Anthropometric risk factors for patellar tendon injury among volleyball players

Objective: Abnormal imaging in the patellar tendon reveals pathology that is often associated with knee pain. Anthropometric measures of body size and mass, such as height, weight and waist-to-hip ratio (WHR), have been individually associated with abnormal imaging. The aim of this study was to investigate the anthropometric factors that have the strongest relationship with abnormal imaging in volleyball players.

Methods: Height, weight, body mass index (BMI), waist girth, hip girth and WHR were measured in a cohort of 113 competitive volleyball players (73 men, 40 women). The univariate (ANOVA) and multivariable (discriminant function analysis) association between abnormal imaging and these anthropometric factors were investigated.

Results: No significant association was found in the female volleyball players. A significant univariate association was observed between abnormal imaging and heavier weight, greater BMI, larger waist and hip girth and larger WHR in the male volleyball players. Waist girth was the only factor that retained this association in a multivariable model (p<0.05).

Conclusions: Men with a waist girth greater than 83 cm seem to be at greater risk of developing patellar tendon pathology. There may be both mechanical and biochemical reasons for this increased risk.

Influence of posture on the range of axial rotation and coupled lateral flexion of the thoracic spine

Objective
This study examines the influence of posture on the range of axial rotation of the thorax and the range and direction of the coupled lateral flexion.

Methods
The ranges of mid thoracic axial rotation and coupled lateral flexion were measured in 52 asymptomatic subjects (aged 18-43 years) using an optical motion analysis system. To examine the influence of posture on primary and coupled motion, we initiated axial rotation from a neutral sitting posture and from end-range thoracic flexion and extension.

Results
There was a significant decrease in the range of thoracic rotation in flexion compared with the neutral and extended postures (P < .001). The mean range of coupled lateral flexion was 8.9% of the axial rotation range in the neutral posture and increased to 14.3% and 23.2% in the extended and flexed postures, respectively. Patterns of coupled motion varied between subjects, but an ipsilateral pattern was more common in the flexed posture, whereas a contralateral pattern was more common in the neutral and extended postures.

Conclusions
The ranges and patterns of coupled motion of the thorax appear to be strongly influenced by the posture from which the movement is initiated. This has important implications in relation to the interpretation of clinical tests of thoracic motion and in consideration of mechanisms of development of thoracic pain disorders.

Lateral strength of zero bond masonry walls subjected to wind loads

Masonry walls are usually laid with the individual masonry units along a course overlapping units in the course below. Commonly, the perpend joints in the course occur above the mid-points of the units below to form a ‘half-bond’ or above a third point to form a ‘third-bond’. The amount of this overlap has a profound influence on the strength of a wall supported on three or four sides, where lateral pressures from wind cause combined vertical and horizontal flexure. Where masonry units are laid with mortar joints, the torsional shear bond resistance between the mortar and overlapping units largely determines the horizontal flexural strength. If there is zero bond strength between units, then the horizontal flexural strength is derived from the frictional resistance to torsion on the overlapping bed-faces of the units. This thesis reports a theoretical and experimental investigation into the frictional properties of overlapping units when subjected to combinations of vertical and horizontal moments and vertical axial compression. These basic properties were used to develop a theory to predict the lateral strength of walls supported on two, three or four sides. A plastic theory of behaviour was confirmed by experiment. The theory was then used to determine maximum unbraced panel sizes for particular boundary conditions. Design charts were developed to determine temporary bracing requirements for panels during construction.

Changes in the composition of the extracellular matrix in patellar tendinopathy

Objective: To compare the chemical levels and mRNA expression of proteoglycan and collagen in normal human patellar tendons and tendons exhibiting chronic overuse tendinopathy.

Methods: Sulfated glycosaminoglycan and hydroxyproline content were investigated by spectrophotometric measurement using papain-digested samples. Deglycosylated proteoglycan core proteins were analysed by Western blot using specific antibodies. Total mRNA isolated from samples of frozen tendons was assayed by relative quantitative RT-PCR for decorin, biglycan, fibromodulin, versican, aggrecan, and collagens Type I, II and III and normalised to glyceraldehyde-3-phosphate dehydrogenase.

Results: There was a significant increase in sulfated glycosaminoglycan content in pathologic tendons compared to normal. This was attributed to an increased deposition of the large aggregating proteoglycans versican and aggrecan and the small proteoglycans biglycan and fibromodulin, but not decorin. Aggrecan and versican were extensively degraded in both normal and pathologic tendons, biglycan was more fragmented in the pathologic tendons while predominantly intact fibromodulin and decorin were present in normal and pathologic tendons. There was a greater range in total collagen content but no change in the level of total collagen in pathologic tendons. There were no significant differences between the pathologic and normal tendon for all genes, however p values close to 0.05 indicated a trend in downregulation of Type I collagen and fibromodulin, and upregulation in versican and Type III genes in pathologic tissue.

Conclusion: The changes in proteoglycan and collagen levels observed in patellar tendinopathy appear to be primarily due to changes in the metabolic turnover of these macromolecules. Changes in the expression of these macromolecules may not play a major role in this process.

Surgical treatment of lateral clavicle fractures associated with complete coracoclavicular ligament disruption: clinico-radiological outcomes of acromioclavicular joint sparing and spanning implants

Distal clavicle fracture associated with complete coracoclavicular ligament disruption represents an unstable injury, and osteosynthesis is recommended. This study was performed (1) to retrospectively analyse the clinico-radiological outcomes of two internal fixation techniques, and (2) to identify and analyse radiographic fracture patterns of fracture that are associated with this injury. Conclusions: Internal fixation of this fracture pattern is associated with a high union rate and favorable clinical outcomes with both techniques. A combination of distal radius plate and ligament reconstruction device resulted in stable fixation and significantly lower reoperation rates, and should be used when fracture geometry permits (Types 1 and 2).

Lateral positioning for critically ill adult patients: a systematic review

A systematic review was undertaken to evaluate the effect of lateral positioning compared to other body positions on morbidity, mortality, and clinical adverse events for critically ill patients. Twenty three studies met the criteria. Hypoxaemia was not consistently reported. No clinical practice recommendations could be drawn from the included studies due to methodological shortcomings.