51
|
Ma W, Pan CY, Diehl LH, Wittstein JR, Riboh JC, Toth AP, Amendola A, Faherty MS, Killelea C, Le DT, Sell TC. Altered lower extremity biomechanics following anterior cruciate ligament reconstruction during single-leg and double-leg stop-jump tasks: A bilateral total support moment analysis. Clin Biomech (Bristol, Avon) 2022; 91:105533. [PMID: 34847471 DOI: 10.1016/j.clinbiomech.2021.105533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Injury to the anterior cruciate ligament (ACL) can lead to long-lasting biomechanical alterations that put individuals at risk of a second ACL injury. Examining the total support moment may reveal between- and within-limb compensatory strategies. METHODS Twenty-six participants who were cleared to return to sport following ACL reconstruction were recruited. Each participant completed the single-leg and double-leg stop jump tasks. These tasks were analyzed using force plates and a 3D motion analysis system. The total support moment was calculated by summing the internal moments of the hip, knee and ankle at peak vertical ground reaction force. FINDINGS Internal knee extensor moment was lower in the involved limb compared to the uninvolved for both tasks (17.6%, P = 0.022; 18.4%, P = 0.008). No significant between-limb differences were found for the total support moment. The involved limb exhibited an 18.2% decrease in knee joint contribution (P = 0.01) and a 21.6% increase in ankle joint contribution (P = 0.016) to the total support moment compared to the uninvolved limb in the single-leg stop jump task. INTERPRETATION Compensation for the involved knee is likely due to altered biomechanics that redistributes load to the uninvolved knee or to adjacent joints of the same limb. A partial shift in joint contribution from the knee to the ankle during the single-leg stop jump task demonstrates a tendency to decrease load to the knee. Further studies are needed to investigate how these adaptations impact the prevalence of subsequent injury and poor joint health.
Collapse
Affiliation(s)
- Willa Ma
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar Street, Los Angeles, CA 90089, United States; Michael W. Kryzyzewski Human Performance Laboratory, Department of Orthopaedic Surgery, Duke University, 3475 Erwin Road, Durham, NC 27705, United States.
| | - Cindy Y Pan
- Michael W. Kryzyzewski Human Performance Laboratory, Department of Orthopaedic Surgery, Duke University, 3475 Erwin Road, Durham, NC 27705, United States
| | - Lee H Diehl
- Department of Orthopaedic Surgery, Duke University, 3475 Erwin Road, Durham, NC 27705, United States
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University, 3475 Erwin Road, Durham, NC 27705, United States
| | - Jonathan C Riboh
- Department of Orthopaedic Surgery, Duke University, 3475 Erwin Road, Durham, NC 27705, United States
| | - Alison P Toth
- Department of Orthopaedic Surgery, Duke University, 3475 Erwin Road, Durham, NC 27705, United States
| | - Annunziato Amendola
- Department of Orthopaedic Surgery, Duke University, 3475 Erwin Road, Durham, NC 27705, United States
| | - Mallory S Faherty
- Michael W. Kryzyzewski Human Performance Laboratory, Department of Orthopaedic Surgery, Duke University, 3475 Erwin Road, Durham, NC 27705, United States
| | - Carolyn Killelea
- Department of Orthopaedic Surgery, Duke University, 3475 Erwin Road, Durham, NC 27705, United States
| | - Daniel T Le
- Michael W. Kryzyzewski Human Performance Laboratory, Department of Orthopaedic Surgery, Duke University, 3475 Erwin Road, Durham, NC 27705, United States
| | - Timothy C Sell
- Atrium Health Musculoskeletal Institute, 2001 Vail Ave, Charlotte, NC 28207, United States
| |
Collapse
|
52
|
Carter H, Lewis G, Smith BE. Preoperative predictors for a successful return to sport following anterior cruciate ligament reconstruction (ACLR): a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e048295. [PMID: 34949606 PMCID: PMC8712982 DOI: 10.1136/bmjopen-2020-048295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR) is the primary goal for most patients. However, the decision of when to RTS is difficult for patients and clinicians as it is based on limited available evidence. Over the past decade, a number of predictor variables have been associated with RTS after ACLR. We present a Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols compliant protocol for a systematic review and meta-analysis of preoperative predictors for RTS/preinjury levels of physical activity following ACLR. METHODS AND ANALYSIS A literature search will be performed in six electronic databases (CINAHL, AMED, MEDLINE, SPORTDiscus and PsycINFO via EBSCOhost and Web of Science) from inception to December 2020. Prospective, retrospective and cross-sectional study designs will be included. To be included, studies will need to identify at least one preoperative predictor and identify the relationship between the predictor(s) and RTS/preinjury levels of physical activity following ACLR. Blinded assessment with consensus agreement will be applied for inclusion of studies, data extraction, risk of bias assessment using the Quality in Prognostic Studies tool and the Grading of Recommendations Assessment, Development and Evaluation framework. If data allows and studies are considered homogeneous, data will be pooled through a meta-analysis. If heterogenous, a narrative synthesis will be completed. Subgroup and sensitivity analyses will be completed, where appropriate. ETHICS AND DISSEMINATION Ethical permission is not required for this study. The results will be published in a peer-reviewed journal and presented at national and international conferences. PROSPERO REGISTRATION NUMBER CRD42020222567.
Collapse
Affiliation(s)
- Hayley Carter
- Department of Physiotherapy, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Gwyn Lewis
- Department of Physiotherapy, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Benjamin Edward Smith
- Department of Physiotherapy, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, Nottinghamshire, UK
| |
Collapse
|
53
|
Redler LH, Sugimoto D, Bassett AJ, Kocher MS, Micheli LJ, Heyworth BE. Effect of Concomitant Meniscal Tear on Strength and Functional Performance in Young Athletes 6 Months After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft. Orthop J Sports Med 2021; 9:23259671211046608. [PMID: 34778471 PMCID: PMC8573495 DOI: 10.1177/23259671211046608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The effect of concomitant meniscal tears, and their associated treatment, on strength and functional recovery after anterior cruciate ligament reconstruction (ACLR) has not been adequately investigated in young populations. Hypothesis: Concomitant meniscal tears, treated with or without repair, would not adversely affect strength, balance, or functional hop test performance at 6 months postoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively analyzed return-to-sports (RTS) assessments prospectively collected 6 months after ACLR with hamstring autograft in 165 patients ≤25 years of age. Descriptive, surgical, and RTS testing data were analyzed, and subgroups were compared using analysis of covariance models designed to assess the effects of sex, meniscal tear, and meniscal repair on RTS performance. Results: Included were 115 female (70%) and 50 male (30%) patients with a mean age of 16.4 years (range, 12.3-25 years). Of these patients, 58% had concomitant meniscal tears (59% lateral, 27% medial, 14% lateral + medial), comprising 53% of the female and 70% of the male patients. The authors treated 61% of the tears with repair, with range of motion (ROM) and weightbearing limitations imposed within the first 6 weeks postoperatively, whereas 39% were treated with partial meniscectomy, rasping, or trephination (no ROM or weightbearing restrictions). The mean deficit in hamstring strength at 6 months postoperatively was significantly greater in the meniscal tear group than in those without a tear (32.3% vs 24.6%; P = .028). The meniscal repair group had greater hamstring strength deficits than the group with meniscectomy, rasping or trephination (34.3% vs 26.2%; P = .023). Performance on dynamic balance and functional hop tests was similar among all meniscus subgroups. There were no sex-based effects on any subgroup comparisons. Conclusion: At 6 months postoperatively, both young male and young female patients who underwent ACLR with hamstring autograft demonstrated significant hamstring strength deficits compared with their nonoperative leg. The presence of a meniscal tear and subsequent repair, or its related rehabilitation restrictions, appears to have adverse effects on the postoperative recovery of hamstring strength.
Collapse
Affiliation(s)
- Lauren H Redler
- Columbia University Medical Center, Sports Medicine & Shoulder Service, New York, New York, USA
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Faculty of Sports Sciences, Waseda University, Tokyo, Japan
| | - Ashley J Bassett
- The Orthopedic Institute of New Jersey, Morristown, New Jersey, USA
| | - Mininder S Kocher
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Benton E Heyworth
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
54
|
Byrne L, King E, Mc Fadden C, Jackson M, Moran R, Daniels K. The effect of meniscal pathology and management with ACL reconstruction on patient-reported outcomes, strength, and jump performance ten months post-surgery. Knee 2021; 32:72-79. [PMID: 34425491 DOI: 10.1016/j.knee.2021.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/21/2021] [Accepted: 07/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to examine the differences in patient-reported outcome measures, isokinetic strength, plyometric ability and ability to meet return to play criteria ten months after anterior cruciate ligament (ACL) reconstruction surgery between those who underwent meniscectomy, those who underwent meniscal repair and those with no meniscal intervention alongside ACL reconstruction surgery. METHODS Three hundred and thirteen athletes with clinically and radiologically confirmed ACL ruptures were included in this study. Participants were grouped according to their intra-operative procedures (isolated ACL reconstruction surgery n = 155, ACL reconstruction surgery with meniscectomy n = 128, ACL reconstruction surgery with meniscal repair n = 30). Participants completed patient-reported outcome measures questionnaires (Marx Activity Rating Scale, the ACL Return to Sport after Injury and the International Knee Documentation Committee Score) and completed a battery of objective functional testing including isokinetic dynamometry and jump performance testing (countermovement jump and drop jump) between 9 and 11 months after surgery. RESULTS No significant between-group differences were identified in any metric relating to patient-reported outcome measures (p = .611), strength and jump measures (p = .411) or the ability to achieve symmetry-based return to play criteria (p = .575). CONCLUSIONS Clinically, these results suggest that concomitant meniscal surgery has no significant effects on patient-reported outcome measures, strength and jump metrics at the return to play stage post-operatively and can inform the pre-operative counselling of those awaiting ACL reconstruction surgery with likely meniscal intervention.
Collapse
Affiliation(s)
- Laura Byrne
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland.
| | - Enda King
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland; Department of Life Sciences, University of Roehampton, London, UK
| | - Ciaran Mc Fadden
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland; Department of Life Sciences, University of Roehampton, London, UK
| | - Mark Jackson
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland
| | - Ray Moran
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland
| | - Katherine Daniels
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland; Queen's School of Engineering, University of Bristol, Bristol, UK; Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
55
|
Johnston PT, McClelland JA, Feller JA, Webster KE. Knee muscle strength after quadriceps tendon autograft anterior cruciate ligament reconstruction: systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2918-2933. [PMID: 33026536 DOI: 10.1007/s00167-020-06311-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Restoration of knee muscle strength is associated with better outcomes following anterior cruciate ligament (ACL) reconstruction, but little is known about the outcome of strength following quadriceps tendon autograft (QT) ACL reconstruction in relation to other graft types. The aim of this review was to evaluate strength outcomes of the knee extensors and knee flexors following QT ACL reconstruction compared to (1) the non-reconstructed contralateral limb and (2) alternative ACL graft types. METHODS Four electronic databases were searched up until 21st February 2020. Summary meta-analyses were performed comparing knee strength outcomes following QT ACL reconstruction to the contralateral limb by way of limb symmetry index (LSI). Comparative meta-analyses were performed comparing QT ACL reconstruction to alternative ACL grafts for the two most frequently reported strength outcome measures which were peak knee extensor torque LSI, and peak knee flexor torque LSI at the following post-operative periods: 3, 5-8, 9-15, 24, 36-60 months. RESULTS In total, 18 studies met the inclusion criteria. Knee strength outcomes of 952 QT ACL reconstructions were included and compared to either the contralateral limb or 1 of 4 alternative ACL graft types; 245 hamstring tendon autograft (HT), 143 patellar tendon autograft (PT), 45 quadriceps tendon allograft, and 21 tibialis anterior allograft. Knee extensor strength LSI following QT ACL reconstruction did not reach 90% even at 24 months post-operatively. Conversely, knee flexor strength LSI following QT ACL reconstruction exceeded 90% at the 9-15 months post-operative period. Knee extensor strength at 5-8 months following QT ACL reconstruction appears similar to PT but weaker than HT ACL reconstruction. In addition, peak knee flexor LSI was significantly greater at 5-8 months in QT ACL reconstruction patients compared to HT patients. CONCLUSION The decision to utilize a QT graft for ACL reconstruction should include consideration of strength outcomes. Knee extensor strength recovery following QT ACL reconstruction appears not to be restored before 24 months. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Peta T Johnston
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Jodie A McClelland
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Julian A Feller
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia.,OrthoSport Victoria Research Unit, Melbourne, Australia
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia
| |
Collapse
|
56
|
Hunnicutt JL, Xerogeanes JW, Tsai LC, Sprague PA, Newsome M, Slone HS, Lyle MA. Terminal knee extension deficit and female sex predict poorer quadriceps strength following ACL reconstruction using all-soft tissue quadriceps tendon autografts. Knee Surg Sports Traumatol Arthrosc 2021; 29:3085-3095. [PMID: 33175281 DOI: 10.1007/s00167-020-06351-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The all-soft tissue quadriceps tendon (QT) autograft is becoming increasingly popular for ACL reconstruction (ACLR); however, studies reporting strength recovery and early outcomes after QT autograft are limited with patient samples composed of predominantly males. The primary purpose was to characterize early, sex-specific recovery of strength, range of motion (ROM), and knee laxity in a large cohort of patients undergoing primary ACLR with standardized harvest technique of the all-soft tissue QT autograft. The secondary purpose was to examine the influence of demographic factors and clinical measures on 6-month quadriceps strength. METHODS Patients 14-25 years who underwent primary, unilateral ACLR with all-soft tissue QT autografts were prospectively followed. Knee laxity and ROM were collected at 6 weeks, 3 and 6 months; while, quadriceps normalized torques and limb symmetry indices (LSI) were collected at 3 and 6 months using isokinetic dynamometry at 60°/s. Two-way ANOVAs with repeated measures were conducted to determine recovery over time and between sexes. Stepwise linear multiple regressions were conducted to determine predictors of 6-month quadriceps strength. RESULTS Three-hundred and twenty patients were included (18 ± 3 years; 156 males:164 females; BMI = 24 ± 4 kg/m2) with no early graft failures within the study period. For strength, there were significant main effects of time (p < 0.001) and sex (p < 0.001), indicating similar improvement from 3 to 6 months with males demonstrating greater quadriceps LSI (6 months: 72.1 vs 63.3%) and normalized strength (6 months: 2.0 vs 1.6 Nm/kg). A significantly higher proportion of females had knee extension ROM deficits ≥ 5° compared to males at 6 weeks (61 vs 39%; p = 0.002). Female sex and 3-month extension ROM deficits were identified as significant predictors of 6-month quadriceps LSI (R2 = 0.083; p < 0.001). Female sex, BMI, and 6-week extension ROM deficits were identified as significant predictors of 6-month normalized quadriceps strength (R2 = 0.190; p < 0.001). CONCLUSIONS Females had decreased quadriceps strength and greater extension ROM deficits at 3 and 6 months following ACLR using all-soft tissue QT autografts. Female sex, higher BMI, and loss of extension ROM were independent predictors of poorer quadriceps strength at 6 months. There were no early graft failures, and laxity remained within normal ranges for both males and females. Surgeons and rehabilitation clinicians should be aware of the increased risk of postoperative loss of extension ROM in females and its implications on quadriceps strength recovery. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Jennifer L Hunnicutt
- Department of Orthopaedics, School of Medicine, Emory University, 1968 Hawks Lane, Atlanta, GA, 30329, USA.
| | - John W Xerogeanes
- Department of Orthopaedics, School of Medicine, Emory University, 1968 Hawks Lane, Atlanta, GA, 30329, USA.,Emory Orthopaedics and Spine Center, Emory Healthcare, Atlanta, USA
| | - Liang-Ching Tsai
- Department of Physical Therapy, College of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Peter A Sprague
- Division of Physical Therapy, School of Medicine, Emory University, Atlanta, USA
| | - Michael Newsome
- Emory Orthopaedics and Spine Center, Emory Healthcare, Atlanta, USA
| | - Harris S Slone
- Department of Orthopaedics, College of Medicine, Medical University of South Carolina, Charleston, USA
| | - Mark A Lyle
- Division of Physical Therapy, School of Medicine, Emory University, Atlanta, USA
| |
Collapse
|
57
|
Ishida T, Samukawa M, Suzuki M, Matsumoto H, Ito Y, Sakashita M, Aoki Y, Yamanaka M, Tohyama H. Improvements in asymmetry in knee flexion motion during landing are associated with the postoperative period and quadriceps strength after anterior cruciate ligament reconstruction. Res Sports Med 2021; 31:285-295. [PMID: 34406086 DOI: 10.1080/15438627.2021.1966010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study investigated the relationship between quadriceps strength and knee kinematics during a drop vertical jump (DVJ) at 6, 9 and 12 months after anterior cruciate ligament reconstruction (ACLR) in 9 male and 22 female athletes (16.6 ± 2.1 years old). Isokinetic quadriceps strength was measured by a dynamometer (Biodex System 3). Knee flexion excursion was assessed using two-dimensional analysis. Knee flexion excursion at 6 months was significantly smaller in the involved limb than in the uninvolved limb independent of quadriceps strength (56.7° ± 9.3°, 63.4° ± 11.4°, P < 0.001). At 9 months, only the low quadriceps strength group demonstrated a similar interlimb difference (57.2°± 12.3°, 63.3° ± 10.5°, P < 0.001). At 12 months, there was no significant interlimb difference in knee flexion excursion regardless of quadriceps strength. These findings indicate that restoration in symmetrical knee flexion excursion during a DVJ requires rehabilitation as well as quadriceps strength.
Collapse
Affiliation(s)
- Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.,Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Makoto Suzuki
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Hisashi Matsumoto
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Yu Ito
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Miku Sakashita
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Yoshimitsu Aoki
- Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Masanori Yamanaka
- Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | | |
Collapse
|
58
|
Sole G, Lamb P, Pataky T, Klima S, Navarre P, Hammer N. Immediate and 6-week effects of wearing a knee sleeve following anterior cruciate ligament reconstruction: a cross-over laboratory and randomised clinical trial. BMC Musculoskelet Disord 2021; 22:655. [PMID: 34348704 PMCID: PMC8336666 DOI: 10.1186/s12891-021-04540-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/22/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Rehabilitation following anterior cruciate ligament (ACL) reconstructions is based mainly on comprehensive progressive exercise programmes using a multi-dimensional approach. Elastic knee sleeves may be useful adjuncts to rehabilitation. The aim of this study was to determine the immediate and 6-week effects of wearing a knee sleeve on person-reported outcomes and function in participants who had undergone an ACL reconstruction and who had residual self-reported functional limitations. METHODS Individuals with ACL reconstruction in the previous 6 months to 5 years were recruited. Immediate effects of a commercially-available elastic knee sleeve on single-leg horizontal hop distance were explored using a cross-over design. Following this first session, participants were randomised into a Control Group and a Sleeve Group who wore the sleeve for 6 weeks, at least 1 h daily. Outcome measures for the randomised clinical trial (RCT) were the International Knee Documentation Classification Subjective Knee Form (IKDC-SKF) score, the single-leg horizontal hop distance, and isokinetic quadriceps and hamstring peak torque. Linear mixed models were used to determine random effects. Where both limbs were measured at multiple time points, a random measurement occasion effect nested within participant was used. RESULTS Thirty-four individuals (16 women) with ACL reconstruction completed the cross-over trial. Hop distance for the injured side during the sleeve condition increased by 3.6 % (95 % CI 0.4-6.8 %, p = 0.025). There was no evidence of differential changes between groups for the IKDC-SKF (Sleeve Group n = 15; Control Group n = 16; p = 0.327), or relative improvement in the injured side compared to the uninjured side for the physical performance measures (Sleeve Group n = 12, Control Group n = 12; three-way interaction p = 0.533 [hop distance], 0.381 [quadriceps isokinetic peak torque], and 0.592 [hamstring isokinetic peak torque]). CONCLUSIONS Single-leg hop distance of the ACL reconstructed side improved when wearing a knee sleeve. Wearing the knee sleeve over 6 weeks did not lead to enhanced improvements in self-reported knee function, hop distance and thigh muscle strength compared to the control group. TRIAL REGISTRATION The trial was prospectively registered with the Australia New Zealand Clinical Trials Registry No: ACTRN12618001083280 , 28 June 2018.
Collapse
Affiliation(s)
- Gisela Sole
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Peter Lamb
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Todd Pataky
- Graduate School of Medicine, Department of Human Health Sciences, Kyoto University, Kyoto, Japan
| | | | - Pierre Navarre
- Orthopaedic Surgeon, Southland Hospital, Invercargill, New Zealand
- University of Otago, Dunedin, New Zealand
| | - Niels Hammer
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
- Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
- Fraunhofer IWU, Dresden, Germany
| |
Collapse
|
59
|
Ogborn D. Optimizing Exercise Selection for the Asymmetric Athlete After Anterior Cruciate Ligament Reconstruction. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
60
|
Determination of the Strongest Factor and Component in a Relationship between Lower-Extremity Assessment Protocol and Patient-Oriented Outcomes in Individuals with Anterior Cruciate Ligament Reconstruction: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158053. [PMID: 34360344 PMCID: PMC8345576 DOI: 10.3390/ijerph18158053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
Although the Lower-Extremity Assessment Protocol (LEAP) assesses multidimensional aspects of a patient with anterior cruciate ligament (ACL) injury, there is a need to reduce the dimensionality of LEAP items to effectively assess patients. Therefore, the present study aimed to establish the validity of LEAP and to determine associated factors and components in a relationship between LEAP and the International Knee Documentation Committee (IKDC) questionnaire. Fifteen patients who had ACL reconstruction more than 1 year and less than 5 years earlier were recruited. Patients performed LEAP, including muscular strength, fatigue index, static balance, drop landing, and functional hopping assessment. They also completed the IKDC questionnaire and the Tegner Activity Score. Factor analysis and stepwise regression analysis were performed. The 14 components of LEAP were categorized into four factors (functional task, muscle strength, neuromuscular control, and fatigue), which accounted for 83.8% of the cumulative variance by factor analysis. In the stepwise regression analysis, the functional task (R2 = 0.43, p = 0.008) in factors and single-leg hop (R2 = 0.49, p = 0.004) in components were associated with patient-oriented outcomes, respectively. In conclusion, the functional task and single-leg hop may be used for providing valuable information about knee joints to patients and clinicians.
Collapse
|
61
|
Schmücker M, Haraszuk J, Hölmich P, Barfod KW. Graft Failure, Revision ACLR, and Reoperation Rates After ACLR With Quadriceps Tendon Versus Hamstring Tendon Autografts: A Registry Study With Review of 475 Patients. Am J Sports Med 2021; 49:2136-2143. [PMID: 34102074 DOI: 10.1177/03635465211015172] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been indicated that anterior cruciate ligament reconstruction (ACLR) with a quadriceps tendon (QT) graft has a higher risk of revision compared with ACLR performed with a hamstring tendon (HT) graft. PURPOSE/HYPOTHESIS To investigate whether ACLR with QT graft had a higher risk of graft failure, revision ACLR, or reoperation compared with HT graft in a high-volume center. We hypothesized that there would be no between-group differences. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This was a registry study with review of medical records. Our study cohort consisted of patients who underwent primary ACLR with either QT or HT graft performed at Copenhagen University Hospital Hvidovre between January 2015 and December 2018. The cohort was identified from the Danish Knee Ligament Reconstruction Registry and linked to the Danish National Patient Registry to identify all hospital contacts after ACLR. The outcome variables were graft failure (rerupture or >3-mm side-to-side difference in anteroposterior [AP] laxity), revision ACLR, reoperation due to cyclops lesion, reoperation due to meniscal injury, and reoperation due to any reason. AP laxity and pivot shift were assessed at 1 year. Kaplan-Meier estimates were used to evaluate the rates of events at 2 years, and comparison was performed with Cox regression analysis. RESULTS A total of 475 patients (252 HT, 223 QT) were included. The rate of graft failure at 2 years was 9.4% for the QT group and 11.1% for the HT group (P = .46). For the QT and HT groups, respectively, the rate of revision ACLR was 2.3% and 1.6% (P = .60), the rate of reoperation due to cyclops lesion was 5.0% and 2.4% (P = .13), and the rate of reoperation due to meniscal injury was 4.3% and 7.1% (P = .16). The rate of reoperation due to any reason was 20.5% and 23.6% (P = .37). At 1-year follow-up, AP laxity was 1.4 mm for QT and 1.5 mm for HT (P = .51), and the proportion of patients with a positive pivot shift was 29-30% for both groups. CONCLUSION QT and HT grafts yielded similar rates of graft failure, revision ACLR, and reoperation at 2 years of follow-up after ACLR. Graft failure was found in 9% to 11% of patients. Patients with QT ACLR showed a non-statistically significant trend of higher risk for reoperation due to cyclops lesion, and those with HT showed a non-statistically significant trend of higher risk for reoperation due to meniscal injury.
Collapse
Affiliation(s)
- Malte Schmücker
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Denmark
| | - Jørgen Haraszuk
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Denmark
| | - Kristoffer W Barfod
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Denmark
| |
Collapse
|
62
|
Alt T, Breitenmoser T, Vonhoegen J, Horn D, Severin J, Nolte K, Knicker AJ, Jaitner T, Strüder HK. The dynamic control ratio masks bilateral asymmetries - A gender-specific analysis of 264 healthy and ACL-injured athletes. Res Sports Med 2021; 30:1-18. [PMID: 34187258 DOI: 10.1080/15438627.2021.1943389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Isokinetic strength tests are frequently applied to assess anterior cruciate ligament (ACL) rehabilitation processes. However, diverging methodologies cause misleading conclusions. This cross-sectional study evaluated the effects of gender (male vs. female), group (healthy vs. ACL-injured) and limb (dominant/healthy vs. non-dominant/ACL-injured) on thigh muscle balance of 138 female and 126 male athletes (50% ACL-injured, averagely 12.8 months after surgery). Balance was analysed between legs (bilateral asymmetry) and between concentric knee extensor (Qcon) and eccentric knee flexor strength (Hecc) (DCR = dynamic control ratio, DCRe = DCR at the equilibrium point). Females were generally 17-27% weaker than males. Independent of gender and time after surgery, ACL-injured athletes demonstrated bilateral asymmetries (7-20%) in peak (PMQcon, PMHecc) and DCRe moments (p ≤0.030; 0.018≤ηp2≤0.215). ACL-injured athletes' affected (24-28%) and unaffected (12-24%) hamstrings and quadriceps peak moments were significantly weaker compared to healthy athletes (p<0.001; 0.061≤ηp2≤0.362). The bilateral asymmetries of PMQcon significantly decreased from early to late self-reported rehabilitation phases (p<0.001; ηp2=0.158). Peak and DCRe moments detected bilateral asymmetries, whereas DCR revealed ~50% false negative attributions. This knowledge provides guidance for future design and interpretation of isokinetic tests.
Collapse
Affiliation(s)
- Tobias Alt
- Department of Biomechanics, Performance Analysis and Strength & Conditioning, Olympic Training and Testing Centre Westphalia, Dortmund, Germany.,Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Thomas Breitenmoser
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Jan Vonhoegen
- Department of Orthopaedics and Sports Traumatology, Klinik am Ring, Cologne, Germany
| | - Dennis Horn
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Jannik Severin
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
| | - Kevin Nolte
- Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Axel J Knicker
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany.,Department of Arthromuscular Performance Diagnostics, Research Centre for Elite Sports momentum, Cologne
| | - Thomas Jaitner
- Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Heiko K Strüder
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany.,Department of Arthromuscular Performance Diagnostics, Research Centre for Elite Sports momentum, Cologne
| |
Collapse
|
63
|
Le CY, Toomey CM, Emery CA, Whittaker JL. What Does the Future Hold? Health-Related Quality of Life 3-12 Years Following a Youth Sport-Related Knee Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136877. [PMID: 34206869 PMCID: PMC8295930 DOI: 10.3390/ijerph18136877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022]
Abstract
Knee trauma can lead to poor health-related quality of life (HRQoL) and osteoarthritis. We aimed to assess HRQoL 3–12 years following youth sport-related knee injury considering HRQoL and osteoarthritis determinants. Generic (EQ-5D-5L index, EQ-VAS) and condition-specific (Knee injury and Osteoarthritis Outcome Score quality of life subscale, KOOS QOL) HRQoL were assessed in 124 individuals 3–12 years following youth sport-related knee injury and 129 uninjured controls of similar age, sex, and sport. Linear regression examined differences in HRQoL outcomes by injury group. Multivariable linear regression explored the influence of sex, time-since-injury, injury type, body mass index, knee muscle strength, Intermittent and Constant Osteoarthritis Pain (ICOAP) score, and Godin Leisure-Time Exercise Questionnaire (GLTEQ) moderate-to-strenuous physical activity. Participant median (range) age was 23 years (14–29) and 55% were female. Injury history was associated with poorer KOOS QOL (−8.41; 95%CI −10.76, −6.06) but not EQ-5D-5L (−0.0074; −0.0238, 0.0089) or EQ-VAS (−3.82; −8.77, 1.14). Injury history (−5.14; −6.90, −3.38), worse ICOAP score (−0.40; −0.45, −0.36), and anterior cruciate ligament tear (−1.41; −2.77, −0.06) contributed to poorer KOOS QOL. Worse ICOAP score contributed to poorer EQ-5D-5L (−0.0024; −0.0034, −0.0015) and higher GLTEQ moderate-to-strenuous physical activity to better EQ-VAS (0.10; 0.03, 0.17). Knee trauma is associated with poorer condition-specific but not generic HRQoL 3–12 years post-injury.
Collapse
Affiliation(s)
- Christina Y. Le
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada;
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC V6X 2C7, Canada
| | - Clodagh M. Toomey
- School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, V94 T9PX Limerick, Ireland;
- Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
| | - Carolyn A. Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, Health Sciences Centre Foothills Campus, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Room 293, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, HRIC 3A08, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Jackie L. Whittaker
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada;
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC V6X 2C7, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, HRIC 3A08, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, #223 212 Friedman Building, 2177 Wesbrook Road, Vancouver, BC V6T 1Z3, Canada
- Correspondence:
| |
Collapse
|
64
|
Irfan A, Kerr S, Hopper G, Wilson W, Wilson L, Mackay G. A Criterion Based Rehabilitation Protocol for ACL Repair with Internal Brace Augmentation. Int J Sports Phys Ther 2021; 16:870-878. [PMID: 34123539 PMCID: PMC8169034 DOI: 10.26603/001c.22217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022] Open
Abstract
The anterior cruciate ligament (ACL) is one of the main stabilizing structures of the knee and its rupture is a common injury in young active adults. ACL reconstruction has been the preferred operative management of an ACL rupture for several decades; however, success rates are variable. Recently, interest in arthroscopic primary repair of the ligament has increased. The repair is augmented with an Internal Brace (IB), which is an ultra-high strength suture tape that bridges the ligament. This technique protects the ligament during the healing and the ligament is encouraged to heal naturally, whilst not requiring any external braces. It acts as a stabiliser to permit early mobilization and optimise rehabilitation. As understanding of rehabilitation has progressed, there has been an increased focus on early weight-bearing and achieving full range of movement. While detailed criterion-based rehabilitation protocols exist for ACL reconstruction, this is not the case for ACL repair. The purpose of this commentary is to present a novel criterion-based rehabilitation protocol following ACL repair surgery augmented with an IB. LEVEL OF EVIDENCE V.
Collapse
|
65
|
Schagemann J, Koebrich T, Wendlandt R, Schulz AP, Gille J, Oheim R. Comparison of hamstring and quadriceps tendon autografts in anterior cruciate ligament reconstruction with gait analysis and surface electromyography. J Orthop Traumatol 2021; 22:20. [PMID: 34021423 PMCID: PMC8140171 DOI: 10.1186/s10195-021-00581-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tear is the most frequent ligamentous injury of the knee joint. Autografts of hamstring (HS) or quadriceps tendons (QT) are used for primary ACL reconstruction. In this study, we planned to examine whether harvesting an HS graft is related to a deficit in dynamic knee stabilisation and strength revealed by dynamic valgus as compared with QT graft or the uninjured leg. Furthermore, if this deficit exists, is it compensated by higher neuromuscular activity of the quadriceps muscle? MATERIALS AND METHODS Adult patients who had undergone ACL reconstruction with QT or HS autografts were included in this two-armed cohort study. Clinical outcome was assessed by clinical data analysis, physical examination and the Lysholm Score and Knee Injury and Osteoarthritis Score (KOOS). In addition, gait analysis and non-invasive surface electromyography were performed. RESULTS A complete data set of 25 patients (QT: N = 8, HS: N = 17) was analysed. There was no significant demographic difference between the groups. Time between surgery and follow-up was significantly longer for the QT group. Significant differences regarding clinical outcome were not found between the treated and untreated leg or between the two groups, with excellent scores at the time of follow-up. Gait analysis revealed no significant differences of varus-valgus angles. Significant differences in surface electromyography were only found in the QT group with increased vastus medialis obliquus activity of the treated legs (p < 0.01). CONCLUSIONS Our results suggest that harvesting of HS grafts for primary ACL reconstruction will not lead to a medial collapse and consequently impaired medial stabilisation of the knee when compared with QT grafts. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- J Schagemann
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
| | - T Koebrich
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - R Wendlandt
- Clinic for Orthopedics and Trauma Surgery, Laboratory for Biomechanics, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee, 160, 23538, Luebeck, Germany
| | - A P Schulz
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.,Clinic for Orthopedics and Trauma Surgery, Laboratory for Biomechanics, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee, 160, 23538, Luebeck, Germany.,BG Klinikum Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
| | - J Gille
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.,BG Klinikum Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
| | - R Oheim
- Clinic for Orthopedics and Trauma Surgery, University Medical Center Schleswig Holstein UKSH Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.,BG Klinikum Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
| |
Collapse
|
66
|
Jiang H, Zhang L, Zhang RY, Zheng QJ, Li MY. Comparison of hamstring and quadriceps strength after anatomical versus non-anatomical anterior cruciate ligament reconstruction: a retrospective cohort study. BMC Musculoskelet Disord 2021; 22:452. [PMID: 34006272 PMCID: PMC8132361 DOI: 10.1186/s12891-021-04350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background Strength recovery of injured knee is an important parameter for patients who want to return to sport after anterior cruciate ligament reconstruction (ACLR). Comparison of muscle strength between anatomical and non-anatomical ACLR has not been reported. Purpose To evaluate the difference between anatomical and non-anatomical single-bundle ACLR in hamstring and quadriceps strength and clinical outcomes. Methods Patients received unilateral primary single-bundle hamstring ACLR between January 2017 to January 2018 were recruited in this study. Patients were divided into anatomical reconstruction group (AR group) and non-anatomical reconstruction group (NAR group) according to femoral tunnel aperture position. The hamstring and quadriceps isokinetic strength including peak extension torque, peak flexion torque and H/Q ratio were measured at an angular velocity of 180°/s and 60°/s using an isokinetic dynamometer. The isometric extension and flexion torques were also measured. Hamstring and quadriceps strength were measured preoperatively and at 3, 6, and 12 months after surgery. Knee stability including Lachman test, pivot-shift test, and KT-1000 measurement and subjective knee function including International Knee Documentation Committee (IKDC) and Lysholm scores were evaluated during the follow-up. Results Seventy-two patients with an average follow-up of 30.4 months (range, 24–35 months) were included in this study. Thirty-three were in AR group and 39 in NAR group. The peak knee flexion torque was significant higher in AR group at 180°/s and 60°/s (P < 0.05 for both velocity) at 6 months postoperatively and showed no difference between the two groups at 12 months postoperatively. The isometric knee extension torque was significant higher in AR group at 6 months postoperatively (P < 0.05) and showed no difference between the two groups at 12 months postoperatively. No significant differences between AR group and NAR group were found regarding knee stability and subjective knee function evaluations at follow-up. Conclusions Compared with non-anatomical ACLR, anatomical ACLR showed a better recovery of hamstring and quadriceps strength at 6 months postoperatively. However, the discrepancy on hamstring and quadriceps strength between the two groups vanished at 1 year postoperatively.
Collapse
Affiliation(s)
- Hai Jiang
- Department of Orthopedic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, NO. 106, Zhongshan 2nd Road, 510000, Guangzhou, China
| | - Lei Zhang
- Department of Rehabilitation, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, NO. 106, Zhongshan 2nd Road, 510000, Guangzhou, China
| | - Rui-Ying Zhang
- Department of Orthopedic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, NO. 106, Zhongshan 2nd Road, 510000, Guangzhou, China
| | - Qiu-Jian Zheng
- Department of Orthopedic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, NO. 106, Zhongshan 2nd Road, 510000, Guangzhou, China.
| | - Meng-Yuan Li
- Department of Orthopedic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, NO. 106, Zhongshan 2nd Road, 510000, Guangzhou, China.
| |
Collapse
|
67
|
Buckthorpe M. Recommendations for Movement Re-training After ACL Reconstruction. Sports Med 2021; 51:1601-1618. [PMID: 33840081 DOI: 10.1007/s40279-021-01454-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/18/2022]
Abstract
It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). Restoring movement quality during sporting-type movements is important prior to return-to-sport (RTS) after ACLR. Alterations in movement quality during an array of functional tasks are common amongst ACLR patients at or near the time of RTS and are associated with worse outcomes after ACLR. The inability to correct movement issues prior to RTS is likely due to the use of incomplete programmes or a lack of volume and intensity of movement re-training programmes. Although most clinicians and researchers understand that re-training movement after ACLR is important (e.g., the 'why'), there is often a disconnect with understanding the 'how' and 'what' of movement re-training post ACLR. The aim of this paper was to discuss factors relevant to movement dysfunction and re-training after ACLR and provide recommendations for clinicians to restore movement quality of patients after ACLR, prior to RTS. The paper recommends: (i) considering the factors which influence the expression of movement quality, which revolve around individual (e.g., neuromuscular, biomechanical, sensorimotor and neurocognitive factors), task-specific and environmental constraints; (ii) incorporating a three-staged movement re-training approach aligned to the ACLR functional recovery process: (1) addressing the neuromuscular and biomechanical and sensorimotor control factors which affect movement quality and motor learning, (2) including a progressive movement re-training approach to re-learn an array of functional tasks optimising coordination and motor learning (3) performing the final aspect of rehabilitation and movement training on the field, in realistic environments progressively simulating the sporting movement demands and environmental constraints; and (iii) effectively designing the movement programme for optimal load management, employing effective coach and feedback techniques and utilising qualitative movement analysis for transition between exercises, stages and for RTS.
Collapse
Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Health and Applied Science, St Marys University, Twickenham, London, TW1 4SX, UK.
| |
Collapse
|
68
|
Brown C, Marinko L, LaValley MP, Kumar D. Quadriceps Strength After Anterior Cruciate Ligament Reconstruction Compared With Uninjured Matched Controls: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:2325967121991534. [PMID: 33889639 PMCID: PMC8040575 DOI: 10.1177/2325967121991534] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The limb symmetry index may overestimate the recovery of quadriceps muscle strength after anterior cruciate ligament reconstruction. Comparison of individuals who have had anterior cruciate ligament reconstruction with age-, sex-, and activity-matched individuals might be more appropriate to guide rehabilitation interventions. Purpose: To compare the quadriceps strength between the injured limb of people with anterior cruciate ligament reconstruction and the limb of an age-, sex-, and activity-matched control group. Study Design: Systematic review; Level of evidence, 3. Methods: MEDLINE, CINAHL, EMBASE, SCOPUS, and SPORTDiscus were searched between inception and April 2019. Studies were included if they reported the peak quadriceps strength for persons with anterior cruciate ligament reconstruction and age-, sex-, and activity-matched control groups measured using isometric or isokinetic dynamometry. Risk of bias was assessed, and meta-analyses and metaregression (for effect of time since surgery) were performed. Results: A total of 2759 studies were identified and 21 were included for analyses. Quadriceps strength was lower in the limbs with anterior cruciate ligament reconstruction compared with the limb from matched controls within 6 months of anterior cruciate ligament reconstruction (standardized mean difference [SMD], –1.42; 95% CI, –1.62 to –1.23), 6 to 18 months after anterior cruciate ligament reconstruction (SMD, –0.92; 95% CI, –1.18 to –0.66), and >18 to 48 months after anterior cruciate ligament reconstruction (SMD, –0.38; 95% CI, –0.79 to 0.03). Results of the metaregression were significant, with the difference between anterior cruciate ligament reconstruction and matched controls decreasing with time since surgery (P < .001). Conclusion: In people with anterior cruciate ligament reconstruction, the injured limb had lower quadriceps strength compared with the limb of age-, sex-, and activity-matched controls up to 4 years after surgery. Clinicians should consider comparison with matched cohorts for return to sports decision making.
Collapse
Affiliation(s)
- Conlan Brown
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Lee Marinko
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Michael P LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.,Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Deepak Kumar
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA.,Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
69
|
Abstract
Outcomes following anterior cruciate ligament (ACL) reconstruction need improving, with poor return-to-sport rates and high risk of secondary re-injury. There is a need to improve rehabilitation strategies after ACL reconstruction, if we can support enhanced patient outcomes. This paper discusses how to optimise the mid-stage rehabilitation process after ACL reconstruction. Mid-stage is a difficult and vitally important stage of the functional recovery process and provides the foundation on which to commence late-stage rehabilitation training. Often many aspects of mid-stage rehabilitation (e.g. knee extensors isolated muscle strength) are not actually restored prior to return-to-sport. In addition, if we are to allow time for optimal late-stage rehabilitation and return-to-sport training, we need to optimise the mid-stage rehabilitation approach and complete it in a timely manner. This paper forms a key part of a strategy to optimise the ACL rehabilitation approach and considers factors more specific to mid-stage rehabilitation characterised in 3 areas: (1) muscle strength: muscle and joint specific, in particular at the knee level, with the knee extensors and flexors and distally with the triceps surae and proximally with the lumbo-pelvic-hip complex, as well as closed kinetic chain strength; (2) altered basic motor patterning (movement quality) and (3) fitness re-conditioning. In addition, the paper provides recommendations on how to implement these into practice, discussing training planning and programming and suggests specific screening to monitor work and when the athlete is able to progress to the next stage (e.g. late-stage rehabilitation criteria).
Collapse
|
70
|
Cardoso VA, Resende RA, Aquino CF, Andrade AGP, Silva PLP, Amaral GM, Fonseca ST, Ocarino JM. A novel single-leg squat test with speed and accuracy requirements: Reliability and validity in anterior cruciate ligament reconstructed individuals. Knee 2021; 29:150-159. [PMID: 33636564 DOI: 10.1016/j.knee.2021.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/18/2020] [Accepted: 01/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some traditional single-leg squat tests focused on number of repetitions may not demand precise control of lower limb dynamic alignment, especially in the frontal and transverse planes. The primary objective of this study was to evaluate test-retest reliability and construct validity of a novel single-leg squat test - the 'precision-squat test' (PST) - designed to assess performance under varying task demands that can impact the execution of lower limb movements. A secondary objective was to investigate whether musculoskeletal factors predict performance in the PST in healthy individuals. METHODS Thirty healthy participants were assessed to verify test-retest reliability. To verify the test's construct validity, we compared the performance of 21 anterior cruciate ligament reconstructed (ACLR) individuals and 21 matched controls. Finally, 36 healthy individuals were assessed to verify the musculoskeletal factors related to PST performance. All participants performed the PST: they executed single-leg squats while moving a laser pointer (attached to the thigh) between two targets. We varied target size and distance between targets to manipulate the task difficulty. RESULTS Reliability of the PST was excellent at all demand levels (intraclass correlation coefficient (ICC)(3,2) > 0.93). Squat time increased under test conditions involving higher task difficulty (P < 0.001) and in ACLR individuals compared with age-matched controls (P < 0.05). Regression analyses revealed that reduced knee extensors and hip external rotators torques are related to increased squat time (P < 0.05). CONCLUSIONS PST is a valid and reliable tool to assess performance of healthy and ACLR individuals. In addition, hip and knee strength are associated with performance during the test.
Collapse
Affiliation(s)
- Vanessa A Cardoso
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Brazil
| | - Renan A Resende
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Brazil
| | - Cecília F Aquino
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Brazil; Department of Physical Therapy, Universidade José do Rosário Vellano, Campus Divinópolis, Brazil; Department of Physical Therapy, Universidade do Estado de Minas Gerais, Unidade Divinópolis, Brazil
| | - André G P Andrade
- Department of Sports, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Brazil
| | - Paula L P Silva
- Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Giovanna M Amaral
- Biological and Health Sciences Institute, Centro Universitário de Belo Horizonte, Brazil
| | - Sérgio T Fonseca
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Brazil
| | - Juliana M Ocarino
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Brazil.
| |
Collapse
|
71
|
Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review with Meta-Analyses. Sports Med 2021; 51:321-338. [PMID: 33247378 PMCID: PMC7846527 DOI: 10.1007/s40279-020-01386-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. OBJECTIVE To identify how peri-articular neuromuscular function changes over time after knee injury and surgery. DESIGN Systematic review with meta-analyses. DATA SOURCES PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes. RESULTS A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at < 6 months (moderate evidence) but decreased at 24+ months (moderate evidence). Spinal-reflex excitability did not change at < 6 months (moderate evidence) but increased at 24+ months (strong evidence). We also found deficits in torque variability, rate of torque development, and electromechanical delay (very limited to moderate evidence). For meniscus injury, strength deficits were evident only in the short-term. No studies reported gastrocnemius, soleus or popliteus muscle outcomes for either injury. No studies were found for other ligamentous or chondral injuries. CONCLUSIONS Neuromuscular deficits persist for years post-injury/surgery, though the majority of evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA. TRIAL REGISTRATION NUMBER PROSPERO CRD42019141850.
Collapse
Affiliation(s)
- Beyza Tayfur
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.
| | | | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, Barts Health NHS Trust, London, E1 4DG, UK
| | | |
Collapse
|
72
|
Kawashima T, Omi Y, Kuriyama S, Hoshida T, Sugimoto D. Effect of Graft Rupture Prevention Training on Young Athletes After Anterior Cruciate Ligament Reconstruction: An 8-Year Prospective Intervention Study. Orthop J Sports Med 2021; 9:2325967120973593. [PMID: 33614794 PMCID: PMC7869172 DOI: 10.1177/2325967120973593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/30/2020] [Indexed: 01/14/2023] Open
Abstract
Background: There is a lack of research on the effects of a postoperative rehabilitation
program on anterior cruciate ligament (ACL) graft rupture. Hypothesis: We hypothesized that a hip-focused rehabilitation protocol with graft rupture
education and avoidance training (HIP-GREAT program) would demonstrate lower
ACL graft rupture rates compared with a traditional physical therapy (PT)
program. Study Design: Cohort study; Level of evidence, 3. Methods: This study consisted of young athletes who had undergone ACL reconstruction
at a single institution. Postoperatively, 136 participants (mean age, 16.9 ±
2.4 years) were enrolled in a traditional PT protocol between 2006 and 2010,
and 153 participants (mean age, 17.0 ± 2.3 years) were enrolled in the
HIP-GREAT protocol between 2011 and 2015. Follow-up rates were 31% (42/136)
and 27% (41/153) in the traditional PT and HIP-GREAT groups, respectively,
at 3 years postoperatively. The hazard ratio was calculated, and absolute
risk reduction (ARR) and number-needed-to-treat (NNT) analyses were
performed to compare the 2 protocols. Results: ACL graft rupture occurred in 10 patients (7.4%) in the traditional PT group
and 5 patients (3.3%) in the HIP-GREAT group. This difference was not
statistically significant (hazard ratio, 0.39; 95% CI, 0.14 to 1.16;
P = .09). The ARR was 0.041 (95% CI, –0.011 to 0.093),
and the NNT was 24.5. Conclusion: This study did not demonstrate a statistically significant reduction of ACL
graft rupture in patients in the HIP-GREAT group. However, high ARR values
and low NNT values were found, which suggests the possible effectiveness of
the HIP-GREAT protocol to reduce ACL graft ruptures in young athletes.
Collapse
Affiliation(s)
- Tatsuhiro Kawashima
- Department of Rehabilitation, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.,Department of Rehabilitation, Ichihara Hospital, Tsukuba, Ibaraki, Japan
| | - Yorikatsu Omi
- Department of Rehabilitation, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
| | - Setsurou Kuriyama
- Department of Orthopedic Surgery, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.,Department of Orthopedic Surgery, Showa University School of Medicine, Shinagwa, Tokyo, Japan.,Department of Orthopedic Surgery, Tokyo Asuka Hospital, Setagaya, Tokyo, Japan
| | - Takahiko Hoshida
- Department of Orthopedic Surgery, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.,Department of Orthopedic Surgery, Showa University School of Medicine, Shinagwa, Tokyo, Japan.,Department of Orthopedic Surgery, Tokyo Asuka Hospital, Setagaya, Tokyo, Japan
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Faculty of Sports Sciences, Waseda University, Tokorozawa, Saitama, Japan
| |
Collapse
|
73
|
Relationships between physical capacities and biomechanical variables during movement tasks in athletic populations following anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 48:209-218. [PMID: 33529930 DOI: 10.1016/j.ptsp.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction has a detrimental impact on athletic performance. Despite rehabilitation guidelines and criterion-based progressions to ensure safe restoration of fundamental physical capacities and maladaptive movement strategies, residual deficits in maximal strength, rate of force development (RFD), power and reactive strength are commonly reported. These combined with associated compensatory inter and intra-limb strategies increase the risk of re-injury. OBJECTIVE The aim of this article is to examine the relationships between fundamental physical capacities and biomechanical variables during dynamic movement tasks. DESIGN Narrative review. RESULTS The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS CONCLUSION: The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS.
Collapse
|
74
|
Standard RTS criteria effectiveness verification using FMS, Y-balance and TJA in footballers following ACL reconstruction and mild lower limb injuries. Sci Rep 2021; 11:1558. [PMID: 33452381 PMCID: PMC7810698 DOI: 10.1038/s41598-021-81152-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/04/2021] [Indexed: 01/07/2023] Open
Abstract
The anterior cruciate ligament (ACL) is the most frequently injured knee ligament. In previous studies, it was demonstrated that patients following ACL reconstruction may present motor deficits which may be related to increased risk of injury. The objective of the study was to determine whether players who have passed RTS assessment still have deficits in movement patterns or in neuromuscular control after such a serious injury as ACL rupture and reconstruction,. Sixty-five male football players (age 18-25 years), recruited from regional teams, were divided into three groups: (1) ACL group-subjects after ACL rupture and reconstruction (n = 24); (2) Mild Injury (MI) group-subjects after mild lower limb injuries (n = 21); and (3) Control (C) group-subjects without injuries (n = 20). For all groups, the Y-balance test, Functional Movement Screen (FMS) and Tuck Jump Assessment (TJA) were performed. For the Y-balance test in ACL group for the injured leg, significantly lower values were demonstrated for anterior reach ((ACL) 69.2 ± 5.7% vs. (MI) 74.8 ± 4.5% vs. (C) 74.0 ± 5.6%), at posterior-lateral reach ((ACL) 103.2 ± 6.4% vs. (C) 108.5 ± 6.0%) and composite score ((ACL) 93.9 ± 4.4% vs. (MI) 97.9 ± 4.3%) in comparison to the remaining two groups. In the FMS test, the ACL group had significantly lower composite score (12 ± 4 points) compared to the C group (15 ± 2 points). Also, compared to the remaining groups, subjects following ACL reconstruction demonstrated significantly lower performance in the TJA test related to the following elements: thighs do not reach parallel, thighs not equal side-to-side, foot placement not shoulder width apart, technique declines prior to 10 s and lower extremity valgus at landing. The authors have observed that athletes after ACL reconstruction still have deficits in movement patterns or in neuromuscular control despite passing the RTS and being cleared to perform sports. Creating a set of sufficiently sensitive assessment methods may significantly reduce the potential risk of injury due to the fact that diagnosed and monitored deficits may be treated on an ongoing basis. The authors suggest that individual elements of the Y-balance and TJA tests may be suitable for such specific assessment.
Collapse
|
75
|
Bodkin SG, Weltman AL, Hart JM. ISB clinical biomechanics award winner 2019: Knee extensor fatigue resistance in individuals following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2021; 81:105242. [PMID: 33309931 DOI: 10.1016/j.clinbiomech.2020.105242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals following anterior cruciate ligament reconstruction demonstrate quadriceps weakness throughout the post-operative recovery and at the time of returning to sport. This is often accompanied with patterns of quadriceps fatigue resistance. As such, fatigue may be an identifier of individuals with delayed recovery. The purpose was to assess quadriceps fatigue in anterior cruciate ligament reconstructed patients at the time of return to sport in comparison to healthy controls. METHODS A total of 215 individuals, 120 following anterior cruciate ligament reconstruction (21.0 (2.9) years, 63 Female, 5.96 (0.48) months post-surgery) and 95 healthy controls (21.5 (8.4) years, 49 Female), participated in this study. All participants completed a 30-s knee extensor maximum voluntary isometric contraction. Knee extensor strength, limb symmetry index, and fatigue (%) were compared between groups. Between-limb fatigue comparisons were made through the Fatigue Index Limb Difference = [(Involved Limb Fatigue Index) - (Uninvolved Limb Fatigue Index)]. FINDINGS Individuals following anterior cruciate ligament reconstruction (18.7 (10.9)%, -5.6 (11.2)) demonstrated lower values of unilateral fatigue and Fatigue Index Limb Difference compared to healthy participants (22.5 (8.2)%, P = .002; 2.2 (7.9), P < .001). For anterior cruciate ligament reconstructed patients, there was a weak, negative, significant relationship between the involved limb strength and fatigue (r = -0.184, P = .048). There was no relationship between limb symmetry and Fatigue Index Limb Difference (r = 0.137, P = .142). For Healthy individuals, there was a positive, moderate relationship between limb symmetry and Fatigue Index Limb Difference (r = 0.400, P < .001). INTERPRETATION Individuals following anterior cruciate ligament reconstruction demonstrate fatigue resistance compared to healthy active controls and greater resistance to fatigue in their involved limb compared to their contralateral limb.
Collapse
Affiliation(s)
- Stephan G Bodkin
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
| | - Arthur L Weltman
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Joe M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
76
|
Strength, rate of force development, power and reactive strength in adult male athletic populations post anterior cruciate ligament reconstruction - A systematic review and meta-analysis. Phys Ther Sport 2021; 47:91-104. [DOI: 10.1016/j.ptsp.2020.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/26/2022]
|
77
|
Kaur M, Ribeiro DC, Lamb P, Webster KE, Sole G. Low knee-related quality of life and persistent physical asymmetries in participants up to 10 years post-ACL reconstruction - A cross-sectional study. Phys Ther Sport 2020; 48:35-42. [PMID: 33352396 DOI: 10.1016/j.ptsp.2020.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare self-report and functional outcomes between participants with anterior cruciate ligament reconstruction (ACLR) with age and activity matched controls. DESIGN Cross-sectional study. SETTING University laboratory-based study. PARTICIPANTS Twenty-five participants (30.8 ± 9.7 years; 13 women), two to ten years post anterior cruciate ligament reconstruction; 24 controls (31.0 ± 10 years, 13 women). MAIN OUTCOME MEASURES Knee Osteoarthritis and Injury Outcome Score (KOOS), Tegner, Marx Activity and Fear of Re-injury scales, and SF-12; isokinetic quadriceps and hamstring peak torque and single-leg hop distance. RESULTS There were no between-groups differences for the Tegner and the Marx Activity Scales. The ACLR group had lower KOOS dimensions (p < 0.001), SF-12 Physical Component Scores (p = 0.008), and higher Fear of Reinjury Scores (<0.001) than the controls. No significant differences were found for physical performance measures between the ACLR and the control groups. Significant between-side differences for the ACLR group were evident for concentric quadriceps (p < 0.001) and concentric hamstring peak torque (p = 0.002), and hop distance (p < 0.001). CONCLUSION Knee-specific symptoms and function, activity and quality of life were lower, and fear of re-injury was higher for participants with ACLR than controls. Side-to-side thigh muscle strength and hop distance deficits were evident for the ACLR group.
Collapse
Affiliation(s)
- Mandeep Kaur
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Daniel Cury Ribeiro
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Peter Lamb
- School of Physical Education Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.
| | - Kate E Webster
- School of Allied Health, La Trobe University, Victoria, Australia.
| | - Gisela Sole
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| |
Collapse
|
78
|
Goes RA, Cossich VRA, França BR, Campos AS, Souza GGA, Bastos RDC, Grangeiro Neto JA. RETURN TO PLAY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION. REV BRAS MED ESPORTE 2020. [DOI: 10.1590/1517-8692202026062019_0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The anterior cruciate ligament (ACL) tear represents more than half of all knee injuries in sports that involve body rotations and sudden changes of direction. Discharging the athlete for return to play (RTP) post-ACL reconstruction (ACLR) is a difficult task with multidisciplinary responsibility. For many years, a six-month period post-ACLR was adopted as the only criterion for RTP. However, it is now suggested that RTP should not be exclusively time-based, but to clinical data and systematic assessments. Despite the importance of post-ACLR factors for RTP, pre- and peri-ACLR factors must also be considered. Historically, ACLR is performed with the hamstring or autologous patellar tendons, although the choice of graft is still an open and constantly evolving theme. Anterolateral ligament reconstruction and repair of meniscal ramp tear associated with ACLR have recently been suggested as strategies for improving knee joint stability. Subjective questionnaires are easy to apply, and help identify physical or psychological factors that can hamper RTP. Functional tests, such as hop tests and strength assessment by means of isokinetic dynamometers, are fundamental tools for decision making when associated with clinical evaluation and magnetic resonance imaging. Recently, the capacity to generate force explosively has been incorporated into the muscle strength assessment. This is quantified through the rate of torque development (RTD). Due to characteristics inherent to the practice of sport, there is an extremely short time available for produce strength. Thus, RTD seems to better represent athletic demands than the maximum strength assessment alone. This review investigates the pre-, peri- and post-ACLR factors established in the literature, and shares our clinical practice, which we consider to be best practice for RTP. Level of evidence V; Specialist opinion.
Collapse
Affiliation(s)
- Rodrigo A. Goes
- Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad, Brazil
| | - Victor R. A. Cossich
- Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad, Brazil; Universidade Federal do Rio de Janeiro, Brazil
| | - Bráulio R. França
- Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad, Brazil; Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad, Brazil
| | | | | | | | | |
Collapse
|
79
|
Welch N, Richter C, Moran K, Franklyn-Miller A. Rehabilitation interventions need more than methodological standardisation: an individualised approach. BMJ Open Sport Exerc Med 2020; 6:e000899. [PMID: 33304604 PMCID: PMC7704286 DOI: 10.1136/bmjsem-2020-000899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/02/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The main aim in the current study was to use a single-subject analysis to profile the physical performance characteristics of individuals within an injured group and a between-group approach to profile the group as a whole. These profiles were then used to inform single-subject and between-group rehabilitation interventions. METHODS Fifty-three (28 with athletic groin pain and 25 non-injured) Gaelic football players (24.8 years±7.1 years; 179 cm±5.5 cm; 79.7 kg±9.2 kg) underwent 3D biomechanical analysis, which was used to measure a series of physical performance characteristics. The non-injured group was used to create a 'performance database' to compare the injured individuals, and a between-group analysis was also conducted. The scores from each analysis were used to inform the targets of interventions. RESULTS The analysis highlighted the variety of profiles that existed across the tested individuals and that these profiles differed from that of the between-group analysis. By analysing individuals in a single-subject approach, detail can be seen that is lost with between-group analysis.
Collapse
Affiliation(s)
- Neil Welch
- Sports Medicine, Sports Surgery Clinic, Dublin, Ireland.,INSIGHT Research Centre, Dublin City University, Dublin, Ireland
| | - Chris Richter
- Sports Medicine, Sports Surgery Clinic, Dublin, Ireland
| | - Kieran Moran
- School of Health and Human Performance, Dublin City University, Dublin, Ireland.,Human Sensing, INSIGHT Research Centre, Dublin, Ireland
| | - Andy Franklyn-Miller
- Sports Medicine, Sports Surgery Clinic, Dublin, Ireland.,Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| |
Collapse
|
80
|
Rice D, Lewis G, McNair P. Impaired Regulation of Submaximal Force after ACL Reconstruction: Role of Muscle Spindles. Int J Sports Med 2020; 42:550-558. [PMID: 33176382 DOI: 10.1055/a-1292-4461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ongoing motor deficits are routinely present following anterior cruciate ligament (ACL) reconstruction, including the ability to regulate muscle force. While such deficits are known, it is unclear why this occurs. The goal of the current study was to investigate the potential influence of muscle spindle input on submaximal force regulation and muscle activity at the knee in people following ACL reconstruction. Fourteen participants (8 female) who were 6-24 months post-ACL reconstruction and 15 control participants (8 female) undertook submaximal force matching and force modulation tasks before and after 20 min of vibration applied to the patella tendon. Across all tasks, the ACL reconstruction participants were poorer at force matching (P=0.007). The effect of vibration was not significant in either group for the force matching tasks (P=0.06), although there was a reduction in maximum voluntary contraction post-vibration in the control group (P<0.001). The ACL reconstruction group also showed evidence of greater activation of the medial hamstring muscles in comparison to controls (P=0.04). Individuals who have undergone ACL reconstruction have a diminished ability to accurately match and regulate submaximal muscle force, but this does not appear to be related to impaired muscle spindle input. Neuromuscular retraining programs that involve force regulation tasks may be necessary to optimize rehabilitation after ACL reconstruction.
Collapse
Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.,Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
| | - Gwyn Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
81
|
Kaur M, Ribeiro DC, Webster KE, Sole G. Knee biomechanics while navigating steps in participants with anterior cruciate ligament reconstruction, between 2 and 10 years following surgery. Phys Ther Sport 2020; 46:70-76. [DOI: 10.1016/j.ptsp.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 01/13/2023]
|
82
|
Early clinical and neuromuscular properties in patients with normal or sub-normal subjective knee function after anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 2020; 140:1231-1239. [PMID: 32270278 DOI: 10.1007/s00402-020-03436-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Indexed: 02/09/2023]
Abstract
PURPOSE To determine clinical and neuromuscular properties in patients with normal or sub-normal subjective knee function after finalisation of 6 months' post-operative rehabilitation following anterior cruciate ligament reconstruction (ACLR). METHODS Sixty patients after primary anatomical single-bundle hamstring ACLR were prospectively enrolled. Demographics, subjective, clinical and functional status of the injured knee were recorded at baseline, 6 and 12 months post-operatively. Return to pre-injury activities time (months) was monitored. Tensiomyography and isokinetic dynamometry of thigh muscles were performed at 6 months, when standard ACLR rehabilitation is finalized. Based on their IKDC Subjective Knee Evaluation scores at 6 months, they were assigned into "Normal" or "Sub-normal" group. All the above measured parameters were then compared between the two groups. RESULTS At 6 months' timeline, 21 patients (35%) perceived their knee function as "Normal", while 39 (65%) were "Sub-normal". There were no differences in clinical status between both groups, but patients in Normal group achieved higher IKDC, Lysholm, Tegner scores as well as higher single-leg hop test. They were taller, had lower body mass index and more of them achieved their preinjury level of activity at 12 months (67% vs. 33%). Tensiomyography revealed higher biceps femoris as well as semitendinosus and semimembranosus radial displacement values on the operated leg in Normal group. Isokinetic dynamometry showed significantly higher normalised peak torque and average power of knee extensor muscles. CONCLUSIONS Patients who perceive their knee function as normal at 6 months following ACLR presented with better neuromuscular properties of the thigh muscles. Decreased hamstring stiffness seems to be the key to higher return-to-preinjury activity. Postoperative rehabilitation should be more focused on reducing hamstring stiffness in addition to improving knee extensor muscle strength. Level of evidence II (prospective cohort study).
Collapse
|
83
|
Anterior cruciate ligament reconstruction with the use of adductor canal block can achieve similar pain control as femoral nerve block. Knee Surg Sports Traumatol Arthrosc 2020; 28:2675-2686. [PMID: 32166390 DOI: 10.1007/s00167-020-05933-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Moderate-to-severe postoperative pain remains a challenge for both patients and surgeons after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to systematically review the current evidence in the literature to compare adductor canal block (ACB) with femoral nerve block (FNB) in the treatment of ACLR. METHODS A comprehensive search of the published literature in PubMed, Scopus, EMBASE, and Cochrane Library databases was performed. Only English randomized clinical trials (RCTs) were included in this study. The primary outcome was pain score. Secondary outcome measures included opioid consumption, postoperative adverse events, patient satisfaction, and quadriceps strength. RESULTS Eight RCTs with a total of 587 patients were included. No statistically significant difference was observed between the ACB and FNB groups in pain scores at 6 h, 12 h, 24 h, or 48 h; cumulative opioid consumption at 24 h or 48 h; patient satisfaction at 24 or 48 h; and postoperative adverse event. However, ACB showed superior quadriceps strength in the early postoperative period. CONCLUSIONS Both treatments provided similar overall pain relief after ACLR. The potential benefits of quadriceps preservation with ACB are worthy of future study. Therefore, ACB is recommended as an attractive alternative to FNB as the peripheral nerve block of choice for ACLR. LEVEL OF EVIDENCE Meta-analysis of Level 1 was performed in this study.
Collapse
|
84
|
Warren M, Lininger MR, Smith CA, Copp AJ, Chimera NJ. Association of Functional Screening Tests and Noncontact Injuries in Division I Women Student-Athletes. J Strength Cond Res 2020; 34:2302-2311. [DOI: 10.1519/jsc.0000000000003004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
85
|
Importance of functional performance and psychological readiness for return to preinjury level of sports 1 year after ACL reconstruction in competitive athletes. Knee Surg Sports Traumatol Arthrosc 2020; 28:2203-2212. [PMID: 31679068 DOI: 10.1007/s00167-019-05774-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/23/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to identify independent predictive factors for return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction in competitive-level athletes and to determine optimal cut-off values for these factors at 6 months after surgery. METHODS A total of 124 competitive athletes (50 males and 74 females; mean age, 17.0 years; preinjury Tegner activity scale > 7) who underwent primary ACL reconstruction were enrolled. Assessments at 6 months after surgery consisted of knee functional tests [quadriceps index, hamstrings index, and single-leg hop for distance (SLH)] and 2 self-report questionnaires [IKDC subjective score and ACL-Return to Sport after Injury scale (ACL-RSI)]. At 1 year after surgery, athletes were classified into the RTS group (n = 101) or non-RTS group (n = 23) based on self-reported sports activities. After screening possible predictive factors of RTS, multivariate logistic regression and receiver operating characteristic curve analyses were performed to identify independent factors. RESULTS Multivariate logistic regression analysis identified SLH (odds ratio, 2.861 per 10 unit increase; P < 0.001) and ACL-RSI (odds ratio, 1.810 per 10 unit increase; P = 0.001) at 6 months as independent predictors of RTS at 1 year after surgery. Optimal cut-off values of SLH and ACL-RSI were 81.3% (sensitivity = 0.891; specificity = 0.609) and 55 points (sensitivity = 0.693; specificity = 0.826), respectively. CONCLUSION In competitive athletes, SLH < 81% and ACL-RSI < 55 points at 6 months after surgery were associated with a greater risk of unsuccessful RTS at 1 year after surgery. SLH and ACL-RSI at 6 months could serve as screening tools to identify athletes who have difficulties with returning to sports after ACL reconstruction. LEVEL OF EVIDENCE III.
Collapse
|
86
|
Lesevic M, Kew ME, Bodkin SG, Diduch DR, Brockmeier SF, Miller MD, Gwathmey FW, Werner BC, Hart JM. The Affect of Patient Sex and Graft Type on Postoperative Functional Outcomes After Primary ACL Reconstruction. Orthop J Sports Med 2020; 8:2325967120926052. [PMID: 32637429 PMCID: PMC7313335 DOI: 10.1177/2325967120926052] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/29/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Graft choice in anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation may affect strength recovery differently in men than women and therefore affect a timely and successful return to sport. Purpose: To compare knee extensor and flexor strength between men and women who underwent isolated ACLR with either patellar tendon or hamstring tendon (HST) autografts. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 166 patients (87 women, 79 men) with primary unilateral and uncomplicated ACLRs were recruited for participation. A total of 100 patients had bone–patellar tendon–bone (BPTB) autografts and 66 had HST autografts. At 6 months postoperatively, all patients completed the Tegner activity scale and International Knee Documentation Committee Subjective Knee Evaluation as well as underwent bilateral isokinetic (90 deg/s) tests of the knee extensor and flexor groups. Outcomes were recorded in a single session as part of a return-to-sport test battery. Surgical notes were obtained to determine the type of autograft and nerve block used at the time of ACLR. Results: There was a significant sex × graft type interaction for mass-normalized knee flexor torque (P = .017). Female patients with an HST graft had a significantly lower knee flexor torque compared with female patients with a BPTB graft (0.592 ± 0.49 N·m/kg vs 0.910 ± 0.24 N·m/kg; Cohen d [95% CI] = 0.91 [0.45, 1.36]). They also had a significantly lower knee flexor torque when compared with male patients with an HST graft (0.592 ± 0.49 N·m/kg vs 0.937 ± 0.35 N·m/kg; Cohen d [95% CI]= 0.88 [0.45, 1.31]). There were significant main effects for graft type with knee flexion (P = .001) and extension (P = .008) symmetry. Patients with a BPTB graft demonstrated lower knee extensor symmetry (65.7% ± 17.0%) and greater knee flexor symmetry (98.7% ± 18.0%) compared with patients with an HST graft (extension: 77.1% ± 32%, Cohen d [95% CI] = 0.47 [0.16, 0.79]; flexion: 82.9% ± 33.3%, Cohen d [95% CI] = 0.63 [0.31, 0.95]). We also observed a significant main effect for sex (P = .028) and graft type (P = .048) for mass-normalized knee extensor strength. Female participants and patients of either sex with BPTB grafts had lower knee extensor strength compared with male participants and patients with HST grafts, respectively. Conclusion: At approximately 6 months after ACLR, female patients reconstructed with HST autografts demonstrated weaker HST strength compared with female patients with a BPTB autograft. There were no differences in HST strength between graft types in male patients. Female patients appear to be recovering HST strength differently than male patients when using an HST autograft. These findings may have implications in surgical planning, postoperative rehabilitation, and return-to-sport decision making.
Collapse
Affiliation(s)
- Milos Lesevic
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Michelle E Kew
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephan G Bodkin
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Joseph M Hart
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.,Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
87
|
Turpeinen J, Freitas TT, Rubio‐Arias JÁ, Jordan MJ, Aagaard P. Contractile rate of force development after anterior cruciate ligament reconstruction—a comprehensive review and meta‐analysis. Scand J Med Sci Sports 2020; 30:1572-1585. [DOI: 10.1111/sms.13733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 01/01/2023]
Affiliation(s)
| | - Tomás T. Freitas
- UCAM Research Center for High Performance Sport Murcia Spain
- NAR—Nucleus of High Performance in Sport São Paulo Brazil
| | - Jacobo Ángel Rubio‐Arias
- UCAM Research Center for High Performance Sport Murcia Spain
- LFE Research Group Department of Health and Human Performance Faculty of Physical Activity and Sport Science‐INEF Universidad Politécnica de Madrid Madrid Spain
| | | | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics SDU Muscle Research Cluster (SMRC) University of Southern Denmark Odense M Denmark
| |
Collapse
|
88
|
Moore JM, Cessford K, Willmott AP, Raj D, Exell TA, Burbage J, Mullineaux DR. Lower limb biomechanics before and after anterior cruciate ligament reconstruction: A systematic review. J Biomech 2020; 106:109828. [PMID: 32517975 DOI: 10.1016/j.jbiomech.2020.109828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/30/2020] [Accepted: 05/02/2020] [Indexed: 12/29/2022]
Abstract
This review aimed to synthesise the findings of literature that have assessed the changes in lower limb biomechanics following anterior cruciate ligament (ACL) reconstructive surgery. Systematic searches of CINHAL, MEDLINE, SCOPUS, and SPORTDiscus databases were run. All included studies had presented biomechanical variables pre- and post-surgery for the same participants. Articles were categorised by the analysed movement, and effect sizes were calculated. Fifty-four studies met the inclusion criteria, providing data on gait (n = 31), balance (n = 12), joint position sense (n = 5), stair ambulation (n = 4), pivoting (n = 6), and landing (n = 5). Measures of balance performance and joint position sense showed improvements from pre- to post-surgery. Changes in joint kinematics were inconsistent between studies, however increased knee flexion excursion, and reduced tibial anterior translation and internal rotation post reconstruction were identified. Joint kinetics reduced in magnitude in the early stages after surgery (≤5 weeks), then increased later in recovery (≥24 weeks). Risk of bias assessment identified most articles had a moderate or high risk (low = 5; moderate = 21; high = 11) resulting from participant retention and surgical intervention differences. The results of the review identified that although lower limb biomechanics did alter following reconstruction, few variables provided consistent results across studies and tasks. The low methodological quality of some articles may have contributed to these inconsistent findings. Alternatively, differences across studies may have resulted from individual coping strategies of participants that have previously been suggested to be present before reconstructive surgery, and future research should look to explore individual coping strategies to ACL reconstruction.
Collapse
Affiliation(s)
- Joseph M Moore
- School of Sport, Health and Exercise Science, University of Portsmouth, UK.
| | - Kimberly Cessford
- School of Sport, Health and Exercise Science, University of Portsmouth, UK; Department of Sport and Exercise Sciences, University of Chichester, UK
| | | | - Dipak Raj
- Department of Orthopaedics, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, UK
| | - Timothy A Exell
- School of Sport, Health and Exercise Science, University of Portsmouth, UK
| | - Jenny Burbage
- School of Sport, Health and Exercise Science, University of Portsmouth, UK
| | | |
Collapse
|
89
|
Kitaguchi T, Tanaka Y, Takeshita S, Akizaki K, Takao R, Kinugasa K, Tachibana Y, Natsuume T, Horibe S. Preoperative quadriceps strength as a predictor of return to sports after anterior cruciate ligament reconstruction in competitive athletes. Phys Ther Sport 2020; 45:7-13. [PMID: 32563035 DOI: 10.1016/j.ptsp.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine whether preoperative quadriceps strength predicts the likelihood of return to sports (RTS) following anterior cruciate ligament reconstruction (ACLR) in competitive athletes. DESIGN Case-control study. SETTING Single-center. PARTICIPANTS A total of 221 competitive athletes who underwent primary ACLR were followed and divided into RTS (n = 177) and non-RTS (n = 44) groups based on self-reported sports activities at one year postoperatively. MAIN OUTCOME MEASURES Isokinetic quadriceps strength tests were performed preoperatively and at six months and one year postoperatively, and the quadriceps index (QI) was calculated. Functional performance was evaluated by the single-leg hop (SLH) test at six months postoperatively. RESULTS Preoperative QI significantly predicted the likelihood of RTS (odds ratio, 1.68 per 10-unit increase; P < 0.001), with a preoperative QI cut-off of 66% (AUC: 0.74; sensitivity: 68.9%; specificity: 77.3%). Subjects with a preoperative QI < 66% had a significantly lower postoperative QI, SLH, and rates of RTS compared to those with a higher preoperative QI (P < 0.01). CONCLUSIONS Preoperative quadriceps strength could predict the likelihood of RTS following ACLR, and a preoperative QI < 66% was associated with a greater risk of unsuccessful RTS at one year postoperatively. Preoperative QI should be evaluated as a predictor of RTS.
Collapse
Affiliation(s)
- Takuya Kitaguchi
- Department of Rehabilitation, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan.
| | - Yoshinari Tanaka
- Department of Sports Orthopaedics, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Shinya Takeshita
- Department of Rehabilitation, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Koji Akizaki
- Department of Rehabilitation, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Rikio Takao
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, 3-7-30 Habikino, Habikino, Osaka, 583-8555, Japan
| | - Kazutaka Kinugasa
- Department of Sports Orthopaedics, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yuta Tachibana
- Department of Sports Orthopaedics, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Takashi Natsuume
- Department of Rehabilitation, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Shuji Horibe
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, 3-7-30 Habikino, Habikino, Osaka, 583-8555, Japan
| |
Collapse
|
90
|
Hop test does not correlate with neuromuscular control during drop vertical jump test: A prognostic comparative study utilizing healthy subjects. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
91
|
Barber-Westin S, Noyes FR. One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years. Sports Health 2020; 12:587-597. [PMID: 32374646 DOI: 10.1177/1941738120912846] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury rates have been reported, and the factors responsible are unclear. Studies differ with regard to age, graft type, surgical techniques, postoperative rehabilitation, RTS guidelines, and methods used to determine ACL failures. OBJECTIVE To determine RTS rates; the effect of participation in high-risk sports, sex, and graft type on ACL reinjury rates; and whether objective test criteria before RTS correlate with lower reinjury rates. DATA SOURCES A systematic review of the literature from inception to May 31, 2019, was conducted using the PubMed and Cochrane databases. STUDY SELECTION Studies on transphyseal ACLR in athletes <20 years old with a minimum mean follow-up of 2 years that reported reinjury rates, the number that RTS, and detailed the type of sport were included. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. RESULTS A total of 1239 patients in 8 studies were included; 87% returned to sport and 80% resumed high-risk activities. Of the patients, 18% reinjured the ACL graft and/or the contralateral ACL. Nine percent of patellar tendon autografts and 15% of hamstring autografts failed (odds ratio [OR], 0.52; P = 0.002). Of reinjuries, 90% occurred during high-risk sports. Male patients had a significantly higher rate of ACL graft failure than female patients (OR, 1.64; P = 0.01). There was no sex-based effect on contralateral ACL injuries. Only 1 study cited objective criteria for RTS. CONCLUSION A high percentage of athletes returned to sport, but 1 in 5 suffered reinjuries to either knee. Male patients were more likely to reinjure the ACL graft. Objective criteria for RTS were rarely mentioned or not detailed. The need for testing of knee stability, strength, neuromuscular control, agility, and psychological measures before RTS remains paramount in young athletes.
Collapse
Affiliation(s)
- Sue Barber-Westin
- Cincinnati Sportsmedicine and Orthopaedic Center-Mercy Health, and the Noyes Knee Institute, Cincinnati, Ohio
| | - Frank R Noyes
- Cincinnati Sportsmedicine and Orthopaedic Center-Mercy Health, and the Noyes Knee Institute, Cincinnati, Ohio
| |
Collapse
|
92
|
Bonnette S, Diekfuss JA, Grooms DR, Kiefer AW, Riley MA, Riehm C, Moore C, Foss KDB, DiCesare CA, Baumeister J, Myer GD. Electrocortical dynamics differentiate athletes exhibiting low- and high- ACL injury risk biomechanics. Psychophysiology 2020; 57:e13530. [PMID: 31957903 PMCID: PMC9892802 DOI: 10.1111/psyp.13530] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are physically and emotionally debilitating for athletes,while motor and biomechanical deficits that contribute to ACL injury have been identified, limited knowledge about the relationship between the central nervous system (CNS) and biomechanical patterns of motion has impeded approaches to optimize ACL injury risk reduction strategies. In the current study it was hypothesized that high-risk athletes would exhibit altered temporal dynamics in their resting state electrocortical activity when compared to low-risk athletes. Thirty-eight female athletes performed a drop vertical jump (DVJ) to assess their biomechanical risk factors related to an ACL injury. The athletes' electrocortical activity was also recorded during resting state in the same visit as the DVJ assessment. Athletes were divided into low- and high-risk groups based on their performance of the DVJ. Recurrence quantification analysis was used to quantify the temporal dynamics of two frequency bands previously shown to relate to sensorimotor and attentional control. Results revealed that high-risk participants showed more deterministic electrocortical behavior than the low-risk group in the frontal theta and central/parietal alpha-2 frequency bands. The more deterministic resting state electrocortical dynamics for the high-risk group may reflect maladaptive neural behavior-excessively stable deterministic patterning that makes transitioning among functional task-specific networks more difficult-related to attentional control and sensorimotor processing neural regions.
Collapse
Affiliation(s)
- Scott Bonnette
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jed A. Diekfuss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, GA, USA,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Adam W. Kiefer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,Department of Psychology, Center for Cognition, Action & Perception, University of Cincinnati, Cincinnati, OH, USA,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael A. Riley
- Department of Psychology, Center for Cognition, Action & Perception, University of Cincinnati, Cincinnati, OH, USA
| | - Christopher Riehm
- Department of Psychology, Center for Cognition, Action & Perception, University of Cincinnati, Cincinnati, OH, USA
| | - Charles Moore
- Department of Psychology, Center for Cognition, Action & Perception, University of Cincinnati, Cincinnati, OH, USA
| | - Kim D. Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher A. DiCesare
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jochen Baumeister
- Exercise Science and Neuroscience, Department Exercise & Health, Paderborn University, Paderborn, Germany
| | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| |
Collapse
|
93
|
Hall M, Perraton LG, Stevermer CA, Gillette JC. Alterations in medial-lateral postural control after anterior cruciate ligament reconstruction during stair use. Gait Posture 2020; 77:283-287. [PMID: 32106044 DOI: 10.1016/j.gaitpost.2020.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dynamic postural control during everyday tasks is poorly understood in people following anterior cruciate ligament reconstruction (ACLR). Understanding dynamic postural control can provide insight into potentially modifiable impairments in people following ACLR who are at increased risk for second ACL injury and/or knee osteoarthritis. RESEARCH QUESTION Determine whether measures indicative of dynamic postural control differ between individuals with and without ACLR during stair ascent and descent. METHODS Seventeen individuals with ACLR (>1 yr post-surgery) and 16 age and sex-matched healthy controls participated. Centre of pressure (COP) measures included: i) COP excursion, ii) COP velocity, and iii) dynamic time-toboundary (TTB). Mixed linear models were used to compare COP measures for the ACLR leg, non-ACLR leg, and healthy controls during stair ascent and stair descent. RESULTS There were no statistically significant differences observed during stair ascent (all p > 0.05). Several statistical differences were found during stair descent for individual with ACLR, but not between those with ACLR and healthy controls. The ACLR leg had higher medial-lateral COP excursion (mean difference 1.06 cm, [95 %CI 0.08-2.06 cm], p = 0.036; effect size = 0.38) compared to the non-ACLR leg during stair descent. In addition, the ACLR leg had a lower medial-lateral TTB (mean difference -13 ms [95 %CI -38 to 2 ms], p = 0.005; effect size = 0.49) and medial-lateral TTB normalized to stance time (mean difference -5.8 % [95 %CI -10.3 to 1.3 %], p = 0.012; effect size = 0.80) compared to the non-ACLR leg during stair descent. No statistical differences were observed for anterior-posterior measures during stair descent (all p > 0.05). SIGNIFICANCE Taken together, findings indicate that there are small to large differences in medial-lateral postural control in the ACLR leg compared to the non-ACLR leg during stair descent. Further work is required to understand clinical implication of these novel observations.
Collapse
Affiliation(s)
- Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, The University of Melbourne, VIC, 3010, Australia.
| | - Luke G Perraton
- Department of Physiotherapy, Monash University, Frankston, VIC, Australia
| | | | | |
Collapse
|
94
|
King E, Richter C, Jackson M, Franklyn-Miller A, Falvey E, Myer GD, Strike S, Withers D, Moran R. Factors Influencing Return to Play and Second Anterior Cruciate Ligament Injury Rates in Level 1 Athletes After Primary Anterior Cruciate Ligament Reconstruction: 2-Year Follow-up on 1432 Reconstructions at a Single Center. Am J Sports Med 2020; 48:812-824. [PMID: 32031870 PMCID: PMC9893516 DOI: 10.1177/0363546519900170] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the importance of return-to-play (RTP) rates, second anterior cruciate ligament (ACL) injury rates, and patient-reported outcomes of athletes returning to sports after ACL reconstruction (ACLR), these outcomes have not been evaluated together across a single cohort nor the pre- and intraoperative factors influencing outcomes explored. PURPOSE To prospectively report outcomes after ACLR relating to RTP, second ACL injury, and International Knee Document Committee (IKDC) scores in a large cohort of athletes at a single center to examine the influence of pre- and intraoperative variables on these outcomes. DESIGN Cohort study; Level of evidence, 3. METHODS A consecutive cohort of 1432 athletes undergoing primary ACLR by 2 orthopaedic surgeons was followed up prospectively more than 2 years after surgery. Pre- and intraoperative findings were reported with outcomes at follow-up relating to RTP, second ACL injury, and IKDC. Between-group differences for each outcome were reported and the predictive ability of pre- and intraoperative variables relating to each outcome assessed with logistic regression. RESULTS There was >95% follow-up 2 years after surgery. The RTP rate was 81%, and of those who returned, 1.3% of those with patellar tendon grafts and 8.3% of those with hamstring grafts experienced ipsilateral rerupture (hazard ratio, 0.17). The contralateral ACL injury rate was 6.6%, and the IKDC score at follow-up was 86.8, with a greater proportion of patients with patellar tendon grafts scoring <80 on the IKDC (odds ratio, 1.56; 95% CI, 1.15-3.12). There was no relationship between time to RTP and second ACL injury, and there was a moderate correlation between ACL-Return to Sport After Injury score and RTP at follow-up (P < .001, rho = 0.46). There were a number of differences in pre- and intraoperative variables between groups for each outcome, but they demonstrated a poor ability to predict outcomes in level 1 athletes at 2-year follow-up. CONCLUSION Findings demonstrated high overall RTP rates, lower reinjury rates with patellar tendon graft after 2-year follow-up in level 1 athletes, and no influence of time to RTP on second ACL injury. Despite differences between groups, there was poor predictive ability of pre- and intraoperative variables. Results suggest pre- and intraoperative variables for consideration to optimize outcomes in level 1 athletes after ACLR, but future research exploring other factors, such as physical and psychological recovery, may be needed to improve outcome prediction after ACLR. REGISTRATION NCT02771548 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
- Department of Life Sciences, Roehampton University, Roehampton, UK
- Address correspondence to Enda King, PT, PhD, Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland () (Twitter: @enda_king)
| | - Chris Richter
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
- Department of Life Sciences, Roehampton University, Roehampton, UK
| | - Mark Jackson
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
| | - Andy Franklyn-Miller
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Eanna Falvey
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Departments of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Siobhan Strike
- Department of Life Sciences, Roehampton University, Roehampton, UK
| | - Dan Withers
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
| | - Ray Moran
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Ireland
| |
Collapse
|
95
|
Hunnicutt JL, McLeod MM, Slone HS, Gregory CM. Quadriceps Neuromuscular and Physical Function After Anterior Cruciate Ligament Reconstruction. J Athl Train 2020; 55:238-245. [PMID: 31995392 DOI: 10.4085/1062-6050-516-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Persistent neuromuscular deficits in the surgical limb after anterior cruciate ligament reconstruction (ACLR) have been repeatedly described in the literature, yet little is known regarding their association with physical performance and patient-reported function. OBJECTIVE To describe (1) interlimb differences in neuromuscular and functional outcomes and (2) the associations of neuromuscular outcomes with measures of physical and knee-related patient-reported function. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty individuals after primary, unilateral ACLR (19 males; age = 21.5 years [range, 14-41 years]; 8 months [range = 6-23 months] postsurgery). MAIN OUTCOME MEASURE(S) Knee-extensor isometric and isokinetic peak torque was measured with an isokinetic dynamometer. Cross-sectional area (CSA) was measured bilaterally for each of the quadriceps muscles via magnetic resonance imaging. We measured quadriceps central activation bilaterally via the superimposed-burst technique. Physical performance (single-legged hop tests, step length via spatiotemporal gait analysis) and patient-reported outcomes (International Knee Documentation Committee questionnaire and Knee Injury and Osteoarthritis Outcome Score Sport and Recreation subscale) were also recorded. We conducted Wilcoxon signed rank tests to identify interlimb differences. Spearman ρ correlation analyses revealed associations between limb symmetry and neuromuscular and functional outcomes, as well as with patient-reported function. RESULTS Deficits in the surgical limb as compared with the nonsurgical limb were present for all outcomes (P values < .05). Greater single-legged hop-test symmetry (83%) was significantly correlated with greater symmetry in knee-extensor isometric (63%; rs = 0.567, P = .002) and isokinetic (68%; rs = 0.540, P = .003) strength, as well as greater cross-sectional area of the vastus medialis (78%; rs = 0.519, P = .006) and vastus lateralis (82%; rs = 0.752, P < .001). A higher International Knee Documentation Committee questionnaire score (82.2) was significantly correlated with greater symmetry in knee-extensor isokinetic strength (rs = 0.379, P = .039). CONCLUSIONS Although deficits were observed in the surgical limb for all neuromuscular measures, greater symmetry in the size and strength of the quadriceps, rather than activation, was more strongly associated with physical performance after ACLR. Greater symmetry in strength was also more strongly associated with patient-reported function.
Collapse
Affiliation(s)
| | | | - Harris S Slone
- Department of Orthopaedics, College of Medicine, and Department of Health Science & Research, Medical University of South Carolina, Charleston
| | - Chris M Gregory
- Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston
| |
Collapse
|
96
|
Abstract
INTRODUCTION Ruptures of the anterior cruciate ligament (ACL) can be accompanied by meniscal lesions. Generally, the rehabilitation protocols are altered by meniscal repair. Therefore, the aim of this study was to investigate the effect of meniscal repair on the early recovery of thigh muscle strength in ACL reconstruction (ACLR). MATERIALS AND METHODS We performed a matched cohort analysis of n = 122 isolated ACLR (CON) compared to n = 61 ACLR with meniscal repair (ACLR + MR). The subgroups of meniscal repair consisted of 30 patients who had undergone medial meniscus repairs (MM), 19 lateral meniscus repairs (LM) and 12 repairs of medial and lateral meniscus (BM). Isokinetic strength measurement was performed pre-operatively and 6 months post-surgery to perform a cross-sectional and a longitudinal analysis. All injuries were unilateral, and the outcome measures were compared to the non-affected contralateral leg. RESULTS Six months postoperatively overall there is no significant difference between the groups (extension strength MR 82% vs. CON 85% and flexion strength 86% vs. 88%, resp.). Subgroup analysis showed that medial repairs exhibit a comparable leg symmetry while lateral repairs performed worse with leg symmetry being 76% in extension and 81% in flexion strength. Patients undergoing BM repair performed in between lateral and medial repairs (82% extension, 86% flexion). CONCLUSION Generally, meniscal repair in conjunction with ACLR does not significantly alter the recovery of limb symmetry in strength at 6 months postoperatively. Interestingly, medial repairs seem to perform superior to lateral meniscal repair and repair of both menisci. Since the recovery of symmetric strength is a major factor in rehabilitation testing, these results will help to advise surgeons on appropriate rehabilitation protocols and setting realistic goals for the injured athlete. LEVEL OF EVIDENCE III, retrospective cohort study.
Collapse
|
97
|
Ishibashi Y, Adachi N, Koga H, Kondo E, Kuroda R, Mae T, Uchio Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci 2020; 25:6-45. [PMID: 31843222 DOI: 10.1016/j.jos.2019.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND This clinical guideline presents recommendations for the management of patients with anterior cruciate ligament (ACL) injury, endorsed by the Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). METHODS The JOA ACL guideline committee revised the previous guideline based on "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which proposed a desirable method for preparing clinical guidelines in Japan. Furthermore, the importance of "the balance of benefit and harm" was also emphasized. This guideline consists of 21 clinical questions (CQ) and 23 background questions (BQ). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS We evaluated the objectives and results of each study in order to make a decision on the level of evidence so as to integrate the results with our recommendations for each CQ. For BQ, the guideline committee proposed recommendations based on the literature. CONCLUSIONS This guideline is intended to be used by physicians, orthopedic surgeons, physical therapists, and athletic trainers managing ACL injuries. We hope that this guideline is useful for appropriate decision-making and improved management of ACL injuries.
Collapse
Affiliation(s)
- Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Japan
| |
Collapse
|
98
|
O'Connor RF, King E, Richter C, Webster KE, Falvey ÉC. No Relationship Between Strength and Power Scores and Anterior Cruciate Ligament Return to Sport After Injury Scale 9 Months After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2020; 48:78-84. [PMID: 31877093 DOI: 10.1177/0363546519887952] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Psychological factors including self-reported readiness to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) measured with the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale have been shown to correlate with RTS. Physical deficits have been shown to exist in the later stages after ACLR rehabilitation. No previous studies have investigated the relationship between self-reported readiness to RTS and objective physical measures of power and strength. PURPOSE To investigate the relationship between ACL-RSI scores and measures of strength and power scores after ACLR. STUDY DESIGN Case control study; Level of evidence, 3. METHODS This study recruited 452 male athletes who had undergone primary ACLR. Each athlete completed the ACL-RSI questionnaire, isokinetic strength testing, and jump testing approximately 9 months after surgery. RESULTS ACL-RSI scores showed a trivial or weak correlation with strength and power measures at 9 months after surgery (r = 0.06-0.16). Similar results were found for the relationship between ACL-RSI scores and limb symmetry index for strength and power measures (r = 0.04-0.15). Comparing the strength and power measures of athletes with higher (≥90) ACL-RSI scores (n = 93) versus athletes with lower (≤75) ACL-RSI scores (n = 92) showed no significant differences except for isokinetic hamstring strength, but with a trivial effect size (P = .040; effect size = 0.15). CONCLUSION Self-reported readiness to RTS as measured by the ACL-RSI had little or no relationship with athletes' strength and power measures, and there was no meaningful difference in strength and power between athletes with higher and lower ACL-RSI scores at 9 months after ACLR. The findings suggest that psychological recovery and physical recovery after ACLR are different constructs, and strategies to measure and address each construct separately may be necessary to ensure successful RTS after ACLR.
Collapse
Affiliation(s)
- Richard F O'Connor
- Department of Medicine, University College Cork, Cork, Republic of Ireland.,Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland
| | - Enda King
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland
| | - Chris Richter
- Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Éanna Cian Falvey
- Department of Medicine, University College Cork, Cork, Republic of Ireland.,Sports Medicine Research Department, Sports Surgery Clinic, Santry Demesne, Dublin, Republic of Ireland
| |
Collapse
|
99
|
Lee RJ, Margalit A, Nduaguba A, Gunderson MA, Wells L. Obesity and recovery of muscle strength after anterior cruciate ligament reconstruction in pediatric patients. J Orthop Surg (Hong Kong) 2019; 26:2309499018806631. [PMID: 30352544 DOI: 10.1177/2309499018806631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE: To explore factors influencing muscle strength after anterior cruciate ligament (ACL) reconstruction (ACLR) in pediatric patients. We hypothesized that obesity/overweight, autograft hamstring tendon, and concomitant injuries would be associated with slower muscle recovery. METHODS: We retrospectively reviewed the records of pediatric ACLR patients during a 3-year period. Muscle recovery was defined as ≥85% of peak torque compared with the contralateral side. We categorized patients as either obese/overweight or normal weight. Statistical analysis was performed using Mann-Whitney U, analysis of variance, and χ2 tests ( α level < 0.05). RESULTS: The study group consisted of 330 patients, of whom 198 (60%) and 231 (70%) met quadriceps and hamstring recovery criteria, respectively, at final testing (mean: 7.0 ± 3.2 months). Patients recovered hamstring and quadriceps strength at a mean of 5.3 ± 2.2 months and 6.1 ± 2.3 months, respectively. Hamstring muscle recovery took significantly longer in obese/overweight patients (mean: 5.7 ± 2.2 months) versus normal-weight patients (mean: 5.1 ± 2.1 months; p = 0.025), but quadriceps recovery did not (obese/overweight mean: 6.5 ± 2.6 months; normal-weight mean: 5.9 ± 2.1 months; p = 0.173). CONCLUSION: Concomitant injuries and graft type were not associated with length of time to recovery of muscle strength. Obesity/overweight was associated with delay in recovery of hamstring but not quadriceps strength.
Collapse
Affiliation(s)
- R Jay Lee
- 1 Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adam Margalit
- 1 Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Afam Nduaguba
- 2 Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melissa A Gunderson
- 2 Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lawrence Wells
- 2 Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
100
|
Kellis E, Galanis N, Kofotolis N. Hamstring-to-Quadriceps Ratio in Female Athletes with a Previous Hamstring Injury, Anterior Cruciate Ligament Reconstruction, and Controls. Sports (Basel) 2019; 7:sports7100214. [PMID: 31569442 PMCID: PMC6835705 DOI: 10.3390/sports7100214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/22/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022] Open
Abstract
Muscle strength imbalances around the knee are often observed in athletes after anterior cruciate ligament (ACL) surgery and hamstring muscle injury. This study examined three hamstrings-to-quadriceps (H:Q) strength ratio types (conventional, functional, and mixed) in thirteen female athletes with a history of hamstring injury, fourteen basketball players following ACL reconstruction and 34 controls. The conventional (concentric H:Q) peak torque ratio was evaluated at 120°·s−1 and 240°·s−1. The functional (eccentric hamstring to concentric quadriceps) torque ratio was evaluated at 120°·s−1. Finally, the mixed (eccentric hamstrings at 30°·s−1 to concentric quadriceps at 240°·s−1) torque ratio was calculated. Both ACL and the hamstring-injured groups showed a lower quadriceps and hamstrings strength compared with controls (p < 0.05). However, non-significant group differences in the H:Q ratio were found (p > 0.05). Isokinetic assessment of muscle strength may be useful for setting appropriate targets of training programs for athletes with a history of ACL surgery or hamstring strain. However, isokinetic evaluation of the H:Q ratio is not injury—specific and it does not vary between different methods of calculating the H:Q ratio.
Collapse
Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, 62100 Thessaloniki, Greece.
| | - Nikiforos Galanis
- Division of Sports Medicine, Department of Orthopaedics, General Hospital Papageorgiou, Aristotle University of Thessaloniki Medical School, 56403 Thessaloniki, Greece.
| | - Nikolaos Kofotolis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, 62100 Thessaloniki, Greece.
| |
Collapse
|