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Robby T, Hussein N, Welbeck A, Faherty M, Killelea C, Diehl L, Wittstein J, Riboh J, Toth A, Amendola N, Sell TC. Sex-differences in psychological readiness for return-to-sport following anterior cruciate ligament reconstruction. PLoS One 2024; 19:e0307720. [PMID: 39292660 PMCID: PMC11410221 DOI: 10.1371/journal.pone.0307720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 07/10/2024] [Indexed: 09/20/2024] Open
Abstract
Females are at greatest risk for reinjury after return to sport (RTS) following anterior cruciate ligament (ACL) reconstruction (ACLR). The reasons for these sex differences, however, remain unclear. Psychological factors such as kinesiophobia have been identified as a potential predictor for reinjury following RTS. Studies investigating kinesiophobia have identified sex differences, yet whether this holds in the ACLR population remains unknown. The purpose of this study was to examine whether there are sex differences in kinesiophobia and other psychological factors, such as readiness to RTS and self-reported pain in the ACLR population. A total of 20 participants, eleven males (23.0 ± 8.4 years, 178.9 ± 7.6 cm, 76.8 ± 10.4 kg) and 9 females (19.6 ± 5.3 years, 165.1 ± 4.0 cm, 73.2 ± 25.0 kg) voluntarily participated in this study. The Tampa Scale for Kinesiophobia (TSK-11), Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale, and self-reported pain using a visual analog scale (VAS) were administered after clearance for RTS (10.5 ± 2.3 months post-ACLR). Statistical significance was set a priori at p<0.05. A significant difference between sexes was observed for the ACL-RSI with males reporting a significantly higher score (92.82±16.16) compared to females (77.0±15.54; p = 0.040). There were no significant differences between sexes for VAS for pain (males = 4.55 ± 6.50; females = 1.22 ± 3.31; p = 0.228) and TSK-11 (males = 18.73 ± 3.17; females = 19.67 ± 4.61; p = 0.596). The results of this study demonstrated males had significantly higher ACL-RSI scores than females, suggesting males may have higher psychological readiness following clearance for RTS. This study did not demonstrate significant differences between sexes for kinesiophobia or pain level. Caution in interpretation of results is warranted due to the small sample size, highlighting the need for further research in this area.
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Affiliation(s)
- Turk Robby
- Department of Orthopaedic Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, United States of America
| | - Nadim Hussein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Arakua Welbeck
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Mallory Faherty
- OhioHealth Research Institute, OhioHealth, Columbus, Ohio, United States of America
| | - Carolyn Killelea
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Lee Diehl
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Jocelyn Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Jonathan Riboh
- OrthoCarolina Sports Medicine, Charlotte, NC, United States of America
| | - Alison Toth
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Ned Amendola
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Timothy C Sell
- Atrium Health Musculoskeletal Institute, Charlotte, NC, United States of America
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Al Ta'ani Z, Al Ta'ani O, Gabr A, Tanashat M, Lin Lee J, Al-Bitar F, Lee JL, Al-Ajlouni YA. From Fear to Resilience: A Scoping Review of Psychological Components in Anterior Cruciate Ligament Rehabilitation. J Sport Rehabil 2024:1-28. [PMID: 39299682 DOI: 10.1123/jsr.2023-0420] [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: 12/11/2023] [Revised: 06/25/2024] [Accepted: 07/05/2024] [Indexed: 09/22/2024]
Abstract
CONTEXT Anterior cruciate ligament (ACL) injuries, prevalent in athletic contexts have profound physical and psychological impacts. Despite extensive research on the physiological aspects of ACL recovery, the psychological dimensions of this process have gained increased attention. This scoping review delves into the intricate landscape of psychological factors influencing ACL rehabilitation. DESIGN Scoping review. METHODS A literature search across multiple databases was conducted to identify relevant published studies that provide insight into the psychological aspects of ACL recovery. This search spanned various study designs, enabling a nuanced understanding of the psychological intricacies surrounding ACL recovery. Overall, a total of 1830 unique articles were screened, of which 66 were included in this review. Our findings are further contextualized through alignment with insights from prior reviews on similar themes. Through a comprehensive analysis of diverse literature, we explore 3 key themes: psychological challenges, current rehabilitation programs, and the integration of psychological support. RESULTS Psychological challenges emerged as a pervasive aspect of ACL rehabilitation, encompassing fear, anxiety, motivation, and depression. The nuanced emotional responses, particularly the fear of reinjury, impact treatment adherence and overall well-being. Contemporary rehabilitation programs revealed inconsistencies in incorporating psychological support, emphasizing the need for standardized, multidisciplinary approaches. The alignment with prior reviews in the literature reinforced the importance of psychological traits, such as knee self-efficacy, in predicting positive outcomes. CONCLUSION This scoping review provides a comprehensive overview of psychological factors within ACL rehabilitation, highlighting the importance of tailored interventions and standardized approaches. The integration of multidisciplinary expertise emerges as crucial for optimizing patient outcomes. Our findings not only contribute to a nuanced understanding of psychological nuances in ACL rehabilitation but also offer valuable implications for clinical practice and policy development.
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Affiliation(s)
- Zaid Al Ta'ani
- Department of Special Surgery and Orthopedics, University of Jordan Hospital, Amman, Jordan
| | | | - Ahmad Gabr
- New York Medical College School of Medicine, Valhalla, NY, USA
| | | | - Justin Lin Lee
- New York Medical College School of Medicine, Valhalla, NY, USA
| | - Farah Al-Bitar
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jessica Lin Lee
- New York Medical College School of Medicine, Valhalla, NY, USA
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Barth T, Bond CW, MacFadden LN, Skelley NW, Combs J, Noonan BC. Effect of Time and Sex on Post-Anterior Cruciate Ligament Reconstruction Psychological Patient-Reported Outcome Measure Scores. J Athl Train 2024; 59:898-905. [PMID: 38014794 PMCID: PMC11440824 DOI: 10.4085/1062-6050-0189.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
CONTEXT Low scores on psychological patient-reported outcomes measures, including the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) and Injury-Psychological Readiness to Return to Sport (I-PRRS), after anterior cruciate ligament reconstruction (ACLR) have been associated with a maladaptive psychological response to injury and poor prognosis. OBJECTIVE To assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores and generate normative reference curves. DESIGN Case series. SETTING Outpatient sports medicine and orthopaedic clinic. PATIENTS OR OTHER PARTICIPANTS A total of 507 patients (age at ACLR, 17.9 ± 3.0 years) who had undergone primary ACLR and completed ACL-RSI or I-PRRS assessments ≥1 times (n = 796) between 0 and 1 year post-ACLR. MAIN OUTCOME MEASURE(S) An honest broker provided anonymous data from our institution's knee-injury clinical database. Generalized additive models for location, scale, and shape and generalized least-squares analyses were used to assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores. RESULTS The ACL-RSI and I-PRRS scores increased over time post-ACLR. Males had higher scores than females until approximately 5 months post-ACLR, with scores converging thereafter. CONCLUSIONS Males reported higher ACL-RSI and I-PRRS scores than females in the initial stages of rehabilitation, but scores converged between sexes at times associated with return to play post-ACLR. Normative reference curves can be used to objectively appraise ACL-RSI and I-PRRS scores at any time post-ACLR. This may lead to timely recognition of patients with a maladaptive psychological response to injury and a higher likelihood of a poor prognosis, optimizing ACLR outcomes.
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Affiliation(s)
- Tiffany Barth
- Sanford Orthopedics and Sports Medicine Research, Sanford Health, Fargo, ND
| | - Colin W Bond
- Sanford Orthopedics and Sports Medicine Research, Sanford Health, Fargo, ND
| | - Lisa N MacFadden
- Department of Biomedical Engineering
- Sanford School of Medicine, University of South Dakota, Sioux Falls
| | - Nathan W Skelley
- Sanford Orthopedics and Sports Medicine Research, Sanford Health, Sioux Falls, SD
| | - Josefine Combs
- Sanford Orthopedics and Sports Medicine Research, Sanford Health, Sioux Falls, SD
| | - Benjamin C Noonan
- Sanford Orthopedics and Sports Medicine Research, Sanford Health, Fargo, ND
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Fang Z, Liu W. Obesity-associated outcomes after ACL reconstruction: a propensity-score-matched analysis of the US Nationwide Inpatient Sample 2005-2018. J Orthop Traumatol 2024; 25:36. [PMID: 39048813 PMCID: PMC11269535 DOI: 10.1186/s10195-024-00779-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: 01/28/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are common among physically active individuals, and obesity may increase the risk of such injuries due to factors like biomechanical stress on the knee. We aimed to determine if obesity affects postoperative outcomes after ACL reconstruction. METHODS Data from adults aged 20 years and older with ACL injuries who underwent inpatient reconstruction from 2005 to 2018 were extracted from the United States (US) Nationwide Inpatient Sample (NIS) database. Patients were divided into two groups based on the presence of co-existing obesity, defined as a body mass index (BMI) ≥ 30 kg/m2. Propensity-score matching (PSM) was employed to balance between-group differences. Associations between obesity and concomitant meniscus injury, length of stay (LOS), post-procedural complications, and non-routine discharge were examined using univariate and multivariable logistic and linear regressions. RESULTS After PSM, data from 1323 patients (representing 6396 individuals in the US) were analyzed. Of these, 441 (33%) were classified as obese, while 882 (67%) were not obese. After adjustment, obesity was significantly associated with a longer LOS (adjusted beta (aBeta) = 0.32, 95% confidence interval (CI) 0.31-0.321) and an increased likelihood of non-routine discharge (adjusted OR (aOR) = 2.18, 95% CI 1.47-3.22). There were no significant associations between obesity and concomitant meniscus injury (aOR = 1.04, 95% CI 0.81-1.32) or post-procedural complications (aOR = 0.97, 95% CI 0.74-1.27). CONCLUSIONS In patients undergoing ACL reconstruction in the US, obesity is independently associated with a longer LOS and a higher risk of non-routine discharge. Nevertheless, obesity does not appear to be associated with concomitant meniscus injury or post-procedural complications.
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Affiliation(s)
- Zhaoyi Fang
- Biodynamics Laboratory, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wenxin Liu
- Department of Sports Medicine, National Center for Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China.
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Nedder VJ, Raju AG, Moyal AJ, Calcei JG, Voos JE. Impact of Psychological Factors on Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2024:19417381241256930. [PMID: 39041333 DOI: 10.1177/19417381241256930] [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: 07/24/2024] Open
Abstract
CONTEXT Anterior cruciate ligament (ACL) tears are a common orthopaedic injury, and the incidence of ACL reconstruction (ACLR) continues to increase. Current clinical practice guidelines (CPGs) recognize the role of psychological factors in rehabilitation, but patient-reported outcome measures (PROs) and psychological readiness are rarely incorporated into rehabilitation. OBJECTIVE The purpose of this review was to highlight the importance of psychological health after ACL injury, understand the current metrics used to monitor psychological recovery, and outline how psychological recovery can be better incorporated in current CPGs. DATA SOURCES A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA); 63 studies were identified with a PubMed search using the term "ACL Injuries/psychology". STUDY SELECTION Exclusion criteria included lack of consideration of psychological effects or studies validating PROs after ACLR. Studies were reviewed by multiple reviewers, and a total of 38 studies were included after applying exclusion criteria. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3b. DATA EXTRACTION Two independent reviewers analyzed the included articles to extract sample size, psychological readiness scale or other measures used, and key results. RESULTS Psychological outcomes, especially kinesiophobia and fear of reinjury, are seen commonly after ACLR. Psychological factors were shown to impede return to sport (RTS), alter measurable knee biomechanics, and potentially increase the risk for re-rupture. Targeted interventions such as kinesiotaping, knee bracing, and imagery training can help improve psychological and functional testing after ACLR. CONCLUSION ACLR is often complicated by psychological factors. Psychological readiness is a crucial yet often unincorporated part of rehabilitation. Patients with higher levels of kinesiophobia and lower psychological readiness to RTS specifically should be identified to allow for administration of interventions, such as imagery training, knee bracing, or kinesiotaping, that can mitigate the negative effects of psychological outcomes and improve recovery.
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Affiliation(s)
| | - Akash G Raju
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Andrew J Moyal
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jacob G Calcei
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - James E Voos
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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Simonsson R, Piussi R, Högberg J, Sundberg A, Hamrin Senorski E. Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2024; 43:513-533. [PMID: 38811125 DOI: 10.1016/j.csm.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Rehabilitation after an anterior cruciate ligament (ACL) reconstruction requires patience, devotion, and discipline. Rehabilitation should be individualized to each patient's specific need and sport. Return to sport is a continuum throughout the rehabilitation, and patients should not return to performance before passing a battery of muscle function tests and patient-reported outcomes, as well as change of direction-specific tests. Return to full participation should be an agreement between the patient, physical therapist, surgeon, and coach. For minimal risk for second ACL injury, patients should continue with maintenance and prevention training even after returning to sport.
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Affiliation(s)
- Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Axel Sundberg
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Capio Ortho Center, Arvid Wallgrens Backe 4a, Gothenburg SE-413 13, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Swedish Olympic Committee, Olympiastadion 114 33, Stockholm, Sweden.
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7
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Glover MA, St Jeor JD, Parikh N, Rider DE, Bullock GS, Trasolini NA, Waterman BR. Previous Knee Surgery, Anteromedial Portal Drilling, Quadriceps Tendon Autograft, and Meniscal Involvement Associated With Delayed Return to Sport After Anterior Cruciate Ligament Reconstruction in Amateur Athletes. Arthrosc Sports Med Rehabil 2024; 6:100911. [PMID: 39006786 PMCID: PMC11240041 DOI: 10.1016/j.asmr.2024.100911] [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: 09/10/2023] [Accepted: 02/07/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To identify prognostic factors associated with a delayed return-to-sport (RTS) time in amateur athletes who return to full participation after a primary isolated anterior cruciate ligament (ACL) reconstruction. Methods A retrospective review was performed among athletes who underwent ACL reconstruction between October 2014 and October 2021. Inclusion criteria were any amateur athletes with an ACL reconstruction who had a documented RTS and greater than 1-year follow-up. Nonathletes, those with multiligamentous knee injury, and those missing documented RTS timelines were excluded. RTS was defined as participation in athletics at a level equivalent to or greater than the preinjury level participation. Demographic and prognostic factors, including previous knee surgery, meniscal involvement, level of participation, surgical approach, and graft type, were recorded along with RTS time and analyzed via Poisson regression. Results In total, 91 athletes, average age 18.8 (± 6.7) years, who underwent ACL reconstruction at a single institution from 2014 to 2021 were identified with an average follow-up time of 4.6 (± 2.5) years (range 1.1, 9.0). Meniscal involvement (1.11; 95% confidence interval [CI] 1.08-1.15, P < .001) and previous knee surgery (1.43; 95% CI 1.29-1.58; P < .001) were related to a delayed RTS. Quadriceps tendon and bone-patellar tendon-bone autografts, as well as allograft, showed a significant association with a longer RTS time when compared with hamstring autograft (1.16, 95% CI 1.13-1.20, P < .001; 1.04, 95% CI 1.01-1.07, P = .020; 1.11, 95% CI 1.03-1.19, P = .004, respectively), as did anteromedial portal drilling, when compared with the outside in approach for femoral drilling (1.19, 95% CI 1.16-1.23, P < .001). Conclusions Previous knee surgery, anteromedial femoral drilling, quadriceps tendon autograft, and meniscus tear were most associated with a delayed timeline for RTS among young athletes who were able to return. Level of Evidence Level IV, prognostic case series.
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Affiliation(s)
- Mark A Glover
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Jeffery D St Jeor
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Nihir Parikh
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Danielle E Rider
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Nicholas A Trasolini
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
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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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9
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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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10
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Dauty M, Le Mercier E, Menu P, Grondin J, Hirardot T, Daley P, Fouasson-Chailloux A. Prolonged Physiotherapy after Anterior Cruciate Ligament Reconstruction Does Not Improve Muscular Strength and Function. J Clin Med 2024; 13:2519. [PMID: 38731047 PMCID: PMC11084926 DOI: 10.3390/jcm13092519] [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: 01/29/2024] [Revised: 04/03/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background: After the rupture of the anterior cruciate ligament (ACL), surgery is proposed in the case of knee instability or for athletes who want to return to a pivotal and/or contact sport. The current trend is to extend physiotherapy sessions until a patient's return to sport. We aimed to assess the interest in prolonging the physiotherapy sessions up to 4 postoperative months to restore muscle knee strength and function. Methods: From a historical cohort, 470 patients (24.3 ± 8.7 years) were included; 312 (66%) were males. They all had undergone a primary ACL reconstruction with a hamstring procedure. The number of physiotherapy sessions was established at 4 postoperative months. The main study parameters to assess the benefit of prolonged physiotherapy were the isokinetic limb symmetry index (LSI) for the quadriceps and the hamstrings as well as the Lysholm score. Results: At 4 postoperative months, 148 patients (31.4%) still had physiotherapy sessions. This group had performed 49 ± 14 physiotherapy sessions at the time of evaluation compared to 33 ± 9 sessions performed by the group that stopped physiotherapy at 3 months post-ACL reconstruction. The isokinetic knee LSI and the Lysholm score were not different between the two groups. Continued physiotherapy sessions were associated with female gender, previous high sport level, meniscal repair, lateral tenodesis and outpatient rehabilitation at the beginning of the rehabilitation management, while knee pain complications were not associated. Conclusions: No significant correlation was found between the number of physiotherapy sessions and the knee strength LSI or the Lysholm score. Prolonging patient physiotherapy sessions after 3 months post-ACL reconstruction seems ineffective in improving knee strength recovery and function.
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Affiliation(s)
- Marc Dauty
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
| | - Emmanuel Le Mercier
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
| | - Pierre Menu
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
| | - Jérôme Grondin
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
| | - Thomas Hirardot
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
| | - Pauline Daley
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
| | - Alban Fouasson-Chailloux
- Physical Medicine and Rehabilitation, Sport Medicine Center, University Hospital of Nantes, CHU Nantes, 44093 Nantes, France; (M.D.); (E.L.M.); (P.M.); (T.H.)
- Institut Régional de Médecine du Sport des Pays de Loire (IRMS), 44093 Nantes, France;
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
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Ressman J, von Rosen P, Grooten WJA, Rasmussen-Barr E. Factors associated with the Single Leg Squat test in female soccer players: a cross-sectional study. BMC Sports Sci Med Rehabil 2024; 16:76. [PMID: 38566260 PMCID: PMC10985895 DOI: 10.1186/s13102-024-00853-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The Single Leg Squat (SLS) test is widely used in the clinical setting to examine and evaluate rehabilitation goals. It is simple to perform and is proposed to have biomechanical and neuromuscular similarities to athletic movements. The aim of the present study was to investigate whether demographics, previous injuries, and biomechanical and psychosocial factors are associated with the outcome of the SLS, assessed as a total score for all segments and as a separate knee segment in elite and sub-elite female soccer players. METHODS We conducted a cross-sectional study involving 254 female soccer players (22 yrs; SD ± 4, height 1.69 m; SD ± 0.1, weight 64 kg; SD ± 6) from divisions 1-3 of the Swedish Soccer League. During the preseason, we assessed the participants using the SLS and tested their hip strength and ankle mobility. Demographics, previous injury, sleep quality, fear of movement, anxiety, and perceived stress were assessed with questionnaires. Logistic regression models were built to analyse the association between the outcome of the SLS and the independent variables for the dominant and non-dominant leg. RESULTS Significantly more participants failed the SLS on the dominant leg compared with the non-dominant leg (p < 0.001). The outcome of the SLS associated with various biopsychosocial factors depending on if the dominant or non-dominant leg was tested. The total score associated with hip strength for the dominant (OR 0.99, 95% CI 0.98-0.99, p = 0.04) and the non-dominant leg (OR 0.99, 95% CI 0.97-0.99, p = 0.03). The knee segment associated with division level for the dominant (div 2; OR 2.34, 95% CI 1.01-5.12, p = 0.033. div 3; OR 3.07, 95% CI 1.61-5.85, p = 0.001) and non-dominant leg (div 2; OR 3.30, 95% CI 1.33-8.00, p = 0.01. div 3; OR 3.05, 95% CI 1.44-6.43, p = 0.003). CONCLUSIONS This study identified that leg dominance, division level, hip strength, and psychosocial factors were associated with the outcome of the SLS when assessed as a total score and as a separate knee segment. This indicates that clinicians need to understand that movement control is associated with factors from several domains. Whether these factors and, the results of the SLS are related to injury need to be studied prospectively. TRIAL REGISTRATION Clinical Trials Gov, date of registration 2022-03-01. CLINICAL TRIALS IDENTIFIER NCT05289284A.
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Affiliation(s)
- John Ressman
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Stockholm, 141 83, Sweden.
| | - Philip von Rosen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Stockholm, 141 83, Sweden
| | - Wilhelmus Johannes Andreas Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Stockholm, 141 83, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, Allied Health Professionals, Karolinska University Hospital, Stockholm, 141 86, Sweden
| | - Eva Rasmussen-Barr
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Stockholm, 141 83, Sweden
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12
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Borman A, Derman W, Grobbelaar H. Psychosocial experiences of competitive rugby players on the "long, long journey" to recovery following ACL ruptures and reconstruction. Scand J Med Sci Sports 2024; 34:e14604. [PMID: 38551139 DOI: 10.1111/sms.14604] [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: 05/29/2023] [Revised: 02/15/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024]
Abstract
Anterior Cruciate Ligament (ACL) injuries are serious and potentially career-ending. Reconstruction surgery and extended rehabilitation typically follow, but some athletes never attain the same level of sport performance. The psychosocial experiences of athletes who sustain ACL injuries and their cognitive appraisal, emotional and behavioral responses to the injury, and reconstruction require further attention during the different recovery phases. The aim is to explore these psychosocial experiences, social support needs and sources thereof of competitive athletes who sustained unilateral ACL ruptures and underwent reconstruction surgery. Semi-structured interviews with six competitive rugby players (M age: 22.3 ± 2.92 years), elicited information at seven time-points. We analyzed the qualitative information through thematic analysis. Five common themes emerged: (1) cognitive appraisal, (2) emotional responses (negative and positive affective responses), (3) behavioral responses, (4) social support needs and sources thereof, and (5) adversity-induced identity expansion (athletic and person-centered identities). In-vivo quotes gave a rich description of the athletes' experiences throughout the "long, long journey" to return-to-sport. These findings may sensitize and assist sports healthcare professionals, coaches, teammates, family, and friends to explore various psychosocial experiences throughout the injury and recovery period. Phase-appropriate psychosocial support or referral to sport psychology services is recommended to enhance the recovery process, improve long-term physical and mental health, and subsequent performance.
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Affiliation(s)
- Anel Borman
- Division of Sport Science, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Wayne Derman
- Division of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Heinrich Grobbelaar
- Division of Sport Science, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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DeFoor MT, Cognetti DJ, Bedi A, Carmack DB, Arner JW, DeFroda S, Ernat JJ, Frangiamore SJ, Nuelle CW, Sheean AJ. Patient Resilience Does Not Conclusively Affect Clinical Outcomes Associated With Arthroscopic Surgery but Substantial Limitations of the Literature Exist. Arthrosc Sports Med Rehabil 2024; 6:100812. [PMID: 38379604 PMCID: PMC10877194 DOI: 10.1016/j.asmr.2023.100812] [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: 03/12/2023] [Accepted: 09/13/2023] [Indexed: 02/22/2024] Open
Abstract
Purpose To determine whether low resilience is predictive of worse patient-reported outcomes (PROs) or diminished improvements in clinical outcomes after joint preserving and arthroscopic surgery. Methods A comprehensive search of PubMed, Medline, Embase, and Science Direct was performed on September 28, 2022, for studies investigating the relationship between resilience and PROs after arthroscopic surgery in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses guidelines. Results Nine articles (level II-IV studies) were included in the final analysis. A total of 887 patients (54% male, average age 45 years) underwent arthroscopic surgery, including general knee (n = 3 studies), ACLR-only knee (n = 1 study), rotator cuff repair (n = 4 studies), and hip (n = 1 study). The Brief Resilience Scale was the most common instrument measuring resilience in 7 of 9 studies (78%). Five of 9 studies (56%) stratified patients based on high, normal, or low resilience cohorts, and these stratification threshold values differed between studies. Only 4 of 9 studies (44%) measured PROs both before and after surgery. Three of 9 studies (33%) reported rates of return to activity, with 2 studies (22%) noting high resilience to be associated with a higher likelihood of return to sport/duty, specifically after knee arthroscopy. However, significant associations between resilience and functional outcomes were not consistently observed, nor was resilience consistently observed to be predictive of subjects' capacity to return to a preinjury level of function. Conclusions Patient resilience is inconsistently demonstrated to affect clinical outcomes associated with joint preserving and arthroscopic surgery. However, substantial limitations in the existing literature including underpowered sample sizes, lack of standardization in stratifying patients based on pretreatment resilience, and inconsistent collection of PROs throughout the continuum of care, diminish the strength of most conclusions that have been drawn. Level of Evidence Level IV, systematic review of level II-IV studies.
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Affiliation(s)
| | | | - Asheesh Bedi
- NorthShore University Health System, Skokie, Illinois
| | | | - Justin W. Arner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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14
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Petushek EJ, Diekfuss JA, Lamplot JD, Mørtvedt AI, Hoey LC, Heo K, Petit CB, Barber Foss KD, Warren SM, Slutsky-Ganesh AB, Kenyon CD, McPherson AL, Biller ME, Newsome M, Jennings B, Xerogeanes JW, Myer GD. Usefulness of Current Patient-Reported Outcome Scales for ACL Injury: A Mixed-Methods Evaluation of Stakeholder-Perceived Utility of Specific Constructs and Items Across the Rehabilitation Timeline. Orthop J Sports Med 2024; 12:23259671231218964. [PMID: 38784528 PMCID: PMC11113051 DOI: 10.1177/23259671231218964] [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: 05/09/2023] [Accepted: 06/29/2023] [Indexed: 05/25/2024] Open
Abstract
Background Numerous patient-reported outcome measures (PROMs) have been used in patients with anterior cruciate ligament reconstruction (ACLR), often with overlapping constructs of interest and limited content validity. Inefficient scale application increases burden and diminishes overall usefulness for both the patient and practitioner. Purpose To isolate specific PROM items across a diverse set of constructs that patients and practitioners perceive as having the greatest value at various stages of recovery and return to sport (RTS) in patients after ACLR. Study Design Cross-sectional study. Methods A combined 77 stakeholders participated in this 2-phase mixed-methods investigation. In phase 1, a total of 27 patients and 21 practitioners selected individual PROM items from various constructs that had the greatest utility or importance. In phase 2, the highest rated items were further tested in a head-to-head comparison with 29 stakeholders who attended the 2022 ACL Injury Research Retreat. In addition to the utility assessment, practitioners answered other questions related to importance and timing of PROM assessments. Results In phase 1, both patients and practitioners shared the same top item in 6 of the 8 (75%) constructs assessed. In phase 2, the construct of psychological burden was rated as "extremely important" by 59% of respondents, followed by physical function (54%), symptoms (35%), and donor site issues (10%). The PROM items of confidence, perceived likelihood of reinjury, and difficulty stopping quickly were rated by a respective 93%, 89%, and 86% of the sample as either "very useful" or "extremely useful." All constructs except donor site issues were rated by most stakeholders to be absolutely necessary to evaluate treatment progress and RTS readiness at the 6-month postoperative time and at RTS. Conclusion Overall, psychological burden, with specific items related to confidence and reinjury likelihood, were rated as most important and useful by both patients and practitioners. The second most important and useful PROM item was related to higher intensity function (eg, decelerating or jumping/landing activities during sports).
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Affiliation(s)
- Erich J. Petushek
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Jed A. Diekfuss
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Joseph D. Lamplot
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Anne-Inger Mørtvedt
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Lauren C. Hoey
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Kevin Heo
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Camryn B. Petit
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Kim D. Barber Foss
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Shayla M. Warren
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | | | - Charles D. Kenyon
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - April L. McPherson
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Michael E. Biller
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Michael Newsome
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Brian Jennings
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - John W. Xerogeanes
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
| | - Gregory D. Myer
- Investigation performed at Michigan Technological University, Houghton, Michigan, USA
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Sheean AJ, DeFoor MT, Spindler KP, Arner JW, Athiviraham A, Bedi A, DeFroda S, Ernat JJ, Frangiamore SJ, Nuelle CW, Sheean AJ, Spindler KP, Bedi A. The Psychology of ACL Injury, Treatment, and Recovery: Current Concepts and Future Directions. Sports Health 2024:19417381241226896. [PMID: 38374636 DOI: 10.1177/19417381241226896] [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: 02/21/2024] Open
Abstract
CONTEXT Interest in the relationship between psychology and the outcomes of anterior cruciate ligament (ACL) reconstruction (ACLR) continues to grow as variable rates of return to preinjury level of activity continue to be observed. EVIDENCE ACQUISITION Articles were collected from peer-reviewed sources available on PubMed using a combination of search terms, including psychology, resilience, mental health, recovery, and anterior cruciate ligament reconstruction. Further evaluation of the included bibliographies were used to expand the evidence. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS General mental health and wellbeing, in addition to a host of unique psychological traits (self-efficacy, resilience, psychological readiness and distress, pain catastrophizing, locus of control, and kinesiophobia) have been demonstrated convincingly to affect treatment outcomes. Moreover, compelling evidence suggests that a number of these traits may be modifiable. Although the effect of resilience on outcomes of orthopaedic surgical procedures has been studied extensively, there is very limited information linking this unique psychological trait to the outcomes of ACLR. Similarly, the available information related to other parameters, such as pain catastrophizing, is limited with respect to the existence of adequately sized cohorts capable of accommodating more rigorous and compelling analyses. A better understanding of the specific mechanisms through which psychological traits influence outcomes can inform future interventions intended to improve rates of return to preinjury level of activity after ACLR. CONCLUSION The impact of psychology on patients' responses to ACL injury and treatment represents a promising avenue for improving low rates of return to preinjury activity levels among certain cohorts. Future research into these areas should focus on specific effects of targeted interventions on known, modifiable risk factors that commonly contribute to suboptimal clinical outcomes. STRENGTH-OF-RECOMMENDATION TAXONOMY (SORT) B.
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Affiliation(s)
| | | | | | - Justin W Arner
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Asheesh Bedi
- NorthShore University Health System, Skokie, Illinois
| | | | | | | | | | | | | | - Asheesh Bedi
- NorthShore University Health System, Skokie, Illinois
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16
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Herman ZJ, Benvegnu NA, Dadoo S, Chang A, Scherer R, Nazzal EM, Özbek EA, Kaarre J, Hughes JD, Lesniak BP, Vyas D. Outcomes of bone-patellar tendon-bone autograft and quadriceps tendon autograft for ACL reconstruction in an all-female soccer player cohort with mean 4.8-year follow up. J ISAKOS 2024; 9:34-38. [PMID: 37952847 DOI: 10.1016/j.jisako.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The purpose is to compare functional outcomes, return to soccer rates, and revision rates in an all-female soccer player cohort undergoing quadriceps tendon (QT) autograft ACLR versus bone-patellar tendon-bone (BPTB) autograft ACLR. METHODS Female soccer players who sustained an ACL rupture and underwent primary anatomic, single-bundle ACLR with BPTB autograft or QT autograft were included. Demographic and surgical characteristics were collected. Outcomes of interest included Tegner score, International Knee Documentation Committee (IKDC) score, Marx score, return to soccer rates, and failure rates. RESULTS Data on 23 patients undergoing BPTB autograft ACLR and 14 undergoing QT autograft ACLR was available. Average age was 18.7 years, and average follow up was 4.8 years. Overall, 76 % (28/37) returned to soccer and 5.4 % (2/37) underwent revision ACLR. No major significant differences were found in demographic or surgical characteristics. No differences were found in postoperative IKDC scores, preoperative, postoperative, or change from pre-to postoperative Marx activity scores, or pre-and postoperative Tegner scores between the groups. QT autograft ACLR patients had significantly less change in Tegner scores pre-to postoperatively compared to the BTPB autograft ACLR group (0.6 ± 1.2 versus 2.1 ± 1.8; p = 0.02). Both groups had similar rates of return to soccer [78 % (18/23) BPTB autograft ACLR versus 71 % (10/14) QT autograft ACLR; p = 0.64] and rates of revision (8.7 % (2/23) BPTB autograft ACLR; 0 % (0/14) QT autograft ACLR. CONCLUSION Results of this study suggest that BPTB autograft ACLR and QT autograft ACLR produce comparable, successful functional and return to soccer outcomes in this all-female soccer player cohort study. Larger, prospective studies are needed to improve the strength of conclusions and provide more information on the optimal graft choice for female soccer players. Surgeons can use the results of this study to counsel female soccer players on expected outcomes after ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15203, USA
| | - Neilen A Benvegnu
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15203, USA
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15203, USA
| | - Audrey Chang
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Robert Scherer
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15203, USA
| | - Emre Anil Özbek
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15203, USA; Department of Orthopedics and Traumatology, Ankara University, Ankara 06100, Turkey
| | - Janina Kaarre
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg 43130, Sweden
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15203, USA.
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15203, USA
| | - Dharmesh Vyas
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15203, USA
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Abstract
Though research is inconclusive in being able to determine if young athletes are more or less likely to suffer from mental health disorders compared with their non-athlete peers, there are important psychological considerations that are unique to the athletic population. This includes depression in the context of overtraining and burnout, performance anxiety, perfectionism, psychological sequalae of concussion, and injury as an independent risk factor for depression, anxiety, post-traumatic stress, and high-risk behaviors. Optimization of mental health care in youth athletes requires continued efforts to improve mental health literacy, decrease stigma, encourage help-seeking behaviors, and advance the routine implementation of effective screening practices.
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Affiliation(s)
- Mary M Daley
- Department of Orthopaedic Surgery, Division of Sports Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Claudia L Reardon
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, 6001 Research Park Boulevard, Madison, WI 53719, USA
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Naderi A, Fallah Mohammadi M, Dehghan A, Baker JS. Psychosocial interventions seem redact kinesiophobia after anterior cruciate ligament reconstruction but higher level of evidence is needed: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5848-5855. [PMID: 37973676 DOI: 10.1007/s00167-023-07630-6] [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: 02/10/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Psychosocial interventions have shown potential in reducing the fear of re-injury after anterior cruciate ligament reconstruction (ACLR), but this has not been systematically reviewed. The aim of this study was to assess the available evidence on the effect of psychosocial interventions on kinesiophobia after ACLR. METHODS Two independent researchers conducted a systematic search in the electronic databases including Scopus, PubMed, Web of Science (WOS), SPORTDiscus, PsycINFO, and CINAHL from their inception until May 2022. They included studies that utilised a randomised controlled study design with a control group, and measured kinesiophobia using the Tampa Scale for kinesiophobia in patients who underwent primary ACLR. The outcome of interest was the mean and standard deviation of kinesiophobia. Extracted data were analysed using Comprehensive Meta-Analysis software, version 3.0 (CMA.V2), employing a random-effects model to calculate the overall effect estimates of psychosocial interventions on Kinesiophobia. The standardised mean difference with 95% confidence intervals (CIs) was computed based on the mean and standard deviation in each group. RESULTS This systematic review and meta-analysis included 5 randomised controlled trials with a total of 213 patients who underwent ACLR. The results of the meta-analysis showed that psychosocial intervention was more effective than non-psychosocial comparators in reducing kinesiophobia among patients who underwent a primary ACLR (5 trials, MD 0.56, 95% CI 0.28-0.83, p < 0.001). The heterogeneity score was zero (I2 = 0%; n.s. for Cochran's Q test), indicating no significant variation among the studies. CONCLUSIONS Psychosocial interventions can alleviate kinesiophobia in patients with primary ACLR. Although the limited number of reviewed studies and their methodological limitations precludes drawing a definitive conclusion regarding the effectiveness of psychosocial interventions on kinesiophobia, these promising findings can serve as a basis for developing psychological strategies to manage kinesiophobia in patients with primary ACLR and can also guide future research this issue. LEVEL OF EVIDENCE II. TRIAL REGISTRATION This trial is registered in PROSPERO on December 2021 (CRD42021282413).
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Affiliation(s)
- Aynollah Naderi
- Corrective Exercise and Sport Rehabilitation Lab, School of Sport Science, Shahrood University of Technology, Shahrood, Semnan, Iran.
| | - Mohammad Fallah Mohammadi
- Department of Sports Sciences, Faculty of Humanities, Higher Education Institute of Shafagh, Tonekabon, Iran
| | - Azizallah Dehghan
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Julien S Baker
- Research Centre for Population Health and Medical Informatics, Department of Sport and Physical Education, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
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Kaarre J, Herman ZJ, Grassi A, Hamrin Senorski E, Musahl V, Samuelsson K. Comparison of Improvement in Patient-Reported Knee Function After Revision and Multiple-Revision ACL Reconstruction Compared With Primary ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231217725. [PMID: 38145220 PMCID: PMC10748942 DOI: 10.1177/23259671231217725] [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: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 12/26/2023] Open
Abstract
Background Graft failure after anterior cruciate ligament reconstruction (ACLR) is a debilitating complication often requiring revision surgery. It is widely agreed upon that functional knee outcomes after revision ACLR (r-ACLR) are inferior compared with those after primary reconstruction. However, data are scarce on outcomes after multiple-revision ACLR (mr-ACLR). Purpose To compare patient-reported knee function in terms of Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and 1-year postoperatively after primary ACLR, r-ACLR, and mr-ACLR and evaluate the pre- to postoperative improvement in KOOS scores for each procedure. Study Design Cohort study; Level of evidence, 3. Methods Patients from the Swedish National Knee Ligament Registry who underwent their index ACLR between 2005 and 2020 with a minimum age of 15 years at the time of surgery were included in this study. All patients had pre- and postoperative KOOS data. The 1-year postoperative KOOS and the pre- to postoperative changes in KOOS were assessed between patients who underwent primary ACLR and those who underwent subsequent r-ACLR and mr-ACLR. Results Of 20,542 included patients, 19,769 (96.2%) underwent primary ACLR, 760 (3.7%) underwent r-ACLR, and 13 (0.06%) underwent mr-ACLR. Patients who underwent r-ACLR had significantly smaller pre- to postoperative changes on all KOOS subscales compared with patients undergoing primary ACLR (P < .0001 for all). Furthermore, patients in the mr-ACLR group had significantly smaller changes in the KOOS-Pain subscale compared with patients in the r-ACLR group (-9 ± 23.3 vs 2.5 ± 18; P = .024). Conclusion The study results indicated that while improvement is seen after primary ACLR, r-ACLR, and mr-ACLR, the greatest improvement in functional outcomes is observed after primary ACLR. Patients who underwent at least 1 r-ACLR, specifically mr-ACLR, had lower postoperative outcome scores, indicating that primary ACLR may provide the best chance for recovery after ACL injury.
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Affiliation(s)
- Janina Kaarre
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zachary J. Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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van Melick N, Sierevelt IN, Agricola R, Webster KE, Bogie R. The Dutch language short Anterior Cruciate Ligament-Return to Sport after Injury scale has good to excellent construct validity, internal consistency, and test-retest reliability when assessing athletes undergoing rehabilitation after ACL injury or ACL reconstruction. J ISAKOS 2023; 8:412-419. [PMID: 37499873 DOI: 10.1016/j.jisako.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To examine the validity and reliability of the Dutch language short Anterior Cruciate Ligament-Return to Sport after Injury scale (short ACL-RSI-NL) in recreational athletes undergoing rehabilitation after ACL injury or ACL reconstruction (ACLR). METHODS The original 12-item version of the ACL-RSI had been translated into Dutch. Short ACL-RSI-NL items were derived from this 12-item Dutch version. Content validity was evaluated by a team consisting of eight ACL experts and eight athletes. A cohort of 115 athletes with ACL injury or after ACLR completed the short ACL-RSI-NL and related questionnaires at various time points during their rehabilitation. Construct validity (hypothesis testing using Spearman correlations), internal consistency (Cronbach's alpha), floor and ceiling effects (percentage of athletes having the lowest or highest score possible), and structural validity (exploratory factor analysis) were evaluated in the entire ACL athlete group. Test-retest reliability (using intra-class correlation, ICC; standard error of measurement, SEM; smallest detectable change, SDC, at both group and individual levels) was investigated in a subgroup of athletes with a stable outcome on psychological readiness within a two-week interval (n = 27). RESULTS The short ACL-RSI-NL demonstrated good construct validity (83% of hypotheses confirmed). Internal consistency was excellent (Cronbach's alpha 0.84), and there were no floor and ceiling effects (≤13.9% lowest or highest score). Test-retest reliability was good (ICC 0.89 with 95% CI 0.77-0.95, SEM 6.93, SDC individual level 19.2, SDC group level 3.7). Exploratory factor analysis confirmed the presence of a single underlying factor (accounting for 56.4% of the total variance of the score). CONCLUSION The short ACL-RSI-NL exhibited good to excellent construct validity, internal consistency, and test-retest reliability. An averaged score ranging from 0 to 100 can be used to measure psychological readiness to return to sport. The short ACL-RSI-NL has potential for use in day-to-day practice to assess the psychological readiness of recreational athletes to return to sport after ACL injury or ACLR during their rehabilitation process. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Nicky van Melick
- Sports & Orthopedics Research Center, Anna Hospital, Geldrop, the Netherlands
| | - Inger N Sierevelt
- Orthopaedic Department, Xpert Clinics, Amsterdam, the Netherlands; Orthopaedic Department, Spaarne Gasthuis Academy, Hoofddorp, the Netherlands
| | - R Agricola
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Orthopedic Surgery, Anna Hospital, Geldrop, the Netherlands.
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Rob Bogie
- Sports & Orthopedics Research Center, Anna Hospital, Geldrop, the Netherlands; Department of Orthopedic Surgery, Anna Hospital, Geldrop, the Netherlands
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21
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Gibbs D, Mallory N, Hoge C, Jones G, Bishop J, Cvetanovich G, Rauck R. Psychological Factors That Affect Return to Sport After Surgical Intervention for Shoulder Instability: A Systematic Review. Orthop J Sports Med 2023; 11:23259671231207649. [PMID: 38035214 PMCID: PMC10686029 DOI: 10.1177/23259671231207649] [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: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 12/02/2023] Open
Abstract
Background Recent advances have begun to identify the nonphysical factors facilitating successful return to sport (RTS) after shoulder instability surgery, yet little is currently known regarding psychological factors and RTS. Purpose/Hypothesis The purposes of this study were to (1) identify psychological factors associated with RTS, (2) evaluate the prognostic utility of various psychological factors, and (3) evaluate the available metrics used to assess psychological RTS readiness. It was hypothesized that psychological factors would be identified as critical elements influencing a patient's RTS. Study Design Systematic review; Level of evidence, 4. Methods Clinical studies reporting on the psychological determinants of RTS for patients who had surgery for shoulder instability between 1996 and 2022 were identified from MEDLINE, Embase, and Cochrane databases. Demographic, clinical, and psychometric properties were extracted for pooled weighted analysis. Results Of the 969 studies screened, 24 (2.5%) met inclusion criteria. Overall, 2135 patients were included (mean age, 26.0 years; range, 17.4-35.5 years; 84.7% male). The mean time to RTS was 6.8 months (range, 3.7-11.9 months). There was a 76.3% rate of any RTS; of the 1212 patients who reported level of play at return, 305 (25.2%) were unable to perform at their prior level. Psychological reasons were cited by 85% (n = 360) of patients who did not RTS. Fear of reinjury was the most common reason (n = 154; 42.8%); other psychological factors included lack of confidence (n = 46; 12.8%), anxiety (n = 45; 12.5%), depression (n = 44; 12.2%), psychosocial factors (n = 48; 13.3%), and lack of motivation (n = 23; 6.4%). The Shoulder Instability Return to Sport after Injury, Western Ontario Shoulder Instability Index, Quick Inventory of Depressive Symptoms Self Report, Degree of Shoulder Involvement in Sports, Tampa Scale of Kinesiophobia-11, and Veterans Rand 12-Item Health Survey were reported measures for assessing psychology and RTS. Conclusion Fear of reinjury was found to be the most commonly reported impediment to RTS. The psychological characteristics identified through this review may be incorporated into future RTS protocols seeking to address resilience and nonphysical factors associated with RTS.
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Affiliation(s)
- David Gibbs
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Noah Mallory
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Connor Hoge
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Grant Jones
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julie Bishop
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gregory Cvetanovich
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ryan Rauck
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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22
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Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Pineda-Galán C, García-Rios MC, Torrontegui-Duarte M, Luque-Suarez A. Is it Possible to Reduce Pain-Related Fear in Individuals with Knee Osteoarthritis? a Systematic Review of Randomised Clinical Trials. Physiother Theory Pract 2023; 39:1106-1132. [PMID: 35200089 DOI: 10.1080/09593985.2022.2038743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 11/26/2021] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of different interventions in reducing pain-related fear outcomes in people with knee osteoarthritis who have or have not had previous knee surgery, and to analyze whether included trials reported their interventions in full detail. METHODS Systematic searches were carried out in the Cochrane CENTRAL, CINAHL, EMBASE, PEDro, PsycINFO, PubMed, and SPORTDiscus from the inception of the database up to November 2019. Searches were manually updated to July 2021. We included randomized clinical trials that evaluated pain-related fear outcomes as a primary or secondary outcome in adults with knee osteoarthritis. The Cochrane Risk of Bias Tool 2 and the GRADE approach evaluated the risk of bias and the certainty of the evidence, respectively. RESULTS Eighteen trials were included. Four trials evaluated pain-related fear as a primary outcome and all evaluated kinesiophobia in samples that had previously undergone a knee surgical procedure. These trials found that interventions based primarily on cognitive aspects (e.g. cognitive-behavioral principles) can be effective in reducing kinesiophobia. Trials evaluating pain-related fear as the secondary outcome also found that interventions that included cognitive aspects (e.g. pain neuroscience education) decreased the levels of pain-related fear (e.g. fear of falling or kinesiophobia) in patients with or without a previous knee surgery. However, serious to very serious risk of bias and imprecisions were found in included trials. Thus, the certainty of the evidence was judged as low and very low using the GRADE approach. All trials reported insufficient details to allow a complete replication of their interventions. CONCLUSIONS Interventions that include cognitive aspects may be the best option to reduce pain-related fear in people with knee osteoarthritis. However, we found a general low and very low certainty of the evidence and the findings should be considered with caution.
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Affiliation(s)
- Javier Martinez-Calderon
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Mar Flores-Cortes
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | - Jose Miguel Morales-Asencio
- Biomedical Research Institute of Malaga (Ibima), Spain
- Department of Nursing, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | | | | | | | - Alejandro Luque-Suarez
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
- Biomedical Research Institute of Malaga (Ibima), Spain
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23
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Return to Sport After Anterior Cruciate Ligament Reconstruction Requires Evaluation of >2 Functional Tests, Psychological Readiness, Quadriceps/Hamstring Strength, and Time After Surgery of 8 Months. Arthroscopy 2023; 39:790-801.e6. [PMID: 36216133 DOI: 10.1016/j.arthro.2022.08.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/14/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of this study was to examine the factors commonly used to determine readiness for return to sport (RTS) in the ACL reconstruction (ACL-R) patient population and assess which were most influential to successfully returning to sport and avoiding re-tear. METHODS The PUBMED, EMBASE and Cochrane Library databases were queried for studies related to RTS in ACL-R. Inclusion and exclusion criteria were applied to identify studies with greater than 1-year outcomes detailing the rate of return and re-tear given a described RTS protocol. Data of interest were extracted, and studies were stratified based on level of evidence and selected study features. Meta-analysis or subjective synthesis of appropriate studies was used to assess more than 25 potentially significant variables effecting RTS and re-tear. RESULTS After initial search of 1503 studies, 47 articles were selected for inclusion in the final data analysis, including a total of 1432 patients (31.4% female, 68.6% male). A meta-analysis of re-tear rate for included Level of Evidence 1 studies was calculated to be 2.8%. Subgroups including protocols containing a strict time until RTS, strength testing, and ≥2 dynamic tests demonstrated decreased RTS and re-tear heterogeneity from the larger group. Time to RTS, strength testing, dynamic functional testing, and knee stability were also found to be among the most prevalent reported criteria in RTS protocol studies. CONCLUSIONS This study suggests a multifactorial clinical algorithm for successful evaluation of RTS. The "critical criteria" recommended by the authors to be part of the postoperative RTS criteria include time since surgery of 8 months, use of >2 functional tests, psychological readiness testing, and quadriceps/hamstring strength testing in addition to the modifying patient factors of age and female gender. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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24
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Gajardo-Burgos R, Valdebenito-Tejos C, Gálvez-García G, Bascour-Sandoval C. Pain and Psychological Readiness to Return to Sport in Elite Volleyball Players: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2492. [PMID: 36767858 PMCID: PMC9915367 DOI: 10.3390/ijerph20032492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 06/18/2023]
Abstract
UNLABELLED Pain is modulated by multiple factors. A relevant psychological process peculiar to athletes and which could be associated with pain is Psychological Readiness to Return to Sport (PRRS). The analysis of this association in competition context is particularly important. OBJECTIVE To determine the correlation between the PRRS and pain intensity in elite volleyball players during their participation in a continental sporting event. METHODS A cross-sectional study was conducted. Data from 107 male volleyball players (23.50 ± 4.08 years of age) participating in the South American Volleyball Championship were used. The athletes answered a self-report questionnaire on the day the championship began regarding their history of injuries in the previous six months. The athletes who declared injuries were asked about the current pain intensity using the Pain Numeric Rating Scale (NRS) and Psychological Readiness to Return to Sport using the Injury-Psychological Readiness to Return to Sport scale (I-PRRS). RESULTS 43.93% (n = 47) of the athletes (23.70 ± 3.54 years) reported an injury in the six months prior to the championship. They presented a median on the NRS of three (interquartile range (IQR), 2-5), and 54 (IQR, 46-58) on the I-PRRS. The Spearman's Rho correlation test showed an inversely and moderate correlation (rs = -0.36; p = 0.011; CI: -0.64--0.08) between pain intensity and PRRS. CONCLUSIONS In male elite volleyball players who participate in a Continental Championship in South America, higher levels of PRRS was correlated to lower pain intensity.
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Affiliation(s)
- Rubén Gajardo-Burgos
- Instituto de Aparato Locomotor y Rehabilitación, Facultad de Medicina, Universidad Austral de Chile, Valdivia 5090000, Chile
- Programa de Magister en Terapia Física, Mención Musculoesquelética, Universidad de La Frontera, Avenida Francisco Salazar 01145, Temuco 4780000, Chile
| | - Camila Valdebenito-Tejos
- Dirección de Desarrollo Estudiantil, Universidad de La Frontera, Avenida Francisco Salazar 01145, Temuco 4780000, Chile
| | - Germán Gálvez-García
- Departamento de Psicología, Universidad de La Frontera, Avenida Francisco Salazar 01145, Temuco 4780000, Chile
- Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Campus Ciudad Jardín, Universidad de Salamanca, 37005 Salamanca, Spain
| | - Claudio Bascour-Sandoval
- Programa de Magister en Terapia Física, Mención Musculoesquelética, Universidad de La Frontera, Avenida Francisco Salazar 01145, Temuco 4780000, Chile
- Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Avenida Francisco Salazar 01145, Temuco 4780000, Chile
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25
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Guo Y, Li D, Wu YB, Sun X, Sun XY, Yang YP. Mobile health-based home rehabilitation education improving early outcomes after anterior cruciate ligament reconstruction: A randomized controlled clinical trial. Front Public Health 2023; 10:1042167. [PMID: 36711410 PMCID: PMC9877440 DOI: 10.3389/fpubh.2022.1042167] [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: 09/12/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Objective This study aimed to assess changes in joint range of motion (ROM) and knee joint function between patients who received the mobile health-based intervention and those who received regular care at 2 and 6 weeks after anterior cruciate ligament (ACL) reconstruction to provide better interventions in the future. Methods Patients who underwent ACL reconstruction were randomized into the experimental [Mobile health-based intervention (MHI); n = 62] and control (CON) groups (n = 63). The CON group underwent home-based rehabilitation exercise following the paper rehabilitation schedule, while the intervention group received additional mobile health-based education at weeks 1-6 after surgery. ROM, thigh circumference difference, and flexion pain were the primary outcomes. The secondary outcomes were the international knee documentation committee knee evaluation form (IKDC) scores and rehabilitation compliance scores. All the outcomes were measured 1 day before surgery as references and at 2 and 6 weeks after surgery. Results There was no statistical difference in the patients' ROM, thigh circumference difference, and VAS scores at the 2-week follow-up. At the 6-week follow-up, the ROM of the affected leg was (118.1 ± 20.5)° in the CON group and (126.6 ± 20.5)° in the MHI group, and the difference was statistically significant (P = 0.011). The difference in thigh circumference was 3.0 (2.0, 3.5) cm in the CON group and 2.5 (1.0, 3.0) cm in the MHI group. The difference was statistically significant (P < 0.001). The VAS score in the CON group was 3.0 (2.0, 4.0), and the MHI group was 2.5 (1.0, 3.0). The difference was statistically significant (P < 0.05). At the 6-week follow-up, the compliance score of patients in the MHI group was significantly higher than that in the CON group (P = 0.047, β = 2.243, 95%CI: 0.026-4.459). There is no statistically significant difference in IKDC scores. Conclusion Mobile health-based intervention positively affected patients undergoing ACL reconstruction surgery, particularly in improving the clinical outcome indicators of the knee joint.
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Affiliation(s)
- Yi Guo
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China,School of Public Health, Peking University Health Science Center, Beijing, China
| | - Dai Li
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yi-bo Wu
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China
| | - Xin Sun
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China
| | - Xin-ying Sun
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China,*Correspondence: Xin-ying Sun ✉
| | - Yu-ping Yang
- School of Public Health, Peking University Health Science Center, Beijing, China,Department of Sports Medicine, Peking University Third Hospital, Beijing, China,Yu-ping Yang ✉
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26
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Mir B, Vivekanantha P, Dhillon S, Cotnareanu O, Cohen D, Nagai K, de Sa D. Fear of reinjury following primary anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 31:2299-2314. [PMID: 36562808 DOI: 10.1007/s00167-022-07296-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE This review aims to elucidate the most commonly reported method to quantify fear of reinjury or kinesiophobia and to identify key variables that influence the degree of kinesiophobia following primary anterior cruciate ligament reconstruction (ACLR). METHODS A systematic search across three databases (Pubmed, Ovid (MEDLINE), and EMBASE) was conducted from database inception to August 7th, 2022. The authors adhered to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Quality assessment of the included studies was conducted according to the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS Twenty-six studies satisfied the inclusion criteria and resulted in 2,213 total patients with a mean age of 27.6 years and a mean follow-up time of 36.7 months post-surgery. The mean MINORS score of the included studies was 11 out of 16 for non-comparative studies and 18 out of 24 for comparative studies. Eighty-eight percent of included studies used variations of the Tampa Scale of Kinesiophobia (TSK) to quantify kinesiophobia and 27.0% used Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI). The results of this study shows a common association between higher kinesiophobia and poor patient-reported functional status measured using International Knee Documentation Committee (IKDC) Scores, Activity of Daily Living (ADL), Quality of Life (QOL), and Sports/Recreation (S/R) subscales of Knee Osteoarthritis and Outcome Score (KOOS) and Lysholm scores. Postoperative symptoms and pain catastrophizing measured using the KOOS pain and symptom subscales and Pain Catastrophizing Score (PCS) also influenced the degree of kinesiophobia following ACLR. Patients with an increased injury to surgery time and being closer to the date of surgery postoperatively demonstrated higher levels of kinesiophobia. Less common variables included being a female patient, low preoperative and postoperative activity status and low self-efficacy. CONCLUSION The most common methods used to report kinesiophobia following primary ACLR were variations of the TSK scale followed by ACL-RSI. The most commonly reported factors influencing higher kinesiophobia in this patient population include lower patient-reported functional status, more severe postoperative symptoms such as pain, increased injury to surgery time, and being closer to the date of surgery postoperatively. Kinesiophobia following primary ACLR is a critical element affecting post-surgical outcomes, and screening should be implemented postoperatively to potentially treat in rehabilitation and recovery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Basit Mir
- Ashford and St. Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey, UK
| | | | | | - Odette Cotnareanu
- Faculty of Arts and Science, Queen's University, Kingston, ON, Canada
| | - Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E14, Hamilton, ON, L8N 3Z5, Canada
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main Street West, 4E14, Hamilton, ON, L8N 3Z5, Canada.
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27
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Ohji S, Aizawa J, Hirohata K, Ohmi T, Mitomo S, Koga H, Yagishita K. Changes in subjective knee function and psychological status from preoperation to 6 months post anterior cruciate ligament reconstruction. J Exp Orthop 2022; 9:114. [DOI: 10.1186/s40634-022-00551-2] [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: 08/26/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract
Purpose
To determine characteristic changes in subjective knee function, kinesiophobia, and psychological readiness to return to sports between scores taken before anterior cruciate ligament reconstruction (ACLR) and those taken 6 months post-ACLR.
Methods
Thirty-two participants (median age, 20.0 years) were included. Subjective knee function was assessed using the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF). The Tampa Scale for Kinesiophobia (TSK-11) and Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) scale were used to evaluate kinesiophobia and psychological readiness to return to sport, respectively. Questionnaires were administered 1 day before surgery and at 6 months post-ACLR. A positive change was defined as an increase in IKDC-SKF and ACL-RSI scores and a decrease in TSK-11 score. The change in each score from pre-ACLR to 6 months post-ACLR was analyzed using a paired t-test. The percentage change in scores was calculated, and the correlations of the percentage change in the TSK-11 and ACL-RSI scores and that in the IKDC-SKF score were analyzed.
Results
All scores differed significantly positively from pre-ACLR to 6 months post-ACLR. The proportion of participants whose scores did not change positively from pre-ACLR to 6 months post-ACLR was higher for the TSK-11 (38.0%) and ACL-RSI (38.0%) than for the IKDC-SKF (6.3%). No correlation was observed between the percentage change in the IKDC-SKF score and that in the TSK-11 or ACL-RSI scores from pre-ACLR to 6 months post-ACLR.
Conclusions
Changes in subjective knee function and psychological status from pre-ACLR and 6 months post-ACLR may not be interdependent.
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Chava NS, Fortier LM, Verma N, Khan Z, Kerzner B, Dasari SP, Bedi A, Verma NN. Patients With Medicaid Insurance Undergoing Anterior Cruciate Ligament Reconstruction have Lower Postoperative International Knee Documentation Committee Scores and are Less Likely to Return to Sport Than Privately Insured Patients. Arthrosc Sports Med Rehabil 2022; 4:e1457-e1464. [PMID: 36033202 PMCID: PMC9402460 DOI: 10.1016/j.asmr.2022.05.005] [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: 03/07/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose Methods Results Conclusions Level of Evidence
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Affiliation(s)
- Neha S. Chava
- Department of Orthopaedic Surgery, Sports Medicine Division, Rush University Medical Center, Chicago, Illinois
| | - Luc M. Fortier
- Department of Orthopaedic Surgery, Sports Medicine Division, Rush University Medical Center, Chicago, Illinois
| | - Neil Verma
- Department of Orthopaedic Surgery, Sports Medicine Division, Rush University Medical Center, Chicago, Illinois
| | - Zeeshan Khan
- Department of Orthopaedic Surgery, Sports Medicine Division, Rush University Medical Center, Chicago, Illinois
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Sports Medicine Division, Rush University Medical Center, Chicago, Illinois
| | - Suhas P. Dasari
- Department of Orthopaedic Surgery, Sports Medicine Division, Rush University Medical Center, Chicago, Illinois
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, Sports Medicine Division, MedSport, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Nikhil N. Verma
- Department of Orthopaedic Surgery, Sports Medicine Division, Rush University Medical Center, Chicago, Illinois
- Address correspondence to Dr. Nikhil N. Verma, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612.
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Gokeler A, Grassi A, Hoogeslag R, van Houten A, Bolling C, Buckthorpe M, Norte G, Benjaminse A, Heuvelmans P, Di Paolo S, Tak I, Villa FD. Return to sports after ACL injury 5 years from now: 10 things we must do. J Exp Orthop 2022; 9:73. [PMID: 35907095 PMCID: PMC9339063 DOI: 10.1186/s40634-022-00514-7] [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: 04/23/2022] [Accepted: 07/19/2022] [Indexed: 11/11/2022] Open
Abstract
Background The outcome after ACL reconstruction (ACLR) is in general disappointing with unacceptable number of athletes that do not return to pre-injury level of sports, high re-injury rates, early development of osteoarthritis and shorter careers. Athletes after ACLR have high expectation to return to sports which is in contrast with the current outcomes. The aim of this manuscript is to present an overview of factors that are needed to be incorporated and to personalize the rehabilitation process for an athlete who has undergone an ACLR. Level of evidence 4.
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Affiliation(s)
- Alli Gokeler
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, The Netherlands. .,Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam Collaboration On Health and Safety in Sports, Amsterdam UMC, Amsterdam, Netherlands. .,Department Exercise and Health, Faculty of Science, Exercise Science and Neuroscience, Paderborn University, Paderborn, Germany.
| | | | - Roy Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, The Netherlands
| | - Albert van Houten
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, The Netherlands
| | - Caroline Bolling
- Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam Collaboration On Health and Safety in Sports, Amsterdam UMC, Amsterdam, Netherlands
| | - Matthew Buckthorpe
- Allied Health and Performance Science, St Mary's University, Twickenham, London, England
| | - Grant Norte
- Exercise Science Program, School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, USA
| | - Anne Benjaminse
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,School of Sport Studies, Hanze University Groningen, Groningen, the Netherlands
| | - Pieter Heuvelmans
- Department Exercise and Health, Faculty of Science, Exercise Science and Neuroscience, Paderborn University, Paderborn, Germany
| | - Stefano Di Paolo
- Dipartimento Di Scienze Biomediche E Neuromotorie DIBINEM, Università Di Bologna, Bologna, BO, Italy
| | - Igor Tak
- Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam Collaboration On Health and Safety in Sports, Amsterdam UMC, Amsterdam, Netherlands.,Sports Physical, Therapy Clinic Fysiotherapie Utrecht Oost, Utrecht, The Netherlands
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Center of Excellence, Bologna, Italy
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de Queiroz JHM, Murakawa YAB, de Castro SS, Almeida GPL, de Oliveira RR. Biopsychosocial Model Domains in Clinical Practice Guidelines for Return to Sport After ACL Injury: Systematic Review Using the AGREE II Checklist. Sports Health 2022; 15:165-175. [PMID: 35581734 PMCID: PMC9951001 DOI: 10.1177/19417381221094582] [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: 11/16/2022] Open
Abstract
CONTEXT The current status of return-to-sport (RTS) criteria can be understood from the International Classification of Functioning, Disability, and Health (ICF), which emphasizes an individual-centered approach and inclusion of all domains of human functioning, and ensures the multifactorial and biopsychosocial nature of decision-making. OBJECTIVE To analyze the inclusion of biopsychosocial model domains in clinical practice guidelines (CPGs) for RTS after anterior cruciate ligament (ACL) injury, as well as the quality of these CPGs. STUDY DESIGN Systematic review of CPGs. LEVEL OF EVIDENCE Level 1. SEARCH STRATEGY Two independent reviewers developed the search strategy, and a third reviewer corrected and compiled the developed strategies used. DATA SOURCES Ovid/Medline, Embase, and PEDro without restriction dates. STUDY SELECTION CPGs for RTS after ACL injury at any age or sport level, and published in English. DATA EXTRACTION Two independent reviewers codified the RTS criteria recommended in the CPGs according to the ICF domains, and the Appraisal of Guidelines for Research and Evaluation II (AGREE II Checklist) was used for critical appraisal. RESULTS A total of 715 records were identified, and 7 CPGs were included. Frequency distribution of the biopsychosocial model domains was as follows: body functions (37.77%), activity and participation (20.00%), body structure (13.33%), environmental factors (11.11%), and personal factors (8.88%). In the AGREE II Checklist, the lowest mean domain scores were for rigor of development (37.86 ± 36.35) and applicability (49.29 ± 22.30), and 71.42% were of low or moderate quality. CONCLUSION The CPGs cannot address the biopsychosocial model domains satisfactorily and some do not address all the ICF conceptual model components, emphasizing body functions and activity and participation domains. Therefore, the functioning model advocated by the World Health Organization has not yet been adequately incorporated into the recommendations for RTS after ACL injury. Moreover, most CPGs are of limited quality.
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Affiliation(s)
- Jeffeson Hildo Medeiros de Queiroz
- Tendon Research Group, Master Program
in Physical Therapy and Functioning Physical Therapy Department, Federal University
of Ceará, Fortaleza, CE, Brazil
| | - Yanka Aparecida Bandeira Murakawa
- Tendon Research Group, Master Program
in Physical Therapy and Functioning Physical Therapy Department, Federal University
of Ceará, Fortaleza, CE, Brazil
| | - Shamyr Sulyvan de Castro
- Master Program in Physical Therapy and
Functioning, Public Health Post Graduate Program, Physical Therapy Department,
Federal University of Ceará, Fortaleza, CE, Brazil
| | - Gabriel Peixoto Leão Almeida
- Knee and Sports Research Group, Master
Program in Physical Therapy and Functioning, Physical Therapy Department, Federal
University of Ceará, Fortaleza, CE, Brazil
| | - Rodrigo Ribeiro de Oliveira
- Tendon Research Group, Master Program
in Physical Therapy and Functioning Physical Therapy Department, Federal University
of Ceará, Fortaleza, CE, Brazil,Rodrigo Ribeiro de
Oliveira, PhD, Tendon Research Group, Physical Therapy Department, Federal
University of Ceará, Alexandre Baraúna 949, Physical Therapy Department, Rodolfo
Teófilo, Fortaleza, Ceará, Brazil ()
(Twitter: @ROliveira_fisio)
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van Melick N, Pronk Y, Nijhuis-van der Sanden M, Rutten S, van Tienen T, Hoogeboom T. Meeting movement quantity or quality return to sport criteria is associated with reduced second ACL injury rate. J Orthop Res 2022; 40:117-128. [PMID: 33650704 DOI: 10.1002/jor.25017] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 02/04/2023]
Abstract
The purposes of this prospective cohort study were (1) to assess if second anterior cruciate ligament (ACL) injury rate 2 years after ACL reconstruction (ACLR) in those who returned to pivoting sport was associated with meeting (a) quantitative return to sport (RTS) criteria, (b) qualitative RTS criteria, and (c) combined quantitative and qualitative RTS criteria, and (2) to determine why athletes did not return to their preinjury (level of) sport. Athletes after ACLR performed RTS tests immediately before RTS: seven movement quantity (strength and hop test battery) and two movement quality (countermovement jump with LESS score and hop-and-hold test) tests. A 2-year postoperative questionnaire asked for RTS, reasons for not returning to the same (level of) sport and second ACL injuries. One hundred and forty-four athletes (82%) completed the questionnaire and 97 of them returned to a pivoting sport. Seven of these athletes had a second ACL injury. Meeting the hop test battery RTS criterion (absolute risk reduction 11%; p = .047) and hop-and-hold test RTS criterion (absolute risk reduction 15%; p = .031) were both significantly associated with a reduced second ACL injury rate. Meeting combined RTS criteria were not significantly associated with second ACL injury rate. Therefore, RTS tests after ACLR should at least comprise a hop test battery or the hop-and-hold test to reduce second ACL injury risk after return to pivoting sport. Also, one-third of all athletes mentioned fear of reinjury as the main reason for not returning to their preinjury (level of) sport. This psychological component should be taken seriously and discussed during rehabilitation.
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Affiliation(s)
- Nicky van Melick
- Research Department, Kliniek ViaSana, Mill, The Netherlands.,KneeSearch, Heesch, The Netherlands
| | - Yvette Pronk
- Research Department, Kliniek ViaSana, Mill, The Netherlands
| | - Maria Nijhuis-van der Sanden
- Research Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sebastiaan Rutten
- Department of Orthopedic Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Tony van Tienen
- Department of Orthopedic Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - Thomas Hoogeboom
- Research Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Fares MY, Khachfe HH, Salhab HA, Bdeir A, Fares J, Baydoun H. Physical Testing in Sports Rehabilitation: Implications on a Potential Return to Sport. Arthrosc Sports Med Rehabil 2022; 4:e189-e198. [PMID: 35141551 PMCID: PMC8811492 DOI: 10.1016/j.asmr.2021.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/29/2021] [Indexed: 10/26/2022] Open
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Woon EL, Low J, Sng YL, Hor AB, Pua YH. Feasibility, correlates, and validity of the one-leg sit-to-stand test in individuals following anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 52:280-286. [PMID: 34700261 DOI: 10.1016/j.ptsp.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Regular quadriceps strength assessment is important following anterior cruciate ligament reconstruction (ACLR). The one-leg sit-to-stand (OLSTS) test potentially overcomes the barrier of accessibility to specialised testing equipment. However, feasibility and validity testing of OLSTS is lacking in the ACLR population. This study aims to examine the feasibility, correlates, and predictive validity of OLSTS with self-reported running and jumping difficulty in individuals post-ACLR. DESIGN Retrospective longitudinal study. METHODS 20 patients with primary unilateral ACLR were tested at 6-months and 1-year post-ACLR. Feasibility was assessed by the number of patients who had safely performed OLSTS at both timepoints. Cross-sectional gender-adjusted Spearman correlations of OLSTS with quadriceps strength, physical impairments, and psychological variables were measured at 6-months. Predictive validity was assessed via ordinal regression, quantifying the associations of OLSTS with self-reported running and jumping difficulty across time-points. RESULTS All patients understood the instructions to and were able to self-administer the OLSTS test safely. OLSTS is a valid measure of quadriceps strength (gender-adjusted Spearman's ρ = 0.53, P = 0.02). Knee pain (ρ = 0.44, P = 0.046) and readiness to return-to-sport (ρ = 0.55, P = 0.02) were additional correlates. Greater OLSTS performance was associated with greater odds of better self-reported running and jumping function (interquartile-range ORs, 12.0 [95% CI: 3.6-45] and 18.5 [95% CI: 5-67], respectively). CONCLUSION OLSTS is a feasible and valid test of quadriceps strength, demonstrating predictive validity with self-reported running and jumping post-ACLR. OLSTS potentially allows independent tracking of ACLR rehabilitation progress at home - an increasingly urgent necessity in the face of a global pandemic.
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Affiliation(s)
- Ee-Lin Woon
- Department of Physiotherapy, Singapore General Hospital, Singapore.
| | - Juanita Low
- Department of Physiotherapy, Singapore General Hospital, Singapore.
| | - Yee-Ling Sng
- Department of Health and Social Sciences, Singapore Institute of Technology, Singapore.
| | - Aaron Bingqian Hor
- Department of Health and Social Sciences, Singapore Institute of Technology, Singapore.
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore; Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore.
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Xue X, Li S, Li H, Li Q, Hua Y. Deactivation of the dorsal anterior cingulate cortex indicated low postoperative sports levels in presurgical patients with chronic ankle instability. BMC Sports Sci Med Rehabil 2021; 13:121. [PMID: 34627368 PMCID: PMC8501719 DOI: 10.1186/s13102-021-00353-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 09/30/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Injury-related fear contributed to disability in chronic ankle instability (CAI), while there still lacked exploration on the appraisal processes of the injury-related stimuli. This study aimed to compare the neural activities of the appraisal processes of sprain-related stimuli between presurgical chronic ankle instability patients and healthy controls through functional magnetic resonance imaging (fMRI) and evaluate its relationships with the clinical outcomes of orthopedic surgeries. METHODS Eighteen presurgical CAI patients and fourteen healthy controls were recruited and underwent an fMRI session with visual stimulation of movies that showing typical ankle sprains accidents or control videos and the corresponding fear ratings. The clinical outcomes were collected at baseline and a minimum of 2 years after surgery; these included the American Orthopaedic Foot and Ankle Society (AOFAS) scores, the Numeric Rating Scale (NRS) scores, and the Tegner Activity Rating Scale scores. The two-sample t-test would be applied to identify which brain regions were influenced by CAI, and the correlation analysis would be applied to measure the relationship between the activation and clinical outcomes. RESULTS Dorsal anterior cingulate cortex (dACC) was deactivated in CAI patients when compared with healthy controls, and the dACC deactivation strength revealed a moderate correlation with the values of fear ratings for all participants. The deactivation strength was negatively correlated with AOFAS at baseline, with Tegner at follow-up and its improvement. CONCLUSIONS Presurgical CAI patients presented deactivated dACC as a different neural activity of appraisal processes of sprain-related stimuli when compared with healthy controls, which was associated with lower postoperative sports levels. More comprehensive patients care including psychological interventions were needed in the clinical management of chronic ankle instability.
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Affiliation(s)
- Xiao'ao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Shengkun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Qianru Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
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Abstract
The psychosocial benefits of participating in sports have long been appreciated. However, athletes are often faced with circumstances that make them susceptible to psychological challenges unique to the athletic population. One such circumstance is injury in sport, which can be a source of notable distress and may precipitate the emergence of new or exacerbation of underlying psychological disorders. In athletes who are injured, particularly those undergoing surgical intervention, psychological factors play a substantial role in the recovery process. A more comprehensive understanding of the complex interplay between psychological and physical health in the setting of an injury is essential to optimize patient care. The aim of this review was to highlight the impact of psychological factors on measurable outcomes after orthopaedic surgical interventions and to explore interventions that can be implemented to improve surgical outcomes and the overall care of injured athletes.
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Mid-term outcomes of anterior cruciate ligament reconstruction across age groups: A national database study. J Orthop 2021; 23:150-154. [PMID: 33551608 DOI: 10.1016/j.jor.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to examine the impact of age on complication risk after anterior cruciate ligament reconstruction. Methods The TriNetX research database was retrospectively queried for patients undergoing primary arthroscopic ACL reconstruction. Univariate logistic regression was performed to evaluate the risk of complication by age group. Results A total of 21,449 patients were included in the study. Patients ≥61 years old demonstrated significantly higher rates of repeat reconstruction. Rates of postoperative opioid related disorders and surgical site infection varied by age. Conclusion For patients undergoing ACL reconstruction, increasing age is associated with increased risk of developing opioid related disorders, and repeat reconstruction.
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Low correlation between functional performance and patient reported outcome measures in individuals with non-surgically treated ACL injury. Phys Ther Sport 2021; 47:185-192. [DOI: 10.1016/j.ptsp.2020.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
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Peterson JG, Tjong VK, Mehta MP, Goyette BN, Patel M, Kadakia AR. A qualitative assessment of return to sport following Achilles tendon repair. J Orthop 2020; 23:46-51. [PMID: 33456215 DOI: 10.1016/j.jor.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023] Open
Abstract
Studies have demonstrated successful return to sport rates following Achilles tendon rupture and repair. The purpose of this study is to understand the subjective intrinsic and extrinsic motivational factors influencing an athlete's return to pre-injury level of sport following Achilles tendon repair. Qualitative, semi-structured interviews of 23 athletes who had undergone Achilles tendon repair were conducted and analyzed to derive codes, categories, and themes. Three major themes affecting return to sport were elucidated from the interviews: personal motivation, shift in focus, and confidence in healthcare team. These findings can direct healthcare teams on how to better guide patients post-operatively.
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Affiliation(s)
- Joshua G Peterson
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Mitesh P Mehta
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Bailey N Goyette
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Milap Patel
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Anish R Kadakia
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
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