Purpose: Adolescents have significantly higher rates of diagnosed anterior cruciate ligament (ACL) injuries compared to adult cohorts. Approximately two-thirds of ACL injuries are non-contact scenarios that occur while performing “high-risk” maneuvers. Less than 50% of adolescents are able to return-to-activity, with females specifically having a lower activity level post-injury (Hewett, Di Stasi, & Myer, 2013; Schmale, Kweon, Larson, & Bompadre, 2014). Identifying the quantitative demand of a task used to assess return-to-activity will help establish its role in evaluating the knee stabilization strategies based on muscular coactivations and biomechanical outputs. Therefore, the aim of this study was to (1) assess the neuromuscular and biomechanical quantitative outputs of the lunge and drop-vertical jump (DVJ) in healthy adolescent male and females athletes and (2) to examine the muscular coactivation strategies of adolescent male and female athletes with and without an ACL injury. Methods: A total of 68 uninjured adolescent male and female athletes between the ages of 10 to-18 were used to identify the quantitative demand of the lunge and DVJ. Neuromuscular and biomechanical quantitative outputs included mean peak knee flexion (PKF), integrated knee excursion (iKEXC) in the sagittal and frontal planes, integrated knee joint power (iJP), and integrated electromyography (EMG) were used to assess the within (task) and between (sex) interactions. An additional 17 male and 37 female adolescents with an ACL injury were included to assess the impact of an ACL injury on the knee stabilization strategies (coactivations) used to maintain dynamic knee joint stability (frontal plane knee excursion). Ethics was approved by the University of Ottawa Research Ethics Board (uOttawa REB H09/17/10) (CHEO REB 17/74X). Results: Quantitative data for uninjured groups indicated that the lunge produced greater peak knee flexion, knee excursion, and quadriceps activation values than the DVJ. Conversely, the DVJ produced greater joint power, biceps femoris, gastrocnemii, and gluteus medius values. As for knee stabilization strategies, during the DVJ female ACL injured groups produced greater symmetry and higher muscular activations between anterior-posterior and medial-lateral muscular coactivations, which resulted in increased stability compared to uninjured female groups. Males with an ACL injury indicated similar knee stabilization strategies however decreased stability compared to males without an ACL injury. Conclusion: Results of this thesis identified differences in quantitative data between the lunge and DVJ, indicating differing demand requirements for each task. Results of the second study indicate that uninjured females use knee stabilization strategies that do not restrict their degrees of freedom through asymmetrical coactivations, while females with an ACL injury have increased coactivations in both anterior-posterior and medial-lateral muscle groups, resulting in increased dynamic knee joint stability as evidenced by reduced frontal plane knee excursion motion. Males, however, failed to show a difference between groups in dynamic knee stability, suggesting that those with an ACL injury compensated in a way to perform the DVJ efficiently and similarly to the uninjured group, while maintaining dynamic knee joint stability. In a clinical setting, these findings may help in understanding the direction of use of the lunge and DVJ tasks in a rehabilitation setting. As well as provide insight into the differing male and female adolescent knee stabilization strategies used to maintain dynamic knee joint stability during functional tasks.

Title: The Effect of Expertise in Elite Artistic Gymnasts on Postural Control Objective: The main aim of this thesis is to assess the level of postural stability in elite artistic gymnasts using NeuroCom Smart EquiTest System dynamic computer posturograph and to compare the measured data with a control group of people who do not do any elite sport activity. Methods: In this quantitative observational study were involved 32 probands aged 18-28 years. The probands were divided into two groups. The experimental group consisted of elite male and female gymnasts (n=16) in the selected age range of 18-27 years, with a mean age 21,38 years. The control group consisted of the people who do not do any elite sport activity (n=16) in the age range of 22-28 years, with a mean age of 25,08 years. The experimental group was further divided into individuals with a history of knee injury (n=8) in the age range 18-27 years, with mean age of 22,01 years and without injury (n=8) in the age range 19-24 years with mean age of 20,75 years. The NeuroCom Smart EquiTest System was chosen to objectively assess postural stability. The actual measurements were performed in the kinesiology laboratory at the Faculty of Physical Education and Sport, Charles University. Five protocols were selected from the whole set of tests:...

Introduktion: Skador på främre korsbandet är en av de vanligaste ortopediska skadorna hos hundar. Korsbandets huvudsakliga uppgift är att stabilisera knäleden. En främre korsbandsskada kan behandlas konservativt eller operativt, och i bägge fall är rehabilitering en viktig åtgärd. Syfte: Belysa studier kring postoperativ rehabilitering av främre korsbandsskada hos hund. Frågeställningar var; “Vilka postoperativa rehabiliteringsmetoder för främre korsbandsskada har studerats för hund?” och “Vilka effekter har de olika behandlingarna i studierna visat?” Metod: Denna systematiska litteraturstudie har följt Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) och granskningsmallar för originalstudier från Statens beredning för medicinsk utvärdering (SBU). Sökningen för litteratursammanställningen gjordes på PubMed och Scopus. Resultat: Tio artiklar kvalificerades för inkludering. Några rehabiliteringsmetoder som nämnts är bandage, köldterapi, ROM-träning, gång på vattenband, löpband, promenader, CCT och elektroterapi. Resultatet visar att extensionsvinkeln påverkas i högre grad än flexionsvinkeln. Vattenbandsträning och CCT ökar ledvinkeln postoperativt och ESWT ger snabbare belastning av det opererade benet. MET tillsammans med bandage, kall kompression och kall kompression tillsammans med bandage gav hade bäst effekt på svullnad. Konklusion: Resultatet visar att rehabilitering och fysioterapeutiska åtgärder är en viktig del för att återfå bästa möjliga funktion, minska smärta samt att förebygga försämrad funktion postoperativt efter en CrCL skada. Vidare forskning med fördjupning på rehabiliteringstyp och antal rehabiliteringstillfällen behövs för att kunna fastställa vilken rehabilitering som är mest gynnsam.

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<p><strong>Objective</strong>: To perform an environmental survey of clinical practice amongst surgeons and physiotherapists in making return to sport (RTS) decisions following ACL reconstruction (ACLR); to gain a better understanding of how clinicians and patients define successful return to sport; and to compare patients’ level of satisfaction with their current level of activity following ACLR.</p> <p><strong>Design: </strong>Multidisciplinary cross sectional study.</p> <p><strong>Setting</strong>: Online</p> <p><strong>Participants:</strong> Orthopaedic surgeons and registered physiotherapists; and patients who had undergone ACLR within the previous 6-18 months.</p> <p><strong>Interventions: </strong>Surgeons and physiotherapists completed separate web surveys, each consisting of 10 closed format questions that included sections on demographics, outcome measures, treatment procedures, and RTS decisions. Patients completed a web survey consisting of 19 questions about their activity level, their experience surrounding the process of rehabilitation after ACLR, and their decisions surrounding RTS.</p> <p><strong>Main Outcome Measures</strong><strong>: </strong>Descriptive and subjective data were collected for all groups. Clinician responses were compared for differences in frequencies of clinical outcome measures used to decide RTS readiness. Frequency data were collected for all groups for the definition of successful RTS following ACLR using a self-report form. The relationship between patient satisfaction and current level of activity following ACLR was compared using the Tegner Activity Scale and Single Assessment Numeric Evaluation (SANE).</p> <p><strong>Results:</strong> All patients were unanimous in their definition of successful RTS post ACLR as the ability to fully participate in pre-injury level of sport with no limitations or deficits (100%), and restoring functional stability (100%). Mean Tegner activity level scores of respondents decreased a mean of 3.4 (SD ± 2.5) from pre-injury to current level of activity (p < 0.011). However, no significant decrease from pre-injury level of activity to expected level of activity post surgery was seen. A statistically significant correlation was demonstrated between patients’ level of satisfaction and current level of activity (r = 0.84, p = 0.02), with higher levels of activity associated with increased levels of satisfaction. Overall, the majority of clinician respondents reported that jump tests, range of motion (ROM), Lachman clinical test of stability, pain, swelling, functional movement and giving way contributed to their RTS decisions. Unanimous consensus existed between clinicians for the ability to participate in any level of sport, with or without limitations, as the definition of successful RTS following ACLR.</p> <p><strong>Conclusions:</strong> Following ACLR, medically cleared patients had not met their high expectations of functional stability and ability to return to their pre-injury level of sport. The discordance between unmet expectations and current level of sporting activity was reflected in lower rates of patient satisfaction. Most clinicians reported using primarily impairment based not self-report measures to contribute to their RTS decisions. Clinicians and patients expressed subtle differences in their definition of successful RTS.</p> <p><strong>Clinical Relevance: </strong>Establishing an operational definition of success, and professional consensus on measures which include patient reported outcomes is an important next step in the development of goal oriented RTS guidelines.</p> / Master of Science Rehabilitation Science (MSc)

Bakgrund: Knäskador är vanligt förekommande bland yngre fysiskt aktiva personer. Ofta skadas flera strukturer samtidigt vilket medför att den mekaniska stabiliteten i knäleden försämras samt att den neuromuskulära funktionen i benet försämras, vilket påverkar den posturala kontrollen samt stabiliteten på knät. För att upptäcka instabilitet behövs mer utmanande och specifika test som Star Excursion Balance Test (SEBT). I dagsläget saknas studier gjorda med SEBT på en svensk population. Fysioterapeuter är beroende av tillförlitliga instrument för att kunna göra en korrekt bedömning. Syfte: Syftet med studien var att undersöka test-retest reliabiliteten för SEBT samt att undersöka samtidig validitet mellan SEBT och Unilateral Stance test (UST) för personer med knäproblematik.Syftet var dessutom att undersöka hur den posturala kontrollen var för personer i åldrarna 20-30 år med knäproblematik mätt med SEBT och UST. Metod: Studien var gjord med en icke experimentell design som var både deskriptiv och korrelerande. Alla tester gjordes vid ett tillfälle med 5 minuters vila mellan testerna. I studien ingick 30 personer med diagnostiserad alternativt självupplevd knäproblematik i åldern 20-30 år som studerade på Biomedicinskt centrum vid Uppsala Universitet. Resultat: Den posturala kontrollen för testpersonerna (n=30) var uppmätt till god både mätt med både SEBT och UST. Validiteten mellan SEBT och UST var låg r=0,3 (p=0,12). Test-retest reliabiliteten för SEBT var god r=0,74 (p=0.00013). Konklusion: SEBT har en god interbedömarreliabilitet. Korrelationen mellan UST och SEBT var låg. SEBT är ett test som är ett väldigt specifikt test där man behöver både material och tid för utförandet. Det behövs mer studier för att få fram om testet går att användas effektivt på allmänna kliniker som ett utvärderingsinstrument för postural kontroll. Keywords: Postural balance, Dynamic balance, Reliability, Validity, Star excursion balance test (SEBT), Unilateral stance test (UST), knee injury.

Introduction: Arthroscopic partial resection of degenerative meniscal injuries has previously been frequently performed but has been questioned in recent years. However, contradictory data exist. Aim: We aimed to asses patient- reported outcome in patients over 40 years of age after arthroscopic surgery due to degenerative meniscal injury. We further aimed to compare women and men due to diagnosis and to examine the number of patients that have needed knee arthroplasty during the follow-up period. Methods: Patients &gt; 40 years of age who underwent arthroscopic surgery of the knee in the years of 2011-2013 were studied using validated questionnaire KOOS (Knee Injury and Osteoarthritis Outcome Score) along with a self-constructed questionnaire. Results: In all subjects, the highest median score was seen in all daily living (Women:93, Men: 96) and knee pain (Women: 86, Men: 92). The lowest score was seen in sports and recreation (Women: 55, Men: 65). Men had an overall higher KOOS-score in every subscale compared to women (p&gt;0.05). No significant difference was seen between women and men divided by diagnosis (p&gt;0.05). 72% women and 80% men experienced improved knee function today compared to before surgery. 22% women and 14% men experienced deterioration in knee function. 6% women and men experienced unaltered knee function. 24 patients (9.5%) had got a knee arthroplasty. Conclusions: This study showed that most middle-age patients experienced increased knee function and high satisfaction rate after partial meniscectomy when suffering from degenerative meniscal injury.

Orientador: Sérgio Rocha Piedade / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T17:24:46Z (GMT). No. of bitstreams: 1 Inada_MauroMitsuo_M.pdf: 1830767 bytes, checksum: 4b553d2b930c1c4c78288e15aa3c117e (MD5) Previous issue date: 2014 / Resumo: Introdução: A lesão bicruzado do joelho é rara e está frequentemente associada a traumas de alta energia, sendo o procedimento cirúrgico o tratamento instituído devido a sua complexidade. Objetivo: Avaliar os resultados clínicos e funcionais de pacientes submetidos a reconstrução bicruzado do joelho, realizada em dois tempos cirúrgicos, utilizando os Escores de Lysholm, Tegner, KOOS e SF-36. Materiais e Métodos: 25 pacientes (20 homens e 5 mulheres) foram avaliados, idade média de 32,3 anos (17 a 53 anos), IMC médio de 26,2(18,9 a 34,9 Kg/m²), tempo de lesão de 18,3 meses (lesões crônicas). Quanto ao mecanismo de lesão, os acidentes auto-moto-ciclístico responsáveis por 72% dos casos, a prática esportiva por 16% e queda ou entorse por 12%. Inicialmente, foi utilizada a técnica Inlay para a reconstrução do LCP, utilizando o terço central do tendão patelar. Após um intervalo mínimo de 3 meses realizou-se a reconstrução do ligamento cruzado anterior via artroscópica, utilizando tendões flexores. Foram observadas as seguintes lesões associadas: condral em 7 pacientes (28%), meniscal em 16 pacientes (64%), lesões ligamentares associadas em 12 pacientes (48%). Procedimento cirúrgico adicional foram necessários em 4 pacientes (tendão patelar em 2 casos e ligamento colateral medial em 2 pacientes). Resultados: Com seguimento pós-operatório médio de 24,8 meses, em 60% dos casos a gaveta posterior foi classificada como zero e + (0,5 cm), enquanto 40% foram classificados como ++ (até 1cm). 60% dos pacientes obtiveram Escore de Lysholm bom/excelente. O Escore de atividade Tegner apresentou queda no nível de atividade física pós-reconstrução bicruzado, em comparação com o nível de atividade física pré-lesão, com relevância estatística. Entretanto, apenas 1 paciente retornou ao mesmo nível de atividade pré-lesão. A análise estatística revelou que o tempo de lesão influenciou negativamente os resultados clínicos pós-operatórios, em particular os parâmetros atividades esportivas/recreativas, do questionário KOOS, além dos domínios capacidade funcional, limitação dos aspectos físicos, vitalidade e saúde mental, do questionário SF-36. Por outro lado, variáveis como idade, IMC, presença de lesões condrais, meniscais e ligamentares associadas, assim como gaveta posterior residual não afetaram o resultado final. Conclusão: neste estudo o tempo de lesão teve um impacto negativo no prognóstico pós-operatório da reconstrução bicruzado, realizado em dois tempos cirúrgicos. Entretanto, é importante ressaltar que outras variáveis estudadas devem ser consideradas. Palavras-chave: ligamento cruzado posterior, ligamento cruzado anterior, joelho, traumatismos do joelho / Abstract: Introduction: Bicruciate lesions of the knee are rare and often related to high-energy traumas. A surgical procedure is used because of their complexity. Objective: to assess the clinical and the functional outcomes after two-stages bicruciate knee reconstruction using the Lysholm, Tegner, KOOS and SF-36 scores. Materials and methods: 25 patients (20 males and 5 females) were evaluated, mean age 32,3 years (17-53 years), mean BMI 26,2 (18,9-34,9), mean duration of lesion 18,3 months (chronic lesions). Regarding the mechanism of injury, car, motorcycle and bicycle accidents were responsible for 72%, while sports practices 16% and falls or sprains 12%. The Inlay technique was applied in PCL reconstruction using the central 1/3 of the patellar tendon. After 3 months minimum interval, ACL reconstruction was arthroscopically performed using flexor tendons. The following intraoperative lesions were detected: chondral ¿ 07 patients (28%); meniscal ¿ 16 patients (64%); associated ligament lesions ¿ 12 (48%). An additional surgical procedure was required for 4 patients (patellar tendon ¿ 2 cases, CML ¿ 2 cases). Results: With a 24,8 month mean postoperative follow-up of the cases, the posterior drawer test rated zero or + (0,5 cm) were observed in 60% of the patients, while 40% as ++ ( 1cm) and 60% of patients rated good/excellent condition (Lysholm). The Tegner activity score revealed that postoperative physical activity was less than physical activity level before the lesion and and the reduction was statistically significant. Moreover, only one patient achieved the pre-lesion activity level. The statistical analysis revealed that duration of lesion negatively influenced postoperative clinical results, especially regarding parameters such as sports/recreative activities (KOOS) and physical functioning, limitation of physical aspects, vitality and mental health (SF-36). However, in this study, the variables such as age, BMI, presence of chondral, meniscal, ligament lesions and residual posterior drawer did not affect the final result. Conclusion: The results obtained by this study concluded that duration of lesion had a negative impact on postoperative prognosis. However, it is important that other analyzed variables should also be considered. Keywords: posterior cruciate ligament, anterior cruciate ligament, knee, knee injury / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências