BACKGROUND & AIMS: :Magnetic-activated cell sorting (MACS) using paramagnetic annexin V-conjugated microbeads eliminates spermatozoa with externalized phosphatidylserine, which is considered one of the features of apoptosis. The objective of this study was to evaluate sperm recovery following the use of MACS as a sperm preparation technique. Mature spermatozoa were separated and divided into two fractions: the first was prepared by density gradient centrifugation (DGC) and MACS, while the second was prepared by DGC only. Following MACS, the percentage of cells collected in the annexin-negative fraction was significantly higher than the annexin-positive fraction and the sperm recovery rate was 73.8 +/- 12.1%. In conclusion, the integration of MACS with DGC can be considered as an effective sperm preparation technique that does not lead to significant cell loss. Separating a distinctive population of non-apoptotic spermatozoa with intact membranes may optimize the outcome of assisted reproduction.

背景与目标： : 使用顺磁性膜联蛋白V偶联微珠的磁激活细胞分选 (MACS) 消除了具有外化磷脂酰丝氨酸的精子，这被认为是凋亡的特征之一。这项研究的目的是评估使用MACS作为精子制备技术后的精子恢复情况。将成熟的精子分离并分为两个部分: 第一个部分通过密度梯度离心 (DGC) 和MACS制备，而第二个部分仅通过DGC制备。在MACS之后，在膜联蛋白阴性部分中收集的细胞百分比显著高于膜联蛋白阳性部分，并且精子治愈率为73.8 +/- 12.1%。总之，MACS与DGC的整合可以被认为是一种有效的精子制备技术，不会导致细胞大量丢失。分离具有完整膜的独特的非凋亡精子群体可能会优化辅助生殖的结果。

BACKGROUND & AIMS: STUDY DESIGN:A cross-sectional study of the spine in 40 young adults after solid organ transplantation in childhood. OBJECTIVE:To evaluate the impact of organ transplantation and long-term immunosuppressive treatment on growing spine using magnetic resonance imaging (MRI). SUMMARY OF BACKGROUND DATA:A review of the current literature reveals no systematic evaluation of the spine after transplantation in childhood. METHODS:A total of 40 adult patients (mean age 22.1 years, range, 16.0-27.0), who received either kidney, liver, or heart transplant as children, were evaluated. Mean follow-up after transplantation was 11.2 years (range 3.0-18.0). All patients filled in a questionnaire, underwent an interview and physical examination, as well as had MRI of the spine. Standing spinal radiographs were taken from patients with a rib hump > or = 6 degrees. RESULTS:There were 8 (20%) patients who had a history of vertebral fracture. Eleven (28%) patients reported frequent back pain at rest. There were 15 (38%) patients who had scoliosis > 10 degrees (range 10 degrees -69 degrees ). On MRI, narrowed disc spaces were noted in 32 (80%) patients, and irregular endplates were noted in 24 (60%). There were 14 (35%) patients who had at least 1 compressed or wedged vertebra (> 20%). Patients treated for acute rejection had wedged vertebrae, speckled or black disc spaces, and irregular endplates more often than patients without rejections. Males had wedged vertebrae more often than females (P = 0.0067). CONCLUSIONS:Back pain, scoliosis, wedged vertebrae, and narrowed, degenerated disc spaces are common after solid organ transplantation in childhood.

背景与目标：

BACKGROUND & AIMS: Magnetic resonance has assumed a preeminent role in the imaging evaluation of the spine. Owing to its multiplanar capability and superior soft tissue contrast, magnetic resonance imaging is the procedure of choice for a host of spinal disorders including degenerative disc disease, tumor evaluation, trauma, and spinal deformities. It represents the most accurate means of distinguishing between recurrent disc herniation and epidural fibrosis, and it excels at the assessment of many postoperative abnormalities such as infection, adjacent segment disc degeneration, and arachnoiditis. Magnetic resonance imaging is also helpful in the evaluation of numerous diagnostic challenges that are less well resolved by other means. This includes the distinction between disc herniation and epidural hematoma, synovial cyst from nonspecific fibrous thickening of a facet capsule, and the evaluation of numerous other soft tissue abnormalities. Computed tomography, computed tomography myelography, and scintigraphy continue to be useful for numerous specific disorders and in those patients with metal hardware or contraindications to magnetic resonance scanning. Overall, however, magnetic resonance is the imaging procedure preferred for many spinal disorders. This article is the first installment of a 3-part series discussing the role of magnetic resonance imaging of spinal disorders. Section 1 will describe the varying imaging modalities available and their relative advantages and disadvantages. A consideration of magnetic resonance imaging techniques will follow, followed by a discussion of the imaging manifestations of early degenerative disc disease. Section 2 will be devoted to an in depth discussion of specific pathologic processes encountered in patients with degenerative disc disease. Section 3 will end the series with a consideration of postoperative imaging followed by a discussion of spinal deformities, trauma, and neoplasms.

背景与目标： 磁共振在脊柱的成像评估中发挥了重要作用。由于其多平面能力和出色的软组织对比度，磁共振成像是许多脊柱疾病 (包括退行性椎间盘疾病，肿瘤评估，创伤和脊柱畸形) 的首选方法。它代表了区分复发性椎间盘突出症和硬膜外纤维化的最准确方法，并且擅长评估许多术后异常，例如感染，相邻节段椎间盘退变和蛛网膜炎。磁共振成像也有助于评估许多诊断难题，而其他方法无法很好地解决这些难题。这包括椎间盘突出症和硬膜外血肿之间的区别，关节突囊的非特异性纤维增厚引起的滑膜囊肿，以及对许多其他软组织异常的评估。计算机断层扫描，计算机断层扫描脊髓造影和闪烁显像对于许多特定疾病以及那些具有金属硬件或磁共振扫描禁忌症的患者仍然有用。然而，总的来说，磁共振是许多脊柱疾病首选的成像程序。本文是由3部分组成的系列文章的第一部分，讨论了脊柱疾病的磁共振成像的作用。第1节将描述可用的各种成像方式及其相对的优缺点。随后将考虑磁共振成像技术，然后讨论早期退行性椎间盘疾病的成像表现。第2节将致力于深入讨论退行性椎间盘疾病患者遇到的特定病理过程。第3节将在系列结束时考虑术后影像学，然后讨论脊柱畸形，创伤和肿瘤。

BACKGROUND & AIMS: :Isolated cleft mitral valve (ICMV) is a rare entity not known to be related to pulmonary atresia with ventricular septal defect (PA-VSD). This report describes the use of cardiovascular magnetic resonance (CMR) imaging to diagnose ICMV in a patient with repaired PA-VSD who presented with incidental severe mitral regurgitation (MR) on follow-up echocardiography. An associated pulmonary varix secondary to the severe MR also was shown by CMR.

背景与目标： : 孤立的二尖瓣裂 (ICMV) 是一种罕见的实体，与肺动脉闭锁伴室间隔缺损 (pa-vsd) 无关。本报告描述了使用心血管磁共振 (CMR) 成像诊断经修复的PA-VSD患者的ICMV，该患者在后续超声心动图检查中出现了严重的二尖瓣反流 (MR)。CMR还显示了继发于严重MR的相关肺静脉曲张。

BACKGROUND & AIMS: :In a prospective magnetic resonance imaging and cognitive study of 38 demented patients and 15 control subjects, 11 of 27 patients with Alzheimer's disease and 8 of 11 patients with vascular dementia had significant periventricular hyperintensities. Memory and language testing in the early investigation of dementia is useful to distinguish patients with or without periventricular hyperintensities on magnetic resonance imaging. Patients without periventricular hyperintensities are worse on memory and conceptualization tests than patients with periventricular hyperintensities, who tend to be worse on comprehension and attention tests. These differences in cognitive pattern are present between patients with different pathogenesis who are otherwise matched for dementia severity. Language and some nonverbal cognitive deficits correlate with the extent of cortical and ventricular atrophy in Alzheimer's disease.

背景与目标： : 在对38名痴呆患者和15名对照受试者的前瞻性磁共振成像和认知研究中，27例阿尔茨海默氏病患者中的11例和11例血管性痴呆患者中的8例具有明显的脑室周围高信号。在痴呆症的早期研究中进行记忆和语言测试可用于在磁共振成像上区分有无脑室周围高信号的患者。没有脑室周围高强度的患者在记忆和概念化测试上比脑室周围高强度的患者更差，后者在理解和注意力测试上往往更差。这些认知模式的差异存在于具有不同发病机理的患者之间，这些患者在痴呆严重程度上是匹配的。语言和某些非语言认知缺陷与阿尔茨海默氏病的皮质和心室萎缩程度相关。

BACKGROUND & AIMS: :We investigated the effect of homogeneous and inhomogeneous static magnetic field (SMF) exposure on the thermal nociceptive threshold of snail in the hot plate test (43 °C). Both homogeneous (hSMF) and inhomogeneous (iSMF) SMF increased the thermo-nociceptive threshold: 40.2%, 29.2%, or 41.7% after an exposure of 20, 30, or 40 min hSMF by p < 0.001, p < 0.0001, or p < 0.001, and 32.7% or 46.2% after an exposure of 20 or 40 min iSMF by p < 0.05 or p < 0.0001. These results suggest that SMF has an antinociceptive effect in snail. On the other hand, naloxone as an atypical opioid antagonist in an amount of 1 μg/g was found to significantly decrease the thermo-nociceptive threshold (41.9% by p < 0.002), which could be antagonized by hSMF exposure implying that hSMF exerts its antinociceptive effect partly via opioid receptors.

背景与目标： : 我们在热板测试 (43 °C) 中研究了均匀和不均匀的静磁场 (SMF) 暴露对蜗牛的热伤害性阈值的影响。均质 (hSMF) 和不均质 (iSMF) SMF均增加了热伤害感受阈值: 暴露20、30或40分钟hSMF后40.2% 、29.2% 或41.7%，p <0.001，p <0.0001或p <0.001，和32.7% 或46.2% 暴露20或40分钟后的iSMF被p <0.05或p <0.0001。这些结果表明SMF对蜗牛具有抗伤害作用。另一方面，发现纳洛酮作为1 μ g/g量的非典型阿片类拮抗剂显着降低了热伤害性阈值 (41.9% p <0.002)，这可以通过hSMF暴露来拮抗，这意味着hSMF部分地通过阿片受体发挥其抗伤害感受作用。

BACKGROUND & AIMS: :The objective of this study was to prepare a 72 h-release formulation of silybin (72 h-SLB) using a combination of solid dispersion, gel matrix and porous silica nanoparticles (PSNs) and to investigate the in vitro/in vivo correlations (IVIVCs). The results of scanning electron microscopy and N(2) adsorption demonstrated that empty PSNs possessed a spherical shape, a highly porous structure, a large specific surface area (385.89 ± 1.12 m(2)/g) and a small pore size (2.74 nm on average). The in vitro dissolution profiles of both 72 h-SLB and silybin-loaded PSNs in different concentrations (0.01, 0.06 and 0.08M) of Na(2)CO(3) solutions revealed that 0.06 M Na(2)CO(3) solution was the optimal medium in which silybin could be released from 72 h-SLB with first-order release kinetics and from PSNs with Higuchi kinetics. Furthermore, the IVIVCs of 72 h-SLB and silybin-loaded PSNs in beagle dogs were also established. Using 0.06 M Na(2)CO(3) solution as the in vitro dissolution medium, a good linear relationship could be achieved for both 72 h-SLB and silybin-loaded PSNs. The findings support the fact that the 72 h-SLB (consisting of solid dispersion, regular gel matrix and PSNs) together with Na(2)CO(3) solution as an in vitro dissolution medium can be developed into a promising formulation for poorly soluble drugs, which enjoys a good IVIVC.

背景与目标： : 本研究的目的是使用固体分散体，凝胶基质和多孔二氧化硅纳米颗粒 (psn) 的组合制备水飞蓟宾 (72 h-SLB) 的72 h释放制剂，并研究体外/体内相关性 (IVIVCs)。扫描电子显微镜和N(2) 吸附结果表明，空psn具有球形，高度多孔结构，大的比表面积 (385.89 ± 1.12 m(2)/g) 和小的孔径 (平均2.74 nm)。72 h-SLB和水飞蓟宾负载的psn在不同浓度 (0.01，0.06和0.08M) 的Na(2)CO(3) 溶液表明，0.06 M Na(2)CO(3) 溶液是最佳介质，其中水飞蓟宾可以从72 h-SLB中释放，具有一级释放动力学和psn。具有Higuchi动力学。此外，还建立了beagle犬中72 h-SLB和水飞蓟宾psn的ivvc。使用0.06 M Na(2)CO(3) 溶液作为体外溶出介质，对于72 h-SLB和水飞蓟宾负载的psn都可以实现良好的线性关系。研究结果支持以下事实: 72 h-SLB (由固体分散体，规则凝胶基质和psn组成) 与Na(2)CO(3) 溶液一起作为体外溶出介质，可以开发为具有良好的IVIVC可溶性药物的有希望的制剂。

BACKGROUND & AIMS: :Prostatic magnetic resonance images of 22 male volunteers less than 30 years old and with no known genito-urinary tract disease were obtained at 1.5 T. Normal anatomical features of the prostate were studied with spin-echo techniques. Different zones of the normal gland are shown by T2-weighted images: the anterior fibromuscular fascia, the central prostate, the peripheral prostate and the periurethral zone can be differentiated. The normal prostate gland is shown on T1-weighted images as a homogeneous appearance. It is important to recognize the normal zonal anatomy of the prostate since prostatic disorders arise in different anatomical zones.

背景与目标： : 在1.5 T时获得了22名30岁以下且没有已知生殖泌尿道疾病的男性志愿者的前列腺磁共振图像。使用自旋回波技术研究了前列腺的正常解剖特征。T2-weighted图像显示了正常腺体的不同区域: 可以区分前纤维肌筋膜，中央前列腺，外周前列腺和尿道周围区域。正常前列腺在T1-weighted图像上显示为均匀外观。重要的是要认识到前列腺的正常区域解剖结构，因为前列腺疾病发生在不同的解剖区域。

BACKGROUND & AIMS: :We tried to evaluate the possible involvement of fetuin in the scavenger receptors (SRs)-mediated hepatic uptake of polystyrene nanospheres with the size of 50 nm (NS-50), which has surface negative charge (zeta potential=-21.8+/-2.3 mV). The liver perfusion studies in rats revealed that the hepatic uptake of NS-50 pre-coated with fetuin (NS-50-fetuin) was significantly inhibited by poly inosinic acid (poly I), a typical inhibitor of SRs, whereas that of plain NS-50 or NS-50 pre-coated with BSA (NS-50-BSA) was not. The uptake of NS-50-fetuin by cultured Kupffer cells was also significantly inhibited by poly I, and anti-class A scavenger receptors (SR-A) antibody, suggesting that fetuin on NS-50 mediated the recognition and internalization of NS-50 by Kupffer cells and at least SR-A would be responsible for the uptake. Taken that Western blot analysis confirmed that fetuin certainly adsorbed on the surface of NS-50 after the incubation of NS-50 with serum, the results obtained in the present study indicate that fetuin would be one of the serum proteins that were substantially involved in the hepatic uptake of NS-50 via SRs.

背景与目标： : 我们试图评估胎球蛋白可能参与清道夫受体 (SRs) 介导的聚苯乙烯纳米球的肝摄取，其尺寸为50 nm (NS-50)，具有表面负电荷 (ζ 电位 =-21.8/-2.3 mV)。大鼠的肝脏灌注研究表明，预包被胎球蛋白 (NS-50-fetuin) 的NS-50的肝脏摄取被典型的SRs抑制剂聚肌苷酸 (poly I) 显着抑制，而普通NS-50或预包被的NS-50的肝脏摄取BSA (NS-50-BSA) 没有。培养的库普弗细胞对NS-50-fetuin的摄取也被poly I和抗A类清道夫受体 (sr-a) 抗体显着抑制，这表明NS-50上的胎球蛋白介导了库普弗细胞对NS-50的识别和内化，至少sr-a将负责摄取。认为Western印迹分析证实胎球蛋白在将NS-50与血清孵育后肯定吸附在NS-50表面，本研究获得的结果表明，胎球蛋白将是基本上参与肝脏摄取的血清蛋白之一NS-50通过SRs。

BACKGROUND & AIMS: Using 31phosphorus magnetic resonance spectroscopy (31P-MRS) and surface coils, we noninvasively assessed the intracellular changes in delayed skin flaps of the high-energy phosphometabolites, ATP and phosphocreatine, which are basic energy sources of living cells. In 5 rats, a 3.5 x 7.5 cm bipedicled skin flap was elevated from the dorsum and its caudal base divided after a delay period of 2 weeks. MRS spectra were collected at four timesimmediately, 1 week and 2 weeks after elevation of the bipedicled flap, and 18 hours after division of its caudal base.

From the spectra, we calculated the intracellular pH and the following ratiosPi/PCr, PCr/(PCr + Pi), ATP/(PCr + Pi) (PCr, phosphocreatine; Pi, inorganic phosphate; ATP, adenosine triphosphate). As an undelayed control group, cranially based skin flaps of the same size were elevated in another 5 rats, and MRS spectra were obtained 18 hours later. The length of the surviving area was longer in the delayed flaps than in the undelayed flaps. Intracellular pH and ATP/(PCr + Pi) showed no significant alteration in the delayed skin flaps, not only during the delay period but also after conversion of the flaps into cranially based flaps by division of their caudal base. In contrast, PCr/(PCr + Pi) decreased with each surgical procedure (bipedicled flap elevation and base division). Compared with the necrotic distal portion of the undelayed flaps, the surviving distal portion of the delayed flaps had higher levels of intracellular pH and ATP/(PCr + Pi) and lower levels of PCr/(PCr + Pi). Intracellular pH and ATP/(PCr + Pi) showed a strong correlation with the viability of the delayed and undelayed skin flaps, and they can be prognostic indices for predicting the fate of skin flaps. The reason the surviving distal portions of the delayed flaps maintained their level of ATP despite the low intracellular level of PCr may be that the accumulation of mitochondrial creatine kinase enhances the so-called 'energy transport' function of the creatine kinase/phosphocreatine system.

背景与目标： 使用31磷磁共振波谱 (31P-MRS) 和表面线圈，我们无创地评估了高能磷酸代谢物，ATP和磷酸肌酸 (它们是活细胞的基本能量来源) 的延迟皮瓣的细胞内变化。在5只大鼠中，从背部抬高3.5 x 7.5厘米双蒂皮瓣，并在2周的延迟期后将其尾基分开。在双蒂皮瓣抬高后1周和2周以及尾基分裂后18小时立即收集4次MRS光谱。
从光谱中，我们计算了细胞内pH和以下比率Pi/PCr，PCr/(PCr Pi)，ATP/(PCr + Pi) (PCr，磷酸肌酸; Pi，无机磷酸盐; ATP，三磷酸腺苷)。作为不延迟的对照组，在另外5只大鼠中升高了相同大小的基于颅骨的皮瓣，并在18小时后获得了MRS光谱。延迟皮瓣中存活区域的长度比未延迟皮瓣中的更长。细胞内pH和ATP/(PCr Pi) 在延迟的皮瓣中没有显示出明显的变化，不仅在延迟期间，而且在通过将其尾基分割将皮瓣转化为基于颅骨的皮瓣之后。相反，每次手术 (双蒂皮瓣抬高和基底分裂) 时，PCr/(PCr Pi) 均降低。与未延迟皮瓣的坏死远端部分相比，存活的延迟皮瓣的远端部分具有较高的细胞内pH和ATP/(PCr Pi) 水平和较低的PCr/(PCr Pi) 水平。细胞内pH和ATP/(PCr Pi) 与延迟和未延迟皮瓣的生存能力有很强的相关性，它们可以作为预测皮瓣命运的预后指标。尽管细胞内PCr水平较低，但存活的延迟皮瓣远端部分仍保持其ATP水平的原因可能是线粒体肌酸激酶的积累增强了肌酸激酶/磷酸肌酸系统的所谓 “能量传输” 功能。

BACKGROUND & AIMS: OBJECTIVE:To evaluate the evidence for the efficacy of magnetic resonance imaging (MRI) in the diagnosis of disk position and configuration, disk perforation, joint effusion, and osseous and bone marrow changes in the temporomandibular joint. STUDY DESIGN:A PubMed literature search with specific indexing terms and a hand search were made. Two reviewers assessed the level of evidence of relevant publications as high, moderate, or low. Based on this, the evidence grade for diagnostic efficacy was rated as strong, moderately strong, limited, or insufficient. RESULTS:The literature search yielded 494 titles, of which 22 were relevant. No publication had a high level of evidence, and 12 had moderate and 10 low levels of evidence. The evidence grade for diagnostic efficacy expressed as sensitivity, specificity, and predictive values was insufficient. CONCLUSION:That evidence is insufficient emphasizes the need for high-quality studies on the diagnostic efficacy of MRI, incorporating accepted methodologic criteria.

背景与目标：

BACKGROUND & AIMS: :Diverse animals can orient using geomagnetic cues, but little is known about the neurophysiological mechanisms that underlie magnetic field detection. The marine mollusc Tritonia diomedea (Bergh) has a magnetic sense and its nervous system is amenable to cellular-level electrophysiological analysis. In a semi-intact whole-animal preparation, intracellular recordings from the large, visually identifiable neurons left pedal 5 (LPe5) and right pedal 5 (RPe5) in the brain of Tritonia revealed enhanced electrical activity in response to changes in ambient earth-strength magnetic fields. No such changes in activity were observed in approximately 50 other neurons subjected to identical magnetic stimuli. The responses of LPe5 were characterized by increases in spiking frequency occurring about 6-16 min after the ambient magnetic field had been rotated to a new position. The response was abolished when the brain had been isolated from the periphery of the animal by severing nerves, a procedure that also transected prominent neurites of LPe5. We hypothesize that LPe5 is one component of a neural circuit mediating detection of the earth's magnetic field or orientation to it.

背景与目标： : 各种动物可以使用地磁提示进行定向，但对磁场检测的神经生理机制知之甚少。海洋软体动物三倍体 (Bergh) 具有磁性，其神经系统易于进行细胞水平的电生理分析。在半完整的全动物制剂中，来自Tritonia大脑中视觉上可识别的大型神经元左踏板5 (LPe5) 和右踏板5 (RPe5) 的细胞内记录显示，响应周围地球强度磁场的变化，电活动增强。在大约50个其他受到相同磁刺激的神经元中未观察到这种活动变化。LPe5的响应的特征是在环境磁场旋转到新位置后约6-16分钟发生的尖峰频率增加。当通过切断神经将大脑与动物的外围隔离时，这种反应被消除了，这一过程也横切了lpe5的突出神经突。我们假设LPe5是介导检测地球磁场或对其定向的神经电路的一个组成部分。

BACKGROUND & AIMS: OBJECTIVE:To investigate cortical representation of articulation of the bilabial plosive in patients with cleft lip and palate. DESIGN:We examined cortical representation for /pa/-articulation in cleft lip and palate patients using blood oxygenation level-dependent functional magnetic resonance imaging. SUBJECTS:Data from four postsurgical adult cleft lip and palate patients were compared with those from six healthy volunteers. RESULTS:Activation foci were found in the bilateral primary sensorimotor cortex in all cleft lip and palate patients, as in the controls. The sensorimotor cortex ipsilateral to the side of cleft lip and palate showed greater activation in unilateral cleft lip and palate patients, whereas the sensorimotor cortex contralateral to the side on which cheiloplasty had been performed earlier showed greater activation in a bilateral cleft lip and palate patient. CONCLUSIONS:The results suggest that there may be an ipsilateral dominance in cortical representation during bilabial articulation to the side of the cleft in the upper lip.

背景与目标：

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: BACKGROUND:Hamstring strains can be of 2 types with different injury mechanisms, 1 occurring during high-speed running and the other during stretching exercises. HYPOTHESIS:A stretching type of injury to the proximal rear thigh may involve specific muscle-tendon structures that could affect recovery time. STUDY DESIGN:Case series (prognosis); Level of evidence, 2. METHODS:Fifteen professional dancers with acute first-time hamstring strains were prospectively included in the study. All subjects were examined, clinically and with magnetic resonance imaging, on 4 occasions after injury: at day 2 to 4, 10, 21, and 42. The clinical follow-up period was 2 years. RESULTS:All dancers were injured during slow hip-flexion movements with extended knee and experienced relatively mild acute symptoms. All injuries were located proximally in the posterior thigh close to the ischial tuberosity. The injury involved the semimembranosus (87%), quadratus femoris (87%), and adductor magnus (33%). All injuries to the semimembranosus involved its proximal free tendon. There were no significant correlations between clinical or magnetic resonance imaging parameters and the time to return to preinjury level (median, 50 weeks; range, 30-76 weeks). CONCLUSION:Stretching exercises can give rise to a specific type of strain injury to the posterior thigh. A precise history and careful palpation provide the clinician enough information to predict a prolonged time until return to preinjury level. One factor underlying prolonged recovery time could be the involvement of the free tendon of the semimembranosus muscle.

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