Females aged between 13 and 17 years old possess the highest non-contact ACL injury incidence of any sex-age strata. Considering that energy absorption strategies have been associated with a reduced ...risk for sustaining an ACL injury, evaluating landing performance in youth athletes requires investigations beyond the kinematic level. The purpose of this study was to identify sex-specific energy absorption strategies in adolescent males and females, including the relationship between strength and the observed strategies. Thirty-one healthy adolescent athletes completed unanticipated single-leg drop-jump landings on their dominant limb. Sex-specific kinematics and lower-limb contributions to energy absorption were then compared over the landing phase for each jump. Pearson and Spearman correlation coefficients determined the relationship between isometric joint strength and the observed kinematics and energy absorption. Female participants absorbed a larger proportion of the landing energy at the ankle (p = 0.046, d = 0.75) and smaller proportion at the hip (p = 0.028, d = 0.85) compared to males. Females also reached larger peak negative joint power in their knee (p = 0.001, d = 1.1) and ankle (p = 0.04, d = 0.79). Hip extension strength was positively correlated with trunk flexion (r = 0.559, p = 0.001) and negatively correlated with forward pelvic tilt (r = -0.513, p = 0.003). Females adopted an energy absorption strategy which utilized the distal joints to absorb a larger portion of the landing forces and tended to absorb the forces later in the landing phase relative to males. The greater reliance on distal joints is correlated to reduced hip strength and may increase the risk for sustaining an ACL injury.
The purpose of this study was to describe neuromuscular and kinematic differences during failed and successful drop-vertical jumps in a pediatric population. Healthy young athletes (n = 32) completed ...single-leg drop vertical jump landings where the required landing leg was unanticipated. Trials were categorized as failed if the participant shifted their base of support during the landing. Joint kinematics and muscle activation amplitudes were time normalized over the flight and landing phases. Statistical parametric mapping (SPM) was used to compare landings and a moving average convergence divergence oscillator was then calculated to determine where failed and successful waveforms began to diverge prior to reaching statistical significance. SPM determined that participants performed the failed trials with reduced pelvic tilt towards the landing limb during 41–69% of the flight phase, greater trunk flexion angle during 31–100% of the landing phase and greater trunk tilt away from the landing limb during 3–13% and 21–90% of the landing phase. Greater rectus femoris activation during the failed trials was identified during 88–100% of the flight phase, as well as 1–4% and 71–97% of the landing phase. Greater gluteus medius and biceps femoris activation was also identified in the failed trials during 54–72% and 76–89% of the landing phase respectively. These findings indicate that the control of proximal joints has an important role in determining if a participant will fail a landing; and that how athletes prepare for a landing may be more relevant than the kinematics following ground contact.
Neuromuscular control is critical for maintaining dynamic joint stability and mitigating the risk of anterior cruciate ligament (ACL) injury. Given the increased risk of ACL injury in females, ...sex-based differential muscle activation strategies are often associated with this risk. For example, the quadriceps-dominant muscle activation strategy sometimes observed in females has been discussed as a cause of their increased risk of ACL injury. However, there has been no synthesised knowledge on sex differences in muscle activation patterns associated with ACL injuries. Therefore, the purpose of this review was to synthesise sex differences in muscle activation patterns in movements associated with ACL injuries in both adult and adolescent populations. A systematic electronic database search was conducted. Thirty studies were included in the review. Females demonstrated higher pre- and post-landing activation of the quadriceps and lower activation of the hamstrings in 15 studies. Females also had higher quadriceps-to-hamstring co-contraction ratios during pre- and post-landing phases compared to their male counterparts in 4 of 9 studies that considered co-contraction. While some studies supported the quadriceps-dominant activation strategies in females, no consensus can be drawn due to methodological inconsistencies and limitations. Also, despite the importance of ACL injury prevention in children and adolescents, the evidence on sex difference in muscle activation patterns in this population is insufficient to draw meaningful conclusions.
Purpose/Rationale:
Physical exercise interventions for the management of knee osteoarthritis are well known to be effective and accessible forms of rehabilitation and symptom management. However, ...without adequate reporting of these interventions, accurate replication and clinical use is negatively impacted.
Objectives:
The main objective of this article was to assess content reporting using The Consensus on Exercise Reporting Template list and 2016 American College of Sports Medicine guidelines among moderate- to high-quality exercise interventions randomized controlled trials (total score of ≥6/10 on the PEDro scale) involving individuals with knee osteoarthritis.
Results:
The Consensus on Exercise Reporting Template mean total score for all 47 included randomized controlled trials was 4.42 out of 19, demonstrating generally low quality of reporting. The Consensus on Exercise Reporting Template list and the 2016 American College of Sports Medicine guidelines scores were moderately correlated (based on 95% confidence interval, intraclass correlation coefficient = 0.508) for aerobic interventions only.
Conclusion:
The content analysis of exercise interventions in knee osteoarthritis demonstrated low scores for moderate- to high-quality trials. Improved standardized reporting is recommended to ensure knowledge transfer and replication of effective exercise programs for individuals with knee osteoarthritis.
Rationale:
Exercise programs for the management of fibromyalgia are well recognized as being effective. However, the incomplete descriptions of exercise programs make replication and implementation ...difficult. Also, existing reporting tools have not been validated in relation to pain relief as well as with each other.
Objectives:
This study aimed to evaluate the description of exercise programs in randomized control trials for the management of fibromyalgia using different assessment tools, and the correlations of each tool in relation to effectiveness of pain relief of fibromyalgia, and the correlations between each tool.
Method/Results:
Through a consensus made by two different pairs of reviewers and an arbitrator, the mean total scores for the exercise programs were reported: 10.61/19 for Consensus on Exercise Reporting Template; 4.17/12 for Template for Intervention Description and Replication; 7.05/12 for the Consensus on Therapeutic Exercise Training; and 2.50/4 (aerobic) and 2.36/5 (flexibility and resistance) for the 2016 American College of Sports Medicine guidelines. This demonstrates generally low reporting scores (less than 60% out of the total number of items were reported). Overall, low correlations (Cohen’s kappa value, ranging from −0.47 (poor) to 0.313 (fair)) were found between all tools and pain relief. Good to excellent correlations (0.680–0.908) among the reporting tools were shown.
Conclusion:
Incomplete descriptions of exercise programs were consistently shown among the randomized clinical trials assessed in this study. The overall weak correlations demonstrated that the reporting tools have the limited ability to determine whether exercise programs were or were not effective for pain relief among individuals with fibromyalgia.
Background:
The rates of anterior cruciate ligament (ACL) graft failure or contralateral ACL rupture range from 17% to 30% in pediatric patients after ACL reconstruction (ACLR). A contributing factor ...to the high reinjury rate in this population may be the limited evidence regarding appropriate criteria for allowing unrestricted return to activity (RTA) postoperatively.
Purpose:
To review the literature and identify the most commonly used criteria when determining unrestricted RTA after ACLR in pediatric patients.
Study Design:
Systematic review; Level of evidence, 4.
Methods:
A search was performed of the Medline/PubMed, Cochrane Central Register of Controlled Trials, Embase, CINAHL, and SPORTDiscus databases using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The authors identified studies that included pediatric patients (<19 years of age) and specified the criteria used to determine RTA after ACLR.
Results:
A total of 27 articles met all criteria for review, of which 13 studies only used 1 criterion when determining RTA. Objective criteria were the most common type of criteria for RTA (17 studies). Strength tests (15 studies) and hop tests (10 studies) were the most commonly used tasks when deriving RTA criteria. Only 2 studies used validated questionnaires to assess the patient’s physiological readiness for RTA, and only 2 studies used an objective assessment of movement quality before RTA.
Conclusion:
Only 14 of the 27 reviewed studies reported using >1 criterion when determining RTA. Furthermore, few studies used patient-reported outcome measures or lower limb kinematics as RTA criteria, indicating that more research is needed to validate these metrics in the pediatric population.
Anterior cruciate ligament (ACL) rupture is a debilitating knee injury associated with sequela such as joint instability and progressive degeneration. Unfortunately, following surgical ACL ...reconstruction in adolescents, the rates of ACL graft failure range from 17 to 19%. A contributing factor to the high reinjury rate in this population may be the limited evidence regarding appropriate criteria for allowing unrestricted return-to-activities (RTA) postoperatively. Several systematic reviews have already sought to develop a consensus on what criteria should be utilized for releasing patients to unrestricted sports activities; however, these reviews have focused on adult populations, a group at much lower risk for reinjury. Our objective is to systematically examine the literature and identify the criteria used when determining unrestricted RTA following an ACL reconstruction in an adolescent population.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search will be performed of the MEDLINE/PubMed, Cochrane, Embase, CINAHL, and SPORTDiscus electronic databases. Searches will be conducted from January 1, 2000, until submission of the final review. Studies will be identified that include adolescent patients (10-18 years old) undergoing a primary ACL reconstruction and which have specified the criteria used to determine RTA. Each article will be independently screened by two reviewers. To supplement the electronic database search, citations within all included studies will be manually reviewed. Reviewers will record the RTA assessment utilized and the rates of ACL reinjury through a standardized data extraction sheet. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the most commonly used types of RTA criteria.
This systematic review will determine the most commonly used RTA criteria in adolescent patients post-ACL reconstruction. This will help future interventions build more effective adolescent-specific RTA assessments through the validation of current RTA criteria as well as the implementation of new criteria according to the identified literature gaps.
Sex-related neuromuscular differences have been linked to greater risk of anterior cruciate ligament injuries in females. Despite this, it remains unclear if sex-related differences are present after ...injury. This study sought to determine if sex differences are present in the functional roles of knee joint muscles in an anterior cruciate ligament deficient population.
An isometric, weight-bearing, force-generation protocol required injured and healthy males and females to modulate ground reaction forces. Electromyography was used to classify the functional role of 10 lower limb muscles in their contribution to knee joint stability during various loading directions. These roles were compared between the four groups at 12 loading directions using a directional analysis.
Functional muscle roles were different between groups, except for injured males and healthy females. Healthy males had either joint actuators or specific joint stabilisers, but no general stabilisers; the vastus medialis and lateralis of injured males and healthy females were classified as general stabilisers while injured females added the gluteus medialis and medial gastrocnemius as general stabilisers.
A population-based hierarchy in functional muscle roles was discovered. Healthy males demonstrated the most specific muscle roles, which can be viewed as more adaptive to variable loading conditions. The more generalised stabilisation strategies seen in injured males and females would alter joint loading which may be detrimental to the knee joint health over time. In summary, (1) these injuries alter muscle roles; (2) these alterations are sex-specific; (3) rehabilitation might be optimised if sex-differences are considered.
•Sex influences neuromuscular control in a healthy population.•Sex influences neuromuscular control after an anterior cruciate ligament injury.•A population-based hierarchy in knee stabilisation strategy was identified.•Rehabilitation programs should consider sex-specific muscle function after injury.
The reporting quality of physical activity (PA) programs in randomized controlled trials (RCTs) for the management of juvenile idiopathic arthritis (JIA) remains unknown. This study aimed to assess ...and compare the reporting quality of PA programs in RCTs for the management of JIA using three difference standardized assessment tools, and to describe the elements that were similar and different between these tools.
A systematic search was conducted for moderate-to high-quality RCTs of PA programs in JIA, published up until January 2019. Two reviewers independently included 10 RCTs and scored the reporting quality of PA programs using the following tools: Consensus on Exercise Reporting Template (CERT) checklist, Consensus on Therapeutic Exercise Training (CONTENT) scale, and Template for Intervention Description and Replication (TIDieR) checklist.
Results showed that reporting of PA programs in 10 moderate- to high-quality RCTs for JIA management remains incomplete. The average reporting quality (± standard deviation) for all RCTs combined was moderate for the three standardized assessment tools with 70.8 (±14.3)% for the TIDieR checklist, 53.2 (±20.2)% for the CERT checklist, and 70.0 (±18.9)% for the CONTENT scale. Despite some overlap, the three standardized assessment tools (TIDieR, CERT, CONTENT) included different elements resulting in different scores. All tools assess elements linked to PA programs (provider, location, timing, personalization and adherence), but the CERT checklist includes other essential elements (e.g., additional resources, motivational strategies, adverse events).
The lack of complete reporting of PA programs in RCTs for the management of JIA and the variation in scores and assessed elements among standardized assessment tools show the need to improve reporting. Using the most comprehensive standardized tool (i.e., the CERT) and providing accessible supplemental information on PA programs may improve the reporting quality of PA programs in RCTs and help reproduce PA programs in research and clinical practice.
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