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Fältström A, Kvist J, Gauffin H, Hägglund M. Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls. Am J Sports Med 2019; 47:31-40. [PMID: 30481050 DOI: 10.1177/0363546518808006] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many patients with anterior cruciate ligament (ACL) reconstruction who return to sport suffer new ACL injuries or quit sports soon after returning. PURPOSE To prospectively follow a cohort of female soccer players with primary unilateral ACL reconstruction and matched knee-healthy controls from the same soccer teams to compare (1) the rate of new traumatic and nontraumatic knee injuries and other injuries, (2) the proportion of players who quit soccer, and (3) player-reported activity level and satisfaction with activity level and knee function. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 117 active female soccer players (mean ± SD age, 19.9 ± 2.5 years) 18.9 ± 8.7 months after ACL reconstruction and 119 knee-healthy female soccer players (19.5 ± 2.5 years) matched from the same teams were prospectively followed for 2 years for new knee injuries, other injuries, soccer playing level, activity level according to the Tegner Activity Scale, and satisfaction with activity level and knee function. RESULTS Players with ACL reconstruction had a higher rate of new ACL injuries (n = 29 vs 8; 19 vs 4 per 100 player years; rate ratio [RR], 4.82; 95% CI, 2.20-10.54; P < .001), other traumatic knee injuries (29 vs 16 per 100 player years; RR, 1.84; 95% CI, 1.16-2.93; P < .01), and nontraumatic knee injuries (33 vs 9 per 100 player years; RR, 3.62; 95% CI, 2.11-6.21; P < .001) as compared with controls. There was no difference in the rate of other (not knee) injuries (43 vs 48 per 100 player years; RR, 0.90; 95% CI, 0.65-1.23; P = .494). During the 2-year follow-up, 72 (62%) players with ACL reconstruction quit soccer, as opposed to 43 (36%) controls ( P = .001). The median Tegner Activity Scale score decreased in both groups ( P < .001) but more for the ACL-reconstructed group ( P < .015). CONCLUSION Female soccer players with ACL reconstruction had nearly a 5-fold-higher rate of new ACL injuries and a 2- to 4-fold-higher rate of other new knee injuries, quit soccer to a higher degree, and reduced their activity level to a greater extent as compared with knee-healthy controls.
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Affiliation(s)
- Anne Fältström
- Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.,Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Joanna Kvist
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Gauffin
- Department of Orthopedics, Linköping University, Linköping, Sweden
| | - Martin Hägglund
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Football Research Group, Linköping University, Linköping, Sweden
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202
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Ebert JR, Webster KE, Edwards PK, Joss BK, D'Alessandro P, Janes G, Annear P. Current perspectives of Australian therapists on rehabilitation and return to sport after anterior cruciate ligament reconstruction: A survey. Phys Ther Sport 2018; 35:139-145. [PMID: 30557764 DOI: 10.1016/j.ptsp.2018.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate views and practices of Australian therapists on rehabilitation and return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). DESIGN Survey-based study. SETTING Online survey platform. PARTICIPANTS Australian Physiotherapists and Accredited Exercise Physiologists (n = 223). MAIN OUTCOME MEASURES 1) perceived benefit, timing and frequency of rehabilitation, 2) timing of RTS and information on RTS evaluation and discharge criteria. RESULTS Therapists preferred to consult patients for the first time at 1-4 days (27.8%), ≤7 days (25.6%) or 7-14 days (30.5%) post-surgery. Within the first 6 weeks, 82.1% of therapists preferred patient visitation 1-2 times per week. Between 3 and 6 months, therapists mainly recommended less frequent visitation with a focus on home exercises. While 22.0% and 53.8% of therapists were willing to discharge patients for sport at 6-9 and 9-12 months, respectively, 22.9% preferred 12-18 months. Common RTS considerations were functional capacity (98.7%), strength (87.0%), lower limb and trunk mechanics (96.0%) and psychological readiness (87.9%). Knee strength was evaluated via manual muscle testing (33.0%), hand held (26.7%) and isokinetic (11.8%) dynamometry. For functional evaluation, 84.3% of therapists employed a hop battery (≥2 hop tests). CONCLUSIONS This survey revealed variation in beliefs and practices surrounding rehabilitation and RTS evaluation in Australian therapists.
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Western Australia, Australia; HFRC Rehabilitation Clinic, Nedlands, Western Australia, Australia.
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Peter K Edwards
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Western Australia, Australia; HFRC Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Brendan K Joss
- HFRC Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Peter D'Alessandro
- Coastal Orthopaedics, Bethesda Hospital, Claremont, Western Australia, Australia
| | - Greg Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
| | - Peter Annear
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
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203
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Greater fear of reinjury is related to stiffened jump-landing biomechanics and muscle activation in women after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:3682-3689. [PMID: 29700560 DOI: 10.1007/s00167-018-4950-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 04/16/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Fear of reinjury is an important factor in determining who returns to sport following anterior cruciate ligament reconstruction (ACLR). Evidence from other musculoskeletal injuries indicates fear of reinjury may be related to stiffened movement patterns observed in individuals following ACLR. The relationship between fear of reinjury and performance on dynamic tasks, however, has not been investigated. Therefore, the purpose of this study was to investigate the relationship between fear of reinjury and jump-landing biomechanics. METHODS Thirty-six females (height = 168.7 ± 6.5 cm, body mass = 67.2 ± 10.0 kg, age = 18.9 ± 1.5 years) with a history of ACLR (time from surgery = 26.1 ± 13.3 months) participated in the study. Each participant performed five trials of a standard jump-landing task. 3D motion capture and surface electromyography was used to record peak kinematics and lower extremity muscle activation on the injured limb during the jump landings. Spearman's rank correlations established the relationship between TSK-11 scores and each biomechanical variable of interest. RESULTS There was a significant, negative relationship between fear of reinjury (TSK-11: 19.9 ± 4.5) and knee (p = 0.006), hip (p = 0.003), and trunk flexion (p = 0.013). There was also a significant, positive relationship between hip adduction (p = 0.007), and gluteus maximus preparatory activation (p = 0.001). CONCLUSIONS The results of this study indicate that higher fear of reinjury is associated with stiffened movement patterns that are associated with increased risk of a second ACL injury. Similar movement patterns have been observed in patients with low back pain. Clinicians should evaluate psychological and emotional consequences of injury in addition to the physical consequences as they appear to be related. LEVEL OF EVIDENCE III.
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204
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Slagers AJ, Reininga IHF, Geertzen JHB, Zwerver J, van den Akker-Scheek I. Translation, cross-cultural adaptation, validity, reliability and stability of the Dutch Injury - Psychological Readiness to Return to Sport (I-PRRS-NL) scale. J Sports Sci 2018; 37:1038-1045. [DOI: 10.1080/02640414.2018.1540101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Anton J. Slagers
- Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge H. F. Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan H. B. Geertzen
- Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes Zwerver
- Department of Sport and Exercise Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Sport and Exercise Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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205
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Psychological and Functional Readiness for Sport Following Advanced Group Training in Patients With Anterior Cruciate Ligament Reconstruction. J Orthop Sports Phys Ther 2018; 48:864-872. [PMID: 29895233 DOI: 10.2519/jospt.2018.8041] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Decreased psychological readiness for sport may contribute to poor return-to-sport rates after anterior cruciate ligament reconstruction (ACLR). Though advanced rehabilitation is used to improve functional readiness for sport after ACLR, the effect of advanced rehabilitation on psychological readiness is unknown. OBJECTIVE To examine changes in psychological and functional measures and readiness for sport based on these measures in patients with ACLR following advanced group training. METHODS In this retrospective cohort study, patients with primary ACLR enrolled in a 5-week group training program after completing traditional physical therapy. Data collection pretraining and posttraining included demographic information, the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, and single-leg hop testing (single, triple, crossover triple, and timed hops). Readiness for sport was based on criteria for the ACL-RSI scale score (low threshold, 56 points or greater; high threshold, 75 points or greater) and hop tests (90% or greater limb symmetry). RESULTS Fifty-eight patients (21 male) participated. Mean ACL-RSI scale scores, mean hop test limb symmetry, and the proportion of patients meeting ACL-RSI and hop test readiness-for-sport criteria significantly improved from pretraining to posttraining. Posttraining ACL-RSI scale scores were correlated with single hop (r = 0.269) and triple hop (r = 0.275) limb symmetry, yet changes in the measures were not significantly correlated. After training, only 53.4% (lower ACL-RSI threshold) or 37.9% (higher ACL-RSI threshold) of the sample met both psychological and functional readiness criteria. CONCLUSION Advanced group training following ACLR improved psychological and functional outcomes; however, further, individualized intervention may be needed to address residual deficiencies in some patients. LEVEL OF EVIDENCE Therapy, level 2b. J Orthop Sports Phys Ther 2018;48(11):864-872. Epub 12 Jun 2018. doi:10.2519/jospt.2018.8041.
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206
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Edwards PK, Ebert JR, Joss B, Ackland T, Annear P, Buelow JU, Hewitt B. Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation. Orthop J Sports Med 2018; 6:2325967118797575. [PMID: 30263898 PMCID: PMC6149022 DOI: 10.1177/2325967118797575] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Preventing and mitigating the risk of reinjury after anterior cruciate
ligament reconstruction (ACLR) rest on variables including age, surgical
restoration of knee stability, adequate physical function, and thorough and
complete postoperative rehabilitation, but to what degree these factors
influence return to sport is unclear. Purpose: To investigate factors predictive of return to sport 12 months after ACLR.
The factors specifically evaluated were strength, hop function,
self-reported knee function, patient age, and quality of postoperative
rehabilitation. Study Design: Case-control study; Level of evidence, 3. Methods: This study evaluated 113 patients approximately 12 months after ACLR using a
rehabilitation grading tool, the subjective International Knee Documentation
Committee (IKDC) form, and a return-to-sport battery consisting of maximal
isokinetic quadriceps and hamstring strength and 4 functional hop tests.
Mann-Whitney U tests and chi-square analyses were used to
determine differences between patients who had or had not returned to sport.
A subsequent binary logistic hierarchical regression determined the factors
predictive of a patient’s return to sport. In those patients who had
returned to sport, relationships between either age or level of
rehabilitation and passing the return-to-sport battery were also
investigated. Results: Complete rehabilitation (adjusted odds ratio [OR], 7.95; P =
.009), age ≤25 years (adjusted OR, 3.84; P = .024), and
higher IKDC scores (P < .001) were predictive of return
to sport at 12 months. In participants who had returned to sport, 21% passed
the return-to-sport battery compared with only 5% who did not. Of those who
had returned to sport, 37% who underwent complete rehabilitation passed the
return-to-sport battery as opposed to 5% who underwent incomplete
rehabilitation. In patients aged ≤25 years, only 48% underwent complete
rehabilitation, despite having returned to sport. Additionally, in this
group of patients, 40% underwent complete rehabilitation and passed the
physical performance battery as opposed to only 4% who did not undergo
complete rehabilitation. Conclusion: Younger patients and higher subjective IKDC scores were predictive of return
to sport. Patients who completed 6 months of rehabilitation incorporating
jumping and agility tasks had a higher rate of return to sport, suggesting
that postoperative rehabilitation is important in predicting return to
sport. Specialists and physical therapists alike should stress the
importance of thorough postoperative rehabilitation and adequate
neuromuscular strength and function to patients whose goals are to return to
sport.
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Affiliation(s)
- Peter K Edwards
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia.,Hollywood Functional Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Jay R Ebert
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia.,Hollywood Functional Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Brendan Joss
- Hollywood Functional Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Timothy Ackland
- Hollywood Functional Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Peter Annear
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
| | - Jens-Ulrich Buelow
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
| | - Ben Hewitt
- Orthology, West Perth, Western Australia, Australia
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207
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Blakeney WG, Ouanezar H, Rogowski I, Vigne G, Guen ML, Fayard JM, Thaunat M, Chambat P, Sonnery-Cottet B. Validation of a Composite Test for Assessment of Readiness for Return to Sports After Anterior Cruciate Ligament Reconstruction: The K-STARTS Test. Sports Health 2018; 10:515-522. [PMID: 30024344 PMCID: PMC6204642 DOI: 10.1177/1941738118786454] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: There is limited information on the appropriate timing of return to sports after anterior cruciate ligament (ACL) reconstruction. A composite test was developed to assess the athlete’s ability to return to sports after ACL reconstruction: the Knee Santy Athletic Return To Sport (K-STARTS) test. Hypothesis: The K-STARTS test meets validation criteria for an outcome score assessing readiness for return to sports after ACL reconstruction. Study Design: Diagnostic study. Level of Evidence: Level 3. Methods: A prospective comparative study identified 410 participants: 371 participants who had undergone ACL reconstruction and a control group of 39 healthy participants. The K-STARTS score is calculated as the sum of 7 tests (8 components), for a maximal value of 21 points. Construct validity, internal consistency, discriminant validity, and sensitivity to change were used to validate this new test. Results: The K-STARTS assessment showed a high completion rate (100%), high reproducibility (intraclass correlation coefficient, 0.87; coefficient of variation, 7.8%), and high sensitivity to change. There was moderate correlation with the ACL Return to Sports after Injury scale (ACL-RSI) and hop tests. There were no ceiling or floor effects. There was a significant difference between K-STARTS scores assessed at 6 and 8 months postoperatively (11.2 ± 2.7 vs 17.1 ± 3.2; P < 0.001). The K-STARTS score in the control group was significantly higher than that in the ACL reconstruction group (17.3 ± 2.1 and 13.7 ± 3.8, respectively; P < 0.001). Conclusion: The K-STARTS test is an objective outcome measure for functional improvement after ACL reconstruction. Clinical Relevance: It is important for the clinician to determine when return to sports is optimal after ACL reconstruction to reduce the current high risk of reinjury.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bertrand Sonnery-Cottet
- Bertrand Sonnery-Cottet, MD, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay-Générale de Sante, Hôpital Prive Jean Mermoz, Lyon, France ()
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208
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Olmedilla A, Rubio VJ, Fuster-Parra P, Pujals C, García-Mas A. A Bayesian Approach to Sport Injuries Likelihood: Does Player's Self-Efficacy and Environmental Factors Plays the Main Role? Front Psychol 2018; 9:1174. [PMID: 30034359 PMCID: PMC6043686 DOI: 10.3389/fpsyg.2018.01174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
The psychological factors of sports injuries constitute a growing field of study, even from the point of view of the prediction of their occurrence. Most of them, however, do not take into account the likelihood of the injuries' occurrence and the weight and role of the psychological variables on it. We conducted a study building up a Bayesian Network on a big sample of athletes, trying to assess these probabilistic links among several relevant psychological variables and the injuries' occurrence. The sample was constituted by 297 athletes (239 males, 58 females) from a wide range of sports: track and field; judo; fencing; karate; boxing; swimming; kayaking; artistic rollerskating, and team sports as football, basketball, and handball (Mean age: 25.10 ±-3.87; range: 21-38 years). Several psychological variables, such as anxiety, social support, and self-efficacy were studied. Also, we recorded the history of injuries as well the body mass index and personal epidemiological data. The overall picture of the generated graph and Bayesian Network and its analysis - including the use of hypothetical data by means of several instantiations - includes the nuclear role of the Self-Efficacy regarding the injuries' occurrence likelihood; the decreasing impact of the competitive anxiety previous to the injury; the probabilistic independence of the players' risk behaviors, and the relevance of the environmental clues such the use of coping strategies and social support in order to build up a good level of Self-Efficacy after the occurrence of an injury. All these data are relevant when designing both preventive and recovery interventions from the multidisciplinary as well as from the psychological point of view.
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Affiliation(s)
- Aurelio Olmedilla
- Department of Personality, Assessment and Psychological Intervention, University of Murcia, Murcia, Spain
| | - Víctor J. Rubio
- Department of Biological and Health Psychology, School of Psychology, University Autonoma of Madrid, Madrid, Spain
| | - Pilar Fuster-Parra
- Department of Mathematics and Computer Science, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Constanza Pujals
- Department of Psychology, Faculdade Ingá/UNINGA, Maringá, Brazil
| | - Alexandre García-Mas
- Department of Basic Psychology, University of the Balearic Islands, Palma de Mallorca, Spain
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209
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Scala E, Decosterd I, Faouzi M, Burnand B, Rodondi PY. Level of readiness of chronic pain patients to practise active self-care. Eur J Pain 2018; 22:1800-1812. [PMID: 29956872 DOI: 10.1002/ejp.1276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Given the limited alleviation of chronic pain with pharmacological treatments, various nonpharmacological and self-care approaches are often proposed that require patients' motivation. OBJECTIVE To evaluate the level of readiness (LOR) to practise different types of active self-care among chronic pain patients. METHOD A quantitative cross-sectional survey was conducted among all chronic pain patients seeking care at the Pain Center of an academic hospital from June 2013 to March 2015. Sociodemographic data, pain characteristics, treatments and the LOR to practise active self-care were investigated. RESULTS Among the 1524 eligible patients, 639 (41.9%) were included. The median pain duration was 8.5 years (interquartile range = 7.5). Two-thirds (63.7%) of the patients reported high pain-related disability, and 64.6% had used opioids during the previous six months. Most patients had a high (44.1%) or moderate (24.6%) LOR to practise active self-care. Multivariable multinomial regression analysis showed that independent factors associated with a high LOR were a higher level of education (relative risk ratio (RRR) = 3.42, 95% confidence interval (CI): 1.90-6.13, p < 0.001), unemployed status due to medical condition (RRR = 2.92, 95% CI: 1.30-6.56, p = 0.009), the use of dietary supplements 'against pain' (RRR = 2.77, 95% CI: 1.52-5.04, p = 0.001) and neuropathic pain characteristics (RRR = 1.80, 95% CI: 1.40-3.12, p = 0.036). Older age was a factor predicting a lower LOR (RRR = 0.97, 95% CI: 0.94-0.99, p = 0.039). Long-term chronic pain, severe pain-related disability and the presence of a mood disorder were not associated with a lower LOR. CONCLUSION Most chronic pain patients, including those severely affected, indicated their readiness to practise active self-care methods. SIGNIFICANCE Most chronic pain patients, even those severely affected, appeared to be ready to practise active self-care therapies and we believe that further studies are needed to investigate their impact on pain and quality of life.
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Affiliation(s)
- E Scala
- Pain Center and Center for integrative and complementary medecine (CEMIC), Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - I Decosterd
- Pain Center and Center for integrative and complementary medecine (CEMIC), Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - M Faouzi
- Institute of Social and Preventive Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - B Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - P-Y Rodondi
- Institute of Social and Preventive Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
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210
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Webster KE, Nagelli CV, Hewett TE, Feller JA. Factors Associated With Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery. Am J Sports Med 2018; 46:1545-1550. [PMID: 29718684 PMCID: PMC6598700 DOI: 10.1177/0363546518773757] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury has a significant psychological effect, and a negative psychological state is a commonly cited reason for a reduction or cessation of sports participation after ACL reconstruction (ACLR) surgery. PURPOSE To identify factors that contribute to an athlete's psychological readiness to return to sport (RTS) after ACLR. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A cohort of 635 athletes (389 male, 246 female) who underwent ACLR and had been cleared to RTS completed the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale at an average 12 months (range, 11-24 months) after surgery. Demographics (age, sex), sporting outcomes (preinjury frequency), surgical timing (injury to surgery interval), clinical factors (laxity), functional measures (single-limb hop symmetry), and symptoms of pain and function (International Knee Documentation Committee subjective) were also taken, and univariate and multiple regression models were used to determine the association between these and the psychological readiness of the athlete to RTS (ACL-RSI scores). Data for the entire cohort were initially analyzed; then, patients were grouped according to whether they had returned to competitive sport, and the analysis repeated for each group (return/nonreturn). RESULTS Univariate analysis for the entire group showed that all of the following had a positive effect on psychological readiness: male sex (β = 5.8; 95% CI, 2-10), younger age (β = -0.2; 95% CI, -0.4 to 0.01), a shorter interval between injury and surgery (β = -0.1; 95% CI, -0.1 to -0.02), a higher frequency of preinjury sport participation (β = 5.4; 95% CI, 2-9), greater limb symmetry (β = 0.5; 95% CI, 0.3-0.6), and higher subjective knee scores (β = 1.3; 95% CI, 1.1-1.4). In the multivariate model, subjective knee scores and age significantly accounted for 37% of the variance in psychological readiness ( r2 = 0.37, P < .0001). The only difference between the groups who had and had not returned to sport was that female sex was a significant contributor for the nonreturn group. CONCLUSION Self-reported symptoms and function were most associated with psychological readiness to RTS after ACLR surgery. Male patients who participated frequently in sport before ACL injury had higher psychological readiness. Conversely, female patients had a more negative outlook and may therefore benefit more from interventions designed to facilitate a smooth transition back to sport.
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Affiliation(s)
- Kate E. Webster
- School of Allied Health, La Trobe University, Melbourne, Australia.,Address correspondence to Kate E. Webster, PhD, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Victoria 3086, Australia ()
| | - Christopher V. Nagelli
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E. Hewett
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Biomechanics Laboratories and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
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211
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212
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Burland JP, Toonstra J, Werner JL, Mattacola CG, Howell DM, Howard JS. Decision to Return to Sport After Anterior Cruciate Ligament Reconstruction, Part I: A Qualitative Investigation of Psychosocial Factors. J Athl Train 2018; 53:452-463. [PMID: 29505304 PMCID: PMC6107765 DOI: 10.4085/1062-6050-313-16] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CONTEXT Return-to-sport criteria after anterior cruciate ligament (ACL) injury are often based on "satisfactory" functional and patient-reported outcomes. However, an individual's decision to return to sport is likely multifactorial; psychological and physical readiness to return may not be synonymous. OBJECTIVE To determine the psychosocial factors that influence the decision to return to sport in athletes 1 year post-ACL reconstruction (ACLR). DESIGN Qualitative study. SETTING Academic medical center. PATIENTS OR OTHER PARTICIPANTS Twelve participants (6 males, 6 females) were purposefully chosen from a large cohort. Participants were a minimum of 1-year postsurgery and had been active in competitive athletics preinjury. DATA COLLECTION AND ANALYSIS Data were collected via semistructured interviews. Qualitative analysis using a descriptive phenomenologic process, horizontalization, was used to derive categories and themes that represented the data. The dynamic-biopsychosocial model was used as a theoretical framework to guide this study. RESULTS Six predominant themes emerged that described the participants' experiences after ACLR: (1) hesitation and lack of confidence led to self-limiting tendencies, (2) awareness was heightened after ACLR, (3) expectations and assumptions about the recovery process influenced the decision to return to sport after ACLR, (4) coming to terms with ACL injury led to a reprioritization, (5) athletic participation helped reinforce intrinsic personal characteristics, and (6) having a strong support system both in and out of rehabilitation was a key factor in building a patient's confidence. We placed themes into components of the dynamic-biopsychosocial model to better understand how they influenced the return to sport. CONCLUSIONS After ACLR, the decision to return to sport was largely influenced by psychosocial factors. Factors including hesitancy, lack of confidence, and fear of reinjury are directly related to knee function and have the potential to be addressed in the rehabilitation setting. Other factors, such as changes in priorities or expectations, may be independent of physical function but remain relevant to the patient-clinician relationship and should be considered during postoperative rehabilitation.
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213
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Abstract
The rate of anterior cruciate ligament (ACL) ruptures diagnosed among the pediatric and adolescent population is increasing. The rise in ACL injuries may be attributed to earlier sports specialization, year-round sports participation, increased awareness, and improved ability to diagnose the injury. Treatment options for pediatric or adolescent ACL injuries include nonoperative conservative treatment, ACL repair, or various techniques for ACL reconstruction. The best course of treatment for ACL rupture in young patients continues to be debated. Anterior cruciate ligament reconstruction with autograft is currently the gold standard and has been shown to be successful in restoring joint stability. This article reviews predisposing factors, common mechanisms, diagnostic procedures, and treatments for ACL rupture in adolescent patients, with a focus on using quadriceps patellar tendon autograft. [Orthopedics. 2018; 41(3):129-134.].
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214
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What Is the Relationship of Fear Avoidance to Physical Function and Pain Intensity in Injured Athletes? Clin Orthop Relat Res 2018; 476:754-763. [PMID: 29480885 PMCID: PMC6260093 DOI: 10.1007/s11999.0000000000000085] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fear avoidance can play a prominent role in maladaptive responses to an injury. In injured athletes, such pain-related fear or fear avoidance behavior may have a substantial influence on the recovery process. Specifically, it may explain why some are able to reach their preinjury abilities, whereas others are unable to return to sport. QUESTIONS/PURPOSES (1) Is fear avoidance in athletes associated with decreased physical function after injury? (2) To what degree is fear avoidance associated with athletes' pain intensity? METHODS In a cross-sectional study, we recruited injured athletes-defined as patients with sports-related injury, weekly engagement in sport activities, participation in competitive events as part of a team or club, self-identification as an athlete, and a desire to return to sport after recovery-from an orthopaedic sports medicine center at a major urban university hospital. Of 130 approached patients, 102 (84% men; mean ± SD age 25 ± 8.5 years) met the inclusion criteria. Participants completed a demographic questionnaire, the Athlete Fear Avoidance Questionnaire, which assesses injury-related fear and avoidance behavior specifically in an athletic population, the Pain Catastrophizing Scale, the Hospital Anxiety and Depression Scale, and two Patient-Reported Outcomes Measurement Information System measures: Physical Function Computerized Adaptive Testing (CAT) and Pain Intensity CAT. RESULTS After controlling for age, injury region (upper versus lower extremity), catastrophic thinking, and emotional distress, we found that an increase in athletes' fear avoidance was associated with a decrease in physical function (b = -0.32; p = 0.002). The model explained 30% of the variation in physical function with 7.3% explained uniquely by fear avoidance. After controlling for initial appointment/followup, surgery for the current condition, multiple pain conditions, history of prior sport-related injury/surgery, pain medication prescription, catastrophic thinking, and emotional distress, athletes' fear avoidance was not associated with pain (b = -0.14; p = 0.249). The model explained 40% of the variation in pain intensity and pain catastrophizing (b = 0.30; p = 0.001) uniquely explained 7.1% of this variation. CONCLUSIONS In injured athletes, fear avoidance is independently associated with decreased physical function, whereas pain catastrophizing is associated with high pain intensity. Both level of an athlete's fear avoidance and catastrophic thinking about pain should be accounted for in clinical interventions aimed at helping athletes improve recovery and return to sport. LEVEL OF EVIDENCE Level II, prognostic study.
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215
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Clinical Outcomes, Return to Sports, and Patient Satisfaction After Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients in an Asian Population-A 2-Year Follow-up Study. Arthroscopy 2018; 34:1054-1059. [PMID: 29305288 DOI: 10.1016/j.arthro.2017.10.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction in young and middle-aged Asians. METHODS A retrospective study was performed using prospectively collected data from a tertiary institution ACL registry. All Asian patients with ACL tears who underwent primary arthroscopic ACL reconstruction by a single surgeon between 2008 and 2014, with minimum 2-year follow-up, were included. Patients with previous knee surgery or multiligamentous knee injuries were excluded. Two groups were formed: young patients (YP) (age <30) and middle-aged patients (MP) (age >40). They were compared preoperatively and 6 months, 1 year, and 2 years postoperatively for demographics, knee range of motion, anterior laxity, Tegner level, Lysholm and International Knee Documentation Committee grade, ability to return to preinjury level of activity, and patient satisfaction. RESULTS YP (n = 84) and MP (n = 22) had differences in mean age (YP = 23.1 years, range 18-29 years; MP = 46.4 years, range 41-59 years, P < .001), preinjury Tegner level (YP = 7.4, MP = 6.4, P = .005), and preoperative Lysholm scores (YP = 65.3, MP = 53.0, P = .034). The incidence of meniscal and chondral injuries was similar. Two years postoperatively, both groups had comparable knee range of motion and anterior laxity. The Tegner score was different (YP = 6.3, MP = 5.2, P = .028), but the proportion of patients returning to preinjury Tegner level (YP = 45.2%, MP = 46.9%, P = .812), Lysholm scores (YP = 92.5, MP = 93.8, P = .794), proportion of patients with knees rated International Knee Documentation Committee A/B (YP = 77.4%, MP = 81.8%, P = .777), and satisfaction levels (YP = 98.5%, MP = 94.1%, P = .370) were similar. There were no graft ruptures or reoperations. CONCLUSIONS In an Asian, predominantly male population, the clinical outcomes of arthroscopic ACL reconstruction in YP and MP are equally good at 2-year follow-up. MP can benefit as much as younger patients from ACL reconstruction in terms of restoration of knee function and return to preinjury activity level, are equally satisfied with outcomes, and should not be excluded from surgery on the basis of age alone. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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216
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Ardern CL, Ekås G, Grindem H, Moksnes H, Anderson AF, Chotel F, Cohen M, Forssblad M, Ganley TJ, Feller JA, Karlsson J, Kocher MS, LaPrade RF, McNamee M, Mandelbaum B, Micheli L, Mohtadi NG, Reider B, Roe JP, Seil R, Siebold R, Silvers-Granelli HJ, Soligard T, Witvrouw E, Engebretsen L. 2018 International Olympic Committee Consensus Statement on Prevention, Diagnosis, and Management of Pediatric Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2018; 6:2325967118759953. [PMID: 29594177 PMCID: PMC5865521 DOI: 10.1177/2325967118759953] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In October 2017, the International Olympic Committee hosted an international expert group of physical therapists and orthopaedic surgeons who specialize in treating and researching pediatric anterior cruciate ligament (ACL) injuries. The purpose of this meeting was to provide a comprehensive, evidence-informed summary to support the clinician and help children with ACL injury and their parents/guardians make the best possible decisions. Representatives from the following societies attended: American Orthopaedic Society for Sports Medicine; European Paediatric Orthopaedic Society; European Society for Sports Traumatology, Knee Surgery, and Arthroscopy; International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; Pediatric Orthopaedic Society of North America; and Sociedad Latinoamericana de Artroscopia, Rodilla, y Deporte. Physical therapists and orthopaedic surgeons with clinical and research experience in the field and an ethics expert with substantial experience in the area of sports injuries also participated. This consensus statement addresses 6 fundamental clinical questions regarding the prevention, diagnosis, and management of pediatric ACL injuries. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision making with children and the potential long-term ramifications of the injury.
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Affiliation(s)
| | - Clare L. Ardern
- Clare L. Ardern, PT, PhD, Division of Physiotherapy, Linköping University, Linköping, Sweden (ORCID ID: 0000-0001-8102-3631) ()
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217
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Rosso F, Bonasia DE, Cottino U, Cambursano S, Dettoni F, Rossi R. Factors Affecting Subjective and Objective Outcomes and Return to Play in Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study. JOINTS 2018; 6:23-32. [PMID: 29675503 PMCID: PMC5906119 DOI: 10.1055/s-0038-1636931] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose
To analyze the prognostic factors influencing subjective and objective outcomes and return to play (RTP) after anterior cruciate ligament reconstruction (ACL-R).
Methods
Primary ACL-Rs using a transtibial technique performed between 2008 and 2012 were included. Data regarding patients, surgery, sports, and rehabilitation, including an on-field rehabilitation (OFR) and duration of the rehabilitation program, were collected. The International Knee Documentation Committee (IKDC) subjective and objective evaluation forms, and the Knee Injury and Osteoarthritis Outcome Score and Lysholm questionnaires were used for the assessment of subjective and objective outcomes. The Subjective Patient Outcome for Return to Sports and ACL–return to sport after injury (RSI) scores were used for RTP evaluation. Several potential predictors of outcome were tested with a univariate analysis. All the variables with
p
< 0.1 were retested in a logistic regression model to evaluate their association with the outcomes.
Results
In total, 176 cases were included with an average follow-up of 44.1 months. Of the patients, 92.2% were rated as normal or nearly normal at the IKDC evaluation. In addition, 90.1% of the patients returned to sport, with 57.6% returning to the same preinjury level. Objective outcomes were negatively influenced by late rehabilitation (odds ratio [OR] = 2.75). Performing an OFR phase during the rehabilitation was associated with better subjective outcomes (OR = 2.71). Length of rehabilitation strongly influenced the RTP rate (OR = 13.16). Conversely, higher ACL-RSI score was inversely related to RTP. Objective IKDC score was inversely related to the ACL-RSI (OR = 0.31), whereas subjective score was correlated with both the total ACL-RSI score (OR = 0.15) and the level of activity (OR = 0.20).
Conclusion
This study confirmed the role of rehabilitation on subjective and objective outcomes and on RTP. Particularly, the complete adherence to a rehabilitation program, including an OFR phase, resulted in better subjective outcomes and higher RTP rate. The relationship between psychological factors, measured through the ACL-RSI score, and RTP was confirmed.
Level of Evidence
Level III, observational study without a control group.
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Affiliation(s)
- Federica Rosso
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, Turin, Italy
| | - Davide E Bonasia
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, Turin, Italy
| | - Umberto Cottino
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, Turin, Italy
| | - Simone Cambursano
- Department of Orthopedics and Traumatology, University of Turin, Turin, Italy
| | - Federico Dettoni
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, Turin, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, Turin, Italy
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218
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Ardern CL, Ekås G, Grindem H, Moksnes H, Anderson AF, Chotel F, Cohen M, Forssblad M, Ganley TJ, Feller JA, Karlsson J, Kocher MS, LaPrade RF, McNamee M, Mandelbaum B, Micheli L, Mohtadi N, Reider B, Roe J, Seil R, Siebold R, Silvers-Granelli HJ, Soligard T, Witvrouw E, Engebretsen L. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. J ISAKOS 2018. [DOI: 10.1136/jisakos-2018-000200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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219
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Lentz TA, Paterno MV, Riboh JC. So you think you can return to sport? Br J Sports Med 2018; 52:1482-1483. [DOI: 10.1136/bjsports-2017-099006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2018] [Indexed: 11/04/2022]
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220
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Ardern CL, Ekås GR, Grindem H, Moksnes H, Anderson AF, Chotel F, Cohen M, Forssblad M, Ganley TJ, Feller JA, Karlsson J, Kocher MS, LaPrade RF, McNamee M, Mandelbaum B, Micheli L, Mohtadi N, Reider B, Roe J, Seil R, Siebold R, Silvers-Granelli HJ, Soligard T, Witvrouw E, Engebretsen L. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Br J Sports Med 2018; 52:422-438. [PMID: 29478021 PMCID: PMC5867447 DOI: 10.1136/bjsports-2018-099060] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/25/2022]
Abstract
In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.
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Affiliation(s)
- Clare L Ardern
- Division of Physiotherapy, Linköping University, Linköping, Sweden.,School of Allied Health, La Trobe University, Melbourne, Australia
| | - Guri Ranum Ekås
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Grindem
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Håvard Moksnes
- Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Franck Chotel
- Department of Pediatric Orthopaedic Surgery, Hôpital Femme Mere Enfant, Lyon, France
| | - Moises Cohen
- Orthopedic Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Magnus Forssblad
- Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | - Theodore J Ganley
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Julian A Feller
- OrthoSport Victoria Research Unit, Epworth Healthcare, Melbourne, Australia.,College of Science, Health & Engineering, La Trobe University, Melbourne, Australia
| | - Jón Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Minider S Kocher
- Division of Sports Medicine, Boston Children's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, USA.,The Steadman Clinic, Vail, USA
| | | | - Bert Mandelbaum
- Santa Monica Orthopaedic and Sports Medicine Group, Los Angeles, USA
| | - Lyle Micheli
- Division of Sports Medicine, Boston Children's Hospital, Boston, USA.,Harvard Medical School, Boston, USA.,The Micheli Center for Sports Injury Prevention, Waltham, USA
| | | | - Bruce Reider
- Department of Orthopaedics and Rehabilitation Medicine, University of Chicago, Chicago, USA
| | - Justin Roe
- North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg, Luxembourg.,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg
| | - Rainer Siebold
- Institute for Anatomy and Cell Biology, Ruprecht-Karls-University, Heidelberg, Germany.,HKF International Center for Hip, Knee, Foot Surgery and Sports Traumatology, ATOS Klinik, Heidelberg, Germany
| | | | - Torbjørn Soligard
- Medical & Scientific Department, International Olympic Committee, Chateau de Vidy, Lausanne, Switzerland.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - Lars Engebretsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Medical & Scientific Department, International Olympic Committee, Chateau de Vidy, Lausanne, Switzerland
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221
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Gledhill A, Forsdyke D, Murray E. Psychological interventions used to reduce sports injuries: a systematic review of real-world effectiveness. Br J Sports Med 2018; 52:967-971. [PMID: 29463497 DOI: 10.1136/bjsports-2017-097694] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To systematically review studies examining the role of psychological interventions in injury prevention. The primary research question was: What is the real-world effectiveness of psychological intervention in preventing sports injuries? DESIGN Mixed methods systematic review with best evidence synthesis. DATA SOURCES CINAHL, MEDLINE, PsycARTICLES, PsycINFO, SPORTDiscus, Science Direct and PubMed. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials (RCT), non-RCTs that included a comparison group, before and after study designs and qualitative methods. Studies were required to outline specific unimodal or multimodal psychological interventions used in relation to injury prevention in the real-world setting. OUTCOME MEASURE Studies were independently appraised with the Mixed Methods Appraisal Tool. RESULTS Thirteen papers (incorporating 14 studies) met the eligibility criteria, of which 93% (13/14) reported a decrease in injury rates (effect size range=0.2-1.21). There was an overall moderate risk of bias in reporting (52%). There is a dominance of stress management-based interventions in literature due to the prominence of the model of stress and athletic injury within the area. SUMMARY/CONCLUSIONS Psychological interventions demonstrate small (0.2) to large (1.21) effects on sports injury rates. The research area demonstrates a cumulative moderate risk in reporting bias (52%). PROSPERO REGISTRATION NUMBER CRD42016035879.
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Affiliation(s)
- Adam Gledhill
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | | | - Eliot Murray
- Faculty of Health and Social Sciences, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
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222
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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 meniscus and articular cartilage lesions. J Orthop Sports Phys Ther. 2018;48(2):A1-A50. doi:10.2519/jospt.2018.0301.
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223
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Ardern CL, Ekås G, Grindem H, Moksnes H, Anderson A, Chotel F, Cohen M, Forssblad M, Ganley TJ, Feller JA, Karlsson J, Kocher MS, LaPrade RF, McNamee M, Mandelbaum B, Micheli L, Mohtadi N, Reider B, Roe J, Seil R, Siebold R, Silvers-Granelli HJ, Soligard T, Witvrouw E, Engebretsen L. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Knee Surg Sports Traumatol Arthrosc 2018; 26:989-1010. [PMID: 29455243 PMCID: PMC5876259 DOI: 10.1007/s00167-018-4865-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/05/2018] [Indexed: 12/11/2022]
Abstract
In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric anterior cruciate ligament (ACL) injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery and Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.
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Affiliation(s)
- Clare L. Ardern
- 0000 0001 2162 9922grid.5640.7Division of Physiotherapy, Linköping University, Linköping, Sweden ,0000 0001 2342 0938grid.1018.8School of Allied Health, La Trobe University, Melbourne, Australia
| | - Guri Ekås
- 0000 0004 0389 8485grid.55325.34Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway ,0000 0000 8567 2092grid.412285.8Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway ,0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Grindem
- 0000 0000 8567 2092grid.412285.8Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Håvard Moksnes
- 0000 0000 8567 2092grid.412285.8Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Franck Chotel
- grid.414103.3Department of Pediatric Orthopaedic Surgery, Hôpital Femme Mere Enfant, Lyon, France
| | - Moises Cohen
- 0000 0001 0514 7202grid.411249.bOrthopedic Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Magnus Forssblad
- 0000 0004 1937 0626grid.4714.6Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | - Theodore J. Ganley
- 0000 0001 0680 8770grid.239552.aDepartment of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Julian A. Feller
- 0000 0001 0459 5396grid.414539.eOrthoSport Victoria Research Unit, Epworth Healthcare, Melbourne, Australia ,0000 0001 2342 0938grid.1018.8College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Jón Karlsson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mininder S. Kocher
- 0000 0004 0378 8438grid.2515.3Division of Sports Medicine, Boston Children’s Hospital, Boston, USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, USA
| | - Robert F. LaPrade
- 0000 0001 0367 5968grid.419649.7Steadman Philippon Research Institute, Vail, USA ,0000 0001 0027 3736grid.419648.6The Steadman Clinic, Vail, USA
| | - Mike McNamee
- 0000 0001 0658 8800grid.4827.9College of Engineering, Swansea University, Swansea, UK
| | - Bert Mandelbaum
- Santa Monica Orthopaedic and Sports Medicine Group, Los Angeles, USA
| | - Lyle Micheli
- 0000 0004 0378 8438grid.2515.3Division of Sports Medicine, Boston Children’s Hospital, Boston, USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, USA ,The Micheli Center for Sports Injury Prevention, Waltham, USA
| | - Nicholas Mohtadi
- 0000 0004 1936 7697grid.22072.35University of Calgary Sports Medicine Centre, Calgary, Canada
| | - Bruce Reider
- 0000 0004 1936 7822grid.170205.1Department of Orthopaedics and Rehabilitation Medicine, University of Chicago, Chicago, USA
| | - Justin Roe
- 0000 0004 0382 8241grid.420075.4North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Romain Seil
- 0000 0004 0578 0421grid.418041.8Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg, Luxembourg City, Luxembourg ,0000 0004 0621 531Xgrid.451012.3Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Rainer Siebold
- 0000 0001 2190 4373grid.7700.0Institute for Anatomy and Cell Biology, Ruprecht-Karls-University, Heidelberg, Germany ,HKF International Center for Hip, Knee, Foot Surgery and Sportstraumatology, ATOS Klinik, Heidelberg, Germany
| | | | - Torbjørn Soligard
- 0000 0004 0626 1762grid.469323.9Medical and Scientific Department, International Olympic Committee, Chateau de Vidy, Lausanne, Switzerland ,0000 0004 1936 7697grid.22072.35Faculty of Kinesiology, Sports Injury Prevention Centre, University of Calgary, Calgary, Alberta Canada
| | - Erik Witvrouw
- 0000 0001 2069 7798grid.5342.0Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Healthscience, Ghent University, Ghent, Belgium
| | - Lars Engebretsen
- 0000 0004 0389 8485grid.55325.34Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway ,0000 0000 8567 2092grid.412285.8Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway ,0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,0000 0004 0626 1762grid.469323.9Medical and Scientific Department, International Olympic Committee, Chateau de Vidy, Lausanne, Switzerland
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Meyer CAG, Gette P, Mouton C, Seil R, Theisen D. Side-to-side asymmetries in landing mechanics from a drop vertical jump test are not related to asymmetries in knee joint laxity following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:381-390. [PMID: 28712025 PMCID: PMC5794826 DOI: 10.1007/s00167-017-4651-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/12/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Asymmetries in knee joint biomechanics and increased knee joint laxity in patients following anterior cruciate ligament reconstruction (ACLR) are considered risk factors for re-tear or early onset of osteoarthritis. Nevertheless, the relationship between these factors has not been established. The aim of the study was to compare knee mechanics during landing from a bilateral drop vertical jump in patients following ACLR and control participants and to study the relationship between side-to-side asymmetries in landing mechanics and knee joint laxity. METHODS Seventeen patients following ACLR were evaluated and compared to 28 healthy controls. Knee sagittal and frontal plane kinematics and kinetics were evaluated using three-dimensional motion capture (200 Hz) and two synchronized force platforms (1000 Hz). Static anterior and internal rotation knee laxities were measured for both groups and legs using dedicated arthrometers. Group and leg differences were investigated using a mixed model analysis of variance. The relationship between side-to-side differences in sagittal knee power/energy absorption and knee joint laxities was evaluated using univariate linear regression. RESULTS A significant group-by-leg interaction (p = 0.010) was found for knee sagittal plane energy absorption, with patients having 25% lower values in their involved compared to their non-involved leg (1.22 ± 0.39 vs. 1.62 ± 0.40 J kg-1). Furthermore, knee sagittal plane energy absorption was 18% lower at their involved leg compared to controls (p = 0.018). Concomitantly, patients demonstrated a 27% higher anterior laxity of the involved knee compared to the non-involved knee, with an average side-to-side difference of 1.2 mm (p < 0.001). Laxity of the involved knee was also 30% higher than that of controls (p < 0.001) (leg-by-group interaction: p = 0.002). No relationship was found between sagittal plane energy absorption and knee laxity. CONCLUSIONS Nine months following surgery, ACLR patients were shown to employ a knee unloading strategy of their involved leg during bilateral landing. However, this strategy was unrelated to their increased anterior knee laxity. Side-to-side asymmetries during simple bilateral landing tasks may put ACLR patients at increased risk of second ACL injury or early-onset osteoarthritis development. Detecting and correcting asymmetric landing strategies is highly relevant in the framework of personalized rehabilitation, which calls for complex biomechanical analyses to be applied in clinical routine. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Christophe A. G. Meyer
- Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, 76, Rue d’Eich, 1460 Luxembourg, Luxembourg
| | - Paul Gette
- Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, 76, Rue d’Eich, 1460 Luxembourg, Luxembourg
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg – Clinique d’Eich, Luxembourg, Luxembourg
| | - Romain Seil
- Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, 76, Rue d’Eich, 1460 Luxembourg, Luxembourg ,Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg – Clinique d’Eich, Luxembourg, Luxembourg
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Department of Population Health, Luxembourg Institute of Health, 76, Rue d'Eich, 1460, Luxembourg, Luxembourg.
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225
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Paterno MV, Flynn K, Thomas S, Schmitt LC. Self-Reported Fear Predicts Functional Performance and Second ACL Injury After ACL Reconstruction and Return to Sport: A Pilot Study. Sports Health 2017; 10:228-233. [PMID: 29272209 PMCID: PMC5958451 DOI: 10.1177/1941738117745806] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Outcomes after anterior cruciate ligament reconstruction (ACLR) are highly variable. Previous studies have failed to report the relationship between fear, objective measures of function, and reinjury rates. The purpose of this study was to determine whether fear was related to functional performance measures and risk of second ACL injury after ACLR and return to sport (RTS). Hypothesis: Fear will be associated with performance on functional testing and second ACL injury rate. Study Design: Prospective cohort study. Level of Evidence: Level 2. Methods: A total of 40 patients cleared to RTS after ACLR completed the Tampa Scale of Kinesiophobia (TSK-11), hop testing, and quadriceps strength testing, bilaterally. Patients were tracked for 12 months after RTS to identify the incidence of second ACL injury. Chi-square analyses determined whether patients with high fear (TSK-11, ≥17) were more likely to have lower levels of activity, greater asymmetry on functional testing, and higher reinjury rates. Results: Patients with greater fear on the TSK-11 (≥17) at RTS were 4 times (odds ratio [OR], 3.73; 95% CI, 0.98-14.23) more likely to report lower levels of activity, 7 times (OR, 7.1; 95% CI, 1.5-33.0) more likely to have a hop limb symmetry lower than 95%, and 6 times (OR, 6.0; 95% CI, 1.3-27.8) more likely to have quadriceps strength symmetry lower than 90%. Patients who went on to suffer an ipsilateral second ACL injury had a greater TSK-11 score at the time of RTS (mean, 19.8 ± 4.0) than those who did not suffer a second ACL injury (mean, 16.4 ± 3.6) (P = 0.03). Patients with a TSK-11 score of 19 or greater at the time of RTS were 13 times (relative risk, 13.0; 95% CI, 2.1-81.0) more likely to suffer a second ACL tear within 24 months after RTS. Conclusion: Patients with greater self-reported fear were less active, presented with lower single-leg hop performance and isometric quadriceps strength, and had an increased risk of suffering a second ACL injury in the 24 months after RTS. Clinical Relevance: Self-reported fear of movement/reinjury after ACLR at the time of RTS may be an important measure to incorporate into discharge criteria prior to release to return to pivoting and cutting sports after ACLR.
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Affiliation(s)
- Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Kaitlyn Flynn
- Division of Sports Physical Therapy, Children's Hospital of Colorado, Aurora, Colorado
| | - Staci Thomas
- Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Laura C Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, Ohio
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226
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Kugelman DN, Qatu AM, Haglin JM, Konda SR, Egol KA. Participation in Recreational Athletics After Operative Fixation of Tibial Plateau Fractures: Predictors and Functional Outcomes of Those Getting Back in the Game. Orthop J Sports Med 2017; 5:2325967117743916. [PMID: 29276713 PMCID: PMC5734475 DOI: 10.1177/2325967117743916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Tibial plateau fractures can be devastating traumatic injuries to the knee, particularly in active athletes. Purpose/Hypothesis: The purpose of this study was to report on the return to participation in recreational athletics after operatively managed tibial plateau fractures. In addition, this study assessed factors associated with the ability to return to participation in recreational athletics after tibial plateau fractures treated with open reduction internal fixation and compared final outcomes between patients who were able to return to recreational athletics and those who could not. The hypothesis was that returning to participation in recreational athletics would be dependent on the time from surgery after operative fixation of tibial plateau fractures. Less severe injuries would be associated with a quicker return to athletics. Study Design: Case-control study; Level of evidence, 3. Methods: All tibial plateau fractures treated by 1 of 3 surgeons at a single academic institution over an 11-year period were prospectively followed. Final outcomes were evaluated using the Short Musculoskeletal Function Assessment at latest follow-up. All complications were recorded at each follow-up. Differences between the groups were compared using Student t tests for continuous variables. Chi-square analysis was used to determine whether differences between categorical variables existed. Logistic regression was performed to assess independent variables associated with returning to participation in recreational athletics. Results: A total of 169 patients who underwent operative management of their tibial plateau fracture reported participation in recreational athletics before their injury. By the 6-month time point, 48 patients (31.6%) had returned to participation in recreational athletics, and at final follow-up (mean, 15 months), 89 patients (52.4%) had returned to participation in recreational athletics. Predictors of returning to recreational athletics included white race, female sex, social alcohol consumption, younger age, increased range of motion (ROM), low-energy Schatzker patterns (I-III), injuries not inclusive of orthopaedic polytrauma or open fractures, and no postoperative complications. White race, social alcohol consumption, and increased ROM were associated with returning to athletics at both 6-month and final follow-up. Lack of a venous thromboembolism was associated with returning to athletics at final follow-up. Patients who returned to recreational athletics had associations with better functional outcomes and emotional status than those who did not. Conclusion: The number of patients who returned to participation in recreational athletics gradually increased over time after operative fixation of tibial plateau fractures. Less severe injuries and a lack of postoperative complications were associated with a quicker return to athletics. Predictors of returning to participation in recreational athletics after operatively managed tibial plateau fractures can be used to target patients at risk of not returning to play to provide interventions aimed at improving their recovery, such as early knee range of motion, muscle strengthening, and participation in low-impact activities.
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Affiliation(s)
- David N Kugelman
- Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York, USA.,Jamaica Hospital Medical Center, New York, New York, USA
| | - Abdullah M Qatu
- Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York, USA.,Jamaica Hospital Medical Center, New York, New York, USA
| | - Jack M Haglin
- Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York, USA.,Jamaica Hospital Medical Center, New York, New York, USA
| | - Sanjit R Konda
- Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York, USA.,Jamaica Hospital Medical Center, New York, New York, USA
| | - Kenneth A Egol
- Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York, USA.,Jamaica Hospital Medical Center, New York, New York, USA
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227
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Dunphy E, Hamilton FL, Spasić I, Button K. Acceptability of a digital health intervention alongside physiotherapy to support patients following anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2017; 18:471. [PMID: 29162071 PMCID: PMC5697059 DOI: 10.1186/s12891-017-1846-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/14/2017] [Indexed: 01/29/2023] Open
Abstract
Background Physiotherapy rehabilitation following surgical reconstruction to the Anterior Cruciate Ligament (ACL) can take up to 12 months to complete. Given the lengthy rehabilitation process, a blended intervention can be used to compliment face-to-face physiotherapy with a digital exercise intervention. In this study, we used TRAK, a web–based tool that has been developed to support knee rehabilitation, which provides individually tailored exercise programs with videos, instructions and progress logs for each exercise, relevant health information and a contact option that allows a patient to email a physiotherapist for additional support. The aim of this study was to evaluate the acceptability of TRAK–based blended intervention in post ACL reconstruction rehabilitation. Methods A qualitative research design using semi-structured interviews was used on a convenience sample of participants following an ACL reconstruction, and their treating physiotherapists, in a London NHS hospital. Participants were asked to use TRAK alongside face-to-face physiotherapy for 16 weeks. Interviews were carried out, audio recorded, transcribed verbatim and coded by two researchers independently. Data were analyzed using thematic analysis. Results Of the 25 individuals that were approached to be part of the study, 24 consented, comprising 8 females and 16 males, mean age 30 years. 17 individuals used TRAK for 16 weeks and were available for interview. Four physiotherapists were also interviewed. The six main themes identified from patients were: the experience of TRAK rehabilitation, personal characteristics for engagement, strengths and weaknesses of the intervention, TRAK in the future and attitudes to digital healthcare. The main themes from the physiotherapist interviews were: potential benefits, availability of resources and service organization to support use of TRAK. Conclusions TRAK was found to be an acceptable method of delivering ACL rehabilitation alongside face-to-face physiotherapy. Patients reported that TRAK, specifically the videos, increased their confidence and motivation with their rehabilitation. They identified ways in which TRAK could be developed in the future to meet technological expectations and further support rehabilitation. For Physiotherapists time and availability of computers affected acceptability. Organization of care to support integration of digital exercise interventions such as TRAK into a blended approach to rehabilitation is required.
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Affiliation(s)
- Emma Dunphy
- E-Health Unit, Research Department of Primary Care and Population Health, Upper Third Floor UCL Medical School (Royal Free Campus), Rowland Hill Street, NW3 2PF, London, UK. .,Homerton University Hospital NHS Trust, Homerton Row E96SR, London, UK.
| | - Fiona L Hamilton
- E-Health Unit, Research Department of Primary Care and Population Health, Upper Third Floor UCL Medical School (Royal Free Campus), Rowland Hill Street, NW3 2PF, London, UK
| | - Irena Spasić
- School of Computer Science & Informatics, Cardiff University, Queens Building, 5 The Parade, Cardiff, CF24 3AA, UK
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Eastgate House, Newport Road, Cardiff, CF24 0AB, UK.,Cardiff & Vale University Health Board, Health Park, Cardiff, CF14 4XW, UK
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228
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Vlahovich N, Hughes DC, Griffiths LR, Wang G, Pitsiladis YP, Pigozzi F, Bachl N, Eynon N. Genetic testing for exercise prescription and injury prevention: AIS-Athlome consortium-FIMS joint statement. BMC Genomics 2017; 18:818. [PMID: 29143596 PMCID: PMC5688405 DOI: 10.1186/s12864-017-4185-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There has been considerable growth in basic knowledge and understanding of how genes are influencing response to exercise training and predisposition to injuries and chronic diseases. On the basis of this knowledge, clinical genetic tests may in the future allow the personalisation and optimisation of physical activity, thus providing an avenue for increased efficiency of exercise prescription for health and disease. RESULTS This review provides an overview of the current status of genetic testing for the purposes of exercise prescription and injury prevention. As such there are a variety of potential uses for genetic testing, including identification of risks associated with participation in sport and understanding individual response to particular types of exercise. However, there are many challenges remaining before genetic testing has evidence-based practical applications; including adoption of international standards for genomics research, as well as resistance against the agendas driven by direct-to-consumer genetic testing companies. Here we propose a way forward to develop an evidence-based approach to support genetic testing for exercise prescription and injury prevention. CONCLUSION Based on current knowledge, there is no current clinical application for genetic testing in the area of exercise prescription and injury prevention, however the necessary steps are outlined for the development of evidence-based clinical applications involving genetic testing.
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Affiliation(s)
- Nicole Vlahovich
- Australian Institute of Sport (AIS), Australian Sports Commission, Canberra, Australia
| | - David C Hughes
- Australian Institute of Sport (AIS), Australian Sports Commission, Canberra, Australia
- University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, Australia
| | - Lyn R Griffiths
- Genomics Research Centre, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Guan Wang
- Reference Collaborating Centre of Sports Medicine for Anti-Doping Research, University of Brighton, Eastbourne, UK
| | - Yannis P Pitsiladis
- Reference Collaborating Centre of Sports Medicine for Anti-Doping Research, University of Brighton, Eastbourne, UK
- Department of Movement Human and Health Sciences University of Rome "Foro Italico", Rome, Italy
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Fabio Pigozzi
- Department of Movement Human and Health Sciences University of Rome "Foro Italico", Rome, Italy
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Nobert Bachl
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Sports and Exercise Physiology, Centre for Sports Science and University Sports of the University of Vienna, Vienna, Austria
| | - Nir Eynon
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
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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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230
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Caron JG, Bloom GA, Podlog LW. Are athletes psychologically ready for sport following a concussion? Br J Sports Med 2017; 52:1-2. [PMID: 29056597 DOI: 10.1136/bjsports-2017-098319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jeffrey G Caron
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Gordon A Bloom
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Leslie W Podlog
- Department of Kinesiology, Health and Recreation, University of Utah, Salt Lake City, Utah, USA
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231
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Nwachukwu BU, Chang B, Voleti PB, Berkanish P, Cohn MR, Altchek DW, Allen AA, Williams RJ. Preoperative Short Form Health Survey Score Is Predictive of Return to Play and Minimal Clinically Important Difference at a Minimum 2-Year Follow-up After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2017; 45:2784-2790. [PMID: 28727937 DOI: 10.1177/0363546517714472] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is increased interest in understanding the preoperative determinants of postoperative outcomes. Return to play (RTP) and the patient-reported minimal clinically important difference (MCID) are useful measures of postoperative outcomes after anterior cruciate ligament reconstruction (ACLR). PURPOSE To define the MCID after ACLR and to investigate the role of preoperative outcome scores for predicting the MCID and RTP after ACLR. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS There were 294 active athletes enrolled as part of an institutional ACL registry with a minimum 2-year follow-up who were eligible for inclusion. A questionnaire was administered to elicit factors associated with RTP. Patient demographic and clinical data as well as patient-reported outcome measures were captured as part of the registry. Outcome measures included the International Knee Documentation Committee (IKDC) subjective knee evaluation form, Lysholm scale, and 12-Item Short Form Health Survey (SF-12) physical component summary (PCS) and mental component summary (MCS). Preoperative outcome score thresholds predictive of RTP were determined using a receiver operating characteristic (ROC) with area under the curve (AUC) analysis. The MCID was calculated using a distribution-based method. Multivariable logistic models were fitted to identify predictors for achieving the MCID and RTP. RESULTS At a mean (±SD) follow-up of 3.7 ± 0.7 years, 231 patients were included from a total 294 eligible patients. The mean age and body mass index were 26.7 ± 12.5 years and 23.7 ± 3.2 kg/m2, respectively. Of the 231 patients, 201 (87.0%) returned to play at a mean time of 10.1 months. Two-year postoperative scores on all measures were significantly increased from preoperative scores (IKDC: 50.1 ± 15.6 to 87.4 ± 10.7; Lysholm: 61.2 ± 18.1 to 89.5 ± 10.4; SF-12 PCS: 41.5 ± 9.0 to 54.7 ± 4.6; SF-12 MCS: 53.6 ± 8.1 to 55.7 ± 5.7; P < .001 for all). The corresponding MCID values were 9.0 (IKDC), 10.0 (Lysholm), 5.1 (SF-12 PCS), and 4.3 (SF-12 MCS). Preoperative score thresholds predictive of RTP were the following: IKDC, 60.9; Lysholm, 57.0; SF-12 PCS, 42.3; and SF-12 MCS, 48.3. These thresholds were not independently predictive but achieved significance as part of the multivariable analysis. In the multivariable analysis for RTP, preoperative SF-12 PCS scores above 42.3 (odds ratio [OR], 2.73; 95% CI, 1.09-7.62) and SF-12 MCS scores above 48.3 (OR, 4.41; 95% CI, 1.80-10.98) were predictive for achieving RTP; an ACL allograft (OR, 0.26; 95% CI, 0.06-1.00) was negatively predictive of RTP. In the multivariable analysis for the MCID, patients with higher preoperative scores were less likely to achieve the MCID ( P < .0001); however, a higher preoperative SF-12 MCS score was predictive of achieving the MCID on the IKDC form (OR, 1.27; 95% CI, 1.11-1.52) and Lysholm scale (OR, 1.08; 95% CI, 1.00-1.16). Medial meniscal injuries, older age, and white race were also associated with a decreased likelihood for achieving the MCID. CONCLUSION Preoperative SF-12 MCS and PCS scores were predictive of RTP after ACLR; patients scoring above 42.3 on the SF-12 PCS and 48.3 on the SF-12 MCS were more likely to achieve RTP. Additionally, we defined the MCID after ACLR and found that higher SF-12 MCS scores were predictive of achieving the MCID on knee-specific questionnaires.
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Affiliation(s)
- Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Brenda Chang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Pramod B Voleti
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Patricia Berkanish
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Matthew R Cohn
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - David W Altchek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Answorth A Allen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Nawasreh Z, Logerstedt D, Cummer K, Axe M, Risberg MA, Snyder-Mackler L. Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery. Br J Sports Med 2017; 52:375. [PMID: 28954801 DOI: 10.1136/bjsports-2016-097095] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Assessing athletes' readiness is a key component for successful outcomes after ACL reconstruction (ACLR). OBJECTIVES To investigate whether return-to-activity criteria, individually or in combination, at 6 months after ACLR can predict return to participation in the same preinjury activity level at 12 and 24 months after ACLR. METHODS Ninety-five level I/II participants completed return-to-activity criteria testing (isometric quadriceps index, single-legged hop tests, Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and Global Rating Score (GRS)) at 6 months after ACLR. The PASS group was defined as scoring >90% on all criteria and the FAIL group as scoring <90% on any criteria. At 12 and 24 months after ACLR, participants were asked if they had returned to participate in the same preinjury activity level or not. All return-to-activity criteria, except quadriceps index, were entered into the logistic regression model. RESULTS 81% and 84.4% of the PASS group returned to participation in the same preinjury activity level, while only 44.2% and 46.4% of the FAIL group returned at 12 and 24 months, respectively, after ACLR. The 6-meter timed hop, single hop and triple hop limb symmetry indexes; GRS; and KOS-ADLS individually predicted the outcome of interest at 12 months after ACLR (range: R2: 0.12-0.22, p<0.024). In combination, they explained 27% of the variance (p=0.035). All hop tests, individually, predicted the outcome of interest at 24 months after ACLR (range: R2: 0.26-0.37; p<0.007); in combination they explained 45% of the variance (p<0.001). CONCLUSION Return to participation in the same preinjury activity level at 12 and 24 months after ACLR was higher in those who passed the criteria compared with those who failed. Individual and combined return-to-activity criteria predicted the outcomes of interest, with the hop tests as consistent predictors at 12 and 24 months after ACLR.
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Affiliation(s)
- Zakariya Nawasreh
- Department of Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, Delaware, USA.,Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - David Logerstedt
- Department of Physical Therapy, University of the Sciences, Philadelphia, Pennsylvania, USA.,Delaware Rehabilitation Institute, University of Delaware, Newark, Delaware, USA
| | - Kathleen Cummer
- Department of Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Michael Axe
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, USA.,Department of Orthopedics, First State Orthopedics, Newark, Delaware, USA
| | - May Arna Risberg
- Division of Orthopedic Surgery, Department of Sports Medicine, Norwegian Research Center for Active Rehabilitation, Norwegian School of Sport Sciences, Oslo University Hospital, Oslo, Norway
| | - Lynn Snyder-Mackler
- Department of Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, Delaware, USA.,Delaware Rehabilitation Institute, University of Delaware, Newark, Delaware, USA.,Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, USA
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233
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Silva LO, Mendes LMR, Lima PODP, Almeida GPL. Translation, cross-adaptation and measurement properties of the Brazilian version of the ACL-RSI Scale and ACL-QoL Questionnaire in patients with anterior cruciate ligament reconstruction. Braz J Phys Ther 2017; 22:127-134. [PMID: 28941959 PMCID: PMC5883994 DOI: 10.1016/j.bjpt.2017.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 01/13/2023] Open
Abstract
The Brazilian versions of ACL-RSI and ACL-QoL were translated and culturally adapted. The Brazilian ACL-RSI and ACL-QoL demonstrated adequate measurement properties. The Brazilian ACL-RSI and ACLQoL are useful outcomes for clinical and research.
Background Scales to assess the quality of life and return-to-sport after reconstruction of the anterior cruciate ligament (ACL) may help the clinical decision-making process. Objective To cross-culturally adapt and determine the validity of the Brazilian versions of the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) and the Quality of Life Questionnaire (ACL-QoL). Methods The process of translation and cross-cultural adaptation followed the recommendations of international guidelines. One hundred participants filled out the Brazilian versions of these instruments, the Tampa Scale for Kinesiophobia (TSK), the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and the 36-Item Short Form Health Survey (SF-36). The measurement properties of reliability, internal consistency and construct validity were measured. Results The ACL-RSI and the ACL-QoL were successfully translated and cross-culturally adapted. Both questionnaires showed good test–retest reliability (ICC2,1 = 0.78, 95% CI = 0.67–0.85 for the ACL-RSI; and ICC2,1 = 0.84, 95% CI = 0.76–0.90 for the ACL-QoL) and good internal consistency (Cronbach's alpha = 0.87 for the ACL-RSI; and Cronbach's alpha = 0.96 for the ACL-QoL). A reasonable correlation was found between both questionnaires and the TSK, and a low to reasonable correlation was found between the questionnaires and the SF-36 in terms of validity. Compared to the IKDC Subjective Knee Evaluation Form, the ACL-RSI had a reasonable correlation and the ACL-QoL had a good correlation. Conclusion The Brazilian versions of the ACL-RSI and the ACL-QoL have adequate measurement properties and may be used in assessing Brazilians after ACL reconstruction.
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Affiliation(s)
- Laryssa Oliveira Silva
- Department of Physical Therapy, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil; Knee Research Group, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil
| | - Luana Maria Ramos Mendes
- Department of Physical Therapy, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil; Knee Research Group, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil
| | - Pedro Olavo de Paula Lima
- Department of Physical Therapy, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil; Knee Research Group, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil
| | - Gabriel Peixoto Leão Almeida
- Department of Physical Therapy, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil; Knee Research Group, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil.
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Chen T, Zhang P, Li Y, Webster K, Zhang J, Yao W, Yin Y, Ai C, Chen S. Translation, cultural adaptation and validation of simplified Chinese version of the anterior cruciate ligament return to sport after injury (ACL-RSI) scale. PLoS One 2017; 12:e0183095. [PMID: 28817645 PMCID: PMC5560729 DOI: 10.1371/journal.pone.0183095] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/28/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To translate and cross-culturally adapt the anterior cruciate ligament-return to sport after injury (ACL-RSI) into simplified Chinese [ACL-RSI (Cn)]. METHOD In this diagnostic study, the translation, cross-culturally adaptation, and validation of the ACL-RSI was performed according to international guidelines. A total of 112 patients with ACL reconstruction participated in this study. All were capable of competitive sports before the injury and completed the Knee Injury and Osteoarthritis Outcome (KOOS), the International Knee Documentation Committee (IKDC), the Tampa Scale of Kinesiophobia (TSK), and the Tegner activity score. Forty-eight patients completed the ACL-RSI (Cn) twice within two weeks. The validity was tested using seven premade hypotheses. Internal consistency, reliability, and measurement error was assessed. RESULT At meanly 15.6 months postoperative, 81 (72.3%) patients returned to sport, with 57 (50.9%) to competitive sport and 24 (21.4%) to recreational sport. Thirty-one (27.7%) patients didn't return to any sport, with 19 (17.0%) still had planned to return, and 12 (10.7%) gave up sport. The ACL-RSI (Cn) demonstrated excellent validity with all hypotheses confirmed. The outcome of ACL-RSI (Cn) was strongly correlated the KOOS subscale quality of life (r = 0.66, p<0.001), the TSK (r = -0.678, p<0.001), the Tegner score (r = 0.695, p<0.001). There was statistic difference between cases returned (68.6 ± 10.1) and didn't return to sport (41.3 ± 17.7), p<0.001; between cases returned to competitive (71.1 ± 8.9) and recreational sport (62.9 ± 10.5), (P = 0.002); between cases who planned to return (50.7 ± 14.1) and gave up sport (26.5 ± 11.7), (P<0.001). The internal consistency (Cronbach's α = 0.96) and test-retest reliability [intra-class correlation coefficient (ICC) = 0.90] was excellent. The measurement error, floor and ceiling effect was satisfactory. Administration time was 3.2 minutes, and no item was missed. CONCLUSIONS The ACL-RSI (Cn) scale was confirmed as a valid, reliable, and feasible tool for evaluating psychological factors influencing return to sport.
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Affiliation(s)
- Tianwu Chen
- Department of Sports Medicine and Arthroscopy, Huashan Hospital, Shanghai, China
- Sports Medicine Center, Fudan University, Shanghai, China
| | - Peng Zhang
- Department of Sports Medicine and Arthroscopy, Huashan Hospital, Shanghai, China
- Sports Medicine Center, Fudan University, Shanghai, China
| | - Yunxia Li
- Department of Sports Medicine and Arthroscopy, Huashan Hospital, Shanghai, China
- Sports Medicine Center, Fudan University, Shanghai, China
| | - Kate Webster
- Musculoskeletal Research Centre, La Trobe University, Victoria, Australia
| | - Jian Zhang
- Department of Sports Medicine and Arthroscopy, Huashan Hospital, Shanghai, China
- Sports Medicine Center, Fudan University, Shanghai, China
| | - Wei Yao
- Department of Sports Medicine and Arthroscopy, Huashan Hospital, Shanghai, China
- Sports Medicine Center, Fudan University, Shanghai, China
| | - Yue Yin
- West Anhui University Health Vocational College, Luan, Anhui Province, China
| | - Chingchong Ai
- Department of Sports Medicine and Arthroscopy, Huashan Hospital, Shanghai, China
- Sports Medicine Center, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine and Arthroscopy, Huashan Hospital, Shanghai, China
- Sports Medicine Center, Fudan University, Shanghai, China
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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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Nwachukwu BU, Voleti PB, Berkanish P, Chang B, Cohn MR, Williams RJ, Allen AA. Return to Play and Patient Satisfaction After ACL Reconstruction: Study with Minimum 2-Year Follow-up. J Bone Joint Surg Am 2017; 99:720-725. [PMID: 28463915 DOI: 10.2106/jbjs.16.00958] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Return to play and patient satisfaction after anterior cruciate ligament reconstruction (ACLR) have been inconsistently studied. The purposes of this study were to (1) investigate rates and predictors of return to play after ACLR, (2) evaluate patient satisfaction after ACLR, and (3) analyze the relationship between return to play and satisfaction with the result of ACLR. METHODS Eligible patients were active athletes included in an institutional ACL registry who had undergone ACLR and had been followed for a minimum of 2 years. A questionnaire was administered to elicit information regarding factors associated with return to play, sports performance, reinjury, and overall patient satisfaction. The Wilcoxon-Mann-Whitney U test was used to compare return to play with patient satisfaction. Multivariable logistic regression was used to identify demographic, sports, and clinical factors associated with return to play. RESULTS Two hundred and thirty-two patients with a mean age of 26.7 years (standard deviation [SD] = 12.5 years) who had been followed for a mean of 3.7 years were enrolled. Of 231 patients who responded to the return-to-play question, 201 (87.0%) had returned to play, at a mean of 10.1 months; of 175 athletes eligible to return to their prior level of competition, 89.1% had done so. Overall satisfaction was high: 85.4% were very satisfied with the outcome and 98.1% stated that they would have surgery again. Patients were more likely to respond "very satisfied" if they had returned to play (p < 0.001). Use of a patellar tendon autograft (odds ratio [OR] = 5.63, 95% confidence interval [CI] = 1.32 to 25.76) increased the chance of returning to play whereas playing soccer (OR = 0.23, 95% CI = 0.08 to 0.66) or lacrosse (OR = 0.24, 95% CI = 0.06 to 0.99) preoperatively decreased the likelihood of returning to play. CONCLUSIONS The rates of return to play and patient satisfaction are high after ACLR in active athletes. The use of patellar tendon autograft increased the likelihood of returning to play whereas preinjury participation in soccer and lacrosse decreased these odds. Additionally, patients who returned to play were more likely to be very satisfied with the result of the ACLR. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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237
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Ekhtiari S, Kay J, de Sa D, Simunovic N, Musahl V, Peterson DC, Ayeni OR. What Makes a Successful Survey? A Systematic Review of Surveys Used in Anterior Cruciate Ligament Reconstruction. Arthroscopy 2017; 33:1072-1079.e3. [PMID: 28351554 DOI: 10.1016/j.arthro.2017.01.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize and assess the methodological quality of patient and physician surveys related to anterior cruciate ligament reconstruction, and to analyze the factors influencing response rate. METHODS The databases MEDLINE, Embase, and PubMed were searched from database inception to search date and screened in duplicate for relevant studies. Data regarding survey characteristics, response rates, and distribution methods were extracted. A previously published list of recommendations for high-quality surveys in orthopaedics was used as a scale to assess survey quality (12 items scored 0, 1, or 2; maximum score = 24). RESULTS Of the initial 1,276 studies, 53 studies published between 1986 and 2016 met the inclusion criteria. Sixty-four percent of studies were distributed to physicians, compared with 32% distributed to patients and less than 4% to coaches. The median number of items in each survey was 10.5, and the average response rate was 73% (range: 18% to 100%). In-person distribution was the most common method (40%), followed by web-based methods (28%) and mail (25%). Response rates were highest for surveys targeted at patients (77%, P < .0001) and those delivered in-person (94%, P < .0001). The median quality score was 12/24 (range = 8.5/24 to 21/24). There was high inter-rater agreement using the quality scale (intraclass correlation coefficient = 0.92), but there was no correlation with the response rate (Rho = -0.01, P = .97). CONCLUSIONS Response rates vary based on target audience and distribution methods, with patients responding at a significantly higher rate than physicians and in-person distribution yielding significantly higher response rates than web or mail surveys. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Seper Ekhtiari
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Centre for Evidence Based Orthopaedics, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Volker Musahl
- Division of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Devin C Peterson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Comparison of outcome after anatomic double-bundle and antero-medial portal non-anatomic single-bundle reconstruction in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 2017; 25:1307-1315. [PMID: 27106922 DOI: 10.1007/s00167-016-4132-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to compare anatomic double-bundle anterior cruciate ligament reconstruction with non-anatomic single-bundle reconstruction. METHODS In a prospective consecutive series, 94 unselected patients [45 anatomic double-bundle (ADB) and 49 non-anatomic single-bundle (SB)] underwent ACL reconstruction involving hamstring tendon autograft, interference screw fixation on both the femoral and tibial side and drilling the femoral tunnel(s) through the antero-medial portal in both groups. In the ADB group, the remnants of the ACL were identified and the grafts were placed anatomically. In the SB group, traditional placement of the graft was performed in a less anatomic manner. Pre-operatively, the groups were comparable in terms of age, gender, time between injury and operation and associated injuries. One independent physiotherapist performed all the pre-operative and post-operative assessments. RESULTS The follow-up period was 26 (22-34) and 24 (23-30) months in the ADB and SB groups, respectively (p = 0.005). At follow-up, 78 % in the ADB group and 74 % in the SB group had a negative pivot-shift test (n.s.). The KT-1000 134N measurements were 2 (-5 to 10.5) and 2 (-4 to 7) mm in the ADB and SB groups, respectively (n.s.). At follow-up, the extension deficit was significantly larger in the ADB group than in the SB group (p = 0.001). The Tegner activity scale was significantly higher in the ADB group both pre-operatively and at follow-up (p = 0.03 and p = 0.004). In overall terms, both groups had improved significantly at the two-year follow-up. CONCLUSION In an unselected group of ACL-injured patients, anatomic double-bundle reconstruction did not result in better rotational or antero-posterior stability measurements than antero-medial portal non-anatomic single-bundle reconstruction at the two-year follow-up. LEVEL OF EVIDENCE III.
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Nawasreh Z, Logerstedt D, Cummerm K, Axe MJ, Risberg MA, Snyder-Mackler L. Do Patients Failing Return-to-Activity Criteria at 6 Months After Anterior Cruciate Ligament Reconstruction Continue Demonstrating Deficits at 2 Years? Am J Sports Med 2017; 45:1037-1048. [PMID: 28125899 PMCID: PMC5376235 DOI: 10.1177/0363546516680619] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The variability in outcomes after anterior cruciate ligament reconstruction (ACLR) might be related to the criteria that are used to determine athletes' readiness to return to their preinjury activity level. A battery of return-to-activity criteria (RTAC) that emphasize normal knee function and movement symmetry has been instituted to quantitatively determine athletes' readiness to return to preinjury activities. PURPOSE To investigate performance-based and patient-reported measures at 12 and 24 months after ACLR between patients who passed or failed RTAC at 6 months after ACLR. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 108 patients who had participated in International Knee Documentation Committee level 1 or 2 sports activities completed RTAC testing at 6, 12, and 24 months after surgery. The RTAC included the isometric quadriceps strength index (QI), 4 single-legged hop tests, the Knee Outcome Survey-activities of daily living subscale (KOS-ADLS), and the global rating scale of perceived function (GRS). Patients who scored ≥90% on all RTAC were classified as the pass group, and those who scored <90% on any RTAC were classified as the fail group. At 12- and 24-month follow-ups, patients were asked if they had returned to the same preinjury activity level. RESULTS At the 6-month follow-up, there were 48 patients in the pass group and 47 in the fail group. At the 12-month follow-up, 31 patients (73.8%) from the pass group and 15 patients (39.5%) from the fail group passed RTAC, and at the 24-month follow-up, 25 patients (75.8%) from the pass group and 14 patients (51.9%) from the fail group passed RTAC. The rate of return to activities in the pass group was 81% and 84% at 12 and 24 months after ACLR, respectively, compared with only 44% and 46% in the fail group ( P ≤ .012), respectively; however, some patients in the fail group participated in preinjury activities without being cleared by their therapists. At 12 and 24 months, 60.5% and 48.1% of patients continued to fail again on the criteria, respectively. A statistically significant group × time interaction was found for the single hop and 6-m timed hop limb symmetry indices (LSIs) ( P ≤ .037), with only the fail group demonstrating a significant improvement over time. A main effect of group was detected for the QI and the crossover hop and triple hop LSIs ( P < .01), with patients in the pass group demonstrating higher performance. A main effect of time was detected for the crossover hop and triple hop LSIs and the GRS, with improvements seen in both groups ( P < .05). CONCLUSION Patients who passed the RTAC early after ACLR were more likely to demonstrate normal knee function and movement symmetry at 12 and 24 months postoperatively, while patients who failed the RTAC early were more likely to demonstrate impaired knee function and movement asymmetry at 12- and 24-month follow-ups. Patients in the pass group had a higher rate of return to their preinjury activity level compared with those in the fail group. A group of patients chose to return to their preinjury activities, even though they were functionally not ready.
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Affiliation(s)
- Zakariya Nawasreh
- Address correspondence to Zakariya Nawasreh, BPT, MS, PhD, Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan ()
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Lai CCH, Ardern CL, Feller JA, Webster KE. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. Br J Sports Med 2017; 52:128-138. [DOI: 10.1136/bjsports-2016-096836] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 01/10/2023]
Abstract
ObjectivesThe primary objective was to calculate the rate of return to sport (RTS) following anterior cruciate ligament (ACL) reconstruction in elite athletes. Secondary objectives were to estimate the time taken to RTS, calculate rates of ACL graft rupture, evaluate postsurgical athletic performance and identify determinants of RTS.DesignPooled RTS and graft rupture rates were calculated using random effects proportion meta-analysis. Time to RTS, performance data and determinants of RTS were synthesised descriptively.Data sourcesMEDLINE, EMBASE, AMED, CINAHL, AMI, PEDro, SPORTDiscus and The Cochrane Library were searched from inception to 19 January 2016. Hand searching of 10 sports medicine journals and reference checking were also performed.Eligibility criteria for selecting studiesStudies were included if they reported the ratio of elite athletes who returned to their preinjury level of sport following ACL reconstruction. Twenty-four studies were included.ResultsThe pooled RTS rate was 83% (95% CI 77% to 88%). The mean time to RTS ranged from 6 to 13 months. The pooled graft rupture rate was 5.2% (95% CI 2.8% to 8.3%). Six out of nine studies that included a noninjured control group found no significant deterioration in athletic performance following ACL reconstruction. Indicators of greater athletic skill or value to the team were associated with RTS.Summary and conclusionsEighty-three per cent of elite athletes returned to sport following ACL reconstruction, while 5.2% sustained a graft rupture. Most athletes who returned to sport performed comparably with matched, uninjured controls. This information may assist in guiding expectations of athletes and clinicians following ACL reconstruction.
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Nwachukwu BU, Voleti PB, Chang B, Berkanish P, Mahony GT, Williams RJ, Altchek DW, Allen AA. Comparative Influence of Sport Type on Outcome After Anterior Cruciate Ligament Reconstruction at Minimum 2-Year Follow-up. Arthroscopy 2017; 33:415-421. [PMID: 27773640 DOI: 10.1016/j.arthro.2016.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate differences between sport types for patient-reported outcome after anterior cruciate ligament reconstruction (ACLR). METHODS Included patients were enrolled as part of a prospective institutional ACL registry. Inclusion criteria were preoperative self-identification as a competitive athlete, maximum score on the preoperative Marx Activity Scale, and minimum 2-year follow-up. Demographic, intraoperative, and outcome data were extracted from the registry. Outcome tools administered as part of the registry included International Knee Documentation Committee (IKDC), Lysholm-Tegner Scales, Marx Activity Scale (MAS), and 12-Item Short Form Health Survey (SF-12). RESULTS A total of 294 patients with a mean age of 25.5 years (standard deviation 12.1) met the study inclusion criteria; mean follow-up was 3.7 years. Included sports categories were soccer (n = 92; 31.3%), skiing (n = 67; 22.8%), basketball (n = 56; 19.1%), lacrosse (n = 38; 12.9%), football (n = 29; 9.9%), and Tennis (n = 12; 4.1%). At baseline, compared with other sports, lacrosse players have higher outcome scores while skiers had lower scores. At 2-year follow-up, however, across all outcome tools, football players demonstrated significantly higher outcome scores than all other athletes (IKDC, 93.2, P = .001; Lysholm, 93.2, P = .03; MAS, 13.1, P = .03; SF-12 Mental Component Summary, 57.9, P = .0002). Conversely, at 2-year follow-up, soccer players demonstrated a significantly lower Lysholm (86.7, P = .02) and a trend toward lower IKDC (85.6, P = .09) scores. CONCLUSIONS Patient-reported outcomes after ACLR among active athletes are comparable. Football players demonstrate quantitatively higher outcome scores whereas soccer players have lower scores. However, these outcome score differences may not be clinically significant and may be subject to confounding variables. Continued attention should be paid to understanding sport-specific outcome after ACLR. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Pramod B Voleti
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Brenda Chang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Patricia Berkanish
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Gregory T Mahony
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Riley J Williams
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - David W Altchek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Answorth A Allen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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Sonesson S, Kvist J, Ardern C, Österberg A, Silbernagel KG. Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. Knee Surg Sports Traumatol Arthrosc 2017; 25:1375-1384. [PMID: 27562372 PMCID: PMC5432589 DOI: 10.1007/s00167-016-4294-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/12/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To describe individuals' expectations, motivation, and satisfaction before, during, and after rehabilitation for ACL reconstruction and to explore how these factors were associated with return to pre-injury sport activity at 1-year follow-up. METHODS Sixty-five individuals (34 males), median age 22 (15-45) years, scheduled for ACL reconstruction participated. Participants completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and questions about expectations, satisfaction, and motivation pre-operatively and at 16 and 52 weeks after surgery. RESULTS Prior to surgery, 86 % of participants stated that their goal was to return to their pre-injury sport activity. Those who had returned to their pre-injury sport activity at 52 weeks were more motivated during rehabilitation to return to their pre-injury activity level, more satisfied with their activity level and knee function at 52 weeks, and scored significantly higher on the IKDC-SKF [median 92.0 (range 66.7-100.0)] at 52 weeks, compared to those who had not returned [median 77.6 (range 50.6-97.7)]. CONCLUSION Prior to ACL reconstruction, most participants expected to return to their pre-injury activity level. Higher motivation during rehabilitation was associated with returning to the pre-injury sport activity. The participants who had returned to their pre-injury sport activity were more satisfied with their activity level and knee function 1 year after the ACL reconstruction. Facilitating motivation might be important to support individuals in achieving their participation goals after ACL reconstruction. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Affiliation(s)
- Sofi Sonesson
- Division of Physiotherapy, Linköping University, 581 83, Linköping, Sweden.
| | - Joanna Kvist
- 0000 0001 2162 9922grid.5640.7Division of Physiotherapy, Linköping University, 581 83 Linköping, Sweden
| | - Clare Ardern
- 0000 0001 2162 9922grid.5640.7Division of Physiotherapy, Linköping University, 581 83 Linköping, Sweden ,0000 0001 2342 0938grid.1018.8School of Allied Health, Faculty of Health Sciences, La Trobe University, Melbourne, VIC Australia ,Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Annika Österberg
- 0000 0001 2162 9922grid.5640.7Division of Physiotherapy, Linköping University, 581 83 Linköping, Sweden ,0000 0004 1936 9457grid.8993.bCentre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Karin Grävare Silbernagel
- 0000 0001 0454 4791grid.33489.35Department of Physical Therapy, University of Delaware, Newark, DE USA
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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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Forsdyke D, Gledhill A, Ardern C. Psychological readiness to return to sport: three key elements to help the practitioner decide whether the athlete is REALLY ready? Br J Sports Med 2016; 51:555-556. [DOI: 10.1136/bjsports-2016-096770] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 11/04/2022]
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Tjong VK, Cogan CJ, Riederman BD, Terry MA. A Qualitative Assessment of Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement. Orthop J Sports Med 2016; 4:2325967116671940. [PMID: 27896294 PMCID: PMC5117156 DOI: 10.1177/2325967116671940] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hip arthroscopy for femoroacetabular impingement (FAI) is known to produce excellent outcomes, yet some patients do not return to their preinjury level of sport participation. Much literature on return to sport has revolved around anterior cruciate ligament reconstruction and even shoulder instability, but none to date have used qualitative, semistructured patient interviews on patients with hip labral tears. PURPOSE To understand the factors influencing the decision to return to sport after arthroscopic hip surgery for FAI. STUDY DESIGN Case series; Level of evidence, 4. METHODS An experienced interviewer conducted qualitative, semistructured interviews of patients aged 18 to 60 years who had arthroscopic hip surgery for FAI. All had preinjury participation in sport and a minimum 2-year follow-up with no revision surgery. Qualitative analysis was then performed to derive codes, categories, and themes. An assessment of preinjury and current sports participation by type, level of competition, and frequency along with patient-reported hip function was also obtained. In addition, current modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), Hip Outcome Score-sports-specific subscale (HOS-SSS), and a coping mechanism evaluation (Brief COPE) were also recorded. RESULTS A total of 23 patients were interviewed to reveal the overarching themes of internal motivation, external encouragement, and resetting expectations as the predominant factors influencing a patient's decision to return to preinjury sport. Subjective outcome measurements (mHHS, iHOT-12, patient satisfaction) showed significant differences between patients who did and did not return to sport. Interestingly, the adaptive and maladaptive coping mechanisms matched and supported our themes in those patients who described fear and self-motivation as defining features influencing their cessation of or return to play, respectively. CONCLUSION Self-motivation, aging, pain, encouragement from others, and adapting to physical limitations can largely affect a patient's decision to return to sport after arthroscopic hip surgery for FAI. Innate coping mechanisms may also help to predict the course of and subsequently aid in a patient's postoperative recovery.
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Affiliation(s)
- Vehniah K Tjong
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles J Cogan
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brett D Riederman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael A Terry
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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246
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Can Clinical Evaluation Predict Return to Sport after Acute Hamstring Injuries? A Systematic Review. Sports Med 2016; 47:1123-1144. [DOI: 10.1007/s40279-016-0639-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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247
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Abstract
Context: A sports injury has both physical and psychological consequences for the athlete. A common postinjury psychological response is elevated fear of reinjury. Objective: To provide an overview of the implications of fear of reinjury on the rehabilitation of athletes, including clinical methods to measure fear of reinjury; the impact of fear of reinjury on rehabilitation outcomes, including physical impairments, function, and return to sports rate; and potential interventions to address fear of reinjury during rehabilitation. Evidence Acquisition: PubMed was searched for articles published in the past 16 years (1990-2016) relating to fear of reinjury in athletes. The reference lists of the retrieved articles were searched for additionally relevant articles. Study Design: Clinical review. Level of Evidence: Level 3. Results: Fear of reinjury after a sports injury can negatively affect the recovery of physical impairments, reduce self-report function, and prevent a successful return to sport. Athletes with high fear of reinjury might benefit from a psychologically informed practice approach to improve rehabilitation outcomes. The application of psychologically informed practice would be to measure fear of reinjury in the injured athletes and provide interventions to reduce fear of reinjury to optimize rehabilitation outcomes. Conclusion: Fear of reinjury after a sports injury can lead to poor rehabilitation outcomes. Incorporating principles of psychologically informed practice into sports injury rehabilitation could improve rehabilitation outcomes for athletes with high fear of reinjury.
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Affiliation(s)
- Chao-Jung Hsu
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois
| | | | - Steven Z George
- Department of Physical Therapy, University of Florida, Gainesville, Florida.,Brooks Rehabilitation, Jacksonville, Florida
| | - Terese L Chmielewski
- TRIA Orthopaedic Center, Bloomington, Minnesota.,Department of Physical Therapy, University of Florida, Gainesville, Florida
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248
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Ardern CL, Österberg A, Sonesson S, Gauffin H, Webster KE, Kvist J. Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity. Arthroscopy 2016; 32:1631-1638.e3. [PMID: 27020461 DOI: 10.1016/j.arthro.2016.01.035] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 12/04/2015] [Accepted: 01/15/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether patient-reported outcomes (psychological factors, appraisals of knee function, and physical activity participation) were associated with satisfaction with knee function after anterior cruciate ligament (ACL) reconstruction. METHODS Participants who were aged 18 to 45 years and a minimum 12 months post primary ACL reconstruction completed a questionnaire battery evaluating knee self-efficacy, knee-related quality of life, self-reported function, and physical activity participation. Participants' responses to the question "If you were to spend the rest of your life with your knee just the way it has been in the last week, would you feel . . . (7-point ordinal scale; 1 = happy, 7 = unhappy)" were categorized as satisfied, mostly satisfied, or dissatisfied and used as the primary outcome. Ordinal regression was used to examine associations between independent variables and the primary outcome. RESULTS A total of 177 participants were included at an average of 3 years after primary ACL reconstruction. At follow-up, 44% reported they would be satisfied, 28% mostly satisfied, and 28% dissatisfied with the outcome of ACL reconstruction. There were significant differences in psychological responses and appraisal of knee function between the 3 groups (P = .001), and significantly more people in the satisfied group had returned to their preinjury activity (58%) than in the mostly satisfied (28%) and dissatisfied (26%) groups (P = .001). Multivariable analysis demonstrated that the odds of being satisfied increased by a factor of 3 with higher self-efficacy, greater knee-related quality of life, and returning to the preinjury activity. CONCLUSIONS People who had returned to their preinjury physical activity and who reported higher knee-related self-efficacy and quality of life were more likely to be satisfied with the outcome of ACL reconstruction. LEVEL OF EVIDENCE Level IV, prognostic case series.
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Affiliation(s)
- Clare L Ardern
- Division of Physiotherapy, Linköping University, Linköping, Sweden; Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar; School of Allied Health, La Trobe University, Melbourne, Australia.
| | - Annika Österberg
- Division of Physiotherapy, Linköping University, Linköping, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Sofi Sonesson
- Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Håkan Gauffin
- Orthopaedic Department, Linköping University, Linköping, Sweden
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Joanna Kvist
- Division of Physiotherapy, Linköping University, Linköping, Sweden
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249
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Balazs GC, Brelin AM, Donohue MA, Dworak TC, Rue JPH, Giuliani JR, Dickens JF. Incidence Rate and Results of the Surgical Treatment of Pectoralis Major Tendon Ruptures in Active-Duty Military Personnel. Am J Sports Med 2016; 44:1837-43. [PMID: 27037284 DOI: 10.1177/0363546516637177] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pectoralis major tendon ruptures are commonly described as rare injuries affecting men between 20 and 40 years of age, with generally excellent results after surgical repair. However, this perception is based on a relatively small number of case series and prospective studies in the orthopaedic literature. PURPOSE To determine the incidence of pectoralis major tendon ruptures in the active-duty military population and the demographic risk factors for a rupture and to describe the outcomes of surgical treatment. STUDY DESIGN Case control study; Level of evidence, 3. METHODS We utilized the Military Health System Data Repository (MDR) to identify all active-duty military personnel surgically treated for a pectoralis major tendon rupture between January 2012 and December 2014. Electronic medical records were searched for patients' demographic information, injury characteristics, and postoperative complications and outcomes. Risk factors for a rupture were calculated using Poisson regression, based on population counts obtained from the MDR. Risk factors for a postoperative complication, the need for revision surgery, and the inability to continue with active duty were determined using univariate analysis and multivariate logistic regression. RESULTS A total of 291 patients met inclusion criteria. The mean patient age was 30.5 years, all patients were male, and the median follow-up period was 18 months. The incidence of injuries was 60 per 100,000 person-years over the study period. Risk factors for a rupture included service in the Army, junior officer or junior enlisted rank, and age between 25 and 34 years. White race and surgery occurring >6 weeks after injury were significant risk factors for a postoperative complication. Among the 214 patients with a minimum of 12 months' clinical follow-up, 95.3% were able to return to military duty. Junior officer/enlisted status was a significant risk factor for failure to return to military duty. CONCLUSION Among military personnel, Army soldiers and junior officer/enlisted rank were at highest risk of pectoralis major tendon ruptures, and junior personnel were at highest risk of being unable to return to duty after surgical treatment. Although increasing time from injury to surgery was not a risk factor for treatment failure or inability to return to duty, it did significantly increase the risk of a postoperative complication.
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Affiliation(s)
- George C Balazs
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Alaina M Brelin
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael A Donohue
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Theodora C Dworak
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - John-Paul H Rue
- Department of Orthopaedic Surgery, Naval Health Clinic Annapolis, United States Naval Academy, Annapolis, Maryland, USA
| | - Jeffrey R Giuliani
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jonathan F Dickens
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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250
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McCormack RG, Hutchinson MR. Time to be honest regarding outcomes of ACL reconstructions: should we be quoting 55–65% success rates for high-level athletes? Br J Sports Med 2016; 50:1167-8. [DOI: 10.1136/bjsports-2016-096324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 11/03/2022]
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