Knee proprioceptive function and physical performance of patients with patellofemoral pain: A matched case-control study.

BACKGROUND: Patients with patellofemoral pain (PFP) present pain, functional limitation, and alteration in knee proprioception. PURPOSE: To compare the knee joint position sense and lower extremity functionality between patients with PFP and controls. Secondarily, investigate the relationship between proprioceptive acuity and physical performance. METHODS: This is a matched case-control study including 48 patients with PFP and 48 healthy individuals matched by age, sex, weight, height, and limb dominance. The proprioceptive evaluation was performed using the joint position sense test (absolute error and relative error) and functionality was assessed using the Single-Leg Triple-Hop test and the Y-Balance Test. The groups were compared using the independent student's T-test. Proprioceptive acuity and physical performance correlations were determined by Pearson correlation coefficient. RESULTS: Participants were on average 31 years old and 62.5% were men. There was no statistically difference for absolute and relative angular error between groups. Patients presented lower relative reached distance on the anterior direction of the Y-Balance Test than controls [patients=58.6 (6.6) % versus controls=61.7 (5.9) %, p=.020]. No differences between groups were found for other functional measures. Significant correlation was found between absolute angular error and anterior component at 60° (r=0.225, p=.028) and relative angular error at 60° with the posterolateral component of the Y- Balance Test (r=0.231, p=.024). CONCLUSION: Proprioceptive acuity of patients with PFP was not reduced. The anterior direction of the Y-Balance Test was impaired compared to matched controls. Proprioceptive sense is related to dynamic balance but not to jump ability.

Association between movement patterns and risk of musculoskeletal injuries in navy cadets: A cohort study.

OBJECTIVE: To investigate the association of movement patterns evaluated by the Dynamic Movement Assessment (DMA) with the occurrence of musculoskeletal injuries in navy cadets. DESIGN: Cohort study. SETTING: Participants were filmed performing the six functional tests of the DMA (deep squat, step up, single-leg squat, hop, plank and side-plank tests). PARTICIPANTS: 240 navy cadets. MAIN OUTCOME MEASUREMENTS: Depending on the number of certain movement patterns on the Dynamic Movement Assessment (DMA), participants were classified as high, moderate, medium or low risk of developing injuries. Predictive associations between injuries and risk classification were examined using logistic regression analysis. RESULTS: Considering sex, previous injuries and the type of secondary school as covariates, participants who were classified as high risk were not more likely to develop injuries. Non-military high school was an independent risk factor for any injuries (OR = 3.14, 95% CI [1.43,6.91]; OR = 4.57, 95% CI [1.92,10.83]), overuse injuries (OR = 2.58, 95% CI [1.05,6.30]; OR = 2.55, 95% CI [1.06, 6.14]) and acute injuries (OR = 4.88, 95% CI [1.19,19.99]), respectively. Previous musculoskeletal symptoms also increased the chance of AI (OR = 4.45, 95% CI [1.15,17.18]; OR = 5.91, 95% CI [1.13,30.88]). CONCLUSIONS: Movement patterns evaluated by DMA are not associated with an increased risk of injuries. However, attendance of a non-military high school and previous musculoskeletal symptoms are associated with musculoskeletal injuries.

Soldier Load Carriage, Injuries, Rehabilitation and Physical Conditioning: An International Approach.

Soldiers are often required to carry heavy loads that can exceed 45 kg. The physiological costs and biomechanical responses to these loads, whilst varying with the contexts in which they are carried, have led to soldier injuries. These injuries can range from musculoskeletal injuries (e.g., joint/ligamentous injuries and stress fractures) to neurological injuries (e.g., paresthesias), and impact on both the soldier and the army in which they serve. Following treatment to facilitate initial recovery from injuries, soldiers must be progressively reconditioned for load carriage. Optimal conditioning and reconditioning practices include load carriage sessions with a frequency of one session every 10-14 days in conjunction with a program of both resistance and aerobic training. Speed of march and grade and type of terrain covered are factors that can be adjusted to manipulate load carriage intensity, limiting the need to adjust load weight alone. Factors external to the load carriage program, such as other military duties, can also impart physical loading and must be considered as part of any load carriage conditioning/reconditioning program.

Trunk endurance, posterior chain flexibility, and previous history of musculoskeletal pain predict overuse low back and lower extremity injury: a prospective cohort study of 545 Navy Cadets.

OBJECTIVE: To investigate predictors of low back and lower extremity musculoskeletal injury in a cohort of Naval cadets. DESIGN: Prospective Cohort Study METHODS: 545 Naval cadets (Males, n = 394, 72%) were followed-up over eight months. Nine variables were investigated as predictors: history of musculoskeletal symptoms in the last 12 months, ankle dorsiflexion range of motion, sit and reach test, isometric hip abduction and external rotation strength, alignment during the single leg squat test, single leg hop test for distance, prone plank and side plank tests. All injuries that required medical attention were registered. Predictive associations were examined using univariable and multivariable logistic regression analyses. RESULTS: The incidence of all injuries was 7%. Cadets who failed the 60-second plank test (OR = 3.3; 95% CI, 1.2-8.8, P = 0.04), had ≤18 cm in the sit and reach test (OR = 4.0; 95% CI, 1.4-11.2, P = 0.01), or reported pain in the last 12 months in two or more body regions (OR = 2.7; 95% CI, 1.02-7.3, P = 0.04), had greater odds of sustaining an overuse injury. No predictors were identified for acute injuries. CONCLUSION: Decreased trunk endurance on the prone plank test, reduced posterior chain flexibility on the sit and reach test, and a history of pain reported in two or more sites in the last 12 months were predictors of overuse injuries in Naval cadets. Assessment and intervention of these modifiable risk factors may be clinically relevant in injury screening and prevention.

Reliability and Validity of Frontal Plane Kinematics of the Trunk and Lower Extremity Measured With 2-Dimensional Cameras During Athletic Tasks: A Systematic Review With Meta-analysis.

BACKGROUND: Two-dimensional (2-D) analysis is commonly used to quantify frontal plane kinematics of the trunk and lower extremity. However, there are conflicting results regarding the reliability and validity of these measurements. OBJECTIVE: To synthesize the current literature to determine whether 2-D analysis is a reliable and valid method of measuring frontal plane kinematics of the trunk and lower extremity during squatting, landing, and cutting tasks. METHODS: For this systematic review with meta-analysis, MEDLINE, CINAHL, Embase, Scopus, and SPORTDiscus databases were searched from inception until March 2017. The authors included 16 studies that evaluated the reliability and/or validity of 2-D measurements of frontal plane trunk and/or lower extremity kinematics when compared to 3-D measurements during any of the following tasks: squatting, landing, or cutting. RESULTS: Intrarater reliability (intraday and interday) and interrater reliability of the 2-D video measurements varied from moderate to excellent. In terms of validity, there was poor agreement between the 2-D and 3-D methods, with no correlation between 2-D knee frontal plane projection angle and 3-D knee frontal plane angles (r = 0.127, P = .094) for the single-leg squat, but a moderate to good relationship (r = 0.619, P<.001) for the landing task. CONCLUSION: Two-dimensional video analysis of frontal plane trunk and lower extremity kinematics is reliable, but this appears to be dependent on the task and the type of reliability evaluated. The current evidence does not support the use of 2-D video analysis for measuring trunk and lower extremity frontal plane kinematics when accurate measures are required. LEVEL OF EVIDENCE: Diagnosis, level 3. J Orthop Sports Phys Ther 2018;48(10):812-822. Epub 12 Jun 2018. doi:10.2519/jospt.2018.8006.

The Effects of Injury Prevention Programs on the Biomechanics of Landing Tasks: A Systematic Review With Meta-analysis.

BACKGROUND: Anterior cruciate ligament (ACL) tear is a common injury in sports and often occurs during landing from a jump. PURPOSE: To synthesize the evidence on the effects of injury prevention programs (IPPs) on landing biomechanics as they relate to the ligament, quadriceps, trunk, and leg dominance theories associated with ACL injury risk. STUDY DESIGN: Meta-analysis. METHODS: Six electronic databases were searched for studies that investigated the effect of IPPs on landing task biomechanics. Prospective studies that reported landing biomechanics at baseline and post-IPP were included. Results from trunk, hip, and knee kinematics and kinetics related to the ACL injury theories were extracted, and meta-analyses were performed when possible. RESULTS: The criteria were met by 28 studies with a total of 466 participants. Most studies evaluated young females, bilateral landing tasks, and recreational athletes, while most variables were related to the ligament and quadriceps dominance theories. An important predictor of ACL injury, peak knee abduction moment, decreased ( P = .01) after the IPPs while other variables related to the ligament dominance theory did not change. Regarding the quadriceps dominance theory, after the IPPs, angles of hip flexion at initial contact ( P = .009), peak hip flexion ( P = .002), and peak knee flexion ( P = .007) increased, while knee flexion at initial contact did not change ( P = .18). Moreover, peak knee flexion moment decreased ( P = .005) and peak vertical ground-reaction force did not change ( P = .10). CONCLUSION: The exercises used in IPPs might have the potential to improve landing task biomechanics related to the quadriceps dominance theory, especially increasing peak knee and hip flexion angles. Importantly, peak knee abduction moment decreased, which indicates that IPPs influence a desired movement strategy to help athletes overcome dangerous ligament dominance loads arising from lack of frontal plane control during dynamic tasks. The lack of findings for some biomechanical variables suggests that future IPPs may be enhanced by targeting participants' baseline profile deficits, highlighting the need to deliver an individualized and task-specific IPP.

The development and validation of a custom built device for assessing frontal knee joint laxity.

INTRODUCTION: This study reports the development and validation of a quantitative technique of assessing frontal knee joint laxity through a custom built device named KLICP. The objectives of this study were to determine: (i) the intra- and inter-rater reliability and (ii) the validity of the device when compared to real time ultrasound. METHODS: Twenty-five participants had their frontal knee joint laxity assessed by the KLICP, by manual varus/valgus tests and by ultrasound. Two raters independently assessed laxity manually by three repeated measurements, repeated at least 48h later. Results were validated by comparing them to the medial and lateral joint space opening measured by the ultrasound. Intraclass correlation coefficients and standard error of measurement reliability were calculated. Pearson's correlation coefficients were calculated to determine the correlation between the KLICP and the joint space. RESULTS: Intra-rater reliability (intra-session) for each rater was good on both sessions (0.91-0.98), intra-rater reliability (inter-sessions) was moderate to good (0.62-0.87), and inter-rater reliability (intra-session) was good (0.75-0.80). There is low agreement for intra-rater (inter-session) and for inter-rater (intra-session) reliability. The KLICP measurement has a significant positive fair to moderate correlation to the ultrasound measurement at the left (r: 0.61, p: 0.01) and right (r: 0.48, p: 0.02) knee in the valgus direction and at the left (r: 0.51, p: 0.01) and right (r: 0.39, p: 0.05) knee in the varus direction. There is low agreement between the KLICP and the RTU. CONCLUSIONS: Reliability and agreement was good only when measured for intra-rater, within session.

Sedentary Occupation Workers Who Meet the Physical Activity Recommendations Have a Reduced Risk for Metabolic Syndrome: A Cross-Sectional Study.

OBJECTIVE: We tested the hypothesis that sedentary occupation workers who meet the physical activity recommendations present a lower risk for metabolic syndrome (MetS) than their nonactive counterparts. METHODS: A cross-sectional study involving 502 sedentary occupation workers. Physical activity level was self-reported. MetS was defined by International Diabetes Federation criteria. RESULTS: The active group showed lower odds for MetS [odds ratio (OR) 0.52, 95% confidence interval (95% CI) 0.27 to 0.98], abdominal obesity (OR 0.36, 95% CI 0.16 to 0.82), elevated blood pressure (OR 0.47, 95% CI 0.26 to 0.84), and reduced high-density lipoprotein cholesterol (OR 0.54, 95% CI 0.31 to 0.93) than the sedentary group after adjustments for age, time in job, body mass index, and tobacco use. CONCLUSIONS: Sedentary occupation workers who meet the physical activity recommendations have a reduced risk for MetS.

EPIDEMIOLOGY OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN BRAZIL'S PUBLIC HEALTH SYSTEM / EPIDEMIOLOGIA DA RECONSTRUÇÃO DO LIGAMENTO CRUZADO ANTERIOR NO SISTEMA PÚBLICO DE SAÚDE DO BRASIL / EPIDEMIOLOGÍA DE LA RECONSTRUCCIÓN DEL LIGAMENTO CRUZADO ANTERIOR EN EL SISTEMA DE SALUD PÚBLICA DE BRASIL

ABSTRACT Introduction: Several studies have reported on the epidemiology of Anterior Cruciate Ligament Reconstruction (ACLR) in Europe and North America; however, there is currently no data relating to Brazil. Objective: To describe the incidence of ACLR in Brazil and investigate temporal trends and differences between age and sex groups. Methods: All reported ACLR cases in the public hospital system between January 2008 and December 2014 were extracted from the Information Technology Department of the Brazilian Ministry of Health. Linear regression analysis was used to assess changes in ACLR incidence in the overall population and among sex and age groups, hospitalization time, and health care costs. Results: A total of 48,241 ACLR were reported from 2008-2014 with an overall incidence of 3.49 per 100,000 persons/year. Males accounted for 82% of the procedures. The incidence of ACLR increased by 56% among males (p=0.01) and by 112% among females (p=0.001). The mean hospitalization time decreased from 2.4 days in 2008 to 1.8 day in 2014 (R2 = 0.883, p= 0.002). The total cost across all years was US$56 million, with a mean of US$1,145 per ACLR. Conclusion: Although the total incidence of ACLR in Brazil is lower compared to other countries, it has increased over the years, especially in females. The creation of an ACLR registry is necessary in the future, for more accurate control and new investigations.

RESUMO Introdução: Vários estudos têm relatado a epidemiologia da reconstrução do ligamento cruzado anterior (RLCA) na Europa e América do Norte, no entanto, não há atualmente dados referentes ao Brasil. Objetivo: Descrever a incidência de RLCA no Brasil e investigar tendências temporais e diferenças entre os grupos de idade e sexo. Métodos: Todos os casos relatados de RLCA no sistema público de saúde do Brasil entre janeiro de 2008 e dezembro 2014 foram extraídos do Departamento de Informática do Ministério da Saúde do Brasil. A análise de regressão linear foi usada para avaliar as mudanças na incidência de RLCA na população total e entre grupos de sexo e idade, tempo de internação e custos hospitalares. Resultados: Um total de 48,241 RLCA foi reportado entre 2008 e 2014, com incidência geral de 3,49 por 100.000 pessoas/ano. Homens foram responsáveis por 82% dos procedimentos. A incidência de RLCA aumentou 56% entre os homens (p = 0,01) e 112% entre as mulheres (p = 0,001). O tempo médio de permanência hospitalar diminuiu de 2,4 dias em 2008 para 1,8 dia em 2014 (R2 = 0,883, p = 0,002). O custo total em todos os anos foi de US$ 56 milhões, com média de US$ 1.145 por RLCA. Conclusão: Apesar da incidência total de RLCA no Brasil ser menor em comparação com outros países, ela tem aumentado ao longo dos anos, principalmente em mulheres. A criação de um registro de RLCA se faz necessária no futuro para um controle mais acurado e novas investigações.

RESUMEN Introducción: Diversos estudios han informado sobre la epidemiología de la reconstrucción del ligamento cruzado anterior (RLCA) en Europa y América del Norte, sin embargo, no hay actualmente datos relativos a Brasil. Objetivo: Describir la incidencia de la RLCA en Brasil e investigar las tendencias temporales y diferencias entre los grupos de edad y sexo. Métodos: Todos los casos reportados de RLCA en el sistema de salud pública en Brasil entre enero de 2008 y diciembre de 2014 fueron extraídos del Departamento de Informática del Ministerio de Salud de Brasil. Se utilizó un análisis de regresión lineal para evaluar los cambios en la incidencia de RLCA en la población total y entre los grupos de edad y sexo, duración de la estancia hospitalaria y los costes de hospitalización. Resultados: Un total de 48.241 reconstrucciones del LCA fue reportado entre 2008 y 2014, con una incidencia general de 3,49 por 100.000 personas/año. Los hombres representaron el 82% de los procedimientos. La incidencia de RLCA aumentó 56% en los hombres (p = 0,01) y 112% en las mujeres (p = 0,001). La duración media de la estancia hospitalaria se redujo de 2,4 días en 2008 a 1,8 día en 2014 (R2 = 0,883, p = 0,002). El coste total en todos los años fue de US$ 56 millones, con un promedio de US$ 1.145 para cada RLCA. Conclusión: Aunque la incidencia global de RLCA en Brasil sea más pequeña en comparación con otros países, se ha incrementado en los últimos años, especialmente en las mujeres. La creación de un registro de la RLCA es necesaria en el futuro para un control más preciso y nuevas investigaciones.

Combinação de fatores de risco relacionados à síndrome metabólica em militares da Marinha do Brasil / Combination of risk factors for metabolic syndrome in the military personnel of the Brazilian Navy

FUNDAMENTO: As doenças cardiovasculares representam a principal causa de morte na população, e a síndrome metabólica (SM) é uma condição clínica significativamente associada ao aumento da morbimortalidade. OBJETIVO: Descrever o padrão de combinação dos fatores de risco relacionados ao diagnóstico de SM em militares da Marinha do Brasil e identificar eventuais variáveis associadas à presença da referida síndrome nessa população. MÉTODOS: Estudo transversal envolvendo 1.383 homens (18-62 anos) lotados nas organizações militares da Grande Natal-RN. O critério utilizado para diagnóstico de SM foi o proposto pela International Diabetes Association. A razão entre a prevalência observada e a esperada e os respectivos intervalos de confiança foram utilizados para identificar as combinações de fatores de risco que excediam o esperado para a população. A análise de regressão logística foi utilizada para identificar variáveis associadas à SM. RESULTADOS: A prevalência de SM foi de 17,6 por cento. Aproximadamente um terço dos militares apresentou dois ou mais fatores de risco para SM. Todas as combinações específicas dos fatores de risco para SM que excederam a prevalência esperada apresentaram a obesidade abdominal como um de seus componentes. Nas análises ajustadas, idade, tabagismo e nível de atividade física mantiveram-se associados à SM. CONCLUSÃO: Nossos achados reforçam a constante presença da obesidade abdominal no fenótipo da SM. Além disso, nossos dados também suportam a ideia de que idade, tabagismo e baixo nível de atividade física são variáveis independentes para a ocorrência de SM.

BACKGROUND: Cardiovascular diseases are the major cause of death in the population, and metabolic syndrome (MS) is a clinical condition significantly associated with the increase in morbidity and mortality. OBJECTIVE: To describe the pattern of combination of the risk factors related to the diagnosis of MS in the military personnel of the Brazilian Navy and to identify variables associated with the presence of MS in that population. METHODS: Cross-sectional study involving 1,383 men (18-62 years) assigned to military organizations in the city of Natal, state of Rio Grande do Norte. The criterion proposed by the International Diabetes Association was used for the diagnosis of MS. The ratio between observed and expected prevalence and the respective confidence intervals were used to identify the combinations of risk factors that exceeded that expected for the population. Logistic regression was used to identify variables associated with MS. RESULTS: The prevalence of MS was 17.6 percent. Approximately one third of the military personnel studied had two or more risk factors for MS. All specific combinations of risk factors for MS that exceeded the expected prevalence had abdominal obesity as one of its components. In the adjusted analyses, age, smoking and physical activity level remained associated with MS. CONCLUSION: Our findings reinforce the constant presence of abdominal obesity in the phenotype of MS. In addition, our data also support the idea that age, smoking and low level of physical activity are independent variables for the occurrence of MS.

Combination of risk factors for metabolic syndrome in the military personnel of the Brazilian Navy.

BACKGROUND: Cardiovascular diseases are the major cause of death in the population, and metabolic syndrome (MS) is a clinical condition significantly associated with the increase in morbidity and mortality. OBJECTIVE: To describe the pattern of combination of the risk factors related to the diagnosis of MS in the military personnel of the Brazilian Navy and to identify variables associated with the presence of MS in that population. METHODS: Cross-sectional study involving 1,383 men (18-62 years) assigned to military organizations in the city of Natal, state of Rio Grande do Norte. The criterion proposed by the International Diabetes Association was used for the diagnosis of MS. The ratio between observed and expected prevalence and the respective confidence intervals were used to identify the combinations of risk factors that exceeded that expected for the population. Logistic regression was used to identify variables associated with MS. RESULTS: The prevalence of MS was 17.6%. Approximately one third of the military personnel studied had two or more risk factors for MS. All specific combinations of risk factors for MS that exceeded the expected prevalence had abdominal obesity as one of its components. In the adjusted analyses, age, smoking and physical activity level remained associated with MS. CONCLUSION: Our findings reinforce the constant presence of abdominal obesity in the phenotype of MS. In addition, our data also support the idea that age, smoking and low level of physical activity are independent variables for the occurrence of MS.

Avaliação da capacidade de caminhada e nível de atividade física de pacientes obesos mórbidos antes e após cirurgia bariátrica / Assesment of the walking ability and physical activity level of morbidly obese patients before and after bariatric surgery

Introduction: Morbidly obese have low walking ability compared to people of normal weight. Despite improvement in the results of a six-minute walk test (6MWT) after bariatric surgery, little is known about how much and how physical activity levels before and after surgery influence this improvement. Objective: To evaluate the walking ability and physical activity level of morbidly obese patients before and after bariatric surgery. Methods: walking ability was assessed in 22 patients before (BMI=50.4 kg/ m2), 6-12 months (Group I - BMI=35.4 kg/m2), and up to 13 months (Group II - BMI=34 kg/m2) after surgery using the 6MWT. Total distance and speed were evaluated every minute. Physical activity levels were estimated using the Baecke Questionnaire, analyzing occupation, leisure and travel, and leisure and physical activity. Results: The walking ability of Groups I and II increased by 47.2 ± 14.5 m (p=O.OOl)and 76.4 ± 17.5 m (p=O.OOl), respectively, after surgery. Despite the weight loss, there was no difference in the physical activity level in any of the categories before (Group1= 7.4 ± 1.1; Group II = 8.2 :!: 1.2) and after surgery (Group 1= 7.4 ± 1.0; Group II = 8.3 ± 1.8). The post operative time was not related to the distance walked (r = 0.37; P = 0.09), which did not occur with the percentage of excess weight lost (r = 0.48; P = 0.02), the BMI (r = -0.68; P = 0.001), or the Baecke (r = 0.52; P = 0.01). Conclusion: Despite the improvement in walking ability by the distance achieved in the 6MWT after the weight loss, this did not lead to an increase in the physical activity level of the obese patients after surgery.

Introdução: Na obesidade mórbida, há uma baixa capacidade de caminhada em comparação com pessoas de peso normal. Apesar da melhoria nos resultados de um teste de caminhada de seis minutos (TC6) após a cirurgia bariátrica, pouco se sabe sobre quanto e como os níveis de atividade física antes e depois da cirurgia influenciam nessa melhora. Objetivo: Avaliar a capacidade de caminhada e nível de atividade física de obesos mórbidos antes e após a cirurgia bariátrica. Métodos: Foi avaliada a capacidade de caminhada em 22 pacientes antes da cirurgia (IMC = 50,4 kg / m2), 6-12 meses (Grupo I - IMC = 35,4 kg/m2), e mais de 13 meses (Grupo II - IMC = 34 kg/m2 ) após a cirurgia, através do TC6. Distância total e velocidade foram avaliados a cada minuto. Níveis de atividade física foram estimados usando o Questionário de Baecke, analisando fatores como ocupação, lazer e viagens, Lazer e atividade física. Resultados: A capacidade de caminhada dos Grupos I e II aumentou de 47,2 ± 14,5 m (p = 0,001) e 76,4 ± 17,5m (p = 0,001), respectivamente, após a cirurgia. Apesar da perda de peso, não houve diferença no nível de atividade física em qualquer das categorias antes (grupo 1= 7,4 ± 1,1; Grupo II = 8,2 ± 1,2) e após a cirurgia (grupo 1= 7,4± 1,0; Grupo II = 8,3 ± 1,8). O tempo pós-operatório não foi relacionado com a distância percorrida (r = 0,37, p =0,09), o que não ocorreu com a percentagem de excesso de peso perdido (r = 0,48, P = 0,02), com IMC (r = -0,68, p = 0,001), ou com o Questionário Baecke (r = 0,52, P = 0,01). Conclusão: Apesar da melhora na capacidade de caminhada pela distância percorrida no TC6 após a perda de peso, não houve aumento do nível de atividade física dos pacientes obesos após a cirurgia.