Background:The lever sign test is a new physical examination tool to diagnose anterior cruciate ligament (ACL) tears. Preliminary results suggest almost 100% sensitivity and specificity to diagnose acute and chronic complete ACL tears and clinically significant partial tears as compared with magnetic resonance imaging (MRI).Purpose:To assess the sensitivity and specificity of the lever sign test for the diagnosis of acute ACL injuries, as compared to MRI. We also aimed to determine the accuracy of the lever sign test compared with 3 other tests (anterior drawer, Lachman, and pivot shift) when performed by providers of various training levels, and with the patient awake or under anesthesia.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:We evaluated patients with a chief concern of acute (≤4 weeks) knee pain seen between October 2014 and January 2015, with a thorough history, physical examination, and standard radiographs. MRI was the reference standard; patients without an MRI evaluation were excluded. The 4 physical examination maneuvers were performed on each symptomatic knee during the initial clinic visit (for nonsurgical patients) or under anesthesia in the operating room (for surgical patients) by a randomly assigned undergraduate student, medical student, orthopaedic resident, or orthopaedic fellow. The senior author trained all staff to perform the lever sign test. Statistical analyses were performed.Results:Of 102 patients, 54 were surgical (28 female, 26 male), and 48 were nonsurgical (16 female, 32 male); the mean patient age was 23 years (range, 15-66 years). The overall accuracy of the lever sign test was 77% (63% sensitivity, 90% specificity); the accuracy was similar between patients under anesthesia and awake (77% vs 76%, respectively). There were no significant differences when comparing the sensitivity and specificity of the lever sign test with patients under anesthesia and awake (sensitivity: under anesthesia, 86%, and awake, 68% [P = .40]; specificity: under anesthesia, 85%, and awake, 96% [P = .17]). Furthermore, the accuracy of the lever sign test was similar when performed on female versus male patients (75% vs 79%, respectively) or when performed by undergraduate students and medical students compared with orthopaedic residents and fellows (84% vs 88%, respectively).Conclusion:Our study results challenge the exceptional sensitivity and specificity values (both 100%) of the lever sign test, as reported by the original author of the test.

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After ACL reconstruction, 78% of athletes returned to professional sports. For those who returned, changes in performance were not statistically significant relative to the comparison group.

Background. Rugby is a physically demanding body contact sport. Optimising dietary intake and body composition can positively affect the performance of rugby players. Objectives. To determine the body composition, habitual and game-specific nutritional practices of FNB Maties Varsity Cup (MVC) rugby players. Methods. A descriptive, cross-sectional study with an analytical component was conducted. Of all the MVC rugby players (N=35), 18 completed the sections on body composition and match-day dietary intake, while 11 completed the habitual dietary intake section. Body composition data were collected by an International Society for the Advancement of Kinanthropometry-accredited biokineticist. Habitual dietary intake data (via a self-administered 7-day food record) and match-day dietary strategies (via telephonic 24-hour recall interview) were collected and compared with nutritional requirements reported by the International Olympic Committee, the American Dietetic Association, the American College of Sports Medicine and the International Society of Sport Nutrition. Results. Forwards had significantly higher weight (p=0.01), sum of seven skinfolds (p=0.01), percentage body fat (p=0.02), fat mass (p=0.01) and fat-free mass (p=0.01) than backs. Compared with current recommendations, group habitual dietary intake (mean (standard deviation)) was inadequate for total energy (45.4 (9.0) kcal/kg body weight (BW)), carbohydrate (4.3 (0.4) g/kg BW), polyunsaturated fatty acids (6.2 (1.7)% of total energy (TE)), calcium:protein ratio (6.5:1 (3.5:1)) and copper (2.3 (0.4) mg), while displaying higherthan-recommended intakes for total protein (2.4 (0.7) g/kg BW), fibre (37.7 (7.3) g/day), total fat (33.8 (4.3)% TE), saturated fatty acids (11.2 (13.1)% TE), cholesterol (766.3 (371.8) mg) and niacin (45.2 (6.9) µg). Habitual supplement use was high at 91% (n=10/11). Nutritional match-day strategies were excessive for protein (1.2 (0.6) g/kg BW) and fat (0.9 (0.4) g/kg BW) in the pre-event meal, inadequate for energy and carbohydrate during the game and excessive for alcohol (54.4 (59.9) g) after the game. Conclusion. Forwards and backs differed significantly in various body composition measurements. In relation to observed practices, hab it ual dietary intake and nutritional match-day strategies were suboptimal, with high reported supplement use. Players in this sport potentially could benefit from specialist input to optimise dietary strategies and body composition in order to enhance performance. 2014;26(2):35-43. S Afr J SM

Cancer-related fatigue (CRF) is the most common and debilitating side effect of patients receiving treatment of cancer. It is reported that 60% to 100% of patients will develop CRF as a result of the treatment or the cancer itself. The effects last for years posttreatment and lower overall quality of life. The purpose of this integrative review was to determine whether exercise interventions could reduce CRF and improve overall health-related quality of life (HRQOL) among selected cancer patients. Clinical Key, ProQuest Nursing and Allied Health Source, Cochrane Library, Mosby's Nursing Consult, and MEDLINE (Ovid) were the databases searched. Key terms searched were fatigue, exercise, cancer fatigue, holistic, spiritual, quality of life, and prevention. Findings from most studies suggest that exercise can decrease the effects of CRF among cancer patients, leading to an overall improved HRQOL. No negative results on the effects of exercise on CRF were reported. Nurses can be instrumental in developing holistic multidisciplinary exercise programs to assist in the management of CRF and improve HRQOL among cancer patients during and after cancer treatment. Recommendations for future research include the need for larger study sample sizes, a universal definition of fatigue, determination of the best exercise regimens, more consistent fatigue measures to facilitate better comparison across studies, and specifically assess patient improvements in overall mental and spiritual well-being within a holistic framework.