101
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Ahmadi S, Gutierrez GL, Uchida MC. Asymmetry in glenohumeral muscle strength of sitting volleyball players: an isokinetic profile of shoulder rotations strength. J Sports Med Phys Fitness 2019; 60:395-401. [PMID: 31684706 DOI: 10.23736/s0022-4707.19.10144-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sitting volleyball (SV) is a popular Paralympic game, in which shoulders of SV players are overloaded continuously during play. Nevertheless, shoulder girdle muscle function has never been measured in this population yet. The objective of this study was to investigate the dominant and non-dominant strength profile of male and female elite SV players on a glenohumeral level. METHODS A total of 13 Brazilian SV national team players volunteered to participate in this study (male: N.=6, age 32.8±4.1 years, body mass 83.2±19.4 kg, seated height 1.47±0.04 m; female: N.=7, age 32.8±4.1 years, body mass 80.1±17.9 kg, seated height 1.36±0.05 m). A Biodex dynamometer was used to measure internal rotation (IR) and external rotation (ER) of the glenohumeral muscle strength at 60°/s and 180°/s velocities in a concentric/concentric mode. RESULTS It was observed that male SV players were stronger than the female players at both upper limbs. Concerning the side effects, significant differences were found for IR at 60°/s velocity (F=7.55, P=0.02) and ER at 180°/s velocity (F=5.91, P=0.03), with higher values on the dominant limb in comparison to the non-dominant limb for both the male and female players. There were significant gender differences for the IR inter-limb asymmetry at 180°/s velocity, with a greater asymmetry between both shoulders in the male players compared to the female players, preference for the dominant side in both groups. CONCLUSIONS The SV players have an asymmetrical rotational strength profile. As muscular imbalance is a common injury pattern among overhead players. The findings of this study may assist the SV coaches and physiotherapists for evaluation and training of strength of the ER and IR shoulders of these players.
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Affiliation(s)
- Shirko Ahmadi
- Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas, Brazil -
| | - Gustavo L Gutierrez
- Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas, Brazil
| | - Marco C Uchida
- Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas, Brazil
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102
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Welling W, Benjaminse A, Lemmink K, Dingenen B, Gokeler A. Progressive strength training restores quadriceps and hamstring muscle strength within 7 months after ACL reconstruction in amateur male soccer players. Phys Ther Sport 2019; 40:10-18. [DOI: 10.1016/j.ptsp.2019.08.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
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103
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Barfod KW, Feller JA, Clark R, Hartwig T, Devitt BM, Webster KE. Strength Testing After Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study Investigating Overlap of Tests. J Strength Cond Res 2019; 33:3145-3150. [DOI: 10.1519/jsc.0000000000002491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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104
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Akınoğlu B, Kocahan T. The effect of deafness on the physical fitness parameters of elite athletes. J Exerc Rehabil 2019; 15:430-438. [PMID: 31316937 PMCID: PMC6614780 DOI: 10.12965/jer.1938100.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/11/2019] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study is to determine the health-related physical fitness parameters of athletes, who are deaf. The study group consisted of 137 deaf athletes (52 females and 85 males with a mean age of 23.99±6.56 years) who have participated in the 2017 Deaflympics games. The assessed parameters included the isokinetic muscle strength, core endurance, balance assessments, grip strength, and body composition. At the end of the study, the following results were obtained. Hamstring/quadriceps ratio was in the range of 53%–54%, which was within 50%–60% of the normal limit. Endurance of the anterior and posterior core muscles was low as compared to the normative data. The athletes’ balance was better with their eyes open than closed; and the grip strength was low as compared to the normative data in the literature. Also, the body fat percentage of deaf female athletes were similar to ones in healthy individuals with sedentary lifestyle, whereas male ones had slightly lower body fat mass percentage. These results can be used as the initial reference parameters to define the training program requirements of deaf athletes.
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Affiliation(s)
- Bihter Akınoğlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Tuğba Kocahan
- Department of Health Services, Center of Athlete Training and Health Research, Sports General Directorship, The Ministry of Youth and Sports, Ankara, Turkey
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105
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Miles JJ, King E, Falvey ÉC, Daniels KAJ. Patellar and hamstring autografts are associated with different jump task loading asymmetries after ACL reconstruction. Scand J Med Sci Sports 2019; 29:1212-1222. [DOI: 10.1111/sms.13441] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/03/2019] [Accepted: 04/18/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Joshua J. Miles
- Sports Medicine Research Department Sports Surgery Clinic Dublin Ireland
- Department for Health University of Bath Bath UK
| | - Enda King
- Sports Medicine Research Department Sports Surgery Clinic Dublin Ireland
- Department of Life Sciences University of Roehampton London UK
| | - Éanna Cian Falvey
- Sports Medicine Research Department Sports Surgery Clinic Dublin Ireland
- Department of Medicine University College Cork Cork Ireland
| | - Katherine A. J. Daniels
- Sports Medicine Research Department Sports Surgery Clinic Dublin Ireland
- Queen’s School of Engineering University of Bristol Bristol UK
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106
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Hunnicutt JL, Gregory CM, McLeod MM, Woolf SK, Chapin RW, Slone HS. Quadriceps Recovery After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Versus Patellar Tendon Autografts. Orthop J Sports Med 2019; 7:2325967119839786. [PMID: 31041332 PMCID: PMC6482652 DOI: 10.1177/2325967119839786] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Quadriceps tendon (QT) autografts are being increasingly used for anterior cruciate ligament reconstruction (ACLR). A paucity of studies exist that compare QT autografts with alternative graft options. Additionally, concerns exist regarding quadriceps recovery after graft harvest insult to the quadriceps muscle-tendon unit. Purpose/Hypothesis The purpose of this study was to compare quadriceps recovery and functional outcomes in patients with QT versus bone-patellar tendon-bone (BPTB) autografts. The hypothesis was that those with QT autografts would demonstrate superior outcomes. Study Design Cohort study; Level of evidence, 3. Methods Active patients with a history of primary, unilateral ACLR with soft tissue QT or BPTB autografts participated. Quadriceps recovery was quantified using variables of strength, muscle size, and activation. Knee extensor isometric and isokinetic strength was measured bilaterally with an isokinetic dynamometer and normalized to body weight. Quadriceps activation was measured with the superimposed burst technique. The maximal cross-sectional area of each quadriceps muscle was measured bilaterally using magnetic resonance imaging. Assessors of muscle size were blinded to the graft type and side of ACLR. Functional tests included hop tests and step length symmetry during walking, measured via spatiotemporal gait analysis. Self-reported function was determined with the International Knee Documentation Committee (IKDC) questionnaire. Neuromuscular and functional outcomes were expressed as limb symmetry indices (LSIs: [surgical limb/nonsurgical limb]*100%). Wilcoxon rank-sum tests were used to compare the LSIs and IKDC scores between groups. Results There were 30 study participants (19 male, 11 female; median age, 22 years [range, 14-41 years]; median time since surgery, 8 months [range, 6-23 months]), with 15 patients in each group. There were no significant between-group differences in demographic variables or outcomes. LSIs were not significantly different between the QT versus BPTB group, respectively: knee extensor isokinetic strength at 60 deg/s (median, 70 [range, 41-120] vs 68 [range, 37-83]; P = .285), activation (median, 95 [range, 85-111] vs 92 [range, 82-105]; P = .148), cross-sectional area of the vastus medialis (median, 79 [range, 62-104] vs 77 [range, 62-95]; P = .425), single-leg hop test (median, 88 [range, 35-114] vs 77 [range, 49-100]; P = .156), and step length symmetry (median, 99 [range, 93-104] vs 98 [range, 92-103]; P = .653). The median IKDC scores between the QT and BPTB groups were also not significantly different: 82 (range, 67-94) versus 83 (range, 54-94); respectively (P = .683). Conclusion Patients with QT autografts demonstrated similar short-term quadriceps recovery and postsurgical outcomes compared with patients with BPTB autografts.
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Affiliation(s)
- Jennifer L Hunnicutt
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chris M Gregory
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michelle M McLeod
- Department of Health and Human Performance, College of Charleston, Charleston, South Carolina, USA
| | - Shane K Woolf
- Department of Orthopaedics and Physical Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Russell W Chapin
- Department of Radiology and Radiological Science, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Harris S Slone
- Department of Orthopaedics and Physical Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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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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108
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Ward SH, Perraton L, Bennell K, Pietrosimone B, Bryant AL. Deficits in Quadriceps Force Control After Anterior Cruciate Ligament Injury: Potential Central Mechanisms. J Athl Train 2019; 54:505-512. [PMID: 31009232 DOI: 10.4085/1062-6050-414-17] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
CONTEXT Poor quadriceps force control has been observed after anterior cruciate ligament (ACL) reconstruction but has not been examined after ACL injury. Whether adaptations within the central nervous system are contributing to these impairments is unknown. OBJECTIVE To examine quadriceps force control in individuals who had sustained a recent ACL injury and determine the associations between cortical excitability and quadriceps force control in these individuals. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Eighteen individuals with a recent unilateral ACL injury (6 women, 12 men; age = 29.6 ± 8.4 years, height = 1.74 ± 0.07 m, mass = 76.0 ± 10.4 kg, time postinjury = 69.5 ± 42.5 days) and 18 uninjured individuals (6 women, 12 men; age = 29.2 ± 6.8 years, height = 1.79 ± 0.07 m, mass = 79.0 ± 8.4 kg) serving as controls participated. MAIN OUTCOME MEASURE(S) Quadriceps force control was quantified as the root mean square error between the quadriceps force and target force during a cyclical force-matching task. Cortical excitability was measured as the active motor threshold and cortical silent period. Outcome measures were determined bilaterally in a single testing session. Group and limb differences in quadriceps force control were assessed using mixed analyses of variance (2 × 2). Pearson product moment correlations were performed between quadriceps force control and cortical excitability in individuals with an ACL injury. RESULTS Individuals with an ACL injury exhibited greater total force-matching error with their involved (standardized mean difference [SMD] = 0.8) and uninvolved (SMD = 0.9) limbs than did controls (F1,27 = 11.347, P = .03). During the period of descending force, individuals with an ACL injury demonstrated greater error using their involved (SMD = 0.8) and uninvolved (SMD = 0.8) limbs than uninjured individuals (F1,27 = 4.941, P = .04). Greater force-matching error was not associated with any cortical excitability measures (P > .05). CONCLUSIONS Quadriceps force control was impaired bilaterally after recent ACL injury but was not associated with selected measures of cortical excitability. The findings highlight a need to incorporate submaximal-force control tasks into rehabilitation and "prehabilitation," as the deficits were present before surgery.
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Affiliation(s)
- Sarah H Ward
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia.,Dr Ward is now with the Insight Centre for Data Analytics, University College Dublin, Ireland
| | - Luke Perraton
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Adam L Bryant
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
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109
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Busch A, Blasimann A, Henle P, Baur H. Neuromuscular activity during stair descent in ACL reconstructed patients: A pilot study. Knee 2019; 26:310-316. [PMID: 30733114 DOI: 10.1016/j.knee.2018.12.011] [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: 07/13/2018] [Revised: 11/20/2018] [Accepted: 12/21/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The anterior cruciate ligament (ACL) rupture is a severe knee injury. Altered kinematics and kinetics in ACL reconstructed (ACL-R) patients compared to healthy participants (ACL-I) are known and attributed to an altered sensorimotor control. However, studies on neuromuscular control often lack homogeneous patient cohorts. The objective was to examine neuromuscular activity during stair descent in patients one year after ACL reconstruction. METHOD Neuromuscular activity of vastus medialis (VM) and lateralis (VL), biceps femoris (BF) and semitendinosus (ST) was recorded by electromyography in 10 ACL-R (age: 26 ± 10 years; height: 175 ± 6 cm; mass: 75 ± 14 kg) and 10 healthy matched controls (age: 31 ± 7 years; height: 175 ± 7 cm; mass: 68 ± 10 kg). A 10-minute walking treadmill warm-up was used for submaximal normalization. Afterwards participants descended 10 times a six-step stairway at a self-selected speed. The movement was separated into pre-activation (PRE), weight acceptance (WA) and push-off phase (PO). Normalized root mean squares for each muscle, limb and movement phase were calculated. Kruskal-Wallis ANOVA compared ACL-R injured and contralateral leg and the ACL-I leg (α = 0.05). RESULTS Significant increased normalised activity in ST during WA in ACL-R injured leg compared to ACL-I and during PO in VL in the ACL-R contralateral leg compared to ACL-I. Decreased activity was shown in VM in ACL-R injured compared to contralateral leg (p < 0.05). CONCLUSION Altered neuromuscular activations are present one year after ACL reconstruction compared to the contralateral and healthy matched control limb. Current standard rehabilitation programs may not be able to fully restore sensorimotor control and demand further investigations.
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Affiliation(s)
- Aglaja Busch
- Department Health & Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, CH-3008 Bern, Switzerland; University Outpatient Clinic, Sports Medicine & Sports Orthopedics, University of Potsdam, Am Neuen Palais 10, DE-14469 Potsdam, Germany.
| | - Angela Blasimann
- Department Health & Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, CH-3008 Bern, Switzerland.
| | - Philipp Henle
- Department of Knee Surgery and Sports Traumatology, Sonnenhof Orthopaedic Center, Buchserstrasse 30, CH-3006 Bern, Switzerland.
| | - Heiner Baur
- Department Health & Physiotherapy, Bern University of Applied Sciences, Murtenstrasse 10, CH-3008 Bern, Switzerland.
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110
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Dobija L, Reynaud V, Pereira B, Van Hille W, Descamps S, Bonnin A, Coudeyre E. Measurement properties of the Star Excursion Balance Test in patients with ACL deficiency. Phys Ther Sport 2019; 36:7-13. [DOI: 10.1016/j.ptsp.2018.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/05/2018] [Accepted: 12/18/2018] [Indexed: 12/23/2022]
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111
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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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112
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Huber R, Viecelli C, Bizzini M, Friesenbichler B, Dohm-Acker M, Rosenheck T, Harder L, Maffiuletti NA. Knee extensor and flexor strength before and after anterior cruciate ligament reconstruction in a large sample of patients: influence of graft type. PHYSICIAN SPORTSMED 2019; 47:85-90. [PMID: 30252577 DOI: 10.1080/00913847.2018.1526627] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Hamstring and patellar tendon autografts are the most frequently-used graft types for anterior cruciate ligament (ACL) reconstruction, with no consensus on their respective effects on thigh muscle strength. The objective of this study was to re-examine isokinetic knee extensor and flexor strength before and after ACL reconstruction with patellar and hamstring tendon grafts using a single-center and a relatively large database, where surgical, rehabilitation and testing procedures were strictly standardized for all patients. METHODS A total of 464 patients with a unilateral ACL rupture underwent arthroscopic ACL reconstruction with either patellar or hamstring tendon grafts. Isokinetic concentric strength was evaluated prior to surgery and at 5- and 9-month postoperative follow-ups in different patient subgroups (n = 140, 464 and 215, respectively). RESULTS Knee extensor strength was lower in patients operated with the patellar tendon graft at the 5-month (p < 0.05) but not at the 9-month follow-up. Knee flexor strength was lower in patients operated with the hamstring tendon graft at both postoperative time points (p < 0.05). The prevalence of quadriceps weakness was high (66-91%) in both patient groups at both follow-ups. CONCLUSION Overall, postoperative recovery of thigh muscle function seems to be better with the patellar than with the hamstring tendon graft due to the fact that both, knee extensor and flexor strength, were more impaired after ACL reconstruction with the hamstring tendon autograft.
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Affiliation(s)
- Raphael Huber
- a Human Performance Laboratory , Schulthess Clinic , Zurich , Switzerland
| | - Claudio Viecelli
- a Human Performance Laboratory , Schulthess Clinic , Zurich , Switzerland
| | - Mario Bizzini
- a Human Performance Laboratory , Schulthess Clinic , Zurich , Switzerland
| | | | - Markus Dohm-Acker
- a Human Performance Laboratory , Schulthess Clinic , Zurich , Switzerland
| | - Thomas Rosenheck
- a Human Performance Laboratory , Schulthess Clinic , Zurich , Switzerland
| | - Laurent Harder
- a Human Performance Laboratory , Schulthess Clinic , Zurich , Switzerland
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113
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Zult T, Gokeler A, van Raay JJAM, Brouwer RW, Zijdewind I, Farthing JP, Hortobágyi T. Cross-education does not improve early and late-phase rehabilitation outcomes after ACL reconstruction: a randomized controlled clinical trial. Knee Surg Sports Traumatol Arthrosc 2019; 27:478-490. [PMID: 30182287 DOI: 10.1007/s00167-018-5116-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 08/14/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE Limited evidence suggests that cross-education affords clinical benefits in the initial 8 weeks after anterior cruciate ligament (ACL) reconstruction, but it is unknown if such cross-education effects are reproducible and still present in later phases of rehabilitation. We examined whether cross-education, as an adjuvant to standard therapy, would accelerate the rehabilitation up to 26 weeks after ACL reconstruction by attenuating quadriceps weakness. METHODS ACL-reconstructed patients were randomized into experimental (n = 22) and control groups (n = 21). Both groups received standard care after ACL reconstruction. In addition, the experimental group strength trained the quadriceps of the non-operated leg during weeks 1-12 after surgery (i.e., cross-education). Self-reported knee function was assessed with the Hughston Clinic Knee score as the primary outcome. Secondary outcomes were maximal quadriceps and hamstring strength and single leg hop distance. All outcomes were measured 29 ± 23 days prior to surgery, as a reference, and at 5-week, 12-week, and 26-week post-surgery. RESULTS Both groups scored 12% worse on self-reported knee function 5-week post-surgery (95% CI 7-17) and showed 15% improvement 26-week post-surgery (95% CI - 20 to - 10). No cross-education effect was found. Interestingly, males scored 8-10% worse than females at each time point post-surgery. None of 33 secondary outcomes showed a cross-education effect. At 26-week post-surgery, both legs improved maximal quadriceps (5-14%) and hamstring strength (7-18%), and the non-injured leg improved 2% in hop distance. The ACL recovery was not affected by limb dominance and age. CONCLUSION 26 weeks of standard care improved self-reported knee function and maximal leg strength relative to pre-surgery and adding cross-education did not further accelerate ACL recovery. LEVEL OF EVIDENCE I. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION This randomized controlled clinical trial is registered at the Dutch trial register ( http://www.trialregister.nl ) under NTR4395.
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Affiliation(s)
- Tjerk Zult
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Vision and Eye Research Unit, School of Medicine, Anglia Ruskin University, Young Street 213, Cambridge, CB1 1PT, UK.
| | - Alli Gokeler
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jos J A M van Raay
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Reinoud W Brouwer
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Inge Zijdewind
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Tibor Hortobágyi
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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114
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Chai F, Wan F, Jiang J, Chen S. Micro-scale assessment of the postoperative effect of anterior cruciate ligament reconstruction preclinical study using a 7.1T micro-magnetic resonance imaging. Exp Ther Med 2019; 17:214-220. [PMID: 30651785 PMCID: PMC6307410 DOI: 10.3892/etm.2018.6080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/01/2018] [Indexed: 11/26/2022] Open
Abstract
High-field micro-magnetic resonance imaging (MRI) scanning may provide additional information for quantitative analysis of graft bone healing processes, thus serving as a promising supplementary method in graft and bone healing evaluation following anterior cruciate ligament reconstruction (ACLR) surgery during preclinical studies. The present study included 12 New Zealand white rabbits that underwent ACLR with polyethylene terephthalate (PET) ligament. At 4, 8, and 16 weeks following surgery, 4 rabbits were euthanized and knee joint samples were harvested for a 7.1T micro-magnetic resonance imaging (MRI) scan. The graft bone tunnel diameter and signal noise ratio (SNR) at the region of interest (ROI) were measured. Hematoxylin-eosin staining was performed at each time point to verify the graft bone healing process in histology. The bone tunnel diameter at the graft tunnel interface decreased over time in both femoral and tibial parts. Notably, the tunnel size was smaller than the diameter of the drilling Kirschner wire that was used to observe the femoral part and proximal site of the tibial part at 16 weeks following surgery. SNR research demonstrated that both the femoral and tibial part PET ligaments selected in the ROI exhibited a marked increase in SNR from the initial 4-week results. The micro-MRI result was consistent with that of histological analysis. Micro-MRI scanning was applied in an animal model that underwent ACL reconstruction surgery with PET ligament, and it was determined that micro-MRI is promising in quantitatively observing graft bone healing processes directly with a focus on graft tunnel distances and SNRs.
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Affiliation(s)
- Fang Chai
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310003, P.R. China.,Department of Sports Medicine and Arthroscopic Surgery, Huashan Hospital, Sports Medicine Center, Fudan University, Shanghai 200040, P.R. China
| | - Fang Wan
- Department of Sports Medicine and Arthroscopic Surgery, Huashan Hospital, Sports Medicine Center, Fudan University, Shanghai 200040, P.R. China
| | - Jia Jiang
- Department of Sports Medicine and Arthroscopic Surgery, Huashan Hospital, Sports Medicine Center, Fudan University, Shanghai 200040, P.R. China
| | - Shiyi Chen
- Department of Sports Medicine and Arthroscopic Surgery, Huashan Hospital, Sports Medicine Center, Fudan University, Shanghai 200040, P.R. China
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Barfod KW, Feller JA, Hartwig T, Devitt BM, Webster KE. Knee extensor strength and hop test performance following anterior cruciate ligament reconstruction. Knee 2019; 26:149-154. [PMID: 30554909 DOI: 10.1016/j.knee.2018.11.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/28/2018] [Accepted: 11/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee extensor strength and single limb hop for distance have been suggested as useful measures to evaluate readiness to return to sport after anterior cruciate ligament (ACL) reconstruction. The aim of the study was to examine the association between knee extensor strength and single leg hop for distance following ACL reconstruction and to determine the proportion of patients with knee extensor strength symmetry deficits at six and 12 months. METHODS From December 2013 to December 2015 69 patients aged 14 to 45 undergoing primary ACL reconstruction were recruited. Isokinetic concentric knee extensor strength testing and single limb hop for distance were performed six and 12 months postoperatively. Satisfactory knee extensor strength was defined as a leg symmetry index (LSI) ≥85%. RESULTS At six months 27.5% (19/69) of patients had recovered satisfactory knee extensor strength in the injured leg, improving to 46.4% (32/69) at 12 months. Recovery of satisfactory strength was associated with hopping distance. Hop symmetry was achieved considerably faster than knee extensor symmetry, with 66.7% (46/69) of patients demonstrating satisfactory hopping symmetry at six months, 89.9% (62/69) at 12 months. Recovery of hopping distance was not associated with knee extensor strength. CONCLUSIONS Single leg hop test cannot be used as a surrogate measure for knee extensor strength as no association was found between hop tests and knee extensor strength. Less than one in three patients at six months and one in two at 12 months had recovered satisfactory knee extensor strength.
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Affiliation(s)
- Kristoffer W Barfod
- OrthoSport Victoria Research Unit, Epworth HealthCare, Level 5, 89 Bridge Rd, Richmond 3121, Australia; Afdelingslæge Artroskopisk Center, Hvidovre Hospital, Denmark
| | - Julian A Feller
- OrthoSport Victoria Research Unit, Epworth HealthCare, Level 5, 89 Bridge Rd, Richmond 3121, Australia
| | - Taylor Hartwig
- OrthoSport Victoria Research Unit, Epworth HealthCare, Level 5, 89 Bridge Rd, Richmond 3121, Australia
| | - Brian M Devitt
- OrthoSport Victoria Research Unit, Epworth HealthCare, Level 5, 89 Bridge Rd, Richmond 3121, Australia
| | - Kate E Webster
- School of Allied Health, College of Science, Health & Engineering, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia.
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Only one patient out of five achieves symmetrical knee function 6 months after primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:3461-3470. [PMID: 30778627 PMCID: PMC6800857 DOI: 10.1007/s00167-019-05396-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the percentage of patients achieving symmetrical knee function 6 months after primary anterior cruciate ligament (ACL) reconstruction (ACLR) and to identify factors affecting its achievement, in a large cohort. METHODS Data were extracted from our clinic database. Patients who underwent primary ACLR from 2000 to 2015 and were assessed with the isokinetic quadriceps and hamstring muscles strength tests and single-leg-hop test at the 6-month follow-up were included in the study. Demographic data, information on the graft used, cartilage injuries and concomitant meniscal surgery were reviewed. Patients who reached a limb symmetry index (LSI) of ≥ 90% in all three tests were considered to have achieved symmetrical knee function. A multivariate logistic regression analysis was used to determine whether patient age, gender, time from injury to surgery, pre-injury Tegner activity level, graft type, cartilage injury and the presence of medial meniscus (MM) or lateral meniscus (LM) resection or repair were factors associated with the achievement of symmetrical knee function 6 months after primary ACLR. RESULTS A total of 4093 patients (54.3% males) with a mean age of 28.3 ± 10.7 years were included. Data from all three tests were available for 3541 patients. The proportion of patients that achieved a LSI of ≥ 90% was 35.7%, 47.3% and 67.9% for isokinetic quadriceps muscle strength, hamstring muscles strength and the single-leg-hop test, respectively. A total of 693 patients (19.6%) achieved symmetrical knee function, reaching a LSI of ≥ 90% in all three tests. Older age (≥ 30 years) (OR, 0.50; 95% CI 0.41-0.61; P < 0.001), MM resection (OR, 0.75; 95% CI 0.57-0.98; P = 0.03) and MM repair (OR, 0.63; 95% CI 0.40-0.98; P = 0.04) reduced the odds, whereas the use of hamstring tendon (HT) autograft (OR, 2.28; 95% CI 1.51-3.45; P < 0.001) over bone-patellar tendon-bone (BPTB) autograft increased the odds of achieving symmetrical knee function. CONCLUSION Only 19.6% of the patients achieved symmetrical knee function 6 months after primary ACLR. Age ≥ 30 years, MM resection and MM repair reduced the chance, whereas the use of HT autograft over BPTB autograft increased the chance of achieving symmetrical knee function 6 months after primary ACLR. This study shows that most of the patients are yet to regain symmetrical knee function 6 months after primary ACLR and, moreover, it identifies several factors affecting its achievement in a large cohort. The results of this study should be used to counsel patients about their expected functional recovery and to optimize rehabilitation and maximize knee function after ACLR. LEVEL OF EVIDENCE III.
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Quadriceps and Patient-Reported Function in ACL-Reconstructed Patients: A Principal Component Analysis. J Sport Rehabil 2019; 28:8-16. [DOI: 10.1123/jsr.2017-0080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/25/2017] [Accepted: 06/18/2017] [Indexed: 11/18/2022]
Abstract
Context: Assessment of physical function for individuals after anterior cruciate ligament reconstruction (ACL-R) is complex and warrants the use of diverse evaluation strategies. To maximize the efficiency of assessment, there is a need to identify tests that provide the most meaningful information about this population. Objective: To investigate underlying constructs of quadriceps muscle function that uniquely describe aspects of performance in patients after ACL-R and establish clinical thresholds for measures able to classify patients with and without ACL-R. Design: Cross-sectional. Setting: Research laboratory. Patients (or Other Participants): Seventy-two patients with a primary, unilateral ACL-R (32 males and 40 females, age = 26.0 [9.3] y, time since surgery = 46.5 [58.0] mo) and 30 healthy controls (12 males and 18 females, age = 22.7 [4.6] y). Intervention(s): Quadriceps function was assessed bilaterally during 1 study visit. Main Outcome Measures: Isokinetic strength (peak torque, total work, and average power) at 90° and 180°/s, maximal voluntary isometric contraction torque, fatigue index, central activation ratio, Hoffmann reflex, and active motor threshold. Principal component analyses were performed for the involved limb, contralateral limb, and limb symmetry. Receiver–operator characteristic curve analyses were conducted to determine the diagnostic utility of each variable. Binary logistic regression was used to predict group membership (ACL-R vs healthy). Results: Three components of peripheral, central, and combined (peripheral and central) muscle function were identified, explaining 70.7% to 80.5% of variance among measures of quadriceps function. Total knee-extensor work at 90°/s (≥18.4 J/kg), active motor threshold (≥39.5%), and central activation ratio (≥94.7%) of the involved limb were strong predictors of patient status and correctly classified 83.5% of patients with ACL-R (P < .001). Conclusions: Unique constructs of peripheral, central, and combined muscle function exist in patients with ACL-R. Total knee-extensor work at 90°/s, active motor threshold, and central activation ratio consistently explained a significant portion of variance in measures of quadriceps function, demonstrated acceptable to excellent diagnostic utility, and predicted group membership with 72.8% to 83.5% accuracy.
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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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Baumgart C, Welling W, Hoppe MW, Freiwald J, Gokeler A. Angle-specific analysis of isokinetic quadriceps and hamstring torques and ratios in patients after ACL-reconstruction. BMC Sports Sci Med Rehabil 2018; 10:23. [PMID: 30534382 PMCID: PMC6282246 DOI: 10.1186/s13102-018-0112-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022]
Abstract
Background Strength deficits, muscle imbalances, and quadriceps inhibition are common after the surgical reconstruction of the anterior cruciate ligament (ACL), even after the patient’s returned-to-sport. Typically, asymmetries between the operated and non-operated leg as well as the hamstring/quadriceps (HQ) ratio are calculated using maximum isokinetic torque values. Moreover, the knee flexion angles, which correspond to the measured torque values, were not considered. Therefore, the aim of the study was to evaluate the usage of an angle-specific approach for the analysis of isokinetic data in patients after an ACL-reconstruction. Methods A cross-sectional laboratory study design was used to investigate the influence of leg (operated vs. non-operated) and two velocities on angle-specific isokinetic data. Concentric quadriceps and hamstring torques and ratios of 38 patients were assessed 6.6 months after ACL-reconstruction with a hamstring tendon graft. At a velocity of 60°/s and 180°/s, angle-specific torques and HQ-ratios were analyzed with conventional discrete parameters and a Statistical Parametric Mapping procedure, which evaluates continuous data. The relationship between angle-specific and conventional HQ-ratios was evaluated with Pearson correlation coefficients. Results Angle-specific torques and HQ-ratios were different between the operated and non-operated leg and between velocities. In the operated leg, the quadriceps deficit was higher at 60°/s in knee flexion angles > 50°. The HQ-ratios decreased with greater knee flexion at both velocities, but with a different magnitude. Around 30°, the HQ-ratios reached 1.0 and did not differ between the velocities, while leg differences were present from 40 to 60°. At the higher testing velocity, the maximum flexion torque occurred at greater knee flexion, whereas the maximum extension torque were present at a similar joint angle. The correlation coefficients between conventional and angle-specific HQ-ratios were low in knee angles < 35° and > 65° and varied according to leg and velocity. Conclusions The angle specific approach is recommended for future ACL-research, as it reveals strength deficits and imbalances, which were not captured by conventional parameters. The results provide a rationale for more specific joint angle and/or velocity based training and may help for return-to-sport decisions.
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Affiliation(s)
- Christian Baumgart
- 1Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119 Wuppertal, Germany
| | - Wouter Welling
- 2Center for Human Movement Science, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.,Medisch Centrum Zuid, Sportlaan 2-1, 9728 PH Groningen, The Netherlands
| | - Matthias W Hoppe
- 1Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119 Wuppertal, Germany.,Department of Orthopedic, Trauma and Hand Surgery, Klinikum Osnabrück GmbH, Osnabrück, Am Finkenhügel 1, 49076 Osnabrück, Germany
| | - Jürgen Freiwald
- 1Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119 Wuppertal, Germany
| | - Alli Gokeler
- 5Exercise Science and Neuroscience, Department of Exercise & Health, University of Paderborn, Warburger Str. 100, 33098 Paderborn, Germany.,Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science, Luxembourg, Luxembourg
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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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Duarte JP, Valente-Dos-Santos J, Costa D, Coelho-E-Silva MJ, Deprez D, Philippaerts R, Lenoir M, Vaeyens R, Malina RM. Multilevel modelling of longitudinal changes in isokinetic knee extensor and flexor strength in adolescent soccer players. Ann Hum Biol 2018; 45:453-456. [PMID: 30380339 DOI: 10.1080/03014460.2018.1521470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The purpose of the study was to model the longitudinal development of knee extension (KE) and flexion (KF) strength in adolescent soccer players. A mixed-longitudinal sample composed of 67 soccer players aged 11.0-13.9 years at baseline was followed on three-to-five occasions over 5 years. Stature, body mass and several skinfold thicknesses were measured. Fat mass was estimated from skinfolds and fat-free mass (FFM) derived. Skeletal age was estimated with the TW2-RUS protocol. An isokinetic dynamometer was used to obtain peak torque of KE and KF from concentric assessments at an angular velocity of 180°/s. Multilevel random effects regression analyses were performed. Among youth soccer players aged 11-16 years, isokinetic strength of the knee muscle groups was reasonably predicted from chronological age (CA), stature and FFM: KE = -66.170 + 5.353 × (CA) + 0.594 × (CA2) + 0.552 × (stature) + 1.414 × (FFM), and KF = -9.356 + 2.708 × (CA) + 1.552 × (FFM). In conclusion, CA per se accounted for annual increments of 5.4 Nm in KE and 2.7 Nm in KF.
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Affiliation(s)
- João P Duarte
- a Research Unity for Sport and Physical Activity (CIDAF, UID/DTP/04213/2016) , University of Coimbra , Coimbra , Portugal.,b Faculty of Sport Sciences and Physical Education , University of Coimbra , Coimbra , Portugal.,c Portuguese Foundation for Science and Technology (SFRH/BD/101083/2014) , Lisbon , Portugal
| | - João Valente-Dos-Santos
- a Research Unity for Sport and Physical Activity (CIDAF, UID/DTP/04213/2016) , University of Coimbra , Coimbra , Portugal.,d Portuguese Foundation for Science and Technology (SFRH/BPD/100470/2014) , Lisbon , Portugal.,e Faculty of Physical Education and Sport , Lusófona University of Humanities and Technologies , Lisbon , Portugal
| | - Daniela Costa
- a Research Unity for Sport and Physical Activity (CIDAF, UID/DTP/04213/2016) , University of Coimbra , Coimbra , Portugal
| | - Manuel J Coelho-E-Silva
- a Research Unity for Sport and Physical Activity (CIDAF, UID/DTP/04213/2016) , University of Coimbra , Coimbra , Portugal.,b Faculty of Sport Sciences and Physical Education , University of Coimbra , Coimbra , Portugal
| | - Dieter Deprez
- f Club Brugge Koninklijke Club Brugge KV , Brugge , Belgium
| | | | - Matthieu Lenoir
- g Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
| | - Roel Vaeyens
- f Club Brugge Koninklijke Club Brugge KV , Brugge , Belgium.,g Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
| | - Robert M Malina
- h Department of Kinesiology and Health Education , University of Texas , Austin , TX , USA
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Peos JJ, Helms ER, Fournier PA, Sainsbury A. Continuous versus intermittent moderate energy restriction for increased fat mass loss and fat free mass retention in adult athletes: protocol for a randomised controlled trial-the ICECAP trial (Intermittent versus Continuous Energy restriction Compared in an Athlete Population). BMJ Open Sport Exerc Med 2018; 4:e000423. [PMID: 30364484 PMCID: PMC6196972 DOI: 10.1136/bmjsem-2018-000423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 01/20/2023] Open
Abstract
Introduction Reducing fat mass (FM) while retaining fat free mass (FFM) is a common goal of athletes. Evidence suggests that some-but not all-forms of intermittent energy restriction (IER) may be superior to the conventional method of continuous energy restriction (CER) for people with excess body fat that are sedentary, by reducing some of the adaptive responses to ER. However, it is yet to be established whether this dietary approach is effective for athletes. Methods and analysis A single-blind, parallel group, randomised controlled trial with a 1:1 allocation ratio is proposed. Sixty healthy athletes aged ≥18 years will be recruited from local sporting facilities and randomised to an intervention of either moderate CER (mCER) or moderate IER (mIER). Both interventions will consist of 12 weeks of moderate ER, plus 3 weeks in energy balance (EB). The mCER intervention will entail 12 weeks of continuous moderate ER, followed by 3 weeks in EB. The mIER intervention will entail 12 weeks of moderate ER, administered as 4×3 week blocks of moderate ER, interspersed with 3×1 week blocks of EB. The co-primary outcomes are changes in FM and FFM after 12 weeks of moderate ER. Secondary outcomes will be changes in FM and FFM at 15 weeks after intervention commencement, as well as muscle performance, physical activity, sleep quality, changes in resting energy expenditure, subjective drive to eat, circulating concentrations of appetite-regulating hormones, mood states and diet acceptability. Trial registration ACTRN12618000638235p.
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Affiliation(s)
- Jackson J Peos
- School of Human Sciences, The University of Western Australia (UWA), Crawley, Western Australia, Australia
| | - Eric R Helms
- Sports Performance Institute New Zealand (SPRINZ), Auckland University of Technology, at AUT Millennium, Auckland, New Zealand
| | - Paul A Fournier
- School of Human Sciences, The University of Western Australia (UWA), Crawley, Western Australia, Australia
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
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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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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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125
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Vanderstukken F, Jansen N, Mertens T, Cools AM. Elite male field hockey players have symmetric isokinetic glenohumeral strength profiles, but show asymmetry in scapular muscle strength. J Sports Sci 2018; 37:484-491. [PMID: 30074436 DOI: 10.1080/02640414.2018.1507238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Shoulders of elite field hockey players are loaded continuously during play. However, shoulder girdle muscle performance in this population has never been examined yet. This study aimed to compare isokinetic shoulder girdle performance in elite male field hockey players to matched controls, with respect to strength, endurance and muscle balance. The complete male national field hockey team of Belgium (n = 25) was included and matched to a gender- and age-matched control group of healthy participants (n = 25). A Biodex system-4 dynamometer was used to measure glenohumeral and scapular muscle strength at 2 velocities in a concentric/concentric mode. With the main outcome measures being isokinetic strength values, peak force (protraction-retraction), peak torque (rotations), fatigue index and agonist/antagonist ratio's. Measurement results showed that elite male field hockey players were stronger than their matched controls, for both the rotational and the protraction-retraction movement. Concerning rotational strength, symmetrical findings were established, contrary to scapular strength, where side differences were noted. At low velocity, retraction peak force was higher on the dominant side. Protraction peak force was higher on the non-dominant side when measured at high velocity. In conclusion, elite field hockey players have a symmetrical rotational strength profile, in contrast to their scapular strength profile.
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Affiliation(s)
- Fran Vanderstukken
- a Department of Revalidation Sciences and Physiotherapy , Ghent University , Gent , Belgium
| | - Nick Jansen
- b Department of Orthopedic Surgery, AZ Monica Antwerpen , Antwerpen , Belgium
| | | | - Ann M Cools
- a Department of Revalidation Sciences and Physiotherapy , Ghent University , Gent , Belgium
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126
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Ebert JR, Edwards P, Yi L, Joss B, Ackland T, Carey-Smith R, Buelow JU, Hewitt B. Strength and functional symmetry is associated with post-operative rehabilitation in patients following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:2353-2361. [PMID: 28916871 DOI: 10.1007/s00167-017-4712-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/08/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate strength and functional symmetry during common tests in patients after anterior cruciate ligament reconstruction (ACLR), and its association with post-operative rehabilitation. METHODS At a median 11.0 months post-surgery (range 10-14), 111 ACLR patients were assessed. A rehabilitation grading tool was employed to evaluate the duration and supervision of rehabilitation, as well as whether structured jumping, landing and agility exercises were undertaken. Patients completed the Noyes Activity Score (NSARS), maximal isokinetic knee extensor and flexor strength assessment, and a 4-hop test battery. Limb Symmetry Indices (LSIs) were calculated, presented for the entire group and also stratified by activity level. ANOVA evaluated differences between the operated and unaffected limbs across all tests. Correlations were undertaken to assess the relationship between post-operative rehabilitation and objective test LSIs. RESULTS The unaffected limb was significantly better (p < 0.0001) than the operated limb for all tests. Only 52-61 patients (47-55%) demonstrated LSIs ≥ 90% for each of the hop tests. Only 34 (30.6%) and 61 (55.0%) patients were ≥ 90% LSI for peak quadriceps and hamstring strength, respectively. Specifically in patients actively participating in jumping, pivoting, cutting, twisting and/or turning sports, 21 patients (36.8%) still demonstrated an LSI < 90% for the single hop for distance, with 37 patients (65.0%) at < 90% for peak knee extension strength. Rehabilitation was significantly associated with the LSIs for all tests. CONCLUSION Rehabilitation was significantly correlated with limb symmetry, and lower limb symmetry was below recommended criterion for many community-level ACLR patients, including those already engaging in riskier activities. It is clear that many patients are not undertaking the rehabilitation required to address post-operative strength and functional deficits, and are being cleared to return to sport (or are returning on their own accord) without appropriate evaluation and further guidance. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,HFRC, 117 Stirling Highway, Nedlands, WA, 6009, Australia.
| | - Peter Edwards
- School of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.,HFRC, 117 Stirling Highway, Nedlands, WA, 6009, Australia
| | - Luke Yi
- School of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Brendan Joss
- HFRC, 117 Stirling Highway, Nedlands, WA, 6009, Australia
| | - Timothy Ackland
- School of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Richard Carey-Smith
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth, WA, 6005, Australia.,School of Surgery (Orthopaedics), University of Western Australia, Crawley, WA, 6009, Australia.,Sir Charles Gairdner Hospital (Orthopaedic Surgery Department), Nedlands, WA, 6009, Australia
| | - Jens-Ulrich Buelow
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth, WA, 6005, Australia
| | - Ben Hewitt
- Orthology, Suite 1, 48 Outram Street, West Perth, WA, 6005, Australia
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127
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Castro MPD, Ruschel C, Santos GM, Ferreira T, Pierri CAA, Roesler H. Isokinetic hip muscle strength: a systematic review of normative data. Sports Biomech 2018; 19:26-54. [PMID: 29895216 DOI: 10.1080/14763141.2018.1464594] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The aim of this study was to conduct a systematic review to determine the quality of evidence of studies assessing isokinetic hip muscle strength in adult non-injured individuals. We also aimed to summarise and pool data of normative values for hip muscle strength. The influence of methodological and participant-related factors on hip strength performance was explored as well. Guidelines proposed in the PRISMA were used to undertake a search strategy involving the keyword 'hip' associated with a set of keywords reflecting muscle strength. Five databases were searched: ProQuest, PubMed, Science Direct, Scopus and Web of Science. From the 2,939 records initially retained, 28 articles were included in this systematic review. Eight articles were classified as high quality. This systematic review exposed the methodological fragility of most studies assessing hip strength in non-injured adult population. Only data from studies with a small number of participants are available to be used as reference. A few individual studies suggest no differences in torque parameters between dominant and non-dominant lower limbs; differences in torque parameters between age groups; and between male and female participants. Overall, reference values for hip muscle performance in isokinetic tests are mostly unclear.
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Affiliation(s)
- Marcelo Peduzzi de Castro
- Centre of Health and Sports Sciences, University of the State of Santa Catarina, Florianópolis, Brazil.,Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory - LaBClin, Florianópolis, Brazil
| | - Caroline Ruschel
- Centre of Health and Sports Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Gilmar Moraes Santos
- Centre of Health and Sports Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Taylor Ferreira
- Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory - LaBClin, Florianópolis, Brazil
| | | | - Helio Roesler
- Centre of Health and Sports Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
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Hamrin Senorski E, Svantesson E, Beischer S, Grassi A, Krupic F, Thomeé R, Samuelsson K. Factors Affecting the Achievement of a Patient-Acceptable Symptom State 1 Year After Anterior Cruciate Ligament Reconstruction: A Cohort Study of 343 Patients From 2 Registries. Orthop J Sports Med 2018; 6:2325967118764317. [PMID: 29780834 PMCID: PMC5954350 DOI: 10.1177/2325967118764317] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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 There is insufficient knowledge regarding the influence of concomitant injuries on the recovery of short-term subjective knee function after anterior cruciate ligament (ACL) reconstruction. Purpose To determine whether patient characteristics, concomitant injuries, and graft choice during ACL reconstruction can predict which patients achieve acceptable knee function 1 year after reconstruction. Study Design Case-control study; Level of evidence, 3. Methods Data from 1 physical therapist-specific and 1 surgeon-specific register were used. Patients who had completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at 1-year follow-up were included. Additional intraoperative information was extracted from a database. The primary outcome was achieving a patient-acceptable symptom state (PASS) for each subscale of the KOOS. Univariable and multivariable logistic regression models were used, with patient sex, age, and preinjury level of physical activity as covariates. Results A total of 343 patients (51% females) were included. The proportion of patients achieving PASS 1 year after ACL reconstruction varied between 40% and 85% among the KOOS subscales. Younger age at reconstruction and male sex provided favorable odds of achieving acceptable knee function across the KOOS subscales. Patients without cartilage injury had increased odds of achieving PASS in the KOOS sport and recreation subscale; the increase was 1.63-fold (95% CI, 1.01-2.64; P = .045). Patients receiving patellar tendon autograft had a 0.41-fold (95% CI, 0.19-0.85; P = .017) decrease in odds of achieving PASS on the KOOS quality of life (QoL) subscale. In the multivariable analysis, increased odds of achieving PASS on the KOOS QoL subscale were associated with the absence of meniscal injury (odds ratio, 1.62; 95% CI, 1.04-2.54; P = .035), and increased odds were found for hamstring tendon autograft (OR, 2.63; 95% CI, 1.25-5.56; P = .011). Conclusion More than half of the patients reported an acceptable symptom state on 4 of the 5 KOOS subscales 1 year after ACL reconstruction. A lack of consistency was noted related to the effect of concomitant knee injuries and graft choice on acceptable knee function. However, younger age and male sex were favorable, nonmodifiable characteristics that increased the odds of early acceptable function.
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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, Sports 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, Sports Medicine Clinic, Gothenburg, Sweden
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II-Lab. di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ferid Krupic
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sportrehab, Sports Medicine Clinic, Gothenburg, 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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129
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Baida SR, Gore SJ, Franklyn-Miller AD, Moran KA. Does the amount of lower extremity movement variability differ between injured and uninjured populations? A systematic review. Scand J Med Sci Sports 2018; 28:1320-1338. [DOI: 10.1111/sms.13036] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/30/2022]
Affiliation(s)
- S. R. Baida
- Sports Medicine Department; Sports Surgery Clinic; Santry Demesne; Dublin Ireland
- School of Health and Human Performance; Dublin City University; Dublin Ireland
- Insight Centre for Data Analytics; Dublin City University; Dublin Ireland
| | - S. J. Gore
- Sports Medicine Department; Sports Surgery Clinic; Santry Demesne; Dublin Ireland
- School of Health and Human Performance; Dublin City University; Dublin Ireland
- Insight Centre for Data Analytics; Dublin City University; Dublin Ireland
| | - A. D. Franklyn-Miller
- Sports Medicine Department; Sports Surgery Clinic; Santry Demesne; Dublin Ireland
- Centre for Health, Exercise and Sports Medicine; University of Melbourne; Melbourne VIC Australia
| | - K. A. Moran
- School of Health and Human Performance; Dublin City University; Dublin Ireland
- Insight Centre for Data Analytics; Dublin City University; Dublin Ireland
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130
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Beischer S, Hamrin Senorski E, Thomeé C, Samuelsson K, Thomeé R. Young athletes return too early to knee-strenuous sport, without acceptable knee function after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:1966-1974. [PMID: 29032484 PMCID: PMC6061439 DOI: 10.1007/s00167-017-4747-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/04/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the return to knee-strenuous sport rate, muscle function and subjective knee function among adolescent patients (15-20 years of age) and adult patients (21-30 years of age) 8 and 12 months, respectively, after anterior cruciate ligament (ACL) reconstruction. It was hypothesised that no differences in outcome would be found between age groups at 8 or 12 months after ACL reconstruction. METHODS Cross-sectional data from five tests of muscle function, from the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Scale (Tegner), performed at 8 and 12 months after a primary ACL reconstruction, were extracted from a rehabilitation outcome register. A total of 270 (51% women) athletes, aged 15-30 years, who were all involved in knee-strenuous sport prior the injury, were included at 8 months after ACL reconstruction. At 12 months 203 (51% women) were included. The return to knee-strenuous-sport rates and the rate of achieving a limb symmetry index of ≥ 90% in all five tests of muscle function, defined as recovery of muscle function, and subjective knee function scores, as measured with the KOOS, were compared between age groups. RESULTS The adolescent patients had a higher (50%) return to knee-strenuous sport rate compared with the adult patients (38%) 8 months after ACL reconstruction (p = 0.04). At the 12-month follow-up, no difference was found between the age groups; 74 and 63%, respectively. At the 8-month follow-up, 29% of the patients, in both age groups, who had returned to sport had recovered their muscle function in all five tests of muscle function. At the 12-month follow-up, the corresponding results were 20% for the adolescents and 28% for the adult patients. No difference in mean KOOS scores was found between the age groups at 8 or at 12 months after ACL reconstruction. CONCLUSION The majority of young athletes make an early return to knee-strenuous sport after a primary ACL reconstruction, without recovering their muscle function. To set realistic expectations, clinicians are recommended to ensure that young athletes receive information about not to return before muscle function is recovered and that this may take longer time than 12 months. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Susanne Beischer
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden.
| | - Eric Hamrin Senorski
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
| | - Christoffer Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roland Thomeé
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
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131
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Concomitant injuries may not reduce the likelihood of achieving symmetrical muscle function one year after anterior cruciate ligament reconstruction: a prospective observational study based on 263 patients. Knee Surg Sports Traumatol Arthrosc 2018; 26:2966-2977. [PMID: 29404655 PMCID: PMC6154030 DOI: 10.1007/s00167-018-4845-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 11/05/2022]
Abstract
PURPOSE A better understanding of patient characteristics and the way common concomitant injuries affect the recovery of muscle function after surgery should help providers to treat patients with anterior cruciate ligament (ACL) injuries. The aim of this study was to determine whether patient characteristics, concomitant injuries and graft choice at ACL reconstruction were associated with symmetrical knee muscle function at one year. The hypothesis was that the presence of concomitant injuries would negatively influence the opportunity to achieve symmetrical knee function at the one-year follow-up. METHODS Data was extracted from the Swedish National Knee Ligament Register and a rehabilitation outcome register between August 2012 and December 2016. The patients had been evaluated with a battery of tests comprising knee extension and flexion strength, vertical jump, hop for distance and the side-hop test one year after ACL reconstruction. Univariable and multivariable logistic regression analyses were performed with achieving a limb symmetry index (LSI) of ≥ 90% in all tests of muscle function as primary outcome. RESULTS A total of 263 patients with a mean age of 26.7 ± 10.3 years were included in the study (47% females). No patient demographic or intra-operative predictors were found to be significant when attempting to predict the achievement of a symmetrical muscle function. Lateral meniscus injury and a patellar tendon autograft reduced the odds of achieving an LSI of ≥ 90% in knee extension strength, OR = 0.49 [(95% CI 0.25-0.97), p = 0.039] and OR = 0.30 [(95% CI 0.14-0.67), p = 0.0033] respectively. In addition, reduced odds of recovering knee extension strength were found in older patients, OR = 0.76 [(95% CI 0.60-0.98), p = 0.034]. A higher pre-injury level of physical activity increased the odds of recovering knee flexion strength, OR = 1.14 [(95% CI 1.01-1.29), p = 0.037]. CONCLUSION Intra-operatively identified concomitant injuries or graft choice did not affect the likelihood of recovering symmetrical performance in five different tests of muscle function one year after ACL reconstruction. However, fewer than one in four patients achieved an LSI of ≥ 90% in all tests. LEVEL OF EVIDENCE Prospective observational study: Level 2.
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132
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Menzer H, Slater LV, Diduch D, Miller M, Norte G, Goetschius J, Hart JM. The Utility of Objective Strength and Functional Performance to Predict Subjective Outcomes After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2017; 5:2325967117744758. [PMID: 29318168 PMCID: PMC5753987 DOI: 10.1177/2325967117744758] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Many clinicians release patients to return to activity after anterior cruciate ligament reconstruction (ACLR) based on time from surgery despite deficits in muscle strength and function. It is unclear whether symmetry or unilateral performance is the best predictor of subjective outcomes after ACLR. PURPOSE To determine physical performance predictors of patient-reported outcomes after reconstruction. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 88 participants (49 males, 39 females; mean ± SD height, 174.0 ± 9.6 cm; weight, 76.1 ± 18.5 kg; age, 19.4 ± 3.7 years) who underwent primary, unilateral ACLR volunteered for this study. Participants had undergone reconstruction a mean of 6.9 ± 1.8 months (range, 5.0-14.1 months) before the study. All participants underwent strength testing as well as hop testing and then completed the International Knee Documentation Committee (IKDC) and Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaires. Stepwise linear regression models were used for symmetry and unilateral performance to identify the proportion of variance explained in the IKDC score, KOOS total score, KOOS-sport subscale, and time from surgery, as well as receiver operating characteristic (ROC) curve analyses on those variables that explained the most variance in patient-reported outcomes to determine cutoff thresholds. RESULTS No significant correlations were found between time from surgery and objective performance. The only significant predictors of IKDC score were single-hop limb symmetry index (LSI) and age (R2 = 0.177) and unilateral triple-hop performance and age (R2 = 0.228). The cutoff for single-hop symmetry was 0.92 (area under the curve [AUC], 0.703; P = .012), and the cutoff for normalized triple-hop distance was 3.93 (AUC, 0.726; P = .005). When stratified by age, the cutoff for single-hop symmetry was 0.81 (AUC, 0.721; P = .051) for younger patients (age <19.1 years) and was not significant for older patients (age ≥19.1 years). The cutoff for normalized triple-hop distance was 3.85 (AUC, 0.832; P = .005) in older patients and was not significant for younger patients. The only significant predictors of KOOS-sport subscale were single-hop LSI (R2 = 0.140) and normalized knee extensor power at 180 deg/s (R2 = 0.096). When subjective outcomes were predicted based on KOOS-sport subscale, the cutoff for single-hop symmetry was 0.85 (AUC, 0.692; P = .018). CONCLUSION Hopping performance is the most predictive functional variable of subjective outcomes after reconstruction. Single-hop symmetry was most important for younger patients and unilateral triple-hop distance was most important for older patients. Clinicians should consider hopping performance when making return-to-activity decisions after ACLR.
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Affiliation(s)
- Heather Menzer
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Lindsay V. Slater
- Shirley Ryan AbilityLab, Neuromechanics of Impaired Locomotion Lab, Chicago, Illinois, USA
| | - David Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Grant Norte
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, Ohio, USA
| | - John Goetschius
- Department of Exercise Science and Athletic Training, Adrian College, Adrian, Michigan, USA
| | - Joseph M. Hart
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
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Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to knee ligament sprain. J Orthop Sports Phys Ther. 2017;47(11):A1-A47. doi:10.2519/jospt.2017.0303.
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134
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Gokeler A, Dingenen B, Mouton C, Seil R. Clinical course and recommendations for patients after anterior cruciate ligament injury and subsequent reconstruction: A narrative review. EFORT Open Rev 2017; 2:410-420. [PMID: 29209517 PMCID: PMC5702954 DOI: 10.1302/2058-5241.2.170011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Almost all athletes who have suffered an anterior cruciate ligament (ACL) injury expect a full return to sports at the same pre-injury level after ACL reconstruction (ACLR). Detailed patient information on the reasonable outcomes of the surgery may be essential to improve patient satisfaction. Pre-operative rehabilitation before ACLR should be considered as an addition to the standard of care to maximise functional outcomes after ACLR. We propose an optimised criterion-based rehabilitation programme within a biopsychosocial framework. No benchmark exists for evaluating return-to-sport (RTS) readiness after ACLR. Therefore, the authors propose a multi-factorial RTS test battery. A combination of both physical and psychological elements should be included in the RTS test battery. There is need for shared decision-making regarding RTS.
Cite this article: EFORT Open Rev 2017;2:410-420. DOI: 10.1302/2058-5241.2.170011
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Affiliation(s)
- Alli Gokeler
- University of Groningen, University Medical Center Groningen, Center for Human Movement Science, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Bart Dingenen
- Rehabilitation Research Institute, Biomedical Research Institute, Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
| | - Caroline Mouton
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxembourg - Clinique d'Eich, 76, rue d'Eich, L-1460 Luxembourg, Luxembourg
| | - Romain Seil
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxembourg - Clinique d'Eich, 76, rue d'Eich, L-1460 Luxembourg, Luxembourg and Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76, rue d'Eich, L-1460 Luxembourg, Luxembourg
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Pua YH, Ho JY, Chan SAS, Khoo SJ, Chong HC. Associations of isokinetic and isotonic knee strength with knee function and activity level after anterior cruciate ligament reconstruction: a prospective cohort study. Knee 2017; 24:1067-1074. [PMID: 28739425 DOI: 10.1016/j.knee.2017.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/28/2017] [Accepted: 06/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although isokinetic dynamometry often serves as a reference to assess the concurrent validity of weight-machine isotonic strength testing, it is unknown whether isokinetic knee strength is associated with knee function and activity level more strongly than isotonic knee strength in patients with an anterior cruciate ligament reconstruction (ACLR). This study aimed to compare the associations of isokinetic and isotonic knee strength with knee function and work-and-sports activity levels in patients with ACLR. METHODS One-hundred and six patients with a unilateral ACLR participated. At three months post-ACLR, isokinetic quadriceps and hamstrings strength was measured using an isokinetic dynamometer whilst isotonic strength was measured using weight machines. At six months post-ACLR, patients performed the single-leg hop-for-distance test. Self reported knee function and work-and-sports activity levels were assessed by the Lysholm Knee Score and Tegner Activity Score, respectively. RESULTS In multivariable analyses, isotonic and isokinetic quadriceps strength limb symmetry indices (LSIs) were significantly associated with all outcomes (P≤0.03) and had comparable predictive performance. Isotonic and isokinetic hamstrings strength LSIs were significantly associated with Lysholm scores (P≤0.03) and isotonic hamstrings strength was additionally significantly associated with hop-for-distance LSI (P=0.01). CONCLUSIONS Weight machine-derived isotonic quadriceps strength was independently and consistently associated with knee function and work-and-sport activity level post-ACLR. Isokinetic knee strength was not more strongly associated than isotonic knee strength with the various outcomes. These findings have logistic and economic implications because the isokinetic dynamometer system is relatively expensive and its operation requires more logistic effort and technical skills.
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore.
| | - Jia-Ying Ho
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | | | - Shin-Jiun Khoo
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Hwei-Chi Chong
- Department of Physiotherapy, Singapore General Hospital, Singapore
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136
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Pietrosimone B, Lepley AS, Harkey MS, Luc-Harkey BA, Blackburn JT, Gribble PA, Spang JT, Sohn DH. Quadriceps Strength Predicts Self-reported Function Post-ACL Reconstruction. Med Sci Sports Exerc 2017; 48:1671-7. [PMID: 27054675 DOI: 10.1249/mss.0000000000000946] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION/PURPOSE Quadriceps strength is a useful clinical predictor of self-reported function after anterior cruciate ligament reconstruction (ACLR). However, it remains unknown if quadriceps strength normalized to body mass (QBM) or quadriceps strength limb symmetry index (QLSI) is the best predictor of self-reported function in individuals with ACLR. We sought to determine whether QBM and QLSI are able to predict individuals with ACLR who self-report high function (≥90% on the international knee documentation committee (IKDC) index). METHODS Ninety-six individuals with a history of a primary unilateral ACLR were recruited for a multisite cross-sectional descriptive laboratory experiment. Bilateral isometric quadriceps strength was collected at 90° of knee flexion to calculate QBM and QLSI (ratio of the ACLR limb to the contralateral limb). Area under the curve (AUC) values were calculated using receiver operating characteristic curve analyses to determine the capacity of QBM and QLSI to predict individuals with high self-reported function on the IKDC index. RESULTS QBM displayed high accuracy (AUC = 0.76; 95% confidence interval, 0.66-0.86) for identifying participants with an IKDC index ≥90%. A QBM cutoff score of 3.10 N·m·kg was found to maximize sensitivity (0.61) and specificity (0.84), and displayed 8.15 (3.09-21.55) times higher odds of reporting high function. QLSI displayed a moderate accuracy (AUC = 0.62, 0.50-0.73) for identifying participants with an IKDC index ≥90%. A QLSI cutoff score of 96.5% maximized sensitivity (0.55) and specificity (0.70), and represented 2.78 (1.16-6.64) times higher odds reporting high function. CONCLUSION QBM is a stronger predictor of high self-reported function compared with QLSI in individuals with ACLR. Rehabilitation guidelines may benefit from incorporating the use of QBM measurements for the purpose of predicting participants that may maintain high self-reported function.
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Affiliation(s)
- Brian Pietrosimone
- 1Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC; 2Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC; 3Department of Kinesiology, University of Connecticut, Storrs, CT; 4Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; 5Department of Rehabilitation Sciences, University of Kentucky, Lexington, KY; and 6Department of Orthopaedics, University of Toledo, Toledo, OH
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137
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Abstract
PURPOSE OF REVIEW Because of the epidemiological incidence of anterior cruciate ligament (ACL) injuries, the high reinjury rates that occur when returning back to sports, the actual number of patients that return to the same premorbid level of competition, the high incidence of osteoarthritis at 5-10-year follow-ups, and the effects on the long-term health of the knee and the quality of life for the patient, individualizing the return to sports after ACL reconstruction (ACL-R) is critical. However, one of the challenging but unsolved dilemmas is what criteria and clinical decision making should be used to return an athlete back to sports following an ACL-R. This article describes an example of a functional testing algorithm (FTA) as one method for clinical decision making based on quantitative and qualitative testing and assessment utilized to make informed decisions to return an athlete to their sports safely and without compromised performance. The methods were a review of the best current evidence to support a FTA. RECENT FINDINGS In order to evaluate all the complicated domains of the clinical decision making for individualizing the return to sports after ACL-R, numerous assessments need to be performed including the biopsychosocial concepts, impairment testing, strength and power testing, functional testing, and patient-reported outcomes (PROs). The optimum criteria to use for individualizing the return to sports after ACL-R remain elusive. However, since this decision needs to be made on a regular basis with the safety and performance factors of the patient involved, this FTA provides one method of quantitatively and qualitatively making the decisions. Admittedly, there is no predictive validity of this system, but it does provide practical guidelines to facilitate the clinical decision making process for return to sports. The clinical decision to return an athlete back into competition has significant implications ranging from the safety of the athlete, to performance factors and actual litigation issues. By using a multifactorial FTA, such as the one described, provides quantitative and qualitatively criteria to make an informed decision in the best interests of the athlete.
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Affiliation(s)
- George J Davies
- Physical Therapy Program, Armstrong State University, Savannah, GA, USA.
- Coastal Therapy, Savannah, GA, USA.
- Gundersen Health System, LaCrosse, WI, USA.
| | - Eric McCarty
- Sports Medicine and Performance Center, Colorado University, Boulder, CO, USA
| | - Matthew Provencher
- Steadman Clinic and Steadman Philippon Research Institute, Vail, CO, USA
| | - Robert C Manske
- Department of Physical Therapy, Wichita State University, Via Christi Health, Wichita, KS, USA
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138
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Meurer MC, Silva MF, Baroni BM. Strategies for injury prevention in Brazilian football: Perceptions of physiotherapists and practices of premier league teams. Phys Ther Sport 2017; 28:1-8. [PMID: 28886473 DOI: 10.1016/j.ptsp.2017.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 07/17/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe the physiotherapists perceptions and the current practices for injury prevention in elite football (soccer) clubs in Brazil. DESIGN Cross-sectional study. SETTING Group of Science in Sports & Exercise, Federal University of Healthy Sciences of Porto Alegre (Brazil). PARTICIPANTS 16 of the 20 football clubs involved in the Brazilian premier league 2015. MAIN OUTCOME MEASURES Physiotherapists answered a structured questionnaire. RESULTS Most physiotherapists (∼88%) were active in design, testing and application of prevention programs. Previous injury, muscle imbalance, fatigue, hydration, fitness, diet, sleep/rest and age were considered "very important" or "important" injury risk factors by all respondents. The methods most commonly used to detect athletes' injury risk were: monitoring of biochemical markers (100% of teams), isokinetic dynamometry (81%), questionnaires (75%), functional movement screen (56%), fleximetry (56%) and horizontal jump tests (50%). All clubs used strength training, functional training, core exercises and balance/proprioception exercises in their injury prevention program; and Nordic hamstring exercise and other eccentric exercises were used by 94% of clubs. "FIFA 11+" prevention program was adapted by 88% of clubs. CONCLUSION Physiotherapists perceptions and current practices of injury prevention within Brazilian elite football clubs were similar to those employed in developed countries. There remains a gap between clinical practice and scientific evidence in high performance football.
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Affiliation(s)
- Maurício Couto Meurer
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Marcelo Faria Silva
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.
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139
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to identify strategies for a successful transition to sports in patients following rehabilitation for ACL reconstruction surgery (ACLR). RECENT FINDINGS Recent research continues to demonstrate a relatively low rate of return to previous level of play among athletes following ACLR combined with a significant risk of injury to either the ipsi or the contralateral ACL. Recent research also demonstrates a growing use of a varied battery of assessments to determine readiness to return to sport as well as a lack of consensus on the ideal rehabilitation program, the criteria for clearance for return to play (both in time from surgery and functional milestones), and the nature of a conditioning program designed specifically for transitioning the cleared athlete back to competition. Due to the lack of consensus and consistency regarding rehabilitation protocols and criteria for clearance to play after ACLR, deficits in strength, neuromuscular control, and psychological readiness may exist in "cleared" athletes. These deficits may not only negatively impact sports performance but also raise the risk of re-injury. Programs designed to successfully return an athlete to previous level of play should include not only strength and conditioning aimed at restoring fitness that was compromised as a result of the injury but also include attention to psychological readiness and address deficits in neuromuscular control. Problems that exist following ACLR cannot be solved by one professional; successful rehabilitation and return to play require a coordinated effort among the surgeon, physical therapist, athletic trainer, and fitness professional. Future research is needed to determine the optimal strategy to restore the neuromuscular control, functional strength, and psychological readiness necessary for a successful return to competition following ACLR.
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Affiliation(s)
- Polly de Mille
- Sports Rehabilitation and Performance Center, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Jamie Osmak
- Sports Rehabilitation and Performance Center, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Rambaud AJM, Semay B, Samozino P, Morin JB, Testa R, Philippot R, Rossi J, Edouard P. Criteria for Return to Sport after Anterior Cruciate Ligament reconstruction with lower reinjury risk (CR'STAL study): protocol for a prospective observational study in France. BMJ Open 2017; 7:e015087. [PMID: 28667211 PMCID: PMC5734254 DOI: 10.1136/bmjopen-2016-015087] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The decision regarding when to return to sport after an anterior cruciate ligament reconstruction (ACLR) is an important one. Using a variety of subjective and objective parameters, various attempts have been made to determine an optimal timeline for a return to sport after ACLR, but none have been validated.The aim of the present study is therefore to determine which criteria or combination of criteria could allow to return to sport with the lowest possible risk of reinjury. METHODS AND ANALYSIS This study is a prospective cohort, single-centre study, with repeated assessments at 6, 9 and 12 months post-ACL surgical reconstruction and including a 3-year follow-up of patients' sporting activity and reinjuries. 275 patients will be included to test explanatory variables. Postural control analysis, knee laxity, questionnaires (International Knee Documentation Committee (IKDC), Tampa Scale of Kinesiophobia-11 (TSK-11), Anterior Cruciate Ligament-Return to Sport After Reinjury (ACL-RSI) and Single Assessment Numeric Evaluation (SANE)), modified Star Excursion Balance Test, running and sprinting biomechanics, Hop Tests and Isokinetic Tests will all be used. The primary outcome will be any reinjury during the follow-up period, defined as a graft rupture, a contralateral ACL rupture or any injury necessitating an interruption of training and requiring a medical consultation. Two groups will be constituted during the follow-up, separating reinjured from non-reinjured patients. In addition, classic analysis and data mining approaches will be used to build predictive models. ETHICS AND DISSEMINATION The results of this study will be disseminated through peer-reviewed publications and scientific presentations. Ethical approval was obtained through the ethics committee of the University Hospital of Saint-Etienne (reference number IRBN522015/CHUSTE).
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Affiliation(s)
- Alexandre J M Rambaud
- Inter‐university Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint-Etienne, France
- Physiotherapy Clinic of the Sport Center, La Talaudière, France
| | - Bertrand Semay
- Inter‐university Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint-Etienne, France
- Department of Orthopaedic and Trauma Surgery, University Hospital Center of Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - Pierre Samozino
- Université Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM), EA 7424, F-73000 Chambéry, France
| | | | - Rodolphe Testa
- Inter‐university Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint-Etienne, France
| | - Rémi Philippot
- Inter‐university Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint-Etienne, France
- Department of Orthopaedic and Trauma Surgery, University Hospital Center of Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - Jérémy Rossi
- Inter‐university Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint-Etienne, France
| | - Pascal Edouard
- Inter‐university Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint-Etienne, France
- Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France
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141
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Davies GJ. Individualizing the Return to Sports After Anterior Cruciate Ligament Reconstruction. ACTA ACUST UNITED AC 2017. [DOI: 10.1053/j.oto.2017.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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142
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Jung HC, Lee S, Seo MW, Song JK. Isokinetic assessment of agonist and antagonist strength ratios in collegiate taekwondo athletes: a preliminary study. SPORT SCIENCES FOR HEALTH 2017. [DOI: 10.1007/s11332-016-0337-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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143
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Myklebust G, Bahr R, Nilstad A, Steffen K. Knee function among elite handball and football players 1-6 years after anterior cruciate ligament injury. Scand J Med Sci Sports 2017; 27:545-553. [PMID: 28107551 DOI: 10.1111/sms.12842] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 12/26/2022]
Abstract
The aim of the study was to describe objective and self-reported knee function for athletes who have returned to elite handball and football play after an ACL injury, comparing these to non-injured players at the same level. A total of 414 handball and 444 football players completed baseline tests from 2007 through 2014, examining lower extremity strength, dynamic balance, knee laxity, and knee function (KOOS questionnaire). Measures were compared between injured and non-injured legs and between injured legs and legs of controls. Eighty (9.3%) of the 858 players reported a previous ACL injury, 1-6 years post-injury (3.5±2.5 years), 49 handball (61.3%) and 31 football players (38.7%). We found no difference in strength or dynamic balance between previously ACL-injured (N=80) and non-injured players legs (N=1556). However, lower quadriceps (6.3%, 95% CI: 3.2-9.2) and hamstrings muscle strength (6.1%, 95% CI: 3.3-8.1) were observed in previously ACL-injured legs compared to the non-injured contralateral side (N=80). ACL-injured knees displayed greater joint laxity than the contralateral knee (N=80, 17%, 95% CI: 8-26) and healthy knees (N=1556, 23%, 95% CI: 14-33). KOOS scores were significantly lower for injured knees compared to knees of non-injured players. ACL-injured players who have successfully returned to elite sport have comparable strength and balance measures as their non-injured teammates. Subjective perception of knee function is strongly affected by injury history, with clinically relevant lower scores for the KOOS subscores Pain, Function, Sport, and Quality Of Life.
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Affiliation(s)
- G Myklebust
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - R Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - A Nilstad
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - K Steffen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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144
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Optimization of the Return-to-Sport Paradigm After Anterior Cruciate Ligament Reconstruction: A Critical Step Back to Move Forward. Sports Med 2017; 47:1487-1500. [DOI: 10.1007/s40279-017-0674-6] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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145
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Gokeler A, Welling W, Zaffagnini S, Seil R, Padua D. Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:192-199. [PMID: 27423208 PMCID: PMC5315711 DOI: 10.1007/s00167-016-4246-3] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/06/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE There is a lack of consensus regarding the appropriate criteria for releasing patients to return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). A test battery was developed to support decision-making. METHODS Twenty-eight patients (22 males and 6 females) with a mean age of 25.4 ± 8.2 years participated and were 6.5 ± 1.0 months post-ACLR. All patients followed the same rehabilitation protocol. The test battery used consisted of the following: isokinetic test, 3 hop tests and the jump-landing task assessed with the LESS. The isokinetic tests and single-leg hop tests were expressed as a LSI (involved limb/uninvolved limb × 100 %). In addition, patients filled out the IKDC and ACL-Return to Sport after Injury (ACL-RSI) scale. RTS criteria to pass were defined as a LSI > 90 % on isokinetic and hop tests, LESS < 5, ACL-RSI > 56 and a IKDC within 15th percentile of healthy subjects. RESULTS Two out of 28 patients passed all criteria of the test protocol. The pass criterion for the LESS < 5 was reached by 67.9 % of all patients. For the hop tests, 78.5 % of patients passed LSI > 90 % for SLH, 85.7 % for TLH and 50 % for the SH. For the isokinetic test, 39.3 % of patients passed criteria for LSI peak torque quadriceps at 60°/s, 46.4 % at 180°/s and 42.9 at 300°/s. In total, 35.7 % of the patients passed criterion for the peak torque at 60°/s normalized to BW (>3.0 Nm) for the involved limb. The H/Q ratio at 300°/s > 55 % for females was achieved by 4 out of 6 female patients, and the >62.5 % criterion for males was achieved by 75 %. At 6 months post-ACLR, 85.7 % of the patients passed the IKDC score and 75 % the ACL-RSI score >56 criteria. CONCLUSION The evidence emerging from this study suggests that the majority of patients who are 6 months after ACLR require additional rehabilitation to pass RTS criteria. The RTS battery described in this study may serve as a framework for future studies to implement multivariate models in order to optimize the decision-making regarding RTS after ACLR with the aim to reduce incidence of second ACL injuries. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alli Gokeler
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
| | - Wouter Welling
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
- Medisch Centrum Zuid, Groningen, The Netherlands
| | | | - Romain Seil
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxemburg, Luxemburg, Luxemburg
| | - Darin Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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146
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Abstract
In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself. Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents. Modern rehabilitation protocols emphasize teamwork and proper rehabilitation planning, and the rehabilitation team has to be lead by a trained sports physiotherapist, with an understanding of the protocols and interventions required at various stages. Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding. Inputs from surgeons are mandatory if surgical interventions have been performed. What is often missing in the underdeveloped world is psychological support and a clear understanding by the athlete of his/her rehabilitation protocols. World over, the primary aims are safe return to sports and minimizing reinjury on return to sport; this involves rehabilitation in stages, and current methodology clearly demarcates acute and chronic phases of injury. Close coordination with trainers and coaches is mandatory, and all need to understand that the reconditioning phase is crucial; skill assessment before progression has now become a specialized domain and needs to be introduced at all levels of the sport. A key factor in all sports injury rehabilitation protocols is injury prevention; this involves data maintenance by teams or trainers, which is still not fully developed in the Indian context. The injury and subsequent problems need to be comprehended both by athletes and their coaches. The current review is an attempt to clarify some of the issues that are important and routinely used world over, with the aim to improving rehabilitation after sports even in the underdeveloped world.
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Affiliation(s)
| | - Sidak Dhilllon
- Department of Sports Medicine, Sri Ramachandra Medical University, Chennai, Tamil Nadu, India
| | - Mandeep S Dhillon
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation Medicine, Sports Injury Clinic, PGIMER, Chandigarh, India,Address for correspondence: Prof. Mandeep S Dhillon, 1027, Sector 24 B, Chandigarh - 160 023, India. E-mail:
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