Hollman, John H.

BackgroundMedial meniscal extrusion (MME) has been correlated with medial meniscal injury and progression of medial knee osteoarthritis (OA).ObjectiveTo examine the difference in MME between non‐weight‐bearing (supine) and weight‐bearing (standing) positions in patients with and without medial knee OA. Determine the correlation between body mass index (BMI), Kellgren‐Lawrence (KL) grade, Knee Osteoarthritis Outcome Score (KOOS), and MME.DesignProspective.SettingTertiary institution PM&R Department.ParticipantsForty five participants (29 female, 16 male), 24 with healthy knees and 21 with OA.Methods or InterventionsA single physician sonographer measured supine and standing MME with ultrasound (US) on each participant. The physician was blinded to all measurements. BMI was recorded on all participants. KL grades and KOOS questionnaires were obtained for the OA group.Main Outcome MeasuresMME in supine and standing positions, change in MME from supine to standing, BMI, KL grade, and KOOS subscale scores.ResultsMME increased .52 mm from supine to standing (P < .001). MME was greater in the OA group in both the supine (P = .002) and standing (P < .001) positions. Increasing BMI was moderately correlated with increasing MME (supine P = .001, standing <.001). Increasing age was correlated with increasing MME (supine P = .012, standing P = .002). Increasing KL grade (from 1 to 4) was correlated with increasing MME (supine P = .015, standing = .006). There was a small‐to‐moderate correlation between KOOS activities of daily living (ADL) subscale score and change in MME from supine to standing (P = .035). The change in MME from supine to standing positions had a small‐to‐moderate correlation (P = .035) with KOOS ADL subscale score alone but did not correlate with any of the other KOOS subscale scores or KOOS total scores. Receiver operating characteristic curve analysis suggested a standing MME value of 4.2 mm provides a positive likelihood ratio of 6.02 for knee OA.ConclusionsMME is greater in those with OA and with weight‐bearing. MME correlates with BMI, age, KL grade, and the KOOS ADL subscale score. Finally, standing MME of 4.2 mm yielded a higher positive likelihood ratio to differentiate between healthy knees and those with medial compartment OA than the previously reported value of 3.0 mm.

BackgroundDistal iliotibial band friction syndrome (ITBFS) is a common cause of knee pain in endurance athletes. Nonsurgical treatment is usually successful, but surgery is occasionally required for recalcitrant cases. No published studies to date have evaluated the feasibility of an ultrasound‐guided (USG) partial iliotibial band (ITB) release.ObjectiveTo determine the feasibility of an USG partial ITB release using a cutting wire. A secondary aim was to assess whether adjacent structures were damaged. We hypothesized that the posterior distal ITB could be partially transected with a cutting wire under USG with no injury to adjacent structures.DesignCadaveric study.SettingQuaternary‐care academic institute.ParticipantsTen cadaveric knees ranging from 76‐89 years old with a mean body mass index of 21.9 kg/m2.InterventionsOne physician sonographer performed USG releases of the posterior ITBs at the level of the lateral femoral epicondyle with a cutting wire. Dissection was carried out by an independent second physician to assess for primary and secondary outcomes.Main Outcome Measures(1) Release of the posterior border of the ITB; (2) width of the release; (3) evaluation for any injury to adjacent structures; (4) technical difficulty of the procedure (0 = no difficulty, 10 = most difficult procedure possible); (5) duration of time it took to complete the procedure.ResultsAll 10 knees had the posterior border of the ITB transected. Mean release length was 16 mm (range 15‐17), which was within 1 mm of the target release length of 15 mm. No adjacent structures were damaged.ConclusionA USG release of the posterior ITB utilizing a cutting wire is feasible and safe in a cadaveric model. Translational research is warranted to determine how these results apply to the clinical setting.

Background: Balance assessment is used by clinicians as part of athlete concussion screening. The King-Devick (K-D) Balance app is designed to provide an objective balance assessment value. The purpose of this study was to investigate the responsiveness of a balance assessment using the K-D Balance app. Hypothesis: The K-D Balance app will demonstrate acceptable responsiveness for balance assessment. Study Design: Repeated-measures study. Level of Evidence: Level 5. Methods: A convenience sample of 25 participants between the ages of 20 and 25 years completed testing procedures. A battery of balance tests using the K-D Balance app on an iPhone were conducted 1 week apart. After a 5-minute warm-up, 3 stances were assessed: double leg, tandem right, and tandem left. The K-D Balance app guided the test positions and test times. A value representing movement was generated by the app algorithm. Analysis included descriptive statistics along with intraclass correlation coefficient and minimal detectable change (MDC). Results: The median score of the K-D test was 0.5 for session 1 and 0.4 for session 2. The ICC was 0.42 (95% CI, 0.04-0.70), and the MDC was 1.58. Conclusion: The MDC value of 1.58 represents the threshold of meaningful change in balance, as measured with the K-D Balance app. Clinical Relevance: Clinicians can use the results of this study to objectively assess changes in balance over time using the K-D Balance app.

Background and Purpose/Objective: Patients undergoing hematopoietic stem cell transplantation (HSCT) are at risk for strength impairments and activity limitations. Research describing how HSCT affects physical performance is limited. The purposes of this study were to report the short-term (≤30 days) effects of HSCT on physical performance and to compare changes among patients during the engraftment and recovery periods following HSCT. Methods: Design: Prospective observational study. Setting: Academic medical center. Patients: Twenty-five adults 21 years and older undergoing HSCT. Intervention: None. Measurements: Measures were collected at 3 time points: (1) day of transplant; (2) 8 to 14 days posttransplant; and (3) 15 to 30 days posttransplant. Beside demographic data, the authors collected Short Physical Performance Battery (SPPB) scores, Functional Comorbidity Index scores, resting heart rate, and hospitalization status. Longitudinal changes in SPPB scores were analyzed with a generalized linear model (α = 0.05). Results: SPPB scores were negatively associated with patients' body mass index values and resting heart rate measurements. Additionally, the hospitalization × time interaction was statistically significant. SPPB scores among nonhospitalized patients remained consistent across the testing periods but among hospitalized patients decreased from the day of transplant to both the 8 to 14 days (mean change = 4.0 points) and 15 to 30 days (mean change = 4.1 points) posttransplant time points. Conclusion: Physical performance scores decreased in the first 30 days of recovery among patients who were hospitalized following HSCT, but not among patients who received transplant on an outpatient basis. Future studies to examine causes of and interventions for the reduction in physical performance among hospitalized patients post-HSCT are warranted.

Background: Adductor longus tendinopathy is a well-known etiology of chronic groin pain in elite athletes. Surgery is indicated for those who fail conservative treatment. No studies to date have evaluated the feasibility of an ultrasound-guided release of the proximal adductor longus tendon. Purpose/Hypothesis: The primary aim of this study was to determine the feasibility of an ultrasound-guided selective adductor longus release with a cutting wire. A secondary aim was to determine safety by avoiding injury to adjacent structures. We hypothesized that the proximal adductor longus tendon can be released under ultrasound guidance with a cutting wire without injury to adjacent neurovascular or genitourinary structures. Study Design: Descriptive laboratory study. Methods: Ten adductor longus tendons (5 cadaveric specimens) from 4 males and 1 female between 76 and 89 years of age with a mean body mass index of 21.9 kg/m 2 (range, 16.8-29.6 kg/m 2 ) were used during this study. A single experienced physician sonographer performed ultrasound-guided proximal adductor longus tendon releases on all cadaveric specimens using a cutting wire. Dissection was performed by a second physician to determine the completeness of the tendon transections and to detect injury to adjacent neurovascular or genitourinary structures. Results: All 10 adductor longus tendons were transected. Eight of 10 transections were complete, whereas in 2 transections, >99% of the tendon was transected. There were no injuries to adjacent genitourinary or neurovascular structures. Conclusion: Ultrasound-guided adductor tendon release is feasible and safe in a cadaveric model. Further translational research should be performed to determine whether these results can be replicated in the clinical setting. Clinical Relevance: Adductor longus tendinopathy frequently requires surgical intervention and prolonged time away from sport. The present study suggests that a selective adductor longus tendon release can be performed with ultrasound guidance. This procedure warrants further translational research to explore its use in clinical practice.

PurposeIncreasing stride‐rate by 5%‐10% has been used for injury prevention and rehabilitation but evidence is limited if an independent program can alter stride‐rate in runners. The objective of this study was to determine whether the preferred stride‐rate of recreational runners can be increased by 5%‐10% following a 6‐week independent training program.MethodsThirty‐eight runners running a minimum of 15 miles/wk with a preferred stride‐rate ≤85 strides/min determined during treadmill testing were randomized into two groups: (a) Experimental group was instructed to increase stride‐rate by 10% using a watch and foot pod for stride‐rate feedback; and (b) Control group was instructed to continue normal running. Compliance was tracked with a training log. One stride being defined as two sequential steps. Preferred running stride‐rate was retested at 6 weeks using the same testing protocol.ResultsThere was no significant difference in baseline preferred running stride‐rates between the experimental or control groups. A significant (P < .001) increase in stride‐rate from 79.9 ± 4.8 to 86.8 ± 5.7 strides/min (8.6% increase) was found in the experimental group. The control group did not significantly change their stride‐rate (Baseline: 80.4 ± 4.2, 6 weeks: 81.3 ± 3.3 strides/min).ConclusionA 6‐week home training program using a watch and foot pod can increase the preferred running stride‐rate by 5%‐10% in runners with a stride‐rate of 85 or less. Clinicians may be able to apply this type of gait retraining in recreational runners when designing injury prevention and rehabilitation programs.

BackgroundUltrasound has become a useful instrument in evaluating musculoskeletal pathology. Recent studies suggest that ultrasound imaging of weight‐bearing menisci may enhance the assessment of knee pathology, such as osteoarthritis (OA) and meniscal injuries.ObjectiveThe primary aim of this study was to determine the intrarater and interrater reliability of ultrasound measurements of medial meniscal extrusion (MME) after a brief training session.DesignProspective reliability study.SettingPhysical medicine and rehabilitation (PM&R) department within a tertiary care institution.ParticipantsForty‐five participants (29 female, 16 male) were recruited to serve as models, 24 of whom had healthy knees and 21 of whom had radiographically confirmed medial compartment knee OA. Three physician sonographers (1 = experienced, 1 = sports medicine fellow, 1 = post‐graduate year [PGY]‐4 PM&R resident) were recruited to serve as operators.Methods or InterventionsOperators received a brief training session on identifying and measuring MME. All operators measured bilateral MME in each model in the standing and supine positions on two separate days. Operators were blinded to all measurements.Main Outcome MeasurementsPrimary outcomes were inter‐ and intrarater intraclass correlation coefficients (ICCs) of MME measurements among operators with different levels of ultrasound experience.ResultsSupine MME intrarater reliability ICCs were 0.927, 0.885, and 0.780 for the experienced physician, sports medicine fellow, and PGY‐4 operators, respectively. Standing MME intrarater reliability ICCs were 0.941, 0.902, and 0.824 for the experienced physician, sports medicine fellow, and PGY‐4 operators, respectively. Interrater reliability ICCs were 0.896 and 0.842 for supine and standing measurements, respectively. There was a statistically significant increase in intrarater reliability with experience between the PGY‐4 resident and experienced physician operators.ConclusionsOperators with different levels of ultrasound experience demonstrated good MME measurement intra‐ and interrater reliabilities in both supine and standing positions.

Background: Cervical muscle strength, proposed as a modifiable risk factor in concussions, can be assessed using various methods. The purpose of this study was to compare the reliability and force outputs of 3 methods that use handheld dynamometry (HHD) for assessing cervical muscle strength. Hypothesis: All 3 testing methods are reliable, and force outputs are significantly different between methods. Study Design: Repeated-measures reliability. Level of Evidence: Level 5. Methods: The study used a convenience sample of 30 participants. HHD “make tests” for cervical extension, flexion, and right and left side bending were performed using lying push tests, sitting push tests, and sitting pull tests. A sole examiner performed all tests. Two testing sessions were conducted 1 week apart. Analysis included intraclass correlation coefficients (ICCs), repeated-measures analyses of variance (α = 0.05) with post hoc Bonferroni tests, and minimal detectable change (MDC) calculations. Results: All testing methods were reliable; the lying push test had the greatest point estimate values (ICC, 0.89-0.95). Significant differences in force were found between the 3 testing methods. The MDC was most sensitive for the lying push method. Conclusion: Of the 3 cervical muscle testing methods investigated, the lying position with a push test had the largest ICC according to the point estimate and the most sensitive MDC. Force values between the 3 methods were significantly different, which suggests that consistent testing methods should be used. Clinical Relevance: Results from this study support the clinical use of an HHD “make test” in a lying position for assessing cervical muscle strength. The test is reliable and more sensitive to change compared with tests in a seated position.

Background and Purpose/Objective: Few studies have examined the efficacy of fall risk assessment tools for patients undergoing hematopoietic cell transplant (HCT). The purpose of this study was to determine whether the Hendrich II Fall Risk Model (HFRM II) can distinguish patients who fell from those who did not fall in the inpatient HCT population. Methods: Observational study. Design: Retrospective chart review. Setting: Academic medical center. Patients: Patients undergoing HCT who fell during the first 100 days posttransplant. Intervention: None. Measurements: Independent-sample t tests were performed to determine differences in HFRM II score, age, pulse, systolic and diastolic blood pressure, platelet count, hemoglobin concentration, and hematocrit for fallers compared with nonfallers. Chi-square tests of independence determined differences regarding sex, assistive device used on the day of fall, transplant type, and physical therapy. Logistic regression analysis detected odds of falling dependent on transplant type, pulse rate, and HFRM II score. Results: Forty-seven patients who fell within 100 days after HCT were control matched by transplant date with 2 nonfallers each. Significant differences included HFRM II mean score (5.36 for fallers vs 3.41 for nonfallers; t = 4.510, P < .001) and mean pulse rates (100.09 vs 88.70 bpm; t = 3.398, P = .001). Patients with allogeneic HCT were 3.46 times more likely to have fallen than those with autologous HCT (P = .007). Limitations: Potential selection bias of retrospective review. Conclusions: HCT patients with higher HFRM II scores, greater pulse rate, or allogeneic transplant were more likely to fall.