Anterior cruciate ligament (ACL) reconstruction is the most common ligament reconstruction done till date. The tendency has inclined toward the surgical reconstruction from conservative means. In this review article, we will discuss the phases of the rehabilitation of the patient following the surgical reconstruction of the ACL. Importance will be given especially on early return of passive motion, early weight bearing, bracing, kinetic chain exercises, neuromuscular drill, and accelerated rehabilitation. There are many young individual who are not recovering enough to regain the preinjured level of activities. In this review article, we will present some of the recent evidences regarding ACL rehabilitation in an effort to help the hectic surgeons and physiotherapist comprehend and associate basic and clinical research to rehabilitation of a patient following reconstruction.

An injury to the anterior cruciate ligament (ACL) results in significant functional disability. One-third of the patients require reconstruction. The graft choice for ACL reconstruction is a controversial issue. The graft choices include autograft, allograft, and synthetic/prosthetic ligaments. Autografts include the middle third of the patella tendon, the quadriceps tendon, semitendinosus tendon, gracilis tendon, iliotibial band, tensor fascia lata, and the Achilles tendon. In last few decades, there have been several meta-analyses, comparative trials, which have fail to an answer with regards to the best graft available. The purpose of this review article is to provide concepts in graft choices for ACL reconstruction. This article will emphasize the pros and cons of the graft choices available and also regarding the donor site morbidity.

Weightlifting is considered as a dynamic strengthen exercise and power sport in which the athletes lifts a maximum weight with one repetition. The weightlifting as other sports has common musculoskeletal injuries in different body location corresponding to the sports beneficial. However, identifying the injuries incidence and the etiology is a first two-step in the model of the injury prevention in order to introduce preventive measures for sports. Therefore, this literature review is aimed to focus on the incidence and the etiology related to injuries of the weightlifting. However, the incidence injuries studies revealed that the children have more injuries related to accident than the adults. Whereas, the adults have more injuries related to strain and sprain. The most common injured locations are shoulder, lumbar spine, knee, elbow, hand, and wrist in the weightlifters. The percentage of the injuries according to location is the shoulder (36%), lumbar spine (24%), elbow (11%), and the knee (9%). In the other hand, the rule and regulation in the weightlifting had been changed since 1972 in which the clean and press lift eliminated from the competition due to the risk of this lift. Finally, weightlifting considered as safe sport if it is compared with other sports.

Field hockey is considered as a popular sport worldwide next to soccer in popularity. According to National Collegiate Athlete Association overall injury rate is 6.3%/1000 athlete exposure. Mechanism of injury could be extrinsic injury that is, being struck by hockey stick or ball or intrinsic injury due to internal force acting on muscle or an overuse injury which includes tibial stress syndrome, shin soreness, illiotibial band pain, low back dysfunction, tendonitis, patello-femoral pain, planter fasciitis, and stress fracture of foot and leg. Initial approach to injured athlete includes airways, breathing, circulation, rest, ice, compression, elevation, referral protocol, normalize joint range of motion (ROM), restore strengthening, Improve proprioception, agility and balance, minimize chance of re injury by maintaining flexibility. Strengthening and therapeutic exercises that will vary accordingly to the injured part. Countermeasures include preparticipation screening, preseason conditioning, fitness program, adequate warm and pregame stretch, followed by cool down and postgame stretch, following rules and penalty and finally by wearing protective equipment. This article discusses the biomechanics and common injuries in field hockey. Patho-mechanics, diagnosis, and physiotherapy management of the common injures are outlined. This may help the health care practitioners who deals with different injuries related to hockey.

Introduction: Football (soccer) is certainly one of the most popular sports worldwide. Football is a dynamic sport that requires the athlete to perform many different movements and skills such as rapid acceleration and deceleration, quick changes of directions, jumping, kicking, and sliding. Compared with other sports, football is vigorous sporting activity with relatively high incidence of injury. Tightness in hamstring muscle leads to hamstring muscle injury. Prevalence of hamstring injury is common in football players due to its tightness. Purpose of Study: The purpose of this study was to find out the effect of muscle energy technique (MET) on the flexibility of hamstring muscle in national level football players. The players were given 6 days MET on hamstring muscle to improve its flexibility. Hamstring length was checked using the sit and reach test presession as well as postsession, and both values were compared. Result: The increase in hamstring length following the 6 days MET on hamstring proved to be statistically significant (P < 0.01) when compared with the presession (24.31) and postsession (26.77) values. Conclusion: It is concluded that MET increases the flexibility of hamstring muscle in Indian National Football Players and hence it can prevent the injuries and improves their performance.

Context: Understanding the concept of prevalence and risk factors of exercise-related leg pain (ERLP) in distance runners. Aims: To find out the prevalence and in the seasonal incidence of ERLP in inter university distance runners. To investigate risk factors for developing ERLP. Settings and Design: The present cross-sectional study conducted at the track and field in Guru Nanak Dev University and other universities in Punjab. Materials and Methods: A total 70 athletes (40 male, 30 female) were participated voluntarily. Precompetitive demographic, basic anthropometric, training parameters and ERLP history data were collected from the initial questionnaire. Foot type and plantar flexor endurance were measured from each individual using navicular drop test, standard heel raise test, and runners were tracked throughout the session to note the percentage of in seasonal ERLP. Statistical Analysis Used: Chi-square and odds ratio was applied to find out the risk factors of ERLP. Results: Overall 48.57% male and 37.14% female athletes had a history of ERLP and 14.2% athletes did not have any history of ERLP out of 70 athletes. Among them 81.4% (57) athletes completed postseasonal questionnaire, out of 57 athlete's 42.1% (24) male and 28% (16) female athletes developed in seasonal ERLP, bilateral lower leg pain was the most common presentation. There was a significant difference seen between ERLP history (1-month) and body mass index (BMI) within seasonal ERLP (P < 0.02), (P < 0.04), as compared to 6 and 12 month history of ERLP. Conclusions: The results of the present study conclude that BMI and ERLP history (1-month) was the only risk factor for in the seasonal development of ERLP in distance runners.

Background: Medical education is inherently stressful and emotionally demanding training. Objectives: The objective was to assess the stress levels, its causes, and impact on health and education on first MBBS students. Materials and Methods: This cross-sectional pilot project was conducted in a Medical College in Eastern India during a time span of 2 months, after receiving approval from the Institutional Ethics Committee and informed consent from the subjects. One hundred and fifty MBBS students in the age group of 18–20 years under stress were chosen for the study. Stress level was assessed according to the Presumptive Life Event Stress Scale (PSLES) and categorized into two groups: 41–200: less/moderate stress; more than 200: severe stress. The Perceived Stress Scale (PSS) of Sheldon Cohen was also used. Scores around 13 were considered as average. Scores of 20 or higher were considered high stress. Baseline anthropometric measurements were done; body mass index and waist to hip ratio (WHR) were calculated. Resting pulse rate and blood pressure were measured. The results of internal assessment examinations conducted in this time period were recorded. The computer software Statistical Package for the Social Sciences version 16 was used for analysis of the data. Results: A total of 30 subjects had moderate PSLES scores (167.25 ± 26.67); 120 had high scores (373.86 ± 149.21; P < 0.000). We found statistically significant higher heart rate, diastolic blood pressure, WHR, and PSS scores (22.05 ± 5.02 vs. 19.25 ± 4.21; P 0.003) in subjects having high PSLES scores. No significant effect of stress scores were observed on systolic blood pressure. Examination results were significantly worse in the highly stressed group (64.3 ± 10.8 vs. 69.1 ± 9.6; P 0.019) as compared to subjects having moderate stress. Conclusions: These results indicated a negative impact of stress on health and education among MBBS students.

Background: Stress has become a part and parcel of modern day life. Lifestyle modifications may be a cost-effective way to improve health and quality of life. Aims: To compare effects of progressive muscle relaxation (PMR) and walking on stress and cardiovascular profile in young adults working in the health sector. Materials and Methods: This pilot study was conducted at a tertiary care hospital of Eastern India after taking institutional ethical clearance and informed consent of the subjects. One hundred and twenty young adults from the health-care sector with the presumptive life event stress scale of more than 200 were selected for the study. Anthropometric measurements were carried out. Pulse and blood pressure were recorded. Perceived Stress Scale (PSS) scores were calculated, lipid profile analyzed, and isometric hand grip test, orthostatic tolerance test, and breath-holding test were done. Study subjects were divided into two groups G1 and G2. Group G1 was asked to practice PMR and Group G2 was advised to walk in the morning for 3 months. All parameters were re-evaluated after 3 months. The primary outcome measures from baseline to final follow-up were measured by blinded observers. Results: There was no difference in age, sex, PSS, cardiovascular profile, and dietary habits between the two groups before training. Ten subjects failed to attend follow-up clinic and were excluded. PSS, cardiovascular profile were significantly improved in both groups after the training session. PSS and cardiovascular profile improved equally in both groups. Conclusion: PMR and walking were equally effective in reducing stress and improving cardiovascular profile in young adults and may be used as a cost-effective way to improve health and quality of life.

Purpose: The purpose was to evaluate short to medium term outcome of total elbow arthroplasty (TEA) in the grossly comminuted intercondylar fracture humerus in the elderly population. Patients and Methods: It is a prospective study. Data were collected from the patients attended with intercondylar fracture humerus in a tertiary care hospital from June 2009 to July 2014. Thirty-five patients attended with intercondylar fracture humerus in these periods. We had done 13 cases of primary TEA for comminuted intercondylar fracture of the distal humerus. Grossly comminuted fracture, osteoporotic bone and age more than 65 years were considered for TEA. All the patients were evaluated at 6 weeks after the operation, and then at 3, 6, 9, 12, 18, and 24 months. We used the Mayo score to assess the functional results. Results: Mean age of the patients was 70.84 years (range: 66–78 years). Of thirteen patients, nine patients were female, and four patients were male. The mean interval between the time of the accident and operation was 4.07 days (range: 2–10 days). The mean hospital stay was 12 days (range: 8–16 days). The mean follow-up was for 19.46 months (range: 18–31 months). All the elbows were stable. The mean flexion was to 115.38° (90°–140°). The mean arc of rotational movement was 161.53° (130°–180°). Eleven patients had no limitation of daily living, and two had some limitation of daily living. Mean Mayo score was 93.84 (range: 85–100). One patient developed osteolysis around the stem of the prosthesis in the humerus in follow-up radiograph, but the clinically patient had no complaint. Three patients had a surgical site infection, and two patients had ulnar nerve paresis but infection controlled after 7–10 days and nerve paresis completely cured after 3–4 months. Conclusion: The primary TEA in a case of grossly comminuted intercondylar fracture humerus in elderly population gives comparable short to medium term results.

The theory that there is a possible correlation between blood types and personality characteristics, other diseases, neurological disorders have been prevalent for a long-time. Background/Aims: To find correlation of perceived stress with blood group A and O among medical students and its effect on lipid profile in a medical college of eastern India. Materials and Methods: This cross-sectional study was conducted in a time span of 6 months after taking approval from the institutional ethics committee and informed consent of the subjects. Stress level in the subjects was assessed according to the presumptive life event stress scale (PSLES). 465 subjects with scores above 200 were chosen for the study. Blood groups of the subjects were assessed (blood group O 185; A 95; B 150: AB 35 [total 465]). Lipid profiles of subjects with blood group O and A were analyzed following exposure to stress. The perceived stress scale (PSS) of Sheldon Cohen was used to measure perceived stress. Data were analyzed using SPSS version 16. Results: There was no significant difference in PSLES scores, body mass index, total cholesterol, triglyceride, high-density lipoprotein, very low-density lipoprotein between subjects of blood group O and A. PSS score was significantly higher in group O as compared to group A (22.4 ± 4.6 vs. 19.36 ± 4.9; P value 0.036*). Low-density lipoprotein-cholesterol (LDL-C) was significantly higher in group O (132.63 ± 19.43 vs. 115.59 ± 18.7; P value 0.004**). PSS scores were positively correlated with LDL with r value of 0.03 [P < 0.01]). Conclusions: The results of our study indicate that subjects with blood group perceived more stress as compared to subjects of blood group A and perceived stress significantly worsened LDL-C levels.

Background: Postmenopausal females with osteoarthritis (OA) of knee joint often report episodes of knee instability limiting their daily activities and this causes an added stress. Aims: To evaluate the effects of progressive muscle relaxation (PMR) on balancing exercises to improve functional ability in postmenopausal females with OA of knee. Materials and Methods: This interventional study was conducted on 60 postmenopausal females in a tertiary care hospital of Eastern India after taking Institutional Ethical Clearance and informed consent of the subjects. Perceived stress scores of the subjects were assessed. Patients were randomly allocated into two groups and they received either balancing exercises and PMR (Group A) or balancing exercises (Group B). Both of the groups received transcutaneous electrical nerve stimulation and treatment was given for 4 days a week for 4 weeks. The outcome measures were Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Results: After 4 weeks of treatment, significant reduction in the WOMAC score and VAS was found in both Groups. The results showed that improvement was more in Group A than Group B. Perceived stress scores significantly decreased in Group A (27.8 ± 1.95 vs. 20.16 ± 3.33; P < 0.000**) but the change was not significant in Group B (28.2 ± 1.4 vs. 27.46 ± 1.45; P value: 0.53). Perceived Stress Scale (PSS) was positively correlated with WOMAC and VAS scores at R value of 0.68 and 0.81, respectively. Conclusion: The results of the study indicates that balancing exercise when practiced along with stress relaxation exercises is more effective in improving the functional ability of OA knee.

Objective: Walking on a treadmill is a common tool for lower extremity rehabilitation in the clinical setting. Backward walking (BW) shows significant differences with forward walking (FW) and these differences are potentially useful in rehabilitation. The aim of this study was to evaluate the effect of BW and FW on sports performance variables such as functional strength, balance, aerobic and anaerobic capacities of young healthy adults. Materials and Methods: Totally, 30 young healthy male subjects with a mean age of 26.1 ± 4.3 years participated in this study. Subjects were divided into two groups, forward walking group (FWG) and backward walking group (BWG) (n = 15) and performed forward and backward directions walking on a treadmill at consistent speed and 10% inclination, respectively, for duration of 6 weeks. Study outcomes such as functional strength, balance, aerobic and anaerobic capacities were measured on pre- and post-intervention. Results: The results of the study observed that lower limb functional strength, aerobic and anaerobic capacities were improved with BWG than FWG. However, the static and dynamic balances were showed no significant improvement between both walking groups. Conclusion: Backward walking training has been proved to be effective in improving the lower limb functional strength, aerobic and anaerobic capacities of the normal healthy individuals, whereas the balance components has to be studied in future in an extensive ways in BW.

Being intra-articular nature and disruption of anterior cruciate ligament complex, tibial spine fracture, it is mandatory to fix the displaced fracture of tibial spine in order to maintain the knee kinematics. Fixation of the fracture has shifted from open to arthroscopic assisted. The deficit of a few degrees of movement is a noted complication due to arthrofibrosis which require arthrolysis. We are presenting a case report of a 12 year male patient with type III tibial spine fracture that was fixed using a 7 mm cannulated cancellous screw. Functional outcome was excellent.

Locking symptoms in the knee joint generally occur due to meniscal tears and loose bodies. The purpose of this report is to describe a case of nodular synovitis, an intra-articular tenosynovial giant-cell tumor, as a rare differential diagnosis for locking of the knees. Arthroscopic removal ensured prompt symptomatic relief without any recurrence at 1-year follow-up. Nodular synovitis has a better prognosis with limited risk of local recurrence. There is no role for complete synovectomy or postoperative radiotherapy. Knee arthroscopy is the procedure of choice, and prompt symptomatic relief is the usual outcome expected; however, a close follow-up is still warranted to look for recurrence.

Guillain–Barré syndrome (GBS) is often triggered by a preceding bacterial or viral infection. A molecular mimicry mechanism is supposed to be involved in the pathogenesis of GBS triggered by infectious agents, although the nature of the shared epitopes has not been characterized in most instances, including that in the case of hepatotropic viruses. We report a case of GBS following acute hepatitis E.

Clinical picture of brachial plexopathy may be overlapped by concomitant presence of ipsilateral fracture of humerus. Compound fracture of proximal shaft of humerus in high-energy road traffic accident may completely mask the feature of brachial plexus injury, especially when a patient is under the influence of alcohol. We are reporting a case that sustained compound fracture of proximal shaft of humerus with missed brachial plexus injury which was evident 3 weeks after the trauma. The best of clinical services can lead to excellent functional outcome but cannot avoid medico-legal consequences.