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Anterior cruciate ligament (ACL) injuries are common and lead to posttraumatic osteoarthritis (PTOA) in a high percentage of patients. Research has been ineffective in identifying successful treatment options for people suffering from symptomatic PTOA resulting in a shift of focus toward the young, ACL injured patients at risk of developing PTOA. Randomized clinical trials examining the very early phase after ACL injury are ideal to study this population; however, these trials face significant challenges regarding recruitment as well as reproducibility of patient-reported outcomes (PROs) and inflammatory and/or chondrodegenerative biomarkers associated with early PTOA. The aim of this work was to develop an approach to allow for early recruitment into an RCT for early treatment following ACL injury and to analyze the variability of commonly used measures and biomarkers at various time points after injury. This paper reports the study design and data related to the first month of treatment for the placebo group of an ongoing 2-year clinical trial to evaluate the effect of an early intra-articular intervention after ACL injury. The results of this study suggest that acute ACL injury results in early changes of both inflammatory and chondrodegenerative biomarkers. These results also provide vital information for researchers to consider when developing future protocols, both related to the logistics of early patient enrollment as well as the appropriate timing of biomarker and patient-reported outcome collection. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:641-650, 2017.

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The purposes of this study were to determine the prevalence of anxiety and depression in patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and to compare duration of symptoms (DOS), hip morphology and self-reported pain and function between patients with and without anxiety or depression. From our Institutional Review Board approved registry, we identified 127 consecutive participants [94F/33M; age = 35.2 ± 12.1 years; body mass index (BMI) = 26.8 ± 5.6 kg/m2] scheduled for primary hip arthroscopy for FAIS. Anxiety and depression were recorded based on medical chart diagnoses or anti-depressive/anti-anxiety prescriptions. Alpha angle, lateral center edge angle and DOS were recorded, and the Hip Disability and Osteoarthritis Outcome Score (HOOS) was completed. Groups were compared using Mann–Whitney U tests, and categorical variables were compared using Fisher’s exact tests. Overall, 45 of 127 participants (35.4%) (94F/33M; age = 35.2 ± 12.1 years; BMI = 26.8 ± 5.6 kg/m2) had anxiety or depression. DOS and bony morphology did not differ between groups (P = 0.11–0.21). Participants with anxiety or depression were older (P = 0.03) and had worse HOOS QOL (21.4 ± 18.4; 30.7 ± 19.6; P = 0.006; 95% CI 2.4–16.3) and HOOS sport (25.6 ± 17.8, 34 ± 21.1, P = 0.03, 95% CI 1.4–15.4). More than one third of participants presented with anxiety or depression. Self-reported quality of life and function were worse for these participants, but neither symptom chronicity nor bony morphology differed. Concomitant anxiety or depression should be considered when counseling patients with FAIS. Adjunct interventions as well genetic and/or developmental factors that may contribute to the high prevalence should be examined.

Context: Postoperative quadriceps strength weakness after knee surgery is a persistent issue patients and health care providers encounter. Objective: To investigate the effect of neuromuscular electrical stimulation (NMES) parameters on quadriceps strength after knee surgery. Data Sources: CINAHL, MEDLINE, SPORTDiscus, and PubMed were systematically searched in December 2018. Study Selection: Studies were excluded if they did not assess quadriceps strength or if they failed to report the NMES parameters or quadriceps strength values. Additionally, studies that applied NMES to numerous muscle groups or simultaneously with other modalities/treatments were excluded. Study quality was assessed with the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials. Study Design: Systematic review. Level of Evidence: Level 1. Data Extraction: Treatment parameters for each NMES treatment was extracted for comparison. Quadriceps strength means and standard deviations were extracted and utilized to calculate Hedge g effect sizes with 95% CIs. Results: Eight RCTs were included with an average Physiotherapy Evidence Database scale score of 5 ± 2. Hedge g effect sizes ranged from small (−0.37; 95% CI, −1.00 to 0.25) to large (1.13; 95% CI, 0.49 to 1.77). Based on the Strength of Recommendation Taxonomy Quality of Evidence table, the majority of the studies included were low quality RCTs categorized as level 2: limited quality patient-oriented evidence. Conclusion: Because of inconsistent evidence among studies, grade B evidence exists to support the use of NMES to aid in the recovery of quadriceps strength after knee surgery. Based on the parameters utilized by studies demonstrating optimal treatment effects, it is recommended to implement NMES treatment during the first 2 postoperative weeks at a frequency of ≥50 Hz, at maximum tolerable intensity, with a biphasic current, with large electrodes and a duty cycle ratio of 1:2 to 1:3 (2- to 3-second ramp).