The current study investigated the distribution of periodontal epithelial cells and nerve fibres within the furcations of rat maxillary molar teeth subjected to hypothermic injury. The upper right first molars of 30 Sprague-Dawley rats were subjected to a single 20 minute application of dry ice in order to produce aseptic necrosis within the periodontal ligament, while the contralateral first molar served as an untreated control. Five animals were each sacrificed via cardiac perfusion after 7, 10, 14, 18, 21 and 28 days respectively and the maxillae were dissected out. After fixation in paraformaldehyde and processing, the tissues were embedded in paraffin wax and cut into 7µm serial coronal sections through the furcation region. Consecutive sections were then stained with H&E, cytokeratin AE1/AE3 and PGP 9.5 immunostains. Light microscopic examination of the H&E stained sections revealed that ankylosis had not developed in all of the experimental teeth, and in some of the observation groups fewer teeth were ankylosed than unaffected. The morphology of the ankylotic areas appeared to change with time, initially consisting of fine bony trabeculae, then progressing to solid bone occupying the entire furcation before becoming less solid again by the latest observation periods. Root resorption was often seen adjacent to areas of ankylosis, but the cementum of the tooth root at the point of ankylotic union was usually intact and free of resorption. Changes within the pulp chambers of the experimental teeth were also noted, with reduction in cellularity and tissue disorganisation initially, then increasing cellularity and formation of a cementum-like material on the chamber walls later. Cytokeratin AE1/AE3 immunostaining successfully identified epithelial cells within the periodontal ligament and their distribution around control teeth was similar to previous reports. Counting of these cells revealed lower numbers around experimental teeth, with the lowest counts around experimental teeth which had developed ankylosis. No change in the epithelial cell counts was detected over time, and these cells did not appear to regenerate after necrosis regardless of whether or not ankylosis developed. Statistical analysis indicated that the probability of ankylosis decreased as the number of epithelial cells increased. The PGP 9.5 immunostain identified periodontal nerve fibres, but the use of this stain was quite technique sensitive. The furcations of the molar teeth were noted to have relatively sparse innervation, with most of the visible nerve fibres being closely associated with blood vessels and located in the outer two-thirds of the ligament. Counting of the nerve fibres revealed fewer fibres around experimental teeth compared to control teeth, especially in the part of the ligament closest to the tooth root. There was no relationship detected between nerve count and time or between nerve and epithelial cell counts. Resorption was found to be more prevalent in experimental teeth, and the probability of resorption in a given tooth decreased as the epithelial cell count increased. The findings of this study suggest that the epithelial cells within the periodontal ligament have a protective function in the prevention of dentoalveolar ankylosis and resorption. Evidence of an intimate interrelationship between periodontal nerve fibre and epithelial cell numbers could not be confirmed. The null hypothesis that epithelial cell rests of Malassez do not provide a protective function against ankylosis and external root resorption was rejected, and the null hypothesis that nerve fibres and epithelial cells are not inter-dependent was retained. / http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297409 / Thesis (D.Clin.Dent.) -- School of Dentistry, 2007

The human jaw, like all other articulated body parts, exhibits small oscillatory movements during isometric holding tasks. These movements, known as physiological tremor, arise as a consequence of the interaction of various factors. One of these factors is reflex feedback from peripheral receptors. In the human jaw, receptors that innervate the periodontium are able to transduce minute changes in force. This thesis examines the contribution of these periodontal mechanoreceptors (PMRs) to the genesis of physiological tremor of the human jaw. By using frequency domain analysis of time series recorded during isometric biting tasks, the character of physiological jaw tremor can be revealed. Physiological jaw tremor was observed in force recorded from between the teeth as well as from electromyograms recorded from the principal muscles of mastication. These recordings have shown us that jaw physiological tremor consists of a frequency invariant component between 6 and 10Hz. This frequency remains unaltered under various load conditions where the mechanical resonance of the jaw would be expected to vary greatly (Chapter 2). Such findings indicate a ‘neurogenic’ origin for this tremor. A possible candidate for this neurogenic component of physiological tremor in the jaw is the reflex feedback arising from the PMRs. Using local anaesthetisation, it has been shown in this thesis, that by blocking outflow from the PMRs, the amplitude of neurogenic physiological jaw tremor can be reduced dramatically. This procedure caused a dramatic reduction in not only the mechanical recordings of tremor but also in the coupling between masseteric muscles bilaterally (Chapter 3) and between single motor units recorded from within a homonymous muscle (Chapter 4). The obvious mechanism by which periodontal mechanoreceptor anaesthetisation could reduce the amplitude of physiological tremor in the jaw would be by reducing the amplitude of the oscillatory input to the motoneurones driving the tremor. This interpretation remains controversial however as physiological tremor in the jaw can be observed at force levels above which the PMRs are supposedly saturated in their response. In light of this knowledge, the saturating characteristics of these receptors in terms of reflex output were examined. To do this, a novel stimulation paradigm was devised whereby the incisal teeth were mechanically stimulated with identical stimulus waveforms superimposed upon increasing tooth preloads. This necessitated the use of a frequency response method to quantify the reflexes. An optimal frequency for stimulation was identified and used to confirm that the hyperbolic saturating response of PMRs observed previously, translated to a similar phenomenon in masticatory reflexes (Chapter 5). These data reinforced the idea that physiological tremor in the jaw was not just a consequence of rhythmic reflex input from PMRs, as the dynamic reflex response uncoupled from the input as the receptor-mediated reflex response saturated. An alternative hypothesis was then developed that suggested the effect of PMR suppression in physiological tremor was via tonic rather than rhythmic effects on the masseteric motoneurone pool. By utilising a novel contraction strategy to manipulate the mean firing rate of the motor neuron pool at a given level of force production, data contained in Chapter 6 shows that population motor unit firing statistics influence the expression of physiological tremor, and such manipulations mimic, to an extent, the changes in firing statistics and tremor amplitude seen during anaesthetisation of the PMRs. This thesis therefore posits a mechanism whereby periodontal input influences the firing rate of motoneurones in such a way as to promote tremulous activity (Chapter 5). However, as this proposed mechanism did not explain the full extent of tremor suppression seen during PMR anaesthetisation it can therefore only be considered a contributing factor in a multifactor process. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297555 / Thesis (Ph.D.) -- University of Adelaide, School of Molecular and Biomedical Science, 2007

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

INTRODUÇÃO: Anualmente nos E.U. A, estima-se mais de 250.000 mil casos de lesão do ligamento cruzado anterior, o que torna a reconstrução cirúrgica um procedimento comum na pratica da medicina esportiva. Ainda não existe consenso sobre o quanto de atividade promove uma reabilitação adequada sem prejudicar o enxerto ou produzir uma frouxidão anterior anormal, com consequente dano ao menisco e a cartilagem articular. OBJETIVO: Analisar e comparar o efeito de um protocolo de fisioterapia acelerado na estabilidade anterior e evolução clínica dos indivíduos submetidos à reconstrução do ligamento cruzado anterior. MÉTODOS: Foram incluídos 29 indivíduos no estudo que apresentaram ruptura total do LCA confirmada por RM e submetidos à reconstrução ligamentar com Tendão patelar. Aleatoriamente foram alocados em dois grupos com intervalos de reabilitação diferentes: Grupo Acelerado (4 meses) ou Grupo Convencional (6 meses). No pré-operatório, sexto e no quarto mês de pós-operatório um avaliador cego registrou: a lassidão anterior através do KT1000, Força muscular (CYBEX) e a função do joelho acometido através do IKDC (2000) e o Hop Test. RESULTADOS: os grupos foram semelhantes em relação aos dados demográficos. Não foi encontrada diferença estatística na lassidão anterior no quarto mês 0,92mm versus 1,33mm e no sexto mês 0,50mm versus 1,67mm sendo Grupo Convencional versus Grupo Acelerado respectivamente. No quarto mês o Grupo Acelerado apresentou uma melhora significativa (P< 0,001) na evolução clínica do IKDC (2000) 79,50 versus 60,61 do Grupo Convencional, essa diferença não se repetiu no sexto mês. A força muscular e o Hop Test, o Grupo Acelerado apresentou maiores valores, mas não de forma significativa nos dois momentos de avaliação (P> 0.05). CONCLUSÃO: Com base nos resultados obtidos, o protocolo acelerado quando comparado ao Convencional, não se diferiu quanto à estabilidade anterior do joelho e foi suficiente para demonstrar uma melhora significativa precoce na evolução clínica do joelho / BACKGROUND: Each year in the US, it is estimated more than 250 million cases of anterior cruciate ligament injury, which makes surgical reconstruction a common procedure in the practice of sports medicine. There is still no consensus on how much activity to promote adequate rehabilitation without damaging the graft or produce an abnormal anterior laxity, with consequent damage to the meniscus and articular cartilage. PURPOSE: To analyze and compare the effect of an accelerated physiotherapy protocol in the anterior-stability and clinical outcome of patients undergoing reconstruction of the anterior cruciate ligament. METHODS: We included 29 subjects in the study who had total ACL rupture confirmed by MRI and underwent ligament reconstruction with patellar tendon. Patients were randomly allocated in two groups with different rehabilitation intervals: Accelerated Group (4 months) or Conventional Group (6 months). Preoperatively, six and four months postoperatively a blind evaluator recorded: anterior laxity by KT1000, Brawn (CYBEX) and knee function affected by IKDC (2000) and the Hop Test. RESULTS: the groups were similar relative to demographic data. There was no statistical difference in anterior laxity in the fourth month 0,92mm versus 1.33mm and 0.50mm in the sixth month versus 1,67mm being conventional group versus accelerated group respectively. In the fourth month the accelerated group showed a significant improvement (P <0.001) in the clinical evolution of the IKDC (2000) 79.50 versus 60.61 in the conventional group, this difference was not repeated in the sixth month. Muscle strength and the Hop Test, the fast group had higher values, but not significantly in both time points (P> 0.05). CONCLUSION: Based on these results, the Accelerated protocol when compared to conventional, do not differ as the anterior knee stability and was sufficient to establish an early significant improvement in the clinical outcome of the knee

No description available.

L’objectif général du mémoire est de développer un protocole d’évaluation de l’impact d’une orthèse optimisée sur la biomécanique intra-articulaire afin de prévenir une re déchirure du LCA lors du retour au jeu. La rupture du ligament croisé antérieur (LCA) est l’une des blessures les plus fréquentes au genou. Une déchirure de LCA implique généralement à court terme une reconstruction chirurgicale suivie d’une réadaptation d’au moins 6 mois avant de considérer un retour au jeu. Dans la population pédiatrique, jusqu’à un patient sur quatre subira une rupture du greffon au moment du retour au jeu. Cela a un impact catastrophique chez les jeunes athlètes qui abandonnent souvent le sport et développent une gonarthrose à plus long terme. La littérature est contradictoire concernant la prescription et l’utilisation d’une orthèse fonctionnelle lors du retour au jeu pour prévenir la déchirure du greffon chez les athlètes à haut risque. Une orthèse optimisée pédiatrique de genou pourrait s’avérer une avenue innovante afin de réduire le taux de re-déchirures chez cette population à risque. Pour répondre à l’objectif général, deux objectifs spécifiques ont été déterminés: 1) Développer une revue systématique pour évaluer l’utilisation d’orthèses fonctionnelles lors du retour au jeu et leur efficacité dans la prévention des re blessures, 2) Évaluer l’effet du port d’une orthèse optimisée lors de la réalisation de mouvements athlétiques. Cet objectif s’articule suivant deux sous objectifs : 2.1 Mettre au point un protocole d’évaluation, 2.2 évaluer l’impact du port de l’orthèse sur l’alignement articulaire du genou. À cet effet, nous avons publié une revue systématique qui a permis de démontrer une tendance quant à l’effet préventif de l’utilisation d’une orthèse fonctionnelle lors du retour au jeu sur le taux de re-déchirures chez certaines populations, dont les adolescents de moins de 17 ans. Un protocole expérimental a été développé afin d’évaluer l’effet d’une orthèse pédiatrique optimisée du genou sur la biomécanique 3D lors de gestes sportifs. / The overall objective of the thesis is to develop a protocol to evaluate the impact of an optimized knee brace on intra-articular biomechanics to prevent ACL reinjury when returning to play. An anterior cruciate ligament (ACL) rupture is one of the most common knee injuries. An ACL tear usually involves short-term surgical reconstruction followed by at least six months of rehabilitation before considering a return to play. Nearly one in four patients will experience a graft rupture upon return to play. This injury has a catastrophic impact on young athletes who often drop out of sport and develop knee osteoarthritis in the longer term, thus disrupting their quality of life. The problem lies in the prevention of ACL injury when identifying patients at high risk. The prescription and use of a functional knee brace upon return to play to prevent graft tear in high-risk athletes is inconsistent in the literature. An optimized pediatric knee brace may be an innovative avenue to reduce the rate of re-tears in at-risk populations. In addition to the main objective, two more specific goals were determined to answer the general objective. First, the development of a systematic review to evaluate the effect of wearing an optimized knee brace when return to play and their effectiveness in preventing reinjury. Second, to evaluate the effect of wearing a knee brace when performing athletic movement. This objective is structures according to two sub-objectives: 2.1 Develop an evaluation protocol, 2.2 evaluate the impact of wearing the knee brace on the biomechanics of the knee. To address the research objectives, we have published a systematic review that demonstrated a trend in the preventive effect of the use of a knee brace when returning to play on the reinjury rate in certain populations, including adolescents (< 17 years old). An experimental protocol has been developed to evaluate the effect of an optimized pediatric knee orthosis on 3D biomechanics during sport movements.

Resumo: O prognóstico de um dente reimplantado está relacionado a integridade do ligamento periodontal cementário e da camada de cemento. Esta, por sua vez, e influenciada por vários fatores, sendo os principais, o periodo extra-alveolar e o meio de conservação. Existem dúvidas, no entanto, se alterações sistêmicas, como o diabetes, também podem interferir no prognóstico do reimplante dentário. Portanto, o propósito deste trabalho foi avaliar o processo de reparo do reimplante de incisivos de ratos diabéticos nao controlados após a manutenção dos dentes em leite bovino pasteurizado. Para tanto, 32 ratos foram divididos em dois grupos de 16 animais cada, sendo que no Grupo I foi administrada, por via endovenosa, injeção de tampão citrato e no Grupo II inoculada estreptozotocina dissolvida em tampão citrato pela mesma via, para a indução do diabetes. Após controle glicêmico e a comprovação das altas taxas de glicemia, o incisivo superior direito de cada animal foi extraído e mantido em leite durante sessenta minutos. Na sequência, realizou-se o tratamento endodontico com a colocação de curativo de hidróxido de cálcio e o posterior reimplante dos dentes em seus respectivos alveolos. A antibioticoterapia sistêmica foi instituida no pós-operatório imediato. Decorridos 10 e 60 dias após o reimplante, realizou-se a eutanasia dos animais e as peças obtidas foram submetidas ao processamento laboratorial para a obtenção dos cortes, os quais foram corados com hematoxilina e eosina e Tricromicro de Masson para análise histologica e histométrica. Os resultados demonstraram que o tecido conjuntivo adjacente a superfície radicular se apresentou desorganizado nos animais diabéticos. Ìndices menores de reabsorção radicular externa e anquilose também foram encontrados neste grupo, porém, sem diferenças estatísticas significantes. / Abstract: The prognosis of a replanted tooth is related to the integrity of the cemental periodontal ligament and the cementum layer, which, in turn, is influenced by several factors. Among these factors, the extra-alveolar time and the storage medium are the most important. However, it remains unclear whether systemic alterations, such as diabetes, may also interfere with the prognosis of tooth replantation. Therefore, the purpose of this investigation was therefore to evaluate the healing process of non-controlled diabetic rats' incisors replanted after storage of the teeth in bovine pasteurized milk. A total of 32 rats were assigned to two groups of 16 animals each. In group I, a citrate buffer injection was administered intravenously to rats while the animals in group II received an intravenous injection of streptozotocin dissolved in citrate buffer to induce diabetes. After confirmation of high glycemic levels, the maxillary right incisor of each animal was extracted and stored in milk during 60 minutes. Thereafter, the teeth were endodontically treated, with placement of a calcium hydroxide-based intracanal dressing, and the teeth replanted into their sockets. Systemic antibiotic therapy started in the immediate postoperative period. The animals were euthanized 10 and 60 days postoperatively. The anatomical pieces were removed, submitted to routine laboratorial processing and serially sectioned to obtain cuts that were stained by hematoxylin and eosin and Masson's Trichrome for histologic and histometric analyses. The results showed that the connective tissue adjacent to the root surface was disorganized in the diabetic rats. Lower indices of external root resorption and ankylosis were also observed in the diabetic group, though with no statistically significant difference. / Orientador: Celso Koogi Sonoda / Coorientador: Alessandra Marcondes Aranega / Banca: Luis Eduardo Marques Padovan / Banca: Wilson Roberto Poi / Mestre

Objective: The primary aim of this research was to examine the temporal pattern of neuromuscular quadriceps deficits in both the involved and uninvolved limbs of patients assigned to the control group after anterior cruciate ligament reconstruction (ACLr), by assessing quadriceps strength, voluntary activation, and corticomotor excitability prior to surgery (baseline), three months after ACLr, and six months after ACLr. A secondary aim of this research was to determine whether quadriceps strength, voluntary activation, and/or corticomotor excitability assessed in patients prior to ACLr and/or at three months after surgery, is predictive of lower extremity postural control and/or self-reported function at six months after ACLr. Lastly, a tertiary aim of this research was to determine if a 12-week home-based neuromuscular electrical stimulation (Home-NMES) program elicits greater bilateral improvements in quadriceps strength, voluntary activation, and corticomotor excitability of patients at three and six months after ACLr compared to a 12-week standard home-exercise program (control group). Participants: Fifty patients scheduled to undergo unilateral ACLr were randomly allocated to the home-NMES group (19 Female, 6 Male; age: 18.9 ± 5.4 years; height: 170.8 ± 9.7 cm; weight: 74.6 ± 18.5 kg; 28.0±20.0 days-post-injury) or control group (14 Female, 11 Male; age: 19.4 ± 4.5 years; height: 171.1 ± 11.5 cm; weight: 70.7 ± 11.9 kg). Methods: A randomized clinical trial design was used in this study. Prior to ACLr, isometric quadriceps strength and voluntary quadriceps activation were assessed in both limbs of patients, and corticomotor excitability was assessed in the involved limb. Three days after ACLr, both groups were instructed to begin their allocated interventions. The Home-NMES group administered NMES to their involved limb’s quadriceps three sessions a day for 15 minutes, and five days a week for 12 weeks using a portable NMES device. The control group was treated according to the current standard-of-care, but they were also instructed to perform volitional isometric quadriceps contractions for the same duration and frequency as the Home-Based NMES protocol. The outcomes measures were reassessed in both groups at three and six months post-ACLr. Main Outcome Measures: Quadriceps strength and voluntary activation were assessed using maximal voluntary isometric contractions and the superimposed burst technique, respectively. Normalized peak knee extension torque and central activation ratio were used to quantify isometric quadriceps strength and activation, respectively. Corticomotor excitability was evaluated with transcranial magnetic stimulation, and quantified with active motor threshold). The Y-balance test anterior reach (YBT-A) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess the patients lower extremity knee function at six months post-ACLr. Statistical Analyses: Specific Aim 1: A 2x3 (limb x time) mixed model, ANOVA with repeated measures was performed in the control group to assess differences between the involved limb and the uninvolved limb for isometric quadriceps strength, and voluntary quadriceps activation over time. A one-way mixed model, ANOVA with repeated measures was performed in the control group to assess differences in corticomotor excitability over time. Post-hoc comparisons were performed when appropriate. Specific Aim 2: Separate, mixed model, linear regression analyses were performed in the control group (involved limb) to determine the effect that the neuromuscular quadriceps outcome measures assessed at baseline and 3 months post-ACLr, had on lower extremity knee functional outcome measures assessed at 6 months post-ACLr. Specific Aim 3: A 2x2x3 (group x limb x time) mixed model, ANOVA with repeated measures was performed to assess group differences between the involved limb and the uninvolved limb in isometric quadriceps strength, and voluntary quadriceps activation over time. A 2x3 (group x time) mixed model, ANOVA with repeated measures was performed to assess group differences in corticomotor excitability over time. Post-hoc comparisons were performed when appropriate. Results: Aim 1: Patients demonstrated lower quadriceps strength on their involved limb compared to their uninvolved limb at baseline, three months post-ACLr, and six months post-ACLr. Quadriceps strength progressively decreased in the involved limb of patients from baseline to 3 months post-ACLr, baseline to 6 months post-ACLr, and increased from 3 months to 6 months post-ACLr. Quadriceps strength was also decreased in the uninvolved limb of patients from baseline to 6 months post-ACLr. ). Irrespective of when it was assessed, voluntary quadriceps activation was higher in the involved limb of patients compared to their uninvolved limb. There were no changes in corticomotor excitability of the involved limb over time. Specific Aim 2: The quadriceps strength of patients at three months post-ACLr had a significant positive effect on their 6-month YBT-A performance KOOS score. ). Neither voluntary quadriceps activation or corticomotor excitability or AMT (at baseline or 3-month post-ACLr) had a significant effect on any of the 6-month lower extremity functional outcome measures. Specific Aim 3: Irrespective of limb or when it was assessed, quadriceps strength was higher in the control group compared to the Home-NMES group. Both groups demonstrated lower quadriceps strength on their involved limbs compared to their uninvolved limbs at baseline, three months post-ACLr, and six months post-ACLr. Quadriceps progressively decreased in the involved limbs of both groups from baseline to three months post-ACLr and baseline to six months post-ACLr, and increased from three months to six months post- ACLr. At baseline, voluntary quadriceps activation was higher in the involved limbs of both groups compared to their uninvolved limbs. There were no group differences or changes over time observed in the involved limb of both groups with corticomotor excitability. Conclusion: Although quadriceps weakness is more apparent in the involved limb of patients after ACLr, the quadriceps strength of their uninvolved limb was also affected. Clinicians are encouraged to not rely on a quadriceps strength limb symmetry index when making return-sport-decisions for their patients after recovering from ACLr. The quadriceps in the uninvolved limb of patients demonstrated more inhibition, which may explain the quadriceps strength deficits observed in the uninvolved limb of patients following ACLr. To reduce the risk of subsequent injury upon return-to-sport and protect against the development of knee OA, we recommend that clinicians incorporate bilateral interventions aimed at restoring quadriceps strength and disinhibiting the quadriceps. Intensive quadriceps strengthening should be performed in the early stages of ACLr rehabilitation, so that lower extremity function can be improved in patients later on. Lastly, the effectiveness of home-based NMES as a modality for restoring quadriceps strength and activation in patients after ACLr is inconclusive. Home-based NMES provides patients with the ability to receive higher doses of NMES to the quadriceps; but its effectiveness may be limited by low contraction intensities and poor treatment compliance in patients.

Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The anterior cruciate ligament is the most commonly injured ligament in the knee, with only one third of athletes returning to their pre-injury level of sport. Identifying intrinsic factors associated with an increased likelihood of return to sport may improve the surgical outcome. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. The objective was to systematically appraise publications describing intrinsic factors which may be associated with return to sport, after anterior cruciate ligament reconstruction. A comprehensive eligibility checklist was composed. Methodological quality appraisal of cohort studies revealed that high quality studies were included in the review. A descriptive synthesis of the findings associating intrinsic factors with return to sport was performed. Ten studies were included. The most important finding was the association of fear of re-injury preventing return to sports participation. Knee function did not always correspond with the likelihood of returning to sport. Younger athletes and competitive, male athletes appeared more likely to return. Across these studies, the 141 athletes not returning to pre-injury sport were questioned as to the reason for non return. An average of 35% (49 athletes) cited fear of re-injury as the reason. Fear of re-injury was thus investigated further as it could be considered in the post-operative management of anterior cruciate ligament reconstruction. In a qualitative study with supplemental cross-sectional analysis, factors informing fear of re-injury were explored. Male and female athletes, aged 17-50 years were included (n=59). Reconstruction procedures using any graft type were included; however revision and multi-ligament reconstruction was excluded. Twenty-four participants (41%) did not return to the pre-injury sport. Those citing fear of re-injury as the only reason for not-retuning to sport were interviewed (n=12). Thus, those who did not return to pre-injury type and level of sport despite good knee function. Athletes’ experiences informing fear of re-injury were explored by semi-structured interviews. Data analysis was performed by content analysis. Codes were allocated and categorised and these categories were synthesised into themes. The Qualitative review guidelines – RATS were followed. From the participant interviews, four themes emerged: undergoing the surgery and recovery again, nature of the pre-injury sport imposing risk of re-injury, personality traits, and social priorities. An accelerated rehabilitation programme was suggested to improve the post–operative experience. The supplementary analysis revealed athletes younger than 20 years of age were more likely to return to sport. Modifiable fears include pain, length of rehabilitation, mechanism of injury and psychological aspects. Pain management, motivation and education are important considerations post-operatively and during rehabilitation. Clinicians should be aware of factors informing fear of re-injury on an individual basis to develop a tailored management plan. / AFRIKAANSE OPSOMMING: OPSOMMING Die anterior kruisligament is die mees algemeen beseerde ligamente in die knie, met slegs een derde van die atlete wat terugkeer na hul pre-besering vlak van sport. Identifisering van intrinsieke faktore wat verband hou met 'n verhoogde moontlikheid van terugkeer na sport kan die chirurgiese uitkoms verbeter. 'n Sistematiese oorsig wat die Voorkeur Verslag Items vir Sistematiese oorsig en Meta-ontledingsriglyne volg, is uitgevoer . Die doel was om stelselmatig publikasies, wat intrinsieke faktore beskryf wat verband hou met terugkeer na sport na anterior kruisligament rekonstruksie, te beoordeel. 'n Omvattende kontrolelys is saamgestel. Metodologiese kwaliteit beoordeling van ‘n groep studies het 'n hoë gehalte studie aan die lig gebring, wat ingesluit is in die oorsig. 'n Beskrywende sintese van die bevindinge wat intrinsieke faktore met die terugkeer na sport assosieer, is uitgevoer. Tien studies is ingesluit. Die belangrikste bevinding wat terugkeer na sportdeelname verhinder was die vrees van herbesering. Kniefunksie het nie altyd ooreengestem met die moontlikheid van terugkeer na sport nie. Jonger atlete en wedywerende manlike atlete was meer geneig om terug te keer. In al die ingesluite studies, is die 141 atlete wat nie teruggekeer het na sport voorbesering ondervra oor die rede vir nie terugkeer. 'n Gemiddeld van 35% (49 atlete) het vrees vir herbesering as rede aangevoer. Vrees vir herbesering is dus verder ondersoek, as oorwegende faktor in die post-operatiewe bestuur van anterior kruisligament rekonstruksie. In 'n primêre, kwalitatiewe studie met aanvullende deursnee-analise, is die redes vir die vrees vir herbesering ondersoek. Manlike en vroulike atlete, tussen die ouderdomme van 17-50 jaar is ingesluit (n = 59). Rekonstruksie prosedures deur enige soort oorplanting is ingesluit; hersiening en verskeie ligament rekonstruksie is egter uitgesluit. Vier-en-twintig deelnemers (41%) het nie teruggekeer na die pre-besering sport nie. Diegene wat vrees vir herbesering as die enigste rede vir nie terugkering na sport aanvoer, is onderhoude mee gevoer (n = 12). Dus, diegene wat nie teruggekeer het na pre-besering, tipe en vlak, van sport ten spyte van goeie knie funksie. Die redes vir die vrees vir herbesering is ondersoek deur semi-gestruktureerde onderhoude. Dataanalise is uitgevoer deur die inhoud / tematiese analise. Kodes is toegeken en gekategoreer. Hierdie kategorieë is herverdeel in temas. Uit die deelnemer onderhoude, het vier temas na vore gekom: die operasie en herstel proses, die aard van die prebesering sport as risiko vir herbesering, persoonlikheidseienskappe en sosiale prioriteite. 'n Versnelde rehabilitasieprogram is voorgestel om die post-operatiewe ervaring te verbeter. Die aanvullende analise het getoon dat atlete jonger as 20 jaar oud meer geneig was om terug te keer na die sport. Aanpasbare oorsake van vrees sluit in pyn, die lengte van rehabilitasie, meganisme van besering en sielkundige aspekte. Pyn bestuur, motivering en opvoeding is belangrike oorwegings post-operatief en tydens rehabilitasie. Dokters en fisioterapeute moet bewus wees van die vrees vir herbesering en die veranderbare oorsake daarvan ondersoek op 'n individuele basis om 'n pasient spesifieke bestuursplan te ontwikkel.

Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Introduction ACL injuries are among the most serious injuries that professional and amateur sports men and women sustain. More than 120 000 ACL injuries occur annually in the USA alone. The highest incidence of ACL injuries are seen in multi-directional and multi-factorial sports such as soccer, basketball, lacrosse, American football, rugby and Australian rules football. It is hoped that the proposed review will clarify issues relating to the effect of fatigue on knee control, as it will focus on multiple movements found in different sporting codes. By including both studies on healthy adults as well as subjects who have sustained ACL injuries, a clearer picture can be formed on the global effect of fatigue on knee control. Objective The objective of this review was to identify, collate and analyse the current evidence on the effect of fatigue protocols on knee control during functional tasks, such as side-stepping, bilateral jumping/landing and crossover-cutting. Methodology A comprehensive search of electronic databases was conducted between April 2013 and August 2013 (updated in April 2014) for eligible articles for inclusion in the review. Methodological quality was assessed using a modified Downs and Black checklist. Results Ten studies met the eligibility criteria and were included in the review. The included studies reported a wide variety of fatigue protocols. Several different test movements were utilised in the studies. The test movements included cutting movements, drop jumps, stop jumps, vertical jumps, bilateral drop landing and rotational movements. The overall results indicated that fatigue had a negative impact on knee control. There were however studies which reported conflicting results. Gender differences were also highlighted in the results of included studies where it became evident that females tend to be more susceptible to knee injuries due to altered kinematics as a result of fatigue. Conclusion Fatigue generally seems to affect knee control negatively across various fatigue protocols. Future research should investigate using a standardised fatigue protocol to achieve more accurate and consistent results during the different functional activities. / AFRIKAANSE OPSOMMING: Nie beskikbaar