1
|
Bøe B. Nonoperative Anterior Cruciate Ligament Injury Treatment. Clin Sports Med 2024; 43:343-354. [PMID: 38811114 DOI: 10.1016/j.csm.2023.08.003] [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
This article outlines the key points in the nonoperative treatment of an anterior cruciate ligament (ACL) injury. Initial evaluation and treatment of an acute knee injury, often performed by a physician with limited experience in the treatment of an ACL injury, follow the basic diagnostic workup that lead to the diagnosis. The principles of rehabilitation after ACL injury have changed from time based to criteria based, and the different phases based on physical criteria are described.
Collapse
Affiliation(s)
- Berte Bøe
- Division of Orthopaedics, Oslo University Hospital, Ullevål Sykehus, Postboks 4956, Nydalen, Oslo 0424.
| |
Collapse
|
2
|
Tondelli E, Feroldi A, García F, Meza F, Dingenen B. Rehabilitation and return-to-sport after anterior cruciate ligament injury and reconstruction: Exploring physical therapists' approaches in Argentina. Phys Ther Sport 2024; 67:131-140. [PMID: 38703448 DOI: 10.1016/j.ptsp.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To investigate the current clinical practice regarding pre- and post-surgical rehabilitation and return to sport (RTS) criteria following anterior cruciate ligament reconstruction (ACLR). DESIGN Cross-sectional design. Online survey. SETTING Survey platform. PARTICIPANTS Argentinian physical therapists (PTs). OUTCOME MEASURES The survey consisted of a combination of 39 open- and closed-ended questions, divided across 3 sections: (1) demographic and professional information, (2) clinical practice and rehabilitation strategies, and (3) return-to-running (RTR) and RTS. RESULTS A total of 619 PTs completed the survey. Considerable variability was observed in preoperative rehabilitation, criteria used for rehabilitation progression and RTS decision-making criteria used by PTs. From the total surveyed, 336 (54.3%) carried out RTS assessment in their clinical practice. Most of PTs (53.3%) use visual estimation to assess knee range of motion. Only 20% of the PTs reported incorporating patient-reported outcome measures in their decision-making. From PTs who use strength assessment as a criterion of RTS (68.8%), 16.6% extrapolate this from jump tests and 15.3% use manual muscle testing. Less than the 50% of the PTs recommended nine months or more to allow patients to RTS. CONCLUSIONS Current rehabilitation practices of Argentinian PTs following ACLR are largely variable and not aligned with current evidence and scientific guidelines. To achieve better rehabilitation and RTS practices better knowledge dissemination and implementation are required.
Collapse
Affiliation(s)
- Eduardo Tondelli
- Sport Physiotherapy, Faculty of Medical Sciences, Pontifical Catholic University of Argentina, Buenos Aires, Argentina; Sport Physiotherapy (CPC), School of Physiotherapy, Faculty of Medical Sciences, University of Buenos Aires, Buenos Aires, Argentina.
| | - Alejo Feroldi
- Sport Physiotherapy (CPC), School of Physiotherapy, Faculty of Medical Sciences, University of Buenos Aires, Buenos Aires, Argentina; Functional Anatomy and Biomechanics, Faculty of Medical Sciences, Favaloro University, Buenos Aires, Argentina
| | - Felipe García
- Sport Physiotherapy (CPC), School of Physiotherapy, Faculty of Medical Sciences, University of Buenos Aires, Buenos Aires, Argentina; New Performance Argentina Athletic Center, Buenos Aires, Argentina
| | - Franco Meza
- Sport Physiotherapy (CPC), School of Physiotherapy, Faculty of Medical Sciences, University of Buenos Aires, Buenos Aires, Argentina; Physical Therapy and Medical Department, Club Atlético Huracán, Buenos Aires, Argentina
| | - Bart Dingenen
- Reval Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
3
|
Urhausen AP, Grindem H, H. Ingelsrud L, Roos EM, Silbernagel KG, Snyder-Mackler L, Risberg MA. Patient Acceptable Symptom State Thresholds for IKDC-SKF and KOOS at the 10-Year Follow-up After Anterior Cruciate Ligament Injury: A Study From the Delaware-Oslo ACL Cohort. Orthop J Sports Med 2024; 12:23259671241250025. [PMID: 38827138 PMCID: PMC11143835 DOI: 10.1177/23259671241250025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/16/2023] [Indexed: 06/04/2024] Open
Abstract
Background Clinicians need thresholds for the Patient Acceptable Symptom State (PASS) and Treatment Failure to interpret group-based patient-reported outcome measures after anterior cruciate ligament (ACL) injury. Validated thresholds that are crucial for accurately discerning patient symptom state and facilitating effective interpretation have not been determined for long-term follow-up after ACL injury. Purpose To calculate and validate thresholds for PASS and Treatment Failure for the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales at the 10-year follow-up after ACL injury. Study Design Cohort study; Level of evidence, 3. Methods A total of 163 participants with unilateral ACL injury (treated with reconstruction or rehabilitation alone) from the Delaware-Oslo ACL Cohort were included. Thresholds for PASS were calculated for IKDC-SKF and KOOS subscales using anchor-based predictive modeling and receiver operating characteristic (ROC) analysis. Too few participants had self-reported Treatment Failure to calculate thresholds for that outcome. Nonparametric bootstrapping was used to derive 95% CIs. The criterion validity of the predictive modeling and ROC-derived thresholds were assessed by comparing actual patient-reported PASS outcome with the calculated PASS outcome for each method of calculation and calculating their positive and negative predictive values with respect to the anchor questions. Results A total of 127 (78%) participants reported satisfactory symptom state. Predictive modeling PASS thresholds (95% CIs) were 76.2 points (72.1-79.4 points) for IKDC-SKF, 85.4 points (80.9-89.2 points) for KOOS Pain, 76.5 points (67.8-84.7 points) for KOOS Symptoms, 93.8 points (90.1-96.9 points) for KOOS activities of daily living, 71.6 points (63.4-77.7 points) for KOOS Sports, and 59.0 points (53.7-63.9 points) for KOOS quality of life (QoL). Predictive modeling thresholds classified 81% to 93% of the participants as having satisfactory symptom state, whereas ROC-derived thresholds classified >50% as unsatisfied. The thresholds for IKDC-SKF, KOOS Sports, and KOOS QoL resulted in the most accurate percentages of PASS among all identified thresholds and therefore demonstrate the highest validity. Conclusion Predictive modeling provided valid PASS thresholds for IKDC-SKF and KOOS at the 10-year follow-up after ACL injury. The thresholds for IKDC-SKF, KOOS Sports, and KOOS QoL should be used when determining satisfactory outcomes. ROC-derived thresholds result in substantial misclassification rates of the participants who reported satisfactory symptom state.
Collapse
Affiliation(s)
- Anouk P. Urhausen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hege Grindem
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Lina H. Ingelsrud
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Ewa M. Roos
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Lynn Snyder-Mackler
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - May Arna Risberg
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
4
|
Wenning M, Mauch M, Heitner AH, Bode G, Sofack G, Ritzmann R. Early ACL reconstruction shows an improved recovery of isokinetic thigh muscle strength compared to delayed or chronic cases. Arch Orthop Trauma Surg 2023; 143:5741-5750. [PMID: 37052664 PMCID: PMC10450006 DOI: 10.1007/s00402-023-04863-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/26/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION The recovery of periarticular strength is a major criterion in return-to-play testing. The rationale of the study was to assess the impact of the delay of surgery (∆ between injury and surgery) on knee extensor and knee flexor strength of anterior cruciate ligament (ACL)-deficient patients six months after reconstruction. MATERIALS AND METHODS In a retrospective cohort study, all patients with ACL ruptures between 03/2015 and 12/2019 were analyzed. Inclusion criteria were isolated ACL rupture without any associated lesions undergoing a reconstruction using ipsilateral hamstring tendon autograft and adherence to isokinetic strength testing before and at 5-7 months postoperatively. These patients were then clustered into three groups: EARLY reconstruction (∆ < 42 days), DELAYED reconstruction (∆42-180d), and CHRONIC (∆ > 180d). Knee extensor and flexor strength of the ipsi- and contralateral leg were analyzed by concentric isokinetic measurement (60°/s). Primary outcomes were the maximal knee extension and flexion torque, hamstrings-to-quadriceps ratio (H/Q) ratio), and the corresponding limb symmetry indices. RESULTS n = 444 patients met the inclusion criteria. From EARLY to DELAYED to CHRONIC, a progressive reduction in postoperative strength performance was observed in knee extension (1.65 ± 0.45 to 1.62 ± 0.52 to 1.51 ± 0.5 Nm/kg resp.) and flexion (1.22 ± 0.29 to 1.18 ± 0.3 to 1.13 ± 0.31 Nm/kg resp.) strength on the ACL reconstructed leg. This general loss in periarticular strength was already apparent in the preoperative performance even on the healthy side. When controlling for the preoperative performance using ANCOVA analysis, EARLY performed significantly better than DELAYED (extension p = 0.001, flexion p = .02) and CHRONIC (extension p = 0.005, flexion p < 0.001). Also, there were significantly higher values for H/Q ratio in the injured leg across all groups where the H/Q ratio increased from EARLY to CHRONIC and from pre- to postoperative values. CONCLUSIONS With respect to the force generating capacity when returning-to-play, it is advantageous to seek for an early ACL reconstruction within the first 12 weeks after the injury. The increasing loss of thigh muscle strength observed in delayed or chronic cases affects the injured and also the non-injured leg. LEVEL OF EVIDENCE III, retrospective cohort study.
Collapse
Affiliation(s)
- Markus Wenning
- Rennbahnklinik, Kriegackerstr. 100, 4132 Muttenz, BL Switzerland
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, University Medical Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Marlene Mauch
- Rennbahnklinik, Kriegackerstr. 100, 4132 Muttenz, BL Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | | | - Gerrit Bode
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, University Medical Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Praxisklinik 2000, Wirthstr. 11, 79100 Freiburg, Germany
| | - Ghislain Sofack
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Zinkmattenstr. 6a, 79108 Freiburg, Germany
| | - Ramona Ritzmann
- Institute of Sport and Sport Science, Department of Motor Control, University of Freiburg, Freiburg, Germany
| |
Collapse
|
5
|
Saueressig T, Braun T, Steglich N, Diemer F, Zebisch J, Herbst M, Zinser W, Owen PJ, Belavy DL. Primary surgery versus primary rehabilitation for treating anterior cruciate ligament injuries: a living systematic review and meta-analysis. Br J Sports Med 2022; 56:1241-1251. [PMID: 36038357 DOI: 10.1136/bjsports-2021-105359] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Compare the effectiveness of primarily surgical versus primarily rehabilitative management for anterior cruciate ligament (ACL) rupture. DESIGN Living systematic review and meta-analysis. DATA SOURCES Six databases, six trial registries and prior systematic reviews. Forward and backward citation tracking was employed. ELIGIBILITY CRITERIA Randomised controlled trials that compared primary reconstructive surgery and primary rehabilitative treatment with or without optional reconstructive surgery. DATA SYNTHESIS Bayesian random effects meta-analysis with empirical priors for the OR and standardised mean difference and 95% credible intervals (CrI), Cochrane RoB2, and the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence. RESULTS Of 9514 records, 9 reports of three studies (320 participants in total) were included. No clinically important differences were observed at any follow-up for self-reported knee function (low to very low certainty of evidence). For radiological knee osteoarthritis, we found no effect at very low certainty of evidence in the long term (OR (95% CrI): 1.45 (0.30 to 5.17), two studies). Meniscal damage showed no effect at low certainty of evidence (OR: 0.85 (95% CI 0.45 to 1.62); one study) in the long term. No differences were observed between treatments for any other secondary outcome. Three ongoing randomised controlled trials were identified. CONCLUSIONS There is low to very low certainty of evidence that primary rehabilitation with optional surgical reconstruction results in similar outcome measures as early surgical reconstruction for ACL rupture. The findings challenge a historical paradigm that anatomic instability should be addressed with primary surgical stabilisation to provide optimal outcomes. PROSPERO REGISTRATION NUMBER CRD42021256537.
Collapse
Affiliation(s)
- Tobias Saueressig
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | - Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, North Rhine-Westphalia, Germany.,HSD Hochschule Döpfer (University of Applied Sciences), Cologne, North Rhine-Westphalia, Germany
| | - Nora Steglich
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, North Rhine-Westphalia, Germany
| | | | - Jochen Zebisch
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | - Maximilian Herbst
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | | | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Daniel L Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, North Rhine-Westphalia, Germany
| |
Collapse
|
6
|
Allahabadi S, Mittal A, Coughlan MJ, Kim AE, Hung NJ, Pandya NK. Outcomes, Including Graft Tears, Contralateral Anterior Cruciate Ligament Tears, and All-Cause Ipsilateral Knee Operations, are Similar for Adult-type, Transphyseal, and Partial Transphyseal Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft in Pediatric and Adolescent Patients. Arthrosc Sports Med Rehabil 2022; 4:e1465-e1474. [PMID: 36033172 PMCID: PMC9402463 DOI: 10.1016/j.asmr.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/22/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco
| | - Ashish Mittal
- San Francisco Orthopedic Residency Program, St. Mary’s Medical Center, San Francisco
| | - Monica J. Coughlan
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco
| | - Arin E. Kim
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco
| | - Nicole J. Hung
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles
| | - Nirav K. Pandya
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco
- Benioff Children’s Hospital Oakland, University of California, San Francisco, Oakland, California, U.S.A
- Address correspondence to Nirav K. Pandya, M.D., Department of Orthopaedic Surgery, Benioff Children’s Hospital Oakland, University of California, San Francisco, 747 52nd St., Oakland, CA 94609.
| |
Collapse
|
7
|
Gamble AR, McKay MJ, Pappas E, Dale M, O'Keeffe M, Ferreira G, Richardson K, Zadro JR. Online information about the management of anterior cruciate ligament ruptures in Australia: A content analysis. Musculoskelet Sci Pract 2022; 59:102555. [PMID: 35305513 DOI: 10.1016/j.msksp.2022.102555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most people who suffer an anterior cruciate ligament (ACL) injury search for information online. OBJECTIVES Summarise the proportion of webpages on ACL rupture management that present evidence-based information. DESIGN Content analysis. METHODS We examined webpage information on ACL ruptures identified through (1) Google searches using terms synonymous with 'anterior cruciate ligament rupture' and searching 'knee surgeon' linked to each Australian capital city, and (2) websites of professional associations. The primary outcome was the proportion of webpages that suggest people can return to at least some form of sport with non-surgical management. Secondary outcomes included webpage information on return to sport with ACL reconstruction (ACLR) and non-surgical management, benefits, harms, and risk of osteoarthritis related to these options, and activity modification. RESULTS Out of 115 webpages analysed, 48% suggested people can return to at least some form of sport with non-surgical management. Almost half of webpages suggested most people will return to some form of sport following ACLR (41%) and mentioned benefits of ACLR (43%). Fewer webpages mentioned benefits of non-surgical management (14%), approximately two in three people return to pre-injury level of sport following ACLR (4%), risk of re-injury following ACLR (23%), most people return to sport within 9 months of ACLR (27%), activity modification as a management approach (20%), and ACLR will reduce the risk of osteoarthritis (23%). CONCLUSION Most online information on ACL rupture management isn't aligned with the best available evidence. Inaccurate information could mislead patients' treatment choices and create unrealistic expectations for return to sport.
Collapse
Affiliation(s)
- Andrew R Gamble
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
| | - Marnee J McKay
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Evangelos Pappas
- School of Medicine and Illawarra Health and Medical Research Institute, The University of Wollongong, Wollongong, NSW, Australia
| | - Michael Dale
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Giovanni Ferreira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | | | - Joshua R Zadro
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| |
Collapse
|
8
|
Patra SK, Nanda SN, Patro BP, Sahu NK, Mohnaty CR, Jain M. Protocolo de reabilitação acelerada precoce versus conservadora retardada após reconstrução do ligamento cruzado anterior: Um ensaio prospectivo randomizado. Rev Bras Ortop 2022; 57:429-436. [PMID: 35785121 PMCID: PMC9246531 DOI: 10.1055/s-0042-1748970] [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: 07/15/2021] [Accepted: 09/24/2021] [Indexed: 12/02/2022] Open
Abstract
Objective
To compare the effectiveness of the early accelerated rehabilitation and delayed conservative rehabilitation protocols after arthroscopic anterior cruciate ligament reconstruction, in terms of the International Knee Documentation Committee (IKDC) score, pain (according to the Visual Analog Scale), laxity, and stiffness one year postoperatively to determine the best outcome.
Materials and Methods
A total of 80 subjects were divided into 2e groups (early accelerated group and delayed conservative group), which were analyzed by the Pearson Chi-squared and Wilcoxon rank-sum tests.
Results
One year postoperatively, knee laxity was significantly higher (
p
= 0.039) in the early accelerated group compared with the delayed conservative group. Regarding postoperative pain (according to the Visual Analogue Scale) and IKDC scores, both groups presented similar results. The postoperative range of motion was better in the early accelerated group, but this was not statistically significant (
p
= 0.36).
Conclusion
One year postoperatively, the early accelerated rehabilitation protocol was associated with significant knee laxity compared to the delayed conservative rehabilitation protocol.
Collapse
Affiliation(s)
| | | | | | | | | | - Mantu Jain
- Departamento de Ortopedia, AIIMS, Bhubaneswar, Índia
| |
Collapse
|
9
|
Slater D, Kvist J, Ardern CL. Biopsychosocial Factors Associated With Return to Preinjury Sport After ACL Injury Treated Without Reconstruction: NACOX Cohort Study 12-Month Follow-up. Sports Health 2022; 15:176-184. [PMID: 35633030 PMCID: PMC9950991 DOI: 10.1177/19417381221094780] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The limited research on prognosis after nonsurgical management of anterior cruciate ligament (ACL) injury has focused on physical factors. We aimed to assess relationships between key patient-reported outcomes, in line with a biopsychosocial approach, and returning to preinjury sport at 12 months after ACL injury treated without reconstruction. HYPOTHESIS We hypothesized that biopsychosocial factors would be associated with returning to preinjury sport at 12 months after ACL injury. STUDY DESIGN Prospective single cohort study. LEVEL OF EVIDENCE Level 2. METHODS Patients who had an ACL injury and did not have reconstruction during the first year after injury were recruited from healthcare clinics in Sweden, and followed up at 3, 6, and 12 months after injury. Return to preinjury sport at 12 months was the primary outcome. Explanatory variables were psychological readiness to return to sport, knee-related quality of life, and self-reported knee function. Using generalized estimating equations, we evaluated the relationships between the explanatory variables and the primary outcome at each timepoint. RESULTS Data were analyzed for 88 participants with a median age of 27 years (15-40 years). Soccer was the most frequently reported preinjury sport (n = 22). Forty participants (46%) had returned to their preinjury sport at 12 months after ACL injury. The odds of returning to preinjury sport at 12 months increased with higher self-reported knee function at 6 months (odds ratio [OR], 1.1; 95% CI, 1.0-1.1), and the odds of being returned to the preinjury sport at 12 months doubled for every 1-point increase (1-10 scale) in psychological readiness to return to sport measured at 12 months (OR, 1.9; 95% CI, 1.2-3.2). CONCLUSION Superior self-reported knee function at 6 months and greater psychological readiness to return to sport at 12 months were associated with returning to the preinjury sport 1 year after ACL injury treated without reconstruction. CLINICAL RELEVANCE Consider highlighting the relevance of biopsychosocial factors to returning to preinjury sport after ACL injury when discussing prognosis during shared decision-making.
Collapse
Affiliation(s)
- Diane Slater
- Unit of Physiotherapy, Department of
Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | - Joanna Kvist
- Unit of Physiotherapy, Department of
Health, Medicine and Caring Science, Linköping University, Linköping, Sweden,Center for Medical Image Science and
Visualization (CMIV), Department of Health, Medicine and Caring Sciences, Linköping
University, Linköping, Sweden,Stockholm Sports Trauma Research
Center, Department of Molecular Medicine and Surgery, Karolinska Institute,
Stockholm, Sweden,Joanna Kvist, PhD, Unit of
Physiotherapy, Department of Health, Medicine and Caring Science, Linköping
University, Hus 511-001, Ingang 76/78, Linköping, SE 581 83, Sweden (
) (Twitter: @JoannaKvist)
| | - Clare L. Ardern
- Unit of Physiotherapy, Department of
Health, Medicine and Caring Science, Linköping University, Linköping, Sweden,Sport and Exercise Medicine Research
Centre, La Trobe University, Melbourne, Australia,Department of Family Practice,
University of British Columbia, Vancouver, Canada
| |
Collapse
|
10
|
Kunze KN, Polce EM, Ranawat AS, Randsborg PH, Williams RJ, Allen AA, Nwachukwu BU, Pearle A, Stein BS, Dines D, Kelly A, Kelly B, Rose H, Maynard M, Strickland S, Coleman S, Hannafin J, MacGillivray J, Marx R, Warren R, Rodeo S, Fealy S, O'Brien S, Wickiewicz T, Dines JS, Cordasco F, Altcheck D. Application of Machine Learning Algorithms to Predict Clinically Meaningful Improvement After Arthroscopic Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:23259671211046575. [PMID: 34671691 PMCID: PMC8521431 DOI: 10.1177/23259671211046575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Understanding specific risk profiles for each patient and their propensity to experience clinically meaningful improvement after anterior cruciate ligament reconstruction (ACLR) is important for preoperative patient counseling and management of expectations. Purpose: To develop machine learning algorithms to predict achievement of the minimal clinically important difference (MCID) on the International Knee Documentation Committee (IKDC) score at a minimum 2-year follow-up after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: An ACLR registry of patients from 27 fellowship-trained sports medicine surgeons at a large academic institution was retrospectively analyzed. Thirty-six variables were tested for predictive value. The study population was randomly partitioned into training and independent testing sets using a 70:30 split. Six machine learning algorithms (stochastic gradient boosting, random forest, neural network, support vector machine, adaptive gradient boosting, and elastic-net penalized logistic regression [ENPLR]) were trained using 10-fold cross-validation 3 times and internally validated on the independent set of patients. Algorithm performance was assessed using discrimination, calibration, Brier score, and decision-curve analysis. Results: A total of 442 patients, of whom 39 (8.8%) did not achieve the MCID, were included. The 5 most predictive features of achieving the MCID were body mass index ≤27.4, grade 0 medial collateral ligament examination (compared with other grades), intratunnel femoral tunnel fixation (compared with suspensory), no history of previous contralateral knee surgery, and achieving full knee extension preoperatively. The ENPLR algorithm had the best relative performance (C-statistic, 0.82; calibration intercept, 0.10; calibration slope, 1.15; Brier score, 0.068), demonstrating excellent predictive ability in the study’s data set. Conclusion: Machine learning, specifically the ENPLR algorithm, demonstrated good performance for predicting a patient’s propensity to achieve the MCID for the IKDC score after ACLR based on preoperative and intraoperative factors. The femoral tunnel fixation method was the only significant intraoperative variable. Range of motion and medial collateral ligament integrity were found to be important physical examination parameters. Increased body mass index and prior contralateral surgery were also significantly predictive of outcome.
Collapse
Affiliation(s)
- Kyle N Kunze
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Evan M Polce
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Anil S Ranawat
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Per-Henrik Randsborg
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Answorth A Allen
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Benedict U Nwachukwu
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | | | - Andrew Pearle
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Beth S Stein
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - David Dines
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Anne Kelly
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Bryan Kelly
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Howard Rose
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Michael Maynard
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Sabrina Strickland
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Struan Coleman
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Jo Hannafin
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - John MacGillivray
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Robert Marx
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Russell Warren
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Scott Rodeo
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Stephen Fealy
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Stephen O'Brien
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Thomas Wickiewicz
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - Frank Cordasco
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| | - David Altcheck
- Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,All authors are listed in the Authors section at the end of this article.,Investigation performed at the Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
11
|
Fausett WA, Reid DA, Larmer PJ. Current perspectives of New Zealand physiotherapists on rehabilitation and return to sport following anterior cruciate ligament reconstruction: A survey. Phys Ther Sport 2021; 53:166-172. [PMID: 34711502 DOI: 10.1016/j.ptsp.2021.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the clinical beliefs and practices of New Zealand physiotherapists regarding pre- and post-surgical rehabilitation and return to sport (RTS) criteria following anterior cruciate ligament reconstruction (ACLR). DESIGN Online cross-sectional survey. METHODS A survey was adapted from a previously published survey and disseminated to New Zealand physiotherapists who were considered more likely to be involved in post-ACLR rehabilitation. RESULTS The number of completed surveys was 318. Most physiotherapists (85%) preferred to first consult patients within 14 days of ACLR. In the first six weeks following ACLR, 89% of physiotherapists see patients at least once per week. Between 3- and 6-months post-ACLR, 76% of physiotherapists see patients at least once a fortnight. Pre-operative rehabilitation and post-operative rehabilitation exceeding six months are considered essential or important to patient outcomes by over 95% of physiotherapists. While 63% of physiotherapists support RTS 9-12 months after ACLR, 11% permit RTS within 6-9 months of surgery. Common RTS considerations include functional capacity, movement quality during functional tasks, time from ACLR, and knee strength. CONCLUSION The survey revealed variability in the beliefs and practices of NZ physiotherapists regarding post-ACLR rehabilitation, and these beliefs and practices are at times inconsistent with best practice recommendations.
Collapse
Affiliation(s)
- Wayne A Fausett
- Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand.
| | - Duncan A Reid
- School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Peter J Larmer
- School of Clinical Sciences, Auckland University of Technology, New Zealand
| |
Collapse
|
12
|
Pedersen M, Grindem H, Johnson JL, Engebretsen L, Axe MJ, Snyder-Mackler L, Risberg MA. Clinical, Functional, and Physical Activity Outcomes 5 Years Following the Treatment Algorithm of the Delaware-Oslo ACL Cohort Study. J Bone Joint Surg Am 2021; 103:1473-1481. [PMID: 33999877 PMCID: PMC8376754 DOI: 10.2106/jbjs.20.01731] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries can be treated with or without ACL reconstruction (ACLR), and more high-quality studies evaluating outcomes after the different treatment courses are needed. The purpose of the present study was to describe and compare 5-year clinical, functional, and physical activity outcomes for patients who followed our decision-making and treatment algorithm and chose (1) early ACLR with preoperative and postoperative rehabilitation, (2) delayed ACLR with preoperative and postoperative rehabilitation, or (3) progressive rehabilitation alone. Early ACLR was defined as that performed ≤6 months after the preoperative rehabilitation program, and late ACLR was defined as that performed >6 months after the preoperative rehabilitation program. METHODS We included 276 patients from a prospective cohort study. The patients had been active in jumping, pivoting, and cutting sports before the injury and sustained a unilateral ACL injury without substantial concomitant knee injuries. The patients chose their treatment through a shared decision-making process. At 5 years, we assessed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale, sports participation, quadriceps muscle strength, single-legged hop performance, and new ipsilateral and contralateral knee injuries. RESULTS The 5-year follow-up rate was 80%. At 5 years, 64% of the patients had undergone early ACLR, 11% had undergone delayed ACLR, and 25% had had progressive rehabilitation alone. Understandably, the choices that participants made differed by age, concomitant injuries, symptoms, and predominantly level-I versus level-II preinjury activity level. There were no significant differences in any clinical, functional, or physical activity outcomes among the treatment groups. Across treatment groups, 95% to 100% of patients were still active in some kind of sports and 65% to 88% had IKDC-SKF and KOOS scores above the threshold for a patient acceptable symptom state. CONCLUSIONS Patients with ACL injury who were active in jumping, pivoting, and cutting sports prior to injury; who had no substantial concomitant knee injuries; and who followed our decision-making and treatment algorithm had good 5-year knee function and high sport participation rates. Three of 4 patients had undergone ACLR within 5 years. There were no significant differences in any outcomes among patients treated with early ACLR, delayed ACLR, or progressive rehabilitation alone. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Marie Pedersen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hege Grindem
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jessica L. Johnson
- Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Michael J. Axe
- Department of Physical Therapy, University of Delaware, Newark, Delaware
- First State Orthopaedics, Newark, Delaware
| | - Lynn Snyder-Mackler
- Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - May Arna Risberg
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
13
|
Pedersen M, Grindem H, Berg B, Gunderson R, Engebretsen L, Axe MJ, Snyder-Mackler L, Risberg MA. Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study. Orthop J Sports Med 2021; 9:23259671211027530. [PMID: 34423060 PMCID: PMC8375355 DOI: 10.1177/23259671211027530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients and clinicians often struggle to choose the optimal management strategy for posttraumatic knee osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury. An evaluation of radiographic outcomes after a decision-making and treatment algorithm applicable in clinical practice can help to inform future recommendations and treatment choices. PURPOSE To describe and compare 5-year radiographic outcomes and knee pain in individuals who had gone through our decision-making and treatment algorithm and chosen (1) early (<6 months) ACL reconstruction (ACLR) with pre- and postoperative rehabilitation, (2) delayed (>6 months) ACLR with pre- and postoperative rehabilitation, or (3) progressive rehabilitation alone. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS We included 276 patients with unilateral ACL injury from a prospective cohort study. Patients chose management using a shared decision-making process and treatment algorithm, and 5-year postoperative radiographs of the index and contralateral knees were assessed using the Kellgren and Lawrence (K&L) classification and minimum joint space width measurements. We defined radiographic tibiofemoral OA as K&L grade ≥2 and knee pain as a Knee injury and Osteoarthritis Outcome Score for Pain ≤72. To further explore early radiographic changes, we included alternative cutoffs for radiographic knee OA using K&L grade ≥2/osteophyte (definite osteophyte without joint space narrowing) and K&L grade ≥1. RESULTS At 5 years, 64% had undergone early ACLR; 11%, delayed ACLR; and 25%, progressive rehabilitation alone. Radiographic examination was attended by 187 patients (68%). Six percent of the cohort had radiographic tibiofemoral OA (K&L grade ≥2) in the index knee; 4%, in the contralateral knee. Using the alternative cutoffs at K&L grade ≥2/osteophyte and K&L grade ≥1, the corresponding numbers were 20% and 33% in the index knee and 18% and 29% in the contralateral knee. Six percent had a painful index knee. There were no statistically significant differences in any radiographic outcomes or knee pain among the 3 management groups. CONCLUSION There were no statistically significant differences in any 5-year radiographic outcomes or knee pain among the 3 management groups. Very few of the patients who participated in our decision-making and treatment algorithm had knee OA or knee pain at 5 years.
Collapse
Affiliation(s)
- Marie Pedersen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hege Grindem
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Bjørnar Berg
- Orthopedic Clinic, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | | | - Lars Engebretsen
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Orthopedic Clinic, Oslo University Hospital, Oslo, Norway
| | - Michael J. Axe
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- First State Orthopaedics, Newark, Delaware, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - May Arna Risberg
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Orthopedic Clinic, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
14
|
Hart DA, Martin CR, Scott M, Shrive NG. The instrumented sheep knee to elucidate insights into osteoarthritis development and progression: A sensitive and reproducible platform for integrated research efforts. Clin Biomech (Bristol, Avon) 2021; 87:105404. [PMID: 34171651 DOI: 10.1016/j.clinbiomech.2021.105404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/12/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteoarthritis of the knee is a very common condition that has been difficult to treat. The majority of cases are considered idiopathic. Much research effort remains focused on biology rather than the biomechanics of such joints. Some new methods were developed and validated to better appreciate the subtleties of the biomechanical integrity of joints, and how changes in biomechanics can contribute to osteoarthritis. METHODS Over the past 15 years our lab has enhanced the sensitivity of the assessment of knee biomechanics of an instrumented, trained large animal model (sheep) of osteoarthritis and integrated the findings with biological and histological assessments. These new methods include gait analysis before and after injury followed by robotic validation post-sacrifice, and more recently using Fibre Bragg Grating sensors to detect alterations in cartilage stresses. RESULTS A review of the findings obtained with this model are presented. The findings indicate that sheep, like humans, exhibit individual characteristics. They also indicate that joint kinetics, rather than kinematics may better define the alterations induced by injury. With the addition of Fibre Bragg Grating sensors, it has been possible to measure with good accuracy, alterations to cartilage stresses following a controlled knee injury. INTERPRETATION Using this model as Proof of Concept, this sheep system can now be viewed as a sensitive platform to address many questions related to risk for development of idiopathic osteoarthritis of the human knee, the efficacy of potential interventions to correct biomechanical disruptions, and how joint biomechanics and biology are integrated during aging.
Collapse
Affiliation(s)
- David A Hart
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Department of Surgery, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Bone & Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
| | - C Ryan Martin
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Section of Orthopedics, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Michael Scott
- Department of Veterinary Clinical & Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada; Department of Surgery, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Department of Civil Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
15
|
Sonesson S, Gauffin H, Kvist J. Early knee status affects self-reported knee function 1 year after non-surgically treated anterior cruciate ligament injury. Phys Ther Sport 2021; 50:173-183. [PMID: 34052567 DOI: 10.1016/j.ptsp.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The primary aim was to assess impact of early knee status on self-reported knee function at 3 and 12 months and on quadriceps strength at 12 months after non-surgically treated ACL injury. The secondary aim was to describe the recovery of muscle strength during the first year after the injury. DESIGN Prospective cohort study. PARTICIPANTS 70 patients (42 males; mean age 27 ± 7 years) with acute ACL injury. MAIN OUTCOME Knee symptoms, knee function and sporting activities were assessed with the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF). Muscle strength was assessed with an isokinetic dynamometer. Clinical assessment performed at baseline was used to evaluate early knee status. RESULTS Global knee function, knee joint stability during ADL, gait pattern and one-legged squat assessed in mean 2 weeks after injury hadimpact on self-reported knee function at 3 and 12 months (r2 0.105-0.267). Mean limb symmetry index (LSI) of muscle strength and jump performance were 91-98% at 12 months. CONCLUSION Early knee symptoms affect self-reported knee function at 3 and 12 months, while other factors are important for gaining muscle strength. Muscle strength recovered during the first year after ACL injury and reached mean LSI above 90%. LEVEL OF EVIDENCE Prospective cohort study, level II.
Collapse
Affiliation(s)
- Sofi Sonesson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Håkan Gauffin
- Department of Orthopaedics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| |
Collapse
|
16
|
Grevnerts HT, Sonesson S, Gauffin H, Ardern CL, Stålman A, Kvist J. Decision Making for Treatment After ACL Injury From an Orthopaedic Surgeon and Patient Perspective: Results From the NACOX Study. Orthop J Sports Med 2021; 9:23259671211005090. [PMID: 33948447 PMCID: PMC8053763 DOI: 10.1177/23259671211005090] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background: In the treatment of anterior cruciate ligament (ACL) injuries, there is little evidence of when and why a decision for ACL reconstruction (ACLR) or nonoperative treatment (non-ACLR) is made. Purpose: To (1) describe the key characteristics of ACL injury treatment decisions and (2) compare patient-reported knee instability, function, and preinjury activity level between patients with non-ACLR and ACLR treatment decisions. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 216 patients with acute ACL injury were evaluated during the first year after injury. The treatment decision was non-ACLR in 73 patients and ACLR in 143. Reasons guiding treatment decision were obtained from medical charts and questionnaires to patients and orthopaedic surgeons. Patient-reported instability and function were obtained via questionnaires and compared between patients with non-ACLR and ACLR treatment decisions. The ACLR treatment group was classified retrospectively by decision phase: acute phase (decision made between injury day and 31 days after injury), subacute phase (decision made between 32 days and up to 5 months after injury), and late phase (decision made 5-12 months after injury). Data were evaluated using descriptive statistics, and group comparisons were made using parametric or nonparametric tests as appropriate. Results: The main reasons for a non-ACLR treatment decision were no knee instability and no problems with knee function. The main reasons for an ACLR treatment decision were high activity demands and knee instability. Patients in the non-ACLR group were significantly older (P = .031) and had a lower preinjury activity level than did those in the acute-phase (P < .01) and subacute-phase (P = .006) ACLR decision groups. There were no differences in patient-reported instability and function between treatment decision groups at baseline, 4 weeks after injury, or 3 months after injury. Conclusion: Activity demands, not patient-reported knee instability, may be the most important factor in the decision-making process for treatment after ACL injury. We suggest a decision-making algorithm for patients with ACL injuries and no high activity demands; waiting for >3 months can help distinguish those who need surgical intervention from those who can undergo nonoperative management. Registration: NCT02931084 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Hanna Tigerstrand Grevnerts
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Activity and Health, Linköping University, Linköping, Sweden
| | - Sofi Sonesson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Håkan Gauffin
- Division of Surgery, Orthopedics and Oncology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Clare L Ardern
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Sport & Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Anders Stålman
- Stockholm Sports Trauma Research Center, MMK, Karolinska Institutet, Stockholm.,Capio Artro Clinic, Sophiahemmet, Stockholm
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
17
|
Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, Svantesson E, Hamrin Senorski E, Hewett TE, Sherman SL, Lesniak BP, Symposium P. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. J ISAKOS 2021; 6:138-146. [PMID: 34006577 DOI: 10.1136/jisakos-2020-000495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS after ACL injury and description of the RTS continuum, as well as provide clinical guidance on RTS testing and decision-making. METHODS An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. RESULTS Key points include that RTS is characterised by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries. CONCLUSION The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biological assessment of healing and recovery.
Collapse
Affiliation(s)
- Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA .,Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Thomas Rauer
- Klinik für Traumatologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | | | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery Innsbruck, Innsbruck, Austria
| | - Theresa Diermeier
- Department of Sportorthopedic, Technical University of Munich, Munchen, Germany
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Sport Trauma Research Center, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Gothenburg Sport Trauma Research Center, Gothenburg, Sweden.,Department of Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden
| | | | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford Medicine, Stanford, California, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Panther Symposium
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
18
|
He X, Huang WY, Leong HT, Qiu JH, Ma CC, Fu SC, Ong MTY, Yung PSH. Decreased passive muscle stiffness of vastus medialis is associated with poorer quadriceps strength and knee function after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2021; 82:105289. [PMID: 33581470 DOI: 10.1016/j.clinbiomech.2021.105289] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/24/2020] [Accepted: 01/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Muscle deficits of the quadriceps and hamstrings are common after anterior cruciate ligament reconstruction, and increase the risk of knee reinjury. Muscle stiffness is an important factor for dynamic joint stability. However, the changes in quadriceps and hamstring muscle stiffness and its influence after anterior cruciate ligament reconstruction remain unclear. METHOD Twenty-five male subjects with anterior cruciate ligament reconstruction and twenty-one matched healthy subjects participated in this study. The passive muscle stiffness of the quadriceps and hamstrings was assessed by shear modulus using ultrasound shear wave elastography. The isokinetic muscle strengths of the quadriceps and hamstrings were tested. Knee function was evaluated by the International Knee Documentation Committee and Lysholm score. Muscle stiffness was compared between limbs via non-parametric tests. Correlation analysis was used to detect the relationship between muscle stiffness, isokinetic muscle strength and knee functional scores. FINDINGS The involved limb exhibited significantly decreased shear modulus in the vastus medialis compared to the dominant limbs(z = -3.585;P = 0.001;ES = 1.13) and non-dominant limbs(z = -3.551;P = 0.002;ES = 1.24) of healthy controls. The shear modulus of ST was also significantly lower in the involved limb when compared with the contralateral limbs(z = -3.996;P < 0.001;ES = 1.33), dominant limbs(z = -4.477;P < 0.001;ES = 1.65) and non-dominant limbs(z = -4.234;P = 0.001;ES = 1.43) of healthy controls. The shear modulus of the vastus medialis was associated with quadriceps peak torque at 60°/s(r = 0.470; p < 0.001) and knee functional score(r = 0.459; p = 0.021). INTERPRETATION The passive muscle stiffness of the vastus medialis decreased after anterior cruciate ligament reconstruction, which is associated with poorer quadriceps strength and knee function. The effect of modulation of muscle stiffness on improving knee function warrants future investigation.
Collapse
Affiliation(s)
- Xin He
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wan Yun Huang
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Hio Teng Leong
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Ji Hong Qiu
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Chun Cheong Ma
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Sai-Chuen Fu
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Michael Tim-Yun Ong
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| |
Collapse
|
19
|
Dutaillis B, Maniar N, Opar DA, Hickey JT, Timmins RG. Lower Limb Muscle Size after Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis. Sports Med 2021; 51:1209-1226. [PMID: 33492623 DOI: 10.1007/s40279-020-01419-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is known to have a number of deleterious effects on lower limb muscle function. Alterations in muscle size are one such effect that have implications towards reductions in strength and functioning of the lower limbs. However, a comprehensive analysis of alterations in muscle size has yet to be undertaken. OBJECTIVE To systematically review the evidence investigating lower limb muscle size in ACL injured limbs. DESIGN Systematic review DATA SOURCES: Database searches of Medline, SPORTDiscus, Embase, Cinahl and Web of Science as well as citation tracking and manual reference list searching. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Individuals with ACL deficient or reconstructed limbs with an assessment of lower limb muscle size and control limb data (contralateral or uninjured control group) METHODS: Risk of bias assessment was completed on included studies. Data were extracted and where possible meta-analyses performed. Best evidence synthesis was also undertaken. RESULTS 49 articles were included in this review, with 37 articles included in the meta-analyses. 66 separate meta-analyses were performed using various measures of lower limb muscle size. Across all measures, ACL deficient limbs showed lesser quadriceps femoris muscle size (d range = - 0.35 to - 0.40), whereas ACL reconstructed limbs showed lesser muscle size in the quadriceps femoris (d range = - 0.41 to - 0.69), vastus medialis (d = - 0.25), vastus lateralis (d = - 0.31), hamstrings (d = - 0.28), semitendinosus (d range = - 1.02 to - 1.14) and gracilis (d range = - 0.78 to - 0.99) when compared to uninjured limbs. CONCLUSION This review highlights the effect ACL injury has on lower limb muscle size. Regardless of whether an individual chooses a conservative or surgical approach, the quadriceps of the injured limb appear to have lesser muscle size compared to an uninjured limb. When undertaking reconstructive surgery with a semitendinosus/gracilis tendon graft, the harvested muscle shows lesser muscle size compared to the uninjured limb.
Collapse
Affiliation(s)
- Benjamin Dutaillis
- School of Behavioural and Health Sciences, Australian Catholic University, 17 Young Street, Fitzroy, VIC, 3065, Australia.
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, 17 Young Street, Fitzroy, VIC, 3065, Australia
| | - David A Opar
- School of Behavioural and Health Sciences, Australian Catholic University, 17 Young Street, Fitzroy, VIC, 3065, Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC, 3065, Australia
| | - Jack T Hickey
- School of Behavioural and Health Sciences, Australian Catholic University, 17 Young Street, Fitzroy, VIC, 3065, Australia
| | - Ryan G Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, 17 Young Street, Fitzroy, VIC, 3065, Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC, 3065, Australia
| |
Collapse
|
20
|
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]
|
21
|
Krogsgaard MR, Brodersen J, Christensen KB, Siersma V, Jensen J, Hansen CF, Engebretsen L, Visnes H, Forssblad M, Comins JD. How to translate and locally adapt a PROM. Assessment of cross‐cultural differential item functioning. Scand J Med Sci Sports 2020; 31:999-1008. [DOI: 10.1111/sms.13854] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/22/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Michael R. Krogsgaard
- Section for Sports Traumatology M51 Bispebjerg and Frederiksberg Hospital Copenhagen Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Copenhagen Denmark
- Primary Health Care Research Unit Region Zealand, Sorø Denmark
| | - Karl B. Christensen
- Section of Biostatistics Department of Public Health University of Copenhagen Copenhagen Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Copenhagen Denmark
| | - Jonas Jensen
- Section for Sports Traumatology M51 Bispebjerg and Frederiksberg Hospital Copenhagen Denmark
| | - Christian Fugl Hansen
- Section for Sports Traumatology M51 Bispebjerg and Frederiksberg Hospital Copenhagen Denmark
| | - Lars Engebretsen
- Orthopedic Clinic Oslo Sports Trauma Research Center University of Oslo Medical School Oslo Norway
| | - Håvard Visnes
- Norwegian National Knee Ligament Registry Department of Orthopedic Surgery Haukeland University Hospital Bergen Norway
- Oslo Sports Trauma Research Center Norwegian School of Sports Sciences Oslo Norway
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery Stockholm Sports Trauma Research Center Karolinska Institute Stockholm Sweden
| | - Jonathan D. Comins
- Section for Sports Traumatology M51 Bispebjerg and Frederiksberg Hospital Copenhagen Denmark
- The Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Copenhagen Denmark
| |
Collapse
|
22
|
Vermeijden HD, Yang XA, van der List JP, DiFelice GS. Large variation in indications, preferred surgical technique and rehabilitation protocol for primary anterior cruciate ligament repair: a survey among ESSKA members. Knee Surg Sports Traumatol Arthrosc 2020; 28:3613-3621. [PMID: 32328697 DOI: 10.1007/s00167-020-06011-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/16/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess current surgical preferences and practice patterns regarding primary anterior cruciate ligament (ACL) repair among European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) members. METHODS A web-based survey was designed, including questions regarding indications for primary repair, outcomes of primary repair, and rehabilitation protocols. An invitation for study participation was sent by email to all ESSKA e-mail contacts. Descriptive statistics were performed. RESULTS A total of 169 surgeons responded to the survey (7% response rate of active members). Lack of supporting scientific evidence is the main reason for not using repair as a surgical treatment (63%). Most important indications were proximal avulsion tears (84%), younger age (49%), and older age (34%). Among those currently utilizing repair as a treatment option, transosseous tunnel fixation repair (34%) and repair with internal brace using transosseous tunnel fixation (32%) were the most preferred techniques. Eleven percent indicated dynamic intraligamentary stabilization as their preferred technique. A similar rate of progression for rehabilitation for repair and reconstruction techniques was noted among respondents. CONCLUSION This practice survey shows that the majority of surgeons indicated the main reason for not incorporating primary repair in their current practices was a lack of supporting scientific evidence. Among those holding favourable attitudes and beliefs, most surgeons indicated patients with proximal tears, younger-aged, and older-aged patients might be eligible for repair. Prospective studies with higher levels of evidence are warranted to establish guidelines for repair, including indications, optimal surgical technique, and rehabilitation protocols. LEVEL OF EVIDENCE V (expert opinion).
Collapse
Affiliation(s)
- Harmen D Vermeijden
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA
| | - Xiuyi A Yang
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA
| | - Jelle P van der List
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA.,Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gregory S DiFelice
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA.
| |
Collapse
|
23
|
Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, Svantesson E, Hamrin Senorski E, Hewett TE, Sherman SL, Lesniak BP. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Knee Surg Sports Traumatol Arthrosc 2020; 28:2403-2414. [PMID: 32347344 DOI: 10.1007/s00167-020-06009-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/16/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS and description of the RTS continuum, as well as to provide clinical guidance on RTS testing and decision-making. METHODS An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. RESULTS Key points include that RTS is characterized by achievement of the pre-injury level of sport and involves a criteria-based progression from return to participation to return to sport, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along a RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries. CONCLUSION The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biologic assessment of healing and recovery. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA.
| | - Thomas Rauer
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery Innsbruck, Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), UMIT, Hall in Tirol, Austria
| | - Theresa Diermeier
- Department of Sportorthopedics, Klinikum rechts der Isar Technische Universitat Munchen, Munchen, Germany
| | - Benjamin B Rothrauff
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA
| | - Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Gothenburg Sport Trauma Research Center, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Gothenburg Sport Trauma Research Center, Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford Medicine, Stanford, CA, USA
| | - Bryson P Lesniak
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, 15203, PA, USA
| |
Collapse
|
24
|
Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, Svantesson E, Hamrin Senorski E, Hewett TE, Sherman SL, Lesniak BP, Bizzini M, Chen S, Cohen M, Villa SD, Engebretsen L, Feng H, Ferretti M, Fu FH, Imhoff AB, Kaeding CC, Karlsson J, Kuroda R, Lynch AD, Menetrey J, Musahl V, Navarro RA, Rabuck SJ, Siebold R, Snyder-Mackler L, Spalding T, van Eck C, Vyas D, Webster K, Wilk K. Return to Sport After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Orthop J Sports Med 2020; 8:2325967120930829. [PMID: 32647735 PMCID: PMC7328222 DOI: 10.1177/2325967120930829] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022] Open
Abstract
Background A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sport and their previous activity level. Purpose The aim of the Panther Symposium ACL Injury Return to Sport Consensus Group was to provide a clear definition of RTS after ACL injury and a description of the RTS continuum as well as provide clinical guidance on RTS testing and decision-making. Study Design Consensus statement. Methods An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. Results Key points include that RTS is characterized by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS and, ultimately, return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum, with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors, and concomitant injuries. Conclusion The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing, and methods for the biological assessment of healing and recovery.
Collapse
Affiliation(s)
- Sean J Meredith
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Thomas Rauer
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Terese L Chmielewski
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christian Fink
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Theresa Diermeier
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Benjamin B Rothrauff
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eleonor Svantesson
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eric Hamrin Senorski
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Timothy E Hewett
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seth L Sherman
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryson P Lesniak
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Mario Bizzini
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shiyi Chen
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Moises Cohen
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stefano Della Villa
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lars Engebretsen
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hua Feng
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mario Ferretti
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andreas B Imhoff
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christopher C Kaeding
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jon Karlsson
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ryosuke Kuroda
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew D Lynch
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jacques Menetrey
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ronald A Navarro
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stephen J Rabuck
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rainer Siebold
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lynn Snyder-Mackler
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tim Spalding
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carola van Eck
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dharmesh Vyas
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kate Webster
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kevin Wilk
- Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
25
|
von Essen C, McCallum S, Barenius B, Eriksson K. Acute reconstruction results in less sick-leave days and as such fewer indirect costs to the individual and society compared to delayed reconstruction for ACL injuries. Knee Surg Sports Traumatol Arthrosc 2020; 28:2044-2052. [PMID: 30762087 PMCID: PMC7347679 DOI: 10.1007/s00167-019-05397-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/01/2019] [Indexed: 11/05/2022]
Abstract
PURPOSE To compare the total number of sick-leave days caused by the knee injury from the day of injury and over the first year between acute (within 8 days) and delayed (6-10 weeks) anterior cruciate ligament reconstruction (ACLR) and also assess other clinical outcomes during this period. METHODS Seventy patients with an acute ACL injury and Tegner level of 6 or more were randomized to acute (within 8 days) or delayed (after 6-10 weeks) ACLR. Patient-reported outcomes; objective IKDC and manual stability measurements were assessed at 6 and 12 months. With data from the Swedish Social Insurance Agency (Försäkringskassan) information about the number of sick-leave days due to the knee injury over the following 12 months was collected and compared between the two groups. RESULTS Seventy-one percent received compensation for sick leave (26 in the acute versus 23 in the delayed group). The mean number of sick-leave days for the acute group was significantly lower (M = 56.9, SD = 36.4) compared to the delayed group (M = 88.5, SD = 50.2), p < 0.05. The acute group was also significantly stronger in flexion in both slow and fast angle velocities according to Biodex®. No other differences were found between the groups in other clinical assessments or in terms of associated injuries. CONCLUSION Acute and delayed ACLR provided comparable clinical outcomes after 12 months. Acute reconstruction resulted in less sick-leave days and as such fewer indirect costs to the individual and society. These findings suggest that if patients requiring ACLR can be identified early and ACLR can be performed in the acute phase, socioeconomic costs can potentially be reduced by minimizing time off work. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Christoffer von Essen
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Sebastian McCallum
- grid.4714.60000 0004 1937 0626Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Björn Barenius
- grid.4714.60000 0004 1937 0626Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Karl Eriksson
- grid.4714.60000 0004 1937 0626Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
26
|
Jin J, Yu L, Wei M, Shang Y, Wang X. Comparison of efficacy and safety of different fixation devices for anterior cruciate ligament reconstruction: A Bayesian network meta-analysis protocol. Medicine (Baltimore) 2019; 98:e14911. [PMID: 30896646 PMCID: PMC6709171 DOI: 10.1097/md.0000000000014911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is a common ligament injury to the knee joint, and often lead to limited function, osteoarthritis after knee trauma, secondary damage to meniscus and cartilage, and impaired quality of life. ACL reconstruction is the gold standard surgical treatment for ACL injury, and ligament fixation after reconstruction is the key factor of ACL reconstruction success. However, the optimal fixation device for ACL reconstruction remains unclear. This study aims to evaluate the efficacy and safety of different fixation devices and to find the best fixation device for ACL reconstruction. METHODS The PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Chinese Biomedicine Literature will be searched to identify relevant studies from inception to December 2018. We will include randomized controlled trials (RCTs) comparing the effects of different fixation devices fixed on the femoral side in arthroscopically assisted ACL reconstruction. Risk of bias assessment of the included RCTs will be conducted according to the Cochrane Handbook 5.1.0. A Bayesian network meta-analysis (NMA) will be performed using R software. RESULTS The results of this NMA will be submitted to a peer-reviewed journal for publication. CONCLUSION This NMA will summarize the direct and indirect evidence to evaluate the effect of different fixation devices for ACL reconstruction.
Collapse
Affiliation(s)
- Jiaxin Jin
- Department of Orthopaedics, Second Hospital of Lanzhou University
| | - Liping Yu
- Department of Nursing, Rehabilitation Center Hospital of Gansu Province
| | - Min Wei
- Department of Anesthesiology, Affiliated Hospital of Gansu University of Chinese Medicine
| | - Yi Shang
- Department of General Surgery, Second Hospital of Lanzhou University
| | - Xin Wang
- Department of Orthopaedics, First Hospital of Lanzhou University, Lanzhou, China
| |
Collapse
|
27
|
Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol 2019; 33:33-47. [PMID: 31431274 PMCID: PMC6723618 DOI: 10.1016/j.berh.2019.01.018] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Anterior cruciate ligament (ACL) rupture occurs most commonly in young and active individuals and can have negative long-term physical and psychological impacts. The diagnosis is made with a combination of patient's history, clinical examination, and, if appropriate, magnetic resonance imaging. The objectives of management are to restore knee function, address psychological barriers to activity participation, prevent further injury and osteoarthritis, and optimize long-term quality of life. The three main treatment options for ACL rupture are (1) rehabilitation as first-line treatment (followed by ACL reconstruction (ACLR) in patients, who develop functional instability), (2) ACLR and post-operative rehabilitation as the first-line treatment, and (3) pre-operative rehabilitation followed by ACLR and post-operative rehabilitation. We provide practical recommendations for informing and discussing management options with patients, and describe patient-related factors associated with a worse ACL-rupture outcome. Finally, we define evidence-based rehabilitation and present phase-specific rehabilitation recommendations and criteria to inform return to sport decisions.
Collapse
Affiliation(s)
- Stephanie R Filbay
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, UK.
| | - Hege Grindem
- Oslo Sport Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014 Ullevål Stadion, Oslo, 0806, Norway.
| |
Collapse
|