STUDY DESIGN: Prospective cohort study. OBJECTIVES: First, to classify a group of individuals with an anterior cruciate ligament (ACL)-deficient knee as potential copers or potential noncopers, based on an established screening examination. Second, to prospectively follow a cohort of individuals with an ACL injury and characterize the nonoperatively treated subjects as true copers and true noncopers 1 year after injury, and evaluate the outcomes in operatively treated individuals 1 year after ACL reconstruction. Finally, to calculate the predictive value of the screening examination based on a 1-year follow-up of the group of subjects with ACL tears treated nonoperatively. BACKROUND: A screening examination has been developed for early classification of individuals with ACL injuries. Potential copers have successfully been identified as rehabilitation candidates and have shown that they are able to continue preinjury activities without ACL reconstruction (true copers). However, the potential of individuals identified as noncopers to become true copers has not been studied. METHODS AND MEASURES: One hundred and twenty-five subjects with ACL injury were evaluated using a screening examination consisting of 4 single-legged hop tests, the Knee Outcome Survey activities of daily living scale, the global rating of knee function, and the numbers of episodes of giving way. Knee laxity measurements, the international knee documentation committee subjective knee form (IKDC2000), and return to sport were included as outcome measurements. RESULTS: Thirty-seven percent (n = 46) of the subjects with ACL injury were classified as potential copers at the screening examination. Of the 102 subjects examined at follow-up, 51% (n = 52) had undergone nonoperative treatment. Sixty-five percent (n = 34) of the nonoperated subjects were classified as true copers at the 1 year follow-up. Among the potential copers, 60% were true copers, while 70% of the subjects initially classified as potential noncopers were true copers at the 1 year follow-up. The positive predictive value for correctly classifying true copers at the screening examination was 60% (95% confidence interval: 41%-78%), while the negative predictive value was 30% (95% confidence interval: 16%-49%). CONCLUSION: A majority (70%) of subjects classified as potential noncopers were true copers after 1 year of nonoperative treatment. Individuals with nonoperative treatment and ACL reconstruction showed excellent knee function and were highly active at the 1 year follow-up. The prognostic accuracy of this screening examination for correctly classifying true copers was poor. LEVEL OF EVIDENCE: Prognosis, level 1b.

J Orthop Sports Phys Ther. 2008;38(10):586-595, published online 18 July 2008. doi:10.2519/jospt.2008.2750

KEY WORDS: ACL, knee, copers, screening, surgery

STUDY DESIGN: Case-control study of females with patellofemoral pain syndrome (PFPS) and a control group. OBJECTIVES: Three different approaches were used to examine the utility of a 2-dimensional (2-D) frontal plane projection angle (FPPA) measure of knee alignment. First, we measured the FPPA association with respect to 3-dimensional (3-D) lower extremity joint rotations during single-leg squats. Second, we determined the correlation of the FPPA during single-leg squats with hip and knee joint rotations during running and single leg jumping.  Third, we compared the FPPA between females with and without PFPS. BACKGROUND: PFPS is associated with altered lower extremity kinematics during weight-bearing activities that decrease retropatellar contact area and increase retropatellar stress. An objective and simple procedure to quantify altered kinematics during weight-bearing activities may help clinicians identify individuals who may likely benefit from interventions to improve lower extremity kinematics. METHODS AND MEASURES: Twenty females with PFPS and 20 healthy female controls performed single-leg squats, running, and repetitive single-leg jumps while 3-D lower extremity kinematics were recorded. The FPPA was recorded by a digital camera during single-leg stance and single-leg squats. Correlation coefficients were used to quantify the association between the FPPA and transverse and frontal plane hip and knee angles for all activities. Independent t tests were used to compare FPPA values between groups. RESULTS: FPPA values representing medial displacement of the knee during single-leg squats were associated with increased hip adduction (r = 0.32 to 0.38, P<.044) and knee external rotation (r = 0.48 to 0.55, P<.001) across activities. FPPA values for the PFPS group reveal greater medial displacement of the knee compared with those of the control group during single-leg squats (P = .012). CONCLUSION: The association between the FPPA and lower extremity kinematics that are associated with PFPS suggest that the FPPA during single-leg squats may be a useful clinical measure. However, these methods should not be used to quantify 3-D joint rotations. LEVEL OF EVIDENCE: Level 5.

J Orthop Sports Phys Ther. 2008;38(10):606-615, published online 11 July 2008. doi:10.2519/jospt.2008.2706

KEY WORDS: anterior knee pain, kinematics, knee, patella, 2-dimensional analysis

STUDY DESIGN: Experimental descriptive laboratory study. OBJECTIVES: To describe the change in fascicle length of the human vastus lateralis (VL) muscle during the stance phase of stair ascent and descent. BACKGROUND: Muscle fascicle length changes during lower limb functional activities, such as walking and jumping, do not always coincide with joint angle changes. METHODS AND MEASURES: Thirty-three healthy, college-age women walked up and down 4 standard steps. VL fascicle length and pennation angle were measured using real-time ultrasonography. Knee angle was monitored using an electrical goniometer. Foot switches indicated foot contact and release. VL muscle activity was monitored using surface electrodes. The VL muscle-tendon complex and tendon length were calculated based on published models. RESULTS: During initial weight acceptance in stair ascent, the knee joint extended only 3°, VL muscle activity increased to a maximum, VL fascicles shortened, and the tendon lengthened. As the knee extended to ascend the step, the fascicles and tendon shortened throughout the movement. During weight acceptance in stair descent, VL muscle activity increased, VL fascicle length did not change significantly, but the tendon lengthened as 10° of knee flexion occurred. As the knee flexed to complete descent, VL muscle activity peaked, and VL fascicles and tendon lengthened. CONCLUSION: VL fascicles shorten and lengthen as expected during the respective knee extension and knee flexion phases of stair ascent and descent. However, during initial weight acceptance in both stair ascent and descent, the fascicle length change did not coincide with the knee joint kinematics.

J Orthop Sports Phys Ther. 2008;38(10):624-631, published online 11 July 2008. doi:10.2519/jospt.2008.2816

KEY WORDS: knee, muscle-tendon complex, quadriceps, tendon, ultrasonography

STUDY DESIGN: Clinical measurement, intrarater reliability study. OBJECTIVES: To determine the intrarater reliability of cervical active range of motion (AROM) measurement of subjects with and without neck pain using the cervical range-of-motion device (CROM). BACKGROUND: Cervical spine AROM data are used by physical therapists to assist in identifying movement impairment, monitor patient progress, and evaluate the effectiveness of intervention. Presently, insufficient literature exists regarding the intrarater reliability of cervical AROM measurements using the CROM. METHODS AND MEASURES: Twenty-five adult subjects without neck pain and 22 adult subjects with neck pain volunteered for the study. Two trials of cervical AROM measurement (6 movements) were performed for each subject. Practice sessions, methods of measurement, and rest time between trials were standardized; order of measurement was randomized. RESULTS: The intraclass correlation coefficients (ICC_3,1) for the subjects without neck pain ranged from 0.87 for flexion (95% confidence interval [CI]: 0.76-0.95) to 0.94 for left rotation (95% CI: 0.87-0.97). The standard error of the measurement ranged from 2.3° to 4.0°. The ICCs for the subjects with neck pain ranged from 0.88 for flexion (95% CI: 0.73-0.95) to 0.96 for left rotation (95% CI: 0.91-0.98). The standard error of the measurement ranged from 2.5° to 4.1°. Minimal detectable change ranged from 5.4° for left rotation in the subjects without neck pain to 9.6° for flexion in the subjects with neck pain. CONCLUSION: Intrarater reliability for cervical AROM measurement of persons with and without neck pain is sufficient to consider use of the CROM in clinical practice, although changes between 5° to 10° are needed to feel confident that a real change in spine mobility has occurred. 

J Orthop Sports Phys Ther. 2008;38(10):640-645, published online 11 July 2008. doi:10.2519/jospt.2008.2680

KEY WORDS: physical therapy, psychometrics, ROM

Letter to the editor-in-chief regarding the passing of Ronald Moller Stensnes, a founding father of manual therapy.