Background: We examined four commonly used scores, the SF-36, the Ankle Osteoarthritis Scale (AOS), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Score, and the Foot Function Index (FFI) to determine their responsiveness and validity. Methods: Patients with end stage ankle arthritis were recruited into a prospective multicenter cohort study and baseline and one year outcome scores were compared. The Standardized Response Mean and Effect Size for the AOS, AOFAS, and FFI were calculated and the three region- or disease-specific scores were compared with the SF-36 to determine their criterion validity. Results: All four scores showed acceptable responsiveness, and when using the validated SF-36 as the standard the three region or disease specific scores all showed similar criterion validity. Conclusion: All four scores are responsive and can be considered for use in this population. The objective component of the AOFAS Ankle Hindfoot Score may make it harder to perform than the other three scores which have subjective components only, and as yet its objective component has not been shown to demonstrate reliability. We recommend use of a purely subjective score such as the Ankle Osteoarthritis Scale or Foot Function Index as the region- or disease-specific score of choice in this population. As the SF-36 shows acceptable responsiveness, using it alone could also be considered. Level of Evidence: II, Prospective Comparative Study

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Thoracic deformation under an applied load is an established indicator of injury risk, but the force required to achieve an injurious level of deformation currently is not understood adequately. This article evaluates how two potentially important factors, loading condition and muscle tensing, affect the structural response of the dynamically loaded thorax. Structural models of two human cadaver thoraxes and two porcine thoraxes were used to quantify the effects. The human cadavers, which represent anthropometric extremes, were subjected to anterior loading from (1) a 5.1-cm-wide belt oriented diagonally (i.e., seatbelt-like loading), (2) a 15.2-cm-diameter rigid hub, and (3) a 20.3-cm-wide belt oriented laterally (i.e., a distributed load). A structural model having the mathematical formulation of a quasilinear viscoelastic material model was used to model the elastic and viscous response, with ramp-hold tests used to determine the model coefficients. The effect of thoracic musculature was assessed using similar ramp-hold tests on the porcine subjects, each with and without forced muscle contraction. Even maximally contracted thoracic musculature is shown to have a minimal effect on the response, with similar elastic and viscous characteristics exhibited by each subject regardless of muscle tone. The elastic response is shown to be approximately a factor of three stiffer for diagonal belt loading and for this distributed loading condition than for the hub loading, indicating that the response is influenced most by the particular anatomical structures that are engaged and, secondarily, by the area of load application. Specifically, shoulder involvement is shown to have a strong influence. The force relaxation is found to be pronounced, but insensitive to the loading condition, with long-time force relaxation coefficients (G( infinity )) in the range of 0.1 to 0.3. The findings of this study provide restraint-specific guidelines for the force-deflection characteristics of both physical and computational thoracic models.

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