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Niederer D, Keller M, Schüttler KF, Schoepp C, Petersen W, Best R, Mengis N, Mehl J, Krause M, Jakob S, Wießmeier M, Vogt L, Pinggera L, Guenther D, Ellermann A, Efe T, Groneberg DA, Behringer M, Stein T. Late-stage rehabilitation after anterior cruciate ligament reconstruction: A multicentre randomised controlled trial (PReP). Ann Phys Rehabil Med 2024; 67:101827. [PMID: 38479249 DOI: 10.1016/j.rehab.2024.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/01/2023] [Accepted: 12/26/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND At the completion of formal rehabilitation after anterior cruciate ligament reconstruction, functional capacity is only restored in a small proportion of affected individuals. Therefore, the end of formal rehabilitation is not the end of functional rehabilitation. OBJECTIVE To compare adherence to and effectiveness of a late-stage rehabilitation programme with usual care after anterior cruciate ligament (ACL) reconstruction. METHODS This prospective, double-blind, multicentre, parallel group, randomised controlled trial, included people aged 18 to 35 years after formal rehabilitation completion (mean [SD] 241 [92] days post-reconstruction). Participants were block-randomised to a 5-month neuromuscular performance intervention (Stop-X group) or usual care (medically prescribed standard physiotherapy, individual formal rehabilitation, home-exercises). All outcomes were measured once/month. Primary outcome was the normalised knee separation distance on landing after drop jump. Baseline-adjusted linear mixed models were calculated. RESULTS In total, 112 participants (Stop-X: 57; Usual care: 55,) were analysed. Initially, mean (SD) intervention frequency (units/week) was higher in the Stop-X than the Usual care group: 2.65 (0.96) versus 2.48 (1.14) units/week in the first and 2.28 (1.02) versus 2.14 (1.31) units/week in the second month. No between-group*time(*baseline)-differences were found for the primary outcome. Between-group*time-effects favoured the Stop-X-group at 2 months (fewer self-reported knee problems during sport, KOOS-SPORT) (estimate = 64.3, 95 % CI 24.4-104.3 for the Stop-X), more confidence to return to sport (ACL-RSI) (62.4, 10.7-114.2), fewer pain-associated knee problems (KOOS-PAIN) (82.8, 36.0-129.6), improved everyday activity abilities (KOOS-ADL) (71.1, 6.4-135.7), and improved limb symmetry index in the front hop for distance at 3 and 4 months (0.34, 0.10-0.57; 0.31, 0.08-0.54). No between-group*time-effects occurred for kinesiophobia, symptom-associated knee problems or balance hops performance. At the end of the intervention, 79 % of the Stop-X and 70 % of the Usual care participants (p < 0.05) had successfully returned to their pre-injury sport type and level. CONCLUSIONS The Stop-X intervention was slightly superior to usual care as part of late-stage rehabilitation after ACL-reconstruction. The small benefit might justify its use after formal rehabilitation completion.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Germany; Department of Movement and Training Science, Faculty of Humanities and Social Sciences, Institute of Sport Science, University of Wuppertal, Wuppertal, Germany.
| | | | | | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum Duisburg gGmbH, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | - Raymond Best
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | | | - Julian Mehl
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Jakob
- Department of Sport Science, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Max Wießmeier
- Department of Sport Science, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sport Science, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Lucia Pinggera
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Germany
| | - Andree Ellermann
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - Turgay Efe
- OSINSTITUT ortho & sport, Munich, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Germany
| | - Michael Behringer
- Department of Sport Science, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Stein
- Department of Sport Science, Goethe University Frankfurt, Frankfurt am Main, Germany; SPORTHOLOGICUM Frankfurt - Center for Sport and Joint injuries, Frankfurt am Main, Germany
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Niederer D, Keller M, Wießmeier M, Vogt L, Stöhr A, Schüttler KF, Schoepp C, Petersen W, Pinggera L, Mengis N, Mehl J, Krause M, Janko M, Guenther D, Engeroff T, Ellermann A, Efe T, Best R, Groneberg DA, Behringer M, Stein T. The End of the Formal Rehabilitation Is Not the End of Rehabilitation: Knee Function Deficits Remain After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2024; 33:88-98. [PMID: 38176405 DOI: 10.1123/jsr.2023-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/20/2023] [Accepted: 10/22/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To rate athletes' functional ability and return to sport (RTS) success at the end of their individual, formal, medically prescribed rehabilitation after anterior anterior cruciate ligament (ACL) reconstruction. METHODS In our prospective multicenter cohort study, 88 (42 females) adults aged 18-35 years after acute unilateral ACL rupture and subsequent hamstring grafting were included. All patients were prospectively monitored during their rehabilitation and RTS process until the end of their formal rehabilitation and RTS release. As outcome measures, functional hop and jump tests (front hop, balance hops, and drop jump screening test) and self-report outcomes (Knee Injury and Osteoarthritis Outcome Score, ACL-RTS after injury) were assessed. Literature-based cut-off values were selected to rate each performance as fulfilled or not. RESULTS At 7.5 months (SD 2.3 months) after surgery, the percentage of participants meeting the functional thresholds ranged from 4% (Knee Injury and Osteoarthritis Outcome Score SPORT) and over 44% (ACL-RTS after injury sum score) to 59% (Knee Injury and Osteoarthritis Outcome Score activities of all daily living) in the self-report and from 29% (Balance side hop) to 69% (normalized knee separation distance) in performance testing. Only 4% fulfilled all the cut-offs, while 45% returned to the same type and level of sport. Participants who successfully returned to their previous sport (type and level) were more likely to be "over-cut-off-performers." CONCLUSIONS The low share of the athletes who fulfilled the functional RTS criteria highlights the importance of continuing the rehabilitation measures after the formal completion to assess the need for and success of, inter alia, secondary-preventive therapies.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Max Wießmeier
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | | | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum Duisburg gGmbH, Duisburg, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | - Lucia Pinggera
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | | | - Julian Mehl
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maren Janko
- Department of Trauma, Hand, and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Daniel Guenther
- Department of Orthopedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Witten, Germany
| | - Tobias Engeroff
- Division Health and Performance, Goethe University Frankfurt, Institute of Occupational, Social and Environmental Medicine, Frankfurt am Main, Germany
| | | | - Turgay Efe
- Orthopaedicum Lich Giessen, Lich, Germany
| | - Raymond Best
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Michael Behringer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Stein
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
- SPORTHOLOGICUM Frankfurt-Center for Sport and Joint injuries, Frankfurt am Main, Germany
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Niederer D, Keller M, Jakob S, Petersen W, Mengis N, Vogt L, Guenther D, Brandl G, Drews BH, Behringer M, Groneberg DA, Stein T. Quadriceps and hamstring anterior cruciate ligament reconstruction differ only marginally in function after the rehabilitation: a propensity score-matched case-control study. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07422-y. [PMID: 37120794 PMCID: PMC10149044 DOI: 10.1007/s00167-023-07422-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To determine potential quadriceps versus hamstring tendon autograft differences in neuromuscular function and return to sport (RTS)-success in participants after an anterior cruciate ligament (ACL) reconstruction. METHODS Case-control study on 25 participants operated on with an arthroscopically assisted, anatomic ipsilateral quadriceps femoris tendon graft and two control groups of 25 participants each, operated on with a semitendinosus tendon or semitendinosus-gracilis (hamstring) tendon graft ACL reconstruction. Participants of the two control groups were propensity score matched to the case group based on sex, age, Tegner activity scale and either the total volume of rehabilitation since reconstruction (n = 25) or the time since reconstruction (n = 25). At the end of the rehabilitation (averagely 8 months post-reconstruction), self-reported knee function (KOOS sum scores), fear of loading the reconstructed knee during a sporting activity (RSI-ACL questionnaire), and fear of movement (Tampa scale of kinesiophobia) were followed by hop and jump tests. Front hops for distance (jumping distance as the outcome) were followed by Drop jumps (normalised knee joint separation distance), and concluded by qualitative ratings of the Balanced front and side hops. Between-group comparisons were undertaken using 95% confidence intervals comparisons, effect sizes were calculated. RESULTS The quadriceps case group (always compared with the rehabilitation-matched hamstring graft controls first and versus time-matched hamstring graft controls second) had non-significant and only marginal higher self-reported issues during sporting activities: Cohen's d = 0.42, d = 0.44, lower confidence for RTS (d = - 0.30, d = - 0.16), and less kinesiophobia (d = - 0.25, d = 0.32). Small and once more non-significant effect sizes point towards lower values in the quadriceps graft groups in the Front hop for distance limb symmetry values in comparison to the two hamstring control groups (d = - 0.24, d = - 0.35). The normalised knee joint separation distance were non-significantly and small effect sized higher in the quadriceps than in the hamstring groups (d = 0.31, d = 0.28). CONCLUSION Only non-significant and marginal between-graft differences in the functional outcomes at the end of the rehabilitation occurred. The selection of either a hamstring or a quadriceps graft type cannot be recommended based on the results. The decision must be undertaken individually. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany.
| | | | - Sarah Jakob
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | - Natalie Mengis
- Arcus Sportklinik, Pforzheim, Germany
- KSA Aarau/Spital Zofingen, Aarau, Switzerland
- University Hospital, Basel, Switzerland
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Witten, Germany
| | - Georg Brandl
- Department of Orthopaedic Surgery II, Herz-Jesu Krankenhaus, Vienna, Austria
| | | | - Michael Behringer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Stein
- SPORTHOLOGICUM Frankfurt-Center for Sport and Joint Injuries, Frankfurt am Main, Germany
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
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Niederer D, Mengis N, Wießmeier M, Keller M, Petersen W, Ellermann A, Drenck T, Schoepp C, Stöhr A, Fischer A, Achtnich A, Best R, Pinggera L, Krause M, Guenther D, Janko M, Kittl C, Efe T, Schüttler KF, Vogt L, Behringer M, Stein T. Contributors to self-report motor function after anterior cruciate ligament reconstruction. Sci Rep 2023; 13:3073. [PMID: 36813953 PMCID: PMC9947165 DOI: 10.1038/s41598-023-30291-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Numerous functional factors may interactively contribute to the course of self-report functional abilities after anterior cruciate ligament (ACL)-reconstruction. This study purposes to identify these predictors using exploratory moderation-mediation models in a cohort study design. Adults with post unilateral ACL reconstruction (hamstring graft) status and who were aiming to return to their pre-injury type and level of sport were included. Our dependent variables were self-reported function, as assessed by the the KOOS subscales sport (SPORT), and activities of daily living (ADL). The independent variables assessed were the KOOS subscale pain and the time since reconstruction [days]. All other variables (sociodemographic, injury-, surgery-, rehabilitation-specific, kinesiophobia (Tampa Scale of Kinesiophobia), and the presence or absence of COVID-19-associated restrictions) were further considered as moderators, mediators, or co-variates. Data from 203 participants (mean 26 years, SD 5 years) were finally modelled. Total variance explanation was 59% (KOOS-SPORT) and 47% (KOOS-ADL). In the initial rehabilitation phase (< 2 weeks after reconstruction), pain was the strongest contributor to self-report function (KOOS-SPORT: coefficient: 0.89; 95%-confidence-interval: 0.51 to 1.2 / KOOS-ADL: 1.1; 0.95 to 1.3). In the early phase (2-6 weeks after reconstruction), time since reconstruction [days] was the major contributor (KOOS-SPORT: 1.1; 0.14 to 2.1 / KOOS-ADL: 1.2; 0.43 to 2.0). Starting with the mid-phases of the rehabilitation, self-report function was no longer explicitly impacted by one or more contributors. The amount of rehabilitation [minutes] is affected by COVID-19-associated restrictions (pre-versus-post: - 672; - 1264 to - 80 for SPORT / - 633; - 1222 to - 45 for ADL) and by the pre-injury activity scale (280; 103 to 455 / 264; 90 to 438). Other hypothesised contributors such as sex/gender or age were not found to mediate the time or pain, rehabilitation dose and self-report function triangle. When self-report function is rated after an ACL reconstruction, the rehabilitation phases (early, mid, late), the potentially COVID-19-associated rehabilitation limitations, and pain intensity should also be considered. As, for example, pain is the strongest contributor to function in the early rehabilitation phase, focussing on the value of the self-report function only may, consequently, not be sufficient to rate bias-free function.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt, Germany.
| | | | - Max Wießmeier
- grid.7839.50000 0004 1936 9721Institute of Occupational, Social and Environmental Medicine, Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487 Frankfurt, Germany
| | | | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | | | | | - Christian Schoepp
- grid.491667.b0000 0004 0558 376XBerufsgenossenschaftliche Unfallklinik Duisburg, Duisburg, Germany
| | | | - Andreas Fischer
- grid.5252.00000 0004 1936 973XDepartment of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Andrea Achtnich
- grid.15474.330000 0004 0477 2438Department for Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Raymond Best
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - Lucia Pinggera
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - Matthias Krause
- grid.13648.380000 0001 2180 3484Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Guenther
- grid.412581.b0000 0000 9024 6397Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Witten, Germany
| | - Maren Janko
- grid.7839.50000 0004 1936 9721Department of Trauma, Hand, and Reconstructive Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christoph Kittl
- grid.16149.3b0000 0004 0551 4246Universitätsklinikum Münster, Munster, Germany
| | - Turgay Efe
- Orthopaedicum Lich Giessen, Lich, Germany
| | | | - Lutz Vogt
- grid.7839.50000 0004 1936 9721Department of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Michael Behringer
- grid.7839.50000 0004 1936 9721Department of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas Stein
- SPORTHOLOGICUM Frankfurt - Center for Sport and Joint Injuries, Frankfurt, Germany ,grid.7839.50000 0004 1936 9721Department of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
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Championship interseason period did not reduce knee peak moment: A 10-years retrospective study of 467 elite soccer players. BIOMEDICAL HUMAN KINETICS 2022. [DOI: 10.2478/bhk-2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Study aim: To compare knee moment profiles of professional soccer players from different playing positions before and after an interseason period.
Material and methods: Retrospective study of 467 healthy, professional elite Brazilian soccer players before and after an official championship interseason period during 10-years. Main outcome measures were isokinetic peak moment from knee extensors and flexors from concentric and eccentric contractions. A Two-way ANOVA analysis was used to compare each playing position before and after interseason period.
Results: It was found no statistical difference in Ext.CPT (from p = 0.11 to p = 0.97), Ext.EPT (from p = 0.07 to p = 0.85), Flx. CPT (from p = 0.14 to p = 0.90) or Flx.EPT (from p = 0.10 to p = 0.91) between End-Season and Pre-Season evaluations for all playing positions (from Goalkeepers, Defenders, Backsiders, Midfielders and Forwards).
Conclusions: Isokinetic peak moment did not have significant differences after an interseason period of 4 to 6 weeks, allowing trainers and coaches to focus their pre-season period on other performance concerns than strengthening.
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Niederer D, Giesche F, Janko M, Niemeyer P, Wilke J, Engeroff T, Stein T, Frank J, Banzer W, Vogt L. Unanticipated jump-landing quality in patients with anterior cruciate ligament reconstruction: How long after the surgery and return to sport does the re-injury risk factor persist? Clin Biomech (Bristol, Avon) 2020; 72:195-201. [PMID: 31901699 DOI: 10.1016/j.clinbiomech.2019.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/05/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inadequate reactions to unforeseen external stimuli are regarded as a major cause for non-contact anterior cruciate ligament (ACL) injuries. We aimed to delineate a potential deficit in the ability to perform unanticipated jump-landing manoeuvres, its sustainability and potential as a new outcome measure after ACL-reconstruction. METHODS Physically active adults (n = 27, 13 females, 14 males, 29.7 standard deviation 3.1 years) with a history of unilateral ACL rupture and subsequent reconstruction (6 months to 7 years ago), cleared for return to sports, were included. All participants performed counter-movement jumps with unanticipated single leg landings. Visual information shown after jump take-off indicated the required landing leg. Jump time [s] and successfulness [yes/no], vertical peak ground reaction forces at landing [N], as well as time to stabilisation after landing [s] and path length of the centre of pressure (CoP, [mm]) were calculated. Limb symmetry ratios were determined and analysed for their association with the time since surgery. FINDINGS Time since ACL reconstruction was logarithmically (basis 10) associated with side symmetry improvements in peak ground reaction force (R2 = 0.23, p < .01) and time to stabilisation (R2 = 0.18, p < .01) during and after landing in unanticipated/unpredictable single-leg jump landing tasks. The asymmetry found persists up to 18-26 months post-surgery. INTERPRETATION A deficit in unanticipated jump-landing ability seems to persist far beyond surgical restoration of mechanical stability and resumption of initial physical activities levels. The assessment of the ability to suddenly adapt movements to unanticipated visual stimuli may be a relevant complementary component within current functional testing canon in monitoring therapy success and return to sport testing.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Germany.
| | - Florian Giesche
- Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Goethe University, Frankfurt, Germany
| | - Maren Janko
- Department of Trauma- Hand and Reconstructive Surgery, Hospital of the Goethe-University Frankfurt am Main, Goethe University, Frankfurt, Germany
| | - Philipp Niemeyer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Germany
| | - Jan Wilke
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Germany
| | - Tobias Engeroff
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Germany
| | - Thomas Stein
- Department of Sport Traumatology-, Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Germany
| | - Johannes Frank
- Department of Trauma- Hand and Reconstructive Surgery, Hospital of the Goethe-University Frankfurt am Main, Goethe University, Frankfurt, Germany
| | - Winfried Banzer
- Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Goethe University, Frankfurt, Germany
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Germany
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Niemeyer P, Niederer D, Giesche F, Janko M, Frank J, Vogt L, Banzer W. Unanticipated jump-landing after anterior cruciate ligament reconstruction: Does unanticipated jump-landing testing deliver additional return to sport information to traditional jump performance tests? Clin Biomech (Bristol, Avon) 2019; 70:72-79. [PMID: 31408765 DOI: 10.1016/j.clinbiomech.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to delineate if unanticipated jump-landing assessments delivers complementary information to those of commonly used hop and jump tests after anterior cruciate ligament reconstruction. METHODS Eleven participants (5 males) performed a series of unanticipated jump-landings and traditional hop and jump performance tests (single leg hops for distance, triple crossover hops for distance and drop jumps). The number of mistrials, time to stabilization and peak ground reaction force (pGRF) at landing and jump/hop distance were measured. Pearson correlations to find potential associations between the unanticipated jump-landing-values and the traditional jump/hop performance tests were calculated twice: once for the affected and once for the unaffected legs. t-Tests for dependent samples were used to detect differences between affected and unaffected leg within each test condition. FINDINGS The pGRF at unanticipated landing significantly correlated to the pGRF at drop jump landing (r = 0.68) and the hopping distance after the triple crossover hops (r = 0.71, each p < .05). No other significant correlation occurred (p > .05). Hopping distance after single leg hops (mean: 110.2 cm vs. 95.5 cm) and triple crossover hops for distance (mean: 315.3 cm vs. 294.2 cm) showed significant differences between the unaffected and the reconstructed leg (p < .05). Other parameters showed no significant between-legs differences (p > .05). INTERPRETATION Both, the reconstructed and the contralateral leg seems to be affected. Unanticipated jump landing tasks deliver information beyond those of commonly used jump and hop tests, the thereby assessed abilities may thus be a complementary aspect of dynamic knee function than those assessed with classic tests.
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Affiliation(s)
- Philipp Niemeyer
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany.
| | - Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany; Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Germany
| | - Florian Giesche
- Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Germany
| | - Maren Janko
- Department of Trauma- Hand and Reconstructive Surgery, Hospital of the Goethe-University Frankfurt am Main, Germany
| | - Johannes Frank
- Department of Trauma- Hand and Reconstructive Surgery, Hospital of the Goethe-University Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany
| | - Winfried Banzer
- Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Germany
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8
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Niederer D, Keller M, Achtnich A, Akoto R, Ateschrang A, Banzer W, Barié A, Best R, Ellermann A, Fischer A, Guenther D, Herbort M, Höher J, Janko M, Jung TM, Krause M, Petersen W, Stoffels T, Stöhr A, Welsch F, Stein T. Effectiveness of a home-based re-injury prevention program on motor control, return to sport and recurrence rates after anterior cruciate ligament reconstruction: study protocol for a multicenter, single-blind, randomized controlled trial (PReP). Trials 2019; 20:495. [PMID: 31409425 PMCID: PMC6693217 DOI: 10.1186/s13063-019-3610-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/23/2019] [Indexed: 12/26/2022] Open
Abstract
Background Although anterior cruciate ligament (ACL) tear-prevention programs may be effective in the (secondary) prevention of a subsequent ACL injury, little is known, yet, on their effectiveness and feasibility. This study assesses the effects and implementation capacity of a secondary preventive motor-control training (the Stop-X program) after ACL reconstruction. Methods and design A multicenter, single-blind, randomized controlled, prospective, superiority, two-arm design is adopted. Subsequent patients (18–35 years) with primary arthroscopic unilateral ACL reconstruction with autologous hamstring graft are enrolled. Postoperative guideline rehabilitation plus Classic follow-up treatment and guideline rehabilitation plus the Stop-X intervention will be compared. The onset of the Stop-X program as part of the postoperative follow-up treatment is individualized and function based. The participants must be released for the training components. The endpoint is the unrestricted return to sport (RTS) decision. Before (where applicable) reconstruction and after the clearance for the intervention (aimed at 4–8 months post surgery) until the unrestricted RTS decision (but at least until 12 months post surgery), all outcomes will be assessed once a month. Each participant is consequently measured at least five times to a maximum of 12 times. Twelve, 18 and 24 months after the surgery, follow-up-measurements and recurrence monitoring will follow. The primary outcome assessement (normalized knee-separation distance at the Drop Jump Screening Test (DJST)) is followed by the functional secondary outcomes assessements. The latter consist of quality assessments during simple (combined) balance side, balance front and single-leg hops for distance. All hop/jump tests are self-administered and filmed from the frontal view (3-m distance). All videos are transferred using safe big content transfer and subsequently (and blinded) expertly video-rated. Secondary outcomes are questionnaires on patient-reported knee function, kinesiophobia, RTS after ACL injury and training/therapy volume (frequency – intensity – type and time). All questionnaires are completed online using the participants’ pseudonym only. Group allocation is executed randomly. The training intervention (Stop-X arm) consists of self-administered home-based exercises. The exercises are step-wise graduated and follow wound healing and functional restoration criteria. The training frequency for both arms is scheduled to be three times per week, each time for a 30 min duration. The program follows current (secondary) prevention guidelines. Repeated measurements gain-score analyses using analyses of (co-)variance are performed for all outcomes. Trial registration German Clinical Trials Register, identification number DRKS00015313. Registered on 1 October 2018.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt am Main, Germany.
| | | | - Andrea Achtnich
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Ralph Akoto
- Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Atesch Ateschrang
- BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt am Main, Germany.,Department of Preventive and Sports Medicine, Institute for Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Alexander Barié
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Raymond Best
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany.,Department of Orthopaedic Sportsmedicine, University of Tuebingen, Tuebingen, Germany
| | | | - Andreas Fischer
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Jürgen Höher
- Sports Clinic Cologne at Cologne Merheim Medical Center, Cologne, University of Witten/Herdecke, Cologne, Germany
| | - Maren Janko
- Department of Trauma, Hand, and Reconstructive Surgery, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Tobias M Jung
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | - Thomas Stoffels
- Department of Trauma and Orthopaedic Surgery, Unfallkrankenhaus Marzahn, Berlin, Germany
| | | | - Frederic Welsch
- Department of Sporttraumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Thomas Stein
- Department of Sporttraumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
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Niederer D, Wilke J, Krause F, Banzer W, Engeroff T. Integrating the Evidence and Clinical Expertise in the Shared Decision and Graduated Return to Sport Process: A Time Series Case Study after Anterior Cruciate Ligament Rupture and Reconstruction. J Orthop Case Rep 2019; 10:35-44. [PMID: 32547976 PMCID: PMC7276579 DOI: 10.13107/jocr.2019.v10.i01.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Rehabilitation following anterior cruciate ligament (ACL) rupture is often characterized by a large discrepancy between the available scientific evidence and its implementation into practice. PURPOSE We aimed to research, selectively rate, and transfer the available evidence to the returntosport (RTS) process after ACL rupture adopting an athlete time series case study design. CASE REPORT AND METHODS The participant is a male athlete aged 33 who was diagnosed with an isolated right-sided total ACL rupture. Knee arthroscopy using semitendinosus tendon plastic (×4) was performed. For rehabilitation, a graded and shared decision RTS algorithm was derived from the existing evidence and all relevant decision-makers expertise. Starting with basic functional abilities and range of motion, the functional ability at each stage had to be achieved before the next stage was aimed. The corresponding therapeutic focus (in addition to standard therapy) was adopted to reach this goal. Functions to be tested were as follows: Knee function confidence, dynamic balance, isometric and isokinetic strength/torque testing, as well as jumping ability (single-leg hop and triple crossover hop for distance). RESULTS RTS was reached (Level 3) 5 months and (Level 2) 10 months post-surgery. CONCLUSION Integrating the available evidence and the clinical expertise of all relevant stakeholders into a shared decision and graduated RTS process after ACL rupture and reconstruction was feasible and successful. Particularly, multiple functional measurements in a time series approach to determine the actual rehabilitation focus seem promising.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan Wilke
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Frieder Krause
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Winfried Banzer
- Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Germany
| | - Tobias Engeroff
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
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10
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Risberg MA, Steffen K, Nilstad A, Myklebust G, Kristianslund E, Moltubakk MM, Krosshaug T. Normative Quadriceps and Hamstring Muscle Strength Values for Female, Healthy, Elite Handball and Football Players. J Strength Cond Res 2018; 32:2314-2323. [PMID: 29794892 PMCID: PMC6092090 DOI: 10.1519/jsc.0000000000002579] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Risberg, MA, Steffen, K, Nilstad, A, Myklebust, G, Kristianslund, E, Moltubakk, MM, and Krosshaug, T. Normative quadriceps and hamstring muscle strength values for female, healthy, elite handball and football players. J Strength Cond Res 32(8): 2314–2323, 2018—This study presents normative values for isokinetic knee extension and flexion muscle strength tests in 350 elite, female, handball (n = 150) and football (n = 200) players. Isokinetic concentric muscle strength tests at 60°·sec−1 were recorded bilaterally using a dynamometer. Peak torque (in Newton meter [N·m]), body mass normalized peak torque (N·m·kg−1), and hamstring to quadriceps ratio (H:Q ratio) for dominant and nondominant legs were recorded. The female elite players were 20.9 ± 4.0 years, started playing at the elite level at the age of 18.2 ± 2.7 years, with a mean of 9.7 ± 2.2 hours of weekly in-season training. Handball players demonstrated greater quadriceps muscle strength compared with football players (11.0%) (p < 0.001), also when normalized to body mass (4.1%) (p = 0.012), but not for weight-adjusted hamstring muscle strength. The H:Q ratio was higher on the dominant compared with the nondominant leg for handball players only (p = 0.012).The H:Q ratio was significantly lower for handball players (0.58) compared with football players (0.60) (p < 0.02). These normative values for isokinetic knee extension and flexion torques of healthy, elite, female handball and football players can be used to set rehabilitation goals for muscle strength after injury and enable comparison with uninjured legs. Significantly greater quadriceps muscle strength was found for handball players compared with football players, also when normalized to body mass.
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Affiliation(s)
| | | | | | | | | | - Marie M Moltubakk
- Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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11
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Niederer D, Engeroff T, Wilke J, Vogt L, Banzer W. Return to play, performance, and career duration after anterior cruciate ligament rupture: A case-control study in the five biggest football nations in Europe. Scand J Med Sci Sports 2018; 28:2226-2233. [DOI: 10.1111/sms.13245] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine; Institute of Sports Sciences; Goethe-University Frankfurt; Frankfurt am Main Germany
| | - Tobias Engeroff
- Department of Sports Medicine; Institute of Sports Sciences; Goethe-University Frankfurt; Frankfurt am Main Germany
| | - Jan Wilke
- Department of Sports Medicine; Institute of Sports Sciences; Goethe-University Frankfurt; Frankfurt am Main Germany
| | - Lutz Vogt
- Department of Sports Medicine; Institute of Sports Sciences; Goethe-University Frankfurt; Frankfurt am Main Germany
| | - Winfried Banzer
- Department of Sports Medicine; Institute of Sports Sciences; Goethe-University Frankfurt; Frankfurt am Main Germany
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