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Coronado RA, Sterling EK, Fenster DE, Bird ML, Heritage AJ, Woosley VL, Burston AM, Henry AL, Huston LJ, Vanston SW, Cox CL, Sullivan JP, Wegener ST, Spindler KP, Archer KR. Cognitive-behavioral-based physical therapy to enhance return to sport after anterior cruciate ligament reconstruction: An open pilot study. Phys Ther Sport 2020; 42:82-90. [PMID: 31954959 DOI: 10.1016/j.ptsp.2020.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/30/2019] [Accepted: 01/06/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To describe feasibility, adherence, acceptability, and outcomes of a cognitive-behavioral-based physical therapy (CBPT-ACLR) intervention for improving postoperative recovery after anterior cruciate ligament reconstruction (ACLR). DESIGN Pilot study. SETTING Academic medical center. PARTICIPANTS Eight patients (mean age [SD] = 20.1 [2.6] years, 6 females) participated in a 7-session telephone-based CBPT-ACLR intervention beginning preoperatively and lasting 8 weeks after surgery. MAIN OUTCOME MEASURES At 6 months, patients completed Knee Injury and Osteoarthritis Outcome Score (KOOS) sports/recreation and quality of life (QOL) subscales, International Knee Documentation Committee (IKDC), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), and Knee Self-Efficacy Scale (K-SES), return to sport (Subjective Patient Outcome for Return to Sports), and satisfaction. Minimal clinically important difference (MCID) was used for meaningful change. RESULTS Seven (88%) patients completed all sessions. Seven (88%) patients exceeded MCID on the TSK, 6 (75%) on the PCS, 5 (63%) on the KOOS sports/recreation subscale, 4 (50%) on the IKDC, and 3 (38%) on the KOOS QOL subscale. Three (38%) patients returned to their same sport at the same level of effort and performance. All patients were satisfied with their recovery. CONCLUSIONS A CBPT-ACLR program is feasible and acceptable for addressing psychological risk factors after ACLR.
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Affiliation(s)
- Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emma K Sterling
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dana E Fenster
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mackenzie L Bird
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Allan J Heritage
- Department of Psychology, Vanderbilt University, Nashville, TN, USA; Department of Psychology, Counseling & Family Science, Lipscomb University, Nashville, TN, USA
| | | | - Alda M Burston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Abigail L Henry
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura J Huston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan W Vanston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Charles L Cox
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jaron P Sullivan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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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.
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103
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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.
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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
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104
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Timing of anterior cruciate ligament reconstruction and preoperative pain are important predictors for postoperative kinesiophobia. Knee Surg Sports Traumatol Arthrosc 2020; 28:2502-2510. [PMID: 31879792 PMCID: PMC7429522 DOI: 10.1007/s00167-019-05838-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE Fear of movement (kinesiophobia) is a major limiting factor in the return to pre-injury sport level after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to gain insight into the prevalence of kinesiophobia pre-ACLR, 3 months post-ACLR and 12 months post-ACLR. Furthermore, the preoperative predictability of kinesiophobia at 3 months post-ACLR was addressed. METHODS A retrospective study with data, which were prospectively collected as part of standard care, was conducted to evaluate patients who underwent ACLR between January 2017 and December 2018 in an orthopaedic outpatient clinic. Patient characteristics (age, sex, body mass index), injury-to-surgery time, preoperative pain level (KOOS pain subscale) and preoperative knee function (IKDC-2000) were used as potential predictor variables for kinesiophobia (TSK-17) at 3 months post-ACLR in linear regression analysis. RESULTS The number of patients with a high level of kinesiophobia (TSK > 37) reduced from 92 patients (69.2%) preoperatively to 44 patients (43.1%) 3 months postoperatively and 36 patients (30.8%) 12 months postoperatively. The prediction model, based on a multivariable regression analysis, showed a positive correlation between four predictor variables (prolonged injury-to-surgery time, high preoperative pain level, male sex and low body mass index) and a high level of kinesiophobia at 3 months postoperatively (R2 = 0.384, p = 0.02). CONCLUSION The prevalence of kinesiophobia decreases during postoperative rehabilitation, but high kinesiophobia is still present in a large portion of the patients after ACLR. Timing of reconstruction seems to be the strongest predictor for high kinesiophobia 3 months post-ACLR. This study is the first step in the development of a screening tool to detect patients with kinesiophobia after ACLR. Identifying patients preoperatively opens the possibility to treat patients and thereby potentially increase the return to pre-injury sport level rate after ACLR. LEVEL OF EVIDENCE III.
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105
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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.
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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
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106
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Tejpal T, Gupta A, Shanmugaraj A, Horner NS, Simunovic N, Peterson DC, Ayeni OR. Anteromedial Portal Double-Bundle Anterior Cruciate Ligament Reconstruction Yields Similar Outcomes to Non-AMP Femoral Drilling Double-Bundle Techniques: A Systematic Review of Comparative Studies. Orthop J Sports Med 2019; 7:2325967119888140. [PMID: 31853457 PMCID: PMC6906356 DOI: 10.1177/2325967119888140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Biomechanical studies have shown double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) to have increased anterior and rotational stability as compared with single-bundle ACLR. Various techniques exist to drill the femoral tunnel, such as anteromedial portal (AMP), outside-in (OI), and transtibial (TT) drilling. However, it is unclear whether one drilling technique is superior to others when a DB graft is used. Purpose To systematically assess the outcomes and complications in patients undergoing DB ACLR through an AMP technique as compared with other femoral drilling techniques. Study Design Systematic review; Level of evidence, 3. Methods PubMed, Medline, and EMBASE databases were searched in April 2018. Nonrandomized studies were assessed with the MINORS (Methodological Index for Nonrandomized Studies), whereas randomized studies were assessed with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Results Ten studies comprising 722 patients satisfied the inclusion criteria. A total of 351 patients underwent DB ACLR with AMP drilling (mean ± SD age, 32.7 ± 4.7 years); 318 patients had DB ACLR with OI drilling (age, 31.9 ± 4.1 years); and 53 received a DB ACLR with TT drilling (age, 26.5 ± 2.0 years). Graft types used included hamstring autograft (74.1%; n = 247), tibialis anterior autograft (6.0%; n = 20) and unspecified grafts (19.8%; n = 66). No significant difference in postoperative Tegner and Lysholm scores was found between the AMP and OI groups postoperatively. The AMP group had a lower anterior and posterior graft bending angle as compared with the OI group. Four patients (1.1%) in the AMP group had graft reruptures, as compared with 9 reruptures (2.8%) in the OI group. There were no reports of rerupture in the TT group. Conclusion DB AMP ACLR results in significantly improved functional outcome scores postoperatively. AMP techniques yield similar functional outcomes to OI ACLR. No direct comparison in functional outcomes scores were available between the AMP and TT techniques. Low overall complication and revision rates were observed for patients undergoing DB AMP ACLR and were found to be similar to those of other femoral drilling techniques. Owing to a steeper graft bending angle in patients undergoing OI or TT ACLR relative to AMP ACLR, patients treated with OI or TT femoral drilling may have increased strain placed on the graft. Based on the various limitations in the available literature, it is not currently possible to make a definite conclusion of whether AMP is superior to non-AMP techniques in the setting of DB ACLR.
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Affiliation(s)
- Tushar Tejpal
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Gupta
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Devin C Peterson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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107
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Figueroa D, Calvo R, Vaisman A, Arellano S, Figueroa F, Donoso R, Bernal N, O'Connell LA. Arthroscopic Intercondylar Notch Bone Marrow Aspiration During Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2019; 8:e1437-e1441. [PMID: 31890519 PMCID: PMC6928362 DOI: 10.1016/j.eats.2019.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/20/2019] [Indexed: 02/03/2023] Open
Abstract
The anterior cruciate ligament is the most commonly injured ligament, with up to 10% of surgery failure. Atraumatic instability in the early postoperative period (<6 months) occurs as the result of poor surgical technique, failure of graft integration, or early mechanical overload during rehabilitation. Engineered cell therapy is a developing resource designed to increase the rate of tendon-to-bone interface healing. We describe a simple and safe technique to harvest mesenchymal stem cells by arthroscopic bone marrow aspiration from the intercondylar notch.
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Affiliation(s)
| | | | | | | | | | | | | | - Luis A. O'Connell
- Address correspondence to Luis A. O'Connell, M.D., Servicio de Traumatología y Ortopedia de Adultos, Clínica Alemana de Santiago-Universidad del Desarrollo, Av Manquhue Norte 1410, Vitacura, Santiago, Chile.
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108
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Kitagawa T, Matsui N, Nakaizumi D. Impact of combination of therapeutic exercise and psychological intervention for a patient with first-time traumatic shoulder dislocation. J Phys Ther Sci 2019; 31:850-854. [PMID: 31645818 PMCID: PMC6801349 DOI: 10.1589/jpts.31.850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] A young female with first-time traumatic shoulder dislocation showed a good
outcome at the 1 year follow-up in returning to work and sports after undergoing a
combination of exercise therapy and psychological intervention. [Participant and Methods]
A 24-year-old female who worked as an occupational therapist and played badminton for
recreation had dislocated her shoulder in a fall. We evaluated her compliance with
home-exercise, range of motion, return to work, fear of movement, sports activity level,
and instability of shoulder joint using the modified Rowe score at each timepoint
necessary. During early sessions of the physical therapy, the range of motion and
instability score for the shoulder joint were poor. We treated her using a phase-based
approach, and subsequently, added the Watson program to restore normal kinematics. Because
of a psychological problem during middle sessions of the physical therapy, we provided
psychological education and support. [Results] At the final session of the therapy, her
compliance with home-exercise was good. She had achieved almost a full range of motion.
The fear of movement decreased, and she could play sports again. The modified Rowe score
improved from 5 to 85. [Conclusion] As a conservative treatment for patients with
first-time traumatic shoulder instability, a combination of therapeutic exercise and
psychological intervention may be useful.
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Affiliation(s)
- Takashi Kitagawa
- Department of Physical Therapy, School of Health Sciences, Shinshu University: 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan
| | - Nobumasa Matsui
- Department of Rehabilitation, Japanese Red Cross Kanazawa Hospital, Japan
| | - Dai Nakaizumi
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Japan
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109
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Conti C, di Fronso S, Robazza C, Bertollo M. The Injury-Psychological Readiness to return to sport (I-PRRS) scale and the Sport Confidence Inventory (SCI): A cross-cultural validation. Phys Ther Sport 2019; 40:218-224. [PMID: 31610419 DOI: 10.1016/j.ptsp.2019.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purpose of this study was to cross-culturally validate in the Italian language the I-PRRS and the SCI. DESIGN Cross-sectional study. SETTING Injured Italian athletes. PARTICIPANTS We recruited male (n = 73) and female (n = 27) athletes who returned to practice after having completed the rehabilitation. MAIN OUTCOME MEASURES The measures comprised the I-PRRS, the SCI, and the Italian Mood Scale (ITAMS). Athletes completed the questionnaires within 1 day before their first official competition following injury. We investigated the construct validity, the internal consistency, and the concurrent validity of the I-PRRS and SCI with the ITAMS. RESULTS Confirmatory Factor Analysis supported the two-factor structure of the I-PRRS (Confidence in performance capability and Confidence in recovery) and the three-factor structure of the SCI (SC-Physical Skills and Training, SC-Cognitive Efficiency, and SC-Resilience). The reliability scores of both I-PRRS and SCI subscales indicated good internal consistency. Correlation between the I-PRRS and the SCI ranged in magnitude from weak to moderately high. A similar trend of correlations was found between the subscales of the I-PRRS and the ITAMS, as well as between the subscales of the SCI and the ITAMS. CONCLUSIONS Study findings showed satisfactory psychometric properties of the Italian version of the I-PRRS and SCI.
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Affiliation(s)
- Cristiana Conti
- BIND-Behavioral Imaging and Neural Dynamics Center, Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Selenia di Fronso
- BIND-Behavioral Imaging and Neural Dynamics Center, Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Claudio Robazza
- BIND-Behavioral Imaging and Neural Dynamics Center, Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Maurizio Bertollo
- BIND-Behavioral Imaging and Neural Dynamics Center, Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; School of Science, Technology and Engineering, University of Suffolk, Ipswich, UK.
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110
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Flagg KY, Karavatas SG, Thompson S, Bennett C. Current criteria for return to play after anterior cruciate ligament reconstruction: an evidence-based literature review. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S252. [PMID: 31728376 DOI: 10.21037/atm.2019.08.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) has continued to be a popular surgical option in the last decade, and frequently we have seen athletes complete successful surgical intervention and rehabilitation. Even more so, the time that it takes some athletes to return to play (RTP) has gained a lot of media attention. In light of these conditions, we set out to examine the status of research on rehabilitation protocols, tests and measures, and criteria for RTP after ACLR, especially bone-tendon-bone (BTB) procedures. An evidence-based literature review was conducted. PubMed and CINAHL database searches were performed using various combinations of the following keywords: ACL reconstruction, bone to bone graft, rehabilitation. The search was limited to systematic reviews of randomized control trials (RCT) published within the last 10 years in the English language. Ten systematic reviews were identified and nine of them were included in this review. Conflicting and inconsistent evidence exists for determining RTP criteria for athletes following ACLR. None of the systemic reviews established strong evidence for the specific qualities a patient should possess prior to returning to sport in order to minimize reinjury of the same knee or sustaining a new injury to the contralateral limb. There appears to be little consensus on what exactly should constitute RTP testing criteria following an ACLR. In addition, variance exists within the exact rehabilitation timeline and goals used to determine how ACLR rehabilitation protocols are structured. What is currently agreed upon for individuals participating in sports involving side to side/pivoting movements, ACLR is the preferred surgical procedure for returning these individuals back to their respective field of play after an ACL injury.
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Affiliation(s)
- Kala Y Flagg
- Department of Physical Therapy, CNAHS, Howard University, Washington, DC, USA
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111
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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.
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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.
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112
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Vereijken A, Aerts I, van Trijffel E, Meeusen R. TRANSLATION AND VALIDATION OF THE DUTCH INJURY PSYCHOLOGICAL READINESS TO RETURN TO SPORT SCALE (I-PRRS). Int J Sports Phys Ther 2019; 14:785-793. [PMID: 31598416 PMCID: PMC6769267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND In facilitating and predicting successful return to sport (RTS), not only are physical factors important, but also the athlete's psychological status. No questionnaire in the Dutch language exists for measuring psychological readiness for RTS after injuries in general. PURPOSE To translate and validate the Injury-Psychological Readiness to Return to Sport scale into the Dutch language. STUDY DESIGN Cross-sectional, validation study. METHODS One hundred and sixty-eight athletes, returning to high impact sports after lower extremity injuries, completed the Dutch I-PRRS twice. Another 162 athletes who visited their physical therapist for initial intake also completed the questionnaire. Floor and ceiling effects, internal consistency, reproducibility, construct validity, and divergent validity were analyzed. RESULTS The I-PRRS was successfully translated into Dutch and showed no floor or ceiling effects. It had good internal consistency (0.85) and good test-retest reproducibility (ICC 0.74, 95% CI 0.43-0.86) where the lower bound of 95% CI indicates at least fair reproducibility. The SEM was 2.02 and the MDC 5.58 points. There was a significant fair correlation between total scores on the I-PRRS and TSK (rs = 0.41, p<0.001). Athletes who RTS and those who initially visited their physical therapist differed significantly on all items and on total scores (p<0.001). CONCLUSIONS The I-PRRS was successfully translated into Dutch and can be administered to athletes with lower extremity injuries who have clearance to RTS. The MDC of 5.58 on the total score indicated that with a score below six, there is no noticeable change outside the measurement error. For measuring and monitoring psychological readiness for RTS, the use of the Dutch I-PRRS is recommended for Dutch physical therapists. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
| | - Inne Aerts
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
| | | | - Romain Meeusen
- Human Physiology research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
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Norte GE, Solaas H, Saliba SA, Goetschius J, Slater LV, Hart JM. The relationships between kinesiophobia and clinical outcomes after ACL reconstruction differ by self-reported physical activity engagement. Phys Ther Sport 2019; 40:1-9. [PMID: 31421282 DOI: 10.1016/j.ptsp.2019.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To investigate whether relationships between kinesiophobia, lower extremity function, and patient-reported function differ by self-reported physical activity engagement after ACL reconstruction (ACLR). DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Seventy-seven patients with a primary, unilateral ACLR. MAIN OUTCOME MEASURES Kinesiophobia (TSK-17) was the primary outcome. Lower extremity function included quadriceps and hamstrings strength, fatigue, and hop performance. Patient-reported function included regional function (IKDC, KOOS subscales) and physical activity engagement (Godin Leisure-Time Exercise). Patients were evaluated together, then stratified by LOW and HIGH physical activity. Correlations and multiple regression analyses identified relationships between kinesiophobia and outcome measures. RESULTS Greater kinesiophobia was associated with lesser hamstrings strength, hop performance, and patient-reported function. Greater hamstrings fatigue and lesser KOOSADL explained greater kinesiophobia in patients reporting LOW physical activity. Lesser triple hop symmetry, crossover hop distance, and IKDC explained greater kinesiophobia in patients reporting HIGH physical activity. CONCLUSIONS Greater kinesiophobia associated with worse outcomes after ACLR. Relationships differed by self-reported physical activity engagement. Interventions that improve the ability to perform knee-related activities of daily living may be appropriate to minimize the impact of fear in less active patients, while those targeting hop performance and knee-related sport activities may be better suited for more active patients.
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Affiliation(s)
- Grant E Norte
- University of Toledo, School of Exercise and Rehabilitation Sciences, Athletic Training Program, 2801 W. Bancroft St.Health and Human Services 2505H, Mail Stop 119, Toledo, OH, 43606, United States.
| | - Haley Solaas
- University of Virginia, Kinesiology Department, Sports Medicine Program, 210 Emmet Street North, Memorial Gymnasium, 209 PO Box 400407, Charlottesville, VA, 22904, United States.
| | - Susan A Saliba
- University of Virginia, Kinesiology Department, Sports Medicine Program, 210 Emmet Street North, Memorial Gymnasium, 209 PO Box 400407, Charlottesville, VA, 22904, United States; University of Virginia, Department of Orthopedic Surgery, Sports Medicine Division, 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, Charlottesville, VA, 22908, United States.
| | - John Goetschius
- Adrian College Exercise Science & Athletic Training Department, 110 S. Madison Street Merillat 209, Adrian, MI, 49221, United States.
| | - Lindsay V Slater
- Shirley Ryan AbilityLab, Neuromechanics of Impaired Locomotion Lab, 355 East Erie, Chicago, IL, 60611, United States.
| | - Joseph M Hart
- University of Virginia, Kinesiology Department, Sports Medicine Program, 210 Emmet Street North, Memorial Gymnasium, 209 PO Box 400407, Charlottesville, VA, 22904, United States; University of Virginia, Department of Orthopedic Surgery, Sports Medicine Division, 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, Charlottesville, VA, 22908, United States.
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No shortage of disagreement between biomechanical and clinical hop symmetry after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2019; 68:144-150. [PMID: 31212209 DOI: 10.1016/j.clinbiomech.2019.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/04/2019] [Accepted: 05/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evaluating average performance on functional hop tasks can potentially overestimate physical function, as it masks variability present within individual trials and may lead to clinician oversight regarding the overall movement quality. The purpose was to evaluate the trial-by-trial agreement between hop-distance symmetry and knee biomechanics (knee flexion angle, knee extension moment) to reveal the full extent of agreement between these measures. METHODS Sixteen individuals with primary, unilateral anterior cruciate ligament reconstruction participated (age: 22(2) y; height: 1.71(0.11) m; mass: 68.94(13.06) kg; gender: 8 males, 8 females; years' post-surgery:4(3) y) in a cross-sectional study. Knee kinematics and kinetics were measured using 3D motion analysis and hop distance was collected during the triple hop for distance. Individual limb difference values for individual hop trials were calculated and values for each trial were dichotomized as pass/fail based on achieving a limb difference of <10%. Cohen's Kappa and confirmatory McNemar's test were performed to determine the level of agreement between measures of physical and biomechanical function between trials. FINDINGS No agreement between triple hop and peak knee flexion angle symmetry (κ = 0.033, p = 0.387) and peak internal knee extension moment (κ = 0.022, p = 0.475) were found. McNemar tests confirmed no agreement between hop-distance %LD and knee flexion angle/knee extension moment %LD (p = 0.000). INTERPRETATION These findings suggest that while individuals after ACLR may on average achieve symmetrical hop-distance, they may not necessarily pass subsequent functional tasks. Further, individual trial-by-trial analyses may provide insight into an individual's true physical capability compared to simply evaluating the average, which may overestimate physical function or mask altered movement strategies.
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Keays SL, Newcombe P, Keays AC. Nearly 90% participation in sports activity 12 years after non-surgical management for anterior cruciate ligament injury relates to physical outcome measures. Knee Surg Sports Traumatol Arthrosc 2019; 27:2511-2519. [PMID: 30386997 DOI: 10.1007/s00167-018-5258-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/23/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Traditionally reconstructive surgery is recommended for patients planning to return to sport (RTS), especially to pivoting sports after anterior cruciate (ACL) rupture. Recent trends focus on delaying or avoiding surgery as some studies have found similar rates of RTS following both surgical and conservative management. This study aimed to establish long-term RTS levels in ACL-ruptured individuals treated conservatively, and to investigate the relationship between outcome measures and RTS, in particular, pivoting sports. METHOD Fifty-five patients from a cohort of 132 ACL-deficient patients were followed-up for 12 (IQR 8,19) years post injury. Mean-aged 42 years, 22 patients were females and 33 males, 35 had meniscal injuries. Patients were treated with physiotherapy focussing on strength and dynamic stability training and not reconstructive surgery. Return to sport was measured on a 6-point scale. Outcome measures included: objective stability, subjective stability, quadriceps and hamstring strength. Spearman's rho and Chi-square tests were used to assess the relationship between RTS and outcome measures. RESULTS Eighty-nine percent of ACL-deficient patients were currently participating in sport despite a 38% increase in anterior translation (p < 0.001) and a 7.5% loss of quadriceps strength (p = 0.004) compared to the contralateral side. Six patients (11%) did not RTS, ten (18%) returned to safe sports, five (9%) returned to running and 16 (29%) to non-strenuous sports involving limited twisting. Eighteen patients (33%) returned to pivoting sports, 12(22%) at recreational level and six (11%) at competitive level. The level of RTS was related to subjective stability (p = 0.002), and to quadriceps and hamstring strength of the injured leg (p < 0.001). Patients able to return to pivoting sports differed significantly from those not doing so in outcome measures including objective (p = 0.022) and subjective stability (p = 0.035), and quadriceps strength (p = 0.044). CONCLUSIONS Eighty-nine percent of ACL-ruptured individuals treated conservatively lead an active sporting life. One-third returned to pivoting sports. Overall RTS was related to subjective and objective stability and quadriceps and to a lesser extent hamstring strength. This finding reinforced the importance of dynamic stability training as an initial treatment option in most cases. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Susan L Keays
- Private Practice, Nambour, Australia. .,School of Health and Sports Sciences, The University of the Sunshine Coast, Sippy Downs, QLD, Australia.
| | - Peter Newcombe
- School of Psychology and Institute for Teaching and Learning Innovation, The University of Queensland, St Lucia, Brisbane, QLD, Australia
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Factors affecting return to sport following hamstrings anterior cruciate ligament reconstruction in non-elite athletes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1771-1779. [DOI: 10.1007/s00590-019-02494-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/06/2019] [Indexed: 12/31/2022]
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Ahn JH, Koh IJ, McGarry MH, Patel NA, Lin CC, Lee TQ. Elongation Patterns of the Anterior and Posterior Borders of the Anterolateral Ligament of the Knee. Arthroscopy 2019; 35:2152-2159. [PMID: 31272636 DOI: 10.1016/j.arthro.2019.02.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/28/2018] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the elongation patterns of the anterior and posterior borders of the anterolateral ligament (ALL) at varying knee flexion angles with the knee in a neutral position without any external forces and with external forces applied, including anterior-posterior translation, internal-external rotation, and varus-valgus angulation. METHODS Eight cadaveric knees were tested in a custom knee testing system. Elongation of the anterior and posterior borders of the ALL was measured using a MicroScribe 3DLX system at knee flexion angles of 0°, 30°, 60°, and 90° and after the application of internal-external rotation, anterior-posterior translation, and varus-valgus angulation. RESULTS The anterior border showed a slight noncontinuous increase in percentage elongation (0.8% ± 2.2%) whereas the posterior border showed a continuous decrease in percentage elongation (-12.0% ± 2.8%) as knee flexion increased (P < .001). Apart from the elongation of the posterior border at 90° of knee flexion, internal rotation, varus angulation, and anterior translation resulted in a significant increase in the percentage elongation of the anterior and posterior borders at each flexion angle compared with external rotation, valgus angulation, and posterior translation, respectively. CONCLUSIONS The ALL shows different elongation patterns between the anterior and posterior borders, with a continuous decrease in the percentage elongation of the posterior border as knee flexion increases. CLINICAL RELEVANCE This study presents useful evidence to resolve the uncertainty regarding the change in length of the ALL at various degrees of knee flexion. This information may be helpful for deciding the optimal knee flexion angle during ALL graft fixation. The findings from this study suggest that graft fixation during ALL reconstructions should be performed at close to full extension of the knee.
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Affiliation(s)
- Ji Hyun Ahn
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea.
| | - In Jun Koh
- Department of Orthopaedic Surgery, St Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, California, U.S.A
| | - Nilay A Patel
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Charles C Lin
- School of Medicine, University of California, Irvine, Irvine, California, U.S.A
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, California, U.S.A.; Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, U.S.A
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Ithurburn MP, Paljieg A, Thomas S, Hewett TE, Paterno MV, Schmitt LC. Strength and Function Across Maturational Levels in Young Athletes at the Time of Return to Sport After ACL Reconstruction. Sports Health 2019; 11:324-331. [PMID: 31173697 DOI: 10.1177/1941738119849070] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The impact of maturation on lower extremity strength and function after anterior cruciate ligament reconstruction (ACLR) may help guide future studies of age-specific rehabilitation. HYPOTHESIS Pediatric ACLR patients would demonstrate higher thigh strength symmetry and knee-related function at return to sport (RTS) compared with adolescent and young adult participants who underwent traditional ACLR. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 2. METHODS A total of 144 young athletes at the time of RTS clearance post-ACLR were classified into 3 maturational groups (pediatric, n = 16 with physeal-sparing ACLR [mean age = 12.3 years; range = 9.2-14.6 years]; adolescent, n = 113 [mean age = 16.5 years; range = 14.1-19.8 years]; young adult, n = 15 [mean age = 22.0 years; range = 20.5-24.9 years]). Quadriceps and hamstring strength were measured using an electromechanical dynamometer. Knee-related function was measured using the International Knee Documentation Committee (IKDC) subjective form and single-leg hop tests. The Limb symmetry Index (LSI) was used in calculations for hop and strength tests. Group differences were compared with Kruskal-Wallis tests and Mann-Whitney U post hoc tests. Proportions of participants meeting literature-recommended RTS criterion cutoffs were compared among the groups using chi-square tests. RESULTS The pediatric group demonstrated higher quadriceps LSI (P = 0.01), IKDC scores (P < 0.01), single-hop LSI (P < 0.01), and crossover-hop LSI (P = 0.02) compared with the young adult group. In addition, the pediatric group demonstrated higher IKDC scores (P < 0.01) and single-hop LSI (P = 0.02) compared with the adolescent group. The adolescent group demonstrated higher IKDC scores (P < 0.01), single-hop LSI (P = 0.02), and crossover-hop LSI (P = 0.03) compared with the young adult group. The proportions of participants meeting all RTS criterion cutoffs were highest in the pediatric group and lowest in the young adult group (P = 0.03). CONCLUSION Young athletes at RTS clearance after pediatric ACLR demonstrated higher quadriceps strength symmetry and knee-related function than adolescents and young adults after traditional ACLR. CLINICAL RELEVANCE These findings demonstrate the need for further study regarding the impact of these group differences on longitudinal outcomes after ACLR, including successful RTS and risk of second ACL injury.
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Affiliation(s)
- Matthew P Ithurburn
- Department of Physical Therapy and Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam Paljieg
- Doctor of Physical Therapy Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Staci Thomas
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Timothy E Hewett
- Biomechanics Laboratories and Sports Medicine, Departments of Orthopedic Surgery, Physical Medicine, and Physiology and Biomedical Engineering, Mayo Clinic, Rochester and Minneapolis, Minnesota
| | - Mark V Paterno
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Laura C Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med 2019; 53:667-699. [DOI: 10.1136/bjsports-2019-100715] [Citation(s) in RCA: 349] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/03/2022]
Abstract
Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.
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Ha JK, Kim JG, Yoon KH, Wang JH, Seon JK, Bae JH, Jang KM. Korean Version of the Anterior Cruciate Ligament-Return to Sport after Injury Scale: Translation and Cross-cultural Adaptation. Clin Orthop Surg 2019; 11:164-169. [PMID: 31156767 PMCID: PMC6526123 DOI: 10.4055/cios.2019.11.2.164] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/19/2018] [Accepted: 12/25/2018] [Indexed: 11/14/2022] Open
Abstract
Background To translate into Korean and culturally adapt the anterior cruciate ligament-return to sports after injury (ACL-RSI) scale assessing psychological readiness to return to sports after ACL reconstruction and to validate its psychometric properties. Methods The ACL-RSI scale was forward translated into Korean and back-translated into English for cultural adaptation according to the standardized guideline. For validation, the Korean version of the ACL-RSI (ACL-RSI Kr) was administered to patients who underwent ACL reconstruction. The following subjective questionnaires were also administered: International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), Lysholm scale, Knee injury and Osteoarthritis Outcome Score (KOOS), and a Return to Sports Questionnaire. Test-retest reliability, internal consistency, content validity, construct validity, and discriminant validity of the ACL-RSI Kr were assessed. Results A total of 129 patients (102 men and 27 women) were included in the study. Their mean age was 28.3 years. The average follow-up duration was 13.2 months. Test-retest reliability was remarkable (intraclass correlation coefficient, 0.949), internal consistency was high (Cronbach's alpha, 0.932), and floor and ceiling effects were confirmed to be less than 10%. Construct validity assessed by correlation analysis with KOOS, IKDC-SKF, and Lysholm scale showed the correlation coefficients ranging from 0.169 to 0.679 (all p < 0.01). Compared with the Return to Sports Questionnaire, statistically significant difference was found in the ACL-RSI Kr between patients who received more than 7 points and less than 7 points (72.2 vs. 60.3, p = 0.025) for performance level scored using a 10-point Likert scale, proving its discriminative value. Conclusions The ACL-RSI Kr demonstrated good psychometric properties. This scale can be an excellent instrument for evaluating patient's psychological readiness to return to sports after ACL injury.
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Affiliation(s)
- Jeong Ku Ha
- Department of Orthopedic Surgery and Sports Medical Center, and Sports Medical Research Institute, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery and Sports Medical Center, KonKuk University Medical Center, Seoul, Korea
| | - Kyoung Ho Yoon
- Department of Orthopedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Keun Seon
- Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Ji Hoon Bae
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Ki Mo Jang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, Korea
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Greenberg EM, Greenberg ET, Albaugh J, Storey E, Ganley TJ. Anterior Cruciate Ligament Reconstruction Rehabilitation Clinical Practice Patterns: A Survey of the PRiSM Society. Orthop J Sports Med 2019; 7:2325967119839041. [PMID: 31041331 PMCID: PMC6481008 DOI: 10.1177/2325967119839041] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Recovery after anterior cruciate ligament (ACL) reconstruction (ACLR) requires extensive postoperative rehabilitation. Although no ideal rehabilitation procedure exists, most experts recommend a fusion of time and strength and functional measures to guide decision making for activity progression during rehabilitation. This process is often directed by surgeon protocols; however, the adoption of contemporary rehabilitation recommendations among surgeons is unknown. Purpose: To understand the current landscape of surgeon practice as it relates to ACLR rehabilitation recommendations in adolescent athletes. Study Design: Cross-sectional study. Methods: An online survey was distributed among members of the Pediatric Research in Sports Medicine (PRiSM) Society in January 2017. The survey was designed to identify clinical practice patterns during 3 key transitional points of rehabilitation after ACLR: progression to jogging, modified sports activity, and unrestricted return to sports. Results: Responses from 60 orthopaedic surgeons were analyzed. While 80% of surgeons agreed upon initiating jogging within a 1-month range (3-4 months postoperatively), similar levels of agreement were only captured when including a wider 4-month (4-8 months) and 6-month range (6-12 months) for modified sports activity and unrestricted return to sports, respectively. All respondents (100%) reported using knee strength as a determinant to progress to modified sports activity; however, the mode of testing varied, with most using manual muscle testing (60%), followed by isokinetic (28%) or isometric (12%) testing. Most surgeons (68%) reported using some form of functional testing to return to modified sports activity, but the mode of testing and required progression criteria varied considerably among all reported testing procedures. The use of patient-reported outcome measures was limited to 20% of the sample, and no respondents reported using fear or self-efficacy questionnaires. Upon completion of rehabilitation, 73% recommended injury prevention programs, and 50% recommended the use of a functional ACL brace. Conclusion: Rehabilitation progression practices in adolescent athletes are variable and become more inconsistent as the time from surgery increases. While the majority of the sample considered strength and functional testing important, the mode of testing and criteria thresholds for activity advancement varied considerably.
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Affiliation(s)
- Elliot M. Greenberg
- Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Elliot M. Greenberg, PT, PhD, Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA () (Twitter: @egreenberg01)
| | - Eric T. Greenberg
- Department of Physical Therapy, New York Institute of Technology, Old Westbury, New York, USA
| | - Jeffrey Albaugh
- Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eileen Storey
- Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Theodore J. Ganley
- Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Effect of Academic Grade Level on Return to Athletic Competition After Anterior Cruciate Ligament Reconstruction. J Pediatr Orthop 2019; 39:198-201. [PMID: 30839479 DOI: 10.1097/bpo.0000000000000909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND After anterior cruciate ligament (ACL) reconstruction, 63% to 87% of high school athletes return to competition. Although physical and psychological factors are known contributors for failure to return to play, little attention has been paid to effect of academic grade level. Our purpose was to determine the influence of effect of academic grade level on return to competitive play. The primary hypothesis is that high school seniors who undergo ACL reconstruction or knee arthroscopy will be less likely to return to competitive play at 1 year than those in grades 9 to 11. METHODS We retrospectively reviewed high school athletes who injured their knee during competitive athletic activity and underwent arthroscopic knee surgery, including ACL reconstruction. We included those 14 to 18 years old at time of surgery and analyzed records for grade level, sporting activity, surgery details, and date of return to play. The definition of return to competitive play was return to same preinjury sport within 1 year of surgery and the sport had to be organized. RESULTS Our study group included 225 patients that underwent an ACL reconstruction and 74 had knee arthroscopy. Athletes undergoing ACL reconstructions were less likely to return to preinjury sport within 1 year than those undergoing knee arthroscopy (P=0.0163). Seniors were significantly less likely to return to play at 1 year than athletes in grades 9 to 11 after both ACL reconstruction (P<0.0001) and knee arthroscopy (P=0.0335). Although return to competitive play rates remained fairly constant within grades 9 to 11, a precipitous decline by 28.9% and 29.4% in return to play rates occurred in the ACL reconstruction and knee arthroscopy groups, respectively, between the junior and senior years of high school. DISCUSSION Although return to competition rates were lower for high school athletes undergoing ACL reconstruction than those undergoing knee arthroscopy, both had declines in return when the surgery occurs during their senior season. These data are useful when interpreting return to play rates. Future studies would benefit from further defining this relationship, or at least, noting the number of "senior" athletes studied. LEVEL OF EVIDENCE Therapeutic study-Level III.
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Niederer D, Kalo K, Vogel J, Wilke J, Giesche F, Vogt L, Banzer W. Quadriceps Torque, Peak Variability and Strength Endurance in Patients after Anterior Cruciate Ligament Reconstruction: Impact of Local Muscle Fatigue. J Mot Behav 2019; 52:22-32. [PMID: 30732548 DOI: 10.1080/00222895.2019.1570909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We tested if ACL-reconstructed participants show a decreased quadriceps torque, a lower muscle endurance capacity and a higher peak torque variability compared to unimpaired control participants prior to and following local muscle fatigue. Participants (n = 19, 10 women; 25 ± 5yrs.) with unilateral hamstrings autograft ACL-reconstruction and a matched unimpaired control group were recruited. Participants performed two maximal isometric voluntary force (MIVF) contractions of the knee extensors. In between, standardized local muscle fatigue was induced. ACL-reconstructed knees display a lower peak torque of the knee extensors in comparison to the contralateral limb (3.2 ± .3Nm/kg vs. 3.5 ± .3 Nm/kg). Peak torque variability and fatigue resistance were not affected by local muscle fatigue (p > .05). Participants with ACL-reconstructed knees show a persistent quadriceps muscle dysfunction. This dysfunction and lower limb side asymmetries might be risk factors for ACL re-ruptures.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kristin Kalo
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johanna Vogel
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan Wilke
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Giesche
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
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Poget F, Blackburn T, Descloux F, Fiddler H. Participating in an exercise group after anterior cruciate ligament reconstruction (ACLR) is perceived to influence psychosocial factors and successful recovery: a focus group qualitative study. Physiotherapy 2019; 105:492-500. [PMID: 30717882 DOI: 10.1016/j.physio.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 12/01/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To explore the patients' experiences of participating in an exercise group following anterior cruciate ligament reconstruction (ACLR). DESIGN Hermaneutic phenomenological qualitative study of two focus groups. SETTING Outpatient care, private rehabilitation centre. PARTICIPANTS Nine adults who had participated in an exercise group led by a physiotherapist following ACLR. RESULTS Three major themes emerged from the data: psychosocial factors, physical outcomes and identity of the exercise group. The most significant perception of engaging in an exercise group following ACLR was its influence on psychosocial factors, especially motivation, self-confidence and social support. The group influenced the participants' motivation, enjoyment and commitment to exercise during their rehabilitation. Social support, self-confidence and reassurance were mostly gained. The participants taking part in sport experienced the ACLR group as a substitute for sport trainings. The group was perceived to help enhance speed of recovery and facilitate the return to normal life, especially for participants with lower reported motivation and adherence to home-exercises. The authors interpreted that the subjective physical outcomes' improvements described by all the participants was potentially an increased level of self-efficacy. The challenging role of the physiotherapist was highlighted as well as the promotion of shared accountability between patients and the group's leader. The exercise group's identity was questioned within the rehabilitation process, and the need for more knowledge of its existence in order to promote exercise group therapy was suggested. CONCLUSION Participating in an exercise group therapy influences psychosocial factors such as motivation, self-confidence, social support, potentially self-efficacy and helps enhance a faster successful recovery following ACLR. Our findings indicate that participants with a lower reported adherence to home-exercises may especially benefit from it.
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Affiliation(s)
- Fanny Poget
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), 1011 Lausanne, Switzerland.
| | - Tiffany Blackburn
- School of Health Sciences, University of Brighton, Darley Road, Eastbourne BN20 7UR, United Kingdom.
| | - Fanny Descloux
- Physio Grancy 47, Boulevard de Grancy 47, 1006 Lausanne, Switzerland.
| | - Helen Fiddler
- School of Health Sciences, University of Brighton, Darley Road, Eastbourne BN20 7UR, United Kingdom.
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125
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Relationship Between Physical Therapy Characteristics, Surgical Procedure, and Clinical Outcomes in Patients After ACL Reconstruction. J Sport Rehabil 2019; 28:171-179. [DOI: 10.1123/jsr.2017-0176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context: Postoperative rehabilitation is critical to optimize outcomes after anterior cruciate ligament reconstruction (ACLR). However, the relationship between physical therapy (PT) and clinical outcomes is unclear. Objective: To describe PT characteristics following ACLR and to assess the relationships between PT characteristics, surgical procedure, and clinical outcomes. Design: Cross-sectional. Setting: Laboratory. Patients (or Other Participants): A total of 60 patients (31 females/29 males, age = 22.4 [9.2] y, height = 171.7 [9.9] cm, and mass = 70.2 [14.7] kg) with a history of primary unilateral ACLR (53.6% patellar tendon and 46.4% hamstring) participated. Intervention(s): Patients completed a performance assessment and rated subjective knee function prior to physician clearance (mean = 6.3 [1.3] mo postoperatively) and were contacted within 6 months of clearance to complete a PT questionnaire. Main Outcome Measures: PT questionnaire item response, knee extension maximum voluntary isometric contraction (MVIC) torque, peak isokinetic knee extension torque, single leg hop distance, and International Knee Documentation Committee were measured. Correlations assessed relationships between PT quantity and clinical outcomes. Independent t tests compared PT quantity and clinical outcomes based on return-to-sport status, readiness to return to sport, and surgical procedure. Results: Patients completed regular PT (2 d/wk, 25 wk, 58 visits) and were most likely to conclude when discharged by the therapist (68.3%). More than half (56.7%) returned to sport, yet most (73.3%) felt unready at discharge. Isokinetic torque was correlated with days of PT/week (r = .29, P = .03). Isokinetic torque and hop symmetry were reduced in patients who returned to sport (P < .05). Patients who felt ready to return completed fewer weeks of PT (P < .05). Patients with a patellar tendon graft completed more days of PT/week and total visits, but demonstrated lower MVIC torque, MVIC symmetry, and isokinetic symmetry (P < .05). Conclusions: Many patients felt unready to return to sport at PT discharge. PT frequency was associated with isokinetic torque, yet this relationship was small. Outcomes were reduced in patients who returned to sport, suggesting premature resumption of preinjury activity.
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Chmielewski TL, George SZ. Fear avoidance and self-efficacy at 4 weeks after ACL reconstruction are associated with early impairment resolution and readiness for advanced rehabilitation. Knee Surg Sports Traumatol Arthrosc 2019; 27:397-404. [PMID: 29971519 DOI: 10.1007/s00167-018-5048-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 06/28/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE To examine the association of fear avoidance and self-efficacy psychological factors within 4 weeks after anterior cruciate ligament (ACL) reconstruction with knee impairment resolution and readiness for advanced rehabilitation at 12 weeks post-surgery. METHODS Seventy-five patients participated. Data collection included demographics; questionnaires on fear avoidance (Pain Catastrophizing Scale, PCS; shortened Tampa Scale for Kinesiophobia, TSK-11) and self-efficacy (modified Self-Efficacy for Rehabilitation Outcome Scale, SER; Knee Activity Self-Efficacy, KASE) at 1, 4, and 12 weeks post-surgery; and knee impairment measures (pain intensity, range of motion, and quadriceps symmetry index) at 12 weeks post-surgery. Readiness for advanced rehabilitation (READY or NOT READY) was determined by knee impairment resolution criteria; demographics and questionnaire scores were compared between groups. Questionnaire scores at 1 and 4 weeks post-surgery and the change between time points were examined for association with knee impairment measures and group assignment. RESULTS READY included 32 patients; NOT READY included 43 patients. Questionnaire scores improved in both groups over time. Significant correlations across groups were: PCS scores at 1 and 4 weeks post-surgery with pain intensity at 12 weeks post-surgery (r = 0.24 and 0.29, respectively) and KASE score 4 weeks post-surgery with range of motion deficit at 12 weeks post-surgery (r = - 0.26). Contact injury was more prevalent in READY. After accounting for mechanism of injury, higher TSK-11 and fear of re-injury subscale scores at 4 weeks post-surgery increased the odds of NOT READY assignment at 12 weeks post-surgery (odds ratios 1.10 and 1.31, respectively). CONCLUSIONS Lower pain catastrophizing and higher knee activity self-efficacy levels 4 weeks after ACL reconstruction were associated with better knee impairment resolution at 12 weeks post-surgery, whereas lower kinesiophobia at 4 weeks post-surgery increased the odds of meeting advanced rehabilitation criteria at 12 weeks post-surgery. The clinical implication of these findings is that measuring pain catastrophizing, knee activity self-efficacy and kinesiophobia at 4 weeks post-surgery may improve prediction of patients at risk for delayed rehabilitation progression 12 weeks post-surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Steven Z George
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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127
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The Association Between Passing Return-to-Sport Criteria and Second Anterior Cruciate Ligament Injury Risk: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2019; 49:43-54. [PMID: 30501385 DOI: 10.2519/jospt.2019.8190] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is no consensus on the components of return-to-sport (RTS) testing following anterior cruciate ligament (ACL) reconstruction or whether passing RTS criteria can reduce a patient's risk of reinjury. OBJECTIVES To determine whether impartial, criteria-based RTS decisions are associated with less risk of a second ACL injury (either graft failure or contralateral ACL injury). METHODS In this systematic review with meta-analysis, the authors conducted an electronic literature search in PubMed/MEDLINE, Embase, CINAHL, SPORTDiscus, and ProQuest Dissertations and Theses Global using database-specific vocabulary related to ACL reconstruction and return to sport. Individual study quality was assessed using the modified Downs and Black checklist, and overall quality of evidence was determined with the Grading of Recommendations Assessment, Development and Evaluation scale. Pooled risk difference (passed versus failed RTS criteria), injury incidence proportion, and the diagnostic accuracy of each RTS criterion were calculated. RESULTS Four studies met the selection criteria. Overall, 42.7% (95% confidence interval [CI]: 18%, 69%) of patients passed RTS criteria, and 14.4% (95% CI: 8%, 21%) of those who passed experienced a second ACL injury (graft rupture or contralateral ACL injury). There was a nonsignificant 3% reduced risk of a second ACL injury after passing RTS criteria (risk difference, -3%; 95% CI: -16%, 10%; I2 = 74%, P = .610). The evidence rating of the Grading of Recommendations Assessment, Development and Evaluation scale was "very low quality," due to imprecision and heterogeneity of the pooled risk difference estimate. CONCLUSION Passing RTS criteria did not show a statistically significant association with risk of a second ACL injury. The quality-of-evidence rating prevents a definitive conclusion on this question and indicates an opportunity for future research. LEVEL OF EVIDENCE Prognosis, Level 2a-. J Orthop Sports Phys Ther 2019;49(2):43-54. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8190.
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128
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Fukunaga T, Johnson CD, Nicholas SJ, McHugh MP. Muscle hypotrophy, not inhibition, is responsible for quadriceps weakness during rehabilitation after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:573-579. [PMID: 30269167 DOI: 10.1007/s00167-018-5166-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/25/2018] [Indexed: 01/18/2023]
Abstract
PURPOSE Quadriceps weakness is common after anterior cruciate ligament reconstruction (ACLR). Limited neuromuscular activation may have a role in the weakness. The purpose of this study was to use peripheral magnetic stimulation to measure changes in quadriceps inhibition in patients during rehabilitation from ACLR. METHODS Ten patients (7M/3F; age 35 ± 8 years; BMI 26.0 ± 4.8 kg/m2) who had ACLR with patellar tendon autograft were recruited. At 3 and 6 months postoperatively, patients' knee extension peak torque was measured during maximum voluntary isometric contraction (MVIC), magnetic stimulation-evoked contraction, and MVIC augmented with superimposed burst magnetic stimulation to the femoral nerve. All tests were done bilaterally at 30° and 65° of knee flexion on a dynamometer. Central activation ratio was calculated by dividing the peak torque before stimulation by peak torque after stimulation. RESULTS Patients had marked deficits in MVIC, with improvement from 3 to 6 months that was more apparent at 65° versus 30° (P < 0.05). There was significant deficit in stimulation-evoked torque on the involved side that diminished over time, and this change occurred differently between the two angles (P < 0.05). Central activation ratio was lower on the involved side versus the noninvolved side and this effect was more prominent at 3 versus 6 months: combining the angles, mean central activation ratio on the involved and noninvolved sides, respectively, was 91.4 ± 7.6% and 97.5 ± 5.3% at 3 months, and 93.0 ± 7.8% and 95.8 ± 6.8% at 6 months. CONCLUSIONS At 3 and 6 months after ACLR, there were significant deficits in quadriceps strength and activation. Quadriceps activation levels were high (> 90%) for both sides at both time points. The substantial strength deficits at this postoperative period may be largely due to muscle atrophy with limited contribution from central inhibition. Rehabilitation interventions to normalize quadriceps strength should emphasize hypertrophic stimuli as opposed to neuromuscular activation strategies. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- Takumi Fukunaga
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye, Ear, and Throat Hospital, 210 East 64th Sreet, New York, NY, 10065, USA.
| | - Christopher D Johnson
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye, Ear, and Throat Hospital, 210 East 64th Sreet, New York, NY, 10065, USA
| | - Stephen J Nicholas
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye, Ear, and Throat Hospital, 210 East 64th Sreet, New York, NY, 10065, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye, Ear, and Throat Hospital, 210 East 64th Sreet, New York, NY, 10065, USA
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129
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Wang D, Chang B, Coxe FR, Pais MD, Wickiewicz TL, Warren RF, Rodeo SA, Williams RJ. Clinically Meaningful Improvement After Treatment of Cartilage Defects of the Knee With Osteochondral Grafts. Am J Sports Med 2019; 47:71-81. [PMID: 30481044 DOI: 10.1177/0363546518808030] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mosaicplasty and fresh osteochondral allograft transplantation (OCA) are popular cartilage restoration techniques that involve the single-stage implantation of viable, mature hyaline cartilage-bone dowels into chondral lesions of the knee. Recently, there has been greater focus on what represents a clinically relevant change in outcomes reporting, and commonly applied metrics for measuring clinical significance include the minimal clinically important difference (MCID) and substantial clinical benefit (SCB). PURPOSE To define the MCID and SCB after mosaicplasty or OCA for the International Knee Documentation Committee (IKDC) subjective form and Knee Outcome Survey-Activities of Daily Living (KOS-ADL) and to determine patient factors that are predictive of achieving the MCID and SCB after mosaicplasty or OCA. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS An institutional cartilage registry was reviewed to identify patients who underwent mosaicplasty or OCA. The decision to perform either mosaicplasty or OCA was generally based on chondral defect size. The IKDC and KOS-ADL were administered preoperatively and at a minimum of 2 years postoperatively. Patient responses to the outcome measures were aggregated, and the MCID and SCB of these outcome scores were calculated with anchor-based methods. Multivariate analysis adjusted for age and sex was performed to identify patient factors predictive of achieving the MCID and SCB. RESULTS Of the 372 eligible patients, 151 (41%) were lost to follow-up, 46 (12%) had incomplete preoperative outcome scores and 2 were treated with OCA of the tibia and therefore excluded. In total, 173 knees were analyzed (n = 173 patients; mean age, 33.0 years; 37% female). Seventy-five (43%) and 98 (57%) knees were treated with mosaicplasty and OCA, respectively. The mean ± SD MCIDs for the IKDC and KOS-ADL were 17 ± 3.9 and 10 ± 3.7, respectively. The SCBs for the IKDC and KOS-ADL were 30 ± 6.9 and 17 ± 3.9, respectively. Univariate analysis demonstrated no association between procedure (mosaicplasty or OCA) and likelihood of achieving the MCID or SCB. In the multivariate analysis, lower preoperative IKDC and KOS-ADL scores, higher preoperative Marx Activity Rating Scale scores, lower preoperative 36-Item Short Form Health Survey pain scores, and a history of ≤1 prior ipsilateral knee surgical procedure were predictive of achieving the MCID and/or SCB. CONCLUSION These values can be used to define a clinically meaningful improvement for future outcome studies. For surgeons considering mosaicplasty or OCA for their patients, these results can help guide clinical decision making and manage patient expectations before surgery.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA.,Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Brenda Chang
- Biostatistics Core, Hospital for Special Surgery, New York, New York, USA
| | - Francesca R Coxe
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Mollyann D Pais
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Thomas L Wickiewicz
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Russell F Warren
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA
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130
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Kosy JD, Phillips JRP, Edordu A, Pankhania R, Schranz PJ, Mandalia V. Failure to Return to Preinjury Activity Level after Hamstring Anterior Cruciate Ligament Reconstruction: Factors Involved and Considerations in Goal Setting. Indian J Orthop 2019; 53:714-720. [PMID: 31673171 PMCID: PMC6804386 DOI: 10.4103/ortho.ijortho_186_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recent interest in the return to sports, following anterior cruciate ligament reconstruction, has focused on the influence of psychological factors. However, many factors contribute to this endpoint. This study aimed to investigate the ability of nonprofessional athletes to return alongside the reasons for failure. MATERIALS AND METHODS We retrospectively studied 101 postreconstruction patients with followup in excess of 12 months. All patients underwent hamstring autograft anterior cruciate reconstruction. The Cincinnati Sports Activity Scale was used to define activity level preinjury, postinjury, and postreconstruction. Structured questionnaires were used to identify factors in those who did not return to the same level. RESULTS Seventy percent of patients returned to their preinjury activity score. Of the 30% of patients who failed, age, reconstruction type, and associated pathology were unrelated. However, reconstruction within 6 months of injury resulted in increased return to preinjury score (P < 0.05). Failure was associated with continued knee symptoms (57%), lifestyle changes (27%), anxiety (27%), fear (23%), and other musculoskeletal problems (10%). Considerable interplay was found between these factors. Failure to return was associated with increased further surgery, but this was successful in only one-third of patients. CONCLUSION Psychological factors are important (and may require targeted input), but return-to-sport is multifactorial. Ongoing symptoms may prompt further surgery, but this is frequently unsuccessful in achieving return. Patient-specific goals should be sought and revisited throughout the rehabilitation program. Acknowledging psychological barriers, in those aiming to return to the same level, may help achieve this goal. In other patients, success may be return to a desired lower level. Understanding the patient's expectations is important in goal setting.
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Affiliation(s)
- Jonathan D Kosy
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK,Address for correspondence: Mr. Jonathan D Kosy, Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK. E-mail.
| | - Jonathan R P Phillips
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Adaeze Edordu
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Rahul Pankhania
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Peter J Schranz
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Vipul Mandalia
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
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131
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Raoul T, Klouche S, Guerrier B, El-Hariri B, Herman S, Gerometta A, Lefevre N, Bohu Y. Are athletes able to resume sport at six-month mean follow-up after anterior cruciate ligament reconstruction? Prospective functional and psychological assessment from the French Anterior Cruciate Ligament Study (FAST) cohort. Knee 2019; 26:155-164. [PMID: 30473373 DOI: 10.1016/j.knee.2018.11.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/29/2018] [Accepted: 11/07/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The decision to return to sport following anterior cruciate ligament (ACL) reconstruction should not only be based on time since surgery. This study aimed to assess, using isokinetic and neuromuscular (hops) testing in a large group, postoperative objective functional recovery of the knee. The secondary objective was to determine the relationship between psychological, functional scores, and these postoperative tests. METHODS This prospective study included athletes who underwent surgery between 2013 and 2016 for an isolated full-thickness ACL tear. They received a complete evaluation of functional performance of the knee by isokinetic tests performed on a dynamometer to measure quadriceps and hamstring strength, and neuromuscular assessment based on single-leg hop tests. The main judgment criterion was satisfactory functional recovery (yes/no) defined as a difference of ≤10% both in the quadriceps 60°/s and the single hop at a minimum of four months of follow-up. RESULTS A total of 234 athletes were analyzed. The mean age was 28.4 ± 8.6 years. At 6.5 ± 1.7 months mean follow-up, 44 (18.5%) patients had satisfactory functional recovery of the knee. The correlations between isokinetic/hop tests and the different scores were variable. During follow-up, two patients presented with a graft tear and two with a contralateral ACL tear, all in the group with unsatisfactory functional recovery. CONCLUSION At a mean of six months after ACL reconstruction, objective functional recovery of the knee was generally unsatisfactory and this seemed to be a risk factor for recurrent tears. LEVEL OF EVIDENCE IV; case series.
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Affiliation(s)
- Tiana Raoul
- Clinique du Sport Paris, Paris, France; Institut de l'Appareil Locomoteur Nollet, Paris, France
| | - Shahnaz Klouche
- Clinique du Sport Paris, Paris, France; Institut de l'Appareil Locomoteur Nollet, Paris, France.
| | | | | | - Serge Herman
- Clinique du Sport Paris, Paris, France; Institut de l'Appareil Locomoteur Nollet, Paris, France
| | - Antoine Gerometta
- Clinique du Sport Paris, Paris, France; Institut de l'Appareil Locomoteur Nollet, Paris, France
| | - Nicolas Lefevre
- Clinique du Sport Paris, Paris, France; Institut de l'Appareil Locomoteur Nollet, Paris, France
| | - Yoann Bohu
- Clinique du Sport Paris, Paris, France; Institut de l'Appareil Locomoteur Nollet, Paris, France; Racing 92, Le Plessis-Robinson, France
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132
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Perceptions of Rehabilitation and Return to Sport Among High School Athletes With Anterior Cruciate Ligament Reconstruction: A Qualitative Research Study. J Orthop Sports Phys Ther 2018; 48:951-959. [PMID: 29932875 DOI: 10.2519/jospt.2018.8277] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adolescent athletes struggle to return to sport following anterior cruciate ligament reconstruction (ACLR) for physical and psychosocial reasons. The ability to integrate contextual evidence obtained directly from patients with the growing body of quantitative rehabilitation research may aid clinicians in taking an evidence-based approach to rehabilitation and return to sport within the adolescent population. OBJECTIVES To assess perceived barriers to return to sport, as well as positive and negative factors influencing recovery, among high school athletes with recent history of ACLR. METHODS This phenomenographic cross-sectional study included a sample of 10 high school-aged individuals (7 female, 3 male; mean ± SD age, 16.8 ± 1.1 years; time since surgery, 5.5 ± 1.4 months) who underwent ACLR and had not returned to sports. Participants completed a semi-structured interview focused on attitudes related to return to sport, perceived physical or psychosocial barriers to physical activity and return to sport, and rehabilitation characteristics that may facilitate or hinder return to sport. RESULTS Participants reported psychosocial barriers to return to sport with greater consistency than physical barriers. Consistently reported barriers included the feeling that sport-based activities were now associated with injury, a persistent sense of uncertainty regarding full recovery, and the sense that comparison to others with ACLR by parents or coaches hindered their ability to make progress in rehabilitation. CONCLUSION Early identification of athletes at risk for persistent psychosocial barriers, such as fear of reinjury and uncertainty regarding full recovery, and establishment of peer mentoring groups to facilitate psychosocial support throughout the rehabilitation process may be key components of a gradual, patient-centered approach to improving mental and physical readiness for return to sport. J Orthop Sports Phys Ther 2018;48(12):951-959. Epub 22 Jun 2018. doi:10.2519/jospt.2018.8277.
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133
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Heidorn SN, Canapp SO, Zink CM, Leasure CS, Carr BJ. Rate of return to agility competition for dogs with cranial cruciate ligament tears treated with tibial plateau leveling osteotomy. J Am Vet Med Assoc 2018; 253:1439-1444. [DOI: 10.2460/javma.253.11.1439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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134
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Greater fear of reinjury is related to stiffened jump-landing biomechanics and muscle activation in women after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:3682-3689. [PMID: 29700560 DOI: 10.1007/s00167-018-4950-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 04/16/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Fear of reinjury is an important factor in determining who returns to sport following anterior cruciate ligament reconstruction (ACLR). Evidence from other musculoskeletal injuries indicates fear of reinjury may be related to stiffened movement patterns observed in individuals following ACLR. The relationship between fear of reinjury and performance on dynamic tasks, however, has not been investigated. Therefore, the purpose of this study was to investigate the relationship between fear of reinjury and jump-landing biomechanics. METHODS Thirty-six females (height = 168.7 ± 6.5 cm, body mass = 67.2 ± 10.0 kg, age = 18.9 ± 1.5 years) with a history of ACLR (time from surgery = 26.1 ± 13.3 months) participated in the study. Each participant performed five trials of a standard jump-landing task. 3D motion capture and surface electromyography was used to record peak kinematics and lower extremity muscle activation on the injured limb during the jump landings. Spearman's rank correlations established the relationship between TSK-11 scores and each biomechanical variable of interest. RESULTS There was a significant, negative relationship between fear of reinjury (TSK-11: 19.9 ± 4.5) and knee (p = 0.006), hip (p = 0.003), and trunk flexion (p = 0.013). There was also a significant, positive relationship between hip adduction (p = 0.007), and gluteus maximus preparatory activation (p = 0.001). CONCLUSIONS The results of this study indicate that higher fear of reinjury is associated with stiffened movement patterns that are associated with increased risk of a second ACL injury. Similar movement patterns have been observed in patients with low back pain. Clinicians should evaluate psychological and emotional consequences of injury in addition to the physical consequences as they appear to be related. LEVEL OF EVIDENCE III.
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135
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Wellsandt E, Axe MJ, Snyder-Mackler L. Poor Performance on Single-Legged Hop Tests Associated With Development of Posttraumatic Knee Osteoarthritis After Anterior Cruciate Ligament Injury. Orthop J Sports Med 2018; 6:2325967118810775. [PMID: 30505875 PMCID: PMC6259076 DOI: 10.1177/2325967118810775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The risk for knee osteoarthritis (OA) is substantially increased after anterior cruciate ligament (ACL) injury. Tools are needed to identify characteristics of patients after ACL injury who are most at risk for posttraumatic OA. Purpose To determine whether clinical measures of knee function after ACL injury are associated with the development of radiographic knee OA 5 years after injury. Study Design Cohort study; Level of evidence, 2. Methods A total of 76 athletes (mean age, 28.7 ± 11.3 years; 35.5% female) with ACL injury were included. Clinical measures of knee function (quadriceps strength, single-legged hop tests, patient-reported outcomes) were assessed after initial impairment resolution (baseline), after 10 additional preoperative or nonoperative rehabilitation sessions (posttraining), and 6 months after ACL reconstruction or nonoperative rehabilitation. Posterior-anterior bent-knee radiographs were completed at 5 years and graded in the medial compartment by use of the Kellgren-Lawrence system. Logistic regression models were used at each of the 3 time points to determine the ability of clinical measures to predict knee OA at 5 years. Results Of the 76 patients, 9 (11.8%) had knee OA at 5 years. After adjustment for ACL reconstruction compared with nonoperative management, ipsilateral second ACL injuries, and the presence of contralateral knee OA, clinical measures of knee function at posttraining (6-m timed hop, Knee Outcomes Survey-Activities of Daily Living Scale) explained the most variance in posttraumatic OA development at 5 years (P = .006; ▵R 2, 27.5%). The 6-m hop test was the only significant posttraining predictor of OA at 5 years (P = .023; patients without OA, 96.6% ± 5.4%; patients with OA, 84.9% ± 14.1%). Similar significant group differences in hop scores and subjective knee function were present at baseline. No significant group differences in clinical measures existed at 6 months after ACL reconstruction or nonoperative rehabilitation. Conclusion Poor performance in single-legged hop tests early after ACL injury but not after reconstruction or nonoperative rehabilitation is associated with the development of radiographic posttraumatic knee OA 5 years after injury. Clinical measures of knee function were most predictive of subsequent OA development following an extended period of rehabilitation early after ACL injury.
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Affiliation(s)
- Elizabeth Wellsandt
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.,Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Michael J Axe
- First State Orthopaedics, Newark, Delaware, USA.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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136
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Hunnicutt JL, Hand BN, Gregory CM, Slone HS, McLeod MM, Pietrosimone B, Kuenze C, Velozo CA. KOOS-JR Demonstrates Psychometric Limitations in Measuring Knee Health in Individuals After ACL Reconstruction. Sports Health 2018; 11:242-246. [PMID: 30444674 DOI: 10.1177/1941738118812454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Measurement properties of the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR) are not established in individuals after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to determine the extent to which the KOOS-JR measures the construct of knee health in individuals post-ACLR using Rasch analysis. HYPOTHESIS The KOOS-JR will fit the Rasch model, but significant ceiling effects will be present. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Rasch analysis of the KOOS-JR from 166 individuals 10 months post-ACLR was conducted. Unidimensionality, a key criterion of the Rasch model, was evaluated using confirmatory factor analysis. Model fit of the rating scale, items, and persons were evaluated. Mean square fit statistics ≥1.6 and standardized z-scores ≥2.0 were indicative of person or item misfit. Additionally, reliability indicators including person reliability and separation indices were examined. RESULTS The KOOS-JR fit the criteria of unidimensionality. All items demonstrated model fit; however, ceiling effects were noted (n = 36; 22%). Person reliability was low (0.47). Calculation of person strata revealed that the KOOS-JR did not separate participants into more than 1 stratum. The mean person measure was 3.56 logits higher than the mean item measure, indicating that this sample is skewed toward increased knee health. CONCLUSION Although the KOOS-JR represented a unidimensional construct with items and persons fitting the Rasch model, several limitations were noted: ceiling effects, low person reliability, and poor person differentiation. Ceiling effects indicate that many individuals in this sample experienced better knee health than the KOOS-JR items were able to measure. CLINICAL RELEVANCE Evaluating the measurement properties of the KOOS-JR is necessary to determine its clinical value in sports medicine. In later stages after ACLR recovery, administration of the KOOS-JR may not be adequate.
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Affiliation(s)
- Jennifer L Hunnicutt
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, Georgia
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Chris M Gregory
- Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.,Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Harris S Slone
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina
| | - Michelle M McLeod
- Department Health and Human Performance, College of Charleston, Charleston, South Carolina
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher Kuenze
- Department of Kinesiology, Michigan State University, East Lansing, Michigan
| | - Craig A Velozo
- Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.,Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
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137
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Rehabilitation Practice Patterns Following Anterior Cruciate Ligament Reconstruction: A Survey of Physical Therapists. J Orthop Sports Phys Ther 2018; 48:801-811. [PMID: 29787697 DOI: 10.2519/jospt.2018.8264] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recovery from anterior cruciate ligament reconstruction (ACLR) requires an intensive course of postoperative rehabilitation. Although guidelines outlining evidence-based rehabilitation recommendations have been published, actual practice patterns of physical therapists are unknown. OBJECTIVES To analyze the current landscape of clinical practice as it pertains to rehabilitation progression and the use of time and objective criteria in rehabilitation following ACLR. METHODS In this cross-sectional study, an online survey was distributed to members of the Academy of Orthopaedic Physical Therapy, the American Academy of Sports Physical Therapy, and the Private Practice Section of the American Physical Therapy Association between January and March 2017. RESULTS The study analyzed a sample of 1074 responses. Supervised physical therapy was reported to last 5 months or less by 56% of survey respondents. The most frequent time frames for activity progression were 3 to 4 months (58%) for jogging, 4 to 5 months (50%) for modified sports activity, and 9 to 12 months (40%) for unrestricted sports participation. More than 80% of respondents reported using strength and functional measures during rehabilitation. Of those physical therapists who assessed strength, 56% used manual muscle testing as their only means of strength testing. Single-limb hop testing (89%) was the most frequently reported measure used to allow patients to begin modified sports activity following ACLR. Performance criteria for strength and functional tests varied significantly across all phases of rehabilitation. The 45% of respondents who reported using patient-reported outcome measures indicated that just under 10% of those measures involved fear or athletic confidence scales. CONCLUSION Considerable variation in practice exists among American Physical Therapy Association members regarding rehabilitation following ACLR. This variability in practice may contribute to suboptimal outcomes and confusion among practitioners and patients. J Orthop Sports Phys Ther 2018;48(10):801-811. Epub 22 May 2018. doi:10.2519/jospt.2018.8264.
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138
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Hughes L, Paton B, Haddad F, Rosenblatt B, Gissane C, Patterson SD. Comparison of the acute perceptual and blood pressure response to heavy load and light load blood flow restriction resistance exercise in anterior cruciate ligament reconstruction patients and non-injured populations. Phys Ther Sport 2018; 33:54-61. [DOI: 10.1016/j.ptsp.2018.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/07/2018] [Accepted: 07/07/2018] [Indexed: 01/20/2023]
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139
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Abstract
OBJECTIVE For elite athletes to train and compete at peak performance levels, it is necessary to manage their pain efficiently and effectively. A recent consensus meeting on the management of pain in elite athletes concluded that there are many gaps in the current knowledge and that further information and research is required. This article presents the crystallization of these acknowledged gaps in knowledge. DATA SOURCES Information was gathered from a wide variety of published scientific sources that were reviewed at the consensus meeting and the gaps in knowledge identified. MAIN RESULTS Gaps have been identified in the epidemiology of analgesic use, the management of pain associated with minor injuries, and the field of play management of pain for athletes with major injuries. From a pharmacological perspective, there is a lack of information on the prescribing of opioid medications in elite athletes and more data are required on the use of local anesthetics injections, corticosteroids, and nonsteroidal anti-inflammatory drugs during training and in competition. Pain management strategies for the general population are widely available, but there are few for the elite sporting population and virtually none for elite athletes with a disability. More research is also needed in assessing cognitive-behavior therapies in improving specific outcomes and also into the new process of psychologically informed physiotherapy. A key issue is the paucity of data relating to incidence or prevalence of persistent pain and how this relates to persistent dysfunction, exercise performance, and physiological function in later life. CONCLUSIONS The identification of the gaps in knowledge in the management of pain in elite athletes will provide a unified direction for the retrieval of information and further research that will provide reassurance, speed return to active sport, and benefit performance.
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140
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O'Malley E, Richter C, King E, Strike S, Moran K, Franklyn-Miller A, Moran R. Countermovement Jump and Isokinetic Dynamometry as Measures of Rehabilitation Status After Anterior Cruciate Ligament Reconstruction. J Athl Train 2018; 53:687-695. [PMID: 30109947 DOI: 10.4085/1062-6050-480-16] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Despite an increase in the literature, few definitive guidelines are available to determine when an athlete has been fully rehabilitated after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE To examine countermovement jump and isokinetic dynamometry measures to (1) identify which measures can best distinguish between ACLR and control participants and (2) provide normative values for identified measures in young adult male multidirectional field-sport athletes. DESIGN Cross-sectional study. SETTING Orthopaedic hospital. PATIENTS OR OTHER PARTICIPANTS Young adult male multidirectional field-sport athletes (n = 118) who had undergone unilateral patellar-tendon graft ACLR at least 6 months earlier and healthy male participants (n = 44) with no previous knee injury. INTERVENTION(S) Single-legged countermovement jump (SL CMJ). MAIN OUTCOME MEASURE(S) Three-dimensional biomechanical analysis of the SL CMJ and mean peak concentric knee-extension and -flexion torque using isokinetic dynamometry (ISO) were compared in the 2 groups. A stepwise logistic regression was carried out to identify the best predictors of ACLR- or control-group membership (SL CMJ height, limb symmetry index, peak power, joint power contribution, ISO peak torque, limb symmetry index variables). RESULTS The control group differed strongly from the ACLR group in isokinetic knee-extension peak torque (d = -1.33), SL CMJ performance (d > 0.4), and limb symmetry measures in both ISO and jump outcomes (d > 1.1). The combination of measures from both ISO and SL CMJ identified group membership with an accuracy of 89%. CONCLUSIONS Rehabilitation of ACLR patients may be complete when they achieve isokinetic knee-extension peak torque of 260% (±40%) body mass, SL CMJ performance of >17 cm (±4 cm), and reach-limb symmetry measures of >90% in both strength and jump outcomes. The outcomes in the control group can inform return-to-play criteria for young adult male multidirectional field-sport athletes after ACLR.
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Affiliation(s)
| | - Chris Richter
- Sports Surgery Clinic, Dublin, Ireland.,University of Roehampton, London, United Kingdom
| | - Enda King
- Sports Surgery Clinic, Dublin, Ireland.,University of Roehampton, London, United Kingdom
| | | | | | - Andrew Franklyn-Miller
- Sports Surgery Clinic, Dublin, Ireland.,Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
| | - Ray Moran
- Sports Surgery Clinic, Dublin, Ireland
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141
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Padaki AS, Noticewala MS, Levine WN, Ahmad CS, Popkin MK, Popkin CA. Prevalence of Posttraumatic Stress Disorder Symptoms Among Young Athletes After Anterior Cruciate Ligament Rupture. Orthop J Sports Med 2018; 6:2325967118787159. [PMID: 30109239 PMCID: PMC6083780 DOI: 10.1177/2325967118787159] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The risk of depression and the fear of reinjury were documented in recent investigations of patients after anterior cruciate ligament (ACL) ruptures. The extent of psychological trauma accompanying these injuries among young athletes, however, has never been assessed. Hypothesis: Posttraumatic stress disorder (PTSD) symptoms after ACL injury are present among young athletes with high athletic identities. Study Design Case series; Level of evidence, 4. Methods: Patients ≤21 years of age who had suffered an acute ACL rupture were consecutively recruited at a tertiary care center. Patients completed the Horowitz Impact of Event Scale - Revised (IES-R) to analyze for PTSD symptomatology, the Athletic Identity Measurement Scale, and an athlete specialization instrument created at the authors’ institution. Results: A total of 24 patients were consecutively recruited. The mean patient age was 14.5 ± 2.7 years, and 50% of patients were male. More than 87.5% of patients experienced avoidance symptoms, 83.3% acknowledged symptoms of intrusion, and 75% had symptoms of hyperarousal. Patients aged 15 to 21 years incurred a higher severity of PTSD symptoms than younger patients (P = .033). Female patients experienced greater emotional trauma than male patients (P = .017). Finally, patients with high athletic identities experienced greater emotional trauma than those with lesser athletic identities, but this finding was not statistically significant (P = .14). Conclusion: Following ACL rupture, young athletes experience significant emotional trauma, including symptoms of avoidance, intrusion, and hyperarousal. High school and college athletes, female athletes, and patients with high athletic identities may be most susceptible.
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Affiliation(s)
- Ajay S Padaki
- Columbia University Medical Center, New York, New York, USA
| | | | | | | | - Michael K Popkin
- Department of Psychiatry, Hennepin County Medical Center, Minneapolis, Minnesota, USA
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Blakeney WG, Ouanezar H, Rogowski I, Vigne G, Guen ML, Fayard JM, Thaunat M, Chambat P, Sonnery-Cottet B. Validation of a Composite Test for Assessment of Readiness for Return to Sports After Anterior Cruciate Ligament Reconstruction: The K-STARTS Test. Sports Health 2018; 10:515-522. [PMID: 30024344 PMCID: PMC6204642 DOI: 10.1177/1941738118786454] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: There is limited information on the appropriate timing of return to sports after anterior cruciate ligament (ACL) reconstruction. A composite test was developed to assess the athlete’s ability to return to sports after ACL reconstruction: the Knee Santy Athletic Return To Sport (K-STARTS) test. Hypothesis: The K-STARTS test meets validation criteria for an outcome score assessing readiness for return to sports after ACL reconstruction. Study Design: Diagnostic study. Level of Evidence: Level 3. Methods: A prospective comparative study identified 410 participants: 371 participants who had undergone ACL reconstruction and a control group of 39 healthy participants. The K-STARTS score is calculated as the sum of 7 tests (8 components), for a maximal value of 21 points. Construct validity, internal consistency, discriminant validity, and sensitivity to change were used to validate this new test. Results: The K-STARTS assessment showed a high completion rate (100%), high reproducibility (intraclass correlation coefficient, 0.87; coefficient of variation, 7.8%), and high sensitivity to change. There was moderate correlation with the ACL Return to Sports after Injury scale (ACL-RSI) and hop tests. There were no ceiling or floor effects. There was a significant difference between K-STARTS scores assessed at 6 and 8 months postoperatively (11.2 ± 2.7 vs 17.1 ± 3.2; P < 0.001). The K-STARTS score in the control group was significantly higher than that in the ACL reconstruction group (17.3 ± 2.1 and 13.7 ± 3.8, respectively; P < 0.001). Conclusion: The K-STARTS test is an objective outcome measure for functional improvement after ACL reconstruction. Clinical Relevance: It is important for the clinician to determine when return to sports is optimal after ACL reconstruction to reduce the current high risk of reinjury.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bertrand Sonnery-Cottet
- Bertrand Sonnery-Cottet, MD, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay-Générale de Sante, Hôpital Prive Jean Mermoz, Lyon, France ()
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Gomez-Piqueras P, González-Víllora S, Grassi A, Gojanovic B, Hägglund M, Waldén M. Are we making SMART decisions regarding return to training of injured football players? Preliminary results from a pilot study. ISOKINET EXERC SCI 2018. [DOI: 10.3233/ies-172201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Pedro Gomez-Piqueras
- Faculty of Education, Department of Corporal Expression, University of Castilla-La Mancha, Albacete, Spain
| | - Sixto González-Víllora
- Faculty of Education, Department of Corporal Expression, University of Castilla-La Mancha, Cuenca, Spain
| | - Alberto Grassi
- Laboratorio di Biomecanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Boris Gojanovic
- Hôpital de la Tour, Sports Medicine, Swiss Olympic Medical Center, Meyrin, Switzerland
| | - Martin Hägglund
- Football Research Group, Linköping, Sweden
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Markus Waldén
- Football Research Group, Linköping, Sweden
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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144
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Webster KE, Nagelli CV, Hewett TE, Feller JA. Factors Associated With Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery. Am J Sports Med 2018; 46:1545-1550. [PMID: 29718684 PMCID: PMC6598700 DOI: 10.1177/0363546518773757] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury has a significant psychological effect, and a negative psychological state is a commonly cited reason for a reduction or cessation of sports participation after ACL reconstruction (ACLR) surgery. PURPOSE To identify factors that contribute to an athlete's psychological readiness to return to sport (RTS) after ACLR. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A cohort of 635 athletes (389 male, 246 female) who underwent ACLR and had been cleared to RTS completed the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale at an average 12 months (range, 11-24 months) after surgery. Demographics (age, sex), sporting outcomes (preinjury frequency), surgical timing (injury to surgery interval), clinical factors (laxity), functional measures (single-limb hop symmetry), and symptoms of pain and function (International Knee Documentation Committee subjective) were also taken, and univariate and multiple regression models were used to determine the association between these and the psychological readiness of the athlete to RTS (ACL-RSI scores). Data for the entire cohort were initially analyzed; then, patients were grouped according to whether they had returned to competitive sport, and the analysis repeated for each group (return/nonreturn). RESULTS Univariate analysis for the entire group showed that all of the following had a positive effect on psychological readiness: male sex (β = 5.8; 95% CI, 2-10), younger age (β = -0.2; 95% CI, -0.4 to 0.01), a shorter interval between injury and surgery (β = -0.1; 95% CI, -0.1 to -0.02), a higher frequency of preinjury sport participation (β = 5.4; 95% CI, 2-9), greater limb symmetry (β = 0.5; 95% CI, 0.3-0.6), and higher subjective knee scores (β = 1.3; 95% CI, 1.1-1.4). In the multivariate model, subjective knee scores and age significantly accounted for 37% of the variance in psychological readiness ( r2 = 0.37, P < .0001). The only difference between the groups who had and had not returned to sport was that female sex was a significant contributor for the nonreturn group. CONCLUSION Self-reported symptoms and function were most associated with psychological readiness to RTS after ACLR surgery. Male patients who participated frequently in sport before ACL injury had higher psychological readiness. Conversely, female patients had a more negative outlook and may therefore benefit more from interventions designed to facilitate a smooth transition back to sport.
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Affiliation(s)
- Kate E. Webster
- School of Allied Health, La Trobe University, Melbourne, Australia.,Address correspondence to Kate E. Webster, PhD, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Victoria 3086, Australia ()
| | - Christopher V. Nagelli
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E. Hewett
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Biomechanics Laboratories and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
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145
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Hamrin Senorski E, Svantesson E, Beischer S, Thomeé C, Thomeé R, Karlsson J, Samuelsson K. Low 1-Year Return-to-Sport Rate After Anterior Cruciate Ligament Reconstruction Regardless of Patient and Surgical Factors: A Prospective Cohort Study of 272 Patients. Am J Sports Med 2018; 46:1551-1558. [PMID: 29659299 DOI: 10.1177/0363546518765120] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is insufficient knowledge about the way that concomitant injuries affect the short-term likelihood of a return to a knee-strenuous sport after anterior cruciate ligament (ACL) reconstruction. Hypotheses/Purpose: The purpose was to study whether patient characteristics, concomitant injuries, and graft choice at primary ACL reconstruction can predict return to sport (RTS) 1 year after surgery. The hypotheses were that younger age at the time of ACL reconstruction would positively affect RTS, while the presence of concomitant injuries would negatively affect RTS 1 year after surgery. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were extracted from a rehabilitation-specific register and the Swedish National Knee Ligament Register. Twelve months after surgery, all patients were evaluated for RTS via the Tegner Activity Scale. The primary outcome was a return to knee-strenuous sport, defined as a Tegner Activity Scale ≥6. Univariable and multivariable logistic regression analyses were performed with patient characteristics, concomitant knee injuries, and graft choice as independent variables. RESULTS A total of 272 patients (51% female) with a mean ± SD age of 25.0 ± 9.2 years were included. In the multivariable analysis, a favorable odds ratio (OR) for returning to sport was found for patients of male sex (OR, 2.58; 95% CI, 1.43-4.65; P = .0016), younger age at the time of ACL reconstruction (OR, 2.32; 95% CI, 1.59-3.33; P < .0001), a higher preinjury score on the Tegner Activity Scale (OR, 1.45; 95% CI, 1.13-1.87; P = .0038), and an absence of injury to the meniscus (OR, 1.92; 95% CI, 1.10-3.36; P = .023) and medial collateral ligament (OR, 7.61; 95% CI, 1.42-40.87; P = .018). In addition, the absence of cartilage injury was favorable in terms of RTS in the univariable analysis (OR, 2.48; 95% CI, 1.40-4.39; P = .0018). CONCLUSION Positive predictors of a return to knee-strenuous sport 1 year after ACL reconstruction were male sex, younger age, a high preinjury level of physical activity, and the absence of concomitant injuries to the medial collateral ligament and meniscus.
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Affiliation(s)
- Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Beischer
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden
| | - Christoffer Thomeé
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden
| | - Roland Thomeé
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden
| | - Jón Karlsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kristian Samuelsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
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146
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Burland JP, Kostyun RO, Kostyun KJ, Solomito M, Nissen C, Milewski MD. Clinical Outcome Measures and Return-to-Sport Timing in Adolescent Athletes After Anterior Cruciate Ligament Reconstruction. J Athl Train 2018; 53:442-451. [PMID: 29847160 DOI: 10.4085/1062-6050-302-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Multiple factors are likely associated with an adolescent athlete's ability to return to play after anterior cruciate ligament (ACL) reconstruction (ACLR). OBJECTIVE To investigate the relationship between self-reported and functional outcome measures on return-to-play timing in an adolescent population, in athletes who returned and those who did not return to sport, and to identify a cutoff value for isometric quadriceps strength that could serve as a clinical target for maximizing the odds of returning to play after ACLR. DESIGN Cross-sectional study. SETTING Outpatient clinic. PATIENTS OR OTHER PARTICIPANTS Adolescent athletes who underwent ACLR and completed clinical measures at their 3- and 6-month follow-up appointments were included. MAIN OUTCOME MEASURE(S) Clinical measures included functional outcomes of isometric and isokinetic strength tests and the Anterior Cruciate Ligament Return to Sport After Injury scale and the pediatric version of the International Knee Documentation Committee subjective form. Physician clearance dates for return to play were obtained from patient records. RESULTS Higher strength measures were associated with better scores on the Anterior Cruciate Ligament Return to Sport After Injury and the pediatric version of the International Knee Documentation Committee instruments at each follow-up. Differences were found in isometric extension strength ( P = .001) and isokinetic extension strength at 180°/s ( P = .03) and 300°/s ( P = .002) between patients who returned to sports and those who did not. A 6-month isometric extension deficit (mean Limb Symmetry Index = 85.48 ± 23.15) displayed high accuracy (area under the curve = 0.82, 95% confidence interval = 0.68, 0.95) for identifying patients who returned to play after ACLR. CONCLUSIONS Higher strength measures at both 3 and 6 months after ACLR were associated with greater self-reported knee function and greater readiness to return to functional activities at 6 months and ultimately earlier return to sport in adolescent athletes. These results provide evidence that self-reported outcome scores should be used as an additional screening tool in conjunction with quadriceps strength testing to help provide realistic recovery timeframes for adolescent patients.
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Affiliation(s)
| | - Regina O Kostyun
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington
| | - Kyle J Kostyun
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington
| | - Matthew Solomito
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington
| | - Carl Nissen
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington
| | - Matthew D Milewski
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington.,Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, MA
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147
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Webster KE, Feller JA. Development and Validation of a Short Version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale. Orthop J Sports Med 2018; 6:2325967118763763. [PMID: 29662909 PMCID: PMC5894922 DOI: 10.1177/2325967118763763] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale was developed to measure an athlete's psychological readiness to return to sport after anterior cruciate ligament (ACL) injury and reconstruction surgery. The scale is being used with increasing frequency in both research and clinical settings. Purpose To generate and validate a short version of the ACL-RSI scale. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods The ACL-RSI scale was administered to 535 patients who had undergone ACL reconstruction surgery. Reliability (Cronbach alpha) was determined and factor analysis of the full scale was undertaken along with a process of item selection and elimination. A second group of 250 patients participated in a predictive validation analysis. This group completed the ACL-RSI scale at 6 months and reported return-to-sport outcomes 12 months following ACL reconstruction surgery. The predictive validity of both scales (full and short versions) was assessed by use of receiver operating characteristic (ROC) curve statistics. Results The scale was found to have high internal consistency (Cronbach alpha, 0.96), which suggested that item redundancy was present. After an item selection process, the scale was reduced to a 6-item format. Cronbach alpha for the short version was 0.92, and factor analysis confirmed the presence of 1 factor accounting for 71% of the total variance. Scores for the short version were significantly different between patients who had and those who had not returned to sport. Six-month ACL-RSI scores for both the full and short versions had fair to good predictive ability for 12-month return-to-sport outcomes (full version: area under ROC curve, 0.77 [95% CI, 0.7-0.8]; short version: area under ROC curve, 0.75 [95% CI, 0.7-0.8]). Conclusion A 6-item short version of the ACL-RSI scale was developed from a large cohort of patients undergoing ACL reconstruction. The short version appears to be as robust as the full version for discriminating between and predicting return-to-sport outcomes. The short version of the ACL-RSI may be of use in busy clinical settings to help identify athletes who may find return to sport challenging.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Julian A Feller
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia
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Niederer D, Wilke J, Vogt L, Banzer W. Return to Play After Injuries: A Survey on the Helpfulness of Various Forms of Assistance in the Shared Decision-Making Process in Semiprofessional Athletes in Germany. Arch Phys Med Rehabil 2018; 99:690-698. [DOI: 10.1016/j.apmr.2017.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/29/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022]
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Bousquet BA, O'Brien L, Singleton S, Beggs M. POST-OPERATIVE CRITERION BASED REHABILITATION OF ACL REPAIRS: A CLINICAL COMMENTARY. Int J Sports Phys Ther 2018; 13:293-305. [PMID: 30090687 PMCID: PMC6063063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
The anterior cruciate ligament (ACL) is the most commonly reconstructed ligament of the knee. Most often, the goal of surgical reconstruction is to recreate stability within the knee and prevent joint degeneration. To date, clinical studies have not demonstrated the ability of various reconstruction techniques in establishing complete knee stability when comparing rates of osteoarthritis. Rates of osteoarthritis commonly resemble those of knees which have not be reconstructed and in this light, may not demonstrate a successful outcome. As modern medicine continues to develop and in the understanding of underlying biological processes grows, some surgeons have turned their attention back to an ACL repair technique. The purpose of this clinical commentary is to discuss the parameters associated with a phase progression for an isolated ACL repair. Physiological healing time frames, along with objective clinical assessment, following a criterion-based progression is described in accordance with post-operative healing parameters to serve as a reference for a rehabilitation specialist. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Brett A Bousquet
- Intermountain Hospital Park City Physical Therapy, Park City, UT, USA
- Howard Head Sports Medicine Center, Vail, CO, USA
- Fort Worth Orthopedics, Fort Worth, TX, USA
- Steadman Clinic, Vail, CO, USA
| | - Luke O'Brien
- Intermountain Hospital Park City Physical Therapy, Park City, UT, USA
- Howard Head Sports Medicine Center, Vail, CO, USA
- Fort Worth Orthopedics, Fort Worth, TX, USA
- Steadman Clinic, Vail, CO, USA
| | - Steve Singleton
- Intermountain Hospital Park City Physical Therapy, Park City, UT, USA
- Howard Head Sports Medicine Center, Vail, CO, USA
- Fort Worth Orthopedics, Fort Worth, TX, USA
- Steadman Clinic, Vail, CO, USA
| | - Michael Beggs
- Intermountain Hospital Park City Physical Therapy, Park City, UT, USA
- Howard Head Sports Medicine Center, Vail, CO, USA
- Fort Worth Orthopedics, Fort Worth, TX, USA
- Steadman Clinic, Vail, CO, USA
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The success of return to sport after ulnar collateral ligament injury in baseball: a systematic review and meta-analysis. J Shoulder Elbow Surg 2018; 27:561-571. [PMID: 29433647 DOI: 10.1016/j.jse.2017.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/17/2017] [Accepted: 12/03/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar collateral ligament injury (UCLI) has significantly increased in overhead sports during the past 2 decades. Differences in return to sport (RTS) and RTS at previous level (RTSP) after UCLI have not been differentiated. METHODS A computer-assisted literature search of PubMed, CINAHL, Embase, and SportDiscus databases using keywords related to RTS for UCLI was implemented. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for study methodology. Quality assessment was conducted using a modified Downs and Black scale. RESULTS A total of 22 retrospective, level 3b or 4, studies (n = 2289) qualified for analysis. Overall RTS proportion was 90% (95% confidence interval [CI], 86%-94%) and overall RTSP proportion was 79% (95% CI, 75%-84%), both with significant heterogeneity (P < .001, I2 = 74%-84%). RTS and RTSP proportions were 89% (95% CI, 83%-94%) and 78% (95% CI, 72%-83%) for Major League Baseball players, 91% (95% CI, 77%-99%) and 67% (95% CI, 52%-81%) for Minor League Baseball players, 95% (95% CI, 75%-100%) and 92% (95% CI, 82%-98%) for collegiate players, and 93% (95% CI, 81%-100%) and 83% (95% CI, 77%-89%) for high school players, respectively. Increased earned run average, walks, and hits per inning pitched, decreased innings pitched, and decreased fastball velocity were found after UCLI. CONCLUSION Low-level, high-bias evidence demonstrates overall RTS proportion is higher than RTSP, regardless of treatment type for UCLI. Although RTS proportions remained consistent across various levels of play, RTSP proportions were lower in professional players, particularly Minor League Baseball compared with collegiate and high school players. Pitching performance significantly decreased postoperatively in most studies.
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