Background: New biologic strategies are arising to enhance healing and improve the clinical outcome of anterior cruciate ligament (ACL) reconstruction. Purpose: To evaluate the efficacy of a new oral nutritional supplement (Progen) that contains hydrolyzed collagen peptides and plasma proteins, a hyaluronic acid–chondroitin sulfate complex, and vitamin C. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: The study included patients who underwent ACL reconstruction with hamstring autografts using the same fixation method. All patients received the same analgesia and physical therapy (PT) protocol and were randomized to receive either the nutritional supplement (supplemented group) or no additional therapy (control group). Patients were followed up at days 7, 30, 60, and 90. Pain was assessed by use of a visual analog scale (VAS) and by analgesic consumption. Clinical outcome was assessed via International Knee Documentation Committee (IKDC) score and the number of PT sessions. Perceived efficacy and tolerability were rated on a 5-point Likert scale. Graft maturation was assessed by a blinded musculoskeletal radiologist using magnetic resonance imaging. The number of adverse events (AEs) was recorded. Results: The intention-to-treat analysis included 72 patients, 36 allocated to the supplemented group and 36 to the control group, with no significant differences regarding demographic and preoperative characteristics. Both groups showed significant improvement in pain and function (measured by VAS and IKDC scores) during the 90-day follow-up period ( P < .001 for both), without significant differences between groups. The supplemented group had fewer patients that needed analgesics (8.5% vs 50.0%; P < .05) and attended fewer PT sessions (38.0 vs 48.4 sessions; P < .001) at 90 days and had a higher IKDC score at 60 days (62.5 vs 55.5; P = .029) compared with the control group. Patient- and physician-perceived efficacy was considered significantly higher in the supplemented group at 60 and 90 days ( P < .05). Perceived tolerability of the overall intervention was better in the supplemented group at 30, 60, and 90 days ( P < .05). Graft maturation showed more advanced degrees (grades 3 and 4) in the supplemented group at 90 days (61.8% vs 38.2%; P < .01). No intolerance or AEs associated with the nutritional supplement treatment were reported. Conclusion: The combination of the nutritional supplement and PT after ACL reconstruction improved pain, clinical outcome, and graft maturation. Nutritional supplementation showed higher efficacy during the second month of recovery, without causing AEs. Registration: NCT03355651 ( ...

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Objectives: The aim of this study was to determine whether a static stretch of posterior deltoid could reduce the glenohumeral internal rotation deficit (GIRD) and the total arc of movement deficit (TAMD) in professional swimmers after competition. Methods: Participants: A total of 74 professional swimmers aged from 16-33 years volunteered to participated in the study. Their competition experience were more than 2 years at national level. All the subjects were informed in written and verbal form and signed their informed consent before being assessed. Design and procedures: A randomized repeated measures design was used to assess the glenohumeral rotation in 3 moments: prior to the race, just after finishing their trial and after performing a static passive stretch of posterior deltoid muscles of 90-sec. In randomized order the computer selected 20 subjects as a control group (CG) who didn’t perform the stretching. The experimental group (EG) included 54 swimmers. The glenohumeral internal and external rotation (IR and ER) were recorded by a video camera (IPhone 6 S, version 10.1), in sagittal plane, with the center of the screen at shoulder high. Subjects were laying on supine position over a massage table, with the glenohumeral joint at 90° of abduction, the elbow at 90° of flexion, and the researcher controlling the scapula movements by pushing the shoulder over coracoid apophasis. The App Thechnique (Ubersense ©) was used to measure the glenohumeral rotation degrees between the vertical line (controlled by a plumb) and the forearm segment. Results: The multifactorial ANOVA showed that there were significant differences on GIRD and TAMD between the experimental and the control group performing the stretching F(2,70)=49.150, P=0.000, η2p=0.992. The experimental group reduced the GIRD a16.2% and the TAMD a 6.7%. The dominant IR mean values changed significantly from 66.3±12.5 to 79.2±10.4 degrees for EG ( P=0.00) and non-significantly for CG, from 74.6±12.7 to 77.6±13.9 degrees ( P=0.11). The dominant TAM means changed significantly in EG from 173.2±16.8 to 192.0±17.0 degrees ( P=0.00) and non- significantly for CG 181.5±21.7 to 188.2±23.3 degrees ( P=0.12). Conclusion: To apply a static passive stretching on posterior deltoid during 90-sec reduced GIRD and the TAMD in professional swimmers after competition, which suggest a reduced risk of shoulder injury in these overhead athletes.

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