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Yensen K, Mayfield CK, Bolia IK, Palmer RA, Brown M, Kim DR, Abu-Zahra MS, Kotlier JL, Webb T, Cleary E, Saboori N, Petrigliano FA, Weber AE. Subjective Causes for Failure to Return to Sport After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Sports Health 2024:19417381241231631. [PMID: 38532528 DOI: 10.1177/19417381241231631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
CONTEXT While current literature has explored the outcomes of athletes who return to sport (RTS) after anterior cruciate ligament (ACL) injuries, less is known about the outcomes of those who are unsuccessful in returning to sport. OBJECTIVE To determine the rate of athletes who did not RTS after primary ACL reconstruction (ACLR) and to identify the specific subjective reasons for failure to RTS. DATA SOURCES A comprehensive search of the PubMed/MEDLINE, Scopus, and Web of Science databases was conducted through April 2021. STUDY SELECTION Eligible studies included those explicitly reporting the rate of failure for RTS after ACLR as well as providing details on reasons for athletes' inability to return; 31 studies met the inclusion criteria. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2 to 4. DATA EXTRACTION The reasons for failure to RTS referred to in our study are derived from those established previously in the studies included. Data were collected on the number of athletes, mean age, mean follow-up time, type of sport played, failure to RTS rate, and specific reasons for failure to return. RESULTS The weighted rate of failure to RTS after ACLR was 25.5% (95% CI, 19.88-31.66). The estimated proportion of psychosocial-related reasons cited for failure to RTS was significantly greater than knee-related reasons for failure RTS (55.4% vs 44.6%, P < 0.01). The most cited reason for failure to RTS was fear of reinjury (33.0%). CONCLUSION This study estimates the rate of failure to RTS after ACLR to be 25.5%, with the majority of athletes citing fear of reinjury as the major deterrent for returning to sports. We highlight how factors independent of surgical outcomes may impact an athlete's ability to return to play given that the predominant reason for no RTS after ACLR was unrelated to the knee.
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Affiliation(s)
- Katie Yensen
- Keck School of Medicine of USC, Los Angeles, California
| | | | | | - Ryan A Palmer
- Keck School of Medicine of USC, Los Angeles, California
| | - Michael Brown
- Keck School of Medicine of USC, Los Angeles, California
| | - Daniel R Kim
- Keck School of Medicine of USC, Los Angeles, California
| | | | | | - Thomas Webb
- Keck School of Medicine of USC, Los Angeles, California
| | - Emmett Cleary
- Keck School of Medicine of USC, Los Angeles, California
| | - Nima Saboori
- Keck School of Medicine of USC, Los Angeles, California
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Çokyaşar B, Altun O, Daşar U. Anterior Cruciate Ligament Reconstruction Improves Functional Scores and Quality of Life in Patients Older Than 50 Years of Age. Arthrosc Sports Med Rehabil 2023; 5:100806. [PMID: 37881191 PMCID: PMC10594561 DOI: 10.1016/j.asmr.2023.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/31/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose To evaluate quality of life changes and functional outcomes of anterior cruciate ligament reconstruction in patients older than 50 years of age with anterior cruciate ligament injury. Methods Patients who were older than 50 years of age and had undergone anterior cruciate ligament reconstruction with single-bundle hamstring tendon auto graft surgery between January 2016 and February 2018 were identified. Preoperative Tegner activity scores, Lysholm knee scores, International Knee Documentation Committee (IKDC) 2000 scores, and Short-Form 36 scores were compared with results that were documented 1 year after surgery. Results A total of 35 patients were included (20 male/15 female; mean age 52 years [range 50-59 years]). Patients' preoperative mean Tegner score was 1.48. Mean Tegner score at 1-year follow-up was 3.82. Preoperative mean Lysholm score was 45.8. Postoperative mean Lysholm score was 88. Preoperative mean IKDC 2000 score was 33. Postoperative mean IKDC 2000 score was 82. All of these changes were statistically significant (P < .05). All of the parameter changes at Short Form-36 except for role limitations due to emotional problems were statistically significant. Conclusions Improved functional knee scores, quality of life, and psychological status were achieved at anterior cruciate ligament reconstruction in patients older than 50 years of age. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Batuhan Çokyaşar
- Department of Orthopedics and Traumatology, Merzifon Kara Mustafa Paşa State Hospital, Amasya, Turkey
| | - Ozan Altun
- Department of Orthopedics and Traumatology, Çankırı State Hospital, Çankırı, Turkey
| | - Uygar Daşar
- Department of Orthopedics and Traumatology, Karabuk University, Karabuk, Turkey
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Bley JA, Master H, Huston LJ, Block S, Pennings JS, Coronado RA, Cox CL, Sullivan JP, Dale KM, Saluan PM, Spindler KP, Archer KR. Return to Sports After Anterior Cruciate Ligament Reconstruction: Validity and Reliability of the SPORTS Score at 6 and 12 Months. Orthop J Sports Med 2022; 10:23259671221098436. [PMID: 35693459 PMCID: PMC9185013 DOI: 10.1177/23259671221098436] [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: 01/11/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The Subjective Patient Outcome for Return to Sports (SPORTS) score is a
single-item scale that measures athletes' ability to return to their
preinjury sport based on effort and performance. Purpose/Hypothesis: The purpose of this study was to examine the psychometric properties of the
SPORTS score and a modified score within the first year after anterior
cruciate ligament reconstruction (ACLR). The modified version replaced “same
sport” with “any sport” in the answer choices. It was hypothesized that both
versions of the SPORTS score would have acceptable floor and ceiling effects
and internal responsiveness, moderate convergent validity, and excellent
test-retest reliability. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients were recruited preoperatively from 2 academic medical centers. The
authors collected responses to the 1-item SPORTS scores at 6 and 12 months
after ACLR and the Tegner activity scale, Lysholm knee score, Knee injury
and Osteoarthritis Outcome Score (KOOS)–sport/recreation subscale, and Marx
activity rating scale preoperatively and 6 and 12 months after ACLR. Ceiling
and floor effects and responsiveness were assessed using descriptive
statistics and cross-tabulations, respectively, at both follow-up time
points. Spearman correlations and intraclass correlation coefficients were
used to examine convergent validity and test-retest reliability,
respectively. Results: Follow-up rates at 6 and 12 months were 100% and 99%, respectively.
Test-retest follow-up was 77%. Floor effects for the SPORTS scores were not
observed, while ceiling effects at 12 months ranged from 38% to 40%.
Cross-tabulation of the SPORTS scores showed that 64% to 66% of patients
reported a change in their score from 6 to 12 months, with significant
differences noted between the proportions that improved versus worsened for
return to any sport. Convergent validity was observed at 6 and 12 months via
moderate correlations with the Tegner, Lysholm, KOOS–sport/recreation, and
Marx scores (r = 0.31 to 0.47). Fair to good test-retest
reliability (intraclass correlation coefficient, 0.58 and 0.60) was found at
12 months after ACLR. Conclusion: The SPORTS score appears to be a reliable, responsive, and valid 1-item scale
that can be used during the first year after ACLR. No differences in
psychometric properties were found between the SPORTS score and the modified
version.
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Affiliation(s)
- Jordan A Bley
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hiral Master
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J Huston
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shannon Block
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles L Cox
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jaron P Sullivan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin M Dale
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul M Saluan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic Florida Region, Weston, Florida, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Hadley CJ, Rao S, Tjoumakaris FP, Ciccotti MG, Dodson CC, Marchetto PA, Hammoud S, Cohen SB, Freedman KB. Safer Return to Play After Anterior Cruciate Ligament Reconstruction: Evaluation of a Return-to-Play Checklist. Orthop J Sports Med 2022; 10:23259671221090412. [PMID: 35464900 PMCID: PMC9019333 DOI: 10.1177/23259671221090412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Questions remain regarding the traditional protocols used in rehabilitation and clearance for return to sports after anterior cruciate ligament reconstruction (ACLR). Purpose/Hypothesis: To investigate the impact on injury rates after return to sports by developing and validating a Safer Return to Play Following ACL Reconstruction Checklist consisting of subjective and objective functional tests that can be quickly and easily implemented into a sports medicine practice. It was hypothesized that patients who successfully passed the checklist before returning to sports would experience lower rates of ipsilateral and contralateral knee injuries at a 2-year follow-up as compared with patients who returned to play before completing the checklist. Study Design: Cohort study; Level of evidence, 2. Methods: First, a systematic review was performed to generate a list of the most common outcome measures used to assess return to play after ACLR. To refine our checklist, we conducted a survey with an expert panel of 10 medical professionals utilizing the Delphi technique. After the creation of the checklist, validation was performed by prospectively evaluating patients who had undergone ACLR for injury of the ipsilateral or contralateral knee, with a minimum 2-year follow-up. Results: After our systematic review of 60 studies, 7 criteria were included in the final checklist. During the period studied, October 2014 to December 2017, a total of 222 patients met the inclusion criteria and were enrolled in the study. At a minimum 2 years of follow-up, there were 146 patients who successfully passed the checklist and 38 who did not. Overall, 24 (16.4%) patients who had passed the checklist sustained an injury to either knee, as compared with 10 (26.3%) from the group that did not pass the checklist (P = .162). Of the group that passed the checklist, 8 (5.5%) patients sustained an injury to the ipsilateral knee, as compared with 7 (18.4%) in the group that did not pass (P = .017). Conclusion: Prospective validation of our checklist demonstrated that patients who successfully passed the checklist before returning to play experienced a significantly lower incidence of ipsilateral anterior cruciate ligament injury as compared with patients who did not pass the checklist.
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Affiliation(s)
- Christopher J. Hadley
- The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Somnath Rao
- The Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Fotios P. Tjoumakaris
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael G. Ciccotti
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher C. Dodson
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul A. Marchetto
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sommer Hammoud
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Steven B. Cohen
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin B. Freedman
- Rothman Orthopaedic Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Thiebat G, Cucchi D, Spreafico A, Muzzi S, Viganò M, Visconti L, Facchini F, de Girolamo L. Italian version of the anterior cruciate ligament-return to sport after injury scale (IT ACL-RSI): translation, cross-cultural adaptation, validation and ability to predict the return to sport at medium-term follow-up in a population of sport patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:270-279. [PMID: 33620511 DOI: 10.1007/s00167-021-06498-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The timing of psychological and physical recovery after anterior cruciate ligament reconstruction represents an open issue in current orthopedic practice. Several tools have been developed to evaluate these factors, with the most recent being represented by the anterior cruciate ligament (ACL) return to sport injury scale (ACL-RSI). The aims of this study were to provide a validated Italian translation of the ACL-RSI in a population of sport patients, and to identify a possible correlation of the ACL-RSI score with the return to sport (RTS) time and the level of sport participation in comparison to the pre-injury one. METHODS The Italian translation and cultural adaptation of the scale were completed using a using the "translation-back translation" method. A total of 130 patients were enrolled and completed the study questionnaires 6 months after ACL reconstruction. Randomly, 65 of them were re-tested for the ACL-RSI within 2 weeks. The internal consistency, reliability, feasibility, and construct validity of the Italian version of ACL-RSI were assessed and compared to Italian version of the KOOS, the Lysholm Score, the AKPS and the IKDC subjective score. Responsiveness was tested comparing patients returning to sport at 6 and 12 months. The Tegner activity scale was collected at baseline, 6 and 12 months to identify the level of activity after return to sport, in relation to the ACL-RSI score. RESULTS The Italian adaptation of the ACL-RSI demonstrated excellent internal consistency (Cronbach's alpha = 0.953), reliability (test-retest ICC = 0.916) and feasibility, with no ceiling or floor effect. Construct validity was confirmed by the moderate to strong correlation with all the other scales (p < 0.0001). Slight and non-significant higher ACL-RSI score was shown by patients returned to sport at 6 or 12 months after surgery. Nevertheless, the ACL-RSI score at 6 months was significantly different between patients who returned and those who did not returned to the same level of sport activity 12 months after the procedure. CONCLUSIONS This study demonstrated that the Italian ACL-RSI is a reliable tool for evaluating the psychological readiness for return to sports of athletes who underwent ACL reconstruction, especially when collected at the end of the rehabilitation process. Since the IT ACL-RSI used in this study is a faithful translation of the original English version, this finding can be generalized to other cultural contexts and languages too. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Gabriele Thiebat
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Andrea Spreafico
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
- Università Degli Studi Di Milano, Milano, Italy
| | - Stefano Muzzi
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
- Università Degli Studi Di Milano, Milano, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
| | | | - Francesca Facchini
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
| | - Laura de Girolamo
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
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The Functional Assessment of Balance in Concussion (FAB-C) Battery. Int J Sports Phys Ther 2021; 16:1250-1259. [PMID: 34631245 PMCID: PMC8486398 DOI: 10.26603/001c.28157] [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: 03/24/2021] [Accepted: 08/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background There is no clinical tool that assesses multiple components of postural control potentially impacted by sport-related concussion (SRC). Objective To develop and assess the feasibility and construct validity of the Functional Assessment of Balance in Concussion (FAB-C) battery. Study Design Cross-sectional study. Methods Tests for inclusion in the FAB-C battery were identified through a search of the literature. The feasibility and construct validity of the battery was assessed with a convenience sample of active individuals (13-24 years) with and without a SRC. Feasibility outcomes included battery completion (yes/no), number of adverse events, time to administer (minutes) and cost of the battery (Canadian Dollars). Construct validity was assessed by examining correlations between tests included in the battery, and describing differences [mean (standard deviation), median (range) or proportion] in outcomes between uninjured participants and participants with SRC. Results Seven tests were included in the FAB-C battery. All 40 uninjured participants [12 female; median age 17 years] completed the FAB-C assessment compared to 86% of seven participants with SRC [1 female; median age 17]. No participants demonstrated adverse effects. The median administration time of the battery was 49 minutes (range 44-60). The cost of the battery was low (~$100 Canadian Dollars). Limited correlations (r<0.7) between tests in the battery were observed. A greater percentage of uninjured participants (52% to 82%) passed individual tests in the battery compared to participants with SRC (17% to 66%). Conclusion Although promising, the FAB-C battery requires further evaluation before adoption for widespread clinical use. Level of Evidence Level 3b.
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Hanna M, Whicker EA, Traub B, Allam E, Labib SA. Sport activity levels following ankle fusion. INTERNATIONAL ORTHOPAEDICS 2021; 45:2347-2354. [PMID: 34228148 DOI: 10.1007/s00264-021-05100-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/25/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Ankle arthrodesis (AA) is frequently employed in the treatment of end-stage ankle arthritis, which is common following trauma and athletic injuries. While AA remains a popular therapeutic option, little data exists about activity and sporting capacity following AA. The objective of this research was to determine functional outcomes and sporting activity levels in patients following Ankle Arthrodesis. METHODS Validated questionnaires were emailed to 35 patients with a history of AA at an average follow-up of 52 months. Functional outcomes were assessed using the Foot and Ankle Disability Index (FADI), as well as the associated FADI-Sport. Responses were compared to those from a control population of RESULTS: 24 patients scheduled for AA, at an average pre-operative visit of three months. Activity levels were assessed prior to injury as well as pre- and post-operatively using the Tegner activity level scale. Average Tegner scores of the 35 surgical patients decreased from 3.82 ± 0.38 before their injury, to 1.15 ± 0.19 immediately pre-op, with recovery to 2.67 ± 0.26 following fusion. Average post arthrodesis FADI and FADI-sport scores in our patients were 76.5 ± 3.19% and 33.8 ± 23.06%. For the pre-operative control population, corresponding scores were 47.41 ± 2.61% and 22.24 ± 1.03%. Following AA, we found that patients improved upon their pre-op Tegner score, although they did not return to their pre-injury level of sporting participation. Additionally, patients reported that they had no current dysfunction with their lower leg. CONCLUSION Patients undergoing Ankle Arthrodesis should expect improved lower leg function, though will not likely return to their pre-injury level of activity.
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Affiliation(s)
- Maged Hanna
- Department of Orthopedics, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, USA.
| | - Emily A Whicker
- Department of Orthopaedics, Drexel University College of Medicine, 245 N Broad St, Philadelphia, PA, USA
| | - Brian Traub
- Depatment of Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY, 10467, USA
| | - Emad Allam
- Department of Radiology, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA
| | - Sameh A Labib
- Department of Orthopaedics, Emory University, 59 Executive Park South Suite 3000, Atlanta, GA, 30329, USA
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Wypych M, Lundqvist R, Witoński D, Kęska R, Szmigielska A, Paradowski PT. Prediction of improvement after anterior cruciate ligament reconstruction. Open Med (Wars) 2021; 16:833-842. [PMID: 34124374 PMCID: PMC8165257 DOI: 10.1515/med-2021-0300] [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] [Received: 01/26/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022] Open
Abstract
Objective The retrospective investigation was carried out to assess whether subjects who fulfilled our proposed recruitment criteria responded more favorably to anterior cruciate ligament reconstruction (ACLR) than those who did not. Methods We retrospectively analyzed 109 skeletally mature subjects (78 men and 31 women) according to the following proposed criteria of recruitment: (1) pre-injury Tegner activity score ≥7 and a wish to return to a professional sports activity, (2) residual knee instability following injury and/or (3) age <20 years at the operation. The primary outcome was an improvement between assessment A (before operation) and B (mean follow-up of 1.6 years) in the average score for four of the five Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, covering pain, symptoms, difficulty in sports and recreational activities, and quality of life (KOOS4). Results The proposed recruitment criteria for ACLR were met by 58 subjects (53%). There were 49 subjects (45%) who improved between assessment A and B. Subjects who met proposed recruitment criteria were more likely to improve clinically after ACLR (OR 5.7, 95% CI 2.5–13.3). Conclusions Fulfillment of proposed recruitment criteria was a strong predictive factor for outcome improvement in short- to medium-term follow-up after ACLR. Level of evidence Case-control study. Level of evidence 3.
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Affiliation(s)
- Mikołaj Wypych
- Department of Emergency Medicine, Stanisław Rybicki Regional Hospital, Skierniewice, Poland
| | - Robert Lundqvist
- Research and Innovation Unit, Norrbotten County Council, Luleå, Sweden
| | - Dariusz Witoński
- Chair of Clinical Physiotherapy, Institute of Health Sciences, Social Academy of Sciences, Łódź, Poland
| | - Rafał Kęska
- Department of Orthopedics, Poddębice Health Centre, Poddębice, Poland
| | - Anna Szmigielska
- Department of Cardiology, Władysław Biegański Medical University Hospital, Łódź, Poland
| | - Przemysław T Paradowski
- Department of Surgical and Perioperative Sciences, Division of Orthopedics, Sunderby Research Unit, Umeå University, Sunderby Central Hospital of Norrbotten, SE-971 80 Luleå, Sweden.,Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, Jagiellońska 13/15, PL-85-067 Bydgoszcz, Poland.,Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Orthopedics, Lund University, SE-221 85 Lund, Sweden
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Zampogna B, Vasta S, Torre G, Gupta A, Hettrich CM, Bollier MJ, Wolf BR, Amendola A. Return to Sport After Anterior Cruciate Ligament Reconstruction in a Cohort of Division I NCAA Athletes From a Single Institution. Orthop J Sports Med 2021; 9:2325967120982281. [PMID: 33681400 PMCID: PMC7900794 DOI: 10.1177/2325967120982281] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) tears are common in collegiate athletes. The
rate of return to the preinjury level of sport activities after ACL
reconstruction continues to evolve. Purpose/Hypothesis: The purpose was to determine the return-to-sport rate after ACL
reconstruction in a cohort of National Collegiate Athletic Association
Division I athletes in different sports. It was hypothesized that, with
intensive supervision of rehabilitation, the return-to-sport rate would be
optimal. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the records of 75 collegiate athletes from a
single institution who had undergone unilateral or bilateral ACL
reconstruction between 2001 and 2013 and participated in an extensive
supervised rehabilitation program. Prospectively collected athlete data as
well as data about preinjury exposure, associated lesions, surgical
technique, time lost to injury, number of games missed, time to return to
full sport activity or retire, and subsequent surgical procedures were
extracted from the medical and athletic trainer records. Results: The 75 patients (40 male, 35 female; mean age, 20.1 years) underwent 81
reconstruction procedures (73 primary, 8 revision). The mean follow-up was
19.3 months. The overall return-to-sport rate was 92%. After reconstruction,
9 athletes (12%) retired from collegiate sports, but 3 of them returned to
sport activities after graduation. Overall, 8 athletes (11%) experienced an
ACL graft retear. Conclusion: The return-to-sport rate in our National Collegiate Athletic Association
Division I athletes compared favorably with that reported in other studies
in the literature. The strict follow-up by the surgeon, together with the
high-profile, almost daily technical and psychological support given mainly
by the athletic trainers during the recovery period, may have contributed to
preparing the athletes for a competitive rate of return to sport at their
preinjury level.
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Affiliation(s)
- Biagio Zampogna
- Orthopedics and Trauma Surgery Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Sebastiano Vasta
- Orthopedics and Trauma Surgery Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Guglielmo Torre
- Orthopedics and Trauma Surgery Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Akhil Gupta
- Department of Orthopaedic Surgery, University of Iowa Health Care, Iowa City, Iowa, USA
| | - Carolyn M Hettrich
- Department of Orthopaedic Surgery, University of Iowa Health Care, Iowa City, Iowa, USA
| | - Matthew J Bollier
- Department of Orthopaedic Surgery, University of Iowa Health Care, Iowa City, Iowa, USA
| | - Brian R Wolf
- Department of Orthopaedic Surgery, University of Iowa Health Care, Iowa City, Iowa, USA
| | - Annunziato Amendola
- Department of Orthopaedic Surgery, University of Iowa Health Care, Iowa City, Iowa, USA
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Targeted Application of Motor Learning Theory to Leverage Youth Neuroplasticity for Enhanced Injury-Resistance and Exercise Performance: OPTIMAL PREP. ACTA ACUST UNITED AC 2021. [DOI: 10.1007/s42978-020-00085-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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11
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Ovigue J, Bouguennec N, Graveleau N. Arthroscopic anterior cruciate ligament reconstruction is a reliable option to treat knee instability in patients over 50 years old. Knee Surg Sports Traumatol Arthrosc 2020; 28:3686-3693. [PMID: 32886155 DOI: 10.1007/s00167-020-06254-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/21/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate return to sport and clinical outcomes with at least 2 years followup after arthroscopic reconstruction ACL in population over 50 years-old. METHODS eighty-one patients aged 50 years or older underwent isolated, primary ACL reconstruction with hamstring autograft between 2014 and 2016. In all patients, a period of conservative treatment had failed (minimum 6 months), and they complained of functional instability and/or limitation during daily activity. Patients were assessed preoperatively and at the latest follow-up with a physical examination, return to sports activity, the Lysholm score, the International Knee Documentation Committee scoring system, the Knee injury and Osteoarthritis Outcome Score, and the Tegner activity scale. Data regarding complications and revision surgeries were collected at 2-year follow-up. RESULTS At the last follow-up, significant improvement in outcome scores from pre- to postoperative assessments was found. The mean overall IKDC score increased from a preoperative mean of 54.4-82.9 (p < 0.001). Mean preoperative Lysholm score increased from a preoperative mean of 67.4-90.4 (p < 0.001). The mean overall KOOS score increased from a preoperative mean (p < 0.001). Median preoperative Tegner score was 5 (range 2-8) and median postoperative score was 5 (range 1-7). 86% of patients returned to the sport, 51% to their preinjury sports level. Tegner score, before accident, was the only positive influencing factor a return to pre-injury level of the sport. CONCLUSION Arthroscopic reconstruction ACL in patients over 50 years-old resulted in excellent functional outcomes, with most patients returning to sport and at the same level they had before the injury. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jordan Ovigue
- Sports Clinic of Bordeaux-Merignac, 33700, Mérignac, France.
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12
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Porter A, Yang S, Chauhan A, Early S, Challa S, D'Angelo J, Keefe D, Hoenecke H, Fronek J. Professional Advancement and Performance of Amateur Baseball Players Selected in the Major League Baseball Draft With Previous Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2020; 48:581-587. [PMID: 31990575 DOI: 10.1177/0363546519898194] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effect that an anterior cruciate ligament injury requiring reconstructive surgery has on the professional advancement and performance of amateur baseball players selected in the Major League Baseball draft is not known. Return to sports after anterior cruciate ligament reconstruction (ACLR) in professional athletes has been shown to be high, but mixed results with regard to performance and return to preinjury level have been demonstrated in other sports. PURPOSE To (1) investigate the highest level of professional advancement among Major League Baseball draftees with a history of ACLR before entering the draft, (2) examine how much time these players spent on the disabled list (DL) and determine if it was related to the knee, and (3) compare the batting and pitching performance of these players against healthy matched controls. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Predraft medical records of all players selected in the Major League Baseball draft from 2004 to 2008 were reviewed. Players with a documented anterior cruciate ligament injury treated with ACLR before the draft were included. For each study player, 3 controls were identified. Data were accumulated from the time when players were drafted through the 2015 season. Outcome variables included highest professional level of advancement, DL time, and batting and pitching performance. RESULTS Forty draftees with a history of ACLR (22 pitchers, 18 position players) were identified and matched to 120 controls (66 pitchers, 54 position players). The difference in the highest level of professional advancement between the groups was not statistically significant (P = .488). The mean total number of times and the mean total number of days on the DL were similar between the groups (1.83 vs 1.47, P = .297; 121.54 vs 109.62, P = .955); however, the mean number of times on the DL because of a knee injury was significantly different (0.28 vs 0.11, P = .004), as was the mean number of days on the DL because of a knee injury (17.36 vs 7.72, P = .009). Among pitchers, there were no differences in performance. Similarly, there were no differences among position players in batting performance. CONCLUSION There was no difference between draftees with a history of ACLR and their controls in terms of advancement from the minor to the major leagues. Additionally, pitching and batting performance were similar. Although the 2 groups spent similar time on the DL, the ACLR group spent more time on the DL because of a knee injury than the control group.
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Affiliation(s)
- Anthony Porter
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Shawn Yang
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Aakash Chauhan
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Samuel Early
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Sravya Challa
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | | | - Daniel Keefe
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Heinz Hoenecke
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Jan Fronek
- Division of Sports Medicine, Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
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13
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Burland JP, Toonstra JL, Howard JS. Psychosocial Barriers After Anterior Cruciate Ligament Reconstruction: A Clinical Review of Factors Influencing Postoperative Success. Sports Health 2019; 11:528-534. [PMID: 31469614 DOI: 10.1177/1941738119869333] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
CONTEXT Psychosocial factors arising after anterior cruciate ligament (ACL) injury may have a direct influence on an individual's decision to return to sport after ACL reconstruction (ACLR). While there is ample evidence to suggest that deficits in quadriceps strength, neuromuscular control, and clinical functional tasks exist after ACLR, the root and contribution of psychological dysfunction to an individual's success or return to sport after ACLR is still largely uncertain and unexplored. Given the discrepancy between successful functional outcomes and the percentage of athletes who return to sport, it is important to thoroughly address underlying factors, aside from physical function, that may be contributing to these lower return rates. EVIDENCE ACQUISITION Articles that reported on return to sport, psychological factors, and psychosocial factors after ACLR were collected from peer-reviewed sources available on Medline (1998 through August 2018). Search terms included the following: anterior cruciate ligament OR ACL AND return-to-sport OR return-to-activity, anterior cruciate ligament OR ACL AND psychological OR psychosocial OR biopsychosocial OR fear OR kinesiophobia OR self-efficacy, return-to-activity AND psychological OR psychosocial. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS Psychosocial factors relative to injury are important components of the rehabilitation process. To fully understand how psychosocial factors potentially influence return to sport, an athlete's emotions, experiences, and perceptions during the rehabilitation process must be acknowledged and taken into consideration. CONCLUSION Acknowledgment of these psychosocial factors allows clinicians to have a better understanding of readiness to return to sport from a psychological perspective. Merging of the current ACLR rehabilitation protocols with knowledge related to psychosocial factors creates a more dynamic, comprehensive approach in creating a positive and successful rehabilitation environment, which may help improve return-to-sport rates in individuals after ACLR.
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Affiliation(s)
- Julie P Burland
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Jennifer L Toonstra
- School of Human Movement, Sport & Leisure Studies, Bowling Green State University, Bowling Green, Ohio
| | - Jennifer S Howard
- Department of Health and Exercise Science, Beaver College of Health Sciences, Appalachian State University, Boone, North Carolina
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14
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Factors affecting return to sport following hamstrings anterior cruciate ligament reconstruction in non-elite athletes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1771-1779. [DOI: 10.1007/s00590-019-02494-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/06/2019] [Indexed: 12/31/2022]
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Correlation Analysis of Magnetic Resonance Imaging-Based Graft Maturity and Outcomes After Anterior Cruciate Ligament Reconstruction Using International Knee Documentation Committee Score. Am J Phys Med Rehabil 2019; 98:387-391. [DOI: 10.1097/phm.0000000000001106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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16
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Kosy JD, Phillips JRP, Edordu A, Pankhania R, Schranz PJ, Mandalia V. Failure to Return to Preinjury Activity Level after Hamstring Anterior Cruciate Ligament Reconstruction: Factors Involved and Considerations in Goal Setting. Indian J Orthop 2019; 53:714-720. [PMID: 31673171 PMCID: PMC6804386 DOI: 10.4103/ortho.ijortho_186_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recent interest in the return to sports, following anterior cruciate ligament reconstruction, has focused on the influence of psychological factors. However, many factors contribute to this endpoint. This study aimed to investigate the ability of nonprofessional athletes to return alongside the reasons for failure. MATERIALS AND METHODS We retrospectively studied 101 postreconstruction patients with followup in excess of 12 months. All patients underwent hamstring autograft anterior cruciate reconstruction. The Cincinnati Sports Activity Scale was used to define activity level preinjury, postinjury, and postreconstruction. Structured questionnaires were used to identify factors in those who did not return to the same level. RESULTS Seventy percent of patients returned to their preinjury activity score. Of the 30% of patients who failed, age, reconstruction type, and associated pathology were unrelated. However, reconstruction within 6 months of injury resulted in increased return to preinjury score (P < 0.05). Failure was associated with continued knee symptoms (57%), lifestyle changes (27%), anxiety (27%), fear (23%), and other musculoskeletal problems (10%). Considerable interplay was found between these factors. Failure to return was associated with increased further surgery, but this was successful in only one-third of patients. CONCLUSION Psychological factors are important (and may require targeted input), but return-to-sport is multifactorial. Ongoing symptoms may prompt further surgery, but this is frequently unsuccessful in achieving return. Patient-specific goals should be sought and revisited throughout the rehabilitation program. Acknowledging psychological barriers, in those aiming to return to the same level, may help achieve this goal. In other patients, success may be return to a desired lower level. Understanding the patient's expectations is important in goal setting.
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Affiliation(s)
- Jonathan D Kosy
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK,Address for correspondence: Mr. Jonathan D Kosy, Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK. E-mail.
| | - Jonathan R P Phillips
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Adaeze Edordu
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Rahul Pankhania
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Peter J Schranz
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Vipul Mandalia
- Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
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Pottkotter KA, Di Stasi SL, Schmitt LC, Magnussen RA, Paterno MV, Flanigan DC, Kaeding CC, Hewett TE. Improvements in Thigh Strength Symmetry Are Modestly Correlated With Changes in Self-Reported Function After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2018; 6:2325967118807459. [PMID: 30534573 PMCID: PMC6280613 DOI: 10.1177/2325967118807459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: The association between quadriceps strength and functional outcomes after anterior cruciate ligament reconstruction (ACLR) is a focus of current research, while evaluations of hamstring strength are limited, despite the frequent use of hamstring autografts. Purpose/Hypothesis: The purpose of this study was to determine the relationship between changes in quadriceps and hamstring strength symmetry and self-reported outcomes before ACLR and at 12 and 24 weeks after surgery. We hypothesized that improvements in quadriceps and hamstring strength symmetry would be correlated with improvements in self-reported outcome measures within the first 6 months after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: Thirty patients who underwent ACLR with a hamstring autograft were enrolled. Quadriceps and hamstring strength and Knee injury and Osteoarthritis Outcome Score (KOOS) values were assessed before and at 12 and 24 weeks after ACLR; limb symmetry indexes for strength were calculated at each time point. The Friedman and Wilcoxon signed-rank tests were used to analyze changes in KOOS values over time. Spearman rank-order correlations were used to test the relationship between changes in strength and KOOS values between each time point. Results: Hamstring and quadriceps limb symmetry significantly increased with time (P ≤ .03). Fair correlations were observed between changes in the hamstring index and changes in the KOOS Symptoms subscore from before surgery to 12 weeks postoperatively (r = 0.48; P ≤ .05). Changes in the quadriceps index (QI) were moderately correlated with changes in the KOOS Sport/Recreation subscore (r = 0.60; P = .001), and fair correlations were seen between the QI and the KOOS Quality of Life subscore (r = 0.39; P ≤ .04) from preoperatively to 12 weeks after surgery. Moderate correlations were seen between the QI and the KOOS Sport/Recreation subscore (r = 0.57; P = .005) from 12 to 24 weeks after surgery. Conclusion: Improvements in quadriceps and hamstring strength symmetry were modestly associated with improvements in athletes’ perceived function in the first 6 months after ACLR. Specifically, improvements in hamstring symmetry were associated with improvements in knee symptoms within the first 12 weeks postoperatively, while improvements in quadriceps symmetry were associated with improvements in self-reported sport function throughout the first 6 months after ACLR. The restoration of strength symmetry within the first 6 months may be a critical component of rehabilitation aimed at maximizing function after ACLR. Further investigation is warranted to comprehensively evaluate whether the timing of strength gains predicts future function, including those who successfully return to their preinjury activity level after ACLR.
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Affiliation(s)
- Kristy A Pottkotter
- Sports Medicine Physical Therapy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephanie L Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Laura C Schmitt
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Robert A Magnussen
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David C Flanigan
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Christopher C Kaeding
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Timothy E Hewett
- Orthopedics Biomechanics Laboratory and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
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18
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Prior Anterior Cruciate Ligament Reconstruction Effects on Future Total Knee Arthroplasty. J Arthroplasty 2018; 33:2821-2826. [PMID: 29731267 DOI: 10.1016/j.arth.2018.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The impact of prior anterior cruciate ligament (ACL) reconstruction on total knee arthroplasty (TKA) has rarely been studied. The objective of this study was to compare intraoperative characteristics in patients who underwent TKA with pre-existing hardware from prior ACL reconstruction with a matched cohort control group. METHODS A retrospective study of patients who had undergone primary TKA with pre-existing hardware from prior ACL reconstruction was performed from June 2012 through June 2017. These patients were 2-to-1 matched to the ACL group based on similar patient demographic and provider variables. Outcomes investigated included operative time, estimated blood loss (EBL), and postoperative complications. RESULTS One hundred one patients met the inclusion/exclusion criteria. The mean age was 54 ± 9 years, and the mean body mass index was 32.6 ± 6.5 kg/m2. The ACL group was divided into 4 subgroups: group 1, no pre-existing hardware removed (22 TKAs); group 2, pre-existing hardware removed from the femur only (8 TKAs); group 3, pre-existing hardware removed from the tibia only (45 TKAs); and group 4, pre-existing hardware removed from both the femur and tibia (26 TKAs). There was no statistical difference in EBL and postoperative complication between the ACL group and controls. Statistical differences were detected between 2 subgroups regarding mean operative time variables: ACL group 3 (74 ± 23 minutes; control: 64 ± 21 minutes, P = .020) and group 4 (79 ± 24 minutes; control: 65 ± 19 minutes, P = .010). CONCLUSION Hardware retained, especially on the tibia, from prior ACL reconstruction has a major impact on TKA surgical procedure operative time but not on EBL and/or complications.
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Zaman S, White A, Shi WJ, Freedman KB, Dodson CC. Return-to-Play Guidelines After Medial Patellofemoral Ligament Surgery for Recurrent Patellar Instability: A Systematic Review. Am J Sports Med 2018; 46:2530-2539. [PMID: 28678520 DOI: 10.1177/0363546517713663] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medial patellofemoral ligament (MPFL) reconstruction and repair continue to gain acceptance as viable treatment options for recurrent patellar instability in patients who wish to return to sports after surgery. Return-to-play guidelines with objective or subjective criteria for athletes after MPFL surgery, however, have not been uniformly defined. PURPOSE To determine whether a concise and objective protocol exists that may help athletes return to their sport more safely after MPFL surgery. STUDY DESIGN Systematic review. METHODS The clinical evidence for return to play after MPFL reconstruction was evaluated through a systematic review of the literature. Studies that measured outcomes for isolated MPFL surgery with greater than a 12-month follow-up were included in our study. We analyzed each study for a return-to-play timeline, rehabilitation protocol, and any measurements used to determine a safe return to play after surgery. RESULTS Fifty-three studies met the inclusion criteria, with a total of 1756 patients and 1838 knees. The most commonly cited rehabilitation guidelines included weightbearing restrictions and range of motion restrictions in 90.6% and 84.9% of studies, respectively. Thirty-five of 53 studies (66.0%) included an expected timeline for either return to play or return to full activity. Ten of 53 studies (18.9%) in our analysis included either objective or subjective criteria to determine return to activity within their rehabilitation protocol. CONCLUSION Most studies in our analysis utilized time-based criteria for determining return to play after MPFL surgery, while only a minority utilized objective or subjective patient-centric criteria. Further investigation is needed to determine safe and effective guidelines for return to play after MPFL reconstruction and repair.
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Affiliation(s)
| | - Alex White
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Weilong J Shi
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin B Freedman
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Burland JP, Toonstra J, Werner JL, Mattacola CG, Howell DM, Howard JS. Decision to Return to Sport After Anterior Cruciate Ligament Reconstruction, Part I: A Qualitative Investigation of Psychosocial Factors. J Athl Train 2018; 53:452-463. [PMID: 29505304 PMCID: PMC6107765 DOI: 10.4085/1062-6050-313-16] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CONTEXT Return-to-sport criteria after anterior cruciate ligament (ACL) injury are often based on "satisfactory" functional and patient-reported outcomes. However, an individual's decision to return to sport is likely multifactorial; psychological and physical readiness to return may not be synonymous. OBJECTIVE To determine the psychosocial factors that influence the decision to return to sport in athletes 1 year post-ACL reconstruction (ACLR). DESIGN Qualitative study. SETTING Academic medical center. PATIENTS OR OTHER PARTICIPANTS Twelve participants (6 males, 6 females) were purposefully chosen from a large cohort. Participants were a minimum of 1-year postsurgery and had been active in competitive athletics preinjury. DATA COLLECTION AND ANALYSIS Data were collected via semistructured interviews. Qualitative analysis using a descriptive phenomenologic process, horizontalization, was used to derive categories and themes that represented the data. The dynamic-biopsychosocial model was used as a theoretical framework to guide this study. RESULTS Six predominant themes emerged that described the participants' experiences after ACLR: (1) hesitation and lack of confidence led to self-limiting tendencies, (2) awareness was heightened after ACLR, (3) expectations and assumptions about the recovery process influenced the decision to return to sport after ACLR, (4) coming to terms with ACL injury led to a reprioritization, (5) athletic participation helped reinforce intrinsic personal characteristics, and (6) having a strong support system both in and out of rehabilitation was a key factor in building a patient's confidence. We placed themes into components of the dynamic-biopsychosocial model to better understand how they influenced the return to sport. CONCLUSIONS After ACLR, the decision to return to sport was largely influenced by psychosocial factors. Factors including hesitancy, lack of confidence, and fear of reinjury are directly related to knee function and have the potential to be addressed in the rehabilitation setting. Other factors, such as changes in priorities or expectations, may be independent of physical function but remain relevant to the patient-clinician relationship and should be considered during postoperative rehabilitation.
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Novaretti JV, Franciozi CE, Forgas A, Sasaki PH, Ingham SJM, Abdalla RJ. Quadriceps Strength Deficit at 6 Months After ACL Reconstruction Does Not Predict Return to Preinjury Sports Level. Sports Health 2018; 10:266-271. [PMID: 29485941 PMCID: PMC5958456 DOI: 10.1177/1941738118759911] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: There is a lack of literature-based objective criteria for return to sport after anterior cruciate ligament (ACL) injury. Establishing such objective criteria is crucial to improving return to sport after ACL reconstruction (ACLR). Hypotheses: Patients who return to their preinjury level of sport will have higher isokinetic, postural stability, and drop vertical jump test scores 6 months after surgery and greater patient satisfaction compared with those who did not. Additionally, quadriceps strength deficit cutoff values of 80% and 90% would differentiate patients who returned to preinjury sports level from those who did not. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A retrospective search was conducted to identify all patients who underwent ACLR and completed isokinetic evaluation, postural stability analysis, and drop vertical jump testing at 6 months postoperatively. Patients were asked to complete 3 questionnaires at a minimum 1 year after surgery. Chi-square and logistic regression analyses were used for categorical dependent variables, while the Student t test, Pearson correlation, or analyses of variance with Bonferroni post hoc testing were used for continuous dependent variables. A post hoc power analysis was completed. Based on the results regarding correlations between return to preinjury level and all other variables, effect sizes from 0.24 to 3.03 were calculated. With these effect sizes, an alpha of 0.05 and sample size of 58, a power ranging from 0.15 to 0.94 was calculated. Results: The rates of return to preinjury level and to any sports activity were 53.4% and 84.4%. Those who were able to return to their preinjury level of sport (n = 33) showed significantly higher Lysholm (91.6 ± 9.7 vs 76.7 ± 15.4) and International Knee Documentation Committee (IKDC) (83.6 ± 10.6 vs 69.8 ± 14.6) values compared with those who were unable to return to their preinjury level of sport (n = 25) (P < 0.001). No significant differences were found for the clinical evaluations between those who were and those who were not able to return at the same level for the clinical evaluations (isokinetic evaluation, postural stability, drop vertical jump test) (P > 0.05). No significant differences were found when comparing quadriceps strength deficit with cutoff values of 80% and 90% for return to preinjury activity level (Tegner), Lysholm, and IKDC scores. Conclusion: Quadriceps strength deficit, regardless of cutoff value (80% or 90%), at 6 months after ACLR does not predict return to preinjury level of sport. Patients who returned to sport at their preinjury level were more satisfied with their reconstruction compared with those who did not. Clinical Relevance: Quadriceps strength deficit is not a reliable predictor of return to sports, and therefore it should not be used as the single criterion in such evaluations.
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Janssen RPA, van Melick N, van Mourik JBA, Reijman M, van Rhijn LW. Similar clinical outcome between patellar tendon and hamstring tendon autograft after anterior cruciate ligament reconstruction with accelerated, brace-free rehabilitation: a systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Panariello RA, Stump TJ, Allen AA. Rehabilitation and Return to Play Following Anterior Cruciate Ligament Reconstruction. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2017.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Liptak MG, Angel KR. Return to Play and Player Performance After Anterior Cruciate Ligament Injury in Elite Australian Rules Football Players. Orthop J Sports Med 2017; 5:2325967117711885. [PMID: 28680894 PMCID: PMC5482352 DOI: 10.1177/2325967117711885] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Australian Rules football is a highly aerobic and anaerobic game that at times requires players to perform cutting or pivoting maneuvers, potentially exposing them to anterior cruciate ligament (ACL) injury. At present, there are limited data available addressing the impact of ACL injury on return to play and preinjury form after ACL reconstruction. Purpose: To determine the prevalence of ACL injury and the incidence of further ACL injury, and to consider player return to play and return to preinjury form after ACL reconstruction. It was hypothesized that elite-level Australian Football League (AFL) players do not return to preinjury form until, at minimum, 2 years after returning to play. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was undertaken on a cohort of elite AFL players who injured their ACL between 1990 and 2000. Return to play after ACL reconstruction was determined by the mean number of ball disposals, or release of the ball by the hand or foot, at 1, 2, and 3 years after return to play and compared with preinjury form. Associations between player and injury characteristics, method of reconstruction, and outcomes (return to play, preinjury form, and further ACL injury) were examined. Results: During the included seasons, a total of 2723 AFL players were listed. Of these, 131 (4.8%) sustained an ACL injury, with 115 players eligible for inclusion. Of 115 players, 26% did not return to elite competition, while 28% of those who did return experienced further ACL injury. The adjusted mean number of disposals (± standard error of the mean) was significantly lower at 1 year (12.21 ± 0.63; P = .003), 2 years (12.09 ± 0.65; P = .008), and 3 years (11.78 ± 0.77; P = .01) after return to play compared with preinjury (14.23 ± 0.67). On average, players did not return to preinjury form by 3 years (P < .01). Players aged 30 years or older were less likely to return to play compared with younger players (P = .0002), moderate-weight players were more likely to return to play compared with lighter-weight players (P = .007), and there were significantly increased odds of not returning to play if the dominant side was injured (odds ratio, 0.10; 95% CI, 0.03-0.34; P = .0002). Conclusion: On average, AFL players do not return to their preinjury form after ACL injury and reconstruction, a common injury in this sporting population. This along with the high occurrence of reinjury highlights the career-threatening nature of ACL injury for elite AFL players.
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Affiliation(s)
- Matthew G Liptak
- Department of Orthopaedic and Trauma Surgery, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Kevin R Angel
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Nawasreh Z, Logerstedt D, Cummerm K, Axe MJ, Risberg MA, Snyder-Mackler L. Do Patients Failing Return-to-Activity Criteria at 6 Months After Anterior Cruciate Ligament Reconstruction Continue Demonstrating Deficits at 2 Years? Am J Sports Med 2017; 45:1037-1048. [PMID: 28125899 PMCID: PMC5376235 DOI: 10.1177/0363546516680619] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The variability in outcomes after anterior cruciate ligament reconstruction (ACLR) might be related to the criteria that are used to determine athletes' readiness to return to their preinjury activity level. A battery of return-to-activity criteria (RTAC) that emphasize normal knee function and movement symmetry has been instituted to quantitatively determine athletes' readiness to return to preinjury activities. PURPOSE To investigate performance-based and patient-reported measures at 12 and 24 months after ACLR between patients who passed or failed RTAC at 6 months after ACLR. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 108 patients who had participated in International Knee Documentation Committee level 1 or 2 sports activities completed RTAC testing at 6, 12, and 24 months after surgery. The RTAC included the isometric quadriceps strength index (QI), 4 single-legged hop tests, the Knee Outcome Survey-activities of daily living subscale (KOS-ADLS), and the global rating scale of perceived function (GRS). Patients who scored ≥90% on all RTAC were classified as the pass group, and those who scored <90% on any RTAC were classified as the fail group. At 12- and 24-month follow-ups, patients were asked if they had returned to the same preinjury activity level. RESULTS At the 6-month follow-up, there were 48 patients in the pass group and 47 in the fail group. At the 12-month follow-up, 31 patients (73.8%) from the pass group and 15 patients (39.5%) from the fail group passed RTAC, and at the 24-month follow-up, 25 patients (75.8%) from the pass group and 14 patients (51.9%) from the fail group passed RTAC. The rate of return to activities in the pass group was 81% and 84% at 12 and 24 months after ACLR, respectively, compared with only 44% and 46% in the fail group ( P ≤ .012), respectively; however, some patients in the fail group participated in preinjury activities without being cleared by their therapists. At 12 and 24 months, 60.5% and 48.1% of patients continued to fail again on the criteria, respectively. A statistically significant group × time interaction was found for the single hop and 6-m timed hop limb symmetry indices (LSIs) ( P ≤ .037), with only the fail group demonstrating a significant improvement over time. A main effect of group was detected for the QI and the crossover hop and triple hop LSIs ( P < .01), with patients in the pass group demonstrating higher performance. A main effect of time was detected for the crossover hop and triple hop LSIs and the GRS, with improvements seen in both groups ( P < .05). CONCLUSION Patients who passed the RTAC early after ACLR were more likely to demonstrate normal knee function and movement symmetry at 12 and 24 months postoperatively, while patients who failed the RTAC early were more likely to demonstrate impaired knee function and movement asymmetry at 12- and 24-month follow-ups. Patients in the pass group had a higher rate of return to their preinjury activity level compared with those in the fail group. A group of patients chose to return to their preinjury activities, even though they were functionally not ready.
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Affiliation(s)
- Zakariya Nawasreh
- Address correspondence to Zakariya Nawasreh, BPT, MS, PhD, Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan ()
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Ross CA, Clifford A, Louw QA. Factors informing fear of reinjury after anterior cruciate ligament reconstruction. Physiother Theory Pract 2017; 33:103-114. [DOI: 10.1080/09593985.2016.1271847] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Cheryl A. Ross
- Physiotherapy Department, University of Stellenbosch, Stellenbosch, South Africa
| | - Amanda Clifford
- Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Quinette A. Louw
- Faculty of Medicine and Health Sciences, University of Stellenbosch Physiotherapy Division/FNB-3D Movement Analysis Laboratory, Tygerberg, South Africa
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Stewart BA, Momaya AM, Silverstein MD, Lintner D. The Cost-Effectiveness of Anterior Cruciate Ligament Reconstruction in Competitive Athletes. Am J Sports Med 2017; 45:23-33. [PMID: 27590175 DOI: 10.1177/0363546516664719] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Competitive athletes value the ability to return to competitive play after the treatment of anterior cruciate ligament (ACL) injuries. ACL reconstruction has high success rates for return to play, but some studies indicate that patients may do well with nonoperative physical therapy treatment. PURPOSE To evaluate the cost-effectiveness of the treatment of acute ACL tears with either initial surgical reconstruction or physical therapy in competitive athletes. STUDY DESIGN Economic and decision analysis; Level of evidence, 2. METHODS The incremental cost, incremental effectiveness, and incremental cost-effectiveness ratio (ICER) of ACL reconstruction compared with physical therapy were calculated from a cost-effectiveness analysis of ACL reconstruction compared with physical therapy for the initial management of acute ACL injuries in competitive athletes. The ACL reconstruction strategy and the physical therapy strategy were represented as Markov models. Costs and quality-adjusted life-years (QALYs) were evaluated over a 6-year time horizon and were analyzed from a societal perspective. Quality of life and probabilities of clinical outcomes were obtained from the peer-reviewed literature, and costs were compiled from a large academic hospital in the United States. One-way, 2-way, and probabilistic sensitivity analyses were used to assess the effect of uncertainty in variables on the ICER of ACL reconstruction. RESULTS The ICER of ACL reconstruction compared with physical therapy was $22,702 per QALY gained. The ICER was most sensitive to the quality of life of returning to play or not returning to play, costs, and duration of follow-up but relatively insensitive to the rates and costs of complications, probabilities of return to play for both operative and nonoperative treatments, and discount rate. CONCLUSION ACL reconstruction is a cost-effective strategy for competitive athletes with an ACL injury.
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Affiliation(s)
| | - Amit M Momaya
- Division of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Functional outcome after transphyseal anterior cruciate ligament reconstruction in young patients with open growth plates. Knee 2016; 23:1121-1132. [PMID: 27717626 DOI: 10.1016/j.knee.2016.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 08/23/2016] [Accepted: 09/01/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study evaluates sports ability, rotational laxity and potential growth changes in children after transphyseal ACL reconstruction with metaphyseal fixation technique, considering physis biology by placing drill holes vertically in the femoral anatomic origin in order to reduce volumetric injury to the physis. METHODS In this retrospective trial of 42 patients data were collected. Thirty-seven were reviewed measuring rotational laxity and anteroposterior tibial translation using the Laxitester (ORTEMA Sport Protection, Markgroeningen, Germany) and the KT1000. Clinical examination was evaluated with the IKDC 2000 knee examination form. Leg axis was determined with digital photography and leg length was assessed clinically. Sports ability was assessed with questionnaires including subjective IKDC, Tegner Activity Scale, Activity Rating Scale and a questionnaire on sports and level of sports. RESULTS Mean follow-up was 24.9months. Mean age at surgery was 13.2years in boys and 13.1years in girls. IKDC 2000 grading was A or B in 28 patients and C in nine patients. Significant increased anterior tibial translation was observed in neutral position and in external tibia rotation. No growth abnormalities were seen. Fifty-seven percent of the patients were able to participate in competitive sports at follow-up. CONCLUSION Transphyseal ACL reconstruction with metaphyseal fixation in children with open growth plates can be done with low risk of growth changes. Return to competitive sports is possible although low rotational laxity still exists. LEVEL OF EVIDENCE IV.
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Rajasekar S, Marchand AM. Fascial Manipulation ® for persistent knee pain following ACL and meniscus repair. J Bodyw Mov Ther 2016; 21:452-458. [PMID: 28532890 DOI: 10.1016/j.jbmt.2016.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/23/2016] [Accepted: 08/21/2016] [Indexed: 11/20/2022]
Abstract
Fascial Manipulation® (FM) is a manual therapy approach for the treatment of musculoskeletal pain. Anomalous fascial tension is common following surgery due to surgical scar, inadequate mobility and fear of movement. Fascial tension may result in pain and loss of mobility. This case report aims at investigating the effectiveness of FM® on pain and function in a patient following knee surgery. A 32 years old male patient, with persisting knee pain following anterior cruciate ligament reconstruction (hamstring graft) and meniscal repair, underwent the systematic FM® assessment process, the selected centers of coordination of myofascial units were treated. Knee Injury Osteoarthritis Outcome Score (KOOS) questionnaire was obtained prior treatment and after 4 treatment sessions. Results showed clinically significant improvements in all subscales of KOOS after 4 weeks, the effect was maintained in subsequent follow-ups at 3 months, 6 months, one year and two years.
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Affiliation(s)
- Sannasi Rajasekar
- Srinivas College of Physiotherapy and Research Centre, Mangalore, Karnataka, 575 001, India
| | - Aurélie Marie Marchand
- Clinical Lecturer, Anglo-European College of Chiropractic, 13-15 Parkwood Road, BH5 2DF Bournemouth, United Kingdom.
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Zellers JA, Carmont MR, Grävare Silbernagel K. Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play. Br J Sports Med 2016; 50:1325-1332. [PMID: 27259751 DOI: 10.1136/bjsports-2016-096106] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/26/2022]
Abstract
AIM This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP. DESIGN A systematic review and meta-analysis were performed. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination. DATA SOURCES PubMed, CINAHL, Web of Science and Scopus databases were searched to identify potentially relevant articles. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies reporting RTP/sport/sport activity in acute, closed Achilles tendon rupture were included. RESULTS 108 studies encompassing 6506 patients were included for review. 85 studies included a measure for determining RTP. The rate of RTP in all studies was 80% (95% CI 75% to 85%). Studies with measures describing determination of RTP reported lower rates than studies without metrics described, with rates being significantly different between groups (p<0.001). CONCLUSIONS 80 per cent of patients returned to play following Achilles tendon rupture; however, the RTP rates are dependent on the quality of the method used to measure RTP. To further understand RTP after Achilles tendon rupture, a standardised, reliable and valid method is required.
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Affiliation(s)
- Jennifer A Zellers
- Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Michael R Carmont
- Department of Orthopaedic Surgery, The Princess Royal Hospital, Telford, Shropshire, UK.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Grävare Silbernagel
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Tan SHS, Lau BPH, Khin LW, Lingaraj K. The Importance of Patient Sex in the Outcomes of Anterior Cruciate Ligament Reconstructions: A Systematic Review and Meta-analysis. Am J Sports Med 2016; 44:242-54. [PMID: 25802119 DOI: 10.1177/0363546515573008] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND One of the well-studied epidemiological phenomena of anterior cruciate ligament (ACL) injuries is the 2- to 9-fold increase in the relative risk of ACL rupture in female athletes compared with male athletes. However, the influence of patient sex on the outcome after ACL reconstruction remains unclear, with some authors reporting inferior outcomes in females and others noting no significant difference. PURPOSE To provide a comprehensive systematic review and meta-analysis to examine the possible association between patient sex and the subjective and objective outcomes after ACL reconstruction. METHODS This study was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies that reported clinical outcomes after ACL reconstruction in males and females independently were included in the review. A quantitative random-effects meta-analysis was performed to compare outcomes between sexes. For outcomes with considerable heterogeneity, meta-regression was used to identify potential moderators. Articles were evaluated qualitatively when quantitative data were not reported. RESULTS A total of 135 publications were included in the review. Females had inferior outcomes in instrumented laxity (standardized mean difference [SMD], 0.24; 95% CI, 0.11-0.37), revision rate (relative risk [RR], 1.15; 95% CI, 1.02-1.28), Lysholm score (SMD, -0.33; 95% CI, -0.55 to -0.11), Tegner activity scale (SMD, -0.37; 95% CI, -0.49 to -0.24), and incidence of not returning to sports (RR, 1.12; 95% CI, 1.04-1.21), all of which were statistically significant. Other outcomes were comparable between sexes, including anterior drawer test, Lachman test, pivot-shift test, timed single-legged hop test, single-legged hop test, quadriceps testing, hamstring testing, extension loss, flexion loss, development of cyclops lesion, and International Knee Documentation Committee (IKDC) knee examination score. Females and males were equally likely to develop anterior knee pain and osteoarthritis after ACL reconstruction. The graft rupture and graft failure rates did not differ significantly between sexes. CONCLUSION There were comparable or inferior results for females compared with males in all outcomes analyzed. No statistically significant sex difference was identified in most of the objective parameters. However, subjective and functional outcomes, including Lysholm score, Tegner activity scale, and ability to return to sports, have been shown to be poorer in females.
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Affiliation(s)
- Si Heng Sharon Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Bernard Puang Huh Lau
- National University Hospital Sports Centre, Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Lay Wai Khin
- Investigational Medicine Unit, Dean's Office, Medicine, National University Health System (NUHS), Singapore Department of Surgery, National University Health System (NUHS), Singapore
| | - Krishna Lingaraj
- National University Hospital Sports Centre, Department of Orthopaedic Surgery, National University Health System, Singapore
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32
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Anterior cruciate ligament reconstruction and service in the British Army. Occup Med (Lond) 2015; 66:17-9. [DOI: 10.1093/occmed/kqv137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Heard WMR, VanSice WC, Savoie FH. Anterior cruciate ligament tears for the primary care sports physician: what to know on the field and in the office. PHYSICIAN SPORTSMED 2015; 43:432-9. [PMID: 26559706 DOI: 10.1080/00913847.2015.1092857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are relatively common and can lead to knee dysfunction. The classic presentation is a non-contact twisting injury with an audible pop and the rapid onset of swelling. Prompt evaluation and diagnosis of ACL injuries are important. Acute treatment consists of cessation of the sporting activity, ice, compression, and elevation with evaluation by a physician familiar with ACL injuries and their management. The diagnosis is made with the use of patient history and physical examination as well as imaging studies. Radiographs may show evidence of a bony injury. MRI confirms the diagnosis and evaluates the knee for concomitant injuries to the cartilage, menisci and other knee ligaments. For active patients, operative treatment is often recommended while less-active patients may not require surgery. The goal of this review is to discuss the diagnosis of an ACL injury and provide clear management strategies for the primary-care sports medicine physician.
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Affiliation(s)
- Wendell M R Heard
- a Department of Orthopaedic Surgery, Tulane University School of Medicine , New Orleans, LA, USA
| | - Wade C VanSice
- a Department of Orthopaedic Surgery, Tulane University School of Medicine , New Orleans, LA, USA
| | - Felix H Savoie
- a Department of Orthopaedic Surgery, Tulane University School of Medicine , New Orleans, LA, USA
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Sciascia A, Haegele LE, Lucas J, Uhl TL. Preseason Perceived Physical Capability and Previous Injury. J Athl Train 2015; 50:937-43. [PMID: 26287492 DOI: 10.4085/1062-6050-50.7.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT Patient opinion about the ability to perform athletic maneuvers is important after injury; however, prospective assessment of self-perceived physical capability for athletes before the beginning of a season is lacking. OBJECTIVE To perform a descriptive analysis of knee, shoulder, and elbow self-perceived measures of physical capability specific to athletics and to compare the measures between athletes with and without a history of injury. DESIGN Cross-sectional study. SETTING Preparticipation physical examinations. PATIENTS OR OTHER PARTICIPANTS A total of 738 collegiate athletes (486 men, 251 women; age = 19 ± 1 years) were administered questionnaires after receiving medical clearance to participate in their sports. Of those athletes, 350 reported a history of injury. MAIN OUTCOME MEASURE(S) Athletes self-reported a history of knee, shoulder, or elbow injury. Perceived physical capability of the 3 joints was evaluated using the Knee Injury and Osteoarthritis Outcome Score Sport and Recreation Function and Knee-Related Quality of Life subscales and the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score. We conducted nonparametric analysis to determine if scores differed between athletes with and without a history of injury. RESULTS Median values for the Knee Injury and Osteoarthritis Outcome Score Sports and Recreation Function and Knee-Related Quality of Life subscales and the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score for all athletes were 100. Median values for perceived physical capability of athletes with a history of injury were 3 to 12 points lower for each questionnaire before the start of the season (P < .001). CONCLUSIONS Our study provided descriptive values for individual perceived knee, shoulder, and elbow physical capability of collegiate athletes participating in 19 sports. Athletes who did not report previous injuries perceived their physical capabilities to be nearly perfect, which could set the goal for these athletes to return to participation after injury. Athletes reporting previous injuries perceived less physical capability before the competitive season. Self-assessment of joint-specific capability may supplement preseason physical examinations, identifying particular athletes needing further monitoring or care during a season.
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Affiliation(s)
| | | | | | - Timothy L Uhl
- Division of Athletic Training, Department of Rehabilitation Science, University of Kentucky, Lexington
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35
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Ross CA, Clifford A, Louw QA. Intrinsic factors associated with return to sport after anterior cruciate ligament reconstruction: A systematic review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2015; 71:230. [PMID: 30135871 PMCID: PMC6093112 DOI: 10.4102/sajp.v71i1.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/15/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The anterior cruciate ligament is the most commonly injured ligament in the knee, with an average of only 64% of affected athletes returning to their pre-injury level of sport. Intrinsic factors associated with an increased likelihood of return to sport may be addressed during rehabilitation to improve the outcome of the reconstruction. The objectives of this review were to systematically appraise publications from six electronic databases describing intrinsic factors that may be associated with return to sport after anterior cruciate ligament reconstruction. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Methodological quality appraisal was performed according to the Critical Appraisal Skills Programme for cohort studies. We performed a descriptive synthesis of the findings that associated intrinsic factors with return to sport. RESULTS Ten studies were included in the review. The findings show that fear of re-injury is a common reason for not returning to participation in sport. Younger patients may be more likely to return to sport, but findings regarding gender were equivocal, with male competitive athletes appearing to be more likely to return to sport than their female counterparts. Good knee function is not always associated with a higher likelihood to return to sport. CONCLUSION Fear of re-injury and age should be considered in the management of sports participants after anterior cruciate ligament reconstruction.
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Affiliation(s)
- Cheryl A Ross
- Department of Physiotherapy, Stellenbosch University, South Africa
| | - Amanda Clifford
- Department of Clinical Therapies, University of Limerick, Ireland
| | - Quinette A Louw
- Department of Physiotherapy, Stellenbosch University, South Africa
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Fabricant PD, Chin CS, Conte S, Coleman SH, Pearle AD, Dines JS. Return to play after anterior cruciate ligament reconstruction in major league baseball athletes. Arthroscopy 2015; 31:896-900. [PMID: 25660011 DOI: 10.1016/j.arthro.2014.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 11/24/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the study was to (1) investigate the rate of return to play among Major League Baseball (MLB) athletes after anterior cruciate ligament reconstruction (ACLR), (2) determine the impact of ACL injury on ability to perform baseball-specific planting and pivoting tasks (batting and stealing bases), and (3) to explore the effect of the injured side on these metrics. METHODS ACL injury data from 1999 to 2012 were compiled, along with player performance statistics recorded for players with at least 30 games before ACL injury. Predictor variables included side of injury and outcome variables focused on batting average, stolen bases, and number of times caught stealing before injury and after surgery. RESULTS Twenty-three of 26 (88%) players were able to return to at least 30 games after ACLR, although they experienced a decline of 21.2% in number of games played (P = .004). Those who had a ACLR for a rear batting leg injury averaged a 12.3% decline in batting average, whereas those who had ACLR for a lead leg injury had a 6.4% increase in batting average (P = .04). Side of injury was not predictive of stolen base metrics. CONCLUSIONS The overall rate of return to play among MLB position players after ACLR was 88%, although there was a 21.2% decline in the number of games played postoperatively. Injury to the rear batting leg resulted in a lower returning batting average compared with an injury to the lead batting leg. Side of injury had no effect on stolen bases or on the number of times a player was caught stealing. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Peter D Fabricant
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Christopher S Chin
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Stan Conte
- Los Angeles Dodgers Baseball Club, Los Angeles, California, U.S.A
| | - Struan H Coleman
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Andrew D Pearle
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Joshua S Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
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37
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McLean SG, Mallett KF, Arruda EM. Deconstructing the Anterior Cruciate Ligament: What We Know and Do Not Know About Function, Material Properties, and Injury Mechanics. J Biomech Eng 2015; 137:020906. [DOI: 10.1115/1.4029278] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 12/20/2022]
Abstract
Anterior cruciate ligament (ACL) injury is a common and potentially catastrophic knee joint injury, afflicting a large number of males and particularly females annually. Apart from the obvious acute injury events, it also presents with significant long-term morbidities, in which osteoarthritis (OA) is a frequent and debilitative outcome. With these facts in mind, a vast amount of research has been undertaken over the past five decades geared toward characterizing the structural and mechanical behaviors of the native ACL tissue under various external load applications. While these efforts have afforded important insights, both in terms of understanding treating and rehabilitating ACL injuries; injury rates, their well-established sex-based disparity, and long-term sequelae have endured. In reviewing the expanse of literature conducted to date in this area, this paper identifies important knowledge gaps that contribute directly to this long-standing clinical dilemma. In particular, the following limitations remain. First, minimal data exist that accurately describe native ACL mechanics under the extreme loading rates synonymous with actual injury. Second, current ACL mechanical data are typically derived from isolated and oversimplified strain estimates that fail to adequately capture the true 3D mechanical response of this anatomically complex structure. Third, graft tissues commonly chosen to reconstruct the ruptured ACL are mechanically suboptimal, being overdesigned for stiffness compared to the native tissue. The net result is an increased risk of rerupture and a modified and potentially hazardous habitual joint contact profile. These major limitations appear to warrant explicit research attention moving forward in order to successfully maintain/restore optimal knee joint function and long-term life quality in a large number of otherwise healthy individuals.
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Affiliation(s)
- Scott G. McLean
- Human Performance Innovation Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Kaitlyn F. Mallett
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Ellen M. Arruda
- Department of Mechanical Engineering, Department of Biomedical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
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Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 2014; 48:1543-52. [PMID: 25157180 DOI: 10.1136/bjsports-2013-093398] [Citation(s) in RCA: 777] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of this study was to update our original systematic review of return to sport rates following anterior cruciate ligament (ACL) reconstruction surgery. METHOD Electronic databases were searched from April 2010 to November 2013 for articles reporting the number of patients returning to sport following ACL reconstruction surgery. Return to sport rates, physical functioning and contextual data were extracted and combined using random-effects meta-analyses. Data from the original review (articles published up to April 2010) were combined with data from the updated search. RESULTS Sixty-nine articles, reporting on 7556 participants, were reviewed. On average, 81% of people returned to any sport, 65% returned to their preinjury level of sport and 55% returned to competitive level sport after surgery. Symmetrical hopping performance (d=0.3) and the contextual factors of younger age (d=-0.3), male gender (OR=1.4), playing elite sport (OR=2.5) and having a positive psychological response (d=0.3) favoured returning to the preinjury level sport. Receiving a hamstring tendon autograft favoured returning to competitive level sport (OR=2.4), whereas receiving a patellar tendon autograft favoured returning to the preinjury level sport (OR=1.2). CONCLUSIONS Returning to sport varied according to different physical functioning and contextual factors, which could warrant additional emphasis in postoperative rehabilitation programmes to maximise participation.
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Affiliation(s)
- Clare L Ardern
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Julian A Feller
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia Epworth Healthcare, Richmond, Victoria, Australia
| | - Kate E Webster
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
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Correlação entre o resultado da reconstrução artroscópica do ligamento cruzado anterior do joelho e o retorno à atividade esportiva. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2014.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Almeida A, Valin MR, Ferreira R, de Almeida NC, Agostini AP. Correlation between the result from arthroscopic reconstruction of the anterior cruciate ligament of the knee and the return to sports activity. Rev Bras Ortop 2014; 49:240-4. [PMID: 26229807 PMCID: PMC4511682 DOI: 10.1016/j.rboe.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 06/14/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the return to pre-injury sports activity in a group of patients who underwent anterior cruciate ligament (ACL) reconstruction, in relation to age, sex, body mass index (BMI) and associations with upper-limb fractures. METHODS A group of 265 patients who underwent ACL reconstruction using an ipsilateral graft from the thigh flexor tendons, between July 2000 and November 2007, was analyzed. RESULTS A total of 176 patients was evaluated after a mean period of 34.95 ± 18.8 months (median: 31 months) (interquartile range: 20-48 months). The minimum evaluation period was 12 months and the maximum was 87 months. The number of patients who returned to their sports activity prior to tearing the ACL was 121/176 (68.8%). Patients under 30 years of age more frequently returned to sports activity and this was considered significant: p = 0.016; odds ratio, OR = 0.44 (95% confidence interval, CI: 0.22-0.86). Returning to previous sports activity more frequently was not considered significant for male sex (p = 0.273), individuals with BMI < 25 (p = 0.280) or patients with an ACL injury unrelated to an initial traumatic episode with upper-limb fracturing (p = 0.353). CONCLUSIONS The rate of return to the sports activity prior to ACL injury was 68.8%. It was found that patients under the age of 30 years had a significantly greater rate of return to sports activity after the surgery. In relation to sex, BMI and association with an initial traumatic episode of upper-limb fracturing, there was no statistical difference in the return to sports activity.
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Affiliation(s)
| | | | - Ramon Ferreira
- Hospital Saúde de Caxias do Sul, Caxias do Sul, F4, Brazil
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Murawski CD, van Eck CF, Irrgang JJ, Tashman S, Fu FH. Operative treatment of primary anterior cruciate ligament rupture in adults. J Bone Joint Surg Am 2014; 96:685-94. [PMID: 24740666 DOI: 10.2106/jbjs.m.00196] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Operative management of an acute anterior cruciate ligament (ACL) rupture may be required in young and active patients to stabilize the knee and return patients to desired daily activities. ACL reconstruction should be performed anatomically. The majority of studies show no differences between anatomic single-bundle and double-bundle ACL reconstruction with respect to patient-reported outcome scores. Double-bundle reconstruction may provide superior knee joint laxity measurements compared with the single-bundle technique. Following ACL reconstruction, the age and activity level of a patient are predictive of his or her time of return to sports and reinjury. Concomitant meniscal and/or cartilage damage at the time of surgery, in addition to a persistent knee motion deficit, are associated with the development of osteoarthritis after ACL reconstruction.
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Affiliation(s)
- Christopher D Murawski
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213. E-mail address for F.H. Fu:
| | - Carola F van Eck
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213. E-mail address for F.H. Fu:
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213. E-mail address for F.H. Fu:
| | - Scott Tashman
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213. E-mail address for F.H. Fu:
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213. E-mail address for F.H. Fu:
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Czuppon S, Racette BA, Klein SE, Harris-Hayes M. Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review. Br J Sports Med 2013; 48:356-64. [PMID: 24124040 DOI: 10.1136/bjsports-2012-091786] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND As one of the purposes of anterior cruciate ligament reconstruction (ACLR) is to return athletes to their preinjury activity level, it is critical to understand variables influencing return to sport. Associations between return to sport and variables representing knee impairment, function and psychological status have not been well studied in athletes following ACLR. PURPOSE The purpose of this review was to summarise the literature reporting on variables proposed to be associated with return to sport following ACLR. STUDY DESIGN Systematic review. METHODS Medline, EMBASE, CINAHL and Cochrane databases were searched for articles published before November 2012. Articles included in this review met these criteria: (1) included patients with primary ACLR, (2) reported at least one knee impairment, function or psychological measure, (3) reported a return to sport measure and (4) analysed the relationship between the measure and return to sport. RESULTS Weak evidence existed in 16 articles suggesting variables associated with return to sport included higher quadriceps strength, less effusion, less pain, greater tibial rotation, higher Marx Activity score, higher athletic confidence, higher preoperative knee self-efficacy, lower kinesiophobia and higher preoperative self-motivation. CONCLUSIONS Weak evidence supports an association between knee impairment, functional and psychological variables and return to sport. Current return to sport guidelines should be updated to reflect all variables associated with return to sport. Utilising evidence-based return to sport guidelines following ACLR may ensure that athletes are physically and psychologically capable of sports participation, which may reduce reinjury rates and the need for subsequent surgery.
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Affiliation(s)
- Sylvia Czuppon
- Program in Physical Therapy, Washington University School of Medicine, , St Louis, Missouri, USA
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Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med 2013; 41:1549-58. [PMID: 23733635 DOI: 10.1177/0363546513489284] [Citation(s) in RCA: 317] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Up to two-thirds of athletes may not return to their preinjury level of sport by 12 months after anterior cruciate ligament (ACL) reconstruction surgery, despite being physically recovered. This has led to questions about what other factors may influence return to sport. PURPOSE To determine whether psychological factors predicted return to preinjury level of sport by 12 months after ACL reconstruction surgery. STUDY DESIGN Case control study; Level of evidence, 3. METHODS Recreational and competitive-level athletes seen at a private orthopaedic clinic with an ACL injury were consecutively recruited. The primary outcome was return to the preinjury level of sports participation. The psychological factors evaluated were psychological readiness to return to sport, fear of reinjury, mood, emotions, sport locus of control, and recovery expectations. Participants were followed up preoperatively and at 4 and 12 months postoperatively. RESULTS In total, 187 athletes participated. At 12 months, 56 athletes (31%) had returned to their preinjury level of sports participation. Significant independent contributions to returning to the preinjury level by 12 months after surgery were made by psychological readiness to return to sport, fear of reinjury, sport locus of control, and the athlete's estimate of the number of months it would take to return to sport, as measured preoperatively (χ(2) 2 = 18.3, P < .001, classification accuracy = 70%) and at 4 months postoperatively (χ(2) 4 = 38.7, P < .001, classification accuracy = 86%). CONCLUSION Psychological responses before surgery and in early recovery were associated with returning to preinjury level of sport at 12 months, suggesting that attention to psychological recovery in addition to physical recovery after ACL injury and reconstruction surgery may be warranted. Clinical screening for maladaptive psychological responses in athletes before and soon after surgery may help clinicians identify athletes at risk of not returning to their preinjury level of sport by 12 months.
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Affiliation(s)
- Clare L Ardern
- Department of Physiotherapy, School of Allied Health, La Trobe University, Health Science 3 Building, Bundoora, VI 3086, Australia.
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Kreuz PC, Müller S, von Keudell A, Tischer T, Kaps C, Niemeyer P, Erggelet C. Influence of sex on the outcome of autologous chondrocyte implantation in chondral defects of the knee. Am J Sports Med 2013; 41:1541-8. [PMID: 23729686 DOI: 10.1177/0363546513489262] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sex-specific outcomes have been reported in anterior cruciate ligament reconstruction as well as in osteoarthrosis progression, but there are currently no related published data on autologous chondrocyte implantation (ACI). The present prospective study was performed to investigate sex-dependent differences in the results after ACI. HYPOTHESIS The clinical and magnetic resonance imaging (MRI) results after ACI of the knee are influenced by the patient's sex. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The midterm clinical and MRI results of a cell-based fibrin-polymer graft for the treatment of full-thickness cartilage defects were evaluated preoperatively and 6, 12, and 48 months after surgery in 52 patients (male:female ratio, 25:27; average age, 35.6 years). Depending on the sex and the location of the defects (femoral condyles, n = 32; patellofemoral compartment, n = 20), patients were assigned to 4 different groups. Baseline clinical scores were compared with follow-up data by paired Wilcoxon tests for the Lysholm score and the International Knee Documentation Committee (IKDC) scoring system. Sex-specific differences were evaluated with the Mann-Whitney U test. The MRI evaluation was performed with the Henderson score at final follow-up. RESULTS Clinical scores improved in all groups over the whole study period (P < .05). Compared with female patients, male patients achieved significantly better results in the Lysholm score at all time intervals and in the IKDC score at 6 and 12 months after surgery (P < .05). In a subgroup analysis, female patients with patellar defects had the worst results in both clinical scores. With the available number of patients, MRI evaluation at 48 months after surgery revealed no significant difference in defect fill between male and female patients (P > .05). The Pearson correlation coefficient between both clinical scores and the MRI parameters of defect fill and cartilage signal was significant (P < .05). CONCLUSION Autologous chondrocyte implantation is a promising treatment option for full-thickness cartilage defects of male and female knee joints. Female patients with patellar defects have worse prognostic factors.
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Affiliation(s)
- Peter C Kreuz
- Department of Orthopaedic Surgery, University Medical Center Rostock, Doberanerstr. 142, 18057 Rostock, Germany.
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Preoperative predictors for noncopers to pass return to sports criteria after ACL reconstruction. J Appl Biomech 2013; 28:366-73. [PMID: 22983930 DOI: 10.1123/jab.28.4.366] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Less than 50% of athletes pass criteria to return to sports (RTS) 6 months after ACL reconstruction (ACLR). Using data on 38 noncopers, we hypothesized that preoperative age, quadriceps strength index (QI), and knee flexion moments (KFM) during gait would predict the ability to pass/fail RTS criteria and that preoperative quadriceps strength gains would be predictive of passing RTS criteria. Gait analysis and strength data were collected before and after a preoperative intervention and 6 months after ACLR. Age, QI, and KFM each contributed to the predictability to pass or fail RTS criteria 6 months after ACLR. Collectively, the variables predict 69% who would pass and 82% who would fail RTS criteria 6 months after ACLR. Younger athletes who have symmetrical quadriceps strength and greater KFM were more likely to pass RTS criteria. Further, 63% of those who increased preoperative quadriceps strength passed RTS criteria, whereas 73% who did not failed. Increasing quadriceps strength in noncopers before ACLR seems warranted.
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46
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Feller J, Webster KE. Return to sport following anterior cruciate ligament reconstruction. INTERNATIONAL ORTHOPAEDICS 2013; 37:285-90. [PMID: 23138966 PMCID: PMC3560893 DOI: 10.1007/s00264-012-1690-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/14/2012] [Indexed: 11/30/2022]
Abstract
Rates of return to pre-injury sport following anterior cruciate ligament (ACL) reconstruction are less than might be expected from standard outcome measures and there appears to be a rapid decline in sporting participation after two to three years. There are many factors that influence whether an individual will return to sport following this type of surgery. They include not only surgical details and rehabilitation, but also social and psychological factors, as well as demographic characteristics. Age is of particular importance with older patients being less likely to resume their pre-injury sport. It is important that future research clearly identify the pre-injury characteristics of the study cohort when investigating return to sport, and also that there is consistent and precise terminology used to report rates of return to sporting activities. Little is known about how to determine when it is safe to return to sport following ACL reconstruction or how to predict whether an athlete will be able to successfully return to sport. Finally, it needs to be recognised that return to sport following ACL reconstruction is associated with a risk of further injury and the development of osteoarthritis.
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47
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Anterior Cruciate Ligament Tear: Surgical Reconstruction Versus Nonsurgical Management. PM R 2012; 4:1006-14. [DOI: 10.1016/j.pmrj.2012.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 11/09/2012] [Indexed: 11/22/2022]
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McCullough KA, Phelps KD, Spindler KP, Matava MJ, Dunn WR, Parker RD, Reinke EK. Return to high school- and college-level football after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study. Am J Sports Med 2012; 40:2523-9. [PMID: 22922520 PMCID: PMC3692362 DOI: 10.1177/0363546512456836] [Citation(s) in RCA: 208] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a relative paucity of data regarding the effect of anterior cruciate ligament (ACL) reconstruction on the ability of American high school and collegiate football players to return to play at the same level of competition as before their injury or to progress to play at the next level of competition. PURPOSE (1) To identify the percentage of high school and collegiate American football players who successfully returned to play at their previous level of competition, (2) to investigate self-reported performance for those players able to return to play or reason(s) for not returning to play, and (3) to elucidate risk factors responsible for players not being able to return to play or not returning to the same level of performance. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study was a retrospective analysis of prospective patients taken from the Multicenter Orthopaedic Outcomes Network (MOON) cohort who identified football as their primary or secondary sport. Identified patients were then questioned in a structured interview regarding their ACL injury, participation in football before their injury, and factors associated with returning to play. Data were analyzed for player position, concurrent meniscal/ligamentous/chondral injury, surgical technique and graft used for ACL reconstruction, and issues pertaining to timing and ability to return to play. RESULTS One hundred forty-seven players (including 68 high school and 26 collegiate) met our criteria and were contacted from the 2002 and 2003 MOON cohorts. Return to play rates for all high school and collegiate athletes were similar (63% and 69%, respectively). Based on player perception, 43% of the players were able to return to play at the same self-described performance level. Approximately 27% felt they did not perform at a level attained before their ACL tear, and 30% were unable to return to play at all. Although two thirds of players reported some "other interest" contributing to their decision not to return, at both levels of competition, fear of reinjury or further damage was cited by approximately 50% of the players who did not return to play. Analysis of patient-reported outcome scores at a minimum of 2 years after surgery between patients who returned to play and those who did not demonstrated clinically and statistically significant differences in the International Knee Documentation Committee form, Marx Activity Scale, and Knee injury and Osteoarthritis Outcome Score knee-related quality of life subscale in the collegiate players. Similar clinical differences were not statistically significant in the high school students. Player position did not have a statistically significant effect on the ability to return to play for high school players, and 41% of "skilled" position players and 50% of "nonskilled" position players were able to return to play at the same performance level. CONCLUSION Return to play percentages for amateur American football players after ACL reconstruction are not as high as would be expected. While technical aspects of ACL reconstruction and the ensuing rehabilitation have been studied extensively, the psychological factors (primarily a fear of reinjury) influencing the ability to return to play after ACL surgery may be underestimated as a critical factor responsible for athletes not returning to play at any level of competition.
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Della Villa S, Boldrini L, Ricci M, Danelon F, Snyder-Mackler L, Nanni G, Roi GS. Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol. Sports Health 2012; 4:17-24. [PMID: 23016064 PMCID: PMC3435892 DOI: 10.1177/1941738111417564] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Rehabilitation of soccer players after anterior cruciate ligament reconstruction is usually performed without sport-specific guidelines, and the final phases are often left to the team coaches. The possibility of changing this approach has not yet been investigated. Study Design: Case series. Hypothesis: A specific rehabilitation protocol for soccer players, with direct control of the last on-field rehabilitation phases, may lead to complete functional recovery. Methods: Fifty competitive soccer players who followed a sport-specific rehabilitation protocol for soccer were evaluated during the recovery period until their return to competition. The assessment of the functional outcomes was performed using the Knee Outcome Survey–Sports Activity Scale and isokinetic and aerobic fitness tests. Results: The average start of on-field rehabilitation was 90 ± 26 days after surgery; the average time to return to the competitions was 185 ± 52 days. The improvement in the Knee Outcome Survey–Sports Activity Scale during on-field rehabilitation was significant (P < 0.01; from 79 ± 15% to 96 ± 7%). The isokinetic and aerobic fitness tests showed a significant improvement of muscle strength (knee extensors, +55%, P < 0.01; knee flexors, +86%, P < 0.01) and aerobic threshold (+23%, P < 0.01) from the beginning to the end of on-field rehabilitation. Conclusions: Adding on-field rehabilitation to the traditional protocols after anterior cruciate ligament reconstruction may safely lead to complete functional recovery in soccer players.
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Shelbourne KD, Sullivan AN, Bohard K, Gray T, Urch SE. Return to basketball and soccer after anterior cruciate ligament reconstruction in competitive school-aged athletes. Sports Health 2012; 1:236-41. [PMID: 23015878 PMCID: PMC3445250 DOI: 10.1177/1941738109334275] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Little is known about the return to sports after anterior cruciate ligament reconstruction and whether sex differences exist regarding the level and timing at which athletes return. HYPOTHESES Compared to school-aged girls, boys return to full sports earlier and at a higher frequency after surgery (1). Athletes who return to sports earlier will not have a higher incidence of subsequent injury to either knee after surgery (2). STUDY DESIGN Cohort. METHODS The patient population comprised 413 consecutive school-aged athletes who were injured while competing in basketball or soccer. Patients were enrolled prospectively, and activity levels were obtained through follow-up visits, surveys, phone calls, and e-mail. RESULTS Follow-up was obtained for 402 patients (basketball: 58 boys, 242 girls; soccer: 25 boys, 77 girls). Eighty-seven percent of girls and boys returned to high school basketball after surgery: the mean time to return to full participation in basketball was 5.2 ± 2.1 months for girls and 5.3 ± 2.2 months for boys (P = .92). Similarly, 93% of girls and 80% of boys returned to compete in high school soccer after surgery (P = .13); the mean time to return to full participation in soccer was 5.1 ± 1.9 months for girls and 5.1 ± 2.0 for boys (P = 1.00). About 20% of athletes went on to compete in their sport in college. The time of return to sports was not a statistically significant factor for the incidence of subsequent anterior cruciate ligament injury. CONCLUSION Of 402 athletes competing in basketball and soccer, women and men returned at the same rate and same level of sport after surgery. Athletes who returned to sports at earlier times after surgery did not have a higher incidence of subsequent anterior cruciate ligament injury than patients who returned at later times.
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Affiliation(s)
- K. Donald Shelbourne
- Address correspondence to K. Donald Shelbourne, MD, 1815 North Capitol Avenue, Indianapolis, IN 46202 (e-mail: )
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