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Girdwood M, Culvenor AG, Rio EK, Patterson BE, Haberfield M, Couch J, Mentiplay B, Hedger M, Crossley KM. Tale of quadriceps and hamstring muscle strength after ACL reconstruction: a systematic review with longitudinal and multivariate meta-analysis. Br J Sports Med 2024:bjsports-2023-107977. [PMID: 39389762 DOI: 10.1136/bjsports-2023-107977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2024] [Indexed: 10/12/2024]
Abstract
OBJECTIVE This study aimed to investigate how knee extensor and flexor strength change over time after anterior cruciate ligament reconstruction (ACLR). DESIGN Systematic review with longitudinal meta-analysis. DATA SOURCES Medline, Embase, CINAHL, Scopus, Cochrane CENTRAL and SPORTDiscus to 28 February 2023. ELIGIBILITY CRITERIA Studies of primary ACLR (n≥50), with mean participant age 18-40 years, reporting a quantitative measure of knee extensor or flexor strength were eligible. Muscle strength had to be reported for the ACL limb and compared with: (1) the contralateral limb (within-person); and/or (2) an uninjured control limb (between-person). RESULTS We included 232 studies of 34 220 participants. Knee extensor and flexor strength showed sharp initial improvement postoperatively before tailing off at approximately 12-18 months post surgery with minimal change thereafter. Knee extensor strength was reduced by more than 10% compared with the contralateral limb and approximately 20% compared with uninjured controls at 1 year for slow concentric, fast concentric and isometric contractions. Knee flexor strength showed smaller deficits but was still 5%-7% lower than the contralateral limb at 1 year for slow concentric, fast concentric and isometric contractions. Between-person comparisons showed larger deficits than within-person comparisons. CONCLUSION Knee extensor muscle strength is meaningfully reduced (>10%) at 1 year, with limited improvement after this time up to and beyond 5 years post surgery. Many people likely experience persistent and potentially long-term strength deficits after ACLR. Comparison within person (to the contralateral limb) likely underestimates strength deficits in contrast to uninjured controls.
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Affiliation(s)
- Michael Girdwood
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Ebonie K Rio
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- The Australian Ballet, Southbank, Victoria, Australia
- The Victorian Institute of Sport, Melbourne, Victoria, Australia
| | - Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Melissa Haberfield
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Jamon Couch
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Benjamin Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Michael Hedger
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Wu X, Zhang H, Cui H, Pei W, Zhao Y, Wang S, Cao Z, Li W. Surface Electromyography and Gait Features in Patients after Anterior Cruciate Ligament Reconstruction. Orthop Surg 2024. [PMID: 39367757 DOI: 10.1111/os.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 09/03/2024] [Accepted: 09/11/2024] [Indexed: 10/07/2024] Open
Abstract
OBJECTIVE An important reason for the poor recovery of anterior cruciate ligament (ACL) injuries is the poor recovery of muscle function. Therefore, we used surface electromyography (sEMG) and gait analysis to explore the muscle activation patterns and gait characteristics between lower limbs under different exercise states in patients, following anterior cruciate ligament reconstruction (ACLR). METHODS Forty-one adults with unilateral ACL injuries in Binzhou Medical University Hospital from October 2022 to June 2023 were allocated to three groups according to the time after ACL reconstruction: group A (≤3 months, 16), group B (3 months-1 year, 13), and group C (>1 year, 12). Patients were tested by sEMG and gait, while straight leg raising (SLR), walking at normal speed, fast walking, and walking up and down the stairs. Two related sample tests were performed for the normalized root mean square (RMS) values and gait parameters. RESULTS Muscle function changes varied in different training tasks. The RMS value of the involved side was more than the uninvolved side in biceps femoris and semitendinosus of group A (p < 0.010), and for the bilateral rectus femoris (RS), vastus medialis (VM), and vastus lateralis in group B, only the comparison of the RS was significant in group C during fast walking and going up and down the stairs. The ground impact (0.90 [0.63, 1.33] vs. 0.71 [0.43, 1.02], p = 0.035) of the uninvolved side was significantly decreased compared to those of the involved side in patients with ACLR when going down the stairs. CONCLUSION Different muscles need to be focused on at different stages of the postoperative period. sEMG and gait analysis can guide the development of a rehabilitation program.
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Affiliation(s)
- Xipeng Wu
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, China
| | - Hao Zhang
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, China
| | - Hongxing Cui
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, China
| | - Wenbin Pei
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, China
| | - Yixuan Zhao
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, China
| | - Shanshan Wang
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, China
| | - Zhijie Cao
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, China
| | - Wei Li
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, China
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Walker A, Sattler L, Heyward S, Tedesco J, Jones Z, D'Lima C, Higham C, Cuthbert S, Hing W. An 8-week physiotherapist-led return to sport group program after anterior cruciate ligament reconstruction improves measures of physical and psychological function: A case series. Musculoskelet Sci Pract 2024; 73:103149. [PMID: 39047591 DOI: 10.1016/j.msksp.2024.103149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Low return to competitive sport, high reinjury rates and long-term functional impairment of anterior cruciate ligament reconstruction (ACLR) present significant challenges for patients. A program that facilitates a safe return to sport (RTS) following ACLR could potentially improve outcomes. STUDY DESIGN Case Series. METHODS Sixty participants (median 20-years-old (13-36), 43 males, 18 females, median 7.5 months (4-25) post-ACLR) completed an eight-week exercise program. A battery of physical tests and patient-reported outcome measures were assessed pre and post-program. The number of participants passing RTS criteria was evaluated, and RTS rates were determined. The correlation between the ACL-RSI and measures of physical function was explored. RESULTS Improvements in all isometric strength, hop tests, running T-test, and patient reported outcome measures were seen post-program. Five (8%) participants successfully passed all RTS criteria and eighty-five percent of participants returned to their previous level of sport. The ACL-RSI and the IKDC showed correlation across all time points (pre rs = 0.49; post rs = 0.40; change r = 0.40). CONCLUSIONS Our study demonstrated improvements in all RTS criteria tests upon completing the 8-week rehabilitation program; however, few participants (8%) passed all RTS criteria. Psychological readiness is more closely related to patient-reported function than functional tests.
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Affiliation(s)
- Adam Walker
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia; Gold Coast Knee Group, Gold Coast, Australia.
| | - Larissa Sattler
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia; Gold Coast Knee Group, Gold Coast, Australia
| | - Samuel Heyward
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Jordan Tedesco
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Zachariah Jones
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Corey D'Lima
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Caroline Higham
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Sophie Cuthbert
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Wayne Hing
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
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Mancin S, Sguanci M, Andreoli D, Piredda M, De Marinis MG. Nutritional assessment in acute stroke patients: A systematic review of guidelines and systematic reviews. Int J Nurs Stud 2024; 158:104859. [PMID: 39043111 DOI: 10.1016/j.ijnurstu.2024.104859] [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: 01/23/2024] [Revised: 06/17/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Dysphagia and malnutrition are major contributors to mortality in patients with acute stroke. An early assessment of nutritional status upon hospital admission is crucial to enhance clinical outcomes by reducing the associated high-risk complications. However, the fragmented nature of the existing literature makes it difficult to optimize clinical practices. OBJECTIVE This study aims to identify the best clinical practices that nurses and other healthcare professionals can employ for the immediate assessment of nutritional risk in patients diagnosed with acute stroke. DESIGN Systematic review of clinical practice guidelines and systematic reviews. DATA SOURCES Comprehensive bibliographic searches were conducted up to May 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across the databases Cochrane Library, PubMed, Embase, CINAHL, and Scopus, and three recognized guideline repositories. REVIEW METHODS The quality of clinical practice guidelines was ascertained using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, and the quality of systematic reviews was assessed through A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). The evidence quality was appraised based on the classifications by the European Society of Cardiology. RESULTS Out of 2534 identified records, 15 were incorporated into this review. Predominantly, the selected clinical practice guidelines and systematic reviews exhibited high methodological quality. Notably, the Gugging Swallowing Screen and the Malnutrition Universal Screening Tool were pinpointed as primary tools for initial screenings. Most studies recommended that these assessments, ideally conducted within the first 24 h of patient admission, should be carried out by specially trained professionals, highlighting the pivotal role of nurses. Deviations in screening outcomes necessitate complementary specialist evaluations. CONCLUSIONS This systematic review offers a consolidation of current insights, proposing an innovative and integrated approach to assess nutritional needs of high-risk patients. It underscores the importance of nurses in the screening process, emphasizing their pivotal role in the nutritional management of patients with acute stroke, and advocates for further research endeavors to standardize intervention protocols to elevate patient clinical outcomes. PROTOCOL REGISTRATION NUMBER PROSPERO CRD42023425140.
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Affiliation(s)
- Stefano Mancin
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Sguanci
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Desirèe Andreoli
- Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | - Michela Piredda
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Roma, Italy.
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Carter HM, Beard DJ, Leighton P, Moffatt F, Smith BE, Webster KE, Logan P. 'Going through the motions'; a rich account of the complexity of the anterior cruciate ligament reconstruction pathway, a UK qualitative study. BMJ Open 2024; 14:e079468. [PMID: 39289010 PMCID: PMC11409353 DOI: 10.1136/bmjopen-2023-079468] [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: 09/19/2024] Open
Abstract
OBJECTIVES This study aimed to understand the lived experiences of patients on the anterior cruciate ligament reconstruction (ACLR) pathway up to 3 months before, 3 months after and 1 year after surgery. Study objectives were to explore (1) patient experiences of preoperative and postoperative treatment, (2) views of/involvement in prehabilitation and (3) sources and consistency of healthcare advice. DESIGN Semi-structured interviews analysed using reflexive thematic analysis. SETTING Midlands, England. PARTICIPANTS Purposive sample of 18 participants aged 18-45. Three identified as female and 15 as male. Participants' ethnic origin was white (n=14), Indian (n=2), British Asian (n=1) and Pakistani (n=1). 10 participants were awaiting ACLR, six were 3months postsurgery and two were 1 year postsurgery. RESULTS Participants gave a rich account of ACLR pathway experiences discussing negative impacts of the injury, difficulties with navigating the pathway and making decisions about surgery. Interacting with healthcare professionals and managing the variety of resources, advice and opinions were also highlighted as challenges. Participants reflected on their preoperative journey accounting a wide spectrum of expectations and realities of returning to work and physical activity postoperatively. Prehabilitation was perceived to offer an advantage to recovery, mental well-being, injury knowledge, postoperative rehabilitation and supports a faster return to physical activity. Five themes were identified:Injury experience, impact and support.Navigating the treatment pathway.Sense making in the preoperative period.Uncertainty, expectations and reality of the postsurgical period.Balancing resources, advice and opinions. CONCLUSION This study has illuminated patient experiences of the National Health Service (NHS) ACLR pathway, novel to the evidence base.The results highlight the perceived shortcomings in patient support. They also demonstrate the difficulty patients face when navigating the NHS system, communicating with clinicians, making decisions about treatment and managing conflicting sources of healthcare advice. These problems are more prominent than previously recognised in the literature. REGISTRATION ClinicalTrials.gov Identifier: NCT05529511.
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Affiliation(s)
- Hayley M Carter
- Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - David J Beard
- Surgical Intervention Trials Unit, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Benjamin E Smith
- Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Phillipa Logan
- School of Medicine, University of Nottingham, Nottingham, UK
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6
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Tayfur B, Keneen Johnson A, Palmieri-Smith R. Changes in Quadriceps Rate of Torque Development After Anterior Cruciate Ligament Reconstruction and Association to Single-Leg Hop Distance. Sports Health 2024; 16:808-816. [PMID: 37873996 PMCID: PMC11346242 DOI: 10.1177/19417381231205295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Quadriceps neuromuscular function is negatively affected after anterior cruciate ligament reconstruction (ACLR). The specific effect that the ACLR has on the quadriceps femoris rate of force production and its impact on functional recovery is unknown. HYPOTHESIS The anterior cruciate ligament (ACL) limb would present persistent deficits in the rate of torque development (RTD), when compared with the non-ACL limb before ACLR until 9 months (9M) post-ACLR. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS Twenty-eight participants performed quadriceps maximum voluntary isometric contractions (MVICs) before (PRE), at 5 months (5M) and at 9M after ACLR. Single-leg hop distance was also assessed at 9M. Quadriceps RTD was calculated at 50, 100, and 200 ms after the onset of torque production. Maximum RTD was also calculated. A 2 (limb) × 3 (time) repeated-measures analysis of variance was used for RTD50, RTD100, RTD200, and RTDmax. Linear regressions were used to evaluate the associations of MVIC and RTD values at 5M and 9M with single-leg hop distance at 9M. RESULTS The ACL limb had lower RTD values at all times compared with the non-ACL limb (P < 0.05). RTD of the ACL limb significantly decreased from PRE to 5M, and then recovered to PRE levels at 9M (P < 0.05). The non-ACL limb displayed no differences from baseline to either 5M or 9M. MVIC and RTD200 at 5M predicted (R2 = 0.313 and R2 = 0.262, respectively) single-leg hop distance at 9M, better than the strength and RTD at 9M (R2 = 0.235 and R2 = 0.128, respectively). CONCLUSION Quadriceps RTD is negatively affected after ACLR, and deficits may persist at the time of return to activity. Strength and RTD during recovery at 5M may predict more than 25% of the variance in single-leg hop distance at 9M, independently; hence, both provide important information to monitor functional recovery post-ACLR. CLINICAL RELEVANCE RTD should be measured to understand the changes in neuromuscular capacity after ACLR, and rehabilitation strategies that target quick force production, ie, quick muscle activation and functional tasks, should be implemented.
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Affiliation(s)
- Beyza Tayfur
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Orthopedic Rehabilitation and Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Alexa Keneen Johnson
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Orthopedic Rehabilitation and Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, Michigan
| | - Riann Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
- Orthopedic Rehabilitation and Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, Michigan
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan
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Tagliero AJ, Miller MD. Anterior Cruciate Ligament Tears in Soccer Players. Sports Med Arthrosc Rev 2024; 32:138-145. [PMID: 39087703 DOI: 10.1097/jsa.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Anterior cruciate ligament (ACL) injuries to soccer players present unique challenges in sports medicine, given the sport's global prevalence and intricate injury dynamics. These injuries, especially in the youth and female demographic, have become a substantial concern in sports medicine. This review explores the epidemiology, mechanism of injury, diagnostic procedures, treatment modalities, and rehabilitation strategies related to ACL tears within the soccer community. Progress in diagnostics, treatments, and rehabilitation underscores the importance of evidence-based approaches. As soccer continues its ascent in popularity, addressing the specific risks and nuances of ACL injuries in this context remains of paramount significance.
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Affiliation(s)
- Adam J Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Mark D Miller
- Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA
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Lee Y, Hircock C, Dang J, Jung J, Zevin B, Elnahas A, Khamar J, Vergis A, Tahir U, Hardy K, Samarasinghe Y, Gill R, Gu J, McKechnie T, Pescarus R, Biertho L, Lam E, Neville A, Ellsmere J, Karmali S, Jackson T, Okrainec A, Doumouras A, Kroh M, Hong D. Assessment of guidelines for bariatric and metabolic surgery: a systematic review and evaluation using appraisal of guidelines for research and evaluation II (AGREE II). Int J Obes (Lond) 2024; 48:1193-1204. [PMID: 38890403 DOI: 10.1038/s41366-024-01559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/01/2024] [Accepted: 05/31/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND In recent years, multiple guidelines on bariatric and metabolic surgery were published, however, their quality remains unknown, leaving providers with uncertainty when using them to make perioperative decisions. This study aims to evaluate the quality of existing guidelines for perioperative bariatric surgery care. METHODS A comprehensive search of MEDLINE and EMBASE were conducted from January 2010 to October 2022 for bariatric clinical practice guidelines. Guideline evaluation was carried out using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework. RESULTS The initial search yielded 1483 citations, of which, 26 were included in final analysis. The overall median domain scores for guidelines were: (1) scope and purpose: 87.5% (IQR: 57-94%), (2) stakeholder involvement: 49% (IQR: 40-64%), (3) rigor of development: 42.5% (IQR: 22-68%), (4) clarity of presentation: 85% (IQR: 81-90%), (5) applicability: 6% (IQR: 3-16%), (6) editorial independence: 50% (IQR: 48-67%), (7) overall impressions: 48% (IQR: 33-67%). Only six guidelines achieved an overall score >70%. CONCLUSIONS Bariatric surgery guidelines effectively outlined their aim and presented recommendations. However, many did not adequately seek patient input, state search criteria, use evidence rating tools, and consider resource implications. Future guidelines should reference the AGREE II framework in study design.
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Affiliation(s)
- Yung Lee
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Caroline Hircock
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Jerry Dang
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Jung
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Ahmad Elnahas
- Division of General Surgery, Western University, London, ON, Canada
| | - Jigish Khamar
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Ashley Vergis
- Division of General Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Umair Tahir
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Krista Hardy
- Division of General Surgery, University of Manitoba, Winnipeg, MB, Canada
| | | | - Richdeep Gill
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey Gu
- Division of General Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tyler McKechnie
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Radu Pescarus
- Division of General Surgery, University of Montreal, Montreal, QC, Canada
| | - Laurent Biertho
- Department of Surgery, Laval University, Quebec City, QC, Canada
| | - Elaine Lam
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Amy Neville
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - James Ellsmere
- Division of General and Gastrointestinal Surgery, Dalhousie University, Halifax, NS, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Timothy Jackson
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Allan Okrainec
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Matthew Kroh
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, ON, Canada.
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Ripic Z, Letter M, Schoenwether B, Kaplan LD, Baraga MG, Costello Ii JP, Eskenazi J, Dennison M, Best TM, Signorile JF, Eltoukhy M. A hop testing alternative for functional performance following anterior cruciate ligament reconstruction. PLoS One 2024; 19:e0309003. [PMID: 39150940 PMCID: PMC11329148 DOI: 10.1371/journal.pone.0309003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/04/2024] [Indexed: 08/18/2024] Open
Abstract
The purpose of this work was to provide a simple method to determine reactive strength during the 6-meter timed hop test (6mTH) and evaluate its association with isokinetic peak torque in patients following anterior cruciate ligament reconstruction (ACLR). Twenty-nine ACLR patients who were at least four months from surgery were included in this analysis. Participants were brought into the laboratory on one occasion to complete functional testing. Quadriceps and hamstring isokinetic testing was completed bilaterally at 60, 180, and 300 deg∙s-1, using extension peak torque from each speed as the outcome measure. The 6mTH was completed bilaterally using a marker-based motion capture system, and reactive strength ratio (RSR) was calculated from the vertical velocity of the pelvis during the test. An adjustment in RSR was made using the velocity of the 6mTH test to account for different strategies employed across participants. Repeated measures correlations were used to determine associations among isokinetic and hop testing variables. A two-way mixed analysis of variance was used to determine differences in isokinetic and hop testing variables between operated and non-operated legs and across male and female participants. Moderate positive associations were found between RSR (and adjusted RSR) and isokinetic peak torque at all speeds (r = .527 to .577). Mean comparisons showed significant main effects for leg and sex. Patients showed significant deficits in their operated versus non-operated legs in all isokinetic and hop testing variables, yet only isokinetic peak torque and timed hop time showed significant differences across male and female groups. Preliminary results are promising but further development is needed to validate other accessible technologies available to calculate reactive strength during functional testing after ACLR. Pending these developments, the effects of movement strategies, demographics, and levels of participation on RSR can then be explored to translate this simple method to clinical environments.
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Affiliation(s)
- Zachary Ripic
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, United States of America
- Department of Orthopaedics, University of Miami Health System - Sports Medicine Institute, Coral Gables, FL, United States of America
| | - Michael Letter
- Department of Orthopaedics, University of Miami Health System - Sports Medicine Institute, Coral Gables, FL, United States of America
| | - Brandon Schoenwether
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, United States of America
| | - Lee D Kaplan
- Department of Orthopaedics, University of Miami Health System - Sports Medicine Institute, Coral Gables, FL, United States of America
| | - Michael G Baraga
- Department of Orthopaedics, University of Miami Health System - Sports Medicine Institute, Coral Gables, FL, United States of America
| | - Joseph P Costello Ii
- Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Jordan Eskenazi
- Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Molly Dennison
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, United States of America
| | - Thomas M Best
- Department of Orthopaedics, University of Miami Health System - Sports Medicine Institute, Coral Gables, FL, United States of America
| | - Joseph F Signorile
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, United States of America
| | - Moataz Eltoukhy
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, United States of America
- Department of Industrial and Systems Engineering, University of Miami, Coral Gables, FL, United States of America
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, United States of America
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10
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Nedder VJ, Raju AG, Moyal AJ, Calcei JG, Voos JE. Impact of Psychological Factors on Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2024:19417381241256930. [PMID: 39041333 DOI: 10.1177/19417381241256930] [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: 07/24/2024] Open
Abstract
CONTEXT Anterior cruciate ligament (ACL) tears are a common orthopaedic injury, and the incidence of ACL reconstruction (ACLR) continues to increase. Current clinical practice guidelines (CPGs) recognize the role of psychological factors in rehabilitation, but patient-reported outcome measures (PROs) and psychological readiness are rarely incorporated into rehabilitation. OBJECTIVE The purpose of this review was to highlight the importance of psychological health after ACL injury, understand the current metrics used to monitor psychological recovery, and outline how psychological recovery can be better incorporated in current CPGs. DATA SOURCES A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA); 63 studies were identified with a PubMed search using the term "ACL Injuries/psychology". STUDY SELECTION Exclusion criteria included lack of consideration of psychological effects or studies validating PROs after ACLR. Studies were reviewed by multiple reviewers, and a total of 38 studies were included after applying exclusion criteria. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3b. DATA EXTRACTION Two independent reviewers analyzed the included articles to extract sample size, psychological readiness scale or other measures used, and key results. RESULTS Psychological outcomes, especially kinesiophobia and fear of reinjury, are seen commonly after ACLR. Psychological factors were shown to impede return to sport (RTS), alter measurable knee biomechanics, and potentially increase the risk for re-rupture. Targeted interventions such as kinesiotaping, knee bracing, and imagery training can help improve psychological and functional testing after ACLR. CONCLUSION ACLR is often complicated by psychological factors. Psychological readiness is a crucial yet often unincorporated part of rehabilitation. Patients with higher levels of kinesiophobia and lower psychological readiness to RTS specifically should be identified to allow for administration of interventions, such as imagery training, knee bracing, or kinesiotaping, that can mitigate the negative effects of psychological outcomes and improve recovery.
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Affiliation(s)
| | - Akash G Raju
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Andrew J Moyal
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jacob G Calcei
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - James E Voos
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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11
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Stofberg JPJ, Aginsky K, van Aswegen M, Kramer M. Changes in isometric mid-thigh pull peak force and symmetry across anterior cruciate ligament reconstruction rehabilitation phases. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1418270. [PMID: 39036284 PMCID: PMC11258044 DOI: 10.3389/fresc.2024.1418270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 07/23/2024]
Abstract
Background Whether functionally relevant strength assessments, such as the isometric mid-thigh pull (IMTP), can be used either bilaterally or unilaterally to evaluate and guide rehabilitation progress in those with anterior cruciate ligament reconstruction (ACLR) is under-researched. This study assessed changes in peak force (PF) and asymmetry across 3 phases for bilateral and unilateral IMTP assessments in patients with ACLR. Peak isometric force from the IMTP was compared to peak torque from isokinetic dynamometry as well as against a cohort of healthy, uninjured individuals. Method Participants (ACLR, n = 15) completed bilateral and unilateral IMTP assessments at weeks 12 (baseline), 16 (phase 3), and 20 (phase 4) of rehabilitation to evaluate changes in PF and asymmetry. Asymmetry was evaluated using the asymmetry angle. Isometric data from the IMTP were compared to that from an isokinetic dynamometer as well as against a cohort of healthy, uninjured participants (n = 63) allowing for a detailed analysis of limb-specific force production. Results The PF during the bilateral IMTP increased for both the injured (0.94 N/kg) and uninjured (0.26 N/kg) limbs from baseline to phase 4, whereas the PF of the injured limb increased by 1.5 N/kg during the unilateral IMTP in the same time frame. Asymmetry values systematically reduced by ∼1% and ∼0.5% for the bilateral and unilateral IMTP tests from baseline to phase 4. Significant differences in PF of the injured limb were evident between those with ACLR and healthy controls across all phases (p = 0.022-0.001). The rate of progression in PF capacity was dependent on test type, amounting to 0.1 and 0.2 body weights per week for the bilateral and unilateral IMTP respectively. Small-to-large correlations (r = 0.12-0.88) were evident between IMTP PF and peak torque from the isokinetic dynamometer as well as between asymmetry metrics from both tests. Conclusion The findings suggest that IMTP PF has potential for monitoring changes in PF and asymmetry during the ACLR rehabilitation progress. Both injured limb and uninjured limb show improvement in force-generating capacity, implying a positive adaptation to rehabilitation protocols. The findings highlight that ACLR is a unilateral injury that requires bilateral rehabilitation.
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Affiliation(s)
- Johannes P. J. Stofberg
- Centre for Health and Human Performance (CHHP), North-West University, Potchefstroom, South Africa
| | - Kerith Aginsky
- Ribstein Center for Sports Medicine and Research, Wingate Institute, Netanya, Israel
| | - Mariaan van Aswegen
- Physical Activity, Sport, and Recreation (PhASRec) Research Focus Area, North-West University, Potchefstroom, South Africa
| | - Mark Kramer
- Physical Activity, Sport, and Recreation (PhASRec) Research Focus Area, North-West University, Potchefstroom, South Africa
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Kotiuk V, Ziółek T, Kostrub O, Blonskyi R, Podik V, Smirnov D. Smith machine squats pose high risk to ACL graft integrity after the ACL reconstruction and conventional squats are a safer alternative. Knee Surg Sports Traumatol Arthrosc 2024; 32:1902-1910. [PMID: 38751107 DOI: 10.1002/ksa.12263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of squats after the anterior cruciate ligament (ACL) reconstruction on the ACL graft, considering new data on biomechanics, posterior tibial slope (PTS) and anterolateral ligament (ALL). METHODS Utilising finite element analysis on the new 14-component knee joint model, we have evaluated stresses on the knee elements separately for the knee with a native double-bundle ACL and with a single-bundle ACL graft for the 5° and 14° PTS variants during both conventional and Smith machine horizontal squats. RESULTS Replacing a native ACL with a single-bundle graft causes an overstrain on the graft compared to the intact ACL under all conditions. Stresses on the ACL, ACL graft and ALL are much higher during the Smith machine squats compared to the conventional ones. The stress on the menisci is 3.6-4.9 times higher with conventional squats. PTS at the squats' lowest point minimally affects ACL stress but impacts menisci. CONCLUSIONS The single-bundle ACL reconstruction (ACLR) does not reproduce the biomechanics of the native ACL and increases stresses in most knee joint elements, according to the current study. Conventional squats are relatively safe for the ACL graft at their lowest point. Passing the half-squat position is the most dangerous point. Smith machine horizontal squats produce stress on the ACL graft several times higher than its estimated breaking load and dangerous stress levels on the ALL. During the rehabilitation following ACLR, it is advisable to prioritise the conventional squats over Smith machine squats until ligamentisation is complete. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Oleksandr Kostrub
- Department of Sports and Ballet Trauma of State Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kyiv, Ukraine
| | - Roman Blonskyi
- Department of Sports and Ballet Trauma of State Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kyiv, Ukraine
| | - Volodymyr Podik
- Department of Sports and Ballet Trauma of State Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kyiv, Ukraine
| | - Dmytro Smirnov
- Department of Sports and Ballet Trauma of State Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kyiv, Ukraine
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Cederström N, Ageberg E, Granér S. Lived experiences of physical therapists treating traumatic knee injury using integrated psychological training (MOTIFS): a qualitative interview study. Physiother Theory Pract 2024; 40:1522-1536. [PMID: 36779818 DOI: 10.1080/09593985.2023.2176729] [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: 06/12/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND The novel Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) training model, which began development in 2018, integrates psychological training into physical rehabilitation in knee-injured people. OBJECTIVE This qualitative interview study aims to understand, interpret, and describe how physical therapists perceive using the MOTIFS Model. METHODS One-on-one semi-structured interviews were conducted with six physical therapists familiar with the MOTIFS model and eight with experience with care-as-usual training only, analyzed using Interpretive Phenomenological Analysis. RESULTS Two major themes were generated in the MOTIFS group: 1) "MOTIFS increases psychological focus during rehabilitation training"; and 2) "Care-as-Usual training is mainly physical, and lacks the necessary psychological focus." Physical therapists perceived structured methods of addressing psychological factors, such as using imagery to influence patients' motivation, fear, and preparation for return to activity. Three major themes were generated in the Care-as-Usual group: 1) "Rehabilitation is mainly to restore physical function"; 2) "Rehabilitation training includes a biopsychosocial interaction"; and 3) "Psychological factors are important to address, but strategies are lacking." CONCLUSION Physical therapists perceive MOTIFS as a method of consciously shifting perspective toward an increased focus on psychological factors in knee-injury rehabilitation. Results indicate that a training model with integrated psychological strategies to create more holistic rehabilitation may be beneficial.
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Affiliation(s)
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Simon Granér
- Department of Psychology, Lund University, Lund, Sweden
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14
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Gill VS, Tummala SV, Sullivan G, Han W, Haglin JM, Marks L, Tokish JM. Functional Return-to-Sport Testing Demonstrates Inconsistency in Predicting Short-Term Outcomes Following Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2024; 40:2135-2151.e2. [PMID: 38216071 DOI: 10.1016/j.arthro.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/26/2023] [Accepted: 12/17/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE To systematically review the relationship between functional testing at the time of return to sport (RTS) and short-term outcomes, such as second anterior cruciate ligament (ACL) tear and return to a preinjury level of sport, among athletes who underwent anterior cruciate ligament reconstruction (ACLR). METHODS A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science to identify studies examining athletes who underwent functional RTS testing and were followed for at least 12 months following ACLR. Studies were screened by 2 reviewers. A standardized template was used to extract information regarding study characteristics, ACLR information, functional test results, and risk factors associated with retear or reduced RTS. RESULTS Of the 937 studies identified, 22 met the inclusion criteria. The average time between ACLR and RTS testing was 8.5 months. Single leg hop for distance performance had no association with retear risk in any study and no association with RTS rates in most studies. Quadriceps strength had conflicting results in relation to retear risk, whereas it had no relationship with RTS rates. Rates of reinjury and RTS were similar between patients who passed and did not pass combined hop and strength batteries. Asymmetric knee extension and hip moments, along with increased knee valgus and knee flexion angles, demonstrated increased risk of retear. CONCLUSIONS Individual hop and strength tests that are often used in RTS protocols following ACLR may have limited and inconsistent value in predicting ACL reinjury and reduced RTS when used in isolation. Combined hop and strength test batteries also demonstrate low sensitivity and negative predictive value, highlighting conflicting evidence to suggest RTS testing algorithm superiority. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Vikram S Gill
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A..
| | | | | | - Will Han
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | - Jack M Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Arizona, U.S.A
| | - Lisa Marks
- Division of Education, Department of Library Services, Mayo Clinic, Arizona, U.S.A
| | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic, Arizona, U.S.A
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15
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Elagami RA, Laux CM, Gallegos CL, Tedesco TK, Cóvos TG, Braga MM, Mendes FM, Cenci MS, Raggio DP. Do the clinical practice guidelines for paediatric dentistry meet the quality standards? A meta-research and quality appraisal using the AGREE II tool. Int J Paediatr Dent 2024; 34:360-371. [PMID: 37984836 DOI: 10.1111/ipd.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/24/2023] [Accepted: 10/10/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) enhance health care and aid clinicians' decisions. AIM To evaluate the quality of clinical guidelines in paediatric dentistry using the AGREE II tool. DESIGN PubMed, EMBASE, Scopus, LIVIVO, Lilacs, international guidelines websites, scientific societies, and gray literature were searched until September 2021. We included paediatric dental clinical guidelines and excluded drafts or guidelines for patients with special needs. Two independent reviewers performed quality assessment using the APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument. We calculated the mean overall domain scores (95% confidence interval) for each guideline. We used regression analysis to correlate the score of overall assessment and the six domains of AGREE II with guideline characteristics. RESULTS Forty-four guidelines were included in this study. Highest mean score was for Domain 4 (Clarity of Presentation; 58%, 95% CI: 50.8-64.9), whereas the lowest was for Domain 5 (Applicability; 16%, 95% CI: 10.8-21.4). The reporting quality was improved in Domains 1-5 with reporting checklists (p < .001), whereas that of Domain 6 was improved by decreasing years since publication (p = .047). CONCLUSION Paediatric dental guidelines do not comply with the methodological quality standard, especially in Domain 5 (Applicability). The AGREE reporting checklist should be implemented with a system to evaluate the certainty of evidence for future guidelines.
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Affiliation(s)
- Rokaia Ahmed Elagami
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Caroline Mariano Laux
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Claudia López Gallegos
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Tamara Kerber Tedesco
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Mariana Minatel Braga
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Fausto Medeiros Mendes
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Maximiliano Sérgio Cenci
- Department of Dentistry, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, The Netherlands
| | - Daniela Prócida Raggio
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
- School of Dentistry, Cardiff University, Cardiff, UK
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Chaput M, Simon JE, Taberner M, Grooms DR. From Control to Chaos: Visual-Cognitive Progression During Recovery from ACL Reconstruction. J Orthop Sports Phys Ther 2024; 54:431-439. [PMID: 38832659 DOI: 10.2519/jospt.2024.12443] [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: 06/05/2024]
Abstract
BACKGROUND: Anterior cruciate ligament tear is a serious knee injury with implications for central nervous system (CNS) plasticity. To perform simple knee movements, people with a history of ACL reconstruction (ACL-R) engage cross-modal brain regions and when challenged with cognitive-motor dual-tasks, physical performance deteriorates. Therefore, people with ACL-R may increase visual-cognitive neural processes for motor control. CLINICAL QUESTION: What components of CNS plasticity should the rehabilitation practitioner target with interventions, and how can practitioners augment rehabilitation exercises to target injury associated plasticity? KEY RESULTS: This clinical commentary (1) describes the neurophysiological foundation for visual-cognitive compensation after ACL-R, (2) provides a theoretical rationale for implementing visual-cognitive challenges throughout the return to sport (RTS) continuum, and (3) presents a framework for implementing visual-cognitive challenges from the acute phases of rehabilitation. The 'Visual-Cognitive Control Chaos Continuum (VC-CCC) framework consists of five training difficulties that progress visual-cognitive challenges from high control to high chaos, to better represent the demands of sport. CLINICAL APPLICATION: The VC-CCC framework augments traditional rehabilitation so that each exercise can progress to increase difficulty and promote sensorimotor and visual-cognitive adaptation after ACL-R.
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Solie BS, Tollefson LV, Doney CP, O'Keefe JMJ, Thompson WC, LaPrade RF. Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction: A Practical Review with Medical Recommendations. Int J Sports Med 2024; 45:572-588. [PMID: 38527465 DOI: 10.1055/a-2270-3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Returning to sport after anterior cruciate ligament reconstruction (ACLR) can be a challenging and complex process for the athlete, with the rate of return to the pre-injury level of sport observed to be less than athlete expectations. Of the athletes that do return to sport (RTS), knee re-injury rates remain high, and multiple studies have observed impaired athletic performance upon RTS after ACLR as well as reduced playing time, productivity, and career lengths. To mitigate re-injury and improve RTS outcomes, multiple RTS after ACLR consensus statements/clinical practice guidelines have recommended objective RTS testing criteria to be met prior to medical clearance for unrestricted sports participation. While the achievement of RTS testing criteria can improve RTS rates after ACLR, current criteria do not appear valid for predicting safe RTS. Therefore, there is a need to review the various factors related to the successful return to the pre-injury level of sport after ACLR, clarify the utility of objective performance testing and RTS criteria, further discuss safe RTS decision-making as well as present strategies to reduce the risk of ACL injury/re-injury upon RTS. This article provides a practical review of the current RTS after ACLR literature, as well as makes medical recommendations for rehabilitation and RTS decision-making after ACLR.
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Affiliation(s)
- Braidy S Solie
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
- Research, Twin Cities Orthopedics, Edina, MN, United States
| | | | - Christopher P Doney
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
| | - Jeremy M J O'Keefe
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
| | - Will C Thompson
- Sports Science, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
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18
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Sheehan N, Summersby R, Bleakley C, Caulfield B, Matthews M, Klempel N, Holden S. Adolescents' experience with sports-related pain and injury: A systematic review of qualitative research. Phys Ther Sport 2024; 68:7-21. [PMID: 38843686 DOI: 10.1016/j.ptsp.2024.05.003] [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: 02/21/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE The aim of this review is to synthesise qualitative studies examining adolescents' experience with pain and injury arising from sports participation. METHODS This review was registered on Open Science Framework prior to data extraction. A systematic search of PubMed, Embase, and SPORTDiscus was conducted. Studies were appraised using the CASP (critical appraisal skills programme) checklist. Data was synthesised using a meta aggregation. STUDY SELECTION CRITERIA Inclusion criteria included studies related to adolescents aged 14-19yrs with sports related pain/injury, employed a qualitative design, full text publications in English. RESULTS Sixteen studies of 216 participants were included. Studies investigated severe knee injuries, concussion, or other musculoskeletal injuries. Synthesised findings show that, regardless of injury type, adolescents experience a mix of positive (motivation to rehab and return to sport, optimism) and negative emotions (fear of re-injury, isolation, depressive responses) throughout recovery. Common coping strategies were to ignore symptoms, modify activity levels, or seek support. CONCLUSION Sports-related pain and injury has a multifaceted effect on the adolescent athlete. There is a pervasive fear of re-injury and social isolation, but the desire to return to sports is facilitated through motivation and support. Peer motivation effects the willingness of the adolescent to persist with rehabilitation.
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Affiliation(s)
- Niamh Sheehan
- School of Public Health Sport Science and Physiotherapy, University College Dublin, Ireland.
| | - Ryan Summersby
- School of Public Health Sport Science and Physiotherapy, University College Dublin, Ireland
| | - Chris Bleakley
- School of Health Sciences, Ulster University, Belfast, UK
| | - Brian Caulfield
- School of Public Health Sport Science and Physiotherapy, University College Dublin, Ireland
| | | | | | - Sinead Holden
- School of Public Health Sport Science and Physiotherapy, University College Dublin, Ireland
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Simonsson R, Piussi R, Högberg J, Sundberg A, Hamrin Senorski E. Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2024; 43:513-533. [PMID: 38811125 DOI: 10.1016/j.csm.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Rehabilitation after an anterior cruciate ligament (ACL) reconstruction requires patience, devotion, and discipline. Rehabilitation should be individualized to each patient's specific need and sport. Return to sport is a continuum throughout the rehabilitation, and patients should not return to performance before passing a battery of muscle function tests and patient-reported outcomes, as well as change of direction-specific tests. Return to full participation should be an agreement between the patient, physical therapist, surgeon, and coach. For minimal risk for second ACL injury, patients should continue with maintenance and prevention training even after returning to sport.
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Affiliation(s)
- Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Axel Sundberg
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Capio Ortho Center, Arvid Wallgrens Backe 4a, Gothenburg SE-413 13, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Swedish Olympic Committee, Olympiastadion 114 33, Stockholm, Sweden.
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Wang K, Peng L, You M, Deng Q, Li J. Multicomponent supervised tele-rehabilitation versus home-based self-rehabilitation management after anterior cruciate ligament reconstruction: a study protocol for a randomized controlled trial. J Orthop Surg Res 2024; 19:381. [PMID: 38943178 PMCID: PMC11212401 DOI: 10.1186/s13018-024-04871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024] Open
Abstract
INTRODUCTION Our study aims to assess the effectiveness of multicomponent supervised tele-rehabilitation compared to home-based self-rehabilitation management in patients following anterior cruciate ligament reconstruction (ACLR). METHODS The current study is designed as a single-center, single-blinded, randomized controlled, two-arm trial. Participants will be randomized and allocated at a 1:1 ratio into either a multicomponent supervised tele-rehabilitation group or a home-based self-rehabilitation group. All participants receive uniform preoperative education through the HJT software. Participants in the intervention group undergo multicomponent supervised tele-rehabilitation, while those in the control group follow a home-based self-rehabilitation program. All the participants were assessed and measured for the included outcomes at the outpatient clinic before the procedure, and in 2, 4, 8, 12, and 24 weeks after ACLR by two assessors. The primary outcome was the percentage of patients who achieve a satisfactory active ROM at the 12 weeks following the ACLR. The satisfactory active ROM was also collected at 2, 4, 8, and 24 weeks after ACLR. The secondary outcomes were active and passive range of motion (ROM), pain, muscle strength, and function results. REGISTRATION DETAILS Ethical approval has been obtained from the West China Hospital Ethics Committee (approval number 2023-1929, December 2023). The trial has been registered on ClinicalTrials.gov (registration number NCT06232824, January 2024).
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Grants
- 2023NSFSC1754 Natural Science Foundation of Sichuan Province, China
- 2023NSFSC1754 Natural Science Foundation of Sichuan Province, China
- 2023NSFSC1754 Natural Science Foundation of Sichuan Province, China
- 2023NSFSC1754 Natural Science Foundation of Sichuan Province, China
- 2023NSFSC1754 Natural Science Foundation of Sichuan Province, China
- ZYGD21005 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University
- ZYGD21005 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University
- ZYGD21005 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University
- ZYGD21005 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University
- ZYGD21005 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University
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Affiliation(s)
- Kexin Wang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Linbo Peng
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Mingke You
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Deng
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
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Pamboris GM, Pavlou K, Paraskevopoulos E, Mohagheghi AA. Effect of open vs. closed kinetic chain exercises in ACL rehabilitation on knee joint pain, laxity, extensor muscles strength, and function: a systematic review with meta-analysis. Front Sports Act Living 2024; 6:1416690. [PMID: 38887689 PMCID: PMC11180725 DOI: 10.3389/fspor.2024.1416690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries are common among physically active individuals, often requiring ACL reconstruction (ACLR) for recovery. Rehabilitating these injuries involves determining the appropriate timing for initiating open kinetic chain (OKC) exercises. Although OKC exercises are effective post-ACLR, their use in rehabilitation remains a subject of debate. Therefore, this study aims to conduct a systematic review to determine whether OKC or closed kinetic chain (CKC) exercises result in differences in laxity, strength of the knee extensor muscle group, function, and functional performance in ACL rehabilitation. Five electronic databases were searched for randomized controlled between-group trials (RCTs). Two reviewers independently evaluated the risk of bias using the PEDro scale. We performed a meta-analysis using a random-effects model or calculated mean differences (fixed-effect) where appropriate. Certainty of evidence was judged using the GRADE approach. The systematic literature search yielded 480 articles, of which 9 met the inclusion criteria. The evidence for all outcomes ranged from very low to low certainty. Across all comparisons, inconsistent results were found in outcome measures related to knee function between OKC and CKC exercises post-ACLR. A significant increase in quadriceps isokinetic strength was found in post-ACLR and ACL-deficient knees in favor of OKC exercises at 3 (p = 0.03) and 4 (p = 0.008) months, respectively. A significant decrease in knee laxity was observed in ACL-deficient knees in favor of OKC at 10 weeks (p = 0.01), although inconsistency was noted at 4 months. Finally, a significant decrease in pain was found in favor of early OKC compared to late OKC (p < 0.003). Additionally, in ACL-deficient knees, low load resistance training (LLRT) OKC showed no significant laxity difference compared to controls (p > 0.05). In contrast, high load resistance training (HLRT) OKC had less laxity than controls at 6 weeks (p = 0.02) but not at 12 weeks (p > 0.05). OKC exercises appear to be superior to CKC for improving quadriceps strength 3-4 months post-injury, whether as a part of conservative or post-surgery rehabilitation. On the other hand, OKC exercises seem to be either superior or equally effective to CKC for improving knee laxity, thus presenting their importance in being included in a rehabilitation protocol from the initial phase. Systematic Review Registration PROSPERO [CRD42023475230].
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Affiliation(s)
- George M. Pamboris
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Kyriakos Pavlou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Eleftherios Paraskevopoulos
- Department of Physiotherapy, Aegean College, Athens, Greece
- Laboratory of Biomechanics, Department of Physiotherapy, University of Peloponnese, Sparta, Greece
| | - Amir A. Mohagheghi
- Division of Sport, Health, and Exercise Sciences, Brunel University London, Uxbridge, United Kingdom
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22
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Mancin S, Sguanci M, Andreoli D, Soekeland F, Anastasi G, Piredda M, De Marinis MG. Systematic review of clinical practice guidelines and systematic reviews: A method for conducting comprehensive analysis. MethodsX 2024; 12:102532. [PMID: 38226356 PMCID: PMC10788252 DOI: 10.1016/j.mex.2023.102532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
A systematic review (SR) is a research method for synthesizing evidence on a specific topic. Among the various types of systematic reviews, there are SRs of guidelines (CPGs) and SRs of SRs. Traditionally, they are limited to just one type of secondary evidence. This paper introduces an innovative SR methodology that combines CPGs and SRs to improve evidence synthesis and overcome the limitations of isolated use. Essential steps that should always precede the actual research process include registering the research protocol, formulating research questions and setting inclusion/exclusion criteria. Using the PRISMA protocol for comprehensive database searches, it's crucial to combine keywords with boolean operators and remove duplicates. The eligibility of studies should be assessed by selecting potentially relevant articles through an initial screening of titles and abstracts, followed by a meticulous analysis of the full-texts. Rigorous evidence evaluation tools, such as AGREE II for CPGs and AMSTAR 2 for SRs, and the double reviewer approach ensure high-quality selections. Additionally, converting summarized results into percentages and applying statistical analyses facilitate interpretation and improve the reliability of rater assessments. A further characteristic of this methodology is its adaptability to the evolution of healthcare research.
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Affiliation(s)
- Stefano Mancin
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Sguanci
- Department of Medicine and Surgery, Research Unit of Nursing Science, University Campus Bio-Medico, Rome, Italy
| | - Desirèe Andreoli
- Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | - Fanny Soekeland
- University of Applied Sciences, School of Health Professions, Bern, Switzerland
| | - Giuliano Anastasi
- Department of Trauma, AOU G. Martino University Hospital, Messina, Italy
| | - Michela Piredda
- Department of Medicine and Surgery, Research Unit of Nursing Science, University Campus Bio-Medico, Rome, Italy
| | - Maria Grazia De Marinis
- Department of Medicine and Surgery, Research Unit of Nursing Science, University Campus Bio-Medico, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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23
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Kaya S, Unal YC, Guven N, Ozcan C, Dundar A, Turkozu T, Ozkan S, Adanas C, Gokalp MA. The impact of early weight-bearing on results following anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2024; 25:395. [PMID: 38773398 PMCID: PMC11106972 DOI: 10.1186/s12891-024-07525-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) ruptures are common injuries that typically affect young, physically active individuals and may require surgical reconstruction. Studies have shown that the long time success of ACL reconstruction depends on the surgical technique and the postoperative rehabilitation strategy. However, there is still no consensus on the content of rehabilitation programs. Hence, additional research is required to elucidate the significance of early weight-bearing in the rehabilitation process following ACL reconstruction. The aim of this article is to examine the impact of weight-bearing on the clinical results of ACL reconstruction. MATERIALS AND METHODS We retrospectively reviewed patient records who had undergone arthroscopic reconstruction using a semitendinosus-gracilis tendon graft for anterior cruciate ligament rupture between January 2018 and December 2020. The study included the data of 110 patients. The patients were split into two groups: Group 1 underwent early weight-bearing, while Group 2 followed a non-weight-bearing regimen for three weeks. We assessed the patients using the anterior drawer test, Lachman test, range of motion, Lysholm knee scale, Cincinnati scale, Tegner scale, International Knee Documentation Committee (IKDC) form and clinical records. Analytical tests were conducted to compare the results. RESULTS The complication rates did not show a significant difference between the groups. Group 1 had higher frequencies of positive anterior drawer and Lachman tests. The Lysholm and Cincinnati knee scores of patients in Group 1 were notably lower than those of patients in Group 2. Additionally, the Tegner activity scores and IKDC scores of patients in Group 1 were also meaningfully lower than those of patients in Group 2. In Group 1 patients, there was no notable relationship observed between body mass index (BMI) and the results of the anterior drawer test (ADT) or Lachman test. However, patients with a BMI of 25 or higher in Group 1 showed a decrease in postoperative IKDC scores. In Group 2 patients, no significant relationship was identified between BMI and either the ADT or the Lachman test outcome. CONCLUSION Based on current literature and current rehabilitation guidelines following ACL reconstruction, the decision to initiate early weight-bearing is based on a limited number of studies with low levels of evidence. In our study, we found that patients who followed a non-weight-bearing regimen for 3 weeks after surgery had better mid-term results than those who were allowed to bear weight early. It appears that further prospective studies on this topic are needed to update rehabilitation guidelines in the next.
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Affiliation(s)
- Sehmuz Kaya
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey.
| | - Yunus Can Unal
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
| | - Necip Guven
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
| | - Can Ozcan
- Department of Orthopaedics and Traumatology, Orhaneli State Hospital, Bursa, Turkey
| | - Abdulrahim Dundar
- Department of Orthopaedics and Traumatology, Hitit University, Corum, Turkey
| | - Tulin Turkozu
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
| | - Sezai Ozkan
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
| | - Cihan Adanas
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
| | - Mehmet Ata Gokalp
- Department of Orthopaedics and Traumatology, Yuzuncu Yil University, Van, Turkey
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24
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Marmura H, Bryant D, Getgood A, Webster F. 'It's just my knee': a qualitative study investigating the process of reframing and young athletes' perceived quality of life between anterior cruciate ligament injury and surgery. BMJ Open 2024; 14:e076799. [PMID: 38724051 PMCID: PMC11086484 DOI: 10.1136/bmjopen-2023-076799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES To understand the factors influencing young athletes' perceptions of quality of life (QOL) following an anterior cruciate ligament (ACL) rupture, prior to reconstructive surgery. DESIGN Qualitative descriptive study using semi-structured interviews and thematic analysis of data. SETTING Tertiary sports medicine clinic with patients recruited from the practices of three specialist orthopaedic surgeons. PARTICIPANTS Twenty athletes aged 14-25 provided consent to participate in the study and completed interviews prior to their ACL reconstruction surgery. Participants were eligible to participate if they were scheduled to undergo ACL reconstruction, were 25 years of age or younger, identified as athletes (participated in any level of organised sport), could communicate in English and agreed to be audio recorded. Participants were not eligible if they had experienced a multiligament injury or fracture. RESULTS Young athletes shared common factors that made up their QOL; social connections and support, sport, health, and independence. However, participants' perceptions of their current QOL were quite variable (13-95/100 on a Visual Analogue Scale). Participants who were able to reframe their injury experience by shifting focus to the positive or unaffected aspects of their lives tended to have more favourable perceptions of their QOL than participants who shifted focus to the losses associated with injury. CONCLUSIONS Young athletes who have experienced an ACL injury define their QOL based on social support, sport, health and independence. Individual processes of adaptation and cognitive reframing in response to an ACL injury may exert a greater influence on postinjury QOL than the physical ramifications of the injury itself. Understanding individual perceptions may help target potential interventions or supports to enhance athletes' adaptation to injury.
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
| | - Dianne Bryant
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Alan Getgood
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Fiona Webster
- Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
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25
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Yu F, Xiao LE, Wang T, Hu Y, Xiao J. Nurse-Assisted Rehabilitation Protocols Following Anterior Cruciate Ligament Reconstruction. Orthop Nurs 2024; 43:163-178. [PMID: 38861747 DOI: 10.1097/nor.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Despite significant advancements in surgical instruments and operation skills, short- and long-term outcomes following anterior cruciate ligament reconstruction (ACLR) remain unsatisfactory, as many patients fail to return to their pre-injury level of sports. Inadequate ACL rehabilitation is the primary cause of poor outcomes. Nurses have become a crucial element in the rehabilitation process. Although there is no consensus regarding the optimal post-operative rehabilitation protocols, restoring muscle strength and neuromuscular control are consistently the primary goals. This literature review presents nurse-assisted rehabilitation protocols aiming at improving muscle strength and neuromuscular control. The review discusses postoperative rehabilitation, including home-based and supervised rehabilitation, open and closed kinetic chain exercises, eccentric and concentric training, blood flow restriction training, and plyometric training. Each training protocol has its benefits and drawbacks, and should be used cautiously in specific stages of rehabilitation. Neuromuscular training, such as neuromuscular electrical stimulation, neuromuscular control exercises, and vibration therapy, is considered crucial in rehabilitation.
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Affiliation(s)
- Fang Yu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Li-En Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Tao Wang
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Yong Hu
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
| | - Jun Xiao
- Fang Yu, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Li-En Xiao, BD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Tao Wang, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
- Yong Hu, PhD, Department of Joint Surgery, the Fifth Affiliated Hospital of Southern Medical University, GuangZhou City, GuangDong Province, China
- Jun Xiao, PhD, Department of Joint Surgery, People's Hospital of GanZhou City, GanZhou City, JiangXi Province, China
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26
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Girdwood M, Culvenor AG, Patterson B, Haberfield M, Rio EK, Hedger M, Crossley KM. No sign of weakness: a systematic review and meta-analysis of hip and calf muscle strength after anterior cruciate ligament injury. Br J Sports Med 2024; 58:500-510. [PMID: 38537939 DOI: 10.1136/bjsports-2023-107536] [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: 02/28/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE We aimed to determine hip and lower-leg muscle strength in people after ACL injury compared with an uninjured control group (between people) and the uninjured contralateral limb (between limbs). DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, EMBASE, CINAHL, Scopus, Cochrane CENTRAL and SportDiscus to 28 February 2023. ELIGIBILITY CRITERIA Primary ACL injury with mean age 18-40 years at time of injury. Studies had to measure hip and/or lower-leg muscle strength quantitatively (eg, dynamometer) and report muscle strength for the ACL-injured limb compared with: (i) an uninjured control group and/or (ii) the uninjured contralateral limb. Risk of bias was assessed according to Cochrane Collaboration domains. RESULTS Twenty-eight studies were included (n=23 measured strength ≤12 months post-ACL reconstruction). Most examined hip abduction (16 studies), hip extension (12 studies) and hip external rotation (7 studies) strength. We found no meaningful difference in muscle strength between people or between limbs for hip abduction, extension, internal rotation, flexion or ankle plantarflexion, dorsiflexion (estimates ranged from -9% to +9% of comparator). The only non-zero differences identified were in hip adduction (24% stronger on ACL limb (95% CI 8% to 42%)) and hip external rotation strength (12% deficit on ACL limb (95% CI 6% to 18%)) compared with uninjured controls at follow-ups >12 months, however both results stemmed from only two studies. Certainty of evidence was very low for all outcomes and comparisons, and drawn primarily from the first year post-ACL reconstruction. CONCLUSION Our results do not show widespread or substantial muscle weakness of the hip and lower-leg muscles after ACL injury, contrasting deficits of 10%-20% commonly reported for knee extensors and flexors. As it is unclear if deficits in hip and lower-leg muscle strength resolve with appropriate rehabilitation or no postinjury or postoperative weakness occurs, individualised assessment should guide training of hip and lower-leg strength following ACL injury. PROSPERO REGISTRATION NUMBER CRD42020216793.
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Affiliation(s)
- Michael Girdwood
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Brooke Patterson
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Melissa Haberfield
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Ebonie Kendra Rio
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
- The Victorian Institute of Sport, Melbourne, Victoria, Australia
- The Australian Ballet, Melbourne, Victoria, Australia
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27
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Syed RIB, Hangody LR, Frischmann G, Kós P, Kopper B, Berkes I. Comparative Effectiveness of Supervised and Home-Based Rehabilitation after Anterior Cruciate Ligament Reconstruction in Competitive Athletes. J Clin Med 2024; 13:2245. [PMID: 38673520 PMCID: PMC11051221 DOI: 10.3390/jcm13082245] [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: 03/06/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: After the increasingly common anterior cruciate ligament reconstruction (ACLR) procedure in competitive athletes, rehabilitation is crucial for facilitating a timely return to sports (RTS) and preventing re-injury. This pilot study investigates the patient-reported outcomes of postoperative rehabilitation in competitive athletes, comparing supervised rehabilitation (SVR) and home-based rehabilitation (HBR). Methods: After ACLR, 60 (out of 74 screened) athletes were recruited and equally divided into HBR and SVR groups using non-probability convenience sampling, with each group comprising 15 males and 15 females. The rehabilitation outcomes in the respective groups were evaluated at 8 months using measures (Tegner Activity Scale [TAS], International Knee Documentation Committee subjective knee form [IKDC-SKF], ACL Return to Sport after Injury [ACL-RSI]) and objective parameters (isometric muscle strength, hamstring/quadricep asymmetry). RTS was evaluated at 9 months, with ACL re-injury rates recorded approximately 6 months post-RTS. Results: Both groups exhibited decreased TAS scores (HBR: 8 to 6, SVR: 8 to 7), with the SVR group demonstrating superior postoperative IKDC-SKF scores (81.82 vs. 68.43) and lower ACL-RSI scores (49.46 vs. 55.25). Isometric and isokinetic muscle strength, along with asymmetry values, was higher in the SVR group 8 months post-ACLR (p < 0.05). The SVR group showed a higher RTS rate to the same level (76.6% vs. 53.3%), while the re-injury rate was the same in both the rehabilitation groups (3.3%). Conclusions: Although both rehabilitation approaches yielded comparable outcomes, SVR may demonstrate some superior biomechanical improvements in athletes, resulting in a higher RTS rate. However, the psychological outcomes and re-injury rates did not significantly differ between the groups, emphasizing the need to address individual psychological needs during rehabilitation. Further investigation is recommended with a larger sample size to address the differences of gender among competitive athletes.
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Affiliation(s)
| | | | - Gergely Frischmann
- Biomechanics Lab, TSO Medical Hungary Kft., 1118 Budapest, Hungary; (G.F.); (P.K.)
| | - Petra Kós
- Biomechanics Lab, TSO Medical Hungary Kft., 1118 Budapest, Hungary; (G.F.); (P.K.)
| | - Bence Kopper
- Department of Biomechanics, Hungarian University of Sports Science, 1123 Budapest, Hungary;
| | - István Berkes
- Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary;
- Department of Traumatology, Semmelweis University, 1085 Budapest, Hungary;
- Department of Health Sciences and Sport Medicine, Hungarian University of Sports Science, 1123 Budapest, Hungary
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28
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Ou J, Li J, Liu Y, Su X, Li W, Zheng X, Zhang L, Chen J, Pan H. Quality appraisal of clinical guidelines for Helicobacter pylori infection and systematic analysis of the level of evidence for recommendations. PLoS One 2024; 19:e0301006. [PMID: 38598539 PMCID: PMC11006150 DOI: 10.1371/journal.pone.0301006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 03/09/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To systematically assess the quality of clinical practice guidelines (CPGs) for Helicobacter pylori (HP) infection and identify gaps that limit their development. STUDY DESIGN AND SETTING CPGs for HP infection were systematically collected from PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and six online guideline repositories. Three researchers independently used the AGREE Ⅱ tool to evaluate the methodological quality of the eligible CPGs. In addition, the reporting and recommendation qualities were appraised by using the RIGHT and AGREE-REX tools, respectively. The distribution of the level of evidence and strength of recommendation among evidence-based CPGs was determined. RESULTS A total of 7,019 records were identified, and 24 CPGs met the eligibility criteria. Of the eligible CPGs, 19 were evidence-based and 5 were consensus-based. The mean overall rating score of AGREE II was 50.7% (SD = 17.2%). Among six domains, the highest mean score was for scope and purpose (74.4%, SD = 17.7%) and the lowest mean score was for applicability (24.3%, SD = 8.9). Only three of 24 CPGs were high-quality. The mean overall score of recommendation quality was 35.5% (SD = 12.2%), and the mean scores in each domain of AGREE-REX and RIGHT were all ≤ 60%, with values and preferences scoring the lowest (16.6%, SD = 11.9%). A total of 505 recommendations were identified. Strong recommendations accounted for 64.1%, and only 34.3% of strong recommendations were based on high-quality evidence. CONCLUSION The overall quality of CPGs for HP infection is poor, and CPG developers tend to neglect some domains, resulting in a wide variability in the quality of the CPGs. Additionally, CPGs for HP infection lack sufficient high-quality evidence, and the grading of recommendation strength should be based on the quality of evidence. The CPGs for HP infection have much room for improvement and further researches are required to minimize the evidence gap.
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Affiliation(s)
- Jiayin Ou
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiayu Li
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yang Liu
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohong Su
- The People’s Hospital of Gaozhou, Gaozhou, China
| | - Wanchun Li
- School of Chinese Materia Medica, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaojun Zheng
- Clinical Medical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lang Zhang
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing Chen
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huafeng Pan
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
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29
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Queiroz NCA, Hamu TCDDS, Barboza SD, Oliveira-Junior SAD, Luiz Carregaro R. Are lower limb symmetry and self-reported symptoms associated with functional and neuromuscular outcomes in Brazilian adults with anterior cruciate ligament reconstruction? A cross-sectional study. J Bodyw Mov Ther 2024; 38:168-174. [PMID: 38763558 DOI: 10.1016/j.jbmt.2023.12.002] [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: 12/28/2021] [Revised: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION After anterior cruciate ligament (ACL) reconstruction, determining readiness to return to participation is challenging. The understanding of which neuromuscular performance parameters are associated with limb symmetry and self-reported symptoms may be useful to improve monitoring the rehabilitation towards adequate decision-making to return. OBJECTIVES To compare the ACL-operated and injury-free lower limbs regarding functional performance; and to investigate whether lower limb strength and functional performance are associated with self-reported symptoms and functional lower limb symmetry. METHOD Thirty-four participants were included. Functional performance was assessed by using the Y-Balance test, Single-leg Hop, and Functional Movement Screen. An isokinetic dynamometer was used to evaluate the strength levels in open and closed kinetic chains. The functional lower limb symmetry was calculated considering the single-leg hop test results for each lower limb. RESULTS There were no differences in dynamic balance (Y-Balance) between the operated and injury-free limbs. The operated limb presented a worst performance in the single-leg hop. Self-reported symptoms prevalence and lower limb symmetry were associated with knee extension strength and functional performance (Y-Balance). CONCLUSION Individuals submitted to ACL-reconstruction presented worse functional performance in the operated limb compared to the injury-free limb. Both knee strength and dynamic balance were associated with limb symmetry and self-reported symptoms.
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Affiliation(s)
| | - Tânia Cristina Dias da Silva Hamu
- Physiotherapy Department, Musculoskeletal Research Laboratory (LAPEME), State Universidade Estadual de Goiás (UEG), Goiânia Campus, Brazil
| | - Saulo Delfino Barboza
- Master Program on Health & Education, University of Ribeirao Preto, Sao Paulo, Brazil; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Universities Medical Centers, VU University Medical Center Amsterdam, Amsterdam, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports, Amsterdam Movement Sciences, Amsterdam Universities Medical Centers, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | | | - Rodrigo Luiz Carregaro
- Master in Rehabilitation Sciences, Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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Straub RK, Powers CM. A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. Int J Sports Phys Ther 2024; 19:490-501. [PMID: 38576836 PMCID: PMC10987311 DOI: 10.26603/001c.94600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/07/2024] [Indexed: 04/06/2024] Open
Abstract
The squat is one of the most frequently prescribed exercises in the rehabilitative setting. Performance of the squat can be modified by changing parameters such as stance width, foot rotation, trunk position, tibia position, and depth. An understanding of how the various squatting techniques can influence joint loading and muscular demands is important for the proper prescription of this exercise for various clinical conditions. The purpose of this clinical commentary is to discuss how the biomechanical demands of the squat can be influenced by various modifiable parameters. General recommendations for specific clinical conditions are presented. Level of Evidence 5.
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Fan M, Liu A, Lu T, Zhou X, Tian C, Liu B, Xie Q, Cai J, Yin L, Ge L, Wu D. Quality appraisal of clinical practice guidelines addressing massage interventions using the AGREE II instrument. Syst Rev 2024; 13:83. [PMID: 38459534 PMCID: PMC10921609 DOI: 10.1186/s13643-024-02503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/23/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE The purpose of this study was to systematically evaluate the methodological quality of massage-related clinical practice guidelines (CPGs)/consensus on massage using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument and to summarize the current status of recommendations in the CPGs. METHODS The Chinese National Knowledge Infrastructure (CNKI), WanFang Data, China Science and Technology Journal Database (VIP), China Biology Medicine disc (CBM), PubMed, Embase, and guideline websites (such as the Chinese Medical Ace Base, the China Association of Chinese Medicine, the World Health Organization, Guideline International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network) were searched from inception to October 31, 2022. In addition, the reference lists of relevant studies were reviewed to identify domestic and overseas massage CPGs/consensus. The search terms adopted a combination of subject words and free words, mainly including traditional Chinese medicine, complementary therapies, Tuina, massage, manipulation, chiropractic/osteopathic, spinal, acupressure, guideline, and consensus. Two researchers independently completed the eligible records and extracted the data. Before the formal research, calibrations were performed twice on AGREE II, and all reviewers completed the pilot test three times until they understood and reached an agreement on the assessment items. Three researchers appraised the methodological quality of the included guidelines using the AGREE II instrument and calculated the overall intraclass correlation coefficient (ICC) of agreement. RESULTS The evaluation results showed that among the 49 eligible CPGs/consensus, 4 (8.2%) CPGs/consensus were considered "recommended", 15 (30.6%) CPGs/consensus were considered "recommended with modifications", and 30 (61.2%) CPGs/consensus were considered "not recommended", while the consensus was considered "not recommended". Generally, the scores in the six domains of the guidelines were all higher than the consensus. Evaluation results for the overall quality of 36 CPGs showed that 4 (11%) were "good quality", 15 (42%) were "sufficient quality" and 17 (47%) were "lower quality". The AGREE II quality scores of domains ranged from 0.30 to 0.75 ([ICC = 0.993, 95% CI (0.992, 0.995)]). The domain of scope and purpose (domain 1), with a median score of 0.75 (0.52~0.91), performed best in the guidelines with AGREE II, and stakeholder involvement (domain 2) [median 0.39 (0.31~0.56)] and application (domain 5) [median 0.30 (0.17~0.47] obtained lower scores. The consensus score of domain 1 was better at 26.0 (21.6~44.8), followed by rigor of development (domain 3) with a score of 18.0 (10.0~28.9). A total of 119 massage-related recommendations were extracted from 49 guidelines/consensuses, including "in favor" (102, 85.7%), "against" (9, 7.6%), and "did not make recommendations" (8, 6.7%). CONCLUSION The overall quality of the included guidelines was low, and most of the guidelines were not "recommended". In future guideline updates, the existing evidence should be used, the professional composition of members of the expert group should be enriched, and patients' values and preferences should be fully considered. It is necessary to clearly propose recognizable recommendations and strengthen the rigor and standardization of guideline formulation. Thus, clear standard guidelines can be formulated to better guide clinical practice.
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Affiliation(s)
- Mingyue Fan
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Aolin Liu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Taoying Lu
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Outcome assessment research team in Chinese medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, People's Republic of China
| | - Xiaowen Zhou
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Chen Tian
- Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
| | - Bingqing Liu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Qianwen Xie
- Outcome assessment research team in Chinese medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, People's Republic of China
| | - Jianxiong Cai
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Outcome assessment research team in Chinese medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, People's Republic of China
| | - Lingjia Yin
- Outcome assessment research team in Chinese medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, People's Republic of China
- Karolinska Institutet, Stockholm, Sweden
| | - Long Ge
- Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, People's Republic of China
| | - Darong Wu
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
- Outcome assessment research team in Chinese medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, People's Republic of China.
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
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Golberg E, Sommerfeldt M, Pinkoski A, Dennett L, Beaupre L. Anterior Cruciate Ligament Reconstruction Return-to-Sport Decision-Making: A Scoping Review. Sports Health 2024; 16:115-123. [PMID: 36707977 PMCID: PMC10732109 DOI: 10.1177/19417381221147524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
CONTEXT Clinical guidelines support the use of testing batteries to assess athlete readiness for return to sport (RTS) and risk of reinjury after anterior cruciate ligament (ACL) reconstruction (ACL-R). There is no consensus on the composition of the testing batteries. Test selection is based mainly on commonality in research, personal preference, and equipment availability. Including athletic performance assessments (APA) used in the athlete's sport may assist RTS decision-making for stakeholders. OBJECTIVE To determine whether APA for speed, agility, strength, or cardiovascular endurance are (1) used in ACL-R RTS literature and (2) indicative of RTS or reinjury rates. DATA SOURCES A systematic search was performed in MEDLINE, EMBASE, CINAHL, SPORTDiscus, Scopus, Web of Science, and ProQuest Dissertations and Theses Global. STUDY SELECTION Eligibility criteria were as follows: (1) athletes between 6 months and 2 years post-ACL-R, (2) commonly used APA, (3) peer-reviewed primary study with original published data. STUDY DESIGN Scoping Review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION A total of 17 studies included 24 instances of APA with a high degree of heterogeneity for both tests and protocols. RESULTS Agility makes up 75% of the APA. Only 17.6% of studies reported RTS or reinjury rates, none of which reported a significant relationship between these rates and APA outcomes. CONCLUSION Speed, strength, and cardiovascular endurance tests are underrepresented in ACL-R RTS literature. Compared with healthy controls, deficits in APA results for ACL-R athletes were common; however, many studies reported significant improvements in results for ACL-R athletes over time. There is some evidence that well-trained ACL-R athletes can match the performance of uninjured athletes in high-level sports.
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Affiliation(s)
- Eric Golberg
- Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Mark Sommerfeldt
- Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada
| | - Adam Pinkoski
- Epidemiology, School of Public Health, University of Alberta, Edmonton, Canada
| | - Liz Dennett
- Scott Health Sciences Library, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren Beaupre
- Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Pulver M, Hilfiker R, Bizzini M, Mathieu N, Meyer S, Allet L. Clinical practice and barriers among Swiss physiotherapists treating patients with anterior cruciate ligament reconstruction: A survey of pre-operative rehabilitation to return to sport. Phys Ther Sport 2024; 65:38-48. [PMID: 38006798 DOI: 10.1016/j.ptsp.2023.10.007] [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: 06/26/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVES To investigate current clinical practice of Swiss physiotherapists treating patients with anterior cruciate ligament reconstruction (ACLR) from pre-operative rehabilitation until return to sport (RTS). We assessed optimisation strategies in daily practice and the perceived barriers to these optimisations, and evaluated whether there was a relevant difference in clinical practice for physiotherapists with post-graduate certification in sports physiotherapy or deep clinical experience and those without such experience. DESIGN Cross-sectional survey. SETTING Online survey platform. PARTICIPANTS Swiss physiotherapists. MAIN OUTCOME MEASURES The survey comprised six sections: participant information, pre-operative rehabilitation, post-operative rehabilitation, RTS, re-injury prevention, and optimisation strategies and barriers. RESULTS A minority of physiotherapists treated ACLR patients pre-operatively. Overall, 91% included quadriceps open kinetic chain exercise in their treatment, 37% used patient-reported outcomes measures (PROMs) and 39% considered psychological criteria when making decisions about RTS. Most physiotherapists (67%) felt limited due to the time available, the number of prescriptions and the tariffication system. CONCLUSION This study highlights areas within ACLR rehabilitation practice in Switzerland that could be improve. Improvements in understanding of the barriers to implementation of best evidence in practice and a redefinition of the clinical process around ACLR rehabilitation in Switzerland are necessary.
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Affiliation(s)
- Mathieu Pulver
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Sion, Switzerland.
| | | | - Mario Bizzini
- Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Nicolas Mathieu
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Switzerland
| | - Stephan Meyer
- Sport Physiotherapy, Swiss Federal Institute of Sport Magglingen SFISM, Magglingen, Switzerland
| | - Lara Allet
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Sion, Switzerland; The Sense, Innovation & Research Center, Sion, Switzerland; Department of Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
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Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, Patterson S, Compagnin A, La Rosa G, Della Villa F. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 2024; 54:49-72. [PMID: 37787846 DOI: 10.1007/s40279-023-01934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK.
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Lee Herrington
- Centre for Human Sciences Research, University of Salford, Salford, UK
| | - Mick Hughes
- North Queensland Physiotherapy Centre, Townsville, QLD, Australia
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ross Wadey
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Stephen Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Alessandro Compagnin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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Romandini I, Cance N, Dan MJ, Pineda T, Pairot de Fontenay B, Demey G, Dejour DH. A non-weight bearing protocol after ACL reconstruction improves static anterior tibial translation in patients with elevated slope and increased weight bearing tibial anterior translation. J Exp Orthop 2023; 10:142. [PMID: 38114884 PMCID: PMC10730494 DOI: 10.1186/s40634-023-00694-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023] Open
Abstract
PURPOSE Aim of this study is to evaluate the impact of a non-weight bearing (NWB) protocol within 21 post-operative days after anterior cruciate ligament (ACL) reconstruction on static and dynamic anterior tibial translations (SATT and DATT, respectively). The hypothesis is that delayed WB would improve ATT at 9 months follow-up. METHODS A series of patients treated with ACL reconstruction was retrospectively reviewed, comparing a group with immediate post-operative weight bearing (WB group) and a group without post-operative weight bearing (NWB group). The NWB protocol was applied to patients with posterior tibial slope (PTS) ≥ 12°, pre-operative SATT ≥ 5 mm, and/or meniscal lesions of root or radial type. SATT, and PTS were measured on 20° flexion monopodal lateral x-rays, while DATT on Telos™ x-rays at pre-operative and 9-months follow-up. RESULTS One hundred seventy-nine patients were included (50 NWB group, 129 WB group). The SATT worsened in the WB group with a mean increase of 0.7 mm (SD 3.1 mm), while in the NWB group, the SATT improved with a mean decrease of 1.4 mm (SD 3.1 mm) from the pre-operative to 9 months' follow-up (p < 0.001). The side-to-side Telos™ evaluation showed a significant improvement in DATT within both the groups (p < 0.001), but there was no difference between the two groups (p = 0.99). CONCLUSION The post-operative protocol of 21 days without WB led to an improvement in SATT at 9 months without an influence on DATT, and it is recommended for patients with a SATT ≥ 5 mm and/or a PTS ≥ 12° as part of an "à la carte" approach to ACL reconstruction. LEVEL OF EVIDENCE Level IV, Retrospective case series.
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Affiliation(s)
- Iacopo Romandini
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de La Sauvegarde, 29 Avenue Des Sources, 69009, Lyon, France.
- IRCCS Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica 2, Via Pupilli 1, Bologna, 40136, Italy.
| | - Nicolas Cance
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de La Sauvegarde, 29 Avenue Des Sources, 69009, Lyon, France
| | - Michael J Dan
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de La Sauvegarde, 29 Avenue Des Sources, 69009, Lyon, France
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School, University of New South Wales, 2052, Sydney, Australia
| | - Tomas Pineda
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de La Sauvegarde, 29 Avenue Des Sources, 69009, Lyon, France
- Hospital El Carmen, Santiago, Chile
| | - Benoit Pairot de Fontenay
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de La Sauvegarde, 29 Avenue Des Sources, 69009, Lyon, France
| | - Guillaume Demey
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de La Sauvegarde, 29 Avenue Des Sources, 69009, Lyon, France
| | - David H Dejour
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de La Sauvegarde, 29 Avenue Des Sources, 69009, Lyon, France
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Gao SL, Liu CQ, Han QH, Dai XR, Liu YW, Li K. Quality appraisal of clinical practice guidelines for the management of Dysphagia after acute stroke. Front Neurol 2023; 14:1310133. [PMID: 38116112 PMCID: PMC10728278 DOI: 10.3389/fneur.2023.1310133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
Objectives Dysphagia is a common complication in stroke patients, widely affecting recovery and quality of life after stroke. The objective of this systematic review is to identify the gaps that between evidence and practice by critically assessing the quality of clinical practice guidelines (CPGs) for management of dysphagia in stroke. Methods We systematically searched academic databases and guideline repositories between January 1, 2014, and August 1, 2023. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was used by two authors to independently assess CPG quality. Results In a total of 14 CPGs included, we identified that three CPGs obtained a final evaluation of "high quality," nine CPGs achieved "moderate quality" and two CPGs received "low quality." The domain of "scope and purpose" achieved the highest mean score (91.1%) and the highest median (IQR) of 91.7% (86.1, 94.4%), while the domain of "applicability" received the lowest mean score (55.8%) and the lowest median (IQR) of 55.4% (43.2, 75.5%). Conclusion The CPG development group should pay more attention to improving the methodological quality according to the AGREE II instrument, especially in the domain of "applicability" and "stakeholder involvement;" and each item should be refined as much as possible.
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Affiliation(s)
- Shi-Lin Gao
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Chang-Qing Liu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Qing-Hua Han
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiao-Rong Dai
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yi-Wen Liu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ka Li
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Lilova R, Dubin J, Hameed D, Pettijohn WA, Bains SS, Reich J, Moore MC, Delanois RE. Assessment of the AAOS guidelines using the AGREE II instrument: An update. J Orthop 2023; 46:83-89. [PMID: 37969226 PMCID: PMC10643090 DOI: 10.1016/j.jor.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023] Open
Abstract
Background The American Academy of Orthopaedic Surgeons (AAOS) provides clinical guidelines and frequently updates and expands on the recommendations. High quality, up-to-date, and applicable clinical guidelines are increasingly important tools for physicians to have. Assessing these continuously updating guidelines' overall quality has most recently been done in 2013 when there were 14 guidelines. Since then, nearly all guidelines have been updated and now 28 guidelines are provided. Our goal was to evaluate the updated 2023 AAOS guidelines using the well-established Advancing Guideline Development, Reporting and Evaluation in Health Care (AGREE II) tool. Methods On April 23, 2023, all 28 guidelines set forth by AAOS were compiled. Using the AGREE II tool, a well-recognized and established tool for evaluation of guideline quality used across all disciplines, three independent reviewers appraised the current guidelines. These data were used to run descriptive statistics and assessed accordingly. Results Across the 28 guidelines, the average AGREE II domain scores were as follows: Scope and Purpose (median score, 85%), Stakeholder Involvement (median score, 87%), Rigor of Development (median score, 87%), Clarity of Presentation (median score, 87%), Applicability (median score, 48%), Editorial Independence (median score, 87%), and Overall Assessment (median score, 80s%). Conclusions Five of the six AGREE II domains, including the overall assessment, tested achieved a median score above the 50% mark. These results indicate that the AAOS guidelines met many criteria for high quality based on a critical appraisal.
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Affiliation(s)
- Radina Lilova
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Whitney A. Pettijohn
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy Reich
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Mallory C. Moore
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E. Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Harput G, Demirci S, Nyland J, Soylu AR, Tunay VB. Sports activity level after ACL reconstruction is predicted by vastus medialis or vastus medialis obliquus thickness, single leg triple hop distance or 6-m timed hop, and quality of life score. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3483-3493. [PMID: 37198499 DOI: 10.1007/s00590-023-03571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Recovery after anterior cruciate ligament reconstruction (ACLR) may take > 2 years, and younger athletes have higher re-injury risk. The purpose of this prospective longitudinal study was to determine how the early to mid-term Tegner Activity Level Scale (TALS) scores of athletically active males ≥ 2 years post-ACLR follow-up was predicted by bilateral isokinetic knee extensor and flexor torque, quadriceps femoris thickness, single leg hop test performance, and self-reported knee function (Knee Injury and Osteoarthritis Outcome Score (KOOS); International Knee Documentation Committee (IKDC) Subjective Assessment score). METHODS After ACLR with a hamstring tendon autograft and safely returning to sports at least twice weekly, 23 men (18.4 ± 3.5 years of age) were evaluated at final follow-up (mean = 4.5, range = 2-7 years). Exploratory forward stepwise multiple regression was used to determine the relationship between independent surgical and non-surgical lower limb variables peak concentric isokinetic knee extensor-flexor torque at 60°/sec and 180°/sec, quadriceps femoris muscle thickness, single leg hop test profile results, KOOS subscale scores, IKDC Subjective Assessment scores, and time post-ACLR on TALS scores at final follow-up. RESULTS Subject TALS scores were predicted by KOOS quality of life subscale score, surgical limb vastus medialis obliquus (VMO) thickness, and surgical limb single leg triple hop for distance (SLTHD) performance. Subject TALS scores were also predicted by KOOS quality of life subscale score, non-surgical limb vastus medialis (VM) thickness, and non-surgical limb 6 m single leg timed hop (6MSLTH) performance. CONCLUSION TALS scores were influenced differently by surgical and non-surgical lower extremity factors. At ≥ 2 years post-ACLR, ultrasound VM and VMO thickness measurements, single leg hop tests that challenge knee extensor function, and self-reported quality of life measurements predicted sports activity levels. The SLTHD test may be better than the 6MSLTH for predicting long-term surgical limb function.
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Affiliation(s)
- Gulcan Harput
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Serdar Demirci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Balıkesir University, Balıkesir, Turkey
| | - John Nyland
- Kosair Charities College of Health and Natural Sciences, Athletic Training Program, Norton Orthopedic Institute, Spalding University, 901 South 4Th Street, Louisville, KY, USA.
| | - Abdullah Ruhi Soylu
- Department of Biophysics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Volga Bayrakci Tunay
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Knurr KA, Cobian DG, Kliethermes SA, Stiffler-Joachim MR, Heiderscheit BC. The Influence of Quadriceps Strength and Rate of Torque Development on the Recovery of Knee Biomechanics During Running After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2023; 51:3171-3178. [PMID: 37681433 PMCID: PMC10985737 DOI: 10.1177/03635465231194617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND After anterior cruciate ligament reconstruction (ACLR), altered surgical knee biomechanics during running is common. Although greater quadriceps strength is associated with more symmetrical running knee kinetics after ACLR, abnormal running mechanics persist even after resolution of quadriceps strength deficits. As running is a submaximal effort task characterized by limited time to develop knee extensor torque, quadriceps rate of torque development (RTD) may be more closely associated with recovery of running knee mechanics than peak torque (PT). PURPOSE To assess the influence of recovery in quadriceps PT and RTD symmetry on knee kinematic and kinetic symmetry during running over the initial 2 years after ACLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 39 Division I collegiate athletes (106 testing sessions; 19 female) completed serial isometric performance testing and running analyses between 3 and 24 months after ACLR. Athletes performed maximal and rapid isometric knee extension efforts with each limb to assess PT and RTD between-limb symmetry indices (PTLSI and RTDLSI), respectively. Peak knee flexion difference (PKFDIFF) and peak knee extensor moment limb symmetry index (PKEMLSI) during running were computed. Multivariable linear mixed-effects models assessed the influence of PTLSI and RTDLSI on PKFDIFF and PKEMLSI over the initial 2 years after ACLR. RESULTS Significant main effects of RTDLSI (P < .001) and time (P≤ .02) but not PTLSI (P≥ .24) were observed for both PKFDIFF and PKEMLSI models. For a 10% increase in RTDLSI, while controlling for PTLSI and time, a 0.9° (95% CI, 0.5°-1.3°) reduction in PKFDIFF and a 3.5% (95% CI, 1.9%-5.1%) increase in PKEMLSI are expected. For every month after ACLR, a 0.2° (95% CI, 0.1°-0.4°) reduction in PKFDIFF and a 1.3% (95% CI, 0.6%-2.0%) increase in PKEMLSI are expected, controlling for PTLSI and RTDLSI. CONCLUSION Quadriceps RTDLSI was more strongly associated with symmetrical knee biomechanics during running compared with PTLSI or time throughout the first 2 years after ACLR.
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Affiliation(s)
- Keith A. Knurr
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Medicine, Division of Geriatrics, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Daniel G. Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Stephanie A. Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Mikel R. Stiffler-Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Bryan C. Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA
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Knurr KA, Lyon JP, Haack CR, Kliethermes SA, Cobian DG, Stiffler-Joachim MR, Binkley NC, Scerpella TA, Heiderscheit BC. Quadriceps Performance and Running Biomechanics Influence Femur BMD Changes after ACL Reconstruction in Collegiate Athletes. Med Sci Sports Exerc 2023; 55:1540-1547. [PMID: 37101347 PMCID: PMC10523868 DOI: 10.1249/mss.0000000000003186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
PURPOSE Reduced bone mineral density of the distal femur (BMD DF ) can persist long term after anterior cruciate ligament reconstruction (ACLR), even in athletes who return to high levels of competition. These deficits may have implications for the onset and progression of knee osteoarthritis. It is unknown if clinically modifiable factors are associated with losses in BMD DF . This study evaluated the potential influence of knee extensor peak torque (PT), rate of torque development (RTD), as well as peak knee flexion (PKF) angle and peak knee extensor moment (PKEM) during running, on longitudinal changes in BMD DF post-ACLR. METHODS After ACLR, 57 Division I collegiate athletes underwent serial whole-body dual-energy x-ray absorptiometry (DXA) scans between 3 and 24 months post-ACLR. Of these, 43 athletes also had isometric knee extensor testing (21 female, 105 observations), and 54 had running analyses (26 female, 141 observations). Linear mixed-effects models, controlling for sex, assessed the influence of surgical limb quadriceps performance (PT and RTD), running mechanics (PKF and PKEM), and time post-ACLR on BMD DF (5% and 15% of femur length). Simple slope analyses were used to explore interactions. RESULTS Athletes with RTD less than 7.20 (N·m)·kg -1 ·s -1 (mean) at 9.3 months post-ACLR demonstrated significant decreases in 15% BMD DF over time ( P = 0.03). Athletes with PKEM during running less than 0.92 (N·m)·kg -1 (-1 SD below mean) at 9.8 months post-ACLR demonstrated significant decreases in 15% BMD DF over time ( P = 0.02). Significant slopes were not detected at -1 SD below the mean for PT (1.75 (N·m)·kg -1 , P = 0.07) and PKF (31.3°, P = 0.08). CONCLUSIONS Worse quadriceps RTD and running PKEM were associated with a greater loss of BMD DF between 3 and 24 months post-ACLR.
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Affiliation(s)
- Keith A. Knurr
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Medicine – Division of Geriatrics, University of Wisconsin-Madison, Madison, WI
| | - James P. Lyon
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Colten R. Haack
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Stephanie A. Kliethermes
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Daniel G. Cobian
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Mikel R. Stiffler-Joachim
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Neil C. Binkley
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Medicine – Division of Geriatrics, University of Wisconsin-Madison, Madison, WI
- University of Wisconsin Osteoporosis Clinical Research Program, Madison, WI
| | - Tamara A. Scerpella
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
| | - Bryan C. Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
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Kotiuk V, Kostrub O, Blonskyi R, Podik V, Sushchenko L. How safe are partial squats after the anterior cruciate ligament reconstruction? A finite element analysis. Knee 2023; 43:192-199. [PMID: 37459692 DOI: 10.1016/j.knee.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/27/2023] [Accepted: 06/30/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Partial squats are a part of many rehabilitation programs. Progress to deeper squats can only be performed through the partial squat position. However, squats safety, onset time, and rational depth are still controversial. Most previous studies have not considered the influence of posterior tibial slope (PTS) and anterolateral ligament (ALL) on the stress on the knee anatomical elements in partial squats. METHODS We have created the new comprehensive knee computer models, which considered muscle exertions while weight bearing 75, 100, 125, and 150 kg in partial squats, included the ALL, two variants of PTS (5° and 13.9°), and two variants of anterior cruciate ligament (ACL) (a native 6 mm double-bundle ACL and an 8 mm single-bundle ACL graft). Using the finite element analysis, we have analyzed stresses in 14 anatomical elements in each model in partial squats (55° knee flexion and 10° anterior tibia tilt). RESULTS PTS change from 5° to 13.9° in a partial squat increases stress 1.2-1.3 times on the native ACL and 1.3-1.4 times on the ALL. In the case of single-bundle ACL reconstruction, PTS growth from 5° to 13.9° results in stress increasing 1.2-1.3 times on the graft and 1.3-1.4 times on the ALL. Thus, increased PTS is a significant risk factor, especially in the early postoperative period. Weight-bearing predictably increases stress on the ACL, ALL, and other joint elements proportional to the weight growth. Patients with thinner grafts after the ACL reconstruction may already reach the risk level for graft rupture in a single load in partial squatting if they weigh 125 kg or more. The risk rises with increasing PTS angle or the patient's weight. Because of the reduction of the graft strength by six weeks after surgery by 27%, partial squats in six weeks are associated with forces that may exceed the maximal ACL load even in patients with 75 kg of weight without additional load. CONCLUSION In the early postoperative period, partial squats can put the ACL graft at risk of failure. This risk is proportional to the patient's weight and PTS angle, and inversely proportional to the graft thickness. The choice of physical therapy strategies after ACL reconstruction, exercises, and their initiation timing is complex and cannot be standardized for all patients. Factors like the thickness of the graft, the method of fixation, the patient's weight, the ALL insufficiency, the PTS angle, and the patient's goals in the short and long term should be considered when planning the rehabilitation program.
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Affiliation(s)
- V Kotiuk
- Carolina Medical Center, 78 Pory Street, Warsaw 02-757, Poland.
| | - O Kostrub
- Department of Sports and Ballet Trauma, State Institute of Traumatology and Orthopedics, NAMS of Ukraine, 27 Bulvarno-Kudriavska Street, Kyiv 01601, Ukraine.
| | - R Blonskyi
- Department of Sports and Ballet Trauma, State Institute of Traumatology and Orthopedics, NAMS of Ukraine, 27 Bulvarno-Kudriavska Street, Kyiv 01601, Ukraine.
| | - V Podik
- Department of Sports and Ballet Trauma, State Institute of Traumatology and Orthopedics, NAMS of Ukraine, 27 Bulvarno-Kudriavska Street, Kyiv 01601, Ukraine.
| | - L Sushchenko
- Department of Physical Therapy, National Pedagogical Dragomanov University, 9 Pyrogova Street, Kyiv 01601, Ukraine.
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Piussi R, Simonson R, Högberg J, Thomeé R, Samuelsson K, Hamrin Senorski E. No Effect of Return to Sport Test Batteries with and without Psychological PROs on the Risk of a Second ACL Injury: A Critical Assessment of Four Different Test Batteries. Int J Sports Phys Ther 2023; 18:874-886. [PMID: 37547843 PMCID: PMC10399086 DOI: 10.26603/001c.81064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background Patients report psychological barriers as important when returning to sport, however, psychological outcome measures are seldom included in return to sport (RTS) assessment. There is a need for clinical trials to integrate psychological patient-reported outcomes (PROs) in return to sport batteries assessing patients treated with ACL reconstruction. Objective The aim of this study was to determine the association between passing clinical tests of muscle function and psychological PROs and sustaining a second ACL injury in patients who RTS after primary ACL reconstruction. Design Retrospective Cohort study. Methods Patients' sex, age, height and weight, and the results of strength and hop tests, as well as answers to PRO's (including Tegner activity scale, the ACL Return to Sport after Injury scale (ACL-RSI) as well as the Quality of Life (QoL) subscale of the Knee injury and Osteoarthritis Outcome Score [KOOS]), were extracted from a rehabilitation-specific registry. Four different test batteries comprising muscle function tests and PROs were created to assess whether patients were ready to RTS. Passing each of the test batteries (yes/no) was used as an independent variable. A multivariable Cox proportional hazard model analysis was performed, with sustaining a second ACL injury (either ipsi- or contralateral; yes/no) within two years of RTS as the dependent variable. Results A total of 419 patients (male, n=214; 51%) were included, of which 51 (12.2%) suffered a second ACL injury within the first two years after RTS. There were no differences in passing rates in the different RTS test batteries comprising muscle function tests and PROs for patients who suffered a second ACL injury compared to patients who did not. Conclusion No association between passing the RTS clinical tests batteries comprising muscle function and psychological PROs used, and the risk of a second ACL injury could be found. Level of Evidence 3©The Author(s).
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Affiliation(s)
- Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
- Sahlgrenska Sport Medicine Center, Gothenburg, Sweden
| | - Rebecca Simonson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
- Sahlgrenska Sport Medicine Center, Gothenburg, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
- Sahlgrenska Sport Medicine Center, Gothenburg, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sport Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
- Sahlgrenska Sport Medicine Center, Gothenburg, Sweden
- Swedish Olympic Committee, Stockholm, Sweden
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Le CY, Galarneau JM, R Filbay S, Emery CA, Manns PJ, Whittaker JL. Youth With a Sport-Related Knee Injury Exhibit Significant and Persistent Knee-Related Quality-of-Life Deficits at 12-Month Follow-up Compared to Uninjured Peers. J Orthop Sports Phys Ther 2023; 53:480–489. [PMID: 37339378 DOI: 10.2519/jospt.2023.11611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE: We aimed to compare knee-related quality of life (QOL) between youth with and without an intra-articular, sport-related knee injury at baseline (≤4 months postinjury), 6-month, and 12-month follow-up, and assess the association between clinical outcomes and knee-related QOL. DESIGN: Prospective cohort study. METHODS: We recruited 86 injured and 64 uninjured youth (similar age, sex, sport). Knee-related QOL was assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS) QOL subscale. Linear mixed models (95% confidence interval [CI]; clustered on sex and sport) compared KOOS QOL between study groups over the study period, considering sex-based differences. We also explored the association of injury type (anterior cruciate ligament [ACL]/meniscus injury or other), knee extensor strength (dynamometry), moderate-to-vigorous physical activity (accelerometer), intermittent knee pain (Intermittent and Constant Osteoarthritis Pain [ICOAP] measure), and fear of reinjury (17-item Tampa Scale of Kinesiophobia) with knee-related QOL. RESULTS: Participant median (range) age was 16.4 (10.9-20.1) years, 67% were female, and 56% of injuries were ACL ruptures. Injured participants had lower mean KOOS QOL scores at baseline (-61.05; 95% CI: -67.56, -54.53), 6-month (-41.37; 95% CI: -47.94, -34.80), and 12-month (-33.34; 95% CI: -39.86, -26.82) follow-up, regardless of sex. Knee extensor strength (6- and 12-month follow-up), moderate-to-vigorous physical activity (12-month follow-up), and ICOAP (all time points) were associated with KOOS QOL in injured youth. Additionally, having an ACL/meniscus injury and higher Tampa Scale of Kinesiophobia scores were associated with worse KOOS QOL in injured youth. CONCLUSION: Youth with a sport-related knee injury have significant, persistent knee-related QOL deficits at 12-month follow-up. Knee extensor strength, physical activity, pain, and fear of reinjury may contribute to knee-related QOL. JOSPT 2023;53(8):1-10. Epub: 20 June 2023. doi:10.2519/jospt.2023.11611.
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Achermann S, Marty J, Beck A, Rieger B, Hirschmüller A, Baur H. [Return to Sport (RTS) After Anterior Cruciate Ligament Reconstruction: Which Factors Influence the RTS Decision?]. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2023; 37:133-140. [PMID: 37348535 DOI: 10.1055/a-2025-1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND It is unknown which valid criteria should be considered to justify the decision for return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). The research question is whether gender, age, the outcome of the isokinetic maximal strength measurement and the single-leg hop test (quantitative/qualitative) influence the decision for RTS nine months after ACLR. METHODS This study is a retrospective data analysis. The research question was evaluated with a multiple logistic regression analysis (MLR). The dependent variable, RTS yes/no, is based on the decision of the orthopaedist in charge of treatment nine months (±30 days) after ACLR. The following possible influencing factors were investigated: gender, age, limb symmetry index (LSI) of maximal knee extension and knee flexion strength at 60°/sec., LSI of single-leg hop test and evaluation of knee valgus. RESULTS Data of 71 patients were included for MLR. The odds ratios (OR) for RTS increased with female gender (OR, 4.808; p=0.035), a higher LSI of maximal strength of knee extension (OR, 1.117; p=0.009) and a higher LSI of the single-leg hop test (OR, 1.125; p=0.020). Age, the LSI of maximal strength of knee flexion and knee valgus had no influence on the RTS decision. CONCLUSION Gender and the limb symmetry indexes of the maximal strength of knee extension and of the single-leg hop test are associated with RTS nine months after ACLR. These results should be considered to optimise rehabilitation after ACLR.
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Affiliation(s)
- Sibylle Achermann
- School of Health Professions, Bern University of Applied Sciences: Berner Fachhochschule, Bern, Switzerland
| | - Julia Marty
- Altius Swiss Sportmed Center, Rheinfelden, Switzerland
| | - Andreas Beck
- Altius Swiss Sportmed Center, Rheinfelden, Switzerland
| | | | | | - Heiner Baur
- School of Health Professions, Bern University of Applied Sciences: Berner Fachhochschule, Bern, Switzerland
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Ou JY, Liu JJ, Xu J, Li JY, Liu Y, Liu YZ, Lu LM, Pan HF, Wang L. Quality appraisal of clinical practice guidelines for motor neuron diseases or related disorders using the AGREE II instrument. Front Neurol 2023; 14:1180218. [PMID: 37528849 PMCID: PMC10388716 DOI: 10.3389/fneur.2023.1180218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Objectives This study aimed to systematically assess the quality of CPGs for motor neuron diseases (MNDs) or related disorders and identify the gaps that limit evidence-based practice. Methods Four scientific databases and six guideline repositories were searched for eligible CPGs. Three researchers assessed the eligible CPGs using the Appraisal of Guidelines Research and Evaluation II instrument. The distribution of the level of evidence and strength of recommendation of these CPGs were determined. The univariate regression analysis was used to explore the characteristic factors affecting the quality of CPGs. Results Fifteen CPGs met the eligibility criteria: 10 were for MND and 5 were for spinal muscular atrophy. The mean overall rating score was 44.5%, and only 3 of 15 CPGs were of high quality. The domains that achieved low mean scores were applicability (24.4%), rigor of development (39.9%), and stakeholder involvement (40.3%). Most recommendations were based on low-quality evidence and had a weak strength. The CPGs that were updated, meant for adults, and evidence based, and used a CPG quality tool and a grading system were associated with higher scores in certain specific domains and overall rating. Conclusion The overall quality of CPGs for MNDs or related disorders was poor and recommendations were largely based on low-quality evidence. Many areas still need improvement to develop high-quality CPGs, and the use of CPG quality tools should be emphasized. A great deal of research on MNDs or related disorders is still needed to fill the large evidence gap.
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Affiliation(s)
- Jia-Yin Ou
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun-Jun Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing Xu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia-Yu Li
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yang Liu
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - You-Zhang Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li-Ming Lu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hua-Feng Pan
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lin Wang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Henning M, Henning R, Dummett J. Improving the quality of rehabilitation following anterior cruciate ligament reconstruction surgery, in an outpatient physiotherapy department. BMJ Open Qual 2023; 12:e002300. [PMID: 37524514 PMCID: PMC10391794 DOI: 10.1136/bmjoq-2023-002300] [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: 02/01/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) is a type of orthopaedic knee surgery and physiotherapy rehabilitation is undertaken for several months postoperatively, often with the aim of returning the patient to sport. Variations in postoperative protocols to guide rehabilitation exist between National Health Service (NHS) Trusts. Although there is no single guideline to guide clinicians, strong evidence does support several clinical measures to be included post-ACLR, to improve outcomes and reduce the need for revision surgery. This project aimed to align our NHS Trust's ACLR physiotherapy care with best-evidence.A literature review was completed to establish key quality standards for ACLR rehabilitation. A retrospective notes audit was then undertaken to quantify the baseline quality of care, measured against these standards. Quality improvement methods were used to improve the quality of care and postoperative rehabilitation processes for ACLR patients. A new evidence-based, postoperative rehabilitation protocol was created, a core group of clinicians was formed to see ACLR patients and a rehabilitation class, solely for ACLR patients was also implemented.The key process measure for the project was patients engaging in 'criteria-driven progressions of rehabilitation'. This 'criteria-driven progressions' rate increased from 0% at baseline to 100% during the project period. Overall, non-attendance rates maintained at a similar level from 5.4% at baseline to a final rate of 4.8%. There was also an increase in mean 'return to sport' times, from 6 to 9.9 months, which is in line with best-evidence recommendations.The previous rehabilitation provided in our trust was not aligned with current evidence. This quality improvement project has led to improvements in patient care and lessons from the project will allow other trusts to learn from the changes made, to improve their own care pathways.
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Affiliation(s)
- Michael Henning
- Orthopaedic Interface, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Rose Henning
- Physiotherapy Outpatients, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Joe Dummett
- Physiotherapy Outpatients, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
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Verhagen AP, Mehta P, Hildenbrand C, Pace J, Nasser A, McCambridge AB. Can patients and clinicians find conservative management protocols of anterior cruciate ligament injuries online? A systematic review. Musculoskelet Sci Pract 2023; 65:102754. [PMID: 37098282 DOI: 10.1016/j.msksp.2023.102754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To systematically search the internet for conservative rehabilitation protocols for people with an anterior cruciate ligament (ACL) injury and critically appraise the websites and exercise protocols. DESIGN Systematic review of online rehabilitation protocols. SEARCH We searched four online search-engines (Google, Yahoo, Bing, DuckDuckGo). SELECTION CRITERIA Rehabilitation protocols on active, English language websites aimed at conservative (non-surgical) management of an ACL injury. DATA SYNTHESIS We extracted descriptive information and assessed quality of the websites using the Journal of the American Medical Association (JAMA) benchmark criteria, the Health on the Net Code (HONcode) certificate, and the Flesch-Kincaid Reading Ease (FKRE). We assessed completeness of exercise protocol reporting using the Consensus on Exercise Reporting Template (CERT). We performed a descriptive analysis. RESULTS We found 14 websites that met our selection criteria. The protocols varied between 10 and 26 weeks duration, nine were from the United States, five targeted patients, and 13 used multiple phases with a variety of different criteria for progression. Three protocols scored good quality with the JAMA, two were HonCode certified, and ten had good readability according to the FKRE. Completeness of exercise protocol reporting in all but one protocol was poor according to the CERT. CONCLUSION Few rehabilitation protocols for conservative management of ACL injuries were available online. Most of the websites showed good readability, but poor quality and credibility with inadequate description of exercise protocols.
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Affiliation(s)
- Arianne P Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia.
| | - Poonam Mehta
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Chiara Hildenbrand
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Jarrod Pace
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Anthony Nasser
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Alana B McCambridge
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia; Public Health Association of New Zealand, New Zealand
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Kotsifaki R, Korakakis V, King E, Barbosa O, Maree D, Pantouveris M, Bjerregaard A, Luomajoki J, Wilhelmsen J, Whiteley R. Infographic. Aspetar clinical practice guideline on rehabilitation after ACL reconstruction: an interactive figure. Br J Sports Med 2023; 57:551-552. [PMID: 37024286 PMCID: PMC10176354 DOI: 10.1136/bjsports-2022-106679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Roula Kotsifaki
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Vasileios Korakakis
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Enda King
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Olivia Barbosa
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Dustin Maree
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Michail Pantouveris
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Andreas Bjerregaard
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Julius Luomajoki
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jan Wilhelmsen
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Rod Whiteley
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Forelli F, Le Coroller N, Gaspar M, Memain G, Kakavas G, Miraglia N, Marine P, Maille P, Hewett TE, Rambaud AJ. Ecological and Specific Evidence-Based Safe Return To Play After Anterior Cruciate Ligament Reconstruction In Soccer Players: A New International Paradigm. Int J Sports Phys Ther 2023; 18:526-540. [PMID: 37020454 PMCID: PMC10069338 DOI: 10.26603/001c.73031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/15/2023] [Indexed: 04/04/2023] Open
Abstract
Existing return to play (RTP) assessments have not demonstrated the ability to decrease risk of subsequent anterior cruciate ligament (ACL) injury after reconstruction (ACLR). RTP criteria are standardized and do not simulate the physical and cognitive activity required by the practice of sport. Most RTP criteria do not include an ecological approach. There are scientific algorithms as the "5 factor maximum model" that can identify risk profiles and help reduce the risk of a second anterior cruciate ligament injury. Nevertheless, these algorithms remain too standardized and do not include the situations experienced in games by soccer players. This is why it is important to integrate ecological situations specific to the environment of soccer players in order to evaluate players under conditions closest to their sporting activity, especially with high cognitive load. One should identify high risk players under two conditions: Clinical analyses commonly include assessments such as isokinetic testing, functional tests (hop tests, vertical force-velocity, profile), running, clinical assessments (range of motion and graft laxity), proprioception and balance (Star Excursion Balance Test modified, Y-Balance, stabilometry) and psychological parameters (kinesophobia, quality of life and fear of re-injury). Field testing usually includes game simulation, evaluation under dual-task conditions, fatigue and workload analysis, deceleration, timed-agility-test and horizontal force-velocity profiles. Although it seems important to evaluate strength, psychological variables and aerobic and anaerobic capacities, evaluation of neuromotor control in standard and ecological situations may be helpful for reducing the risk of injury after ACLR. This proposal for RTP testing after ACLR is supported by the scientific literature and attempts to approximate the physical and cognitive loads during a soccer match. Future scientific investigation will be required to demonstrate the validity of this approach. Level of Evidence 5.
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Kuenze C, Weaver A, Grindstaff TL, Ulman S, Norte GE, Roman DP, Giampetruzzi N, Lisee CM, Birchmeier T, Triplett A, Farmer B, Hopper H, Sherman DA, Ness BM, Collins K, Walaszek M, Baez SE, Harkey MS, Tulchin-Francis K, Ellis H, Wilson PL, Chang ES, Wilcox CL, Schorfhaar A, Shingles M, Hart JM. Age-, Sex-, and Graft-Specific Reference Values From 783 Adolescent Patients at 5 to 7 Months After ACL Reconstruction: IKDC, Pedi-IKDC, KOOS, ACL-RSI, Single-Leg Hop, and Thigh Strength. J Orthop Sports Phys Ther 2023; 53:194-201. [PMID: 36688716 DOI: 10.2519/jospt.2023.11389] [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: 01/24/2023]
Abstract
OBJECTIVE: To describe age-, sex-, and graft source-specific reference values for patient-reported, physical function, and strength outcome measures in adolescents at 5 to 7 months after anterior cruciate ligament reconstruction. DESIGN: Cross-sectional study. METHODS: Data were collected at 3 universities and 2 children's hospitals. The participants completed at least one of the International Knee Documentation Committee (IKDC) Subjective Evaluation Form, Pediatric IKDC (Pedi-IKDC), Knee Injury and Osteoarthritis Outcomes Score (KOOS), and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale. Participants also completed single-leg hop tests and/or isokinetic quadriceps and hamstrings strength assessments (at 60°/s). Reference values were summarized using descriptive statistics and stratified for age, sex, and graft source. RESULTS: Reference values were reported for common patient-reported outcomes and measures of physical function and strength from 783 participants (56% females, age = 16. 4 ± 2.0 years) who were in early adolescence (12-14 years, N = 183, 52% females), middle adolescence (15-17 years, N = 456, 58% females), or late adolescence (18-20 years, N = 144, 55% females). Three hundred seventy-nine participants (48.4%) received a bone-patellar tendon-bone autograft, 292 participants (37.3%) received hamstring tendon autograft, and 112 participants (14.3%) received autograft or allograft from an alternative source. CONCLUSION: Reference values for common patient-reported outcomes and measures of physical function and strength differed depending on a patient's age, sex, and graft source. Using patient-specific reference values, in addition to previously described age-appropriate cutoff values, may help clinicians monitor and progress patients through rehabilitation and return to physical activity after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2023;53(4):1-8. Epub: 23 January 2023. doi:10.2519/jospt.2023.11389.
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