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Alashram AR, D'Onofrio R, Sannicandro I, Manzi V, Padua E, Youssef T, Annino G. Return to training in soccer players after anterior cruciate ligament reconstruction: reflections and considerations. J Sports Med Phys Fitness 2024; 64:578-587. [PMID: 38324269 DOI: 10.23736/s0022-4707.23.15448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
This clinical and rehabilitative overview focuses on the return to unrestricted sporting activity, aiming to consolidate the scientific evidence surrounding the structural progression of athletes, particularly footballers, undergoing anterior cruciate ligament reconstruction (ACLR). A multidisciplinary approach necessitates a shared language and standardized methodologies. Unfortunately, significant disparities persist in the structural strategies guiding the decision-making process for returning to on-field activities, the latter stages of rehabilitation, and subsequent restoration of technical and tactical football abilities. Divergences in definitions, terminologies, and rehabilitation protocols can substantially influence final outcomes. Presently, scientific consensus studies regarding the decision-making process during the final stages of on-field rehabilitation are lacking. Nevertheless, this overview outlines and defines pivotal language parameters crucial for effective communication and the seamless integration of clinical and rehabilitative data among the diverse professionals involved in facilitating the athlete's return to peak performance. In conclusion, the successful resumption of competitive sporting activities for footballer's post ACLR demands a collaborative decision-making approach encompassing various professionals. Additionally, it necessitates a cohesive transition from rehabilitation to on-field work, aiming at reinstating athleticism, technical prowess, and tactical acumen.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan -
- Applied Science Research Center, Applied Science Private University, Amman, Jordan -
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy -
| | - Rosario D'Onofrio
- Medical-Scientific Multidisciplinary Commission, Italian Football Doctors Association, L.A.M.I.CA., Rome, Italy
| | - Italo Sannicandro
- Experimental and Clinical Department, University of Foggia, Foggia, Italy
| | - Vincenzo Manzi
- Department of Humanities Science, Pegaso Open University, Naples, Italy
| | - Elvira Padua
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Tarek Youssef
- Department of Physiotherapy, Middle East University, Amman, Jordan
| | - Giuseppe Annino
- Center of Space Bio-Medicine, Department of Medicine Systems, Tor Vergata University, Rome, Italy
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2
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Lin YC, Chen YJ, Fan TY, Chou PH, Lu CC. Effect of bone marrow aspiration concentrate and platelet-rich plasma combination in anterior cruciate ligament reconstruction: a randomized, prospective, double-blinded study. J Orthop Surg Res 2024; 19:4. [PMID: 38169406 PMCID: PMC10763110 DOI: 10.1186/s13018-023-04512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The effect of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) combination in enhancing graft maturation and tendon-bone tunnel interfacial healing after anterior cruciate ligament (ACL) reconstruction remains unclear. We hypothesised that BMAC and PRP combination could lead to better clinical results and better graft maturation/interface healing than PRP alone or conventional ACL reconstruction without any other biologic augmentation. METHODS In this randomised double-blind prospective study, patients undergoing ACL reconstruction surgery were randomly assigned into three groups: (1) control group (without any biologic augmentation), (2) PRP treatment group, and (3) combined BMAC and PRP (BMAC + PRP) group. Moreover, they were evaluated using the clinical functional score, laxity examination, and magnetic resonance imaging (MRI) analysis. RESULTS No significant difference was observed in the improvement of functional scores among groups. However, laxity improvement at 24 weeks showed a significant difference with the BMAC + PRP group having the lowest laxity. MRI analysis showed no significant change in whole graft maturation among groups. In particular, the BMAC + PRP group showed delayed signal peak and higher graft signal at 24 weeks compared with the other two groups; however, the difference was not significant. With regard to tendon-bone interfacial healing, the BMAC + PRP group showed significantly wider tendon-bone interface in the femoral bone tunnel at 24 weeks compared with the other two groups. Moreover, the BMAC + PRP group showed significantly higher peri-tunnel edema signal in the femoral bone tunnel at 12 weeks compared with the other two groups. CONCLUSION PRP alone and BMAC and PRP combination showed limited enhancing effect in clinical function, graft maturation and tendon-bone interfacial healing compared with control (no additional treatment). When BMAC is used in ACL reconstruction, the possibility of greater inflammation in the early stage to graft maturation and bone tunnel healing should be considered.
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Affiliation(s)
- Yu-Chuan Lin
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Jen Chen
- Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tsang-Yu Fan
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Hsi Chou
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Chang Lu
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Orthopaedic Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Evidence-Based Practice Should Supersede Evidence-Based Medicine Through Consideration of Clinical Experience and Patient Characteristics in Addition to the Published Literature. Arthroscopy 2023; 39:903-907. [PMID: 36872029 DOI: 10.1016/j.arthro.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 03/07/2023]
Abstract
On the surface, the benefits of evidence-based medicine (EBM) seem self-evident. However, reliance on the scientific literature alone has limitations. Studies may be biased, statistically fragile, and/or not reproducible. Reliance solely on EBM may ignore physician clinical experience and individual patient characteristics and input. Reliance solely on EBM may overvalue quantitative, statistical significance, resulting in a false sense of certainty. Reliance solely on EBM may fail to consider lack of generalizability of published studies to individually unique patients. The concept of evidence-based practice goes beyond EBM and incorporates (1) EBM, (2) clinical expertise, and (3) individual patient characteristics, values, and preferences. Even if branded as evidence-based, a suggested treatment may not be the best treatment. Evidence-based practice must be considered before determining what is best for our patients.
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Lu CC, Ho CJ, Chen SJ, Liu ZM, Chou PPH, Ho ML, Tien YC. Anterior cruciate ligament remnant preservation attenuates apoptosis and enhances the regeneration of hamstring tendon graft. Bone Joint Res 2023; 12:9-21. [PMID: 36617435 PMCID: PMC9872040 DOI: 10.1302/2046-3758.121.bjr-2021-0434.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIMS The effects of remnant preservation on the anterior cruciate ligament (ACL) and its relationship with the tendon graft remain unclear. We hypothesized that the co-culture of remnant cells and bone marrow stromal cells (BMSCs) decreases apoptosis and enhances the activity of the hamstring tendons and tenocytes, thus aiding ACL reconstruction. METHODS The ACL remnant, bone marrow, and hamstring tendons were surgically harvested from rabbits. The apoptosis rate, cell proliferation, and expression of types I and III collagen, transforming growth factor-β (TGF-β), vascular endothelial growth factor (VEGF), and tenogenic genes (scleraxis (SCX), tenascin C (TNC), and tenomodulin (TNMD)) of the hamstring tendons were compared between the co-culture medium (ACL remnant cells (ACLRCs) and BMSCs co-culture) and control medium (BMSCs-only culture). We also evaluated the apoptosis, cell proliferation, migration, and gene expression of hamstring tenocytes with exposure to co-culture and control media. RESULTS Compared to BMSCs-only culture medium, the co-culture medium showed substantially decreased early and late apoptosis rates, attenuation of intrinsic and extrinsic apoptotic pathways, and enhanced proliferation of the hamstring tendons and tenocytes. In addition, the expression of collagen synthesis, TGF-β, VEGF, and tenogenic genes in the hamstring tendons and tenocytes significantly increased in the co-culture medium compared to that in the control medium. CONCLUSION In the presence of ACLRCs and BMSCs, the hamstring tendons and tenocytes significantly attenuated apoptosis and enhanced the expression of collagen synthesis, TGF-β, VEGF, and tenogenic genes. This in vitro study suggests that the ACLRCs mixed with BMSCs could aid regeneration of the hamstring tendon graft during ACL reconstruction.Cite this article: Bone Joint Res 2023;12(1):9-21.
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Affiliation(s)
- Cheng-Chang Lu
- Department of Orthopedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan,Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Jung Ho
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan,Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Jung Chen
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan,Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zi-Miao Liu
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Paul P-H. Chou
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Ling Ho
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan,Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Physiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yin-Chun Tien
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Yin-Chun Tien. E-mail:
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Halvorsen KC, Marx RG, Wolfe I, Taber C, Jivanelli B, Pearle AD, Ling DI. Higher Adherence to Anterior Cruciate Ligament Injury Prevention Programs Is Associated With Lower Injury Rates: A Meta-Analysis and Meta-Regression. HSS J 2022; 19:154-162. [PMID: 37065096 PMCID: PMC10090850 DOI: 10.1177/15563316221140860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/01/2022] [Indexed: 12/23/2022]
Abstract
Background: Athletes who participate in sports that involve cutting and pivoting movements are particularly susceptible to anterior cruciate ligament (ACL) injury. Preventing this injury is the best way to combat its health consequences and costs. There may be a dose-response relationship between adherence and injury reduction. Purpose: We sought to examine whether athletes’ adherence to injury prevention programs (IPPs) is associated with reductions in ACL and lower extremity (LE) injuries. Methods: We conducted a systematic review of the PubMed, EMBASE, and Cochrane Library databases, searching for studies published between 2011 and 2021. Studies were included if they reported on the use of an ACL IPP compared with a control group and recorded the rate of injuries to calculate a rate ratio, as well as adherence to the program as a percentage of sessions performed. For the meta-analysis, the rate ratios were pooled using the DerSimonian-Laird random-effects model. Results: For the 15 studies included (11 randomized controlled trials and 4 cohort studies), the random-effects model grouped athletes’ adherence to an IPP as high (76% or more of the sessions), moderate (51%–75% of the sessions), and low (50% or fewer of the sessions). We found that athletes with the highest level of IPP adherence had a significantly lower incidence of ACL injury. The rate ratios for moderate and low adherence did not demonstrate a reduced incidence of ACL injury. Injury prevention program participation was also associated with a decrease in LE injury rates. Conclusion: This systematic review and meta-analysis found that athletes with high adherence to IPPs had reduced rates of ACL and LE injuries. Our findings suggest that educating coaches and athletes on the dose-dependent benefits of IPPs may promote the routine incorporation of these programs into warm-up sessions to decrease the risk of ACL and LE injuries.
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Affiliation(s)
- Kristin C. Halvorsen
- Sports Medicine Institute, Hospital for
Special Surgery, New York, NY, USA
- Stanford University School of Medicine,
Stanford University, Stanford, CA, USA
| | - Robert G. Marx
- Sports Medicine Institute, Hospital for
Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Weill
Cornell Medical College, New York, NY, USA
| | - Isabel Wolfe
- Sports Medicine Institute, Hospital for
Special Surgery, New York, NY, USA
| | - Caroline Taber
- Sports Medicine Institute, Hospital for
Special Surgery, New York, NY, USA
| | - Bridget Jivanelli
- Sports Medicine Institute, Hospital for
Special Surgery, New York, NY, USA
| | - Andrew D. Pearle
- Sports Medicine Institute, Hospital for
Special Surgery, New York, NY, USA
| | - Daphne I. Ling
- Sports Medicine Institute, Hospital for
Special Surgery, New York, NY, USA
- Department of Population Health
Sciences, Weill Cornell Medical College, New York, NY, USA
- Department of Medical Research and
Development, Chang Gung Memorial Hospital, Taoyuan
- Daphne I. Ling, PhD, MPH, Department of
Medical Research and Development, Chang Gung Memorial Hospital, No. 15 Wenhua
1st Road, Guishan, Taoyuan 333.
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Rosso F, Rossi R, Faletti R, Cantivalli A, Blonna D, Bonasia DE. Transepicondylar distance measured on MRI can predict the length of the graft required for different anterior cruciate ligament reconstruction (ACLR) techniques useful for revision surgery. J Orthop Traumatol 2022; 23:50. [PMID: 36242704 PMCID: PMC9569264 DOI: 10.1186/s10195-022-00670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study is to find a correlation between linear measurements and the graft length required for different anterior cruciate ligament (ACL) revision techniques, to extract formulas to predict required graft length during the preoperative planning. Methods At time 0 and 30 days later, two observers measured eight linear distances on standard 2D knee magnetic resonance imaging (MRI), and nine curved distances on 3D MRI sequences, corresponding to different techniques for ACL revision, anatomic anterolateral ligament (ALL) reconstruction, and lateral extrarticular tenodesis (LET). Intra- and interobserver reliability was tested for 2D and 3D measurements. The correlation between 2D and 3D measurements was tested. The 2D measurements with highest repeatability and reproducibility, and with strongest correlation with 3D measurements were used to extract formulas to calculate the graft length from 2D values. Results Fifty MRIs acquired with both 2D and 3D sequences were used. The intra- and interobserver reliability of linear 2D measurement was high, with the transepicondylar distance (TD) showing the highest reproducibility and repeatability. The intra- and interobserver reliability of 3D measurements was lower than 2D, but acceptable for all measurements except for ALL reconstruction. The TD showed the strongest correlation with 3D measurements. The formulas extracted to calculate the graft length from the TD proved to be accurate. Conclusion Accurate formulas were created to calculate the graft length needed for different ACL revision techniques and ALL reconstruction/LET techniques from TD. These formulas can be used during preoperative planning of ACL revision cases.
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Affiliation(s)
- Federica Rosso
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy. .,Università Degli Studi Di Torino, Via Po 8, 10100, Turin, Italy.
| | - Riccardo Faletti
- Department of Radiology, AOU "Città Della Salute e Della Scienza" Hospital, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Antonino Cantivalli
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
| | - Davide Blonna
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
| | - Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
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7
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Weir G. Anterior cruciate ligament injury prevention in sport: biomechanically informed approaches. Sports Biomech 2021:1-21. [PMID: 34965847 DOI: 10.1080/14763141.2021.2016925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 12/06/2021] [Indexed: 01/14/2023]
Abstract
This paper reviews a series of studies contributing to a framework for preventing anterior cruciate ligament (ACL) injuries in sport. As the majority of these injuries are non-contact in nature, theoretically, these injuries are preventable. The studies presented in this paper focus on understanding biomechanical countermeasures of ACL injury and how this knowledge can inform both screening and training intervention research and practice in sport. These countermeasures include: 1) modifying an athlete's technique to reduce externally applied loads to the knee; 2) increasing the muscle support around the knee and hip to counter elevated loads applied to the knee and; 3) improving an athlete's perception during dynamic sports tasks to increase planning time to coordinate desirable movement patterns. By furthering the empirical evidence of modifiable biomechanical countermeasures of ACL injury risk, we can better understand best practices for developing interventions on a mass scale to prevent ACL injuries in the sporting community.
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Affiliation(s)
- Gillian Weir
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA, USA
- School of Human Sciences, University of Western Australia, Perth, Australia
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Crowley SG, Swindell HW, Saltzman BM, Ahmad CS, Popkin CA, Trofa DP. Rehabilitation Variability Following Femoral Condyle and Patellofemoral Microfracture Surgery of the Knee. Cartilage 2021; 13:1801S-1813S. [PMID: 34151611 PMCID: PMC8808894 DOI: 10.1177/19476035211025818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for microfracture of femoral condyle and patellofemoral lesions of the knee. DESIGN Online postoperative microfracture rehabilitation protocols from US orthopedic programs and the scientific literature were reviewed. A custom scoring rubric was developed to analyze each protocol for the presence of discrete rehabilitation modalities and the timing of each intervention. RESULTS A total of 18 programs (11.6%) from 155 US academic orthopedic programs' published online protocols and a total of 44 protocols were analyzed. Seventeen protocols (56.7%) recommended immediate postoperative bracing for femoral condyle lesions and 17 (89.5%) recommended immediate postoperative bracing for patellofemoral lesions. The average time to permitting weight-bearing as tolerated (WBAT) was 6.1 weeks (range, 0-8) for femoral condyle lesions and 3.7 weeks (range, 0-8 weeks) for patellofemoral lesions. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. For femoral condyle lesions, 10 protocols (33.3%) recommended functional testing prior to return to sport at an average of 23.3 weeks postoperatively (range, 12-32 weeks). For patellofemoral lesions, 4 protocols (20.0%) recommended functional testing for return to sport at an average of 21.0 weeks postoperatively (range, 12-32 weeks). CONCLUSION A minority of US academic orthopedic programs publish microfracture rehabilitation protocols online. Among the protocols currently available, there is significant variability in the inclusion of specific rehabilitation components and timing of many modalities. Evidence-based standardization of elements of postoperative rehabilitation may help improve patient care and subsequent outcomes.
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Affiliation(s)
| | - Hasani W. Swindell
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | | | - Christopher S. Ahmad
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | - Charles A. Popkin
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | - David P. Trofa
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA,David P. Trofa, Department of Orthopedic
Surgery, Columbia University Medical Center, New York, NY 10032, USA.
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9
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D'Amore T, Rao S, Corvi J, Jack RA, Tjoumakaris FP, Ciccotti MG, Freedman KB. The Utility of Continuous Passive Motion After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Comparative Studies. Orthop J Sports Med 2021; 9:23259671211013841. [PMID: 34262979 PMCID: PMC8246506 DOI: 10.1177/23259671211013841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background The application of continuous passive motion (CPM) after anterior cruciate ligament reconstruction (ACLR) was popularized in the 1990s, but advancements in the understanding of ACLR rehabilitation have made the application of CPM controversial. Many sports medicine fellowship-trained surgeons report using CPM machines postoperatively. Purpose To determine the efficacy of CPM use for recovery after ACLR with respect to knee range of motion (ROM), knee swelling, postoperative pain, and postoperative complications. Study Design Systematic review; Level of evidence, 3. Methods The PubMed (MEDLINE), EMBASE, Cochrane, Cumulative Index of Nursing, and Allied Health Literature databases were searched from inception to January 1, 2020, for studies with evidence levels 1 to 3 on the use of CPM for ACLR rehabilitation. Included studies were those that comparatively evaluated postoperative outcomes after ACLR between at least 2 groups of patients, with 1 having received CPM rehabilitation and the other not having received CPM. Results A total of 12 studies from 1989 to 2019 met the inclusion criteria. These studies included 808 patients who underwent ACLR. There was no evidence of CPM improving knee stability, final postoperative ROM, or subjective pain scores. Additionally, CPM did not lead to decreased muscle atrophy or improved International Knee Documentation Committee scores. Regarding pain medication intake during postoperative hospitalization, 2 studies found that the CPM group used less pain medication, 1 study found the CPM group used more pain medication, and 1 study found that there was no difference between the 2 groups. Complications varied widely, with 2 of 12 studies reporting complications that required a return to the operating room. Conclusion A clinical benefit of postoperative CPM use after ACLR was not identified in this review. While our systematic review identified a number of studies that suggest CPM use may be associated with lower usage of pain medication in hospitalized patients, this cannot be confirmed without further investigation with standardized CPM protocols and larger sample sizes. Routine CPM use after ACLR was not supported by this systematic review.
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Affiliation(s)
- Taylor D'Amore
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Somnath Rao
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - John Corvi
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA.,Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Fotios P Tjoumakaris
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Michael G Ciccotti
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Kevin B Freedman
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
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Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, Svantesson E, Hamrin Senorski E, Hewett TE, Sherman SL, Lesniak BP, Symposium P. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. J ISAKOS 2021; 6:138-146. [PMID: 34006577 DOI: 10.1136/jisakos-2020-000495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS after ACL injury and description of the RTS continuum, as well as provide clinical guidance on RTS testing and decision-making. METHODS An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. RESULTS Key points include that RTS is characterised by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries. CONCLUSION The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biological assessment of healing and recovery.
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Affiliation(s)
- Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA .,Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Thomas Rauer
- Klinik für Traumatologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | | | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery Innsbruck, Innsbruck, Austria
| | - Theresa Diermeier
- Department of Sportorthopedic, Technical University of Munich, Munchen, Germany
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sport Trauma Research Center, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Gothenburg Sport Trauma Research Center, Gothenburg, Sweden.,Department of Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden
| | | | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford Medicine, Stanford, California, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Panther Symposium
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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11
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Lu CC, Chou SH, Shen PC, Chou PH, Ho ML, Tien YC. Extracorporeal shock wave promotes activation of anterior cruciate ligament remnant cells and their paracrine regulation of bone marrow stromal cells' proliferation, migration, collagen synthesis, and differentiation. Bone Joint Res 2020; 9:458-468. [PMID: 32832074 PMCID: PMC7418778 DOI: 10.1302/2046-3758.98.bjr-2019-0365.r1] [Citation(s) in RCA: 11] [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] [Indexed: 12/26/2022] Open
Abstract
Aims Proliferation, migration, and differentiation of anterior cruciate ligament (ACL) remnant and surrounding cells are fundamental processes for ACL reconstruction; however, the interaction between ACL remnant and surrounding cells is unclear. We hypothesized that ACL remnant cells preserve the capability to regulate the surrounding cells' activity, collagen gene expression, and tenogenic differentiation. Moreover, extracorporeal shock wave (ESW) would not only promote activity of ACL remnant cells, but also enhance their paracrine regulation of surrounding cells. Methods Cell viability, proliferation, migration, and expression levels of Collagen-I (COL-I) A1, transforming growth factor beta (TGF-β), and vascular endothelial growth factor (VEGF) were compared between ACL remnant cells untreated and treated with ESW (0.15 mJ/mm2, 1,000 impulses, 4 Hz). To evaluate the subsequent effects on the surrounding cells, bone marrow stromal cells (BMSCs)' viability, proliferation, migration, and levels of Type I Collagen, Type III Collagen, and tenogenic gene (Scx, TNC) expression were investigated using coculture system. Results ESW-treated ACL remnant cells presented higher cell viability, proliferation, migration, and increased expression of COL-I A1, TGF-β, and VEGF. BMSC proliferation and migration rate significantly increased after coculture with ACL remnant cells with and without ESW stimulation compared to the BMSCs alone group. Furthermore, ESW significantly enhanced ACL remnant cells' capability to upregulate the collagen gene expression and tenogenic differentiation of BMSCs, without affecting cell viability, TGF-β, and VEGF expression. Conclusion ACL remnant cells modulated activity and differentiation of surrounding cells. The results indicated that ESW enhanced ACL remnant cells viability, proliferation, migration, and expression of collagen, TGF-β, VEGF, and paracrine regulation of BMSC proliferation, migration, collagen expression, and tenogenesis.Cite this article: Bone Joint Res 2020;9(8):458-468.
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Affiliation(s)
- Cheng-Chang Lu
- Department of Orthopedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Hsiang Chou
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chih Shen
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Hsi Chou
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Ling Ho
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Physiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yin-Chun Tien
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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12
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Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, Svantesson E, Hamrin Senorski E, Hewett TE, Sherman SL, Lesniak BP. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Knee Surg Sports Traumatol Arthrosc 2020; 28:2403-2414. [PMID: 32347344 DOI: 10.1007/s00167-020-06009-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/16/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS and description of the RTS continuum, as well as to provide clinical guidance on RTS testing and decision-making. METHODS An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. RESULTS Key points include that RTS is characterized by achievement of the pre-injury level of sport and involves a criteria-based progression from return to participation to return to sport, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along a RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries. CONCLUSION The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biologic assessment of healing and recovery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA.
| | - Thomas Rauer
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery Innsbruck, Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), UMIT, Hall in Tirol, Austria
| | - Theresa Diermeier
- Department of Sportorthopedics, Klinikum rechts der Isar Technische Universitat Munchen, Munchen, Germany
| | - Benjamin B Rothrauff
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA
| | - Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Gothenburg Sport Trauma Research Center, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Gothenburg Sport Trauma Research Center, Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford Medicine, Stanford, CA, USA
| | - Bryson P Lesniak
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA
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13
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Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, Svantesson E, Hamrin Senorski E, Hewett TE, Sherman SL, Lesniak BP, Bizzini M, Chen S, Cohen M, Villa SD, Engebretsen L, Feng H, Ferretti M, Fu FH, Imhoff AB, Kaeding CC, Karlsson J, Kuroda R, Lynch AD, Menetrey J, Musahl V, Navarro RA, Rabuck SJ, Siebold R, Snyder-Mackler L, Spalding T, van Eck C, Vyas D, Webster K, Wilk K. Return to Sport After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Orthop J Sports Med 2020; 8:2325967120930829. [PMID: 32647735 PMCID: PMC7328222 DOI: 10.1177/2325967120930829] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022] Open
Abstract
Background A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sport and their previous activity level. Purpose The aim of the Panther Symposium ACL Injury Return to Sport Consensus Group was to provide a clear definition of RTS after ACL injury and a description of the RTS continuum as well as provide clinical guidance on RTS testing and decision-making. Study Design Consensus statement. Methods An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. Results Key points include that RTS is characterized by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS and, ultimately, return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum, with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors, and concomitant injuries. Conclusion The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing, and methods for the biological assessment of healing and recovery.
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Affiliation(s)
- Sean J Meredith
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Thomas Rauer
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Terese L Chmielewski
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christian Fink
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Theresa Diermeier
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Benjamin B Rothrauff
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eleonor Svantesson
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eric Hamrin Senorski
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Timothy E Hewett
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seth L Sherman
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryson P Lesniak
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Mario Bizzini
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shiyi Chen
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Moises Cohen
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stefano Della Villa
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lars Engebretsen
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hua Feng
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mario Ferretti
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andreas B Imhoff
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christopher C Kaeding
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jon Karlsson
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ryosuke Kuroda
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew D Lynch
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jacques Menetrey
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ronald A Navarro
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stephen J Rabuck
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rainer Siebold
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lynn Snyder-Mackler
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tim Spalding
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carola van Eck
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dharmesh Vyas
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kate Webster
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kevin Wilk
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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14
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Aydarov VI, Khasanov ER, Akhtyamov IF. [Rehabilitation program for patients after the anterior cruciate ligament of the knee plasty]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2020; 97:29-35. [PMID: 32356632 DOI: 10.17116/kurort20209702129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Arthroscopic anterior cruciate ligament (ACL) plasty is currently a standard operation that makes it possible for patients to return to an active lifestyle. Despite its high prevalence, specific programs for postoperative patient rehabilitation have not yet been developed. Traditional approaches to rehabilitation are inferior and are unable to provide a complete recovery process. The developed program is structured, easy to use and includes the use of proprietary techniques and devices that accelerate the patient recovery process. AIM Of this study was to evaluate the effectiveness of the developed author's program for the rehabilitation of patients after ACL plasty. MATERIAL AND METHODS A total of 74 patients were examined after arthroscopic plasty of ACL. The primary group included 34 patients whose rehabilitation was carried out using the developed author's program. The comparison group included 40 patients who underwent traditional unstructured rehabilitation after such an operation. Reconstructive treatment was carried out in the 1st week after surgery within the hospital, then on an outpatient basis. The control was carried out through electronic communication and patients visiting the rehabilitologist 1, 2, and 8 months after the operation. Evaluation criteria were the patient complaints, pain assessment on a visual analogue scale (VAS) and goniometry. RESULTS The final result was evaluated in 70 observations. Among the patients of the comparison group, 12 (33.3%) had pain from 2 to 6 VAS points by the end of the 1st month after surgery, and contractures were recorded in 8 (22.2%). In the primary group, only 4 (11.8%) patients during this period had pain of 3 and 4 points according to VAS, there were no restrictions on mobility. 1 month after surgery, 26 (76.5%) patients in the primary group were able to fully return to an active lifestyle and household tasks, in the comparison group 20 (55.5%) patients experienced difficulties in doing housework and returned to full activity only 3-5 months later. CONCLUSION The developed rehabilitation program has shown its effectiveness compared to the standard one. It is convenient to use and may be recommended for patients after ACL plastic surgery both at the inpatient and outpatient stages of rehabilitation.
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Affiliation(s)
- V I Aydarov
- Republican Clinical Hospital, Kazan, Republic of Tatarstan, Russia
| | - E R Khasanov
- Kazan State Medical University, Kazan, Republic of Tatarstan, Russia
| | - I F Akhtyamov
- Kazan State Medical University, Kazan, Republic of Tatarstan, Russia
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15
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The relationship between knee muscle strength and knee biomechanics during running at 6 and 12 months after anterior cruciate ligament reconstruction. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2019; 16:14-18. [PMID: 30984558 PMCID: PMC6445434 DOI: 10.1016/j.asmart.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/12/2018] [Accepted: 11/20/2018] [Indexed: 11/20/2022]
Abstract
Background Knee joint kinematics and kinetics during running recover at 12 months, not 6 months, following anterior cruciate ligament (ACL) reconstruction surgery. Knee muscle strength is a criterion used to assess an individual's readiness to return-to-sports (RTS); however, the relationship between knee muscle strength and knee biomechanics is unclear. This study investigated the relationship between knee muscle strength and dynamic knee biomechanics during running at 6 and 12 months after ACL reconstruction surgery. Methods Knee joint kinematics and kinetics during running were analyzed in 21 patients (10 males, 11 females) who underwent ACL reconstruction for a unilateral ACL deficiency. Kinematics and Kinetics were measured by three-dimensional motion analysis system, and Knee flexion angle was calculated using Point cluster technique and internal extension moment was calculated by the inverse dynamics method. Patients were compared to a control group matched by age, height and weight. Isokinetic knee extension and flexion strength in ACL-reconstructed patients were measured at 6 and 12 months postsurgery, by separated gender. Results Knee flexion angle was significantly lower in ACL patients at 6 months postsurgery compared to the control group (F (2, 62)=5.78, P=0.014). There were significant lower peak knee flexion angles in male groups than female (F (1, 62)=6.33, P<0.01). Knee extension moments were significantly lower in both male and female ACL patients compared to the control group at 6 and 12 months postsurgery (F (2, 62)=12.05, P<0.01(6 months), P=0.034(12 months)), and there were significant correlations with knee extension moments and maximum torque of knee extension/flexion (P<0.05). At 12 months after surgery, knee joint kinematics in ACL patients were restored. Both peak knee angle and knee extension moment were significantly associated with maximum knee extension/flexion torque values in female patients at 12 months postsurgery. Conclusions Dynamic knee biomechanics during running were not restored 6 and 12 months after ACL reconstruction both male and female. It is necessary to strengthen knee extension and flexion muscles to restore knee kinetics during running, especially female patients.
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