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Physiologic loading of the anterior cruciate ligament does not activate quadriceps or hamstrings in the anesthetized cat.

We attempted to elicit quadriceps and hamstring electromyographic responses in seven chloralose-anesthetized cats by loading the ACL with controlled anterior displacement of the tibia on the femur using rigid fixation and an MTS testing machine. We did not detect reflex activity in the quadriceps or hamstring muscles of any of the cats in response to anterior tibial displacements of up to 4 mm, with rise times ranging from 1.0 to 0.1 seconds. In four of the cats we loaded the ACL using a wire loop. Loads of up to 125 N (4 to 5 times body weight) produced no reflex activity in any of the four animals, although we consistently observed monosynaptic reflex responses to tendon taps. Whole nerve recordings from the posterior articular nerve revealed substantial activity from afferents in response to tugging on the ACL, although we could not differentiate receptors in the ACL from those in other periarticular tissues. Thus, while traction on the intact ACL causes signals in the afferent nerves, those signals are not translated into direct monosynaptic reflexes.

Animals↗

Anterior cruciate ligament reconstruction using the semitendinosus and gracilis tendons augmented by the losee iliotibial band tenodesis. A long-term study.

Seventy patients were evaluated after combined intra- and extraarticular reconstruction of the anterior cruciate ligament. Semitendinosus and gracilis tendons were used for the intraarticular reconstruction and Losee iliotibial band tenodesis for the extraarticular procedure. Minimum followup was 5 years (average, 7). Clinical examination and instrumented ligament examination with the KT-1000 arthrometer and the Cybex II dynamometer were used to evaluate results. Subjectively, patients had no complaints of instability with daily activities; 93% had no complaints of instability with athletic participation. Clinical examination demonstrated that 81% had less than a 1 + Lachman test; 98% had a negative pivot shift. Instrumented examination of the anteroposterior limits of motion revealed that only 57% had less than 3-mm side-to-side difference; 30% had 3- to 5-mm; and 13% had 6- to 9-mm. Mean hamstring muscle strength measured with the Cybex II dynamometer was 94% at 60 and 96% at 100 deg/sec. When evaluated with the Zarins scale, 90% were rated good or excellent, 6% fair, and 4% poor. This reconstructive procedure restores functional, but not necessarily normal, stability in most anterior cruciate ligament-deficient knees. It allows patients to increase activity levels without significant risk of additional injuries.

Adult↗

The effect of tourniquet use in anterior cruciate ligament reconstruction. A prospective, randomized study.

To evaluate the effect of tourniquet use during anterior cruciate ligament reconstruction, 40 consecutive patients were randomized into two groups: Group I (tourniquet) and Group II (no tourniquet). Preoperative evaluation included electromyography, measurement of thigh and calf girth, and determination of serum creatinine phosphokinase levels. Initial postoperative evaluations included serial creatinine phosphokinase determinations. At 1 and 6 months postoperatively, the electromyographic examination was repeated and thigh and calf girth measurements were obtained. At 6 months and 1 year after surgery, the following evaluations were made: thigh and calf girth, KT-1000 arthrometric testing, isokinetic testing of quadriceps and hamstring muscles, single-legged hop test for time, single-legged hop test for distance, and the Lysholm knee score. In Group I, the tourniquet was inflated for an average of 87 minutes, with an average pressure of 269 mm Hg. At 1 month postoperatively, 6 of 20 patients in Group I had positive electromyographic recordings (compared with 2 of 20 in Group II, P = 0.08). At 1 month, thigh girths measured 10 cm proximal to the medial joint line suggested more atrophy in the tourniquet group (P = 0.07). At 6 months, all electromyographic recordings had returned to normal. At 6 months and 1 year postoperatively, girth measurements, isokinetic strength testing, functional testing, KT-1000 arthrometer evaluation, and the Lysholm knee scores were similar for both groups.

Adolescent↗

Ankle inversion injuries. The role of the dynamic defense mechanism.

We investigated the role of a muscular defense in the stabilization and protection of the ankle joint against sudden forced inversion. Ten volunteers with mechanically stable ankles were tested in different standing and walking situations using a trap door model and lower extremity electromyography and electrogoniometers. Peroneal electromyographic activity was observed 54 msec after the detection of ankle inversion. This latency was shorter when the ankle was already in inversion and longer with the ankle in eversion. Quadriceps and hamstring muscle electromyographic activity occurred 68 msec after the ankle inversion stimulus. Evidence of active eversion was seen 176 msec after sudden inversion. Active changes in knee and hip joint angles occurred even later. In contrast, the trap door rotated 30 degrees in approximately 80 msec. We conclude that the reflex reaction to sudden inversion is initiated at a peripheral level by the inversion motion followed by a reaction pattern mediated by spinal or cortical motor centers. Both peripheral and central reactions, however, seem too slow to protect the ankle in case of sudden inversion occurring at the time of heel contact.

Adult↗

Sympathetic mediation of peripheral vasodilation induced by spinal cord stimulation: animal studies of the role of cholinergic and adrenergic receptor subtypes.

Electric spinal cord stimulation (SCS) is widely used as a treatment modality for ischemic pain in peripheral arterial insufficiency. The background for the therapeutic effect may be a temporary inhibition of sympathetically maintained peripheral vasoconstriction. In this series of experiments, the involvement of different types of cholinergic and adrenergic receptor subclasses in the vasodilatory effect was explored in anesthetized rats. The microcirculation in hindlimb skin and hamstring muscle was studied by the laser Doppler technique. The ganglionic blocker hexamethonium as well as the nicotinic receptor antagonist chlorisondamine abolished the effect in both vascular beds, whereas the muscarinic receptor antagonists pirenzepine and atropine were ineffective. Among the adrenergic receptor active compounds, phentolamine, prazosine (an alpha 1-receptor antagonist), and clonidine in high doses suppressed the SCS-induced vasodilation. Yohimbine (an alpha 2-receptor antagonist) did not alter the effect. The beta-adrenergic compounds had a differential effect on muscle and skin perfusion. Atenolol, a beta 1-receptor antagonist, inhibited SCS-induced vasodilation only in the skin, whereas the beta 2-receptor antagonist butoxamine selectively depressed the muscle response. The vasodilatory effect of SCS in the animal model used here seems to a large extent to be mediated by an inhibitory effect on peripheral vasoconstriction maintained via efferent sympathetic activity involving nicotinic transmission in the ganglia and the postganglionic alpha 1-adrenoreceptors. The involvement of beta-receptors seems to be different in skin and muscle, beta 1 being more important for the changes in the skin and beta 2 being more important for those in muscle. The high-intensity antidromic response, earlier believed to explain how SCS exerted its vasodilatory effect, was resistant to cholinergic and adrenergic manipulations and seems to depend on entirely different mechanisms.

Animals↗

EMG power spectra of intercollegiate athletes and anterior cruciate ligament injury risk in females.

PURPOSE: Females have a disproportionately high incidence of anterior cruciate ligament (ACL) injuries compared with males in analogous sports. Although the pathogenesis of this higher frequency has not been elucidated, gender differences in neuromuscular control of the knee may play an important role. This study evaluates EMG power spectra of the quadriceps and hamstring muscles during dynamic, fatiguing exercise to examine differences between male and female intercollegiate athletes. METHODS: Fifty-one collegiate basketball and soccer players (25 female, 26 male) were studied. Maximum voluntary contraction (MVC) was determined for knee flexion and extension. Three consecutive 2-min bouts of isokinetic knee flexion and extension exercise were performed at 40% MVC. EMG activity in the biceps femoris and vastus medialis obliquus was recorded using bipolar surface electrodes. RESULTS: MVC normalized to body weight was significantly greater in males than in females for the quadriceps (P< 0.01). Quadriceps coactivation ratios were significantly higher in females than in males during knee flexion exercises (P< 0.01). CONCLUSIONS: This study demonstrates differences in the EMG power spectra for females when compared with a matched group of males. Increased quadriceps coactivation in females may increase anterior tibial loads under dynamic conditions, thus placing the ACL at higher risk for injury in the female athlete.

Adolescent↗

Reconstruction does not reduce tibial translation in the cruciate-deficient knee an in vivo study.

We have assessed the effectiveness of reconstruction of the anterior cruciate ligament (ACL) in reducing functional tibial translation (TT). The gait of 11 ACL-deficient patients was studied using Vicon equipment before and after surgery. Measurements of the angle between the patellar tendon and the long axis of the tibia were obtained in order to calculate TT in the sagittal plane relative to the uninjured limb during standing and walking. Before surgery, patients did not show abnormal TT on the injured side, but after surgery significant anterior TT was found in the operated limb for every parameter of gait. Abnormal anterior TT occurring during activity does not seem to be reduced by reconstruction; rather, it increases. It may be that the increased translation results from relaxation of excess contraction of the hamstring muscles, since compensatory muscle activity no longer is required in a reconstructed knee. The reduction of TT may not be an appropriate objective in surgery on the ACL.

Adult↗

A comparison of two stretching protocols on hip range of motion: implications for total daily stretch duration.

It is theorized that the total stretch time in a day is more important than the actual single stretch duration time. The purpose of this study was to compare 2 stretching protocols, keeping total stretching time equivalent. The 2 protocols were a 10-second duration stretch and a 30-second duration stretch. Although the stretch durations differed, the total stretching time over the course of a day was held constant at 2 minutes for both protocols. Participants were randomly assigned a protocol to each of their legs: subjects stretched 1 leg with the 10-second protocol and the opposite leg with the 30-second protocol. The 10-second stretch was repeated 6 times for a total of 1 minute; the 30-second protocol was repeated 2 times for a total of 1 minute. Stretching was performed twice daily (a total of 2 minutes each day) for 6 weeks. All stretching was performed to the hamstring muscles. Hip flexion measurements were recorded at pretest, 3-weeks, and 6-weeks. Subjects demonstrated significant gains in range of motion for hip flexion over the course of 6 weeks, p = 0.000. No differences existed between the 2 protocols. Range of motion gains were equal between the 2 stretching protocols. The common denominator was total stretch time for a day. Regardless of the duration of a single stretch, the key to improvement was the total daily stretch time. These findings are important as they allow clinicians and individuals to customize stretching protocols to meet individual needs.

Adult↗

Controlled warm-up intensity enhances hip range of motion.

Acute effects of active and passive warm-up, proprioceptive neuromuscular facilitation (PNF), and ratings of perceived exertion (RPE) were compared during hip-joint range of motion (ROM). Two active warm-up treatments included (a) achieving a respiratory exchange ratio (RER) of 1.00 and (b) achieving 60% of heart rate reserve (HRR). Hydrocollator pads (HP) served as the passive warm-up treatment. These treatments and a control were randomly assigned to increase hamstring muscle temperature of the dominant leg. Warm-up treatments were administered to 12 men (mean 25.3 years) with a minimum of 24 hours interspersed between each treatment. A timed PNF (slow-reversal-hold) technique was conducted after each warm-up treatment. Tukey tests (p < 0.05) showed ROM for RER (107.4 degrees) was greater than all other treatments. ROM for HRR (102.8 degrees) and HP (103.4 degrees) did not differ from each other but were greater than the control (98.8 degrees). Ratings of perceived exertion were lowest for RER (4.0) and highest for control (8.5). Ratings of perceived exertion for HRR (6.0) and HP (6.5) were similar. In conclusion, an active warm-up before PNF stretching appears to be the most effective treatment to increase hip ROM. Results of RPE reinforce that active warm-up reduces the resistance to stretch. In a field setting, it is estimated that a warm-up of 70% of HRR would duplicate the muscle readiness equivalent to an RER of 1.00 before PNF stretching.

Adult↗

Ischial apophysis injuries in athletes.

The diagnosis and treatment of ischial tuberosity pain in athletes include several clinical entities. These injuries include apophysitis, adult tug lesion, painful unfused apophysis, and acute and old avulsions. In some avulsion injuries a bony fragment can be seen, but they can also be x-ray-negative, especially in children. An insertional tendon rupture is also possible. Conservative treatment of apophysitis includes modification of activities and anti-inflammatory medication. Avulsions, if diagnosed early, usually heal with conservative therapy, especially if the displacement is not marked. Urgent surgical treatment is recommended in cases with total or nearly total soft-tissue hamstring muscle insertion rupture. Surgery has to be considered also in cases with dislocation of the apophysis or bony avulsion of more than 2cm. Excision of the excessive mass or poorly united fragment provides relief of pain in some cases of old avulsions.

Adolescent↗

MR lymphography with iron oxide compound AMI-227: studies in ferrets with filariasis.

OBJECTIVE: The purpose of this study was to assess the MR lymphographic potential of AMI-227 to reduce the signal intensity of hyperplastic inflammatory lymph nodes by using ferrets with filariasis as the animal model. Both interstitial and IV modes of administration were studied. MATERIALS AND METHODS: Twelve ferrets were infected with the filaria Brugia malayi and six control ferrets were injected with super-paramagnetic iron oxide AMI-227, either interstitially or IV. Signal intensities of the left popliteal lymph node, left hamstring muscle, and left inguinal fat were measured before, 48 hr after, and up to 138 days after contrast injection with the use of both spin-echo and gradient-echo techniques. The signal intensity data were statistically analyzed. The lymph nodes, liver, spleen, and lungs were studied with light and electron microscopy. RESULTS: Forty-eight hours after the interstitial injection of AMI-227, the signal intensities of the ipsilateral popliteal nodes of the infected and control ferrets were significantly reduced (p less than .0005) without significant changes in the signal intensities of the surrounding tissues on both spin-echo and gradient-echo MR images. No nodal signal reduction occurred with the IV route of injection in ferrets. Light microscopy revealed iron to be localized within nodal marginal zones exclusively. Lymphatic trunks were visualized after interstitial injection. Signal reduction persisted to our end point at 138 days. CONCLUSION: AMI-227 shows regional specificity with significant enhancement of nodal structures and demonstrates potential as an interstitial MR lymphographic agent.

Animals↗

Relationship between active knee extension and active straight leg raise test measurements.

This study was conducted to determine the relationship between two alternative tests for indicating hamstring musculotendinous length, active knee extension (AKE) and active straight leg raise (ASLR). Before alternatives to a commonly practiced clinical test such as AKE can be recommended for application, their convergent validity should be established. Twenty-three healthy subjects (mean age = 29.4 years) were tested. A 35-mm camera was used to record the position of the right side of the pelvis and lower limb during the performance of the ASLR test on the right. The camera set-up was also used to record the position of the right knee and pelvis during the performance of AKE with the right hip flexed to 90 degrees. For ASLR, the angle of the straight leg to the horizontal was measured. For AKE, the angle of knee extension was measured. The intraclass correlation coefficients for the AKE (.861) and ASLR (.953) tests were good and high, respectively. There was a significant relationship (r = -.718; r2 = .515; p < .001) between AKE and ASLR. The significant correlation between the measurements obtained using these two tests suggests that both are providing an indication of the same basic phenomenon, presumably hamstring musculotendinous length. For this reason, the AKE test may be a useful alternative to the straight leg raise test for providing an indication of hamstring muscle length.

Adult↗

Anterior tibial translation during progressive loading of the ACL-deficient knee during weight-bearing and nonweight-bearing isometric exercise.

Many protocols for rehabilitating the knee following anterior cruciate ligament (ACL) injury or repair call for the use of both weight-bearing and nonweight-bearing exercises. However, not much is known about the strain these exercises place on the passive restraining mechanisms. The purpose of this study was to examine the effect of progressive loading of the knee extensors on anterior tibial translation during weight-bearing and nonweight-bearing isometric exercise. Fourteen subjects diagnosed as ACL-deficient via arthroscopic surgery participated in the study. An arthrometer was used to measure anterior tibial translation during weight-bearing and nonweight-bearing exercises with the knee in 20 degrees of flexion and with a quadriceps load equivalent to 25, 50, 75, and 100% of body weight. Hamstring muscle activations during all testing were monitored to eliminate the possibility of substantial cocontractions. During the weight-bearing exercise, anterior tibial translation was found to be significantly less than that measured during the Lachman's evaluation and the 50, 75, and 100% nonweight-bearing exercises. For the nonweight-bearing exercises, anterior tibial translation was either equivalent to or greater than the Lachman's evaluation. During the weight-bearing exercises, anterior tibial translation was not different under the different loading conditions. During the nonweight-bearing exercises, anterior tibial translation progressively increased with increased loading. The results from this study imply that weight-bearing exercises minimize strain to the passive restraining structures whereas nonweight-bearing exercises will strain these structures, and the magnitude of this strain appears to be proportional to the knee extensor moment.

Adolescent↗

Effects of ipsilateral anterior thigh soft tissue stretching on passive unilateral straight-leg raise.

STUDY DESIGN: Randomized 3-group pretest-posttest with blind assessment of outcome. OBJECTIVES: The purpose of this study was to examine the effect of sagittal plane hold-relax exercise applied to the ipsilateral anterior thigh, and prone positioning on passive unilateral straight-leg raise measurements. BACKGROUND: Straight-leg raising has been viewed as a measurement for hamstring muscle length, but literature suggests that other structures may affect this measurement. METHODS AND MEASURES: Sixty subjects (45 men, 15 women) qualified for inclusion into the study based on a straight-leg raise measurement of < or = 65 degrees. Subjects were randomly assigned to one of three groups: control, static stretch, or sagittal plane hold-relax exercise. Pretest and posttest straight-leg raise measurements of the right lower extremity were performed for each subject. RESULTS: A 1-way ANOVA of the change scores showed a significant difference between groups. A Tukey post hoc analysis of the change scores showed that both treatment groups' means differed significantly from the control group and from each other, with the sagittal plane hold-relax group exhibiting the largest change (mean of 7.8 degrees +/- 2.8 degrees). CONCLUSIONS: The results of this study show that sagittal plane hold-relax exercise and passive prone results of this study show that sagittal plane hold-relax and passive prone positioning can significantly increase straight-leg raise range of motion, however the sagittal plane hold-relax stretching of the anterior thigh is more effective than passive prone positioning.

Adult↗

A new model of plastic ankle foot orthosis (FAFO (II)) against spastic foot and genu recurvatum.

A plastic ankle foot orthosis (AFO) was developed, referred to as functional ankle foot orthosis Type 2 (FAFO (II)), which can deal with genu recurvatum and the severe spastic foot in walking. Clinical trials were successful for all varus and drop feet, and for most cases of genu recurvatum. Electromyogram studies showed that the FAFO (II) reduced the spasticity of gastrocnemius and hamstring muscles and activated the quadricep muscles. Gait analysis revealed a reduction of the knee angles in the stance phase on the affected side when using the FAFO (II). Mechanical stress tests showed excellent durability of the orthosis and demonstrated its effectiveness for controlling spasticity in comparison with other types of plastic AFOs.

Adolescent↗

Lumbar dorsal ramus syndrome.

Low back pain, referred pain in the lower limbs, and spasm of the back, gluteal, and hamstring muscles are clinical features which can be induced in normal volunteers by stimulating structures which are innervated by the lumbar dorsal rami. Conversely, they can be relieved in certain patients by selective interruption of conduction along dorsal rami. These facts permit the definition of a lumbar dorsal ramus syndrome, which can be distinguished from the intervertebral disc syndrome and other forms of low back pain. The distinguishing feature is that, in lumbar dorsal ramus syndrome, all the clinical features are exclusively mediated by dorsal rami and do not arise from nerve-root compression. The pathophysiology, pathology, and treatment of this syndrome are described. Recognition of this syndrome, and its treatment with relatively minor procedures, can obviate the need for major surgery which might otherwise be undertaken.

Animals↗

[Risk factors for low back pain among 1.389 pupils in the 8th and 9th grade. An epidemiologic study].

INTRODUCTION: The aim of this study was to investigate the frequency and severity of low back pain (LBP) in 13-16-year-old pupils in relation to selected factors, such as anthropometry, physical activity, smoking, hypermobility, and tightness of hamstring muscles. METHODS: The study was designed as a cross-sectional questionnaire-based survey and all the pupils were examined by the school doctor for height, weight, mobility of joints, and general health status. RESULTS: The lifetime prevalence of non-specific LBP was 58.9% and the one-year prevalence was 50.8% with no differences between the sexes. Recurrent/continuous LBP in a moderate to severe degree was recorded in 19.4% of the school children (182 F, 88 M). This was positively correlated to a female gender, a BMI of more than 25 kg/square meter, competitive sports for boys, poor physical fitness, daily smoking, heavy jobs in leisure time, increased use of the health system, and reduced life quality. DISCUSSION: Stepwise logistic regression analysis indicates that a female gender, daily smoking, and heavy jobs are important associated factors for severe LBP in adolescents, with an observed probability of 46% if all factors are present. We do not know yet whether these factors have any causal importance for the development of severe LBP.

Adolescent↗

Evaluation of aorto-iliac disease with Doppler ultrasound and isotope clearance techniques.

The clearance of 99mTc from the hamstring muscle compartment of patients with aorto-iliac or iliac disease was examined with the patients at rest and after exercise. The values were compared with those obtained in a group of controls and another group with superficial femoral, or femoropopliteal arterial occlusion. A statistically significant difference in the rate of 99mTc clearance was found in patients with proximal vascular disease.

Ankle↗