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Pontoh LAP, Canintika AF. Reconstruction of chronic quadriceps tendon rupture using autologous semitendinosus tendon graft: A case report. Int J Surg Case Rep 2024; 117:109488. [PMID: 38471221 PMCID: PMC10945271 DOI: 10.1016/j.ijscr.2024.109488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Chronic quadriceps tendon rupture is a relatively rare injury that can be challenging to treat. Several techniques have been described for chronic quadriceps tendon repair, including the use of autografts, allografts, and synthetic mesh. We reported a case of 17-year-old male with chronic quadriceps tendon rupture treated using autologous semitendinosus tendon graft. CASE PRESENTATION A 17-year-old male presented with left knee pain since 8 months ago after he fell into a ditch. Physical examination demonstrated palpable gap on suprapatellar region. Magnetic resonance imaging demonstrated quadriceps discontinuity and hyperintensity surrounding the insertion of the quadriceps tendon. The patient underwent quadriceps tendon reconstruction using ipsilateral autologous semitendinosus graft. After 3 weeks the patient was sent for physiotherapy to regain his left knee's range of motion. At final follow up at six months, the patient was able to walk with bipedal unassisted normal gait. Active knee extension and straight leg raising was possible. Final knee range of motion was 0° to 130°. DISCUSSION In this case, we demonstrated a successfully treated chronic quadriceps tendon rupture using autologous semitendinosus tendon graft. For cases of chronic quadriceps tendon rupture with tissue loss, it is advisable to utilise an autologous graft for the purpose of repairing and restoring the structure and function of the quadriceps tendon. CONCLUSION Surgical treatment of chronic quadriceps tendon rupture is challenging and lacks evidence-based guidelines. We propose the use of ipsilateral semitendinosus tendon autograft as choice for chronic quadriceps tendon rupture in this report, as it leads to favorable outcomes postoperatively.
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Affiliation(s)
- Ludwig Andribert Powantia Pontoh
- Department of Orthopaedics and Traumatology, dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anissa Feby Canintika
- Department of Orthopaedics and Traumatology, dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
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Forelli F, Mazeas J, Zeghoudi Y, Vandebrouck A, Duffiet P, Ratte L, Kakavas G, Hewett TE, Korakakis V, Rambaud AJM. Intrinsic graft laxity variation with open kinetic chain exercise after anterior cruciate ligament reconstruction: A non-randomized controlled study. Phys Ther Sport 2024; 66:61-66. [PMID: 38335650 DOI: 10.1016/j.ptsp.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To determine whether quadriceps and hamstring strengthening in a rehabilitation program involving early open kinetic chain (OKC) and/or closed kinetic chain (CKC) knee joint exercises had an influence on graft laxity at 1, 3, and 6 months after anterior cruciate ligament reconstruction (ACLR). DESIGN Retrospective study. METHODS Two groups (n = 53) of ACLR patients (combination of OKC and CKC exercises group compared to a CKC exercise group) were recruited. OKC protocol was introduced at 2 weeks post-operatively without external resistance and progressed at 4 weeks with load. Comparative ACL graft laxity measurement and isokinetic strength testing were prospectively performed up to 6 months in both groups. RESULTS No significant differences were observed in the knee laxity at 1 (p = 0.263), 3 (p = 0.263), and 6 months (p = 0.256) follow up between the groups. Similarly, no significant results were observed in within-group knee laxity between 1 and 6 months after ACLR in the intervention (p = 0.155) and control group (p = 0.690). CONCLUSION The early initiation of OKC along with CKC exercises doesn't seem to increase the ACLR graft laxity as compared to a rehabilitation program with only CKC exercises.
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Affiliation(s)
- Florian Forelli
- Orthosport Rehab Center, 16 Rue de Paris, 95330 Domont, France; Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France; SFMKS-Lab, Société Française des Masseurs-kinésithérapeutes Du Sport, Pierrefitte/Seine, France.
| | - Jean Mazeas
- Orthosport Rehab Center, 16 Rue de Paris, 95330 Domont, France; Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France
| | - Yannis Zeghoudi
- Orthosport Rehab Center, 16 Rue de Paris, 95330 Domont, France; Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France
| | - Amaury Vandebrouck
- Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France
| | - Pascal Duffiet
- Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France
| | - Louis Ratte
- Clinic of Domont, Ramsay Healthcare, 85 Route de Domont, 95330 Domont, France
| | - Georgios Kakavas
- Fysiotek Spine & Sports Lab, Athens, Greece; Department of Physical Education and Sport Sciences, ErgoMech-Lab, University of Thessaly, Trikala, Greece
| | - Timothy E Hewett
- Department of Orthopaedic Surgery, Marshall University, Huntington, WV, United States
| | - Vasileios Korakakis
- Department of Health Sciences, School of Life Sciences and Health Sciences, PhD in Physiotherapy Program, University of Nicosia, Cyprus; Hellenic Orthopaedic Manipulative Therapy Education (HOMT Edu), Athens, Greece
| | - Alexandre J M Rambaud
- SFMKS-Lab, Société Française des Masseurs-kinésithérapeutes Du Sport, Pierrefitte/Seine, France; IFMK Saint Etienne, Saint Michel Campus, 42000 Saint Etienne, France
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Johnson QJ, Jabal MS, Arguello AM, Lu Y, Jurgensmeier K, Levy BA, Camp CL, Krych AJ. Machine learning can accurately predict risk factors for all-cause reoperation after ACLR: creating a clinical tool to improve patient counseling and outcomes. Knee Surg Sports Traumatol Arthrosc 2023; 31:4099-4108. [PMID: 37414947 DOI: 10.1007/s00167-023-07497-7] [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] [Received: 04/23/2023] [Accepted: 06/16/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Identifying predictive factors for all-cause reoperation after anterior cruciate ligament reconstruction could inform clinical decision making and improve risk mitigation. The primary purposes of this study are to (1) determine the incidence of all-cause reoperation after anterior cruciate ligament reconstruction, (2) identify predictors of reoperation after anterior cruciate ligament reconstruction using machine learning methodology, and (3) compare the predictive capacity of the machine learning methods to that of traditional logistic regression. METHODS A longitudinal geographical database was utilized to identify patients with a diagnosis of new anterior cruciate ligament injury. Eight machine learning models were appraised on their ability to predict all-cause reoperation after anterior cruciate ligament reconstruction. Model performance was evaluated via area under the receiver operating characteristics curve. To explore modeling interpretability and radiomic feature influence on the predictions, we utilized a game-theory-based method through SHapley Additive exPlanations. RESULTS A total of 1400 patients underwent anterior cruciate ligament reconstruction with a mean postoperative follow-up of 9 years. Two-hundred and eighteen (16%) patients experienced a reoperation after anterior cruciate ligament reconstruction, of which 6% of these were revision ACL reconstruction. SHapley Additive exPlanations plots identified the following risk factors as predictive for all-cause reoperation: diagnosis of systemic inflammatory disease, distal tear location, concomitant medial collateral ligament repair, higher visual analog scale pain score prior to surgery, hamstring autograft, tibial fixation via radial expansion device, younger age at initial injury, and concomitant meniscal repair. Pertinent negatives, when compared to previous studies, included sex and timing of surgery. XGBoost was the best-performing model (area under the receiver operating characteristics curve of 0.77) and outperformed logistic regression in this regard. CONCLUSIONS All-cause reoperation after anterior cruciate ligament reconstruction occurred at a rate of 16%. Machine learning models outperformed traditional statistics and identified diagnosis of systemic inflammatory disease, distal tear location, concomitant medial collateral ligament repair, higher visual analog scale pain score prior to surgery, hamstring autograft, tibial fixation via radial expansion device, younger age at initial injury, and concomitant meniscal repair as predictive risk factors for reoperation. Pertinent negatives, when compared to previous studies, included sex and timing of surgery. These models will allow surgeons to tabulate individualized risk for future reoperation for patients undergoing anterior cruciate ligament reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Quinn J Johnson
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mohamed S Jabal
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Deichsel A, Oeckenpöhler S, Raschke MJ, Grunenberg O, Peez C, Briese T, Herbst E, Kittl C, Glasbrenner J. Recurrent Instability Rate and Subjective Knee Function following Accelerated Rehabilitation after ACL Reconstruction in Comparison to a Conservative Rehabilitation Protocol. J Clin Med 2023; 12:4567. [PMID: 37510682 PMCID: PMC10380741 DOI: 10.3390/jcm12144567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The Purpose of the present study was to assess the outcome of anterior cruciate ligament reconstruction (ACLR) with an accelerated rehabilitation protocol and to compare it to a conservative rehabilitation protocol. It was hypothesized that an accelerated rehabilitation protocol, including brace-free early weight bearing, would result in a higher rate of recurrent instability and revision surgery compared to a conservative rehabilitation protocol. METHODS From 2016 to 2017, two different rehabilitation protocols for isolated ACLR were used at a high-volume knee surgery center. A total of 65 consecutive patients with isolated hamstring ACLR, of whom n = 33 had been treated with an accelerated (AccRehab) and n = 32 with a conservative rehabilitation protocol (ConRehab), were retrospectively included in the study. Patients were evaluated for recurrent instability, revision surgery, and other complications at a mean follow-up period of 64 ± 7.4 months. In addition, Tegner Activity Scale, Lysholm Score, and IKDC-subjective Score were evaluated. Statistical comparison between the two groups was performed utilizing Fisher's exact test and Student's t-test. RESULTS Mean age (29.3 vs. 26.6 years) and preoperative Tegner Score (6.4 vs. 5.9) were comparable between both groups. At 64 ± 7.4 months after ACLR, six cases of recurrent instability were reported in the AccRehab group (18%) in comparison to three cases (9%) in the ConRehab group (p = n.s.). There was no significant difference regarding revision surgery and further complications. Furthermore, no significant difference was found between both groups regarding Tegner (5.5 ± 1.9 vs. 5.5 ± 1.2), Lysholm (93.6 ± 6.3 vs. 89.3 ± 10.7), and IKDC score (89.7 ± 7.9 vs. 86.7 ± 12.1). CONCLUSION No significant disadvantage of an accelerated rehabilitation protocol following ACLR was found in terms of recurrent instability rate, revision surgery, or patient-reported outcome. However, a trend towards a higher reinstability rate was found for an accelerated rehabilitation protocol. Future level one trials evaluating brace-free early weight bearing following ACLR are desirable.
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Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Simon Oeckenpöhler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Ole Grunenberg
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
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Kotsifaki R, Korakakis V, King E, Barbosa O, Maree D, Pantouveris M, Bjerregaard A, Luomajoki J, Wilhelmsen J, Whiteley R. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med 2023; 57:500-514. [PMID: 36731908 DOI: 10.1136/bjsports-2022-106158] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (eg, exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose-response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used.While there is a very low level of certainty for most components of rehabilitation, most of the recommendations provided in this guideline were agreed to by expert clinicians. This guideline also highlights several new elements of ACLR management not reported previously.
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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
| | - Rodney Whiteley
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Kochman M, Kasprzak M, Kielar A. ACL Reconstruction: Which Additional Physiotherapy Interventions Improve Early-Stage Rehabilitation? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15893. [PMID: 36497965 PMCID: PMC9739138 DOI: 10.3390/ijerph192315893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Despite the restoration of the mechanical stability of the knee joint after ACL reconstruction (ACLR), patients often experience postoperative limitations. To our knowledge, there are no systematic reviews analyzing additional physiotherapy interventions implementing standard rehabilitation programs in the early postoperative phase after ACLR. The objective of this study was to analyze the additional physiotherapy interventions implemented in standard rehabilitation programs that improve early-stage ACLR rehabilitation. For this systematic review, we followed the PRISMA guidelines. In March 2022 we conducted a literature review using electronic databases. Primary outcomes were pain, edema, muscle strength, ROM, and knee function. The risk of bias and scientific quality of included studies were assessed with the RoB 2, ROBINS-I and PEDro scale. For the review, we included 10 studies that met the inclusion criteria (total n = 3271). The included studies evaluated the effectiveness of Kinesio Taping, Whole-body vibration, Local Vibration Training, Trigger Point Dry Needling, High Tone Power Therapy, alternating magnetic field, and App-Based Active Muscle Training Program. Most of the additional physiotherapy interventions improved pain, edema, ROM, knee muscle strength, or knee function in early-stage postoperative ACL rehabilitation. Except for one study, no adverse events occurred in the included studies, which demonstrates the safety of the discussed physiotherapy interventions. Further in-depth research is needed in this area.
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Uquillas JA, Spierings J, van der Lande A, Eren AD, Bertrand M, Yuan H, Yuan H, van Groningen B, Janssen R, Ito K, de Boer J, Foolen J. An off-the-shelf decellularized and sterilized human bone-ACL-bone allograft for anterior cruciate ligament reconstruction. J Mech Behav Biomed Mater 2022; 135:105452. [PMID: 36122497 DOI: 10.1016/j.jmbbm.2022.105452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022]
Abstract
Approximately 1% of active individuals participating in sports rupture their anterior cruciate ligaments (ACL) every year, which is currently reconstructed using tendon autografts. Upon reconstruction, clinical issues of concern are ACL graft rupture, persistent knee instability, limited return to sports, and early onset of osteoarthritis (OA). This happens because tendon autografts do not have the same compositional, structural, and mechanical properties as a native ACL. To overcome these problems, we propose to use decellularized bone-ACL-bone allografts in ACL reconstruction (ACLR) as a mechanically robust, biocompatible, and immunologically safe alternative to autografts. Here, a decellularization protocol combined with sterilization using supercritical carbon dioxide (scCO2) was used to thoroughly decellularize porcine and human ACLs attached to tibial and femoral bone blocks. The specimens were named ultrACLean and their compositional, structural, and mechanical properties were determined. Our results indicate that: 1) decellularization of ultrACLean allografts leads to the removal of nearly 97% of donor cells, 2) ultrACLean has mechanical properties which are not different to native ACL, 3) ultrACLean maintained similar collagen content and decreased GAG content compared to native ACL, and 4) ultrACLean is not cytotoxic to seeded tendon-derived cells in vitro. Results from an in vivo pilot experiment showed that ultrACLean is biocompatible and elicits a moderate immunological response. In summary, ultrACLean has proven to be a mechanically competent and biocompatible graft with the potential to be used in ACLR surgery.
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Affiliation(s)
- Jorge Alfredo Uquillas
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Janne Spierings
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Antonio van der Lande
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Aysegul Dede Eren
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Manon Bertrand
- Hightech Contract Manufacturing Medical, Nijmegen, the Netherlands
| | - Hao Yuan
- Huipin Yuan's Lab, Sichuan, China
| | | | - Bart van Groningen
- Department of Orthopaedic Surgery, Maxima Medical Centre Eindhoven/Veldhoven, the Netherlands
| | - Rob Janssen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Orthopaedic Surgery, Maxima Medical Centre Eindhoven/Veldhoven, the Netherlands; Health Innovations and Technology, Department of Paramedical Sciences, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Keita Ito
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jan de Boer
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jasper Foolen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.
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Glattke KE, Tummala SV, Chhabra A. Anterior Cruciate Ligament Reconstruction Recovery and Rehabilitation: A Systematic Review. J Bone Joint Surg Am 2022; 104:739-754. [PMID: 34932514 DOI: 10.2106/jbjs.21.00688] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The success of anterior cruciate ligament (ACL) reconstruction is influenced by effective rehabilitation. Previously published, comprehensive systematic reviews evaluating rehabilitation after ACL reconstruction have studied Level-I and II evidence published through 2012. Interval studies continue to evaluate the efficacy of various rehabilitative modalities. METHODS A total of 824 articles from 2012 to 2020 were identified using multiple search engines. Fifty Level-I or II studies met inclusion criteria and were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) criteria and National Institutes of Health (NIH) Study Quality Assessment Tools. RESULTS Accelerated rehabilitation can be effective for patients with semitendinosus-gracilis grafts. Blood flow restriction (BFR) training with high-intensity exercise is not effective for ACL reconstruction recovery. Postoperative bracing does not offer any advantages or improve limb asymmetry. Cryotherapy is an effective analgesic when used perioperatively. The early introduction of open kinetic chain exercises may improve ACL reconstruction outcomes, and high-intensity plyometric exercise is not effective. Estimated pre-injury capacity (EPIC) levels may be more accurate than the Limb Symmetry Index (LSI) when using functional test results to predict reinjury rates, and hip external rotation strength may be the most accurate predictor of the hop test performance. Nerve blocks can provide postoperative analgesia with minimal complication risk. Neuromuscular electrical stimulation is effective when used independently and in combination with rehabilitative exercises. Psychological readiness should be evaluated both objectively and subjectively before allowing patients to safely return to sport. Electromyography biofeedback may help to regain muscular function, and whole-body vibration therapy can improve postural control. Supervised rehabilitation is more effective than unsupervised rehabilitation. CONCLUSIONS Various rehabilitative modalities following ACL reconstruction are effective in improving surgical outcomes and return-to-sport rates. Further evidence and improved study design are needed to further validate modalities including accelerated rehabilitation, BFR training, functional testing, and return-to-sport criteria. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kaycee E Glattke
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona
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9
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Koc BB, Truyens A, Heymans MJLF, Jansen EJP, Schotanus MGM. Effect of Low-Load Blood Flow Restriction Training After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Int J Sports Phys Ther 2022; 17:334-346. [PMID: 35391871 PMCID: PMC8975583 DOI: 10.26603/001c.33151] [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: 07/26/2021] [Accepted: 01/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background Quadriceps strength and mass deficits are common after anterior cruciate ligament (ACL) reconstruction. Postoperatively, heavy load resistance training can have detrimental effects on knee joint pain and ACL graft laxity. Therefore, low-load blood flow restriction (LL-BFR) training has been suggested as an alternative to traditional strength rehabilitation. Purpose The present systematic review aimed to investigate the effect of LL-BFR training on quadriceps strength, quadriceps mass, knee joint pain, and ACL graft laxity after ACL reconstruction compared to non-BFR training. Study design Systematic review. Methods A systematic literature search of PubMed, EMBASE.com, Cochrane Library/Wiley, CINAHL/Ebsco and Web of Science/Clarivate Analytics was performed on 19 February 2021. Studies were included if they compared LL-BFR and non-BFR training after ACL reconstruction with pre- and post-intervention quadriceps strength, quadriceps mass, knee joint pain or ACL graft laxity measurement. Systematic reviews, editorials, case reports and studies not published in a scientific peer reviewed journal were excluded. The risk of bias of randomized studies was assessed with the use of the Cochrane Risk of Bias Tool. Results A total of six randomized controlled trials were included. Random sequence generation and allocation concealment was defined as high risk in two of the six studies. In all studies blinding of participants and personnel was unclear or could not be performed. The included studies used different LL-BFR and non-BFR protocols with heterogeneous outcome measurements. Therefore, a qualitative analysis was performed. Two of the six studies assessed quadriceps strength and demonstrated significant greater quadriceps strength after LL-BFR compared to non-BFR training. Quadriceps mass was evaluated in four studies. Two studies observed significant greater quadriceps mass after LL-BFR compared to non-BFR training, while two studies observed no significant difference in quadriceps mass. Knee joint pain was assessed in three studies with significantly less knee joint pain after LL-BFR compared to non-BFR training. Two studies evaluated ACL graft laxity and observed no significant difference in ACL graft laxity between LL-BFR and non-BFR training. Conclusion The results of this systematic review indicate that LL-BFR training after ACL reconstruction may be beneficial on quadriceps strength, quadriceps mass, and knee joint pain compared to non-BFR training with non-detrimental effects on ACL graft laxity. However, more randomized controlled trials with standardized intervention protocols and outcome measurements are needed to add evidence on the clinical value of LL-BFR training. Level of evidence 2a.
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Affiliation(s)
- Baris B Koc
- Department of Orthopedics and Sports Surgery, Zuyderland Medical Center
| | - Alexander Truyens
- Department of Orthopedics and Sports Surgery, Zuyderland Medical Center
| | | | - Edwin J P Jansen
- Department of Orthopedics and Sports Surgery, Zuyderland Medical Center
| | - Martijn G M Schotanus
- Department of Orthopedics and Sports Surgery, Zuyderland Medical Centre; School of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Centre
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Civilette MD, Rate WR, Haislup BD, Cohen AS, Camire L, Bodendorfer BM, Gould HP. The top 100 most impactful articles on the anterior cruciate ligament: An altmetric analysis of online media. SAGE Open Med 2022; 10:20503121221111694. [PMID: 35924141 PMCID: PMC9340895 DOI: 10.1177/20503121221111694] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/13/2022] [Indexed: 12/17/2022] Open
Abstract
Objectives: To identify the top 100 most impactful anterior cruciate ligament articles in online media as measured by the Altmetric Attention Score and compare their characteristics to the most-cited anterior cruciate ligament articles in the scientific literature. Methods: The Altmetric database was queried to identify all published articles pertaining to the anterior cruciate ligament. The search yielded 9445 articles, which were stratified by highest to lowest Altmetric Attention Score. The top 100 articles were included. Collected data included article type, article topic, journal name, and online mentions in news, blogs, Twitter, Facebook, Wikipedia, and other sources. The geographic origin of each article was also determined based on the institutional affiliation of the first author. Results: Altmetric Attention Score of the top 100 anterior cruciate ligament articles ranged from 109 to 2193 (median 172.0, interquartile range 137.5–271.5). Of the 100 articles, 65 were published in three journals: American Journal of Sports Medicine, British Journal of Sports Medicine, and Journal of Orthopaedic & Sports Physical Therapy. The most prevalent article type was original research (60%), followed by systematic review/meta-analysis (18%). The most prevalent article topic was rehabilitation and return to play after anterior cruciate ligament reconstruction (22%), followed by epidemiology/risk factors (16%), injury prevention (14%), and biomechanics of anterior cruciate ligament injuries (14%). Of the top 100 articles, 54% were American, 31% were European, and 15% were published in other countries outside of the United States and Europe. Conclusion: This study used Altmetric Attention Score to identify the 100 most engaged anterior cruciate ligament articles in online media. The characteristics of these articles differed substantially from the most-cited anterior cruciate ligament articles in the literature with regard to article type, article topic, geographic origin, and publication journal. These findings suggest that alternative metrics measure distinct components of anterior cruciate ligament article engagement and add an important dimension to understanding the overall impact of published research on the anterior cruciate ligament.
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Affiliation(s)
- Matthew D Civilette
- Georgetown University Medical Center, Washington, DC, USA
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - William R Rate
- Georgetown University Medical Center, Washington, DC, USA
| | - Brett D Haislup
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Andrew S Cohen
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lyn Camire
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Blake M Bodendorfer
- Division of Sports Medicine and Shoulder Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Heath P Gould
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Waldron K, Brown M, Calderon A, Feldman M. Anterior Cruciate Ligament Rehabilitation and Return to Sport: How Fast Is Too Fast? Arthrosc Sports Med Rehabil 2022; 4:e175-e179. [PMID: 35141549 PMCID: PMC8811519 DOI: 10.1016/j.asmr.2021.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022] Open
Abstract
This article summarizes the benefits and limitations of various approaches of anterior cruciate ligament (ACL) rehabilitation, more specifically a conservative or traditional rehabilitation approach versus a more accelerated approach. The conservative model is considered one with a return to sport at 9 months or later with more time-based criteria, and an accelerated approach is defined as one with a goal of return to sport by 6 months. Although there are some similarities between the 2 types of rehabilitation, key differences exist and will be highlighted. Additionally, we discuss a criteria-based return-to-sport model that we favor. Level of Evidence V, expert opinion.
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van Vijven M, van Groningen B, Janssen RPA, van der Steen MC, van Doeselaar M, Stefanoska D, van Donkelaar CC, Ito K, Foolen J. Local variations in mechanical properties of human hamstring tendon autografts for anterior cruciate ligament reconstruction do not translate to a mechanically inferior strand. J Mech Behav Biomed Mater 2021; 126:105010. [PMID: 34896765 DOI: 10.1016/j.jmbbm.2021.105010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 11/17/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022]
Abstract
A ruptured anterior cruciate ligament (ACL) is often reconstructed with a multiple-strand autograft of a semitendinosus tendon alone or combined with a gracilis tendon. Up to 10% of patients experience graft rupture. This potentially results from excessive local tissue strains under physiological loading which could either result in direct mechanical failure of the graft or induce mechanobiological weakening. Since the original location in the hamstring tendon cannot be traced back from an autograft rupture site, this study explored whether clinical outcome could be further improved by avoiding specific locations or regions of human semitendinosus and/or gracilis tendons in ACL grafts due to potential mechanical or biochemical inferiority. Additionally, it examined numerically which clinically relevant graft configurations experience the lowest strains - and therefore the lowest rupture risk - when loaded with equal force. Remnant full-length gracilis tendons from human ACL reconstructions and full-length semitendinosus- and ipsilateral gracilis tendons of human cadaveric specimens were subjected to a stress-relaxation test. Locations at high risk of mechanical failure were identified using particle tracking to calculate local axial strains. As biochemical properties, the water-, collagen-, glycosaminoglycan- and DNA content per tissue region (representing graft strands) were determined. A viscoelastic lumped parameter model per tendon region was calculated. These models were applied in clinically relevant virtual graft configurations, which were exposed to physiological loading. Configurations that provided lower stiffness - i.e., experiencing higher strains under equal force - were assumed to be at higher risk of failure. Suitability of the gracilis tendon proper to replace semitendinosus muscle-tendon junction strands was examined. Deviations in local axial strains from the globally applied strain were of similar magnitude as the applied strain. Locations of maximum strains were uniformly distributed over tendon lengths. Biochemical compositions varied between tissue regions, but no trends were detected. Viscoelastic parameters were not significantly different between regions within a tendon, although semitendinosus tendons were stiffer than gracilis tendons. Virtual grafts with a full-length semitendinosus tendon alone or combined with a gracilis tendon displayed the lowest strains, whereas strains increased when gracilis tendon strands were tested for their suitability to replace semitendinosus muscle-tendon junction strands. Locations experiencing high local axial strains - which could increase risk of rupture - were present, but no specific region within any of the investigated graft configurations was found to be mechanically or biochemically deviant. Consequently, no specific tendon region could be indicated to provide a higher risk of rupture for mechanical or biochemical reasons. The semitendinosus tendon provided superior stiffness to a graft compared to the gracilis tendon. Therefore, based on our results it would be recommended to use the semitendinosus tendon, and use the gracilis tendon in cases where further reinforcement of the graft is needed to attain the desired length and cross-sectional area. All these data support current clinical standards.
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Affiliation(s)
- M van Vijven
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands
| | - B van Groningen
- Department of Orthopaedic Surgery & Trauma, Máxima MC: Dominee Theodor Fliednerstraat 1, 5631, BM, Eindhoven, the Netherlands
| | - R P A Janssen
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Máxima MC: Dominee Theodor Fliednerstraat 1, 5631, BM, Eindhoven, the Netherlands; Value-Based Health Care, Department of Paramedical Sciences, Fontys University of Applied Sciences, Postbus 347, 5600, AH, Eindhoven, the Netherlands
| | - M C van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima MC: Dominee Theodor Fliednerstraat 1, 5631, BM, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623, EJ, Eindhoven, the Netherlands
| | - M van Doeselaar
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands
| | - D Stefanoska
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands
| | - C C van Donkelaar
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands
| | - K Ito
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands
| | - J Foolen
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands.
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Walston Z, Barillas RB. The impact of graft type on rehabilitation outcomes following ACL reconstruction: Bone patellar tendon bone versus quadriceps tendon grafts. Phys Ther Sport 2021; 52:234-238. [PMID: 34634591 DOI: 10.1016/j.ptsp.2021.10.004] [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: 10/15/2020] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aims of this study were to 1) compare the dosage of physical therapy provided for patients following an anterior cruciate ligament reconstruction (ACL-R) with either quadriceps or bone-patellar tendon-bone (BPTB) graft type and their resulting outcomes and 2) investigate the frequency therapists documented surgical graft type. DESIGN Retrospective observational. SETTING Outpatient orthopedics. PARTICIPANTS Data was collected from the electronic medical records of 212 patients: BPTB (41) and quadriceps tendon (33) were analyzed. Forty-eight cases were other graft types and 90 were unspecified. MAIN OUTCOME MEASURE An independent samples t-test was used to compare differences in knee range of motion (ROM) and Knee Functional Status (FS) between BPTB and quadriceps grafts. RESULTS There were no differences in knee flexion (p = 0.148) or extension (p = 0.305) ROM between groups at discharge. The quadriceps group achieved greater improvement in functional outcomes (p < 0.001). The quadriceps group received more sessions (p = 0.021) and a longer duration of care (p = 0.007). CONCLUSIONS The significant difference in treatment dosage makes it difficult to conclude which graft is superior. It is unknown if the frequent omission of graft type in the patient chart is an indication of poor documentation practice or a lack of perceived importance in knowing the graft type for PT.
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Aujla RS, Ebert JR, Annear PT. Anterior Cruciate Ligament Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Versus Hamstrings Alone: A Comparative Cohort Study. Orthop J Sports Med 2021; 9:23259671211046631. [PMID: 34708141 PMCID: PMC8543570 DOI: 10.1177/23259671211046631] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/08/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Few studies have reported the return-to-sports (RTS) rate in patients after augmentation of autologous anterior cruciate ligament reconstruction (ACLR) with the Ligament Augmentation and Reconstruction System (LARS). PURPOSE/HYPOTHESIS The purpose of this study was to compare postoperative outcomes in patients who underwent ACLR with single-bundle 4-strand hamstring autograft either without augmentation (HA-ACLR group) or with LARS augmentation (AUG-ACLR group). It was hypothesized that clinical outcomes and RTS rates would be better in the AUG-ACLR group at the 1-year follow-up, with similar outcomes in both cohorts by 2 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent ACLR between April 2014 and December 2017 were included in the current comparative study if they were skeletally mature and had 1- and 2-year follow-up outcomes; patients with concomitant meniscal surgery were also included. Included were 66 patients with AUG-ACLR (mean age, 26.8 years; 67% male) and 130 patients with HA-ACLR (mean age, 27.5 years; 61% male). Subjective outcome measures included the International Knee Documentation Committee Subjective Knee Evaluation Form, Knee injury and Osteoarthritis Outcome Score, Lysholm scale, Tegner activity scale, and the Noyes sports activity rating scale. Objective measures included knee laxity, maximal isokinetic knee flexion and extension strength, and the results of 4 functional hop tests. RESULTS There were no significant differences between the study groups in age, sex distribution, body mass index, time to surgery, or number of concurrent meniscal surgeries. At the 1-year follow-up, the AUG-ACLR group had a significantly higher Tegner score (P = .001) and rates of RTS (P = .029) and return to preinjury level of sport (P = .003) compared with the HA-ACLR group. At the 2-year follow-up, there were no differences in these measures between groups. There were no between-group differences in other subjective outcomes, knee laxity, or strength and hop test results at either postoperative time point. There were also no differences in rerupture rates or other complications between the groups. CONCLUSION Patients with AUG-ACLR had higher 1-year postoperative Tegner scores and rates of RTS and preoperative sport level compared with the HA-ACLR group. The 2-year rerupture rate for the AUG-ACLR group was low, and no intra-articular inflammatory complications were noted.
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Affiliation(s)
- Randeep S. Aujla
- Perth Orthopaedic and Sports Medicine Centre, Perth, Western Australia, Australia
| | - Jay R. Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Western Australia, Australia
- HFRC Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Peter T. Annear
- Perth Orthopaedic and Sports Medicine Centre, Perth, Western Australia, Australia
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Gupta R, Rana S, Kapoor A, Patil B, Sachdeva V, Masih GD. Better and early recovery in ACL reconstructed elite players with addition of core stability exercises in postoperative rehabilitation program. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-020-00696-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Sinha C, Singh AK, Kumar A, Kumar A, Kumar S, Kumari P. Analgesic effect of continuous adductor canal block versus continuous femoral nerve block for knee arthroscopic surgery: a randomized trial. Braz J Anesthesiol 2021; 72:553-559. [PMID: 33901552 PMCID: PMC9515667 DOI: 10.1016/j.bjane.2021.03.017] [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: 06/25/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background and objectives Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed orthopedic procedures. The ability to perform ACLR on an outpatient basis is largely dependent on an effective analgesic regimen. The aim of the study was to compare the analgesic effect between continuous adductor canal block (cACB) and femoral nerve block (cFNB) during arthroscopy guided ACLR. Method In this prospective, randomized, controlled clinical trial, 60 ASA I/II patients for arthroscopic ACLR were recruited. Patients in Group I received cACB and those in Group II cFNB. A bolus dose of 20 cc 0.5% levobupivacaine followed by 0.125% 5 mL.h-1 was started for 24 hours. Rescue analgesia in the form of paracetamol 1 g intravenous (IV) was given. Parameters assessed were time of first rescue analgesia, total analgesic requirement in 24 hours, and painless range of motion of the knee (15 degrees of flexion to further painless flexion). Results The time-to-first postoperative analgesic request (hours) was earlier in Group II (14.40 ± 4.32) than Group I (16.90 ± 3.37) and this difference was statistically significant (p < 0.05). The cumulative 24-h analgesic consumption (paracetamol in g) was 0.70 ± 0.47 in Group I and 1.70 ± 0.65 in Group II (p < 0.001). The painless range of motion (degree) was 55.67 ± 10.40 in Group I and 40.00 ± 11.37 in Group II (p < 0.001). Conclusion The findings of this study suggest that continuous adductor canal block provides superior analgesia in patients undergoing arthroscopic ACLR when compared to continuous femoral nerve block.
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Affiliation(s)
- Chandni Sinha
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, India
| | - Akhilesh Kumar Singh
- Department of Anaesthesiology, Nalanda Medical College and Hospital, Patna, India
| | - Amarjeet Kumar
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, India.
| | - Ajeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, India
| | - Sudeep Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Patna, India
| | - Poonam Kumari
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, India
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Kim JG, Kim WS, Kim SG, Lee DH. Accelerated Versus Non-accelerated Rehabilitation After Primary Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts: A Systematic Review and Meta-analysis of Comparative Studies. Indian J Orthop 2021; 55:405-415. [PMID: 33927819 PMCID: PMC8046886 DOI: 10.1007/s43465-021-00375-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/03/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to compare the clinical outcomes between accelerated rehabilitation (AR) and non-accelerated rehabilitation (NR) after anterior cruciate ligament reconstruction (ACLR) using hamstring autografts through a systematic review and meta-analysis. METHODS To compare the outcomes between AR and NR, we searched Medline, Embase, and the Cochrane Library. Studies comparing their clinical outcomes after ACLR using hamstring autografts were included. AR was characterized by the starting range of motion and weight-bearing within 3 days and return to sports within 6-9 months. A meta-analysis of clinical outcome parameters used in ≥ 3 studies was conducted. RESULTS Seven studies were included. The International Knee Documentation Committee subjective score was significantly higher in AR than in NR at the 3- (mean difference [MD], 7.30; 95% confidence interval [CI] 1.55-13.05; P = 0.013) and 6-month follow-ups (MD, 5.64; 95% CI 0.11-11.17; P = 0.046). The side-to-side difference in anterior tibial translation at the final follow-up assessed in four studies was significantly lower in NR than in AR (MD, 0.59; 95% CI 0.12-1.07; P = 0.015). Overall Tunnel widening at the final follow-up assessed in four studies was also smaller in NR than in AR (MD, 0.48; 95% CI 0.00-0.96; P = 0.0479). However, the mean side-to-side difference and overall tunnel widening between them was < 1 mm. CONCLUSION The early subjective clinical outcomes of AR after ACLR using hamstring autografts were superior to those of NR. Although tunnel widening and anterior instability were also significantly larger in AR than in NR, the difference was not clinically relevant.
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Affiliation(s)
- Jae Gyoon Kim
- grid.411134.20000 0004 0474 0479Department of Orthopedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeongki-do 15355 Republic of Korea
| | - Won Seok Kim
- grid.411134.20000 0004 0474 0479Department of Orthopedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeongki-do 15355 Republic of Korea
| | - Sang-Gyun Kim
- grid.411134.20000 0004 0474 0479Department of Orthopedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeongki-do 15355 Republic of Korea
| | - Dae Hee Lee
- grid.264381.a0000 0001 2181 989XDepartment of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
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Is Cyclic Exercise Performed before Tibial Fixation Effective on Grafts during Anterior Cruciate Ligament Reconstruction? MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:475-482. [PMID: 33364890 PMCID: PMC7751239 DOI: 10.14744/semb.2020.07752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/18/2020] [Indexed: 11/20/2022]
Abstract
Objectives The necessity of cyclic exercise to pre-stretch the autograft before tibial fixation during ACL reconstruction is unknown. In this study, we evaluated whether there was a statistically significant difference between the results of patients who underwent cyclic exercise by way of physical examinations, knee joint stability tests, and functional evaluation tests, compared with the patients who underwent ACL reconstructions with or without cyclic exercise. Methods Between March 2016 and May 2018, 59 patients with at least eight months' follow-up of an ACL reconstruction were identified. Thirty patients (Group 1) who underwent cyclic exercise before tibial fixation and 29 patients (Group 2) who did not undergo cyclic exercise were evaluated and compared. Results The mean age of the patients in Group 1 and Group 2 was 25.9 (range, 18-36) years and 25.2 (range, 18-35) years, respectively. The mean follow-up period in Group 1 was 14.6 (range, 8-22) months and 13.5 months in Group 2 (range, 8-21 months).The mean Lysholm scores of Group 1 and 2 were 95.1 (range, 83-100) and 87.1 (range, 78-100), respectively. The modified Cincinnati scores of Groups 1 and 2 were 28.7 (range, 24-30) and 26.2 (range, 21-30). The mean IKDC subjective knee evaluation scores in Groups 1 and 2 were 91.9 (range, 83-100) and 86.7 (range, 75-100). The mean thigh atrophy was 1.5 cm in Group 1 and 2.5 cm in Group 2. In Group 1, 23 patients jumped 85% of the distance compared with the intact side in the single-legged hop test, and 12 patients in Group 2 were able to hop this distance successfully.Group 1 had statistically significantly better results in Lysholm activity scores, modified Cincinnati scores, IKDC subjective knee assessment scores, two-time IKDC activity scale results, comparison of thigh diameters, and single-legged hop tests (p<0.05). No significant difference was found in other examinations and tests. Conclusion Cyclic exercise during the operation had a positive effect on functional scores. We believe that cyclic exercise should be added to the operative procedure.
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Does an Accelerated Program Give Equivalent Results in Both Elite Athletes and Nonathletes? J Sport Rehabil 2020; 29:572-577. [PMID: 31094619 DOI: 10.1123/jsr.2018-0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/12/2019] [Accepted: 03/24/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Although many researchers have investigated the functional outcomes of different accelerated rehabilitation programs after anterior cruciate ligament reconstruction (ACLR), the functional results of the same accelerated rehabilitation program following ACLR applied for both elite athletes and nonathletes have not yet been investigated. OBJECTIVE To examine the effects of the same accelerated anterior cruciate ligament rehabilitation program on pain and functionality of elite athletes and nonathletes. DESIGN Prospective preintervention-postintervention design. SETTING Physiotherapy department. PARTICIPANTS Fifteen elite athletes and 15 nonathletes who underwent unilateral ACLR with autologous hamstring tendon graft. INTERVENTION All participants received the same protocol for 6 weeks (5 sessions in a week). MAIN OUTCOME MEASURES Primary measurements were pain intensity, which was measured by visual analog scale, range of motion measurement using universal goniometer, and functionality, which was detected by Lysholm score. Secondary measurements were short form-36 and Beck Depression Inventory. RESULTS Higher Lysholm (P = .001) and Beck Depression Inventory (P = .03) scores were observed in the elite athlete group, and higher pain (P = .001) was observed in the nonathlete group at baseline assessments. Significant improvement detected for pain (P < .05), knee flexion range (P < .05), Lysholm score (P < .05), and Beck Depression Inventory (P < .05) compared with preintervention for both groups. Finally, after comparing the mean change values, the nonathlete group displayed greater decrease in pain level (P = .01) and participants in the elite athlete group further showed a greater decrease in depression level (P = .001). CONCLUSIONS This study found that the same accelerated rehabilitation protocol provides significant improvements for pain, functionality, and depression in both elite athletes and nonathletes after ACLR. Clinicians should consider our results when applying an anterior cruciate ligament rehabilitation program for nonathlete groups.
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Holland EL, Robbins RE, Low DK, Bosenberg AT, Bompadre V, Schmale GA. Comparison of Continuous Adductor Canal and Femoral Nerve Blocks for Analgesia and Return of Quadriceps Function After Anterior Cruciate Ligament Reconstruction in Adolescent Patients. Arthrosc Sports Med Rehabil 2020; 2:e121-e128. [PMID: 32368748 PMCID: PMC7190540 DOI: 10.1016/j.asmr.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/09/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To compare early pain relief and late quadriceps function after anterior cruciate ligament reconstruction (ACLR) with hamstring autograft in adolescent patients treated with either a continuous femoral nerve block (cFNB) or continuous adductor canal block (cACB). METHODS We retrospectively reviewed a consecutive series of adolescent patients who underwent ACLR and received either a cACB or cFNB for postoperative pain management. Over a 1-year period, all patients underwent ACLR with cFNBs. Over the subsequent 9 months, all patients underwent their ACLR with cACBs. Patient demographics, postoperative pain scores, opioid consumption, satisfaction and complications, and dates and results of quadriceps function derived at the Return to Sports evaluation were compared. RESULTS Ninety-one patients (53 cFNB, 38 cACB) were reviewed. There were no differences in the demographics of the 2 groups. There were no statistically significant differences between groups in variations in postoperative pain scores (P = .21), or satisfaction with the blocks (P = .93). Patients in the cFNB group consumed a greater number of opioid doses on postoperative day 3 (2.2 ± 2.1 doses cFNB, 1.1 ± 1.6 doses cACB, P = .03) and a greater number of opioid doses overall for postoperative days 1 to 3 (mean 6.8 ± 5.3 doses cFNB, 3.8 ± 2.1 doses cACB, P = .03). There was no difference in time to return of acceptable quadriceps strength and function when comparing the 2 groups (30.9 ± 7.7 weeks cFNB, 28.9 ± 6.6 weeks cACB, P = .087). CONCLUSIONS We found few differences in postoperative analgesic requirements when comparing patients who underwent ACLR with hamstring autograft with a cACB to those who underwent a similar procedure with a cFNB. Return of quadriceps strength and function by six months did not appear to vary with regional technique, either cACB or cFNB, employed at surgery. LEVEL OF EVIDENCE III, Retrospective comparative study.
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Affiliation(s)
- Erica L. Holland
- Department of Anesthesiology and Pain Medicine, Seattle Children’s, Seattle, Washington, U.S.A
| | - Robin E. Robbins
- Department of Anesthesiology, Legacy Emanuel Medical Center, Portland, Oregon, U.S.A
| | - Daniel K. Low
- Department of Anesthesiology and Pain Medicine, Seattle Children’s, Seattle, Washington, U.S.A
| | - Adrian T. Bosenberg
- Department of Anesthesiology and Pain Medicine, Seattle Children’s, Seattle, Washington, U.S.A
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children’s, Seattle, Washington, U.S.A
| | - Gregory A. Schmale
- Department of Orthopedics and Sports Medicine, Seattle Children’s, Seattle, Washington, U.S.A
- Address correspondence to Gregory A. Schmale, M.D., Department of Orthopedics and Sports Medicine, M/S MB.10.620, P.O. Box 5371, Seattle, WA 98145-5005.
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Niederer D, Wilke J, Krause F, Banzer W, Engeroff T. Integrating the Evidence and Clinical Expertise in the Shared Decision and Graduated Return to Sport Process: A Time Series Case Study after Anterior Cruciate Ligament Rupture and Reconstruction. J Orthop Case Rep 2020. [PMID: 32547976 PMCID: PMC7276579 DOI: 10.13107/jocr.2020.v10.i01.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Rehabilitation following anterior cruciate ligament (ACL) rupture is often characterized by a large discrepancy between the available scientific evidence and its implementation into practice. PURPOSE We aimed to research, selectively rate, and transfer the available evidence to the returntosport (RTS) process after ACL rupture adopting an athlete time series case study design. CASE REPORT AND METHODS The participant is a male athlete aged 33 who was diagnosed with an isolated right-sided total ACL rupture. Knee arthroscopy using semitendinosus tendon plastic (×4) was performed. For rehabilitation, a graded and shared decision RTS algorithm was derived from the existing evidence and all relevant decision-makers expertise. Starting with basic functional abilities and range of motion, the functional ability at each stage had to be achieved before the next stage was aimed. The corresponding therapeutic focus (in addition to standard therapy) was adopted to reach this goal. Functions to be tested were as follows: Knee function confidence, dynamic balance, isometric and isokinetic strength/torque testing, as well as jumping ability (single-leg hop and triple crossover hop for distance). RESULTS RTS was reached (Level 3) 5 months and (Level 2) 10 months post-surgery. CONCLUSION Integrating the available evidence and the clinical expertise of all relevant stakeholders into a shared decision and graduated RTS process after ACL rupture and reconstruction was feasible and successful. Particularly, multiple functional measurements in a time series approach to determine the actual rehabilitation focus seem promising.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany,Address of Correspondence: Dr. Daniel Niederer, Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany. E-mail:
| | - Jan Wilke
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Frieder Krause
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Winfried Banzer
- Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Germany
| | - Tobias Engeroff
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
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Niederer D, Wilke J, Krause F, Banzer W, Engeroff T. Integrating the Evidence and Clinical Expertise in the Shared Decision and Graduated Return to Sport Process: A Time Series Case Study after Anterior Cruciate Ligament Rupture and Reconstruction. J Orthop Case Rep 2019; 10:35-44. [PMID: 32547976 DOI: 10.13107/jocr.2019.v10.i01.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Rehabilitation following anterior cruciate ligament (ACL) rupture is often characterized by a large discrepancy between the available scientific evidence and its implementation into practice. Purpose We aimed to research, selectively rate, and transfer the available evidence to the returntosport (RTS) process after ACL rupture adopting an athlete time series case study design. Case Report and Methods The participant is a male athlete aged 33 who was diagnosed with an isolated right-sided total ACL rupture. Knee arthroscopy using semitendinosus tendon plastic (×4) was performed. For rehabilitation, a graded and shared decision RTS algorithm was derived from the existing evidence and all relevant decision-makers expertise. Starting with basic functional abilities and range of motion, the functional ability at each stage had to be achieved before the next stage was aimed. The corresponding therapeutic focus (in addition to standard therapy) was adopted to reach this goal. Functions to be tested were as follows: Knee function confidence, dynamic balance, isometric and isokinetic strength/torque testing, as well as jumping ability (single-leg hop and triple crossover hop for distance). Results RTS was reached (Level 3) 5 months and (Level 2) 10 months post-surgery. Conclusion Integrating the available evidence and the clinical expertise of all relevant stakeholders into a shared decision and graduated RTS process after ACL rupture and reconstruction was feasible and successful. Particularly, multiple functional measurements in a time series approach to determine the actual rehabilitation focus seem promising.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan Wilke
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Frieder Krause
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Winfried Banzer
- Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Hospital of the Goethe-University Frankfurt am Main, Germany
| | - Tobias Engeroff
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
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