Context: Knee muscle atrophy and weakness are common impairments after anterior cruciate ligament... more Context: Knee muscle atrophy and weakness are common impairments after anterior cruciate ligament (ACL) reconstruction. Blood flow restriction (BFR) training represents a new approach to treat such impairments. However, limited evidence currently exists to support this intervention in related patients. Objective: To appraise literature comparing the effects of BFR training with conventional therapy on knee muscle morphological and strength properties in ACL-reconstructed patients. Data Sources: PubMed, SPORTDiscus, CINAHL, and Cochrane Central Register databases were searched for relevant articles from January 1991 through April 2021. Study Selection: Articles were minimum Level 3 evidence focusing on knee muscle morphologic as well as extensor and flexor strength outcomes in ACL-reconstructed patients of all graft types. Study Design: Systematic review. Level of Evidence: Level 2. Data Extraction: Critical appraisal instruments (Downs and Black checklist, Cochrane Collaboration too...
Prior research suggests peak sprint power (PSP) is correlated with cycling sprint times, indicati... more Prior research suggests peak sprint power (PSP) is correlated with cycling sprint times, indicating that individuals able to produce higher PSP demonstrate faster ride times. These faster ride times are indicative of better performance in sprint cycling competitions. PURPOSE: The primary aim of the study was to determine if a simple vertical jump height (VJH) test would correlate with PSP on a bike. It was hypothesized that a higher VJH would correlate with a higher PSP. METHODS: Trained cyclists were enrolled in the study and completed a VJH test, PSP test, and provided demographic and anthropometric data. Seventeen cyclists were enrolled in the study. Their age, mass, height, thigh circumference, and cyclist experience level (CEL) were collected (29.1 ± 17.2 years, 77.0 ± 13.3 kg, 172.8 ± 8.2 cm, 59.4 ± 4.8 cm, and 1.8 ± 0.9 CEL). Simple linear regression examined VJH as a predictor of normalized PSP. PSP was normalized by taking the PSP and dividing by the subjects mass. RESULTS:...
Context : University-sponsored summer sport camps often employ athletic trainers; however, there... more Context : University-sponsored summer sport camps often employ athletic trainers; however, there is a dearth of epidemiologic studies describing the injury and illness experience of sport-camp participants to guide clinicians. Objective : To describe the injury and illness experience of youth participants at a university-sponsored summer sport-camp program during a 4-year period. Design : Descriptive epidemiology study. Setting : A National Collegiate Athletic Association Division I university that sponsored 76 to 81 camps for 28 sports each summer. Patients or Other Participants : A total of 44 499 camp participants enrolled during the 4 years. Male and female participants ranged in age from 10 to 17 years and in athletic skill from novice to elite. Main Outcome Measure(s) : Data from handwritten injury and illness log books, maintained by sports health care personnel, were accessed retrospectively, entered into an electronic spreadsheet, and coded. Data were applied to the N...
Non‐invasive determination of mitochondrial capacity via near infrared spectroscopy (NIRS) typica... more Non‐invasive determination of mitochondrial capacity via near infrared spectroscopy (NIRS) typically involves voluntary exercise of a single muscle group followed by as many as 26 brief ischemic cuff occlusions to determine a single recovery rate constant (k).
Context There is a lack of current evidence to help athletic training programs identify students ... more Context There is a lack of current evidence to help athletic training programs identify students poised for first-time Board of Certification (BOC) exam success as a means to ensure compliance with contemporary accreditation standards. Various academic variables have been previously identified as predictors of first-time success; however, these investigations reflect prior versions of the credentialing examination based on what are now obsolete editions of the professional practice analysis. Objective To determine the accuracy of undergraduate athletic training student performance factors as indicators of successfully passing the current version of the BOC exam on a first attempt. Design Casual-comparative (ex–post facto) quasi-experimental. Setting An accredited undergraduate athletic training program. Patients or Other Participants A recent sample of athletic training program graduates (n = 43). Intervention(s) Archived data were collected from student academic records and analyze...
CONTEXT Psychological readiness is a significant factor in determining successful return to sport... more CONTEXT Psychological readiness is a significant factor in determining successful return to sport (RTS) and physical activities after anterior cruciate ligament (ACL) reconstruction. Knowing the influence of kinesiophobia on physical tests that are used to guide RTS, such as the single-leg hop for distance (SLHD), would contribute to advancing clinical practice. OBJECTIVE To investigate the association between kinesiophobia and SLHD performance in patients after ACL reconstruction. DATA SOURCES A comprehensive search strategy entailed surveying 6 databases for relevant articles published from January 2009 to March 2021. STUDY SELECTION Articles published in English that were a minimum of level 3 evidence describing kinesiophobia, as measured by the Tampa Scale for Kinesiophobia, and related to SLHD performance in patients after ACL reconstruction. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3. DATA EXTRACTION Study characteristics, sample population demographics, instrum...
Anterior cruciate ligament (ACL) reconstructions are a common orthopedic surgical technique where... more Anterior cruciate ligament (ACL) reconstructions are a common orthopedic surgical technique where the ACL is reconstructed using either a tendon allograft or autograft. Both graft types undergo significant structural remodeling post-surgery, which includes an initial loss and subsequent recovery of mechanical properties. However, allografts do not regain their mechanical properties to the same degree as autografts. Since graft remodeling is sensitive to mechanical loading and differences in outcomes between graft types is most pronounced in active individuals, we hypothesize that allografts have a deficient response loading. The objective of this thesis was to develop an in vitro culture and loading protocol to study the mechanobiology of ACL reconstructive grafts. A bioreactor was used to load the harvested grafts and a loading protocol was validated by studying the cell viability of native ACLs. Moreover, a method to extract RNA from ACLs was also determined for future use to comp...
Resistance exercise using concentric and eccentric muscle contraction (i.e., dumbbell curl exerci... more Resistance exercise using concentric and eccentric muscle contraction (i.e., dumbbell curl exercise) decreased significantly bioelectrical impedance analysis (BIA) (Atsuta et al. 2019). However, the influence of muscle contraction type on exercise-induced BIA change remains unclear. PURPOSE: The purpose of the present study was to examine time course changes in muscle swelling evaluated by BIA following concentric-muscle contraction. METHODS: Nine male subjects (20.0 ± 0.8 yrs, 175.4 ± 2.4 cm, 65.2 ± 6.3 kg) performed isokinetic (60 deg/s) concentric knee extension (6 repetitions × 10sets, 60 s rest period between sets). Before and during 24 h of post-exercise, time course changes in BIA (locally evaluated BIA for vastus lateralis muscle), maximal voluntary contraction (MVC) of knee extension exercise, muscle thickness (evaluated by ultrasound) for vastus lateralis muscle and thigh circumference were evaluated. Blood samples were also drawn to investigate blood lactate, serum creatine kinase (CK) and myoglobin levels. RESULTS: Blood lactate and CK levels were significantly increased after exercise (P<0.05). Moreover, the MVC was significantly decreased immediately after exercise (before exercise: 269.2 ± 30.4 Nm, immediately after exercise: 233.6 ± 28.7 Nm, P<0.05). However, BIA value, muscle thickness and circumference did not change significantly after the exercise (p>0.05 for all variables). CONCLUSIONS: Resistance exercise consisting of concentric muscle contraction did not affect local BIA. The finding was not consistent with that in our previous study using the resistance exercise consisting of both concentric and eccentric muscle contraction.
Background Tibial tubercle-trochlear groove (TT-TG) distance is a measurement generally made on C... more Background Tibial tubercle-trochlear groove (TT-TG) distance is a measurement generally made on CT scans that is commonly used to quantify the risk of patellofemoral instability (PFI); however, its interrater reliability and accuracy as an indicator of PFI in patients is poorly characterized. Questions/purposes The purposes of our study were (1) to primarily analyze interrater reliability of the TT-TG distance among orthopaedists with varied experience as measured by MRI, (2) to secondarily compare TT-TG distances between PFI and control groups, and (3) to determine an accurate TT-TG distance threshold indicative of PFI. Methods The electronic medical records of a senior fellowship-trained orthopaedic sports medicine surgeon were surveyed between 2012 and 2016 for patients who had experienced at least one episode of patellar subluxation or dislocation, who reported no other knee-related history, and who underwent MRI due to persistent PFI signs and symptoms. The records of 48 PFI patients (23 males, 25 females; 19 ± 4 years of age) were compared with 83 controls (60 males, 23 females; 31 ± 8 years of age) having no history of PFI, presenting with an isolated meniscal lesion as determined from MRI and treated by the same orthopaedist during this time. All records meeting study criteria were consecutively included to offset selection bias of the retrospective analysis. Two sports medicine fellows, one who had just completed orthopaedic residency training, and another with a year of experience after residency, and a sports medicine subspecialist with more than 15 years of experience in practice independently recorded TT-TG distance, indicative of tibial tubercle lateralization relative to the femoral trochlea, to the nearest millimeter (mm) in a blinded and randomized fashion. Intraclass correlation coefficient computed interrater reliability accompanied by standard error of measurement (SEM); a one-tailed, two-sample t-test analyzed group differences with accompanying effect size per Cohen’s d; receiver operating characteristic (ROC) curve determined accuracy and threshold for PFI risk. A p value < 0.05 denoted statistical significance. Results Interrater reliability was excellent, at 0.93 (95% confidence interval [CI], 0.84–0.97; SEM = 0.6 mm) for PFI patients and 0.95 (95% CI, 0.91–0.97; SEM = 0.4 mm) for controls. Distance was greater (95% CI, 2–5; p < 0.001) in PFI patients (14 ± 4 mm; range = 7–24 mm) than controls (10 ± 3 mm; range = 3–19 mm) with an effect size of 1 (95% CI, 0.3–2). Area under the ROC curve was 0.75 (95% CI, 0.66–0.83) and threshold was 13 mm (sensitivity = 0.52, 1-specificity = 0.25), suggesting the measure is a fairly accurate indicator of risk and values of 13 mm or greater are better suited to rule in PFI. Respective positive and negative likelihood ratios of 2 and 0.6 at this threshold confirm that this distance yields a small increase in probability for PFI and a minimal decrease in probability for risk; specifically, a 13-mm TT-TG distance is two times more likely to be found in patients with PFI. Furthermore, this threshold is estimated to increase a correct PFI diagnosis by approximately 15%. Conclusions The MRI-specific TT-TG distance, based on a single measurement using cartilaginous-tendon landmarks within a standardized trochlear range, is reliable as performed by orthopaedists of varied experience. Patients with PFI display a 4-mm greater distance than controls, which may represent a difference large enough for clinicians to discern in practice using MRI. A 13-mm TT-TG distance is two times more likely seen in patients with PFI. However, this threshold increases a correct PFI diagnosis by only about 15%; therefore, clinical decision-making should not be influenced by this criterion alone and instead used in conjunction with other relevant variables. Level of Evidence Level IV, diagnostic study,
Context: Knee muscle atrophy and weakness are common impairments after anterior cruciate ligament... more Context: Knee muscle atrophy and weakness are common impairments after anterior cruciate ligament (ACL) reconstruction. Blood flow restriction (BFR) training represents a new approach to treat such impairments. However, limited evidence currently exists to support this intervention in related patients. Objective: To appraise literature comparing the effects of BFR training with conventional therapy on knee muscle morphological and strength properties in ACL-reconstructed patients. Data Sources: PubMed, SPORTDiscus, CINAHL, and Cochrane Central Register databases were searched for relevant articles from January 1991 through April 2021. Study Selection: Articles were minimum Level 3 evidence focusing on knee muscle morphologic as well as extensor and flexor strength outcomes in ACL-reconstructed patients of all graft types. Study Design: Systematic review. Level of Evidence: Level 2. Data Extraction: Critical appraisal instruments (Downs and Black checklist, Cochrane Collaboration too...
Prior research suggests peak sprint power (PSP) is correlated with cycling sprint times, indicati... more Prior research suggests peak sprint power (PSP) is correlated with cycling sprint times, indicating that individuals able to produce higher PSP demonstrate faster ride times. These faster ride times are indicative of better performance in sprint cycling competitions. PURPOSE: The primary aim of the study was to determine if a simple vertical jump height (VJH) test would correlate with PSP on a bike. It was hypothesized that a higher VJH would correlate with a higher PSP. METHODS: Trained cyclists were enrolled in the study and completed a VJH test, PSP test, and provided demographic and anthropometric data. Seventeen cyclists were enrolled in the study. Their age, mass, height, thigh circumference, and cyclist experience level (CEL) were collected (29.1 ± 17.2 years, 77.0 ± 13.3 kg, 172.8 ± 8.2 cm, 59.4 ± 4.8 cm, and 1.8 ± 0.9 CEL). Simple linear regression examined VJH as a predictor of normalized PSP. PSP was normalized by taking the PSP and dividing by the subjects mass. RESULTS:...
Context : University-sponsored summer sport camps often employ athletic trainers; however, there... more Context : University-sponsored summer sport camps often employ athletic trainers; however, there is a dearth of epidemiologic studies describing the injury and illness experience of sport-camp participants to guide clinicians. Objective : To describe the injury and illness experience of youth participants at a university-sponsored summer sport-camp program during a 4-year period. Design : Descriptive epidemiology study. Setting : A National Collegiate Athletic Association Division I university that sponsored 76 to 81 camps for 28 sports each summer. Patients or Other Participants : A total of 44 499 camp participants enrolled during the 4 years. Male and female participants ranged in age from 10 to 17 years and in athletic skill from novice to elite. Main Outcome Measure(s) : Data from handwritten injury and illness log books, maintained by sports health care personnel, were accessed retrospectively, entered into an electronic spreadsheet, and coded. Data were applied to the N...
Non‐invasive determination of mitochondrial capacity via near infrared spectroscopy (NIRS) typica... more Non‐invasive determination of mitochondrial capacity via near infrared spectroscopy (NIRS) typically involves voluntary exercise of a single muscle group followed by as many as 26 brief ischemic cuff occlusions to determine a single recovery rate constant (k).
Context There is a lack of current evidence to help athletic training programs identify students ... more Context There is a lack of current evidence to help athletic training programs identify students poised for first-time Board of Certification (BOC) exam success as a means to ensure compliance with contemporary accreditation standards. Various academic variables have been previously identified as predictors of first-time success; however, these investigations reflect prior versions of the credentialing examination based on what are now obsolete editions of the professional practice analysis. Objective To determine the accuracy of undergraduate athletic training student performance factors as indicators of successfully passing the current version of the BOC exam on a first attempt. Design Casual-comparative (ex–post facto) quasi-experimental. Setting An accredited undergraduate athletic training program. Patients or Other Participants A recent sample of athletic training program graduates (n = 43). Intervention(s) Archived data were collected from student academic records and analyze...
CONTEXT Psychological readiness is a significant factor in determining successful return to sport... more CONTEXT Psychological readiness is a significant factor in determining successful return to sport (RTS) and physical activities after anterior cruciate ligament (ACL) reconstruction. Knowing the influence of kinesiophobia on physical tests that are used to guide RTS, such as the single-leg hop for distance (SLHD), would contribute to advancing clinical practice. OBJECTIVE To investigate the association between kinesiophobia and SLHD performance in patients after ACL reconstruction. DATA SOURCES A comprehensive search strategy entailed surveying 6 databases for relevant articles published from January 2009 to March 2021. STUDY SELECTION Articles published in English that were a minimum of level 3 evidence describing kinesiophobia, as measured by the Tampa Scale for Kinesiophobia, and related to SLHD performance in patients after ACL reconstruction. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3. DATA EXTRACTION Study characteristics, sample population demographics, instrum...
Anterior cruciate ligament (ACL) reconstructions are a common orthopedic surgical technique where... more Anterior cruciate ligament (ACL) reconstructions are a common orthopedic surgical technique where the ACL is reconstructed using either a tendon allograft or autograft. Both graft types undergo significant structural remodeling post-surgery, which includes an initial loss and subsequent recovery of mechanical properties. However, allografts do not regain their mechanical properties to the same degree as autografts. Since graft remodeling is sensitive to mechanical loading and differences in outcomes between graft types is most pronounced in active individuals, we hypothesize that allografts have a deficient response loading. The objective of this thesis was to develop an in vitro culture and loading protocol to study the mechanobiology of ACL reconstructive grafts. A bioreactor was used to load the harvested grafts and a loading protocol was validated by studying the cell viability of native ACLs. Moreover, a method to extract RNA from ACLs was also determined for future use to comp...
Resistance exercise using concentric and eccentric muscle contraction (i.e., dumbbell curl exerci... more Resistance exercise using concentric and eccentric muscle contraction (i.e., dumbbell curl exercise) decreased significantly bioelectrical impedance analysis (BIA) (Atsuta et al. 2019). However, the influence of muscle contraction type on exercise-induced BIA change remains unclear. PURPOSE: The purpose of the present study was to examine time course changes in muscle swelling evaluated by BIA following concentric-muscle contraction. METHODS: Nine male subjects (20.0 ± 0.8 yrs, 175.4 ± 2.4 cm, 65.2 ± 6.3 kg) performed isokinetic (60 deg/s) concentric knee extension (6 repetitions × 10sets, 60 s rest period between sets). Before and during 24 h of post-exercise, time course changes in BIA (locally evaluated BIA for vastus lateralis muscle), maximal voluntary contraction (MVC) of knee extension exercise, muscle thickness (evaluated by ultrasound) for vastus lateralis muscle and thigh circumference were evaluated. Blood samples were also drawn to investigate blood lactate, serum creatine kinase (CK) and myoglobin levels. RESULTS: Blood lactate and CK levels were significantly increased after exercise (P<0.05). Moreover, the MVC was significantly decreased immediately after exercise (before exercise: 269.2 ± 30.4 Nm, immediately after exercise: 233.6 ± 28.7 Nm, P<0.05). However, BIA value, muscle thickness and circumference did not change significantly after the exercise (p>0.05 for all variables). CONCLUSIONS: Resistance exercise consisting of concentric muscle contraction did not affect local BIA. The finding was not consistent with that in our previous study using the resistance exercise consisting of both concentric and eccentric muscle contraction.
Background Tibial tubercle-trochlear groove (TT-TG) distance is a measurement generally made on C... more Background Tibial tubercle-trochlear groove (TT-TG) distance is a measurement generally made on CT scans that is commonly used to quantify the risk of patellofemoral instability (PFI); however, its interrater reliability and accuracy as an indicator of PFI in patients is poorly characterized. Questions/purposes The purposes of our study were (1) to primarily analyze interrater reliability of the TT-TG distance among orthopaedists with varied experience as measured by MRI, (2) to secondarily compare TT-TG distances between PFI and control groups, and (3) to determine an accurate TT-TG distance threshold indicative of PFI. Methods The electronic medical records of a senior fellowship-trained orthopaedic sports medicine surgeon were surveyed between 2012 and 2016 for patients who had experienced at least one episode of patellar subluxation or dislocation, who reported no other knee-related history, and who underwent MRI due to persistent PFI signs and symptoms. The records of 48 PFI patients (23 males, 25 females; 19 ± 4 years of age) were compared with 83 controls (60 males, 23 females; 31 ± 8 years of age) having no history of PFI, presenting with an isolated meniscal lesion as determined from MRI and treated by the same orthopaedist during this time. All records meeting study criteria were consecutively included to offset selection bias of the retrospective analysis. Two sports medicine fellows, one who had just completed orthopaedic residency training, and another with a year of experience after residency, and a sports medicine subspecialist with more than 15 years of experience in practice independently recorded TT-TG distance, indicative of tibial tubercle lateralization relative to the femoral trochlea, to the nearest millimeter (mm) in a blinded and randomized fashion. Intraclass correlation coefficient computed interrater reliability accompanied by standard error of measurement (SEM); a one-tailed, two-sample t-test analyzed group differences with accompanying effect size per Cohen’s d; receiver operating characteristic (ROC) curve determined accuracy and threshold for PFI risk. A p value < 0.05 denoted statistical significance. Results Interrater reliability was excellent, at 0.93 (95% confidence interval [CI], 0.84–0.97; SEM = 0.6 mm) for PFI patients and 0.95 (95% CI, 0.91–0.97; SEM = 0.4 mm) for controls. Distance was greater (95% CI, 2–5; p < 0.001) in PFI patients (14 ± 4 mm; range = 7–24 mm) than controls (10 ± 3 mm; range = 3–19 mm) with an effect size of 1 (95% CI, 0.3–2). Area under the ROC curve was 0.75 (95% CI, 0.66–0.83) and threshold was 13 mm (sensitivity = 0.52, 1-specificity = 0.25), suggesting the measure is a fairly accurate indicator of risk and values of 13 mm or greater are better suited to rule in PFI. Respective positive and negative likelihood ratios of 2 and 0.6 at this threshold confirm that this distance yields a small increase in probability for PFI and a minimal decrease in probability for risk; specifically, a 13-mm TT-TG distance is two times more likely to be found in patients with PFI. Furthermore, this threshold is estimated to increase a correct PFI diagnosis by approximately 15%. Conclusions The MRI-specific TT-TG distance, based on a single measurement using cartilaginous-tendon landmarks within a standardized trochlear range, is reliable as performed by orthopaedists of varied experience. Patients with PFI display a 4-mm greater distance than controls, which may represent a difference large enough for clinicians to discern in practice using MRI. A 13-mm TT-TG distance is two times more likely seen in patients with PFI. However, this threshold increases a correct PFI diagnosis by only about 15%; therefore, clinical decision-making should not be influenced by this criterion alone and instead used in conjunction with other relevant variables. Level of Evidence Level IV, diagnostic study,
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Papers by Giampietro Vairo