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Muscle, Ligaments and Tendons Journal

Chondrocalcinosis: a morphofunctional study of crystal deposition in mechanically stressed shoulder soft tissues

Original Article, 465 - 472
doi: 10.11138/mltj/2018.8.4.465
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Introduction: Chondrocalcinosis is a pathological condition characterized by the presence of calcium pyrophosphate dihydrate (CPPD) crystal deposition in the soft tissues. Even if knee articular cartilage is the most involved anatomical area, different kind of tissue and joint can be affected by this disorder.
Methods: The aim of this manuscript is to analyze at histological and ultrastructural level the crystal deposition in shoulder soft tissue subjected to mechanical stress of patients affected by CPPD disease. Moreover, the cellular behavior in the same specimens has been investigated by means of transmission electron microscopy at variable distances from crystal deposits.
Results: An interesting relationship between CPPD and cellular impairment appears in humeral articular cartilage, joint capsule and long head of biceps brachii tendon sheath, where respectively chondrocytes and fibroblasts, close to crystal deposits, reveal numerous cell damages, such as chromatin condensation, dilation of organelles or cell membrane rupture.
Conclusion: Considering that cells far to the crystals are healthy, their behavior appears to be different from that of neighboring cells, then our preliminary results suggest a possible cause-effect relationship between events.
Level of evidence: basic science study.

Functional hyper-extension deficit of the knee and patellar dimple sign in patellofemoral pain syndrome. A preliminary study

Original Article, 473 - 476
doi: 10.11138/mltj/2018.8.4.473
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Introduction: The aim of this study was to investigate the presence of two new signs in patellofemoral pain syndrome (PFPS).
Methods: Twenty-three patients with unilateral patellofemoral pain were participated.
The study was designed with each subject acting as their own internal control by using the unaffected limb for comparison. The pain level during squat & stair up-down, functional hyper-knee-extension lack, absence of the patellar dimple sign, and Kujala patellofemoral score were measured in patients.
Results: All patients had an unclear and weak patellar dimple sign. Mean pain level during the squat was 7.13±2.54. The functional hyper-knee-extension lack was 4.39±1.23° in the affected side while was - 3.91±1.37° in the unaffected side.
Conclusion: This study is the first to demonstrate absence of the patellar dimple sign and functional hyperextension lack in patients with patellofe moral pain syndrome. It is suggested that future studies might look at the effect of functional hyperextension knee exercises and look at the longer term follow-up of these signs.
Level of evidence: IIIb.

The triple F knot: a sliding-locking arthroscopic knot

Original Article, 477 - 481
doi: 10.11138/mltj/2018.8.4.477
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Introduction: Arthroscopic knot tying is a necessary skill for arthroscopic surgeons. Different arthroscopic knot configurations are available, and young surgeons may find it difficult to choose which one is best suited to them.
Methods: We describe a simple technique for a sliding locking arthoscopic knot, which is fast to execute, and easy to perform and to teach to young surgeons.

MRI scans do not accurately predict hamstring graft diameter for ACL reconstruction

Original Article, 482 - 487
doi: 10.11138/mltj/2018.8.4.482
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Introduction: Identify whether magnetic resonance imaging (MRI) pre-operatively can help predict intra-operative hamstring graft size for anterior cruciate ligament (ACL) reconstruction. Previous literature has shown correlation but not accuracy or reproducibility of such a prediction.
Methods: 60 pre-operative MR scans from patients who had undergone ACL reconstruction were studied retrospectively. We measured the cross sectional area of gracilis and semitendinosus tendons using MR axial views. The intraoperative graft diameter was recorded. If the diameter intra-operatively was below an 8 mm threshold the case was highlighted. We then correlated these results with the pre-operative MR measurements. Pearson correlation and Bland-
Altman plots were used to assess correlation and agreement between the MR and intra-operative measurements.
Results: The Pearson correlation co-efficient was 0.35. The Bland-Altman plots showed poor agreement and reproducibility between readers. We highlighted 6 cases that had a graft diameter below 8 mm. We were able to predict these 6 cases with the pre-operative MR scans producing 100% sensitivity, but low specificity of 19%.
Conclusion: Pre-operative MR scan measurement of hamstring size is a poor predictor of graft size due to poor specificity and not being reproducible between readers. Therefore, we do not recommend pre-operative MR scan hamstring measurement to predict intra-operative graft size.
Level of evidence: IV.

Treating Haglund's Deformity with percutaneous Achilles tendon decompression: a case series

Original Article, 488 - 494
doi: 10.11138/mltj/2018.8.4.488
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Introduction: Haglund’s syndrome is a deformity of the postero-superior and lateral heel-shaped profile commonly associated with inflammation of the retro-calcaneal bursa and characterized by pain and swelling. Aim of the study was to evaluate the reliability and effectiveness of minimally invasive percutaneous surgical procedure for Achilles tendon decompression.
Methods: From January 2014 to April 2016, a total of 21 continuous patients with Haglund’s deformity (15 men, 6 women, mean age of 40 years) were enrolled. The regularization of calcaneous profile and borsectomy were performed in all cases. The results were evaluated both clinically with American Orthopaedic Foot and Ankle Society hindfoot score (AOFAS-hindfoot), Visual Analog Scale (VAS) before surgery and at 6 months’ follow-up. Radiographic results were also collected using Fowler-Philip before the surgery and one-month follow-up.
Results: The average AOFAS-hindfoot score increased from 50.57 to 97.42 (p<.00001). VAS score decreased from 6.85 to 0.19 (p<.00001) and the mean Fowler-Philip angle decreased from 79,57° to 53.76°(p<.00001). In our series, no complications were observed and all patients were satisfied at last follow-up.
Conclusions: Our results suggest that Achilles decompression by percutaneous approach for painful Haglund’s deformity is a reliable and effective surgical procedure.
Level of evidence: IV.

Structured training volume in early adolescence: a risk factor for femoroacetabular impingement?

Original Article, 495 - 501
doi: 10.11138/mltj/2018.8.4.495
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Introduction: To determine whether athletes undergoing surgical intervention for FAI completed more hours of structured training in adolescence than matched healthy athletes.
Methods: Sixty-seven athletes (25.53 ± 4.8 years) undergoing surgical intervention for symptomatic FAI were asked to recall the number of hours engaged in structured training between the ages of 10-12 and 13-15 years old (FAI group). Results
were compared to an age (24.56 ± 4.5 years), gender and activity level matched control group (n=71) with no history of chronic hip/groin pain or hip stiffness and who were currently engaged in similar levels of training and competition.
Results: The FAI group reported significantly more structured training hours between the ages of 10-12 years than controls (6.55 ± 3.1 versus 5.69 ± 3.7 hrs/week, p=0.02) but no differences were observed for training volume between the ages of 13-15 years (8.45 ± 3.4 vs 8.03 ± 3.7 hrs/week, p=.397).
Conclusion: Higher volumes of structured training in early adolescence are a potential risk factor for the development of symptomatic FAI later in the player pathway.
Level of evidence: IV.

Relationship between anthropometric characteristics and playing position in youth soccer

Original Article, 502 - 506
doi: 10.11138/mltj/2018.8.4.502
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Introduction: There are four principles positions in soccer: goalkeepers, defenders, midfielders and forwards. Midfielders run longer distances than the others; defenders dribble shorter distances, whilst forwards perform significantly more sprints. These different performance requirements could be better achieved when supported by optimal physical characteristics. Accordingly, forwards are generally leaner than midfielders, defenders, and goalkeepers and the muscle percentage is higher in the forwards compared to the midfielders and the goalkeepers.
These data are related to adults and adolescents, while up to now there are no data on pre-adolescent players. The purpose of the study is to verify if the anthropometric characteristics could influence the assignment of the position for soccer players aged 12 to 14 years.
Methods: We designed an observational study in order to measure the anthropometric parameters of 36 under-14 players: 11 defenders (DF); 13 midfielders (MF); 12 forwards (FW).
Results: We found that the DFs were the heaviest (58,6±7,9 kg) and tallest (165,7±7,8 cm) players and had the two greater measures (waist circumference: 71,4±7,0 cm; waist diameter: 74,5±5.1 cm). The FWs were the lightest (49,9±6,8 kg) and with the smallest waist (63,6±4,0 cm) and pelvis circumferences (67,6±4.7 cm), whilst the midfielders were the shortest (157,2±9,3 cm). All the players underwent three tests to measure the main physical capacities involved to soccer: sprint test, Nittoli skip test and Sargent jump test. No correlation emerged between the roles and physical performances.
Conclusion: In soccer players between 12 and 14 years old, we did not find any correlation between the position and physical performance. In this age group the assignment of the position of play is not yet influenced by the anthropometric characteristics of the player, probably because in these years the weight, height and body circumferences are rapidly changing. In the following years, when the constitutional characteristics are stabilized, they will be valorized and used as a starting point to optimize performances.
Level of evidence: IV.

Posture and scapular dyskinesis in young bowed string instrumental musicians

Original Article, 507 - 512
doi: 10.11138/mltj/2018.8.4.507
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Introduction: Instrumental musicians impose intense and repetitive strains on the musculoskeletal system. This makes them particularly susceptible to musculoskeletal disorders, especially at the spine and the scapular girdle, including scapular dyskinesis. The present study evaluated the presence of incorrect posture and scapular dyskinesis in young musicians playing bowed string instruments.
Methods: We recruited 32 young adult students of the Music Academy “Conservatorio C. Pollini” of Padua, including 14 violinists, 3 violists, 10 cellists and 5 double bass players. Scapular dyskinesis was assessed with a specific test, which involves the repetition of shoulder abduction and flexion movements with dumbbells weighting 1 and 2 kg. The spine was assessed using a headband with compass mechanism (IncliMed®) and a gibbometer.
Results: Scapular dyskinesis was identified in 46.9% (N=15), hyperkyphosis in 34.8% (N=11), and a hump in 37.5% (N=12) of the subjects. The association between hump and weekly hours of practice was statistically significant (p<0.05), as well as the association between the presence of a hump and hyperkyphosis (p=0.05).
Conclusions: Bowed strings instrumental musicians exhibit changes in static and dynamic posture of the shoulder girdle and spine. Such alterations could lead to the onset of postural asymmetries (hyperkyphosis), the onset and/or worsening of underlying and unrecognized conditions such as scoliosis, and the impairment of normal biomechanics resulting in the appearance of scapular dyskinesis.
Level of evidence: III.

Shoulder external/internal rotation peak torques ratio side-asymmetry, mean work and power ratios balance worsening due to different fatigue resistance of the rotator muscles in male handball players

Original Article, 513 - 519
doi: 10.11138/mltj/2018.8.4.513
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Introduction: Fatigue could worsen shoulder cuff rotator balance if fatigue of the external rotation (ER) could appear faster in comparison with the internal rotation (IR). The shoulder rotation peak torques (τmax) side-asymmetry and muscle endurance effect on the mean work (W), mean power (P) and their ratio of ER/IR in handball players was investigated.
Methods: Eighteen semi-professional male handball players participated. The tests were performed using an isokinetic dynamometer by the shoulder isokinetic internal-external rotation movements at angular velocities of 60°/s, 240°/s via concentric contractions. The W, P were determined and their ratios of the ER/IR were calculated for the first ten and last ten repetitions of the movements at 240°/s.
Results: Muscle side asymmetry in Tmax, W, P was not observed at 240°/s. The W, P of the ER and ratios of the ER/IR (WER/WIR=0.76 (dominant D), 0.74 (non-dominant N) arm; PER/PIR=0.68 D, 0.70 N) in the last ten repetitions were significantly lower than those (WER/WIR=0.80 D, 0.79 N; PER/PIR=0.78 D, 0.77 N) in the first ten movements.
Conclusion: Fatigue resistance of the ER was lower than that of the IR. Therefore, the ER/IR ratios of W, P decrease due to repeated rotation movements.
Level of evidence: IIIa.

Does TRX training induce similar effects to crossfit?
Study on the variation of body fat mass, endurance and explosive force

Original Article, 520 - 525
doi: 10.11138/mltj/2018.8.4.520
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Introduction: Though TRX suspension training and CrossFit are similar methods of functional training, until now the differences in the effects on body composition and motor skills are not known.
Methods: A sample of CrossFitters and TRXers was enrolled and evaluated at the beginning of the study and after 6 months. body mass index (BMI), waist-to-height-ratio (WHtR), body fat percentage,
Sargent test and Balke test were used for the evaluation of the two groups.
Results: Fat percentage, WHtR showed a significant improvement over time, without statistical significant differences between the two groups. No statistical differences were found between groups for aerobic capacity, even if both present an improvement for all parameters during time (p<0.05).
The study revels also a greater increase for VO2max values in CrossFit group instead of TRX group, confirmed by the fact that changes in the values are related to the treatment group (p=0.01).
The average mean score for the Sargent test revealed how the modification of the values are explained for time (p=0.0002) and for groups (p=0.009).
Conclusion: Our study shows that both functional training methods lead to improvements both from an anthropometric point of view and from an aerobic resistance point of view. Additionally, CrossFit athletes method reveals a lower limb explosiveness and VO2max high values than the TRX group.
Level of evidence: IIIb.

The therapeutic effects of manipulation technique on sacroiliac joint dysfunction in young women

Original Article, 526 - 533
doi: 10.11138/mltj/2018.8.4.526
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Introduction: The aims of this research was to measure the effects of manipulation by remarking the type of dysfunction and the orientation of the correcting maneuver in patients with iliosacral joint dysfunctions.
Methods: Sixty women with ant innominate or post innominate dysfunctions were gathered for the research and divided into two groups, treatment group received a session of manipulation and the control group randomly (N=30). The range of flexion and extension of the lumbar, internal and external rotations of the hip, VAS, active SLR and pressure pain threshold were evaluated before, immediately and 24 hours after manipulation.
Results: As per the results of this study, in treatment group, manipulation had helped to relieve the level of pain and decreased the mean score of ASLR and its effects remained up to 24 hours (p<0.05) and also increased immediately the ROM of the hip internal and external rotations and the lumbar flexion and extension (p<0.05) but in control group we didn’t see any significant difference (p>0.05). We didn’t see any significant difference at PPT before, immediately after and 24 hours after manipulation in patients in both groups (p>0.05).
Conclusion: Applying manipulation regarding the kind of dysfunction may be reducing patient’s symptoms.
Level of evidence: Ib.

Changes of joint position sense in responses to upper trapezius muscle fatigue in subclinical myofascial pain syndrome participants versus healthy control

Original Article, 534 - 543
doi: 10.11138/mltj/2018.8.4.534
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Introduction: Fatigue of the neck muscles can lead to change in upper limb proprioception, motor patterns and kinematics. Restricted range of motion is a characteristic of myofascial trigger point. There is no evidence indicating an association of fatigue with restricted range of motion and non specific myofascial pain syndrome without underlying disease. This study evaluates cervical motions in flexion/extension, side bending and rotation before and after fatigue. Clinically, proprioception is evaluated using the Joint Position
Sense Error (JPSE), which reflects a person’s ability to accurately return his head to a predefined target after a cervical movement. This study design is randomized control trial.
Methods: 23 healthy right handed volunteers (11 males and 12 females) from a physical therapy clinic in rehabilitation faculty participated in the study.
Fatigue protocol was done, the recordings of pain threshold and intensity and kinematics, before and after fatigue, were all repeated.
Results: Neck muscle fatigue had different effects on neck kinematics for each group. JPSE in neck side bending repositioning was significantly greater following the upper trapezius muscle fatiguing protocol in a frontal plane.
Conclusion: The increased accuracy was most pronounced for movements directed towards the activated side. Hence, prolonged unilateral neck muscle contraction may increase the sensitivity of cervical proprioceptors. Cervical range of motion
in side bending was the only variable associated with changes in neck pain.
Level of evidence: IIIb.

Extruded collagen fibres and biphasic collagen sponge for rotator cuff tendon repair application: an ovine in vitro study

Original Article, 544 - 551
doi: 10.11138/mltj/2018.8.4.544
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Introduction: High failure rates have been reported for rotator cuff repairs. Tendon grafts have been developed to augment these repairs. Two types of grafts are collagen sponge and collagen fibres. This study investigates the biocompatibility of a biphasic collagen sponge as a bone-tendon interposition device that may induce tendon regeneration, comparing its results to an established tendon graft.
Methods: Ovine tenocytes were exposed to either: (1) Control - a collagen fibre that has been shown to be conducive to tenocytes; (2) intervention - Chondromimetic, a novel biphasic tendon sponge, consisting of mineralized and unmineralized layers.
The following parameters were measured over a three week period: cellular DNA, type I collagen, decorin, and glycosaminoglycan production.
Results: Tendon cells are able to adhere and multiply in the collagen sponge. The increase in cellular DNA, type I collagen, and glycosaminoglycan in the collagen sponge graft was similar to fibre graft over the study period.
Conclusion: Chondromimetic is biocompatible with ovine tendon cell growth.
Level of evidence: IIIb.

The comparison of dynamic postural control and muscle activity in time domain in athletes with and without chronic ankle instability

Original Article, 552 - 559
doi: 10.11138/mltj/2018.8.4.552
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Introduction: The objectives of this study were to compare muscle activation time and dynamic postural variables in athletes with and without chronic ankle instability during jump-landing, followed by a choice reaction time task which was provided by the visual stimulus.
Methods: Nineteen athletes [11 healthy athletes and 8 athletes with chronic ankle instability (CAI)] participated in this cross-sectional study. After informing them about the procedure and goals of the study, they started jump-landing protocol in response to the visual stimulus. Muscle activation time and dynamic postural control data were taken using an electromyographic (EMG) machine and force plate, respectively.
Results: The results of the two-way repeated measurement analysis of variance (ANOVA) showed that there were significant differences in athletes with and without CAI for medial/lateral stability index (MLSI; tested leg effect: p=0.006); the pre-motor time of the gastroc-soleus, peroneus longus, and peroneus brevis (interaction effects of the tested leg and the tested group: p=0.001, p=0.015 and p=0.006, respectively) and the pre-motor time of the tibialis anterior (tested group effect: p=0.036).
Conclusion: More attention should be on the muscle activation time because changes in this parameter may be one of the preliminary risk factors for instability, although cohort studies are required to prove it. A more challenging task with more sensitivity for differentiating between stable and unstable ankle is needed.
Level of evidence: IIIb.

Vol. 8 (No. 4) 2018 October/December

  1. Chondrocalcinosis: a morphofunctional study of crystal deposition in mechanically stressed shoulder soft tissues
    Burini D., Salucci S., Fardetti F., Beccarini A., Calvisi V., Gobbi P., Falcieri E., Curzi D.
    doi: 10.11138/mltj/2018.8.4.465
  2. Functional hyper-extension deficit of the knee and patellar dimple sign in patellofemoral pain syndrome. A preliminary study
    Kaya D., Aksahin E., Doral M.N.
    doi: 10.11138/mltj/2018.8.4.473
  3. The triple F knot: a sliding-locking arthroscopic knot
    Spezia F., Franceschetti E., Franceschi F., Maffulli N., Oliva F.
    doi: 10.11138/mltj/2018.8.4.477
  4. MRI scans do not accurately predict hamstring graft diameter for ACL reconstruction
    Ricci P., Cullen C., Imalingat H., Sergeant J.C., Jain N.
    doi: 10.11138/mltj/2018.8.4.482
  5. Treating Haglund's Deformity with percutaneous Achilles tendon decompression: a case series
    Sergio F., Catani O., Fusini F., Langella F., Cautiero G., Ponzo I., Zanchini F.
    doi: 10.11138/mltj/2018.8.4.488
  6. Structured training volume in early adolescence: a risk factor for femoroacetabular impingement?
    Mullins K., Hanlon M., Carton P.
    doi: 10.11138/mltj/2018.8.4.495
  7. Relationship between anthropometric characteristics and playing position in youth soccer
    Notarnicola A., Maccagnano G., Chierico A., Tafuri S., Moretti B.
    doi: 10.11138/mltj/2018.8.4.502
  8. Posture and scapular dyskinesis in young bowed string instrumental musicians
    Frizziero A., Gasparre G., Corvo S., Gamberini J., Finotti P., Masiero S., Maffulli N.
    doi: 10.11138/mltj/2018.8.4.507
  9. Shoulder external/internal rotation peak torques ratio side-asymmetry, mean work and power ratios balance worsening due to different fatigue resistance of the rotator muscles in male handball players
    Pontaga I.
    doi: 10.11138/mltj/2018.8.4.513
  10. Does TRX training induce similar effects to crossfit? Study on the variation of body fat mass, endurance and explosive force
    Notarnicola A., Salatino G., Napoletano P., Monno A., Moretti B., Tafuri S.
    doi: 10.11138/mltj/2018.8.4.520
  11. The therapeutic effects of manipulation technique on sacroiliac joint dysfunction in young women
    Ashraf V., Shadmehr A., Moghadam B.A., Olyaei G., Reza Hadian M., Khazaeipour Z.
    doi: 10.11138/mltj/2018.8.4.526
  12. Changes of joint position sense in responses to upper trapezius muscle fatigue in subclinical myofascial pain syndrome participants versus healthy control
    Roya M., Gholam Reza O., Azadeh S., Reza H.M., Saeed T.M.
    doi: 10.11138/mltj/2018.8.4.534
  13. Extruded collagen fibres and biphasic collagen sponge for rotator cuff tendon repair application: an ovine in vitro study
    Zafar A., Rushton N.
    doi: 10.11138/mltj/2018.8.4.544
  14. The comparison of dynamic postural control and muscle activity in time domain in athletes with and without chronic ankle instability
    Fereydounnia S., Shadmehr A., Talebian Moghadam S., Olyaei G., Jalaie S., Shiravi Z., Salemi S.
    doi: 10.11138/mltj/2018.8.4.552
Last Viewed articles: la lista degli ultimi x visitati.
  1. The comparison of dynamic postural control and muscle activity in time domain in athletes with and without chronic ankle instability
    Fereydounnia S., Shadmehr A., Talebian Moghadam S., Olyaei G., Jalaie S., Shiravi Z., Salemi S.
    doi: 10.11138/mltj/2018.8.4.552
  2. Extruded collagen fibres and biphasic collagen sponge for rotator cuff tendon repair application: an ovine in vitro study
    Zafar A., Rushton N.
    doi: 10.11138/mltj/2018.8.4.544
  3. Changes of joint position sense in responses to upper trapezius muscle fatigue in subclinical myofascial pain syndrome participants versus healthy control
    Roya M., Gholam Reza O., Azadeh S., Reza H.M., Saeed T.M.
    doi: 10.11138/mltj/2018.8.4.534
  4. The therapeutic effects of manipulation technique on sacroiliac joint dysfunction in young women
    Ashraf V., Shadmehr A., Moghadam B.A., Olyaei G., Reza Hadian M., Khazaeipour Z.
    doi: 10.11138/mltj/2018.8.4.526
  5. Does TRX training induce similar effects to crossfit?
    Study on the variation of body fat mass, endurance and explosive force

    Notarnicola A., Salatino G., Napoletano P., Monno A., Moretti B., Tafuri S.
    doi: 10.11138/mltj/2018.8.4.520
  6. Shoulder external/internal rotation peak torques ratio side-asymmetry, mean work and power ratios balance worsening due to different fatigue resistance of the rotator muscles in male handball players
    Pontaga I.
    doi: 10.11138/mltj/2018.8.4.513
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