During APTA's Combined Sections Meeting in New Orleans last month, the Journal of Orthopaedic & Sports Physical Therapy recognized for the first time the most outstanding research manuscript and clinical practice paper published in the JOSPT within a calendar year. Presentations of the awards were made at the awards receptions of the Orthopaedic and Sports Physical Therapy Sections.

J Orthop Sports Phys Ther. 2005; 35(3):128-129. doi:10.2519/jospt.2005.0103

Key Words: JOSPT awards

Study Design: Prospective cohort study. Objectives: To determine the effect of rotator cuff tear size on shoulder strength and range of motion. Background: Patients with rotator cuff pathology typically present with weakness and motion loss in various motions. The extent to which the presence of a rotator cuff tear and the size of the tear affect strength and range of motion is not well understood. Methods and Measures: Sixty-one patients scheduled for surgery, with a diagnosis of a rotator cuff tear and/or subacromial impingement, underwent examination for shoulder pain, function, range of motion, and strength. The extent of rotator cuff pathology was documented during subsequent surgery (presence of tear, tear size, tear thickness). Results: There were 10 massive tears, 15 large tears, 13 medium tears, 12 small tears, and 11 rotator cuffs without a tear. Patients had marked weakness in abduction strength at 90° and 10° of abduction, in external rotation strength at 90°, and in the ‘‘full can test’’ (all, P<.0001). Marked range of motion losses in shoulder flexion and external rotation at 0° and 90° abduction (all, P<.001) were also observed. Abduction strength deficit at 10° was affected by rotator cuff tear size (P<.0001). Twenty of 25 patients with large or massive tears had deficits greater than 50%, compared with only 1 of 11 patients with no tear, 2 of 12 patients with a small tear, and 5 of 13 patients with a medium tear (P<.0001). Other strength and range of motion deficits or indices of pain and function were unaffected by tear size. Conclusions: Weakness of greater than 50% relative to the contralateral side in shoulder abduction at 10° of abduction was indicative of a large or massive rotator cuff tear.

J Orthop Sports Phys Ther. 2005;35(3):130-135. doi: 10.2519/jospt.2005.1626

Key Words: handheld dynamometer, shoulder muscle strength

Study Design: Prospective methodological study of repeated measures using a sample of consecutive patients. Objective: To determine the test-retest reliability and responsiveness of the Anterior Knee Pain Scale (AKPS) and the Lower Extremity Functional Scale (LEFS) in patients with anterior knee pain. Background: Anterior knee pain is one of the most common orthopedic complaints affecting the knee. Yet there is currently no self-report outcome measure that has well-established reliability and responsiveness, specifically for this population. As a result, clinicians and researchers may be making inappropriate conclusions regarding patient outcomes by using questionnaires that are misleading. Methods and Measures: This multisite study involved 30 patients from 4 outpatient physical therapy clinics in Dallas, TX (24 women, 6 men; age range, 16-50 years; mean ± SD age, 35.2 ± 9.1 years). Patients receiving physical therapy for a chief complaint of anterior knee pain completed the AKPS and LEFS at their initial appointment and again 2 to 3 days later. Upon completion of physical therapy, the patients completed the AKPS, LEFS, and a global rating of change form. The treating therapist also completed a global rating of change form at the patient’s final visit. The mean of the patient’s and therapist’s global rating of change was used as the criterion measure of change. Results: Test-retest reliability was high for both questionnaires (ICC_2,1 = 0.95 for the AKPS and 0.98 for the LEFS). A significant correlation was found between the criterion measure of change and both questionnaires. Receiver-operating characteristic curve analysis revealed that both questionnaires were moderately responsive with the area under the curve slightly higher for the LEFS (0.77) than the AKPS (0.69). Conclusion: The LEFS and the AKPS both demonstrated high test-retest reliability and appear to be moderately responsive to clinical change in patients with anterior knee pain. Reliability and responsiveness were slightly higher in the LEFS than the AKPS. Further research is needed to determine if these measures could be modified, or new measures created, to produce an even more sensitive tool for this population.

J Orthop Sports Phys Ther. 2005;35(3):136-146. doi: 10.2519/jospt.2005.1403

Key Words: iliotibial band syndrome, outcome measures, patellofemoral pain syndrome, patellar tendinitis

Study Design: Evaluation of agreement between assessors. Objective: To evaluate agreement between an expert in selective tissue tension (STT) and 3 other trained assessors, all using STT in conjunction with a preliminary clinical history, on their diagnostic labeling of painful shoulders. Background: Consensus on diagnostic labeling for shoulder pain is poor, hampering interpretation of the evidence for interventions. STT, a systematic approach to physical examination and diagnosis, offers potential for standardization, but its reliability is contentious. Methods and Measures: Four trained assessors, 1 of whom was considered an expert, separately assessed 56 painful shoulders in 53 subjects (32 male [mean ± SD age, 51 ± 13 years], 21 female [mean ± SD age, 57 ± 12 years]), using STT in conjunction with a preliminary clinical history. Assessors labeled each painful shoulder as ‘‘rotator cuff lesion,’’ ‘‘bursitis,’’ ‘‘capsulitis,’’ ‘‘other diagnosis,’’ or ‘‘no diagnosis.’’ Combinations of diagnoses were allowed. Results: A diagnosis was made in every case, with less than 7% of the diagnoses being combined. With the diagnostic categories pooled, agreement (kappa and 95% confidence interval [CI]) between the expert assessor and each of the other assessors was good, ranging from 0.61 (0.44-0.78) to 0.75 (0.60-0.90). For single diagnostic categories, agreement between the expert and each of the others (dichotomized data) ranged from 0.35 (–0.03-0.73) to 0.58 (0.29 0.87) for bursitis; 0.63 (0.40-0.86) to 0.82 (0.65-0.99) for capsulitis; 0.71 (0.49-0.93) to 0.79 (0.61-0.96) for rotator cuff lesions; and from 0.69 (0.35-1.00) to 0.78 (0.48-1.00) for other diagnoses. Conclusions: Overall, STT in conjunction with a preliminary clinical history enables good agreement between trained assessors. Future work is required to evaluate its criterion validity.

J Orthop Sports Phys Ther. 2005;35(3):147-153. doi: 10.2519/jospt.2005.1502

Key Words: orthopedics, physical therapy, tests

Study Design: Case report. Background: Athletic Lisfranc injuries are characterized by disruption of the soft tissues about the tarsometatarsal joint complex. They are frequently missed on initial consultation due to a paucity of demonstrable physical signs, yet often result in significant disability. This case illustrates the 2 great challenges in managing these injuries: firstly, arriving at an accurate diagnosis and, secondly, determining whether the injury is stable and, therefore, appropriate for conservative management. Case Description: The athlete was a 21-year-old professional basketball player with a recurrent ligamentous injury of the Lisfranc joint. A global approach to evaluation and treatment of the entire lower extremity and pelvis in managing this injury is emphasized. Outcomes: The athlete in this case report made a successful return to his previous level of competition 12 weeks postinjury. At 2-year follow-up he continues to play professionally without any symptoms. Discussion: In selected cases for which patients have no osseous displacement and the ability to run on the toes soon after injury, conservative management of Lisfranc injury may be appropriate. Key features of a conservative approach include recognition of a prolonged recovery time, adequate rest for soft tissue healing, restoration of a normal gait pattern to prevent chronic overstress of injured tissues, appropriate orthotic prescription, and proprioceptive retraining.

J Orthop Sports Phys Ther. 2005;35(3):154-164. doi: 10.2519/jospt.2005.1365

Key Words: foot, ligament injury, midfoot sprain, sports injury, tarsometatarsal joint

We present a clinical commentary of existing evidence regarding popliteus musculotendinous complex anatomy, biomechanics, muscle activation, and kinesthesia as they relate to functional knee joint rehabilitation. The popliteus appears to act as a dynamic guidance system for monitoring and controlling subtle transverse- and frontal-plane knee joint movements, controlling anterior-posterior lateral meniscus movement, unlocking and internally rotating the knee joint (tibia) during flexion initiation, assisting with 3-dimensional dynamic lower extremity postural stability during single-leg stance, preventing forward femoral dislocation on the tibia during flexed-knee stance, and providing for postural equilibrium adjustments during standing. These functions may be most important during mid-range knee flexion when capsuloligamentous structures are unable to function optimally. Because the popliteus musculotendinous complex has attachments that approximate the borders of both collateral ligaments, it has the potential for providing instantaneous 3-dimensional kinesthetic feedback of both medial and lateral tibiofemoral joint compartment function. Enhanced popliteus function as a kinesthetic knee joint monitor acting in synergy with dynamic hip muscular control of femoral internal rotation and adduction, and ankle subtalar muscular control of tibial abduction-external rotation or adduction-internal rotation, may help to prevent athletic knee joint injuries and facilitate recovery during rehabilitation by assisting the primary sagittal plane dynamic knee joint stabilization provided by the quadriceps femoris, hamstrings, and gastrocnemius.

J Orthop Sports Phys Ther. 2005;35(3):165-179. doi: 10.2519/jospt.2005.1414

Key Words: knee, lateral meniscus, lower extremity