Serum cartilage oligomeric matrix protein (sCOMP) is elevated in patients with knee osteoarthritis: a systematic review and meta-analysis.

OBJECTIVE: To be used in diagnostic studies, it must be demonstrated that biomarkers can differentiate between diseased and non-diseased patients. Therefore, the purpose of this study was to answer the following questions: (1) Is serum cartilage oligomeric matrix protein (sCOMP) elevated in patients with radiographically diagnosed knee osteoarthritis (OA) compared to controls? (2) Are there differences in sCOMP levels when comparing differing radiographic OA severities to controls? METHODS: Systematic review and meta-analysis. DATA SOURCES: A systematic search of CINAHL, PEDro, Medline, and SportsDiscus was completed in March 2010. KEYWORDS: knee, osteoarthritis, sCOMP, radiography. Study inclusion criteria: Studies were written in English, compared healthy adults with knee OA patients, used the Kellgren Lawrence (K/L) classification, measured sCOMP, and reported means and standard deviations for sCOMP. RESULTS: For question 1, seven studies were included resulting in seven comparisons. A moderate overall effect size (ES) indicated sCOMP was consistently elevated in those with radiographically diagnosed knee OA when compared to controls (ES = 0.60, P < 0.001). For question 2, four studies were included resulting in 13 comparisons between radiographic OA severity levels and controls. Strong ESs were calculated for K/L-1 (ES = 1.43, P = 0.28), K/L-3 (ES = 1.05, P = 0.04), and K/L-4 (ES = 1.40, P = 0.003). A moderate ES was calculated for K/L-2 (ES = 0.60, P = 0.01). CONCLUSIONS: These results indicate sCOMP is elevated in patients with knee OA and is sensitive to OA disease progression. Future research studies with a higher level of evidence should be conducted to investigate the use of this biomarker as an indicator for OA development and progression.

Lateral ankle ligament anesthesia significantly alters single limb postural control.

Lateral ankle anesthesia has been used as a model to explore effects of ligament deafferentation related to ankle sprain on single limb postural control with conflicting results. Time-to-boundary (TTB) is a postural control measurement technique found to be sensitive in detecting subtle deficits in postural control in those with chronic ankle instability. The objective of this study was to determine the effects of lateral ankle ligament anesthesia on TTB measures of single limb postural control in healthy adults. Twenty-two healthy adults with no history of lower extremity injury within the past 6 months or balance disorders participated in the study. All subjects received a lidocaine injection to the lateral ankle structures on one of two testing days. On both testing days, subjects performed 3 eyes open and 3 eyes closed, 10-s trials of barefoot single limb stance on a forceplate. The dependent variables were the mean of TTB minima(s) and standard deviation of TTB minima(s) in mediolateral (ML) and anteroposterior (AP) directions. Separate condition (anesthesia, control) by vision (eyes open, eyes closed) ANOVAs with repeated measures were used for each TTB variable to determine the effects of anesthesia on postural control. Alpha level was set a priori at p≤0.05. The anesthesia day TTBAP magnitude (p=0.008) and variability (p=0.044) measures were significantly lower than the control day, regardless of vision. Anesthesia of the lateral ankle ligamentous structures significantly reduced the magnitude and variability of TTBAP measures. These findings are similar to deficits found in those with chronic ankle instability.

Ultrasound assessment of spleen size in collegiate athletes.

OBJECTIVES: To determine normal spleen dimensions in a healthy collegiate athletic population. METHODS: 631 Division I collegiate athletes from one university participated in the study. During pre-participation examinations, demographic data collected were collected from volunteer athletes including sex, race, measurement of height and weight, and age. Subjects also completed a medical history form to determine any history of mononucleosis infection, platelet disorder, sickle cell disease (or trait), thalassaemia, or recent viral symptoms. Subjects then underwent a limited abdominal ultrasound examination, where splenic length and width were recorded. RESULTS: Mean (SD) splenic length was 10.65 (1.55) cm and width, 5.16 (1.21) cm. Men had larger spleens than women (p<0.001). White subjects had larger spleens than African-American subjects (p<0.001). A previous history of infectious mononucleosis or the presence of recent cold symptoms had no significant affect on spleen size. In more than 7% of athletes, baseline spleen size met current criteria for splenomegaly. CONCLUSIONS: There is a wide range of normal spleen size among collegiate athletes. Average spleen size was larger in men and white athletes than in women and black athletes. A single ultrasound examination for determination of splenomegaly is of limited value in this population.

Assessment of the endoscopic semitendinosus/gracilis autograft procedure with interference screw fixation for reconstruction of the anterior cruciate ligament.

The semitendinosus/gracilis autograft procedure with interference screw fixation was evaluated for clinical effectiveness of anterior cruciate ligament (ACL) reconstruction. Thirty patients underwent the procedure and were evaluated an average of 15 months postoperatively. Results revealed 22 (73%) patients had a standard knee evaluation form score of normal or nearly normal, and 24 (80%) patients returned to strenuous or moderate activity levels. Average Lysholm outcome score was 89, and bilateral KT-2000 differences were <3 mm at follow-up. Functional knee test symmetry index percentage outcome for the one-legged hop test was 92.6% for distance and 98% for time. Length of time (i.e., < or =90 days or > or =91 days) between injury and surgery was independent of outcome. These findings indicate the semitendinosus/gracilis autograft is a viable procedure for reconstruction of the ACL-deficient knee.

Management of ankle sprains.

Without adequate care, acute ankle trauma can result in chronic joint instability. Use of a standardized protocol enhances the management of ankle sprains. In patients with grades I or II sprains, emphasis should be placed on accurate diagnosis, early use of RICE (rest, ice, compression and elevation), maintenance of range of motion and use of an ankle support. Sprains with complete ligament [corrected] tears (grade III) may require surgical intervention. Although early motion and mobility are recommended, ligamentous strength does not return until months after an ankle sprain.

Effect of a semi-rigid ankle stabilizer on performance in persons with functional ankle instability.

STUDY DESIGN: Within-group repeated measures. OBJECTIVES: To determine the effect of a semi-rigid prophylactic ankle stabilizer (PAS) on performance of subjects with post-acute, unilateral ankle sprains who have mechanically stable ankles, but are functionally impaired. BACKGROUND: Most studies on PAS performance to date are limited to subjects with noninjured, nonimpaired ankles. No research has been reported to determine the effect PASs have on performance in subjects who have a mechanically stable, nonacute ankle sprain with functional impairment. METHODS AND MEASURES: Twenty-five subjects (8 men and 17 women; average height = 168.91 +/- 33.02 cm, average weight = 61.10 +/- 29.5 kg, and average age = 16.2 +/- 6 years) met the qualification criteria of the study. Subjects had unilateral grade I or II lateral ankle sprains of 3 to 4 weeks duration and were cleared medically to return to activities of daily living. Each subject's injured ankle was mechanically stable as determined by physical exam but was functionally impaired as determined by instability during the modified Rhomberg test. Separate 2 x 2 ANOVAs with repeated measures on brace condition (Aircast SportStirrup and nonbraced control) and test session (test session 1 and test session 2) were completed to assess the effect of ankle stabilization on 2 dependent variables (36.58-m shuttle-run and vertical-jump). RESULTS: Shuttle-run time was significantly faster for the braced condition (mean = 9.43 +/- .72 seconds) than for the nonbraced control (mean = 9.57 +/- .75 seconds), regardless of test session. Shuttle-run time was significantly faster for test session 2 (mean = 9.43 +/- .79 seconds) than for test session 1 (mean = 9.57 +/- .68 seconds), regardless of brace condition. No significant main or interaction effects occurred for vertical-jump. CONCLUSIONS: Use of a semi-rigid PAS significantly increased shuttle-run but not vertical-jump performance. This effect was immediate and did not require PAS acclimation.

Effect of orthotics on postural sway after fatigue of the plantar flexors and dorsiflexors.

OBJECTIVE: To examine the effects of orthotic intervention on unilateral postural sway after fatigue of the plantar flexor and dorsiflexor muscle groups. DESIGN AND SETTING: Subjects were assigned to both orthotic and nonorthotic testing conditions in a counterbalanced order, then assessed for postural sway before and after isokinetic fatiguing contractions of the plantar flexors and dorsiflexors. Postural stability was measured on the motor-dominant extremity. (Motor dominance was assessed as the foot the subject used to kick a ball.) SUBJECTS: Eleven active, healthy male subjects (mean age = 24 +/- 2.0 years, wt = 74.5 +/- 8.8 kg, ht = 180.3 +/- 8.4 cm) volunteered to participate in the study. MEASUREMENTS: Center-of-pressure postural sway was assessed via the force platforms of a Chattecx Dynamic Balance System and transformed via 4 transducers as values indicative of sway in the anterior-posterior and medial-lateral directions. The dependent measure was postural sway in centimeters. Fatigue was induced by consecutive concentric plantar flexiondorsiflexion contractions on a Kin-Com II isokinetic dynamometer. RESULTS: A repeated-measures analysis of variance revealed a significant orthotic-by-test interaction. Post hoc analysis with the Tukey honestly significant difference method revealed that postural sway values of the postfatigue nonorthotic condition were significantly greater when compared with the prefatigue orthotic, prefatigue nonorthotic, and postfatigue orthotic conditions. CONCLUSIONS: Our results suggest that molded orthotics may be an effective means of decreasing postural sway after an isokinetic fatigue protocol. Further research is needed to determine the exact mechanism of this improvement and whether orthotics are an effective means of preventing ankle injury.

Effect of microcurrent stimulation on delayed-onset muscle soreness: a double-blind comparison.

OBJECTIVE: To examine the efficacy of microcurrent electrical neuromuscular stimulation (MENS) treatment on pain and loss of range of motion (ROM) associated with delayed-onset muscle soreness (DOMS). DESIGN AND SETTING: We assigned subjects to 1 of 2 groups. Group 1 received treatment with microcurrent stimulation (200 muA, 30 Hz, for 10 minutes, then 100 muA, 0.3 Hz, for 10 minutes) 24, 48, and 72 hours after DOMS induction. Group 2 served as a sham group and was treated using a machine altered by the manufacturer so that no current could flow through the electrodes. SUBJECTS: DOMS was induced in the biceps brachii of the nondominant arm of 18 subjects (3 males, 15 females: age = 20.33 +/- 2.3 years, ht = 170.81 +/- 7.3 cm, wt = 69.61 +/- 13.1 kg). Dominance was defined as the arm used by the subject to throw a ball. MEASUREMENTS: Subjective pain and active elbow extension ROM were evaluated before and after treatment each day. Two methods were used to assess pain: constant pressure using a weighted Orthoplast sphere and full elbow extension to the limit of pain tolerance. Subjective pain was measured with a graphic rating scale and active elbow extension ROM using a standard, plastic, double-armed goniometer. Three repeated-measures ANOVAs (between-subjects variable was group, within- subjects variables were day and test) were used to assess ROM and pain scores for the 2 groups. RESULTS: We found no significant difference in the measurement of subjective pain scores or elbow extension ROM when the MENS group was compared with the sham group. CONCLUSIONS: Our results indicate that the MENS treatment, within the parameters used for this experiment, was not effective in reducing the pain or loss of ROM associated with delayed-onset muscle soreness.

Importance of selected athletic trainer employment characteristics in collegiate, sports medicine clinic, and high school settings.

OBJECTIVE: We examined employer importance ratings of 35 employee characteristics in the collegiate, sports medicine clinic, and high school settings and made comparisons among these settings. DESIGN AND SETTING: All prospective employers were sent a survey. Of the 472 surveys mailed, 282 (60%) were returned, with a sample error rate of 1.9%. SUBJECTS: All prospective employers listed on the NATA position vacancy notices from January 1, 1994 to October 1, 1994. MEASUREMENTS: Employers were asked to rate 35 employee characteristics as "not important" " minimally important," " important." or "very important." Additionally, employers chose 1 of 15 job descriptors that best identified their position vacancy. These 15 descriptors were then categorized into collegiate, sports medicine clinic, and high school settings. Discriminant analysis and analysis of variance procedures were used to determine if the 35 employee characteristics differed across the 3 settings. RESULTS: The discriminant analysis produced 2 significant discriminant functions (P < .05) with 23 of the original 35 characteristics remaining in the analysis. The first function discriminated between the collegiate setting and the other settings, with the collegiate setting scoring the highest. The second function discriminated among all 3 groups, with the sports medicine clinic and high school settings scoring the highest and lowest, respectively. Additionally, the analyses of variance (ANOVAs) revealed that 21 of the characteristics remaining in the discriminant analysis differed across the 3 settings. CONCLUSIONS: Employers from all 3 settings rated educational program reputation, written recommendations, job interview performance, and NATA-BOC certification eligibility as important to very important. For the collegiate setting, 7 characteristics were rated above important and included such characteristics as possession of a master's degree and collegiate experience. For the sports medicine clinic, 8 characteristics were rated above important and included sports medicine clinic experience, high school experience, and sport-specific experience. Finally, for the high school setting, 5 characteristics were rated above important. These included NATA-BOC certification, a bachelor's degree, and high school experience.

Effects of a 6-week strength and proprioception training program on measures of dynamic balance: a single-case design.

OBJECTIVE: To examine the effects of a 6-week strength and proprioception training program on clinical measures of balance, and to introduce characteristics of a single-case research design that may be beneficial to the athletic training profession as both a research and a clinical tool. DESIGN AND SETTING: A multiple baseline design across subjects was used to assess the effects of the intervention. The training program was performed three times a week and consisted of manual muscle strengthening and proprioception training for the plantar flexor, dorsiflexor, inversion, and eversion muscle groups. SUBJECTS: Three subjects (age = 17.6 +/- 1.24 yr, wt = 78.6 +/- 1.07 kg, ht = 186.2 +/- 4.3 cm) who had previously sustained first-degree lateral ankle sprains. MEASUREMENTS: Dynamic balance was tested three times a week using a single-plane balance board (SPBB). Each subject was tested for two double-leg conditions (forward/backward, right/left) and one single-leg condition (forward/backward) for each extremity. The dependent variable was the number of times that the balance board made contact with the floor. Visual inspection was used to evaluate whether the treatment resulted in a change of performance. RESULTS: Although the intervention did not produce obvious improvements in balance for all evaluation criteria for all testing conditions, it is apparent that the strength and proprioception training program positively influenced all three subjects' ability to balance dynamically on an SPBB. A change in mean scores from baseline to intervention phase was evident for all testing conditions. However, a change in slope and level was not as apparent for all testing conditions, especially the single-leg conditions. CONCLUSION: The results revealed that the strength and proprioception training program produced improvements in the ability to balance as assessed dynamically on an SPBB.

1994 athletic trainer employment and salary characteristics.

OBJECTIVE: THE PURPOSE OF THIS STUDY WAS TO DETERMINE: 1) demographics and professional credentials of recently hired athletic trainers, 2) the association between these characteristics and the high school, clinical, and collegiate setting, and 3) which of these factors best predicted salary. DESIGN AND SETTING: A survey was sent to all prospective employers. Of the 472 surveys sent, 282 (60%) were returned. SUBJECTS: Prospective employers who were listed on the NATA job vacancy notices from January 1, 1994 to October 1, 1994. MEASUREMENTS: Employers selected a job description for their position opening and indicated the characteristics of the people they hired. The job descriptions were placed into three categories. A chi-square analysis was used to determine the degree of association between applicant characteristics and job descriptions. Employee characteristics were coded and a stepwise multiple regression analysis was performed to determined which of the characteristics best predicted salary. Analyses of variance were performed to determine differences among the three practice settings and as follow-up analyses to the multiple regression. An analysis of variance was also performed to compare salaries based on job description and teaching responsibilities. RESULTS: No association was found between the employment setting and gender, ethnicity, marital status, educational route, physical therapy, credential, or EMT certification. There was an association between the CPR instructor's credential and employment setting and between highest degree attained and employment setting. CONCLUSIONS: The results suggest that these factors were most closely associated with employment in the collegiate setting. With regard to salary, it was determined that a doctoral degree, a master's degree, and marital status were the best predictors of salary.

Intertester reliability of assessing postural sway using the chattecx balance system.

In this study, we examined intertester reliability of dynamic and static balance using the Chattecx Dynamic Balance System. Ten female and two male subjects were randomly assigned to two testers and completed ten, 10-second preprogrammed double- and single-leg test conditions. Balance was measured as postural sway in centimeters by the Chattecx Dynamic Balance System. Static balance consisted of the platform remaining stable, whereas dynamic balance consisted of the platform tilting in an anterior and posterior direction during testing. The protocols and average postural sway values were:1. Double-Leg Static Eyes Open ([unk] = .28 cm)2. Double-Leg Static Eyes Closed ([unk] = .37 cm)3. Double-Leg Dynamic Eyes Open ([unk] = .86 cm)4. Double-Leg Dynamic Eyes Closed ([unk] = 1.72 cm)5. Single-Leg Static Dominant Eyes Open ([unk] = .99 cm)6. Single-Leg Static Dominant Eyes Closed ([unk] = 1.70 cm)7. Single-Leg Static Nondominant Eyes Open ([unk] = .65 cm)8. Single-Leg Static Nondominant Eyes Closed ([unk] = 1.48 cm)9. Single-Leg Dynamic Dominant Eyes Open ([unk] = .99cm)10. Single-Leg Dynamic Nondominant Eyes Open ([unk] = .91 cm).The mean values of postural sway ranged from .28 cm to 1.72 cm for double-leg stance measures and from .65 cm to 1.70 cm for the single-leg stance measures. The intraclass correlations (ICCs)(2,1) ranged from poor to excellent (ICCs = .06 to .90) and the standard error of measurement (SEM) ranged from .06 to .34 for the 10 trials. We feel that variability exists between subjects and/or testers between trials. The wide range of reliability values suggests that further research should determine both intratester and intertester reliability using a variety of protocols for assessment of static and dynamic balance.