Orientador: Sérgio Rocha Piedade / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T00:56:21Z (GMT). No. of bitstreams: 1 Takaes_IgorGiglio_D.pdf: 3495607 bytes, checksum: 997a8e42e41218f941a9801fb74230d6 (MD5) Previous issue date: 2013 / Resumo: INTRODUÇÃO: A Avaliação pós-operatória das lesões ligamentares do joelho realizada por escores clínicos, na maioria das vezes, privilegia a análise subjetiva e não fornece dados do equilíbrio muscular. A dinamometria isocinética fornece dados objetivos do déficit e equilíbrio muscular do joelho e aprimora a análise e a interpretação dos resultados pós-operatórios. OBJETIVOS: Avaliar o equilíbrio funcional do joelho pela dinamometria após reconstrução do complexo bicruzado e sua correlação com escores clínicos. MATERIAL E MÉTODOS: Foram avaliados 21 pacientes (16 homens e 05 mulheres), com idade media de 33 anos, IMC médio de 26,2 ± 3.4. Todos os pacientes foram submetidos à reconstrução cirúrgica do LCP e do LCA em dois tempos, com intervalo médio de 03 meses entre os procedimentos. Com tempo mínimo de 01 ano de pós-operatório, foi realizada a análise isocinética dos joelhos e aplicado o escore de Lysholm, Tegner e SF-36. Os testes isocinéticos foram conduzidos a 05 repetições nas velocidades de 60º/s e 180º/s e 15 repetições a 300º/s. RESULTADOS: A média do escore de Lysholm foi 82,6 ± 16,9 pontos, enquanto o escore de Tegner apresentou redução de 38,6% comparada ao nível pré-lesão. Foram obtidos os seguintes valores médios no SF- 36 nos itens: capacidade funcional (70,71); limitação por aspectos físicos (58,33); dor (73,79); aspectos gerais de saúde (80,71); vitalidade (72,0); aspectos sociais (85,12); aspectos emocionais (85,7); e saúde mental (76,76). Na avaliação isocinética, o lado operado apresentou déficit de torque extensor médio de 20 % a 60º/s, 15% a 180º/s e 14% a 300º/s, enquanto no torque flexor o déficit médio foi de 11% a 60º/s, 12% a 180º/s e 12% a 300º/s. Embora tenha sido registrado menor valor médio de torque nos joelhos operados comparado aos joelhos controle, não houve diferenças estatísticas com relação ao equilíbrio funcional do joelho (isquiotibiais/quadríceps). CONCLUSÃO: Os resultados isocinéticos da reconstrução do complexo bicruzado realizada em dois tempos evidenciaram déficit do torque extensor e flexor no lado operado. Embora, nenhum paciente tenha retornado ao nível pré-lesão, o equilíbrio funcional do joelho (flexor-extensor) pode ter contribuído para avaliação subjetiva regular nos escores clínicos / Abstract: INTRODUCTION: Postoperative evaluation of knee ligament injuries made by clinical scores, in most cases, favors the subjective analysis of the data and does not provide muscular balance. Isokinetic dynamometry provides torque deficit and knee muscle balance and thus enhances analysis and interpretation of clinical results after surgery. OBJECTIVES: To assess the functional balance of the knee after bicruciate reconstruction and its correlation with clinical scores. MATERIALS AND METHODS: We evaluated 21 patients (16 men and 05 women), mean age 33 years, mean BMI of 26.2 ± 3.4. All patients underwent surgical reconstruction of the PCL and ACL in two stages, with a mean interval of 03 months between the procedures. With a minimum of one year postoperatively, the analysis was performed isokinetic knee and applied the Lysholm score, Tegner and SF-36. The isokinetic tests were conducted to 05 repetitions at 60°/s and 180°/s and 15 repetitions at 300°/s. RESULTS: The Lysholm score was 82.6 ± 16.9 points and Tegner scores showed a deficit of 38,6% compared to pre-injury level. We obtained the following average values in items of SF-36: functional capacity (70.71); limitations due to physical aspects (58.33); pain (73.79), general health (80.71), vitality 72, social aspects (85.12), emotional aspects (85.7) and mental health (76.76). In isokinetic evaluation, the deficit of the operated quadriceps average torque was 20% at 60 º/s, 180°/s at 15% and 14% up to 300°/s, while the average flexor torque deficit was 11% at 60°/s, 12% at 180°/s and 12% at 300º /s. Although, it was registered that operated knees presented a minor mean values of torque compared to the control knees, no difference was founded to the knee functional balance (hamstrings/quadriceps). CONCLUSION: The results of isokinetic bicruciate reconstruction, performed at two stages, showed a deficit of extensor and flexor torque in the operated side. Although no patient has returned to pre-injury level, the functional balance of the knee (flexor-extensor) may have contributed to the good subjective Lysholm score / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

Study Design: Methodological study. Objectives: To examine the agreement and validity of using observational risk screening guidelines to evaluate ACL injury risk factors. Background: Post-pubescent females have an increased risk of anterior cruciate ligament (ACL) injury compared with their male counterparts partly due to their high-risk landing and cutting strategies. There are currently no scientifically-tested methods to screen for these high risk strategies in the clinic or on the field. Methods and Measures: Three physiotherapists used observational risk screening guidelines to rate the neuromuscular characteristics of 40 adolescent female soccer players. Drop jumps were rated as high risk or low risk based on the degree of knee abduction. Side hops and side cuts were rated on the degree of lower limb 'reaching'. Ratings were evaluated for intrarater and interrater agreement using kappa coefficients. 3D motion analysis was used as a gold standard for determining the validity of ratings. Results: Acceptable intrarater and interrater agreement (k≥0.61) were attained for the drop jump and the side hop, with kappa coefficients ranging from 0.64 to 0.94. Acceptable sensitivity (≥0.80) was attained for the side hop and the side cut, with values ranging from 0.88 to 1.00. Acceptable specificity (≥0.50) was attained for the drop jump, with values ranging from 0.64 to 0.72. Conclusion: Observational risk screening is a practical and cost-effective method of screening for ACL injury risk. Based on levels of agreement and sensitivity, the side hop appears to be a suitable screening task. Agreement was acceptable for the drop jump but its validity needs further investigation. / Medicine, Faculty of / Graduate

Introduction: The anterior cruciate ligament (ACL) is a supporting ligament in the knee. ACL injuries are associated with concomitant meniscal tears and cartilage lesions. Aim: Our aim was to study the incidence of meniscal tears and cartilage lesions in patients with ACL injury and how it varies with time from injury to surgery Methods: This was a cohort study using the Swedish Knee Ligament Registry. We reviewed 479 patients who had ACL reconstruction in Region Örebro County between 2005-01-01 and 2019-03-19. Results: The incidence of meniscal tears was 33 %, cartilage lesions 18 %, both meniscal tears and cartilage lesions 29 %. The incidence of meniscal tears distributed over time from injury to surgery was 8 % for 0-3 months., 38 % for 4-12 months, 53 % for > 12 months. The incidence of cartilage lesions was 8 % for 0-3 months, 45 % for 4-12 months, 47 % for > 12 months. The incidence of both meniscal tears and cartilage lesions was 4 % for 0-3 months, 34 % for 4-12 months, 62 % for > 12 months Conclusions: Patients treated with ACL reconstruction had an increased rate of concomitant damage to menisci and articular cartilage with increased time from injury to surgery, suggesting a benefit of early reconstructive interventions following an ACL injury. Male patients displayed a higher incidence in cartilage lesions than did female. Young age was associated with a higher incidence of meniscal tears, whereas an increasing of age was associated with an increased incidence of cartilage lesions.

Inledning: 70% av alla skador av det främre korsbandet (ACL) sker vid icke-kontakt-situationer. En låg kokontraktionsratio mellan hamstrings och quadriceps (H:Q) kan ses som en riskfaktor för ACL. Få studier är gjorda kring detta i samband med enbenslandningar på olika underlag. Syfte: Syftet med studien var att undersöka kokontraktionen mellan rektus femoris och biceps femoris samt ground reaction force (GRF) vid drop landing från 30 cm på stabilt respektive instabilt underlag. Metod: Tre män deltog i studien. Studien utfördes i ett rörelselabb där deltagarna utförde enbenslandningar på stabilt respektive instabilt underlag. Muskelaktivitet mättes med elektromyografi (EMG) i musklerna rektus femoris och biceps femoris. GRF mättes med kraftplatta. EMG-amplituden beräknades i relation till respektive deltagares maximum voluntary isometric contraction (MVIC). Medelvärde och standardavvikelse för respektive muskel, H:Q-kokontraktionsratio och högsta uppmätta GRF (N/kg) beräknades. Resultat: EMG visade en högre aktivitet i rektus femoris jämfört med biceps femoris vid landning på respektive underlag. På gruppnivå visade biceps femoris minskad aktivitet vid landning på instabilt underlag och H:Q-kokontraktionsration minskade. Högsta uppmätta GRF visade en tendens att minska vid landning på instabilt underlag. Konklusion: Den minskade aktiviteten i biceps femoris vid instabilt underlag var oväntad vilket eventuellt kan förklaras med det låga deltagarantalet, den interindividuella variationen och val av underlag. Mer forskning behövs med ett större urval för att få ett mer tillförlitligt resultat. Det vore även intressant att standardisera och mäta knäledsvinkeln och inkludera mer utmanande instabila underlag. Detta skulle kunna bidra till ökade kunskaper kring olika underlag vid preventions- och rehabiliteringsträning.

Bakgrund: Skada på främre korsbandet är vanligt hos unga kvinnliga fotbollsspelare. Det finns evidens för att neuromuskulär träning kan reducera risken att drabbas av främre korsbandsskada med 64–88 %. Knäkontroll är ett neuromuskulärt träningsprogram som Svenska Fotbollförbundet (SvFF) implementerade i sin tränarutbildning år 2010. Syfte: Syftet med studien var att kartlägga hur väl rekommendationerna för utförande av knäkontrollträning följs i flickfotbollslag i åldrarna 12–17 år samt om förekomst av knäkontrollträning var högre i de flickfotbollslag där lagledaren genomfört tränarutbildning efter år 2010. Metod: Studiens design var en kvantitativ, icke-experimentell tvärsnittsstudie. Data samlades in via en egenkomponerad enkät som besvarades via mejl av 33 lagledare för flickfotbollslag. Deltagarna var ett stickprov ur en större population med geografisk spridning över Sverige. Resultat: Studiens resultat blev att fyra (12 %) lagledare bedömdes tillhöra kategorin Följer helt rekommendationerna, 21 (64 %) lagledare bedömdes tillhöra kategorin Följer delvis rekommendationerna och åtta (24 %) lagledare bedömdes tillhöra kategorin Följer inte rekommendationerna. Någon skillnad i utförande av programmet Knäkontroll beroende på om lagledare hade genomfört tränarutbildning efter 2010 eller om lagledare saknade tränarutbildning kunde inte ses. Slutsats: Slutsatsen av studien blev att majoriteten av lagledare för flickfotbollslag i åldrarna 12–17 delvis följde rekommendationerna för utförande av programmet Knäkontroll. Inga skillnader kunde ses i hur väl programmet Knäkontroll följdes beroende på lagledarens tränarutbildning. / Background: Anterior cruciate ligament (ACL) injuries are common in young female soccer players. There is evidence that neuromuscular training can reduce the risk of ACL injury with 64–88 %. Knee control is a neuromuscular training programme that was implemented in the national education for soccer coaches in 2010. Aim: The aim of the study was to examine how well girl soccer teams, ages 12–17, follow the existing recommendations regarding knee control training to prevent ACL injuries and if adherence was higher in teams where the coach was educated later than 2010. Method: The study design was a quantitative, non experimental cross-sectional study. A self-composed questionnaire was answered through e-mail by 33 coaches for girl soccer teams. Participants were a random sample of a larger population with a geographical spread across Sweden. Results: The result of the study was that four (12 %) coaches were placed in the category Following the recommendations fully, 21 (64 %) coaches in the category Following the recommendations partly and eight coaches in the category Do not follow recommendations. A difference in adherence to the programme Knee control could not be seen based on if the coach had completed the national education for soccer coaches later than 2010 or lacked this education. Conclusion: The conclusion of the study was that the majority of coaches for girl soccer teams, ages 12–17, followed the recommendations partly for performance of the programme Knee control. No difference could be seen in adherence to the programme Knee control based on the coach’s education.

Abstract The majority of sports injuries involve the lower body, particularly the knees. Roughly 2,5 million people suffer a knee injury each year. Through sudden harsh movements the knee can get damaged. Often, these injuries never truly heal. Once the knee is weakened the risk of injury increases and in many cases the function of the knee will never fully return. The goal of this project was to empower patients who suffer from damage to the Anterior Cruciate Ligament (ACL) to recover faster by providing a personalized and humanized rehabilitation plan. Inspiration and Method Interviews, shadowing sessions and workshops were done with patients, athletes, surgeons and therapists to truly gain an in depth understanding of the rehabilitation process and how to prevent the injury from happening. This showed that there is a clear problem with the rehabilitation between the therapist and the patients. The outcome of the treatment is too much determined by the capabilities of the therapist, who often do not have enough expertise or get too little information to generate a personalized treatment for each individual. Another big problem is the fact that patients lose their motivation since they feel that they are not improving, and alone in the overall process. It became clear that patients need to be empowered and to let them know that the outcome of the rehabilitation is completely in their hands. Result The result of this collaboration is Ara, the smart rehabilitation bracelet. Ara continuously monitors the injured knee to provide an increased amount of insights, which enables practitioners to take humanized, and data driven decisions to personalize the rehabilitation plan for each individual. It empowers patients to take an active part in their own rehabilitation by providing live and precise feedback on their activities throughout the day.

No description available.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第17955号 / 人健博第9号 / 新制||人健||1(附属図書館) / 30785 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 坪山 直生, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

No description available.

Background: Evidence indicates that an external focus (EF) of attention on the intended effect of one’s movement results in better motor performance and motor control than an internal focus (IF) on one’s own body. Despite this, an IF is predominantly encouraged through instructions and feedback provided by clinicians during sports and rehabilitation from injuries such as anterior cruciate ligament (ACL) injury. Aim: The aim of this pilot study was to investigate the influence of EF and IF on motor control and performance on a bilateral leg extension and flexion task. The secondary aim was to investigate potential differences in the outcomes between a control group and a group with ACL reconstruction (ACLR). Method: Fourteen controls and four individuals with ACLR performed a bilateral leg extension and flexion task with instructions that encouraged either an IF, EF or neutral focus (NF) of attention. The instructions encouraged participants to either keep the individual tubes located on the footplates under the soles of the feet (EF) or the feet themselves (IF) level with each other. A three-dimensional motion capture system was used to record kinematics. Motor control was assessed based on the movement smoothness according to the knee angular velocity profile and performance was assessed based on the absolute mean deviation of the tubes/footplates from parallel. Results: For the control group, IF instructions resulted in significantly better motor control than EF instructions for left knee movement smoothness (p=0.02) and NF instructions resulted in significantly better motor control than EF on a majority of dependent variables. Conclusion: For our task, EF instructions did not result in better outcomes compared to IF instructions which might be explained because the task was proprioceptive demanding with less involvement of the vision. The reason for better motor control with NF instructions compared to EF instructions might be because of differences in angular velocity and instructions between conditions.