251
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Culvenor AG, Collins NJ, Guermazi A, Cook JL, Vicenzino B, Whitehead TS, Morris HG, Crossley KM. Early Patellofemoral Osteoarthritis Features One Year After Anterior Cruciate Ligament Reconstruction: Symptoms and Quality of Life at Three Years. Arthritis Care Res (Hoboken) 2016; 68:784-92. [DOI: 10.1002/acr.22761] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/21/2015] [Accepted: 10/13/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Adam G. Culvenor
- University of Queensland, Brisbane, Queensland, and La Trobe University, Melbourne, Victoria, Australia, and Paracelsus Medical University–Salzburg & NuremburgSalzburg Austria
| | - Natalie J. Collins
- University of Queensland, Brisbane, Queensland, and University of MelbourneMelbourne Victoria Australia
| | - Ali Guermazi
- Boston University School of MedicineBoston Massachusetts
| | - Jill L. Cook
- La Trobe University and Monash UniversityMelbourne Victoria Australia
| | | | - Timothy S. Whitehead
- University of Queensland, Brisbane, Queensland, and La Trobe UniversityMelbourne Victoria Australia
| | - Hayden G. Morris
- The Park Clinic and St. Vincent's Private Hospital, Melbourne, Victoria, Australia
| | - Kay M. Crossley
- University of Queensland, Brisbane, Queensland, and La Trobe University, Melbourne, Victoria, Australia
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252
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What is the evidence to support a psychological component to rehabilitation programs after anterior cruciate ligament reconstruction? CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000371] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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253
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Ardern CL, Kvist J, Webster KE. Psychological Aspects of Anterior Cruciate Ligament Injuries. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2015.09.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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254
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Chmielewski TL, George SZ, Tillman SM, Moser MW, Lentz TA, Indelicato PA, Trumble TN, Shuster JJ, Cicuttini FM, Leeuwenburgh C. Low- Versus High-Intensity Plyometric Exercise During Rehabilitation After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2016; 44:609-17. [PMID: 26797700 DOI: 10.1177/0363546515620583] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Plyometric exercise is used during rehabilitation after anterior cruciate ligament (ACL) reconstruction to facilitate the return to sports participation. However, clinical outcomes have not been examined, and high loads on the lower extremity could be detrimental to knee articular cartilage. PURPOSE To compare the immediate effect of low- and high-intensity plyometric exercise during rehabilitation after ACL reconstruction on knee function, articular cartilage metabolism, and other clinically relevant measures. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Twenty-four patients who underwent unilateral ACL reconstruction (mean, 14.3 weeks after surgery; range, 12.1-17.7 weeks) were assigned to 8 weeks (16 visits) of low- or high-intensity plyometric exercise consisting of running, jumping, and agility activities. Groups were distinguished by the expected magnitude of vertical ground-reaction forces. Testing was conducted before and after the intervention. Primary outcomes were self-reported knee function (International Knee Documentation Committee [IKDC] subjective knee form) and a biomarker of articular cartilage degradation (urine concentrations of crosslinked C-telopeptide fragments of type II collagen [uCTX-II]). Secondary outcomes included additional biomarkers of articular cartilage metabolism (urinary concentrations of the neoepitope of type II collagen cleavage at the C-terminal three-quarter-length fragment [uC2C], serum concentrations of the C-terminal propeptide of newly formed type II collagen [sCPII]) and inflammation (tumor necrosis factor-α), functional performance (maximal vertical jump and single-legged hop), knee impairments (anterior knee laxity, average knee pain intensity, normalized quadriceps strength, quadriceps symmetry index), and psychosocial status (kinesiophobia, knee activity self-efficacy, pain catastrophizing). The change in each measure was compared between groups. Values before and after the intervention were compared with the groups combined. RESULTS The groups did not significantly differ in the change of any primary or secondary outcome measure. Of interest, sCPII concentrations tended to change in opposite directions (mean ± SD: low-intensity group, 28.7 ± 185.5 ng/mL; high-intensity group, -200.6 ± 255.0 ng/mL; P = .097; Cohen d = 1.03). Across groups, significant changes after the intervention were increased the IKDC score, vertical jump height, normalized quadriceps strength, quadriceps symmetry index, and knee activity self-efficacy and decreased average knee pain intensity. CONCLUSION No significant differences were detected between the low- and high-intensity plyometric exercise groups. Across both groups, plyometric exercise induced positive changes in knee function, knee impairments, and psychosocial status that would support the return to sports participation after ACL reconstruction. The effect of plyometric exercise intensity on articular cartilage requires further evaluation. REGISTRATION NUMBER Clinicaltrials.gov NCT01851655.
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Affiliation(s)
- Terese L Chmielewski
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA TRIA Orthopaedic Center, Bloomington, Minnesota, USA
| | - Steven Z George
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Susan M Tillman
- UF Health Rehab Center at the Orthopaedics and Sports Medicine Institute, Gainesville, Florida, USA
| | - Michael W Moser
- Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Trevor A Lentz
- UF Health Rehab Center at the Orthopaedics and Sports Medicine Institute, Gainesville, Florida, USA
| | - Peter A Indelicato
- Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Troy N Trumble
- Veterinary Population Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonathan J Shuster
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida, USA
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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255
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Forsdyke D, Smith A, Jones M, Gledhill A. Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. Br J Sports Med 2016; 50:537-44. [DOI: 10.1136/bjsports-2015-094850] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 11/08/2015] [Indexed: 01/12/2023]
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256
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Howard JS, Lembach ML, Metzler AV, Johnson DL. Rates and Determinants of Return to Play After Anterior Cruciate Ligament Reconstruction in National Collegiate Athletic Association Division I Soccer Athletes: A Study of the Southeastern Conference. Am J Sports Med 2016; 44:433-9. [PMID: 26637285 DOI: 10.1177/0363546515614315] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Factors and details regarding return to play in elite, collegiate female soccer athletes after an anterior cruciate ligament (ACL) injury and reconstruction have not been well studied. PURPOSE To evaluate return to play among collegiate female soccer players, specifically examining the effect of surgical and individual athlete characteristics on the return-to-play rate. STUDY DESIGN Descriptive epidemiology study. METHODS Sports medicine and athletic training staff at institutions from the National Collegiate Athletic Association Southeastern Conference (SEC) were contacted to request participation in the study. All institutions were sent a standardized spreadsheet with response choices and instructions regarding athlete inclusion criteria. Athlete, injury, surgical technique, and return-to-play data were requested for ACL reconstructions performed on female soccer athletes at the participating institutions over the previous 8 years. χ(2) analyses were used to compare the return-to-play rate by year in school, scholarship status, position, depth chart status, procedure, graft type, graft fixation, concomitant procedures, and previous ACL injuries. RESULTS All 14 of the SEC institutions chose to participate and provided data. A total of 80 ACL injuries were reported, with 79 surgical reconstructions and return-to-play data for 78 collegiate soccer athletes. The overall return-to-play rate was 85%. There was a statistical significance in return-to-play rates favoring athletes in earlier years of eligibility versus later years (P < .001). Athletes in eligibility years 4 and 5 combined had a return-to-play rate of only 40%. Scholarship status likewise showed significance (P < .001), demonstrating a higher return-to-play rate for scholarship athletes (91%) versus nonscholarship athletes (46%). No significant differences in return-to-play rates were observed based on surgical factors, including concomitant knee procedures, graft type, and graft fixation method. CONCLUSION Collegiate female soccer athletes have a high initial return-to-play rate. Undergoing ACL reconstruction earlier in the college career as well as the presence of a scholarship had a positive effect on return to play. Surgical factors including graft type, fixation method, tunnel placement technique, concomitant knee surgeries, and revision status demonstrated no significant effect on the return-to-play rate.
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Affiliation(s)
- Jennifer S Howard
- Appalachian State University, Boone, North Carolina, USA University of Kentucky, Lexington, Kentucky, USA
| | | | - Adam V Metzler
- Commonwealth Orthopaedic Centers, Edgewood, Kentucky, USA
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257
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Fältström A, Hägglund M, Kvist J. Factors associated with playing football after anterior cruciate ligament reconstruction in female football players. Scand J Med Sci Sports 2015; 26:1343-1352. [DOI: 10.1111/sms.12588] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 12/24/2022]
Affiliation(s)
- A. Fältström
- Department of Physiotherapy; Ryhov County Hospital; Jönköping Sweden
- Division of Physiotherapy; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - M. Hägglund
- Division of Physiotherapy; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - J. Kvist
- Division of Physiotherapy; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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258
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Tjong VK, Devitt BM, Murnaghan ML, Ogilvie-Harris DJ, Theodoropoulos JS. A Qualitative Investigation of Return to Sport After Arthroscopic Bankart Repair: Beyond Stability. Am J Sports Med 2015; 43:2005-11. [PMID: 26078450 DOI: 10.1177/0363546515590222] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic shoulder stabilization is known to have excellent functional results, but many patients do not return to their preinjury level of sport, with return to play rates reported between 48% and 100% despite good outcome scores. PURPOSE To understand specific subjective psychosocial factors influencing a patient's decision to return to sport after arthroscopic shoulder stabilization. STUDY DESIGN Case series; Level of evidence, 4. METHODS Semistructured qualitative interviews were conducted with patients aged 18 to 40 years who had undergone primary arthroscopic shoulder stabilization and had a minimum 2-year follow-up. All patients participated in sport before surgery without any further revision operations or shoulder injuries. Qualitative data analysis was performed in accordance with the Strauss and Corbin theory to derive codes, categories, and themes. Preinjury and current sport participation was defined by type, level of competition, and the Brophy/Marx shoulder activity score. Patient-reported pain and shoulder function were also obtained. RESULTS A total of 25 patients were interviewed, revealing that fear of reinjury, shifts in priority, mood, social support, and self-motivation were found to greatly influence the decision to return to sport both in patients who had and had not returned to their preinjury level of play. Patients also described fear of sporting incompetence, self-awareness issues, recommendations from physical therapists, and degree of confidence as less common considerations affecting their return to sport. CONCLUSION In spite of excellent functional outcomes, extrinsic and intrinsic factors such as competing interests, kinesiophobia, age, and internal stressors and motivators can have a major effect on a patient's decision to return to sport after arthroscopic shoulder stabilization. The qualitative methods used in this study provide a unique patient-derived perspective into postoperative recovery and highlight the necessity to recognize and address subjective and psychosocial factors rather than objective functional outcome scores alone as contributing to a patient's decision to return to play.
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Affiliation(s)
- Vehniah K Tjong
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada Orthopaedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Brian M Devitt
- Orthopaedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - M Lucas Murnaghan
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada Orthopaedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada Women's College Hospital, Toronto, Ontario, Canada The Hospital for Sick Children, Toronto, Ontario, Canada Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Darrell J Ogilvie-Harris
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada Orthopaedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada Women's College Hospital, Toronto, Ontario, Canada Toronto Western Hospital, Toronto, Ontario, Canada
| | - John S Theodoropoulos
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada Orthopaedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada Women's College Hospital, Toronto, Ontario, Canada Mount Sinai Hospital, Toronto, Ontario, Canada
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259
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Ardern CL. Anterior Cruciate Ligament Reconstruction-Not Exactly a One-Way Ticket Back to the Preinjury Level: A Review of Contextual Factors Affecting Return to Sport After Surgery. Sports Health 2015; 7:224-30. [PMID: 26131299 PMCID: PMC4482306 DOI: 10.1177/1941738115578131] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CONTEXT A recently updated meta-analysis of return-to-sport rates after anterior cruciate ligament (ACL) reconstruction demonstrated that 65% of athletes returned to their preinjury level of sport after surgery. The aim of this clinical review was to explore contextual factors associated with returning or not returning to the preinjury level after ACL reconstruction. EVIDENCE ACQUISITION Data were obtained from peer-reviewed literature via a search of the electronic databases Medline, Embase, CINAHL, and SPORTDiscus from database inception to January 2015. The keywords anterior cruciate ligament and return to sport were used. Additional literature was identified via hand-searching of the reference lists of relevant articles and the ePublication lists of key scientific journals. Random effects meta-analyses were used to pool the results of modifiable contextual factors and to examine their association with returning or not returning to the preinjury level of sport after surgery. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 2. RESULTS Lower fear of reinjury (standardized mean difference, 0.7), greater psychological readiness to return to sport (standardized mean difference, 1.0), and a more positive subjective assessment of knee function (standardized mean difference, 0.9) favored return to the preinjury level after surgery. CONCLUSION Returning or not returning to the preinjury level after ACL reconstruction is complex and multifactorial. Screening for potentially modifiable contextual factors, particularly psychological factors, early after ACL injury may help clinicians identify athletes who could be at risk of not returning to the preinjury level of sport and institute interventions that could improve returning to sport.
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Affiliation(s)
- Clare L Ardern
- Linköping University, Linköping, Sweden ; La Trobe University, Melbourne, Victoria, Australia
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260
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Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: a prospective follow-up of physical function and psychological factors in 122 athletes. Am J Sports Med 2015; 43:848-56. [PMID: 25583757 DOI: 10.1177/0363546514563282] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A return to their preinjury level of sport is frequently expected within 1 year after anterior cruciate ligament (ACL) reconstruction, yet up to two-thirds of athletes may not have achieved this milestone. The subsequent sports participation outcomes of athletes who have not returned to their preinjury level sport by 1 year after surgery have not previously been investigated. PURPOSE To investigate return-to-sport rates at 2 years after surgery in athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS A consecutive cohort of competitive- and recreational-level athletes was recruited prospectively before undergoing ACL reconstruction at a private orthopaedic clinic. Participants were followed up at 1 and 2 years after surgery with a sports activity questionnaire that collected information regarding returning to sport, sports participation, and psychological responses. An independent physical therapist evaluated physical function at 1 year using hop tests and the International Knee Documentation Committee knee examination form and subjective knee evaluation. RESULTS A group of 122 competitive- and recreational-level athletes who had not returned to their preinjury level sport at 1 year after ACL reconstruction participated. Ninety-one percent of the athletes returned to some form of sport after surgery. At 2 years after surgery, 66% were playing sport, with 41% playing their preinjury level of sport and 25% playing a lower level of sport. Having a previous ACL reconstruction to either knee, poorer hop-test symmetry and subjective knee function, and more negative psychological responses were associated with not playing the preinjury level sport at 2 years. CONCLUSION Most athletes who were not playing sport at 1 year had returned to some form of sport within 2 years after ACL reconstruction, which may suggest that athletes can take longer than the clinically expected time of 1 year to return to sport. However, only 2 of every 5 athletes were playing their preinjury level of sport at 2 years after surgery. When the results of the current study were combined with the results of athletes who had returned to sport at 1 year, the overall rate of return to the preinjury level sport at 2 years was 60%. Demographics, physical function, and psychological factors were related to playing the preinjury level sport at 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial.
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Affiliation(s)
- Clare L Ardern
- School of Allied Health, La Trobe University, Melbourne, Australia Division of Physiotherapy, Linköping University, Linköping, Sweden
| | | | - Julian A Feller
- School of Allied Health, La Trobe University, Melbourne, Australia OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia
| | | | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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