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Ko J, Seo SW, Cho JH. Managing Alpine Skiing Injuries: Focus on Anterior Cruciate Ligament (ACL) Tear Prevention in Adolescent Athletes. IRANIAN JOURNAL OF PUBLIC HEALTH 2024; 53:1209-1210. [PMID: 38912138 PMCID: PMC11188639 DOI: 10.18502/ijph.v53i5.15603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 06/25/2024]
Abstract
The Article Abstract is not available.
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Affiliation(s)
- Jupil Ko
- Division of Health and Kinesiology, Incheon National University, Incheon, Republic of Korea
| | - Sang-Won Seo
- Department of Sports Science, Gwangju University, Gwangju, Republic of Korea
| | - Ji-Hoon Cho
- Department of Exercise Prescription, Dongshin University, Naju, Republic of Korea
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Crotti M, Heering T, Lander N, Fox A, Barnett LM, Duncan MJ. Extrinsic Risk Factors for Primary Noncontact Anterior Cruciate Ligament Injury in Adolescents Aged between 14 and 18 years: A Systematic Review. Sports Med 2024; 54:875-894. [PMID: 38236505 DOI: 10.1007/s40279-023-01975-1] [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: 11/20/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Adolescents present a high incidence of ACL injury compared with other age groups. Examining the risk factors that predispose adolescents to primary noncontact ACL injury is a key strategy to decrease the number of injuries in this population. OBJECTIVE The aim of this systematic review was to summarise the existing literature investigating extrinsic risk factors that have been linked with primary noncontact ACL injury risk (identified either using ACL injury occurrence or using screening tests measuring biomechanical mechanisms for noncontact ACL injury) in adolescents including research investigating: (1) the association between extrinsic risk factors and primary noncontact ACL injury risk; and (2) whether primary noncontact ACL injury risk was different in populations or groups exposed to different extrinsic risk factors in adolescents. METHODS The same search strategy was used in MEDLINE, SPORTDiscus, CINAHL, PubMed and Embase. Articles were included if: written in English; published in peer-reviewed journals; investigating and discussing primary noncontact ACL injury risk associated with extrinsic risk factors; they were original research articles with an observational design; and participants presented a mean age ranging between 14 and 18 years. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (QATOCCS) was used to assess the quality and risk of bias of the articles included in this systematic review. RESULTS The systematic review included 16 eligible articles published up to August 2022 about extrinsic risk factors for primary noncontact ACL injury including: sport (8 studies); sport exposure amount (5); sport level (3); sport season (1); environment (2); equipment (1). Differences in biomechanical risk factors predisposing to ACL injury were reported by sport in female adolescents playing basketball and soccer; however, no good evidence of differences in primary noncontact ACL injury rate by sport was reported in both male and female adolescents. There was contrasting evidence about associations between sport exposure and biomechanical and neuromuscular risk factors predisposing to ACL injury or primary noncontact ACL injury rate in both male and female adolescent players from different sports. There was weak evidence of differences in biomechanical risk factors predisposing to ACL injury by environmental condition in both male and female adolescents playing soccer and season phase in male adolescents playing basketball. Lastly, few good-quality articles suggested that higher sport level might be associated with increased primary noncontact ACL injury rate in female adolescents playing basketball and floorball and that bracing might not prevent primary noncontact ACL injuries in both male and female adolescent players from different sports. DISCUSSION The findings emphasise the need for further research to clarify the evidence about extrinsic risk factors and primary noncontact ACL injury in adolescents to develop ACL injury prevention guidelines that would help practitioners and researchers identify adolescents at risk and design future interventions. Future epidemiological studies should collect data about extrinsic factors as well as data about primary noncontact injury separately from secondary injuries or contact injuries to better inform primary noncontact ACL injury prevention in adolescents. REGISTRATION https://doi.org/10.17605/OSF.IO/VM82F (11/08/2021).
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Affiliation(s)
- Matteo Crotti
- Centre for Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK.
| | - Theresa Heering
- Centre for Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Natalie Lander
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
| | - Aaron Fox
- School of Exercise and Nutrition Science, Deakin University, Melbourne, VIC, Australia
| | - Lisa M Barnett
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
| | - Michael J Duncan
- Centre for Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
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Magaña-Ramírez M, Gallardo-Gómez D, Álvarez-Barbosa F, Corral-Pernía JA. What exercise programme is the most appropriate to mitigate anterior cruciate ligament injury risk in football (soccer) players? A systematic review and network meta-analysis. J Sci Med Sport 2024; 27:234-242. [PMID: 38395699 DOI: 10.1016/j.jsams.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 12/29/2023] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES To examine the effectiveness of different exercise-based interventions to mitigate the risk of anterior cruciate ligament injury in football players, and to determine which is the most appropriate for them, specifically for female football players. DESIGN Four databases were accessed in July 2023 using the keywords football, soccer, athletic injuries, anterior cruciate ligament, knee injuries, injury prevention, exercise-based programme, and risk factor. METHODS Randomised controlled trials that evaluated any exercise-based injury prevention intervention compared with a control group on the prevention of anterior cruciate ligament injury in football players were included. RESULTS Eleven studies were included. Data were presented as logarithm hazard ratio, credible intervals and standard deviation. FIFA 11+ was the most effective in reducing anterior cruciate ligament injury risk in football players (logarithm hazard ratio = -1.23 [95% credible intervals: -2.20, -0.35]; SD = 0.47), followed by the Knäkontroll programme (logarithm hazard ratio = -0.76 [95% credible intervals: -1.60, -0.03]; standard deviation = 0.42). For females, only Knäkontroll had a significant impact on reducing the risk of anterior cruciate ligament injury (logarithm hazard ratio = -0.62 [95% credible intervals: -1.71, 0.62]; standard deviation = 0.58). CONCLUSIONS Our results support the use of FIFA 11+ and Knäkontroll to mitigate injury incidence at overall level. However, the effectiveness of these interventions changed when adjusting for females. Knäkontroll is postulated as the programme with the greatest preventive nature, although these results should be interpreted with caution due to the lack of the sample.
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Affiliation(s)
- Manuel Magaña-Ramírez
- University of Seville, Faculty of Education Sciences, Spain. https://twitter.com/manuemaga
| | - Daniel Gallardo-Gómez
- University of Seville, Faculty of Education Sciences, Spain. https://twitter.com/DanielG12754470
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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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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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Bruder AM, Patterson BE, Crossley KM, Mosler AB, Haberfield MJ, Hägglund M, Culvenor AG, Cowan SM, Donaldson A. If we build it together, will they use it? A mixed-methods study evaluating the implementation of Prep-to-Play PRO: an injury prevention programme for women's elite Australian Football. Br J Sports Med 2024; 58:213-221. [PMID: 38216324 DOI: 10.1136/bjsports-2023-107518] [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] [Accepted: 12/12/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVES We evaluated the implementation of Prep-to-Play PRO, an injury prevention programme for women's elite Australian Football League (AFLW). METHODS The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of Prep-to-Play PRO were assessed based on the proportion of AFLW players and/or staff who: were aware of the programme (R), believed it may reduce anterior cruciate ligament injury (E), attempted to implement any/all programme components (A), implemented all intended components as practically as possible (I) and intended future programme implementation (M). Quantitative and qualitative data were triangulated to assess 58 RE-AIM items (evidence of yes/no/unsure/no evidence) and the 5 RE-AIM dimensions (fully achieved=evidence of yes on >50% dimension items, partially achieved=50% of items evidence of yes and 50% unsure or 50% mix of unsure and unanswered, or not met=evidence of yes on <50% dimension items). RESULTS Multiple sources including AFLW training observations (n=7 total), post-implementation surveys (141 players, 25 staff), semistructured interviews (19 players, 13 staff) and internal programme records (9 staff) contributed to the RE-AIM assessment. After the 2019 season, 8 of 10 (80%) AFLW clubs fully met all five RE-AIM dimensions. All 10 clubs participating in the AFLW fully achieved the reach (R) dimension. One club partially achieved the implementation (I) dimension, and one club partially achieved the effectiveness (E) and adoption (A) dimensions. CONCLUSION The Prep-to-Play PRO injury prevention programme for the AFLW achieved high implementation, possibly due to the programme's deliberately flexible approach coupled with our pragmatic definition of implementation. Engaging key stakeholders at multiple ecological levels (organisation, coaches, athletes) throughout programme development and implementation likely enhanced programme implementation.
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Affiliation(s)
- Andrea M Bruder
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Andrea B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Melissa J Haberfield
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Martin Hägglund
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Sallie M Cowan
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Alex Donaldson
- Centre for Sport and Social Impact, La Trobe University, Melbourne, Victoria, Australia
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Lunn DE, Nicholson G, Cooke M, Crespo R, Robinson T, Price RJ, Walker J. Discrete Hamstring: Quadriceps Strength Ratios Do Not Represent Angle-Specific Ratios in Premier League Soccer Players. J Strength Cond Res 2023; 37:2417-2422. [PMID: 37815243 DOI: 10.1519/jsc.0000000000004574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
ABSTRACT Lunn, DE, Nicholson, G, Cooke, M, Crespo, R, Robinson, T, Price, RJ, and Walker, J. Discrete hamstring: quadriceps strength ratios do not represent angle-specific ratios in Premier League soccer players. J Strength Cond Res 37(12): 2417-2422, 2023-This study compared angle-specific hamstring:quadriceps (H:Q) ratios with their discrete counterparts during strength testing in professional male soccer players. Twenty-seven professional English Premier League soccer players were recruited for this study (age: 22 ± 4 years; stature: 1.81 ± 0.08 m; body mass: 74.7 ± 6.5 kg). Isokinetic testing of the knee flexors and extensors was conducted concentrically at two angular velocities (60° and 240°·s -1 ) and eccentrically (for the knee flexors only) at 30°·s -1 . Conventional H:Q ratio was calculated as the ratio between peak joint moment in the flexors and extensors at 60°·s -1 . Functional H:Q ratio was calculated as the peak joint moment in the flexors during the eccentric condition and the extensors at 240°·s -1 . Discrete conventional and functional H:Q ratios were 0.56 ± 0.06 and 1.28 ± 0.22, respectively. The residual differences between discrete values and angle-specific residual values were 13.60 ± 6.56% when normalized to the magnitude of the discrete value. For the functional ratios, the normalized residual was 21.72 ± 5.61%. Therefore, neither discrete ratio was representative of angle-specific ratios, although the conventional ratio had lower error overall. Therefore, practitioners should consider H:Q ratio throughout the full isokinetic range of motion, not just the discrete ratio calculated from peak joint moments, when designing and implementing training programs or monitoring injury risk, recovery from injury, and readiness to return to play.
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Affiliation(s)
- David E Lunn
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom; and
| | - Gareth Nicholson
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom; and
| | - Mark Cooke
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom; and
| | - Rubén Crespo
- Leeds United Football Club, Leeds, United Kingdom
| | - Tom Robinson
- Leeds United Football Club, Leeds, United Kingdom
| | - Rob J Price
- Leeds United Football Club, Leeds, United Kingdom
| | - Josh Walker
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom; and
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Amundsen R, Thorarinsdottir S, Clarsen B, Andersen TE, Møller M, Bahr R. #ReadyToPlay: health problems in women's football-a two-season prospective cohort study in the Norwegian premier league. Br J Sports Med 2023:bjsports-2023-107141. [PMID: 37968072 DOI: 10.1136/bjsports-2023-107141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES To describe the prevalence, incidence and burden of all health problems in the Norwegian women's premier league. METHODS During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported all health problems (sudden-onset injuries, gradual-onset injuries and illnesses) weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Team medical staff diagnosed reported problems using the Sport Medicine Diagnostic Coding System. We calculated average weekly prevalence, incidence and burden of all health problems reported. RESULTS We included 294 players (age: 22±4 years) from 11 teams. Response rate to the weekly questionnaire was 79%. On average, 32% (95% CI: 31% to 33%) of the players reported at least one health problem at any time and 22% (95% CI: 21% to 23%) reported a substantial health problem negatively affecting their training volume or performance. The overall incidence was 10.7 health problems per 1000 hours of football exposure. Sudden-onset injuries were most severe (68% of the total time loss), followed by gradual-onset injuries (25%) and illnesses (8%). Thigh was the most common injury location (26%), while knee injuries were most severe, causing 42% of the total injury time loss. Anterior cruciate ligament (ACL) injuries alone caused 30% of the total injury time loss. CONCLUSION One in five players had a health problem negatively affecting their training volume or performance at any time. Sudden-onset injuries represented the most burdensome health problem. Thigh injuries were most frequent, while knee injuries, ACL injuries especially, were most severe.
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Affiliation(s)
- Roar Amundsen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Solveig Thorarinsdottir
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Benjamin Clarsen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Norway
- FIFA Medical, Federation Internationale de Football Association, Zurich, Switzerland
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- The Norwegian Football Association Medical Centre (Idrettens helsesenter), The Norwegian Football Association, Oslo, Norway
| | - Merete Møller
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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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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10
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Abstract
The anterior cruciate ligament (ACL) is frequently injured in elite athletes, with females up to eight times more likely to suffer an ACL tear than males. Biomechanical and hormonal factors have been thoroughly investigated; however, there remain unknown factors that need investigation. The mechanism of injury differs between males and females, and anatomical differences contribute significantly to the increased risk in females. Hormonal factors, both endogenous and exogenous, play a role in ACL laxity and may modify the risk of injury. However, data are still limited, and research involving oral contraceptives is potentially associated with methodological and ethical problems. Such characteristics can also influence the outcome after ACL reconstruction, with higher failure rates in females linked to a smaller diameter of the graft, especially in athletes aged < 21 years. The addition of a lateral extra-articular tenodesis can improve the outcomes after ACL reconstruction and reduce the risk of failure, and it should be routinely considered in young elite athletes. Sex-specific environmental differences can also contribute to the increased risk of injury, with more limited access to and availablility of advanced training facilities for female athletes. In addition, football kits are designed for male players, and increased attention should be focused on improving the quality of pitches, as female leagues usually play the day after male leagues. The kit, including boots, the length of studs, and the footballs themselves, should be tailored to the needs and body shapes of female athletes. Specific physiotherapy programmes and training protocols have yielded remarkable results in reducing the risk of injury, and these should be extended to school-age athletes. Finally, psychological factors should not be overlooked, with females' greater fear of re-injury and lack of confidence in their knee compromising their return to sport after ACL injury. Both intrinsic and extrinsic factors should be recognized and addressed to optimize the training programmes which are designed to prevent injury, and improve our understanding of these injuries.
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ayman Gabr
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- The Bone & Joint Journal , London, UK
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Kakavas G, Forelli F, Malliaropoulos N, Hewett TE, Tsaklis P. Periodization in Anterior Cruciate Ligament Rehabilitation: New Framework Versus Old Model? A Clinical Commentary. Int J Sports Phys Ther 2023; 18:541-546. [PMID: 37020434 PMCID: PMC10069386 DOI: 10.26603/001c.73035] [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: 11/21/2022] [Accepted: 01/28/2023] [Indexed: 04/03/2023] Open
Abstract
The physiological and psychological changes after anterior cruciate ligament reconstruction (ACLR) do not always allow a return to sport in the best condition and at the same level as before. Moreover, the number of significant re-injuries, especially in young athletes should be considered and physical therapists must develop rehabilitation strategies and increasingly specific and ecological test batteries to optimize safe return to play. The return to sport and return to play of athletes after ACLR must progress through the recovery of strength, neuromotor control, and include cardiovascular training while considering different psychological aspects. Because motor control seems to be the key to a safe return to sport, it should be associated with the progressive development of strength, and cognitive abilities should also be considered throughout rehabilitation. Periodization, the planned manipulation of training variables (load, sets, and repetitions) to maximize training adaptations while minimizing fatigue and injury, is relevant to the optimization of muscle strengthening, athletic qualities, and neurocognitive qualities of athletes during rehabilitation after ACLR. Periodized programming utilizes the principle of overload, whereby the neuromuscular system is required to adapt to unaccustomed loads. While progressive loading is a well-established and widely used concept for strengthening, the variance of volume and intensity makes periodization effective for improving athletic skills and attributes, such as muscular strength, endurance, and power, when compared with non-periodized training. The purpose of this clinical commentary is to broadly apply concepts of periodization to rehabilitation after ACLR.
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Solie B, Monson J, Larson C. Graft-Specific Surgical and Rehabilitation Considerations for Anterior Cruciate Ligament Reconstruction with the Quadriceps Tendon Autograft. Int J Sports Phys Ther 2023; 18:493-512. [PMID: 37020435 PMCID: PMC10069402 DOI: 10.26603/001c.73797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/28/2023] [Indexed: 04/03/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) with a bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autograft has traditionally been the preferred surgical treatment for patients returning to Level 1 sports. More recently, international utilization of the quadriceps tendon (QT) autograft for primary and revision ACLR has increased in popularity. Recent literature suggests that ACLR with the QT may yield less donor site morbidity than the BPTB and better patient-reported outcomes than the HT. Additionally, anatomic and biomechanical studies have highlighted the robust properties of the QT itself, with superior levels of collagen density, length, size, and load-to-failure strength compared to the BPTB. Although previous literature has described rehabilitation considerations for the BPTB and HT autografts, there is less published with respect to the QT. Given the known impact of the various ACLR surgical techniques on postoperative rehabilitation, the purpose of this clinical commentary is to present the procedure-specific surgical and rehabilitation considerations for ACLR with the QT, as well as further highlight the need for procedure-specific rehabilitation strategies after ACLR by comparing the QT to the BPTB and HT autografts. Level of Evidence Level 5.
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Ferrández-Laliena L, Vicente-Pina L, Sánchez-Rodríguez R, Orantes-González E, Heredia-Jimenez J, Lucha-López MO, Hidalgo-García C, Tricás-Moreno JM. Diagnostics Using the Change-of-Direction and Acceleration Test (CODAT) of the Biomechanical Patterns Associated with Knee Injury in Female Futsal Players: A Cross-Sectional Analytical Study. Diagnostics (Basel) 2023; 13:diagnostics13050928. [PMID: 36900071 PMCID: PMC10000524 DOI: 10.3390/diagnostics13050928] [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: 01/05/2023] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
The primary aim of this study was to identify kinematic differences at initial contact between female futsal players with and without previous knee injury, using a functional motor pattern test. The secondary aim was to determine kinematic differences between the dominant and non-dominant limb in the whole group, using the same test. A cross-sectional study was performed in 16 female futsal players allocated into two groups: eight females with a previous knee injury, i.e., affected by the valgus collapse mechanism without surgical intervention, and eight with no previous injury. The evaluation protocol included the change-of-direction and acceleration test (CODAT). One registration was made for each lower limb, i.e., the dominant (the preferred kicking limb) and non-dominant limb. A 3D motion capture system (Qualisys AB, Göteborg, Sweden) was used to analyze the kinematics. The Cohen's d effect sizes between the groups demonstrated a strong effect size towards more physiological positions in the non-injured group in the following kinematics in the dominant limb: hip adduction (Cohen's d = 0.82), hip internal rotation (Cohen's d = 0.88), and ipsilateral pelvis rotation (Cohen's d = 1.06). The t-test for the dominant and non-dominant limb in the whole group showed the following differences in knee valgus: dominant limb (9.02 ± 7.31 degrees) and non-dominant limb (1.27 ± 9.05 degrees) (p = 0.049). Conclusions: The players with no previous history of knee injury had a more physiological position for avoiding the valgus collapse mechanism in the hip adduction and internal rotation, and in the pelvis rotation in the dominant limb. All the players showed more knee valgus in the dominant limb, which is the limb at greater risk of injury.
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Affiliation(s)
- Loreto Ferrández-Laliena
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Lucía Vicente-Pina
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Rocío Sánchez-Rodríguez
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Eva Orantes-González
- Department of Sports and Computer Science, Faculty of Physical Education and Sports, University of Pablo de Olavide, 41013 Sevilla, Spain
| | - José Heredia-Jimenez
- Department of Physical Education and Sports, Faculty of Education, Economy & Technology, University of Granada, 51001 Ceuta, Spain
| | - María Orosia Lucha-López
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
- Correspondence: (M.O.L.-L.); (C.H.-G.); Tel.: +34-626-480-131 (M.O.L.-L.)
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
- Correspondence: (M.O.L.-L.); (C.H.-G.); Tel.: +34-626-480-131 (M.O.L.-L.)
| | - José Miguel Tricás-Moreno
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
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Bencke J, Strøm M, Curtis DJ, Bandholm T, Zebis MK. Differences in Thigh Muscle Activation Between Standing and Landing Exercises for Knee Injury Prevention and Rehabilitation. Int J Sports Phys Ther 2023; 18:102-112. [PMID: 36793578 PMCID: PMC9897038 DOI: 10.26603/001c.67829] [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: 01/18/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background In injury prevention or rehabilitation programs, exercises that facilitate enhanced hamstring activity may be beneficial when aiming to enhance knee joint stability during movements in sports with higher risk of acute knee injury. Information about neuromuscular activation of the hamstring muscles in commonly used exercises may improve exercise selection and progression in programs for knee injury prevention or rehabilitation. Purpose To investigate (1) how balance devices with progressing degrees of instability influence the activity of muscles controlling the knee joint in typical balance exercises with different demands on postural control, and (2) if any between-sex differences exist. Study design Cross-sectional study. Methods Twenty habitually active healthy adults (11 males) participated in this cross-sectional study. Single-leg stance, single-leg squat and single-leg landing were performed on the floor and two different balance devices imposing various levels of challenge to postural control. Three-dimensional motion analysis was used to obtain hip and knee joint angles, and as primary outcomes, and peak normalized EMG activity from the hamstrings and quadriceps muscles was measured for comparison between exercises. Results The more challenging in terms of maintaining stable balance the devices were, the higher hamstring muscle activity levels were observed. There was a clear progression across balance devices from single-leg stance to single-leg squat and further to single-leg landing displaying increasing hamstring activity levels. The change in medial hamstring activity across all devices when changing from single-leg squat to single-leg landing was significantly higher for the female participants than for the males reaching a higher level of activity. Conclusion The muscle activity of the hamstrings and quadriceps increased when the motor task was more dynamic. Specifically, single-leg landings were effective in increasing the hamstring muscle activity over the single-leg stance to single-leg squat exercises, and muscle activity was significantly increased with the most unstable device. Increases in hamstring muscle activation was greater in female subjects than males with increasing instability of the balance devices. Trial identifier Not registered. Level of evidence 3.
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Affiliation(s)
- Jesper Bencke
- Human Movement Analysis Laboratory, Dept. of Orthopaedic Surgery Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Mark Strøm
- Clinic of Sports Physiotherapy and Rehabilitation, Denmark
| | - Derek J Curtis
- Human Movement Analysis Laboratory, Dept. of Orthopaedic Surgery Copenhagen University Hospital, Amager-Hvidovre, Denmark
- Child Centre Copenhagen The Child and Youth Administration, Denmark
| | - Thomas Bandholm
- Department of Clinical Research Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - Mette K Zebis
- Department of Physiotherapy and Occupational Therapy University College Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen Copenhagen University Hospital-Bispebjerg and Frederiksberg, Denmark
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Räisänen AM, Galarneau JM, van den Berg C, Eliason P, Benson LC, Owoeye OBA, Pasanen K, Hagel B, Emery CA. Who Does Not Respond to Injury Prevention Warm-up Programs? A Secondary Analysis of Trial Data From Neuromuscular Training Programs in Youth Basketball, Soccer, and Physical Education. J Orthop Sports Phys Ther 2023; 53:94-102. [PMID: 36484352 DOI: 10.2519/jospt.2022.11526] [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: 12/14/2022]
Abstract
OBJECTIVES: To identify factors associated with nonresponse to neuromuscular training (NMT) warm-up programs among youth exposed to NMT warm-ups. METHODS: This is a secondary analysis of youth (aged 11-18 years) in the intervention groups of 4 randomized controlled trials in high school basketball, youth community soccer, and junior high school physical education. Youth who were exposed to NMT and who sustained an injury during the study were considered nonresponders. Odds ratios (ORs) were based on generalized estimating equations logistic regression controlling for clustering by team/class and adjusted for age, weight, height, balance performance, injury history, sex, and sport (soccer/basketball/physical education). RESULTS: A total of 1793 youth were included. Youth with a history of injury in the previous year had higher odds (OR = 1.64; 95% CI: 1.14, 2.37) of injury during the study, and females were more likely (OR = 1.67; 95% CI: 1.21, 2.31) to sustain an injury than males who were participating in NMT. Age was not associated with the odds of sustaining an injury (OR = 1.10; 95% CI: 0.93, 1.30). Soccer players benefited most from greater adherence, with 81% lower odds of injury (OR = 0.19; 95% CI: 0.06, 0.57) when completing 3 NMT sessions a week compared with 1 session per week. CONCLUSION: Factors associated with nonresponse to an NMT warm-up program were female sex, history of injury during the previous 12 months, and lower weekly NMT session adherence in some sports (soccer). J Orthop Sports Phys Ther 2023;53(2):94-102. Epub: 9 December 2022. doi:10.2519/jospt.2022.11526.
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Effects of Gluteus Medius and Biceps Femoris Stimulation on Reduction of Knee Abduction Moment During a Landing Task. J Appl Biomech 2023; 39:110-117. [PMID: 36870343 DOI: 10.1123/jab.2021-0107] [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: 03/30/2021] [Revised: 10/30/2022] [Accepted: 01/05/2023] [Indexed: 03/06/2023]
Abstract
Anterior cruciate ligament injury prevention should focus primarily on reduction of the knee abduction moment (KAM) in landing tasks. Gluteus medius and hamstring forces are considered to decrease KAM during landing. The effects of different muscle stimulations on KAM reduction were compared using 2 electrode sizes (standard 38 cm2 and half size 19 cm2) during a landing task. Twelve young healthy female adults (22.3 [3.6] y, 1.62 [0.02] m, 50.2 [4.7] kg) were recruited. KAM was calculated under 3 conditions of muscle stimulation (gluteus medius, biceps femoris, and both gluteus medius, and biceps femoris) using 2 electrode sizes, respectively versus no stimulation during a landing task. A repeated-measures analysis of variance determined that KAM differed significantly among stimulation conditions and post hoc analysis revealed that KAM was significantly decreased in conditions of stimulating either the gluteus medius (P < .001) or the biceps femoris (P < .001) with the standard electrode size, and condition of stimulating both gluteus medius and biceps femoris with half-size electrode (P = .012) when compared with the control condition. Therefore, stimulation on the gluteus medius, the biceps femoris, or both muscles could be implemented for the examination of anterior cruciate ligament injury potential.
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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: 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: 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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18
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Rodas G, Cáceres A, Ferrer E, Balagué-Dobón L, Osaba L, Lucia A, González JR. Sex Differences in the Association between Risk of Anterior Cruciate Ligament Rupture and COL5A1 Polymorphisms in Elite Footballers. Genes (Basel) 2022; 14:33. [PMID: 36672775 PMCID: PMC9858943 DOI: 10.3390/genes14010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Single-nucleotide polymorphisms (SNPs) in collagen genes are predisposing factors for anterior cruciate ligament (ACL) rupture. Although these events are more frequent in females, the sex-specific risk of reported SNPs has not been evaluated. PURPOSE We aimed to assess the sex-specific risk of historic non-contact ACL rupture considering candidate SNPs in genes previously associated with muscle, tendon, ligament and ACL injury in elite footballers. STUDY DESIGN This was a cohort genetic association study. METHODS Forty-six (twenty-four females) footballers playing for the first team of FC Barcelona (Spain) during the 2020-21 season were included in the study. We evaluated the association between a history of non-contact ACL rupture before July 2022 and 108 selected SNPs, stratified by sex. SNPs with nominally significant associations in one sex were then tested for their interactions with sex on ACL. RESULTS Seven female (29%) and one male (4%) participants had experienced non-contact ACL rupture during their professional football career before the last date of observation. We found a significant association between the rs13946 C/C genotype and ACL injury in women footballers (p = 0.017). No significant associations were found in male footballers. The interaction between rs13946 and sex was significant (p = 0.027). We found that the C-allele of rs13946 was exclusive to one haplotype of five SNPs spanning COL5A1. CONCLUSIONS The present study suggests the role of SNPs in genes encoding for collagens as female risk factors for ACL injury in football players. CLINICAL RELEVANCE The genetic profiling of athletes at high risk of ACL rupture can contribute to sex-specific strategies for injury prevention in footballers.
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Affiliation(s)
- Gil Rodas
- Medical Department of Football Club Barcelona (FIFA Medical Centre of Excellence), 08970 Barcelona, Spain
- Barça Innovation Hub of Football Club Barcelona, 08028 Barcelona, Spain
- Sports Medicine Unit, Hospital Clínic-Sant Joan de Déu, 08029 Barcelona, Spain
| | - Alejandro Cáceres
- ISGlobal, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), 08003 Barcelona, Spain
- Department of Mathematics, Escola d’Enginyeria de Barcelona Est (EEBE), Universitat Politècnica de Catalunya, 08019 Barcelona, Spain
| | - Eva Ferrer
- Barça Innovation Hub of Football Club Barcelona, 08028 Barcelona, Spain
- Sports Medicine Unit, Hospital Clínic-Sant Joan de Déu, 08029 Barcelona, Spain
| | | | - Lourdes Osaba
- Progenika Biopharma, A Grifols Company, 48160 Derio, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Research Institute Imas12, Hospital 12 de Octubre, 28041 Madrid, Spain
| | - Juan R. González
- ISGlobal, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), 08003 Barcelona, Spain
- Department of Mathematics, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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Tang Y, Li Y, Yang M, Zheng X, An B, Zheng J. The effect of hip abductor fatigue on knee kinematics and kinetics during normal gait. Front Neurosci 2022; 16:1003023. [PMID: 36267239 PMCID: PMC9577318 DOI: 10.3389/fnins.2022.1003023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To investigate the effect of hip abductor fatigue on the kinematics and kinetics of the knee joint during walking in healthy people to provide a new approach for the prevention and treatment of knee-related injuries and diseases. Methods Twenty healthy participants, ten females, and ten males, with a mean age of 25.10 ± 1.2 years, were recruited. Isometric muscle strength testing equipment was used to measure the changes in muscle strength before and after fatigue, and the surface electromyography (SEMG) data during fatigue were recorded synchronously. The Vicon system and an AMTI© force platform were used to record the kinematic parameters and ground reaction force (GRF) of twenty participants walking at a self-selected speed before and after fatigue. Visual 3D software was used to calculate the angles and torques of the hip and knee joints. Results After fatigue, the muscle strength, median frequency (MF) and mean frequency (MNF) of participants decreased significantly (P < 0.001). The sagittal plane range of motion (ROM) of the knee (P < 0.0001) and hip joint (P < 0.01) on the fatigue side was significantly smaller than before fatigue. After fatigue, the first and second peaks of the external knee adduction moment (EKAM) in participants were greater than before fatigue (P < 0.0001), and the peak values of the knee abduction moment were also higher than those before fatigue (P < 0.05). On the horizontal plane, there is also a larger peak of internal moment during walking after fatigue (P < 0.01). Conclusion Hip abductor fatigue affects knee kinematics and kinetics during normal gait. Therefore, evaluating hip abductor strength and providing intensive training for patients with muscle weakness may be an important part of preventing knee-related injuries.
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Affiliation(s)
- Yuting Tang
- Department of Rehabilitation, Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanfeng Li
- Department of Rehabilitation, Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Maosha Yang
- Department of Rehabilitation, The Second Rehabilitation Hospital, Shanghai, China
| | - Xiao Zheng
- Department of Rehabilitation, Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xiao Zheng,
| | - Bingchen An
- Department of Rehabilitation, HuaDong Hospital, FuDan University, Shanghai, China
- Bingchen An,
| | - Jiejiao Zheng
- Department of Rehabilitation, HuaDong Hospital, FuDan University, Shanghai, China
- Jiejiao Zheng,
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Collins K, Fajardo R, Harkey M, Knake J, Lisee C, Wilcox L, Tasco J, Kuenze C. Knee symptoms do not affect walking biomechanics among women 6 months after anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:2240-2247. [PMID: 35001419 DOI: 10.1002/jor.25265] [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: 07/01/2021] [Revised: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
Women with anterior cruciate ligament reconstruction report worse pain and knee-related symptoms, and also exhibit biomechanical changes that may be related to knee osteoarthritis (OA) development. This is particularly concerning as symptom state has been previously associated with knee OA development. The purpose of this study was to compare lower extremity walking biomechanics between women (age: 21.40 ± 8.54 years) experiencing clinically significant knee-related symptoms and women with acceptable symptoms 6 months following surgery. Twenty-eight women with history of primary, unilateral anterior cruciate ligament reconstruction who completed a lower extremity walking biomechanics assessment 6 months following surgery were included in this analysis. Women were dichotomized as experiencing acceptable or clinically significant knee symptoms according to Knee injury and OA Outcomes Score cut-offs described by Englund et al. Walking biomechanics were compared between women with clinically significant and acceptable symptoms using one-way analysis of covariances for involved limb biomechanics. Biomechanical variables of interest were: peak vertical ground reaction forces (vGRFs), vGRF loading rates, knee flexion angles, knee extension moments, knee adduction angles, and knee adduction moments, and gait speed. Nearly 60% of women reported clinically significant knee symptoms 6 months postoperative. There were no statistically significant differences between symptom groups for walking biomechanics and gait speed outcomes. These findings suggest patient reported knee symptoms may not be a primary influence on walking biomechanics 6 months following anterior cruciate ligament reconstruction. Though, longitudinal assessment of changes in symptom state and walking biomechanics may be warranted as poorer walking biomechanics and symptoms are indicators of knee OA.
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Affiliation(s)
- Katherine Collins
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Ryan Fajardo
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Matthew Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jeffrey Knake
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Caroline Lisee
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Luke Wilcox
- Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
| | - Jamie Tasco
- Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
| | - Christopher Kuenze
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA.,Department of Orthopedics, Michigan State University, East Lansing, Michigan, USA
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Patterson BE, Donaldson A, Cowan SM, King MG, Barton CG, McPhail SM, Hagglund M, White NM, Lannin NA, Ackerman IN, Dowsey MM, Hemming K, Makdissi M, Culvenor AG, Mosler AB, Bruder AM, Choong J, Livingstone N, Elliott RK, Nikolic A, Fitzpatrick J, Crain J, Haberfield MJ, Roughead EA, Birch E, Lampard SJ, Bonello C, Chilman KL, Crossley KM. Evaluation of an injury prevention programme (Prep-to-Play) in women and girls playing Australian Football: design of a pragmatic, type III, hybrid implementation-effectiveness, stepped-wedge, cluster randomised controlled trial. BMJ Open 2022; 12:e062483. [PMID: 36104145 PMCID: PMC9476120 DOI: 10.1136/bmjopen-2022-062483] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Due to the increase in participation and risk of anterior cruciate ligament (ACL) injuries and concussion in women's Australian Football, an injury prevention programme (Prep-to-Play) was codesigned with consumers (eg, coaches, players) and stakeholders (eg, the Australian Football League). The impact of supported and unsupported interventions on the use of Prep-to-Play (primary aim) and injury rates (secondary aim) will be evaluated in women and girls playing community Australian Football. METHODS AND ANALYSIS This stepped-wedge, cluster randomised controlled trial will include ≥140 teams from U16, U18 or senior women's competitions. All 10 geographically separated clusters (each containing ≥14 teams) will start in the control (unsupported) phase and be randomised to one of five dates (or 'wedges') during the 2021 or 2022 season to sequentially transition to the intervention (supported Prep-to-Play), until all teams receive the intervention. Prep-to-Play includes four elements: a neuromuscular training warm-up, contact-focussed football skills (eg, tackling), strength exercises and education (eg, technique cues). When transitioning to supported interventions, study physiotherapists will deliver a workshop to coaches and player leaders on how to use Prep-to-Play, attend team training at least two times and provide ongoing support. In the unsupported phase, team will continue usual routines and may freely access available Prep-to-Play resources online (eg, posters and videos about the four elements), but without additional face-to-face support. Outcomes will be evaluated throughout the 2021 and 2022 seasons (~14 weeks per season). PRIMARY OUTCOME use of Prep-to-Play will be reported via a team designate (weekly) and an independent observer (five visits over the two seasons) and defined as the team completing 75% of the programme, two-thirds (67%) of the time. SECONDARY OUTCOMES injuries will be reported by the team sports trainer and/or players. Injury definition: any injury occurring during a football match or training that results in: (1) being unable to return to the field of play for that match or (2) missing ≥ one match. Outcomes in the supported and unsupported phases will be compared using a generalised linear mixed model adjusting for clustering and time. Due to the type III hybrid implementation-effectiveness design, the study is powered to detect a improvement in use of Prep-to-Play and a reduction in ACL injuries. ETHICS AND DISSEMINATION La Trobe University Ethics Committee (HREC 20488) approved. Coaches provided informed consent to receive the supported intervention and players provided consent to be contacted if they sustained a head or knee injury. Results will be disseminated through partner organisations, peer-reviewed publications and scientific conferences. TRIAL REGISTRATION NUMBER NCT04856241.
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Affiliation(s)
- Brooke E Patterson
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Alex Donaldson
- Centre for Sport and Social Impact, La Trobe University, Melbourne, Victoria, Australia
| | - Sallie M Cowan
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Matthew G King
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Christian G Barton
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Steven M McPhail
- Australian Centre for Health Service Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Digital Health and Informatics, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Martin Hagglund
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linkopings Universitet, Linkoping, Östergötland, Sweden
| | - Nicole M White
- Australian Centre for Health Service Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Clayton, Victoria, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, St.Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael Makdissi
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Adam G Culvenor
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Andrea B Mosler
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Andrea M Bruder
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Jessica Choong
- Medibank Better Health Foundation, Medibank Private, Melbourne, Victoria, Australia
| | | | | | - Anja Nikolic
- Australian Physiotherapy Association, Hawthorn, Victoria, Australia
| | - Jane Fitzpatrick
- Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
| | - Jamie Crain
- Sports Medicine Australia, Albert Park, Victoria, Australia
| | - Melissa J Haberfield
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Eliza A Roughead
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Elizabeth Birch
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Sarah J Lampard
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Christian Bonello
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Karina L Chilman
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Kay M Crossley
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
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22
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Rinaldi VG, Prill R, Jahnke S, Zaffagnini S, Becker R. The influence of gluteal muscle strength deficits on dynamic knee valgus: a scoping review. J Exp Orthop 2022; 9:81. [PMID: 35976534 PMCID: PMC9385941 DOI: 10.1186/s40634-022-00513-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Anterior cruciate ligament (ACL) injuries are caused by both contact and non-contact injuries. However, it can be claimed that non-contact ones account approximately for 70% of all cases. Thus, several authors have emphasized the role of reduction of muscle strength as a modifiable risk factor referred to non-contact ACL injury, with the latter being targeted by specific training interventions.The present paper wants to review the available literature specifically on the relationship between dynamic knee valgus, gluteal muscles (GM) strength, apart from the potential correlation regarding ACL injury.After a research based on MEDLINE via PubMed, Google scholar, and Web of Science, a total of 29 articles were collected and thus included.Additionally, this review highlights the crucial role of gluteal muscles in maintaining a correct knee position in the coronal plane during different exercises, namely walking, running, jumping and landing.
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Affiliation(s)
- Vito Gaetano Rinaldi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy.
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg, Germany
| | - Sonja Jahnke
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg, Germany
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy.,DIBINEM, University of Bologna, Bologna, Italy
| | - Roland Becker
- Medical School Theodor Fontane, 14770, Brandenburg, Germany.,Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg, Germany
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23
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Sigurðsson HB, Briem K, Grävare Silbernagel K, Snyder-Mackler L. Don't Peak Too Early: Evidence for an ACL Injury Prevention Mechanism of the 11+ Program. Int J Sports Phys Ther 2022; 17:823-831. [PMID: 35949375 PMCID: PMC9340830 DOI: 10.26603/001c.36524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background The 11+ program prevents anterior cruciate ligament (ACL) injuries in athletes through unknown mechanisms. Purpose The aim of the current study was to evaluate the effects of The 11+ intervention program, performed by female soccer players during a single season, on the frequency of Early Peaks during athletic tasks. Methods Three teams (69 players) of collegiate female soccer athletes (Divisions I and II) were recruited. Two teams (49 players) volunteered to perform The 11+ three times per week for one season (~22 weeks plus three weeks pre-season), and one team (20 players) served as controls. The athletes performed three repetitions of a cutting maneuver, side shuffle direction change, and forwards to backwards running direction change before and after the competitive season and were recorded using marker-based 3D motion capture. Knee valgus moment time series were calculated for each repetition with inverse kinematics and classified as either "Very Early Peak", "Early Peak" or "other" using cluster analysis. The classification was based timing of the peak relative to the timing of ACL injuries. The effect of the intervention on the frequency of Very Early Peaks and Early Peaks was evaluated with a mixed Poisson regression controlling for the movement task and pre-season frequency. Results The 11+ intervention reduced the frequency of Early Peak knee valgus moment in one intervention team (coefficient = -1.16, p = 0.004), but not the other (coefficient = -0.01, p = 0.977). No effect was observed on the frequency of Very Early Peak knee valgus moment. Conclusions Reduced frequency of knee valgus moment Early Peak during athletic tasks may explain the mechanism by which The 11+ program decreases risk of ACL injury. Prospective studies with a much larger sample size are required to establish a link between Early Peak knee valgus moments and risk of ACL injury. Level of evidence 2b.
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24
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Culvenor AG, Girdwood MA, Juhl CB, Patterson BE, Haberfield MJ, Holm PM, Bricca A, Whittaker JL, Roos EM, Crossley KM. Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus. Br J Sports Med 2022; 56:1445-1453. [PMID: 35768181 DOI: 10.1136/bjsports-2022-105495] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Synthesise evidence for effectiveness of rehabilitation interventions following ACL and/or meniscal tear on symptomatic, functional, clinical, psychosocial, quality of life and reinjury outcomes. DESIGN Overview of systematic reviews with Grading of Recommendations Assessment, Development and Evaluation certainty of evidence. DATA SOURCES MEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Library. ELIGIBILITY CRITERIA Systematic reviews of randomised controlled trials investigating rehabilitation interventions following ACL and/or meniscal tears in young adults. RESULTS We included 22 systematic reviews (142 trials of mostly men) evaluating ACL-injured individuals and none evaluating isolated meniscal injuries. We synthesised data from 16 reviews evaluating 12 different interventions. Moderate-certainty evidence was observed for: (1) neuromuscular electrical stimulation to improve quadriceps strength; (2) open versus closed kinetic chain exercises to be similarly effective for quadriceps strength and self-reported function; (3) structured home-based versus structured in-person rehabilitation to be similarly effective for quadriceps and hamstring strength and self-reported function; and (4) postoperative knee bracing being ineffective for physical function and laxity. There was low-certainty evidence that: (1) preoperative exercise therapy improves self-reported and physical function postoperatively; (2) cryotherapy reduces pain and analgesic use; (3) psychological interventions improve anxiety/fear; and (4) whole body vibration improves quadriceps strength. There was very low-certainty evidence that: (1) protein-based supplements improve quadriceps size; (2) blood flow restriction training improves quadriceps size; (3) neuromuscular control exercises improve quadriceps and hamstring strength and self-reported function; and (4) continuous passive motion has no effect on range of motion. CONCLUSION The general level of evidence for rehabilitation after ACL or meniscal tear was low. Moderate-certainty evidence indicates that several rehabilitation types can improve quadriceps strength, while brace use has no effect on knee function/laxity.
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Affiliation(s)
- Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Michael A Girdwood
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Carsten B Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Copenhagen, Denmark
| | - Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Melissa J Haberfield
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Pætur M Holm
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Funen, Denmark
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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25
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Eustace SJ, Morris R, Tallis J, Page RM, Greig M. The influence of angle-specific torque of the knee flexors and extensors on the angle-specific dynamic control ratio in professional female soccer players. J Sports Sci 2022; 40:1235-1242. [PMID: 35389325 DOI: 10.1080/02640414.2022.2061251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to assess whether dynamic torque ratios (DCR) from isokinetic strength assessments of eccentric knee flexors (eccKF) and concentric knee extensors (conKE) display differences when stratified into specific angle-specific DCR (DCRAST) groups. Fifty-two professional female soccer players (age 21.30 ± 4.44 years; height 166.56 ± 5.17 cm; mass 61.55 ± 5.73 kg) from the English Women's Super League completed strength assessments of both lower limbs on an isokinetic dynamometer at 60°∙s-1. Angle-specific torque (AST) were used to calculate DCRAST to create sub-groups using clustering algorithms. The results identified for the dominant side that the Medium DCRAST group elicited significantly higher conKE AST when compared to Low and High DCRAST groups at increased knee extension (P ≤ 0.05). For the non-dominant side, the High DCRAST group had significantly higher and lower eccKF and conKE AST compared to the Low DCRAST group at increased knee extension (P ≤ 0.05). This study highlights that the inclusion of AST data may subsequently help practitioners to prescribe exercise that promotes strength increases at targeted joint angles. In turn, these approaches can be used to help reduce injury risk, identify rehabilitation responses and help inform return to play.
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Affiliation(s)
- Steven James Eustace
- School of Life Sciences, Science & Health Building, Coventry University, Coventry, UK
| | - Rhys Morris
- School of Life Sciences, Science & Health Building, Coventry University, Coventry, UK
| | - Jason Tallis
- School of Life Sciences, Science & Health Building, Coventry University, Coventry, UK
| | - Richard Michael Page
- Sports Injuries Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Matt Greig
- Sports Injuries Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
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26
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Hogg JA, Avedesian JM, Diekfuss JA, Acocello SN, Shimmin RD, Kelley EA, Kostrub DA, Myer GD, Wilkerson GB. Sex Moderates the Relationship between Perceptual-Motor Function and Single-Leg Squatting Mechanics. J Sports Sci Med 2022; 21:104-111. [PMID: 35250339 PMCID: PMC8851119 DOI: 10.52082/jssm.2022.104] [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: 11/25/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
To examine the isolated and combined effects of sex and perceptual-motor function on single-leg squatting mechanics in males and females. We employed a cross-sectional design in a research laboratory. Fifty-eight females (22.2 ± 3.5 yrs, 1.60 ± .07 m, 64.1 ± 13.0 kg) and 35 males (23.5 ± 5.0 yrs, 1.80 ± .06m, 84.7 ± 15.3 kg) free from time-loss injury in the six months prior, vertigo, and vestibular conditions participated in this study. Independent variables were sex, perceptual-motor metrics (reaction time, efficiency index, conflict discrepancy), and interaction effects. Dependent variables were peak frontal plane angles of knee projection, ipsilateral trunk flexion, and contralateral pelvic drop during single-leg squatting. After accounting for the sex-specific variance and perceptual-motor function effects on frontal plane squatting kinematics, female sex amplified the associations of: higher reaction time, lower efficiency index, and higher conflict discrepancy with greater right ipsilateral peak trunk lean (R2 = .13; p = .05); higher reaction time, lower efficiency index, and higher conflict discrepancy with decreased right contralateral pelvic drop (R2 = .22; p < .001); higher reaction time and lower conflict discrepancy with greater right frontal plane knee projection angle (R2 = .12; p = .03); and higher reaction time with greater left frontal plane knee projection angle (R2 = .22; p < .001). Female sex amplified the relationship between perceptual-motor function and two-dimensional frontal plane squatting kinematics. Future work should determine the extent to which perceptual-motor improvements translate to safer movement strategies.
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Affiliation(s)
- Jennifer A Hogg
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN, 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
| | - Shellie N Acocello
- Department of Health and Human Performance, 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
| | - Gary B Wilkerson
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN, USA
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27
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Szymski D, Achenbach L, Zellner J, Weber J, Koch M, Zeman F, Huppertz G, Pfeifer C, Alt V, Krutsch W. Higher risk of ACL rupture in amateur football compared to professional football: 5-year results of the 'Anterior cruciate ligament-registry in German football'. Knee Surg Sports Traumatol Arthrosc 2022; 30:1776-1785. [PMID: 34524500 PMCID: PMC9033691 DOI: 10.1007/s00167-021-06737-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries are a common severe type of football injury at all levels of play. A football-specific ACL registry providing both prospective ACL injury data according to the skill level and risk factors for ACL injury is lacking in the literature. METHODS This study is based on the prospective 'ACL registry in German Football' implemented in the 2014-15 season. Professional (1st-3rd league), semi-professional (4th-6th league) and amateur leagues (7th league) were analysed regarding the incidence and risk factors for ACL injuries. Injuries were registered according to the direct reports of the injured players to the study office and double-checked via media analysis. After injury registration, the players received a standardised questionnaire. Data were analysed from the 2014-15 to the 2018-19 football season. RESULTS Overall, 958 ACL injuries were registered during the 5-year study period. The incidence of ACL injuries was highest in amateur football (0.074/1000 h football exposure) compared to professional (0.058/1000 h; p < 0.0001) and semi-professional football (0.043/1000 h; p < 0.0001). At all skill levels, match incidence (professional: 0.343; semi-professional: 0.249; amateur: 0.319) was significantly higher than training incidence (professional: 0.015; semi-professional: 0.004; amateur: 0.005). Major risk factors were previous ACL injury (mean: 23.3%), other knee injuries (mean: 19.3%) and move to a higher league (mean: 24.2%). CONCLUSION This sports-specific ACL registry provides detailed information on the incidence and risk factors for ACL injuries in football over five years. Risk factors are skill level, match exposure, move to a higher league and previous knee injury. These factors offer potential starting points for screening at-risk players and applying targeted prevention. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Dominik Szymski
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Leonard Achenbach
- Department of Orthopedics, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Johannes Zellner
- Department of Trauma Surgery, Caritas Hospital St. Josef, Regensburg, Germany
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Matthias Koch
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Gunnar Huppertz
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Christian Pfeifer
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany ,SportDocsFranken, Nürnberg, Germany
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28
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Uncommon Bone Injuries in Soccer Players. J Hum Kinet 2021; 80:125-138. [PMID: 34868423 PMCID: PMC8607781 DOI: 10.2478/hukin-2020-0032] [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] [Indexed: 11/20/2022] Open
Abstract
Soccer is the most common team sport in the world. A significant number of players are associated with a large number of injuries. Injuries occur in a variety of contexts regardless of the age or performance level of players. The vast majority of injuries involve soft tissues. Bone injuries are less common, but usually result in long-term exclusion from the game. Three different types of fractures related to soccer are classified as acute types, stress fractures and avulsion. This manuscript outlines the diagnostic procedures and treatments for stress fractures, avulsion fractures and bone cyst. The common feature of the described injuries includes frequent difficulties associated with the correct diagnosis and treatment direction. In therapeutic treatment, the doctor and the patient often have to choose between conservative treatment and surgical treatment, which in many cases is not simple. We suggest that in the event of injuries to soccer players, surgical treatment should be used, shortening the time to return to full sports activity. A very important element of the therapeutic process is proper rehabilitation, which should be individually tailored to the patient in order to optimize the treatment process. Some of the rehabilitation protocols should be permanently incorporated into the warm-up protocols for training. Such a procedure has a preventive effect.
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29
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Scanaliato JP, Wells ME, Dunn JC, Garcia EJ. Overview of Sport-Specific Injuries. Sports Med Arthrosc Rev 2021; 29:185-190. [PMID: 34730116 DOI: 10.1097/jsa.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Athletes are at risk for a variety of injuries not typically sustained in everyday life. The team physician must be capable of not only identifying and treating injuries as they occur, but he or she must be armed with the knowledge to minimize the risk of injuries before they occur. This review serves to provide an overview of the various sport-specific injuries typically encountered by team physicians. Injuries are grouped by body part and/or organ system, when possible. We do not aim to cover in detail the various treatments for these injuries; rather, we hope that this article provides a comprehensive overview of sport-specific injury, and demonstrate the well-roundedness in skills that must be possessed by team physicians.
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30
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Herman DC, Pritchard KA, Cosby NL, Selkow NM. Effect of Strength Training on Jump-Landing Biomechanics in Adolescent Females. Sports Health 2021; 14:69-76. [PMID: 34751052 DOI: 10.1177/19417381211056089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Sex-based differences in neuromuscular characteristics relevant to anterior cruciate ligament (ACL) injury risk may arise as compensation for divergent strength development during puberty. Strength training during this period may prevent the development of these undesirable neuromuscular characteristics. HYPOTHESIS Strength-trained middle school girls will have improved jump-landing biomechanics compared with control participants. STUDY DESIGN Cohort study. LEVEL OF EVIDENCE Level 3. METHODS Maximum voluntary isometric contraction in hip extension and abduction and knee extension and flexion as well as Landing Error Scoring System (LESS) scores were collected for healthy female middle school students of grades 6 to 8. Strength-training participants (STR: N = 30; height, 1.63 ± 0.07 m; mass, 48.1 ± 7.6 kg; age, 12.5 ± 1.0 y) were matched with control participants (CON: N = 30; height, 1.60 ± 0.09 m; mass, 47.2 ± 8.9 kg; age, 12.6 ± 0.9 y). The training consisted of a 6-month strength-training program administered through a gym class curriculum that targeted the lower extremity. A repeated-measures mixed-model analysis of variance was used for comparisons between groups and across time (α = 0.05). Stepwise linear regression was used to examine the relationship between strength change and LESS score change. RESULTS Strength values (N·m/kg) increased across time and to a greater degree in STR for hip extension (baseline 3.98 ± 1.15 vs follow-up 4.77 ± 1.80), hip abduction (4.22 ± 1.09 vs 5.13 ± 2.55), and knee flexion (3.27 ± 0.62 vs 3.64 ± 1.40) compared with CON. LESS grades significantly decreased across time in STR (5.58 ± 1.21 vs 4.86 ± 1.44) and were significantly lower than CON (5.98 ± 1.42) at follow-up (P < 0.001). The change in hip extension and knee extension strength explained 67% of the variance (P < 0.001) in the LESS change score in the STR group. CONCLUSION A school-based strength-training program that focused on hip and knee musculature significantly improved jump-landing biomechanics (as determined by LESS) relevant to ACL injury risk. Further investigation using different strength-training approaches in this age group is warranted. CLINICAL RELEVANCE Strength training during adolescence holds promise as an injury prevention program. The use of a school-based approach is novel and may represent a robust opportunity for injury prevention programs, as physical education class is often mandatory in this age group.
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Affiliation(s)
- Daniel C Herman
- Department of Physical Medicine and Rehabilitation, University of California, Davis, Davis, California
| | | | - Nicole L Cosby
- College of Health Sciences, Point Loma Nazarene University, San Diego, California
| | - Noelle M Selkow
- School of Kinesiology and Recreation, Illinois State University, Normal, Illinois
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Collings TJ, Diamond LE, Barrett RS, Timmins RG, Hickey JT, du Moulin WS, Gonçalves BAM, Cooper C, Bourne MN. Impact of prior anterior cruciate ligament, hamstring or groin injury on lower limb strength and jump kinetics in elite female footballers. Phys Ther Sport 2021; 52:297-304. [PMID: 34742028 DOI: 10.1016/j.ptsp.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare lower limb strength and countermovement jump (CMJ) kinetics between elite female footballers with and without a history of anterior cruciate ligament reconstruction (ACLR), hamstring strain, or hip/groin injury. DESIGN Cross-sectional. SETTING Field-based. PARTICIPANTS 369 elite female Australian football, soccer and rugby league players aged 15-35. MAIN OUTCOME MEASURES Isometric hip adductor and abductor strength, eccentric knee flexor strength, and CMJ vertical ground reaction forces, including between-leg asymmetry. Players reported their lifetime history of ACLR, and whether they had sustained a hamstring strain, or hip/groin injury in the previous 12-months. RESULTS Players with a unilateral history of ACLR (n = 24) had significant between-leg asymmetry in eccentric knee flexor strength (mean = -6.3%, 95%CI = -8.7 to -3.9%, P < .001), isometric hip abductor strength (mean = -2.5%, 95%CI = -4.3 to -0.7%, P = .008), and CMJ peak landing force (mean = -5.5%, 95%CI = -10.9 to -0.1%, P = .046). Together, between-leg asymmetry in eccentric knee flexor strength, isometric hip abductor strength, and CMJ peak landing force distinguished between players with and without prior ACLR with 93% accuracy. CONCLUSION Elite female footballers with a history of ACLR, but not hamstring or hip/groin injury, exhibit persistent between-leg asymmetries in lower limb strength and jump kinetics following a return to sport.
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Affiliation(s)
- Tyler J Collings
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Australia.
| | - Laura E Diamond
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Australia; Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Rod S Barrett
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Australia.
| | - Ryan G Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia; Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Victoria, Australia.
| | - Jack T Hickey
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia.
| | - William S du Moulin
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Australia.
| | - Basílio A M Gonçalves
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Australia.
| | - Christopher Cooper
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Australia.
| | - Matthew N Bourne
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Australia; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.
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32
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Ardern CL, Büttner F, Andrade R, Weir A, Ashe MC, Holden S, Impellizzeri FM, Delahunt E, Dijkstra HP, Mathieson S, Rathleff MS, Reurink G, Sherrington C, Stamatakis E, Vicenzino B, Whittaker JL, Wright AA, Clarke M, Moher D, Page MJ, Khan KM, Winters M. Implementing the 27 PRISMA 2020 Statement items for systematic reviews in the sport and exercise medicine, musculoskeletal rehabilitation and sports science fields: the PERSiST (implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science) guidance. Br J Sports Med 2021; 56:175-195. [PMID: 34625401 PMCID: PMC8862073 DOI: 10.1136/bjsports-2021-103987] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 02/01/2023]
Abstract
Poor reporting of medical and healthcare systematic reviews is a problem from which the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields are not immune. Transparent, accurate and comprehensive systematic review reporting helps researchers replicate methods, readers understand what was done and why, and clinicians and policy-makers implement results in practice. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and its accompanying Explanation and Elaboration document provide general reporting examples for systematic reviews of healthcare interventions. However, implementation guidance for sport and exercise medicine, musculoskeletal rehabilitation, and sports science does not exist. The Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science (PERSiST) guidance attempts to address this problem. Nineteen content experts collaborated with three methods experts to identify examples of exemplary reporting in systematic reviews in sport and exercise medicine (including physical activity), musculoskeletal rehabilitation (including physiotherapy), and sports science, for each of the PRISMA 2020 Statement items. PERSiST aims to help: (1) systematic reviewers improve the transparency and reporting of systematic reviews and (2) journal editors and peer reviewers make informed decisions about systematic review reporting quality.
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Affiliation(s)
- Clare L Ardern
- Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden .,Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fionn Büttner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Renato Andrade
- Clinical Research, Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal
| | - Adam Weir
- Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar.,Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Sport Medicine and Exercise Clinic Haarlem (SBK), Haarlem, The Netherlands
| | - Maureen C Ashe
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sinead Holden
- SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - H Paul Dijkstra
- Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department for Continuing Education, University of Oxford, Oxford, UK
| | - Stephanie Mathieson
- Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Skovdal Rathleff
- SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Guus Reurink
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emmanuel Stamatakis
- Charles Perkins Centre, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Bill Vicenzino
- University of Queensland School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, Queensland, Australia
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Alexis A Wright
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University, Belfast, UK
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karim M Khan
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Institutes of Health Research-Institute of Musculoskeletal Health, Vancouver, British Columbia, Canada
| | - Marinus Winters
- Center for General Practice, Aalborg University, Aalborg, Denmark
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Football de haut-niveau : analyses physique et physiologique – blessures et prévention. Sci Sports 2021. [DOI: 10.1016/j.scispo.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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The deep lateral femoral notch sign: a reliable diagnostic tool in identifying a concomitant anterior cruciate and anterolateral ligament injury. Knee Surg Sports Traumatol Arthrosc 2021; 29:1968-1976. [PMID: 32974801 DOI: 10.1007/s00167-020-06278-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of the present study was to investigate the validity and reliability of the deep lateral femoral notch sign (DLFNS) in identifying a concomitant anterior cruciate ligament (ACL)/anterolateral ligament (ALL) rupture and predicting the clinical outcomes following an anatomical single-bundle ACL reconstruction. It was hypothesized that patients with a concomitant ACL/ALL rupture would have an increased DLFNS compared to patients without a concomitant ACL/ALL rupture. METHODS The lateral preoperative radiographs and MRI images of 100 patients with an ACL rupture and 100 control subjects were evaluated for the presence of a DLFNS and ACL/ALL rupture, respectively. The patients were evaluated clinically preoperatively and at a minimum 1 year following the ACL reconstruction. A receiver operator curve (ROC) analysis was performed to define the optimal cut-off value of the DLFNS for identifying a concomitant ACL/ALL injury. The relative risk (RR) was also calculated to determine whether the presence of the DLFNS was a risk factor for residual instability or ACL graft rupture following an ACL reconstruction. RESULTS The prevalence of DLFNS was 52% in the ACL-ruptured patients and 15% in the control group. At a minimum 1-year follow-up, 35% (6/17) of the patients with DLFNS > 1.8 mm complained of persistent instability, and an MRI evaluation demonstrated a graft re-rupture rate of 12% (2/17). In patients with a DLFNS < 1.8 mm, 8% (7/83) reported a residual instability, and the graft rupture rate was 2.4% (2/83). A DLFNS > 1.8 mm demonstrated a sensitivity of 89%, a specificity of 95%, a negative predictive value of 98%, and a positive predictive value of 89% in identifying a concomitant ACL/ALL rupture. Patients with a DLFNS > 1.8 mm had 4.2 times increased risk for residual instability and graft rupture compared to patients with a DLFNS ≤ 1.8 mm. CONCLUSIONS A DLFNS > 1.8 mm could be a clinically relevant diagnostic tool for identifying a concomitant ACL/ALL rupture with high sensitivity and PPV. Patients with a DLFNS > 1.8 mm should be carefully evaluated for clinical and radiological signs of a concomitant ACL/ALL rupture and treated when needed with a combined intra-articular ACL reconstruction and extra-articular tenodesis to avoid a residual rotational instability and ACL graft rupture. LEVEL OF EVIDENCE III.
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Sandon A, Söderström T, Stenling A, Forssblad M. Can Talented Youth Soccer Players Who Have Undergone Anterior Cruciate Ligament Reconstruction Reach the Elite Level? Am J Sports Med 2021; 49:384-390. [PMID: 33332148 DOI: 10.1177/0363546520976651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) ruptures are common in soccer players, and reconstructive surgery is often performed to restore knee stability and enable a return to play. PURPOSE To investigate whether an ACL reconstruction for talented youth soccer players affects their potential to become elite players at the senior level. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All soccer players who participated in the Swedish National Elite Camp for 15-year-old players between 2005 and 2011 (N = 5285 players; 2631 boys and 2654 girls) were matched with the Swedish National Knee Ligament Registry to identify the players who had undergone ACL reconstruction. Information on player participation in Swedish league games and level of play was collected from the Swedish Football Association's administrative data system. The players with an ACL reconstruction who were injured at the ages of 15 to 19 years were compared with the rest of the players who participated in the National Elite Camp to see whether an early ACL reconstruction affected whether they remained active as soccer players and their chance to play at the elite level as seniors. RESULTS A total of 524 (9.9%) players had undergone an ACL reconstruction, and 292 (5.5%; 75 male and 217 female) had sustained their injury at age 15 to 19 years. During the follow-up period, 122 (23.3%) players underwent ACL reconstruction: revision (11.5%; n = 60) or contralateral (11.8%; n = 62). Male and female soccer players undergoing an ACL reconstruction at age 15 to 19 years experienced no significant effect on being active or playing at the elite level in the season that they turned 21 years old. Of the youth players who underwent ACL reconstruction, 12% of the male players and 11.5% of the female players progressed to the elite level at the age of 21 years compared with 10.3% of the men and 11.1% of the women among the uninjured players. CONCLUSION ACL reconstructive surgery in talented youth soccer players offers them the opportunity to become elite players as seniors and permits an activity level on a par with that of their uninjured peers. However, almost 1 in 4 requires further ACL surgery, so the players' future knee health should be considered when deciding on a return to play.
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Affiliation(s)
- Alexander Sandon
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Tor Söderström
- Department of Education, Umeå School of Sport Sciences, Umeå University, Umeå, Sweden
| | - Andreas Stenling
- Department of Psychology, Umeå School of Sport Sciences, Umeå University, Umeå, Sweden
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
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Geertsema C, Geertsema L, Farooq A, Harøy J, Oester C, Weber A, Bahr R. Injury prevention knowledge, beliefs and strategies in elite female footballers at the FIFA Women's World Cup France 2019. Br J Sports Med 2021; 55:801-806. [PMID: 33397672 DOI: 10.1136/bjsports-2020-103131] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study assessed knowledge, beliefs and practices of elite female footballers regarding injury prevention. METHODS A survey was sent to players participating in the FIFA Women's World Cup France 2019. Questions covered three injury prevention domains: (1) knowledge; (2) attitudes and beliefs; (3) prevention practices in domestic clubs. Additionally, ACL injury history was assessed. RESULTS Out of 552 players, 196 women responded (35.5%). More than 80% of these considered injury risk to be moderate or high. Players listed knee, ankle, thigh, head and groin as the most important injuries in women's football. The most important risk factors identified were low muscle strength, followed by poor pitch quality, playing on artificial turf, too much training, reduced recovery and hard tackles. In these elite players, 15% did not have any permanent medical staff in their domestic clubs, yet more than 75% had received injury prevention advice and more than 80% performed injury prevention exercises in their clubs. Players identified the two most important implementation barriers as player motivation and coach attitude. Two-thirds of players used the FIFA 11+ programme in their clubs. CONCLUSIONS This diverse group of elite players demonstrated good knowledge of risk level and injury types in women's football. Of the risk factors emphasised by players, there was only one intrinsic risk factor (strength), but several factors out of their control (pitch quality and type, training volume and hard tackles). Still players had positive attitudes and beliefs regarding injury prevention exercises and indicated a high level of implementation, despite a lack of medical support.
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Affiliation(s)
- Celeste Geertsema
- Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar .,Weill Cornell Medical College, Doha, Qatar
| | - Liesel Geertsema
- Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,Weill Cornell Medical College, Doha, Qatar
| | - Abdulaziz Farooq
- Athlete Health and Performance Research, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Joar Harøy
- Senter for idrettsskadeforskning, Norges Idrettshøgskole, Oslo, Norway.,Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
| | - Chelsea Oester
- Federation Internationale de Football Association, Zurich, Switzerland
| | - Alexis Weber
- Medicine & Science, Federation Internationale de Football Association, Zurich, Zürich, Switzerland
| | - Roald Bahr
- Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway.,Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
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Performance on sprint, agility and jump tests have moderate to strong correlations in youth football players but performance tests are weakly correlated to neuromuscular control tests. Knee Surg Sports Traumatol Arthrosc 2021; 29:1659-1669. [PMID: 33030610 PMCID: PMC8038985 DOI: 10.1007/s00167-020-06302-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/22/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed at evaluating the correlation between seven different performance tests and two neuromuscular control tests in youth football players and to evaluate the influence of sex and age groups on test results. METHODS One-hundred and fifteen football players (66 boys, 49 girls) mean age 14 ± 0.7 (range 13-16) years from youth teams were tested at the start of the second half of the competitive season. A test battery including agility t-test, 505 agility test, single-leg hop for distance test, side-hop test, countermovement jump test, 10-m sprint test, 20-m sprint test, tuck jump assessment (TJA) and drop vertical jump (DVJ) was completed. RESULTS Correlations between the seven different performance tests of agility, jump and sprint ability were generally moderate to strong (r = 0.534-0.971). DVJ did not correlate with the performance tests (rho = 0.004 to - 0.101) or with TJA total score (rho = 0.127). There were weak to moderate correlations between TJA total score and the performance tests (r = - 0.323-0.523). Boys performed better than girls in all performance tests (p < 0.001) and in TJA total score (p = 0.002). In boys, older players performed better than younger players in the majority of the tests, while there was no clear age influence among girls. CONCLUSION Sprint performance was moderately to strongly correlated with agility and jump performance, and performance tests were weakly to moderately correlated to TJA, while DVJ did not correlate with the other tests. Boys performed better than girls on performance tests and TJA. An age effect on performance was evident in boys but not in girls. LEVEL OF EVIDENCE Level IV TRIAL REGISTRATION: Clinical Trials gov identifier: NCT03251404.
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INCORPORATING WORKLOAD MEASURES INTO REHABILITATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A CASE REPORT. Int J Sports Phys Ther 2020; 15:823-831. [PMID: 33110702 DOI: 10.26603/ijspt20200823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and purpose: Second anterior cruciate ligament (ACL) injury rates continue to be high, with a majority of injuries occurring soon after return-to-play, potentially because athletes may not be ready for the external load demands of the sport. Load metrics, tracked through wearable technology, may provide complementary information to standard limb symmetry indices in the return-to-play decision making process. The purpose of this case report was to quantify and monitor load using innovative technology during physical therapy rehabilitation after ACL reconstruction (ACLr) and compare to normative sport participation data.Case Description: The subject was a 12-year-old female soccer player that suffered an ACL injury followed by surgical reconstruction with a hamstring autograft and standard rehabilitation. Single-leg hop performance, isokinetic strength, and external loads (using wearable technology) were measured longitudinally during rehabilitation and analyzed at the time of return-to-play.Outcomes: The subject successfully achieved >90% LSI for isometric quadriceps strength (week 14), single leg hop battery (week 23), and isokinetic hamstrings (week 26) and quadriceps (week 31) strength by the time of return-to-play (week 39). At the time of return to play, external load metrics indicated that the subject's most intense rehabilitation session consisted of 36% less frequent movements, 38% lower total distances, and activity durations that were 29% lower than the expected demands of a match. Discussion Standard rehabilitation may underload patients relative to required sport demands. Measuring external load during the rehabilitation period may help clinicians adequately progress workload to the necessary demands of the patient's sport. With the current emphasis on restoring limb symmetry, clinicians may need to shift focus towards load preparation when returning a patient to their sport.Level of Evidence: 4Keywords: anterior cruciate ligament, load, rehabilitation, return to play, step count, movement system.
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Owoeye OBA, VanderWey MJ, Pike I. Reducing Injuries in Soccer (Football): an Umbrella Review of Best Evidence Across the Epidemiological Framework for Prevention. SPORTS MEDICINE - OPEN 2020; 6:46. [PMID: 32955626 PMCID: PMC7505904 DOI: 10.1186/s40798-020-00274-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
Soccer is the most popular sport in the world. Expectedly, the incidence of soccer-related injuries is high and these injuries exert a significant burden on individuals and families, including health and financial burdens, and on the socioeconomic and healthcare systems. Using established injury prevention frameworks, we present a concise synthesis of the most recent scientific evidence regarding injury rates, characteristics, mechanisms, risk and protective factors, interventions for prevention, and implementation of interventions in soccer. In this umbrella review, we elucidate the most recent available evidence gleaned primarily from systematic reviews and meta-analyses. Further, we express the exigent need to move current soccer injury prevention research evidence into action for improved player outcomes and widespread impact through increased attention to dissemination and implementation research. Additionally, we highlight the importance of an enabling context and effective implementation strategies for the successful integration of evidence-based injury prevention programs into real-world soccer settings. This narrative umbrella review provides guidance to inform future research, practice, and policy towards reducing injuries among soccer players.
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Affiliation(s)
- Oluwatoyosi B A Owoeye
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, Allied Health Professions Building, 3437 Caroline Street, St. Louis, MO, 63104, USA.
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| | - Mitchell J VanderWey
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, Allied Health Professions Building, 3437 Caroline Street, St. Louis, MO, 63104, USA
| | - Ian Pike
- Department of Paediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Crossley KM, Patterson BE, Culvenor AG, Bruder AM, Mosler AB, Mentiplay BF. Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players. Br J Sports Med 2020; 54:1089-1098. [PMID: 32253193 PMCID: PMC7497572 DOI: 10.1136/bjsports-2019-101587] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2020] [Indexed: 01/27/2023]
Abstract
Objective To evaluate the effects of injury prevention programmes on injury incidence in any women’s football code; explore relationships between training components and injury risk; and report injury incidence for women’s football. Design Systematic review and meta-analysis. Data sources Nine databases searched in August 2019. Eligibility criteria Randomised controlled trials evaluating any injury prevention programme (eg, exercise, education, braces) were included. Study inclusion criteria were: ≥20 female football players in each study arm (any age, football code or participation level) and injury incidence reporting. Results Twelve studies, all in soccer, met inclusion criteria, with nine involving adolescent teams (aged <18 years). All studies (except one) had a high risk of bias. Eleven studies examined exercise-based programmes, with most (9/11) including multiple (≥2) training components (eg, strength, plyometric, balance exercises). Multicomponent exercise programmes reduced overall (any reported) injuries (incidence rate ratio (IRR) 0.73, 95% CI 0.59 to 0.91) and ACL injuries (IRR 0.55, 95% CI 0.32 to 0.92). For exercise-based strategies (single-component and multicomponent), hamstring injuries were also reduced (IRR 0.40, 95% CI 0.17 to 0.95). While exercise-based strategies resulted in less knee, ankle and hip/groin injuries, and the use of multiple training components was associated with greater reductions in overall and knee injuries, further studies would be required to increase the precision of these results. The incidence of overall injuries in women’s football was 3.4 per 1000 exposure hours; with ankle injuries most common. Conclusion In women’s football, there is low-level evidence that multicomponent, exercise-based programmes reduce overall and ACL injuries by 27% and 45%, respectively. PROSPERO registration number CRD42018093527.
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Affiliation(s)
- Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Andrea M Bruder
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Andrea B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
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Sandon A, Engström B, Forssblad M. High Risk of Further Anterior Cruciate Ligament Injury in a 10-Year Follow-up Study of Anterior Cruciate Ligament-Reconstructed Soccer Players in the Swedish National Knee Ligament Registry. Arthroscopy 2020; 36:189-195. [PMID: 31439457 DOI: 10.1016/j.arthro.2019.05.052] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/15/2019] [Accepted: 05/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To follow up on soccer players 10 years after a primary anterior cruciate ligament (ACL) reconstruction to find out how many players returned to play soccer, what influenced their decision, and if there are any differences in additional ACL injuries (graft failure and/or contralateral ACL injury) between those who returned to play and those who did not. METHODS The study cohort consists of 1661 soccer players from the Swedish National Knee Ligament Registry. A questionnaire was sent to each player regarding their return to play and additional knee injuries that may have occurred 10 years after their primary ACL. The results are based on the 684 responders. Data such as age, sex, surgical procedural data, associated injuries, patient-reported outcome measures, and additional knee surgeries were collected from the registry. RESULTS In this study, 51% returned to play soccer. For those who did not return to play, the primary reason was knee related (65.4% of the cases). The most common knee-related reasons for not returning were pain and/or instability (50%; n = 109), followed by fear of reinjury (32%; n = 69). Players who return to soccer have a significantly higher risk of additional ACL injury. Of the players who returned to play soccer, 28.7% (odds ratio [OR] 2.3, P < .001) had additional ACL injury, 9.7% (OR 2.9, P < .001) had a graft failure and 20.6% (OR 2.1, P < .001) had a contralateral ACL injury. CONCLUSIONS Players that return to soccer have a significantly higher risk of sustaining further ACL injury. Only half of the soccer players return to play after ACL reconstruction, and in two-thirds of those who did not return, the reason was knee related. The high risk of sustaining additional knee injury is of serious concern to the player's future knee health and should be considered when deciding on a return to play. LEVEL OF EVIDENCE Level III retrospective case-control study.
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Affiliation(s)
- Alexander Sandon
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Västmanland Regional Hospital, Västerås, Sweden.
| | - Björn Engström
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
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Astur DC, Novaretti JV, Cavalcante ELB, Goes A, Kaleka CC, Debieux P, Krob JJ, de Freitas EV, Cohen M. Pediatric Anterior Cruciate Ligament Reruptures Are Related to Lower Functional Scores at the Time of Return to Activity: A Prospective, Midterm Follow-up Study. Orthop J Sports Med 2019; 7:2325967119888888. [PMID: 31840033 PMCID: PMC6904784 DOI: 10.1177/2325967119888888] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Skeletally immature patients show a higher rate of anterior cruciate ligament
(ACL) reruptures. A better understanding of the risk factors for an ACL
rerupture in this population is critical. Purpose/Hypothesis: The objective of this study was to analyze preoperative, intraoperative, and
postoperative characteristics of pediatric patients undergoing ACL
reconstruction and determine the relationship of these factors with an ACL
rerupture. It was hypothesized that patients with worse activity scores and
knee function at the time of return to activity would have a higher rate of
ACL reruptures at midterm follow-up. Additionally, it was hypothesized that
most ACL reruptures would occur before age 20 years in the study
population. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 65 skeletally immature patients (age <16 years) with ACL
ruptures underwent reconstruction with a quadruple hamstring tendon graft
between 2002 and 2016. Of these patients, 52 were available for the study.
Patient characteristics, surgical details, Tegner and Lysholm scores, and
ACL reconstruction outcomes were recorded. Patients were analyzed and
compared according to ACL rerupture occurrence. Results: Of the 52 patients, 18 (34.6%) experienced an ACL rerupture after
reconstruction. The majority of reruptures (77.8%) occurred before age 20
years. There were 2 patients who sustained ACL reruptures during the
rehabilitation period before they returned to activity. The majority of
reruptures occurred after 12 months (83.2%), with 66.6% occurring after 24
months. Upon returning to activity between 6 and 9 months postoperatively,
patients who ended up with intact ACL grafts reported 69% higher mean Tegner
scores (P = .006) and 64% higher mean Lysholm scores than
patients who sustained ACL reruptures (P < .001). Within
the limits of this study, we could identify no statistical relationship
between the rate of ACL reruptures and different sport types, surgical
techniques, or associated injuries (P > .05). Conclusion: Skeletally immature patients who underwent ACL reconstruction and sustained
ACL reruptures had lower Tegner and Lysholm scores upon returning to
activity than patients without ACL reruptures. In addition, most ACL
reruptures occurred in patients younger than 20 years (77.8%) and after 24
months postoperatively (66.6%).
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Affiliation(s)
- Diego Costa Astur
- Centro de Traumatologia do Esporte, Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - João Victor Novaretti
- Centro de Traumatologia do Esporte, Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Joseph J Krob
- University of Illinois College of Medicine, Peoria, Illinois, USA
| | | | - Moises Cohen
- Centro de Traumatologia do Esporte, Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil
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Sigurðsson HB, Briem K. Cluster analysis successfully identifies clinically meaningful knee valgus moment patterns: frequency of early peaks reflects sex-specific ACL injury incidence. J Exp Orthop 2019; 6:37. [PMID: 31396723 PMCID: PMC6687789 DOI: 10.1186/s40634-019-0205-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/25/2019] [Indexed: 01/14/2023] Open
Abstract
Background Biomechanical studies of ACL injury risk factors frequently analyze only a fraction of the relevant data, and typically not in accordance with the injury mechanism. Extracting a peak value within a time series of relevance to ACL injuries is challenging due to differences in the relative timing and size of the peak value of interest. Aims/hypotheses The aim was to cluster analyze the knee valgus moment time series curve shape in the early stance phase. We hypothesized that 1a) There would be few discrete curve shapes, 1b) there would be a shape reflecting an early peak of the knee valgus moment, 2a) youth athletes of both sexes would show similar frequencies of early peaks, 2b) adolescent girls would have greater early peak frequencies. Methods N = 213 (39% boys) youth soccer and team handball athletes (phase 1) and N = 35 (45% boys) with 5 year follow-up data (phase 2) were recorded performing a change of direction task with 3D motion analysis and a force plate. The time series of the first 30% of stance phase were cluster analyzed based on Euclidean distances in two steps; shape-based main clusters with a transformed time series, and magnitude based sub-clusters with body weight normalized time series. Group differences (sex, phase) in curve shape frequencies, and shape-magnitude frequencies were tested with chi-squared tests. Results Six discrete shape-clusters and 14 magnitude based sub-clusters were formed. Phase 1 boys had greater frequency of early peaks than phase 1 girls (38% vs 25% respectively, P < 0.001 for full test). Phase 2 girls had greater frequency of early peaks than phase 2 boys (42% vs 21% respectively, P < 0.001 for full test). Conclusions Cluster analysis can reveal different patterns of curve shapes in biomechanical data, which likely reflect different movement strategies. The early peak shape is relatable to the ACL injury mechanism as the timing of its peak moment is consistent with the timing of injury. Greater frequency of early peaks demonstrated by Phase 2 girls is consistent with their higher risk of ACL injury in sports.
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Affiliation(s)
| | - Kristín Briem
- Research Centre for Movement Sciences, University of Iceland, Reykjavík, Iceland
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44
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McPherson AL, Feller JA, Hewett TE, Webster KE. Psychological Readiness to Return to Sport Is Associated With Second Anterior Cruciate Ligament Injuries. Am J Sports Med 2019; 47:857-862. [PMID: 30753794 DOI: 10.1177/0363546518825258] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Psychological responses after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) have been identified as predictors of return to sport but have not been investigated in relation to further injury. PURPOSE/HYPOTHESIS To determine whether psychological readiness to return to sport is associated with second ACL injury. It was hypothesized a priori that at both preoperative and 12-month postoperative time points, patients who sustained a second ACL injury would have lower psychological readiness than patients who did not have a second injury. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients who had a primary ACLR procedure between June 2014 and June 2016 completed the ACL-Return to Sport after Injury (ACL-RSI) (short version) scale before their ACLR and repeated the scale at 12 months after surgery to assess psychological readiness to return to sport. Patients were followed for a minimum of 2 years (range, 2-4 years) after surgery to determine further injury. The primary outcome was the relationship between ACL-RSI scores and the incidence of second ACL injury. RESULTS In 329 patients who returned to sport after ACLR, 52 (16%) sustained a second ACL injury. No difference in psychological readiness was observed at the preoperative time point, but patients who sustained a second injury trended toward lower psychological readiness at 12 months compared with noninjured patients (60.9 vs 67.2 points; P = .11). Younger (≤20 years) patients with injury had significantly lower psychological readiness to return to sport than young noninjured patients (60.8 vs 71.5 points; P = .02), but no difference was found in older patients (60.9 vs 64.6 points; P = .58). In younger patients, receiver operating characteristic curve analysis revealed a cutoff score of 76.7 points with 90% sensitivity to identify younger patients who sustained a second ACL injury. CONCLUSION Younger patients with lower psychological readiness are at higher risk for a second ACL injury after return to sport.
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Affiliation(s)
- April L McPherson
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Julian A Feller
- OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia
| | - Timothy E Hewett
- Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.,Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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Abstract
Context: Alpine skiing is a popular sport worldwide but has significant risk for injury. The epidemiology of skiing-related injuries has been described, which has led to the identification of risk factors for specific types of injuries. Evidence Acquisition: Pertinent literature from peer-reviewed publications was reviewed. Study Design: Clinical review. Level of Evidence: Level 5. Results: The adoption of international standards for ski-boot-binding systems has changed the profile of skiing-related injuries over time, as has the widespread use of helmets. An understanding of mechanisms of injury, risk factors, and preventative measures may decrease the incidence of skiing-related injuries. Conclusion: Advances in standards for skiing equipment have been effective at decreasing both the frequency and severity of skiing-related injuries, but additional efforts are required to improve the safety of the sport.
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Affiliation(s)
- Annabelle Davey
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Nathan K Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Robert J Johnson
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
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