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Graham MC, Thompson KL, Hawk GS, Fry CS, Noehren B. Muscle Fiber Cross-Sectional Area Is Associated With Quadriceps Strength and Rate of Torque Development After ACL Injury. J Strength Cond Res 2024; 38:e273-e279. [PMID: 38349361 PMCID: PMC11116075 DOI: 10.1519/jsc.0000000000004743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
ABSTRACT Graham, MC, Thompson, KL, Hawk, GS, Fry, CS, and Noehren, B. Muscle fiber cross-sectional area is associated with quadriceps strength and rate of torque development after ACL injury. J Strength Cond Res 38(6): e273-e279, 2024-The purpose of this study was to investigate the relationship between muscle fiber type-specific properties of the vastus lateralis and quadriceps muscle performance in individuals after an anterior cruciate ligament (ACL) tear. 26 subjects (22.0 ± 5.4 years) were included in this cross-sectional study, and all data were collected before ACL reconstruction. Quadriceps peak torque (QPT) and early (0-100 ms) and late (100-200 ms) rate of torque development (RTD) were obtained from maximal voluntary isometric quadriceps strength testing. Muscle fiber cross-sectional area (fCSA) and percent fiber type distribution (FT%) were evaluated through immunohistochemical analysis of a muscle biopsy. Between-limb differences in fiber characteristics were assessed using paired t-tests (with α-level 0.05). Relationships between fiber-specific properties and quadriceps muscle performance were determined using separate multiple linear regression analyses for ACL-injured and noninjured limbs. There were significant differences in fCSA between ACL-injured and noninjured limbs across all fiber types, but no differences in FT%. Type 1 fCSA, type 2a fCSA, and their interaction effect were the explanatory variables with the strongest relationship to all performance outcomes for the ACL-injured limb. The explanatory variables in the ACL-injured limb had a significant relationship to QPT and late RTD, but not early RTD. These findings suggest that QPT and late RTD are more heavily influenced by fCSA than FT% in ACL-injured limbs. This work serves as a foundation for the development of more specific rehabilitation strategies aimed at improving quadriceps muscle function before ACL reconstruction or for individuals electing nonsurgical management.
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Affiliation(s)
- Megan C Graham
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | | | - Gregory S Hawk
- Department of Statistics, University of Kentucky, Lexington, Kentucky; and
| | - Christopher S Fry
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
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Hopper H, Adsit M, Reiter CR, Satalich JR, Schmidt RC, Peri MI, Cyrus JW, Vap AR. Female Sex, Older Age, Earlier Surgery, Anticoagulant Use, and Meniscal Repair Are Associated With Increased Risk of Manipulation Under Anesthesia or Lysis of Adhesions for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2024; 40:1687-1699. [PMID: 38000486 DOI: 10.1016/j.arthro.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE To determine what patient or surgical factors are associated with an increased risk of arthrofibrosis requiring manipulation under anesthesia (MUA) or lysis of adhesions (LOA) after anterior cruciate ligament reconstruction (ACLR). METHODS A systematic review was performed in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane, Embase, and Medline databases were searched for studies published through February 2023. Inclusion criteria were studies that identified risk factors for MUA and/or LOA after ACLR. Studies investigating arthrofibrosis after multiligamentous knee injuries or ACL repair were excluded. RESULTS Eleven studies including a total of 333,876 ACLRs with 4,842 subsequent MUA or LOA (1.45%) were analyzed. Increasing age was associated with an increased risk in 3 studies (P < .001, P < .05, P < .01) but was found to have no association another two. Other factors that were identified by multiple studies as risk factors for MUA/LOA were female sex (4 studies), earlier surgery (5 studies), use of anticoagulants other than aspirin (2 studies), and concomitant meniscal repair (4 studies). CONCLUSIONS In total, 1.45% of the patients who underwent ACLR and were included in this systematic review had to undergo a subsequent MUA/LOA to treat arthrofibrosis. Female sex, older age, earlier surgery, use of anticoagulants other than aspirin, and concomitant meniscal repair were associated with increased risk of MUA/LOA. The modifiable risks, including use of anticoagulants and time between injury and surgery, can be considered when making treatment decisions. LEVEL OF EVIDENCE Level IV, systematic review of Level III-IV studies.
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Affiliation(s)
- Haleigh Hopper
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A..
| | - Matthew Adsit
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Charles R Reiter
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, U.S.A
| | - James R Satalich
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - R Cole Schmidt
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Maria I Peri
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - John W Cyrus
- Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Alexander R Vap
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
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Frouin A, Desfontaines N, Lacourpaille L, Nordez A, Le Sant G. Preoperative Rehabilitation Enhances Mental and Physical Well-Being in Anterior Cruciate Ligament-Injured Individuals: A Mixed Methods Study. J Sport Rehabil 2024; 33:289-296. [PMID: 38580299 DOI: 10.1123/jsr.2023-0312] [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: 09/18/2023] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 04/07/2024]
Abstract
CONTEXT Rehabilitation after an anterior cruciate ligament injury is recommended to be started soon after the injury. When surgery is required, research supports the delivery of physiotherapy before anterior cruciate ligament reconstruction (prehabilitation) to optimize recovery and positive outcomes. Individuals attending prehabilitation have never been questioned regarding their adherence to prehabilitation, perception of utility in meeting needs, upcoming events, or anticipated recovery goals. DESIGN Mixed methods cross-sectional study: Methods: 25 individuals before anterior cruciate ligament reconstruction (43% of eligible individuals from 12 clinics during the delivery period) were surveyed on their mindset and recovery expectancies. Semistructured interviews conducted in 9 of 25 participants assessed their lived experience of prehabilitation. RESULTS Participants reported that preventing a reinjury (96% of responses) and feeling confident during daily activities about their knee (92%) were the higher rating expectations at this stage of their treatment course. Three themes were developed from the interviews and analyses. (1) Participants reported that prehabilitation was a period full of challenges with memories of the injury and uncertainties. (2) They viewed prehabilitation as a step to move forward by finding support and self-motivating. (3) They believed that prehabilitation would have positive impacts on the treatment outcomes. Participants were confident that prehabilitation would accelerate the recovery of muscle volume (88%) and strength (84%). CONCLUSION Participants had positive experiences of prehabilitation, aligning with the findings on functional outcomes in the existing literature on prehabilitation.
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Affiliation(s)
- Antoine Frouin
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- Institut Sport Atlantique, ISA Clinic, Saint-Herblain, France
| | | | - Lilian Lacourpaille
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
| | - Antoine Nordez
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- Institut Universitaire de France, IUF, Paris, France
| | - Guillaume Le Sant
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- School of Physiotherapy, IFM3R, St-Sebastien/Loire, France
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Crecchi A, Tozzini A, Benedetti R, Maltinti M, Bonfiglio L. Case report: Intensive rehabilitation program delivered before and after single-event multilevel surgery in a girl with diplegic cerebral palsy. Front Neurol 2024; 14:1323697. [PMID: 38283677 PMCID: PMC10811248 DOI: 10.3389/fneur.2023.1323697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Diplegic cerebral palsy (CP) is often associated with musculoskeletal disorders that contribute to worsen walking function. The standard care in these cases is single-event multilevel surgery (SEMLS) followed by rehabilitation. Our aim was to investigate whether a rehabilitation program starting even before SEML could add a benefit with respect to standard postoperative programs considered by previous research. Methods From 2 months before to 13 months after SEMLS (except for the first month after surgery), the participant underwent a motor training focused on ROM exercises with tactile and kinaesthetic feedback. Walking performance, walking capacity, and quality-of-life were assessed before and after SEMLS at different follow-up times. Results Walking capacity improved 3 months after SEMLS (i.e., earlier than in current literature) and walking performance improved 12 months after SEMLS (instead of simply returning to baseline as previously reported), with a positive impact on quality-of-life. Conclusions This case suggests that a rehabilitation program starting even before SEMLS could add benefits over walking function and quality-of-life of children with diplegic CP compared to postoperative programs only.
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Affiliation(s)
- Alessandra Crecchi
- Unit of Developmental Neurorehabilitation, Maternal and Child Department, Pisa University Hospital, Pisa, Italy
| | - Alessandra Tozzini
- Unit of Developmental Neurorehabilitation, Maternal and Child Department, Pisa University Hospital, Pisa, Italy
| | - Roberta Benedetti
- Department of Translational Research on New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Maltinti
- 1st Unit of Orthopaedics and Trauma, Pisa University Hospital, Pisa, Italy
| | - Luca Bonfiglio
- Unit of Developmental Neurorehabilitation, Maternal and Child Department, Pisa University Hospital, Pisa, Italy
- Department of Translational Research on New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
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Özüdoğru A, Gelecek N. Effects of closed and open kinetic chain exercises on pain, muscle strength, function, and quality of life in patients with knee osteoarthritis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230164. [PMID: 37466598 DOI: 10.1590/1806-9282.20230164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/11/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Therapeutic exercises are well documented for the treatment of osteoarthritis; there is less evidence on what the effect of closed kinetic chain exercises is for knee osteoarthritis. The aim of this study was to investigate the effects of open kinetic chain exercises and closed kinetic chain exercises on pain, muscle strength, functional status, and quality of life in patients with knee osteoarthritis. METHODS The study included a total of 60 patients with primary unilateral knee osteoarthritis grade I and II. The patients were categorized into three groups as open kinetic chain exercises (n=20), closed kinetic chain exercises (n=20), and control group (n=20). The outcome measures, including pain, isokinetic muscle strength, functional status, and quality of life, were collected at baseline and at the end of 6 and 12 weeks. RESULTS Closed kinetic chain exercises and open kinetic chain exercises had significant improvement in pain, muscle strength, WOMAC, and SF-36 scores after the treatment and at their 6th and 12th week follow-ups compared to their baseline values and compared to the control group (p<0.05). CONCLUSION The changes in all outcome measures were similar between closed kinetic chain exercises and open kinetic chain exercises (p>0.05). Closed kinetic chain exercises and open kinetic chain exercises were similar for knee osteoarthritis grade I and II. Closed kinetic chain exercises could be safely added to the exercise programs of patients with low-grade knee osteoarthritis.
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Affiliation(s)
- Anıl Özüdoğru
- Kırşehir Ahi Evran University, School of Physical Therapy and Rehabilitation- Kırşehir, Turkey
| | - Nihal Gelecek
- Dokuz Eylül University, School of Physical Therapy and Rehabilitation - İzmir, Turkey
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Agarwal AR, Harris AB, Tarawneh O, Malyavko A, Kreulen RT, Thakkar SC, Doerre T, Best MJ. Delay of Timing of Anterior Cruciate Ligament Reconstruction Is Associated With Lower Risk of Arthrofibrosis Requiring Intervention. Arthroscopy 2023:S0749-8063(23)00161-5. [PMID: 36774969 DOI: 10.1016/j.arthro.2023.01.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/09/2023] [Accepted: 01/25/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE To conduct 2 separate stratum-specific likelihood ratio analyses in patients younger than 40 year of age (<40 years) and those aged 40 and older (40+ years) at time of anterior cruciate ligament (ACL) reconstruction to define data-driven strata between ACL tear and primary isolated ACL reconstruction in which the risk of arthrofibrosis, using manipulation under anesthesia and arthroscopic lysis of adhesions as surrogates, is significantly different. METHODS A retrospective cohort analysis was conducted using the PearlDiver Database. Patients who underwent ACL reconstruction were identified using the Current Procedure Terminology code 29888. Patients were stratified to those aged younger than 40 (<40) and those 40 and older (40+) at time of ACL reconstruction. The incidence of 2-year arthrofibrosis was calculated for weekly intervals from initial ACL injury to reconstruction. Stratum specific likelihood ratio analysis was conducted to determine data-driven intervals from initial ACL tear to reconstruction that optimize differences in 2-year arthrofibrosis. Following the identification of these intervals for both those <40 and 40+, multivariable analysis was conducted. RESULTS For those <40, stratum-specific likelihood ratio analysis identified only 2 data-driven timing strata: 0-5 and 6-26 weeks. For those 40+, stratum-specific likelihood ratio analysis also only identified 2 data-driven strata: 0-9 and 10-26 weeks. A delay in ACL reconstruction from initial injury by at least 6 weeks in patients younger than 40 and at least 10 weeks in patients older than 40 years is associated with a 65% and 35% reduction of 2-year manipulation under anesthesia and arthroscopic lysis of adhesions, respectively. CONCLUSIONS Our analysis showed a delay in ACLR of at least 6 weeks in patients younger than 40 years to be associated with a 65% reduction in the risk of surgical intervention for arthrofibrosis and a delay of at least 10 weeks in patients 40 years and older to be associated with only a 35% reduction in the risk of surgical intervention for arthrofibrosis. The authors propose this difference in reduction to be multifactorial and potentially associated with mechanism of injury, activity level, and preoperative factors such as amount of physical therapy, rather than solely timing. LEVEL OF EVIDENCE III, retrospective comparative prognostic study.
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Affiliation(s)
- Amil R Agarwal
- Department of Orthopedic Surgery, George Washington Hospital, Washington DC, U.S.A..
| | - Andrew B Harris
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, Maryland, U.S.A
| | | | - Alisa Malyavko
- Department of Orthopedic Surgery, George Washington Hospital, Washington DC, U.S.A
| | - R Timothy Kreulen
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, Maryland, U.S.A
| | | | - Teresa Doerre
- Department of Orthopedic Surgery, George Washington Hospital, Washington DC, U.S.A
| | - Matthew J Best
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, Maryland, U.S.A
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7
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Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus. J ISAKOS 2022; 7:150-161. [PMID: 35998884 DOI: 10.1016/j.jisako.2022.08.004] [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: 07/09/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer-one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. METHODS 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. RESULTS Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. CONCLUSIONS The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer.
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Webber SC, Parsons JL, Arnott T, Bauer A, D'Errico D, Fillion J, Giesbrecht J, Loewen A, Scheller C, Tse JYY, Thille P. Signs of Inequitable Access: Users of Private Physiotherapy Services Do Not Reflect the Urban Population in Winnipeg, Manitoba. Physiother Can 2022; 74:379-386. [PMID: 37324616 PMCID: PMC10262718 DOI: 10.3138/ptc-2020-0111] [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: 10/06/2020] [Revised: 03/29/2021] [Accepted: 06/14/2021] [Indexed: 07/28/2023]
Abstract
Purpose: Both private and public funding cover outpatient physiotherapy (PT) in Canada. Knowledge is lacking in who does and does not access PT services, which limits the ability to identify health/access inequities created by current financing structures. This study characterizes the individuals accessing private PT in Winnipeg to better understand whether inequities exist, given the very limited publicly financed PT. Methods: Patients attending PT in 32 private businesses, sampled for geographic variation, completed a survey online or on paper. We compared the sample's demographic characteristics with Winnipeg population data using chi-square goodness-of-fit tests. Results: In total, 665 adults accessing PT participated. Respondents were older and had higher levels of income and education compared to Winnipeg census data (p < 0.001). Our sample included higher proportions of female and White individuals, and lower proportions of Indigenous persons, newcomers, and people from visible minorities (p < 0.001). Conclusions: There are signs that inequities exist in access to PT in Winnipeg; the cohort who access private PT services does not reflect the wider population, which suggests that some segments of the population are not receiving care.
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Affiliation(s)
- Sandra C Webber
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joanne L Parsons
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Taylor Arnott
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexandra Bauer
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Desiree D'Errico
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janique Fillion
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justin Giesbrecht
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adam Loewen
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Scheller
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joanna Y Y Tse
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia Thille
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Alsiaf H, O'Neill TW, Callaghan MJ, Goodwin PC. Physical therapy of patients undergoing first-time lumbar discectomy: a survey of current UK practice. BMC Musculoskelet Disord 2022; 23:503. [PMID: 35624458 PMCID: PMC9137089 DOI: 10.1186/s12891-022-05346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The type, timing, and extent of provision of rehabilitation for lumbar discectomy patients in the UK are currently unknown. The aim of this study was to determine the provision and type of rehabilitation for patients undergoing lumbar discectomy in UK neurosurgical centers. METHOD Physical therapists involved in treating lumbar discectomy patients in UK neurosurgery centers were invited to complete an online survey that asked about the type, timing (preop, postop), and rehabilitation content for patients undergoing lumbar discectomy. RESULTS Seventeen UK neurosurgery centers completed the survey. Twelve (36%) responded from the 33 centers targeted as well as an additional five private centers. All participating centers provided a rehabilitation service for lumbar discectomy patients. Rehabilitation was provided preoperatively in n = 6 (35%) centers, postoperatively as an inpatient in all centers, and postoperatively as an outpatient in n = 14 (82%) centers. Factors that influenced the decision to provide rehabilitation included both external and internal or patient-related factors. Preoperative rehabilitation focused mainly on education, whilst postoperative outpatient rehabilitation focused more on exercises. Rehabilitation consistently included mobility, functional task training, and exercise prescription. CONCLUSIONS Whilst all neurosurgical centers in this survey provided some form of rehabilitation for patients undergoing LD surgery, the approach remains inconsistent. Rehabilitation was delivered most frequently postoperatively, with one in three centers providing it preoperatively. Rehabilitation content also varied depending on when it was provided. Further research is needed to determine the optimum timing, contents, and target of rehabilitation for patients undergoing LD surgery.
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Affiliation(s)
- Hanan Alsiaf
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. .,Department of Physiotherapy, King Fahad Military Medical Complex - KFMMC, Dhahran, Kingdom of Saudi Arabia.
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Department of Rheumatology, Salford Royal, NHS Foundation Trust, Salford, UK
| | - Michael J Callaghan
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Department of health Professions, Manchester Metropolitan University, Manchester, UK.,Medical, Manchester United Ltd, Manchester, UK
| | - Peter C Goodwin
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Department of health Professions, Manchester Metropolitan University, Manchester, UK
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Kim DK, Park G, Wang JH, Kuo LT, Park WH. Preoperative quadriceps muscle strength deficit severity predicts knee function one year after anterior cruciate ligament reconstruction. Sci Rep 2022; 12:5830. [PMID: 35388112 PMCID: PMC8986796 DOI: 10.1038/s41598-022-09816-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/28/2022] [Indexed: 11/09/2022] Open
Abstract
Quadriceps strength is critical for patients with anterior cruciate ligament (ACL) reconstruction; however, little is known about the relationship between preoperative quadriceps strength deficit and postoperative subjective knee functions. The study aimed to investigate the relationship between preoperative quadriceps strength and postoperative knee function in patients after ACL reconstruction. Seventy-five male patients with primary ACL reconstruction surgery with hamstring autografts between 2014 and 2017 were included. An isokinetic dynamometer assessed quadriceps strength while self-reported knee functions were measured by the International Knee Documentation Committee (IKDC) and Lysholm scores at baseline and 1 year after surgery. The three identified groups (Q1-Q3) were classified according to the preoperative quadriceps muscle strength deficit. Q1 were patients with < 25% quadriceps muscle strength deficit, Q2 showed a 25-45% deficit, and Q3 included those with a deficit > 45%. We compared knee functions between the three groups and examined the associations between preoperative variables and functional knee outcomes. The preoperative quadriceps muscle strength deficit had a negative association with the knee functional scores at 1 year follow-up including the IKDC score (rs = - 0.397, p = 0.005) and the Lysholm score (rs = - 0.454, p < 0.001), but not other factors. Furthermore, only the Q1 group, with < 25% deficit in preoperative quadriceps muscle strength, showed a significant correlation in postoperative IKDC score (r = - 0.462, p = 0.030), and Lysholm score (r = - 0.446, p = 0.038). Preoperative quadriceps muscle strength deficit had a significant negative relationship with postoperative function at 1 year following ACL reconstruction.
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Affiliation(s)
- Do Kyung Kim
- Department of Sports Medicine Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Geon Park
- Department of Sports Medicine Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Liang-Tseng Kuo
- Department of Orthopaedic Surgery, Sports Medicine Center, Chang Gung Memorial Hospital, No. 6 West Sec, Chia-Pu Road, Putz City, Chiayi, 613, Taiwan. .,Department of Medicine, Chang Gung University, Taoyüan, Taiwan.
| | - Won Hah Park
- Department of Sports Medicine Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
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11
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Jenkins SM, Guzman A, Gardner BB, Bryant SA, Del Sol SR, McGahan P, Chen J. Rehabilitation After Anterior Cruciate Ligament Injury: Review of Current Literature and Recommendations. Curr Rev Musculoskelet Med 2022; 15:170-179. [PMID: 35381974 DOI: 10.1007/s12178-022-09752-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament reconstruction (ACLR) is a common surgical procedure with an estimated 120,000 cases performed in the USA each year. Physical therapy plays a critical role in the successful recovery of both surgically and non-surgically managed patients. Interestingly, ACL rehabilitation protocols vary greatly with little consensus among practitioners. Nonetheless, there has been agreement over the last decade to shift from conservative, standardized length protocols to more accelerated, individualized protocols that vary in length and modalities based on patient-specific findings and preferences. This review summarizes the most recent trends, opinions, and modalities in ACL rehabilitation research, with a specific focus on novel methods to treat the specific psychosocial needs of ACL deficient patients. RECENT FINDINGS We found that new protocols emphasize early weight bearing, open kinetic chain (OKC) exercises, and other alternative modalities such as neuromuscular electrical stimulation and blood flow restriction. We also found a recent trend toward the use of clinical milestones to determine when a patient is ready for the next phase of a "step-up" rehabilitation program. One particularly nascent topic of research is the inclusion of methods to treat the psychosocial impacts of ACL injury, recovery, and the anxiety around return to sport. Rehabilitation strategy has become increasingly patient-dependent, and the new modalities being utilized are accelerating patient recovery. Return to sport is a particularly important factor for many ACLR patients, and recovery has an important psychological component that has only recently been addressed in the literature, with positive preliminary findings.
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Affiliation(s)
- Sarah M Jenkins
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA.
| | - Alvarho Guzman
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Brandon B Gardner
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Stewart A Bryant
- University of Hawaii Orthopaedic Surgery Residency, Honolulu, HI, USA
| | - Shane Rayos Del Sol
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Patrick McGahan
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - James Chen
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
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12
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Martini A, Ayala A, Lechable M, Rannou F, Lefèvre-Colau MM, Nguyen C. Determinants of apprehension to return to sport after reconstruction of the anterior cruciate ligament: an exploratory observational retrospective study. BMC Sports Sci Med Rehabil 2022; 14:37. [PMID: 35287699 PMCID: PMC8922866 DOI: 10.1186/s13102-022-00433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Only 65% of people return to a level of sport equivalent to that before after anterior cruciate ligament (ACL) surgery. Persisting apprehension may in part explain this observation. We aimed to describe characteristics of people with ACL-Return to Sport after Injury (RSI) scores ≥ 60/100 (low apprehension) at 6 months after injury and to identify variables independently associated with low apprehension at 6 months. METHODS We conducted a single-center retrospective study. People who had surgery for an ACL rupture and who participated in an outpatient post-operative rehabilitation program were included consecutively. The ACL-RSI questionnaire was self-administered at 6 months after injury. Baseline characteristics of people with ACL-RSI scores ≥ 60/100 and < 60/100 were described. Multiple logistic regression was performed to identify baseline variables associated with low apprehension at 6 months. RESULTS We included 37 participants: 13/37 (35.1%) were women and mean age was 27.2 (9.2) years. At 6 months, 21/37 (56.8%) had an ACL-RSI score ≥ 60/100. Participants who had an ACL-RSI score ≥ 60/100 more often received a preoperative rehabilitation (16/21 [76.2%] vs 5/16 [31.2%]), and had less often knee pain (7/21 [33.3%] vs 7/16 [43.7%]) and effusion (5/21 [23.8%] vs 8/16 [50.0%]) at 1 month after surgery, than participants who had an ACL-RSI score < 60/100. In the multivariate analysis, preoperative rehabilitation was associated with low apprehension at 6 months (OR [95% CI] = 0.107 [0.023 to 0.488], p = 0.002). CONCLUSIONS Preoperative rehabilitation was independently associated with low apprehension at 6 months. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Alexandre Martini
- AP-HP.Centre-Université Paris Cité, Hôpital Cochin, Rééducation Et Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Centre de Rééducation Fonctionnelle, 94350, Villiers-Sur-Marne, France
| | - Anne Ayala
- Centre de Rééducation Fonctionnelle, 94350, Villiers-Sur-Marne, France
| | - Marc Lechable
- Centre de Rééducation Fonctionnelle, 94350, Villiers-Sur-Marne, France
| | - François Rannou
- AP-HP.Centre-Université Paris Cité, Hôpital Cochin, Rééducation Et Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006, Paris, France.,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire Et Biomarqueurs (T3S), Campus Universitaire des Saints-Pères, 75006, Paris, France
| | - Marie-Martine Lefèvre-Colau
- AP-HP.Centre-Université Paris Cité, Hôpital Cochin, Rééducation Et Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006, Paris, France.,INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris Sorbonne Cité (CRESS), ECaMO Team, 75004, Paris, France.,Institut Fédératif de Recherche Sur Le Handicap, 75013, Paris, France
| | - Christelle Nguyen
- AP-HP.Centre-Université Paris Cité, Hôpital Cochin, Rééducation Et Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006, Paris, France. .,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire Et Biomarqueurs (T3S), Campus Universitaire des Saints-Pères, 75006, Paris, France.
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13
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Mohan MM, Srinivasalu S, Pilar A, Manohar S, Joseph J, Amaravathi R. The effect of preoperative rehabilitation on the outcome of anterior cruciate ligament reconstruction. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Cunha J, Solomon DJ. ACL Prehabilitation Improves Postoperative Strength and Motion and Return to Sport in Athletes. Arthrosc Sports Med Rehabil 2022; 4:e65-e69. [PMID: 35141537 PMCID: PMC8811524 DOI: 10.1016/j.asmr.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jamie Cunha
- California Orthopedics and Spine / EXOS Physical Therapy, Larkspur, California, U.S.A
| | - Daniel J. Solomon
- California Orthopedics and Spine, Larkspur, California, U.S.A
- Address correspondence to D. J. Solomon, M.D., California Orthopedics and Spine, 18 Bon Air Rd., Larkspur, CA, 94939, U.S.A.
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15
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Potts G, Reid D, Larmer P. The effectiveness of preoperative exercise programmes on quadriceps strength prior to and following anterior cruciate ligament (ACL) reconstruction: A systematic review. Phys Ther Sport 2021; 54:16-28. [PMID: 34933208 DOI: 10.1016/j.ptsp.2021.12.004] [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: 08/26/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES to evaluate the effectiveness of preoperative exercise programmes on quadriceps strength prior to and following anterior cruciate ligament (ACL) reconstruction. DESIGN Systematic review. METHODS a systematic review was undertaken, included studies were evaluated using the Modified Downs and Black checklist which is appropriate for determining the quality of randomised and non-randomised studies. Scientific databases searched included PubMED, EBSCO Health, CINAHL, Medline, and Cochrane Library databases from inception to March 2021. RESULTS Ten studies met the inclusion criteria. There were six randomised studies and four prospective studies. The level of evidence is categorised as 'limited' due to heterogenicity and only six studies reported quadriceps strength increases. Five studies demonstrated preoperative exercise of 4-16 weeks duration can significantly increase preoperative quadriceps strength. One study demonstrated preoperative OKC exercise produced significantly stronger preoperative quadriceps compared to CKC exercise. One study showed no between group (intervention vs control) quadriceps strength difference pre or 12 weeks postoperatively. CONCLUSIONS 4-16 weeks of preoperative exercise could increase quadriceps strength preoperatively but any persistent postoperative strength benefit from undertaking a standardised preoperative intervention is unclear. There is considerable variation and methodological limitations across the included studies and the composition of optimal preoperative ACLR exercise is currently unknown.
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Affiliation(s)
- Geoff Potts
- Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand; KneeCare, 5 Akoranga Drive, Northcote, 0627, Auckland, New Zealand.
| | - Duncan Reid
- Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Peter Larmer
- Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
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16
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Fausett WA, Reid DA, Larmer PJ. Current perspectives of New Zealand physiotherapists on rehabilitation and return to sport following anterior cruciate ligament reconstruction: A survey. Phys Ther Sport 2021; 53:166-172. [PMID: 34711502 DOI: 10.1016/j.ptsp.2021.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the clinical beliefs and practices of New Zealand physiotherapists regarding pre- and post-surgical rehabilitation and return to sport (RTS) criteria following anterior cruciate ligament reconstruction (ACLR). DESIGN Online cross-sectional survey. METHODS A survey was adapted from a previously published survey and disseminated to New Zealand physiotherapists who were considered more likely to be involved in post-ACLR rehabilitation. RESULTS The number of completed surveys was 318. Most physiotherapists (85%) preferred to first consult patients within 14 days of ACLR. In the first six weeks following ACLR, 89% of physiotherapists see patients at least once per week. Between 3- and 6-months post-ACLR, 76% of physiotherapists see patients at least once a fortnight. Pre-operative rehabilitation and post-operative rehabilitation exceeding six months are considered essential or important to patient outcomes by over 95% of physiotherapists. While 63% of physiotherapists support RTS 9-12 months after ACLR, 11% permit RTS within 6-9 months of surgery. Common RTS considerations include functional capacity, movement quality during functional tasks, time from ACLR, and knee strength. CONCLUSION The survey revealed variability in the beliefs and practices of NZ physiotherapists regarding post-ACLR rehabilitation, and these beliefs and practices are at times inconsistent with best practice recommendations.
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Affiliation(s)
- Wayne A Fausett
- Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand.
| | - Duncan A Reid
- School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Peter J Larmer
- School of Clinical Sciences, Auckland University of Technology, New Zealand
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17
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Bulow A, Anderson JE, Leiter JRS, MacDonald PB, Peeler JD. Safety and Effectiveness of a Perturbation-based Neuromuscular Training Program on Dynamic Balance in Adolescent Females: A Randomized Controlled Trial. Int J Sports Phys Ther 2021; 16:1001-1015. [PMID: 34386279 PMCID: PMC8329312 DOI: 10.26603/001c.25685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adolescent females are at much greater risk for ACL injury than their male counterparts when participating in the same sports. Preventative and pre-operative rehabilitation neuromuscular (NM) exercise programs are often recommended to improve knee function and reduce injury rates. The effectiveness of perturbation-based NM training program has been established in an adult population but has yet to be investigated in the at-risk adolescent female population. PURPOSE To determine the effectiveness of a perturbation-based NM exercise program in a group of physically active adolescent females. STUDY DESIGN Prospective randomized trial. METHODS Twenty-four healthy and an exploratory group of 10 ACL-injured females (ages 12-18) were equally randomized into a perturbation-based NM training or control group and evaluated before and after a five-week intervention period. The primary outcome of dynamic balance was measured using the Y-Balance test (YBT); secondary outcome measures included lower limb strength, proprioception, and flexibility. RESULTS The perturbation-based NM training intervention was safely completed by all participants but had no significant effect on YBT scoring, lower limb strength, proprioception or flexibility in either the healthy or ACL-injured groups. CONCLUSIONS Perturbation-based NM training is safe, but may offer little preventative benefit for healthy or pre-operative rehabilitation benefit for ACL-injured adolescent females. Future research should examine whether the effectiveness of perturbation-based NM training is influenced by the length of the training intervention, training intensity, or when it is combined with other forms of prophylactic or pre-surgical rehabilitation frequently used with at-risk adolescent females who regularly participate in sport. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | | | | | | | - Jason D Peeler
- Human Anatomy & Cell Science, University of Manitoba; Pan Am Clinic
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18
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Grevnerts HT, Sonesson S, Gauffin H, Ardern CL, Stålman A, Kvist J. Decision Making for Treatment After ACL Injury From an Orthopaedic Surgeon and Patient Perspective: Results From the NACOX Study. Orthop J Sports Med 2021; 9:23259671211005090. [PMID: 33948447 PMCID: PMC8053763 DOI: 10.1177/23259671211005090] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background: In the treatment of anterior cruciate ligament (ACL) injuries, there is little evidence of when and why a decision for ACL reconstruction (ACLR) or nonoperative treatment (non-ACLR) is made. Purpose: To (1) describe the key characteristics of ACL injury treatment decisions and (2) compare patient-reported knee instability, function, and preinjury activity level between patients with non-ACLR and ACLR treatment decisions. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 216 patients with acute ACL injury were evaluated during the first year after injury. The treatment decision was non-ACLR in 73 patients and ACLR in 143. Reasons guiding treatment decision were obtained from medical charts and questionnaires to patients and orthopaedic surgeons. Patient-reported instability and function were obtained via questionnaires and compared between patients with non-ACLR and ACLR treatment decisions. The ACLR treatment group was classified retrospectively by decision phase: acute phase (decision made between injury day and 31 days after injury), subacute phase (decision made between 32 days and up to 5 months after injury), and late phase (decision made 5-12 months after injury). Data were evaluated using descriptive statistics, and group comparisons were made using parametric or nonparametric tests as appropriate. Results: The main reasons for a non-ACLR treatment decision were no knee instability and no problems with knee function. The main reasons for an ACLR treatment decision were high activity demands and knee instability. Patients in the non-ACLR group were significantly older (P = .031) and had a lower preinjury activity level than did those in the acute-phase (P < .01) and subacute-phase (P = .006) ACLR decision groups. There were no differences in patient-reported instability and function between treatment decision groups at baseline, 4 weeks after injury, or 3 months after injury. Conclusion: Activity demands, not patient-reported knee instability, may be the most important factor in the decision-making process for treatment after ACL injury. We suggest a decision-making algorithm for patients with ACL injuries and no high activity demands; waiting for >3 months can help distinguish those who need surgical intervention from those who can undergo nonoperative management. Registration: NCT02931084 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Hanna Tigerstrand Grevnerts
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Activity and Health, Linköping University, Linköping, Sweden
| | - Sofi Sonesson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Håkan Gauffin
- Division of Surgery, Orthopedics and Oncology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Clare L Ardern
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Sport & Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Anders Stålman
- Stockholm Sports Trauma Research Center, MMK, Karolinska Institutet, Stockholm.,Capio Artro Clinic, Sophiahemmet, Stockholm
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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19
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Gamble AR, Pappas E, O'Keeffe M, Ferreira G, Maher CG, Zadro JR. Intensive supervised rehabilitation versus less supervised rehabilitation following anterior cruciate ligament reconstruction? A systematic review and meta-analysis. J Sci Med Sport 2021; 24:862-870. [PMID: 33736965 DOI: 10.1016/j.jsams.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate whether intensive supervised rehabilitation following ACL reconstruction leads to superior self-reported function and sports participation compared to less supervised rehabilitation. DESIGN Systematic review and meta-analysis. METHODS We included randomised controlled trials (RCTs) comparing supervised rehabilitation to rehabilitation with a similar protocol that used less supervised sessions for athletes following ACL reconstruction. Two reviewers independently screened studies and extracted data. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate methodological quality and GRADE to evaluate overall quality of evidence. Self-reported function and sports participation were the primary outcomes. Data were pooled using random effects meta-analyses. RESULTS Our search retrieved 4075 articles. Seven articles reporting on six RCTs were included (n=353). Very-low to low-certainty evidence suggests intensive supervised rehabilitation is not superior to less supervised rehabilitation following ACL reconstruction for improving self-reported function, sports participation, knee flexor and extensor strength, range of motion, sagittal plane knee laxity, single leg hop performance, or quality of life. CONCLUSION Based on uncertain evidence, intensive supervised rehabilitation is not superior to less supervised rehabilitation for athletes following ACL reconstruction. Although high-quality RCTs are needed to provide more certain evidence, clinicians should engage athletes in shared decision making to ensure athletes' rehabilitation decisions align with current evidence on supervised rehabilitation as well as their preferences and values.
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Affiliation(s)
- Andrew R Gamble
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Australia; School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - Giovanni Ferreira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Australia
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Australia
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20
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Caetano D, Oliveira C, Correia C, Barbosa P, Montes A, Carvalho P. Rehabilitation outcomes and parameters of blood flow restriction training in ACL injury: A scoping review. Phys Ther Sport 2021; 49:129-137. [PMID: 33676203 DOI: 10.1016/j.ptsp.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify the outcomes of physical function, physical fitness, training, and cuff parameters, used in BFRT in ACL rehabilitation. METHODS This scoping review was initiated on April 25th, 2020, according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Relevant literature was identified searching three main concepts: BFRT, rehabilitation and ACL injury on MEDLINE (PubMed), CENTRAL of Cochrane Library, Web of Science and PEDro. Studies looking at adults with a primary ACL injury undergoing conservative or pre/post-surgery rehabilitation with BFR or BFRT, with physical fitness and physical function as outcomes or other physical outcomes were included. RESULTS Sixty-eight articles were identified and six were included. One article was added through backward tracking. All studies used BFRT in the ACL injury surgical rehabilitation. Most studies evaluated physical fitness (muscular strength and volume) however, physical function was not considered a primary outcome. Training and cuff parameters were heterogeneously prescribed. CONCLUSION The existing evidence is not enough to draw definitive conclusions due to the heterogenous reported outcomes and parameters. Future investigation with standardized outcome measures and specific protocols are needed to draw conclusions on patients' physical function, so BFRT can be used more effectively in clinical rehabilitation practice.
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Affiliation(s)
| | | | | | | | - António Montes
- ESS - Porto School of Health, Portugal; ATCFT - Physiotherapy Technical-Scientific Departement, Portugal.
| | - Paulo Carvalho
- ESS - Porto School of Health, Portugal; ATCFT - Physiotherapy Technical-Scientific Departement, Portugal.
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21
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Carter HM, Webster KE, Smith BE. Current preoperative physiotherapy management strategies for patients awaiting Anterior Cruciate Ligament Reconstruction (ACLR): A worldwide survey of physiotherapy practice. Knee 2021; 28:300-310. [PMID: 33482621 DOI: 10.1016/j.knee.2020.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/23/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior cruciate ligament ruptures are the most common ligament injury to the knee with surgical reconstruction considered standard treatment. This study aimed to explore the current physiotherapy management strategies used during the preoperative phase of rehabilitation for patients awaiting anterior cruciate ligament reconstruction (ACLR). METHODS An anonymous survey was disseminated online via Twitter and the 'interactive Chartered Society of Physiotherapy' message board. Practising physiotherapists who treated at least one patient prior to ACLR in the past year were invited to take part. Responses were collected over a 4-week period in March 2020. Data were analysed using descriptive statistics. RESULTS In total, 183 respondents replied; 122 completed the full survey. Responses were collected from 20 countries across 3 settings, NHS/public health services, private and sports. Most respondents reported prescribing exercises, advice and education to patients during prehabilitation. Up to 40% also utilised passive treatments including manual therapy, taping/bracing and electrotherapy. The frequency of recommended exercise completion and length of treatment varied. Most respondents (n = 103/84.4%) felt that many patients waiting for ACLR did not receive prehabilitation. Many physiotherapists reported that patients expressed concerns regarding their readiness for surgery (n = 61/50%) and return to preinjury levels of physical activity (n = 112/91.8%). Almost all respondents would discuss non-operative management with patients (n = 112/91.8%) if they had returned to their preinjury level of physical activity before their ACLR. CONCLUSION Overall, this survey provides some insight as to how physiotherapists manage patients awaiting ACLR. Areas of uncertainty in physiotherapy practice have also been highlighted that require further high-quality research.
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Affiliation(s)
- Hayley M Carter
- University Hospitals of Derby and Burton NHS Foundation Trust, Department of Physiotherapy, London Road Community Hospital, Derby, UK.
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Benjamin E Smith
- University Hospitals of Derby and Burton NHS Foundation Trust, Department of Physiotherapy, London Road Community Hospital, Derby, UK; Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
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22
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Giesche F, Niederer D, Banzer W, Vogt L. Evidence for the effects of prehabilitation before ACL-reconstruction on return to sport-related and self-reported knee function: A systematic review. PLoS One 2020; 15:e0240192. [PMID: 33112865 PMCID: PMC7592749 DOI: 10.1371/journal.pone.0240192] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/22/2020] [Indexed: 12/26/2022] Open
Abstract
Study design Systematic review. Background and objectives Preoperative neuromuscular function is predictive for knee function and return to sports (RTS) after reconstruction of the anterior cruciate ligament (ACL). The aim of this review was to examine the potential benefits of prehabilitation on pre-/postoperative objective, self-reported and RTS-specific outcomes. Methods A systematic search was conducted within three databases. From the 1.071 studies screened, two randomized control trials (RCTs), two control trials (CTs) and two cohort studies (CS) met the inclusion criteria. Methodological quality rating adopted the PEDro- (RCT, CT) or Newcastle-Ottawa-Scale (CS). Results and conclusions Methodological quality of the included studies was moderate (PEDro score: 6.5 ± 1.7; range 4 to 9). Two studies reported higher increases of the maximal quadriceps torque from baseline to pre-reconstruction: one study in the limb symmetry index (LSI), and one in both legs of the prehabilitation group compared to the controls. At 12-weeks post-reconstruction, one study (from two) indicated that the prehabilitation group had a lesser post-operative decline in the single-leg-hop for distance LSI (clinically meaningful). Similar findings were found in terms of quadriceps strength LSI (one study). At both pre-reconstruction (three studies) and two-year post-surgery (two studies), the prehabilitation groups reached significantly higher self-reported knee function (clinically meaningful) than the controls. RTS tended to be faster (one study). At two years post-surgery, RTS rates (one study) were higher in the prehabilitation groups. The results provide evidence for the relevance of prehabilitation prior to ACL-reconstruction to improve neuromuscular and self-reported knee function as well as RTS. More high quality confirmatory RCTs are warranted. Registration number PROSPERO 2017: CRD42017065491.
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Affiliation(s)
- Florian Giesche
- Division of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt/Main, Germany
- * E-mail:
| | - Daniel Niederer
- Department of Sports Medicine & Exercise Physiology, Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Winfried Banzer
- Division of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine & Exercise Physiology, Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt/Main, Germany
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23
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Carter HM, Littlewood C, Webster KE, Smith BE. The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review. BMC Musculoskelet Disord 2020; 21:647. [PMID: 33010802 PMCID: PMC7533034 DOI: 10.1186/s12891-020-03676-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/24/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR). METHOD A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. RESULTS The search identified 739 potentially eligible studies, three met the inclusion criteria. All included RCTs scored 'high' risk of bias. PreHab in all three RCTs was an exercise programme, each varied in content (strength, control, balance and perturbation training), frequency (10 to 24 sessions) and length (3.1- to 6-weeks). Statistically significant differences (p < 0.05) were reported for quadriceps strength (one RCT) and single leg hop scores (two RCTs) in favour of PreHab three months after ACLR, compared to no PreHab. One RCT reported no statistically significant between-group difference for pain and function. No RCT evaluated post-operative psychological outcomes. CONCLUSION Very low quality evidence suggests that PreHab that includes muscular strength, balance and perturbation training offers a small benefit to quadriceps strength and single leg hop scores three months after ACLR compared with no PreHab. There is no consensus on the optimum PreHab programme content, frequency and length. Further research is needed to develop PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness and return to sport. TRIAL REGISTRATION PROSPERO trial registration number. CRD42020162754 .
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Affiliation(s)
- Hayley M Carter
- Department of Physiotherapy, London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, London Road Community Hospital, Derby, DE1 2QY, UK.
| | - Chris Littlewood
- Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Benjamin E Smith
- Department of Physiotherapy, London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, London Road Community Hospital, Derby, DE1 2QY, UK
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
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Current Perspectives of the Australian Knee Society on Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2020; 29:970-975. [PMID: 31775119 DOI: 10.1123/jsr.2019-0291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/04/2019] [Accepted: 10/01/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT The importance of rehabilitation and evaluation prior to return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction has been reported. OBJECTIVE This study sought to investigate current perspectives of Australian orthopedic surgeons on rehabilitation and RTS evaluation. DESIGN Survey. PARTICIPANTS Members of the Australian Knee Society. MAIN OUTCOME MEASURES A 14-question survey was disseminated to Australian Knee Society members (orthopedic surgeons) to investigate (1) preferred graft choice, (2) estimated retear rate, (3) importance of preoperative and postoperative rehabilitation, and (4) preferred timing of RTS and evaluation prior to RTS discharge. RESULTS Of all 85 Australian Knee Society members contacted, 86% (n = 73) responded. Overall, 66 respondents (90.4%) preferentially used hamstring tendon autografts. All surgeons estimated their retear rate to be ≤15%, with 31 (42.5%) <5%. Twenty-eight surgeons (38.4%) reported no benefit in preoperative rehabilitation. The majority of surgeons (82.2%-94.5%) reported that postoperative rehabilitation was important within various periods throughout the postoperative timeline. Most surgeons did not permit RTS until ≥9 months (n = 56, 76.7%), with 17 (23.3%) allowing RTS between 6 and 9 months. The most highly reported considerations for RTS clearance were time (90.4%), functional capacity (90.4%), and strength (78.1%). Most commonly, knee strength and/or function was assessed via referral to a preferred rehabilitation specialist (50.7%) or with the surgeon at their practice (11.0%). CONCLUSIONS This survey revealed variation in beliefs and practices surrounding rehabilitation and RTS evaluation. This is despite the current evidence demonstrating the benefit of preoperative and postoperative rehabilitation, as well as the emerging potential of RTS assessments consisting of strength and functional measures to reduce reinjury rates.
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Meints SM, Edwards RR, Gilligan C, Schreiber KL. Behavioral, Psychological, Neurophysiological, and Neuroanatomic Determinants of Pain. J Bone Joint Surg Am 2020; 102 Suppl 1:21-27. [PMID: 32251127 PMCID: PMC8272523 DOI: 10.2106/jbjs.20.00082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Samantha M. Meints
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher Gilligan
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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26
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Niederer D, Keller M, Achtnich A, Akoto R, Ateschrang A, Banzer W, Barié A, Best R, Ellermann A, Fischer A, Guenther D, Herbort M, Höher J, Janko M, Jung TM, Krause M, Petersen W, Stoffels T, Stöhr A, Welsch F, Stein T. Effectiveness of a home-based re-injury prevention program on motor control, return to sport and recurrence rates after anterior cruciate ligament reconstruction: study protocol for a multicenter, single-blind, randomized controlled trial (PReP). Trials 2019; 20:495. [PMID: 31409425 PMCID: PMC6693217 DOI: 10.1186/s13063-019-3610-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/23/2019] [Indexed: 12/26/2022] Open
Abstract
Background Although anterior cruciate ligament (ACL) tear-prevention programs may be effective in the (secondary) prevention of a subsequent ACL injury, little is known, yet, on their effectiveness and feasibility. This study assesses the effects and implementation capacity of a secondary preventive motor-control training (the Stop-X program) after ACL reconstruction. Methods and design A multicenter, single-blind, randomized controlled, prospective, superiority, two-arm design is adopted. Subsequent patients (18–35 years) with primary arthroscopic unilateral ACL reconstruction with autologous hamstring graft are enrolled. Postoperative guideline rehabilitation plus Classic follow-up treatment and guideline rehabilitation plus the Stop-X intervention will be compared. The onset of the Stop-X program as part of the postoperative follow-up treatment is individualized and function based. The participants must be released for the training components. The endpoint is the unrestricted return to sport (RTS) decision. Before (where applicable) reconstruction and after the clearance for the intervention (aimed at 4–8 months post surgery) until the unrestricted RTS decision (but at least until 12 months post surgery), all outcomes will be assessed once a month. Each participant is consequently measured at least five times to a maximum of 12 times. Twelve, 18 and 24 months after the surgery, follow-up-measurements and recurrence monitoring will follow. The primary outcome assessement (normalized knee-separation distance at the Drop Jump Screening Test (DJST)) is followed by the functional secondary outcomes assessements. The latter consist of quality assessments during simple (combined) balance side, balance front and single-leg hops for distance. All hop/jump tests are self-administered and filmed from the frontal view (3-m distance). All videos are transferred using safe big content transfer and subsequently (and blinded) expertly video-rated. Secondary outcomes are questionnaires on patient-reported knee function, kinesiophobia, RTS after ACL injury and training/therapy volume (frequency – intensity – type and time). All questionnaires are completed online using the participants’ pseudonym only. Group allocation is executed randomly. The training intervention (Stop-X arm) consists of self-administered home-based exercises. The exercises are step-wise graduated and follow wound healing and functional restoration criteria. The training frequency for both arms is scheduled to be three times per week, each time for a 30 min duration. The program follows current (secondary) prevention guidelines. Repeated measurements gain-score analyses using analyses of (co-)variance are performed for all outcomes. Trial registration German Clinical Trials Register, identification number DRKS00015313. Registered on 1 October 2018.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt am Main, Germany.
| | | | - Andrea Achtnich
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Ralph Akoto
- Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Atesch Ateschrang
- BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt am Main, Germany.,Department of Preventive and Sports Medicine, Institute for Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Alexander Barié
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Raymond Best
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany.,Department of Orthopaedic Sportsmedicine, University of Tuebingen, Tuebingen, Germany
| | | | - Andreas Fischer
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Jürgen Höher
- Sports Clinic Cologne at Cologne Merheim Medical Center, Cologne, University of Witten/Herdecke, Cologne, Germany
| | - Maren Janko
- Department of Trauma, Hand, and Reconstructive Surgery, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Tobias M Jung
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | - Thomas Stoffels
- Department of Trauma and Orthopaedic Surgery, Unfallkrankenhaus Marzahn, Berlin, Germany
| | | | - Frederic Welsch
- Department of Sporttraumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Thomas Stein
- Department of Sporttraumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
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Ebert JR, Webster KE, Edwards PK, Joss BK, D'Alessandro P, Janes G, Annear P. Current perspectives of Australian therapists on rehabilitation and return to sport after anterior cruciate ligament reconstruction: A survey. Phys Ther Sport 2018; 35:139-145. [PMID: 30557764 DOI: 10.1016/j.ptsp.2018.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate views and practices of Australian therapists on rehabilitation and return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). DESIGN Survey-based study. SETTING Online survey platform. PARTICIPANTS Australian Physiotherapists and Accredited Exercise Physiologists (n = 223). MAIN OUTCOME MEASURES 1) perceived benefit, timing and frequency of rehabilitation, 2) timing of RTS and information on RTS evaluation and discharge criteria. RESULTS Therapists preferred to consult patients for the first time at 1-4 days (27.8%), ≤7 days (25.6%) or 7-14 days (30.5%) post-surgery. Within the first 6 weeks, 82.1% of therapists preferred patient visitation 1-2 times per week. Between 3 and 6 months, therapists mainly recommended less frequent visitation with a focus on home exercises. While 22.0% and 53.8% of therapists were willing to discharge patients for sport at 6-9 and 9-12 months, respectively, 22.9% preferred 12-18 months. Common RTS considerations were functional capacity (98.7%), strength (87.0%), lower limb and trunk mechanics (96.0%) and psychological readiness (87.9%). Knee strength was evaluated via manual muscle testing (33.0%), hand held (26.7%) and isokinetic (11.8%) dynamometry. For functional evaluation, 84.3% of therapists employed a hop battery (≥2 hop tests). CONCLUSIONS This survey revealed variation in beliefs and practices surrounding rehabilitation and RTS evaluation in Australian therapists.
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Affiliation(s)
- 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.
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Peter K Edwards
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Western Australia, Australia; HFRC Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Brendan K Joss
- HFRC Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Peter D'Alessandro
- Coastal Orthopaedics, Bethesda Hospital, Claremont, Western Australia, Australia
| | - Greg Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
| | - Peter Annear
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
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Tibial tunnel widening following anterior cruciate ligament reconstruction: A retrospective seven-year study evaluating the effects of initial graft tensioning and graft selection. Knee 2018; 25:1107-1114. [PMID: 30414786 PMCID: PMC6286238 DOI: 10.1016/j.knee.2018.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/09/2018] [Accepted: 08/11/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate tibial tunnel widening in ACL reconstruction patients over seven years to establish the effects of initial graft tension on tibial widening and clinical outcomes when using both patellar tendon (BTB) and hamstring tendon (HS) grafts. METHODS Ninety patients, who were reconstructed with BTB or HS autografts, were randomized using one of two initial graft tension protocols; 1) tensioned to restore normal anteroposterior laxity ("low-tension"; n = 46) and 2) tensioned to over-constrain anteroposterior (AP) laxity by two millimeters ("high-tension"; n = 44). Seventy patients had post-surgical data with 45 available for review at seven years. Tunnel widening was assessed via radiographs at one-, three-, and seven-year follow-up. Patient-reported outcomes were compared. RESULTS The mean ± 95% confidence intervals of the initial diameters for the BTB autografts were 10.3 ± 0.5 mm (Low-tension) and 10.2 ± 0.6 mm (High-tension) with final diameters of 10.8 ± 0.6 mm (Low-tension) and 9.9 ± 0.6 mm (High-tension). The initial diameters for HS autografts were 8.1 ± 0.9 mm (Low-tension) and 8.4 ± 0.7 mm (High-tension) with final diameters of 11.5 ± 1.1 mm (Low-tension) and 11.1 ± 0.9 mm (High-tension). For subjects with HS autografts, mean tunnel diameters significantly changed over time (p < .001); no significant changes were observed in BTB autografts (p = .29). Change in diameter of the HS autograft group remained significantly greater than the BTB group at all time points for both tension groups (p < .05). No differences in patient-reported outcomes were found between tension groups or graft types. CONCLUSIONS Patients who underwent ACL-R with HS autograft exhibited tibial tunnel widening over seven years. Patients with BTB autografts did not experience widening, regardless of initial graft tension. Patient-reported outcomes were equivalent.
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29
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Niederer D, Engeroff T, Wilke J, Vogt L, Banzer W. Return to play, performance, and career duration after anterior cruciate ligament rupture: A case-control study in the five biggest football nations in Europe. Scand J Med Sci Sports 2018; 28:2226-2233. [DOI: 10.1111/sms.13245] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine; Institute of Sports Sciences; Goethe-University Frankfurt; Frankfurt am Main Germany
| | - Tobias Engeroff
- Department of Sports Medicine; Institute of Sports Sciences; Goethe-University Frankfurt; Frankfurt am Main Germany
| | - Jan Wilke
- Department of Sports Medicine; Institute of Sports Sciences; Goethe-University Frankfurt; Frankfurt am Main Germany
| | - Lutz Vogt
- Department of Sports Medicine; Institute of Sports Sciences; Goethe-University Frankfurt; Frankfurt am Main Germany
| | - Winfried Banzer
- Department of Sports Medicine; Institute of Sports Sciences; Goethe-University Frankfurt; Frankfurt am Main Germany
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Di Miceli R, Marambio CB, Zati A, Monesi R, Benedetti MG. Do Knee Bracing and Delayed Weight Bearing Affect Mid-Term Functional Outcome after Anterior Cruciate Ligament Reconstruction? JOINTS 2017; 5:202-206. [PMID: 29270556 PMCID: PMC5738480 DOI: 10.1055/s-0037-1606617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose The aim of this study was to assess the effect of knee bracing and timing of full weight bearing after anterior cruciate ligament reconstruction (ACLR) on functional outcomes at mid-term follow-up. Methods We performed a retrospective study on 41 patients with ACLR. Patients were divided in two groups: ACLR group, who received isolated ACL reconstruction and ACLR-OI group who received ACL reconstruction and adjunctive surgery. Information about age at surgery, bracing, full or progressive weight bearing permission after surgery were collected for the two groups. Subjective IKDC score was obtained at follow-up. Statistical analysis was performed to compare the two groups for IKDC score. Subgroup analysis was performed to assess the effect of postoperative regimen (knee bracing and weight bearing) on functional outcomes. Results The mean age of patients was 30.8 ± 10.6 years. Mean IKDC score was 87.4 ± 13.9. The mean follow-up was 3.5 ± 1.8 years. Twenty-two (53.7%) patients underwent ACLR only, while 19 (46.3%) also received other interventions, such as meniscal repair and/or collateral ligament suture. Analysis of overall data showed no differences between the groups for IKDC score. Patients in the ACLR group exhibited a significantly better IKDC score when no brace and full weight bearing after 4 weeks from surgery was prescribed in comparison with patients who worn a brace and had delayed full weight bearing. No differences were found with respect to the use of brace and postoperative weight bearing regimen in the ACLR-OI group. Conclusion Brace and delayed weight bearing after ACLR have a negative influence on long-term functional outcomes. Further research is required to explore possible differences in the patients operated on ACLR and other intervention with respect to the use of a brace and the timing of full weight bearing to identify optimal recovery strategies. Level of Evidence Level III, retrospective observational study.
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Affiliation(s)
- Riccardo Di Miceli
- SC Medicina Fisica e Riabilitativa, Istituto Ortopedico Rizzoli di Bologna, Bologna, Italy
| | | | - Alessandro Zati
- SC Medicina Fisica e Riabilitativa, Istituto Ortopedico Rizzoli di Bologna, Bologna, Italy
| | - Roberta Monesi
- SC Medicina Fisica e Riabilitativa, Istituto Ortopedico Rizzoli di Bologna, Bologna, Italy
| | - Maria Grazia Benedetti
- SC Medicina Fisica e Riabilitativa, Istituto Ortopedico Rizzoli di Bologna, Bologna, Italy
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Jungmann PM, Baum T, Nevitt MC, Nardo L, Gersing AS, Lane NE, McCulloch CE, Rummeny EJ, Link TM. Degeneration in ACL Injured Knees with and without Reconstruction in Relation to Muscle Size and Fat Content-Data from the Osteoarthritis Initiative. PLoS One 2016; 11:e0166865. [PMID: 27918596 PMCID: PMC5137877 DOI: 10.1371/journal.pone.0166865] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 11/04/2016] [Indexed: 12/19/2022] Open
Abstract
Background Anterior cruciate ligaments (ACL) injuries represent a major risk factor for early osteoarthritis (OA). Purpose To evaluate the prevalence and 4-year progression of knee OA measured with 3T MR-imaging in individuals with ruptured, reconstructed or normal ACL and to assess the impact of thigh muscle characteristics. Methods A total of 54 knees (23/54 male, 31/54 female) were recruited from the Osteoarthritis Initiative (OAI). At baseline, 15/54 subjects had prevalent ACL ruptures and 15/54 subjects had prevalent ACL reconstruction (24/54 normal ACL). Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores, Physical Activity Scores of the Elderly (PASE) and thigh muscle characteristics including strength, fat infiltration (Goutallier score) and thigh muscle cross-sectional area (CSA) MR measurements were obtained at baseline. Whole-organ MR-imaging Scores (WORMS) were obtained at baseline and at a 4-year follow-up time-point. Multivariate regression models, adjusting for covariates (age, gender, body mass index), were used for statistical analysis. Results At baseline, subjects with prevalent ACL ruptures had worse WORMS total scores (mean±SEM, 44.1±3.5) than subjects with ACL reconstruction (30.8±4.0; P = 0.015) and worse than subjects with normal ACL (21.3±3.0; P<0.001). Cartilage scores were worse in both femorotibial compartments in ACL injured knees than in knees with normal ACL (P<0.05). Knees with ACL reconstruction showed an increased degeneration of the medial meniscus (P = 0.036), cartilage degeneration at the medial femoral condyle (P = 0.011). In a multivariate regression model, including both ACL groups and total muscle characteristics as influence parameters, high thigh muscle CSA, high muscle/ fat ratio and low Goutallier scores were associated with less degenerative changes at the knee, independent of ACL status. Knees with ACL reconstruction showed an increased progression of cartilage degeneration at the medial tibia compared to the normal ACL group (P = 0.027). Conclusions High thigh muscle CSA is associated with less degenerative changes at the knee, independent of the ACL status and may potentially be advantageous in the prevention of early OA.
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Affiliation(s)
- Pia M. Jungmann
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
- * E-mail:
| | - Thomas Baum
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Lorenzo Nardo
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | | | - Nancy E. Lane
- Department of Internal Medicine, UC Davis Medical Center, Sacramento, California, United States of America
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Ernst J. Rummeny
- Department of Radiology, Technische Universitaet Muenchen, Munich, Germany
| | - Thomas M. Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
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