51
|
Nuccio S, Labanca L, Rocchi JE, Mariani PP, Sbriccoli P, Macaluso A. Altered Knee Laxity and Stiffness in Response to a Soccer Match Simulation in Players Returning to Sport Within 12 Months After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:2150-2158. [PMID: 34038185 DOI: 10.1177/03635465211013020] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The acute effects of exercise on anterior knee laxity (AKL) and anterior knee stiffness (AKS) have been documented in healthy participants, but only limited evidence has been provided for athletes cleared to return to sports after anterior cruciate ligament (ACL) reconstruction (ACLR). PURPOSE/HYPOTHESIS The purpose was to determine if 45 minutes of a soccer match simulation lead to acute changes in AKL and AKS in soccer players returning to sport within 12 months after ACLR. We hypothesized that the reconstructed knee of the ACLR group would exhibit an altered response to sport-specific exercise. STUDY DESIGN Controlled laboratory study. METHODS A total of 13 soccer players cleared to return to sport after ACLR and 13 healthy control soccer players matched for age, physical activity level, limb dominance, and anthropometric characteristics were recruited. To assess the effects of a standardized soccer match simulation (Soccer Aerobic Field Test [SAFT45]) on AKL and AKS, an arthrometric evaluation was carried out bilaterally before and immediately after SAFT45. To conduct a comprehensive examination of the force-displacement curve, the absolute and side-to-side difference (SSD) values of both AKL and AKS were extracted at 67, 134, and 200 N. RESULTS The ACLR and control groups showed similar AKL and AKS at baseline (P > .05). In response to SAFT45, laxity increased bilaterally at all force levels by 14% to 17% only in the control group (P < .025). Similarly, AKS at 134 and 200 N decreased in response to SAFT45 only in the control group (10.5% and 20.5%, respectively; P < .025). After SAFT45, the ACLR group had 1.9 and 2.5 times higher SSDs of AKS at 67 and 134 N compared with the control group, respectively (P < .025), as well as a 1.9 times higher SSD of AKS at 134 N compared with baseline (P = .014). CONCLUSION Soccer players at the time of return to sport after ACLR showed an altered mechanical response to a sport-specific match simulation consisting of bilaterally unchanged AKL and AKS. CLINICAL RELEVANCE Soccer players showing altered AKL and AKS in response to exercise after ACLR may not be ready to sustain their preinjury levels of sport, thus potentially increasing the risk of second ACL injuries.
Collapse
Affiliation(s)
- Stefano Nuccio
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Luciana Labanca
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Jacopo Emanuele Rocchi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.,Villa Stuart Sport Clinic, Rome, Italy
| | - Pier Paolo Mariani
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.,Villa Stuart Sport Clinic, Rome, Italy
| | - Paola Sbriccoli
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.,Villa Stuart Sport Clinic, Rome, Italy
| |
Collapse
|
52
|
Malafronte J, Hannon J, Goto S, Singleton SB, Dietrich L, Garrison JC, Kovacs T. Limb dominance influences energy absorption contribution (EAC) during landing after anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 50:42-49. [PMID: 33865217 DOI: 10.1016/j.ptsp.2021.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the role of limb dominance on energy absorption contribution (EAC) during a jump landing (JL) task at return to sport (RTS) after ACL-R. DESIGN Cross-sectional study. SETTING Clinical Research Laboratory. PARTICIPANTS One hundred eight participants (age = 16.19 ± 1.74, Height = 172.25 ± 9.96 cm, Weight = 72.61 ± 15.48 kg). MAIN OUTCOME MEASURES Participants were grouped into two groups: those who injured their dominant limb ACL (D-ACL) and those who injured their non-dominant limb ACL (ND-ACL). A multiple analysis of variance (MANOVA) was used to assess for between group differences in EAC across the three joints. RESULTS In the surgical limb, D-ACL demonstrated smaller hip (D-ACL = 32.23 ± 10.44%, ND-ACL = 69.68 ± 8.51%, p < 0.008) and greater knee (D-ACL = 45.86 ± 10.36%, ND-ACL = 9.41 ± 5.68%, p < 0.008) EAC than ND-ACL. In the non-surgical limb, D-ACL demonstrated greater hip (D-ACL = 62.59 ± 9.03%, ND-ACL = 25.95 ± 7.15%, p < 0.008), and smaller knee (D-ACL = 13.79 ± 5.57%, ND-ACL = 58.01 ± 7.86%, p < 0.008), EAC than ND-ACL. CONCLUSION After ACL-R, eccentric loading strategies during a JL task at RTS are different depending upon limb dominance. D-ACL demonstrated a greater knee loading strategy on the surgical side compared to ND-ACL.
Collapse
Affiliation(s)
- Jack Malafronte
- PT Solutions, 2221 S. Dale Mabry Hwy, Tampa, FL, 33629, USA.
| | - Joseph Hannon
- Texas Health Sports Medicine Southwest, 6301 Harris Pkwy. Suite 150, Fort Worth, TX, 76132, USA
| | - Shiho Goto
- Texas Health Sports Medicine Southwest, 6301 Harris Pkwy. Suite 150, Fort Worth, TX, 76132, USA
| | - Steve B Singleton
- Fort Worth Orthopedics, 6301 Harris Pkwy. Suite 200, Fort Worth, TX, 76132, USA
| | - Lindsey Dietrich
- Sideline Orthopedics and Sports, 4401 Park Springs Blvd. Suite 130, Arlington, TX, 76017, USA
| | - J Craig Garrison
- Northwestern University, Department of Physical Therapy & Human Movement Sciences: Feinberg School of Medicine, Chicago, IL, USA
| | - Trevor Kovacs
- Elite Orthosport Physical Therapy and Performance, 12121 Wilshire Blvd, Unit 100, Los Angeles, CA, 90025, USA
| |
Collapse
|
53
|
Lindanger L, Strand T, Mølster AO, Solheim E, Inderhaug E. Effect of Early Residual Laxity After Anterior Cruciate Ligament Reconstruction on Long-term Laxity, Graft Failure, Return to Sports, and Subjective Outcome at 25 Years. Am J Sports Med 2021; 49:1227-1235. [PMID: 33656379 DOI: 10.1177/0363546521990801] [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 In spite of supposedly successful surgery, slight residual knee laxity may be found at follow-up evaluations after anterior cruciate ligament reconstruction (ACLR), and its clinical effect is undetermined. PURPOSE To investigate whether a 3- to 5-mm increase in anterior translation 6 months after ACLR affects the risk of graft failure, rate of return to sports, and long-term outcome. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS From a cohort of 234 soccer, team handball, and basketball players undergoing ACLR using bone-patellar tendon-bone graft, 151 athletes were included who attended 6-month follow-up that included KT-1000 arthrometer measures. A tight graft was defined as <3-mm side-to-side difference between knees (n = 129), a slightly loose graft as 3 to 5 mm (n = 20), and a loose graft as >5 mm (n = 2). Graft failure was defined as ACL revision surgery, >5-mm side-to-side difference, or anterolateral rotational instability 2+ or 3+ at 2-year follow-up. Finally, a 25-year evaluation was performed, including a clinical examination and questionnaires. RESULTS The rate of return to pivoting sports was 74% among athletes with tight grafts and 70% among those with slightly loose grafts. Also, return to preinjury level of sports was similar between those with slightly loose and tight grafts (40% vs 48%, respectively), but median duration of the sports career was longer among patients with tight grafts: 6 years (range, 1-25 years) vs 2 years (range, 1-15 years) (P = .01). Five slightly loose grafts (28%) and 6 tight grafts (5%) were classified as failures after 2 years (P = .002). Thirty percent (n = 6) of patients with slightly loose grafts and 6% (n = 8) with tight grafts had undergone revision (P = .004) by follow-up (25 years, range, 22-30 years). Anterior translation was still increased among the slightly loose grafts as compared with tight grafts at long-term follow-up (P < .05). In patients with tight grafts, 94% had a Lysholm score ≥84 after 24 months and 58% after 25 years, as opposed to 78% (P = .02) and 33% (P = .048), respectively, among patients with slightly loose grafts. CONCLUSION A slightly loose graft at 6 months after ACLR increased the risk of later ACL revision surgery and/or graft failure, reduced the length of the athlete's sports career, caused permanent increased anterior laxity, and led to an inferior Lysholm score.
Collapse
Affiliation(s)
- Line Lindanger
- Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Torbjørn Strand
- Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Orthopedics, Haukeland University Hospital, The Coastal Hospital at Hagevik, Bergen, Norway
| | - Anders Odd Mølster
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eirik Solheim
- Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eivind Inderhaug
- Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
54
|
Age, rehabilitation and surgery characteristics are re-injury risk factors for adolescents following anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 49:196-203. [PMID: 33765648 DOI: 10.1016/j.ptsp.2021.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine the effect of age on post-ACLR rehabilitative outcomes and identify surgical/rehabilitative characteristics as ACL re-injury risk factors in adolescents. DESIGN Cohort study. SETTING Children's hospital. PARTICIPANTS 273 adolescents with first-time ACLR. MAIN OUTCOME MEASURES Demographics, injury history, surgery, and outcomes documented during post-ACLR physical therapy (PT) sessions were extracted from medical records. Effects of age on outcomes were examined using multivariate regression. ACL re-injury risk factors were identified using survival analysis with Cox regression. RESULTS Re-injury was recorded in 47 patients (17.2%) with a median follow-up time of 3.1 years and median re-injury time of 13.4 months post-surgery. Younger age (Hazard-Ratio, HR = 1.264 per year decrease; P = 0.005), receiving surgery within 1 month post-injury (HR = 3.378 vs. >3 months; P = 0.012), starting PT within 3 days post-surgery (HR = 3.068; P = 0.022), and decreased number of PT sessions (HR = 1.118 per 3-session decrease; P = 0.010) increased re-injury risk. Although age was associated with re-injury risk, age was not associated with any outcome (P > 0.059). CONCLUSION Adolescents who are younger, receive surgery and post-surgery PT sooner, or attend fewer PT sessions may be at an increased re-injury risk. Younger patients achieved similar outcomes despite elevated re-injury risk. Current discharge criteria are inadequate in identifying high re-injury risk patients.
Collapse
|
55
|
van Kuijk KS, Eggerding V, Reijman M, van Meer BL, Bierma-Zeinstra SM, van Arkel E, Waarsing JH, Meuffels DE. Differences in Knee Shape between ACL Injured and Non-Injured: A Matched Case-Control Study of 168 Patients. J Clin Med 2021; 10:jcm10050968. [PMID: 33801168 PMCID: PMC7957627 DOI: 10.3390/jcm10050968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Anterior cruciate ligament (ACL) injury prevention programs could be more effective if we could select patients at risk for sustaining an ACL rupture. The purpose of this study is to identify radiographic shape variants of the knee between patients with and patients without an ACL rupture. METHODS We compared the lateral and Rosenberg view X-rays of 168 prospectively followed patients with a ruptured ACL to a control group with intact ACLs, matched for gender, after knee trauma. We used statistical shape modeling software to examine knee shape and find differences in shape variants between both groups. RESULTS In the Rosenberg view X-rays, we found five shape variants to be significantly different between patients with an ACL rupture and patients with an intact ACL but with knee trauma. Overall, patients who had ruptured their ACL had smaller, flatter intercondylar notches, a lower lateral tibia plateau, a lower medial spike of the eminence, and a smaller tibial eminence compared to control patients. CONCLUSION Patients with an ACL rupture have smaller intercondylar notches and smaller tibial eminences in comparison to patients with an intact ACL after knee trauma.
Collapse
Affiliation(s)
- Koen S.R. van Kuijk
- Department of Orthopedic Surgery, Erasmus MC University Medical Centre, 3015 CN Rotterdam, The Netherlands; (V.E.); (M.R.); (S.M.A.B.-Z.); (J.H.W.); (D.E.M.)
- Department of Radiology, Albert Schweitzer hospital, 3318 AT Dordrecht, The Netherlands
- Correspondence:
| | - Vincent Eggerding
- Department of Orthopedic Surgery, Erasmus MC University Medical Centre, 3015 CN Rotterdam, The Netherlands; (V.E.); (M.R.); (S.M.A.B.-Z.); (J.H.W.); (D.E.M.)
| | - Max Reijman
- Department of Orthopedic Surgery, Erasmus MC University Medical Centre, 3015 CN Rotterdam, The Netherlands; (V.E.); (M.R.); (S.M.A.B.-Z.); (J.H.W.); (D.E.M.)
| | - Belle L. van Meer
- Department of Sports Medicine, St Antonius Hospital, 3543 AZ Utrecht, The Netherlands;
| | - Sita M.A. Bierma-Zeinstra
- Department of Orthopedic Surgery, Erasmus MC University Medical Centre, 3015 CN Rotterdam, The Netherlands; (V.E.); (M.R.); (S.M.A.B.-Z.); (J.H.W.); (D.E.M.)
- Department of General Practice, Erasmus MC University Medical Centre, 3015 CN Rotterdam, The Netherlands
| | - Ewoud van Arkel
- Department of Orthopaedic Surgery, Haaglanden Medical Centre Haaglanden, 2512 VA The Hague, The Netherlands;
| | - Jan H. Waarsing
- Department of Orthopedic Surgery, Erasmus MC University Medical Centre, 3015 CN Rotterdam, The Netherlands; (V.E.); (M.R.); (S.M.A.B.-Z.); (J.H.W.); (D.E.M.)
| | - Duncan E. Meuffels
- Department of Orthopedic Surgery, Erasmus MC University Medical Centre, 3015 CN Rotterdam, The Netherlands; (V.E.); (M.R.); (S.M.A.B.-Z.); (J.H.W.); (D.E.M.)
| |
Collapse
|
56
|
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
|
57
|
运 行, 魏 钰, 李 众, 刘 玉, 王 志, 张 强, 刘 洋, 魏 民. [Mid-term effectiveness of anterior cruciate ligament revision]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:58-63. [PMID: 33448200 PMCID: PMC8171610 DOI: 10.7507/1002-1892.202008125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/16/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the mid-term effectiveness of anterior cruciate ligament (ACL) revision and to analyze the relevant factors that may affect the surgical outcomes. METHODS The clinical data of 24 patients who underwent ACL revision surgery between April 2009 and July 2018 and were followed up for more than 2 years were retrospectively analyzed. There were 20 males and 4 females with a median age of 30 years [interquartile distance (IQR) was (25, 36) years]. The median body mass index was 24.45 kg/m 2 and IQR was (22.93, 25.93) kg/m 2. The median time between ACL revision and reconstruction was 41 months and IQR was (15, 85) months. The direct cause of the failure of reconstruction surgery included 14 cases of trauma, 8 cases of no obvious cause, and 2 cases of infection. During the revision operation, 14 patients had a poor bone tunnel position, all of which were drilled with new tunnels, the remaining 10 patients were freshly modified on the basis of the original bone tunnel. Seventeen patients used autogenous tendon revision, 7 patients used LARS ligament; 16 patients had cartilage injury. The Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Tegner sports rating score were used for functional evaluation before operation, at 1 year after operation, and at last follow-up. The Likert satisfaction score was recorded at last follow-up. RESULTS Patients were followed up with a median time of 47 months and IQR was (32, 61) months. The Lysholm score, IKDC score, and Tegner sports rating score were significantly improved at 1 year after operation and at last follow-up when compared with preoperative scores ( P<0.05). There was no significant difference between at last follow-up and at 1 year after operation ( P>0.05). At last follow-up, the median Likert satisfaction score was 4.0 and IQR was (3.0, 4.5). According to the presence or absence of cartilage damage and the type of graft, the above scores at last follow-up were compared between the groups, and the differences were not significant ( P>0.05). At last follow-up, 2 patients had graft fractures due to trauma again, and autogenous iliac bones were taken to fill the bone tunnel, and the second stage was revised; the rest of the patients recovered satisfactorily. CONCLUSION With preoperative identification of the cause of ACL reconstruction failure, the stability and function of knee joint can be significantly improved by selecting appropriate bone tunnels and grafts during the revision and by active rehabilitation exercises.
Collapse
Affiliation(s)
- 行 运
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopaedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 钰 魏
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopaedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 众利 李
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopaedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 玉杰 刘
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopaedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 志刚 王
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopaedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 强 张
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopaedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 洋 刘
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopaedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 民 魏
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopaedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| |
Collapse
|
58
|
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]
|
59
|
DeFazio MW, Curry EJ, Gustin MJ, Sing DC, Abdul-Rassoul H, Ma R, Fu F, Li X. Return to Sport After ACL Reconstruction With a BTB Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120964919. [PMID: 33403206 PMCID: PMC7745570 DOI: 10.1177/2325967120964919] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) tears are debilitating injuries frequently suffered by athletes. ACL reconstruction is indicated to restore knee stability and allow patients to return to prior levels of athletic performance. While existing literature suggests that patient-reported outcomes are similar between bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts, there is less information comparing return-to-sport (RTS) rates between the 2 graft types. Purpose To compare RTS rates among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft. Study Design Systematic review; Level of evidence, 4. Methods The MEDLINE, Embase, and Cochrane Library databases were searched, and studies that reported on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Studies that utilized ACL repair techniques, quadriceps tendon autografts, graft augmentation, double-bundle autografts, allografts, or revision ACL reconstruction were excluded. RTS information was extracted and analyzed from all included studies. Results Included in the review were 20 articles investigating a total of 2348 athletes. The overall RTS rate in our cohort was 73.2%, with 48.9% returning to preinjury levels of performance and a rerupture rate of 2.4%. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 81.0%, with 50.0% of athletes returning to preinjury levels of performance and a rerupture rate of 2.2%. Patients after primary ACL reconstruction with an HT autograft had an overall RTS rate of 70.6%, with 48.5% of athletes returning to preinjury levels of performance and a rerupture rate of 2.5%. Conclusion ACL reconstruction using BTB autografts demonstrated higher overall RTS rates when compared with HT autografts. However, BTB and HT autografts had similar rates of return to preinjury levels of performance and rerupture rates. Less than half of the athletes were able to return to preinjury sport levels after ACL reconstruction with either an HT or BTB autograft.
Collapse
Affiliation(s)
- Matthew W DeFazio
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Michael J Gustin
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David C Sing
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Hussein Abdul-Rassoul
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Richard Ma
- Missouri Orthopaedic Institute, Columbia, Missouri, USA
| | - Freddie Fu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
60
|
Marom N, Ouanezar H, Jahandar H, Zayyad ZA, Fraychineaud T, Hurwit D, Imhauser CW, Wickiewicz TL, Pearle AD, Nawabi DH. Lateral Extra-articular Tenodesis Reduces Anterior Cruciate Ligament Graft Force and Anterior Tibial Translation in Response to Applied Pivoting and Anterior Drawer Loads. Am J Sports Med 2020; 48:3183-3193. [PMID: 33017168 DOI: 10.1177/0363546520959322] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The biomechanical effect of lateral extra-articular tenodesis (LET) performed in conjunction with anterior cruciate ligament (ACL) reconstruction (ACLR) on load sharing between the ACL graft and the LET and on knee kinematics is not clear. PURPOSE/HYPOTHESIS The purpose was to quantify the effect of LET on (1) forces carried by both the ACL graft and the LET and (2) tibiofemoral kinematics in response to simulated pivot shift and anterior laxity tests. We hypothesized that LET would decrease forces carried by the ACL graft and anterior tibial translation (ATT) in response to simulated pivoting maneuvers and during simulated tests of anterior laxity. STUDY DESIGN Controlled laboratory study. METHODS Seven cadaveric knees (mean age, 39 ± 12 years [range, 28-54 years]; 4 male) were mounted to a robotic manipulator. The robot simulated clinical pivoting maneuvers and tests of anterior laxity: namely, the Lachman and anterior drawer tests. Each knee was assessed in the following states: ACL intact, ACL sectioned, ACL reconstructed (using a bone-patellar tendon-bone autograft), and after performing LET (the modified Lemaire technique after sectioning of the anterolateral ligament and Kaplan fibers). Resultant forces carried by the ACL graft and LET at the peak applied loads were determined via superposition. ATT was determined in response to the applied loads. RESULTS With the applied pivoting loads, performing LET decreased ACL graft force up to 80% (44 ± 12 N; P < .001) and decreased ATT of the lateral compartment compared with that of the intact knee up to 7.6 ± 2.9 mm (P < .001). The LET carried up to 91% of the force generated in the ACL graft during isolated ACLR (without LET). For simulated tests of anterior laxity, performing LET decreased ACL graft force by 70% (40 ± 20 N; P = .001) for the anterior drawer test with no significant difference detected for the Lachman test. No differences in ATT were deteced between ACLR with LET and the intact knee on both the Lachman and the anterior drawer tests (P = .409). LET reduced ATT compared with isolated ACLR on the simulated anterior drawer test by 2.4 ± 1.8 mm (P = .032) but not on the simulated Lachman test. CONCLUSION In a cadaveric model, LET in combination with ACLR transferred loads from the ACL graft to the LET and reduced ATT with applied pivoting loads and during the simulated anterior drawer test. The effect of LET on ACL graft force and ATT was less pronounced on the simulated Lachman test. CLINICAL RELEVANCE LET in addition to ACLR may be a suitable option to offload the ACL graft and to reduce ATT in the lateral compartment to magnitudes less than that of the intact knee with clinical pivoting maneuvers. In contrast, LET did not offload the ACL graft or add to the anterior restraint provided by the ACL graft during the Lachman test.
Collapse
Affiliation(s)
- Niv Marom
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Hervé Ouanezar
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Hamidreza Jahandar
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Zaid A Zayyad
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Thomas Fraychineaud
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Daniel Hurwit
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Thomas L Wickiewicz
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Danyal H Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
61
|
Return to sports bridge program improves outcomes, decreases ipsilateral knee re-injury and contralateral knee injury rates post-ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:3676-3685. [PMID: 32699921 DOI: 10.1007/s00167-020-06162-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To present the results of a return to sports bridge program designed to reduce knee injuries following ACL reconstruction and physical therapy. METHODS One hundred and fifty (male = 83, female = 67) patients participated in a whole body neuromuscular control, progressive resistance strength and agility training program. Post-program testing included functional movement form, dynamic knee stability, lower extremity power, agility, and sports skill assessments. Participants completed the Knee Outcome Survey-Sports Activity Scale (KOS-SAS) before and after program initiation. Pre-participation scores were re-estimated following program completion. RESULTS Global rating KOS-SAS score at program entry was 75 ± 13. Post-program global rating and calculated KOS-SAS were 91.0 ± 9.8 and 90.9 ± 9.7, respectively (p < 0.0001). Pre-participation KOS-SAS score re-estimates at program completion were 54.5 ± 23.3 and 57.3 ± 18.5, respectively. The approximately 20% lower pre-program KOS-SAS score re-estimates (p < 0.0001) observed at program completion suggests that subjects had inaccurately high sports readiness perceptions at program entry. Perceived overall sports activity knee function ratings improved from 2.9 ± 0.6 (abnormal) at program entry to 1.3 ± 0.5 (normal) at completion (p < 0.0001). Most subjects returned back to sports at or above their pre-injury performance skill/performance level (84%, 126/150). By 6.8 ± 3.2 years (range = 2-13 years) post-surgery, ten subjects had sustained an ipsilateral knee re-injury or contralateral knee injury (6.7%). The 2.7% non-contact contralateral and 1.3% non-contact ipsilateral knee injury rates observed were significantly lower than those cited in previous reports. CONCLUSION Supplementing primary ACL reconstruction and standard physical therapy with a return to sports bridge program prior to release to unrestricted sports performance was effective at improving patient outcomes and decreasing ipsilateral knee re-injury and contralateral knee injury rates. LEVEL OF EVIDENCE II.
Collapse
|
62
|
Tramer JS, Khalil LS, Ziedas A, Mehran N, Okoroha KR. Return to Play and Performance in the Women's National Basketball Association After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2020; 8:2325967120947078. [PMID: 32984422 PMCID: PMC7498979 DOI: 10.1177/2325967120947078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/06/2020] [Indexed: 01/13/2023] Open
Abstract
Background: The incidence of anterior cruciate ligament (ACL) injuries in Women’s
National Basketball Association (WNBA) athletes continues to increase. There
is a paucity of data regarding return-to-play (RTP) rates and performance
after ACL reconstruction in these athletes. Purpose: To quantify RTP rates and performance after ACL reconstruction in WNBA
athletes. Study Design: Cohort study; Level of evidence, 3. Methods: All ACL tears sustained in the WNBA from 1997 through 2018 were identified.
Body mass index (BMI), age, and position at the time of injury were
collected for each player. RTP rates were calculated, and performance data
were collected for each player before and after injury to determine changes
in playing time and statistical performance. Players who successfully
returned to play after ACL reconstruction were compared with a group of
healthy controls who were matched by age, years of experience, position,
height, and BMI. Statistics at 1 and 3 years after injury were compared to
assess acute and longitudinal changes in performance relative to preinjury
baseline. Results: A total of 59 WNBA players sustained ACL tears during the study period, and
41 (69.5%) were able to successfully RTP. Players played a mean of 7.5 ±
12.8 fewer games, played 5.0 ± 9.2 fewer minutes per game, and scored 3.7 ±
5.0 fewer points per game in their first year after RTP compared with the
year before injury. Athletes with ACL reconstruction demonstrated
significantly decreased performance measures regarding games played, games
started, minutes, rebounds, assists, and blocks per game in their first
season after RTP compared with control athletes in the same indexed year;
however, these differences resolved by year 3 after surgery. Conclusion: WNBA athletes have a high RTP rate after ACL reconstruction. Players may
experience an initial decrease in playing time and performance when
returning to play; however, these variables were found to return to baseline
over time.
Collapse
Affiliation(s)
- Joseph S Tramer
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lafi S Khalil
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Alexander Ziedas
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nima Mehran
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| |
Collapse
|
63
|
What is the optimal time for return to sports after anterior cruciate ligament reconstruction? Jt Dis Relat Surg 2020; 31:1. [PMID: 32160485 PMCID: PMC7489119 DOI: 10.5606/ehc.2020.57891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|