1
|
Butler L, Martinez A, Entessari M, Cardenas G, Wright M, Sugimoto D. Qualitative and quantitative return-to-sport test battery and second anterior cruciate ligament injury risk factors. BMJ Open Sport Exerc Med 2024; 10:e002000. [PMID: 39104374 PMCID: PMC11298729 DOI: 10.1136/bmjsem-2024-002000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2024] [Indexed: 08/07/2024] Open
Abstract
ABSTRACT Objective To determine risk factors for second anterior cruciate ligament (ACL) injury following primary ACL reconstruction (ACLR) using return-to-sport (RTS) tests consisting of qualitative and quantitative measures in young athletes. Methods A case-control study design was used, and a retrospective review of adolescent athletes after primary ACLR was performed. All athletes completed an RTS test consisting of qualitative and quantitative assessments and psychological assessments with the Tampa Scale of Kinesiophobia. Athlete demographics, surgical characteristics and sports participation were also examined. A binary logistic regression was performed to verify an independent association between risk factors and second ACL injury using adjusted OR (aORs), 95% CI and p<0.05. Results In 72 eligible athletes, 12 (16.7%) suffered a second ACL injury. The mean Tegner activity level was 8.4+1.1, and the mean time from ACLR to RTS test completion was 10.4+2.9 months. One variable that showed the lowest p-value in the preliminary analysis was entered into the binary logistic regression model, which resulted in that qualitative assessment of knee valgus during the sidestep cut was associated with second ACL injury (aOR=4.64, 95% CI: 1.18 to 18.23, p=0.03). Conclusion Athletes who demonstrated excessive dynamic knee valgus on the involved limb during the sidestep cut were approximately 4.6 times more likely to suffer a second ACL injury.
Collapse
Affiliation(s)
- Lauren Butler
- Florida International University, Miami, Florida, USA
- Nicklaus Children's Hospital, Miami, Florida, USA
| | | | | | | | | | - Dai Sugimoto
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| |
Collapse
|
2
|
Walker A, Sattler L, Heyward S, Tedesco J, Jones Z, D'Lima C, Higham C, Cuthbert S, Hing W. An 8-week physiotherapist-led return to sport group program after anterior cruciate ligament reconstruction improves measures of physical and psychological function: A case series. Musculoskelet Sci Pract 2024; 73:103149. [PMID: 39047591 DOI: 10.1016/j.msksp.2024.103149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Low return to competitive sport, high reinjury rates and long-term functional impairment of anterior cruciate ligament reconstruction (ACLR) present significant challenges for patients. A program that facilitates a safe return to sport (RTS) following ACLR could potentially improve outcomes. STUDY DESIGN Case Series. METHODS Sixty participants (median 20-years-old (13-36), 43 males, 18 females, median 7.5 months (4-25) post-ACLR) completed an eight-week exercise program. A battery of physical tests and patient-reported outcome measures were assessed pre and post-program. The number of participants passing RTS criteria was evaluated, and RTS rates were determined. The correlation between the ACL-RSI and measures of physical function was explored. RESULTS Improvements in all isometric strength, hop tests, running T-test, and patient reported outcome measures were seen post-program. Five (8%) participants successfully passed all RTS criteria and eighty-five percent of participants returned to their previous level of sport. The ACL-RSI and the IKDC showed correlation across all time points (pre rs = 0.49; post rs = 0.40; change r = 0.40). CONCLUSIONS Our study demonstrated improvements in all RTS criteria tests upon completing the 8-week rehabilitation program; however, few participants (8%) passed all RTS criteria. Psychological readiness is more closely related to patient-reported function than functional tests.
Collapse
Affiliation(s)
- Adam Walker
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia; Gold Coast Knee Group, Gold Coast, Australia.
| | - Larissa Sattler
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia; Gold Coast Knee Group, Gold Coast, Australia
| | - Samuel Heyward
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Jordan Tedesco
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Zachariah Jones
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Corey D'Lima
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Caroline Higham
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Sophie Cuthbert
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Wayne Hing
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| |
Collapse
|
3
|
Solie BS, Tollefson LV, Doney CP, O'Keefe JMJ, Thompson WC, LaPrade RF. Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction: A Practical Review with Medical Recommendations. Int J Sports Med 2024; 45:572-588. [PMID: 38527465 DOI: 10.1055/a-2270-3233] [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: 03/27/2024]
Abstract
Returning to sport after anterior cruciate ligament reconstruction (ACLR) can be a challenging and complex process for the athlete, with the rate of return to the pre-injury level of sport observed to be less than athlete expectations. Of the athletes that do return to sport (RTS), knee re-injury rates remain high, and multiple studies have observed impaired athletic performance upon RTS after ACLR as well as reduced playing time, productivity, and career lengths. To mitigate re-injury and improve RTS outcomes, multiple RTS after ACLR consensus statements/clinical practice guidelines have recommended objective RTS testing criteria to be met prior to medical clearance for unrestricted sports participation. While the achievement of RTS testing criteria can improve RTS rates after ACLR, current criteria do not appear valid for predicting safe RTS. Therefore, there is a need to review the various factors related to the successful return to the pre-injury level of sport after ACLR, clarify the utility of objective performance testing and RTS criteria, further discuss safe RTS decision-making as well as present strategies to reduce the risk of ACL injury/re-injury upon RTS. This article provides a practical review of the current RTS after ACLR literature, as well as makes medical recommendations for rehabilitation and RTS decision-making after ACLR.
Collapse
Affiliation(s)
- Braidy S Solie
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
- Research, Twin Cities Orthopedics, Edina, MN, United States
| | | | - Christopher P Doney
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
| | - Jeremy M J O'Keefe
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
| | - Will C Thompson
- Sports Science, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
| | | |
Collapse
|
4
|
Simonsson R, Piussi R, Högberg J, Sundberg A, Hamrin Senorski E. Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2024; 43:513-533. [PMID: 38811125 DOI: 10.1016/j.csm.2023.07.004] [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] [Indexed: 05/31/2024]
Abstract
Rehabilitation after an anterior cruciate ligament (ACL) reconstruction requires patience, devotion, and discipline. Rehabilitation should be individualized to each patient's specific need and sport. Return to sport is a continuum throughout the rehabilitation, and patients should not return to performance before passing a battery of muscle function tests and patient-reported outcomes, as well as change of direction-specific tests. Return to full participation should be an agreement between the patient, physical therapist, surgeon, and coach. For minimal risk for second ACL injury, patients should continue with maintenance and prevention training even after returning to sport.
Collapse
Affiliation(s)
- Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Axel Sundberg
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Capio Ortho Center, Arvid Wallgrens Backe 4a, Gothenburg SE-413 13, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Swedish Olympic Committee, Olympiastadion 114 33, Stockholm, Sweden.
| |
Collapse
|
5
|
Stitelmann A, Allet L, Armand S, Tscholl P. Reliability and Validity of Temporal Parameters during the Side Hop Test in Patients after Anterior Cruciate Ligament Reconstruction. J Clin Med 2024; 13:3407. [PMID: 38929938 PMCID: PMC11204192 DOI: 10.3390/jcm13123407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/26/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The side hop test (SHT) measures the number of jumps performed over 30 s. Although this measure has demonstrated its value in clinical practice, the temporal parameters of the SHT allow for a deeper analysis of the execution strategy. The aim of this study is to assess the reliability and construct validity of contact time parameters during the SHT recorded by a video analysis system in anterior cruciate ligament reconstructed (ACLR) patients. Methods: We investigated the reliability (intra-rater, standard error of measurement (SEM), and minimum detectable change (MDC)), discriminant validity (operated (OP) versus non-operated (NOP) side), and convergent validity (relationship with strength and psychological readiness) of SHT contact time parameters, number of valid hops and limb symmetry index (LSI) in 38 ACLR patients. Contact time parameters are presented as mean, standard deviation (SD), and coefficient of variation (CV) of contact time. Results: Intra-tester reliability was good to excellent for all contact time parameters. For discriminant validity, the mean and SD contact times of the OP leg were significantly longer than those of the NOP leg, although the difference was smaller than the SEM and MDC values. The number of valid jumps and CV contact time parameters were not significantly different. Isokinetic quadriceps strength (60°/s) was strongly correlated with mean contact time for both legs. However, psychological readiness was not correlated with any of the contact time parameters. Conclusions: Temporal parameters of the SHT measured on video analysis are valid and reliable parameters to assess the performance strategy of the SHT. The results should be interpreted with caution regarding the SEM and MDC values. Further studies are needed to measure criterion validity, inter-rater reliability, and responsiveness.
Collapse
Affiliation(s)
- Anna Stitelmann
- Department of Orthopedic Surgery and Traumatology of the Musculoskeletal System, Geneva University Hospitals, 1205 Geneva, Switzerland
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1202 Geneva, Switzerland
| | - Lara Allet
- Wallis School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1950 Sion, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Philippe Tscholl
- Department of Orthopedic Surgery and Traumatology of the Musculoskeletal System, Geneva University Hospitals, 1205 Geneva, Switzerland
- ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health, 4000 Liège, Belgium
| |
Collapse
|
6
|
Sugimoto D, Milewski MD, Williams KA, Coene RP, Nunally KD, Kocher MS, Kramer DE, Micheli LJ, Yen YM, Christino MA. Effect of Age and Sex on Anterior Cruciate Ligament Functional Tests Approximately 6 Months After Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2024; 6:100897. [PMID: 39006798 PMCID: PMC11240043 DOI: 10.1016/j.asmr.2024.100897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/10/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To examine age- and sex-related differences in postoperative functional outcomes at approximately 6 months after anterior cruciate ligament reconstruction (ACLR). Methods In this study, patients who underwent primary ACLR performed a series of return-to-sport functional tests at 5 to 8 months after surgery. Functional tests included strength tests (knee extensors, knee flexors, hip abductors, and hip extensors), a balance test (Y-balance composite score), and hop tests (single, triple, crossover, and 6-m timed hop tests). Limb symmetry was calculated to compare the reconstructed limb with the uninvolved limb. A 2-way multivariate analysis of covariance was used, and effect size was calculated for data analysis. Results A total of 176 subjects were included in this study. There were no significant interaction between age and sex on return-to-sport functional tests after ACLR. Also, no main effects of age and sex on return-to-sport functional tests were found in our data. Conclusions Age and sex do not significantly affect functional test performance after ACLR 6 months postoperatively. Level of Evidence Level III, retrospective review of prospective cohort study.
Collapse
Affiliation(s)
- Dai Sugimoto
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, U.S.A
| | - Matthew D Milewski
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kathryn A Williams
- Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Ryan P Coene
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Kianna D Nunally
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Mininder S Kocher
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Dennis E Kramer
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Lyle J Micheli
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, U.S.A
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Yi-Meng Yen
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Melissa A Christino
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| |
Collapse
|
7
|
Welling W. Return to sports after an ACL reconstruction in 2024 - A glass half full? A narrative review. Phys Ther Sport 2024; 67:141-148. [PMID: 38749349 DOI: 10.1016/j.ptsp.2024.05.001] [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: 04/24/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 06/10/2024]
Abstract
A successful return to sports (RTS) after an anterior cruciate ligament reconstruction (ACLR) is multifactorial, and therefore difficult and challenging. Unfortunately, low percentages of patients RTS, and for those who succeed, one-fifth of patients will sustain a second ACL injury. Over the past years, test batteries were developed to assess whether patients can RTS with a low risk for a second ACL injury risk. Low rates of patients who meet RTS criteria were found, coupled with the insufficiency of current RTS test batteries in predicting second ACL injuries suggesting poor sensitivity. The result of an RTS test is likely to reflect the content of a rehabilitation program, raising critical questions regarding what we are offering patients within the rehabilitation programme. Are we preparing our patients well enough for the high demands of complex situations within pivoting team sports? This narrative review offers insights from key lessons of the last 15 years on 1) RTS testing, 2) the content of rehabilitation, and 3) the RTS continuum, all from a "helicopter perspective".
Collapse
Affiliation(s)
- Wouter Welling
- Pro-F Fysiotherapie, Kotkampweg 65, 7531 AS, Enschede, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Science, A. Deusinglaan 1, 9713 AV, Groningen, the Netherlands.
| |
Collapse
|
8
|
Zhou T, Xu Y, Zhang A, Zhang X, Deng K, Wu H, Xu W. Association of Graft Maturity on MRI With Return to Sports at 9 Months After Primary Single-Bundle ACL Reconstruction With Autologous Hamstring Graft. Orthop J Sports Med 2024; 12:23259671241248202. [PMID: 38736770 PMCID: PMC11084992 DOI: 10.1177/23259671241248202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/13/2023] [Indexed: 05/14/2024] Open
Abstract
Background The relationship between graft maturity on magnetic resonance imaging (MRI) and return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction is unclear. Purpose To compare signal-to-noise quotient (SNQ) values and ACL graft T2* (gradient echo) values between patients who did RTS and those who did not RTS (NRTS) after ACL reconstruction and to evaluate the predictive value of T2* mapping for RTS after ACL reconstruction. Study Design Case-control study; Level of evidence, 3. Methods At a minimum of 9 months after arthroscopic single-bundle ACL reconstruction with autologous hamstring tendon graft, 82 patients underwent RTS assessment as well as MRI evaluation. The patients were classified into RTS (n = 53) and NRTS (n = 29) groups based on the results of the assessment. The SNQ values in the proximal, middle, and distal regions of the graft and the T2* values of the graft were measured on MRI. The correlation between T2* values and RTS was assessed using Spearman correlation analysis. Receiver operating characteristic curves were constructed to compare the diagnostic performance, and the optimal T2* cutoff value for detecting RTS was determined based on the maximum Youden index. Results At 9 months after ACL reconstruction, the proximal, middle, and mean SNQ values in the RTS group were significantly lower than those in the NRTS group (proximal: 17.15 ± 4.85 vs 19.55 ± 5.05, P = .038; middle: 13.45 ± 5.15 vs. 17.75 ± 5.75, P = .001; mean: 12.37 ± 2.74 vs 15.07 ± 3.32, P < .001). The T2* values were lower in the RTS group (14.92 ± 2.28 vs 17.69 ± 2.48; P < .001) and were correlated with RTS (r = -0.41; P = .02). The area under the curve of T2* was 0.79 (95% CI, 0.75-0.83), and the optimal cutoff value for T2* was 16.65, with a sensitivity and specificity for predicting failure to RTS of 67.9% and 88.2%, respectively. Conclusion Study findings indicated that the SNQs (mean, proximal, and middle) and the T2* values of the graft in the RTS group were significantly lower than those in NRTS group. A T2* value of 16.65 was calculated to predict patients who failed RTS tests with a sensitivity of 67.9% and specificity of 88.2%.
Collapse
Affiliation(s)
- Tianping Zhou
- Department of Joint Surgery and Sports Medicine, Changhai Hospital affiliated to Navy Medical University, Shanghai, China
| | - Yihong Xu
- Department of Joint Surgery and Sports Medicine, Changhai Hospital affiliated to Navy Medical University, Shanghai, China
| | - Aiai Zhang
- Department of Burn Surgery, Changhai Hospital affiliated to Navy Medical University, Shanghai, China
| | - Xuchao Zhang
- Department of Joint Surgery and Sports Medicine, Changhai Hospital affiliated to Navy Medical University, Shanghai, China
| | - Kehan Deng
- Department of Stomatology, Changhai Hospital affiliated to Navy Medical University, Shanghai, China
| | - Haoran Wu
- Department of Spine Surgery, Changhai Hospital affiliated to Navy Medical University, Shanghai, China
| | - Weidong Xu
- Department of Joint Surgery and Sports Medicine, Changhai Hospital affiliated to Navy Medical University, Shanghai, China
| |
Collapse
|
9
|
Zhou W, Liu X, Hong Q, Wang J, Luo X. Association between passing return-to-sport testing and re-injury risk in patients after anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis. PeerJ 2024; 12:e17279. [PMID: 38699196 PMCID: PMC11064852 DOI: 10.7717/peerj.17279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Background Inconsistent results have been obtained regarding the association between return-to-sport (RTS) testing and the risk of subsequent re-injury following anterior cruciate ligament reconstruction (ACLR). We therefore conducted a systematic review and meta-analysis to assess the potential association between passing of RTS and the risk of re-injury for patients after ACLR. Methods This meta-analysis was registered in INPLASY with the registration number INPLASY202360027. The electronic databases MedLine, EmBase, and the Cochrane library were systematically searched to identify eligible studies from their inception up to September 2023. The investigated outcomes included knee injury, secondary ACL, contralateral ACL injury, and graft rupture. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the random-effects model. Results A total number of nine studies involving 1410 individuals were selected for the final quantitative analysis. We noted that passing RTS test was not associated with the risk of subsequent knee injury (OR: 0.95; 95% CI: 0.28-3.21; P = 0.929), secondary ACL injury (OR: 0.98; 95% CI: 0.55-1.75; P = 0.945), and contralateral ACL injury (OR: 1.53; 95% CI: 0.63-3.71; P = 0.347). However, the risk of graft rupture was significantly reduced (OR: 0.49; 95% CI: 0.33-0.75; P = 0.001). Conclusions This study found that passing RTS test was not associated with the risk of subsequent knee injury, secondary ACL injury, and contralateral ACL injury, while it was associated with a lower risk of graft rupture. Thus, it is recommended that patients after ACLR pass an RTS test in clinical settings.
Collapse
Affiliation(s)
- Wenqi Zhou
- Department of Sport Medicine, Sichuan Orthopedic Hospital, Chengdu, Sichuan, China
| | - Xihui Liu
- Department of Sport Medicine, Sichuan Orthopedic Hospital, Chengdu, Sichuan, China
| | - Qiaomei Hong
- Department of Sport Medicine, Sichuan Orthopedic Hospital, Chengdu, Sichuan, China
| | - Jingping Wang
- Department of Sport Medicine, Sichuan Orthopedic Hospital, Chengdu, Sichuan, China
| | - Xiaobing Luo
- Department of Sport Medicine, Sichuan Orthopedic Hospital, Chengdu, Sichuan, China
| |
Collapse
|
10
|
Forelli F, Riera J, Marine P, Gaspar M, Memain G, Miraglia N, Nielsen-LE Roux M, Bouzekraoui Alaoui I, Kakavas G, Hewett TE, King E, Rambaud AJ. Implementing Velocity-Based Training to Optimize Return to Sprint After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Clinical Commentary. Int J Sports Phys Ther 2024; 19:355-365. [PMID: 38439768 PMCID: PMC10909314 DOI: 10.26603/001c.92704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/02/2024] [Indexed: 03/06/2024] Open
Abstract
After anterior cruciate ligament reconstruction (ACLR), return to sprint is poorly documented in the literature. In soccer, return to sprint is an essential component of return to play and performance after ACLR. The characteristics of running in soccer are specific (velocity differences, nonlinear, intensity). It is important to address these particularities, such as curvilinear running, acceleration, deceleration, changes of direction, and variations in velocity, in the patient's rehabilitation program. Force, velocity, and acceleration capacities are key elements to sprint performance. Velocity-based training (VBT) has gained much interest in recent years and may have a role to play in optimizing return to play and return to sprint after ACLR. Force, velocity, and acceleration can be assessed using force-velocity-power and acceleration-speed profiles, which should inform rehabilitation. The purpose of this commentary is to describe a velocity-based return to sprint program which can be used during ACLR rehabilitation.
Collapse
Affiliation(s)
- Florian Forelli
- Orthosport Rehab Center, Domont, France
- Clinic of Domont, Orthopedic Surgery Department, Ramsay Healthcare, Domont, France
- SFMKS-Lab, Société Française des Masseurs-kinésithérapeutes du Sport, Pierrefitte/Seine, France
| | - Jérôme Riera
- University Jean Monnet Saint-Etienne, Lyon 1, University Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
- University of Bordeaux, College of Health Sciences, IUSR, 33000, Bordeaux, France
| | | | - Maxime Gaspar
- Clairefontaine Medical Center, French Football Federation, France
| | - Geoffrey Memain
- Clairefontaine Medical Center, French Football Federation, France
| | | | | | - Ismail Bouzekraoui Alaoui
- Mohammed VI Faculty of Nursing and Allied Health Professions, Mohammed VI University of Sciences and Health, Casablanca, Morocco
- Research Unit, Mohammed VI Center for Research and Innovation, Rabat, Morocco
| | - Georgios Kakavas
- Fysiotek Spine & Sports Lab, Athens, Greece
- Department of Physical Education and Sport Science, University of Thessaly, @ErgoMechLab, Trikala,Greece
| | - Timothy E Hewett
- Department of Orthopaedic Surgery, Marshall University, Huntington, West Virginia
| | - Enda King
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Alexandre Jm Rambaud
- SFMKS-Lab, Société Française des Masseurs-kinésithérapeutes du Sport, Pierrefitte/Seine, France
- Department of Clinical and Exercise Physiology, Sports Medicine Unity, University Hospital of Saint Etienne, Faculty of medicine, Saint-Etienne. France
| |
Collapse
|
11
|
Petushek EJ, Diekfuss JA, Lamplot JD, Mørtvedt AI, Hoey LC, Heo K, Petit CB, Barber Foss KD, Warren SM, Slutsky-Ganesh AB, Kenyon CD, McPherson AL, Biller ME, Newsome M, Jennings B, Xerogeanes JW, Myer GD. Usefulness of Current Patient-Reported Outcome Scales for ACL Injury: A Mixed-Methods Evaluation of Stakeholder-Perceived Utility of Specific Constructs and Items Across the Rehabilitation Timeline. Orthop J Sports Med 2024; 12:23259671231218964. [PMID: 38784528 PMCID: PMC11113051 DOI: 10.1177/23259671231218964] [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: 05/09/2023] [Accepted: 06/29/2023] [Indexed: 05/25/2024] Open
Abstract
Background Numerous patient-reported outcome measures (PROMs) have been used in patients with anterior cruciate ligament reconstruction (ACLR), often with overlapping constructs of interest and limited content validity. Inefficient scale application increases burden and diminishes overall usefulness for both the patient and practitioner. Purpose To isolate specific PROM items across a diverse set of constructs that patients and practitioners perceive as having the greatest value at various stages of recovery and return to sport (RTS) in patients after ACLR. Study Design Cross-sectional study. Methods A combined 77 stakeholders participated in this 2-phase mixed-methods investigation. In phase 1, a total of 27 patients and 21 practitioners selected individual PROM items from various constructs that had the greatest utility or importance. In phase 2, the highest rated items were further tested in a head-to-head comparison with 29 stakeholders who attended the 2022 ACL Injury Research Retreat. In addition to the utility assessment, practitioners answered other questions related to importance and timing of PROM assessments. Results In phase 1, both patients and practitioners shared the same top item in 6 of the 8 (75%) constructs assessed. In phase 2, the construct of psychological burden was rated as "extremely important" by 59% of respondents, followed by physical function (54%), symptoms (35%), and donor site issues (10%). The PROM items of confidence, perceived likelihood of reinjury, and difficulty stopping quickly were rated by a respective 93%, 89%, and 86% of the sample as either "very useful" or "extremely useful." All constructs except donor site issues were rated by most stakeholders to be absolutely necessary to evaluate treatment progress and RTS readiness at the 6-month postoperative time and at RTS. Conclusion Overall, psychological burden, with specific items related to confidence and reinjury likelihood, were rated as most important and useful by both patients and practitioners. The second most important and useful PROM item was related to higher intensity function (eg, decelerating or jumping/landing activities during sports).
Collapse
Affiliation(s)
- Erich J. Petushek
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Jed A. Diekfuss
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Joseph D. Lamplot
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Anne-Inger Mørtvedt
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Lauren C. Hoey
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Kevin Heo
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Camryn B. Petit
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Kim D. Barber Foss
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Shayla M. Warren
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | | | - Charles D. Kenyon
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - April L. McPherson
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Michael E. Biller
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Michael Newsome
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Brian Jennings
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - John W. Xerogeanes
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Gregory D. Myer
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| |
Collapse
|
12
|
Suits WH, Roe ON, Snyder CM, Voss LJ. The Interruption of Rehabilitation Following Anterior Cruciate Ligament Reconstruction due to COVID-19 Restrictions: Association With Return-to-Sport Testing. J Sport Rehabil 2024; 33:149-154. [PMID: 38194957 DOI: 10.1123/jsr.2023-0277] [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: 08/25/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024]
Abstract
CONTEXT Among many unanticipated changes, access to rehabilitation was disrupted during the onset of the COVID-19 pandemic. It is unclear how the timing of late-stage rehabilitation following anterior cruciate ligament with surgical reconstruction (ACLR) during the initial months of the pandemic affected outcomes. The purpose of this study was to compare physical performance outcome measures in patients following ACLR prior to and following COVID-19-related restrictions. DESIGN Retrospective cohort study. METHODS Data from patients who underwent return-to-sport testing following ACLR were analyzed based on date. December 2018 through March of 2020 (n = 66) was defined as the baseline period, and June through October 2020 (n = 27) was defined as the surveillance period. Outcome measures included single leg hop, triple hop, single leg vertical jump, and the lower-extremity functional test (LEFT). Linear mixed models were used to compare outcome measures before and after the onset of pandemic-related restrictions, clustered by sex and sport. A 1-way analysis of variance was performed to analyze the association between the number of virtual rehabilitation visits and outcome measures for subjects in the surveillance period. RESULTS Subjects in the surveillance period performed significantly worse in the LEFT (+7.88 s; 95% confidence interval, 1.11 to 14.66; P = .02) and single leg vertical jump on the unaffected side (-4.32 cm; 95% confidence interval, -7.44 to -1.19, P < .01), and performed better with single leg vertical jump symmetry (+6.3%; 95% confidence interval, 1.0% to 11.5%; P = .02). There were no other statistically significant differences. There was no significant association between having virtual rehabilitation visits and any of the performance outcomes. CONCLUSIONS There was a decline in physical performance outcome measures in patients following ACLR who did not attend regular in-person physical therapy sessions in the late-stage rehabilitation due to COVID-19-related restrictions. Other factors during this unique time period, such as access to training facilities or psychosocial stressors, may have also influenced outcomes.
Collapse
Affiliation(s)
- William H Suits
- Department of Physical Therapy, University of Michigan-Flint, Flint, MI, USA
| | - Olivia N Roe
- Department of Physical Therapy, University of Michigan-Flint, Flint, MI, USA
| | - Corey M Snyder
- Michigan Medicine MedSport, Michigan Medicine, Ann Arbor, MI, USA
| | - Luke J Voss
- Michigan Medicine MedSport, Michigan Medicine, Ann Arbor, MI, USA
| |
Collapse
|
13
|
Naderi A, Fallah Mohammadi M, Dehghan A, Baker JS. Psychosocial interventions seem redact kinesiophobia after anterior cruciate ligament reconstruction but higher level of evidence is needed: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5848-5855. [PMID: 37973676 DOI: 10.1007/s00167-023-07630-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Psychosocial interventions have shown potential in reducing the fear of re-injury after anterior cruciate ligament reconstruction (ACLR), but this has not been systematically reviewed. The aim of this study was to assess the available evidence on the effect of psychosocial interventions on kinesiophobia after ACLR. METHODS Two independent researchers conducted a systematic search in the electronic databases including Scopus, PubMed, Web of Science (WOS), SPORTDiscus, PsycINFO, and CINAHL from their inception until May 2022. They included studies that utilised a randomised controlled study design with a control group, and measured kinesiophobia using the Tampa Scale for kinesiophobia in patients who underwent primary ACLR. The outcome of interest was the mean and standard deviation of kinesiophobia. Extracted data were analysed using Comprehensive Meta-Analysis software, version 3.0 (CMA.V2), employing a random-effects model to calculate the overall effect estimates of psychosocial interventions on Kinesiophobia. The standardised mean difference with 95% confidence intervals (CIs) was computed based on the mean and standard deviation in each group. RESULTS This systematic review and meta-analysis included 5 randomised controlled trials with a total of 213 patients who underwent ACLR. The results of the meta-analysis showed that psychosocial intervention was more effective than non-psychosocial comparators in reducing kinesiophobia among patients who underwent a primary ACLR (5 trials, MD 0.56, 95% CI 0.28-0.83, p < 0.001). The heterogeneity score was zero (I2 = 0%; n.s. for Cochran's Q test), indicating no significant variation among the studies. CONCLUSIONS Psychosocial interventions can alleviate kinesiophobia in patients with primary ACLR. Although the limited number of reviewed studies and their methodological limitations precludes drawing a definitive conclusion regarding the effectiveness of psychosocial interventions on kinesiophobia, these promising findings can serve as a basis for developing psychological strategies to manage kinesiophobia in patients with primary ACLR and can also guide future research this issue. LEVEL OF EVIDENCE II. TRIAL REGISTRATION This trial is registered in PROSPERO on December 2021 (CRD42021282413).
Collapse
Affiliation(s)
- Aynollah Naderi
- Corrective Exercise and Sport Rehabilitation Lab, School of Sport Science, Shahrood University of Technology, Shahrood, Semnan, Iran.
| | - Mohammad Fallah Mohammadi
- Department of Sports Sciences, Faculty of Humanities, Higher Education Institute of Shafagh, Tonekabon, Iran
| | - Azizallah Dehghan
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Julien S Baker
- Research Centre for Population Health and Medical Informatics, Department of Sport and Physical Education, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| |
Collapse
|
14
|
Simonsson R, Högberg J, Lindskog J, Piussi R, Sundberg A, Sansone M, Samuelsson K, Thomeé R, Hamrin Senorski E. A comparison between physical therapy clinics with high and low rehabilitation volumes of patients with ACL reconstruction. J Orthop Surg Res 2023; 18:842. [PMID: 37936163 PMCID: PMC10629052 DOI: 10.1186/s13018-023-04304-4] [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: 07/19/2023] [Accepted: 10/20/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Treatment volume can impact outcomes after surgical procedures of the knee between surgeons with high- and low-patient-volumes. However, the difference between physical therapeutic clinics with high- and low-volumes has not been widely researched. This registry study aims to investigate how patient volume affects knee function outcomes after anterior cruciate ligament (ACL) reconstruction at physical therapy (PT) clinics in terms of odds for a second ACL injury, return to pre-injury level of activity, perceived knee function, and recovery of strength and hop performance. METHOD Data were extracted from the Project ACL, a local rehabilitation registry. High- and low-volume clinics were defined based on the number of patients who attended different clinics. High-volume clinics were defined as those with > 100 patient registrations in Project ACL during the study period while low-volume clinics were those with ≤ 100 patient registrations. High- and low-volume clinics were compared, based on muscle function and patient-reported outcomes across 4 follow-ups, 2-, 4-, 8-, and 12 months, during the first year after ACL reconstruction, and odds of second ACL injury up to 2 years after ACL reconstruction. RESULT Of the 115 rehabilitation clinics included, 111 were classified as low-volume clinics and included 733 patients, and 4 as high-volume clinics which included 1221 patients. There were 31 (1.6%) second ACL injuries to the ipsilateral or contralateral side within the first 12 months and 68 (4.0%) within 2 years. No difference in the incidence of a second ACL injury, within 12 months follow-up odds ratio (OR) 0.95 [95% CI 0.46-1.97] or within 2 years follow-up OR 1.13 [95% CI 0.68-1.88], was found between high- and low-volume clinics. There were early (2 months) and non-clinically relevant differences in patient-reported outcomes (PROs) and physical activity levels early after ACL reconstruction in favor of high-volume clinics. One year after ACL reconstruction, no differences were observed between high- and low-volume clinics in terms of PROs, muscle function, and return to pre-injury level of activity. CONCLUSION No clinically relevant difference in the incidence of secondary ACL injuries in patients who underwent rehabilitation after ACL reconstruction at high- or low-volume physical therapist clinics was found. In addition, no clinically relevant differences in outcomes were found during the first year in terms of patient-reported outcomes, recovery of muscle function, or return to pre-injury level of activity.
Collapse
Affiliation(s)
- Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden.
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Jakob Lindskog
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Axel Sundberg
- Capio Ortho Center Gothenburg, Drakegatan 7A, SE-412 50, Gothenburg, Sweden
| | - Mikael Sansone
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
- Swedish Olympic Committee, Stockholm, Sweden
| |
Collapse
|
15
|
Shankar DS, Milton HA, Mojica ES, Buzin S, Strauss EJ, Campbell KA, Alaia MJ, Gonzalez-Lomas G, Jazrawi LM. Force plate jump testing metrics are predictive of performance on a multimodal return to sport testing protocol among anterior cruciate ligament reconstruction patients at minimum six-month follow-up. J Sports Med Phys Fitness 2023; 63:1208-1217. [PMID: 37526491 DOI: 10.23736/s0022-4707.23.14850-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: 08/02/2023]
Abstract
BACKGROUND Force plate-based jump testing may serve as a potential alternative to traditional return to sport (RTS) testing batteries. The purpose of our study was to identify force plate jump metrics that were predictive of RTS test findings in patients who were at least six months postoperative following anterior cruciate ligament reconstruction (ACLR). METHODS We conducted a cross-sectional study of patients who underwent ACLR at our center and were at least six months postoperative. Subjects completed a multimodal Institutional RTS (IRTS) testing battery which included range of motion (ROM) testing and isokinetic quadriceps strength testing. Subjects also completed a countermovement jump testing protocol on a commercially-available force plate. Jump metrics predictive of IRTS test findings were identified using multivariable linear and logistic regression with stepwise selection. Model significance was assessed at α=0.002. RESULTS Sixteen patients (7M, 9F) were enrolled in our study with median age of 29 years (range 20-47). Relative concentric impulse was positively predictive of knee flexion active ROM (β=7.07, P=0.01) and passive ROM (β=9.79, P=0.003). Maximum power was positively predictive of quadriceps strength at 60 deg/s (β=3.27, P<0.001) and 180 deg/s (β=2.46, P<0.001). Center-of-pressure (COP) shift acceleration along the force plate X-axis was negatively predictive of Bunkie lateral test score (β=-945, P<0.001) and medial test score (β=-839, P=0.03). CONCLUSIONS Force plate-derived vertical jump testing metrics are predictive of certain components of a multimodal RTS physical assessment for ACLR patients, including knee flexion ROM, quadriceps strength on isokinetic testing, and Bunkie Test performance.
Collapse
Affiliation(s)
- Dhruv S Shankar
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA -
| | - Heather A Milton
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Edward S Mojica
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Scott Buzin
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Eric J Strauss
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Michael J Alaia
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Guillem Gonzalez-Lomas
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Laith M Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| |
Collapse
|
16
|
Almeida GPL, Albano TR, Rodrigues CAS, Tavares MLA, de Paula Lima PO. _Combining return to sport, psychological readiness, body mass, hamstring strength symmetry, and hamstring/quadriceps ratio increases the risk of a second anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2023; 31:5087-5095. [PMID: 37728760 DOI: 10.1007/s00167-023-07559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To investigate the combinations of variables that comprise the biopsychosocial model domains to identify clinical profiles of risk and protection of second anterior cruciate ligament injury. METHODS One hundred and forty-five patients for return-to-sport testing after anterior cruciate ligament (ACL) reconstruction (ACLR) were contacted, and 97 were deemed eligible. All were evaluated between 6 and 24 months and followed up for 2 years. Participants answered the International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI), performed the postural stability assessment using the Biodex Balance System, and assessed muscle strength at 60° and 300°/s on the isokinetic dynamometer. Personal factors (age, gender, body mass index), body structures (graft type and concomitant injuries), and environmental factors (time between surgery and evaluation) were also collected. The participants were asked about the occurrence of a second ACL injury and return to sport after 2 years of follow-up. Classification and regression tree (CART) analysis was used to determine predictors of a second ACL injury. The receiver operating characteristic (ROC) curve was performed to verify the accuracy of the CART analysis, in addition to the sensitivity, specificity, and relative risk (RR) of the model. RESULTS Of the initial 97 participants, 88 (89.8%) responded to follow-up and 14 (15.9%) had a second ACL injury (11 graft ruptures and three contralateral ACL). CART analysis identified the following variables as predictors of second ACL injury: return to sport, hamstring strength symmetry at 300°/s, ACL-RSI score, hamstrings/quadriceps ratio at 60°/s, and body mass index (BMI). CART correctly identified 9 (64.3%) of the 14 participants who were reinjured and 71 (95.9%) of the 74 participants who were not. The total correct classification was 90.9%. The area under the ROC curve was 0.88 (95% CI 0.72-0.99; p < 0.001), and the model showed a sensitivity of 75% (95% CI 42.8-94.5), specificity of 93.4% (95% CI 85.3-97.8), and RR of 15.9 (95% CI 4.9-51.4; p < 0.0001). CONCLUSION The combination of hamstring strength symmetry, hamstring/quadriceps ratio (body functions); return to sport (activity and participation); psychological readiness; and BMI (personal factors) could identify three clinical risk profiles for a second ACL injury with good accuracy. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Gabriel Peixoto Leão Almeida
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil.
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Thamyla Rocha Albano
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Carlos Augusto Silva Rodrigues
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Maria Larissa Azevedo Tavares
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Pedro Olavo de Paula Lima
- Knee and Sports Research Group, Federal University of Ceará, Alexandre Baraúna Street, 949 - 1° andar - Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, CE, Brazil
| |
Collapse
|
17
|
Maestroni L, Turner A, Papadopoulos K, Sideris V, Read P. Total Score of Athleticism: Profiling Strength and Power Characteristics in Professional Soccer Players After Anterior Cruciate Ligament Reconstruction to Assess Readiness to Return to Sport. Am J Sports Med 2023; 51:3121-3130. [PMID: 37681510 PMCID: PMC10543956 DOI: 10.1177/03635465231194778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/11/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND There is no consensus on the optimal testing procedure to determine return-to-sport (RTS) readiness after anterior cruciate ligament (ACL) reconstruction. Current approaches use limb symmetry across a range of tests, but this does not consider a patient's level of athleticism or benchmarks relative to his or her noninjured counterparts. PURPOSE To examine the utility of the Total Score of Athleticism (TSA), a composite scale including strength, power, and reactive strength assessments, to aid RTS decision-making. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 95 professional soccer players (60 who underwent ACL reconstruction [mean age, 25.1 ± 12.6 years] and 35 who were uninjured [mean age, 23.8 ± 2.8 years]) completed a battery of tests including isokinetic knee extension and flexion torque, bilateral and unilateral countermovement jump height, relative peak power, and reactive strength index-modified. The TSA score (derived from Z scores) was calculated, and we (1) examined differences between the ACL-reconstructed and uninjured groups at the time of RTS, (2) assessed the predictive ability of the TSA to identify the player's status (ACL reconstruction vs uninjured control), and (3) included a case series to discuss the characteristics of players who sustained a subsequent injury within 4 months after RTS. RESULTS A large difference between the ACL-reconstructed and uninjured groups in the TSA score (d = 0.84; P < .0001) was evident. For every additional increase of 1 unit in the TSA score, the odds of belonging to the ACL-reconstructed group decreased by 74% (95% CI, 0.19-0.56). By visual inspection, the frequency of reinjured players was higher in the low (4/7) TSA tertile compared with the medium (2/7) and high (1/7) TSA tertiles. CONCLUSION Preliminary evidence indicates that the TSA may be a useful RTS readiness tool, as the composite score derived from strength and power measures was different in soccer players at the time of RTS after ACL reconstruction compared with healthy matched controls. There was also a higher frequency of low TSA scores in players who sustained a second injury after RTS. Therefore, it is recommended to routinely administer RTS tests encompassing strength, power, and reactive strength qualities each season across the largest possible number of players (ideally teammates).
Collapse
Affiliation(s)
- Luca Maestroni
- ReAct, Bergamo, Italy
- London Sport Institute, Faculty of Science and Technology, Middlesex University, London, UK
| | - Anthony Turner
- London Sport Institute, Faculty of Science and Technology, Middlesex University, London, UK
| | | | - Vasileios Sideris
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Paul Read
- Institute of Sport, Exercise and Health, London, UK
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- Faculty of Sport, Allied Health and Performance Sciences, St Marys University, Twickenham, UK
| |
Collapse
|
18
|
Faleide AGH, Inderhaug E. It is time to target psychological readiness (or lack of readiness) in return to sports after Anterior Cruciate Ligament tears. J Exp Orthop 2023; 10:94. [PMID: 37728618 PMCID: PMC10511393 DOI: 10.1186/s40634-023-00657-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023] Open
Abstract
Functional recovery has for long been the focus of rehabilitation after an Anterior Cruciate Ligament (ACL) injury. It is now increasingly recognized that more attention should be given to patients` mental recovery, their psychological readiness for returning to sport, after such an injury. Within this relatively new field of science, clinicians need clarity on when and how psychological factors should be monitored and how inexpedient psychological responses may be addressed during rehabilitation. In this Expert Opinion suggestions on how targeting psychological readiness may improve rehabilitation and return-to-sport evaluations are made based on current evidence-and issues in need of further clarification are addressed.
Collapse
Affiliation(s)
- Anne Gro Heyn Faleide
- Haraldsplass Deaconess Hospital, Ulriksdal 8, 5009, Bergen, Norway.
- The University of Bergen, Bergen, Norway.
| | - Eivind Inderhaug
- Haraldsplass Deaconess Hospital, Ulriksdal 8, 5009, Bergen, Norway
- The University of Bergen, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
19
|
Suzuki M, Ishida T, Matsumoto H, Kaneko S, Inoue C, Aoki Y, Tohyama H, Samukawa M. Association of Psychological Readiness to Return to Sports With Subjective Level of Return at 12 Months After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231195030. [PMID: 37693806 PMCID: PMC10492488 DOI: 10.1177/23259671231195030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/03/2023] [Indexed: 09/12/2023] Open
Abstract
Background Return-to-sports (RTS) rates after anterior cruciate ligament (ACL) reconstruction (ACLR) differ according to the level at which patients return. It is unclear whether the level of RTS is affected by psychological readiness to return. Purpose To examine the association between psychological readiness to RTS and subjective RTS level 12 months after ACLR. Study Design Case-control study; Level of evidence, 3. Methods A total of 47 patients who underwent unilateral primary ACLR surgery were enrolled. Assessments at 6 and 12 months postoperatively consisted of knee strength testing (isokinetic quadriceps and hamstring strength), the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale to measure psychological readiness to RTS. Patients were assigned to 1 of 3 subgroups based on their subjective assessment of RTS level at 12 months postoperatively: RTS at or above preinjury level (RTS≥Pre; n = 19), RTS below preinjury level (RTS Results Significant differences were found among the RTS≥Pre, RTS Conclusion The ACL-RSI score was significantly different among the study groups, and the ACL-RSI score at 12 months postoperatively and younger age were associated with RTS at or above preinjury level.
Collapse
Affiliation(s)
- Makoto Suzuki
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Hisashi Matsumoto
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Satoru Kaneko
- Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Chiharu Inoue
- Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Yoshimitsu Aoki
- Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | | | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| |
Collapse
|
20
|
Hysing-Dahl T, Magnussen LH, Faleide AGH, Inderhaug E. Feasibility of return to sports assessment 6 months after patellar instability surgery. BMC Musculoskelet Disord 2023; 24:662. [PMID: 37596551 PMCID: PMC10439663 DOI: 10.1186/s12891-023-06767-2] [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: 03/20/2023] [Accepted: 07/29/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND The evidence regarding the usefulness of assessment tools to support decisions of return-to-sport after surgery for patellar instability is scarce. The purpose of this study was therefore to explore the feasibility of functional tests assessing readiness for return-to-sport six months after patellar stabilizing surgery. However, there is little evidence on what a functional assessment should include to support these decisions following surgery for patellar instability. Therefore the purpose of this study was to explore the feasibility of functional tests assessing readiness for return-to-sport six months after patellar stabilizing surgery. METHODS In this cross-sectional study a prospective cohort of 78 patients were subjected to a range of return-to-sport readiness tests at six months after surgery for patellar instability with an "a la carte" approach. Lower Quarter Y-Balance Test (YBT-LQ), single-legged hop tests and isokinetic strength tests were performed. In addition, self-reported function was measured with the Banff Patellofemoral Instability Instrument 2.0 (BPII) and Norwich Patellar Instability score (NPI). Return-to-sport clearance criteria were defined as: ≤4 cm YBT-LQ anterior reach difference between legs, leg-symmetry-index (LSI) ≥ 95% in the YBT-LQ composite score, mean sum score LSI ≥ 85% of all single-leg hop tests and LSI ≥ 90% in isokinetic quadriceps strength. RESULTS Sixty-four patients (82%) were able to complete all functional tests, while only eleven (14%) patients were deemed ready for return-to-sport, passing all return-to-sport clearance criteria. Patients with bilateral problems demonstrated worse performance in the contralateral leg, which resulted in higher LSI scores compared to individuals with unilateral instability. A supplementary finding was that the extent of surgery (MPFL-R only versus combined surgery) did not predict and mainly did not affect self-reported function or functional performance at the follow-up. CONCLUSION The functional assessment used in the current study seems feasible to conduct at six months after patellar stabilizing surgery. However, current suggested clearance standards and the use of leg-symmetry-index seems inappropriate for patients with patellar instability. Therefore, further exploration of appropriate tests and return-to-sport clearance criteria is justified. TRIAL REGISTRATION clinicaltrial.gov, NCT05119088. Registered 12.11.2021 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05119088 .
Collapse
Affiliation(s)
- Trine Hysing-Dahl
- Haraldsplass Deaconess Hospital, V/Avdeling for Rehabiliteringstjenester Postboks 6165, Bergen, 5892, Norway.
- University of Bergen, Bergen, Norway.
| | - L H Magnussen
- Western Norway University of Applied Science, Haugesund, Norway
| | - A G H Faleide
- Haraldsplass Deaconess Hospital, V/Avdeling for Rehabiliteringstjenester Postboks 6165, Bergen, 5892, Norway
| | - E Inderhaug
- Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
21
|
Lindskog J, Piussi R, Simonson R, Högberg J, Samuelsson K, Thomeé R, Sundemo D, Hamrin Senorski E. Lower rates of return to sport in patients with generalised joint hypermobility two years after ACL reconstruction: a prospective cohort study. BMC Sports Sci Med Rehabil 2023; 15:100. [PMID: 37573382 PMCID: PMC10422717 DOI: 10.1186/s13102-023-00707-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/24/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Generalised joint hypermobility (GJH) has been associated with an increased risk of suffering an anterior cruciate ligament (ACL) injury. Patients with GJH exhibit lower muscle strength and poorer scores for patient-reported outcomes after ACL reconstruction, compared with patients without GJH. The aim of this study was to examine differences in the percentages of patients who return to sport (RTS) or pre-injury level of activity (RTP), muscle function and patient-reported outcomes at the time of RTS or RTP, as well as the time of RTS or RTP in patients with GJH compared with patients without GJH in the first two years after ACL reconstruction. METHODS This prospective study used data from an ACL- and rehabilitation-specific register located in Gothenburg, Sweden. Patients aged between 16 and 50, who had a primary ACL injury treated with reconstruction, were included. Data up to two years after ACL reconstruction were used and consisted of achieving RTS and RTP, results from isokinetic muscle function tests for knee extension and flexion and patient-reported outcomes (Knee Self-Efficacy Scale, Knee injury and Osteoarthritis Outcome Score and ACL-Return to Sport after Injury scale) at the time of RTS, as well as the time of RTP. A Beighton Score of ≥ 5/9 was used to define GJH. A Tegner Activity Scale of ≥ 6 was used to define RTS, while a Tegner equal to or above pre-injury level was used to define RTP. RESULTS A total of 1,198 patients (54.7% women) with a mean age of 28.5 ± 8.6 years were included. A smaller proportion of patients with GJH achieved RTS compared with patients without GJH (49.2% vs. 57.3%, Odds ratio: 0.720, p = 0.041). Furthermore, patients with GJH were marginally less symmetrical on the knee extension strength test, expressed as a Limb Symmetry Index, at the time of RTP compared with patients without GJH (87.3 ± 13.5 vs. 91.7 ± 14.3, Cohen's d = 0.142, p = 0.022). No further differences were found between groups regarding any muscle function tests or patient-reported outcomes. CONCLUSION A smaller proportion of patients with GJH achieved RTS compared with patients without GJH. Patients with GJH displayed less symmetrical knee extension strength at the time of RTP compared with patients without GJH.
Collapse
Affiliation(s)
- Jakob Lindskog
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
| | - Rebecca Simonson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden
| | - David Sundemo
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Närhälsan Lerum Primary Health Care Center, Lerum, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg, SE-411 01, Sweden.
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg, SE-405 30, Sweden.
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden.
| |
Collapse
|
22
|
Oladeji L, Reynolds G, Gonzales H, DeFroda S. Anterior Cruciate Ligament Return to Play: Where Are We Now? J Knee Surg 2023. [PMID: 37459893 DOI: 10.1055/a-2130-4909] [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] [Indexed: 08/09/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is a commonly performed orthopaedic procedure, and it is crucial to assess an athlete's readiness to safely return to sports following ACLR to minimize the risk of reinjury. Despite this, determining optimal return to play (RTP) criteria following ACLR that is accurate, accessible, and reproducible remains challenging. This review aims to discuss commonly employed RTP criteria domains, including functional assessments, patient-reported outcomes, and psychological tests, as well as emerging technologies such as magnetic resonance imaging (MRI) that may play a role as a gold standard in RTP assessment. The findings of this review suggest RTP decision making after ACL surgery is nuanced and traditionally used objective measures do not perfectly predict RTS rates or clinical outcomes. In the future, a standardized MRI screening tool could help predict reinjury. The role of functional and psychological patient-reported outcome measures needs to defined, and objective criteria should be rigorously evaluated for whether they accurately screen an athlete's physical readiness and should be expanded to include more sport-specific movement analysis.
Collapse
Affiliation(s)
- Lasun Oladeji
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri
| | - Grace Reynolds
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri
| | - Hyeri Gonzales
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri
| | - Steven DeFroda
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri
| |
Collapse
|
23
|
Piussi R, Simonson R, Högberg J, Thomeé R, Samuelsson K, Hamrin Senorski E. No Effect of Return to Sport Test Batteries with and without Psychological PROs on the Risk of a Second ACL Injury: A Critical Assessment of Four Different Test Batteries. Int J Sports Phys Ther 2023; 18:874-886. [PMID: 37547843 PMCID: PMC10399086 DOI: 10.26603/001c.81064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background Patients report psychological barriers as important when returning to sport, however, psychological outcome measures are seldom included in return to sport (RTS) assessment. There is a need for clinical trials to integrate psychological patient-reported outcomes (PROs) in return to sport batteries assessing patients treated with ACL reconstruction. Objective The aim of this study was to determine the association between passing clinical tests of muscle function and psychological PROs and sustaining a second ACL injury in patients who RTS after primary ACL reconstruction. Design Retrospective Cohort study. Methods Patients' sex, age, height and weight, and the results of strength and hop tests, as well as answers to PRO's (including Tegner activity scale, the ACL Return to Sport after Injury scale (ACL-RSI) as well as the Quality of Life (QoL) subscale of the Knee injury and Osteoarthritis Outcome Score [KOOS]), were extracted from a rehabilitation-specific registry. Four different test batteries comprising muscle function tests and PROs were created to assess whether patients were ready to RTS. Passing each of the test batteries (yes/no) was used as an independent variable. A multivariable Cox proportional hazard model analysis was performed, with sustaining a second ACL injury (either ipsi- or contralateral; yes/no) within two years of RTS as the dependent variable. Results A total of 419 patients (male, n=214; 51%) were included, of which 51 (12.2%) suffered a second ACL injury within the first two years after RTS. There were no differences in passing rates in the different RTS test batteries comprising muscle function tests and PROs for patients who suffered a second ACL injury compared to patients who did not. Conclusion No association between passing the RTS clinical tests batteries comprising muscle function and psychological PROs used, and the risk of a second ACL injury could be found. Level of Evidence 3©The Author(s).
Collapse
Affiliation(s)
- Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
- Sahlgrenska Sport Medicine Center, Gothenburg, Sweden
| | - Rebecca Simonson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
- Sahlgrenska Sport Medicine Center, Gothenburg, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
- Sahlgrenska Sport Medicine Center, Gothenburg, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sport Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
- Sahlgrenska Sport Medicine Center, Gothenburg, Sweden
- Swedish Olympic Committee, Stockholm, Sweden
| |
Collapse
|
24
|
Bruce Leicht AS, Thompson XD, Kaur M, Hopper HM, Stolzenfeld RL, Wahl AJ, Sroufe MD, Werner BC, Diduch DR, Gwathmey FW, Brockmeier SF, Miller MD, Hart JM. Hip Strength Recovery After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2023; 11:23259671231169196. [PMID: 37435425 PMCID: PMC10331192 DOI: 10.1177/23259671231169196] [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: 02/07/2023] [Accepted: 02/22/2023] [Indexed: 07/13/2023] Open
Abstract
Background Return-to-play (RTP) assessment after anterior cruciate ligament reconstruction (ACLR) rarely includes hip strength. Hypothesis It was hypothesized that (1) patients after ACLR will have weaker hip abduction (AB) and adduction (AD) strength compared with the contralateral limb, with larger deficits in women, (2) there will be a correlation between hip and thigh strength ratios and patient-reported outcomes (PROs), and (3) hip AB and AD strength will improve over time. Study Design Descriptive laboratory study. Methods Included were 140 patients (74 male, 66 female; mean age, 24.16 ± 10.82 years) who underwent RTP assessment at 6.1 ± 1.6 months after ACLR; 86 patients underwent a second assessment at 8.2 ± 2.2 months. Hip AB/AD and knee extension/flexion isometric strength were measured and normalized to body mass, and PRO scores were collected. Strength ratios (hip vs thigh), limb differences (injured vs uninjured), sex-based differences, and relationships between strength ratios and PROs were determined. Results Hip AB strength was weaker on the ACLR limb (ACLR vs contralateral: 1.85 ± 0.49 vs 1.89 ± 0.48 N·m/kg; P < .001) and hip AD torque was stronger (ACLR vs contralateral: 1.80 ± 0.51 vs 1.76 ± 0.52 N·m/kg; P = .004), with no sex-by-limb interaction found. Lower hip-to-thigh strength ratios of the ACLR limb were correlated with higher PRO scores (r = -0.17 to -0.25). Over time, hip AB strength increased in the ACLR limb more than in the contralateral limb (P = .01); however, the ACLR limb remained weaker in hip AB at visit 2 (ACLR vs contralateral: 1.88 ± 0.46 vs 1.91 ± 0.45 N·m/kg; P = .04). In both limbs, hip AD strength was greater at visit 2 than visit 1 (ACLR: 1.82 ± 0.48 vs 1.70 ± 0.48 N·m/kg; contralateral: 1.76 ± 0.47 vs 1.67 ± 0.47 N·m/kg; P < .01 for both). Conclusion The ACLR limb had weaker hip AB and stronger AD compared with the contralateral limb at initial assessment. Hip muscle strength recovery was not influenced by sex. Hip strength and symmetry improved over the course of rehabilitation. Although strength differences across limbs were minor, the clinical importance of these differences is still unknown. Clinical Relevance The evidence provided highlights the need to integrate hip strength into RTP assessments to identify hip strength deficits that may increase reinjury or lead to poor long-term outcomes.
Collapse
Affiliation(s)
| | - Xavier D. Thompson
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Mandeep Kaur
- Department of Physical Therapy, Northern Arizona University, Phoenix, Arizona, USA
| | - Haleigh M. Hopper
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Alexander J. Wahl
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Madison D. Sroufe
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - David R. Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - F. Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen F. Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D. Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Joe M. Hart
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
25
|
Forelli F, Le Coroller N, Gaspar M, Memain G, Kakavas G, Miraglia N, Marine P, Maille P, Hewett TE, Rambaud AJ. Ecological and Specific Evidence-Based Safe Return To Play After Anterior Cruciate Ligament Reconstruction In Soccer Players: A New International Paradigm. Int J Sports Phys Ther 2023; 18:526-540. [PMID: 37020454 PMCID: PMC10069338 DOI: 10.26603/001c.73031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/15/2023] [Indexed: 04/04/2023] Open
Abstract
Existing return to play (RTP) assessments have not demonstrated the ability to decrease risk of subsequent anterior cruciate ligament (ACL) injury after reconstruction (ACLR). RTP criteria are standardized and do not simulate the physical and cognitive activity required by the practice of sport. Most RTP criteria do not include an ecological approach. There are scientific algorithms as the "5 factor maximum model" that can identify risk profiles and help reduce the risk of a second anterior cruciate ligament injury. Nevertheless, these algorithms remain too standardized and do not include the situations experienced in games by soccer players. This is why it is important to integrate ecological situations specific to the environment of soccer players in order to evaluate players under conditions closest to their sporting activity, especially with high cognitive load. One should identify high risk players under two conditions: Clinical analyses commonly include assessments such as isokinetic testing, functional tests (hop tests, vertical force-velocity, profile), running, clinical assessments (range of motion and graft laxity), proprioception and balance (Star Excursion Balance Test modified, Y-Balance, stabilometry) and psychological parameters (kinesophobia, quality of life and fear of re-injury). Field testing usually includes game simulation, evaluation under dual-task conditions, fatigue and workload analysis, deceleration, timed-agility-test and horizontal force-velocity profiles. Although it seems important to evaluate strength, psychological variables and aerobic and anaerobic capacities, evaluation of neuromotor control in standard and ecological situations may be helpful for reducing the risk of injury after ACLR. This proposal for RTP testing after ACLR is supported by the scientific literature and attempts to approximate the physical and cognitive loads during a soccer match. Future scientific investigation will be required to demonstrate the validity of this approach. Level of Evidence 5.
Collapse
|
26
|
Return to Sport After Anterior Cruciate Ligament Reconstruction Requires Evaluation of >2 Functional Tests, Psychological Readiness, Quadriceps/Hamstring Strength, and Time After Surgery of 8 Months. Arthroscopy 2023; 39:790-801.e6. [PMID: 36216133 DOI: 10.1016/j.arthro.2022.08.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/14/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of this study was to examine the factors commonly used to determine readiness for return to sport (RTS) in the ACL reconstruction (ACL-R) patient population and assess which were most influential to successfully returning to sport and avoiding re-tear. METHODS The PUBMED, EMBASE and Cochrane Library databases were queried for studies related to RTS in ACL-R. Inclusion and exclusion criteria were applied to identify studies with greater than 1-year outcomes detailing the rate of return and re-tear given a described RTS protocol. Data of interest were extracted, and studies were stratified based on level of evidence and selected study features. Meta-analysis or subjective synthesis of appropriate studies was used to assess more than 25 potentially significant variables effecting RTS and re-tear. RESULTS After initial search of 1503 studies, 47 articles were selected for inclusion in the final data analysis, including a total of 1432 patients (31.4% female, 68.6% male). A meta-analysis of re-tear rate for included Level of Evidence 1 studies was calculated to be 2.8%. Subgroups including protocols containing a strict time until RTS, strength testing, and ≥2 dynamic tests demonstrated decreased RTS and re-tear heterogeneity from the larger group. Time to RTS, strength testing, dynamic functional testing, and knee stability were also found to be among the most prevalent reported criteria in RTS protocol studies. CONCLUSIONS This study suggests a multifactorial clinical algorithm for successful evaluation of RTS. The "critical criteria" recommended by the authors to be part of the postoperative RTS criteria include time since surgery of 8 months, use of >2 functional tests, psychological readiness testing, and quadriceps/hamstring strength testing in addition to the modifying patient factors of age and female gender. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
Collapse
|
27
|
West TJ, Bruder AM, Crossley KM, Culvenor AG. Unilateral tests of lower-limb function as prognostic indicators of future knee-related outcomes following anterior cruciate ligament injury: a systematic review and meta-analysis of 13 150 adolescents and adults. Br J Sports Med 2023:bjsports-2022-105736. [PMID: 36669871 DOI: 10.1136/bjsports-2022-105736] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the prognostic capacity of individual hop tests, hop test batteries and other unilateral functional performance tests following anterior cruciate ligament (ACL) injury. DESIGN Systematic review with meta-analysis. DATA SOURCES Six databases searched up to June 2021. ELIGIBILITY CRITERIA Studies reporting associations between unilateral lower-limb function (eg, hop tests) following ACL injury and future (≥3 months) knee-related outcomes. RESULTS Of 42 included studies (13 150 participants), all assessed the single-forward hop test and 32 assessed a repeated-forward hop test (crossover hop, triple hop, 6m-timed hop), mostly within a year after ACL injury/reconstruction. Results of meta-analyses indicated that higher single-forward and repeated-forward hop limb symmetry were associated with higher odds of return-to-sport 1-3 years post-ACL reconstruction (OR 2.15; 95% CI 1.30 to 3.54; OR 2.11; 95% CI 1.23 to 3.60, respectively). Higher single-forward and repeated-forward hop limb symmetry was associated with better self-reported symptoms and function 1-37 years after ACL injury (OR 2.51; 95% CI 1.62 to 3.88; OR 4.28; 95% CI 1.65 to 11.08, respectively). Higher limb symmetry on a repeated-forward hop does not appear to be associated with higher odds of successful rehabilitation without ACL reconstruction (OR 1.51; 95% CI 0.94 to 2.44). Achieving ≥90% limb symmetry on the single-forward hop was associated with reduced odds of knee osteoarthritis 5-37 years after ACL injury (OR 0.46; 95% CI 0.23 to 0.94). CONCLUSION Very low certainty evidence suggests single-forward and repeated-forward hop tests are prognostic indicators for important knee-related outcomes in individuals after ACL injury and may help stratify individuals at risk of poor outcomes to target rehabilitation interventions. PROSPERO REGISTRATION NUMBER CRD42018092197.
Collapse
Affiliation(s)
- Thomas J West
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Australian IOC Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Andrea M Bruder
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Australian IOC Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Australian IOC Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia .,Australian IOC Research Centre, La Trobe University, Bundoora, Victoria, Australia
| |
Collapse
|
28
|
Cronström A, Tengman E, Häger CK. Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction. Sports Med 2023; 53:91-110. [PMID: 36001289 PMCID: PMC9807539 DOI: 10.1007/s40279-022-01747-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified. OBJECTIVE The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR. METHODS A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality. RESULTS Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69-9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26-3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32-3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58-2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21-2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34-2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39-0.59), female sex (OR 0.88, 95% CI 0.79-0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69-0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62-0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture. CONCLUSION Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.
Collapse
Affiliation(s)
- Anna Cronström
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
29
|
Ronden AE, Koc BB, van Rooij L, Schotanus MG, Jansen EJ. Low percentage of patients passed the 'Back in Action' test battery 9 months after bone-patellar tendon-bone anterior cruciate ligament reconstruction. J Clin Orthop Trauma 2022; 34:102025. [PMID: 36147380 PMCID: PMC9486609 DOI: 10.1016/j.jcot.2022.102025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction is recommended in patients who intend to return to high-level sports. However, there is only a 55-80% return to pre-injury level of sports after ACL reconstruction, with a re-injury rate up to 20%. The aim of this study was to determine the percentage of patients passing the Back in Action (BIA) test 9 months after primary bone-patellar-tendon-bone (BPTB) ACL reconstruction, and evaluate the association between passing the BIA test and patient reported outcome measurements (PROMs). Methods Patients underwent the BIA test 9 months after BPTB ACL reconstruction. In total 103 patients were included. Passing the BIA test (PASSED-group) was defined as a normal or higher score at all sub-tests with limb symmetry index (LSI) ≥90% for the dominant leg and LSI >80% for the non-dominant leg. Patients who did not meet these criteria were defined as the FAILED-group. PROMs included the International Knee Documentation Committee, Knee injury Osteoarthritis Outcome Score and Anterior Cruciate Ligament-Return to Sport after Injury. Results Eighteen patients (17.5%) passed the BIA test 9 months after BPTB ACL reconstruction. PROMs were not statistically significant different between the PASSED- and FAILED-group. Conclusion Low percentage of patients passed the BIA test 9 months after BPTB ACL reconstruction. Although current PROMs cut-off values were met, the BIA test results show persistent functional deficits. Therefore, the BIA test could be of additional value in the decision-making process regarding return to sport (RTS). This study highlights the need for additional rehabilitation as RTS in a condition of incomplete recovery may increase the risk of re-injury. Level of evidence II.
Collapse
Affiliation(s)
- Annick E. Ronden
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Baris B. Koc
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Lize van Rooij
- Maastricht University, Faculty of Health Medicine & Life Sciences, Maastricht, the Netherlands
| | - Martijn G.M. Schotanus
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Edwin J.P. Jansen
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| |
Collapse
|
30
|
Piussi R, Krupic F, Sundemo D, Svantesson E, Ivarsson A, Johnson U, Samuelsson K, Hamrin Senorski E. 'I was young, I wanted to return to sport, and re-ruptured my ACL' - young active female patients' voices on the experience of sustaining an ACL re-rupture, a qualitative study. BMC Musculoskelet Disord 2022; 23:760. [PMID: 35941679 PMCID: PMC9360700 DOI: 10.1186/s12891-022-05708-9] [Citation(s) in RCA: 2] [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: 11/19/2021] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Despite anterior cruciate ligament (ACL) re-ruptures being common, research on patient experiences after knee trauma has primarily focused on the time after primary ACL reconstruction. Integrating qualitative research and patient experiences can facilitate researchers and clinicians in understanding the burden of an ACL re-rupture. The aim of the study was to explore the experiences of an ACL re-rupture journey in young active females aiming to return to knee-strenuous sports after primary ACL reconstruction. Method Fifteen young (19[range 16–23] years old) active females who suffered an ACL re-rupture were interviewed with semi-structured interviews. Qualitative content analysis using deductive approach based on Wiese-Bjornstal’s ‘integrated model of response to sport injury’ was used. Results The results are presented in two timelines 1) from first ACL injury to ACL re-rupture, and 2) from ACL re-rupture to present day, and further stratified according to the domains of the ‘integrated model of psychological response to injury’. Results in the first timeline are summarised into seven categories: Finding hope for the journey; Accepting my ACL injury; I succeeded; What matters now? Who am I?; Where will this end? What is going to happen? In the second timeline, eight categories were identified: Fighting spirit; A helping hand; Working hard; I am a new me; I am destroyed; Loneliness; Painful changes; and, I could have made it to the pro´s. Conclusion Young active females who suffered an ACL re-rupture did not express any positive experience following their first ACL injury, however, in contrast, expressed positive experiences and personal growth after going through the ACL re-rupture journey, characterized by a lot of struggling, and ultimately led to the experience of becoming a new, stronger person.
Collapse
Affiliation(s)
- Ramana Piussi
- SportRehab Sports Medicine Clinic, Gothenburg, Sweden. .,Sahlgrenska Sports Medicine Center, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ferid Krupic
- Sahlgrenska Sports Medicine Center, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Sundemo
- Sahlgrenska Sports Medicine Center, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eleonor Svantesson
- Sahlgrenska Sports Medicine Center, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Ivarsson
- Centre of Research On Welfare Health and Sport (CVHI), Halmstad University, Halmstad, Sweden.,Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Urban Johnson
- Centre of Research On Welfare Health and Sport (CVHI), Halmstad University, Halmstad, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- SportRehab Sports Medicine Clinic, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
31
|
Ueda Y, Matsushita T, Shibata Y, Takiguchi K, Ono K, Kida A, Ono R, Nagai K, Hoshino Y, Matsumoto T, Sakai Y, Kuroda R. Association Between Meeting Return-to-Sport Criteria and Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221093985. [PMID: 35571971 PMCID: PMC9096206 DOI: 10.1177/23259671221093985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The relationship between meeting return-to-sport criteria and psychological readiness after anterior cruciate ligament (ACL) reconstruction is unknown. Purposes: To examine (1) whether patients who met 1 of the criteria for return to sport had higher psychological readiness than those who did not meet any of the criteria and (2) if those who met more criteria had higher psychological readiness. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included 144 patients who underwent unilateral ACL reconstruction. All patients had regularly participated in some sport activities before an ACL rupture. At 12 months postoperatively, each patient completed 3 knee function tests (isokinetic quadriceps strength, isokinetic hamstring strength, and single-leg hop distance) and 2 self-reported measures (International Knee Documentation Committee [IKDC] 2000 subjective form and ACL–Return to Sport after Injury [ACL-RSI] scale); the ACL-RSI scale was used to measure psychological readiness to return to sport. The 4 criteria for return to sport were a limb symmetry index (LSI) ≥90% for each of the 3 function tests in addition to an IKDC score ≥90. Multivariate regression analysis was used to determine the association between meeting the individual criteria and the ACL-RSI score. In addition, the patients were divided into 5 groups according to the number of criteria met, and the Kruskal-Wallis and Steel-Dwass tests were used to compare the ACL-RSI scores among the groups. Results: Overall, 23 patients (16.0%) met none of the criteria for return to sport, 27 (18.7%) met 1 of the criteria, 34 (23.6%) met 2 criteria, 35 (24.3%) met 3 criteria, and 25 (17.4%) met all 4 criteria. Meeting the criteria for the hamstring strength LSI (P = .002), single-leg hop distance LSI (P = .004), and IKDC subjective score (P < .001) was each associated with higher ACL-RSI scores. Significant differences in ACL-RSI scores were found between patients who met none versus 2, 3, and 4 of the return-to-sport criteria (P < .001 for all) and between patients who met 1 versus 4 criteria (P < .001). Conclusion: Meeting return-to-sport criteria was positively associated with psychological readiness, and the patients who met multiple criteria had higher psychological readiness.
Collapse
Affiliation(s)
- Yuya Ueda
- Kobe University Graduate School of Health Sciences, Kobe, Japan
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yohei Shibata
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Kohei Takiguchi
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Kumiko Ono
- Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Akihiro Kida
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan
| | - Rei Ono
- Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Department of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
32
|
Drigny J, Ferrandez C, Gauthier A, Guermont H, Praz C, Reboursière E, Hulet C. Knee strength symmetry at 4 months is associated with criteria and rates of return to sport after anterior cruciate ligament reconstruction. Ann Phys Rehabil Med 2022; 65:101646. [PMID: 35167984 DOI: 10.1016/j.rehab.2022.101646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 12/24/2021] [Accepted: 01/24/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Strength limb symmetry index (LSI) is a useful criterion to help in return-to-sport performance (RTP) after anterior cruciate ligament reconstruction (ACLR). OBJECTIVES We aimed to assess whether knee extensor and flexor LSI values at 4 months after ACLR are associated with those recommended at 8 months after ACLR for RTP (80%, 85% and 90%) and with successful RTP after 2 years. METHODS This was prospective cohort study of 113 participants who underwent primary ACLR. Personal factors such as demographic and sport information, injury and surgery characteristics were collected at 6 weeks after surgery. Isokinetic strength LSI (60°/s) was calculated at 4 months (LSI[4m]) and 8 months (LSI[8m]) for knee extensors (Q-LSI) and flexors (H-LSI). Participants were followed at 2 years after ACLR to determine their self-reported RTP. Multiple linear regression analysis was used to determine associations between personal factors and LSI at 4 and 8 months. Associations between passing the optimal cut-off thresholds and RTP were tested with chi-square tests and odds ratios (ORs) with effect sizes (ES). RESULTS Among the 113 participants (mean age 25.2 [SD 9.7] years; 42% females), extended tourniquet time and lower level of pre-injury sport were associated with lower Q-LSI[4m] and H-LSI[4m]. Bone-patellar tendon-bone graft was associated with lower Q-LSI[4m] and Q-LSI[8m], and older age was associated with lower Q-LSI[4m]. For knee extensors, Q-LSI[4m] >59% was associated with Q-LSI[8m] >80% (OR= 31.50, p <0.001, large ES) and increased odds of successful RTP (60% vs 31%, OR= 3.45, p= 0.003, medium ES). For knee flexors, H-LSI[4m] >72% was associated with H-LSI[8m] >90% (OR= 6.03, p <0.001, large ES) and increased odds of successful RTP (53% vs 23%, OR= 3.76, p= 0.013, small-to-medium ES). CONCLUSIONS After primary ACLR, 4-month post-operative strength symmetry was negatively associated with age, pre-injury sport and tourniquet time and bone-patellar tendon-bone graft. Four-month post-operative LSI was associated with 8-month post-operative LSI, and Q-LSI[4m] >59% or H-LSI[4m] >72% was associated with increased RTP rates after 2 years. CLINICALTRIALS.GOV: : NCT04071912.
Collapse
Affiliation(s)
- Joffrey Drigny
- Service de Médecine Physique et de Réadaptation, Service de Médecine du Sport, CHU de Caen Normandie, Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, Caen 14000, France.
| | - Clémence Ferrandez
- Service de Médecine Physique et de Réadaptation, Service de Médecine du Sport, CHU de Caen Normandie, Caen 14000, France
| | - Antoine Gauthier
- Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, Caen 14000, France
| | - Henri Guermont
- Service de Médecine du Sport, CHU de Caen Normandie, Caen 14000, France
| | - César Praz
- Département d'orthopédie et de traumatologie, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen 14000, France
| | | | - Christophe Hulet
- Département d'orthopédie et de traumatologie, Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, Caen 14000, France
| |
Collapse
|
33
|
Di Paolo S, Zaffagnini S, Tosarelli F, Grassi A, Della Villa F. Beyond Distance: A Simple Qualitative Assessment of the Single-Leg Hop Test in Return-to-Play Testing. Sports Health 2022; 14:906-911. [PMID: 35081839 PMCID: PMC9631045 DOI: 10.1177/19417381211063450] [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] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Limb symmetry index in the single-leg hop (SLH) test has been questioned for its low predictive value in identifying secondary anterior cruciate ligament (ACL) injury. The purpose of this study was to describe a qualitative 2-dimensional (2D) scoring system for the assessment of the SLH test and associate it with the vertical ground-reaction forces (vGRF) and sagittal plane biomechanics evaluated through gold standard 3D motion analysis. HYPOTHESIS Stiff landings would be associated with low 2D scores. STUDY DESIGN Descriptive laboratory study. LEVEL OF EVIDENCE Level 4. METHODS Thirty-four competitive football (soccer) players (age 22.8 ± 4.1 years, 16 women) were enrolled. Each athlete performed a series of SLH tests. Three-dimensional motion analysis was recorded using 10 stereophotogrammetric cameras, a force platform, and 3 high-speed cameras. The 2D qualitative assessment was performed through a scoring system based on the video-analysis of sagittal plane joint kinematics. A score of 0/2 (inadequate), 1/2 (partially adequate), or 2/2 (adequate) was attributed to the movement, based on objective measurements. The vGRF was extracted from the force platform and grouped according to the results of the 2D evaluation. RESULTS Significantly higher vGRF (stiffer landing) was found for athletes obtaining a 0/2 score compared with those obtaining a 2/2 score (up to 0.8 body weight higher, P < 0.01). A significant negative rank correlation was found between the vGRF and the total score (ρ = -0.17, P = 0.03). CONCLUSION The qualitative scoring system effectively identified stiff landings in the SLH for distance test. CLINICAL RELEVANCE The qualitative scoring system could be a user-friendly standardized method to assess athletes' movement quality in return to sport clearance decision after ACL injury.
Collapse
Affiliation(s)
- Stefano Di Paolo
- Department for Life Quality Studies,
University of Bologna, Bologna, Italy
- Stefano Di Paolo,
Department for Life Quality Studies QUVI, Università di Bologna, Via Giulio
Cesare Pupilli, 1, Bologna (BO), 40136, Italy (
) (Twitter: @StDiPaolo)
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic
Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor
Sciences, University of Bologna, Bologna, Italy
| | - Filippo Tosarelli
- Education and Research Department,
Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Alberto Grassi
- 2nd Orthopaedic and Traumatologic
Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department,
Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| |
Collapse
|
34
|
van der Horst N, Denderen R. Isokinetic hamstring and quadriceps strength interpretation guideline for football (soccer) players with ACL reconstruction: a Delphi consensus study in the Netherlands. SCI MED FOOTBALL 2022; 6:434-445. [DOI: 10.1080/24733938.2021.2024592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nick van der Horst
- Fifa Medical Centre of Excellence, Royal Netherlands Football Association (Knvb), Zeist, The Netherlands
| | - Remy Denderen
- Fifa Medical Centre of Excellence, Royal Netherlands Football Association (Knvb), Zeist, The Netherlands
| |
Collapse
|
35
|
van Melick N, Pronk Y, Nijhuis-van der Sanden M, Rutten S, van Tienen T, Hoogeboom T. Meeting movement quantity or quality return to sport criteria is associated with reduced second ACL injury rate. J Orthop Res 2022; 40:117-128. [PMID: 33650704 DOI: 10.1002/jor.25017] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 02/04/2023]
Abstract
The purposes of this prospective cohort study were (1) to assess if second anterior cruciate ligament (ACL) injury rate 2 years after ACL reconstruction (ACLR) in those who returned to pivoting sport was associated with meeting (a) quantitative return to sport (RTS) criteria, (b) qualitative RTS criteria, and (c) combined quantitative and qualitative RTS criteria, and (2) to determine why athletes did not return to their preinjury (level of) sport. Athletes after ACLR performed RTS tests immediately before RTS: seven movement quantity (strength and hop test battery) and two movement quality (countermovement jump with LESS score and hop-and-hold test) tests. A 2-year postoperative questionnaire asked for RTS, reasons for not returning to the same (level of) sport and second ACL injuries. One hundred and forty-four athletes (82%) completed the questionnaire and 97 of them returned to a pivoting sport. Seven of these athletes had a second ACL injury. Meeting the hop test battery RTS criterion (absolute risk reduction 11%; p = .047) and hop-and-hold test RTS criterion (absolute risk reduction 15%; p = .031) were both significantly associated with a reduced second ACL injury rate. Meeting combined RTS criteria were not significantly associated with second ACL injury rate. Therefore, RTS tests after ACLR should at least comprise a hop test battery or the hop-and-hold test to reduce second ACL injury risk after return to pivoting sport. Also, one-third of all athletes mentioned fear of reinjury as the main reason for not returning to their preinjury (level of) sport. This psychological component should be taken seriously and discussed during rehabilitation.
Collapse
Affiliation(s)
- Nicky van Melick
- Research Department, Kliniek ViaSana, Mill, The Netherlands.,KneeSearch, Heesch, The Netherlands
| | - Yvette Pronk
- Research Department, Kliniek ViaSana, Mill, The Netherlands
| | - Maria Nijhuis-van der Sanden
- Research Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sebastiaan Rutten
- Department of Orthopedic Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Tony van Tienen
- Department of Orthopedic Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - Thomas Hoogeboom
- Research Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
36
|
Gokeler A, Dingenen B, Hewett TE. Rehabilitation and Return to Sport Testing After Anterior Cruciate Ligament Reconstruction: Where Are We in 2022? Arthrosc Sports Med Rehabil 2022; 4:e77-e82. [PMID: 35141539 PMCID: PMC8811523 DOI: 10.1016/j.asmr.2021.10.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/30/2021] [Indexed: 01/02/2023] Open
Abstract
Athletes who sustain an anterior cruciate ligament (ACL) injury often opt for an ACL reconstruction (ACLR) with the goal and expectation to return to sports at the preinjury level. The proportion of athletes who successfully return to preinjury-level sport is low and disappointing, whereas the rate of second ACL injury in athletes under the age of 20 has been reported to be as high as 40% after return to sport (RTS). Although in recent years, new insights pertaining to RTS have been published, the lack of validity of RTS criteria after ACLR remain. The purpose of this clinical commentary is to present a critical overview of the current literature on RTS testing after ACLR.
Collapse
Affiliation(s)
- Alli Gokeler
- OCON Centre of Orthopaedic Surgery and Sports Medicine, Hengelo, The Netherlands.,Exercise Science and Neuroscience Unit, Department Exercise & Health, Faculty of Science, University of Paderborn, Paderborn, Germany
| | - Bart Dingenen
- Reval Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Timothy E Hewett
- Hewett Global Consultants, Rochester, Minnesota, U.S.A.,Rocky Mountain Consortium for Sports Research, Edwards, Colorado, U.S.A
| |
Collapse
|
37
|
Chaaban CR, Turner JA, Padua DA. Think outside the box: Incorporating secondary cognitive tasks into return to sport testing after ACL reconstruction. Front Sports Act Living 2022; 4:1089882. [PMID: 36873910 PMCID: PMC9975395 DOI: 10.3389/fspor.2022.1089882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/30/2022] [Indexed: 02/17/2023] Open
Abstract
The optimal set of return to sport (RTS) tests after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) remains elusive. Many athletes fail to pass current RTS test batteries, fail to RTS, or sustain secondary ACL injuries if they do RTS. The purpose of this review is to summarize current literature regarding functional RTS testing after ACLR and to encourage clinicians to have patients "think" (add a secondary cognitive task) outside the "box" (in reference to the box used during the drop vertical jump task) when performing functional RTS tests. We review important criteria for functional tests in RTS testing, including task-specificity and measurability. Firstly, tests should replicate the sport-specific demands the athlete will encounter when they RTS. Many ACL injuries occur when the athlete is performing a dual cognitive-motor task (e.g., attending to an opponent while performing a cutting maneuver). However, most functional RTS tests do not incorporate a secondary cognitive load. Secondly, tests should be measurable, both through the athlete's ability to complete the task safely (through biomechanical analyses) and efficiently (through measures of performance). We highlight and critically examine three examples of functional tests that are commonly used for RTS testing: the drop vertical jump, single-leg hop tests, and cutting tasks. We discuss how biomechanics and performance can be measured during these tasks, including the relationship these variables may have with injury. We then discuss how cognitive demands can be added to these tasks, and how these demands influence both biomechanics and performance. Lastly, we provide clinicians with practical recommendations on how to implement secondary cognitive tasks into functional testing and how to assess athletes' biomechanics and performance.
Collapse
Affiliation(s)
- Courtney R Chaaban
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jeffrey A Turner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
38
|
Predictors of patient satisfaction after primary hamstring anterior cruciate ligament reconstruction. Knee 2022; 34:246-251. [PMID: 35065328 DOI: 10.1016/j.knee.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/26/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Predictors of patient satisfaction (PS) after anterior cruciate ligament (ACL) reconstruction are not well known. This study investigated predictors of PS and whether PS was associated with pre-injury level of sport participation, patient reported knee function and quality of life after ACL reconstruction. METHODS Patients who underwent primary hamstring ACL reconstruction between January 2015 and December 2017 were retrospectively evaluated. An online survey was used to evaluate PS (yes = satisfied, no = unsatisfied), duration of supervised postoperative rehabilitation, timing of return to pre-injury level of sport, pre-injury level of sport participation, patient reported knee function and quality of life. Preoperative, operative and postoperative variables were collected from the medical records. RESULTS A total of 183 patients completed the survey at a median of 3.6 (1.5) years after ACL surgery. At final follow-up, 82% of patients were satisfied with the outcome. Preoperative (e.g. age) and operative (e.g. meniscal tear) variables were not predictors of PS (p > 0.05). Duration of supervised postoperative rehabilitation, timing of return to pre-injury level of sport and postoperative ACL injury were predictors of PS (p = 0.018, p = 0.016 and p < 0.001, respectively). Pre-injury level of sport participation was significantly higher in satisfied compared to unsatisfied patients: 44.7% (n = 67) versus 18.2% (n = 6) (p = 0.005). In addition, satisfied patients reported significantly higher patient reported knee function and quality of life compared to unsatisfied patients (p < 0.001). CONCLUSION This study provided data on predictors of PS after primary ACL reconstruction. Furthermore, PS was associated with pre-injury level of sport participation, patient reported knee function and quality of life.
Collapse
|
39
|
Hughes R, Cross M, Stokes K, Tobin D, Power E, McNally S, Pamment J. Novel biomechanical injury risk score demonstrates correlation with lower limb posterior chain injury in 50 elite-level rugby union athletes. BMJ Open Sport Exerc Med 2021; 7:e001062. [PMID: 34745646 PMCID: PMC8527128 DOI: 10.1136/bmjsem-2021-001062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 01/07/2023] Open
Abstract
Objectives Lower limb posterior chain injury (PCI) is common among athletic populations, with multifactorial risk factors including age, previous injury, strength measurements, range of motion and training load. Biomechanics are commonly considered in the prevention and rehabilitation of PCI by performance staff. However, there is no documented testing method to assess for associations between biomechanics and PCI. The aim of this study was to investigate whether there is an association between an easily applicable, novel biomechanical assessment tool and PCI. Methods Fifty male elite-level rugby union athletes (age 22.83±5.08) participating in the highest tier of England were tested at the start of the 2019 preseason period and PCIs (N=48) were recorded over the 2019/2020 playing season. Participants’ biomechanics were analysed using two-dimensional video analysis against an injury risk score (IRS) system in the performance of the combined movement—prone hip extension and knee flexion. Participants’ biomechanics in carrying out this movement were scored against the 10-point IRS, where the more compensatory movement recorded sees an increase in an individual’s IRS. Participants’ IRS was then compared against the number of PCIs sustained and Spearman’s correlation coefficient was used for statistical analysis. Results There is a significant association between IRS and PCI (R=0.542, p<0.001). Linear regression demonstrated that an increase in 1 in IRS was associated with a 35% increase in PCI incidence (R²=0.346). Conclusion A significance between the IRS and PCI provides preliminary support for its use as an injury risk assessment tool.
Collapse
Affiliation(s)
- Rhys Hughes
- Performance Medical Department, Gloucester Rugby Ltd, Gloucester, UK.,Department for Health, University of Bath, Bath, UK
| | - Matt Cross
- Research and Rugby Development, Premier Rugby Ltd, Twickenham, UK
| | - Keith Stokes
- Department for Health, University of Bath, Bath, UK.,Medical Research, Rugby Football Union, Twickenham, London, UK
| | - Daniel Tobin
- Performance Medical Department, Gloucester Rugby Ltd, Gloucester, UK
| | - Eoin Power
- Performance Medical Department, Gloucester Rugby Ltd, Gloucester, UK
| | - Steph McNally
- Performance Medical Department, Gloucester Rugby Ltd, Gloucester, UK
| | - Jonathan Pamment
- Performance Medical Department, Gloucester Rugby Ltd, Gloucester, UK
| |
Collapse
|
40
|
de Fontenay BP, van Cant J, Gokeler A, Roy JS. Reintroduction of running after ACL reconstruction with a hamstring graft: can we predict short-term success? J Athl Train 2021; 57:540-546. [PMID: 34623431 DOI: 10.4085/1062-6050-0407.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Return to running (RTR) after anterior cruciate ligament reconstruction (ACL-R) is a crucial milestone. However, there is uncertainty on how and when to start a running program. OBJECTIVE To explore the feasibility of a structured program to reintroduce running after ACL-R and to evaluate the predictive value of potential predictors of short-term success. DESIGN Longitudinal cohort study. SETTING Local Research Center / participant's home. PATIENTS Thirty-five participants were recruited after ACL-R. INTERVENTION Program with a progression algorithm to reintroduce running (10 running sessions in 14 days). MAIN OUTCOME MEASURES The criterion for short-term success was no exacerbation of symptoms. Potential predictors included: (i) the International Knee Document Committee (IKDC) subjective knee form; (ii) ACL Return to Sport after Injury questionnaire; (iii) quadriceps and hamstring strength; (iv) Step-Down Endurance test; and (v) the modified Star Excursion Balance test. Descriptive statistics were performed to study the feasibility of the RTR program and Poisson regression analysis was used to evaluate predictors of success. RESULTS Of the 34 participants included, 33 completed the RTR program. Sixteen participants experienced some temporary exacerbation of symptoms, but only one had to stop the RTR program. Initial IKDC score was the only significant predictor of a successful RTR with an Area under the ROC curve of 80.4%. An ICKD cut-off of 63.7/100 differentiated responders and non-responders with the highest sensitivity and specificity (77.8% and 75.0%, respectively). There was a 3-fold greater chance of success with an IKDC score above this threshold. CONCLUSIONS Our results confirm the feasibility of our RTR program and progression algorithm after ACL-R. Clinicians should use an IKDC score of >64 as a criterion to reintroduce running after ACL-R to increase the likelihood of short-term success.
Collapse
Affiliation(s)
- Benoit Pairot de Fontenay
- 1 University of Lyon - University Claude Bernard Lyon 1, EA 7424 - Inter-university Laboratory of Human Movement Science
| | - Joachim van Cant
- 2 Faculté des Sciences de la Motricité, Université Libre de Bruxelles, Brussels, Belgium
| | - Alli Gokeler
- 3 Exercise Science & Neuroscience Unit, Department Exercise and Health, Faculty of Science, Paderborn University, Paderborn.,4 Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg.,5 Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean-Sebastien Roy
- 6 Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada G1M 2S8.,7 Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada G1R 1P5
| |
Collapse
|
41
|
Larson D, Nathan Vannatta C, Rutherford D, Kernozek TW. Kinetic changes associated with extended knee landings following anterior cruciate ligament reconstruction in females. Phys Ther Sport 2021; 52:180-188. [PMID: 34555646 DOI: 10.1016/j.ptsp.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To determine the relationship between knee flexion excursion symmetry and lower extremity kinematics, kinetics, and muscle, joint, and ligament forces in females 1-3 years after ACL reconstruction. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Twenty-one, college-aged females. MAIN OUTCOME MEASURES Lower extremity kinetics and kinematics, including estimated muscle, tibiofemoral, and ligament forces were assessed using 3D motion analysis and a musculoskeletal modeling approach. Participants demonstrating greater than 10% asymmetry in knee flexion excursion were classified as landing with an "extended knee". Group and between-limb differences were compared. RESULTS Ten participants were classified as landing with an "extended knee" on the involved limb, while eleven exhibited a symmetric landing pattern. Participants landing with an "extended knee" demonstrated reduced knee extension moment and quadriceps force in the involved limb (p < 0.05). CONCLUSIONS These findings indicate that an "extended knee" landing pattern was associated with reduced knee extension moment and quadriceps muscle force in females 1-3 years after ACL reconstruction. This may represent an altered strategy that clinicians may choose to identify and address during rehabilitation.
Collapse
Affiliation(s)
- Daniel Larson
- Sports Physical Therapy Department, Gundersen Health System, Onalaska, WI, USA.
| | - C Nathan Vannatta
- Sports Physical Therapy Department, Gundersen Health System, Onalaska, WI, USA; La Crosse Institute for Movement Science, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Drew Rutherford
- La Crosse Institute for Movement Science, University of Wisconsin-La Crosse, La Crosse, WI, USA; Health Professions Department, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, University of Wisconsin-La Crosse, La Crosse, WI, USA; Health Professions Department, University of Wisconsin-La Crosse, La Crosse, WI, USA
| |
Collapse
|
42
|
Composite Score of Readiness (CSR) as Holistic Profiling of Functional Deficits in Footballers Following ACL Reconstruction. J Clin Med 2021; 10:jcm10163570. [PMID: 34441865 PMCID: PMC8397164 DOI: 10.3390/jcm10163570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background: The decision to return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction is difficult; thus, coaching staff require a readable, easy-to-use, and holistic indication of an athlete’s readiness to play. Purpose: To present the Composite Score of Readiness (CSR) as a method providing a single score for RTS tests after ACL reconstruction. Methods: The study comprised 65 male football players (age 18–25 years), divided into three groups: ACL group—subjects after ACL rupture and reconstruction, Mild Injury (MI) group—subjects after mild lower limb injuries, and Control (C) group—subjects without injuries. The CSR was calculated based on three performed tests (Y-balance test, Functional Movement Screen, and Tuck Jump Assessment) and expressed as the sum of z-scores. The CSR index allows highlighting an athlete’s functional deficits across tests relative to the evaluated group. Results: The CSR indicated that relative to the group of athletes under the study, similar functional deficits were present. Comparing athletes following ACL reconstruction to both the MI and C groups, in the majority of subjects, the CSR index was below zero. The correlation between CSR and raw tests results indicated that the CSR is most strongly determined by YBT. Conclusion: The CSR is a simple way to differentiate people after serious injuries (with large functional deficits) from people without injuries or with only small deficits. Because the CSR is a single number, it allows us to more easily interpret the value of functional deficits in athletes, compared to rating those deficits based on raw tests results.
Collapse
|
43
|
Fältström A, Hägglund M, Hedevik H, Kvist J. Poor Validity of Functional Performance Tests to Predict Knee Injury in Female Soccer Players With or Without Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:1441-1450. [PMID: 33844590 DOI: 10.1177/03635465211002541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various tests have been developed to evaluate athletes' functional performance and for use as screening tools for injury prediction. Further validation of their accuracy to predict injury is needed. PURPOSE To investigate the validity of predetermined cutoffs used to differentiate between high- and low-risk players in different functional performance tests to predict (1) anterior cruciate ligament (ACL) injury or (2) severe traumatic knee injury in a cohort of female soccer players with a primary unilateral ACL reconstruction and a cohort of knee-healthy players. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 117 active female soccer players (mean age ± SD, 20 ± 2 years) an average of 19 ± 9 months after ACL reconstruction and 119 knee-healthy players (age, 19 ± 3 years) were prospectively followed up for 2 years for new knee injuries. At baseline, all players underwent tests to assess postural control (Star Excursion Balance Test), hop performance (single-leg hop for distance, side hop), and movement asymmetries in the lower limbs and trunk (drop vertical jump [DVJ], tuck jump). The predictive validity of the test cutoffs to identify players who would sustain an ACL injury or a severe traumatic knee injury (absence from soccer play, >28 days) was assessed. The risk ratio (RR), area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated. RESULTS A total of 46 players (39%) with ACL reconstruction sustained 48 severe knee injuries, including 28 ACL ruptures. Of the knee-healthy players, 13 (11%) sustained 14 severe knee injuries, including 8 ACL ruptures. No association was found between the predetermined functional performance test cutoffs and the risk of a new ACL injury or severe knee injury in players with ACL reconstruction. In knee-healthy players, the only variable associated with future ACL injury was ≥6.5 cm knee valgus in the frontal plane (any knee) in the DVJ (RR, 4.93; 95% CI, 1.04-23.40; P = .045), but with only fair predictive validity (AUC, 0.7; sensitivity, 0.75; specificity, 0.65). CONCLUSION In our cohorts of female soccer players, the validity of commonly used functional performance tests to predict new knee injuries was poor. Only knee valgus during the DVJ was associated with new ACL injuries in knee-healthy players, but with only fair predictive validity.
Collapse
Affiliation(s)
- Anne Fältström
- Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.,Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Martin Hägglund
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Hedevik
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
44
|
Roe C, Jacobs C, Hoch J, Johnson DL, Noehren B. Test Batteries After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2021; 14:205-215. [PMID: 33896240 DOI: 10.1177/19417381211009473] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT There is a lack of consensus regarding test batteries for return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE To report the RTS test batteries for individuals after ACLR and to examine alignment with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC). Finally, to examine how published RTS batteries prior to the AAOS AUC (2010-2015) compared with those after publication of the AUC (2016-2020). DATA SOURCE A systematic search of PubMed (2010-2020). STUDY SELECTION Studies were included if they were published from 2010 to 2020, patients underwent primary ACLR and were tested between 6 months and 2 years postoperatively and included a minimum of 2 assessments. Studies were excluded if patients were tested outside the designated time; had undergone a revision, contralateral, or multiligament injury; included healthy participants; were level 5 evidence or the study was a systematic review. A total of 1012 articles were reviewed and 63 met the criteria. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Information regarding the RTS batteries and patient demographics were extracted from the included articles. RESULTS A total of 63 studies met the inclusion and exclusion criteria (22 from 2010-2015 and 41 from 2016-2020). The most common RTS batteries included the hop test, quadriceps strength test, and patient-reported outcome measures. No study met all 7 AUC; the most common criteria met were functional skills (98.4%), followed by confidence (22.2%), then range of motion and knee stability (20.6%). CONCLUSION The test batteries in the current literature show high variability and a lack of essential components necessary for RTS. No study met the AUC guidelines, suggesting a disconnect between recommended guidelines and clinical practice. Test battery research has expanded over the past decade; however, standardized, clinically applicable batteries that encompass all criteria are needed.
Collapse
Affiliation(s)
- Chelsey Roe
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | - Cale Jacobs
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Johanna Hoch
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Darren L Johnson
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
45
|
Faleide AGH, Magnussen LH, Strand T, Bogen BE, Moe-Nilssen R, Mo IF, Vervaat W, Inderhaug E. The Role of Psychological Readiness in Return to Sport Assessment After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:1236-1243. [PMID: 33656938 PMCID: PMC8020301 DOI: 10.1177/0363546521991924] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knowledge about the predictive value of return to sport (RTS) test batteries applied after anterior cruciate ligament reconstruction (ACLR) is limited. Adding assessment of psychological readiness has been recommended, but knowledge of how this affects the predictive ability of test batteries is lacking. PURPOSE To examine the predictive ability of a RTS test battery on return to preinjury level of sport and reinjury when evaluation of psychological readiness was incorporated. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 129 patients were recruited 9 months after ACLR. Inclusion criteria were age ≥16 years and engagement in sports before injury. Patients with concomitant ligamentous surgery or ACL revision surgery were excluded. Baseline testing included single-leg hop tests, isokinetic strength tests, the International Knee Documentation Committee (IKDC) Subjective Knee Form 2000, a custom-made RTS questionnaire, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. The RTS criteria were IKDC 2000 score ≥85% and ≥85% leg symmetry index on hop and strength test. At a 2-year follow-up evaluation, further knee surgery and reinjuries were registered and the RTS questionnaire was completed again. Regression analyses and receiver operating characteristic analyses were performed to study the predictive ability of the test battery. RESULTS Out of the 103 patients who completed the 2-year follow-up, 42% returned to their preinjury level of sport. ACL-RSI 9 months after surgery (odds ratio [OR], 1.03) and age (OR, 1.05) predicted RTS. An ACL-RSI score <47 indicated that a patient was at risk of not returning to sport (area under the curve 0.69; 95% CI, 0.58-0.79), with 85% sensitivity and 45% specificity. The functional tests did not predict RTS. Six patients sustained ACL reinjuries and 7 underwent surgery for other knee complaints/injuries after RTS testing. None of the 29 patients who passed all RTS criteria, and were therefore cleared for RTS, sustained a second knee injury. CONCLUSION ACL-RSI and age were predictors of 2-year RTS, while functional tests were not informative. Another main finding was that none of the patients who passed the 85% RTS criteria sustained another knee injury.
Collapse
Affiliation(s)
- Anne Gro Heyn Faleide
- Haraldsplass Deaconess Hospital, Bergen,
Norway,University of Bergen, Bergen,
Norway,Anne Gro Heyn Faleide, PT, MSc, Haraldsplass Deaconess Hospital,
V/Avdeling for Rehabiliteringstjenester, Postboks 6165, Bergen, 5892, Norway
() (Twitter:
@Knegruppen)
| | | | | | - Bård Erik Bogen
- Haraldsplass Deaconess Hospital, Bergen,
Norway,Western Norway University of Applied
Sciences, Bergen, Norway
| | | | | | | | - Eivind Inderhaug
- University of Bergen, Bergen,
Norway,Haukeland University Hospital, Bergen,
Norway
| |
Collapse
|
46
|
Low correlation between functional performance and patient reported outcome measures in individuals with non-surgically treated ACL injury. Phys Ther Sport 2021; 47:185-192. [DOI: 10.1016/j.ptsp.2020.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
|
47
|
Can We Capitalize on Central Nervous System Plasticity in Young Athletes to Inoculate Against Injury? ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42978-020-00080-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|