1
|
Tagliero AJ, Miller MD. Anterior Cruciate Ligament Tears in Soccer Players. Sports Med Arthrosc Rev 2024; 32:138-145. [PMID: 39087703 DOI: 10.1097/jsa.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Anterior cruciate ligament (ACL) injuries to soccer players present unique challenges in sports medicine, given the sport's global prevalence and intricate injury dynamics. These injuries, especially in the youth and female demographic, have become a substantial concern in sports medicine. This review explores the epidemiology, mechanism of injury, diagnostic procedures, treatment modalities, and rehabilitation strategies related to ACL tears within the soccer community. Progress in diagnostics, treatments, and rehabilitation underscores the importance of evidence-based approaches. As soccer continues its ascent in popularity, addressing the specific risks and nuances of ACL injuries in this context remains of paramount significance.
Collapse
Affiliation(s)
- Adam J Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Mark D Miller
- Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA
| |
Collapse
|
2
|
Engebretsen L, Møller M, Kooy C, Yamaguchi T, Moatshe G. The gender and sex data gap in anterior cruciate ligament injuries in paediatric patients. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39126265 DOI: 10.1002/ksa.12397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024]
Abstract
Anterior cruciate ligament (ACL) injury is a concerning problem in the paediatric population, impacting joint health and longevity. Moreover, ACL injury hampers physical activity, which is important for children's social network and general well-being. Recent data demonstrates a rise in paediatric ACL reconstructions, affecting both girls and boys. However, it is unclear whether this rise reflects a higher injury rate or a more proactive approach towards surgery, as information on nonoperated patients is lacking. Regarding gender differences, increasing evidence implies that girls engaged in pivoting sports experience a higher incidence of ACL injuries and reinjuries compared to boys. Furthermore, data suggest that girls have inferior outcomes and lower return-to-sport rates than boys. The social context in which girls compete in sports is likely a significant contributing factor to the risk of serious knee injuries. Lack of attention and insufficient data on gender-based differences in ACL injuries, outcomes and evidence-based treatment guidelines highlight the need for further research on this topic. LEVEL OF EVIDENCE: Level IV.
Collapse
Affiliation(s)
- Lars Engebretsen
- Oslo Sports trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Arthroscopy and Sports Medicine, Oslo University Hospital Aker, University of Oslo, Oslo, Norway
| | - Merete Møller
- Oslo Sports trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Sports Science and Clinical Biomechanics, Research Unit of Musculoskeletal Function and Physiotherapy, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Caroline Kooy
- Oslo Sports trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Arthroscopy and Sports Medicine, Oslo University Hospital Aker, University of Oslo, Oslo, Norway
- Department of Orthopedic Surgery, Akershus University Hospital, Oslo, Norway
| | - Tetsuo Yamaguchi
- Department of Industriial and Social Sciences, Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Tokushima, Japan
| | - Gilbert Moatshe
- Oslo Sports trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Arthroscopy and Sports Medicine, Oslo University Hospital Aker, University of Oslo, Oslo, Norway
| |
Collapse
|
3
|
Nijmeijer EM, Kempe M, Elferink-Gemser MT, Benjaminse A. Observe, Practice, and Improve? Enhancing Sidestep Cutting Execution in Talented Female Soccer Players: A Four-Week Intervention Program With Video Instruction. J Strength Cond Res 2024; 38:e430-e439. [PMID: 38662706 PMCID: PMC11286158 DOI: 10.1519/jsc.0000000000004796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
ABSTRACT Nijmeijer, EM, Kempe, M, Elferink-Gemser, MT, and Benjaminse A. Observe, practice and improve? Enhancing sidestep cutting (SSC) execution in talented female soccer players: A four-week intervention program with video instruction. J Strength Cond Res 38(8): e430-e439, 2024-Implicit learning has the potential to improve movement execution and reduce injury risk. Previous research showed beneficial effects of short-term interventions with implicit learning in male athletes. However, research on long-term interventions in female athletes is lacking. The aim of this study was to examine the effects of a 4-week intervention with video instruction on movement execution of SSC, a task that is highly related with anterior cruciate ligament (ACL) injury risk, in female athletes. Twenty talented adolescent female soccer players were part of the control (CTRL, n = 10) or video instruction (VIDEO, n = 10) group. All subjects practiced 4 weeks and received general task instructions. In addition, the VIDEO group received expert video instruction during practice. Lower extremity kinematics and kinetics and vertical ground reaction force of SSC were examined during baseline, immediate post, and 1-week retention tests. After nonlinear registration, differences between each subject and the expert she had seen were determined. These differences were analyzed with SPM1D 2-way ANOVA. No interaction effects between time and group were found ( p > 0.05). Main effects of time were found in the frontal plane. In particular, smaller deviations of subjects compared with the seen expert of the knee adduction ( p = 0.005, 97.9-100% stance phase [SP]) and hip abduction ( p = 0.005, 11.5-13.8% SP) and adduction ( p < 0.001, 33.4-87.7% SP) moments were found in immediate post compared with baseline. These frontal plane short-term improvements, replicating earlier findings in both sexes, may lower ACL injury risk. The large observed interindividual differences over time may have concealed the long-term effects of video instruction at the group level.
Collapse
Affiliation(s)
- Eline M Nijmeijer
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | |
Collapse
|
4
|
MOIROUX–SAHRAOUI A, FORELLI F, MAZEAS J, RAMBAUD AJM, BJERREGAARD A, RIERA J. Quadriceps Activation After Anterior Cruciate Ligament Reconstruction: The Early Bird Gets the Worm! Int J Sports Phys Ther 2024; 19:1044-1051. [PMID: 39100933 PMCID: PMC11297573 DOI: 10.26603/001c.121423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/28/2024] [Indexed: 08/06/2024] Open
Abstract
Arthrogenic Muscle Inhibition (AMI) is a phenomenon observed in individuals with joint injury or pathology, characterized by a reflexive inhibition of surrounding musculature, altered neuromuscular control, and compromised functional performance. After anterior cruciate ligament reconstruction (ACLR) one of the most obvious consequences of AMI is the lack of quadriceps activation and strength. Understanding the underlying mechanisms of AMI is crucial for developing effective therapeutic interventions. The surgical procedure needed to reconstruct the ACL has biochemical et physiological consequences such as inflammation, pain, and altered proprioception. These alterations contribute to the development of AMI. Therapeutic interventions aimed at addressing AMI encompass a multidimensional approach targeting pain reduction, inflammation management, proprioceptive training, and quadriceps activation. Early management focusing on pain modulation through modalities like ice, compression, and pharmacological agents help mitigate the inflammatory response and alleviate pain, thereby reducing the reflexive inhibition of quadriceps. Quadriceps activation techniques such as neuromuscular electrical stimulation (NMES) and biofeedback training aid in overcoming muscle inhibition and restoring muscle strength. NMES elicits muscle contractions through electrical stimulation, bypassing the inhibitory mechanisms associated with AMI, thus facilitating muscle activation and strength gains. Comprehensive rehabilitation programs tailored to individual needs and stage of recovery are essential for optimizing outcomes in AMI. The objective of this clinical viewpoint is to delineate the significance of adopting a multimodal approach for the effective management of AMI, emphasizing the integration of pain modulation, proprioceptive training, muscle activation techniques, and manual therapy interventions. Highlighting the critical role of early intervention and targeted rehabilitation programs, this article aims to underscore their importance in restoring optimal function and mitigating long-term complications associated with AMI.
Collapse
Affiliation(s)
- Ayrton MOIROUX–SAHRAOUI
- Orthosport Rehab Center, Domont, France
- Orthopaedic Surgery DepartmentClinic of Domont, Ramsay Healthcare, @OrthoLab, Domont, France
- Physiotherapy School, IPMR, Nevers, France
| | - Florian FORELLI
- Orthosport Rehab Center, Domont, France
- Orthopaedic Surgery DepartmentClinic of Domont, Ramsay Healthcare, @OrthoLab, Domont, France
- Physiotherapy School, IPMR, Nevers, France
- SFMK Lab, Pierrefite sur seine, France
| | - Jean MAZEAS
- Orthosport Rehab Center, Domont, France
- Orthopaedic Surgery DepartmentClinic of Domont, Ramsay Healthcare, @OrthoLab, Domont, France
| | - Alexandre JM RAMBAUD
- SFMK Lab, Pierrefite sur seine, France
- Physiotherapy School of Saint Etienne, St Michel Campus, Saint Etienne, France
| | - Andreas BJERREGAARD
- Rehabilitation DepartmentAspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jérôme RIERA
- University Jean Monnet Saint-Etienne, Lyon 1, University Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France
- University of Bordeaux, College of Health Sciences, IUSR, 33000, Bordeaux, France
| |
Collapse
|
5
|
Sarakatsianos V, Cristiani R, Edman G, Stålman A. Diameter of quadrupled semitendinosus autograft in primary anterior cruciate ligament reconstruction did not impact early revision rate or functional outcome in a large cohort of patients. Arthroscopy 2024:S0749-8063(24)00515-2. [PMID: 39069025 DOI: 10.1016/j.arthro.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE To determine whether the diameter of the quadrupled semitendinosus tendon (ST) graft in primary anterior cruciate ligament reconstruction (ACLR) is related to the risk of revision ACLR within 2 years of primary ACLR, postoperative knee laxity and patient reported knee outcome. Furthermore, to investigate whether smaller graft than estimated is related to revision ACLR. METHODS Patients who underwent primary ACLR with a quadrupled ST autograft at our institution, from January 2005 to December 2017 were identified. Data from the Swedish National Knee Ligament Registry (SNKLR) were collected up to two years or until revision surgery was registered within two years after primary ACLR. Knee laxity was assessed, pre-operatively and at 6-months follow up using the KT-1000 arthrometer (134 N anterior tibial load). The Knee injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and at two years postoperatively from SNKLR. Based on anthropometric measurements (body height and weight) and sex the estimated quadrupled ST graft diameter was calculated. RESULTS A total of 4,519 patients who underwent ACLR with a quadrupled ST autograft were included. The mean graft diameter was 8.3 mm± 0.7 mm; 8.0 mm± 0.6 mm for women and 8.6 mm ± 0.7 mm for men. The quadrupled ST graft diameter was not significantly correlated to revision ACLR. There was no significant difference in the ST graft diameter regarding post-operative knee laxity. The correlations between ST graft diameter and KOOS were weak, except for the "Sport and Recreation" subscale (P=.012). CONCLUSIONS The quadrupled ST graft diameter was not significantly related to the need for early revision ACLR nor was related to postoperative knee laxity or patient reported outcome except for the KOOS "Sport and Recreation" subscale. Smaller ST graft than estimated was not a risk factor for revision ACLR. The outcome after ACLR is multifactorial and ST graft diameter is of no significant importance.
Collapse
Affiliation(s)
- Vasileios Sarakatsianos
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Solna, Sweden; Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden.
| | - Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Solna, Sweden; Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden
| | - Gunnar Edman
- Research and Development, Norrtälje Hospital, Tiohundra AB, Norrtälje, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Stålman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Solna, Sweden; Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden
| |
Collapse
|
6
|
Ulman S, Loewen A, Erdman A, Õunpuu S, Chafetz R, Tulchin-Francis K, Wren TAL. Model variations for tracking the trunk during sports testing in a motion capture lab. Front Sports Act Living 2024; 6:1429822. [PMID: 39101153 PMCID: PMC11294157 DOI: 10.3389/fspor.2024.1429822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/10/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction As motion capture technology becomes more popular for athlete monitoring and return-to-play evaluation, it is imperative that trunk mechanics are modeled similarly across participants. The purpose of this study was to determine how adjusting marker placement at the sternum or removing potentially occluded markers for purposes of tracking the trunk segment influences trunk kinematics during gait and a drop vertical jump (DVJ). Methods Sagittal plane trunk angles of 18 participants were computed for a Definition Model and three trunk model variations. Model variations were specifically chosen to avoid difficulties with placement of the sternum and/or thorax markers in female participants due to sports bra coverage and/or occlusion. Intraclass correlation coefficients were computed per trunk model variation to determine agreement with the Definition Model. Results The Mid-Sternum model, in which the xiphoid process marker was adjusted to the midpoint of the xiphoid process and jugular notch, exhibited the least discrepancies and excellent agreement with the Definition Model across both tasks. Alternatively, the No-Thorax model, in which the thorax marker was removed, exhibited the greatest kinematic differences during the DVJ and moderate to excellent agreement across both tasks. Conclusion The marker set chosen to track trunk motion during dynamic tasks must include locations that can be placed similarly on all participants. Based on these findings, the xiphoid process marker may be adjusted superiorly prior to the collection of dynamic trials. The recommended model for tracking the trunk segment includes marker placements on the jugular notch, mid-sternum, and 1st and 10th thoracic spinous processes.
Collapse
Affiliation(s)
- Sophia Ulman
- Orthopedic and Sports Medicine Center, Scottish Rite for Children, Dallas, TX, United States
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Alex Loewen
- Orthopedic and Sports Medicine Center, Scottish Rite for Children, Dallas, TX, United States
| | - Ashley Erdman
- Orthopedic and Sports Medicine Center, Scottish Rite for Children, Dallas, TX, United States
| | - Sylvia Õunpuu
- Center for Motion Analysis, Connecticut Children’s Medical Center, Hartford, CT, United States
| | - Ross Chafetz
- Motion Analysis Center, Shriners Hospital for Children, Philadelphia, PA, United States
| | - Kirsten Tulchin-Francis
- Department of Orthopedic Surgery, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Tishya A. L. Wren
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital of Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
7
|
Cerezal A, Roriz D, Canga A, Cerezal L. Imaging of sports injuries in adolescents. Pediatr Radiol 2024:10.1007/s00247-024-05991-9. [PMID: 38995428 DOI: 10.1007/s00247-024-05991-9] [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: 05/16/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
Musculoskeletal injuries in adolescents tend to occur in particular locations and have distinct characteristics, as they affect an immature skeleton. Increased engagement in sports, extended training and competition periods, and early specialization in specific sports, among other factors, have contributed significantly to the rise in musculoskeletal sports injuries in adolescents. Furthermore, females show a particularly pronounced increase in sports participation, where anatomical and hormonal factors play crucial roles in the development and increased frequency of sports-related injuries. Consequently, there is a growing demand for diagnostic imaging techniques. Musculoskeletal and pediatric radiologists require a comprehensive understanding of intrinsic and extrinsic risk factors and the successive stages of skeletal development that can influence the specific characteristics of sports injuries in adolescents. These aspects are crucial for the diagnostic, prognostic, and therapeutic management of these injuries and for mitigating chronic conditions that could compromise future sports participation. This review analyzes the primary musculoskeletal injuries in adolescent athletes and highlights the pivotal role of different imaging methods in their diagnosis and management.
Collapse
Affiliation(s)
- Alvaro Cerezal
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Diogo Roriz
- Department of Radiology, ULSAM, Viana Do Castelo, Portugal
| | - Ana Canga
- Department of Radiology, Valdecilla University Hospital, Santander, Spain
| | - Luis Cerezal
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Calle Castilla 6, 39002, Santander, Spain.
| |
Collapse
|
8
|
Butcher AJ, Ward S, Clissold T, Richards J, Hébert-Losier K. Maturation and biomechanical risk factors associated with anterior cruciate ligament injury: Is there a link? A systematic review. Phys Ther Sport 2024; 68:31-50. [PMID: 38908221 DOI: 10.1016/j.ptsp.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE To establish the potential link between sex-specific maturation and biomechanical factors associated with ACL injury during dynamic tasks. DESIGN Systematic review. LITERATURE SEARCH Five databases (CINHAL®, Cochrane Library, PubMed®, Scopus®, and SPORTDiscus) were searched and monitored until 27 May 2024. STUDY SELECTION CRITERIA Cross-sectional, cohort, case-control, or interventional studies reporting one or more biomechanical variable linked with ACL injury and which assessed participants across two or more maturation phases were considered eligible. DATA SYNTHESIS Studies were assessed for risk of bias using a modified version of the Newcastle Ottawa Scale and overall quality of evidence was rated using GRADE. Metrics and effect sizes were presented where available. RESULTS Eighteen included studies examined 400 males, 1377 females, and 315 participants of undefined sex across various maturation phases. The methodological quality of most studies (n = 16) was considered good, and satisfactory for two. Knee abduction angle, knee abduction moment, knee flexion angle, and ground reaction forces were most commonly reported. Knee abduction angles and moments and knee flexion angles were greater in late and post-pubertal females than males and pre-pubertal females during both landing and cutting tasks. When normalised for body mass, ground reaction forces were generally greater in males compared to females overall and for less mature participants for both sexes. Overall quality of evidence was low or medium across the four biomechanical measures. CONCLUSION Sex-specific maturation considerations are important in the targeted development and implementation of ACL injury risk identification and prevention strategies.
Collapse
Affiliation(s)
- Anna J Butcher
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, 52 Miro Street, 3116, Tauranga, New Zealand.
| | - Sarah Ward
- Department of Exercise Sciences, University of Auckland, Suiter Street, Newmarket, New Zealand. https://twitter.com/sarahward_nz
| | - Tracey Clissold
- Toi Ohomai Institute of Technology, 70 Windermere Drive, Poike, 3112, Tauranga, New Zealand
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, England, United Kingdom. https://twitter.com/ProfJimRichards
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, 52 Miro Street, 3116, Tauranga, New Zealand. https://twitter.com/KimHebertLosier
| |
Collapse
|
9
|
Bixby EC, Heyworth BE. Management of Anterior Cruciate Ligament Tears in Skeletally Immature Patients. Curr Rev Musculoskelet Med 2024; 17:258-272. [PMID: 38639870 PMCID: PMC11156825 DOI: 10.1007/s12178-024-09897-9] [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] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament (ALC) tears are increasingly common in skeletally immature patients, as more children and adolescents participate in intensive sports training and specialization at increasingly younger ages. These injuries were historically treated nonoperatively, given concerns for physeal damage and subsequent growth disturbances after traditional ACL reconstruction techniques. However, there is now sufficient data to suggest superior outcomes with operative treatment, specifically with physeal-sparing and physeal-respecting techniques. This article reviews considerations of skeletal maturity in patients with ACL tears, then discusses surgical techniques, with a focus on their unique indications and outcomes. Additional surgical adjuncts and components of postoperative rehabilitation, which may reduce retear rates, are also considered. RECENT FINDINGS Current research shows favorable patient-reported outcomes and high return-to-sport rates after ACL reconstruction in skeletally immature patients. Graft rupture (ACL retear) rates are low, but notably higher than in most adult populations. Historically, there has been insufficient research to comprehensively compare reconstruction techniques used in this patient population. However, thoughtful systematic reviews and multicenter prospective studies are emerging to address this deficit. Also, more recent data suggests the addition of lateral extra-articular procedures and stringent return-to-sports testing may lower retear rates. Physeal-sparing and physeal-respecting ACL reconstructions result in stabilization of the knee, while respecting the growth remaining in children or skeletally immature adolescents. Future research will be essential to compare these techniques, given that more than one may be appropriate for patients of a specific age and skeletal maturity.
Collapse
Affiliation(s)
- Elise C Bixby
- Department of Sports Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Benton E Heyworth
- Department of Sports Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| |
Collapse
|
10
|
Kantrowitz DE, Colvin A. Comprehensive Clinical Examination of ACL Injuries. Clin Sports Med 2024; 43:311-330. [PMID: 38811112 DOI: 10.1016/j.csm.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
A comprehensive clinical examination of the potentially anterior cruciate ligament (ACL)-deficient knee should proceed as follows: inspection; palpation; range of motion; varus and valgus stress; neurovascular status; and finally provocative maneuvers. The Lachman, anterior drawer, Lever, and pivot shift tests are all greater than 90% specific for ACL pathology. Due to the relatively high coincidence of ACL injuries and those to the posterior cruciate ligament, posterolateral corner , posteromedial corner , and menisci, it is critical that the examiner perform provocative maneuvers to evaluate the integrity of these structures as well.
Collapse
Affiliation(s)
- David E Kantrowitz
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA.
| | - Alexis Colvin
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA
| |
Collapse
|
11
|
Lau J, Garcia-Lopez E, Feeley BT, Pandya NK. Association of Spanish as a Primary Language With Retear Rates After Pediatric ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241252936. [PMID: 38881856 PMCID: PMC11179484 DOI: 10.1177/23259671241252936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 06/18/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) injuries are one of the most common knee injuries in pediatric patients in the United States. The patient's primary spoken language may affect outcomes after ACL reconstruction (ACLR). Purpose/Hypothesis The purpose of this study was to identify differences in ACLR outcomes between patients whose primary, preferred spoken language was either English or Spanish. It was hypothesized that there would be a difference in retear rates between patients preferring English versus Spanish. Study Design Cohort study; Level of evidence, 3. Methods A retrospective cohort study was performed on pediatric and adolescent patients who underwent ACLR at a single institution. Patients were divided into 2 cohorts based on their preferred spoken language: English or Spanish. All patients underwent either hamstring tendon or bone-patellar tendon-bone autograft ACLR performed by the same surgeon with the same postoperative rehabilitation protocols. Linear regression, chi-square tests, and multivariate logistic regression were used to determine if outcomes, graft tear, revision surgery, and contralateral injury differed between groups. Results A total of 68 patients were identified: 33 patients whose preferred language was English and 35 patients whose preferred language was Spanish. The overall mean age of the patients was 16.4 ± 1.4 years (range, 13.2-20.5 years), and the mean follow-up time was 3.26 ± 1.98 years (range, 0.53-8.13 years). Patients who preferred Spanish were more likely than those who preferred English to experience graft tears requiring revision surgery after ACLR (P = .02; odds ratio [OR] = 5.81; adjusted OR = 1.94), at a tear rate of 14.3%. Conclusion Patients who preferred to speak Spanish experienced higher graft tear rates when compared with patients who preferred speaking English, even after adjusting for sex, sport played, graft type, type of insurance, and time to surgery.
Collapse
Affiliation(s)
- Justin Lau
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Edgar Garcia-Lopez
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Nirav K Pandya
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| |
Collapse
|
12
|
Ogura A, Miyazaki T, Ida H, Shibata S, Takemura M. Postural Control During Single-Leg Landing in Female Athletes After Anterior Cruciate Ligament Reconstruction. Int J Sports Phys Ther 2024; 19:681-691. [PMID: 38835982 PMCID: PMC11144668 DOI: 10.26603/001c.117400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/09/2024] [Indexed: 06/06/2024] Open
Abstract
Background Secondary anterior cruciate ligament (ACL) injury is a complication of ACL reconstruction (ACLR), which may result from altered neuromuscular control affecting anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) required for maintaining balance during movement. However, it remains unclear how APAs and CPAs differ in single-leg landings post-ACLR compared to healthy subjects. Purpose The purpose of this study was to clarify the differences in muscle activities of APAs and CPAs, lower limb kinematics, and kinetics between athletes with a history of ACLR and healthy athletes during single-leg landing. Study design Cross-sectional study. Methods Eighteen female athletes were recruited and divided into ACLR (n = 9) and control groups (n = 9). The experimental task involved a single-leg landing from a 30 cm box. Joint angles and moments were determined using a 3-dimensional motion analysis system, while muscle activity was assessed using surface electromyography. Analysis intervals were divided into two phases: the APA phase (-150 ms to 50 ms) and the CPA phase (50 ms to 250 ms), with initial contact (0 ms) as the reference point. Muscle activity onset time was defined as the time when the baseline exceeded by the sum of mean values and 2 standard deviations. Results No significant differences were observed in muscle activity or onset time between the ACLR and control groups. However, an increased hip external rotation moment was observed during the CPA phase in the ACLR group. Conclusion These findings suggest that APAs and CPAs of athletes who returned to sports more than 1 year post-ACLR may be similar. The increased hip external rotation moment in the ACLR group during the CPA phase could represent a specific compensatory strategy to decrease the hip internal rotation angle post-ACLR. Level of Evidence III.
Collapse
Affiliation(s)
- Ayane Ogura
- Graduate School of Comprehensive Human Sciences University of Tsukuba
| | | | - Hirofumi Ida
- Human Science Center Ibaraki Prefectural University of Health Sciences
| | - Satoshi Shibata
- Physical Therapy Ibaraki Prefectural University of Health Sciences
| | | |
Collapse
|
13
|
Hernandez PA, Bradford JC, Brahmachary P, Ulman S, Robinson JL, June RK, Cucchiarini M. Unraveling sex-specific risks of knee osteoarthritis before menopause: Do sex differences start early in life? Osteoarthritis Cartilage 2024:S1063-4584(24)01172-5. [PMID: 38703811 DOI: 10.1016/j.joca.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/15/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Sufficient evidence within the past two decades have shown that osteoarthritis (OA) has a sex-specific component. However, efforts to reveal the biological causes of this disparity have emerged more gradually. In this narrative review, we discuss anatomical differences within the knee, incidence of injuries in youth sports, and metabolic factors that present early in life (childhood and early adulthood) that can contribute to a higher risk of OA in females. DESIGN We compiled clinical data from multiple tissues within the knee joint-since OA is a whole joint disorder-aiming to reveal relevant factors behind the sex differences from different perspectives. RESULTS The data gathered in this review indicate that sex differences in articular cartilage, meniscus, and anterior cruciate ligament are detected as early as childhood and are not only explained by sex hormones. Aiming to unveil the biological causes of the uneven sex-specific risks for knee OA, we review the current knowledge of sex differences mostly in young, but also including old populations, from the perspective of (i) human anatomy in both healthy and pathological conditions, (ii) physical activity and response to injury, and (iii) metabolic signatures. CONCLUSIONS We propose that to close the gap in health disparities, and specifically regarding OA, we should address sex-specific anatomic, biologic, and metabolic factors at early stages in life, as a way to prevent the higher severity and incidence of OA in women later in life.
Collapse
Affiliation(s)
- Paula A Hernandez
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | | | - Priyanka Brahmachary
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT 59717, USA.
| | - Sophia Ulman
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Movement Science Laboratory, Scottish Rite for Children, Frisco, TX 75034, USA.
| | - Jennifer L Robinson
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195, USA; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA 98109, USA.
| | - Ronald K June
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT 59717, USA.
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg/Saar D-66421, Germany.
| |
Collapse
|
14
|
Martínez-Calderon J, García-Muñoz C. GRADE system in systematic reviews of prevalence or incidence studies evaluating sport-related injuries: why is GRADE important? Br J Sports Med 2024; 58:527-528. [PMID: 38442951 DOI: 10.1136/bjsports-2023-107788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Javier Martínez-Calderon
- Instituto de Biomedicina de Sevilla, IBiS, Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain
- CTS 1110: Understanding Movement and Self in health from Science (UMSS) Research Group, Andalusia, Spain
| | - Cristina García-Muñoz
- CTS 1110: Understanding Movement and Self in health from Science (UMSS) Research Group, Andalusia, Spain
- Departamento de Ciencias de la Salud y Biomédicas, Universidad Loyola de Andalucía, Sevilla, Spain
| |
Collapse
|
15
|
Childers J, Eng E, Lack B, Lin S, Knapik DM, Kaplan DJ, Jackson GR, Chahla J. Reported Anterior Cruciate Ligament Injury Incidence in Adolescent Athletes Is Greatest in Female Soccer Players and Athletes Participating in Club Sports: A Systematic Review and Meta-analysis. Arthroscopy 2024:S0749-8063(24)00298-6. [PMID: 38692337 DOI: 10.1016/j.arthro.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To identify the risk of anterior cruciate ligament (ACL) injury in adolescent athletes based on sex, sport, and sport affiliation. METHODS A literature search was performed using 3 online databases (PubMed, Cochrane Library, and EMBASE) from database inception to November 2023 per the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies consisted of Level I or II studies reporting on ACL injury exposures in time (hours) or injuries per 1,000 athlete-exposures (AEs) (1 game or practice) in adolescent athletes. Exclusion criteria consisted of non-English studies, case reports, animal/cadaveric studies, and review articles. Methodological quality and bias assessment of the included studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. ACL injuries were analyzed and pooled to calculate incidence rates (IRs), per-season risk, and relative risk (RR) based on sex, sport, and sport affiliation (club sport participation vs school sport participation). RESULTS A total of 1,389 ACL injuries over 19,134,167 AEs were identified (IR, 0.075; 95% confidence interval [CI], 0.071-0.079). Of these, 670 ACL injuries were reported in female athletes over 7,549,892 AEs (IR, 0.089; 95% CI, 0.087-0.091) with 719 in males over 11,584,275 AEs (IR, 0.062; 95% CI, 0.058-0.067). The greatest RR for ACL injury in females was in soccer (RR, 3.12; 95% CI, 2.58-3.77) for AEs. The greatest per-season risk of ACL injuries reported in female athletes occurred in soccer (1.08%), basketball (1.03%), and gymnastics (1.01%). The greatest per-season risk of ACL injuries reported in male athletes occurred in football (0.82%), lacrosse (0.64%), and soccer (0.35%). Club sport participation, in both AEs (RR, 3.94; 95% CI, 3.19-4.87) and hours of exposure (RR, 1.57; 95% CI, 1.07-2.28), demonstrated an increased risk of ACL injury. CONCLUSIONS The risk of ACL injuries was 1.56-fold greater in adolescent female athletes compared with male athletes. The highest-risk sport for females was soccer. Participation in club sports possessed higher rates of injury compared with school sports. LEVEL OF EVIDENCE Level II; meta-analysis of Level I and II studies.
Collapse
Affiliation(s)
- Justin Childers
- Charles E. Schmidt School of Medicine, Florida Atlantic University, Boca Raton, Florida, U.S.A
| | - Emma Eng
- Charles E. Schmidt School of Medicine, Florida Atlantic University, Boca Raton, Florida, U.S.A
| | - Benjamin Lack
- Charles E. Schmidt School of Medicine, Florida Atlantic University, Boca Raton, Florida, U.S.A
| | - Shu Lin
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, Florida, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, U.S.A
| | - Daniel J Kaplan
- NYU Langone Health, New York University Langone Medical Center, New York, New York, U.S.A
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| |
Collapse
|
16
|
Jin X, Wu X, Xu W, She C, Li L, Mao Y. Gender differences in the impact of anatomical factors on non-contact anterior cruciate ligament injuries: a magnetic resonance study. BMC Musculoskelet Disord 2024; 25:264. [PMID: 38575985 PMCID: PMC10996128 DOI: 10.1186/s12891-024-07390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE To identify MRI-detected anatomical risk factors for non-contact anterior cruciate ligament (ACL) injuries across genders. METHODS A retrospective analysis was performed on 141 ACL-reconstructed patients (35 females, 106 males) and 142 controls (37 females, 105 males) from January 2020 to April 2022. Inclusion criteria were primary non-contact ACL injuries. The tibial plateau slope, lateral femoral condyle index, Insall-Salvati index, and patellar tendon angle were measured, using binary logistic regression for gender-specific risk evaluation. RESULTS Increased lateral tibial plateau slope, reduced intercondylar notch width index, lateral femoral condyle index, and patellar tendon angle correlated with ACL injuries in both genders. The Insall-Salvati index was a significant risk factor in females but not in males. CONCLUSION This study identifies the lateral tibial plateau slope, notch width index, lateral femoral condyle index, and patellar tendon angle at near-extension as risk factors for ACL injuries in both genders, with the Insall-Salvati index also implicated in females.
Collapse
Affiliation(s)
- Xixin Jin
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Xujin Wu
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Chang She
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Liubing Li
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Yongtao Mao
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China.
| |
Collapse
|
17
|
D'Ambrosi R, Carrozzo A, Meena A, Corona K, Yadav AK, Annibaldi A, Kambhampati SBS, Abermann E, Fink C. A slight degree of osteoarthritis appears to be present after anterior cruciate ligament reconstruction compared with contralateral healthy knees at a minimum of 20 years: A systematic review of the literature. J Exp Orthop 2024; 11:e12017. [PMID: 38577065 PMCID: PMC10993150 DOI: 10.1002/jeo2.12017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/03/2024] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Abstract
Purpose The aim of the present systematic review was to quantitatively synthesize the best literature evidence regarding osteoarthritis developing after anterior cruciate ligament reconstruction (ACLR), including only studies with a follow-up duration of at least 20 years. Material and Methods A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on four electronic databases (PubMed, Scopus, EMBASE and Cochrane Library). The outcome measures extracted from the studies were failure rate, subsequent knee surgery on the same knee, radiographic development of osteoarthritis measured with Kellgren-Lawrence, International Knee Documentation Committee (IKDC) radiographic score and Ahlbäck classification. The health of both the ACLR knee and the contralateral knee was compared. Results A total of 1552 patients were included in the study, of which 1290 (83.11%) were operated on using a patellar tendon graft, 190 (12.24%) with hamstrings, 27 (1.73%) with an iliotibial band and 45 (2.89%) with patellar tendon plus a ligament augmentation device (LAD). The mean age at the time of surgery was 25.18 ± 1.91 years, and the mean follow-up time was 23.34 ± 2.56 years. Analysing IDKC Score at final follow-up, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 33.2% (324/976) of the patients showed a moderate to severe degree (Grade C or D) of osteoarthritis, while for Kellgren-Lawrence, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 28.9% (196/678) of the patients showed a moderate to severe degree (Grade III or IV) of osteoarthritis. In total, 1552 patients were registered, 155 reruptures (9.98%) and a total of 300 (19.3%) new surgeries, of which 228 meniscectomy (14.69%), 21 (1.35%) knee arthroplasty and 17 (1.09%) hardware removal were recorded. Conclusions ACL reconstruction appears to result in mild osteoarthritis in the long term in most of the patients and only less than 33.2% develop a moderate to severe degree of knee OA according to IKDC radiographic score. A slight degree of osteoarthritis appears to be present in ACLR knees compared with contralateral healthy knees. Level of Evidence Level IV.
Collapse
Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi—Sant'AmbrogioMilanItaly
- Dipartimento di Scienze Biomediche per la SaluteUniversità degli Studi di MilanoMilanItaly
| | - Alessandro Carrozzo
- Orthopaedic Unit, Sant'Andrea HospitalUniversity of Rome La SapienzaRomeItaly
| | - Amit Meena
- Division of OrthopedicsShalby Multi‐Specialty HospitalJaipurIndia
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
| | - Katia Corona
- Department of Medicine and Health Sciences “Vincenzo Tiberio”University of MoliseCampobassoItaly
| | | | | | | | - Elisabeth Abermann
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
| | - Christian Fink
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health SciencesMedical Informatics and TechnologyInnsbruckAustria
| |
Collapse
|
18
|
Daniel AV, Smith PA. Primary All-Soft Tissue Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction With Suture Tape Augmentation Resulted in Satisfactory Patient Outcomes and a Low Graft Failure Rate in High School and Collegiate Athletes. Arthroscopy 2024:S0749-8063(24)00234-2. [PMID: 38518869 DOI: 10.1016/j.arthro.2024.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE To evaluate ≥2-year patient outcomes after primary all-soft tissue quadriceps tendon autograft (ASTQ) anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation (STA) in skeletally mature high school and collegiate athletes. METHODS All high school and collegiate athletes who underwent primary ASTQ ACLR with STA with a minimum of 2-year follow-up were analyzed retrospectively. Patients were administered validated patient-reported outcome measures (PROMs) pre- and postoperatively. The minimal clinically important difference was calculated for each PROM based on this study population and applied to the individual patient. Return to sport, subsequent surgical intervention including contralateral ACLR, and KT-1000 arthrometer measurements for knee laxity were collected. Complications were assessed by physical examination, radiologic studies, or obtained via telephone. RESULTS In total, 60 patients were included in the final data analysis, with a mean age of 16.8 years (95% confidence interval 13-23) and mean final follow-up of 37.1 months (95% confidence interval 33.1-41.1). Twelve patients (20%) required subsequent surgery on the ipsilateral knee, which included 7 patients having a subsequent meniscal procedure and 3 patients who underwent arthrolysis. None sustained a graft failure, and 6 patients sustained a contralateral ACL injury necessitating surgery. All PROMs improved at the final follow-up (P < .001). In addition, KT-1000 arthrometer measurements significantly improved postoperatively at 1-year clinical follow-up (P < .001). Most patients obtained the minimal clinically important difference thresholds for each PROM at the final follow-up. There were 48 patients (80%) who participated in pivoting sports. The return-to-sport rate at same level was 54 patients (90%), with 6 patients (10%) not returning to the same level because of graduation. CONCLUSIONS ASTQ ACLR with STA in a young athletic patient population may result in a low graft failure rate while maintaining satisfactory patient outcomes at short-term follow-up, including a return to sport at the same level of 90%. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Adam V Daniel
- Columbia Orthopaedic Group, Columbia, Missouri, U.S.A..
| | | |
Collapse
|
19
|
Erdman A, Loewen A, Dressing M, Wyatt C, Oliver G, Butler L, Sugimoto D, Black AM, Tulchin-Francis K, Bazett-Jones DM, Janosky J, Ulman S. A 2D video-based assessment is associated with 3D biomechanical contributors to dynamic knee valgus in the coronal plane. Front Sports Act Living 2024; 6:1352286. [PMID: 38558858 PMCID: PMC10978775 DOI: 10.3389/fspor.2024.1352286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Adolescent athletes involved in sports that involve cutting and landing maneuvers have an increased risk of anterior cruciate ligament (ACL) tears, highlighting the importance of identifying risky movement patterns such as dynamic knee valgus (DKV). Qualitative movement screenings have explored two-dimensional (2D) scoring criteria for DKV, however, there remains limited data on the validity of these screening tools. Determining a 2D scoring criterion for DKV that closely aligns with three-dimensional (3D) biomechanical measures will allow for the identification of poor knee position in adolescent athletes on a broad scale. The purpose of this study was to establish a 2D scoring criterion that corresponds to 3D biomechanical measures of DKV. Methods A total of 41 adolescent female club volleyball athletes performed a three-task movement screen consisting of a single-leg squat (SLS), single-leg drop landing (SLDL), and double-leg vertical jump (DLVJ). A single rater scored 2D videos of each task using four criteria for poor knee position. A motion capture system was used to calculate 3D joint angles, including pelvic obliquity, hip adduction, knee abduction, ankle eversion, and foot progression angle. Receiver operating characteristic curves were created for each 2D scoring criterion to determine cut points for the presence of movement faults, and areas under the curve (AUC) were computed to describe the accuracy of each 2D criterion compared to 3D biomechanical data. Results 3D measures indicated knee abduction angles between 2.4°-4.6° (SD 4.1°-4.3°) at the time point when the center of the knee joint was most medial during the three tasks. AUCs were between 0.62 and 0.93 across scoring items. The MEDIAL scoring item, defined as the knee joint positioned inside the medial border of the shoe, demonstrated the greatest association to components of DKV, with AUCs ranging from 0.67 to 0.93. Conclusion The MEDIAL scoring criterion demonstrated the best performance in distinguishing components of DKV, specifically pelvic obliquity, hip adduction, ankle eversion, and foot progression. Along with the previously published scoring definitions for trunk-specific risk factors, the authors suggest that the MEDIAL criterion may be the most indicative of DKV, given an association with 3D biomechanical risk factors.
Collapse
Affiliation(s)
- Ashley Erdman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Alex Loewen
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Michael Dressing
- Department of Orthopedics, Joe DiMaggio Children’s Hospital, Hollywood, FL, United States
| | - Charles Wyatt
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gretchen Oliver
- Sports Medicine & Movement Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
| | - Lauren Butler
- Department of Rehabilitation, Nicklaus Children’s Hospital, Miami, FL, United States
| | - Dai Sugimoto
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- Sports Medicine Division, The Micheli Center for Sports Injury Prevention, Waltham, MA, United States
| | - Amanda M. Black
- Centre for Healthy Youth Development Through Sport, Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Kirsten Tulchin-Francis
- Department of Orthopedic Surgery, Nationwide Children’s Hospital, Columbus, OH, United States
| | - David M. Bazett-Jones
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, Toledo, OH, United States
| | - Joseph Janosky
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, United States
| | - Sophia Ulman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
20
|
Zink GP, Zwolski CM, Thomas SM, Paterno MV, Schmitt LC. The Influence of Strength and Sport Exposure on Psychological Readiness After ACL Reconstruction. Sports Health 2024; 16:239-246. [PMID: 38288482 PMCID: PMC10916781 DOI: 10.1177/19417381231223522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Among young athletes returning to sport after anterior cruciate ligament reconstruction (ACLR), the extent to which psychological readiness is influenced by factors beyond the psychological domain is largely unknown. HYPOTHESIS Young athletes with recent sport exposure and higher quadriceps strength will demonstrate higher psychological readiness within 8 weeks of medical clearance to return to sport (RTS) after ACLR. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS A total of 38 young athletes after primary ACLR completed testing within 8 weeks of medical clearance to RTS. All participants completed isometric knee extension strength testing, in addition to the ACL Return to Sport after Injury (ACL-RSI) questionnaire. Athletes who participated in sport between time of medical clearance to RTS and date of study enrollment were categorized as SPORT-YES. Those who had not yet participated in sports were categorized as SPORT-NO. Multiple linear regression analyses were used to determine differences in ACL-RSI scores based on quadriceps strength and sport exposure status, while adjusting for age and sex. RESULTS Of the 38 participants, 20 (52.6%) were categorized as SPORT-YES. The regression model estimating overall ACL-RSI score (P < 0.01, adjusted R2 = 0.389) included significant independent contributions from age, sex, and sport exposure variables (age: P = 0.01, β [95% CI] = -2.01 [-3.54, -0.48]; sex (male): P = 0.02, β [95% CI] = 12.50 [2.36, 22.64]; strength: P = 0.51, β [95% CI] = -2.47 [-10.07,5.13]; sport exposure: P < 0.01, β [95% CI] = 12.89 [3.58, 22.19]). CONCLUSION In partial accordance with our hypothesis, recent sport exposure was significantly associated with higher ACL-RSI scores among young athletes in the weeks after medical clearance to RTS after ACLR, while quadriceps strength was not. CLINICAL RELEVANCE Future prospective work is needed to determine the existence and direction of causal relationships between exposure to sport environment and psychological readiness among young athletes after ACLR.
Collapse
Affiliation(s)
- Griffin P Zink
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
- Department of Physical Therapy, Bon Secours Mercy Health Orthopaedic and Sports Medicine, Cincinnati, Ohio
| | - Christin M Zwolski
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Staci M Thomas
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Laura C Schmitt
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
- Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
21
|
Mortimer JW, Rust PA, Paxton JZ. Anatomical design and production of a novel three-dimensional co-culture system replicating the human flexor digitorum profundus enthesis. J Anat 2024. [PMID: 38400563 DOI: 10.1111/joa.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
The enthesis, the specialized junction between tendon and bone, is a common site of injury. Although notoriously difficult to repair, advances in interfacial tissue engineering techniques are being developed for restorative function. Most notably are 3D in vitro co-culture models, built to recreate the complex heterogeneity of the native enthesis. While cell and matrix properties are often considered, there has been little attention given to native enthesis anatomical morphometrics and replicating these to enhance clinical relevance. This study focuses on the flexor digitorum profundus (FDP) tendon enthesis and, by combining anatomical morphometrics with computer-aided design, demonstrates the design and construction of an accurate and scalable model of the FDP enthesis. Bespoke 3D-printed mould inserts were fabricated based on the size, shape and insertion angle of the FDP enthesis. Then, silicone culture moulds were created, enabling the production of bespoke anatomical culture zones for an in vitro FDP enthesis model. The validity of the model has been confirmed using brushite cement scaffolds seeded with osteoblasts (bone) and fibrin hydrogel scaffolds seeded with fibroblasts (tendon) in individual studies with cells from either human or rat origin. This novel approach allows a bespoke anatomical design for enthesis repair and should be applied to future studies in this area.
Collapse
Affiliation(s)
- Jeremy W Mortimer
- Anatomy@Edinburgh, Deanery of Biomedical Sciences, Old Medical School, University of Edinburgh, Edinburgh, UK
- School of Anatomy, University of Bristol, Bristol, UK
| | - Philippa A Rust
- Anatomy@Edinburgh, Deanery of Biomedical Sciences, Old Medical School, University of Edinburgh, Edinburgh, UK
- Hooper Hand Unit, St. John's Hospital, Livingston, Edinburgh, UK
| | - Jennifer Z Paxton
- Anatomy@Edinburgh, Deanery of Biomedical Sciences, Old Medical School, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
22
|
García JR, Boden SA, Spaan J, Gonzalez Ayala S, Warrier AA, Allende F, Verma NN, Chahla J. Preoperative Depression Negatively Impacts Pain and Functionality Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00084-7. [PMID: 38320656 DOI: 10.1016/j.arthro.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE To systematically investigate the influence of preoperative depression diagnosis and symptom severity on outcomes after anterior cruciate ligament reconstruction (ACLR). METHODS A literature search was performed using the PubMed, Scopus, and Embase databases according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies evaluating the impact of depression on clinical outcomes after ACLR were included. Clinical outcomes, changes in depression, and complications were aggregated. RESULTS Nine studies comprising 308,531 patients (mean age, 28.1 years; age range, 14-50 years) were included. The depression incidence ranged from 3.8% to 42%. Seven studies showed postoperative improvement in depression scores, with 5 reporting statistical significance. Assessment of depression exhibited substantial variability, with Patient-Reported Outcomes Measurement Information System (PROMIS) scores being the most common method. Patients with depression, despite showing greater improvements in scores, experienced significantly higher PROMIS Pain Interference scores preoperatively (range, 59.1-65.7 vs 56.8-59.2) and postoperatively (range, 46.3-52.3 vs 46.3-47.4) than patients without depression. They also showed significantly lower preoperative (range, 33-38.1 vs 39.7-41.5) and postoperative (range, 51.6-56.7 vs 56.7-57.6) PROMIS Physical Function scores, regardless of greater score improvement. Patients affected by depression had significantly higher rates of minimal clinically important difference achievement for the PROMIS Physical Function score (71%-100% vs 80%) and similar rates for the PROMIS Pain Interference score (71%-81% vs 68%) compared with patients without depression in 3 studies. Depression was associated with reduced adherence to rehabilitation protocols and increased postoperative complications, including infection, graft failure, arthrofibrosis, and readmission. CONCLUSIONS ACLR yields favorable outcomes for patients with and without preoperative depression. Individuals with preoperative depression may report inferior outcomes in terms of pain and functionality; nevertheless, despite these challenges, they exhibit significant improvements across all outcome measures after surgery, including reductions in depression levels. LEVEL OF EVIDENCE Level IV, systematic review of Level II to IV studies.
Collapse
Affiliation(s)
- José Rafael García
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Stephanie A Boden
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | | | | | - Felicitas Allende
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| |
Collapse
|
23
|
Urhausen AP, Grindem H, Engebretsen L, Silbernagel KG, Axe MJ, Snyder-Mackler L, Risberg MA. The Delaware-Oslo ACL Cohort treatment algorithm yields superior outcomes to usual care 9-12 years after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2024; 32:214-222. [PMID: 38226690 PMCID: PMC11291834 DOI: 10.1002/ksa.12039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Patient-reported outcomes were compared between participants who followed the treatment algorithm of the Delaware-Oslo ACL Cohort, consisting of progressive preoperative and postoperative rehabilitation, patient education, clinical testing and shared decision-making about treatment choice, and those who followed usual care 9-12 years after anterior cruciate ligament reconstruction (ACLR). METHODS Participants with primary ACLR were included from the Norwegian arm of the Delaware-Oslo ACL Cohort and the Norwegian Knee Ligament Registry (usual care). The Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores and the International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF) scores were compared. KOOS scores for the usual care group were converted to IKDC-SKF scores with recently published validated crosswalk. The percentages of participants with scores above predefined thresholds for patient acceptable symptom state (PASS) were also calculated. RESULTS Eighty of 100 (80%) participants from the Delaware-Oslo ACL Cohort and 1588 of 3248 (49%) from the usual care group participated in the follow-up. Participants from the Delaware-Oslo ACL Cohort had higher KOOS subscale (p < 0.001) and IKDC-SKF scores (p < 0.001), and a higher percentage reached PASS (84%-96% vs. 62%-76%, p ≤ 0.002) for KOOS Pain, symptoms, activities of daily living and sports compared to the usual care group. No significant differences were found for KOOS quality of life scores (not significant [n.s.]) or PASS percentages (80% vs. 74%, n.s.). CONCLUSION Participants with ACLR who followed the Delaware-Oslo ACL Cohort treatment algorithm had reduced knee symptoms, superior function and higher percentages of satisfactory outcomes than participants who followed usual care. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Anouk P. Urhausen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hege Grindem
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Lars Engebretsen
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Michael J. Axe
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- First State Orthopaedics, Newark, Delaware, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - May Arna Risberg
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
24
|
Riehm CD, Bonnette S, Rush JL, Diekfuss JA, Koohestani M, Myer GD, Norte GE, Sherman DA. Corticomuscular cross-recurrence analysis reveals between-limb differences in motor control among individuals with ACL reconstruction. Exp Brain Res 2024; 242:355-365. [PMID: 38092900 PMCID: PMC10872341 DOI: 10.1007/s00221-023-06751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/16/2023] [Indexed: 01/04/2024]
Abstract
Surgical reconstruction of the anterior cruciate ligament (ACL) and subsequent physical therapy can help athletes return to competition; however, re-injury rates remain disproportionately high due, in part, to lingering biomechanical and neurological factors that are not fully addressed during rehabilitation. Prior reports indicate that individuals exhibit altered electrical activity in both brain and muscle after ACL reconstruction (ACLR). In this investigation, we aimed to extend existing approaches by introducing a novel non-linear analysis of corticomuscular dynamics, which does not assume oscillatory coupling between brain and muscle: Corticomuscular cross-recurrence analysis (CM-cRQA). Our findings indicate that corticomuscular dynamics vary significantly between involved (injured) and uninvolved legs of participants with ACLR during voluntary isometric contractions between the brain and both the vastus medialis and lateralis. This finding points to a potential lingering neural deficit underlying re-injury for athletes after surgical reconstruction, namely the dynamical structure of neuromuscular (brain to quad muscle) coordination, which is significantly asymmetric, between limbs, in those who have ACLR.
Collapse
Affiliation(s)
- Christopher D Riehm
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA.
- Emory Sports Medicine Center, Atlanta, GA, USA.
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Justin L Rush
- Division of Physical Therapy, School of Rehabilitation Sciences, Ohio University, Athens, OH, USA
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Moein Koohestani
- Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
| | - Grant E Norte
- Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - David A Sherman
- Live4 Physical Therapy and Wellness, Acton, MA, USA
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| |
Collapse
|
25
|
McGinley J, Stapleton E, Gale E, Worrall H, Podvin C, Ellis HB, Wilson PL, Ulman S. Differences in athletic identity, sport participation, and psychosocial factors following anterior cruciate ligament rehabilitation in youth athletes. Front Psychol 2024; 14:1303887. [PMID: 38259536 PMCID: PMC10800524 DOI: 10.3389/fpsyg.2023.1303887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction While youth sports benefits the developing athlete, athletes may also be subject to injury and subsequent return-to-sport protocols. The current return-to-sport criteria emphasize physical measures; however, psychological measures may also be valuable to inform providers of an athlete's readiness. One such measure is athletic identity defined as the degree to which an individual identifies with the athlete role. To better understand athletic identity in return-to-sport, this study aimed to identify relationships and trends between the Athletic Identity Measurement Scale (AIMS), demographic variables, sport participation measures, and the Athletic Coping Skills Inventory-28 (ACSI-28) in youth athletes during rehabilitation following anterior cruciate ligament reconstruction (ACLR). Methods A retrospective review was completed of patients who underwent ACLR at a sports medicine clinic between October 2019 and May 2021. Patients responded to a series of patient reported outcomes (PROs) regarding physical and psychological function at a pre-surgical baseline and after 1 year of rehabilitation. Patients were then divided into groups of high/low AIMS and an increased/decreased AIMS between 1 year and baseline for comparison. Independent samples t-tests and ANOVAs were performed as appropriate with a 95% confidence interval. Results In the final sample, 87 patients (15.3 ± 1.8 years) were included, with 51.7% being females. Total AIMS scores decreased from 50.3 to 47.5 over rehabilitation (p = 0.019). Furthermore, results indicated that nearly all AIMS scores decreased during rehabilitation, with none showing an increase; however, not all domains were significant. Conversely, all sport participation and coping ability PROs increased over time points except for ACSI-Confidence and Achievement Motivation. Generally, those in the groups with high AIMS and an increase in AIMS also had higher scores in physical function and coping ability PROs, with the groups separated by high/low AIMS exhibiting more frequent statistical significance. Discussion Given these results, it appears that athletes may lose identification with the athlete role after ACLR and struggle even 1 year for rehabilitation, but those who recover athletic identity the best may also be those able to cope most effectively with the stressors induced by injury.
Collapse
Affiliation(s)
- James McGinley
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, Frisco, TX, United States
| | - Emily Stapleton
- Department of Psychology, Scottish Rite for Children, Frisco, TX, United States
| | - Emily Gale
- Department of Psychology, Scottish Rite for Children, Frisco, TX, United States
| | - Hannah Worrall
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, Frisco, TX, United States
| | - Caroline Podvin
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, Frisco, TX, United States
| | - Henry B. Ellis
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Philip L. Wilson
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sophia Ulman
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
26
|
Kemper WC, Carpenter CM, Wagner KJ, Chen CC, Saleem L, Wilson PL, Ellis HB. Differences in Short-Term Sport-Specific Functional Recovery After Primary ACL Reconstruction in the Adolescent Athlete. Sports Health 2024; 16:139-148. [PMID: 36872596 PMCID: PMC10732105 DOI: 10.1177/19417381231156395] [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: 03/07/2023] Open
Abstract
BACKGROUND Although anterior cruciate ligament (ACL) injury rates have been studied extensively, it is unclear whether levels of functional and psychological readiness for return-to-sport after primary ACL reconstruction (ACLR) differ based on an athlete's primary sport. HYPOTHESIS Youth athletes in different primary sports will demonstrate differences in short-term functional recovery, as well as patient-reported psychological and functional recovery after primary ACLR. STUDY DESIGN Retrospective cohort study of consecutive patients treated for ACL injury in pediatric sports medicine clinics. LEVEL OF EVIDENCE Level 3. METHODS Patients included underwent primary ACLR between December 1, 2015 and December 31, 2019 and reported sports participation at the time of injury. Demographic data, sports participation, surgical data, functional testing scores (Y-Balance Test [YBT]), functional and psychological patient-reported outcome measures (PROMs), and timing of return-to-play clearance were reviewed. YBT scores were the primary metric for clearance. Four groups were studied: soccer, football, basketball, and other. RESULTS A total of 220 male and 223 female athletes were included; 65.28% of soccer players were female and 100% of football players were male (P < 0.01). At initial postoperative YBT testing (6-9 months), soccer players had higher operative (P < 0.01) and nonoperative (P < 0.01) leg composite scores when compared with basketball players. No significant differences were found between sports in functional or psychological PROMs at presurgical baseline or 6 months postoperatively. When compared with football, soccer players completed functional clearance in a shorter time from surgery (P = 0.02). Multivariate analysis showed level of competition as a significant independent variable for clearance in female athletes. CONCLUSION After primary ACLR, athletes, especially female athletes, demonstrated short-term sport-specific differences in YBT scores. Soccer players attained clearance sooner than football players. Level of competition influenced YBT composite scores in all athletes and time to clearance in female athletes. CLINICAL RELEVANCE Sport-specific differences in reinjury should be investigated to determine whether changes in return-to-play evaluation should be implemented.
Collapse
Affiliation(s)
| | | | - K. John Wagner
- Texas Scottish Rite Hospital for Children, Frisco, Texas
| | | | - Laura Saleem
- Texas Scottish Rite Hospital for Children, Frisco, Texas
| | - Philip L. Wilson
- Texas Scottish Rite Hospital for Children, Frisco, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Henry B. Ellis
- Texas Scottish Rite Hospital for Children, Frisco, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
27
|
Thompson JD, Howe D, Griffith EH, Fisher MB. Neo-Natal Castration Leads to Subtle Differences in Porcine Anterior Cruciate Ligament Morphology and Function in Adolescence. J Biomech Eng 2024; 146:011002. [PMID: 37831117 PMCID: PMC10680984 DOI: 10.1115/1.4063744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
Female adolescent athletes are at a higher risk of tearing their anterior cruciate ligament (ACL) than male counterparts. While most work related to hormones has focused on the effects of estrogen to understand the increased risk of ACL injury, there are other understudied factors, including testosterone. The purpose of this study was to determine how surgical castration in the male porcine model influences ACL size and function across skeletal growth. Thirty-six male Yorkshire crossbreed pigs were raised to 3 (juvenile), 4.5 (early adolescent), and 6 months (adolescent) of age. Animals were either castrated (barrows) within 2 weeks after birth or were left intact (boars). Posteuthanasia, joint and ACL size were assessed via MRI, and biomechanics were assessed via a robotic testing system. Joint size increased throughout age, yet barrows had smaller joints than boars. ACL cross-sectional area (CSA), length, volume, and in situ stiffness increased with age, as did the percent contribution of the ACL anteromedial (AM) bundle to resisting loads. Boar ACL, AM bundle, and PL bundle volumes were 19%, 25%, and 15% larger than barrows across ages. However, ACL CSA, in situ stiffness, and bundle contribution were similar between boars and barrows. The barrows had smaller temporal increases in AM bundle function than boars, but these data were highly variable. Early and sustained loss in testosterone leads to subtle differences in ACL morphology but may not influence measures associated with increased injury risk, such as CSA or bundle forces in response to applied loads.
Collapse
Affiliation(s)
- Jacob D. Thompson
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| | - Danielle Howe
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| | - Emily H. Griffith
- Department of Statistics, North Carolina State University, Raleigh, NC 27695
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, 4130 Engineering Building III, 1840 Entrepreneur Drive, CB 7115, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695; Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| |
Collapse
|
28
|
Zhang L, Huang T, Li C, Xing X, Zou D, Dimitriou D, Tsai T, Li P. Race and Gender Differences in Anterior Cruciate Ligament Femoral Footprint Location and Orientation: A 3D-MRI Study. Orthop Surg 2024; 16:216-226. [PMID: 37953405 PMCID: PMC10782238 DOI: 10.1111/os.13918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE The femoral tunnel position is crucial to anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, but the ideal femoral footprint position are mostly based on small-sized cadaveric studies and elderly patients with a single ethnic background. This study aimed to identify potential race- or gender-specific differences in the ACL femoral footprint location and ACL orientation, determine the correlation between the ACL orientation and the femoral footprint location. METHODS Magnetic resonance images (MRIs) of 90 Caucasian participants and 90 matched Chinese subjects were used for reconstruction of three-dimensional (3D) femur and tibial models. ACL footprints were sketched by several experienced orthopedic surgeons on the MRI photographs. The anatomical coordinate system was applied to reflect the ACL footprint location and orientation of scanned samples. The femoral ACL footprint locations were represented by their distance from the origin in the anteroposterior (A/P) and distal-proximal (D/P) directions. The orientation of the ACL was described with the sagittal, coronal and transverse deviation angles. The ACL orientation and femoral footprint position were compared by the two-sided t-test. Multiple regression analysis was used to study the correlation between the orientation and femoral footprint position. RESULTS The average femur footprint A/P position was -6.6 ± 1.6 mm in the Chinese group and -5.1 ± 2.3 mm in the Caucasian group, (p < 0.001). The average femur footprint D/P position was -2.8 ± 2.4 mm in Chinese and - 3.9 ± 2.0 mm in Caucasians, (p = 0.001). The Chinese group had a mean difference of a 1.5 mm (6.1%) more posterior and 1.1 mm (5.3%) more proximal in the position from the flexion-extension axis (FEA). And the males have a sagittal plane elevation about 4-5° higher than females in both racial groups. Furthermore, for every 1% (0.40 mm) increase in A/P and D/P values, the sagittal angle decreased by about 0.12° and 0.24°, respectively; the coronal angle decreased by about 0.10° and 0.30°, respectively. For every 1% (0.40 mm) increase in D/P value, the transverse angle increased by about 0.14°. CONCLUSION The significant race- and gender-specific differences in the femoral footprint and orientation of the ACL should be taken in consideration during anatomic single-bundle ACL reconstruction. Furthermore, the quantitative relationship between the ACL orientation and the footprint location might provide some reference for surgeons to develop a surgical strategy in ACL single-bundle reconstruction and revision.
Collapse
Affiliation(s)
- Lihang Zhang
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Tianwen Huang
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Changzhao Li
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- Department of BiostatisticsBioinformatics & Biomathematics Georgetown UniversityWashington, DCUSA
| | - Xing Xing
- School of Biomedical Engineering & Med‐X Research InstituteShanghai Jiao Tong UniversityShanghaiChina
| | - Diyang Zou
- Engineering Research Center of Digital Medicine and Clinical TranslationMinistry of EducationShanghaiChina
- Department of Orthopedic Surgery, Shanghai Key Laboratory of Orthopedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of OrthopedicsUniversity Hospital BalgristZurichSwitzerland
| | | | - Tsung‐Yuan Tsai
- Engineering Research Center of Digital Medicine and Clinical TranslationMinistry of EducationShanghaiChina
- Department of Orthopedic Surgery, Shanghai Key Laboratory of Orthopedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of OrthopedicsUniversity Hospital BalgristZurichSwitzerland
| | - Pingyue Li
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| |
Collapse
|
29
|
Dennis JD, Choe KH, Montgomery MM, Lynn SK, Crews BM, Pamukoff DN. Lower extremity and trunk sagittal plane coordination strategies and kinetic distribution during landing in males and females. J Sports Sci 2024; 42:169-178. [PMID: 38423997 DOI: 10.1080/02640414.2024.2323857] [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: 10/10/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
Force attenuation during landing requires coordinated motion of the ankle, knee, hip, and trunk, and strategies may differ between sexes. Sagittal plane coordination of the ankle/knee, knee/hip, and knee/trunk, and lower extremity and trunk kinematics and kinetics was compared throughout landing between 28 males and 28 females. Coordination was assessed with a modified vector coding technique and binning analysis. Total support moments (TSM), each joint's percent contribution, and timing of the TSM were compared. Females landed with less isolated knee flexion in the ankle/knee, knee/hip, and knee/trunk couplings, but more simultaneous ankle/knee flexion, less simultaneous knee flexion/hip extension, and more simultaneous trunk/knee flexion. Females landed with larger plantarflexion angles from 0-16% and smaller trunk flexion angles from 0-78%. In females, absolute TSM were larger from 0-6% and smaller from 42-100%, and normalized TSM were larger from 0-8% and 26-42%. Females had greater ankle contribution to the TSM from 14-15% and 29-35%, smaller absolute peak TSM, and the peak TSM occurred earlier. Females compensated for less isolated knee flexion with greater simultaneous ankle/knee flexion early in landing and knee/trunk flexion later in landing. Coordination and TSM differences may influence force attenuation strategies and have implications for knee injury disparity between sexes.
Collapse
Affiliation(s)
- Justin D Dennis
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Kinesiology, California State University, Fullerton, CA, USA
| | - Kevin H Choe
- Department of Kinesiology, California State University, Fullerton, CA, USA
- Department of Kinesiology, Whittier College, Whittier, CA, USA
| | | | - Scott K Lynn
- Department of Kinesiology, California State University, Fullerton, CA, USA
| | | | | |
Collapse
|
30
|
Golberg E, Sommerfeldt M, Pinkoski A, Dennett L, Beaupre L. Anterior Cruciate Ligament Reconstruction Return-to-Sport Decision-Making: A Scoping Review. Sports Health 2024; 16:115-123. [PMID: 36707977 PMCID: PMC10732109 DOI: 10.1177/19417381221147524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
CONTEXT Clinical guidelines support the use of testing batteries to assess athlete readiness for return to sport (RTS) and risk of reinjury after anterior cruciate ligament (ACL) reconstruction (ACL-R). There is no consensus on the composition of the testing batteries. Test selection is based mainly on commonality in research, personal preference, and equipment availability. Including athletic performance assessments (APA) used in the athlete's sport may assist RTS decision-making for stakeholders. OBJECTIVE To determine whether APA for speed, agility, strength, or cardiovascular endurance are (1) used in ACL-R RTS literature and (2) indicative of RTS or reinjury rates. DATA SOURCES A systematic search was performed in MEDLINE, EMBASE, CINAHL, SPORTDiscus, Scopus, Web of Science, and ProQuest Dissertations and Theses Global. STUDY SELECTION Eligibility criteria were as follows: (1) athletes between 6 months and 2 years post-ACL-R, (2) commonly used APA, (3) peer-reviewed primary study with original published data. STUDY DESIGN Scoping Review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION A total of 17 studies included 24 instances of APA with a high degree of heterogeneity for both tests and protocols. RESULTS Agility makes up 75% of the APA. Only 17.6% of studies reported RTS or reinjury rates, none of which reported a significant relationship between these rates and APA outcomes. CONCLUSION Speed, strength, and cardiovascular endurance tests are underrepresented in ACL-R RTS literature. Compared with healthy controls, deficits in APA results for ACL-R athletes were common; however, many studies reported significant improvements in results for ACL-R athletes over time. There is some evidence that well-trained ACL-R athletes can match the performance of uninjured athletes in high-level sports.
Collapse
Affiliation(s)
- Eric Golberg
- Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Mark Sommerfeldt
- Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada
| | - Adam Pinkoski
- Epidemiology, School of Public Health, University of Alberta, Edmonton, Canada
| | - Liz Dennett
- Scott Health Sciences Library, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren Beaupre
- Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| |
Collapse
|
31
|
Vari N, Cavaignac E, Cavaignac M, Bérard É, Marot V. Outcomes of hamstring graft with preserved tibial insertion for ACL reconstruction: systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:67-73. [PMID: 37644333 PMCID: PMC10771374 DOI: 10.1007/s00590-023-03698-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Evaluate the outcomes of ACL (Anterior Cruciate Ligament) reconstruction techniques that use a hamstring graft with a preserved tibial insertion and compare them to standard techniques. METHODS A systematic literature review and meta-analysis was done of the PubMed, MEDLINE, Cochrane and Ovid databases to identify published clinical studies on ACL reconstruction in which a non-detached hamstring tendon (NDHT) was used as a graft and to compare them to studies in which a detached hamstring tendon (DHT) or other techniques were used. The eligible studies were analyzed for the knee laxity, Lachman test, pivot shift test, joint range of motion, anterior drawer, pain, re-tear, revision surgery, Lysholm score, Tegner score, ACL-RSI scale, KOOS, IKDC, SNQ and Howell scale. RESULTS Twelve articles in which NDHT was used for ACL reconstruction were analyzed. There was no significant difference between NDHT and DHT in the Lachman > 1 (p = .07), pivot shift test > 1 (p = .40), re-tears (p = .62), pain (p = .85) and the Tegner score (p = .95). However, the outcomes were somewhat better with the NDHT technique for the Lachman (RR = 0.30; 95% CI 0.08-1.12), pivot shift test (RR = 0.50; 95% CI 0.10-2.49) and re-tears (RR = 0.66; 95% CI 0.13-3.42). The other criteria were not included in the meta-analysis because of lack of data or because specific outcome scores were used in each article. CONCLUSION NDHT techniques provide similar results to DHT for ACL reconstruction and tend to produce better stability and a lower re-tear rate.
Collapse
Affiliation(s)
- Nicolas Vari
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France.
| | - Etienne Cavaignac
- Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | | | - Émilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR 1295 CERPOP, University of Toulouse, INSERM, UPS, Toulouse University Hospital (CHU), Toulouse, France
| | - Vincent Marot
- Orthopaedics Unit, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| |
Collapse
|
32
|
Tavakoli Darestani R, Afzal S, Pourmojarab A, Baroutkoub M, Sayyadi S, Barati H. A comparative analysis of suture-augmented and standard hamstring autograft single-bundle ACL reconstruction outcomes: short-term functional benefits without long-term impact. BMC Musculoskelet Disord 2023; 24:971. [PMID: 38102582 PMCID: PMC10722839 DOI: 10.1186/s12891-023-07100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Augmentation of the biologic graft with nonabsorbable suture material during anterior cruciate ligament reconstruction (ACLR) is a relatively new technique to enhance its biomechanical properties and add additional support to the critical process of healing. We aimed to compare the short-term functional patient-reported outcome measures (PROMs) and complication rates of patients treated with either standard single-bundle four-strand hamstring ACLR or added suture augmentation (SA). METHODS Patients undergoing arthroscopic ACLR between February 2015-January 2017 and in the standard ACLR group, and between February 2017-September 2019 in the SA-ACLR group operated by adding a no.5 FiberWire® (Arthrex, Naples, FL, USA) braided suture to the hamstring autograft, were retrospectively reviewed and the PROMs were compared. Patients were followed up for a 24-month period and PROMs were assessed by the International Knee Documentation Committee (IKDC) Subjective Knee Form and Tegner-Lysholm knee score. Patients' demographic and clinical characteristics, and postoperative complications including graft retear requiring revision surgery, deep vein thrombois, and surgical site infection were recorded and analyzed. RESULTS We included 79 patients with mean age of 31.6 ± 8.3 years in the standard ACLR group, and 90 patients with mean oge of 30.5 ± 7.6 in the SA-ACLR group. There was no statistically significant difference between the two groups in terms of age, sex, body mass index, and medical comorbidities. The values of the IKDC scores increased to 75.8 ± 18.9 in the standard ACLR group, and 85.6 ± 12.6 in the SA-ACLR group, 24 months after the operation (P < 0.05). The 24-month postoperative Tegner-Lysholm scores escalated to 79.3 ± 21.0 in the standard ACLR group and 91.0 ± 13.7 in the SA-ACLR group (P < 0.05). Four (5.1%) patients in the standard ACLR group and 4 (4.4%) in the SA-ACLR group experienced graft retear requiring revision surgery (P > 0.05). Incidence of surgical site infection and deep vein thrombosis showed no significant differences between the two groups, 24 months after ACLR. CONCLUSION SA-ACLR is associated with improved short-term functional PROMs compared to the standard hamstring ACLR. Although SA did not reduce the retear rate, and infection and DVT rates did not differ between study groups, superior improvement of PROMs in SA approach, leverages this method for ACLR.
Collapse
Affiliation(s)
- Reza Tavakoli Darestani
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Afzal
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Pourmojarab
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Baroutkoub
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Sayyadi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Barati
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
33
|
Carabasa García L, Lorca-Gutiérrez R, Vicente-Mampel J, Part-Ferrer R, Fernández-Ehrling N, Ferrer-Torregrosa J. Relationship between Anterior Cruciate Ligament Injury and Subtalar Pronation in Female Basketball Players: Case-Control Study. J Clin Med 2023; 12:7539. [PMID: 38137608 PMCID: PMC10744164 DOI: 10.3390/jcm12247539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/27/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
Anterior cruciate ligament (ACL) injuries are a common issue in basketball. Several studies point to subtalar pronation as a relevant risk factor for these injuries, despite their multiarticular and multiplanar nature. This study evaluated the correlation between subtalar pronation and ACL injuries in female basketball players. A total of 30 players were recruited and divided into two groups: 15 with previous ACL injury and 15 without injury. The navicular drop test (NDT) and drop vertical jump test were applied to quantify parameters such as navicular drop, calcaneal eversion, ankle dorsiflexion, knee flexion, and dynamic valgus. The results showed significantly higher NDT values (6.93 ± 1.64 mm vs. 5.41 ± 1.96 mm, p = 0.029) and maximum calcaneal eversion angle (10.94 ± 3.22° vs. 5.30 ± 3.33°, p < 0.001) in the injured group. There were also significant differences in maximum dynamic valgus (152.73 ± 15.00° vs. 165.26 ± 5.628°, p = 0.005) and knee flexion (93.70 ± 7.47° vs. 82.92 ± 11.14°, p = 0.004) between groups. These findings suggest that subtalar pronation, assessed by NDT, and calcaneal eversion could be indicators of higher susceptibility to ACL injuries in female basketball players.
Collapse
Affiliation(s)
- Laura Carabasa García
- Sport Podiatry Department, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Rubén Lorca-Gutiérrez
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (R.L.-G.); (N.F.-E.); (J.F.-T.)
| | - Juan Vicente-Mampel
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Roser Part-Ferrer
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (R.L.-G.); (N.F.-E.); (J.F.-T.)
| | - Nadia Fernández-Ehrling
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (R.L.-G.); (N.F.-E.); (J.F.-T.)
| | - Javier Ferrer-Torregrosa
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain; (R.L.-G.); (N.F.-E.); (J.F.-T.)
| |
Collapse
|
34
|
Fridén C, Ekenros L, Hirschberg AL, von Rosen P. Body Weight Satisfaction, Comments, Nutrition and Injury Risk in 489 Adolescent Elite Athletes. Int J Sports Med 2023; 44:1086-1092. [PMID: 37848049 DOI: 10.1055/a-2160-1615] [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: 10/19/2023]
Abstract
Exposure to critical body weight comments in youth athletes could lead to decreased self-esteem, affect body image, and increase the risk of eating disorders and cause depressive symptoms. The aim was to explore differences between sex, body mass index, sports type, with regards to body weight satisfaction, exposure to critical body weight comments from their coach and nutrition status in adolescent elite athletes. A questionnaire about body weight, critical body weight comments and nutrition was distributed to 489 adolescent elite athletes and injury prevalence was monitored across 20 weeks. The results showed that almost one in four athletes (n=116, 24%) was not satisfied with their weight and 12% (n=59) had received critical body weight comments from their coach. Of the athletes who were unsatisfied with their body weight (n=116), 47% wanted to lose weight (n=55). A significant (p<0.05) higher proportion of ice hockey players and swimmers used nutritional supplements, were unsatisfied with their body weight, and were more exposed to critical body weight comments compared to athletes from other sports. Adolescent elite athletes as young as 15-16 years old are exposed to critical body weight comments from their coach and experience challenges with body weight satisfaction that is partly dependent on the sport-specific context.
Collapse
Affiliation(s)
- Cecilia Fridén
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Linda Ekenros
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Philip von Rosen
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
35
|
Turner TW, Kaar SG. Time to return to school following ACL reconstruction: influence of the COVID-19 pandemic. PHYSICIAN SPORTSMED 2023; 51:558-563. [PMID: 36243035 DOI: 10.1080/00913847.2022.2136983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/12/2022] [Indexed: 10/24/2022]
Abstract
INTRODUCTION ACL reconstruction is commonly performed in school-aged patients for whom missed time from school can have an impact on their education. Additionally, the COVID-19 pandemic has led to different ways of accessing school content. We sought to determine how many days of school school-aged patients should expect to miss following ACL reconstruction and how the availability of remote learning during the COVID-19 pandemic affected this. METHODS We evaluated 53 ACL reconstruction patients in grades 7-12 undergoing surgery during the school year. Demographic, medical, and educational information were collected. Patients were placed into 1 of 2 cohorts: Group A (surgery before the COVID-19 pandemic) or Group B (surgery during the COVID-19 pandemic). We calculated days missed from school after surgery until return to either virtual or in-person school. RESULTS Overall, patients returned to school after missing an average of 4.4 (SD, 3.0) days of school after ACL reconstruction surgery. Patients in Group A missed an average of 5.5 (SD, 2.9) school days, while patients in Group B missed an average of 2.3 (SD, 1.4) school days (p <.001). Eighty-nine percent of Group B patients first returned to school utilizing a virtual option. Among those returning virtually, these patients missed an average of 1.9 (SD, 0.9) school days. CONCLUSIONS A virtual distance learning option results in fewer missed days of school post ACL reconstruction. When given this option, school-aged patients can expect to return to school within two days post-op. Otherwise, patients should expect to miss about one week of in-person schooling. In this regard, the COVID-19 pandemic has positively impacted educational opportunities for students post-surgery, and physicians should advocate for continuing virtual options for students receiving medical treatment.
Collapse
Affiliation(s)
- Travis W Turner
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Scott G Kaar
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri, USA
| |
Collapse
|
36
|
Gao H, Hu H, Sheng D, Sun L, Chen J, Chen T, Chen S. Risk Factors for Ipsilateral Versus Contralateral Reinjury After ACL Reconstruction in Athletes: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231214298. [PMID: 38145217 PMCID: PMC10748928 DOI: 10.1177/23259671231214298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 12/26/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) reinjury after ACL reconstruction (ACLR) can occur on the ipsilateral or contralateral side. Limited evidence exists regarding the difference between the incidence of reinjury to either knee, which is important in developing interventions to prevent ACL reinjury. Purpose To compare the reinjury rate of the ACL on the ipsilateral side versus the contralateral side in athletes after ACLR and investigate the risk factors that may cause different reinjury rates between the sides. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that involved ACL reinjury in athletes after ACLR were reviewed. Considering several risk factors, including age and sex, a comparison of ACL reinjury incidence on the ipsilateral and contralateral sides was performed using a meta-analysis. Results Of the 17 selected studies, 3 were found to be at high risk of bias, and thus, 14 (n = 3424 participants) studies were included in the meta-analysis. In this athletic population, the contralateral ACL had a significantly higher rupture rate than the ipsilateral graft (risk ratio [RR], 1.41; P < .0001). Female athletes were found to have a greater risk of ACL reinjury on the contralateral versus the ipsilateral side (RR, 1.65; P = .0005), but different results were found in male athletes. (RR, 0.81; P = .21). There was no statistical difference in the incidence rate of ACL reinjury to either side in adolescent athletes (RR, 1.15; P = .28). Conclusion The contralateral ACL was more vulnerable to reinjury than the ipsilateral side in athletes after ACLR. Female athletes were more likely to reinjure their contralateral native ACL, while the same trend was not found in their male counterparts. The reinjury rate was comparable in both knees in adolescent athletes.
Collapse
Affiliation(s)
- Han Gao
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Haichen Hu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Luyi Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Tianwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
37
|
Phillips DA, Buckalew BR, Keough B, Alencewicz JS. Preparing to Land: Hamstring Preactivation Is Higher in Females and Is Inhibited by Fatigue. J Appl Biomech 2023; 39:370-376. [PMID: 37491013 DOI: 10.1123/jab.2022-0287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/27/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023]
Abstract
The hamstring plays an important role in reducing loads born by the anterior cruciate ligament. As anterior cruciate ligament injuries occur rapidly after ground contact, how the hamstring is activated prior to landing can influence injury risk. The purpose was to determine sex-related differences in hamstring activation immediately before landing and the effect of fatigue on "preactivation." Twenty-four participants (13 males and 11 females, age = 24.3 [6.5] y, mass = 72.2 [19.3] kg, height = 169 [9.7] cm) participated in this study. Participants completed a drop-vertical jump protocol before and after a lower body fatigue protocol. Hamstring electromyography (EMG) amplitude at 5 periods prior to landing, peak vertical ground reactions forces (in newtons/body weight), rate of loading (in body weight/second), and landing error scoring system were measured. Females had higher EMG amplitude before and after fatigue (P < .024), with decreased EMG amplitude for both sexes after fatigue (P = .025). There was no change on vertical ground reaction force, rate of loading, or landing error scoring system. Males and females demonstrated similar landing performance before and after fatigue but have different hamstring neuromuscular coordination strategies. The acute reduction in hamstring EMG amplitude following fatigue may increase loading on the anterior cruciate ligament.
Collapse
Affiliation(s)
- David Alan Phillips
- Program in Kinesiology, College of Public Health and Human Sciences, Oregon State University-Cascades, Bend, OR,USA
- Department of Exercise Science and Physical Education, Montclair State University, Montclair, NJ,USA
| | - Bridgette Rae Buckalew
- Department of Exercise Science and Physical Education, Montclair State University, Montclair, NJ,USA
| | - Bridget Keough
- Department of Exercise Science and Physical Education, Montclair State University, Montclair, NJ,USA
| | | |
Collapse
|
38
|
Gill VS, Tummala SV, Boddu SP, Brinkman JC, McQuivey KS, Chhabra A. Biomechanics and situational patterns associated with anterior cruciate ligament injuries in the National Basketball Association (NBA). Br J Sports Med 2023; 57:1395-1399. [PMID: 37648410 DOI: 10.1136/bjsports-2023-107075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES Perform a comprehensive video analysis of all anterior cruciate ligament (ACL) injuries in National Basketball Association (NBA) athletes from 2006 to 2022 to determine the associated biomechanics, injury mechanism and game situation. METHODS NBA players diagnosed with an ACL tear from 2006 to 2022 were identified and videos of each injury evaluated by two reviewers. Visual evaluation included assessment of joint kinematics at three time points: initial contact of the injured leg with the ground (IC), 33 milliseconds later (IC+33) and 66 milliseconds later (IC+66). Game situation was assessed qualitatively. RESULTS Videos of 38 out of 47 (80.9%) ACL tears were obtained. 9 injuries were non-contact, while 29 involved indirect contact. Between IC and IC+33, average knee valgus increased from 5.1° to 12.0° and knee flexion increased from 12.6° to 32.6°. At all time points, the majority of injuries involved trunk tilt and rotation towards the injured leg, hip abduction and neutral foot rotation. The most common game situations for injury included the first step when attacking the basket following picking up the ball (n=13), landing following contact in the air (n=11) and jump stop (n=5). CONCLUSION Three major mechanisms predominate ACL tears in NBA players: the first step following picking up the ball when attacking, landing and jump stops. None of the injuries reviewed demonstrated direct contact to the knee, emphasising the importance of body kinematics in this injury pattern. The increase in knee valgus and knee flexion between IC and IC+33 should be noted as a possible precipitant to injury.
Collapse
Affiliation(s)
- Vikram S Gill
- School of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Sailesh V Tummala
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Sayi P Boddu
- School of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Kade S McQuivey
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| |
Collapse
|
39
|
Maheshwer B, Paliobeis A, Halkiadakis P, Konda S, Calcei JG, Voos JE. Anterior Cruciate Ligament Tears in the Adolescent Population: Injury Demographics and Risk of Reinjury Among High School Athletes. J Pediatr Orthop 2023; 43:591-597. [PMID: 37728131 DOI: 10.1097/bpo.0000000000002505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) injuries is increasing among the adolescent population with a peak occurring in the high school age range. PURPOSE To characterize recent epidemiologic trends of ACL injuries, ACL reconstruction (ACLR), and retear rates in high school adolescents based on age, participating sport, and mechanism of injury. STUDY DESIGN Retrospective case series. METHODS A prospectively maintained institutional database was retrospectively reviewed for all patients 18 or younger who underwent primary ACLR between 2015 and 2020. Odds ratios were calculated for baseline patient characteristics and their association with risk of retear. Multivariate regression analysis was also performed to identify the relationship between retear and specific categorical variables. RESULTS A total of 482 patients were included, with a mean follow-up time of 13.0 ± 11.8 months. Patients were an average age of 16.1 ± 1.3 years old (range: 13 to 18 y). Initial presentation of ACL injuries in high school athletes often occurred at 16 years old regardless of the sport played. Based on age, high school freshmen and seniors are found to have an increased risk of ACL retear. One hundred three patients (21.6%) completed at least 2 or more years of follow-up after ACLR. Of these patients, 38.8% received a bone-tendon-bone (BTB) autograft, 36.9% hamstring autograft, 14.6% quadriceps tendon autograft, and 3.9% received hamstring allograft or other graft (eg, tibialis anterior and BTB allograft), respectively. There were 25 ipsilateral ACL retears that occurred in the patient cohort (5.2%). Thirteen (52%) of retears were females. Football and soccer were the most common sports played by patients with a retear of the ipsilateral knee (31.8% and 27.3%, respectively). Patients who were 13 to 14 or 18 years old ( P = 0.009 and 0.035, respectively) or who received a tibialis anterior/BTB allograft ( P = 0.002) were found to have increased risk of ACL retear compared with other age groups. When evaluating by sex, female soccer players had a greater risk of retear compared with male soccer players ( P = 0.007). When adjusting for multiple variables, (including age, sex, body mass index, primary reconstruction graft choice, sport, and length of follow-up), the odds of ipsilateral retear in patients who received hamstring autograft ( P = 0.02), sustained a contralateral ACL tear ( P = 0 .04), or a contact injury ( P = 0.01) were increased. CONCLUSION Initial presentation of ACL injuries in high school athletes often occurs at 16 years old regardless of the sport played. Based on age, high school freshmen and seniors are found to have an increased risk of ACL retear. However, the overall rate of ACL retear in high school athletes of all ages is low. Patients who underwent ACLR with hamstring tendon autograft had a greater risk of retear compared with other graft types. Female soccer players also had a greater risk of ACL retear. High school athletes must take caution when in the early high school years (underclassman) and more senior years (upperclassman), as susceptibility for ACL retears is elevated. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Bhargavi Maheshwer
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; and
| | - Andrew Paliobeis
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; and
| | - Penelope Halkiadakis
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; and
| | - Sreenivas Konda
- Department of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL
| | - Jacob G Calcei
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; and
| | - James E Voos
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; and
| |
Collapse
|
40
|
Ekenros L, Fridén C, von Rosen P. Previous Injury and Lower Well-being Increase Injury Risk in Female Adolescent Athletes. Int J Sports Med 2023; 44:919-924. [PMID: 37490928 DOI: 10.1055/a-2108-6463] [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: 07/27/2023]
Abstract
Several risk factors for injury have been suggested in female elite athletes. However, there is a lack of prospective studies in young female athletes where multiple risk factors have been studied. The aim of this study was to identify risk factors for injury in female adolescent elite athletes. Substantial injuries were monitored in 222 athletes using the validated Oslo Sports Trauma Research Centre Questionnaire over 20 weeks. Over 20 potential risk factors were explored. Based on a binomial generalized linear mixed model, two significant (p<0.05) risk factors for injury were identified; previous injury within the last 12 months (OR 2.55) and well-being (OR 0.97). An athlete with a previous injury had twice as high a risk of injury (13% vs. 6%) compared to an athlete with no previous injury. Higher perceived well-being was associated with a decreased risk of injury. Based on a prospective design with a large sample of female adolescent elite athletes, investigating over 20 potential risk factors for injury, our results suggest that a previous injury and well-being are risk factors for injury.
Collapse
Affiliation(s)
- Linda Ekenros
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Cecilia Fridén
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Philip von Rosen
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
41
|
Gureck AE, Crockett Z, Barsky BW, Samuels S, Frank JS, Storer SK, Fazekas ML. Do Differences Exist in Impact Test Domains between Youth Athletes with and without an Anterior Cruciate Ligament Injury? Healthcare (Basel) 2023; 11:2764. [PMID: 37893838 PMCID: PMC10606848 DOI: 10.3390/healthcare11202764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Poor baseline reaction time, as measured via the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), has been associated with anterior cruciate ligament (ACL) injury risk in adult athletes. Our study sought to determine whether the reaction time and impulse control ImPACT test domains differed between ACL injured and uninjured pediatric athletes. A total of 140 high-school aged athletes comprising 70 athletes who went on to sustain an ACL injury between 2012 and 2018 and 70 age- and sex-matched uninjured controls were included in the study. Mean reaction times were similar for the injured (0.67 s) and uninjured (0.66 s) athletes (p = 0.432), and the impulse control scores were also similar for those with (5.67) and without (6.07) an ACL injury (p = 0.611). Therefore, neurocognitive risk factors for sustaining an ACL injury in adults cannot necessarily be extrapolated to adolescent athletes. Further research is needed to understand why differences exist between injury risk in youth and adult athletes.
Collapse
Affiliation(s)
- Ashley E. Gureck
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Zack Crockett
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Brandon W. Barsky
- Department of Sports Medicine, Kettering Health, Kettering, OH 45429, USA
| | - Shenae Samuels
- Memorial Healthcare System, Office of Human Research, Hollywood, FL 33021, USA
| | - Jeremy S. Frank
- Department of Orthopaedic Surgery and Sports Medicine, JoeDiMaggio Children’s Hospital, Hollywood, FL 33021, USA
| | - Stephen K. Storer
- Department of Orthopaedic Surgery and Sports Medicine, JoeDiMaggio Children’s Hospital, Hollywood, FL 33021, USA
| | - Matthew L. Fazekas
- Department of Orthopaedic Surgery and Sports Medicine, JoeDiMaggio Children’s Hospital, Hollywood, FL 33021, USA
| |
Collapse
|
42
|
Li F, Zhai P, Yang C, Feng G, Yang J, Yuan Y. Automated diagnosis of anterior cruciate ligament via a weighted multi-view network. Front Bioeng Biotechnol 2023; 11:1268543. [PMID: 37885456 PMCID: PMC10598377 DOI: 10.3389/fbioe.2023.1268543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Objective: To build a three-dimensional (3D) deep learning-based computer-aided diagnosis (CAD) system and investigate its applicability for automatic detection of anterior cruciate ligament (ACL) of the knee joint in magnetic resonance imaging (MRI). Methods: In this study, we develop a 3D weighted multi-view convolutional neural network by fusing different views of MRI to detect ACL. The network is evaluated on two MRI datasets, the in-house MRI-ACL dataset and the publicly available MRNet-v1.0 dataset. In the MRI-ACL dataset, the retrospective study collects 100 cases, and four views per patient are included. There are 50 ACL patients and 50 normal patients, respectively. The MRNet-v1.0 dataset contains 1,250 cases with three views, of which 208 are ACL patients, and the rest are normal or other abnormal patients. Results: The area under the receiver operating characteristic curve (AUC) of the ACL diagnosis system is 97.00% and 92.86% at the optimal threshold for the MRI-ACL dataset and the MRNet-v1.0 dataset, respectively, indicating a high overall diagnostic accuracy. In comparison, the best AUC of the single-view diagnosis methods are 96.00% (MRI-ACL dataset) and 91.78% (MRNet-v1.0 dataset), and our method improves by about 1.00% and 1.08%. Furthermore, our method also improves by about 1.00% (MRI-ACL dataset) and 0.28% (MRNet-v1.0 dataset) compared with the multi-view network (i.e., MRNet). Conclusion: The presented 3D weighted multi-view network achieves superior AUC in diagnosing ACL, not only in the in-house MRI-ACL dataset but also in the publicly available MRNet-v1.0 dataset, which demonstrates its clinical applicability for the automatic detection of ACL.
Collapse
Affiliation(s)
- Feng Li
- Orthopedic Department, Ningbo No. 2 Hospital, Ningbo, China
| | - Penghua Zhai
- Center for Pattern Recognition and Intelligent Medicine, Guoke Ningbo Life science and Health industry Research Institute, Ningbo, China
| | - Chao Yang
- Orthopedic Department, Ningbo No. 2 Hospital, Ningbo, China
| | - Gong Feng
- Orthopedic Department, Ningbo No. 2 Hospital, Ningbo, China
| | - Ji Yang
- Orthopedic Department, Ningbo No. 2 Hospital, Ningbo, China
| | - Yi Yuan
- Orthopedic Department, Ningbo No. 2 Hospital, Ningbo, China
| |
Collapse
|
43
|
VanZile A, Snyder M, Jones D, Gus Almonroeder T. Athletes with a History of ACL Reconstruction Exhibit Greater Inter-Limb Asymmetry in Impact Forces During the First Landing of a Drop Vertical Jump Compared to the Second Landing. J Electromyogr Kinesiol 2023; 72:102809. [PMID: 37556873 DOI: 10.1016/j.jelekin.2023.102809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023] Open
Abstract
The primary objective of this study was to examine the degree of inter-limb asymmetry in impact force magnitudes and rates during the first and second landings of a drop vertical jump in adolescent athletes with a history of anterior cruciate ligament (ACL) reconstruction. We also compared the degree of asymmetry exhibited by the athletes who had undergone ACL reconstruction to a group of uninjured athletes. This study included 14 athletes who had undergone ACL reconstruction and 28 uninjured athletes, matched for age, sex, and sport. All athletes completed a double-leg drop vertical jump task. Peak vertical ground reaction forces (vGRFs) and loading rates were examined for both limbs during the first and second landings of the drop vertical jump. For the athletes who had undergone ACL reconstruction, peak vGRFs were 11.9% greater for the uninvolved limb vs. the involved limb during the first landing; however, peak vGRFs were only 2.4% greater for the uninvolved limb (vs. the involved limb) during the second landing. The athletes who had undergone ACL reconstruction exhibited greater asymmetry in peak vGRFs for the first landing compared to the uninjured athletes; however, there was no difference between the groups (ACL reconstruction, uninjured) for the second landing.
Collapse
Affiliation(s)
- Adam VanZile
- Optimum Performance Therapy, Fort Wayne, IN, USA
| | | | | | | |
Collapse
|
44
|
DeMaio EL, Tompson JD, Terry MA, Tjong VK. Qualitative Research in Return to Sport: a Current Review of the Literature. Curr Rev Musculoskelet Med 2023; 16:480-487. [PMID: 37480428 PMCID: PMC10497483 DOI: 10.1007/s12178-023-09854-y] [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] [Accepted: 06/28/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE OF REVIEW Return to sport (RTS) is an important metric tied to patient satisfaction after receiving treatment for a sports-related injury. Recently, there has been an explosion of literature on RTS; yet a comprehensive review encompassing multiple injuries does not exist. Furthermore, RTS has historically been defined by quantitative measures that assess strength, function, and pain but little consideration has been given to psychologic factors nor has there been an open-ended forum for athletes to share with health care providers which factors they feel are most influential for RTS. This review also serves to heighten surgeons' awareness of underlying psychologic/psychosocial factors affecting RTS. RECENT FINDINGS Qualitative studies which employ open-ended questioning of athletes who have undergone surgical management of superior labral anterior-posterior (SLAP) tears, shoulder instability, ulnar collateral ligament (UCL) rupture, femoral acetabular impingement (FAI), and anterior cruciate ligament (ACL) tear demonstrate that fear of reinjury, lack of social support, and unrealistic expectations are all barriers to RTS. Qualitative studies give health care providers unique insight into the perspectives of their patients so that unmet postoperative needs can be addressed to facilitate RTS. Sports psychologists, coaches, athletic trainers, and physical therapists should create a positive environment to address these needs and provide optimal, holistic care to return athletes to the field safely. Though time consuming, further qualitative research is necessary to understand the unique factors affecting RTS in athletes.
Collapse
Affiliation(s)
- Emily L. DeMaio
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Arkes Family Pavilion, 676 N Saint Claire, Ste 1350, IL 60611 Chicago, USA
| | - Jeffrey D. Tompson
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Arkes Family Pavilion, 676 N Saint Claire, Ste 1350, IL 60611 Chicago, USA
| | - Michael A. Terry
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Arkes Family Pavilion, 676 N Saint Claire, Ste 1350, IL 60611 Chicago, USA
| | - Vehniah K. Tjong
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Arkes Family Pavilion, 676 N Saint Claire, Ste 1350, IL 60611 Chicago, USA
| |
Collapse
|
45
|
Johnson AK, Rodriguez KM, Lepley AS, Palmieri-Smith RM. Quadriceps torque complexity before and after anterior cruciate ligament reconstruction. J Sci Med Sport 2023; 26:533-538. [PMID: 37775409 DOI: 10.1016/j.jsams.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES The purpose of this project was to longitudinally examine quadriceps torque complexity in a group of individuals who tore their ACL and underwent ACL reconstruction. DESIGN Cohort analysis. METHODS Thirty-four individuals completed maximal effort bilateral isometric strength testing after ACL injury but pre-surgery, five months' post-surgery (mid-point of rehabilitation), and when cleared to return to activity. Sample entropy, a nonlinear analysis of quadriceps torque control (complexity), was calculated from maximal isometric contractions. Two 3 × 2 repeated measures analysis of variance were used to examine changes over time and between limbs for quadriceps torque complexity and peak torque. RESULTS Quadriceps peak torque was lower in the involved limb when compared to the uninvolved limb at every time point (p < 0.001). Peak torque of the involved limb was decreased at mid-point of rehabilitation compared to before surgery (p = 0.023) and at mid-point compared to return to activity (p = 0.041). Quadriceps sample entropy was higher in the involved limb compared to the uninvolved limb at the mid-point of rehabilitation (p < 0.001) and return to activity (p < 0.001), indicating greater complexity. The involved limb also demonstrated increased torque sample entropy from pre-surgery to mid-point of rehabilitation (p = 0.023), but not from pre-surgery to return to activity (p = 0.169) or from mid-point to return to activity (p = 0.541). CONCLUSIONS Not only does quadriceps strength decline with ACL reconstruction, but quality of the quadriceps muscle contraction is also compromised. Increased torque complexity experienced in the ACL limb after reconstruction may contribute to impaired physical function in individuals following ACL reconstruction.
Collapse
Affiliation(s)
| | | | | | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, USA; Department of Orthopedic Surgery, University of Michigan, USA
| |
Collapse
|
46
|
Abstract
The anterior cruciate ligament (ACL) is frequently injured in elite athletes, with females up to eight times more likely to suffer an ACL tear than males. Biomechanical and hormonal factors have been thoroughly investigated; however, there remain unknown factors that need investigation. The mechanism of injury differs between males and females, and anatomical differences contribute significantly to the increased risk in females. Hormonal factors, both endogenous and exogenous, play a role in ACL laxity and may modify the risk of injury. However, data are still limited, and research involving oral contraceptives is potentially associated with methodological and ethical problems. Such characteristics can also influence the outcome after ACL reconstruction, with higher failure rates in females linked to a smaller diameter of the graft, especially in athletes aged < 21 years. The addition of a lateral extra-articular tenodesis can improve the outcomes after ACL reconstruction and reduce the risk of failure, and it should be routinely considered in young elite athletes. Sex-specific environmental differences can also contribute to the increased risk of injury, with more limited access to and availablility of advanced training facilities for female athletes. In addition, football kits are designed for male players, and increased attention should be focused on improving the quality of pitches, as female leagues usually play the day after male leagues. The kit, including boots, the length of studs, and the footballs themselves, should be tailored to the needs and body shapes of female athletes. Specific physiotherapy programmes and training protocols have yielded remarkable results in reducing the risk of injury, and these should be extended to school-age athletes. Finally, psychological factors should not be overlooked, with females' greater fear of re-injury and lack of confidence in their knee compromising their return to sport after ACL injury. Both intrinsic and extrinsic factors should be recognized and addressed to optimize the training programmes which are designed to prevent injury, and improve our understanding of these injuries.
Collapse
Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ayman Gabr
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- The Bone & Joint Journal , London, UK
| |
Collapse
|
47
|
Wang K, Cheng L, Wang B, He B. Effect of isokinetic muscle strength training on knee muscle strength, proprioception, and balance ability in athletes with anterior cruciate ligament reconstruction: a randomised control trial. Front Physiol 2023; 14:1237497. [PMID: 37795267 PMCID: PMC10546193 DOI: 10.3389/fphys.2023.1237497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Objective: This study aimed to investigate the effects of regular isokinetic muscle strength training on knee muscle strength, proprioception, and balance ability in athletes after anterior cruciate ligament (ACL) reconstruction. Methods: Forty-one athletes who underwent ACL reconstruction were randomly divided into the experimental (n = 21) and control (n = 20) groups. The experimental group used an isokinetic muscle strength tester for 4 weeks (five times/ week) of knee flexion and extension isokinetic muscle strength training. The control group used the knee joint trainer (pneumatic resistance) for the same exercise regimen as the experimental group. Results: 1) Four weeks when compared with the baseline. Experimental group: the knee flexion and extension PT (60°/s and 240°/s) increased by 31.7%, 40.3%, 23.4%, and 42.9% (p < 0.01), and the flexion muscular endurance increased by 21.4% and 19.7% (p < 0.01). The flexion and extension kinaesthesia and the 30° and 60° position sense decreased by 36.2%, 32.3%, 40.0%, and 18.9% (p < 0.05). The anterior-posterior and medial-lateral displacement and speed decreased by 30.2%, 44.2%, 38.4%, and 24.0% (p < 0.05). Control group: the knee peak torque (60°/s) increased by 18.8% (p < 0.01). The anterior-posterior and medial-lateral displacement and speed decreased by 14.9%, 40.0%, 26.8%, and 19.5% (p < 0.01). 2) After 4 weeks, compared with the control group, the knee flexion and extension peak torque (60°/s), extension, peak torque (240°/s), and extension muscular endurance of the treatment group increased to varying degrees (p < 0.05). However, the kinaesthesia, 30° position sense, and anterior-posterior displacement decreased to varying degrees (p < 0.05). Conclusion: Adding regular isokinetic muscle strength training to rehabilitation training further improved the knee flexion and extensor strength and extensor endurance of athletes with ACL reconstruction, as well as enhanced the kinaesthesia and 30° position sense and the balance between the anterior and posterior directions. However, the treatment had limited effects on knee flexion kinaesthesia and muscle endurance.
Collapse
Affiliation(s)
- Kun Wang
- Post-Doctoral Scientific Research Workstation of Affiliated Sport Hospital, Chengdu Sport University, Chengdu, China
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Liang Cheng
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Bingcheng Wang
- Jinling Hospital, General Hospital of Eastern Theater Command, Nanjing, China
| | - Benxiang He
- Sichuan Academy of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
48
|
Anastasio AT, Adams SB. Addressing the Need for a Better Understanding of Foot and Ankle Pathology Relevant to the Adolescent Athlete. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1342. [PMID: 37628340 PMCID: PMC10453569 DOI: 10.3390/children10081342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Abstract
Foot and ankle pathology in the adolescent athlete is a growing area of basic science, translational, and clinical research [...].
Collapse
Affiliation(s)
- Albert T. Anastasio
- Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Duke University, Durham, NC 27710, USA;
| | | |
Collapse
|
49
|
Park-Braswell K, Shultz SJ, Ross SE, Sunnassee D, Grooms DR, Schmitz RJ. The Impact of Differential Knee Laxity on Brain Activation During Passive Knee Joint Loading. J Orthop Res 2023; 42:10.1002/jor.25664. [PMID: 37442639 PMCID: PMC10851619 DOI: 10.1002/jor.25664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 07/11/2023] [Indexed: 07/15/2023]
Abstract
Although higher anterior knee laxity is an established risk factor of ACL injury, underlying mechanisms are uncertain. While decreased proprioception and altered movement patterns in individuals with anterior knee laxity have been identified, the potential impact of higher laxity on brain activity is not well understood. Thus, the purpose of this study is to identify the impact of different magnitudes of knee laxity on brain function during anterior knee joint loading. Twenty-seven healthy and active female college students without any previous severe lower leg injuries volunteered for this study. Anterior knee laxity was measured using a knee arthrometer KT-2000 to assign participants to a higher laxity (N=15) or relatively lower laxity group (N=12). Functional magnetic resonance images were obtained during passive anterior knee joint loading in a task-based design using a 3T MRI scanner. Higher knee laxity individuals demonstrated diminished cortical activation in the left superior parietal lobe during passive anterior knee joint loading. Less brain activation in the regions associated with awareness of bodily movements in females with higher knee laxity may indicate a possible connection between brain activity and knee laxity. The results of this study may help researchers and clinicians develop effective rehabilitation programs for individuals with increased knee laxity. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Sandra J. Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Scott E. Ross
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Devdass Sunnassee
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, Ohio, USA
- Division of Physical Therapy & Division of Athletic Training, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - Randy J. Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
- Gateway MRI Center University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| |
Collapse
|
50
|
Loflin BE, Ahn T, Colglazier KA, Banaszak Holl MM, Ashton-Miller JA, Wojtys EM, Schlecht SH. An Adolescent Murine In Vivo Anterior Cruciate Ligament Overuse Injury Model. Am J Sports Med 2023; 51:1721-1732. [PMID: 37092727 PMCID: PMC10348391 DOI: 10.1177/03635465231165753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Overuse ligament and tendon injuries are prevalent among recreational and competitive adolescent athletes. In vitro studies of the ligament and tendon suggest that mechanical overuse musculoskeletal injuries begin with collagen triple-helix unraveling, leading to collagen laxity and matrix damage. However, there are little in vivo data concerning this mechanism or the physiomechanical response to collagen disruption, particularly regarding the anterior cruciate ligament (ACL). PURPOSE To develop and validate a novel in vivo animal model for investigating the physiomechanical response to ACL collagen matrix damage accumulation and propagation in the ACL midsubstance, fibrocartilaginous entheses, and subchondral bone. STUDY DESIGN Controlled laboratory study. METHODS C57BL/6J adolescent inbred mice underwent 3 moderate to strenuous ACL fatigue loading sessions with a 72-hour recovery between sessions. Before each session, randomly selected subsets of mice (n = 12) were euthanized for quantifying collagen matrix damage (percent collagen unraveling) and ACL mechanics (strength and stiffness). This enabled the quasi-longitudinal assessment of collagen matrix damage accrual and whole tissue mechanical property changes across fatigue sessions. Additionally, all cyclic loading data were quantified to evaluate changes in knee mechanics (stiffness and hysteresis) across fatigue sessions. RESULTS Moderate to strenuous fatigue loading across 3 sessions led to a 24% weaker (P = .07) and 35% less stiff (P < .01) ACL compared with nonloaded controls. The unraveled collagen densities within the fatigued ACL and entheseal matrices after the second and third sessions were 38% (P < .01) and 15% (P = .02) higher compared with the nonloaded controls. CONCLUSION This study confirmed the hypothesis that in vivo ACL collagen matrix damage increases with tissue fatigue sessions, adversely impacting ACL mechanical properties. Moreover, the in vivo ACL findings were consistent with in vitro overloading research in humans. CLINICAL RELEVANCE The outcomes from this study support the use of this model for investigating ACL overuse injuries.
Collapse
Affiliation(s)
- Benjamin E. Loflin
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Taeyong Ahn
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kaitlyn A. Colglazier
- Purdue School of Engineering and Technology, Purdue University–Indianapolis, Indianapolis, Indiana, USA
| | - Mark M. Banaszak Holl
- Department of Orthopaedic Surgery, Heersink School of Medicine, University of Alabama–Birmingham, Birmingham, Alabama, USA
| | | | - Edward M. Wojtys
- Department of Orthopaedic Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Stephen H. Schlecht
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Purdue School of Engineering and Technology, Purdue University–Indianapolis, Indianapolis, Indiana, USA
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|