Explore the vast range of titles available.

Background Neutral mechanical alignment (MA) in total knee arthroplasty (TKA) aims to position femoral and tibial components perpendicular to the mechanical axis of the limb. In contrast, kinematic alignment (KA) attempts to match implant position to the prearthritic anatomy of the individual patient with the aim of improving functional outcome. However, comparative data between the two techniques are lacking. Questions/purposes In this randomized trial, we asked: (1) Are 2-year patient-reported outcome scores enhanced in patients with KA compared with an MA technique? (2) How does postoperative component alignment differ between the techniques? (3) Is the proportion of patients undergoing reoperation at 2 years different between the techniques? Methods Ninety-nine primary TKAs in 95 patients were randomized to either MA (n = 50) or KA (n = 49) groups. A pilot study of 20 TKAs was performed before this trial using the same patient-specific guides positioning in kinematic alignment. In the KA group, patient-specific cutting blocks were manufactured using individual preoperative MRI data. In the MA group, computer navigation was used to ensure neutral mechanical alignment accuracy. Postoperative alignment was assessed with CT scan, and functional scores (including the Oxford Knee Score, WOMAC, and the Forgotten Joint Score) were assessed preoperatively and at 6 weeks, 6 months, and 1 and 2 years postoperatively. No patients were lost to followup. We set sample size at a minimum of 45 patients per treatment arm based on a 5-point improvement in the mean Oxford Knee Score (OKS; the previously reported minimum clinically significant difference for the OKS in TKA), a pooled SD of 8.3, 80% power, and a two-sided significance level of 5%. Results We observed no difference in 2-year change scores (postoperative minus preoperative score) in KA versus MA patients for the OKS (mean 21, SD 8 versus 20, SD 8, least square means 1.0, 95% confidence interval [CI], −1.4 to 3.4, p = 0.4), WOMAC score (mean 38, SD 18 versus 35, SD 8, least square means 3, 95% CI, −3.2 to 8.9, p = 0.3), or Forgotten Joint score (28 SD 37 versus 28, SD 28, least square means 0.8, 95% CI, −9.1–10.7, p = 0.8). Postoperative hip-knee-ankle axis was not different between groups (mean KA 0.4° varus SD 3.5 versus MA 0.7° varus SD 2.0), but in the KA group, the tibial component was a mean 1.9° more varus than the MA group (95% CI, 0.8°−3.0°, p = 0.003) and the femoral component in 1.6° more valgus (95% CI, −2.5° to −0.7°, p = 0.003). Complication rates were not different between groups. Conclusions We found no difference in 2-year patient-reported outcome scores in TKAs implanted using the KA versus an MA technique. The theoretical advantages of improved pain and function that form the basis of the design rationale of KA were not observed in this study. Currently, it is unknown whether the alterations in component alignment seen with KA will compromise long-term survivorship of TKA. In this study, we were unable to demonstrate an advantage to KA in terms of pain or function that would justify this risk. Level of Evidence Level I, therapeutic study.

Joining dissimilar materials such as plastics and metals in engineered structures remains a challenge 1 . Mechanical fastening, conventional welding and adhesive bonding are examples of techniques currently used for this purpose, but each of these methods presents its own set of problems 2 such as formation of stress concentrators or degradation under environmental exposure, reducing strength and causing premature failure. In the biological tissues of numerous animal and plant species, efficient strategies have evolved to synthesize, construct and integrate composites that have exceptional mechanical properties 3 . One impressive example is found in the exoskeletal forewings (elytra) of the diabolical ironclad beetle, Phloeodes diabolicus . Lacking the ability to fly away from predators, this desert insect has extremely impact-resistant and crush-resistant elytra, produced by complex and graded interfaces. Here, using advanced microscopy, spectroscopy and in situ mechanical testing, we identify multiscale architectural designs within the exoskeleton of this beetle, and examine the resulting mechanical response and toughening mechanisms. We highlight a series of interdigitated sutures, the ellipsoidal geometry and laminated microstructure of which provide mechanical interlocking and toughening at critical strains, while avoiding catastrophic failure. These observations could be applied in developing tough, impact- and crush-resistant materials for joining dissimilar materials. We demonstrate this by creating interlocking sutures from biomimetic composites that show a considerable increase in toughness compared with a frequently used engineering joint. A jigsaw-style configuration of interlocking structures identified in the elytra of the remarkably tough diabolical ironclad beetle, Phloeodes diabolicus , is used to inspire crush-resistant multilayer composites for engineering joints.

The biomechanical characteristics of the erector spinae muscles are crucial for evaluating treatment effectiveness. Although it is widely believed that myofascial release directly impacts muscle biomechanics, there has been limited research directly comparing manual (MMR) and tool-assisted (TMR) applications. This study aimed to fill this gap by investigating the immediate biomechanical effects of MMR and TMR on the erector spinae muscles, using the MyotonPRO device to measure and compare changes in muscle tone, stiffness, and elasticity. Thirty healthy adult physical therapy students (21.19 ± 1.93 years) were recruited and randomly assigned to either the MMR or TMR group. Biomechanical properties (elasticity, tone, and stiffness) were measured before and immediately after three sets of 15 repetitions of the assigned intervention. Post-intervention, the MMR group showed a significant decrease in muscle stiffness and tone (p < 0.0125), while the TMR group showed no significant changes in any of the measured parameters (all p > 0.05). A comparison of the percentage change from baseline also revealed significant differences in elasticity, stiffness, and tone between the two groups (p < 0.0125). This study demonstrates that MMR produces a significant and immediate reduction in erector spinae muscle stiffness and tone, an effect not observed with TMR.

Early amniote development is highly self-organized, capable of adapting to interference through local and long-range cell–cell interactions. This process, called embryonic regulation 1 , has been well illustrated in experiments on avian embryos, in which subdividing the epiblast disk into different parts not only redirects cell fates to eventually form a complete and well-proportioned embryo at its original location, but also leads to the self-organization of additional, fully formed embryos 2 , 3 in the other separated parts. The cellular interactions underlying embryonic self-organization are widely believed to be mediated by molecular signals, yet the identity of such signals is unclear. Here, by analysing intact and mechanically perturbed quail embryos, we show that the mechanical forces that drive embryogenesis self-organize, with contractility locally self-activating and the ensuing tension acting as a long-range inhibitor. This mechanical feedback governs the persistent pattern of tissue flows that shape the embryo 4 – 6 and also steers the concomitant emergence of embryonic territories by modulating gene expression, ensuring the formation of a single embryo under normal conditions, yet allowing the emergence of multiple, well-proportioned embryos after perturbations. Thus, mechanical forces act at the core of embryonic self-organization, shaping both tissues and gene expression to robustly yet plastically canalize early development. Mechanical forces act at the core of bird embryonic self-organization, shaping both tissues and gene expression to robustly yet plastically canalize early development.

Learning a sports skill is a complex process in which practitioners are challenged to cater for individual differences. The main purpose of this study was to explore the effectiveness of a Nonlinear Pedagogy approach for learning a sports skill. Twenty-four 10-year-old females participated in a 4-week intervention involving either a Nonlinear Pedagogy (i.e.,manipulation of task constraints including equipment and rules) or a Linear Pedagogy (i.e., prescriptive, repetitive drills) approach to learn a tennis forehand stroke. Performance accuracy scores, movement criterion scores and kinematic data were measured during pre-intervention, post-intervention and retention tests. While both groups showed improvements in performance accuracy scores over time, the Nonlinear Pedagogy group displayed a greater number of movement clusters at post-test indicating the presence of degeneracy (i.e., many ways to achieve the same outcome). The results suggest that degeneracy is effective for learning a sports skill facilitated by a Nonlinear Pedagogy approach. These findings challenge the common misconception that there must be only one ideal movement solution for a task and thus have implications for coaches and educators when designing instructions for skill acquisition.

The study investigated the effects of FIFA 11+ and HarmoKnee, both being popular warm-up programs, on proprioception, and on the static and dynamic balance of professional male soccer players. Under 21 year-old soccer players (n = 36) were divided randomly into 11+, HarmoKnee and control groups. The programs were performed for 2 months (24 sessions). Proprioception was measured bilaterally at 30°, 45° and 60° knee flexion using the Biodex Isokinetic Dynamometer. Static and dynamic balances were evaluated using the stork stand test and Star Excursion Balance Test (SEBT), respectively. The proprioception error of dominant leg significantly decreased from pre- to post-test by 2.8% and 1.7% in the 11+ group at 45° and 60° knee flexion, compared to 3% and 2.1% in the HarmoKnee group. The largest joint positioning error was in the non-dominant leg at 30° knee flexion (mean error value = 5.047), (p<0.05). The static balance with the eyes opened increased in the 11+ by 10.9% and in the HarmoKnee by 6.1% (p<0.05). The static balance with eyes closed significantly increased in the 11+ by 12.4% and in the HarmoKnee by 17.6%. The results indicated that static balance was significantly higher in eyes opened compared to eyes closed (p = 0.000). Significant improvements in SEBT in the 11+ (12.4%) and HarmoKnee (17.6%) groups were also found. Both the 11+ and HarmoKnee programs were proven to be useful warm-up protocols in improving proprioception at 45° and 60° knee flexion as well as static and dynamic balance in professional male soccer players. Data from this research may be helpful in encouraging coaches or trainers to implement the two warm-up programs in their soccer teams.

Purpose The acromioclavicular ligament complex (ACLC) is the primary stabilizer against horizontal translation with the superior ACLC providing the main contribution. The purpose of this study was to evaluate the specific regional contributions in the superior half of ACLC, where the surgeon can easily access and repair or reconstruct, for posterior translational and rotational stability. Methods The superior half of ACLC was divided into three regions; Region A (0°–60°): an anterior 1/3 region of the superior half of ACLC, Region B (60°–120°): a superior 1/3 region of the superior half of ACLC, and Region C (120°–180°): a posterior 1/3 region of the superior half of ACLC. Fifteen fresh-frozen cadaveric shoulders were used. Biomechanical testing was performed to evaluate the resistance force against passive posterior translation (10 mm) and the resistance torque against passive posterior rotation (20°) during the following the four conditions. (1) Stability was tested on all specimens in their intact condition ( n  = 15). (2) The ACLC was dissected and stability was tested ( n  = 15). (3) Specimens were randomly divided into three groups by regions of suturing. Stability was tested after suturing Region A, Region B, or Region C ( n  = 5 per group). (4) Stability was tested after suturing additional regions: Region A + B (0°–120°), Region B + C (60°–180°), or Region A + C (0°–60°, 120°–180°, n  = 5 per group). Results The translational force increased after suturing Region A when compared with dissected ACLC ( P  = 0.025). The force after suturing Region A + B was significantly higher compared to the dissected ACLC ( P  < 0.001). The rotational torque increased after suturing Region A or Region B compared with dissected ACLC ( P  = 0.020, P  = 0.045, respectively). The torque after suturing the Region A + C was significantly higher compared to the dissected ACLC ( P  < 0.001). Conclusion The combined Region A + B contributed more to posterior translational stability than Region B + C or Region A + C. In contrast, combined Region A + C contributed more to posterior rotational stability than Region A + B or Region B + C. Based on these findings, surgical techniques restoring the entire superior ACLC are recommended to address both posterior translational and rotational stability of the AC joint.