Rotational Stability of the Knee in a Comparative Study of Anterior Cruciate Ligament Reconstruction Using the Double-Bundle and Single-Bundle Techniques.

Background: The purpsose of this study was to evaluate the biomechanical outcomes of patients who underwent ACL reconstruction either with the DB or SB technique. We hypothesized that the DB technique would provide better rotation control of the knee following ACL reconstruction. Methods: The study included seventy-five participants (26 DB, 22 SB, and 27 healthy volunteers). Only cases with at least one year of postoperative follow-up were included. The participants performed three different demand tasks: walk task, walk and change direction, and stair descent and change direction, which was tracked using a three-dimensional 4-camera optoelectronic system. The following kinematic data were analyzed: tibial rotation amplitude and maximal internal and external rotation. Knees with ACL reconstruction were compared to contralateral knees with intact ACL and healthy knees. Clinical outcomes were determined using the subjective and objective International Knee Documentation Committee (IKDC) questionnaire and a manual arthrometer (KT 1000). Results: Both surgical groups exhibited similar clinical outcomes (mean subjective IKDC 91 SB vs. 90 DB, P=0.815; KT 1000 difference: 2mm in both groups, P=0.772). The vertical component of the ground force reaction revealed no differences between the surgical and control groups (P>0.05). Tibial rotation amplitude and maximal internal and external rotation were similar between the control, SB, and DB groups in all three different demand tasks (P>0.05). Conclusion: ACL reconstruction using either the SB or DB technique can restore rotational control to the level of a healthy knee. No clinical or functional differences were found between the SB and DB surgical options.

Avaliação do torque muscular e sarcopenia em mulheres praticantes de fisioterapia aquática / Evaluation of muscle torque and sarcopenia in women who practice aquatic physiotherapy / Evaluación del torque muscular y la sarcopenia en mujeres que practican fisioterapia acuática

O aumento da expectativa de vida acarreta, muitas vezes, a prevalência de algumas doenças crônico-degenerativas relacionadas ao envelhecimento, como osteoporose e sarcopenia. Trata-se de pesquisa retrospectiva e prospectiva, com abordagem quantitativa do tipo quase-experimental com pré- e pós-teste, sem grupo-controle, utilizando-se um protocolo de exercícios na fisioterapia aquática. Amostra com 13 mulheres, entre 57 e 84 anos, com diagnóstico médico de osteopenia/osteoporose, comprovado por densitometria óssea. Aplicado protocolo no meio aquático, em 30 semanas, 2 vezes na semana; participantes submetidas a avaliações pré- e pós-intervenção, avaliando-se a força muscular por meio do torque músculo quadríceps com a dinamometria, e a sarcopenia, pelo teste Short Physical Performance Battery (SPPB). Os resultados, após o protocolo de fisioterapia aquática, mostraram que o torque de ambos os lados foi estatisticamente significativo; porém, o lado não dominante (p=0,0059) apresentou maior ganho de força em relação ao membro dominante (p=0,01). Os resultados da sarcopenia também foram estatisticamente significativos após protocolo aquático (p = 0,03458), do que se pode concluir que a fisioterapia aquática se mostra eficaz no torque muscular e sarcopenia.

The increase in life expectancy often leads to the prevalence of some chronic-degenerative diseases related to aging, such as osteoporosis and sarcopenia. This is a retrospective and prospective research, with quantitative approach of the quasi-experimental kind, with pre- and post-test, without control group, using a protocol of exercises in aquatic physiotherapy. Sample with 13 women, between 57 and 84 years old, with a medical diagnosis of osteopenia / osteoporosis, confirmed by bone densitometry. A protocol was applied in aquatic mean, with the duration of 30 week, twice a week. The participants were submitted to pre and post-intervention evaluations, measuring their muscle force through torque of quad muscle with dynamometry, and sarcopenia through Short Physical Performance Battery (SPPB) test. The results, after the aquatic physiotherapy protocol, showed that the torque on both sides was statistically significant; however, the non-dominant side (p = 0.0059) showed greater strength gain compared to the dominant member (p=0.01). The results of sarcopenia were also statistically significant after aquatic protocol (p=0.03458), from which it can be concluded that aquatic physiotherapy is effective in muscle torque and sarcopenia.

El aumento de la esperanza de vida a menudo conduce a la prevalencia de algunas enfermedades crónicas degenerativas relacionadas con el envejecimiento, como la osteoporosis y la sarcopenia. Este es un estudio retrospectivo y prospectivo, con un enfoque cuantitativo cuasi-experimental con prueba previa y posterior, sin un grupo de control, utilizando un protocolo de ejercicio en fisioterapia acuática. Muestra con 13 mujeres, entre 57 y 84 años, con diagnóstico médico de osteopenia / osteoporosis, confirmado por densitometría ósea. Protocolo aplicado en el medio acuático, en 30 semanas, dos veces por semana; Los participantes se sometieron a evaluaciones previas y posteriores a la intervención, evaluando la fuerza muscular utilizando el torque muscular del cuádriceps con dinamometría y sarcopenia, utilizando la prueba de la Batería de rendimiento físico corto (SPPB). Los resultados, después del protocolo de fisioterapia acuática, mostraron que el torque en ambos lados fue estadísticamente significativo; sin embargo, el lado no dominante (p = 0.0059) mostró una mayor ganancia de fuerza en comparación con el miembro dominante (p = 0.01). Los resultados de la sarcopenia también fueron estadísticamente significativos después del protocolo acuático (p=0.03458), a partir del cual se puede concluir que la fisioterapia acuática es efectiva en el torque muscular y la sarcopenia.

Muscle force distribution of the lower limbs during walking in diabetic individuals with and without polyneuropathy.

BACKGROUND: Muscle force estimation could advance the comprehension of the neuromuscular strategies that diabetic patients adopt to preserve walking ability, which guarantees their independence as they deal with their neural and muscular impairments due to diabetes and neuropathy. In this study, the lower limb's muscle force distribution during gait was estimated and compared in diabetic patients with and without polyneuropathy. METHODS: Thirty individuals were evaluated in a cross-sectional study, equally divided among controls (CG) and diabetic patients with (DNG) and without (DG) polyneuropathy. The acquired ground reaction forces and kinematic data were used as input variables for a scaled musculoskeletal model in the OpenSim software. The maximum isometric force of the ankle extensors and flexors was reduced in the model of DNG by 30% and 20%, respectively. The muscle force was calculated using static optimization, and peak forces were compared among groups (flexors and extensors of hip, knee, and ankle; ankle evertors; and hip abductors) using MANOVAs, followed by univariate ANOVAs and Newman-Keuls post-hoc tests (p < 0.05). RESULTS: From the middle to late stance phase, DG showed a lower soleus muscle peak force compared to the CG (p=0.024) and the DNG showed lower forces in the gastrocnemius medialis compared to the DG (p=0.037). At the terminal swing phase, the semitendinosus and semimembranosus peak forces showed lower values in the DG compared to the CG and DNG. At the late stance, the DNG showed a higher peak force in the biceps short head, semimembranosus, and semitendinosus compared to the CG and DG. CONCLUSION: Peak forces of ankle (flexors, extensors, and evertors), knee (flexors and extensors), and hip abductors distinguished DNG from DG, and both of those from CG. Both diabetic groups showed alterations in the force production of the ankle extensors with reductions in the forces of soleus (DG) and gastrocnemius medialis (DNG) seen in both diabetic groups, but only DNG showed an increase in the hamstrings (knee flexor) at push-off. A therapeutic approach focused on preserving the functionality of the knee muscles is a promising strategy, even if the ankle dorsiflexors and plantarflexors are included in the resistance training.

The effects of Achilles tendon compliance on triceps surae mechanics and energetics in walking.

Achilles tendon (AT) compliance can affect the generation and transmission of triceps surae muscle forces, and thus has important biomechanical consequences for walking performance. However, the uniarticular soleus (SOL) and the biarticular (GAS) function differently during walking, with in vivo evidence suggesting that their associated fascicles and tendinous structures exhibit unique kinematics during walking. Given the strong association between muscle fiber length, velocity and force production, we conjectured that SOL and GAS mechanics and energetic behavior would respond differently to altered AT compliance. To test this, we characterized GAS and SOL muscle and tendon mechanics and energetics due to systematic changes in tendon compliance using musculoskeletal simulations of walking. Increased tendon compliance enlarged GAS and SOL tendon excursions, shortened fiber operation lengths and affected muscle excitation patterns. For both muscles, an optimal tendon compliance (tendon strains of approximately 5% with maximum isometric force) existed that minimized metabolic energy consumption. However, GAS muscle-tendon mechanics and energetics were significantly more sensitive to changes in tendon compliance than were those for SOL. In addition, GAS was not able to return stored tendon energy during push-off as effectively as SOL, particularly for larger values of tendon compliance. These fundamental differences between GAS and SOL sensitivity to altered tendon compliance seem to arise from the biarticular nature of GAS. These insights are potentially important for understanding the functional consequences of altered Achilles tendon compliance due to aging, injury, or disease.

Effects of a full season on stabilometric parameters of team handball elite athletes / Efeitos da temporada completa em parâmetros estabilométricos em atletas de handebol de elite / Efectos de la temporada completa en parámetros estabilométricos en atletas de balonmano de élite

It is unclear whether athletes change their postural control over the course of a full sport season, or become more asymmetrical with respect to their neuromuscular performance over the same period. The aim of this study was to investigate the effects of a full sport season on the postural control of team handball elite athletes. Ten healthy, elite male team handball players performed bipodal standing (BP) and right and left unipodal standing (UP) during 30s. We used the RMS and speed of the center of pressure to describe postural sway. For the BP task, the sway was lower at the end of the season (p<0.005). For the UP tasks, the sway was lower at the end of the season only for the non-dominant limb (p<0.001). Differences between limbs were observed only at the end of the season (p<0.03). In conclusion, a full team handball season did not lead to deterioration of the athletes' postural control, but by the end of the season, the athletes were more asymmetrical.

Não é claro na literatura científica se atletas mudam seu controle postural ao longo de uma temporada esportiva, ou mesmo se tornam mais assimétricos em relação ao seu desempenho neuromuscular durante o mesmo período. O objetivo deste estudo foi investigar os efeitos de uma temporada esportiva completa no controle postural de atletas de elite do handebol. Dez jogadores de elite de handebol, saudáveis, realizaram a tarefa de postura ereta quieta bipodal (BP) e unipodal direito e esquerdo durante 30 segundos. Foi utilizada a RMS e a velocidade do centro de pressão para descrever a oscilação postural. Para a tarefa de BP, a oscilação foi menor após a temporada esportiva (p < 0,005). Para as tarefas unipodais, a oscilação foi menor após temporada esportiva apenas para o membro não dominante (p < 0,001). Apenas após a temporada, foram observadas diferenças entre os membros (p < 0,03). Em conclusão, uma temporada esportiva para o handebol não levou à deterioração do controle postural dos atletas, entretanto no final da temporada, os atletas apresentaram-se mais assimétricos.

No está claro en la literatura científica si los atletas cambian su control postural a lo largo de una temporada deportiva o incluso si llegan a ser más asimétricas en relación con su rendimiento neuromuscular durante el mismo período. El objetivo de este estudio fue investigar los efectos de una temporada deportiva completa en control postural de deportistas de elite de balonmano. Diez jugadores de balonmano de élite, sanos, llevaron a cabo la tarea de la tranquilidad de la postura de pie bipodal (BP) y unipodal izquierda y derecha durante 30 segundos. RMS fue utilizado y la velocidad del centro de presión para describir el balanceo postural. Para la tarea de BP, la oscilación fue menor después de la temporada de deportes (p < 0,005). Para unipodais las tareas, la oscilación fue menor después de la temporada deportiva para el miembro no dominante (p < 0,001). Solamente después de la temporada, se observaron diferencias entre los miembros (p < 0,03). En conclusión, una temporada de deportes para el balonmano no conduce al deterioro del control postural de los atletas, sin embargo al final de la temporada, los atletas presentaron más asimétrica.

Reconstrução do ligamento cruzado anterior com a técnica de duplo feixe - avaliação no laboratório de biomecânica / Anterior cruciate ligament reconstruction using the double bundle technique - evaluation in the biomechanics laboratory

OBJETIVO: O objetivo deste estudo é descrever a metodologia da análise da rotação do joelho utilizando instrumentos do laboratório de biomecânica e apresentar os resultados preliminares de um estudo comparativo com pacientes submetidos à reconstrução do ligamento cruzado anterior com a técnica de duplo feixe. MÉTODOS: Descreveu-se o protocolo atualmente utilizado em nosso laboratório e realizou-se a análise cinemática tridimensional e medida da amplitude de rotação do joelho de oito pacientes normais (grupo controle) e 12 pacientes operados com a técnica de duplo feixe em três tarefas no laboratório de biomecânica. RESULTADOS: Não indicam diferenças significativas entre os lados operados e não operados em relação às amplitudes médias da marcha, da marcha com mudança de direção ou da marcha com mudança de direção ao descer a escada (p > 0,13). CONCLUSÕES: Os resultados preliminares não demonstraram diferença da técnica de reconstrução de LCA em duplo feixe em relação ao lado contralateral e ao grupo controle.

OBJECTIVE: The objective of this study was to describe the methodology of knee rotation analysis using biomechanics laboratory instruments and to present the preliminary results from a comparative study on patients who underwent anterior cruciate ligament (ACL) reconstruction using the double-bundle technique. METHODS: The protocol currently used in our laboratory was described. Three-dimensional kinematic analysis was performed and knee rotation amplitude was measured on eight normal patients (control group) and 12 patients who were operated using the double-bundle technique, by means of three tasks in the biomechanics laboratory. RESULTS: No significant differences between operated and non-operated sides were shown in relation to the mean amplitudes of gait, gait with change in direction or gait with change in direction when going down stairs (p > 0.13). CONCLUSION: The preliminary results did not show any difference in the double-bundle ACL reconstruction technique in relation to the contralateral side and the control group.

Joint forces and torques when walking in shallow water.

This study reports for the first time an estimation of the internal net joint forces and torques on adults' lower limbs and pelvis when walking in shallow water, taking into account the drag forces generated by the movement of their bodies in the water and the equivalent data when they walk on land. A force plate and a video camera were used to perform a two-dimensional gait analysis at the sagittal plane of 10 healthy young adults walking at comfortable speeds on land and in water at a chest-high level. We estimated the drag force on each body segment and the joint forces and torques at the ankle, knee, and hip of the right side of their bodies using inverse dynamics. The observed subjects' apparent weight in water was about 35% of their weight on land and they were about 2.7 times slower when walking in water. When the subjects walked in water compared with walking on land, there were no differences in the angular displacements but there was a significant reduction in the joint torques which was related to the water's depth. The greatest reduction was observed for the ankle and then the knee and no reduction was observed for the hip. All joint powers were significantly reduced in water. The compressive and shear joint forces were on average about three times lower during walking in water than on land. These quantitative results substantiate the use of water as a safe environment for practicing low-impact exercises, particularly walking.

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING THE DOUBLE-BUNDLE TECHNIQUE - EVALUATION IN THE BIOMECHANICS LABORATORY.

OBJECTIVE: The objective of this study was to describe the methodology of knee rotation analysis using biomechanics laboratory instruments and to present the preliminary results from a comparative study on patients who underwent anterior cruciate ligament (ACL) reconstruction using the double-bundle technique. METHODS: The protocol currently used in our laboratory was described. Three-dimensional kinematic analysis was performed and knee rotation amplitude was measured on eight normal patients (control group) and 12 patients who were operated using the double-bundle technique, by means of three tasks in the biomechanics laboratory. RESULTS: No significant differences between operated and non-operated sides were shown in relation to the mean amplitudes of gait, gait with change in direction or gait with change in direction when going down stairs (p > 0.13). CONCLUSION: The preliminary results did not show any difference in the double-bundle ACL reconstruction technique in relation to the contralateral side and the control group.

Evaluation of alternative technical markers for the pelvic coordinate system.

In this study, we evaluated alternative technical markers for the motion analysis of the pelvic segment. Thirteen subjects walked eight times while tri-dimensional kinematics were recorded for one stride of each trial. Five marker sets were evaluated, and we compared the tilt, obliquity, and rotation angles of the pelvis segment: (1) standard: markers at the anterior and posterior superior iliac spines (ASIS and PSIS); (2) markers at the PSIS and at the hip joint centers, HJCs (estimated by a functional method and described with clusters of markers at the thighs); (3) markers at the PSIS and HJCs (estimated by a predictive method and described with clusters of markers at the thighs); (4) markers at the PSIS and HJCs (estimated by a predictive method and described with skin-mounted markers at the thighs based on the Helen-Hayes marker set); (5) markers at the PSIS and at the iliac spines. Concerning the pelvic angles, evaluation of the alternative technical marker sets evinced that all marker sets demonstrated similar precision across trials (about 1 degrees ) but different accuracies (ranging from 1 degrees to 3 degrees ) in comparison to the standard marker set. We suggest that all the investigated marker sets are reliable alternatives to the standard pelvic marker set.