Bakgrund: Behandlingen av Mediala collateral ligament (MCL) skador är debatterad. En skada på MCL kan leda till sämre medial stabilitet och nedsatt aktivitetsförmåga. Målet med den konservativa behandlingsformen är att minska svullnad och smärta för att på så vis få tillbaka full rörlighet och stabilitet. Behandlingen innebär ofta någon form av öppen eller låst ortos tillsammans med ett rehabiliteringsprogram. Syftet: Syftet med studien är att utifrån litteraturen analysera studiernas bevisvärde och beskriva konservativa behandlingsmetoder för MCL, med öppna och låsta ortoser tillsammans med träning. Metod: En litteraturstudie användes, då syftet var att göra en beskrivning av kunskapsläget. Artikelsökningen resulterade i 13 inkluderade studier. För att bestämma bevisvärde för studierna användes en granskningsmall av Carlsson och Eiman (2003) och Statens beredning för medicinsk utvärderings punkt om studiedesign. Resultat: Studierna fick bevisvärden från lågt - mycket lågt. Efter analys av de inkluderade studierna framkom att den mediala knästabiliteten uppvisade ett varierat resultat i båda grupperna med öppen och låst ortos. Dock återgick de flesta patienter till sin tidigare aktivitetsförmåga efter behandlingarnas slut. Slutsats: Av litteraturstudien kan inga slutsatser dras gällande i vilken utsträckning den mediala knästabiliteten och aktivitetsförmågan förändrats efter konservativ behandling med öppen respektive låst orts tillsammans med träning. Studiernas låga bevisvärde och varierade behandlingsmetoder inom låst respektive öppen ortos försvagar slutsatsen ytterligare.

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The knee is the most complex joint in the human body. It consists of a system of muscle, bone, and ligaments that endures repetitive loading during daily and athletic activities. When this loading is excessive, damage  to the knee occurs leading to a decreased quality of life.The medial collateral ligament (MCL) is one of the 4 major ligaments known to be commonly injured in the knee. The risk of injury to the knee joint increases with the elderly and individuals who experience chronic dehydration. For this reason, the focus of this study is to compare different mechanical quantities that can be used to analyze damage to the MCL. In this study, a novel mechanical testing protocol is used to progressively induce damage in dehydrated rat MCLs by performing tensile tests. This involves stretching the ligaments along their longitudinal axes to consecutive and increasing displacements starting at a 0.4 mm displacement and in increments of 0.2 mm until complete failure occurs. The load and change in length that the ligament experiences are measured at each displacement. Three different methods were evaluated to determine subfailure and damage propagation in rat MCLs: changes in tangent stiffness and chord stiffness, and changes in the load value at the 0.4 mm displacement for each load-displacement curve. The findings of this study indicate that the tangent stiffness and load at the 0.4 mm displacement provide information of the early onset of damage propagation. The decrease in chord stiffness of the ligament does not indicate damage progression in the ligament, but rather is the sign of the imminent failure of the MCL.This study provides insightful data into understanding the subfailure damage in the MCL. / Master of Science

Bakgrund: Skada på det mediala kollateralligamentet (MCL) är en av de vanligast förekommande knäskadorna och drabbar främst yngre idrottande personer. En av fysioterapeutens roller i rehabiliteringen är att se till människans helhet där biomedicinska, psykiska och sociala aspekter ingår, detta för att patienten ska få ett bra omhändertagande. Syfte: Att undersöka hur fysioterapeuter beskriver sitt arbete med rehabilitering av patienter med MCL-skador. Metod: En kvalitativ intervjustudie med deskriptiv design utfördes. Data insamlad från sex intervjuer av fysioterapeuter bearbetades med hjälp av en induktiv ansats i en kvalitativ innehållsanalys. Ett ändamålsenligt bekvämlighetsurval användes vid valet av intervjupersoner. Resultat/slutsats: Studiens resultat mynnade ut i fyra kategorier med två underkategorier inom varje. Kategoriernas namn var ”Identifierar behov av och arbetar med att ge patienterna stöd”, ”Anpassar rehabilitering efter patientens träningsmöjligheter och olika aktiviteter”, ”Arbetar med att minska rädsla, oro och öka tillit till knät hos patienterna” och ”Arbetar med patienternas motivation”. Det visade sig i studiens resultat att hänsyn togs av intervjupersonerna till såväl biomedicinska som psykosociala faktorer i sitt arbete med denna patientgrupp. / Background: Injury to the Medial Collateral Ligament (MCL) are one of the most common knee injuries and mainly affect younger athletes. One of the physiotherapists' roles in rehabilitation is to look at the whole of the human being, which includes biomedical, psychological and social aspects, in order to ensure a good medical care. Purpose: To investigate how physiotherapists describe their work with rehabilitation of patients with MCL injuries. Method: The design of the study was a qualitative interview study, with an inductive approach. Data collected from six interviews of physiotherapists was analysed using a qualitative content analysis. An appropriate convenience sample was used in the selection of interviewees. Result / conclusion: The study's results consisted of four categories with two subcategories within each. The names of the categories were "Identifying need of and work with supporting biopsychosocial factors", "Adapting rehabilitation to the patient's possibilities regarding training and various activities", "Working with reducing fear, worry and increasing the patient’s confidence regarding their knees" and "Working with the patients' motivation". It was shown in the results that consideration was taken by the interviewees regarding the patient’s biomedical and psychosocial factors.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12919号 / 論医博第2094号 / 新制||医||1009(附属図書館) / 32129 / (主査)教授 戸口田 淳也, 教授 妻木 範行, 教授 安達 泰治 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DGAM

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Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2016-06-08T21:04:44Z No. of bitstreams: 2 Dissertação - Gustavo Henrique Coutinho Ribeiro - 2015.pdf: 1861535 bytes, checksum: dbcf200e9f28a73a6beb4e4697cae540 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-06-09T11:47:39Z (GMT) No. of bitstreams: 2 Dissertação - Gustavo Henrique Coutinho Ribeiro - 2015.pdf: 1861535 bytes, checksum: dbcf200e9f28a73a6beb4e4697cae540 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-06-09T11:47:39Z (GMT). No. of bitstreams: 2 Dissertação - Gustavo Henrique Coutinho Ribeiro - 2015.pdf: 1861535 bytes, checksum: dbcf200e9f28a73a6beb4e4697cae540 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-12-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The main structures that restrict movements in frontal plane and rotation of the distal inter phalangeal joint (DIJ) are the collateral ligaments (CL). Lesions of CLs represent one of the major cause of lameness in horses and can affect all limbs, but the incidence is much higher in forelimbs. It can be either unilateral or bilateral. Medial or lateral CLs, can be affected simultaneously, but medial desmitis has been reported more often. The CL appears as an oval and echogenic structure in ultrasound images in the collateral fossa of the middle phalanx. This study has aimed to evaluate the collateral ligaments of the distal inter phalangeal joint of the forelimbs in Quarter horses without lameness, through ultrasound examination. Thirty Quarter horses, aged between two and 23 years (7 ± 3.30), of both genders, average weight of 442.9 ± 40.2, body score 3/5, with no lameness, were used for ultra-sonographic evaluation of the forelimbs collateral ligaments (CL) of the distal interphalangeal joint. All animals were calf roping (13) or barrel race (17) horses, divided into three groups (A, B and C) based on the age. Six parameters were evaluated: ligament area (LA), hypoechogenicity (HO), collapse of coronal vessels (CV), heterogeneity (HT), hyperechogenicity (HR) and irregularity of ligament margins (IM). In average, the ligament was 7.0 ± 0.9 mm thick, 11.7 ± 1.4 mm wide and had 0.77 ± 0.17 cm² of cross-sectional area, and appeared as an oval and echogenic structure. Sixteen percent of CLs had at least one of the above related changes. When comparing medial and lateral CLs, the medial CL showed changes more often (17%) than the lateral CL (14%). The most common findings included changes in echogenicity of the fibers and thickening of the CL, measured by LA; this parameter was abnormal in 17% of examined CL. Considering lateral and medial CLs separately, this rate was 13% and 20%, respectively. When the medial CL was compared in different groups, it was also more affected by increasing LA. In group B, the rate of increased LA was significantly higher (25%). Animals from groups B and C showed an upward trend in the frequency of HR (28 and 31%, respectively). Ligament fibers HT was significantly more frequent in group C. HO was observed in only 20% of the examined CLs. IM appeared in 38% animals of group C, while CV was only observed in a few horses. / As principais estruturas que limitam o movimento colateral e a rotação da articulação inter falangeana distal são os ligamentos colaterais (LC). As lesões dos LCs representam uma causa importante de claudicação em equinos e podem acometer qualquer um dos membros no cavalo, porém a frequência é bem maior nos membros torácicos, de modo uni ou bilateral. Ambos os LCs, medial ou lateral, podem ser afetados, simultaneamente, mas a desmite do LC medial tem sido relatada com maior frequência. As imagens ultrassonográficas do LC aparecem como uma estrutura oval e ecogênica dentro da fossa colateral da falange média (FM). Esse trabalho objetivou avaliar o ligamento colateral da articulação inter falangeana distal dos membros torácicos em equinos Quarto de Milha sem claudicação, empregando o exame ultrassonográfico. Foram utilizados trinta equinos, da raça quarto de milha, com idades entre dois e 23 anos (7 ± 3,30), de ambos os sexos, média de peso de 442,9 ± 40,2, escore corporal 3/5 e sem claudicação para avaliação ultrassonográfica dos ligamentos colaterais da articulação inter falangeana distal nos membros torácicos. Os animais praticavam provas de laço de bezerro (13) ou três tambores (17) e foram divididos em três grupos, de acordo com a idade: A: entre três e quatro anos; B entre cinco e dez anos; C: acima de dez anos. Foram avaliados seis parâmetros ao ultrassom: área do ligamento (AL), hipoecogenicidade (HO), colapso dos vasos coronais (CV), heterogeneidade (HT), hiperecogenicidade (HR) e irregularidade de bordas do ligamento (IB). O LC apresentou, em média, 7,0 ± 0,9 mm de espessura, 11,7 ± 1,4 mm de largura, área transversal de 0,77 ± 0,17 cm², e apareceu como uma estrutura oval e ecogênica. Dos 30 animais, 16% dos LCs apresentaram pelo menos uma das alterações relacionadas. Quando comparados os LCs medial e lateral, o LCM apresentou alterações com maior frequência (17%) que o LCL (14%). Na imagem transversal, os achados mais comuns incluíram mudanças na ecogenicidade das fibras e espessamento do LC, medido pela AL, parâmetro que se mostrou alterado em 17% dos LC examinados. Quando foram considerados os LCLs e LCMs separadamente, a frequência de alterações foi de 13% e 20%, respectivamente. O LCM, quando analisado em grupos de diferentes idades, também foi o mais acometido pelo aumento da AL; no grupo B, a frequência do aumento de área se mostrou aumentada significativamente (25%). Animais dos grupos B e C demonstraram uma tendência de aumento da frequência da HR (28 e 31%, respectivamente). A HT de fibras foi observada com uma frequência significativamente maior no grupo C. A HO apareceu em apenas 20% dos LCs examinados. A IB apareceu em 38% dos animais do grupo C, enquanto o CV foi observado em poucos animais.

INTRODUCTION. Frontal collisions have been observed to cause the severe injuries on heavy goods vehicle occupants, and the lower extremities have been frequently injured. Injuries of knee joints are rarely life threatening, however they tend to give long-term consequences. AIM. Evaluate non-lethal frontal impacts towards the knee joint of Total Human Model for Safety (THUMS) v4.0 using a cylindrical barrier. The main objectives are to 1) create local injury risk functions of the knee ligaments restraining frontal impacts, 2) simulate frontal impacts towards the knee joints of THUMS and3) prepare the Hybrid III (HIII)-model for corresponding frontal impacts conducted on THUMS. The intention is for future HIII-simulations to be cross-correlated with the responses from THUMS for the ability to estimate knee ligament strains by investigating impacts on HIII. METHODS. 1) Ligament risk curves of PCL, MCL and LCL were formulated by assembling mean strain threshold values and standard deviations from literature. Virtual values were generated from these pooled strain thresholds, creating the risk curves. 2) THUMS lower body was impacted by a cylindrical steel barrier at four different locations - middle of patella, middle of knee joint, upper tibia and below tibia tuberositas. Four impact velocities ranging from 8-14 km/h were used at each location, giving a total of 16 impacts. 3) The HIII-model was prepared by removing the upper body and inserting the cylindrical steel barrier into the model file. RESULTS. The strain threshold at 50% rupture risk for PCL resulted in 23.6±4.4%, 34.2±6.0% for MCL and 26.6±6.5% for LCL. The simulated THUMS PCL strains reached between 36%-58% for the highest velocity at the impact locations where tibia was involved. Both MCL and LCL gave an approximate 5% strain outcome. The resultant knee displacement for these impacts ranged between 22 mm - 32 mm. The knee displacements at the PCL strain threshold ranged between 14 mm - 16 mm. DISCUSSION and CONCLUSION. Most of the maximal PCL strains exceeded the PCL threshold with large margins. However, the knee displacement at the PCL strain threshold resulted in outcomes comparable to the thresholds used for HIIImodel. These results supported the obtained PCL threshold to be within a reasonable range.

The purpose of this thesis is to determine what effects draft order, monetary earnings, and Tommy John Surgery (TJS) have on the perceived value of a pitcher in Major League Baseball (MLB). For the context of this thesis, value will be defined as a player's ability to contribute to their team's wins in a positive manner. TJS has become synonymous with MLB and baseball as a sport, and many are either skeptical of its effects or over-assuming of its benefits. The three aforementioned areas of concerns were used to structure the thesis, as each dependent outcome is analyzed in a chapter of its own. Multiple articles and studies pertaining to the effects draft order, financial earnings, and TJS may have on pitcher value were compiled and analyzed. Looking at studies between pitchers who underwent TJS prior to being drafted, their order by which they are picked by a team is not as affected as assumed, but the pitcher is more likely to return to the disabled/injured list during their career in MLB. A lens of economic value saw that pitchers who were paid more added to their teams' respective wins. However, the financial loss caused by a pitcher missing time to recover from TJS could outweigh the cost of wins. From a purely Tommy-John standpoint, there are significant changes both beneficial and detrimental to a pitcher's overall statistics. Further research and personal knowledge should be explored prior to receiving TJS as a pitcher. Overall, the factor of TJS seems to have a slightly negative influence on the other two factors and an overall stronger influence than draft order or monetary earnings.