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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.
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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
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Kuwik P, Florkiewicz E, Benedict T, Mason J, Morris J, Crowell M. Assessing the Relationship of Psychological Sport Readiness, Single-leg Vertical Jump, and Non-Sagittal Single-Leg Hops to Quadriceps Strength After Anterior Cruciate Ligament Reconstruction. Int J Sports Phys Ther 2024; 19:942-955. [PMID: 39100937 PMCID: PMC11297365 DOI: 10.26603/001c.121597] [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: 01/27/2024] [Accepted: 06/21/2024] [Indexed: 08/06/2024] Open
Abstract
Background Limitations exist with current ACLR functional testing assessments that may be mitigated by including single-leg multi-directional testing. Hypothesis/Purpose To compare Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI) scores, limb symmetry index (LSI) of the single-leg vertical jump (SLVJ), single-leg medial rotation hop (SLMRH), single-leg lateral hop (SLLH), and isokinetic quadriceps strength between participants with an ACLR and healthy controls and assess predictors of quadriceps strength asymmetry. It was hypothesized that ACL-RSI scores and LSIs for all tests would differ between ACLR and healthy control groups and within the ACLR group a strong correlation would exist between all outcome measures and quadriceps strength. Study Design Cross-Sectional Study. Methods Twenty-six participants with an ACLR (median 13 months after surgery) and twenty-six matched healthy controls were recruited to participate in this study. Performance was assessed via SLVJ, SLMRH, SLLH, and isokinetic quadriceps strength. Between-group comparisons were made with independent t-tests and Mann-Whitney U test. Within the ACLR group, bivariate correlation and multivariate regression analysis were performed to assess the relationship between the outcome measures and quadriceps strength asymmetry. Results Significant between-limb differences were only identified in the ACLR group (p< 0.05): SLVJ LSI: 88.5%, SLMRH LSI: 93.6%, SLLH LSI: 92.7%, quadriceps strength LSI 80.9% - 83.9%, which were significantly lower (p <0.05) than the healthy control group. Within the ACLR group, a moderate-strong significant (p < 0.05) correlations existed with quadriceps strength and SLVJ (r=0.44-0.65), SLMRH (r =0.43-0.83), and SLLH (r=0.54-0.63); while ACL-RSI had a weak non-significant (p > 0.05) correlation with quadriceps strength (r= 0.12-0.30). Conclusion Single-leg multidirectional test LSIs were less in ACLR participants than matched healthy controls and all were directly related to quadriceps strength. Psychological readiness to return to sport was not related to quadriceps strength.
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Affiliation(s)
- Paul Kuwik
- Baylor University – Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
| | - Erin Florkiewicz
- Baylor University – Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
- Doctor of Philosophy in Health Sciences ProgramRocky Mountain University of Health Professions, Provo, Utah
| | - Timothy Benedict
- Baylor University – Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
| | - John Mason
- Baylor University – Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
| | - Jamie Morris
- Baylor University – Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
| | - Michael Crowell
- Baylor University – Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
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3
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Chen MJ, Fu SF. Letter to the editor regarding: "Risk factors of knee reinjury after anterior cruciate ligament reconstruction". INTERNATIONAL ORTHOPAEDICS 2024; 48:2273-2274. [PMID: 38886258 DOI: 10.1007/s00264-024-06240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Mei-Jie Chen
- Department of Orthopaedics, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, Zhejiang Province, China
| | - Sheng-Fan Fu
- Department of Orthopaedics, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, Zhejiang Province, China.
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Annibaldi A, Monaco E, Carrozzo A, Caiolo V, Criseo N, Cantagalli MR, Ferretti A, Maffulli N. Return to Soccer After Acute Anterior Cruciate Ligament Primary Repair: A 2-Year Minimum Follow-up Study of 50 Amateur Players. Am J Sports Med 2024; 52:2237-2243. [PMID: 38868946 DOI: 10.1177/03635465241256099] [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] [Indexed: 06/14/2024]
Abstract
BACKGROUND Return to sport (RTS) after treatment of an anterior cruciate ligament (ACL) tear is a critical parameter to assess the outcome of a surgical procedure. However, few studies have investigated RTS after ACL repair. PURPOSE To evaluate RTS of a group of amateur soccer players at a minimum follow-up of 2 years after ACL repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review of all patients treated with acute ACL repair was conducted. A total of 50 amateur soccer players were included in the study. Patients were examined clinically or contacted to complete postoperative patient-reported outcome measures, namely the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee questionnaire, the ACL-Return to Sport After Injury scale, and the Forgotten Joint Score-12. RESULTS The patients' mean age was 25.8 ± 7.7 years (range, 14-47 years), and the mean follow-up was 34.3 ± 10.7 months (range, 24-51.3 months). The median Tegner Activity Scale score was 9. The ACL repair failure rate was 16% (8/50). The mean time from repair to failure was 23.1 ± 12.7 months (range, 6-44 months), and the mean age of patients who sustained ACL repair failure was 19.9 ± 3.3 years (range, 14-24 years), significantly lower compared with patients who did not experience ACL repair failure (26.9 ± 7.9 years; range, 16-47 years; P = .017). Multivariate analysis showed that age ≤21 years was the only significant risk factor for ACL repair failure (odds ratio, 5.45; confidence interval, 1.24-27.91; P = .041). Excluding the 8 patients who experienced repair failure, 31 of 42 patients (73.8%) returned to soccer after ACL repair, with 29 of the 31 (93.5%) returning at their preinjury level of play. Moreover, patients who played competitive soccer and returned to their preinjury level of play were significantly younger than those who did not return to their preinjury level of play (mean, 21.1 ± 3.4 vs 29.2 ± 9.5 years, respectively; P = .002) and had significantly better ACL-Return to Sport After Injury scores (mean, 96.6 ± 4 vs 87.8 ± 11, respectively; P = .044). CONCLUSION In this study, 73.8% (n = 31) of patients returned to playing soccer, of whom 93.5% (n = 29) returned to their preinjury level after ACL repair. The failure rate was 16% (n = 8) and mainly involved patients ≤21 years old.
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Affiliation(s)
- Alessandro Annibaldi
- Institute of Sports Medicine and Science, Italian National Olympic Committee CONI, Rome, Italy
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Edoardo Monaco
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Alessandro Carrozzo
- Institute of Sports Medicine and Science, Italian National Olympic Committee CONI, Rome, Italy
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Vito Caiolo
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Natale Criseo
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Matteo Romano Cantagalli
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Andrea Ferretti
- Institute of Sports Medicine and Science, Italian National Olympic Committee CONI, Rome, Italy
| | - Nicola Maffulli
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
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Gill VS, Tummala SV, Sullivan G, Han W, Haglin JM, Marks L, Tokish JM. Functional Return-to-Sport Testing Demonstrates Inconsistency in Predicting Short-Term Outcomes Following Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2024; 40:2135-2151.e2. [PMID: 38216071 DOI: 10.1016/j.arthro.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/26/2023] [Accepted: 12/17/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE To systematically review the relationship between functional testing at the time of return to sport (RTS) and short-term outcomes, such as second anterior cruciate ligament (ACL) tear and return to a preinjury level of sport, among athletes who underwent anterior cruciate ligament reconstruction (ACLR). METHODS A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science to identify studies examining athletes who underwent functional RTS testing and were followed for at least 12 months following ACLR. Studies were screened by 2 reviewers. A standardized template was used to extract information regarding study characteristics, ACLR information, functional test results, and risk factors associated with retear or reduced RTS. RESULTS Of the 937 studies identified, 22 met the inclusion criteria. The average time between ACLR and RTS testing was 8.5 months. Single leg hop for distance performance had no association with retear risk in any study and no association with RTS rates in most studies. Quadriceps strength had conflicting results in relation to retear risk, whereas it had no relationship with RTS rates. Rates of reinjury and RTS were similar between patients who passed and did not pass combined hop and strength batteries. Asymmetric knee extension and hip moments, along with increased knee valgus and knee flexion angles, demonstrated increased risk of retear. CONCLUSIONS Individual hop and strength tests that are often used in RTS protocols following ACLR may have limited and inconsistent value in predicting ACL reinjury and reduced RTS when used in isolation. Combined hop and strength test batteries also demonstrate low sensitivity and negative predictive value, highlighting conflicting evidence to suggest RTS testing algorithm superiority. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Vikram S Gill
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A..
| | | | | | - Will Han
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | - Jack M Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Arizona, U.S.A
| | - Lisa Marks
- Division of Education, Department of Library Services, Mayo Clinic, Arizona, U.S.A
| | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic, Arizona, U.S.A
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Pyrz K, Hargreaves M, Wood A, Girardi A, McGwin G, Kirk J, Patton B, Casp A, Momaya A. Does Insurance Provide Adequate Coverage for Physical Therapy Visits for Common Orthopedic Diagnoses? A Survey Study. South Med J 2024; 117:353-357. [PMID: 38959960 DOI: 10.14423/smj.0000000000001707] [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: 07/05/2024]
Abstract
OBJECTIVES This study aimed to analyze the association between physical therapists' recommended number of visits for a full recovery from common orthopedic injuries/surgeries and the extent of insurance coverage for these visits. METHODS A prospective observational study was conducted with board-certified physical therapists. A qualitative questionnaire was used to gather physical therapists' demographics and the recommended number of physical therapy visits to achieve a full recovery after 11 common orthopedic diagnoses. Physical therapists also were asked to report whether they believe that insurance provides an adequate number of visits overall. In addition to the qualitative survey, insurance coverage details of major Alabama companies were obtained for comparison. Descriptive statistics of the participating therapists were analyzed for sex, age, degree/training, and years of experience. Kruskal-Wallis statistics were used to analyze variance between the aforementioned groupings when compared with the reported average number of sessions. RESULTS The survey (N = 251) collected data on the average number of physical therapy sessions that are necessary for a complete recovery as recommended by physical therapists for 11 common orthopedic diagnoses. From this survey, the average number of necessary visits ranged from 11.3 visits (ankle sprains) to 37.3 visits (anterior cruciate ligament reconstruction), with the overall average number of visits being 23.8. Only 24% of physical therapists believed that insurance companies provided enough coverage. Insurance coverage varied but often required additional procedures to allocate the adequate number of visits for the studied orthopedic pathologies. CONCLUSIONS The majority of practicing physical therapists in Alabama perceive insufficient insurance coverage for physical therapy visits for most orthopedic diagnoses. This study has implications for healthcare decision making and patient-centered rehabilitation goals. Physicians and physical therapists can use this information to optimize treatment decisions and rehabilitation goals. Patients will benefit from improved physical and economic well-being. This study has the potential to drive further research and influence national insurance policies to better serve patients' needs.
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Affiliation(s)
| | | | | | | | | | - Justin Kirk
- the Department of Physical Therapy, University of Alabama at Birmingham, Birmingham
| | - Bolton Patton
- the Department of Physical Therapy, University of Alabama at Birmingham, Birmingham
| | - Aaron Casp
- From the Department of Orthopaedic Surgery
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Eshraghi N, Mirghaderi P, Omid R, Sajadi M, Pashapour‐Yeganeh A, Hosseini‐Dolama R, Rahimzadeh P, Moharrami A, Rakhshan A, Javad Mortazavi SM. Anterior cruciate ligament-Return to sport after injury scale brief version after ACL reconstruction: Persian translation, cross-cultural adaptation and validation. J Exp Orthop 2024; 11:e12074. [PMID: 38978972 PMCID: PMC11228620 DOI: 10.1002/jeo2.12074] [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: 01/30/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose The purpose of this study is to analyze the short anterior cruciate ligament return to sport after injury (ACL-RSI) (Persian) version's cultural adaption and validity. Methods To assess test-retest reliability, 102 participants were filled out the short ACL-RSI(Per) scale 6 months or more after ACLR surgery. Internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficients), construct validity (Pearson's r) and sensitivity (floor/ceiling effect) were determined. In addition, patient completed other relevant measures such as Lysholm scores, the hospital for special surgery ACL satisfaction survey (HSS ACL-SS), the visual analogue scale (VAS) of pain and patient's satisfaction, the Tegner activity score (TAS), the single assessment numeric evaluation (SANE) and the Cincinnati Knee Rating System (CKRS). Results The short ACL-RSI(Per) scale showed high internal consistency (Cronbach's alpha = 0.91) and test-retest reliability (ICC = 0.923). Significant correlations between short ACL-RSI(Per) and other scales supported validity. There was a statistically significant connection between the short ACL-RSI(Per) and the following outcomes: HSS ACL-SS (r = 0.698, p < 0.001), VAS pain (r = 0.356, p < 0.001), CKRS (r = 0.644, p < 0.001), TAS (r = 0414, p < 0.001), Lysholm score (r = 0.467, p < 0.001) and SANE score (r = 0.536; p < 0.001). In addition to a satisfactory ceiling impact (15%), a sizeable floor effect (16.7%) was also seen. Conclusion The short ACL-RSI(Per) scale is a reliable and valid tool for assessing psychological readiness for return to sport after ACL reconstruction in Persian. Level of Evidence III.
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Affiliation(s)
- Nasim Eshraghi
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Peyman Mirghaderi
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Reza Omid
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Mohamad Sajadi
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Amirreza Pashapour‐Yeganeh
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Reza Hosseini‐Dolama
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Payman Rahimzadeh
- Surgical Research Society (SRS), Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | - Alireza Moharrami
- Joint Reconstruction Research CenterTehran University of Medical SciencesTehranIran
| | - Amir Rakhshan
- Department of Foreign LanguagesTehran University of Medical SciencesTehranIran
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Chen T, Dong Y, Li Y, Chen S. Four-year comparative analysis of return to sport and psychological recovery following ACL revision: Artificial ligament vs. anterior tibial tendon allograft. J Orthop Translat 2024; 47:29-38. [PMID: 38994236 PMCID: PMC11237355 DOI: 10.1016/j.jot.2024.05.003] [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: 12/21/2023] [Revised: 02/25/2024] [Accepted: 05/03/2024] [Indexed: 07/13/2024] Open
Abstract
Background Research on return to sport and psychological recovery in anterior cruciate ligament (ACL) revision remains scarce. The clinical efficacy of artificial ligament in ACL revision requires further exploration. Our objectives were (1) to compare the midterm clinical outcomes of artificial ligament versus allogenic tendon graft in ACL revision and (2) to analyze the effects of employing artificial ligament on return to sport and psychological recovery in ACL revision. Methods This cohort study included the cases receiving ACL revision from 2014 to 2021 in Sports Medicine Department of Huashan Hospital. The grafts used were Ligament Advanced Reinforcement System (LARS) and ATT allograft. We recorded patients' baseline data. The final follow-up assessment included subjective scales, physical examination, and return to sport status. We recorded the rates and timings of return to sport. Subjective scales included the 2000 International Knee Documentation Committee (IKDC) subjective score, Lysholm Knee Scaling Score (LKSS), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity score, Marx activity rating score, and Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI). Anterior knee stability was assessed using the KT-1000 arthrometer. Results Fifty cases (LARS group: 27; ATT group: 23) enrolled and 45 (LARS group: 23; ATT group: 22) completed evaluations with a median follow-up period of 49 months. At recent follow-up, LARS group outperformed in knee stability (1.0 ± 1.9 mm vs. 2.6 ± 3.0 mm, P = 0.039), confidence (86.7 ± 12.4 vs. 69.4 ± 18.6, P < 0.001), emotion (82.7 ± 11.3 vs. 70.7 ± 16.2, P < 0.001), KOOS knee function (78.7 ± 8.8 vs. 69.5 ± 11.0, P = 0.003), quality of life (79.1 ± 16.1 vs. 66.4 ± 19.5, P = 0.014), Tegner score (6.3 ± 1.9 vs. 5.2 ± 2.1, P < 0.001), and Marx activity score (10.7 ± 3.7 vs. 7.9 ± 4.0, P = 0.012). The LARS group had significantly higher return rates: recreational (91.3 % vs. 63.6 %, P = 0.026), knee cutting and pivoting (87.0 % vs. 59.1 %, P = 0.035), competitive (78.3 % vs. 45.5 %, P = 0.023), and pre-injury (56.5 % vs. 27.3 %, P = 0.047). For return timings, the LARS group was earlier at recreational (11.2 ± 3.9 vs. 27.8 ± 9.0 weeks, P < 0.001), knee cutting and pivoting (17.2 ± 5.8 vs. 35.6 ± 13.8 weeks, P < 0.001), competitive (24.8 ± 16.2 vs. 53.2 ± 22.0 weeks, P < 0.001), and pre-injury levels (32.8 ± 11.0 vs. 72.8 ± 16.9 weeks, P < 0.001). Conclusion In ACL revision, using LARS demonstrated improved joint stability and functionality compared to using allogenic ATT four years postoperative. Patients accepting the LARS procedure exhibited higher rates and earlier timings of return to various levels of sport, indicating enhanced confidence and emotional resilience. The translational potential of this article In ACL revision, the choice of artificial ligament to shorten recovery time, thereby enabling patients to return to sport more quickly and effectively, is thought-provoking. The research value extends beyond mere graft selection, guiding future clinical trials and studies. This research enhances our understanding of the application value of artificial ligament in ACL revision, emphasizing the importance of psychological recovery and updating our perceptions of return to sport levels post-revision. It stimulates exploration into personalized rehabilitation programs and treatment strategies, aiming to optimize clinical outcomes and meet the real-world needs of patients with failed ACL reconstruction.
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Affiliation(s)
- Tianwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, China
- Sports Medicine Institute, Fudan University, China
| | - Yu Dong
- Department of Sports Medicine, Huashan Hospital, Fudan University, China
- Sports Medicine Institute, Fudan University, China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, China
- Sports Medicine Institute, Fudan University, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, China
- Sports Medicine Institute, Fudan University, China
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Mo IF, Harlem T, Faleide AGH, Strand T, Vindfeld S, Solheim E, Inderhaug E. ACL Reconstruction Using Quadrupled Semitendinosus Versus Double-Stranded Semitendinosus and Gracilis Autograft: 2-Year Results From a Prospective Randomized Controlled Study. Am J Sports Med 2024; 52:1927-1936. [PMID: 38845474 DOI: 10.1177/03635465241254048] [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] [Indexed: 07/02/2024]
Abstract
BACKGROUND A disadvantage of using hamstring tendon autograft consisting of the semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction is pain from tendon harvesting and persistent hamstring weakness. In the tendon-sparing all-inside technique, a quadrupled semitendinosus graft and adjustable-loop cortical fixation are suggested to give less postoperative flexion deficits while displaying overall similar clinical results to the traditional hamstring technique. However, there are a limited number of high-quality studies comparing these techniques with inconsistent results. PURPOSE To investigate differences between the all-inside (quadrupled semitendinosus) and traditional hamstring (double-stranded semitendinosus and gracilis) technique regarding (1) self-reported function, (2) hamstring strength, and (3) knee laxity. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 98 patients were randomized to either the all-inside or the traditional hamstring technique. Perioperatively, duration of surgery and graft size were obtained. The International Knee Documentation Committee 2000 Subjective Knee Form score, Knee injury and Osteoarthritis Outcome Score, Tegner Activity Scale score, knee laxity (KT-1000 arthrometer side-to-side difference and pivot shift), range of motion, isokinetic knee strength, and hop test score were collected preoperatively and 2 years postoperatively. Return-to-sport readiness was evaluated 9 months postoperatively. RESULTS A total of 89 patients completed 2-year follow-up, 45 patients with the all-inside technique and 44 patients with the traditional hamstring technique. There were no significant differences between groups in any of the outcome measures 2 years after surgery, but there was a tendency in the all-inside group toward having increased anterior translation (mean, 3.6 mm vs 2.7 mm), a higher number of revision surgeries (5 patients vs 2 patients), and more patients having +1 and +2 pivot-shift values (29 vs 18 patients) when compared with the traditional group. CONCLUSION The all-inside technique yields equivalent results to the traditional hamstring technique 2 years after surgery and should be considered a reliable technique to use for ACL reconstruction. Sparing the gracilis tendon does not lead to less persistent hamstring weakness. Long-term follow-up is needed to further determine whether the tendency of increased anterior translation seen at 2 years postoperatively will lead to a higher risk of graft failure.
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Affiliation(s)
- Ingunn Fleten Mo
- University of Bergen, Bergen, Norway
- Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | | | | | - Søren Vindfeld
- University of Bergen, Bergen, Norway
- Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Eirik Solheim
- University of Bergen, Bergen, Norway
- Aleris Hospital Nesttun Bergen, Bergen, Norway
| | - Eivind Inderhaug
- University of Bergen, Bergen, Norway
- Haraldsplass Deaconess Hospital, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
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Ryan PC, Ching IC, Ierulli VK, Pickett K, Mulcahey MK. Fear of Reinjury, Psychological Factors, and Sport Played Have Negative Impact on Return to Sport Following Medial Patellofemoral Ligament Reconstruction for Patellar Instability. Arthroscopy 2024:S0749-8063(24)00399-2. [PMID: 38849062 DOI: 10.1016/j.arthro.2024.05.022] [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: 12/21/2023] [Revised: 05/06/2024] [Accepted: 05/12/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE To analyze factors that affect return to sport after medial patellofemoral ligament reconstruction (MPFLR), such as psychological factors, sport played, and a positive apprehension test following surgery, and to determine the average return to sport rates and time to return to sport. METHODS A literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies met the following criteria: patients underwent MPFLR for patellar instability, return to sport was recorded, and a factor that affected return to sport was mentioned. Search terms included medial patellofemoral ligament, tibial tubercle osteotomy, tibial tubercle transfer, return to play, and return to sport. RESULTS Eighteen of 632 identified studies met inclusion criteria, and 1,072 patients who underwent MFPLR were recorded. Return-to-sport rates and mean/median time ranged from 60.0% to 100% and 3 to 10.4 months, respectively. Of the patients, 55.6% to 84.0% returned to sport without decreasing the level of competition. Six of 12 studies (50.0%) reported fear of reinjury as the top reason for patients not returning or returning at a lower level of sport. Volleyball/handball had the lowest return to the same level following surgery (18.2%-50.0%). CONCLUSIONS Athletes who underwent MPFLR following recurrent patellar instability returned to sport at a range of 60.0% to 100%. Return to sport at the same level or higher was found to have a lower maximum rate at 55.6% to 84.0%. Fear of reinjury and sport played were found to have a substantial impact on ability to return to sport. Surgeons can use this information to advise patients on expectations following surgery. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Patrick C Ryan
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Idaleen C Ching
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Victoria K Ierulli
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Keith Pickett
- Rudolph Matas Library of the Health Sciences, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Mary K Mulcahey
- Department of Orthopedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, U.S.A..
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11
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Cao Z, Wang C, Ma Y, Wang J, Wang H, Liu P, Yang Y, Gong X, Wang J, Shi W. Good clinical outcomes of anterior cruciate ligament reconstruction in patients over 60 years of age. Knee Surg Sports Traumatol Arthrosc 2024; 32:1396-1404. [PMID: 38558103 DOI: 10.1002/ksa.12148] [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: 12/23/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To evaluate the clinical outcomes following arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) in patients over 60 years and to investigate the potential impact of preoperative osteoarthritis (OA) on these outcomes. METHODS A retrospective study included ACL-injured patients over 60 years who underwent primary arthroscopic ACLR between 2010 and 2020. The Lysholm score and the International Knee Documentation Committee (IKDC) score were assessed preoperatively and at the final follow-up. The Tegner activity scale was performed to evaluate patients' activity levels. Data on return to sports, patient satisfaction, subsequent injuries and complications were collected. Preoperative radiographs were used to grade OA according to the Kellgrene-Lawrence classification. Correlation analysis between OA and clinical outcomes was performed. The rates of achieving the minimal clinically significant difference and patient-acceptable symptoms state were documented. RESULTS A total of 37 patients were included in this study. The mean age at surgery was 62.3 ± 2.3 years, with a mean follow-up of 6.3 ± 3.2 years (range: 2.1-12.4). Patients showed statistically significant (all p < 0.001) improvements in the mean IKDC (38.9 ± 9.4-66.8 ± 12.5), Lysholm (48.8 ± 15.4-83.0 ± 12.8) and Tegner (1-3) scores. Fourteen patients (37.8%) returned to sports. No correlation was observed between the degree of preoperative OA and clinical outcomes (n.s.). CONCLUSION Patients over 60 years with symptomatic ACL-deficient knees could benefit from ACLR, even when mild to moderate OA is present preoperatively. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Zhuohan Cao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yong Ma
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jian Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Haijun Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Ping Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yuping Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Xi Gong
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jianquan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
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12
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Dombrowski N, Cleary CJ, Bernard CD, Vopat BG, Herda AA. Psychological Readiness Is Weakly Related to Physical Function Tests at Return to Sport for Men and Not at All for Women Following Anterior Cruciate Ligament Reconstruction and Rehabilitation. Arthroscopy 2024; 40:1870-1878. [PMID: 38061685 DOI: 10.1016/j.arthro.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/07/2023] [Accepted: 11/19/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE To assess the relationships between physical function tests of the operative limb and psychological readiness to return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction (return to sport after injury [ACL-RSI]) by sex. The secondary purpose was to quantify sex-specific differences in physical function test outcomes. METHODS Patient records were retrospectively identified as cases who performed RTS physical function testing (strength, horizontal hops, vertical jumps, single-leg leg press, and drop landing knee excursion, etc.), and completed a 6-question ACL-RSI survey at the time point they were cleared to RTS. Independent t-tests compared all variables between sex at P ≤ .05. Correlations and regression models were produced per sex to identify factors related to operative limb physical function tests and ACL-RSI scores. RESULTS With a total of 127 patients (63 men; 64 women), there was no difference in ACL-RSI scores and leg press repetitions between sex (P = .32 and P = .12, respectively). There were sex differences for all other physical performance outcomes (P < .001 for all). To estimate readiness using physical function test scores, the men's regression model identified knee excursion (β = 0.345; P = .033) as the only contributor to ACL-RSI (R2 = 0.089), whereas there was no relationship between physical performance outcomes and ACL-RSI in women (R2 = 0.00, P = 1.00). CONCLUSIONS Men and women reported similar ACL-RSI scales, indicating high readiness to return to sport. Likely due to sex-related physiological differences, men performed better at most physical function tests. Further, male ACL-RSI could be predicted using only one physical function outcome and 91% variability of the ACL-RSI coming from other contributors not evaluated, as indicated by R2. No physical function variables predict ACL-RSI in women. The evaluated variables are considered the primary indicators relevant for patients to be permitted to RTS yet cannot adequately predict psychological readiness in these patients. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Nicholas Dombrowski
- School of Medicine, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Christopher J Cleary
- Department of Health, Sport, and Exercise Sciences, University of Kansas Edwards Campus, Overland Park, Kansas, U.S.A
| | - Christopher D Bernard
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Bryan G Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Ashley A Herda
- Department of Health, Sport, and Exercise Sciences, University of Kansas Edwards Campus, Overland Park, Kansas, U.S.A..
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13
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Knapik DM, Kamitani A, Smith MV, Motley J, Haas AK, Matava MJ, Wright RW, Brophy RH. Relationship between Kinesiophobia and Dynamic Postural Stability after Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study. J Knee Surg 2024. [PMID: 38677296 DOI: 10.1055/a-2315-8034] [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: 04/29/2024]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) injuries in young, active patients generally require ACL reconstruction (ACLR) to restore mechanical and postural stability. The fear of movement or reinjury (kinesiophobia) has become increasingly recognized in the post-ACLR population; however, the association between restoration of postural stability and kinesiophobia remains largely unknown. The purpose of this study was to investigate changes in mean Tampa Scale of Kinesiophobia-11 (TSK-11), dynamic motion analysis (DMA) scores, and time on the testing platform, as well as any correlation between TSK-11 and mean overall and individual translational and rotational DMA scores during the first 12 months following ACLR. DESIGN Cohort study. METHODS Patients undergoing ACLR were prospectively enrolled and dynamic postural stability and kinesiophobia based on the TSK-11 were collected within 2 days prior to surgery and at 6 and 12 months following ACLR. Dynamic postural stability was quantified by calculating a DMA score, with score calculated in three translational (anterior/posterior [AP], up/down [UD], medial/lateral [ML]) and three rotational (left/right [LR], flexion/extension, and internal/external rotation) independent planes of motions. Correlations between DMA and TSK-11 scores at each time point were analyzed. RESULTS A total of 25 patients meeting inclusion criteria were analyzed. Mean overall DMA and TSK-11 scores increased with each successive testing interval. At 6-month follow-up, a weakly positive association between TSK-11 and DMA scores was appreciated based on overall DMA, AP, UD, ML, and LR. At 12 months, a moderately positive correlation was appreciated between TSK-11 and the translational, but not rotational, planes of motion. CONCLUSIONS Following ACLR, lower level of kinesiophobia were found to be moderately associated with improved dynamic stability, especially in the translation planes of motion.
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Affiliation(s)
- Derrick M Knapik
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Aguri Kamitani
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Matthew V Smith
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - John Motley
- STAR Sports Therapy and Rehabilitation, Chesterfield, Missouri
| | - Amanda K Haas
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Matthew J Matava
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Robert H Brophy
- Division of Sports Medicine, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri
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14
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Cobian DG, Knurr KA, Joachim MR, Bednarek AL, Broderick AM, Heiderscheit BC. Does It Matter? Isometric or Isokinetic Assessment of Quadriceps Strength Symmetry 9 Months After ACLR in Collegiate Athletes. Sports Health 2024:19417381241247819. [PMID: 38742396 DOI: 10.1177/19417381241247819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Greater quadriceps strength symmetry is associated with better outcomes after anterior cruciate ligament reconstruction (ACLR). Isometric and isokinetic assessments of quadriceps strength inform therapeutic exercise prescription and return-to-sport decisions. It is unclear whether isometric and isokinetic measures provide similar information post-ACLR. HYPOTHESIS Quadriceps strength symmetry is similar between isometric and isokinetic assessments. Isokinetic and isometric strength symmetries have similar associations to functional knee kinetics and self-reported knee function. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS NCAA Division I athletes (N = 35), 8.9 ± 2.5 months post-ACLR completed isometric and isokinetic quadriceps strength assessments, countermovement jumps (CMJs), and treadmill running. Self-reported knee function was assessed using the International Knee Documentation Committee Subjective Knee Form (IKDC). Agreement between isometric and isokinetic strength symmetry was assessed using Bland-Altman analysis, with associations to functional knee kinetics and IKDC assessed using Pearson correlations and linear regressions. RESULTS Mean difference in quadriceps strength symmetry between isokinetic and isometric assessments was 1.0% (95% limits of agreement of -25.1% to 23.0%). Functional knee kinetics during running and CMJ were moderately to strongly associated with isometric strength symmetry (r = 0.64-0.80, P < 0.01) and moderately associated with isokinetic strength symmetry (r = 0.41-0.58, P < 0.01). IKDC scores were weakly to moderately associated with isometric (r = 0.39, P = 0.02) and isokinetic (r = 0.49, P < 0.01) strength symmetry. CONCLUSION Isokinetic and isometric assessments of quadriceps strength symmetry in collegiate athletes 9 months post-ACLR demonstrated strong agreement. Quadriceps strength symmetry is associated with functional knee kinetic symmetry post-ACLR. CLINICAL RELEVANCE Considerable individual variation suggests mode of contraction should be consistent throughout postoperative assessment. Isometric strength symmetry may be a better indicator of functional knee kinetic symmetry, while isokinetic strength symmetry may be associated more closely with patient-reported outcomes.
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Affiliation(s)
- Daniel G Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin
- Doctor of Physical Therapy Program, University of Wisconsin-Madison, Madison, Wisconsin
- Sports Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Keith A Knurr
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin
- Doctor of Physical Therapy Program, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine, Division of Geriatrics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Mikel R Joachim
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Amy L Bednarek
- Sports Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Andrew M Broderick
- Sports Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, Wisconsin
- Sports Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
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15
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Herring SA, Putukian M, Kibler WB, LeClere L, Boyajian-O'Neill L, Day MA, Franks RR, Indelicato P, Matuszak J, Miller TL, O'Connor F, Poddar S, Svoboda SJ, Zaremski JL. Team Physician Consensus Statement: Return to Sport/Return to Play and the Team Physician: A Team Physician Consensus Statement-2023 Update. Curr Sports Med Rep 2024; 23:183-191. [PMID: 38709944 DOI: 10.1249/jsr.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington KY
| | - Lance LeClere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Peter Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | | | - Timothy L Miller
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Fran O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sourav Poddar
- Primary Sports Medicine, University of Colorado School of Medicine, Denver, CO
| | | | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, University of Florida Health, Gainesville, FL
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16
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Herring SA, Putukian M, Kibler WB, Leclere L, Boyajian-O'Neill L, Day MA, Franks RR, Indelicato P, Matuszak J, Miller TL, O'Connor F, Poddar S, Svoboda SJ, Zaremski JL. Team Physician Consensus Statement: Return to Sport/Return to Play and the Team Physician: A Team Physician Consensus Statement-2023 Update. Med Sci Sports Exerc 2024; 56:767-775. [PMID: 38616326 DOI: 10.1249/mss.0000000000003371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington KY
| | - Lance Leclere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Peter Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | | | - Timothy L Miller
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Fran O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sourav Poddar
- Primary Sports Medicine, University of Colorado School of Medicine, Denver, CO
| | | | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, University of Florida Health, Gainesville, FL
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17
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Honeywill C, Salmon L, Pinczewski L, Sundaraj K, Roe J. Comparison of Contralateral ACL Rupture Versus ACL Graft Rupture in Australian Netballers After ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241247488. [PMID: 38784789 PMCID: PMC11113052 DOI: 10.1177/23259671241247488] [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: 09/15/2023] [Accepted: 10/24/2023] [Indexed: 05/25/2024] Open
Abstract
Background Netball is a popular sport worldwide, particularly for women. However, its nature puts players at high risk for anterior cruciate ligament (ACL) injury. Purpose To determine (1) the prevalence of ACL graft rupture and contralateral ACL (CACL) rupture in Australian female netballers after ACL reconstruction (ACLR) and (2) the rate of return to sports (RTS) and psychological readiness. Study Design Cohort study; Level of evidence, 3. Methods A patient database identified 332 consecutive female netball players who underwent ACLR with hamstring tendon autografts performed by 2 surgeons between 2007 and 2015. Patients were retrospectively surveyed at a minimum of 7 years postoperatively-including details of a second ACL injury to either knee, RTS, and psychological readiness per the ACL-Return to Sport After Injury (ACL-RSI) score. Multivariate regression assessed the association between selected variables and repeat ACL injury. Results A total of 267 patients (80%) were included with a mean follow-up of 8.4 years (range, 7-15 years). ACL graft rupture and CACL rupture occurred in 11 (4%) and 27 (10%) patients, respectively, at 7 years postoperatively. The ACL graft had a survival rate of 99%, 97%, 97%, and 96% at 1, 2, 5, and 7 years after surgery, respectively. The native CACL had a survival rate of 100%, 99%, 94%, and 90% at 1, 2, 5, and 7 years, respectively. Adolescents had a 4.5 times greater hazard for ACL graft rupture (95% CI, 1.4-14.6; P = .014) and a 2.5 times greater hazard for CACL rupture (95% CI, 1.2-5.5; P = .021) compared with adults. CACL injury was also associated with a return to level 1-including jumping, hard pivoting, and cutting-sports (hazard ratio, 10.3 [95% CI, 1.4-77.1]; P = .023). Most (62%) participants returned to netball, with those with higher ACL-RSI scores more likely to RTS. Conclusion The prevalence of repeat ACL injury was higher in the contralateral knee (10%) than the ACL-reconstructed knee (4%) at 7 years postoperatively. ACLR was a suitable option for female netballers who sustained an ACL rupture with low long-term rates of graft rupture. Repeat ACL injuries to either knee were more common in adolescents and those who returned to cutting and pivoting sports.
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Affiliation(s)
- Conor Honeywill
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Lucy Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Leo Pinczewski
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Keran Sundaraj
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Justin Roe
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia
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18
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Sell TC, Zerega R, King V, Reiter CR, Wrona H, Bullock GS, Mills N, Räisänen A, Ledbetter L, Collins GS, Kvist J, Filbay SR, Losciale JM. Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI) Scores over Time After Anterior Cruciate Ligament Reconstruction: A Systematic Review with Meta-analysis. SPORTS MEDICINE - OPEN 2024; 10:49. [PMID: 38689130 PMCID: PMC11061071 DOI: 10.1186/s40798-024-00712-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Psychological readiness is an important consideration for athletes and clinicians when making return to sport decisions following anterior cruciate ligament reconstruction (ACLR). To improve our understanding of the extent of deficits in psychological readiness, a systematic review is necessary. OBJECTIVE To investigate psychological readiness (measured via the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI)) over time after ACL tear and understand if time between injury and surgery, age, and sex are associated with ACL-RSI scores. METHODS Seven databases were searched from the earliest date available to March 22, 2022. Articles reporting ACL-RSI scores after ACL tear were included. Risk of bias was assessed using the ROBINS-I, RoB-2, and RoBANS tools based on the study design. Evidence certainty was assessed for each analysis. Random-effects meta-analyses pooled ACL-RSI scores, stratified by time post-injury and based on treatment approach (i.e., early ACLR, delayed ACLR, and unclear approach). RESULTS A total of 83 studies were included in this review (78% high risk of bias). Evidence certainty was 'weak' or 'limited' for all analyses. Overall, ACL-RSI scores were higher at 3 to 6 months post-ACLR (mean = 61.5 [95% confidence interval (CI) 58.6, 64.4], I2 = 94%) compared to pre-ACLR (mean = 44.4 [95% CI 38.2, 50.7], I2 = 98%), remained relatively stable, until they reached the highest point 2 to 5 years after ACLR (mean = 70.7 [95% CI 63.0, 78.5], I2 = 98%). Meta-regression suggests shorter time from injury to surgery, male sex, and older age were associated with higher ACL-RSI scores only 3 to 6 months post-ACLR (heterogeneity explained R2 = 47.6%), and this reduced 1-2 years after ACLR (heterogeneity explained R2 = 27.0%). CONCLUSION Psychological readiness to return to sport appears to improve early after ACL injury, with little subsequent improvement until ≥ 2-years after ACLR. Longer time from injury to surgery, female sex and older age might be negatively related to ACL-RSI scores 12-24 months after ACLR. Due to the weak evidence quality rating and the considerable importance of psychological readiness for long-term outcomes after ACL injury, there is an urgent need for well-designed studies that maximize internal validity and identify additional prognostic factors for psychological readiness at times critical for return to sport decisions. REGISTRATION Open Science Framework (OSF), https://osf.io/2tezs/ .
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Affiliation(s)
- Timothy C Sell
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Ryan Zerega
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Victoria King
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | | | - Hailey Wrona
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK
| | - Nilani Mills
- University of New South Wales, Sydney, NSW, Australia
| | - Anu Räisänen
- Department of Physical Therapy Education-Oregon, College of Health Sciences-Northwest, Western University of Health Sciences, Oregon, USA
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | | | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine, and Caring Medicine, University of Linkoping, Linköping, Sweden
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | - Stephanie R Filbay
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Justin M Losciale
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
- Arthritis Research Canada, Vancouver, Canada.
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19
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Syed RIB, Hangody LR, Frischmann G, Kós P, Kopper B, Berkes I. Comparative Effectiveness of Supervised and Home-Based Rehabilitation after Anterior Cruciate Ligament Reconstruction in Competitive Athletes. J Clin Med 2024; 13:2245. [PMID: 38673520 PMCID: PMC11051221 DOI: 10.3390/jcm13082245] [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: 03/06/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: After the increasingly common anterior cruciate ligament reconstruction (ACLR) procedure in competitive athletes, rehabilitation is crucial for facilitating a timely return to sports (RTS) and preventing re-injury. This pilot study investigates the patient-reported outcomes of postoperative rehabilitation in competitive athletes, comparing supervised rehabilitation (SVR) and home-based rehabilitation (HBR). Methods: After ACLR, 60 (out of 74 screened) athletes were recruited and equally divided into HBR and SVR groups using non-probability convenience sampling, with each group comprising 15 males and 15 females. The rehabilitation outcomes in the respective groups were evaluated at 8 months using measures (Tegner Activity Scale [TAS], International Knee Documentation Committee subjective knee form [IKDC-SKF], ACL Return to Sport after Injury [ACL-RSI]) and objective parameters (isometric muscle strength, hamstring/quadricep asymmetry). RTS was evaluated at 9 months, with ACL re-injury rates recorded approximately 6 months post-RTS. Results: Both groups exhibited decreased TAS scores (HBR: 8 to 6, SVR: 8 to 7), with the SVR group demonstrating superior postoperative IKDC-SKF scores (81.82 vs. 68.43) and lower ACL-RSI scores (49.46 vs. 55.25). Isometric and isokinetic muscle strength, along with asymmetry values, was higher in the SVR group 8 months post-ACLR (p < 0.05). The SVR group showed a higher RTS rate to the same level (76.6% vs. 53.3%), while the re-injury rate was the same in both the rehabilitation groups (3.3%). Conclusions: Although both rehabilitation approaches yielded comparable outcomes, SVR may demonstrate some superior biomechanical improvements in athletes, resulting in a higher RTS rate. However, the psychological outcomes and re-injury rates did not significantly differ between the groups, emphasizing the need to address individual psychological needs during rehabilitation. Further investigation is recommended with a larger sample size to address the differences of gender among competitive athletes.
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Affiliation(s)
| | | | - Gergely Frischmann
- Biomechanics Lab, TSO Medical Hungary Kft., 1118 Budapest, Hungary; (G.F.); (P.K.)
| | - Petra Kós
- Biomechanics Lab, TSO Medical Hungary Kft., 1118 Budapest, Hungary; (G.F.); (P.K.)
| | - Bence Kopper
- Department of Biomechanics, Hungarian University of Sports Science, 1123 Budapest, Hungary;
| | - István Berkes
- Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary;
- Department of Traumatology, Semmelweis University, 1085 Budapest, Hungary;
- Department of Health Sciences and Sport Medicine, Hungarian University of Sports Science, 1123 Budapest, Hungary
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20
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Garra S, Li ZI, Eskenazi J, Jazrawi T, Rao N, Campbell KA, Alaia MJ, Strauss EJ, Jazrawi LM. Patients With Segond Fracture Demonstrate Similar Rates of Return to Sport and Psychological Readiness After Anterior Cruciate Ligament Reconstruction: A Matched Cohort Study at Minimum 2-Year Follow-Up. Arthroscopy 2024; 40:1247-1255. [PMID: 37716633 DOI: 10.1016/j.arthro.2023.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To compare clinical outcomes, rate of return to sports, and psychological readiness among patients undergoing anterior cruciate ligament reconstruction (ACLR) with and without concomitant Segond fracture. METHODS We retrospectively identified patients who underwent primary ACLR from January 2012 to December 2020 with minimum 2-year follow-up. Exclusion criteria were additional ligamentous injury, age <16 years, or a concomitant lateral augmentation procedure. Preoperative knee radiographs were reviewed to identify Segond fractures. Identified patients were matched 1:2 to controls by age/sex/body mass index/graft type. Charts were reviewed for pre- and postoperative knee stability. Surveys administered included preinjury sport participation and return status, Lysholm score, Tegner activity scale, and ACL-Return to Sport Index (ACL-RSI), a metric of psychological sport readiness. Multivariable logistic regression was conducted to identify predictors of return to sport. RESULTS There were 120 patients who were included in the final analysis (40 Segond, 80 controls) at a mean follow-up of 5.7 ± 2.4 years. A total of 52.5% of patients received bone-patellar tendon-bone autograft. The overall rate of return to sport was 79.5% in the Segond group compared with an 83.8% rate of return in the control group (P = .569). In total, 48.7% of the Segond group and 56.8% of the control group returned to their preinjury level of sport (P = .415). Lysholm (89.6 ± 10.3 vs 85.4 ± 16.7, P = .296), Tegner (5.7 ± 1.8 vs 6.1 ± 2.2, P = .723), and ACL-RSI (62.2 ± 25.4 vs 56.6 ± 25.4, P = .578) scores were similar between Segond and control groups. There was a single graft failure in the Segond group 5 years' postoperatively. Increasing ACL-RSI score was significantly predictive of return to sport (P < .001). CONCLUSIONS Patients who had an ACL tear and a concomitant Segond fracture who underwent isolated ACLR without lateral augmentation procedures had similar clinical outcomes and rates of return sport compared with a matched isolated ACLR control group at minimum 2-year follow-up. There was no significant difference in psychological readiness between groups as measured by the ACL-RSI. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.; Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Taylor Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Naina Rao
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
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21
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Ebert JR, Calvert ND, Radic R. A Prospective Randomized Controlled Trial Investigating Quadriceps Versus Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2024; 52:660-669. [PMID: 38284303 PMCID: PMC10905979 DOI: 10.1177/03635465231222279] [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: 07/15/2023] [Accepted: 11/06/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Numerous graft options are available when undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although a lack of high-quality evidence exists comparing quadriceps (QT) and hamstring (HT) autografts. PURPOSE To investigate patient outcomes in patients undergoing HT versus QT ACLR. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS After recruitment and randomization, 112 patients (HT = 55; QT = 57) underwent ACLR. Patients were assessed pre- and postoperatively (6 weeks and 3, 6, 12, and 24 months), with a range of patient-reported outcome measures (PROMs), graft laxity (KT-1000 arthrometer; primary outcome variable), active knee flexion and extension range of motion (ROM), peak isokinetic knee extensor and flexor strength, and a 6-hop performance battery. Limb symmetry indices (LSIs) were calculated for strength and hop measures. Secondary procedures, ACL retears, and contralateral ACL tears were reported. RESULTS All PROMs and knee ROM measures significantly improved (P < .0001), and no other group differences (P > .05) were observed-apart from the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score, which was significantly better in the HT group at 3 (P = .008), 6 (P = .010), and 12 (P = .014) months. No significant changes were observed in side-to-side laxity from 6 to 24 months (P = .105), and no group differences were observed (P = .487) at 6 (HT mean, 1.2; QT mean, 1.3), 12 (HT mean, 1.1; QT mean, 1.3), and 24 (HT mean, 1.1; QT mean, 1.2) months. While the HT group demonstrated significantly greater (P < .05) quadriceps strength LSIs at 6 and 12 months, the QT group showed significantly greater (P < .05) hamstring strength LSIs at 6, 12, and 24 months. The HT group showed significantly greater (P < .05) LSIs for the single horizontal (6 months), lateral (6 and 12 months), and medial (6 months) hop tests for distance. Up until 24 months, 1 patient (QT at 22 months) had a retear, with 2 contralateral ACL tears (QT at 19 months; HT at 23 months). Secondary procedures included 5 in the HT group (manipulation under anesthesia, notch debridement, meniscal repair, and knee arthroscopy for scar tissue) and 6 in the QT group (notch debridement, meniscal repair, knee arthroscopy for scar tissue, tibial tubercle transfer, and osteochondral autologous transplantation). CONCLUSION Apart from the ACL-RSI, the 2 autograft groups compared well for PROMs, knee ROM, and laxity. However, greater hamstring strength LSIs were observed for the QT cohort, with greater quadriceps strength (and hop test) LSIs in the HT cohort. The longer-term review will continue to evaluate return to sports and later-stage reinjury between the 2 graft constructs. REGISTRATION ACTRN12618001520224p (Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- Jay R. Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
- HFRC Rehabilitation Clinic, Perth, Western Australia, Australia
- Perth Orthopaedic & Sports Medicine Research Institute, Perth, Western Australia, Australia
| | - Nicholas D. Calvert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
- Perth Orthopaedic & Sports Medicine Research Institute, Perth, Western Australia, Australia
- Department of Orthopaedics, Royal Perth Hospital, Perth, Western Australia, Australia
- Perth Orthopaedic & Sports Medicine Centre, Perth, Western Australia, Australia
| | - Ross Radic
- Perth Orthopaedic & Sports Medicine Research Institute, Perth, Western Australia, Australia
- Department of Orthopaedics, Royal Perth Hospital, Perth, Western Australia, Australia
- Perth Orthopaedic & Sports Medicine Centre, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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22
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Momaya AM, Wood AS, Benson EM, Kwapisz AL. The Influence of Psychosocial Factors on Patients Undergoing Anterior Cruciate Ligament Reconstruction. Sports Health 2024; 16:230-238. [PMID: 38297441 PMCID: PMC10916773 DOI: 10.1177/19417381231223560] [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: 02/02/2024] Open
Abstract
CONTEXT Anterior cruciate ligament (ACL) injuries greatly impact patients in terms of future performance, reduced physical activity and athletic participation, and overall economic burden. Decades of research have investigated how to improve ACL reconstruction (ACLR) outcomes. Recently, there has been growing interest to understand the effects of psychosocial factors on patient outcomes. STUDY DESIGN Clinical review. EVIDENCE ACQUISITION A search of the PubMed database was performed in March 2023. Articles were reviewed by at least 2 authors to determine relevance. We highlighted publications of the past 5 years while incorporating previous pertinent studies. LEVEL OF EVIDENCE Level 5. RESULTS There is no standardization of psychosocial factors regarding ACLR. As such, there is a lack of consensus regarding which psychosocial measures to use and when. There is a need for clarification of the complex relationship between psychosocial factors and physical function. Despite this, psychosocial factors have the potential to help predict patients who are more likely to return to sport: (1) desire/motivation to return; (2) lower levels of kinesiophobia; (3) higher levels of self-efficacy, confidence, and subjective knee function; (4) risk acceptance; and (5) social support. However, there are no standardized interventions to improve psychosocial factors after ACLR. CONCLUSION Psychosocial factors affect outcomes after ACLR. However, the interplay between psychosocial factors and physical function is complex. There is emerging evidence that testing and interventions may improve ACLR outcomes. There is a lack of standardized interventions to determine or improve psychosocial factors after ACLR. Further research is needed to identify psychosocial factors and to develop standardized interventions for clinicians to implement to improve clinical outcomes.
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Affiliation(s)
- Amit M Momaya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Audria S Wood
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth M Benson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam L Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland
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23
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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.
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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..
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Buldo-Licciardi M, Rynecki ND, Rao N, Eskenazi J, Montgomery SR, Li ZI, Moore M, Alaia MJ, Strauss EJ, Jazrawi LM, Campbell KA. Psychological Readiness to Return to Sport (RTS) and RTS Rates Are Similar in Patients After Either Bilateral or Unilateral Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2024; 6:100823. [PMID: 38162590 PMCID: PMC10755276 DOI: 10.1016/j.asmr.2023.100823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/21/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose To compare psychological readiness to return to sport (RTS), RTS rate, level of return, and time to return between patients who underwent bilateral anterior cruciate ligament reconstruction (ACLR) and those who underwent unilateral ACLR. Methods The electronic medical record at a single academic medical center was queried for patients who underwent ACLR from January 2012 to May 2020. The inclusion criteria were skeletally mature patients who underwent either single or sequential bilateral ACLR and who had undergone either the primary ACLR or second contralateral ACLR at least 2 years earlier. Bilateral ACLRs were matched 1:3 to unilateral reconstructions based on age, sex, and body mass index. Psychological readiness to RTS was assessed using the validated ACL Return to Sport After Injury (ACL-RSI) scale. This, along with time to return and level of RTS, was compared between the 2 cohorts. Results In total, 170 patients were included, of whom 44 underwent bilateral ACLR and 132 underwent unilateral ACLR. At the time of the first surgical procedure, patients in the unilateral cohort were aged 28.8 ± 9.4 years and those in the bilateral cohort were aged 25.7 ± 9.8 years (P = .06). The average time difference between the first and second surgical procedures was 28.4 ± 22.3 months. There was no difference in psychological readiness to RTS (50.5 in bilateral cohort vs 48.1 in unilateral cohort, P = .66), RTS rate (78.0% in unilateral cohort vs 65.9% in bilateral cohort, P = .16), percentage of return to preinjury sport level (61.2% in unilateral cohort vs 69.0% in bilateral cohort, P = .21), or time to return (41.2 ± 29.3 weeks in unilateral cohort vs 35.2 ± 23.7 weeks in bilateral cohort, P = .31) between the 2 cohorts. Conclusions Compared with patients who undergo unilateral ACLR, patients who undergo bilateral ACLR are equally as psychologically ready to RTS, showing equal rates of RTS, time to return, and level of return. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Michael Buldo-Licciardi
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Nicole D. Rynecki
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Naina Rao
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Samuel R. Montgomery
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Zachary I. Li
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Michael Moore
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Michael J. Alaia
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Eric J. Strauss
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Laith M. Jazrawi
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Kirk A. Campbell
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
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Sengoku T, Nakase J, Yoshimizu R, Kimura M, Kanayama T, Sakurai G, Yoshida S, Kitagawa T, Kitaoka K, Tsuchiya H. Preoperative psychological competitive ability has little relationship with subjective knee function and return to sports at 6 months postoperatively in patients with anterior cruciate ligament reconstruction. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:9-14. [PMID: 38025405 PMCID: PMC10656217 DOI: 10.1016/j.asmart.2023.10.001] [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: 08/08/2022] [Revised: 09/07/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This prospective study aimed to investigate the relationship between preoperative psychological competitive ability and preoperative and 6 months postoperative subjective knee function in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods Eighty-four patients who underwent ACL reconstruction and had a Tegner Activity Scale score of 6 or more were included in this study. Preoperatively, all patients were administered the Diagnostic Inventory of Psychological Competitive Ability for Athletes (DIPCA.3) for psychological competitive ability assessment and the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form for subjective knee function assessment. The IKDC subjective score was re-evaluated 6 months postoperatively. We evaluated the associations of volition for competition, mental stability and concentration, confidence, strategic ability, and cooperation (DIPCA.3 factors) with the IKDC subjective score preoperatively and 6 months postoperatively. Furthermore, patients were classified into two groups according to whether they could return to participate in the entire practice and compared the DIPCA.3 total score and IKDC subjective score. Results The DIPCA.3 confidence score negatively correlated with the preoperative IKDC subjective score (β = -0.34, p = 0.04). However, there was no association between the DIPCA.3 score for all variables and IKDC subjective score at 6 months after ACL reconstruction. Moreover, the DIPCA.3 total score was not related to return to participate in the entire practice 6 months after ACL reconstruction. Conclusion Psychological competitive ability is not associated with a return to participate in the entire practice, and a low preoperative IKDC subjective score should not be viewed too negatively.
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Affiliation(s)
- Takuya Sengoku
- Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Mitsuhiro Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Tomoyuki Kanayama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Goro Sakurai
- Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Shinya Yoshida
- Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Takashi Kitagawa
- Department of Physical Therapy, School of Health Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Katsuhiko Kitaoka
- Department of Orthopaedic Surgery, Kijima Hospital, Matsuteramachi, Kanazawa, Ishikawa, 920-0011, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
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García-Rodríguez P, Pecci J, Vázquez-González S, Pareja-Galeano H. Acute and Chronic Effects of Blood Flow Restriction Training in Physically Active Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2023:19417381231208636. [PMID: 37946502 DOI: 10.1177/19417381231208636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
CONTEXT Muscle atrophy and loss of knee function are common findings after anterior cruciate ligament (ACL) reconstruction. Rehabilitation through blood flow restriction (BFR) has gained clinical relevance when combined with low loads to improve these disorders in recent years. OBJECTIVE To evaluate the rehabilitation effectiveness of ACL reconstruction with the use of BFR on pain, functionality, strength, and muscle mass in physically active people. DATA SOURCES A search of PubMed, Web of Science, and MEDLINE was performed on March 31, 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. STUDY SELECTION Randomized clinical trials with active adults who underwent ACL surgery were included. They had to compare conventional treatments with the use of BFR, reporting values of pain, functionality, strength, or cross-sectional area (CSA). Articles whose participants presented concomitant injuries and whose intervention combined the use of BFR with treatments other than resistance training were excluded. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION Study design, population, cuff pressure, and main outcomes including strength, quadriceps CSA, pain, and functionality. RESULTS Six studies out of a total of 389 were included (152 participants; 90 men and 62 women). These included studies showed no differences on CSA or strength when comparing BFR training with high loads exercise. BFR has demonstrated improvements in knee functionality and pain compared with other interventions such as immobilization or high loads training. CONCLUSION The use of low loads combined with BFR improves pain, strength, functionality, and CSA. In addition, knee pain reduction and functionality are greater with BFR compared with the use of high loads or immobilization.
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Affiliation(s)
- Pere García-Rodríguez
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Madrid, Spain
| | - Javier Pecci
- Department of Physical Education and Sport, University of Seville, Seville, Spain
| | - Sergio Vázquez-González
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Madrid, Spain
- Rehabilitación Premium Madrid Clinic, Madrid, Spain
| | - Helios Pareja-Galeano
- Department of Physical Education, Sport and Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
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Zarro M, Dickman M, Hulett T, Rowland R, Larkins D, Taylor J, Nelson C. Hop to It! The Relationship Between Hop Tests and The Anterior Cruciate Ligament - Return to Sport Index After Anterior Cruciate Ligament Reconstruction in NCAA Division 1 Collegiate Athletes. Int J Sports Phys Ther 2023; 18:1076-1084. [PMID: 37795334 PMCID: PMC10547069 DOI: 10.26603/001c.86130] [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: 02/08/2023] [Accepted: 08/05/2023] [Indexed: 10/06/2023] Open
Abstract
Background Outcomes after anterior cruciate ligament reconstruction (ACLR) may not be optimal, with poor physical and psychological function potentially affecting return to sport (RTS) ability. Understanding the relationship between commonly used hop tests and the Anterior Cruciate Ligament - Return to Sport Index (ACL-RSI) may improve rehabilitation strategies and optimize patient outcomes. Hypothesis/Purpose The purpose of this study was to examine the relationship between ACL-RSI scores and limb symmetry index (LSI) for the single hop for distance (SHD), triple hop for distance (THD), crossover hop for distance (CHD), timed 6-meter hop (T6H), and single leg vertical hop (SLVH) in a cohort of National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes after ACLR. The hypothesis was that SLVH LSI would be more highly correlated with ACL-RSI score than all horizontal hop tests. Study design Cross-Sectional Study. Methods Twenty-one National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes (7 males, 14 females) at 6.62 ± 1.69 months after ACLR were included in this retrospective study. Primary outcomes were ACL-RSI score and LSI for SHD, THD, CHD, T6H, and SLVH. The relationship between ACL-RSI scores and performance on hop tests (LSIs) was evaluated using correlation analysis and step-wise linear regression (p ≤ 0.05). Results There were significant correlations found when comparing ACL-RSI and the LSI for SHD (rs = 0.704, p < 0.001), THD (rs = 0.617, p = 0.003), CHD (rs = 0.580, p = 0.006), and SLVH (rs = 0.582, p = 0.006). The CHD explained 66% (R2 value of 0.660) of the variance in the ACL-RSI, while the other hop tests did not add to the predictive model. Conclusions Physical function has the capacity to influence psychological status after ACLR. Clinicians should recognize that SLVH, SHD, THD, and CHD are correlated with ACL-RSI and improvements in physical function during rehabilitation may improve psychological status and optimize RTS after ACLR. Level of evidence Level 3.
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Affiliation(s)
- Michael Zarro
- Physical Therapy and Rehabilitation Science University of Maryland, Baltimore
- Orthopaedics University of Maryland, Baltimore
| | - Madelyn Dickman
- Physical Therapy and Rehabilitation Science University of Maryland, Baltimore
| | - Timothy Hulett
- Physical Therapy and Rehabilitation Science University of Maryland, Baltimore
| | - Robert Rowland
- Physical Therapy and Rehabilitation Science University of Maryland, Baltimore
- Orthopaedics University of Maryland, Baltimore
| | - Derrick Larkins
- Physical Therapy and Rehabilitation Science University of Maryland, Baltimore
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28
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Suzuki M, Ishida T, Matsumoto H, Kaneko S, Inoue C, Aoki Y, Tohyama H, Samukawa M. Association of Psychological Readiness to Return to Sports With Subjective Level of Return at 12 Months After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231195030. [PMID: 37693806 PMCID: PMC10492488 DOI: 10.1177/23259671231195030] [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: 03/30/2023] [Accepted: 05/03/2023] [Indexed: 09/12/2023] Open
Abstract
Background Return-to-sports (RTS) rates after anterior cruciate ligament (ACL) reconstruction (ACLR) differ according to the level at which patients return. It is unclear whether the level of RTS is affected by psychological readiness to return. Purpose To examine the association between psychological readiness to RTS and subjective RTS level 12 months after ACLR. Study Design Case-control study; Level of evidence, 3. Methods A total of 47 patients who underwent unilateral primary ACLR surgery were enrolled. Assessments at 6 and 12 months postoperatively consisted of knee strength testing (isokinetic quadriceps and hamstring strength), the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale to measure psychological readiness to RTS. Patients were assigned to 1 of 3 subgroups based on their subjective assessment of RTS level at 12 months postoperatively: RTS at or above preinjury level (RTS≥Pre; n = 19), RTS below preinjury level (RTS Results Significant differences were found among the RTS≥Pre, RTS Conclusion The ACL-RSI score was significantly different among the study groups, and the ACL-RSI score at 12 months postoperatively and younger age were associated with RTS at or above preinjury level.
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Affiliation(s)
- Makoto Suzuki
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Hisashi Matsumoto
- Department of Rehabilitation, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Satoru Kaneko
- Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Chiharu Inoue
- Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Yoshimitsu Aoki
- Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | | | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Hysing-Dahl T, Magnussen LH, Faleide AGH, Inderhaug E. Feasibility of return to sports assessment 6 months after patellar instability surgery. BMC Musculoskelet Disord 2023; 24:662. [PMID: 37596551 PMCID: PMC10439663 DOI: 10.1186/s12891-023-06767-2] [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: 03/20/2023] [Accepted: 07/29/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND The evidence regarding the usefulness of assessment tools to support decisions of return-to-sport after surgery for patellar instability is scarce. The purpose of this study was therefore to explore the feasibility of functional tests assessing readiness for return-to-sport six months after patellar stabilizing surgery. However, there is little evidence on what a functional assessment should include to support these decisions following surgery for patellar instability. Therefore the purpose of this study was to explore the feasibility of functional tests assessing readiness for return-to-sport six months after patellar stabilizing surgery. METHODS In this cross-sectional study a prospective cohort of 78 patients were subjected to a range of return-to-sport readiness tests at six months after surgery for patellar instability with an "a la carte" approach. Lower Quarter Y-Balance Test (YBT-LQ), single-legged hop tests and isokinetic strength tests were performed. In addition, self-reported function was measured with the Banff Patellofemoral Instability Instrument 2.0 (BPII) and Norwich Patellar Instability score (NPI). Return-to-sport clearance criteria were defined as: ≤4 cm YBT-LQ anterior reach difference between legs, leg-symmetry-index (LSI) ≥ 95% in the YBT-LQ composite score, mean sum score LSI ≥ 85% of all single-leg hop tests and LSI ≥ 90% in isokinetic quadriceps strength. RESULTS Sixty-four patients (82%) were able to complete all functional tests, while only eleven (14%) patients were deemed ready for return-to-sport, passing all return-to-sport clearance criteria. Patients with bilateral problems demonstrated worse performance in the contralateral leg, which resulted in higher LSI scores compared to individuals with unilateral instability. A supplementary finding was that the extent of surgery (MPFL-R only versus combined surgery) did not predict and mainly did not affect self-reported function or functional performance at the follow-up. CONCLUSION The functional assessment used in the current study seems feasible to conduct at six months after patellar stabilizing surgery. However, current suggested clearance standards and the use of leg-symmetry-index seems inappropriate for patients with patellar instability. Therefore, further exploration of appropriate tests and return-to-sport clearance criteria is justified. TRIAL REGISTRATION clinicaltrial.gov, NCT05119088. Registered 12.11.2021 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05119088 .
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Affiliation(s)
- Trine Hysing-Dahl
- Haraldsplass Deaconess Hospital, V/Avdeling for Rehabiliteringstjenester Postboks 6165, Bergen, 5892, Norway.
- University of Bergen, Bergen, Norway.
| | - L H Magnussen
- Western Norway University of Applied Science, Haugesund, Norway
| | - A G H Faleide
- Haraldsplass Deaconess Hospital, V/Avdeling for Rehabiliteringstjenester Postboks 6165, Bergen, 5892, Norway
| | - E Inderhaug
- Haukeland University Hospital, Bergen, Norway
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Xiao M, van Niekerk M, Trivedi NN, Hwang CE, Sherman SL, Safran MR, Abrams GD. Patients Who Return to Sport After Primary Anterior Cruciate Ligament Reconstruction Have Significantly Higher Psychological Readiness: A Systematic Review and Meta-analysis of 3744 Patients. Am J Sports Med 2023; 51:2774-2783. [PMID: 35722814 DOI: 10.1177/03635465221102420] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although objective outcomes assessing knee function are essential measurements for return to sport, psychological factors have become increasingly recognized as equally important parameters for determining an athlete's ability to return to sport after surgery. PURPOSE To systematically review the literature to determine whether patients who returned to sport after anterior cruciate ligament (ACL) reconstruction had improved psychological scores (as measured with validated questionnaires) compared with patients who did not return to sport. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 3. METHODS A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was preregistered on PROSPERO. Four databases were searched for level 1 to 3 studies that compared at least 1 psychological outcome measured by a validated questionnaire for patients who did and did not return to sport after primary ACL reconstruction. The following data were recorded: study and patient characteristics; psychological metrics (ACL-Return to Sport Injury [ACL-RSI] scale, Knee Self-Efficacy Scale [K-SES], and Tampa Scale of Kinesiophobia [TSK/TSK-11]); International Knee Documentation Committee (IKDC) score; and clinical metrics. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS), and the mean difference (MD) and 95% CI were calculated for each psychological outcome score using the inverse variance method. RESULTS We included and analyzed 16 articles (3744 patients; 38.9% female; mean age range, 17-28.7 years; mean MINORS score, 19.9 ± 1.4). Overall, 61.8% of athletes returned to sport (66.8% of male patients; 55.4% of female patients). Patients who returned scored significantly higher on the ACL-RSI scale (MD, 20.8; 95% CI, 15.9 to 25.7; P < .001), significantly higher on the K-SES (MD, 1.3; 95% CI, 0.2 to 2.3; P = .036), and significantly lower on the TSK/TSK-11 (MD, 10.1%; 95% CI, -12.1% to -8.2%; P = .004). Those returning to sport did not exceed the minimal clinically important difference for IKDC score versus those not returning to sport. CONCLUSION Patients who returned to sport after primary ACL reconstruction had significantly higher psychological readiness, higher self-efficacy, and lower kinesiophobia compared with those who did not return to sport, despite having clinically similar knee function scores. Evaluation of psychological readiness, in combination with other objective measurements, is a critical component of return-to-sport evaluation in athletes after primary ACL reconstruction. REGISTRATION CRD42021284735 (PROSPERO).
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Affiliation(s)
- Michelle Xiao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Maike van Niekerk
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Nikunj N Trivedi
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Calvin E Hwang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
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Henning M, Henning R, Dummett J. Improving the quality of rehabilitation following anterior cruciate ligament reconstruction surgery, in an outpatient physiotherapy department. BMJ Open Qual 2023; 12:e002300. [PMID: 37524514 PMCID: PMC10391794 DOI: 10.1136/bmjoq-2023-002300] [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: 02/01/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) is a type of orthopaedic knee surgery and physiotherapy rehabilitation is undertaken for several months postoperatively, often with the aim of returning the patient to sport. Variations in postoperative protocols to guide rehabilitation exist between National Health Service (NHS) Trusts. Although there is no single guideline to guide clinicians, strong evidence does support several clinical measures to be included post-ACLR, to improve outcomes and reduce the need for revision surgery. This project aimed to align our NHS Trust's ACLR physiotherapy care with best-evidence.A literature review was completed to establish key quality standards for ACLR rehabilitation. A retrospective notes audit was then undertaken to quantify the baseline quality of care, measured against these standards. Quality improvement methods were used to improve the quality of care and postoperative rehabilitation processes for ACLR patients. A new evidence-based, postoperative rehabilitation protocol was created, a core group of clinicians was formed to see ACLR patients and a rehabilitation class, solely for ACLR patients was also implemented.The key process measure for the project was patients engaging in 'criteria-driven progressions of rehabilitation'. This 'criteria-driven progressions' rate increased from 0% at baseline to 100% during the project period. Overall, non-attendance rates maintained at a similar level from 5.4% at baseline to a final rate of 4.8%. There was also an increase in mean 'return to sport' times, from 6 to 9.9 months, which is in line with best-evidence recommendations.The previous rehabilitation provided in our trust was not aligned with current evidence. This quality improvement project has led to improvements in patient care and lessons from the project will allow other trusts to learn from the changes made, to improve their own care pathways.
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Affiliation(s)
- Michael Henning
- Orthopaedic Interface, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Rose Henning
- Physiotherapy Outpatients, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Joe Dummett
- Physiotherapy Outpatients, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
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Hysing-Dahl T, Inderhaug E, Faleide AGH, Magnussen LH. Patients' experiences of living with patellar instability before and after surgery: a qualitative interview study. BMJ Open 2023; 13:e072141. [PMID: 37295823 PMCID: PMC10277117 DOI: 10.1136/bmjopen-2023-072141] [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: 01/25/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES To explore the experience of living with patellar instability before and after surgery. DESIGN Qualitative individual semistructured interviews of patients with patellar instability using a four-step thematic cross-case analysis strategy (systematic text condensation). SETTING Two orthopaedic units within two large Hospitals in Norway. PARTICIPANTS A convenience sample of 15 participants, aged between 16 and 32 years, who had undergone surgery for patellar instability within the last 6-12 months. RESULTS Participants offered rich and detailed descriptions of the impact and lived experience of patellar instability, including fear of new dislocations, increased awareness of the knee and adaptations to avoidance behaviour in everyday life both before and after surgery. The four major themes that emerged from the data were: (1) fear of patella dislocations governs everyday life activities, (2) adaptation to avoidance behaviour, (3) feeling different, misunderstood and stigmatised affects self-esteem and (4) feeling stronger, but still not fully confident in the knee after surgery. CONCLUSIONS These findings offer insight into the experience of living with patellar instability. Patients reported that the instability had major impacts on their everyday life, affecting ability to participate in social life and physical activities both before and after surgery. This may imply that an increased attention towards cognitive interventions may be useful in the management of patellar instability. TRIAL REGISTRATION NUMBER NCT05119088.
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Affiliation(s)
- Trine Hysing-Dahl
- Department of Surgery, Haraldsplass Deaconess Hospital, Bergen, Norway
- University of Bergen, Bergen, Norway
| | - Eivind Inderhaug
- University of Bergen, Bergen, Norway
- Haukeland Universitetssjukehus, Bergen, Norway
| | - Anne Gro Heyn Faleide
- Department of Surgery, Haraldsplass Deaconess Hospital, Bergen, Norway
- University of Bergen, Bergen, Norway
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Tian B, Zhang M, Kang X. Strategies to promote tendon-bone healing after anterior cruciate ligament reconstruction: Present and future. Front Bioeng Biotechnol 2023; 11:1104214. [PMID: 36994361 PMCID: PMC10040767 DOI: 10.3389/fbioe.2023.1104214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
At present, anterior cruciate ligament (ACL) reconstruction still has a high failure rate. Tendon graft and bone tunnel surface angiogenesis and bony ingrowth are the main physiological processes of tendon-bone healing, and also the main reasons for the postoperative efficacy of ACL reconstruction. Poor tendon-bone healing has been also identified as one of the main causes of unsatisfactory treatment outcomes. The physiological process of tendon-bone healing is complicated because the tendon-bone junction requires the organic fusion of the tendon graft with the bone tissue. The failure of the operation is often caused by tendon dislocation or scar healing. Therefore, it is important to study the possible risk factors for tendon-bone healing and strategies to promote it. This review comprehensively analyzed the risk factors contributing to tendon-bone healing failure after ACL reconstruction. Additionally, we discuss the current strategies used to promote tendon-bone healing following ACL reconstruction.
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Arias R, Monaco J, Schoenfeld BJ. Return to Sport After an Anterior Cruciate Ligament Tear: Bridging the Gap Between Research and Practice. Strength Cond J 2023. [DOI: 10.1519/ssc.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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Ogunleye P, Jäger H, Zimmermann F, Balcarek P, Sobau C, Ellermann A, Zimmerer A. Patients older than 55 years regain sporting and recreational activities after arthroscopic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:632-640. [PMID: 35988115 DOI: 10.1007/s00167-022-07116-x] [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: 02/20/2022] [Accepted: 08/05/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE (1) To compare sporting and recreational activity levels before and at a minimum 6 year follow-up, and (2) to assess the clinical and functional outcomes after anterior cruciate ligament (ACL) reconstruction in patients older than 55 years. METHODS A retrospective evaluation of prospectively collected data of 150 patients with a mean age of 64 ± 4.5 (57-74) years was evaluated 8.6 ± 1.4 (6-11) years after primary ACL reconstruction using hamstring autograft. All patients were assessed using the International Knee Documentation Committee scoring system (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity level, and visual analog scale (VAS) for pain. The level of recreational activities was assessed using a sport-specific questionnaire. All patients were categorized according to Isolated and Combined ACL injury groups. RESULTS The data of 125 patients were analyzed at the last follow-up. While 25 patients were lost to follow-up, 117 of 125 patients were active before their injury in at least one sports discipline compared to 121 of 125 patients after ACL reconstruction. One hundred and two (82%) patients had returned to their recreational activities at the final follow-up. The mean IKDC subjective score increased from 49.5 ± 23.2 (11.5-100) to 76.2 ± 14.8 (33.3-100) (p < 0.0001). The mean KOOS sport increased significantly from 36 ± 36.2 (0-100) to 74.1 ± 25.5 (0-100) (p < 0.0001). The mean VAS score improved from 6.0 ± 2.6 (0-10) to 1.0 ± 1.4 (0-6) (p < 0.0001). There was no significant difference in the median Tegner activity level (preoperative 5 (2-8) vs. follow-up 5 (2-8) (n.s). There was no significant difference in the number of sports disciplines and duration when comparing pre-injury and mid-term follow-up activity after ACL reconstruction. High-impact activities experienced a significant decline, while a significant increase in participation in low-impact activities was recorded. CONCLUSION The majority of patients with symptomatic instability regained their pre-injury recreational activity level with excellent clinical and functional outcomes after arthroscopic ACL reconstruction. Nevertheless, a change from high-to low-impact activities has been observed. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Hannah Jäger
- ARCUS Kliniken, Rastatterstr 17-19, 75179, Pforzheim, Germany
| | | | - Peter Balcarek
- ARCUS Kliniken, Rastatterstr 17-19, 75179, Pforzheim, Germany
| | - Christian Sobau
- ARCUS Kliniken, Rastatterstr 17-19, 75179, Pforzheim, Germany
| | | | - Alexander Zimmerer
- ARCUS Kliniken, Rastatterstr 17-19, 75179, Pforzheim, Germany.
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine, Greifswald, Germany.
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West TJ, Bruder AM, Crossley KM, Culvenor AG. Unilateral tests of lower-limb function as prognostic indicators of future knee-related outcomes following anterior cruciate ligament injury: a systematic review and meta-analysis of 13 150 adolescents and adults. Br J Sports Med 2023:bjsports-2022-105736. [PMID: 36669871 DOI: 10.1136/bjsports-2022-105736] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the prognostic capacity of individual hop tests, hop test batteries and other unilateral functional performance tests following anterior cruciate ligament (ACL) injury. DESIGN Systematic review with meta-analysis. DATA SOURCES Six databases searched up to June 2021. ELIGIBILITY CRITERIA Studies reporting associations between unilateral lower-limb function (eg, hop tests) following ACL injury and future (≥3 months) knee-related outcomes. RESULTS Of 42 included studies (13 150 participants), all assessed the single-forward hop test and 32 assessed a repeated-forward hop test (crossover hop, triple hop, 6m-timed hop), mostly within a year after ACL injury/reconstruction. Results of meta-analyses indicated that higher single-forward and repeated-forward hop limb symmetry were associated with higher odds of return-to-sport 1-3 years post-ACL reconstruction (OR 2.15; 95% CI 1.30 to 3.54; OR 2.11; 95% CI 1.23 to 3.60, respectively). Higher single-forward and repeated-forward hop limb symmetry was associated with better self-reported symptoms and function 1-37 years after ACL injury (OR 2.51; 95% CI 1.62 to 3.88; OR 4.28; 95% CI 1.65 to 11.08, respectively). Higher limb symmetry on a repeated-forward hop does not appear to be associated with higher odds of successful rehabilitation without ACL reconstruction (OR 1.51; 95% CI 0.94 to 2.44). Achieving ≥90% limb symmetry on the single-forward hop was associated with reduced odds of knee osteoarthritis 5-37 years after ACL injury (OR 0.46; 95% CI 0.23 to 0.94). CONCLUSION Very low certainty evidence suggests single-forward and repeated-forward hop tests are prognostic indicators for important knee-related outcomes in individuals after ACL injury and may help stratify individuals at risk of poor outcomes to target rehabilitation interventions. PROSPERO REGISTRATION NUMBER CRD42018092197.
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Affiliation(s)
- Thomas J West
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Australian IOC Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Andrea M Bruder
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Australian IOC Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.,Australian IOC Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia .,Australian IOC Research Centre, La Trobe University, Bundoora, Victoria, Australia
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Li H. The construction and practice path of safety education mechanism in colleges and universities integrating the psychological characteristics of students in the new era. Front Psychol 2023; 13:1056021. [PMID: 36687817 PMCID: PMC9853448 DOI: 10.3389/fpsyg.2022.1056021] [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: 09/28/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
Background With the rapid development of higher education in China, the scale of colleges and universities is expanding, and the phenomenon of campus socialization is becoming more and more obvious. In particular, the campus and its surrounding environment are becoming more and more complex, which brings many hidden dangers in university life. Objective In order to improve the effectiveness of safety education in colleges and universities and maintain the long-term effectiveness of college students' safety awareness, the paper proposes the construction and practice path of college safety education mechanism that integrates the psychological characteristics of students in the new era. Methods Security issues facing universities at home, this track identifies the relationship between campus security incidents and security education and advocacy. Eight solutions to prevent and reduce incidents in schools. The paper proposes to give importance to the study of the security of college students, to create an awareness of security questions in the bank based on the recommendation algorithm, and to create to have online learning and testing for safety awareness. Results The passing rate of 10 majors such as humanities, composition and theory of composition technology was 100%, accounting for 12% of the 83 enrolled majors, and the passing rate of 54 majors such as clinical medicine was over 90%. Conclusion The safety online learning and testing system of college students' safety education is lively in form and highly accepted by students. The development of college students' safety education starts from the time of receiving the university admission notice, making full use of the "golden time," so as to effectively prevent and reduce the occurrence of campus safety accidents.
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Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus. J ISAKOS 2022; 7:150-161. [PMID: 35998884 DOI: 10.1016/j.jisako.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer-one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. METHODS 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. RESULTS Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. CONCLUSIONS The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer.
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Gauthier M, Lê TN, Wehn A, Joseph S, Tscholl PM. Subjective knee apprehension is not associated to physical parameters 6–12 months after anterior cruciate ligament reconstruction. J Exp Orthop 2022; 9:110. [DOI: 10.1186/s40634-022-00545-0] [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: 07/21/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Purpose
Anterior cruciate ligament (ACL) rupture is a common injury and psychological parameters measured at 6–8 months are said to be almost more predictive for return to sport (RTS) than physiological. Purpose was 1) to evaluate the correlation between knee apprehension using ACL-RSI and physical factors after ACL reconstruction (ACLR), 2) to assess the correlation between ACL-RSI and patient parameters (age, pivot-sport, BMI), and 3) to evaluate ACL-RSI over time.
Methods
Patients with ACLR with or without meniscal repair between 2013 and 2020 were retrospectively analyzed. Including criteria were RTS testing battery, assessed at least 6 months after surgery, including physical parameters (strength, triple hop test, side hop test, and bilateral knee stability) and psychological parameters (ACL-RSI). 5 subgroups were analyzed to assessed factors such as age, BMI, pivot sport, time interval between two RTS testing battery.
Results
Three hundred three patients (212 male, 91 female) presenting ACLR were included. Mean age at surgery was 27 (± 8) years. 258 patients practiced pivot-sport activity and 45 non-pivot-sport activity. The mean interval between ACL rupture and surgery was 6.5 (± 4.5) months. RTS testing battery were performed at 8 (± 7) months after ACLR.
Mean ACL-RSI was 58 (± 28). 1) ACL-RSI was not influenced by muscle strength, coordination and stability of the knee. 2) ACL-RSI was significantly better in lower BMI and non-pivot-sport activities. No correlation was found between graft type, age, sex, and ACL-RSI assessment. 3) For patients who performed two RTS testing battery at 8 and 12 months, ACL-RSI did not significantly increase over time (56 to 64 points, p = 0.22) in spite of significant increased quadriceps (127 to 151 Nm/kg, p = 0.005) and hamstring (93 to 105 Nm/kg, p = 0.05) strength.
Conclusions
Psychological readiness before RTS, measured upon ACL-RSI does not correlate with any physical parameter at 8–12 months postoperatively. Although quadriceps and hamstring strength increased significantly over time, ACL-RSI does not and must therefore be routinely assessed.
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Ronden AE, Koc BB, van Rooij L, Schotanus MG, Jansen EJ. Low percentage of patients passed the 'Back in Action' test battery 9 months after bone-patellar tendon-bone anterior cruciate ligament reconstruction. J Clin Orthop Trauma 2022; 34:102025. [PMID: 36147380 PMCID: PMC9486609 DOI: 10.1016/j.jcot.2022.102025] [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: 05/05/2022] [Revised: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction is recommended in patients who intend to return to high-level sports. However, there is only a 55-80% return to pre-injury level of sports after ACL reconstruction, with a re-injury rate up to 20%. The aim of this study was to determine the percentage of patients passing the Back in Action (BIA) test 9 months after primary bone-patellar-tendon-bone (BPTB) ACL reconstruction, and evaluate the association between passing the BIA test and patient reported outcome measurements (PROMs). Methods Patients underwent the BIA test 9 months after BPTB ACL reconstruction. In total 103 patients were included. Passing the BIA test (PASSED-group) was defined as a normal or higher score at all sub-tests with limb symmetry index (LSI) ≥90% for the dominant leg and LSI >80% for the non-dominant leg. Patients who did not meet these criteria were defined as the FAILED-group. PROMs included the International Knee Documentation Committee, Knee injury Osteoarthritis Outcome Score and Anterior Cruciate Ligament-Return to Sport after Injury. Results Eighteen patients (17.5%) passed the BIA test 9 months after BPTB ACL reconstruction. PROMs were not statistically significant different between the PASSED- and FAILED-group. Conclusion Low percentage of patients passed the BIA test 9 months after BPTB ACL reconstruction. Although current PROMs cut-off values were met, the BIA test results show persistent functional deficits. Therefore, the BIA test could be of additional value in the decision-making process regarding return to sport (RTS). This study highlights the need for additional rehabilitation as RTS in a condition of incomplete recovery may increase the risk of re-injury. Level of evidence II.
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Affiliation(s)
- Annick E. Ronden
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Baris B. Koc
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Lize van Rooij
- Maastricht University, Faculty of Health Medicine & Life Sciences, Maastricht, the Netherlands
| | - Martijn G.M. Schotanus
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Edwin J.P. Jansen
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
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Rossi LA, Pasqualini I, Brandariz R, Fuentes N, Fieiras C, Tanoira I, Ranalletta M. Relationship of the SIRSI Score to Return to Sports After Surgical Stabilization of Glenohumeral Instability. Am J Sports Med 2022; 50:3318-3325. [PMID: 36018821 DOI: 10.1177/03635465221118369] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Literature is scarce regarding the influence of psychological readiness on return to sports after shoulder instability surgery. PURPOSE To evaluate the predictive ability of the Shoulder Instability-Return to Sport after Injury (SIRSI) score in measuring the effect of psychological readiness on return to sports and to compare it between athletes who returned to sports and athletes who did not return to sports. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A prospective analysis was performed of patients who underwent an arthroscopic Bankart repair or a Latarjet procedure between January 2019 and September 2020. Psychological readiness to return to play was evaluated using the SIRSI instrument. Preoperative and postoperative functional outcomes were measured by the Rowe, Athletic Shoulder Outcome Scoring System, and Western Ontario Shoulder Instability Index scores. The predictive validity of the SIRSI was assessed by the use of receiver operating characteristic (ROC) curve statistics. The Youden index was calculated and used to determine a SIRSI score cutoff point that best discriminated psychological readiness to return to sports. A logistic regression analysis was performed to evaluate the effect of psychological readiness on return to sports and return to preinjury sports level. RESULTS A total of 104 patients were included in this study. Overall, 79% returned to sports. The SIRSI had excellent predictive ability for return-to-sport outcomes (return to sports: area under ROC curve, 0.87 [95% CI, 0.80-0.93]; return to preinjury sports level: area under ROC curve, 0.96; [95% CI, 0.8-0.9]). A cutoff level of ≥55 was used to determine whether an athlete was psychologically ready to return to sports and to return to preinjury sports level (Youden index, 0.7 and 0.9, respectively). Of those who returned to sports, 76.8% were psychologically ready to return to play, with a median SIRSI score of 65 (interquartile range, 57-80). In comparison, in the group that did not return to sports, only 4.5% achieved psychological readiness with a median SIRSI score of 38.5 (interquartile range, 35-41) (P < .001). Regression analysis for the effect of SIRSI score on return to sports was performed. For every 10-point increase in the SIRSI score, the odds of returning to sports increased by 2.9 times. Moreover, those who did not achieve their preinjury sports level showed poorer psychological readiness to return to play and SIRSI score results. CONCLUSION The SIRSI was a useful tool for predicting whether patients were psychologically ready to return to sports after glenohumeral stabilization surgery. Patients who returned to sports and those who returned to their preinjury sports level were significantly more psychologically ready than those who did not return. Therefore, we believe that the SIRSI score should be considered along with other criteria that are used to decide whether the patient is ready to return to sports.
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Affiliation(s)
| | | | | | - Nora Fuentes
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Webster KE, Feller JA. Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction in the Adolescent Athlete. J Athl Train 2022; 57:955-960. [PMID: 36638341 PMCID: PMC9842114 DOI: 10.4085/1062-6050-0543.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT Psychological readiness to return to sport has been shown to be associated with future play after anterior cruciate ligament (ACL) reconstruction surgery but has not been extensively studied in adolescent athletes. OBJECTIVE To investigate the psychometric properties of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale in adolescent athletes at multiple time points after ACL reconstruction surgery and determine whether psychological readiness scores at 6 months predict return to competition sport at 12 months. DESIGN Case series. SETTING Private orthopaedic clinic. PATIENTS OR OTHER PARTICIPANTS A total of 115 adolescent athletes (65 girls, 50 boys) 17 years and younger who had undergone primary unilateral ACL reconstruction. MAIN OUTCOME MEASURE(S) The ACL-RSI scale was administered at 6 and 12 months after surgery, and return-to-sport status was also documented. Factor analysis was undertaken and predictive validity assessed using between-groups comparisons and receiver operating characteristic (ROC) curve statistics. RESULTS The ACL-RSI scores increased between 6 and 12 months (55 to 71; P < .001, effect size = 0.98). No floor or ceiling effects were present, and the scale had high internal consistency (Cronbach α at 6 months = 0.91 and at 12 months = 0.94). Principal component analysis showed that 2 factors were present: the first represented performance confidence and risk appraisal and the second, emotions. For the full-scale ACL-RSI, scores at 6 months had acceptable predictive ability for a return to play at 12 months (area under the ROC curve = 0.7, P = .03). When the 2 identified factors were analyzed separately, the emotions factor also had acceptable predictive ability (area under the ROC curve = 0.73, P = .009), but the confidence in performance and risk appraisal factors had poor predictive ability (area under the ROC curve = 0.59, P = .09). CONCLUSIONS Greater psychological readiness was associated with return to sport in adolescent athletes after ACL reconstruction, with the athletes' emotional response appearing to be more influential than their confidence in their performance or their appraisal of risk.
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Affiliation(s)
- Kate E. Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Betsch M, Darwich A, Chang J, Whelan D, Ogilvie-Harris D, Chahal J, Theodoropoulos J. Wide Variability in Return-to-Sport Criteria used by Team Physicians After Anterior Cruciate Ligament Reconstruction in Elite Athletes—A Qualitative Study. Arthrosc Sports Med Rehabil 2022; 4:e1759-e1766. [DOI: 10.1016/j.asmr.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
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Aizawa J, Hirohata K, Ohji S, Ohmi T, Mitomo S, Koga H, Yagishita K. Cross-sectional study on relationships between physical function and psychological readiness to return to sport after anterior cruciate ligament reconstruction. BMC Sports Sci Med Rehabil 2022; 14:97. [PMID: 35650622 PMCID: PMC9161472 DOI: 10.1186/s13102-022-00491-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Information about specific factors of physical function that contribute to psychological readiness is needed to plan rehabilitation for a return to sports. The purpose of this study was to identify specific physical functions related to the psychological readiness of patients aiming to return to sports 6 months after reconstruction. We hypothesized that the knee strength is a factor related to the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI) cutoff score for a return to sports. METHODS This was a cross-sectional study. Fifty-four patients who had undergone primary reconstruction using hamstring tendon participated in this study. Psychological readiness was measured using the ACL-RSI in patients at 6 months after reconstruction. To identify specific physical functions related to the ACL-RSI score, participants were divided into groups with ACL-RSI scores of ≥ 60 or < 60. Non-paired t-tests or the Mann-Whitney test were performed to analyze group differences in objective variables in physical function: (1) knee strength in both legs; (2) leg anterior reach distance on both sides; and (3) single-leg hop (SLH) distances in three directions for both legs. RESULTS Significant differences between groups were identified in knee flexion strength (60°/s) for the uninvolved limb, hamstring-to-quadriceps ratio (60°/s) for the uninvolved limb, knee flexion strength (180°/s) for the involved limb, limb symmetry index (LSI) of leg anterior reach distance, the ratio of the distance to the height of the patient and LSI of SLH distances in lateral and medial directions. CONCLUSION This study revealed that at 6 months after reconstruction, increased knee flexion strength (ratio of peak torque measured to body mass of the patient), hamstring-to-quadriceps ratio, leg anterior reach distance LSI, and lateral and medial SLH appear important to exceed the ACL-RSI cutoff for a return to sports. The present results may be useful for planning post-operative rehabilitation for long-term return to sports after reconstruction.
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Affiliation(s)
- Junya Aizawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, 3-2-12 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Rehabilitation Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kenji Hirohata
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Mitomo
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
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Malahias MA, Capece FM, Ballarati C, Viganò M, Marano M, Hofbauer M, Togninalli D, de Girolamo L, Denti M. Sufficient MRI graft structural integrity at 9 months after anterior cruciate ligament reconstruction with hamstring tendon autograft. Knee Surg Sports Traumatol Arthrosc 2022; 30:1893-1900. [PMID: 35039919 DOI: 10.1007/s00167-021-06830-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/02/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the MRI-measured structural integrity of hamstring autograft at 9 months after anterior cruciate ligament reconstruction (ACLR) surgery. METHODS A prospective cohort study was conducted including 34 patients (mean age 36.8 ± 11.8 years; 73.5% males) who underwent ACLR with hamstring autograft. In addition, 36 patients (mean age 39.2 ± 10.5 years; 69.4% males) without any ACL injury were also reviewed and served as control group. The primary outcome used for examining graft maturity at 9 months after ACLR was the MRI-based signal-to-noise quotient (SNQ) of reconstructed ACL. SNQ values were stratified into 3 different categories: excellent: < 0.1; good: ≥ 0.1 and ≤ 0.19; fair: ≥ 0.2. The KT-1000 knee arthrometer was used to measure the side-to-side difference in the anterior tibial translation between the ACLR knee and the contralateral healthy knee in the ACLR group. RESULTS Reconstructed ACLs were found with a mean SNQ of 0.078 ± 0.061, while almost all ACL-reconstructed patients (97%; 33 out of 34) were found with excellent or good SNQ values (< 0.019). The mean KT-1000 in the ACLR group was 0.071 mm ± 0.926 mm, while there were no patients in the ACLR cohort with a KT-1000 value > 3 mm. The mean 9-months MRI-based SNQ of ACLR group was significantly higher compared to the mean MRI-based SNQ of the control group (p < 0.001). Multiple regression analysis showed no correlation between SNQ and age, gender, time from injury to ACLR, graft size, or simultaneous treatment of additional intra-articular knee lesions. CONCLUSIONS In this cohort of 34 ACL-reconstructed patients, 97% of hamstring tendon autografts demonstrated excellent/good MRI signal intensity and excellent functional results (KT-1000 < 3 mm) at 9 months after surgery. Based on this finding, it is suggested that return to sports after ACLR with hamstring autograft can be considered safe at 9 months post surgery. Furthermore, while structural integrity of the graft has been achieved at this time point, statistical differences found in SNQ values of ACL-reconstructed patients compared to ACLs of healthy individuals highlight the continuing process of graft maturation and remodelling. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Michael-Alexander Malahias
- Department of Orthopaedics and Traumatology, Clinical Ars Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - Francesco Maria Capece
- Department of Orthopaedics and Traumatology, Clinical Ars Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland. .,University of Rome 'Tor Vergata', Rome, Italy.
| | - Claudio Ballarati
- Department of Radiology, Clinical Ars Medica, Gravesano, Ticino, Switzerland
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Marco Marano
- Department of Orthopaedics and Traumatology, Clinical Ars Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | | | - Danilo Togninalli
- Department of Orthopaedics and Traumatology, Clinical Ars Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | | | - Matteo Denti
- Department of Orthopaedics and Traumatology, Clinical Ars Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland.,IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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Marigi EM, Song BM, Wasserburger JN, Camp CL, Levy BA, Stuart MJ, Okoroha KR, Krych AJ. Anterior Cruciate Ligament Reconstruction in 107 Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 6-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221092770. [PMID: 35547615 PMCID: PMC9083060 DOI: 10.1177/23259671221092770] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background Wrestling is a physically demanding sport, with young athletes prone to anterior cruciate ligament (ACL) injuries. There is a paucity of data evaluating the results of ACL reconstruction (ACLR) in this cohort. Purpose To assess return to sport (RTS), patient-reported outcomes, reoperation rates, and graft survival after ACLR in a large cohort of competitive wrestlers at midterm follow-up. Study Design Case series; Level of evidence, 4. Methods We identified all competitive wrestlers (club, high school, collegiate, or professional) with a history of an ACLR at a single institution between 2000 and 2019. Graft failure was defined as a retear (as determined via clinical or advanced imaging evaluation) and/or revision ACLR. All patients were contacted for determination of reinjury rates; current sport status; and pain visual analog scale, International Knee Documentation Committee, and Tegner activity scores. Results Included were 107 knees in 103 wrestlers, with a median follow-up time of 5.9 years (interquartile range [IQR], 3.9-10.3 years). The median age was 17 years (IQR, 15-18 years), with 106 (99%) male patients, and the distribution of bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts was 64 (60%) and 43 (40%), respectively. At final follow-up, 80% of athletes were able to RTP at a median of 280 days (IQR, 212-381 days). Graft failure occurred in 14 (13%) knees at a median time of 1.8 years (IQR, 0.7-5.3 years) after the index ACLR. BTB autograft demonstrated a lower failure rate compared with HT autograft (8% vs 21%; P = .044) and was associated with better survival compared with HT autograft up to 15 years after the index ACLR (90.4% vs 76.3%; P = .030). When compared by graft diameter, HT autografts of at least 7.5 mm were not associated with a lower graft failure than BTB constructs of all sizes (P = .205). Conclusion Return to competitive wrestling was observed in 80% of athletes after ACLR, with 14% of wrestlers experiencing graft failure. BTB autograft was associated with better survival than HT autograft.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryant M. Song
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J. Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelechi R. Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Aaron J. Krych, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA () (Twitter: @DrKrych)
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Li Y, Chen C, Jiang J, Liu S, Zhang Z, Xiao L, Lian R, Sun L, Luo W, Tim‐yun Ong M, Yuk‐wai Lee W, Chen Y, Yuan Y, Zhao J, Liu C, Li Y. Bioactive Film-Guided Soft-Hard Interface Design Technology for Multi-Tissue Integrative Regeneration. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2105945. [PMID: 35322573 PMCID: PMC9130887 DOI: 10.1002/advs.202105945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/14/2022] [Indexed: 06/14/2023]
Abstract
Control over soft-to-hard tissue interfaces is attracting intensive worldwide research efforts. Herein, a bioactive film-guided soft-hard interface design (SHID) for multi-tissue integrative regeneration is shown. Briefly, a soft bioactive film with good elasticity matchable to native ligament tissue, is incorporated with bone-mimic components (calcium phosphate cement, CPC) to partially endow the soft-film with hard-tissue mimicking feature. The hybrid film is elegantly compounded with a clinical artificial ligament to act as a buffer zone to bridge the soft (ligament) and hard tissues (bone). Moreover, the bioactive film-decorated ligament can be rolled into a 3D bio-instructive implant with spatial-controllable distribution of CPC bioactive motifs. CPC then promotes the recruitment and differentiation of endogenous cells in to the implant inside part, which enables a vascularized bone growth into the implant, and forms a structure mimicking the biological ligament-bone interface, thereby significantly improving osteointegration and biomechanical property. Thus, this special design provides an effective SHID-guided implant-bioactivation strategy unreached by the traditional manufacturing methods, enlightening a promising technology to develop an ideal SHID for translational use in the future.
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Affiliation(s)
- Yamin Li
- Shanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai200233China
| | - Can Chen
- Engineering Research Centre for Biomedical Materials of Ministry of EducationThe Key Laboratory for Ultrafine Materials of Ministry of EducationSchool of Material Science and EngineeringFrontiers Science Center for Materiobiology and Dynamic ChemistryEast China University of Science and TechnologyShanghai200237China
| | - Jia Jiang
- Shanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai200233China
| | - Shengyang Liu
- Engineering Research Centre for Biomedical Materials of Ministry of EducationThe Key Laboratory for Ultrafine Materials of Ministry of EducationSchool of Material Science and EngineeringFrontiers Science Center for Materiobiology and Dynamic ChemistryEast China University of Science and TechnologyShanghai200237China
| | - Zeren Zhang
- Engineering Research Centre for Biomedical Materials of Ministry of EducationThe Key Laboratory for Ultrafine Materials of Ministry of EducationSchool of Material Science and EngineeringFrontiers Science Center for Materiobiology and Dynamic ChemistryEast China University of Science and TechnologyShanghai200237China
| | - Lan Xiao
- Centre for Biomedical TechnologiesQueensland University of TechnologyThe Australia‐China Centre for Tissue Engineering and Regenerative Medicine (ACCTERM)60 Musk Avenue, Kelvin GroveBrisbaneQLD4059Australia
| | - Ruixian Lian
- Engineering Research Centre for Biomedical Materials of Ministry of EducationThe Key Laboratory for Ultrafine Materials of Ministry of EducationSchool of Material Science and EngineeringFrontiers Science Center for Materiobiology and Dynamic ChemistryEast China University of Science and TechnologyShanghai200237China
| | - Lili Sun
- Engineering Research Centre for Biomedical Materials of Ministry of EducationThe Key Laboratory for Ultrafine Materials of Ministry of EducationSchool of Material Science and EngineeringFrontiers Science Center for Materiobiology and Dynamic ChemistryEast China University of Science and TechnologyShanghai200237China
| | - Wei Luo
- Engineering Research Centre for Biomedical Materials of Ministry of EducationThe Key Laboratory for Ultrafine Materials of Ministry of EducationSchool of Material Science and EngineeringFrontiers Science Center for Materiobiology and Dynamic ChemistryEast China University of Science and TechnologyShanghai200237China
| | - Michael Tim‐yun Ong
- Department of Orthopaedics and TraumatologyFaculty of MedicinePrince of Wales HospitalThe Chinese University of Hong KongShatinHong KongChina
| | - Wayne Yuk‐wai Lee
- Department of Orthopaedics and TraumatologyLi Ka Shing Institute of Health SciencesFaculty of MedicinePrince of Wales HospitalThe Chinese University of Hong KongShatinHong KongChina
| | - Yunsu Chen
- Shanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai200233China
| | - Yuan Yuan
- Engineering Research Centre for Biomedical Materials of Ministry of EducationThe Key Laboratory for Ultrafine Materials of Ministry of EducationSchool of Material Science and EngineeringFrontiers Science Center for Materiobiology and Dynamic ChemistryEast China University of Science and TechnologyShanghai200237China
| | - Jinzhong Zhao
- Shanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai200233China
| | - Changsheng Liu
- Engineering Research Centre for Biomedical Materials of Ministry of EducationThe Key Laboratory for Ultrafine Materials of Ministry of EducationSchool of Material Science and EngineeringFrontiers Science Center for Materiobiology and Dynamic ChemistryEast China University of Science and TechnologyShanghai200237China
| | - Yulin Li
- Engineering Research Centre for Biomedical Materials of Ministry of EducationThe Key Laboratory for Ultrafine Materials of Ministry of EducationSchool of Material Science and EngineeringFrontiers Science Center for Materiobiology and Dynamic ChemistryEast China University of Science and TechnologyShanghai200237China
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Ebert JR, Edwards P, Joss B, Annear PT. A structured accelerated versus control rehabilitation pathway after anterior cruciate ligament reconstruction using autologous hamstrings demonstrates earlier improvement in physical outcomes without increasing graft laxity: A randomized controlled trial. Phys Ther Sport 2022; 55:271-281. [DOI: 10.1016/j.ptsp.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
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Rossi LA, Pasqualini I, Tanoira I, Ranalletta M. Factors That Influence the Return to Sport After Arthroscopic Bankart Repair for Glenohumeral Instability. Open Access J Sports Med 2022; 13:35-40. [PMID: 35401017 PMCID: PMC8985826 DOI: 10.2147/oajsm.s340699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Numerous studies have reported high rates of return to sports following arthroscopic Bankart repair (ABR) However, there is enormous controversy regarding the optimal management of these patients in the postoperative period. Controversy issues include rehabilitation, criteria for returning to sports, and the specific management of each athlete according to the sport they practice. Even though there are several rehabilitation protocols published in the literature, wide variability exists concerning the key elements of rehabilitation after an ABR. Regarding criteria for return to sports, there is a wide variation across the different published studies. The type of sports has been shown to affect an athlete’s decision to return to sports. Nevertheless, most research is evaluated by classifications that cluster different sports into categories that may have other influences in return to sports when analyzed separately. Finally, in addition to physical readiness, the athlete’s psychological state is crucial for returning to sports. However, the contribution of psychological readiness to an athlete’s return to sports after shoulder instability surgery remains uncertain and unexplored.
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Affiliation(s)
- Luciano Andrés Rossi
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
- Correspondence: Luciano Andrés Rossi, Peron 4190 (C1199ABB), Buenos Aires, Argentina, Email
| | - Ignacio Pasqualini
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
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50
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Superior results of return to sport after double-bundle versus single-bundle anterior cruciate ligament reconstruction in young active patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:4156-4161. [PMID: 35652951 PMCID: PMC9668923 DOI: 10.1007/s00167-022-07010-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare return to sport and clinical results in young active patients who underwent anatomic single-bundle (SB) versus double-bundle (DB) anterior cruciate ligament reconstruction (ACLR). METHODS Young active patients undergoing SB or DB ACLR from 2017 to 2019 at our institution were retrospectively reviewed. The primary outcome measures were the rate and time to return to sports, with secondary measures including the Lachman test, pivot shift test, Lysholm scores, International Knee Documentation Committee (IKDC) scores and graft rupture. RESULTS The study included a total of 90 patients (DB group, 42; SB group, 48), with a mean follow-up of 27.1 ± 6.1 months. Young active patients who underwent DB ACLR had a higher rate of return to pivoting sports than those who underwent SB ACLR (HR = 2.4; 95% confidence interval [CI]: 1.4, 4.1; p = 0.013). The DB group returned to pivoting sports at a mean ± SD of 11.0 ± 2.9 months compared with 12.7 ± 2.7 months in the SB group (p = 0.01). There was one traumatic failure in the SB group and one contralateral ACL rupture in the DB group. There was no significant difference in the rate and time to return to running, Lachman test, pivot-shift test, Lysholm or IKDC scores in either group. CONCLUSION Both anatomical SB and DB techniques achieved satisfactory clinical outcomes. DB techniques led to superior performance of return to pivoting sports but nonsignificant differences in time and rate of return to running, passive stability measurement, subjective knee function outcome and graft rupture rate in both groups at the 2-year follow-up. The DB ACLR should be considered a viable option to treat young patients with high activity demands. LEVEL OF EVIDENCE III.
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