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Marmura H, Bryant DM. Evaluation of Outcomes After Anterior Cruciate Ligament Reconstruction: What We Know, What We Have, and What to Consider. Clin Sports Med 2024; 43:479-499. [PMID: 38811123 DOI: 10.1016/j.csm.2023.08.011] [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
Measurement of success following anterior cruciate ligament reconstruction (ACLR) hinges on the appropriate use of high quality and meaningful outcome measures. We identified and categorized over 100 outcome measures for ACLR using the International Classification of Functioning, Disability and Health (ICF) model. The ICF model is a useful framework to facilitate decisions about outcome selection and describe recovery following ACL injury. We outline key considerations when selecting outcome measures during study design (purpose, measurement properties, sample size, global assessment) or evaluating reported outcomes (measurement properties, sample size, magnitude/precision, clinical relevance, applicability), and discuss challenges in outcome measurement following ACLR.
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON N6A 5B9, Canada; Fowler Kennedy Sport Medicine Clinic, 3M Centre, 1151 Richmond Street, London, ON N6A 3K7, Canada; Bone and Joint Institute, Western University, The Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital B6-200, London, ON N6G 2V4, Canada; Lawson Research, London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Dianne M Bryant
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON N6A 5B9, Canada; Fowler Kennedy Sport Medicine Clinic, 3M Centre, 1151 Richmond Street, London, ON N6A 3K7, Canada; Bone and Joint Institute, Western University, The Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital B6-200, London, ON N6G 2V4, Canada; Lawson Research, London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada; Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 5C1, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Health Sciences Centre, 2C1280 Main Street West Hamilton, ON L8S 4L8, Canada.
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Wylde MJ, Callaway AJ, Williams JM, Yap J, Leow S, Low CY. Limb specific training magnitude and asymmetry to discriminate between athletes with and without unilateral or bilateral injury history. Phys Ther Sport 2022; 56:76-83. [DOI: 10.1016/j.ptsp.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
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Monaco E, Pisanu G, Carrozzo A, Giuliani A, Conteduca J, Oliviero M, Ceroni L, Sonnery-Cottet B, Ferretti A. Translation, cross-cultural adaptation, and validation of the Italian version of the anterior cruciate ligament–return to sport after injury (ACL-RSI) scale and its integration into the K-STARTS test. J Orthop Traumatol 2022; 23:11. [PMID: 35190905 PMCID: PMC8861218 DOI: 10.1186/s10195-021-00622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background The timing of a return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) represents a major subject of debate in sports medicine practice. Recently, the Knee Santy Athletic Return to Sport (K-STARTS) composite test was validated. This consists of a battery of physical tests and a psychological evaluation using the anterior cruciate ligament–return to sport after injury scale (ACL-RSI). This study aimed to translate the ACL-RSI and K-STARTS from English to Italian and determine the scale’s reliability and validity in an Italian context. Methods The translation and cultural adaptation process was performed according to the guidelines for the cross-cultural adaptation of self-report measures. The patients were asked to fill an anonymized online form created for this purpose that included the KOOS, the Lysholm, the IKDC-SKF, and the Italian translation of the ACL-RSI (ACL-RSI-It). After 1 week, the attendees were asked to repeat the ACL-RSI-It to investigate the test–retest reliability. Results The final study population comprised 115 patients who underwent ACLR, with a mean follow-up of 37.37 ± 26.56 months. The ACL-RSI-It showed axcellent internal consistency (Cronbach’s α = 0.963), reliability (test–retest ICC = 0.966), and good construct validity (positive correlations with the other scales were above 75%). Conclusions The ACL-RSI-It is valid, reliable, and comparable to the original English version of the questionnaire for Italian-speaking patients. It can be used to assess the psychological readiness of patients for a RTS after primary and unilateral ACLR, and can be integrated into the Italian K-STARTS test. Level of evidence Level II. Supplementary Information The online version contains supplementary material available at 10.1186/s10195-021-00622-7.
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Coquard M, Carrozzo A, Saithna A, Vigne G, Le Guen M, Fournier Y, Hager JP, Vieira TD, Sonnery-Cottet B. Anterolateral Ligament Reconstruction Does Not Delay Functional Recovery, Rehabilitation, and Return to Sport After Anterior Cruciate Ligament Reconstruction: A Matched-Pair Analysis From the SANTI (Scientific ACL Network International) Study Group. Arthrosc Sports Med Rehabil 2022; 4:e9-e16. [PMID: 35141532 PMCID: PMC8811495 DOI: 10.1016/j.asmr.2021.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To determine whether the addition of an anterolateral ligament reconstruction (ALLR) resulted in delayed functional recovery (based on the Knee Santy Athletic Return to Sport [K-STARTS] score) at 6 months after anterior cruciate ligament reconstruction (ACLR). METHODS A retrospective analysis of prospectively collected data from consecutive patients who underwent an ACLR between September 2017 and December 2020 was conducted. Patients who received an isolated hamstring autograft (isolated ACLR group) were propensity matched in a 1:1 ratio to patients who received a hamstring autograft ACLR combined with an ALLR (ACLR-ALLR group). Outcome measures included the Tegner Activity Scale and the K-STARTS test-a validated composite return-to-sports test (including the Anterior Cruciate Ligament-Return to Sport After Injury scale, Qualitative Assessment of Single-Leg Landing tool, limb symmetry index, and ability to change direction using the Modified Illinois Change of Direction Test). RESULTS The study included 111 matched pairs. At 6 months postoperatively, there were no significant differences between groups in the overall K-STARTS score (65.4 for isolated ACLR vs 61.2 for ACLR-ALLR, P = .087) or the Tegner Activity Scale score (3.7 for isolated ACLR vs 3.8 for ACLR-ALLR, P = .45). In addition, an evaluation of the subscales of the K-STARTS score revealed no disadvantage across the domains of neuromuscular control, limb symmetry index, agility, or psychological readiness to return to sport when an ALLR was performed. CONCLUSIONS The addition of ALLR at the time of ACLR does not delay functional recovery. Specifically, at 6 months postoperatively, there was no disadvantage in patients undergoing ALLR-ACLR, when compared with those undergoing isolated ACLR, with respect to neuromuscular control, limb symmetry indices (hop tests), agility, or psychological readiness to return to sport. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Marine Coquard
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Alessandro Carrozzo
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Adnan Saithna
- Arizona Brain, Spine & Sports Injuries Center, Scottsdale, Arizona, U.S.A
| | | | | | - Yann Fournier
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Jean-Philippe Hager
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
- Address correspondence to Thais Dutra Vieira, M.D., Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, 24 Avenue Paul Santy, 69008, Lyon, France.
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
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Roe C, Jacobs C, Kline P, Lucas K, Johnson D, Ireland ML, Lattermann C, Noehren B. Correlations of Single-Leg Performance Tests to Patient-Reported Outcomes After Primary Anterior Cruciate Ligament Reconstruction. Clin J Sport Med 2021; 31:e265-e270. [PMID: 32032156 PMCID: PMC7415502 DOI: 10.1097/jsm.0000000000000780] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 06/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the relationship between patient-reported outcomes (PROs) to the single-leg step-down test (SLSD) and the Y-balance anterior reach (YB-A) 6 months after primary anterior cruciate ligament reconstruction (ACLR). DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Sixty-six patients 6 months after ACLR participated. INTERVENTIONS Patients performed the SLSD, YB-A, and completed PROs after ACLR. MAIN OUTCOME MEASURES Patients completed the International Knee Documentation Committee Score (IKDC), the Lysholm Activity Scale, the Tampa Scale of Kinesiophobia (TSK-11), and the Knee Injury and Osteoarthritis Outcome Score (KOOS)-Symptom, -Sport, and -Quality of Life (QOL) subscales. The SLSD requires subjects to complete as many single-leg step-downs as possible in 60 seconds, and the YB-A involves reaching anteriorly on a single limb. Pearson product moment correlations were used to assess relationships between the YB-A and SLSD performance to each PRO. RESULTS Single-leg step-down test symmetry was significantly correlated with the TSK-11 (r = -0.70), KOOS-Sport (r = 0.40), -Symptom (r = 0.46), and -QOL (r = 0.42). The YB-A symmetry was significantly correlated with the KOOS-Symptom (r = 0.30) and KOOS-Sport (r = 0.30). CONCLUSIONS Single-leg step-down test performance demonstrated stronger relationships to patient-reported knee function than the YB-A. Furthermore, the SLSD symmetry was strongly correlated with fear of movement. The SLSD provides a robust method for clinicians to assess dynamic knee function and may aid in identifying patients who could benefit from intervention to reduce fear of movement or reinjury.
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Affiliation(s)
- Chelsey Roe
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, KY
| | - Cale Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Paul Kline
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Denver, Colorado
| | - Kathryn Lucas
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, KY
| | - Darren Johnson
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Mary Lloyd Ireland
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Christian Lattermann
- Department of Orthopaedic Surgery, Harvard Medical School and Brigham and Women’s Hospital, Chestnut Hill, MA
| | - Brian Noehren
- Division of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY
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DeFroda SF, ODonnell RM, Fadale PD, Owens BD, Fleming BC. The role of magnetic resonance imaging in evaluating postoperative ACL reconstruction healing and graft mechanical properties: a new criterion for return to play? PHYSICIAN SPORTSMED 2021; 49:123-129. [PMID: 32897799 PMCID: PMC8007665 DOI: 10.1080/00913847.2020.1820846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/02/2020] [Indexed: 01/13/2023]
Abstract
Background: Disruption of the anterior cruciate ligament (ACL) is a common injury. In active patients, it is routinely treated with ACL reconstruction surgery. Following reconstruction, one of the critical decisions that must be made is the optimal timing of return to sport. While many biomechanical, biological, and functional criteria have been proposed to determine return to play, these methods are limited at best.Reasoning: As criteria for return to play are multifactorial, there is a growing need for noninvasive technologies, such as magnetic resonance imaging (MRI), to objectively track graft healing, to better assess the graft itself. Measuring the changes in the strength of the healing ligament has been shown to be a reliable means of objectively documenting graft healing in preclinical studies. While the initial studies of MR-based modeling of ACL graft healing are promising, this technology is still in its infancy and requires optimization.Purpose: The goals of this review are: 1) to outline the shortcomings of current return to play criteria, 2) to highlight the ability of MRI to determine the status of ACL graft healing, and 3) to discuss the future of imaging technology to determine return to play and its potential role in the clinical evaluation of patientsConclusion: There continues to be a wide variabiltiy regarding adequate return to play criteria, most of which are subjective in nature.
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Affiliation(s)
- Steven F DeFroda
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, US
| | - Ryan M ODonnell
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, US
| | - Paul D Fadale
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, US
| | - Brett D Owens
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, US
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, US
- School of Engineering, Brown University, Providence, RI, US
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Koc BB, Schotanus MG, Jansen EJ. Preferences in anterior cruciate ligament reconstruction and return to sport: A survey among surgeons in the Netherlands. J Clin Orthop Trauma 2021; 12:183-186. [PMID: 33716445 PMCID: PMC7920332 DOI: 10.1016/j.jcot.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the preferences of surgeons on technique for femoral tunnel placement, graft selection and criteria for return to sport in the Netherlands. METHODS A web-based survey among the Dutch Association of Arthroscopy was conducted. RESULTS A total of 125 members (24.0%) were included in the analysis. A total of 87.2% (n = 109) used hamstring autografts for primary ACL reconstruction followed by patellar tendon autograft (n = 11, 8.8%) and quadriceps tendon autograft (n = 5, 4.0%). The anteromedial technique was favored by 50.4% (n = 63), whereas 11.2% (n = 14) of the participants favored the transtibial technique. Return to sport after 9 months of primary ACL reconstruction was allowed by 75.2% (n = 94) of the participants. Regarding criteria to evaluate readiness to return to sport, the surgeons stated postoperative period (n = 107, 85.6%) and functional performance tests (n = 96, 76.8%) as important. CONCLUSION The majority of the participants of the Dutch Association of Arthroscopy favored the hamstring autografts for primary anterior cruciate ligament reconstruction. Furthermore, most participants stated postoperative time and functional performance tests as important criteria to evaluate readiness to return to sport. This is the first survey demonstrating a high preference of surgeons to use functional performance tests in the decision-making of readiness to return to sport.
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Affiliation(s)
- Baris B. Koc
- Corresponding author. Department of Orthopaedic Surgery Dr. H. vd Hoffplein 1, 6162 AG, Sittard-Geleen, the Netherlands.
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Piussi R, Broman D, Musslinder E, Beischer S, Thomeé R, Hamrin Senorski E. Recovery of preoperative absolute knee extension and flexion strength after ACL reconstruction. BMC Sports Sci Med Rehabil 2020; 12:77. [PMID: 33302996 PMCID: PMC7727173 DOI: 10.1186/s13102-020-00222-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/22/2020] [Indexed: 11/21/2022]
Abstract
Background The recovery of muscle function after an Anterior Cruciate Ligament (ACL) reconstruction is most commonly reported as limb-to-limb differences using the Limb Symmetry Index (LSI), which is not free from limitations. The purpose of this study was to compare the proportion of patients who recover their Preoperative Absolute Muscle Strength (PAMS) 8 and 12 months after ACL reconstruction with the proportion of patients who recover their symmetrical knee strength. A secondary aim was to assess the relationship between psychological Patient-Reported Outcomes (PROs) and recovering PAMS at 8 and 12 months after ACL reconstruction and rehabilitation. Method Preoperative, 8- and 12-month results from quadriceps and hamstring strength tests and PROs for 117 patients were extracted from a rehabilitation registry. Individual preoperative peak torques from strength tests were compared with results from the 8- and 12-month follow-ups respectively. Patients were defined as having recovered their PAMS upon reaching 90% of their preoperative peak torque for both quadriceps and hamstring strength. Patients were defined as having recovered their LSI upon reaching a value ≥90% when comparing the results for their injured knee with those of their healthy knee. Correlations between the recovery of PAMS and PROs at 8 and 12 months were analyzed. Results There was no difference in the proportion of patients who recovered their PAMS compared with patients who recovered their LSI. In all, 30% and 32% of the patients who recovered their LSI had not recovered their PAMS at 8 months and 12 months respectively. In the patients who had recovered their PAMS, 24% and 31% had not recovered their symmetrical LSI at 8 months and 12 months respectively. There was no significant correlation between the recovery of PAMS and psychological PROs. Conclusion The use of both PAMS and LSI provides more detailed information on the recovery of muscle strength after ACL reconstruction. The recovery of PAMS was not correlated with psychological traits, which implies that both PROs and PAMS are important when evaluating patients after ACL reconstruction. Trial registration This trial was not registered.
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Affiliation(s)
- Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
| | - Daniel Broman
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden
| | - Erik Musslinder
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden
| | - Susanne Beischer
- 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
| | - 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
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden. .,Sahlgrenska Sports Medicine Center, Gothenburg, Sweden. .,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30, Gothenburg, Sweden.
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Ochi A, Ohko H, Ota S, Shimoichi N, Takemoto T, Mitsuke K. Custom-made hinged knee braces with extension support can improve dynamic balance. J Exerc Sci Fit 2019; 16:94-98. [PMID: 30662501 PMCID: PMC6323182 DOI: 10.1016/j.jesf.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 08/20/2018] [Accepted: 08/29/2018] [Indexed: 12/26/2022] Open
Abstract
Background/Objective: We investigated whether custom-made hinged knee braces can facilitate knee extensor and flexor strength and influence functional performance as compared with other knee braces. Methods We enrolled 28 healthy young participants with no history of physical activity or brace use. The participants executed functional performance tests under the following 5 conditions: 1) without a knee brace, 2) wearing a knee sleeve, 3) wearing a hinged knee brace without assistance, 4) wearing a knee brace with extension support (KBE), and 5) wearing a knee brace with flexion support (KBF). The KBE and KBF were custom-made hinged knee braces equipped with rubber tubes. The functional performance tests performed assessed maximal isokinetic strength, single-leg jumping height/distance, anterior and posterior reach distance on a single leg, and dynamic balance ability. Results The benefit of the custom-made hinged knee brace was observed only during the anterior reach distance on a single leg. The KBE allowed a significantly greater single-leg anterior reach distance when compared to that in the no brace condition. There was a significant relationship between the improvement in the single leg anterior reach distance with KBE and the changes in isokinetic knee extension with KBE compared to the no brace condition. With regard to other parameters, there were no differences compared with the use of other knee braces and thus no apparent benefit. Conclusion Our findings suggest that using a KBE enhances performance during dynamic balance activity in individuals who benefit from improved knee extension strength.
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Affiliation(s)
- Akira Ochi
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
| | - Hiroshi Ohko
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
| | - Susumu Ota
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
| | - Nami Shimoichi
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
| | - Tsukasa Takemoto
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
| | - Kaho Mitsuke
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
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Partial Anterior Cruciate Ligament Ruptures: Advantages by Intraligament Autologous Conditioned Plasma Injection and Healing Response Technique-Midterm Outcome Evaluation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3204869. [PMID: 30148163 PMCID: PMC6083554 DOI: 10.1155/2018/3204869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/02/2018] [Indexed: 02/06/2023]
Abstract
The historical treatment options for partial anterior cruciate ligament (ACL) ruptures were conservative therapy or ACL reconstruction by injured bundle or entire ACL replacement. In awareness of the regenerative potential of biologic agents such as mesenchymal stem cells or platelet rich plasma (PRP), the healing response technique was developed to preserve the injured ACL with better outcomes than the conservative therapy. Further improvement of this technique seems to be obtained by the additional application of PRP products. Thus, the aim of this study was to evaluate the midterm outcome after intraligament autologous conditioned plasma (ACP) by a clinical, scoring, and functional performance assessment. 42 patients were evaluated in this study. The failure rate was 9.5%. Outcome evaluation showed good to excellent results. The scores were IKDC subjective 83.2 (SD 14.5), Lysholm 85.5 (SD 15.5), Tegner 4.7 (SD 1.7), and Cincinnati 85.4 (SD 15.5) after a mean follow-up of 33 months. Clinical examination showed stable Lachman test, negative pivot shift phenomenon, and a significant reduction in AP-laxity compared to preoperative status (rolimeter preoperative: 1.9 (SD1.4); postoperative 0.6 (SD1.8), p=0.001) in all patients. Functional performance testing showed no significant differences between the injured and healthy side. Return to sport was achieved after a mean of 5.8 months (SD 3.6) in 71.1% of the included patients. In summary, this new treatment option revealed in midterm follow-up promising results to treat partial ACL lesions with a reduced need for conversion to ACL reconstruction and with a high percentage of return to preinjury sport activity.
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Blakeney WG, Ouanezar H, Rogowski I, Vigne G, Guen ML, Fayard JM, Thaunat M, Chambat P, Sonnery-Cottet B. Validation of a Composite Test for Assessment of Readiness for Return to Sports After Anterior Cruciate Ligament Reconstruction: The K-STARTS Test. Sports Health 2018; 10:515-522. [PMID: 30024344 PMCID: PMC6204642 DOI: 10.1177/1941738118786454] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: There is limited information on the appropriate timing of return to sports after anterior cruciate ligament (ACL) reconstruction. A composite test was developed to assess the athlete’s ability to return to sports after ACL reconstruction: the Knee Santy Athletic Return To Sport (K-STARTS) test. Hypothesis: The K-STARTS test meets validation criteria for an outcome score assessing readiness for return to sports after ACL reconstruction. Study Design: Diagnostic study. Level of Evidence: Level 3. Methods: A prospective comparative study identified 410 participants: 371 participants who had undergone ACL reconstruction and a control group of 39 healthy participants. The K-STARTS score is calculated as the sum of 7 tests (8 components), for a maximal value of 21 points. Construct validity, internal consistency, discriminant validity, and sensitivity to change were used to validate this new test. Results: The K-STARTS assessment showed a high completion rate (100%), high reproducibility (intraclass correlation coefficient, 0.87; coefficient of variation, 7.8%), and high sensitivity to change. There was moderate correlation with the ACL Return to Sports after Injury scale (ACL-RSI) and hop tests. There were no ceiling or floor effects. There was a significant difference between K-STARTS scores assessed at 6 and 8 months postoperatively (11.2 ± 2.7 vs 17.1 ± 3.2; P < 0.001). The K-STARTS score in the control group was significantly higher than that in the ACL reconstruction group (17.3 ± 2.1 and 13.7 ± 3.8, respectively; P < 0.001). Conclusion: The K-STARTS test is an objective outcome measure for functional improvement after ACL reconstruction. Clinical Relevance: It is important for the clinician to determine when return to sports is optimal after ACL reconstruction to reduce the current high risk of reinjury.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bertrand Sonnery-Cottet
- Bertrand Sonnery-Cottet, MD, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay-Générale de Sante, Hôpital Prive Jean Mermoz, Lyon, France ()
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Vaisman A, Guiloff R, Rojas J, Delgado I, Figueroa D, Calvo R. Lower Limb Symmetry: Comparison of Muscular Power Between Dominant and Nondominant Legs in Healthy Young Adults Associated With Single-Leg-Dominant Sports. Orthop J Sports Med 2017; 5:2325967117744240. [PMID: 29318166 PMCID: PMC5753919 DOI: 10.1177/2325967117744240] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Achieving a symmetrical power performance (difference <15%) between lower limbs is generally recommended during sports rehabilitation. However, athletes in single-leg-dominant sports, such as professional soccer players, could develop significant asymmetry between their dominant and nondominant legs, such that symmetry does not act as a viable comparison. Purpose To (1) compare maximal muscular power between the dominant and nondominant legs in healthy young adults, (2) evaluate the effect of a single-leg-dominant sport activity performed at the professional level, and (3) propose a parameter of normality for maximal power difference in the lower limbs of this young adult population. Study Design Controlled laboratory study. Methods A total of 78 healthy, male, young adults were divided into 2 groups according to sport activity level. Group 1 consisted of 51 nonathletes (mean ± SD age, 20.8 ± 1.5 years; weight, 71.9 ± 10.5 kg) who participated in less than 8 hours a week of recreational physical activity with nonspecific training; group 2 consisted of 27 single-leg-dominant professional soccer players (age, 18.4 ± 0.6 years; weight, 70.1 ± 7.5 kg) who specifically trained and competed at their particular activity 8 hours or more a week. For assessment of maximal leg power, both groups completed the single-leg squat jump test. Dominance was determined when participants completed 2 of 3 specific tests with the same extremity. Statistical analysis included the Student t test. Results No statistical difference was found for maximal power between dominant and nondominant legs for nonathletes (t = -1.01, P = .316) or single-leg-dominant professional soccer players (t = -1.10, P = .281). A majority (95%) of participants studied showed a power difference of less than 15% between their lower extremities. Conclusion Among young healthy adults, symmetrical power performance is expected between lower extremities independent of the existence of dominance and difference in sport activity level. A less than 15% difference in power seems to be a proper parameter to define symmetrical power performance assessed by vertical single-leg jump tests.
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Affiliation(s)
- Alex Vaisman
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Rodrigo Guiloff
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Juan Rojas
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Iris Delgado
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - David Figueroa
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Rafael Calvo
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Krafft FC, Stetter BJ, Stein T, Ellermann A, Flechtenmacher J, Eberle C, Sell S, Potthast W. How does functionality proceed in ACL reconstructed subjects? Proceeding of functional performance from pre- to six months post-ACL reconstruction. PLoS One 2017; 12:e0178430. [PMID: 28562674 PMCID: PMC5451139 DOI: 10.1371/journal.pone.0178430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/12/2017] [Indexed: 11/25/2022] Open
Abstract
This is the first study examining functionality of subjects with anterior cruciate ligament (ACL) tears and a subsequent reconstruction comprehensively by multiple test sessions from pre- to six months post-reconstruction. The purpose was to evaluate if a generally applied rehabilitation program restores functionality to levels of healthy controls. Subjects with unilateral tears of the ACL were compared to matched healthy controls throughout the rehabilitation. 20 recreational athletes were tested: T1 (preoperative), 6 weeks after tear; T2, 6 weeks, T3, 3 months, T4, 6 months post-reconstruction. At all test sessions, subjects self-evaluated their activity level with the Tegner activity score and their knee state with the Knee Injury and Osteoarthritis Outcome Score. Passive range of motion during knee flexion and extension and leg circumference were measured as functional clinical tests. Bilateral countermovement jumps, one-leg jumps for distance and isometric force tests in knee flexion and extension with 90° and 110° knee angle were conducted as functional performance tests. For determination of functionality, leg symmetry indices (LSIs) were calculated by dividing values of the injured by the uninjured leg. In the ACL group most LSIs decreased from T1 to T2, and increased from T2 and T3 to T4. LSIs of ACL subjects remained lower than LSIs of healthy controls at 6 months post-reconstruction in nearly all parameters. Self-evaluation of ACL subjects showed, additionally, that activity level was lower than the pre-injury level at 6 months post-reconstruction. Low LSIs and low self-evaluation indicate that knee joint functionality is not completely restored at 6 months post-reconstruction. The study shows that multiple comprehensive testing throughout the rehabilitation gives detailed images of the functional state. Therefore, the functional state of ACL reconstructed individuals should be evaluated comprehensively and continuously throughout the rehabilitation to detect persisting deficiencies detailed and adapt rehabilitation programs individually depending on the functionality.
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Affiliation(s)
- Frieder Cornelius Krafft
- Sports Orthopaedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- * E-mail:
| | - Bernd Josef Stetter
- Sports Orthopaedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Thorsten Stein
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | | | | | | | - Stefan Sell
- Sports Orthopaedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Hospital Neuenbürg, Joint Center Black Forest, Neuenbürg, Germany
| | - Wolfgang Potthast
- Arcus Sports Clinic, Pforzheim, Germany
- Institute for Biomechanics and Orthopaedics, German Sport University (GSU), Cologne, Germany
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