Cross-Cultural adaptation and validation of the Exercise-Induced Leg Pain questionnaire for Spanish speaking patients.

OBJECTIVES: To cross-culturally adapt and validate a Spanish version of the Exercise-Induced Leg Pain questionnaire. DESIGN: Clinical measurement study. PARTICIPANTS: The validity and reliability of the adapted version were assessed in four groups of 40 patients with exercise-induced leg pain, 40 physically active healthy individuals (control group), 40 athletes with other leg conditions and 40 athletes, military personnel and candidates with no history of injury (risk group). MAIN MEASURE: Exercise-Induced Leg Pain questionnaire. REFERENCE MEASURES: Spanish version of the Short-Form 36 and Schepsis postsurgical classification scale. RESULTS: In patients with exercise-induced leg pain, the mean age was 24.9 (± 6.7) years and the mean score of the questionnaire was 62.8 (± 10.9). The standard error of measurement and minimum detectable change threshold were 1.67 and 4.63 points, respectively. Excellent internal consistency (Cronbach's α = 0.942) and test-retest reliability (intraclass correlation coefficient = 0.995) were found. The exploratory and confirmatory factor analyses indicated that a one-factor solution explained 66.84% of the variance. For construct validity, 87.5% of the previously stated hypotheses were fulfilled between the total score of the questionnaire and Short-Form 36 dimensions. Concurrent validity, assessed by the Schepsis scale, was almost perfect (r = 0.92, p < 0.001). The predictive validity of the questionnaire was demonstrated using the receiving operating curve (area of 0.992; 95% CI: 0.983-1, p < 0.001). CONCLUSION: The Spanish version of the Exercise-Induced Leg Pain questionnaire resulted in a reliable and valid instrument to assess patients with exercise-induced leg pain.

Microdialysis for chronic exertional compartment syndrome: a pilot study.

BACKGROUND: Diagnosing chronic exertional compartment syndrome (CECS) is still a challenge. An increase in intramuscular pressure during and following exercise is accepted as the diagnostic standard. However, neither the methods used nor the interpretation of the obtained results are sufficiently standardized. METHODS: In the present pilot study, the metabolic state of CECS patients was investigated using microdialysis. We hypothesized that there was no difference in intramuscular concentrations of glucose, lactate, glutamate, and glycerol before and after exercise (H10) or between patients suffering from CECS and healthy control subjects (H20). This study was designed as an explorative case-control study (level of evidence III). Twelve patients suffering from CECS of the lower leg and six matched asymptomatic control subjects underwent microdialysis in the anterior (n = 7) or deep posterior compartment (n = 11) of the leg. Following ultrasound-guided insertion of the microdialysis catheters, 10-minute fractions of the dialysates were collected first during rest and then following fatigue- or pain-induced discontinuation of exercise. Dialysates were analysed for lactate, glucose, glutamate, and glycerol concentrations 6 × 10 min before and 6 × 10 min after exercise. RESULTS: Exercise-induced increases in lactate, glutamate, and glycerol concentrations were detected in both CECS patients and control subjects (all p < 0.001). No differences between CECS patients and control subjects were found by comparing the intramuscular glucose, lactate, glutamate, and glycerol concentrations at rest and following exercise (all p > 0.05). CONCLUSIONS: We found exercise-induced increases in the lactate, glutamate, and glycerol levels in skeletal muscle. However, the metabolic changes did not differentiate CECS patients from healthy subjects. TRIAL REGISTRATION: The registration trial number is DRKS00021589 on DRKS. 'Retrospectively registered'. Date of registration: April 4, 2020.

Validation of the FASH (Functional Assessment Scale for Acute Hamstring Injuries) questionnaire for German-speaking football players.

BACKGROUND: The FASH (Functional Assessment Scale for Acute Hamstring Injuries) questionnaire has been recently developed as a disease-specific self-administered questionnaire for use in Greek, English, and German languages. Its psychometric qualities (validity and reliability) were tested only in Greek-speaking patients mainly representing track and field athletes. As hamstring injuries represent the most common football injury, we tested the validity and reliability of the FASH-G (G = German version) questionnaire in German-speaking footballers suffering from acute hamstring injuries. METHODS: The FASH-G questionnaire was tested for reliability and validity, in 16 footballers with hamstring injuries (patients' group), 77 asymptomatic footballers (healthy group), and 19 field hockey players (at-risk group). Known-group validity was tested by comparing the total FASH-G scores of the injured and non-injured groups. Reliability of the FASH-G questionnaire was analysed in 18 asymptomatic footballers using the intra-class coefficient. RESULTS: Known-group validity was demonstrated by significant differences between injured and non-injured participants (p < 0.001). The FASH-G exhibited very good test-retest reliability (intra-class correlation coefficient = 0.982, p < 0.001). Internal consistency was excellent (α = 0.938). Compared with the results presented in the original publication, no statistical differences were found between healthy athletes (p = 0.257), but patients' groups and at-risk groups presented scoring differences (p = 0.040 and <0.001, respectively). CONCLUSIONS: The FASH-G is a valid and reliable instrument to assess and determine the severity of hamstring injuries in German footballers.

Historical ESWT Paradigms Are Overcome: A Narrative Review.

Extracorporeal Shock Wave Therapy (ESWT) is a conservative treatment modality with still growing interest in musculoskeletal disorders. This narrative review aims to present an overview covering 20-year development in the field of musculoskeletal ESWT. Eight historical paradigms have been identified and put under question from a current perspective: energy intensity, focus size, anesthesia, imaging, growth plates, acuteness, calcifications, and number of sessions. All paradigms as set in a historical consensus meeting in 1995 are to be revised. First, modern musculoskeletal ESWT is divided into focused and radial technology and the physical differences are about 100-fold with respect to the applied energy. Most lesions to be treated are easy to reach and clinical focusing plays a major role today. Lesion size is no longer a matter of concern. With the exception of nonunion fractures full, regional, or even local anesthesia is not helpful in musculoskeletal indications. Juvenile patients can also effectively be treated without risk of epiphyseal damage. Further research is needed to answer the question about if and which acute injuries can be managed effectively. Treatment parameters like the number of sessions are still relying on empirical data and have to be further elucidated.

Success and Recurrence Rate after Radial Extracorporeal Shock Wave Therapy for Plantar Fasciopathy: A Retrospective Study.

Background and Aims. The exploration of an individualised protocol of radial extracorporeal shock wave therapy (rESWT) for plantar fasciopathy, assessing success rates and the recurrence rate over a 1-year period after treatment, is not yet identified in literature. Methods and Results. Between 2006 and 2013, 68 patients (78 heels) were assessed for plantar fasciopathy. An individualised rESWT treatment protocol was applied and retrospectively analysed. Heels were analysed for mean number of shock wave impulses, mean pressure, and mean frequency applied. Significant mean pain reductions were assessed through Visual Analogue Scale (VAS) after 1-month, 3-month, and 1-year follow-up. Success rates were estimated as the percentage of patients having more than 60% VAS pain decrease at each follow-up. 1-year recurrence rate was estimated. The mean VAS score before treatment at 6.9 reduced to 3.6, 1 month after the last session, and to 2.2 and 0.9, after 3 months and 1 year, respectively. Success rates were estimated at 19% (1 month), 70% (3 months), and 98% (1 year). The 1-year recurrence rate was 8%. Moderate positive Spearman's rho correlation (r = 0.462, p < 0.001) was found between pretreatment pain duration and the total number of rESWT sessions applied. Conclusions. Individualised rESWT protocol constitutes a suitable treatment for patients undergoing rESWT for plantar fasciitis.

Surgical treatment for achilles tendinopathy - a systematic review.

BACKGROUND: The purpose of this systematic review is to analyse the results of operative treatment for midportion Achilles tendinopathy and to provide evidence based recommendation for the indication of the individual published techniques. METHODS: MEDLINE, Cochrane Database, ISI Web of Knowledge and Google databases (1945 till September 2014) were electronically searched. The quality of the included articles was evaluated using the Coleman Methodology Score. Success rates, patient satisfaction, and the complication rates were determined. RESULTS: Twenty studies met our inclusion criteria. A total of 801 tendons were treated in 714 patients with open or minimally invasive techniques. The mean success rate was 83.4 %. Complications were reported in 6.3 % of the cases. The articles on minimally invasive techniques and open procedures reported on an average success rate of 83.6 % and 78.9 (p = 0.987). Patient satisfaction rates for minimally invasive techniques and open procedures were 78.5 % and 78.1 % (p = 0.211). The complication rate was 5.3 % for the minimally invasive techniques and 10.5 % for the open procedures (p = 0.053). CONCLUSION: We conclude that success rates of minimally invasive and open treatments are not different and that there is no difference in patient satisfaction but there is a tendency for more complications to occur in open procedures.

Endoscopic-assisted Release of Lower Leg Chronic Exertional Compartment Syndromes: Results of a Systematic Literature Review.

Endoscopic treatment of recalcitrant chronic exertional compartment syndromes (CECS) of the lower leg is rarely reported. Until now, endoscopic release of CECS of the lower leg is described in only 3 papers addressing 48 interventions in 30 patients. A systematic literature analysis was performed comparing endoscopic and minimally invasive lower leg CECS releases. No statistically relevant difference was found between the results of endoscopic (unweighted mean success rate=86.3%) and minimally invasive (unweighted mean success rate=80.0%) CECS release. However, the methodological quality of the analyzed studies is not sufficient and the number of endoscopically treated patients are too low to draw final conclusions.

Cross-cultural Adaptation and Validation of the Exercise-Induced Leg Pain Questionnaire for English- and Greek-Speaking Individuals.

STUDY DESIGN: Clinical measurement. OBJECTIVES: To translate the German version of the Exercise-Induced Leg Pain Questionnaire (EILP-G) to Greek and English and evaluate the psychometric properties of the Greek version. BACKGROUND: The EILP-G was developed to evaluate the severity of symptoms and sports ability in individuals with exercise-induced leg pain (EILP). Translation of the questionnaire to other languages will provide a standard outcome measure across populations. METHODS: The EILP-G questionnaire was cross-culturally adapted to Greek and English, according to established guidelines. The validity and reliability of the Greek version were assessed in 40 patients with EILP, 40 patients with other lower extremity injuries, 40 track-and-field athletes with no history of EILP, and 40 young adults without pathology. Participants completed the questionnaire at baseline and again after 7 to 10 days. RESULTS: The expert committee and the participants considered the questionnaire to have good face and content validity. Concurrent validity as assessed using the Schepsis score was almost perfect (rho = 0.947, P<.001). Dimensionality analysis revealed a 1-factor solution, explaining 83.8% of the total variance. Known group validity was demonstrated by significant differences between patients compared with the asymptomatic groups (P<.001). The Greek version exhibited excellent test-retest reliability (intraclass correlation coefficient = 0.995 for the EILP group) and internal consistency (Cronbach α = .942 for the EILP group). Finally, no ceiling or floor effects were found, as none of the individuals with EILP scored the maximum or minimum possible values on the questionnaire. CONCLUSION: The Greek version, adapted from the original EILP-G, is a valid and reliable questionnaire, and its psychometric properties are comparable with the original version.

Differences between mechanically stable and unstable chronic ankle instability subgroups when examined by arthrometer and FAAM-G.

BACKGROUND: The objective measurement of the mechanical component and its role in chronic ankle instability is still a matter of scientific debate. We analyzed known group and diagnostic validity of our ankle arthrometer. Additionally, functional aspects of chronic ankle instability were evaluated in relation to anterior talar drawer. METHODS: By manual stress testing, 41 functionally unstable ankles were divided as mechanically stable (n = 15) or mechanically unstable (n = 26). Ankle laxity was quantified using an ankle arthrometer. Stiffness values from the load displacement curves were calculated between 40 and 60 N. Known group validity and eta(2) were established by comparing manual and arthrometer testing results. Diagnostic validity for the ankle arthrometer was determined by a 2 × 2 contingency table. The functional ankle instability severity was quantified by the German version of the Foot and Ankle Ability Measure (FAAM-G). Stiffness (40-60 N) and FAAM-G values were correlated. RESULTS: Mechanically unstable ankles had lower 40-60 N stiffness values than mechanically stable ankles (p = 0.006 and <0.001). Eta for the relation between manual and arthrometer anterior talar drawer testing was 0.628. With 5.1 N/mm as cut-off value, accuracy, sensitivity, and specificity were 85%, 81%, and 93%, respectively. The correlation between individual 40-60 N arthrometer stiffness values and FAAM-G scores was r = 0.286 and 0.316 (p = 0.07 and 0.04). CONCLUSIONS: In this investigation, the ankle arthrometer demonstrated a high diagnostic validity for the determination of mechanical ankle instability. A clear interaction between mechanical (ankle arthrometer) and functional (FAAM-G) measures could not be demonstrated.

Development and validation of a questionnaire to measure the severity of functional limitations and reduction of sports ability in German-speaking patients with exercise-induced leg pain.

BACKGROUND: Currently, there is no generally agreed measure available to quantify a subject's perceived severity of exercise-induced leg pain symptoms. The aim of this study was to develop and validate a questionnaire that measures the severity of symptoms that impact on function and sports ability in patients with exercise-induced leg pain. METHODS: The exercise-induced leg pain questionnaire for German-speaking patients (EILP-G) was developed in five steps: (1) initial item generation, (2) item reduction, (3) pretesting, (4) expert meeting and (5) validation. The resulting EILP-G was tested for reliability, validity and internal consistency in 20 patients with exercise-induced leg pain, 20 asymptomatic track and field athletes serving as a population at risk and 33 asymptomatic sport students. RESULTS: The patient group scored the EILP-G questionnaire significantly lower than both control groups (each p<0.001). Test-retest demonstrates an excellent reliability in all tested groups (Intraclass Correlation Coefficient, ICC=0.861-0.987). Concurrent validity of the EILP-G questionnaire showed a substantial agreement when correlated with the chronic exertional compartment syndrome classification system of Schepsis (r=-0.743; p<0.001). Internal consistency for the EILP-G questionnaire was 0.924. CONCLUSIONS: EILP-G questionnaire is a valid and reliable self-administered and disease-related outcome tool to measure the severity of symptoms that impact on function and sports ability in patients with exercise-induced leg pain. It can be recommended as a robust tool for measuring the subjectively perceived severity in German-speaking patients with exercise-induced leg pain.

Development and validation of a questionnaire (FASH--Functional Assessment Scale for Acute Hamstring Injuries): to measure the severity and impact of symptoms on function and sports ability in patients with acute hamstring injuries.

OBJECTIVE: To develop a condition-specific patient-reported outcome measure, the Functional Assessment Scale for Acute Hamstring Injuries (FASH), de novo in three languages, following distinct and rigorous methodology for content generation, analysis and validation and to assess its psychometric properties. BACKGROUND: To our knowledge, there is no patient-reported functional scale specific for acute hamstring injuries. METHODS: The development of the scale followed specific guidelines, as well as de novo construction in three languages (Greek, English and German). Item generation was accomplished by selecting three different sources of items: literature review, focus group and key informant interviews. Content analysis was conducted by an expert committee. The 21 items selected as appropriate were tested through a structured content analytic method and item-content validity coefficient, and 10 were retained for the FASH. The validation and assessment of its psychometric properties followed theConsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) recommendations to ensure quality, in a convenience sample of 140 participants. RESULTS: The face validity was adequate and tested by expert committees, authors and participants. Content validity was characterised as well addressed and conducted independently by experts and through specific content validation procedures. The dimensionality analysis indicated a one-factor solution explaining the 95.8% of total variance. Known group validity was demonstrated by significant differences between patients and controls (p<0.001). The FASH exhibited very good test-retest reliability (intraclass correlation coefficient=0.9, p<0.001), internal consistency (α=0.98) and responsiveness (3.81 and 5.23 using baseline and pooled SD, respectively; standardised response mean (SRD)=4.68). CONCLUSION: This study provides initial evidence for psychometric properties of the first scale assessing hamstring injuries.

Results of operative treatment for recalcitrant retrocalcaneal bursitis and midportion Achilles tendinopathy in athletes.

BACKGROUND: The results of operative treatment for recalcitrant midportion Achilles tendinopathy and recalcitrant retrocalcaneal bursitis were evaluated using the patient administered, disease specific, and validated VISA-A-G questionnaire. METHODS: A cohort of 89 patients was prospectively followed. These patients underwent operations for sport induced midportion Achilles tendinopathy (39 procedures) or retrocalcaneal bursitis (55 procedures). Depending on the individual intraoperative findings the patients of either disease were treated with two respective operative modifications (tendon repair or no tendon repair). Preoperative and follow-up status (3, 6, and 12 months) were investigated using the VISA-A-G questionnaire. RESULTS: Preoperatively, the four groups scored from 37.0 ± 17.6 to 45.9 ± 15.2 (p = 0.376-0.993) on the VISA-A-G questionnaire. Six and 12 months postoperatively, the VISA-A-G scores improved significantly (p < 0.001). Twelve months postoperatively, the groups' scores were not different (p = 0.100-0.952) and ranged from 80.8 ± 17.9 to 90.3 ± 10.6. CONCLUSION: Retrocalcaneal bursitis and midportion Achilles tendinopathy responded equally well to operative treatment. When repaired, additional tendon lesions did not influence this result. We demand to differentiate not only between midportion Achilles tendinopathy and retrocalcaneal bursitis but also to identify additional Achilles tendon lesions to specifically address these lesions during operative procedures.

Mechanical instability destabilises the ankle joint directly in the ankle-sprain mechanism.

BACKGROUND: Despite massive research efforts, it remains unclear how mechanical ankle instability (MAI) and functional ankle instability (FAI) affect joint control in the situation of ankle sprain. Thus, the purpose of this study was to evaluate whether individuals with MAI have deficits in stabilising their ankle joint in a close-to-injury situation compared with those with FAI and healthy controls. METHODS: Ankle-joint control was assessed by means of three-dimensional motion analysis and electromyography in participants with FAI and MAI (n=19), in participants with pure FAI (n=9) and in healthy controls (n=18). Close-to-injury situations were simulated during standing, walking and jumping by means of a custom-made tilt platform. RESULTS: Individuals with FAI and MAI displayed significantly greater maximum ankle inversion angles (+5°) and inversion velocities (+50°/s) in the walking and jumping conditions compared to those with pure FAI and controls. Furthermore, individuals in the FAI and MAI group showed a significantly decreased pre-activation of the peroneus longus muscle during jumping compared to those with FAI. No differences between groups were found for plantar flexion and internal rotation, or for muscle activities following tilting of the platform. CONCLUSIONS: The present study demonstrates that MAI is characterised by impairments of ankle-joint control in close-to-injury situations. This could make these individuals more prone to recurrent ankle sprains, and suggests the need for additional mechanical support such as braces or even surgery. In addition, the study highlights the fact that dynamic experimental test conditions in the acting participant are needed to further unravel the mystery of chronic ankle instability.

Retrocalcaneal bursitis but not Achilles tendinopathy is characterized by increased pressure in the retrocalcaneal bursa.

BACKGROUND: We questioned whether different forms of Achilles tendon overuse injuries can be differentiated by retrocalcaneal bursa pressure measurement. METHODS: Retrocalcaneal bursa pressure was determined by using invasive pressure measurement in patients suffering from retrocalcaneal bursitis (n=13) or Achilles tendinopathy (n=15), respectively. Standardized measurements were taken with the subject lying prone. Initially, the foot and ankle was in a spontaneous, unsupported position. Then passive dorsiflexion was induced by an increasing pressure which was applied in five defined steps against the plantar forefoot. FINDINGS: Mean pressures found in unloaded position were 30.5 (SD 28.9) mmHg in retrocalcaneal bursitis and -9.9 (SD 17.2) mmHg in Achilles tendinopathy (p<0.001). A stepwise increase in passive ankle dorsiflexion was associated with increasing pressure values in both groups. The differences were p=0.009 to 0.035 when dorsiflexion was initiated with 10, 20, 30, and 40N, respectively. Dorsiflexion induced by 50N load resulted in a mean pressure of 113.7 (SD 124.9) mmHg for retrocalcaneal bursitis and 32.5 (SD 48.9) mmHg for Achilles tendinopathy (p=0,051). INTERPRETATION: Higher retrocalcaneal bursa pressure values were found in patients suffering from chronic retrocalcaneal bursitis. This result supports the hypothesis that retrocalcaneal bursa hypertension leads to an impingement lesion of the corresponding anterior Achilles tendon.

Expecting ankle tilts and wearing an ankle brace influence joint control in an imitated ankle sprain mechanism during walking.

A thorough understanding of the functional aspects of ankle joint control is essential to developing effective injury prevention. It is of special interest to understand how neuromuscular control mechanisms and mechanical constraints stabilize the ankle joint. Therefore, the aim of the present study was to determine how expecting ankle tilts and the application of an ankle brace influence ankle joint control when imitating the ankle sprain mechanism during walking. Ankle kinematics and muscle activity were assessed in 17 healthy men. During gait rapid perturbations were applied using a trapdoor (tilting with 24° inversion and 15° plantarflexion). The subjects either knew that a perturbation would definitely occur (expected tilts) or there was only the possibility that a perturbation would occur (potential tilts). Both conditions were conducted with and without a semi-rigid ankle brace. Expecting perturbations led to an increased ankle eversion at foot contact, which was mediated by an altered muscle preactivation pattern. Moreover, the maximal inversion angle (-7%) and velocity (-4%), as well as the reactive muscle response were significantly reduced when the perturbation was expected. While wearing an ankle brace did not influence muscle preactivation nor the ankle kinematics before ground contact, it significantly reduced the maximal ankle inversion angle (-14%) and velocity (-11%) as well as reactive neuromuscular responses. The present findings reveal that expecting ankle inversion modifies neuromuscular joint control prior to landing. Although such motor control strategies are weaker in their magnitude compared with braces, they seem to assist ankle joint stabilization in a close-to-injury situation.

Nerve entrapment after hamstring injury.

Hamstring muscle injuries are a frequent cause of athletic sequelae, and the frequency of reinjuries is high. Frequently, disability in sport is the consequence and performance is limited. A case report of a soccer player who was unable to play his sport after a minor hamstring muscle injury is presented. We introduce a previously undescribed lesion featured by a scar compromising a motor branch of the sciatic nerve to the long head of the biceps femoris muscle. Resection of the involved branch of the nerve resulted in complete pain relief and full sport capacity. This case report demonstrates that in very rare cases, a scar tissue-induced intramuscular entrapment of a branch of the sciatic nerve must be considered as a reason for athletic incapacity after minor hamstring injury. Both the degree of a muscular injury and its specific location within the injured muscle may therefore influence the functional outcome.

Training effects of two different unstable shoe constructions on postural control in static and dynamic testing situations.

OBJECTIVE: The aim of this study was to compare training effects on postural control using two different unstable shoe constructions. SUBJECTS AND SETTING: Twenty-nine healthy subjects participated in this study and were randomly divided into three groups. Two experimental groups (10 subjects in each group) were assigned to a 6 week training program of specific sensorimotor exercises with unstable shoe constructions, one group using MBT(®) shoes and one group wearing Reflex Control(®) shoes (RC). Subjects in the control group (9 subjects) did not perform balance training. MAIN OUTCOME MEASURES: Postural control was measured in one-leg stance in two testing conditions. We recorded postural sway on a force plate (static testing situation) and displacements of a moveable platform (dynamic testing situation) before and after the training period. RESULTS: There were no effects of training with unstable shoe constructions on postural sway in the static testing condition (for comparison of groups: p = 0.990 and p = 0.119). However, the RC group showed statistically significant improvements in the dynamic testing situation (p = 0.014 compared to control subjects). In the MBT group improvements were not significantly different in comparison to control group (p = 0.518). CONCLUSIONS: Our results indicate that exercises using unstable shoe constructions, particularly the RC, improve postural control only in dynamic conditions.

Cross-cultural adaptation and validation of the VISA-P questionnaire for German-speaking patients with patellar tendinopathy.

STUDY DESIGN: Clinical measurement study. OBJECTIVES: To cross-culturally adapt and validate the Victorian Institute of Sports Assessment Patellar Tendinopathy Questionnaire (VISA-P) for German-speaking patients. BACKGROUND: Like most questionnaires, the VISA-P was developed for English-speaking patients. There is a need to adapt the scale for German-speaking patients and thereby add to the total body of psychometric evidence relating to this instrument. METHODS: The VISA-P questionnaire was translated and cross-culturally adapted into German (VISA-P-G) in 6 steps: translation, synthesis, back translation, expert committee review, pretesting, and advisory committee appraisal. The psychometric properties of the VISA-P-G were determined using 23 patients with patellar tendinopathy and 57 active healthy persons (32 sport students and 25 basketball players). Reliability was evaluated by applying the questionnaire twice within a week to all 80 participants. Known group validity was calculated using a 1-way analysis of variance. Additionally, VISA-P-G results were correlated with the Blazina classification system for patellar tendinopathy, using the Spearman rank correlation coefficient. VISA-P-G ratings from the present study groups were further compared with respective data published in the original English, Dutch, and Swedish versions by a 2-sample t test. Internal consistency for the individual items of the questionnaire was determined within the patient group using a Cronbach alpha. RESULTS: Test-retest revealed excellent reliability for the patient and the asymptomatic control group (ICC = 0.88 and 0.87, respectively). Internal consistency for the patients was 0.88. Concurrent validity was almost perfect (ρ = -0.81; P<.001). CONCLUSION: The VISA-P-G is a reliable and valid questionnaire for the self-assessment of pain, symptoms, and function in German-speaking patients with patellar tendinopathy. Its psychometric properties are comparable with the original English and international adaptations (Swedish, Dutch, and Italian).

Minimally invasive retrocalcaneal bursa pressure measurement: development and pilot application.

Up to now diagnosis of Haglund's disease is based on patient's history and clinical findings. There is no valid diagnostic tool described to functionally detect retrocalcaneal bursitis. Retrocalcaneal bursa pressure may be increased in these patients. We hypothesized that retrocalcaneal bursa pressure can directly be measured. In this pilot investigation we tested the feasibility of a system which is already in clinical use for arterial blood pressure monitoring to quantitatively assess retrocalcaneal bursa pressure in a human and a swine cadaver specimen and in vivo. Using the presented system retrocalcaneal bursa pressure measurement is demonstrated to be feasible. Moreover, intrabursal pressure is reproducibly and validly quantified. In an uninjured subject increasing ankle dorsiflexion was not associated with increasing pressure in the retrocalcaneal bursa. Experimental liquid injection in the retrocalcaneal bursa was associated with increased intrabursal pressure and increasing pain. Feasibility of the tested setup could be proven. The question, if retrocalcaneal bursitis can be distinguished from further heel pathologies by different pressures in the retrocalcaneal bursa has to be addressed in a subsequent in vivo study.