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Konishi Y, Yoshii R, Takeshita D. Tactile stimulation restores inhibited stretch reflex attributable to attenuation of Ia afferents during surprise landing. Scand J Med Sci Sports 2024; 34:e14568. [PMID: 38268071 DOI: 10.1111/sms.14568] [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: 05/27/2023] [Revised: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
Arthrogenic muscle inhibition (AMI) is induced by pathological knee conditions. The present study aimed to investigate the effect of tactile stimulation on reflex changes induced by simulated AMI during unpredictable landing performances. Twenty participants performed six unilateral landing tasks: 15 cm normal landing (15NL), 30 cm normal landing (30NL), surprise landing (SL), 30 cm normal landing following vibration (30NLV), SL following vibration (SLV), and SL following vibration with Kinesiology tape (SLK). For SL, the solid landing platform (15 cm) was removed and replaced by a false floor. Since the false floor dislodged easily under load, participants unpredictably fell through the platform to the actual landing surface 15 cm below. After completing 15NL, 30NL, and SL, vibration was applied to participants' knees to induce neurological changes similar to AMI. After vibration, participants performed 30NLV, SLV, and SLK in a random order. EMG signals in the post-landing short latency (31-60 ms) and medium latency (61-90 ms) periods were examined. EMG signals from the vastus lateralis (VL), vastus medialis (VM), and biceps femoris (BF) were recorded and compared between tasks. EMG signals of all muscles in SL were significantly enhanced in the medium latency period as compared with 30NL. Enhanced EMG signals in SL were suppressed by vibration stimulation in the VL, but the suppressed EMG signals were restored after cutaneous stimulation with Kinesiology tape (p < 0.01). Our findings suggest that AMI could alter motor control patterns during unpredictable landing and that tactile stimulation could restore the altered motor control to a normal state.
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Affiliation(s)
- Yu Konishi
- Department of Physical Education, National Defense Academy of Japan, Kanagawa, Japan
| | - Ryo Yoshii
- Division of Medicine, Department of Health Sciences, Interdisciplinary Graduate School, University of Yamanashi, Yamanashi, Japan
- Department of Rehabilitation, National Hospital Organization, Kofu National Hospital, Yamanashi, Japan
| | - Daisuke Takeshita
- Department of Life Sciences (Sports Sciences), University of Tokyo, Tokyo, Japan
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2
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Priming Effects of Anodal Transcranial Direct Current Stimulation on the Effects of Conventional Physiotherapy on Balance and Muscle Performance in Athletes With Anterior Cruciate Ligament Injury. J Sport Rehabil 2023; 32:315-324. [PMID: 36623509 DOI: 10.1123/jsr.2022-0188] [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: 05/14/2022] [Revised: 10/02/2022] [Accepted: 11/07/2022] [Indexed: 01/11/2023]
Abstract
CONTEXT In athletes, postural control impairment and knee muscle dysfunction are the most common disorders following anterior cruciate ligament (ACL) injury. Because of functional changes in the motor cortex following ACL injury, physiotherapy (PT) is not enough for treatment and using neuromodulators, such as trans-cranial direct current stimulation (tDCS) may be necessary. The present study focused on the effects of anodal tDCS (a-tDCS) over the primary motor cortex (M1) concurrent with PT on postural control and muscular performance in the athletes with ACL injury. DESIGN In this study, 34 athletes with ACL injury were randomly assigned in 2 groups of intervention group (active M1 a-tDCS concurrent with PT, n = 16) and control group (sham M1 a-tDCS concurrent with PT, n = 16). METHODS The participants of all groups received 20-minute 2 mA M1 a-tDCS with PT during 10 sessions, while tDCS was turned off after 30 seconds in the sham group. Before, immediately following, and 1 month after the interventions, the center of pressure and the average of power of flexor and extensor muscles at 2 velocities of 30°/s and 60°/s were measured by force plate and isokinetic devices, respectively. RESULTS One month after treatment, the displacement of center of pressure was decreased in the intervention group (P < .05), while there were no changes in the control group. Y-axis of center of pressure decreased in the intervention group relative to the control group, although average of power of flexor and extensor muscles increased immediately in both groups, but the rise in the intervention group was larger than that in the control group (P < .05). CONCLUSION The findings indicated that M1 a-tDCS can induce the efficacy of PT, which has a lasting effect on the improvement of the postural control in athletes with ACL injury.
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3
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Logerstedt DS, Ebert JR, MacLeod TD, Heiderscheit BC, Gabbett TJ, Eckenrode BJ. Effects of and Response to Mechanical Loading on the Knee. Sports Med 2021; 52:201-235. [PMID: 34669175 DOI: 10.1007/s40279-021-01579-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.
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Affiliation(s)
- David S Logerstedt
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA, USA.
| | - Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, WA, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia.,Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia
| | - Toran D MacLeod
- Department of Physical Therapy, Sacramento State University, Sacramento, CA, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, QLD, Australia.,Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Brian J Eckenrode
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
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Bulow A, Anderson JE, Leiter JRS, MacDonald PB, Peeler JD. Safety and Effectiveness of a Perturbation-based Neuromuscular Training Program on Dynamic Balance in Adolescent Females: A Randomized Controlled Trial. Int J Sports Phys Ther 2021; 16:1001-1015. [PMID: 34386279 PMCID: PMC8329312 DOI: 10.26603/001c.25685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adolescent females are at much greater risk for ACL injury than their male counterparts when participating in the same sports. Preventative and pre-operative rehabilitation neuromuscular (NM) exercise programs are often recommended to improve knee function and reduce injury rates. The effectiveness of perturbation-based NM training program has been established in an adult population but has yet to be investigated in the at-risk adolescent female population. PURPOSE To determine the effectiveness of a perturbation-based NM exercise program in a group of physically active adolescent females. STUDY DESIGN Prospective randomized trial. METHODS Twenty-four healthy and an exploratory group of 10 ACL-injured females (ages 12-18) were equally randomized into a perturbation-based NM training or control group and evaluated before and after a five-week intervention period. The primary outcome of dynamic balance was measured using the Y-Balance test (YBT); secondary outcome measures included lower limb strength, proprioception, and flexibility. RESULTS The perturbation-based NM training intervention was safely completed by all participants but had no significant effect on YBT scoring, lower limb strength, proprioception or flexibility in either the healthy or ACL-injured groups. CONCLUSIONS Perturbation-based NM training is safe, but may offer little preventative benefit for healthy or pre-operative rehabilitation benefit for ACL-injured adolescent females. Future research should examine whether the effectiveness of perturbation-based NM training is influenced by the length of the training intervention, training intensity, or when it is combined with other forms of prophylactic or pre-surgical rehabilitation frequently used with at-risk adolescent females who regularly participate in sport. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | | | | | | | - Jason D Peeler
- Human Anatomy & Cell Science, University of Manitoba; Pan Am Clinic
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Ito N, Capin JJ, Arhos EK, Khandha A, Buchanan TS, Snyder-Mackler L. Sex and mechanism of injury influence knee joint loading symmetry during gait 6 months after ACLR. J Orthop Res 2021; 39:1123-1132. [PMID: 32761919 PMCID: PMC7864984 DOI: 10.1002/jor.24822] [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: 09/16/2019] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 02/04/2023]
Abstract
Early-onset knee osteoarthritis (OA) is associated with gait asymmetries after anterior cruciate ligament reconstruction (ACLR). Women have higher risks of sustaining non-contact injuries, and are more likely to present with aberrant movement patterns associated with the mechanism of injury (MOI). We hypothesized that sex and MOI would influence gait after ACLR. Seventy participants, grouped by sex and MOI, completed biomechanical testing during over-ground walking when they had full knee range of motion, trace or less knee effusion, greater than 80% quadriceps strength limb symmetry index, ability to hop on each leg without pain, and initiated running. Bilateral knee kinetics, kinematics, and joint contact forces were compared using mixed-model analysis of variance (α = .05). There was a three-way interaction effect of sex × MOI × limb for peak medial compartment contact force (P = .002), our primary outcome measure previously associated with OA development. Men with non-contact injuries walked with asymmetry characterized by underloading of the involved limb. Men with contact injuries walked with the most symmetrical loading. In women, no clear pattern emerged based on MOI. Targeting, and possibly prioritizing interventions for athletes who present with gait asymmetries after ACLR based on sex and MOI, may be necessary to optimize outcomes. Statement of Clinical Significance: Sex and MOI may influence walking mechanics, and could be considered in future interventions to target gait symmetry, as a response to interventions may vary based on differences in sex and MOI.
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Affiliation(s)
- Naoaki Ito
- Department of Physical Therapy, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Jacob J. Capin
- Department of Physical Therapy, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO,Eastern Colorado Veterans Affairs (VA) Geriatric Research Education and Clinical Center (GRECC), Aurora, CO
| | - Elanna K. Arhos
- Department of Physical Therapy, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Ashutosh Khandha
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Thomas S. Buchanan
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA,Mechanical Engineering, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Department of Biomedical Engineering, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
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6
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Bulow A, Bellemare A, Anderson JE, Leiter JRS, MacDonald PB, Peeler JD. Lower Extremity Kinematics of the Y-Balance Test in Healthy and ACL Injured Adolescent Females. Int J Sports Phys Ther 2021; 16:381-392. [PMID: 33842034 PMCID: PMC8016411 DOI: 10.26603/001c.21529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adolescent females are at significant risk for sustaining an ACL injury. The Y-Balance Test (YBT) is frequently used to evaluate neuromuscular control and lower extremity function. However, few studies have quantified 2D lower extremity kinematics during performance of the YBT, and there is an absence of kinematic data specific to at-risk adolescent females. PURPOSE To examine lower extremity joint kinematics during execution of the YBT by healthy and ACL-injured adolescent females. STUDY DESIGN Prospective cohort. METHODS Twenty-five healthy and ten ACL-injured (mean time from injury 143 days) adolescent females were assessed using the YBT. Sagittal and frontal plane knee and ankle motion was video recorded during execution of the YBT anterior reach movement. Ankle dorsi-flexion, knee flexion, and knee valgus angles were quantified via kinematic analysis. ANOVAs with a post hoc Bonferroni correction were used to compare YBT scoring (%LL) and kinematic data between groups. Pearson product-moment correlations determined the relationship between kinematic data and YBT scoring. RESULTS Healthy and ACL-injured subjects demonstrated similar YBT scores and lower extremity kinematic data. Healthy subjects demonstrated a weak positive correlation between ankle dorsiflexion and YBT scoring, and a weak negative correlation between knee valgus and YBT scoring. These relationships did not exist for ACL-injured subjects. Kinematic data for both groups also demonstrated a large degree of variability, regardless of YBT score. CONCLUSIONS Adolescent females frequently utilize a variety of lower extremity movement strategies when performing a functional movement task, and scoring on the YBT offers limited insight regarding lower extremity joint kinematics and ACL-injury risk in a physically active adolescent female population. LEVEL OF EVIDENCE Level 3.
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Dunphy E, Hamilton FL, Button K, Murray E. A scoping review of the resources needed to deliver anterior cruciate ligament physiotherapy rehabilitation in randomised controlled trials. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1762521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- E. Dunphy
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - F. L. Hamilton
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - K. Button
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - E. Murray
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
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8
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Hop test does not correlate with neuromuscular control during drop vertical jump test: A prognostic comparative study utilizing healthy subjects. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Smith AH, Capin JJ, Zarzycki R, Snyder-Mackler L. Athletes With Bone-Patellar Tendon-Bone Autograft for Anterior Cruciate Ligament Reconstruction Were Slower to Meet Rehabilitation Milestones and Return-to-Sport Criteria Than Athletes With Hamstring Tendon Autograft or Soft Tissue Allograft : Secondary Analysis From the ACL-SPORTS Trial. J Orthop Sports Phys Ther 2020; 50:259-266. [PMID: 31775553 PMCID: PMC7196003 DOI: 10.2519/jospt.2020.9111] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Graft choices for athletes undergoing anterior cruciate ligament reconstruction (ACLR) include bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts and soft tissue allografts. The objective was to assess time to meet clinical milestones by graft type in athletes who completed a return-to-sport (RTS) program after ACLR. DESIGN Retrospective cohort study. METHODS Seventy-nine athletes enrolled after ACLR (allograft, n = 18; BPTB, n = 24; HT, n = 37). Time from surgery to meet (1) enrollment criteria (12 or more weeks post surgery, 80% or greater isometric quadriceps strength index, minimal effusion, and full knee range of motion), and (2) RTS criteria (90% or greater quadriceps strength index, hop testing limb symmetry, and patient-reported outcomes) was calculated. Quadriceps strength, hop performance, and patient-reported outcomes were measured before and after training, and at 1 year post surgery. Descriptive statistics, chi-square tests, and 1-way analyses of variance (α = .05) were used to analyze differences among graft types. RESULTS On average, the BPTB group (28.5 ± 7.6 weeks) took longer to meet enrollment milestones than the HT (22.5 ± 7.6 weeks, P = .007) and allograft (18.9 ± 5.8 weeks, P<.001) groups. The BPTB group (44.7 ± 15.8 weeks) took longer from surgery to meet RTS criteria than the HT (32.5 ± 9.9 weeks, P = .001) and allograft (29.3 ± 9.0 weeks, P<.001) groups. After training, the quadriceps strength index was lower in the BPTB group (86.1% ± 11.4%) than it was in the HT (96.1% ± 12.9%, P = .004) and allograft (96.9% ± 5.9%, P = .009) groups. CONCLUSION Athletes with a BPTB autograft may take longer than athletes with an HT autograft or a soft tissue allograft to complete postoperative rehabilitation, recover quadriceps strength, and meet RTS criteria. J Orthop Sports Phys Ther 2020;50(5):259-266. Epub 27 Nov 2019. doi:10.2519/jospt.2020.9111.
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Flowers D, Olmedo M. Non-surgical management of a tibiofemoral knee dislocation in a patient with sarcoidosis. BMJ Case Rep 2019; 12:12/11/e229605. [PMID: 31678917 DOI: 10.1136/bcr-2019-229605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case presents a patient who sustained a knee dislocation, and who due to her diagnosis of sarcoidosis, other comorbidities, and prolonged use of corticosteroids, external fixation and physical therapy were implemented versus soft tissue reconstruction/repair. Research indicates worse functional outcomes with non-surgical treatment, and guidelines on optimising outcomes in this population are lacking. Integrated care of the patient-even when complex injuries and comorbid medical conditions are present-can lead to positive functional recovery, despite previous data. Evidence from related injuries can be successfully adapted in non-surgical management of these injuries, providing general treatment guidelines.
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Affiliation(s)
- Daniel Flowers
- Rehabilitation Sciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Margaret Olmedo
- Orthopaedic Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
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11
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Clinical and Biomechanical Efficacies of Mechanical Perturbation Training After Anterior Cruciate Ligament Rupture. J Sport Rehabil 2019; 28:877-886. [PMID: 30300071 DOI: 10.1123/jsr.2017-0363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 08/11/2018] [Accepted: 08/27/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Manual perturbation training improves knee functional performance and mitigates abnormal gait in patients with anterior cruciate ligament (ACL) rupture. However, manual perturbation training is time- and labor-intensive for therapists. OBJECTIVE To investigate whether perturbation training administered using a mechanical device can provide effects similar to manual training on clinical measures and knee biomechanics after ACL rupture. DESIGN Prospective cohort (therapeutic) study. A 2 × 2 analysis of variance was used for statistical analysis. SETTING A clinical and biomechanical laboratory. PATIENTS Eighteen level I/II patients with acute ACL ruptures participated in this preliminary study. INTERVENTION Nine patients received mechanical perturbation training on an automated mechanical device (mechanical group), and 9 patients received manual perturbation training (manual group). OUTCOME MEASURES Patients completed performance-based testing (quadriceps strength and single-legged hop tests), patient-reported questionnaires (Knee Outcome Survey-Activities of Daily Living Scale, Global Rating Score, and International Knee Documentation Committee 2000), and 3-dimensional gait analysis before (pretesting) and after (posttesting) training. RESULTS There was no significant group-by-time interaction found for all measures (P ≥ .18). Main effects of time were found for International Knee Documentation Committee 2000 (pretesting: 69.10 [10.95], posttesting: 75.14 [7.19]), knee excursion during weight-acceptance (pretesting: 16.01° [3.99°]; posttesting: 17.28° [3.99°]) and midstance (pretesting: 14.78° [4.13°]; posttesting: 16.92° [4.53°]) and external knee-flexion moment (pretesting: 0.43 [0.11] N m/kg/m; posttesting: 0.48 [0.11] N m/kg/m) (P ≤ .04). After accounting for pretesting groups' differences, the mechanical group scored significantly higher on triple hops (mechanical: 96.73% [6.65%]; manual: 84.97% [6.83%]) and 6-m timed hops (mechanical: 102.07% [9.50%]; manual: 91.21 [9.42%]) (P ≤ .047) compared with manual group. CONCLUSION The clinical significance of this study is the mechanical perturbation training produced effects similar to manual training, with both training methods were equally effective at improving patients' perception of knee function and increasing knee excursion and external flexion moment during walking after acute ACL rupture. Mechanical perturbation training is a potential treatment to improve patients' functional and biomechanical outcomes after ACL rupture.
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12
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Statistical Parametric Mapping as a Measure of Differences Between Limbs: Applications to Clinical Populations. J Appl Biomech 2019; 35:377–387. [PMID: 31629339 DOI: 10.1123/jab.2018-0392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 07/02/2019] [Accepted: 07/15/2019] [Indexed: 11/18/2022]
Abstract
In healthy individuals, symmetrical lower-extremity movement is often assumed and calculated using discrete points during various tasks. However, measuring overall movement patterns using methods such as statistical parametric mapping (SPM) may allow for better interpretation of human movement. This study demonstrated the ability of SPM to assess interlimb differences in lower-extremity movement during 2 example tasks: running and landing. Three-dimensional motion analysis was used to determine sagittal and frontal plane lower-extremity joint angles in (1) young and older individuals during running and (2) patients with anterior cruciate ligament reconstruction and uninjured control athletes during landing. Interlimb differences within each group were compared using SPM and paired t tests on peak discrete angles. No differences between limbs were found between young and older runners using SPM. Peak ankle eversion and plantar flexion angles differed between limbs in young and older runners. Sagittal plane hip angle varied between limbs in uninjured control athletes. Frontal plane ankle angle and sagittal plane knee and hip angles differed between limbs in patients with anterior cruciate ligament reconstruction using SPM and discrete analysis. These data suggest that SPM can be useful to determine clinically meaningful interlimb differences during running and landing in multiple populations.
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13
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Smale KB, Alkjaer T, Flaxman TE, Krogsgaard MR, Simonsen EB, Benoit DL. Predicting post-operative functional ability from pre-operative measures in ACL-injured individuals. Scand J Med Sci Sports 2019; 30:166-173. [PMID: 31486128 DOI: 10.1111/sms.13549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aimed to quantify the relationship between objective and subjective measures of functional ability and determine if measures in the deficient (ACLd) state were correlated to, and capable of predicting a patient's objective and subjective measures in the reconstructed (ACLr) state. METHODS Twenty ACL-injured participants completed hop and side cut movements prior to and 10 months post-reconstruction. Their subjective measures (Tegner, Lysholm, IKDC, KOOS, and KNEEs) were related to objective measures of functional ability (peak knee flexion, peak knee extensor moment, stiffness, knee joint center excursion (KJCE), and knee joint center boundary). Correlations were used to determine relationships between variables whereas regressions were used to identify ACLd score's predictive ability of an ACLr score. RESULTS Relationships between objective and subjective measures were task and ACL status dependent with KJCE and stiffness most commonly being related to subjective scores. The greatest correlation was between knee stiffness and Tegner in the ACLr group during the side cut (r = 0.69). Peak knee flexion angle (adj. R2 = 0.4-0.66) was the best objective predictor between ACLd and ACLr states while KOOS-ADL had the strongest correlations (r = 0.70-0.77) and Tegner had the greatest predictive power (odds ratio: 1.46-1.86) between states in both tasks. CONCLUSION Objective measures show a wide range of correlation to subjective measures with some being quite strong. Furthermore, objective measures in the ACLd state are more correlated and more often capable of predicting ACLr scores than the subjective measures of functional ability.
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Affiliation(s)
- Kenneth B Smale
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Tine Alkjaer
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Teresa E Flaxman
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Michael R Krogsgaard
- Section for Sports Traumatology M51, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Erik B Simonsen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Daniel L Benoit
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada.,School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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14
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Capin JJ, Failla M, Zarzycki R, Dix C, Johnson JL, Smith AH, Risberg MA, Huston LJ, Spindler KP, Snyder-Mackler L. Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in 10 Return-to-Sport Training Sessions: Comparison of ACL-SPORTS Randomized Controlled Trial With Delaware-Oslo and MOON Cohorts. Orthop J Sports Med 2019; 7:2325967119861311. [PMID: 31413963 PMCID: PMC6676263 DOI: 10.1177/2325967119861311] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Outcomes after anterior cruciate ligament reconstruction (ACLR) are not uniformly good and are worse among young female athletes. Developing better rehabilitation and return-to-sport training programs and evaluating their outcomes are essential. Purpose: (1) Test the effect of strength, agility, plyometric, and secondary prevention (SAPP) exercises with and without perturbation training (SAPP + PERT) on strength, hops, function, activity levels, and return-to-sport rates in young female athletes 1 and 2 years after ACLR and (2) compare 2-year functional outcomes and activity levels among young female athletes in the Anterior Cruciate Ligament Specialized Post-Operative Return-to-Sports (ACL-SPORTS) trial to homogeneous cohorts who completed criterion-based postoperative rehabilitation alone (Multicenter Orthopaedic Outcomes Network [MOON]) and in combination with extended preoperative rehabilitation (Delaware-Oslo). Study Design: Randomized controlled trial, Level of evidence, 1; and cohort study, Level of evidence, 3. Methods: A total of 40 level 1 and level 2 female athletes were enrolled after postoperative impairment resolution 3 to 9 months after primary ACLR. Participants were randomized to 10 SAPP or SAPP + PERT sessions and were tested 1 and 2 years after ACLR on quadriceps strength, hop tests, functional outcomes, and return-to-sport rates. Participants were then compared with homogeneous cohorts of young (<25 years) female athletes who completed criterion-based postoperative rehabilitation alone (MOON) and in combination with extended preoperative rehabilitation (Delaware-Oslo) on 2-year functional outcomes. Results: No significant or meaningful differences were found between SAPP and SAPP + PERT, so groups were collapsed for comparison with the other cohorts. At 2-year follow-up, ACL-SPORTS had the highest scores (P < .01) on the Marx activity rating scale (ACL-SPORTS, 13.5 ± 3.3; Delaware-Oslo, 12.5 ± 2.7; MOON, 10.6 ± 5.1); International Knee Documentation Committee Subjective Knee Evaluation Form (96 ± 7, 92 ± 9, and 84 ± 14, respectively); and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales for Pain (98 ± 4, 94 ± 9, and 90 ± 10, respectively), Symptoms (94 ± 6, 90 ± 9, and 83 ± 14, respectively), Activities of Daily Living (100 ± 1, 99 ± 4, and 96 ± 7, respectively), Sports and Recreation (94 ± 8, 86 ± 15, and 82 ± 17, respectively), and Quality of Life (89 ± 14, 78 ± 18, and 76 ± 19, respectively). The Patient Acceptable Symptom State threshold on the KOOS–Sports and Recreation was achieved by 100% of the ACL-SPORTS cohort compared with 90% of Delaware-Oslo and 78% of MOON (P = .011). Conclusion: Although perturbation training provided no added benefit, 10 sessions of return-to-sport training, compared with criterion-based postoperative rehabilitation alone, yielded statistically significant and clinically meaningfully higher 2-year functional outcomes among young, high-level female athletes after ACLR. Registration: NCT01773317 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jacob J Capin
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Mathew Failla
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Ryan Zarzycki
- Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Celeste Dix
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Jessica L Johnson
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Angela H Smith
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - May Arna Risberg
- Department of Sport Medicine, Norwegian School of Sports Sciences, Oslo, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Laura J Huston
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Smale KB, Flaxman TE, Alkjaer T, Simonsen EB, Krogsgaard MR, Benoit DL. Anterior cruciate ligament reconstruction improves subjective ability but not neuromuscular biomechanics during dynamic tasks. Knee Surg Sports Traumatol Arthrosc 2019; 27:636-645. [PMID: 30306241 DOI: 10.1007/s00167-018-5189-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 10/01/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to identify high-functioning anterior cruciate ligament-deficient patients and assess the effects of reconstruction on their self-reported functionality, muscle activations and biomechanical properties. METHODS Twenty young and active patients participated pre- (11.5 ± 14.3 months post-injury) and again 10.5 ± 1.7 months post-reconstruction and were individually matched to 20 healthy controls. Participants completed hop and side cut movements while patient-related outcome measures, lower limb electromyography, kinetic, and whole body kinematic data were collected. One-dimensional statistical parametric mapping was used to test for group differences (healthy vs deficient; deficient vs reconstructed; reconstructed vs healthy). RESULTS When comparing healthy to anterior cruciate ligament-deficient participants, all questionnaires indicated significant lower subjective function while the only substantial biomechanical difference between these participants was a decreased knee extensor moment in both the hop (peak difference: 0.63 Nm/kg, p < 0.001) and side cut (peak difference: 0.76 Nm/kg, p < 0.001). When comparing patients' pre- and post-reconstruction, no biomechanical differences were observed whereas only half of the questionnaires (Tegner, Lysholm, KNEES-ADL, KNEES-Slackness, KNEES-Looseness, KNEES-Sport Behaviour, IKDC, and KOOS-QoL) indicated higher function in the reconstructed state. When comparing the reconstructed patients to the healthy participants, all questionnaires were still significantly higher in the healthy controls. The reconstructed group also had a smaller flexion angle (peak difference: 14.5°, p = 0.007) and knee extensor moment (peak difference: 0.62 Nm/kg, p < 0.001) during the hop and a smaller knee extensor moment (peak difference: 0.90 Nm/kg, p < 0.001) during the side-cut task. CONCLUSION At 10-months post-reconstruction, the current results indicate that in high-functioning anterior cruciate ligament-deficient patients, reconstruction had little impact on objective measures of functional ability during dynamic tasks although self-reported function was improved. LEVEL OF EVIDENCE Therapeutic prospective cohort study, Level II.
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Affiliation(s)
- Kenneth B Smale
- School of Human Kinetics, University of Ottawa, 200 Lees Avenue, Ottawa, K1S 5S9, Canada
| | - Teresa E Flaxman
- School of Rehabilitation Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, K1S 5S9, Canada
| | - Tine Alkjaer
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Erik B Simonsen
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Michael R Krogsgaard
- Section for Sports Traumatology M51 (a part of IOC Sports Medicine Copenhagen), Bispebjerg-Frederiksberg Hospital, Frederiksberg, Denmark
| | - Daniel L Benoit
- School of Human Kinetics, University of Ottawa, 200 Lees Avenue, Ottawa, K1S 5S9, Canada. .,School of Rehabilitation Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, K1S 5S9, Canada.
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16
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Capin JJ, Khandha A, Zarzycki R, Arundale AJH, Ziegler ML, Manal K, Buchanan TS, Snyder-Mackler L. Gait mechanics and tibiofemoral loading in men of the ACL-SPORTS randomized control trial. J Orthop Res 2018; 36:2364-2372. [PMID: 29575090 PMCID: PMC6157011 DOI: 10.1002/jor.23895] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/09/2018] [Indexed: 02/04/2023]
Abstract
The risk for post-traumatic osteoarthritis is elevated after anterior cruciate ligament reconstruction (ACLR), and may be especially high among individuals with aberrant walking mechanics, such as medial tibiofemoral joint underloading 6 months postoperatively. Rehabilitation training programs have been proposed as one strategy to address aberrant gait mechanics. We developed the anterior cruciate ligament specialized post-operative return-to-sports (ACL-SPORTS) randomized control trial to test the effect of 10 post-operative training sessions consisting of strength, agility, plyometric, and secondary prevention exercises (SAPP) or SAPP plus perturbation (SAPP + PERT) training on gait mechanics after ACLR. A total of 40 male athletes (age 23 ± 7 years) after primary ACLR were randomized to SAPP or SAPP + PERT training and tested at three distinct, post-operative time points: 1) after impairment resolution (Pre-training); 2) following 10 training sessions (Post-training); and 3) 2 years after ACLR. Knee kinematic and kinetic variables as well as muscle and joint contact forces were calculated via inverse dynamics and a validated electromyography-informed musculoskeletal model. There were no significant improvements from Pre-training to Post-training in either intervention group. Smaller peak knee flexion angles, extension moments, extensor muscle forces, medial compartment contact forces, and tibiofemoral contact forces were present across group and time, however the magnitude of interlimb differences were generally smaller and likely not meaningful 2 years postoperatively. Neither SAPP nor SAPP + PERT training appears effective at altering gait mechanics in men in the short-term; however, meaningful gait asymmetries mostly resolved between post-training and 2 years after ACLR regardless of intervention group. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2364-2372, 2018.
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Affiliation(s)
- Jacob J. Capin
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
| | | | - Ryan Zarzycki
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
| | | | - Melissa L. Ziegler
- Biostatistics Core, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Kurt Manal
- Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Thomas S. Buchanan
- Biomedical Engineering, University of Delaware, Newark, DE, USA
- Mechanical Engineering, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
- Biomedical Engineering, University of Delaware, Newark, DE, USA
- Physical Therapy, University of Delaware, Newark, DE, USA
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17
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Diermeier T, Herbst E, Braun S, Saracuz E, Voss A, Imhoff AB, Achtnich A. Outcomes after bone grafting in patients with and without ACL revision surgery: a retrospective study. BMC Musculoskelet Disord 2018; 19:246. [PMID: 30031398 PMCID: PMC6054851 DOI: 10.1186/s12891-018-2174-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current literature is lacking of data regarding functional outcomes in patients following bone tunnel grafting with or without revision anterior cruciate ligament (ACL) reconstruction. Therefore, the aim of the present study was to evaluate the clinical outcome in patients with (RACL) or without revision ACL reconstruction (OBG) following bone grafting. METHODS Fifty-nine patients (18 female, 41 male) who underwent bone grafting due to recurrent, symptomatic ACL deficiency following ACL reconstruction between 2011 and 2014 were retrospectively analyzed. In 44 patients (mean age: 30,5 ± 8,5 years) a staged revision ACL reconstruction (RACL) was performed after bone grafting. 10 patients (mean age: 33.2 ± 10.3 years) refused to have ACL revision surgery after bone grafting (OBG). Outcome measures included instrumented laxity testing, the International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score and Tegner activity scale. RESULTS After mean period of 33,9 ± 17.0 months, 54 patients were available for follow up examination. In the RACL group, the Lysholm score was 77,2 ± 15,5 (range 35-100), the mean IKDC subjective knee score was 69,0 ± 13,4 (range 39,1-97,7) and the mean Tegner activity score was 4,1 ± 1,5 (range, 1-9). Similarly, in the OBG group the mean Lysholm score was 72,90 ± 18,7 (range 50-100), the mean IKDC subjective score was 69,3 ± 20,0 (range 44,1-100) and the mean Tegner activity score was 4,6 ± 1,2 (range, 3-6). No significant difference was observed between the two groups. Knee laxity measurements were elevated without revision ACL surgery, however the difference was not significant. CONCLUSION Bone tunnel grafting with or without second stage ACL revision surgery showed no significant difference in functional outcome score. Thus, in case of revision ACL instability careful patient selection is necessary and expectations should be discussed openly with the patients.
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Affiliation(s)
- Theresa Diermeier
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Elmar Herbst
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sepp Braun
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Emine Saracuz
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas Voss
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Andrea Achtnich
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
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18
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Nawasreh Z, Failla M, Marmon A, Logerstedt D, Snyder-Mackler L. Comparing the effects of mechanical perturbation training with a compliant surface and manual perturbation training on joints kinematics after ACL-rupture. Gait Posture 2018; 64:43-49. [PMID: 29852358 PMCID: PMC6062476 DOI: 10.1016/j.gaitpost.2018.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/15/2018] [Accepted: 05/22/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Performing physical activities on a compliant surface alters joint kinematics and increases joints stiffness. However, the effect of compliant surface on joint kinematics after ACL-rupture is yet unknown. AIM To compare the effects of mechanical perturbation training with a compliant surface to manual perturbation training on joint kinematics after ACL-rupture. METHODS Sixteen level I/II athletes with ACL-rupture participated in this preliminary study. Eight patients received mechanical perturbation with compliant surface (Mechanical) and 8 patients received manual perturbation training (Manual). Patients completed standard gait analysis before (Pre) and after (Post) training. RESULTS Significant group-by-time interactions were found for knee flexion angle at initial contact (IC) and peak knee flexion (PKF) (p<0.004), with manual group significantly increased knee flexion angle at IC and PKF (p<0.03). Main effects of group were found for hip flexion angle at IC (Manual:34.34+3.51°, Mechanical:27.68+4.08°, p = 0.011), hip rotation angle at PKE (Manual:-3.40+4.78°, Mechanical:5.43+4.78°, p < 0.0001), and knee adduction angle at PKE (Manual:-2.00+2.23°, Mechanical:0.55+2.23°, p = 0.039). Main effects of time were found for hip adduction angle at PKE (Pre:6.98+4.48°, Post:8.41+4.91°, p = 0.04), knee adduction angle at IC (Pre:-2.90+3.50°, Post:-0.62+2.58°, p = 0.03), ankle adduction angle at IC (Pre:2.16+3.54, Post:3.8+3.68, p = 0.008), and ankle flexion angle at PKF (Pre:-4.55+2.77°, Post:-2.39+3.48°, p = 0.01). DISCUSSION Training on a compliant surface induces different effects on joint kinematics compared to manual perturbation training after ACL-rupture. Manual perturbation improved hip alignment and increased knee flexion angles, while mechanical training decreased knee flexion angles throughout the stance phase. Administering training on a compliant surface after ACL-rupture may help improving dynamic knee stability, however, long-term effects on knee health needs to be determined.
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Affiliation(s)
- Zakariya Nawasreh
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA,Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan
University of Science and Technology, Irbid, Jordan,Corresponding author at: P.O. Box 3030, Irbid, 22110, Jordan., (Z.
Nawasreh)
| | - Mathew Failla
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Adam Marmon
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - David Logerstedt
- University of the Sciences, Department of Physical Therapy, Philadelphia, PA, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA,Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
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19
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Arundale AJH, Capin JJ, Zarzycki R, Smith A, Snyder-Mackler L. Functional and Patient-Reported Outcomes Improve Over the Course of Rehabilitation: A Secondary Analysis of the ACL-SPORTS Trial. Sports Health 2018; 10:441-452. [PMID: 29924719 PMCID: PMC6116107 DOI: 10.1177/1941738118779023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Anterior Cruciate Ligament-Specialized Post-Operative Return to Sports (ACL-SPORTS) randomized controlled trial was designed to address deficits in functional and patient-reported outcomes. The trial examined the effects of a secondary ACL prevention program that included progressive strengthening, agility training, plyometrics (SAP), and other components of current primary prevention protocols, with perturbation training (SAP + PERT group) and without PERT (SAP group). A secondary purpose of this study was to examine whether study outcomes differed between men and women. HYPOTHESES (1) Athletes in both the SAP and SAP + PERT groups will have improved knee function and patient-reported outcome measures from pre- to posttraining, (2) the SAP + PERT group would have higher outcome scores than the SAP group, and (3) outcomes will differ by sex. STUDY DESIGN Randomized controlled trial (NCT01773317). LEVEL OF EVIDENCE Level 2. METHODS A total of 79 athletes (39 women) were randomized into the SAP and SAP + PERT groups. All athletes had undergone primary ACL reconstruction and achieved 80% quadriceps strength limb symmetry (QI), full range of motion, had minimal effusion, and had no pain. Additionally, all had begun running again. Prior to and after the training program, athletes' QI, hopping, and patient-reported outcomes were assessed. Repeated-measures analyses of variance were used to determine whether there were differences between groups. Subsequently, the SAP and SAP + PERT groups were collapsed to analyze differences between sexes. RESULTS There were significant increases for all variables, with the exception of QI. There were no differences between the SAP and SAP + PERT groups. Both men and women made significant improvements in all knee function and patient-reported outcome measures except QI. Men made significant improvements in QI, whereas women did not. CONCLUSION The common elements of the training program that all athletes received (10 sessions of progressive strengthening, agility training, plyometrics, and secondary prevention) may be a beneficial addition to the return-to-sport phase of ACL reconstruction rehabilitation. The results suggest that women may require further quadriceps strengthening to maintain and improve QI, an important focus given the relationship between QI and risk for reinjury. CLINICAL RELEVANCE During the return-to-sport phase of ACL reconstruction rehabilitation, clinicians tend to shift their focus away from strengthening toward more advanced sports-related tasks. These results indicate that women in particular need continued focus on quadriceps strengthening.
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Affiliation(s)
- Amelia J H Arundale
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
| | - Jacob J Capin
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
| | - Ryan Zarzycki
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
| | - Angela Smith
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware.,Department of Physical Therapy, University of Delaware, Newark, Delaware
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20
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Nawasreh Z, Logerstedt D, Cummer K, Axe M, Risberg MA, Snyder-Mackler L. Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery. Br J Sports Med 2017; 52:375. [PMID: 28954801 DOI: 10.1136/bjsports-2016-097095] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Assessing athletes' readiness is a key component for successful outcomes after ACL reconstruction (ACLR). OBJECTIVES To investigate whether return-to-activity criteria, individually or in combination, at 6 months after ACLR can predict return to participation in the same preinjury activity level at 12 and 24 months after ACLR. METHODS Ninety-five level I/II participants completed return-to-activity criteria testing (isometric quadriceps index, single-legged hop tests, Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and Global Rating Score (GRS)) at 6 months after ACLR. The PASS group was defined as scoring >90% on all criteria and the FAIL group as scoring <90% on any criteria. At 12 and 24 months after ACLR, participants were asked if they had returned to participate in the same preinjury activity level or not. All return-to-activity criteria, except quadriceps index, were entered into the logistic regression model. RESULTS 81% and 84.4% of the PASS group returned to participation in the same preinjury activity level, while only 44.2% and 46.4% of the FAIL group returned at 12 and 24 months, respectively, after ACLR. The 6-meter timed hop, single hop and triple hop limb symmetry indexes; GRS; and KOS-ADLS individually predicted the outcome of interest at 12 months after ACLR (range: R2: 0.12-0.22, p<0.024). In combination, they explained 27% of the variance (p=0.035). All hop tests, individually, predicted the outcome of interest at 24 months after ACLR (range: R2: 0.26-0.37; p<0.007); in combination they explained 45% of the variance (p<0.001). CONCLUSION Return to participation in the same preinjury activity level at 12 and 24 months after ACLR was higher in those who passed the criteria compared with those who failed. Individual and combined return-to-activity criteria predicted the outcomes of interest, with the hop tests as consistent predictors at 12 and 24 months after ACLR.
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Affiliation(s)
- Zakariya Nawasreh
- Department of Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, Delaware, USA.,Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - David Logerstedt
- Department of Physical Therapy, University of the Sciences, Philadelphia, Pennsylvania, USA.,Delaware Rehabilitation Institute, University of Delaware, Newark, Delaware, USA
| | - Kathleen Cummer
- Department of Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Michael Axe
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, USA.,Department of Orthopedics, First State Orthopedics, Newark, Delaware, USA
| | - May Arna Risberg
- Division of Orthopedic Surgery, Department of Sports Medicine, Norwegian Research Center for Active Rehabilitation, Norwegian School of Sport Sciences, Oslo University Hospital, Oslo, Norway
| | - Lynn Snyder-Mackler
- Department of Biomechanics and Movement Science program, College of Health Sciences, University of Delaware, Newark, Delaware, USA.,Delaware Rehabilitation Institute, University of Delaware, Newark, Delaware, USA.,Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, USA
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21
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Panariello RA, Stump TJ, Allen AA. Rehabilitation and Return to Play Following Anterior Cruciate Ligament Reconstruction. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2017.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update to the most objective, evidence-based path through a non-operative course of rehabilitation after anterior cruciate ligament injury for those hoping to return to pivoting and cutting sports. RECENT FINDINGS Anterior cruciate ligament (ACL) injuries are prevalent in pivoting and cutting athletes with many of these patients electing to pursue surgical reconstruction in hopes of returning to prior levels of function. Despite many athletes pursing ACL reconstruction, some may elect to pursue a non-operative course of care. Success with this treatment plan should be defined as the ability to return to sport without subsequent giving way episodes. Identification of those most likely to successfully return to sport with a non-operative course begins with completion of an evidence-based screening tool. If the patient has no concomitant injury and successfully passes the screening, they may proceed to a systematic, evidence-based progression through rehabilitation. Finally, the patient must complete a return to sport program and meet appropriate objective criteria, prior to return to sport.
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Affiliation(s)
- Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 10001, Cincinnati, OH, 45229, USA.
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23
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Iliopoulos E, Galanis N, Iosifidis M, Zafeiridis A, Papadopoulos P, Potoupnis M, Geladas N, Vrabas IS, Kirkos J. Anterior cruciate ligament deficiency reduces walking economy in "copers" and "non-copers". Knee Surg Sports Traumatol Arthrosc 2017; 25:1403-1411. [PMID: 26231149 DOI: 10.1007/s00167-015-3709-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 07/13/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Patients with ACL injury requiring surgical treatment (non-copers) demonstrate altered neuromuscular control and gait pattern compared with those returning to their pre-injury activities without surgery (copers). Pathological gait pattern may increase the energy cost of walking. We compared the energy cost of flat, uphill, and downhill walking between ACL-deficient and healthy individuals and between "copers" and "non-copers". METHODS Nineteen young males with unilateral ACL injury were allocated into "copers" and "non-copers" according to their ability to return to pre-injury activity without ACL reconstruction. Lysholm and IKDC scales were recorded, and a control group (n = 10) matched for physical characteristics and activity levels was included. All participants performed 8-min walking tasks at 0, +10, and -10 % gradients. Energy cost was assessed by measurement of oxygen consumption (VO2). HR and ventilation (VE), respiratory exchange ratio (RER), and VE/VO2 were also measured. RESULTS VO2 and HR were higher in ACL-deficient patients than in controls during walking at 0, +10, and -10 % gradients (p < 0.01-0.05). There were no differences between "copers" and "non-copers" in VO2 and HR for any gradient. No differences were observed in VE, RER, and VE/VO2 among the three groups. CONCLUSIONS The walking economy of level, uphill, and downhill walking is reduced in ACL-deficient patients. Despite the improved functional and clinical outcome of "copers", their walking economy appears similar to that of "non-copers" but impaired compared with healthy individuals. The higher energy demand and effort during locomotion in "copers" and "non-copers" has clinical implications for designing safer rehabilitation programmes. The increased energy cost in "copers" may be another parameter to consider when deciding on the most appropriate therapeutic intervention (operative and non-operative), particularly for athletes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Efthymios Iliopoulos
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece
| | - Nikiforos Galanis
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece.
| | - Michael Iosifidis
- Sports Medicine Unit, 2nd Orthopaedic Department, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Pericles Papadopoulos
- 1st Department of Orthopaedics, Papanikolaou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Potoupnis
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece
| | - Nikolaos Geladas
- Department of Sport Medicine and Biology of Exercise, School of Physical Education and Sport Science, University of Athens, Athens, Greece
| | - Ioannis S Vrabas
- Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - John Kirkos
- Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece
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Nawasreh Z, Logerstedt D, Cummerm K, Axe MJ, Risberg MA, Snyder-Mackler L. Do Patients Failing Return-to-Activity Criteria at 6 Months After Anterior Cruciate Ligament Reconstruction Continue Demonstrating Deficits at 2 Years? Am J Sports Med 2017; 45:1037-1048. [PMID: 28125899 PMCID: PMC5376235 DOI: 10.1177/0363546516680619] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The variability in outcomes after anterior cruciate ligament reconstruction (ACLR) might be related to the criteria that are used to determine athletes' readiness to return to their preinjury activity level. A battery of return-to-activity criteria (RTAC) that emphasize normal knee function and movement symmetry has been instituted to quantitatively determine athletes' readiness to return to preinjury activities. PURPOSE To investigate performance-based and patient-reported measures at 12 and 24 months after ACLR between patients who passed or failed RTAC at 6 months after ACLR. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 108 patients who had participated in International Knee Documentation Committee level 1 or 2 sports activities completed RTAC testing at 6, 12, and 24 months after surgery. The RTAC included the isometric quadriceps strength index (QI), 4 single-legged hop tests, the Knee Outcome Survey-activities of daily living subscale (KOS-ADLS), and the global rating scale of perceived function (GRS). Patients who scored ≥90% on all RTAC were classified as the pass group, and those who scored <90% on any RTAC were classified as the fail group. At 12- and 24-month follow-ups, patients were asked if they had returned to the same preinjury activity level. RESULTS At the 6-month follow-up, there were 48 patients in the pass group and 47 in the fail group. At the 12-month follow-up, 31 patients (73.8%) from the pass group and 15 patients (39.5%) from the fail group passed RTAC, and at the 24-month follow-up, 25 patients (75.8%) from the pass group and 14 patients (51.9%) from the fail group passed RTAC. The rate of return to activities in the pass group was 81% and 84% at 12 and 24 months after ACLR, respectively, compared with only 44% and 46% in the fail group ( P ≤ .012), respectively; however, some patients in the fail group participated in preinjury activities without being cleared by their therapists. At 12 and 24 months, 60.5% and 48.1% of patients continued to fail again on the criteria, respectively. A statistically significant group × time interaction was found for the single hop and 6-m timed hop limb symmetry indices (LSIs) ( P ≤ .037), with only the fail group demonstrating a significant improvement over time. A main effect of group was detected for the QI and the crossover hop and triple hop LSIs ( P < .01), with patients in the pass group demonstrating higher performance. A main effect of time was detected for the crossover hop and triple hop LSIs and the GRS, with improvements seen in both groups ( P < .05). CONCLUSION Patients who passed the RTAC early after ACLR were more likely to demonstrate normal knee function and movement symmetry at 12 and 24 months postoperatively, while patients who failed the RTAC early were more likely to demonstrate impaired knee function and movement asymmetry at 12- and 24-month follow-ups. Patients in the pass group had a higher rate of return to their preinjury activity level compared with those in the fail group. A group of patients chose to return to their preinjury activities, even though they were functionally not ready.
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Affiliation(s)
- Zakariya Nawasreh
- Address correspondence to Zakariya Nawasreh, BPT, MS, PhD, Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan ()
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Nguyen JT, Wasserstein D, Reinke EK, Spindler KP, Mehta N, Doyle JB, Marx RG. Does the Chronicity of Anterior Cruciate Ligament Ruptures Influence Patient-Reported Outcomes Before Surgery? Am J Sports Med 2017; 45:541-549. [PMID: 27802963 PMCID: PMC5770240 DOI: 10.1177/0363546516669344] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The time between an anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) may influence baseline knee-related and general health-related patient-reported outcome measures (PROMs). Despite the common use of PROMs as main outcomes in clinical studies, this variable has never been evaluated. PURPOSE To compare baseline health-related quality of life measures and the prevalence/pattern of meniscal and articular cartilage lesions between patients who underwent acute and chronic ACLR so as to provide clinicians with benchmark PROMs in 2 different patient populations with ACL injuries. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 1192 patients from the MOON (Multicenter Orthopaedic Outcomes Network) cohort who underwent primary ACLR were eligible. "Acute" ACLR was defined as <3 months (n = 853; 71.6%) and "chronic" ACLR as >6 months (n = 339; 28.4%) from injury. Patient demographics, surgical characteristics (articular cartilage injury, medial meniscal [MM] and lateral meniscal [LM] tears), and baseline PROM scores (Marx activity rating scale, International Knee Documentation Committee [IKDC] subjective form, Knee injury and Osteoarthritis Outcome Score [KOOS], and Short Form-36 Health Survey [SF-36]) were collected to determine whether the time from injury to ACLR influences (1) baseline PROMs and (2) the pattern and prevalence of concurrent articular cartilage and meniscal injuries. Analysis of covariance models were used to adjust for confounders on baseline outcome scores (age, sex, body mass index [BMI], smoking status, competition level, education). RESULTS The median patient age was 23 years (interquartile range [IQR], 17-35 years), 530 (44.5%) were female, and the median BMI was 25.0 kg/m2 (IQR, 22.3-27.9 kg/m2); however, the chronic group was older, had a higher BMI, and consisted of fewer collegiate athletes. A significantly greater number of partial LM tears were seen in the acute group versus the chronic group (14.2% vs 6.5%, respectively; P < .001), but there were more meniscal tears overall (73.5% vs 63.2%, respectively; P = .001), complete MM tears (49.0% vs 22.5%, respectively; P < .001), and articular cartilage injuries (54.0% vs 32.8%, respectively; P < .001) in the chronic group versus the acute group. After controlling for confounders, patients in the chronic ACLR group reported a significantly lower baseline Marx score (7.75 vs 12.10, respectively; P < .001) but higher baseline IKDC, SF-36 physical functioning, and all KOOS subscale scores except the KOOS-quality of life subscale score compared to those in the acute ACLR group; however, only the KOOS-sports and recreation subscale exceeded the minimum clinically importance difference of 8 points (62.30 vs 48.26, respectively; P < .001). CONCLUSION After controlling for age, sex, competition level, smoking, and BMI, patients in the chronic ACLR group participated in less pivoting and cutting sports but reported better pain/function. Whether decreased activity is deliberate after an ACL injury or patients who undergo chronic ACLR are simply less active and may be treated successfully without surgery warrants further investigation. Nonrandomized studies that utilize PROMs should consider time from injury in study design and data interpretation.
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Affiliation(s)
- Joseph T. Nguyen
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - David Wasserstein
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | - Robert G. Marx
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY
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Secrist ES, Frederick RW, Tjoumakaris FP, Stache SA, Hammoud S, Freedman KB. A Comparison of Operative and Nonoperative Treatment of Anterior Cruciate Ligament Injuries. JBJS Rev 2016; 4:01874474-201611000-00004. [DOI: 10.2106/jbjs.rvw.15.00115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Failla MJ, Arundale AJH, Logerstedt DS, Snyder-Mackler L. Controversies in knee rehabilitation: anterior cruciate ligament injury. Clin Sports Med 2015; 34:301-12. [PMID: 25818715 PMCID: PMC4379426 DOI: 10.1016/j.csm.2014.12.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Controversy in management of athletes exists after anterior cruciate ligament (ACL) injury and reconstruction. Consensus criteria for evaluating successful outcomes following ACL injury include no reinjury or recurrent giving way, no joint effusion, quadriceps strength symmetry, restored activity level and function, and returning to preinjury sports. Using these criteria, the success rates of current management strategies after ACL injury are reviewed and recommendations are provided for the counseling of athletes after ACL injury.
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Affiliation(s)
- Mathew J Failla
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA.
| | | | - David S Logerstedt
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE, USA; Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Wang JH, Hsu WL, Lee SC, Wang TG, Rolf C, Su SC, Shih TTF, Wang HK. Neuromechanical characteristics in the knees of patients who had primary conservative treatment for a torn cruciate ligament and reconstruction afterward. J Formos Med Assoc 2015; 114:1240-9. [PMID: 25624115 DOI: 10.1016/j.jfma.2014.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND/PURPOSE To compare the neuromechanical characteristics and subjective outcomes for knees of patients with a cruciate ligament tear and reconstruction with those for knees of controls at three time intervals, and to determine correlations between the characteristics and subjective outcomes. METHODS Ten participants with a cruciate ligament tear and at least a 12-week conservative treatment prior to ligament reconstruction were prospectively measured prior to and 3 months and 6 months after surgery. Ten healthy individuals were recruited as controls. Questionnaire surveys regarding the injured knee were conducted, as were bilateral measurements of root mean square electromyography (EMG), the rate of EMG rise, the median frequency in the vastus medialis of the quadriceps muscles and antagonist coactivation from the semitendinosus muscle, and force capacities, including peak torque, rate of force development, and total works of the knee extension. Correlations between the EMG variables (of the vastus medialis and semitendinosus) and the force capacities, and between the EMG variables and the knee injury and osteoarthritis outcome scores (KOOS), and between force capacities and the KOOS were assessed in the participants with a ligament reconstruction. RESULTS Pre- and postoperative results of EMG variable and force capacities were lower in both knees of the experimental group participants than in the control group participants (all p < 0.05). Correlations between EMG and force capacities, and between these parameters and the KOOS were found. CONCLUSION There were bilateral neuromechanical defects in the knees of the participants who had undergone conservative treatment as well as reconstruction after a cruciate ligament tear.
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Affiliation(s)
- Jyh-Horng Wang
- Department of Orthopedic Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Song-Ching Lee
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Tyng-Guey Wang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Christer Rolf
- Department of Orthopaedics, Clintec, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sheng-Chu Su
- Department of Business Administration, Hwa Hsia Institute of Technology, Taipei, Taiwan, ROC
| | - Tiffany T F Shih
- Department of Medical Image, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan, ROC.
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Self-reported knee function can identify athletes who fail return-to-activity criteria up to 1 year after anterior cruciate ligament reconstruction: a delaware-oslo ACL cohort study. J Orthop Sports Phys Ther 2014; 44:914-23. [PMID: 25347228 PMCID: PMC4285556 DOI: 10.2519/jospt.2014.4852] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cohort study, cross-sectional. OBJECTIVES To determine if self-reported knee function assessed with the International Knee Documentation Committee 2000 Subjective Knee Form (IKDC 2000) could discriminate between successful and nonsuccessful performance on return-to-activity criteria (RTAC) tests after anterior cruciate ligament (ACL) reconstruction. BACKGROUND Selecting appropriate performance-based and patient-reported tests that can detect side-to-side asymmetries, assess global knee function, and determine a participant's readiness to return to activity after ACL reconstruction can be a challenge for rehabilitation specialists. A simple tool or questionnaire to identify athletes with neuromuscular impairments or activity limitations could provide rehabilitation specialists with crucial data pertinent to their patients' current knee function and readiness to return to higher-level activities. METHODS One hundred ninety-four level I and level II athletes who underwent ACL reconstruction participated in the study. One hundred fifty-eight athletes at 6 months after ACL reconstruction and 141 of the athletes at 12 months after ACL reconstruction completed a battery of functional tests to determine readiness to return to activity and the IKDC 2000 to determine self-reported knee function. For each athlete, status on the RTAC test battery was dichotomized into "passed" or "failed," and status on the IKDC 2000 scores was dichotomized into "within" or "below" age- and sex-matched normal ranges. Comparisons were made between status on the RTAC test battery and the IKDC 2000 using chi-square tests. Accuracy statistics were also calculated. RESULTS Six months after ACL reconstruction, 112 athletes (70.9%) failed RTAC and 76 (48.1%) were classified as having self-reported knee function below normal ranges. Among the 76 participants with IKDC 2000 scores below normal ranges, 69 (90.8%) failed the RTAC test battery (P<.001). However, among the 82 participants whose IKDC 2000 scores were within normal limits at 6 months, only 39 (47.6%) passed the RTAC test battery (P = .74). Twelve months after ACL reconstruction, 67 athletes (47.5%) failed RTAC and 31 (22.0%) had knee function below normal ranges. Among the 31 participants with IKDC 2000 scores below normal ranges, 25 (80.6%) failed the RTAC test battery (P<.001). However, among the 110 participants whose IKDC 2000 scores were within normal limits at 12 months, only 68 (61.8%) passed the RTAC test battery (P = .017). CONCLUSION The IKDC 2000 may be a clinically relevant tool to determine the timeliness or necessity of RTAC testing. For scores obtained 6 and 12 months after ACL reconstruction, low IKDC 2000 scores were reasonably indicative of failure on the RTAC test battery, whereas normal IKDC 2000 scores were not predictive of passing scores on the RTAC test battery.
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Norouzi Fashkhami A, Rahimi A, Khademi Kalantari K. The Voluntary Response Index in Electromyographic Study During Landing Test of the Patients With ACL Deficiency: A New Study Protocol. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14119. [PMID: 25031855 PMCID: PMC4082515 DOI: 10.5812/ircmj.14119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 02/03/2014] [Accepted: 03/10/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Daily Increased rate of anterior cruciate ligament (ACL) injuries in athletes calls for more investigation in these patients to differentiate copers from noncoper ACL-deficient (ACLD) knees as soon as possible. OBJECTIVES The current study aims to introduce a new electromyographic protocol, named voluntary response index (VRI), that might help to categorize and differentiate patients with ACLD knee from others in the early stage. MATERIALS AND METHODS Thirty-four patients with ACLD knee were allocated into two equal groups, namely, coper and noncoper groups, based upon their ability to return to sport during the preceding six months. The patients with ACLD knee were asked to perform a jump on a force platform from a 75-cm distance. RESULTS The results were compared with 17 matched healthy participants. The electromyographic disposable electrodes were attached to the seven muscles of the lower extremity of the participants before performing the test. The outcome measures were the magnitude and similarity index of the VRI, time to stop, vertical ground reaction force, the displacement of the center of pressure's (COP) path line length, and the participants' Tegner, IKDC (International Knee Documentation Committee) as well as KOOS (Knee injury and Osteoarthritis Outcome Score) questionnaires scores. Using the appropriate statistical analysis, the electromyographic and force plate data were compared among the three groups. All efforts went into determining whether an association exists between the findings of each group and the participants' functional questionnaires scores. CONCLUSIONS The results of this study would be helpful in objectively differentiating the patients with ACLD knee into coper and noncoper groups to receive appropriate treatments before their return to the competitions.
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Affiliation(s)
- Amin Norouzi Fashkhami
- Physiotherapy Department, Shahid Behehshti University of Medical Sciences, Tehran, IR Iran
| | - Abbas Rahimi
- Physiotherapy Department, Shahid Behehshti University of Medical Sciences, Tehran, IR Iran
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Kinesiophobia after anterior cruciate ligament rupture and reconstruction: noncopers versus potential copers. J Orthop Sports Phys Ther 2013; 43:821-32. [PMID: 24175594 PMCID: PMC4915102 DOI: 10.2519/jospt.2013.4514] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Secondary-analysis, longitudinal cohort study. OBJECTIVES To compare kinesiophobia levels in noncopers and potential copers at time points spanning pre- and post-anterior cruciate ligament (ACL) reconstruction and to examine the association between changes in kinesiophobia levels and clinical measures. BACKGROUND After ACL injury, a screening examination may be used to classify patients as potential copers or noncopers based on dynamic knee stability. Quadriceps strength, single-leg hop performance, and self-reported knee function are worse in noncopers. High kinesiophobia levels after ACL reconstruction are associated with poorer self-reported knee function and lower return-to-sport rates. Kinesiophobia levels have not been examined before ACL reconstruction, across the transition from presurgery to postsurgery, or based on potential coper and noncoper classification. METHODS Quadriceps strength indexes, single-leg hop score indexes, self-reported knee function (Knee Outcome Survey activities of daily living subscale, global rating scale), and kinesiophobia (Tampa Scale of Kinesiophobia [TSK-11]) scores were compiled for potential copers (n = 50) and noncopers (n = 61) from 2 clinical trial databases. A repeated-measures analysis of variance was used to compare TSK-11 scores between groups and across 4 time points (before preoperative treatment, after preoperative treatment, 6 months post-ACL reconstruction, and 12 months post-ACL reconstruction). Correlations determined the association of kinesiophobia levels with other clinical measures. RESULTS Presurgery TSK-11 scores were significantly higher in noncopers than in potential copers. Postsurgery, no group differences existed. TSK-11 scores in both groups decreased across all time points; however, TSK-11 scores decreased more in noncopers in the interval between presurgery and postsurgery. In noncopers, the decreases in TSK-11 scores from presurgery to postsurgery and after surgery were related to improvements in the Knee Outcome Survey activities of daily living subscale, whereas the association was only present in potential copers after surgery. CONCLUSION Kinesiophobia levels were high in both noncopers and potential copers preoperatively. Restoration of mechanical knee stability with surgery might have contributed to decreased kinesiophobia levels in noncopers. Kinesiophobia is related to knee function after surgery, regardless of preoperative classification as a potential coper or noncoper.
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Beattie PF, Nelson RM, Basile K. Differences among health care settings in utilization and type of physical rehabilitation administered to patients receiving workers' compensation for musculoskeletal disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2013; 23:347-360. [PMID: 23328956 PMCID: PMC3734600 DOI: 10.1007/s10926-012-9412-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION There is a paucity of data describing the relationship between practice setting and the delivery of physical rehabilitation to injured workers. PURPOSE To determine differences in the number of visits, the number of treatment units, and the proportion of billing for physical agents over an episode of care between different practice settings' providing physical rehabilitation to patients receiving workers' compensation for a musculoskeletal problem. METHODS A large administrative database was evaluated retrospectively. Practice settings were classified as physician office, corporate physical therapy clinic, occupational medicine clinic, hospital-based outpatient clinic, or private physical therapy practice. RESULTS 70,306 subjects (72.7 % male; mean age = 44.6, SD = 11.8 years) were included in this study. Corporate physical therapy clinics had the highest mean values for total visits (13.1, SD = 12.7) and for total units (66.8, SD = 85.5), and the lowest mean values for proportion of physical agents during the episode of care (.22, SD = .18). Occupational medicine clinics had the lowest mean values for total visits (6.8, SD = 7.9) and for total units (30.4, SD = 36.5), and the highest mean value for proportion of physical agents during the episode of care (.41, SD = .22). When controlling for ICD-9-CM codes, body-part treated, surgical status, and geographical region there were small changes in effect size; however, the significance and directionality of differences between practice settings were not changed. CONCLUSIONS There were significant differences in billing for physical rehabilitation services between practice settings for patients receiving workers' compensation. Corporate physical therapy clinics billed for more total visits and total units over an episode of care than did other practice settings; however they also billed for a lower proportion of physical agents indicating a greater use of those interventions supported by evidence-based guidelines (exercise and manual therapy) compared to other practice settings.
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Affiliation(s)
- Paul F. Beattie
- Doctoral Program in Physical Therapy, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208 USA
| | - Roger M. Nelson
- Clinical Benchmarks, LLC, King of Prussia, PA 19406 USA
- Lebanon Valley College, Annville, PA 17003 USA
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Brown CA, McAdams TR, Harris AHS, Maffulli N, Safran MR. ACL reconstruction in patients aged 40 years and older: a systematic review and introduction of a new methodology score for ACL studies. Am J Sports Med 2013; 41:2181-90. [PMID: 23548805 DOI: 10.1177/0363546513481947] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of the anterior cruciate ligament (ACL)-deficient knee in older patients remains a core debate. PURPOSE To perform a systematic review of studies that assessed outcomes in patients aged 40 years and older treated with ACL reconstruction and to provide a new methodological scoring system that is directed at critical assessment of studies evaluating ACL surgical outcomes: the ACL Methodology Score (AMS). STUDY DESIGN Systematic review. METHODS A comprehensive literature search was performed from 1995 to 2012 using MEDLINE, EMBASE, and Scopus. Inclusion criteria for studies were primary ACL injury, patient age of 40 years and older, and mean follow-up of at least 21 months after reconstruction. Nineteen studies met the inclusion criteria from the 371 abstracts from MEDLINE and 880 abstracts from Scopus. Clinical outcomes (International Knee Documentation Committee [IKDC], Lysholm, and Tegner activity scores), joint stability measures (Lachman test, pivot-shift test, and instrumented knee arthrometer assessment), graft type, complications, and reported chondral or meniscal injury were evaluated in this review. A new methodology scoring system was developed to be specific at critically analyzing ACL outcome studies and used to examine each study design. RESULTS Nineteen studies describing 627 patients (632 knees; mean age, 49.0 years; range, 42.6-60.0 years) were included in the review. The mean time to surgery was 32.0 months (range, 2.9-88.0 months), with a mean follow-up of 40.2 months (range, 21.0-114.0 months). The IKDC, Lysholm, and Tegner scores and knee laxity assessment indicated favorable results in the studies that reported these outcomes. Patients did not demonstrate a significant difference between graft types and functional outcome scores or stability assessment. The mean AMS was 43.9 ± 7.2 (range, 33.5-57.5). The level of evidence rating did not positively correlate with the AMS, which suggests that the new AMS system may be able to detect errors in methodology or reporting that may not be taken into account by the classic level of evidence rating. CONCLUSION Patients aged 40 years and older with an ACL injury can have satisfactory outcomes after reconstruction. However, the quality of currently available data is still limited, such that further well-designed studies are needed to determine long-term efficacy and to better inform our patients with regard to expected outcomes.
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Affiliation(s)
- Christopher A Brown
- Finger Lakes Bone and Joint Center and Sports Medicine, 875 Pre Emption Road, Geneva, NY 14456, USA.
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O'Brien VH, Giveans MR. Effects of a dynamic stability approach in conservative intervention of the carpometacarpal joint of the thumb: a retrospective study. J Hand Ther 2013. [PMID: 23177671 DOI: 10.1016/j.jht.2012.10.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective cohort. INTRODUCTION Conservative intervention of carpometacarpal joint (CMC) thumb pain, caused by osteoarthritis and ligament laxity, is frequently seen in hand therapy. Traditional intervention for pain and disability reduction includes orthoses, exercises, and joint protection education. The literature on conservative management is unclear which design or program of exercises create an effective result. Results of a conservative dynamic stability interventional model for thumb pain are presented as a design which positively effects pain and disability. PURPOSE OF THE STUDY The purposes were to primarily investigate change in pain and disability in persons with CMC pain in a dynamic stability modeled approach to intervention, and secondarily, to assess the average number of visits and the duration of total visits in this model. METHODS A retrospective chart review was completed on 35 charts of those seen at a multicenter hand therapy clinic. The pain and disability scores from the QuickDASH were used as outcome measures. RESULTS The average group pain and disability scores improved by 17.9% (p < .01) and 19.3% (p < .01) respectively, with average individual disability improvement of 15.7%, which is greater than the accepted MCID. The average patient visits were 2.37 over an average range of 44.5 days. The group demographics match current literature: 31 females to 4 males, with average age of 58 years (range of 30-82 years). CONCLUSION Significant reduction in pain and disability is noted with a conservative dynamic stability modeled approach to intervention, with information on average visits and duration in this model of care for individuals with thumb pain at the CMC joint. LEVEL OF EVIDENCE 4.
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Di Stasi SL, Logerstedt D, Gardinier ES, Snyder-Mackler L. Gait patterns differ between ACL-reconstructed athletes who pass return-to-sport criteria and those who fail. Am J Sports Med 2013; 41:1310-8. [PMID: 23562809 PMCID: PMC3732407 DOI: 10.1177/0363546513482718] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The current standard of practice for an athlete to return to sport after anterior cruciate ligament (ACL) reconstruction is varied. Attempt to return to activity is typically advised 6 months after surgery, but functional performance deficits and gait abnormalities are often still evident and may have important implications on future function. HYPOTHESIS When comparing the involved and uninvolved limbs, patients who failed return-to-sport (RTS) criteria would demonstrate (1) smaller peak knee angles, extensor moments, and peak power absorption at the knee of the involved limb and (2) larger peak hip angles, extensor moments, and peak power generation of the involved limb. STUDY DESIGN Controlled laboratory study. METHODS A total of 42 patients completed functional and biomechanical gait assessment 6 months after ACL reconstruction. Functional testing involved an isometric quadriceps strength test, 4 single-legged hop tests, and 2 self-report questionnaires. Three-dimensional motion analysis was used to measure sagittal plane kinematics and kinetics of the hip and knee. A mixed-model analysis of variance and post hoc t tests were used to compare the limb symmetry of those who passed and those who did not pass RTS criteria. Minimal clinically important differences were calculated from healthy gait data and used to further define meaningful limb asymmetries. RESULTS Twenty of the 42 (48%) patients passed RTS criteria 6 months after ACL reconstruction. Patients who did not pass the criteria demonstrated statistically significant differences between limbs on all kinematic and kinetic variables at the knee (P ≤ .027). Clinically meaningful asymmetries at the hip were also identified in this group. Only kinetic asymmetries at the knee were identified in the patients who passed RTS criteria. CONCLUSION Athletes who demonstrate superior functional performance 6 months after ACL reconstruction may have fewer abnormal and asymmetrical gait behaviors than their poorer performing counterparts. Patients who did not pass RTS criteria not only demonstrated larger kinematic and kinetic asymmetries between limbs but also appeared to use a gait strategy more closely aligned with athletes early after ACL rupture. CLINICAL RELEVANCE Poor performance on a battery of functional performance measures may be related to the presence of movement asymmetries in athletes after ACL reconstruction. Objective RTS criteria have the potential to provide information to clinicians who determine when these athletes return to activity, and may aid in the prescription of targeted rehabilitation to address underlying movement asymmetry.
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Affiliation(s)
- Stephanie L. Di Stasi
- Sports Health & Performance Institute, The Ohio State University Sports Medicine, Columbus, Ohio.,Address correspondence to Stephanie L. Di Stasi, PT, PhD, OCS, The Ohio State University Sports Medicine, Sports Health & Performance Institute, 2050 Kenny Road, Suite 3100, Columbus, OH 43221 ()
| | - David Logerstedt
- Department of Physical Therapy, College of Health Sciences, Newark, Delaware.,Delaware Rehabilitation Institute, Newark, Delaware
| | - Emily S. Gardinier
- Delaware Rehabilitation Institute, Newark, Delaware.,Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, College of Health Sciences, Newark, Delaware.,Delaware Rehabilitation Institute, Newark, Delaware.,Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
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White K, Di Stasi SL, Smith AH, Snyder-Mackler L. Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial. BMC Musculoskelet Disord 2013; 14:108. [PMID: 23522373 PMCID: PMC3617067 DOI: 10.1186/1471-2474-14-108] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 03/13/2013] [Indexed: 02/05/2023] Open
Abstract
Background Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk. Methods/Design 80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures. Discussion The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR. Trial registration Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317
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Affiliation(s)
- Kathleen White
- University of Delaware, Biomechanics and Movement Science Program, Newark, DE, USA.
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Preoperative predictors for noncopers to pass return to sports criteria after ACL reconstruction. J Appl Biomech 2013; 28:366-73. [PMID: 22983930 DOI: 10.1123/jab.28.4.366] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Less than 50% of athletes pass criteria to return to sports (RTS) 6 months after ACL reconstruction (ACLR). Using data on 38 noncopers, we hypothesized that preoperative age, quadriceps strength index (QI), and knee flexion moments (KFM) during gait would predict the ability to pass/fail RTS criteria and that preoperative quadriceps strength gains would be predictive of passing RTS criteria. Gait analysis and strength data were collected before and after a preoperative intervention and 6 months after ACLR. Age, QI, and KFM each contributed to the predictability to pass or fail RTS criteria 6 months after ACLR. Collectively, the variables predict 69% who would pass and 82% who would fail RTS criteria 6 months after ACLR. Younger athletes who have symmetrical quadriceps strength and greater KFM were more likely to pass RTS criteria. Further, 63% of those who increased preoperative quadriceps strength passed RTS criteria, whereas 73% who did not failed. Increasing quadriceps strength in noncopers before ACLR seems warranted.
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Myer GD, Stroube BW, DiCesare CA, Brent JL, Ford KR, Heidt RS, Hewett TE. Augmented feedback supports skill transfer and reduces high-risk injury landing mechanics: a double-blind, randomized controlled laboratory study. Am J Sports Med 2013; 41:669-77. [PMID: 23371471 PMCID: PMC4166501 DOI: 10.1177/0363546512472977] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a current need to produce a simple, yet effective method for screening and targeting possible deficiencies related to increased anterior cruciate ligament (ACL) injury risk. HYPOTHESIS Frontal plane knee angle (FPKA) during a drop vertical jump will decrease upon implementing augmented feedback into a standardized sport training program. STUDY DESIGN Controlled laboratory study. METHODS Thirty-seven female participants (mean ± SD: age, 14.7 ± 1.5 years; height, 160.9 ± 6.8 cm; weight, 54.5 ± 7.2 kg) were trained over 8 weeks. During each session, each participant received standardized training consisting of strength training, plyometrics, and conditioning. They were also videotaped running on a treadmill at a standardized speed and performing a repeated tuck jump for 10 seconds. Study participants were randomized into 2 groups and received augmented feedback on either their jumping (AF) or sprinting (CTRL) form. Average (mean of 3 trials) and most extreme (trial with greatest knee abduction) FPKA were calculated from 2-dimensional video captured during performance of the drop vertical jump. RESULTS After testing, a main effect of time was noted, with the AF group reducing their FPKA average by 37.9% over the 3 trials while the CTRL group demonstrated a 26.7% reduction average across the 3 trials (P < .05). Conversely, in the most extreme drop vertical jump trial, a significant time-by-group interaction was noted (P < .05). The AF group reduced their most extreme FPKA by 6.9° (pretest, 18.4° ± 12.3°; posttest, 11.4° ± 10.1°) on their right leg and 6.5° (pretest, 16.3° ± 14.5°; posttest, 9.8° ± 10.7°) on their left leg, which represented a 37.7% and 40.1% reduction in FPKA, respectively. In the CTRL group, no similar changes were noted in the right (pretest, 16.9° ± 14.3°; posttest, 14.0° ± 12.3°) or left leg (pretest, 9.8° ± 11.1°; posttest, 7.2° ± 9.2°) after training. CONCLUSION Providing athletes with augmented feedback on deficits identified by the tuck jump assessment has a positive effect on their biomechanics during a different drop vertical jump task that is related to increased ACL injury risk. The ability of the augmented feedback to support the transfer of skills and injury risk factor reductions across different tasks provides exciting new evidence related to how neuromuscular training may ultimately cross over into retained biomechanics that reduce ACL injuries during sport. CLINICAL RELEVANCE The tuck jump assessment's ease of use makes it a timely and economically favorable method to support ACL prevention strategies in young girls.
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Affiliation(s)
- Gregory D Myer
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Hurd W, Axe M, Snyder-Mackler L. Management of the athlete with acute anterior cruciate ligament deficiency. Sports Health 2012; 1:39-46. [PMID: 23015853 PMCID: PMC3445111 DOI: 10.1177/1941738108326977] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Identification of highly active individuals early after acute anterior cruciate ligament deficiency who are good candidates for nonoperative management is a clinical challenge. The University of Delaware has developed and validated a treatment algorithm and screening examination to distinguish between nonoperative and surgical candidates. Study Design: Review. Evidence Acquisition: A description of the decision-making rules and rehabilitation protocol for highly active individuals with anterior cruciate ligament deficiency is provided. Results from clinical trials, outcome studies, and biomechanical investigations conducted using the treatment algorithm and screening examination are also reviewed. Results: Patients identified as nonoperative rehabilitation candidates using these clinical guidelines have a far greater success rate than what has been reported when patients self-select nonoperative management. Furthermore, nonoperative outcomes are improved when patients participate in a perturbation-enhanced rehabilitation protocol. Divergent lower extremity movement patterns are consistent with the different functional abilities of the dichotomous patient groups identified with the screening examination. Conclusion: Given the differential patient response to anterior cruciate ligament injury, implementation of the decision-making guidelines discussed in this review offers clinicians the opportunity to provide individualized patient care rather than continuing with a blanket surgical treatment strategy.
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Affiliation(s)
- Wendy Hurd
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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40
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Quadriceps activation failure after anterior cruciate ligament rupture is not mediated by knee joint effusion. J Orthop Sports Phys Ther 2012; 42:502-10. [PMID: 22523081 PMCID: PMC3597089 DOI: 10.2519/jospt.2012.3793] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Descriptive prospective cohort study. OBJECTIVES To investigate the relationships between knee joint effusion, quadriceps activation, and quadriceps strength. These relationships may help clinicians better identify impaired quadriceps activation. BACKGROUND After anterior cruciate ligament (ACL) injury, the involved quadriceps may demonstrate weakness. Experimental data have shown that quadriceps activation and strength may be directly mediated by intracapsular joint pressure created by saline injection. An inverse relationship between quadriceps activation and the amount of saline injected has been reported. This association has not been demonstrated for traumatic effusion. We hypothesized that traumatic joint effusion due to ACL rupture and postinjury quadriceps strength would correlate well with quadriceps activation, allowing clinicians to use effusion and strength measurement as a surrogate for electrophysiological assessment of quadriceps activation. METHODS Prospective data were collected on 188 patients within 100 days of ACL injury (average, 27 days) referred from a single surgeon. A complete clinical evaluation of the knee was performed, including ligamentous assessment and assessment of range of motion and effusion. Quadriceps function was electrophysiologically assessed using maximal volitional isometric contraction and burst superimposition techniques to quantify both strength and activation. RESULTS Effusion grade did not correlate with quadriceps central activation ratio (CAR) (zero effusion: mean ± SD CAR, 93.5% ± 5.8%; trace effusion: CAR, 93.8% ± 9.5%; 1+ effusion: CAR, 94.0% ± 7.5%; 2+/3+ effusion: CAR, 90.6% ± 11.1%). These values are lower than normative data from healthy subjects (CAR, 98% ± 3%). CONCLUSION Joint effusion after ACL injury does not directly mediate quadriceps activation failure seen after injury. Therefore, it should not be used as a clinical substitute for electrophysiological assessment of quadriceps activation. Patients presenting to physical therapy after ACL injury should be treated with high-intensity neuromuscular electrical stimulation to help normalize this activation.
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Di Stasi SL, Snyder-Mackler L. The effects of neuromuscular training on the gait patterns of ACL-deficient men and women. Clin Biomech (Bristol, Avon) 2012; 27:360-5. [PMID: 22061048 PMCID: PMC3288430 DOI: 10.1016/j.clinbiomech.2011.10.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 10/11/2011] [Accepted: 10/12/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior cruciate ligament rupture is the most common knee ligament injury sustained by active individuals, and the relative injury risk is sex-specific. Women not only demonstrate an increased risk for injury, but also a poorer response following ligament rupture. Perturbation training has shown positive results in healthy females, but gender-specific responses to training after injury have not been evaluated. The purpose of this investigation was to describe the effects of perturbation training on the gait characteristics of male and female non-copers. METHODS Biomechanical data were collected before and after training on 12 male and nine female non-copers using standard motion analysis techniques. Subjects walked at a consistent, self-selected speed over an embedded force plate. Data from both limbs were post-processed and analyzed using a mixed model analysis of variance and minimal clinically important differences to compare the limb behaviors of men and women. FINDINGS Prior to training, only women demonstrated significant hip joint excursion asymmetry (ES=1.03; P=0.009). Minimal clinically important difference values showed that the involved limb of the women had reduced hip and knee flexion angles and moments, truncated knee excursions, and increased hip excursions when compared to their own uninvolved limb and the limbs of the male non-copers. Following training, only knee extensor moment values exceeded the minimal clinically important differences in women. INTERPRETATION Female non-copers demonstrated unique movement strategies following injury and perturbation training. Women may be a meaningful subgroup of non-copers, and future investigations should consider the effects of gender in the outcomes of non-copers.
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Affiliation(s)
- Stephanie L. Di Stasi
- University of Delaware, Biomechanics and Movement Science Program, Newark, DE, USA
- The Ohio State University, Sports Health and Performance Institute, Columbus, OH, USA
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Return to preinjury sports participation following anterior cruciate ligament reconstruction: contributions of demographic, knee impairment, and self-report measures. J Orthop Sports Phys Ther 2012; 42:893-901. [PMID: 22951437 PMCID: PMC3680881 DOI: 10.2519/jospt.2012.4077] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional cohort. OBJECTIVES (1) To examine differences in clinical variables (demographics, knee impairments, and self-report measures) between those who return to preinjury level of sports participation and those who do not at 1 year following anterior cruciate ligament reconstruction, (2) to determine the factors most strongly associated with return-to-sport status in a multivariate model, and (3) to explore the discriminatory value of clinical variables associated with return to sport at 1 year postsurgery. BACKGROUND Demographic, physical impairment, and psychosocial factors individually prohibit return to preinjury levels of sports participation. However, it is unknown which combination of factors contributes to sports participation status. METHODS Ninety-four patients (60 men; mean age, 22.4 years) 1 year post-anterior cruciate ligament reconstruction were included. Clinical variables were collected and included demographics, knee impairment measures, and self-report questionnaire responses. Patients were divided into "yes return to sports" or "no return to sports" groups based on their answer to the question, "Have you returned to the same level of sports as before your injury?" Group differences in demographics, knee impairments, and self-report questionnaire responses were analyzed. Discriminant function analysis determined the strongest predictors of group classification. Receiver-operating-characteristic curves determined the discriminatory accuracy of the identified clinical variables. RESULTS Fifty-two of 94 patients (55%) reported yes return to sports. Patients reporting return to preinjury levels of sports participation were more likely to have had less knee joint effusion, fewer episodes of knee instability, lower knee pain intensity, higher quadriceps peak torque-body weight ratio, higher score on the International Knee Documentation Committee Subjective Knee Evaluation Form, and lower levels of kinesiophobia. Knee joint effusion, episodes of knee instability, and score on the International Knee Documentation Committee Subjective Knee Evaluation Form were identified as the factors most strongly associated with self-reported return-to-sport status. The highest positive likelihood ratio for the yes-return-to-sports group classification (14.54) was achieved when patients met all of the following criteria: no knee effusion, no episodes of instability, and International Knee Documentation Committee Subjective Knee Evaluation Form score greater than 93. CONCLUSION In multivariate analysis, the factors most strongly associated with return-to-sport status included only self-reported knee function, episodes of knee instability, and knee joint effusion.
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Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther 2012; 42:601-14. [PMID: 22402434 PMCID: PMC3576892 DOI: 10.2519/jospt.2012.3871] [Citation(s) in RCA: 327] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED The management of patients after anterior cruciate ligament reconstruction should be evidence based. Since our original published guidelines in 1996, successful outcomes have been consistently achieved with the rehabilitation principles of early weight bearing, using a combination of weight-bearing and non-weight-bearing exercise focused on quadriceps and lower extremity strength, and meeting specific objective requirements for return to activity. As rehabilitative evidence and surgical technology and procedures have progressed, the original guidelines should be revisited to ensure that the most up-to-date evidence is guiding rehabilitative care. Emerging evidence on rehabilitative interventions and advancements in concomitant surgeries, including those addressing chondral and meniscal injuries, continues to grow and greatly affect the rehabilitative care of patients with anterior cruciate ligament reconstruction. The aim of this article is to update previously published rehabilitation guidelines, using the most recent research to reflect the most current evidence for management of patients after anterior cruciate ligament reconstruction. The focus will be on current concepts in rehabilitation interventions and modifications needed for concomitant surgery and pathology. LEVEL OF EVIDENCE Therapy, level 5.
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Identifying individuals with an anterior cruciate ligament-deficient knee as copers and noncopers: a narrative literature review. J Orthop Sports Phys Ther 2011; 41:758-66. [PMID: 21979555 DOI: 10.2519/jospt.2011.3384] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Narrative literature review. OBJECTIVES First, to explore the differences and outcomes between individuals who have had anterior cruciate ligament (ACL) reconstruction and those who did not undergo surgical intervention, following a tear of the ACL. Second, to review the evidence related to the ability to identify individuals who may or may not need surgery after an ACL rupture. Finally, to describe the differences between copers and noncopers. BACKGROUND ACL rupture may result in increased tibiofemoral laxity and impaired neuromuscular function, which ultimately may lead to knee instability and dysfunction. Individuals who opt to choose surgery due to these changes may be defined as "noncopers." Conversely, those individuals who have an ACL-deficient knee without functional impairment and instability and successfully resume preinjury activity levels without surgical intervention may be defined as "copers." METHODS An electronic search was conducted up to April 2011, using medical subject headings and free-text words. The subject-specific search was based on the terms "anterior cruciate ligament reconstruction versus conservative treatment," "copers," "noncopers." RESULTS A similar percentage of copers and noncopers return to sporting activity. Three papers used an algorithm and screening examination involving individuals with ACL injuries. Evidence suggests that, as opposed to copers, noncopers have deficits in quadriceps strength, vastus lateralis atrophy, quadriceps activation deficits, altered knee movement patterns, reduced knee flexion moment, and greater quadriceps/hamstring cocontraction. CONCLUSION ACL screening examination showed preliminary evidence for detecting potential copers. Objective differences exist between copers and noncopers. Individuals with ACL injury should be informed of the possibility of good knee function following a nonoperative rehabilitation program.
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Albright JC, Crepeau AE. Functional Bracing and Return to Play After Anterior Cruciate Ligament Reconstruction in the Pediatric and Adolescent Patient. Clin Sports Med 2011; 30:811-5. [DOI: 10.1016/j.csm.2011.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roewer BD, Di Stasi SL, Snyder-Mackler L. Quadriceps strength and weight acceptance strategies continue to improve two years after anterior cruciate ligament reconstruction. J Biomech 2011; 44:1948-53. [PMID: 21592482 PMCID: PMC3124616 DOI: 10.1016/j.jbiomech.2011.04.037] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 04/26/2011] [Accepted: 04/27/2011] [Indexed: 02/02/2023]
Abstract
The anterior cruciate ligament (ACL) is the most commonly-injured knee ligament during sporting activities. After injury, most individuals experience episodes of the knee giving way during daily activities (non-copers). Non-copers demonstrate asymmetrical quadriceps strength and movement patterns, which could have long-term deleterious effects on the integrity of the knee joint. The purpose of this study was to determine if non-copers resolve their strength and movement asymmetries within two years after surgery. 26 Non-copers were recruited to undergo pre-operative quadriceps strength testing and 3-dimensional gait analysis. Subjects underwent surgery to reconstruct the ligament followed by physical therapy focused on restoring normal range of motion, quadriceps strength, and function. Subjects returned for quadriceps strength testing and gait analysis six months and two years after surgery. Acutely after injury, quadriceps strength was asymmetric between limbs, but resolved six months after surgery. Asymmetric knee angles, knee moments, and knee and hip power profiles were also observed acutely after injury and persisted six months after surgery despite subjects achieving symmetrical quadriceps strength. Two years after surgery, quadriceps strength in the involved limb continued to improve and most kinematic and kinetic asymmetries resolved. These findings suggest that adequate quadriceps strength does not immediately resolve gait asymmetries in non-copers. They also suggest that non-copers have the capacity to improve their quadriceps strength and gait symmetry long after ACL reconstruction.
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Affiliation(s)
- Ben D Roewer
- University of Delaware Department of Physical Therapy, 301 McKinly Lab, Newark, DE 19716, USA.
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Time line for noncopers to pass return-to-sports criteria after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2010; 40:141-54. [PMID: 20195019 PMCID: PMC3613129 DOI: 10.2519/jospt.2010.3168] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized clinical trial. OBJECTIVES Determine effective interventions for improving readiness to return to sports postoperatively in patients with complete, unilateral, anterior cruciate ligament (ACL) rupture who do not compensate well after the injury (noncopers). Specifically, we compared the effects of 2 preoperative interventions on quadriceps strength and functional outcomes. BACKGROUND The percentage of athletes who return to sports after ACL reconstruction varies considerably, possibly due to differential responses after acute ACL rupture and different management. Prognostic data for noncopers following ACL reconstruction is absent in the literature. METHODS Forty noncopers were randomly assigned to receive either progressive quadriceps strength-training exercises (STR group) or perturbation training in conjunction with strength-training exercises (PERT group) for 10 preoperative rehabilitation sessions. Postoperative rehabilitation was similar between groups. Data on quadriceps strength indices [(involved limb/uninvolved limb force) x 100], 4 hop score indices, and 2 self-report questionnaires were collected preoperatively and 3, 6, and 12 months postoperatively. Mann-Whitney U tests were used to compare functional differences between the groups. Chi-square tests were used to compare frequencies of passing functional criteria and reasons for differences in performance between groups postoperatively. RESULTS Functional outcomes were not different between groups, except a greater number of patients in the PERT group achieved global rating scores (current knee function expressed as a percentage of overall knee function prior to injury) necessary to pass return-to-sports criteria 6 and 12 months after surgery. Mean scores for each functional outcome met return-to-sports criteria 6 and 12 months postoperatively. Frequency counts of individual data, however, indicated that 5% of noncopers passed RTS criteria at 3, 48% at 6, and 78% at 12 months after surgery. CONCLUSION Functional outcomes suggest that a subgroup of noncopers require additional supervised rehabilitation to pass stringent criteria to return to sports. LEVEL OF EVIDENCE Therapy, level 2b.Note: If watching the first video, we recommend downloading and referring to the accompanying PowerPoint slides for any text that is not readable.
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Current controversies in rehabilitation after anterior cruciate ligament reconstruction. Sports Med Arthrosc Rev 2010; 18:43-7. [PMID: 20160630 DOI: 10.1097/jsa.0b013e3181cdb5d3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Rehabilitation concepts after anterior cruciate ligament (ACL) reconstruction continue to advance rapidly. A review of the recent literature reveals numerous aspects of the rehabilitation program, the subject of investigation, and validation. Areas discussed in this article include the efficacy of functional bracing after ACL reconstruction and perturbation training programs in nonoperative, preoperative and postoperative rehabilitation programs. Also discussed is the need for criteria-based progression through the late stages (return to sports) of the ACL reconstruction rehabilitation.
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