https://www.oarsijournal.com/article/S1063-4584(02)90801-0/pdf

Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects.

Background and Purpose. Treatment of patients with impingement symptoms commonly includes exercises intended to restore “normal” movement patterns. Evidence that indicates the existence of abnormal patterns in people with shoulder pain is limited. The purpose of this investigation was to analyze glenohumeral and scapulothoracic kinematics and associated scapulothoracic muscle activity in a group of subjects with symptoms of shoulder impingement relative to a group of subjects without symptoms of shoulder impingement matched for occupational exposure to overhead work. Subjects. Fifty-two subjects were recruited from a population of construction workers with routine exposure to overhead work. Methods. Surface electromyographic data were collected from the upper and lower parts of the trapezius muscle and from the serratus anterior muscle. Electromagnetic sensors simultaneously tracked 3-dimensional motion of the trunk, scapula, and humerus during humeral elevation in the scapular plane in 3 hand-held load conditions: (1) no load, (2) 2.3-kg load, and (3) 4.6-kg load. An analysis of variance model was used to test for group and load effects for 3 phases of motion (31°–60°, 61°–90°, and 91°–120°). Results. Relative to the group without impingement, the group with impingement showed decreased scapular upward rotation at the end of the first of the 3 phases of interest, increased anterior tipping at the end of the third phase of interest, and increased scapular medial rotation under the load conditions. At the same time, upper and lower trapezius muscle electromyographic activity increased in the group with impingement as compared with the group without impingement in the final 2 phases, although the upper trapezius muscle changes were apparent only during the 4.6-kg load condition. The serratus anterior muscle demonstrated decreased activity in the group with impingement across all loads and phases. Conclusion and Discussion. Scapular tipping (rotation about a medial to lateral axis) and serratus anterior muscle function are important to consider in the rehabilitation of patients with symptoms of shoulder impingement related to occupational exposure to overhead work.

https://ir.uiowa.edu/cgi/viewcontent.cgi?article=1000&context=oeh_pubs

Alterations in Shoulder Kinematics and Associated Muscle Activity in People With Symptoms of Shoulder Impingement

Background: New methods have been used, with promising results, to treat full-thickness cartilage defects. The objective of the present study was to compare autologous chondrocyte implantation with microfracture in a randomized trial. We are not aware of any previous randomized studies comparing these methods.

Methods: Eighty patients without general osteoarthritis who had a single symptomatic cartilage defect on the femoral condyle in a stable knee were treated with autologous chondrocyte implantation or microfracture (forty in each group). We used the International Cartilage Repair Society, Lysholm, Short Form-36 (SF-36), and Tegner forms to collect data. An independent observer performed a follow-up examination at twelve and twenty-four months. Two years postoperatively, arthroscopy with biopsy for histological evaluation was carried out. The histological evaluation was done by a pathologist and a clinical scientist, both of whom were blinded to each patient's treatment.

Results: In general, there were small differences between the two treatment groups. At two years, both groups had significant clinical improvement. According to the SF-36 physical component score at two years postoperatively, the improvement in the microfracture group was significantly better than that in the autologous chondrocyte implantation group (p = 0.004). Younger and more active patients did better in both groups. There were two failures in the autologous chondrocyte implantation group and one in the microfracture group. No serious complications were reported. Biopsy specimens were obtained from 84% of the patients, and histological evaluation of repair tissues showed no significant differences between the two groups. We did not find any association between the histological quality of the tissue and the clinical outcome according to the scores on the Lysholm or SF-36 form or the visual analog scale.

Conclusions: Both methods had acceptable short-term clinical results. There was no significant difference in macroscopic or histological results between the two treatment groups and no association between the histological findings and the clinical outcome at the two-year time-point.

Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial.

Review: tissue engineering for regeneration of articular cartilage

We evaluated the durability of autologous chondrocyte transplantation grafts in 61 patients treated for isolated cartilage defects on the femoral condyle or the patella and followed up for a mean of 7.4 years (range, 5 to 11). Durability was determined by comparing the clinical status at the long-term follow-up with that found 2 years after the transplantation. After 2 years, 50 of the 61 patients had good or excellent clinical results, and 51 of 61 had good or excellent results at 5 to 11 years later. Grafted areas from 11 of the patients were evaluated with an electromechanical indentation probe during a second-look arthroscopy procedure (mean follow-up, 54.3 months; range, 33 to 84); stiffness measurements were 90% or more of those of normal cartilage in eight patients. Eight of twelve 2-mm biopsy samples taken from these patients showed hyaline characteristics with safranin O staining and a homogeneous appearance in polarized light. Three fibrous and eight hyaline biopsy specimens stained positive to aggrecan and to cartilage oligomeric matrix protein. Hyaline-like specimens stained positive for type II collagen, and fibrous, for type I collagen. Autologous chondrocyte transplantation for the treatment of articular cartilage injuries has a durable outcome for as long as 11 years.

Autologous Chondrocyte Transplantation Biomechanics and Long-Term Durability

Background
Little data exists regarding injury risk factors for professional football players. Athletes with poor dynamic balance or asymmetrical strength and flexibility (i.e. poor fundamental movement patterns) are more likely to be injured. The patterns of the Functional Movement Screen™ (FMS) place the athlete in positions where range of motion, stabilization, and balance deficits may be exposed.

/pdf/can-serious-injury-in-professional-football-be-predicted-by-5foim90qrh.pdf

Can Serious Injury in Professional Football be Predicted by a Preseason Functional Movement Screen

Part 1 of this two‐part series (presented in the June issue of IJSPT) provided an introduction to functional movement screening, as well as the history, background, and a summary of the evidence regarding the reliability of the Functional Movement Screen (FMS™). Part 1 presented three of the seven fundamental movement patterns that comprise the FMS™, and the specific ordinal grading system from 0‐3, used in the their scoring. Specifics for scoring each test are presented.

Part 2 of this series provides a review of the concepts associated with the analysis of fundamental movement as a screening system for functional movement competency. In addition, the four remaining movements of the FMS™, which complement those described in Part 1, will be presented (to complete the total of seven fundamental movements): Shoulder Mobility, the Active Straight Leg Raise, the Trunk Stability Push‐up, and Rotary Stability. The final four patterns are described in detail, and the specifics for scoring each test are presented, as well as the proposed clinical implications for receiving a grade less than a perfect “3”.

The intent of this two part series is to present the concepts associated with screening of fundamental movements, whether it is the FMS™ system or a different system devised by another clinician. Such a fundamental screen of the movement system should be incorporated into pre‐participation screening and return to sport testing in order to determine whether an athlete has the essential movements needed to participate in sports activities at a level of minimum competency.

Part 2 concludes with a discussion of the evidence related to functional movement screening, myths related to the FMS™, the future of functional movement screening, and the concept of movement as a system.

Level of Evidence:
5

Functional movement screening: the use of fundamental movements as an assessment of function ‐ part 1

It is hypothesized that proprioceptive information plays an important role in joint stabilization and that muscle fatigue may alter proprioceptive ability. The purpose of this study was to determine what effect shoulder muscle fatigue has on glenohumeral proprioception and to examine the relationship between arm dominance and shoulder proprioception. Eighty subjects without a history of glenohumeral pathology participated. Each was seated on an isokinetic dynamometer with a randomly selected shoulder positioned in 90 degrees of abduction and elbow flexion. With vision blinded, the arm was passively positioned in 75 degrees of external rotation for 10 seconds, then passively returned to the neutral starting position. Three trials each of active and passive repositioning (2 degrees/sec) were recorded. Following a fatigue protocol, both active and passive repositioning were reassessed. Testing order was randomized. A significant difference was detected between pre- and post-fatigue scores. No significant difference was detected between dominant and nondominant extremities. No relationship between arm dominance and shoulder proprioception was established. It is concluded that shoulder proprioception is diminished in the presence of shoulder muscle fatigue, suggesting clinical rehabilitation protocols must emphasize increasing muscular endurance.

The Effects of Muscle Fatigue on and the Relationship of Arm Dominance to Shoulder Proprioception

The scapular musculature is often neglected in designing a rehabilitation protocol for the shoulder. Weakness of the scapular stabilizers and resultant altered biomechanics could result in: 1) abnormal stresses to the anterior capsular structures of the shoulder, 2) increased possibility of rotator cuff compression, and 3) decreased performance. This article presents known facts about the biomechanics of the scapula and surrounding muscles and suggests methods for evaluation of scapular muscle weakness. Exercise techniques to maximally strengthen the scapular musculature are also described. As our ability to document strength of these muscles improves, we will be able to determine the effect of scapular strengthening on improving symptoms related to impingement and instability. Scapular strengthening exercises are usually nonstressful to the rotator cuff and are easily implemented into a rehabilitation program for the shoulder.

The Role of the Scapula

The treatment of focal full thickness articular defects in the knee has continued to present a challenge, with no traditional treatment method providing consistent acceptable long-term clinical results. Patients with significant chondral defects frequently have persistent joint line pain, swelling, and catching in the knee. In contrast to marrow stimulation treatment techniques, such as abrasion arthroplasty, drilling, or microfracture which populate the defect with pluripotential stem cells, the use of cultured autologous chondrocytes fills the defect with cells of a committed pathway to develop hyaline-like cartilage. This hyaline-like cartilage more closely recreates the wear characteristics and durability of normal hyaline cartilage than the fibrous or fibrocartilage repair tissue formed by pluripotential stem cells. The purpose of this paper is to review the efficacy of available treatment options as well as the basic science rationale, indications, technique, postoperative rehabilitation, and clinical results of using cultured autologous chondrocytes in the treatment of focal full thickness chondral defects of the knee.

https://www.jospt.org/doi/pdf/10.2519/jospt.1998.28.4.241

Michael L. Voight

Papers

Can Serious Injury in Professional Football be Predicted by a Preseason Functional Movement Screen

Functional movement screening: the use of fundamental movements as an assessment of function ‐ part 1

The Effects of Muscle Fatigue on and the Relationship of Arm Dominance to Shoulder Proprioception

The Role of the Scapula

Treatment of Articular Cartilage Defects of the Knee With Autologous Chondrocyte Implantation