Relationship between Kinesiophobia and Dynamic Postural Stability after Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study.

INTRODUCTION: Anterior cruciate ligament (ACL) injuries in young, active patients generally require ACL reconstruction (ACLR) to restore mechanical and postural stability. The fear of movement or reinjury (kinesiophobia) has become increasingly recognized in the post-ACLR population; however, the association between restoration of postural stability and kinesiophobia remains largely unknown. The purpose of this study was to investigate changes in mean Tampa Scale of Kinesiophobia-11 (TSK-11), dynamic motion analysis (DMA) scores, and time on the testing platform, as well as any correlation between TSK-11 and mean overall and individual translational and rotational DMA scores during the first 12 months following ACLR. DESIGN: Cohort study. METHODS: Patients undergoing ACLR were prospectively enrolled and dynamic postural stability and kinesiophobia based on the TSK-11 were collected within 2 days prior to surgery and at 6 and 12 months following ACLR. Dynamic postural stability was quantified by calculating a DMA score, with score calculated in three translational (anterior/posterior [AP], up/down [UD], medial/lateral [ML]) and three rotational (left/right [LR], flexion/extension, and internal/external rotation) independent planes of motions. Correlations between DMA and TSK-11 scores at each time point were analyzed. RESULTS: A total of 25 patients meeting inclusion criteria were analyzed. Mean overall DMA and TSK-11 scores increased with each successive testing interval. At 6-month follow-up, a weakly positive association between TSK-11 and DMA scores was appreciated based on overall DMA, AP, UD, ML, and LR. At 12 months, a moderately positive correlation was appreciated between TSK-11 and the translational, but not rotational, planes of motion. CONCLUSIONS: Following ACLR, lower level of kinesiophobia were found to be moderately associated with improved dynamic stability, especially in the translation planes of motion.

Landing Posture in Elite Female Athletes During a Drop Vertical Jump Before and After a High-Intensity Ergometer Fatigue Protocol: A Study of 20 Japanese Women's Soccer League Players.

Background: Even elite athletes, who usually show stable postural control, sometimes cannot control their posture after high-load training. This instability may contribute to anterior cruciate ligament injury. Purpose/Hypothesis: The purpose of this study was to evaluate the landing posture of elite female soccer players before and after a novel high-intensity fatigue-inducing exercise protocol. We hypothesized that the landing posture will change before versus after the fatigue protocol. Study Design: Descriptive laboratory study. Method: The study participants were 20 female elite soccer players. All athletes performed 3 drop vertical jumps (DVJs), pedaled an ergometer 8 times with full force for 10 seconds each (fatigue protocol), and then repeated the 3 DVJs. We measured and compared the athletes' blood lactate levels before and after the fatigue protocol, as well as the hip flexion, knee flexion, and ankle dorsiflexion angles and final landing posture during the DJVs. Results: Blood lactate levels increased significantly pre- to postprotocol (from 2.7 ± 1.9 to 15.0 ± 3.6 mmol/L; P < .001), while there were decreases in hip flexion angle (from 35.0° ± 11.2° to 22.4° ± 8.8°; P < .001) and ankle dorsiflexion angle (from 26.4° ± 3.9° to 20.0° ± 3.7°; P < .001). The number of athletes who could not maintain a stable DVJ final landing posture increased from 10% before the fatigue protocol to 70% after. Conclusion: The elite female athletes in our study showed significant decreases in hip flexion and ankle dorsiflexion angles in the DVJ landing after a fatigue-inducing protocol. Most elite athletes were unable to maintain a stable posture on the DVJ landing after the fatigue protocol. Clinical Relevance: This study advances our understanding of how elite athletes land in a fatigued state.

Adjustable-Loop Devices Promote Graft Revascularization in the Femoral Tunnel After ACL Reconstruction: Comparison With Fixed-Loop Devices Using Magnetic Resonance Angiography.

BACKGROUND: Hamstring tendon grafts are usually fixed in anterior cruciate ligament (ACL) reconstruction using either an adjustable-loop device (ALD) or a fixed-loop device (FLD). The contact area between the graft and the tunnel wall is different between the 2 devices. PURPOSE: To determine using magnetic resonance angiography (MRA) whether ALD and FLD result in different blood flow of the graft in the femoral tunnel during the early postoperative period. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between 2008 and 2018, a total of 42 patients (17 men and 25 women) underwent MRA at 3 months after ACL reconstruction. All surgical procedures were performed using semitendinosus tendon autografts folded into 4 strands. Overall, 23 patients underwent the FLD procedure and 19 patients underwent the ALD procedure. The signal intensity of the superior portion of the graft in the femoral tunnel was evaluated using transverse MRA images perpendicular to the femoral tunnel axis. RESULTS: MRA images showed high signal intensity in the superior portion of the graft in the femoral tunnel in 94.7% and 60.9% of the ALD patients and FLD patients, respectively, a statistically significant difference (P = .03). CONCLUSION: MRA images at 3 months after surgery revealed that blood flow reached the superior end of the tendon graft in the femoral tunnel in more patients who underwent ACL reconstruction with an ALD compared with an FLD.

Outcomes of arthroscopic repair using the all-inside inter-leaf vertical suture technique for horizontal meniscal tears sustained in sports.

The aim of the study was to evaluate the outcomes of arthroscopic repair using the all-inside inter-leaf vertical suture arthroscopic technique for sports-related horizontal meniscal tears.The inter-leaf vertical suture procedure was performed to repair sports-related horizontal tears in the middle and posterior segments of the medial (11 cases) and lateral (2 cases) menisci in 13 patients (mean age: 30 ±â€Š14 years). Pre- and post-operative Barrett criteria, Lysholm scores, and patient ability to resume sports were assessed. Magnetic resonance imaging (MRI) grades and signal intensity changes near the joint capsule were evaluated in the 9 cases among which pre- and post-operative MRI images were available.All Barrett criteria items were negative following surgery; Lysholm scores increased from 70.2 ±â€Š13.1 before surgery to 98.9 ±â€Š2.64 after surgery (P < .01). All patients were able to resume their sport. Preoperative MRI grade of tears was 3 for all patients; postoperative MRI grades were 1 in 3 cases, 2 in 4 cases, and 3 in 2 cases (P < .05). Importantly, MRI signal intensity at the repaired menisci near the joint capsule was reduced in 8 of these 9 cases postoperatively.The inter-leaf vertical suture procedure is associated with good outcomes for horizontal tears in the middle and posterior segments of the medial and lateral menisci. The procedure is useful and convenient.

A novel arthroscopic all-inside suture technique using the Fast-Fix 360 system for repairing horizontal meniscal tears in young athletes: 3 case reports.

RATIONALE: Considering the risk of osteoarthritis following resection of a horizontally torn meniscus of the knee, repairing and preserving the meniscus as much as possible is preferred. We report 3 cases of restoration of horizontally torn menisci using a novel arthroscopic method we have called "all-inside interleaf vertical suture" that afforded preservation. PATIENT CONCERNS: The 3 patients (aged 14, 17, and 21 years) had knee pain through sports activity. DIAGNOSES: All patients had horizontal tears in the posteromedial part of the meniscus. INTERVENTIONS: The method uses Fast-Fix, whereby a first anchor is inserted from the tibial surface of the tear's superior leaflet and a second anchor is inserted from the femoral surface of the tear's inferior leaflet, and the 2 leaflets are closed using vertical suture. In all cases, the suture knots were embedded between the superior leaflet and inferior leaflet, avoiding contact with the articular cartilage, and superior leaflet and inferior leaflet crimping was good. OUTCOMES: All 3 were able to resume competing in sport and ≥ 1 year after surgery they had no pain and their postoperative mean Lysholm scores were 99.7. There were no complications or recurrence. On magnetic resonance imaging, the signal intensity of all the horizontal tears was high before surgery but low after surgery, suggesting that the repaired tear was healing. LESSONS: The all-inside interleaf vertical suture procedure is a new surgical technique that can repair posteromedial horizontal meniscal tears of the knee of young people by easy crimping of the superior and inferior leaflets without the suture knots causing complications.

Rocuronium anaphylaxis in a 7-year-old boy during the induction of anesthesia.

We report a case of rocuronium-induced anaphylaxis in a previously healthy 7-year-old boy. The first presenting sign of anaphylaxis was bronchospasm, appearing 11 min after he received intravenous doses of rocuronium (1 mg/kg) (Eslax®, MSD Co. Ltd., Tokyo, Japan), propofol (2 mg/kg), and cefazolin sodium (25 mg/kg). After the administration of adrenalin and ephedrine hydrochloride, bronchospasm resolved, and the vital signs became stable. Percutaneous pinning of his left humeral supracondylar fracture was performed without problems. The next day, he was successfully liberated from the ventilator support and discharged on the fifth hospital day. On the 76th postoperative day, we performed intradermal tests of rocuronium, propofol, and cefazolin. It showed that diluted rocuronium alone induced 14 mm of flare and 8 mm of wheal within 5 min, both of which disappeared within 15 min after the intradermal injection. The reaction was too quick to mention the possible contribution of rocuronium-specific IgE. His rapid reaction at the rocuronium skin test and anaphylactic reaction upon the first exposure to this drug may highlight the association of rocuronium anaphylaxis with IgE independent mast cell stimulation through mas-related G-protein coupled receptor X2 (MRGPRX2 receptor).