Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement.

Context: The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury.

Objective: Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps.

Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement.

After an anterior cruciate ligament (ACL) injury, people need secondary prevention strategies to identify osteoarthritis at its earliest stages so that interventions can be implemented to halt or slow the progression toward its long-term burden. The Osteoarthritis Action Alliance formed an interdisciplinary Secondary Prevention Task Group to develop a consensus on recommendations to provide clinicians with secondary prevention strategies that are intended to reduce the risk of osteoarthritis after a person has an ACL injury. The group achieved consensus on 15 out of 16 recommendations that address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models.

Interleukin-1 receptor antagonist inhibits arthrofibrosis in a post-traumatic knee immobilization model.

Background: Therapies for arthrofibrosis after knee surgery are needed to prevent loss of joint function. Interleukin-1 receptor antagonists (IL-1RA) have shown promise in treating established arthrofibrosis in pilot clinical studies. The objective of this study was to evaluate the ability of intra-articular injection of IL-1RA to prevent knee joint contracture in a post-traumatic knee immobilization model.

Identifying achilles tendon structure differences by ultrasound tissue characterization in asymptomatic individuals.

Ultrasound Tissue Characterization (UTC) is a modality that can be utilized to characterize tendon tissue structure using ultrasonographic imaging paired with a computer algorithm to distinguish echo-types. Several studies have demonstrated UTCs ability to distinguish Achilles tendon morphology changes, but no study has established normative data of the Achilles tendon in the general population. The aim of this study was to determine UTC echo-type distribution in the Achilles tendon in an asymptomatic population.

Differences in Biomechanical Loading Magnitude During a Landing Task in Male Athletes with and without Patellar Tendinopathy.

Context: Prior research has not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with patellar tendon structural abnormality (PTA) compared to healthy athletes.

Objective: The purpose was to compare involved limb landing biomechanics between male athletes with and without patellar tendinopathy.

Design: Cross-sectional study Setting: Laboratory Patients or Other Participants: 43 males were grouped based on patellar tendon pain & ultrasound imaging of the proximal patellar tendon: symptomatic with PTA (SYM-PTA; n=13; 20±2yrs; 1.

Landing biomechanics are not immediately altered by a single-dose patellar tendon isometric exercise protocol in male athletes with patellar tendinopathy: A single-blinded randomized cross-over trial.

Objectives: To a) determine the acute effects of a single-dose patellar tendon isometric exercise protocol on involved limb landing biomechanics in individuals with patellar tendinopathy and asymptomatic patellar tendon pathology, and b) determine if individuals with patellar tendinopathy demonstrated changes in pain following a single-dose patellar tendon isometric exercise protocol.

Design: Single-blinded randomized cross-over trial.

Setting: Laboratory; PARTICIPANTS: 28 young male athletes with symptomatic (n = 13, age: 19.

Landing Biomechanics, But Not Physical Activity, Differ in Young Male Athletes With and Without Patellar Tendinopathy.

Objective: To examine differences in biomechanical and physical activity load in young male athletes with and without patellar tendinopathy.

Design: Cross-sectional cohort study.

Methods: Forty-one young male athletes (15-28 years of age) were categorized into 3 distinct groups: symptomatic athletes with patellar tendon abnormalities (PTA) (n = 13), asymptomatic athletes with PTA (n = 14), and a control group of asymptomatic athletes without PTA (n = 14).

Minocycline microspheres did not significantly improve outcomes after collagenase injection of tendon.

Background: Tetracycline antibiotics inhibit matrix metalloproteinases and pro-inflammatory cytokines implicated in the pathogenesis of tendinopathy, while microsphere formulations allow sustained release of drug contents. The purpose of this study was to evaluate the ability of a local minocycline microsphere injection to restore normal tendon properties in a rat model of collagenase-induced patellar tendinopathy.

Methods: A total of 22 rats were randomly assigned to the control (n = 11) or minocycline (n = 11) group and received bilateral patellar tendon injections of collagenase.

The use of an IL1-receptor antagonist to reverse the changes associated with established tendinopathy in a rat model.

Interleukin-1 (IL1) is a cytokine that plays a role in inflammation and is a potential contributor to the inflammation present in tendinopathy. Its inhibition may be of use in the treatment of tendinopathy and has been a target for treatment. To evaluate how an IL1-receptor antagonist (IL1-RA) reverses pathologic changes associated with established patellar tendinopathy, we randomized 48 Sprague-Dawley retired breeder rats into three groups having weekly bilateral patellar tendon injections for 6 weeks.

CORRECTED ERROR VIDEO VERSUS A PHYSICAL THERAPIST INSTRUCTED HOME EXERCISE PROGRAM: ACCURACY OF PERFORMING THERAPEUTIC SHOULDER EXERCISES.

Background And Purpose: The accurate performance of physical therapy exercises can be difficult. In this evolving healthcare climate it is important to continually look for better methods to educate patients. The use of handouts, in-person demonstration, and video instruction are all potential avenues used to teach proper exercise form.

Effect of Swim Training on the Physical Characteristics of Competitive Adolescent Swimmers.

Background: Subacromial space distance and forward head and shoulder posture are common characteristics resulting from swim training. These alterations can cause abnormal scapular kinematics and positioning, potentially increasing compression of structures in the subacromial space and increasing the risk for the development of swimmer's shoulder.

Purpose: To evaluate the effect of the swim training season on subacromial space distance and forward head and forward shoulder posture as well as to determine the relationship between these variables.

Comparison of Upper Extremity Physical Characteristics Between Adolescent Competitive Swimmers and Nonoverhead Athletes.

Context: Alterations to upper extremity physical characteristics of competitive swimmers (posture, range of motion [ROM], and subacromial-space distance) are commonly attributed to cumulative training load during a swimmer's competitive career. However, this accepted clinical belief has not been established in the literature. It is important to understand whether alterations in posture and associated physical characteristics occur as a result of sport training or factors other than swimming participation to better understand injury risk and possible interventions.

Use of an IL1-receptor antagonist to prevent the progression of tendinopathy in a rat model.

This study evaluated if inhibiting IL1-β activity with an IL1-receptor antagonist (IL1-RA) will prevent pathologic changes commonly seen in tendinopathy. Thirty-six Sprague-Dawley retired-breeder rats were divided into three groups having weekly bilateral patellar tendon injections: CON (0.1 ml Saline), CAR (0.

Sports medicine ultrasound (US) beyond the musculoskeletal system: use in the abdomen, solid organs, lung, heart and eye.

The use of point-of-care ultrasound (US) by non-radiologists is not new and the expansion into sports medicine practice is relatively young. US has been used extensively to evaluate the musculoskeletal system including the diagnosis of muscle, tendon and bone injuries. However, as sports medicine practitioners we are responsible for the care of the entire athlete.

Whole body and local muscle vibration reduce artificially induced quadriceps arthrogenic inhibition.

Objective: To evaluate the effects of whole body vibration (WBV) and local muscle vibration (LMV) on quadriceps function after experimental knee effusion (ie, simulated pathology).

Design: Randomized controlled trial.

Setting: Research laboratory.

Fibrin glue as a non-invasive outpatient treatment for post-arthroscopic knee seromas.

Post-surgical seromas and cysts have been reported across many surgical subspecialties including orthopaedics. Treatments include both invasive surgical approaches and more recently reported non-invasive techniques. Non-invasive approaches currently include compressive wrapping, vasopneumatic cryotherapy, and motion exercises.

Clinical utility of ultrasound guidance for intra-articular knee injections: a review.

Intra-articular corticosteroid and hyaluronic acid injections provide short-term symptom amelioration for arthritic conditions involving structural damage or degenerative changes in the knee. Conventional palpation-guided anatomical injections frequently result in inaccurate needle placement into extra-articular tissue and adjacent structures. The purpose of this review was to determine the effect of ultrasound guidance on the accuracy of needle placement, clinical outcomes, and cost-effectiveness in comparison with anatomical landmark-guided intra-articular large joint injections, with particular emphasis on the knee.

Dermal tissue allograft for the repair of massive irreparable rotator cuff tears.

Background: Massive irreparable rotator cuff tears in patients without advanced glenohumeral arthritis can pose a challenge to surgeons. Numerous management strategies have been utilized, and studies have shown varied results with regard to shoulder pain, range of motion, strength, and overall function.

Hypothesis: Patients undergoing repair of massive irreparable rotator cuff tears through a mini-open approach with the use of human dermal tissue matrix allograft would demonstrate an improvement in pain, range of motion, strength, and subjective functional outcomes.

The evaluation of cardiac complaints in marathon runners.

In the United States there are now approximately 521 marathons, and in 2005 approximately 432,000 participants completed one. The number of frequent runners (more than 100 days a year) is estimated at over 11 million. When one of these patients presents to the emergency department with cardiac complaints, the risk profile and evaluation may be different than in sedentary subjects.

Heart rate variability in elite American track-and-field athletes.

Prolonged training leads to changes in autonomic cardiac balance. This sympathetic and parasympathetic balance can now be studied using heart rate variability (HRV). Studies have shown that endurance athletes have an elevated level of parasympathetic tone in comparison to sedentary people.

An uncommon presentation of acute angle closure glaucoma.

Acute angle closure glaucoma is an ocular emergency that is treatable with prompt and appropriate intervention. Recognition of this disease entity is sometimes difficult. We report a case of bilateral acute angle closure glaucoma in a 55-year-old, otherwise healthy individual, and discuss the different ways the condition may present.