Background:Achieving a symmetrical power performance (difference <15%) between lower limbs is generally recommended during sports rehabilitation. However, athletes in single-leg-dominant sports, such as professional soccer players, could develop significant asymmetry between their dominant and nondominant legs, such that symmetry does not act as a viable comparison.Purpose:To (1) compare maximal muscular power between the dominant and nondominant legs in healthy young adults, (2) evaluate the effect of a single-leg-dominant sport activity performed at the professional level, and (3) propose a parameter of normality for maximal power difference in the lower limbs of this young adult population.Study Design:Controlled laboratory study.Methods:A total of 78 healthy, male, young adults were divided into 2 groups according to sport activity level. Group 1 consisted of 51 nonathletes (mean ± SD age, 20.8 ± 1.5 years; weight, 71.9 ± 10.5 kg) who participated in less than 8 hours a week of recreational physical activity with nonspecific training; group 2 consisted of 27 single-leg-dominant professional soccer players (age, 18.4 ± 0.6 years; weight, 70.1 ± 7.5 kg) who specifically trained and competed at their particular activity 8 hours or more a week. For assessment of maximal leg power, both groups completed the single-leg squat jump test. Dominance was determined when participants completed 2 of 3 specific tests with the same extremity. Statistical analysis included the Student t test.Results:No statistical difference was found for maximal power between dominant and nondominant legs for nonathletes (t = –1.01, P = .316) or single-leg-dominant professional soccer players (t = –1.10, P = .281). A majority (95%) of participants studied showed a power difference of less than 15% between their lower extremities.Conclusion:Among young healthy adults, symmetrical power performance is expected between lower extremities independent of the existence of dominance and difference in sport activity level. A less than 15% difference in power seems to be a proper parameter to define symmetrical power performance assessed by vertical single-leg jump tests.
Limited knowledge of the anatomy and biomechanics of the posterolateral corner (PLC) of the knee, coupled with poor patient outcomes with non-operative management, resulted in the PLC often being labelled as the ‘dark side’ of the knee. In the last two decades, extensive research has resulted in a better understanding of the anatomy and function of the PLC, and has led to the development of anatomic reconstructions that have resulted in improved patient outcomes. Despite considerable attention in the clinical orthopaedic literature (nearly 400 articles published in the last decade), a standardized algorithm for the diagnosis and treatment of the PLC is still lacking, and much controversy remains. Considering the literature review, there is not a reconstruction technique that clearly prevails over the others. As anatomic, biomechanical, and clinical knowledge of PLC injuries continues to progress, finding the balance between re-creating native anatomy and safely performing PLC reconstruction provides a big challenge. Treatment decisions should be made on a case-by-case basis. Cite this article: EFORT Open Rev 2021;6:676-685. DOI: 10.1302/2058-5241.6.200096
Introduction: Validity and reproducibility of the clinician's eye (CE) to diagnose patella alta (PA) on a lateral knee radiography (radiograph) is unknown. Methods: Cross-sectional study of 46 lateral knee x-rays. Three blind observers used CE, Insall-Salvati (IS), modified Insall-Salvati (mIS), and Caton-Deschamps (C-D) to determine patellar height. Sensitivity and specificity of each observer was compared with the musculoskeletal radiologist's C-D measurements. Intraobserver and interobserver agreement were assessed with intraclass correlation coefficient and Fleiss κ, respectively. Time needed to estimate patellar height for every method was recorded in seconds. Statistical differences between observers were calculated with a generalized estimating equation. Analysis of variance and post hoc Bonferroni test compared duration of each method ( P < 0.05). Data were analyzed using Stata 15 (StataCorp). Results: CE, IS, mIS, and C-D's sensitivity and specificity values are as follows: 77%, 92%; 94%, 52%; 67%, 58%; and 53%, 89%, respectively. Intraclass correlation coefficient and Fleiss κ of CE, IS, mIS, and C-D values are as follows: 0.66 and 0.43, 0.88 and 0.68, 0.54 and 0.09, and 0.68 and 0.59, respectively. CE was the second most sensitive and most specific method for diagnosis of PA, with moderate intraobserver and interobserver agreement. IS was the most sensitive method with good intraobserver and interobserver agreement. CE was significantly faster ( P < 0.05) than all other conventional radiographic ratios. Conclusion: CE's sensitivity increases with observer's experience and is highly specific. If normal patellar height is diagnosed, no other ratios are necessary, even in the less experienced clinician. Intraobserver and interobserver reproducibilities were moderate and only inferior to the IS ratio. In case patellar height is uncertain with the CE, the IS ratio is the most sensitive and reproducible method to confirm the diagnosis of PA.
Resumen Introducción No existen reportes sobre el índice de burnout en traumatólogos que ejercen en Chile. Objetivo Evaluar la presencia de burnout y otros aspectos de calidad de vida en esa población. Material y Método Estudio transversal analítico. Encuesta diseñada para conocer el auto-reporte de burnout y síntomas depresivos entre otros factores. Se incluyeron variables demográficas, laborales, sociales, hábitos personales y anímicas. La encuesta fue compartida vía online a miembros de la Sociedad Chilena de Ortopedia y Traumatología. Se realizó análisis estadístico para buscar asociación entre variables, utilizando pruebas de Chi-cuadrado, test exacto de Fisher y regresión logística (p < 0,05). Resultados Encuesta respondida por 136 especialistas. Rango etario modal menor de 40 años (46,3%), 94,1% hombres. Un 53,7% reportó burnout más de una vez al año, 11% anhedonia, 9,6% ánimo depresivo más de la mitad del mes o casi todos los días y 59,6% cansancio diario. Se encontró asociación significativa entre burnout y edad menor de 40 años (p = 0,004), ausencia de hijos (p = 0,007), dieta no saludable (p = 0,001), anhedonia (p = 0,007), temor a demandas (p < 0,001) y cansancio (p < 0,003). Conclusión Más de la mitad de los traumatólogos encuestados reportaron burnout más de una vez al año y cerca del 10% presentan síntomas depresivos semanalmente. Una edad menor a 40 años, anhedonia, el temor a demandas laborales y el cansancio al final de la jornada, fueron las variables de mayor impacto en la manifestación del burnout. La presencia de hijos y una dieta saludable fueron factores protectores.
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