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Rhim HC, Reichenbach R, Afifi T, Ruiz J, Noble-Taylor K, Barrack MT, Rauh MJ, Tenforde AS. Epidemiology of injuries in united states high school track and field jumping events from 2008 - 2019. PHYSICIAN SPORTSMED 2024:1-8. [PMID: 39158839 DOI: 10.1080/00913847.2024.2394850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/30/2024] [Accepted: 07/24/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES Reports of injury characteristics of high school track and field athletes participating in jumping events in the United States are limited. In this descriptive epidemiological study, we report injury rates and patterns in these athletes. METHODS Injuries and athletic exposures (AE) from the National High School Sports Related Injury Surveillance System, and High School Reporting Information Online (RIO) from 2008-2019 were analyzed. Jumping events included high jump, long jump, triple jump, and pole vault. Injury rate ratios (IRR) and injury proportion ratios (IPR) were examined by sex. RESULTS A total of 727 injuries related to jumping events during 5,486,279 AEs occurred with the highest frequency at the thigh (20.3%) followed by the ankle (18.2%), knee (16.1%), and lower leg (11.0%). The most common types of injuries were muscle strain (29.0%) and ligament sprain (21.2%). Most athletes returned to sport within 1 week (43.1%, n = 312) or 3 weeks (34.7%, n = 243). Few jumping-related injuries resulted in surgery (4.9%, n = 35) or medical disqualification (4.4%, n = 31). The jumping-related injury rate was 1.33 injuries/10,000 AEs from 2008 to 2019. The rate of jumping-related injuries was higher in competition than in practice (IRR = 2.63, 95% confidence interval [CI]: 2.25-3.06). Injury rates were significantly higher in practice for female athletes than for males (IRR = 1.51, 95% CI: 1.23-1.86). Compared to male athletes, female athletes sustained a higher proportion of ankle injuries (IPR = 1.63, 95% CI: 1.15-2.32) and ligament sprains (IPR = 1.55, 95% CI: 1.16-2.09). CONCLUSIONS This study describes injury characteristics of high school track and field jumping athletes from 2008 to 2019. We found an overall injury rate of 1.33 injuries per 10,000 AEs. Higher overall rates of jumping-related injuries occurred during competitions than in practice, and female athletes displayed a significantly higher rate of injuries during practices compared to male athletes.
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Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | - Toqa Afifi
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Joseph Ruiz
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Kayle Noble-Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, USA
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Charlestown, MA, USA
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Babalola OR, Akinyemi BA. Correlation of anthropometric parameters with semitendinosus tendon length in anterior cruciate ligament injured patients. Acta Orthop Belg 2023; 89:435-439. [PMID: 37935226 DOI: 10.52628/89.3.9318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) surgery is now a common procedure performed following a tear of the anterior cruciate ligament. The length of the harvested hamstring tendon is critical to the outcome of the surgery as it may influence the final length and thickness of the graft. The goal of this study was to attempt to establish a relation- ship between the height, weight and body mass index and the harvested length of the semitendinosus tendon of patients having ACLR surgery. This was a retrospective study. The weight, height, and body mass index (BMI) of patients for primary anterior cruciate ligament reconstruction were noted. The average length of the tendon was noted. The correla- tion between each of these anthropometric parameters and the tendon length was estimated. The range of values for the semitendinosus length, height and weight in males and females respectively were 24-39cm (31.26 +/- 2.93) and 26-35cm (29.26 +/- 2.08); 1.6-1.96 m and 1.65-1.8m; and 52-110kg and 60-106kg. Only the height revealed a moderate correlation with the length of the harvested tendon among the male patients. Linear regression analyses yielded the equation Sem- itendinosus tendon length = 23.25xheight-10.28 at a p-value of 0.002. Patient height could be predictive of the length of the harvested semitendinosus tendon.
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Dawkins J, Teel J, Kitziger R, Khair M. Anterior Cruciate Ligament Injury Prevention and Rehabilitation. HSS J 2023; 19:365-372. [PMID: 37435132 PMCID: PMC10331261 DOI: 10.1177/15563316231154475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/23/2022] [Indexed: 07/13/2023]
Abstract
At all levels of American football, knee injuries are common, with injuries to the anterior cruciate ligament (ACL) making up a significant proportion. Historically, ACL injuries were career-altering for professional players, but innovative techniques in surgery and rehabilitation have returned many to the field. While there is a consensus on surgical techniques for ACL reconstruction, significant discrepancies remain on injury prevention and rehabilitation programs. This review article describes the burden of ACL injury on players in the National Football League, best practices in injury prevention and rehabilitation, and evidence-based recommendations for preparing injured athletes to return to play.
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Affiliation(s)
| | - Jordan Teel
- Baylor University Medical Center, Dallas, TX, USA
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Sadeqi S, Norte GE, Murray A, Erbulut DU, Goel VK. Effect of Whole Body Parameters on Knee Joint Biomechanics: Implications for ACL Injury Prevention During Single-Leg Landings. Am J Sports Med 2023; 51:2098-2109. [PMID: 37259968 DOI: 10.1177/03635465231174899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Previous studies have examined the effect of whole body (WB) parameters on anterior cruciate ligament (ACL) strain and loads, as well as knee joint kinetics and kinematics. However, articular cartilage damage occurs in relation to ACL failure, and the effect of WB parameters on ACL strain and articular cartilage biomechanics during dynamic tasks is unclear. PURPOSES (1) To investigate the effect of WB parameters on ACL strain, as well as articular cartilage stress and contact force, during a single-leg cross drop (SLCD) and single-leg drop (SLD). (2) To identify WB parameters predictive of high ACL strain during these tasks. STUDY DESIGN Descriptive laboratory study. METHODS Three-dimensional motion analysis data from 14 physically active men and women were recorded during an SLCD and SLD. OpenSim was used to obtain their kinematics, kinetics, and muscle forces for the WB model. Using these data in kinetically driven finite element simulations of the knee joint produced outputs of ACL strains and articular cartilage stresses and contact forces. Spearman correlation coefficients were used to assess relationships between WB parameters and ACL strain and cartilage biomechanics. Moreover, receiver operating characteristic curve analyses and multivariate binary logistic regressions were used to find the WB parameters that could discriminate high from low ACL strain trials. RESULTS Correlations showed that more lumbar rotation away from the stance limb at peak ACL strain had the strongest overall association (ρ = 0.877) with peak ACL strain. Higher knee anterior shear force (ρ = 0.895) and lower gluteus maximus muscle force (ρ = 0.89) at peak ACL strain demonstrated the strongest associations with peak articular cartilage stress or contact force in ≥1 of the analyzed tasks. The regression model that used muscle forces to predict high ACL strain trials during the dominant limb SLD yielded the highest accuracy (93.5%), sensitivity (0.881), and specificity (0.952) among all regression models. CONCLUSION WB parameters that were most consistently associated with and predictive of high ACL strain and poor articular cartilage biomechanics during the SLCD and SLD tasks included greater knee abduction angle at initial contact and higher anterior shear force at peak ACL strain, as well as lower gracilis, gluteus maximus, and medial gastrocnemius muscle forces. CLINICAL RELEVANCE Knowledge of which landing postures create a high risk for ACL or cartilage injury may help reduce injuries in athletes by avoiding those postures and practicing the tasks with reduced high-risk motions, as well as by strengthening the muscles that protect the knee during single-leg landings.
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Affiliation(s)
- Sara Sadeqi
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Grant E Norte
- Motion Analysis and Integrative Neurophysiology Lab, Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Amanda Murray
- Motion Analysis and Integrative Neurophysiology Lab, Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Deniz U Erbulut
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Vijay K Goel
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
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Mickevicius M, Satkunskiene D, Sipaviciene S, Kamandulis S. Riding a Mechanical Scooter from the Inconvenient Side Promotes Muscular Balance Development in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1064. [PMID: 37371295 DOI: 10.3390/children10061064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Mechanical scooter riding is a popular physical activity among children, but little is known about the differences in muscle loading between the dominant and non-dominant sides during this activity. The objective of this study was to identify the muscle activation patterns in children's dominant and non-dominant legs as they rode scooters on the convenient and inconvenient sides. The study included nine healthy children aged 6-8. The participants rode 20 m on a mechanical scooter at a self-selected pace using both the convenient and inconvenient sides. Electromyography was used to measure the muscle activity in the dominant and non-dominant legs during the pushing and gliding phases. A 20 m sprint run was used as a control exercise to estimate the typical differences in muscle activation between the dominant and non-dominant legs. In the pushing phase, the symmetry index for five of the eight analyzed muscles exceeded 50% (p < 0.05); four of these muscles were more active in the pushing leg, and one was more active in the standing leg. In the gliding phase, four muscles were more active in the standing leg, and one was more active in the pushing leg (p < 0.05). Upon observing children who changed sides while riding a scooter, it was found that the pattern of muscle activation displayed a reverse trend that resembled the initial pattern. Our study indicated notable differences in muscle activity patterns between the dominant and non-dominant sides of individual leg muscles during children's scooter riding. These patterns were reversed when children switched sides on the scooter. These findings suggest that using both legs and switching sides while riding a scooter may be a viable strategy for promoting balanced muscular development.
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Affiliation(s)
- Mantas Mickevicius
- Institute of Sports Science and Innovations, Lithuanian Sports University, 44221 Kaunas, Lithuania
| | - Danguole Satkunskiene
- Institute of Sports Science and Innovations, Lithuanian Sports University, 44221 Kaunas, Lithuania
| | - Saule Sipaviciene
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, 44221 Kaunas, Lithuania
| | - Sigitas Kamandulis
- Institute of Sports Science and Innovations, Lithuanian Sports University, 44221 Kaunas, Lithuania
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Mert A, Cinaroglu S, Keleş H, Aydin M, Çiçek F. Evaluation of Autografts Used in Anterior Cruciate Ligament Reconstruction in Terms of Tensile Strength. Cureus 2023; 15:e39927. [PMID: 37409216 PMCID: PMC10318378 DOI: 10.7759/cureus.39927] [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] [Accepted: 06/03/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Anterior cruciate ligament (ACL) injuries increase the likelihood of chronic knee problems in later years, including early onset osteoarthritis. Therefore, ACL treatment is important in preventing knee problems from developing. The treatment of choice for ACL tears is surgery (ACL reconstruction), and the most popular tendons for ACL reconstruction are the patellar tendon, hamstring tendon (semitendinosus and gracilis tendons), and bone-patellar tendon-bone. The present study compares the tensile strength of autografts used in ACL reconstruction to identify the optimum autograft for ACL in terms of mechanical properties. Methods Cadavers were dissected, and the Achilles tendons, quadriceps tendons, hamstring tendons (semitendinosus and gracilis tendons), patellar tendon grafts, and ACLs were harvested. Tensile tests of each tendon graft were performed using a Shimadzu Autograph AG-IS 100 kN tester (Shimadzu, Kyoto, Japan). Results The mean difference in tensile strength between ACL and other grafts was lowest for the quadriceps in both males and females (p ˂ 0.001), meaning that ACL and quadriceps grafts are more compatible than other tendon grafts in terms of tensile strength. Conclusion The present study found the lowest mean difference in tensile strength to be between the ACL and the quadriceps tendon, suggesting that the use of the quadriceps tendon in ACL reconstruction will yield more positive outcomes.
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Affiliation(s)
- Ahmet Mert
- Department of Orthopedics and Traumatology, Niğde Ömer Halisdemir University Faculty of Medicine, Niğde, TUR
| | - Selim Cinaroglu
- Department of Anatomy, Niğde Ömer Halisdemir University Faculty of Medicine, Niğde, TUR
| | - Hacı Keleş
- Department of Anatomy, Niğde Ömer Halisdemir University Faculty of Medicine, Niğde, TUR
| | - Murat Aydin
- Department of Orthopedics and Traumatology, Niğde Ömer Halisdemir University Faculty of Medicine, Niğde, TUR
| | - Fatih Çiçek
- Department of Anatomy, Niğde Ömer Halisdemir University Faculty of Medicine, Niğde, TUR
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Dalvandpour N, Zareei M, Abbasi H, Abdoli B, Mohammadian MA, Rommers N, Rössler R. Focus of Attention During ACL Injury Prevention Exercises Affects Improvements in Jump-Landing Kinematics in Soccer Players: A Randomized Controlled Trial. J Strength Cond Res 2023; 37:337-342. [PMID: 36696258 DOI: 10.1519/jsc.0000000000004201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT Dalvandpour, N, Zareei, M, Abbasi, H, Abdoli, B, Mohammadian, MA, Rommers, N, and Rössler, R. Focus of attention during ACL injury prevention exercises affects improvements in jump-landing kinematics in soccer players: a randomized controlled trial. J Strength Cond Res 37(2): 337-342, 2023-Anterior cruciate ligament tears are severe and complex knee injuries that commonly occur in soccer. Prevent injuries enhance performance (PEP) is an exercise-based prevention program to effectively reduce anterior cruciate ligament injuries. It is, however, unclear how the delivery of the program contributes to its effectiveness. Therefore, we aimed to investigate the effect of the focus of attention that was emphasized during the delivery of the PEP program on jump-landing kinematics in male, elite-level, U21 soccer players. Forty-two players participated in this randomized controlled trial and were allocated to (a) the internal focus of attention (IF) group, receiving instructions focusing on the execution of the exercise (b), the external focus of attention (EF) group, receiving instructions focusing on the outcome of the exercise, or (c) the control group. Before and after the 8-week intervention, players performed a jump-landing task during which we measured hip and knee angles at the initial contact, peak knee flexion, and peak vertical ground reaction force using a 3-dimensional motion analyzer. A repeated-measures analysis of variance was used to compare groups over time. Significant time-by-group interaction effects with large effect sizes were found for hip flexion at all moments (p < 0.032; η2 > 0.15) and for the knee flexion angle at initial contact and maximum knee flexion (p < 0.001; η2 > 0.35), all in favor of the EF group. This shows that EF during PEP improves hip and knee joint kinematics in the sagittal plane more than IF. Therefore, EF during PEP instructions is preferred to increase the effectiveness of this injury prevention program.
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Affiliation(s)
- Nazanin Dalvandpour
- Department of Sport Rehabilitation and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Mostafa Zareei
- Department of Sport Rehabilitation and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Hamed Abbasi
- Department of Sport Injuries and Corrective Exercises, Sport Sciences Research Institute, Tehran, Iran
| | - Behrouz Abdoli
- Department of Behavioral and Cognitive Sciences in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | | | - Nikki Rommers
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland; and
| | - Roland Rössler
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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8
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Paudel YR, Sommerfeldt M, Voaklander D. Increasing incidence of anterior cruciate ligament reconstruction: a 17-year population-based study. Knee Surg Sports Traumatol Arthrosc 2023; 31:248-255. [PMID: 35948850 DOI: 10.1007/s00167-022-07093-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries are one of the most frequently studied injuries in orthopedic care and research. However, limited epidemiological data are available in Canada regarding trend and distribution of anterior cruciate ligament reconstruction (ACLR). In this paper, our purpose was to assess trends of ACLR between 2002/03 and 2018/19 by age, sex, season of surgery, and location (inpatient vs outpatient) of surgery. METHODS In this descriptive epidemiological study of retrospective data available from Alberta Ministry of Health, we report annual incidence of ACLR between 2002/03 until 2018/19 among Albertans aged 10 years and older. Information was collected by authors from physician claims database for primary ACLR and revision ACLR and linked with other databases. Incidence proportions (number of ACLR/100,000 population) were calculated and compared by age category and gender over the study period. RESULTS A total of 28,401 primary ACLR and 2085 revision ACLR were identified during the study period. Age-standardized annual incidence of primary ACLR increased from 40.6 to 51.2 per 100,000 population aged 10 years and older. Average annual increase in ACLR incidence was higher among females (1.8% per years) compared to males (0.96% per year). The overall peak incidence and peak incidence among males was observed in 20-29 year age group, whereas peak incidence in females was observed in 10-19 years of age. The number of ACLR in females outnumbers those among males for 10-19 year age group. Generally, a lower proportion of ACLR were conducted in summer compared to other seasons. Primary ACLR conducted in outpatient setting increased from 72% in 2002/03 to 97% in 2018/19. CONCLUSION The incidence of ACLR is increasing in Alberta, especially among females and among younger cohorts under 20 years of age. This information can help clinicians to provide patient education and policy-makers to design and implement targeted ACL injury prevention programs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yuba Raj Paudel
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Mark Sommerfeldt
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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O’Connor JP, Holden P, Gagnier JJ. Systematic review: preoperative psychological factors and total hip arthroplasty outcomes. J Orthop Surg Res 2022; 17:457. [PMID: 36253795 PMCID: PMC9575292 DOI: 10.1186/s13018-022-03355-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Total hip arthroplasties (THA) are cost-effective interventions for patients with osteoarthritis refractory to physical therapy or medical management. Most individuals report positive surgical outcomes with reduction in pain and improved joint function. Multiple recent studies demonstrated the influence of patient mental health on surgical success. We sought to determine the relationship between patient preoperative psychological factors and postoperative THA outcomes, specifically pain and function. Methods PubMed, EMBASE and Cochrane Reviews databases were queried using terms “(mental OR psychological OR psychiatric) AND (function OR trait OR state OR predictor OR health) AND (outcome OR success OR recovery OR response) AND total joint arthroplasty).” A total of 21 of 1,286 studies fulfilled inclusion criteria and were included in the review. All studies were analyzed using GRADE and Risk of Bias criteria. Results Overall, compared to cohorts with a normal psychological status, patients with higher objective measures of preoperative depression and anxiety reported increased postoperative pain, decreased functionality and greater complications following THA. Additionally, participants with lower self-efficacy or somatization were found to have worse functional outcomes. Conclusions Preoperative depression, anxiety and somatization may negatively impact patient reported postoperative pain, functionality and complications following THA. Surgeons should consider preoperative psychological status when counseling patients regarding expected surgical outcomes. Level of evidence 3. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03355-3.
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Davis-Wilson HC, Thoma LM, Johnston CD, Young E, Evans-Pickett A, Spang JT, Blackburn JT, Hackney AC, Pietrosimone B. Fewer daily steps are associated with greater cartilage oligomeric matrix protein response to loading post-ACL reconstruction. J Orthop Res 2022; 40:2248-2257. [PMID: 35060165 DOI: 10.1002/jor.25268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/19/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
Aberrant joint loading contributes to the development of posttraumatic knee osteoarthritis (PTOA) following anterior cruciate ligament reconstruction (ACLR); yet little is known about the association between joint loading due to daily walking and cartilage health post-ACLR. Accelerometer-based measures of daily steps and cadence (i.e., rate of steps/min) provide information regarding daily walking in a real-world setting. The purpose of this study was to determine the association between changes in serum cartilage oligomeric matrix protein (COMP; %∆COMP), a mechanosensitive biomarker that is associated with osteoarthritis progression, following a standardized walking protocol and daily walking in individuals with ACLR and uninjured controls. Daily walking was assessed over 7 days using an accelerometer worn on the right hip in 31 individuals with ACLR and 21 controls and quantified as mean steps/day and time spent in ≥100 steps/min. Serum COMP was measured before and following a 3000-step walking protocol at a preferred speed. %∆COMP was calculated as a change in COMP relative to the prewalking value. Linear regressions were used to examine associations between daily walking and %∆COMP after adjusting for preferred speed. Fewer daily steps (ΔR2 = 0.18, p = 0.02) and fewer minutes spent in ≥100 steps/min (ΔR2 = 0.16, p = 0.03) were associated with greater %∆COMP following walking in individuals with ACLR; no statistically significant associations existed in controls (daily steps: ΔR2 = 0.03, p = 0.47; time ≥100 steps/min: ΔR2 < 0.01, p = 0.81). Clinical significance: Individuals with ACLR who engage in less daily walking undergo greater %ΔCOMP, which may represent greater cartilage degradation or turnover in response to walking.
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Affiliation(s)
- Hope C Davis-Wilson
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Louise M Thoma
- Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher D Johnston
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emma Young
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Athletic Training Program, The Steadman Clinic, Vail, Colorado, USA
| | - Alyssa Evans-Pickett
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J Troy Blackburn
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anthony C Hackney
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Hawkinson LE, Yates L, Minnig MC, Register-Mihalik JK, Golightly YM, Padua DA. Understanding Youth Sport Coaches' Perceptions of Evidence-Based Injury-Prevention Training Programs: A Systematic Literature Review. J Athl Train 2022; 57:877-893. [PMID: 36638345 PMCID: PMC9842123 DOI: 10.4085/1062-6050-0215.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To systematically review and summarize the knowledge, attitudes, beliefs, and contextual perceptions of youth sport coaches toward injury-prevention training programs by using the Theoretical Domains Framework to guide the organization of results. DATA SOURCES Systematic searches of PubMed and Google Scholar were undertaken in November 2021. STUDY SELECTION The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed. Results were limited to full-text articles that were published in peer-reviewed journals and printed in English. Additional studies were added after a citation search of included studies. Studies were eligible for inclusion if researchers evaluated youth sport coaches' knowledge, beliefs, contextual perceptions, or all 3 of anterior cruciate ligament injury-prevention training programs. DATA EXTRACTION Data charting was performed by 1 author and confirmed by a separate author. DATA SYNTHESIS Of the 1194 articles identified, 19 were included in the final sample. Among articles in which researchers assessed knowledge (n = 19), coaches' awareness of the existence and components of injury-prevention training programs was inconsistent. Among articles in which researchers assessed beliefs (n = 19), many coaches had positive attitudes toward injury-prevention training programs, but few believed youth athletes are at a high risk of injury. Among articles in which researchers assessed contextual perceptions (n = 13), many coaches did not feel they had access to information about injury-prevention training programs and cited a lack of time, space, support, and other resources as barriers to implementation. CONCLUSIONS Our findings support the need for programs, protocols, and policies to enhance knowledge of and support for youth sport coaches who wish to implement injury-prevention training programs. A gap exists in the research about addressing the needs of youth sport coaches in the United States high school sports setting. The use of multilevel implementation science frameworks (such as the Theoretical Domains Framework) will be beneficial for identifying constructs that affect implementation and developing train-the-trainer programming to meet the needs of individual youth sport coaches.
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Affiliation(s)
- Lauren E. Hawkinson
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Lindsey Yates
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill
| | - Mary Catherine Minnig
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Johna K. Register-Mihalik
- Matthew Gfeller Center and STAR Heel Performance Laboratory, Department of Exercise and Sport Science, Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, Biomedical Engineering, Allied Health Sciences, University of North Carolina at Chapel Hill
- MOTION Science Institute, University of North Carolina at Chapel Hill
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12
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Ageberg E, Brodin EM, Linnéll J, Moesch K, Donaldson A, Adébo E, Benjaminse A, Ekengren J, Granér S, Johnson U, Lucander K, Myklebust G, Møller M, Tranaeus U, Bunke S. Cocreating injury prevention training for youth team handball: bridging theory and practice. BMJ Open Sport Exerc Med 2022; 8:e001263. [PMID: 35505981 PMCID: PMC8984048 DOI: 10.1136/bmjsem-2021-001263] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/12/2022] Open
Abstract
Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants’ contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.
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Affiliation(s)
- Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Eva M Brodin
- Department of Educational Sciences, Lund University, Lund, Sweden.,Centre for Higher and Adult Education (CHAE), Stellenbosch University, Stellenbosch, South Africa
| | - Jennie Linnéll
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Karin Moesch
- Department of Psychology, Lund University, Lund, Sweden
| | - Alex Donaldson
- Centre for Sport and Social Impact (CSSI), La Trobe University, Melbourne, Victoria, Australia
| | - Emme Adébo
- Regional Handball Federation in South Sweden, Lund, Sweden
| | - Anne Benjaminse
- Center for Human Movement Sciences, University of Groningen, Groningen, The Netherlands.,School of Sport Studies, Hanze University Groningen School of Social Studies, Groningen, The Netherlands
| | - Johan Ekengren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Simon Granér
- Department of Psychology, Lund University, Lund, Sweden
| | - Urban Johnson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | | | - Grethe Myklebust
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
| | - Merete Møller
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ulrika Tranaeus
- Department of physiology, nutrition and biomechanics, The Swedish School of Sport and Health Sciences, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Bunke
- Department of Psychology, Lund University, Lund, Sweden
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13
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Wong AYY, Man GCW, Wu YM, Wong HW, Ong MTY, Yung PSH. Risk of surgery and epidemiological profile of athletes presenting to a single sports injury clinic in Hong Kong. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221082314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Although participation in sports and exercise is promoted widely due to its health benefits, sports-related injuries can also be a detriment to an individual's health and a burden for the healthcare system. Herein, the aim of this study is to provide a comprehensive review on the epidemiological profile and the risk for surgery of athletes presented to a sports injuries clinic in Hong Kong. Methods A total of 566 patients attending the sports injuries clinic at a local hospital between October 2017 and September 2018 were reviewed. Only 271 patients sustaining injuries from sports activities were included. These patients attended a survey-based data collection session, which recorded their demographic, injury site, events leading to injury, exercise details (type, level-of-play, frequency, experience), and functional score according to the injury site. Results The highest proportion of injuries was observed in amateur athletes (45.4%) than in recreational (28.8%) and professional (25.8%). Those patients aged between 18–29 years old (50.2%) had the most injuries. Both soccer (25.1%) and basketball (25.1%) were the two most common sports to incurred injuries. Whereas, the lower extremities being the most common injured sites. Based on our logistic model, athletes with less experience were more prone to required surgeries with injuries in the lower extremities. Conclusion Preventive measures should be targeted at less experience athletes, focusing on strengthening the knee region, to reduce sports-related injuries and surgeries. Importantly, this study demonstrates the need to further identify factors to develop effective sports injury prevention programmes for tailoring athletes at different levels-of-play.
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Affiliation(s)
- Ashley Ying-Ying Wong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Gene Chi-Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yuen-Man Wu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Hiu-Wun Wong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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14
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Mattu AT, Ghali B, Linton V, Zheng A, Pike I. Prevention of Non-Contact Anterior Cruciate Ligament Injuries among Youth Female Athletes: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084648. [PMID: 35457516 PMCID: PMC9027388 DOI: 10.3390/ijerph19084648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023]
Abstract
Anterior cruciate ligament (ACL) injuries account for a large percentage of knee injuries, disproportionately affecting female athletes. To help health professionals stay current, we performed an umbrella review to evaluate the effectiveness of ACL injury prevention programs in reducing non-contact ACL injury rates, determine the effective components within interventions, and provide clinical recommendations. Twelve databases (Medline, Embase, Cochrane Database of Systematic Reviews, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, PEDro, Web of Science Core Collection, Epistemonikos, TRIP, BC Guidelines and Protocols, CPG Infobase, ProQuest Dissertations and Theses Global) were searched in May 2021 to identify relevant systematic reviews and meta-analyses. Four databases were searched again in September 2021 to identify recent primary literature. Non-contact ACL injury data were extracted to calculate incidence rate ratios (IRRs) and these were combined using an inverse variance random-effects model. A qualitative assessment of included reviews was performed. The methodological quality of the studies was assessed using a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) or Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Sixteen reviews and two primary studies met the inclusion criteria. Across 11 primary studies, prevention programs were effective in reducing non-contact ACL injuries by 64% (IRR = 0.36 (95% CI: 0.18–0.70)). A multi-faceted exercise program, beginning in the pre-season and containing at least three exercise types, may be beneficial in reducing ACL injury risk.
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Affiliation(s)
- Anmol T. Mattu
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence:
| | - Brianna Ghali
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Vanessa Linton
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3V4, Canada
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15
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Boden BP, Sheehan FT. Mechanism of non-contact ACL injury: OREF Clinical Research Award 2021. J Orthop Res 2022; 40:531-540. [PMID: 34951064 PMCID: PMC8858885 DOI: 10.1002/jor.25257] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) ruptures significantly impact athletes in terms of return to play and loss of long-term quality of life. Before the onset of this study, understanding the mechanism of ACL injury was limited. Thus, the primary focus of this manuscript is to describe our multi-faceted approach to uncovering the mechanism of noncontact ACL injury (NC-ACLI) with the goal of developing preventive strategies. The initial qualitative analysis of ACL injury events revealed most (70%) injuries involve minimal to no contact and occurr during landing or deceleration maneuvers in team sports with a minor perturbation before the injury that may disrupt the neuromuscular system leading to poor body dynamics. A series of quantitative videotape studies demonstrated differences in leg and trunk positions at the time of NC-ACLI in comparison to control subjects. Analysis of the faulty dynamics provoking NC-ACLI, especially the flat-footed landing component, supports the theory that an axial compressive force is the critical factor responsible for NC-ACLI. Our magnetic resonance imaging study demonstrated the NC-ACLI position was associated with a higher tibial slope, and joint contact occurring on the flat, anterior portion of the lateral femoral condyle versus the round, posterior aspect. Both anatomic conditions favor sliding (pivot shift) over rolling in the presence of an axial compressive force. Subsequent cadaveric studies supported axial compressive forces as the primary component of NC-ACLI. Both a strong eccentric quadriceps contraction and knee abduction moments may increase the compressive force at the joint thereby lowering the axial threshold to injury. This manuscript summarizes the NC-ACLI mechanism portion of the 2021 OREF Clinical Research Award.
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Affiliation(s)
- Barry P. Boden
- The Orthopaedic Center, a Division of Centers for Advanced Orthopaedics, 14995 Shady Grove Road, Suite 350, Rockville, MD 20815
| | - Frances T. Sheehan
- National Institutes of Health, Department of Rehabilitation Medicine, 6707 Democracy Blvd., Suite 856, Bethesda, Maryland 20817
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16
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Wagemans J, Bleakley C, Taeymans J, Schurz AP, Kuppens K, Baur H, Vissers D. Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: A systematic review update with meta-analysis. PLoS One 2022; 17:e0262023. [PMID: 35134061 PMCID: PMC8824326 DOI: 10.1371/journal.pone.0262023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/15/2021] [Indexed: 12/26/2022] Open
Abstract
Research questions 1) Do exercise-based rehabilitation programs reduce re-injury following acute ankle sprain?; 2) Is rehabilitation effectiveness moderated by the exercise’s therapeutic quality, content and volume? Methods This systematic review with meta-analysis (PROSPERO: CRD42020210858) included randomized controlled trials in which adults who sustained an acute ankle sprain received exercise-based rehabilitation as an intervention. Databases CINAHL, Web of Science, SPORTDiscus, Cochrane Central Register of Controlled Trials, PEDro and Google Scholar were searched for eligible articles (last search: March 2021). ROB II screening tool by Cochrane was used to assess risk of bias and the i-CONTENT tool was used to assess quality of interventions. Both qualitative analysis and quantitative data synthesis were performed. Results Fourteen randomized controlled trials comprising 2182 participants were included. Five studies were judged overall low risk of bias and i-CONTENT assessment showed poor to moderate therapeutic quality of exercise across all included articles. Pooled data found significant reductions in re-injury prevalence at 12 months, in favour of the exercise-based rehabilitation group vs usual care (OR: 0.60; 95%CI: 0.36 to 0.99). Pooled data for re-injury incidence showed not-significant results (MD: 0.027; 95%CI: -2.14 to 2.19). Meta-regression displayed no statistically significant association between training volume and odds of re-injury (r = -0.00086; SD: 0.00057; 95%CI: -0.00197 to 0.00025). Results from patient-reported outcomes and clinical outcomes were inconclusive at 1 month, 3–6 months and 7–12 months of follow up. Conclusion Exercise-based rehabilitation reduces the risk of recurrent ankle sprain compared to usual care, but there is insufficient data to determine the optimal content of exercise-based interventions. Training volume varied considerably across studies but did not affect the odds of sustaining a re-injury. Effects on patient-reported outcomes and clinical outcomes are equivocal. Future research should compare different exercise contents, training volumes and intensities after ankle sprain.
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Affiliation(s)
- Jente Wagemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- * E-mail: ,
| | - Chris Bleakley
- School of Health Science, Ulster University, Newtownabbey, Northern Ireland
| | - Jan Taeymans
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Kevin Kuppens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Heiner Baur
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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17
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The "SHRed Injuries Basketball" Neuromuscular Training Warm-up Program Reduces Ankle and Knee Injury Rates by 36% in Youth Basketball. J Orthop Sports Phys Ther 2022; 52:40-48. [PMID: 34972488 DOI: 10.2519/jospt.2022.10959] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a neuromuscular training warm-up prevention program, Surveillance in High school and community sport to Reduce (SHRed) Injuries Basketball, for reducing all-complaint ankle and knee injuries in youth basketball players. DESIGN Quasi-experimental study. METHODS High school/club basketball teams (male and female players aged 11-18 years) in Calgary, Canada participated in 2016-2017 (control; season 1) and 2017-2018 (intervention; season 2). The control season included a standard-of-practice warm-up. In season 2, a SHRed Injuries Basketball coach workshop was completed by participating team coaches. Teams were randomized by school/club to an unsupervised or a supervised (weekly supervision by study personnel) implementation of the coach-delivered SHRed Injuries Basketball program. The 10-minute SHRed Injuries Basketball program included 13 exercises (ie, aerobic, agility, strength, balance). All-complaint ankle and knee injuries were collected weekly using validated injury surveillance. Multilevel, multivariable Poisson regression analyses (considering important covariates, clustering by team and individual, and offset by exposure hours) estimated incidence rate ratios (IRRs) by intervention group (season 1 versus season 2) and secondarily considered the control versus completion of the SHRed Injuries Basketball program, unsupervised and supervised. RESULTS Sixty-three teams (n = 502 players) participated in season 1 and 31 teams (n = 307 players: 143 unsupervised, 164 supervised) participated in season 2. The SHRed Injuries Basketball program was protective against all-complaint knee and ankle injuries (IRR = 0.64; 95% confidence interval [CI]: 0.51, 0.79). Unsupervised (IRR = 0.62; 95% CI: 0.47, 0.83) and supervised (IRR = 0.64; 95% CI: 0.49, 0.85) implementations of the SHRed Injuries Basketball program had similar protective effects. CONCLUSION The SHRed Injuries Basketball program was associated with a 36% lower rate of ankle and knee injuries. Neuromuscular training warm-ups are recommended as the minimal standard of practice for injury prevention in youth basketball. J Orthop Sports Phys Ther 2022;52(1):40-48. doi:10.2519/jospt.2022.10959.
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18
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Davis AM, Wong R, Steinhart K, Cruz L, Cudmore D, Dwyer T, Li L, Marks P, McGlasson R, Urquhart N, Wilson JA, Nimmon L, Ogilvie-Harris D, Chahal J. Development of an intervention to manage knee osteoarthritis risk and symptoms following anterior cruciate ligament injury. Osteoarthritis Cartilage 2021; 29:1654-1665. [PMID: 34597801 DOI: 10.1016/j.joca.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/28/2021] [Accepted: 08/12/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) injury is a risk factor for developing knee osteoarthritis (OA). We developed an intervention to support people manage risk factors for OA. METHODS We conducted one-on-one interviews with 20 individuals with OA symptoms 6-15 years post ACL injury and used a nominal group process during a workshop with 40 patients and healthcare professionals (HCPs) to elicit information on the intervention content and delivery characteristics (timing, HCPs, and methods). Interview data were analyzed using content analysis. Nominal group ideas with importance ratings ≥5 of 7 met criteria for inclusion. Results were integrated, considering similarities and differences. RESULTS Eight content categories were identified: 1. understanding knee injury and expectations about recovery; 2. understanding OA risk; 3. understanding OA signs and symptoms; 4. managing OA risk; 5. managing knee OA symptoms; 6. information for influencers; 7. credible sources; and, 8. updates on new evidence and treatments. Delivery timing reflected a lifespan approach from time of injury through symptomatic knee OA management. Although multiple media for delivery were identified, introductory face-to-face discussions and opportunity for re-accessing HCPs were critical. All HCPs who treat people with ACL should be familiar with and able to deliver the intervention. CONCLUSIONS This co-development approach identified that an intervention to support people with ACL injury to limit and manage knee OA requires content embedded within an easily accessible, multi-media delivery model with capacity for check-back with HCPs that is appealing to different age groups and personal preferences over the lifespan post injury.
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Affiliation(s)
- A M Davis
- Institute of Health Policy, Management and Evaluation and Department of Physical Therapy, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada.
| | - R Wong
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
| | - K Steinhart
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
| | - L Cruz
- LiveActive Sport Medicine and Women's College Hospital, University of Toronto, Toronto, Canada.
| | - D Cudmore
- Family and Sport Medicine, St. Francis Xavier University, Antigonish, and Department of Family Medicine, Dalhousie University, Halifax, Canada.
| | - T Dwyer
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital College and Mount Sinai Hospital, University of Toronto, Toronto, Canada.
| | - L Li
- Arthritis Research Canada, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
| | - P Marks
- University of Toronto Orthopaedic Sports Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
| | | | - N Urquhart
- Dartmouth General Hospital, Orthopaedic Surgery, Dalhousie University, Halifax, Canada.
| | - J A Wilson
- Department of Surgery, McMaster University, Hamilton, Canada.
| | - L Nimmon
- Centre for Health Education Scholarship, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - D Ogilvie-Harris
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, Toronto, Canada.
| | - J Chahal
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Schroeder Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada.
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Stephenson SD, Kocan JW, Vinod AV, Kluczynski MA, Bisson LJ. A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies. Orthop J Sports Med 2021; 9:23259671211035776. [PMID: 34734094 PMCID: PMC8558815 DOI: 10.1177/23259671211035776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/03/2021] [Indexed: 12/26/2022] Open
Abstract
Background A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs. Purpose To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries. Study Design Systematic review; Level of evidence, 4. Methods We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version). Results A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias. Conclusion This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.
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Affiliation(s)
- Samuel D Stephenson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Joseph W Kocan
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Amrit V Vinod
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
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20
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Tait DB, Newman P, Ball NB, Spratford W. What did the ankle say to the knee? Estimating knee dynamics during landing - A systematic review and meta-analysis. J Sci Med Sport 2021; 25:183-191. [PMID: 34509342 DOI: 10.1016/j.jsams.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Landing-based measures of the knee are often used to assess risk of anterior cruciate ligament (ACL) injury and inform prevention strategies. There is less understanding of the ankle's influence on knee measures during landing. OBJECTIVE 1. Examine interactions of dynamic ankle measures alongside various subject and task characteristics on knee dynamics in vertical landing and 2. Determine whether ankle measures alone can estimate dynamic knee measures associated with ACL injury risk. DESIGN Systematic review and meta-analysis. METHODS Electronic databases Medline, EMBASE, CINAHL, Web of Science and Cochrane were screened for studies that included measurement of initial contact angles and internal joint moments of both the ankle and knee during landing in uninjured individuals. RESULTS 28 studies were included for analysis. Using 1144 landing trials from 859 individuals, RRelief F algorithm ranked dynamic ankle measures more important than landing task and subject characteristics in estimating knee dynamics. An adaptive boosting model using four dynamic ankle measures accurately estimated knee extension (R2 = 0.738, RMSE = 3.65) and knee abduction (R2 = 0.999, RMSE = 0.06) at initial contact and peak knee extension moment (R2 = 0.988, RMSE = 0.13) and peak knee adduction moment (R2 = 1, RMSE = 0.00). CONCLUSIONS Dynamic ankle measures can accurately estimate initial contact angles and peak moments of the knee in vertical landing, regardless of landing task or individual subject characteristics. This study provides a theoretical basis for the importance of the ankle in ACL injury prevention.
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Affiliation(s)
- Daniel B Tait
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia; UC Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, Australia.
| | - Phillip Newman
- UC Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, Australia
| | - Nick B Ball
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia; UC Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, Australia
| | - Wayne Spratford
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia; UC Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, Australia
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21
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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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22
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Allahabadi S, Feeley SE, Lansdown DA, Pandya NK, Feeley BT. Influential Articles on Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Bibliometric Analysis. Orthop J Sports Med 2021; 9:23259671211010772. [PMID: 34164558 PMCID: PMC8191091 DOI: 10.1177/23259671211010772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/09/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The understanding of pediatric anterior cruciate ligament (ACL) injuries and optimal treatment has evolved significantly. Influential articles have been previously evaluated using article citations to determine impact. PURPOSE To identify and characterize the 50 most cited and recent influential articles relating to pediatric and adolescent ACL injuries, to examine trends in publication characteristics, and to evaluate correlations of study citations with quality of evidence. STUDY DESIGN Cross-sectional study. METHODS The top 50 most cited articles on pediatric and adolescent ACL injuries were gathered using the Web of Science and Scopus online databases by averaging the number of citations from each database. Articles from recent years were also aggregated and sorted by citation density (citations/year). Publication and study characteristics were recorded. Level of evidence and methodologic quality were assessed where applicable using the modified Coleman Methodology Score (mCMS), modified Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS). Spearman correlation was used to evaluate the association between citation data and level of evidence or methodologic quality scorings. RESULTS The top 50 cited papers had a mean of 117.5 ± 58.8 citations (range, 58.5-288.5 citations), with a mean citation density of 9.4 ± 5.4 citations per year (range, 2.9-25.8 citations/year); 80% were published in 2000 or later, and 6% were considered basic science. Articles were mainly level 4 evidence (27/42; 64.3%), and none was level 1. There were moderate, significant associations between publication year and level of evidence (r S = -0.45; P = .0030) and citation density and publication year (r S = 0.59; P < .001). Mean methodologic quality scores were as follows: mCMS, 53 ± 7.2 (range, 39-68); modified Jadad scale, 3.2 ± 1.1 (range, 2-6); and MINORS, 11.2 ± 3.2 (range, 6-20). There was a significant, strong correlation between rank of mean citations and modified Jadad scale (r S = 0.76; P < .0001), suggesting poorer score associated with more mean citations. CONCLUSION Influential articles on pediatric and adolescent ACL injuries were relatively recent, with a low proportion of basic science-type articles. Most of the studies had a lower evidence level and poor methodologic quality scores. Higher methodologic quality did not correlate positively with citation data.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, California, USA
| | - Sonali E. Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, California, USA
| | - Drew A. Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, California, USA
| | - Nirav K. Pandya
- Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, California, USA
| | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, California, USA
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23
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Look MC, Iyengar Y, Barcellona M, Shortland A. Does delayed onset muscle soreness affect the biomechanical variables of the drop vertical jump that have been associated with increased ACL injury risk? A randomised control trial. Hum Mov Sci 2021; 76:102772. [PMID: 33609960 DOI: 10.1016/j.humov.2021.102772] [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: 03/26/2020] [Revised: 11/27/2020] [Accepted: 02/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Delayed onset muscle soreness (DOMS) and Anterior Cruciate Ligament (ACL) injuries are both prevalent in sport. It is currently unknown whether DOMS increases ACL injury risk. AIM This study aimed to provide preliminary insight on whether DOMS affects ACL injury risk by investigating whether DOMS affects the biomechanical variables of the DVJ that have been identified as risk factors for future ACL injury. METHODS This was a randomised control trial involving 32 active individuals aged 18-35 years, with no history of ACL injury. Participants underwent two sessions of force-plate testing and 3D motion analysis of the drop vertical jump (DVJ). The DVJ was chosen as it has been investigated prospectively for association with future ACL injury. Initial testing was followed by randomisation to DOMS or control group. The DOMS group underwent a DOMS-inducing exercise protocol, the control group did not. Both groups were re-tested 48 h after initial testing. Five variables of the DVJ that have been associated with future ACL injury were chosen for analysis - peak knee flexion angle, peak vertical ground reaction force, ground contact time, peak knee abduction angle & peak knee abduction moment. Between-group differences were compared using a two-way mixed analysis of variance; alpha level set to 0.05. RESULTS DOMS was successfully induced in all participants of the DOMS group however no statistically significant group x time interactions were found for any of the five variables analysed. CONCLUSIONS DOMS did not affect the biomechanical variables of the DVJ that have been associated with future ACL injury. By extension, this may suggest that DOMS might not affect ACL injury risk. However, it is also possible that certain attributes of the DVJ meant that any effect of DOMS was simply unable to be quantified, even if an effect existed. All considered, our position is that conclusion cannot be drawn from this study alone on whether DOMS affects ACL injury risk. Further research is required.
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Affiliation(s)
- Matthew C Look
- Academic Department of Physiotherapy, Faculty of Life Sciences and Medicine, King's College London, 2(nd) Floor Addison House, Guy's Campus, London SE1 1UL, United Kingdom.
| | - Yogita Iyengar
- Academic Department of Physiotherapy, Faculty of Life Sciences and Medicine, King's College London, 2(nd) Floor Addison House, Guy's Campus, London SE1 1UL, United Kingdom.
| | - Massimo Barcellona
- Department of Physiotherapy, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom.
| | - Adam Shortland
- Department of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, 4(th) Floor, Lambeth Wing, St Thomas' Hospital, London SE1 7EH, United Kingdom.
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24
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GALI JULIOCESAR, FADEL GUILIAWENDT, MARQUES MARCOSFELIPE, ALMEIDA TYAGOARAÚJO, GALI FILHO JULIOCESAR, FARIA FELIPEALEXANDRESEPAROVIC. THE NEW INJURIES' RISK AFTER ACL RECONSTRUCTION MIGHT BE REDUCED WITH FUNCTIONAL TRAINING. ACTA ORTOPEDICA BRASILEIRA 2021; 29:21-25. [PMID: 33795964 PMCID: PMC7976865 DOI: 10.1590/1413-785220212901240903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: The objective of our study was to evaluate if functional training with the Functional Movement Screen (FMS) can reduce the risk of a new injury for patients that underwent an anterior cruciate ligament reconstruction (ACLR). Our hypothesis was that the functional training might reduce the risk of a new injury. Methods: Our training protocol consisted of six phases, each one lasting six weeks. It began two months after surgery. The study group was composed of 10 individuals that completed our protocol after ACLR. The control group consisted of 10 people that completed a regular ACLR rehabilitation protocol. The FMS was used to compare the study and control group performance. Patients with a score of 14 or less on the FMS were considered more likely to suffer an injury than those with a score higher than 14. Results: The study group average FMS score was 16.6 compared to the control group at 12.3. Functional training for ACLR rehabilitation added a statistically significant benefit (p < 0.0002) to reduce the risk of a new injury compared to regular protocol. Conclusion: Functional training may be considered an alternative to the regular ACLR rehabilitation to reduce the risk of a new injury before returning to sports. Level of Evidence III, Case control study.
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25
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Cederström N, Granér S, Nilsson G, Ageberg E. Effect of motor imagery on enjoyment in knee-injury prevention and rehabilitation training: A randomized crossover study. J Sci Med Sport 2020; 24:258-263. [PMID: 32958377 DOI: 10.1016/j.jsams.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/14/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The novel MOTor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) model takes a uniquely holistic approach by integrating mental and physical aspects into current training programs. The aim of this trial was to evaluate enjoyment of MOTIFS training as compared to Care-as-Usual (CaU) knee injury and/or rehabilitation training. The primary hypothesis was that enjoyment would be greater following MOTIFS training than CaU training. DESIGN Block-randomized 2×2 cross-over trial. METHODS Thirty athletes (18-31years, 50% women) currently or previously active in team ball sports, with no pain or injury preventing jump and/or directional changes. MOTIFS training integrates sport-specific experiences and equipment into physical exercises to increase individualized realism and meaning. The CaU condition included solely physical exercise. The main outcome was the Physical Activity Enjoyment Scale (PACES). Secondary outcomes included Self-Assessment Manikin (SAM; subscales Valence, Arousal, Dominance), Perceived exertion, pulse, duration, and movement quality. RESULTS PACES scores were better following MOTIFS training than CaU (point estimate 24.67; 95% CI: 19.0; 30.3). Between-groups differences in SAM Valence (median 2, quartiles 1;3), Arousal (median 1, quartiles 0;2.25), and Dominance (median 0.5, quartiles 0;2), and RPE (median 1, quartiles -0.3;2), training duration (mean 5.34, 95% CI: -0.17; -0.73), and pulse (median 7.50, quartiles 0.25;16.75) were higher following MOTIFS training than CaU training. CONCLUSIONS Results suggest that the MOTIFS model, which integrates simultaneous physical and psychological interventions, is a clinically plausible method of influencing enjoyment and other psychological outcomes. Further studies may explore effects of the MOTIFS principles on injury prevention and rehabilitation training.
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Affiliation(s)
| | - Simon Granér
- Department of Psychology, Lund University, Sweden
| | | | - Eva Ageberg
- Department of Health Sciences, Lund University, Sweden
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26
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Davis AM, Chahal J, Wong R, Steinhart K, Dwyer T, Li L, Marks P, Cruz L, Urquhart N, Wilson JA, Cudmore D, Nimmon L, Ogilvie-Harris D. Limiting the Risk of Osteoarthritis After Anterior Cruciate Ligament Injury: Are Health Care Providers Missing the Opportunity to Intervene? Arthritis Care Res (Hoboken) 2020; 73:1754-1762. [PMID: 32937005 DOI: 10.1002/acr.24419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/11/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To understand what sports orthopedic surgeons (OS), primary care physicians (PCPs) with sports medicine training, and physical therapists (PTs) managing nonelite athletes with anterior cruciate ligament (ACL) injury tell their patients about their osteoarthritis (OA) risk. METHODS An electronic survey was distributed by the Canadian Academy of Sport and Exercise Medicine (PCPs, OS), the Sports and Orthopedic Divisions of the Canadian Physiotherapy Association (PTs), and to OS identified through the Royal College of Physicians and Surgeons and the Canadian Orthopaedic Association. The survey included 4 sections: demographics, factors discussed, timing of discussions, and discussion of risk factors and their management. Proportions or means with 95% confidence intervals were calculated. RESULTS A total of 501 health care professionals (HCPs) responded (98 PCPs, 263 PTs, and 140 OS). Of those responding, 70-77% of physicians reported always discussing OA risk, but only 35% of PTs did. All HCPs reported that patient activities perceived as detrimental to knee health, ACL reinjury, and simultaneous injury to other structures in the knee were most often the reason for discussing OA risk. OA risk was discussed at initial management post-injury (65-94%), with few discussing risk subsequently. Eighty percent of physicians and 99% of PTs indicated that PTs were suited to provide OA risk and management information. CONCLUSION HCPs routinely managing people with ACL injury do not consistently discuss OA risk post-injury with them. Educational strategies for HCPs are urgently needed to develop care pathways inclusive of support for OA risk management following ACL injury.
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Affiliation(s)
| | - Jas Chahal
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Tim Dwyer
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Linda Li
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Marks
- University of Toronto, Toronto, Ontario, Canada
| | - Laura Cruz
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Urquhart
- Dartmouth General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - David Cudmore
- St. Francis Xavier University and Dalhousie University, Nova Scotia, Antigonish and Halifax, Canada
| | - Laura Nimmon
- University of British Columbia, Vancouver, British Columbia, Canada
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27
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Heneghan NR, Heathcote L, Martin P, Spencer S, Rushton A. Injury surveillance in elite Paralympic athletes with limb deficiency: a retrospective analysis of upper quadrant injuries. BMC Sports Sci Med Rehabil 2020; 12:36. [PMID: 32537168 PMCID: PMC7288474 DOI: 10.1186/s13102-020-00183-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Compared to injury surveillance in Olympic athletes relatively little literature exists for Paralympic athletes. Injury surveillance data underpin design and evaluation of injury prevention strategies in elite sport. The aim of this study is investigate upper quadrant injuries in elite athletes with limb deficiency. METHODS A retrospective analysis of upper quadrant injuries in elite athletes with limb deficiency with available data (2008-2016) was conducted using medical notes extracted from English Institute of Sport (EIS) records. Eligibility criteria included funded athletes, eligible for EIS physiotherapy support with an upper and/or lower limb disability arising from full or partial limb deficiency. RESULTS A total 162 injuries from 34 athletes were included. Participant characteristics: 20 males (59%), from 9 sports, with mean age 27 years (range 16-50 years) and 15 with congenital limb loss (44%). Athletes age 20-29 years experienced most injuries, four per athlete. The glenohumeral joint was the reported injury site (23%, n = 38). Index (first) injuries accounted for 77% (n = 128) injuries, 17% (n = 28) a recurrence and 6% (n = 10) an exacerbation. More than half of injuries occurred in training (58%, n = 94), this being slightly higher in those with traumatic limb loss. Athletes with quadruple levels of limb deficiency had double the number of recurrent injuries as those with single or double limb deficiency. CONCLUSION Elite athletes with limb deficiency experience upper quadrant injuries, with glenohumeral joint the most frequently reported. The quality and consistency of data reported limits definitive conclusions, although findings highlight the importance of precision and accuracy in recording injury surveillance to enable implementation of effective injury prevention strategies.
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Affiliation(s)
- N. R. Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - L. Heathcote
- The English Institute of Sport, The Manchester Institute of Health and Performance, 299 Alan Turing Way, Manchester, M11 3BS UK
| | - P. Martin
- The English Institute of Sport, The Manchester Institute of Health and Performance, 299 Alan Turing Way, Manchester, M11 3BS UK
| | - S. Spencer
- The English Institute of Sport, The Manchester Institute of Health and Performance, 299 Alan Turing Way, Manchester, M11 3BS UK
| | - A. Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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28
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Sugimoto D, Loiacono AJ, Blenis A, Morse JM, Borg DR, Meehan WP. Risk Factors in Elite, Adolescent Male Soccer Players: Prospective Study. Clin Pediatr (Phila) 2020; 59:596-605. [PMID: 32423344 DOI: 10.1177/0009922820916895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose. To find risk factors for soccer-related musculoskeletal injuries among elite, adolescent male soccer players. Methods. Prior to the season, various physical, clinical, and functional measurements were taken. One season was used as an injury surveillance period. Then, after the season, measures of potential risk factors were compared between (1) those players who sustained musculoskeletal injuries and (2) those who remained injury free. Results. Among 61 players, 37.7% (23/61) sustained soccer-related musculoskeletal injuries. After adjusting for covariates in a logistic regression model, presence of previous hip and low back injury (adjusted odds ratio [aOR] = 8.93, P = .046) and Functional Movement Screen (FMS) scores (aOR = 1.92, P = .022) were independently associated with musculoskeletal injures. Conclusion. Elite, adolescent male soccer players with a history of hip and back injury are at greater risk of sustaining a soccer-related musculoskeletal injury. In addition, our study indicated greater risk of sustaining a future soccer-related injury as FMS scores increase.
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Affiliation(s)
- Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Faculty of Sport Sciences, Waseda University, Tokyo, Japan
| | | | | | - Jennifer M Morse
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Dennis R Borg
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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29
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Huang YL, Jung J, Mulligan CMS, Oh J, Norcross MF. A Majority of Anterior Cruciate Ligament Injuries Can Be Prevented by Injury Prevention Programs: A Systematic Review of Randomized Controlled Trials and Cluster-Randomized Controlled Trials With Meta-analysis. Am J Sports Med 2020; 48:1505-1515. [PMID: 31469584 DOI: 10.1177/0363546519870175] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury prevention programs (IPPs) are generally accepted as being valuable for reducing injury risk. However, significant methodological limitations of previous meta-analyses raise questions about the efficacy of these programs and the extent to which meeting current best-practice ACL IPP recommendations influences the protective effect of these programs. PURPOSE To (1) estimate the protective effect of ACL IPPs while controlling for common methodological limitations of previous meta-analyses and (2) systematically categorize IPP components and factors related to IPP delivery to assess the validity of current best-practice IPP recommendations. STUDY DESIGN Systematic review with meta-analysis. METHODS A systematic search of 5 electronic scientific databases was conducted to identify studies testing the efficacy of ACL IPPs. Studies were included if (1) the intervention aimed to prevent ACL injury, (2) the incidence rate (IR) or other outcome data that made it possible to calculate the IR for both the intervention and control groups were reported, and (3) the study design was a prospective randomized controlled trial (RCT) or cluster-RCT. RESULTS Of the 2219 studies screened, 8 studies were included in the quantitative synthesis, and their analysis revealed a significant reduction in ACL IR when athletes received IPPs (IR ratio = 0.47; 95% CI, 0.30-0.73; P < .001). The majority of included IPPs tended to meet minimum best-practice recommendations and incorporated plyometric, strengthening, and agility exercises along with feedback on proper landing technique. However, the specific exercises included in each IPP and key factors related to IPP delivery were highly variable. CONCLUSION Despite limiting the analysis to only high-quality studies and controlling for time at risk and potential clustering effects, the study showed that ACL IPPs had a significant protective effect and reduced injury rates by 53%. However, significant variability in the specific exercises and the manner of program delivery suggests that ACL IPPs may be able to be designed within an overarching best-practice framework. This may allow practitioners the flexibility to develop IPPs that meet the specific characteristics of the target population and potentially increase the likelihood that these programs will be widely adopted and implemented.
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Affiliation(s)
- Yu-Lun Huang
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Jaehun Jung
- Department of Health and Human Performance, College of Education, Northwestern State University, Natchitoches, Louisiana, USA
| | - Colin M S Mulligan
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Jaekeun Oh
- Department of Health and Exercise Science, Korea National Sport University, Seoul, Republic of Korea
| | - Marc F Norcross
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
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30
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Bonnette S, Diekfuss JA, Grooms DR, Kiefer AW, Riley MA, Riehm C, Moore C, Foss KDB, DiCesare CA, Baumeister J, Myer GD. Electrocortical dynamics differentiate athletes exhibiting low- and high- ACL injury risk biomechanics. Psychophysiology 2020; 57:e13530. [PMID: 31957903 PMCID: PMC9892802 DOI: 10.1111/psyp.13530] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are physically and emotionally debilitating for athletes,while motor and biomechanical deficits that contribute to ACL injury have been identified, limited knowledge about the relationship between the central nervous system (CNS) and biomechanical patterns of motion has impeded approaches to optimize ACL injury risk reduction strategies. In the current study it was hypothesized that high-risk athletes would exhibit altered temporal dynamics in their resting state electrocortical activity when compared to low-risk athletes. Thirty-eight female athletes performed a drop vertical jump (DVJ) to assess their biomechanical risk factors related to an ACL injury. The athletes' electrocortical activity was also recorded during resting state in the same visit as the DVJ assessment. Athletes were divided into low- and high-risk groups based on their performance of the DVJ. Recurrence quantification analysis was used to quantify the temporal dynamics of two frequency bands previously shown to relate to sensorimotor and attentional control. Results revealed that high-risk participants showed more deterministic electrocortical behavior than the low-risk group in the frontal theta and central/parietal alpha-2 frequency bands. The more deterministic resting state electrocortical dynamics for the high-risk group may reflect maladaptive neural behavior-excessively stable deterministic patterning that makes transitioning among functional task-specific networks more difficult-related to attentional control and sensorimotor processing neural regions.
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Affiliation(s)
- Scott Bonnette
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jed A. Diekfuss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, GA, USA,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Adam W. Kiefer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,Department of Psychology, Center for Cognition, Action & Perception, University of Cincinnati, Cincinnati, OH, USA,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael A. Riley
- Department of Psychology, Center for Cognition, Action & Perception, University of Cincinnati, Cincinnati, OH, USA
| | - Christopher Riehm
- Department of Psychology, Center for Cognition, Action & Perception, University of Cincinnati, Cincinnati, OH, USA
| | - Charles Moore
- Department of Psychology, Center for Cognition, Action & Perception, University of Cincinnati, Cincinnati, OH, USA
| | - Kim D. Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher A. DiCesare
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jochen Baumeister
- Exercise Science and Neuroscience, Department Exercise & Health, Paderborn University, Paderborn, Germany
| | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
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31
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Patel NM, Bram JT, Talathi NS, DeFrancesco CJ, Lawrence JTR, Ganley TJ. Which Children Are at Risk for Contralateral Anterior Cruciate Ligament Injury After Ipsilateral Reconstruction? J Pediatr Orthop 2020; 40:162-167. [PMID: 30882565 DOI: 10.1097/bpo.0000000000001364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Following anterior cruciate ligament (ACL) reconstruction, children are at significant risk for complications, including contralateral ACL rupture. The purpose of this study is to determine which children are at risk for a contralateral ACL tear after ipsilateral reconstruction. METHODS After review of medical records, we contacted patients who underwent primary ACL reconstruction between 2009 and 2016. Patients were included in the study if they were able to provide follow-up data either in person or remotely at least 2 years after surgery. Demographic data, sports participation, and intraoperative findings and techniques were recorded. All patients were also asked to confirm returning to sport information and postoperative complications (including contralateral ACL tear). Univariate analysis consisted of χ and independent samples t tests. Purposeful entry logistic regression was then conducted to control for confounding factors. Kaplan-Meier analysis was performed to assess contralateral ACL survival. RESULTS A total of 498 children with average follow-up of 4.3±2.1 years were included in the analysis. The mean age was 15.0±2.3 years and 262 patients (52.6%) were female. Thirty-five subjects (7.0%) sustained a contralateral ACL tear at a mean of 2.7±1.7 years following index reconstruction. Kaplan-Meier analysis revealed the median contralateral ACL survival time to be 8.9 years [95% confidence interval (CI): 8.3, 9.5 y]. In univariate analysis, 11.5% of female patients had a contralateral rupture compared with 2.1% of male patient (P<0.001). Patients with a contralateral tear had a mean age of 14.4±2.0 years compared with 15.1±2.3 years for those without an ACL injury in the opposite knee (P=0.04). After controlling for numerous factors in a multivariate model, female patients had 3.5 times higher odds of sustaining a contralateral ACL tear than male patients (95% CI: 1.1, 10.6; P=0.03). Each year of decreasing age raised the odds of contralateral injury by a factor of 1.3 (95% CI: 1.1, 1.6; P=0.02). Furthermore, children younger than 15 years had 3.1 times higher odds of contralateral rupture than those aged 15 and older (95% CI: 1.3, 7.2; P=0.01). CONCLUSIONS After adjusting for confounding factors in a multivariate model, female patients were at increased risk of contralateral ACL tear following ipsilateral reconstruction, as were younger children. Specifically, ACL rupture in the opposite knee was more likely in patients below the age of 15 years. LEVEL OF EVIDENCE Level III-prognostic study.
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Affiliation(s)
- Neeraj M Patel
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Joshua T Bram
- The Children's Hospital of Philadelphia, Philadelphia, PA
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Woolen SA, Shankar PR, Gagnier JJ, MacEachern MP, Singer L, Davenport MS. Risk of Nephrogenic Systemic Fibrosis in Patients With Stage 4 or 5 Chronic Kidney Disease Receiving a Group II Gadolinium-Based Contrast Agent: A Systematic Review and Meta-analysis. JAMA Intern Med 2020; 180:223-230. [PMID: 31816007 PMCID: PMC6902198 DOI: 10.1001/jamainternmed.2019.5284] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Risk of nephrogenic systemic fibrosis (NSF) to individual patients with stage 4 or 5 chronic kidney disease (CKD; defined as estimated glomerular filtration rate of <30 mL/min/1.73 m2) who receive a group II gadolinium-based contrast agent (GBCA) is not well understood or summarized in the literature. OBJECTIVE To assess the pooled risk of NSF in patients with stage 4 or 5 CKD receiving a group II GBCA. DATA SOURCES A health sciences informationist searched the Ovid (MEDLINE and MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citation, and Daily and Versions), Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Open Grey databases from inception to January 29, 2019, yielding 2700 citations. STUDY SELECTION Citations were screened for inclusion in a multistep process. Agreement for final cohort inclusion was determined by 2 blinded screeners using Cohen κ. Inclusion criteria consisted of stage 4 or 5 CKD with or without dialysis, administration of an unconfounded American College of Radiology classification group II GBCA (gadobenate dimeglumine, gadobutrol, gadoterate meglumine, or gadoteridol), and incident NSF as an outcome. Conference abstracts, retracted manuscripts, narrative reviews, editorials, case reports, and manuscripts not reporting total group II GBCA administrations were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction was performed for all studies by a single investigator, including publication details, study design and time frame, patient characteristics, group II GBCA(s) administered, total exposures for patients with stage 4 or stage 5 CKD, total cases of unconfounded NSF, reason for GBCA administration, follow-up duration, loss to follow-up, basis for NSF screening, and diagnosis. MAIN OUTCOMES AND MEASURES Pooled incidence of NSF and the associated upper bound of a 2-sided 95% CI (risk estimate) for the pooled data and each of the 4 group II GBCAs. RESULTS Sixteen unique studies with 4931 patients were included (κ = 0.68) in this systematic review and meta-analysis. The pooled incidence of NSF was 0 of 4931 (0%; upper bound of 95% CI, 0.07%). The upper bound varied owing to different sample sizes for gadobenate dimeglumine (0 of 3167; upper bound of 95% CI, 0.12%), gadoterate meglumine (0 of 1204; upper bound of 95% CI, 0.31%), gadobutrol (0 of 330; upper bound of 95% CI, 1.11%), and gadoteridol (0 of 230; upper bound of 95% CI, 1.59%). CONCLUSIONS AND RELEVANCE This study's findings suggest that the risk of NSF from group II GBCA administration in stage 4 or 5 CKD is likely less than 0.07%. The potential diagnostic harms of withholding group II GBCA for indicated examinations may outweigh the risk of NSF in this population. TRIAL REGISTRATION PROSPERO identifier: CRD42019123284.
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Affiliation(s)
- Sean A Woolen
- Department of Radiology, University of Michigan, Ann Arbor.,Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor
| | - Prasad R Shankar
- Department of Radiology, University of Michigan, Ann Arbor.,Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor.,Department of Epidemiology, University of Michigan, Ann Arbor
| | | | - Lisa Singer
- Dana-Farber Cancer Institute, Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew S Davenport
- Department of Radiology, University of Michigan, Ann Arbor.,Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor.,Department of Urology, Michigan Medicine, Ann Arbor
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Abstract
Osteoarthritis (OA) is a degenerative disease of the articular cartilage with subchondral bone lesions. Osteoarthritis etiologies are mainly related to age, obesity, strain, trauma, joint congenital anomalies, joint deformities, and other factors. Osteoarthritis seriously affects the quality of life; however, there is no effective way to cure osteoarthritis. Aerobic exercise refers to a dynamic rhythmic exercise involving the large muscle groups of the body with aerobic metabolism. More and more evidence shows that exercise has become a useful tool for the treatment of osteoarthritis. This chapter will discuss the role of exercise in the prevention and treatment of osteoarthritis.
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Affiliation(s)
- Lei Chen
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Yu
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Bonnette S, DiCesare CA, Kiefer AW, Riley MA, Barber Foss KD, Thomas S, Kitchen K, Diekfuss JA, Myer GD. Injury Risk Factors Integrated Into Self-Guided Real-Time Biofeedback Improves High-Risk Biomechanics. J Sport Rehabil 2019; 28:831-839. [PMID: 29952696 PMCID: PMC6667313 DOI: 10.1123/jsr.2017-0391] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/03/2018] [Accepted: 05/17/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Existing anterior cruciate ligament (ACL) injury prevention programs have failed to reverse the high rate of ACL injuries in adolescent female athletes. OBJECTIVE This investigation attempts to overcome factors that limit efficacy with existing injury prevention programs through the use of a novel, objective, and real-time interactive visual feedback system designed to reduce the biomechanical risk factors associated with ACL injuries. DESIGN Cross-over study. SETTING Medical center laboratory. PARTICIPANTS A total of 20 females (age = 19.7 [1.34] y; height = 1.74 [0.09] m; weight = 72.16 [12.45] kg) participated in this study. METHODS Participants performed sets of 10 bodyweight squats in each of 8 training blocks (ie, 4 real-time and 4 control blocks) and 3 testing blocks for a total of 110 squats. Feedback conditions were blocked and counterbalanced with half of participants randomly assigned to receive the real-time feedback block first and half receiving the control (sham) feedback first. RESULTS Heat map analysis revealed that during interaction with the real-time feedback, squat performance measured in terms of key biomechanical parameters was improved compared with performance when participants squatted with the sham stimulus. CONCLUSIONS This study demonstrates that the interactive feedback system guided participants to significantly improve movement biomechanics during performance of a body weight squat, which is a fundamental exercise for a longer term ACL injury risk reduction intervention. A longer training and testing period is necessary to investigate the efficacy of this feedback approach to effect long-term adaptations in the biomechanical risk profile of athletes.
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Affiliation(s)
- Scott Bonnette
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH
| | - Christopher A. DiCesare
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH
| | - Adam W. Kiefer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH
- Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH
- University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Michael A. Riley
- Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH
| | - Kim. D. Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH
| | - Staci Thomas
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH
| | - Katie Kitchen
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH
| | - Jed A. Diekfuss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH
| | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH
- University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, OH
- Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA
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Could a specific exercise programme prevent injury in elite orienteerers? A randomised controlled trial. Phys Ther Sport 2019; 40:177-183. [PMID: 31586871 DOI: 10.1016/j.ptsp.2019.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/21/2019] [Accepted: 09/21/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine the effect of a specific exercise programme on preventing lower extremity injury in adult elite orienteerers. DESIGN Randomised controlled trial. SETTING Elite orienteering. PARTICIPANTS Sixty-two orienteerers (n = 32/30, male/female) were randomized and followed over 14 weeks. The intervention group completed an exercise programme 4 times per week. MAIN OUTCOME MEASURES Number of substantial injuries, average substantial injury prevalence and incidence of ankle sprains over the competitive season. In per-protocol analyses, compliance rate to exercise programme was considered. RESULTS No significant differences between control and intervention group were found for substantial injured orienteerers (OR 0.50, 95% CI 0.19-1.34), number of substantial injuries (OR 0.46, 95% CI 0.18-1.13) and incidence of ankle sprains (p = 0.775). In per-protocol analyses, significant differences in substantial injured orienteerers (difference -7.9%, OR 0.25, 95% CI 0.06-0.97) and number of substantial injuries (difference -8.5%, OR 0.26, 95% CI 0.07-0.92) in favour for the orienteers completing the exercises at least twice a week, compared to the control group, were found. CONCLUSIONS An exercise programme, consisting of balance and jump exercises, is suggested to be performed at least twice per week in order to reduce the risk of lower extremity injury in elite orienteerers.
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Gagnier JJ, Johnston BC. Poor quality patient reported outcome measures bias effect estimates in orthopaedic randomized studies. J Clin Epidemiol 2019; 116:36-38. [PMID: 31374331 DOI: 10.1016/j.jclinepi.2019.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/10/2019] [Accepted: 07/16/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The objective was to assess the potential for biased treatment effects associated with patient-reported outcome measures (PROMs) of varying psychometric quality in randomized clinical trials (RCTs) for rotator cuff disease (RCD). STUDY DESIGN AND SETTING We searched for RCTs published in the past 5 years (January 2011 to December 2016) in the top five 2015 impact factor orthopedic journals. We accepted RCTs including human participants with RCD, published in English, and using PROMs specific to RCD. We extracted data on study design, sample size, risk of bias for RCTs, quality of PROM used, estimates of effect, and associated measures of variance. PROMs were given numerical ratings of psychometric quality from a prior publication. Continuous measures of effect were transformed by dividing the effect estimate by the standard deviation. Multilevel linear regression analyses were performed to determine whether PROM quality was associated with the magnitude of effect. RESULTS Overall, we included 72 RCTs reporting 174 separate outcomes. Mean sample size was 66.8 (95% CI 62.30 to 71.27), mean risk of bias score across all studies was 7.00/10 (95% CI 6.72 to 7.29), psychometric quality summary scores ranged from -2 to 10, and the standardized mean effect estimate was 0.47 (95% CI -0.17 to 1.11). Regression revealed that higher-quality PROMs had smaller estimates of effect (β = -0.32; 95% CI -0.51 to -0.13; P = 0.001). We also found that a longer follow-up period predicted slightly increased effect estimates (β = 0.08; 95% CI 0.02 to 0.13; P = 0.007). CONCLUSIONS PROMs with poor or unknown psychometric properties overestimate treatment effects in clinical research of RCD by 68.4% (β -0.32/standardized mean effect 0.47). To our knowledge, this is the first empirical evidence that variations in the quality of PROMs bias treatment effect estimates. Researchers and clinicians using data from PROMs must be cautious to explore the quality of that measure so as to not mislead decision-making resulting from biased outcomes.
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Affiliation(s)
- Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Bradley C Johnston
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Anderson T, Wasserman EB, Shultz SJ. Anterior Cruciate Ligament Injury Risk by Season Period and Competition Segment: An Analysis of National Collegiate Athletic Association Injury Surveillance Data. J Athl Train 2019; 54:787-795. [PMID: 31322904 DOI: 10.4085/1062-6050-501-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Although fatigue has been implicated in anterior cruciate ligament (ACL) injury, few researchers have examined the timing of injury across a competitive sport season or within a competitive session to gain insight into the potential effects of fatigue on the incidence of ACL injury. OBJECTIVE To identify the time segments across a competitive season or within an individual competition associated with the greatest ACL injury incidence. DESIGN Descriptive epidemiology study. METHODS Data from the National Collegiate Athletic Association Injury Surveillance Program for 2004-2005 through 2015-2016 for basketball, lacrosse, and soccer were analyzed. Incidence rate ratios (IRRs) compared ACL injury rates by sport, sex, season segment, and competition period. Poisson regression was used to examine the associations between each of these categories and the incidence of ACL injury as well as interaction effects. RESULTS During the early regular season, the incidence rate was elevated relative to the preseason (IRR = 1.86; 95% confidence interval [CI] = 1.27, 2.74), middle regular season (IRR = 1.48; 95% CI = 1.01, 2.15), late regular season (IRR = 1.56; 95% CI = 1.08, 2.27), and postseason (IRR = 2.20; 95% CI = 1.06, 4.56). A sport-by-season interaction indicated this effect was largely attributable to a higher incidence in the early season among lacrosse athletes. An interaction between season segment and competition period (P = .02) revealed a greater injury incidence before halftime in the early regular season (IRR = 0.38, 95% CI = 0.19, 0.76), but a greater incidence after halftime in the late regular season (IRR = 2.40, 95% CI = 1.15, 5.02). Fewer noncontact injuries occurred in soccer than in basketball or lacrosse. CONCLUSIONS The ACL injury incidence was higher in the early part of the regular season, particularly among lacrosse athletes. Although the injury incidences before and after halftime were similar, further analyses of player time and time of injury within each half are necessary. Coaches and practitioners should be cognizant of the elevated injury incidence during the early season among lacrosse athletes. Future authors should consider more specific analyses to further elucidate the potential role of fatigue development in exacerbating the incidence of ACL injury in collegiate athletes both within games and across the season.
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Affiliation(s)
- Travis Anderson
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Erin B Wasserman
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro
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Benjaminse A, Webster KE, Kimp A, Meijer M, Gokeler A. Revised Approach to the Role of Fatigue in Anterior Cruciate Ligament Injury Prevention: A Systematic Review with Meta-Analyses. Sports Med 2019; 49:565-586. [PMID: 30659497 PMCID: PMC6422960 DOI: 10.1007/s40279-019-01052-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Causes of anterior cruciate ligament (ACL) injuries are multifactorial. Anterior cruciate ligament injury prevention should thus be approached from a multifactorial perspective as well. Training to resist fatigue is an underestimated aspect of prevention programs given that the presence of fatigue may play a crucial role in sustaining an ACL injury. OBJECTIVES The primary objective of this literature review was to summarize research findings relating to the kinematic and kinetic effects of fatigue on single-leg landing tasks through a systematic review and meta-analysis. Other objectives were to critically appraise current approaches to examine the effects of fatigue together with elucidating and proposing an optimized approach for measuring the role of fatigue in ACL injury prevention. METHODS A systematic literature search was conducted in the databases PubMed (1978-November 2017), CINAHL (1992-November 2017), and EMBASE (1973-November 2017). The inclusion criteria were: (1) full text, (2) published in English, German, or Dutch, (3) healthy subjects, (4) average age ≥ 18 years, (5) single-leg jump landing task, (6) evaluation of the kinematics and/or kinetics of the lower extremities before and after a fatigue protocol, and (7) presentation of numerical kinematic and/or kinetic data. Participants included healthy subjects who underwent a fatigue protocol and in whom the effects of pre- and post-fatigue on three-dimensional lower extremity kinematic and kinetics were compared. Methods of data collection, patient selection, blinding, prevention of verification bias, and study design were independently assessed. RESULTS Twenty studies were included, in which four types of single-leg tasks were examined: the single-leg drop vertical jump, the single-leg drop landing, the single-leg hop for distance, and sidestep cutting. Fatigue seemed to mostly affect initial contact (decreased angles post-fatigue) and peak (increased angles post-fatigue) hip and knee flexion. Sagittal plane variables at initial contact were mostly affected under the single-leg hop for distance and sidestep cutting conditions whilst peak angles were affected during the single-leg drop jump. CONCLUSIONS Training to resist fatigue is an underestimated aspect of prevention programs given that the presence of fatigue may play a crucial role in sustaining an ACL injury. Considering the small number of variables affected after fatigue, the question arises whether the same fatigue pathways are affected by the fatigue protocols used in the included laboratory studies as are experienced on the sports field.
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Affiliation(s)
- Anne Benjaminse
- Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
- School of Sport Studies, Hanze University Groningen, Groningen, The Netherlands.
| | - Kate E Webster
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne, VIC, Australia
| | - Alexander Kimp
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Melbourne, VIC, Australia
| | - Michelle Meijer
- Midwifery Academy Amsterdam Groningen (AVAG), Groningen, The Netherlands
| | - Alli Gokeler
- Exercise Science & Neuroscience Unit, Department Exercise & Health, Faculty of Science, University of Paderborn, Paderborn, Germany
- Luxembourg Institute of Research for Orthopedics, Medicine and Science in Sports, Luxembourg City, Luxembourg
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Bleakley CM, Taylor JB, Dischiavi SL, Doherty C, Delahunt E. Rehabilitation Exercises Reduce Reinjury Post Ankle Sprain, But the Content and Parameters of an Optimal Exercise Program Have Yet to Be Established: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2018; 100:1367-1375. [PMID: 30612980 DOI: 10.1016/j.apmr.2018.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 08/03/2018] [Accepted: 10/11/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine if exercise-based rehabilitation reduces reinjury following acute ankle sprain. Our secondary objective was to assess if rehabilitation efficacy varies according to exercise content and training volume. DATA SOURCES The following electronic databases were searched: EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION Randomized controlled trials investigating the effect of exercise-based rehabilitation programs on reinjury and patient-reported outcomes (perceived instability, function, pain) in people with an acute ankle sprain. No restrictions were made on the exercise type, duration, or frequency. Exercise-based programs could have been administered in isolation or as an adjunct to usual care. Comparisons were made to usual care consisting of 1 or all components of PRICE (protection, rest, ice, compression, elevation). DATA EXTRACTION Effect sizes with 95% CIs were calculated in the form of mean differences for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. Pooled effects were calculated for reinjury prevalence with meta-analysis undertaken using RevMan software. DATA SYNTHESIS Seven trials (n=1417) were included (median PEDro score, 8/10). Pooled data found trends toward a reduction in reinjury in favor of the exercise-based rehabilitation compared with usual care at 3-6 months (OR, 0.87; 95% CI, 0.48-1.58) with significant reductions reported at 7-12 months (OR, 0.53; 95% CI, 0.38-0.73). Sensitivity analysis based on pooled reinjury data from 2 high quality studies (n=629) also found effects in favor of exercise-based rehabilitation at 12 months (OR, 0.60; 95% CI, 0.49-0.89). Training volume differed substantially across rehabilitation programs with total rehabilitation time ranging from 3.5-21 hours. The majority of rehabilitation programs focused primarily on postural balance or strength training. CONCLUSIONS Exercise-based rehabilitation reduces the risk of reinjury following acute ankle sprain when compared with usual care alone. There is no consensus on optimal exercise content and training volume in this field. Future research must explicitly report all details of administered exercise-based rehabilitation programs.
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Affiliation(s)
- Chris M Bleakley
- Congdon School of Health Sciences, High Point University, High Point, NC.
| | - Jeffrey B Taylor
- Congdon School of Health Sciences, High Point University, High Point, NC
| | - Steven L Dischiavi
- Congdon School of Health Sciences, High Point University, High Point, NC
| | - Cailbhe Doherty
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Eamonn Delahunt
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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Gouttebarge V, Zuidema V. Prevention of musculoskeletal injuries in recreational field hockey: the systematic development of an intervention and its feasibility. BMJ Open Sport Exerc Med 2018; 4:e000425. [PMID: 30364464 PMCID: PMC6196939 DOI: 10.1136/bmjsem-2018-000425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 11/03/2022] Open
Abstract
Objective This article describes the systematic development of an intervention for the prevention of lower extremity injuries in field hockey and the assessment of its feasibility. Methods The intervention was developed according to the first four steps of the intervention mapping and knowledge transfer scheme processes, mostly based on focus group interviews with experts in field hockey and injury prevention (needs assessment; objective and target groups; content selection; development). Subsequently, a quasi-experimental research (one-group post-test design) was conducted among 35 young field hockey players and 7 coaches. Participants were asked to use the intervention for 3 weeks, and the degrees of relevancy, suitability, satisfaction and usability of the intervention were assessed by means of a questionnaire and a group interview. Results First, the needs assessment conducted among the main actors within recreational field hockey revealed that an injury prevention intervention was needed, ideally delivered through videos via an application for smartphone/tablet or website. Second, the objective and target groups of the intervention were defined, namely to prevent or reduce the occurrence of lower extremity injuries among both young and adult recreational field hockey players. Third, warming-up exercises were selected as preventive measures and strategies (eg, core stability, strength, coordination). Last, the 'Warming-Up Hockey' intervention was developed, consisting of a warm-up programme (delivered by coaches including more than 50 unique exercises). The relevancy, satisfaction and usability of 'Warming-Up Hockey' were positively evaluated, but two main alterations were made: the duration of the 'Warming-up Hockey' was reduced from 16 to 12 min and a match-specific warm-up was added. Conclusion The feasibility of 'Warming-Up Hockey' was positively assessed by players and coaches. Prior to its nationwide implementation, the effectiveness of the intervention on injury reduction among field hockey players should be conducted.
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Affiliation(s)
- Vincent Gouttebarge
- Dutch Consumer Safety Institute, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.,Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Victor Zuidema
- Dutch Consumer Safety Institute, Amsterdam, The Netherlands
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Webster KE, Hewett TE. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. J Orthop Res 2018; 36:2696-2708. [PMID: 29737024 DOI: 10.1002/jor.24043] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/27/2018] [Indexed: 02/04/2023]
Abstract
Several meta-analyses have been published on the effectiveness of anterior cruciate ligament (ACL) injury prevention training programs to reduce ACL injury risk, with various degrees of risk reduction reported. The purpose of this research was to perform a systematic review and meta-analysis of overlapping meta-analyses evaluating the effectiveness of ACL injury prevention training programs so as to summarize the amount of reduction in risk for all ACL and non-contact ACL injuries into a single source, and determine if there were sex differences in the relative efficacy of ACL injury prevention training programs. Five databases (Medline, PubMed, Embase, CINAHL, and Cochrane) were searched to identify meta-analyses that evaluated the effectiveness of ACL injury prevention training programs on ACL injury risk. ACL injury data were extracted and the results from each meta-analysis were combined using a summary meta-analysis based on odds ratios (OR). Eight meta-analyses met eligibility criteria. Six of the eight only included data for female athletes. Summary meta-analysis showed an overall 50% reduction (OR = 0.5 [0.41-0.59]; I2 = 15%) in the risk of all ACL injuries in all athletes and a 67% reduction (OR = 0.33 [0.27-0.41]; I2 = 15%) for non-contact ACL injuries in females. This paper combines all previous meta-analyses into a single source and shows conclusive evidence that ACL injury prevention programs reduce the risk of all ACL injuries by half in all athletes and non-contact ACL injuries by two-thirds in female athletes. There is insufficient data to make conclusions as to the effectiveness of ACL injury prevention programs in male athletes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2696-2708, 2018.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, La Trobe University, Victoria, Australia
| | - Timothy E Hewett
- Mayo Clinic Biomechanics Laboratories, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, Minnesota.,Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Taylor JB, Ford KR, Schmitz RJ, Ross SE, Ackerman TA, Shultz SJ. A 6-week warm-up injury prevention programme results in minimal biomechanical changes during jump landings: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2018; 26:2942-2951. [PMID: 29340745 DOI: 10.1007/s00167-018-4835-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/08/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To examine the extent to which an ACL injury prevention programme modifies lower extremity biomechanics during single- and double-leg landing tasks in both the sagittal and frontal plane. It was hypothesized that the training programme would elicit improvements in lower extremity biomechanics, but that these improvements would be greater during a double-leg sagittal plane landing task than tasks performed on a single leg or in the frontal plane. METHODS Ninety-seven competitive multi-directional sport athletes that competed at the middle- or high-school level were cluster randomized into intervention (n = 48, age = 15.4 ± 1.0 years, height = 1.7 ± 0.07 m, mass = 59.9 ± 11.0 kg) and control (n = 49, age = 15.7 ± 1.6 years, height = 1.7 ± 0.06 m, mass = 60.4 ± 7.7 kg) groups. The intervention group participated in an established 6-week warm-up-based ACL injury prevention programme. Three-dimensional biomechanical analyses of a double- (SAG-DL) and single-leg (SAG-SL) sagittal, and double- (FRONT-DL) and single-leg (FRONT-SL) frontal plane jump landing tasks were tested before and after the intervention. Peak angles, excursions, and external joint moments were analysed for group differences using 2 (group) × 4 (task) repeated measures MANOVA models of delta scores (post-pre-test value) (α < 0.05). RESULTS Relative to the control group, no significant biomechanical changes were identified in the intervention group for any of the tasks (n.s.). However, a group by task interaction was identified for knee abduction (λ = 0.80, p = 0.02), such that participants in the intervention group showed relative decreases in knee abduction moments during the SAG-DL compared to the SAG-SL (p = 0.005; d = 0.45, CI = 0.04-0.85) task. CONCLUSION A 6-week warm-up-based ACL injury prevention programme resulted in no significant biomechanical changes during a variety of multi-directional jump landings. Clinically, future prevention programmes should provide a greater training stimulus (intensity, volume), more specificity to tasks associated with the mechanism of ACL injury (single-leg, non-sagittal plane jump landings), and longer programme duration (> 6 weeks) to elicit meaningful biomechanical changes. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Jeffrey B Taylor
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, 27268, USA. .,Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA.
| | - Kevin R Ford
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, 27268, USA
| | - Randy J Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Scott E Ross
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
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Brunner R, Friesenbichler B, Casartelli NC, Bizzini M, Maffiuletti NA, Niedermann K. Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes: an umbrella review. Br J Sports Med 2018; 53:282-288. [PMID: 30201793 DOI: 10.1136/bjsports-2017-098944] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify which exercise combinations are most effective as part of a lower extremity injury prevention programme for team-sport athletes. DESIGN Umbrella review. DATA SOURCES A comprehensive literature search was performed in PubMed, Scopus, Cochrane Library and PEDro databases. Studies published between January 2000 and March 2017 were included in this umbrella review. STUDY ELIGIBILITY CRITERIA Moderate to high-quality systematic reviews that investigated the effectiveness of a combination of two or more exercise components, that is, strength, agility, plyometrics, balance, stretching, technique, warm-up and functional activity, regarding injury incidence/rate of lower extremity injuries in team-sport athletes. The methodological quality of the included systematic reviews was independently assessed by two reviewers using the Assessing the Methodological Quality of Systematic Reviews measurement tool and the Grading of Recommendations Assessment, Development and Evaluation guidelines were used to assess the overall quality of evidence for particular outcomes. RESULTS Twenty-four systematic reviews met the inclusion criteria. Multicomponent exercise interventions were effective in reducing the injury incidence/rate of lower extremity, knee, ACL and ankle injuries, but not groin injuries. Strength and balance exercise components were included in 10 of 11 effective injury prevention programmes for the lower extremity, knee, ACL and ankle injuries. SUMMARY/CONCLUSION Lower extremity injury prevention programmes in team sports are effective in preventing lower extremity, knee, ACL and ankle injuries. Lower extremity muscle strength and balance exercises should be prioritised in lower extremity injury prevention programmes for team-sport athletes.
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Affiliation(s)
- Romana Brunner
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
| | | | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Mario Bizzini
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
| | | | - Karin Niedermann
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
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Abstract
The Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This particular guideline focuses on the exercise-based prevention of knee injuries. J Orthop Sports Phys Ther. 2018;48(9):A1-A42. doi:10.2519/jospt.2018.0303.
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Mickevičius M, Degens H, Kesminas R, Rutkauskas S, Satkunskienė D, Vadopalas K, Pukėnas K, Jürimäe J, Skurvydas A, Kamandulis S. Early anterior knee pain in male adolescent basketball players is related to body height and abnormal knee morphology. Phys Ther Sport 2018; 32:273-281. [DOI: 10.1016/j.ptsp.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 03/30/2018] [Accepted: 04/04/2018] [Indexed: 11/26/2022]
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Seil R, Laver L, Landreau P, Myklebust G, Waldén M. ESSKA helps making a change: the example of handball medicine. Knee Surg Sports Traumatol Arthrosc 2018; 26:1881-1883. [PMID: 28271368 DOI: 10.1007/s00167-017-4478-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/10/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg.
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg.
| | - Lior Laver
- Department of Trauma and Orthopaedics, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Philippe Landreau
- Surgery Department. Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Grethe Myklebust
- Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway
| | - Markus Waldén
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Orthopaedics, Hässleholm-Kristianstad-Ystad Hospitals, Hässleholm, Sweden
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Gokeler A, Seil R, Kerkhoffs G, Verhagen E. A novel approach to enhance ACL injury prevention programs. J Exp Orthop 2018; 5:22. [PMID: 29916182 PMCID: PMC6005994 DOI: 10.1186/s40634-018-0137-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022] Open
Abstract
Efficacy studies have demonstrated decreased anterior cruciate ligament (ACL) injury rates for athletes participating in injury prevention programs. Typically, ACL injury prevention programs entail a combination of plyometrics, strength training, agility and balance exercises. Unfortunately, improvements of movement patterns are not sustained over time. The reason may be related to the type of instructions given during training. Encouraging athletes to consciously control knee movements during exercises may not be optimal for the acquisition of complex motor skills as needed in complex sports environments. In the motor learning domain, these types of instructions are defined as an internal attentional focus. An internal focus, on one's own movements results in a more conscious type of control that may hamper motor learning. It has been established in numerous studies that an external focus of attention facilitates motor learning more effectively due to the utilization of automatic motor control. Subsequently, the athlete has more recourses available to anticipate on situations on the field and take appropriate feed forward directed actions. The purpose of this manuscript was to present methods to optimize motor skill acquisition of athletes and elaborate on athletes' behavior.
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Affiliation(s)
- Alli Gokeler
- Luxembourg Institute of Research for Orthopedics, Medicine and Science in Sports, 76 rue d'Eich, L-1460, Luxembourg, Luxembourg. .,Department of Applied Neuroscience in Sports and Exercise, Institute of Sports Medicine, University of Paderborn, Paderborn, Germany. .,University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, Netherlands.
| | - Romain Seil
- Luxembourg Institute of Research for Orthopedics, Medicine and Science in Sports, 76 rue d'Eich, L-1460, Luxembourg, Luxembourg
| | - Gino Kerkhoffs
- Academic Center for Evidence based Sports Medicine (ACES), Academic Medical Center, Amsterdam, Netherlands.,Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, Netherlands.,Amsterdam Collaboration for Health & Safety in Sports (ACHSS), IOC Research Center, Academic Medical Center/VU Medical Center, Amsterdam, Netherlands
| | - Evert Verhagen
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), IOC Research Center, Academic Medical Center/VU Medical Center, Amsterdam, Netherlands.,Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, Netherlands.,Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
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Omi Y, Sugimoto D, Kuriyama S, Kurihara T, Miyamoto K, Yun S, Kawashima T, Hirose N. Effect of Hip-Focused Injury Prevention Training for Anterior Cruciate Ligament Injury Reduction in Female Basketball Players: A 12-Year Prospective Intervention Study. Am J Sports Med 2018; 46:852-861. [PMID: 29360406 DOI: 10.1177/0363546517749474] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Programs to prevent anterior cruciate ligament (ACL) injuries in female basketball players are scarce. Also, ACL injury prevention training that focuses on hip joint function has not been reported. PURPOSE To determine the effectiveness of a hip-focused ACL injury prevention program in female basketball players. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A prospective intervention study was conducted for 12 years. Incidence rates of ACL injuries were collected in the first 4 years (observation period) from college female basketball players. After the observation period, a hip-focused ACL injury prevention program was implemented for 8 years (intervention period). A total of 309 players (mean ± SD age, 19.6 ± 1.2 years; height, 163.7 ± 5.6 cm; weight, 59.1 ± 5.1 kg; body mass index, 22.0 ± 1.4) were tracked in the observation period and compared with 448 players (age, 19.6 ± 1.1 years; height, 162.6 ± 5.8 cm; weight, 58.0 ± 5.7 kg; body mass index, 21.9 ± 1.5) who participated in the intervention period. Athlete-exposures (AEs), ACL numbers and mechanisms of injury (MOIs), relative risk (RR), absolute risk reduction (ARR), numbers needed to treat (NNT), and compliance were analyzed. RESULTS There were 16 ACL injuries (13 noncontact MOIs) in the 4-year observation period, whereas 9 ACL injuries (8 noncontact MOIs) were recorded in the 8-year intervention period. The overall ACL injury incidence was 0.25/1000 AEs in the 4-year observation period compared with 0.10/1000 AEs in the 8-year intervention period, respectively. Compared with the 4-year observation period, significant RR reduction was observed (0.38; 95% CI, 0.17-0.87; P = .017) with ARR and NNT of 0.032 (95% CI, 0.027-0.037) and 31.6 (95% CI, 27.1-37.7), respectively, in the 8-year intervention period. The noncontact ACL injury incidence was 0.21 per 1000 AEs during the 4-year observation period compared with 0.08/1000 AEs in the 8-year intervention period, which also showed significant RR reduction (0.37; 95% CI, 0.15-0.92; P = .026), with ARR and NNT of 0.024 (95% CI, 0.020-0.029) and 41.3 (95% CI, 34.6-51.3), respectively. The mean compliance rate during the intervention periods (8 years) was 89%. CONCLUSION A hip-focused injury prevention program demonstrated significant reduction in the incidence of ACL injury in female collegiate basketball players.
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Affiliation(s)
- Yorikatsu Omi
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan.,Department of Rehabilitation, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Waltham, Massachusetts, USA.,Department of Orthopaedics, Harvard Medical School, Boston, Massachusetts, USA
| | - Setsurou Kuriyama
- Department of Orthopedic Surgery, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan.,Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Tomohisa Kurihara
- Department of Rehabilitation, Nippon Koukan Hospital, Kawasaki, Kanagawa, Japan
| | - Kenji Miyamoto
- Department of Rehabilitation, Aobasawai Hospital, Yokohama, Kanagawa, Japan
| | - Songjo Yun
- Department of Rehabilitation, Ito shimin Hospital, Ito, Shizuoka, Japan
| | | | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
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Boykin RE. Editorial Commentary: The Downstream Effects of Limited Hip Rotation and Femoroacetabular Impingement on the Anterior Cruciate Ligament: Could a Little Hip Stretching Every Day (or Surgery) Keep the Knee Doctor Away? Arthroscopy 2018; 34:951-952. [PMID: 29502708 DOI: 10.1016/j.arthro.2017.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 02/02/2023]
Abstract
Patients with radiographic evidence of femoroacetabular impingement and decreased hip internal rotation have a higher rate of anterior cruciate ligament (ACL) tears. Limited internal rotation of the hip increases strain and potentially resultant fatigue failure of the ACL. Although causation has not been proven, a better understanding of the lower extremity kinetic chain may allow improved ACL prevention strategies through measures (operative or nonoperative) to improve rotation of the hip.
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