Aim: To investigate the potential for using video as a method of documentation in physiotherapy for children and adolescents, and potential facilitators and barriers for use and implementation. Design: The study followed physiotherapists from six collaborating locations in private, municipal, and specialist healthcare services, from project start and early testing and over a period of three years, to gather the physiotherapists' experiences with the use of video over time. Material & Methods: The material includes semi-structured interviews, a survey, workshops, observations, minutes from meetings and follow-up conversations with physiotherapists and a supplier of software for video editing and storage. Data was analysed using thematic analysis. Findings: The physiotherapists found video to be a useful tool that supports their current practices by providing better documentation and an "extra set of eyes". Video allows for new practices, including opportunities for sharing videos with other health care professionals, parents and institutions. Several facilitators and barriers for use and implementation were identified, including challenges related to time consumption, privacy concerns, the need for training and technical support and accessible and relevant technology. Conclusion: There is great potential for the use of video in physiotherapy. Using video is in line with the need for better tools for documentation that physiotherapists experience. Yet, further adaptation is needed before implementation into clinical practice. Moreover, unclear data protection regulations create insecurity. As a result, using video becomes cumbersome and non-attractive, despite its potential. Key-words: physiotherapy, clinical documentation e-health, video, communication.

Introduction: There is a lack of data describing the blood pressure response (BPR) in well-trained individuals. In addition, continuous bio-signal measurements are increasingly investigated to overcome the limitations of intermittent cuff-based BP measurements during exercise testing. Thus, the present study aimed to assess the BPR in well-trained individuals during a cycle ergometer test with a particular focus on the systolic BP (SBP) and to investigate pulse arrival time (PAT) as a continuous surrogate for SBP during exercise testing.Materials and Methods: Eighteen well-trained male cyclists were included (32.4 ± 9.4 years; maximal oxygen uptake 63 ± 10 ml/min/kg) and performed a stepwise lactate threshold test with 5-minute stages, followed by a continuous test to voluntary exhaustion with 1-min increments when cycling on an ergometer. BP was measured with a standard automated exercise BP cuff. PAT was measured continuously with a non-invasive physiological measurements device (IsenseU) and metabolic consumption was measured continuously during both tests.Results: At lactate threshold (281 ± 56 W) and maximal intensity test (403 ± 61 W), SBP increased from resting values of 136 ± 9 mmHg to maximal values of 219 ± 21 mmHg and 231 ± 18 mmHg, respectively. Linear within-participant regression lines between PAT and SBP showed a mean r2 of 0.81 ± 17.Conclusion: In the present study focusing on the BPR in well-trained individuals, we observed a more exaggerated systolic BPR than in comparable recent studies. Future research should follow up on these findings to clarify the clinical implications of the high BPR in well-trained individuals. In addition, PAT showed strong intra-individual associations, indicating potential use as a surrogate SBP measurement during exercise testing.

Shock impacts during activity may cause damage to the joints, muscles, bones, or inner organs. To define thresholds for tolerable impacts, there is a need for methods that can accurately monitor shock impacts in real-life settings. Therefore, the main aim of this scoping review was to present an overview of existing methods for assessments of shock impacts using wearable sensor technology within two domains: sports and occupational settings. Online databases were used to identify papers published in 2010–2020, from which we selected 34 papers that used wearable sensor technology to measure shock impacts. No studies were found on occupational settings. For the sports domain, accelerometry was the dominant type of wearable sensor technology utilized, interpreting peak acceleration as a proxy for impact. Of the included studies, 28 assessed foot strike in running, head impacts in invasion and team sports, or different forms of jump landings or plyometric movements. The included studies revealed a lack of consensus regarding sensor placement and interpretation of the results. Furthermore, the identified high proportion of validation studies support previous concerns that wearable sensors at present are inadequate as a stand-alone method for valid and accurate data on shock impacts in the field.

Background: Untreated developmental hip dysplasia may result in pain, loss of function and is a common cause of osteoarthritis (OA). The periacetabular osteotomy (PAO) was developed to relieve symptoms and postpone further degeneration of the hip. We aimed to assess preoperative clinical and radiographic prognostic factors and evaluate survivorship of PAO after medium-term follow-up of 7.4 (2-15) years. Methods: 59 patients (69 hips) operated with a PAO through an anterior intrapelvic approach from 1999 to 2011 were retrospectively identified. The patients were evaluated radiographically and clinically with Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index and 15D quality of life questionnaires. Survival analyses identified native hip joint survival predictors. Results: 9 hips (9 patients) were converted to a total hip arthroplasty (THA). Of the 50 remaining patients (60 hips), 44 patients (54 hips) were examined at medium-term follow-up. 3 patients were lost to follow-up or declined participation and 3 were interviewed by telephone. Patient age at time of surgery was 32 (14-44) years. Survival analyses showed 84.3% (95% confidence interval [CI], 68.7-92.5%) survival of the native hip at 8years follow-up (number at risk 32) (worst case scenario 80% survival at 8years, 95% CI, 63.9-89.2%, number at risk 32). Cox regression with presence of preoperative OA (Tonnis 1), showed a crude hazard ratio for conversion to THA with preoperative OA of 13.73, p < 0.001. Conclusions: Periacetabular osteotomy through the anterior intrapelvic approach can be performed safely and with satisfactory results at medium-term follow-up. The presence of preoperative incipient OA (Tonnis 1) is the most important predictor for poor hip joint survival.

Background: Reduced quadriceps strength influences knee function and increases the risk of knee osteoarthritis. Thus, it is of significant clinical relevance to precisely quantify strength deficits in patients with knee injuries. Purpose: To evaluate isokinetic concentric quadriceps muscle strength torque values, assessed both from peak torque and at specific knee flexion joint angles, in patients with anterior cruciate ligament (ACL) injury, focal cartilage lesions, and degenerative meniscus tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were synthesized from patients included in 3 previously conducted research projects: 2 prospective cohort studies and 1 randomized controlled trial. At the time of inclusion, all patients were candidates for surgery. Isokinetic concentric quadriceps muscle strength measurements (60 deg/s) were performed at baseline (preoperative status) and after a period of progressive supervised exercise therapy (length of rehabilitation period: 5 weeks for ACL injury, 12 weeks for cartilage lesions and degenerative meniscus). Outcome measures were peak torque and torque at specific knee flexion joint angles from 20° to 70°. All patients had unilateral injuries, and side-to-side deficits were calculated. For comparisons between and within groups, we utilized 1-way analysis of variance and paired t tests, respectively. Results: In total, 250 patients were included. At baseline, cartilage patients had the most severe deficit (39.7% ± 24.3%; P < .001). Corresponding numbers for ACL and degenerative meniscus subjects were 21.7% (±13.2%) and 20.7% (±16.3%), respectively. At retest, there was significant improvement in all groups ( P < .001), with remaining deficits of 24.7% (±18.5%) for cartilage, 16.8% (±13.9%) for ACL, and 3.3% (±17.8%) for degenerative meniscus. Peak torque was consistently measured at 60° of knee flexion, whereas the largest mean deficits were measured at 30° at baseline and 70° at retest for the ACL group, at 70° at baseline and retest for the degenerative meniscus group, and at 60° at baseline and at 50° at retest for the cartilage group. Conclusion: This study underlines the importance of including torque at specific knee flexion joint angles from isokinetic assessments to identify the most severe quadriceps muscle strength deficits. Furthermore, it confirms the importance of progressive exercise therapy interventions before potential surgery in patients with knee injuries.

BACKGROUND:It is unknown whether gait biomechanics in hip osteoarthritis patients with mild to moderate symptoms change following exercise therapy interventions. The aim of the present study was to compare stance phase gait characteristics in hip osteoarthritis patients with mild to moderate symptoms participating in a randomized trial with two different interventions; patient education only or patient education followed by a 12-week supervised exercise therapy program.RESULTS:The study was conducted as a secondary analysis of a single-blinded randomized controlled trial. Patients aged 40 to 80 years, with hip osteoarthritis verified from self-reported pain and radiographic changes, were included. The final material comprised 23 patients (10 males/13 females, mean (SD) age 58.2 (10.02) years) in the patient education only group, and 22 patients (9 males/13 females, mean (SD) age 60.2 (9.49) years) in the patient education + exercise therapy group. Three-dimensional gait analysis was conducted at baseline and at four month follow-up. Sagittal and frontal plane joint angle displacement and external joint moments of the hip, knee and ankle were compared from a one-way analysis of covariance between the groups at follow-up, with baseline values as covariates (p < 0.05). No group differences were observed at the four-month follow-up in gait velocity, joint angle displacement, or moments. As the compliance in the exercise therapy group was inadequate, we calculated possible associations between the number of completed exercise sessions and change in each of the kinematic or kinetic variables. Associations were weak to neglible. Thus, the negative findings in this study cannot be explained from inadequate compliance alone, but most likely also suggest the exercise therapy program itself to be insufficient to engender gait alterations.CONCLUSIONS:Adding a 12-week supervised exercise therapy program to patient education did not induce changes in our selected biomechanical variables during the stance phase of gait, even when adjusting for poor compliance. Thus, we did not find evidence to support our exercise therapy program to be an efficacious intervention to induce gait alterations in this population of hip osteoarthritis patients.TRIAL REGISTRATION:NCT00319423 at ClinicalTrials.gov (registration date 2006-04-26).

Single-legged hop tests and isokinetic muscle torque are common outcome measures in the evaluation of knee function. The reliability of the single-legged hop tests in children has not been documented. The aim was to examine inter- and intrarater reliability of four single-legged hop tests and isokinetic muscle torque measurements in children.

Existent biomechanical studies on hip osteoarthritic gait have primarily focused on the end stage of disease. Consequently, there is no clear consensus on which specific gait parameters are of most relevance for hip osteoarthritis patients with mild to moderate symptoms. The purpose of this study was to explore sagittal plane gait characteristics during the stance phase of gait in hip osteoarthritis patients not eligible for hip replacement surgery. First, compared to healthy controls, and second, when categorized into two subgroups of radiographic severity defined from a minimal joint space of ≤/>2 mm.

Because ACL reconstruction does not automatically lead to successful outcomes and return to play,1 ,2 active rehabilitation is a realistic option that is being adopted by an increasing number of patients.3 In the Delaware-Oslo ACL Cohort Study, we found no differences in 2-year knee function, sports participation or new knee injuries between patients treated with ACL reconstruction followed by progressive preoperative and postoperative active rehabilitation, and patients treated with active rehabilitation alone.4 In our 2015 paper, we found that 86–94% of our ACL reconstruction and active rehabilitation group reported 2-year Knee injury and Osteoarthritis Outcome Score (KOOS) within …

Objectives: Identification of patient characteristics early after injury that influences long-term outcomes is needed to guide appropriate decision-making with regard to surgical management. The purpose of this study was to determine factors early after ACL injury which predict outcomes following non-operative management of ACL injury. Methods: 59 (52.5% F; mean age 31.3±10.7 yrs) athletes completed rehabilitation to resolve knee joint range of motion, effusion, pain and gait impairments (quiet knee) after ACL injury. Patients then completed 10 additional rehabilitation sessions over 5 weeks consisting of progressive strengthening and neuromuscular training. Quadriceps strength testing, 4 single-legged hop tests, the Knee Outcome Survey Activities of Daily Living Scale (KOS), Global Rating Scale for Perceived Function (GR), and International Knee Documentation Committee 2000 form (IKDC) were completed following these 10 sessions. Two years after non-operative rehabilitation patients again completed the IKDC. “Normal” knee function was defined as an IKDC score in the top 85% of scores reported by uninjured people of the same age and sex, with “below normal” knee function equal to scores in the bottom 15% of normative data. Fisher's exact tests and Mann-Whitney U tests were used to test differences in baseline and clinical measures after non-operative rehabilitation between those with “normal” and “below normal” knee function at 2 years. A logistic regression model was used to identify factors predictive of 2 year knee function. A prior significance level was set at p≤.05. Results: 11 patients (18.6%) reported knee function <15% on the IKDC at 2 years (Normal: 93.8±4.5%, 95% CI: 92.3-95.1; Below Normal: 72.1±12.7%, 95% CI: 63.6-80.6). No group differences existed for age (p=0.613) or sex (p=0.320) between those who scored in the normal range and those who scored <15%. Patients with self-reported IKDC knee function <15% had significantly lower IKDC scores at baseline (p=0.010; Normal: 83.0±10.0%, 95% CI: 80.1-85.9; Below Normal: 72.7±10.8%, 95% CI: 64.9-80.4) and required a greater number of days to achieve a quiet knee after injury (p=0.005; Normal: 58.5±21.9 days, 95% CI: 52.1-64.8; Below Normal: 77.6±17.7 days, 95% CI: 65.7-89.5). A trend toward significance was present for quadriceps strength (p=0.076; Normal: 93.5±9.1%, 95% CI: 90.8-96.1; Below Normal: 88.4±7.4%, 95% CI: 83.4-93.4) but no group differences were present for hop scores (single: p=0.684; crossover: p=0.630; triple: p=0.724; 6-meter timed: p=0.341), KOS (p=0.119), or GR (p=0.136). A logistic regression model including IKDC, days to achieve a quiet knee, and quadriceps strength was statistically significant with IKDC and days to achieve a quiet knee being significant predictors of knee function at 2 years (p=0.001; R2=0.433; IKDC: p=0.040, OR=0.909; days to achieve a quiet knee: p=0.014, OR=1.054; quad strength: p=0.220, OR=0.941). Conclusion: Only 18% of active individuals managed non-operatively after ACL injury had IKDC scores <15% of norms 2 years after injury and rehabilitation. Lower baseline subjective knee function was predictive of poorer self-reported non-operative outcomes despite similar hop scores to those reporting normal knee function at 2 years. Longer time from injury to resolution of initial knee impairments also predicted poorer self-reported knee function, highlighting the importance of early rehabilitation with aggressive intervention to resolve impairments.

STUDY DESIGN:Longitudinal laboratory study.OBJECTIVES:(1) To compare gait characteristics between individuals with early-stage hip osteoarthritis who underwent total hip replacement (THR) and those who did not undergo THR, and (2) to evaluate whether gait characteristics, function, and symptoms declined among individuals who did not undergo THR during a 6- to 7-year follow-up.BACKGROUND:The natural history of symptoms, function, and gait changes secondary to hip osteoarthritis, including potential differences at an early stage of disease, is unknown.METHODS:Forty-three individuals (mean age, 58.9 years) with radiographic and symptomatic hip osteoarthritis participated. Outcome measures included 3-D gait analysis; self-reported pain, stiffness, and function; hip range of motion; and the six-minute walk test. Baseline comparisons between individuals who later underwent THR and those who did not undergo THR were made using independent t tests or Mann-Whitney U tests. Comparisons of baseline measures and 6- to 7-year follow-up for the nonoperated individuals were conducted with paired-samples t tests or Wilcoxon signed-rank tests (P<.05).RESULTS:Twelve (27.9%) of the 43 individuals initially evaluated had not undergone THR at the 6- to 7-year follow-up. At baseline, these individuals had larger sagittal plane hip and knee joint excursions, larger joint space width, lower body mass index, and superior self-reported function compared with the individuals who later underwent THR. At the 6- to 7-year follow-up, the individuals who did not undergo THR exhibited no decline in gait characteristics, minimum joint space, or overall function. Furthermore, their self-reported pain had significantly decreased (P = .024).CONCLUSION:Individuals who did not undergo THR during a 6- to 7-year follow-up period did not exhibit a decline in gait, function, or symptoms compared to those who underwent THR. These findings are suggestive of a phenotype of hip osteoarthritis with a very slow disease progression, particularly in regard to pain.LEVEL OF EVIDENCE:Prognosis, level 1b.

BACKGROUND:Preoperative knee function is associated with successful postoperative outcome after anterior cruciate ligament reconstruction (ACLR). However, there are few longer term studies of patients who underwent progressive preoperative and postoperative rehabilitation compared to usual care. OBJECTIVES:To compare preoperative and 2 year postoperative patient-reported outcomes (PROs) in patients undergoing progressive preoperative and postoperative rehabilitation at a sports medicine clinic compared with usual care. METHODS:We included patients aged 16-40 years undergoing primary unilateral ACLR. The preoperative and 2 year postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) of 84 patients undergoing progressive preoperative and postoperative rehabilitation at a sports medicine clinic (Norwegian Research Center for Active Rehabilitation (NAR) cohort) were compared with the scores of 2690 patients from the Norwegian National Knee Ligament Registry (NKLR). The analyses were adjusted for sex, age, months from injury to surgery and cartilage/meniscus injury at ACLR. RESULTS:The NAR cohort had significantly better preoperative KOOS in all subscales, with clinically relevant differences (>10 points) observed in KOOS Pain, activities of daily living (ADL), Sports and Quality of Life. At 2 years, the NAR cohort still had significantly better KOOS with clinically relevant differences in KOOS Symptoms, Sports and Quality of Life. At 2 years, 85.7-94% of the patients in the NAR cohort scored within the normative range of the different KOOS subscales, compared to 51.4-75.8% of the patients in the NKLR. CONCLUSIONS:Patients in a prospective cohort who underwent progressive preoperative and postoperative rehabilitation at a sports medicine clinic showed superior patient-reported outcomes both preoperatively and 2 years postoperatively compared to patients in the NKLR who received usual care.

BACKGROUND While there are many opinions about the expected knee function, sports participation, and risk of knee reinjury following nonsurgical treatment of injuries of the anterior cruciate ligament (ACL), there is a lack of knowledge about the clinical course following nonsurgical treatment compared with that after surgical treatment. METHODS This prospective cohort study included 143 patients with an ACL injury. Isokinetic knee extension and flexion strength and patient-reported knee function as recorded on the International Knee Documentation Committee (IKDC) 2000 form were collected at baseline, six weeks, and two years. Sports participation was reported monthly for two years with use of an online activity survey. Knee reinjuries were reported at the follow-up evaluations and in a monthly online survey. Repeated analysis of variance (ANOVA), generalized estimating equation (GEE) models, and Cox regression analysis were used to analyze group differences in functional outcomes, sports participation, and knee reinjuries, respectively. RESULTS The surgically treated patients (n = 100) were significantly younger, more likely to participate in level-I sports, and less likely to participate in level-II sports prior to injury than the nonsurgically treated patients (n = 43). There were no significant group-by-time effects on functional outcome. The crude analysis showed that surgically treated patients were more likely to sustain a knee reinjury and to participate in level-I sports in the second year of the follow-up period. After propensity score adjustment, these differences were nonsignificant; however, the nonsurgically treated patients were significantly more likely to participate in level-II sports during the first year of the follow-up period and in level-III sports over the two years. After two years, 30% of all patients had an extensor strength deficit, 31% had a flexor strength deficit, 20% had patient-reported knee function below the normal range, and 20% had experienced knee reinjury. CONCLUSIONS There were few differences between the clinical courses following nonsurgical and surgical treatment of ACL injury in this prospective cohort study. Regardless of treatment course, a considerable number of patients did not fully recover following the ACL injury, and future work should focus on improving the outcomes for these patients. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Sit-To-Stand (STS) transition is a mechanically demanding task that may pose particular challenges for individuals with lower limb osteoarthritis (OA). Biomechanical features of STS have been investigated in patients with OA, but not in patients with early stage hip OA. The purpose of this study was to explore inter-limb weight-bearing asymmetries (WBA) and selected kinematic and kinetic variables during STS in patients with mild-to-moderate hip OA compared with healthy controls. Twenty-one hip OA patients and 23 controls were included in the study. Sagittal and frontal plane kinematic and kinetic data were collected using an eight-camera motion analysis system synchronized with two force plates embedded in the floor. There were no distinctive biomechanical alterations in sagittal or frontal plane kinematics or kinetics, movement time, or time to reach peak ground reaction force (GRF) in hip OA patients compared with controls. However, the hip OA patients revealed a distinct pattern of WBA compared with the controls, in unloading their involved limb by 18.4% at peak GRF. These findings indicate that patients with early stage hip OA are not yet forced into a stereotypical movement strategy for STS; however, the observed pattern of WBA requires clinical attention.

OBJECTIVES: To determine if self-reported knee-function-assessed with the International Knee Documentation Committee 2000 Subjective Knee Form (IKDC 2000) could discriminate between successful and nonsuccessful performance on-return-to-activity criteria (RTAC) tests after anterior cruciate ligament (ACL) reconstruction.BACKGROUND: Selecting appropriate performance-based and patient-reported tests that can detect side-to-side asymmetries, assess global knee function, and determine a participant's-readiness to return to activity after ACL reconstruction can be a challenge for rehabilitation specialists. A simple tool or questionnaire to identify athletes with neuromuscular impairments or activity limitations could provide rehabilitation specialists with crucial data pertinent to their patients' current knee function and readiness to return to higher-level activities.METHODS: One hundred ninety-four level I and level II athletes-who underwent ACL reconstruction participated in the study. One hundred fifty-eight athletes at 6 months after ACL reconstruction and 141 of the athletes at 12 months after ACL reconstruction completed a battery of functional tests to determine readiness to return to activity and the IKDC 2000 to determine self-reported knee function. For each athlete, status on the RTAC test battery was dichotomized into "passed" or "failed," and status on the IKDC 2000 scores was dichotomized into "within" or "below" age- and sex-matched normal ranges. Comparisons were made between status on the RTAC test battery and the IKDC 2000 using chi-square tests. Accuracy statistics were also calculated.RESULTS: Six months after ACL reconstruction, 112 athletes (70.9%) failed RTAC and 76(48.1%) were classified as having self-reported knee function below normal ranges. Among the 76 participants with IKDC 2000 scores below normal ranges, 69(90.8%) failed the RTAC test battery (P<.001). However, among the 82 participants whose IKDC 2000 scores were within normal limits at,6 months, only 39(47.6%) passed the RTAC test battery (P = .74). Twelve months after ACL reconstruction, 67 athletes (47.5%) failed RTAC and 31 (22.0%) had knee function below normal ranges. Among the 31 participants with IKDC 2000 scores below normal ranges,25 (80.6%) failed the RTAC test battery (P<.001). However, among the 110 participants whose IKDC 2000 scores were within normal limits at 12 months, only 68 (61.8%) passed the RTAC test battery (P = .017).CONCLUSION: The IKDC 2000 may be a clinically relevant tool to determine the timeliness or necessity of RTAC testing. For scores obtained 6 and 12 months after ACL reconstruction, low IKDC 2000 scores were reasonably indicative of failure on the RTAC test battery, whereas normal IKDC 2000 scores were not predictive of passing scores on the RTAC test battery.CONCLUSION: The IKDC 2000 may be a clinically relevant tool to determine the timeliness or necessity of RTAC testing. For scores obtained 6 and 12 months after ACL reconstruction, low IKDC 2000 scores were reasonably indicative of failure on the RTAC test battery, whereas normal IKDC 2000 scores were not predictive of passing scores on the RTAC test battery.

Background The current methods measuring sports activity after anterior cruciate ligament (ACL) injury are commonly restricted to the most knee-demanding sports, and do not consider participation in multiple sports. We therefore developed an online activity survey to prospectively record the monthly participation in all major sports relevant to our patient-group. Objective To assess the reliability, content validity and concurrent validity of the survey and to evaluate if it provided more complete data on sports participation than a routine activity questionnaire. Methods 145 consecutively included ACL-injured patients were eligible for the reliability study. The retest of the online activity survey was performed 2 days after the test response had been recorded. A subsample of 88 ACL-reconstructed patients was included in the validity study. The ACL-reconstructed patients completed the online activity survey from the first to the 12th postoperative month, and a routine activity questionnaire 6 and 12 months postoperatively. Results The online activity survey was highly reliable (κ ranging from 0.81 to 1). It contained all the common sports reported on the routine activity questionnaire. There was a substantial agreement between the two methods on return to preinjury main sport (κ=0.71 and 0.74 at 6 and 12 months postoperatively). The online activity survey revealed that a significantly higher number of patients reported to participate in running, cycling and strength training, and patients reported to participate in a greater number of sports. Conclusions The online activity survey is a highly reliable way of recording detailed changes in sports participation after ACL injury. The findings of this study support the content and concurrent validity of the survey, and suggest that the online activity survey can provide more complete data on sports participation than a routine activity questionnaire.

Purpose: Existing studies concerning biomechanics in hip osteoarthritis have primarily included patients in a severe stage of disease. Therefore, current knowledge on the natural history and progression of hip osteoarthritis from a biomechanical perspective is sparse, and prospective studies on hip osteoarthritis patients who do not undergo total hip replacement are needed. The aims of this study were firstly to compare hip- and knee joint excursion and moments during the stance phase of gait between hip osteoarthritis patients with mild to moderate symptoms who later underwent total hip replacement, and patients who remained non-operated; and secondly to evaluate alterations in gait, minimum joint space or physical function among the non-operated patients at a 6-7 year follow-up. Methods: Fourty-three subjects were included in the material. Inclusion criteria were age between 40 and 80 years, radiographic osteoarthritis defined from Danielson’s criteria, and a Harris Hip Score between 60 and 95. Patients with knee pain and/or knee osteoarthritis were excluded. Gait analyses both at baseline and at 6-7 year follow-up were conducted utilizing a Qualisys Pro-Reflex motion analysis system with 8 cameras, synchronized with two AMTI LG6 force plates. Four selected events during stance phase were identified for analysis: Initial contact, mid-stance, peak hip extension angle, and toe-off. Minimal joint space was measured with standardized postero-anterior digital pelvic radiographs centered on the symphysis. In addition, we included self-reported pain, stiffness and function from the Western Ontario and McMaster Universities Arthritis Index (WOMAC), hip range of motion and the 6-minute walk test. Gait characteristics in patients who later underwent total hip replacement and patients who remained non-operated were compared at baseline with independent t-test and Mann-Whitney U-test. For the non-operated patients, paired samples t-test and Wilcoxons Sign Rank Test were conducted to compare data at baseline and at 6-7 year follow-up. Statistical significance was set as p<0.05. Results: To our knowledge, this is the first study to explore long-term gait characteristics and functional status in hip OA subjects who have not undergone total hip replacement. At the 6-7 year follow-up, 31 of the patients (19 females/12 males; mean (SD) age 58.0 (9.48) years) had undergone total hip replacement surgery, whereas 12 patients (10 females/2 males; mean (SD) age 59.8 (7.06) years) were still non-operated. At baseline, statistically significant differences were found between the non-operated subjects and those who later underwent total hip replacement. The non-operated patients had lower BMI (p = 0.033), larger minimal joint space (p<0.001), and superior self-reported WOMAC function (p = 0.019) and stiffness (p = 0.019). During gait, the non-operated patients had larger hip- and knee joint excursion and a larger hip flexion moment during the latter 50% of stance (p-values 0.003 to 0.015). No differences were found from baseline to follow-up in gait characteristics, minimal joint space, 6-meter walk test, or overall function at the 6-7 year follow-up of the non-operated patients. Self-reported pain assessed from the WOMAC was significantly improved (p = 0.024). Conclusions: Even if all patients were classified as having mild to moderate symptoms at inclusion, we found significant baseline differences both in gait and function between the patients who later underwent total hip replacement and those who were still non-operated at the 6-7 year follow-up. The non-operated patients revealed no signs of disease progression at follow-up. Joint excursion and moments were maintained, and neither the minimal joint space, 6-meter walk test, overall hip range of motion, or self-reported WOMAC function, stiffness or pain deteriorated.

BACKGROUND:The methodological quality of studies on treatment of anterior cruciate ligament (ACL) injuries in skeletally immature children after ACL injury is low, and no prospective studies have evaluated the functional outcomes following a non-operative treatment algorithm.PURPOSE:To report changes in knee function and activity level in skeletally immature children following a non-operative treatment algorithm for a minimum of 2 years after ACL injury.STUDY DESIGN:Prospective cohort.METHODS:46 skeletally immature children aged 12 years and younger were evaluated at baseline and subsequent yearly follow-ups using patient-reported outcome measurements, isokinetic muscle strength measurements, single-legged hop tests and clinical examinations over a minimum period of 2 years. Participation in physical activities was monitored using a monthly online activity survey, and the main leisure-time sport activity was registered at the yearly follow-ups.RESULTS:36 (78%) of the children did not undergo an ACL reconstruction during the follow-up. Statistically significant changes with questionable clinical relevance were discovered with the patient-reported outcome measurements or hop tests. Leg symmetry indexes were consistently above 90% for muscle strength and single legged hop tests throughout the study, and the isokinetic muscle strength improved significantly in the injured limb. Ninety-one per cent maintained participation in pivoting sports and/or physical education in school, although 38% of the ACL deficient children changed their main activity from a level 1 to a level 2 activity.CONCLUSIONS:A non-operative treatment algorithm may be appropriate for ACL injured skeletally immature children, although a reduced participation in level 1 activities may be necessary for some children.

Background No gold standard exists for identifying successful outcomes 1 and 2 years after operative and non-operative management of anterior cruciate ligament (ACL) injury. This limits the ability of a researcher and clinicians to compare and contrast the results of interventions. Purpose To establish a consensus based on expert consensus of measures that define successful outcomes 1 and 2 years after ACL injury or reconstruction. Methods Members of international sports medicine associations, including the American Orthopaedic Society for Sports Medicine, the European Society for Sports Traumatology, Surgery, and Knee Arthroscopy and the American Physical Therapy Association, were sent a survey via email. Blinded responses were analysed for trends with frequency counts. A summed importance percentage (SIP) was calculated and 80% SIP operationally indicated consensus. Results 1779 responses were obtained. Consensus was achieved for six measures in operative and non-operative management: the absence of giving way, patient return to sports, quadriceps and hamstrings’ strength greater than 90% of the uninvolved limb, the patient having not more than a mild knee joint effusion and using patient-reported outcomes (PRO). No single PRO achieved consensus, but threshold scores between 85 and 90 were established for PROs concerning patient performance. Conclusions The consensus identified six measures important for successful outcome after ACL injury or reconstruction. These represent all levels of the International Classification of Functioning: effusion, giving way, muscle strength (body structure and function), PRO (activity and participation) and return to sport (participation), and should be included to allow for comparison between interventions.

Purpose: In contrast to the numerous studies that exist on biomechanical characteristics of patients with knee osteoarthritis (OA), few studies have assessed patients with hip OA. In particular, knowledge is sparse with concern to patients in the early stage of disease, not eligible for total hip replacement. The purpose of this study was, therefore, to explore sagittal plane biomechanics of the hip and knee during gait in hip OA patients with mild to moderate pain compared to age-matched healthy controls, and furthermore, to investigate whether radiographic severity affected gait. Methods: Inclusion criteria for hip OA patients were self-reported hip pain lasting ≥3 months, radiographic OA using Danielson's criteria (<4mm minimal joint space (MJS) for patients <70 years and <3mm MJS for patients ≥70 years), and a Harris Hip Score between 60-96 points. Gait analyses were performed using eight Qualisys Motion Capture System cameras synchronized with three AMTI force plates. Sagittal plane data for the target hip joint and ipsilateral knee joint of the patients and right hip and knee joint of the controls were calculated using Visual 3D software. Joint angles were identified at initial contact (IC), peak knee flexion (PKF), peak knee extension (PKE) and toe-off (TO), in addition to total hip and knee joint excursion during stance. Moments were given as external moments. Hip OA patients with minimum joint space (MJS) <2mm were defined to have severe radiographic OA. Differences between patients and controls and between those with severe and less severe radiographic OA were assessed with an independent Mann-Whitney U-test with significance level p<0.05. Results:Forty-seven patients with hip OA (29 women/18 men) with mean age 59.2 (±9.5) years and mean BMI 24.6 (±3.4) and 21 controls (13 women/8 men) with mean age 58.4 (± 8.9) years and mean BMI 23.88 (±3.5) were included. The hip OA patients walked significantly slower than the controls (p=0.002). They further revealed reduced hip extension and knee extension at PKE and TO (p<0.001), reduced total excursion in both the hip (p<0.001) and knee joint (p=0.004), a smaller hip flexion moment at PKE (p=0.009), a smaller knee flexion moment at PKF (p= 0.009) and a smaller knee extension moment at PKE (p=0.036). Of the 47 patients, 21 were defined to have severe radiographic hip OA. Compared to patients with MJS≥2 mm, these patients had significantly reduced hip extension at PKE (p=0.029) and TO (p=0.032). No other differences were revealed. Conclusions:Patients in the early stage of hip OA reveal deviant biomechanical gait characteristics compared to controls, with reduced hip and knee extension during the latter phase of stance as the main feature. More severe radiographic OA enhances the deficits in hip extension during the latter phase of stance.