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Walker A, Sattler L, Heyward S, Tedesco J, Jones Z, D'Lima C, Higham C, Cuthbert S, Hing W. An 8-week physiotherapist-led return to sport group program after anterior cruciate ligament reconstruction improves measures of physical and psychological function: A case series. Musculoskelet Sci Pract 2024; 73:103149. [PMID: 39047591 DOI: 10.1016/j.msksp.2024.103149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Low return to competitive sport, high reinjury rates and long-term functional impairment of anterior cruciate ligament reconstruction (ACLR) present significant challenges for patients. A program that facilitates a safe return to sport (RTS) following ACLR could potentially improve outcomes. STUDY DESIGN Case Series. METHODS Sixty participants (median 20-years-old (13-36), 43 males, 18 females, median 7.5 months (4-25) post-ACLR) completed an eight-week exercise program. A battery of physical tests and patient-reported outcome measures were assessed pre and post-program. The number of participants passing RTS criteria was evaluated, and RTS rates were determined. The correlation between the ACL-RSI and measures of physical function was explored. RESULTS Improvements in all isometric strength, hop tests, running T-test, and patient reported outcome measures were seen post-program. Five (8%) participants successfully passed all RTS criteria and eighty-five percent of participants returned to their previous level of sport. The ACL-RSI and the IKDC showed correlation across all time points (pre rs = 0.49; post rs = 0.40; change r = 0.40). CONCLUSIONS Our study demonstrated improvements in all RTS criteria tests upon completing the 8-week rehabilitation program; however, few participants (8%) passed all RTS criteria. Psychological readiness is more closely related to patient-reported function than functional tests.
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Affiliation(s)
- Adam Walker
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia; Gold Coast Knee Group, Gold Coast, Australia.
| | - Larissa Sattler
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia; Gold Coast Knee Group, Gold Coast, Australia
| | - Samuel Heyward
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Jordan Tedesco
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Zachariah Jones
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Corey D'Lima
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Caroline Higham
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Sophie Cuthbert
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Wayne Hing
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
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Wang F, Fu Z, Song Y, Qiao X. Establishment and validation of a prognostic model after adrenal tumor surgery. Asian J Surg 2024; 47:4388-4390. [PMID: 39069418 DOI: 10.1016/j.asjsur.2024.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024] Open
Affiliation(s)
- Fei Wang
- Affiliated Hospital of Panzhihua University, Panzhihua Hospital of Integrated Traditional Chinese and Western Medicine, Basic and Clinical Research Team of Affiliated Hospital of Panzhihua University, Research and Innovation Platform of Panzhihua Urology, Panzhihua, 617000, China
| | - Zhengwei Fu
- Jianyang Hospital of Traditional Chinese Medicine, Chengdu, 610,000, China
| | - Yiwei Song
- Affiliated Hospital of Panzhihua University, Panzhihua Hospital of Integrated Traditional Chinese and Western Medicine, Basic and Clinical Research Team of Affiliated Hospital of Panzhihua University, Research and Innovation Platform of Panzhihua Urology, Panzhihua, 617000, China
| | - Xuhua Qiao
- Affiliated Hospital of Panzhihua University, Panzhihua Hospital of Integrated Traditional Chinese and Western Medicine, Basic and Clinical Research Team of Affiliated Hospital of Panzhihua University, Research and Innovation Platform of Panzhihua Urology, Panzhihua, 617000, China.
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Maayan O, Zhang B, Fourman MS, Clohisy J, Pajak A, Nakarai H, Kazarian GS, Du J, Merrill R, Kaidi A, Knopp R, Akosman I, Samuel J, Andrews L, Shahi P, Lovecchio FC, Kim HJ. Return to sporting activities following long fusions to the pelvis in adult spinal deformity. Spine J 2024; 24:1817-1824. [PMID: 38871060 DOI: 10.1016/j.spinee.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/23/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND CONTEXT Returning to recreational sporting activities after adult spinal deformity (ASD) correction may significantly impact the patient's perceived quality of life. PURPOSE This study sought to characterize participation in sporting activities before and after ASD surgery, and to identify factors associated with impaired return to sports. STUDY DESIGN Cross-sectional survey and retrospective review of prospectively collected data. PATIENT SAMPLE Patients who underwent posterior-only thoracolumbar ASD surgery between 2016 and 2021 with ≥1 year follow-up and ≥3 levels of fusion to the pelvis were included. OUTCOME MEASURES Preoperative and postoperative participation in sports, timing of return to these activities, and reasons for limited sports participation postoperatively were assessed. METHODS A survey was used to evaluate outcome measures. Differences in demographic, surgical, and perioperative variables between patients who reported improved, unchanged, or worsened activity tolerance were evaluated. RESULTS Ninety-five patients were included (mean age: 64.3±10.1 years; BMI: 27.3±6.1 kg/m2; median levels fused: 7). The survey was completed at an average of 43.5±15.9 months after surgery. Sixty-eight (72%) patients participated in sports preoperatively. The most common sports were swimming (n=33, 34.7%), yoga (n=23, 24.2%), weightlifting (n=20, 21.1%), elliptical (n=19, 20.0%), and golf (n=11, 11.6%). Fifty-seven (83.8%) returned to at least one sport postoperatively, most commonly 6-12 months after surgery (45%). Elliptical had the highest rate of equal or improved participation (53%). Patients generally returned below their preoperative level to all other sports. Reasons for reduced sporting activities included physical limitation (51.4%), fear (20.0%), pain (17.1%), and surgeon advice (8.6%). There were no differences in the demographic, surgical, or perioperative characteristics between those who returned to sports at the same or better level compared with those who returned at a lower level. CONCLUSIONS About 84% of patients successfully resumed sporting activities after undergoing fusion to the sacrum/pelvis for ASD. However, this return is typically at a lower level of participation than their preoperative participation, particularly in higher demand sports. Understanding trends in sporting activity may be valuable for counseling patients and setting expectations.
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Affiliation(s)
- Omri Maayan
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Bo Zhang
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Mitchell S Fourman
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Montefiore Einstein, 1250 Waters Pl, Tower 1, 11th Fl, Bronx, NY 10461, USA
| | - John Clohisy
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Anthony Pajak
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Hiroyuki Nakarai
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | | | - Jerry Du
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Robert Merrill
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Austin Kaidi
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Rachel Knopp
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Izzet Akosman
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Justin Samuel
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Leah Andrews
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Pratyush Shahi
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | | | - Han Jo Kim
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
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Keoliya A, Ramteke SU. Perturbation Training in Anterior Cruciate Ligament Graft Tear and Posterolateral Corner Injury: A Case Report of a Combined Injury. Cureus 2024; 16:e68750. [PMID: 39371700 PMCID: PMC11455971 DOI: 10.7759/cureus.68750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 09/05/2024] [Indexed: 10/08/2024] Open
Abstract
This case study illustrates how rehabilitation for combination injuries necessitates a thorough, customized strategy that includes perturbation training to address complicated biomechanical impairments because of the complex relationship between the anterior cruciate ligament (ACL) and the posterolateral corner (PCL). An 18-year-old female basketball player visited the Sports Rehab Outpatient Department with a complaint of pain in the posterior aspect of her knee, difficulty fully flexing her right knee joint, and intermittent instability one month after an injury. Her grade 2 ACL tear was accompanied by thinning of the lateral collateral ligament and strain of the popliteofibular ligament as per the MRI findings before the ACL reconstruction surgery. She underwent a knee graft sprain and ACL re-injury. The decision was made to manage the injury conservatively by implementing a rehabilitation program focused on perturbations to improve neuromuscular control and functional stability of the knee. This case report highlights the significance of a multidisciplinary approach, evidence-based interventions (such as the Lysholm score, International Knee Documentation Committee-Subjective Knee Form, and Tempa Scale of Kinesiophobia as outcome measures), and patient-centered care. This study intends to make a significant contribution to sports medicine and orthopedic rehabilitation by clarifying the complexities of rehabilitation in such complicated circumstances.
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Affiliation(s)
- Ashish Keoliya
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapnil U Ramteke
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Bashaireh KM, Yabroudi MA, Logerstedt D, Snyder-Mackler L, Nawasreh ZH. Reasons for Not Returning to Pre-injury Sport Level After ACL-Reconstruction. Int J Sports Med 2024; 45:698-704. [PMID: 38718825 DOI: 10.1055/a-2270-3306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
The study aimed to identify athlete-reported reasons for not returning to pre-injury sports level after anterior cruciate ligament reconstruction (ACLR) and to identify the factors associated with these reasons. Ninety-one athletes with 2 years post-ACLR indicated whether or not they had returned to their pre-injury sport level (same frequency, duration, and intensity). Athletes who did not return were asked to provide the reasons. Athletes' characteristics and injury-related factors were used to determine factors associated with the reasons for not returning. Only nine athletes (10%) returned to pre-injury sport level after ACLR. The most common reasons for not returning were lack of confidence or concerns about re-injury (48.8%), followed by continued post-surgical impairments in the reconstructed knee (39%). Having episodes of the knee giving way after ACLR was the only significant predictor of post-surgical impairments (48.8%; OR=8.3, 95%CI=2.48-27.42, p=0.001). Lack of confidence, concerns about re-injury, or post-surgical impairments in the reconstructed knee were the most frequently reported reasons for not returning to pre-injury sports level with 2 years post-ACLR. Reported dynamic knee instability was the only factor associated with ongoing post-surgical knee impairments after ACLR. Rehabilitation programs should address athletes' psychological responses and resolve knee impairments to optimize return to pre-injury sport level after ACLR.
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Affiliation(s)
- Khaldoon M Bashaireh
- Department of Special Surgery, Jordan University of Science and Technology, Irbid central post o, Jordan
| | - Mohammad A Yabroudi
- Division of physical therapy, Dept. of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - David Logerstedt
- Physical Therapy, Saint Joseph's University, Philadelphia, United States
| | | | - Zakariya H Nawasreh
- Division of physical therapy, Dept. of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Hoffer AJ, McConkey MO, Lodhia P, Leith JM. Not all patient-reported outcome measures are equivalent at two years compared to one year after anterior cruciate ligament reconstruction based on a retrospective analysis. J ISAKOS 2024; 9:510-518. [PMID: 38492849 DOI: 10.1016/j.jisako.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE This article aims to assess for clinically important differences in patient-reported outcome measures (PROMs) at one and two years post anterior cruciate ligament reconstruction (ACLR). METHODS A retrospective comparison of prospectively collected PROMs for a single cohort who underwent a primary ACLR with or without associated meniscal surgery from 2016 to 2020 was assessed. Six externally validated PROMs were collected preoperatively and at standardized times postoperatively. Descriptive statistics and paired equivalence testing of PROMs at one and two years after surgery was completed using previously published or calculated minimal clinically important differences as upper and lower equivalence limits. A repeated measures analysis of PROMs that were not clinically equivalent at one and two years after surgery was completed to assess for a clinically significant difference. Subgroup analyses based on sex, age and associated meniscal injury were completed. RESULTS One-hundred and forty-five participants with a mean age of 28.7 years (standard deviation: 9.9 years) were included in the final analysis. All PROMs were clinically equivalent at two years compared to one year after ACLR except the quality of life and sport and recreation domains of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The quality of life (mean difference (MD):12.3, P < 0.01, effect size (η2): 0.65) and sport and recreation (MD: 8.78, P < 0.01, η2: 0.50) domains of the KOOS were clinically different at two years compared to one year postoperatively. No major differences were found in the subgroup analyses compared to the entire included sample. CONCLUSION While most PROMs were equivalent at two years compared to one year after ACLR, the quality of life and sport and recreation domains of the KOOS, which reflect knee performance during higher demand activities, exhibited a clinically significant difference. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alexander J Hoffer
- Department of Surgery, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
| | - Mark O McConkey
- Department of Orthopaedics, Gordon and Leslie Diamond Health Care Centre 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Parth Lodhia
- Department of Orthopaedics, Gordon and Leslie Diamond Health Care Centre 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jordan M Leith
- Department of Orthopaedics, Gordon and Leslie Diamond Health Care Centre 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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García-Albó E, Nomdedéu Sancho J, Gispert Estadella M, Sevil Mayayo R, Andrés-Peiró JV, Pijoan Bueno J, Reverté-Vinaixa MM, Minguell-Monyart J. Lateral extra-articular tenodesis in association to All-inside anterior cruciate ligament reconstruction does not modify return to play in basketball players: A comparative cohort study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00135-8. [PMID: 39089575 DOI: 10.1016/j.recot.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/27/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Return to play rates after anterior cruciate ligament (ACL) reconstruction range between 50-98% depending on sport professionality, without being modified by the addition of an extra-articular augmentation (EA). The objective of the study is to describe the rate of return to play in our cohort. The hypothesis is that the addition of EA increases that rate. MATERIAL AND METHODS A retrospective, descriptive and analytical study of a 130 basketball players cohort between 18 and 45 years old, whom underwent ACL reconstruction between the years 2018 and 2022, with a minimum follow-up of 18 months. Data was collected by reviewing medical records. IKDC score was registered after one year from surgery. All patients operated from 2020 received an extra-articular tenodesis. RESULTS Of all patients, 72.31% returned to training, 70.77% returned to competition and 46.15% returned to the same level of performance prior to injury. The EA group (46.15%) did not increase the rate of return to competition (P=.552) nor to the same level of performance (P=.664). The mean IKDC. score was 86.83 (SD 14.85), and was not higher in the EA group (P=.418). However, its value was higher in the players who returned to training, competition and level of performance (P<.05). EA did not delay the return to play in any group (P=.282). CONCLUSION To sum up, the EA does not modify the return to sport rate. Higher IKDC values predict a greater return to sport rate. in all groups. Prospective studies with larger sample size and longer follow-up time are required.
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Affiliation(s)
- E García-Albó
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Traumatología Lenox Clínica Corachan, Barcelona, España.
| | - J Nomdedéu Sancho
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Gispert Estadella
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - R Sevil Mayayo
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Traumatología Lenox Clínica Corachan, Barcelona, España
| | - J V Andrés-Peiró
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Traumatología Lenox Clínica Corachan, Barcelona, España
| | - J Pijoan Bueno
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Traumatología Lenox Clínica Corachan, Barcelona, España
| | - M M Reverté-Vinaixa
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Traumatología Lenox Clínica Corachan, Barcelona, España
| | - J Minguell-Monyart
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Traumatología Lenox Clínica Corachan, Barcelona, España
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de Geofroy B, Trescos F, Ghabi A, Choufani C, Peras M, Barbier O, de Landevoisin E, Jouvion AX. Anterior Cruciate Ligament Reconstruction in French Army: Return to Prior Level of Running on Selected Military Tests. Mil Med 2024; 189:e995-e1002. [PMID: 37864821 DOI: 10.1093/milmed/usad406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture is frequently encountered in athletes as well as in military personnel. In civilian population, many studies have looked at the return to sport, but return to duty in Army is a topic that requires further research.The purpose of this study was to determine through annual military fitness tests in real conditions, the return to sport in soldiers after ACL reconstruction and factors influencing failure. MATERIALS AND METHODS This was a retrospective comparative study. Patients were all soldiers and had followed up in a Military Hospital. The SUCCESS group was military personnel who obtained a result of the specific aptitude test greater than or equal to this same test carried out before reconstruction of the ACL, the FAILURE group comprised the others. Results of the annual specific aerobic fitness tests were collected before and after ACL reconstruction. Preoperative epidemiological data, intraoperative information, and isokinetic test results were collected. RESULTS One hundred forty four soldiers were included between January 2011 and December 2017 (94.9% of men with a median age of 27.6 years); 40.3% obtained a result greater than or equal to the preoperative fitness test after ACL reconstruction. Among the soldiers who did not regain their performance, 24.3% were declared unfit or discharged. In the FAILURE group, we found patients with a higher body mass index (25.5 vs. 24.4; P = .04), less patients with isokinetic deficit < 30% on the knee flexors and extensors (26.6% vs. 62.9%; P < .01), more long sick leave (39.5% vs. 13.7%; P < .01), and late resumption of military activities (10.5 vs. 8.9 months; P < .01). CONCLUSION Rupture of ACL has a significant impact on the operational capacity of the French army. The proportion of return to the same level in annual specific fitness tests after ACL reconstruction is 40% among soldiers. Several variables are important to consider in the follow-up of these patients to optimize their recovery of sports performance and therefore their operational capacity.
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Affiliation(s)
- Bernard de Geofroy
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, Marseille, 13013, France
| | - Florent Trescos
- Department of Physical Medicine and Rehabilitation of the Injured, HIA Laveran, Marseille, 13013, France
| | - Ammar Ghabi
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, Marseille, 13013, France
| | - Camille Choufani
- Department of Orthopaedic Surgery and Traumatology, HIA Sainte Anne, Toulon, 83000, France
| | - Mathieu Peras
- Department of Orthopaedic Surgery and Traumatology, HIA Sainte Anne, Toulon, 83000, France
| | - Olivier Barbier
- Department of Orthopaedic Surgery and Traumatology, HIA Sainte Anne, Toulon, 83000, France
| | | | - Arnaud-Xavier Jouvion
- Department of Physical Medicine and Rehabilitation of the Injured, HIA Laveran, Marseille, 13013, France
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Welling W. Return to sports after an ACL reconstruction in 2024 - A glass half full? A narrative review. Phys Ther Sport 2024; 67:141-148. [PMID: 38749349 DOI: 10.1016/j.ptsp.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 06/10/2024]
Abstract
A successful return to sports (RTS) after an anterior cruciate ligament reconstruction (ACLR) is multifactorial, and therefore difficult and challenging. Unfortunately, low percentages of patients RTS, and for those who succeed, one-fifth of patients will sustain a second ACL injury. Over the past years, test batteries were developed to assess whether patients can RTS with a low risk for a second ACL injury risk. Low rates of patients who meet RTS criteria were found, coupled with the insufficiency of current RTS test batteries in predicting second ACL injuries suggesting poor sensitivity. The result of an RTS test is likely to reflect the content of a rehabilitation program, raising critical questions regarding what we are offering patients within the rehabilitation programme. Are we preparing our patients well enough for the high demands of complex situations within pivoting team sports? This narrative review offers insights from key lessons of the last 15 years on 1) RTS testing, 2) the content of rehabilitation, and 3) the RTS continuum, all from a "helicopter perspective".
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Affiliation(s)
- Wouter Welling
- Pro-F Fysiotherapie, Kotkampweg 65, 7531 AS, Enschede, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Science, A. Deusinglaan 1, 9713 AV, Groningen, the Netherlands.
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Hopper HM, Bruce Leicht AS, Thompson XD, Gwathmey FW, Miller MD, Werner BC, Brockmeier SF, Diduch DR, Hart JM. The effect of factors from different time points on psychological readiness following ACL reconstruction. Phys Ther Sport 2024; 67:161-166. [PMID: 38823214 DOI: 10.1016/j.ptsp.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 05/18/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE The purpose of this study was to examine factors correlated with psychological readiness to return to activity after ACLR. DESIGN cross sectional study. SETTING controlled laboratory. PARTICIPANTS 164 patients (82 M/82 F, 22.5 ± 8.9yr, 171.6 ± 11.0 cm, 77.4 ± 18.6 kg, 8.6 ± 3.4 months post-ACLR) participated in this study after a primary, isolated, and uncomplicated ACLR. MAIN OUTCOME MEASURES ACL Return to Sport Index (ACL-RSI). RESULTS ACL-RSI scores demonstrated a weak positive correlation with activity level at the time of injury and a fair positive correlation with activity level at the time of post-operative testing (p-values: 0.004, <0.001). ACL-RSI scores showed a statistically significant fair negative correlation with pain and a moderate negative correlation with kinesiophobia during rehabilitation (p-values: <0.001, <0.001). There was no statistical significance between ACL-RSI and the surgical variables (p-value range: 0.10-0.61). CONCLUSIONS Outcomes from testing during postoperative rehabilitation were most correlated with psychological readiness to return to activity after ACLR. Increased pain and kinesiophobia were associated with a decreased psychological readiness. Increased activity level prior to injury and activity level at the time of testing during rehabilitation were both correlated with increased psychological readiness. Psychological readiness to return to activity may need to be customized based on potentially modifiable patient-specific factors during the post-operative rehabilitation.
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Affiliation(s)
- Haleigh M Hopper
- University of Virginia, Department of Kinesiology, Charlottesville, VA, USA.
| | | | - Xavier D Thompson
- University of Virginia, Department of Kinesiology, Charlottesville, VA, USA
| | - F Winston Gwathmey
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | - Mark D Miller
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | - Brian C Werner
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | - Stephen F Brockmeier
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | - David R Diduch
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | - Joseph M Hart
- University of North Carolina, Department of Orthopaedics, Chapel Hill, NC, USA
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Kacprzak B, Rosińska K. Rehabilitation of Soccer Players' Knee Injuries: Cartilage Reconstruction, Anterior Cruciate Ligament Surgery, and Intensive Recovery-A Pilot Study. J Clin Med 2023; 12:6893. [PMID: 37959358 PMCID: PMC10650160 DOI: 10.3390/jcm12216893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Knee injuries, particularly anterior cruciate ligament (ACL) damage and cartilage defects, are highly prevalent among athletes and affect their sports performance and long-term joint function. The purpose of this research was to evaluate the effectiveness of a comprehensive combination therapy approach for individuals with ACL and cartilage injuries. Twelve professional soccer players aged 18 to 30 years underwent bone-tendon-bone ACL reconstruction, microfracture cartilage repair surgery, and hyaluronic acid scaffold treatment. Early postoperative rehabilitation included immediate supervised physiotherapy and complete weight bearing. Follow-up assessments involved clinical evaluations, functional joint assessments, and magnetic resonance imaging (MRI) scans to measure cartilage defect repair and symptom alleviation. The results showed that patients resumed pain-free activities within 3-4 weeks and returned to their pre-injury level within 4.5 months. MRI demonstrated the absence of inflammatory reactions, repair of marrow edema, and the emergence of new cartilage. Six months and one year after surgery, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Short Form (36) Health Survey (SF-36) questionnaire results demonstrated considerable improvement in patients' health condition and quality of life. Overall, the study suggests that the combination of Hyalofast membranes, microfracture surgery, tissue adhesive, and intensive postoperative physical therapy may be a potential alternative to commonly used treatments for patients with ACL rupture, allowing them to recover efficiently and return to sports activities.
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Affiliation(s)
- Bartłomiej Kacprzak
- Orto Med Sport Łódź, 28 Pułku Strzelców Kaniowskich 45, 90-640 Łódź, Poland;
| | - Karolina Rosińska
- Wolf Project Studio Krzysztof Król, ul. Gdańska 79/D01, 90-613 Łódź, Poland
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12
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Rahardja R, Love H, Clatworthy MG, Young SW. Meniscal repair failure following concurrent primary anterior cruciate ligament reconstruction: results from the New Zealand ACL Registry. Knee Surg Sports Traumatol Arthrosc 2023; 31:4142-4150. [PMID: 37145132 PMCID: PMC10471701 DOI: 10.1007/s00167-023-07424-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/01/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE This study aimed to identify the risk factors for meniscal repair failure following concurrent primary anterior cruciate ligament (ACL) reconstruction. METHODS Prospective data recorded by the New Zealand ACL Registry and the Accident Compensation Corporation were reviewed. Meniscal repairs performed during concurrent primary ACL reconstruction were included. Repair failure was defined as a subsequent reoperation involving meniscectomy of the repaired meniscus. Multivariate survival analysis was performed to identify the risk factors for failure. RESULTS A total of 3,024 meniscal repairs were analysed with an overall failure rate of 6.6% (n = 201) at a mean follow-up of 2.9 years (SD 1.5). The risk of medial meniscal repair failure was higher with hamstring tendon autografts (adjusted HR [aHR] = 2.20, 95% CI 1.36-3.56, p = 0.001), patients aged 21-30 years (aHR = 1.60, 95% CI 1.30-2.48, p = 0.037) and in patients with cartilage injury in the medial compartment (aHR = 1.75, 95% CI 1.23-2.48, p = 0.002). The risk of lateral meniscal repair failure was higher in patients aged ≤ 20 years (aHR = 2.79, 95% CI 1.17-6.67, p = 0.021), when the procedure was performed by a low case volume surgeon (aHR = 1.84, 95% CI 1.08-3.13, p = 0.026) and when a transtibial technique was used to drill the femoral graft tunnel (aHR = 2.30, 95% CI 1.03-5.15, p = 0.042). CONCLUSION The use of a hamstring tendon autograft, younger age and the presence of medial compartment cartilage injury are risk factors for medial meniscal repair failure, whereas younger age, low surgeon volume and a transtibial drilling technique are risk factors for lateral meniscal repair failure. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Richard Rahardja
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand.
| | | | - Mark G Clatworthy
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Simon W Young
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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13
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Solie B, Monson J, Larson C. Graft-Specific Surgical and Rehabilitation Considerations for Anterior Cruciate Ligament Reconstruction with the Quadriceps Tendon Autograft. Int J Sports Phys Ther 2023; 18:493-512. [PMID: 37020435 PMCID: PMC10069402 DOI: 10.26603/001c.73797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/28/2023] [Indexed: 04/03/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) with a bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autograft has traditionally been the preferred surgical treatment for patients returning to Level 1 sports. More recently, international utilization of the quadriceps tendon (QT) autograft for primary and revision ACLR has increased in popularity. Recent literature suggests that ACLR with the QT may yield less donor site morbidity than the BPTB and better patient-reported outcomes than the HT. Additionally, anatomic and biomechanical studies have highlighted the robust properties of the QT itself, with superior levels of collagen density, length, size, and load-to-failure strength compared to the BPTB. Although previous literature has described rehabilitation considerations for the BPTB and HT autografts, there is less published with respect to the QT. Given the known impact of the various ACLR surgical techniques on postoperative rehabilitation, the purpose of this clinical commentary is to present the procedure-specific surgical and rehabilitation considerations for ACLR with the QT, as well as further highlight the need for procedure-specific rehabilitation strategies after ACLR by comparing the QT to the BPTB and HT autografts. Level of Evidence Level 5.
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14
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Ronden AE, Koc BB, van Rooij L, Schotanus MG, Jansen EJ. Low percentage of patients passed the 'Back in Action' test battery 9 months after bone-patellar tendon-bone anterior cruciate ligament reconstruction. J Clin Orthop Trauma 2022; 34:102025. [PMID: 36147380 PMCID: PMC9486609 DOI: 10.1016/j.jcot.2022.102025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction is recommended in patients who intend to return to high-level sports. However, there is only a 55-80% return to pre-injury level of sports after ACL reconstruction, with a re-injury rate up to 20%. The aim of this study was to determine the percentage of patients passing the Back in Action (BIA) test 9 months after primary bone-patellar-tendon-bone (BPTB) ACL reconstruction, and evaluate the association between passing the BIA test and patient reported outcome measurements (PROMs). Methods Patients underwent the BIA test 9 months after BPTB ACL reconstruction. In total 103 patients were included. Passing the BIA test (PASSED-group) was defined as a normal or higher score at all sub-tests with limb symmetry index (LSI) ≥90% for the dominant leg and LSI >80% for the non-dominant leg. Patients who did not meet these criteria were defined as the FAILED-group. PROMs included the International Knee Documentation Committee, Knee injury Osteoarthritis Outcome Score and Anterior Cruciate Ligament-Return to Sport after Injury. Results Eighteen patients (17.5%) passed the BIA test 9 months after BPTB ACL reconstruction. PROMs were not statistically significant different between the PASSED- and FAILED-group. Conclusion Low percentage of patients passed the BIA test 9 months after BPTB ACL reconstruction. Although current PROMs cut-off values were met, the BIA test results show persistent functional deficits. Therefore, the BIA test could be of additional value in the decision-making process regarding return to sport (RTS). This study highlights the need for additional rehabilitation as RTS in a condition of incomplete recovery may increase the risk of re-injury. Level of evidence II.
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Affiliation(s)
- Annick E. Ronden
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Baris B. Koc
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
| | - Lize van Rooij
- Maastricht University, Faculty of Health Medicine & Life Sciences, Maastricht, the Netherlands
| | - Martijn G.M. Schotanus
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Edwin J.P. Jansen
- Department of Orthopedic Surgery and Traumatology, Sports Orthopedic Research Center Zuyderland, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, the Netherlands
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15
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Differences in the course of rehabilitation and outcomes for publicly insured pediatric patients after anterior cruciate ligament reconstruction. Phys Ther Sport 2022; 58:52-57. [PMID: 36174372 DOI: 10.1016/j.ptsp.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Examine the effect of insurance type on physical therapy (PT) utilization and outcomes within pediatric and adolescent patients after anterior cruciate ligament reconstruction. DESIGN Multicenter retrospective cohort study. METHODS PT visits and functional hop test performance were extracted into a shared database. The average number of PT visits per week was assessed overall and by time period. Independent samples t-test examined the effect of insurance on PT utilization and the effect of insurance status on the odds of passing single-legged hop tests was assessed using multivariable logistic regression. RESULTS A total of 281 patients (15.7 ± 1.9, 42% female) were included in this analysis. Of these, 128 (45%) had public insurance. Publicly insured patients experienced a longer delay from surgery to hop test (8.3vs7.7 months, p = 0.009), attended overall fewer PT visits per week (0.92vs1.04, p = 0.005), with most of the decreased frequency occurring between weeks 7-24. Insurance status had a significant effect on the odds of passing the single leg hop test (2.72; 95%CI, 1.27-5.81). CONCLUSION Publicly insured patients average a lower number of weekly PT visits, experienced a longer delay from surgery to hop testing and were 2.7 times less likely to pass the single leg hop for distance test.
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Rodriguez-Merchan EC, Valentino LA. Return to Sport Activities and Risk of Reinjury Following Primary Anterior Cruciate Ligament Reconstruction. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:648-660. [PMID: 36258743 PMCID: PMC9569141 DOI: 10.22038/abjs.2021.50463.2504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This article examines the elements that affect the return to sport (RTS) and the risk and percentages of reinjury following a prior primary anterior cruciate ligament reconstruction (ACLR). The prevalence of RTS following ACLR ranges from 71% to 83%. Concerning elements affecting RTS, a limb symmetry index score of 90 or more duplicates the likelihood of RTS and triplicates it when the International Knee Documentation Committee (IKDC) score is 95 or more, irrespective of age. Other elements recognized to be preindicative of RTS at 1 year include complete rehabilitation, age ≤25, and higher IKDC scores. The prevalence of reinjury following ACLR ranges from 1.5% to 37.5% (between 9% and 29% in the majority of reports). It has been published that 1 in 5 individuals suffers reinjury to either knee, and that male individuals are more prone to reinjure following ACLR. The highest percentage of ACLR reinjury happens in younger male (<18 years), being substantially higher than in female of the same age. Passing a combination of functional tests with predetermined cut-off points utilized as RTS criteria are related diminished ACLR reinjury percentages.
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17
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Walker A, Hing W, Gough S, Lorimer A. 'Such a massive part of rehab is between the ears'; barriers to and facilitators of anterior cruciate ligament reconstruction rehabilitation: a qualitative focus group analysis. BMC Sports Sci Med Rehabil 2022; 14:106. [PMID: 35701850 PMCID: PMC9199234 DOI: 10.1186/s13102-022-00499-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/30/2022] [Indexed: 12/05/2022]
Abstract
Background Current evidence demonstrates that few patients complete anterior cruciate ligament reconstruction rehabilitation according to evidence-based guidelines. It is important to investigate the viewpoints of our patients to identify patient-reported barriers and facilitators of anterior cruciate ligament reconstruction rehabilitation. Qualitative analysis can provide insight into potential methods for improving the delivery of rehabilitation services. Methods In this qualitative study, utilising a social constructionism orientation, viewed through the social phenomenological lens, three focus groups were conducted with individuals 1–20 years post anterior cruciate ligament reconstruction (n = 20, 9 males, 11 females, mean 6.5 years post-surgery, 19–51 years old). Utilising a semi-structured interview guide, participants were asked about their experiences during anterior cruciate ligament reconstruction rehabilitation. Focus groups were recorded, transcribed, and coded using an inductive semantic thematic analysis methodology. Results Five organising themes were identified (consisting of 19 sub-themes) to provide a framework to present the data: psychological, physiological, rehabilitation service, rehabilitation characteristics, and interaction with others. Each theme details aspects of rehabilitation, such as exercise delivery, informational support, frequency, and duration of care, kinesiophobia, weight management and interactions with teams and coaches, which present barriers or facilitators for patients to adhere to and participate in rehabilitation. Example quotes are provided for each theme to provide context and the patient’s voice. Conclusions This qualitative investigation identified key aspects of a patient's rehabilitation in which they encounter a variety of barriers and facilitators of ACL reconstruction rehabilitation. These aspects, such as the rehabilitation characteristics, service delivery, psychological and physiological factors, and interactions with others, were consistently identified by this cohort as factors which affected their rehabilitation. The themes may provide targets for clinicians to improve rehabilitation and deliver patient-centred care. However, the themes must be evaluated in future trials to assess whether interventions to remove barriers or enhance facilitators improves subsequent outcomes such as return to sport and re-injury rates. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00499-x.
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Affiliation(s)
- Adam Walker
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia. .,Bond Institute of Health and Sport, Promethean Way, Robina, QLD, 4226, Australia.
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
| | - Anna Lorimer
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226, Australia
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18
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Varshneya K, Abrams GD, Sherman SL, Safran MR. Patient-Specific Risk Factors Exist for Hip Fractures After Arthroscopic Femoroacetabular Impingement Surgery, But Not for Dislocation—An Analysis of More Than 25,000 Hip Arthroscopies. Arthrosc Sports Med Rehabil 2022; 4:e519-e525. [PMID: 35494300 PMCID: PMC9042775 DOI: 10.1016/j.asmr.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 11/13/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose To identify postoperative complications and risk factors associated with hip fracture and dislocation following primary arthroscopic surgical management of femoroacetabular impingement (FAI) syndrome. Methods MarketScan was queried to identify patients who underwent FAI surgery from 2007 to 2016. Patients were stratified into 2 groups: acetabuloplasty only or femoroplasty only. A subanalysis of combined acetabuloplasty and femoroplasty also was undertaken. Surgical outcomes were followed postoperatively for 180 days. Multivariate logistic regression was used to control for with an alpha value of 0.05 set as significant. Results This study identified 13,809 patients (mean age, 36.3 years) who underwent primary acetabuloplasty or femoroplasty. We also identified 10,026 patients who underwent both procedures. Postoperative complication rates were similar between the cohorts (acetabuloplasty 17.1%, femoroplasty 19.9%, P = .0622). Rates of hip fracture (femoroplasty: 2.4% vs acetabuloplasty: 2.0%, P = .0302) and heterotopic ossification (femoroplasty: 11.3% vs acetabuloplasty: 8.8%, P < .0001) were greater in the femoroplasty-only cohort. Combined acetabuloplasty and femoroplasty was associated with the greatest complication burden of 21.6% (P < .0001). After multivariate regression, differences in age, sex, comorbid status, or procedure type did not influence odds in risk for postoperative hip dislocation. Adjusted data showed that neither femoroplasty nor acetabuloplasty influenced odds of hip fracture (P > .05). Patients who were aged younger than 20 years old were significantly less likely to fracture their hips postoperatively than patients aged 60+ years (odds ratio 0.3, 95% confidence interval 0.1-0.8). Hypertension was independently associated with increased odds of hip fracture (odds ratio 1.7, 95% confidence interval 1.2-3.5). Conclusions Older age, male sex, and hypertension all carry increased risk for a hip fracture following acetabuloplasty or femoroplasty. Patient- and procedure-specific factors that could be assessed with this database did not influence risk for hip dislocation. Level of Evidence Level III; retrospective comparative observation trial.
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19
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Lu Y, Forlenza E, Wilbur RR, Lavoie-Gagne O, Fu MC, Yanke AB, Cole BJ, Verma N, Forsythe B. Machine-learning model successfully predicts patients at risk for prolonged postoperative opioid use following elective knee arthroscopy. Knee Surg Sports Traumatol Arthrosc 2022; 30:762-772. [PMID: 33420807 DOI: 10.1007/s00167-020-06421-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/14/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Recovery following elective knee arthroscopy can be compromised by prolonged postoperative opioid utilization, yet an effective and validated risk calculator for this outcome remains elusive. The purpose of this study is to develop and validate a machine-learning algorithm that can reliably and effectively predict prolonged opioid consumption in patients following elective knee arthroscopy. METHODS A retrospective review of an institutional outcome database was performed at a tertiary academic medical centre to identify adult patients who underwent knee arthroscopy between 2016 and 2018. Extended postoperative opioid consumption was defined as opioid consumption at least 150 days following surgery. Five machine-learning algorithms were assessed for the ability to predict this outcome. Performances of the algorithms were assessed through discrimination, calibration, and decision curve analysis. RESULTS Overall, of the 381 patients included, 60 (20.3%) demonstrated sustained postoperative opioid consumption. The factors determined for prediction of prolonged postoperative opioid prescriptions were reduced preoperative scores on the following patient-reported outcomes: the IKDC, KOOS ADL, VR12 MCS, KOOS pain, and KOOS Sport and Activities. The ensemble model achieved the best performance based on discrimination (AUC = 0.74), calibration, and decision curve analysis. This model was integrated into a web-based open-access application able to provide both predictions and explanations. CONCLUSION Following appropriate external validation, the algorithm developed presently could augment timely identification of patients who are at risk of extended opioid use. Reduced scores on preoperative patient-reported outcomes, symptom duration and perioperative oral morphine equivalents were identified as novel predictors of prolonged postoperative opioid use. The predictive model can be easily deployed in the clinical setting to identify at risk patients thus allowing providers to optimize modifiable risk factors and appropriately counsel patients preoperatively. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Enrico Forlenza
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ryan R Wilbur
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ophelie Lavoie-Gagne
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael C Fu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Adam B Yanke
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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20
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Mok AC, Fancher AJ, Vopat ML, Baker J, Tarakemeh A, Mullen S, Schroeppel JP, Templeton K, Mulcahey MK, Vopat BG. Sex-Specific Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671221076883. [PMID: 35224122 PMCID: PMC8873558 DOI: 10.1177/23259671221076883] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Despite the significant difference between men and women in incidence of anterior cruciate ligament (ACL) injuries, there is a paucity of consistent information on the influence of patient sex on outcomes after ACL reconstruction. A previous meta-analysis has demonstrated that female patients have worse outcomes with regard to laxity, revision rate, Lysholm score, and Tegner activity score and are less likely to return to sports (RTS). Purpose: To conduct a systematic review and meta-analysis to evaluate and compare sex-specific outcomes after ACL reconstruction. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using PubMed, PubMed Central, Embase, OVID, and Cochrane databases per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following search terms were used: “anterior cruciate ligament reconstruction” OR “ACL reconstruction” OR “anterior cruciate ligament” OR “ACL” AND “gender” OR “sex” OR “male” OR “female” AND “outcome” AND “2015-Present” to gather all relevant articles between 2015 and 2020. A risk-of-bias assessment and quality assessment was conducted on included studies. Results: Of 9594 studies initially identified, 20 studies with 35,935 male and 21,455 female patients were included for analysis. The 7 studies reporting International Knee Documentation Committee (IKDC) scores showed that male patients had statistically significantly higher postoperative scores (mean difference, 3.02 [95% CI, 1.19-4.84]; P< .01; I2 = 66%), and 7 studies that reported the rate of ACL revision showed there was no significant difference between male and female patients (odds ratio, 0.85 [95% CI, 0.45-1.60]; P = .61; I2 = 94%). The 7 studies that reported rates of rerupture showed that males were significantly more likely than females to have a graft rerupture (odds ratio, 1.35 [95% CI, 1.22-1.50]; P < .01; I2 = 0%). Male patients reported a higher RTS rate than did their female counterparts (59.82% compared with 42.89%); however, no formal statistical analysis could be done because of the variability in reporting techniques. Conclusion: Male and female patients with ACL injuries demonstrated similar outcomes regarding their rates of revision; however, male patients were found to have statistically significantly higher postoperative IKDC scores but at the same time higher rerupture rates. Our findings suggest that sex-based differences in outcomes after ACL reconstruction vary based on which metric is used. These results must be considered when counseling patients with ACL injuries.
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Affiliation(s)
- Anthony C. Mok
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | | | - Matthew L. Vopat
- Department of Orthopaedics, The Steadman Clinic, Vail, Colorado, USA
| | - Jordan Baker
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Scott Mullen
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - John P. Schroeppel
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Kim Templeton
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Mary K. Mulcahey
- Department of Orthopaedics, Tulane University, New Orleans, Louisiana, USA
| | - Bryan G. Vopat
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, Kansas, USA
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21
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A Compound Hop Index for Assessing Soccer Players' Performance. J Clin Med 2022; 11:jcm11010255. [PMID: 35011996 PMCID: PMC8745790 DOI: 10.3390/jcm11010255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 02/01/2023] Open
Abstract
Athletes regularly have to pass a series of tests, among which one of the most frequently used functional performance measures are single-leg hop tests. As the collected individual results of tests constitute a large amount of data, strategies to decrease the amount of data without reducing the number of performed tests are being searched for. Therefore, the study aimed to present an effective method to reduce the hop-test battery data to a single score, namely, the Compound Hop Index (CHI) in the example of a soccer team. A male, first-league soccer team performed a battery of commonly used single-leg hop tests, including single hop and triple hop for distance tests and the six-meter timed hop test. Gathered data, including Limb Symmetry Indexes of the three tests, normalized to body height for the single- and triple-hop-tests distance separately for right and left legs, and the time of the six-meter timed hop test separately for right and left legs were standardized to z-scores. Consecutively, the z-scores were averaged and formed CHI. The developed CHI represents a novel score derived from the average of z-scores that significantly reduces, clarifies, and organizes the hop performance-measures data.
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22
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Gokeler A, Dingenen B, Hewett TE. Rehabilitation and Return to Sport Testing After Anterior Cruciate Ligament Reconstruction: Where Are We in 2022? Arthrosc Sports Med Rehabil 2022; 4:e77-e82. [PMID: 35141539 PMCID: PMC8811523 DOI: 10.1016/j.asmr.2021.10.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/30/2021] [Indexed: 01/02/2023] Open
Abstract
Athletes who sustain an anterior cruciate ligament (ACL) injury often opt for an ACL reconstruction (ACLR) with the goal and expectation to return to sports at the preinjury level. The proportion of athletes who successfully return to preinjury-level sport is low and disappointing, whereas the rate of second ACL injury in athletes under the age of 20 has been reported to be as high as 40% after return to sport (RTS). Although in recent years, new insights pertaining to RTS have been published, the lack of validity of RTS criteria after ACLR remain. The purpose of this clinical commentary is to present a critical overview of the current literature on RTS testing after ACLR.
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Affiliation(s)
- Alli Gokeler
- OCON Centre of Orthopaedic Surgery and Sports Medicine, Hengelo, The Netherlands.,Exercise Science and Neuroscience Unit, Department Exercise & Health, Faculty of Science, University of Paderborn, Paderborn, Germany
| | - Bart Dingenen
- Reval Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Timothy E Hewett
- Hewett Global Consultants, Rochester, Minnesota, U.S.A.,Rocky Mountain Consortium for Sports Research, Edwards, Colorado, U.S.A
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23
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Beere M, Ebert JR, Joss B, Ackland T. Isometric dynamometry, dependent on knee angle, is a suitable alternative to isokinetic dynamometry when evaluating quadriceps strength symmetry in patients following anterior cruciate ligament reconstruction. Knee 2022; 34:124-133. [PMID: 34890924 DOI: 10.1016/j.knee.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/19/2021] [Accepted: 11/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee extensor strength deficits increase re-injury risk following anterior cruciate ligament reconstruction (ACLR). This study investigated whether isometric strength testing methods are a suitable alternative to isokinetic assessment for identifying knee extensor strength asymmetry. METHODS This study recruited 22 patients at 9-12 months after ACLR and 22 healthy controls. The single hop for distance (SHD) and knee extensor strength via isokinetic (60°/s and 120°/s) and isometric (positions of 90°, 60° and 30° of flexion, from full knee extension) methods were assessed. Absolute scores (normalized to body weight) and limb symmetry indices (LSIs) were calculated, with t-tests employed for statistical comparisons. RESULTS The SHD LSI was significantly higher (p < 0.01) than both isokinetic speeds and the 30° isometric position. No significant LSI differences (p > 0.01) existed within isokinetic or isometric test conditions. In ACLR patients, only the 60°/s isokinetic condition was significantly lower (p = 0.005) than the 60° isometric condition. When normalized to body weight, the operated limb in ACLR patients was significantly weaker than the non-operated limb during peak isokinetic strength testing at 60°/s (p = 0.001) and 120°/s (p = 0.010), as well as isometric testing at 30° (p = 0.009). Compared with controls, ACLR patients demonstrated significantly lower (p < 0.01) mean LSIs across most measures. CONCLUSIONS Assessment of knee extensor strength via isometric methods appears suitable in the absence of isokinetic testing equipment, though consideration of test angle (30° and 90° knee angles better detect asymmetries similar to isokinetic testing) is important.
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Affiliation(s)
- Michael Beere
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; HFRC, 117 Stirling Highway, Nedlands, Western Australia 6009, Australia
| | - Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; HFRC, 117 Stirling Highway, Nedlands, Western Australia 6009, Australia.
| | - Brendan Joss
- HFRC, 117 Stirling Highway, Nedlands, Western Australia 6009, Australia
| | - Timothy Ackland
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; HFRC, 117 Stirling Highway, Nedlands, Western Australia 6009, Australia
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Muller B, Yabroudi MA, Lynch A, Popchak AJ, Lai CL, van Dijk CN, Fu FH, Irrgang JJ. Return to preinjury sports after anterior cruciate ligament reconstruction is predicted by five independent factors. Knee Surg Sports Traumatol Arthrosc 2022; 30:84-92. [PMID: 33885946 DOI: 10.1007/s00167-021-06558-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 03/30/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To determine factors that predict return to the same frequency and type of sports participation with similar activity demands as before injury. METHODS Individuals 1 to 5 years after primary ACL reconstruction completed a comprehensive survey related to sports participation and activity before injury and after surgery. Patient characteristics, injury variables, and surgical variables were extracted from the medical record. Return to preinjury sports (RTPS) was defined as: "Returning to the same or more demanding type of sports participation, at the same or greater frequency with the same or better Marx Activity Score as before injury." Variables were compared between individuals that achieved comprehensive RTPS and those that did not with univariate and multivariate logistic regression models. RESULTS Two-hundred and fifty-one patients (mean age 26.1 years, SD 9.9) completed the survey at an average of 3.4 years (SD 1.3) after ACL reconstruction. The overall rate of RTPS was 48.6%. Patients were more likely to RTPS if they were younger than 19 years old (OR = 4.07; 95%CI 2.21-7.50; p < 0.01) or if they were competitive athletes (OR = 2.07; 95%CI 1.24-3.46; p = 0.01). Patients were less likely to RTPS if surgery occurred more than 3 months after injury (OR = 0.31, 95%CI 0.17-0.58; p < 0.01), if there was a concomitant cartilage lesion (OR = 0.38; 95%CI 0.21-0.70; p < 0.01), and if cartilage surgery was performed (OR = 0.17; 95%CI 0.04-0.80; p = 0.02). CONCLUSION Five variables best predicted RTPS including age at time of surgery. Only time from injury to surgery is a potentially modifiable factor to improve RTPS; however, the reasons for which patients delayed surgery may also contribute to them not returning to sports. Regardless, younger patients, those that partake in sports on a competitive level, those that undergo surgery sooner, or do not have a cartilage injury or require cartilage surgery are more likely to return to pre-injury sports participation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Bart Muller
- Department of Orthopaedic Surgery, Xpert Clinics, Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands
| | - Mohammad A Yabroudi
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Andrew Lynch
- Department of Physical Therapy, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Chung-Liang Lai
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, 199, sec. 1, San-Min Road, Taichung, Taiwan
| | - C Niek van Dijk
- Department of Orthopaedic Surgery, Xpert Clinics, Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - James J Irrgang
- Department of Physical Therapy, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. .,Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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Forsythe B, Lu Y, Agarwalla A, Ezuma CO, Patel BH, Nwachukwu BU, Beletsky A, Chahla J, Kym CR, Yanke AB, Cole BJ, Bush-Joseph CA, Bach BR, Verma NN. Delaying ACL reconstruction beyond 6 months from injury impacts likelihood for clinically significant outcome improvement. Knee 2021; 33:290-297. [PMID: 34739960 DOI: 10.1016/j.knee.2021.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The effect of surgical latency on outcomes of anterior cruciate ligament reconstruction (ACLR) is a topic that is heavily debated. Some studies report increased benefit when time from injury to surgery is decreased while other studies report no benefit. The purpose of our analysis was to compare achievement of clinically significant outcomes (CSOs) in patients with greater than six months of time from injury to ACLR to those with less than or equal to six months of time to surgery. METHODS Patients undergoing primary ACLR between January 2017 and January 2018 with minimum one year follow-up were included. International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) were collected. Multivariate logistic regression was performed for outcome achievement and risk of revision ACLR and Weibull parametric survival analysis was performed for relative time to outcome achievement. The level of significance was set at α = 0.05. RESULTS 379 patients were included of which, 140 patients sustained ACL injury greater than six months prior to surgery. This group of patients experienced reduced likelihood to achieve patient-acceptable symptomatic state (PASS) on the IKDC (p = 0.03), KOOS Pain (p = 0.01) and a greater likelihood to undergo revision ACLR (p = 0.001). There was no impact of surgical timing on minimal clinically important difference (MCID). CONCLUSION Patients with greater than 6 months from injury to ACLR reported reduced likelihood to achieve CSOs, delayed achievement of CSOs, and increased rates of revision surgery.
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Affiliation(s)
- Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
| | - Yining Lu
- Dept. of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Avinesh Agarwalla
- Dept. of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Chimere O Ezuma
- School of Medicine, Vagelos Columbia College of Physicians and Surgeons, New York, NY, USA
| | - Bhavik H Patel
- Dept. of Orthopaedic Surgery, University of Illinois - Chicago, Chicago, IL, USA
| | | | - Alexander Beletsky
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Craig R Kym
- Dept. of Orthopaedic Surgery, University of Illinois - Chicago, Chicago, IL, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | | | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
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Betsch M, Hoit G, Dwyer T, Whelan D, Theodoropoulos J, Ogilvie-Harris D, Chahal J. Postoperative Pain Is Associated With Psychological and Physical Readiness to Return to Sports One-Year After Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2021; 3:e1737-e1743. [PMID: 34977628 PMCID: PMC8689248 DOI: 10.1016/j.asmr.2021.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 08/03/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose To identify whether any patient factors, injury factors, or symptom severity scores are associated with either psychological or physical readiness to return to sport after anterior cruciate ligament reconstruction (ACLR). Methods Consecutive patients with an ACL injury that required surgical treatment were included in this study. All patients completed the single-legged hop testing and the Anterior Cruciate Ligament Return to Sport Index (ACL-RSI) at 1 year postoperatively. Multivariable regression analysis models were used to determine whether an independent relationship existed between baseline patient factors (age, sex, BMI, preinjury Marx Activity Score), injury factors (meniscal tear and chondral injury), physical symptoms (Knee Injury and Osteoarthritis Outcome Score [KOOS] for pain and symptoms), and the dependent variables of physical and psychological readiness to return to sport (single-legged hop and ACL-RSI). Results Of the 113 patients who were included, 37% were female, and the mean age of our population was 28.2 years (SD = 8.1). Multivariable regression models demonstrated that patient-reported pain symptoms at 1 year postoperatively, as measured by the KOOS pain subscale, was significantly associated with both ACL-RSI score (Beta estimate: 1.11 [95% CI: .62-1.60] P < .001) and the ability to pass the single-legged hop test (OR: 1.07 [95% CI: 1.004-1.142] P = .037). Conclusions Patients with higher reported pain levels at 1 year following ACLR have lower psychological and physical readiness to return to sport. Level of Evidence Level 3, retrospective cohort study.
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Affiliation(s)
- Marcel Betsch
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada.,Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University Heidelberg, Mannheim, Germany
| | - Graeme Hoit
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
| | - Tim Dwyer
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
| | - Daniel Whelan
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
| | - John Theodoropoulos
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
| | - Darrell Ogilvie-Harris
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada
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Zhang JK, Barron J, Arvesen J, Israel H, Kim C, Kaar SG. Effect of Patient Resilience and the Single Assessment Numeric Evaluation (SANE) Score on Return to Sport Following Anterior Cruciate Ligament Reconstruction Surgery. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:512-518. [PMID: 34692933 DOI: 10.22038/abjs.2021.48823.2562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/19/2021] [Indexed: 11/06/2022]
Abstract
Background This study aims to determine the effect of resilience, as measured by the Brief Resilience Scale (BRS), and perceived self-efficacy of knee function, as measured by the Single Assessment Numeric Evaluation (SANE) score on return to sport outcomes following ACL Reconstruction (ACLR) surgery. Methods Seventy-one patients undergoing ACLR surgery were followed up for a minimum of one year. At six-months post-op, ACLR patients completed the BRS and the SANE score. Patients were stratified into low, normal, and high resilience groups, and outcome scores were calculated. Results The median return to sports participation, in months post-operatively, for the low, normal, and high resiliency groups were 7.1, 7.3, and 7.2 months, respectively (P=0.78). A multiple logistic regression analysis revealed that the SANE score was a significant predictor of return to sport at nine months when adjusted for age, sex, and BRS score (P=0.01). Patients that returned to sport by nine months demonstrated a mean SANE score of 92.7, compared to a mean of 85.7 (P=0.08). In patients who had returned to sport, neither the BRS resilience group nor the SANE score were significant predictors of the returned level of competition status (P=0.06; P=0.18). Conclusion The SANE score may serve as a significant predictor of return to sport when adjusted for age, sex, and BRS score. Resilience, as measured by the BRS, was not significantly associated with return to sport, but may have utility in specific patient populations.
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Affiliation(s)
- Justin K Zhang
- Department of Orthopedics, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - John Barron
- Department of General Surgery, Cleveland Clinic School of Medicine, Cleveland, OH, USA
| | - John Arvesen
- Department of Orthopedics, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Heidi Israel
- Department of Orthopedics, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Christopher Kim
- The Iowa Clinic, Department of Orthopedic Surgery, Sports Medicine and Shoulder Surgery, Des Moines, IA, USA
| | - Scott G Kaar
- Department of Orthopedics, Saint Louis University School of Medicine, St. Louis, MO, USA
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28
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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.
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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
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29
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de Fontenay BP, van Cant J, Gokeler A, Roy JS. Reintroduction of running after ACL reconstruction with a hamstring graft: can we predict short-term success? J Athl Train 2021; 57:540-546. [PMID: 34623431 DOI: 10.4085/1062-6050-0407.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Return to running (RTR) after anterior cruciate ligament reconstruction (ACL-R) is a crucial milestone. However, there is uncertainty on how and when to start a running program. OBJECTIVE To explore the feasibility of a structured program to reintroduce running after ACL-R and to evaluate the predictive value of potential predictors of short-term success. DESIGN Longitudinal cohort study. SETTING Local Research Center / participant's home. PATIENTS Thirty-five participants were recruited after ACL-R. INTERVENTION Program with a progression algorithm to reintroduce running (10 running sessions in 14 days). MAIN OUTCOME MEASURES The criterion for short-term success was no exacerbation of symptoms. Potential predictors included: (i) the International Knee Document Committee (IKDC) subjective knee form; (ii) ACL Return to Sport after Injury questionnaire; (iii) quadriceps and hamstring strength; (iv) Step-Down Endurance test; and (v) the modified Star Excursion Balance test. Descriptive statistics were performed to study the feasibility of the RTR program and Poisson regression analysis was used to evaluate predictors of success. RESULTS Of the 34 participants included, 33 completed the RTR program. Sixteen participants experienced some temporary exacerbation of symptoms, but only one had to stop the RTR program. Initial IKDC score was the only significant predictor of a successful RTR with an Area under the ROC curve of 80.4%. An ICKD cut-off of 63.7/100 differentiated responders and non-responders with the highest sensitivity and specificity (77.8% and 75.0%, respectively). There was a 3-fold greater chance of success with an IKDC score above this threshold. CONCLUSIONS Our results confirm the feasibility of our RTR program and progression algorithm after ACL-R. Clinicians should use an IKDC score of >64 as a criterion to reintroduce running after ACL-R to increase the likelihood of short-term success.
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Affiliation(s)
- Benoit Pairot de Fontenay
- 1 University of Lyon - University Claude Bernard Lyon 1, EA 7424 - Inter-university Laboratory of Human Movement Science
| | - Joachim van Cant
- 2 Faculté des Sciences de la Motricité, Université Libre de Bruxelles, Brussels, Belgium
| | - Alli Gokeler
- 3 Exercise Science & Neuroscience Unit, Department Exercise and Health, Faculty of Science, Paderborn University, Paderborn.,4 Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg.,5 Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean-Sebastien Roy
- 6 Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada G1M 2S8.,7 Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada G1R 1P5
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Sonesson S, Kvist J. Rehabilitation after ACL injury and reconstruction from the patients' perspective. Phys Ther Sport 2021; 53:158-165. [PMID: 34656448 DOI: 10.1016/j.ptsp.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To describe and compare patients' appraisal of the rehabilitation and adherence to the rehabilitation program after acute ACL injury treated with (ACLR) or without (non-ACLR) reconstruction. DESIGN Prospective cohort study. PARTICIPANTS 275 patients (143 females; mean age 25 ± 7 years) with acute ACL injury, of whom 166 patients had ACLR within 24 months. MAIN OUTCOME Adherence to rehabilitation was assessed using the modified Sports Injury Rehabilitation Adherence Scale (SIRAS). RESULTS Appraisal of rehabilitation was higher in the post-ACLR group compared to the non-ACLR group at 3 months (91% compared to 70% scored rehabilitation as necessary, p = 0.025) and at 6 months (87% compared to 70% scored it as necessary, p = 0.017). SIRAS score did not differ between 3 and 6 months for the non-ACLR group (median (IQR) 13 (2) vs 13 (2)) or the post-ACLR group (14 (1) vs 14 (2), p > 0.05). The post-ACLR group had a higher SIRAS score than the non-ACLR group at 3 and 6 months (p ≤ 0.001). CONCLUSION Patients treated with ACLR reported valuing their rehabilitation more and rated greater adherence to the rehabilitation programme than non-surgically treated patients. As rehabilitation is essential for good knee function, strategies to improve adherence after non-ACLR treatment should be implemented. LEVEL OF EVIDENCE Prospective cohort study, level II.
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Affiliation(s)
- Sofi Sonesson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualisation (CMIV), Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
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31
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Nichols ZW, O'Brien D, White SG. Is resistance training intensity adequately prescribed to meet the demands of returning to sport following anterior cruciate ligament repair? A systematic review. BMJ Open Sport Exerc Med 2021; 7:e001144. [PMID: 34422294 PMCID: PMC8323367 DOI: 10.1136/bmjsem-2021-001144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/03/2022] Open
Abstract
Objective To identify, critique and synthesise the research findings that evaluate the use of resistance training (RT) programmes on return to sport outcome measures for people following ACL repair (ACLR). Design and data sources This systematic review included a comprehensive search of electronic databases (EBSCO health databases (CINAHL, MEDLINE, SPORTDiscus), Scopus and Pedro) performed in June 2020 and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies were appraised using the Downs and Black checklist. Eligibility criteria Randomised and non-randomised controlled trials, longitudinal cohort studies and case series were considered for inclusion where an adequate description of the RT intervention was provided as a part of the study's ACLR rehabilitation protocol. Articles that did not include outcome measures related to return to sport criteria were excluded. Results Eleven articles met the inclusion criteria and were subjected to appraisal and data extraction. Study quality ranged from poor to excellent. RT intensity varied considerably among studies (between 5% and >80% of one repetition maximum). Only one identified study specifically investigated the effect of a low-intensity versus high-intensity RT protocol. The majority of studies reported participant outcomes that would not meet commonly used return to sport criteria. Conclusion There appears to be considerable variation in the intensity of RT prescribed in research for people following ACLR. Furthermore, in most of the identified studies, RT protocols promoted muscle endurance and hypertrophy without progressing to strength or power-based RT. The findings of this review provide insight into potential factors limiting returning to sport and contributing to reinjury for people following ACLR.
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Affiliation(s)
- Zackary William Nichols
- Physiotherapy, Auckland University of Technology Faculty of Health and Environmental Sciences, Auckland, New Zealand
| | - Daniel O'Brien
- Physiotherapy, Auckland University of Technology Faculty of Health and Environmental Sciences, Auckland, New Zealand
| | - Steven Gordon White
- Physiotherapy, Auckland University of Technology Faculty of Health and Environmental Sciences, Auckland, New Zealand
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Sole G, Lamb P, Pataky T, Klima S, Navarre P, Hammer N. Immediate and 6-week effects of wearing a knee sleeve following anterior cruciate ligament reconstruction: a cross-over laboratory and randomised clinical trial. BMC Musculoskelet Disord 2021; 22:655. [PMID: 34348704 PMCID: PMC8336666 DOI: 10.1186/s12891-021-04540-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/22/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Rehabilitation following anterior cruciate ligament (ACL) reconstructions is based mainly on comprehensive progressive exercise programmes using a multi-dimensional approach. Elastic knee sleeves may be useful adjuncts to rehabilitation. The aim of this study was to determine the immediate and 6-week effects of wearing a knee sleeve on person-reported outcomes and function in participants who had undergone an ACL reconstruction and who had residual self-reported functional limitations. METHODS Individuals with ACL reconstruction in the previous 6 months to 5 years were recruited. Immediate effects of a commercially-available elastic knee sleeve on single-leg horizontal hop distance were explored using a cross-over design. Following this first session, participants were randomised into a Control Group and a Sleeve Group who wore the sleeve for 6 weeks, at least 1 h daily. Outcome measures for the randomised clinical trial (RCT) were the International Knee Documentation Classification Subjective Knee Form (IKDC-SKF) score, the single-leg horizontal hop distance, and isokinetic quadriceps and hamstring peak torque. Linear mixed models were used to determine random effects. Where both limbs were measured at multiple time points, a random measurement occasion effect nested within participant was used. RESULTS Thirty-four individuals (16 women) with ACL reconstruction completed the cross-over trial. Hop distance for the injured side during the sleeve condition increased by 3.6 % (95 % CI 0.4-6.8 %, p = 0.025). There was no evidence of differential changes between groups for the IKDC-SKF (Sleeve Group n = 15; Control Group n = 16; p = 0.327), or relative improvement in the injured side compared to the uninjured side for the physical performance measures (Sleeve Group n = 12, Control Group n = 12; three-way interaction p = 0.533 [hop distance], 0.381 [quadriceps isokinetic peak torque], and 0.592 [hamstring isokinetic peak torque]). CONCLUSIONS Single-leg hop distance of the ACL reconstructed side improved when wearing a knee sleeve. Wearing the knee sleeve over 6 weeks did not lead to enhanced improvements in self-reported knee function, hop distance and thigh muscle strength compared to the control group. TRIAL REGISTRATION The trial was prospectively registered with the Australia New Zealand Clinical Trials Registry No: ACTRN12618001083280 , 28 June 2018.
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Affiliation(s)
- Gisela Sole
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Peter Lamb
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Todd Pataky
- Graduate School of Medicine, Department of Human Health Sciences, Kyoto University, Kyoto, Japan
| | | | - Pierre Navarre
- Orthopaedic Surgeon, Southland Hospital, Invercargill, New Zealand
- University of Otago, Dunedin, New Zealand
| | - Niels Hammer
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
- Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
- Fraunhofer IWU, Dresden, Germany
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Negrete R, Simms S, Gross J, Nunes Rabello L, Hixon M, Zeini IM, Jenkins WL, Davies GJ. The Test Re-Test Reliability of A Novel Single Leg Hop Test (T-Drill Hop Test). Int J Sports Phys Ther 2021; 16:724-731. [PMID: 34123525 PMCID: PMC8169018 DOI: 10.26603/001c.23677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Functional training and testing are an important part of a comprehensive rehabilitation program stressing the neuromuscular system in ways that simulate athletic performance to help determine criteria for return to sport. There are numerous single leg hop tests that have been used for these purposes, however, the validity and clinical relevance has been questioned. Many of the functional performance tests assess only the sagittal plane or forward direction and may only partially assess a person's athletic abilities. There is a need for reliable and valid functional tests to assess in a multi-directional manner. PURPOSE/HYPOTHESIS The purpose of this study is to determine the test re-test reliability of a novel multi-directional timed single leg hop test (T-Drill Hop Test) for use in rehabilitation and performance assessments. STUDY DESIGN Cross-sectional reliability study. METHODS Fifty healthy recreationally active college age subjects, (23 males and 27 females) between the ages of 18 and 35, (mean age 23.48 with SD 3.82) consented to perform the test. The subjects hopped along a 10ft. x 10ft. "T" shaped course. Subjects performed two timed maximum effort trials of the T-Drill Hop Test on each leg with an interval of 3-7 days between the two testing days. Intraclass Correlation Coefficients (ICC) were calculated to determine intersession reliability. RESULTS The inter-rater reliability (ICC's) for the entire group of 50 subjects ranged between .98 and 1.00 suggesting excellent reliability. The bilateral comparison, utilizing paired t-tests, of the T-Drill Hop Test demonstrated no significant differences between the time scores for the dominant and non-dominant legs for either males or females (p>.05). CONCLUSION This study demonstrates the T-Drill Hop Test has excellent test re-test reliability. These results are important prior to validation and utilization as a clinical functional performance test. LEVELS OF EVIDENCE Level 2.
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Dunphy E, Button K, Hamilton F, Williams J, Spasic I, Murray E. Feasibility randomised controlled trial comparing TRAK-ACL digital rehabilitation intervention plus treatment as usual versus treatment as usual for patients following anterior cruciate ligament reconstruction. BMJ Open Sport Exerc Med 2021; 7:e001002. [PMID: 34035951 PMCID: PMC8103946 DOI: 10.1136/bmjsem-2020-001002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 01/24/2023] Open
Abstract
Objectives To evaluate the feasibility of trialling taxonomy for the rehabilitation of knee conditions—ACL (TRAK-ACL), a digital health intervention that provides health information, personalised exercise plans and remote clinical support combined with treatment as usual (TAU), for people following ACL reconstruction. Methods The study design was a two-arm parallel randomised controlled trial (RCT). Eligible participants were English-speaking adults who had undergone ACL reconstruction within the last 12 weeks, had access to the internet and could provide informed consent. Recruitment took place at three sites in the UK. TRAK-ACL intervention was an interactive website informed by behaviour change technique combined with TAU. The comparator was TAU. Outcomes were: recruitment and retention; completeness of outcome measures at follow-up; fidelity of intervention delivery and engagement with the intervention. Individuals were randomised using a computer-generated random number sequence. Blinded assessors allocated groups and collected outcome measures. Results Fifty-nine people were assessed for eligibility at two of the participating sites, and 51 were randomised; 26 were allocated to TRAK-ACL and 25 to TAU. Follow-up data were collected on 44 and 40 participants at 3 and 6 months, respectively. All outcome measures were completed fully at 6 months except the Client Service Receipt Inventory. Two patients in each arm did not receive the treatment they were randomised to. Engagement with TRAK-ACL intervention was a median of 5 logins (IQR 3–13 logins), over 18 weeks (SD 12.2 weeks). Conclusion TRAK-ACL would be suitable for evaluation of effectiveness in a fully powered RCT.
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Affiliation(s)
- Emma Dunphy
- Research Department of Primary Care and Population Health, University College London, London, UK.,Physiotherapy Department, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.,Physiotherapy Department, Cardiff and Vale University Local Health Board, Cardiff, UK
| | - Fiona Hamilton
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jodie Williams
- Physiotherapy Department, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Irena Spasic
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
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Roe C, Jacobs C, Hoch J, Johnson DL, Noehren B. Test Batteries After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2021; 14:205-215. [PMID: 33896240 DOI: 10.1177/19417381211009473] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT There is a lack of consensus regarding test batteries for return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE To report the RTS test batteries for individuals after ACLR and to examine alignment with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC). Finally, to examine how published RTS batteries prior to the AAOS AUC (2010-2015) compared with those after publication of the AUC (2016-2020). DATA SOURCE A systematic search of PubMed (2010-2020). STUDY SELECTION Studies were included if they were published from 2010 to 2020, patients underwent primary ACLR and were tested between 6 months and 2 years postoperatively and included a minimum of 2 assessments. Studies were excluded if patients were tested outside the designated time; had undergone a revision, contralateral, or multiligament injury; included healthy participants; were level 5 evidence or the study was a systematic review. A total of 1012 articles were reviewed and 63 met the criteria. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Information regarding the RTS batteries and patient demographics were extracted from the included articles. RESULTS A total of 63 studies met the inclusion and exclusion criteria (22 from 2010-2015 and 41 from 2016-2020). The most common RTS batteries included the hop test, quadriceps strength test, and patient-reported outcome measures. No study met all 7 AUC; the most common criteria met were functional skills (98.4%), followed by confidence (22.2%), then range of motion and knee stability (20.6%). CONCLUSION The test batteries in the current literature show high variability and a lack of essential components necessary for RTS. No study met the AUC guidelines, suggesting a disconnect between recommended guidelines and clinical practice. Test battery research has expanded over the past decade; however, standardized, clinically applicable batteries that encompass all criteria are needed.
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Affiliation(s)
- Chelsey Roe
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | - Cale Jacobs
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Johanna Hoch
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Darren L Johnson
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
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Davies WT, Myer GD, Read PJ. Is It Time We Better Understood the Tests We are Using for Return to Sport Decision Making Following ACL Reconstruction? A Critical Review of the Hop Tests. Sports Med 2021; 50:485-495. [PMID: 31745732 PMCID: PMC7018781 DOI: 10.1007/s40279-019-01221-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
There has been a move towards a criterion-based return to play in recent years, with 4 single-leg hop tests commonly used to assess functional performance. Despite their widespread integration, research indicates that relationships between ‘passing’ ‘hop test criteria and successful outcomes following rehabilitation are equivocal, and, therefore, require further investigation. This critical review includes key information to examine the evolution of these tests, their reliability, relationships with other constructs, and sensitivity to change over time. Recommendations for how measurement and administration of the tests can be improved are also discussed. The evidence presented in this review shows that hop tests display good reliability and are sensitive to change over time. However, the use of more than 2 hop tests does not appear to be necessary due to high collinearity and no greater sensitivity to detect abnormality. The inclusion of other hop tests in different planes may give greater information about the current function of the knee, particularly when measured over time using both relative and absolute measures of performance. It is recommended that the contralateral limb be tested prior to surgery for a more relevant benchmark for performance, and clinicians are strongly advised to measure movement quality, as hop distance alone appears to overestimate the recovery of the knee.
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Affiliation(s)
- William T Davies
- Aspetar, Orthopaedic and Sports Medicine Hospital, Sports City Street, P.O. Box 29222, Doha, Qatar.
| | - Gregory D Myer
- Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Paul J Read
- Aspetar, Orthopaedic and Sports Medicine Hospital, Sports City Street, P.O. Box 29222, Doha, Qatar
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Dauty M, Menu P, Mesland O, Fouasson-Chailloux A. Arthrogenic muscle inhibition and return to sport after arthrofibrosis complicating anterior cruciate ligament surgery. Eur J Sport Sci 2021; 22:627-635. [PMID: 33487103 DOI: 10.1080/17461391.2021.1881620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Arthrofibrosis is a devastating complication after Anterior Cruciate Ligament reconstruction (ACLr) characterized by a muscle weakness secondary to an arthrogenic muscle inhibition process. The loss of knee isokinetic strength due to arthrogenic muscle inhibition may be more important after arthrofibrosis, compared to an ACLr population with no complication. The isokinetic strength deficit [Limb Symmetry Index (LSI) at 60 and 180°/s of angular speed] was measured at 4, 7 and 12 post-operative months. Knee function, return to running and return to sport were evaluated. A comparison of the Quadriceps and the Hamstring LSI between patients with arthrofibrosis and those without post-operative complication was performed according to time and taking into consideration the type of surgical procedure. 539 primary ACLr patients were assessed. The arthrofibrosis group presented at 4, 7 and 12 post-operative months a Quadriceps LSI significantly lower compared to the control group, without influence of the graft procedure (LSI: 38, 53, 68% vs 63, 73, 85% at 60°/s, respectively). The Hamstring LSI was significantly lower at 4 and 7 post-operative months, but comparable at 12 months with an influence of the Hamstring procedure. Knee function was significantly lower at 4 and 7 post-operative months. Few arthrofibrosis ACLr patients returned to running at 7 post-operative months (6.8% vs 69.9%; p < .0001). An important and durable Quadriceps muscle weakness occurred after arthrofibrosis, whatever the type of graft procedure. This is explained by an Arthrogenic muscle inhibition which compromised the return to sport at the same level until 12 post-operative months. HighlightsAn important and durable quadriceps muscle weakness occurred after arthrofibrosis.The arthrogenic muscle inhibition was significant on the operated side independently of the type of the graft procedure.Arthrogenic muscle inhibition compromised the return to sport at the same level until 12 post-operative months.
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Affiliation(s)
- Marc Dauty
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France.,INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton - Nantes University, Nantes, France
| | - Pierre Menu
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France.,INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton - Nantes University, Nantes, France
| | - Olivier Mesland
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France
| | - Alban Fouasson-Chailloux
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France.,INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton - Nantes University, Nantes, France
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Franck F, Saithna A, Vieira TD, Pioger C, Vigne G, Le Guen M, Rogowski I, Fayard JM, Thaunat M, Sonnery-Cottet B. Return to Sport Composite Test After Anterior Cruciate Ligament Reconstruction (K-STARTS): Factors Affecting Return to Sport Test Score in a Retrospective Analysis of 676 Patients. Sports Health 2021; 13:364-372. [PMID: 33550916 DOI: 10.1177/1941738120978240] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Return to sport (RTS) to the preinjury level is the main purpose after anterior cruciate ligament (ACL) reconstruction but the factors affecting the RTS are not completely known. Knee Santy Athletic Return to Sport (K-STARTS) is a composite test designed to assess readiness for RTS after ACL reconstruction. PURPOSE To determine the key factors that influence K-STARTS scores in a large cohort of patients after ACL reconstruction. STUDY DESIGN Case-control study. LEVEL OF EVIDENCE Level 3. METHODS A retrospective analysis of prospectively collected data was undertaken. All patients who underwent ACL reconstruction surgery between March 2016 and May 2017 and also had a K-STARTS assessment at 6 months postoperatively were included. To identify factors influencing the K-STARTS score, an analysis of variance was performed. Age, sex, sports level, delay between injury and surgery, concomitant lesions, graft type, additional lateral tenodesis procedure, and participation in the RTS program were analyzed to identify factors influencing the K-STARTS score. RESULTS A total of 676 patients were included in the study. The K-STARTS score was significantly higher in male patients than in female patients (13.9 vs 12.4; P < 0.001), in younger patients (those aged <30 years vs older patients; 14.2 vs 12; P < 0.001), ACL reconstructions performed with hamstring tendon autografts compared with bone-patellar tendon-bone (13.5 vs 13.1; P = 0.03) and in those who completed a specific RTS program in addition to standard rehabilitation, compared with those who did not participate (17.1 vs 13.1; P < 0.001). However, the only factor that significantly influenced the K-STARTS score beyond the minimal detectable change threshold was the completion of the additional RTS program. The preinjury frequency of sports participation, whether the dominant limb was injured, time from injury to surgery, the presence of associated meniscal injuries, and whether a lateral tenodesis was performed did not significantly influence the K-STARTS score. CONCLUSION Completion of a specific RTS program, in addition to standard rehabilitation, was the most important factor influencing the K-STARTS composite functional and psychological RTS test score at 6 months after ACL reconstruction. CLINICAL RELEVANCE This study shows that the completion of a specific RTS program affects positively the RTS test score at 6 months after ACL reconstruction.
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Affiliation(s)
- Florent Franck
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Adnan Saithna
- Arizona Brain, Spine & Sports Injuries Center, Scottsdale, Arizona
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Charles Pioger
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | | | | | - Isabelle Rogowski
- Laboratoire Interuniversitaire de Biologie de la Motricité, Université de Lyon, Villeurbanne Cedex, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Lyon, France.,Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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Walker A, Hing W, Lorimer A, Rathbone E. Rehabilitation characteristics and patient barriers to and facilitators of ACL reconstruction rehabilitation: A cross-sectional survey. Phys Ther Sport 2021; 48:169-176. [PMID: 33486409 DOI: 10.1016/j.ptsp.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To investigate patient-reported rehabilitation characteristics and barriers to and facilitators of ACL reconstruction rehabilitation. DESIGN Survey-based study. SETTING Online survey platform. PARTICIPANTS Adults 1-20 years post ACL reconstruction (n = 304). MAIN OUTCOME MEASURES 1) rehabilitation characteristics, 2) barriers to and facilitators of rehabilitation. RESULTS Fear of re-injury (43.8%) was the highest rating barrier to rehabilitation adherence, while a good relationship with your rehabilitation provider was regarded as the most important factor (83.6%) in facilitating rehabilitation. Rehabilitation frequency reduced across the duration of rehabilitation from most commonly 1 x week (38.2%) in the first three months to once every month (26%) from 6 to 9 months. Almost all participants (95.7%) consulted a rehabilitation provider for the first six months. Only 43.4% of respondents returned to their previous level of sport. The exploratory analysis identified that low barriers to rehabilitation and a longer duration of supervised rehabilitation are associated with a faster return to sport, greater likelihood of return to previous level of sport and fewer reported ongoing problems with the knee. CONCLUSIONS This cross-sectional survey provides insight into the patient's experience of rehabilitation practices and a patient's perspective on the key barriers to and facilitators of ACL rehabilitation adherence and participation.
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Affiliation(s)
- Adam Walker
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast 4226, Australia.
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast 4226, Australia
| | - Anna Lorimer
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast 4226, Australia
| | - Evelyne Rathbone
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast 4226, Australia
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DeFazio MW, Curry EJ, Gustin MJ, Sing DC, Abdul-Rassoul H, Ma R, Fu F, Li X. Return to Sport After ACL Reconstruction With a BTB Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120964919. [PMID: 33403206 PMCID: PMC7745570 DOI: 10.1177/2325967120964919] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) tears are debilitating injuries frequently suffered by athletes. ACL reconstruction is indicated to restore knee stability and allow patients to return to prior levels of athletic performance. While existing literature suggests that patient-reported outcomes are similar between bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts, there is less information comparing return-to-sport (RTS) rates between the 2 graft types. Purpose To compare RTS rates among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft. Study Design Systematic review; Level of evidence, 4. Methods The MEDLINE, Embase, and Cochrane Library databases were searched, and studies that reported on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Studies that utilized ACL repair techniques, quadriceps tendon autografts, graft augmentation, double-bundle autografts, allografts, or revision ACL reconstruction were excluded. RTS information was extracted and analyzed from all included studies. Results Included in the review were 20 articles investigating a total of 2348 athletes. The overall RTS rate in our cohort was 73.2%, with 48.9% returning to preinjury levels of performance and a rerupture rate of 2.4%. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 81.0%, with 50.0% of athletes returning to preinjury levels of performance and a rerupture rate of 2.2%. Patients after primary ACL reconstruction with an HT autograft had an overall RTS rate of 70.6%, with 48.5% of athletes returning to preinjury levels of performance and a rerupture rate of 2.5%. Conclusion ACL reconstruction using BTB autografts demonstrated higher overall RTS rates when compared with HT autografts. However, BTB and HT autografts had similar rates of return to preinjury levels of performance and rerupture rates. Less than half of the athletes were able to return to preinjury sport levels after ACL reconstruction with either an HT or BTB autograft.
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Affiliation(s)
- Matthew W DeFazio
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Michael J Gustin
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David C Sing
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Hussein Abdul-Rassoul
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Richard Ma
- Missouri Orthopaedic Institute, Columbia, Missouri, USA
| | - Freddie Fu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
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Cancienne JM, Browning R, Werner BC. Patient-Related Risk Factors for Contralateral Anterior Cruciate Ligament (ACL) Tear After ACL Reconstruction: An Analysis of 3707 Primary ACL Reconstructions. HSS J 2020; 16:226-229. [PMID: 33380951 PMCID: PMC7749876 DOI: 10.1007/s11420-019-09687-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Return to play after anterior cruciate ligament (ACL) reconstruction can increase risk for both ipsilateral graft rupture and contralateral ACL rupture. The risk for injury of the contralateral knee after ACL reconstruction could be nearly double that of ipsilateral graft rupture. QUESTIONS/PURPOSES We sought to identify independent, patient-related risk factors for contralateral ACL rupture following primary ACL reconstruction. METHODS A national database was queried for patients who underwent primary ACL reconstruction from 2007 to 2015 with a minimum of 2 years of post-operative follow-up (n = 12,044). Patients who underwent subsequent primary ACL reconstruction on the contralateral extremity were then identified. A multivariate binomial logistic regression analysis was utilized to evaluate patient-related risk factors for contralateral ACL rupture, including demographic and comorbidity variables. Adjusted odds ratios and 95% confidence intervals were calculated for each risk factor. RESULTS Of the 3707 patients who had a minimum of 2 years of database activity and comprised the study group, 204 (5.5%) experienced a contralateral ACL rupture requiring reconstruction. Independent risk factors for contralateral ACL rupture included age less than 20 years, female gender, tobacco use, and depression. Obesity, morbid obesity, type 1 diabetes, type 2 diabetes, and a history of anxiety were not significant predictors of contralateral injury. CONCLUSION We were able to adequately power an analysis to identify several significant patient-related risk factors for contralateral ACL rupture after primary ACL reconstruction, including younger age, female gender, tobacco use, and depression. This information can be used to counsel patients on the risk of injury to the contralateral knee.
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Affiliation(s)
| | - Robert Browning
- Midwest Orthopedics at Rush, 1611 W Harrison St, Chicago, IL 60612 USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, PO Box 800159, Charlottesville, VA 22908 USA
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Johnston PT, Feller JA, McClelland JA, Webster KE. Strength deficits and flexion range of motion following primary anterior cruciate ligament reconstruction differ between quadriceps and hamstring autografts. J ISAKOS 2020; 6:88-93. [PMID: 33832982 DOI: 10.1136/jisakos-2020-000481] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine if anterior cruciate ligament (ACL) reconstruction with a quadriceps tendon (QT) could achieve faster postoperative recovery compared with hamstring tendon (HT) ACL reconstruction. METHODS Thirty-seven QT patients were matched for gender, age and preinjury activity level with 74 HT patients. A 6-month postoperative assessment included standardised reported outcome measures: patient-reported outcome measures (PROMs) (International Knee Documentation Committee-subjective knee evaluation form, Knee injury and Osteoarthritis Outcome Score-knee related quality of life subscale, ACL-Return to Sport after Injury scale, Marx activity scale, anterior knee pain), range of motion (active, standing and passive), anterior knee laxity testing, hop tests (single and triple crossover hop for distance) and isokinetic strength testing of the knee extensors and flexors. T-tests or Mann Whitney U tests were used to compare data between groups. RESULTS There were no significant differences between the two groups for any of the PROMs. The HT group had reduced active and standing knee flexion range compared with the QT group (p<0.001). Isokinetic strength testing showed significant deficits in limb symmetry indices for both concentric hamstring peak torque at 60°/s (p<0.001) and 180°/s (p=0.01) in the HT group. There were significantly greater deficits in limb symmetry indices for concentric quadriceps peak torque at 60°/s (p<0.001) and 180°/s (p=0.001) in the QT group. CONCLUSION The QT graft does not appear to offer a more rapid recovery in terms of knee symptoms or function which could have allowed for faster progression to the dynamic phases of rehabilitation. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Peta T Johnston
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | | | - Jodie A McClelland
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Carter HM, Littlewood C, Webster KE, Smith BE. The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review. BMC Musculoskelet Disord 2020; 21:647. [PMID: 33010802 PMCID: PMC7533034 DOI: 10.1186/s12891-020-03676-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/24/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR). METHOD A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. RESULTS The search identified 739 potentially eligible studies, three met the inclusion criteria. All included RCTs scored 'high' risk of bias. PreHab in all three RCTs was an exercise programme, each varied in content (strength, control, balance and perturbation training), frequency (10 to 24 sessions) and length (3.1- to 6-weeks). Statistically significant differences (p < 0.05) were reported for quadriceps strength (one RCT) and single leg hop scores (two RCTs) in favour of PreHab three months after ACLR, compared to no PreHab. One RCT reported no statistically significant between-group difference for pain and function. No RCT evaluated post-operative psychological outcomes. CONCLUSION Very low quality evidence suggests that PreHab that includes muscular strength, balance and perturbation training offers a small benefit to quadriceps strength and single leg hop scores three months after ACLR compared with no PreHab. There is no consensus on the optimum PreHab programme content, frequency and length. Further research is needed to develop PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness and return to sport. TRIAL REGISTRATION PROSPERO trial registration number. CRD42020162754 .
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Affiliation(s)
- Hayley M Carter
- Department of Physiotherapy, London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, London Road Community Hospital, Derby, DE1 2QY, UK.
| | - Chris Littlewood
- Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Benjamin E Smith
- Department of Physiotherapy, London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, London Road Community Hospital, Derby, DE1 2QY, UK
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
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44
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Allahabadi S, Rubenstein WJ, Lansdown DA, Feeley BT, Pandya NK. Incidence of anterior cruciate ligament graft tears in high-risk populations: An analysis of professional athlete and pediatric populations. Knee 2020; 27:1378-1384. [PMID: 33010751 DOI: 10.1016/j.knee.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/29/2020] [Accepted: 06/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Professional athletes are at increased risk of injury with high activity levels and additional pressure to return to sports quickly after anterior cruciate ligament (ACL) injury. The purpose of this study was to determine ACL graft re-tear rates in National Basketball Association (NBA), Major League Baseball (MLB), and National Hockey League (NHL) athletes using publicly available databases and to compare these to general populations, National Football League (NFL) athletes, and the pediatric population to establish a baseline for those partaking in high-risk sporting activity. METHODS A comprehensive online search was performed to identify athletes in the NBA, MLB, and NHL who had a reported ACL tear between 2007 and 2017. For each tear, the type of tear (initial or re-tear) and return to play data were documented. Comparisons of re-tear rates from these leagues to prior registry, meta-analyses, and epidemiologic studies were performed using Fisher's exact or Chi-squared tests. RESULTS The aggregate re-tear rate was 11.9%. ACL re-tear rates by league did not statistically differ. Return to play rate after index surgery was 95.8%, whereas after a revision procedure was 92.3%. There was a statistically significant difference between the studied ACL re-tear rates (NBA, MLB, NHL) and those of national registries (P < 0.01), and no difference when compared with the pediatric population or with the NFL. CONCLUSIONS Exposure to higher-risk sporting activity, common to pediatric patients and professional athletes, is a likely major influential factor in ACL re-tear.
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Affiliation(s)
| | | | - Drew A Lansdown
- UCSF Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Brian T Feeley
- UCSF Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Nirav K Pandya
- UCSF Department of Orthopaedic Surgery, San Francisco, CA, USA
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45
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Anterior Cruciate Ligament Injuries in Skeletally Immature Patients: A Meta-analysis Comparing Repair Versus Reconstruction Techniques. J Pediatr Orthop 2020; 40:492-502. [PMID: 32282620 DOI: 10.1097/bpo.0000000000001569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) surgery remains challenging in the skeletally immature patient. Despite the widespread use of physeal-sparing reconstruction techniques, there has been renewed interest in the ACL repair. The purpose of this study was to systematically review the literature to better understand outcomes following all-epiphyseal (AE) reconstruction to extraphyseal reconstruction, while also evaluating ACL repair outcomes in skeletally immature patients. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all studies in the literature from January 1970 to August 2019 reporting on skeletally immature patients undergoing ACL surgery were identified. Inclusion criteria were pediatric patients with open physes indicative of skeletal immaturity sustaining complete ACL ruptures treated with AE reconstruction, extraphyseal reconstruction or ACL repair. Chronologic age, bone age, postoperative outcomes scores, return to sport rate, and the incidence of complications, namely reruptures, were analyzed. RESULTS A total of 14 studies comprising 443 patients were identified. No significant difference in chronologic age or postoperative outcome scores at final follow-up were appreciated between patients undergoing AE versus extraphyseal reconstruction. Return to activity rate was significant greater following extraphyseal reconstruction when compared with AE reconstruction. The incidence of any limb-length discrepancies and limb discrepancies measuring ≥10 mm were significant higher following AE reconstruction, while rerupture rates were more common following AE reconstruction. CONCLUSIONS Patients undergoing AE reconstruction possessed significantly lower return to activity rates, higher incidences of limb-length discrepancies and more commonly experienced ACL reruptures when compared with patients undergoing extraphyseal reconstruction. Further investigations analyzing results following ACL repair in skeletally immature patients are warranted to allow for the comparison of outcomes with current physeal-sparing reconstruction techniques. LEVEL OF EVIDENCE Level IV-systematic review-therapeutic study.
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46
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Lloyd RS, Oliver JL, Kember LS, Myer GD, Read PJ. Individual hop analysis and reactive strength ratios provide better discrimination of ACL reconstructed limb deficits than triple hop for distance scores in athletes returning to sport. Knee 2020; 27:1357-1364. [PMID: 33010748 PMCID: PMC9892801 DOI: 10.1016/j.knee.2020.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/09/2020] [Accepted: 07/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The triple hop for distance test commonly uses a limb symmetry index (LSI) 'pass' threshold of >90% for total hop distance following anterior cruciate ligament reconstruction (ACLR). However, understanding the manner in which athletes generate and dissipate forces during consecutive hops within the test may provide greater insight into residual limb deficits. The aim of the study was to examine reactive strength ratios (RSR) of individual hops during a triple hop test in a cohort of ACLR patients at discharge prior to return-to-sport. METHODS Twenty male athletes (24.6 ± 4.2 years; height 175.3 ± 10.2 cm; mass 73.6 ± 14.5 kg) completed the test on both non-operated and operated limbs. Total distance hopped, contact times, flight times and RSR were collected for each hop using a floor-level optical measurement system. RESULTS Significant, small to moderate between-limb differences (p < 0.05; d = 0.45-0.72) were shown for triple hop distance, flight time and RSR for each hop, with lower performance consistently displayed in the operated limb. Large, significant differences in RSR were evident between hops one and two on the operated limb (p < 0.05; d = 0.97). Despite 80% of participants achieving >90% LSI for total hop distance, less than 50% of participants reached the >90% LSI threshold for RSR. CONCLUSIONS Standardised LSI 'pass' thresholds (>90% LSI) for triple hop distance may mask residual deficits in reactive strength performance of operated limbs; therefore, more detailed analyses of individual hop performance may be warranted to enhance return to sport criteria following ACLR.
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Affiliation(s)
- Rhodri S. Lloyd
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK,Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand,Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand,Corresponding author at: School of Sport, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff CF23 6XD, UK. . (R.S. Lloyd)
| | - Jon L. Oliver
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK,Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| | - Lucy S. Kember
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,The Micheli Center for Sports Injury Prevention, Boston, MA, USA
| | - Paul J. Read
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
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47
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Vereijken A, Aerts I, Jetten J, Tassignon B, Verschueren J, Meeusen R, van Trijffel E. Association between Functional Performance and Return to Performance in High-Impact Sports after Lower Extremity Injury: A Systematic Review. J Sports Sci Med 2020; 19:564-576. [PMID: 32874110 PMCID: PMC7429422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/06/2020] [Indexed: 06/11/2023]
Abstract
After lower extremity injury, only half of the injured athletes return to their pre-injury sports level. Even though functional performance tests are often used to make return to sport decisions, it is unknown whether functional performance is associated with return to performance after such injuries. The aim of this systematic review was to identify, critically appraise, and analyze studies that investigated the association of functional performance tests with return to performance after lower extremity injuries in athletes participating in high-impact sports. MEDLINE, Embase, Web of Science, and CINAHL were systematically searched for relevant studies. Articles were independently screened by two authors and data were obtained from each included study using a data extraction form. Two authors independently scored methodological quality using the Quality In Prognosis Studies tool. A qualitative best evidence synthesis was conducted. Eight studies reported the association of functional performance with return to performance after lower extremity injuries, involving 1,246 athletes after anterior or posterior cruciate ligament reconstruction. No studies were found on the association of functional performance with return to performance for lower extremity injuries other than after anterior or posterior cruciate ligament reconstruction. All included studies had a high risk of bias. Two studies found significant but small associations for selected hop tests after anterior cruciate ligament reconstruction. Low evidence of association between functional performance and return to performance was present after anterior cruciate ligament reconstruction for the triple hop for distance, the 6-meter timed hop, the side hop in female athletes, and for the combination of the single and crossover hop for distance. In athletes after posterior cruciate ligament reconstruction, the vertical jump showed a significant but small association with return to performance. There is no high-quality evidence that functional performance is associated with return to performance after lower extremity injuries in athletes practicing high-impact sports. Low quality evidence suggests small associations after anterior and posterior cruciate ligament reconstruction. No evidence exists for lower extremity injuries other than after anterior or posterior cruciate ligament reconstruction. Therefore, research on functional performance associated with return to performance is recommended in high-quality prospective cohort studies including athletes with any type of lower extremity injury.
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Affiliation(s)
- Astrid Vereijken
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
- Annatommie MC, Utrecht, the Netherlands
| | - Inne Aerts
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
| | - Jorrit Jetten
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
- Annatommie MC, Utrecht, the Netherlands
| | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Verschueren
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy research group, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
- Strategic Research Program 'Exercise and the Brain in Health & Disease: the added value of Human-Centered Robotics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emiel van Trijffel
- SOMT University of Physiotherapy, Amersfoort, the Netherlands
- Experimental Anatomy research department, Department of Physiotherapy, Human physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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The Influence, Barriers to and Facilitators of Anterior Cruciate Ligament Rehabilitation Adherence and Participation: a Scoping Review. SPORTS MEDICINE-OPEN 2020; 6:32. [PMID: 32681200 PMCID: PMC7367990 DOI: 10.1186/s40798-020-00258-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/30/2020] [Indexed: 01/04/2023]
Abstract
Background Outcomes following anterior cruciate ligament (ACL) reconstruction are considered poor. There are many factors which may influence patient outcomes. As such, the purpose of this review was to report on the influence, barriers to and facilitators of rehabilitation adherence and participation after ACL reconstruction, providing information to help clinicians and patients make quality decisions to facilitate successful rehabilitation. Methods A systematic search of five electronic databases was undertaken in identifying studies from inception to 18 July 2019. The search included English language articles reporting on the influence, barriers to and facilitators of adherence and participation in rehabilitation of patients who have undergone ACL reconstruction. Data extraction and synthesis of included studies were undertaken. Results Full text articles (n = 180) were assessed for eligibility following screening of titles and abstracts (n = 1967), yielding 71 studies for inclusion. Forty-four articles investigated ‘rehabilitation prescription and participation’ and 36 articles investigated ‘rehabilitation barriers and facilitators’. The results indicate that a moderately or minimally supervised rehabilitation program is at least as effective as a fully supervised high-frequency rehabilitation program, although a longer duration of supervised rehabilitation is associated with improvement in a multitude of functional outcomes. A number of psychological factors associated with rehabilitation adherence were also identified. The most commonly investigated concepts were self-motivation, athletic identity and social support. Patients perceived the therapeutic relationship, interaction with family and friends, self-motivation, fear of reinjury, organisation/lack of time and interpersonal comparison as the most common barriers to and facilitators of rehabilitation. Conclusions A longer duration of supervised rehabilitation is associated with an increased chance of meeting functional and return to sport criteria; however, the optimal supervised rehabilitation frequency is yet to be determined. Identification of the barriers to and facilitators of adherence and participation in ACL rehabilitation provides an opportunity for further research to be conducted to address personal, environmental and treatment-related factors, with the aim to improve rehabilitation outcomes.
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Importance of functional performance and psychological readiness for return to preinjury level of sports 1 year after ACL reconstruction in competitive athletes. Knee Surg Sports Traumatol Arthrosc 2020; 28:2203-2212. [PMID: 31679068 DOI: 10.1007/s00167-019-05774-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/23/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to identify independent predictive factors for return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction in competitive-level athletes and to determine optimal cut-off values for these factors at 6 months after surgery. METHODS A total of 124 competitive athletes (50 males and 74 females; mean age, 17.0 years; preinjury Tegner activity scale > 7) who underwent primary ACL reconstruction were enrolled. Assessments at 6 months after surgery consisted of knee functional tests [quadriceps index, hamstrings index, and single-leg hop for distance (SLH)] and 2 self-report questionnaires [IKDC subjective score and ACL-Return to Sport after Injury scale (ACL-RSI)]. At 1 year after surgery, athletes were classified into the RTS group (n = 101) or non-RTS group (n = 23) based on self-reported sports activities. After screening possible predictive factors of RTS, multivariate logistic regression and receiver operating characteristic curve analyses were performed to identify independent factors. RESULTS Multivariate logistic regression analysis identified SLH (odds ratio, 2.861 per 10 unit increase; P < 0.001) and ACL-RSI (odds ratio, 1.810 per 10 unit increase; P = 0.001) at 6 months as independent predictors of RTS at 1 year after surgery. Optimal cut-off values of SLH and ACL-RSI were 81.3% (sensitivity = 0.891; specificity = 0.609) and 55 points (sensitivity = 0.693; specificity = 0.826), respectively. CONCLUSION In competitive athletes, SLH < 81% and ACL-RSI < 55 points at 6 months after surgery were associated with a greater risk of unsuccessful RTS at 1 year after surgery. SLH and ACL-RSI at 6 months could serve as screening tools to identify athletes who have difficulties with returning to sports after ACL reconstruction. LEVEL OF EVIDENCE III.
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50
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Effect of Graft Type on Thigh Circumference, Knee Range of Motion, and Lower-Extremity Strength in Pediatric and Adolescent Males Following Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2020; 29:555-562. [PMID: 31094620 DOI: 10.1123/jsr.2018-0272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/12/2019] [Accepted: 03/24/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT To treat anterior cruciate ligament (ACL) injury, ACL reconstruction (ACLR) surgery is currently a standard of the care. However, effect of graft type including bone-patellar tendon-bone (BTB), hamstring tendon, or iliotibial band (ITB) on thigh size, knee range of motion (ROM), and muscle strength are understudied. OBJECTIVE To compare postoperative thigh circumference, knee ROM, and hip and thigh muscle strength in adolescent males who underwent ACLR, based on the 3 different autograft types: BTB, hamstring (HS), and ITB. SETTING Biomechanical laboratory. PARTICIPANTS Male ACLR patients who are younger than 22 years of age (total N = 164). INTERVENTION At 6- to 9-month postoperative visits, thigh circumference, knee ROM, and hip and thigh muscle strength were measured. MAIN OUTCOME MEASURES Deficits of each variable between the uninvolved and ACLR limb were compared for pediatric and adolescent ACLR males in the BTB, HS, and ITB cohorts. Baseline characteristics, including physical demographics and meniscus tear status, were compared, and differences identified were treated as covariates and incorporated in analysis of covariance. RESULTS Data were from 164 adolescent male ACLR patients [mean age 15.7 (1.2) years]. There were no statistical differences in thigh circumference, knee ROM, hip abductor, and hip-extensor strength among the 3 autografts. However, patients with BTB demonstrated 12.2% deficits in quadriceps strength compared with 0.5% surplus in HS patients (P = .002) and 1.2% deficits in ITB patients (P = .03). Patients with HS showed 31.7% deficits in hamstring strength compared with 5.4% deficits in BTB (P = .001) and 7.7% deficits in ITB (P = .001) groups at 6- to 9-month postoperative visits. CONCLUSION Adolescent male ACLR patients with BTB and HS autografts demonstrated significant deficits in quadriceps and hamstring strength, respectively, at 6 to 9 months postoperatively. Minimal lower-extremity strength deficits were demonstrated in pediatric male ACLR patients undergoing ITB harvest.
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