_Combining return to sport, psychological readiness, body mass, hamstring strength symmetry, and hamstring/quadriceps ratio increases the risk of a second anterior cruciate ligament injury.

PURPOSE: To investigate the combinations of variables that comprise the biopsychosocial model domains to identify clinical profiles of risk and protection of second anterior cruciate ligament injury. METHODS: One hundred and forty-five patients for return-to-sport testing after anterior cruciate ligament (ACL) reconstruction (ACLR) were contacted, and 97 were deemed eligible. All were evaluated between 6 and 24 months and followed up for 2 years. Participants answered the International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI), performed the postural stability assessment using the Biodex Balance System, and assessed muscle strength at 60° and 300°/s on the isokinetic dynamometer. Personal factors (age, gender, body mass index), body structures (graft type and concomitant injuries), and environmental factors (time between surgery and evaluation) were also collected. The participants were asked about the occurrence of a second ACL injury and return to sport after 2 years of follow-up. Classification and regression tree (CART) analysis was used to determine predictors of a second ACL injury. The receiver operating characteristic (ROC) curve was performed to verify the accuracy of the CART analysis, in addition to the sensitivity, specificity, and relative risk (RR) of the model. RESULTS: Of the initial 97 participants, 88 (89.8%) responded to follow-up and 14 (15.9%) had a second ACL injury (11 graft ruptures and three contralateral ACL). CART analysis identified the following variables as predictors of second ACL injury: return to sport, hamstring strength symmetry at 300°/s, ACL-RSI score, hamstrings/quadriceps ratio at 60°/s, and body mass index (BMI). CART correctly identified 9 (64.3%) of the 14 participants who were reinjured and 71 (95.9%) of the 74 participants who were not. The total correct classification was 90.9%. The area under the ROC curve was 0.88 (95% CI 0.72-0.99; p < 0.001), and the model showed a sensitivity of 75% (95% CI 42.8-94.5), specificity of 93.4% (95% CI 85.3-97.8), and RR of 15.9 (95% CI 4.9-51.4; p < 0.0001). CONCLUSION: The combination of hamstring strength symmetry, hamstring/quadriceps ratio (body functions); return to sport (activity and participation); psychological readiness; and BMI (personal factors) could identify three clinical risk profiles for a second ACL injury with good accuracy. LEVEL OF EVIDENCE: IV.

The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review was to evaluate the association between ankle dorsiflexion (ADF) and dynamic knee valgus (DKV). METHODS: Electronic searches were conducted in MEDLINE, EMBASE, CINAHL and SPORTDiscus. A modified Downs and Black checklist was used for quality assessment and meta-analysis was performed to compare standardised mean differences (SMD) of ADF. RESULTS: Seventeen studies met the inclusion criteria. Meta-analysis showed that reduced ADF is associated with participants presenting with DKV compared to controls (SMD -0.65, 95% CI -0.88 to -0.41). Subgroup analysis showed consistent results regarding different forms of ADF measurement; restriction in ADF measured in weight-bearing position (SMD -1.25, 95% CI -2.24 to -0.25), non-weight-bearing with knee flexed (SMD -0.56, 95% CI -0.97 to -0.16) or non-weight-bearing with knee extended (SMD -0.54, 95% CI -0.80 to -0.28) was significantly associated with DKV. CONCLUSION: The meta-analysis results provide evidence that reduced ADF is correlated with DKV. The assessment of ADF in the clinical setting is important, as it may be related to harmful movement patterns of the lower limbs.

Reliability and Validity of the Hip Stability Isometric Test (HipSIT): A New Method to Assess Hip Posterolateral Muscle Strength.

Study Design Cross-sectional study. Background The Hip Stability Isometric Test (HipSIT) evaluates the strength of the hip posterolateral stabilizers in a position that favors greater activation of the gluteus maximus and gluteus medius and lower activation of the tensor fascia lata. Objectives To check the validity and reliability of the HipSIT and to evaluate the HipSIT in women with patellofemoral pain (PFP). Methods The HipSIT was evaluated with a handheld dynamometer. During testing, the participants were sidelying, with their legs positioned at 45° of hip flexion and 90° of knee flexion. Participants were instructed to raise the knee of the upper leg while keeping the upper and lower heels in contact. To establish reliability and validity, 49 women were tested with the HipSIT by 2 different evaluators on day 1, and then again 7 days later. The strength of the hip extensors, abductors, and external rotators was also evaluated. Twenty women with unilateral PFP were also evaluated. Results The HipSIT has excellent intrarater and interrater reliability. The standard error of measurement was 0.01 kgf/kg, and the minimal detectable change was 0.036 kgf/kg. The HipSIT showed good validity in isolated hip abduction, external rotation, and extension (P<.01). Women with PFP showed a 10% deficit in the HipSIT results for the symptomatic limb (P = .01). Conclusion The HipSIT showed excellent interrater and intrarater reliability, moderate to good validity in women, and was able to identify strength deficits in women with PFP. J Orthop Sports Phys Ther 2017;47(12):906-913. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7274.

THERE ARE NO BIOMECHANICAL DIFFERENCES BETWEEN RUNNERS CLASSIFIED BY THE FUNCTIONAL MOVEMENT SCREEN.

BACKGROUND: Running has been one of the main choices of physical activity in people seeking an active lifestyle. The Functional Movement Screen (FMS™) is a screening tool that aims to discern movement competency. PURPOSE: The purposes of this study were to compare biomechanical characteristics between two groups rated using the composite FMS™ score, and to analyze the influence of specific individual tests. The hypothesis was that the group that scored above 14 would demonstrate better performance on biomechanical tests than the group that scored below 14. STUDY DESIGN: Cross-Sectional Study. METHODS: Runners were screened using the FMS™ and were dichotomized into groups based on final score: Functional, where the subjects scored a 14 or greater (G≥14, n = 16) and dysfunctional, when the subjects scored less than 14 (G < 14, n = 16). All runners were evaluated using measures for flexibility, postural balance, muscle strength, knee dynamic valgus during forward step down test and time for the electromyographic response of the transversus abdominis and fibularis longus muscles. All data were analyzed with SPSS (p ≤ 0.05) and the index of asymmetry (IS) was calculated with the mean score of nondominant limb divided by the mean score of the dominant limb, multiplied by 100. RESULTS: There were no statistically significant differences in flexibility, muscle strength, knee dynamic valgus, or myoelectric response time of the transversus abdominis and long fibular muscles. Index of asymmetry (IS) of global stability was 3.26 ± 26.79% in G≥14 and 31.72 ± 52.69% in G<14 (p = 0.02). In-line lunge and active straight-leg raise tests showed no significant difference between the groups (p > 0.05). CONCLUSIONS: Overall, there were no biomechanical differences between the groups of runners as classified by the FMS™. In addition, in-line lunge and active strength-leg raise tests did not influence on the FMS™ final score. LEVEL OF EVIDENCE: 2b.

Y balance test has no correlation with the Stability Index of the Biodex Balance System.

STUDY DESIGN: A cross-sectional study design. BACKGROUND: The Stability Index of the Biodex Balance System (SI-BBS) and Y Balance Test (YBT) has been used in studies assessing postural stability but no studies have verified the association of the YBT with the SI-BBS. OBJECTIVE: To analyze the association of the Y Balance Test (YBT) with the Stability Index of the Biodex Balance System (SI-BBS) to evaluate postural stability. METHODS: Forty participants who engaged in recreational physical activities, 12 of whom had a history of injury to the lower limbs. Was used the SI-BBS and the anterior, posterolateral, posteromedial, and composite measures of the YBT. The order of execution of the tests and of the lower limbs evaluated was randomized and blind tested by two evaluators. RESULTS: Pearson's correlation coefficient was used to check the strength of the relationship between the distances achieved on the YBT and the SI-BBS. The YBT showed excellent reliability in the anterior, posteromedial, and posterolateral directions. However, the YBT showed no statistically significant correlation with any variables in the SI-BBS, indicating poor validity between YBT and SI-BBS assessments of postural stability in people with and without history of lower limb injuries. CONCLUSIONS: The results of this study showed the YBT is not correlated with the SI-BBS as an assessment of postural stability. This finding has implications for researchers and clinicians using YBT results as the only measure of postural stability.

Evaluation of the isokinetic muscle function, postural control and plantar pressure distribution in capoeira players: a cross-sectional study.

BACKGROUND: Capoeira is a cultural practice with Brazilian roots that combines several elements including dance, fighting and body rhythm. Because of the diverse elements involved in its practice, capoeira is excellent at developing the physical and social abilities of its players. The aim of this study was to compare the biomechanical profile of muscle strength, plantar pressure distribution, and postural balance between players and non-players of capoeira. METHODS: We evaluated 51 subjects who were allocated into two groups: capoeira group and control group. Subjects were evaluated using a baropodometer (Diasu®) and an isokinetic dynamometer (Biodex®). RESULTS: When comparing plantar pressure distribution between groups and limbs, there were significant differences in mean load of forefoot (p=0.008) and total load (p=0.001). There were no significant differences between groups and limbs in balance and muscle strength; however, a significant difference was found in quadriceps torque peak (p=0.001) and agonist/antagonist ratio (p=0.001) when comparing these variables between the groups. CONCLUSION: Capoeira players displayed a tendency to have an asymmetric profile in plantar pressure distribution. No difference was found in balance between groups. Despite the fact that capoeira players showed increased strength of the quadriceps muscle, their agonist/antagonist ratio was more asymmetrical than the control group. LEVEL OF EVIDENCE: IV.

Neuromuscular efficiency of the vastus medialis obliquus and postural balance in professional soccer athletes after anterior cruciate ligament reconstruction.

The purpose of this study was to evaluate the neuromuscular efficiency of the vastus medialis obliquus and postural balance in high-performance soccer athletes after anterior cruciate ligament (ACL) reconstruction, compared to the uninvolved leg. A cross-sectional study was conducted with 22 male professional soccer players after ACL reconstruction (4-12 months postoperatively). The athletes were submitted to functional rehabilitation with an accelerated protocol on the soccer team. They were evaluated using isokinetic dynamometer, surface electromyography and electronic baropodometer. There was no decrease or difference between neuromuscular efficiency of the VMO when comparing both the limbs after ACL reconstruction in the professional soccer athletes under treatment. The same result was found in postural balance. It can be concluded that the NME of the VMO in the involved member and postural balance were successfully re-established after the reconstruction procedure of the ACL in the sample group studied.

Measurement properties of the pressure biofeedback unit in the evaluation of transversus abdominis muscle activity: a systematic review.

BACKGROUND: Measurements from pressure biofeedback units (PBUs) can be used to evaluate the activity of the transversus abdominis (TrA) muscle indirectly. These measurements can classify patients or monitor the progress of treatment programmes for people with low back pain. OBJECTIVE: To systematically review studies on the measurement properties of PBUs for the assessment of TrA activity. DATA SOURCES: Eligible studies were identified through searches of PUBMED, CINAHL and BIREME (1990 to 2009). In addition, hand searches of journals and citation tracking were performed. STUDY SELECTION: Full-text studies involving any type of clinimetric tests of PBU measurement for the assessment of TrA activity were selected. DATA EXTRACTION: Two independent reviewers selected the studies, extracted the data and assessed methodological quality. DATA SYNTHESIS: Due to the heterogeneity of study designs and statistical analysis, it was not possible to pool the data for a meta-analysis. RESULTS: Six studies met the inclusion criteria. These studies were typically of low quality and recruited healthy subjects rather than patients with low back pain. The studies found moderate to good reproducibility (intra-class correlation coefficients from 0.47 to 0.82) and acceptable construct validity (intra-class correlation coefficients from 0.48 to 0.90). CONCLUSIONS: The current evidence about the measurement properties of PBUs for the assessment of TrA activity is mainly based on studies with suboptimal designs, and the findings from these studies are likely to be overly optimistic. The most important clinical questions about the measurement properties of PBUs for the assessment of TrA activity are yet to be answered.