Morphology-based interslice interpolation on manual segmentations of joint bones and muscles in MRI

This paper presents a validation study on the application of a novel interslice interpolation technique for musculoskeletal structure segmentation of articulated joints and muscles on human magnetic resonance imaging data. The interpolation technique is based on morphological shape-based interpolation combined with intensity based voxel classification. Shape-based interpolation in the absence of the original intensity image has been investigated intensively. However, in some applications of medical image analysis, the intensity image of the slice to be interpolated is available. For example, when manual segmentation is conducted on selected slices, the segmentation on those unselected slices can be obtained by interpolation. We proposed a two- step interpolation method to utilize both the shape information in the manual segmentation and local intensity information in the image. The method was tested on segmentations of knee, hip and shoulder joint bones and hamstring muscles. The results were compared with two existing interpolation methods. Based on the calculated Dice similarity coefficient and normalized error rate, the proposed method outperformed the other two methods.

Anterior cruciate ligament reconstruction with special reference to magnetic resonance imaging of the postoperative outcome

Anterior cruciate ligament (ACL) tear is a common sports injury of the knee. Arthroscopic reconstruction using autogenous graft material is widely used for patients with ACL instability. The grafts most commonly used are the patellar and the hamstring tendons, by various fixation techniques. Although clinical evaluation and conventional radiography are routinely used in follow-up after ACL surgery, magnetic resonance imaging (MRI) plays an important role in the diagnosis of complications after ACL surgery. The aim of this thesis was to study the clinical outcome of patellar and hamstring tendon ACL reconstruction techniques. In addition, the postoperative appearance of the ACL graft was evaluated using several MRI sequences. Of the 175 patients who underwent an arthroscopically assisted ACL reconstruction, 99 patients were randomized into patellar tendon (n=51) or hamstring tendon (n=48) groups. In addition, 62 patients with hamstring graft ACL reconstruction were randomized into either cross-pin (n=31) or interference screw (n=31) fixation groups. Follow-up evaluation determined knee laxity, isokinetic muscle performance and several knee scores. Lateral and anteroposterior view radiographs were obtained. Several MRI sequences were obtained with a 1.5-T imager. The appearance and enhancement pattern of the graft and periligamentous tissue, and the location of bone tunnels were evaluated. After MRI, arthroscopy was performed on 14 symptomatic knees. The results revealed no significant differences in the 2-year outcome between the groups. In the hamstring tendon group, the average femoral and tibial bone tunnel diameter increased during 2 years follow-up by 33% and 23%, respectively. In the asymptomatic knees, the graft showed homogeneous and low signal intensity with periligamentous streaks of intermediate signal intensity on T2-weighted MR images. In the symptomatic knees, arthroscopy revealed 12 abnormal grafts and two meniscal tears, each with an intact graft. Among 3 lax grafts visible on arthroscopy, MRI showed an intact graft and improper bone tunnel placement. For diagnosing graft failure, all MRI findings combined gave a specificity of 90% and a sensitivity of 81%. In conclusion, all techniques appeared to improve patients' performance, and were therefore considered as good choices for ACL reconstruction. In follow-up, MRI permits direct evaluation of the ACL graft, the bone tunnels, and additional disorders of the knee. Bone tunnel enlargement and periligamentous tissue showing contrast enhancement were non-specific MRI findings that did not signify ACL deficiency. With an intact graft and optimal femoral bone tunnel placement, graft deficiency is unlikely, and the MRI examination should be carefully scrutinized for possible other causes for the patients symptoms.

The effect of collagen organization on tensile strength loss in anterior cruciate ligament grafts post-reconstruction surgery

Gemstone Team LEGS

A influência da massagem na sensação retardada de desconforto muscular

Introdução: Apesar dos muitos estudos sobre a temática da sensação retardada de desconforto muscular, atualmente, ainda se discute a explicação dos mecanismos subjacentes a esta condição clínica, bem como, a sua prevenção e tratamento. A literatura sugere a massagem como uma das formas de terapia, contudo, os estudos têm mostrado resultados controversos. Objetivo: Verificar se a massagem aplicada 2 horas após um protocolo de exercício excêntrico tem influência na sensação retardada de desconforto muscular, bem como, se o seu efeito varia dependendo do tempo de aplicação. Métodos: 21 participantes (23,62±1,32 anos; 76,95±12,17 kg; 174,71±4,78 cm; 25,25±4,26 Kg/m 2) foram divididos em três grupos. Foi avaliada a dor, força muscular e a perimetria antes, e 2h, 24h, 48h, e 72h após um protocolo de exercício constituído por três séries de dez repetições de contrações excêntricas dos isquiotibiais do membro dominante, com 80% da força máxima, a uma velocidade constante de 60º/s, numa amplitude entre 0º e 80º, utilizando o dinamómetro isocinético Biodex System 4. A massagem foi efetuada 2 horas após o exercício em dois grupos experimentais com durações diferentes, sendo o terceiro grupo de controlo. Para identificar diferenças entre os grupos no momento inicial e na variável diferença entre o momento inicial e os restantes momentos, recorreu-se ao teste de Kruskal-Wallis, seguido de uma análise Post-Hoc através do teste de Dunn com um nível de significância de 0,05. Resultados: Verificou-se que a massagem teve efeito na redução da dor e na perimetria. Relativamente à força não foram encontradas alterações significativas. Conclusão: Os resultados mostraram que a massagem aplicada 2 horas após o exercício excêntrico, independentemente da duração utilizada, teve efeito na redução da dor, mas não na força muscular. Na perimetria apesar de haver alterações, estas não foram consideradas relevantes.

Comparação do efeito da técnica de facilitação neuromuscular proprioceptiva com a técnica de músculo energia no alongamento muscular dos isquiotibiais a curto prazo

Introdução: A aplicação das técnicas de Contrair-Relaxar com Contracção do Antagonista (CRCA) e de Músculo Energia (TME) promovem um aumento da flexibilidade muscular, contudo poucos estudos comparam a eficácia de ambas. Apresentam aspectos comuns como a contracção prévia do músculo a alongar sendo esta máxima na CRCA e uma percentagem da máxima na TME. Contudo, alguma evidência sugere que não existe correspondência entre a força produzida e a desejada pelo que este aspecto da TME carece de explicação. Objectivos: Confirmar se a técnica CRCA e a TME são efectivas no alongamento muscular dos isquiotibiais a curto prazo, caso sejam determinar qual a mais efectiva. Pretende-se ainda avaliar se a percepção ao esforço durante a aplicação da TME corresponde à força efectivamente realizada. Métodos: Efectuou-se um estudo experimental com 45 voluntários distribuídos aleatoriamente pelos grupos CRCA, TME e Controlo. Avaliou-se a amplitude articular passiva de extensão do joelho antes e depois de aplicar as técnicas, utilizando um goniómetro. Nos participantes submetidos à TME avaliou-se a percepção ao esforço, solicitando uma contracção submáxima isométrica de 40% medida através do dinamómetro de mão. Resultados: Verificou-se um efeito das técnicas entre as avaliações (Teste ANOVA medidas repetidas factor tempo: p<0,001) e entre os grupos (tempo*grupo: p<0,001). Comparando os grupos dois a dois, verificaram-se diferenças entre o grupo CRCA e o grupo Controlo (Teste Post Hoc Games-Howell: p=0,001) e entre o grupo TME e o grupo Controlo (p=0,009), não existindo diferenças entre os grupos CRCA e TME (p=0,376). Os grupos CRCA e TME obtiveram um ganho de 10,7º e de 11,4º respectivamente, não havendo diferenças significativas entre os ganhos (Teste T-Student Independente: p=0,599). Existiram diferenças significativas entre os 40% CMVI produzida e desejada (Teste Wilcoxon: p=0,018). Conclusão: Ambas foram efectivas no aumento da flexibilidade muscular dos isquiotibiais a curto prazo. Os efeitos foram comparáveis, mas dada a menor complexidade e menor solicitação a TME foi considerada mais eficiente. A percepção ao esforço durante a aplicação da TME não correspondeu ao esforço desejado, existindo uma tendência para a produção de intensidades de contracções maiores.

Força Muscular Isocinética após Reconstrução do Ligamento Cruzado Anterior – Influência do Tipo de Enxerto (Osso-Tendão-Osso/Isquio-Tibiais)

Introdução: É reconhecida a importância do ligamento cruzado anterior (LCA) no funcionamento normal do joelho. Em caso de rotura ligamentar, nomeadamente em desportos com marcada solicitação dos movimentos de rotação do joelho, é justificada a necessidade de reconstrução do LCA na maioria dos casos. Objetivo (s): Avaliar a influência do tipo de enxerto na reconstrução do ligamento cruzado anterior na força muscular isocinética, assim como na funcionalidade e sintomas após 6 meses. Métodos: Estudo transversal analítico, constituído por 20 indivíduos voluntários do sexo masculino, que haviam sido submetidos a uma ligamentoplastia do cruzado anterior, pelo mesmo cirurgião, seguido de uma intervenção individualizada por um fisioterapeuta. Em 10 indivíduos, o procedimento cirúrgico foi realizado com enxerto do tendão rotuliano (grupo OTO), e nos restantes 10 com enxerto do semitendinoso e gracilis (grupo STG). Como forma de avaliar a Força Muscular Isocinética (Peak Torque, Trabalho Total Muscular, ratio Isquiotibiais/Quadricipite), foi utilizado o Dinamómetro Isocinético Biodex. A avaliação foi efectuada apenas aos 6 meses após o procedimento cirúrgico. Para observação da funcionalidade, amplitude de movimento e sintomas, utilizou-se o questionário International Knee Documentation Committee (IKDC). Resultados: Foi possível observar que entre os grupos apenas se observaram diferenças significativas no peak torque de extensão a 180º no membro não lesado (p=0,019). Contudo, foi observada uma tendência para o grupo OTO apresentar um maior défice no peak torque e trabalho total muscular em extensão. Comparativamente ao membro contra-lateral, o membro lesado apresentou valores significativamente inferiores na maioria das variáveis ( p < 0,05). Conclusão: Após 6 meses de pós-cirúrgico com reabilitação de fisioterapia, não foi possível apontar qual o enxerto que garante uma melhor recuperação da força muscular. Aos 6 meses, ambos os grupos ainda apresentaram limitações musculares, quando comparados com o lado contra-lateral. Relativamente ao rácio isquiotibiais/quadricípite, assim como no IKDC, não se observaram diferenças entre os dois tipos de enxertos.

Active isolated stretching : an investigation of the mechanical mechanisms

The Active Isolated Stretching (AIS) technique proposes that by contracting a muscle (agonist) the opposite muscle (antagonist) will relax through reciprocal inhibition and lengthen without increasing muscle tension (Mattes, 2000). The clinical effectiveness of AIS has been reported but its mechanism of action has not been investigated at the tissue level. Proposed mechanisms for increased range of motion (ROM) include mechanical or neural changes, or an increased stretch tolerance. The purpose of the study was to investigate changes in mechanical properties, i.e. stiffness, of skeletal muscle in response to acute and long-term AIS stretching for the hamstring muscle group. Recreationally active university-aged students (female n=8, male n=2) classified as having tight hamstrings, by a knee extension test, volunteered for the study. All stretch procedures were performed on the right leg, with the left leg serving as a control. Each subject was assessed twice: at an initial session and after completing a 6-week AIS hamstring stretch training program. For both test sessions active knee extension (ROM) to a position of "light irritation", passive resisted torque and stiffness were determined before and after completion of the AIS technique (2x10 reps). Data were collected using a Biodex System 3 Pro (Biodex Medical Systems, NY, USA) isokinetic dynamometer. Surface electromyography (EMG) was used to monitor vastus lateralis (VL) and hamstring muscle activity during the stretching movements. Between test sessions, 2x10 reps of the AIS bent knee hamstring stretch were performed daily for 6-weeks.

Programa de preparación física para controlar el desequilibrio muscular lumbo-pelvico como factor de riesgo de la pubalgia en los jugadores de la categoría sub 21 del club deportivo los millonarios

El presente trabajo es el resultado de un exhaustivo proceso investigativo a cerca de los factores de riesgo que predisponen al futbolista de alta competencia a padecer una entidad patológica severamente incapacitante como es la Pubalgia, la cual interfiere en el desempeño del mismo. Inicialmente el trabajo se centra en la revisión y comprensión de los conceptos básicos relacionados con salud, perfil del fisioterapeuta, actividad física, altas demandes cinéticas, anatomía y biomecánica normal de la Pélvis y sus alteraciones, definición de la Pubalgia, los principales factores de riesgo tanto intrínsecos como extrínsecos y el manejo médico y fisioterapéutico de esta entidad patológica.

Perceptions of wellness to monitor adaptive responses to training and competition in elite Australian football

Perceptions of wellness are often used by athletes and coaches to assess adaptive responses to training. The purpose of this research was to describe how players were coping with the demands of elite level Australian football over a competitive season using subjective ratings of physical and psychological wellness and to assess the ecological validity of such a monitoring approach. Twenty-seven players completed ratings for 9 items (fatigue, general muscle, hamstring, quadriceps, pain/stiffness, power, sleep quality, stress, well-being). Players subjectively rated each item as they arrived at the training or competition venue on a 1–5 visual analog scale, with 1 representing the positive end of the continuum. A total of 2,583 questionnaires were analyzed from completions on 183 days throughout the season (92 ± 24 per player, 103 ± 20 per week; mean ± SD). Descriptive statistics and multilevel modelling were used to understand how player ratings of wellness varied over the season and during the week leading into game day and whether selected player characteristics moderated these relationships. Results indicated that subjective ratings of physical and psychological wellness were sensitive to weekly training manipulations (i.e., improve steadily throughout the week to a game day low, p < 0.001), to periods of unloading during the season (i.e., a week of no competition, p < 0.05) and to individual player characteristics (e.g., muscle strain after a game was poorer in players with high maximum speed, p < 0.01). It is concluded that self-reported player ratings of wellness provide a useful tool for coaches and practitioners to monitor player responses to the rigorous demands of training, competition, and life as a professional athlete.

Muscle activity and inactivity periods during normal daily life

Recent findings suggest that not only the lack of physical activity, but also prolonged times of sedentary behaviour where major locomotor muscles are inactive, significantly increase the risk of chronic diseases. The purpose of this study was to provide details of quadriceps and hamstring muscle inactivity and activity during normal daily life of ordinary people. Eighty-four volunteers (44 females, 40 males, 44.1±17.3 years, 172.3±6.1 cm, 70.1±10.2 kg) were measured during normal daily life using shorts measuring muscle electromyographic (EMG) activity (recording time 11.3±2.0 hours). EMG was normalized to isometric MVC (EMGMVC) during knee flexion and extension, and inactivity threshold of each muscle group was defined as 90% of EMG activity during standing (2.5±1.7% of EMGMVC). During normal daily life the average EMG amplitude was 4.0±2.6% and average activity burst amplitude was 5.8±3.4% of EMGMVC (mean duration of 1.4±1.4 s) which is below the EMG level required for walking (5 km/h corresponding to EMG level of about 10% of EMGMVC). Using the proposed individual inactivity threshold, thigh muscles were inactive 67.5±11.9% of the total recording time and the longest inactivity periods lasted for 13.9±7.3 min (2.5–38.3 min). Women had more activity bursts and spent more time at intensities above 40% EMGMVC than men (p<0.05). In conclusion, during normal daily life the locomotor muscles are inactive about 7.5 hours, and only a small fraction of muscle's maximal voluntary activation capacity is used averaging only 4% of the maximal recruitment of the thigh muscles. Some daily non-exercise activities such as stair climbing produce much higher muscle activity levels than brisk walking, and replacing sitting by standing can considerably increase cumulative daily muscle activity.

Differential atrophy of the lower-limb musculature during prolonged bed-rest

Patients with medical, orthopaedic and surgical conditions are often assigned to bed-rest and/or immobilised in orthopaedic devices. Although such conditions lead to muscle atrophy, no studies have yet considered differential atrophy of the lower-limb musculature during inactivity to enable the development of rehabilitative exercise programmes. Bed-rest is a model used to simulate the effects of spaceflight and physical inactivity. Ten male subjects underwent 56-days of bed-rest. Magnetic resonance imaging of the lower-limbs was performed at 2-weekly intervals during bed-rest. Volume of individual muscles of the lower-limb and subsequently, rates of atrophy were calculated. Rates of atrophy differed (F = 7.4, p < 0.0001) between the muscles with the greatest rates of atrophy seen in the medial gastrocnemius, soleus and vastii (p < 0.00000002). The hamstring muscles were also affected (p < 0.00015). Atrophy was less in the ankle dorsiflexors and anteromedial hip muscles (p > 0.081). Differential rates of atrophy were seen in synergistic muscles (e.g. adductor magnus > adductor longus, p = 0.009; medial gastrocnemius > lateral gastrocnemius, p = 0.002; vastii > rectus femoris, p = 0.0002). These results demonstrate that muscle imbalances can occur after extended periods of reduced postural muscle activity, potentially hampering recovery on return to full upright body position. Such deconditioned patients should be prescribed "closed-chain" simulated resistance exercises, which target the lower-limb antigravity extensor muscles which were most affected in bed-rest.

Differential atrophy of the postero-lateral hip musculature during prolonged bedrest and the influence of exercise countermeasures

As part of the 2nd Berlin BedRest Study (BBR2-2), we investigated the pattern of muscle atrophy of the postero-lateral hip and hamstring musculature during prolonged inactivity and the effectiveness of two exercise countermeasures. Twenty-four male subjects underwent 60 days of head-down tilt bedrest and were assigned to an inactive control (CTR), resistive vibration exercise (RVE), or resistive exercise alone (RE) group. Magnetic resonance imaging (MRI) of the hip and thigh was taken before, during, and at end of bedrest. Volume of posterolateral hip and hamstring musculature was calculated, and the rate of muscle atrophy and the effect of countermeasure exercises were examined. After 60 days of bedrest, the CTR group showed differential rates of muscle volume loss (F = 21.44; P ≤ 0.0001) with fastest losses seen in the semi-membranosus, quadratus femoris and biceps femoris long head followed by the gluteal and remaining hamstring musculature. Whole body vibration did not appear to have an additional effect above resistive exercise in preserving muscle volume. RE and RVE prevented and/or reduced muscle atrophy of the gluteal, semi-membranosus, and biceps femoris long head muscles. Some muscle volumes in the countermeasure groups displayed faster recovery times than the CTR group. Differential atrophy occurred in the postero-lateral hip musculature following a prolonged period of unloading. Short-duration high-load resistive exercise during bedrest reduced muscle atrophy in the mono-articular hip extensors and selected hamstring muscles. Future countermeasure design should consider including isolated resistive hamstring curls to target this muscle group and reduce the potential for development of muscle imbalances.

Relação entre a tensão aplicada e a sensação de desconforto nos músculos isquiotibiais durante o alongamento

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of two proprioceptive neuromuscular facilitation techniques in different planes on hamstrings muscles of healthy subjects

Introduction: The proprioceptive neuromuscular facilitation technique (PNF) has been proven to be efficient, since it was found higher gain of joint range-of-motion compared to the classic stretching. This study aimed to perform a comparison between the muscular stretching techniques and the PNF hold-relax on the internal and external sagittal/diagonal plane.Method: Randomly divided in 3 groups by a drawing, 30 healthy male individuals have undergone the test. In group I the hold-relax technique was utilized on the sagittal plane, grupo II receveid hold-relax on the internal and external diagonals, and group III, on which an evaluation was performed, worked as control. All the groups went through tests on the first, fifth and fifteenth day after the application of the different approaches. In this evaluation it was used a Flexis (R) Fleximeter.Result: Group II (diagonal) obtained statistically significant gain of 13.99% in the immediate post-test and post test later obtained a loss of 4.81%, group I (sagittal) showed no statistical difference as the group III (control).Conclusion: We conclude that the technique of PNF in the diagonal plane is effective in the flexibility of the hamstring muscles.

Correlação entre torque, equlíbrio e função do joelho após reconstrução do LCA

Background: Several studies emphasize the importance of assessing the knee function after anterior cruciate ligament (ACL) reconstruction. The influence of several variables on the function of these patients has been analyzed, but there is no consensus in the science literature. Purpose: To evaluate the correlation between the torque and balance on the knee function after ACL reconstruction. Methods: 23 males patients with ACL reconstruction were tested. The procedures of the study included analysis of concentric peak torque at 60o/s and 180o/s of quadriceps femoris and hamstring muscle with a isokinetic dynamometer. The balance in single-limb stance was measured with stabilometry. The functional performance were performed by two hop tests. To estimate the subjective function of the patients was applied Lysholm Knee Scoring Scale and a Global Rating scale. Results: The analysis of data showed a moderate positive correlation between knee extensor torque and functional performance tests (r= 0,48; p=0,02). A moderate negative correlation was found between the two variables of the stabilometry center of pressure and average speed of centre of pressure and the Global Rating scale (r = -0.4, p = 0,04 and r = -0,49, p = 0 ,02, respectively). No correlation was found between peak torque and balance in single-limb stance. Conclusion: The results of the present study suggest that knee extensor strength and postural balance have some influence on knee function in patients after ACL reconstruction