Diego Costa Astur1, Gustavo Gonçalves Arliani1, Camila Cohen Kaleka2, Wahy Jalikjian3, Pau Golano4,5, Moises Cohen11Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2Department of Orthopedics and Traumatology, Faculdade de Medicina da Santa Casa de Misericórdia de São Paulo, São Paulo, 3Department of Orthopedics and Traumatology, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil; 4Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain; 5Orthopedic Surgery Department, Pittburgh University, Pittsburgh, PA, USABackground: Recently, an interest has developed in understanding the anatomy of the posterior and posterolateral knee. The posterolateral compartment of the knee corresponds to a complex arrangement of ligaments and myotendinous structures. Undiagnosed lesions in this compartment are the main reason for failure of the anterior and posterior cruciate ligament reconstructions. Understanding the anatomy of these structures is essential to assist in the diagnosis and treatment of these lesions. The aim of this study was to better understand the relationship between these structures of the knee using three-dimensional technology.Methods: Ten knees were included from cadaver lower limbs of adult patients. The skin and subcutaneous tissue were removed leaving only the muscle groups and ligaments. The neurovascular bundles and their ramifications were preserved. Images were acquired from the dissections using a Nikon D40 camera with AF-S Nikkor 18–55 mm (1:3.5 5.6 GII ED) and Micro Nikkor 105 mm (1:2.8) lenses. The pair of images were processed using Callipyan 3D and AnaBuilder software, which transforms the two images into one anaglyphic image.Results: During the dissection of the knees, twelve pictures were acquired and transformed into anaglyphic images.Conclusion: The use of three-dimensional images in this study demonstrates that this technique is useful to improve the knowledge in anatomy of the knee as well as for knee reconstruction surgery.Keywords: knee joint anatomy and histology, humans, anatomy education, photography methods, education, medical methods, eyeglasses

Mitsuru Hanada, Hiroshi Koyama, Masaaki Takahashi, Yukihiro MatsuyamaDepartment of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanBackground: Osgood–Schlatter disease (OSD) is one of the common causes of knee pain in active adolescents who play sports. The common age for boys to have OSD is between 12 and 15 years and for girls, between 8 and 12 years. Radiographic studies are helpful in diagnosis and treatment of OSD.Purpose: We examine the age at onset of OSD in detail and investigate the relationship between clinical findings, radiographic bone morphology, and the severity of OSD in adolescents.Results: The average age at onset of knee pain was 12 years and 6 months – 12 years and 9 months in boys, and 12 years and 1 month in girls. Boys were significantly older than girls at onset. In addition, there were significant relationships between duration from first onset to visit to the clinic, radiographic bone stage, body morphology, and radiographic severity. The patients who delayed their visit to the clinic from the first onset of pain and who were older showed a later bone stage and more radiographic severity grade of OSD. There was significant differences concerning weight and body mass index between severity grade I and III. Conclusion: For the age at the onset of OSD, the mean age of boys was significantly older than that of girls. The patients at a later bony stage had a higher severity grade. The boys and girls with OSD who had less weight or body mass index showed less severity.Keywords: Osgood–Schlatter disease, radiographic classification, tibial tuberosity, body morphology

Takuya Honda1, Hiroharu Kamioka21Research Fellow of the Japanese Society for the Promotion of Science, 2Laboratory of Physical and Health Education, Faculty of Regional Environment Science, Tokyo University of Agriculture, Tokyo, JapanBackground: The purpose of this study was to report on the health benefits and curative effects of aquatic exercise.Methods: We adopted the results of high-grade study designs (ie, randomized controlled trials and nonrandomized controlled trials), for which there were many studies on aquatic exercise. Aquatic exercise, in this study, means walking in all directions, stretching, and various exercises and conditioning performed with the feet grounded on the floor of a swimming pool. We excluded swimming. We decided to treat aquatic exercise, underwater exercise, hydrotherapy, and pool exercise as all having the same meaning.Results: Aquatic exercise had significant effects on pain relief and related outcome measurements for locomotor diseases.Conclusion: Patients may become more active, and improve their quality of life, as a result of aquatic exercise.Keywords: aquatic exercise, health enhancement, evidence

Diego Trevisan Brunelli,1 João Paulo Borin,1 Ariel Rodrigues,1 Valéria Bonganha,1 Jonato Prestes,2 Paulo César Montagner,1 Cláudia Regina Cavaglieri11Faculty of Physical Education, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; 2Graduate Program of Physical Education and Health, Catholic University of Brasilia, Brasilia, Distrito Federal, BrazilObjective: The aim of this study was to investigate the immunological responses and the association between variation in exercise load and self-reported occurrence of upper respiratory illness (URI) symptoms in young basketball athletes.Materials and methods: The sample was composed of twelve young male athletes aged 12.7 ± 0.6 years, with a height of 170 ± 10 cm, body mass of 57.6 ± 12.6 kg, and fat-free mass of 18.7 ± 5.9%. Daily training and occurrences of URI symptoms were recorded. Blood samples were collected at baseline (M1) and after 8 weeks (M2) of the preparatory period of periodization training to measure total and differential leukocyte counts, serum interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α).Results: There was a significant decrease in monocytes at M2 compared to M1 (P = 0.004). There were no significant alterations in total leukocytes (P = 0.07), neutrophils (P = 0.07), or lymphocytes (P = 0.09). No significant changes in plasma concentrations of TNF-α (P = 0.30) or IL-6 (P = 0.90) were found. The weekly load from week 6 was higher when compared with weeks 1, 2, 4, and 8 (P < 0.05), and week 8 was the lowest when compared with week 5 (P < 0.05). Self-reported URI incidences were highest at weeks 1 and 2.Conclusion: Variations in weekly training load during the preparatory period were not correlated with changes in self-reported occurrence of URI incidences, suggesting that young athletes may have an attenuated response to exercise-induced perturbations to the immune system.Keywords: immune system, upper respiratory illness, young athletes, cytokines

Beat Knechtle,1,2 Christoph Alexander Rüst,2 Thomas Rosemann,2 Romuald Lepers31Gesundheitszentrum St Gallen, St Gallen, Switzerland; 2Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland; 3INSERM U1093, Faculty of Sport Sciences, University of Burgundy, Dijon, FranceBackground: To date, the age-related decline and gender differences in performance have been investigated for both Olympic and Ironman distance triathlons, but not for the intermediate distance (ie, the half-Ironman distance triathlon covering 1.9 km swimming, 90 km cycling and 21.1 km running, Ironman 70.3®). We determined the age-related differences in performance and the gender differences for female and male half-Ironman triathletes of 6303 finishers (1115 women and 5188 men) at the Ironman 70.3 Switzerland in Rapperswil, Switzerland, from 2007 to 2010.Methods: Analyses of variance were used to examine performance trends and differences between the genders.Results: Gender differences in total event time were affected by age (F = 4.2; P < 0.001). Women achieved their best performance between 25 and 39 years whereas men attained their fastest race times between 18 and 39 years. The gender difference for ages 18–24 years was significantly (P < 0.01) greater compared to older age groups (25–29 years and 40–44 years), and the gender difference for age groups 45–49 years and 50–54 years was significantly (P < 0.01) greater than for those between the ages of 35–39 years.Conclusion: The present data suggest that the fastest race time in a half-Ironman triathlon was achieved between the age of 25 and 39 years for women and between 18 and 39 years for men. Further studies considering the influences on endurance performance are required to better understand the age and gender interactions in half-Ironman triathlon performances, and these studies may provide valuable information to delineate the difference in performance between female and male half-Ironman triathletes.Keywords: cycling, endurance, female, male, running, swimming

Evelyn Eichenberger,1 Beat Knechtle,1,2 Christoph Alexander Rüst,1 Thomas Rosemann,1 Romuald Lepers31Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3INSERM U1093, Faculty of Sport Sciences, University of Burgundy, Dijon, FranceBackground: The aims of the study were to examine the (a) participation, (b) difference in running times between the sexes, and (c) age-related decline in the running times of ultramarathoner women and men competing in the Swiss Alpine Marathon from 1998 to 2011.Methods: The ultramarathoners competing in the Swiss Alpine Marathon were analyzed in terms of participation, difference in running times between the sexes, age of the fastest runners, and age-related decline in the fastest running times. The race covers a distance of 78 km, with a total altitude change of approximately 2260 m. A total of 12,194 men and 1781 women finished the race between 1998 and 2011.Results: Women's participation increased from approximately 10% in 1998 to approximately 16% in 2011 (r2 = 0.57; P = 0.001), but participation remained unchanged in men (r2 = 0.17; P > 0.05). Over the years, the top ten women showed no change in running times (r2 = 0.02; P > 0.05), whereas the top ten men's running times increased (r2 = 0.46; P < 0.01). The age for peak running times increased over time both for the top ten women (r2 = 0.58; P < 0.01) and for the top ten men (r2 = 0.40; P = 0.01).Conclusion: Among the top women, participation increased, the age for peak running times increased, and the running times remained unchanged. Among the men, however, the participation remained steady, and both the peak running-time age and the running times increased.Keywords: ultra-endurance, aging, sex difference, running

Sachiko Sumida,1,2 Jun Iwamoto,3 Naoto Kamide,4 Toshiro Otani1,3,51Graduate School of Health Management, Keio University, 2Sports Medicine Research Center, Keio University, Kanawaga; 3Institute for Integrated Sports Medicine, School of Medicine, Keio University, Tokyo, 4School of Allied Health Sciences, Kitasato University, Kanagawa, 5Faculty of Nursing and Medical Care, Keio University, Kanawaga, JapanAbstract: The objectives of this study were to reveal the proportion of Shorinji Kempo athletes who had suffered fractures related to sports activities, and to evaluate bone mass, bone turnover, nutritional status, and physical function in these athletes. A medical examination was carried out for 16 Shorinji Kempo collegiate athletes. Seven athletes (43.8%) had experienced a sports-related traumatic fracture during Shorinji Kempo practice. Four athletes (25.0%) had a lower speed of sound (% young adult mean < 100%), and five athletes (31.3%) had higher levels of urinary cross-linked N-terminal telopeptides of type 1 collagen (a bone turnover marker) than the age-adjusted standard values. All the athletes had a lower daily calcium intake than the adequate intake, 12 (75.0%) had a lower daily vitamin D intake, and 15 (93.8%) had a lower daily vitamin K intake. Significant positive correlations were found between the vertical jump height, and the daily energy, and protein intakes. Results suggest that fractures are a common injury in Shorinji Kempo athletes, and that some Shorinji Kempo athletes need to improve their bone mass, bone metabolism, and nutritional status in order to strengthen bone and improve physical function.Keywords: medical checkup, Shorinji Kempo, fracture, nutrition; physical function

Christoph Alexander Rüst,1 Beat Knechtle,1,2 Patrizia Knechtle,2 Thomas Rosemann11Institute of General Practice and for Health Services Research, University of Zurich, Zurich, 2Gesundheitszentrum St Gallen, St Gallen, SwitzerlandBackground: Of the anthropometry and training variables used to predict race performance in a 24-hour ultrarun, the personal best marathon time is the strongest predictor in recreational male 24-hour ultramarathoners. This finding raises the question of whether similarities exist between male recreational 24-hour ultramarathoners and male recreational marathoners.Methods: The association between age, anthropometric variables (ie, body mass, body height, body mass index, percent body fat, skeletal muscle mass, limb circumference, and skinfold thickness at the pectoral, mid axillary, triceps, subscapular, abdominal, suprailiac, front thigh, and medial calf sites), previous experience and training characteristics (ie, volume, speed, and personal best time), and race time for 79 male recreational 24-hour ultramarathoners and 126 male recreational marathoners was investigated using bivariate and multivariate analysis.Results: The 24-hour ultramarathoners were older (P < 0.05), had a lower circumference at both the upper arm (P < 0.05) and thigh (P < 0.01), and a lower skinfold thickness at the pectoral, axillary, and suprailiac sites (P < 0.05) compared with the marathoners. During training, the 24-hour ultramarathoners were running for more hours per week (P < 0.001) and completed more kilometers (P < 0.001), but were running slower (P < 0.01) compared with the marathoners. In the 24-hour ultramarathoners, neither anthropometric nor training variables were associated with kilometers completed in the race (P > 0.05). In the marathoners, percent body fat (P < 0.001) and running speed during training (P < 0.0001) were related to marathon race times.Conclusion: In summary, differences in anthropometric and training predictor variables do exist between male recreational 24-hour ultramarathoners and male recreational marathoners for race performance.Keywords: endurance, performance, athlete, body fat, skinfold thickness

Beat Knechtle,1,2 Sabrina Baumgartner,1 Patrizia Knechtle,2 Christoph Alexander Rüst,1 Thomas Rosemann,1 Raúl Bescós31Institute of General Practice and Health Services Research, University of Zurich, Zurich; 2Gesundheitszentrum St Gallen, St Gallen, Switzerland; 3National Institute of Physical Education, Barcelona, SpainBackground: Changes in single skinfold thickness and body fat have been investigated in ultraswimmers and ultracyclists, but not in ultrarunners. The present study investigated the changes in single skinfold thickness during a 100 km ultramarathon.Methods: Firstly, we investigated associations between prerace preparation and prerace body composition and, secondly, changes in single skinfold thickness during a 100 km ultramarathon in 219 male ultramarathoners. Changes in fat mass and skeletal muscle were estimated using anthropometric methods.Results: Kilometers run weekly prerace and running speed during training were negatively associated with all skinfold thicknesses (P < 0.05) except for the front thigh skinfold. During the race, skinfold thickness at the pectoral (−0.1%), suprailiac (−1.8%), and calf (−0.8%) sites decreased (P < 0.05). The subjects lost 1.9 ± 1.4 kg of body mass (P < 0.001), 0.7 ± 1.0 kg of estimated skeletal muscle mass (P < 0.001), and 0.2 ± 1.3 kg of estimated fat mass (P < 0.05). The decrease in body mass was positively related to the decrease in both estimated skeletal muscle mass (r = 0.21, P = 0.0017) and estimated fat mass (r = 0.41, P < 0.0001).Conclusion: Firstly, prerace fat mass and prerace skinfold thickness were associated with both volume and speed in running training. Secondly, during the ultramarathon, skinfold thickness decreased at the pectoral, suprailiac, and calf sites, but not at the thigh site. Percent decreases in skinfold thickness for ultrarunners was lower than the percent decreases in skinfold thickness reported for ultraswimmers and ultracyclists.Keywords: endurance, athlete, fat mass, muscle mass, adipose subcutaneous tissue

Romuald Lepers,1 Paul J Stapley,2 Beat Knechtle3,41INSERM U1093, University of Burgundy, Dijon, France; 2School of Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia; 3Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland; 4Gesundheitszentrum St Gallen, St Gallen, SwitzerlandBackground: The purpose of the study was (1) to examine the changes in participation and performance of males and females at the Oita International Wheelchair Marathon in Oita, Japan, between 1983 and 2011, and (2) to analyze the gender difference in the age of peak wheelchair marathon performance.Methods: Age and time performance data for all wheelchair athletes completing the Oita International Wheelchair Marathon from 1983 to 2011 were analyzed.Results: Mean annual number of finishers was 123 ± 43 for males and 6 ± 3 for females (5.0% ± 2.0% of all finishers), respectively. Mean age of overall finishers was significantly (P = 0.026) greater for males (41.3 ± 1.8 years) compared to females (32.7 ± 1.4 years). In contrast, there was no difference in the mean age of the top three overall finishers between males (35.8 ± 3.2 years) and females (31.6 ± 1.5 years). The race time of the top three overall finishers was significantly lower (P < 0.01) for males (1:34 ± 0:11 hours:minutes) compared to females (1:59 ± 0:20 hours:minutes), but it was not significantly different between male (2:06 ± 0:12 hours:minutes) and female (2:12 ± 0:18 hours:minutes) overall finishers. The mean gender difference in time was 26.1% ± 9.7% for the top three overall finishers.Conclusion: Further studies are required to investigate the reasons for the low participation of females in wheelchair marathons and why the gender difference in marathon performance is much greater for disabled athletes than for able-bodied athletes.Keywords: endurance, sex difference, disabled athlete, spinal cord injury

Gustavo Gonçalves Arliani,1 Diego Costa Astur,1 Eduardo Ramalho Moraes,1 Camila Cohen Kaleka,2 Wahi Jalikjian,3 Pau Golano,4,5 Moisés Cohen11Centro de Traumatologia do Esporte (CETE), Departamento de Ortopedia e Traumatologia da Universidade Federal de São Paulo SP, Brazil (DOT-UNIFESP/EPM); 2Departamento de Ortopedia e Traumatologia Faculdade de Ciências Médicas da Santa Casa de São Paulo SP, Brazil; 3Departamento de Ortopedia e Traumatologia da Faculdade de Medicina de São José do Rio Preto SP, Brazil; 4Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics, University of Barcelona, Spain; 5Department of Orthopedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USABackground: The anterior cruciate ligament (ACL) is an important structure in the knee. The ACL does not heal following lesions, and surgical reconstruction is the standard treatment among athletes. Some steps of ACL reconstruction remain controversial. It is important to fully understand the anatomy of the ACL to accurately reproduce its anatomy during surgical reconstructions. The purpose of this study was to evaluate the use of anaglyphic images that produce 3D images to better visualize the anatomy of the ACL, and to highlight the anatomical features of this ligament as reported in the literature.Methods: We included ten knees in this study. After dissection of the knee structures, pictures were acquired using a camera with Nikon D40, AF-S Nikkor 18–55 mm (1:3.5–5.6 G2 ED), and Micro Nikkor 105 mm (1:2.8) lenses. The pair of images was processed using Callipyan 3D Anabuilder software, which transforms the two images into one anaglyphic image.Results: During the dissection of the knees, nine pictures were acquired and transformed into anaglyphic images.Conclusion: This study, demonstrated that the use of 3D images is a useful tool that can improve the knowledge of the anatomy of the knee, while also facilitating knee reconstruction surgery.Keywords: anatomy education, photography methods, education, medical methods, eyeglasses, anaglyphic

Michael TC Liang,1 Lorena Quezada,1 WY Jamie Lau,1 Bulent Sokmen,2 Thomas W Spalding11Department of Kinesiology and Health Promotion, California State Polytechnic University, Pomona, CA, USA; 2Department of Kinesiology, Sonoma State University, Rohnert Park, CA, USAAbstract: To examine the effect of a 10-week upper-body resistance training program on bone turnover markers and site-specific bone mineral density (BMD) in the wrist and distal half of the ulna and radius in untrained and healthy young premenopausal women.Methods: Twenty-two subjects (aged 22.1 ± 1.8 years) were randomly assigned to a resistance training (n = 12) or no training control (n = 10) group. The following outcome variables were measured before and after 10 weeks of resistance training: (1) bone formation biomarker osteocalcin, and bone resorption biomarker tartrate-resistant acid phosphatase isoform 5b; (2) BMD in the wrist and distal half of the ulna and radius; (3) isokinetic strength of the elbow and knee extensors and flexors; (4) dynamic strength of the arm extensors and flexors; and (5) maximum number of push-ups.Results: The 10-week upper body resistance training intervention resulted in improved strength performance in push-ups (resistance training versus control: P < 0.05), chest presses (P < 0.05), and pulldowns (P < 0.05). However, there was no improvement in the BMD of the wrist (P > 0.05), BMD of the distal half of the ulna and radius (P > 0.05), and metabolic biomarkers osteocalcin (P > 0.05) and tartrate-resistant acid phosphatase isoform 5b (P > 0.05), except for the osteocalcin/tartrate-resistant acid phosphatase isoform 5b ratio. Also, no improvement in the resistance training group was observed for isokinetic strength of the knee and elbow flexion/extension.Conclusion: Upper-body muscular strength performance, but not bone metabolic markers and BMD of the wrist, can be improved with a 10-week upper body resistance training program of the nonweight-bearing limbs in untrained young premenopausal women.Keywords: osteocalcin, TRACP5b, wrist and heel mineral density, isokinetic strength, dynamic strength training

Alexander Drozdovski,1 Irina Gromova,2 Konstantin Korotkov,1 Oleg Shelkov,1 Femi Akinnagbe31Saint Petersburg Federal Research Institute of Physical Culture and Sport, St Petersburg, Russia; 2Paralympic Team of Russia, Moscow, Russia; 3Georgetown University, Washington, DC, USAObjective: Evaluation of elite athletes’ psycho-physiological condition at various stages of preparation and in international competition.Design: Athletes were tested during training and participation in international competition using methods of galvanic skin response (GSR) and gas discharge visualization (GDV).Setting: Saint Petersburg Federal Research Institute of Physical Culture and Sport, Russia and Paralympic athletic training camp, Norway.Participants: Eighteen athletes from Russia’s Skiing and Biathlon Paralympic Team. All athletes had some level of damage to their musculoskeletal system.Main outcome measures: Stress level (SL), energy potential (EP), and psycho-emotional tension (PET).Results: It was found that the higher the level of EP achieved by the athlete in the training period, the lower the SL in the competition time. The SL of an athlete recorded in the training period significantly correlates with the SL both before and at the time of competition. The PET and SL before the World Cup was negatively correlated to the results of skiing competitions.Conclusion: Evaluation of PET, EP, and SL through GSR and GDV offers a fast, highly precise, non-invasive method to assess an athlete’s level of readiness during both training and at the time of competition.Keywords: paralympic sport, express-analysis, galvanic skin response (GSR), gas discharge visualization (GDV)