( P .015). Hip flexion ROM was greater at 3 months after surgery ( P = .013). Flexion, IR, and ER ROM was greater at 6 months ( P .041). At 6 months, IR ROM ( P = .003) and flexion, IR, and ER strength ( P .005) remained less than matched controls. With the exception of squeeze and flexion, all directions of hip strength and hip flexion ROM are significantly improved 3 months after arthroscopy to address chondrolabral pathology. By 6 months after arthroscopy, strength in all directions and flexion and rotation ROM are significantly improved in both limbs, but hip flexion, IR, and ER strength and IR ROM remain significantly less than that of healthy matched controls in both limbs.
Publisher: Wiley
Date: 14-09-2017
DOI: 10.1016/J.PMRJ.2017.09.005
Abstract: A timely return to competitive sport is a primary goal of anterior cruciate ligament reconstruction (ACLR). It is not known whether an accelerated return to sport increases the risk of early-onset knee osteoarthritis (KOA). To determine whether an accelerated return to sport post-ACLR (ie, <10 months) is associated with increased odds of early KOA features on magnetic resonance imaging (MRI) 1 year after surgery and to evaluate the relationship between an accelerated return to sport and early KOA features stratified by type of ACL injury (isolated or concurrent chondral/meniscal injury) and lower limb function (good or poor). Cross-sectional study. Private radiology clinic and university laboratory. A total of 111 participants (71 male mean age 30 ± 8 years) 1-year post-ACLR. Participants completed a self-report questionnaire regarding postoperative return-to-sport data (specific sport, postoperative month first returned), and isotropic 3-T MRI scans were obtained. Early KOA features (bone marrow, cartilage and meniscal lesions, and osteophytes) assessed with the MRI OA Knee Score. Logistic regression analyses evaluated the odds of early KOA features with an accelerated return to sport (<10 months post-ACLR versus ≥10 months or no return to sport) in the total cohort and stratified by type of ACL injury and lower limb function. Forty-six (41%) participants returned to competitive sport <10 months post-ACLR. An early return to sport was associated with significantly increased odds of bone marrow lesions (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.3-6.0) but not cartilage (OR 1.2, 95% CI 0.5-2.6) or meniscal lesions (OR 0.8, 95% CI 0.4-1.8) or osteophytes (OR 0.6, 95% CI 0.3-1.4). In those with poor lower limb function, early return to sport exacerbated the odds of bone marrow lesions (OR 4.6, 95% CI 1.6-13.5), whereas stratified analyses for type of ACL injury did not reach statistical significance. An accelerated return to sport, particularly in the presence of poor lower limb function, may be implicated in posttraumatic KOA development. IV.
Publisher: Elsevier BV
Date: 09-2013
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.JPHYS.2016.02.011
Abstract: How do people with knee symptoms describe their quality of life and experiences 5 to 20 years after anterior cruciate ligament reconstruction (ACLR)? What factors impact upon the quality of life of these people? Qualitative study. Seventeen people with knee symptoms 5 to 20 years after ACLR and high (n=8) or low (n=9) quality of life scores were recruited from a cross-sectional study. Semi-structured telephone interviews were conducted and transcribed. The data obtained from the interventions underwent inductive coding and thematic analysis. Four consistent themes emerged from the interviews as common determinants of quality of life following ACLR: physical activity preferences lifestyle modifications adaptation and acceptance and fear of re-injury. All participants described the importance of maintaining a physically active lifestyle and the relationship between physical activity and quality of life. Participants who avoided sport or activity reported experiencing reduced quality of life. Participants who suppressed or overcame re-injury fears to continue sport participation described experiencing a satisfactory quality of life while taking part in sport despite knee symptoms. For some participants, resuming competitive sport resulted in subsequent knee trauma, anterior cruciate ligament re-rupture or progressive deterioration of knee function, with negative impacts on quality of life following sport cessation. Participants who enjoyed recreational exercise often adapted their lifestyle early after ACLR, while others described adapting their lifestyle at a later stage to accommodate knee impairments this was associated with feelings of acceptance and satisfaction, irrespective of knee symptoms. Activity preferences, lifestyle modifications and fear of re-injury influenced quality of life in people with knee symptoms up to 20 years following ACLR. People with a preference for competitive sport who do not enjoy recreational exercise might be at heightened risk of poor quality of life outcomes and could benefit from support to facilitate a transition to a physically active, satisfying lifestyle.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 03-2021
Publisher: BMJ
Date: 13-12-2016
DOI: 10.1136/BJSPORTS-2016-096545
Abstract: Patellofemoral pain (PFP) is a multifactorial and often persistent knee condition. One strategy to enhance patient outcomes is using clinically assessable patient characteristics to predict the outcome and match a specific treatment to an in idual. A systematic review was conducted to determine which baseline patient characteristics were (1) associated with patient outcome (prognosis) or (2) modified patient outcome from a specific treatment (treatment effect modifiers). 6 electronic databases were searched (July 2016) for studies evaluating the association between those with PFP, their characteristics and outcome. All studies were appraised using the Epidemiological Appraisal Instrument. Studies that aimed to identify treatment effect modifiers underwent a checklist for methodological quality. The 24 included studies evaluated 180 participant characteristics. 12 studies investigated prognosis, and 12 studies investigated potential treatment effect modifiers. Important methodological limitations were identified. Some prognostic studies used a retrospective design. Studies aiming to identify treatment effect modifiers often analysed too many variables for the limiting s le size and typically failed to use a control or comparator treatment group. 16 factors were reported to be associated with a poor outcome, with longer duration of symptoms the most reported (>4 months). Preliminary evidence suggests increased midfoot mobility may predict those who have a successful outcome to foot orthoses. Current evidence can identify those with increased risk of a poor outcome, but methodological limitations make it difficult to predict the outcome after one specific treatment compared with another. Adequately designed randomised trials are needed to identify treatment effect modifiers.
Publisher: Elsevier BV
Date: 07-2019
Publisher: BMJ
Date: 02-2023
DOI: 10.1136/BMJOPEN-2022-068040
Abstract: Running is one of the most popular recreational activities worldwide, due to its low cost and accessibility. However, little is known about the impact of running on knee joint health in runners with and without a history of knee surgery. The primary aim of this longitudinal cohort study is to compare knee joint structural features on MRI and knee symptoms at baseline and 4-year follow-up in runners with and without a history of knee surgery. Secondary aims are to explore the relationships between training load exposures (volume and/or intensity) and changes in knee joint structure and symptoms over 4 years explore the relationship between baseline running biomechanics, and changes in knee joint structure and symptoms over 4 years. In addition, we will explore whether additional variables confound, modify or mediate these associations, including sex, baseline lower-limb functional performance, knee muscle strength, psychological and sociodemographic factors. A convenience s le of at least 200 runners (sex/gender balanced) with (n=100) and without (n=100) a history of knee surgery will be recruited. Primary outcomes will be knee joint health (MRI) and knee symptoms (baseline 4 years). Exposure variables for secondary outcomes include training load exposure, obtained daily throughout the study from wearable devices and three-dimensional running biomechanics (baseline). Additional variables include lower limb functional performance, knee extensor and flexor muscle strength, biomarkers, psychological and sociodemographic factors (baseline). Knowledge and beliefs about osteoarthritis will be obtained through predefined questions and semi-structured interviews with a subset of participants. Multivariable logistic and linear regression models, adjusting for potential confounding factors, will explore changes in knee joint structural features and symptoms, and the influence of potential modifiers and mediators. Approved by the La Trobe University Ethics Committee (HEC-19524). Findings will be disseminated to stakeholders, peer-review journals and conferences.
Publisher: BMJ
Date: 07-03-2018
Publisher: BMJ
Date: 29-07-2015
DOI: 10.1136/BJSPORTS-2015-094864
Abstract: Physical and psychological impairments impacting quality of life (QOL) are common following ACL reconstruction. Rehabilitation alone is an effective alternative to reconstruction for some patients, warranting the investigation of QOL in ACL-deficient in iduals. To report and compare QOL in ACL-deficient in iduals with population norms and ACL-reconstructed groups, and investigate relationships between participant characteristics and QOL. Systematic review and meta-analysis. We systematically identified and methodologically appraised all studies reporting QOL in ACL-deficient in iduals ≥5 years following ACL rupture. Knee-related and health-related QOL scores in ACL-deficient cohorts were compared to ACL-reconstructed groups using a random-effects meta-analysis. Descriptive comparisons were made with population norms. Eleven studies reported QOL in 473 ACL-deficient in iduals, a mean of 10 (range 5-23) years following ACL rupture. Eight studies reported knee-related QOL using the Knee injury and Osteoarthritis Outcome Score QOL subscale (KOOS-QOL) scores (mean±SD) ranging from 54±17 to 77±22 were impaired compared to population norms. Health-related QOL, measured with the SF-36 domain scores in five studies, was similar to population norms, but impaired compared to physically active populations. Meta-analysis revealed no significant differences in KOOS-QOL (mean difference (95% CI) 2.9 (-3.3 to 9.1)) and SF-36 scores (for all SF-36 domains except Vitality) between ACL-deficient and ACL-reconstructed groups. This systematic review found impaired knee-related QOL in ACL-deficient in iduals ≥5 years after ACL rupture, compared to population norms. Meta-analysis revealed similar knee-related QOL in ACL-deficient and ACL-reconstructed groups, and no difference in health-related QOL scores for seven of the eight SF-36 domains.
Publisher: Wiley
Date: 30-12-2009
DOI: 10.1002/ART.24089
Abstract: Musculoskeletal conditions of the knee involve changes in sensorimotor function, but it is unclear whether these changes are a cause or result of pain. Induction of experimental pain may help solve this issue. Although this is commonly achieved by injection of hypertonic saline into muscle, muscle is commonly not the source of pain. This study investigated whether pain induced by injection of saline into the infrapatellar fat pad changes motor control of the quadriceps muscles of the knee. Ten participants performed a standardized task involving ascending and descending a series of steps. Electromyographic activity (EMG) of vastus medialis obliquus (VMO) and vastus lateralis (VL) was recorded with surface electrodes. Trials were conducted without pain, with anterior knee pain induced by injection (0.25 ml) of hypertonic saline (5%) into the infrapatellar fat pad, with anticipation of pain associated with unpredictable electrical shocks to the knee, and 20 minutes after pain cessation. EMG onset and litude were analyzed. When participants ascended the steps with pain, the onset of VMO EMG was delayed relative to that of VL, in contrast to simultaneous or earlier activation of VMO EMG in the pre- and postpain trials. VL EMG litude was decreased significantly from the control condition. These data show that alterations in coordination of knee muscle activity can be caused by pain, even when it is of nonmuscle origin. Treatment of pain is therefore important to facilitate performance of the quadriceps muscles, which are essential for locomotor and functional tasks as well as for knee stability.
Publisher: Wiley
Date: 25-09-2014
DOI: 10.1002/ACR.22313
Abstract: Patellofemoral (PF) osteoarthritis (OA) is prevalent following anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate differences in transverse plane rotation between knees with varus and valgus alignment during gait in people with and without PFOA after ACLR. Thirty-six in iduals who were mean ± SD 9 ± 2 years post-ACLR (18 radiographic PFOA and 18 no knee OA) participated in this cross-sectional study. Knee internal-external rotation angles were measured using a 3-dimensional motion analysis system during walking and running. Weight-bearing frontal plane knee alignment, measured with an inclinometer, was used to classify participants as having varus or valgus alignment. Two-way analysis of covariance was used to assess the effect of both PFOA and frontal plane knee alignment on dynamic knee internal-external rotation. Significant interactions were found between PFOA status and frontal plane alignment on knee internal-external rotation angles during walking (P = 0.019) and running (P = 0.002). Tests of simple effects revealed that during walking, in iduals with valgus alignment and PFOA demonstrated a mean 3.9° (95% confidence interval [95% CI] 0.7, 7.1) less knee internal rotation than those with valgus alignment and no OA. During running this difference increased to 6.1° (95% CI 1.8, 10.4). For in iduals with varus alignment, no significant effects were observed. Less knee internal rotation during gait was found in in iduals with PFOA and valgus alignment. A rotational shift of this magnitude may be sufficient to initiate or accelerate patellofemoral cartilage degeneration. Prospective studies are required to determine if these altered kinematic patterns result from, or contribute to, PFOA development after reconstruction.
Publisher: Elsevier BV
Date: 05-2000
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 11-2015
Abstract: Synopsis Achilles tendinopathy is a common overuse injury in athletes involved in running and jumping activities and sports. The intervention with the highest level of evidence is exercise therapy, and it is recommended that all patients initially be treated with exercise for at least 3 months prior to considering other treatment options. Recovery from Achilles tendinopathy can take up to a year, and there is a high propensity for recurrence, especially during the return-to-sport phase. The extent of the tendon injury, the age and sex of the athlete, the magnitude of pain/symptoms, the extent of impairments, and the demands of the sport all need to be considered when planning for return to sport. This clinical commentary describes an approach to return to sport for patients with midportion Achilles tendinopathy. The aim of the return-to-sport program is to facilitate the decision-making process in returning an athlete with midportion Achilles tendinopathy back to full sport participation and to minimize the chances for recurrence of the injury. J Orthop Sports Phys Ther 2015 (11):876-886. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5885.
Publisher: BMJ
Date: 27-10-2016
Publisher: BMJ
Date: 22-06-2023
DOI: 10.1136/BJSPORTS-2022-106620
Abstract: The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) to female athlete health data. In May 2021, five researchers and clinicians with expertise in sports medicine, epidemiology and female athlete health convened to form a consensus working group, which identified key themes. Twenty additional experts were invited and an iterative process involving all authors was then used to extend the IOC consensus statement, to include issues which affect female athletes. Ten domains of female health for categorising health problems according to biological, life stage or environmental factors that affect females in sport were identified: menstrual and gynaecological health preconception and assisted reproduction pregnancy postpartum menopause breast health pelvic floor health breast feeding, parenting and caregiving mental health and sport environments. This paper extends the IOC consensus statement to include 10 domains of female health, which may affect female athletes across the lifespan, from adolescence through young adulthood, to mid-age and older age. Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies.
Publisher: BMJ
Date: 31-01-2016
DOI: 10.1136/BJSPORTS-2015-H3939REP
Abstract: Patellofemoral pain refers to pain behind or around the patella (also known as patellofemoral pain syndrome, anterior knee pain, runner's knee, and, formerly, chondromalacia patellae). Patellofemoral pain is common, accounting for 11-17% of all knee pain presentations to general practice.(1 2) While it typically occurs in physically active people aged <40 years, it also affects people of all activity levels and ages.(1 2) Patellofemoral pain can be diagnosed in the clinic, and evidence based treatments can reduce pain and improve function, allowing patients to maintain a physically active lifestyle.
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.KNEE.2016.09.016
Abstract: The purpose of the study was to determine whether prefabricated foot orthoses immediately reduce pain during functional tasks in people with patellofemoral osteoarthritis, compared to flat insoles and shoes alone. Eighteen people with predominant lateral patellofemoral osteoarthritis (nine women mean [SD] age 59 [10]years body mass index 27.9 [3.2]kg/m Compared to shoes alone, foot orthoses (p=0.002 median difference 1.5 [IQR 3]) and flat insoles (p<0.001 2 [3]) significantly reduced pain during step-downs foot orthoses reduced pain during walking (p=0.008 1 [1.25]) and flat insoles reduced pain during stair ambulation (p=0.001 1 [1.75]). No significant differences between foot orthoses and flat insoles were observed for pain severity, ease of performance or knee stability. Foot orthoses were less comfortable than flat insoles and shoes alone (p<0.05). In people with patellofemoral osteoarthritis, immediate pain-relieving effects of prefabricated, contoured foot orthoses are equivalent to flat insoles. Further studies should investigate whether similar outcomes occur with longer-term wear or different orthosis designs.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2016
Abstract: Anterior cruciate ligament (ACL) rupture is a well-established risk factor for knee osteoarthritis (OA). Fifty to ninety percent of in iduals will develop radiographic tibiofemoral OA within a decade after ACL injury and anterior cruciate ligament reconstruction (ACLR). Although less well recognized, radiographic patellofemoral OA is present in approximately 50% of in iduals at more than 10 years after ACLR. This early-onset OA and its associated pain and functional limitations pose a particular challenge to younger adults with OA compared to an older OA population. Targeted interventions need to be developed to reduce the burden of early-onset OA following ACLR. Emerging evidence suggests that such interventions should target both the patellofemoral and tibiofemoral joints.
Publisher: Journal of Rehabilitation Research & Development
Date: 2004
DOI: 10.1682/JRRD.2003.07.0103
Abstract: This study evaluated the usefulness of the Human Activity Profile (HAP) in people with knee osteoarthritis (OA). People with OA (N = 226) completed the HAP and a battery of pain and physical function measures. Healthy elderly controls (N = 33) also completed the HAP, and 20 OA participants underwent repeat testing 2 to 7 days later. Test-retest reliability was excellent (intraclass correlation coefficients 0.96 and 0.95). The HAP was sensitive enough to detect differences in physical activity between people with (N = 33) and without OA (N = 33) (p < 0.01). When OA in iduals were classified as impaired, moderately active, or active based on HAP score, differences in pain and physical function were detected (p < 0.05). Correlations between HAP and commonly used pain and physical function measures were weak to moderate (r = 0.18-0.63, all p < 0.01), indicating that the HAP measures additional information not gained by other assessment tools. The HAP is a reliable measure, and it is sensitive enough to discriminate between people with and without knee OA, and within an OA cohort. The HAP appears to have greater applicability in osteoarthritic women than men.
Publisher: Elsevier BV
Date: 2021
Publisher: SAGE Publications
Date: 27-03-2018
Abstract: Musculoskeletal hip/groin screening tests are commonly performed to detect at-risk in iduals. Bony hip morphology is considered a potential intrinsic risk factor but has not been examined prospectively. To evaluate the association between intrinsic risk factors identified from musculoskeletal and radiographic screening tests and hip/groin injuries leading to time loss from training and/or match play in professional male soccer players. Prospective cohort study Level of evidence, 2. Male professional soccer players, aged ≥18 years, underwent screening specific for hip/groin pain during 2 consecutive seasons of the Qatar Stars League. The screening battery included pain provocation, range of motion, and strength tests as well as a hip radiographic examination. The radiographic examination included an anteroposterior pelvic view and 45° Dunn view, with bony hip morphology determined using quantitative methods. Time-loss (≥1 day) hip/groin injuries and in idual player exposure (training and match play) were recorded prospectively, and injuries were categorized as adductor-related, inguinal-related, iliopsoas-related, pubic-related, or hip-related groin pain, or “other,” as recommended in the Doha agreement. We calculated hazard ratios (HRs) from univariate and multivariate Cox regression models to assess the relationship between potential risk factors and hip/groin injuries. There were 438 players, completing 609 player seasons, and 113 hip/groin injuries that met the criteria for inclusion, with 85 injuries categorized as adductor-related. The proportion of players with bony morphological variants was the following: cam, 71% pincer, 5% and acetabular dysplasia, 13%. Previous hip/groin injuries (HR, 1.8 95% CI, 1.2-2.7) and eccentric adduction strength were associated with the risk of hip/groin injuries. Higher ( SD above the mean) than normal eccentric adduction strength was associated with an increased risk for all hip/groin injuries (HR, 1.6 95% CI, 1.0-2.5). Lower ( SD below the mean) than normal eccentric adduction strength was associated with an increased risk for adductor-related injuries (HR, 1.7 95% CI, 1.0-3.0). No other musculoskeletal screening test or bony hip morphology variables were associated with the injury risk. Previous groin injuries and eccentric adduction strength were associated with the risk of groin injuries. However, these associations were not strong enough to identify an “at-risk” in idual, and therefore, musculoskeletal screening tests were not useful to dictate in idualized prevention strategies. Bony hip morphology was not associated with the risk of groin injuries.
Publisher: Wiley
Date: 28-12-2009
DOI: 10.1002/ACR.20012
Abstract: To investigate the construct validity of walking knee stiffness as a measure to differentiate between in iduals with and without knee osteoarthritis (OA) and the construct validity of walking knee stiffness as related to self-reported knee stiffness. The contributors to walking stiffness and its relationship with loading rate and adduction moment are also investigated. Thirty-seven in iduals with knee OA and 11 asymptomatic controls participated. Knee stiffness was calculated during walking as the change in knee flexion-extension moment ided by the change in knee flexion angle. Forward-stepwise regression models and Pearson's correlation coefficients were used to evaluate the relationships between variables. Knee stiffness in walking was significantly greater in the OA group (mean +/- SD 10.1 +/- 4.4 Nm/ degrees /kg x 100) compared with the controls (mean +/- SD 5.6 +/- 1.5 Nm/degrees/kg x 100) (P < 0.001). Knee excursion range explained 39% of the variance in walking knee stiffness (B = -0.736, P < 0.001) and knee extensor moment a further 7% (B = 6.974, P = 0.045). In the OA group, walking knee stiffness was not associated with self-reported stiffness (r = 0.029 P = 0.863). For the OA group, greater self-reported stiffness was associated with lower peak knee adduction moment (B = -0.354, P < 0.001). The construct validity of walking knee stiffness is supported. The poor correlation between walking stiffness and self-reported stiffness suggests the 2 measures evaluate different aspects of knee stiffness. Since a measure of walking stiffness is likely to provide valuable information, future research evaluating its clinical significance is merited.
Publisher: Springer Science and Business Media LLC
Date: 06-10-2018
DOI: 10.1007/S00167-018-5197-7
Abstract: In iduals with impaired knee function after anterior cruciate ligament reconstruction (ACLR) may be at greater risk of developing knee osteoarthritis related to abnormal knee joint movement and loading. The aim of this study was to assess the association between knee biomechanics and knee laxity during hopping and clinically assessed knee function (i.e., patient-reported knee function and hop tests) following ACLR. Sixty-six participants (23 women, mean age 28 ± 6 years, mean 18 ± 3 months following ACLR) completed a standardized single-leg hopping task. Three-dimensional movement analysis was used to assess knee flexion excursion and body weight/height normalized knee flexion moments during landing for the involved limb. Anterior-posterior knee laxity was assessed with a KT-1000 knee arthrometer. Participants then completed a patient-reported knee function questionnaire and three separate hop tests (% of uninvolved limb) and were ided into poor and satisfactory knee function groups (satisfactory: ≥85% patient-reported knee function and ≥ 85% hop test symmetry). Associations between knee function and hop biomechanics/knee laxity were assessed using logistic regression and interquartile range scaled odds ratios (OR Greater knee flexion excursion (OR Greater knee flexion excursion/moment during hop-landing and lesser knee laxity is associated with better patient-reported knee function and single-leg hop test performance following ACLR. Patients with lower levels of knee function following ACLR demonstrated hop-landing biomechanics previously associated with early patellofemoral osteoarthritis. Therefore, interventions aimed at improving hop landing biomechanics in people with poor knee function are likely required. III, Cross-sectional study.
Publisher: Wiley
Date: 21-08-2017
DOI: 10.1002/JMRI.25823
Abstract: To develop methods for evaluating 3D patellofemoral and tibiofemoral alignment in vertical open-bore magnetic resonance (MR) scanners, with participants upright and fully weight-bearing and to evaluate the repeatability of these methods in in iduals with patellofemoral osteoarthritis (OA) and in asymptomatic knees. Our methods extend previously validated, reliable methods for evaluating alignment into an upright MR environment. In 10 participants with early patellofemoral OA and 10 with asymptomatic knees, we acquired sagittal T Intraclass correlation coefficients (ICCs) were ≥0.94, with the exception of patellar spin (0.79). Standard errors of measure (SEM) were <2° rotation and <0.9 mm translation. Repeatability remained adequate when stratified by group, with the exception of patellar spin (ICC 0.57 for asymptomatic knees vs. 0.91 for OA knees). We demonstrate methods for evaluating 3D alignment in upright fully weight-bearing participant positions in a vertical open-bore MR scanner. With the exception of patellar spin, repeatability was good to excellent. 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018 :841-847.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.PTSP.2019.04.010
Abstract: To evaluate the feasibility of a 12-week progressive resistance training program for people with patellofemoral pain (PFP) targeting proximal muscle strength and power and resulting clinical and muscle capacity outcomes. Feasibility study. Clinical environment. Mixed-sex s le of people with PFP. Feasibility outcomes included eligibility, recruitment rate, intervention adherence, and drop-outs. Secondary outcomes included perceived recovery, physical function (AKPS and KOOS-PF), worst pain (VAS-cm), kinesiophobia (T a), physical activity (IPAQ), and hip strength (isometric and 10 repetition maximum) and power. Eleven people, from 36 who responded to advertisements, commenced the program. One participant withdrew. Ten participants who completed the program reported improvement (3 completely recovered 6 marked and 1 moderate). Higher AKPS (effect size [ES] = 1.81), improved KOOS-PF (ES = 1.37), and reduced pain (ES = 3.36) occurred alongside increased hip abduction and extension dynamic strength (ES = 2.22 and 1.92, respectively) and power (ES = 0.78 and 0.77, respectively). Isometric strength improved for hip abduction (ES = 0.99), but not hip extension. A 12-week progressive resistance training program targeting proximal muscle strength and power is feasible and associated with moderate-large improvements in pain, function, and hip muscle capacity in people with PFP. Further research evaluating the efficacy of progressive resistance training is warranted.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2018
Abstract: Study Design Study protocol for a randomized controlled trial and a prospective cohort. Background The number of arthroscopic surgical procedures for patients with femoroacetabular impingement syndrome (FAIS) has significantly increased worldwide, but high-quality evidence of the effect of such interventions is lacking. Objectives The primary objective will be to determine the efficacy of hip arthroscopic procedures compared to sham surgery on patient-reported outcomes for patients with FAIS (HIP ARThroscopy International [HIPARTI] Study). The secondary objective will be to evaluate prognostic factors for long-term outcome after arthroscopic surgical interventions in patients with FAIS (Hip ARthroscopy Prospective [HARP] Study). Methods The HIPARTI Study will include 140 patients and the HARP Study will include 100 patients. The international Hip Outcome Tool-33 will be the primary outcome measure at 1 year. Secondary outcome measures will be the Hip disability and Osteoarthritis Outcome Score, Arthritis Self-Efficacy Scale, fear of movement (T a Scale of Kinesiophobia), Patient-Specific Functional Scale, global rating of change score, and expectations. Other outcomes will include active hip range of motion, hip muscle strength tests, functional performance tests, as well as radiological assessments using radiographs and magnetic resonance imaging. Conclusion To determine the true effect of surgery, beyond that of placebo, double-blinded placebo-controlled trials including sham surgery are needed. The HIPARTI Study will direct future evidence-based treatment of FAIS. Predictors for long-term development and progression of degenerative changes in the hip are also needed for this young patient group with FAIS hence, responders and nonresponders to treatment could be determined. J Orthop Sports Phys Ther 2018 (4):325-335. doi:10.2519/jospt.2018.7931.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.GAITPOST.2017.03.027
Abstract: The iliocapsularis muscle of the anterior hip may play an important role in hip function, but no electromyographic (EMG) recordings have been made. This muscle provides the most substantial muscular attachment to the anterior hip capsule and is hypothesised to have a dynamic role to limit capsular impingement and to augment joint stability. Current understanding of the function of iliocapsularis is based on limited cadaveric and radiographic studies. Located deep over the hip joint it would require intramuscular fine-wire EMG to evaluate its activity directly with limited cross-talk from overlying muscles. The primary aim of this study was to describe a new technique for insertion of intramuscular EMG electrodes into iliocapsularis and to report its activation during different directions of hip maximum voluntary isometric contraction (MVIC). Fifteen healthy volunteers (10M, mean age (SD) 22 (2) years) who were free from hip pain were recruited for electrode insertion and to perform MVIC's in six directions at 0° and three directions at 90° of hip flexion. Intramuscular electrodes were successfully inserted into the iliocapsularis muscle with guidance from real-time ultrasound imaging. The greatest muscle activity occurred during resisted hip flexion at 90° (Median (IQR) 100.0 (1.2) % MVIC) and lowest activity during hip extension, 0° (0.5 (0.3) % MVIC). These findings have implications for our understanding of iliocapsularis' functional role. This paper provides the first report of intramuscular electrode insertion into iliocapsularis with guided technical instructions for future EMG investigations in other populations and tasks.
Publisher: BMJ
Date: 14-07-2015
DOI: 10.1136/BJSPORTS-2015-094723
Abstract: Proximal muscle rehabilitation is commonly prescribed to address muscle strength and function deficits in in iduals with patellofemoral pain (PFP). This review (1) evaluates the efficacy of proximal musculature rehabilitation for patients with PFP (2) compares the efficacy of various rehabilitation protocols and (3) identifies potential biomechanical mechanisms of effect in order to optimise outcomes from proximal rehabilitation in this problematic patient group. Web of Knowledge, CINAHL, EMBASE and Medline databases were searched in December 2014 for randomised clinical trials and cohort studies evaluating proximal rehabilitation for PFP. Quality assessment was performed by two independent reviewers. Effect size calculations using standard mean differences and 95% CIs were calculated for each comparison. 14 studies were identified, seven of high quality. Strong evidence indicated proximal combined with quadriceps rehabilitation decreased pain and improved function in the short term, with moderate evidence for medium-term outcomes. Moderate evidence indicated that proximal when compared with quadriceps rehabilitation decreased pain in the short-term and medium-term, and improved function in the medium term. Limited evidence indicated proximal combined with quadriceps rehabilitation decreased pain more than quadriceps rehabilitation in the long term. Very limited short-term mechanistic evidence indicated proximal rehabilitation compared with no intervention decreased pain, improved function, increased isometric hip strength and decreased knee valgum variability while running. A robust body of work shows proximal rehabilitation for PFP should be included in conservative management. Importantly, greater pain reduction and improved function at 1 year highlight the long-term value of proximal combined with quadriceps rehabilitation for PFP.
Publisher: BMJ
Date: 26-03-2020
DOI: 10.1136/BJSPORTS-2019-100935
Abstract: To test (i) if greater foot pronation (measured as midfoot width mobility) is associated with better outcomes with foot orthoses treatment, compared with hip exercises and (ii) if hip exercises are superior to foot orthoses, irrespective of midfoot width mobility. A two-arm parallel, randomised superiority clinical trial was conducted in Australia and Denmark. Participants (18–40 years) were included who reported an insidious onset of knee pain (≥6 weeks duration) ≥3/10 numerical pain rating, that was aggravated by activities (eg, stairs, squatting, running). Participants were stratified by midfoot width mobility ( high ≥11 mm change in midfoot width) and site, randomised to foot orthoses or hip exercises and blinded to objectives and stratification. Success was defined a priori as much better or better on a patient-perceived 7-point scale at 12 weeks. Of 218 stratified and randomised participants, 192 completed 12-week follow-up. This study found no difference in success rates between foot orthoses versus hip exercises in those with high (6/21 vs 9/20 29% vs 45%, respectively) or low (42/79 vs 37/72 53% vs 51%) midfoot width mobility. There was no association between midfoot width mobility and treatment outcome (Interaction effect p=0.19). This study found no difference in success rate between foot orthoses versus hip exercises (48/100 vs 46/92 48% vs 50%). Midfoot width mobility should not be used to help clinicians decide which patient with patellofemoral pain might benefit most from foot orthoses. Clinicians and patients may consider either foot orthoses or hip exercises in managing patellofemoral pain. ACTRN12614000260628.
Publisher: Springer Science and Business Media LLC
Date: 14-03-2011
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.GAITPOST.2019.03.029
Abstract: Patellofemoral OA is characterized by PF pain during activities that load a flexed knee. Stair stepping ability is frequently impaired, yet little is known of the muscular recruitment strategies utilized during this task. Altered recruitment strategies may provide targets for clinical interventions. We aimed to determine if people with PFOA ascend and descend stairs with different muscular recruitment strategies compared to similar aged healthy in iduals. Twenty-two people with PFOA and 20 controls were recruited. Electromyographic recordings from gluteus maximus and medius, medial and lateral hamstrings, vastus medialis and lateralis, medial and lateral gastrocnemius and soleus were acquired during stair ascent and descent. Force plate data was acquired to determine timing of foot placements and characterize dynamic stability. Seventeen people with PFOA (59 ± 10 years, 73 ± 13 kg, 167 ± 9 cm) and 15 controls (57 ± 10 years, 73 ± 16 kg, 171 ± 11 cm) had complete data. People with PFOA demonstrated: longer vastii activation duration during descent (lateralis: p = 0.01 medialis: p = 0.02) earlier onset of vastus lateralis for ascent (p < 0.01) and descent (p = 0.04) earlier onset of soleus in descent (p = 0.04) and shorter duration of GMax during ascent (p = 0.05). Peak Fz timing (time between the start of the anticipatory postural adjustment and the end of the stepping task) was ∼70ms later during stair descent in PFOA compared to controls (p = 0.01). People with PFOA utilize muscular activation strategies consistent with minimizing knee pain during stair ambulation. Clinical interventions aimed at gluteal and quadriceps activation may be warranted in PFOA.
Publisher: Springer Science and Business Media LLC
Date: 09-05-2017
DOI: 10.1007/S00167-017-4571-1
Abstract: Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10-15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR. Participants (aged 18-50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated. Of 111 participants [age 30 ± 8.5 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes. Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to in iduals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention. IV.
Publisher: BMJ
Date: 06-04-2020
DOI: 10.1136/BJSPORTS-2019-101587
Abstract: To evaluate the effects of injury prevention programmes on injury incidence in any women’s football code explore relationships between training components and injury risk and report injury incidence for women’s football. Systematic review and meta-analysis. Nine databases searched in August 2019. Randomised controlled trials evaluating any injury prevention programme (eg, exercise, education, braces) were included. Study inclusion criteria were: ≥20 female football players in each study arm (any age, football code or participation level) and injury incidence reporting. Twelve studies, all in soccer, met inclusion criteria, with nine involving adolescent teams (aged years). All studies (except one) had a high risk of bias. Eleven studies examined exercise-based programmes, with most (9/11) including multiple (≥2) training components (eg, strength, plyometric, balance exercises). Multicomponent exercise programmes reduced overall (any reported) injuries (incidence rate ratio (IRR) 0.73, 95% CI 0.59 to 0.91) and ACL injuries (IRR 0.55, 95% CI 0.32 to 0.92). For exercise-based strategies (single-component and multicomponent), hamstring injuries were also reduced (IRR 0.40, 95% CI 0.17 to 0.95). While exercise-based strategies resulted in less knee, ankle and hip/groin injuries, and the use of multiple training components was associated with greater reductions in overall and knee injuries, further studies would be required to increase the precision of these results. The incidence of overall injuries in women’s football was 3.4 per 1000 exposure hours with ankle injuries most common. In women’s football, there is low-level evidence that multicomponent, exercise-based programmes reduce overall and ACL injuries by 27% and 45%, respectively. CRD42018093527.
Publisher: BMJ
Date: 31-08-2020
Publisher: Wiley
Date: 27-03-2015
DOI: 10.1002/ART.39005
Abstract: To determine the prevalence and factors associated with knee osteoarthritis (OA) defined by magnetic resonance imaging (MRI) and specific OA features on MRI 1 year after anterior cruciate ligament reconstruction (ACLR). Isotropic 3.0T MRI scans were obtained for 111 participants (71 men mean ± SD age 30 ± 8 years) 1 year after ACLR as well as for 20 age-, sex-, and activity level-matched uninjured controls. The MRI OA Knee Score was used to score specific OA features. MRI-defined tibiofemoral and patellofemoral OA was evaluated based on published criteria. Logistic regression identified factors associated with MRI-defined OA and specific OA features after ACLR. Following ACLR, medial and lateral tibiofemoral OA on MRI was observed in 7 participants (6%) and 12 participants (11%), respectively, while 19 participants (17%) had patellofemoral OA on MRI. The femoral trochlea was the region most affected by bone marrow lesions (19% of participants), cartilage lesions (31% of participants), and osteophytes (37% of participants). Meniscectomy at the time of ACLR (odds ratio 6.8 [95% confidence interval 2.0-23.3]) and body mass index (BMI) >25 kg/m(2) (odds ratio 3.0 [95% confidence interval 1.3-6.9]) predicted MRI-defined tibiofemoral OA and osteophytes, respectively. Men had higher odds of patellofemoral osteophytes (odds ratio 6.3 [95% confidence interval 2.4-16.2]). No uninjured controls had tibiofemoral or patellofemoral OA on MRI, and specific OA features were uncommon. OA 1 year following ACLR was more common than previously recognized, while being absent in uninjured control knees. The patellofemoral compartment seems to be at particular risk for early OA after ACLR, especially in men. The association with meniscectomy and BMI demonstrates the construct validity of MRI criteria.
Publisher: Human Kinetics
Date: 09-2020
Abstract: Context : Hip pain is associated with reduced hip muscle strength, range of movement (ROM), and decreased postural stability. Single-leg squat is a reliable and valid method to measure dynamic balance. Objective : To evaluate the influence of physical characteristics and use of a decline board on squat performance in a hip pain population. Design : Cross-sectional study setting. Clinical Patients : In total, 33 in iduals scheduled for arthroscopic hip surgery were matched with 33 healthy controls. Interventions : Hip and ankle ROM, hip strength, and trunk endurance were assessed, along with knee and trunk kinematics during squat on flat and 25° decline surfaces. Main Outcome Measures : Between-group and surface differences in alignment, between-group strength and ROM, and associations between alignment and physical characteristics were assessed and determined using mixed model analysis of variance and Pearson R . Results : The hip pain group had significantly less strength and ROM for all directions except abduction strength and ankle dorsiflexion ( P .02). No differences existed between the 2 groups for trunk ( P .70) or knee displacement ( P .46) during squat on either surface. When the 2 groups were combined (n = 66), decline squat significantly reduced knee medial displacement in both limbs by approximately 1 cm ( P .01). Decline squat reduced trunk lateral movement on 1 side only ( P = .03). Reduced knee displacement during decline squat showed fair association with less hip-extension strength ( r = −.29), hip-flexion strength ( r = −.25), and less dorsiflexion ( r = −.24). Strength and range were not associated with trunk displacement. Conclusions : Decline squat reduced medial knee and lateral trunk displacement regardless of hip pain. Reductions may be greater in those with lesser hip muscle strength and dorsiflexion. Use of a decline board during squat for improving knee and trunk alignment should be considered as a goal of exercise intervention.
Publisher: SAGE Publications
Date: 17-09-2019
Abstract: Physical rehabilitation for total hip replacement patients following hospital discharge is beneficial however, accessing rehabilitation is often challenging. Telerehabilitation helps negate access issues and is efficacious in total knee and hip replacement patients. This study aims to compare the cost-effectiveness of a telerehabilitation programme delivered remotely into patients’ homes versus traditional care for total hip replacement patients following hospital discharge. A cost-effectiveness (cost-utility) analysis was conducted from the perspective of a health service alongside a two-arm randomised controlled trial comparing telerehabilitation ( n=35) with in-person care ( n=35) following hospital discharge after total hip replacement. The primary analysis used an Incremental Cost-Effectiveness Ratio to compare the cost per Quality Adjusted Life Year (QALY) accrued in the telerehabilitation group versus in-person control using costs and effects data from the randomised trial. A secondary analysis was conducted whereby the time accrued by patients attending rehabilitation sessions (including travel time) was considered the “cost” (i.e. a time burden), rather than cost from the health service perspective. Estimated mean differences in healthcare costs and QALYs gained were detected but were not significant. The estimated mean (95%CI) difference in cost of telerehabilitation versus in-person was –$28.90 (–$96.37 to $40.45), favouring the telerehabilitation group. The estimated mean (95%CI) difference in QALYs gained from telerehabilitation versus in-person was –0.0025 (–0.0227 to 0.0217). The estimated mean (95%CI) difference in time burden favoured less time burden for the telerehabilitation group (–4.21 (–4.69 to –3.74) hours). Telerehabilitation in the total hip replacement population incurred similar costs and yielded similar effects to traditional in-person care. Telerehabilitation significantly reduced the time burden for patients and carers. These findings are valuable for healthcare providers seeking to implement accessible patient-centred rehabilitation services.
Publisher: Wiley
Date: 2008
DOI: 10.1002/ART.23578
Abstract: Increased medial knee loading is associated with a much higher risk of disease progression in knee osteoarthritis (OA). Interventions that can reduce medial knee joint load have the potential to slow disease progression over time. We evaluated the effects of shoes and a cane on knee load in people with knee OA. Forty people with medial knee OA underwent 3-dimensional gait analysis to measure their peak knee adduction moment, an indicator of medial knee joint load. Results when walking in bare feet were compared with those obtained when walking in their own usual shoes. Twenty participants also underwent testing using a cane, and results were compared with walking unaided. Compared with barefoot, walking in shoes was associated with a significant increase in the peak knee adduction moment (mean +/- SD N x m/BW x H% 3.49 +/- 0.84 versus 3.77 +/- 0.90 P < 0.001), although there was considerable in idual variation. The use of a cane resulted in a 10% decrease in the knee adduction moment (mean +/- SD N x m/BW x H% 3.76 +/- 0.95 versus 3.38 +/- 0.68 P = 0.001). Wearing shoes increases medial knee joint load compared with walking barefoot. Given the variable response to shoes observed, further research is required to ascertain which shoe types might be optimal for those with knee OA. The use of a cane significantly reduces medial knee loading and has the potential to reduce the risk of disease progression in knee OA.
Publisher: SAGE Publications
Date: 27-05-2010
Abstract: Background: Achilles tendinopathy is a considerable problem for active people. The degenerative processes associated with tendinopathy may be associated with changes in the inherent mechanical properties of the musculotendinous unit. Purpose: The purpose of this study was to compare Achilles tendon–aponeurosis strain between male athletes with and without Achilles tendinopathy. Study Design: Cross-sectional study Level of evidence, 3. Methods: Fifteen healthy men (age, 35 ± 9 years height, 1.78 ± 0.05 m mass, 79 ± 11 kg) and 14 men with midportion Achilles tendinopathy (age, 40 ± 8 years height, 1.77 ± 0.06 m mass, 80 ± 9 kg) who were all running over 20 km per week participated in the study. Each participant was tested in a single session that involved maximal isometric plantar flexion efforts being performed on a calf-raise apparatus while synchronous real-time ultrasonography of the triceps surae aponeurosis was recorded. Achilles tendon–aponeurosis strain (%) was calculated by iding tendon displacement during plantar flexion by resting tendon length (intrarater reliability: intraclass correlation coefficient = .92). Results: Participants in the Achilles tendinopathy group (5.2% ± 2.6%) had significantly ( P = .039) higher Achilles tendon–aponeurosis strain compared with the control group (3.4% ± 1.8%). In contrast, there were no significant between-group differences for maximal isometric plantar flexion force. Conclusion: Achilles tendon–aponeurosis strain is higher in male athletes with tendinopathy than those without. The results of this study provide a rationale for current clinical approaches to management of Achilles tendinopathy, whereby repetitive mechanical loading may impart a positive benefit through reduced compliance of the musculotendinous unit.
Publisher: SAGE Publications
Date: 07-2010
Abstract: Hamstring strains remain one of the most prevalent injuries in Australian Rules football. The authors prospectively examined the relationship between musculotendinous stiffness of the hamstring and leg stiffness with hamstring injury in professional Australian Rules footballers during the 2006 season. Higher hamstring stiffness and leg stiffness are related to noncontact, soft tissue hamstring injury risk in professional Australian Rules footballers. Case-control study Level of evidence, 3. Unilateral hamstring stiffness and leg stiffness were assessed in 136 professional footballers in the month before the commencement of the competitive season. This information was then investigated relative to players who suffered noncontact, soft tissue hamstring injuries during either matches or training throughout the season to identify whether preseason stiffness was related to injury occurrence. Fourteen tested players recorded acute, noncontact hamstring injuries, resulting in 3.3 ± 2.8 weeks of missed match play per injury. At preseason testing, the players who ended up sustaining a hamstring injury during the season recorded significantly higher mean hamstring stiffness (11%, P = .04) and leg stiffness (5%, P = .03). When considering the injured players, the leg stiffness of the involved limb was significantly higher than the noninjured players (P = .02), whereas hamstring stiffness was significantly higher on the noninvolved limb (P = .01). Further, those players who suffered a hamstring injury were significantly older than the noninjured players (P = .01). It appears that a high bilateral hamstring stiffness and leg stiffness may be a determinant in the risk of sustaining a hamstring injury. Further, relatively lower hamstring stiffness in the involved limb of injured players appears to be associated with increased injury and may be related to a lack of strength. The information from stiffness assessment may allow medical staff to determine the hamstring risk status for in idual players in team sports.
Publisher: Public Library of Science (PLoS)
Date: 08-12-2017
Publisher: BMJ
Date: 26-11-2015
DOI: 10.1136/BJSPORTS-2015-095255
Abstract: To explore the effects of exercise (water-based or land-based) and/or manual therapies on pain in adults with clinically and/or radiographically diagnosed hip osteoarthritis (OA). A systematic review and meta-analysis was performed, with patient reported pain assessed using a visual analogue scale (VAS) or the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale. Data were grouped by follow-up time (0-3 months=short term 4-12 months=medium term and >12 months=long term), and standardised mean differences (SMD) with 95% CIs were used to establish intervention effect sizes. Study quality was assessed using modified PEDro scores. 19 trials were included. Four studies showed short-term benefits favouring water-based exercise over minimal control using the WOMAC pain subscale (SMD -0.53, 95% CI -0.96 to -0.10). Six studies supported a short-term benefit of land-based exercise compared to minimal control on VAS assessed pain (SMD -0.49, 95% CI -0.70 to -0.29). There were no medium (SMD -0.23, 95% CI -0.48 to 0.03) or long (SMD -0.22, 95% CI -0.51 to 0.06) term benefits of exercise therapy, or benefit of combining exercise therapy with manual therapy (SMD -0.38, 95% CI -0.88 to 0.13) when compared to minimal control. Best available evidence indicates that exercise therapy (whether land-based or water-based) is more effective than minimal control in managing pain associated with hip OA in the short term. Larger high-quality RCTs are needed to establish the effectiveness of exercise and manual therapies in the medium and long term.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Springer Science and Business Media LLC
Date: 08-01-2016
DOI: 10.1007/S00167-015-3937-5
Abstract: Impairments in quadriceps force control and altered quadriceps and hamstring muscle activation strategies have been observed following anterior cruciate ligament reconstruction however, the functional implications of these impairments are unclear. This study examined the cross-sectional associations between quadriceps force control, quadriceps activation, hamstring coactivation and clinically assessed knee function following anterior cruciate ligament reconstruction with a hamstring graft. Sixty-six patients (18 ± 3 months following surgery) and 41 uninjured in iduals participated. Quadriceps force control was assessed using an isometric knee extension task. Participants cyclically increased and decreased quadriceps force at slow speeds between 5 and 30 % maximum voluntary isometric contraction matching a moving target displayed on a screen. Quadriceps activation and hamstring coactivation were assessed concurrently using surface electromyography. Knee function was assessed with the Cincinnati Knee Rating Scale and three single-leg hop tests. The reconstructed group completed the task with 48 % greater root-mean-square error (RMSE), indicating significantly worse quadriceps force control (p < 0.001). In a multivariable model adjusted for sex, greater RMSE and greater lateral hamstring coactivation were significantly associated with worse knee function that is greater odds of scoring <85 % on one or more knee functional assessment. Less-accurate quadriceps force output and greater hamstring coactivation are associated with worse knee joint function following anterior cruciate ligament reconstruction and may contribute to irregular knee joint loading and the onset or progression of knee osteoarthritis. Impairments in quadriceps force control and altered muscle activation strategies may be modifiable through neuromuscular training, and this is an area for future research. Case-control study, Level III.
Publisher: BMJ
Date: 07-12-2016
DOI: 10.1136/BJSPORTS-2016-096768
Abstract: Patellofemoral pain (PFP) occurs frequently, and may be related to patellofemoral osteoarthritis (PFOA). Obesity is associated with increased risk of knee OA. This systematic review involves a meta-regression and analysis to determine the relationship between body mass index (BMI) and PFP and PFOA, and to determine the link between BMI and interventional outcomes. We searched seven electronic databases and reference lists of relevant papers and systematic reviews, for cross-sectional, prospective, human-based observational and interventional studies reporting BMI in in iduals with PFP or PFOA compared to healthy controls. Two independent reviewers appraised methodological quality (epidemiological appraisal instrument). Where possible, data from prospective studies were pooled to conduct meta-regression and case-control, and intervention studies to conduct meta-analysis using the following categories: adolescents with PFP, adults with PFP and PFOA. 52 studies were included. We found greater BMI in adults with PFP (standardised mean difference: 0.24, 95% CI 0.12 to 0.36) and PFOA (0.73, 0.46 to 0.99) compared to healthy controls, but not in adolescents with PFP (-0.19, -0.56 to 0.18). We also observed statistical trends (p<0.10) towards higher BMI being a predictor for development of PFP in adults (0.34, -0.04 to 0.71). No significant link between BMI and intervention outcomes in adults with PFP was identified. Higher BMI is present in PFP and PFOA, but not in adolescents with PFP. CRD42015024812.
Publisher: SAGE Publications
Date: 19-08-2016
Abstract: Participation in high-impact athletic activities has recently been associated with a higher prevalence of cam deformity. Bony hip morphology has also emerged as an important factor in the development of hip osteoarthritis. However, it is unknown whether bony morphology differs between ethnicities in athletes participating in high-impact sports. To investigate whether the prevalence of specific bony hip morphological abnormalities differed between professional male soccer players of erse ethnic backgrounds. Cross-sectional study Level of evidence, 3. Professional male soccer players from an entire league attending preparticipation screening were invited to participate in this study. Ethnicity was registered, and standardized radiographs of anteroposterior pelvic and Dunn views were obtained. Cam and pincer deformity, and acetabular dysplasia were quantified using the alpha angle, triangular index, and lateral center-edge angle (LCEA). Regression analyses with generalized estimating equations were used to determine prevalence differences in bony hip morphology. A total of 445 male soccer players (890 hips mean age ± SD, 25 ± 4.9 years) participated in the study, representing the following ethnic groups: Arabic (59%), black (24%), Persian (7%), white (6%), East Asian (2%), and other (2%). The prevalence of cam deformity (alpha angle °) ranged from 57.5% to 71.7% across 4 of the groups, but East Asians had a significantly lower prevalence (18.8% P ≤ .032). A large cam deformity (alpha angle °) was more prevalent in white (33.3%) compared with black soccer players (17.8% P = .041) and was absent in East Asian players. Pincer deformity (LCEA °) was uncommon (3%) in all ethnicities. The prevalence of acetabular dysplasia (LCEA °) ranged from 8.0% to 16.7%, apart from the white group, in which prevalence was only 1.9% ( P = .03). The prevalence of a cam deformity and acetabular dysplasia differed between ethnicities in this cohort of professional male soccer players. These findings suggest that there may be ethnic differences in both acetabular morphology and femoral bony response to athletic load.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Wiley
Date: 31-03-2006
DOI: 10.1002/ART.21836
Abstract: To assess the concurrent validity of alternative measures of frontal plane knee alignment, namely the radiographic anatomic axis and 5 clinical measures, in medial compartment knee osteoarthritis (OA) as compared with the mechanical axis on radiograph. Forty in iduals (mean +/- SD age 64.7 +/- 9.4 years) with symptomatic medial knee OA participated. Knee alignment was measured according to the following methods: lower-limb mechanical axis on radiograph, lower-limb anatomic axis on radiograph, visual observation, distance between medial knee joint lines or medial malleoli using a caliper, distance between a plumb line and medial knee joint line or malleolus using a caliper, tibial alignment using a gravity inclinometer, and lower-limb alignment using a goniometer. Data were analyzed using Pearson's correlation coefficient or Spearman's rho correlation coefficient and simple linear regression. The anatomic axis best correlated with the mechanical axis (r = 0.88), followed closely by the inclinometer method (r = 0.80). Other clinical measures of alignment that were significantly associated with the mechanical axis were the caliper method, the plumb-line method, and visual observation (r = 0.76, 0.71, and -0.52, respectively). However, the goniometer method failed to correlate. The anatomic axis on radiograph and the inclinometer method appear to be valid alternatives to the mechanical axis on full-leg radiograph for determining frontal plane knee alignment in medial knee OA. These alternative methods of measuring knee alignment may increase the assessment of this parameter by clinicians and researchers alike, given that malalignment is an important indicator of disease progression and treatment outcome.
Publisher: Elsevier BV
Date: 08-2010
Publisher: SAGE Publications
Date: 08-07-2013
Abstract: Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown. To evaluate the reliability, validity, responsiveness, and interpretability of 5 PROs (Copenhagen Hip and Groin Outcome Score [HAGOS], Hip Disability and Osteoarthritis Outcome Score [HOOS], Hip Outcome Score [HOS], International Hip Outcome Tool [iHOT-33], and Modified Harris Hip Score [MHHS]) in a population undergoing hip arthroscopic surgery and also to provide a recommendation of the best PROs in patients undergoing hip arthroscopic surgery. Cohort study (diagnosis) Level of evidence, 2. Study participants were adults (mean age, 37 ± 11 years) who had undergone hip arthroscopic surgery 12 to 24 months previously and pain-free, healthy age-matched controls (mean age, 35 ± 11 years). Baseline characteristics including age, height, weight, waist girth, physical activity, and occupation were collected for both groups. The hip arthroscopic surgery group completed the 5 PRO questionnaires on 3 occasions, while the healthy control group completed the PRO questionnaires on 1 occasion. The reliability (test-retest reliability [intraclass correlation coefficient, or ICC] and minimal detectable change [MDC]), validity (construct validity, ability to detect a difference between groups, acceptability including floor and ceiling effects), responsiveness, and interpretability (minimal important change [MIC]) of each measure were calculated. The test-retest reliability of PROs was excellent (ICC, 0.91-0.97), with an MDC of %. The HOOS, HAGOS, and iHOT-33 had acceptable content validity. All PROs demonstrated construct validity and were able to detect a difference between the hip arthroscopic surgery and control groups. No measures demonstrated a floor effect however, the MHHS and subscales relating to activities of daily living of the HOOS, HOS, and HAGOS demonstrated a ceiling effect. The HOOS, iHOT-33, and MHHS demonstrated adequate responsiveness, and the MIC for all measures was points of a possible 100 points. The PROs of the HOOS and iHOT-33 demonstrate psychometric properties that may enable researchers and clinicians to use them with confidence in a population undergoing hip arthroscopic surgery. The psychometric properties of the MHHS, HOS, and some subscales of the HAGOS are reduced, and these PROs may be less valuable in this group.
Publisher: Elsevier BV
Date: 04-2019
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JSAMS.2014.09.011
Abstract: To compare knee confidence and kinesiophobia (fear of re-injury) in those with and without knee osteoarthritis following anterior cruciate ligament reconstruction, and determine whether poorer knee confidence is associated with greater kinesiophobia, worse knee-related symptoms, and functional impairments in those with knee osteoarthritis. Cross-sectional. Sixty-six in iduals, 5-12 years following anterior cruciate ligament reconstruction, with (n=30) and without (n=36) knee osteoarthritis were included. Knee injury and Osteoarthritis Outcome Score quality-of-life question (Q3), assessed knee confidence and T a Scale of Kinesiophobia assessed kinesiophobia. In the osteoarthritis group, knee-related symptoms (International Knee Documentation Committee and Anterior Knee Pain Scale), self-reported function (Knee injury and Osteoarthritis Outcome Score activities daily living), sport/recreation (Knee injury and Osteoarthritis Outcome Score-sport and recreation), and performance-based function (hopping, one leg rise tasks) were assessed. Between-group differences in knee confidence and kinesiophobia were evaluated with the Chi square test and analysis of variance, respectively. In the osteoarthritis group, between-group differences (none, mild/moderate and severe/extreme problems with knee confidence) in kinesiophobia, symptoms and function were determined with analysis of variances: p<0.05. Following anterior cruciate ligament reconstruction, participants with knee osteoarthritis had significantly worse knee confidence (p=0.010) and greater kinesiophobia (p=0.006) than those without osteoarthritis. In those with knee osteoarthritis, poorer knee confidence was significantly associated with worse symptoms (Anterior Knee Pain Scale, p=0.001 International Knee Documentation Committee, p<0.001), kinesiophobia (p=0.030), Knee injury and Osteoarthritis Outcome Score-activities of daily living (p=0.005), Knee injury and Osteoarthritis Outcome Score-sport and recreation (p=0.001), single-leg hop (p=0.011), side-to-side hop (p=0.013) and one leg rise (p=0.001). Psychological impairments are evident in people with knee osteoarthritis following anterior cruciate ligament reconstruction, compared to those without. Future studies should further investigate the psychological impairments associated with knee osteoarthritis after anterior cruciate ligament reconstruction.
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.JSAMS.2015.07.008
Abstract: Patellofemoral pain is a frequent and troublesome complication following anterior cruciate ligament reconstruction (ACLR), irrespective of graft source. Yet, little is known about the factors associated with patellofemoral pain following hamstring-tendon ACLR. Retrospective analysis of potential patellofemoral pain predictors, and cross-sectional analysis of possible patellofemoral pain consequences. Potential predictors (pre-injury patellofemoral pain and activity level, concomitant patellofemoral cartilage damage and meniscectomy, age, sex, and surgical delay) and consequences (hopping performance, quality of life, kinesiophobia, and return to sport rates and attitudes) of patellofemoral pain 12 months following hamstring-tendon ACLR were assessed in 110 participants using univariate and multivariate analyses. Thirty-three participants (30%) had patellofemoral pain at 12 months post-ACLR. Older age at the time of ACLR was the only predictor of post-operative patellofemoral pain. Following ACLR, those with patellofemoral pain had a higher body mass index, and worse physical performance, quality of life, kinesiophobia and return to sport attitudes. Patellofemoral pain has a significant burden on in iduals 12 months following hamstring-tendon ACLR. Clinicians need to be cognisant of patellofemoral pain, particularly in older in iduals and those with a higher body mass index. The importance of considering psychological factors that are not typically addressed during ACLR rehabilitation, such as kinesiophobia, quality of life and return to sport attitudes is emphasised.
Publisher: SAGE Publications
Date: 04-09-2018
Abstract: An anterior cruciate ligament (ACL) injury is a well-established risk factor for the long-term development of radiographic osteoarthritis (OA). However, little is known about the early degenerative changes (ie, years after injury) of in idual joint features (ie, cartilage, bone marrow), which may be reversible and responsive to interventions. To describe early degenerative changes between 1 and 5 years after ACL reconstruction (ACLR) on magnetic resonance imaging (MRI) and explore participant characteristics associated with these changes. Case-control study Level of evidence, 3. Seventy-eight participants (48 men median age, 32 years median body mass index [BMI], 26 kg/m 2 ) underwent 3.0-T MRI at 1 and 5 years after primary hamstring autograft ACLR. Early tibiofemoral and patellofemoral OA features were assessed with the MRI Osteoarthritis Knee Score. The primary outcome was worsening (ie, incident or progressive) cartilage defects, bone marrow lesions (BMLs), osteophytes, and meniscal lesions. Logistic regression with generalized estimating equations evaluated participant characteristics associated with worsening features. Worsening of cartilage defects in any compartment occurred in 40 (51%) participants. Specifically, worsening in the patellofemoral and medial and lateral tibiofemoral compartments was present in 34 (44%), 8 (10%), and 10 (13%) participants, respectively. Worsening patellofemoral and medial and lateral tibiofemoral BMLs (14 [18%], 5 [6%], and 10 [13%], respectively) and osteophytes (7 [9%], 8 [10%], and 6 [8%], respectively) were less prevalent, while 17 (22%) displayed deteriorating meniscal lesions. Worsening of at least 1 MRI-detected OA feature, in either the patellofemoral or tibiofemoral compartment, occurred in 53 (68%) participants. Radiographic OA in any compartment was evident in 5 (6%) and 16 (21%) participants at 1 and 5 years, respectively. A high BMI ( kg/m 2 ) was consistently associated with elevated odds (between 2- and 5-fold) of worsening patellofemoral and tibiofemoral OA features. High rates of degenerative changes occur in the first 5 years after ACLR, particularly the development and progression of patellofemoral cartilage defects. Older patients with a higher BMI may be at particular risk and should be educated about this risk.
Publisher: Wiley
Date: 26-07-2013
DOI: 10.1002/ART.38025
Abstract: To determine whether people with patellofemoral (PF) joint osteoarthritis (OA) ascend and descend stairs with different PF joint loading, knee joint moments, lower limb kinematics, and muscle forces compared to healthy people. We recruited 17 participants with isolated PF joint OA, 13 participants with concurrent PF joint OA and tibiofemoral (TF) joint OA, and 21 age-matched controls. Joint kinematics and ground reaction forces were measured while participants ascended and descended stairs at a self-selected speed. Musculoskeletal computer modeling was used to determine lower limb muscle forces and the PF joint reaction force, and these parameters were compared between groups by analysis of variance. Compared to their healthy counterparts, participants with isolated PF joint OA and participants with concurrent PF and TF joint OA ascended and descended stairs with lower knee extension moments, lower quadriceps muscle forces, lower PF joint reaction forces, and increased anterior pelvic tilt. Participants with OA also ascended stairs with increased hip flexion angles and descended stairs with smaller knee flexion angles and smaller hip abductor muscle forces. No differences were evident between the two groups with OA. Compared to their healthy counterparts, people with PF joint OA (with or without concurrent TF joint OA) exhibit lower PF joint reaction forces during stair ascent and descent, in conjunction with lower knee extension moments and lower quadriceps muscle forces.
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJSEM-2020-000877
Abstract: To explore clinical characteristics in in iduals with patellofemoral osteoarthritis (PFOA) compared to in idually-matched asymptomatic controls. We also explored associations between functional performance and patient-reported symptoms with patellofemoral alignment. We assessed 15 in iduals with PFOA and 15 in idually-matched asymptomatic controls. In addition to physical examination and patient-reported questionnaires, we evaluated functional performance, lower extremity strength and range of motion, and patellar alignment (using MRI). We analysed group differences with Wilcoxon’s matched-pairs signed rank tests, and within-group associations with Spearman’s rank correlations. We included 24 (80%) women with median (IQR) age of 56 (9) years and BMI of 22.8 (5.9) kg/m 2 . In iduals with PFOA reported lower quality of life (8/100 points lower EQ-5D-5L, p=0.02), and performed worse on two functional tests: repeated one-leg rises (median 16 fewer rises, p=0.04) and timed stair climb (1.2 s slower, p=0.03). There were no differences in strength tests performed or range of motion. Patellar proximal translation correlated with worse functional performance and worse patient-reported pain, function and self-efficacy, while lateral translation and lateral tilt correlated with worse knee-related quality of life (Spearman’s r ranging from 0.5 to 0.7). Functional performance was worse in in iduals with PFOA, despite those in iduals having no significant differences on lower extremity strength testing. Patellofemoral alignment was associated with worse functional performance as well as worse patient-reported outcomes, and it may represent one mechanism underpinning PFOA-related symptoms.
Publisher: BMJ
Date: 08-2007
Publisher: Springer Science and Business Media LLC
Date: 10-04-2019
DOI: 10.1007/S40279-019-01092-Y
Abstract: In athletes, hip and groin pain is considered to be associated with hip intra-articular pathologies and hip osteoarthritis (OA). A greater understanding of the relationship between hip and groin pain and imaging findings is required. Our objective was to undertake a systematic review and meta-analysis to determine the prevalence of hip intra-articular pathologies and hip OA in athletes with and without hip and groin pain. Seven electronic databases were searched on 29 January 2018 for studies investigating the prevalence of hip intra-articular pathologies and hip OA using X-ray, magnetic resonance imaging, magnetic resonance arthrography or computed tomography. The search, study selection, quality appraisal and data extraction were performed by two independent reviewers. When studies were considered homogenous, meta-analysis was undertaken. A strength of evidence was given to pooled results. Twenty studies reporting on the prevalence of hip intra-articular pathologies and hip OA in athletes were identified. Included studies were considered moderate to high risk of bias, with only three studies adjudged as low risk of bias. In asymptomatic athletes, limited evidence identified a labral tear prevalence of 54% per person and moderate evidence of 33% per hip. In symptomatic athletes, moderate evidence of a labral tear prevalence of 20% per hip was found. Moderate evidence of a cartilage defect prevalence of 10% per person was reported in asymptomatic athletes. In symptomatic athletes, cartilage defect prevalence was 7-40%. In asymptomatic athletes, the prevalence of hip OA was 0-17%, compared with 2% in symptomatic athletes. The prevalence of hip intra-articular pathologies and hip OA in symptomatic and asymptomatic athletes is variable. Labral tears and cartilage defects appear to be seen often in athletes with and without pain. Hip OA is rarely seen in athletes either with or without hip and groin pain. PROSPERO registration CRD42017082457.
Publisher: Informa UK Limited
Date: 10-07-2018
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.JOCA.2018.10.008
Abstract: To synthesise and evaluate the current evidence investigating muscle size and composition in non-inflammatory articular hip pathology. A systematic review of five electronic databases, using three concepts articular hip pathology (e.g., osteoarthritis (OA)) hip muscles and outcomes (e.g., muscle size and adiposity) was undertaken. Studies addressing non-inflammatory or non-traumatic articular hip pain, using measures of muscle size and adiposity were included and appraised for risk of bias. Data was extracted to calculate standardised mean differences (SMD) and pooled where possible for meta-analysis. Thirteen cross-sectional studies were included all studies measured muscle size and 5/13 measured adiposity. In OA, there was low to very low quality evidence of no difference in hip muscle size, compared with matched controls. In unilateral OA, there was low to very low quality evidence of smaller size in gluteus minimus (SMD -0.38 95% confidence interval (CI) -0.74, -0.01), gluteus medius (-0.44 95% CI: -0.83, -0.05) and gluteus maximus (-0.39 95% CI: -0.75, -0.02) muscles in the symptomatic limb. In idual studies demonstrated non-uniform changes in muscle size in OA. No significant difference was observed in muscle size in other pathologies or in adiposity for any group. There is some low quality evidence that specific hip muscles are smaller in unilateral hip OA. Variation in the magnitude of differences indicate changes in size are not uniform across all muscles or stage of pathology. Studies in larger cohorts investigating muscle size and composition across the spectrum of articular pathologies are required to clarify these findings.
Publisher: Wiley
Date: 07-03-2011
DOI: 10.1002/JOR.21345
Abstract: Patellar tendon adhesion is a complication from anterior cruciate ligament (ACL) reconstruction that may affect patellofemoral and tibiofemoral biomechanics. A computational model was used to investigate the changes in knee joint mechanics due to patellar tendon adhesion under normal physiological loading during gait. The calculations showed that patellar tendon adhesion up to the level of the anterior tibial plateau led to patellar infera, increased patellar flexion, and increased anterior tibial translation. These kinematic changes were associated with increased patellar contact force, a distal shift in peak patellar contact pressure, a posterior shift in peak tibial contact pressure, and increased peak tangential contact sliding distance over one gait cycle (i.e., contact slip). Postadhesion, patellar and tibial contact locations corresponded to regions of thinner cartilage. The predicted distal shift in patellar contact was in contrast to other patellar infera studies. Average patellar and tibial cartilage pressure did not change significantly following patellar tendon adhesion however, peak medial tibial pressure increased. These results suggest that changes in peak tibial cartilage pressure, contact slip, and the migration of contact to regions of thinner cartilage are associated with patellar tendon adhesion and may be responsible for initiating patellofemoral pain and knee joint structural damage observed following ACL reconstruction.
Publisher: Wiley
Date: 28-12-2007
DOI: 10.1002/ART.23242
Abstract: To evaluate the evidence for patellar taping and bracing in the management of chronic knee pain. Randomized or quasi-randomized studies assessing patellar taping or bracing effects on chronic knee pain were sourced from 7 electronic databases (to November 2006), and assessed using the Physiotherapy Evidence Database scale. Weighted mean differences were determined, and pooled estimates of taping and bracing effects were obtained using random-effects models. Of 16 eligible trials, 13 investigated patellar taping or bracing effects in in iduals with anterior knee pain, and 3 investigated taping effects in in iduals with knee osteoarthritis (OA). The methodologic quality of the taping studies was significantly higher than the bracing studies (mean+/-SD 4.8+/-2.1 versus 2.8+/-0.8 P<0.05). On a 100-mm scale, tape applied to exert a medially-directed force on the patella decreased chronic knee pain compared with no tape by 16.1 mm (95% confidence interval [95% CI] -22.2, -10.0 P<0.001) and sham tape by 10.9 mm (95% CI -18.4, -3.4 P<0.001). For anterior knee pain and OA, medially-directed tape decreased pain compared with no tape by 14.7 mm (95% CI -22.8, -6.9 P<0.001) and 20.1 mm (95% CI -26.0, -14.3 P<0.001), respectively. There was disputable evidence from low-quality studies for patellar bracing benefits. There was evidence that tape applied to exert a medially-directed force on the patella produces a clinically meaningful change in chronic knee pain. There was limited evidence to demonstrate the efficacy of patellar bracing. These outcomes were limited by the presence of high heterogeneity between study outcomes and significant publication bias.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2017
Publisher: JMIR Publications Inc.
Date: 05-03-2020
Abstract: atellofemoral pain (PFP) impairs joint- and health-related quality of life and may be associated with knee osteoarthritis. We developed a novel, 2-phase, stepped-care approach for PFP, combining (1) self-directed web-based education and exercise therapy with (2) physiotherapist-supported education and exercise therapy. Physiotherapy sessions can be provided using 2 different modalities: face-to-face and telerehabilitation. his study aims to (1) determine the feasibility of our stepped-care approach, (2) explore patient-reported outcomes following self-directed web-based education and exercise therapy in people with PFP (phase 1), and (3) estimate the differences in treatment effects between face-to-face and telerehabilitation to support further education and exercise therapy (phase 2) in those who had not completely recovered following self-directed care. hase 1 involved 6 weeks of self-directed web-based education and exercise therapy. Phase 2 involved random allocation to a further 12 weeks of physiotherapist-led (up to 8 sessions) education and exercise therapy delivered face-to-face or via telerehabilitation to participants who did not rate themselves as completely recovered following phase 1. Feasibility indicators of process, adherence, and participant retention were collected as primary outcomes alongside patient-reported outcomes on Global Rating of Change and knee pain, disability, knee-related quality of life, pain catastrophism, kinesiophobia, and knee self-efficacy. All participants were assessed at baseline, 6 weeks, and 18 weeks. total of 71 participants were screened to identify 35 participants with PFP to enter the study. Overall, 100% (35/35) and 88% (31/35) of the participants were followed up with at 6 and 18 weeks, respectively. In phase 1 of the study, participants accessed the My Knee Cap website for an average of 6 (7.5) days and performed the exercises for an average of 2.5 (3.6) times per week. A total of 20% (7/35) of the participants reported that they had completely recovered at 6 weeks. Furthermore, 93% (26/28) of the participants who were followed up and had not completely recovered at 6 weeks agreed to be enrolled in phase 2. No statistically significant differences were found between the face-to-face and telerehabilitation groups for any outcome. The novel stepped-care approach was associated with marked improvement or complete recovery in 40% (14/35) of the participants following phase 1 and 71% (25/35) of the participants following phase 2. elf-directed web-based education and exercise therapy for people with PFP is feasible, as noted by the high rate of participant retention and home exercise adherence achieved in this study. Furthermore, 20% (7/35) of people reported complete recovery at 6 weeks. Both face-to-face and telerehabilitation physiotherapy should be considered for those continuing to seek care, as there is no difference in outcomes between these delivery modes. Determining the efficacy of the stepped-care model may help guide more efficient health care for PFP.
Publisher: Oxford University Press (OUP)
Date: 12-2002
DOI: 10.1093/RHEUMATOLOGY/41.12.1388
Abstract: To compare balance in in iduals with symptomatic knee osteoarthritis (OA) and in age-, gender- and body-mass-matched controls using simple clinical measures. Thirty-three people with OA and 33 controls participated. Static postural sway [antero-posterior (AP), lateral and total] was measured using a swaymeter on two different surfaces and under two visual conditions. Dynamic standing balance was assessed using the 'step test'. Both groups displayed similar postural sway on most variables measured. Significantly greater sway was noted in the OA group on a firm surface in both lateral (eyes open) and AP directions (eyes closed), as well as total sway (eyes closed) (P < 0.05). Poorer dynamic standing balance was observed in the OA group as evidenced by the step test (P < 0.0001). Balance deficits can be identified in the osteoarthritic population using simple, inexpensive measures. However, the clinical relevance of the small deficits identified remains unknown and warrants further investigation.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 12-0007
Abstract: Background Hip-related groin pain is common in sub-elite football players and may be associated with altered hip biomechanics. Objectives To compare the hip biomechanics, bony hip morphology associated with femoroacetabular impingement (FAI) syndrome, and hip strength and range of motion (ROM) between the symptomatic and asymptomatic limbs of sub-elite football players with unilateral hip-related groin pain and a positive flexion, adduction, and internal rotation (FADIR) test. Methods Fifteen sub-elite football (soccer) players with unilateral hip-related groin pain and a positive FADIR test were recruited for this observational cross-sectional study. Three-dimensional motion analysis and ground reaction force data were recorded for walking and a single-leg drop-jump (SLDJ) task. Participants also underwent a standard anterior-posterior hip radiograph and hip strength and ROM assessment. Between-limb differences were assessed using paired t tests or Wilcoxon signed-rank tests. Results The symptomatic limb displayed a smaller peak hip extension angle (P = .01) and a lower peak hip adduction moment (P = .03) compared with the asymptomatic limb during the stance phase of walking. Additionally, during the SLDJ, the symptomatic limb demonstrated less total sagittal plane ROM (P = .04). The symptomatic limb also demonstrated less external rotation ROM (P = .03). However, no differences were found between limbs for bony hip morphology associated with FAI syndrome or hip strength. Conclusion This study found between-limb asymmetries in low- and high-impact functional tasks, such as walking and an SLDJ, in football players with unilateral hip-related groin pain. Despite unilateral pain, bony morphology associated with FAI syndrome did not differ between limbs. J Orthop Sports Phys Ther 2018 (7):584-593. Epub 8 May 2018. doi:10.2519/jospt.2018.7910.
Publisher: Human Kinetics
Date: 11-2018
Abstract: Context : It is important to validate single-leg squat visual rating criteria used in clinical practice and research. Foot orthoses may improve single-leg squat performance in those who demonstrate biomechanics associated with increased risk of lower limb injury. Objective : Validate visual rating criteria proposed by Crossley et al, by determining whether athletes rated as poor single-leg squat performers display different single-leg squat biomechanics than good performers and evaluate immediate effects of foot orthoses on single-leg squat biomechanics in poor performers. Design : Comparative cross-sectional study. Setting : University laboratory. Participants : 79 asymptomatic athletes underwent video classification of single-leg squat performance based on established visual rating criteria (overall impression, trunk posture, pelvis “in space,” hip movement, and knee movement), and were rated as good (n = 23), fair (n = 41), or poor (n = 15) performers. Intervention : A subset of good (n = 16) and poor (n = 12) performers underwent biomechanical assessment, completing 5 continuous single-leg squats on their dominant limb while 3-dimensional motion analysis and ground reaction force data were recorded. Poor performers repeated the task standing on prefabricated foot orthoses. Main Outcome Measures : Peak external knee adduction moment (KAM) and peak angles for the trunk, hip, knee, and ankle. Results : Compared with good performers, poor performers had a significantly lower peak KAM (mean difference = 0.11 Nm/kg, 95% confidence interval = 0.02 to 0.2 Nm/kg), higher peak hip adduction angle (−4.3°, −7.6° to −0.9°), and higher peak trunk axial rotation toward their stance limb (3.8°, 0.4° to 7.2°). Foot orthoses significantly increased the peak KAM in poor performers (−0.06 Nm/kg, −0.1 to −0.01 Nm/kg), with values approximating those observed in good performers. Conclusions : Findings validate Crossley et al’s visual rating criteria for single-leg squat performance in asymptomatic athletes, and suggest that “off-the-shelf” foot orthoses may be a simple intervention for poor performers to normalize the magnitude of the external KAM during single-leg squat.
Publisher: Wiley
Date: 11-05-2016
DOI: 10.1111/SMS.12698
Abstract: Many in iduals experience long-term quality of life (QOL) impairment following anterior cruciate ligament reconstruction (ACLR). Factors contributing to poor QOL and psychological health >5 years after ACLR remain unclear. This study aimed to describe QOL and psychological health outcomes in people with knee difficulties (pain, symptoms, or functional limitations) 5-20 years following ACLR and identify factors explaining variability in these outcomes. Participants with knee difficulties 5-20 years following ACLR completed a battery of validated patient-reported outcomes [including the Knee injury and Osteoarthritis Outcome Score (KOOS), ACL-QOL, and the Assessment of QOL (AQoL-8D) instrument]. Multivariable linear regression was used to identify factors explaining variability in outcomes. One hundred sixty-two participants aged 38 ± 9 (mean ± SD) years completed questionnaires 9 ± 4 (range 5-20) years following ACLR. Thirty-nine percent of participants returned to competitive sport, 28% returned to a lower level, and 32% did not return to sport after ACLR. Not returning to sport after ACLR was associated with worse KOOS-QOL (β = 0.29, P = 0.001 [mean ± SD (55 ± 20)], ACL-QOL [β = 0.48, P < 0.001 (57 ± 21)], and AQoL-8D [β = 0.22, P = 0.02 (0.80 ± 0.14)]) scores. Increased body mass index (56% were overweight/obese) was related to worse QOL and more depressive symptoms. Subsequent knee surgery and contralateral ACLR were also associated with poorer QOL outcomes in these in iduals.
Publisher: Springer Science and Business Media LLC
Date: 25-01-2016
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.PTSP.2019.08.005
Abstract: To report physical characteristics of lower-limb strength, endurance, range of motion, balance, and pain during adductor squeeze in elite female Australian Football (AF) players, and to examine the effect of limb dominance, previous AF experience, age, and previous level of sports participation on these characteristics. Cross-sectional study. Three elite AF clubs. Eighty-five female players. All were aged ≥18, contracted for the 2018 season, and participated in pre-season training. The physical characteristic assessments included pain on adductor squeeze, weight-bearing lunge, side bridge, isometric hip abduction and adduction strength, and the modified star excursion balance test. The adductor squeeze had low pain scores, with 93% of players scoring ≤2 on the numerical rating scale. Other assessment results were (mean ± SD): 10.8 ± 2.7 cm for weight-bearing lunge, 95 ± 39s for side bridge, 1.85 ± 0.23 and 1.85 ± 0.36Nm/kg for hip abduction and adduction strength respectively, and 92 ± 8% for the modified star excursion balance test. There was no clinically relevant effect of limb dominance, previous AF experience, age, or previous level of sports on physical characteristics. Physical characteristics for five assessments are reported. These data can be used for comparison purposes in the screening and clinical management of elite female AF players.
Publisher: Wiley
Date: 27-01-2021
DOI: 10.1002/JOR.24987
Abstract: Infrapatellar fat pad (IPFP) morphology and Hoffa‐synovitis may be relevant to the development and progression of post‐traumatic osteoarthritis (OA). We aimed to compare IPFP volume and Hoffa‐synovitis in participants with anterior cruciate ligament reconstruction (ACLR) and uninjured controls, and to determine their association with prevalent and worsening early knee OA features and pain in participants post‐ACLR. We assessed IPFP volume and Hoffa‐synovitis from magnetic resonance imaging (MRI) in 111 participants 1‐year post‐ACLR and 20 uninjured controls. Patellofemoral and tibiofemoral cartilage and bone marrow lesions (BMLs) were assessed from MRIs at 1 and 5 years post‐ACLR, and worsening defined as any longitudinal increase in lesion size/severity. IPFP volume and Hoffa‐synovitis prevalence were compared between groups with analysis of covariance and χ 2 tests, respectively. Generalized linear models assessed the relation of IPFP volume and Hoffa‐synovitis to prevalent and worsening features of OA and knee pain (Knee injury and Osteoarthritis Outcome Score—Pain Subscale, Anterior Knee Pain Scale). No significant between‐group differences were observed in IPFP volume (ACLR 34.39 ± 7.29cm 3 , Control 34.27 ± 7.56cm 3 ) and Hoffa‐synovitis (ACLR 61%, Control 80%). Greater IPFP volume at 1‐year post‐ACLR was associated with greater odds of patellofemoral BMLs at 1‐year (odds ratio [OR] [95% confidence intervals]: 1.104 [1.016, 1.200]) and worsening tibiofemoral cartilage lesions at 5‐year post‐ACLR (OR: 1.234 [1.026, 1.483]). Hoffa‐synovitis at 1‐year post‐ACLR was associated with greater odds of worsening patellofemoral BMLs at 5‐year post‐ACLR (OR: 7.465 [1.291, 43.169]). In conclusion, IPFP volume and Hoffa‐synovitis prevalence are similar between in iduals 1‐year post‐ACLR and controls. Greater IPFP volume and Hoffa‐synovitis appear to be associated with the presence and worsening of some early OA features in those post‐ACLR, but not pain.
Publisher: BMJ
Date: 25-02-2014
Publisher: The Company of Biologists
Date: 2019
DOI: 10.1242/JEB.209460
Abstract: We explored how humans adjust the stance phase mechanical function of their major lower-limb joints (hip, knee, ankle) during maximum acceleration sprinting. Experimental data (motion capture and ground reaction force (GRF)) were recorded from eight participants as they performed overground sprinting trials. Six alternative starting locations were used to obtain a dataset that incorporated the majority of the acceleration phase. Experimental data were combined with an inverse-dynamics-based analysis to calculate lower-limb joint mechanical variables. As forward acceleration magnitude decreased, the vertical GRF impulse remained nearly unchanged whereas the net horizontal GRF impulse became smaller due to less propulsion and more braking. Mechanical function was adjusted at all three joints, although more dramatic changes were observed at the hip and ankle. The impulse from the ankle plantar-flexor moment was almost always larger than those from the hip and knee extensor moments. Forward acceleration magnitude was linearly related to the impulses from the hip extensor moment (R2=0.45) and the ankle plantar-flexor moment (R2=0.47). Forward acceleration magnitude was also linearly related to the net work done at all three joints, with the ankle displaying the strongest relationship (R2=0.64). The ankle produced the largest amount of positive work (1.55±0.17 J/kg) of all the joints, and provided a significantly greater proportion of the summed amount of lower-limb positive work as running speed increased and forward acceleration magnitude decreased. We conclude that the hip and especially the ankle represent key sources of positive work during the stance phase of maximum acceleration sprinting.
Publisher: BMJ
Date: 11-03-2009
Abstract: Groin pain commonly affects football players and can be associated with prolonged recovery periods. Understanding the relationship between groin pain and reliable measures of hip flexibility and strength may facilitate the development of optimal rehabilitation and prevention strategies. In this study, the reliability and association with athletic groin pain of hip flexibility and strength measures were investigated. A cohort of 29 football players (15-21 years) participating in junior elite competitions (Australian Rules football and soccer) were recruited. The intra-rater reliability (n=13) and inter-rater reliability (n=12) of various hip flexibility (bent knee fall out test, hip internal rotation, hip external rotation) and strength (hip abduction, hip internal rotation, hip external rotation, hip adduction (squeeze test)) measures were investigated using intraclass correlation coefficients (ICC). Reliable hip flexibility and strength measures were compared between football players with (n=10) and without (n=19) groin pain. The bent knee fall out test, hip internal rotation flexibility and the squeeze test demonstrated acceptable (ICC>0.75) intra-rater and inter-rater reliability, while hip external rotation flexibility and hip abduction strength demonstrated acceptable intra-rater but not inter-rater reliability. Hip internal and external rotation strength tests were not found to be reliable. Football players with groin pain had significantly reduced force production on the squeeze test (p>0.05). Several hip flexibility and strength measures were found to be reliable. Only the squeeze test discriminated between football players with and without groin pain.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.JOCA.2019.05.015
Abstract: The Joint Effort Initiative was endorsed by Osteoarthritis Research Society International (OARSI) in 2018 as a collaboration between international researchers and clinicians with an interest in the implementation of osteoarthritis management programs (OAMPs). This study aimed to identify and prioritise activities for future work of the Joint Effort Initiative. A survey was emailed to delegates of the 2018 OARSI World Congress attending a pre-conference workshop or with a known interest in OAMPs (n = 115). Delegates were asked about the most important issues regarding OAMP implementation. The top 20 issues were synthesised into 17 action statements, and respondents were invited to participate in a priority ranking exercise to determine the order of importance of the statements. Survey respondents (n = 51, 44%) were most commonly female (71%), with an allied health background (57%), affiliated with universities (73%) from Oceania (37%), and Europe/UK (45%). The five highest ranked action statements were: CONCLUSION: Prioritising statements will bring focus to the future work of the Joint Effort Initiative in the future and provide a basis for longer-term actions.
Publisher: BMJ
Date: 23-09-2021
Publisher: Springer Science and Business Media LLC
Date: 26-04-2017
Publisher: BMJ
Date: 28-09-2022
DOI: 10.1136/BJSPORTS-2022-105626
Abstract: Determine the long-term health-related quality-of-life (HRQoL), work limitation, physical activity, health/economic cost and disease burden of traumatic ACL and/or meniscal injury. Findings will inform OPTIKNEE evidence-based consensus recommendations. Random-effects meta-analysis evaluated HRQoL (SF-36/SF-12/VR-12 Physical Component Scores (PCS) and Mental Component Scores (MCS), EuroQol-5D (EQ-5D)) stratified by time postinjury, and pooled mean differences (95% CI) between ACL-injured and uninjured controls. Other outcomes were synthesised descriptively. Risk-of-bias (RoB) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed. MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021. Studies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury. Fifty studies were included (10 high-RoB, 28 susceptible-to-some-bias and 12 low-RoB). Meta-analysis (27 studies, very low certainty of evidence) estimated a pooled mean (95% CI) PCS of 52.4 (51.4 to 53.4) and MCS of 54.0 (53.0 to 55.0) 2–14 years post-ACL injury. Pooled PCS scores were worse years (50.8 (48.7 to 52.9)) compared with 2–5 years (53.9 (53.1 to 54.7)) postinjury. Excluding high-RoB studies, PCS scores were worse in ACL-injured compared with uninjured controls (−1.5 (−2.9 to –0.1)). Six studies (low certainty of evidence) informed a pooled EQ-5D score of 0.83 (0.81 to 0.84). Some in iduals experienced prolonged work absenteeism and modified activities ≥2 years post-ACL injury. ACL injury was associated with significant direct and indirect costs, and early ACL reconstruction may be less cost-effective than rehabilitation. Only three studies evaluated meniscal injury outcomes (all evaluated HRQoL). There is a very-low certainty of evidence that PCS scores ≥2 years post-ACL injury are worse than uninjured controls and decline over time, whereas MCS scores remain high. ACL injury can result in prolonged work absenteeism and high health/economic costs. Further studies are needed to determine the long-term burden of traumatic meniscal injury.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2015
Publisher: Springer Science and Business Media LLC
Date: 05-2010
DOI: 10.2165/11530780-000000000-00000
Abstract: Patellofemoral pain syndrome (PFPS) is a highly prevalent condition, often reducing functional performance and being linked to osteoarthritis development later in life. Prescribing foot orthoses is often advocated, although the link between foot mechanics and PFPS development remains unclear. This systematic review was conducted to summarize and critique the existing evidence for the efficacy of foot orthoses in in iduals with PFPS and to provide guidance for future research evaluating foot orthoses in in iduals with PFPS. A comprehensive search of MEDLINE, EMBASE, CINAHL and Current Contents revealed 138 citations for review. Two of the authors independently reviewed and assessed each citation for inclusion and quality using a modified version of the quality assessment scale for randomized controlled trials in PFPS designed by Bizzini and colleagues. A total of seven studies were included in the final review. The review found limited evidence that prefabricated foot orthoses may reduce the range of transverse plane knee rotation and provide greater short-term improvements in in iduals with PFPS compared with flat inserts. Findings also indicated that combining physiotherapy with prefabricated foot orthoses may be superior to prefabricated foot orthoses alone. Further research is now needed to establish the mechanisms behind the efficacy of foot orthoses and to identify in iduals with PFPS who are most likely to benefit from prescription of foot orthoses. A comparison of the efficacy between prefabricated and customized foot orthoses is also needed.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.GAITPOST.2015.02.013
Abstract: Clinical musculoskeletal pain commonly accompanies hip pathology and can impact balance performance. Due to the cross-sectional designs of previous studies, and the multifactorial nature of musculoskeletal pain conditions, it is difficult to determine whether pain is a driver of balance impairments in this population. This study explored the effects of experimentally induced hip muscle pain on static and dynamic balance. Twelve healthy adults (4 women, mean[SD]: 27.1[3] years) performed three balance tasks on each leg, separately: single-leg standing (eyes closed), single-leg squat (eyes open), forward step (eyes open) before and after hypertonic saline injection (1ml, 5% NaCl) into the right gluteus medius. Range, standard deviation (SD), and velocity of the centre of pressure (CoP) in medio-lateral (ML) and anterior-posterior (AP) directions were considered. During the single-leg squat task, experimental hip pain was associated with significantly reduced ML range (-4[13]%, P=0.028), AP range (-14[21]%, P=0.005), APSD (-15[28]%, P=0.009), and AP velocity (-6[13]%, P=0.032), relative to the control condition, in both legs. No effect of pain was observed during single-leg standing and forward stepping. Significant between-leg differences in ML velocity were observed during the forward stepping task (P=0.034). Pain is a potentially modifiable patient-reported outcome in in iduals with hip problems. This study demonstrates that acute hip muscle pain alone, without interference of musculoskeletal pathology, does not lead to the same impairments in balance as exhibited in clinical populations with hip pathologies. This is the first step in understanding how and why balance is altered in painful hip pathologies.
Publisher: BMJ
Date: 09-06-2018
DOI: 10.1136/BJSPORTS-2018-099257
Abstract: Knee MRI is increasingly used to inform clinical management. Features associated with osteoarthritis are often present in asymptomatic uninjured knees however, the estimated prevalence varies substantially between studies. We performed a systematic review with meta-analysis to provide summary estimates of the prevalence of MRI features of osteoarthritis in asymptomatic uninjured knees. We searched six electronic databases for studies reporting MRI osteoarthritis feature prevalence (ie, cartilage defects, meniscal tears, bone marrow lesions and osteophytes) in asymptomatic uninjured knees. Summary estimates were calculated using random-effects meta-analysis (and stratified by mean age: vs ≥40 years). Meta-regression explored heterogeneity. We included 63 studies (5397 knees of 4751 adults). The overall pooled prevalence of cartilage defects was 24% (95% CI 15% to 34%) and meniscal tears was 10% (7% to 13%), with significantly higher prevalence with age: cartilage defect years 11% (6%to 17%) and ≥40 years 43% (29% to 57%) meniscal tear years 4% (2% to 7%) and ≥40 years 19% (13% to 26%). The overall pooled estimate of bone marrow lesions and osteophytes was 18% (12% to 24%) and 25% (14% to 38%), respectively, with prevalence of osteophytes (but not bone marrow lesions) increasing with age. Significant associations were found between prevalence estimates and MRI sequences used, physical activity, radiographic osteoarthritis and risk of bias. Summary estimates of MRI osteoarthritis feature prevalence among asymptomatic uninjured knees were 4%–14% in adults aged years to 19%–43% in adults ≥40 years. These imaging findings should be interpreted in the context of clinical presentations and considered in clinical decision-making.
Publisher: BMJ
Date: 30-06-2017
DOI: 10.1136/BJSPORTS-2016-097277
Abstract: Groin injury epidemiology has not previously been examined in an entire professional football league. We recorded and characterised time loss groin injuries sustained in the Qatar Stars League. Male players were observed prospectively from July 2013 to June 2015. Time loss injuries, in idual training and match play exposure were recorded by club doctors using standardised surveillance methods. Groin injury incidence per 1000 playing hours was calculated, and descriptive statistics used to determine the prevalence and characteristics of groin injuries. The Doha agreement classification system was used to categorise all groin injuries. 606 footballers from 17 clubs were included, with 206/1145 (18%) time loss groin injuries sustained by 150 players, at an incidence of 1.0/1000 hours (95% CI 0.9 to 1.1). At a club level, 21% (IQR 10%–28%) of players experienced groin injuries each season and 6.6 (IQR 2.9–9.1) injuries were sustained per club per season. Of the 206 injuries, 16% were minimal (1–3 days), 25% mild (4–7 days), 41% moderate (8–28 days) and 18% severe ( days), with a median absence of 10 days/injury (IQR 5–22 days). The median days lost due to groin injury per club was 85 days per season (IQR 35–215 days). Adductor-related groin pain was the most common entity (68%) followed by iliopsoas (12%) and pubic-related (9%) groin pain. Groin pain caused time loss for one in five players each season. Adductor-related groin pain comprised 2/3 of all groin injuries. Improving treatment outcomes and preventing adductor-related groin pain has the potential to improve player availability in professional football.
Publisher: BMJ
Date: 07-10-2021
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.JOCA.2012.07.011
Abstract: The study aimed to (1) assess whether higher vasti (VASTI), gluteus medius (GMED), gluteus maximus (GMAX) and gluteus minimus (GMIN) forces are associated with participant characteristics (lower age, male gender) and clinical characteristics (lower radiographic disease severity, lower symptom severity and higher walking speed) and (2) determine whether hip and knee muscle forces are lower in people with patellofemoral joint (PFJ) osteoarthritis (OA) compared to those without PFJ OA. Sixty participants with PFJ OA and 18 (asymptomatic, no radiographic OA) controls ≥40 years were recruited from the community or via referrals. A three-dimensional musculoskeletal model was used in conjunction with optimisation theory to calculate lower-limb muscle forces during walking. Associations of peak muscle forces with participant and clinical characteristics were conducted using Pearson's r or independent t-tests and between-group comparisons of mean peak muscle forces performed with walking speed as a covariate. Peak muscle forces were not significantly associated with participant, symptomatic or radiographic-specific characteristics. Faster walking speed was associated with higher VASTI muscle force in the PFJ OA (r = 0.495 P < 0.001) and control groups (r = 0.727 P = 0.001) and higher GMAX muscle force (r = 0.593 P = 0.009) in the control group only. In iduals with PFJ OA (N = 60) walked with lower GMED and GMIN muscle forces than controls (N = 18): GMED, mean difference 0.15 [95% confidence interval (CI): 0.01 to 0.29] body weight (BW) GMIN, 0.03 [0.01 to 0.06] BW. No between-group differences were observed in VASTI or GMAX muscle force: VASTI, 0.10 [-0.11 to 0.31] BW GMAX, 0.01 [-0.11 to 0.09] BW. In iduals with PFJ OA ambulate with lower peak hip abductor muscle forces than their healthy counterparts.
Publisher: Springer Science and Business Media LLC
Date: 11-01-2021
DOI: 10.1186/S12891-020-03919-6
Abstract: Guided rehabilitation beyond 6-months is rare following anterior cruciate ligament reconstruction (ACLR), despite high prevalence of unacceptable symptoms and quality of life (QoL). Our primary aim was to determine the feasibility of a randomised controlled trial (RCT) evaluating a physiotherapist-guided intervention for in iduals 1-year post-ACLR with persistent symptoms. Our secondary aim was to determine if a worthwhile treatment effect could be observed for the lower-limb focussed intervention (compared to the trunk-focussed intervention), for improvement in knee-related QoL, symptoms, and function. Participant- and assessor-blinded, pilot feasibility RCT. Participant eligibility criteria: i) 12–15 months post-ACLR ii) 87.5/100 on the Knee injury and Osteoarthritis Outcome Score (KOOS) QoL subscale and either a one-leg rise test 22 repetitions, single-hop 90% limb symmetry or Anterior Knee Pain Scale 87/100. Participants were randomised to lower-limb or trunk-focussed focussed exercise and education. Both interventions involved 8 face-to-face physiotherapy sessions over 16-weeks. Feasibility was assessed by eligibility rate ( 1 in 3 screened), recruitment rate ( 4 participants/month), retention ( 20% drop-out), physiotherapy attendance and unsupervised exercise adherence ( 80%). Between-group differences for knee-related QoL (KOOS-QoL, ACL-QoL), symptoms (KOOS-Pain, KOOS-Symptoms), and function (KOOS-Sport, functional performance tests) were used to verify that the worthwhile effect (greater than the minimal detectable change for each measure) was contained within the 95% confidence interval. 47% of those screened were eligible, and 27 participants (3 participants/month 48% men, 34±12 years) were randomised. Two did not commence treatment, and two were lost to follow-up (16% drop-out). Physiotherapy attendance was 80% for both groups but reported adherence to unsupervised exercise was low ( 55%). Both interventions had potentially worthwhile effects for KOOS-QoL and ACL-QoL, while the lower-limb focussed intervention had potentially greater effects for KOOS-Sport, KOOS-Pain, and functional performance. A larger-scale RCT is warranted. All feasibility criteria were met, or reasonable recommendations could be made to achieve the criteria in future trials. Strategies to increase recruitment rate and exercise adherence are required. The potential worthwhile effects for knee-related QoL, symptoms, and function indicates a fully-powered RCT may detect a clinically meaningful effect. Prospectively registered ( ACTRN12616000564459 ).
Publisher: BMJ
Date: 14-12-2022
Publisher: Springer Science and Business Media LLC
Date: 28-02-2023
DOI: 10.1007/S00167-017-4810-5
Abstract: Poor knee function after anterior cruciate ligament reconstruction (ACLR) may increase the risk of future knee symptoms and knee osteoarthritis via abnormal knee joint loading patterns, particularly during high-impact activity. This study aimed to assess the relationship between poor self-reported or clinically measured knee function and knee moments/vertical ground reaction force (vGRF) in in iduals following ACLR. 61 participants (mean 16.5 ± 3 months following ACLR, 23 women) completed a patient-reported knee function questionnaire and three hop tests (% of uninvolved limb). Participants were ided into satisfactory and poor knee function groups (poor < 85% patient-reported knee function and/or < 85% hop test symmetry). The knee biomechanics of both groups were assessed with three-dimensional motion analysis during the stance phase of overland running at self-selected speeds, and the association between knee function and knee moments was assessed using analysis of covariance with running speed as a covariate. Participants with poor knee function (n = 30) ran with significantly smaller peak knee flexion moments (moderate effect size 0.7, p = 0.03) and significantly smaller peak vGRFs (large effect size 1.0, p = 0.002) compared to those with satisfactory knee function (n = 31). No significant differences were observed for knee adduction and knee external rotation moments or knee kinematics. In iduals following ACLR with poor self-reported knee function and/or hop test performance demonstrate knee moments during running that may be associated with lower knee joint contact forces. These findings provide greater understanding of the relationship between knee biomechanics during running and clinical assessments of knee function. III. Cross-sectional study.
Publisher: Springer Science and Business Media LLC
Date: 25-01-2017
Publisher: JMIR Publications Inc.
Date: 02-03-2017
DOI: 10.2196/RESPROT.7083
Publisher: BMJ
Date: 31-03-2014
DOI: 10.1136/BJSPORTS-2013-093305
Abstract: To evaluate and synthesise the literature on hip strength among patients with patellofemoral pain (PFP) to address the following: (1) differentiate between hip strength as a risk factor and associated deficit in PFP (2) describe hip strength in men and women with PFP across different age ranges (3) investigate the effects of hip strengthening on biomechanical knee variables associated with PFP development. MEDLINE, CINAHL, Web of Science, SportDiscus and Google Scholar were searched in November 2013 for studies investigating hip strength among patients with PFP. Two reviewers independently assessed papers for inclusion and quality. Means and SDs were extracted from each included study to allow effect size calculations and comparisons of results. Moderate-to-strong evidence from prospective studies indicates no association between isometric hip strength and risk of developing PFP. Moderate evidence from cross-sectional studies indicates that men and women with PFP have lower isometric hip musculature strength compared to pain-free in iduals. Limited evidence indicates that adolescents with PFP do not have the same strength deficits as adults with PFP. This review highlights a possible discrepancy between prospective and cross-sectional research. Cross-sectional studies indicate that adult men and women with PFP appear to have lower hip strength compared to pain-free in iduals. Contrary to this, a limited number of prospective studies indicate that there may be no association between isometric hip strength and risk of developing PFP. Therefore, reduced hip strength may be a result of PFP rather than the cause.
Publisher: BMJ
Date: 25-02-2014
Publisher: Wiley
Date: 23-03-2018
DOI: 10.1002/JOR.23883
Abstract: This study quantified the contributions by muscular, gravitational and inertial forces to the ground reaction force (GRF) and external knee adduction moment (EKAM) for knee osteoarthritis (OA) patients and controls walking at similar speeds. Gait data for 39 varus mal-aligned medial knee OA patients and 15 controls were input into musculoskeletal models to calculate the contributions of in idual muscles and gravity to the fore-aft (progression), vertical (support), and mediolateral (balance) GRF, and the EKAM. The temporal patterns of contributions to GRF and EKAM were similar between the groups. Magnitude differences in GRF contributions were small but some reached significance. Peak GRF contributions were lower in patients except hamstrings in early-stance progression (p < 0.001) and gastrocnemius in late-stance progression (p < 0.001). Both EKAM peaks were higher in patients, due mainly to greater adduction contribution from gravity (p < 0.001) at the first peak, and lower abduction contributions from soleus (p < 0.001) and gastrocnemius (p < 0.001) at the second peak. Gluteus medius contributed most to EKAM in both groups, but was higher in patients during mid-stance only (p < 0.001). Differences in GRF contributions were attributed to altered quadriceps-hamstrings action as well as compensatory adaptation of the ankle plantarflexors to reduced gluteus medius action. The large effect of varus mal-alignment on the frontal-plane moment arms of the gravity, soleus, and gastrocnemius GRF contributions about the knee explained greater patient EKAM. Our results shed further light on how the EKAM contributes to altered knee-joint loads in OA and why some interventions may affect different portions of the EKAM waveform. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Publisher: Oxford University Press (OUP)
Date: 16-12-2003
Publisher: Center for Open Science
Date: 25-01-2023
Abstract: The primary objective of this review is to critically appraise, compare and summarize the quality of the measurement properties of functional performance tests assessing physical function in persons with ACL or meniscus injury. A secondary objective is to critically appraise, compare and summarize the quality of the measurement properties of muscle strength tests assessing knee extensor or flexor muscle strength in persons with ACL or meniscus injury.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.PTSP.2018.06.006
Abstract: The aim of this systematic review is to describe QoL in in iduals with PFP, and determine the impact of PFP interventions on QoL. Five databases were searched for studies reporting QoL in in iduals with PFP, with mean age under 50 years. Data were pooled based on QoL tool (e.g. Knee Injury and Osteoarthritis Outcome Score [KOOS] QoL subscale, Short-Form 36 item health survey [SF-36]) using random-effects models, or through narrative synthesis where inadequate data were available. In iduals with PFP, had worse KOOS-QOL scores (pooled mean: 47[95% CI: 34 to 61] and health-related QoL (pooled SF-36 PCS and MCS: 47[95% CI: 41 to 53] and 54[95% CI: 47 to 62], respectively) compared with pain-free controls and population norms. Physical interventions were associated with improvements in knee- and health-related QoL in in iduals with PFP in repeated measures studies. However, the effect of physical interventions compared to a control treatment was conflicting. In iduals with PFP aged under 50 years, have markedly reduced knee- and health-related QoL compared to pain-free controls and population norms. Knee- and health-related QoL may improve following intervention, but it is unclear if these improvements are greater than that which occur in a control group.
Publisher: BMJ
Date: 06-2005
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.PTSP.2019.08.010
Abstract: To (i) compare objective function in a range of tasks between people with and without patellofemoral pain (PFP) and (ii) evaluate the relationship of objective function with hip muscle capacity and self-reported function in people with PFP. Cross-sectional. Laboratory. Thirty-two physically active people (16 with PFP and 16 controls). Functional assessments included stair climbing (time), single-legged chair stand (repetitions), step down (repetitions), forward hop for distance and side hop (repetitions). Hip abductor and extensor capacity assessments included power, endurance, isometric and dynamic strength. Self-reported function included the Kujala scale and Patellofemoral sub-scale of the Knee injury and Osteoarthritis Outcome Score (KOOS-PF). The PFP group was 15% slower climbing stairs (effect size [ES] = 0.90), performed 12% fewer chair stands (ES = 0.62) and forward hopped 20% shorter (ES = 0.79) compared to controls. Lower hip muscle strength and power correlated with lower objective function (r = 0.52-0.78). Lower Kujala scores correlated with longer stair climbing time (r = -0.53). People with PFP have objective functional impairments, that are associated with reduced hip muscle capacity, indicating progressive resistance training may be beneficial. Absence of a strong correlation between self-reported, and objective, function indicates assessment of both when treating people with PFP is warranted.
Publisher: Springer Science and Business Media LLC
Date: 02-08-2020
DOI: 10.1186/S13047-020-00417-9
Abstract: Patellofemoral pain (PFP) is a common cause of knee pain in adolescents, but there are limited evidence-based treatment options for this population. Foot orthoses can improve pain and function in adults with PFP, and may be effective for adolescents. The primary aim of this study is to determine the feasibility of conducting a full-scale randomised controlled trial (RCT) evaluating the effects of contoured foot orthoses on knee pain severity and patient-perceived global change, compared to flat shoe insoles, in adolescents with PFP. The secondary aim is to provide an estimate of treatment effects for foot orthoses, compared to flat insoles, in adolescents with PFP. This randomised, controlled, participant- and assessor-blinded, feasibility trial has two parallel groups. Forty adolescents (aged 12–18 years) with clinical symptoms of PFP will be recruited from Queensland, Australia. Participants will be randomised to receive either prefabricated contoured foot orthoses or flat shoe insoles. Both interventions will be fit by a physiotherapist, and worn for 3 months. Feasibility will be evaluated through assessing willingness of volunteers to enrol, number of eligible participants, recruitment rate, adherence with the study protocol, adverse effects, success of blinding, and drop-out rate. Secondary outcomes will evaluate knee-related pain, symptoms, function, quality of life, global rating of change, patient acceptable symptom state, and use of co-interventions, at 6 weeks and 3 months. Primary outcomes will be reported descriptively, while estimates of standard deviation and between-group differences (with 95% confidence intervals) will be reported for secondary outcomes. Findings of this study will inform the feasibility of a full-scale RCT investigating the efficacy of contoured foot orthoses in adolescents with PFP. This full-scale study is necessary to improve the evidence base for management of adolescent PFP, and enhance outcomes for this population. ACTRN12619000957190 .
Publisher: Wiley
Date: 27-07-2015
DOI: 10.1016/J.PMRJ.2015.07.004
Abstract: To evaluate single-leg squat performance 1-2 years after arthroscopy for intra-articular hip pathology compared with control subjects and the nonsurgical limb, and to investigate whether single-leg squat performance on the operated limb was associated with hip muscle strength. Cross-sectional study. Private physiotherapy clinic and university laboratory. Thirty-four participants (17 women, 36.7 ± 12.6 years) 1-2 years after hip arthroscopy and 34 gender-matched control subjects (17 women, 33.1 ± 11.9 years). Participants performed single-leg squats using a standardized testing procedure. Squat performance was captured using video. Video footage was uploaded and reformatted for analyses. Hip muscle strength was measured with handheld dynamometry using reliable methods. Frontal plane pelvic obliquity, hip adduction, and knee valgus were measured. Repeated measures analysis of variance evaluated between-group differences, with limb as a within-subjects factor (surgical versus nonsurgical) and gender as a between-subjects factor (P .05). One to 2 years after hip arthroscopy, deficits in single-leg squat performance exist that have the potential to increase hip joint impingement and perpetuate postoperative symptoms. Rehabilitation after hip arthroscopy should target retraining in functional single-leg positions.
Publisher: Wiley
Date: 02-2021
DOI: 10.1002/ACR.24098
Abstract: To determine the feasibility of a full-scale randomized controlled trial (RCT) comparing foot orthoses and footwear to footwear alone in in iduals with patellofemoral (PF) osteoarthritis (OA). This 4-month, parallel, 2-arm pilot trial took place in Brisbane, Queensland and Hobart, Tasmania (August 2014 to October 2016). Forty-six in iduals with PF OA were randomized by concealed allocation to foot orthoses plus prescribed footwear (n = 24) or prescribed footwear alone (n = 22). Study feasibility was the primary outcome (e.g., recruitment rate, adherence, adverse events, dropout rate). Secondary outcomes included patient-reported outcome measures of pain, function, and quality of life. Effect sizes with 95% confidence intervals were calculated at the 4-month primary end point (standardized mean differences for between-group effects standardized response mean for within-group effects). From 782 volunteers, 47 were eligible (6%), and 46 participated. One participant withdrew (2%), and 1 (2%) was lost to follow-up. Intervention adherence was high for both groups (9-10 hours of wear per day). No serious adverse events were reported. More than 80% of questionnaires were completed at 4 months. Between-group effect sizes for patient-reported outcome measures were typically small, while moderate-to-large within-group response effects were observed in both groups. A full-scale RCT for PF OA is feasible with modifications to eligibility criteria. However, our observed small between-group effect sizes, combined with moderate-to-large within-group responses for both interventions, indicate that a full-scale trial is unlikely to find clinically meaningful differences. Secondary outcomes suggest that both interventions can be recommended for in iduals with PF OA.
Publisher: Elsevier BV
Date: 07-2011
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.JSAMS.2012.11.887
Abstract: This study investigated tests of hip muscle strength and functional performance. The specific objectives were to: (i) establish intra- and inter-rater reliability (ii) compare differences between dominant and non-dominant limbs (iii) compare agonist and antagonist muscle strength ratios (iv) compare differences between genders and (v) examine relationships between hip muscle strength, baseline measures and functional performance. Reliability study and cross-sectional analysis of hip strength and functional performance. In healthy adults aged 18-50years, normalised hip muscle peak torque and functional performance were evaluated to: (i) establish intra-rater and inter-rater reliability (ii) analyse differences between limbs, between antagonistic muscle groups and genders and (iii) associations between strength and functional performance. Excellent reliability (intra-rater ICC=0.77-0.96 inter-rater ICC=0.82-0.95) was observed. No difference existed between dominant and non-dominant limbs. Differences in strength existed between antagonistic pairs of muscles: hip abduction was greater than adduction (p<0.001) and hip ER was greater than IR (p<0.001). Men had greater ER strength (p=0.006) and hop for distance (p<0.001) than women. Strong associations were observed between measures of hip muscle strength (except hip flexion) and age, height, and functional performance. Deficits in hip muscle strength or functional performance may influence hip pain. In order to provide targeted rehabilitation programmes to address patient-specific impairments, and determine when in iduals are ready to return to physical activity, clinicians are increasingly utilising tests of hip strength and functional performance. This study provides a battery of reliable, clinically applicable tests which can be used for these purposes.
Publisher: BMJ
Date: 20-01-2023
DOI: 10.1136/BJSPORTS-2022-105736
Abstract: To investigate the prognostic capacity of in idual hop tests, hop test batteries and other unilateral functional performance tests following anterior cruciate ligament (ACL) injury. Systematic review with meta-analysis. Six databases searched up to June 2021. Studies reporting associations between unilateral lower-limb function (eg, hop tests) following ACL injury and future (≥3 months) knee-related outcomes. Of 42 included studies (13 150 participants), all assessed the single-forward hop test and 32 assessed a repeated-forward hop test (crossover hop, triple hop, 6m-timed hop), mostly within a year after ACL injury/reconstruction. Results of meta-analyses indicated that higher single-forward and repeated-forward hop limb symmetry were associated with higher odds of return-to-sport 1–3 years post-ACL reconstruction (OR 2.15 95% CI 1.30 to 3.54 OR 2.11 95% CI 1.23 to 3.60, respectively). Higher single-forward and repeated-forward hop limb symmetry was associated with better self-reported symptoms and function 1–37 years after ACL injury (OR 2.51 95% CI 1.62 to 3.88 OR 4.28 95% CI 1.65 to 11.08, respectively). Higher limb symmetry on a repeated-forward hop does not appear to be associated with higher odds of successful rehabilitation without ACL reconstruction (OR 1.51 95% CI 0.94 to 2.44). Achieving ≥90% limb symmetry on the single-forward hop was associated with reduced odds of knee osteoarthritis 5–37 years after ACL injury (OR 0.46 95% CI 0.23 to 0.94). Very low certainty evidence suggests single-forward and repeated-forward hop tests are prognostic indicators for important knee-related outcomes in in iduals after ACL injury and may help stratify in iduals at risk of poor outcomes to target rehabilitation interventions. CRD42018092197.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.JSAMS.2016.05.010
Abstract: To determine the normal profiles for hip strength and range of motion (ROM) in a professional football league in Qatar, and examine the effect of leg dominance, age, past history of injury, and ethnicity on these profiles. Cross-sectional cohort study. Participants included 394 asymptomatic, male professional football players, aged 18-40 years. Strength was measured using a hand held dynamometer with an eccentric test in side-lying for hip adduction and abduction, and the squeeze test in supine with 45° hip flexion. Range of motion measures included: hip internal and external rotation in 90° flexion, hip IR in prone, bent knee fall out and hip abduction in side-lying. Demographic information was collected and the effect on the profiles was analysed using linear mixed models with repeated measures. Strength values (mean±SD) were: adduction=3.0±0.6Nm/kg, abduction=2.6±0.4Nm/kg, adduction/abduction ratio=1.2±0.2, Squeeze test=3.6±0.8N/kg. Range of motion values: internal rotation in flexion=32±8°, external rotation=38±8°, internal rotation in prone=38±8°, bent knee fall out=13±4.4cm, abduction in side-lying=50±7.3°. Leg dominance had no clinically relevant effect on these profiles. Multivariate analysis demonstrated that age had a minor influence on squeeze strength (-0.03N/kg/year), external rotation (-0.30°/year) and abduction range (-0.19°/year) but past history of injury, and ethnicity did not. Normal values are documented for hip strength and range of motion that can be used as reference profiles in the clinical assessment, screening, and management of professional football players. Leg dominance, recent past injury history and ethnicity do not need to be accounted for when using these profiles for comparison purposes.
Publisher: Springer Science and Business Media LLC
Date: 15-02-2018
Publisher: SAGE Publications
Date: 15-10-2018
Abstract: Patellofemoral malalignment has been observed among people with patellofemoral pain (PFP) and may be associated with the presence of imaging features of osteoarthritis, symptoms, and function. To determine whether patellofemoral joint alignment and bony shape are associated with (1) cartilage, bone, and soft tissue morphological abnormalities defined on magnetic resonance imaging (MRI) and (2) reported symptoms and function among people with PFP. Cross-sectional study Level of evidence, 3. Participants (mean ± SD age, 30.2 ± 9.5 years range, 14-50 years 78 females, 58.6%) completed questionnaires regarding demographics, pain, symptoms, and function and underwent a 3-T MRI scan of their more symptomatic eligible knee. Structural MRI abnormalities were scored with the MOAKS (Magnetic Resonance Imaging Osteoarthritis Knee Score), and MRI alignment and shape were measured with standardized methods. Associations among MOAKS features, PFP symptoms, and alignment and shape measures were evaluated with regression analyses (α = .05). Minor cartilage defects were present in 22 (16.5%) participants, patellar osteophytes in 83 (62.4%), anterior femur osteophytes in 29 (21.8%), Hoffa synovitis in 81 (60.9%), and prefemoral fat pad synovitis in 49 (36.8%). A larger Insall-Salvati ratio was significantly associated with the presence of patellar osteophytes (odds ratio [OR], 51.82 95% CI, 4.20-640.01), Hoffa synovitis (OR, 60.37 95% CI, 4.66-782.61), and prefemoral fat pad synovitis (OR, 43.31 95% CI, 4.28-438.72) in the patellofemoral joint. A larger patellar tilt angle was significantly associated with the presence of minor cartilage defects (OR, 1.10 95% CI, 1.00-1.20), the presence of patellar osteophytes (OR 1.12 95%CI 1.02-1.22), and prefemoral fat pad synovitis (OR, 1.11 95% CI, 1.03-1.20) in the patellofemoral joint. Finally, a larger bisect offset was significantly associated with the presence of minor cartilage defects (OR, 1.05 95% CI, 1.00-1.11) and patellar osteophytes (OR, 1.07 95% CI, 1.01-1.14) in the patellofemoral joint. The majority of patellofemoral alignment measures were not associated with symptoms or function. For people with PFP, the presence of morphological abnormalities defined on MRI appears to be related to particular patellofemoral alignment measures, including higher Insall-Salvati ratio (indicating patella alta), larger patellar tilt angle (indicating greater lateral tilt), and larger bisect offset (indicating greater lateral displacement). Hardly any associations were found with symptoms or function. So there might be a distinct subgroup of PFP that is more prone to developing patellofemoral osteoarthritis later in life, as particular alignment measures seem to be associated with the presence of patellar osteophytes. Prospective studies are required to investigate the longitudinal relationship between alignment or bony shape and morphological abnormalities defined on MRI in this patient population.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.JOCA.2018.09.013
Abstract: The aims of this study were twofold: firstly, to compare hip abductor muscle volumes in in iduals with patellofemoral joint (PFJ) osteoarthritis (PFJ OA) against those of healthy controls and secondly, to determine whether hip muscle volumes and hip kinematics during walking are related in in iduals with PFJ OA and healthy controls. Fifty-one in iduals with PFJ OA and thirteen asymptomatic, age-matched healthy controls ≥40 years were recruited. Volumes of the gluteus medius, gluteus minimus and tensor fasciae latae were obtained from magnetic resonance (MR) images. Video motion capture was used to measure three-dimensional hip joint kinematics during overground walking. Significantly smaller gluteus medius (P = 0.017), gluteus minimus (P = 0.001) and tensor fasciae latae (P = 0.027) muscle volumes were observed in PFJ OA participants compared to controls. Weak correlations were observed between smaller gluteus minimus volume and larger hip flexion angle at contralateral heel strike (CHS) (r = -0.279, P = 0.038) as well as between smaller gluteus minimus volume and increased hip adduction angle at CHS (r = -0.286, P = 0.046). Reduced hip abductor muscle volume is a feature of PFJ OA and is associated with increased hip flexion and adduction angles during the late stance phase of walking for PFJ OA participants and healthy controls.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 02-2017
Abstract: Synopsis Although osteoarthritis (OA) has traditionally been considered a disease of older age, hip and knee OA can and does affect younger adults, with a profound impact on psychosocial well-being and work capacity. Obesity and a history of traumatic knee injury (eg, anterior cruciate ligament rupture and/or meniscal tear) are key risk factors for the accelerated development of knee OA, while structural hip deformities (including those contributing to femoroacetabular impingement syndrome) are strong predictors of early-onset hip OA. In view of these associations, rising rates of obesity and sports injuries are concerning, and may signal a future surge in OA incidence among younger people. Assessment of hip and knee OA in younger people should focus on a patient-centered history, comprehensive physical examination, performance-based measures, and patient-reported outcome measures to enable monitoring of symptoms and function over time. Referral for imaging should be reserved for people presenting with atypical signs or symptoms that may indicate diagnoses other than OA. Nonpharmacological approaches are core strategies for the management of hip and knee OA in younger people, and these include appropriate disease-related education, activity modification (including for work-related tasks), physical therapist- prescribed exercise programs to address identified physical impairments, and weight control or weight loss. High-quality evidence has shown no benefit of arthroscopy for knee OA, and there are no published clinical trials to support the use of hip arthroscopy for OA. Referral for joint-conserving or joint replacement surgery should be considered when nonpharmacological and pharmacological management strategies are no longer effective. J Orthop Sports Phys Ther 2017 (2):67-79. doi:10.2519/jospt.2017.7286.
Publisher: SAGE Publications
Date: 03-2007
Abstract: Diagnosis of patellar tendinopathy is based primarily on clinical examination however, it is commonplace to image the patellar tendon for diagnosis confirmation, with the imaging modalities of choice being magnetic resonance imaging (MRI) and ultrasonography (US). The comparative accuracy of these modalities has not been established. Magnetic resonance imaging and US have good ( %) accuracy and show substantial agreement in confirming clinically diagnosed patellar tendinopathy. Cohort study (diagnosis) Level of evidence, 2. Magnetic resonance imaging and US (gray scale [GS-US] and color Doppler [CD-US]) features of 30 participants with clinically diagnosed patellar tendinopathy and 33 activity-matched, asymptomatic participants were prospectively compared. Accuracy, sensitivity, specificity, positive and negative predictive values, and the likelihood of positive and negative test results were determined for each technique. The accuracy of MRI, GS-US, and CD-US was 70%, 83%, and 83%, respectively (P = .04 MRI vs GS-US). The likelihood of positive MRI, GS-US, and CD-US was 3.1, 4.8, and 11.6, respectively. The MRI and GS-US had equivalent specificity (82% vs 82% P = 1.00) however, the sensitivity of GS-US was greater than MRI (87% vs 57% P = .01). Sensitivity (70% vs 87% P = .06) and specificity (94% vs 82% P = .10) did not differ between CD-US and GS-US. Ultrasonography was more accurate than MRI in confirming clinically diagnosed patellar tendinopathy. GS-US and CD-US may represent the best combination for confirming clinically diagnosed patellar tendinopathy because GS-US had the greatest sensitivity, while a positive CD-US test result indicated a strong likelihood an in idual was symptomatic.
Publisher: BMJ
Date: 14-06-2016
DOI: 10.1136/BJSPORTS-2016-096152
Abstract: Femoroacetabular impingement (FAI) and associated pathologies are associated with pain and reduced quality of life. Physical impairments can be associated with worse symptoms and may be an important target of rehabilitation programmes in this patient group. Knowledge regarding physical impairments in people with symptomatic FAI is limited. In adults aged 18–50 years with symptomatic FAI: (1) to identify physical impairments in range of motion (ROM), hip muscle function and functional tasks (2) to compare physical impairments with healthy controls and (3) to evaluate the effects of interventions targeting physical impairments. Systematic review. A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The modified Downs and Black checklist was used for quality appraisal. Studies of adults aged 18–50 years with symptomatic FAI that examined ROM, hip muscle function and functional tasks were included. Standardised mean differences were calculated where possible or best evidence synthesis and study conclusions were presented. Twenty-two studies fulfilled all inclusion criteria. Methodological quality was varied. Results for hip joint ROM differences between people with symptomatic FAI compared and control subjects were varied. People with symptomatic FAI demonstrated some deficits in hip muscle strength and reduced balance on one leg when compared with control subjects. For hip joint ROM and hip muscle strength results for within-group differences between preintervention and postintervention time points were limited and inconclusive. No randomised controlled trials evaluated the effect of different types of interventions for symptomatic patients with symptomatic FAI. People with symptomatic FAI demonstrate impairments in some hip muscle strength and single leg balance. This information may assist therapists in providing targeted rehabilitation programmes for people with FAI and associated pathology. Further research is needed to determine whether symptomatic FAI affects other aspects of functional performance and to evaluate whether targeted interventions are effective in symptomatic FAI. This information may assist therapists in providing targeted rehabilitation programmes for people with symptomatic FAI.
Publisher: BMJ
Date: 29-01-2007
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.PTSP.2019.03.010
Abstract: To determine eccentric knee flexor strength in elite female Australian Rules Football (ARF) players with and without a history of unilateral anterior cruciate ligament reconstruction (ACLR) using an ipsilateral semitendinosus graft. Case-control. Elite ARF Women's competition. Eighty-four elite female ARF players (mean age, 25 ± 4.9 years height, 1.71 ± 0.73 m weight, 67 kg ± 7.4 kg) with (n = 12) and without (n = 72) a history of unilateral ACLR in the previous 10 years. Peak eccentric knee flexor force during the Nordic hamstring exercise (NHE). Players with a history of unilateral ACLR displayed lower levels of eccentric knee flexor strength in their surgically reconstructed limb than their uninjured contralateral limb (mean difference -53.77 N, 95% CI = -85.06 to -24.27, d = -0.51) and compared to the limbs of players with no history of injury (mean difference = -46.32 N, 95% CI = -86.65 to -11.13, d = -0.73). Elite female ARF players with a history of unilateral ACLR display deficits in eccentric knee flexor strength in their surgically reconstructed limb for up to 10 years following surgery.
Publisher: Wiley
Date: 30-04-2021
DOI: 10.1002/JOR.25053
Abstract: Altered biomechanics are frequently observed following anterior cruciate ligament reconstruction (ACLR). Yet, little is known about knee‐joint loading, particularly in the patellofemoral‐joint, despite patellofemoral‐joint osteoarthritis commonly occurring post‐ACLR. This study compared knee‐joint reaction forces and impulses during the landing phase of a single‐leg forward hop in the reconstructed knee of people 12‐24 months post‐ACLR and uninjured controls. Experimental marker data and ground forces for 66 participants with ACLR (28 ± 6 years, 78 ± 15 kg) and 33 uninjured controls (26 ± 5 years, 70 ± 12 kg) were input into scaled‐generic musculoskeletal models to calculate joint angles, joint moments, muscle forces, and the knee‐joint reaction forces and impulses. The ACLR group exhibited a lower peak knee flexion angle (mean difference: −6° 95% confidence interval: [−10°, −2°]), internal knee extension moment (−3.63 [−5.29, −1.97] percentage of body weight × participant height (body weight [BW] × HT), external knee adduction moment (‐1.36 [−2.16, −0.56]% BW × HT) and quadriceps force (−2.02 [−2.95, −1.09] BW). The ACLR group also exhibited a lower peak patellofemoral‐joint compressive force (−2.24 [−3.31, −1.18] BW), net tibiofemoral‐joint compressive force (−0.74 [−1.20, 0.28] BW), and medial compartment force (−0.76 [−1.08, −0.44] BW). Finally, only the impulse of the patellofemoral‐joint compressive force was lower in the ACLR group (−0.13 [−0.23, −0.03] body weight‐seconds). Lower compressive forces are evident in the patellofemoral‐ and tibiofemoral‐joints of ACLR knees compared to uninjured controls during a single‐leg forward hop‐landing task. Our findings may have implications for understanding the contributing factors for incidence and progression of knee osteoarthritis after ACLR surgery.
Publisher: Elsevier BV
Date: 2021
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.PTSP.2018.11.003
Abstract: To evaluate differences in clinical measures of hip abductor and extensor capacity (strength, endurance and power) in people with patellofemoral pain (PFP) compared to asymptomatic controls. Cross-sectional. Laboratory. Thirty-two physically active people (16 with PFP and 16 controls). Strength was evaluated isometrically using a hand-held dynamometer and dynamically using 10 repetitions maximum (10RM) tests. Power was assessed using a linear position transducer. Endurance was assessed using maximum number of repetitions. The PFP group had significant deficits compared to the control group in isometric strength (21-25%) for hip abduction (ES = 0.98) and extension (ES = 0.85) in 10RM (15-18%) for hip abduction (ES = 0.72) and extension (ES = 0.85) and in power (24-31%) for hip abduction (ES = 0.80), and extension (ES = 0.94). No difference was identified for hip abduction and extension in endurance tests. Clinical assessments can identify deficits in isometric and dynamic hip strength, as well as power in people with PFP. Hip muscle capacity deficits in people with PFP including strength and power highlight a potential need for more progressive resistance training in this population.
Publisher: Springer Science and Business Media LLC
Date: 27-01-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Publisher: BMJ
Date: 21-05-2019
Publisher: BMJ
Date: 25-02-2014
Publisher: BMJ
Date: 21-03-2014
DOI: 10.1136/BJSPORTS-2013-093312
Abstract: This study aimed to describe chondropathy prevalence in adults who had undergone hip arthroscopy for hip pain. The relationships between chondropathy severity and (1) participant characteristics and (2) patient-reported outcomes (PROs) at initial assessment (∼18 months postsurgery) and over a further 12 months (∼30 months postsurgery) were evaluated. Finally, the relationships between chondropathy and coexisting femoroacetabular impingement (FAI) and labral pathology at the time of surgery were evaluated. 100 consecutive patients (36±12 years) who underwent hip arthroscopy 18 months previously participated. Hip Osteoarthritis and Disability Outcome Score (HOOS) and International Hip Outcome Tool (iHOT-33) data were collected prospectively at 18 months postsurgery and at 30 months postsurgery. Surgical data were collected retrospectively. Participants were grouped: Outerbridge grade 0, no chondropathy Outerbridge grade I-II, mild chondropathy Outerbridge III-IV, severe chondropathy. The presence of FAI or labral pathology was noted. The prevalence of chondropathy (≥grade I) at hip arthroscopy was 72%. Participants with severe chondropathy were significantly worse for all HOOS subscales and the iHOT-33 at 18 months postsurgery (HOOS-symptoms (p=0.017) HOOS-pain (p=0.024) HOOS-activity (p=0.009) HOOS-sport (p=0.004) HOOS-quality-of-life (p=0.006) iHOT-33 (p=0.013)) than those with no chondropathy. At 12-month follow-up, HOOS-quality-of-life in those without chondropathy was the only PRO that improved. Relative risk of coexisting chondropathy with labral pathology or FAI was 40%. Chondropathy was prevalent, and associated with increasing age, coexisting labral pathology or FAI. Severe chondropathy was associated with worse pain and function at 18 months postsurgery. Little improvements were observed in participants over a further 12 months, regardless of chondropathy status.
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.CLINBIOMECH.2012.02.007
Abstract: Excessive rearfoot eversion is thought to be a risk factor for patellofemoral pain syndrome development, based on theoretical rationale linking it to greater tibial internal rotation and hip adduction. This study aimed to establish the relationship of rearfoot eversion with tibial internal rotation and hip adduction during walking in in iduals with and without patellofemoral pain syndrome. Twenty-six in iduals with patellofemoral pain syndrome and 20 controls (18-35years) participated. Each underwent instrumented three-dimensional motion analysis during over-ground walking. Pearson's correlation coefficients (r) were calculated to establish the relationship of rearfoot eversion with tibial internal rotation and hip adduction (peak and range of motion). Greater peak rearfoot eversion was associated with greater peak tibial internal rotation in the patellofemoral pain syndrome group (r=0.394, P=0.046). Greater rearfoot eversion range of motion was associated with greater hip adduction range of motion in the patellofemoral pain syndrome (r=0.573, P=0.002) and control (r=0.460, P=0.041) groups and greater peak hip adduction in the control group (r=0.477, P=0.033). Associations between greater rearfoot eversion and greater hip adduction indicate that interventions targeted at the foot or hip in in iduals with patellofemoral pain syndrome may have similar overall effects on lower limb motion and clinical outcomes. The relationship between rearfoot eversion and tibial internal rotation identified in the patellofemoral pain syndrome group may be related to aetiology. However, additional prospective research is needed to confirm this.
Publisher: Springer Science and Business Media LLC
Date: 08-05-2007
DOI: 10.1038/NCPRHEUM0503
Publisher: BMJ
Date: 03-2009
DOI: 10.1136/BMJ.A1735
Abstract: To compare the clinical efficacy of foot orthoses in the management of patellofemoral pain syndrome with flat inserts or physiotherapy, and to investigate the effectiveness of foot orthoses plus physiotherapy. Prospective, single blind, randomised clinical trial. Single centre trial within a community setting in Brisbane, Australia. 179 participants (100 women) aged 18 to 40 years, with a clinical diagnosis of patellofemoral pain syndrome of greater than six weeks' duration, who had no previous treatment with foot orthoses or physiotherapy in the preceding 12 months. Six weeks of physiotherapist intervention with off the shelf foot orthoses, flat inserts, multimodal physiotherapy (patellofemoral joint mobilisation, patellar taping, quadriceps muscle retraining, and education), or foot orthoses plus physiotherapy. Global improvement, severity of usual and worst pain over the preceding week, anterior knee pain scale, and functional index questionnaire measured at 6, 12, and 52 weeks. Foot orthoses produced improvement beyond that of flat inserts in the short term, notably at six weeks (relative risk reduction 0.66, 99% confidence interval 0.05 to 1.17 NNT 4 (99% confidence interval 2 to 51). No significant differences were found between foot orthoses and physiotherapy, or between physiotherapy and physiotherapy plus orthoses. All groups showed clinically meaningful improvements in primary outcomes over 52 weeks. While foot orthoses are superior to flat inserts according to participants' overall perception, they are similar to physiotherapy and do not improve outcomes when added to physiotherapy in the short term management of patellofemoral pain. Given the long term improvement observed in all treatment groups, general practitioners may seek to hasten recovery by prescribing prefabricated orthoses. Australian Clinical Trials Registry ACTRN012605000463673 and ClinicalTrials.gov NCT00118521.
Publisher: Wiley
Date: 27-06-2017
DOI: 10.1002/ACR.23110
Abstract: To determine the comparative prevalence, associations with selected patient characteristics, and clinical outcomes of medial and lateral compartment patellofemoral (PF) joint osteoarthritis (OA). Information was collected by questionnaires, clinical assessment, and radiographs from 745 eligible community‐dwelling symptomatic adults age ≥50 years. PF joint space narrowing (JSN) and osteophytes were scored from skyline radiographs using the Osteoarthritis Research Society International atlas. Multilevel models were used to assess associations of compartmental PF joint OA with age, sex, body mass index (BMI) and varus–valgus malalignment, while median regression was used to examine associations with clinical outcomes (current pain intensity on a numeric rating scale [0–10] and the function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index [0–68]). Isolated lateral PF joint OA was more common than isolated medial PF joint OA, particularly at higher severity thresholds. Irrespective of severity threshold, age (≥2 odds ratio [OR] 1.19 [95% confidence interval (95% CI) 1.12, 1.26]), BMI (≥2 OR 1.15 [95% CI 1.07, 1.24]), and valgus malalignment (≥2 OR 2.58 [95% CI 1.09, 6.07]) were associated with increased odds of isolated lateral JSN, but isolated medial JSN was only associated with age (≥2 OR 1.20 [95% CI 1.14, 1.27]). The pattern of association was less clear for PF joint osteophytes. Isolated lateral PF joint OA, defined by JSN or osteophytes, was associated with higher pain scores than isolated medial PF joint OA, but these differences were modest and were not significant. A similar pattern of association was seen for functional limitation but only when PF joint OA was defined by JSN. Isolated lateral PF joint OA is more common than isolated medial PF joint OA, and it is more consistently associated with established OA risk factors. It is also associated with higher, but clinically nonsignificant, pain and function scores than isolated medial PF joint OA, particularly when PF joint OA is defined using JSN.
Publisher: Springer Science and Business Media LLC
Date: 21-09-2010
DOI: 10.1007/S00421-010-1647-8
Abstract: Estrogen receptors in skeletal muscle suggest a tissue-based mechanism for influencing neuromuscular control. This has important physiological implications for both eumenorrheic women with fluctuating estrogen levels and those with constant and attenuated estrogen levels, i.e., women using the monophasic oral contraceptive pill (MOCP). This study examined the effects of endogenous plasma estrogen levels on leg stiffness (K (LEG)) and foot center of pressure (COP) during hopping. Nineteen females (Age = 28.0 ± 4.2 years, Ht = 1.67 ± 0.07 m, Mass = 61.6 ± 6.8 kg) who had been using the MOCP for at least 12 months together with 19 matched, female, non-MOCP users (Age = 31.9 ± 7.3 years, Ht = 1.63 ± 0.05 m, Mass = 62.5 ± 5.9 kg) participated. Non-MOCP users were tested at the time of lowest (menstruation) and highest (≈ ovulation) estrogen whilst MOCP users were tested at Day 1 and Day 14 of their cycle. At each test session, K (LEG) (N m(-1) kg(-1)) and foot COP path length (mm) and path velocity (mm s(-1)) were determined from ground reaction force data as participants hopped at 2.2 Hz on a force plate. Statistical analysis revealed no significant (p < 0.05) differences for K (LEG). In contrast, significantly higher COP path length (30%) and COP path velocity (25%) were identified at ≈ ovulation compared to menstruation in the non-MOCP users. Whilst there was no evidence of an estrogen-induced effect on K (LEG) significantly elevated estrogen at ≈ ovulation presumably increased extensibility of connective tissue and/or diminished neuromuscular control. Consistent lower limb dynamics of MOCP users demands less reliance on acutely modified neuromuscular control strategies during dynamic tasks and may explain the lower rate of lower limb musculoskeletal injuries in this population compared to non-MOCP users.
Publisher: BMJ
Date: 20-01-2020
Publisher: BMJ
Date: 19-10-2017
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 11-2016
Abstract: Study Design Cross-sectional study. Background Functional task performance in patients with chondrolabral pathology following hip arthroscopy is unknown. Objectives To investigate in people with chondrolabral pathology following hip arthroscopy (1) the bilateral differences in functional task performance compared to controls, (2) the association of hip muscle strength with functional task performance, and (3) the association of functional task performance scores with good outcome, as measured by International Hip Outcome Tool score. Methods Seventy-one patients who had unilateral hip arthroscopy for hip pain and 60 controls were recruited. Patient-reported outcomes included the 4 subscales of the International Hip Outcome Tool. Hip muscle strength measures included abduction, adduction, extension, flexion, external rotation, and internal rotation. Functional tasks assessed included the single hop test, the side bridge test, and the single-leg rise test. For aim 1, analyses of covariance tests were used. For aim 2, stepwise multiple linear regression analyses were used. For aim 3, receiver operating characteristic curve analyses were used. Results Compared to controls, the chondrolabral pathology group had significantly worse performance on both legs for each of the functional tasks (P<.001). Greater hip abduction strength was moderately associated with better performance on functional tasks in the chondrolabral pathology group (adjusted R
Publisher: American Physiological Society
Date: 10-2008
DOI: 10.1152/JAPPLPHYSIOL.01281.2007
Abstract: The purpose of this study was to elucidate the effect of normal fluctuating [non-monophasic oral contraceptive pill (MOCP) users] and low, consistent (MOCP users) endogenous plasma estrogen levels on the strain behavior of the Achilles tendon in vivo. Twenty women (age 28.0 ± 4.2 yr, height 1.67 ± 0.07 m, mass 61.6 ± 6.8 kg) who had been using the MOCP for at least 12 mo together with 20 matched women who were non-MOCP users (age 31.9 ± 7.3 yr, height 1.63 ± 0.05 m, mass 62.5 ± 5.9 kg) participated in this study. Non-MOCP users were tested at the time of lowest (menstruation) and highest (≈ovulation) estrogen, whereas MOCP users, who exhibited constant and attenuated endogenous estrogen levels, were tested at day 1 and day 14 of their cycle. At each test session, maximal isometric plantarflexion efforts were performed on a calf-raise apparatus while synchronous real-time ultrasonography of the triceps surae aponeurosis was recorded. Achilles tendon strain (%) was calculated by iding tendon displacement during plantarflexion by resting tendon length. Repeated-measures ANOVA revealed a significant ( P 0.05) main effect of subject group with significantly lower Achilles strain (25.5%) in the MOCP users compared with the non-MOCP users. In conclusion, acute fluctuations in plasma estrogen across the menstrual cycle in non-MOCP users did not alter the strain behavior of the Achilles tendon. Conversely, long-term exposure to attenuated estrogen in MOCP users resulted in a decrease in Achilles tendon strain, which is thought to be attributed to the effects of endogenous estrogen on collagen synthesis. These findings have a number of important functional and clinical implications.
Publisher: Elsevier BV
Date: 08-2002
Abstract: To determine if the electromyographic onset of vastus lateralis and kinematic knee joint motion in in iduals with knee osteoarthritis (OA) differs from that of asymptomatic persons, during the task of stair stepping. Cross-sectional. University laboratory in Australia. Twenty-five participants with symptomatic knee OA and 33 asymptomatic controls. Not applicable. Surface electromyography to determine the onset of vastus lateralis activity. Two-dimensional kinematic analysis of sagittal plane knee motion during stance phase of stair ascent and descent. Participants with knee OA showed delayed onset of vastus lateralis activity during stair descent (P<.05) but not ascent. Both groups displayed a similar total range of knee motion. However, during stair descent, participants with OA had less knee flexion during early stance (P<.05) than controls. In iduals with knee OA display altered quadriceps function and knee joint kinematics during stair descent. These impairments may have implications for force attenuation across the knee joint and warrant future investigation.
Publisher: BMJ
Date: 29-04-2017
DOI: 10.1136/BJSPORTS-2017-097515
Abstract: Patellofemoral osteoarthritis (PF OA) is more prevalent than previously thought and contributes to patient's suffering from knee OA. Synthesis of prevalence data can provide estimates of the burden of PF OA. This study aims to conduct a systematic review and meta-analysis on the prevalence of PF OA and structural damage based on radiography and MRI studies in different populations. We searched six electronic databases and reference lists of relevant cross-sectional and observational studies reporting the prevalence of PF OA. Two independent reviewers appraised methodological quality. Where possible, data were pooled using the following categories: radiography and MRI studies. Eighty-five studies that reported the prevalence of patellofemoral OA and structural damage were included in this systematic review. Meta-analysis revealed a high prevalence of radiographic PF OA in knee pain or symptomatic knee OA (43%), radiographic knee OA or at risk of developing OA (48%) and radiographic and symptomatic knee OA (57%) cohorts. The MRI-defined structural PF damage in knee pain or symptomatic population was 32% and 52% based on bone marrow lesion and cartilage defect, respectively. One half of people with knee pain or radiographic OA have patellofemoral involvement. Prevalence of MRI findings was high in symptomatic and asymptomatic population. These pooled data and the variability found can provide evidence for future research addressing risk factors and treatments for PF OA. PROSPERO systematic review protocol (CRD42016035649).
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JOCA.2015.04.024
Abstract: Patellofemoral joint osteoarthritis (PFJ OA) contributes considerably to knee OA symptoms. This study aimed to determine the efficacy of a PFJ-targeted exercise, education manual-therapy and taping program compared to OA education alone, in participants with PFJ OA. A randomised, participant-blinded and assessor-blinded clinical trial was conducted in primary-care physiotherapy. 92 people aged ≥40 years with symptomatic and radiographic PFJ OA participated. Physiotherapists delivered the PFJ-targeted exercise, education, manual-therapy and taping program, or the OA-education (control condition) in eight sessions over 12 weeks. Primary outcomes at 3-month (primary) and 9-month follow-up: (1) patient-perceived global rating of change (2) pain visual analogue scale (VAS) (100 mm) and (3) activities of daily living (ADL) subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS). 81 people (88%) completed the 3-month follow-up and data analysed on an intention-to-treat basis. Between-group baseline similarity for participant characteristics was observed. The exercise, education, manual-therapy and taping program resulted in more people reporting much improvement (20/44) than the OA-education group (5/48) (number needed to treat 3 (95% confidence interval (CI) 2 to 5)) and greater pain reduction (mean difference: -15.2 mm, 95% CI -27.0 to -3.4). No significant effects on ADL were observed (5.8 95% CI -0.6 to 12.1). At 9 months there were no significant effects for self-report of improvement, pain (-10.5 mm, 95% CI -22.7 to 1.8) or ADL (3.0, 95% CI -3.7 to 9.7). Exercise, education, manual-therapy and taping can be recommended to improve short-term patient rating of change and pain severity. However over 9-months, both options were equivalent. Australian New Zealand Clinical Trials Registry (ACTRN12608000288325): www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=82878.
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.BJPT.2021.05.003
Abstract: Efficacious injury prevention programs exist, yet translation to practice in real-world settings is poor. Little is known about how women playing elite team ball-sports perceive and experience injury prevention programs in practice. Understanding the end-user's (athlete's) perspective is essential to improve program uptake and adherence. To explore the perspectives and experiences of injury prevention practices in athletes from the elite Australian Football League for Women (AFLW). Convenience s le of 13 athletes from three AFLW clubs. Semi-structured interviews were audio-recorded and transcribed verbatim, analysed with a thematic analysis approach, and classified within the Socio-Ecological Model (SEM). Women playing elite Australian Football: (1) believe injury prevention programs have multiple aims and benefits, (2) perceive varying injury prevention practices between and within AFLW clubs, (3) believe injury prevention program adoption and implementation is complex and multi-factorial, and (4) think implementing injury prevention programs in the AFLW could be enhanced through education and resources. Mapping our results onto the SEM highlighted that athletes perceive multiple ecological levels (i.e. in idual, interpersonal, community, and organizational) are involved in sports injury prevention. Multi-level engagement strategies are required to enhance injury prevention program adoption and implementation and to maximise athlete adherence.
Publisher: BMJ
Date: 09-01-2018
Publisher: American Medical Association (AMA)
Date: 10-2014
Abstract: There is debate about benefits of acupuncture for knee pain. To determine the efficacy of laser and needle acupuncture for chronic knee pain. Zelen-design clinical trial (randomization occurred before informed consent), in Victoria, Australia (February 2010-December 2012). Community volunteers (282 patients aged ≥50 years with chronic knee pain) were treated by family physician acupuncturists. No acupuncture (control group, n = 71) and needle (n = 70), laser (n = 71), and sham laser (n = 70) acupuncture. Treatments were delivered for 12 weeks. Participants and acupuncturists were blinded to laser and sham laser acupuncture. Control participants were unaware of the trial. Primary outcomes were average knee pain (numeric rating scale, 0 [no pain] to 10 [worst pain possible] minimal clinically important difference [MCID], 1.8 units) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0 [no difficulty] to 68 [extreme difficulty] MCID, 6 units) at 12 weeks. Secondary outcomes included other pain and function measures, quality of life, global change, and 1-year follow-up. Analyses were by intention-to-treat using multiple imputation for missing outcome data. At 12 weeks and 1 year, 26 (9%) and 50 (18%) participants were lost to follow-up, respectively. Analyses showed neither needle nor laser acupuncture significantly improved pain (mean difference -0.4 units 95% CI, -1.2 to 0.4, and -0.1 95% CI, -0.9 to 0.7, respectively) or function (-1.7 95% CI, -6.1 to 2.6, and 0.5 95% CI, -3.4 to 4.4, respectively) compared with sham at 12 weeks. Compared with control, needle and laser acupuncture resulted in modest improvements in pain (-1.1 95% CI, -1.8 to -0.4, and -0.8 95% CI, -1.5 to -0.1, respectively) at 12 weeks, but not at 1 year. Needle acupuncture resulted in modest improvement in function compared with control at 12 weeks (-3.9 95% CI, -7.7 to -0.2) but was not significantly different from sham (-1.7 95% CI, -6.1 to 2.6) and was not maintained at 1 year. There were no differences for most secondary outcomes and no serious adverse events. In patients older than 50 years with moderate or severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function. Our findings do not support acupuncture for these patients. anzctr.org.au Identifier: ACTRN12609001001280.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
DOI: 10.1249/MSS.0000000000001689
Abstract: Knowledge of hip biomechanics during locomotion is necessary for designing optimal rehabilitation programs for hip-related conditions. The purpose of this study was to: 1) determine how lower-limb muscle contributions to the hip contact force (HCF) differed between walking and running and 2) compare both absolute and per-unit-distance (PUD) loads at the hip during walking and running. Kinematic and ground reaction force data were captured from eight healthy participants during overground walking and running at various steady-state speeds (walking: 1.50 ± 0.11 m·s −1 and 1.98 ± 0.03 m·s −1 running: 2.15 ± 0.18 m·s −1 and 3.47 ± 0.11 m·s −1 ). A three-dimensional musculoskeletal model was used to calculate the HCF as well as lower-limb muscular contributions to the HCF in each direction (posterior–anterior inferior–superior lateral–medial). The impulse of the resultant HCF was calculated as well as the PUD impulse (BW·s·m −1 ) and PUD force (BW·m −1 ). For both walking and running, HCF magnitude was greater during stance than swing and was largest in the inferior–superior direction and smallest in the posterior–anterior direction. Gluteus medius, iliopsoas, and gluteus maximus generated the largest contributions to the HCF during stance, whereas iliopsoas and hamstrings generated the largest contributions during swing. When comparing all locomotion conditions, the impulse of the resultant HCF was smallest for running at 2.15 m·s −1 with an average magnitude of 2.14 ± 0.31 BW·s, whereas the PUD impulse and force were smallest for running at 3.47 m·s −1 with average magnitudes of 0.95 ± 0.18 BW·s·m −1 and 1.25 ± 0.24 BW·m −1 , respectively. Hip PUD loads were lower for running at 3.47 m·s −1 compared with all other locomotion conditions because of a greater distance travelled per stride (PUD impulse) or a shorter stride duration combined with a greater distance travelled per stride (PUD force).
Publisher: Wiley
Date: 11-2011
DOI: 10.1002/ACR.20632
Publisher: Springer Science and Business Media LLC
Date: 02-07-2012
Abstract: Achilles tendinopathy (AT) is a common condition, causing considerable morbidity in athletes and non-athletes alike. Conservative or physical therapies are accepted as first-line management of AT however, despite a growing volume of research, there remains a lack of high quality studies evaluating their efficacy. Previous systematic reviews provide preliminary evidence for non-surgical interventions for AT, but lack key quality components as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Statement. The aim of this study was to conduct a systematic review and meta-analysis (where possible) of the evidence for physical therapies for AT management. A comprehensive strategy was used to search 11 electronic databases from inception to September 2011. Search terms included Achilles, tendinopathy, pain, physical therapies, electrotherapy and exercise (English language full-text publications, human studies). Reference lists of eligible papers were hand-searched. Randomised controlled trials (RCTs) were included if they evaluated at least one non-pharmacological, non-surgical intervention for AT using at least one outcome of pain and/or function. Two independent reviewers screened 2852 search results, identifying 23 suitable studies, and assessed methodological quality and risk of bias using a modified PEDro scale. Effect size calculation and meta-analyses were based on fixed and random effects models respectively. Methodological quality ranged from 2 to 12 (/14). Four studies were excluded due to high risk of bias, leaving 19 studies, the majority of which evaluated midportion AT. Effect sizes from in idual RCTs support the use of eccentric exercise. Meta-analyses identified significant effects favouring the addition of laser therapy to eccentric exercise at 12 weeks (pain VAS: standardised mean difference −0.59, 95% confidence interval −1.11 to −0.07), as well as no differences in effect between eccentric exercise and shock wave therapy at 16 weeks (VISA-A:–0.55,–2.21 to 1.11). Pooled data did not support the addition of night splints to eccentric exercise at 12 weeks (VISA-A:–0.35,–1.44 to 0.74). Limited evidence from an in idual RCT suggests microcurrent therapy to be an effective intervention. Practitioners can consider eccentric exercise as an initial intervention for AT, with the addition of laser therapy as appropriate. Shock wave therapy may represent an effective alternative. High-quality RCTs following CONSORT guidelines are required to further evaluate the efficacy of physical therapies and determine optimal clinical pathways for AT.
Publisher: BMJ
Date: 03-02-2022
DOI: 10.1136/BJSPORTS-2021-104686
Abstract: To systematically review and synthesise patellofemoral joint reaction force (PFJRF) in healthy in iduals and those with patellofemoral pain and osteoarthritis (OA), during everyday activities, therapeutic exercises and with physical interventions (eg, foot orthotics, footwear, taping, bracing). A systematic review with meta-analysis. Medline, Embase, Scopus, CINAHL, SportDiscus and Cochrane Library databases were searched. Observational and interventional studies reporting PFJRF during everyday activities, therapeutic exercises, and physical interventions. In healthy in iduals, the weighted average of mean (±SD) peak PFJRF for everyday activities were: walking 0.9±0.4 body weight (BW), stair ascent 3.2±0.7 BW, stair descent 2.8±0.5 BW and running 5.2±1.2 BW. In those with patellofemoral pain, peak PFJRF were: walking 0.8±0.2 BW, stair ascent 2.5±0.5 BW, stair descent 2.6±0.5 BW, running 4.1±0.9 BW. Only single studies reported peak PFJRF during everyday activities in in iduals with patellofemoral OA/articular cartilage defects (walking 1.3±0.5 BW, stair ascent 1.6±0.4 BW, stair descent 1.0±0.5 BW). The PFJRF was reported for many different exercises and physical interventions however, considerable variability precluded any pooled estimates. Everyday activities and exercises involving larger knee flexion (eg, squatting) expose the patellofemoral joint to higher PFJRF than those involving smaller knee flexion (eg, walking). There were no discernable differences in peak PFJRF during everyday activities between healthy in iduals and those with patellofemoral pain/OA. The information on PFJRF may be used to select appropriate variations of exercises and physical interventions.
Publisher: Springer Science and Business Media LLC
Date: 28-01-2020
DOI: 10.1186/S40798-020-0234-8
Abstract: Hip arthroscopy is a common surgical intervention for young and middle-aged adults with hip-related pain and dysfunction, who have high expectations for returning to physical activity following surgery. The purpose of this review was to evaluate the impact of hip arthroscopy on physical activity post-arthroscopy. A systematic search of electronic databases was undertaken in identifying studies from January 1st 1990 to December 5th 2019. The search included English language articles reporting physical activity as an outcome following hip arthroscopy in adults aged 18-50 years. Quality assessment, data extraction and synthesis of included studies were undertaken. Full text articles ( n = 234) were assessed for eligibility following screening of titles and abstracts ( n = 2086), yielding 120 studies for inclusion. The majority (86%) of the studies were level 4 evidence. One study reported objective activity data. The most frequently occurring patient-reported outcome measure was the Hip Outcome Score-sport-specific subscale (HOS-SS, 84% of studies). Post--arthroscopy improvement was indicated by large effect sizes for patient-reported outcome measures (standard paired difference [95% confidence interval] −1.35[−1.61 to −1.09] at more than 2 years post-arthroscopy) however, the majority of outcome scores for the HOS-SS did not meet the defined level for a patient-acceptable symptom state. The current level of available information regarding physical activity for post arthroscopy patients is limited in scope. Outcomes have focused on patients’ perceived difficulties with sport-related activities with a paucity of information on the type, quality and quantity of activity undertaken. Level IV, systematic review of Level 2 through to Level 4 studies
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2018
Abstract: Study Design Cross-sectional cohort study. Objectives To investigate the relationship between musculoskeletal screening findings and bony hip morphology in asymptomatic male soccer players. Background Athletes with femoroacetabular impingement (FAI) syndrome have cam and/or pincer morphology, pain on orthopaedic testing, and often reduced hip range of motion (ROM) and strength. However, cam and pincer morphology is also common in asymptomatic hips. Therefore, it is currently unknown whether the ROM and strength deficits observed in athletes with FAI syndrome result from the variance in their bony hip morphology or from their hip condition. Methods Male professional soccer players in Qatar were screened specifically for hip/groin pain in 2 consecutive seasons. The screening battery included pain provocation, ROM and strength tests, and hip radiographs. Univariate and multivariate regression analyses, using generalized estimating equations, evaluated the relationship between musculoskeletal screening findings and each bony hip morphological variant (cam, large cam, pincer, and acetabular dysplasia). Results Asymptomatic hips with cam and large cam morphology were associated with lower internal rotation ROM and bent-knee fall-out, and with a higher likelihood of pain on provocation testing. Pincer morphology was associated with lower abduction ROM and higher abduction strength. Acetabular dysplasia was associated with higher abduction ROM. Each association was weak and demonstrated poor or failed discriminatory power. Conclusion Bony hip morphology is associated with hip joint ROM and abduction strength, but musculoskeletal screening tests have a poor ability to discriminate between the different morphologies. J Orthop Sports Phys Ther 2018 (4):250-259. doi:10.2519/jospt.2018.7848.
Publisher: Springer Science and Business Media LLC
Date: 07-07-2017
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 15-10-2017
Abstract: Study Design Cross-sectional study. Background Visual rating of postural orientation during functional tasks may be a valuable tool to track rehabilitation progress following anterior cruciate ligament (ACL) injury. A valid test battery assessing postural orientation as a separate construct is lacking. Objectives To evaluate measurement properties of a test battery to assess postural orientation in patients with ACL injury. Methods The content validity of functional tasks was assessed by expert focus group discussions. Fifty-one patients (45% women) with ACL injury performed 9 functional tasks of varying difficulty. Interpretability, internal consistency, interrater reliability, and measurement error were assessed for segment-specific postural orientation errors (POEs), within-task POEs, and total POE score. Postural orientation errors were scored on video on an ordinal scale from 0 (no POEs) to 3 (major POEs). Results Stair ascent, deep squat, and crossover hop for distance were excluded in focus group discussions. Postural orientation errors in some tasks were excluded due to floor effects. The mini-squat and drop jump were excluded due to poor internal consistency (α≤.184). Interrater reliability values for segment-specific POEs and within-task POEs yielded fair to almost perfect agreement (κ = 0.429-0.875) and almost perfect agreement for total POE score (intraclass correlation coefficient = 0.842), without systematic differences between raters. The smallest detectable changes were 0.7 and 5 points for groups and in iduals, respectively. Conclusion The final test battery (single-leg mini-squat, stair descent, forward lunge, single-leg hop for distance) of 4 POEs (foot pronation, medial knee-to-foot position, hip joint POEs, and trunk segment POEs) demonstrated good measurement properties in people with ACL injury. J Orthop Sports Phys Ther 2017 (11):863-873. doi:10.2519/jospt.2017.7270.
Publisher: BMJ
Date: 16-11-2010
Abstract: There is growing evidence for the provision of foot orthoses when treating in iduals with patellofemoral pain syndrome (PFPS), and prescription is frequently based on the assessment of foot posture/function. However, evaluation of the link between abnormal foot posture/function and foot orthoses outcomes has previously been limited to static alignment measures and has produced inconsistent findings. In this study, the ability of baseline foot kinematics associated with pronation to predict marked improvement 12 weeks following foot orthoses prescription in in iduals with PFPS was evaluated. 26 in iduals with PFPS were issued with prefabricated foot orthoses, and patient-reported level of improvement was documented at 12 weeks. Potential predictors of marked improvement at 12 weeks were measured during walking at baseline and included forefoot dorsiflexion and abduction, and rearfoot eversion. Of the 25 participants who completed the study, seven (28%) reported marked improvement with the foot orthoses after 12 weeks. Discriminant function analysis revealed a greater peak rearfoot eversion to be the only significant independent predictor of marked improvement. These findings provide preliminary evidence that greater peak rearfoot eversion is predictive of marked improvement 12 weeks following prefabricated foot orthoses prescription in in iduals with PFPS. Therefore, foot orthoses may be most effective in the subgroup of people with PFPS and increased dynamic foot pronation.
Publisher: BMJ
Date: 06-05-2020
DOI: 10.1136/BJSPORTS-2019-101690
Abstract: To report the effectiveness of physiotherapist-led interventions in improving pain and function in young and middle-aged adults with hip-related pain. Systematic review and meta-analysis. A comprehensive, reproducible search strategy was performed on five databases in May 2019. Reference lists and grey literature were also searched. Population: people aged ≥18 years with hip-related pain (with or without a diagnosis of femoroacetabular impingement syndrome). Intervention(s): physiotherapist-led interventions for hip pain. Comparators: sham treatment, no treatment or other treatment (eg, hip arthroscopic surgery). Outcomes: primary outcomes included patient-reported hip pain and function. Secondary outcomes included physical function measures. 1722 papers were identified. After exclusion criteria were applied, 14 studies were included for analysis. They had varied risk of bias. There were no full-scale placebo-controlled randomised controlled trials (RCTs) of physiotherapist-led treatment. Pooled effects ranged from moderate effects (0.67 (95% CI 0.07 to 1.26)) favouring physiotherapist-led intervention over no treatment post-arthroscopy, to weak effects (−0.32 (95% CI 0.57 to 0.07)) favouring hip arthroscopy over physiotherapist-led treatment. Physiotherapist-led interventions might improve pain and function in young and middle-aged adults with hip-related pain, however full-scale high-quality RCT studies are required. CRD42018089088.
Publisher: Springer Science and Business Media LLC
Date: 11-07-2019
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.GAITPOST.2019.12.012
Abstract: The efficacy of foot orthoses in reducing patellofemoral pain (PFP) is well documented however, the mechanisms by which foot orthoses modulate pain and function are poorly understood. This within-subject study investigated the immediate effects of foot orthoses on lower limb kinematics and angular impulses during level walking and stair ambulation in in iduals with persistent PFP. Forty-two participants with persistent PFP (≥3 months duration) underwent quantitative gait analysis during level walking, stair ascent and stair descent while using: (i) standard running sandals (control) and (ii) standard running sandals fitted with prefabricated foot orthoses. Hip, knee, and ankle joint kinematics and angular impulses were calculated and statistically analyzed using paired t-tests (p < 0.05). Relative to the control condition, foot orthoses use was associated with small but significant decreases in maximum ankle inversion angles during walking (mean difference [95% confidence interval]: -1.00° [-1.48 to -0.53]), stair ascent (-1.06° [-1.66 to -0.45]) and stair decent (-0.94° [-1.40 to -0.49]). Foot orthoses were also associated with decreased ankle eversion impulse during walking (-9.8Nms/kg [-12.7 to -6.8]), and decreased ankle dorsiflexion and eversion impulse during stair ascent (-67.6Nms/kg [-100.7 to -34.6] and -17.5Nms/kg [-23.6 to -11.4], respectively) and descent (-50.4Nms/kg [-77.2 to -23.6] and -11.6Nms/kg [-15.6 to -7.5], respectively). Ankle internal rotation impulse decreased when participants ascended stairs with foot orthoses (-3.3Nms/kg [-5.4 to -1.3]). Limited changes were observed at the knee and hip. In in iduals with persistent PFP, small immediate changes in kinematics and angular impulses - primarily at the ankle - were observed when foot orthoses were worn during walking or stair ambulation. The clinical implications of these small changes, as well as the longer-term effects of foot orthoses on lower limb biomechanics, are yet to be determined.
Publisher: BMJ
Date: 07-2220
DOI: 10.1136/BJSPORTS-2019-101453
Abstract: There is no agreement on how to classify, define or diagnose hip-related pain-a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility a comprehensive approach is therefore essential. A negative flexion-adduction-internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head-neck radiographs are the initial diagnostic imaging of choice-advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.
Publisher: Springer Science and Business Media LLC
Date: 19-01-2010
Abstract: Patellofemoral pain syndrome (PFP) is a common musculoskeletal condition that has a tendency to become chronic and problematic in a proportion of affected in iduals. The objective of this study was to identify prognostic factors that may have clinical utility in predicting poor outcome on measures of pain and function in in iduals with PFP. A prospective follow-up study was conducted of 179 participants in a randomised clinical trial. Nine baseline factors (age, gender, body mass index, arch height, duration of knee pain, worst pain visual analogue scale, Kujala Patellofemoral Score (KPS), functional index questionnaire (FIQ), step down repetitions) were investigated for their prognostic ability on outcome assessed at six, 12 and 52 weeks (worst pain, KPS and FIQ). Factors with significant univariate associations were entered into multivariate linear regression models to identify a group of factors independently associated with poor outcome. Long symptom duration was the most consistent predictor of poor outcome over 52 weeks rated on the KPS and the FIQ (β-0.07, 95% confidence interval -0.1 to -0.03, p 0.000 and -0.02, -0.03 to -0.01, p 0.000, respectively). Worse KPS at baseline was predictive of outcome at six, 12 and 52 weeks. Gender, body mass index and arch height were generally not associated with outcome (univariate analysis), while age, worst pain, FIQ and step downs were excluded during multivariate analyses. Patients presenting with PFP of long duration who score worse on the KPS have a poorer prognosis, irrespective of age, gender and morphometry. These results suggest that strategies aimed at preventing chronicity of more severe PFP may optimise prognosis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
DOI: 10.1249/MSS.0000000000001685
Abstract: To evaluate common modeling strategies in training load and injury risk research when modeling continuous variables and interpreting continuous risk estimates and present improved modeling strategies. Workload data were pooled from Australian football ( n = 2550) and soccer ( n = 23,742) populations to create a representative s le of acute:chronic workload ratio observations for team sports. Injuries were simulated in the data using three predefined risk profiles (U-shaped, flat and S-shaped). One-hundred data sets were simulated with s le sizes of 1000 and 5000 observations. Discrete modeling methods were compared with continuous methods (spline regression and fractional polynomials) for their ability to fit the defined risk profiles. Models were evaluated using measures of discrimination (area under receiver operator characteristic [ROC] curve) and calibration (Brier score, logarithmic scoring). Discrete models were inferior to continuous methods for fitting the true injury risk profiles in the data. Discrete methods had higher false discovery rates (16%–21%) than continuous methods (3%–7%). Evaluating models using the area under the ROC curve incorrectly identified discrete models as superior in over 30% of simulations. Brier and logarithmic scoring was more suited to assessing model performance with less than 6% discrete model selection rate. Many studies on the relationship between training loads and injury that have used regression modeling have significant limitations due to improper discretization of continuous variables and risk estimates. Continuous methods are more suited to modeling the relationship between training load and injury. Comparing injury risk models using ROC curves can lead to inferior model selection. Measures of calibration are more informative judging the utility of injury risk models.
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.PTSP.2010.09.002
Abstract: This study evaluated the effects of unmodified prefabricated foot orthoses over a 12-week period on functional performance and subjective pain and function in in iduals with patellofemoral pain syndrome (PFPS). Prospective cohort study over 12 weeks. Each participant was prescribed prefabricated foot orthoses at baseline. Sixty in iduals with PFPS (18-35 years). Change in pain and ease of completing a single leg squat change in the number of pain free step downs and single leg rises from sitting usual and worst pain in the previous week the anterior knee pain scale (AKPS) and the lower extremity functional scale (LEFS). At 12 weeks, significant improvements in single leg squat pain and ease, and the number of pain free step downs and single leg rises from sitting were found. Additionally, significant reductions in usual and worst pain, and improvements on the AKPS and LEFS were observed. Functional performance improvements following unmodified prefabricated foot orthoses were greater at 12 weeks that those achieved immediately. Enhanced functional performance over time may have significant implications for osteoarthritis prevention in some in iduals with PFPS. Improvements in subjective pain and function appear to plateau over time.
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2022-062483
Abstract: Due to the increase in participation and risk of anterior cruciate ligament (ACL) injuries and concussion in women’s Australian Football, an injury prevention programme (Prep-to-Play) was codesigned with consumers (eg, coaches, players) and stakeholders (eg, the Australian Football League). The impact of supported and unsupported interventions on the use of Prep-to-Play (primary aim) and injury rates (secondary aim) will be evaluated in women and girls playing community Australian Football. This stepped-wedge, cluster randomised controlled trial will include ≥140 teams from U16, U18 or senior women’s competitions. All 10 geographically separated clusters (each containing ≥14 teams) will start in the control (unsupported) phase and be randomised to one of five dates (or ‘wedges’) during the 2021 or 2022 season to sequentially transition to the intervention (supported Prep-to-Play), until all teams receive the intervention. Prep-to-Play includes four elements: a neuromuscular training warm-up, contact-focussed football skills (eg, tackling), strength exercises and education (eg, technique cues). When transitioning to supported interventions, study physiotherapists will deliver a workshop to coaches and player leaders on how to use Prep-to-Play, attend team training at least two times and provide ongoing support. In the unsupported phase, team will continue usual routines and may freely access available Prep-to-Play resources online (eg, posters and videos about the four elements), but without additional face-to-face support. Outcomes will be evaluated throughout the 2021 and 2022 seasons (~14 weeks per season). Primary outcome: use of Prep-to-Play will be reported via a team designate (weekly) and an independent observer (five visits over the two seasons) and defined as the team completing 75% of the programme, two-thirds (67%) of the time. Secondary outcomes: injuries will be reported by the team sports trainer and/or players. Injury definition: any injury occurring during a football match or training that results in: (1) being unable to return to the field of play for that match or (2) missing ≥ one match. Outcomes in the supported and unsupported phases will be compared using a generalised linear mixed model adjusting for clustering and time. Due to the type III hybrid implementation-effectiveness design, the study is powered to detect a improvement in use of Prep-to-Play and a reduction in ACL injuries. La Trobe University Ethics Committee (HREC 20488) approved. Coaches provided informed consent to receive the supported intervention and players provided consent to be contacted if they sustained a head or knee injury. Results will be disseminated through partner organisations, peer-reviewed publications and scientific conferences. NCT04856241 .
Publisher: Wiley
Date: 27-09-2016
DOI: 10.1002/ACR.22842
Abstract: We conducted a systematic review to evaluate the associations of knee alignment or trochlear morphology (measured on imaging) with presence, severity, onset, and/or progression of patellofemoral osteoarthritis (PFOA). We prospectively registered our protocol with PROSPERO (International prospective register of systematic reviews) and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to report this review. We searched 10 electronic databases, screened citing articles, and reviewed reference lists. We extracted data and evaluated methodologic quality. Due to study design heterogeneity, we used a best-evidence synthesis to summarize the evidence. We included 16 publications (2,892 participants, 66% women) after removing 4 papers that did not meet our threshold for methodologic quality. There were 11 cross-sectional and 5 longitudinal papers. The target population was knee OA in 11 studies, PFOA in 2 studies, and other knee conditions in 3 studies. Alignment or morphology was measured using radiographs in 8 studies, magnetic resonance imaging in 7 studies, and computed tomography in 2 papers. Limitations include substantial heterogeneity in s les and methods, short followup times in longitudinal studies, and a small number of studies that specifically recruited participants with PFOA. There is strong evidence that PFOA is associated with both trochlear morphology and frontal plane knee alignment, while evidence is limited but consistent in the sagittal and axial planes. These findings suggest that alignment should be evaluated clinically in in iduals with PFOA. Clinical interventions targeting knee alignment warrant further investigation.
Publisher: Center for Open Science
Date: 25-01-2023
Abstract: The primary objective of this systematic review is to determine the long-term burden of anterior cruciate ligament andmeniscal injury. The secondary objective is to determine the burden of living with radiographic and/orsymptomatic osteoarthritis, following anterior cruciate ligament and/or meniscal injury.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2018
Abstract: Synopsis The number of hip arthroscopies for the management of femoroacetabular impingement syndrome and other hip intra-articular conditions has grown exponentially in the last decade. Postoperative rehabilitation is part of the treatment algorithm, although there is a lack of high-quality studies on the efficacy of both surgery and postoperative rehabilitation programs. It is known that impairments can be present up to 2 years after hip arthroscopy, with in iduals exhibiting reduced function and quality of life when compared to those of similar age, highlighting a need to improve postoperative care. Postoperative rehabilitation programs aim to improve hip function however, the description of interventions as well as criteria for progression are lacking in the literature. The aim of this clinical commentary was to present a targeted clinical rehabilitation approach for in iduals undergoing hip arthroscopy. J Orthop Sports Phys Ther 2018 (4):336-342. doi:10.2519/jospt.2018.8002.
Publisher: International Journal of Sports Physical Therapy
Date: 08-2022
DOI: 10.26603/001C.36528
Abstract: Little is known about muscle morphology in people with hip-related pain, without signs of femoro-acetabular impingement syndrome (FAIS). Identifying changes in hip muscle volume, fatty infiltrate and establishing relationships between muscle volume and strength, may provide insight into potential early treatment strategies. To: (i) compare the volumes and fatty infiltrate of gluteus maximus, gluteus medius, gluteus minimis, tensor fascia latae and quadratus femoris between symptomatic and less-symptomatic sides of participants with hip-related pain (ii) compare the volumes and fatty infiltrate of hip muscles between healthy controls and symptomatic participants and (iii) explore relationships of hip muscle volumes to muscle strength and patient-reported outcome measures in people with hip-related pain. Cross-sectional study Muscle volume and fatty infiltrate (from magnetic resonance imaging), hip muscle strength, patient-reported symptoms, function and quality of life (QOL) were determined for 16 participants with hip-related pain (no clinical signs of FAIS 37±9 years) and 15 controls (31±9 years). Using One Way Analysis of Co-Variance tests, muscle volume and fatty infiltrate was compared between the symptomatic and less-symptomatic sides in participants with hip-related pain as well as between healthy controls and symptomatic participants. In addition, hip muscle volume was correlated with hip muscle strength, hip-reported symptoms, function and QOL. No differences in all the studied muscle volumes or fatty infiltrate were identified between the symptomatic and less-symptomatic hips of people with hip-related pain or between people with and without hip-related pain. Greater GMED volume on the symptomatic side was associated with less symptoms and better function and QOL (ρ=0.522-0.617) for those with hip-related pain. Larger GMAX volume was associated with greater hip abduction and internal rotation strength, larger GMED volume was associated with greater hip extension strength, and larger QF volume was associated with greater hip abduction strength (rho=0.507-0.638). People with hip-related pain and no clinical signs of FAIS have hip muscle volumes that are not significantly different than those of matched pain-free controls or their less-symptomatic hip. Larger GMED muscle volume was associated with fewer symptoms and greater strength. Level 3a
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2004
DOI: 10.1249/01.MSS.0000117116.90297.E1
Abstract: Tibial stress fracture is a common overuse running injury that results from the interplay of repetitive mechanical loading and bone strength. This research project aimed to determine whether female runners with a history of tibial stress fracture (TSF) differ in ground reaction force (GRF) parameters during running, regional bone density, and tibial bone geometry from those who have never sustained a stress fracture (NSF). Thirty-six female running athletes (13 TSF 23 NSF) ranging in age from 18 to 44 yr were recruited for this cross-sectional study. The groups were well matched for demographic, training, and menstrual parameters. A force platform measured selected GRF parameters (peak and time to peak for vertical impact and active forces, and horizontal braking and propulsive forces) during overground running at 4.0 m.s.(-1). Lumbar spine, proximal femur, and distal tibial bone mineral density were assessed by dual energy x-ray absorptiometry. Tibial bone geometry (cross-sectional dimensions and areas, and second moments of area) was calculated from a computerized tomography scan at the junction of the middle and distal thirds. There were no significant differences between the groups for any of the GRF, bone density, or tibial bone geometric parameters (P > 0.05). Both TSF and NSF subjects had bone density levels that were average or above average compared with a young adult reference range. Factor analysis followed by discriminant function analysis did not find any combinations of variables that differentiated between TSF and NSF groups. These findings do not support a role for GRF, bone density, or tibial bone geometry in the development of tibial stress fractures, suggesting that other risk factors were more important in this cohort of female runners.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 05-2018
Abstract: Study Design Clinical measurement, cross-sectional. Background In iduals who have undergone anterior cruciate ligament (ACL) reconstruction commonly experience long-term impairments in quality of life (QoL), which may be related to persistent knee symptoms or radiographic osteoarthritis (ROA). Understanding the impact of knee symptoms and ROA on QoL after ACL reconstruction may assist in the development of appropriate management strategies. Objectives To (1) compare QoL between groups of in iduals after ACL reconstruction (including those who are symptomatic with ROA, symptomatic without ROA, and asymptomatic [unknown ROA status]), and (2) identify specific aspects of QoL impairment in symptomatic in iduals with and without ROA post ACL reconstruction. Methods One hundred thirteen participants completed QoL measures (Knee injury and Osteoarthritis Outcome Score QoL subscale [KOOS-QoL], Anterior Cruciate Ligament Quality of Life [ACL-QoL], Assessment of Quality of Life-8 Dimensions [AQoL-8D]) 5 to 20 years after ACL reconstruction. Eighty-one symptomatic in iduals underwent radiographs, and 32 asymptomatic in iduals formed a comparison group. Radiographic osteoarthritis was defined as a Kellgren-Lawrence grade of 2 or greater for the tibiofemoral and/or patellofemoral joints. Mann-Whitney U tests compared outcomes between groups. In idual ACL-QoL items were used to explore specific aspects of QoL. Results In symptomatic in iduals after ACL reconstruction, ROA was related to worse knee-related outcomes on the KOOS-QoL (median, 50 interquartile range [IQR], 38-69 versus median, 69 IQR, 56-81 P<.001) and the ACL-QoL (median, 51 IQR, 38-71 versus median, 66 IQR, 50-82 P = .04). The AQoL-8D scores showed that health-related QoL was impaired in both symptomatic groups compared to the asymptomatic group. The ACL-QoL item scores revealed greater limitations and concern surrounding sport and exercise and social/emotional difficulties in the symptomatic group with ROA. Conclusion Osteoarthritis is associated with worse knee-related QoL in symptomatic in iduals after ACL reconstruction. Diagnosing ROA in symptomatic in iduals after ACL reconstruction may be valuable, because these in iduals may require unique management. Targeted strategies to facilitate participation in satisfying activities have potential to improve QoL in symptomatic people with ROA after ACL reconstruction. J Orthop Sports Phys Ther 2018 (5):398-408. doi:10.2519/jospt.2018.7830.
Publisher: BMJ
Date: 24-06-2016
Publisher: University of Toronto Press Inc. (UTPress)
Date: 08-2017
DOI: 10.3138/PTC.2016-34
Abstract: Purpose: This study aimed to investigate the effects of a pre–hip arthroscopy exercise intervention on hip strength, pain, and function in in iduals with femoroacetabular impingement (FAI). Methods: A total of 20 in iduals with FAI completed a 10-week, partially supervised exercise programme this included three phases of increasing resistance and functionality, consisting of four to six exercises per phase. Hip strength in all six directions hip pain function, as measured by the Hip disability and Osteoarthritis Outcome Score (HOOS) and objective physical function, as measured by the Timed Stair Climb test, were determined before and after the intervention. Results: Maximum isometric hip strength significantly increased in abduction (p=0.008), adduction (p=0.021), and internal rotation (p=0.006) at follow-up. Increases in flexion, extension, and external rotation strength did not reach statistical significance. Self-reported HOOS pain (p .01) and activities of daily living sub-scale scores (p .01) significantly improved at follow-up. Timed Stair Climb times (p .001) also significantly decreased at follow-up. Conclusion: A 10-week exercise programme can be safely completed by adults with FAI before surgery, and statistically significant changes in strength, function, and self-reported clinical outcomes can be achieved.
Publisher: Wiley
Date: 20-02-2019
DOI: 10.1002/EJP.1371
Abstract: Identifying the physical impairments associated with worse symptoms and greater functional limitations in people with hip pain could enable targeted rehabilitation programmes designed to improve quality of life. The objective of this study was to compare physical characteristics between subgroups of symptoms and functional limitation severity in in iduals with hip pain scheduled for arthroscopic surgery. Hip range of motion (ROM) and muscle strength were measured in 114 in iduals (48 women aged 32 ± 8 years) with hip pain scheduled for hip arthroscopy. Pain and disability were measured with the International Hip Outcome Tool (iHOT33) subscale of Symptoms and Functional Limitation, and a cluster analysis was used to identify mild, moderate and severe subgroups. Between-group differences were then evaluated using multivariate analysis of covariance, including sex as a covariate, followed by post hoc testing. Significance was set at 0.05. Lesser hip muscle strength in all directions was reported in the severe symptoms and functional limitation group compared to the mild group. Hip flexion ROM differed when comparing the moderate to both the mild and severe subgroups. Hip internal rotation did not differ between subgroups of severity. In iduals with hip pain and severe scores in the iHOT33 subscale of symptoms and functional limitations present with significantly lesser hip muscle strength and hip flexion ROM than in iduals with moderate or mild scores. Targeted programmes to improve hip strength and flexion ROM in more severe patients may help reduce symptoms and improve function. In iduals with severe hip pain and functional limitation possess significantly lesser muscle strength and flexion ROM than in iduals with moderate or mild scores.
Publisher: SAGE Publications
Date: 15-07-2021
DOI: 10.1177/03635465211027180
Abstract: The International Hip Outcome Tool–33 (iHOT-33) was developed to evaluate patients seeking surgery for hip and/or groin (hip/groin) pain and may not be appropriate for those seeking nonsurgical treatment. To evaluate the psychometric properties of the iHOT-33 total (iHOT-Total) score and all subscale scores in adults with hip/groin pain who were not seeking surgery. Cohort study (diagnosis) Level of evidence, 3. Patients with hip/groin pain who were not seeking surgery were recruited from 2 ongoing studies in Australia. Semistructured one-on-one interviews assessed content validity. Construct validity was assessed by testing hypothesized correlations between iHOT-33 and Copenhagen Hip and Groin Outcome Score (HAGOS) subscale scores. Test-retest reliability was assessed in patients not undertaking treatment and who reported “no change” in their Global Rating of Change (GROC) score at 6-month follow-up. Scores were reliable at group and in idual levels if intraclass correlation coefficients (ICCs) were ≥0.80 and ≥0.90, respectively. Scores were responsive if Spearman rank correlations (ρ) between the change in the iHOT-33 score and the GROC score were ≥0.40. In total, 278 patients with hip/groin pain (93 women mean age, 31 years) and 55 pain-free control participants (14 women mean age, 29 years) were recruited. The iHOT-33 demonstrated acceptable content validity. Construct validity was acceptable, with all hypothesized strong positive correlations between iHOT-33 and HAGOS subscale scores confirmed ( r range, 0.60-0.76 P .001), except for one correlation between the iHOT-Sport and HAGOS-Sport ( r = .058 P .001). All scores were reliable at the group level, except for the iHOT-33 job subscale (iHOT-Job) (ICC range, 0.78-0.88 [95% CI, 0.60-0.93]). None of the subscales met the criteria for adequate reliability for use at the in idual level (all ICCs .90). Minimal detectable change values (group level) ranged from 2.3 to 3.7 (95% CI, 1.7-5.0). All iHOT-33 subscale scores were responsive (ρ range, 0.40-0.58 P≤ .001), except for the iHOT-Job in patients not undertaking treatment (ρ = 0.27 P = .001). All iHOT-33 subscale scores were valid for use in patients with hip/groin pain who were not seeking surgery. Acceptable test-retest reliability was found for all subscale scores at the group level, except the iHOT-Job. All subscale scores, excluding the iHOT-Job, were responsive, regardless of undertaking physical therapist–led treatment or no treatment.
Publisher: Springer Science and Business Media LLC
Date: 10-08-2010
DOI: 10.1007/S00167-010-1221-2
Abstract: To demonstrate the potential for a simple clinical test of hamstring muscle strength to identify susceptibility to muscle strain injury. A single-case design was used specifically, an elite-level male Australian Rules football player performed bilateral isometric maximum voluntary contractions of the hamstring muscles on a weekly basis for a period of 5 weeks preceding a right hamstring muscle strain injury. Minimal asymmetry (no greater than ±1.2% difference) was evident in the hamstring isometric maximum voluntary contractions during the first 4 weeks, but 5 days prior to injury, the right hamstring isometric maximum voluntary contraction was reduced by 10.9% compared to the left. Measuring asymmetry in isometric maximum voluntary contractions of the hamstring muscles may be a useful clinical test to identify susceptibility to muscle strain injury.
Publisher: BMJ
Date: 31-05-2016
Publisher: BMJ
Date: 12-2016
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2018
Abstract: Study Design Cross-sectional. Background Hip pain is associated with reduced muscle strength and range of movement (ROM). These impairments may contribute to decreased postural stability and balance. The Star Excursion Balance Test (SEBT) is a reliable and valid method to measure dynamic postural control. Objectives To evaluate the association between SEBT performance and hip strength, hip ROM, trunk endurance, and group characteristics in in iduals with hip pain. Methods One hundred eleven in iduals with hip pain, scheduled for arthroscopic hip surgery, were matched with 62 healthy controls. Hip ROM and muscle strength, trunk endurance, and SEBT reach were measured prior to surgery. Data were analyzed for between-group differences using t tests, and associations between SEBT reach and hip strength, hip ROM, and population characteristics were evaluated with Pearson correlation coefficients and stepwise backward regression analyses. Results Star Excursion Balance Test performance (P<.01), hip strength (P<.01), and hip ROM (P<.05) were lower in the presurgery group compared to controls. In the presurgery group, when adjusted for height and weight, hip flexion strength and internal rotation ROM accounted for 44% of the variance in anteromedial SEBT reach. In the posteromedial direction, hip adduction strength and sex accounted for 53% of the variance. For the posterolateral direction, hip adduction and internal rotation strength accounted for 46% of reach variance. Conclusion The in iduals who were scheduled for arthroscopic hip surgery were significantly weaker, had less hip mobility, and had reduced dynamic balance compared to controls. In this population, dynamic balance performance was associated with various hip strength and ROM measurements in a direction-specific manner. J Orthop Sports Phys Ther 2018 (4):280-288. doi:10.2519/jospt.2018.7946.
Publisher: BMJ
Date: 16-09-2022
DOI: 10.1136/BJSPORTS-2022-105498
Abstract: Critically appraise and summarise the measurement properties of knee muscle strength tests after anterior cruciate ligament (ACL) and/or meniscus injury using the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist. Systematic review with meta-analyses. The modified Grading of Recommendations Assessment, Development and Evaluation-guided assessment of evidence quality. Medline, Embase, CINAHL and SPORTSDiscus searched from inception to 5 May 2022. Studies evaluating knee extensor or flexor strength test reliability, measurement error, validity, responsiveness or interpretability in in iduals with ACL and/or meniscus injuries with a mean injury age of ≤30 years. Thirty-six studies were included involving 31 different muscle strength tests (mode and equipment) in in iduals following an ACL injury and/or an isolated meniscus injury. Strength tests were assessed for reliability (n=8), measurement error (n=7), construct validity (n=27) and criterion validity (n=7). Isokinetic concentric extensor and flexor strength tests were the best rated with sufficient intrarater reliability (very low evidence quality) and construct validity (moderate evidence quality). Isotonic extensor and flexor strength tests showed sufficient criterion validity, while isometric extensor strength tests had insufficient construct and criterion validity (high evidence quality). Knee extensor and flexor strength tests of in iduals with ACL and/or meniscus injury lack evidence supporting their measurement properties. There is an urgent need for high-quality studies on these measurement properties. Until then, isokinetic concentric strength tests are most recommended, with isotonic strength tests a good alternative.
Publisher: Elsevier BV
Date: 07-2020
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.GAITPOST.2016.11.013
Abstract: Following anterior cruciate ligament (ACL) rupture, reconstructive surgery (ALCR) is often performed to mechanically stabilise the knee, however functional deficits often persist long after surgery. Impaired single-limb standing balance has been observed in the ACLR limb compared to healthy in iduals. However, it remains inconclusive as to whether these same balance deficits exist between the injured and contralateral uninjured limbs, during challenging balance tasks, and at a time when patients are permitted to return to sport. 100 adults who had undergone a primary hamstring-tendon ACLR 12 months previously (68 male median[IQR] age: 28.1[14.1] years) performed tests of single-limb standing with the knee in a functional position of 20-30° flexion, with their eyes closed, over 20s (Nintendo Wii Balance Board). Two repetitions were performed on the ACLR and uninjured limb. Measures of postural control included centre of pressure (CoP) path velocity, anterior-posterior and mediolateral range and standard deviation, and were averaged across the two trials. Wilcoxon signed-rank tests showed no significant between-leg differences in single-limb balance for any of the CoP measures of interest (all P values>0.686). Further, multiple linear regression analyses showed no significant associations between concomitant meniscectomy or chondral lesions noted at the time of ACLR and measures of single-limb balance on the ACLR limb one year later (all P values>0.213). In the context of prior research, these findings suggest bilateral balance deficits may exist prior to ACL injury, or appear post ACL-injury or ACLR. Treatment of balance deficits should therefore consider both limbs after ACLR.
Publisher: BMJ
Date: 16-08-2022
DOI: 10.1136/BJSPORTS-2022-105497
Abstract: We synthesised and assessed credibility (ie, trustworthiness) of thresholds that define meaningful scores for patient-reported outcome measures (PROMs) following interventions for anterior cruciate ligament (ACL) tear or traumatic meniscus injury. Systematic review, narrative synthesis. We searched five databases, handsearched references of included studies and tracked citations. Included studies investigated: in iduals with ACL tear or meniscus injury mean age years and PROM thresholds calculated using any method to define a minimal important change (MIC) or a meaningful post-treatment score (Patient Acceptable Symptom State (PASS) or Treatment Failure). We included 18 studies (15 ACL, 3 meniscus). Three different methods were used to calculate anchor-based MICs across 9 PROMs, PASS thresholds across 4 PROMs and treatment failure for 1 PROM. Credibility was rated ‘high’ for only one study—an MIC of 18 for the Knee injury and Osteoarthritis Outcome Score Quality-of-life (KOOS-QOL) subscale (using the MID Credibility Assessment Tool). Where multiple thresholds were calculated among ‘low’ credibility thresholds in ACL studies, MICs converged to within a 10-point range for KOOS-Symptoms (−1.2 to 5.4) and function in daily living (activities of daily living, ADL 0.5–8.1) subscales, and the International Knee Documentation Committee Subjective Knee Form (7.1–16.2). Other PROM thresholds differed up to 30 points. PASS thresholds converged to within a 10-point range in KOOS-ADL for ACL tears (92.3–100), and KOOS-Symptoms (73-78) and KOOS-QOL (53-57) in meniscus injuries. Meaningful PROM thresholds were highly susceptible to study heterogeneity. While PROM thresholds can aid interpretability in research and clinical practice, they should be cautiously interpreted.
Publisher: Walter de Gruyter GmbH
Date: 07-2018
Abstract: To investigate whether training load monitoring data could be used to predict injuries in elite Australian football players, data were collected from athletes over 3 seasons at an Australian football club. Loads were quantified using GPS devices, accelerometers and player perceived exertion ratings. Absolute and relative training load metrics were calculated for each player each day. Injury prediction models (regularised logistic regression, generalised estimating equations, random forests and support vector machines) were built for non-contact, non-contact time-loss and hamstring specific injuries using the first two seasons of data. Injury predictions were then generated for the third season and evaluated using the area under the receiver operator characteristic (AUC). Predictive performance was only marginally better than chance for models of non-contact and non-contact time-loss injuries (AUC .65). The best performing model was a multivariate logistic regression for hamstring injuries (best AUC=0.76). Injury prediction models built using training load data from a single club showed poor ability to predict injuries when tested on previously unseen data, suggesting limited application as a daily decision tool for practitioners. Focusing the modelling approach on specific injury types and increasing the amount of training observations may improve predictive models for injury prevention
Publisher: BMJ
Date: 02-09-2022
DOI: 10.1136/BJSPORTS-2022-105496
Abstract: To identify and quantify potential risk factors for osteoarthritis (OA) following traumatic knee injury. Systematic review and meta-analyses that estimated the odds of OA for in idual risk factors assessed in more than four studies using random-effects models. Remaining risk factors underwent semiquantitative synthesis. The modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach for prognostic factors guided the assessment. MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to 2009-2021. Randomised controlled trials and cohort studies assessing risk factors for symptomatic or structural OA in persons with a traumatic knee injury, mean injury age ≤30 years and minimum 2-year follow-up. Across 66 included studies, 81 unique potential risk factors were identified. High risk of bias due to attrition or confounding was present in 64% and 49% of studies, respectively. Ten risk factors for structural OA underwent meta-analysis (sex, rehabilitation for anterior cruciate ligament (ACL) tear, ACL reconstruction (ACLR), ACLR age, ACLR body mass index, ACLR graft source, ACLR graft augmentation, ACLR+cartilage injury, ACLR+partial meniscectomy, ACLR+total medial meniscectomy). Very-low certainty evidence suggests increased odds of structural OA related to ACLR+cartilage injury (OR=2.31 95% CI 1.35 to 3.94), ACLR+partial meniscectomy (OR=1.87 1.45 to 2.42) and ACLR+total medial meniscectomy (OR=3.14 2.20 to 4.48). Semiquantitative syntheses identified moderate-certainty evidence that cruciate ligament, collateral ligament, meniscal, chondral, patellar/tibiofemoral dislocation, fracture and multistructure injuries increase the odds of symptomatic OA. Moderate-certainty evidence suggests that various single and multistructure knee injuries (beyond ACL tears) increase the odds of symptomatic OA. Risk factor heterogeneity, high risk of bias, and inconsistency in risk factors and OA definition make identifying treatment targets for preventing post-traumatic knee OA challenging.
Publisher: BMJ
Date: 29-06-2022
DOI: 10.1136/BJSPORTS-2022-105495
Abstract: Synthesise evidence for effectiveness of rehabilitation interventions following ACL and/or meniscal tear on symptomatic, functional, clinical, psychosocial, quality of life and reinjury outcomes. Overview of systematic reviews with Grading of Recommendations Assessment, Development and Evaluation certainty of evidence. MEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Library. Systematic reviews of randomised controlled trials investigating rehabilitation interventions following ACL and/or meniscal tears in young adults. We included 22 systematic reviews (142 trials of mostly men) evaluating ACL-injured in iduals and none evaluating isolated meniscal injuries. We synthesised data from 16 reviews evaluating 12 different interventions. Moderate-certainty evidence was observed for: (1) neuromuscular electrical stimulation to improve quadriceps strength (2) open versus closed kinetic chain exercises to be similarly effective for quadriceps strength and self-reported function (3) structured home-based versus structured in-person rehabilitation to be similarly effective for quadriceps and hamstring strength and self-reported function and (4) postoperative knee bracing being ineffective for physical function and laxity. There was low-certainty evidence that: (1) preoperative exercise therapy improves self-reported and physical function postoperatively (2) cryotherapy reduces pain and analgesic use (3) psychological interventions improve anxiety/fear and (4) whole body vibration improves quadriceps strength. There was very low-certainty evidence that: (1) protein-based supplements improve quadriceps size (2) blood flow restriction training improves quadriceps size (3) neuromuscular control exercises improve quadriceps and hamstring strength and self-reported function and (4) continuous passive motion has no effect on range of motion. The general level of evidence for rehabilitation after ACL or meniscal tear was low. Moderate-certainty evidence indicates that several rehabilitation types can improve quadriceps strength, while brace use has no effect on knee function/laxity.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2002
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/BMJOPEN-2020-041742
Abstract: This double-blind, randomised controlled trial (RCT) aims to estimate the effect of a physiotherapist-led intervention with targeted strengthening compared with a physiotherapist-led intervention with standardised stretching, on hip-related quality of life (QOL) or perceived improvement at 6 months in people with femoroacetabular impingement (FAI) syndrome. We hypothesise that at 6 months, targeted strengthening physiotherapist-led treatment will be associated with greater improvements in hip-related QOL or greater patient-perceived global improvement when compared with standardised stretching physiotherapist-led treatment. We will recruit 164 participants with FAI syndrome who will be randomised into one of the two intervention groups, both receiving one-on-one treatment with the physiotherapist over 6 months. The targeted strengthening physiotherapist-led treatment group will receive a personalised exercise therapy and education programme. The standardised stretching physiotherapist-led treatment group will receive standardised stretching and personalised education programme. Primary outcomes are change in hip-related QOL using International Hip Outcome Tool-33 and patient-perceived global improvement. Secondary outcomes include cost-effectiveness, muscle strength, range of motion, functional task performance, biomechanics, hip cartilage structure and physical activity levels. Statistical analyses will make comparisons between both treatment groups by intention to treat, with all randomised participants included in analyses, regardless of protocol adherence. Linear mixed models (with baseline value as a covariate and treatment condition as a fixed factor) will be used to evaluate the treatment effect and 95% CI at primary end-point (6 months). The study protocol was approved (La Trobe University Human Ethics Committee (HEC17-080)) and prospectively registered with the Australian New Zealand Clinical Trials Registry. The findings of this RCT will be disseminated through peer reviewed scientific journals and conferences. Patients were involved in study development and will receive a short summary following the completion of the RCT. ACTRN12617001350314
Publisher: BMJ
Date: 17-02-2020
DOI: 10.1136/BJSPORTS-2019-101456
Abstract: Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews (2) preliminary discussion within the working group (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality and (5) voting and consensus. Out of 102 articles retrieved, 6 systematic reviews were selected and assessed for quality according to AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Two showed moderate quality. We then updated the most recent review. The updated literature search resulted in 10 additional studies that were included in the qualitative synthesis. The recommendations based on evidence summary and PROMs limitations were presented at the consensus meeting. The group makes the following recommendations: (1) the Hip and Groin Outcome Score (HAGOS) and the International Hip Outcome Tool (iHOT) instruments (long and reduced versions) are the most appropriate PROMs to use in young and middle-aged active adults with hip-related pain (2) more research is needed into the utility of the HAGOS and the iHOT instruments in a non-surgical treatment context and (3) generic quality of life measures such as the EuroQoL-5 Dimension Questionnaire and the Short Form Health Survey-36 may add value for researchers and clinicians in this field. We conclude that as none of the instruments shows acceptable quality across various psychometric properties, more methods studies are needed to further evaluate the validity of these PROMS—the HAGOS and iHOT—as well as the other (currently not recommended) PROMS.
Publisher: BMJ
Date: 15-11-2020
DOI: 10.1136/BJSPORTS-2019-101458
Abstract: The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain (2) patient-reported outcome measures for hip-related pain (3) measurement of physical capacity for hip-related pain (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for ex le: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement in idualised, evidence-based physiotherapist-led rehabilitation programmes.
Publisher: Wiley
Date: 28-07-2014
DOI: 10.1002/ACR.22274
Abstract: To document the prevalence of radiographic osteoarthritis (OA) in the medial and lateral patellofemoral (PF) joint compartments relative to the prevalence of tibiofemoral (TF) joint OA in middle-aged and older adults with chronic PF knee pain. A convenience s le of 224 people who volunteered for a clinical trial underwent weight-bearing posteroanterior and skyline knee radiographs of their most symptomatic eligible knee. Radiographic severity in the TF joint and in the medial and lateral PF joint compartments was independently graded by 2 examiners using the Kellgren/Lawrence (K/L) grading system. K/L grades ≥2 were considered evidence of OA. OA was common in this cohort, and the most prevalent pattern was combined TF joint and PF joint OA (n = 98 [44%]), followed by isolated PF joint OA (n = 57 [25%]). Isolated TF joint OA was rare. Overall, more people demonstrated radiographic OA in the PF joint (n = 155 [69%]) than in the TF joint (n = 100 [45%]). The majority of people with PF joint OA had OA in both the medial and lateral PF joint compartments (n = 98 [63%]). Even in people ages <50 years, radiographic OA was common (isolated PF joint OA, 26% [n = 21] combined TF joint and PF joint OA, 29% [n = 23]). The severity of PF joint OA was similar across men and women. PF joint OA was highly prevalent, more so than TF joint OA, and even in in iduals ages <50 years. Further research is needed to elucidate the cause and effect relationship between chronic PF pain and PF joint OA.
Publisher: BMJ
Date: 19-12-2020
DOI: 10.1136/BJSPORTS-2019-101457
Abstract: Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport erformance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupation) be quantified, and sport-specific activities should be assessed prior to return to sport. The IHiPRN participants were uncertain regarding recommendations for range of motion assessment. Research recommendations were that the measurement properties of range of motion, strength and functional performance tests be investigated, reported and improved in both clinical and research settings. Reporting of movement-related parameters (biomechanics and muscle function) should be standardised and the relationship among movement-related parameters, symptoms, function, quality of life, and intra-articular and imaging findings should be investigated. Quantification of return to physical activity (including sport and occupational demands) is required in future research, and the return to sport continuum should be used. Future research is required to determine the best criteria for rehabilitation progression and return to physical activity following hip-related pain management.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2018
Abstract: Study Design A pilot double-blind randomized controlled trial (RCT). Background The effectiveness of physical therapy for femoroacetabular impingement syndrome (FAIS) is unknown. Objectives To determine the feasibility of an RCT investigating the effectiveness of a physical therapy intervention for FAIS. Methods Participants were 17 women and 7 men (mean ± SD age, 37 ± 8 years body mass index, 25.4 ± 3.4 kg/m
Publisher: Springer Science and Business Media LLC
Date: 08-11-2019
DOI: 10.1007/S00296-019-04472-9
Abstract: To determine the longitudinal association of baseline body mass index and change in body mass index over 8 years to incident of patellofemoral osteoarthritis at the 8-year follow-up. A s le of 528 women and men, aged 45-65 years, with knee complaints and without radiographic evidence of patellofemoral and tibiofemoral osteoarthritis at baseline, were selected from the Cohort Hip and Cohort Knee cohort. Incidence of patellofemoral osteoarthritis was defined as presence of radiographic patellofemoral osteoarthritis (with or without tibiofemoral osteoarthritis) at the 8-year follow-up. Baseline body mass index data were categorized into normal, overweight, and obese weight-categories. Logistic regression analyses, adjusted for age and sex, were conducted to determine the association of baseline body mass index and change in body mass index to patellofemoral osteoarthritis incidence 8 years later. Obesity was associated with greater odds of radiographic patellofemoral osteoarthritis incident (odds ratio: 1.8 [95% CI 1.1, 3.1]) 8 years later. There were no significant associations observed between body mass index change over 8 years and incidence of radiographic patellofemoral osteoarthritis in overweight and obese in iduals. Obesity is associated with increased odds of developing radiographic patellofemoral osteoarthritis 8 years later.
Start Date: 2012
End Date: 12-2016
Amount: $430,000.00
Funder: Australian Research Council
View Funded ActivityStart Date: 06-2019
End Date: 06-2022
Amount: $421,140.00
Funder: Australian Research Council
View Funded ActivityStart Date: 05-2016
End Date: 09-2019
Amount: $482,300.00
Funder: Australian Research Council
View Funded ActivityStart Date: 10-2009
End Date: 12-2011
Amount: $233,000.00
Funder: Australian Research Council
View Funded ActivityStart Date: 12-2009
End Date: 12-2015
Amount: $400,000.00
Funder: Australian Research Council
View Funded ActivityStart Date: 05-2011
End Date: 12-2015
Amount: $293,000.00
Funder: Australian Research Council
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