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Larruskain J, Lekue JA, Angulo P, Santisteban JM, Diaz-Beitia G, Martin-Garetxana I, Gil SM, Bidaurrazaga-Letona I, Monasterio X. An injury burden heat map of all men's and women's teams of a professional football club over a decade. Res Sports Med 2024; 32:740-750. [PMID: 37358165 DOI: 10.1080/15438627.2023.2228959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
The aim was to present a descriptive 10-season summary of injury data from all teams of a professional football club using a heat map approach. Injuries and exposure time were registered according to the FIFA consensus in all men's and women's teams from Athletic Club over 10 seasons. A team-by-injury table was created, showing the incidence, median severity, and burden in each cell. Cells were coloured based on the injury burden value using a green - yellow-red gradient (lowest to highest). The highest overall injury burden was found in the women's 2nd and 1st teams and the men's U(under)17 team (>200 days lost/1000 h). Muscle injury burden demonstrated an increasing pattern with age. Knee joint/ligament injuries, particularly anterior cruciate ligament ruptures, had the highest impact on women's teams, followed by the men's 2nd team. In comparison, ankle joint/ligament injuries had a relatively low injury burden in most teams. Growth-related injuries were the most impactful injuries in the men's U15 and younger teams, and the women's U14 team. In conclusion, epidemiological data on injuries can inform and guide injury management processes. New and improved visualization methods might be important assets when presenting injury data to key decision-makers.
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Affiliation(s)
| | | | - Paco Angulo
- Medical Services, Athletic Club, Lezama, Spain
| | | | | | | | - Susana M Gil
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Iraia Bidaurrazaga-Letona
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
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Ho CY, Sum RKW, Yang Y. Effects of stiffness-altered sport compression garments on lower-limb biomechanics in cutting maneuvers. J Biomech 2024; 175:112292. [PMID: 39191073 DOI: 10.1016/j.jbiomech.2024.112292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 08/14/2024] [Accepted: 08/21/2024] [Indexed: 08/29/2024]
Abstract
Athletes commonly use compression garments (CGs) for perceived effectiveness in preventing injury occurrence. However, limited evidence is available on whether lower-limb CGs reduce the risk of injury. This study aimed at (1) evaluating the effects of CGs on mitigating the risk factors of cutting-related knee injuries; (2) identifying undesirable side-effects of CGs on other joints and cutting performance; and (3) identifying possible interactions between sex and condition. 62 healthy adults performed pre-planned 90˚ cutting tasks under four conditions: control, knee sleeves, placebo leggings and stiffness-altered leggings. Joint angle at initial contact, range of motion, moments, and ground reaction force were measured. A mixed two-way (sex*condition) ANOVA was performed, followed by post-hoc comparisons and subset analyses for sexes. Results showed that the leggings restricted hip sagittal (45.4 ± 1.3 vs. control 50.0 ± 1.3˚, p = 0.001) and rotational (16.8 ± 0.8 vs. control 22.5 ± 1.1˚, p < 0.001) motion. At initial contact, the stiffness-altered leggings reduced knee valgus (0.4 ± 0.8 vs. control -2.1 ± 0.8˚, p = 0.031). However, the altered alignment of lower-limb joints did not reduce multiplanar knee joint moments (p > 0.05). CGs were not effective protective equipment yet. There was no significant difference between knee sleeves and control, nor between leggings conditions (p > 0.05). Force plate measurements, such as increased rate of force development (stiffness-altered 42.6 ± 1.1 & placebo 42.9 ± 1.1 vs. control 39.9 ± 1.0 BW/s, p < 0.028), implied the possibility of performance enhancement through CGs. While further investigations on the optimal compression and stiffness alterations are warranted, athletes are recommended to be aware of the discrepancies between the claimed and actual biomechanical effects of CGs.
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Affiliation(s)
- Cheuk-Yin Ho
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Raymond Kim-Wai Sum
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yijian Yang
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Tsarbou C, Liveris NI, Xergia SA, Papageorgiou G, Kvist J, Tsepis E. ACL Injury Etiology in Its Context: A Systems Thinking, Group Model Building Approach. J Clin Med 2024; 13:4928. [PMID: 39201070 PMCID: PMC11355078 DOI: 10.3390/jcm13164928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Given the complex nature of Anterior Cruciate Ligament (ACL) injury, it is important to analyze its etiology with suitable approaches in order to formulate intervention strategies for effective prevention. The present study employs system thinking techniques to develop a Causal Loop Diagram (CLD) Model for investigating the risk factors for ACL Injury (CLD-ACLI), through a Group Model Building approach. Methods: A two-stage procedure was applied involving a comprehensive literature review followed by several systems thinking group-modeling co-creation workshops with stakeholders. Results: Based on input from experts and stakeholders, combined with the latest scientific findings, the derived CLD-ACLI model revealed a series of interesting complex nonlinear interrelationships causal loops between the likelihood of ACL injury and the number of risk factors. Particularly, the interaction among institutional, psychological, neurocognitive, neuromuscular, malalignment factors, and trauma history seem to affect neuromuscular control, which subsequently may alter the biomechanics of landing, predisposing the ACL to injury. Further, according to the proposed CLD-ACLI model, the risk for injury may increase further if specific environmental and anatomical factors affect the shear forces imposed on the ACL. Conclusions: The proposed CLD-ACLI model constitutes a rigorous useful conceptual presentation agreed upon among experts on the dynamic interactions among potential intrinsic and extrinsic risk factors for ACL injury. The presented causal loop model constitutes a vital step for developing a validated quantitative system dynamics simulation model for evaluating ACL injury-prevention strategies prior to implementation.
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Affiliation(s)
- Charis Tsarbou
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (C.T.); (N.I.L.); (E.T.)
| | - Nikolaos I. Liveris
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (C.T.); (N.I.L.); (E.T.)
| | - Sofia A. Xergia
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (C.T.); (N.I.L.); (E.T.)
| | | | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden;
| | - Elias Tsepis
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece; (C.T.); (N.I.L.); (E.T.)
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Manojlovic M, Ninkovic S, Matic R, Versic S, Modric T, Sekulic D, Drid P. Return to Play and Performance After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Systematic Review of Recent Evidence. Sports Med 2024; 54:2097-2108. [PMID: 38710914 PMCID: PMC11329701 DOI: 10.1007/s40279-024-02035-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND The available literature referring to the return to play (RTP) and performance after anterior cruciate ligament reconstruction (ACLR) has already been comprehensively summarized in team sports such as basketball or American Football. Therefore, in this sense, it is necessary to synthesize evidence relating to the mentioned parameters in soccer players who underwent ACLR. OBJECTIVE The aim of this systematic review was to examine RTP and the performance of soccer players after ACLR. METHODS Three electronic databases, Web of Science, Scopus, and PubMed, have been comprehensively searched to identify relevant articles. The following inclusion criteria were applied: (1) the sample of respondents consisted of soccer players irrespective of their age, sex, or level of competition; (2) athletes experienced anterior cruciate ligament injury and underwent ACLR; (3) outcomes estimated referred to the RTP, RTP at the preinjury level of competition, RTP time, performance, and career duration of soccer players; (4) studies were written in the English language. The methodological quality of the research was evaluated using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS Databases searched yielded a total of 694 studies, of which 17 fulfilled the eligibility criteria and were included in the final analysis. These included 3657 soccer players, 2845 males and 812 females, who underwent ACLR and most commonly competed at the elite, national, amateur, and recreational levels. The results obtained indicated that 72% of soccer players successfully RTP and 53% RTP at the preinjury level of participation after ACLR. In addition, recent evidence provided in this literature review demonstrated that mean RTP time was 264 days or 8.7 months. Moreover, the majority of the studies unambiguously suggested that performance related to statistical aspects noticeably deteriorated compared with both the preinjury period and noninjured athletes. The mean career length of soccer players following ACL surgery was approximately between 4 and 5 years. CONCLUSION Although a high percentage of athletes RTP after a relatively short period of absence from the sports field compared with other sports closely related to soccer, ACLR negatively impacts soccer players' performance and career duration.
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Affiliation(s)
- Marko Manojlovic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia.
| | - Srdjan Ninkovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Radenko Matic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Sime Versic
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Toni Modric
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Damir Sekulic
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
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Pinheiro VH, Laughlin M, Borque KA, Ngo D, Kent MR, Jones M, Neves N, Fonseca F, Williams A. Career Length After Surgically Treated ACL Plus Collateral Ligament Injury in Elite Athletes. Am J Sports Med 2024; 52:2472-2481. [PMID: 39097768 DOI: 10.1177/03635465241262440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
BACKGROUND Limited data are available regarding career length and competition level after combined anterior cruciate ligament (ACL) and medial- or lateral-sided surgeries in elite athletes. PURPOSE To evaluate career length after surgical treatment of combined ACL plus medial collateral ligament (MCL) and ACL plus posterolateral corner (PLC) injuries in elite athletes and, in a subgroup analysis of male professional soccer players, to compare career length and competition level after combined ACL+MCL or ACL+PLC surgeries with a cohort who underwent isolated ACL reconstruction (ACLR). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A consecutive cohort of elite athletes undergoing combined ACL+MCL and ACL+PLC surgery was analyzed between February 2001 and October 2019. A subgroup of male elite soccer players from this population was compared with a previously identified cohort having had isolated primary ACLR without other ligament surgery. A minimum 2-year follow-up was required. Outcome measures were career length and competition level. RESULTS A total of 98 elite athletes met the inclusion criteria, comprising 50 ACL+PLC and 48 ACL+MCL surgeries. The mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Return-to-play (RTP) time was significantly longer for ACL+PLC injuries (12.8 months; P = .019) than for ACL+MCL injuries (10.9 months). In the subgroup analysis of soccer players, a significantly lower number of players with combined ACL+PLC surgery were able to RTP (88%; P = .003) compared with 100% for ACL+MCL surgery and 97% for isolated ACLR, as well as requiring an almost 3 months longer RTP timeline (12.9 months; P = .002) when compared with the isolated ACL (10.2 months) and combined ACL+MCL (10.0 months) groups. However, career length and competition level were not significantly different between groups. CONCLUSION Among elite athletes, the mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Professional soccer players with combined ACL+PLC surgery returned at a lower rate and required a longer RTP time when compared with the players with isolated ACL or combined ACL+MCL injuries. However, those who did RTP had the same career longevity and competition level.
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Affiliation(s)
| | - Mitzi Laughlin
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Dylan Ngo
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Madison R Kent
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mary Jones
- Fortius Clinic, London, UK
- FIFA Medical Centre of Excellence, London, UK
| | - Nuno Neves
- Orthopaedic Department, Hospital CUF Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | | | - Andy Williams
- Fortius Clinic, London, UK
- FIFA Medical Centre of Excellence, London, UK
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Bezuglov E, Malyakin G, Emanov A, Baranova I, Stepanov I, Goncharov E, Shoshorina M, Izmailov S, Morgans R. Anterior Cruciate Ligament Ruptures in Russian Premier League Soccer Players During the 2010 to 2021/2022 Competitive Seasons: The Epidemiology and Details of Return to Sports. Orthop J Sports Med 2024; 12:23259671241261957. [PMID: 39131096 PMCID: PMC11307334 DOI: 10.1177/23259671241261957] [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: 01/15/2024] [Accepted: 02/12/2024] [Indexed: 08/13/2024] Open
Abstract
Background There are limited data on the epidemiology of anterior cruciate ligament (ACL) ruptures in elite adult soccer players, especially in the Russian Premier League (RPL). There is an increased risk of injury due to a combination of additional risk factors such as playing in extremely high and low temperatures, frequent long flights, and regular play on natural and artificial surfaces. Purpose To study the epidemiology of ACL ruptures and determine the patterns associated with their occurrence in RPL soccer players. Study Design Descriptive epidemiology study. Methods All ACL ruptures requiring surgery sustained by players competing in the RPL across 12 competitive seasons between 2010 and 2022 were analyzed. All required data were collected from media analysis and confirmed by club doctors. Results A total of 85 players sustained 100 injuries during 12 competitive seasons. A total of 96.5% of players returned to competitive play. The injury incidence in RPL and during participation of RPL teams in European Cups were 0.4760 and 0.5622 per 1000 playing hours, respectively. When analyzing the outcomes of the primary ACL surgery (a total of 76 operations), the following data were obtained: in 11 cases (14.5%), there was a reinjury on the ipsilateral knee joint and in 4 cases (5.3%) on the contralateral knee joint. The mean return-to-play time after all operations was 284 ± 116 days. The time of return to play after primary reconstruction was 289 ± 136 days, 278 ± 91 days after reconstruction on the contralateral knee and 271 ± 51.5 days after the first ACL revision reconstruction on the ipsilateral knee joints. Conclusion RPL ACL injury epidemiology is similar to that in the other leagues from around the world, although there are factors that can potentially influence the number of these injuries.
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Affiliation(s)
- Eduard Bezuglov
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University, Moscow, Russia
- High Performance Sport Laboratory, Sechenov First Moscow State Medical University, Moscow, Russia
- PFC CSKA, Moscow, Russia
| | - Georgiy Malyakin
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University, Moscow, Russia
- High Performance Sport Laboratory, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Anton Emanov
- High Performance Sport Laboratory, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | | | - Evgeniy Goncharov
- Scientific and Clinical Center No. 2 of the Petrovskiy Russian Scientific Center for Surgery, Moscow, Russia
| | - Maria Shoshorina
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Ryland Morgans
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University, Moscow, Russia
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Demeco A, Salerno A, Gusai M, Vignali B, Gramigna V, Palumbo A, Corradi A, Mickeviciute GC, Costantino C. The Role of Virtual Reality in the Management of Football Injuries. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1000. [PMID: 38929617 PMCID: PMC11205647 DOI: 10.3390/medicina60061000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
Injuries represent a serious concern for football players, with a significant loss in terms of sport participation and long periods of rehabilitation. According to the 2019/20 UEFA Élite Club Injury Report, the average incidence of injuries during training is 2.8 per 1000 h of training, with an average absence from training of 20 days. In addition, injured athletes are 4 to 7 times more likely to relapse than uninjured athletes. High workloads and reduced recovery periods represent two of the most important modifiable risk factors. In this context, prevention and an adequate rehabilitation protocol are vital in managing injuries, reducing their incidence, and improving the return to competition. In recent years, technological development has provided new tools in rehabilitation, and Virtual reality (VR) has shown interesting results in treating neurologic and orthopedic pathologies. Virtual Reality (VR) technology finds application in the sports industry as a tool to examine athletes' technical movements. The primary objective is to detect the biomechanical risk factors associated with anterior cruciate ligament injury. Additionally, VR can be used to train athletes in field-specific techniques and create safe and controlled therapeutic environments for post-injury recovery. Moreover, VR offers a customizable approach to treatment based on individual player data. It can be employed for both prevention and rehabilitation, tailoring the rehabilitation and training protocols according to the athletes' specific needs.
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Affiliation(s)
- Andrea Demeco
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
| | - Antonello Salerno
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
| | - Marco Gusai
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
| | - Beatrice Vignali
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
| | - Vera Gramigna
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (V.G.); (A.P.)
| | - Arrigo Palumbo
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (V.G.); (A.P.)
| | - Andrea Corradi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
| | - Goda Camille Mickeviciute
- Center of Rehabilitation, Physical and Sport Medicine, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania;
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.S.); (M.G.); (B.V.); (A.C.)
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Reuter S, Lambert C, Schadt M, Imhoff AB, Centner C, Herbst E, Stöcker F, Forkel P. Effects of transcranial direct current stimulation and sensorimotor training in anterior cruciate ligament patients: a sham-controlled pilot study. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2024; 38:73-78. [PMID: 38657648 DOI: 10.1055/a-2285-7159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Studies showed changes in the central nervous system in patients who sustained an anterior cruciate ligament tear. There is a lack of evidence regarding the effectiveness of transcranial direct-current stimulation in such patients. METHODS A sham-controlled randomised study. One group of patients (n = 6) underwent 6 weeks of sensorimotor training after an anterior cruciate ligament tear during transcranial direct-current stimulation. The stimulation consisted of 20 minutes (3 sessions/week; 2 weeks) of 2 mA anodal transcranial direct-current stimulation over the primary motor and premotor cortex. The second group (n = 6) received sham stimulation with 6 weeks of sensorimotor training. Centre of pressure deviations in the medio-lateral and anterior-posterior direction and centre of pressure velocity were measured. RESULTS The results demonstrated a significant effect of sensorimotor training on the centre of pressure in medio-lateral and anterior-posterior direction (p=0.025) (p=0.03) in the leg in which an anterior cruciate ligament tear occurred. The type of training did not affect the results. Post-hoc tests showed no significant effect of training in the subgroups (p≥0.115). CONCLUSION Sensorimotor training led to a decrease in sway of the centre of pressure in patients who sustained an anterior cruciate ligament tear, but the addition of anodal transcranial direct-current stimulation placed over the primary motor cortex did not potentiate the adaptive responses of the sensorimotor training.
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Affiliation(s)
- Sven Reuter
- SRH University of Applied Sciences Heidelberg: SRH Hochschule Heidelberg, Gera, GERMANY
| | - Christophe Lambert
- Deparment of Trauma and Orthopedic Surgery, University of Witten/Herdecke: Universitat Witten/Herdecke, Cologne, GERMANY
| | - Maja Schadt
- Department of Biomechanics in Sports, Technical University Munich: Technische Universitat Munchen, München, GERMANY
| | - Andreas B Imhoff
- Department for Orthopaedic Sports Medicine, Munich University of Technology: Technische Universitat Munchen, München, GERMANY
| | - Christoph Centner
- University of Freiburg im Breisgau: Albert-Ludwigs-Universitat Freiburg, Freiburg, GERMANY
| | - Elmar Herbst
- Department for Orthopaedic Sports Medicine, Technische Universität München: Technische Universitat Munchen, München, GERMANY
| | - Fabian Stöcker
- Department of Biomechanics in Sports, Technische Universität München: Technische Universitat Munchen, München, GERMANY
| | - Philipp Forkel
- Department for Orthopaedic Sports Medicine, Technische Universität München: Technische Universitat Munchen, München, GERMANY
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Hogg JA, Wilkerson GB, Acocello SN, Schlink BR, Liang Y, Wu D, Myer GD, Diekfuss JA. Either Autonomy Support or Enhanced Expectancies Delivered Via Virtual-Reality Benefits Frontal-Plane Single-Leg Squatting Kinematics. Percept Mot Skills 2024; 131:687-706. [PMID: 38657202 PMCID: PMC11148811 DOI: 10.1177/00315125241246361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Our purpose in this study was to determine the effects of a virtual reality intervention delivering specific motivational motor learning manipulations of either autonomy support (AS) or enhanced expectancies (EE) on frontal plane single-leg squatting kinematics. We allocated 45 participants (21 male, 24 female) demonstrating knee, hip, and trunk frontal plane mechanics associated with elevated anterior cruciate ligament injury risk to one of three groups (control, AS, or EE). Participants mimicked an avatar performing five sets of eight repetitions of exemplary single-leg squats. AS participants were given the added option of choosing the color of their avatar. EE participants received real-time biofeedback in the form of green highlights on the avatar that remained on as long as the participant maintained pre-determined 'safe' frontal plane mechanics. We measured peak frontal plane knee, hip, and trunk angles before (baseline) and immediately following (post) the intervention. The control group demonstrated greater increases in knee abduction angle (Δ = +2.3°) than did the AS (Δ = +0.1°) and EE groups (Δ = -0.4°) (p = .003; η2p = .28). All groups demonstrated increased peak hip adduction (p = .01, ηp2 = .18) (control Δ = +1.5°; AS Δ = +3.2°; EE Δ = +0.7°). Hip adduction worsened in all groups. AS and EE motivation strategies appeared to mitigate maladaptive frontal plane knee mechanics.
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Affiliation(s)
- Jennifer A. Hogg
- Department of Health and Human Performance, University of Tennessee Chattanooga, Chattanooga, TN, USA
| | - Gary B. Wilkerson
- Department of Health and Human Performance, University of Tennessee Chattanooga, Chattanooga, TN, USA
| | - Shellie N. Acocello
- Department of Health and Human Performance, University of Tennessee Chattanooga, Chattanooga, TN, USA
| | | | - Yu Liang
- Department of Computer Science and Engineering, The University of Tennessee Chattanooga, Chattanooga, TN, USA
| | - Dalei Wu
- Department of Computer Science and Engineering, The University of Tennessee Chattanooga, Chattanooga, TN, USA
| | - Gregory D. Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Youth Physical Development Center, Cardiff Metropolitan University, Wales, UK
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
| | - Jed A. Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
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10
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Bloch H, Klein C. [Injury prevention in football : A challenge for team doctors and coaching team]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:420-426. [PMID: 38662137 DOI: 10.1007/s00132-024-04503-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
High injury rates and long injury-related downtimes demonstrate the need for effective and differentiated injury prevention strategies in football. Preventive measures should take place in various fields and should not be reduced to training programmes or medical approaches. The so-called "Big 6 of injury prevention" provide an overview of the key areas that should be addressed. In modern sports medicine, it should be a matter of course that the team doctor already participates in the primary prevention strategies and does not only get involved in the post-traumatic treatment. Similarly, a decision on a player's return to play after an injury should not be based solely on the medical assessment of the team doctor. Good communication and interdisciplinary cooperation, therefore, form the basis for successful prevention.
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Affiliation(s)
- Hendrik Bloch
- Bezirksverwaltung Bielefeld, Verwaltungs-Berufsgenossenschaft (VBG), Nikolaus-Dürkopp-Straße 8, 33602, Bielefeld, Deutschland.
| | - Christian Klein
- Bezirksverwaltung Bergisch Gladbach, Verwaltungs-Berufsgenossenschaft (VBG), Bergisch Gladbach, Deutschland
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Sell TC, Zerega R, King V, Reiter CR, Wrona H, Bullock GS, Mills N, Räisänen A, Ledbetter L, Collins GS, Kvist J, Filbay SR, Losciale JM. Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI) Scores over Time After Anterior Cruciate Ligament Reconstruction: A Systematic Review with Meta-analysis. SPORTS MEDICINE - OPEN 2024; 10:49. [PMID: 38689130 PMCID: PMC11061071 DOI: 10.1186/s40798-024-00712-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Psychological readiness is an important consideration for athletes and clinicians when making return to sport decisions following anterior cruciate ligament reconstruction (ACLR). To improve our understanding of the extent of deficits in psychological readiness, a systematic review is necessary. OBJECTIVE To investigate psychological readiness (measured via the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI)) over time after ACL tear and understand if time between injury and surgery, age, and sex are associated with ACL-RSI scores. METHODS Seven databases were searched from the earliest date available to March 22, 2022. Articles reporting ACL-RSI scores after ACL tear were included. Risk of bias was assessed using the ROBINS-I, RoB-2, and RoBANS tools based on the study design. Evidence certainty was assessed for each analysis. Random-effects meta-analyses pooled ACL-RSI scores, stratified by time post-injury and based on treatment approach (i.e., early ACLR, delayed ACLR, and unclear approach). RESULTS A total of 83 studies were included in this review (78% high risk of bias). Evidence certainty was 'weak' or 'limited' for all analyses. Overall, ACL-RSI scores were higher at 3 to 6 months post-ACLR (mean = 61.5 [95% confidence interval (CI) 58.6, 64.4], I2 = 94%) compared to pre-ACLR (mean = 44.4 [95% CI 38.2, 50.7], I2 = 98%), remained relatively stable, until they reached the highest point 2 to 5 years after ACLR (mean = 70.7 [95% CI 63.0, 78.5], I2 = 98%). Meta-regression suggests shorter time from injury to surgery, male sex, and older age were associated with higher ACL-RSI scores only 3 to 6 months post-ACLR (heterogeneity explained R2 = 47.6%), and this reduced 1-2 years after ACLR (heterogeneity explained R2 = 27.0%). CONCLUSION Psychological readiness to return to sport appears to improve early after ACL injury, with little subsequent improvement until ≥ 2-years after ACLR. Longer time from injury to surgery, female sex and older age might be negatively related to ACL-RSI scores 12-24 months after ACLR. Due to the weak evidence quality rating and the considerable importance of psychological readiness for long-term outcomes after ACL injury, there is an urgent need for well-designed studies that maximize internal validity and identify additional prognostic factors for psychological readiness at times critical for return to sport decisions. REGISTRATION Open Science Framework (OSF), https://osf.io/2tezs/ .
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Affiliation(s)
- Timothy C Sell
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Ryan Zerega
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Victoria King
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | | | - Hailey Wrona
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK
| | - Nilani Mills
- University of New South Wales, Sydney, NSW, Australia
| | - Anu Räisänen
- Department of Physical Therapy Education-Oregon, College of Health Sciences-Northwest, Western University of Health Sciences, Oregon, USA
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | | | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine, and Caring Medicine, University of Linkoping, Linköping, Sweden
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | - Stephanie R Filbay
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Justin M Losciale
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
- Arthritis Research Canada, Vancouver, Canada.
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12
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Liebermann DG, Markström JL, Selling J, Häger CK. Spatiotemporal lower-limb asymmetries during stair descent in athletes following anterior cruciate ligament reconstruction. J Electromyogr Kinesiol 2024; 75:102868. [PMID: 38359579 DOI: 10.1016/j.jelekin.2024.102868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE This study evaluated motor control recovery at different times following anterior cruciate ligament reconstruction (ACLR) by investigating lower-limb spatiotemporal symmetry during stair descent performances. METHODS We used a cross-sectional design to compare asymptomatic athletes (Controls, n = 18) with a group of people with ACLR (n = 49) divided into three time-from-ACLR subgroups (Early: <6 months, n = 17; Mid: 6-18 months, n = 16; Late: ≥18 months, n = 16). We evaluated: "temporal symmetry" during the stance subphases (single-support, first and second double-support) and "spatial symmetry" for hip-knee-ankle intra-joint angular displacements during the stance phase using a dissimilarity index applied on superimposed 3D phase plots. RESULTS We found significant between-group differences in temporal variables (p ≤ 0.001). Compared to Controls, both Early and Mid (p ≤ 0.05) showed asymmetry in the first double-support time (longer for their injured vs. non-injured leg), while Early generally also showed longer durations in all other phases, regardless of stepping leg. No statistically significant differences were found for spatial intra-joint symmetry between groups. CONCLUSION Temporal but not spatial asymmetry in stair descent is often present early after ACLR; it may remain for up to 18 months and may underlie subtle intra- and inter-joint compensations. Spatial asymmetry may need further exploration.
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Affiliation(s)
- Dario G Liebermann
- Dept. of Physical Therapy, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Israel.
| | - Jonas L Markström
- Dept. of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Sweden
| | - Jonas Selling
- Dept. of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Sweden
| | - Charlotte K Häger
- Dept. of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Sweden.
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13
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Labban W, Manaseer T, Golberg E, Sommerfeldt M, Nathanail S, Dennett L, Westover L, Beaupre L. Jumping into recovery: A systematic review and meta-analysis of discriminatory and responsive force plate parameters in individuals following anterior cruciate ligament reconstruction during countermovement and drop jumps. J Exp Orthop 2024; 11:e12018. [PMID: 38572392 PMCID: PMC10986632 DOI: 10.1002/jeo2.12018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/12/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Purpose Comprehensive understanding of force plate parameters distinguishing individuals postprimary anterior cruciate ligament reconstruction (ACLR) from healthy controls during countermovement jumps (CMJ) and/or drop jumps (DJ) is lacking. This review addresses this gap by identifying discriminative force plate parameters and examining changes over time in individuals post-ACLR during CMJ and/or DJ. Methods We conducted a systematic review and meta analyses following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Nine databases were searched from inception to March 2022. We included cross-sectional papers comparing post-ACLR with healthy controls or longitudinal studies of individuals at least 6 months postprimary ACLR while performing CMJ and/or DJ on force plates. The methodological quality was appraised using the Modified Downs and Black Checklist. Results Thirty-three studies including 1185 (50.38%) participants post-ACLR, and 1167 (49.62%) healthy controls, were included. Data were categorised into single-leg CMJ, double-leg CMJ, single-leg DJ, and double-leg DJ. Jump height was reduced in both single (mean difference [MD] = -3.13; p < 0.01; 95% confidence interval [CI]: [-4.12, -2.15]) and double-leg (MD = -4.24; p < 0.01; 95% CI: [-5.14, -3.34]) CMJs amongst individuals with ACLR. Similarly, concentric impulse and eccentric/concentric impulse asymmetry could distinguish between ACLR (MD = 3.42; p < 0.01; 95% CI: [2.19, 4.64]) and non-ACLR (MD = 5.82; p < 0.01; 95% CI: [4.80, 6.80]) individuals. In double-leg DJs, peak vertical ground reaction forces were lower in the involved side (MD = -0.10; p = 0.03; 95% CI: [-0.18, -0.01]) but higher in the uninvolved side (MD = 0.15; p < 0.01; 95% CI: [0.10, 0.20]) when compared to controls and demonstrated significant changes between 6 months and 3 years post-ACLR. Conclusion This study identified discriminative kinetic parameters when comparing individuals with and without ACLR and also monitored neuromuscular function post-ACLR. Due to heterogeneity, a combination of parameters may be required to better identify functional deficits post-ACLR. Level of Evidence Level III.
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Affiliation(s)
- Wasim Labban
- Department of Physiotherapy, Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
- Mirdif Center for Physiotherapy and RehabilitationDubaiUnited Arab Emirate
| | - Thaer Manaseer
- Department of Sport Rehabilitation, Faculty of Physical Education & Sports SciencesThe Hashemite UniversityZarqaJordan
| | - Eric Golberg
- Department of Physiotherapy, Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
| | - Mark Sommerfeldt
- Department of Surgery, Division of Orthopedic Surgery, Faculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada
- Glen Sather Sports Medicine ClinicUniversity of AlbertaEdmontonCanada
| | | | - Liz Dennett
- Geoffrey and Robyn Sperber Health Sciences LibraryUniversity of AlbertaEdmontonCanada
| | | | - Lauren Beaupre
- Department of Physiotherapy, Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
- Department of Surgery, Division of Orthopedic Surgery, Faculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada
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14
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Borque KA, Laughlin MS, Hugo Pinheiro V, Ngo D, Kent M, Balendra G, Jones M, Williams A. The Effect of Primary ACL Reconstruction on Career Longevity in English Premier League and Championship Soccer Players Compared With Uninjured Controls: A Matched Cohort Analysis. Am J Sports Med 2024; 52:1183-1188. [PMID: 38488398 DOI: 10.1177/03635465241235949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Because of the multitude of variables that affect the retirement decisions of professional soccer players, it has proven difficult to isolate the effect of undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) on career longevity. PURPOSE To compare the career longevity of professional soccer players after a primary ACLR with that of an uninjured matched control cohort. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective review of a consecutive series of primary ACLR was performed between 2008 and 2018 in professional male soccer players from the senior author's practice. Each athlete with ACLR was matched to 3 control athletes who had not undergone ACLR according to age, league, playing position, and preinjury game appearances/minutes played. Player career statistics-including league, game appearances, and game minutes-were compiled for each year until retirement or July 1, 2022. RESULTS A total of 82 soccer players in the English Premier League or Championship at the time of their primary ACLR were matched to 246 control athletes. The mean career length after ACLR was 6 ± 2.6 years, while that of the matched control athletes was 7.6 ± 2.8 years (P < .001). After primary ACLR, an athlete had a 2 times greater chance of retirement compared with the matched control athlete (hazard ratio, 2.19; P < .001). At 5 years after ACLR, 16% of athletes had retired from professional soccer, while 8.5% of the matched cohort were retired (P = .060). By 10 years, 72% of the ACLR cohort had retired compared with 43% of the matched cohort (P < .001). Forwards were more likely to have shortened careers compared with goalkeepers (P = .021); however, no significant differences were observed between midfielders, defenders, and forwards. Within the ACLR cohort, a contralateral ACL tear during the athlete's career caused a 2.30 times (P = .022) increased chance of retirement compared with athletes with only 1 ACL tear during their career. Mechanism of injury, meniscal pathology, graft rerupture, and chondral lesions did not affect career length. CONCLUSION Professional male soccer players who underwent ACLR had decreased career length by approximately 1.6 years compared with a matched player cohort.
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Affiliation(s)
| | | | | | - Dylan Ngo
- Houston Methodist Academic Institute, Houston, Texas, USA
| | - Madison Kent
- Houston Methodist Academic Institute, Houston, Texas, USA
| | - Ganesh Balendra
- Fortius Clinic, London, UK
- FIFA Medical Centre of Excellence, London, UK
| | - Mary Jones
- Fortius Clinic, London, UK
- FIFA Medical Centre of Excellence, London, UK
| | - Andy Williams
- Fortius Clinic, London, UK
- FIFA Medical Centre of Excellence, London, UK
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15
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Bangert Y, Jaber A, Trefzer R, Zietzschmann S, Koch KA, Kern R, Spielmann J, Renkawitz T, Weishorn J. The Impact of Injury on Career Progression in Elite Youth Football-Findings at 10 Years. J Clin Med 2024; 13:1915. [PMID: 38610680 PMCID: PMC11012782 DOI: 10.3390/jcm13071915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: There is a lack of evidence regarding the impact of time loss, match exposure, and age at injury on career progression in elite football. Therefore, the aim of this study was to identify injury characteristics and their influence on career progression in a German youth academy. Methods: During the 2012/2013 season, a prospective cohort study reported 107 time-loss injuries among 130 young athletes from an elite German soccer academy. Individual career progression was analyzed using 10-year data. Results: Injuries and time loss were not associated with career progression (p > 0.05) in the overall cohort. In the U17 and U19 groups, 24% were able to reach the professional level, with injuries significantly decreasing this probability (p = 0.002). Injuries lasting more than 28 days had a negative impact on career progression compared to minor injuries (30% vs. 10%; p = 0.02). Conclusions: Not only the characteristics of injuries, but also their impact on career development, vary with age. In the U17 and U19 age groups, serious injuries resulting in more than 28 days of absence have a negative impact on career progression. It is important to be aware of these effects in order to focus on the prevention of long-term injuries to ensure the optimal development of young athletes.
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Affiliation(s)
- Yannic Bangert
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (Y.B.); (A.J.); (S.Z.); (K.-A.K.); (T.R.)
- TSG 1899 Hoffenheim Fußball-Spielbetriebs GmbH, Horrenberger Straße 58, 74939 Zuzenhausen, Germany;
| | - Ayham Jaber
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (Y.B.); (A.J.); (S.Z.); (K.-A.K.); (T.R.)
| | - Raphael Trefzer
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (Y.B.); (A.J.); (S.Z.); (K.-A.K.); (T.R.)
| | - Severin Zietzschmann
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (Y.B.); (A.J.); (S.Z.); (K.-A.K.); (T.R.)
| | - Kevin-Arno Koch
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (Y.B.); (A.J.); (S.Z.); (K.-A.K.); (T.R.)
| | - Ralph Kern
- TSG 1899 Hoffenheim Fußball-Spielbetriebs GmbH, Horrenberger Straße 58, 74939 Zuzenhausen, Germany;
- Ethianum, Fehrentzstrasse 2, 69115 Heidelberg, Germany
| | - Jan Spielmann
- TSG ResearchLab gGmbH, Horrenberger Straße 58, 74939 Zuzenhausen, Germany;
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (Y.B.); (A.J.); (S.Z.); (K.-A.K.); (T.R.)
| | - Johannes Weishorn
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (Y.B.); (A.J.); (S.Z.); (K.-A.K.); (T.R.)
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16
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Piussi R, Simonson R, Zsidai B, Grassi A, Karlsson J, Della Villa F, Samuelsson K, Senorski EH. Better Safe Than Sorry? A Systematic Review with Meta-analysis on Time to Return to Sport After ACL Reconstruction as a Risk Factor for Second ACL Injury. J Orthop Sports Phys Ther 2024; 54:161-175. [PMID: 38032099 DOI: 10.2519/jospt.2023.11977] [Citation(s) in RCA: 2] [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] [Indexed: 12/01/2023]
Abstract
OBJECTIVE: To compare the time to return to sport (RTS) between patients who did and did not suffer a second anterior cruciate ligament (ACL) injury after ACL reconstruction. DESIGN: Etiology systematic review with meta-analysis. LITERATURE SEARCH: Cochrane Library, Embase, Medline, AMED, and PEDro databases were searched in August 2021 and again in November 2022. STUDY SELECTION CRITERIA: Clinical studies reporting time to RTS after ACL reconstruction and second ACL injury were eligible. DATA SYNTHESIS: We pooled continuous data (time [months] and proportions [%]), with random-effects meta-analyses. Pooled estimates were summarized in forest plots. A qualitative data synthesis was also performed. RESULTS: Twenty-one studies were included in the meta-analysis and 33 in the qualitative synthesis. Pooled incidence of second ACL injury was 16.9% (95% confidence interval [CI]: 12.8, 21.6). Patients who suffered a second ACL injury returned to sport significantly earlier (25 days; 95% CI: 9.5, 40.4) than those who did not suffer another injury. There was no difference in time to RTS for professional athletes who suffered a second ACL injury and those who did not. The certainty of evidence was very low. CONCLUSION: There was very low-certainty evidence that patients who suffered a second ACL injury had returned to sport 25 days earlier than patients who did not have another injury. For professional athletes, there was no difference in time to RTS between athletes who suffered a second ACL injury and athletes who did not. J Orthop Sports Phys Ther 2024;54(3):1-15. Epub 30 November 2023. doi:10.2519/jospt.2023.11977.
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Oronowicz J, Seil R, Hörterer H, Moksnes H, Ekas GR, Cabri J, Mouton C, Frenzel G, Tischer T. Anterior cruciate ligament injuries in elite ski jumping reliably allow return to competition but severely affect future top performance. Knee Surg Sports Traumatol Arthrosc 2024; 32:616-622. [PMID: 38363010 DOI: 10.1002/ksa.12076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE In recent years, anterior cruciate ligament (ACL) injuries have been frequently observed in ski jumping. However, available data in this discipline are very scarce. Therefore, the purpose of this study was to investigate whether an ACL injury in elite-level ski jumping limits the performance level after ACL reconstruction (ACLR). METHODS Both male and female elite-level ski jumpers from five national A-teams who suffered an ACL injury were identified retrospectively by searching available media reports and Fédération Internationale de Ski (FIS) database. World Cup (WC) results and time-out-of-competition before ACL injury and after ACLR were compared. Only athletes who suffered the injury during or after the 2009-2010 season and who participated in at least one WC competition before the injury were included in this study. The level of athletes' performance from two full seasons before until three seasons after the injury was compared. RESULTS Eighteen elite-level ski jumpers (11 males/seven females) were eligible for the study. All male and four female athletes returned to professional competition after ACLR. One female athlete ended her career due to prolonged recovery and two have not yet recovered due to a recent injury. The mean return-to-competition (RTC) time was 14.6 months in males and 13.5 months in females. The mean WC placement decreased after the ACL injury: two seasons before injury the mean position was 17.9 ± 11.0 (n = 12), one season before it was 22.4 ± 12.8 (n = 15). After recovery, the mean placement in seasons 1-3 was: 26.4 ± 8.9 (n = 7), 25.7 ± 10.3 (n = 13), 33.6 ± 12.2 (n = 10) (p = 0.008). Among the athletes returning to competition, only six males and three females reached their preinjury level and only one male and one female (compared to seven males and three females preinjury) reached an individual top-3 placement after ACLR, accounting for less than 10% of podiums compared to preinjury. CONCLUSION Only 60% of the professional ski jumpers reached the preinjury level and less than 15% reached a top-3 placement after the ACL injury. These results support the fact that ACL tear during a ski jumping career may be a significant factor limiting high-level performance. In terms of clinical relevance, the findings implicate the need to analyse the reasons of these very low rates of return to elite-level performance, to analyse ACL injury and RTC rates at lower levels of performance and to develop specific prevention strategies in order to reduce the number of ACL injuries in this sport. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jakub Oronowicz
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg (CHL)-Clinique d'Eich, Luxembourg City, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxemburg City, Luxembourg
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD), Luxembourg Institute of Health (LIH), Luxembourg City, Luxembourg
| | - Hubert Hörterer
- Chairman Medical Committee FIS; Member Competition Equipment Committee FIS, Rottach-Egern, Bayern, Germany
| | - Håvard Moksnes
- Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
| | - Guri R Ekas
- Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
- Orthopaedic Department, Akershus University Hospital, Nordbyhagen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Team Physician, Ski Jumping, Norwegian Ski Federation, Oslo, Norway
| | - Jan Cabri
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxemburg City, Luxembourg
- Faculty of Medicine and Pharmacy, GERO, Vrije Universiteit Brussel, Brussels, Belgium
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg (CHL)-Clinique d'Eich, Luxembourg City, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxemburg City, Luxembourg
| | | | - Thomas Tischer
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
- Department of Orthopaedics, University of Rostock, Rostock, Germany
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18
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Gokeler A, Tosarelli F, Buckthorpe M, Della Villa F. Neurocognitive Errors and Noncontact Anterior Cruciate Ligament Injuries in Professional Male Soccer Players. J Athl Train 2024; 59:262-269. [PMID: 37248515 PMCID: PMC10976343 DOI: 10.4085/1062-6050-0209.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Evidence is emerging that core neurocognitive functions such as working memory and inhibitory control (ie, motor-response and attentional inhibition) are linked to the anterior cruciate ligament (ACL) injury risk. Research has been conducted in laboratory settings, but the contribution of neurocognition to actual ACL injuries under real-world conditions is unknown. OBJECTIVE To describe the possible neurocognitive errors involved in noncontact ACL injury mechanisms. DESIGN Case series. SETTING Soccer matches. PATIENTS OR OTHER PARTICIPANTS A total of 47 professional male soccer players. MAIN OUTCOME MEASURE(S) Three independent reviewers evaluated 47 videos of players sustaining noncontact ACL injuries. Neurocognitive errors in inhibitory control were operationalized as follows: (1) motor-response inhibition was scored when a player demonstrated poor decision-making and approached the opponent with high speed that reduced the ability to stop or change the intended action and (2) an attentional error was scored when a player shifted his selective attention away from the relevant task to irrelevant stimuli. RESULTS Of 47 noncontact ACL injuries, 26 (55%) were related to a pressing-type injury, 19 (73%) of which involved a deceiving action made by the opponent, suggesting poor inhibitory control of the defender. Of the remaining 21 noncontact ACL injuries (45%), 16 (76%) could be attributed to attentional errors. Agreement among the 3 raters was very good for all items except poor decision-making, which showed fair to good agreement (Fleiss κ = 0.71). Interrater reliability was excellent (intraclass correlation coefficient = 0.99-1.00). CONCLUSIONS Errors in motor-response inhibitory control and attentional inhibition were common during noncontact ACL injury events in professional male soccer players. The interrater agreement in detecting neurocognitive errors in general was very good.
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Affiliation(s)
- Alli Gokeler
- Exercise Science and Neuroscience Unit, Department of Exercise & Health, Faculty of Science, Paderborn University, Germany
| | - Filippo Tosarelli
- Education & Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Matthew Buckthorpe
- Education & Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
- Faculty of Sport, Allied Health and Performance Science, St Mary’s University, Twickenham, London, United Kingdom
| | - Francesco Della Villa
- Education & Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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19
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Elabd OM, Alghadir AH, Ibrahim AR, Hasan S, Rizvi MR, Sharma A, Iqbal A, Elabd AM. Functional outcomes of accelerated rehabilitation protocol for anterior cruciate ligament reconstruction in amateur athletes: a randomized clinical trial. J Rehabil Med 2024; 56:jrm12296. [PMID: 38385715 PMCID: PMC10910537 DOI: 10.2340/jrm.v56.12296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/11/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is the most common knee injury among athletes, and can result in long-term complications and career-ending conditions for sportspeople. There is no consensus in the literature on the effectiveness of rehabilitation after ACL reconstruction, or the best protocol to follow for functional outcome improvement. OBJECTIVE To determine the impact of an accelerated rehabilitation protocol on knee functional outcomes in amateur athletes with anterior cruciate ligament reconstruction (ACLR). DESIGN Two-arm, parallel-group randomized comparative design. PATIENTS A total of 100 amateur male athletes (mean age 22.01 ± 1.79 years) with ACLR were randomly divided into experimental and control groups (n = 50/group). METHODS An accelerated rehabilitation protocol and a conventional rehabilitation protocol were used for the experimental group. In contrast, only the conventional rehabilitation protocol was used for the control group. The rehabilitation was delivered in 5 weekly sessions for 22 weeks. The primary outcome measure, knee pain, was measured using a visual analogue scale (VAS). Extensive test batteries, for hop tests, Knee Injury and Osteoarthritis Outcome Score (KOOS), and knee effusion, were measured, aiming to add more objective criteria to determine functional performance. RESULTS Both groups (n = 50/group) were well-matched (p = 0.816), with insignificant differences in their demographic characteristics (p > 0.05). A multivariate analysis of variance (MANOVA) test showed no significant difference between the 2 groups (p = 0.781) at baseline. A 2-way MANOVA (2 × 2 MANOVA) of within- and between-group variations indicated overall significant treatment, time, and treatment × time interaction effects (p < 0.001) in favour of the accelerated rehabilitation group. CONCLUSION The accelerated rehabilitation protocol was more effective in improving functional outcomes than a conventional rehabilitation protocol in amateur athletes with ACLR.
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Affiliation(s)
- Omar M Elabd
- Department of Orthopedics and its Surgeries, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
| | - Ahmad H Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Abeer R Ibrahim
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt; Department of Physiotherapy, College of Applied Medical Sciences, Umm Al-Qura University, Saudi Arabia
| | - Shahnaz Hasan
- Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Moattar R Rizvi
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad, India
| | - Ankita Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad, India
| | - Amir Iqbal
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia.
| | - Aliaa M Elabd
- Basic Science Department, Faculty of Physical Therapy, Benha University, Egypt
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20
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Vianna M, Metsavaht L, Guadagnin E, Franciozi CE, Luzo M, Tannure M, Leporace G. Variables Associated With Knee Valgus in Male Professional Soccer Players During a Single-Leg Vertical Landing Task. J Appl Biomech 2024; 40:9-13. [PMID: 37775099 DOI: 10.1123/jab.2023-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 10/01/2023]
Abstract
Prior studies have explored the relationship between knee valgus and musculoskeletal variables to formulate injury prevention programs, primarily for females. Nonetheless, there is insufficient evidence pertaining to professional male soccer players. Here, the aim was to test the correlation of lateral trunk inclination, hip adduction, hip internal rotation, ankle dorsiflexion range of motion, and hip isometric strength with knee valgus during the single-leg vertical jump test. Twenty-four professional male soccer players performed a single-leg vertical hop test, hip strength assessments, and an ankle dorsiflexion range of motion test. A motion analysis system was employed for kinematic analysis. Maximal isometric hip strength and ankle dorsiflexion range of motion were tested using a handheld dynamometer and a digital inclinometer, respectively. The correlation of peak knee valgus with peak lateral trunk inclination was .43 during the landing phase (P = .04) and with peak hip internal rotation was -.68 (P < .001). For knee valgus angular displacement, only peak lateral trunk inclination presented a moderate positive correlation (r = .40, P = .05). This study showed that trunk and hip kinematics are associated with knee valgus, which could consequently lead to increased knee overload in male professional soccer players following a unilateral vertical landing test.
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Affiliation(s)
- Matheus Vianna
- Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Leonardo Metsavaht
- Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil
| | - Eliane Guadagnin
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil
| | - Carlos Eduardo Franciozi
- Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcus Luzo
- Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Gustavo Leporace
- Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil
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21
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Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, Patterson S, Compagnin A, La Rosa G, Della Villa F. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 2024; 54:49-72. [PMID: 37787846 DOI: 10.1007/s40279-023-01934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK.
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Lee Herrington
- Centre for Human Sciences Research, University of Salford, Salford, UK
| | - Mick Hughes
- North Queensland Physiotherapy Centre, Townsville, QLD, Australia
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ross Wadey
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Stephen Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Alessandro Compagnin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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22
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Pinheiro VH, Borque KA, Laughlin MS, Jones M, Balendra G, Kent MR, Ajgaonkar R, Williams A. Determinants of Performance in Professional Soccer Players at 2 and 5 Years After ACL Reconstruction. Am J Sports Med 2023; 51:3649-3657. [PMID: 37960868 DOI: 10.1177/03635465231207832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND A number of studies have investigated return to play after anterior cruciate ligament reconstruction (ACLR) in professional soccer players, but it is unclear which factors are associated with a return to the preinjury performance and ability to play over time. PURPOSE To identify factors that contribute to a professional soccer player's return to preinjury performance after ACLR, as well as to report their playing performance at 2 and 5 years after ACLR compared with their preinjury performance. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A consecutive cohort of professional soccer players undergoing primary ACLR were analyzed between 2005 and 2019. A minimum 2-year follow-up was required. The effect of patient, surgical, and postoperative factors on performance rates, defined as a combination of league level and playing time, was evaluated with univariate and multivariate logistic regression models. RESULTS A total of 200 male professional soccer players were included. When combining league level and playing time, 30% of athletes returned to their preinjury performance at 2 years and 22% at 5 years. However, 53% of athletes returned to their preinjury performance for at least 1 season by year 5. At 2 years, a chondral lesion of grade 3 or 4 decreased the odds of return to preinjury performance (odds ratio [OR], 0.37; P = .010). Athletes receiving an ACLR with the addition of a lateral extra-articular tenodesis procedure were 2.42 times more likely to return to preinjury performance at 2 years than athletes with ACLR alone (P = .004). By 5 years after ACLR, athletes aged ≥25 years at the time of reconstruction were 3 times less likely to be performing at their preinjury performance (OR, 0.32; P < .001), and those with a grade ≥3 chondral lesion were >2 times less likely to be performing at their preinjury performance (OR, 0.43; P = .033). CONCLUSION The presence of >50% thickness chondral pathology, ACLR without lateral extra-articular tenodesis, and age >25 years at the time of surgery were all significant risk factors of worse performance rates after ACLR. Significant decreases in performance rates were noted at 2 and 5 years postoperatively.
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Affiliation(s)
| | - Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mitzi S Laughlin
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mary Jones
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
| | - Ganesh Balendra
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
| | | | - Ryan Ajgaonkar
- University of Texas Rio Grande Valley Medical School, Edinburg, Texas, USA
| | - Andy Williams
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
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23
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Simonsson R, Högberg J, Lindskog J, Piussi R, Sundberg A, Sansone M, Samuelsson K, Thomeé R, Hamrin Senorski E. A comparison between physical therapy clinics with high and low rehabilitation volumes of patients with ACL reconstruction. J Orthop Surg Res 2023; 18:842. [PMID: 37936163 PMCID: PMC10629052 DOI: 10.1186/s13018-023-04304-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/20/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Treatment volume can impact outcomes after surgical procedures of the knee between surgeons with high- and low-patient-volumes. However, the difference between physical therapeutic clinics with high- and low-volumes has not been widely researched. This registry study aims to investigate how patient volume affects knee function outcomes after anterior cruciate ligament (ACL) reconstruction at physical therapy (PT) clinics in terms of odds for a second ACL injury, return to pre-injury level of activity, perceived knee function, and recovery of strength and hop performance. METHOD Data were extracted from the Project ACL, a local rehabilitation registry. High- and low-volume clinics were defined based on the number of patients who attended different clinics. High-volume clinics were defined as those with > 100 patient registrations in Project ACL during the study period while low-volume clinics were those with ≤ 100 patient registrations. High- and low-volume clinics were compared, based on muscle function and patient-reported outcomes across 4 follow-ups, 2-, 4-, 8-, and 12 months, during the first year after ACL reconstruction, and odds of second ACL injury up to 2 years after ACL reconstruction. RESULT Of the 115 rehabilitation clinics included, 111 were classified as low-volume clinics and included 733 patients, and 4 as high-volume clinics which included 1221 patients. There were 31 (1.6%) second ACL injuries to the ipsilateral or contralateral side within the first 12 months and 68 (4.0%) within 2 years. No difference in the incidence of a second ACL injury, within 12 months follow-up odds ratio (OR) 0.95 [95% CI 0.46-1.97] or within 2 years follow-up OR 1.13 [95% CI 0.68-1.88], was found between high- and low-volume clinics. There were early (2 months) and non-clinically relevant differences in patient-reported outcomes (PROs) and physical activity levels early after ACL reconstruction in favor of high-volume clinics. One year after ACL reconstruction, no differences were observed between high- and low-volume clinics in terms of PROs, muscle function, and return to pre-injury level of activity. CONCLUSION No clinically relevant difference in the incidence of secondary ACL injuries in patients who underwent rehabilitation after ACL reconstruction at high- or low-volume physical therapist clinics was found. In addition, no clinically relevant differences in outcomes were found during the first year in terms of patient-reported outcomes, recovery of muscle function, or return to pre-injury level of activity.
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Affiliation(s)
- Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden.
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Jakob Lindskog
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Axel Sundberg
- Capio Ortho Center Gothenburg, Drakegatan 7A, SE-412 50, Gothenburg, Sweden
| | - Mikael Sansone
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, 411 01, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
- Swedish Olympic Committee, Stockholm, Sweden
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24
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Hong IS, Pierpoint LA, Hellwinkel JE, Berk AN, Salandra JM, Meade JD, Piasecki DP, Fleischli JE, Ahmad CS, Trofa DP, Saltzman BM. Clinical Outcomes After ACL Reconstruction in Soccer (Football, Futbol) Players: A Systematic Review and Meta-Analysis. Sports Health 2023; 15:788-804. [PMID: 36988238 PMCID: PMC10606974 DOI: 10.1177/19417381231160167] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
CONTEXT The risk factors for anterior cruciate ligament (ACL) tear for athletes participating in pivoting sports includes young age and female sex. A previous meta-analysis has reported a reinjury rate of 15% after ACL reconstruction (ACLR) for athletes across all sports. To the best of the authors' knowledge, this is the first systematic review and meta-analysis of available literature reporting outcomes after ACLR in soccer players. OBJECTIVE To review and aggregate soccer-specific outcomes data after ACLR found in current literature to help guide a more tailored discussion regarding expectations and prognosis for soccer players seeking operative management of ACL injuries. DATA SOURCES A comprehensive search of publications was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and SPORTDiscus databases. STUDY SELECTION Inclusion criteria consisted of original studies, level of evidence 1 to 4, studies reporting clinical and patient-reported outcomes (PROs) after primary ACLR in soccer players at all follow-up length. STUDY DESIGN The primary outcomes of interest were graft failure/reoperation rates, ACL injury in contralateral knee, return to soccer time, and PROs. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Search of literature yielded 32 studies for inclusion that involved 3112 soccer players after ACLR. RESULTS The overall graft failure/reoperation rate ranged between 3.0% and 24.8% (mean follow-up range, 2.3-10 years) and the combined ACL graft failure and contralateral ACL injury rate after initial ACLR was 1.0% to 16.7% (mean follow-up range, 3-10 years); a subgroup analysis for female and male players revealed a secondary ACL injury incidence rate of 27%, 95% CI (22%, 32%) and 10%, 95% CI (6%, 15%), respectively. Soccer players were able to return to play between 6.1 and 11.1 months and the majority of PROs showed favorable scores at medium-term follow-up. CONCLUSION Soccer players experience high ACL injury rates after primary ACLR and demonstrated similar reinjury rates as found in previous literature of athletes who participate in high-demand pivoting sports.
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Affiliation(s)
- Ian S. Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | | | - Justin E. Hellwinkel
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Alexander N. Berk
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Jonathan M. Salandra
- Department of Orthopaedic Surgery, Jersey City Medical Center, RWJBarnabas Health, Jersey City, New Jersey
| | - Joshua D. Meade
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Dana P. Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - James E. Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Christopher S. Ahmad
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - David P. Trofa
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
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Jiménez-Rubio S, Raya-González J, Lobo-Triviño D, García-Calvo T. The impact of a multicomponent training program on physical fitness and joint injuries in Spanish male professional soccer players. J Sports Sci 2023; 41:1934-1943. [PMID: 38258651 DOI: 10.1080/02640414.2024.2307780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
This study aimed to assess the effects of a multicomponent training program (ProSAS) on selected measures of physical fitness and joint injuries in Spanish male professional soccer players. Twenty-six professional soccer players (age: 25.2 ± 3.1 years) were randomly assigned to either the experimental (EG; n = 16) or control group (CG; n = 10). Y-balance test (YBT), Single leg countermovement jump (SLCMJ), Single leg hop for distance test (SLH), Side-hop test (SH), Speedy jump test (SpJ), Agility T-test (TT) and Lower extremity functional test (LEFT) were performed before and after an 8-weeks training period. Additionally, any joint injury occurring during the intervention period were recorded. Significant improvements in the EG in all tests (p = 0.001 to p = 0.014), except for SLCMJ (p = 0.632) with the dominant leg were observed. CG displayed decreases in SLCMJ with the non-dominant leg (p = 0.014), SH for both legs (p = 0.001 to p = 0.050), TT (p = 0.005), and LEFT (p = 0.001). Inter-groups differences revealed better results for the EG in all variables (p = 0.001 to p = 0.008) except from SLCMJd (p = 0.555). Moreover, the EG exhibited lower joint injury incidence and burden compared to the CG (p < 0.05). These findings suggest that the ProSAS is an effective multicomponent program to improve variables related to risk of joint injuries, and consequently, to reduce the incidence and burden of these injuries in professional soccer players.
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26
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Fältström A, Hägglund M, Hedevik H, Kvist J. Self-reported knee function and activity level are reduced after primary or additional anterior cruciate ligament injury in female football players: a five-year follow-up study. Braz J Phys Ther 2023; 27:100573. [PMID: 38043159 PMCID: PMC10703595 DOI: 10.1016/j.bjpt.2023.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Playing football involves a high risk of anterior cruciate ligament (ACL) injuries and these may affect knee function and activity level. OBJECTIVES To measure changes in self-reported knee function, activity level, and satisfaction with knee function and activity level in female football players with or without an ACL-reconstructed knee. METHODS Female football players, age 19.9 (SD 2.6) years, with either a primary ACL-reconstruction 1.6 (SD 0.7) years after ACL-reconstruction (n = 186) or no ACL injury (n = 113) were followed prospectively for five years. Self-reported data collected at baseline and follow-up included knee function (International Knee Documentation Committee Subjective Knee Form [IKDC-SKF]), activity level (Tegner Activity Scale), and satisfaction with knee function (Likert scale 1=happy; 7=unhappy) and activity level (1-10 scale). Information on any new ACL injury during the follow-up period was collected. RESULTS Players with ACL-reconstruction at baseline who either did (n = 56) or did not (n = 130) sustain an additional ACL injury, and players with no injury at baseline who remained injury free (n = 101) had a lower Tegner score at follow-up. Players with additional ACL injury had lower IKDC-SKF score (mean difference: -11.4, 95% CI: -16.0, -6.7), and satisfaction with activity level (mean difference: -1.5, 95% CI: -2.3, -0.7) at follow-up. Players with no additional ACL injury had higher satisfaction with knee function (mean difference: 0.6, 95% CI: 0.3, 0.9) at follow-up. Players with no ACL injury had lower satisfaction with activity level (mean difference: -0.7, 95% CI: -1.1, -0.3) at follow-up. Players with additional ACL injury had larger decreases in all variables measured compared to the two other groups. CONCLUSION Primary, and even more so additional, ACL injuries decreased self-reported knee function, activity level, and satisfaction with knee function and activity level in female football players.
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Affiliation(s)
- Anne Fältström
- Rehabilitation Centre, Ryhov County Hospital, Jönköping, Region Jönköping County, Sweden; Unit of Physical Therapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Martin Hägglund
- Unit of Physical Therapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Hedevik
- Unit of Physical Therapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Joanna Kvist
- Unit of Physical Therapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Stockholm Sports Trauma Research Center, FIFA Medical Centre of Excellence, Karolinska Institute, Stockholm, Sweden
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27
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Maestroni L, Turner A, Papadopoulos K, Sideris V, Read P. Total Score of Athleticism: Profiling Strength and Power Characteristics in Professional Soccer Players After Anterior Cruciate Ligament Reconstruction to Assess Readiness to Return to Sport. Am J Sports Med 2023; 51:3121-3130. [PMID: 37681510 PMCID: PMC10543956 DOI: 10.1177/03635465231194778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/11/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND There is no consensus on the optimal testing procedure to determine return-to-sport (RTS) readiness after anterior cruciate ligament (ACL) reconstruction. Current approaches use limb symmetry across a range of tests, but this does not consider a patient's level of athleticism or benchmarks relative to his or her noninjured counterparts. PURPOSE To examine the utility of the Total Score of Athleticism (TSA), a composite scale including strength, power, and reactive strength assessments, to aid RTS decision-making. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 95 professional soccer players (60 who underwent ACL reconstruction [mean age, 25.1 ± 12.6 years] and 35 who were uninjured [mean age, 23.8 ± 2.8 years]) completed a battery of tests including isokinetic knee extension and flexion torque, bilateral and unilateral countermovement jump height, relative peak power, and reactive strength index-modified. The TSA score (derived from Z scores) was calculated, and we (1) examined differences between the ACL-reconstructed and uninjured groups at the time of RTS, (2) assessed the predictive ability of the TSA to identify the player's status (ACL reconstruction vs uninjured control), and (3) included a case series to discuss the characteristics of players who sustained a subsequent injury within 4 months after RTS. RESULTS A large difference between the ACL-reconstructed and uninjured groups in the TSA score (d = 0.84; P < .0001) was evident. For every additional increase of 1 unit in the TSA score, the odds of belonging to the ACL-reconstructed group decreased by 74% (95% CI, 0.19-0.56). By visual inspection, the frequency of reinjured players was higher in the low (4/7) TSA tertile compared with the medium (2/7) and high (1/7) TSA tertiles. CONCLUSION Preliminary evidence indicates that the TSA may be a useful RTS readiness tool, as the composite score derived from strength and power measures was different in soccer players at the time of RTS after ACL reconstruction compared with healthy matched controls. There was also a higher frequency of low TSA scores in players who sustained a second injury after RTS. Therefore, it is recommended to routinely administer RTS tests encompassing strength, power, and reactive strength qualities each season across the largest possible number of players (ideally teammates).
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Affiliation(s)
- Luca Maestroni
- ReAct, Bergamo, Italy
- London Sport Institute, Faculty of Science and Technology, Middlesex University, London, UK
| | - Anthony Turner
- London Sport Institute, Faculty of Science and Technology, Middlesex University, London, UK
| | | | - Vasileios Sideris
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Paul Read
- Institute of Sport, Exercise and Health, London, UK
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- Faculty of Sport, Allied Health and Performance Sciences, St Marys University, Twickenham, UK
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28
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Fine R, Curtis W, Stevens K, Imada AO, Stein ER, Treme G, Schenck RC, Richter DL. Return to Sport After Multiligament Knee Injury in Young Athletes. Orthop J Sports Med 2023; 11:23259671231179109. [PMID: 37667679 PMCID: PMC10475233 DOI: 10.1177/23259671231179109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/09/2023] [Indexed: 09/06/2023] Open
Abstract
Background While return to sport (RTS) in young athletes after anterior cruciate ligament (ACL) reconstruction has been well studied, little is known regarding their rate of RTS after multiligament knee injury (MLKI). Purpose To assess the level of and factors associated with RTS after MLKI in young athletes. Study Design Case series; Level of evidence, 4. Methods We retrospectively identified 116 patients aged ≤23 years who had sustained an injury to ≥2 knee ligaments and undergone operative reconstruction or repair of ≥1 ligament. Our primary outcome was self-reported RTS at the preinjury level or higher. We estimated the likelihood of RTS using binomial logistic regression. Secondary variables included the 2000 International Knee Documentation Committee Subjective Knee Form (IKDC-SF), ACL-Return to Sport after Injury (ACL-RSI), and 12-Item Short Form Health Survey (SF-12) physical and mental health summaries. Results A total of 30 (25.9%) patients (24 men, 6 women; mean age, 18.1 ± 2.5 years) completed patient-reported outcome surveys at a mean follow-up of 7.8 years (median, 6.6 years [range, 1.1-19.5 years]). A total of 28 patients underwent surgical treatment of ≥2 ligaments. RTS was achieved by 90% of patients, and 43.3% returned to their preinjury level or higher. Patients who had played sports at a higher level before injury were more likely to RTS at their preinjury level or higher (odds ratio [OR], 3.516 [95% CI, 1.034-11.955]; P = .044), while those who played cutting sports were less likely to do so (OR, 0.013 [95% CI, 0.000-0.461; P = .017). Patients who achieved RTS at their preinjury level or higher had significantly higher IKDC-SF and ACL-RSI scores versus patients who did not (P = .001 and P = .002, respectively). The number of ligaments injured, age, mental health diagnosis, and SF-12 scores were not associated with the ability to RTS at the preinjury or higher levels. Conclusion Most young athletes who sustained MLKI were able to return to play at some level, but a minority returned to their preinjury level. Patients who did return at preinjury or higher levels had higher IKDC-SF and ACL-RSI scores than those who did not. Performance in cutting and/or pivoting sports was negatively associated with RTS.
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Affiliation(s)
- River Fine
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - William Curtis
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Kaleb Stevens
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Allicia O. Imada
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Elena R. Stein
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Gehron Treme
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Robert C. Schenck
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Dustin L. Richter
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Mallinos A, Jones K, Davis BL. Comparison of side-cutting maneuvers versus low impact baseball swing on knee ligament loading in adolescent populations. Clin Biomech (Bristol, Avon) 2023; 106:106004. [PMID: 37257274 DOI: 10.1016/j.clinbiomech.2023.106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND High impact sports are associated with an increased incidence rate for knee ligament injuries, specifically pertaining to the anterior cruciate ligament and medial collateral ligament. What is less clear is (i) the extent to which high impact activities preferentially load the anterior cruciate ligament versus the medial collateral ligament, and (ii) whether both ligaments experience similar stretch ratios during high loading scenarios. Therefore, the goal of this project was to assess how different loading conditions experienced through more at-risk sporting maneuvers influence the relative displacements of the anterior cruciate ligament and medial collateral ligament. The focus of the study was on adolescent patients - a group that has largely been overlooked when studying knee ligament biomechanics. METHODS Through kinetic knee data obtained through motion capture experimentation, two different loading conditions (high vs low impact) were applied to 22 specimen-specific adolescent finite element knee models to investigate the biomechanical impact various sporting maneuvers place on the knee ligaments. FINDINGS The high impact side cutting maneuver resulted in 102% and 47% increases in ligament displacement compared to the low impact baseball swing (p < 0.05) for both the anterior cruciate ligament and medial collateral ligament. INTERPRETATION Quantifying biomechanical risks that sporting activities place on adolescent subjects provides physicians with insight into knee ligament vulnerability. More specifically, knowing the risks that various sports place on ligaments helps guide the selection of sports for at-risk patients (especially those who have undergone knee ligament surgery).
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Affiliation(s)
- Alexandria Mallinos
- Department of Biomedical Engineering, Cleveland State University, Cleveland, OH, USA.
| | - Kerwyn Jones
- Department of Orthopedics, Akron Children's Hospital, Akron, OH, USA
| | - Brian L Davis
- Department of Biomedical Engineering, Cleveland State University, Cleveland, OH, USA; Department of Mechanical Engineering, Cleveland State University, Cleveland, OH, USA
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30
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Georgoulis JD, Melissaridou D, Patras K, Megaloikonomos PD, Trikoupis I, Savvidou OD, Papagelopoulos PJ. Neuromuscular activity of the lower-extremities during running, landing and changing-of-direction movements in individuals with anterior cruciate ligament reconstruction: a review of electromyographic studies. J Exp Orthop 2023; 10:43. [PMID: 37058177 PMCID: PMC10105000 DOI: 10.1186/s40634-023-00603-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Running, jumping/landing and cutting/change of direction (CoD) are critical components of return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR), however the electromyographic (EMG) activity patterns of the operated leg during the execution of these tasks are not clear. METHODS A systematic review was conducted to retrieve EMG studies during running, jumping/landing and cutting/(CoD) in ACLR patients. MEDLINE, PubMed, SPORTDiscus and Web of Science databases were searched from 2000 to May, 2022 using a combination of keywords and their variations: "anterior cruciate ligament reconstruction" OR "ACLR", "electromyography" OR "EMG", "running", "jumping" OR "landing", "cutting" OR "change-of-direction" OR "CoD". The search identified studies comparing EMG data during running, landing and cutting/(CoD) between the involved limb and contralateral or control limbs. Risk of bias was assessed and quantitative analyses using effect sizes were performed. RESULTS Thirty two studies met the inclusion criteria. Seventy five percent (24/32) of the studies reported altered EMG activity pattern of the ACLR leg during running, jumping/landing and cutting/(CoD) when compared with either the healthy control leg or the contra-lateral leg. Twelve studies showed decreased, delayed or earlier onset and delayed peak in quadriceps EMG activity with small to large effect sizes and 9 studies showed increased, delayed or earlier onset and delayed peak in hamstrings EMG activity with small to large effect sizes. Four studies showed a "hamstrings-dominant" strategy i.e. decreased quadriceps coupled with increased hamstrings EMG activity in both running and jumping/landing irrespective of graft type. One study reported that on the grounds of decreased quadriceps activity, lower hamstrings EMG activity was predictive of ipsilateral re-injury in ACLR patients. CONCLUSION This systematic review of Level III evidence showed that the ACLR leg displays decreased quadriceps or increased hamstrings EMG activity or both despite RTS. Simultaneous decreased quadriceps and increased hamstrings EMG activity was shown for both running and jumping/landing. From a clinical perspective this "hamstrings dominant" strategy can serve as a protective mechanism against graft re-injury. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jim D Georgoulis
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece.
- Orthopaedic Sports Medicine Center of Ioannina, University of Ioannina, Ioannina, Greece.
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Patras
- Orthopaedic Sports Medicine Center of Ioannina, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Trikoupis
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Olga D Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens, Greece
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31
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Mitchell A, Waite O, Holding C, Greig M. The Development of a Return to Performance Pathway Involving A Professional Soccer Player Returning From A Multi-Structural Knee Injury: A Case Report. Int J Sports Phys Ther 2023; 18:450-466. [PMID: 37020432 PMCID: PMC10069403 DOI: 10.26603/001c.73317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/14/2023] [Indexed: 04/04/2023] Open
Abstract
This case report describes a male professional soccer player returning to match play (English Championship League) following a medial meniscectomy that occurred during the course of rehabilitation after Anterior Cruciate Ligament (ACL) reconstruction. The player underwent a medial meniscectomy eight months into an ACL rehabilitation program and following 10 weeks of rehabilitation successfully returned to competitive first team match play. This report outlines description of the pathology, the rehabilitation progressions, and the sports specific performance requirements of the player as they progressed through the return to performance pathway (RTP). The RTP pathway included nine distinct phases with evidenced based criteria required to exit each phase. The first five phases were indoor as the player progressed from the medial meniscectomy, through the rehabilitation pathways to the "gym exit Phase". The gym exit Phase was assessed with multiple criteria: a) capacity; b) strength; c) isokinetic dynamometry (IKD); d) hop test battery; e) force plate jumps; and f) supine isometric hamstring rate of force (RFD) development qualities to evaluate the players readiness to start sport specific rehabilitation. The last four phases of the RTP pathway are designed to regain the maximal physical capabilities (plyometric and explosive qualities) in the gym and included the retraining of on-field sport specific qualities utilizing the 'control-chaos continuum.' The player successfully returned to team play in the ninth and final phase of the RTP pathway. The purpose of this case report was to outline a RTP for a professional soccer player who successfully restored specific injury criteria (strength, capacity and movement quality), physical capabilities (plyometric and explosive qualities). and on-field sport specific criteria utilizing the 'control-chaos continuum.' Level of Evidence Level 4.
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Affiliation(s)
| | - Ollie Waite
- Medical Department Crystal Palace Football Club
| | | | - Matt Greig
- Sports Injuries Research Group Edge Hill University
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32
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Akbari H, Kuwano S, Shimokochi Y. Effect of Heading a Soccer Ball as an External Focus During a Drop Vertical Jump Task. Orthop J Sports Med 2023; 11:23259671231164706. [PMID: 37101902 PMCID: PMC10123910 DOI: 10.1177/23259671231164706] [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: 12/14/2022] [Accepted: 01/27/2023] [Indexed: 04/28/2023] Open
Abstract
Background Research has demonstrated that performing a secondary task during a drop vertical jump (DVJ) may affect landing kinetics and kinematics. Purpose To examine the differences in the trunk and lower extremity biomechanics associated with anterior cruciate ligament (ACL) injury risk factors between a standard DVJ and a DVJ while heading a soccer ball (header DVJ). Study Design Descriptive laboratory study. Methods Participants comprised 24 college-level soccer players (18 female and 6 male; mean ± SD age, 20.04 ± 1.12 years; height, 165.75 ± 7.25 cm; weight, 60.95 ± 8.47 kg). Each participant completed a standard DVJ and a header DVJ, and biomechanics were recorded using an electromagnetic tracking system and force plate. The difference (Δ) in 3-dimensional trunk, hip, knee, and ankle biomechanics between the tasks was analyzed. In addition, for each biomechanical variable, the correlation between the data from the 2 tasks was calculated. Results Compared to the standard DVJ, performing the header DVJ led to significantly reduced peak knee flexion angle (Δ = 5.35°; P = .002), knee flexion displacement (Δ = 3.89°; P = .015), hip flexion angle at initial contact (Δ = -2.84°; P = .001), peak trunk flexion angle (Δ = 13.11°; P = .006), and center of mass vertical displacement (Δ = -0.02m; P = .010), and increased peak anterior tibial shear force (Δ = -0.72 N/kg; P = .020), trunk lateral flexion angle at initial contact (Δ = 1.55°; P < .0001), peak trunk lateral flexion angle (Δ = 1.34°; P = .003), knee joint stiffness (Δ = 0.002 N*m/kg/deg; P = .017), and leg stiffness (Δ = 8.46 N/kg/m; P = .046) compared to those in standard DVJs. In addition, individuals' data for these variables were highly and positively correlated between conditions (r = 0.632-0.908; P < .001). Conclusion The header DVJ task showed kinetic and kinematic parameters that suggested increased risk of ACL injury as compared with the standard DVJ task. Clinical Relevance Athletes may benefit from acquiring the ability to safely perform header DVJs to prevent ACL injury. To simulate real-time competition situations, coaches and athletic trainers should incorporate such dual tasks in ACL injury prevention programs.
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Affiliation(s)
- Hadi Akbari
- Department of Sport Sciences, Faculty of Literature and Humanities, University of Zabol, Zabol, Iran
| | - Satoshi Kuwano
- Faculty of Business Information Science, Jobu University, Gunma, Japan
| | - Yohei Shimokochi
- Department of Health and Sport Management, School of Health and Sport Sciences, Osaka University of Health and Sport Sciences, Osaka, Japan
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33
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Simonson R, Piussi R, Högberg J, Senorski C, Thomeé R, Samuelsson K, Senorski EH. Effect of Quadriceps and Hamstring Strength Relative to Body Weight on Risk of a Second ACL Injury: A Cohort Study of 835 Patients Who Returned to Sport After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231157386. [PMID: 37152619 PMCID: PMC10155024 DOI: 10.1177/23259671231157386] [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: 11/15/2022] [Accepted: 01/01/2023] [Indexed: 05/09/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) injuries are common sports-related injuries with a high risk of reinjury after return to sport (RTS). Rehabilitation aims to regain symmetrical knee strength and function to minimize the risk of a second ACL injury after RTS. Purpose To determine the effect of absolute quadriceps and hamstring strength, normalized by body weight, on the risk of a second ACL injury during the first 2 years after RTS in patients who have undergone ACL reconstruction (ACLR). Study Design Cohort study; Level of evidence, 3. Methods Data from patients after index ACLR at the time of RTS were extracted from a rehabilitation registry-Project ACL. Patients who had performed isokinetic tests for quadriceps and hamstring strength and hop tests before RTS were included. The endpoint was a second ACL injury or a follow-up of 2 years after RTS after ACLR. Results A total of 835 patients (46% women), with a mean age of 23.9 ± 7.7 years, were included. During the study period, 69 (8.3%) second ACL injuries (ipsilateral and contralateral) occurred. Greater relative quadriceps strength in the injured leg increased the risk of a second ACL injury (relative risk [RR], 1.69 [95% CI, 1.05-2.74]; P = .032). In patients who had recovered symmetrical quadriceps strength (limb symmetry index ≥90%), there was no effect of quadriceps strength on the risk of second ACL injury (RR, 1.33 [95% CI, 0.69-2.56]; P = .39). Quadriceps strength on the healthy side or hamstring strength, regardless of side, had no effect on the risk of a second ACL injury. Conclusion Greater relative quadriceps strength in the injured leg at the time of RTS after ACLR was associated with an increased risk of a second ACL injury. There was no effect of relative quadriceps strength on the risk of a second ACL injury in patients who had recovered symmetrical quadriceps strength.
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Affiliation(s)
- Rebecca Simonson
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
- Rebecca Simonsson, PT, MSc,
Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of
Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden; Sportrehab, Sports Medicine Clinic, Gothenburg, Sweden,
Sahlgrenska Sports Medicine Center. Box 455, SE-405 30, Gothenburg, Sweden
() (Twitter:
@BeccaSimonson2)
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Senorski
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Department of Orthopaedics, Institute
of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
- Department of Orthopaedics, Sahlgrenska
University Hospital, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic,
Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center,
Gothenburg, Sweden
- Unit of Physiotherapy, Department of
Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
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Sood M, Kulshrestha V, Kumar S, Kumar P, Amaravati RS, Singh S. "Trends and beliefs in ACL reconstruction surgery: Indian perspectives". J Clin Orthop Trauma 2023; 39:102148. [PMID: 36974199 PMCID: PMC10039028 DOI: 10.1016/j.jcot.2023.102148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 01/19/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
Objectives The survey aimed to assess trends and beliefs in the management of anterior cruciate ligament reconstruction (ACLR) amongst orthopaedic surgeons in India. Methods A survey was created and distributed among the various orthopaedic surgeons from India. The questionnaire included brief details of surgeons and their experience, clinical assessment, management strategies and the rehabilitation protocol. Results 135 surgeons completed the survey. 35% of them were having experience of more than 12 years. A large number of surgeons were from government academic institutes (35.5%). The most common criteria for deciding about surgery was Clinical evaluation (94.8%). The most common graft choice was hamstring tendon (94%), and suspensory fixation on the femur side and interference screw on the tibial side (80%) is the most common fixation method. Almost two-thirds of surgeons in this survey use bracing to protect ACL graft in the initial phase. Conclusion We presented the preferences amongst the group of surgeons on the management of ACL injuries. Hamstring tendon graft remains the most preferred graft for ACL reconstruction. Further, the suspensory loop on the femoral side and interference screw on the tibial side are the preferred fixation method. This group of surgeons is conservative in terms of the timing of surgeries and post-operative bracing. Level of evidence Level V, Expert Opinion.
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Affiliation(s)
| | | | | | | | | | - Shalendra Singh
- Department of Anesthesia, Armed Forces Medical College, Pune, 411040, India
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Farinelli L, Abermann E, Meena A, Ueblacker P, Hahne J, Fink C. Return to Play and Pattern of Injury After ACL Rupture in a Consecutive Series of Elite UEFA Soccer Players. Orthop J Sports Med 2023; 11:23259671231153629. [PMID: 36896098 PMCID: PMC9989402 DOI: 10.1177/23259671231153629] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/09/2022] [Indexed: 03/11/2023] Open
Abstract
Background Anterior cruciate ligament rupture represents a career-threatening injury for professional soccer players. Purpose To analyze the pattern of injury, return to play (RTP), and performance of a consecutive series of elite professional soccer players after anterior cruciate ligament reconstruction (ACLR). Study Design Case series; Level of evidence, 4. Methods We evaluated the medical records of 40 consecutive elite soccer players who underwent ACLR by a single surgeon between September 2018 and May 2022. Patient age, height, weight, body mass index, position, injury history, affected side, RTP time, minutes played per season (MPS), and MPS as a percentage of playable minutes before and after ACLR were retrieved from medical records and from publicly available media-based platforms. Results Included were 27 male patients (mean ± SD age at surgery, 23.2 ± 4.3 years; range, 18-34 years). The injury occurred during matches in 24 players (88.9%), with a noncontact mechanism in 22 (91.7%). Meniscal pathology was found in 21 patients (77.8%). Lateral meniscectomy and meniscal repair were performed in 2 (7.4%) and 14 (51.9%) patients, respectively, and medial meniscectomy and meniscal repair were performed in 3 (11.1%) and 13 (48.1%) patients, respectively. A total of 17 players (63.0%) underwent ACLR with bone-patellar tendon-bone autograft and 10 (37.0%) with soft tissue quadriceps tendon. Lateral extra-articular tenodesis was added in 5 patients (18.5%). The overall RTP rate was 92.6% (25 of 27). Two athletes moved to a lower league after surgery. The mean MPS% during the last preinjury season was 56.69% ± 21.71%; this decreased significantly to 29.18% ± 20.6% (P < .001) in the first postoperative season and then increased to 57.76% ± 22.89% and 55.89% ± 25.8% in the second and third postoperative seasons. Two (7.4%) reruptures and 2 (7.4%) failed meniscal repairs were reported. Conclusion ACLR in elite UEFA soccer players was associated with a 92.6% rate of RTP and 7.4% rate of reinjury within 6 months after primary surgery. Moreover, 7.4% of soccer players moved to a lower league during the first season after surgery. Age, graft selection, concomitant treatments, and lateral extra-articular tenodesis were not significantly associated with prolonged RTP.
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Affiliation(s)
- Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Elisabeth Abermann
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria.,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Amit Meena
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria.,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | | | - Jochen Hahne
- Football Club FC Bayern München, Munich, Germany
| | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria.,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
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Lv X, Wang M, Zhao T, Wang L, Dong S, Tan H. All-inside versus complete tibial tunnel techniques in anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2023; 18:127. [PMID: 36810091 PMCID: PMC9945687 DOI: 10.1186/s13018-023-03613-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND All-inside anterior cruciate ligament reconstruction (ACLR) is a novel technique that has gained attention due to its minimally invasive. However, evidence surrounding the efficacy and safety between all-inside and complete tibial tunnel ACLR are lacking. Present work was aimed to compare clinical outcome for ACLR performed with an all-inside versus a complete tibial tunnel technique. METHODS Systematic searches were conducted of published literature on PubMed, Embase, and Cochrane for studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines up to May 10, 2022. The outcomes included KT-1000 arthrometer ligament laxity test, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity scale, and Knee Society Score (KSS) Scale, and tibial tunnel widening. Complications of interest extracted were graft re-ruptures and evaluated the graft re-rupture rate. Data from published RCTs meeting inclusion criteria were extracted and analyzed, and all the extracted data are pooled and analyzed by RevMan 5.3. RESULTS A total of 8 randomized controlled trials involving 544 patients (consisting of 272 all-inside and 272 complete tibial tunnel patients) were included in the meta-analysis. We found clinical outcomes (International Knee Documentation Committee [IKDC] subjective score: mean difference [MD], 2.22; 95% CI, 0.23-4.22; p = 0.03; Lysholm score: MD, 1.09; 95% CI, 0.25-1.93; p = 0.01; Tegner activity scale: MD, 0.41; 95% CI, 0.11-0.71; p < 0.01; Tibial Tunnel Widening: MD = - 1.92; 95% CI, - 3.58 to - 0.25; p = 0.02; knee laxity: MD = 0.66; 95% CI, 0.12-1.20; p = 0.02; and graft re-rupture rate: RR, 1.97;95% CI, 0.50-7.74; P = 0.33) in the all-inside and complete tibial tunnel group. The findings also indicated that all-inside may be more advantageous in tibial tunnel healing. CONCLUSION Our meta-analysis indicated that the all-inside ACLR was superior to complete tibial tunnel ACLR in functional outcomes and tibial tunnel widening. However, the all-inside ACLR was not entirely superior to complete tibial tunnel ACLR in knee laxity measured, and graft re-rupture rate.
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Affiliation(s)
- XiaoYu Lv
- grid.285847.40000 0000 9588 0960Kunming Medical University, Kunming, 650032 Yunnan People’s Republic of China
| | - Ming Wang
- grid.285847.40000 0000 9588 0960Kunming Medical University, Kunming, 650032 Yunnan People’s Republic of China
| | - TianYu Zhao
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming, 650100 Yunnan People’s Republic of China
| | - Ling Wang
- grid.285847.40000 0000 9588 0960Kunming Medical University, Kunming, 650032 Yunnan People’s Republic of China
| | - ShuangBin Dong
- grid.285847.40000 0000 9588 0960Kunming Medical University, Kunming, 650032 Yunnan People’s Republic of China
| | - HongBo Tan
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming, 650100, Yunnan, People's Republic of China.
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Astur DC, Margato GF, Zobiole A, Pires D, Funchal LFZ, Jimenez AE, Freitas EV, Cohen M. The incidence of anterior cruciate ligament injury in youth and male soccer athletes: an evaluation of 17,108 players over two consecutive seasons with an age-based sub-analysis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07331-0. [PMID: 36779987 DOI: 10.1007/s00167-023-07331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/30/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE To evaluate the incidence of anterior cruciate ligament (ACL) injuries in male athletes from professional soccer clubs over two consecutive seasons (2018-2019) with a sub-analysis based on age category: under-13 (U-13), under-15 (U-15), under-17 (U-17), and under-20 (U-20) years. METHODS A total of 17,108 young male soccer players were retrospectively reviewed from sixty-three professional clubs in the four highest Brazilian soccer divisions. Data regarding the number of athletes and the number of ACL injuries confirmed by magnetic resonance imaging (MRI) exams in the 2018 and 2019 seasons were collected. Incidence of ACL injury were compared by season, age category (under-13; under-15; under 17; and under-20), demographic region, and club division. RESULTS Clubs from all regions of Brazil participated in the study. A total of 336 primary ACL injuries were diagnosed over the two seasons (8,167 athletes during the 2018 season and 8,941 athletes during the 2019 season) among all athletes, which corresponds to 2% of the included athletes. There were 11 cases (0.3%) in the under-13, 53 cases (1.3%) in the under-15, 107 cases (2.5%) in the under-17, and 165 cases (3.8%) in the under-20 age category. There was a higher incidence of ACL injury in the older age groups (p < 0.001). CONCLUSION A total of 336 ACL injuries were identified in 17,108 youth soccer players from 63 professional clubs with an overall incidence of 2% over 2 seasons of competition. ACL injury rate ranged from 0.3% to 3.8% and was higher in the older and more competitive club divisions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Diego Costa Astur
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil.
| | - Gabriel Furlan Margato
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil
| | - Alexandre Zobiole
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil
| | - Diego Pires
- Real Instituto de Ortopedia, Recife, PE, Brazil
| | | | | | | | - Moises Cohen
- Disciplina de Medicina Esportiva, Departamento de Ortopedia e Traumatologia Escola Paulista de Medicina, UNIFESP, Avendida Pacaembu 2014, São Paulo, SP, Brazil
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Requejo-Herrero P, Pineda-Galan C, Medina-Porqueres I. Anterior cruciate ligament ruptures in Spanish soccer first division: An epidemiological retrospective study. Knee 2023; 41:48-57. [PMID: 36630867 DOI: 10.1016/j.knee.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/30/2022] [Accepted: 11/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is a severe and complex sport-related injury that can threaten an individual's sporting career. The purpose of this study is to investigate the epidemiological patterns of ACL ruptures in Spanish male first-division soccer players. METHODS The Transfermarkt and Besoccer online electronic databases were screened for ACL injuries between 2010-2011 and 2019-2020 seasons. Injury incidence, injury mechanism, side of the injury, recurrence of the injury, days of recovery and severity, player's position, dominance, season, and moment in which the injury occurs were collected. RESULTS A total of 110 ACL ruptures were registered, with 15.45% of them being re-ruptures either ipsilateral (6.36%) or contralateral ruptures (9.09 %). The ACL incidence rate was 0.0364 per 1000 h of total play with a 68-fold risk in matches compared with training. Predominant injury mechanism was non-contact (56.36%) and the mean lay-off time was 218.8 days, with higher incidence in September-October and March-April. Goalkeeper was found to be the less affected position. CONCLUSIONS This investigation identified an average of 11 ACL tears per season in the Spanish first-division soccer league, most of them occurring in matches with approximately one ACL injury per team every two seasons. Our results from media-based platforms are in accordance with reports based on data from healthcare databases. Further research is needed to corroborate these findings in equivalent contexts. Descriptive studies are classified as Level III evidence according to Daly et al., 2007.
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Affiliation(s)
- Paula Requejo-Herrero
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | | | - Ivan Medina-Porqueres
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain.
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High revision arthroscopy rate after ACL reconstruction in men's professional team sports. Knee Surg Sports Traumatol Arthrosc 2023; 31:142-151. [PMID: 35976389 DOI: 10.1007/s00167-022-07105-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/03/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The study analysed unique data on anterior cruciate ligament (ACL) injuries among German professional male team sports over five consecutive seasons with the aim of improving medical outcomes in the future. Sport-specific differences in injury occurrence, concomitant injuries, timing of ACL reconstruction, graft type selection and short-term complications were examined. METHODS This retrospective study analysed trauma insurance data on all complete ACL tears from players with at least one competitive match appearance in the two highest divisions of German male basketball, ice hockey, football and handball. Each complete ACL tear registered by clubs or physicians between the 2014/15 and 2018/19 seasons with the German statutory accidental insurance for professional athletes (VBG) as part of occupational accident reporting was included. RESULTS In total, 189 out of 7517 players (2.5%) sustained an ACL injury, mainly in handball (n = 82; 43.4%) and football (n = 72; 38.1%) followed by ice hockey (n = 20; 10.6%) and basketball (n = 15; 7.9%).Seventeen players (9.0%) also sustained a second ACL injury. Thus, 206 ACL injuries were included in the analysis. The overall match incidence of ACL injuries was 0.5 per 1000 h and was highest in handballs (1.1 injuries per 1000 h). A total of 70.4% of ACL injuries involved concomitant injury to other knee structures, and 29.6% were isolated ACL injuries. The highest rate of isolated ACL injuries was seen in ice hockey (42.9%). All ACL injuries, except for one career-ending injury, required surgery. In the four analysed team sports, hamstring tendons (71.4%) were the most commonly used grafts for ACL reconstruction; football had the highest percentage of alternative grafts (48.7%). During rehabilitation, 22.9% of all surgically treated ACL injuries (n = 205) required at least two surgical interventions, and 15.6% required revision arthroscopy. The main cause of revision arthroscopy (n = 32; 50.0%) was range-of-motion deficit due to arthrofibrosis or cyclops formation. CONCLUSION The present study shows an overall high rate of revision arthroscopy after ACLR (15.6%), which should encourage surgeons and therapists to evaluate their treatment and rehabilitation strategies in this specific subpopulation. Hamstring tendon grafts are most commonly used for ACL reconstruction but have the highest revision and infection rates. Handball shows the highest ACL injury risk of the four evaluated professional team sports. Concomitant injuries occur in the majority of cases, with the highest share of isolated ACL injuries occurring in ice hockey. LEVEL OF EVIDENCE Level III.
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Reduced performance after return to competition in ACL injuries: an analysis on return to competition in the 'ACL registry in German Football'. Knee Surg Sports Traumatol Arthrosc 2023; 31:133-141. [PMID: 35819462 PMCID: PMC9859836 DOI: 10.1007/s00167-022-07062-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/24/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE ACL injuries are one of the most severe injuries in football, but medical consequences and performance outcomes after return to competition are only rarely investigated. Aim of this study was to analyse the time of return to competition (RTC) in German professional, semi-professional and amateur football. Also, this investigation highlights the rate of career ending and performance outcome after RTC in different playing levels by the measurement of playing level, performed matches and played minutes. METHODS Database of this investigation is the 'ACL registry in German Football' with prospectively collected injury data. Between 2014 and 2018, four seasons in professional (1st-3rd league), semi-professional (4th-6th league) and amateur leagues (7th league) were analysed regarding the return to competition period and performance parameters. Data were collected for three subsequent seasons after injury and compared with the pre-injury and injury season. Data collection was performed using standardized methods. RESULTS A total of 607 ACL injuries were registered during the 4-year period with a mean RTC time of 337.1 day (SD: 183). After primary ACL ruptures, the fastest RTC was found in professional football (247.3 days), while in semi-professional (333.5 d; p < 0.0001) and amateur football (376.2 d; p < 0.0001) a prolonged absence was detected. Re-ruptures occurred in 17.8% (n = 108) and showed similar trend with fastest RTC in professionals (289.9 days; p = 0.002). Within the first three seasons after injury, 92 players (36.7%) in semi-professional and 24 (20%) in professionals had to end their career. Keeping the level of play was only possible for 48 (47.5%) of professionals, while only 47 (29.6%) of semi-professionals and 43 (28.1%) of amateurs were able to. Only in professional football, no significant difference could be seen in the played minutes and games after 2 years compared to the pre-injury season. CONCLUSION Lower playing levels and re-ruptures are the main factors for a prolonged return to competition after ACL rupture in German football. Significant reduction in playing level and a high rate of career endings were found for all levels of play. However, only professional players were able to regain their playing minutes and games 2 years after injury, while lower classed athletes did not reach the same amount within 3 years. LEVEL OF EVIDENCE Level III.
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Armitage M, McErlain-Naylor SA, Devereux G, Beato M, Buckthorpe M. On-field rehabilitation in football: Current knowledge, applications and future directions. Front Sports Act Living 2022; 4:970152. [PMID: 36544545 PMCID: PMC9760760 DOI: 10.3389/fspor.2022.970152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mark Armitage
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
- Performance Services Department, Norwich City Football Club, Norwich, United Kingdom
- Faculty of Sport, Allied Health and Performance Science, St Mary's University Twickenham, London, United Kingdom
| | - Stuart A McErlain-Naylor
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Gavin Devereux
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
| | - Marco Beato
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
| | - Matthew Buckthorpe
- Faculty of Sport, Allied Health and Performance Science, St Mary's University Twickenham, London, United Kingdom
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Pinheiro VH, Jones M, Borque KA, Balendra G, White NP, Ball SV, Williams A. Rates and Levels of Elite Sport Participation at 5 Years After Revision ACL Reconstruction. Am J Sports Med 2022; 50:3762-3769. [PMID: 36326297 DOI: 10.1177/03635465221127297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is a paucity of data regarding return to play (RTP), level of competition, and longevity of play after revision of anterior cruciate ligament (ACL) reconstruction (ACLR) in elite athletes. PURPOSE To report RTP rates and competition levels in elite athletes at the point of RTP, as well as at 2 and 5 years after revision ACLR, and the effect of meniscal and chondral pathology at revision surgery on these outcomes. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review of a consecutive series of all revision ACLRs undertaken by the senior author between 2009 and 2019, with a minimum 2-year follow-up, was carried out. Outcome measures were RTP rates and competition level. RESULTS A total of 49 knees in 48 elite athletes met the inclusion criteria. After revision ACLR, 43 (87.8%) elite athletes achieved RTP, of whom 75.5% were at the same level. At 2 years after surgery, 39 (79.6%) were still playing, 25 (51%) at the same level; at 5 years after surgery, 20 (44.4%) were still playing, 9 (20%) at the same level. Elite athletes with <50% thickness or no articular cartilage lesions were more likely to RTP (94.6% vs 66.7%; P = .026), as well as return to the same competition level (83.8% vs 50%; P = .047), compared with those with ≥50% thickness chondral lesions. Those without medial meniscal pathology were more likely to RTP at the same level after revision surgery (94.4% vs 64.5%; P = .036). The median time elite athletes continued to play after revision ACLR was 73 months (95% CI, 43.4-102.6); 23 months at the same level (95% CI, 13.6-32.4). The probability of still playing at 5 years after surgery was 55.9%, with a 22.5% chance of maintaining preinjury competition level. CONCLUSION In elite athletes, RTP rates and competition level decreased over time after revision ACLR. The presence of >50% thickness chondral pathology was associated with lower RTP rates and competition level at RTP time, while medial meniscal pathology was associated with lower competition level at RTP.
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Affiliation(s)
| | - Mary Jones
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, UK
| | - Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Ganesh Balendra
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, UK
| | - Nathan P White
- Park Clinic Orthopaedics, Melbourne Knee Centre, Melbourne, Australia
| | - Simon V Ball
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, UK.,Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Andy Williams
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, UK
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Olivares-Jabalera J, Fílter A, Dos Santos T, Ortega-Domínguez J, Soto Hermoso VM, Requena B. The Safe Landing warm up technique modification programme: An effective anterior cruciate ligament injury mitigation strategy to improve cutting and jump-movement quality in soccer players. J Sports Sci 2022; 40:2784-2794. [PMID: 36958805 DOI: 10.1080/02640414.2023.2193451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
The objective of the study was to evaluate the effectiveness of the Safe Landing (SL), a 6-week technique-modification (TM) programme, on cutting and jump-landing movement quality in football players. In a non-randomized design, 32 male semi-professional football players from two Spanish clubs participated in the study: one served as the control group (CG, n = 11), while the other performed the SL (n = 15). Performance and movement quality of drop vertical jump and 70º change of direction (COD70) were evaluated through 2D video footage pre- and post-intervention. In such tasks, the Landing Error Scoring System for first (LESS1) and second (LESS2) landings, and the Cutting Movement Assessment Score (CMAS) were used for assessing movement quality. Pre-to-post changes and baseline-adjusted ANCOVA were used. Medium-to-large differences between groups at post-test were shown in CMAS, LESS1 and LESS2 (p < 0.082, ղ2 = 0.137-0.272), with small-to-large improvements in SL (p < 0.046, ES=0.546-1.307), and CG remaining unchanged (p > 0.05) pre-to-post. In COD70 performance, large differences were found between groups (p < 0.047, ղ2 = 0.160-0.253), with SL maintaining performance (p > 0.05, ES=0.039-0.420), while CG moderately decreasing performance (p = 0.024, ES=0.753) pre-to-post. The SL is a feasible and effective TM program to improve movement quality and thus potential injury risk in cutting and landing, while not negatively affecting performance.
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Affiliation(s)
- Jesús Olivares-Jabalera
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), Granada, Spain
- HUMAN Lab, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- FSI Sport Research Lab, FSI Lab, Granada, Spain
- Centro de Estudios, Desarrollo e Investigación del Fútbol Extremeño (CEDIFEX). Federación Extremeña de Fútbol
| | - Alberto Fílter
- FSI Sport Research Lab, FSI Lab, Granada, Spain
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Thomas Dos Santos
- FSI Sport Research Lab, FSI Lab, Granada, Spain
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - José Ortega-Domínguez
- Centro de Estudios, Desarrollo e Investigación del Fútbol Extremeño (CEDIFEX). Federación Extremeña de Fútbol
| | - Víctor M Soto Hermoso
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), Granada, Spain
- HUMAN Lab, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Bernardo Requena
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), Granada, Spain
- HUMAN Lab, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- FSI Sport Research Lab, FSI Lab, Granada, Spain
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Pulici L, Certa D, Zago M, Volpi P, Esposito F. Injury Burden in Professional European Football (Soccer): Systematic Review, Meta-Analysis, and Economic Considerations. Clin J Sport Med 2022; 33:00042752-990000000-00071. [PMID: 36730365 DOI: 10.1097/jsm.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to evaluate the injury burden and the related economic cost in European professional male football players. DATA SOURCES Multiple database research was performed up to August 5, 2022 (PubMed, EMbase, Scopus, Cochrane Library), including only studies that reported severity in the number of days of absence for each injury, incidence reported in the number of injuries/1000 hours, or reported number of injuries and exposure time and adult male football players, professionals from European clubs. Two reviewers extracted data and assessed paper quality with the Strengthening the Reporting of Observational Studies in Epidemiology statement and the Newcastle-Ottawa Scale. MAIN RESULTS Twenty-two studies have reported incidence, severity, and burden of injuries in professional football. The highest injury burden was found for ligament-joint injuries (37.9 days/1000 hours; 222 397 €/1000 hours) and for muscle injuries (34.7 days/1000 hours; 203 620 €/1000 hours). Injury locations with high burden were knee injuries (34.8 days/1000 hours; 20 4206 €/1000 hours)-mainly anterior cruciate ligament injuries (14.4 days/1000 hours; 84 499 €/1000 h)-followed by thigh injuries (25.0 days/1000 hours; 146 700 €/1000 hours), hamstrings injuries (15.4 days/1000 hours; 90 367 €/1000 hours), hip-and-groin injuries (16.1 days/1000 hours; 94 475 €/1000 hours), primarily adductor muscles injuries (9.4 days/1000 hours; 55 159€/1000 hours), and ankle injuries (13.1 days/1000 h; 76 871 €/1000 hours) with ankle sprains (7.4 days/1000 hours; 43 423 €/1000 hours). CONCLUSIONS Being exposed to injury risk has serious consequences for individual and club performance and economy. This review identified the most relevant targets in injury management, compared their injury data with reference values, and provided economic evidence when trying to gain buy-in from the key decision makers.
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Affiliation(s)
| | - Denis Certa
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; and
| | - Matteo Zago
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; and
| | - Piero Volpi
- Knee Surgery and Sport Traumatology Unit, Humanitas Clinical and Research Center, IRCCS Rozzano, Milan, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; and
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Gauthier M, Lê TN, Wehn A, Joseph S, Tscholl PM. Subjective knee apprehension is not associated to physical parameters 6–12 months after anterior cruciate ligament reconstruction. J Exp Orthop 2022; 9:110. [DOI: 10.1186/s40634-022-00545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Purpose
Anterior cruciate ligament (ACL) rupture is a common injury and psychological parameters measured at 6–8 months are said to be almost more predictive for return to sport (RTS) than physiological. Purpose was 1) to evaluate the correlation between knee apprehension using ACL-RSI and physical factors after ACL reconstruction (ACLR), 2) to assess the correlation between ACL-RSI and patient parameters (age, pivot-sport, BMI), and 3) to evaluate ACL-RSI over time.
Methods
Patients with ACLR with or without meniscal repair between 2013 and 2020 were retrospectively analyzed. Including criteria were RTS testing battery, assessed at least 6 months after surgery, including physical parameters (strength, triple hop test, side hop test, and bilateral knee stability) and psychological parameters (ACL-RSI). 5 subgroups were analyzed to assessed factors such as age, BMI, pivot sport, time interval between two RTS testing battery.
Results
Three hundred three patients (212 male, 91 female) presenting ACLR were included. Mean age at surgery was 27 (± 8) years. 258 patients practiced pivot-sport activity and 45 non-pivot-sport activity. The mean interval between ACL rupture and surgery was 6.5 (± 4.5) months. RTS testing battery were performed at 8 (± 7) months after ACLR.
Mean ACL-RSI was 58 (± 28). 1) ACL-RSI was not influenced by muscle strength, coordination and stability of the knee. 2) ACL-RSI was significantly better in lower BMI and non-pivot-sport activities. No correlation was found between graft type, age, sex, and ACL-RSI assessment. 3) For patients who performed two RTS testing battery at 8 and 12 months, ACL-RSI did not significantly increase over time (56 to 64 points, p = 0.22) in spite of significant increased quadriceps (127 to 151 Nm/kg, p = 0.005) and hamstring (93 to 105 Nm/kg, p = 0.05) strength.
Conclusions
Psychological readiness before RTS, measured upon ACL-RSI does not correlate with any physical parameter at 8–12 months postoperatively. Although quadriceps and hamstring strength increased significantly over time, ACL-RSI does not and must therefore be routinely assessed.
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High return to sport rate and few re-ruptures at long term in professional footballers after anterior cruciate ligament reconstruction with hamstrings. Knee Surg Sports Traumatol Arthrosc 2022; 30:3681-3688. [PMID: 35451640 DOI: 10.1007/s00167-022-06944-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Anterior cruciate ligament (ACL) ruptures are considered high burden injuries in sports with high pivotal activity, especially for professional footballers. A lack of evidence exists about long-term follow up of professional elite athletes who underwent ACL reconstruction. The purpose of the study is to analyze the return to play and the career of professional footballers who underwent ACL reconstruction with hamstrings, to evaluate re-rupture and reoperation at either indexed and contralateral knee, and to assess the long-term clinical subjective outcomes and satisfaction. METHODS Twenty-eight professional footballers that underwent 33 ACL reconstructions were retrospectively included in the study. All surgical interventions were performed using hamstring tendons graft and an over the top technique. Inclusion criteria were: inability to compete due to joint instability caused by total or subtotal ACL lesion, patients contracted to a professional football team at time of surgery. Exclusion criteria were: multi-ligament reconstruction or concomitant meniscal allograft transplantation. Patients were contacted by phone and a brief questionnaire about surgery was administered. Subsequently, a Lysholm knee scoring scale was obtained. After that, an online research was performed on publicly available websites in order to retrieve information of the patients included after surgery. RESULTS In all cases, ACL Reconstruction was performed with hamstring tendons using a non-anatomic Double-Bundle technique in 16 cases (49%), an Over-The-Top Single-Bundle technique in 9 cases (27%), and an Over-The-Top Single-Bundle plus Lateral Plasty technique in 8 cases (24%); moreover, a meniscal lesion was present in 20 cases (61%). Three (9%) of the 33 ACL reconstruction failed (2/16 Double-Bundle, 1/9 Single- Bundle, 0/8 Single-Bundle + Lateral Plasty; p = n.s.), with two of them within 12 months from surgery. Other procedures, mainly arthroscopic meniscectomies, were performed in 10 cases (30%). The first official match was played after an average of 8.0 ± 3.6 (4.6-18.2) months in 31 cases (94%). Patients were evaluated after 12.6 ± 3.3 years (6.7-17.5) from the indexed ACL reconstruction. The average Lysholm score was 94.2 ± 8.3. CONCLUSIONS In our small case-series, professional soccer players were able to return to play at a competitive level with a hamstrings over the top technique. Patients with long careers had a high percentage of reoperation on the contralateral knee. LEVEL OF EVIDENCE IV.
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Piedade SR, Leite Arruda BP, de Vasconcelos RA, Parker DA, Maffulli N. Rehabilitation And Advances In Surgical Reconstruction For Anterior Cruciate Ligament Insufficiency: What Has Changed Since The 1960s? - State Of The Art. J ISAKOS 2022:S2059-7754(22)00094-3. [PMID: 36410671 DOI: 10.1016/j.jisako.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/29/2022] [Accepted: 10/10/2022] [Indexed: 11/20/2022]
Abstract
Anterior cruciate ligament (ACL) insufficiency can be disabling, given the physical and sports activity constraints that negatively impact the quality of life. Consequently, surgery is the main approach for most active patients. Nonetheless, ACL reconstruction (ACLR) cannot be successful without adequate preoperative and postoperative rehabilitation. Since the 1960s, post-ACLR rehabilitation has evolved, mainly from advances in surgery, coupled with a better understanding of the biological concepts of graft revascularization, maturation and integration, which have impacted ACL postoperative rehabilitation protocols. However, new technologies do involve a definite learning curve which could affect rehabilitation programs and produce inconsistent results. The development of rehabilitation protocols cannot be defined without an accurate diagnosis of ACL injury and considering the patient's main physical demands and expectations. This article discusses how postoperative rehabilitation following ACLR has changed from the 1960s to now, focussing on surgical technique (type of tendon graft, fixation devices, and graft tensioning), biological concepts (graft maturation and integration), rehabilitation protocols (prevention of ACL injuries, preoperative rehabilitation, postoperative rehabilitation), criteria to return to sports, patient's reported outcomes and outcome. Although rehabilitation plays an essential role in managing ACL injuries, it cannot be fully standardised preoperatively or postoperatively. Preoperative and postoperative rehabilitation should be based on an accurate clinical diagnosis, patients' understanding of their injury, graft tissue biology and biomechanics, surgical technique, the patient's physical demands and expectations, geographical differences in ACL rehabilitation and future perspectives.
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Affiliation(s)
- Sergio R Piedade
- Exercise and Sports Medicine, Department of Orthopedics, Rheumatology, and Traumatology, University of Campinas, UNICAMP, Campinas, SP, 13083-887, Brazil.
| | | | | | - David A Parker
- Sydney Orthopaedic Research Institute, Chatswood, NSW 206, Australia
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
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Fortier LM, Hevesi M, Dasari SP, Mameri ES, Kerzner B, Khan ZA, Chahla J. Bridge-Enhanced Anterior Cruciate Ligament Repair for Mid-Substance Tear With Concomitant Lateral Meniscus Radial Repair. Arthrosc Tech 2022; 11:e1981-e1988. [PMID: 36457385 PMCID: PMC9705715 DOI: 10.1016/j.eats.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
In recent years, repair of the injured anterior cruciate ligament (ACL) has been subject to a renewed interest as novel arthroscopic techniques have been developed. Specifically, the bridge-enhanced ACL repair is a technique composed of a resorbable protein-based implant combined with autologous blood that is used to bridge the gap between 2 torn edges of a mid-substance ACL tear. This implant is believed to help facilitate healing of a primary suture repair and suture cinch and has since demonstrated noninferiority to ACL reconstruction with autograft at 2-year follow-up. The purpose of this Technical Note is to describe a step-by-step surgical technique of a mid-substance ACL repair using the bridge-enhanced ACL repair system in a case with a concomitant lateral meniscus radial repair.
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Affiliation(s)
| | - Mario Hevesi
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | | | | | | | | | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.,Address correspondence to Jorge Chahla, M.D., Ph.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL 60612.
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Molina I, Muñoz A, Linde X. Treatment of ACL injury in a professional soccer player during COVID-19 lockdown. APUNTS SPORTS MEDICINE 2022. [PMCID: PMC9293858 DOI: 10.1016/j.apunsm.2022.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anterior Cruciate Ligament (ACL) injuries stand out as the most severe in sports such as soccer. This study presents the rehabilitation process of a professional soccer player who suffered a total ACL tear. It details the treatment performed after the surgical intervention and all the adaptations that had to be applied in the rehabilitation process due to the lockdown period established at the beginning of the COVID-19 pandemic. During the period comprised between weeks 9 and 21 post-surgery, the rehabilitation treatment was carried out virtually, adapting the actions, work environment and equipment used. Despite the limitations it entailed, the virtual format and the adaptations in the treatment allowed the rehabilitation process to continue, fulfilling all the pre-established objectives and deadlines with a consequent satisfactory and safe return to competitive sport. After carrying out a bibliographic research, no clinical cases have been found regarding the adaptation of the rehabilitation process of an ACL reconstruction in a professional soccer player during the COVID-19 lockdown.
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Comparison of the mechanical properties and mechanical damages to tendon tissue in three suspensory fixation techniques. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 30:1-8. [PMID: 35949263 PMCID: PMC9343929 DOI: 10.1016/j.asmart.2022.05.003] [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: 10/07/2021] [Revised: 03/26/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) injury is the most common traumatic injury to the knee joint. Suspensory fixation has become popular in ACL reconstruction because of its high primary stability, less invasiveness, and surgical convenience. There are two common types of suspensory fixation devices: those with fixed-length and those with adjustable-length loops. Owing to structural differences and differences in initial tensioning techniques, it is expected that mechanical property and damage to the tendons will vary from device to device; however, no literature has examined this so far. The main purpose of this study was to evaluate the damage caused to the tendon by three different suspensory fixation devices. An effective mechanical test was carried out as a prerequisite. Methods First, the mechanical properties of simple loop device (SLD) as fixed-length loop device, first-generation, and second-generation adjustable devices (AD1 and AD2) as adjustable-length loop devices were tested (isolated device testing). Second, each device was tested using bovine extensor tendons (specimen testing). Cyclic testing included 2000 cycles; the devices were subsequently displaced until failure, and the ultimate tensile strength was determined using isolated device testing. Six samples of 3 devices were used in each testing experiment. After specimen testing, the surface structure of the tendon was evaluated quantitatively using optical coherence tomography (OCT) and our original histological scoring system. Results During isolated device testing, SLD demonstrated the least cyclic displacement, followed by AD1 and AD2. The highest ultimate tensile strength was observed in AD2, followed by SLD and AD1. In specimen testing, the least cyclic displacement was observed in SLD, followed by AD1 and AD2. Histologically, AD1 demonstrated a significantly lower score, with damaged surface morphology, than SLD and AD2. OCT values were significantly higher, with a more disturbing tendon surface structure, in AD1 than in SLD and AD2. Conclusions The first-generation adjustable loop device exhibited greatest graft tissue damage at the suspensory site in a clinically relevant setting. The thinner adjustable loop mechanism may have elevated graft damage by frictional stresses during loop adjustment or by repetitive tensioning stresses.
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