The Effect of Longer versus Shorter Duration of Supervised Physiotherapy after ACL Reconstruction on the Vertical Jump Landing Limb Symmetry.

The study investigated the vertical jump landing limb symmetry after ACLR between a group of patients receiving a longer supervised physiotherapeutic procedure and following a shorter supervised physiotherapy. Group I (n = 20) and Group II (n = 15) were males averagely 30 weeks after ACLR. The time since ACLR in both groups (Group I, 27.95 ± 8.26 weeks; Group II, 32.47 ± 7.74 weeks) was insignificant, although the duration of supervised physiotherapy between the two groups (Group I, 27.9 ± 8.26 weeks; Group II, 11.28 ± 8.20 weeks) significantly differenced. Group III (n = 20) were controls. Two-legged and one-legged vertical jumps landing vertical ground reaction force (VGRF) were bilaterally measured in all groups using force plates. The intragroup comparison of two-legged jump landing VGRF revealed p = 0.01 between the involved and uninvolved limbs in Group II. The intergroup comparison revealed p ≤ 0.001 in the two-legged vertical jump between Groups II and III, and I and II. The one-legged limb symmetry was comparable in studied groups. In the group following shorter supervised physiotherapy, the two-legged landing limb symmetry was on a worse level than in the group of patients receiving fully supervised procedure and healthy individuals. A fully supervised postoperative physiotherapy is more effective for improving two-legged vertical jump landing limb symmetry.

Surgical Management of Distal Biceps Tendon Anatomical Reinsertion Complications: Iatrogenic Posterior Interosseous Nerve Palsy.

BACKGROUND Although iatrogenic posterior interosseous nerve (PIN) palsy is an uncommon complication of ruptured distal biceps brachii tendon surgical anatomical reinsertion, it is the most severe complication leading to functional limitation. The present study investigated possible types of PIN palsy as a postoperative complication of anatomical distal biceps tendon reinsertion, and aimed to clinically assess patients at 2 years after its surgical treatment. MATERIAL AND METHODS The studied sample comprised 7 male patients diagnosed with an iatrogenic PIN palsies after anatomical reinsertion of the distal biceps tendon, who were referred to the reference center for management of a peripheral nervous system injury. The nerve injury was intraoperatively evaluated. The clinical assessment used the Medical Research Council (MRC) System for motor recovery, and the Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) was performed before the surgical treatment of the PIN injuries and at 2 years postoperatively. In all studied cases, electromyography was performed preoperatively and postoperatively. RESULTS The comparison of the preoperative (x=1.43±0.53) and postoperative (x=4.71±0.49) results of the motor recovery of the PIN demonstrated a statistically significant improvement (p<0.001). Moreover, the results of functional assessments with the use of the Quick DASH questionnaire significantly improved (p<0.001) postoperatively (x=6.14±6.86) compared to the preoperative evaluations (x=54.29±12.05). CONCLUSIONS The PIN palsies as complications of the surgical anatomical reinsertion of ruptured distal biceps brachii resulted from mechanical nerve compression or direct intraoperative damage. The 2-year outcomes justified the clinical use of surgical management for iatrogenic PIN palsy.

Treatment of Distal Biceps Tendon Injuries with Particular Emphasis on Postoperative Physiotherapy.

Distal biceps tendon injuries are relatively rare. Standard treatment of complete tears and significant partial tears involves surgical anatomical reinsertion of the tendon at the radial tuberosity. Chronic injuries are usually managed with surgical tendon reconstruction using autografts or allografts. Conservative treatment is mostly limited to the elderly, individuals with a very low level of physical activity, patients with evident contraindications to surgical treat-ment, and cases of mild partial tendon tears. The selection of an optimum surgical technique and method of fixation remains controversial. The aim of this paper is to characterize distal biceps tendon injuries, discuss methods of their surgical treatment, and analyze postoperative physiotherapy regimens described in the literature. A literature review did not reveal any relationship between the surgical method and type of fixation used on the one hand and the period of immobilization, type of immobilization, or the postoperative physiotherapy regimen on the other.

Quantitative analysis of peak torque and power-velocity characteristics of shoulder rotator muscles after arthroscopic labral repair.

OBJECTIVES: We aimed to use biomechanical testing to assess differences in the power and strength of patients who participated in a short-term, home-based rehabilitation program following arthroscopic labral repair compared with a healthy control group. DESIGN: The functional outcomes of patients who underwent arthroscopic labral repair followed by self-directed short-term rehabilitation at home were compared with age- and body mass index (BMI)-matched healthy controls. METHODS: Group I included 20 male patients who had undergone arthroscopic labral repair after being diagnosed with recurrent anterior glenohumeral joint instability without bony lesions of the humeral head or glenoid. Postoperatively, they participated in physical therapy for 17±4 appointments, followed by self-guided home-based exercises. Group II included 25 males without injuries. The two groups were matched for age and BMI. The orthopaedic examination, functional tests, and biomechanical measurements were performed under isokinetic conditions at an average of 16±3 months postoperatively. RESULTS: Significant differences were observed in range of shoulder rotation on the operative shoulder compared with the unaffected side and in the dominant arms of the control group. The patients were also found to have significant deficits in biomechanical parameters such as power and peak torque angle. CONCLUSIONS: Significant deficits in peak torque, power, and peak torque angle during external and internal shoulder rotation remained up to 16 months after arthroscopic labral repair. Further research is needed to understand the changes in shoulder power assessment after labral repair.

Biomechanical characteristics of the jump down of healthy subjects and patients with knee injuries.

PURPOSE: The aim of this study is to investigate the drop jump performance of male patients who underwent ACLR and a control group using combined data acquisition system. METHODS: A total of 28 male subjects aged 20 to 26 were studied: 22 did not show and were not diagnosed with any knee joint dysfunction (the control group) and six men who underwent ACLR of the left limb (group of patients). The control group was age, height and body mass matched. A data acquisition setup consisting of three independent modules including force platforms, position analysis system and electromyography was used. Subjects were jumping down from 0.1, 0.2, and 0.3 m step heights. The acquired signals were used to determine the ground reaction force, muscular activity, mass centre position, velocity and acceleration. RESULTS: Statistically significant differences were found between the groups (t-test, p < 0.05) in the maximum vertical ground reaction force in the left limb for 0.2 and 0.3 m step heights. Differences in the muscle activity between the groups were found to be statistically significant (t-test, p < 0.05) before the jump, during the landing phase, and after the jump for selected muscle groups and step heights. CONCLUSION: Combing the three independent measurement systems provided new information on drop jump biomechanics. The distribution of loads in different muscles was not uniform across the groups. Patients allocated more energy to control their motion and seemed to protect their operated limb by shifting the bodyweight to the healthy limb.

Single- vs. double-bundle anterior cruciate ligament reconstruction: a new aspect of knee assessment during activities involving dynamic knee rotation.

Few studies have compared single-bundle (SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) in the knee joint during activities involving change-of-direction maneuvers and knee rotation. This study examined whether the type of ACLR contributes to postphysiotherapy outcomes, with an emphasis on knee function assessment during activities involving dynamic knee rotation. Fifteen male patients after SB ACLR and 15 male patients after DB ACLR took part in the same physiotherapy program. Twenty-four weeks after ACLR, both groups underwent anterior laxity measurement, pivot shift tests, range of movement and joint circumference measurements, subjective assessment of pain and stability levels in the knee joint, peak torque measurement of the muscles rotating the tibia toward the femur, and a run test with maximal speed and change-of-direction maneuvers. Comparative analysis did not show any differences between the results of anterior tibial translation, pivot shift test, range of movement and joint circumference, and subjective assessment of pain and knee joint stability levels. No differences were noted between the groups in peak torque values obtained from the muscles responsible for internal and external tibial rotation or results of the run test. The data obtained from this study can be used by research teams to monitor and compare the effectiveness of various study protocols involving surgical and physiotherapy treatment. The data are especially useful when combined with the clinical assessment of patients who would like to return to sport.

The influence of exercises under isokinetic conditions on heart rate in males aged between 40 and 51.

The aim of the study was to estimate changes in heart rate (HR) values in response to the exercise under isokinetic conditions, with defined protocol using three different angular velocities and 2 minute break. The subjects were divided into two groups. The first group contained 18 males aged between 40 and 50, and the second group contained 20 males who were 20-30 years old. The heart rate was monitored before, during and after the strength moment measurement under isokinetic conditions of extensors and flexors of knee joint. The strength moment was measured with an angular velocity of 180 °/s, 120°/s and 60 °/s. The number of repetitions of extension and flexion of the knee joint was 10 for the angular velocity of 180 °/s, 8 for the angular velocity of 120 °/s and 5 for the angular velocity of 60 °/s. The break between each series of repetitions took 2 minutes. The peak torques for extensors and flexors of both lower extremities were measured. The peak torque and heart rate values increased with a decrease in the preset angular velocity and were lower in the second group. The results were within the norm accepted for submaximal heart rate index in both age groups.

Effect of physiotherapy on the strength of tibial internal rotator muscles in males after anterior cruciate ligament reconstruction (ACLR).

BACKGROUND: The goal of this study was to evaluate the effect of physiotherapy on the strength of muscles responsible for tibial internal rotation (IR) in male patients after anterior cruciate ligament reconstruction (ACLR) using autografts of the semitendinosus and gracilis muscles (STGR). MATERIAL/METHODS: Fifty-nine males were examined. The first group consisted of 19 patients subjected to 4-stage physiotherapy following ACLR. The second group consisted of 20 males without knee injuries. The third group consisted of 20 males who had not undergone systematic physiotherapy within the last 12 months following lower limb injuries. Moments of maximal strength (MMS), isometric torque (IT), and peak torque (PT) were measured under static and isokinetic conditions using the Humac Norm System. In the first group, IT measurements were performed during the 13th and 21st week of physiotherapy, while PT measurements were performed during the 16th and 21st weeks of physiotherapy following ACLR. In the control groups (II and III) the measurements were performed once. RESULTS: In the first group, the IT (13 weeks) and PT (16 weeks) values of internal tibial rotator muscles, obtained from the operated extremities were significantly lower than the values obtained from the uninvolved knees and the control group results. During the 21st week of physiotherapy, the results obtained for IT and PT in patients after ACLR were similar to the values obtained from the uninvolved knees and the results of the second group subjects. CONCLUSIONS: The 21-week physiotherapy in ACLR patients favorably affected the PT values of tibial rotator muscles of the operated knees. In the third group, the IT values did not indicate a complete improvement after 12 months without systematic physiotherapy.