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  • ISSN: 2379-0571
    Volume 8, Issue 1
    Research Article
    Colton L. Wood, Crystal Higginson, and David J. Berkoff*
    Purpose: Partial percutaneous tenotomy and fasciotomy are emerging minimally invasive treatment options for chronic, refractory tendinopathies and fasciopathies. Our aim is to investigate the effectiveness of ultrasound-guided partial percutaneous tenotomy and fasciotomy.
    Methods: We conducted a retrospective satisfaction review via telephone call of 316 patients who had completed partial percutaneous tenotomy or fasciopathy with the Tenex device approximately 1 to 1.5 years earlier. A survey asked patients to rate overall satisfaction, recent pain levels, and willingness to undergo the procedure again. We performed a global analysis as well as subgroup analyses based on associated procedure diagnoses, including insertional Achilles tendinosis, plantar fasciitis, and medial epicondylitis or lateral epicondylitis.
    Results: Of all 189 patients who completed the follow-up interview, 92.5% reported that they were “very satisfied” or “satisfied” with the procedure, 91% reported their pain in the past week was “none” or “mild pain”, and 95% reported they were “willing to undergo procedure again”. Within subgroup analyses, 90% of patients with medial or lateral epicondylitis, 96% with insertional Achilles tendinopathy, and 94% of those with plantar fasciopathy reported satisfaction with their procedure at >1 year follow-up.
    Conclusion: High rates (>90%) of satisfaction, reduced levels of pain, and willingness to repeat partial percutaneous tenotomy and fasciotomy with the Tenex device at >1 year post-procedure highlight the clinical value of this procedure. The results showed no correlation with age, and there was no significant difference between men and women relating to outcome or satisfaction with the procedure.
    Angela J McGlashan* and Dara M Twomey
    Facilitating the development of effective coach delivered sports safety interventions, as part of wider system-level and multifaceted Lower-Limb Injury Prevention (LLIP) efforts, is needed to meet public health priorities of ensuring safe and sustainable sport participation. However little research exists examining the practice behaviours and motivational-beliefs of coaches associated with LLIP, especially in the context of Australian football. The purpose of this preliminary study was to explore and describe the practice behaviours of coaches and their motivational beliefs (self-efficacy, outcome expectancies and risk perceptions) associated with LLIs and their prevention. Community-Australian football (AF) coaches from clubs in two Australian states completed a cross-sectional self-report questionnaire, based on a modified-Health Action Process Approach (HAPA) model. Just over half (58%) of coaches used LLIP strategies with their team. Sixty-nine percent had a formal training plan for the entire season, and most did not explicitly incorporate injury prevention exercise program (IPEP) components into their coaching practices, despite their views being favourable towards IPEPs. Coaches believed their players had a high chance of sustaining a LLI and that they could have serious consequences. They believed it was important to have current knowledge of LLIP approaches such as IPEPs, but many lacked the behavioural capability and self-efficacy to implement them. Sports medicine professionals and coach educators should promote IPEPs to ensure LLIs can be reduced, but need to address why IPEPs are not utilized in community-AF settings. Coach-targeted interventions should focus on strategies such as improving coach self-efficacy, reframing misconceptions, goal-setting and planning.
    Gobinath Aroganam*, Nadarajah Manivannan, David Harrison and Vanja Garaj
    Kicking is the fundamental skill in Football. 2 most common shots are Laces (In step) and Inside (Side foot). Key biomechanical features are Hip flexion, Knee extension, Backswing, Force on landing foot, Ball Contact and Follow through. In this experiment, a simple kick study with University football team regarding their technique upon Ball Contact is analyzed. “1-step” kicking analysis was done via video recording, importing into an application, plotting the motion of kick, and its velocities. An Inertial Measuring Unit sensor was placed on the front outer sole of the football boot to monitor the ankle rotations upon ball contact. The aim was to understand each player’s technique regarding their position profile and gameplay approach. Based on existing opinions on players, could technology analysis, with camera and sensor support observation assessment? A Decision matrix was created to rank each kicker against tracked features linking to selected biomechanics. After reviewing video and sensor data, 2 players showed differences compared to initial observed rank, with greater understanding of 1 player’s technique.
    Aline Suter, Philippe M Tscholl, Christian Hoser and Christian Fink*
    Introduction: This study presents 3 professional alpine skiers with a simultaneous rupture of the Patellar Tendon (PT), Anterior Cruciate Ligament (ACL) and Medial Collateral Ligament (MCL) with a focus on the surgical techniques, functional outcomes and return to sports.
    Material and Methods: Between 2013 and 2018, three professional alpine skiers (one female, two male) sustained a concomitant rupture of the PT and ACL, combined with an additional complete or partial tear of the MCL and either a lateral meniscal tear or an affection of both menisci. All patients underwent acute, single-stage surgery with PT and MCL repairs as well as ACL reconstruction. Clinical and functional assessments (Lysholm and Tegner scores) were performed 6, 12 and 24 months postoperatively.
    Results: All three athletes returned to alpine skiing at the same professional pre-injury level. Postoperative functional scores at 6-month follow-up showed an average Lysholm score of 87 (range 67-100) and an average Tegner score of 8; at 12-month follow-up, the average Lysholm score was 91.7 (range 86-100) and the average Tegner score was 8; at 24-month follow-up, the average Lysholm score was 96.7 (range 94-100) and the average Tegner score was 8. The athletes returned to unrestricted snow training after 11 months (8-13 months) and returned to competition after 15.3 months (12-20 months).
    Conclusion: For all three patients a return to professional alpine skiing was possible after this complex knee ligament injury. This rare injury was always associated with a meniscal tear. Therefore, advanced surgical techniques combining arthroscopic and open approaches are necessary. A single-stage treatment combined with accelerated rehabilitation is recommended for professional athletes to minimize the time to return to sports.
    Karen M Skemp*, Marissa Stehly and Douglas D Baumann
    Ketogenic diets are very high-fat, moderate-protein, carbohydrate-restricted diets. Studies have shown that ketogenic diets induce favorable metabolic and physiological changes, including weight loss and improved body composition.
    Purpose: The purpose of this study was to examine if the ketogenic diet would produce a favorable impact on body composition by producing fat loss while maintaining lean body mass in resistance training women.
    Methods: A sample of 20 women were assigned to either the ketogenic group (N=10) who followed a ketogenic diet of 70% fat, 20% protein, and 10% CHO or a control group (standard diet group) (N=10) who followed their usual standard diet. Both groups participated in resistance training of at least 3 times a week for a duration of 4 weeks. All measurements were taken at week 0 and end of week 4.
    Results: Both the ketogenic group and control group participants lost overall body mass (2.35 lbs. + 3.67) and fat mass (1.06 lbs. + 2.97). Ketogenic group participants lost more overall body mass (4.36 lbs. + 3.59) than the control participants (0.34 lbs. + 2.57) (p=0.005). Fat mass decreased to a greater extent in the ketogenic group (2.15 lbs. + 2.46) compared to the control group which gained fat mass (+0.17 lbs. + 3.08) (p=0.03). Those in the ketogenic group did not lose more lean muscle mass than the control group.
    Conclusion: Results indicate that a ketogenic diet has a favorable impact on body composition of lean muscle mass and fat mass in female resistance training athletes.
    Research Article
    Lauren Porras*, Brendan Lawson, Caroline M. Barrett, Kenzie Jane Bowen Johnston, Andrea Dotson, Crystal Higginson, John D. Hales III, Marcia Newby-Goodman, Julie McNabb, Iva Darkina Ward, Kunal Agnihotri and Harry Stafford
    BESS scores have been shown to be reflective of balance deficits that can cause LE injury or concussions. There is no current literature that addresses whether these scores are predictive of injury.
    Objective: To find if a preseason BESS scores of 15 or greater is predictive of the development of LE injury or concussion and whether a prophylactic ankle rehabilitation program lowers this risk.
    Design: Prospective Cohort Study
    Setting: Sport Setting
    Patients or Other Participants: The North Carolina Central University football team from 2014 – 2016, and 2018.
    Interventions: A prophylactic ankle rehabilitation HEP was performed twice daily during the 2016 and 2018 seasons.
    Main Outcome Measures: Athlete preseason BESS scores and injury data from the season was analyzed using a multiple logistic regression. Those athletes with a BESS score of x≥15 underwent prophylactic ankle rehabilitation and the injury results were compared to see if there was a reduction in risk.
    Results: Elevated Bess scores (x≥15) proved to be non-predictive of LE Injury or concussion in both the control seasons (p = .55, p = .81) or the intervention seasons (p = .90, p = .69), nor did the ankle rehabilitation reduce the injury risk (p = .52, p = .71). A previous concussion did increase the risk of LE injury in the control seasons (p = .03).
    Conclusion: An athlete’s BESS score proved to be non-predictive of LE injury or concussion and the prophylactic ankle program did not reduce the risk of either. Suffering a previous concussion did show an increase in risk to subsequent LE injury.
    Alexander SD Gamble*, Jessica L Bigg, and Lawrence L Spriet
    This study quantified novel local positioning system (LPS) external load metrics and internal load (heart rate-derived training impulse, TRIMP) during the unique environment of an ice hockey championship (overtime) game across three periods of regulation time (60 min) and two periods of overtime (40 min). Data were collected from 15 male varsity ice hockey players (6 defence, 9 forwards; 22.0 ± 0.9 yrs, 84.1 ± 4.6 kg, 181.2 ± 4.4 cm). LPS metrics included skating distance, peak skating speed, peak acceleration/deceleration, and number of accelerations/decelerations, sharp/wide turns, skating transitions, changes of direction, and impacts. The mean skating distance was maintained across periods 1-5 (2110 ± 464, 2126 ± 490, 2012 ± 614, 2315 ± 649, and 2093 ± 549 m). Peak speed (30.25 ± 2.08, 30.78 ± 1.72, 30.67 ± 2.20, 29.99 ± 2.06 and 30.37 ± 2.18 km/hr) and TRIMP (38.47 ± 14.83, 32.67 ± 15.39, 33.43 ± 19.18, 36.39 ± 18.29, 31.41 ± 11.89 AU) were also maintained from period 1 to 5. Forwards had greater peak skating speed, skated further in high-intensity speed zones (>21 km/hr), and had greater TRIMP vs. defence in most periods and the entire game (p<0.048). In summary, this study measured novel and objective LPS-derived external load and TRIMP internal load during an extended men’s varsity ice hockey game and remarkably, there were no decreases in players’ workload in the third period or two overtime periods. This suggested a high level of players’ fitness and potentially high motivation associated the championship game.
    James Melrose*
    Purpose/aim of the study: To immunolocalize perlecan in anterior cruciate ligament (ACL) and review its potential to promote ACL repair.
    Materials and Methods: Perlecan immunolocalisations were undertaken with an antibody to perlecan domain IV (MAb A7L6), toluidine blue staining visualized ACL glycosaminoglycan. Primary ACL cells were cultured in monolayers, cellular morphologies were compared with meniscal, synovial fibroblast and articular chondrocytes from the same knee joints.
    Results: The ACL contained toluidine blue stained proteoglycan associated with linear arrays of fusiform cells between collagen fibre bundles and plumper cells in vascular channels. Perlecan interconnected aligned fusiform cells in collagenous regions and rounded cells in vascular channels. Prominent actin cytoskeletons in monolayer culture demonstrating a contractile phenotype similar to myofibroblasts.
    Discussion: This study showed perlecan interconnected strings of ACL cells in anteriomedial and posteriolateral collagenous bundles in the ACL connecting the tibia and femur providing rotational stability in the knee joint. Type I collagen (70-80%), elastin (5-6 %) and proteoglycans (2-5%) are major ACL components. A review of perlecan’s roles in matrix stabilisation, mechanotransduction, growth factor mediated cellular proliferation and differentiation and its co-localisation with elastin in tensional and weight bearing connective tissues suggest it has potential contributions to make in functional ACL repair. Recently developed methods that have provided improved immobilization and a stable repair environment conducive to ACL repair indicate that the roles of perlecan in ACL repair processes deserve evaluation based on its known functional properties in other tensional and weight bearing connective tissues.
    Paulo Roberto Hernandes Júnior, Manoel Silva, Helena Maia Almeida, Cláudia Regina Cavaglieri, Mara Patrícia T. Chacon-Mikahil, and Amanda Veiga Sardeli*
    There is a concern that a reduction in energy intake would impairs physical performance and functionality in general. However, caloric restriction (CR), a dietary intervention defined as a reduction in energy intake without nutrient deficiency, is able to improve a number of body functions and, thus, could be also able to improve physical functionality. We ran a systematic review in November 2019 that led to inclusion of 9 studies. 15 subgroups were extracted for two main meta-analysis of CR effects on overall functionality: 1) Non-exercise meta-analysis, in which only CR effects were tested by comparison of CR without exercise (CR-NEX) and no diet without exercise (NEX); and 2) Exercise meta-analysis, in which additional CR effects on exercise interventions were tested by comparison of CR plus exercise training (CR-EX) and exercise training (EX). The CR effects on functionality were more evident when CR was the only intervention (SMD: 0.40 [CI95%: 0.015; 0.65], p <0.001), however, the addition of CR intervention for individuals undergoing exercise cause a small but consistent extra improve on functionality (SMD: 0.12 [CI95%: 0.04; 0.19], p <0.001). Among the components of functionality, CR was significantly effective on Balance, daily life endurance and mobility improvements (p<0.05), but not on agility, daily life strength, flexibility or vitality. Therefore, there is no reason for overweight or obese individuals fear functionality loss with caloric restriction.
    Short Communication
    Matthew Tran and Steven D. Stovitz*
    Objective: The primary aim of this study is to evaluate the prevalence of diabetes mellitus (DM) in patients seen with adhesive capsulitis (Frozen Shoulder, FS). Our secondary aim is to assess the prevalence of thyroid disease in these same patients.
    Design: A retrospective chart review.
    Setting: Orthopedics and Sports Medicine Clinics in the Minnesota-Fairview Network from 2009-2020.
    Participants: 638 patients (417 Females and 221 Males)
    Independent Variables: Frozen shoulder (FS)
    Main Outcome Measures: Diabetes mellitus (DM) or thyroid disease
    Results: Of the 638 FS patients, the total prevalence of DM was 49.8% (318/638). Among the 417 females with FS, 202 (48.4%) had DM. Among the 221 Male patients with FS, 116 (52.5%) had DM. The total prevalence of thyroid disease in frozen shoulder patients was 17.7% (113/638).
    Conclusion: Among those seen for FS, approximately one-half also suffered from DM and approximately one-fifth suffered from a thyroid condition. Our results suggest that clinicians should consider screening patients with FS for endocrine conditions.
    Case Report
    Eric R Friedman*, JJ Hoff, and Paul Friedman
    This case is about an 18-year-old African-American male, who is a division-I college football offensive lineman, with a history of asthma and obesity who presented to the emergency department (ED) with fever and myalgias. The patient tested positive for COVID-19 approximately a month before during a routine screening and was asymptomatic at the time. The patient presented to the ED with 2 days of fever, headache, myalgias, and generalized weakness. His labs showed he had markedly elevated inflammatory markers, a transaminitis, and thrombocytopenia. He also had new T-wave inversions on his ECG. He was treated with prophylactic Lovenox due to his elevated D-dimer and risk for VTE. His MIS-C was treated with IVIG 1 g/kg (max 80 g). His inflammatory markers decreased, his symptoms resolved and after a few days he was discharged from the hospital on ASA 81mg. He then did a progressive exercise program which included strict cardiac monitoring which he completed without issue. He returned to full football activity 4 weeks after his initial diagnosis. This is the first known case of MIS-C in an elite college athlete. It is important to consider MIS-C in our younger athletes as a consequence of Covid-19 which may lead to significant risk factors for their playing future. This disease process can be deadly and, in most cases, need admission to an intensive care unit. This case highlights the importance of early diagnosis and treatment, as well as the various cardiac diagnostic modalities needed to assist with the return-to-play process.
    Review Article
    Theresa Schaferhoff*, Manuel Sowada, Peter Schaferhoff1, Paul Klein, Hauke Dewitz, and Marc Banerjee
    Introduction: Medial patellofemoral ligament (MPFL) reconstruction has become a well-established surgical technique to treat recurrent patellar dislocation. However, no golden standard exists so far to treat a patellofemoral instability. An additive trochleoplasty is recommended for patients with a high-grade trochlear dysplasia, that means a lateral trochlear inclination (LTI) of less than 11°.
    The following study was to ascertain if an isolated MPFL reconstruction results in comparable results in patients with and without trochlea dysplasia.
    Methods: The study included 43 patients who underwent an MPFL reconstruction with a median age of 25.6 years and a median follow-up of 37.1 months. Patients were assessed by the International Knee Documentation Committee (IKDC), Tegner Activity, Lysholm and the visual analog scale (VAS) scores. On magnetic resonance imaging (MRI) LTI, Caton-Deschamps Index, tibial tuberosity to trochlear groove (TT-TG) distance and tibial tubercle-posterior cruciate ligament (TT-PCL) distance were measured. According to the LTI patients were divided into groups, group 1 with an LTI less than 11° and group 2 above 10°.
    Results: The mean LTI of group 1 was 6,1 and 14,4 in group 2. The mean IKDC subjective score was 82 in group 1 and 81.6 in group 2. The mean Lysholm score was 84 in group 1 and 86 in group 2. Comparing the level of activity before and after the operation with the Tegner score showed that it was the same or even higher in 89% of all patients in group 1 and 92% in group 2.
    The mean VAS score was 2 (range 0-7) in group 1 and 1.6 (range 0-5) in group 2.
    77.8 % in group 1 were satisfied or very satisfied, whereas 92% in group 2 were satisfied or very satisfied. One patient in group 1 had a recurrent dislocation and one patient in group 2 had a subluxation postoperatively.
    Conclusion: Patients with patellofemoral instability and a trochlea dysplasia achieved excellent results after an isolated MPFL reconstruction comparable to those without trochlea dysplasia. Thus, it seems that the MPFL can partially compensate the dysplasia. Therefore, the indication for a trochleoplasty should not just be according to radiological measures.
    Short Communication
    Ágata Aranha*, Patrícia Aranha-de-Macedo, Rui Resende, Ferreirinha José, Francisco Nataniel Ochoa and José Vilaça-Alves
    Background: This study has investigated 1600 adolescents, between the ages of 15 and17, from 32 Schools in Mainland Portugal and Islands, after the isolation period, resulting from COVID-19 pandemic.
    Methods: these adolescents were weighed and questioned trough several quizzes about their body shape and self-esteem using the Rosenberg scale. After this pretest, physical exercises program was developed and applied during the course of two months with the goals of: development of strength, resistance and velocity. After this trial the previous quizzes were repeated- After-thesis.
    Results: the data showed that the self-esteem and body satisfaction in adolescents were very low 29,8% corresponding to positive self-esteem and 21,6% to body satisfaction.
    Conclusions: The self-esteem and corporal satisfaction got significantly better - 68,9% for positive self-esteem and 62,3% for body satisfaction. The levels of physical and motor fitness capacity rose, which influenced the results of self-esteem and body satisfaction.
    Research Article
    Christiano Marques Chediac, Pedro Bara Zanotto, Ronaldo Kobal, and Cesar Cavinato Cal Abad*
    Flywheel (FW), apparatus is a non-gravity-dependent exercise system that has been proposed to increase eccentric workload and skeletal muscle strength. The acute effect of FW exercise on cardiac, hemodynamic, autonomic, and neuromuscular responses remains scarce. The present study aimed investigate the heart rate (HR), blood pressure (BP), HR variability (HRV), and vertical jump performance (VJ), following a FW exercise. The effort consisted of 4 sets x 12 repetitions on the half squat exercise executed with 3 flywheel rotations and 1-min of intervals between sets. HR was assessed during all experimental session. BP and VJ were assessed pre and immediately 5-, 20-, and 35-min post-exercise. HRV was evaluated by root mean square of the successive differences (RMSSD), at rest, 20-, and 35-min post-exercise. The ANOVA one way was applied followed by Bonferroni´s post hoc test if necessary. The FW moderately improved the cardiac and hemodynamic stress with a concomitant reduction on HRV. The VJ performance was not significantly affected at 5-min post FW exercise, but was impaired at 20-min and remained reduced until 35-min post-exercises. In conclusion, the FW induced a moderate stress in cardiac and hemodynamic responses followed by a decrease in the HRV. In addition, the FW impaired the jumping ability at 20- and 35-min of passive recovery. These findings are important to better comprehend the physiological responses of a FW exercise.
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