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Hollman, John H., Robert H. Deusinger, Linda R. Van Dillen, and Matthew J. Matava. "Knee Joint Movements in Subjects Without Knee Pathology and Subjects With Injured Anterior Cruciate Ligaments." Physical Therapy 82, no. 10 (2002): 960–72. http://dx.doi.org/10.1093/ptj/82.10.960.
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Abstract Background and Purpose. Although weight-bearing (WB) exercise and increased hamstring muscle activity may contribute to knee joint stability in knees with an injured anterior cruciate ligament (ACL), the relationship among ACL integrity, muscle activity, and joint surface motion is not fully understood. The purpose of this study was to investigate whether knee joint rolling and gliding movements and electromyographic (EMG) activity differed between subjects with injured ACLs and subjects without knee pathology. Subjects. Fifteen subjects with injured ACLs (9 men and 6 women; mean age=26 years, SD=7, range=18–36) and 15 age- and sex-matched subjects without knee pathology (9 men and 6 women; mean age=25 years, SD=6, range=18–36) participated in the study. Methods. Sagittal-plane knee joint rolling and gliding movements and lower-extremity EMG activity were measured during non-weight-bearing (NWB) and WB movements. Mixed-model analyses of variance were conducted to analyze rolling and gliding and EMG data. Results. During NWB knee extension, greater joint surface gliding occurred in knees with injured ACLs at full knee extension. During WB knee extension, greater gliding occurred in knees with injured ACLs throughout the range of motion tested. No differences in EMG activity occurred between groups. Discussion and Conclusion. The results suggest that, in the absence of increased hamstring muscle activity, anterior tibial displacement is not reduced in knees with injured ACLs during WB movement.
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Jacobs, Cale, and Carl Mattacola. "Sex Differences in Eccentric Hip-Abductor Strength and Knee-Joint Kinematics When Landing from a Jump." Journal of Sport Rehabilitation 14, no. 4 (2005): 346–55. http://dx.doi.org/10.1123/jsr.14.4.346.
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Context:Decelerating movements such as landing from a jump have been proposed to be a common mechanism of injury to the anterior cruciate ligament (ACL).Objective:To compare eccentric hip-abductor strength and kinematics of landing between men and women when performing a hopping task.Setting:Research laboratory.Patients:18 healthy subjects (10 women, 8 men).Main Outcome Measures:Eccentric peak torque of the hip abductors and peak knee-joint angles during a 350-millisecond interval after impact.Results:No significant sex differences were present, but there was a significant inverse relationship between women's eccentric peak torque and peak knee-valgus angle (r= –.61,P= .03).Conclusions:Women with larger eccentric peak torque demonstrated lower peak knee-valgus angles. By not reaching as large of a valgus angle, there is potentially less stress on the ACL. Increasing eccentric hip-abductor strength might improve knee-joint kinematics during landing from a jump.
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Spiteri, Tania, Nicolas H. Hart, and Sophia Nimphius. "Offensive and Defensive Agility: A Sex Comparison of Lower Body Kinematics and Ground Reaction Forces." Journal of Applied Biomechanics 30, no. 4 (2014): 514–20. http://dx.doi.org/10.1123/jab.2013-0259.
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The aim of this study was to compare biomechanical and perceptual-cognitive variables between sexes during an offensive and defensive agility protocol. Twelve male and female (n = 24) recreational team sport athletes participated in this study, each performing 12 offensive and defensive agility trials (6 left, 6 right) changing direction in response to movements of a human stimulus. Three-dimensional motion, ground reaction force (GRF), and impulse data were recorded across plant phase for dominant leg change of direction (COD) movements, while timing gates and high-speed video captured decision time, total running time, and post COD stride velocity. Subjects also performed a unilateral isometric squat to determine lower body strength and limb dominance. Group (sex) by condition (2 × 2) MANOVAs with follow-up ANOVAs were conducted to examine differences between groups (P ≤ .05). Male athletes demonstrated significantly greater lower body strength, vertical braking force and impulse application, knee and spine flexion, and hip abduction, as well as faster decision time and post COD stride velocity during both agility conditions compared with females. Differences between offensive and defensive movements appear to be attributed to differences in decision time between sexes. This study demonstrates that biomechanical and perceptual-cognitive differences exist between sexes and within offensive and defensive agility movements.
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Takemura, S., Y. Minoda, R. Sugama, et al. "Comparison of a vitamin E-infused highly crosslinked polyethylene insert and a conventional polyethylene insert for primary total knee arthroplasty at two years postoperatively." Bone & Joint Journal 101-B, no. 5 (2019): 559–64. http://dx.doi.org/10.1302/0301-620x.101b5.bjj-2018-1355.r1.
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AimsThe use of vitamin E-infused highly crosslinked polyethylene (HXLPE) in total knee prostheses is controversial. In this paper we have compared the clinical and radiological results between conventional polyethylene and vitamin E-infused HXLPE inserts in total knee arthroplasty (TKA).Patients and MethodsThe study included 200 knees (175 patients) that underwent TKA using the same total knee prostheses. In all, 100 knees (77 patients) had a vitamin E-infused HXLPE insert (study group) and 100 knees (98 patients) had a conventional polyethylene insert (control group). There were no significant differences in age, sex, diagnosis, preoperative knee range of movement (ROM), and preoperative Knee Society Score (KSS) between the two groups. Clinical and radiological results were evaluated at two years postoperatively.ResultsDifferences in postoperative ROM and KSS were not statistically significant between the study and control groups. No knee exhibited osteolysis, aseptic loosening, or polyethylene failure. Additionally, there was no significant difference in the incidence of a radiolucent line between the two groups. One patient from the study group required irrigation and debridement, due to deep infection, at six months postoperatively.ConclusionClinical results were comparable between vitamin E-infused HXLPE inserts and conventional polyethylene inserts at two years after TKA, without any significant clinical failure. Cite this article: Bone Joint J 2019;101-B:559–564.
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Mayne, AIW, HP Harshavardhan, LR Johnston, W. Wang, and A. Jariwala. "Cruciate Retaining compared with Posterior Stabilised Nexgen total knee arthroplasty: results at 10 years in a matched cohort." Annals of The Royal College of Surgeons of England 99, no. 8 (2017): 602–6. http://dx.doi.org/10.1308/rcsann.2017.0086.
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INTRODUCTION Debate has persisted for many years about whether to sacrifice or replace the posterior cruciate ligament when performing total knee arthroplasty. A paucity of long-term follow-up studies comparing outcomes between cruciate-retaining and posterior-stabilised knees exist. We aimed to compare results at ten-year follow-up. METHODS A matched paired study comparing a cohort of 107 Zimmer Nexgen® Cruciate Retaining (CR) patients with a cohort of 107 Nexgen Posterior-Stabilised (PS) knees matched for age, sex, body mass index and preoperative American Knee Society score was undertaken. All patients underwent independent clinical assessment and knee society scoring preoperatively and at 1, 3, 5, 7 and 10 years postoperatively. RESULTS Fifty-three patients (49.5%) in the CR group and 44 patients (41.1%) in the PS group were alive at 10-year follow-up. There were no significant differences between the CR and PS groups with regards to functional assessment (P = 0.95), overall range of movement (P = 0.46) or patient satisfaction (P = 1.0) at 10 years. However, there was a significantly better score improvement in range of movement in PS knees compared with CR knees (P = 0.027). There were six revisions (5.6%) in the PS group and 1 (0.93%) in the CR group (P = 0.12). Both CR and PS knees showed excellent survivorship with no significant difference at 10 years (P = 0.068). CONCLUSIONS There were no significant differences in functional score, overall range of motion or patient satisfaction between the Nexgen cruciate retaining and posterior stabilised total knee arthroplasty at 10-year follow-up. However, PS knees had a greater score improvement in range of motion compared with CR knees.
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Doldo, Neil A., Matthew J. Delmonico, Jason A. Bailey, et al. "Muscle-Power Quality: Does Sex or Race Affect Movement Velocity in Older Adults?" Journal of Aging and Physical Activity 14, no. 4 (2006): 411–22. http://dx.doi.org/10.1123/japa.14.4.411.
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To determine sex and race differences in muscle power per unit of muscle contraction, knee-extensor muscle power normalized for knee-extensor muscle volume was measured in 79 middle-aged and older adults (30 men and 49 women, age range 50–85 years). Results revealed that women displayed a 38% faster peak movement velocity than men and African Americans had a 14% lower peak movement velocity than Whites of a similar age when expressed per unit of involved muscle (p< .001). As expected, men exhibited greater knee-extensor strength and peak power per unit of muscle than women, but women had a faster knee-extension movement velocity per unit of muscle than men at the same relative strength level. Moreover, African Americans had greater knee-extensor muscle volume than Whites but exhibited lower knee-extensor strength and lower movement velocity per unit of muscle when tested at the same relative strength levels.
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Kuenze, Christopher, Brian Pietrosimone, Caroline Lisee, et al. "SEX DIFFERENCES IN QUADRICEPS STRENGTH AMONG ADOLESCENTS WITHIN 1 YEAR OF ACL RECONSTRUCTION." Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (2019): 2325967119S0008. http://dx.doi.org/10.1177/2325967119s00089.
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Background Female patients with ACLR are 40% less likely to return to preinjury levels of sport after subsequent ACLR when compared to their male counterparts. Additionally, 24-30% of young female athletes who do return to sport will go on to experience a second ACL injury to the ipsilateral or contralateral knee within 2 years of ACLR. Despite these findings, sex-based differences in clinical outcomes following ACLR are not currently well understood within the adolescent population. Involved limb knee extension weakness, contralateral limb knee extension weakness, and between limb strength asymmetry persist months to years following ACLR among adolescent patients. Improvements in unilateral and symmetry-based measures of knee extension strength during and after the rehabilitation process have been linked to improved patient-reported knee related function, lower extremity functional performance, and decreased risk of subsequent ACL injury among individuals with recent ACLR. Currently, there is a lack of evidence describing the role that sex plays in persistent quadriceps weakness. Therefore, the purpose of this study was to investigate the effects of patient sex on unilateral and symmetry-based measures of knee extension strength, and patient-reported knee function among adolescent individuals with ACL reconstruction (ACLR) within the first year after surgery. Methods: Fifty-two male participants (age = 16.8±1.3 years, BMI = 25.6±5.6 kg/m2, time since surgery = 6.3±1.4 months) and 66 female participants (age = 16.7±1.4 years, BMI = 23.9±3.9kg/m2, time since surgery = 6.8±1.7 months) with unilateral ACLR, 4-12 months prior to enrollment were recruited for this multi-site cross-sectional study. Participants completed bilateral knee extension maximal voluntary isometric contraction (MVIC) torque assessments using a multimodal dynamometer with continuous verbal encouragement from the tester and visual feedback on a nearby monitor. Peak knee extension MVIC torque was identified for each of 3 trials and was normalized to body mass (Nm/kg). Limb symmetry indices were also calculated by dividing the MVIC torque obtained for the involved limb by the MVIC torque obtained for the contralateral limb. Participants also completed the International Knee Documentation Committee (IKDC) Subjective Knee Form to assess patient-reported knee function. Sex-based comparisons of quadriceps strength outcomes and IKDC score were made using separate ANCOVAs where time since surgery was utilized as a covariate. Cohen’s d effect sizes and 95% confidence intervals (CI95) were calculated to assess the magnitude of sex difference for all outcome measures. Odds ratios and CI95 were also calculated to assess the odds of an adolescent female achieving clinical threshold for acceptable involved limb quadriceps strength (MVIC = 3.0 Nm/kg), quadriceps limb symmetry (LSI = 90.0%), and patient-reported knee function (IKDC = 90.0). Results: The involved limb (male = 2.08±0.95 Nm/kg, female = 1.69±0.63 Nm/kg, p = 0.01, d = -0.50, CI95 = -0.13 to -0.87) and contralateral limbs (male = 2.75±0.75 Nm/kg, female = 2.31±0.64 Nm/kg, p = 0.001, d = -0.64, CI95 = -0.26 to -1.01) of male participants were stronger when compared to female participants but limb symmetry (male = 74.7±22.6%, female = 74.7±24.6%, p = 0.95, d = 0.00, CI95 = 0.36 to -0.36) and IKDC score (male = 84.4±16.1, female = 79.4±13.7, p = 0.08, d = -0.34, CI95 = 0.03 to -0.71) was not significantly different between the sexes. Male participants were 5.66 times (CI95 = 1.46 to 21.87) more likely to meet the clinical threshold for acceptable involved limb quadriceps strength and 3.52 times (CI95 = 1.54 to 8.05) more likely to report acceptable knee related function. The likelihood of achieving clinically acceptable limb symmetry was not significantly different between the sexes (OR = 1.17, CI95 = 0.48 to 2.83). Conclusion/Significance: Adolescent female patients may experience significantly worse involved limb and contralateral quadriceps weakness when compared to adolescent male patients despite displaying equally poor limb symmetry and patient-reported knee function during the first 12 month following surgery. Given the importance of involved limb quadriceps strength as a predictor of patient-reported function and movement quality, clinicians should incorporate patient education regarding the importance of quadriceps function and recommend progressive lower extremity loading when implementing patient-centered rehabilitation plans that promote safe return to healthy levels of physical activity following ACLR.
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Schmitz, Randy J., and Sandra J. Shultz. "Contribution of Knee Flexor and Extensor Strength on Sex-Specific Energy Absorption and Torsional Joint Stiffness During Drop Jumping." Journal of Athletic Training 45, no. 5 (2010): 445–52. http://dx.doi.org/10.4085/1062-6050-45.5.445.
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Abstract Context: Lower extremity injury often occurs during abrupt deceleration when attempting to change the body's direction. Although sex-specific biomechanics have been implicated in the greater risk of acute knee injury in women than in men, it is unknown if sex differences in thigh strength affect sex-specific energy absorption and torsional joint stiffness patterns. Objective: To determine sex differences in energy absorption patterns and joint stiffnesses of the lower extremity during a drop jump and to determine if these sex differences were predicted by knee extensor and flexor strength. Design: Cross-sectional study. Setting: Laboratory environment. Patients or Other Participants: Recreationally active, college-aged students (41 women: age = 22.1 ± 2.9 years, height = 1.63 ± 0.07 m, mass = 59.3 ± 8.0 kg; 40 men: age = 22.4 ± 2.8 years, height = 1.77 ± 0.1 m, mass = 80.9 ± 14.1 kg). Intervention(s): Participants performed knee flexor and extensor maximal voluntary isometric contractions followed by double-leg drop-jump landings. Main Outcome Measure(s): Lower extremity joint energetics (J × N−1 × m−1) and torsional joint stiffnesses (Nm × N−1 × m−1 × degrees−1) were calculated for the hip, knee, and ankle during the initial landing phase. Body weight was measured in newtons and height was measured in meters. Sex comparisons were made and sex-specific regressions determined if thigh muscle strength (Nm/kg) predicted sagittal-plane landing energetics and stiffnesses. Results: Women absorbed 69% more knee energy and had 36% less hip torsional stiffness than men. In women, greater knee extensor strength predicted greater knee energy absorption (R2 = 0.11, P = .04), and greater knee flexor strength predicted greater hip torsional stiffness (R2 = 0.12, P = .03). Conclusions: Sex-specific biomechanics during the deceleration phase of a drop jump revealed that women used a strategy to attempt to decrease system stiffness. Additionally, only female strength values were predictive of landing energetics and stiffnesses. These findings collectively demonstrated that the task may have been more difficult for women, resulting in a different movement strategy among those with different levels of thigh strength to safely complete the task. Future researchers should look at other predictive factors of observed sex differences.
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Murray, Martha, Ata Kiapour, and Samuel Barnett. "Knees with Smaller Posterior Tibial Slope And More Concave Medial Tibial Plateau Are At Higher Risk Of Isolated Meniscal Injuries." Orthopaedic Journal of Sports Medicine 8, no. 7_suppl6 (2020): 2325967120S0046. http://dx.doi.org/10.1177/2325967120s00465.
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Objectives: Meniscal injuries are extremely common. Several anatomical features of the knee, including the tibial plateau morphology, have been shown to influence knee biomechanics and the risk of ligamentous injuries. Little is known, however, how these morphological features influence the risk of isolated meniscal injuries in the ACL intact knee. In the current study, we used MRI and 3D image analysis to investigate anatomical variables of knees in patients with and without isolated meniscus tears. We hypothesized that there are differences in slopes and concavity of the tibial plateau between patients with isolated meniscus tears and matched normal controls. Methods: 65 subjects with first-instance isolated medial or lateral meniscal injuries requiring surgical fixation (Age: 15 +/- 2 years, BMI: 23.2 +/- 3.7 Kg/m2; 43% females) were matched to 65 subjects with normal knees and no prior injuries (Age: 15 +/- 2 years, BMI: 23.1 +/- 3.8 Kg/m2; 43% females) based on age, BMI and sex. Sagittal Proton Density SPACE MR images (preoperative for injured group) were used to measure the posterior slope of the medial (MTS) and lateral (LTS) tibial plateau, coronal slope of the tibial plateau (CTS), and the maximum depth of the medial tibia plateau (MTD, as a measure of medial tibial plateau concavity), following established techniques-Figure 1. Two-sample t-test was used to compare the quantified anatomical features between the cases and matched controls. Results: There were no differences in age (p = 0.999), sex distribution (p = 0.999) and BMI (p = 0.963) between the two cohorts. Compared to matched controls, patients with isolated meniscal tears had lower LTS (3.6 +/- 3.2 vs 5.6 +/- 3.0 degrees; p < 0.001), lower MTS (3.4 +/- 2.9 vs 4.9 +/- 2.5 degrees; p = 0.001) and deeper MTD (2.4 +/- 0.8 vs 1.5 +/- 0.8 mm; p < 0.001). There was no difference in CTS between the groups (3.6 +/- 1.6 vs 3.9 +/- 2.2 degrees; p = 0.300). Conclusion: This study suggests that subjects with isolated meniscus tear have a lower posterior tibial slope and a deeper MTD (more concave medial tibial plateau) than matched population who do not have a meniscus tear. This is contrary to what is known for ACL tears, where a higher posterior tibial slope and a shallower MTD have been associated with an increased risk of ACL tear. During load-bearing activities, in particular high impact movements such as jumping, increased tibial slope and decreased MTD have shown to result in greater anterior shear forces across the knee. In contrast, the less sloped and more concave plateau will experience lower shear forces but more compression, which could be detrimental to the meniscus. This study provides preliminary evidence suggesting a link between tibial plateau morphology and risk of isolated meniscal injuries. Further mechanistic studies are required to better understand the interaction between knee morphology, meniscal loading and subsequent risk of injury. [Figure: see text]
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Kuenze, Christopher M., Stephanie Trigsted, Caroline Lisee, Eric Post, and David R. Bell. "Sex Differences on the Landing Error Scoring System Among Individuals With Anterior Cruciate Ligament Reconstruction." Journal of Athletic Training 53, no. 9 (2018): 837–43. http://dx.doi.org/10.4085/1062-6050-459-17.
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Context: After anterior cruciate ligament reconstruction (ACLR), women have a greater risk of incurring a second anterior cruciate ligament injury and they display different landing movement patterns than men. It remains unclear if clinical movement-assessment tools, such as the Landing Error Scoring System (LESS), can detect sex differences in movement patterns after ACLR. Objective: To compare total LESS scores and individual LESS errors between men and women with a history of ACLR. Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: A total of 168 individuals (41 men and 127 women; mean age: men = 20 years [range, 19–25 years], women = 19 years [range, 18–20 years]; mean time since surgery: men = 21 months [range, 12–36 months], women = 27.5 months [range, 17–39 months]) with a history of primary, unilateral ACLR. Main Outcome Measure(s): Participants completed a minimum of 3 trials of a drop vertical-jump task scored using the LESS. The between-sexes difference in LESS score was assessed using analysis of covariance, whereas the associations between participant sex and errors on each LESS item were assessed using logistic or multinomial regression. Results: Women displayed a greater number of total landing errors (men = 4.6 ± 2.3, women = 6.1 ± 2.3; P &lt; .001) and were more likely to commit errors in trunk flexion at initial contact (men = 4.9%, women = 23.6%; odds ratio [OR] = 4.94), medial knee position at initial contact (men = 17.1%, women = 42.5%; OR = 6.01), medial knee displacement (men = 24.4%, women = 73.2%; OR = 7.88), total joint displacement (1 error: men = 58.5%, women = 71.7%, OR = 2.10; 2 errors: men = 7.3%, women = 14.2%, OR = 3.71), and overall impression (1 error: men = 75.6%, women = 84.3%, OR = 3.24; 2 errors: men = 2.4%, women = 10.2%, OR = 12.89) compared with men. Conclusions: Women with ACLR displayed worse LESS scores and were more likely to commit errors related to medial knee displacement and overall landing quality than men with ACLR.
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Hindle, Benjamin, Anna Lorimer, Paul Winwood, Daniel Brimm, and Justin W. L. Keogh. "The biomechanical characteristics of the strongman atlas stone lift." PeerJ 9 (September 1, 2021): e12066. http://dx.doi.org/10.7717/peerj.12066.
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Background The atlas stone lift is a popular strongman exercise where athletes are required to pick up a large, spherical, concrete stone and pass it over a bar or place it on to a ledge. The aim of this study was to use ecologically realistic training loads and set formats to (1) establish the preliminary biomechanical characteristics of athletes performing the atlas stone lift; (2) identify any biomechanical differences between male and female athletes performing the atlas stone lift; and (3) determine temporal and kinematic differences between repetitions of a set of atlas stones of incremental mass. Methods Kinematic measures of hip, knee and ankle joint angle, and temporal measures of phase and repetition duration were collected whilst 20 experienced strongman athletes (female: n = 8, male: n = 12) performed three sets of four stone lifts of incremental mass (up to 85% one repetition maximum) over a fixed-height bar. Results The atlas stone lift was categorised in to five phases: the recovery, initial grip, first pull, lap and second pull phase. The atlas stone lift could be biomechanically characterised by maximal hip and moderate knee flexion and ankle dorsiflexion at the beginning of the first pull; moderate hip and knee flexion and moderate ankle plantarflexion at the beginning of the lap phase; moderate hip and maximal knee flexion and ankle dorsiflexion at the beginning of the second pull phase; and maximal hip, knee extension and ankle plantarflexion at lift completion. When compared with male athletes, female athletes most notably exhibited: greater hip flexion at the beginning of the first pull, lap and second pull phase and at lift completion; and a shorter second pull phase duration. Independent of sex, first pull and lap phase hip and ankle range of motion (ROM) were generally smaller in repetition one than the final three repetitions, while phase and total repetition duration increased throughout the set. Two-way interactions between sex and repetition were identified. Male athletes displayed smaller hip ROM during the second pull phase of the first three repetitions when compared with the final repetition and smaller hip extension at lift completion during the first two repetitions when compared with the final two repetitions. Female athletes did not display these between-repetition differences. Conclusions Some of the between-sex biomechanical differences observed were suggested to be the result of between-sex anthropometric differences. Between-repetition differences observed may be attributed to the increase in stone mass and acute fatigue. The biomechanical characteristics of the atlas stone lift shared similarities with the previously researched Romanian deadlift and front squat. Strongman athletes, coaches and strength and conditioning coaches are recommended to take advantage of these similarities to achieve greater training adaptations and thus performance in the atlas stone lift and its similar movements.
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Howard, Jennifer S., Melisa A. Fazio, Carl G. Mattacola, Timothy L. Uhl, and Cale A. Jacobs. "Structure, Sex, and Strength and Knee and Hip Kinematics During Landing." Journal of Athletic Training 46, no. 4 (2011): 376–85. http://dx.doi.org/10.4085/1062-6050-46.4.376.
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Context: Researchers have observed that medial knee collapse is a mechanism of knee injury. Lower extremity alignment, sex, and strength have been cited as contributing to landing mechanics. Objective: To determine the relationship among measurements of asymmetry of unilateral hip rotation (AUHR); mobility of the foot, which we described as relative arch deformity (RAD); hip abduction–external rotation strength; sex; and me-dial collapse of the knee during a single-leg jump landing. We hypothesized that AUHR and RAD would be positively correlated with movements often associated with medial collapse of the knee, including hip adduction and internal rotation excursions and knee abduction and rotation excursions. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: Thirty women and 15 men (age = 21 ± 2 years, height = 171.7 ± 9.5 cm, mass = 68.4 ± 9.5 kg) who had no history of surgery or recent injury and who participated in regular physical activity volunteered. Intervention(s): Participants performed 3 double-leg forward jumps with a single-leg landing. Three-dimensional kinematic data were sampled at 100 Hz using an electromagnetic tracking system. We evaluated AUHR and RAD on the preferred leg and evaluated isometric peak hip abductor–external rotation torque. We assessed AUHR by calculating the difference between internal and external hip rotation in the prone position (AUHR = internal rotation – external rotation). We evaluated RAD using the Arch Height Index Measurement System. Correlations and linear regression analyses were used to assess relationships among AUHR, RAD, sex, peak hip abduction–external rotation torque, and kinematic variables for 3-dimensional motion of the hip and knee. Main Outcome Measure(s): The dependent variables were joint angles at contact and joint excursions between contact and peak knee flexion. Results: We found that AUHR was correlated with hip adduction excursion (R = 0.36, P = .02). Asymmetry of unilateral hip rotation, sex, and peak hip abduction–external rotation torque were predictive of knee abduction excursion (adjusted R2 = 0.47, P &lt; .001). Asymmetry of unilateral hip rotation and sex were predictive of knee external rotation excursion (adjusted R2 = 0.23, P = .001). The RAD was correlated with hip adduction at contact (R2 = 0.10, R = 0.32, P = .04) and knee flexion excursion (R2 = 0.11, R = −0.34, P = .03). Conclusions: Asymmetry of unilateral hip rotation, sex, and hip strength were associated with kinematic components of medial knee collapse.
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Petrovic, Milos, Haraldur B. Sigurðsson, Hjálmar J. Sigurðsson, Thorarinn Sveinsson, and Kristín Briem. "Effect of Sex on Anterior Cruciate Ligament Injury–Related Biomechanics During the Cutting Maneuver in Preadolescent Athletes." Orthopaedic Journal of Sports Medicine 8, no. 7 (2020): 232596712093698. http://dx.doi.org/10.1177/2325967120936980.
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Background: There are 2 movement patterns associated with an anterior cruciate ligament (ACL) injury: dynamic valgus and stiff landing. Although sex-dependent differences have been identified for adults, less is known for preadolescent athletes regarding movement patterns known to load the ACL. Hypothesis: We hypothesized that girls would demonstrate greater vertical ground reaction forces and knee valgus angles. We further hypothesized that the exercise intervention would affect girls more than boys and that this would primarily be demonstrated in less sagittal plane excursions, increased vertical ground reaction forces and knee valgus moments for girls than for boys. Study Design: Controlled laboratory study. Methods: Male and female soccer and handball players (n = 288; age range, 9-12 years) were recruited. A motion capture system synchronized to a force platform was used to record 5 trials of a cutting maneuver before and after a 5-minute fatigue intervention. Linear mixed models were constructed, and analysis of variance was used to analyze differences in outcomes associated with the sex of the athletes. Results: Boys showed greater peak knee valgus moment (0.26 vs 0.22 N·m/kg, respectively; P = .048), peak knee internal rotation moment (–0.13 vs –0.10 N·m/kg, respectively; P = .021), knee rotation excursion (–7.9° vs –6.9°, respectively; P = .014), and knee extension excursion (2.7° vs 1.4°, respectively; P < .001) compared with that in girls. A significant sex × fatigue intervention interaction ( F = 7.6; P = .006) was found, which was caused by a greater increase in first peak vertical ground-reaction force (vGRF) from before to after the fatigue intervention for girls (15.3 to 16.0 N/kg) compared with boys (16.4 to 16.5 N/kg). Conclusion: Differences detected for biomechanical factors during the cutting maneuver do not point to a greater ACL injury risk for prepubescent or early pubescent girls than for boys. Nonetheless, girls go on to develop more detrimental movement patterns in adolescence than those in boys in terms of biomechanical risk factors. Clinical Relevance: Early adolescence is a good target age to learn and develop muscular control; balance, strength; flexibility; and jumping, running, and landing control. This time of physical and athletic growth may therefore be an appropriate period to influence biomechanical factors and thereby task execution and the injury risk.
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Schilaty, Nathan D., Nathaniel A. Bates, Christopher V. Nagelli, Aaron J. Krych, and Timothy E. Hewett. "Sex-Based Differences of Medial Collateral Ligament and Anterior Cruciate Ligament Strains With Cadaveric Impact Simulations." Orthopaedic Journal of Sports Medicine 6, no. 4 (2018): 232596711876521. http://dx.doi.org/10.1177/2325967118765215.
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Background: Female patients sustain noncontact knee ligament injuries at a greater rate compared with their male counterparts. The cause of these differences in the injury rate and the movements that load the ligaments until failure are still under dispute in the literature. Purpose/Hypotheses: This study was designed to determine differences in anterior cruciate ligament (ACL) and medial collateral ligament (MCL) strains between male and female cadaveric specimens during a simulated athletic task. The primary hypothesis tested was that female limbs would demonstrate significantly greater ACL strain compared with male limbs under similar loading conditions. A secondary hypothesis was that MCL strain would not differ between sexes. Study Design: Controlled laboratory study. Methods: Motion analysis of 67 athletes performing a drop vertical jump was conducted. Kinetic data were used to categorize injury risk according to tertiles, and these values were input into a cadaveric impact simulator to assess ligamentous strain during a simulated landing task. Uniaxial and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect mechanical data for analysis. Conditions of external loads applied to the cadaveric limbs (knee abduction moment, anterior tibial shear, and internal tibial rotation) were varied and randomized. Data were analyzed using 1-way analysis of variance (ANOVA), 2-way repeated-measures ANOVA, and the Fisher exact test. Results: There were no significant differences ( P = .184) in maximum ACL strain between male (13.2% ± 8.1%) and female (16.7% ± 8.3%) specimens. Two-way ANOVA demonstrated that across all controlled external load conditions, female specimens consistently attained at least 3.5% increased maximum ACL strain compared with male specimens ( F1,100 = 4.188, P = .043); however, when normalized to initial contact, no significant difference was found. There were no significant differences in MCL strain between sexes for similar parameters. Conclusion: When compared with baseline, female specimens exhibited greater values of ACL strain at maximum, initial contact, and after impact (33, 66, and 100 milliseconds, respectively) than male specimens during similar loading conditions, with a maximum strain difference of at least 3.5%. During these same loading conditions, there were no differences in MCL loading between sexes, and only a minimal increase of MCL loading occurred during the impact forces. Our results indicate that female patients are at an increased risk for ACL strain across all similar conditions compared with male patients. Clinical Relevance: These data demonstrate that female specimens, when loaded similarly to male specimens, experience additional strain on the ACL. As the mechanical environment was similar for both sexes with these simulations, the greater ACL strain of female specimens must be attributed to ligament biology, anatomic differences, or muscular stiffness.
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Jenkins, Walter L., D. S. Blaise Williams, Kelsey Williams, Josh Hefner, and Hannah Welch. "Sex differences in total frontal plane knee movement and velocity during a functional single-leg landing." Physical Therapy in Sport 24 (March 2017): 1–6. http://dx.doi.org/10.1016/j.ptsp.2016.09.005.
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Romero-Franco, Natalia, Juan Antonio Montaño-Munuera, Juan Carlos Fernández-Domínguez, and Pedro Jiménez-Reyes. "Validity and Reliability of a Digital Inclinometer to Assess Knee Joint Position Sense in an Open Kinetic Chain." Journal of Sport Rehabilitation 28, no. 4 (2019): 332–38. http://dx.doi.org/10.1123/jsr.2017-0221.
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Context: New methods are being validated to easily evaluate the knee joint position sense (JPS) due to its role in the sports movement and the risk of injury. However, no studies to date have considered the open kinetic chain (OKC) technique, despite the biomechanical differences compared with closed kinetic chain movements. Objective: To analyze the validity and reliability of a digital inclinometer to measure the knee JPS in the OKC movement. Design: The validity and intertester and intratester reliability of a digital inclinometer for measuring knee JPS were evaluated. Setting: Sports research laboratory. Participants: A total of 18 athletes (11 males and 7 females; 28.4 [6.6] y; 71.9 [14.0] kg; 1.77 [0.09] m; 22.8 [3.2] kg/m2) voluntary participated in this study. Main Outcomes Measures: Absolute angular error (AAE), relative angular error (RAE), and variable angular error (VAE) of knee JPS in an OKC. Results: Intraclass correlation coefficient (ICC) and standard error of the mean (SEM) were calculated to determine the validity and reliability of the inclinometer. Data showed excellent validity of the inclinometer to obtain proprioceptive errors compared with the video analysis in JPS tasks (AAE: ICC = .981, SEM = 0.08; RAE: ICC = .974, SEM = 0.12; VAE: ICC = .973, SEM = 0.07). Intertester reliability was also excellent for all the proprioceptive errors (AAE: ICC = .967, SEM = 0.04; RAE: ICC = .974, SEM = 0.03; VAE: ICC = .939, SEM = 0.08). Similar results were obtained for intratester reliability (AAE: ICC = .861, SEM = 0.1; RAE: ICC = .894, SEM = 0.1; VAE: ICC = .700, SEM = 0.2). Conclusions: The digital inclinometer is a valid and reliable method to assess the knee JPS in OKC. Sport professionals may evaluate the knee JPS to monitor its deterioration during training or improvements throughout the rehabilitation process.
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Arnwine, Rachael A., and Douglas W. Powell. "Sex Differences in Ground Reaction Force Profiles of Ballet Dancers During Single- and Double-Leg Landing Tasks." Journal of Dance Medicine & Science 24, no. 3 (2020): 113–17. http://dx.doi.org/10.12678/1089-313x.24.3.113.
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It is well known that sex differences exist in landing biomechanics in athletes, and these differences are purported to underlie a prevalence of traumatic knee injuries in females compared to males. However, it remains unknown if these differences also apply to artistic athletes such as dancers. The purpose of this study was to investigate sex differences in ground reaction forces (GRFs) between male and female dancers during single- and double-leg dance-specific landing movements. Fourteen pre-professional and professional ballet dancers (seven female and seven male) performed grand jeté (single-leg landing) and sauté (double-leg landing) jumps onto two force platforms. Visual3D was used to calculate the resulting GRF time-series, and MAT-LAB to select discrete variables of interest including peak vertical GRF, loading rate, landing duration, and vertical impulse. Paired t-tests were used to compare mean GRF variables between male and female dancers. During single-leg landing male dancers had smaller peak vertical GRFs (p < 0.01), greater time-to-peak GRF (p = 0.03), and smaller loading rates (p < 0.01) than female dancers. No differences were observed in vertical impulse during single-leg landing or in any variables during double-leg landing. These results indicate that sex differences in landing GRFs are most evident in single-leg landing and may underlie divergent injury rates in male and female dancers. Further investigation of relevant lower extremity biomechanics during single- and double-leg landing in male and female dancers should be conducted to identify the mechanisms underlying these distinct GRF profiles.
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Grooms, Dustin R., Ajit Chaudhari, Stephen J. Page, Deborah S. Nichols-Larsen, and James A. Onate. "Visual-Motor Control of Drop Landing After Anterior Cruciate Ligament Reconstruction." Journal of Athletic Training 53, no. 5 (2018): 486–96. http://dx.doi.org/10.4085/1062-6050-178-16.
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Context: Visual feedback is crucial in the control of human movement. When vision is obstructed, alterations in landing neuromuscular control may increase movements that place individuals at risk for injury. Anterior cruciate ligament (ACL) injury may further alter the motor-control response to alterations in visual feedback. The development of stroboscopic glasses that disrupt visual feedback without fully obscuring it has enabled researchers to assess visual-motor control during movements that simulate the dynamic demands of athletic activity. Objective: To investigate the effect of stroboscopic visual-feedback disruption (SVFD) on drop vertical-jump landing mechanics and to determine whether injury history influenced the effect. Design: Cohort study. Setting: Movement-analysis laboratory. Patients or Other Participants: A total of 15 participants with ACL reconstruction (ACLR; 7 men, 8 women; age = 21.41 ± 2.60 years, height = 1.72 ± 0.09 m, mass = 69.24 ± 15.24 kg, Tegner Activity Scale score = 7.30 ± 1.30, time since surgery = 36.18 ± 26.50 months, hamstrings grafts = 13, patellar tendon grafts = 2) and 15 matched healthy control participants (7 men, 8 women; age = 23.15 ± 3.48 years, height = 1.73 ± 0.09 m, mass = 69.98 ± 14.83 kg, Tegner Activity Scale score = 6.77 ± 1.48). Intervention(s): Drop vertical-jump landings under normal and SVFD conditions. Main Outcome Measure(s): The SVFD effect for knee sagittal- and frontal-plane excursions, peak moments, and vertical ground reaction force were calculated during landing and compared with previously established measurement error and between groups. Results: The SVFD altered knee sagittal-plane excursion (4.04° ± 2.20°, P = .048) and frontal-plane excursion (1.98° ± 1.53°, P = .001) during landing above within-session measurement error. Joint-moment difference scores from full vision to the SVFD condition were not greater than within-session error. We observed an effect of ACLR history only for knee flexion (ACLR group = 3.12° ± 3.76°, control group = −0.84° ± 4.45°; P = .001). We did not observe an effect of side or sex. Conclusions: The SVFD altered sagittal- and frontal-plane landing knee kinematics but did not alter moments. Anterior cruciate ligament reconstruction may induce alterations in sagittal-plane visual-motor control of the knee. The group SVFD effect was on a level similar to that of an in-flight perturbation, motor-learning intervention, or plyometric-training program, indicating that visual-motor ability may contribute to knee neuromuscular control on a clinically important level. The individual effects of the SVFD indicated possible unique sensorimotor versus visual-motor movement strategies during landing.
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Dwyer, Maureen K., Samantha N. Boudreau, Carl G. Mattacola, Timothy L. Uhl, and Christian Lattermann. "Comparison of Lower Extremity Kinematics and Hip Muscle Activation During Rehabilitation Tasks Between Sexes." Journal of Athletic Training 45, no. 2 (2010): 181–90. http://dx.doi.org/10.4085/1062-6050-45.2.181.
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Abstract Context: Closed kinetic chain exercises are an integral part of rehabilitation programs after lower extremity injury. Sex differences in lower extremity kinematics have been reported during landing and cutting; however, less is known about sex differences in movement patterns and activation of the hip musculature during common lower extremity rehabilitation exercises. Objective: To determine whether lower extremity kinematics and muscle activation levels differ between sexes during closed kinetic chain rehabilitation exercises. Design: Cross-sectional with 1 between-subjects factor (sex) and 1 within-subjects factor (exercise). Setting: Research laboratory. Patients or Other Participants: Participants included 21 women (age = 23 ± 5.8 years, height = 167.6 ± 5.1 cm, mass = 63.7 ± 5.9 kg) and 21 men (age = 23 ± 4.0 years, height = 181.4 ± 7.4 cm, mass = 85.6 ± 16.5 kg). Intervention(s): In 1 testing session, participants performed 3 trials each of single-leg squat, lunge, and step-up-and-over exercises. Main Outcome Measure(s): We recorded the peak joint angles (degrees) of knee flexion and valgus and hip flexion, extension, adduction, and external rotation for each exercise. We also recorded the electromyographic activity of the gluteus maximus, rectus femoris, adductor longus, and bilateral gluteus medius muscles for the concentric and eccentric phases of each exercise. Results: Peak knee flexion angles were smaller and peak hip extension angles were larger for women than for men across all tasks. Peak hip flexion angles during the single-leg squat were smaller for women than for men. Mean root-mean-square amplitudes for the gluteus maximus and rectus femoris muscles in both the concentric and eccentric phases of the 3 exercises were greater for women than for men. Conclusions: Sex differences were observed in sagittal-plane movement patterns during the rehabilitation exercises. Because of the sex differences observed in our study, future researchers need to compare the findings for injured participants by sex to garner a better representation of altered kinematic angles and muscle activation levels due to injury.
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Shahmohammadi, Mehrdad, Hossein Karami, Milad Salimi Bani, Hossein Bahreini Zadeh, Alireza Karimi, and Mahdi Navidbakhsh. "A Comparative Study on the Kinematic Biomechanical Effects of Tibia Vara in the Healthy and Diseased Individuals." Journal of Multiscale Modelling 07, no. 03 (2016): 1650005. http://dx.doi.org/10.1142/s1756973716500050.
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BACKGROUND: Malalignment about the knee leads to a pathological-mechanical load that may cause early osteoarthritis of the knee joint and high degree of deformity which may need surgical treatment. Analysis of the leg movements in the experimental cases and comparing acquired results to the normal ones during the gait is used as a practical method to evaluate the effects of the disease. METHOD: In this study, gait differences between the patients with tibia vara and normal people were studied according to the data obtained from a three-dimensional (3D) motion analyzer. Various parameters, including positions, linear and angular velocities, linear and angular accelerations, total velocity, total acceleration, and path length at different angels were extracted and processed via a 3D motion analyzer. Then the results of the patient and control groups were compared to identify the differences. RESULTS: The maximum and average values as well as sample entropy were also calculated for all the mentioned parameters. Among all, only nine remarkable differences between these two groups were observed. The results revealed that the great difference between the patients with tibia vara compared to the normal ones in gait cycle lies on the abnormal movement of fibula bone and less irregularities along the [Formula: see text]-axis. CONCLUSIONS: These findings may have implications not only for understanding the differences between the tibia vara in the healthy and diseased individuals, but also for providing a practical understanding for the medical and orthopedic experts to propose a better treatment method.
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Ives, Stephen J., John McDaniel, Melissa A. H. Witman, and Russell S. Richardson. "Passive limb movement: evidence of mechanoreflex sex specificity." American Journal of Physiology-Heart and Circulatory Physiology 304, no. 1 (2013): H154—H161. http://dx.doi.org/10.1152/ajpheart.00532.2012.
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Previous studies have determined that premenopausal women exhibit an attenuated metaboreflex; however, little is known about sex specificity of the mechanoreflex. Thus, we sought to determine if sex differences exist in the central and peripheral hemodynamic responses to passive limb movement. Second-by-second measurements of heart rate, stroke volume, cardiac output (CO), mean arterial pressure, and femoral artery blood flow (FBF) were recorded during 3 min of supine passive knee extension in 24 young healthy subjects (12 women and 12 men). Normalization of CO and stroke volume to body surface area, expressed as cardiac index and stroke index, eliminated differences in baseline central hemodynamics, whereas, peripherally, basal FBF and femoral vascular conductance were similar between the sexes. In response to passive limb movement, women displayed significantly attenuated peak central hemodynamic responses compared with men (heart rate: 9.0 ± 1 vs. 14.8 ± 2% change, stroke index: 4.5 ± 0.6 vs. 7.8 ± 1.2% change, cardiac index: 9.6 ± 1 vs. 17.2 ± 2% change, all P < 0.05), whereas movement induced similar increases in peak FBF (167 ± 32 vs. 193 ± 17% change) and femoral vascular conductance (172 ± 31 vs. 203 ± 16% change) in both sexes (women vs. men, respectively). Additionally, there was a significant positive relationship between individual peak FBF and peak CO response to passive movement in men but not in women. Thus, although both sexes exhibited similar movement-induced hyperemia and peripheral vasodilatory function, the central hemodynamic response was blunted in women, implying an attenuated mechanoreflex. Therefore, this study reveals that, as already recognized with the metaboreflex, there is likely a sex-specific attenuation of the mechanoreflex in women.
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VandenBerg, Curtis D., Mia J. Katzel, Veronica Beltran, Adriana S. Conrad-Forrest, and Tishya A. L. Wren. "EFFECT OF AUTOGRAFT TYPE ON RECOVERY OF KNEE EXTENSOR MECHANISM FUNCTION FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl3 (2021): 2325967121S0009. http://dx.doi.org/10.1177/2325967121s00094.
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Background: While multiple studies have shown clear benefits of autograft over allograft for anterior cruciate ligament reconstruction (ACLR) in young athletes, disagreement remains regarding the optimal autograft choice. Recovery from ACLR may be influenced by autograft type, which can include iliotibial band (IT), hamstring tendon (HT), quadriceps tendon (QT), or patellar tendon (PT) depending on skeletal maturity and surgeon preference. Hypothesis/Purpose: This study compared knee joint function among pediatric athletes with different types of ACLR autografts. We hypothesized that knee extensor function would recover faster for graft types that did not disrupt the knee extensor mechanism (i.e., IT and HT vs. PT and QT). Methods: This retrospective study examined 138 pediatric athletes (73 female; mean age 15.5, SD 2.2, range 8-21 years) who had undergone sports biomechanical testing in our motion analysis laboratory following recent unilateral ACLR (mean 7.7, range 3-18 months post-surgery). All reconstructions used autografts including 20 IT, 26 HT, 37 QT, and 55 PT. Lower extremity sagittal plane kinematics and kinetics were measured during vertical drop jump landing (41 cm height) and 45° cutting. Maximum knee flexion angles, internal knee extensor moments, and energy absorption during the landing phase (initial contact to peak knee flexion) of each movement were compared among graft types and sides (ACLR vs. contralateral) using linear mixed models with sex, age, and time since surgery as covariates. Results: Knee flexion was significantly lower on the operated vs. contralateral side for HT, QT, and PT during drop jump and for QT and PT during cutting (p<0.001). All graft types exhibited lower knee extensor moments and energy absorption on the operated side (p<0.05). This asymmetry was most pronounced for QT and PT and least pronounced for IT (Figure 1.1). Loading on the operated limb decreased from IT to HT to QT and PT, while loading on the contralateral limb increased similarly. Asymmetry of kinetics was significantly lower for IT compared with both QT and PT during both movements (p<0.01). Similar patterns were observed for HT but were not always statistically significant. No differences in asymmetry were observed between IT and HT or between QT and PT. Conclusion: Young athletes with IT and HT autografts exhibit greater engagement of the knee extensors during dynamic loading than peers with PT or QT autografts in the 18 months following ACLR. This may be due to extensor mechanism donor site morbidity associated with PT and QT grafts. Tables/Figures: [Figure: see text]
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Selhorst, Mitchell, Alicia Fernandez-Fernandez, and M. Samuel Cheng. "Rasch analysis of the anterior knee pain scale in adolescents with patellofemoral pain." Clinical Rehabilitation 34, no. 12 (2020): 1512–19. http://dx.doi.org/10.1177/0269215520942950.
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Objective: The aim of this study was to evaluate the Anterior Knee Pain Scale in a cohort of adolescents being treated conservatively for patellofemoral pain using Rasch analysis. Design: This is a psychometric study. Setting: Physical therapy clinics of a large pediatric hospital in Columbus, Ohio (United States) Subjects: A total of 646 adolescent patients with patellofemoral pain (76% female, 14.6 ± 1.6 years old). Intervention: Not applicable. Main Measure: The Anterior Knee Pain Scale. Results: The median Anterior Knee Pain Scale score was 73 (interquartile range 64–81), with scores ranging from 7 to 100 on the 100-point scale. The Rasch person reliability for the Anterior Knee Pain Scale was 0.74 and the Cronbach’s alpha was 0.75, representing an acceptable person reliability. Principal component analysis revealed a ratio of 5.2:1 demonstrating acceptable unidimensionality of the Anterior Knee Pain Scale. A significant misfit was observed in the item “Abnormal Painful Kneecap Movements” (Outfit Means Square 2.74, Infit Means Square 1.41). Ordering of item responses was unsatisfactory as only five of the 13 items demonstrated appropriate distinction between each of the responses. There was no differential item functioning for sex or age for all items of the Anterior Knee Pain Scale, based upon the criterion of ⩾ 0.5 logit difference. Conclusion: The Anterior Knee Pain Scale does not meet interval-level measurement criteria and should be considered ordinal level data.
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McKay, Marnee J., Jennifer N. Baldwin, Paulo Ferreira, Milena Simic, Natalie Vanicek, and Joshua Burns. "Normative reference values for strength and flexibility of 1,000 children and adults." Neurology 88, no. 1 (2016): 36–43. http://dx.doi.org/10.1212/wnl.0000000000003466.
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Objective:To establish reference values for isometric strength of 12 muscle groups and flexibility of 13 joint movements in 1,000 children and adults and investigate the influence of demographic and anthropometric factors.Methods:A standardized reliable protocol of hand-held and fixed dynamometry for isometric strength of ankle, knee, hip, elbow, and shoulder musculature as well as goniometry for flexibility of the ankle, knee, hip, elbow, shoulder, and cervical spine was performed in an observational study investigating 1,000 healthy male and female participants aged 3–101 years. Correlation and multiple regression analyses were performed to identify factors independently associated with strength and flexibility of children, adolescents, adults, and older adults.Results:Normative reference values of 25 strength and flexibility measures were generated. Strong linear correlations between age and strength were identified in the first 2 decades of life. Muscle strength significantly decreased with age in older adults. Regression modeling identified increasing height as the most significant predictor of strength in children, higher body mass in adolescents, and male sex in adults and older adults. Joint flexibility gradually decreased with age, with little sex difference. Waist circumference was a significant predictor of variability in joint flexibility in adolescents, adults, and older adults.Conclusions:Reference values and associated age- and sex-stratified z scores generated from this study can be used to determine the presence and extent of impairments associated with neuromuscular and other neurologic disorders, monitor disease progression over time in natural history studies, and evaluate the effect of new treatments in clinical trials.
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James, E. W., J. L. Blevins, E. B. Gausden, et al. "Increased utilization of constraint in total knee arthroplasty following anterior cruciate ligament and multiligament knee reconstruction." Bone & Joint Journal 101-B, no. 7_Supple_C (2019): 77–83. http://dx.doi.org/10.1302/0301-620x.101b7.bjj-2018-1492.r1.
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Aims Anterior cruciate ligament (ACL) and multiligament knee (MLK) injuries increase the risk of development of knee osteoarthritis and eventual need for total knee arthroplasty (TKA). There are limited data regarding implant use and outcomes in these patients. The aim of this study was to compare the use of constrained implants and outcomes among patients undergoing TKA with a history of prior knee ligament reconstruction (PKLR) versus a matched cohort of patients undergoing TKA with no history of PKLR. Patients and Methods Patients with a history of ACL or MLK reconstruction who underwent TKA between 2007 and 2017 were identified in a single-institution registry. There were 223 patients who met inclusion criteria (188 ACL reconstruction patients, 35 MLK reconstruction patients). A matched cohort, also of 223 patients, was identified based on patient age, body mass index (BMI), sex, and year of surgery. There were 144 male patients and 79 female patients in both cohorts. Mean age at the time of TKA was 57.2 years (31 to 88). Mean BMI was 29.7 kg/m2 (19.5 to 55.7). Results There was a significantly higher use of constrained implants among patients with PKLR (76 of 223, 34.1%) compared with the control group (40 of 223, 17.9%; p < 0.001). Subgroup analysis showed a higher use of constrained implants among patients with prior MLK reconstruction (21 of 35, 60.0%) compared with ACL reconstruction (55 of 188, 29.3%; p < 0.001). Removal of hardware was performed in 69.5% of patients with PKLR. Mean operative time (p < 0.001) and tourniquet time (p < 0.001) were longer in patients with PKLR compared with controls. There were no significant differences in rates of deep vein thrombosis, pulmonary embolism, infection, transfusion, postoperative knee range of movement (ROM), or need for revision surgery. There was no significant difference in preoperative or postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) scores between groups. Conclusion Results of this study suggest a history of PKLR results in increased use of constrained implants but no difference in postoperative knee ROM, patient-reported outcomes, or incidence of revision surgery. Cite this article: Bone Joint J 2019;101-B(7 Supple C):77–83
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Chimera, Nicole J., Craig A. Smith, and Meghan Warren. "Injury History, Sex, and Performance on the Functional Movement Screen and Y Balance Test." Journal of Athletic Training 50, no. 5 (2015): 475–85. http://dx.doi.org/10.4085/1062-6050-49.6.02.
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ContextResearch is limited regarding the effects of injury or surgery history and sex on the Functional Movement Screen (FMS) and Y Balance Test (YBT).ObjectiveTo determine if injury or surgery history or sex affected results on the FMS and YBT.DesignCross-sectional study.SettingAthletic training facilities.Patients or Other ParticipantsA total of 200 National Collegiate Athletic Association Division I female (n = 92; age = 20.0 ± 1.4 years, body mass index = 22.8 ± 3.1 kg/m2) and male (n = 108; age = 20.0 ± 1.5 years, body mass index = 27.0 ± 4.6 kg/m2) athletes were screened; 170 completed the FMS, and 190 completed the YBT.Intervention(s)A self-reported questionnaire identified injury or surgery history and sex. The FMS assessed movement during the patterns of deep squat, hurdle step, in-line lunge, shoulder mobility, impingement-clearing test, straight-leg raise, trunk stability push-up, press-up clearing test, rotary stability, and posterior-rocking clearing test. The YBT assessed balance while participants reached in anterior, posteromedial, and posterolateral directions.Main Outcome Measure(s)The FMS composite score (CS; range, 0–21) and movement pattern score (range, 0–3), the YBT CS (% lower extremity length), and YBT anterior, posteromedial, and posterolateral asymmetry (difference between limbs in centimeters). Independent-samples t tests established differences in mean FMS CS, YBT CS, and YBT asymmetry. The Mann-Whitney U test identified differences in FMS movement patterns.ResultsWe found lower overall FMS CSs for the following injuries or surgeries: hip (injured = 12.7 ± 3.1, uninjured = 14.4 ± 2.3; P = .005), elbow (injured = 12.1 ± 2.8, uninjured = 14.3 ± 2.4; P = .02), and hand (injured = 12.3 ± 2.9, uninjured = 14.3 ± 2.3; P = .006) injuries and shoulder surgery (surgery = 12.0 ± 1.0, no surgery = 14.3 ± 2.4; P &lt; .001). We observed worse FMS movement pattern performance for knee surgery (rotary stability: P = .03), hip injury (deep squat and hurdle: P &lt; .042 for both), hip surgery (hurdle and lunge: P &lt; .01 for both), shoulder injury (shoulder and hand injury: P &lt; .02 for both), and shoulder surgery (shoulder: P &lt; .02). We found better FMS movement pattern performance for trunk/back injury (deep squat: P = .02) and ankle injury (lunge: P = .01). Female athletes performed worse in FMS movement patterns for trunk (P &lt; .001) and rotary (P = .01) stability but better in the lunge (P = .008), shoulder mobility (P &lt; .001), and straight-leg raise (P &lt; .001). Anterior asymmetry was greater for male athletes (P = .02).ConclusionsInjury history and sex affected FMS and YBT performance. Researchers should consider adjusting for confounders.
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Diekfuss, Jed A., Anna J. Saltman, Dustin R. Grooms, et al. "NEURAL CORRELATES OF KNEE MOTOR CONTROL FOR YOUNG FEMALES WITH PATELLOFEMORAL PAIN." Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (2019): 2325967119S0001. http://dx.doi.org/10.1177/2325967119s00012.
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Background: Patellofemoral pain (PFP) is a common knee pain condition that affects up to 30% of adolescents and is disproportionately distributed between sexes, affecting females 2-10 times more frequently than male counterparts (Fulkerson, 2002). PFP, characterized by retro- or peripatellar pain, can be debilitating, leading to cessation of physical activity in 74% of adolescents (Fairbank, Pynsent, van Poortvliet, & Phillips, 1984). Aberrant lower-extremity biomechanics for those with PFP has been identified (Souza & Powers, 2009; Willson & Davis, 2008), but the underlying brain activation patterns contributing to pain-disrupted knee motor control is unknown. Patients with knee ligament deficiency demonstrate decreased sensorimotor activity and increased prelimbic activity in response to knee pain, compared with matched controls (Kadowaki, Tadenuma, Kumahashi, & Uchio, 2017), and those with knee ligament reconstruction demonstrate a disrupted sensory-motor brain activation strategy to control the knee (Grooms et al., 2017; Grooms, Page, & Onate, 2015). As PFP has been identified as a contributing factor to knee osteoarthritis later in life (Utting, Davies, & Newman, 2005), identifying the neural mechanisms driving pain-disrupted motor control could guide innovative neural-targeted interventions to treat and reduce knee pain. We hypothesized that patients with PFP, like those with knee ligament deficiencies and reconstruction, would demonstrate decreased sensorimotor brain activation and increased medial pain network brain activation to control the knee. We used our previously established knee motor control neuroimaging paradigm that simulates knee flexion and extension movements (Grooms et al., 2015) to identify altered neural activation patterns for those with PFP and compared those with matched controls. Methods: Four adolescent girls with patellofemoral pain (PFP: n = 4, 15.4 ± 2.2yrs, 158.5 ± 5.4 cm, 61.5 ± 15.6 kg) were matched with four adolescent girls with no history of knee pain (controls) based on age, height, and weight (Con: n =4, 16.4 ± 1.8yrs, 161.8 ± 5.1 cm, 54.9 ± 6.9 kg). Participants were positioned supine in a magnetic resonance imaging (MRI) scanner and completed a series of unilateral 45° knee extension/flexion movements at a velocity of 1.2 Hz (Figure 1; Left Panel). Various torso straps and head packing procedures were utilized to restrict excessive head motion. A second level mixed-effects (FLAME 1+2) independent samples t-test contrasted brain activation between the PFP and controls using a significance level set a priori at p < .05; Gaussian random field cluster corrected and z threshold set at z > 1.5. Results: Results revealed significantly depressed brain activation in the right parietal operculum cortex (z = 5.99, p < .001) and left Heschl’s gyrus (z = 3.83, p < .001) for the PFP compared to the controls (Figure 1; Right Panel). Discussion: The present study revealed significant differences in the neural activation patterns to control the knee between adolescent girls with PFP and those with no knee pain. Patients with PFP demonstrated less activation in sensorimotor cortices, seen in the parietal operculum, and sensory integration, seen in Heschl’s gyrus, when compared to healthy controls (Grooms et al., 2017; Kadowaki et al., 2017). These results indicate that pain may be suppressing sensory integration to control the knee for those with PFP. Congruent with previous neuroimaging investigations assessing those with knee injury (Grooms et al., 2017; Kadowaki et al., 2017), PFP appears to also induce neuroplastic effects identifiable using fMRI. These results provide a potential neural target for interventions that aim to restore sensorimotor integration in those with PFP, reduce pain, and restore an active lifestyle in young females. [Figure: see text]
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Hogg, Jennifer A., Randy J. Schmitz, Anh-Dung Nguyen, and Sandra J. Shultz. "Passive Hip Range-of-Motion Values Across Sex and Sport." Journal of Athletic Training 53, no. 6 (2018): 560–67. http://dx.doi.org/10.4085/1062-6050-426-16.
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Context: Greater passive hip range of motion (ROM) has been associated with greater dynamic knee valgus and thus the potential for increased risk of anterior cruciate ligament injuries. Normative data for passive hip ROM by sex are lacking. Objective: To establish and compare passive hip ROM values by sex and sport and to quantify side-to-side differences in internal-rotation ROM (ROMIR), external-rotation ROM (ROMER), and total ROM (ROMTOT). Design: Cross-sectional study. Setting: Station-based, preparticipation screening. Patients or Other Participants: A total of 339 National Collegiate Athletic Association Division I athletes, consisting of 168 women (age = 19.2 ± 1.2 years, height = 169.0 ± 7.2 cm, mass = 65.3 ± 10.2 kg) and 171 men (age = 19.4 ± 1.3 years, height = 200.0 ± 8.6 cm, mass = 78.4 ± 12.0 kg) in 6 sports screened over 3 years: soccer (58 women, 67 men), tennis (20 women, 22 men), basketball (28 women, 22 men), softball or baseball (38 women, 31 men), cross-country (18 women, 19 men), and golf (6 women, 10 men). Main Outcome Measure(s): Passive hip ROM was measured with the athlete lying prone with the hip abducted to 20° to 30° and knee flexed to 90°. The leg was passively internally and externally rotated until the point of sacral movement. Three measures were averaged for each direction and leg and used for analysis. We compared ROMIR, ROMER, ROMTOT (ROMTOT = ROMIR + ROMER), and relative ROM (ROMREL = ROMIR − ROMER) between sexes and among sports using separate 2 × 6 repeated-measures analyses of variance. Results: Women had greater ROMIR (38.1° ± 8.2° versus 28.6° ± 8.4°; F1,327 = 91.74, P &lt; .001), ROMTOT (72.1° ± 10.6° versus 64.4° ± 10.1°; F1,327 = 33.47, P &lt; .001), and ROMREL (1.5° ± 16.0° versus −7.6° ± 16.5°; F1,327 = 37.05, P &lt; .001) than men but similar ROMER (34.0° ± 12.2° versus 35.8° ± 11.5°; F1,327 = 1.65, P = .20) to men. Cross-country athletes exhibited greater ROMIR (37.0° ± 9.3° versus 30.9° ± 9.4° to 33.3° ± 9.5°; P = .001) and ROMREL (5.9° ± 18.3° versus −9.6° ± 16.9° to −2.7° ± 17.3°; P = .001) and less ROMER (25.7° ± 7.5° versus 35.0° ± 13.0° to 40.2° ± 12.0°; P &lt; .001) than basketball, soccer, softball or baseball, and tennis athletes. They also displayed less ROMTOT (62.7° ± 8.1° versus 70.0° ± 9.1° to 72.9° ± 11.9°; P &lt; .001) than basketball, softball or baseball, and tennis athletes. Conclusions: Women had greater ROMIR than men, resulting in greater ROMTOT and ROMREL. Researchers should examine the extent to which this greater bias toward ROMIR may explain women's greater tendency for dynamic knee valgus. With the exception of cross-country, ROM values were similar across sports. The clinical implications of these aberrant cross-country values require further study.
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Lewis, Cara L., Hanna D. Foley, Theresa S. Lee, and Justin W. Berry. "Hip-Muscle Activity in Men and Women During Resisted Side Stepping With Different Band Positions." Journal of Athletic Training 53, no. 11 (2018): 1071–81. http://dx.doi.org/10.4085/1062-6050-46-16.
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ContextWeakness or decreased activation of the hip abductors and external rotators has been associated with lower extremity injury, especially in females. Resisted side stepping is commonly used to address hip weakness. Whereas multiple variations of this exercise are used clinically, few data exist regarding which variations to select.ObjectiveTo investigate differences in muscle-activation and movement patterns and determine kinematic and limb-specific differences between men and women during resisted side stepping with 3 resistive-band positions.DesignControlled laboratory study.SettingLaboratory.Patients or Other ParticipantsA total of 22 healthy adults (11 men, 11 women; age = 22.8 ± 3.0 years, height = 171.6 ± 10.7 cm, mass = 68.5 ± 11.8 kg).Intervention(s)Participants side stepped with the resistive band at 3 locations (knees, ankles, feet).Main Outcome Measure(s)We collected surface electromyography of the gluteus maximus, gluteus medius, and tensor fascia lata (TFL) for the moving and stance limbs during the concentric and eccentric phases. We also measured trunk inclination, hip and knee flexion, and hip-abduction excursion.ResultsHip-abductor activity was higher in women than in men (P ≤ .04). The pattern of TFL activity in the stance limb differed by sex. Women performed the exercise in greater forward trunk inclination (P = .009) and had greater hip excursion (P = .003). Gluteus maximus and medius activity increased when the band was moved from the knees to the ankles and from the ankles to the feet, whereas TFL activity increased only when the band was moved from the knees to the ankles. Findings were similar for both the stance and moving limbs, but the magnitudes of the changes differed.ConclusionsCompared with placing the band around the ankles, placing the band around the feet for resisted side stepping elicited more activity in the gluteal muscles without increasing TFL activity. This band placement is most appropriate when the therapeutic goal is to activate the muscles that resist hip adduction and internal rotation.
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Lempke, Landon B., Jeonghoon Oh, Rachel S. Johnson, Julianne D. Schmidt, and Robert C. Lynall. "Single- Versus Dual-Task Functional Movement Paradigms: A Biomechanical Analysis." Journal of Sport Rehabilitation 30, no. 5 (2021): 774–85. http://dx.doi.org/10.1123/jsr.2020-0310.
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Context: Laboratory-based movement assessments are commonly performed without cognitive stimuli (ie, single-task) despite the simultaneous cognitive processing and movement (ie, dual task) demands required during sport. Cognitive loading may critically alter human movement and be an important consideration for truly assessing functional movement and understanding injury risk in the laboratory, but limited investigations exist. Objective: To comprehensively examine and compare kinematics and kinetics between single- and dual-task functional movement among healthy participants while controlling for sex. Design: Cross-sectional study. Setting: Laboratory. Patients (or Other Participants): Forty-one healthy, physically active participants (49% female; 22.5 ± 2.1 y; 172.5 ± 11.9 cm; 71.0 ± 13.7 kg) enrolled in and completed the study. Intervention(s): All participants completed the functional movement protocol under single- and dual-task (subtracting by 6s or 7s) conditions in a randomized order. Participants jumped forward from a 30-cm tall box and performed (1) maximum vertical jump landings and (2) dominant and (3) nondominant leg, single-leg 45° cuts after landing. Main Outcome Measures: The authors used mixed-model analysis of variances (α = .05) to compare peak hip, knee, and ankle joint angles (degrees) and moments (N·m/BW) in the sagittal and frontal planes, and peak vertical ground reaction force (N/BW) and vertical impulse (Ns/BW) between cognitive conditions and sex. Results: Dual-task resulted in greater peak vertical ground reaction force compared with single-task during jump landing (mean difference = 0.06 N/BW; 95% confidence interval [CI], 0.01 to 0.12; P = .025) but less force during dominant leg cutting (mean difference = −0.08 N/BW; 95% CI, −0.14 to −0.02; P = .015). Less hip-flexion torque occurred during dual task than single task (mean difference = −0.09 N/BW; 95% CI, −0.17 to −0.02). No other outcomes were different between single and dual task (P ≥ .053). Conclusions: Slight, but potentially important, kinematic and kinetic differences were observed between single- and dual-task that may have implications for functional movement assessments and injury risk research. More research examining how various cognitive and movement tasks interact to alter functional movement among pathological populations is warranted before clinical implementation.
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Bauer, Leandra, Matthias Woiczinski, Christoph Thorwächter, et al. "Secondary Patellar Resurfacing in TKA: A Combined Analysis of Registry Data and Biomechanical Testing." Journal of Clinical Medicine 10, no. 6 (2021): 1227. http://dx.doi.org/10.3390/jcm10061227.
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The German Arthroplasty registry (EPRD) has shown that different prosthesis systems have different rates of secondary patellar resurfacing: four years after implantation, the posterior-stabilized (PS) Vega prosthesis has a 3.2% risk of secondary patellar resurfacing compared to the cruciate-retaining (CR) Columbus prosthesis at 1.0% (both Aesculap AG, Tuttlingen, Germany). We hypothesized that PS implants have increased retropatellar pressure and a decreased retropatellar contact area compared to a CR design, which may lead to an increased likelihood of secondary patellar resurfacing. Eight fresh frozen specimens (cohort 1) were tested with an established knee rig. In addition, a possible influence of the registry-based patient collective (cohort 2) was investigated. No significant differences were found in patient data–cohort 2-(sex, age). A generally lower number of PS system cases is noteworthy. No significant increased patella pressure could be detected with the PS design, but a lower contact area was observed (cohort 1). Lower quadriceps force (100°–130° flexion), increased anterior movement of the tibia (rollback), greater external tilt of the patella, and increasing facet pressure in the Vega PS design indicate a multifactorial cause for a higher rate of secondary resurfacing which was found in the EPRD patient cohort and might be related to the PS’ principle function.
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Ogawa, Mana, Chiaki Ohtaka, Motoko Fujiwara, and Hiroki Nakata. "Kinematic Characteristics of the Standing Long Jump in Young Children Aged 4–5 Years." Journal of Motor Learning and Development 9, no. 1 (2021): 80–94. http://dx.doi.org/10.1123/jmld.2020-0026.
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The authors investigated the kinematic characteristics of the standing long jump in preschool children. Sixty 4-year-old children (boys: 30 and girls: 30) and sixty 5-year-old children (boys: 30 and girls: 30) participated in the present study. The authors focused on three differences in kinematics: between 4- and 5-year-old children, between boys and girls, and between high and low jumping performance groups at the same age. The kinematic data included the maximum flexions of the knee and hip before takeoff, at takeoff, and on landing; angular displacement of the upper body; takeoff speeds in horizontal and vertical directions; and takeoff angle of the greater trochanter. Anthropometric variables and kinematic data were separately analyzed with factors of age, sex, and group. The authors also performed multiple regression analysis to identify predictors of the jump distance. The movement speed of the greater trochanter in a horizontal direction, the maximum flexion angle of the hip before takeoff, and the hip angle on landing were identified as significant predictors of the jump distance among young children. These findings suggest that knowing how to use the hip and awareness of the horizontal direction are key factors to improve the long jump distance in young children.
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Diekfuss, Jed A., Dustin R. Grooms, Kim Barber Foss, et al. "REAL-TIME BIOFEEDBACK INTEGRATED INTO NEUROMUSCULAR TRAINING INCREASES BRAIN FUNCTIONAL CONNECTIVITY AND REDUCES HIGH-RISK KNEE BIOMECHANICS." Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (2019): 2325967119S0002. http://dx.doi.org/10.1177/2325967119s00022.
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Background: Anterior cruciate ligament (ACL) injury is associated with alterations in the central nervous system and resultant sensorimotor control (Courtney et al., 2005; Grooms et al., 2017). Our prospective data indicates that altered knee-motor functional brain connectivity is associated with increased risk for ACL injury (Diekfuss et al., revisions invited), revealing novel neural targets for neuromuscular training interventions. Specifically, interventions that integrate concomitant sensorimotor feedback with injury prevention techniques have the potential to enhance brain functional connectivity to optimize ACL injury risk reduction strategies. To deliver concomitant sensorimotor feedback, we have developed an augmented neuromuscular training (aNMT) system that utilizes interactive, real-time biofeedback to simultaneously target multiple biomechanical variables associated with ACL injury risk (Bonnette et al., in press; Figure 1A). aNMT calculates and maps key biomechanical parameters to an interactive graphical shape that responds in real time as a function of participants’ movements. Participants are instructed to perform exercises to achieve a goal shape, which equates to producing biomechanical parameters associated with ACL injury risk reduction, while deviations toward injury risk factors result in specific shape distortions. We hypothesized that aNMT would significantly improve biomechanics associated with ACL injury risk and also increase knee-motor functional connectivity. We further predicted that the identified connectivity changes would be associated with the hypothesized changes in biomechanics. Methods: Over six weeks of training, participants (n = 25) performed a series of aNMT-based progressive exercises (e.g., squat, overhead squat, squat jump, tuck jump, single-leg Romanian dead lift, pistol squat) and completed a drop vertical jump (DVJ) task while fully instrumented for 3D motion analysis pre- and post-training. Peak knee abduction moment (pKAM; bilateral average) from the DVJ was used as the biomechanical outcome variable. Resting-state functional magnetic resonance imaging (fMRI) scans were also collected pre- and post-training on a subset of the cohort (n = 17). Thirteen additional participants were recruited to serve as untrained controls and completed the DVJ and resting-state fMRI on two testing sessions separated by approximately 6 weeks. Twenty-five knee-motor regions of interest (ROIs) were created based on the areas of brain activation derived from previously published data (Grooms et al., 2015; Kapreli et al., 2007). Paired-samples t tests with a false discovery rate correction for multiple comparisons determined differences in functional connectivity among these 25 ROIs (post > pre). Fisher-transformed Pearson correlation coefficients between the average residual blood oxygen level dependent (BOLD) signal time series extracted from ROIs that demonstrated significant group level changes were associated with pKAM in DVJ task at pre- and post-training. The pre- and post-training Pearson correlation coefficients were subsequently compared using the cocor package (Diedenhofen & Musch, 2015) to determine if the two relationships were significantly different. Results: Results showed that pKAM in the aNMT group was significantly lower following aNMT (p < .05), while no significant changes were found between the two time points for controls (p > .05). Results also revealed significantly greater functional connectivity between the right supplementary motor area (SMA) and the left thalamus at post-training relative to pre-training for the aNMT group, t(16) = 3.37, p = .04 (Figure 1B). No significant differences between the two time points were observed for the controls (all p > .05). The association between pKAM and the right SMA and left thalamus at pre-training (r = -.22; Figure 1C) was significantly different compared to that at post-training (r = .26; Figure 1D), p < .05, with a positive relationship between pKAM and SMA and thalamus activation following aNMT biofeedback. No similar changes in pKAM and right SMA and left thalamus connectivity were observed for the untrained controls, p > .05. Conclusions/Significance: The right SMA is involved in the planning and coordination of movement, and the left thalamus is associated with neuromotor control. The increased functional connectivity between these regions, combined with the reduction in pKAM, which is associated with reduced risk of ACL injury, indicate a possible neural mechanism for improved motor adaption associated with aNMT biofeedback. These findings have distinct implications for ACL injury prevention strategies. Biofeedback tools such as aNMT can be designed to target specifically the neural drivers of aberrant movement biomechanics underlying increased ACL injury risk. [Figure: see text]
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KWON, YURI, JAE-HOON HEO, HYEONG-MIN JEON, et al. "AGE–GENDER DIFFERENCE IN THE BIOMECHANICAL FEATURES OF SIT-TO-STAND MOVEMENT." Journal of Mechanics in Medicine and Biology 16, no. 08 (2016): 1640027. http://dx.doi.org/10.1142/s0219519416400273.
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The purpose of this study was to investigate the effects of age and gender on the biomechanical features of sit-to-stand (STS) movement. Twenty young subjects and 20 elderly subjects participated in this study. Nine events during STS movement were defined where joint angles and joint moments were extracted for further analyses. Two-way repeated measures ANOVA was performed for joint angles and joint moments with age and gender as independent factors. Major gender differences were shown in joint angles. Women used a sliding forward strategy more than men (more flexion of ankle and knee joint) during mid-phases of STS movement ([Formula: see text]) and men used an exaggerated trunk flexion strategy more than women (more hip flexion) in later phases of STS movement ([Formula: see text]). Age differences were shown in joint moments. Elderly subjects showed smaller knee extension moment (normalized by body weight) but greater ankle plantar flexion moment than young subjects in mid-to-late phases of STS movement ([Formula: see text]). More anterior positioning of center of mass (COM) in the elderly might be the reason for the strategy difference. That is, the shorter distance of COM from the knee joint would require less knee extension moment, and likewise, the more forward displacement of COM with respect to the ankle joint would need more plantar flexion moment. More anterior positioning of COM in the elderly, compared to the young was reflected on center of pressure (COP), and the forward displacement of COP was correlated well with the higher body mass index (BMI) and shorter thigh length ([Formula: see text]).
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Hepper, Peter G., E. Alyson Shannon, and James C. Dornan. "Sex differences in fetal mouth movements." Lancet 350, no. 9094 (1997): 1820. http://dx.doi.org/10.1016/s0140-6736(05)63635-5.
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Nicholson, Karen G., and Doreen Kimura. "Sex Differences for Speech and Manual Skill." Perceptual and Motor Skills 82, no. 1 (1996): 3–13. http://dx.doi.org/10.2466/pms.1996.82.1.3.
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Young men and women were compared on the speeded repetition of speech ( ns = 20 and 18, respectively) and manual movements ( ns = 37 and 38). The repetition of a single speech or manual movement was used as a measure of baseline speed, against which to compare a sequence of movements. Males tended to be faster at repeating a single movement, but using baseline speed as a covariate resulted in a female advantage for the repetition of a sequence of movements. It was concluded that men have a basic motor-speed advantage, but that women may be faster at programming a sequence of speech or manual movements. The results are discussed with respect to sexual variation in the neural organization of motor programming systems.
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Otte, Karen, Tobias Ellermeyer, Masahide Suzuki, et al. "Cultural bias in motor function patterns: Potential relevance for predictive, preventive, and personalized medicine." EPMA Journal 12, no. 1 (2021): 91–101. http://dx.doi.org/10.1007/s13167-021-00236-3.
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Abstract Background Quantification of motor performance has a promising role in personalized medicine by diagnosing and monitoring, e.g. neurodegenerative diseases or health problems related to aging. New motion assessment technologies can evolve into patient-centered eHealth applications on a global scale to support personalized healthcare as well as treatment of disease. However, uncertainty remains on the limits of generalizability of such data, which is relevant specifically for preventive or predictive applications, using normative datasets to screen for incipient disease manifestations or indicators of individual risks. Objective This study explored differences between healthy German and Japanese adults in the performance of a short set of six motor tests. Methods Six motor tasks related to gait and balance were recorded with a validated 3D camera system. Twenty-five healthy adults from Chiba, Japan, participated in this study and were matched for age, sex, and BMI to a sample of 25 healthy adults from Berlin, Germany. Recordings used the same technical setup and standard instructions and were supervised by the same experienced operator. Differences in motor performance were analyzed using multiple linear regressions models, adjusted for differences in body stature. Results From 23 presented parameters, five showed group-related differences after adjustment for height and weight (R2 between .19 and .46, p<.05). Japanese adults transitioned faster between sitting and standing and used a smaller range of hand motion. In stepping-in-place, cadence was similar in both groups, but Japanese adults showed higher knee movement amplitudes. Body height was identified as relevant confounder (standardized beta >.5) for performance of short comfortable and maximum speed walks. For results of posturography, regression models did not reveal effects of group or body stature. Conclusions Our results support the existence of a population-specific bias in motor function patterns in young healthy adults. This needs to be considered when motor function is assessed and used for clinical decisions, especially for personalized predictive and preventive medical purposes. The bias affected only the performance of specific items and parameters and is not fully explained by population-specific ethnic differences in body stature. It may be partially explained as cultural bias related to motor habits. Observed effects were small but are expected to be larger in a non-controlled cross-cultural application of motion assessment technologies with relevance for related algorithms that are being developed and used for data processing. In sum, the interpretation of individual data should be related to appropriate population-specific or even better personalized normative values to yield its full potential and avoid misinterpretation.
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Boyan, Barbara D., Laura Tosi, Richard Coutts, et al. "Sex Differences in Osteoarthritis of the Knee." Journal of the American Academy of Orthopaedic Surgeons 20, no. 10 (2012): 668–69. http://dx.doi.org/10.5435/00124635-201210000-00006.
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Boyan, Barbara D., Laura Tosi, Richard Coutts, et al. "Sex Differences in Osteoarthritis of the Knee." Journal of the American Academy of Orthopaedic Surgeons 20, no. 10 (2012): 668–69. http://dx.doi.org/10.5435/jaaos-20-10-668.
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DAVIS, MARADEE A., WALTER H. ETTINGER, JOHN M. NEUHAUS, and WALTER W. HAUCK. "SEX DIFFERENCES IN OSTEOARTHRITIS OF THE KNEE." American Journal of Epidemiology 127, no. 5 (1988): 1019–30. http://dx.doi.org/10.1093/oxfordjournals.aje.a114878.
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Terreri, Antonio Sérgio A. P., Marco A. Ambrósio, André Pedrinelli, et al. "Isokinetic assessment of the flexor-extensor balance of the knee in athletes with total rupture of the anterior cruciate ligament." Revista do Hospital das Clínicas 54, no. 2 (1999): 35–38. http://dx.doi.org/10.1590/s0041-87811999000200001.
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The purpose of this study was to assess the flexor-extensor group of muscles of the knee in young athletes diagnosed with a total rupture of the anterior cruciate ligament (ACL). Eighteen knees of 18 athletes (14 men and 4 women) with an average age of 21.6 years (range 16-32 years) were assessed with a Cybex 6000 model isokinetic apparatus. The average interval between occurrence of the injury and assessment was 10.2 months (range 2 - 48 months). There was an associated meniscal injury in eight of the knees. Athletes with any other kind of associated injury, limitation, or blockage of the movement of the joint, significant pain during the exam, or interval between injury and exam of less than two months were excluded from the study. The parameters studied were the peak torque-velocity and flexor-extensor relationships at the constant angular velocities of 60°/sec and 240°/sec. Previous warming-up was done by means of an ergometric bicycle and adaptation with 3 submaximal repetitions. The contra-lateral side, which presented no injury, was used as control. Peak torque (PT) at the constant velocity of 60°/sec was greater than that at 240°/sec for knees with and without injuries. However, there was no significant difference between the injured and uninjured sides at 60°/sec or at 240°/sec. The average value for the flexor-extensor relationship at 60°/sec on the injured was 60% (( 6), compared to 57% (( 10) on the contra-lateral side. At 240°/sec, the average value was 75% ((10) on the injured side, and 65% ((12) on the contra-lateral side. In conclusion, despite the complete rupture of the ACL of one knee, the average values for the flexor-extensor relationship were similar on the injured and uninjured sides at the velocity of 60°/sec. As the velocity increased, an increase in the values for the flexor-extensor relationship of the knee also occurred, indicating a tendency of the performance of the flexor muscle group to approach that of the extensor muscle group, and this tendency was more pronounced on the side of the injury.
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Sims, Ershela L., Julie M. Carland, Francis J. Keefe, Virginia B. Kraus, Farshid Guilak, and Daniel Schmitt. "Sex Differences in Biomechanics Associated with Knee Osteoarthritis." Journal of Women & Aging 21, no. 3 (2009): 159–70. http://dx.doi.org/10.1080/08952840903054856.
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Sinclair, J., and J. Selfe. "Sex differences in knee loading in recreational runners." Journal of Biomechanics 48, no. 10 (2015): 2171–75. http://dx.doi.org/10.1016/j.jbiomech.2015.05.016.
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McClelland, Jodie A., Julian A. Feller, and Kate E. Webster. "Sex Differences in Gait After Total Knee Arthroplasty." Journal of Arthroplasty 33, no. 3 (2018): 897–902. http://dx.doi.org/10.1016/j.arth.2017.09.061.
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MATINAZAD, NARGESS, ALI ESTEKI, and HAMED GHOMASHCHI. "COMPREHENSIVE CHARACTERIZATION OF GAIT VARIABILITY IN PATIENTS WITH KNEE OSTEOARTHRITIS FOR ALTERED VELOCITIES." Journal of Mechanics in Medicine and Biology 18, no. 04 (2018): 1850041. http://dx.doi.org/10.1142/s0219519418500410.
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This study focuses on quantifying the alterations in human gait variability in individuals with knee Osteoarthritis (OA). To assess the stride-to-stride variation, estimating the dynamical stability discloses the encrypted behavior of the locomotion system, at times facing perturbations, and for that the Largest Lyapunov Exponent is extracted for both Short ([Formula: see text]) and Long ([Formula: see text]) term. Information about the complexity of movement further bolsters the variation-driven conclusions which are calculated for Correlation Index and Kolmogorov–Sinai (K-S) entropy. Using gait analysis, knee angular displacement is the considered data tested for different walking speeds. In the result, [Formula: see text] revealed significant differences between the groups and their walking velocities while [Formula: see text] failed to represent any distinguishable differences. In contrast to the control group, increases in the walking velocity did not affect the amount of locomotion variability for the patients. The stride features also verified the vicissitudes in the gait pattern of knee OA suffering individuals.
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Lewis, Rodney P., Peter H. Buschang, and Gaylord S. Throckmorton. "Sex differences in mandibular movements during opening and closing." American Journal of Orthodontics and Dentofacial Orthopedics 120, no. 3 (2001): 294–303. http://dx.doi.org/10.1067/mod.2001.115612.
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SOGON, SHUNYA, and CARROLL E. IZARD. "Sex differences in emotion recognition by observing body movements." Japanese Psychological Research 29, no. 2 (1987): 89–93. http://dx.doi.org/10.4992/psycholres1954.29.89.
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Cohen, Nichola Rice, Marc Pomplun, Brian J. Gold, and Robert Sekuler. "Sex differences in the acquisition of complex skilled movements." Experimental Brain Research 205, no. 2 (2010): 183–93. http://dx.doi.org/10.1007/s00221-010-2351-y.
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Ransdell, Lynda B., and Christine L. Wells. "Sex Differences in Athletic Performance." Women in Sport and Physical Activity Journal 8, no. 1 (1999): 55–81. http://dx.doi.org/10.1123/wspaj.8.1.55.
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Do women out-perform men in endurance sports? Are women as strong, pound for pound, as men? Many questions have been raised about the ability of women and men to perform physical tasks equally well. The issue of sex differences and similarities in performance has considerable significance today as women seek physically demanding careers in police-work, fire-fighting, the military, industry, and athletics. As more women participate in recreational and career opportunities formerly open only to men, knowledge about sex differences in response to physical exertion and training becomes increasingly important. In this paper we describes differences between the sexes in athletic performance.Most performance differences are due to variations in morphological (structural) or physiological characteristics typical of women and men (Wells, 1991). Nevertheless, variations in these characteristics are often as large or larger within each sex as they are between the sexes. The same is true of physical performance. Thus, when the entire population is considered, there are extensive differences in performance within each sex, and considerable overlap in performance between the sexes.We will base our examination of performance differences on the most outstanding performances of each sex: those exemplified by World Records in athletic events. We seek to answer such questions as: How large are sex differences in world record performances? Can existing performance differences be explained entirely by biological differences between the sexes? Or, are a large portion of these performance differ-ences attributable to sociocultural factors?We will analyze sex differences in performance relative to the human energy system. This system allows an extraordinary range of mechanisms for neuromuscular coordination and metabolism. Because of this, the human has a virtually unlimited movement repertoire and is capable of movements requiring large bursts of energy over very brief periods of time, as well as movements requiring low levels of energy production over very long periods of time. We will progress from sports that require very high intensity and explosive quality movements such as jumping and power lifting, through the “energy spectrum” to feats of endurance such as marathon running, ultra-distance triathlon, and open-water distance swimming.Due to our desire to focus this paper on a reasonable amount of data, our analysis will be limited as follows:1) for sex differences in high intensity-brief duration, explosive per-formance, we will discuss the high jump, long jump, and various mea-sures of strength (powerlifting),2) for sex differences in high intensity-short duration performance, we will present data on sprint running (100m, 400m) and swimming (100m),3) for sex differences in moderate intensity-moderate duration performance, we will discuss middle-distance running (1500m, 5000m, 10,000m), and swimming (1500m), and4) for differences in low intensity-long duration performance, we will discuss the marathon, the "Ironman Triathlon," and open ocean distance swimming.
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Behan, Fearghal P., Thomas M. Maden-Wilkinson, Matt T. G. Pain, and Jonathan P. Folland. "Sex differences in muscle morphology of the knee flexors and knee extensors." PLOS ONE 13, no. 1 (2018): e0190903. http://dx.doi.org/10.1371/journal.pone.0190903.
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