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Free Tissue Transfer for Patients with Chronic Lower Extremity Wounds.
Bekeny, JC, Zolper, EG, Steinberg, JS, Attinger, CE, Fan, KL, Evans, KK
Clinics in plastic surgery. 2021;(2):321-329
Abstract
Chronic lower extremity wounds are defined as wounds that fail to heal within 3 months of defect onset. Free tissue transfer offers an opportunity for limb salvage and length preservation. Preoperative optimization includes a medical and nutritional consult, complete work-up by vascular surgery, and an analysis of bony stability and gait biomechanics by podiatric surgery. In the authors' practice, the thigh has proved the workhorse donor site and offers fasciocutaneous and muscle-based flaps depending on defect characteristics. Postoperative care requires early monitoring for flap compromise and continued long-term follow-up for wound recurrence.
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2.
Hamstring Injury Prevention Practices in Elite Sport: Evidence for Eccentric Strength vs. Lumbo-Pelvic Training.
Shield, AJ, Bourne, MN
Sports medicine (Auckland, N.Z.). 2018;(3):513-524
Abstract
Hamstring strain injuries are endemic in running-based sports. Given the economic and performance implications of these injuries, a significant body of research has emerged in recent years in an attempt to identify risk factors and develop or optimise injury prevention strategies. Surveys of injury prevention practices among medical and conditioning staff in elite sport suggest that many sporting clubs invest significant efforts in eccentric hamstring conditioning and lumbo-pelvic or trunk stability programmes. The purpose of this narrative review was to critically evaluate the evidence underpinning these practices. Single-exercise eccentric training interventions have proven effective in the prevention of primary and recurrent hamstring strains, when compliance is adequate. However, despite its almost universal acceptance, the authors are aware of only one, very recent, prospective risk factor study examining the effect of lumbo-pelvic motion during sprinting on hamstring injury risk. Furthermore, the interventions exploring the effect of lumbo-pelvic training on hamstring injury rates have not measured stability in any way. An improved understanding of the evidence underpinning commonly employed hamstring injury prevention practices may enable clinicians and coaches to better prioritise effective strategies in the increasingly complex environment of elite sport.
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3.
An Evidence-Based Framework for Strengthening Exercises to Prevent Hamstring Injury.
Bourne, MN, Timmins, RG, Opar, DA, Pizzari, T, Ruddy, JD, Sims, C, Williams, MD, Shield, AJ
Sports medicine (Auckland, N.Z.). 2018;(2):251-267
Abstract
Strength training is a valuable component of hamstring strain injury prevention programmes; however, in recent years a significant body of work has emerged to suggest that the acute responses and chronic adaptations to training with different exercises are heterogeneous. Unfortunately, these research findings do not appear to have uniformly influenced clinical guidelines for exercise selection in hamstring injury prevention or rehabilitation programmes. The purpose of this review was to provide the practitioner with an evidence-base from which to prescribe strengthening exercises to mitigate the risk of hamstring injury. Several studies have established that eccentric knee flexor conditioning reduces the risk of hamstring strain injury when compliance is adequate. The benefits of this type of training are likely to be at least partly mediated by increases in biceps femoris long head fascicle length and improvements in eccentric knee flexor strength. Therefore, selecting exercises with a proven benefit on these variables should form the basis of effective injury prevention protocols. In addition, a growing body of work suggests that the patterns of hamstring muscle activation diverge significantly between different exercises. Typically, relatively higher levels of biceps femoris long head and semimembranosus activity have been observed during hip extension-oriented movements, whereas preferential semitendinosus and biceps femoris short head activation have been reported during knee flexion-oriented movements. These findings may have implications for targeting specific muscles in injury prevention programmes. An evidence-based approach to strength training for the prevention of hamstring strain injury should consider the impact of exercise selection on muscle activation, and the effect of training interventions on hamstring muscle architecture, morphology and function. Most importantly, practitioners should consider the effect of a strength training programme on known or proposed risk factors for hamstring injury.
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4.
Is There Evidence to Support the Use of the Angle of Peak Torque as a Marker of Hamstring Injury and Re-Injury Risk?
Timmins, RG, Shield, AJ, Williams, MD, Opar, DA
Sports medicine (Auckland, N.Z.). 2016;(1):7-13
Abstract
Hamstring strain injuries are the predominant injury in many sports, costing athletes and clubs a significant financial and performance burden; therefore, the ability to identify and intervene with individuals who are considered at high risk of injury is important. One measure that has grown in popularity as an outcome variable following hamstring intervention/prevention studies and rehabilitation is the angle of peak knee flexor torque. This current opinion article will firstly introduce the measure and the processes behind it. Second, the article will summarise how the angle of peak knee flexor torque has been suggested to measure hamstring strain injury risk. Finally, the numerous limitations will be presented and the article will outline how these limitations may influence the usefulness of the angle of peak knee flexor torque measure. These include the lack of muscle specificity, the common concentric contraction mode of assessment, reliability of the measure, various neural contributions (such as rate of force development and neuromuscular inhibition), as well as the lack of prospective data showing any predictive value in the measure.
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5.
Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis.
Wright, AA, Taylor, JB, Ford, KR, Siska, L, Smoliga, JM
British journal of sports medicine. 2015;(23):1517-23
Abstract
BACKGROUND Stress fractures are common overuse injuries with up to 95% occurring in the lower extremities. Among runners, stress fractures account for 15-20% of all musculoskeletal injuries. PURPOSE We systematically reviewed and critiqued the evidence regarding risk factors associated with increased risk of lower extremity stress fractures in runners. STUDY DESIGN Systematic review. METHODS A systematic, computerised literature search of Medline, Embase, PubMed, SPORTDiscus, and CINAHL databases (from database inception through 9 January 2014) using keywords related to risk factors and stress fractures. This systematic review with meta-analysis utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the search and reporting phases of the study. Inverse variance meta-analyses, using a random effects model were used to summarise ORs. RESULTS 8 articles met the inclusion criteria; 7 were considered low risk. 4 articles qualified for meta-analysis. Results of the meta-analysis identified previous history of stress fracture and female sex as the primary risk factors for future stress fracture with a pooled OR of 4.99 (95% CI 2.91 to 8.56; p<0.001; I(2)=0%) and 2.31 (95% CI 1.24 to 4.29; p<0.01; I(2)=0%), respectively. CONCLUSIONS Currently, only previous history of stress fracture and female sex are risk factors for lower extremity stress fractures strongly supported by the data.
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6.
Is there a potential relationship between prior hamstring strain injury and increased risk for future anterior cruciate ligament injury?
Opar, DA, Serpell, BG
Archives of physical medicine and rehabilitation. 2014;(2):401-5
Abstract
Hamstring strain injuries (HSIs) are the most prevalent injury in a number of sports, and while anterior cruciate ligament (ACL) injuries are less common, they are far more severe and have long-term implications, such as an increased risk of developing osteoarthritis later in life. Given the high incidence and severity of these injuries, they are key targets of injury preventive programs in elite sport. Evidence has shown that a previous severe knee injury (including ACL injury) increases the risk of HSI; however, whether the functional deficits that occur after HSI result in an increased risk of ACL injury has yet to be considered. In this clinical commentary, we present evidence that suggests that the link between previous HSI and increased risk of ACL injury requires further investigation by drawing parallels between deficits in hamstring function after HSI and in women athletes, who are more prone to ACL injury than men athletes. Comparisons between the neuromuscular function of the male and female hamstring has shown that women display lower hamstring-to-quadriceps strength ratios during isokinetic knee flexion and extension, increased activation of the quadriceps compared with the hamstrings during a stop-jump landing task, a greater time required to reach maximal isokinetic hamstring torque, and lower integrated myoelectrical hamstring activity during a sidestep cutting maneuver. Somewhat similarly, in athletes with a history of HSI, the previously injured limb, compared with the uninjured limb, displays lower eccentric knee flexor strength, a lower hamstrings-to-quadriceps strength ratio, lower voluntary myoelectrical activity during maximal knee flexor eccentric contraction, a lower knee flexor eccentric rate of torque development, and lower voluntary myoelectrical activity during the initial portion of eccentric contraction. Given that the medial and lateral hamstrings have different actions at the knee joint in the coronal plane, which hamstring head is previously injured might also be expected to influence the likelihood of future ACL. Whether the deficits in function after HSI, as seen in laboratory-based studies, translate to deficits in hamstring function during typical injurious tasks for ACL injury has yet to be determined but should be a consideration for future work.