1
|
Brown CL, Worts PR, Dewig DR, Rolle GA, Ormsbee MJ. Return to Play After an Anterior Cruciate Ligament Reconstruction in the Collegiate Athlete: A Systematic Review Evaluating Return to Play Proportions and Associated Factors. J Orthop Sports Phys Ther 2024; 54:1-9. [PMID: 39348216 DOI: 10.2519/jospt.2024.12483] [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: 10/02/2024]
Abstract
OBJECTIVE: To estimate anterior cruciate ligament reconstruction (ACLR) return-to-play (RTP) factors and proportions across all National Collegiate Athletics Association (NCAA) sports. DESIGN: Systematic review with prognosis and etiology components. LITERATURE SEARCH: Two independent reviewers searched PubMed, Cochrane Library, and Embase databases using terms related to RTP, ACLR, and NCAA for articles published up to June 30, 2023. STUDY SELECTION CRITERIA: Articles were included if RTP proportions or factors affecting RTP were reported and if the study population included NCAA collegiate athletes recovering from an ACLR. DATA SYNTHESIS: The proportion represents the total number of athletes who returned to play after ACLR over the total number of ACLR athletes from each cohort. The cumulative proportion represents the aggregated total from each included study. When eligibility information was available (ie, athletes in their final year of eligibility), RTP proportions were adjusted. The Newcastle-Ottawa Scale (NOS) was used to assess the study quality and scored by 2 raters. RESULTS: Nine studies were included. RTP criteria varied across the studies. Proportions of RTP ranged from 69% to 92%, with a cumulative RTP proportion after ACLR of 84% (628/745). The primary factors associated with the proportion of RTP were scholarship status, competitive eligibility remaining, depth chart position, and surgical graft type. CONCLUSIONS: The cumulative proportion of RTP was 84% and was associated with patient-specific and operative factors. Psychological and functional factors were not routinely reported, and rehabilitation protocols were unknown. Data were not explicitly available for any athletes outside of Division I. The criteria for RTP after ACLR varied. J Orthop Sports Phys Ther 2024;54(10):1-9. Epub 10 September 2024. https://doi.org/10.2519/jospt.2024.12483.
Collapse
|
2
|
Al Ta'ani Z, Al Ta'ani O, Gabr A, Tanashat M, Lin Lee J, Al-Bitar F, Lee JL, Al-Ajlouni YA. From Fear to Resilience: A Scoping Review of Psychological Components in Anterior Cruciate Ligament Rehabilitation. J Sport Rehabil 2024:1-28. [PMID: 39299682 DOI: 10.1123/jsr.2023-0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/25/2024] [Accepted: 07/05/2024] [Indexed: 09/22/2024]
Abstract
CONTEXT Anterior cruciate ligament (ACL) injuries, prevalent in athletic contexts have profound physical and psychological impacts. Despite extensive research on the physiological aspects of ACL recovery, the psychological dimensions of this process have gained increased attention. This scoping review delves into the intricate landscape of psychological factors influencing ACL rehabilitation. DESIGN Scoping review. METHODS A literature search across multiple databases was conducted to identify relevant published studies that provide insight into the psychological aspects of ACL recovery. This search spanned various study designs, enabling a nuanced understanding of the psychological intricacies surrounding ACL recovery. Overall, a total of 1830 unique articles were screened, of which 66 were included in this review. Our findings are further contextualized through alignment with insights from prior reviews on similar themes. Through a comprehensive analysis of diverse literature, we explore 3 key themes: psychological challenges, current rehabilitation programs, and the integration of psychological support. RESULTS Psychological challenges emerged as a pervasive aspect of ACL rehabilitation, encompassing fear, anxiety, motivation, and depression. The nuanced emotional responses, particularly the fear of reinjury, impact treatment adherence and overall well-being. Contemporary rehabilitation programs revealed inconsistencies in incorporating psychological support, emphasizing the need for standardized, multidisciplinary approaches. The alignment with prior reviews in the literature reinforced the importance of psychological traits, such as knee self-efficacy, in predicting positive outcomes. CONCLUSION This scoping review provides a comprehensive overview of psychological factors within ACL rehabilitation, highlighting the importance of tailored interventions and standardized approaches. The integration of multidisciplinary expertise emerges as crucial for optimizing patient outcomes. Our findings not only contribute to a nuanced understanding of psychological nuances in ACL rehabilitation but also offer valuable implications for clinical practice and policy development.
Collapse
Affiliation(s)
- Zaid Al Ta'ani
- Department of Special Surgery and Orthopedics, University of Jordan Hospital, Amman, Jordan
| | | | - Ahmad Gabr
- New York Medical College School of Medicine, Valhalla, NY, USA
| | | | - Justin Lin Lee
- New York Medical College School of Medicine, Valhalla, NY, USA
| | - Farah Al-Bitar
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jessica Lin Lee
- New York Medical College School of Medicine, Valhalla, NY, USA
| | | |
Collapse
|
3
|
Herring SA, Putukian M, Kibler WB, LeClere L, Boyajian-O'Neill L, Day MA, Franks RR, Indelicato P, Matuszak J, Miller TL, O'Connor F, Poddar S, Svoboda SJ, Zaremski JL. Team Physician Consensus Statement: Return to Sport/Return to Play and the Team Physician: A Team Physician Consensus Statement-2023 Update. Curr Sports Med Rep 2024; 23:183-191. [PMID: 38709944 DOI: 10.1249/jsr.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington KY
| | - Lance LeClere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Peter Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | | | - Timothy L Miller
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Fran O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sourav Poddar
- Primary Sports Medicine, University of Colorado School of Medicine, Denver, CO
| | | | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, University of Florida Health, Gainesville, FL
| |
Collapse
|
4
|
Herring SA, Putukian M, Kibler WB, Leclere L, Boyajian-O'Neill L, Day MA, Franks RR, Indelicato P, Matuszak J, Miller TL, O'Connor F, Poddar S, Svoboda SJ, Zaremski JL. Team Physician Consensus Statement: Return to Sport/Return to Play and the Team Physician: A Team Physician Consensus Statement-2023 Update. Med Sci Sports Exerc 2024; 56:767-775. [PMID: 38616326 DOI: 10.1249/mss.0000000000003371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington KY
| | - Lance Leclere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Peter Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | | | - Timothy L Miller
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Fran O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sourav Poddar
- Primary Sports Medicine, University of Colorado School of Medicine, Denver, CO
| | | | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, University of Florida Health, Gainesville, FL
| |
Collapse
|
5
|
Yensen K, Mayfield CK, Bolia IK, Palmer RA, Brown M, Kim DR, Abu-Zahra MS, Kotlier JL, Webb T, Cleary E, Saboori N, Petrigliano FA, Weber AE. Subjective Causes for Failure to Return to Sport After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Sports Health 2024:19417381241231631. [PMID: 38532528 DOI: 10.1177/19417381241231631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
CONTEXT While current literature has explored the outcomes of athletes who return to sport (RTS) after anterior cruciate ligament (ACL) injuries, less is known about the outcomes of those who are unsuccessful in returning to sport. OBJECTIVE To determine the rate of athletes who did not RTS after primary ACL reconstruction (ACLR) and to identify the specific subjective reasons for failure to RTS. DATA SOURCES A comprehensive search of the PubMed/MEDLINE, Scopus, and Web of Science databases was conducted through April 2021. STUDY SELECTION Eligible studies included those explicitly reporting the rate of failure for RTS after ACLR as well as providing details on reasons for athletes' inability to return; 31 studies met the inclusion criteria. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2 to 4. DATA EXTRACTION The reasons for failure to RTS referred to in our study are derived from those established previously in the studies included. Data were collected on the number of athletes, mean age, mean follow-up time, type of sport played, failure to RTS rate, and specific reasons for failure to return. RESULTS The weighted rate of failure to RTS after ACLR was 25.5% (95% CI, 19.88-31.66). The estimated proportion of psychosocial-related reasons cited for failure to RTS was significantly greater than knee-related reasons for failure RTS (55.4% vs 44.6%, P < 0.01). The most cited reason for failure to RTS was fear of reinjury (33.0%). CONCLUSION This study estimates the rate of failure to RTS after ACLR to be 25.5%, with the majority of athletes citing fear of reinjury as the major deterrent for returning to sports. We highlight how factors independent of surgical outcomes may impact an athlete's ability to return to play given that the predominant reason for no RTS after ACLR was unrelated to the knee.
Collapse
Affiliation(s)
- Katie Yensen
- Keck School of Medicine of USC, Los Angeles, California
| | | | | | - Ryan A Palmer
- Keck School of Medicine of USC, Los Angeles, California
| | - Michael Brown
- Keck School of Medicine of USC, Los Angeles, California
| | - Daniel R Kim
- Keck School of Medicine of USC, Los Angeles, California
| | | | | | - Thomas Webb
- Keck School of Medicine of USC, Los Angeles, California
| | - Emmett Cleary
- Keck School of Medicine of USC, Los Angeles, California
| | - Nima Saboori
- Keck School of Medicine of USC, Los Angeles, California
| | | | | |
Collapse
|
6
|
Xiao M, van Niekerk M, Trivedi NN, Hwang CE, Sherman SL, Safran MR, Abrams GD. Patients Who Return to Sport After Primary Anterior Cruciate Ligament Reconstruction Have Significantly Higher Psychological Readiness: A Systematic Review and Meta-analysis of 3744 Patients. Am J Sports Med 2023; 51:2774-2783. [PMID: 35722814 DOI: 10.1177/03635465221102420] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although objective outcomes assessing knee function are essential measurements for return to sport, psychological factors have become increasingly recognized as equally important parameters for determining an athlete's ability to return to sport after surgery. PURPOSE To systematically review the literature to determine whether patients who returned to sport after anterior cruciate ligament (ACL) reconstruction had improved psychological scores (as measured with validated questionnaires) compared with patients who did not return to sport. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 3. METHODS A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was preregistered on PROSPERO. Four databases were searched for level 1 to 3 studies that compared at least 1 psychological outcome measured by a validated questionnaire for patients who did and did not return to sport after primary ACL reconstruction. The following data were recorded: study and patient characteristics; psychological metrics (ACL-Return to Sport Injury [ACL-RSI] scale, Knee Self-Efficacy Scale [K-SES], and Tampa Scale of Kinesiophobia [TSK/TSK-11]); International Knee Documentation Committee (IKDC) score; and clinical metrics. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS), and the mean difference (MD) and 95% CI were calculated for each psychological outcome score using the inverse variance method. RESULTS We included and analyzed 16 articles (3744 patients; 38.9% female; mean age range, 17-28.7 years; mean MINORS score, 19.9 ± 1.4). Overall, 61.8% of athletes returned to sport (66.8% of male patients; 55.4% of female patients). Patients who returned scored significantly higher on the ACL-RSI scale (MD, 20.8; 95% CI, 15.9 to 25.7; P < .001), significantly higher on the K-SES (MD, 1.3; 95% CI, 0.2 to 2.3; P = .036), and significantly lower on the TSK/TSK-11 (MD, 10.1%; 95% CI, -12.1% to -8.2%; P = .004). Those returning to sport did not exceed the minimal clinically important difference for IKDC score versus those not returning to sport. CONCLUSION Patients who returned to sport after primary ACL reconstruction had significantly higher psychological readiness, higher self-efficacy, and lower kinesiophobia compared with those who did not return to sport, despite having clinically similar knee function scores. Evaluation of psychological readiness, in combination with other objective measurements, is a critical component of return-to-sport evaluation in athletes after primary ACL reconstruction. REGISTRATION CRD42021284735 (PROSPERO).
Collapse
Affiliation(s)
- Michelle Xiao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Maike van Niekerk
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Nikunj N Trivedi
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Calvin E Hwang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, USA
| |
Collapse
|
7
|
Schilaty ND, McPherson AL, Nagai T, Bates NA. Differences in psychological readiness for return to sport after anterior cruciate ligament injury is evident in thigh musculature motor unit characteristics. BMJ Open Sport Exerc Med 2023; 9:e001609. [PMID: 37440978 PMCID: PMC10335479 DOI: 10.1136/bmjsem-2023-001609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Background Following anterior cruciate ligament (ACL) injury, many athletes that undergo surgery and 6-9 months of rehabilitation struggle to return to sport. Evidence suggests that psychological factors contribute to this failure to return-to-sport. Objective Determine the motor control relationship between thigh musculature motor unit characteristics and psychological readiness to return to sport between ACL-injured and healthy controls. Study design A longitudinal cohort study. Methods Athletes longitudinally completed the ACL Return to Sport after Injury (ACL-RSI) survey and isometric strength measures with a measurement of electromyography (EMG) of the vastus lateralis, vastus medialis, biceps femoris, and semitendinosus. A score cut-off of 61 on the ACL-RSI was used to divide ACL-injured groups. EMG was decomposed to provide each identified motor unit's characteristics (amplitude, average firing rate, etc). Results Data demonstrated increased average firing rate for hamstrings (p<0.001), decreased average firing rate for vastus lateralis (p<0.001) and decreased motor unit size for both the quadriceps and hamstrings at return-to-sport post-ACL reconstruction compared with sex-matched and age-matched healthy controls (p<0.001). Furthermore, there were marked differences in disparate ACL-RSI scores between ACL-injured athletes. Conclusions At return to sport, ACL-injured athletes have major alterations of thigh musculature motor control, with smaller motor units used by those with low ACL-RSI scores. This study uniquely demonstrates objective thigh muscle motor unit characteristics that coincide with subjective reports of psychological readiness. This information will be important to address psychomotor complexes of injury for future rehabilitation protocols.
Collapse
Affiliation(s)
- Nathan D Schilaty
- Department of Neurosurgery & Brain Repair, University of South Florida Tampa Campus, Tampa, Florida, USA
- Medical Engineering, University of South Florida, Tampa, Florida, USA
- Center for Neuromusculoskeletal Research, University of South Florida, Tampa, Florida, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - April L McPherson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
- Emory Sports Performance and Research Center, Emory University, Atlanta, Georgia, USA
| | - Takashi Nagai
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Military Performance, USARIEM, Natick, Massachusetts, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
8
|
Meade M, Fliegel B, Szukics P, Ford E, Pontes M, McMillan S. Patients With Low Resilience Scores Have Significantly Worse Postoperative Outcomes After Anterior Cruciate Ligament Reconstruction Than Patients With Normal or High Resilience Scores. Arthrosc Sports Med Rehabil 2023; 5:e679-e685. [PMID: 37388868 PMCID: PMC10300540 DOI: 10.1016/j.asmr.2023.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/27/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To evaluate the relationship between patient resilience and patient-reported outcome measures (PROMS) after primary anterior cruciate ligament (ACL) reconstruction. Methods Patients who underwent an ACL reconstruction by a single surgeon between January 2012 and June 2020 were identified by an institutional query using Current Procedural Terminology codes. Patients were included if they (1) underwent a primary ACL reconstruction and (2) had a minimum of 2 years' follow-up. Data were retrospectively collected regarding demographics, surgical details, visual analog scale (VAS) scores, and 12-item short form survey (SF-12) scores. Resilience scores were obtained via the Brief Resilience Scale questionnaire. Stratification into low (LR), normal (NR), and high resilience (HR) was based on standard deviation from mean Brief Resilience Scale score to determine differences in PROMS between groups. Results One-hundred eighty-seven patients were identified by the institutional query. Of the 187 patients, 180 met inclusion criteria. Seven patients underwent revision ACL reconstruction and were excluded from the study. One-hundred three patients (57.2%) completed the postoperative questionnaire and were included. Patients in the NR group and HR group had significantly greater postoperative SF-12 scores (P < .001) and lower postoperative VAS pain scores (P < .001) when compared with those of the LR group. This trend was again shown with breakdown of the SF-12 into physical and mental aspects, each of which were significantly greater in either the NR group or HR group when compared with the LR group (P < .001). Overall, 97.9% and 99.0% of patients had changes in their SF-12 total and VAS pain scores respectively that exceeded the minimal clinically important difference for the cohort. Conclusions Patients with lower resilience scores have worse PROMs and increased pain than patients with greater resilience at a minimum of 2-year follow-up after ACL reconstruction. Level of Evidence Level IV, prognostic case series.
Collapse
Affiliation(s)
- Matthew Meade
- Division of Orthopaedic Surgery, Jefferson Health – New Jersey, Stratford ,New Jersey, U.S.A
| | - Brian Fliegel
- Division of Orthopaedic Surgery, Jefferson Health – New Jersey, Stratford ,New Jersey, U.S.A
| | - Patrick Szukics
- Division of Orthopaedic Surgery, Jefferson Health – New Jersey, Stratford ,New Jersey, U.S.A
| | - Elizabeth Ford
- Division of Orthopaedic Surgery, Inspira Health Network, Vineland, New Jersey, U.S.A
| | - Manuel Pontes
- Division of Marketing, Rowan University, Stratford, New Jersey, U.S.A
| | - Sean McMillan
- Division of Orthopaedic Surgery, Virtua Medical Center, Burlington, New Jersey, U.S.A
| |
Collapse
|
9
|
Gomez-Espejo V, Olmedilla A, Abenza-Cano L, Garcia-Mas A, Ortega E. Psychological readiness to return to sports practice and risk of recurrence: Case studies. Front Psychol 2022; 13:905816. [PMID: 36211933 PMCID: PMC9540195 DOI: 10.3389/fpsyg.2022.905816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Returning to sport after the sports injury is a difficult decision because it's multicausal and the fact that a rash decision can result in numerous negative consequences. Given the importance of psychological variables for the correct rehabilitation of the injured athlete and his or her optimal return to sports practice, there seems to be little information on this subject. In this sense, the objective is to determine the relationship between the subjective psychological disposition of the athlete in the process of Return to Play (RTP) with the type of mood profile and his mental health. This is based on the fact that each athlete evaluates his or her recovery differently and has different levels of anxiety, depression, and stress. For this purpose, four athletes participated in the study. Two males and two females from the sports of indoor soccer and soccer, who had just returned to sports after a moderate or severe injury. The average age was 24.25 years. Various measurements were taken after practices and after matches, to assess mood, psychological readiness, anxiety, stress, and depression. The results confirm Morgan's iceberg profile and the influence that subjective psychological perceptions and assessed emotional states have on athletes' incorporation into their sports practice with a guarantee of success.
Collapse
Affiliation(s)
| | - Aurelio Olmedilla
- Department of Personality, Evaluation and Psychological Treatment, University of Murcia, Murcia, Spain
| | | | - Alejandro Garcia-Mas
- Grupo de Investigación en Ciencias de la Actividad Fisica (GICAFE) (Research Group of Sports Sciences), University of the Balearic Islands, Palma de Mallorca, Spain
| | - Enrique Ortega
- Department of Physical Activity and Sport, Campus of Excellence Mare Nostrum, University of Murcia, Murcia, Spain
| |
Collapse
|
10
|
Bakhsh HR, Metikala S, Billy GG, Vairo GL. Association Between Self-Reported Kinesiophobia and Single-Leg Hop for Distance in Patients With ACL Reconstruction: A Systematic Review. Sports Health 2022; 14:674-680. [PMID: 34651507 PMCID: PMC9460087 DOI: 10.1177/19417381211049357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Psychological readiness is a significant factor in determining successful return to sport (RTS) and physical activities after anterior cruciate ligament (ACL) reconstruction. Knowing the influence of kinesiophobia on physical tests that are used to guide RTS, such as the single-leg hop for distance (SLHD), would contribute to advancing clinical practice. OBJECTIVE To investigate the association between kinesiophobia and SLHD performance in patients after ACL reconstruction. DATA SOURCES A comprehensive search strategy entailed surveying 6 databases for relevant articles published from January 2009 to March 2021. STUDY SELECTION Articles published in English that were a minimum of level 3 evidence describing kinesiophobia, as measured by the Tampa Scale for Kinesiophobia, and related to SLHD performance in patients after ACL reconstruction. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3. DATA EXTRACTION Study characteristics, sample population demographics, instrument(s), or approach(s) used to assess kinesiophobia and SLHD performance, and corresponding results. RESULTS A total of 152 potential studies were identified, 106 studies underwent screening, 40 were reviewed in full, and 7 studies were included. Meta-analysis could not be performed because of differences in experimental design among studies and instances of missing outcome data. Currently, moderate evidence indicates patients with ACL reconstruction that exhibit less kinesiophobia perform better on the SLHD test. CONCLUSION The outcomes of this review propose that sports health practitioners consider the influence of kinesiophobia on SLHD performance as a criterion for RTS and physical activities in patients after ACL reconstruction. Higher quality studies are necessary to establish the extent of association between these variables.
Collapse
Affiliation(s)
- Hadeel R. Bakhsh
- Department of Rehabilitation, College
of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University,
Riyadh, Saudi Arabia
| | - Sreenivasulu Metikala
- Department of Orthopaedic Surgery,
Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Gregory G. Billy
- Department of Orthopaedics &
Rehabilitation, College of Medicine, Pennsylvania State University, University Park,
Pennsylvania
| | - Giampietro L. Vairo
- Department of Orthopaedics &
Rehabilitation, College of Medicine, Pennsylvania State University, University Park,
Pennsylvania
- Department of Kinesiology, College of
Health and Human Development, Pennsylvania State University, University Park,
Pennsylvania
| |
Collapse
|
11
|
Webster KE, Feller JA. Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction in the Adolescent Athlete. J Athl Train 2022; 57:955-960. [PMID: 36638341 PMCID: PMC9842114 DOI: 10.4085/1062-6050-0543.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT Psychological readiness to return to sport has been shown to be associated with future play after anterior cruciate ligament (ACL) reconstruction surgery but has not been extensively studied in adolescent athletes. OBJECTIVE To investigate the psychometric properties of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale in adolescent athletes at multiple time points after ACL reconstruction surgery and determine whether psychological readiness scores at 6 months predict return to competition sport at 12 months. DESIGN Case series. SETTING Private orthopaedic clinic. PATIENTS OR OTHER PARTICIPANTS A total of 115 adolescent athletes (65 girls, 50 boys) 17 years and younger who had undergone primary unilateral ACL reconstruction. MAIN OUTCOME MEASURE(S) The ACL-RSI scale was administered at 6 and 12 months after surgery, and return-to-sport status was also documented. Factor analysis was undertaken and predictive validity assessed using between-groups comparisons and receiver operating characteristic (ROC) curve statistics. RESULTS The ACL-RSI scores increased between 6 and 12 months (55 to 71; P < .001, effect size = 0.98). No floor or ceiling effects were present, and the scale had high internal consistency (Cronbach α at 6 months = 0.91 and at 12 months = 0.94). Principal component analysis showed that 2 factors were present: the first represented performance confidence and risk appraisal and the second, emotions. For the full-scale ACL-RSI, scores at 6 months had acceptable predictive ability for a return to play at 12 months (area under the ROC curve = 0.7, P = .03). When the 2 identified factors were analyzed separately, the emotions factor also had acceptable predictive ability (area under the ROC curve = 0.73, P = .009), but the confidence in performance and risk appraisal factors had poor predictive ability (area under the ROC curve = 0.59, P = .09). CONCLUSIONS Greater psychological readiness was associated with return to sport in adolescent athletes after ACL reconstruction, with the athletes' emotional response appearing to be more influential than their confidence in their performance or their appraisal of risk.
Collapse
Affiliation(s)
- Kate E. Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | | |
Collapse
|
12
|
Kalatakis-dos-Santos AE, de Paula Gomes CAF, Pontes-Silva A, Mendes LP, de Oliveira Simões G, Gonçalves MC, de Oliveira Pires F, Bassi-Dibai D, Dibai-Filho AV. Fear of Return to Sport Scale (FRESS): a new instrument for use in injured professional or recreational athletes in rehabilitation. SPORT SCIENCES FOR HEALTH 2022; 19:1-10. [PMID: 35967547 PMCID: PMC9362635 DOI: 10.1007/s11332-022-00975-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/26/2022] [Indexed: 11/06/2022]
Abstract
Objective To create, develop, and validate the Fear of Return to Sport Scale (FRESS) for injured professional or recreational athletes in rehabilitation. Methods This is a questionnaire validation study. To determine the structural and construct validity, 192 injured professional or recreational athletes of different sports modalities were included. We used a subsample with 32 participants to analyze test-retest reliability and internal consistency. Main outcome measures were the FRESS, Numerical Pain Scale (NPS), Pain-Related Catastrophizing Thoughts Scale (PCTS), Self-Estimated Functional Inability because of Pain Questionnaire for athletes (SEFIP-sport), and Hospital Anxiety and Depression Scale (HADS). Results Initially, 25 questions were proposed by the specialists. Of these, 4 questions were excluded due to similarity with others. After applying the content validity coefficient, 8 questions were excluded for presenting a value lower than 0.80, leaving 13 items. The exploratory factor analysis identified the one-dimensional structure of the FRESS with 13 items. However, five items were excluded for presenting high covariance with the error of several other FRESS items in the confirmatory factor analysis. Thus, the final version of the FRESS was defined with one domain and eight items. Regarding the construct validity, we observed a magnitude of correlation varying between 0.257 and 0.470 between the FRESS and the instruments used here. We observed adequate test-retest reliability (intraclass correlation coefficient = 0.896) and internal consistency (Cronbach's alpha = 0.868). Ceiling and floor effects were not observed. Conclusion The FRESS with one domain and eight items has acceptable measurement properties and its use in clinical and sports environments to measure the fear of returning to sport in injured professional or recreational athletes is supported. Supplementary Information The online version contains supplementary material available at 10.1007/s11332-022-00975-4.
Collapse
Affiliation(s)
| | | | - André Pontes-Silva
- Postgraduate Program in Adult Health, Universidade Federal do Maranhão, Avenida dos Portugueses, 1966, Vila Bacanga, São Luís, MA 65080805 Brazil
| | | | | | | | - Flavio de Oliveira Pires
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, MA Brazil
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA Brazil
| | - Daniela Bassi-Dibai
- Postgraduate Program in Programs Management and Health Services, Universidade Ceuma, São Luís, MA Brazil
| | - Almir Vieira Dibai-Filho
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, MA Brazil
- Postgraduate Program in Adult Health, Universidade Federal do Maranhão, Avenida dos Portugueses, 1966, Vila Bacanga, São Luís, MA 65080805 Brazil
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, MA Brazil
| |
Collapse
|
13
|
Sharma AK, Elbuluk AM, Gkiatas I, Kim JM, Sculco PK, Vigdorchik JM. Mental Health in Patients Undergoing Orthopaedic Surgery: Diagnosis, Management, and Outcomes. JBJS Rev 2021; 9:01874474-202107000-00013. [PMID: 34297704 DOI: 10.2106/jbjs.rvw.20.00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Mental health and psychosocial factors play a critical role in clinical outcomes in orthopaedic surgery. » The biopsychosocial model of disease defines health as a product of physiology, psychology, and social factors and, traditionally, has not been as emphasized in the care of musculoskeletal disease. » Improvement in postoperative outcomes and patient satisfaction is incumbent upon the screening, recognition, assessment, and possible referral of patients with high-risk psychosocial factors both before and after the surgical procedure.
Collapse
Affiliation(s)
- Abhinav K Sharma
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ameer M Elbuluk
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Julia M Kim
- Clinical Psychology, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| |
Collapse
|
14
|
Bortone I, Moretti L, Bizzoca D, Caringella N, Delmedico M, Piazzolla A, Moretti B. The importance of biomechanical assessment after Return to Play in athletes with ACL-Reconstruction. Gait Posture 2021; 88:240-246. [PMID: 34126566 DOI: 10.1016/j.gaitpost.2021.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/14/2021] [Accepted: 06/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Barriers to successful return to previous level of activity following Anterior Cruciate Ligament Reconstruction (ACLR) are multifactorial and recent research suggests that athletic performance deficits persist after completion of the rehabilitation course in a large percentage of patients. RESEARCH QUESTION Do technology-based biomechanical assessments reveal underneath differences in both recreational and competitive athletes in Return to Play after ACL-Reconstruction? METHODS Thirty soccer athletes (26.9 ± 5.7 years old, male) with ACL injury were surgically treated with all-inside technique and semitendinosus tendon autograft. Before 2 years from surgery, they were called back for clinical examination, self-reported psychological scores, and biomechanical outcomes (balance, strength, agility and velocity, and symmetry). Athletes were classified into recreational (n = 15) and competitive (n = 15) according to the self-reported Return to Play Level based on the TALS post-injury. Nonparametric statistical tests have been adopted for group comparisons in terms of age, concomitant presence of meniscus tear, injury on dominant leg, presence of knee laxity, presence of varus/valgus, body sides, and return to different levels of sports. RESULTS Competitive athletes showed better in terms of strength (45.3 ± 5.4 W kg-1 vs 39.3 ± 3.4 W kg-1, P ≤ 0.01) associated with good self-reported outcomes (TLKS, CRSQ) and low fear of reinjury (TSK). However, all the athletes had a functional deficit in at least one subtest, and a safe return to sports could not have been recommended. Our findings confirmed that demographics, physical function, and psychological factors were related to playing the preinjury level sport at mean 2 years after surgery, supporting the notion that returning to sport after surgery is multifactorial. SIGNIFICANCE A strict qualitative and quantitative assessment of athletes' status should be performed at different follow-ups after surgery to guarantee a safe and controlled RTP.
Collapse
Affiliation(s)
- Ilaria Bortone
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Lorenzo Moretti
- Orthopaedic & Trauma Unit, AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Davide Bizzoca
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Nuccio Caringella
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Michelangelo Delmedico
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Andrea Piazzolla
- Orthopaedic & Trauma Unit, AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro", AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy; Orthopaedic & Trauma Unit, AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| |
Collapse
|
15
|
Buerba RA, Zaffagnini S, Kuroda R, Musahl V. ACL reconstruction in the professional or elite athlete: state of the art. J ISAKOS 2021; 6:226-236. [PMID: 34272299 DOI: 10.1136/jisakos-2020-000456] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/27/2020] [Accepted: 11/07/2020] [Indexed: 01/26/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are on the rise at all levels of sport, including elite athletics. ACL injury can have implications on the athlete's sport longevity, as well as other long-term consequences, such as the development of future knee osteoarthritis. In the elite athlete, ACL injury can also have ramifications in terms of contract/scholastic obligations, sponsorships and revenue-generating potential. Although the goal of anterior cruciate ligament reconstruction (ACLR) is to return any athlete to the same preinjury level of sport, management of ACL injuries in the elite athlete come with the additional challenge of returning him or her to an extremely high level of physical performance. Despite outcome studies after ACLR in elite athletes showing a high return-to-sport rate, these studies also show that very few athletes are able to return to sport at the same level of performance. They also show that those athletes who undergo ACLR have careers that are more short-lived in comparison to those without injury. Thus, returning an elite athlete to 'near peak' performance may not be good enough for the athletic demands of elite-level sports. A possible explanation for the variability in outcomes is the great diversity seen in the management of ACL injuries in the elite athlete in terms of rehabilitation, graft choices, portal drilling and reconstruction techniques. Recently, the advent of anatomical, individualised ACLR has shown improved results in ACLR outcomes. However, larger-scale studies with long-term follow-ups are needed to better understand the outcomes of modern ACLR techniques-particularly with the rise of quadriceps tendon as an autograft choice and the addition of lateral extra-articular tenodesis procedures. The purpose of this article was thus to provide an up-to-date state-of-the-art review in the management of ACL injuries in the elite athlete.
Collapse
Affiliation(s)
| | - Stefano Zaffagnini
- 2nd Orthopaedic Surgery and Traumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ryosuke Kuroda
- Orthopaedic, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Volker Musahl
- Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
16
|
Low correlation between functional performance and patient reported outcome measures in individuals with non-surgically treated ACL injury. Phys Ther Sport 2021; 47:185-192. [DOI: 10.1016/j.ptsp.2020.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
|