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Tortoli E, Pellicciari L, Giovannico G, Tak I. Return to running criteria after anterior cruciate ligament reconstruction: an online survey of 1404 Italian physiotherapists. J Sports Med Phys Fitness 2024; 64:931-941. [PMID: 38863416 DOI: 10.23736/s0022-4707.24.15811-2] [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: 06/13/2024]
Abstract
BACKGROUND The aim of this study is to study the clinical decision-making practice of Italian physiotherapists in return to running (RTR) after anterior cruciate ligament (ACL) reconstruction, and the differences in decision-making in relation to physiotherapist's characteristics. METHODS An online survey was developed, 1404 physiotherapists were contacted by email, via chartered association, or via social media. RESULTS Most respondents (83%) indicated that the RTR decision should be made by a multidisciplinary team with RTR clearance around 3-4 months after surgery (47%). The most important criteria guiding the RTR decision were knee flexion range of motion (ROM) >130° (50%), complete extension ROM (95%), no pain (45%) and no effusion (68%). A Limb Symmetry Index (LSI) >70% for quadriceps (49%), hamstring (48%) and LSI >90% for posterolateral hip (45%) and triceps surae strength (42%) should be achieved for RTR. Approximately half of the participants (49%) do not consider ACL laxity tests to be used for RTR decisions. Response differences were found between sample subgroups. More experienced physiotherapists and those with post graduate training had lower thresholds to clear RTR. CONCLUSIONS Experienced physiotherapists who treated a higher number of patients after ACL reconstruction, who had certified specialist training and a specific interest towards ACL rehabilitation, generally reported clinical practice modalities more in line with current evidence.
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Affiliation(s)
- Emanuele Tortoli
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy -
| | | | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Igor Tak
- Sports Rehabilitation and Manual Therapy, Fysiotherapie Utrecht Oost, Utrecht, the Netherlands
- Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam UMC, Amsterdam, the Netherlands
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Sengoku T, Nakase J, Mizuno Y, Ishida Y, Yanatori Y, Takemoto N, Demura S. Knee flexor strength at 6 months after anterior cruciate ligament reconstruction using hamstring tendon can be predicted from that at 3 months. Knee Surg Sports Traumatol Arthrosc 2024; 32:2474-2483. [PMID: 39015061 DOI: 10.1002/ksa.12370] [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: 01/16/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE This study aimed to identify factors influencing persistent muscle weakness in knee flexor strength after anterior cruciate ligament (ACL) reconstruction using the hamstring tendon and establish a clear cut-off value at 3 months postoperatively for the limb symmetry index (LSI) to exceed 90% at 6 months postoperatively. METHODS One hundred forty-eight patients undergoing ACL reconstruction were included and categorised into two groups based on knee flexor strength at 6 months postoperatively: patients with LSI of 90% or greater (achieved group: n = 114) and patients with LSI less than 85% (nonachieved group: n = 34). Items with significant differences between the two groups (preoperative waiting period, LSI to body weight ratio of knee flexor and extensor strength at 3 months postoperatively and peak torque angle of knee flexor muscle) were included in the multiple logistic regression analysis. Additionally, a receiver operating characteristic curve was used to calculate the cut-off value of the LSI at 3 months postoperatively, which was required to achieve the LSI criteria for knee flexor strength 6 months postoperatively. RESULTS Multiple logistic regression analysis extracted the preoperative waiting period and LSI for knee flexor strength at 3 months postoperatively. The cut-off value at 3 months postoperatively was 76.9% (area under the curve value, 0.82; sensitivity, 0.76; and specificity, 0.81) of the LSI. CONCLUSION The LSI of at least 76.9% for knee flexor strength at 3 months after ACL reconstruction was an indicator for achieving the 6 months postoperatively. This is a criterion to aim for, considering the stress on the graft and the regeneration process of the semitendinosus tendon. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Takuya Sengoku
- Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yushin Mizuno
- Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yoshihiro Ishida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yusuke Yanatori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Naoki Takemoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Maestroni L, Turner A, Papadopoulos K, Cohen D, Sideris V, Graham-Smith P, Read P. Comparison of Strength and Power Characteristics Before ACL Rupture and at the End of Rehabilitation Before Return to Sport in Professional Soccer Players. Sports Health 2023; 15:814-823. [PMID: 37203795 PMCID: PMC10606975 DOI: 10.1177/19417381231171566] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Strength and power is often reduced on the involved versus contralateral limb and healthy controls after anterior cruciate ligament (ACL) reconstruction, but no study has compared with preinjury values at the time of return to sport (RTS). HYPOTHESIS Divergent recovery patterns in strength and power characteristics will be present at RTS relative to preinjury baseline data and healthy matched controls. STUDY DESIGN Cohort study. LEVEL OF EVIDENCE Level 3. METHODS Isokinetic strength tests, bilateral and single-leg countermovement jumps (CMJ; SLCMJ) were measured before ACL rupture in 20 professional soccer players. These then had surgical reconstruction (ACL group) and completed follow-up testing before RTS. Healthy controls (uninjured group) were tested at the same time as the ACL group preinjury. Values recorded at RTS of the ACL group were compared with preinjury. We also compared the uninjured and ACL groups at baseline and RTS. RESULTS Compared with preinjury, ACL normalized quadriceps peak torque of the involved limb (difference = -7%), SLCMJ height (difference = -12.08%), and Reactive Strength Index modified (RSImod) (difference = -5.04%) were reduced after ACL reconstruction. No significant reductions in CMJ height, RSImod, and relative peak power were indicated at RTS in the ACL group when compared with preinjury values, but deficits were present relative to controls. The uninvolved limb improved quadriceps (difference = 9.34%) and hamstring strength (difference = 7.36%) from preinjury to RTS. No significant differences from baseline were shown in SLCMJ height, power, and reactive strength of the uninvolved limb after ACL reconstruction. CONCLUSION Strength and power in professional soccer players at RTS after ACL reconstruction were often reduced compared with preinjury values and matched healthy controls. CLINICAL RELEVANCE Deficits were more apparent in the SLCMJ, suggesting that dynamic and multijoint unilateral force production is an important component of rehabilitation. Use of the uninvolved limb and normative data to determine recovery may not always be appropriate.
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Affiliation(s)
- Luca Maestroni
- ReAct, Bergamo (BG), Italy
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | | | - Daniel Cohen
- Masira Research Institute, Faculty of Health Sciences, University of Santander (UDES), Bucaramanga, Colombia
- Mindeporte (Colombian Ministry of Sport) High Performance Centre, Bogota, Colombia
| | | | | | - Paul Read
- Institute of Sport, Exercise and Health, London, UK
- Division of Surgery and Interventional Science, University College London, UK
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
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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).
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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
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Wang IL, Su Y, Yao S, Jiang YH, Li HY, Lai CY. Effect of wearing medical protective masks on treadmill running performance in the postpandemic era: a randomised trial. BMC Sports Sci Med Rehabil 2023; 15:6. [PMID: 36631910 PMCID: PMC9832620 DOI: 10.1186/s13102-022-00598-9] [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: 04/21/2022] [Accepted: 11/24/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND In the postpandemic era, wearing protective masks in public places will still be an important means of blocking popular viruses in the future. The purpose of this study was to explore whether sports performance was affected by mask wearing and exercise duration during 15-min treadmill running at a speed of 75% maximal aerobic speed. METHODS Thirty-six males were randomly divided into mask and nonmask groups. The kinematic and kinetic data were obtained at four time points (RN0-1 min, RN5-6 min, RN9-10 min, and RN14-15 min) during running. Two-way mixed ANOVA was applied to examine the effects between groups and times with Bonferroni post hoc comparison and independent samples t-test. RESULTS The results showed that there was no difference between mask and nonmask group during running (p > 0.05). As running time increased, hip joint ROM, hip joint flexion/extension max, and ankle joint plantarflexion max angles increased; knee joint flexion min and ankle joint dorsiflexion max angles decreased; average peak vertical ground reaction forces (PVGRF) increased after 9 min-running (p < 0.05). CONCLUSIONS Wearing a medical protective mask does not affect the joint angle and touchdown PVGRF of lower extremities during treadmill running while affected by running time and changed after 9 min-treadmill running. Future studies will examine the effects of wearing masks during the pandemic on muscle activation and blood biochemical values during exercise. TRIAL REGISTRATION NO ChiCTR2000040535 (date of registration on December 1, 2020). Prospectively registered in the Chinese Clinical Trial Registry.
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Affiliation(s)
- I-Lin Wang
- grid.462271.40000 0001 2185 8047College of Physical Education, Hubei Normal University, Huangshi, 435000 Hubei China
| | - Yu Su
- Graduate Institute, Jilin Sport University, Changchun, 130022 Jilin China
| | - Shun Yao
- Graduate Institute, Jilin Sport University, Changchun, 130022 Jilin China
| | - Yu-Hong Jiang
- Graduate Institute, Jilin Sport University, Changchun, 130022 Jilin China
| | - Hao-Yu Li
- grid.462271.40000 0001 2185 8047Graduate Institute, Hubei Normal University, Huangshi, 435000 Hubei China
| | - Chien-Ying Lai
- grid.411508.90000 0004 0572 9415Orthopedic Department, China Medical University Hospital, Taichung, 40447 Taiwan
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Powers CM, Straub RK. Quadriceps strength symmetry predicts vertical ground reaction force symmetry during running in patients who have undergone ACL reconstruction. Phys Ther Sport 2022; 57:89-94. [PMID: 35961193 DOI: 10.1016/j.ptsp.2022.07.012] [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: 05/31/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether quadriceps strength symmetry can predict peak vertical ground reaction force (vGRF) running force symmetry in patients who have undergone ACL reconstruction (ACLR). We also sought to determine a cutoff for quadriceps strength symmetry to identify patients at risk for vGRF running asymmetry. DESIGN Retrospective cross-sectional. SETTING Clinical facility. METHODS Bilateral quadriceps strength and vGRF data during running were obtained from 79 patients 26-30 weeks post ACLR. Linear regression was used to determine if quadriceps strength symmetry predicted peak vGRF running force symmetry. Classification and regression tree (CART) analysis was used to determine the cutoff value for quadriceps strength symmetry to identify patients at risk for vGRF running asymmetry. RESULTS Increased quadriceps strength symmetry predicted increased vGRF running symmetry (R2 = 0.20). CART analysis revealed that patients with quadriceps strength symmetry less than or equal to 88% were at highest risk for vGRF running asymmetry (R2 = 26%). CONCLUSION Greater quadriceps strength symmetry is predictive of greater vGRF running force symmetry in patients who have undergone ACLR. This finding highlights the need for clinicians to consider the degree of quadriceps strength symmetry before initiating a return to running program.
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Affiliation(s)
- Christopher M Powers
- University of Southern California, Division of Biokinesiology & Physical Therapy, Los Angeles, CA, USA.
| | - Rachel K Straub
- University of Southern California, Division of Biokinesiology & Physical Therapy, Los Angeles, CA, USA
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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: 5] [Impact Index Per Article: 1.7] [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.
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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
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