Browsing by Author "Silvestre, Rony"

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    Effects of Elbow Crutch Locomotion on Gluteus Medius Activation During Stair Ascending
    (2022) De La Fuente Cancino, Carlos Ignacio; Neira, Alejandro; Torres, Gustavo; Silvestre, Rony; Roby, Matias; Yañez, Roberto; Herrera, Sofia; Martabit, Virgina; McKay, Isabel; Carpes, Felipe P.
    Crutches can help with the locomotion of people with walking disorders or functional limitations. However, little is known about hip muscle activation during stair ascending using different crutch locomotion patterns in people without disorders and limitations. Thus, we determined the acute effects of elbow crutch locomotion on gluteus medius (GM) activity during stair ascending. This comparative analytic cross-sectional study enrolled ten healthy men (22.0 ± 0.47 years). Participants climbed up the stairs with elbow crutches using one or two crutches, with ipsilateral or contralateral use, and after loading or unloading a limb. EMG signals were recorded from anterior, middle, and posterior portions of the GM and compared between the crutch conditions. The Kruskal–Wallis test and Dunn’s multiple comparison test were performed (α= 5%). The activation of the GM increased with the ipsilateral use of crutches, with two crutches and three points, and when all the load depended only on one limb. GM activation decreased with contralateral use and in the unload limb. In conclusion, ascending stairs with elbow crutches alters the GM activation. The more critical factors were choosing the crutches’ lateral use, the number of crutches, and if the limb is loaded or unloaded while ascending the stairs. Our findings can be helpful to increase or decrease the GM activation for those who use or will use crutches.
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    Intraoperative pivot-shift accelerometry combined with anesthesia improves the measure of rotatory knee instability in anterior cruciate ligament injury
    (2021) Caracciolo, Gastón; Yáñez, Roberto; Silvestre, Rony; De la Fuente, Carlos; Zamorano, Héctor; Ossio, Alejandra; Strömbäck, Lars; Abusleme, Sebastian; P. Carpes, Felipe
    Purpose: The knee stifness acquired following an Anterior Cruciate Ligament (ACL) injury might afect clinical knee tests, i.e., the pivot-shift maneuver. In contrast, the motor efects of spinal anesthesia could favor the identifcation of rotatory knee defciencies prior to ACL reconstruction. Hence, we hypothesized that the intra-operative pivot-shift maneuver under spinal anesthesia generates more acceleration in the lateral tibial plateau of patients with an injured ACL than without. Methods: Seventy patients with unilateral and acute ACL rupture (62 men and 8 women, IKDC of 55.1±13.8 pts) were assessed using the pivot-shift maneuver before and after receiving spinal anesthesia. A triaxial accelerometer was attached to the skin between Gerdys’ tubercle and the anterior tuberosity to measure the subluxation and reduction phases. Mixed ANOVA and multiple comparisons were performed considering the anesthesia and leg as factors (alpha=5%). Results: We found a higher acceleration in the injured leg measured under anesthesia compared to without anesthesia (5.12±1.56m.s−2 vs. 2.73±1.19m.s−2 , p<0.001), and compared to the non-injured leg (5.12±1.56m.s−2 vs. 3.45±1.35m.s−2 , p<0.001). There was a presence of signifcant interaction between leg and anesthesia conditions (p<0.001). Conclusions: The pivot-shift maneuver performed under anesthesia identifes better rotatory instability than without anesthesia because testing the pivot-shift without anesthesia underestimates the rotatory subluxation of the knee by an increased knee stifness. Thus, testing under anesthesia provides a unique opportunity to determine the rotational instability prior to ACL reconstruction.