1
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Ackerman DR, Ptasinski AM, Edmond T, Dunleavy ML, Gallo RA. Prophylactic Knee Bracing in Offensive Linemen of the National Football League: A Retrospective Analysis of Usage Trends, Player Performance, and Major Knee Injury. Orthop J Sports Med 2023; 11:23259671231191767. [PMID: 37655245 PMCID: PMC10467376 DOI: 10.1177/23259671231191767] [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: 03/22/2023] [Accepted: 05/03/2023] [Indexed: 09/02/2023] Open
Abstract
Background Offensive linemen in American football are prone to high-energy valgus forces to the knee, leading to associated injuries. Some offensive linemen in the National Football League (NFL) wear prophylactic knee braces (PKB) to prevent ligamentous injury. Purpose/Hypothesis This purpose of the study was to compare injury rates and performance between NFL offensive linemen who wear PKB and those who do not. It was hypothesized that brace wear would be associated with fewer major knee injuries and no difference in gameplay performance. Study Design Cohort study; Level of evidence, 3. Methods For the 2014 through 2020 NFL seasons, offensive linemen with at least 200 game snaps per regular season were identified. Players were grouped by PKB status (bracers vs nonbracers) based on visualization of bilateral, dual-hinged metal knee braces as part of gameday uniforms on publicly available imaging databases and/or game videos. Major knee injuries, defined as those requiring the missing of games, were identified using publicly available data. Performance was assessed with Pro Football Focus grades for each season. Rates of major knee injury were compared between groups with the 2-sample Z test for proportions, and performance grades were compared with the unpaired t test. Results For the cumulative study period, bracers demonstrated a significantly lower rate of major knee injuries than nonbracers (0.013 vs 0.049 injuries per player, respectively; P = .04). Isolated MCL injury was the most common injury for nonbracers. There was no group difference in performance for the cumulative study period or during most individual seasons. Yearly prevalence of PKB usage declined steadily from 16.3% in 2014 to 5.6% in 2020. A subgroup analysis of rookie players demonstrated an overall downtrend in usage during the study period as well. Conclusion Results indicated that knee brace prophylaxis by NFL offensive linemen was associated with a reduced risk of major knee injury without a significant difference in performance when compared with nonbracers. Despite this, the prevalence of PKB declined over the study period.
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Affiliation(s)
- Devon R. Ackerman
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Anna M. Ptasinski
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Travis Edmond
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Mark L. Dunleavy
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Robert A. Gallo
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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2
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Protocol for a Randomized Crossover Trial to Evaluate the Effect of Soft Brace and Rigid Orthosis on Performance and Readiness to Return to Sport Six Months Post-ACL-Reconstruction. Healthcare (Basel) 2023; 11:healthcare11040513. [PMID: 36833047 PMCID: PMC9957425 DOI: 10.3390/healthcare11040513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
A randomized crossover trial was designed to investigate the influence of muscle activation and strength on functional stability/control of the knee joint, to determine whether bilateral imbalances still occur six months after successful anterior cruciate ligament reconstruction (ACLR), and to analyze whether the use of orthotic devices changes the activity onset of these muscles. Furthermore, conclusions on the feedforward and feedback mechanisms are highlighted. Therefore, twenty-eight patients will take part in a modified Back in Action (BIA) test battery at an average of six months after a primary unilateral ACLR, which used an autologous ipsilateral semitendinosus tendon graft. This includes double-leg and single-leg stability tests, double-leg and single-leg countermovement jumps, double-leg and single-leg drop jumps, a speedy jump test, and a quick feet test. During the tests, gluteus medius and semitendinosus muscle activity are analyzed using surface electromyography (sEMG). Motion analysis is conducted using Microsoft Azure DK and 3D force plates. The tests are performed while wearing knee rigid orthosis, soft brace, and with no aid, in random order. Additionally, the range of hip and knee motion and hip abductor muscle strength under isometric conditions are measured. Furthermore, patient-rated outcomes will be assessed.
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3
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Orlando JM, Li B, Bodt B, Lobo MA. Users' Perceptions About Lower Extremity Orthotic Devices: A Systematic Review. Arch Phys Med Rehabil 2022; 104:645-655. [PMID: 36395874 DOI: 10.1016/j.apmr.2022.10.010] [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: 05/18/2022] [Revised: 10/13/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review perceptions from adults, children, and caregivers in scientific and open sources to determine how well lower extremity orthotic devices (LEODs) meet users' functional, expressive, aesthetic, and accessibility (FEA2) needs. DATA SOURCES Scientific source searches were conducted in the National Library of Medicine (PubMed/MEDLINE) and Web of Science; open source searches were conducted in Google Search Engine in April 2020. STUDY SELECTION Inclusion criteria were reporting of users' perceptions about a LEOD, experimental or observational study design, including qualitative studies, and full text in English. Studies were excluded if the device only provided compression or perception data could not be extracted. One hundred seventy three scientific sources of 3440 screened were included (total of 1108 perceptions); 36 open sources of 150 screened were included (total of 508 perceptions). DATA EXTRACTION Users' perceptions were independently coded by 2 trained, reliable coders. DATA SYNTHESIS Across both source types, there were more perceptions about functional needs, and perceptions were more likely to be positive related to functional than expressive, aesthetic, or accessibility needs. Perceptions about expression, aesthetics, and accessibility were more frequently reported and more negative in open vs scientific sources. Users' perceptions varied depending on users' diagnosis and device type. CONCLUSIONS There is significant room for improvement in how LEODs meet users' FEA2 needs, even in the area of function, which is often the primary focus when designing rehabilitation devices. Satisfaction with LEODs may be improved by addressing users' unmet needs. Individuals often choose not to use prescribed LEODs even when LEODs improve their function. This systematic review identifies needs for LEODs that are most important to users and highlights how well existing LEODs address those needs. Attention to these needs in the design, prescription, and implementation of LEODs may increase device utilization.
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Affiliation(s)
- Julie M Orlando
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE
| | - Bai Li
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE
| | - Barry Bodt
- Biostatistics Core Facility, College of Health Sciences, University of Delaware, Newark, DE
| | - Michele A Lobo
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE.
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4
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Milner J, Hartnettt D, DeFroda SF. Alternatives to Knee Braces. J Knee Surg 2022; 35:266-272. [PMID: 34600439 DOI: 10.1055/s-0041-1736198] [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: 02/07/2023]
Abstract
Knee braces continue to be a widely utilized piece of medical equipment, ranging from simple over the counter sleeves to more complex functional braces, with the ability to provide electrical stimulation to muscle groups. Despite their popularity, alternatives to knee braces exist for patients who find braces to be ineffective, uncomfortable, cumbersome, or overly expensive. While high-quality studies are lacking for modalities such as neoprene sleeves, compression stockings, and kinesiotaping, there is promising evidence that these interventions can confer an element of stability and pain relief for a variety of knee pathologies both with regard to acute and chronic injuries as well as in the postoperative rehabilitation period. While no "holy grail" exists for the ideal brace, or bracing alternative, it is important for providers to be aware of the options available to patients as well as the current evidence for these various modalities, so that the provider can best guide musculoskeletal care.
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Affiliation(s)
- John Milner
- Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
| | - Davis Hartnettt
- Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
| | - Steven F DeFroda
- Department of Orthopedic Surgery, University of Missouri System, Columbia, Missouri
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5
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Blecha K, Nuelle CW, Smith PA, Stannard JP, Ma R. Efficacy of Prophylactic Knee Bracing in Sports. J Knee Surg 2022; 35:242-248. [PMID: 34952553 DOI: 10.1055/s-0041-1740930] [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: 02/07/2023]
Abstract
Anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries are common knee injuries, which can result from contact and noncontact during sports, recreation, or work-related activities. Prophylactic knee braces (PKBs) have been designed to protect the knee and decrease risk of recurrence of these injuries. Despite their success, PKBs have not been proven to be consistently effective and cost of the device must be evaluated to optimize its use in sports, particularly American football. Biomechanical studies have suggested that increased hip and knee flexion angles may reduce frontal plane loading with bracing which can protect the knee joint. This is essential with knee loading and rotational moments because they are associated with jumping, landing, and pivoting movements. The clinical efficacy of wearing PKBs can have an impact on athletic performance with respect to speed, power, motion, and agility, and these limitations are evident in athletes who are unaccustomed to wearing a PKB. Despite these concerns, use of PKBs increases in patients who have sustained an MCL injury or recovering from an ACL reconstruction surgery. As the evidence continues to evolve in sports medicine, there is limited definitive data to determine their beneficial or detrimental effects on overall injury risk of athletes, therefore leading those recommendations and decisions for their usage in the hands of the athletic trainers and team physicians' experience to determine the specific brace design, brand, fit, and situations for use.
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Affiliation(s)
- Kyle Blecha
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri
| | - Clayton W Nuelle
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri
| | - Patrick A Smith
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri.,Columbia Orthopedic Group, Columbia, Missouri
| | - James P Stannard
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri.,Department of Orthopedic Surgery, Thompson Laboratory of Orthopedic Institute, University of Missouri, Columbia, Missouri
| | - Richard Ma
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri
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6
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Stephenson SD, Kocan JW, Vinod AV, Kluczynski MA, Bisson LJ. A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies. Orthop J Sports Med 2021; 9:23259671211035776. [PMID: 34734094 PMCID: PMC8558815 DOI: 10.1177/23259671211035776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/03/2021] [Indexed: 12/26/2022] Open
Abstract
Background A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs. Purpose To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries. Study Design Systematic review; Level of evidence, 4. Methods We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version). Results A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias. Conclusion This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.
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Affiliation(s)
- Samuel D Stephenson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Joseph W Kocan
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Amrit V Vinod
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
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7
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Kemker BP, Kankaria R, Patel N, Golladay G. Hip and Knee Bracing: Categorization, Treatment Algorithm, and Systematic Review. J Am Acad Orthop Surg Glob Res Rev 2021; 5:e20.00181-12. [PMID: 34096901 PMCID: PMC8189624 DOI: 10.5435/jaaosglobal-d-20-00181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/26/2021] [Indexed: 11/18/2022]
Abstract
Hip and knee braces or orthoses are often used to provide support after surgery and to prevent or reduce the severity of injuries. The braces are used for stabilization, immobilization, mechanical correction, and rehabilitation. Hip braces consist of stabilization and unloader variations, whereas knee braces are composed of knee sleeves and patellofemoral, prophylactic, unloader, and functional braces. Indications vary widely and depend on the type of brace. Hip braces can treat osteoarthritis to instability after total hip arthroplasty. Knee brace indications range from mild arthralgias to instability and osteoarthritis. Although braces are routinely used clinically, high-level evidence is sparse for their use. With this review, the different types and uses of hip and knee braces have been defined, and their indications exemplified in hopes of spurring future research.
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Affiliation(s)
- Bernard P Kemker
- From the Virginia Commonwealth University Medical Center, Richmond, VA
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8
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The Effect of Functional Knee Braces on Muscular Contributions to Joint Rotational Stiffness in Anterior Cruciate Ligament-Deficient and -Reconstructed Patients. J Appl Biomech 2019; 35:344-352. [PMID: 31541064 DOI: 10.1123/jab.2018-0227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 05/15/2019] [Accepted: 06/25/2019] [Indexed: 11/18/2022]
Abstract
Functional knee braces are frequently prescribed by physicians to ameliorate the function of individuals with anterior cruciate ligament (ACL) injuries. These braces have been shown in the literature to potentially enhance knee stability by augmenting muscle activation patterns and the timing of muscle response to perturbations. However, very few techniques are available in the literature to quantify how those modifications in lower-limb muscle activity influence stability of the knee. The aim of the present study was to quantify the effect of an off-the-shelf functional knee brace on muscle contributions to knee joint rotational stiffness in ACL-deficient and ACL-reconstructed patients. Kinematic, electromyography, and kinetic data were incorporated into an electromyography-driven model of the lower extremity to calculate individual and total muscle contributions to knee joint rotational stiffness about the flexion-extension axis, for 4 independent variables: leg condition (contralateral uninjured, unbraced ACL injured, and braced ACL injured); knee flexion (5°-10°, 20°-25°, and 30°-35°); squat stability condition (stable and unstable); and injury status (ACL deficient and ACL reconstructed). Participants had significantly higher (P < .05, η2 = .018) total knee joint rotational stiffness values while wearing the brace compared with the control leg. A 2-way interaction effect between stability and knee flexion (P < .05, η2 = .040) for total joint rotational stiffness was also found.
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9
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Awwad GEH, Coleman JH, Dunkley CJ, Dewar DC. An Analysis of Knee Injuries in Rugby League: The Experience at the Newcastle Knights Professional Rugby League Team. SPORTS MEDICINE - OPEN 2019; 5:33. [PMID: 31342290 PMCID: PMC6656824 DOI: 10.1186/s40798-019-0206-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/09/2019] [Indexed: 11/10/2022]
Abstract
Background Epidemiologic data in professional sport is becoming an increasingly valuable tool in identifying frequently occurring injuries and developing strategies to reduce their occurrence. Currently, there is a paucity of literature on the epidemiology of knee injuries in professional male rugby league players. Methods We retrospectively reviewed medical records from a single male professional rugby league team (Newcastle Knights), competing in Australia, and evaluated knee injuries and time to return to play. Results In total, 89 knee injuries occurred, with an injury incidence of 616.7 injuries per 1000 players. The most frequently occurring knee injuries were medial collateral ligament (416.7 injuries per 1000 players) and chondral/meniscal injuries (416.7 injuries per 1000 players). For all injury types, being tackled was the most common mechanism of injury, and the median time to return to play was 1 day. Anterior cruciate ligament injuries accounted for the longest time to return to play (median 236.0 days). Conclusion Medial collateral ligament and chondral/meniscal injury types were the most frequent injuries; however, anterior cruciate ligament injuries accounted for the most time missed from sport despite being less common. Professional male rugby league players incur similar knee injury types compared to rugby union based upon our study and other similar studies. Electronic supplementary material The online version of this article (10.1186/s40798-019-0206-z) contains supplementary material, which is available to authorized users.
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10
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Hacker SP, Schall F, Ignatius A, Dürselen L. The effect of knee brace misalignment on the anterior cruciate ligament: An experimental study. Prosthet Orthot Int 2019; 43:309-315. [PMID: 30717630 DOI: 10.1177/0309364618824443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Protective knee braces are used for rehabilitation or prevention. Due to poor patient compliance or slippage, the brace might be misaligned with the knee axis. OBJECTIVES Does a misaligned knee brace stress the anterior cruciate ligament? STUDY DESIGN It is an experimental study. METHODS A strain sensor was implanted on the anterior cruciate ligament in eight limbs. The limbs were mounted in a knee simulator, muscle forces were applied and a cyclic motion from 10° to 60° flexion was performed under three conditions: unbraced, braced and with a misaligned brace. OUTCOME MEASURES The outcome measures were anterior cruciate ligament strain and three-dimensional kinematics of the knee joint. RESULTS The correctly aligned brace significantly reduced the anterior cruciate ligament strain at 10° compared to the unbraced condition from 0% to -1.54% (standard deviation = 1.4). The misaligned brace neutralised the effect of bracing to -0.06% (standard deviation = 1.1) anterior cruciate ligament strain. At 60° flexion angle, bracing had no statistically significant effect on the anterior cruciate ligament strain compared to the unbraced knee: -2.58% (standard deviation = 0.8) versus -1.64% (standard deviation = 1.0). The anterior cruciate ligament in the misaligned braced knee at 60° flexion with a strain of -1.1% (standard deviation = 0.9) was significantly more stressed than in the correctly aligned condition. An effect of bracing on knee kinematics was not detected. CONCLUSION A correctly aligned knee brace reduced anterior cruciate ligament strain. By contrast, a misaligned brace tended to increase the anterior cruciate ligament strain compared to the unbraced knee. CLINICAL RELEVANCE The correct alignment of the brace was identified as a key factor decisively influencing the effectiveness of bracing.
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Affiliation(s)
- Steffen P Hacker
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Florian Schall
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
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11
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Bodendorfer BM, Arnold NR, Shu HT, Leary EV, Cook JL, Gray AD, Guess TM, Sherman SL. Do neoprene sleeves and prophylactic knee braces affect neuromuscular control and cutting agility? Phys Ther Sport 2019; 39:23-31. [PMID: 31203143 DOI: 10.1016/j.ptsp.2019.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/09/2019] [Accepted: 05/23/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To evaluate the effects of neoprene sleeves (NSs) and prophylactic knee braces (PKBs) on neuromuscular control and cutting agility. DESIGN Markerless motion-capture technology tracked subjects (1) without a brace as a control (2) with NSs and (3) with PKBs during single-leg drop vertical jump (SLDVJ), single-leg squat (SLS), Y-excursion, and cutting movements. Movements were recorded five times per bracing condition in three different sessions. SETTING University laboratory. PARTICIPANTS Ten healthy, active subjects (5 male, 5 female; age range, 22-26 years). MAIN OUTCOME MEASURES Degrees of motion and time to completion. RESULTS Use of NSs and PKBs reduced subjects' hip internal rotation in the loading phase of SLDVJ (p = 0.026, 0.02) and SLS (p = 0.005, <0.001), reduced knee flexion in the loading phase of SLDVJ (p = 0.038, <0.001), and reduced knee frontal plane abduction (FPA) with SLS (p = 0.015, 0.024) and Y-excursion (p = 0.002, 0.005) compared to control. Use of PKBs decreased subjects' hip internal rotation in the Y-excursion (p = 0.024) and reduced knee FPA in the SLDVJ loading phase (p = 0.014) compared to control. There was no difference in cutting agility for either group (p = 0.145, 0.347). CONCLUSION Both NSs and PKBs positively impacted neuromuscular control without impacting cutting agility.
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Affiliation(s)
- Blake M Bodendorfer
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
| | - Nicholas R Arnold
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Henry T Shu
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Emily V Leary
- University of Missouri Health Care, Columbia, MO, USA
| | - James L Cook
- University of Missouri Health Care, Columbia, MO, USA
| | - Aaron D Gray
- University of Missouri Health Care, Columbia, MO, USA
| | - Trent M Guess
- University of Missouri Health Care, Columbia, MO, USA
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12
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Baker HP, Varelas A, Shi K, Terry MA, Tjong VK. The NFL's Chop-Block Rule Change: Does It Prevent Knee Injuries in Defensive Players? Orthop J Sports Med 2018; 6:2325967118768446. [PMID: 29780842 PMCID: PMC5954335 DOI: 10.1177/2325967118768446] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The chop block, a football maneuver in which an offensive player blocks an opponent around the thigh while another offensive player engages the same opponent above the waist, was declared illegal by the National Football League (NFL) before the 2016-2017 season. Chop blocks have been hypothesized to be associated with medial collateral ligament and anterior cruciate ligament injury, especially in offensive/defensive linemen. Purpose: To quantify the impact that the chop-block rule change had on the incidence of knee injuries to defensive players in the NFL over 4 seasons (2014-2018). Study Design: Cohort study; Level of evidence, 3. Methods: NFL injury data for all defensive players from regular-season games played from 2014 through 2018 were collected. For this study, all knee injuries were attributed to competitive game play. Injury rates were reported as the number of injuries per 1000 athletic exposures (with 95% CIs). Results: A total of 256 games were played during the 2014-2015, 2015-2016, 2016-2017, and 2017-2018 NFL regular seasons, and all were included in this study. Among defensive players, the relative risk for a knee injury per 1000 athletic exposures was 0.84 (95% CI, 0.75-0.96) for the 2 seasons after the chop-block rule change (2016-2017 and 2017-2018) versus the 2 seasons before (2014-2015 and 2015-2016) (P = .009). Thus, the relative risk reduction was 16%. The relative risk for a defensive player to be placed on injured reserve per season was 0.90 (95% CI, 0.72-1.13) for the 2 seasons after the rule change versus the 2 seasons before (P = .39). Conclusion: The NFL’s recent ruling against in-game chop blocks may have reduced the incidence of knee injuries among defensive players.
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Affiliation(s)
- Hayden P. Baker
- The University of Illinois College of Medicine, Chicago, Illinois, USA
- Hayden Baker, BA, 1537 West Barry Avenue, Chicago, IL 60657, USA ()
| | - Antonios Varelas
- The University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Kevin Shi
- Rush University Medical Center, Chicago, Illinois, USA
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13
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Schrock JB, Carver TJ, Kraeutler MJ, McCarty EC. Evolving Treatment Patterns of NFL Players by Orthopaedic Team Physicians Over the Past Decade, 2008-2016. Sports Health 2018; 10:453-461. [PMID: 29469658 PMCID: PMC6116103 DOI: 10.1177/1941738118758312] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Previous studies have analyzed the treatment patterns used to manage injuries
in National Football League (NFL) players. Hypothesis: Treatment patterns for injuries in NFL players will have changed over the
study period. Study Design: Descriptive epidemiology study. Level of Evidence: Level 5. Methods: The head orthopaedic team physicians for all 32 NFL teams were asked to
complete a survey containing questions regarding experience as team
physician, medical coverage of the team, and treatment preferences for some
of the most common injuries occurring in football players. Responses from
the current survey were compared with responses from the same survey sent to
NFL team physicians in 2008. Results: Responses were received from 31 (31/32, 97%) NFL team physicians in 2008 and
29 (29/32, 91%) NFL team physicians between April 2016 and May 2017. The
proportion of physicians preferring patellar tendon autograft in anterior
cruciate ligament (ACL) reconstruction increased from 87% in 2008 to 97% in
2016 (P = 0.054). In 2008, 49% of physicians allowed return
to contact after ACL reconstruction at 6 months or less as compared with
only 14% of physicians in 2016 (P = 0.033). In 2008, 93% of
physicians used Toradol injections prior to a game to help with nagging
injuries. Toradol injection utilization decreased to 48% of physicians in
2016 (P < 0.001). Seventy-nine percent of physicians
would administer 5 or more Toradol injections prior to a game in 2008, as
compared with 28% of physicians in 2016 (P <
0.0001). Conclusion: Orthopaedic physicians have changed their injury treatment preferences for
professional football players. In particular, physicians have become more
cautious with allowing players to return to play after ACL reconstruction
and with the use of pregame Toradol injections. Clinical Relevance: Expert opinions can help guide treatment decisions and lead to better care of
all athletes.
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Affiliation(s)
- John B Schrock
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Trevor J Carver
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew J Kraeutler
- Department of Orthopaedics, Seton-Hall Hackensack Meridian School of Medicine, South Orange, New Jersey
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
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14
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Carver TJ, Schrock JB, Kraeutler MJ, McCarty EC. The Evolving Treatment Patterns of NCAA Division I Football Players by Orthopaedic Team Physicians Over the Past Decade, 2008-2016. Sports Health 2018; 10:234-243. [PMID: 29298161 PMCID: PMC5958450 DOI: 10.1177/1941738117745488] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Previous studies have analyzed the treatment patterns used to manage injuries
in National Collegiate Athletic Association (NCAA) Division I football
players. Hypothesis: Treatment patterns used to manage injuries in NCAA Division I football
players will have changed over the study period. Study Design: Descriptive epidemiology study. Level of Evidence: Level 5. Methods: The head orthopaedic team physicians for all 128 NCAA Division I football
teams were asked to complete a survey containing questions regarding
experience as team physician, medical coverage of the team, reimbursement
issues, and treatment preferences for some of the most common injuries
occurring in football players. Responses from the current survey were
compared with responses from the same survey sent to NCAA Division I team
physicians in 2008. Results: Responses were received from 111 (111/119, 93%) NCAA Division I orthopaedic
team physicians in 2008 and 115 (115/128, 90%) orthopaedic team physicians
between April 2016 and April 2017. The proportion of team physicians who
prefer a patellar tendon autograft for primary anterior cruciate ligament
reconstruction (ACLR) increased from 67% in 2008 to 83% in 2016
(P < 0.001). The proportion of team physicians who
perform anterior shoulder stabilization arthroscopically increased from 69%
in 2008 to 93% in 2016 (P < 0.0001). Of team physicians
who perform surgery for grade III posterior cruciate ligament (PCL)
injuries, the proportion who use the arthroscopic single-bundle technique
increased from 49% in 2008 to 83% in 2016 (P < 0.0001).
The proportion of team physicians who use Toradol injections prior to a game
to help with nagging injuries decreased from 62% in 2008 to 26% in 2016
(P < 0.0001). Conclusion: Orthopaedic physicians changed their injury treatment preferences for NCAA
Division I football players over the study period. In particular, physicians
have changed their preferred techniques for ACLR, anterior shoulder
stabilization, and PCL reconstruction. Physicians have also become more
conservative with pregame Toradol injections. Clinical Relevance: These opinions may help guide treatment decisions and lead to better care of
all athletes.
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Affiliation(s)
- Trevor J Carver
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - John B Schrock
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew J Kraeutler
- Department of Orthopaedics, Seton-Hall Hackensack Meridian School of Medicine, South Orange, New Jersey
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
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15
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Do Knee Braces Prevent Ski Knee Injuries? Asian J Sports Med 2017. [DOI: 10.5812/asjsm.58678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Abstract
Previous research has reported a prevalence of running related injuries in 25.9% to 72% of all runners. A greater hip internal rotation and adduction during the stance phase in running has been associated with many running related injuries, such as patellofemoral pain. Researchers in the USA designed a treatment device 'the Powers™ strap' to facilitate an external rotation of the femur and to thereby control abnormal hip and knee motion during leisure and sport activities. However, to date no literature exists to demonstrate whether the Powers™ strap is able to reduce hip internal rotation during running. 22 healthy participants, 11 males and 11 females (age: 27.45±4.43 years, height: 1.73±0.06m, mass: 66.77±9.24kg) were asked to run on a 22m track under two conditions: without and with the Powers™ strap. Three-dimensional motion analysis was conducted using ten Qualisys OQUS 7 cameras (Qualisys AB, Sweden) and force data was captured with three AMTI force plates (BP600900, Advanced Mechanical Technology, Inc.USA). Paired sample t-tests were performed at the 95% confidence interval on all lower limb kinematic and kinetic data. The Powers™ strap significantly reduced hip and knee internal rotation throughout the stance phase of running. These results showed that the Powers™ strap has the potential to influence hip motion during running related activities, in doing so this might be beneficial for patients with lower limb injuries. Future research should investigate the influence of the Powers™ strap in subjects who suffer from running related injuries, such as patellofemoral pain.
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Affiliation(s)
- Henrike Greuel
- School of Health Science, University of Salford, Frederick Road Campus, Brian Blatchford building, PO30, Salford M66PU, Greater Manchester, UK, UK.
| | - Lee Herrington
- School of Health Science, University of Salford, Frederick Road Campus, Brian Blatchford building, PO30, Salford M66PU, Greater Manchester, UK, UK.
| | - Anmin Liu
- School of Health Science, University of Salford, Frederick Road Campus, Brian Blatchford building, PO30, Salford M66PU, Greater Manchester, UK, UK.
| | - Richard K Jones
- School of Health Science, University of Salford, Frederick Road Campus, Brian Blatchford building, PO30, Salford M66PU, Greater Manchester, UK, UK.
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17
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Varelas AN, Erickson BJ, Cvetanovich GL, Bach BR. Medial Collateral Ligament Reconstruction in Patients With Medial Knee Instability: A Systematic Review. Orthop J Sports Med 2017; 5:2325967117703920. [PMID: 28567427 PMCID: PMC5439653 DOI: 10.1177/2325967117703920] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The medial collateral ligament (MCL) is the most frequently injured ligament of the knee, but it infrequently requires surgical treatment. Current literature on MCL reconstructions is sparse and offers mixed outcome measures. Purpose/Hypothesis: The purpose of this study was to compare the outcomes of isolated MCL reconstruction and multiligamentous MCL reconstruction. Our hypothesis was that in selective patients, MCL reconstruction would significantly improve objective and subjective patient knee performance measures, those being baseline valgus laxity, range of motion, objective and subjective International Knee Documentation Committee (IKDC) scores, Tegner score, and Lysholm knee activity scores. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and utilizing 3 computer-based databases. Studies reporting clinical outcomes of patients undergoing MCL reconstruction due to chronic instability or injury with mean follow-up of at least 2 years and levels of evidence 1 to 4 were eligible for inclusion. All relevant subject demographics and study data were statistically analyzed using 2-sample and 2-proportion z tests. Results: Ten studies involving 275 patients met our inclusion criteria. Of these patients, 46 underwent isolated MCL reconstruction while another 229 underwent reconstruction of the MCL in addition to a variety of concomitant reconstructions. Overall outcomes for all patients were significant for (1) reducing the medial opening of the knee (8.1 ± 1.3 vs 1.4 ± 1.0 mm; P < .001), (2) improving the patient’s objective IKDC score (1.2% vs 88.4%; P < .001), (3) improving the patient’s subjective IKDC score (49.8 ± 6.9 vs 82.4 ± 9.6; P < .001), and (4) improving the Lysholm knee activity score (69.3 ± 5.9 vs 90.5 ± 6.6; P < .001). No differences existed between concomitant reconstruction groupings except that postoperative Lysholm scores were better for MCL/anterior cruciate ligament reconstruction than MCL/posterior cruciate ligament reconstruction (94.3 ± 4.5 vs 84.0 ± 11.7; P < .001). Normal or nearly normal range of motion was obtained by 88% of all patients. Conclusion: The systematic review of 10 studies and 275 knees found that the reported patient outcomes after MCL reconstruction were significantly improved across all measures studied, with no significant difference in outcomes between concomitant reconstructions.
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Affiliation(s)
| | - Brandon J Erickson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory L Cvetanovich
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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18
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Baker HP, Tjong VK, Dunne KF, Lindley TR, Terry MA. Evaluation of Shoulder-Stabilizing Braces: Can We Prevent Shoulder Labrum Injury in Collegiate Offensive Linemen? Orthop J Sports Med 2016; 4:2325967116673356. [PMID: 27975072 PMCID: PMC5140042 DOI: 10.1177/2325967116673356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Shoulder injuries remain one of the most common injuries among collegiate football athletes. Offensive linemen in particular are prone to posterior labral pathology. Purpose: To evaluate the efficacy of shoulder bracing in collegiate offensive linemen with respect to injury prevention, severity, and lost playing time. Study Design: Cohort study; Level of evidence, 3. Methods: Offensive linemen at a single collegiate institution wore bilateral shoulder-stabilizing braces for every contact practice and game beginning in the spring of 2013. Between spring of 2007 and fall of 2012, offensive linemen did not wear any shoulder braces. Player injury data were collected for all contact practices and games throughout these time periods to highlight differences with brace use. Results: Forty-five offensive linemen (90 shoulders) participated in spring and fall college football seasons between 2007 and 2015. There were 145 complete offensive linemen seasons over the course of the study. Offensive linemen not wearing shoulder braces completed 87 seasons; offensive linemen wearing shoulder braces completed 58 seasons. Posterior labral tear injury rates were calculated for players who wore the shoulder braces (0.71 per 1000 athlete-exposures) compared with shoulders of players who did not wear the braces (1.90 per 1000 athlete-exposures). The risk ratio was 0.46 (95% CI, 0.16-1.30; P = .14). Mean time (contact practices and games) missed due to injury was significant, favoring less time missed by players who used braces (8.7 vs 36.60 contact practices and games missed due to injury; P = .0019). No significant difference in shoulder labral tears requiring surgery was found for brace use compared with no brace use. Conclusion: Shoulder-stabilizing braces were shown not to prevent posterior labral tears among collegiate offensive lineman, although they were associated with less time lost to injury. The results of this study have clinical significance, indicating that wearing a shoulder brace provides a protective factor for offensive linemen.
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Affiliation(s)
- Hayden P Baker
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin F Dunne
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tory R Lindley
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael A Terry
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Abstract
There are various treatments for musculoskeletal-related conditions, including the use of durable medical equipment (DME). Numerous DME devices are currently available. This article addresses several of the common DME devices used for treating upper and lower extremity orthopedic conditions.
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Affiliation(s)
- Bret C Jacobs
- Department of Family & Community Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Mail Code HP 06, Hershey, PA 17033, USA; Department of Orthopaedics & Rehabilitation, Penn State Milton S. Hershey Medical Center, 500 University Drive, Mail Code HP 06, Hershey, PA 17033, USA.
| | - Justin A Lee
- Department of Family Medicine, Brody School of Medicine, East Carolina University, 101 Heart Drive, Mail Stop 654, Greenville, NC 27834, USA
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