VOLUME FOURTEEN NUMBER THREE

 
2019Masthead_V14N3_Cover

June 2019

ERRATUM

ORIGINAL RESEARCH

Epidemiology of Neck Injuries Accompanying Sport Concussions in Youth Over a 13-year Period in a Community-Based Healthcare System.  
Authors:  Carmichael JP, Staton E, Blatchford P, Stevens-Lapsley J
The same trauma that produces concussion may also produce neck injury.  The signs of concussion and neck injury are similar, and symptoms after acceleration-deceleration trauma to the head-neck complex do not accurately discriminate between them. Research on the epidemiology of neck injury among sport-concussed youth is sparse.Therefore, the purpose of this study was to investigate the epidemiology of diagnosed neck injury in non-sport-related concussion (non-SRC) versus sport-related concussion (SRC) in youth by age, sex, and sport. De-identified data from community-based electronic health records over 13 years were extracted to analyze rates and characteristics of neck injuries among non-SRCs and SRCs in youth aged five to 21. Neck injury diagnosis prevalence rates and odds ratios were calculated to estimate risk of neck injury among concussed youth, comparing non-SRCs to SRCs by age and sex. Sixteen thousand, eight hundred and eighty-five concussion records were extracted of which 3,040 SRCs and 2,775 non-SRCs in youth aged five to 21 were identified by cross-filtering sport-related keywords (e.g., football, basketball, soccer, running, swimming, batting, horseback riding, skiing, etc.) with all ICD-9 and ICD-10 concussion codes. The prevalence of neck injuries diagnosed among SRCs (7.2%) was significantly different than the prevalence of neck injuries diagnosed among non-SRCs (12.1%, p < 0.000). Neck injury diagnoses were significantly more prevalent in females overall (p < 0.000) and among non-SRCs (p < 0.000). The prevalence of neck injury diagnoses was not significantly higher in concussed females versus concussed males with SRC (p = 0.164).  Among youth aged five to 21 exposed to concussions, non-SRCs were more likely to be accompanied by a neck injury diagnosis than SRCs (OR 1.66; 95% CI 1.39 to 1.98; p < 0.000). Similarly, female-to-male neck injury prevalence ratios were significantly higher in females in non-SRCs compared to SRCs (IPR 1.90, 95% CI 1.60 to 2.25, p < 0.000). Sports with highest prevalence of concussion differ from sports with highest prevalence of concussion-related neck injury in both sexes.  The authors found that overall prevalence of diagnosed neck injuries in youth was higher in non-SRCs compared to SRCs (12.1 vs. 7.2%, p < 0.001), with the highest prevalence at age 14 in both sexes.  The risk of neck injury diagnosis accompanying concussion was significantly higher in females compared to males (6.1% difference; p < 0.000).

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Use of Clinical Test Clusters versus Advanced Imaging Studies in the Management of Patients with a Suspected SLAP Tear.
Authors:  Clark RC, Chandler CC, Fuqua AC, Glymoh KN, Lambert GC, Rigney KJ.
Use of a Magnetic Resonance Arthrogram (MRA) has served as the gold standard for identifying patients with possible Superior Labrum Anterior-Posterior (SLAP) lesions and are often required by orthopaedic surgeons prior to clinical evaluation. However, as the literature shows MRA sensitivity as 0.65-0.98, and specificity between 0.80-1.00, there is still room for misinterpretation of the imaging study, and potential mismanagement of a patient who may or may not exhibit a true SLAP lesion.  It has been proposed that by grouping a series of clinical special tests it may be possible to develop greater sensitivity in identifying a SLAP lesion, resulting in the ability to better manage this patient population, thus avoiding unnecessary and costly imaging studies and referrals to surgical specialists.  A retrospective search of the current peer-reviewed literature was performed in an effort to identify the clinical special tests with the greatest sensitivity and specificity in identifying SLAP lesions.  Based upon that search, the study was limited to five special tests: Biceps Load I, Biceps Load II, Speed’s, Passive Compression, and O’Brien’s test’s.  A regression analysis was performed that examined grouping of the tests to determine the diagnostic sensitivity/specificity when grouped. Obtaining positive results on three of the five special tests resulted in a sensitivity of 0.992-0.999 and a specificity of 0.992-0.999.  The combination of the Biceps Load I/II and O’Brien’s showed the highest sensitivity and specificity.  Based on the results, the authours concluded that a combination of at least three positive SLAP lesion tests may be clinically useful in diagnosing a shoulder SLAP lesion with greater diagnostic accuracy than those reported for MRA, thus minimizing the need for specialty referral for only those patients who cannot be managed conservatively.

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Baseball Players Diagnosed with Ulnar Collateral Ligament Tears Demonstrate Greater Side to Side Differences in Passive Glenohumeral Abduction Range of Motion Compared to Healthy Controls.
Authors:  Whitt S, Garrison JC, Creed K, Giesler L, Conway JE
Numerous studies have shown that baseball players develop range of motion adaptations in their throwing arm.  While some of these shoulder range of motion adaptations can lead to greater throwing velocity, excessive changes in shoulder range of motion can increase the risk of injury to the ulnar collateral ligament (UCL). The purpose of this study was to compare the passive glenohumeral abduction range of motion (GH-ABD ROM) measures of baseball players with a diagnosed UCL tear (UCL group) to a group of age, activity, and position matched healthy controls (CONT group).  The primary hypothesis was that baseball players with an UCL tear would have a greater loss of passive glenohumeral abduction range of motion in their throwing shoulder than healthy controls. A secondary hypothesis was that baseball players with an UCL tear would demonstrate similar glenohumeral abduction range of motion in their non-throwing arm and increased side-to-side glenohumeral abduction differences compared to the healthy cohort. The UCL group had significantly greater glenohumeral abduction range of motion on their throwing shoulder (132.5°±8.3°) than the CONT group (120.19°±11.2°, p = 0.000).  Similarly, the UCL group had increased glenohumeral abduction range of motion on their non-throwing shoulder (141.2°±9.5°) compared to the CONT group (124.1°±11.4°, p = 0.000). Additionally, the UCL group had a greater glenohumeral abduction difference (-8.7°±8.4°) than the CONT group (-3.8°±7.7°, p = 0.001). In contrast to the original hypotheses, high school and collegiate baseball players that sustained an UCL injury presented with greater glenohumeral abduction range of motion in both their throwing and non-throwing shoulders compared to healthy controls. However, the finding of greater side-to-side glenohumeral abduction range of motion deficits in the UCL group when compared to the matched healthy controls confirms the secondary hypothesis.

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Modifying Midsole Stiffness of Basketball Footwear Affects Foot and Ankle Biomechanics.
Authors:   Taylor JB, Nguyen AD, Parry HA, Zuk EF, Pritchard NS, Ford KR
There is a growing incidence of foot injuries in basketball, which may be from the sport’s repetitive, forceful multi-directional demands. Modifying midsole stiffness of the basketball shoe has been reported to alter ankle motion and plantar forces to reduce the risk of injury; however, the effects on anatomical, in-cleat foot (metatarsal), motion is not well understood. The purpose of this study was to identify differences in foot and ankle biomechanics between basketball shoes with differing midsole stiffness values during single-leg jump landings. It was hypothesized that a stiffer midsole would elicit lower 1st metatarsophalangeal joint (MTPJ) dorsiflexion angles, higher ankle dorsiflexion angles, and higher plantar forces and relative loading in the distal foot.  Twenty high school and collegiate-aged basketball players performed a single-leg side drop jump and a single-leg cross drop jump in a pair of standard basketball shoes and a pair of shoes modified with a fiberglass plate to increase midsole stiffness. Three-dimensional motion analysis and flexible insoles quantified foot and ankle kinematics and plantar force distribution, respectively. Separate 2 (footwear) x 2 (task) repeated measures ANOVA models were used to analyze differences in 1) ankle kinematics, 2) 1st metatarsophalangeal kinematics, 3) maximal regional plantar forces, and 4) relative load. The stiffer shoe elicited decreased peak ankle plantarflexion (mean difference=5.8°, p=0.01) and eversion (mean difference=6.6°, p=0.03) and increased peak ankle dorsiflexion angles (mean difference=5.0°, p=0.008) but no differences were observed in 1st MTPJ motion (p>0.05). The stiffer shoe also resulted in lower peak plantar forces (mean difference=24.2N, p=0.004) and relative load (mean difference=1.9%, p=0.001) under the lesser toes. Altering the midsole stiffness in basketball shoes did not reduce motion at the MTPJ, indicating that added stiffness may reduce shoe motion, but does not reduce in-shoe anatomical motion. Instead, a stiffer midsole elicits other changes, including additional ankle joint motion and a reduction in plantar forces under the lesser toes. Collectively, this indicates that clinicians need to account for unintended compensations that can occur throughout the kinetic chain when altering a shoe property to alleviate a musculoskeletal injury.

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The Effect of Kinesio Tape® on Static Foot Posture, Plantar Pressure, and Rearfoot Motion in Individuals with Pronated Feet.
Authors:  Cornwall MW, Jain TK, Holmgren S, Dorri A, Young C
Kinesio Tape® (KT) is an elastic therapeutic tape that is applied to the skin for treatment of sport-related injuries. Its application has been purported to facilitate the neuromuscular system, thus altering skeletal muscle activity to increase joint range of motion and improve performance. Due to its proposed therapeutic effect, KT may benefit individuals with excess foot pronation in order to decrease pain and improve function. Unfortunately, current research regarding the ability of KT to alter foot biomechanics is limited.  The purpose of this study was to determine if the application of KT to the ankle and lower leg would alter static foot posture, plantar pressure, and foot motion during walking in individuals with foot pronation. Thirty participants (10M/20F) were recruited for this study.  Each participant had their dorsal arch height and midfoot width measured prior to the application of the KT. In addition, their dynamic rearfoot eversion and plantar pressure was recorded during walking using an electrogoniometer and plantar pressure system.  After these measurements were collected, KT was applied to their right foot and lower leg in order to attempt to facilitate activity in the posterior tibialis muscle. After applying the tape, the above measurements were repeated. None of the variables measured were statistically significantly different between the pre-test and post-test. Application of KT did not result in a change in static foot posture, plantar pressure, and frontal plane rearfoot motion during walking. As such, KT cannot be recommended as a treatment for reducing excessive foot pronation where such a goal would be beneficial.

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Medial and Lateral Hamstrings Response and Force Production at Varying Degrees of Knee Flexion and Tibial Rotation in Healthy Individuals.
Authors:  Beyer EB, Lunden JB, Giveans MR
Hamstring weakness is a contributor to lower extremity pathology. Influence of knee flexion and tibial rotation on hamstrings muscle activation and knee flexion force has not been documented in the literature.  The purpose of the study was to determine the angle of knee flexion and tibial rotation that elicits the greatest knee flexion force and hamstrings activation in healthy, physically active adults.  Eighteen young healthy adults were recruited for study participation. Each individual performed maximal voluntary isometric hamstrings contractions at six different knee flexion angles (15°, 30°, 45°, 60°, 75° & 90°), each positioned at three different tibial rotation positions (internal rotation, neutral rotation and external rotation). Electromyographic activity of the medial and lateral hamstrings and knee flexion force production were recorded.  On average, greatest force production was recorded at 30° knee flexion with tibia either in neutral rotation (124.1% of max) or in external rotation (123.5% of max). This same lower limb orientation also produced the highest amount of lateral hamstring activation (156.4% of max). Results also showed that force production and lateral hamstring activation decreased as knee flexion angle increased.  Muscle activation for the medial hamstrings was not affected by knee flexion angle but did show higher activation in neutral or tibial internal rotation. The results of the current research describe the relationship between knee flexion and tibial rotation and their effect on overall knee flexion force production and hamstrings activation. This research provides key insights about the specific knee joint angles and tibial orientation that may be preferred in exercise prescription for maximizing hamstring activation.

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The Effect of One-on-One Intervention in Athletes with Multiple Risk Factors for Injury.
Authors: Schwartzkopf-Phifer K, English RA, Mattacola CG, Dressler EV, Kiesel KB.
Lower extremity injuries in soccer players are extremely common.  Implementation of group injury prevention programs has gained popularity due to time and cost-effectiveness.  Unfortunately, players with greater number of risk factors are most likely to sustain an injury, yet less likely to benefit from a group injury prevention program.  The purpose of this study was to determine if targeting these high risk players with one-on-one treatment would result in a reduction in the number of risk factors they possess.   Division I men’s and women’s soccer players were screened for modifiable risk factors using a battery of tests which assessed mobility, fundamental movement pattern performance, motor control, and pain.  Players with ≥3 risk factors (“high risk”) received one-on-one treatment from a physical therapist via an algorithm twice per week for four weeks.  Players with <3 risk factors (“low risk”) did not receive one-on-one intervention.  The proportion of treatment successes in the intervention group was 0.923 (95% CI 0.640-0.998).  A significant proportion of high risk subjects (0.846) became low risk at posttest (p=0.003).  A significant between group difference was noted in risk factor change from pretest to posttest (p=0.002), with the median risk factor change in the intervention group being -3. Utilizing one-on-one interventions designed to target evidence-based risk factors is an effective strategy to eliminate LE musculoskeletal injury risk factors in high risk individuals.

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Self-assessment during Jump Shot Drills Translates to Decreased Vertical Ground Reaction Forces during Single Limb Drop Jump Landing.
Authors:  Hartigan E, Coleman K, Brooks J, Frisbee H, Lawrence M, Hawke K, Breslen G
Prevention programs reduce hard and stiff landings associated with risk of anterior cruciate ligament (ACL) injury, yet cost and time are barriers to implementation. Providing feedback about landing mechanics during shooting drills at practices using minimal resources and time may improve adherence to educating athletes how to avoid risky mechanics associated with ACL injury when landing. Implementing video, auditory, written, and pictorial feedback into basketball practices to cue athletes on landing mechanics after taking a jump shot may soften the landing. The purpose of this study was to test whether implementing video, auditory, written, and pictorial feedback into a basketball practice jump shot drill (i.e., double limb drop jump landing task) will result in lesser vertical ground reaction force (vGRF) during a single limb drop jump landing without decreasing maximal jump height. During a summer league, 16 female high school basketball players were assigned to an intervention (Int) or control (Con) group. The Int group (n=8) utilized delayed video feedback and task cards (written and pictorial cues) at six practices while the Con group (n=8) received typical coaching only. Cost and compliance with the intervention were measured. Pre- and post-season data collections included five single limb drop jumps from a 31 cm high box onto force plates. The vGRF impulses over the first 10% of landing were calculated for each limb. Data did not differ between limbs, thus data for both limbs were pooled. Mixed model ANOVAs were used to compare groups over time (p<0.05) for vGRF and maximum jump height, respectively.  Compliance with the intervention was 100% and did not increase the time of drills. The implementation cost was less than $10. A time*group interaction (p=0.04; Int significantly decreased vGRF over time), main effect of time (p=0.004), and no main effect of group (p=0.412) were found for vGRF during single limb drop jump landings. A time*group interaction (p=0.03; Int significantly decreased max jump height over time), no main effect of time (p=0.10) and no main effect of group (p=0.32) were found for max jump height.  Athletes landed more softly and jumped less high during a single limb drop jump landing task after receiving feedback during jump shot drills. High team compliance may occur since the intervention required minimal resources and addressed different learning styles.

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Comparison of Lower Quarter Y-Balance Test Scores for Female Collegiate Volleyball Players Based on Competition Level, Position, and Starter Status.
Authors:  Brumitt J, Patterson C, Dudley R, Sorenson E, Hill G, Peterson C
The Lower Quarter Y-Balance Test (YBT-LQ) is used by sports medicine professionals to measure an athlete’s dynamic balance.  The YBT-LQ is used by clinicians to track recovery during clinical rehabilitation, assess an athlete’s readiness to return to sport after injury, and to identify athletes potentially at-risk for a time-loss injury.  Normative data for the YBT-LQ are lacking for female collegiate volleyball (VB) players. Therefore, the purpose of this study was to examine preseason YBT-LQ scores and their relationships to level of competition, starter status, player position, and prior lower quadrant (e.g., low back and lower extremities) injury history.  One-hundred thirty-four female collegiate VB players (mean age = 19.3 ± 1.1 years) representing athletes from three levels of competition (D II = 32, D III = 77, NAIA = 25) participated in this study.  Athletes reported their prior injury history and performed the YBT-LQ testing protocol.  NAIA and D III athletes demonstrated significantly greater reach measures on the YBT-LQ than D II athletes in several directions.  Starters demonstrated significantly greater reach measures in five out of eight reach directions.  Liberos/defensive specialists/setters demonstrated significantly greater posterolateral and composite reach measures bilaterally.  There was no difference in reach measures based on prior history of lower quadrant (low back and lower extremities) injury.  This study provides normative data for YBT-LQ in female collegiate volleyball players.  The data presented in this report may be used by coaches and rehabilitation professionals when evaluating dynamic balance in healthy volleyball players and by clinicians to compare an injured athlete’s recovery to norms.  

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Reliability of a Movement Quality Assessment Tool to Guide Exercise Prescription (MovementSCREEN).
Authors:  Bennett H, Davison K, Arnold J, Martin M, Wood S, Norton K  
Movement quality is commonly assessed to identify movement limitations and guide exercise prescription. Rapid growth in the movement assessment landscape has led to the development and utilization of various movement quality assessments, many without reliability estimates. MovementSCREEN is a novel, tablet-based, video-recorded movement assessment tool, currently without published reliability information. Therefore, the purpose of this study was to determine the intra and inter-rater reliability of the MovementSCREEN, including the impact of rater experience, and provide estimates of measurement error and minimal detectable change. Thirty healthy young adults (14M:16F, mean age 28.4 yrs, SD 9.1) were video recorded completing the nine MovementSCREEN assessment items on two occasions, two weeks apart. Each individual movement was assessed against objective scoring criteria (component items: yes/no) and using a 100-point sliding scale. To create an overall score for each movement, the scale score is weighted against the objective items to provide a score out of 100. At the completion of all nine individual movements, a mean composite score of movement quality is also established (0-100). The first recording was scored twice by two expert and two novice assessors to investigate inter- and intra-rater reliability. The second recording was scored by one expert assessor to investigate within-subject error. Inter- and intra-rater reliability was calculated using intraclass correlation coefficients (ICCs) and Kappa statistics. The standard error of measurement (SEM), and minimal detectable change (MDC95) for the overall score for each movement, and the composite score of movement quality, were calculated.  Intra-rater reliability for the component items ranged from κ = 0.619 – 1.000 (substantial to near perfect agreement) and 0.233 – 1.000 (slight to near perfect agreement) for expert and novice assessors, respectively. The ICCs for the overall movement quality scores for each individual movement ranged from 0.707 – 0.952 (fair to high) in expert and 0.502 – 0.958 (poor to high) in novice assessors. Inter-rater agreement for the component items between expert assessors ranged from κ = 0.242 - 1.000 (slight to almost perfect agreement), while for novice assessors ranged from 0.103 – 1.000 (less than chance to almost perfect agreement). ICCs for the overall scores for each individual movement from expert and novice assessors ranged from 0.294 – 0.851 (poor to good) and 0.249 – 0.775 (poor to fair), respectively.  The SEM for the composite score was 2 points, while the MDC95 was 6 points, with an ICC 0.901. The MovementSCREEN can assess movement quality with fair to high reliability on a test-retest basis when used by experienced assessors, although reliability scores decrease in novice assessors. Comparisons between assessors involve greater error. Therefore, the training of inexperienced assessors is recommended to improve reliability.

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Functional Movement Screen™ in Youth Sport Participants: Evaluating the Proficiency Barrier for Injury.
Authors:  Pfeifer CE, Sacko RS, Ortaglia A, Monsma EV, Beattie PF, Gions J, Stodden DF

The number of youth participating in sport increases yearly; however, the evaluation of youths’ movement ability and preparedness for sport remains inadequate or neglected. The Functional Movement Screen (FMS™) is an assessment of an individual’s movement quality that has been utilized to evaluate risk of injury in collegiate and professional sport; however, there is minimal support regarding the predictive value of the screen in youth sport. The purpose of this study was to evaluate the mean and distribution of FMS™ performance in sport participants age 11-18, and to evaluate the existence of a composite FMS™ score proficiency barrier to predict injury risk. One hundred, thirty-six participants (63 male, 73 female) age 11 to 18 years (16.01 + 1.35) were recruited from local schools and sport organizations. The FMS™ was administered prior to each participant’s competitive season and scored by researchers who demonstrated reliability in assessments derived from the screen (κw = 0.70 to 1). Injury data were collected by the participants’ Athletic Trainer over one season. An injury was defined as any physical insult or harm resulting from sports participation that required an evaluation from a health professional with time modified or time lost from sport participation.  Females scored significantly higher than males for mean FMS™ composite score (t=14.40; m=12.62; p < 0.001), and on individual measures including: the hurdle step (t=1.91; m=1.65; p < 0.001), shoulder mobility (t=2.68; m=2.02; p < 0.001), active straight leg raise (t=2.32; m=1.87; p < 0.001), and the rotary stability components (t=1.91; m=1.65; p < 0.05). Two FMS™ composite scores (score <14 and <15) significantly increased the odds of injury (OR=2.955). When adjusting for sport, there was no score relating to increased odds of injury. Dysfunctional movement as identified by the FMS™ may be related to increased odds of injury during the competitive season in youth athletes. Consideration of an individual’s movement within the context of their sport is necessary, as each sport and individual have unique characteristics. Addressing movement dysfunction may aid in injury reduction and potentially improve sport performance.

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CASE SERIES
Management of Acute Grade II Lateral Ankle Sprains with an Emphasis on Ligament Protection: A Descriptive Case Series

Authors:  Wells B, Allen C, Deyle G, Croy T
Lateral ankle sprain is the most common injury in physically active populations. Individuals who sustain an acute lateral ankle sprain may not receive timely formal rehabilitation and are at an increased risk to have subsequent sprains which can lead to chronic pain and instability. Attention to essential factors for ligament protection and healing while preserving ankle movement, may result in a more stable yet mobile ankle offering improved outcomes. The purpose of this case series was to describe the methods and observe the outcomes associated with a comprehensive strategy for managing acute first episode grade II lateral ankle sprains. Ten patients (mean age 26.7 years, range 16-51 years, mean 2.3 days from injury) with acute grade II lateral ankle sprain were treated with an approach to protect the injured ligament, prevent impairments to movement, restore strength and proprioception, and progress to full function. Patient outcomes were assessed at four, eight and 12 weeks. Follow-up interviews at six and 12 months assessed injury recurrence.  Patients were treated for an average of eight sessions over a mean of seven weeks.  Rapid change in self-reported function, ankle ROM, and pain were observed in the first four weeks of care. Clinically meaningful improvements in function and ankle ROM were also noted at eight weeks and maintained at 12-week follow-ups. All patients returned to desired physical activity with only a single re-sprain event within one year after injury. The results suggest that a treatment approach designed to protect the injured ligament, maintain and restore normal ankle motion, and provide a tailored functional pathway to return to run and sport demonstrated resolution of symptoms and improvement in reported functional outcomes in a group of patients following grade II acute primary ankle sprains.

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LITERATURE REVIEW
Clinical Relevance of the Ligamentum Teres: A Literature Review.
Authors:  Martin RL, McDonough C, Enseki K, Kohreiser D, Kivlan BR
The ligamentum teres (LT) continues to be a structure of debate and interest. Previously thought of as a vestigial structure, an awareness of LT pathology and its potential importance has increased with the expansion of hip arthroscopy. The purpose of this review is to provide a comprehensive literature synthesis on the LT and provide clinicians with the most current research regarding the LT and its anatomical features, functional relevance, prevalence of injury, risk factors for injury, clinical presentation, and treatment for pathology. A systematic literature search was conducted using Medline/PubMed, CINAHL/EBSCO, and Cochrane/Wiley databases/platforms using the following search terms: ligament, ligament teres, hip, femur, femoral head, round ligament. This search yielded 1284 articles of which 44 met the inclusion/exclusion criteria and contributed to this manuscript. Information on the LT was summarized into the following areas: anatomy, function, injury prevalence, risk factors, mechanism of injury, duration of symptoms, clinical presentation (symptoms, range of motion, functional limitations, special testing), imaging, and treatment.   The results of this review supported the following: 1) the LT has a function in restraining hip rotation range of motion; 2) the prevalence of LT pathology in any given population may be largely dependent on the severity of bony deformity (either femoroacetabular impingement(FAI) or dyplasia) and activity level; 3) older age and acetabular bony deformity (either FAI or dyplasia) are risk factors for generalized LT pathology; 4) unique signs and symptoms are difficult to identify because LT pathology rarely occurs in isolation and is likely the end-stage consequence of other hip pathology; 5) the presence of LT pathology may negatively affect an individual’s ability to function; and 6) surgical debridement is recommend for pain relief of partial LT rears with reconstruction possible for complete LT tears when complaints of instability are noted.   

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CLINICAL COMMENTARY
The Role of a Bike Fit in Cyclists with Hip Pain.  A Clinical Commentary.
Authors:  Wadsworth DJS, Weinrauch P
Hip pathology is common amongst athletes and the general population. The mechanics of cycling have the potential to exacerbate symptomatic hip pathology and progress articular pathology in patients with morphologic risk factors such as femoroacetabular impingement. A professional fit of the bicycle to the individual which aims to optimize hip joint function can allow patients with hip pathology to exercise in comfort when alternative high impact exercise such as running may not be possible.  Conversely improper fit of the bicycle can lead to hip symptoms in otherwise healthy individuals who present with risk factors for hip pain.  Accordingly, a bike fit can be a part of the overall management strategy in a cyclist with hip symptoms.  The purpose of this clinical commentary is to discuss hip pathomechanics with respect to cycling, bicycle fitting methodology, and the options available to a physical therapist to optimize hip mechanics during the pedaling action.

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Osteochondral Allograft Transplantation for the Knee: Post-operative Rehabilitation.
Authors:   Haber DB, Logan CA, Murphy CP, Sanchez A, LaPrade RE, Provencher MT
Articular cartilage injuries of the knee are common among young, active patients presenting with knee pain, swelling, and/or mechanical symptoms. These injuries have limited healing potential due to the avascular nature of hyaline cartilage. While several treatment options exist, osteochondral allograft (OCA) transplantation for the knee has been used successfully in primary management of large chondral or osteochondral defects and salvage of previously failed cartilage repair. OCA transplantation potentially yields a natural, matching contour of the native recipient surface anatomy and transplants mature, viable hyaline cartilage to the affected defect. Following OCA transplantation, strict compliance with a rehabilitation protocol is essential to enable optimal recovery. The outlined rehabilitation protocol is informed by the existing literature and incorporates current rehabilitation principles, the science of osteochondral incorporation, and adaptations based on an individual’s readiness to progress through subsequent phases. The purpose of this clinical commentary is to discuss the diagnosis, surgical management, and post-operative rehabilitation following OCA transplantation and to assist the physical therapist in returning athletes to full sports participation.

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