Normalized Hip and Knee Strength in Two Age Groups of Adolescent Female Soccer Players.

ABSTRACT: Hannon, JP, Wang-Price, S, Garrison, JC, Goto, S, Bothwell, JM, and Bush, CA. Normalized hip and knee strength in two age groups of adolescent female soccer players. J Strength Cond Res 36(1): 207-211, 2022-Limb symmetry strength measures are used for clinical decision-making considering when an athlete is ready to return to sport after anterior cruciate ligament (ACL) injuries. However, changes in bilateral muscle strength occur after ACL injury resulting in potentially altered limb symmetry calculations. Adolescent female soccer players are at increased risk of sustaining ACL injuries. Published age and sex-matched strength values in this population may be of benefit to clinicians to improve clinical decision-making. The purpose of this study was to establish normative hip and knee strength data of both the dominant and nondominant limbs in adolescent female soccer players. Sixty-four female soccer players (ages 10-18) were enrolled in this study. Subjects were divided by age into 2 groups (group 1: 10-14 years; group 2: 15-18 years). Subjects underwent Biodex isokinetic strength testing at 60°·s-1 and 180°·s-1 to assess quadriceps and hamstring strength. Isometric hip strength (abduction and external rotation) was measured using a hand-held dynamometer. No significant differences were found between groups on either limb in regards to quadriceps or hamstring strength. No significant differences were found between groups on either limb for hip external rotation strength. Significant differences in hip abduction strength were found between groups on the dominant (group 1: 0.21 ± 0.04; group 2: 0.18 ± 0.04; p = 0.014) and nondominant (group 1: 0.21 ± 0.05; group 2: 0.18 ± 0.05; p = 0.019) limbs. The results of this study shed light on normative strength values for a high-risk injury population.

Effects of anterior cruciate ligament reconstruction on patellofemoral joint stress and lower extremity biomechanics at 12 weeks post-surgery and at time of return to sport in adolescent females.

BACKGROUND: The purpose of this study was to examine kinematic and kinetic differences associated with patellofemoral pain after anterior cruciate ligament reconstruction between limbs at 12-week post-surgery and at time of return to sport. METHOD: Twenty-four adolescent females completed 5 consecutive single leg squats on each limb at 12-weeks post-surgery and again during their RTS assessment. Peak knee extension moment, peak hip adduction angle, and patellofemoral joint stress at 45 degrees of knee flexion were calculated. Separate two by two repeated measures ANOVA were performed. FINDINGS: There was a significant interaction (limb × time) for knee extension moment (p < 0.001). Surgical limb knee extension moment was significantly less than the non-surgical limb at return to sport (p < 0.001). At 12-weeks the surgical limb was significantly less than non-surgical limb (p < 0.001), additionally the surgical limb was significantly greater at time of return to sport than at 12 weeks (p < 0.001). There was a significant main effect of limb for hip adduction angle (p = 0.002). Surgical limb was significantly greater than non-surgical limb (Surgical = 9.84 (SE 1.53) degree, non-surgical = 4.79 (SE 1.01) degree). There was also a main effect of time and limb for patellofemoral joint stress. Return to sport was significantly greater than 12 weeks and the surgical limb was significantly less than non-surgical limb (Surgical = 4.93 (SE 0325) MPa, Nonsurgical = 5.29 (SE 0.30) MPa). INTERPRETATION: The surgical limb of participants following ACL-R demonstrated variables that have been associated with the development of patellofemoral pain.

Quadriceps strength changes across the continuum of care in adolescent male and female athletes with anterior cruciate ligament injury and reconstruction.

OBJECTIVES: To examine the quadriceps strength (QUADS) on the surgical (SURG) and non-surgical (Non-SURG) limbs in adolescent male and female athletes at pre-operative (PRE), 12 weeks post-operative (12WK), and return to sport (RTS) time points following ACL injury and reconstruction. DESIGN: Prospective cohort study design. SETTING: Clinical Research Laboratory. PARTICIPANTS: 66 adolescent athletes. MAIN OUTCOME MEASURES: Isokinetic QUADS of the SURG and Non-SURG limbs at the PRE, 12WK, and RTS time points were assessed and compared between each time point. RESULTS: Both male and female participants had significantly lower 12 WK QUADS in the SURG limb than the PRE QUADS, but the RTS QUADS was significantly greater than the 12WK QUAD (p < 0.05). However, only female participants had greater RTS QUADS as compared to the PRE QUADS (p < 0.001). For the Non-SURG limb, only male participants had a significant improvement over time (PRE vs RTS; p < 0.001). CONCLUSION: Adolescent males and females differ in their QUADS recovery across the continuum of care following ACLR. Clinicians should consider this pattern of recovery when treating adolescent males and females.

Prevention of complications in shoulder arthroplasty: understanding options and critical steps.

Total shoulder arthroplasty provides reliable pain relief of osteoarthritic shoulder pain. The keys to success with shoulder arthroplasty are adhering to appropriate indications, understanding the surgical implications of various pathologies, and applying good surgical technique. Many complications of total shoulder arthroplasty may be avoided with good preoperative preparation. Some key surgical steps that may help avoid the more common complications include proper patient positioning, adequate soft-tissue releases for rebalancing, identification of the axillary nerve, correction of glenoid version, the adjustment of humeral component size and version as needed for stability, and meticulous subscapularis repair. Additional precautions can include postoperative immobilization to protect soft-tissue repairs followed by structured rehabilitation.

Far lateral suboccipital approach for the treatment of proximal posteroinferior cerebellar artery aneurysms: surgical results and long-term outcome.

OBJECTIVE: Proximal posteroinferior cerebellar artery (PICA) aneurysms are challenging to treat surgically, with high reported perioperative complication rates. We describe the perioperative course and long-term clinical outcomes obtained via a far lateral suboccipital approach in 20 consecutive proximal PICA aneurysms. METHODS: Data were collected prospectively on the first 20 proximal PICA aneurysms treated surgically by a single surgeon (ESC) between December 1997 and April 2003. All aneurysms were clipped via a far lateral approach. Patients with unruptured aneurysms were assessed at 3 and 12 months after surgery. For all subarachnoid hemorrhage patients, a battery of outcome tests was performed at 3- and 12-month intervals. Outcomes were then compared with those of a contemporaneously managed population of ruptured right-sided posterior communicating artery aneurysms. RESULTS: The far lateral suboccipital approach achieved adequate exposure in all cases. There were no intraoperative complications or intraoperative aneurysm ruptures. All patients with unruptured aneurysms were fully functional at long-term follow-up. At 3 months of follow-up, 93% of the subarachnoid hemorrhage patients achieved a Glasgow Outcome Scale score of 1 to 2. At 12 months of follow-up, 92% achieved a Glasgow Outcome Scale score of 1 to 2. Compared with the patients with a ruptured right-sided posterior communicating artery aneurysm, no difference could be found in quality of life or activities of daily living at either time point. CONCLUSION: The favorable outcomes and low postoperative morbidity in this subset of patients argues that clipping via this approach be considered a first-line therapeutic option. When performed in this manner, PICA aneurysm surgery seems to have no greater morbidity than right-sided posterior communicating artery aneurysm surgery.