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Local dynamic stability of the lower-limb as a means of post-hoc injury classification.

ABSTRACT: Since most sporting injuries occur at the lower extremity (50% to 66%) and many of those injuries occur at the knee (30% to 45%), it is important to have robust metrics to measure risk of knee injury. Dynamic measures of knee stability are not commonly used in existing metrics but could provide important context to knee health and improve injury screening effectiveness. This study used the Local Dynamic Stability (LDS) of knee kinematics during a repetitive vertical jump to perform a post-hoc previous injury classification of participants. This study analyzed the kinematics from twenty-seven female collegiate division 1 (D1) soccer, D1 basketball, and club soccer athletes from Auburn University (height = 171 ± 8.9cm, weight = 66.3 ± 8.6kg, age = 19.8 ± 1.9yr), with 7 subjects having sustained previous knee injury requiring surgery and 20 subjects with no history of injury. This study showed that LDS correctly identified 84% of previously injured and uninjured subjects using a multivariate logistic regression during a fatigue jump task. Findings showed no statistical difference in kinematic position at maximum knee flexion during all jumps between previously injured and uninjured subjects. Additionally, kinematic positioning at maximum knee flexion was not indicative of LDS values, which would indicate that future studies should look specifically at LDS with respect to injury prevention as it cannot be effectively inferred from kinematics. These points suggest that the LDS preserves information about subtle changes in movement patterns that traditional screening methods do not, and this information could allow for more effective injury screening tests in the future.

SUBMITTER: Larson J

PROVIDER: S-EPMC8177521 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Peripheral arterial disease is a major health problem, and in about 1% to 2% of patients the disease progresses to critical limb ischaemia (CLI). In a substantial number of patients with CLI, no effective treatment option other than amputation is available and around a quarter of these patients will require a major amputation during the following year. This is an update of the review first published in 2011. OBJECTIVES:To determine the effectiveness and safety of local intramuscular transplantation of autologous adult bone marrow mononuclear cells (BMMNCs) as a treatment for critical limb ischaemia (CLI). SEARCH METHODS:For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched February 2014) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1). SELECTION CRITERIA:We included all randomised controlled trials of CLI in which participants were randomly allocated to intramuscular administration of autologous adult BMMNCs or control (either no intervention or conventional conservative therapy). We excluded studies on patients with intermittent claudication. DATA COLLECTION AND ANALYSIS:Two authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data. Disagreements were resolved by consensus or by the third author. MAIN RESULTS:Only two small studies, with a combined total of 57 participants, met our inclusion criteria and were finally included. They were classified as having a moderate risk of bias with unclear issues regarding their methods, and according to the GRADE approach, the overall quality of the evidence would be considered as moderate. In one study the effects of intramuscular injections of BMMNCs in the ischaemic lower limbs of patients with CLI were compared with control (standard conservative treatment). No deaths were reported and no significant difference was observed between the two groups for either pain (P = 0.37) or the ankle brachial index (ABI) parameter. However, the treatment group showed a significantly smaller proportion of participants undergoing amputation compared with the control group (P = 0.026).In the other study, following subcutaneous injections of granulocyte colony-stimulating factor (G-CSF) for five days, peripheral blood derived mononuclear cells were collected and then transplanted by intramuscular injections into ischaemic lower limbs. The effects were compared with daily intravenous prostaglandin E1 injections (control group). No deaths were reported. Pain reduction was greater in the treatment group than in the control group (P < 0.001) as was increase in ABI (mean increase 0.13 versus 0.02, P < 0.01). The treatment group experienced a statistically significant increase in pain-free walking distance (PFWD) compared with the control group (mean increase 306.4 m versus 78.6 m, P = 0.007). A smaller proportion of participants underwent amputation in the treatment group compared with the control group (0% versus 36%, P = 0.007). AUTHORS' CONCLUSIONS:The data from the published trials suggest that there is insufficient evidence to support this treatment. These results were based on only two trials which had a very small number of participants. Therefore evidence from larger randomised controlled trials is needed in order to provide adequate statistical power to assess the role of intramuscular mononuclear cell implantation in patients with CLI.

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Local dynamic stability of the lower-limb as a means of post-hoc injury classification.

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