Presencia de cresta ósea en la epífisis proximal de la tibia: propuesta para su incorporación en la terminologia anatomica / Presence of a bony crest in the proximal epiphysis of the tibia: proposal for its incorporation in the terminologia anatomica

RESUMEN: La Terminologia Anatomica (TA) presenta las estructuras anatómicas en un lenguaje unificado para todas las estructuras del cuerpo humano. Sin embargo, hay características como algunos accidentes óseos que no se han considerado en las actualizaciones de la TA, ya sean epónimos que no se han relacionado con términos actuales o estructuras descritas clásicamente, como es el caso de una característica ósea que se observa y palpa fácilmente en la epífisis proximal de la tibia, a nivel del cóndilo lateral, uniendo el tubérculo anterolateral de la tibia con la tuberosidad de la misma. Esta característica corresponde a una elevación lineal, descrita como lugar de inserción del tracto iliotibial y del músculo tibial anterior. Basado en lo anterior, se analizaron 65 tibias de individuos Chilenos, adultos, de ambos sexos, 60 pertenecientes a la Universidad de La Frontera y 5 a la Universidad San Sebastián, considerando como criterio de inclusión la integridad del tejido compacto en la epífisis proximal. La revisión de las muestras reveló la presencia de una elevación lineal en el 100 % de los casos, uniendo la tuberosidad de la tibia con el tubérculo anterolateral (Gerdy), no observándose elevación similar desde la tuberosidad de la tibia en dirección al cóndilo medial. Esta elevación es utilizada como referencia en la palpación durante la evaluación de la rodilla. Por las evidencias presentadas, consideramos que esta elevación debe considerarse en la TA como una característica más de la tibia, en base a su disposición lineal y elevada, además de su dirección oblicua desde la tuberosidad de la tibia al tubérculo anterolateral de la misma, por lo que proponemos denominarla como cresta anterolateral de la tibia (Crista anterolateralis tibiae).

SUMMARY: Anatomical Terminology (AT) presents anatomical structures in a unified language for all structures of the human body. However, there are characteristics such as some bone accidents that have not been considered in the TA updates, whether they are eponyms that have not been related to current terms or classically described structures, as is the case of a characteristic bone that is easily observed and palpated in the proximal epiphysis of the tibia, at the level of the lateral condyle, joining the anterolateral tubercle of the tibia with the tuberosity of the tibia. This characteristic corresponds to a linear elevation, described as the insertion site of the iliotibial tract and the tibialis anterior muscle. Based on the above, 65 tibiae from Chilean individuals, adults, of both sexes, 60 belonging to the Universidad de La Frontera and 5 from the Universidad San Sebastián were analyzed, considering as an inclusion criterion the integrity of the compact tissue in the epiphysis proximal. The review of the samples revealed the presence of a linear elevation in 100 % of the cases, joining the tibial tuberosity with the anterolateral tubercle (Gerdy), not observing similar elevation from the tibial tuberosity in the direction of the medial condyle. This elevation is used as a reference for palpation during knee evaluation. Based on the evidence presented, we consider that this elevation should be considered in TA as one more characteristic of the tibia, based on its linear and elevated disposition, in addition to its oblique direction from the tibial tuberosity to the anterolateral tubercle of the tibia, for what we propose to call it the Crista anterolateralis tibiae (anterolateral crest of the tibia).

Muscle activation pattern of gluteus medius, tibialis anterior and peroneus longus during drop landing on different surfaces: A cross-sectional study

BACKGROUND@#Gluteus medius (GMeds), peroneus longus (PL), and tibialis anterior (TA) help in maintaining frontal stability of the lower extremity, particularly, the ankle. Muscle activation must be sufficient to prevent the occurrence of an ankle sprain. The purpose of this study is to compare the muscle activation of the GMeds, TA, and PL during drop landing on stable and unstable surfaces of physically active individuals.@*METHODS@#Surface EMG (sEMG) was used to determine the muscle activation pattern of the GMeds, TA, and PL of fifteen (15) recreational athletes during drop landing. The mean percentage of maximum voluntary isometric contraction (%MVIC) was calculated for comparison. Wilcoxon signed-rank test was used to compare means.@*RESULTS@#There were no statistically significant differences in the muscle activity of GMeds (p=0.69), TA (p=0.26), and PL (p=0.23) on stable and unstable surfaces. However, a small effect size showed that GMeds (d=0.30) has higher activation in the unstable surface while TA (d=0.28) and PL (d=0.17) have lower activation on unstable surface.@*CONCLUSION@#Landing surface does not significantly alter muscle activity of GMeds, TA, and PL. However, the magnitude of the difference in the mean %MVIC between groups shows the compensatory mechanism of the body when subjected to different surface conditions. This can be used when creating injury prevention programs of the lower extremity.

Evaluating Electrical Activity of Tibialis Anterior Muscle and Balance in Hemiparetic Patients Following Central and Peripheral Electrical Stimulation - Protocol for a Randomized, Double-blinded, Clinical Trial

Concomitant transcranial direct current stimulation (tDCS) is suggested to enhance the functional effects of other physical rehabilitation methods in individuals with motor impairment stemming from a chronic cerebrovascular disease. Thus, the primary aim of the proposed study is to analyze the electrical activity of the tibialis anterior (TA) muscle of the paretic limb in stroke survivors following an intervention involving the combination of tDCS over the motor cortex and peripheral electrical stimulation (PES) administered over the paretic TA. The secondary objective is to analyze the effect on dynamic balance Methods: Thirty-six adult stroke survivors will be randomized into three groups: 1) Active tDCS+ active PES; 2) Sham tDCS + active PES and 3) Active tDCS + sham PES. TDCSactive will be positioned bilateral over the primary motor cortex of the damaged hemisphere (C1 or C2) and the cathode will be positioned over the primary motor cortex of the undamaged hemisphere (C1 or C2) with a current of 2 mA for 20 minutes. For sham tDCS, will follow the same standarts, however, the equipment will be switched on for only 20 seconds. PES will be administered to the paretic TA at 50 Hz for 30 minutes. Evaluations: the median frequency and root mean square (RMS) of the paretic TA will be analyzed using electromyography (EMG) and dynamic balance will be evaluated using the Mini-Balance Evaluation System (Mini-BESTest) at baseline (pre-intervention), after 10 treatment sessions at a frequency of five times a week for two weeks (post-intervention) and 30 days after the end of the interventions (follow up). Discussion:PES has proven to facilitate the conduction of sensory-motor afferences to the cerebral cortex in stroke survivors. Combining PES with tDCS, which has a direct effect on increasing cortical excitability, could favor motor acquisition and neuronal plasticity in this population

Analysis of Contractile Properties in Gastrocnemius, Tibialis Anterior Muscle of Amateur Male Soccer Players Using Tensiomyography

BACKGROUND: Tensiomyography (TMG) is a relatively new technique that assesses the contractile properties of muscles in response to a single electrical stimulus. This study aimed to evaluate the contractile properties of the gastrocnemius and tibialis anterior (TA) muscles in amateur soccer players using TMG. METHODS: We recruited 41 male soccer players (high school group, n=21; college group, n=20). The gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and TA muscles of both lower extremities were assessed using TMG. The maximal displacement (Dm), delay time, contraction time (Tc), sustained time, and half-relaxation time were obtained and compared between the two groups. RESULTS: First, both groups showed low Dm for the GM and TA muscles, which indicated high stiffness of the muscle tone. Second, the Tc and contraction velocity (Vc) were high for all muscles, except for the GL showing lower speed than the other muscles, which represented the sports-specific characteristics of the soccer players. Third, there were no significant differences in the measurement variables between the dominant and non-dominant sides, except for the Tc of the GM in high school athletes and Vc of the TA in college athletes. CONCLUSIONS: These results reflected the sports-specific needs and characteristics of soccer players. A risk of injury is associated with a high degree of stiffness, and various methods for preventing it should be considered.

Surgical Repair of Tibialis Anterior Muscle Herniation Using a Synthetic Mesh That Was Beneath the Fascia after a Military Training Program: A Case Report

Tibialis anterior muscle herniation is the most common type of skeletal muscle herniation of the lower legs. The treatment of muscle herniation relies on the patient's symptoms. For patients with chronic large fascial defects, fascial grafting with synthetic mesh can be considered. In this case of a patient who was exposed to excessive strain on his lower legs during a military training program, the use of a secure repair technique with synthetic mesh was required. This paper presents a case of tibialis anterior muscle herniation that was treated successfully with a monofilament knitted polypropylene mesh covered by the tibialis anterior fascia. The advantages of this technique include early rehabilitation and an early return to work. No significant difference in the clinical results compared to other methods were observed and there were no complications. The military training program appeared to have aggravated the patient's symptoms of tibialis anterior muscle herniation. On the other hand, larger scale study will be needed to determine if this program actually affects the clinical outcomes.

Morphological variations and accessory ossicles in the peroneal and tibialis muscles / 대한해부학회지

This study describes five bilateral anatomical variations in the feet of a 97-year-old male cadaver. Following routine dissection, all variants were measured and documented. Three accessory tendons and two accessory ossicles were identified. Bilateral accessory tendons were present from the tibialis anterior (type II), peroneus tertius (type III), and peroneus brevis muscles. Accessory tendon length was 36–104 mm and width was 1–3 mm each inserting more distally then the main tendon. Accessory ossicles were identified as an accessory navicular and os peroneum, respectively. Individually, each variation has varying prevalence rates in the literature, but to date, no known studies have been published describing the combined presence of all five bilateral variations. The acknowledgement of multi-variant cases such as this one may be helpful in the clinical setting, particularly for patients with pathology or for those undergoing foot and ankle surgery.

Rotura aguda del tendón tibial anterior / Acute rupture of the tibialis anterior tendon

Resumen: Las roturas del tendón tibial anterior son lesiones infrecuentes, con diversas etiologías, que pueden causar déficits significativos en la funcionalidad del tobillo, lesiones a veces diagnosticadas tardíamente, siendo muchas veces la alteración de la marcha el síntoma que hace acudir al paciente a consulta médica. Seis semanas van a marcar el límite entre la lesión aguda y la crónica, precisando distintos enfoques terapéuticos, junto con otros parámetros como la edad, demanda funcional o patologías concomitantes. Objetivo: Presentar dos casos de rotura aguda, con distinta etiología, la técnica quirúrgica empleada y los resultados finales. Material y métodos: presentamos dos casos de rotura aguda del tendón tibial anterior en su zona crítica hipovascular, un varón y una mujer, con etiología postraumática y espontánea respectivamente, en las cuales se realizó reinserción tendinosa en el escafoides tarsiano con un tornillo de biotenodesis, seguido de una inmovilización con autorización de marcha a las tres semanas y posterior fisioterapia. Resultados: En ambos casos se obtuvo un resultado funcional satisfactorio, con una mejoría importante en la puntuación AOFAS, reincorporándose a sus actividades laborales y deportivas a los 3 y 4 meses de la cirugía, respectivamente, con un seguimiento de 7.5 años y 10 meses. Discusión: Esta técnica, dentro de la variedad descrita en la literatura, nos ha proporcionado excelentes resultados, restaurando la funcionalidad del tendón tibial anterior y mostrándose reproducible por su sencillez, proporcionando un alto grado de seguridad a la hora de realizar una fisioterapia precoz.

Abstract: Tibialis anterior tendon rupture is a relatively rare injury, with diverse etiologies, that can cause significant deficits in the functionality of the ankle. These injuries are sometimes diagnosed too late, being in many occasions the alteration in walking the symptom that makes the patient go to the doctor. The six weeks will mark the limit between acute and chronic injury, requiring different therapeutic approaches, along with other parameters such as age, functional demand or concomitant pathologies. Objective: To present two cases of acute rupture, with different etiology, the surgical technique used and the final results. Material and methods: We present two cases of acute rupture of the tibialis anterior tendon in the critical hipovascular area, a male and a female, with posttraumatic and spontaneous etiology, respectively, in which tendon reinsertion was performed on the tarsal scaphoid with a biothenodesis screw, followed by immobilization with permission to walk at three weeks and subsequent physiotherapy. Results: In both cases a satisfactory final functional result was obtained, with a significant improvement in the AOFAS score, returning to their work and sports activities at 3 and 4 months of surgery respectively, with a follow-up of 7.5 years and 10 months. Discussion: This technique, within the variety described in the medical literature, has provided us excellent results, restoring the functionality of the anterior tibialis tendon and being reproducible for its simplicity, providing a high degree of safety when performing an early physiotherapy.

Therapeutic Observation of Electroacupuncture at Extensors plus Acupoints Based on Syndrome Differentiation for Wrist-ankle Activity in Post-stroke Hemiplegia / 上海针灸杂志

Objective To observe the effect of electroacupuncture at extensors plus acupoints based on syndrome differentiation on the wrist-ankle activity in post-stroke hemiplegia. Method A total of 168 patients with post-stroke hemiplegia were randomly divided into a control group and a treatment group, 84 cases each. Both groups were prescribed with Western medication, based on which, the control group received electroacupuncture at acupoints based on syndrome differentiation, and the treatment group received electroacupuncture at extensors plus acupoints based on syndrome differentiation. The changes of electromyography (EMG) in the two groups after the intervention were observed, and the clinical efficacies were compared between the two groups.Results The total effective rate was 95.1% in the treatment group versus 91.0% in the control group, and the between-group difference was statistically significant (P0.05), but the intra-group differences were statistically significant in both groups(P0.05).Conclusion Electroacupuncture at extensors plus acupoints based on syndrome differentiation can increase the motor unit of carpi radialis and decrease the spasm of gastrocnemius in post-stroke hemiplegia, and consequently produce a remarkable clinical efficacy.

Efeitos do kinesio taping na dinâmica articular durante a marcha de pacientes após acidente vascular encefálico / Effects of kinesio taping in joint dynamics during gait in patients after stroke

Objetivo: Analisar os efeitos do kinesio taping® na dinâmica articular durante a marcha de pacientes hemiparéticos após acidente vascular encefálico (AVE). Métodos: Foi realizado um ensaio piloto com 14 participantes pós-AVE, alocados nos grupos intervenção (n = 7) e sham (n = 7). Foram analisados os ângulos articulares do tornozelo, joelho e quadril, durante as fases de balanço inicial e médio e contato inicial da marcha, antes da aplicação do taping e 24 horas após. A satisfação do paciente também foi analisada. Resultados: Não houve diferença entre os grupos nas angulações do tornozelo [balanço inicial (DM = -0,47º, IC95% -14,37 a 13,42); balanço médio (DM = -1º, IC 95% -14 a 12); contato inicial (DM = 1,22º, IC 95% -11,5 a 13,97)]; joelho [balanço inicial (DM = 5,66º, IC 95% -12,27 a 23,58); balanço médio (DM = -1,94º, IC 95% 23,6 a -19,76)]; quadril [balanço inicial (DM = 1,97º, IC 95% -6,98 a 3,03); balanço médio (DM = 0,68º, IC 95% -7,57 a 8,9); contato inicial (DM = 0º, IC 95% - 3,7 a 3,6)]. O grupo intervenção apresentou 10,5 vezes mais chances (OR = 10,5, IC 95% 0,4 a 267,1) de observar diferença quando o taping é aplicado em comparação ao grupo sham. Conclusão: Não houve diferença nas angulações do tornozelo, joelho e quadril durante a marcha, 24 horas após a aplicação do kinesio taping® em pacientes hemiparéticos. (AU)

Objective: To analyze the effects of Kinesio taping® in the joint dynamics during gait in hemiparetic patients after stroke. Methods: We conducted a pilot study with 14 participants after stroke allocated into intervention group (n = 7) and sham group (n = 7). We measured the joint angles of ankle, knee and hip during gait analysis at initial swing, mid swing and initial contact, without the application of taping and 24 hours after application. We also evaluated the patient's experience. Results: There was no difference between groups in the ankle angles [initial swing (DM = -0.47º, 95% CI -14.37 to 13.42); mid swing (DM = -1º, 95% CI -14 to 12); initial contact (DM = -1.22º, 95% CI -11.5 to 13.97)]; knee [initial swing (DM = 5.66º, 95% CI -12.27 to 23.58); mid swing (DM = -1.94º, 95%CI -19.76 to 23.6)]; hip [initial swing (DM = 1.97º, 95%CI -6.98 to 3.03); mid swing (DM = 0.68º, 95%CI -7.57 to 8.9); initial contact (DM = 0°, 95% -3.7 to 3.6)]. The chance to observe the difference when the taping is applied was 10.5 times higher (OR = 10.5, 95%CI 0.4 a 267.1) in the intervention group. Conclusion: There was no significant difference in angles of ankle, knee and hip during gait, 24 hours after Kinesio Taping® application in hemiparetic patients. (AU)

Tabialis Anterior Muscle Contraction On Driver’s Knee Angle Posture Less Than 101º For Foot Pressing And Releasing An Automotive Pedal

Proper driving requires a proper posture to bring comfort to drivers. A problem that commonly exists in driving is incorrect driving posture which can cause discomfort to the driver, especially when interacting with automotive pedals. Research on contraction of tibialis anterior (TA) muscle on driver's posture based on the knee angle less than 101º in a position of pressing and releasing a pedal was conducted to investigate and overcome this problem. This is a field experiment study and surface electromyography (sEMG) is used in collecting data on the TA muscle. The procedure of collecting data on the TA muscle before and after experiments follows the Surface ElectroMyoGraphy for the Non-Invasive Assessment of Muscles (SENIAM) recommendations. The result of the experiment shows that there is a strong negative relationship between driver's postures in nature based on the angle of the knee with TA muscle contractions, where the Pearson correlation coefficient (r) is - .993. While the temporal analysis measurements based on Maximum Voluntary Isometric Contraction (MVIC) 60% in a position of releasing a pedal exceeding rms µV 39.38, are 39.71 and 40.25 respectively. On the other hand, MVIC 2% rms µV values: 1.19 and 1.2 are obtained in the position of pressing the pedal. The knee angle with TA muscle contractions is significant [F (1, 10) = 660, p<.05] contributing 98.5% variance (R2 = .985) in the driver's posture. A linear equations model has been developed to clearly illustrate the result. In conclusion, when the knee angle of the driver's posture is increased, the TA muscle contraction is decreased. The increase in the knee angle will directly provide comfort to the driver while interacting with the pedal; and this is due to the reduction of TA muscle contractions.

BILATERAL VARIATIONS IN TENDONS OF DORSUM OF FOOT.

Anterior or extensor muscles of foot comprises Peroneus tertius (PT), Extensor digitorum longus (EDL), Extensor hallucis longus (EHL) and Tibialis anterior (TA). Presence of PT in many of the primates and humans suggests terrestrial bipedalism. PT is a dorsi-flexor of ankle joint and a weak evertor of foot. TA is the most medial and superficial dorsiflexor. Standard text-books describe the course of tendon of TA as passing deep to inferior extensor retinaculum (IER). In the present study, absence of PT with a course of TA superficial to IER on one side with variant origin of PT from Extensor digitorum longus on the other side were observed in an adult female cadaver. Knowledge on variations in PT and TA are of clinical significance and academic importance to orthopedic surgeons, radiologists and anatomists.

The effect of intermittent cryotherapy on the activities of citrate synthase and lactate dehydrogenase in regenerating skeletal muscle

This study examined the effect of three sessions of cryotherapy (three sessions of 30 minutes applied each 2 h) and muscle compression in the regenerating skeletal muscle of the rats. The middle belly of tibialis anterior muscle was injured by a frozen iron bar and received one of the following intervention: injury + cryotherapy (treated with cryotherapy); injury + placebo (sand pack), and injury (I).The enzymatic activities of citrate synthase (CS) and lactate dehydrogenase (LDH) were measured in the presence of 1mM or 10mM pyruvate. The ANOVA and Tukey's test (p<0.05) were performed for the statistical analysis. In summary, the intermittent sessions of cryotherapy, associated to muscle compression and applied immediately after the primary muscle injury minimized the CS and LDH activity at 4h30 and 24h periods post-lesion, which could be related to the reduction in the secondary muscle injury inherent to cryotherapy treatment.

Anterior Tibial Muscle Hernia Treated with Local Periosteal Rotational Flap: A Case Report

Tibialis anterior muscle hernia is the most common hernia among lower extremity muscles. This condition can be diagnosed by physical examination and radiologic findings, especially by dynamic ultrasonography. There are surgical methods of treatment for muscle hernia, including direct repair, fasciotomy, fascial patch grafting using autologous fascia lata or synthetic mesh. We report a case of tibialis anterior muscle hernia treated with local periosteal rotational flap. Because there are several advantages to the local periosteal rotational flap, such as lack of donor site morbidity, lack of skin irritation, low cost, simplicity, and an easy approach, this technique could be an option for tibialis anterior muscle hernia.

Comparison of the Outcomes on Second-Look Arthroscopy after Anterior Cruciate Ligament Reconstruction Using a Hamstring Autograft or a Tibialis Anterior Allograft

PURPOSE: We wanted to evaluate the status and changes of the reconstructed anterior cruciate ligament (ACL) graft by performing second-look arthroscopy after arthroscopic reconstruction of the ACL with a hamstring autograft or a tibialis allograft. MATERIALS AND METHODS: From June 2003 to February 2007, second look arthroscopy was performed on 58 cases and a hamstring autograft was used in 36 cases and a tibialis allograft was used in 22 cases. Second-look arthroscopy was conducted at an average of 19.1 (12~42) months after reconstruction. We measured the graft tension using displacement by probing and the synovial coverage by visual analysis at the time of second-look arthroscopy. The Lysholm score, the Lachman test and a KT-2000 arthrometer were used to evaluate the status of the reconstructed ACL. RESULTS: The hamstring tendon autograft group showed normal tension in 25 cases, lax tension in 7 cases and partial tear in 4 cases. The tibialis anterior allograft group showed normal tension in 12 cases, lax tension in 5 cases and partial tear in 5 cases. In the hamstring tendon autograft group, the synovial coverage was good in 23 cases, there was half coverage in 8 cases and it was pale in 5 cases. In the tibialis anterior allograft group, the synovial coverage was good in 10 cases, there was half in 7 cases and it was pale in 5 cases. There were no significant differences between the two groups on the clinical examination, but on second look arthroscopy, the synovial coverage was better in the hamstring tendon autograft group than that for the tibialis anterior allograft group. CONCLUSION: The hamstring autograft group had superior synovial coverage compared to that of the other group on second look arthroscopy. But there were no significant difference of the clinical outcomes between the groups.

Avulsion Fracture of Medial Cuneiform by Tibialis Anterior Tendon (A Case Report) / 대한족부족관절학회지

Avulsion fracture of medial cuneiform by tibialis anterior tendon is quite rare. It has been reported about the avulsion fracture and surgical repair of tibialis anterior tendon rupture at distal insertion site of medial cuneiform in Korea. We report a case of right foot medial cuneiform avulsion fracture by tibialis anterior tendon after autobike accident and describe this case with a review of literature.

Expressions of iNOS and Superoxide Dismutase in the Skeletal Muscle of the Spontaneously Hypertensive Rat after Ischemic-preconditioning / 체질인류학회지

A balance between production and degradation of reactive oxygen species has an important role in the cardiovascular homeostasis, and is known to contribute to hypertension. Under oxidative stress, an upregulation of inducible NOS (iNOS) induces ischemic-reperfusion injury, and is involved in the pathophysiology of the hypertension. Ischemic-reperfusion injury of the skeletal muscle results from reactive oxygen species, and overexpression of iNOS in the skeletal muscle increases the ischemic injury. Superoxide dismutase (SOD), antioxidant, is a major enzyme for degradation of reactive oxygen species (ROS). The purpose of this study was to observe the effect ischemic preconditioning (IP) of the lower limb on the expression of iNOS, CuZnSOD and MnSOD in the white and red muscle of the spontaneously hypertensive rat (SHR). Nine weeks old male normotensive rat (Wistar-Kyoto rat, WKY) and SHR were divided into control and IP groups. The IP group was further divided into 3 (3IP) and 10 (10IP) times of IP. Left common iliac artery was occluded 3 and 10 times for 5 min of ischemia-5 min of reperfusion using rodent vascular clamp. The animals were sacrificed at 0, 0.5, 1, and 3 hours after reperfusion and the Tibialis anterior and Soleus were removed. The expressions of iNOS, CuZnSOD and MnSOD in the skeletal muscle were examined with immunohistochemical methods and Western blot analysis. iNOS was expressed in Tibialis anterior, but in Soleus after IP. The expression of iNOS was increased in both WKY and SHR, it was higher in SHR than WKY. CuZnSOD and MnSOD were expressed in Tibialis anterior and Soleus, higher in Soleus, after IP. The expression of CuZnSOD and MnSOD were increased in both WKY and SHR, higher in WKY than SHR. It is consequently suggested that hypertensive individual and white muscle are more sensitive to ischemic injury of the skeletal muscle as considering their high expression of iNOS and low expression of SODs.

Effects of Ischemic Preconditioning on the Phosphorylation of Akt and the Expression of SOD-1 in the Ischemic-reperfused Rat Skeletal Muscles / 체질인류학회지

Akt, a key protein of cell survival, can promote cell growth and survival by activations of various cellular protective factors. Ischemic preconditioning (IP) has been known to reduce ischemic injury through upregulation of phosphorylation of Akt (p-Akt). CuZn-superoxide dismutase (SOD-1), an antioxidant enzyme, scavenges reactive oxygen species and protects cell from oxidative stress by increasing the activaiton of Akt. The present study was performed to examine the effects of IP on the expression of p-Akt and SOD-1 in the ischemicreperfused rat skeletal muscles. Thirty weeks old male SD rats were divided into 4 groups, such as controls, IP, 4 hour ischemia and 4 hour ischemia with IP. For IP, commom iliac artery was occluded three times for 5 min ischemia followed by 5 min reperfusion using rodent vascular clamps. Ischemia was induced by occlusion on the same artery for 4 hours. The Tibialis anterior and Soleus were removed at 0, 1, 3, and 24 hours of reperfusion. The expressions of p-Akt (Ser 473) and SOD-1 were examined with immunohistochemistry and Western blot analysis.In the IP group, the p-Akt and SOD-1 were increased, compared to the control group. In the ischemia group, the p- Akt and SOD-1 were decreased, compared to the control group, and were more abundant when reperfusion time were increased. IP increased the p-Akt and SOD-1 after 4 hour ischemia, and the p-Akt and SOD-1 were higher in Soleus compared to Tibialis anterior. These findings suggest that IP increases p-Akt and expression of SOD-1 in the ischemic-reperfused rat skeletal muscles, and that upregulations of p-Akt and SOD-1 induced by IP were higher in the red muscle fiber, Soleus, than the white muscle fiber, Tibialis anterior.

Análise da fadiga muscular localizada em atletas e sedentários através de parâmetros de freqüência do sinal eletromiográfico / Analysis of localized muscular fatigue in athletes and sedentary subjects through frequency parameters of electromyographic signal

Embora a análise no domínio da freqüência do sinal eletromiográfico (EMG) seja empregada na caracterização do processo de fadiga muscular localizada, sua aplicação, especificamente a da freqüência mediana (Fmed), é pouco explorada no âmbito esportivo. O objetivo do presente estudo foi verificar a viabilidade da aplicação do sinal EMG, através de sua análise no domínio da freqüência, como parâmetro para determinação e diferenciação no comportamento da fadiga muscular localizada. Dois grupos de sujeitos, um caracterizado como atletas (n =12) e outro como sedentários (n =12), foram submetidos a análises baseadas em procedimentos executados em três diferentes situações experimentais, todos envolvendo a modalidade de exercício isométrico: i) teste máximo para determinação da contração isométrica voluntária máxima (CIVM); ii) teste de fadiga, sustentado por 35 seg. a 80 por cento da CIVM; iii) teste de recuperação, sustentado por 10 seg. a 80 por cento da CIVM; neste ultimo foi monitorado o comportamento da Fmed nos três primeiros (Fmedi) e três últimos segundos (Fmedf) do sinal EMG no músculo tibial anterior durante o teste de fadiga. Durante os 10 segundos do teste de recuperação foi calculada a Fmed referente a todo o período (Fmedr). parâmetro utilizado no cálculo do índice de recuperação muscular (IRM). Os resultados apontam que a Fmedf apresentou valor menor em relação à Fmedi em ambos os grupos (p < 0,05). Quando comparado com o grupo de sedentários, o grupo de atletas apresentou valores maiores de Fmedi e Fmedf (p < 0,05). O valor médio e desvio-padrão do IRM para o grupo de atletas foram de 62,1 por cento ± 28,7 e, para o grupo de sedentários, de 55,2 por cento ± 27,8 (p > 0,05). Dessa forma, os resultados apresentados neste estudo permitem inferir a viabilidade na aplicação de parâmetros no domínio da freqüência do sinal EMG para a determinação e diferenciação do comportamento da fadiga muscular localizada.

Although the analysis in the frequency domain of the Electromyographic Signal (EMG) has been used in the characterization of the localized muscular fatigue process, its application, specifically the Median Frequency (MF), is rarely explored in sports. The objective of this study was to verify the viability of the EMG signal application, through its frequency domain analysis, as a parameter for determination and differentiation of the behavior of localized muscle fatigue. Two groups of subjects, one characterized as athletes (n = 12) and the other as sedentary (n = 12), were submitted to analysis based on procedures from three different experimental situations, all involving isometric exercise modality: i) maximum test for determination of the Maximum Voluntary Isometric Contraction (MVIC); ii) fatigue test, 35 sec. sustained load of 80 percent of MVIC; iii) recovery test, 10 sec. sustained load of 80 percent of MVIC. In the latter, the MF behavior in the three first (Fmedi) and three last (Fmedf) seconds of the EMG signal of tibialis anterior muscle during the fatigue test have been monitored. During the 10 seconds of the recovery test, MF was calculated regarding the whole period (Fmedr); this parameter was used to calculate the Muscular Recovery Index (MRI). The results showed that Fmedf presented lower value in relation to Fmedi in both groups (p < 0.05). Additionally, the Fmedi and Fmedf values for the athlete group were higher in comparison to the sedentary group (p < 0.05). The MRI mean value and standard deviation for the athlete group were 62.1 percent ± 28.7 and for the sedentary group was 55.2 percent ± 27.8 (p > 0.05). Therefore, the results presented in this study allow inferring the viability in the application of the frequency domain parameters of the EMG signal for the determination and differentiation of localized muscle fatigue behavior.

Effects of neuromuscular electrical stimulation on tibialis anterior muscle of spastic hemiparetic children / Efeitos de estimulação elétrica neuromuscular no músculo tibial anterior em crianças hemiparéticas espásticas

OBJECTIVE: This study evaluated the effects of neuromuscular electrical stimulation (NMES) on muscle strength, range of motion (ROM) and gross motor function, among spastic hemiparetic children while standing, walking, running and jumping. METHODS: Ten children were divided into two groups of five. The children who were normally receiving physical therapy sessions twice a week had two 30-minute NMES sessions per week (group 1), while those who were having one physical therapy session per week had one 30-minute NMES session per week (group 2), for seven weeks in both groups. The children were evaluated three times: before beginning the NMES protocol (initial), right after the end of the protocol (final) and eight weeks after the final evaluation (follow-up). The evaluations included manual goniometry on ankle dorsiflexion, manual muscle strength of the tibialis anterior and gross motor function (measurements while standing, walking, running and jumping). The statistical analysis was performed using the Wilcoxon and Mann-Whitney tests, considering a p level of 0.05. RESULTS: There were significant increases in muscle strength, gross motor function and passive ROM of ankle dorsiflexion, in both groups, and in active dorsiflexion in the first group. No significant differences were found between the groups. CONCLUSIONS: The improvements in ROM, muscle strength and gross motor function demonstrated that the use of NMES was effective in both groups, since no significant differences were found between the groups. This study suggests that NMES may be a useful therapeutic tool, even when applied once a week. Further studies are needed to confirm these findings.

OBJETIVO: Este estudo avaliou os efeitos da estimulação elétrica neuromuscular (EENM) na força, amplitude de movimento (ADM) e função motora grossa (FMG) em pé, andando, correndo e pulando de crianças hemiparéticas espásticas. MÉTODOS: Dez crianças foram divididas em dois grupos de cinco. As que realizavam sessões de fisioterapia duas vezes por semana tiveram duas sessões semanais de EENM de 30 minutos cada (grupo 1), enquanto as que compareciam à uma sessão tiveram uma sessão semanal (grupo 2), ambas por sete semanas. As crianças foram avaliadas três vezes: antes do início do protocolo de EENM (inicial), ao final do protocolo (final) e oito semanas após a avaliação final (tardia). As avaliações englobaram goniometria manual da dorsiflexão de tornozelo, força muscular manual do tibial anterior e função motora grossa, (Gross Motor Function Measure em pé, andando correndo e pulando). A análise estatística foi feita pelos testes de Wilcoxon e Mann-Whitney, com p adotado de 0,05. RESULTADOS: Houve aumentos significativos na força muscular, na FMG e na ADM passiva da dorsiflexão de tornozelo em ambos os grupos, assim como na dorsiflexão ativa no primeiro grupo. Nenhuma diferença significativa foi encontrada entre os grupos. CONCLUSÕES: As melhoras obtidas na ADM, força muscular e FMG demonstram que o uso da EENM foi eficaz nos dois grupos, não tendo sido encontradas diferenças significativas entre os mesmos. Este estudo sugere que a EENM pode ser útil no auxílio à terapia, mesmo em baixas freqüências, como uma vez por semana. Estudos adicionais são necessários para confirmar estes achados.

Clinical Outcomes after Arthroscopic ACL Reconstruction using Bone-Patellar Tendon-Bone Allografts, Anterior Tibialis Tendon Allografts, and Hamstring Tendon Autografts

PURPOSE: To use physical and quantitative tests and second look arthroscopy to compare knee joint stability, graft remodeling, and healing after arthroscopic anterior cruciate ligament (ACL) reconstruction in patients receiving bone-patellar tendon-bone (BPTB) allografts, tibialis anterior tendon (TA) allografts, and hamstring (HA) autografts. MATERIALS AND METHODS: We analyzed 338 patients who underwent ACL reconstruction between March 2000 and February 2006 and who were followed up for at least 1 year. There were 60 BPTB allografts, 153 TA allografts, and 125 HA autografts. We compared the range of motion (ROM), Lachman test, pivot shift test, KT-1000 arthrometer test, and International Knee Documentation Committee (IKDC) knee examination form among the three groups, as well as the laxity and synovial coverage of the grafts as determined by second look arthroscopy. RESULTS: There was no significant difference among the three groups with regard to preoperative and postoperative clinical and physical findings. Synovial coverage of greater than 50% was found in 60% of patients in the BPTB allograft group, in 69.2% of patients in the TA allograft group, and in 100% of patients in the HA autograft group. The HA autograft group had a higher incidence of synovial coverage greater than 50% (p=0.017, 0.025). Regarding IKDC grade, Grade A or B was found among 93.7% of the cases with synovial coverage greater than 50% and among 72.2% of the cases with synovial coverage less than 50%. There was a significant correlation between the extent of synovial coverage and the IKDC grade (p=0.015). CONCLUSION: The HA autograft group had superior synovial coverage over the other two groups on second look arthroscopy, and there was a significant correlation between the extent of synovial coverage and the IKDC grade.