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Saad Berreta R, Knapik DM, Lawand J, Moews L, Villarreal-Espinosa JB, Pallone L, Dave U, Spaan J, Rafael Garcia J, Ayala S, Verma NN, Chahla J. Anterior Cruciate Ligament Reconstruction in Patients Aged 50 Years and Older Results in Improvements in Activity and Functional Outcome Measures, Whereas Reported Complication Rates Vary Widely: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00568-1. [PMID: 39233192 DOI: 10.1016/j.arthro.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 07/21/2024] [Accepted: 08/07/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE To systematically review the contemporary literature and evaluate patient-reported outcome measures (PROMs), functional knee measures, and the incidence of complications in patients aged 50 years and older undergoing anterior cruciate ligament reconstruction (ACLR) at short- to mid-term follow-up. METHODS A literature search was conducted across the PubMed, Embase, and Scopus databases, spanning from database inception to November 2023, in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The inclusion criteria consisted of clinical studies reporting PROMs, measures of knee stability, and complication rates after ACLR in patients aged 50 years and older with minimum 2-year follow-up. The Methodological Index for Non-randomized Studies criteria were used to assess study quality. Primary outcome measures consisted of changes in PROMs and complication rates after ACLR. RESULTS A total of 17 studies, consisting of 1,163 patients undergoing ACLR, were identified. Autografts were used in 90.3% of patients, whereas 9.7% of patients were treated using allografts. At minimum 24-month follow-up, mean International Knee Documentation Committee scores ranged from 67.4 to 92.96; mean Lysholm scores, from 84.4 to 94.8; and mean Tegner scores, from 0.3 to 5.4. The mean side-to-side difference at final follow-up ranged from 1.2 to 2.4 mm, and the rates of recurrent instability ranged from 0% to 18%. Complication and revision rates ranged from 0% to 40.4% and 0% to 37.5%, respectively, with the highest rates observed in studies noting a high incidence of intraoperative cartilage lesions. CONCLUSIONS ACLR in patients aged 50 years and older results in favorable International Knee Documentation Committee scores, Lysholm scores, and Tegner activity scores and improvements in functional knee measures. However, a wide range of reoperations and complications are reported, attributed to varying levels of chondral injury and osteoarthritis, which warrant consideration when discussing expectations in patients aged 50 years and older undergoing ACLR. LEVEL OF EVIDENCE Level IV, systematic review of Level II to IV studies.
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Affiliation(s)
- Rodrigo Saad Berreta
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jad Lawand
- Rush University Medical College, Chicago, Illinois, U.S.A
| | - Logan Moews
- Rush University Medical College, Chicago, Illinois, U.S.A
| | | | - Lucas Pallone
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Udit Dave
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jonathan Spaan
- Rush University Medical College, Chicago, Illinois, U.S.A
| | - José Rafael Garcia
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Salvador Ayala
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Sengoku T, Nakase J, Mizuno Y, Ishida Y, Yanatori Y, Takemoto N, Demura S. Knee flexor strength at 6 months after anterior cruciate ligament reconstruction using hamstring tendon can be predicted from that at 3 months. Knee Surg Sports Traumatol Arthrosc 2024; 32:2474-2483. [PMID: 39015061 DOI: 10.1002/ksa.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE This study aimed to identify factors influencing persistent muscle weakness in knee flexor strength after anterior cruciate ligament (ACL) reconstruction using the hamstring tendon and establish a clear cut-off value at 3 months postoperatively for the limb symmetry index (LSI) to exceed 90% at 6 months postoperatively. METHODS One hundred forty-eight patients undergoing ACL reconstruction were included and categorised into two groups based on knee flexor strength at 6 months postoperatively: patients with LSI of 90% or greater (achieved group: n = 114) and patients with LSI less than 85% (nonachieved group: n = 34). Items with significant differences between the two groups (preoperative waiting period, LSI to body weight ratio of knee flexor and extensor strength at 3 months postoperatively and peak torque angle of knee flexor muscle) were included in the multiple logistic regression analysis. Additionally, a receiver operating characteristic curve was used to calculate the cut-off value of the LSI at 3 months postoperatively, which was required to achieve the LSI criteria for knee flexor strength 6 months postoperatively. RESULTS Multiple logistic regression analysis extracted the preoperative waiting period and LSI for knee flexor strength at 3 months postoperatively. The cut-off value at 3 months postoperatively was 76.9% (area under the curve value, 0.82; sensitivity, 0.76; and specificity, 0.81) of the LSI. CONCLUSION The LSI of at least 76.9% for knee flexor strength at 3 months after ACL reconstruction was an indicator for achieving the 6 months postoperatively. This is a criterion to aim for, considering the stress on the graft and the regeneration process of the semitendinosus tendon. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Takuya Sengoku
- Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yushin Mizuno
- Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yoshihiro Ishida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yusuke Yanatori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Naoki Takemoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Tagliero AJ, Miller MD. Anterior Cruciate Ligament Tears in Soccer Players. Sports Med Arthrosc Rev 2024; 32:138-145. [PMID: 39087703 DOI: 10.1097/jsa.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Anterior cruciate ligament (ACL) injuries to soccer players present unique challenges in sports medicine, given the sport's global prevalence and intricate injury dynamics. These injuries, especially in the youth and female demographic, have become a substantial concern in sports medicine. This review explores the epidemiology, mechanism of injury, diagnostic procedures, treatment modalities, and rehabilitation strategies related to ACL tears within the soccer community. Progress in diagnostics, treatments, and rehabilitation underscores the importance of evidence-based approaches. As soccer continues its ascent in popularity, addressing the specific risks and nuances of ACL injuries in this context remains of paramount significance.
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Affiliation(s)
- Adam J Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Mark D Miller
- Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA
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Phillips T, Ronna B, Terner Z, Cushing T, Goldenberg N, Shybut T. After 40 days intra-articular injury, risk profile increases linearly with time to surgery in adolescent patients undergoing primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39189120 DOI: 10.1002/ksa.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries are becoming more common in youth athletes. Time-to-surgery has been shown to significantly affect the rates of concurrent injuries at the time of ACL reconstruction (ACLR). The purpose of this study was to evaluate if time-to-surgery in ACLR impacts observances of intra-articular injuries and to categorize injury profile in relation to time. METHODS An Institutional Review Board-approved retrospective cohort study was conducted. Included subjects were aged 21 and below and underwent primary ACLR within 6 months of injury between January 2012 and April 2020. Skeletal maturity was determined via imaging. Laterality, location and severity/pattern of meniscal and chondral injuries were recorded. Multivariate logistic regression was utilized to identify risk factors for intra-articular pathology. Cut-off analyses were added to regression models to identify trends of concurrent injuries. RESULTS Eight hundred and fifty patients met the inclusion criteria. Patients with observed articular cartilage injuries had a significantly longer time-to-surgery of 66 days (p = 0.01). Risk factors for chondral injury were time-to-surgery (p = 0.01) and skeletal maturity (p = 0.01), while medial meniscal tears were prognosticated by time-to-surgery (p = 0.03), skeletal maturity (p = 0.01) and body mass index (p = 0.00). Cut-off analysis showed that after 40 days the proportion of patients with observed chondral injury increased with time to surgery and that there were significantly different observances of chondral (p = 0.00) and medial meniscal (p = 0.03) injuries in the 6-week model, as compared to the continuous time model. CONCLUSION Longer time-to-surgery in ACLR is associated with higher rates of concomitant intra-articular pathology, especially chondral injuries. After 40 days, the observed rates of intra-articular injury increase proportionately with time from injury. A 6-week categorical model best stratifies intra-articular injury risk profile. Risk factor analysis identified skeletally mature patients with delayed surgery of >12 weeks to be at the highest risk for both chondral and medial meniscal injuries after an ACLR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Todd Phillips
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Brenden Ronna
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Tucker Cushing
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Neal Goldenberg
- Dartmouth Health, Cheshire Medical Center, Keene, New Hampshire, USA
| | - Theodore Shybut
- Orthopedic Surgery, Southern California Orthopedic Institute, Van Nuys, California, USA
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Schmidt S, Krahl D, Podszun J, Knecht S, Zimmerer A, Sobau C, Ellermann A, Ruhl A. Combining a digital health application with standard care significantly enhances rehabilitation outcomes for ACL surgery patients. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39189134 DOI: 10.1002/ksa.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture is one of the most common sports injuries. Regardless of the surgical treatment, patients require intensive education about the pathology, therapeutic options and physical therapy. However, it is often not possible for the patient to start physical therapy directly and schedule adequate consultations. Digital health applications are medical devices that can help bridge the gap between physiotherapy sessions and provide qualified, convenient and effective education and treatment. This study is needed to explore alternative methods to ensure continuous and effective rehabilitation for ACL patients who face delays in accessing traditional physiotherapy. The study aimed to compare app-assisted therapy plus standard of care (conventional orthopaedic and physiotherapeutic measures) versus isolated standard of care for patients with planned ACL surgery. METHODS A monocentric, two-arm, 1:1 randomized controlled study examined 80 patients after a cruciate ligament rupture with or without meniscal injury. Patients over 18 years with a confirmed diagnosis of ACL rupture and planned surgical reconstruction using autologous grafts were included. The study criteria additionally included willingness to use the Orthopy app and sufficient German language proficiency. The study excluded patients with severe concomitant injuries, prior knee surgeries, chronic pain conditions and those not compatible with app usage. Patients were randomized and their baseline data (t0) was collected. Subsequently, they received their treatment according to their treatment group. The study included a presurgery period (2-6 weeks) and a postsurgery period (14 weeks). Interim assessments were done via online questionnaires at t1 (if more than 3 weeks before surgery) and t3, t4 and t5 (postsurgery). Additional clinical assessments were conducted at t2 (presurgery) and t6 (14 weeks postsurgery). Primary outcome measures included the knee injury and osteoarthritis outcome score (KOOS), with subjective pain and function levels (numeric rating scale [NRS]) as secondary endpoints. RESULTS The clinical trial was able to show positive outcomes on the KOOS Pain and Symptoms subscale of the primary endpoint KOOS in the interventional group compared to the standard of care group. A statistically significant pain reduction could be seen at t1 (p = 0.0005), t2 (p = 0.0068) and t4 (approximately 6 weeks after surgery; p = 0.01). A significant reduction of symptoms at t1 (p = 0.0001), t2 (p = 0.0036) and t6 (p = 0.0377) were recognized. These findings are further supported by the significant benefit of the pain NRS at t4 and positive tendencies at t3, t5 and t6. The KOOS subscales quality of life (p = 0.0066), activities of daily living (p = 0.0009) and Sport (p = 0.0484) showed significant effects before surgery. CONCLUSION The Orthopy app is a medical device that is both safe and effective for use. Combining the Orthopy app and standard of care can significantly improve prehabilitation and rehabilitation in surgical treatment with ACL reconstruction compared with the isolated standard of care. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Sebastian Schmidt
- Department of Sports Medicine, ARCUS Kliniken, Pforzheim, Germany
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Krahl
- Department of Sports Medicine, ARCUS Kliniken, Pforzheim, Germany
- Department of Orthopedic Surgery, Vincentius-Diakonissen-Kliniken gAG, Karlsruhe, Germany
| | | | - Sophie Knecht
- Medical Affairs, Orthopy Health GmbH, Hamburg, Germany
| | - Alexander Zimmerer
- Department of Orthopaedic and Trauma Surgery, Orthopädische Klinik Paulinenhilfe, Diakonieklinikum, Stuttgart, Germany
| | - Christian Sobau
- Department of Sports Medicine, ARCUS Kliniken, Pforzheim, Germany
| | - Andree Ellermann
- Department of Sports Medicine, ARCUS Kliniken, Pforzheim, Germany
| | - Alexander Ruhl
- Department of Sports Medicine, ARCUS Kliniken, Pforzheim, Germany
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Tan Y, Kaldau NC, Lumban-Gaol I, Budhiparama NC, Peers K. Anterior cruciate ligament injuries in elite badminton athletes: 84% Return to sport, half return to performance. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38984858 DOI: 10.1002/ksa.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 06/03/2024] [Accepted: 06/17/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Badminton requires fast and pivoting movements, putting athletes at risk of sustaining an anterior cruciate ligament (ACL) injury. The primary purpose is to investigate the return to sport (RTS) and the return to performance (RTP) after an ACL injury in elite badminton athletes. The secondary purpose is to describe ACL injury mechanisms in elite badminton players. METHODS Athletes within the top 200 of the Badminton World Federation World Ranking who sustained an ACL injury between January 2001 and December 2021 were retrospectively included. An anonymous online survey was created in eight languages. RTS, RTP and contributing factors were analysed among athletes aiming to RTP. The injury mechanism was analysed in all participants. RESULTS Sixty-six athletes from 32 countries were included. Fifty-seven athletes (86.4%) aimed to RTP. Forty-eight out of 57 (84.2%) did RTS. Twenty-nine (50.9%) managed to successfully RTP. Forty-nine (74.2%) of ACL injuries occurred during a competition, 14 (21.2%) occured during training. Thirty-one (49.2%) occurred in the rear court backhand side and 47 (74.6%) occurred during landing after a jump. CONCLUSION Forty-eight out of 57 (84.2%) athletes managed to RTS. Half of the athletes managed to successfully RTP. Most of the ACL injuries occurred during competition, in the rear court backhand side and during landing after a jump. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yuhan Tan
- Department of Orthopaedics, Noorderhart Ziekenhuis, Pelt, Belgium
- Department of Orthopaedics, University Hospital Brussels, Brussels, Belgium
- Department of Physical Medicine & Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Niels Christian Kaldau
- Department of Orthopaedic Surgery, Sports Orthopaedic Research Center Copenhagen (SORC-C), Copenhagen University Hospital, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Imelda Lumban-Gaol
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Department of Orthopaedics, Medistra Hospital, Jakarta, Indonesia
| | - Nicolaas C Budhiparama
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Department of Orthopaedics, Medistra Hospital, Jakarta, Indonesia
| | - Koenraad Peers
- Department of Physical Medicine & Rehabilitation, University Hospitals Leuven, Leuven, Belgium
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Solie BS, Tollefson LV, Doney CP, O'Keefe JMJ, Thompson WC, LaPrade RF. Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction: A Practical Review with Medical Recommendations. Int J Sports Med 2024; 45:572-588. [PMID: 38527465 DOI: 10.1055/a-2270-3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Returning to sport after anterior cruciate ligament reconstruction (ACLR) can be a challenging and complex process for the athlete, with the rate of return to the pre-injury level of sport observed to be less than athlete expectations. Of the athletes that do return to sport (RTS), knee re-injury rates remain high, and multiple studies have observed impaired athletic performance upon RTS after ACLR as well as reduced playing time, productivity, and career lengths. To mitigate re-injury and improve RTS outcomes, multiple RTS after ACLR consensus statements/clinical practice guidelines have recommended objective RTS testing criteria to be met prior to medical clearance for unrestricted sports participation. While the achievement of RTS testing criteria can improve RTS rates after ACLR, current criteria do not appear valid for predicting safe RTS. Therefore, there is a need to review the various factors related to the successful return to the pre-injury level of sport after ACLR, clarify the utility of objective performance testing and RTS criteria, further discuss safe RTS decision-making as well as present strategies to reduce the risk of ACL injury/re-injury upon RTS. This article provides a practical review of the current RTS after ACLR literature, as well as makes medical recommendations for rehabilitation and RTS decision-making after ACLR.
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Affiliation(s)
- Braidy S Solie
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
- Research, Twin Cities Orthopedics, Edina, MN, United States
| | | | - Christopher P Doney
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
| | - Jeremy M J O'Keefe
- Physical Therapy, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
| | - Will C Thompson
- Sports Science, Training HAUS, Twin Cities Orthopedics, Eagan, MN, United States
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Manoharan A, Fithian A, Xie V, Hartman K, Schairer W, Khan N. Return to Sports After Anterior Cruciate Ligament Reconstruction. Perm J 2024; 28:102-108. [PMID: 38659351 PMCID: PMC11232915 DOI: 10.7812/tpp/23.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Anterior cruciate ligament (ACL) tears are one of the most common orthopedic injuries among athletes. Although a small proportion of patients with isolated tears can return to sports after completing a nonsurgical rehabilitation program, ACL reconstruction is frequently recommended for young athletes, especially those with concomitant knee injuries or symptomatic knee instability. Alongside emerging evidence for the effect of prehabilitation, the current standard of care for postoperative ACL physical therapy includes pain control, range of motion, quadriceps strengthening, weight bearing, postoperative bracing, and dynamic limb stabilization and control. The early rehabilitation period includes non-weight-bearing exercises and passive range of motion, which is followed by a longer period of gradual strengthening focused on regaining preinjury strength, proprioception, and control with progressively more demanding dynamic movements. The total rehabilitation period is expected to take around 9 months, during which the patient should be evaluated at frequent intervals by a licensed physical therapist in addition to a daily home exercise program. Prior to discharge from the rehabilitation program, patients should be evaluated by both the surgeon and physical therapist. Patients are encouraged to return to sports once they meet a set of perceptual, subjective, objective, neuromuscular, functional, sport-specific drills, and load management testing criteria.
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Affiliation(s)
- Aditya Manoharan
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, El Cajon, CA, USA
| | - Andrew Fithian
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, El Cajon, CA, USA
| | - Virginia Xie
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Kurt Hartman
- Department of Physical Medicine & Rehabilitation/Physical Therapy, Southern California Permanente Medical Group, San Marcos, CA, USA
| | - William Schairer
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, El Cajon, CA, USA
| | - Najeeb Khan
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, San Diego, CA, USA
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Kaleem S, Noor R, Salman Bashir M, Ikram M. Effects of clamshell exercises in terminal extension lag after ACL reconstruction. Knee 2024; 48:226-233. [PMID: 38763073 DOI: 10.1016/j.knee.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/31/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Terminal extension lag (TEL) is common following anterior cruciate ligament reconstruction (ACLR). Clamshell exercises have been suggested as a potential intervention to address TEL, but limited research has been conducted in this area. OBJECTIVE This study aimed to determine the effects of Clamshell exercises in terminal extension lag after anterior cruciate ligament reconstruction. METHODS This randomized controlled trial included 40 participants with a history of ACLR between 1 and 3 years prior. Participants were randomly assigned to either the experimental group (Group A) or the control group (Group B). Group A received conventional exercises along with isolated hip strengthening rehabilitation, while Group B received conventional exercises without specific hip strengthening. The primary outcomes were pain levels (Numeric Pain Rating Scale), knee function (International Knee Documentation Committee scores, (IKDC)), range of motions (goniometer) and strength (sphygmomanometer). RESULTS In between the group comparison shows that all outcome measures (NPRS, IKDC, Goniometer, Sphygmomanometer) show significant results (p < 0.05). Within-group comparisons (paired sample t-test) show that there was a significant difference (p < 0.05) in all outcome measures of both groups. CONCLUSION The addition of Clamshell exercises to the rehabilitation program resulted in a significantly greater reduction in TEL compared to the control group. These findings suggest that Clamshell exercises were found to be an effective intervention for addressing TEL after ACLR.
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Affiliation(s)
- Sohaib Kaleem
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan
| | - Rabiya Noor
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan
| | | | - Mehwish Ikram
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan.
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Alashram AR, D'Onofrio R, Sannicandro I, Manzi V, Padua E, Youssef T, Annino G. Return to training in soccer players after anterior cruciate ligament reconstruction: reflections and considerations. J Sports Med Phys Fitness 2024; 64:578-587. [PMID: 38324269 DOI: 10.23736/s0022-4707.23.15448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
This clinical and rehabilitative overview focuses on the return to unrestricted sporting activity, aiming to consolidate the scientific evidence surrounding the structural progression of athletes, particularly footballers, undergoing anterior cruciate ligament reconstruction (ACLR). A multidisciplinary approach necessitates a shared language and standardized methodologies. Unfortunately, significant disparities persist in the structural strategies guiding the decision-making process for returning to on-field activities, the latter stages of rehabilitation, and subsequent restoration of technical and tactical football abilities. Divergences in definitions, terminologies, and rehabilitation protocols can substantially influence final outcomes. Presently, scientific consensus studies regarding the decision-making process during the final stages of on-field rehabilitation are lacking. Nevertheless, this overview outlines and defines pivotal language parameters crucial for effective communication and the seamless integration of clinical and rehabilitative data among the diverse professionals involved in facilitating the athlete's return to peak performance. In conclusion, the successful resumption of competitive sporting activities for footballer's post ACLR demands a collaborative decision-making approach encompassing various professionals. Additionally, it necessitates a cohesive transition from rehabilitation to on-field work, aiming at reinstating athleticism, technical prowess, and tactical acumen.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan -
- Applied Science Research Center, Applied Science Private University, Amman, Jordan -
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy -
| | - Rosario D'Onofrio
- Medical-Scientific Multidisciplinary Commission, Italian Football Doctors Association, L.A.M.I.CA., Rome, Italy
| | - Italo Sannicandro
- Experimental and Clinical Department, University of Foggia, Foggia, Italy
| | - Vincenzo Manzi
- Department of Humanities Science, Pegaso Open University, Naples, Italy
| | - Elvira Padua
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Tarek Youssef
- Department of Physiotherapy, Middle East University, Amman, Jordan
| | - Giuseppe Annino
- Center of Space Bio-Medicine, Department of Medicine Systems, Tor Vergata University, Rome, Italy
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Motowidło J, Stronska-Garbien K, Bichowska-Pawęska M, Kostrzewa M, Zając A, Ficek K, Drozd M. Effect of Step Load Based on Time under Tension in Hypoxia on the ACL Pre-Operative Rehabilitation and Hormone Levels: A Case Study. J Clin Med 2024; 13:2792. [PMID: 38792333 PMCID: PMC11122198 DOI: 10.3390/jcm13102792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
The aim of the study was to determine the effect of step load in hypoxia on the effectiveness of preoperative rehabilitation (PR) and hormone levels based on a case study. Introduction: We assessed the impact of variables such as rate of movement and time under tension (TUT) in normobaric hypoxia on the levels of growth hormone (GH), insulin-like growth factor 1 (IGF-1), and erythropoietin (EPO). Additionally, the impact of step load on the hypertrophy and strength of knee extensors and flexors was assessed. Methods: The work uses a case study, the research subject of which was a 23-year-old female professional handball player. The tests included an isokinetic assessment of the peak torque of knee extensors and flexors as well as body composition analysis. Results: The results showed a more than (10.81-fold) increase in GH after the microcycle with time under tension (TUT). The deficit between the lower limbs was also reduced. Conclusions: Using a hypoxic environment based on an appropriate altitude, combined with changes such as a short rest break between sets and a controlled tempo of movement with an eccentric phase, TUT may offer an alternative to the PR process, especially among athletes who care about fast RTS.
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Affiliation(s)
- Joanna Motowidło
- Department of Sports Training, Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (K.S.-G.); (M.K.); (A.Z.); (K.F.)
| | - Katarzyna Stronska-Garbien
- Department of Sports Training, Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (K.S.-G.); (M.K.); (A.Z.); (K.F.)
| | - Marta Bichowska-Pawęska
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Maciej Kostrzewa
- Department of Sports Training, Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (K.S.-G.); (M.K.); (A.Z.); (K.F.)
| | - Adam Zając
- Department of Sports Training, Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (K.S.-G.); (M.K.); (A.Z.); (K.F.)
| | - Krzysztof Ficek
- Department of Sports Training, Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (K.S.-G.); (M.K.); (A.Z.); (K.F.)
| | - Miłosz Drozd
- Department of Sports Training, Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (K.S.-G.); (M.K.); (A.Z.); (K.F.)
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12
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Qiu J, Ong MTY, Choi CY, He X, Lau LCM, Fu SC, Fong DTP, Yung PSH. Associations of patient characteristics, rate of torque development, voluntary activation of quadriceps with quadriceps strength, and knee function before anterior cruciate ligament reconstruction. Res Sports Med 2024; 32:491-503. [PMID: 36254570 DOI: 10.1080/15438627.2022.2132860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/28/2022] [Indexed: 10/24/2022]
Abstract
Good preoperative knee function (KF) and quadriceps strength (QS) relate to good prognoses after anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate the associations between patient characteristics, rate of torque development (RTD), voluntary activation (VA) of the quadriceps against preoperative KF and QS. A cross-sectional study was conducted. Forty patients with a primary, unilateral ACL injury who had finished the preoperative rehabilitation and scheduled for an ACLR were included. KF was evaluated using the International Knee Documentation Committee score. QS was measured by maximal voluntary isometric contractions. RTD was divided into the early (RTD0-50) and the late (RTD100-200) phases. Quadriceps VA was measured using the superimposed burst technique. Our results showed that patients with poor preoperative KF had more deficits in RTD0-50 (P = 0.025), higher BMI(P = 0.043), and more meniscus injuries (MI) (P = 0.001) than those with good KF. Patients with asymmetrical QS showed lower BMI (P = 0.020) and shorter time from injury (TFI) (P = 0.027) than those with symmetrical QS. Additionally, a higher pre-injury Tegner score combined with greater RTD100-200 contributed to greater QS on the injured limb (R2 = 0.357, P = 0.001). To conclude, BMI, TFI, concomitant MI, pre-injury physical activity level, and quadriceps RTD are related to QS and KF before ACLR.
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Affiliation(s)
- Jihong Qiu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi-Yin Choi
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xin He
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Chun-Man Lau
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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13
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Frouin A, Desfontaines N, Lacourpaille L, Nordez A, Le Sant G. Preoperative Rehabilitation Enhances Mental and Physical Well-Being in Anterior Cruciate Ligament-Injured Individuals: A Mixed Methods Study. J Sport Rehabil 2024; 33:289-296. [PMID: 38580299 DOI: 10.1123/jsr.2023-0312] [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: 09/18/2023] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 04/07/2024]
Abstract
CONTEXT Rehabilitation after an anterior cruciate ligament injury is recommended to be started soon after the injury. When surgery is required, research supports the delivery of physiotherapy before anterior cruciate ligament reconstruction (prehabilitation) to optimize recovery and positive outcomes. Individuals attending prehabilitation have never been questioned regarding their adherence to prehabilitation, perception of utility in meeting needs, upcoming events, or anticipated recovery goals. DESIGN Mixed methods cross-sectional study: Methods: 25 individuals before anterior cruciate ligament reconstruction (43% of eligible individuals from 12 clinics during the delivery period) were surveyed on their mindset and recovery expectancies. Semistructured interviews conducted in 9 of 25 participants assessed their lived experience of prehabilitation. RESULTS Participants reported that preventing a reinjury (96% of responses) and feeling confident during daily activities about their knee (92%) were the higher rating expectations at this stage of their treatment course. Three themes were developed from the interviews and analyses. (1) Participants reported that prehabilitation was a period full of challenges with memories of the injury and uncertainties. (2) They viewed prehabilitation as a step to move forward by finding support and self-motivating. (3) They believed that prehabilitation would have positive impacts on the treatment outcomes. Participants were confident that prehabilitation would accelerate the recovery of muscle volume (88%) and strength (84%). CONCLUSION Participants had positive experiences of prehabilitation, aligning with the findings on functional outcomes in the existing literature on prehabilitation.
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Affiliation(s)
- Antoine Frouin
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- Institut Sport Atlantique, ISA Clinic, Saint-Herblain, France
| | | | - Lilian Lacourpaille
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
| | - Antoine Nordez
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- Institut Universitaire de France, IUF, Paris, France
| | - Guillaume Le Sant
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, Nantes, France
- School of Physiotherapy, IFM3R, St-Sebastien/Loire, France
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14
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Alshehri YS. Current views on preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia: An online-based cross-sectional survey. Medicine (Baltimore) 2024; 103:e37861. [PMID: 38640285 PMCID: PMC11029962 DOI: 10.1097/md.0000000000037861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024] Open
Abstract
Preoperative rehabilitation is an important stage to both physically and mentally prepare patients for anterior cruciate ligament reconstruction (ACLR) and postoperative rehabilitation. This study aimed to investigate the current preoperative rehabilitation practice after anterior cruciate ligament injury among licensed physical therapists in Saudi Arabia. This was an online-based cross-sectional survey. A total of 114 physical therapists completed the survey. The survey consisted of 16 mandatory questions about management strategies, prescribed exercises, patients' physical and psychological concerns, and discussions about nonoperative management. The majority of the respondents used the following preoperative interventions: education (89.5%), closed kinetic chain exercises (66.7%), stretches (63.2%), open kinetic chain exercises (61.4%), proprioceptive exercises (59.6%), cold (56.1%), and activity modification advice (52.6%). More than half of the respondents would recommend patients awaiting ACLR to complete the exercises 2 to 4 times weekly (56.1%) for up to 8 weeks (80.7%) before ACLR. The respondents (73.7%) reported that patients awaiting ACLR did not receive preoperative rehabilitation due to 2 primary factors: the orthopedic team did not refer patients to rehabilitation specialists, and there was a lack of awareness about preoperative rehabilitation. Most therapists (86%) would discuss conservative management if a patient returned to their preinjury level of function before surgery. The surveyed physical therapists reported using various interventions and preoperative rehabilitation lengths with patients awaiting ACLR. The majority of the therapists indicated that patients awaiting ACLR did not receive preoperative rehabilitation. Future studies are needed to establish a consensus on the optimal preoperative rehabilitation program.
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Affiliation(s)
- Yasir S. Alshehri
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
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15
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Rhim HC, Schon JM, Xu R, Nolan D, Ahn J, Short K, Schon LC. Prehabilitation for Patients Undergoing Elective Foot and Ankle Surgery: A Contemporary Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241255136. [PMID: 38812567 PMCID: PMC11135079 DOI: 10.1177/24730114241255136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jason M. Schon
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Raylin Xu
- Harvard Medical School, Boston, MA, USA
| | - David Nolan
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, MA, USA
- Sports Physical Therapy Service, Massachusetts General Hospital, Boston, MA, USA
| | - Jiyong Ahn
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kelly Short
- Center for Restorative Therapies, Mercy Medical Center, Baltimore, MD, USA
| | - Lew C. Schon
- Director of Orthopaedic Innovation, Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, New York University Langone Health, NY, USA
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Owen MK, Casadonte KR, Thomas NT, Latham CM, Brightwell CR, Thompson KL, Hawk GS, Jacobs CA, Johnson DL, Fry CS, Noehren B. Sex Differences in Quadriceps Atrophy After Anterior Cruciate Ligament Tear. Sports Health 2024:19417381241230612. [PMID: 38436049 DOI: 10.1177/19417381241230612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Female athletes lag behind their male counterparts in recovery from anterior cruciate ligament (ACL) injury. Quadriceps muscle size and strength are crucial factors for regaining function after ACL injury, but little is known about how these metrics vary due to biological sex. HYPOTHESIS Female patients have reduced vastus lateralis fiber cross-sectional area (CSA) and lower quadriceps strength after ACL injury than male patients. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 4. METHODS A total of 60 participants with recent ACL tear were evaluated for vastus lateralis muscle fiber CSA, isometric quadriceps peak torque, and quadriceps rate of torque development. Linear mixed models were fit to determine differences across sex and limb for each variable of interest. RESULTS The female group averaged almost 20% atrophy between limbs (P < 0.01), while the male group averaged just under 4% (P = 0.05). Strength deficits between limbs were comparable between female and male groups. CONCLUSION Immediately after ACL injury, female patients have greater between-limb differences in muscle fiber CSA but between-limb strength deficits comparable with those of male patients. CLINICAL RELEVANCE These results indicate that the underpinnings of strength loss differ based on biological sex, and thus individual patients could benefit from a sex-specific treatment approach to ACL injury.
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Affiliation(s)
- Meredith K Owen
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | - Kelsey R Casadonte
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | - Nicholas T Thomas
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Christine M Latham
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Camille R Brightwell
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Katherine L Thompson
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, Kentucky
| | - Gregory S Hawk
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, Kentucky
| | - Cale A Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Darren L Johnson
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Christopher S Fry
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, and Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
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17
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Drigny J, Reboursière E, Praz C, Guermont H, Hulet C, Gauthier A. Changes in passive hamstring stiffness after primary anterior cruciate ligament reconstruction: A prospective study with comparison of healthy controls. Clin Biomech (Bristol, Avon) 2024; 112:106168. [PMID: 38219455 DOI: 10.1016/j.clinbiomech.2023.106168] [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: 07/25/2023] [Revised: 12/05/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The mechanical properties of knee flexors muscles contribute to reducing anterior cruciate ligament loading. This case-control study evaluated the passive knee flexors stiffness after primary anterior cruciate ligament reconstruction with comparison of healthy controls. METHODS After anterior cruciate ligament reconstruction, 88 participants (24.5 [8.6] years, 56,8% males) had two isokinetic tests at 4 and 8 postoperative months with measurement of the passive resistive torque of knee flexors and extensors/flexors strength. In the control group, 44 participants (24.5 [4.3] years, 56,8% males) had one visit with the same procedures. Passive knee flexors stiffness was calculated as the slope of the passive torque-angle curve on the last 10° of knee extension (Nm/°). We investigated the impact of timing and type of surgery (autograft and combined meniscus repair) and persistent knee extension deficits on knee flexors stiffness. FINDINGS At 4 and 8 postoperative months, passive knee flexors stiffness was lower on the operated limb than on the non-operated limb (P < 0.001) but both limbs had significant lower values than controls (P < 0.001). Stiffness was positively correlated with knee flexors strength (P < 0.010), and knee flexors stiffness at 4 months was lower in individuals who underwent surgery <6 months from injury (P = 0.040). Knee extension deficit or the type of surgery did not have a significant influence on knee flexors stiffness. INTERPRETATION Similarly to neuromuscular factors that are traditionally altered after anterior cruciate ligament reconstruction, evaluating passive knee flexors stiffness changes over time could provide supplementary insights into postoperative muscle recovery.
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Affiliation(s)
- Joffrey Drigny
- Service de Médecine Physique et de Réadaptation, Service de Médecine du Sport, CHU de Caen Normandie, Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000 Caen, France.
| | | | - Cesar Praz
- Département d'orthopédie et de traumatologie, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - Henri Guermont
- Service de Médecine du Sport, CHU de Caen Normandie, 14000 Caen, France
| | - Christophe Hulet
- Département d'orthopédie et de traumatologie, Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000 Caen, France
| | - Antoine Gauthier
- Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000 Caen, France
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18
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Niederer D, Keller M, Wießmeier M, Vogt L, Stöhr A, Schüttler KF, Schoepp C, Petersen W, Pinggera L, Mengis N, Mehl J, Krause M, Janko M, Guenther D, Engeroff T, Ellermann A, Efe T, Best R, Groneberg DA, Behringer M, Stein T. The End of the Formal Rehabilitation Is Not the End of Rehabilitation: Knee Function Deficits Remain After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2024; 33:88-98. [PMID: 38176405 DOI: 10.1123/jsr.2023-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/20/2023] [Accepted: 10/22/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To rate athletes' functional ability and return to sport (RTS) success at the end of their individual, formal, medically prescribed rehabilitation after anterior anterior cruciate ligament (ACL) reconstruction. METHODS In our prospective multicenter cohort study, 88 (42 females) adults aged 18-35 years after acute unilateral ACL rupture and subsequent hamstring grafting were included. All patients were prospectively monitored during their rehabilitation and RTS process until the end of their formal rehabilitation and RTS release. As outcome measures, functional hop and jump tests (front hop, balance hops, and drop jump screening test) and self-report outcomes (Knee Injury and Osteoarthritis Outcome Score, ACL-RTS after injury) were assessed. Literature-based cut-off values were selected to rate each performance as fulfilled or not. RESULTS At 7.5 months (SD 2.3 months) after surgery, the percentage of participants meeting the functional thresholds ranged from 4% (Knee Injury and Osteoarthritis Outcome Score SPORT) and over 44% (ACL-RTS after injury sum score) to 59% (Knee Injury and Osteoarthritis Outcome Score activities of all daily living) in the self-report and from 29% (Balance side hop) to 69% (normalized knee separation distance) in performance testing. Only 4% fulfilled all the cut-offs, while 45% returned to the same type and level of sport. Participants who successfully returned to their previous sport (type and level) were more likely to be "over-cut-off-performers." CONCLUSIONS The low share of the athletes who fulfilled the functional RTS criteria highlights the importance of continuing the rehabilitation measures after the formal completion to assess the need for and success of, inter alia, secondary-preventive therapies.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Max Wießmeier
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | | | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum Duisburg gGmbH, Duisburg, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | - Lucia Pinggera
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | | | - Julian Mehl
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maren Janko
- Department of Trauma, Hand, and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Daniel Guenther
- Department of Orthopedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Witten, Germany
| | - Tobias Engeroff
- Division Health and Performance, Goethe University Frankfurt, Institute of Occupational, Social and Environmental Medicine, Frankfurt am Main, Germany
| | | | - Turgay Efe
- Orthopaedicum Lich Giessen, Lich, Germany
| | - Raymond Best
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Michael Behringer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Stein
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
- SPORTHOLOGICUM Frankfurt-Center for Sport and Joint injuries, Frankfurt am Main, Germany
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19
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Abel R, Zoth N, Wilke C, Schmidt T. [Exercise-Based Prehabilitation In Orthopaedics, Cardiology And Oncology]. DIE REHABILITATION 2024; 63:51-64. [PMID: 38335973 DOI: 10.1055/a-2126-7431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Prehabilitation (prehab) aims to prepare patients for surgery, to reduce perioperative complications and to improve postoperative recovery. Pre-operative interventions depend on the indication and the specific patient characteristics and life circumstances. In orthopaedics, the focus is on preoperative improvement of physical performance, function and muscle strength through specific strength, mobility and sensomotoric training. In cardiology, endurance training and respiratory therapy are used in the preoperative phase, as well as coordination and strengthening exercises and occupational therapy to improve physical fitness and performance and reduce cardiovascular risk factors. In oncology, prehab is used preoperatively and also in addition to chemotherapy or radiotherapy to reduce medical side effects and to increase tolerance to cancer therapies (e. g. surgery, chemotherapy, radiotherapy). Exercise interventions in oncology differ according to the type of cancer (e. g. combined strength and endurance training, respiratory therapy, high-intensity interval training and walking). Study results often show positive effects on health resources using prehab. However, further high-quality clinical intervention studies are needed to confirm the clinical benefits of prehab for implementation in routine care.
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20
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Aregger FC, Kreuzer S, Häckel S, Bigdon SF, Tinner C, Erbach G, Deml MC, Albers CE. Return to sports/activity level after 360° thoracolumbar fusion after burst fractures in young patients. BRAIN & SPINE 2024; 4:102762. [PMID: 38510642 PMCID: PMC10951747 DOI: 10.1016/j.bas.2024.102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 03/22/2024]
Abstract
Introduction Traumatic thoracolumbar burst fractures are the most common spinal injuries and the proper treatment is controversial. In central Europe in particular, these fractures are often treated with minimally invasive anterior-posterior reduction and fusion, whereas a conservative approach is preferred in the USA. Independent of the treatment strategy, no data exists regarding the outcome related to return to activity level/sport. Research question The aim of this study was to evaluate the return to sports and activity levels after 360° fusion in patients with thoracolumbar burst fractures without neurological deficits. Methods Between January 2013 and December 2022, 46 patients aged 18 to 40 years underwent partial or complete vertebral body replacement in the thoracolumbar region due to traumatic burst fractures without neurologic deficit as an isolated injury. Patients were contacted retrospectively by phone calls to assess their activities using a modified version of the Tegner activity scale at different time points: Before trauma, 3, 6, and 12 months post-surgery. Results After applying exclusion criteria, data collection was complete for 28 patients. The median modified Tegner activity scale was 5.4 before sustaining the fracture, declined to 2.9 at three months post-trauma, improved to 4.2 at six months, and reached 5.0 at 12 months. The majority (83%) of patients achieved their pre-accident activity level within 12 months. No significant differences were observed between patients with partial or complete corpectomy. Conclusion This is the first study assessing return to sports/physical activity based on the modified Tegner scale in young patients undergoing 360° fusion for spinal burst fractures. The majority of patients (83%) return to the pre-injury activity level within 12 months after surgery.
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Affiliation(s)
- Fabian Cedric Aregger
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Sebastian Kreuzer
- Department of Orthopaedic Surgery and Traumatology, Spital Thun, Thun, Switzerland
| | - Sonja Häckel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Switzerland
| | - Sebastian Frederick Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Christian Tinner
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Georg Erbach
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Moritz Caspar Deml
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Christoph Emanuel Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
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Adhitya IPGS, Kurniawati I, Sawa R, Wijaya TF, Dewi NPAC. The Risk Factors and Preventive Strategies of Poor Knee Functions and Osteoarthritis after Anterior Cruciate Ligament Reconstruction: A Narrative Review. Phys Ther Res 2023; 26:78-88. [PMID: 38125289 PMCID: PMC10730125 DOI: 10.1298/ptr.r0028] [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: 08/25/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is the standard surgical treatment for ACL injury, which typically uses a graft to replace the torn ligament in the knee that uses small incisions with minimally invasive surgery. The optimal knee functions following ACLR depend on rehabilitation processes before and after the surgery. Knee function is the ability of the knee to perform various types of functional movements like walking, squatting, running, jumping, and pivoting where patients expect to achieve maximum knee function or at least more than 80% of its initial condition before the injury to avoid being categorized as poor knee function after ACLR. Patients use patient-reported outcome measures to collect data on their health status and quality of life after ACLR. Post-traumatic osteoarthritis (PTOA) is a type of OA that manifests in local cartilage injury caused by chondrocyte death, and matrix dispersion occurs following a joint injury like ACL injury. Gender, time from injury to surgery, and graft type were considered as risk factors for poor knee function after ACLR, while overweight, meniscus tear, and cartilage defect as risk factors for PTOA. However, age is an internal risk factor for both poor knee function and PTOA following ACLR. This review suggests several strategies to prevent both conditions, including a pre-operative program, comprehensive rehabilitation, body weight control, and return to sport (RTS) consideration based on physical capacity, proper time, and psychological readiness.
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Affiliation(s)
| | - Ida Kurniawati
- Department of Histology, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Indonesia
| | - Ryuichi Sawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Japan
| | - Tabita Febyola Wijaya
- Bachelor and Professional Program of Physical Therapy, College of Medicine, Universitas Udayana, Indonesia
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Abel R, Niederer D, Offerhaus C, Shafizadeh S, Glowa A, Froböse I, Wilke C. Effects of exercise prehabilitation before anterior cruciate ligament reconstruction on functional outcomes during pre- and postoperative rehabilitation - protocol for a single-blinded randomised controlled trial. Trials 2023; 24:752. [PMID: 38001510 PMCID: PMC10675922 DOI: 10.1186/s13063-023-07776-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Although a benefit of preoperative training prior to anterior cruciate ligament (ACL) reconstruction is likely, there is no consensus on the optimal content (criteria-based programme), supervision (one-on-one guidance or self-administered training) and general setting of preoperative training after ACL injuries. The purpose of this trial is to investigate the efficacy of an individually adaptive, guided, structured and criteria-based preoperative rehabilitation programme in comparison to a non-guided and self-administered home training programme. METHODS The planned single-blinded randomised controlled trial study was approved by the ethics committee of the German Sport University on June 14, 2022 (ethics application no. 093/2022) and prospectively registered (DRKS-ID: DRKS00030312; date of registration: 26.09.2022). N = 114 participants between 16 and 60 years of age with a unilateral ACL rupture and scheduled ACL reconstruction with a hamstring or quadriceps tendon autograft will be randomly (block-randomisation, 1:1 allocation) and blinded assigned to one of two groups: intervention group (structured, criteria-based, guided prehabilitation training) and comparator group (non-guided, self-administered home training). After surgical reconstruction, patients of both groups participate in the same standard, functional measurement-guided, postoperative rehabilitation programme. Stepwise increasing the functional requirements of the assessments, all participants participate in testing at the day of anamnesis (t1), 1-7 days before surgical reconstruction (t2), day of surgical reconstruction (t3) and 30 (t4), 60 (t5), 90 (t6) and 180 (t7) days post-reconstruction. The primary outcome is the overall self-reported knee condition, assessed by the sum score of all sub-scales of the Knee injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include functional outcomes (range of motion, knee flexors and extensors and plantar flexors strength/torque, functional postural control, jumping ability), workability and return to sport (RTS) (psychological readiness, RTS success). DISCUSSION The planned study targets to fill a gap in the evidence regarding effective designs of prehabilitation training before surgical ACL reconstruction. Potential difficulties that could affect the conduct of the study are lack of treatment adherence of the patients and high dropout. TRIAL REGISTRATION German Register of Clinical Trials DRKS-ID: DRKS00030312 . Registered on 26 September 2022.
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Affiliation(s)
- Rebecca Abel
- German Sport University Cologne, Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation - Abt. 1., Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
| | - Daniel Niederer
- Department of Sports Medicine and Performance Physiology, Goethe University Frankfurt, Sophienstr. 1-3, 60487, Frankfurt am Main, Germany
| | - Christoph Offerhaus
- Department of Orthopedic Surgery and Sports Traumatology, Sana Medical Centre, Witten/Herdecke University, Aachener Str. 445-449, 50933, Cologne, Germany
| | - Sven Shafizadeh
- Department of Orthopedic Surgery and Sports Traumatology, Sana Medical Centre, Witten/Herdecke University, Aachener Str. 445-449, 50933, Cologne, Germany
| | - Alexander Glowa
- PhysioSport PACE GmbH, Schanzenstraße 33, 51063, Cologne, Germany
| | - Ingo Froböse
- German Sport University Cologne, Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation - Abt. 1., Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Christiane Wilke
- German Sport University Cologne, Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation - Abt. 1., Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
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23
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You M, Li J, Chen G, Li J. Letter to the editor: Can patients and clinicians find conservative management protocols of anterior cruciate ligament injuries online? A systematic review. Musculoskelet Sci Pract 2023; 67:102839. [PMID: 37563060 DOI: 10.1016/j.msksp.2023.102839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/05/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Mingke You
- West China Hospital, Department of Orthopedics & Orthopedic Research Institute, Sichuan University No.37 Guo Xue Road, Chengdu, Sichuan, 610041, China.
| | - Junqiao Li
- West China Hospital, Department of Orthopedics & Orthopedic Research Institute, Sichuan University No.37 Guo Xue Road, Chengdu, Sichuan, 610041, China
| | - Gang Chen
- West China Hospital, Department of Orthopedics & Orthopedic Research Institute, Sichuan University No.37 Guo Xue Road, Chengdu, Sichuan, 610041, China
| | - Jian Li
- West China Hospital, Department of Orthopedics & Orthopedic Research Institute, Sichuan University No.37 Guo Xue Road, Chengdu, Sichuan, 610041, China.
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Kingery MT, Kaplan D, Resad S, Strauss EJ, Gonzalez-Lomas G, Campbell KA. After Anterior Cruciate Ligament Injury, Patients With Medicaid Insurance Experience Delayed Care and Worse Clinical Outcomes Than Patients With Non-Medicaid Insurance. Arthrosc Sports Med Rehabil 2023; 5:100791. [PMID: 37711162 PMCID: PMC10498400 DOI: 10.1016/j.asmr.2023.100791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/27/2023] [Indexed: 09/16/2023] Open
Abstract
Purpose To evaluate the effects of socioeconomic factors on the operative treatment of anterior cruciate ligament injuries and outcomes following surgical reconstruction. Methods A retrospective cohort study of primary anterior cruciate ligament reconstruction surgeries at a single institution performed from 2011 to 2015 with minimum 2-year follow-up was conducted. Patient demographics, insurance type, workers' compensation status, surgical variables, International Knee Documentation Committee score, and failure were recorded from chart review. Education level and income were obtained via phone interview. Differences between functional outcome were compared between Medicaid and non-Medicaid groups. Results In total, 268 patients were included in the analysis (43 patients in the Medicaid group and 225 patients in the non-Medicaid group, overall mean follow-up of 3.1 ± 0.8 years). The Medicaid group demonstrated lower annual income (P < .001) and a lower level of completed education compared with the non-Medicaid group (P < .001). Patients who received Medicaid had a greater duration between time of initial knee injury and surgery compared with the those in non-Medicaid group (11.8 ± 16.3 months vs 6.1 ± 16.5 months, P < .001). At the time of follow-up, patients in the non-Medicaid group had a significantly greater International Knee Documentation Committee score compared with patients who received Medicaid (82.5 ± 13.8 vs 75.3 ± 20.8, P = .036). Conclusions Patients with Medicaid insurance were seen in the clinic significantly later after initial injury and had worse outcomes compared with patients with other insurance types. Also, patients in higher annual income brackets had significantly better clinical outcomes scores at a minimum of 2 years postoperatively. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Matthew T. Kingery
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Daniel Kaplan
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Sehar Resad
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Eric J. Strauss
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Kirk A. Campbell
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
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25
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Adams BG, Taylor KM, Cameron KL, Ritland BM, Westrick RB. Predicting Postoperative Injury and Military Discharge Status After Knee Surgery in the US Army. Am J Sports Med 2023; 51:2945-2953. [PMID: 37489610 DOI: 10.1177/03635465231187045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND Researchers have assessed postoperative injury or disability predictors in the military setting but typically focused on 1 type of surgical procedure at a time, used relatively small sample sizes, or investigated mixed cohorts with civilian populations. PURPOSE To identify the relationship between baseline variables and injury incidence or military discharge status in US Army soldiers after knee surgery. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data were obtained from a repository containing personnel, performance, and medical records for all active-duty US Army soldiers. Multivariate logistic regressions were used to estimate the effects of numerous variables on postoperative injury or on medical discharge. Variable selection and model validation were conducted using the k-fold method. RESULTS A total of 7567 soldiers underwent knee surgery between 2017 and 2019. Meniscal procedures were the most common type of surgery (39%), and approximately 71% of the cohort had a postoperative injury. Significant predictors for sustaining a postoperative injury included having a previous nonknee injury (odds ratio [OR], 1.5), female sex (OR, 1.3), and Black race (OR, 1.2). Within 4 years after surgery, 17% of soldiers were discharged from the military because of knee-related disability. Significant predictors for discharge from duty included enlisted rank (OR, 2.3), recent fitness test failure (OR, 1.9), number of previous knee surgeries (OR, 1.7), and having a previous nonknee injury (OR, 1.6). CONCLUSION After knee surgery, nearly three-fourths of the soldiers in this cohort sustained a postoperative injury and almost one-fifth of soldiers were medically discharged from the military within 4 years. This study identified variables that indicate statistically increased risk for these postoperative outcomes and highlighted potentially modifiable factors.
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Affiliation(s)
- Benjamin G Adams
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
- School of Health & Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Kathryn M Taylor
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Kenneth L Cameron
- John A. Feagin Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Bradley M Ritland
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Richard B Westrick
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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Wenning M, Mauch M, Heitner AH, Bode G, Sofack G, Ritzmann R. Early ACL reconstruction shows an improved recovery of isokinetic thigh muscle strength compared to delayed or chronic cases. Arch Orthop Trauma Surg 2023; 143:5741-5750. [PMID: 37052664 PMCID: PMC10450006 DOI: 10.1007/s00402-023-04863-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/26/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION The recovery of periarticular strength is a major criterion in return-to-play testing. The rationale of the study was to assess the impact of the delay of surgery (∆ between injury and surgery) on knee extensor and knee flexor strength of anterior cruciate ligament (ACL)-deficient patients six months after reconstruction. MATERIALS AND METHODS In a retrospective cohort study, all patients with ACL ruptures between 03/2015 and 12/2019 were analyzed. Inclusion criteria were isolated ACL rupture without any associated lesions undergoing a reconstruction using ipsilateral hamstring tendon autograft and adherence to isokinetic strength testing before and at 5-7 months postoperatively. These patients were then clustered into three groups: EARLY reconstruction (∆ < 42 days), DELAYED reconstruction (∆42-180d), and CHRONIC (∆ > 180d). Knee extensor and flexor strength of the ipsi- and contralateral leg were analyzed by concentric isokinetic measurement (60°/s). Primary outcomes were the maximal knee extension and flexion torque, hamstrings-to-quadriceps ratio (H/Q) ratio), and the corresponding limb symmetry indices. RESULTS n = 444 patients met the inclusion criteria. From EARLY to DELAYED to CHRONIC, a progressive reduction in postoperative strength performance was observed in knee extension (1.65 ± 0.45 to 1.62 ± 0.52 to 1.51 ± 0.5 Nm/kg resp.) and flexion (1.22 ± 0.29 to 1.18 ± 0.3 to 1.13 ± 0.31 Nm/kg resp.) strength on the ACL reconstructed leg. This general loss in periarticular strength was already apparent in the preoperative performance even on the healthy side. When controlling for the preoperative performance using ANCOVA analysis, EARLY performed significantly better than DELAYED (extension p = 0.001, flexion p = .02) and CHRONIC (extension p = 0.005, flexion p < 0.001). Also, there were significantly higher values for H/Q ratio in the injured leg across all groups where the H/Q ratio increased from EARLY to CHRONIC and from pre- to postoperative values. CONCLUSIONS With respect to the force generating capacity when returning-to-play, it is advantageous to seek for an early ACL reconstruction within the first 12 weeks after the injury. The increasing loss of thigh muscle strength observed in delayed or chronic cases affects the injured and also the non-injured leg. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Markus Wenning
- Rennbahnklinik, Kriegackerstr. 100, 4132 Muttenz, BL Switzerland
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, University Medical Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Marlene Mauch
- Rennbahnklinik, Kriegackerstr. 100, 4132 Muttenz, BL Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | | | - Gerrit Bode
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, University Medical Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Praxisklinik 2000, Wirthstr. 11, 79100 Freiburg, Germany
| | - Ghislain Sofack
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Zinkmattenstr. 6a, 79108 Freiburg, Germany
| | - Ramona Ritzmann
- Institute of Sport and Sport Science, Department of Motor Control, University of Freiburg, Freiburg, Germany
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Marotta N, de Sire A, Calafiore D, Agostini F, Lippi L, Curci C, Ferraro F, Bernetti A, Invernizzi M, Ammendolia A. Impact of COVID-19 Era on the Anterior Cruciate Ligament Injury Rehabilitation: A Scoping Review. J Clin Med 2023; 12:5655. [PMID: 37685722 PMCID: PMC10488473 DOI: 10.3390/jcm12175655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
The surgical intervention rate and the subsequent rehabilitation plan for anterior cruciate ligament (ACL) injury was crucially affected by the COVID-19 pandemic due to the necessity in the face of the emergency. This review aimed to evaluate potential persistent and residual symptoms after COVID-19 disease, including fatigue and neuromuscular disorders. A scoping review design and methodology were used due to the exploratory nature of the research question, according to literature searches on PubMed/Medline, Scopus, Web of Science (WoS), and Physiotherapy Evidence Database (PEDro) electronic databases using the following keywords: "Anterior Cruciate Ligament", "ACL", "SARS-CoV-2", and "COVID-19". Undertraining and muscular knee imbalance might cause inefficient movement strategies, lack of knee stability, and increasing load with negative implications in ACL injuries. In the post-surgery period, during COVID-19, telerehabilitation approaches appeared to be successfully applied to maintain strength and range of motion in this condition. However, no definitive data are available regarding the most effective interventions. This scoping review showed the influence of the COVID-19 pandemic and associated restrictions on postoperative and rehabilitative care of ACL injuries.
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Affiliation(s)
- Nicola Marotta
- Department of Experimental and Clinical Medicine, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Alessandro de Sire
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy; (D.C.); (F.F.)
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele, 00163 Rome, Italy
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy; (D.C.); (F.F.)
| | - Francesco Ferraro
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy; (D.C.); (F.F.)
| | - Andrea Bernetti
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, 73100 Lecce, Italy;
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Antonio Ammendolia
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
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Deviandri R, van der Veen HC, Lubis AMT, Postma MJ, van den Akker-Scheek I. Responsiveness of the Indonesian Versions of the Anterior Cruciate Ligament-Return to Sport After Injury Score, the International Knee Documentation Committee Subjective Knee Form, and the Lysholm Score in Patients With ACL Injury. Orthop J Sports Med 2023; 11:23259671231191827. [PMID: 37655253 PMCID: PMC10467415 DOI: 10.1177/23259671231191827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/03/2023] [Indexed: 09/02/2023] Open
Abstract
Background The Indonesian versions of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI), International Knee Documentation Committee subjective knee form (IKDC), and the Lysholm scores are considered valid and reliable for Indonesian-speaking patients with anterior cruciate ligament (ACL) injury. Purpose/Hypothesis The purpose of this study was to determine the responsiveness of the ACL-RSI, IKDC, and Lysholm scores in an Indonesian-speaking population with ACL injury. It was hypothesized that they would have good responsiveness. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Between March 1, 2021, and February 28, 2022, patients with an ACL injury at a single hospital in Indonesia were asked to complete the ACL-RSI, IKDC, and Lysholm scores before either reconstruction surgery or nonoperative treatment. At 6 months after treatment, the patients completed all 3 scores a second time, plus a global rating of change question. The distribution-based and the anchor-based methods were used to study responsiveness. For each scale, the standardized response mean, minimal clinically important difference (MCID), and minimal detectable change (MDC; at the group [MDCgr] and individual [MDCind] levels) for each scale were determined. Results Of 80 eligible patients, 75 (93.8%) completed the study. The standardized response means for the ACL-RSI, IKDC, and Lysholm scores were 1.59, 1.72, and 1.51, respectively, indicating good responsiveness. The MCIDs for the ACL-RSI, IKDC, and Lysholm scores were 6.8, 7.8, and 4.8, respectively; all MCIDs were larger than that of the MDCgr (1.1, 0.7, and 0.6, respectively). At the individual level, the MCID for the IKDC was larger than the MDCind (7.8 vs 5.8). However, the MCIDs for ACL-RSI and Lysholm scores were smaller than those of the MDCind (6.8 vs 10.9 and 4.8 vs 5.1, respectively). Conclusion The Indonesian ACL-RSI, IKDC, and Lysholm scores indicated good responsiveness and can be used in the follow-up of patients after ACL injury, especially at the group level. In individual patients, IKDC was found to be more efficient than the ACL-RSI or Lysholm scores for detecting clinically important changes over time after ACL treatment.
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Affiliation(s)
- Romy Deviandri
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Physiology-Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
- Division of Orthopedics-Sports Injury, Arifin Achmad Hospital, Pekanbaru, Indonesia
| | - Hugo C. van der Veen
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Andri MT Lubis
- Department of Orthopedics-Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Maarten J. Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, the Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Faculty of Economics and Business, Groningen, the Netherlands
- Department of Pharmacology and Therapy, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Deichsel A, Oeckenpöhler S, Raschke MJ, Grunenberg O, Peez C, Briese T, Herbst E, Kittl C, Glasbrenner J. Recurrent Instability Rate and Subjective Knee Function following Accelerated Rehabilitation after ACL Reconstruction in Comparison to a Conservative Rehabilitation Protocol. J Clin Med 2023; 12:4567. [PMID: 37510682 PMCID: PMC10380741 DOI: 10.3390/jcm12144567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The Purpose of the present study was to assess the outcome of anterior cruciate ligament reconstruction (ACLR) with an accelerated rehabilitation protocol and to compare it to a conservative rehabilitation protocol. It was hypothesized that an accelerated rehabilitation protocol, including brace-free early weight bearing, would result in a higher rate of recurrent instability and revision surgery compared to a conservative rehabilitation protocol. METHODS From 2016 to 2017, two different rehabilitation protocols for isolated ACLR were used at a high-volume knee surgery center. A total of 65 consecutive patients with isolated hamstring ACLR, of whom n = 33 had been treated with an accelerated (AccRehab) and n = 32 with a conservative rehabilitation protocol (ConRehab), were retrospectively included in the study. Patients were evaluated for recurrent instability, revision surgery, and other complications at a mean follow-up period of 64 ± 7.4 months. In addition, Tegner Activity Scale, Lysholm Score, and IKDC-subjective Score were evaluated. Statistical comparison between the two groups was performed utilizing Fisher's exact test and Student's t-test. RESULTS Mean age (29.3 vs. 26.6 years) and preoperative Tegner Score (6.4 vs. 5.9) were comparable between both groups. At 64 ± 7.4 months after ACLR, six cases of recurrent instability were reported in the AccRehab group (18%) in comparison to three cases (9%) in the ConRehab group (p = n.s.). There was no significant difference regarding revision surgery and further complications. Furthermore, no significant difference was found between both groups regarding Tegner (5.5 ± 1.9 vs. 5.5 ± 1.2), Lysholm (93.6 ± 6.3 vs. 89.3 ± 10.7), and IKDC score (89.7 ± 7.9 vs. 86.7 ± 12.1). CONCLUSION No significant disadvantage of an accelerated rehabilitation protocol following ACLR was found in terms of recurrent instability rate, revision surgery, or patient-reported outcome. However, a trend towards a higher reinstability rate was found for an accelerated rehabilitation protocol. Future level one trials evaluating brace-free early weight bearing following ACLR are desirable.
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Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Simon Oeckenpöhler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Ole Grunenberg
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Münster, Germany
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30
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Henning M, Henning R, Dummett J. Improving the quality of rehabilitation following anterior cruciate ligament reconstruction surgery, in an outpatient physiotherapy department. BMJ Open Qual 2023; 12:e002300. [PMID: 37524514 PMCID: PMC10391794 DOI: 10.1136/bmjoq-2023-002300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) is a type of orthopaedic knee surgery and physiotherapy rehabilitation is undertaken for several months postoperatively, often with the aim of returning the patient to sport. Variations in postoperative protocols to guide rehabilitation exist between National Health Service (NHS) Trusts. Although there is no single guideline to guide clinicians, strong evidence does support several clinical measures to be included post-ACLR, to improve outcomes and reduce the need for revision surgery. This project aimed to align our NHS Trust's ACLR physiotherapy care with best-evidence.A literature review was completed to establish key quality standards for ACLR rehabilitation. A retrospective notes audit was then undertaken to quantify the baseline quality of care, measured against these standards. Quality improvement methods were used to improve the quality of care and postoperative rehabilitation processes for ACLR patients. A new evidence-based, postoperative rehabilitation protocol was created, a core group of clinicians was formed to see ACLR patients and a rehabilitation class, solely for ACLR patients was also implemented.The key process measure for the project was patients engaging in 'criteria-driven progressions of rehabilitation'. This 'criteria-driven progressions' rate increased from 0% at baseline to 100% during the project period. Overall, non-attendance rates maintained at a similar level from 5.4% at baseline to a final rate of 4.8%. There was also an increase in mean 'return to sport' times, from 6 to 9.9 months, which is in line with best-evidence recommendations.The previous rehabilitation provided in our trust was not aligned with current evidence. This quality improvement project has led to improvements in patient care and lessons from the project will allow other trusts to learn from the changes made, to improve their own care pathways.
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Affiliation(s)
- Michael Henning
- Orthopaedic Interface, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Rose Henning
- Physiotherapy Outpatients, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Joe Dummett
- Physiotherapy Outpatients, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
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Deviandri R, van der Veen HC, Lubis AM, Postma MJ, van den Akker-Scheek I. Translation, Validity, and Reliability of the Indonesian Version of the Anterior Cruciate Ligament-Return to Sport After Injury Scale. Orthop J Sports Med 2023; 11:23259671231157769. [PMID: 37152552 PMCID: PMC10161318 DOI: 10.1177/23259671231157769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/01/2023] [Indexed: 05/09/2023] Open
Abstract
Background The Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale measures athletes' emotion, confidence, and risk appraisal when returning to sports after an anterior cruciate ligament (ACL) injury and/or ACL reconstruction (ACLR). Purpose To translate the ACL-RSI into the Indonesian language and to assess its validity and reliability in Indonesian-speaking patients after ACLR. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods After a forward-and-backward translation procedure, the validity and reliability of the Indonesian version of the ACL-RSI (I-ACL-RSI) were investigated. Patients who had undergone ACLR at a single hospital were asked to complete 4 questionnaires: I-ACL-RSI, Injury-Psychological Readiness to Return to Sport, Tampa Scale of Kinesiophobia, and International Knee Documentation Committee. After a 2-week interval, patients were asked to complete the I-ACL-RSI a second time. Following the COSMIN reporting guidelines (Consensus-Based Standards for the Selection of Health Measurement Instruments), we determined construct validity using hypothesis testing, as well as test-retest reliability, internal consistency, floor and ceiling effects, and measurement error. Results Of 200 eligible patients, 102 (51%) were included in the analysis. All predefined hypotheses on correlations between the I-ACL-RSI and the other questionnaires were confirmed, indicating good construct validity. An intraclass correlation coefficient of 0.90 (2-way random, type agreement) was found for the first and second I-ACL-RSI scores, indicating good test-retest reliability. A Cronbach α of 0.95 indicated good internal consistency, and no floor or ceiling effects were found. The standard error of measurement was 3.9, with the minimal detectable change calculated as 10.9 points at the individual level and 1.1 points at the group level. Conclusion Based on the study findings, the I-ACL-RSI can be considered a valid and reliable questionnaire for Indonesian-speaking patients after ACL injury and/or ACLR.
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Affiliation(s)
- Romy Deviandri
- Department of Orthopedics Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Physiology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
- Division of Orthopedics–Sports Injury, Arifin Achmad Hospital, Pekanbaru, Indonesia
- Romy Deviandri, MD, Faculty of Medicine, Universitas Riau, Diponegoro Street No. 1, Pekanbaru, Indonesia 28133 (; )
| | - Hugo C. van der Veen
- Department of Orthopedics Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Andri M.T. Lubis
- Department of Orthopedics, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Maarten J. Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, the Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands
- Department of Pharmacology and Therapy, Universitas Airlangga, Surabaya, Indonesia
- Investigation performed at the Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Niederer D, Keller M, Jakob S, Petersen W, Mengis N, Vogt L, Guenther D, Brandl G, Drews BH, Behringer M, Groneberg DA, Stein T. Quadriceps and hamstring anterior cruciate ligament reconstruction differ only marginally in function after the rehabilitation: a propensity score-matched case-control study. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07422-y. [PMID: 37120794 PMCID: PMC10149044 DOI: 10.1007/s00167-023-07422-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To determine potential quadriceps versus hamstring tendon autograft differences in neuromuscular function and return to sport (RTS)-success in participants after an anterior cruciate ligament (ACL) reconstruction. METHODS Case-control study on 25 participants operated on with an arthroscopically assisted, anatomic ipsilateral quadriceps femoris tendon graft and two control groups of 25 participants each, operated on with a semitendinosus tendon or semitendinosus-gracilis (hamstring) tendon graft ACL reconstruction. Participants of the two control groups were propensity score matched to the case group based on sex, age, Tegner activity scale and either the total volume of rehabilitation since reconstruction (n = 25) or the time since reconstruction (n = 25). At the end of the rehabilitation (averagely 8 months post-reconstruction), self-reported knee function (KOOS sum scores), fear of loading the reconstructed knee during a sporting activity (RSI-ACL questionnaire), and fear of movement (Tampa scale of kinesiophobia) were followed by hop and jump tests. Front hops for distance (jumping distance as the outcome) were followed by Drop jumps (normalised knee joint separation distance), and concluded by qualitative ratings of the Balanced front and side hops. Between-group comparisons were undertaken using 95% confidence intervals comparisons, effect sizes were calculated. RESULTS The quadriceps case group (always compared with the rehabilitation-matched hamstring graft controls first and versus time-matched hamstring graft controls second) had non-significant and only marginal higher self-reported issues during sporting activities: Cohen's d = 0.42, d = 0.44, lower confidence for RTS (d = - 0.30, d = - 0.16), and less kinesiophobia (d = - 0.25, d = 0.32). Small and once more non-significant effect sizes point towards lower values in the quadriceps graft groups in the Front hop for distance limb symmetry values in comparison to the two hamstring control groups (d = - 0.24, d = - 0.35). The normalised knee joint separation distance were non-significantly and small effect sized higher in the quadriceps than in the hamstring groups (d = 0.31, d = 0.28). CONCLUSION Only non-significant and marginal between-graft differences in the functional outcomes at the end of the rehabilitation occurred. The selection of either a hamstring or a quadriceps graft type cannot be recommended based on the results. The decision must be undertaken individually. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany.
| | | | - Sarah Jakob
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | - Natalie Mengis
- Arcus Sportklinik, Pforzheim, Germany
- KSA Aarau/Spital Zofingen, Aarau, Switzerland
- University Hospital, Basel, Switzerland
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Witten, Germany
| | - Georg Brandl
- Department of Orthopaedic Surgery II, Herz-Jesu Krankenhaus, Vienna, Austria
| | | | - Michael Behringer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Stein
- SPORTHOLOGICUM Frankfurt-Center for Sport and Joint Injuries, Frankfurt am Main, Germany
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
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Niederer D, Behringer M, Stein T. Functional outcomes after anterior cruciate ligament reconstruction: unravelling the role of time between injury and surgery, time since reconstruction, age, gender, pain, graft type, and concomitant injuries. BMC Sports Sci Med Rehabil 2023; 15:49. [PMID: 37005699 PMCID: PMC10068137 DOI: 10.1186/s13102-023-00663-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/28/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Numerous individual, temporal, injury- and surgery-specific factors impact the functional capacity during rehabilitation, return to sports (RTS), and re-injury prevention after an anterior cruciate ligament (ACL) reconstruction. PURPOSE This multicentre cohort study evaluated the isolated and interactive contributions of time between injury and surgery, time since reconstruction, age, gender, pain, graft type, and concomitant injuries as to inertial sensor-assessed motor function after ACL reconstructions in multiple linear mixed model regressions. METHODS Anonymized data were retrieved from a nationwide German registry. In this cohort study, patients with an acute unilateral ACL rupture, with or without concomitant ipsilateral knee injuries, and having passed an arthroscopically assisted anatomic reconstruction were included. Potential predictors were age [years], gender/sex, time since reconstruction [days], time between injury and reconstruction [days], concomitant intra-articular injuries (isolated ACL tear, meniscal tear, lateral ligament, unhappy triad), graft type (hamstrings, patellar, or quadriceps tendon autograft), and pain during each measurement (visual analogue scale 0-10 cm). Repeated inertial motion unit-assessments of a comprehensive battery of classic functional RTS test were performed in the course of the rehabilitation and return to sports: Joint position sense/kinesthesia (Angle reproduction error [degrees]), Dynamic Balance Composite score [cm] of the Y-Balance test), drop jumps (Knee displacement [cm]), Vertical hop (Hopping height [mm]), Speedy jumps (Duration [seconds]), Side hops (Number of hops [n]), single leg hop for distance (hopping distance [cm]). Repeated measures multiple linear mixed models investigated the impact and nesting interaction of the potential predictors on the functional outcomes. RESULTS Data from 1441 persons (mean age 29.4, SD 11.8 years; 592 female, 849 male) were included. Most had an isolated ACL rupture: n = 938 (65.1%). Minor shares showed lateral ligament involvement: n = 70 (4.9%), meniscal tear: n = 414 (28.7%), or even unhappy triad: n = 15 (1%). Several predictors such as time between injury and reconstruction, time since reconstruction (estimates for ndays ranged from + .05 (i.e., an increase of the hopping distance of 0.05 cm per day since reconstruction occurs) for single leg hop for distance to + 0.17 for vertical hopping height; p < 0.001), age, gender, pain, graft type (patellar tendon graft: estimates between + 0.21 for Y-balance and + 0.48 for vertical hop performance; p < 0.001), and concomitant injuries contribute to the individual courses of functional abilities of the reconstructed side after ACL reconstruction. The unimpaired side was mostly influenced by sex, age, the time between injury and reconstruction (estimates between - 0.0033 (side hops) and + 0.10 (vertical hopping height), p < 0.001)), and time since reconstruction. CONCLUSIONS Time since reconstruction, time between injury and reconstruction, age, gender, pain, graft type, and concomitant injuries are not independent but nested interrelating predictors of functional outcomes after anterior cruciate ligament reconstruction. It might not be enough to assess them isolated; the knowledge on their interactive contribution to motor function is helpful for the management of the reconstruction (earlier reconstructions should be preferred) deficit-oriented function-based rehabilitation (time- and function based rehabilitation instead of solely a time- or function based approach) and individualized return to sports strategies.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany.
| | - Michael Behringer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt, Germany
| | - Thomas Stein
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt, Germany
- Sporthologicum Frankfurt - Center for Sport and Joint Injuries, Frankfurt, Germany
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Snigar K, Paul RW, Spada JM, Zareef U, Hall A, Erickson BJ, Ciccotti MG, Thomas SJ. Does Prehabilitation Before Surgery Affect Return to Sport in Baseball Pitchers With Partial Ulnar Collateral Ligament Tears? Orthop J Sports Med 2023; 11:23259671231162635. [PMID: 37152618 PMCID: PMC10155012 DOI: 10.1177/23259671231162635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/19/2023] [Indexed: 05/09/2023] Open
Abstract
Background Purposeful rehabilitation before surgery (prehabilitation) has been researched and implemented in the treatment of anterior cruciate ligament tears. However, it is unclear whether prehabilitation would affect outcomes for baseball pitchers with partial ulnar collateral ligament (UCL) tears. Purpose/Hypothesis The purpose of this study was to determine whether baseball pitchers with partial UCL tears who completed ≥4 weeks of prehabilitation (prehab group) have different return to play (RTP) outcomes than pitchers with 0 to 3 weeks of preoperative physical therapy (no prehab group). We hypothesized that pitchers in the prehab group would have similar RTP rates compared with pitchers in the no prehab group. Study Design Cohort study; Level of evidence, 3. Methods Baseball pitchers of all competitive levels who underwent primary UCL reconstruction (UCLR) or UCL repair between 2010 and 2019 were included. Physician chart notes, magnetic resonance images, and operative notes were screened to confirm primary UCLR or UCL repair of a partial UCL tear and to identify whether the nonoperative treatment had been attempted. Patients were contacted via RedCap for postoperative complications, reoperations, RTP, and patient-reported outcomes (Kerlan-Jobe Orthopaedic Clinic score, Andrews-Timmerman score, Conway-Jobe score, and satisfaction). Results Overall, 105 baseball pitchers (n = 55 prehab group; n = 50 no prehab group) were included and evaluated at 3.4 ± 2.5 years postoperatively. Six pitchers underwent UCL repair, and 99 pitchers underwent UCLR. All demographic characteristics were similar between groups except the prehab group received a gracilis graft more frequently (76.5% vs 51.2%; P = .038). The RTP rate (prehab [88.1%] vs no prehab [93.8%]; P = .465) was similar between groups. All other postoperative outcomes were also similar between groups, including revision rates and patient-reported outcomes. Conclusion Postoperative and patient-reported outcomes did not differ significantly between pitchers with partial UCL tears who performed rehabilitation before UCL surgery and pitchers who did not attempt a significant period of rehabilitation before UCL surgery. Clinicians should feel comfortable recommending rehabilitation for patients with partial UCL tears who wish to attempt a period of nonoperative treatment, as postoperative outcomes are not affected if UCL surgery is later needed.
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Affiliation(s)
- Kourtney Snigar
- Department of Exercise Science, Thomas
Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ryan W. Paul
- Department of Orthopaedic Surgery,
Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
- Hackensack Meridian School of Medicine,
Nutley, New Jersey, USA
| | - Joshua M. Spada
- Rowan University School of Osteopathic
Medicine, Stratford, New Jersey, USA
| | - Usman Zareef
- Rutgers Robert Wood Johnson Medical
School, New Brunswick, New Jersey, USA
| | - Anya Hall
- Department of Orthopaedic Surgery,
Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Brandon J. Erickson
- Department of Orthopaedic Surgery,
Rothman Orthopaedic Institute, New York, New York, USA
| | - Michael G. Ciccotti
- Department of Orthopaedic Surgery,
Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Stephen J. Thomas
- Department of Exercise Science, Thomas
Jefferson University, Philadelphia, Pennsylvania, USA
- Stephen J. Thomas, PhD,
ATC, Department of Exercise Science, Thomas Jefferson University, 4201 Henry
Avenue, Philadelphia, PA 19144, USA (
) (Twitter: @shoulder_nerd)
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Lin TJ. Editorial Commentary: There Is No Standard for or Standardization of Postoperative Rehabilitation Protocols After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2023; 39:590-591. [PMID: 36740283 DOI: 10.1016/j.arthro.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 02/07/2023]
Abstract
The anterior cruciate ligament (ACL) is the most studied ligament in the knee and one of the most studied topics in orthopaedics, with little consensus on best options for surgical technique or graft choice. While there is little question that physical rehabilitation is one of the most important variables in the episode of care before and after ACL reconstruction (ACLR), recent research surveying orthopaedic surgeons demonstrates no consensus of how to rehab ACLR patients and how to get them to return to sport safely and quickly. Seventy-two percent of surgeons prescribe "pre-hab" prior to ACLR, and 83% of surgeons use postoperative bracing, with most (55%) bracing for 3 to 6 weeks postoperatively. Patient-reported outcome measures (35%) and assessments of psychological readiness (23%) are not commonly used to progress patients through the stages of rehab. When asked what they believe is the single most important factor in unrestricted return to sport, 52% of surgeons stated functional testing scores were most important, while 38% stated time since surgery, and 5% stated muscle strength. As for average time to return to full activity, 50% of surgeons waited until 9+ months for full return, and 42% allowed return within 6 to 8 months. Reductions in practice variability have been shown in orthopaedic surgery and other fields to reduce costs of care delivery and improve patient outcomes, and with so much variability in ACLR rehabilitation protocols, the orthopaedic community would be wise to strive for more consensus focused on evidence-based recommendations for rehabilitation and to fill in knowledge gaps with focused, high-quality research where needed.
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Niederer D, Mengis N, Wießmeier M, Keller M, Petersen W, Ellermann A, Drenck T, Schoepp C, Stöhr A, Fischer A, Achtnich A, Best R, Pinggera L, Krause M, Guenther D, Janko M, Kittl C, Efe T, Schüttler KF, Vogt L, Behringer M, Stein T. Contributors to self-report motor function after anterior cruciate ligament reconstruction. Sci Rep 2023; 13:3073. [PMID: 36813953 PMCID: PMC9947165 DOI: 10.1038/s41598-023-30291-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Numerous functional factors may interactively contribute to the course of self-report functional abilities after anterior cruciate ligament (ACL)-reconstruction. This study purposes to identify these predictors using exploratory moderation-mediation models in a cohort study design. Adults with post unilateral ACL reconstruction (hamstring graft) status and who were aiming to return to their pre-injury type and level of sport were included. Our dependent variables were self-reported function, as assessed by the the KOOS subscales sport (SPORT), and activities of daily living (ADL). The independent variables assessed were the KOOS subscale pain and the time since reconstruction [days]. All other variables (sociodemographic, injury-, surgery-, rehabilitation-specific, kinesiophobia (Tampa Scale of Kinesiophobia), and the presence or absence of COVID-19-associated restrictions) were further considered as moderators, mediators, or co-variates. Data from 203 participants (mean 26 years, SD 5 years) were finally modelled. Total variance explanation was 59% (KOOS-SPORT) and 47% (KOOS-ADL). In the initial rehabilitation phase (< 2 weeks after reconstruction), pain was the strongest contributor to self-report function (KOOS-SPORT: coefficient: 0.89; 95%-confidence-interval: 0.51 to 1.2 / KOOS-ADL: 1.1; 0.95 to 1.3). In the early phase (2-6 weeks after reconstruction), time since reconstruction [days] was the major contributor (KOOS-SPORT: 1.1; 0.14 to 2.1 / KOOS-ADL: 1.2; 0.43 to 2.0). Starting with the mid-phases of the rehabilitation, self-report function was no longer explicitly impacted by one or more contributors. The amount of rehabilitation [minutes] is affected by COVID-19-associated restrictions (pre-versus-post: - 672; - 1264 to - 80 for SPORT / - 633; - 1222 to - 45 for ADL) and by the pre-injury activity scale (280; 103 to 455 / 264; 90 to 438). Other hypothesised contributors such as sex/gender or age were not found to mediate the time or pain, rehabilitation dose and self-report function triangle. When self-report function is rated after an ACL reconstruction, the rehabilitation phases (early, mid, late), the potentially COVID-19-associated rehabilitation limitations, and pain intensity should also be considered. As, for example, pain is the strongest contributor to function in the early rehabilitation phase, focussing on the value of the self-report function only may, consequently, not be sufficient to rate bias-free function.
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Affiliation(s)
- Daniel Niederer
- Institute of Occupational, Social and Environmental Medicine, Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt, Germany.
| | | | - Max Wießmeier
- Institute of Occupational, Social and Environmental Medicine, Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Ginnheimer Landstraße 39, 40487, Frankfurt, Germany
| | | | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
| | | | | | | | | | - Andreas Fischer
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Andrea Achtnich
- Department for Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Raymond Best
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - Lucia Pinggera
- Department of Orthopaedic and Trauma Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Witten, Germany
| | - Maren Janko
- Department of Trauma, Hand, and Reconstructive Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | | | - Turgay Efe
- Orthopaedicum Lich Giessen, Lich, Germany
| | | | - Lutz Vogt
- Department of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Michael Behringer
- Department of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas Stein
- SPORTHOLOGICUM Frankfurt - Center for Sport and Joint Injuries, Frankfurt, Germany
- Department of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
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Blood Flow Restriction Therapy for 2 Weeks Prior to Anterior Cruciate Ligament Reconstruction Did Not Impact Quadriceps Strength Compared to Standard Therapy. Arthroscopy 2023; 39:373-381. [PMID: 35842062 DOI: 10.1016/j.arthro.2022.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the efficacy of a 2-week home-based blood flow restriction (BFR) prehabiliation program on quadriceps strength and patient-reported outcomes prior to anterior cruciate ligament (ACL) reconstruction. METHODS Patients presenting with an ACL tear were randomized into two groups, BFR and control, at their initial clinic visit. Quadriceps strength was measured using a handheld dynamometer in order to calculate peak force, average force, and time to peak force during seated leg extension at the initial clinic visit and repeated on the day of surgery. All patients were provided education on standardized exercises to be performed 5 days per week for 2 weeks between the initial clinic visit and date of surgery. The BFR group was instructed to perform these exercises with a pneumatic cuff set to 80% of limb occlusion pressure placed over the proximal thigh. Patient-Reported Outcome Measurement System Physical Function (PROMIS-PF), knee range of motion, and quadriceps circumference were gathered at the initial clinic visit and day of surgery, and patients were monitored for adverse effects. RESULTS A total 45 patients met inclusion criteria and elected to participate. There were 23 patients randomized to the BFR group and 22 patients randomized into the control group. No significant differences were noted between the BFR and control groups in any demographic characteristics (48% vs 64% male [P = .271] and average age 26.5 ± 12.0 vs 27.0 ± 11.0 [P = .879] in BFR and control, respectively). During the initial clinic visit, there were no significant differences in quadriceps circumference, peak quadriceps force generation, time to peak force, average force, pain, and PROMIS scales (P > .05 for all). Following completion of a 2-week home prehabilitation protocol, all patients indeterminant of cohort demonstrated decreased strength loss in the operative leg compared to the nonoperative leg (P < .05 for both) However, there were no significant differences in any strength or outcome measures between the BFR and control groups (P > .05 for all). There were no complications experienced in either group, and both were compliant with the home-based prehabilitation program. CONCLUSIONS A 2-week standardized prehabilitation protocol preceding ACL reconstruction resulted in a significant improvement in personal quadriceps peak force measurements, both with and without the use of BFR. No difference in quadriceps circumference, strength, or patient reported outcomes were found between the BFR and the control group. The home-based BFR prehabiliation protocol was found to be feasible, accessible, and well tolerated by patients. LEVEL OF EVIDENCE Level II, randomized controlled trial with small effect size.
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Cote MP, Nolan D, Hazzard S, Waugh S, Asnis P. Editorial Commentary: Blood Flow Restriction Therapy Prior to Anterior Cruciate Ligament Reconstruction: Small Effects Require Accurate Measurements. Arthroscopy 2023; 39:382-383. [PMID: 36604004 DOI: 10.1016/j.arthro.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 01/04/2023]
Abstract
A recent research study showed that blood flow restriction (BFR) therapy was safe and well tolerated but failed to demonstrate efficacy as a modality that provides greater gains in quadriceps strength when added to a standard home program in patients awaiting anterior cruciate ligament (ACL) reconstruction. Despite employing a validated method of measurement, the results were highly variable, indicating the need for measurements with sufficient accuracy to detect the small, but potentially meaningful, gains in quadriceps strength that's been attributed to BFR. The results inform future investigations of BFR prior to ACL surgery by demonstrating the need for accurate methods of measurements when the anticipated effects are small.
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Bouguennec N, Orce A, Laboudie P, Pelletier S, Dexhelet J, Graveleau N. Association of COVID-19 Lockdown With Increased Rate of Cyclops Syndrome in Patients With Unexpected Home-Based Self-Guided Rehabilitation After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671221147869. [PMID: 36890983 PMCID: PMC9986909 DOI: 10.1177/23259671221147869] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/11/2022] [Indexed: 03/10/2023] Open
Abstract
Background The risk of cyclops syndrome increases significantly after anterior cruciate ligament (ACL) reconstruction (ACLR) if complete extension is not recovered before the sixth postoperative week. The lockdown in France due to the COVID-19 pandemic led to an absence of supervised rehabilitation, requiring unexpected self-rehabilitation in patients who underwent ACLR just before lockdown. Purpose To determine the rate of cyclops syndrome after ACLR in patients who underwent self-rehabilitation during lockdown. Study Design Cohort study; Level of evidence, 3. Methods A total of 75 patients receiving a hamstring graft for ACLR during the COVID-19 pandemic between February 10, 2022, and March 16, 2020, carried out self-rehabilitation during part of their first 6 postoperative weeks using exercise videos on a dedicated website. Clinical examination was performed at a minimum 1-year follow-up with International Knee Documentation Committee (IKDC), Lysholm, Tegner, and ACL-Return to Sport after Injury (ACL-RSI) scores. This group was compared with a matched-pair control group of 72 patients who underwent surgery in 2019 and completed postoperative supervised rehabilitation with a physical therapist. Rates and reasons for second surgery (arthrolysis, meniscal procedure) were also recorded. Results In the COVID group (n = 72; 3 patients were lost to follow-up), the mean follow-up was 14.5 ± 2.1 months (range, 13-21) and rate of reoperation for clinical cyclops syndrome was 11.1% (n = 8). The rate of cyclops syndrome was significantly lower (1.4%) in the control group (P = .01). In the COVID group, 8 patients underwent anterior arthrolysis at a mean of 8.6 months after the primary surgery, and 4 patients underwent another surgical intervention (meniscal procedure [n = 3], device removal [n = 1]). In the COVID group, mean Lysholm was 86.6 ± 14.1 (range, 38-100), Tegner was 5.6 ± 2.3 (range, 1-10), subjective IKDC was 80.3 ± 14.7 (range, 32-100) and ACL-RSI score was 77.3 ± 19.7 (range, 33-100). Conclusion The rate of cyclops syndrome after ACLR was significantly greater in the COVID group versus the matched controls. The dedicated website was not effective at supporting self-guided rehabilitation and could benefit from interactive improvements so it is at least as effective as supervised rehabilitation.
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Affiliation(s)
| | - Aida Orce
- Sports Clinic of Bordeaux-Merignac, Merignac, France
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Mainprize M, Spencer Netto FAC, Degani C, Szasz P. The Shouldice Method: an expert's consensus. Hernia 2023; 27:147-156. [PMID: 35939246 DOI: 10.1007/s10029-022-02658-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hernia repairs are a commonly performed surgical procedure and the Shouldice Repair of inguinal hernias has been well described before in terms of its outcomes. However, the purpose of this paper was to understand what experts from Shouldice Hospital consider to be the essential steps to the Shouldice Method. METHODS Utilizing a Delphi Methodology, surgeons at Shouldice Hospital who are considered content experts, provided their answers on what is essential to the Shouldice Method. The median, interquartile range, and percent agreement from the responses as well as the Delphi's overall Cronbach's Alpha were determined. All Delphi items were ranked on a five-point Likert scale and consensus was reached when Cronbach's Alpha was ≥ 0.8. The items from the survey that ranked as 5-completely agree or 4-partially agree by ≥ 80% of participants on the five-point Likert scale were included in the final framework. RESULTS The final consensus for the Shouldice Method included 39 items with 7 overarching steps: preoperative preparation of the patient, anesthetic component, incision and nerve identification, treatment of the cremasteric muscles, hernia identification and treatment, reconstruction of the posterior wall, and post-operative management of patients. CONCLUSION The results of this consensus provide a step-by-step approach to the Shouldice Method, as well as information that is timely and can be utilized by surgeons incorporating non-mesh hernia repairs into their practice.
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Affiliation(s)
- Marguerite Mainprize
- Department of Surgery, Shouldice Hospital, 7750 Bayview Avenue, Thornhill, ON, L3T 7N2, Canada.
| | | | - Cassim Degani
- Department of Surgery, Shouldice Hospital, 7750 Bayview Avenue, Thornhill, ON, L3T 7N2, Canada
| | - Peter Szasz
- Department of Surgery, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
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Guo Y, Li D, Wu YB, Sun X, Sun XY, Yang YP. Mobile health-based home rehabilitation education improving early outcomes after anterior cruciate ligament reconstruction: A randomized controlled clinical trial. Front Public Health 2023; 10:1042167. [PMID: 36711410 PMCID: PMC9877440 DOI: 10.3389/fpubh.2022.1042167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Objective This study aimed to assess changes in joint range of motion (ROM) and knee joint function between patients who received the mobile health-based intervention and those who received regular care at 2 and 6 weeks after anterior cruciate ligament (ACL) reconstruction to provide better interventions in the future. Methods Patients who underwent ACL reconstruction were randomized into the experimental [Mobile health-based intervention (MHI); n = 62] and control (CON) groups (n = 63). The CON group underwent home-based rehabilitation exercise following the paper rehabilitation schedule, while the intervention group received additional mobile health-based education at weeks 1-6 after surgery. ROM, thigh circumference difference, and flexion pain were the primary outcomes. The secondary outcomes were the international knee documentation committee knee evaluation form (IKDC) scores and rehabilitation compliance scores. All the outcomes were measured 1 day before surgery as references and at 2 and 6 weeks after surgery. Results There was no statistical difference in the patients' ROM, thigh circumference difference, and VAS scores at the 2-week follow-up. At the 6-week follow-up, the ROM of the affected leg was (118.1 ± 20.5)° in the CON group and (126.6 ± 20.5)° in the MHI group, and the difference was statistically significant (P = 0.011). The difference in thigh circumference was 3.0 (2.0, 3.5) cm in the CON group and 2.5 (1.0, 3.0) cm in the MHI group. The difference was statistically significant (P < 0.001). The VAS score in the CON group was 3.0 (2.0, 4.0), and the MHI group was 2.5 (1.0, 3.0). The difference was statistically significant (P < 0.05). At the 6-week follow-up, the compliance score of patients in the MHI group was significantly higher than that in the CON group (P = 0.047, β = 2.243, 95%CI: 0.026-4.459). There is no statistically significant difference in IKDC scores. Conclusion Mobile health-based intervention positively affected patients undergoing ACL reconstruction surgery, particularly in improving the clinical outcome indicators of the knee joint.
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Affiliation(s)
- Yi Guo
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China,School of Public Health, Peking University Health Science Center, Beijing, China
| | - Dai Li
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yi-bo Wu
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China
| | - Xin Sun
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China
| | - Xin-ying Sun
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China,*Correspondence: Xin-ying Sun ✉
| | - Yu-ping Yang
- School of Public Health, Peking University Health Science Center, Beijing, China,Department of Sports Medicine, Peking University Third Hospital, Beijing, China,Yu-ping Yang ✉
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Kielė D, Solianik R. Four-Week Application of Kinesiotaping Improves Proprioception, Strength, and Balance in Individuals With Complete Anterior Cruciate Ligament Rupture. J Strength Cond Res 2023; 37:213-219. [PMID: 35438677 DOI: 10.1519/jsc.0000000000004245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT Kielė, D and Solianik, R. Four-week application of kinesiotaping improves proprioception, strength, and balance in individuals with complete anterior cruciate ligament rupture. J Strength Cond Res 37(1): 213-219, 2023-Kinesiotaping (KT) is common in musculoskeletal rehabilitation, but whether it is efficacious for surgically untreated anterior cruciate ligament (ACL) ruptures is unknown. Therefore, we evaluated whether a strategy of physiotherapy plus KT would be superior to a strategy of physiotherapy alone on subsequent proprioception and motor function. Men aged 28.1 ± 6.7 years with complete ACL ruptures were randomized to either a control (physiotherapy) or an experimental group (physiotherapy + KT) for a 4-week period. Changes in balance were assessed on the injured leg using a force platform. Knee angle reproduction, maximal voluntary contraction (MVC), and rate of force development (RFD) were measured using dynamometry, and pain was recorded using a visual analog scale. Decreases in knee pain and improvements in angle reproduction were observed in both groups ( p < 0.05), with a greater effect on angle reproduction in the experimental group ( p < 0.05). Both groups demonstrated increased isometric knee flexor MVC and RFD values ( p < 0.05), but an increase in RFD of the knee extensors was observed only in the experimental group ( p < 0.05). Furthermore, the MVC of concentric knee flexors at 60°·s -1 increased only in the experimental group ( p < 0.05), whereas concentric MVC at 180°·s -1 -resulting in greater hamstring-to-quadriceps ratios-increased in both groups ( p < 0.05). Balancing ability on the injured leg increased only in the experimental group ( p < 0.05). Thus, KT plus physiotherapy was beneficial in the treatment of proprioception, strength, and static balance in these individuals with an ACL rupture.
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Affiliation(s)
- Dovilė Kielė
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania ; and.,Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania
| | - Rima Solianik
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania ; and.,Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania
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Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus. J ISAKOS 2022; 7:150-161. [PMID: 35998884 DOI: 10.1016/j.jisako.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer-one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. METHODS 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. RESULTS Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. CONCLUSIONS The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer.
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Kochman M, Kasprzak M, Kielar A. ACL Reconstruction: Which Additional Physiotherapy Interventions Improve Early-Stage Rehabilitation? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15893. [PMID: 36497965 PMCID: PMC9739138 DOI: 10.3390/ijerph192315893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Despite the restoration of the mechanical stability of the knee joint after ACL reconstruction (ACLR), patients often experience postoperative limitations. To our knowledge, there are no systematic reviews analyzing additional physiotherapy interventions implementing standard rehabilitation programs in the early postoperative phase after ACLR. The objective of this study was to analyze the additional physiotherapy interventions implemented in standard rehabilitation programs that improve early-stage ACLR rehabilitation. For this systematic review, we followed the PRISMA guidelines. In March 2022 we conducted a literature review using electronic databases. Primary outcomes were pain, edema, muscle strength, ROM, and knee function. The risk of bias and scientific quality of included studies were assessed with the RoB 2, ROBINS-I and PEDro scale. For the review, we included 10 studies that met the inclusion criteria (total n = 3271). The included studies evaluated the effectiveness of Kinesio Taping, Whole-body vibration, Local Vibration Training, Trigger Point Dry Needling, High Tone Power Therapy, alternating magnetic field, and App-Based Active Muscle Training Program. Most of the additional physiotherapy interventions improved pain, edema, ROM, knee muscle strength, or knee function in early-stage postoperative ACL rehabilitation. Except for one study, no adverse events occurred in the included studies, which demonstrates the safety of the discussed physiotherapy interventions. Further in-depth research is needed in this area.
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Piedade SR, Leite Arruda BP, de Vasconcelos RA, Parker DA, Maffulli N. Rehabilitation And Advances In Surgical Reconstruction For Anterior Cruciate Ligament Insufficiency: What Has Changed Since The 1960s? - State Of The Art. J ISAKOS 2022:S2059-7754(22)00094-3. [PMID: 36410671 DOI: 10.1016/j.jisako.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/29/2022] [Accepted: 10/10/2022] [Indexed: 11/20/2022]
Abstract
Anterior cruciate ligament (ACL) insufficiency can be disabling, given the physical and sports activity constraints that negatively impact the quality of life. Consequently, surgery is the main approach for most active patients. Nonetheless, ACL reconstruction (ACLR) cannot be successful without adequate preoperative and postoperative rehabilitation. Since the 1960s, post-ACLR rehabilitation has evolved, mainly from advances in surgery, coupled with a better understanding of the biological concepts of graft revascularization, maturation and integration, which have impacted ACL postoperative rehabilitation protocols. However, new technologies do involve a definite learning curve which could affect rehabilitation programs and produce inconsistent results. The development of rehabilitation protocols cannot be defined without an accurate diagnosis of ACL injury and considering the patient's main physical demands and expectations. This article discusses how postoperative rehabilitation following ACLR has changed from the 1960s to now, focussing on surgical technique (type of tendon graft, fixation devices, and graft tensioning), biological concepts (graft maturation and integration), rehabilitation protocols (prevention of ACL injuries, preoperative rehabilitation, postoperative rehabilitation), criteria to return to sports, patient's reported outcomes and outcome. Although rehabilitation plays an essential role in managing ACL injuries, it cannot be fully standardised preoperatively or postoperatively. Preoperative and postoperative rehabilitation should be based on an accurate clinical diagnosis, patients' understanding of their injury, graft tissue biology and biomechanics, surgical technique, the patient's physical demands and expectations, geographical differences in ACL rehabilitation and future perspectives.
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Affiliation(s)
- Sergio R Piedade
- Exercise and Sports Medicine, Department of Orthopedics, Rheumatology, and Traumatology, University of Campinas, UNICAMP, Campinas, SP, 13083-887, Brazil.
| | | | | | - David A Parker
- Sydney Orthopaedic Research Institute, Chatswood, NSW 206, Australia
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
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Gursoy S, Clapp IM, Perry AK, Hodakowski A, Kerzner B, Singh H, Vadhera AS, Bach BR, Bush-Joseph CA, Forsythe B, Yanke AB, Verma NN, Cole BJ, Chahla J. Patients Follow 3 Different Rate-of-Recovery Patterns After Anterior Cruciate Ligament Reconstruction Based on International Knee Documentation Committee Score. Arthroscopy 2022; 38:2480-2490.e3. [PMID: 35337956 DOI: 10.1016/j.arthro.2022.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/22/2022] [Accepted: 02/25/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether subgroups of patients exist based on the rate-of-recovery pattern of International Knee Documentation Committee (IKDC) scores after anterior cruciate ligament reconstruction (ACLR) and to determine clinical predictors for these subgroups. METHODS Patients who underwent primary or revision ACLR at a single institution from January 2014 to January 2019 were identified. Latent class growth analyses and growth mixture models (GMMs) with 1 to 6 classes were used to identify subgroups of patients based on functional rate-of-recovery patterns by use of preoperative, 1-year postoperative, and 2-year postoperative IKDC scores. RESULTS A total of 245 patients who underwent ACLR were included in the analysis. A 3-class GMM was chosen as the final model after 6 different models were run. Class 1, showing improvement from preoperatively to 1-year follow-up, with sustained improvement from 1 to 2 years postoperatively, constituted 77.1% of the study population (n = 189), whereas class 2, showing functional improvement between 1- and 2-year follow-up, was the smallest class, constituting 10.2% of the study population (n = 25), and class 3, showing slight improvement at 1-year follow-up, with a subsequent decline in IKDC scores between 1- and 2-year follow-up, constituted 12.7% of the study population (n = 31). Revision surgery (P = .005), a psychiatric history (P = .025), preoperative chronic knee pain (P = .024), and a subsequent knee injury within the follow-up period (P = .011) were the predictors of class 2 and class 3 rate-of-recovery patterns. Patient demographic characteristics, graft type, and concomitant ligament, meniscus, or cartilage injury at the time of surgery were not associated with the different recovery patterns described in this study. CONCLUSIONS Patients may follow different rate-of-recovery patterns after ACLR. By use of the GMMs, 3 different rate-of-recovery patterns based on IKDC scores were identified. Although most patients follow a more ideal rate-of-recovery pattern, fewer patients may follow less favorable patterns. Revision surgery, a history of psychiatric illness, preoperative chronic knee pain, and a subsequent knee injury within the follow-up period were predictive of less favorable rate-of-recovery patterns. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Safa Gursoy
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ian M Clapp
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Allison K Perry
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Alex Hodakowski
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Harsh Singh
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Amar S Vadhera
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bernard R Bach
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Charles A Bush-Joseph
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Adam B Yanke
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Baker HP, Bhattacharjee S, Poff C, Bartolotta C, Athiviraham A. Postoperative Anterior Cruciate Ligament Reconstruction Quadricep and Patella Tendon Rupture, Infection, and Lysis of Adhesions Decreased Despite Changing Graft Trends Over the Past Decade. Arthrosc Sports Med Rehabil 2022; 4:e1437-e1443. [PMID: 36033204 PMCID: PMC9402459 DOI: 10.1016/j.asmr.2022.04.033] [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: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate recent trends in postoperative complications following anterior cruciate ligament (ACL) reconstruction. Methods Patients who underwent ACL reconstruction surgery were identified in a national insurance database and separated into 2 cohorts based on the date of their initial surgery comprising the years 2010 to 2012 and 2016 to 2018, respectively. Patients were matched 1:1 based on comorbidities and Elixhauser Comorbidity Index. All patients were assessed for postoperative complications within 18 months of surgery. Rate of complication was compared between cohorts. Results Overall, the all-cause complication rate was 2%. There were significantly more quadriceps tendon rupture, patella tendon rupture, lysis of adhesion, and infection in the early cohort. There were significantly more instances of deep vein thrombosis in the late cohort. We found no significant difference in manipulations under anesthesia between the 2 cohorts. Conclusions Patients who underwent surgery in the late cohort had lower rates of postoperative complications, except for deep vein thrombosis. The rate of postoperative quadriceps tendon rupture decreased despite considerable increase in the use of quadriceps tendon autograft. Clinical Relevance As there has been an increased use of quadriceps tendon autografts, but little is known about the postoperative complications after ACL reconstruction with these grafts. This information has the potential to improve patient outcomes.
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Affiliation(s)
- Hayden P. Baker
- Address correspondence to Hayden P. Baker, M.D., 5758 S. Maryland Ave., Dept. 4B, Chicago, IL 60637.
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Rivera-Brown AM, Frontera WR, Fontánez R, Micheo WF. Evidence for isokinetic and functional testing in return to sport decisions following ACL surgery. PM R 2022; 14:678-690. [PMID: 35411690 DOI: 10.1002/pmrj.12815] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/06/2022]
Abstract
The rupture and reconstruction of the anterior cruciate ligament (ACL) of the knee are associated with an increased risk of functional instability, a reduction in sports performance, and a higher risk of future additional injuries. Competitive athletes who participate in sports that require pivoting, cutting, and jumping are at particularly high risk for ACL rupture. The return to sport progression continuum after surgery includes sports-specific rehabilitation, evaluation of strength and function, gradual participation in exercise training with progressively challenging activities in the field of play, participation in sports at a lower level, and finally a return to preinjury-level sports competition. This narrative review evaluates the evidence that supports the use of quadriceps and hamstrings isokinetic strength testing and sports-specific functional skills assessments to evaluate progress with rehabilitation after ACL surgery. Strength evaluations, hop tests, agility tests, and the limb symmetry index are described, as well as the associations of quadriceps and hamstrings muscle strength and functional test results with successful return to sports and the risk of ACL graft rupture and contralateral knee injuries. Suggestions for future research directions are presented including the importance of presurgery testing, standardization of test batteries, and comparison of test results with normative data.
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Affiliation(s)
- Anita M Rivera-Brown
- Center for Sports Health and Exercise Sciences, Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.,Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Walter R Frontera
- Center for Sports Health and Exercise Sciences, Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.,Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Richard Fontánez
- Center for Sports Health and Exercise Sciences, Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - William F Micheo
- Center for Sports Health and Exercise Sciences, Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Jenkins SM, Guzman A, Gardner BB, Bryant SA, Del Sol SR, McGahan P, Chen J. Rehabilitation After Anterior Cruciate Ligament Injury: Review of Current Literature and Recommendations. Curr Rev Musculoskelet Med 2022; 15:170-179. [PMID: 35381974 DOI: 10.1007/s12178-022-09752-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament reconstruction (ACLR) is a common surgical procedure with an estimated 120,000 cases performed in the USA each year. Physical therapy plays a critical role in the successful recovery of both surgically and non-surgically managed patients. Interestingly, ACL rehabilitation protocols vary greatly with little consensus among practitioners. Nonetheless, there has been agreement over the last decade to shift from conservative, standardized length protocols to more accelerated, individualized protocols that vary in length and modalities based on patient-specific findings and preferences. This review summarizes the most recent trends, opinions, and modalities in ACL rehabilitation research, with a specific focus on novel methods to treat the specific psychosocial needs of ACL deficient patients. RECENT FINDINGS We found that new protocols emphasize early weight bearing, open kinetic chain (OKC) exercises, and other alternative modalities such as neuromuscular electrical stimulation and blood flow restriction. We also found a recent trend toward the use of clinical milestones to determine when a patient is ready for the next phase of a "step-up" rehabilitation program. One particularly nascent topic of research is the inclusion of methods to treat the psychosocial impacts of ACL injury, recovery, and the anxiety around return to sport. Rehabilitation strategy has become increasingly patient-dependent, and the new modalities being utilized are accelerating patient recovery. Return to sport is a particularly important factor for many ACLR patients, and recovery has an important psychological component that has only recently been addressed in the literature, with positive preliminary findings.
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Affiliation(s)
- Sarah M Jenkins
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA.
| | - Alvarho Guzman
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Brandon B Gardner
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Stewart A Bryant
- University of Hawaii Orthopaedic Surgery Residency, Honolulu, HI, USA
| | - Shane Rayos Del Sol
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - Patrick McGahan
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
| | - James Chen
- Advanced Orthopaedics and Sports Medicine, 450 Sutter St, San Francisco, CA, 94108, USA
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Badawy CR, Jan K, Beck EC, Fleet N, Taylor J, Ford K, Waterman BR. Contemporary Principles for Postoperative Rehabilitation and Return to Sport for Athletes Undergoing Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e103-e113. [PMID: 35141542 PMCID: PMC8811493 DOI: 10.1016/j.asmr.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022] Open
Abstract
Despite advancements in our understanding of anterior cruciate ligament (ACL) injury prevention and nonsurgical management, ACL reconstruction continues to occur at an alarming rate. Among athletic patients, individuals participating in basketball, soccer, and football have the highest incidence of ACL injury, often requiring surgical intervention. To ensure the optimal treatment strategy for return to sport and prevention of secondary graft re-tear, it is important to tailor to the specific demands of the injured athlete and apply evidence-based best practices and rehabilitation principles. The purpose of this review is to provide readers with a brief background regarding ACL injuries, a focused review of clinical outcome studies after ACL reconstruction, and an updated framework with expert-guided recommendations for postoperative rehabilitation and return to sporting activity. Currently, there is no gold standard for rehabilitation after ACL reconstruction, highlighting the need for robust studies evaluating the best modalities for athlete rehabilitation, as well as determining the efficacy of new tools for improving therapy including blood flow restriction therapy and neuromuscular electrical stimulation. Based on clinical experience, a renewed focus on objective, criteria-based milestones may maximize the ability of return to preinjury levels of athletic function.
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Affiliation(s)
- Charles R Badawy
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Kyleen Jan
- University of Illinois College of Medicine, Chicago, Illinois, U.S.A
| | - Edward C Beck
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Niles Fleet
- Department of Athletics, Wake Forest University, Winston-Salem, North Carolina, U.S.A
| | - Jeffrey Taylor
- Department of Physical Therapy, High Point University, High Point, North Carolina, U.S.A
| | - Kevin Ford
- Department of Physical Therapy, High Point University, High Point, North Carolina, U.S.A
| | - Brian R Waterman
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
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